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Nuance is a podcast of The Collaborative helping Christians to faithfully live out their faith in their work. We recognize most of life is not lived in black and white but rather lived in the gray, lived in the nuance.
You can find more, including complementary spiritual exercises, at www.collaborativeorlando.com/nuance.
God is the source of compassion. And with the compassion we receive from him, we're able to show compassion to others. So we are conduits of compassion. We are not generators of compassion. And that's why being able to connect to God at work mitigates compassion fatigue.
Speaker 2:One of the marks of a serious book is that it does not close a conversation, but rather it opens one. Well, after reading doctor Mark Topazian's book, I reached out to a number of physicians that I know, that I trust. Individuals who are practicing medicine in hospitals, clinics, academic settings. I asked them to reflect honestly on doctor Topazian's argument in his new book, Healing Purpose, Finding Satisfaction in a Healthcare Career. I asked them to think about Marx's arguments and to offer their questions, not theological hypotheticals or things to publish in a journal, but the questions that are forged in exam rooms, in hospital corridors, long nights on call.
Speaker 2:And so today's conversation is shaped by those voices. Welcome to Nuance, where we seek to be faithful in the public square. I'm Case Thorpe. Mark, welcome back. Thank you.
Speaker 1:Great to be here, Case, and thank you so much for the chance to talk with you.
Speaker 2:So doctor Mark Topazian, as I mentioned, is the author of this book, Healing Purpose by InterVarsity Press. And he has a long career as a gastroenterologist, a professor, and an author with training having been accomplished at Yale and the Mayo Clinic. Now his work grows out of years of engagement at the intersection of theology and professional formation in the health care system. He's been trained to think carefully about vocation, meaning, and moral formation and passes along that wisdom to us. So I appreciate this.
Speaker 2:Now, Mark, last time, we explored a number of the elements of your book, how to, as a clinician, explore and understand the spiritual state of your patients, how to be attentive to the Lord at work all around you. Well, so like I mentioned, I have asked a number of doctors that I know to give me some questions. So are you ready?
Speaker 1:Sure. Let's
Speaker 2:go From a retired cardiothoracic surgeon, a dear friend and a wonderful supporter of the collaborative, he asks, what's the most spectacular unexpected cure in one of your patients and its explanation?
Speaker 1:Yeah. Wow. Well, I don't know. I'm guessing a cardiothoracic surgeon might have something more spectacular to tell him. Maybe you should ask him to come on the podcast.
Speaker 1:I would say that in general, to me, the distinction between miracles and non miracles is I'm not sure I completely accept that distinction. So that's the first thing I'll say.
Speaker 2:Tell us more I about have
Speaker 1:seen a number of things in my career that are medically improbable. And especially working in low resource situations, have seen where we've had to improvise to try and get something right for a patient. That wouldn't be the case in in America, a very resource rich place. But I'm just talking about the bits and pieces and and equipment and medicines and tests that are available.
Speaker 2:Because you're serving actually right now in Ethiopia.
Speaker 1:Yes. I am. And I've worked in multiple Sub Saharan Africa settings. And, you know, there's just times when you think, okay. Let's try this, and it actually works.
Speaker 1:And you say you can say to the patient or their family afterwards, God has done something really special for you.
Speaker 2:Right.
Speaker 1:And you that's a heartfelt statement. Mhmm. And so it's the improbable. You know? I've seen in my career a couple of tumors disappear.
Speaker 1:Praise God. You know? Is there is there another is there a possible natural scientific explanation? There may be. And does God heal through the laws of the universe sometimes?
Speaker 1:I think probably so. So so yeah. I mean, that those those would be my examples.
Speaker 2:I do believe in miracles, and I have seen them over the years. I was quite moved when in Madagascar a number of years ago that the various churches there will have what's called a tubi. And a tubi is a structure behind the church where you are to bring friends and family for healing. And this structure will have a number of apartments, to say, rooms to keep individuals over a certain term or period. They have a medically trained nurse on staff to help administer medicines and keep track of things.
Speaker 2:But several times a week, the elders from the church come and walk from room to room and lay hands and anoint with oil to pray God's healing on this individual. And I'm a little suspect, of course, coming in with my Western empirically trained and formed mind, and yet my heart is rooted in the scripture and I know that it happens there, so it's possible. And we heard testimony after testimony from both the patients as well as their family members to say, we've been everywhere, and it was only after coming here that our loved one was helped with this combination of both medicine and the healing work of God. Wow. It's and it and what got me is how even a two b is kinda structurally part of this massive denominational system.
Speaker 2:Like, you have a women's ministry in a Sunday school, you have two b's. They just are normal. And that's that was powerful.
Speaker 1:Well, and I do think, follow-up on that, that the occurrence of spiritually of healing that's based in spiritual intervention rather than medical or technical intervention. I think that this is a phenomena that happens more in some places than others.
Speaker 2:For sure.
Speaker 1:And that I'd say more in some times than others. And that it's oftentimes part of God's work breaking into a culture. Surely, you know, my friends who know the history of of the Protestant movement in Ethiopia will tell you that. That here, seventy, eighty, a hundred years ago, the supernatural miraculous healing was a routine event in churches. Yeah.
Speaker 1:And perhaps not so much anymore. Mhmm. And why? What is the Lord doing there? I don't know.
Speaker 1:But I do think that that is true that in some places and cultures and periods of time, this may be a commoner or less commoner phenomenon.
Speaker 2:Well, in my travels in partnership with mission work around the world, it's our western empirical view that does not leave room for the miraculous and the work of God. Whereas you go in some other places, especially that are so resource poor, people are desperate and so they are much more open and eager for God to intervene and it's more visible. It's more visible. Okay. Next question, who is not a surgeon but a cardiologist.
Speaker 2:He asks, how does a Christian health professional avoid or deal with burnout in today's world? You mentioned a term in our last episode, empathy empathy.
Speaker 1:Or Compassion fatigue.
Speaker 2:Mhmm.
Speaker 1:Yeah. So compassion fatigue and burnout are related, and people define these terms a little differently. But let's talk about compassion fatigue. K. The it's a complex phenomena, and it's very common in health care.
Speaker 1:During the COVID epidemic, surveys showed that in some surveys, over ninety percent of working health care professionals were suffering from compassion fatigue.
Speaker 2:I bet.
Speaker 1:Yeah. Yeah. And it's a major reason why there's an exodus of health care professionals from the field. People are quitting. Or they go into administration or somewhere where they don't interact directly with patients.
Speaker 1:And so it's a really important issue around the world and certainly in American health care right now. And the it's a complex phenomena. We talked last time there were bodies, souls, and spirits, and it's true of us health care workers. We are bodies, souls, and spirits. And there's definitely a physical limitation component to compassion fatigue.
Speaker 1:We know that work hours are particularly important. If you're working too many work hours, you can sustain that for a week or a couple of weeks.
Speaker 2:Right.
Speaker 1:But if it's the routine, month after month, you will end up in a place of compassion fatigue and burnout.
Speaker 2:Okay. Explain this to me.
Speaker 1:The sorry?
Speaker 2:If I may interrupt, explain this to me. I've never understood why, especially residents or they let the ER doctors do twelve hour shifts. I mean, I don't want an emergency on somebody's eleventh hour.
Speaker 1:Well, I don't quite view that one that way. Most Most emergency physicians I know will work three twelve hour shifts a week. So that's thirty six hours in the week. And I think that's quite quite doable, frankly.
Speaker 2:Okay. Well I'm sure there's studies on this but it makes me think after twelve hours, you're too tired.
Speaker 1:Well, but you've had a day of rest before, a day of rest after. And they're not all working twelve hours. Sometimes it's ten hours or occasionally eight hours in emergency medicine, I think. Okay. But it's more the cumulative number.
Speaker 1:At least the science says it's the cumulative number of hours in the week. And the limit for different people is different. It's not like it can tell you, here's the exact number. But but you can look for all the spiritual solutions in the world, but if you're working way too many hours a week long term or you have more responsibility at work than one person can reasonably handle
Speaker 2:Yeah.
Speaker 1:You're gonna be compassion fatigue. And so those elements shouldn't be minimized at all, case. But you can get all those things working right, and you can still have compassion fatigue. And because there is a spiritual dimension to it. And compassion fatigue is the weariness that builds from the constant exposure to difficult situations and the giving of yourself to others.
Speaker 1:And it's the feeling that the satisfaction you get from taking care of people is outweighed by the fact you have nothing left to give. And the diagnostic signs of it are irritability, quick to become angry and frustrated, loss of a sense of purpose and meaning in my work. What I'm doing seems increasingly meaningless. Loss of interest in the rest of life outside of work. These are very common sort of symptoms of compassion fatigue.
Speaker 1:And there are actually online tools. You can go and do an online survey and figure out if you have compassion fatigue. Wow. And that's something I think very relevant to pastors actually as well as to healthcare workers. A lot of the same issues apply.
Speaker 1:So there are a number of faith based tools that can help with compassion fatigue. And we even have some data, scientific data in the medical literature, that faith based approaches help with compassion fatigue. Mhmm. And for for Christians, those include integrity. They include lament.
Speaker 1:They include the use of scripture in in your own life in a clinical context. Even include seeking in the midst of your fatigue a new experience of God. And the reason all of those strategies, we could talk about work, is that God is the source of compassion. The first verses of second Corinthians tell us that God is the source of compassion. And with the compassion we receive from him, we're able to show compassion to others.
Speaker 1:So we are conduits of compassion. We are not generators of compassion.
Speaker 2:Oh, that's true.
Speaker 1:Why being able to connect to God at work mitigates compassion fatigue. Like I said, if you're working too many hours, you gotta deal with that, etcetera. But but being able to connect with God takes a burden off your shoulders in the middle of a stressful situation Yeah. And puts the burden on his. And the spirit in real time will bless you with his love, and that in turn gives you love to show to others.
Speaker 1:And we have, again, scientific evidence that when we work in health care, when we're motivated by compassion, which is a caring concern for others, when we're motivated by compassion, we get a lot more satisfaction from our work than if we're doing it just because it's our job. So the spiritual element, it's it's very helpful. For me, scripture memory has been a part of this. So there was a time in my life when I A spiritually dry time in my life case where I just felt that, you know, I felt some distance from God and from spirituality. And out of frustration, I decided to try memorizing scripture.
Speaker 1:When I was a kid, I would memorize the verse of the week on the way to church so I could recite it in Sunday school and get a candy, and then I would forget it on the way home. And so memorization was never all that big a thing in my life. But kinda mid career, out of frustration really, I, you know, I read the bible and there was never anything that was speaking to me. So I started memorizing in Philippians, and I thought maybe I can memorize a whole chapter. So I printed out the thing on a piece of paper, and about the only time I truly had to myself away from a beeper or anything else was when I was jogging.
Speaker 1:So I would take the piece of paper with me jogging and try and get one phrase down. And, you know, it took me, I don't know, a month or two to memorize that chapter. And then I kept going. So one day, I was in a, interventional procedure on a with a patient. I mean, they're out.
Speaker 1:They're asleep. I'm doing endoscopic surgery on them. Mhmm. And there's a problem. Things are not going according to plan.
Speaker 1:And so, you know, this happens in health care, and there's a strategy to deal with those moments. And I'm working through the the strategy, and it's just not helping. And it's a problem. And a very natural reaction at that time is either you get angry or you get frustrated or look for someone else to blame. You know, but none of those are actually helpful in that situation.
Speaker 1:And I had been memorizing Philippians four at the time. And so I'm I'm looking at this technical problem. My mind is full of the technical problem in front of me. And all of a sudden, clear as day, these words are in my mind. Rejoice in the Lord always.
Speaker 1:I will say it again. Rejoice. Let your gentleness be evident to all because the Lord is near. Don't be anxious about anything. Beautiful.
Speaker 1:But in every situation, by prayer and petition with thanksgiving, present your request to God. And it was just there in my head. Yeah. I wasn't looking for
Speaker 2:Right.
Speaker 1:And, wow, that was such a powerful experience for me. And I don't think anyone else in the room realized it. You know? It's just going on in me. But all of a sudden, was peace and clarity.
Speaker 1:And that's what I needed right then. Right. And that was such a remarkable experience for me, and it became a recurring theme actually and has been to this day in my practice when those moments come where things are not going according to plan. And frankly, that's what you want in your doctor. You want someone who's gonna have peace and clarity in those moments.
Speaker 2:Sure.
Speaker 1:And it's such a blessing to me for that to have happened in my life. But it came through having decided to just try and memorize it. So I think there's a lot of pathways to get to what we're talking about.
Speaker 2:I love that partly because I have attempted and I'm not very successful with scripture memory. And I've always thought, okay. If I get imprisoned in another part of the world, I I hear about those missionaries in tough situations and God's word just flows flows flows and supports them. And I think, well, I'm not gonna have that. But but what I will have are hymns.
Speaker 1:The Oh, nice.
Speaker 2:Wonderful hymnody that is Yeah.
Speaker 1:There you go.
Speaker 2:Deep down and so I imagine myself in a jail just singing at the top of my lungs, be thou my vision. So there's a lot of
Speaker 1:scripture Well, I relate to that because I know that if if on my commute to work, if I listen to some praise songs Mhmm. It is likely that some snatches of that will come to mind during the day.
Speaker 2:For
Speaker 1:sure. You know, almost subconsciously, there's a little humming. And, you know, you're busy in health care. There's no time to sit and meditate, have lengthy prayer. You know?
Speaker 1:You're just busy all day long. But if these if you've sort of prepared yourself in a way, if you know the hymn, if you've listened to some music on the way to work, if you've been memorizing scripture, I mean, then it's amazing what these things can actually do at work.
Speaker 2:Okay. You mentioned prayer. This next question comes from a pediatrician, and he asks, what role does prayer have, if any, in the doctor patient relationship? Yeah. That is such a beautiful question.
Speaker 2:And
Speaker 1:I'm gonna answer it as a doctor for adults. I'm an internist and gastroenterologist. So the question's coming from a pediatrician. And that puts an interesting slant on it.
Speaker 2:Yeah. It
Speaker 1:does. And I might have to say we're gonna have to go back to your friend to hear more about pediatric side of that. But let me speak as an internist and gastroenterologist. So I would say that prayer is an important tool in encouraging our patients' spiritual health. And that most Americans believe in God or a higher power.
Speaker 1:Most Americans who have a serious or chronic health condition are asking themselves questions about the meaning of that illness, what we might call spiritual questions.
Speaker 2:Mhmm.
Speaker 1:Some of them are dealing with what we talked about last time, religious struggle. Mhmm. Right? So I think prayer can often be appropriate and helpful to our patients. But that's true for patients who are interested.
Speaker 2:Mhmm.
Speaker 1:And I think that if we're going to offer prayer to our patients, it should be with their permission. We should be offering the prayer with sensitivity and respect.
Speaker 2:Mhmm.
Speaker 1:And, it should be about the patient's need and what's gonna help them, and not my own compulsion to pray. Mhmm. So it'll depend in part on what I learned from taking a patient's spiritual history, and we talked about that last time. Mhmm. But if I find out that spirituality is a part of my patient's life, or it was in the past, maybe long ago, and now in this health situation, it's kind of coming up again, then I may offer prayer, and especially before an interventional procedure, because I do a lot of that.
Speaker 1:And I find that it's among other things, it's an antidote to fear. Because faith is an antidote to fear. I mean, the Bible makes that very clear. So And a couple of examples. In a procedure room, patient lying on an operating table.
Speaker 1:There's there's pumps, medicine pumps beeping. It's a little cold. The nurse is getting the patient a blanket. And the patient looks up at me and says, doctor, I'm afraid. Yeah.
Speaker 1:And more people think that than say that. But I've had patients say to me, doctor, I'm afraid. And what I will say in that setting is I want you to know that we have a great team here to take care of you today. And we've all done this many times before. We're really good at this.
Speaker 1:And we're gonna do everything we can to make it turn out well for you. And I also want you to know that I believe in God and I think God is here and he loves you and he's here with you. And if you'd like, if it would help you, I'd be happy to pray with you. And you know that patient who says to me, I'm afraid, they're always gonna say yes. For sure.
Speaker 1:And the other times that I'll offer prayer is just if I have a sense for spiritual turmoil, spiritual distress Right. Or if the spiritual history has told me this patient sees the spiritual side of things, and this is a they've reached a critical point, You had an intervention or a decision about treatment. And then some of my colleagues will say to their patients, is it okay if I prayed with you? And personally, I'm not a big fan of that way of asking. Cause I think that's more about me and what I wanna do.
Speaker 1:I much prefer what I learned from a colleague which is to ask, would it help if I prayed with you? Because I want it to be about the patient and what's gonna help them. Yeah. It's not about me and my need. I also, I don't want them to feel like an object being prayed over.
Speaker 1:Want them to actually feel like a participant in the prayer. Now, often participant. You know, I think prayer for some of our patients, it's an opportunity to start wading into the ocean of faith. Right. Trying it out.
Speaker 1:You know, even if they're distant from faith or they've left it behind in the past or they're asking themselves questions about spirituality, it's a chance to put their toes in the water. Mhmm. So I don't only offer prayer to people who I know share my faith. Yeah. But I try to always I let the spirit prompt me about when to ask.
Speaker 1:I've tried to get my three d glasses on about who my patient is. And I ask. And I want it to be about the patient, what they want, what's going to help them. And then when I pray, I try and pray using the lament form. And so the acronym I use for that is TREAT.
Speaker 1:Tell God your complaint. Remember His past love and faithfulness. That's the r e. Remember. Ask boldly for help.
Speaker 1:That's the a. And then the last t, trust in God. So these are common elements of lament in Scripture. And so I don't claim healing in prayer for the patient. I don't make any promises in prayer, if you will, about what's But gonna I'd love to give you a brief example here.
Speaker 1:So if the patient says, yes, would be great if we prayed together, I'd say, okay, let's do it. Lord, Mrs. Smith is here today because she has to have this tumor removed or because of this chest pain she's having. Mhmm. Whatever it is.
Speaker 2:That's the tea.
Speaker 1:That's the tea. And then Ari, remember, father, I know you've been with her through life. And even when she hasn't been aware of it, you've been providing for her, and you brought her this far. And you're so good. You're so good.
Speaker 1:So we ask you to have be present today. We ask you to give us success. I ask you for wisdom as I'm working with her today. And we both trust in you. There's the Put this in your hands.
Speaker 1:That's the final thing, the final t. So in my own so in my own life, I find that if I pray a lament about some issue rather than just asking God to fix it, then there's a peace that comes. Because when you pray a lament, you not only bring the issue to God, but you align yourself with him, you remember his faithfulness, and you put your trust in him. So when I pray with a patient, I'm also trying to use that format.
Speaker 2:So good. So good. Okay. Next question from another pediatrician, actually my own children's. And he asks, what aspects of our US healthcare system are uniquely dehumanizing to both patients and practitioners?
Speaker 1:Well, first off I would say that our system is not all dehumanizing. Our healthcare system in The US is full of compassionate people who went into healthcare because they wanted to help people. And so I think more often than not, that's the case case. So I would I would push back a bit on saying we have a we're we're treating people like robots or or a patient. But there is patients can feel like they're on an assembly line and that they've been reduced to their physical condition.
Speaker 1:And that is a real issue. I think in part it's because we're so good at what we do. I mean, we are. And the healthcare, not that we can fix everything, I'm not saying that, but modern medicine is amazing. And it's a gift from God.
Speaker 1:It's powerful. And so that becomes enough for a lot of people. And for some patients, that's all they need, as we talked about last time. But I also think that healthcare work in The US is busier and busier. The demands are higher and higher on the caregiver.
Speaker 1:More and more patients in an hour. More and more documentation and paperwork. Interestingly, AI is helping with that in some ways, which is a beautiful thing. Interesting. It may help with this issue.
Speaker 1:But, so if you're pushed to the point where you have to start dropping stuff and just focusing on some essential, You're gonna focus on the technical details of what you do in medicine, which actually your patient needs that, those details, and you're gonna let go of a lot of the other stuff. And so especially when you're stressed, there's too much work, patients start to become commodities. And in the long term, that steals the satisfaction of the healthcare worker, and it also makes the patient feel like they're being treated like a commodity. So for me as a healthcare worker, part of it is working in a system that allows that's humane and allows sufficient time to care for a patient. For some of us, that means we have to make a decision that we're just not gonna be as financially productive.
Speaker 1:For some of us, if we've decided that the career path we're gonna take is the one that maximizes our income, well there's a trade off there. And don't be surprised if you start to feel like there's no space in your practice for anything but the bare medical essentials. Sometimes though, we're working in a healthcare system that has its priorities wrong and that doesn't treat even its employees like full human beings. And then either we're advocates for change in that system or we just find a better place to work. So there are solutions, but I also think there's hope for our system.
Speaker 1:And like I said, I think AI is actually gonna help us with this because the the paperwork and the logistics and even many of the technical algorithmic details of medicine, AI is increasingly gonna take care of all of that. But what it will never be is one spirit talking to another spirit.
Speaker 2:Mark, last question and this is from a family practitioner who serves the underserved and the vulnerable. He asks, what would you tell first year medical students to prepare them for what's ahead?
Speaker 1:First year. I think I'll answer for third year. So when you go to medical school, the first part is mainly classroom stuff and learning the science. And then you start and it it's not always divided this way, but then you start going to start learning about interactions with patients. And like you're observing.
Speaker 1:And I remember being in a situation as a medical student where I was shadowing a pediatrician and a teenage patient came in with her mom and this patient was dealing with a condition called ulcerative colitis. I didn't know at the time I was gonna become a gastroenterologist and see a lot of patients like this. But anyway, that patient came and most people with ulcerative colitis, it gets better with medicine and they carry on with their life. But this girl, it wasn't getting better. And, it was time to seriously consider having her colon removed so she could carry on with life.
Speaker 1:You know, she's a teenage girl. Body image issues, they're huge. And, you could see she was just completely freaked out by this idea of having an operation to remove her colon and a temporary ileostomy. About emptying into a bag, at least temporarily. And her mom was freaked out and the pediatrician could only give them stick to the medicine.
Speaker 1:Talking about medicine and surgery and the pros and the cons and the risks of surgery. And there's just such a huge disconnect and the patient and her mom left in such turmoil. And I left, I was just a medical student watching in the corner, you know? But I was in turmoil, you know? Afterwards, I was like, I never want that job if that's how patients are gonna walk out of my consultation room.
Speaker 1:And I had like no way to make progress with that in my head case. And so I was like, maybe I just need to go into some field where people always get better. That's easy. Because, you know, I don't wanna have to deal with that. But in fact, that situation, there's a completely different way of dealing with that situation.
Speaker 1:You know? To learn about your patient as a whole person. And what are your concerns? And okay, let's work with those concerns. And let's work together through all of this.
Speaker 1:And as we talked about before, what social, family based, emotional, what spiritual resources do you have that are gonna help us get through all this and get you to a better place than you are now? Let's work on it together. So there's such a different way of approaching those tough situations that I was clueless about as a medical student. And I would say, find a wise older colleague who's been around the block and who's found some good answers to this and spend some time with them in their clinic. And just learn from them how in a difficult situation you can be such an agent of peace and grace and change in those situations.
Speaker 1:That's what I would say. And then you could, you know, you could read a book. You could take sailing process training. Those would be good too. But there's nothing like shadowing somebody who has insight into this.
Speaker 2:Right. Right. Or they could also read your book. Mark, thank you so much. I really appreciate your time, and especially your coming to us from Ethiopia.
Speaker 2:God's blessings on your work there.
Speaker 1:Thank you so much, Case. It's been a huge privilege to talk to you and to to share. And I'd love to hear from anybody who's listened to this and has something they wanna teach me about or share a story or give me some more insight because I'm still learning about this stuff too.
Speaker 2:Well, to do just that, is there a website or a social media platform to best learn more about you and your work?
Speaker 1:Yeah. So you know, I'm over 50, so this social media thing has never really clicked for me. Do have a website, marktpazian.marktpazian, I don't even know. Marktpazian.net, I think. But anyway, if you search for me online, there's I have a very unusual name.
Speaker 1:You'll find me.
Speaker 2:Okay. It's Mark Bazian. We will put something. Okay. Well, we will put that link in our show notes.
Speaker 2:Friends, please go out and pick up Mark's book published by University Press, Healing Purpose, Finding Satisfaction in a Healthcare Career. Well, again, I wanna thank you for spending your time with us, whether you are working out or running errands or just enjoying the view. We appreciate your listening. Share this episode with a colleague or even your doctors that they could be encouraged by this conversation. You can learn more about our work at The Collaborative by going to wecolabor.com.
Speaker 2:That's wecolabor.com. Drop us your email, and we will send you our journal on faith, work, and culture called zeitgeist. Many thanks to the Stein Foundation for making today's episode possible. I'm Case Thorpe, and God's blessings on you.