Healing Beyond Healthcare

In one of the most profound and prayerful White Mass talks, Orthopedic Surgeon and author Dr. Joseph Dutkowsky, reflected on the role of “faith and science” in healthcare. Dr. Dutkowsky, who has dedicated much of his practice to caring for patients with cerebral palsy and other special needs, said every healthcare practitioner has the obligation to know the latest in science and medicine, but also to recognize the role of faith and spirit in healing. Dr. Dutkowsky is an Attending Orthopaedic Surgeon at Bassett Medical Center in upstate New York and an Associate Clinical Professor of Orthopaedic Surgery at Columbia University College of Physicians. He is president of the American Academy for Cerebral Palsy and Developmental Medicine. Many have asked for a copy of his talk, and Fairfield County Catholic is pleased to publish this transcript with Dr. Dutkowsky’s permission.
Healing Beyond Healthcare
address given following the 25th Anniversary White Mass
Roman Catholic Diocese of Bridgeport
March 18, 2018
Joseph Dutkowsky, MD, KM
The year was 1999. I’ll admit it. I was discouraged, really maybe bordering on despondent. After all the years of endless studying, hard work, and sleepless nights being a doctor wasn’t anything like I had expected it would be. Visions of helping mankind had dissolved in the reality of the quotas in clinic schedules and operative cases, delays with insurance preauthorizations, and the ever present practice and hospital administrators with their critical monthly balance sheets. Medicine was business and business meant money and I felt I had evolved little since I was sixteen years old and stacking groceries.
And, of course, then my pager went off. It was Friday, I was on call and an 85 year old woman, Mildred, had fallen down and had a Colles fracture, the common wrist fracture that angulates and pushes the wrist backward. She was in a small rural hospital with no orthopedist and it would have to be set. I told hem to splint her wrist and have her family drive her to my hospital.
Two hours passed. Mildred did not arrive. Under normal circumstances, the drive takes no more than forty-five minutes. I went back to work. Another hour passed and still no Mildred. Concerned, I called the clinic receptionist and then our ER to see if anyone had seen her. No one had. Finally, three and a half hours after my initial page, I got a call from our ER that she had arrived.
I walked into the ER to find a panicked elderly woman in a wheelchair with her right arm in a splint. A nurse knelt beside her, trying to calm her, but the woman was inconsolable. I tried to speak with her but it was as though she did not hear me. She continued weeping and between heartbroken sobs cried out, “I am afraid I’ve lost Gordon.”  Gordon it turned out was Mildred’s husband. More sobs followed. Finally Mildred was able to say, “He went to park the car but I’m sure he’s gotten himself lost. Gordon gets confused. He could be anywhere.”
I asked one of our security officers to go out in the parking lot and look for an Oldsmobile 88 going around in circles. Shortly thereafter he led Gordon into the Emergency Room. With sobs of joy, Mildred had her husband back. I introduced myself to Gordon and started a conversation to try to relax the tension. He was very pleasant and very forgetful. Her fears were well founded.
“Mildred and I have been married for 63 years,” Gordon said more than once. Repeatedly, he told me the same stories of their two children and told Mildred several times that he was pretty sure that he would not be able to find their car in the parking lot. The more Gordon talked, the more amazed I was that the two of them had made it here at all. Yet, as our conversation went on, I noted a real tenderness between this husband and wife that transcended age and forgetfulness. As Gordon retold his stories over and over again, completely unaware that he was repeating himself, Mildred smiled and laughed and added little details as if this was the first time Gordon told the story rather than the fifth. She looked up at him in a way that made it clear that even after 63 years, this small man was her hero. Not even her broken wrist or the presence of some doctor they had never met before in their lives could dampen their affection for one another.
Now that Gordon had been found, I went to work setting Mildred’s wrist. I gave her a hematoma block to numb the pain. As far as I could see, there was nothing out of the ordinary about Mildred’s Colles fracture.
As I went to set her fracture, Mildred suddenly turned to her husband and said, “Gordon, come hold me tight!”  The words penetrated me. Come hold me tight. Four little words that said more of a deep trusting love and commitment than any lyricist has ever composed in all the love songs ever written. I watched as Gordon pushed himself out of his chair and tottered to Mildred. Gently, he put his arm around her, and with a tender touch and protection, he held tight his love of 63 years.
My soul melted. As Gordon wrapped his arm around Mildred something wonderfully profound changed within me. I did not fully understand the change at the moment but I knew without a doubt it had taken place. For two decades I had worked tirelessly to master the basic and clinical sciences that gave me the understanding and skills to care for Mildred in the ER on that day. At the same time, I maintained my faith in a loving and present God and tried to live a life in accordance with that belief. Yet, through all those years my life as a scientist and my life as a believer operated as two parallel pathways that occasionally bumped into each other but never came together as one.
Then Mildred and Gordon walked into the ER. It may seem odd that watching two old lovers care for each other could trigger such a profound transformation, but there was something in that moment that forced my two parallels worlds to collide head on. The two, faith and science, came together like two elements which collide in a nuclear fusion reaction and form a new third element. The release of energy was immense, and this new element formed by this reaction of faith and science became my guide for my practice and life from that moment onward. I had been given a new yardstick to measure the world.
Suddenly, this was not just another procedure. The routine Colles fracture became anything but routine, for the moment Gordon wrapped his arms around Mildred I ceased to be merely the doctor there to set the broken wrist of an 85 year old woman whose husband suffered from Alzheimer’s Disease. Instead, I became a witness to what I can only describe as the glory of God playing out before my eyes. I never got over the experience.
If you have been in the world of healthcare for more than a few weeks you know that not all of the profound events we witness are as beautiful and tender as the story of Mildred and Gordon. In fact many of them test you to the depths of your very soul.
This past fall I operated on the knee of a young man with autism. Initially, post op he did very well. However, about a week after surgery the patient became very aggressive and violent. I had his mother bring him to the clinic and I admitted him to the hospital. He was clearly out of control with self abusive behavior and swinging and kicking at all of us. After a brief history I realized that three days post op his primary care had increased his psychotropic medications to a toxic dose.  A psychiatrist was called who tried every means to sedate this patient as a nurse, physician’s assistant, and myself physically restrained him. I held his shoulders watching his agonized and tortured face with his teeth snapping inches from my exposed arm. When the psychiatrist had run out of options and we moved the patient to the ICU, started a Propofol drip anesthetizing and intubated him to allow his body to detox. In the morning he was his normal self.
My arms ached for days as the struggle at the bedside had lasted for two and a half hours. Several times as I held his shoulders down maintaining my focus to avoid those snapping teeth, I looked at the scared and tortured face and wondered if that was the face of Jesus as he was being nailed to the cross…….for me.
Faith and science, two words that in the last century have drifted apart like two continents to forever reshape the geography of the intellectual world. The origin of the word science is from the Latin word scientia which simply means knowledge. It is fundamentally the study of our universe using empirical techniques to provide explanations and predictions of the world around us. And so we learn subjects like physics and chemistry which we have developed further to the clinical sciences of physiology and pharmacology. And there are also social sciences like psychology and sociology to study individual and corporate human behavior. Contemporary culture considers science the realm of rational men and women who choose the pursuit of an educated mind.
In contrast, faith in our time seems to have been relegated to the image of a fluffy bunny happily romping across the flowered meadows of the weak parts of your brain. I have been asked repeatedly when I talk about faith and science why don’t I talk about faith and reason. My answer is very simple; faith, like science, is reasonable.
All one has to do is read Augustine or Aquinas to explore how these great minds have wrestled and reasoned with the issue of faith. However, as an engineer turned surgeon I have actually never read Augustine or Aquinas so that’s not going to help this talk any. But, you know, you don’t have to be knowledgeable in Einstein’s theory of relativity either to understand that every time you let go of an object it always falls down. You just need a framework to apply to your observations and I would like to share mine with you. I am sure it is not nearly as eloquent as the writings of the great philosophers and I highly suspect Bishop Caggliano did not study it in his theology courses in seminary. But none the less it has been helpful for me. You will pardon the anatomic basis, but we have just worshiped at a White Mass and I am a surgeon. I call it the Theology of Eighteen Inches.
Faith starts in your head. No visitor to earth would step off a spaceship and say, “I’m a traditional Catholic and I prefer the Latin Mass.” Someone has to teach you the faith. Through teaching, reading, observations, or modeling one’s faith journey begins as an intellectual event. However, if it stays in your head your faith will always be what someone has given you but not your own.
Faith becomes your own when it moves the 18 inches from your head to your heart. That is the day your realize God is for real and you have a one on one love relationship with the creator of the entire cosmos, including you, and that this God is absolutely ecstatic about it.  Encountering this beatific passion one can only submit to being engulfed in a divine love fest centered on you.
As you allow yourself to be wrapped in celestial love you find that your faith life is on the move again traveling through your chest and abdomen and landing in your left back pocket where you keep your wallet. Yes, you become more financially generous but you also become a giver instead of a taker. It’s not what I can get from my boyfriend, girlfriend, spouse, or neighbor but it’s what can I give them. You see the world differently and the needs of others take precedence over things which once seemed so important to you. You all know these people, these givers. They might be a nurse, doctor, or someone in food service or maintenance. They stick out and you and everyone else are drawn to them.
Then faith is on the move again traveling eighteen inches from your wallet to your knees and you become a prayer.  We all can pray and God hears all prayers but when you reach this step in your faith journey prayer is no longer something you do but is who you are. It becomes as natural as breathing. It means is that you are developing a steady, continuous dialogue with your creator and the source of all love.
But faith doesn’t stop there. It then travels one last eighteen inches from your knees to your feet and you become a disciple. The most successful parish or diocesan evangelization program is an individual Catholic who walks the faith. Others are drawn to these disciples as they think to themselves, “That person has all the problems in life that I do. Why are they at peace while I am struggling with addiction, depression, anxiety, bad relationships, and conflict? I want what they have!” And a heart softens so that love can break through.
So in my little framework one’s faith journey starts in your head and travels to your heart, back pocket, knees, and feet. Reasonable, rational, isn’t it?  And one can use something like this as a platform to assess their own faith life and spiritual journey.  Say one is struggling with their prayer life. Maybe it’s time to see if they’re holding on to too much and need to become more of a giver so you become more open to dialogue with God.
So let me ask you. What’s the hardest eighteen inches to travel? The answer is from your head to your heart because you can’t do it. You have to surrender to Love and let God do it. May I say if you have never taken that step I would encourage you to do it today, even now, as it is the most amazing magnificent eighteen inches you will ever travel and you’ll never go back.
You see you can’t give yourself faith. It’s a gift. You can only grow and mature it. But let me ask you another question.  What did you do to get the ability to understand chemistry or physiology or pharmacology or psychology? Your ability to gain knowledge, or science is a gift as well. It’s all a gift. So what’s the difference? Why the chasm?  It really makes no sense whatsoever. It’s what you do with the gift that matters.
Nowhere do the issues of faith and science come together in the professional world more clearly than in the life of a nurse or a doctor in their one-on-one encounter with patients. These unplanned meetings between two strangers who are often thrown together in situations of great stress, uncertainty, fear, and fatigue. Two persons, one in serious need and the other with scientific knowledge and skill, may have nothing in common other than a shared life-force which, in itself, binds them together permanently and unconditionally. It is not merely an intellectual, emotional, and physical bond but a metaphysical one as well for empirical science can never alone explain that life-force that holds them together so tightly. Their understandings of God and the eternal may be completely different, but that metaphysical dimension is always there whether it is addressed or not. It is not our place to use that encounter to push our faith but to be open to how a patient’s faith journey may be impacted by their illness, disease, or trauma and to truly listen should they want to talk about it
There is, however, one greater and even preeminent example of the cohesion of faith and science which is the Eucharist. At this time, Bishop Caggliano, I would like to submit my nomination for the most blown off profound line in The Mass. During the preparation of the gifts the celebrant puts a drop of water in the chalice with the wine and says, “By the mystery of this water in wine may we come to share in the divinity of Christ who humbled himself to share in our humanity.”  And it just goes whoosh right pat us. Let’s rewind the tape.
By the mystery of this water in wine may be come to share in THE DIVINITY OF CHRIST…….  Wait a minute. Are you saying that as a human being I get to share in divinity….that’s like God stuff….you mean like with “In the beginning was the Word, and the Word was with God, and the Word was God.  He was in the beginning with God. All things came into being through him, and without him not one thing came into being.”  you mean with that Guy!?! You pullin’ my leg, Bishop?
No, he’s not pulling my leg. You see by faith we believe that through the power of The Holy Spirit the elements of bread and wine become the real presence of Jesus Christ. Then, just minutes ago, we took communion into our own bodies and it doesn’t just vanish or pass through you. You digest it and absorb it meaning that the real presence of Jesus is in your blood, liver, fingers, and brain. Therefore in a very literal and scientific way at this very instant you, we, are sharing in the divinity of Christ who humbled himself to share in our humanity. Wow! You don’t think that will transform you?
During the early editing of the book I gave it to people I knew and asked them to read it and give me suggestions to make it better. About eight weeks after my wife, Karen, died, a young psychiatrist was assigned to work with me at the Columbia CP Center so that we might better understand the mental health needs of this population.  He heard that I had written a book and had given it to my secretary and asked if he could read it. “Of course,” I said really thinking, “this is all I need for some shrink to be reading my story at this time in my life.” Two weeks passed and he came up to me. “I read your book,” he said, “and I want you to know that I went back to church for the first time in twenty years. I realized I had been missing something.”
Daniel not only went back to church but was confirmed at the Easter Vigil Mass. He signed up to go with his parish on a mission trip to an orphanage in Nicaragua. There he met, Ophelia, an eight year old girl who couldn’t speak and could barely walk because of her cerebral palsy.  Over the course of a week he made a wonderful friendship with this child and they shared many meals together at the old beat up tables in the dining hall at the orphanage.
On the day before he was to leave He came into the dining room to find Ophelia all excited. She took his hand and dragged herself across the floor to the staircase. There, with labored effort at every step she pulled herself up the stairwell pointing for Daniel to come with her. After tremendous effort they were at the top of the stairs. There she pointed at a picture of Jesus sitting with some children and words under it that said, “Gracias Senor.” or simply, “Thanks Lord”.
“Yes, God loves you.” Daniel said to Ophelia. But Ophelia stayed excited and kept pointing at Daniel.
“Yes, God loves me, too, Ophelia.” he said somewhat confused. But Ophelia was even more excited pointing back and forth at both the sign and Daniel. Then suddenly Daniel realized what she was trying so hard to tell him, and that he was being given a lesson greater than if Augustan or Aquinas, Freud or Osler were standing at his side.
For Ophelia had put it together. This eight year girl, born with disabilities leaving her unable to talk and barely able to walk, who had been abandoned by her parents, and lived in poverty had been given the gift of faith to believe that despite all this God loved her, and over the course of a week she knew from her own experience, her own knowledge (scientia), that Daniel loved her, and what she was telling him was, “Daniel, you are the image and likeness of God to me.”
And so it is for you, and for me. Sometimes it is easy to see the suffering Christ in the patient with terminal cancer, multiple trauma, or the young man with autism I held down. Too often we can forget that our patients see the image and likeness of the healing God in us. Every time you take a blood pressure, perform a root canal, or do the night shift in the ICU you are the image and likeness of God to the person across from you  who is more often than not scared and worried.
You don’t have to go to Nicaragua to experience this. It happens all the time in places like Bridgeport, Connecticut, and Cooperstown, New York. A few weeks ago I was interviewed by Lisa Hendey, the founder of for her pod cast. She asked me, “What do your patients think about your book?” No more than twenty minutes after we hung up I received the following e-mail from a woman in her 40s that I care for. Due to cerebral palsy she has only the use of her left arm which she uses to drive a power wheelchair. She is totally dependent on others for her daily routine care. In her words:
“I’ve been thinking about memories since I read the first excerpt of your book. I want to share this one with you.  You were standing next to me, and you gave me your hand.  You didn’t say anything, you just did it. It seemed like the most natural thing in the world. It probably sounds stupid, but honestly, you took my breath away. One moment in time can be made absolutely perfect because of one simple choice.”
Honestly, I don’t remember doing that, but she does.
Exactly three weeks ago I received another email from the same patient. In it she asked, “Will stand by my side when I am being baptized?”
You bet I’m going to be there.
Every day through the gifts of faith and science you bring the image and likeness of the healing loving God to your patients.  We are in an honored profession, yes even ministry. We owe it to our patients to stay current of the most recent scientific discoveries. We must always look to expand our knowledge and become proficient and even expert at the skills necessary to be a healer in which ever theater we practice.
But never, ever, walk into a patient room and leave half of yourself outside the door. They need that half of you, too, and there are times it is the only thing we have to give them.  At moments like that, frequently, it is the only thing they want.
To those of you who may be new to our field, there are difficult days ahead that will shake your foundation and there are days that will leave you spell bound in their magnificence. In the brightest and darkest hours do not ever fall prey to the temptation that you are alone. We are The Body of Christ, and all of us are there for each other and I, for one, am excited to share with you in the greatest profession in the world.
So be not afraid! Smile until your face hurts. Cry until you have no more tears.  Live, LIVE, and practice with your whole being. And when the day comes when you breath your last, and you wake up in the next world may the first words you hear be, “Well done, good and faithful servant.”
Sia lodato Gesu Christi!
Thank you.