Dr. Tod Worner
January 9, 2020
I just want to say thank you to Dianne and to all of you for being so welcoming and warm, to have me be a part of Curatio to speak. You know, the intermarriage of our Catholic faith and then the calling to be healers is something that we just can’t separate, and so the sensibility of our Catholicism should really inform our daily work, and this organization is doing its best to try to defend that in the most winsome, loving and faithful way. And so I just want to say thank you for that, and I want to thank you all for coming out here tonight.
Literally this talk is not all these pages, just so you know, but I did prepare some remarks. Curatio, as I’ve come to appreciate it, answers a vital Catholic calling. It’s that of being an apostolate of Catholic health care professionals striving to bring the light of Christ to a physically and emotionally suffering world. And why would I say that this apostolate is vital? It’s because in a world of efficiency and utility, of technique and scientism, we health care professionals are at risk for forgetting who we are. It’s interesting that all of the very scientifically-based, evidence-based approaches to both educating people but also to practice have become so technical that it seems that people are being praised more and more for being less and less human and more and more like a computer. The fact of the matter is, part of the virtue of who we are as practitioners is the very sense that we can think logically, but also we can maintain our humanity, and so we need to be defensive of that humanity.
Health care has become a sprawling business. Clinicians often have too much to do and too little time. Patients are spread between so many care providers at so many locations, and reduced to their component parts we have a specialist for each organ . Patients are often adrift between clinicians that fail to know them in total. And because clinicians are overwhelmed with information and patient needs, they begin to burn out. Not only does medicine cease to be a calling, it becomes a grind. That’s no way to heal, and that’s no way for us to be healers.
So how does one stay human in an increasingly unhealthy, even inhuman profession? Well, first you must start by being quiet. So Dianne alluded to this, but earlier today I was giving two separate hour-and-a-half talks to fourth year medical students at the U, on a lecture I created called “Medicine and Literature.” So we talked about Dostoevsky, Shakespeare, Jane Austen, Robert Frost and so on, and so one of the poems is a poem I joke about, which I love. It is Robert Frost’s “Stopping by Woods on a Snowy Evening.” Now, I don’t know how many of you had to memorize poems when you were in elementary school, but I will say I was in fourth grade and Mrs. Duffy, with her big shock of gray hair and her bright red lipstick, and her limp from polio – that’s how old I am; she actually years ago had polio – asked all 30 of the kids in her fourth grade class to memorize Robert Frost’s “Stopping by Woods on a Snowy Evening” and stand next to their desk and recite it in front of the whole class, and you stand by yourself, say it, and the next kid would do it, all the way through 30 different kids. And so for weeks I had sweat rolling down the back of my neck and I was fidgety – how and why am I going to do this? – and then came the time to recite it, and I think I still remember it. Let me try it. It’s only 16 lines, okay, so understand it’s not an epic; this is a poem.
Stopping by Woods on a Snowy Evening
by Robert Frost
Whose woods these are I think I know.
His house is in the village though;
He will not see me stopping here
To watch his woods fill up with snow.
My little horse must think it queer
To stop without a farmhouse near
Between the woods and frozen lake
The darkest evening of the year.
He gives his harness bells a shake
To ask if there is some mistake.
The only other sound’s the sweep
Of easy wind and downy flake.
The woods are lovely, dark and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.
The point of bringing that up to you guys and also bringing it up to the students that I’m talking about today is when you’re in fourth grade this is an adult poem about a guy who’s just riding with his horse, stops, and then starts riding again. But when you’re in the practice of medicine and you’re on a call in a particularly arduous night and you have three people yet to see, and all four pagers are going off and you’re waiting for the specialists to call you back, and it’s only 2:00 in the morning and it’s a long time until sunrise, all of a sudden this poem comes back into your mind and you see what this guy was talking about. He was out late at night. He was admiring the woods that were owned by somebody else, who was at home resting and relaxing and at peace with his family eating dinner and he’s out in the cold, and the horse is saying, “We gotta go, we gotta go. We’ve got places to go.” And he knew in the back of his mind, “I have promises to keep and miles to go before I sleep,” but he needed to sit and take it all in for just a minute. He needed to find peace. He needed a moment of deep intentionality to reclaim his humanity in the midst of the efficient hyper-drive he was in. All of a sudden, when I was 26 years old, I finally figured out why Mrs. Duffy asked me to memorize this poem. We need to take time to be quiet. We need to reflect on why we are doing what we are doing, how we are doing what we’re doing, and whether we are faithful to the original call to be healers.
The second poem I want to give to you that I have not committed to memory is a lovely one from Walt Whitman, and it’s called “When I Heard the Learn’d Astronomer”; I don’t know if any of you have heard this one.
When I Heard the Learn’d Astronomer
by Walt Whitman
When I heard the learn’d astronomer,
When the proofs, the figures, were ranged in columns before me,
When I was shown the charts and diagrams, to add, divide, and measure them,
When I sitting heard the astronomer where he lectured with much applause in the lecture-room,
How soon unaccountable I became tired and sick,
Till rising and gliding out I wander’d off by myself,
In the mystical moist night-air, and from time to time,
Look’d up in perfect silence at the stars.
We are very scientifically oriented, very fact driven and appropriately so, but at the same time there’s mystery, there’s wonder, there’s the need to let things be and to be immersed in the ineffable that we can’t fully explain, and so that’s a little bit of what Walt Whitman was saying and Robert Frost was saying. Take a moment to think about these things. Pope Benedict XVI once said, “We are no longer able to hear God. There are too many frequencies filling our ears. By being quiet and prayerful, we can more capably open ourselves to God’s grace and more readily discern who we are called to be.” Clearly this is difficult, because the world is jealous and wants our attention; it wants us to value what it values – honor, wealth, power and pleasure, not faith, hope and charity, but it’s up to us to resist this.
Now, I don’t know if you guys have ever read this book by David Brooks – David Brooks wrote this book called the Road to Character, and it’s a pretty good book. I mean, there are some things that I disagree with, but he wrote that several years ago and in it he describes an insight from a Jewish rabbi named Joseph Soloveitchik. Now, in 1965 Soloveitchik characterized each of us as possessing two opposing sides of our nature, which have been sort of with us since the beginning of time but also a little bit at war, and those two sides he dubbed Adam I and Adam II. And I’m just going to … forgive my clumsiness here, but I’m going to read to you just a little bit of what he means by this and you’ll understand.
Adam I is the career-oriented, ambitious side of our nature; Adam I is the external, resume Adam – I want you to remember resume Adam. Adam I wants to build, create, produce and discover things; he wants to have high status and win victories. Adam II is the internal Adam. I would call Adam II the eulogy Adam. Adam II wants to embody certain moral qualities. He wants to have a serene inner character, a quiet but solid sense of right and wrong, not only to do good but to be good. Adam II wants to love intimately, to sacrifice self in the service of others, to live in obedience to some transcendent truth, to have a cohesive inner soul that honors creation and owns one’s possibilities. While Adam I wants to conquer the world, Adam II wants to obey a calling to serve the world. While Adam I is creative and savors his own accomplishments, Adam II sometimes renounces worldly success and status for the sake of some sacred purpose. While Adam I asks how things work, Adam II asks why things exist and what ultimately we are here for. While Adam I wants to venture forth, Adam II wants to return to his roots and savor the warmth of a family meal. While Adam I’s motto is success, Adam II experiences life as a moral drama; his motto is charity, love and redemption.
In all of our experiences, I would say – I could say for mine in particular – as we are training to go into the medical or health care professions that we’re in, we’ve been trained to cultivate Adam I. We’ve been trained to cultivate our resume self, which isn’t a bad thing. I mean, it’s good to succeed, it’s good to achieve. It gets us places; it opens doors; it gives opportunities, but we risk imbalance. If unattended to, the resume Adam will continue to grow unabated through our whole experience of training, through the early years of our practice and beyond, and as I said there is nothing wrong and there is virtue to aspiring and achieving, but when it’s unchecked and not chastened by the intangible, enduring virtues, the permanent things of love, honor, service, loyalty, truth – that is where Adam I, the resume Adam, can become an oversized, unwieldy monstrosity.
So how do we practice medicine? How do we learn all that we can and practice with confidence, efficiency and equanimity, while at the same time keeping our vocation, keeping our calling, maintaining our very soul? I would reason that we do it in four parts, and I’ll give you four parts of a meaningful vocation. The first part of healing the wounded healer is dignity. Every person you see, no matter how sad, how lost, or how incapacitated – you, me, our patients, their families – every person is intrinsically valuable, dignified. It is not something that can be given or taken away; it simply is, but it can be forgotten.
Has anybody here ever read King Lear or gone and seen it? So, I’m going to give you King Lear in 90 seconds, though this doesn’t mean you can’t read it, but here’s King Lear in 90 seconds. King Lear is a king who is older and wants to divest himself of his kingdom to his three daughters, Goneril, Regan and Cordelia, and in order to do that he wants to give a third to each one of them. He wants them to come before the court and profess their undying devotion and love and compliment him, just totally stroke his ego, which is totally inappropriate; it’s a spectacle. Well, Goneril and Regan just want his stuff, so they come in front of all of his friends and say, “You’re the best dad ever,” “You’re a great king,” “You’re so wise,” “I love you,” “I’ll do anything for you,” “You’re amazing.” “Okay, Goneril, here’s a third of the kingdom.” Regan says, “Well, I love you more that. You can live with me,” “I love you more than I love my husband,” “You’re the best.” “Here’s a third for you, Regan.” How about Cordelia, the baby, the favorite? What does Cordelia say? Cordelia says nothing, and Lear is irate. “Have you nothing to say?” She says, “No, Father.” He says, “Well, nothing will come of nothing. You will not get your third of the kingdom.” She says, “Father, this is all act; this is a charade. I love you no more than you are due, I love you to the degree that your dignity is worth, but I’m going to love my husband more. And I will serve you, but I won’t be a flatterer.” And he is so mad, he banishes her and gives her third of the kingdom to the other two.
Now Cordelia lands on her feet. She goes to France, gets married, and becomes the Queen of France. She marries the King of France, so things worked out okay to some extent for her, but the rest of the play King Lear is abused by his other two daughters, who never truly loved him. They emasculate him, they take his knights away from him, they fight over who is going to be having him live with them, and ultimately they want to kill him because of his right to their power, and when he’s finally in one of the most dramatic scenes in all Shakespearean plays, if not all stage theater, there’s a storm that’s taking and whipping King Lear and he’s half naked and half crazed, who should come to his rescue but Cordelia. Cordelia, the Queen of France, comes, and he’s so ashamed and he starts to kneel and says, “I know you hate me and you have reason to hate me,” and she says, “No. No.” And he says, “You have cause to hate me,” and she says, “No cause.” And it’s a moment of deep and tender forgiveness.
And as I said to the medical students earlier today when I was talking about this, we see King Lear in practice every day. King Lear is your CEO who has had a business all of his life, and he comes home after retirement and his wife has a life of her own – very loving, but she’s got all her friends and he doesn’t really fit in with them as much. He calls his kids and they’re all spread across the country, Ivy League educated, great kids, and they have grandkids. “I want to get together with you.” And the fact of the matter is they don’t have any time because John’s got lacrosse and Jamie is in her dance team, and “We’ll see you at the holidays, Dad.” So he goes back to work, and right away he’s in the way. You know … “It’s great to see you. We’re having a board meeting. Do you want to come in? You retired to get away from us. Go on. We’ll see you at the office party.” And then he comes to see me and he’s depressed. He doesn’t know who he is. He thinks his dignity was all wrapped up in all of his achievements.
So the sum of our work, the sum of our oftentimes forgotten work in the midst of all our efficiencies is not to give him dignity; it’s not mine to give. It’s to remind him of the dignity that he’s forgotten. Everyone is and everyone wants to feel valuable; it’s one of the biggest open secrets. I want you to clap at the end of this; I want you to like what I’m saying; I want you to pat me on the back when I’m done, because it feels good. We all want to feel valuable and valued. You do, I do … everyone does.
Mark Twain has a great line I quote when I don’t know what to say to a nice compliment. “I can live a whole month on one compliment,” which is true. You can sometimes just feel that feeling of joy in somebody admiring us or saying “Good job.” By being genuinely engaged and intentional, even if it’s only for an extra moment or two, we will go a long way towards making our job more than a job, towards making it a calling or a vocation.
William Osler, the great internal medicine doctor, godfather of internal medicine who put Johns Hopkins on the map once said, “The good doctor treats the disease; the great doctor treats the patient who has the disease.” It’s the first part of a meaningful vocation. The first way of healing the wounded healer is dignity. The second part is calling. Every one of us wants to be part of something special. We want our lives to have direction, purpose and meaning, and hopefully the strong self-discipline and the heavy sacrifices we have made and that have helped us arrive to where we are tonight speak to the hunger we have to get a calling, to have a calling, to answer a calling. But, as we might now understand, sometimes the high demands of a calling can risk pulling us under, just as it offers us great reward. From early morning to late nights, from meticulous performance under pressure to the softest touch under our power, the earnest practice of medicine is a noble but a difficult calling.
Thomas Macaulay has a wonderful poem called “Horatius.” I don’t know if any of you have ever read this. You’re probably going to understand when you hear this, but it’s a story told of a terrible burden being visited on the City of Rome. This is Thomas Macaulay, the great 19th century English historian. A terrible burden is being visited upon the City of Rome. A marauding army of Lars Porsena and the Etruscans – those dreaded Etruscans – threatens to cross the bridge and sack the City of Rome. And as the Roman leaders looked out at this terrible, inevitable fate that was now descending upon them, Macaulay would write this:
But the Consul’s brow was sad, and the Consul’s speech was low,
And darkly looked he at the wall, and darkly at the foe.
“Their van will be upon us before the bridge goes down;
And if they once may win the bridge, what hope to save the town?”
Then out spoke brave Horatius, the Captain of the Gate:
“To every man upon this earth, death comes soon or late;
And how can man die better than facing fearful odds,
For the ashes of his fathers, and the temples of his Gods,
(The Consul is the head of the City, like the mayor or governor.) And so Horatius and two others would step forward on that bridge, three in total, to form a blockade against the Etruscans while any other measures could happen behind them. They wanted to stand for, to suffer, and to sacrifice for the call – the great call. The first on the bridge against overwhelming odds on behalf of the uncertain many back in Rome would ultimately prove to be successful, but not before Horatius looked like he was going to die. And I will commend you to read the entire poem without being a spoiler, but it’s a good one.
The second part of the meaningful vocation, the second part of healing the wounded healer, is calling. The third part is the hard part … suffering. To imagine that we must do what we must do and what we will see in the practice of medicine will be free of some degree of suffering is to fail to be honest with ourselves. Think about what we see day in and day out, week in and week out – pancreatic cancer and stillbirths, glioblastoma multiforme and widow makers, suicide and dementia; these all populate the landscape of our practice, and if that’s not enough, because of these physical organic things, we see divorce and infidelity, joblessness and homelessness, despair and drug addiction. It’s one of the greatest of paradoxes that a career so intent on helping can hurt so deeply. Think about that.
Robert Frost – again, I love him – in a poem he wrote called “Come In,” he speaks of coming to the edge of the dark woods. The dark woods are dark enough to be a bit menacing, and right when he’s about to be repelled from it, he hears a bird, a thrush, singing from deep within. It’s a beautiful song that is both troubling and inviting, and as Robert Frost says it was almost like a call to come in, to come into the dark and lament. “But no,” Frost says, “I was out for stars; I would not come in. I meant not even if asked, and I hadn’t been.” And he skirts away from the woods. It’s interesting, because when I read this poem for the first time … you should read it. It’s very haunting; it’s called “Come In.” It made me think of Maximillian Kolbe. Maximillian Kolbe, as you know, is the saint of Auschwitz, who when a man was going to be one of the ten men to be taken and put in the starvation chamber because there was an escape of one of the prisoners and fell on his knees and cried that he had a wife and children, Maximillian Kolbe, a Polish priest, steps forward and opts to take his place. And, as we all know, not only did he die in the starvation chamber, but he sang hymns and recited the Rosary until the very last of them were dead, but he did not die until they injected him with carbolic acid. And the work of the darkness of the woods sometimes are the tragedies and sufferings that we can see, but especially it’s where the saints live, and yet the interesting thing about the saints is not only do they live in the darkness and live in the hardship, but they also sing like a thrush, that beautiful, beautiful song that makes the rest of us say, “How? How do they do that?”
In the thirteenth century, as you know, Dante wrote the famous Divine Comedy, starting off with the Inferno, saying “Midway upon the journey of our life, I found myself within a forest dark, for the straightforward pathway had been lost.” Dante’s Divine Comedy, as you know a masterpiece of literature, is all about being lost in the middle of life, uncertain because the path behind is menacing and knowing that to get to the place of utter peace and of fullness is to first have to go through hell and the cleansing of purgatory. To turn and go back the way Dante came was to encounter ravenous beasts, something that he meant old, bad habits. So we encounter the spirit of the Roman poet, Virgil. He is told that there is a way forward out of his present confusion, but to arrive in ultimate paradise he must first travel through the harrows of hell and purgatory. At times now we are Frost, entering and skirting the dark woods but sustained by the music of the thrush; at times we are Dante, trudging through some smaller hell fires with our eyes on ultimate paradise.
The third part of the meaningful vocation, the third part of healing the wounded healer, is suffering. The fourth and final part is grace; it’s grace. Sometimes I can’t believe how blessed I am to have this vocation – people I’ve met, lessons I’ve learned, the struggles I’ve witnessed, and even maybe I’ve helped some people along the way; I’d like to think that. Grace in medicine, if properly looked for, is everywhere, and by the way, if you ever get the chance to read Georges Bernanos’ book, Diary of a Country Priest, it is a striking, wonderful, hard book to read because of the suffering, but it’s interesting because Georges Bernanos, a long-suffering Frenchman, lived as an ex-patriot when the Nazis moved in and took over France. He really weds the narrative of suffering with grace so well, and he tells a story of saints like almost nobody else. So … Georges Bernanos, Diary of a Country Priest.
At the end of my long day of hospital rounds, I remember I would sat with my last patient, James. James was increasingly crippled by heart and renal failure; I always saved him for last, because I wanted to take a little extra time to hear him and listen to him and talk to him. And James would tell me about his time and experience with the 45th Infantry in World War II, as they liberated the notorious Nazi concentration camp at Dachau. He looked at me with his bright eyes that welled with tears every day without fail when he told me about this. He said, “Every day I cry when I think about what I saw,” … every day. He said, “But I’m proud to live in a country that liberated it. I’m proud to tell the story about what it means to be on the good side of history.”
Midday, every few months, I see Shelley’s wheelchair and her contorted, cerebral palsy-wracked body, with braces and straps affixing her to it. She shakes and she shutters, and she smiles and she laughs when I enter the room. She asks about my kids. I ask about her volunteer work and what she’s reading. She always wants a hug, and so do I. She tells me, “I love you. I’m so glad you are my doctor. Everyone else treats me like I’m a vegetable. I’m not. I’m really smart.” And she is.
We all have stories like this. We all have patients that have moved us, not because of a medical diagnosis we made or some curious finding we saw on a CT with them or on their skin. They moved us because we were humbled by their story, and we were better people for having known it. These people, these stories, are not problems to be solved. They are graces that visit us. If we are paying attention, they will help us not to simply become better doctors, but better souls.
I want to give you a quick story. Do you guys know who Sigurd Olson is? Sigurd Olson was an outdoor guide, a wilderness preserver, who actually got the Boundary Waters federally protected. He was out in Ely; he worked as the dean of a community college there. Sigurd Olson is an extraordinary writer. He was living in the 1930s and 1940s, and he told these … I think he had a deeply Catholic sensibility. But here’s what … let me see if I can find it. I write a little bit too on the side, and so this is a particular piece I wrote called “On Finding the Most Beautiful Place You Could Ever Be.” This is just a little portion that I spoke about Sigurd Olson’s work: “It had already been a long day, but it was getting even longer. As famed wilderness writer and explorer, Sigurd Olson, recalled, the scene was vivid. He and a small group of bone-tired canoers raced a relentlessly setting sun to find themselves short of the hopelessly out-of-reach landfall. As wave upon wave of unforgiving river buffeted their canoes, the inhospitable craggy shoreline taunted them. “No shelter here,” it seemed to say.
Have any of you gone to the Boundary Waters? There are some places there that are awesome and then there are some places like you cannot pitch a tent on that. Finally, as the river gave way to the turbulent rapids, the beaten-up canoes pulled aside and were forced to make evening camp. As a fire was lit and the tents were pitched, here’s what happened; these are the words of Sigurd Olson: “After the meal, which was one of those rare affairs where everything happens to be just right, one by one, under the additional influence of good tobacco and dry moccasins, we began to notice what a truly marvelous spot we stumbled into. The rapids tumbled down through a rocky gorge into a broad, placid lower camp. Tall spruces lined the shore, and where the rock was too steeply sloping for trees to secure a foothold, it was covered by a carpet of varicolored mosses and lichen. Gone was the weariness, gone the memories of portaging and miles of paddling. Nothing was left but a feeling of lazy contentment. We all sat smoking and drinking it in for what seemed a long while. Finally Bill, who had cussed at the camp site more than anyone else, broke the silence. He had been sitting on a rock overlooking the river, watching the long streaks of foam float down from the rapids. When he spoke, it was from the bottom of his heart. ‘Boys,’ he said slowly and with conviction, ‘this is one of the most beautiful places we have ever been in.’ We all silently agreed with him, for it was as nearly perfect as anything could be.”
You see, the interesting thing about our lives at times is, when things are going hardest, when things don’t seem to make sense, all of a sudden you find yourself in what was thought to be an inhospitable bad situation, and it’s one of the greatest graces we could have asked for. We just need to see it that way; that’s providence. That’s our being alert to the ineffable ways of God. The final part of the meaningful vocation, as I’ve said, and the final part of the healing of the wounded healer is grace.
In conclusion, every day that we get out of bed in the morning and every night that we go to sleep, in health care we’ve just spent a day trying to help somebody. To listen, to cure, just to lighten the load … that is a damn glorious privilege. As we move ahead from tonight and we strive to stay human in an often unhealthy or inhuman profession, I would advise all of us to try to remember this. Strive not only to be smart, but instead strive to be wise. T. S. Eliot once said this wonderfully in the choruses from “The Rock.” He said, “Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information?” We have so much information on our phones, but that doesn’t convert to knowledge in our brains. We have so much knowledge in our brains, but that doesn’t convert to wisdom about how to use that knowledge. We should strive not to be smart; we should strive to be wise. Secondly, don’t settle for a job; have a calling, a vocation. Thirdly, never, never stop giving a damn. Be confident, but be humble. Be full of wonder at the graces all around you. Read great literature about the current things of humanity, and remember that a meaningful vocation is not comprised of a title, a paycheck, a nice vacation home, or kids with straight teeth. It is work suffused with dignity, informed by calling, wrapped with suffering, and kissed by grace. To be sure, the world makes its claim upon us, but, my friends, we don’t belong to the world. We belong to Christ, and we’re called to go and live accordingly.