Medicine For People!

December 2005

How We Spend Our Lives

In these short winter days we humans traditionally fall into a time of introspection. May I share my thoughts and ruminations with you? Here are recent lessons learned during days in my office.

Lessons on Love

Let me take you in the room with me as I sit with a 65-year-old woman who has a problem. She hasn't had intercourse in twenty years, and her vagina no longer possesses the elasticity and lubrication she enjoyed in her younger days. Now, she tells me, she has a boyfriend. (Yes, dear younger readers, we never outgrow our desire for special "friends.") Unfortunately, their attempts at intercourse bring only pain and difficulty. She hopes that estrogen can help her regain this youthful ability, but she wonders about the risk of estrogen.

I tell her that we generally use identical-to-natural hormones, which are safer than the horse hormones but that even these can increase the risk of cancer. I add that, for her, I believe the health benefits of a happy love life outweigh the risk. Not just slightly, but greatly.

She smiles with relief. "Both of us are lonely people," she said. "We need to be together, and physically as well. Can you write me the prescription?"

As I think of this woman, I am quietly happy. We have only so many years on this earth, and, whether we want it or not, they will pass by. We can try to hoard those years, or we can decide what we want to spend them on. We can spend them in loving relationship, as this woman chose to do.

Lessons on Listening

Last week I visited another patient at her home. For some years her strength has been dwindling, and she had called to tell me that she was dying. We had been friends outside the office and had long enjoyed each other's company. Now, except for her caregivers, she lived alone. I went to see her that afternoon, examined her, and found nothing to make me think she would stop breathing any time soon. Despite my reassurances, she repeated that she was dying. She wasn't worried, she added; she was ready. She wanted to talk about it. I respected her sense of her own mortality, so I sat with her and listened. I found her voice soothing, as I always do, and the hour at her bedside passed quickly.

As I sat there, I found my mind drifting back to an afternoon at a hospital in Wisconsin, listening to a man in his hospital bed tell me things he thought important to say. At the time I did not feel the information he imparted necessary to diagnosis and care, but I recognized his need to speak. From that hospital room I looked out the window at the trees and the lawn and thought about my wife and two young children at home. I felt the tension between my desire to help him and my familial responsibilities.

Last week I gave thanks that the tension was no longer there. My children have left home; they are self-sufficient. I have time to spend listening to someone who needs to talk. I can spend my days in ordinary acts, forgettable acts, but acts that give me an abiding sense of satisfaction and peace.

As I write, my patient is still alive. As for her dying, I'll leave the timing to her.

Lessons on Giving

Let me tell you now about a family we feel fortunate to care for in our office. The husband works in construction; his wife works at home. They have a child of their own as well as twelve they've adopted. Last week two of the children were in the office for physical exams to play basketball. They are happy children, not at all self-centered. Their parents take them to church each Sunday. The family, I suspect, would never evangelize about their faith. They are among the quiet multitudes that live out their beliefs in the world that is all about us, the world that never seems to get onto the TV screen.

When I see how they spend their resources and their years. I feel enriched just to witness.

Lessons on Science and Religion

And all this, believe it or not, speaks to me of the Intelligent Design debate currently in the news. Initially when I heard about this controversy, I groused that our children were going to have a difficult time competing in the world economy with crippled ideas about basic biologic principles. Reading more carefully, I realized that some Creationists were themselves evolving. No longer were they arguing that the world was created 4000 years ago; they were accepting the concept of a few-billion-year-old earth. That's an evolution. I like to think that we students of natural selection can evolve, too. Yes, most of us are betting that life occurs through entirely natural processes, but we can't yet prove that in every detail. Why not allow that we don't know everything? Our knowledge of the natural world progresses a great deal more quickly when we approach it in humility and a sense of wonder.

Did you ever hear this joke?

One day a group of scientists got together and decided that humans had come a long way and no longer needed God. So they picked one scientist to go and tell God so.

The scientist walked up to God and said, "God, we've decided that we no longer need you; we're to the point that we can clone people and do many miraculous things, so why don't you just go on and get lost."

God listened very patiently and kindly to the man. After the scientist was done talking, God said, "Very well, how about this? Let's say we have a man-making contest." To which the scientist replied, "Okay, great!"

"But," God added, "we're going to do this just like I did back in the old days with Adam."

The scientist said, "Sure, no problem" and bent down and grabbed himself a handful of dirt.

God held up his hand and shook his head. "No, no, no," he said. "You go get your own dirt."

This joke highlights one of the most egregious errors we humans are prone to: the notion that what we know is final and absolute. In scientific as well as religious disciplines this preconception leads to bias against new ideas. Here are some examples from medicine.

Maybe some enthusiasts for Intelligent Design share the same error, but many do not. The Pope, for example, has stated that the idea of evolution does not contradict Catholic doctrine.

I conclude that, be we "scientists" or "religious," we are all challenged to keep our minds open and acknowledge that the final answers are not in yet.

Which brings me to my favorite story about prayer:

Mother Theresa is asked what she says to God when she prays. She replies, "I don't say anything. I just listen."

And when asked what God says to her, she says, "He just listens, too."

To me, dear Reader, the essence of both science and religion is the ability to listen and observe.

And then, after that, we must honestly question ourselves. Do our beliefs make sense? Does our course of action respect the rights of others?

A Holiday Wish

All our textbooks, all our religious writings, result from the efforts of many intelligent and hardworking people. In the textbooks, at least, we know for sure that there are errors. We just don't know where they are. The future will correct our mistakes. May we in our spiritual lives share that same humility and willingness to learn.

In this holiday season, we wish you good health and fulfillment in this coming year of 2006.

We give thanks for you our patients. We appreciate your trust in us. We give thanks to you for sharing your lives with us. We are eternally grateful for these limited years on earth that have been generously given to us, that we can spend them in part learning from you and sharing our days together in this ancient, incredible, and unendingly original and holy world.

- Douwe Rienstra, Bonnie Corra, Dixie Scoffield, Pat Herkal

CJK March 16, 2006

story: People Teaching the Doctor, December 2005

Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.