Physicianship III:

HOPE and the Prevention and Relief of Suffering

 by Ken Hamilton, MD ~ Winter 2007 Edition

“You have cancer” he said
His touch was soft, his eyes were kind
“But that can’t be,” I said,
“I eat good food and exercise.”

Sure hands removed the unknown mass.
The pain was brief, it brought relief.
To know the truth and what must come;
The journey was begun.

They talked the talk, I walked the walk;
I didn’t plan to die right then.
“Do what they say, it’s tough I know,
But you are strong and there is H.O.P.E.”

“God”, I said, “I can’t go on, it’s much too hard.”
“But you have gifts to give,” He said.
I had a choice, and so do you—
To sing the song, to live, to give.

Give love and listen well; then offer hope
To those about to walk their path;
So she may know that life, though not the same,
He promises will be more sweet. And so it is.

                                                —Jean Libbey

Jean's experience with her cancer could have been one of suffering had her surgeon not touched this forthright and courageous woman with soft hands and looked at her with kind eyes as named the disease of the "unknown mass." Subsequently, she goes on to face the tough journey of surgery and chemotherapy with her strength and with HOPE… and, in spite of total-body pain and nausea, she more than endured—more than survived—she thrived.

Is pain suffering? Simply put, no. We are well-equipped to deal with pain, depression, and nausea... our endorphins are more powerful than heroin... our serotonin is more powerful than Prozac… our anti-nauseant neurotransmitters are more powerful than Zofran. We turn them on at will to deal with the unbearable. We turn them off in the face of abandonment.

Our minds readily project into the unknown. Imagination, with or without past experience, has the ability to leap into that mystery of the future and create scenes teeming with suffering. To be able to pull oneself out of such images can be a Herculean task. However, the presence of a compassionate other can ease the magnitude of that task. The hands and eyes of Jean's surgeon admirably filled that role... thus preventing her from suffering.

Eric J. Cassel begins the preface to the first edition of his profound work, The Nature of Suffering and the Goals of Medicine (New York; Oxford, 1991) with "The test of a system of medicine should be its adequacy in the face of suffering... modern medicine fails that test." Interestingly, the Hippocratic Oath contains no reference to the alleviation or prevention of suffering, neither in its original version nor in subsequent modern versions. However, physicians have, for centuries, performed as the one portrayed in Sir Luke Fildes' famous painting, The Doctor, 1891, showing a physician at the side of a seriously ill child. The role of compassionate medical presence in the relief of suffering has been with us for ages, but the more recent goals of medicine have been to become a science, and compassion cannot be subjected to the rules of science: measurement, reproduction, and prediction. Medicine is still as much an art as it is a science, and it has come to recognize that what science cannot deal with can be as important as the science, itself.

One of the immeasurable conundrums for science is hope. To Vaclav Havel, hope was "the certainty that things can make sense, regardless of how they work out." To Viktor Frankl, hope was one of two attitudes (love was the other) common to all survivors of Auschwitz . For him, hope was intimately involved with finding meaning in life. Indeed, it was an essential component of his "logotherapy" which he had developed in 1932, six years before the Nazi Anschluss.

Throughout Cassel’s book one finds the importance of seeing individual persons as living systems that cannot be analyzed scientifically. The immediate problem for medicine in the face of the tight time constraints of "managed care" is that working with persons takes time, of which those constraints do not permit. It is not enough that a physician be able to make a decision of what is wrong, what caused it, what can be used to treat it and what reasonable predictions can be made regarding the treatment and its effects; for to do so denies the interaction between these two persons... and a sense of abandonment develops. The physician’s responsibilities include advising the patient to get their affairs in order and get on with their life, and, last but not least, promising the patient of doing everything in his or her power to help the patient get on with that life. This noble promise contains rich and beautiful implications for healing, which is the healer’s purpose.

Such a promise implies a surrender to the needs of the patient. That promise certainly goes back 2300 years to Ruth, recently widowed, who promised her (also) widowed mother-in-law, Naomi, "Whither thou goest, I go with thee." With those words, Naomi's suffering ends... and so does Ruth's.

The mission of HOPE, to help humans find meaning, value, and purpose, is realized as the participants and guide of a HOPE Group give themselves permission to be that present to each other and themselves. Such a group presence makes it possible for perceptions of abandonment to fade away, alleviating thereby suffering already present and suffering yet to come.

Today’s physician must deal with both the “absolutes” of science and the “particulars” of the one-of-a-kind work of art person who is to benefit from the science. The physician is both professional and healer. Both s-he and the patient need those two services. They both need the power of hope and HOPE to integrate the two.

Do you have a story or anecdote you would like to share with the readers of Ripples? Please send it to Ken at HOPE PO Box 276, S. Paris, ME 04281.

We would love to have your HOPE story for Ripples! Please send it to the HOPE office, PO Box 276, South Paris, ME 04281 or email it to hope-at-hopehealing.org. If you don't think you are a writer, record it onto a tape and send that to the office. The editor will transcribe and edit it for you!