5.1 - The Nature and Meaning of Suffering with Wes Ely
Suffering affects all people from all walks of life, but what does it actually mean to suffer? How do we find meaning within suffering? How can we respond to the suffering of another? In this episode, we discuss these important questions with Wes Ely, a critical care physician responsible for changing the face of ICU care in the U.S. Join us as we reflect on how we can flourish in our own suffering and by responding to that of others.
Transcript
Unknown
[Intro music]
John Rhee
Hi and welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society.
John Rhee
In the podcast we aim to reflect on deeper questions in medicine, all with the aim of rediscovering the ideals that brought us to medicine in the first place in order to better serve our patients and colleagues.
John Rhee
Thank you for joining us and we look forward to engaging with you through this podcast.
John Rhee
Foreign.
Michael Egan
Hi and welcome to the Hippocratic Society Podcast. My name is Michael Egan and I am joined today by Dr. John Rhee and Dr. Wes Ely.
Michael Egan
Dr. Rhee is a board certified neurologist, neuro-oncologist and Palliative Care Specialist at Dana-Farber Cancer Institute and Instructor of Neurology at Harvard Medical School.
Michael Egan
Dr. Ely is the Grant W. Liddle Chair in Medicine and Professor of Medicine at Vanderbilt University Medical center in Nashville, Tennessee.
Michael Egan
He is a subspecialist in pulmonary and critical care medicine who conducts patient oriented health services research focused on improving the care and outcomes of critically ill patients with ICU acquired brain disease.
Michael Egan
Dr. Ely has over 550 peer reviewed publications and has been federally funded for nearly 20 years.
Michael Egan
In 2022 he published a book,
Michael Egan
Every Deep Drawn Breath,
Michael Egan
about healing and medicine in the ICU,
Michael Egan
which won the 2022 Christopher Award for Literature.
Michael Egan
And this is just a small snapshot of all of his roles and accomplishments.
Michael Egan
Thank you both very much for joining us on the show today. It is an honor to have you here and I'm very excited for this discussion.
John Rhee
Thanks Michael.
Wes Ely
Thank you, Michael.
Michael Egan
Absolutely. And so, given Dr. Ely's expertise as a critical care physician, we wanted to discuss a topic that is core to the medical practice and that is the nature and meaning of suffering.
Michael Egan
And so to break down such a large topic, I wanted to frame this discussion in three parts.
Michael Egan
First, we'll start with suffering in general and then we'll move to suffering of ourselves and how we can find meaning in personal suffering and then,
Michael Egan
as is apt for the medical profession, responding to another's suffering and how that shapes us.
Michael Egan
So I wanted to start off with a story about my own time as a nursing assistant at Georgetown Hospital.
Michael Egan
When I went into the room of one patient, she was on isolation precautions, bed bound and currently sitting in her own feces.
Michael Egan
As we cleaned her up and took care of the NG tube whose vacuum chamber had been filled with,
Michael Egan
we noticed that her skin was almost leathery. She was in intense pain and when the nurse asked her what she would rate her suffering out of 1 to 10, she rated it a 9.
Michael Egan
A couple weeks later in the ER, I was sitting for a patient and overheard another patient talking to one of the medical providers.
Michael Egan
He was in for a sore throat and described his pain the previous night also as a 9 out of 10.
Michael Egan
Now, both of these patients clearly had immense suffering, and I can't say that I've ever had a sore throat that I would describe as a 9 out of 10. So I can't imagine what he went through,
Michael Egan
but certainly I can't imagine what the other patient was going through. Stuck in the hospital,
Michael Egan
likely for weeks, unable to essentially move herself at all,
Michael Egan
not able to see anyone without isolation, gowns on.
Michael Egan
And so in this context, both these aspects of intense suffering,
Michael Egan
what does it mean to suffer and what is suffering at its core?
Wes Ely
You know, these patients that you're describing help us to frame the topic today, Michael. So thank you to picture once again the woman that you had the privilege of seeing, who was sitting in stool,
Wes Ely
had skin breakdown,
Wes Ely
and as you said, stuck in the hospital.
Wes Ely
The amount of physical pain that she was in from the actual nerves under her skin firing to her brain and feeling like, for example, at times that knives are pushing into her broken down epithelium and integument, it's just hard to even imagine just sitting in that and having the stool with the bacteria and the acid and everything else seeping in,
Wes Ely
how much suffering that is. And then the second component of her suffering we have to put into our minds is the mental suffering of that. Not the physical as much,
Wes Ely
but also the mental, because we can cover the physical by giving pain meds and help relieve the actual,
Wes Ely
you know, on a pain scale, have the pain scale go down from an 8 to a 2 or something.
Wes Ely
But that mental suffering of, oh my goodness, this is my lot in life here, here's where I am.
Wes Ely
I,
Wes Ely
I don't feel dignified now. I feel undignified, I feel embarrassed, I feel dirty.
Wes Ely
These are the elements of suffering that we must consider as well.
Wes Ely
And as fellow human beings, we're all caught up in this situation because all of us have to recognize at some point that we are connected just by the very fact that I'm a human, you're a human, she's a human.
Wes Ely
We as members of the human race, do have inherent dignity, do have inherent,
Wes Ely
inestimable value,
Wes Ely
total pricelessness.
Wes Ely
And yet at that moment, when you're with her,
Wes Ely
it would seem,
Wes Ely
screaming at you, screaming at her that her disease state and where she was, her lot in life, had diminished her value.
Wes Ely
I don't believe that. I don't believe that her value is diminished. And I do believe that I,
Wes Ely
my entire person as a physician,
Wes Ely
as a fellow brother here on earth with her, that I have to devote myself to, to lifting her up again, to relieving that physical suffering and that mental suffering, and to somehow make sure that she knows how invaluable she is now, priceless she is.
Wes Ely
And that means partially getting her out of the stool, cleaning her up, getting her pain relieved and telling her how much and showing her how much she's loved. We say, show me.
Wes Ely
Don't tell me. So showing her how much she's loved.
Wes Ely
Those are my initial thoughts to that situation.
Wes Ely
I want us to keep going on with the suffering piece, but I just wanted to first share those thoughts about your.
Wes Ely
Your anecdote.
Wes Ely
Yeah.
John Rhee
And one thing that I just wanted to reflect back as you were talking to us is just this idea where in medicine we tend to overemphasize perhaps just the physical aspect of perhaps suffering.
John Rhee
And perhaps we should even be thinking about suffering separately from physical aspects of pain in the sense that medical education trains us very much to take into account only perhaps the objective measures and so objective pain or objective measures of how we can see somebody in pain and then devalues in some sense the subjective aspect of it,
John Rhee
which is the person's internal suffering, which is tied closely to the aspects of the mental suffering as you're mentioning. And if we only address the physical aspect of it, then we're missing a large part of that person's suffering that I think in palliative care, we talk about this a lot,
John Rhee
this idea of total pain. Right. There's this idea that when you have somebody who' using escalating opioids and it's not really addressing their pain,
John Rhee
then the question is, are you actually addressing the issue at hand? Or perhaps what's happening is that there are other aspects of the suffering that is not being addressed within that visit with the patient.
Wes Ely
Thank you for saying that, John. I really think that's important,
Wes Ely
Dr. Rhee,
Wes Ely
because this woman in that bed,
Wes Ely
I don't know, I wasn't there. I can't understand how she was suffering.
Wes Ely
But I can say that, that many of my patients in that situation have expressed to me a sense of abandonment.
Wes Ely
And when somebody feels abandoned,
Wes Ely
they tell me, I've learned from my patients the degree of pain that they feel is so amplified.
Wes Ely
It's,
Wes Ely
it's. And it's. It's altogether different than if I cut my finger.
Wes Ely
If I cut my finger, I have physical pain that the nerves do fire to my brain and tell me from proprioception, etc. But that's not providing me a sense of abandonment.
Wes Ely
If we think about the people in life who have been totally abandoned to suffer,
Wes Ely
they come back and tell us that the worst part of it was the absence of community and what, what,
Wes Ely
you know,
Wes Ely
we may talk in a minute about some value in suffering, but never would I as a doctor ever say anything other than my job now is to relieve this suffering.
Wes Ely
I've got to relieve the total pain. And that, that includes the medical management. But and also incredibly important is this addressing this sense of abandonment and providing a sense of community so that my patient knows that, that he or she is surrounded by love and, and mercy.
Wes Ely
And, you know, mercy is a really key piece of this because mercy is my willingness to, to dive into the chaos of another person's life and provide lifting and healing.
Wes Ely
And that's really key, is that second half of the definition is that lifting and healing provision.
Wes Ely
Because diving into chaos, I mean, heck, I do that in the ICU all the time by intubating people and putting them on ventilators and giving them chest tubes. And I do, I dive into their chaos.
Wes Ely
But if I'm not providing actual lifting and healing, then I'm not providing mercy and therefore I'm not reducing suffering.
John Rhee
Yeah, and I just wanted to make one more comment about that. Just this idea where I think in medicine, one of the frameworks that we use, and this is also something that Eric Cassel talks about, Cassel talks about in the Nature of Suffering.
John Rhee
But this idea of this dualist approach that we have in medicine, where we see the person as spirit and body, but separately.
John Rhee
And so we address people's bodily needs, perhaps, but then kind of set aside this idea of the spirit and that somehow it's like different or perhaps needs to be addressed separately, rather than seeing the person as a unified spirit and body whole.
John Rhee
And how we perhaps should be thinking about this less from a dualistic sense, but really an integrated sense of what the person is or who the person is.
John Rhee
Because only then can we address this idea of suffering. Because I think suffering is not just some type of measure that we could have,
John Rhee
but perhaps the sense in which the total person,
John Rhee
spirit and body fully is affected by the disease, not just perhaps the cancer eating into the nerves that are causing a lot of pain,
John Rhee
but also how that affects, like you're saying, the dignity of the person, their relationships, their understanding of self in the context and arc of their story and life.
John Rhee
And that is all affected by the disease itself.
Wes Ely
Thank you for saying that.
Wes Ely
That's very helpful. I love that angle on this.
Wes Ely
You know,
Wes Ely
in the Hippocratic oath we actually say I took the Hippocratic Oath when I graduated from Tulum Medical School.
Wes Ely
And we actually say that we want to approach our art,
Wes Ely
you know, with purity and holiness and beneficence, with the goal of reducing human suffering. So the very,
Wes Ely
the first day when I got out of medical school, I took an oath to reduce human suffering and that Hippocratic oath. And we actually still have a Hippocratic oath banquet at Vanderbilt University every year.
Wes Ely
We just had it two weeks ago.
Wes Ely
It was beautiful. We had over 60 students at this oath banquet and we all took the oath together.
Wes Ely
And so in that oath we stated once again that we were going to pursue this art with beneficence and truth and beauty to reduce human suffering. So that must be.
Wes Ely
How do we do that?
Wes Ely
How every day of our life as a physician,
Wes Ely
as a healthcare professional, do we approach this idea of reducing human suffering?
Michael Egan
Yeah. Thank you both for those deep insights. And it seems to me that at its core suffering is a lack of flourishing in a sense, whether that's subjective or objective or spiritual or physical.
Michael Egan
And as we look at medicine, as you were saying,
Michael Egan
working to reduce suffering,
Michael Egan
could you talk about what medicine's role in the opposite sense is to promote flourishing? If suffering is this sort of lack of community, lack of physical health,
Michael Egan
if medicine is supposed to promote that and reduce the lack of that, could you talk a bit about what does it look like when you are approaching the suffering of a patient, less so of the negative frame of reducing the suffering and more so of filling this patient with flourishing and bringing them up and healing.
Michael Egan
As you were saying.
Wes Ely
Thank you. I love this, Michael. And it's a great reframe.
Wes Ely
We are focusing more and more in medicine on this term flourishing. And it's a, it's obviously a beautiful word and it's a concept that we want to make absolutely certain that the entire person is lifted up.
Wes Ely
And in order to flourish,
Wes Ely
we have to focus on what as a human being makes me healthy,
Wes Ely
what makes, puts, puts me in right place.
Wes Ely
And I know that I can be incredibly in good shape, exercise all the time and be extremely unhealthy and not flourish because I might be so out of balance that I'm focused too much on my physical health and not is not enough on my mental well being and spiritual health.
Wes Ely
And so there are centers for human flourishing around the country now and we're actually using art in Medical schools to bring the medical. And I just noticed in two weeks I've got an appointment at an art museum here in Nashville, Tennessee where we're going to bring medical students and residents.
Wes Ely
There's. And we're going to sit in front of art and look at the art and analyze it in a way.
Wes Ely
And when I did this at the Smithsonian with Liz Gaufberg from Harvard and Meg Chisolm from Johns Hopkins and we were part of their course of which was put on by the center for Human Flourishing,
Wes Ely
I remember that I sat in front of art and analyzed it,
Wes Ely
shared with others what I saw and then in listening to what they saw because we were in community with one another and observing what they saw that I missed,
Wes Ely
I began to flourish more that day because I realized very,
Wes Ely
you know, I was humbled by all the things that I had not noticed that were beautiful and true about these paintings.
Wes Ely
And I took that in with me the next time I was at the bedside when I foamed in and foamed out of the bedside and walked to the bedside, kneeled with my patient, held their hand.
Wes Ely
I was more observant to who they were and what they needed. And I'm not talking about whether it should be a third or fourth generation cephalosporin. I'm talking about the entire person that was sitting in front of me and, and that they needed to know that I cared about the non physical ways that.
Wes Ely
That they were suffering and. And I wanted them to flourish when they left the hospital.
Wes Ely
Not just physically, but also mentally and spiritually as well.
Wes Ely
And I don't want to be the type of doctor I used to be. Michael. And I was really focused as a non gray haired doctor when I was young on just knowing all the facts and reading all the literature and citing chapter and verse, all the papers.
Wes Ely
Now I still am pretty good at that. I read over 20 journals every week and I love the literature. But what I've realized is that science will never be enough for me as a healer.
Wes Ely
When I did take that approach, I was not a full healer. I was a partial healer. My patients were left wanting.
Wes Ely
So I love that you brought up flourishing. This should be our goal. And while reducing suffering is absolutely critical,
Wes Ely
only with an eye toward flourishing,
Wes Ely
reducing that suffering so that we can move the patient into true flourishing.
John Rhee
I just also wanted to reflect on that a little bit and think about how the Hippocratic Society or in the Hippocratic Society, we think about this idea of the good and flourishing.
John Rhee
We have to have that end idea of what the Good is for both the patient, but also for the physician.
John Rhee
And therefore, when we think about the good for the patient,
John Rhee
it's not just the particular physical pain aspect of it though, that's truly crucial in the suffering of the patient. Right. So just separating out this idea of pain being a major cause of suffering, but not being the only cause of suffering, as we were talking about before,
John Rhee
and with addressing pain, of course people's suffering can be lessened, but that's not always the case.
John Rhee
Sometimes you could lessen people's pain, but that their suffering may still remain very high.
John Rhee
And in that setting, then you have to understand, like what is the end of the person. And I think this is where, as you were saying, Wes, that I think is really beautiful is that art,
John Rhee
music, literature allows us to enter into the perspective of another.
John Rhee
And in many ways with our patients as well. What we're doing is trying to enter into their perspective and enter into their story and therefore through entering into the story of their life, their journey as that this disease is part of their journey of life,
John Rhee
we can understand more deeply about,
John Rhee
like, what it is, which direction they've been heading.
John Rhee
Also perhaps a deeper meaning of things that they've been trying to understand in the context of how they feel, like their calling in their life has been perhaps as a parent or as a sibling,
John Rhee
their vocation of what they've been doing professionally and how the disease kind of is part of all of that. Right. And I think as a physician, in some sense we're not necessarily equipped to address all of those things, but what we can do is to help within that moment,
John Rhee
both as a physician and as a fellow human being,
John Rhee
accompany them in that part of that story and to truly develop that deep relationship with them, entering into their story and therefore guiding them in a moment of deep suffering towards recognizing those things that are those end goods in their lives.
John Rhee
Yeah.
Michael Egan
Thank you both. That was incredibly beautiful.
Michael Egan
And I seriously appreciate how this end of medicine towards looking at flourishing and bringing patients up and seeing them in the context of their whole story fits so well with literature and anecdotes on patients who are suffering or not responding to medicine, and then some sort of non medical issue resolves.
Michael Egan
They see a family member, they settle a score that they've been holding for their whole life, they forgive someone, and then even their physical health takes a turn.
Michael Egan
And so I think that very much is complementary to what we've been saying here today.
Michael Egan
And so I wanted to shift a little bit with this eye of if we are meant to flourish, if Medicine is supposed to help us to flourish, and suffering is a lack of this.
Michael Egan
Even as you were talking, I can see that in this doctor patient relationship, there is a lot of meaning and there is a lot of helping people to see meaning in their life.
Michael Egan
But in the suffering,
Michael Egan
in that lack of flourishing, while people are still in that state,
Michael Egan
where can they find meaning? Where is the meaning in that? And how do they understand the meaning of their life, their identity that has been affected by this suffering?
Wes Ely
That's really great. Let's talk about that in terms of the meaning and how to move forward when we know that life will have its suffering.
Wes Ely
The best person, you know, the nicest, sweetest,
Wes Ely
kindest, gentlest person is going to have suffering. And so we. We were never promised that life would be without suffering.
Wes Ely
So how do we say to ourselves,
Wes Ely
life is going to have suffering. And yet I can move forward. And I think for me, two things, the word why and the word acceptance. So what I'd like to focus on,
Wes Ely
so you know, you brought up meaning. And in Viktor Frankl's Man's Search for Meaning book with over 10 million copies sold, beautiful book that I'm sure both of you have read, he.
Wes Ely
He uses Viktor Frankl's quote. Viktor Frankl uses Nietzsche's quote.
Wes Ely
If a man has a why to live,
Wes Ely
he can get by with almost any how.
Wes Ely
And he used it four times,
Wes Ely
four times in the same book.
Wes Ely
If a man has a why to live, he can get by with almost any how. Or for the women listening, if a woman has a why to live, she can get by with almost any how.
Wes Ely
And so we have to help people find their why again.
Wes Ely
And I wrote a story once that. That's online about a patient asking me to end his life. And the short version of the story is that I told him that he was priceless and that I couldn't actively end his life, but that I could.
Wes Ely
That I wanted to know more about who he was. And he told me that he was a plumber and that he liked Shakespeare. And I remember. I remember him citing Portia for Merchant of Venice.
Wes Ely
The quality of mercy is not strained. I remember very clearly him saying that.
Wes Ely
And.
Wes Ely
And so he met a nurse named Christine in the icu, and they talked. And she was going through a hard time in her life, and he helped her think through this difficult time.
Wes Ely
She was an actor herself, and they talked about plays and Shakespeare.
Wes Ely
And the next day he said to me, you know, document,
Wes Ely
Dr. Wes, I don't want to die now. He goes, I'm suffering. With this lung disease, and it's difficult, but I remembered my why and I have a purpose. And I helped Christine yesterday.
Wes Ely
And maybe there's other people that I can help as well.
Wes Ely
He found his why there.
Wes Ely
He had to find that, not me. I couldn't do that for him.
Wes Ely
He did it organically through talking to another person.
Wes Ely
And that's why I mentioned earlier the sense of community and how important that is to us moving forward. And to me,
Wes Ely
the second word, acceptance.
Wes Ely
Certainly, as I said earlier,
Wes Ely
I want to assure everyone I will always do what I can to help reduce people's suffering.
Wes Ely
And yet I won't ever be 100% effective at that. I can never totally remove the world's suffering. That's a naive thought process.
Wes Ely
So what could accompany that for me? I can only speak for myself in my life.
Wes Ely
The suffering from my daughter almost dying to close people in my life dying by suicide to my own ill decisions and things that I've done that have caused others harm.
Wes Ely
The one thing the thread through any of those difficult times has been that it's shown me that I am ultimately powerless and that I don't have control over life and that I don't know much.
Wes Ely
And so the more I acknowledge that I don't know especially what's best for another person,
Wes Ely
then the more I get in more right place with what I'll call my higher power.
Wes Ely
You know, I. I go to Al Anon. I had a lot of people suffering from addiction in my life, and so I go to Al Anon and that we say that Al Anon is a spiritual but not religious program.
Wes Ely
And it has to be spiritual. It cannot be about any specific religion. It's. And in that spirituality, what I find is that when I realize that I'm not in control and that.
Wes Ely
And that I can accept what is happening,
Wes Ely
I can at least find a way, a way forward,
Wes Ely
a way through. Robert Frost said, the only way out is through.
Wes Ely
And so I want to say to my. In my world that these things happening to me, they just are.
Wes Ely
The isness of it, they just are. They're present, they're there.
Wes Ely
And even alongside that difficult stuff is a bunch to be grateful for.
Wes Ely
And that's how I've come to think about my own suffering and how it benefits me is by relinquishing control,
Wes Ely
accepting that I don't know.
Wes Ely
And then for some reason, that helps me find my why and allows me to move forward.
John Rhee
Yeah. Thanks so much, Wes. And one thing that I was also thinking about as you were talking is this theme that we focus on in the Hippocratic Society, which is the importance of the deepening of the relationships that we have with one another, that it is through those bonds that we grow in virtue.
John Rhee
And also, patients repeatedly always talk about this idea that even, especially or at the end of life,
John Rhee
it is those relationships that they have that repeatedly come up as things that are most important to them.
John Rhee
And there's something interesting, I think, about suffering in the context of relationships, specifically, where. Where when a friend comes to you and tells you, let's say that he broke up with his girlfriend and is suffering really deeply about that,
John Rhee
there's something about the fact that when he shares that suffering with you, if that bond between you and that friend is very deep,
John Rhee
somehow just sharing that suffering through the story alleviates some of his suffering. And so there's a sharing in that bond of the relationship between two friends where one can just by being empathetically and empathically listening and also feeling what that person's feeling,
John Rhee
that you could actually, like, take some of that suffering off of the other and then, like, take it on yourself as a burden.
John Rhee
I think as physicians, that is something that we do where we build those deep relationships with patients, and through that bond that we build with them, we can alleviate their suffering, even if it's a little bit by taking on some of that ourselves.
John Rhee
And I think that that's why medicine, in many ways, is very vocational in that sense. That there is a sense in which the sacrifice is not just in terms of the hours in the hospital or the time that we spend in training, but rather has to do with something deeper.
John Rhee
There's a sense in which the sacrifice also entails taking on that burden of suffering from our patients through that bond that we develop with them.
John Rhee
And so this idea of community, this idea of relationships, this idea of always deepening, therefore our own relationships and being able to therefore be of service to others, as you were talking about with that particular patient and finding that meaning.
John Rhee
Meaning there. Ultimately, I think it's in that service to others that we find the deepest meaning and giving of ourselves to others that we find the deepest meaning. Which is why I think also this profession is so deeply fulfilling because we can all.
John Rhee
We can. We basically live that all the time where we could be of service to the lives of others, to our patients.
Wes Ely
Yeah. You know, Albert Schweitzer, who opened so many hospitals in Africa and won the Nobel Peace Prize,
Wes Ely
said,
Wes Ely
none of you will be truly happy unless you find a way to serve others.
Wes Ely
And anybody listening to this Podcast needs to know that we have to look after ourselves for sure. And our own happiness is critical because if we don't focus on. If we don't clean up our side of the street and stay in our lane, then of course, you know, everything's erect.
Wes Ely
But. And at the same time,
Wes Ely
what I try and do is say, wes, how can I clean up my side of the street, focus on my lane? And. And at the same time,
Wes Ely
whatever I'm doing here, whatever I'm developing, the toolbox that I'm using, I hope that I can put it into play very actively for service of other people.
Wes Ely
And that fits with what you just said, John, and this Schweitzer quote that I cited.
Michael Egan
Yeah, it was very beautiful. And I love this aspect of hope that persists through the suffering and through this. Finding your why and accepting where you are and understanding your circumstances and looking at them realistically.
Michael Egan
But then, as you were saying, where there's a why,
Michael Egan
there can be any how. And so understanding where you are and realistically trying to go from there to your why and pursuing that with all you can through community, which just makes it so much more beautiful.
Michael Egan
On that note, I wanted to shift a little bit to this experience of suffering with another, of responding to the suffering of another.
Michael Egan
As you were saying,
Michael Egan
people aren't going to be happy unless there is a way to respond. And many times what that looks like is responding to other suffering.
Michael Egan
And so in medicine in particular, it's very obvious that the whole profession is about responding to others suffering.
Michael Egan
And so in that position,
Michael Egan
what is the goal when we are responding to another suffering? I know we talked about this a bit already,
Michael Egan
but is it more so attending? Is it complete alleviation of their pain? Is it just accompaniment?
Wes Ely
Where.
Michael Egan
How should we approach this response to another suffering?
Michael Egan
And specifically, how does this role of attending versus really trying to or really being able to take away their suffering have an interplay in the physician's response to patients?
Wes Ely
Thank you for that question.
Wes Ely
I have several words popping up in my head about how I view my role at the bedside with my patients in this circumstance. The first thing that I don't think it is,
Wes Ely
it's important to say what it is and what it is not. What is not is justice.
Wes Ely
I'm not there to achieve justice with my patients. So that lets me off the hook for wondering, why did this happen to this person? Did they cause it themselves? Did they bring it on themselves?
Wes Ely
Were they doing something wrong over years that allowed this disease process to come into play? Or any of that that's just not my business.
Wes Ely
I have nothing to do with that as what I have to entertain at the bedside, which liberates me.
Wes Ely
That's why I mentioned that. Because now I'm liberated to just say,
Wes Ely
how can I love this person?
Wes Ely
I don't care how they got here.
Wes Ely
I don't care about the past. I'm only in the present moment with this person,
Wes Ely
in this very present moment.
Wes Ely
How can I love them better?
Wes Ely
And so then, as a doctor, I can say, what toolboxes do I have with either medical knowledge,
Wes Ely
scientific knowledge, or humanism to bring into their treatment plan?
Wes Ely
This combination of science and humanism.
Wes Ely
And one won't work without the other. So my job is to do both. And that's why I kneel at the bedside. My patients kneel down, hold their hand, look in their eyes, put my right.
Wes Ely
My left hand on their right shoulder and try to then do this.
Wes Ely
Meet them where they are,
Wes Ely
not where they need to go where they were.
Wes Ely
But where are you today,
Wes Ely
Mr. Smith? Ms. Johnson, how are you right now in your life and how can I help you?
John Rhee
Thanks so much, Wes. And I think that one of the themes that we're talking about here is this idea where sometimes, as the physician, when we're used to being able to lessen the suffering others through medications,
John Rhee
there can be a tendency to try to want to lessen the suffering in all circumstances, even those that we may not have the power to lessen the suffering in. And so I just wanted to bring up the idea that we don't always have the ability to immediately lessen suffering and that we also have to be okay with holding the suffering.
John Rhee
I think that that's like an important meta awareness, because sometimes we ourselves may be bad at holding the suffering and therefore try to react in a way in which we may try to lessen the suffering, even if it means that we may be doing actually in the larger sense,
John Rhee
harm to a patient. Right. And so thank you for saying that.
Wes Ely
Yes.
John Rhee
Yeah. Of holding that suffering within us and holding that suffering with the patient, and still therefore taking on that suffering ourselves and holding it within ourselves to be there with the patient, I think is really important.
John Rhee
And then the other idea that. Michael, I like the fact that you used the word attending,
John Rhee
because as an attending physician, as a fairly newly minted attending physician, I really love the idea and the word of being an attending,
John Rhee
that I'm attending to my patients, that I'm attending deeply to my colleagues, to my trainees, but then especially attending to the needs of my patients by Being there with them and sharing in them, in their suffering, through attending that attentiveness.
John Rhee
And I think that when we attend to others suffering in a way that has this deep attentionality to it, this attention based approach to it,
John Rhee
then we can actually shape ourselves. And so this last thought of bringing things back to Hippocratic Society, where all of our actions,
John Rhee
if we believe that virtues are habitual dispositions towards the good,
John Rhee
if we approach every patient, where we are trying to disengage from that, or where we have a habitual approach to a patient, where we're not entering deeply into that relationship because of the fact that taking on that suffering is uncomfortable for us or also hard for us,
John Rhee
if we do that repeatedly, we become a cold doctor, a cold physician, where we don't enter into that relationship with the patient. And that ends up being how we live all of the relationships with our patients.
John Rhee
And we have to say that if we do that habitually with another suffering human being,
John Rhee
then that oftentimes affects our own personal lives as well, of how we relate to others in our personal lives. And so when we enter into that relationship with the patient, to enter it with that attentiveness and the desire for that relationship, and therefore the recognition that I may then be holding on and taking some of their suffering from them,
John Rhee
but doing that in a habitual way helps us then to grow in the virtue of being there with the patient,
John Rhee
desiring that relationship, and then them being able to live that well in our relationships outside the hospital as well.
Wes Ely
John, that helped me so much hearing the way you framed all that. Thank you. I will tell you that I am absolutely personally guilty of that scenario you just stated where I was essentially not holding that suffering, but trying too hard to satisfy the suffering that I couldn't satisfy, to reduce the suffering that I had no ability to reduce and therefore was not a healer at the moment.
Wes Ely
I mentioned earlier about me wanting to grow up as a doctor,
Wes Ely
and this is a great example of it.
Wes Ely
I think that, you know, it's a difference between sympathy and empathy. Sympathy feeling sorry for someone,
Wes Ely
empathy feeling with them.
Wes Ely
And it reminded me of this short little excerpt. I just grabbed it as we're talking from every deep drawn breath.
Wes Ely
You mentioned the book earlier, EDDB, Every Deep-Drawn Breath. And there's a place in here where I write as follows.
Wes Ely
I noticed that sometimes I walked away from patients beds feeling a vice like grip around my chest,
Wes Ely
a sense of hurt. And I understand it came from feeling mercy, like the desire that I. I now find that I am now entering into their pain and suffering.
Wes Ely
But I wasn't doing that earlier in my life, so I'm not trying to pretend like I had this down all the time anyway. Derived from Latin misericordia, mercy indicates the suffering of the heart,
Wes Ely
or compassion, compassio, or I suffer with.
Wes Ely
The with brought me back to empathy,
Wes Ely
meaning to feel with.
Wes Ely
That's what you were saying, John.
Wes Ely
Compassion can be understood as empathy and action.
Wes Ely
And I'd long been a believer. I'm still reading here. I'd long been a believer and a researcher. And by with us is Jodi Halpern's work on clinical empathy, especially her teaching that compassion should never be an extra step in our care,
Wes Ely
but instead an adverb to describe how we care.
Wes Ely
Now I began to feel comfortable putting it into practice. I needed to work my way toward it.
Wes Ely
I found that connecting with patients, opening myself up to them,
Wes Ely
took me no more time in a day.
Wes Ely
And the pressure I felt deep in my chest told me I was being a physician, a healer for my patients, and not a provider.
Wes Ely
So these are some thoughts that I think go along with what you're saying and the, the deep need for me as a. As a physician at the bedside to do that and hold that pain and suffering even when I can't cure it,
Wes Ely
I can still care.
Wes Ely
And then the last thing I'll. I'll say about this topic is that there's no doubt that me growing in this way as a doctor has had beautiful blessings on my own personal life and my relationships with my wife and children and friends,
Wes Ely
because those relationships in my life were all being injured by what happened, what was happening to me through medicine,
Wes Ely
and I don't want to live like that anymore.
Wes Ely
Yeah.
John Rhee
My one last response to that is like,
John Rhee
I also fail a lot in this area,
John Rhee
and also I'm trying to improve.
John Rhee
And I think that's one of the beautiful things about the Hippocratic Society, is that we're a community that tries to grow in this together and having, like you said, misericordia mercy towards ourselves, too, that we sometimes are also affected by our own emotions, our own weaknesses.
John Rhee
But that doesn't mean that we can't always get back up and try again and try to continue growing into what it means to be a good physician.
Michael Egan
I really love those reflections. Thank you guys so much. And I think it does reflect also this idea of suffering with. And as you were talking about suffering earlier,
Michael Egan
you had the idea of searching for the why or seeking the why and also accepting. And I think that idea of compassion for a physician is accepting your own ability or inability and then still seeking that why of pursuing flourishing for the patient.
Michael Egan
So I think that's really a beautiful reflection that both of you guys have and suffering even yourself and bringing that into it.
Michael Egan
So thank you so much both for this interview. It's been very fruitful and I've been very edified by it, certainly.
Michael Egan
Please be sure to check out Dr. Ely's book, every Deep Drawn Breath. And we'll see you next time on the Hippocratic Society podcast.
John Rhee
Thanks, Michael.
John Rhee
Thank you very much for joining and reflecting with us today.
John Rhee
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John Rhee
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John Rhee
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John Rhee
And as always, we'll see you next time on the Hippocratic Society podcast.