The white line drawn through the heart of the Piazza del Campo struck my sons as a starting line of a race. Other tourists posed for photos, but my sons sprinted across the line toward the Gothic spires of the Duomo in Siena, ascended the steps to the church doors, and then raced down to see who would get back to the line first. I chuckled, proud of the fact that the most vivacious people in the piazza belonged to me. Then I rounded them up to continue our tour. We stood in the shadow of a magnificent cathedral, but I was too preoccupied with our itinerary to transcend my science-minded thinking and contemplate the scene's spirituality.
I dragged them into an art shop; I knew a remembrance of our Italian getaway on my living room wall would be a source of comfort after a rough ED shift. Begrudgingly at first, but then enticed by the visual feast, my sons helped me purchase the perfect piece to ship home. I began hurrying them out of the store without fully understanding the story behind our painting, like a typical EP who elicits just the facts and then dashes out of the room.
Then stupefying serendipity intervened. The storeowner said, “Before you go, I'll tell you more about your painting so it will be special to you.” What happened next cannot be a coincidence. What I thought was going to be an art lesson transformed, in a way that makes me think maybe someone up there has a master plan for me, into a dose of perspective that had not only been missing from my own life but was also important to explore in EM.
The tower in my painting, the storeowner explained, is Siena's government building. Medieval architects designed it to be the same height as the cathedral to show that humanity and spirituality are in balance. Balanced architecture inspired citizens to feel order within themselves. They knew back in 1215 that men can't govern a city if they can't govern their own spirituality. Now, 800 years later, I contemplated the teaching the medieval builders left us. My EM focus is secular. I fix the body without much thought of the soul. Maybe I'm off balance, and this was a reminder not to forget my soul.
The storeowner said the alchemic colors in my painting represent the three phases of self-growth. Alchemic painters believed that black is darkness and difficulty and that we gradually grow through the purification of white. Finally, we achieve red, the awareness of one's divine self and the highest level of development. The color gold represents God. Those hues on my wall, especially the red, would remind me of the importance of spiritual growth. On a good day, I can heal, bringing people from the darkness of black to the levity and improvement of white. But what about red, the awareness of one's divine self? Was something trying to tell me to remember the spiritual needs of myself and my patients?
The storeowner locked up his store and walked us out to the piazza line to which my sons had been drawn. “This line is a tangible reminder of the balance between physical and spiritual. On one side, Siena's church, the place to cure the soul. On the other, our famous hospital, Santa Maria della Scala, one of the oldest hospitals still surviving in the world.” He didn't know I was a doctor.
Trust in a Higher Power
This time when I looked at the striking white line, I felt enlightened. “The line is equidistant between church and hospital. Curing the spirit belongs side by side with curing the body. You cannot help one without the other.” He had no idea I'd dealt with burnout, depression, divorce, and job upheaval without considering religion as a resource for coping. As if they knew, my kids had been passionately sprinting across the line and up the church steps toward the spiritual world that I don't always incorporate into our lives. Maybe I need to follow their example. Maybe we all do. The wonder of this message, that maybe I needed to nourish my spirit, restored my hope and faith.
As physicians, we turn to science for understanding. Our inability to see meaning doesn't mean it isn't there. EM is full of births, deaths, and all sorts of miracles and horrors in between that sometimes I can't comprehend. I have to believe that there are reasons, answers, meanings, and purposes that I'm just unable to see. Maybe I will grasp them if I slow down and listen, like I did in the art store. Or maybe it comes down to trusting that there is a higher order to things that I may never glimpse, and the best I can hope for is acceptance, not understanding.
Trust in a higher power can be a resource for working with patients in crisis. When people are distraught, they want hope, and faith and hope are synonymous. Sometimes, when we doctors don't have much else to offer in times of desperation, we can give people comfort simply by acknowledging their beliefs. You don't have to be a religious person to be qualified to talk about God. Even if God's not an interventionist, at the very least, believing keeps people from feeling alone. People of strong faith are more likely to die at peace and less likely to engage in futile care. It's OK to have faith and to acknowledge our patients' faith.
When you've seen horrible things, it can be hard to have faith. After witnessing pain and death, there are EPs who are left doubting that there's a higher power. Then, on the other hand, there are those who need to believe that there is a higher power because if we are the only determinants of life, death, and birth (on a good shift), it is too great a responsibility to bear. In our world where misfortune runs rampant, I need to have faith in something good. The wonder of a day like I had in Siena, with its astounding serendipity, encourages me to believe.
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