We doctors are fixers. Medical school teaches us to conquer disease with an arsenal of technology. In the best circumstances, our determination to cure illness fulfills the call to love our neighbors (Matt. 22:39). A physician’s diligence can win people more time to love their families, pursue what matters in life, and glorify our Lord (Col. 3:17).
Yet while we can postpone death, only Jesus has overcome it. Eventually our cures run out. Cancer cells evade chemotherapy. The heart stretches and thins under the strain of living. Infections overwhelm. Ravaged by a sinful world, the body falls apart, its perfectly orchestrated mechanisms collapsing. While we can delay death with our advances, we can eradicate it for no one.
Yet despite its inevitability, many physicians falter when death confronts us. Death feels like failure when we’re trained to focus on the next treatment option, the next test, the next procedure. Our instinct to charge onward can corner the dying and their families into crushing predicaments. We offer options that won’t bring the dying home. We pursue measures that crack ribs and rob people of a voice, without any hope that they’ll again kneel in a garden or recline in a favorite chair. We forge ahead with our technology, inadvertently trampling the lives we aim to protect—not because we’re cruel, but because that’s all we know how to do.
Amid this troubling landscape, one doctor calls for stillness. Dr. Sunita Puri, a palliative care specialist at the University of Southern California, has partnered with myriad people at the end of life and wants to shift the conversation. In her poignant memoir, That Good Night: Life and Medicine in the Eleventh Hour, she unravels the tension between our human impulse to survive at all costs and the reality that death claims us all. In a narrative flowing with compassion, she inspires us to pause in our frenetic struggles against death, to take a breath, and to consider what instills our lives with meaning. Although Dr. Puri doesn’t write from a Christian perspective, the discerning believer can follow her inquiry straight to the cross.
Medicine and Spirituality
At a time when physician memoirs achieve bestseller status, Puri’s book stands apart in its engagement of spiritual concerns. While Atul Gawande’s Being Mortal and Paul Kalanithi’s When Breath Becomes Air [read TGC’s review] offer rich insights into the complexities of medicine, Puri delves deep into the facets of life that supersede the technicalities of our bodies. She weaves her experiences in medicine with memories of her own upbringing to illustrate how the threads of our lives braid together.
The daughter of Indian immigrants, Puri especially draws from her parents’ teachings on religion to untangle conflicts, as in a conversation with her father about a young man with a brain injury: “‘Sometimes, God tests us,’ my father told me. ‘Believing in the impossible is a part of having faith.’ But, I later wondered, isn’t accepting the unbearable also part of having faith?” (58). This tension between acceptance and determination will ring familiar to Christian disciples navigating the hospital. How do we proceed when we know God can perform miracles (Matt. 19:26) but we’re also to trust his sovereignty even over our suffering (Gen. 50:20; Prov. 3:5; Matt. 26:39)?
God’s work through illness and death sharpens in clarity as Puri’s narrative unfolds. “We have our plans as doctors,” she recalls a mentor commenting, “But what if God has another plan for our patients?” (151). Her reflections on faith ultimately foster a more nuanced and compassionate understanding of death and dying: “God’s call. A tiny phrase I had never heard in a medical conversation. Two words that said something enormous, eternal: dying is spiritual, not just medical” (145).
Puri’s reflections on spirituality steer her toward palliative care, a specialty that allows her to come alongside others in their suffering. “As a young doctor,” she recalls, “I was learning how to prevent or fix the body’s dysfunction, but that was different from the act of acknowledging and being with the suffering of another” (65). Throughout, Puri’s luminous prose reflects deep respect for the people under her care. That Good Night swells with empathy and points us repeatedly to the dignity of each individual as an image-bearer of God (Gen. 1:26).
Call to Contemplate
While Puri’s poetic writing lulls one into calm, the content of her memoir demands we snap to attention. That Good Night captures the transience of life, our reliance on God, and the elusiveness of meaning in a medical system that intimidates us with wires, tubing, and jargon. Amid the clamor of intensive medicine, Puri summons us to pause and reflect:
I thought and thought that night, making mint tea and taking a few sips, watching the steam rise from the cup and then disappear. It felt strangely calming to focus on the cooling of heat, to appreciate the fact of temporary warmth. Maybe this, too, was the lesson of mortality: appreciating what we have now, in the midst of life, knowing that it is all a temporary gift. (268)
For the Christian, Puri’s invitation to quiet contemplation doesn’t end with metaphors of life’s temporality. Living our days in the shadow of the cross, we remember that one day the sufferings of this life will roll back like a scroll. Through the promise of Christ, we rejoice in the hope of a new heavens and a new earth, when the need for hospitals, medicines, and hard conversations will be obsolete. In the meantime, I’ll be glad to return to Dr. Puri’s wisdom and to sit with her reminders to prayerfully cling to meaning when the remedies run out.