Wednesday, April 18, 2007

Book Review: The Lonely Patient: How We Experience Illness by Michael Stein, M.D. (New York: William Morrow, 2007)

Every once in a while someone will ask me if I’ve been busy. One of the answers I sometimes give is, “As long as there’s sin and sickness I’ll always have plenty to do.” Indeed, most pastors spend much of their time dealing with parishioners who are having health issues. Sometimes those health issues are very serious; sometimes the diseases are terminal.

Pastors are hardly alone in having the privilege and responsibility of dealing with sick people. Doctors, nurses, and other medical professionals do so all the time. Those who relate to ill folks as family members, as friends, or as members of a faith community are also faced with the challenges that come with trying to be there for their loved one in a positive way.

Then there is the fact that each one of us is a potential patient. While I am healthy so far as I know, I could wake up sick tomorrow. I slept well in my own bed last night, but I may find myself in a hospital bed tonight. Sickness is, then, a universal experience. Chances are that everyone reading this article is either sick or has a close relation who is sick.

Michael Stein’s book The Lonely Patient would therefore be a helpful read for anyone. Stein, a medical doctor, is professor of medicine and community health at Brown University School. He directs HIV clinics in Rhode Island and the Dominican Republic. Stein’s perspective is first that of a physician, then, but it is also much broader than that. He also writes as a family member; a good portion of the book deals with the terminal illness suffered by his cherished brother-in-law Richard. Perhaps most importantly, Stein writes as a human being. While, as he notes in the book, doctors have to keep some emotional distance from their patients, he writes openly about his own emotional struggles in dealing with his patients on the basic human level. Stein writes with clarity about the experiences of the patients with whom he deals and about his own experiences in dealing with them. That clarity is one of the strengths of the book.

Stein was profoundly impacted by the illness and death of his brother-in-law. He wrote, “It’s taken me the six years since Richard’s death to grasp what it takes out of one to be a patient and how doctors and caregivers might help recognize and restore what is lost during illness” (p. 8). As Stein offers the stories of Richard and of some his patients, he weaves a narrative of their experiences that does indeed help the reader better understand the experiences of loss that a patient suffers. “(T)he ill person’s distance from others is the most profound experience of illness, and…this sense of other-ness—of loneliness—is more common in illness than any other emotion, and more dangerous and disturbing” (p. 11).

Along the way, though, Stein identifies and deals with three other experiences of the ill that are also profound: betrayal, terror, and loss. He tells the stories of real patients, with names and some details changed to protect their privacy. While he deals at length with their emotional responses he does not stop there. Stein also reflects upon the role of the doctor in helping the patient to deal with her experiences. I found that aspect of the book especially helpful to me as a pastor, since we pastors also have the responsibility to walk alongside our parishioners as they traverse the dark corners of illness.

While The Lonely Patient is not a theological work, it is not without its share of theology. For instance, in talking about the patient’s experience with pain, Stein notes the religious overtones of pain. He cites some perspectives of religious traditions on pain, including the Judeo-Christian teaching: “Suffering is the central metaphor in Judeo-Christian thought: the test of faith in the story of Job, the sacrificial redemption of the crucifixion” (p. 44). Later, when he says, “The best we can do as doctors is turn ourselves into a reflection of our patients’ pain. The doctor’s job is to make the pain shareable” (p. 53), he makes a profound theological statement as well. I believe that doctors, ministers, family, and friends are doing God’s work when we share another’s pain so as to offer a chance for its redemption.

An accomplished writer of fiction, Stein published four novels before writing The Lonely Patient. His strong writing is another strength of the book. He paints some marvelous word pictures. Here are a few examples.
Pain is God’s arrow. (p. 28)
Pain is an alarm, but doctors can change the pitch. (p. 57)
This was what getting sick was: learning a language he didn’t want to know. (p. 78)
I’ve learned over the years that there are cues to a medical visit but no plot. (p. 90)
Illness carries with it "the losses to come." (p. 160)
I offer those examples to demonstrate what a pleasant read this book is even though it is about a subject that many would regard as a most unpleasant subject.

The section on pp. 196-205 in which Stein tries to answer the questions “So what might help? What does a sick person want from his caregivers and his doctors?” is worth the price of the book for all of us who deal with the sick in our professional roles.

I recommend The Lonely Patient for everyone because everyone deals with illness. I especially recommend it to doctors, nurses, chaplains, pastors, and all others who deal with the sick day in and day out.

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