[Editor's Note Chris:]

The following is a dialogue between Sarah Olson and I, the resident doctor (Sarah) and priest (Chris) at Beams & Struts. The genesis of this article was a set of discussions we've had over the last year about our respective vocations and their interesting intersections. One of those interesting intersections was the name of our roles themselves.  One title for a priest is curate, which comes from the Latin meaning "caretaker" or "doctor" of souls. That's where we got the idea for the title. We are looking for this to be the first in a series of such conversations between the two of us.

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[Chris]

From your first article Sarah:

In his foreword to the anthology Consciousness and Healing, Ken Wilber describes the difference between conventional, integrative and integral medicine like this: conventional medicine treats the illness, integrative medicine treats the whole person, and integral medicine incorporates all of this and also treats the physician. Physicians need to develop the capacity to be in touch with their own interiority and remain compassionately available to their patients, especially in their most challenging moments.

I think this last sentence in particular is a brilliant and succinct description of the yoga of the doctor:  to be in touch with their own interiority and remain compassionately available to their patients.  Can you think of examples in your own practice where this happened or perhaps not?  Have you found certain practices help you to be in touch with your own interiority while also remaining compassionately available to the patients?

[Sarah]

Thanks for highlighting this piece. I've a lot of examples of relative success and failure in this practice, and of course everything in between. I met a patient recently, though, that will probably serve our dialogue well.

Emergency rooms are part of primary care, an entry point into the medical system. Emergency room patients, therefore, represent a remarkably mixed bag of needs and expectations. The gentleman I saw recently was an extremely difficult patient. He's very medically complex, with an extensive cardiac history, several heart attacks, past stroke, obesity, high blood pressure, diabetes, you name it. He is well known to the emergency room staff as a "frequent flyer." He is known to have a very difficult personality and struggles with anxiety and neuroses.. especially about his health. I heard a bit of his story and was prepared for a challenging encounter.

Approaching the stretcher, I was aware of the delicate balance between setting boundaries and being 'tough' with a known difficult patient, and my own natural instinct to be warm, open and to build connection.  I will spare the details of our conversation, but needless to say it was indeed, very challenging. In essence, he wanted reassurance that he didn't have cancer, and had very little insight into his own fears and anxieties. He was also ignorant of how the system works... and took some convincing that we weren't going to admit him to hospital and do a full body MRI to allay his fears with no objective clinical indication. Eventually I ordered an X-ray of the body part in question (normal), gave him some reassurance and sent him home.

It was a very interesting experience for me though, because in the same moment that I was feeling frustrated angry even and was aware that I was taking too long with one patient and that my evaluation was on the line, I was able to hold a certain amount of distance. A part of me remained aware that this man was very sick, lonely, disconnected from source and in complete fear. I think that little bit of space and awareness, that little bit of me that was still in my heart (or space of compassion), allowed me to perhaps react a little bit less--although I did react a bit, to be sure. I was able to keep one foot in my interiority and therefore allow space for understanding and compassion to arise.

Ultimately I have no idea if that changed anything for this individual. Perhaps he is too far gone down the road of fear and unravelling to be touched at this point.  But at least by engaging in the practice, I have strengthened that muscle for myself and will have more to offer in the next difficult situation.

I suppose in essence the shift that has happened for me is one I have already alluded to, which has been to begin to think of my work as my practice. To know what exactly that means we'll need to flesh out what it means to "practice", a thread I know you are well-equipped to pick up.

As I see it, if we physicians are just going about the routines of the day, seeing patients with only a small part of our presence and potential, giving the same advice, prescribing the same medications, playing out the same patterns of expectations and reaction, there is no way we are going to be capable of enacting the vision I describe in my original article. It's only when I bring a real conscious intention to a patient encounter, as a unique and important event, that it becomes even remotely possible. And that takes work, and that's the practice.

What is it that is giving me this very nascent capacity to find this space? A lot of things I guess. It is certainly not coming from my medical school or residency training. From personal meditative practices for one, and I think more importantly, from experiences happening in several intentional groups I am part of. One is a women's group, where we engage in deep listening and authentic speech, and where group and interpersonal dynamics have been an important focus... moving outside myself and becoming sensitive to the subtle shifts in the group space has been very helpful in navigating encounters with patients and other health care professionals.

How does this concept of work as practice land for you? What have you noticed in your very intimate and challenging moments with individuals and families that has allowed you to continue to serve?

[Chris]

It's funny that you mention the intimate and challenging moments. In many ways, a priest is really trained for those and those moments only:  the hospital bedside, the confession, the pastoral counseling or crisis session, the funeral, and so on.  I don't want to say those are "easier" (because they are not easy), but there's a certain way in which I'm there to simply hold space.  Hold the loving space of listening, caring, and confidence.

Because on one level, their issues are clearly not my issues.  Like a therapist who is able to skillfully help another but can't deal with his/her own stuff or doctors not diagnosing their own family, their presenting problems are not mine.  There's a very real felt sense in those moments that each of us is really on an individual journey (to use cliched language). This is especially true when it comes to the dying process.

On the other hand, there is a cost.  In the language of the gospels, there is the story of the woman who touched Jesus' cloak while in a crowd of people.  Jesus notices that "power has gone out from him."  I'm not equating myself here with Jesus, but in some of my more formal priestly roles, particularly in leading worship, power goes out from me.  There is a kind of exhaustion I feel after preaching or presiding at the Eucharist or anointing the sick that is completely unique to that role.  It's unlike anything I ever feel or have felt otherwise. Speaking to my colleagues they all know from experience as well. It's a common thing.

There is a kind of transference that does occur in this work.  Regularly, usually a few times every month, I'll wake up in the middle of the night in a half-awake half-asleep, semi-lucid state in which images of all kinds of people will start flashing through my awareness. It's like light bulbs going on and off.  Or maybe firecrackers, as there is typically a quite energetic even frenetic quality to it.  My responsibility for the church community as a whole is, in some way I can't really comprehend, affecting me.

The best I can fathom what is happening in those moments is that when those images of people roll through my consciousness, something of them that had been left within me is somehow being exorcised--being worked out.

And when I say exorcism, I don't mean there are literally demons or whatever residing within me.  But in another sense, I don't "not" mean that either (if that makes sense).

I work at a downtown church so basically anyone can (and does) walk through the doors. There are people for whom a priest is a trusted person and therefore they share with me--a total stranger--things that I know they haven't told another human being. And this on our first meeting. This isn't a daily occurrence to be sure, but it does regularly take place.

A priest friend of mine says that God has given him the grace to forget what people tell him.  That would be a great grace.  It's unfortunately not one that I possess. I unfortunately remember and am therefore more burdened with the memory of it all.

To loop back to the notion of work as practice, I've taken up a practice to care for myself wherein I forgive others for laying their weight upon me.  Now in Christianity, it's not that I'm eating their karma as say a guru would. I can't even imagine the horror that would be and frankly don't want to.  My belief and practice is one which God ('the space') eats or puts away the sin and I stand as a witness to that reality.  Afterwards, I go about forgiving that person for my having to hear their confession.  Of course they want to be unburdened, so I have no hard feelings towards them.  But somehow I found (given that I do remember) that it takes the sting out of it for me. After the confession, I hold the image of the person in my consciousness and then feel myself releasing the chords. I might repeat a phrase like "I forgive". Or just repeat the word 'forgiveness', until at some point there is a kind of detaching feeling, like something unhooking from my being and then releasing out into the atmosphere. Then there is a sense of warmth and love and a well wish for that person (whom I may never see again incidentally).

Now this is all just one small piece of my work.  It's the stuff people immediately think of when they think of a priest's job.  But the dirty little secret in church world is that pastoral care of this kind (confessions, sick visits, crises, etc.) does not induce spiritual growth.  In those contexts people are rightly much more concerned about getting through the crisis.  We are creatures who seek homeostasis.  People want to get back to "normal" in other words.  There's a common assumption that once I get back to normal--if that does happen to take place--then I'll be able work on my growth.  Sadly, this doesn't often take place in my experience.  I don't think that nullifies the value of that work, but it does contextualize it. It knocks it down a peg or two.

In The Middle Ages there was a common image for the church as the wayside inn for the weary traveler along life's dusty, long road.  Or the church as hospital.  It speaks to a church as a place of sanctuary and rest but on the other hand, they pass right through. People are treated in a fairly individualistic and transient manner ("tourists").  The thing is, the more a church opens itself up to be a place of healing (unsurprisingly) the more broken people show up. People who are there to be cared for rather than to give or grow together.

The challenge is that I am called to be part of a community that has to be one of healing and welcome for those whom society has classified and treated as its dregs.  The lonely, the unloved, the forgotten, the grieving, the imperfect, the slightly mad (or in some cases fully mad), the socially awkward, and so on.  It's a reminder that in many ways, we are all always partly all that--though there are definitely degrees here!!! But at the same time all of the energy can be sucked into the never-ending void of caring for others.

There is the whole realm of actually being called to lead a community of spiritual transformation.  To be all of the things that the scriptures say a church is supposed to be:  "Light", "a holy people", "the community of the beloved", "a communion of saints."

In terms of my own work as practice, the main focus for me now is prioritizing.  Remembering and acting in ways that speak to my commitments.  For me the piece around transformation is the most important and all the rest (pastoral, administrative, etc.) exists within that broader framework.  I work in a culture however in which the priorities are largely reversed--where making friends, doing good work, caring for folks pastorally, feeling some spiritual consolation for time to time, doing everything necessary to keep the institution going, are often the most important and then if there is any room leftover then we would talk about real spiritual transformation.

I often joke that I'd love to put the following on a sign outside a church I'd work at some future point in my life:

"When Jesus calls a person, he bids them come and die."

That is from the great Lutheran theologian Dietrich Bonhoeffer who was murdered in a concentration camp for his resistance to the Nazis.  If I were particularly bold, I might add to that quotation: "in love."  Jesus bids them to come and die in love.  To come and die in ecstatic love.

The joke of course is, "Who the hell would go to a church that wrote on it's front door come and die?"  But to me that's what it's all about.  Come and die so that there hopefully would be some resurrection. 

My own work as practice involves a great deal of daily confession for the realization of how rarely my own practice (moved by grace) ever reaches that point.  

The great theologian (and pastor) St. Augustine built his monumental theology on the point that the spiritual path is one of correctly putting everything (and he meant literally everything) in its proper order.  Context and motivation are all important--they are not everything but they are always part of everything.  Caring for people who need help, making friends, doing good works, keeping a system functioning, experiencing God in prayer & worship, all these are very good things.  But they can obscure the greater thing: becoming a loving sacrifice to The Divine.

[Sarah]

Great stuff, there's certainly a lot in what you shared.

I want to flesh out the difference, the distinction between what the role of the doctor and the priest is in those difficult moments - you articulated very well how your job (and practice) is to "hold space" and to bear witness - and how this often weighs heavily on your soul as you end up bearing the burden of the releasing that can happen for people. In a medical encounter, there is for sure this sense of holding space - which actually is the piece I think we need to develop as physicians. This piece requires the awareness of interiority I called for in my article - but there's also a profound engagement with the person/patient at hand. There's a mutual problem-solving, and one of the roles of the doctor in this moment is to provide reassurance and educate. So there's a real messiness that can happen in this engagement, often handled less than skillfully. I think the risk with this kind of interaction is projection and enmeshment, particularly when physicians don't have the spiritual training and practice to hold space for people in a difficult moment, the way a priest certainly would.

But as you describe it, there is an important lack of engagement when you sit with a member of your congregation in a difficult moment. There is simply a holding of loving, space and presence that allows for a release (even if it is just to get through the crisis, and back to normal). The burden you feel after these moments sounds terrible, to be honest, and I feel fortunate not to experience much of that.

It seems to me that our intuition about the similarities of our professions was on in many ways. We both work on a very personal level with individuals and families in painful and difficult moments. We both deal with illness, death, dying and transformation. We are both aware of the importance of our own inner space in contributing to, or taking away from the encounter. We both acknowledge the opportunity to make our work into practice (although our practices are subtly different).

The last thing I want to mention is something I think we can pick up next time. I was very interested in your saying that when you are doing a (conventionally understood) "good job" in your role as a priest you are helping people through moments of crises without actually seeing them move towards spiritual growth and transformation. I think this is a very insightful and interesting point, and saw immediate parallels with the way we practice medicine which, as you know, is massively weighted towards acute illness (or crises) rather than promoting health and "wellness", or "wholeness", which in its most complete definition most certainly includes spiritual transformation - I am sure you can appreciate the parallels. With this in mind, and given that we have both described our current way of "practicing" as our work - how would our practices (or ways of approaching these encounters, these difficult moments) need to change in order to not just help people through moments of crises, but allure them to more spirit, wholeness and fullness?