A Kind of Faith

FOR EDITORIAL COMMENT, SEE PAGE 1079 FOR EDITORIAL COMMENT, SEE PAGE 1079 Wait Without Hope I said to my soul, be still and wait without hopeFor hope would be hope for the wrong thing; wait without love,For love would be love of the wrong thing; there is yet faithBut the faith and the love and the hope are all in the waiting.Wait without thought, for you are not ready for thought:So the darkness shall be the light, and the stillness the dancing. (T.S. Eliot; East Coker) Late one morning, in the middle of a busy pulmonary hypertension clinic, a thought appeared. The thought said, “I’ll be dead in 5 years.” I had no objective basis for the thought; for me, I was actually quite healthy in that moment. And yet, the thought arrived, the way familiar song lyrics sometimes enter your mind, uninvited. Or notes of music from a distant piano. “Five years,” the voice insisted. The clarity of the thought stunned me, and I excused myself from the clinic room. I reflexively felt my forehead with the back of my hand, wanting to perceive what my body already knew. Probably because I was still in my white coat, I attempted to dismiss my own knowing as worry in the most paternalistic way possible. Doctor-authority-me told myself, “Anxiety is not the same as intuition, Rana.” But when I turned inward and surveyed my body like I would in a yoga class, I could find no nervous stomach, no twisting chest tightness, no tense jaw, no hurried heart or fidgeting limbs. This wasn’t worry; it was simply knowing. It’s difficult to know what to do with this kind of awareness. Truth without proof. I thought of my best friend, who had endured a psychotic break. How confidently she had shared her delusions with me because they were completely true to her: distressing messages that came to her through magazines and social media. One definition of a delusion is a persistent belief, despite not being supported by evidence and not being shared by others. So, I decided two things. One, I wouldn’t tell anyone, and two, I would gather evidence. Proof that I was on the right side of sanity. The knowing at that point just felt so fragile to me, like old-fashioned film before it’s been developed. If I brought it into the light, I knew I risked damaging it. I knew I needed evidence because without tangible proof that others would recognize as valid, my knowing would be relegated to “just a feeling.” It would be deemed silly and dismissed. Cast off into the specious realm of delusions, monsters, and dreams. Like so many of us during the pandemic busily taking care of others, I had put off much of my own self-care. I had suppressed the messages my body had sent me, cut my cognitive self from my feeling self. So, I scheduled the overdue testing. I invited the waves of radiation and the empiric probe of the ultrasound machine to create a window, a portal between the bodily awareness and the science. I encouraged my body to reveal itself to me. As the technician narrowed the focus of her search and grew outwardly concerned and perceptibly sad, slumping her shoulders, and sighing heavily, I felt sorry for her. I recognized the sentiment. I knew the singular guilt that the “discovery” of a tumor could elicit in us. As if by looking for it, we were somehow also responsible for conjuring it into being. In the face of her concern, I felt humbled by the apparent accuracy of my body’s wordless warning. The discrete little packets of encoded chemical signals like musical notes that allowed me to know. Nothing I could ever have deciphered with cognition, with thought. An understanding that could only be received. There was something generous in the shared awareness, an affirmation of communion or a spirit of comradery. And the voice again telling me: “The sick part of you is still you. It still hopes for your healing.” I remember laying on the ultrasound table, comforted by the fact that the cells were now making themselves seen in other silent ways, through reverberating waves of particles that I didn’t fully grasp. I remember feeling that maybe my knowing wasn’t so different. Maybe everything was a just a kind of vibrational wave that we had to feel into with our bodies: love and energy and knowing. Supported by evidence now, I shared the results of the imaging and scheduled the biopsies. I drove myself to each procedure, not wanting to tend to other’s worry or be bathed in false consolations. Hope for the wrong thing. I was actually so sure of the results that I tried to schedule the surgery before the pathologist had a chance to read the slides. I called a friend at the cancer center and told him I had cancer before anyone told me I had cancer. He was baffled but kind and expedited the read; as we waited, I noticed everyone seemed to be holding onto hope that it was “probably nothing” and “expecting it to be benign.” But I sensed that was hope for the wrong thing. In that rigidly constrained kind of hope, I could find no room to simply experience what was true. I needed instead a vectorless hope. Hope that was not dependent on any particular outcome, hope that had no object. Hope simply as an orientation to the future. A capacity to be still, regardless. When we received official confirmation, and the cancer cells were finally visible to others, my husband asked, “Do you think it has spread?” I pointed to the place that vibrated with knowing and said, “It’s gone this far.” He hoped I was wrong, just as I knew it was true. I have had to learn to attune to and honor the signals within me. The aversion to eating fat that signals a biliary stricture developing. The fear of eating at all that far precedes the nausea of a small bowel obstruction. The subtle heaviness in my eyelids that signals impending septic shock. The cancer though was different. I wasn’t facing some foreign invader or pathogen that was fomenting sepsis; I was facing myself. Cells within me had changed, and I sensed that by listening to them. I could help us find a way out. In the preoperative area, I was injected with a miniscule amount of radioactive substance that was then allowed time to be picked up by my lymphatic circulation. Those invisible channels that carry cancer cells away from their primary site to local lymph nodes and then off to new, more nourishing organs like livers and brains. In the operating room, they would listen to this signal to determine which lymph nodes to remove. It made me unreasonably happy that this message too was invisible and inaudible as well, unless you were intentional and used special instruments to detect the faint vibration of the particles. I found it reassuring, even validating, that everyone agreed that kind of wordless message could be trusted, believed. That we could make important decisions based only on that subtle vibration. After the surgery to remove the cancer and the localized lymph nodes and all the surrounding tissue, surgeons gently put me back together again. As my tissues began to settle into place, I adjusted to the new incisions, wound vacs, and drains. Two weeks later, the pathology report confirmed that the tumor had spread just as far as I had marked by pointing. That confirmation led to a subtle change in my husband’s questions, as if he knew he had reason to value the answer differently. He said, “Ok, I’m ready, now what’s your body telling you? Hopefully more than 5 years.” I sat very still, turning inward and listening for what message might resurface. But there was nothing: no warning words, no encoded message to be translated. “No, it’s just quiet now. That knowing is gone.” He exhaled, and we sat in the stillness. And what I heard in that silence was a kind of faith. None declared. The Whole StoryCHESTVol. 164Issue 5PreviewThe Humanities section of this issue of CHEST features the first of three articles that were stories shared at the 2022 CHEST Annual Meeting (CHEST 2022).1 Storytelling is at the very center of how we practice medicine, whether it be listening to the stories of our patients or retelling theirs from our medical lens. How we listen to, interpret, and summarize the stories of our patients is influenced deeply by our own experiences and the chapter of life and career we may be in. Our human experience undergirds our humanism. Full-Text PDF