Saturday, April 17, 2010


I’ve been seeking to explain why medical doctors so widely undervalue patient and caregiver support programs. Support treats not the physical disease, but the emotional suffering of patients and caregivers. One explanation is that disease, as a resident of the physical, measurable world, is fair game for physicians trained exclusively in objective science. But suffering, being subjective, lies outside scientific jurisdiction, so while physicians might recognize it, most don’t feel adequate to address it.

Yesterday a doctor friend offered me another plausible explanation. He pointed out that physicians are excellent problem solvers. They gather the parts of a disease puzzle and put it together. Suffering, though, isn’t a puzzle. It’s a mystery. Puzzles can be solved, but mysteries cannot. Showing a mystery to someone dedicated to solving puzzles only generates distress.

What do we do with mysteries, then?

We need first to admit that there’s much in this life that’s not only unknown, but permanently unknowable. To the questions everyone asks—why we fall in love so erratically, why there’s evil in the world, where lie the sources of good and bad luck—poet Gertrude Stein replied, “There isn’t an answer. There has never been an answer. There is never going to be an answer. That's the answer.” Amazing: no answer, yet somehow we get through our days.

When sick, we can feel trapped, alone, in our particular mystery. Why me? Why now? Why in this way? What’s next? What’s death like? The challenge for physicians is to recognize that every patient and caregiver bears a dimension of discomfort that cannot possibly be fixed. No physician in the world can cure anyone’s suffering, but honestly witnessing it, openly, compassionately appreciating it, will help the sufferer to navigate through it.

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