In the first of the Lenten series of talks a leading figure in the Royal College of Physicians and Consultant at Nevill Hall Hospital, Professor John Saunders said:
Why should the sufferer see the light?
Why is life given to men who find it so bitter?
They wait for death but it does not come,
They seek it more eagerly than hidden treasure.
They are glad when they reach the tomb,
And when they come to the grave they exalt.
Why should a man be born to wander blindly,
Hedged in by God on every side? ( Job 3.11)
Job’s question is my starting point for two reasons. Firstly, it starts from faith – or rather his search for it. “My thoughts today are resentful,” he says later in the poem, “for God’s hand is heavy on me in my trouble. If only I knew how to find him…If I go forward he is not there, if backward I cannot find him, when I turn left I do not descry him, I face right, but I see him not.” Job searches for God and finds a blank. If only, I could know. Well, he can’t. He cannot know God. Nor can I. My guess is that nor can some and perhaps many of you.
But before I go further, let me make two disclaimers. The concept of faith in the Old Testament is different in many ways from the New Testament; but without expanding on this, I don’t think it affects what I want to say. Secondly, there is very little in the synoptic gospels which say much about man’s knowledge of God. The only example is where Jesus says, “No one knows the Son but the Father and no one knows the Father but the Son and those to whom the Son may choose to reveal him.” - a saying some have attributed to the mystery cults of Gnosticism, that were around in the second century. But again, I will pass on.
‘God has given us a book full of stories’, goes the children’s hymn that I learned in Sunday School; and within that book, separate from the history, the poetry, the creation myths, the prophets, major & minor, lies that group of writings called the Wisdom literature: Ecclesiastes, Job, Proverbs, parts of the Psalms, and some of the apocryphal writings. Its fascination is that it is not concerned with God’s special historical revelation through the prophets but the idea that the one God embedded truth within all reality. General as opposed to special revelation. It is for wisdom is to mine its seams. It permits, indeed encourages scepticism, acknowledges ambiguity, reminds us that religion – or religious practice- can easily become an instrument of cruelty unless tempered with the sceptic’s honesty, and it offers an alternative to the prophetic revelation. In short, it offers a different way in and one that I think many moderns may find attractive. It makes a virtue of living with uncertainty, with truth that may be provisional. That appeals to me both as scientifically educated and as a bedside doctor. We have a lot of uncertainty in medicine, a lot more than many patients think: and I think one of the chief abilities of good doctors is to steer a course between different opinions, both scientific and personal. The wisdom literature speaks to me, despite its antiquity.
Secondly, of course, Job is raising the familiar question of human suffering and an omnipotent omniscient God. How could God permit this? Why should a good man like Job be cast into a state of utter misery, impoverished, diseased. Surveying suffering humanity in my daily life, what has God got to do with it or say about it? Anything at all? I shall return to Job presently.
In the remote 18th city of Konigsberg, Immanuel Kant, greatest of modern philosophers, wrote his series of masterpieces. Kant insisted that we cannot know what lies beyond our experience; and in his first Critique demolished the proofs of God’s existence set out by the mediaeval thinkers: Anselm, Augustine,Thomas Aquinas. We cannot know God is there – and, by and large, Kant’s arguments have been thought to stand the test of time. And yet he believed that human freedom was conditional upon God and later described himself as “ a man who believes that in the final moment, only the purest candour concerning our most hidden inner convictions can stand the test and who, like Job, take it to be a sin to flatter God and make inner confessions, perhaps forced out by fear, that fail to agree with what we freely think…By “moral faith” I mean the unconditional trust in divine aid, in achieving all the good that, even with our most sincere efforts, lies beyond our power.”
[“Two things”, he wrote, at the conclusion of the Critique of Practical Reason, “fill the mind with ever new and increasing admiration and reverence, the more often and the more steadily one reflects on them: the starry heavens above me and the moral law within me. I do not need to search for them and merely conjecture them as though they were veiled in obscurity or in the transcendent region beyond my horizon’ I see them before me and connect them immediately with the consciousness of my existence.”]
The existence of God and the immortality of the soul were the postulates of pure practical reason. Kant had, in his own words, done away with knowledge of God “in order to make room for faith.”
Faith, as we know from the writer of the letter to the Hebrews, can be viewed as something that gives substance to our hopes, something we are surrounded by, in what the writer terms “witnesses to faith around us like a cloud.” “Be not faithless, but believing”, said Jesus. “Because you have seen me, you have found faith.” But that faith, that belief in a person, the faith of revealed religion, is also personal in its cultural context; a choice from a menu, always held without the certainty of knowledge. Its essence is not its confidence, but its uncertainty.
[The intensely personal conviction and inner certainty of knowing that John Wesley described in his so-called Aldersgate experience is not for me – or I suspect for many Christians.]
I hope you will forgive me one further philosophical quotation. Here is something by Schelling, one of Kant’s most distinguished successors:
“Far from it being true that man and his activity makes the world comprehensible, he is himself the most incomprehensible of all, and drives me relentlessly to the view of the accursedness of all being, a view manifested in so many painful signs in ancient and modern times. It is precisely man who drives me to the final despairing question: Why is there something? Why not nothing?”
Schelling’s tortured question is hardly a new one and has generated volumes of publications of all sorts. We know there is and can be no proven answer, no knowledge. We can choose to park the question on the shelf as “too difficult” or we can see the answer in God, whatever the cultural package we see God as wrapped up in. In my case, liberal Western protestant Christianity. That may seem a thin diet for many traditional Christian believers,
[bound up in the conviction of an individual personal relationship with God, or finding comfort in an objective view of its central rituals.]
But I find that it has to suffice for me, for it acknowledges the crucial importance of uncertainty, while retaining the conviction of its reasonableness and its tolerance. As one of my teachers wrote, “if faith , hope and love are the gifts of God, as Christians are taught, they are nevertheless a peculiarly unreliable presence in most lives. My supply of them seems to run out every two days.” Our longing for explanations – which Job sought so desperately – our seeking of greater confidence in the numinous, our drought and thirst in life’s difficult times, our impulse to make sense and explore meaning in life, is not met in the certainties of so much Christian worship or the superficialities of church life. Here is the German poet, Rainer Maria von Rilke, in a letter written in 1903:
[Letter Four (16 July 1903)]
Have patience with everything unresolved in your heart and to try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don’t search for the answers, which could not be given to you now, because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even noticing it, live your way into the answer.
[In summary then, I hold a faith that is tolerant, held within a tradition which I value and freely acknowledge is the result of the chances of being born where and at the time I was, liberal in more senses than one, something both important, practical and intellectually defensible.]
How then does faith, that sort of faith, relate to work, to my work, a toiler in a therapy factory of our much derided & admired, criticized & loved, unrecognized & appreciated, undervalued & over rated, national health service?
Not all doctors see patients.
[Some look at the health of populations and sit in offices,; some work in the laboratory; some jump ship and become managers. In fact, doctors are quite a varied bunch.]
but most of us, most of the time are involved with patients: people who either suffer or risk suffering because they are sick, unwell, unhealthy in body or mind. Some know this, others don’t – especially at the start of life and at the end of life. Some never know their illness; some are almost too conscious of it. Some are troubled by trivia; others tolerate the almost unimaginable. To be a doctor, or at least a reasonably sensitive doctor, is to be aware of the spectrum of human experience and its response to disease, to pain, to anguish and to the ultimate existential threat of death.
I don’t want to claim that the doctor’s experience is necessarily unique but I suspect that it may be. The reason for that rather bold claim is that the doctor’s experience of the patient is not simply as a witness to, and an observer of, the suffering human being – family, friends, clergy, psychologists, teachers, police, social workers and a host of others have that experience. It is that the experience is filtered through a scientific education that can understand the mechanisms and causes, the implications and future, of so much of the patient’s problem. It’s easy to overstate, of course, and not all doctors are capable of the indwelling necessary to divine the interior of the human soul. Nor, of course, is this witness to a particular virtuous view of humans. People don’t become nice because they are sick. Nasty well people are often nasty sick people: having said which, let me add that most human beings aren’t nasty – at least no nastier than me.
Our view of the world is channeled through the use of language. It is words that we need to inform us, at least mostly. And words come at a price. Some words have higher prices than others and are perceived differently. People get upset by the word ‘cancer’ when often it is of far less a threat to life and well being than, shall we say, emphysema or ischaemic heart disease. But putting that informational issue to one side, serious diagnosis of some sort brings us, you, me, lots of people to a crisis in our lives. What was once so important now becomes somehow trivial. Priorities are re-ordered.
And ultimate questions are asked. On a small scale, they ask Job’s question: why? Why is life like this? What does this mean for me? Needs and fears which the day before hardly existed now dominate the mind: distraction initially impossible, a threatening presence that cannot be put to one side.
[I remember talking to a patient in the Intensive Care Unit once, who said that he was afraid to go to sleep. I asked him why. He said that it was because if he went to sleep, he was afraid that he would never wake up. At moments like that there are, of course, things that could be said – like why or what are you afraid of. But sometimes silence and a held hand is the better response. Yet the significance of his remarks has often made me think subsequently. What was he afraid of? Isn’t dying in sleep, peacefully, painlessly what most of us desire? I think the fear was not one of dying but rather one of being dead: the extinction of my life, the descent into nothingness, the end of hope and love and experience to one, who in one sense, was actually hopeless. Looking forward through Lent, Easter certainly has something to say about that.]
The crisis point in people’s lives that I meet is not always the illness itself, but the personal dimension of life that somehow has failed: squandered time, pointless quarrels, all the detritus of unrealised ambitions and broken relationships, unnecessary hurts and betrayals, the corrosive sense of failure: things that on some scale most of us experience in greater or lesser measure. It is one of the humbling aspects of medicine that patients will often reveal this to the doctor when they wouldn’t mention it to anybody else. The priestly function has changed in modern society: the medical professional is still trusted to an extraordinary degree – and I hope mostly with justice. Doctors too tend to be the problem solver, not the moralizing judge: knowledge of physiology, of disease’s effects, of psychological patterns makes doctors often useful in sorting out different sorts of life’s mess.
The patient has a new narrative before them and it is felt in a context for which no moral or emotional framework may exist; and certainly no vocabulary. [We are all slaves of language.]
The new narrative, the new story upon which the rest of life must be built is one imposed by something outside the patient, something revealed, even imposed by the doctor: a narrative named and framed that is different from the one they hoped for or expected.
I do not want to make claims that the doctor as believer is any better at this than the unbeliever. But personally it is the ability to see suffering in its unexplained and inexplicable context that helps me to make some sort of sense of it all, even as a question – firstly, biologically of course, but also existentially – what this might mean for a biological organism who also happens to be a human being, [that, in Shakespeare’s phrase in Richard III, is the ‘most replenished sweet work of nature that from the prime creation e’er she framed.’]
In the ugliness of disease, can I still see God’s image in man, can I see the possibility of fulfillment of some sort in the illness experience? Can I respond to the intrinsic human dignity? I hope that isn’t too lyrical a way of expressing myself.
[What is the expectation? Sometimes not much. Some expect little from life and get little too; some expect too much – all resource is finite. But often what is or should be there in crisis is the quality of solidarity (brotherhood, fraternity, if you will). Some of you may be familiar with the picture of the doctor by Sir Luke Fildes, painted in the 19th century and now hanging in the Tate Gallery. Dawn is about to break in a cottage where a mother and child await the outcome of the child’s pneumonia; the doctor sits in the foreground and the drama is in the space between. He can do no more: and in a world of evidence based medicine, paid for his session the space would be empty. But he sits there in solidarity with his patient, sharing the moment, waiting to see if the crisis leads to resolution or death - as so many of us have perhaps sat at the bedside of a dying family member. He offers nothing but his presence; he exemplifies Milton’s phrase that ‘they also serve who only stand and wait.’ It is the role and I believe the duty of the doctor in many of these situations – and less dramatic ones – to support with compassion and the insight that informs it, because]
t(T)he patient is in some way greater than the disease process that is to be managed.
The patient may unburden themselves of the moral, imaginative, intellectual and cultural gaps, the personal lacks and inadequacies, the traumas and broken relationships that face them. The story, their story is told back to them either to make sense of it, to order it, to simply understand it or to provide some sort of solution to it. In so doing, the doctor becomes part of the story. The experience sometimes produces a pearl without price, a quality of living that helps to throw light on future despair, their own and that of others. Some discover that there can be joy in the most profound and difficult situations. ‘The full soul loatheth the honeycomb but to the hungry soul every bitter thing is sweet.’ Others cannot endure the thought that anyone should comfort them.
RS Thomas found his faith informed more by the parish than any of his own studies . I think that is true for all wise people. They get past ego. Egos are sometimes a problem for doctors. For some of us, they are, I’m afraid, too big. We need to learn that our story is not as important than the other person’s. Bonheoffer said the same, Christ is always stronger in our brother’s heart than in our own…we depend on others for faith, the cloud of witnesses.
Doctors have the opportunity to be part of something eternal if they choose to see it that way. Their work is about using their high level intellectual skills and knowledge, analysing different perspectives, interpreting, inferring, sequencing, comparing, contrasting and evaluating, detecting and diagnosing, set alongside a daily experience of the great moral and metaphysical problems of human existence, and the marvel that is this life, and finding in it what there is of significance for themselves and others. The fantastic condition of mortality and impermanence and uncertainty .
But of course you can know a thing to death and be for all purposes completely ignorant of it. A man can know his mother or his daughter, and there might still be nothing between them but loyalty of a sort, and mutual incomprehension. How do doctors learn this? How can we practice if all we understand about people is built on knowledge from text books , and that a well turned cliché can stand in for wisdom? Do I feel that any human face is a claim on me, because I can’t help but recognise the singularity of it, the courage and loneliness of it… and know it is my own? How do I pass on to someone that they will remember grief but never without comfort, or loneliness but never without peace, if I have never understood those things profoundly for myself or learned them from the lives of others? And learned them from a world viewed through the spectacles of the believer in the majesty and love of God. Or do I look at their practice with indifference and say, I followed the protocols so it is of no matter to me what the outcomes are, and it is of no matter to me that no good has come and no evil has ended?
We know more than we can tell; some of our knowledge is not propositional but ineffable – knowledge how we do things, and above all knowledge of persons that we know but cannot specify. We see, as through a glass, darkly.
Theologians talk about a prevenient grace that preceded grace itself and makes us ready to accept it. Perhaps there is also a prevenient courage that allows us to acknowledge that there is more beauty in life than our eyes can bear, that precious things have been put into our hands and to do nothing to honour them is to do great harm. To see things through God’s eyes is to see through a different lens: that is where God and the tradition take me. Where does it come from if not from the God I often find I don’t have time to listen to?
The most basic religious belief is a vote for coherence, purpose, benevolence and direction and acknowledging that wisdom is living with doubt and uncertainty about it all. It takes a lot of knowing to know I may know absolutely nothing that is of importance to a soul in distress, but much is expected of our doctors.
Humans are creators of meaning, and there is nowhere that it matters more than in medicine. Man lives in the meanings that he creates. We, I, may not often succeed in this for in the messy muddle that we call our lives, we cannot fully solve Job’s problem or our own.
Job bemoans his fate in a series of chilling suicidal laments. Job’s friends try to explain his fate with lies of his evil before God’s goodness, but Job is having none of it. Enter God, who confronts Job in three chapters of terrifying poetic power. God makes no apologies, and no excuses for himself. Instead, he describes creation in all its beauty, its cruelty, and its utter unfathomability: “Doth the eagle mount up at thy command, and make her nest on high? Her young ones also suck up blood: and where the slain are, there is she.” We are no longer in the world of infantile religion, or naive therapy for the survivors of trauma. “The grand vista of nature opens before Job and it reveals the working of God in a realm other than man’s moral order.” God’s power emphasises the transcendent.
Faced with tragedy on the worst scale, authenticity is to offer no explanations, no pretence of understanding, no defence of faith. The God of the book of Job is not the reasonable, bland God of wishful liberals, nor the vengeful and punishing God of fundamentalists. He is as he is. That is what makes this book the most enduring handbook for me in dealing professionally with tragedy, loss, and despair.
NEXT SUNDAY we hear from Sir Trefor Morris CBE QPM, former HM Inspector of Constabularies. The talks are part of the 6pm Evensong at St mary’s Priory Church.
Words in [ ] may not be delivered but enhance the text.
Translations are from the New English Bible, 1970
Neville Ward. The Following Plough, Epworth 1978
JL Crenshaw. Old Testament Wisdom: an Introduction, SCM 1981
A Richardson. An Introduction to the Theology of the New Testament,SCM1958