The big question

Monica Maalouf
Chicago, Illinois, USA

 

Open Heart, painting by Monica Maalouf

“Doctor, why are we here?”

I had just finished answering her questions about her insulin dosing and was crouched down, examining her foot rash, when I looked up at Mrs. Syed, feebly trying to mask my annoyance.

“Well, these are just the rooms where my evening clinic is on Tuesdays,” I answered bluntly.

Mrs. Syed has a tendency to throw questions at me rapid-fire and my mind was aching from the previous eleven hours of clinic. My soul was throbbing after having just delivered a cancer diagnosis. She was my last visit of the day and my patience was now razor thin.

But Mrs. Syed did not skip a beat. She smiled at me, almost laughing through her bright pink lipstick, as she adjusted her dark, wispy hair behind her ears — a tendency that failed to hide the grey peeking through.

“No, no, Doctor,” she proceeded, “why are we HERE? What’s the meaning of all this?”

It was 7:45 pm on a Tuesday and she was asking me the meaning of life.

“Mrs. Syed,” I sighed and straightened, placing a gentle hand on her shoulder, “that’s a question for you to take up with God,” I answered as I pointed upwards with the index finger of my other hand.

I felt comfortable invoking God because her earlier mentions of Ramadan and Arabic scripture had told me she was religious.

“I have asked Him, Doctor, but He doesn’t answer. What do you think?”

My defenses dropped and the weight of the day slipped off my shoulders. I dragged over my rolling stool and plopped down beneath the exam table where she was sitting, placing myself level with her floral dress, her eyes looking down at me.

I am not sure what it was, but I wanted to answer her. Perhaps the trials of the day had worn away my professional exterior; perhaps it was that the eyes of a woman twice my age were pleading with me; or, perhaps it was because I wanted to know what she thought of my answer.

I had been forced to confront this question a million times. Never out loud, but often in my mind.

Why did she die? How did he survive? How is this fair? Why did this happen? Why ARE we here?

Grappling with these questions, contemplating the meaning of our existence, is not a struggle unique to me. As physicians, our daily dance with life and death, illness and health, frequently summons us to God’s doorstep and begs us to ask: “Is anybody there?”

A few years ago, just before my wedding, I was having a conversation with Father Khalil, a Catholic priest who would be part of our wedding ceremony. We were sitting around a dark stained dining table, a stack of empty forms between us. But, rather than discuss the details of my upcoming nuptials, I was surprised and delighted to find him intensely curious about my profession. He asked about my reasons for choosing medicine, details of my day, and conversations with my patients.

He asked me how I treat depression.

“That’s an interesting and complicated question, Father. Why do you ask?”

He explained that he had a woman in his parish whom he felt was depressed. She had lost her husband the year before and was grieving his loss; she was struggling financially and had become socially withdrawn. He had tried to offer her spiritual solace but he felt that it was not quite enough and he was worried about her.

“Prior to modern medicine, people used to come to the Church, to the Confessional. That’s where they would look for peace. Today, people still come, but mostly, it seems, they go to their doctors,” he told me. As a young physician, I had often winced at the idea of God playing a role in medicine, of spirituality existing in the exam room. Medicine is science. Medicine is evidence based. Medicine is certain.

That is what medical school had taught me, right?

Just a few years into practice, however, I realize the truth is far more grey. Few things in clinical medicine are absolutes, and every day my decision-making is nuanced by patient desires and individual preferences. What I take home with me at the end of each day are the stories of people, not the science behind their diseases. And every day, I hear God invoked in my presence as patients thank or question Him/Her depending on the news I have to deliver.

I could tell from his tone that Father Khalil was not condemning the flight from the Church, but was genuinely eager to learn how he could better complement his practice by understanding my own. I wondered if the same might be true in reverse. Perhaps exploring and understanding spirituality would help me better serve my patients. Perhaps it would help me better care for myself.

When Mrs. Syed threw her question at me, I had mistaken it for an interruption, another task preventing me from writing my notes and getting home to my doting husband and eager pup.

But in truth, it was an invitation.

“I have my thoughts about why we’re here,” I told her, “but, tell me, Mrs. Syed, why are you asking?”

“I am sometimes struggling with things, Doctor, and I wake up and think, what is the purpose of this? Why am I here if it is just to serve this man?”

Her marital strife was something I had become familiar with. She was an elderly victim of a long-ago arranged marriage and was unhappy. Her personal struggles had manifested as depression and anxiety in the past, and today were the source of her existential distress.

“So, why is it we are here?” she pressed me, nodding at me anxiously for an answer.

“I don’t have the answers,” I fidgeted, realizing the importance my words could have, “but my opinion is that we are here to love one another. Love is what makes us human and it’s what remains in the hearts of our families and friends when we are gone — ”

“But love — I don’t have this,” she said, gesturing aggressively with her hand — as if reaching out towards this elusive emotion. She was still seated above me and I could feel her distress washing over us. She was not happy with my answer.

“That’s not true Mrs. Syed,” I answered calmly, “love comes in different forms for everyone and I know you love your daughter very much… and that she loves you.”

Of this, I was certain, because I had the privilege of being the primary care physician for the entire Syed family. Anisha came to appointments frequently with her mother — organizing her mom’s medications and asking me when she thought more testing was needed. Their frequent fussing together in the exam room told me their relationship was filled with bickering but also mutual love and admiration.

“Yes,” she said.

With that small affirmation, the atmosphere of the room shifted. I could see the tension in her neck muscles relax. For the first time I had ever witnessed, Mrs. Syed became quiet and contemplative.

“I will think about this,” she assured me.

As I wrapped up the visit, placing orders for diabetic bloodwork and scheduling a follow up appointment, I found that the desire to rush home out of the clinic had subsided. I had helped Mrs. Syed find a nugget of peace in her day, and in doing so reminded myself of our common humanity.

To sometimes find oneself fumbling in the darkness, looking for a guiding light or a helping hand, is perhaps one of the few universal human struggles. It is a struggle that bridges science and medicine with spirituality and God, and it is a struggle that connects us with our patients.

Perhaps, sometimes, it’s okay to fumble aloud together.

 


 

MONICA MAALOUF, MD, is a primary care internist and assistant professor of medicine at Loyola Stritch School of Medicine. She did her undergraduate training at the University of Chicago where she received a degree in anthropology. She went to medical school at the University of Minnesota and did her residency training at New York University School of Medicine. Throughout her training, writing has been an essential part of her professional development. As a practicing physician she maintains a narrative blog and teaches narrative medicine to medical students.

 

Summer 2019  |  Hektorama  |  Doctors, Patients, and Diseases