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Upright and whole: An approach to suffering in the face of death

Those of us who work in palliative medicine ignore the lessons of the great books and sacred texts of our civilizations at our own peril. Wisdom lies in works as disparate as Leo Tolstoy’s The Death of Ivan Illyich, the Book of Job, or Ernest Becker’s The Birth and Death of Meaning. It is becoming a more common practice in palliative care and psychooncology training programs for trainees to be exposed to the humanities in an effort to learn about the care of “humans.” Reading and discussing The Death of Ivan Illyich is now quite a popular means of teaching our younger colleagues about the process of dying and the potential for redemption and growth even in the last moments before death. The Book of Job however has eluded many of us in palliative care as a source of lessons that can be applied to clinical intervention in palliative medicine. I suspect there are multiple reasons: (a) The Book of Job is seen as a purely religious text with few secular applications; (b) The lessons of the book of Job are perhaps arcane, unclear, and subject to extensive and divergent interpretations; and (c) although not the final reason, I also suspect that too many of us have not really bothered to actually read the Book of Job, and only know what we hear from others of the lessons that may lie within. The truth is, that over the last 23 years as I have been working in the care of the dying, I have referred to Job hundreds if not thousands of times in the context of discussing suffering, and yet I had never really taken the time to read the text myself; completely and with an open mind. Reading the Book of Job turns out to not be an easy task. There are many versions, of varying lengths and with differing story lines. There is also no paucity of controversy as to which is the accurate version. There is also no dearth of commentary on the interpretations of the lessons of this epic poem. Great thinkers ranging from Maimonides Spinoza to Carl Jung have responded to Job’s story with great thought, insight and differing conclusions as to what it reveals about the relationship between man and God. Most of the debates have focused on the questions of Theodicy (can God and evil coexist), and whether God is a “personal” God, involved in the affairs of human beings, punishing those who sin, rewarding those who are deserving, responding to prayer, or whether God is a “natural” God who is unknowable, mysterious, one’s whose actions cannot be understood by human beings. These are primarily religious questions about the nature of God, yet they are questions that arise in the palliative care setting quite frequently. “Why did this happen to me?” “What did I do to deserve this?” These are questions we are asked frequently as palliative care clinicians. Although these are often religious questions that relate to an individual’s relationship to God, they are also, in essence, universal existential concerns that are being expressed. Patients often turn to us a clinicians for comfort, solace, even answers. Last month I set out to read the Book of Job. I chose to read the Book of Job translated and with an introduction by Stephen Mitchell (1992). Stephen Mitchell is a Brooklyn born poet and translator of sacred texts whose work I was familiar with and had enjoyed reading before. I have particularly enjoyed his translations of the poetry of Rainer Maria Rilke, and his translation of the Psalms. Mitchell does not merely provide a modern accessible translation, but also gives historical context and references that enrich the experience of the reading. This was definitely the case in my reading of his translation of the Book of Job. As an example, I learned that we do not really know who the author of the Book of Job is. There is little evidence as to who the author is, when and where he/she wrote it, or for what kind of audience. One of the greatest paradoxes of this greatest Jewish work of art is that the hero is a Gentile, as might have been the author. Some