God, Medicine and Suffering - Ray Barfield at Tulane University

Welcome to the Veritas Forum
engaging university students and faculty in discussions about life's hardest
questions and the relevance of Jesus Christ to all of life
I really appreciate your having me here
um, and, the thing that
dipping them most looking forward to
on tonight is actually the conversation
more than more than anything else
but accessory several conversations since i've been in here and
halverson really fascinating questions and look forward to that problem
allotted for eight hundred talk about tonight
comes out of my own experience as a pediatric oncologist
and i spent most of my career
working on
um...
it can yanking out here
a camera i guess that a lot uh... modulated everywhere
moses electorate in armenian their re-used for
neuroblastoma
which is a childhood cancer
and
combining the immune their p's um... in the form of anybody's with cellular
therapies
because i was a very meritorious but it was a strand at saint jude children's
church house that are for years
in that context
we had
quite a few patients
forty percent
sometimes fifty percent depending on the category of patient
has a role model of the things that i realize this how little i understood
about
suffering
and about
dime
despite the fact that i had an enormous number of patients to her facing that
so lot of what i'm gonna try to get out tonight has nothing to do with me being
any particular expert there may be something wrong with them microphone
because i'm not
stood still just a little bit
project i did
um...
but a lot of what i'm gonna try to talk about tonight by doesn't come out of any
particular expertise
becomes out of on experience
and so aren't quite open to learning from
your
your own
thoughts and opinions as we go a long hard so we'll see where it was sort of
got her first thing
on the i've noticed
is that
we had some real challenges in this country around madison
and i'm going to going to talk about dr
suffering and medicine
we ought to take straight on and some of the problems that we have
medicine
in this country
medium observations that are completely not based on the expertise whatsoever
when the first things that we hear allot about
and uh... political arena now headed to the very heart of any of the debates
because of how important personal responsibility is to the upcoming
presidential debate
is remembered
expenditures per capita
that we pretend to medicare
if you take this and projected house further
past where we're at right now
there's no
prediction end of this curve
really
bending
if you compare
medicare
with medicaid
which targets the poor
and children
and with social security which is our other
stating that
that we've chosen as a society to put into place
you see that
be done
says as the jury refuse we s
stays
relatively
so that looks pretty doable
and medicaid
with a few tweaks seems to have a slow growth occur
that is also
relatively sustainable
but if you look at the red
at medicare you see that it's like this
and it just keeps growing
one question is why
this is
and the question is how did we get into a place
we are spending
so much money
we had no idea how-to modulate
invests
and one of the questions the becomes very uncomfortable for many of us
who women's medicine
devoted to helping the suffering and helping vehicle
and helping those who are facing dying
when the uncomfortable questions when someone looks at us insists it was their
ever
beloved how much money important
into medicine
if i had to be a difficult questions when they're hoping in conversation we
start to get out because
their questions not only
of justice
that arrives in this
but also questions around the dignity of life
and what it is that we value
as a society
and what specifically sense
i'm coming out of us
are very specifically
christian tradition
whether or not this tradition has anything to say about it
so how did we get here
mandible little bit of a history
but this guy's name francis bacon
because i find him fascinating an incredibly important to my work as a
position
so francis bacon
was essentially the inventor of the scientific method method
and he was a little books that you are going on among others of where he talked
about the scientific method
for the most important things that princess picking date in relationship to
medicine
is to say
we need to stop them
talking about medicine overcoming us
and start talking about
taking the scientific method
and learning how to gain mastery over nature
and applying this mastery over nature
to the well being
of human beings
there was this democratic nation
but venerable very long history
presentation called being over master
by your disease
and one of the hardest that
physicians would bring to the bedside
is to help people understand
when their disease was at a point where
they simply were not going to recover
and this is tremendously important
because knowing that i'm not going to recover knowing that i'm gonna die
princeton university reckoning and doing whatever the work is that i need to be
there
for my diet
and in francis bacon style there were a number of books out there around this
topic called the ours maury and a which is the art sometime
very intentional
very deliberate attempt to understand how we approach
the end of our life and what sorts of things we should be doing at the end of
our life
befriends as they can would have none of this
he said the idea of being
boomer mastered buyers ease means you simply have not learned to apply the
scientific method adequately
to gain power program ager
so that you can stop dying
from this disease and stop being never mastered by it
one of the things that this lead to
is tremendous growth
and our ability to control
infractions for example
to develop he would there be four cancers and you all sorts of things that
seem to truly help people
differences they did was in a different place than we are today
he lives against her religious background was himself a very religious
man
and when she could give a clear articulation appoint a proper human in
is
and when human flourishing properly looks like
and he was convinced
that in all cases the application
the application of the scientific method to gaining mastery over nature
would lead to benefit for human beings
we don't necessarily share
that sort of
social cohesiveness
in our understanding of what constitutes a human head
where web property when flourishing is
and those sorts of things that he did work against a different kind of
background
as it got better and better at this i mean you can follow the history of
medicine
it became more and more convenient as technologies dr
work development and became more advance
to pull the technologies into single locations into hospitals for the six
would come to the hospitals and all these things would be available
over time assessing the early part of the twentieth century with the
production of this thing called the flux in a report
the education of medical students against the scientific background became
much more standardize
and the idea that you go to the hospital
are we ready all
go to the hospital when u product from our sins or could be treated by
scientifically grounded positions became the standard
more and more dire we've got away from
a traditional sort of relationship with families where
this is a very little to offer
but they would go into the house
it gets into the family
be understood their situation
and they were able to be present with people
says it got better and better with technology
all sorts of things began to change
so for example our physical exam
became increasingly needed
by instruments assess the server
by things that we program measuring
in the late eighteen hundreds they began to develop graphic instruments
civic accord
paul's record
pondimin cannibals sort of way the reduction of breathing in the search
dennis
in eighteen ninety seven
began to apply
this new technology
with x_-rays to being able to look at internal organs to be able to look at
new mountaineers without ever touching the patients
began extraneous either
in the early nineteen hundreds
began to develop electrocardiograms so that we could measure
the electrical activity of the heart
again in early nineteen hundred's clinical laboratories began to grow up
they started to flourish
he didn't even need to have the patient there you can have a sample of the blood
of our pieces they're tissue
and you could say the bad and the microscope where you could grow whatever
the micro was that was making them second come to an understanding
of their disease
as you withdrew
nineteen hundred's we began especially in the nineteen fifties increasingly to
think of randomized controlled trials
as the standard for advancing medical science
and the idea here was too
menendez me variables as possible
so that we can come to conclusions that would be generalized ball
any human person who share
human biology
but when you get to the individual level
business fear is that
how we get sick
any physician
can tell you about
and it's one that causes a great deal of distress
uh... for many families
and it's one that caused a great deal of frustration
when we begin to realize that the medical system that we've come to
so much hope into
can't
make us better
if you look at this for
this is a way that i see a lot of my patients die
and this happens in many different contacts that could happen cystic
fibrosis if it happened
uh... congestive heart failure can happen with cancer and happened with
many different kinds of
chronic potentially life on the illnesses
with official go along
and all have a crisis
from their prices their health status
and we were action
we begin to intervene
real talk a little cover
they don't quite recovered to the same level that they were rack
when they first walked into the house
and they go along
and they have another crisis
the russians the hospital
and we intervene
they were covered
but again not quite to the level that they were out before
this happens repeatedly
and overtime as it happens
it against you
develop increasing symptoms
an increasing burden of suffering
certainly increasing financial burden
and a lot of other sorts of things that can impact the quality of her life
so what's really happening here has the question that i have
with each of these crises
we grab ahold of that and we help them to get back to you
whatever
eyes close the baseline as possible
towards the end of a person's life
you begin to sense from them
that they're feeling desperate
because often they're feeling sicker and sicker gets harder and harder to get
them back to any kind of quality of life it seems meaningful to them
and yet to be read part
too
not
intervene
the big issue here of course
chakravarty anticipated
is dying
murdoch
you gotta be kidding
you don
and then be dead
it's very powerful
siad barre scary
and this is a threshold of many people have not
fought about
so much time right
and even as there is this
become more frequent
and become deeper
and you don't recovered to the same level
it's not an easy thing
simply to begin to think about
you're in debt
and how you want a manager approached about
sanofi reports from woody allen
i don't know cheetah mortality through my work
or achieve immortality did not die
for many people this threshold is simply the most terrifying thing at all human
comprehension
precisely because it defies
comprehension
it's interesting to me is that in the past
begins religious background
there is very often a kind of terror of death
there was a terror at don
with not without realizing that death was a project
there was a deep sense think which the work of confession
and ever penzance and of reconciliation
with the work that urgently needed to be done before dark
and one of the serious things and magical
is to simply slip into death
in the middle of the night
these days for our contemporary imagination
which is very
text-align individual productivity individual self
when it is that i compost in the world
one of the biggest fears that we associate with death
is the possibility
of oblivion
now one question that often comes up
in my mind as i think about how people are going to have
navigate these waters
is
where diverse scene
there many people who've never seen a person back
i mentioned many people in this room
have never seen somebody dot
usually very common
we sat dot com
feasting many deaths in the community children
very frequently
times that i've spent in africa in places where we don't have the resources
that we have in this country
death is very common
i've seen
very commonly
the death of children the death of part people from
uh... diseases that in this country would be easily curable and the rural
parts of all salvador or the person to america for example but here
we don't see that very often
we may not see a dead body and we do see that usually made out to look a lot
the places that we do see death
are and video games
com hired vividly remember being obliterated into a cloud of pixel dust
when i was playing pac man as a kid
no one came mario who also gets the dime
there is a
game called modern warfare to that i've laid eyes on that has incredibly
realistic
forms of debt you can choose how to die
ladies checkpoint you're back alive again
that's a really interesting condos
on what is the diet
response so far
every show
he does
there is actually a season
where apparently they got bored with have died
and they actually allowed into the eyes
and able to houston
leaves today
who has a different kind of frailty
then they brought came back
frankly a fascinating little rock
he had whether this is where he had
began six years
and they were feeding them
and there was a lot of media hype of the top of the time
and that the search sherry right before actually the day before i think i could
be mistaken for the day before a jury sharper dot
and this is an incredible
uh... sort of national
crisis in thinking about your shot her and you know with their comedy they got
out and and way dissolving but uh...
as i was walking through the uh...
airport
i was watching from television to television to television as i went from
being treated before defiance b_-sixteen and all of them whitney houston courses
on there
replaces it being carried out to the death of our celebrities
where we are shocked
that they got
and certainly michael jackson age fifty leaders have died from praful
triggered enormous intrigue around the world
there and kind of death
is needed
through the years
through television
comedy
the directing counter with death row
is something that we rarely actually
and it's one of the reasons but it seems to me as a physician
that we need a lot more thought about this and that's why i was personally
very
on the search
in the middle of carter for
wind there was paid bipartisan
placed into health care reform
that was considered relatively non-controversial
and the provision this um...
the provisional out
remuneration
to physicians
to send time sitting down with patients and families
talking about options
when it looked like a patient was beginning to get sicker
from their disease and perhaps moving in to see through there
dot compared to seize
and
everyone about this is a great idea
who's turned ensue
on the rhetoric of death
and once it turned into the rhetoric of death panels there was killed
and there was no way to get it back there
and the one attempt to get it back and
uh... much later wind uh... healthcare college station is being revisited
de panels came up again as a political ploy
and it was again
and so we already his doctors have enough trouble talking about death
because we're scared to talk about it we don't know how to talk about it
um... it's very painful to learn how to talk about it
but do not have
uh... yet to have this opportunity
where we come close to having legislative support for that and that
haven't taken away and the rhetoric of death and sold me a great deal
how we approach death in this country it's one of the things i hope they were
able to bring up in the course of conversation
withdrew all of this
through this discussion of a kind of advancing bacon the in medicine
the sequestering of medicine in hospitals
are denial of death in this country and our great challenges that we have with
approaching the top of death
are repeated interventions as we get sixty product on this one of the
questions that come up to me
bob that relates to the
got part of this spring
is the question what's happened to the patient stories
for me
one of the places where patients get tangled and technology
is when decisions are made without regard for any other part of their story
where their life
or their view of the world
what matters to them
in my life for example
as i think about my vulnerability
on one of the reasons that i'm here tonight
varchar swarm is that i do
frame
my experience of my body
my experiences my mortality in terms of my faith
as a christian
but i also
have to tell you that for a good part of my career
when i had a patient who relapse after bone marrow transplant which generally
means that you're gonna die
the first thing that i would do before i would walk in the rain and talked with
them about the relapse and about time
is to go onto the computer and download every eligible ste clinical protocol
that bombay might be able to roll on
so that after i have
delivered the news i didn't want to deliver which is that your cancer is
back and you're probably going to die
i could hold up three protocols and say it back
we've got some things that we can do i can sign you up on these protocols we
can get this done starting this afternoon i'm charts and maps
despite the fact
but i need
that there was no way
this medicine
who's got a cure
and that it was very likely in fact it was not going to have any effect at all
because many of the protocols that would end up down waiting for someone at that
stage of disease
to be phase one protocols
which are not asking questions about your
foresees response as their primary question asking the question of toxicity
how much of this medicine cannot put into a person before the side effects
are so an acceptable but we can't go anymore and and immediately destroy
before that methodists we start when we go into the clinical trial
the people don't understand that about basement trials and yet
covering the trials in to have something to protect me from the pain of the
conversation
and so on that out
but that an experimental transplant on alley
time by the way this is with her mother submission
guided experimental transplant on alley
for reports done
which was area my research
she had
at the time of this picture
compasses take and i believe two days before she realized she had struggled
with neuroblastoma for eight years
so at the point that i began to take care of her
this is truly the last thing that we had to offer and it was
fairly radical solution based on one case report from japan and several years
before
it's originally transplants
and over the course of six months nearly every day i would walk up to her
and gets a network
and get to know her family she's beautiful brilliant holy re-used sassy
twelve year old girl
now watch the dot for six months
there was one of the most painful experiences i've ever had in my life
comment made me wonder whether or not
are was made for this job
i thought i was gonna be great
i thought this was the perfect job for me
actually began to question it
but as i worked my way through this one of the things i began to realize that
was causing the most difficult
difficulty
is that always so focus
on medicine
as part of this is a commune project
on medicine
as worried to primarily but not exclusively for secure
without questions
that's
all i can think about was the biology of what was going on without you can
respond to that biology
and that's what i did
for six months until she's just a bit came up to date came up to date came up
to date came up
because she talking
his first of all this is your life
some like you have
sitting on a trial run
and that is the kind of decisions you make
matters that decisions that you make in the hospital in relationships illness
reformer ability
for your time
actually makes sense in relationship to the rest of your story however that
story a shapes
but one of the things that is certain
is that life is full
uncertainty
a modern struck
that are modern age is
enormous campaign
against risks
and uncertainty
when i walk through
their borders
but i'm not putting at
tv shows
about whitney houston
i'm listening to instructions they're being
told me overhead about
not picking up someone else's back and not doing this with strangers not doing
that for a long time when i would walk through they would talk about security
level being at level are injured exists this constant sense of
of fluctuating the president
four this security
that we seem to think we walked in the future
whether it's security from disease of security from terrorists are security
from poverty
but when you get sick
your story is much more
uh... than your that this is about much more than your illness
and i don't know anyone who truly experiences illness and biological terms
even though in the hospital the language that were missed number with its
language of biology
i've never met anyone who fully experiences illness in terms of
biology
the experience it
in terms of
relationships in terms of lost
in terms of fear in terms of what happens to me when i die
and because of that it seems to me and i know we've got to have a lot of pre med
students in here because to me was just no
for being preet soul
one of the things that sort of come to you as a position is that we can truly
understand the meaning of how someone decides these important things in on the
suffering of dying
if we don't know anything else about their full story and so
i want to ask just quickly a question what is the story
because it's a fair question
so it's a story
where we start with
a story about the titanic
here the parts of the story
now i've got this from brian macdonald and this is really helped me a great
deal
this is how this is how do you tell a story
uh... the part of the story this first
once upon a time
once upon a time
is getting give you the background again stretch
david said
our fall out the rest of the story
uh... matter it's going to be the background to help you understand the
meaning of events that come about seven
resume once upon a time once upon a time
was a ship called the titanic
it was one of the most technologically advanced ships in the history of
shipbuilding
paris set to go on for age
and it's a great deal of celebration
and music
and journalism coverage
second harvest
and every day
this is going to begin to tell you the pattern that's going to be broken
by the next artist
figures and every day
the people on the ship
eight wonderful food
they play games
they wondered at the stars and start
they wondered at their wonderful show
and one cup also allow
but they are part of the story is the i wanna
until one day
ship ran into
and iceberg
and began to take on water
and because of this
was one of our laws in the era
and because of this
people began to plan
strategies for speaking the ship
safely
began calling out for help
and should continue just to check
and because of this
people became more scared
people became are packed
an hour to
young people who had fallen in love
helped each other
trying to save each others lives
until finally
they ended up
ship heading south
floating on a piece of wood there was only large enough for one
and so she climbed up on the way
and he
but his legs and body hang off the word
pauling talked
until finally he confirms
and he died
and he floated away
and ever since that day
she's kept this in your mind
this memory
streets your wife
there's a part of the story
so you're so i think about it as a doctor
once upon a time
once upon a time of the fifteen year old girl
living with her mother
a sister
intent animals on a farm
and every day she fed the animals
she loves to sing in the choir
she played the piano and scribbled notes for a book she wanted to write
but what makes different animals have been
and she looked at your arriving at her desk
and our beloved room where they're stuffed animals
hiccups
until one day
she began to have bruises
spinner doctor center to the city medical center for tests
petra dot shepard kenya
stand because of this she started dumping the derby
but the leukemia was slow to clear
and because of this
she says from linking that there be to another
the hospital
and because of this
she stopped feeding the animals
she couldn't sing in the choir
shed new piano in the hospital and began to lose and music
and she found a harder to write she's retired
i'm afraid
until finally
became clear that her leukemia was not likely to be cure
and need to build decisions need to be made
so one of the questions that begins to come up in this situation
is what his well being with life
per child
in a position like this
weather problems is that the goal of medicine and of itself can't be the
well-being of the child
the scientific judgment that medicine actually has access
the source of
what constitutes well-being
what constitutes the decision what constitutes value
is rather
the story of the child's life
and what's ironic about medical treatment especially as we did have been
recovered have been recovered debris recovered its occurrence occurrence of
her
is that the nears unity of a person's life
can be program
by medicine
by all the procedures that are gone
and make it harder and harder
for that person to have any sense of what they want to do
and what they ought to do the relationship to their own story
while we procedures for the dying process
and in my experience is often a place for deep questions of faith arrives
this is often the question off in the place where
we begin to ask important questions
about
our experience and wider the larger story
that relates to
and one of them interesting things is that
for most of my patients the decisions to begin chemotherapy
where the decisions to switch chemotherapy for the decisions to have
radiation or the decisions to have surgery or someone or some other sort of
church of intervention
is always playing towards future life
but when we get to a place where someone's not going to be cured
we're no longer talking in terms of of
there hope to be cured so that their life to be part of the ones that we're
talking about and in their lives
and it seems to me that if there's anyplace
where the christian marisa
has impact
it's in your hoping someone
on to understand the way in which their story
even to directors approaching
fits into larger narrative that guy is in control of
and uh... this is the thing that shapes
the part of the story
figure is and ever since that day
to remember she gets until finally it looks like a routine has not been beat
you are
what's the ever since that data look like
seems to me that matters a great deal
what we think this is part of the stories that look like
now one-way
to think about it
is uh...
to think about the ways in which you are going to be remembered
in the minds of people
have not yet dot
and there is a great deal of death
to that kind of sense of
ongoing presence in the minds of others
but there's another way think about it
it seems to me
if we're truly going to talk about
the relevance of christianity
to how experienced on this and suffering and death
and that is to understand
the reality of god's presence in these experiences
adequate for you from this morning in korea tender
who uh... whizzing
outlets and then was an ratings broke concentration camp with her sister betsy
and her sister betsy actually died and she said is there's not a pittance
indeed the god's love is not be purcell
it seems to me in a game here i'm speaking very much as a christian
and that's important to know
progress can be a part of our conversation after this
receipts needed when the threshold is death
that really matters what death actually is
here's a quote from saint paul
you know our our major is wasting away
are any jews being renewed day by day
for this site
injury affliction is preparing us for an eternal weight of glory
beyond all measure
because we look not at what can be seen but what cannot be seen
for what can be seen is temporary
or cannot be seen as a child
interest and a mother and trees are very intertwined
it's a big difference to know that god is good
verses actually knowing the businesses dot as a living reality
this is something that can become
profoundly imported
at the end of life
we were thinking about
how we want to
negotiate paradigm
now and a little bit when we begin the conversation
one of the things that are used in the race
is a recent paper in the journal of the american medical association
which
has some surprising results and light of the way that christianity articulates
the end of life and how we should approach the end of life
but one last quote that i wanna leave you with from saint paul
contacting despite powerful
has to do with the relevance of
the resurrection
for how we view
and what
his exit pollsters
i'm convinced that neither death
your life
angels
the rulers
for the stress and produces com
nor powers nor height
everything else in all creation will be able to separate us from the love of god
in christ jesus our lord
the sex is something that is a very powerful articulation a power christians
at least
think about the end of life
and think about the power of god
in the face of something as frightening as that
but only had one more day that i'd take away from the christian tradition
when i think about the way in which experience nonetheless and i'm grateful
that because unless some run over by a bus from not playing falls out some of
active duty
at some point doctors and walk into the room to read
we'll fix this
and faces
i frequently hear parents
worry over
detention
between their genuine hope
in god
as a sovereign god
and they're genuine
senses here
and isolation
and anger
abusing their child
it seems to me
that's
the story of jesus is life death
and resurrection
has given us
incredible freedom
to all those things intention
w
what i mean by that
we jesus was approaching the end of his life
in the garden of destiny
he great
please let this cup pass from
don't just happen
he criticized the time
father please
but this cup pass
contrary to their time
please let this cup pass
use it in a way
and he was mailed to approx
on the cross
jesus said two things
that's
harrod's in my own experience become nearly traded matter
for the kinds of
tensions
parents
and family members who are losing someone who love have to hold together
one of the things he said from the process this is the judge would be the
next day
so he said today he will be with me in paris
the statement of really adorable
coming from the lips of jesus
but the same gives us
on the same crops
later on cried out my god my god
widely perceived
there seems to me that a tradition
bacon will too
price
and hold those together today you'll be with me in paradise and my god my god
might be for safely
position he said
that offers some very fruitful in size
for those of us who are going to suffer
and that are suffering even as we hold
are going to laments
the loss ever faced
the last thing i want to throughout their
as somebody who will be dead
along with all of you off because everyone in this room is older than ours
and she died
so guarantees are off
but the less you can do but believe it or life
more need to do about its for athletes that
this is a lesson that we can carry with us each and every day
as we live our lives faithfully in response to gov as well
for his leadership dot
and there may be times when instead of
understanding dot recently phil alone
and for sega
that's part of the journey
the david here told
we can't fix their senior year and i has not been bass first data star thinking
about the fact
that we got
approaching death well
and approaching it faithfully
actually is a process that we do
in the course of living
because the tumor choose
that will hold use that
when you come to the end of your life
our patience
and courage
and those are two things better develop from living life
in a certain way
attending to spread
attending to it's doubtful
but also attending to the fact that it does stopped
and with that i'll stop also and we can get our conversation
cities
sykes
and
duties
don't you
it's
hopeful
you does
mystery
uh... back
phase
decision again
easily resolved these games
that's it
use
it's
so when i think that it's a great question
and i'll tell you categorically
that's when i walked into the room
with a family who'd is about to face things like this
the only question that i begin with is who's in front of me
what's their starting point
where they act
and wherever they wrapped that's where i began
i don't preach
i don't proselytize
i don't converts
i don't do any of that
arm
hyatt lives and
for what their worldview is
and that's where i began
because this is their story
i have no idea what direction
this is going to go for them in terms of their story
and it would be on utterly presumptuous of me
to take over their story and to begin narrating at with my story
and my view of what the world s
and i take that to be
bb re
nearly absolute
category of approach
and so what i consider as long as i'm going to be using the language of story
rather than merely the language biologists biology and we all know how
to talk about that
but when it comes to stories the stories i'm interested in is the story that
their work
and it requires time
because frequently patients will know they look at when this is uh... there's
across in my ring and there's a lot of times when patients will have will know
me because i'd treat patients for years sometimes if you could you comment and
you are
a you have um...
ko acute lymphoblastic leukemia for example
if you're a girl you're going to be with me being treated for two and a half
years if you're a boy who treat you for three years
and after that i'm gonna follow you
aren't role
we fall into two years out until you're eighteen whichever is longer so we're
going to know each other a long time and it's likely that my patients are going
to something about my background
what i'm interested in is where you starting with your story enrolling in
there
that fair
and if you want to see please feel free to but that's how i bridget
compliments s
tags at yahoo has filed a common does committee wants the job sarah
that yours the f_b_i_ let's share
members
disease it
uh... just
story
islas
dot
lend explore
beyond susan dot here's a couple of
responses to that central courage
um...
i think a there's there's two kinds of
on there's there's two kinds of ways that i would think about christopher
strength
is probably more obvious than the other way com many of the day
uh... decisions that have to be made
whether their decisions in the direction of treatment for the decisions in the
direction of say what i value is this and i no longer want
and now walking past a lot to be kind of intervention
knowing
that i'm walking into my house
once and for all to dr
that seems to me
when kind of courage
that is
acreage to ask the question
fits my life as i've lived it so far and then to do it
instead of just being swept along by technological responses to changes in
the house
uh... which can also have
the second kind of way that i think the courage manifests is and asking
questions about the truth of things
because phyllis and suffering and the potential for a dime
is in veritable cauldron
for testing for lindsey
approaches to choose
things that will not be the distance but also for finding improving wet really
will go the distance
and it seems to me that something's crumble
in the cauldron and other things become stronger and certainly been the case in
my own life com as ivp in fact onto periods of
sustained it not
in the middle of my hands up
and the courage
part is this
that
we need never be afraid of the truth of things
no matter what the truth things is
in the course of our
exploration
of what's true
when we discover to things that conform to our hopes
we should be willing to rejoice
and when we discover chew things
the conforms our
fears
we embrace them
but that requires courage
answers the second way in which i feel like in the middle of illness
and in the middle of suffering in the middle of dying it's very easy to say oh
you're off the hook you have to worry about all these normal human beings
library over trooper morality or anything like that now
in the cauldron
that may be one of the places where you discover things that you would have
never discovered elsewhere
but some of the navy destroyer
and if they feel like truth
right thing to do is to be courageous embrace and even if they're pregnant
and so that the second way in which i think courage
options out
as far as patients carers
um...
one of the most important parts about about patients is that our bodies are
slow to respond
and so most of the process is in our bodies are not on off switches
they're slow to
challenging difficult
fein's
at my hospital
d'amato is at duke
there's hope
and usually it's you know
not hope for someone who's going to have a compassionate presence while you die
it's hoped that
well you couldn't journey that hospital someone did it or maybe i'll get your
hair
in the middle of that in this
things don't move quickly and it can become frustrating and scary
and i think that uh...
you know kind of patients
towards our body
is is uh...
is limited by a lot of other ways that
other people could could mention
votes
here
seventies
i see a lot of profanity
burger
solutions
dr space
stingy
doctors
now
yours so
jury sits beside eyes
choice
on-screen
jeans patients
did support
juror in translation
position you know his
justice
response
yours
just joined us
i think actually cases
very very often
uh... i mean this is like a real a regular thing that i counter
and begin
i don't try to convince them to do anything
because
i don't view my role
as arm
persuading them to a certain
view of what's valuable
but what i do is two things
no rain
but well need three things actually number one is to acknowledge what's at
stake
how scary this is a why this is such a challenge why this is a difficult to
back she bring that into the room
because that's something that
that you know
older kids teenagers and parents have younger kids
well hold in the background sometimes
the second thing that i do
is to make sure
that in the course of talking about medical decisions
we'd talk about
the larger things which is what you value
which you want your life to look like and that sort of thing you know so we
make sure that we bring those things to be tabled
the third thing that i do that
is to uncovered the costs
art that they may not think about that are associated with these interventions
and sometimes
uh...
this can be incredibly helpful and you can actually draw crime studies uh...
i'll give you an example
uh... many of the studies that have been i mentioned that i've put patients on a
phase one studies
and in phase one stays you generally have to be present at the hospital
you have to be present to get uh... multiple blood draws for pharmacokinetic
studies
you while will not have
dr
uh... trial lawyers subsequent
uh... corollary medical things that happened covered by insurance because
they very often won't cover
experimental therapy since it was going to be uh... financial cost
medicines themselves can have side effects
that can impact the quality of your life
and in can certainly see if you look at a meta-analysis of
phase one trials
what you find is that mom
seven percent
tumors will have some response to phase one trial
but by response any in the tumor may go from here
to hear
it's not a cure
doesn't necessarily prolong your life
and so it's very important to understand you know what it is that you're signing
up for
and what the costs are
and the reason that i have been value questions first
is that the fact that someone who says you know what i really care about kids
uh... like this girl
being on my farm
being around my animals being at my desk so that i could work on my book
being with my pillows and i stuffed animals
that is where i
feel safe in if i'm not there i'm stuck in the hospital and miserable i hate my
day i feel alone and i get woken up all night with vital signs from these
well-meaning nurses
i don't like it
and so if there's something it comes out of the value discussion
it seems incredibly important
then i make sure that lease
that the costs
in terms of trunking that value is also brought to the table
but it's not for the night to persuading them
it through the night to making sure that we may make a decision they make a
decision that's actually in light of the truth is that
so that's where i try to act as a server
not so much a persuader but somebody who's been here thousands hides
i've seen a thousand patients do this
we tell you what it looks like in the new decide if that's really bad
that's not what i do
leaky
right here
adhesion king
access speaker har with
sochti
s
seeing acts
uh... elite he honest
uh... and
pc
times and
stop negativity
foster monthly
power
casting dot
worries back
casket
work
too and savor
so
one thing
is that they're they're definitely places in my life arrest and mute
in front of suffering
and just cry
how else to do
uh...
it seems to me
that before
also some sort of satire
and uh... i think about my
ever since that day
but as far as i know
right now
i'm still had me
and every day
just with a lot
i live my life there in relationship to my death i think about my death every
day
on deliberately so
sometimes
vocalists
to the irritation wildlife
my kids
who really get tired of me going on and off
the scene so important to me
and every morning
when i wake up
lesson time and prayer
i spend time
deliberately
in a process of cracked it
gratefulness
for life
and for a while
as my days go by
right now i'm in the pain
accuser before and they said no no no that i could have easily dot from if i
waited one more week together doctor
uh...
that informs the way
they're accurate eyes my values
one of the things i'm quite certain of
is this
that's
i've got a bag
of days
everyday region
crap alloted a
have to spend it
i can give you the hand and say hey look at you know that days on the line
akin to the bank
and save it
have to spend it
an interesting thing about this thing is that
once i said it
go off
i've traded it for something
and the other weird thing is that i don't know how many of the
things i've got my back
that's the trick
and so when i'd trade my days
uh... i wanna make sure that entry here for something
that's worth one of my he recover bowl days not knowing how many more these
things i have in the back
it's on a daily basis even though the and ever since that day
is something that occurs at the end of my life
mile and a m might negotiation of value
and of love
and of relationship is dying
in these kinds of terms an arm
and so that's the image that i would use to say you know how
how i live at
uh... you know it's your question get if i didn't understand it
and any
ox dot he's for
com suffering
hia
that's for me along with
yeah
because because it's an extremely important question and i'll say i don't
bygones on
i mean i bob
there are a lot of it
books
this is the odyssey
how is it that a guy
that we were shot of love
and soft
as creator
can show up in the middle of suffering
not to do something about it
i'm a doctor
suffer that
all right
no i have great answers
and a lot of my experience
we've got it
is not something where
it's predicated
on the first getting the answers right to make sure that this relationships and
work out
in maine
going with the relationship
too much more like falling in love
and there's a lot of stuff that i don't understand
but there are a lot of things that i experience
in the course of growing
in my relationship with god
that leave me
unable to resort to
explanations that satisfied
not ready time
on p_r_i_ c
and i know
the great arguments
i know they are really smart people like album plan to go
who writes
incredibly
persuasive argument
they don't satisfy any in the middle
of suffering
because what a child dies the only thing is really going to satisfy me as for the
child not to dot
i want the kid back
and so rather then
having explanation
of god in the middle of suffering usually what i do
is to take a hold of
talk to us
by the solace
of lament
and i just limit the loss
and do it in the middle of
uh... and i just told the contradiction to go what feels like a strain confusion
can and that's the only way that i i i approach a i'd be happy to send you a
list of books that i think
are incredibly deadly
email me yeah 'cause there's a lot of them
barros somehow and again i'm just speaking out of my experience today
would wear that now
bright arm
are provide an explanation that
any parent has ever found satisfactory
as they struggle to cancer
that they don't abandon gone
for the most part
uh... they find a deep abiding comfort
in the middle of confusion it is
starch
uses
there that
spoilt
out
uh...
to broker a relic from
i mean it broke
i could not
believe in god
and
it was not because i didn't want to believe in god
but like i said what i was interested in is the truth of things
by and not interested in comfort
i don't want comfortable police
two weeks
and interested in what is true
but the universe
and in the middle of that
particular experience
i was in so much pain
are still to this day don't entirely understand the dynamic
output went on in there
but one of the things that was fascinating to me
is that
i knew enough
to continue my search
i knew enough to remain open
to the truth
but i also knew enough to know
that's uh...
it would be
if i were too
uh...
continue to grow
with god and i would describe myself at that point has eight frightened agnostic
because it's a disorienting to me to find myself i'm able to believe
uh... it was an assertion there is no god it is pride and pain and i find
myself unable to believe
they continue to go to church of the civilian and we do the eucharist every
sunday
and uh... i continue to take the eucharist and and i had a frightening
experience com
as i would pray
and i would take the eucharist i thought the far left
wallace
in that stage of worship
and then i would walk back
and i'll feel at the same began
and this went on for some time
now
i never waivered
from wanting to know the truth of things
and again like
like uh...
the question about
courage
uh... that that was that was where i was
i want true believes
they were my true believes match my host all rejoice
and where true believes match my fears i'll try to find the courage
to embrace that
and so i was interested in truth
the process of need movin
from that experience
to kind of healing
to a deeper understanding of what my work is as a physician
and to a deeper understanding
uh... god's relationship to us in the middle of suffering not in terms of
propositions are explanations but in terms of
presents
is something that we take a long time to talk about and and
uh... it's very important to me but it was a great deal of time to talk about
but there was a process
um...
that was
one of the most important things that's ever happened in my life
value this is the last thing they are saying
uh... there are many ways in which to god that i ceased to believe that
is a guy that i still don't believe
because they were aspects of god
that i was hanging on to
that were interrupting
my ability
too
uh... pursue truth
and they needed to go away
and citizens in which
it felt like he he is
but what it actually was would actually turned out to be
is for growth
in my understanding
of god
and so
the
fearless
best up believing and
uh... was an image that probably needed to be i'm down anyway
say that i could learn more about that
now
as i encounter things like that i no longer experiences in that way it was
just say disorienting i did in the house to describe it and i wanted to say two
things about what my experience was
credit
is
well it's not from what i said to me
and one of the main reasons in fact it's it's one of my it's one of the most
meaningful
things that i do i'd look
forward
to having the privilege of being present
when people are struggling through this
two very different experienced and then when i use
and part of it is the car is that things that need be broken
that were broken
over this girl and her friend emma grace
once they were broken
put me in a position to grow into a new approach to being present
one of the things that i learned
is that
part of my
trauma
and part of the reason that i have waited talking about death for sale on
despite the fact that forty to fifty percent of my patients were back
is dead
highways brought up in our culture
where
the tools that we had our says all
were the language of professionalism
the language i've seen it bioethics about time even absence justice not much
sense
and
uh...
the notion of elders
maintaining a proper distance so that we don't
and it turns out to be able to rubbish
the only way to do it
is to learn what it is learn what love is
and to learn how to be president
and i'm sure you
that there's a way to the loving the president
without resorting to the language of distance or boundaries of
professionalism or
stand about effects
and
in my experience it's deeply rooted
in love
course tomorrow
my view on love i mean this is this is part of my
this is part of my prayer
it actively
becomes prayer
before i walk into a room
where i'm gonna do that
because that's one of the things that i do now
this dissension myself
interpret
there's a very different kind of experience in one of these days are
better at articulating i just absorb
bummbly tonight i can get it out
by tom
here and i A
actually
don't mind
teaching professionalism and those sorts of things
because the teacher motion on morons from hurting people
but the problem is that it's just not enough
it does it for me it didn't get the distance that he was doing the
had played a role
dr point
um...
but there's something much deeper than i think is well worth exploring
but i think that this deep breathing that we explored does require you know a
lot of contacts outside out
biological
language that we use this doctor's and way that were trained out there
there's something missing train
x s
well searched its
it's its
he is
splits
wins
it's
space
eyes or
bounces
well here
first of all
newton fiber dot pretty important
noon five that what he was doing
is actually uncovering
um...
interesting
truth seems
about god's creation
and so knew it was a thorough going pius
darlin
whereas a reluctant
um...
agnostic
and in the last
of his writings
um...
you know he express
real reservations
about
whether or not to write such a stark contrast between
what his theory implied
and what he had come to understand about the possibility
unsigned
really
annoyed when people called him in eighty s
uh... he said i do not want to be called an atheist i am not canadians
now when he began to describe what he was
it sounds very much
a kind of
a kind of a risk the chilean
as a none of those three seem to me simply
to fall
you know categorically indicando on the side of a lot of scientists and
therefore i don't believe dot
there is anything you need
about
science
is that as far as i can see
there a lot of things that are developing that are pushing in the
direction
of
potentially finding
a divine creator
a more satisfying account of what shows up
then
the accidental emergence of the universe from nothing
soon fundamental things changed in the middle of the last century
when it became clear
from bell laboratories
detection
background cosmic radiation
that's
contrary
to what we had thought for a long time
universally getting
mustachioed
mightily resisted
in the scientific community
as having potentially religious over time
and so
uh... it seems to me that there are many ways in which uh... you know we could
spend
hours talking about
uh...
different aspects of science backed by no means
uh... brington and the possibility of got
buck coming out on
three things in and they are starting this person's massive it's incredibly
important
so the first thing
is dead problem
it seems
beary
reasonable
to ask the question what kind of thing just science inquire into and what kind
of methodist science shoes
science
inquires into
the reality
physical work
what a test that's what it's studies that does a incredibly well
and as it were has more and more about the nature of the physical world
miller's more and more about ways in which to impact the physical world to
alter it to begin to use that
for technology is the reason i'm here tonight because for a new lease
principal works
the airplane stayed up
if you say
i'm going to do
fine
the only with german knowledge as knowledge that's accessible
this particular technique
and then you use that technique
and you don't find and knowledge different from what that technique is
capable
explorer
anything else that there is no knowledge besides the knowledge that can be gain
hideki access by your technique
your logic has gone terribly wrong
book icici began offer your eye
to say that only this category of
is getting counters knowledge
then opry or i
you excluded something that in principle is not accessible
too you are married of investigation
if it turned out for example
that the motive investigation that's most likely to help you stumble upon
god's prayer
and you're not paying
interest apprised of your fine dot
i'm not saying that that's the case of just using that as sort of a simple
logical example
the last thing that i would say that over islam most of us who spent a lot of
time
in scientific disciplines and for me it's mostly biological disposable really
interested in physics
on
have to listen to experts and other
barriers of science and taken seriously
but when i look at biological sciences for example
it seems to me
that for someone to say well given evolutionary absolutely camps believe in
god
is the sonics share
given that
looking at the same evolutionary data
francis crick
is making its
stephen jay gould
this after a few straight years
but it's also the case that working at the data evolutionary biologists
simon conway morris
who is one of the top three evolutionary biologists in the world
who teaches paleontology a cambridge university
and who did absolutely groundbreaking work on the came the an explosion
is an orthodox christian
since new someone look at that
physics
married stierheim
who's making ads
who's ass well what was there before the big bang
in his answer is in theory
then you look at someone like
john bowman
who did astonishing work
inquired physics
nineteen seventies
who taught mathematical
physics at the university of bridge who's the president of queens college
cambridge
his name congrates
it seems to me that
paying attention to com
people like that
people like john lenox
oxford mathematician
who's a christian
should at least
you shouldn't be convinced that there are also i think i'm remorseful
best-selling tells us in the world we are in a situation serve tertiary
message you know of course not
not at all
the reason i point to these people is because these are top scientists
who do not see a contradiction between their astonishing science and their fate
with that shit is not the convention but at least to introduce a kind of humility
into the discussion
rather than a sort of a political arrogance
about the relationship of science
so that would be the only thing that i would introduce with with those folks
but uh... redone
and you may find yourself in even deeper waters because uh... they are amazing
thinkers
chapters
art
slackers
it's workers
seems like
aligns
him
spirits
years
our house
yes
armies
uh... long
well i think that that's very good question
i'll tell you i think we need to start
i think that that the church has been
largely absent
for most of the conversations about health care reform
and i think health care reform to be an issue not only about the body
and about stewardship of the body
and about the relationship of our own illness suffering and dying
to the life death and resurrection of jesus
but i think this also to be an issue of things like distributive justice
and the church needs to get its act together
as i would say the place to start
is within communities of faith actually raising the issue and talking about it
and making this an active being you know that's addressed an inside the church
that's really where i would start
uh...
uh... because i think the into our communities of faith
begin to have a more robust response
this can be very difficult to know
and then but i don't mean to like controlling the politics that's not what
i mean i mean just being the church and knowing places
that we think about these things
uh... because many people in the church act
axiom on side effect is business jenna study
that shows that this is the last thing to say
it shows that uh... if you look at
the request for intensive care at the end of life
and you ask
religious people
nonreligious people
who would you guess
embraces the most high-tech intervention at the end of life
is the religious people
there on saturday
so i think that there is
arnelle walked
out a next time i come into our
backing to church needs to get on the spec without okay
i put a government
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