When a Friend Falls Ill

Expect neither exemptions nor easy explanations.

A friend was recently diagnosed with Alzheimer’s disease. Since that moment, his friends and family have been asking the same question over and over: Why him? Why should he find himself perched at the top of this long and seemingly inexorable downslope? What did he do to deserve such a cruel fate?

Western civilization’s classic text on the matter, the Book of Job, provides a sage warning against all attempts to explain suffering. Job’s friends eventually offered many sophisticated explanations, but their most authentic response to their friend’s plight was their initial one, when they simply remained silently at his side for seven days and seven nights, not pretending to know more than they did.

However, the reality of serious illness is simply too pressing to deny or ignore. When we meet such realities face to face, whether professionally or personally, we struggle to find words. Even if we cannot make sense of them, we at least need to cope with them, to get through the day and retain a sense of connection to larger purposes in life. It is here that we frequently get into trouble. 

Those of us who work in healthcare have a tendency to portray such situations in purely medical terms. People have diseases, therefore they need medical care. If a cure is at hand, we celebrate a triumph of modern medicine. My friend with dementia is convinced that he fell ill just a decade too soon, with definitive therapy just around the corner. When we lack such a cure, we call for more funding of biomedical research. In either case, we often find ourselves portraying a largely existential matter in medical terms. 

Casting such situations in a purely medical light is immensely attractive, principally because it seems to put us in the driver’s seat. Physicians have much to offer in many situations, but we are simply not cut from divine cloth.  To the contrary, we are made of human stuff, which means that we are inherently transitory, vulnerable, and mortal. Efforts to wriggle out of this natural state represent the most fundamental form of self-denial.

Health professionals, scientists, and administrators harbor something of a conflict of interest in this matter. Keeping our clinic schedules packed, our laboratories well-funded, and our hospital beds full makes good economic sense. For example, a physician earns a substantially higher fee for prescribing chemotherapy or performing surgery than for engaging in a long and potentially difficult conversation with a terminally ill patient about life’s end.

Yet medicine is no more capable than any other scientific or technological endeavor of shielding us from suffering.  To do so would mean insulating us from all external insults.  It would mean cutting us off from the world in which we live.  It would also mean cutting us off from our doubts, anxieties, and fears.  It would mean not only cutting ourselves off but shutting ourselves down, ceasing to be humanly aware and engaged in the lives we are leading.  In fact, it would mean no longer living at all.  It would mean dying to life itself.

What Western medicine needs most is a healthy dose of humility. Those who doubt it might take the following quiz. An acquaintance has just been diagnosed with lung cancer. What is our first question?  If the answer is, “Was he a smoker?” then we have tested positive. Why are we so keen to know if the patient was a smoker, failed to wear a helmet, or did not maintain a healthy weight?  It is because our first impulse is to claim an exemption. Many of us want desperately to be able to say, “That's too bad, but at least I needn’t worry that the same thing might happen to me.”

Before a better path can come into view, travelers often need to recognize how truly lost they are. We should feel genuine compassion for those who, like my friend with dementia, are diagnosed with serious illness. But genuine compassion is possible only when we recognize that forces beyond our ken – let alone our control – are at work in life. In the case of life’s very most important matters, expect neither exemptions nor easy explanations.

Presented by

Richard Gunderman, MD, PhD, is a contributing writer for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

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