The Line Dividing Pains

AmourBy David P. Clark, M.D.

On the day I graduated from medical school I took the oath of Hippocrates. I didn’t think much about the words: the oath was one more hoop on a long hot morning. My promise to keep patient confidences, always treat patients with justice, and never harm them seemed doable, straightforward, and common sense.

But, I hadn’t actually been a doctor, hadn’t made decisions when faced with suffering and inadequate data and unknown futures.

About four months after starting my first medical practice, one of my new patients, Sharon, called and asked if I would come to her home to answer her husband’s medical questions. Although an unorthodox request, I decided to go.

I was ushered into a living room where, to my surprise, I met ten family members. Once seated, Sharon’s husband Ben—the most prominent lawyer in town—rose and addressed the room.

Ben had recently received the diagnosis of advanced pancreatic cancer from another doctor. After intense research he concluded no treatment was reasonable and calmly noted he had, more or less, a few months to live—months that would likely be filled with pain.

“Doctor,” Ben addressed me, “my family and I agree…” He turned to the assembled group and with varying degrees of speed and emphasis, each of them eventually nodded.

“We have asked you here to request a prescription of sleeping pills sufficient that I could end my life on my own terms.”

I remember being indignant. I couldn’t imagine how a lawyer could ask me to perform such an illegal act.

When I asked why he had selected me, Ben answered without hesitation. “Your partners are all Catholics and we know you are not. We hoped you might take a more enlightened view.”

He and his family were pleasant enough when I refused. I pointed out that although I wasn’t Catholic, my church was similarly unenlightened and Hippocrates had long ago given a mandate for doctors: Primum non nocere (first do no harm). It had been an easy decision.

I thought of Ben when I watched the Oscar-winning (Best Foreign Film) Amour. The female protagonist Anne returns home after an unsuccessful surgery intended to remedy her paralyzing stroke.

Alone with her husband Georges, Anne makes clear she has few illusions concerning her condition and wants him to end her life. Georges, convinced assisting Anne’s death would be an act of harm against his beloved, refuses.

Georges’s certainty concerning the ethical course to be followed reminded me of my early confidence. Georges and I would never presume to suggest or impose on others the “correct” moral choice. However, because of our confidence in a moral vision without blind spots, we would know the correct action.

As Anne’s suffering increases, Georges’s world is reduced to feeding and cleaning and bathing his wife. However, it is neither the grinding physical labor nor Anne’s disability that crushes Georges, but impotence and then rage when he realizes his every action increases Anne’s pain.

As a surgeon, despite understanding the necessity of surgery, I spent sleepless nights worrying if I had caused unnecessary pain. When the surgery did not cure or worsened the situation, my sense of helplessness, like Georges’s, became anger.

In a late scene Georges seals the apartment doors and windows. Like Sartre’s characters in No Exit, he loses hope when he finds himself unable to leave a torment of his own construction. He cannot know precisely Anne’s isolation and pain but now understands that he cannot share or bear her burden.

Suffering, like DNA, is unique.

Georges cannot imagine a hope beyond the four walls; he believes he and Anne are cut-off. Without hope, moral lines he once believed absolute have become sand castles too near the ocean, washed smooth by the tide of Anne’s suffering.

Watching Amour, the faces of former patients jostled my memory. In Georges and Anne I heard the cries of Alan whose heart transplant failed and Roger who was reduced to ninety pounds by melanoma.

These two, like Georges, would have been offended at the thought of suicide or euthanasia until engulfed in their personal hell. I heard again their pleas to end their pain.

After years of caring for patients and second-guessing my own decisions, I now know the line between relieving suffering and doing no harm is thin and hard to see.

As a physician, despite my empathy, I remain an observer. I do not understand why some individuals in the midst of suffering can see a hopeful open door while others cannot.

I confess I do not understand why Jesus’s disciples Peter and Judas both crossed deep lines and came to different ends.

I share a contented life with my wife Terry, whom I have loved for over forty years. While both of us fear becoming a stroke-disabled Anne, my fear is becoming like Georges. I fear watching Terry drool and cleaning her incontinence; but even more I fear a lonely suffering so smothering that she believes she is alone.

I fear a life defined by respirators, feeding tubes, and a morphine drip; but far more I fear believing I am so alone I cannot see the line defining love, and could murder the wife I imperfectly love in service to what I imperfectly believe to be love.

I have always believed in Emmanuel (God with us) but after spending two hours with Georges and Anne I left with questions and a fear that challenge my certainty.

I wonder if the disciples looked back at the cross and feared interpreting and making practical decisions about Christ’s words.

Perhaps like me, they understood the concepts but the messy world narrowed and blurred their vision rendering them unable to separate conditions of the heart from less important issues.

Maybe they worried they’d be like Judas and Peter, lacking courage to stay true.

Or, maybe they worried they’d be like Georges, a man whose vision became so overwhelmed by the darkness of Anne’s suffering, and whose hearing became so deafened by guilt, that he could not sense or imagine or hope in the God who promised never to abandon us.

Like them, I wonder and I’m afraid.

Note: This post was originally published on the Image Journal blog Good Letters.