Physician and patient

by Worthington Hooker

LETTER III.

ON THE MOST ELIGIBLE METHODS TO BE PURSUED.

My Dear Friend,

In accordance with your request, I now proceed to offer a few suggestions derived from personal observation, on the methods which appear to me best calculated to secure the important object of our present correspondence. You will remember, that, even at a distance, I doubted my ability for properly executing this part of the undertaking; and I candidly own that my consciousness of inadequacy has not diminished on a nearer view of the attending difficulties. Should, however, the plain remarks you are about to receive, possess little value in themselves, they may, I am willing to hope, prove indirectly useful, by engaging your own attention more closely and continuously to the subject.

You are too well aware, how deeply the feeling of medical responsibility has pressed upon myself, to suppose for a single moment, that I would inconsiderately superadd to a similar burthen upon you any unnecessary weight of obligation as connected with the spiritual condition of your patients. I cannot, indeed, relinquish the opinion I have deliberately formed, and which has been before avowed, namely, that the peculiar facilities afforded to the medical practitioner entail upon him a proportionate responsibility; yet am I very solicitous not to endanger the peace of a conscientious mind, by incautious or exaggerated statements, or by urging the adoption of any doubtful or impracticable measures. On a subject of such manifest delicacy as well as difficulty, it is highly important that our views should be well defined, and our opinions of the duties and obligations involved, most carefully guarded and qualified, otherwise we may not only inflict a needless wound on a pious mind, but may actually defeat the very object we desire to promote, by the disheartening influence of plans of operation unfeasible in themselves, or inconsistent with our proper, indispensable, and untransferable duties. Allow me, therefore, to request your attention to two preliminary observations.

First,—I would remark that the desire of promoting the patient’s religious welfare should never be allowed to interfere with the thorough performance of medical duties. These cannot be superseded by any other claims. Under this decided impression I would suggest, as a general rule, the propriety of giving your sole, undivided attention to the relief of the patient’s malady, as well as to every circumstance and arrangement which his bodily condition may demand, before you permit yourself to advert to his spiritual exigences. You will kindly observe that I recommend this as a general rule, which may possibly admit of some exceptions. For example, I can conceive that some highly-gifted individuals may have the power of interspersing, in an unobjectionable manner, a few religious hints among their medical enquiries and directions, and without materially distracting their attention, or endangering the temporal well-being of their charge. Yet, even with such facilities, there would sometimes, I apprehend, be a risk of dispersing those energies of mind which the physician ought assuredly, in the first place, to concentrate on his patient, in the earnest, persevering endeavor to remove his disease and preserve his life. Consequently the talent referred to should be used with much judgment and caution. But I foresee that your habits of discrimination will lead you to doubt whether the example I have supposed really constitutes an exception to the rule. It certainly is not foreign to the spirit of the rule, which I think may be thus expressed:—that no attempt should be made by the physician to promote the religious welfare of the sick, which is incompatible with the full, efficient, satisfactory discharge of his medical duties and obligations.

The second preliminary relates to the distinction which it is important to mark between that general responsibility which, in my humble opinion, requires the physician to be always on the alert to profit by every incidental opportunity of employing his influence for the spiritual good of his patient; and that special obligation which may sometimes devolve upon him, (in consequence of the total absence of religious instruction,) to attempt, in a more particular manner, to rescue the sinking soul from perdition, and direct it to Him, who is able “to save to the uttermost.” This distinction leads me to propose, as a second general rule, that, inasmuch as religious instruction forms a part of ministerial and relative duty, it would be highly inexpedient for the physician to add to his already onerous engagements, that of undertaking the spiritual supervision of his patient, except under circumstances of imperious necessity. Whenever, therefore the aid of a Christian minister or a pious relation can be obtained, the medical practitioner may, I conceive, regard himself as free from any special obligation of that nature.

These limitations obviously imply that, in by far the greater number of instances, the religious influence of the physician should be exercised in an occasional, rather than in a stated and formal manner. If alive to the spiritual welfare of his patient, such opportunities of usefulness will not be wanting. Perhaps, nothing would so essentially contribute to the furtherance of the object, as the offering up of earnest supplications to the “Father of lights,” for His especial guidance and help, before the physician enters upon his daily engagements, that he may be enabled both to discern and improve every suitable opportunity, which even in the ordinary exercise of his profession may be presented, of doing good to the souls of his patients.

In seeking, and humbly expecting, thus to employ your influence in this sacred cause, I feel the most encouraging persuasion that “your labors will not be in vain in the Lord.”

It may be convenient to arrange the few thoughts which have occurred to me in reference to the mode of offering “a word in season” in a few leading particulars; premising that, next to the Divine blessing, the secret of usefulness will be found, I humbly anticipate, in the careful, discriminating adaptation of advice to the particular circumstances of the case. Age, sex, degree of intellect and cultivation, particular habits of body and of mind, the actual stage of the disease, the hopes and fears of the patient in relation to futurity, the religious knowledge already possessed, the presence or absence of spiritual instruction, and many other circumstances, will, I am persuaded, appear to you deserving of special consideration. I can, therefore, only hope to suggest a few general principles which may be indefinitely modified and applied, according to the varied and ever-varying circumstances of each individual case.

My first suggestion has already been anticipated. I refer to the importance of recommending and even urging the assistance of a Christian minister or a pious friend, in cases of serious and dangerous illness. I am aware that the very mention of the subject is sometimes productive of considerable alarm, and certainly requires much prudence and caution. With skilful management, however, the exciting of any injurious degree of apprehension and foreboding may generally, I would hope, be avoided. One may say, for example, in the course of conversation, to a patient apparently unconcerned or uninstructed in reference to Eternity, “You must find the change from active life to the confinement of this room rather irksome. Yet some time for calm reflection is really needful for us all. When withdrawn from busy life, we can look upon the world at a distance, as well as come into closer contact with ourselves. Indeed, serious consideration can never be unsuitable. Human life itself is confessedly uncertain, and of course, under disease, still more so. Should you not find a little conversation with a pious minister interesting under your present circumstances?” In this familiar way, (pardon its homeliness,) one may sometimes introduce the subject without abruptness. From having had much personal illness, I have been able to press the matter further, by assuring the patient that such assistance has repeatedly proved very consolatory to my own mind; thus, presenting a living instance of the incorrectness of the popular opinion that, to propose the visit of a minister to the sick, is tantamount to a death-warrant.

Should the recommendation prove entirely fruitless; should the unhappy patient, notwithstanding our utmost professional efforts, be so rapidly hastening into eternity as to afford no opportunity of procuring more efficient spiritual aid, the case will then present one of those special occasions before alluded to, which call for our more immediate and devoted attention, in reference to the immortal spirit. And who, that values his own soul, would not, under such circumstances, endeavor with all possible earnestness and affection, to exhibit to the dying man the compassionate and Almighty Redeemer, as able to save even at the eleventh hour?

I may next suggest that the allusions of the physician to the subject of religion should generally be incidental and conversational; arising spontaneously from a solicitous regard to the particular situation of the sufferer. When such occasional advice appears naturally to flow from the heart, partaking of the disposition and character of the speaker, and having an evident bearing on the special circumstances of the patient, there will be little risk of its being regarded as superfluous or obtrusive. On the contrary, I believe, it will usually be welcomed as a gratifying proof of disinterested friendship. In this incidental way, one may sometimes refer to the experience of great and good men under similar sufferings, and to the signal support vouchsafed to them, and to the happy results of their afflictions. On some occasions, it may be useful to adduce the remarkable fact, that some of the brightest ornaments of the Church and of the world have ascribed much of their success in life to the discipline they were once called to endure in the chamber of sickness and seclusion.

May I add, that the occasional hints of the physician should also be brief? A single sentence well-timed, well-directed, appropriate, and expressive, will possess the great advantage of not wearying the attention of the sufferer, while it may, notwithstanding, supply ample material for reflection during the succeeding hours of solitude and silence. “A word spoken in season, how good it is!”

Nor is it less important, I conceive, that such advice be expressed with clearness and simplicity, in a few plain words and short sentences, bearing a direct and obvious meaning, and free from ambiguity and circumlocution.

Allow me also to suggest that the advice should be considerate and kind; the evident effect of genuine sympathy and tender concern. No word should be dropped that might seem to imply an unmindfulness of the suffering, helpless, unresisting state of the patient, or oblige him to attempt a lengthened and laborious reply. One kind sentence delivered in a tone of kindness, and accompanied with a look of kindness, may, and often will, juvante Deo, penetrate the heart.

In certain states of disease, in which high excitement, or extreme debility prevails, it may sometimes be expedient to address a passing hint to a relative or friend who may be present rather than to the patient himself, thus leaving to the option of the latter, whether or not to reply to the observation.

Yet should the hints be faithful. Any approach to temporizing would be cruel in itself, and might prove fatally delusive in its consequences. It would be, in effect, to administer a moral opiate, from which the helpless victim might awake—only in Eternity.

Permit me also to remark that, whenever the circumstances of the case will permit, our allusions to spiritual subjects should be attractive and encouraging. Doubtless, the torpid insensibility of the sinner may require to be roused by an alarming representation of the direful consequences of transgression and unbelief; nor can we reasonably expect that mercy will be sought until it be felt to be needed. In general, however, I apprehend, that a cheering exhibition of the Almighty Saviour, as “full of grace and truth,” as “ready to forgive,” and “plenteous in mercy to all who call upon Him,” will be found most effectual in softening the heart, and in exciting those earnest desires for pardon and acceptance, which are emphatically described, in our Lord’s own test of sincerity, in the case of Saul,—“Behold, he prayeth.” Let us, my friend, never forget that “he who winneth souls is wise.” The promises of the gospel are, indeed, peculiarly adapted to meet the exigencies of the afflicted and distressed. The blessed Redeemer was pleased to described himself as having come purposely “to seek and to save that which was lost.” Were we even restricted to the use of a single sentence, as a scriptural vade-mecum in the sick chamber, we should still have a volume of encouragement and consolation in our Lord’s assurance,—“Him that cometh to me, I will in no wise cast out.”

Upon the whole, my dear friend, the best preparation for speaking “a word in season” will be found in carefully studying the example, and seeking to imbibe the spirit, of the incarnate Saviour, that all-perfect Physician of the soul and of the body. What a lovely union of simplicity and sincerity, of faithfulness and tenderness, pervaded His addresses to the sick and afflicted! How much is comprised in that short sentence, “The gentleness of Christ!” He did “not break the bruised reed nor quench the smoking flax; but came to bind up the broken-hearted,” and heal their every wound. May we be enabled by grace from on high, though necessarily in a very humble measure, to tread in His steps!

In truth, the Christian-like deportment of the physician comprises within itself a sphere of very important usefulness, affording ample scope for the development of those graces and affections which characterise the sincere follower of the meek and forbearing, the benevolent and sympathizing Saviour. And even should my friend find it sometimes difficult or impracticable to offer a word of spiritual counsel as he could wish, he may yet, in his habitual demeanor, present to the patient and the surrounding relatives, a living “epistle” which they can read and understand, and which, by directing them to the source of every good gift, may issue in the attainment of true and saving wisdom.

In concluding this letter, I must not altogether omit to refer to the season of convalescence, as peculiarly favorable to religious impression. If ever the mind and the heart be open to the feelings of gratitude, love and praise, it is under the circumstances of returning ease and health, and in the hope of being again permitted to enter on the duties and enjoyments of life. It is then that the physician, in my humble opinion, is more especially bound to avail himself of the grateful attachment of his patient by referring any skill or care he may have evinced to the God of all grace, and thus endeavor to give a right direction to those kind and gladsome emotions, which are bursting from a full heart. It is then, I conceive, that the rescue from the grave should be held out as a signal warning, and as a powerful incentive. Then, also, by adroitly following out the convalescent’s own suggestions, a powerful appeal may be made to his best feelings, and an affectionate plea presented for an immediate and entire surrender of himself, “body, soul, and spirit,” unto an Almighty and most merciful Father, who “hath redeemed his life from destruction, and crowned him with loving kindness and tender mercies.”

At such a period, too, we may often recommend, with great advantage, some interesting volume adapted to our patient’s state. Biography and easy letters, as being both interesting and not requiring much effort of attention, will often be found peculiarly acceptable. Indeed, the judicious recommendation of books and tracts may be regarded as an important mode of employing our influence during every period of illness, but particularly during the season of convalescence.

Such, my dear friend, are the few imperfect hints which have occurred to me. I might, indeed, have availed myself of the assistance of some valuable writers on the subject of affliction, particularly of the highly interesting work of my pious and intellectual friend, Mr. Sheppard, “On Christian Encouragement and Consolation;” and the excellent “Thoughts in Affliction,” by another able friend, the Rev. A. S. Thelwall. I might also have enriched these humble letters by a reference to the “Essays to do Good,” of the eminent Dr. Cotton Mather, which contain some admirable suggestions on the same subject. From these several works I have formerly derived much instruction and pleasure, but was unwilling to have recourse to them on the present occasion, as well as from the wish of not unnecessarily extending these letters, as in compliance with your particular desire that I would send you the result of my own observation and experience.

With every kind wish,

Believe me, my dear Friend,

Ever faithfully your’s,

T. H. B.

Tilford, March 1st, 1836.