Once every so often I would glance at Arthur W. Frank’s memoir, At the Will of the Body, in my chaplain book collection and have a feel-good memory about it without knowing precisely why. I had not read it since the time I first started training to be a healthcare chaplain, which was in the late 90’s. What book could be that phenomenal that I still have fond memories of it for more than fifteen years? I decided to find out and reread it. Short answer: that one qualifies. The author is a highly articulate renowned sociologist who expresses his experience of two different sorts of diseases without rancor and without sentimentality. (He has since written much more about “illness narratives.”)
As I read his experience of a heart attack and then of cancer, I found myself at the source of so much that I have incorporated in my interactions with patients. Straight off in the opening pages he asserts, “[The problem with] taking recovery to be the ideal is, how is it possible to find value in the experience of an illness that either lingers on as chronic or ends in death? The answer seems to be in focusing less on recovery and more on renewal. Even continuing illness and dying contain opportunities for renewal.” (p.2) Though I would rarely say so in so many words to a patient, on the right occasion I can guide a patient with open ended questions to making a perspective like that another choice to consider.
A recurrent theme throughout At the Will of the Body is his partially satisfying interactions with doctors and hospitals. Yes, they excelled medically, but fell far short spiritually and emotionally. For example, he says his doctor and he “talked about my heart as if we were consulting about some computer that was producing errors in the output. ‘It’ had a problem….Professional talk goes this way:’ A problem seems to have come up…Here’s our plan; any questions?’ Hearing this talk, I knew full well that I was being offered a deal. If my response was equally cool and professional, I would have at least a junior place on the management team.” (p. 10) As chaplain interns reading this book, we all yearned to be the ones to fill in the spiritual gap, thus the purpose I am sure we were to read it. If only one of us had been there, we thought, to “recognize the patient’s fear, frustration, and personal change,” he would not have suffered as much.
This book is so quotable. Just about every sentence would be a worthwhile Tweet. I noticed when I looked around at other blog reviews, at least one was more filled with quotes than commentary. Oh, I can’t resist either: here’s another: “The time when I cannot immediately put something into words is usually the time when I most need to express myself.” Doctors, as well-meaning as they may be, usually have no time for more than immediate dialogue. The beauty of making chaplains available is that competent ones are all about slowing down. About allowing no competitors for attention such as other people in the area or God forbid a digital device. They have the precious gift of open-ended time, where conversations can unfold at the deliberate pace that it takes to build trust, to risk being vulnerable, and to let pent up emotions gush out.
I hope that these many years later, that the book has become outdated in that respect. I hope chaplains are indeed filling in the gaps, and that doctors and nurses are more aware of how they can let their own “inner chaplain” at least spring into play long enough to acknowledge with a sentence or two what the patient may be experiencing. After the heart doc explained his plan of care to Arthur, he could have added, “Gee, this must really an earth-shaking experience for you.” Of course the danger here is that this might cue the patient to vent for a long time, but I think most know that the doctor’s time is very limited. This risk is worth it to make someone feel like a human being just with one sentence. Besides, a chaplain might be practically at the doctor’s elbow, waiting their turn to be there for you.
Post Script: I was going to end the article here, but when I looked at Twitter today, I saw a reference to the August 13th 2015 article in the online “Well” section of the NY Times called, “Doctors Fail to Address Patients’ Spiritual Needs.” The article is written by a doctor, who sees a heart-wrenching case and wonders if he is even to contact a priest, let alone bring up anything spiritual himself. He concludes, “I still regret my silence with that patient, but have tried to learn from it. Doctors themselves do not have to be spiritual or religious, but they should recognize that for many patients, these issues are important, especially at life’s end. If doctors don’t want to engage in these conversations, they shouldn’t. Instead, a physician can simply say: ‘Some patients would like to have a discussion with someone here about spiritual issues; some patients wouldn’t. If you would like to, we can arrange for someone to talk with you.’” Attaboy! Talk to us chaplains and make referrals!
Alas, At the Will of the Body is as timely now as it was years ago.