The Crumbs

Abstract

Contemporary medicine strains our ability as practitioners to attend adequately to the patients we serve in their moments of need. The account of Jesus’ interaction with the Canaanite woman depicted in the gospel of Matthew offers a vision of patience, humility, and kindness that we as time and resource-stretched practitioners might emulate when faced with such challenges.

ⁱ Then Jesus went from that place and withdrew to the region of Tyre and Sidon.

22And behold, a Canaanite woman of that district came and called out, “Have pity on me, Lord, Son of David! My daughter is tormented by a demon.”

23But he did not say a word in answer to her. His disciples came and asked him, “Send her away, for she keeps calling out after us.”

24* He said in reply, “I was sent only to the lost sheep of the house of Israel.”

25^j But the woman came and did him homage, saying, “Lord, help me.”

26He said in reply, “It is not right to take the food of the children* and throw it to the dogs.”

27She said, “Please, Lord, for even the dogs eat the scraps that fall from the table of their masters.”

28k Then Jesus said to her in reply, “O woman, great is your faith!* Let it be done for you as you wish.” And her daughter was healed from that hour.

-Matthew 15: 21–28 (The Bible)

My pager buzzes viciously at my side as my stomach drops: another one. “Admission Smith in B21. Here with dehydration and alcohol withdrawal, PO intolerance.” I scroll through the page, sigh deeply, and place my head in my hands. Preparing for my fifth admission in two hours, I’m feeling that strong urge to lash out at a system that renders excessive and constant demands with little regard for the time it takes to do medicine well. This feeling has quickly caused me to resent, and even fear, when that pager buzzes, even in times of relative calm. It seems the strain from moments of excess spills over and colors moments of respite, such that any admission page now feels like an affrontery.

How strange it is, I realize in retrospect, to resent this call for help, to despise that summons which I entered the profession to pursue, to care for sick people. Somewhere along the way, the call to care has mutated into an imposition, a greedy, unconscious competitor for my precious time and energy, such time and energy which I’ve learned to guard jealously after it was characteristically wrenched from me throughout four years of residency training.

The patients are legion, and they are needy. Yet by this point, the profound fear and uncertainty these patients may feel upon being admitted to the hospital has been rendered wholly banal for me as I rattle off questions about home medications and code status and scroll through order sets on computer screens. Even in spite of this desensitization, however, in my better moments I recognize that I am set up in these spaces to be charitable, to be one who pours out to those who present themselves seeking my help to find a cure, or at least an occasion for hope.

But right now, I do not feel charitable.

It is my chief resident year — I am expected to work part-time as an independent hospitalist as part of my clinical duties, ostensibly for my own education. But this year I have also learned the way in which clinical work such as this can be shifted upon trainees with little recourse, under the guise of education. I am currently in the midst of a ten-day stretch on the admitting service that rivals the hours and rigor of residency, this after I thought those dues were well paid.

It is against this mental and emotional backdrop that I pull myself together to go and meet Ms. Smith. She is old and lonely, and wants to talk. I sense this immediately, her propensity to share and muse, to deviate from the pointed questions I ask her. Systematically, I re-direct as she begins bemoaning her social situation and a challenging relationship she finds herself in — “Ms. Smith, is it 10 milligrams of amlodipine you take daily?”

She continues to fail to stick to the script — resisting my focused, extractive questioning. But I assiduously re-orient, guarding against anything I deem extraneous for her admission history and physical. As I prepare to examine her, she blurts out tearfully,

“Doc, I need your help. I keep losing weight and I don’t know why. No one knows why. What do you think?”

At this question, I sense an immediate and reflexive encumbrance, a visceral annoyance, even. How could she possibly expect me, the mere admitting physician, to solve this chronic problem for her which dates back several years? The source of her weight loss is likely complex and multifactorial, and will involve a dedicated discussion with her medical team and possibly consultants. Can’t she see that my job as the admitting physician is merely to make sure she is stable, to construct a tentative plan and to ensure her acute issues are addressed before her primary team assumes her care? Why is she asking more of me than my job requires?

“I’m not sure, ma’am,” I respond with some combination of terseness and fatigue. “That is a good question for the team who will take over tomorrow.”

When I read the above encounter between Jesus and the Canaanite woman, I can’t help but be struck by Jesus’ forthrightness, a forthrightness that seems to border on dismissiveness. I am no Biblical scholar so I am certain this interpretation may be overly simplistic. Nevertheless, to refer to someone as a member of the “dogs” seems calloused, or at the very least abrupt.

And while I am sure Jesus is not actually acting in a calloused way, I can identify with his desire to draw limits here in the face of multiple (and competing) seekers of his time and energy, to circumscribe his commitments, with my work in the hospital. As the admitting physician, I am the person others come to in search of help, even as I am painfully aware of the limits of what help I can provide when stretched so thin.

Jesus’ response resonates, too, a move to delineate boundaries in the face of what feels like an unreasonable request, not unlike my perception of Ms. Smith's entreaty into the cause of her chronic illness. Yet it is here where I note an important difference between my reaction and that of Jesus, in the fact that his stated priority — to pursue and redeem the lost sheep of Israel — was one that was reasonable, honorable, and worthy.

In contrast, I recognize that, while I have subtly and powerfully construed my own “lost sheep,” these priorities for my time and energy are often far less worthy, and selfishly motivated. I may hide behind my multiple simultaneous admissions to see, but the truth is that my desire to economize (and minimize) conversation with patients is often also present when such rival commitments are absent.

It is interesting to imagine what it would look like to voice this to the patients I serve, whom I too often perceive as drawing greedily from my limited well of time and empathy.

“I have come,” I would say, “to pursue the good of efficiency, of completing this work for which I am severely undercompensated as quickly as possible.”

“I have come,” I would assert, “to preserve time for me to retreat to my workroom, to pull up my email, to make plans for my life once this shift ends.”

“I have come,” I would inform them, “to break bread with the important and influential, white-coated power brokers, not to expend excessive time with those who cannot benefit my career trajectory.”

In short, in my fatigued, solipsistic, frustrated moments, to serve myself and to avoid excessive time with the ones who will only draw more from me, dominates how I view my work.

“Ms. Smith,” I want to say, when entrenched in this mindset, “My job is to admit you to the hospital, as quickly and effectively as possible. Your musing and meandering and mourning distracts from that goal. It is not right to share the scant bread that allows my own self-preservation in this system of manipulation of trainees and employees, this bread that justifies my self-righteous sloth, and share it with you, a dog, a dog who comes to consume, to draw out, to extract and depend and deplete.”

But then, just when I am inclined to be offended by her call for help, to render Ms. Smith my enemy when all she really wants is comfort and reassurance, I am reminded of Jesus, and his unflinching wisdom, humility, and steadfastness.

Jesus recognizes in the Canaanite woman's response a deep belief in, and reminder of, his own kenotic commitment to her flourishing, and that of her daughter. He does not stubbornly bear down and redouble his effort of boundary-drawing, but demonstrates a humility that issues in charity, toward this woman and her daughter's shalom, their restoration of bodily and spiritual health and wholeness. He recognizes her anew as one of the sheep he has come to serve and exhibits a profound sense of hospitality in spite of his own competing commitments; an ecstatic move outward when external pressures conspires to turn him inward.

I wish that I had considered, and drawn upon Jesus’ remarkable example of patience, humility, and self-giving love in the face of the Canaanite woman's call for help, in my own care of Ms. Smith. Unfortunately I did not, and thereby missed an opportunity to share the good news of Christ's charity to the most needy among us, and to offer comfort in her hour of need.

Yet in this failure I am also reminded that when I myself deserve treatment like a dog, when I mistake and mischaracterize the sheep worthy of my time, energy, and love, when I characteristically fail to recognize Christ in the face of his children for whom I am privileged to care, when I designate myself least of all deserving of the bread he so durably and gently offers, it is precisely here that he meets me and reminds me that the same steadfastness and hospitality he extends to the Canaanite woman, he extends to me. And that in a system in which I am tempted to believe that I must grasp tightly to all that I work hard to earn, and similarly clench those failures which are so hard to release, his grace enters in, at once powerful and winsome, there to rescue and emancipate, if only I have eyes to see it.