Medicine For People!
The recent news blitz about the Terry Shiavo case and follow-up stories about long term care insurance has got me thinking about the time I spent caring for nuns in the Midwest.
The School Sisters of Notre Dame is a religious order of women who devote their lives to teaching in the Catholic school system. When these nuns become unable to work in the schools, they retire to the convent in Elm Grove, Wisconsin, to spend their last days. I had the good fortune to be asked to share in the care of these sisters.
This wasn't the usual "doctor" experience, with modern buildings and high technology. The convent was of stone. Gargoyles surrounded the roof. The unexpected outcome of my profession was that it was a ticket into an area where ordinary mortals never walked. I'd knock on an ornately carved wooden door and wait a while for someone to come. Often it was Sister John Baptist, smiling and businesslike in her severe black and white habit. She'd lead me up to the third floor, always inquiring graciously about my family and my practice. She never chit chatted very long, but led me to our business in a room adjacent to the dispensary. There, around a table, waited my several patients.
The ladies I saw in this part of the convent still took an active part in the operation of the convent. They might work in the kitchen, the gardens, or on the in-patient floors taking care of the nuns who were ill. If they needed to see a doctor, they would gather together in this room. Apparently they had little to hide from each other. Sister John Baptist would tell what she had done so far, and I would then question the ailing nun. If I wanted to listen to her heart, the nun would pull apart her outer garment by a couple of inches, reach inside to some other garment, pull that aside by a couple of inches and by slowly dissecting down through three or four layers, expose for my medical examination about two square inches of skin, somewhere in the vicinity of her heart.
The nuns treated me with the respect given to a Mafia godfather. Whatever I advised was seconded by authoritative head nodding from Sister John Baptist and received without question by the retired schoolteachers. They never asked why I prescribed what I did and seemed to have unwavering trust in my knowledge. A lovely ninety-plus-year-old nun asked me once, "When am I going to see Jesus?" I was flattered that she thought I might know.
After seeing Sister John Baptist's ladies, I'd walk to the other wing to treat the nuns too ill to work. They lived in single rooms in hospital-like wards. The advantage here was that they were in a hospital gown and I could do a decent examination.
Here too, I dealt with a delightful, charming and inspiring group of women. One nun lay in a bed with a collapsed vertebra, something that is extremely painful. She made only the barest admission that she might be in some degree of distress. I had to tease out the story of the nun's pain and her suffering. Standing at her side was one of her sisters, who displayed real affection and real concern for my patient. I made my recommendations, and her sister nuns used every means to make sure that the patient's days in bed were spent in comfort.
The convent was also a place of devotion. In a chapel attached to the in-patient wing, services were held every day. At that time I was a practicing Catholic, so when mass coincided with my visits there, I was invited to attend. My schedule usually allowed no more than a few minutes, but I always found comfort there. These ladies were not "residents" as are people in an extended care facility. They lived as members of a community with deep roots and powerful meaning. They readily acknowledged their need of me, and they had something vital to offer me as well.
When I cared for aging patients at the local hospital and nursing homes, often I'd see loneliness and fear. Many times the anxious and guilt-ridden family was divided and unsure of how to handle matters of life and death. The patient and family sometimes harbored doubt about the level of commitment of we doctors and our nurses.
What a contrast was the convent! From what I could see, the sisters lived and died in the serene knowledge that their life had been lived well and that death was not the enemy. They trusted their sisters and, to my great appreciation, they trusted me.
When there was something we could do to make a sister comfortable or to return her to a meaningful life at the convent, we would do all in our power, and she would participate fully from her side. When a nun drew near to death, however, there was no effort, on her part or her sisters' part, to delay the inevitable. We did not allow her to suffer and we did not prolong her dying.
I am convinced that were the model of the School Sisters of Notre Dame adopted by the United States health care system as a whole, spending on people in long-term care facilities would drop to 20 or 30 percent of what it is today.
How this model can be applied to those of us who haven't devoted our lives to service in the way that these School Sisters have, I don't know. Would that we could somehow learn from these Catholic sisters.
I will never forget them.
CJk February 1, 2006
Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.