Message from the Medical Director
March 16, 2018
I have practiced medicine for over 35 years, mostly at a large healthcare system in Michigan, first as a cardiovascular & interventional radiologist, performing catheter related diagnostic & therapeutic procedures and later, over the last 15 years, in a purely diagnostic capacity, interpreting CT, ultrasound, nuclear medicine, and radiographic studies mainly in patients coming into one of the four emergency departments associated with the system.
In the grand scheme of things I function as a gatekeeper at the entry point into a large and complex system. Day-in and day-out I render interpretations & make decisions that affect the lives of many patients, ranging from broken fingers & toes, to heart attacks & strokes, the entire gamut, from the simple & straightforward to the bafflingly complicated, from shattered bones to completely shattered lives. And from my dual role as both a diagnostic & therapeutic practitioner I’ve seen the system from a variety of angles and interacted with a broad cross-section of its players.
Almost from the beginning I became aware of the limitations of the procedures that I routinely performed: one day I might successfully open up a blocked artery and send the patient home believing that their problem had been corrected; weeks or months later I might run across their name in the obit section of the newspaper. I was applying an expensive band-aid, a technological quick fix, to problems that medical science had barely scratched the surface in terms of understanding not to mention proper treatment.
I became increasingly concerned over medicine’s propensity for throwing money & technology at problems that appeared to be intimately tied into individual lifestyle and conditions within the social environment. I began what would become a decades long study in the medical & historical literature in an attempt to better understand the nature of health & sickness.
In the 1980s & 90s academics became interested in the narrative structure of medicine. It seems strange to talk about storytelling and medical science in the same breath. We think of science as dealing with the factual description of what is real but forget that it’s an interpretive activity, and no matter how accurate its descriptions might be they’re still only interpretations that, at least for the time being, we collectively regard as being true. But there are different kinds of truth in medicine. And in the end medicine uses the medium of storytelling to relate to others the significance of its discoveries and accomplishments. Everyone has a story to tell. Even medicine.
A story is a series of events that connect to each other through time. There are many different stories each of which contain their own unique sequence and plot. Underneath the storyline we encounter the narrative theme, the meaning behind the events and the real reason why the story is told. Some stories are tragic and painful, others uplifting and inspiring; some stories tell about suffering and loss, others about courage and perseverance. The narrative theme represents the thread that ties a series of events into a coherent whole. Jung called it the archetypal realm.
The sick person’s story in its simplest form is about contingency, an encounter with unanticipated and unpredictable events. Serious illness, first and foremost, represents a loss of personal story, a disruption of narrative continuity: the lived present is nothing like what one would have anticipated from the past, and any expectations for the future are clouded with uncertainty.
The story that modern medical science tells is quite different. As Francis Bacon claimed, knowledge is power. In modern societies science and technology are highly valued for they symbolize power, culture’s attempt to exercise agency &control over the body. Science is the dominant narrative in 20th century societies, surpassing both religion & philosophy, and is the primary lens through which many people experience and interpret the world.
The sick person naturally wants to recover his or her health and reclaim the sense of wholeness and purpose that was interrupted by illness; that’s why they go to see a physician in the first place. But what happens in cases of terminal illness when healing is no longer an option and medicine is powerless to change the course of events? The answer to this question led me in a new and unexpected direction. In the early 90s I stumbled across a remarkable article by Therese Schroeder-Sheker in the journal Advances describing a field of palliative care she had founded and pioneered called music-thanatology.
Her vivid description of that first bedside vigil with an old man dying by himself in a dingy nursing home room touched me deeply and with it came the realization of what the institutional medicine I had been practicing for over a decade had been missing: the human equation. It wasn’t so much about asserting power & control over life & death but empathically meeting individuals where they were in their journey. This single story became an archetype that epitomized for me the course that medicine must eventually navigate.
In short order I called Therese to ask questions and discuss the nature of her work. At the time the Chalice of Repose Project was housed at St. Patrick Hospital in Missoula. We began what has evolved into a 25-year dialogue across a wide spectrum of topics: medicine, psychology, philosophy, history, culture & society. Needless to say I was honored when she invited me to become part of the Chalice faculty and for about 7 years I spent one week each semester in Missoula teaching her students the basics of clinical medicine—physiology, interpretation of clinical symptoms & signs, an overview of therapeutic strategies and options. And a handful of years later I became the medical director and a member of the Chalice executive board.
From the onset I was impressed by the pedagogical rigor and discipline of the music-thanatology program and in the depth of the contemplative musicianship ideal. Of course there was an established curriculum and students were given instruction in a variety of areas germane to the practice of music-thanatology—technique & performance, both vocal & instrumental, as well as a broad range of background material from some 17 disciplines in the humanities, each intended to provide context and generate insight into the how & why of their discipline.
Students were without exception expected to assimilate assigned material and demonstrate competency in the core areas. But program was more than the rote assimilation of objective fact & technique. On the other hand those who thought that the discipline was only about subjective expression and good intention soon discovered otherwise. The Chalice pedagogy embodied what Parker J. Palmer in To Know As We Are Known calls a teaching behind the teaching.
To teach is to create an open space within students and the community of practitioners through which the values and principles that underpin the discipline become manifest and realized. If science is recognition of the objective aspects of a discipline, then art must represent apprehension of the context and meaning of its practices. The hidden theme of the program concerns self-formation and transformation through cultivation of insight into these vital organizing principles and to become dutiful in their day-to-day practice.
In this respect it was affirming to accompany Chalice staff & students on vigils and observe a disciplined bedside phenomenology attentive toward the dying & their immediate circumstances, in short, of meeting them where they were at in their journey. The Chalice pedagogy and methods seem to possess all the qualities & attributes that medical educators now generally agree are sorely missing from modern medical education. For contemporary healthcare, in its spiraling deterioration, the Chalice of Repose Project represents a shining example of what could have been and a sad reminder of the path not taken.
Ken Thorp, MD
Board Treasurer and Medical Director
Last updated March 16th, 2018
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