martes, octubre 23, 2018

Job for doctors: Humanizing amongst suffering

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Job for doctors: Humanizing amongst suffering

"Médicos" Source:
David Buendía

Family doctors, specialists, nurses, and technicians constitute, without any doubt, an important health fighting front against those evils that afflict human beings since there is written history: suffering, loss, death. Nevertheless, we wonder whether we are winning such battle, or we are merely resisting the first strike. Are we prepared to finally confront the fact that we are inescapably finite, vulnerable, mortal beings? Or do we fall apart before words such as cancer, Alzheimer, stroke, ictus, depression, divorce, layoff… or eviction? And what do our health professionals need to confront that ocean of suffering that our environment is full of?

To answer these questions, we will first try to point out some specific problems that that obstruct the work of our doctors and that come from the cultural environment we live in. After this shallow analysis, we would want to propose a scientific deviation: the contribution of the doctor Job, collected from the Biblical Vademecum. Please, don´t pass from this article yet, we do not expect readers to learn about religion. But we do want to submerge in the deepest territories of human psyche when everything seems to be lost. In this area, the book of Job has been read and recited by millions of people who were illuminated in the midst of the battle in which you, dear readers, struggle every day.

Contemporary obstacles for the comprehension of suffering

Our Post-Modern Western1 has arrived, not without many avatars, towards a democratic, agnostic and intercultural era2. With its lights and shades, the truth is that our society experiences a strong orientation crisis, once the traditional identity elements have been removed, but they have not been replaced by others equally significant3. Moreover, we belong to the first consumerist world, which has brought along the deification of the aesthetics ideal: youth, money, and the cult of the body have made us enter into the bonfire of vanity. In it, the flashes of fame burn our wings and they unidimension4 us towards the impoverished world of what is seen and touched. Of course, the annoying slums of reality are ignored, with their sick, their elders, hospitals and sanatoriums. Besides, we live in immense urban hives, abruptly separated from nature and its movements, rhythms and interrelations. We have lost an essential reference point, and our gaze can only look as far as our belly button. Through all this, we are no longer part of a fertile world alongside countless living species, but of the planetary factory that nourishes our insatiable need for raw materials and resources. Homo orbi lupus.

This broad picture reveals a society where people has identity and vital orientation issues, impoverished before the prevailing aesthetic materialism in an environment that maintains any expression of suffering or loss as a taboo and that regards itself as the center of the universe.

On the other hand, and focusing on the health environment, who would dare hold in contempt the scientific advances applied to medicine? But all ups have its downs. Let me share with you a real anecdote5 that a kind and efficient doctor from the ESAD6 recently told me:

“In the clinical sessions that we periodically have, or when a patient is entrusted to us, it is not strange to hear things like: this is a lung with liver affectation, or else we referred to you and advanced liver and a kidney with bone metastasis... It is clear we are actually talking about patients, people, although sometimes it may not seem like it.”

This greatly effective medicine treats people like a piece of the production chain7. The epitome of this situation is represented by the famous TV series House, a great and eccentric doctor that investigates diseases like Sherlock Holmes. Everything has its cause and effect, everything inside the human body is subject of his knowledge. EVERYTHING but the human being before him. Thank goodness, many doctors –such as our charming doctor in the ESAD–, nurses and technicians refuse to be like House. However, it represents a trend that is still present in many cases. Why? It is hard to believe, but up until yesterday –almost literally- there was no subject in the Medicine syllabus that dealt with the doctor-patient relationship or with human relationships, with all their complexity and richness. In summary, doctors receive training to treat diseases, not patients.8

With all this luggage, health staff faces the pain of their congeners. This is not an easy task, and, undoubtedly, sometimes they might feel overwhelmed by it. Despite this, it is hard to imagine a more noble profession, and, because of that, it is mandatory for them to have access to the most advanced means to achieve it. Nonetheless, they also need to know what the book of Job teaches. If you grant me a couple of minutes...


The book of Job is essentially a long conversation between friends to which God eventually steps in. The motivation of this chat derives from a narrative frame that comprehends the first two chapters and the last one: it all begins with a bet between God and a character called Satan –don´t get frightened, this character does not have horns or tail–. The matter of the bet was whether Job loved God selflessly, or he did it because he enjoyed a good position in “life”. Before this dilemma, God allows Satan to take away everything he cared for: family ¡except his wife! –Satan does know how to be cruel–, possessions, and even health. Job never understands why he is suffering so many catastrophes, but he is convinced that it is not his fault. Even in this miserable state, Job keeps quiet, admits that everything comes from God, and humbly accepts his fate. Therefore, the proof is a success and Satan does not have other option than to admit that a human being can love God selflessly.

One moment... I can almost hear you say: what kind of God is so barbarian that makes unlikely soap opera style bets? Don´t shoot just yet! Remember that in those days people believed that suffering was their own fault. It was called the doctrine of retribution, more or less our “you reap what you sow”, but stretched to the most absurd extreme. Well then, the first lesson of the book, is that one part of the suffering we undergo comes from outside of us, it is not because we did something wrong. Because life, although it is molded by our decisions, has an “unknown”, unpredictable component that we need to learn to deal with.

The calvary starts here

However, although we´ve seen that the original story had its substance, subsequently, they wrote forty more books where Job did what anyone else would under a similar situation: deny, negotiate, enrage, get depressed, and finally accept it.9 Meanwhile, some friends pay him a visit and he starts talking to them about his suffering. Job explodes like a volcano: “May the day of my birth perish!”10 This is not fictional. And interestingly, Job´s first reaction is to look around and contemplate the pain around him11: he feels sorry for the slaves, with the terminal sick people, the exploited ones, who are oppressed until their final day12. What a relevant thing: how many times are we not capable of seeing the misery and suffering around us until it affects us.

Nevertheless, we need to take into account that in this the first stage of mourning, Job violently denies what happens. Ever since those times, an event as traumatic as that opens an emotional “black hole”. First, one is incapable of finding any sense13, one loses the vital confidence that holds our “world of relationships”, and clings only to one’s most immediate and negative perceptions14. The dream of rationality provokes monsters... pain does too. It is recommended to be “up to the task” and not try to amend reasons in that moment. That is not what Job needs, neither what patients need.

What not to do and what to do

His friends, against such a complex and difficult situation as this one, had started with the right foot. They kept silent and remained by his side. Thus, probably they made it easier for Job to express all his torment at last. However, they made the same mistakes we make nowadays. Let us learn from them:15

–They hold fast to their own interpretation of reality and tried to impose it, whatever the cost. Job´s friends take to him the weight of tradition. And Job is consumed by rage! Doctors can have their excuses, mistake sense for causality16 and try to explain to the patient only the pathogenesis of his illness. However, the doctor cannot provide meaning to the illness17 or the traumatic event and the explications of “the inexplicable” often generate more aggressiveness and resistance in the first stage: “Doubtless you are the only people who matter, and wisdom will die with you!” (Job 12-2).

–Second mistake: They barely have a real dialogue with him. They have their own speech and seem deaf to what their friend wants to communicate18. Is it possible that we treat the lung, the kidney or the depression first, rather than the patient? Can we see the human being before us? “Have pity on me, my friends, have pity” (Job 19:21).

–Thirdly: Understanding Job, not from his concrete experience, but from his categorization: Job is a sinner, because sinners suffer. This way, they “avoid” suffering alongside him and pitying him, he is depersonalized by generalizing his pain. Every patient needs to feel that he is not just part of statistics. Even more, that when he complains for the thousandth time, he is not ignored: “Do you mean to correct what I say, and treat my desperate words as wind?” (Job 6,26).

Not telling the truth “You, however, smear me with lies; you worthless physicians, all of you!” (Job 13:4a). The problem of not confronting reality, among other reasons, because it still represents an important social taboo19, may interfere with the assumption of one’s own reality. Every human being has a right to know the truth, as long as they themselves demand it.

–And lastly, Job´s friends, terrified by both Job’s suffering and his reaction, preferred to stay at a safe distance. It is normal that we protect ourselves from the exposure to constant suffering. The problem is that an essential part of the healing and palliative task barely happens outside our arm’s reach. A handshake, a kind and sincere look, the commitment of being present, are gestures that should not be lost.

A glimpse of hope

We have all experienced in different degrees how a persistent suffering makes reality to fade away.20 Hence comes apathy, depression, stress or despair. That is why it is so important for the patients to find an exterior exit, that allows to place the present moment within a much bigger context. Job will find a path in which the fog drives away –at least for a moment– and the sun gets warm again. Allow me to read some of his happy landscapes:

“How I long for the months gone by, for the days when God watched over me… and by his light I walked through darkness!  when God’s intimate friendship blessed my house… and my children were around me… whoever heard me spoke well of me… because I rescued the poor who cried for help… I was a father to the needy…  the light on my face was precious to them… I was like one who comforts mourners.” (Job 29:1-25).
“I know that my redeemer lives, and that at the end he will stand on the earth” (Job 19:25).

We can never lose sight that our patient is, above all, a non-patient, a person rich in experiences and loved ones. Job frees himself from his self-absorption remembering his happy days, the faces of his children, the respect from his community, his charitable work, and lastly –in a majestic exercise of projection–, he remembers himself cheering those who are mourning (like himself?). We need doctors that can be able to bring about those spaces with their patients, a time to remember and dream again, to return them an image of themselves outside their pain coordinates.

We must not forget also that faith turns out to be decisive for many of them21. Until now, the point is to encourage those aspects that contribute with positive and hopeful perspectives. Therefore, we need to let them express their deepest convictions, because in them relay their strength and freedom. Whatever their creed, religious or atheist, our duty is to embrace him/her respectfully, and, as believers, to reaffirm our confidence in God, for those who demand it from us22.

God speaks, at last!

Throughout forty long chapters Job cries, regrets, accuses and damns God for his insufferable situation23. And suddenly, the divine voice blasts powerfully, decidedly, in the middle of a terrible storm. However, this transcendent and almighty God does not crush the defiant human being with the “divine truth”24, but through his questions, he directs Job within himself to meditate. God is interested in our word, our truth, even if partial; he is interested in that truth that can be raised through dialogue and intimate listening25. Would we be capable of, through dialogue, bring about in our patients a serene reflection to face up disease or loss?

But there are many obstacles that prevent us from thinking –especially in our Western societies–, like that impoverishing anthropocentrism that has now been intensified by an intense suffering26. Precisely, God´s questions purposely open the horizon: little by little they dissolve the blinding fog in which Job is immersed in, with taints of an exuberant, vital, and luminous world, where the most outrageous forces coexist next to the most insignificant beings. Human beings are not considered in the picture. Not everything was made for humans. In fact, Job is not able to answer about this world’s reality, he cannot understand his non-human cause. Therefore, God encourages him to give up the exhausting and useless pretention of being the point of reference27 and to consider himself as part of the unrivalled frame of life surrounding him.

And if he does not know why there is life and harmony in such a big universe, how can he understand the threatening or chaotic forces of nature? Job realizes then how ridiculous that image he used to have of the world was, an image of absolute happiness. No, the world is so utterly beautiful as it is unpredictable, where life coexists with death.
How important it is to accept our finitude, our fragility! A substantial part of our suffering is determined by our unconscious and impossible desire to be “untouchable”28. And reality is presented as a giant alarm clock that takes us away from that childish dream. Doctors know that sooner or later someone will write the word exitus in our medical record. Therefore, you can make a contribution by awakening our society, not in order that they fear death or suffering, but in order that they accept them as part of life, and you can do it in a human way.

Job, in this realization, finds what he was looking for: that God is still there, faithful to his creation, and he will never abandon it, such as he will not abandon him29. He finally opens his eyes and sees beyond himself. Yes, he contemplates the ambivalence of reality, but has the conviction that god is on his side and listens to him30. Now he can rest his soul31, lose himself, like a child in his mother´s lap, even in the midst of suffering32.

It is necessary that Christian doctors also rest upon this transformative hope in such a way that even though they could not share it with their patients explicitly, they can transmit it through their open and honest attitude, a warm handshake, a constant active listening, a word of hope. Do not cure the body only, reach also their fears and anxieties. Jesus had to touch a man´s skin to clean him of leprosy, and he touched a woman to get rid of her fever –of fear?33. You, as his disciples, are you going to follow his example? Will you accept the challenge of helping them to live and die as valuable and unique human beings?

The book of Job. It is not the voice of the latest psychoanalytical discovery. It is also not effective in the same way that a drug such as Prozac, or morphine is. Surprisingly, it captivates us in noble and honest way, even though it does not give a definitive answer to the matter of suffering. However, when you read those pages, you understand better what is essential to fight it when there is still time, to accept it when it is necessary, and to be more human before any circumstance.

This article was translated by Alfredo Francis and reviewed by Nicolás Manfredi, under the grant “God's Evolution” awarded to the Science and Faith Centre (Spain) by the BioLogos Foundation (USA).

  1. Küng, H. Vida eterna (Madrid: Editorial Trotta, 2000), pp. 34-38.
  2. J. J.Tamayo. Católicos, pero menos.
  3. Küng, 2000, p. 25.
  4. Already in One-Dimensional Man (1964), Marcuse states precisely how consumerism and marketing have unbearably constrained mankind.
  5. Many data from this research was collected from a deliberate interview with Dr. Elena Martinez, a remarkable doctor with a vast experience and an unusual sensitivity. From ESAD-CARTAGENA, “Cuidados paliativos de enfermos terminales” (15-01-2015) 
  6. ESAD: Support Teams in Paliative Cares at Domicile
  7. Kung, 2000, p. 249.
  8. Id., p. 250.
  9. Kubler Ross was the one who described the classical form of the different stages of grief.
  10. Job 3:3.
  11. Job 3:17-21.
  12. Lévêque, J. Job: El libro y el mensaje (Estella: Editorial Verbo Divino, 1987), p. 13.
  13. Frankl, V. El hombre en busca de sentido (Barcelona: Editorial Herder, 1979), p. 134.
  14. Lévêque, 1987, p. 14.
  15. Kidner, D. La sabiduría de Proverbios, Job y Eclesiastés (Illinois: Varsity Press, 1985), pp. 46 ss.
  16. Frankl, 1979, p. 133.
  17. Id., p. 131.
  18. Id., p. 21.
  19. States Dr. Martinez in his wide proffessional experience.
  20. Frankl, 1979, pp. 128 ss.
  21. Dr. Martinez describes the different evaluation criteria, including the spiritual dimension of the patient, along with the physical and emotional description.
  22. Referred by Dr. Martinez.
  23. Lewis, C.S. Una pena en observación (Barcelona: Editorial Anagrama, 1994), p.13. In the same way as Lewis abjures of the childish and divine image, and his “illustrated” faith, after the death of his wife. He is a contemporary Job, that deserves to be listened.
  24. Von Rad, G. Sabiduría en Israel (Madrid: Ediciones Cristiandad, 1985), p. 284.
  25. Drewermann, E. La palabra de salvación y sanación (Barcelona: Ed. Herder, 1996), p. 201.
  26. Martini, C. Meditaciones sobre la Carta a los Romanos (Santander: Sal Terrae, 2010), p. 58.
  27. Zamora, P. La fe sencilla (Madrid: Fundación Federico Fliedner, 2011), p. 83.
  28. Frankl, 1979, p. 136.
  29. Von Rad, 1985, p. 285.
  30. Roger, S. Dios nos quiere felices (Boadilla del monte: Editorial PPC, 2000), p. 10.
  31. According to translation proposed by D. Pedro Zamora of Job 42:6.
  32. Küng, H. Ser cristiano (Madrid: Editorial Trotta, 1996), p. 413.
  33. Drewermann, E. Sendas de salvación (Bilbao: Desclée de Brouwer, 2010), p. 25.

Cite as (ISO 690:2010): BUENDÍA, David. Job for doctors: humanizing amongst suffering [online]. RYPC Translations, 23 October 2018. <> [accessed: ].