At the beginning of my fourth year in medical school I had an encounter on the wards of the teaching hospital that prompted me to seriously consider leaving medicine. My mother had asked me to look in on her friend Jane, a woman in her fifties, who was dying with widespread breast cancer. She was a patient on the surgical ward where I was working as a medical student. I started visiting Jane regularly and began to get to know this quiet and lovely woman. One day when I arrived, I found her in a lot of pain. I went to speak with the nurse in charge, who told me that while medicines to relieve pain were available, she did not want to give them to Jane at this point, “In case she really needs them at the end.”
As it turned out, the end was just a few weeks away and, sadly, Jane remained in pain for most of that time. While she did have some moments of respite, these had little if anything to do with her medical care. Jane loved classical music. She had suggested I buy a book about the appreciation of music that introduced different composers and their work and linked them to the visual art of the French Impressionists. Sometimes, after discussing a composer and looking at the images in the book together, we would listen to one of her favorite pieces on her CD player. At these times, she would close her eyes and, with a brief softening in how she held herself, for a little while sink more deeply into her pillows.
Even though I felt awkward and inadequate every time I entered her room, Jane always seemed pleased to see me and would thank me for my visit in a way that made me feel that she really meant it. I would leave her room with a sense that I too had received something from her. It was as though being present to each other in this way, despite our powerlessness to change anything about of her illness or her pain, had brought us both into a mutuality of comfort and consolation. But I was also frustrated and at times outraged to witness her awful, continuing physical pain. Was this the best that modern medicine, with all its technological prowess, could offer? There had to be a better way.
In 1974, during a spiritual retreat at University College Dublin, I met Jean Vanier, the Canadian Catholic philosopher and founder of L’Arche communities for people with developmental disabilities.3 I told him that I was unhappy and disillusioned in my medical studies and thinking of leaving. He listened intently to all I had to say. When I finished, he said, “Before you do, I suggest you visit a place in London called St Christopher’s Hospice….” And then he added, “It’s a place of healing.”
I took Jean Vanier’s advice. A few months later I attended a one-week multidisciplinary training course at St Christopher’s. While there, I met patients who, though weak and frail, were some of the most complete human beings I have ever encountered. It was as though the fire of their illness had burnt away the nonessential and all that remained was their original selves.
I began to think more about what is meant by “healing.” Clearly it was distinct from curing, in the sense of fixing or making better, if it was what I was witnessing here in these individuals so close to death. Suddenly I flashed back to the peaceful give and take of consolation that I had experienced with Jane. I knew at that moment I had discovered the answer to the question as to why I was studying medicine. Even if I had not fully understood what it meant at the time, I was being called to become a healer. I felt deeply encouraged by this insight and was able to return to Ireland and finish my studies.
In August 1980, I began working in St Christopher’s and saw that in fact no one needed to suffer the way Jane had. With careful diagnosis and treatment, pain and other distressing symptoms could be relieved. I also learned that a healing environment could, in itself, have a powerful therapeutic effect. I was told that when I admitted a new patient in pain, I should try not to make too many alterations or dose changes in medications during the first twenty-four hours because, for many, just being in this hospice environment and experiencing close attention and compassionate care for even a short period of time could have powerful therapeutic benefits.
Even though I was skeptical at first about this, I was surprised by a change I witnessed in a man called John. I remember this fifty-year-old man well as he was one of the first patients I admitted to St Christopher’s. On admission the previous evening, he had been in severe pain from the lung cancer that had spread to his bones. He was already on a good regime of pain-relieving medications. I explained to him that I would not change anything that evening, that he could ask for extra pain medication as needed overnight, and that we would reassess and make whatever changes were needed when we saw him the next day.
The following morning, I found John sitting up in bed, looking relaxed and eating a piece of toast. When I asked him how he was doing, he replied, “I got some sleep last night. The pain is not so bad this morning.” It seemed that something had shifted overnight and that this had nothing to do with any clever medical interventions. When John added, “For the first time in months, I’m feeling safe again,” I began to understand that the change I was witnessing had something to do with a lessening of his fear. Suddenly I could see what Cicely Saunders, pioneer of the hospice movement, meant when she spoke of “total pain”: that pain is not so much a self-contained entity as a multidimensional and dynamic process involving every aspect of an individual’s experience, which is exacerbated by isolation and eased by coming back into relationship and community.4
I had just completed my first three months at St Christopher’s when I had an experience that was to turn my world inside out. At that time, I was happy in my work. I looked forward to going into the hospice every day and was giving my patients and their families my all. While there were obvious limits to what I could offer in terms of my clinical and communication skills, I tried to make up for this by being as openhearted as possible. Day after day, I was in the presence of pain and grief on a scale I had not previously encountered. I thought that good intention, careful listening, and my newly acquired skills in treating pain and other symptoms were all I needed. As I sat with a patient, I would take it all in—their pain, their fear, their regrets, their grief, their sadness—and respond in whatever ways I could.
Unbeknownst to me, I was paying a psychological toll by absorbing such a relentless flow of human suffering. The very openness I was offering my patients was also making me vulnerable to their pain. Walking home each evening from the hospice to the apartment where I was living with my wife and our baby daughter, I felt simultaneously enriched and emotionally depleted.
The straw that broke the camel’s back was a heartbreaking situation in which I had to tell three very young children that their mother was dying. As the patient’s husband and the children left the room where a social worker and I had been meeting with them, I knew that what I had just said—that their mother would never be coming home again—had caused them unimaginable pain. In just a few words I had told them something that would change their lives. It was not necessarily that I had done it badly; there was no easy way to put it. When they filed out of the room silently ahead of their father, I did not move. I continued to sit there, feeling hollow.
The following day I came to work in a fog. A sensation of being mentally clouded lingered throughout the day and I noticed that I could not easily concentrate. I was aware of a sense of dread in my chest and I became more and more apprehensive. As I walked down the corridor, my heart was pounding and my mouth was dry. I bumped into the medical director, Tom West, and asked if I could speak with him. We went to his office.
Tom listened carefully as I told him what was happening. “You sound exhausted,” he said. “I can see you’re doing a great job, but I think you may not yet have learned that you also need to take care of yourself. Two suggestions. First, take this Friday off. Make it a long weekend and think about going away somewhere nice with your family. Secondly, it might be helpful for you to have someone to meet with to talk to from time to time. I have been doing this for years and I would not have survived in this work without it.”
My head was still reeling, but I fel
t relieved and grateful that Tom did not think that I was crazy to be feeling this way.
Early the following week I met with a therapist. In the weeks and months that followed, I began to understand that I had suffered psychological trauma as an infant that had made me especially vulnerable to situations such as the one I had encountered with the young children and their dying mother. When I was three months old, my own mother had become seriously ill with tuberculosis while travelling abroad. On returning home, she had been hospitalized for nine months and was considered lucky to survive. During this time she was quarantined and I was not allowed to see her. I am told that when I was led into her room after all that time apart, I had stood at the doorway looking in at her with wide eyes, not recognizing who she was.
The work I did with that therapist was the start of a journey of descent into the unconscious that I have been on ever since. While continuing in therapy, I studied and trained in the use of guided imagery, active imagination, and dreamwork. Initially I saw these activities as exclusively personal pursuits that ran in parallel to the rest of my life. However, as my studies led me further into the field of depth psychology and the work of Carl Jung, this changed. From reading Jung, I began to understand that the unconscious is more than a personal process. Jung describes those aspects of the unconscious beyond the personal as “the collective unconscious,” and in his later work, comes to see this as a shared field of energy and information; something we as individuals participate in rather than possess. He writes, “The collective unconscious surrounds us on all sides….It is more like an atmosphere in which we live than something that is found in us….Also, it does not by any means behave merely psychologically; in the cases of so-called synchronicity it proves to be a universal substrate present in the environment rather than a psychological premise.”5 This way of thinking offered a bridge between the “inner work” I was doing on myself and the rest of my life in the world.
Through my studies of Jung, I was led to the mythological roots of Western health care. I learned about Chiron, the centaur—half man and half horse. One day, Chiron was wounded in the leg by a poisoned arrow, leaving him with a painful, gaping wound that would not heal. Supported on the shoulder of his daughter, Chiron wandered the meadows of the mountainside where he lived, looking for healing herbs. Even though these did not work for him, he became wise in their use. The sick and dying came to see him from far and wide in search of healing. Sometimes his herbal treatments cured their illnesses and sometimes not. However, even if they were not cured, each one who encountered Chiron left feeling understood. In being attended to by someone who was also suffering, they felt more whole. They called Chiron “the wounded healer.”
That title rang true. It described something that had not been named in my medical studies but that resonated for me in my work. I was fascinated to learn that at the roots of Western medicine was a figure who embodied a fusion of human and other-than-human nature.
Chiron was mentor to many of the great Greek mythological heroes. One of these was Asklepios, who had been brought to Chiron as an orphan. Asklepios became Chiron’s favorite pupil. Chiron adopted him as a son and taught him all that he knew about the healing arts. Asklepios became a great healer, and was later immortalized as the Greek god of healing. For over a thousand years, pilgrims journeyed for healing to temples dedicated to Asklepios and his daughter Hygieia throughout the mainland and islands of Greece.
What happened at these temples was a healing ritual called “dream incubation.” Here the patient slept on the ground of the temple for the night and welcomed whatever came, dream or vision, as an epiphany, a visit from the god or goddess of healing. The practice honored the patient’s potential for self-healing that could be awakened in the right circumstances. As mythologist Carl Kerényi puts it, “The physician cannot act alone; side by side with his outside intervention, something inside the patient must lend a helping hand if a cure is to be accomplished. At the crucial moment, something is at work that might best be compared to the flow of a spring.”6
I was excited to learn that nature has been at the heart of healing from the beginnings of Western medicine. The temples of Asklepios were situated in surroundings of great natural beauty close to springs of flowing water. When someone arrived at a healing temple, she began a process of preparation and purification. When the time was right, the “incubant” was led at dusk to the temple. After making some ritual offerings, the priests would invite her to lie down on the ground. Everything led up to this moment. Lying down on the earth in the utter abandonment of sleep was the final and crucial step in doing all that could be done to enable healing to happen. The next move was not up to the physicians, or the priests, or the incubant herself. Healing, if and when it happened, came literally from the ground up, as the earth was seen as the origin of dreams. I have a photograph I took of the healing temple at Lissos on the island of Crete. Situated in a wild and beautiful landscape, its sandstone walls line a mosaic floor that has been worn through by the feet of countless pilgrims since the third century BCE. The open, empty space of the temple speaks to me of what I can and cannot do to help another come into an experience of healing. While I cannot make someone experience healing in the way I can control their pain, for example, there is much I can do to create the environment and circumstances that make it more likely that this will happen. The landscape around the temple, the towering sandstone cliffs behind it, the giant, ancient olive trees close by, remind me how nature is at the very heart of the healing process. There is a spring there that runs to this day, the same fountain from which the incubants would have drunk. The day I visited, someone who had been there just before me told me that he had seen a snake—the symbol of Asklepios and of healing in the ancient world.
I realized why I was so at odds with the study and practice of Western medicine: it had forgotten its origins in the myths of Chiron and Asklepios and the principle they represent of working with nature for the healing of suffering. Instead, Western medicine had invested its all in the historical figure of Hippocrates and his method of deductive reasoning and evidence-based biological materialism. The key operating principle of the Hippocratic method is summarized in the phrase opus contra naturam,7 “working against nature.” While I could see clearly how we sometimes need anti-biotics, and anti-inflammatories, and anti-cancer drugs, it also seemed to me that beyond this literalism, there was anthropomorphic arrogance and a profound disrespect for the healing power of nature.
In the early 1990s, while working with the palliative care team at St Vincent’s Hospital in Dublin, I met James, who had an inoperable tumor of his esophagus. This had shown up as an incidental finding when he was admitted with a heart attack, which he barely survived. His doctors had not told him about the cancer because they were concerned that he might not be able to cope with any more bad news. We had been consulted to see him for palliative care because he was desperately short of breath and very anxious. On the Friday afternoon when I first met him, he was so breathless that he was hardly able to talk. I recommended some changes to his medications to help his symptoms and promised to come back to see him after the weekend.
When I walked into James’s ward the following Monday afternoon and greeted him, I was surprised when he sat up in bed and greeted me in return. I asked him how he was feeling. He replied, “Last night I had the most amazing dream of my life.” I asked him to tell me about it. As he began to talk, his face lit up and his words flowed. He told me that in his dream a man had come to his bedside and woken him, and then taken him to the subterranean, Neolithic burial chamber of Newgrange in County Meath. This man had led James through a tunnel to the center of the tomb, and asked him to lean back against the tombstone. He then told him to walk out again. He gave James a shovel and told him to “start digging.” As James did so he discovered that buried beneath Newgrange was another “pre-ancient” city. As James saw the circular walls of the houses and the straight lines of stones th
at marked the side of a road, he knew that he had unearthed something of great value. He looked straight at me and said, “It was as if I had discovered gold!”
James finished by saying; “I was frightened before I had that dream. I’m not frightened anymore.” In the days that followed, he continued to weaken and never made it home as he had hoped. Despite not talking openly about dying, he quietly took care of his business. His wife and three sons were at his bedside when he gently slipped away.
What I learned from listening to James is that in working with dreams and the imagination in fluid and spontaneous ways, we are working with nature––our “inner nature.” I came to see that much of our suffering comes from disconnection from our own deepest nature, and that this inevitably gives rise to feelings of isolation, alienation, and meaningless. I learned that sometimes a person’s symptoms, be they physical, such as James’ shortness of breath, or psychological, such as his fear, have an underlying deeper diagnosis of disconnection from our deepest selves, and that simply offering respect and hospitality to our dreams enables us to tap into a wisdom that is not just personal but shared, universal, and Earth-based. This inner nature connection practice can ease our suffering by offering us an accessible path out of isolation and back into relationship.
I also saw what happened for James as a move from head to heart. By “heart” I am not simply referring to what Brian Doyle calls “the wet engine” that pumps us through our lives.8 I mean the heart as the source of wisdom and compassion; the heart as hub in a cosmic web of connectedness, where countless invisible threads radiate out in all directions. I saw that those who were the least afraid, and seemed to have the easiest times in their dying, were those who had come into their heart’s estate.
The Nest in the Stream Page 3
