2016-06-30
I am a physician, not an expert in theology or philosophy. I do, however, consider myself an expert in one thing: stress. Like many of my colleagues, I am a connoisseur of stress: if it came in thirty-one flavors, I would have tasted every one. A recent poll listed medical internship as one of the top five most stressful jobs in the United States. On the first day of internship, the only people more nervous than the new interns at a research hospital are the patients who know that they are being cared for by green recruits. My first night on call I was awakened by a page from an anxious nurse who said, "Come quick. Mr. Jones's heart rate is in the 200s and I can't find his pulse." I sped off toward the unit, simultaneously flipping through the little book that tells me what to do in emergencies, my heart rate rivaling that of Mr. Jones, and tripped. I made the final leg of my journey on my stomach as if "sliding into home plate". I glanced at the EKG then gave my first order as a physician. "Let's get ready to shock him." Much to my relief, my resident calmly walked in and shepherded me through the resuscitation. That was the beginning of a love-hate relationship with my pager. On busy days it would go off 40 to 50 times, calling me to emergencies or asking for sleeping pills or enemas. Eating, sleeping and other functions became subject to its dictates. My life ran on my pager and caffeine, plus the adrenaline rush brought on by the fear making a mistake. Within a few months, the interns' idealism began to give into a kind of cynicism reflected in the slang of the hospital subculture. Very sick patients not likely to leave the hospital soon became "rocks." One might ask an intern on the geriatrics service," How big is your rock garden?" Getting a new patient from the E.R. was called "taking a hit." "Torture" analogies dominated. "I really got flogged with pages last night..." Or, "I was hit hard."
The emotional, physical and existential stress of telling a young mother she was full of cancer and making literally fatal errors took its toll on us. The changes in personality produced by this stress were described as "becoming toxic." We learned to overlook our colleagues' depression and irritability as "toxicity." Each of us faced the same questions, "Why am I doing this? What is the meaning of my patient's suffering? What is the value of my work?" There was no time to think about the answers. Products of a contemplatively challenged society with few spiritual roots, most of us kept working and kept going, hoping that the angst would pass with time. My workplace was desperately in need of a soul. For me, that need was met by the teaching of St. Josemaria Escriva, the Spanish priest who founded Opus Dei. Father Escriva emphasized the possibility of contemplation in the midst of a frenetic work life. This message helped me to transform my work from an experience of sheer stress into a place where I can encounter God. I had first encountered serious contemplation during my junior year abroad in India. I sat on a Himalayan peak in Northern India, surrounded by Tibetan prayer flags, thin bits of cloth whipping in the wind, as if echoing the prayers of pilgrims before me who had climbed the mountain in search of peace and spiritual help. I added my brightly colored flags to the faded and tattered ones. I felt very far from home, and from my spiritual upbringing. Baptized Catholic, I had fallen away, despite the example of a very devout mother and a Catholic education. I was turned off by what I considered to be the "corruption of organized religion" and the materialism of my society.
In India, I felt I had escaped the "world" with all its negative influence. I had moments of light and inspiration. Once, in Dharamsala, where the Dalai Lama lives in exile, I noticed bells would ring at odd times. I asked an elderly Tibetan woman what the bells were for, and she laughed: "They are to remind you that it is now." At the time I did not grasp her meaning. (Only later, much later, through the words of St. Josemaria, did I come to understand.) As soon as I returned from India, my Buddhist veneer wore off. Fighting with my brothers and full of complaints, I was longing for my mountain. I had no way of integrating my "spirituality" with the reality of each day. About that time my mother introduced me to some women in Opus Dei. I was immediately fascinated by their ideal of being contemplatives in the middle of the world. I was moved by their love for and intimacy with God, who was a person to them, someone loving and understanding. These women were busy professionals, but somehow they had a depth and peace that helped them absorb the bumps in the road that threw me off kilter. Through my friends in Opus Dei and the life and teaching of St. Josemaria, I came to a deeper understanding of the truths of the Catholic faith. I began to pray and came back to the Sacraments. I no longer needed a mountain retreat to feel close to God. I had discovered Him in the center of my soul. The quest to live with constant knowledge of God's presence and providence was the authentic existence I had been searching for. So much of my life had been spent trying to be in control. I unrealistically worried about "saving" all of my patients, never making mistakes, or always "looking good." I realize how little I listened to people, how worries about work and the people I loved crowded my consciousness.

I began to understand the transforming power of the sense of being a child of God. God was no longer an impersonal spectator or harsh critic, but a loving parent intimately involved in the happenings of each moment. St. Josemaria described this awareness of being a beloved child of God as divine filiation. It is the wellspring from which his whole spiritual life flowed.

This power is illustrated by a vignette I read many years ago. It occurred during the terrible earthquake in Armenia. A grade school had been leveled, and large number of children were buried and presumed dead. No heavy machinery was available to help remove the rubble. Long after the other parents had given up from exhaustion, one man doggedly continued digging until finally he heard the voice of his child. The little boy was saying was saying, "Daddy, I knew you would come. I knew you would come." He just kept repeating that. It took hours to extricate the child, and later relief workers marveled at that child's apparent lack of post-traumatic stress disorder, which many people can have after a horrible experience like that. For the child, the experience had only confirmed the love of his father for him. I remembered this story in the days following Sept. 11, as I saw the toll that event had taken on my patients, who have cancer, and on their families. A young child is buried alive, but survives unscathed, while thousands of people are shaken to their core - because of an event they witnessed on television. At its roots, anxiety is a fear of loss, a fear of rejection, a fear of meaninglessness. It comes from living without a sense of the providence of God, or from losing it. St. Josemaria often repeated and meditated on the words "Omnia in bonum": All things work together for the good of those who love God. "Don't say, "That person bothers me," he used to say. "Think, 'That person sanctifies me.'" This point of view gives my work a sense of meaning. It has even helped me to be on better terms with my beeper. Instead of swearing every time it goes off, I have learned over time to think, "God is calling me."
In Christian terms, as I carry out my work for God, I am participating in his plans to make the world, and myself, better. I see the value of the mundane and the monotonous. I have contemplative moments throughout my day. When I write prescriptions, I picture the face of the patient I am helping. When sit down to do dictations, I offer that hour as a prayer for the patients whose stories I am telling. When I visit a dying patient, I take their hand and comfort them in some way. I become Veronica, wiping the face of Christ. As St. Josemaria would say, the ordinary happenings of my working day can "sanctify" me. I become less centered on myself and more on God and others. I battle the things that separate me from God and lead me to toxicity. E-mail is an ever-present temptation, addiction and vortex. I realized it had become a source of anxiety that interrupts my work. So I only check it twice a day. What a conquest!

This is a true story that happened in a prison in mainland China. A political prisoner in solitary confinement had only one little window. Every day a man came to sweep the courtyard outside, the same man every day. The way that man did his job saved the life of the man in confinement, saved his sanity. The man didn't do just a cursory job. He swept beautifully; if he missed a spot he went back and got it. He allowed the man in solitary confinement to think, "There has to be a meaning in what I am going through, and I can make it to the end." This was a man without any specific faith. After they were both released from the prison, the man who had been in solitary confinement found out that the other man was a Catholic bishop who had been in prison for, I think, more than 20 years. Every day, while he swept, he was offering his work to God.

Christianity is not an inoculation against our weaknesses, or unexpected contradictions, friction with others or fatigue. Christ himself embraced the difficulties of being human. I have a lot of devotion to the stressed Jesus, the tired Jesus, the anxious Jesus. Jesus' public life was a lot like internship and residency. He was up all night and had no time to sleep or eat; he went from one sick person to the next. Jesus showed his infinite wisdom by choosing to come to earth in the pre-beeper era, but people managed to find him even when he tried to hide. Jesus even got "toxic" to show us his humanity. There is a beautiful scene where he is with the apostles, and they are trying to cure someone, and they are just not making it--they can't cut it. There is a big scene, and they pull him in and ask, "Why can't we cure this man?" And the first thing Jesus does is to look up to heaven and say, "O faithless and unbelieving generation. How long must I put up with you?" That has given me a lot of consolation, and a lot of devotion to the humanity of Christ, who chose to experience the frustration that we all experience every day. How did he do it? Christ drew his strength from his rich inner life, nourished by prayer. He saw things with a supernatural vision and was spurred on by his mission, to redeem humanity out of love. He saw every moment with the perspective of eternity. Through my friends in Opus Dei, I discovered the joy and the adventure of developing an inner life. I began to dedicate time to prayer and draw strength from the sacraments. My desk became my altar, the place I can sacrifice myself for others, the place I can encounter God. On a good day, I accept the double bookings, emergency calls at 5 p.m. on Friday, patients who arrive an hour late, and hours of disability forms as coming from God's hands; on my bad days, my job is "flog" and I can get quite "toxic." Every day I start again.
My work gives me the opportunity to reach out to others by example more than words. As most of my patients have cancer, there are many opportunities to affirm their dignity and speak with them about their spiritual concerns. I'm sure you are familiar with the old adage that there are no atheists in foxholes. I can tell you that there are very few atheists among those who are struggling with cancer. As a devout Catholic in an agnostic academic environment, I try to open the minds of my colleagues to the concept of a loving God and the possibility of an inner life. Through my profession as an oncologist and teacher I try to help foster respect for the elderly and the dying. I sometimes find it hard to swim against the tide and have to ask for more courage.

I'm eternally grateful to St. Josemaria for helping me to realize that I didn't need to go to the top of a mountain in order to find God, and that I could find Him in the center of my soul. I would like to end with these words of his: "My children, heaven and earth seem to merge on the horizon. But where they really meet is in your heart."

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