Mahesh Kanojia, M.D.Hearing the dreaded diagnosis of cancer submerges a person into a swirling pool of the ultimate human questions. Who am I? Why am I here? What happens to me after my heart stops beating and my lungs quit breathing?
In all my years of medical training and the billions and even trillions of dollars spent worldwide each year on health care, research and scientific advances fail me in the face of such questions. No statistics will allay my patient’s fear, no prognosis will quell their doubts and no research results will quiet their uncertainties.
The Doctor As Human – Physician William H. Welch said, Medical education is not completed at the medical school, it is only begun. With the luxury of hindsight, I realize now that my diploma for finishing medical school was actually a license to learn. Medical school, my internship and my residency laid the foundation to begin the next phase of my medical training, becoming more fully human. Even as a young medical student, I always knew that I was a human first and a doctor second and that my patients were human beings first and patients second. So in my time, I have paid more than a few phone bills for patients just so they could communicate their needs to my clinic staff. I have mediated upsets and disagreements between spouses, parents, children and siblings. And on numerous occasions, I have sat and just listened when a patient had no friend or family to turn to. And although they rarely notice or care, in these situations, I usually benefit and learn at least as much as my patients. Twice each year, I invite all my patients and their families to gather together at my office and exchange their views and experiences with one another and with me. As a physician specializing in oncology, I deliver chemotherapy but I can not possibly feel what a cancer patient feels. No matter how empathetic I am or how much I want to understand, I will never know how a female patient feels when she loses a breast. At these semi–annual gatherings, I am simply a human, the catalyst that brings them together for mutual support. And in the process, I always learn something, too.
The Doctor As Healer – It took me awhile in the day–to–day practice of medicine to realize that cure and heal are not necessarily synonymous. It dawned on me rather slowly that often healing happens independently of diagnosis or prognosis. Even as cancer ravages someone’s physical body, I am often called to help them heal their life and their relationships, most especially their relationship with themselves and with the Divine. As a fledgling doctor, I was taught to think only of healing the physical aspects of the body. As I grew in my practice, however, I realized that I was missing the major complement of the mind and that the patient’s mind also needed healing. Most people think of a doctor as a healer of pain but that is only completely true if I take into consideration their physical and mental pain. Only then can I become a true healer.
The Doctor As Teacher – I have never thought of myself as a “Born teacher”. Growing up, I never aspired to be a teacher nor ever thought of myself as one. Increasingly, however, with the advent of ever–more complex and complicated technology and ever–more potent drugs, much of what my patients – and their loved ones – rely on me for is to be their teacher. The patients turn to me to help identify and thoroughly evaluate their options to decide which one is best for them and how to weather the side–effects of the powerful drugs involved. The patients’ families look to me to learn how to take care of their loved one who is suffering from this deadly disease and how to remain resilient and strong for their loved one with death written on their forehead.
The Doctor As Preacher – Henry Ward Beecher, one of the nation’s most popular preachers in the mid–1800’s, said, To array a man’s will against his sickness is the supreme art of medicine. Here is where the spirituality in my title really takes root and flourishes. Patients and their loved ones come to me consumed with fear, guilt and sometimes even anger and resentment. It falls to me to be their comforter and guide. I never imagined that I would be a preacher, either, and, in fact, I was never aware that I was a spiritual person at all. My good friend Dr. Nagarathna, Chief Yoga Therapist and Chief Medical Officer of Prashanti Kutiram, a 150–bed hospital in Bangalore, India, recently asked me, Why are you so spiritual? I answered that I did not know I was spiritual. That all I was doing was what is needed for my patients. I realize that there is a force above humans and I am trying to figure out myself how this superior force can help me take care of my patient’s pain. If that is being spiritual, then, yes, I am spiritual. And where this will end, I have no idea. Practice makes man perfect and hopefully I am headed toward perfection. Author Felix Marti–Ibanez sums it up well, To be a doctor, then, means much more than to dispense pills or to patch up or repair torn flesh and shattered minds. To be a doctor is to be an intermediary between man and God.
The Doctor As Artist & Bliss – Paracelsus was born in what is now Switzerland the year after Columbus set sail to the New World. He was a man of medicine and a surgeon who, to the best of our knowledge, never took a medical degree but learned medicine both from his physician father and on the battlefield. Back at the beginning of the sixteenth century, even without the benefit of medical school, he already knew what I soon came to learn in my own practice. Medicine is not only a science, it is also an art. It does not consist of compounding pills and plasters, it deals with the very process of life, which must be understood before they may be guided. And it was Voltaire who said, The art of medicine consists in amusing the patient while nature cures the disease. I have spent my twenty–plus years in practice learning from life and learning from my patients and incorporating all that I have learned into my practice. All of my experiences since I was born – what I have seen, heard, touched and tasted – have made me an artist. And as an artist, I now have the freedom to integrate and incorporate all my life experiences into the ultimate expression of who I am. And, like an artist who as long had in his mind what he wants to produce, at long last when it is produced, the artist reaches to the ultimate freedom and that is bliss.
Fifty centuries ago, medicine took root as an art and flourished as the purview of the wizard, the shaman and the priest. Around the time of Descartes, the pendulum swung to the opposite pole as the church relinquished ownership of the body to the scientists while retaining authority in matters of the spirit. With all the benefit of five thousand years of experience and trial and error, we know now that medicine is not either an art or science but rather part art and science. I for one am grateful that my patients have helped me learn and live that delicate balance.