April 13, 2000
Care for the Soul
HUC conference helps caregivers connect with patients and deal with their own depression
"Medicine itself has fallen ill," Rachel Naomi Remen, MD, warned a crowd of Jewish caregivers last week. "Doctors nationwide say their work has lost its meaning," she reported, adding that a great majority have considered leaving the profession in the last year, and that 40 percent are clinically depressed, according to a recent study.
Just as troubling, she observed that while first-year medical students at University of California at San Francisco (UCSF) are filled with a sense of meaning and privilege with their work, "by the time they enter their fourth year [this sentiment] is gone and replaced by a cynicism and numbness, as if they've forgotten why they've come," she said. A UCSF study recently showed that 75 percent of third-year medical students are also clinically depressed.
While Dr. Remen spoke about doctors specifically, she stressed that "caring for the soul of all caregiving professionals" is critical in a time of cynicism, professional burnout, numbness and depression.
Author of "Kitchen Table Wisdom, Stories that Heal," Dr. Remen told the group stories collected from 10 years of teaching at UCSF that illustrate the depths of doctors' current malaise, and what is possible when these professionals regain the "wonder and mystery" of medicine. She called for a "radical reform" of the medical culture by "returning to the work of the soul" and "bringing the human wholeness" back to the profession. This is more than a cry for better bedside manner; it's a resparking of passion by moving beyond professional detachment to connection with patients.
Dr. Remen's remarks set the tone for the "Re-imagining Illness, Re- imagining Health" conference sponsored by Hebrew Union College (HUC), which brought together more than 140 rabbis, physicians, nurses, therapists and other caregivers to foster greater cooperation in healing.
Dr. Remen's remarks were not lost on conference participants. "I hope that we will use her insights to help break down the walls that often separate patients from healing, and doctors and other caregivers from their calling," said Rabbi Lisa Edwards, Ph.D. of Beth Chayim Chadashim. "Just being in common purpose with medical and other healing professionals, like cantors and social workers, was meaningful. Too often, professional conferences keep us separate and segregated from others who should be our partners in healing."
Healthcare providers also explored the spiritual side of medicine. "If you're a doctor who considers what you do a technical service, there's no reason for any of this. But if you're interested in the healing aspect, you need to be able to communicate with the patient on a deeper level," said Ronald Andiman, MD, a neurologist in private practice and former chief of neurology at Cedars-Sinai Medical Center. "To treat a patient, you have to understand what's in the patient's heart, in a sense, to make spiritual contact."
Similarly, Les Zendle, MD, associate medical director of Kaiser Permanente Southern California, said that while medical knowledge and technical skill are important, they are not always enough. A wise mentor of mine taught me that "patients don't care how much you know until they know how much you care."
Throughout the conference, participants shared thoughts about bringing greater meaning to their work and to those they work to heal. Rabbi Naomi Levy, author of "To Begin Again," helps patients write prayers to pray with their doctors. "It helps patients remember that their doctor isn't G-d, and helps doctors with the healing process. Doctors have been receptive -- one told me this was one of the most powerful and spiritual moments of his life."
The conference also emphasized the potential role of Judaism during times of crisis. "There are so many ways we lose sight of the need to link. People come back to synagogue when they need a rabbi. Touching people during these times and helping them find a connection back to themselves is at the core of Jewish healing," said Rabbi Barry Lutz, director of education for Temple Ahavat Shalom in Northridge.
Other participants focused on those who are too sick for recovery. "Preparation for death has been left out of medical work," said Lobsang Rapgay, Ph.D., of UCLA and the Mind Body Medical Institute at Harvard. Dr. Rapgay led a workshop based on the Tibetan Buddhist techniques to help dying become a peaceful and profound experience for the sick and their families. These practices include counseling, meditation and whispering a poetic narrative into the dying person's ear as death approaches.
The conference also incorporated the healing power of music and ended with a performance by singer/songwriter Debbie Friedman, who has been a longtime participant in the Jewish health and healing movement.
Rabbi William Cutter, Ph.D. of HUC said he was motivated to organize the conference to foster networks between healers of many disciplines and attendees echoed the need. "I work with so many doctors and I have such an ambivalent relationship with them," said Cathy Goldfarb, LCSW, who has worked with seniors and their families for 18 years. "It's hard to get a broader picture when a doctor doesn't communicate about what's happening with a client beyond the basic facts. This is an opportunity to understand where they're coming from. I hope what Dr. Remen teaches becomes part of the medical school curriculum."
The Healers Art
For 10 years, Rachel Naomi Remen, MD has taught a UCSF course called "The Healer's Art" to first year medical students to help them retain their passion and awe of medicine. She also teaches a continuing medical education (CME) course for practicing physicians, which illustrates what is possible when physicians regain the meaning of their work.
* After taking the course, a doctor who claimed nothing about his work moved or inspired him began seeing patients differently, asking them questions not taught in medical school.
* A Jewish oncologist who had not been to shul in years surprised himself by offering to pray with a cancer patient. She touched his cheek and prayed in Spanish and English, asking him to be blessed and strengthened by his work. Both were moved to tears. He now prays regularly.
* An ER doctor living on the edge of burnout for 20 years looks forward to the technical challenge of delivering a child -- perhaps his 200th. As he removes the fluid from the newborn's mouth and nose, she unexpectedly opens her eyes and looks at him "deeply and directly." He realizes that he is the first human being this child has ever seen and he wells up with tears. He now calls this the first baby he's ever delivered.
Dr. Remen's new book "My Grandfather's Blessings: Stories of Strength, Refuge and Belonging" (Riverhead, $24.95) was released earlier this week.
32 Pages of Comfort
Where do you turn to when you're in need of serious healing?
For many Jews, the Hebrew words of the standard liturgy are -- literally -- foreign and the English translation uninspiring. That's what too many of Rabbi Harold Schulweis's congregants at Valley Beth Shalom synagogue in Encino were telling him. So Schulweis set about writing and compiling the synagogue's own book of healing and comfort.
At just 32 pages, "Meditations and Prayers for the Renewal of the Body and Renewal of the Spirit" is really more of a pamphlet. But it is a moving and useful one.
Schulweis, who takes no author credit, has penned a series of sincere supplications, addressing the fears and needs of someone going through all the stages of illness and healing. Himself no stranger to hospitals, the rabbi uses plain but evocative language, leaving no feeling -- anguish, anger, acceptance -- unexpressed.
The theme of the prayers is evident in Schulweis's essay at the very end, "Why Me?" Make no mistake -- this is a distillation of hard-earned wisdom and deep study and reflection, devoid of easy answers and New Age hoo-ha. "Cancer is real, but it is not punishment," he writes. "Cancer is real, but it is not the last word."
The book has circulated throughout the congregation and has made its way into numerous sickbed visits. Funded by the Shafton and Gevirtz families in memory of Julia Gevirtz, it is distributed at no charge. For more information, call (818)788-6000.