Notes on “Midrash and Medicine. Healing Body and Soul in the Jewish Interpretive tradition”
The book is a collection of essays and articles that present the views of some of the most sensitive people to the ideas of jewish cultural tradition of midrash within the healthcare settings. The book is divided into themes, within each of them two different people present their perspective views on the given subject. These are not always the opposite views, I would rather call them complementary of each other. For example, in the first pair essays exploring the use of metaphors in the healing process both Rabbi Simka Y. Weintraub and Stuart Schoffman describe the use of metaphors in understanding of one’s illness and in accessing the healings. While former advocates for the use of metaphors, latter supports his claim with personal experience. Yet, later he would suggest that the whole subject of metaphors is not that simple. The trick, as he points out is when instead of using metaphors to describe disease, one starts using disease as a metaphor, as, for example, the political figures have compared Jews to tumors and the Arab citizens of Israel to cancer. As I said earlier, these two essays do not contradict each other, the second essay is merely calling for our attention to the other side of metaphors.
In the pair of essays named Context of Suffering, Context of Hope there seems to be more contradiction. Here Rabbi Aeryeh Cohen is responding to the essay (chapter) by Ruhama Weiss Neither Suffering Nor Its Reward with detailed critique not only to the ideas expressed in her work, but also to the validity of information she is drawing her conclusions from. Even though the author shows clearly his disagreement with Weiss, yet at the end he admits that his critique has been mostly technical as it has been based on the rhetorical nuances of the theological statements, while the actual sense of Weiss’s work is made within a certain framework that is not so technical, that is more so to say human, and that is perfectly valid in its main proposition – that getting in touch with the reality of being human is possible only through the acknowledgment of inevitability of death. Thus, again, the two essays turn out to be complementary of each other.
This approach, this type of structure in presenting the “difficult” ethical and spiritual topics serves a valuable lesson for anybody immersing in philosophy in general, and specifically in relation to healthcare as it demonstrates that there is always at least one more side to look at any subject. This teaches us to be attentive and not jump into conclusions even when there seems to be enough ground for it.
For example, a pair of essays united by the title God in the Doctor’s Office reflect two opinions on physicians involvement in spiritual care. The first essay Talking to Physicians about Talking about God written by the editor of the volume deals with the ideas of re-introduction of the concept of God into the the healthcare settings. It is not really about a specific religious practice but rather of a common spirituality that resides in our everyday life.
The author notes that this type of spiritual care can be achieved through conversation and proposes that there should be more communication between patients and doctors as well as between doctors in order to “arrive at the wholeness that might be the goal of our healing impulses” (p. 92).
One of the ideas of how to make this communication work is by what Cutter calls co-location, which is necessary as with the patient, just as well between the doctors. All of this should provide the perfect settings that would help meet the needs of patients in their healthcare experience.
While all of the proposals in this essay are valid, it is through reading a response to Cutter’s essay by an actual physician that opens other perspectives on the issue. Dr Ronald Andiman in his Physician’s Response to the Midrashic Invitation does not deny the validity of Cutter’s arguments and ideas. He readily agrees that it would have been perfect to be able to dedicate more time to his patients, get to know them better, and build a trusting relationship with them.
He goes on to show that the realities of doctor’s practice are far from the idealistic picture. First of all, because of the time frame in which the doctor has to be able to provide care to many patients. But, that argument aside, there is an even stronger argument that I found to be necessary to consider – it is the actual expectations that patients have of their doctors. As the author puts it, many patients would actually be impatient with an extended process of communication; most patients are used to getting their emotional support elsewhere.(p. 98)
Some patients have even complained about a doctor who had raised religious questions with them. Another important question is what exactly is spiritual support and in what form a clinician is supposed to offer it. The author rightfully notes that most doctors have not been trained for it. In other words, he argues that it depends on each individual and can not be approached on the “one size fits all” basis.
The author also touches upon the phrase “the scientifically oriented busy physicians” used by Dr. Cutter and expands on the fact that it seems to imply that doctors are insensitive to emotional or spiritual needs of their patients. He points out that this statement is most unfair and is based solely on the assumption drawn from, in fact, the lack of time that physicians are able to dedicate to each patient. In reality the doctors are often deep and spiritual people who care and worry about their patients’ not only physical but also a mental and spiritual wellbeing.
As for the idea that doctors should talk between each other about their patients – Andiman replies that, in fact, they do. Maybe they do not necessarily hold long meetings in one room, again, due to the lack of time, but they do discuss their patients’ by phone or in writing. The interdisciplinary meetings also take place, but usually are held for the end-of-life decisions.
While I totally agreed with the premises and conclusions of the first essay, the response had shaken me to wake up a little from the fantasy of the “ideal” healthcare, and realize that it is, in fact, ideal only from one perspective. It seems to be right to say that each person in the team of specialists working at the hospital is there to do his/her particular job. Asking of a nurses and doctors to provide spiritual care could be compared to asking a chaplain to diagnose an illness.
The training that each member of the hospital staff went through had brought him or her to the exact position he is holding at the moment and is good at.
Andiman says that at the very least the clinician should know his patient well enough to decide how much emotional, psychological, or spiritual support is optimal for them. This, I believe, is the best description of what can be asked of a doctor. Once he had identified the spiritual needs of his patient he should refer them to the spiritual care team who are trained to do this kind of work.