It is in these afflictions, which succeed one another each moment, that God, veiled and obscured, reveals himself, mysteriously bestowing his grace in a manner quite unrecognized by the souls who feel only weakness in bearing their cross… Jean Pierre du Caussade from The Sacrament of the Present Moment
The past few mornings have unveiled in mist and fog, tentative spring dawns of freezing air and warming soil trying to break loose from the vise grip of a tired and dying winter.
I am struggling under the load of 14 hour work days in addition to keeping a barn clean and animals and humans fed. Even sleep is not restful when there is so little time to quiet myself in reflection and gratitude.
I am keenly reminded of my weakness as my strength wanes at the end of a long day, having slipped in the mud while trying to gain traction unloading a couple hundred pounds of manure from the wheelbarrow. Landing on my backside, my pants soaking through, I can choose to laugh or cry.
I choose to see the baptism of mud as a sacrament of the present moment, reminding me of my need for a cleansing grace.
I laugh and cry.
Though obscured from view, God is nevertheless revealed in these moments of being covered in the soil of earth and the waste of its creatures.
He knows I need reminding that I too am dust and to dust shall return.
He knows I am too often wasteful and a failed steward, so need reminding by landing me amidst it.
He knows I need to laugh at myself, so puts me right on my backside.
He knows I need to cry, so sends me those with the saddest stories and greatest needs.
He knows I need Him, always and ever more, to restore a sacrament of grace evident in the present moment and every moment to come.
As a family doctor, I work at clarifying obscurity about the human condition daily, dependent on my patients to communicate the information I need to make a sound diagnosis and treatment recommendation. To begin with, there is much that is still unknown and difficult to understand about psychology, physiology and anatomy. Then throw in a disease process or two or three to complicate what appears to be “normal”, and further consider the side effects and complications of various treatments — even evidence-based decision making isn’t equipped to reflect perfectly the best and only solution to a problem. Sometimes the solution is very muddy, not at all pristine and clear.
Let’s face the lack of facts. A physician’s clinical work is obscure even on the best of days when everything goes well. We hope our patients can communicate their concerns as clearly as possible, reflecting accurately what is happening with their health. In a typical clinic day we see things we’ve never seen before, must expect the unexpected, learn things we never thought we’d need to know, attempt to make the better choice between competing treatment alternatives, unlearn things we thought were gospel truth but have just been disproved by the latest double blind controlled study which may later be reversed by a newer study. Our footing is quicksand much of the time even though our patients trust we are giving them rock-solid advice based on a foundation of truth learned over years of education and training. Add in medical decision-making that is driven by cultural, political or financial outcomes rather than what works best for the individual, and our clinical clarity becomes even further obscured.
Over thirty years of doctoring in the midst of the mystery of medicine — learning, unlearning, listening, discerning, explaining, guessing, hoping, along with a little silent praying — has taught me the humility that any good clinician must have when making decisions with and about patients. What works well for one patient may not be at all appropriate for another despite what the evidence says or what an insurance company or the government is willing to pay for. Each person we work with deserves the clarity of a fresh look and perspective, to be “known” and understood for their unique circumstances rather than treated by cook-book algorithm. The complex reality of health care reform may dictate something quite different.
The future of medicine is dependent on finding clarifying solutions to help unmuddy the health care decisions our patients face. We have entered a time of information technology that is unparalleled in bringing improved communication between clinicians and patients because of more easily shared electronic records. The pitfall of not knowing what work up was previously done will be a thing of the past. The risk and cost of redundant procedures can be avoided. The patient shares responsibility for maintenance of their medical records and assists the diagnostic process by providing online symptom and outcomes documentation. The benefit of this shared record is not that all the muddiness in medicine is eliminated, but that an enhanced transparent partnership between clinician and patient develops, reflecting a relationship able to transcend the unknowns.