July 29, 2010
KRISTA TIPPETT, HOST: I'm Krista Tippett. Today, "Listening Generously," with physician and author Rachel Naomi Remen. Her own lifelong struggle with chronic illness has shaped her practice of medicine. We speak this hour about her art of listening to patients and other physicians, the difference between curing and healing, and how our losses help us to live.
DR. RACHEL NAOMI REMEN: You know, sometimes what appears to be a catastrophe, over time, becomes a strong foundation from which to live a good life. It's possible to live a good life even though it isn't an easy life. And I think that's one of the best-kept secrets in America.
MS. TIPPETT: This is On Being. Stay with us.
MS. TIPPETT: This hour, we revisit my 2005 conversation with a wise physician and lyrical author Rachel Naomi Remen. She's known for books that intertwine stories from her life with Crohn's disease and her work with people with cancer. Looking at the world "from the edge of life," as she puts it, Rachel Naomi Remen has wisdom for our individual lives and our common life. She says that the way we deal with losses, large and small, shapes our capacity to be present to all of our experiences.
I'm Krista Tippett, from American Public Media, with conversation about meaning, faith, ethics, and ideas. Today, "Listening Generously: The Medicine of Rachel Naomi Remen."
Rachel Naomi Remen is a leading figure in the field of integrative medicine, bringing together the best of modern knowledge, both scientific and spiritual. As a clinical professor of medicine at the University of California at San Francisco's School of Medicine, she's drawn attention to the emotional needs of both patients and physicians. Living well, she says, is not about eradicating our wounds and weaknesses, but understanding how they complete our identity and equip us to help others.
From her earliest years as a doctor, Rachel Naomi Remen loved medicine but questioned its limits. At the age of 15, she was diagnosed with a progressive gastrointestinal disorder, Crohn's disease, and she lived for years believing that she would be dead by the age of 40.
Later, when she had become one of few women on a medical faculty in 1960s America, Dr. Remen cultivated a professional mode of objectivity and attachment, but almost against her will she found herself drawn into the stories of the people she was treating. She began to assign clinical importance to the details of patients' lives, details that made every illness different and every course of healing unique. "At first," she has written, "I was surprised that people with the same disease had very different stories. Later, I became deeply moved by these stories, by the unsuspected strengths, the rich and human tapestry initiated by the pathology I was studying and treating."
DR. REMEN: So you may be an expert, let's say, in diabetes or cancer or Crohn's disease, and every time you meet a new person who's struggling with this disease, that person has a completely different story. It has a completely different meaning for that person. And a story, of course, is the container for meaning.
MS. TIPPETT: Such insights changed Rachel Naomi Remen's approach to medicine and to life. Stories are now the medium of her teaching and her two best-selling books, Kitchen Table Wisdom and My Grandfather's Blessings. She reflects on life by way of her experiences as a doctor, she reflects on medicine through the story of her life, and she revisits the stories that she first learned from her rabbi grandfather, a student of the Jewish mystical tradition of Kabbalah. She grew up, she writes, surrounded by doctors and one mystic.
DR. REMEN: Doctors, a few nurses, and one mystic. It's true.
MS. TIPPETT: That would have been your Orthodox rabbi grandfather?
DR. REMEN: Mm-hmm, and student of Kabbalah.
MS. TIPPETT: Student of Kabbalah before it was a fashion trend.
DR. REMEN: Very much so. Oh, and he was a flaming mystic, and he was also a magnificent storyteller.
MS. TIPPETT: What do you mean when you say he was a flaming mystic? I mean, describe that to me.
DR. REMEN: What that means? Oh, it means many different things. It can mean a scholarly thing, like the study of a school of mysticism like Kabbalah, but it's also a way of seeing the world. My grandfather felt that the world was in constant communication with him, that there was a spirit in the world, a God in the world that could be spoken to and could respond at all times, that there was a presence in the world that was holy and sacred and that he was in constant dialogue with this as he went through the events of his day. I think mysticism can be defined in many different ways. I didn't know that my grandfather was a mystic.
MS. TIPPETT: No?
DR. REMEN: I just knew that the world that he lived in was the world I wanted to live in, too.
MS. TIPPETT: You recount this idea of the Kabbalah, which I had known, but — I don't know, I think maybe because you're a storyteller, it was very vivid for me. That — this idea that at the beginning of the creation, the holy was broken up, right?
DR. REMEN: Oh, the story of the birthday of the world, yes.
MS. TIPPETT: Is that how he told it to you?
DR. REMEN: Yes, exactly. Actually, Krista, this was my fourth birthday present, this story. In the beginning there was only the holy darkness, the Ein Sof, the source of life. And then, in the course of history, at a moment in time, this world, the world of a thousand thousand things, emerged from the heart of the holy darkness as a great ray of light. And then, perhaps because this is a Jewish story, there was an accident, and the vessels containing the light of the world, the wholeness of the world, broke. And the wholeness of the world, the light of the world was scattered into a thousand thousand fragments of light, and they fell into all events and all people, where they remain deeply hidden until this very day.
Now, according to my grandfather, the whole human race is a response to this accident. We are here because we are born with the capacity to find the hidden light in all events and all people, to lift it up and make it visible once again and thereby to restore the innate wholeness of the world. It's a very important story for our times. And this task is called tikkun olam in Hebrew. It's the restoration of the world.
MS. TIPPETT: Right.
DR. REMEN: And this is, of course, a collective task. It involves all people who have ever been born, all people presently alive, all people yet to be born. We are all healers of the world. And that story opens a sense of possibility. It's not about healing the world by making a huge difference. It's about healing the world that touches you, that's around you.
MS. TIPPETT: The world into which you have proximity.
DR. REMEN: That's where our power is, yeah. Yeah. Many people feel powerless in today's situations.
MS. TIPPETT: Right. I mean, when you use a phrase like that just out of nowhere, "heal the world," it sounds like a dream. Right? A nice ideal, completely impossible.
DR. REMEN: It's a very old story, comes from the 14th century, and it's a different way of looking at our power. And I suspect it has a key for us in our present situation, a very important key. I'm not a person who is a political person in the usual sense of that word, but I think that we all feel that we're not enough to make a difference, that we need to be more somehow, either wealthier or more educated or somehow or other different than the people we are. And according to this story, we are exactly what's needed. And to just wonder about that a little, what if we were exactly what's needed? What then? How would I live if I was exactly what's needed to heal the world?
MS. TIPPETT: My son, who's seven, I told him this story about the beginning of the universe and, you know, about the sparks and the holy flying out. And he just listened to me so raptly, and he said, "I like that."
DR. REMEN: I was told this story, let's see, 63 years ago. And my response to it was exactly the same. And that's very important about stories. They touch something that is human in us and is probably unchanging. Perhaps this is why, you know, parables — the important knowledge is passed through stories. It's what holds a culture together. Culture has a story, and every person in it participates in that story. And so story, and not facts, are the way the world is made up. The world is made up of stories; it's not made up of facts.
MS. TIPPETT: Although we tell ourselves facts to piece together the story.
DR. REMEN: Well, the facts are the bones of the story, if you want to think of it that way. I mean, the facts are, for example, that I have had Crohn's disease for 52 years. I've had eight major surgeries. But that doesn't tell you about my journey and what's happened to me because of that, and what it means to live with an illness like this and discover the power of being a human being. And, you know, whenever there's a crisis, like 9/11, do you notice how the whole of the United States turned towards the stories in order to…
MS. TIPPETT: You mean, 'Where I was…'
DR. REMEN: Where I was, what happened, what happened in those buildings, what happened to the people who were connected to the people in those buildings. Because that is the only way we can make sense out of life, is through the stories. And the facts are a certain number of people died there, but the stories are about the greatness of being a human being and the vulnerability of being a human being.
MS. TIPPETT: I think you make such an interesting contrast also with the fact that we live with all kinds of stories in our culture, forms of entertainment as well as information, but that those stories always have beginnings and endings. And you say that the stories of our lives, stories as they function in life, take time. Real stories take time.
DR. REMEN: There's a powerful saying that we tell each other stories — sometimes we need a story more than food in order to live. They tell us about who we are, what is possible for us, what we might call upon. They also remind us we're not alone with whatever faces us and that there are resources, both within us, and in the larger world, and in the unseen world, that may be cooperating with us in our struggle to find a way to deal with challenges. And when I say a story doesn't have an ending, for example, part of my story is you telling your little boy the story of the birthday of the world. That's also part of my grandfather's story, right? And your little boy has never met my grandfather, but perhaps my grandfather will be woven into his life in some way. It may be a very small way or it may not, I don't know, but in that sense no one's story is ever finished.
MS. TIPPETT: I'm Krista Tippett and this is On Being from American Public Media.
Rachel Naomi Remen began her medical career as a pediatrician and then began to focus on cancer patients. Listening to people's stories is at the core of her understanding of the doctor/patient relationship. She founded the Commonweal Cancer Help Program in the Bay Area of San Francisco, one of the earliest cancer support programs in the U.S. She also became a medical educator, designing and implementing curricula that enabled doctors nationwide to discover what she calls the "soul, mission, and calling" in their work. I asked her how this happened.
DR. REMEN: We had grants to study the doctor/patient relationship. And then a new administration came in, and we couldn't get the final piece of funding to finish this work. And I spent six months writing grants and then ran out of money. And people had been calling me up — because I'd been writing about these things — and saying, 'Can I come and talk to you about my problem?' And I'd say, 'No, no, no. I don't do that.'
MS. TIPPETT: Other physicians, right?
DR. REMEN: 'I'm not a psychologist. I'm not a psychiatrist. I don't do that.' No, these are people, sick people, friends, friends of friends, all sorts of people. Then when I ran out of money I said, 'Well, I guess I do this.' So I found a little office on a houseboat in Sausalito, the first office, and a few people came by. And I decided I would go and speak to my colleagues in the medical community and tell them that I wanted to work with sick people and with their emotional issues and their struggle to live with disease and also to recover from disease. Most of the physicians in the community said, 'Terrific. Who has the time to talk to these people?'
MS. TIPPETT: Right.
DR. REMEN: You know, 'Once I run out of treatments I have nothing more to offer anyone' — and that's another whole story in and of itself, of course — and 'let me send you over my patients.' And within months I had a completely full practice and most of the people were people with cancer, and I began to work as a person who focused my efforts on working with people with cancer.
MS. TIPPETT: Why do you think that most of the people your colleagues ended up sending you were people with cancer? Was that a particular life experience they weren't equipped to handle in its fullness?
DR. REMEN: The hospice movement is fairly recent in all of this.
MS. TIPPETT: OK. So this was before hospice.
DR. REMEN: This is before that.
MS. TIPPETT: Right.
DR. REMEN: I mean, you knew how to treat the cancer. That's what we were trained to do in medical school. We're trained differently now. The issues of the person with the cancer was something that — we would refer people to psychiatrists but, you know, these aren't people who have psychological illness. These are people who are confronted with a very, very challenging life situation and who need to mobilize their full strength and the strength of their families in order to meet with these things, to live well despite cancer.
MS. TIPPETT: It seems, as you say, you probably didn't plan this. I'm sure you didn't plan this. But what you said earlier about how we're all given the lives we have and that that's good enough, and even what's wrong with us is part of what we have, it seems like it's been really important in your medical practice and also in how you've helped other physicians, how you've reflected on your profession, that you also have struggled in your life with this debilitating illness of Crohn's disease, which you were told was fatal also earlier.
DR. REMEN: Mm-hmm. But, Krista, I don't think it's what's wrong with us. I don't see, you know, sometimes what appears to be a catastrophe, over time, becomes a strong foundation from which to live a good life. It's possible to live a good life even though it isn't an easy life. And I think that's one of the best kept secrets in America.
MS. TIPPETT: You say that the pursuit of perfection has become a major addiction of our time. I mean, we throw that word "addiction" around a lot, but I've never heard anyone talk about our pursuit of perfection as an addiction.
DR. REMEN: Well, I think perfection is the booby prize in life, actually. It's very isolating, very separating, and it's also impossible to achieve. So you're always struggling to become something you're not. But, you know, this is one of the great — it sounds funny. I was going to say the great joys of working with people on the edge of life. The view from the edge of life is so much clearer than the view that most of us have, that what seems to be important is much more simple and accessible for everybody, which is who you've touched on your way through life, who's touched you. What you're leaving behind you in the hearts and minds of other people is far more important than whatever wealth you may have accumulated.
MS. TIPPETT: Now, what is your understanding of why that simple truth that we've all heard said, and it makes so much sense; why is that hard for us, for human beings to take seriously before we get to that edge of life, or for many of us?
DR. REMEN: I think we get distracted. We get distracted by stories other people have told us about ourselves, that we are not enough, that we will be happy if we have material goods, that material goods will keep us safe. None of these stories are true. What is true is that what we have is each other.
MS. TIPPETT: And again, you know, that's so — it's lovely and it's clearly true, and yet we don't…
DR. REMEN: We don't live there.
MS. TIPPETT: We don't live there.
DR. REMEN: And this is why I see people with cancer and other people who have encountered very difficult experiences in their lives as teachers, teachers of wisdom. It's as if the wisdom to live well is — at the moment, the repository of this wisdom are the sick people in our culture, the ill people in our culture.
MS. TIPPETT: Physician and storyteller Rachel Naomi Remen.
Here's a story from her book Kitchen Table Wisdom about a man in one of her cancer support groups. Dieter had escaped from Communist East Germany, and after many years as a refugee had made a new life for himself. Now he was living with cancer.
KATE MOOS: [READER] For some time now Dieter had suspected that the chemotherapy was no longer helping him. Convinced at last of this, he spoke to his doctor and suggested that the treatments be stopped. He asked, if he could come every week just to talk. His doctor responded abruptly, 'If you refuse chemotherapy, there's nothing more I can do for you.' And so Dieter had continued to take the weekly injection in order to have those few moments of connection and understanding with his doctor. The group of people with cancer listened intently. There was another silence. Then Dieter said softly, 'My doctor's love is as important to me as his chemotherapy, but he doesn't know.'
Dieter's statement meant a great deal to me. I had not known either. Medicine is as close to love as it is to science, and its relationships matter even at the edge of life itself.
But I had yet another connection to Dieter's story. His oncologist was one of my patients. Week after week, from the depths of chronic depression, this physician would tell me that no one cared about him. He didn't matter to anyone. He was just another white coat in the hospital, a mortgage payment to his wife, a tuition check to his son. No one would notice if he vanished, as long as someone was there to make rounds or take out the garbage.
So here is Dieter bringing the same validation, the same healing to his doctor that he brought to me. But his doctor, caught up in a sense of failure because he cannot cure cancer, cannot receive it.
MS. TIPPETT: Rachel Naomi Remen writes about recapturing the soul of medicine in great detail on our website. She urges medical professionals, as she puts it, "to pursue something stronger than science," namely to restore a sense of meaning and service through human relationships. You can read that essay and the many other passages we featured in this production at onbeing.org.
And while you're on our site, be sure to check out our blog, Pertinent Posts from the On Being Blog, and read a lovely essay by Susan Carpenter Sims. She listens to our podcast in Taos, New Mexico. She writes about how the power of multiple translations has given her new ways in to thinking about story as "poetic truth" over "hard fact." Share your thoughts with her. Find a link on our home page, onbeing.org.
Coming up, more conversation on how Rachel Naomi Remen is helping new doctors combine science and technology with a sense of medicine as a healing art. I'm Krista Tippett. Stay with us. This program comes to you from American Public Media.
MS. TIPPETT: Welcome back to On Being, public radio's conversation about religion, meaning, ethics, and ideas. I'm Krista Tippett. Today, "Listening Generously," a conversation with Rachel Naomi Remen. She's the author of two best-selling books, Kitchen Table Wisdom and My Grandfather's Blessings. She's been a pioneer in integrative medicine, helping to raise awareness within the medical profession of the emotional and spiritual needs of patients.
In recent years, Rachel Naomi Remen has also worked on publicizing and caring for the needs of physicians themselves. In the U.S., doctors and health care professionals have some of the highest rates of depression in the work force. Dr. Remen traces such problems in part to the structure and focus of medical training itself. Here's a passage from her book Kitchen Table Wisdom, which explores lessons from medicine and life by way of her own story.
MS. MOOS: [READER] It is not possible to be in a 24-hour-a-day intensive training program for many years and not be changed by it. We worked seven days a week, 36 hours on and 12 hours off for most of it. When we were off, we slept. Denial of the body, its needs for sleep, comfort and even food were the very foundation of the schedule. No one complained. It was just the way that we all lived. Many of the rooms I worked and studied in had no windows. Often I did not know what day it was or even the time. I remember watching the nursing shift going past me day after day. I would look up and see Miss Harrison and know it must be morning again.
…On one very rare summer afternoon off, I remember traveling home to visit my parents on the subway, realizing only after a while that I had been unconsciously scanning the veins of the bare-armed people around me, wondering whether my skills with a needle were good enough to allow me to successfully draw blood from them. This sort of training changes the way you see things, the way you think. Gradually things that had been central in my previous life became vague and faded into the background, and other things more heavily rewarded became overdeveloped. After a time, I just forgot many important things.
MS. TIPPETT: At the UCSF, the University of California at San Francisco Medical School, Rachel Naomi Remen has created a course called "The Healer's Art." It's now offered at leading medical schools around the United States as well as in Canada, Israel, Slovenia, and Taiwan. I asked Dr. Remen what this course adds to the training doctors are already receiving.
DR. REMEN: It is validating for students the human agenda in illness. It reminds them that healing is a different relationship than a curing relationship. And it reminds them of their power to make a difference through their human response and connection to their patients. It basically reminds the students of the lineage of medicine. You know, I happen to see medicine as a spiritual path. That's my personal thing, that medicine is a spiritual path, which is characterized by compassion, harmlessness, service, reverence for life, courage and love.
The basic qualities of the Hippocratic Oath are not scientific qualities. They are the qualities of human relationship, and they are spiritual qualities, very profound spiritual qualities. We remind the students of the lineage, and this is young students, and we enable them to see that they belong to it exactly as they are, that they are already the right people to become physicians. All they need to do is learn the science and learn the facts, without allowing themselves to be changed by that process in any way.
MS. TIPPETT: What is it in that process, I mean, it seems ironic, and the stories you tell about how destructive medical school can be seem ironic. We do think of people who go to medical school, as you say, as extraordinary…
DR. REMEN: They are.
MS. TIPPETT: as people who are giving themselves over to this profession that is about healing. And what you describe is an experience that is…
DR. REMEN: We learn how to cure.
MS. TIPPETT: OK.
DR. REMEN: Yeah. Now, that is changing. I mean, obviously, 10 years ago this course would not be in any of these schools. UCSF was forward-looking enough to give it a home, you know. But I think the world is changing. I think we're recognizing the limitations of our science. Our science, you know, that little phrase, 'living better through science,' there's no question that we live better through science. But to live well is going to take something more than that. I mean, if I look at myself without the eight major surgeries and the many medications — and I still take many medications — that keep me alive, I wouldn't be here. But with only these things, I'd be an invalid.
MS. TIPPETT: Right. I wanted to ask a minute ago when you said you think about medicine as a spiritual path, and yet it seems that — medicine is also a science, at least in our culture, and it seems that at some point and somehow the science overwhelmed — or the scientific mindset, even among those of us who are outsiders, how we view science overwhelmed whatever spiritual element there is in that.
DR. REMEN: Well, you have to understand how natural that is. I mean, I'll tell you about myself. When I was a child, I had severe otitis media…
MS. TIPPETT: OK, an ear infection.
DR. REMEN: …and developed an abscess in the bone of my skull, and sulfa drugs were available in the nick of time. And that power was a very heady power. We could do — there was insulin for people with diabetes. I mean, you just have to think about what this meant for people.
MS. TIPPETT: All of this — you've seen all this in your lifetime.
DR. REMEN: Oh, my God. Yes. This meant a huge amount for people. We thought we could cure everything, but it turns out that we can only cure a small amount of human suffering. The rest of it needs to be healed, and that's different. It's different. I think science defines life in its own way, but life is larger than science. Life is filled with mystery, courage, heroism, and love. All these things that we can witness but not measure or even understand, but they make our lives valuable anyway.
MS. TIPPETT: I would say the destructive aspects of life are also mysterious and unmeasurable, right? I mean, we can also observe evil and…
DR. REMEN: I think that's true. Of course it's true. But, you know, the issue is not to eradicate evil. I'm not sure evil can be eradicated. I think it's part of the human condition. The issue is to commit yourself to what's important to you.
MS. TIPPETT: Here's a reading from Rachel Naomi Remen's Kitchen Table Wisdom.
MS. MOOS: [READER] People who are physicians have been trained to believe that it is a scientific objectivity that makes them most effective in their efforts to understand and resolve the pain others bring them, and a mental distance that protects them from becoming wounded by this difficult work. It is extremely demanding training. Yet objectivity makes us far more vulnerable emotionally than compassion or a simple humanity. Objectivity separates us from the life around us and within us. We are wounded by that life just the same; it is only the healing which cannot reach us. Physicians pay a terrible price for their objectivity.
MS. TIPPETT: You question the term "objectivity," that it's part of a scientific framework. I think that word — as a journalist, I'll say, it's also — you know, it's a value that's been held up in many disciplines in our culture. And it's coming into question in many disciplines. You know, 'Is it enough?' Or, you know, 'Are we kidding ourselves when we say we're objective?' And if we're kidding ourselves, then do we need to look at it all over again?
DR. REMEN: Objectivity's cognitive in a funny kind of way, isn't it? But the thing that seems important is that in order to understand life we need to look at it through many different dimensions. And sometimes we understand another person the best and know how to help them the best when we are not objective. You know, when we're just…
MS. TIPPETT: Well, there's another simple statement for you, but we don't always act on it, yeah.
DR. REMEN: But look, objectivity is a bias like anything else. I mean, the funniest story in — I think this one is in Kitchen Table Wisdom — is — this happened at Sloan-Kettering many, many years ago when I was an intern, first-year doctor. We had a man come into the hospital to die. And, you know, people use to come into the hospital to die. There wasn't a hospice movement then, so that if your care was too difficult to achieve at home, you were admitted to the hospital to die. And this man came in riddled with cancer. He had an osteosarcoma and his bones looked like Swiss cheese. All these lesions were cancer, and there were big snowballs of cancer in his lungs. And in the two weeks or so that he was with us in the hospital, all of these lesions disappeared and they never came back, Krista.
Now, were we in awe? Certainly not. We were frustrated. Obviously someone had misdiagnosed him. So we sent the slides out to pathologists all over the country, and the pathologists sent back the slides saying classic osteogenic sarcoma, you know? So then we had a grand rounds, and the slides were shown, the X-rays were shown, the man himself was shown. And the conclusion of this large group of doctors was that the chemotherapy, which had been stopped 11 months before, had suddenly worked.
Now, the embarrassing part of this story is that I believed this. For the next 15 years I never questioned this conclusion. I think too great a scientific objectivity can make you blind.
MS. TIPPETT: What do you think now?
DR. REMEN: I think that that was one of the purist encounters with mystery that I have ever had in my life. It makes me wonder about who we are, what's possible for us, how this world really operates. I have no answers, but I have a lot of questions, and those questions have helped me to live better than any answers I might find.
MS. TIPPETT: Physician and storyteller Rachel Naomi Remen. I'm Krista Tippett, and this is On Being from American Public Media. Today, a conversation with Rachel Naomi Remen on her pioneering work on the needs of patients, physicians, and other human beings. She works with doctors, for example, on the common experience of loss and disappointment. Physicians typically experience many disappointments every week, she says, from the failure of a medication to the blow of a patient dying. Here's a passage of her writing.
MS. MOOS: [READER] I teach a course now at our local medical school to the first and second year students. At the close of one of these evenings, a woman student stood and told me that her class had already been given two lectures on grieving by the department of psychiatry. I had not known this, and I apologized, saying that it might have been better to choose another topic for the evening's discussion. 'Oh, no,' she said. 'It was different. They taught us grief theory and how to recognize when our patients are grieving a loss and be respectful of that. They just didn't say that we would have anything to grieve.'
The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. This sort of denial is no small matter. The way we deal with loss shapes our capacity to be present to life more than anything else. The way we protect ourselves from loss may be the way in which we distance ourselves from life. We burn out, not because we don't care, but because we don't grieve. We burn out because we have allowed our hearts to become so filled with loss that we have no room left to care.
MS. TIPPETT: Rachel Naomi Remen's book Kitchen Table Wisdom. Now back to our conversation.
DR. REMEN: No one is comfortable with loss. Being that we're a technological culture, our wish or our first response — let's put it this way: Our first response to loss is try and fix it. When we are in the presence of a loss that cannot be fixed, which is a great many losses, we feel helpless and uncomfortable and we have a tendency to run away, either emotionally or actually distance ourselves. Yeah. And fixing is too small a strategy to deal with loss, you know.
MS. TIPPETT: Right.
DR. REMEN: What we teach the students is something very simple.
MS. TIPPETT: The medical students?
DR. REMEN: Yeah. We teach them the power of their presence, of simply being there and listening and witnessing another person and caring about another person's loss, letting it matter. Letting it matter. We do six hours on loss, two three-hour sessions, and the students have a very simple instruction, which is, they are asked to remember a story of loss from their own lives, and loss — let's put it differently — a time when things didn't go their way, when they were disappointed, when they lost a dream or a relationship or even a family member, a death, you know?
MS. TIPPETT: Mm-hmm.
DR. REMEN: They get to choose that, and then they spend six hours in small groups talking about their loss. And the group has one instruction: Listen generously. Now, prior to this exercise, we do another exercise with them where we ask them to remember a time of disappointment and loss and to remember someone who helped them. What did that person do? What did they say? What message did they deliver that was helpful to them at a hard time in their lives? And they write these things down very concretely. And then we ask them to remember a time of loss in their lives and remember someone who wanted to help them but was not of help to them. What did that person do and say, and what message did they deliver, and how did they deliver the message? And they write that down.
And then we make a big list. 'What are all the things that helped?' Right? 'Listened to me for as long as I needed to talk.' 'Talked to me in the same way after my loss as they did before my loss.' Right? 'Sat with me.' 'Touched me.' 'Brought me food.' Right? What were the things that didn't help? 'Gave me advice without knowing the full story.' Right? 'Made me feel that the loss was my fault.' So we gather up the wisdom about what helps loss to heal from a group of about a hundred students and faculty, and it's all very simple stuff. And the only instruction is: Listen generously.
MS. TIPPETT: Again, it takes me back to how we began talking about the power of stories in human lives, and your analogy that the stories are the flesh we put on the bones of the facts about our lives. You know, I also hear — I think it's so powerful just to think about this obvious fact, but again one of these obvious facts we don't name very often, that loss is not just catastrophic death. It's that there are many different kinds of losses in our lives all the time, and then this kind of stunning idea that you bring forth that the way we deal with those losses, large and small, can really help or get in the way of the way we deal with the rest of our lives, with what we have. Right? Not just what we've lost.
DR. REMEN: I think this is so. I really do. I feel--how do I put this? Most people try to hold on to the thing that is no longer part of their lives, and they stop themselves in their lives in that way. I have come to see loss as a stage in a process. It's not the bottom line. It's not the end of the story. What happens next is very, very important. And, you know, people respond to losses in different ways. When I first became ill, I was enraged. I hated all the well people. I felt that I was a victim and this was unfair. Right? I was angry for about 10 years. I think all of that anger was my will to live expressed in a very negative way.
And people often are angry in the setting of a terrible loss. They often feel envious of other people, and this is a starting place. But over time things evolve and change. And at the very least, people who have lost a great deal can recognize that they are not victims, they are survivors. They are people who have found the strength to move through something unimaginable to them, perhaps, in the past. And just asking people that question, 'You have suffered a really deep loss. What have you called upon for your strength?' Most people haven't even noticed their strength. They're completely focused on their pain.
MS. TIPPETT: On their loss.
DR. REMEN: On their pain. And isn't that natural, Krista?
MS. TIPPETT: Mm-hmm.
DR. REMEN: Yeah.
MS. TIPPETT: There's something very hopeful all the way through your writing, even when it is about loss and the hard, dark side of being human. I mean, you do insist — and I'm not sure that modern psychiatry insists on this — that integrity is achievable for everyone, that you see it come to people, and sometimes it comes to people in crisis. You say wholeness is never lost, it is only forgotten.
DR. REMEN: Wholeness includes all of our wounds. It includes all of our vulnerabilities. It is our authentic self, and it doesn't sit in judgment on our wounds or our vulnerabilities. It simply says, 'This is the way we connect to one another.' Often we connect through our wounds, through the wisdom we have gained, the growth that has happened to us. Because we have been wounded allows us to be of help to other people. So it's not a moral judgment. Integrity simply means what is true, to live from the place in you that has the greatest truth. And that truth is always evolving as well.
MS. TIPPETT: Rachel Naomi Remen is medical director of the Commonweal Cancer Help Program and a clinical professor of family and community medicine at the University of California San Francisco School of Medicine. Her books include My Grandfather's Blessings: Stories of Strength, Refuge, and Belonging and Kitchen Table Wisdom: Stories that Heal. Here, in closing, is another reading from that work.
MS. MOOS: [READER] The most important questions don't seem to have ready answers, but the questions themselves have healing power when they are shared. An answer is an invitation to stop thinking about something, to stop wondering. Life has no such stopping places. Life is a process whose every event is connected to the moment that just went by. An unanswered question is a fine traveling companion. It sharpens your eye for the road.
As a freshman in medical school, I had been randomly selected as class photographer and given a camera to take pictures for the yearbook. I took pictures for four years. At first I felt burdened by the responsibility, the need to carry the heavy camera with me to class, to remember to look at things. But in time the camera caused me to see my ordinary surroundings far more clearly, to become aware of beauty around me in some very unlikely places. It had given me new eyes. A good question is like that Zeiss camera.
In some fairytales, there is a magic word which has the power to undo the spell that has imprisoned someone and free them. When I was small, I would wait anxiously until the prince or the princess stumbled on the formula and said the healing words that would release them into life. Usually the words were some sort of nonsense like 'Shazam.' My magic words have turned out to be 'I don't know.'
MS. TIPPETT: Rachel Naomi Remen has spent a lifetime listening. And in my unedited interview with her, she shares many more of these stories than we could include in this show. We offer several ways for you to download free MP3s of that 90-minute conversation and this produced show — just subscribe to our podcast, our w-mail updates, or visit the show page at onbeing.org.
And we need you to participate in a community narrative we're producing over the summer. We'll be taking your stories about new realities emerging in sustainability as it is being lived — we're creating an illustrated essay out those stories. What causes for renewal and hope do you see before us? Share your perspective about something concrete that makes you contemplate the deeper meanings of themes we've recently been exploring here, of land and the care of land. Look for that Share Your Story link on our home page — onbeing.org.
This program is produced by Colleen Scheck, Chris Heagle, Nancy Rosenbaum, and Shubha Bala. Anne Breckbill is our Web developer. Trent Gilliss is senior editor.
Kate Moos is our managing producer. And I'm Krista Tippett.
Next time, Joanna Macy, a philosopher of ecology and exquisite translator of the poetry of Rainer Maria Rilke. We explore her sense, after eight decades of life as a thinker and activist, of the grief and promise of our age. Please join us.