התמלול המלא של Suffering, Healing, and Meaning, with Philip Yancey and Julia Wattacheril

Whatever our response, pain and suffering almost always seems to upend our assumptions about the world and our place and purpose in it. So how does one make sense of trauma and suffering? What does it mean to be healed? Is it possible to live into your life's purpose, to flourish as a human being, even in the midst of pain and suffering? And what role does faith play in living fully, even in the midst of pain, suffering, and loss? There are obviously no easy answers to those questions, but we believe there is a wisdom to be gleaned from wrestling with them. And today we have the opportunity to talk with two such worthy wrestlers, both of whom, from different perspectives and vocations, have cared for those who suffer and sought meaning and hope in this dark mystery. Philip Yancey is a best-selling and award-winning author of more than two dozen books, many of which explore the deepest questions around the Christian faith, including those of pain, suffering, and meaning. His many works include The Jesus I Never Knew, Where Is God When It Hurts?, Disappointment with God, What's So Amazing about Grace?, as well as his most recent and truly remarkable work, entitled A Companion in Crisis, in which he introduces and paraphrases the reflections and devotions of poet John Donne, written during the Great Plague of the 1630s. His works have garnered 13 Gold Medallion awards from Christian publishers and booksellers and currently have more than 15 million copies in print, published in over 50 different languages. Joining him is Julia Wattacheril. Julia is a scientist and a physician. She's a transplant hepatologist—or a liver doctor or surgeon—a clinical investigator, and the director of the Adult Nonalcoholic Fatty Liver Disease Program at Columbia University's Irving Medical Center. Last year, around this time, due to the overwhelming influx of patients suffering with Covid into New York City hospitals, she was pulled into the front lines of the Covid crisis, caring for countless numbers of the desperately sick and dying. Philip and Julia, welcome. It's great to see you. Julia Wattacheril: Thank you for having us, Cherie. Cherie Harder: So I'm just going to dive right in here. Julia, I would love to hear about your experience over the last year, what you saw and how it's affected your view of suffering. Julia Wattacheril: Thanks, Cherie. One correction so that we're not confusing or mislabeling anything: I am a hepatologist, not a surgeon. So I'll explain a little bit about that in the answer, because part of addressing some of the suffering that we witnessed is the roles and hats that we wear and how we're trained to address suffering in our line of work. So it was exactly this time last year when I was what we call "redeployed" to a different role. So typically what I do involves patient care with liver transplant patients or general liver care. And so I was reassigned to a supervisory role for patients that were in the hospital but declining in their care and needed ICU care. And this was April in New York. So we were supersaturated; all units were converted to ICUs, including operating rooms. And the transition to an uncertain role was part of gearing up for what we were about to see. The usual paradigms that I'm used to dealing with, with suffering—most physicians, most investigators or scientists are as well—is "how can I alleviate this person's pain?" And there's multiple different types of pain. There's the physical pain which we try to address either with medications, with surgeries, with strategies. We're trying to expand our abilities to deal with pain. But we also try to address emotional pain and, less likely but more needed, existential pain and suffering. And all of that was very, very vivid in the suffering that we saw. With Covid—I won't try to be morbid here, but I will try to be realistic—when you see someone gasping for air, that is a form of suffering. Those who might be listening, who are familiar with end stages of life, it's an agonizing phenomenon to watch. It's an agonizing phenomenon based on patients' stories to experience, whether it's a drowning phenomenon or an inability to breathe. It's not traditional sort of pain, but it is agonizing and it is a form of suffering. And it's one that most of us that are familiar, especially in this season of Eastertide, are familiar with as well from what happened on the cross. So walking in or seeing these types of suffering, these multiple elements of suffering, but also having to adjudicate personnel that are dealing with this suffering—so the acute phenomenon of someone who may or may not need advanced therapies, the things that we're good at, deploying strategies that are at our fingertips and that we have been resourced in order to deploy—but then also the multiple-tiered aspects of suffering that we're not so well used to thinking about and resource limitations and team dynamics as this wave was coming over us with no end in sight, and our anxiety and our inability to sort of take things in was also the unknown. Scientists like to predict and control, and we like to develop strategies to try to predict and control. And so do physicians. We're generally fairly decent at being able to predict negative outcomes and be able to get on top of them. We weren't able to do that in the initial phases of Covid. We were gasping ourselves to try to keep up, not only with the disease, but how to try to treat it and how to try to develop other strategies. So, you know, the bedside suffering that we heard, despite the physical and emotional and existential, the one that I think was hardest for both the providers and the patients was relational, the absence of people at the bedside that they were familiar with, that they drew comfort from. Many of us were seeing patients on an ad hoc basis; we didn't have a long history with them. We were forming relationships as quick as we could. But the suffering of not having a

human around that is used to caring for you was the most profound. And, fortunately, we work with some of the most empathic people with nurses and respiratory therapist and people that are at the bedside so often, [but] no matter how many fingernails got painted in the ICU or how many people got switched from a prone to a supine position, there was no substitute for that family member. Family members are such advocates when they're here in the hospital with us. And we understand the rationale. We understand the justification for it. But it was equally agonizing when I roved through the hallways asking people what they needed—not just PPE or food or whatever. The hardest thing that everyone had reported having to do at the beginning was, "I can't do one more of these FaceTime calls. We have a scheduled intubation at 8:00 p.m. I can't sit with another family member like this. I only have room for happy memes right now. I just can't do this any longer." And, of course, supports were built in along the way. But in those early weeks, it was so clear that relational suffering did the most damage. Cherie Harder: Phil, you have wrestled with suffering vocationally from a different perspective and a different place. But so many of your works deal with suffering and pain, and we'd be interested in hearing from you what led you to focus so much of your vocational energies on this topic? Philip Yancey: When I was a young journalist, one of the things I did was write for Readers Digest magazine—they had a series called "Drama in Real Life"—and I interviewed many people who had gone through some very traumatic experience. They would often tell me the worst part of trying to recover was the visitors I got from my church. They would come with such confusing messages. Some would say, "You did something wrong. God is punishing you." Or somebody else would come in and say, "No, it's not God, it's the devil. The devil is attacking you." And the next person would come in, "No, it's not the devil, it's God. But not because he's punishing you, but because he loves you and wants you to be an example to others on how to handle suffering." And if you're lying there just trying to get well, it doesn't help to have such confused messages. I was confused myself. I didn't know what to say. So I immediately dove in as a young person, having no right to attack the problem of pain that's bedeviled philosophers for centuries. But it was important for my faith and for the people I was around to come up with some sort of coherent view of why, if there is a loving and all-powerful God, why so much suffering exists on this planet. Cherie Harder: Let's talk a little bit about those messages and what you make of it. And, Julia, I'll start with you on this. You saw firsthand how itself was a form of suffering—the isolation of being cut off from others. And yet so often the messages that our visitors give us seem pat, glib, even confusing, whether it's "this is all for a purpose" or "God won't give you more than you can handle" or what have you. And so much of suffering seems senseless, pointless, existentially wrong. Given your front-line view of this, do you believe there is meaning in suffering? And how do people who are in pain, how do your patients, find meaning in their experience? Julia Wattacheril: The short answer is yes, but it's generally quite a— it can be a protracted experience. So when you are hit with suffering, whether it's a new verbal diagnosis of cancer or a physical tumor, and you're recovering from the surgery that we just took out, the aspect of "how do I make meaning of this" can sometimes be too much for that given moment. And so a lot of the answers that you just named—I think there were multiple articles written about this in early 2020—about the limits of toxic positivity and always having a remedy, a pat answer for something quite traumatic. So I don't assume that every patient of mine expects suffering in their life. Most of them do. Most of them have experienced some form of suffering or trauma, but they may not have fully processed it. And that's true for the people taking care of them, too. So what I would say to the aspect, especially around the pandemic in relational suffering that we saw, is that entering into that suffering didn't necessarily come with a glib answer. It was just an acknowledgment and a validation of how much it was terrible. And being in this space, oftentimes silent and maybe even distanced, but being another human warm body that was sharing that agony with them. Obviously that takes a toll. It's an interpersonal type of interaction. And so that's where, you know, the person in me that's wondering about meaning downstream—both for the profession that's having to do this in an untrained manner, but then also the patient population and their families. Because it was spread through those phone calls; those video phone calls were opportunities to share space, whether it was limited by physical space or not. But there was meaning in the sense of community. Naming what the issue was, being mutually frustrated with our inability to be able to deal with it in a superb fashion, but understanding that meaning would come with time, perhaps. And more so an openness to receiving not just the suffering, but the process of trying to make it better. Cherie Harder: You know, the faith that's required to hope that meaning will come in time—I mean, it does require some faith, and, of course, often suffering shakes our faith. Phil, I wanted to ask you, and perhaps unfairly, about one of the great questions of all time for Christian faith as well as for those outside. And that's the question that's been called theodicy, the idea of how can a just, good, and loving God allow such seemingly pointless suffering in the world? I think one poet summarized the idea like, "If God is good, he is not God. If God is God, he is not good," when faced with such seemingly senseless or inexplicable

suffering. C.S. Lewis called this "the problem of pain." And it's a problem that you have wrestled quite a bit with as well. And I'm wondering, in the course of your wrestling with it, how you have come to understand or approach the paradox of theodicy? Philip Yancey: A couple of things: C.S. Lewis also used the phrase about nature and the world: "it's a good thing spoiled." And it's easy in the middle of a pandemic to lose sight of the fact that it is a good thing, that our bodies are amazing works, fearfully and wonderfully made. And even in the pandemic itself, I was surprised to find out that 99 percent of all viruses are not harmful. It's only one percent. But occasionally when one will jump a barrier, say, from an animal to a human host, it can—in this case—cause the entire world to shut down almost. So it's a good world, but it has been spoiled. And I think it's important to remember that God is no more pleased with this world than we are. I remember when I went to Newtown, Connecticut, and spoke on the problem of pain to people who had just lost their six- and seven-year-old children. And I could say to them, biblically, God grieves as much as you do. More than you do. God cares about your children more than you do. God is unhappy with the state of this world. The reason we know that, of course, is because of how Jesus responded when he was here. When he was here, he didn't just say, "OK, get used to it. This is the best we can do." He said, "If you have a problem, whether it's leprosy or born blind or whatever, that's not God's desire. I want to make that well." And he gives us a very bright clue into what God wants for this world. So don't judge God by what's happening on this world. God himself would say it's a spoiled world. He plans to restore it one day. But in the meantime, in the meantime, we're living here on a planet that is wonderful and good, but also dangerous and in some cases even fatal. Cherie Harder: I'm struck by the fact that the New Testament emphasizes, well, at least two things. One, that Jesus himself, God himself, is familiar with suffering as a man of sorrows, as someone who experienced it—both pain, loss, rejection, isolation, all the various forms of suffering. And we're also given the repeated reminder that he is with us. And I'm wondering how both of you—we'll start with you, Phil—believe that that potentially affects our view of suffering in general, but also the individual suffering that we might go through. Philip Yancey: You mentioned this book I've been working on, A Companion in Crisis, which is a modern paraphrase of John Donne's devotions, and Donne lived through the bubonic plague. It was 1623 when he wrote it. And we tend to read parts of it in English literature classes: "No man is an island." "If a clod be washed away by the sea, Europe is the less." "For whom the bell tolls? The bell tolls for you." And in that meditation, John Donne is isolated. He's in quarantine. The only people he sees are doctors. And medicine was rather primitive in those days. It didn't really help very much. But as he heard the tolling bell, he realized, "I've been so self-absorbed. I've been so concerned about my own health"—rightly so, because he thought he was dying—"that I've forgotten about everybody around me." And in that passage, "for whom the bell tolls," he starts thinking of, "it's not just about me. I'm a pastor and there are people in my church and what they're going through should be affecting me." I wrote a few books with Dr. Paul Brand, and he gave me a line that has stayed with me. He said, "A healthy body is not a body that feels no pain." He worked with leprosy patients who destroy themselves because they don't feel pain. They don't have that warning system. "A healthy body," he said, "is a body that feels the pain of the weakest part." And we've seen that in the last year, a little more than a year, with the Covid epidemic. Julia was one of those on the front lines looking for the weakest part. Who is in the deepest need? And, unfortunately, we were so overwhelmed that we had these situations of isolation where people had no human companionship and the fear was completely absorbing, and we lacked what we can often do, which is to reach out with compassion and to say, "You're not alone, I'm with you, I'm here." I interviewed a chaplain who worked at a memory care facility with dementia and Alzheimer's, and suddenly there was an outbreak of Covid. Fourteen people died in this facility. And so all the visitors were banned. And what a terrible thing. These people who are already confused, who only had one tie, say, to their family, and suddenly the family just stopped visiting them. "Don't they care anymore?" And she had to sit with each one of these, often alone, as they died, and then go and carry the news in the lobby to the families. That's one of the great cruelties of this disease. And we've seen pictures of these doctors and chaplains with their iPads and cameras doing FaceTime with the families locked outside. Suffering is meant to be shared. And that is one of the things that the church can do. We can respond with compassion. We can relieve the stresses that keep people from healing. "We'll take care of your dogs. We'll take care of your children. We'll make sure you have enough food." That's what frees up the body to do its healing wonders. And so much of the time in the Covid crisis that was taken away from us. Cherie Harder: And Julia, just to follow on in that, we were talking earlier about sort of unhelpful things that are often said, and one of the platitudes we often get told is "that which does not kill you makes you stronger." But of course, there are injuries and there are sufferings that merely maim and diminish. And one of the things that it seems like is that—whether it's trauma or great suffering—is almost inevitably transformative. One either grows or grows bitter. And from your experience on the front lines,

working with so many people, what distinguishes those who grow better versus growing bitter? And how might we think about enduring and persevering through pain in a way that enables spiritual growth rather than a sense of diminishment? Julia Wattacheril: Thanks for that question, Cherie. You know, I wouldn't even limit it to the patient population that we saw. I see it also in scientific investigation. It's basically when you get a new challenge: how do you deal with overwhelming circumstances? And it does come from a place of privilege to be able to even talk about it, rather than just hustle and deal and survive. But one aspect of being able to: pause and look at the circumstance, which is number one, but to also be open to what you are about to learn. It's a humble posture. It's an openness. They always say change must be open to change. It's a learner's heart. It's a willingness to be taught. That leverages a lot of trust, that there's a teacher out there, that there's someone who's going to guide you, that there is a aspect that's teachable, and that you're going to receive that. That's a lot. So for folks who do have a spiritual background, at least there's language around that, whether or not we feel comfortable as a providers engaging them around that. But from that same conversation that I had with Phil earlier, you know, one of the things, whenever I see a patient and they're overwhelmed with a circumstance—or even a colleague, quite honestly, or a mentor—is, what experiences have you had in the past that have felt similar? It's like when we address pain. Have you ever felt this pain before? What did we know about it? How did that help our diagnosis and treatment? Or how did you cope at that time? What strategies did you learn? And oftentimes that is an unhealed area, perhaps, if they haven't necessarily pursued it towards healing and meaning yet. So there's an opportunity. But it's also a technique that we use to leverage, in order to build more coping mechanisms. If it was the church that came in and supported you and not your multidisciplinary team with all our bells and whistles, then we need to call in your church. Our ineptitude is going to slow down your healing process. But if your church was a liability to your healing or they hurt you along the way, 1) that needs addressing in some way. And sometimes I do represent the church because I'm open about my status as a believer. And I've done a lot of apologizing for church-related trauma with patients. But that person also has an openness towards a new opportunity. That can sometimes be stewarded with another human being, that openness to change. So when you see someone who's resentful or angry, you just have to be curious about where that came from and patient enough to dialogue about it when they're ready to talk about it. Cherie Harder: Well, I feel like we have barely scratched the surface, but before we go to questions from our viewers, I'd really like to hear from both

of you on this—and maybe we can start with you, Philip—in that all of us will suffer in our lives. It's basically inevitability. And we will almost all of us also be in the position of caring for those who are suffering and certainly loving those who suffer. How does one suffer well? And how does one care for and comfort those who suffer in a way that encourages their flourishing? Philip Yancey: There's a good pattern on handling our own suffering in the Bible itself. The apostle Paul in the book of 2 Corinthians talks about a personal pain that he had. He doesn't really describe it; he calls it a thorn in the flesh. And he starts by calling it a messenger of Satan. So I talked about a good world spoiled. Well, the apostle Paul is right there. This should not have happened. I don't deserve this. And then, like most of us, he wanted it taken away, wanted it removed. So he prayed three times, he said—he seemed to be used to having his prayers answered—for God to take it away, but it didn't happen. And then finally he went to the last stage. Well, OK, I got to live with this. Is there something that I can learn from it? Is there some reason, some meaning, as you say, behind it? And he finally came up with. Yes, there is actually. The way I read the apostle Paul, he had trouble with with arrogance. He was not an easy person to get along with. He needed humility. And that's what he learned. We don't know what that thorn was, but somehow it forced him to realize that it's not my strength, it's God's strength. And God's strength is often poured through my weakness. In surveys, they show that if you ask people, "What is a time when you grew most spiritually?", about 80 percent of the time people will talk about a difficult time, a hard time, not the prosperous, easy times, but often involving suffering. And the second part of your question: how do we care for others? I've asked so many people, "Who helped you?" I've never heard them say, "Oh, there was a philosopher I read who just made me understand what was going on." They don't say that. Often it's a grandmother; it's someone who's just got time on her hands, who sits there nearby. And if you need some ice chips or you need some orange juice, she's there. She's not lecturing. She's not philosophizing. She's just being there. And if we are the church, there's a wonderful phrase in 2 Corinthians where God is described as the father of compassion and the God of all comfort. And it says we who have received comfort from that God are called to go out and distribute, to dispense that comfort, that compassion, to those around us. That is the church being the body of Christ, looking for that weak part and responding with comfort and compassion. Cherie Harder: Julia? Julia Wattacheril: The first part of your question about before there's action, I would say—or with an interpersonal dynamic with another human—is—I try to remember and remind my team of this, too—that you can't give what you don't have. And so particularly for people in the helping professions—health care workers, social workers, pastoral staff, etc.—oftentimes the system incentivizes, at the expense of who you are, doing for others. There comes an end to that and then you become dysfunctional if you're not being taken care of yourself. So a lot of the coaching or counseling that I do is encouraging people, working moms especially, to take time for themselves. Otherwise, you will see the effects. We will see the effects for what's happening right now in a year or two, if not sooner. So starting with the self. The second commandment of Jesus, you have to love yourself first. And I think that's very, very hard for a lot of people to hear because there are modern concepts of what that looks like [and it] is not intimacy with Christ necessarily. So I'd say start there. Then, while you are potentially simultaneously letting Jesus address your own personal suffering, you are equipped through the Holy Spirit to help address some of the hurts of others. And as it's a mutual process, that's what the beauty of transformation is. And it's visible and highly recognizable, whether you articulate it or not, when someone is being transformed, because it does— it spills over, it spills over towards a healing aspect. Patients will comment, "Your team has a good vibe." That's all they'll say; we don't necessarily need to say anything more than that. But that spirit of coming together for another person's good, the patient knows that: when you know a team's rallying for you and it's not just about orders being filled or medications going in, but they honestly want you and are rallying for you to get better so that you can reengage your church, your home, and all the things that are so important to a person under our care. In brief, that's how I'd answer it. Cherie Harder: Thank you. That's great. We're going to turn to questions from our viewers. And if you're joining us for the first time, you can not only ask a question in the Q&A box in the bottom center of your screen, but you can also "like" a question and that helps give us an idea of what some of the most popular or pressing questions are from among our viewers. So we'll just start with a question from our viewer, Jenny Savage. And Phil, I think I'll direct this one to you. She asks if there is a role for the practice of lament with our suffering, and if so, what forms of lament have you seen as being most helpful, whether as an individual or as a community practice? Philip Yancey: Early on in the pandemic, Time magazine reached out to N.T. Wright, the theologian—I think he's probably been on your Conversations before, Cherie. And he responded by writing a whole column about lament, saying the first thing we need to do is just cry out. One of the things that strikes me as I read the Bible is God can take it. We can say anything. In fact, sometimes when I'm at a secular university, I'll say I know that there are people here who don't

even believe in God. And I frankly respect a God who not only gives us the freedom to lash out, but actually gives us the words to use, because I haven't found a single argument against God among the great atheists that's not already included in the Bible, in books like Job and Lamentations and the Psalms. The Psalms are a great place to start because the words are there, beautiful words. We often think the Psalms are what you take to a hospital room to read to comfort people. Well, you better read it in advance before you use it as comfort, because there's a lot of anger and there's a lot of protest against God. And God is saying to us, "I understand it's not easy. There are things that you don't understand and will never understand. So I can take it. Just let me have it." And of course, Jesus himself, when he was here, cried out, "My God, why have you forsaken me?", quoting one of those psalms. So lament is a gift that we have. And I like lament being expressed in a group dynamic because there's more than lament. There's also hope, there's perspective. And when you're with other people, it could be that one person feels only anger and protest right now, but actually, there's a lot more going on. And if we're in a group, gradually, we can kind of soften the edges a little bit and learn from each other. But I'm glad that Jenny asked that question because lament is a starting point: "I don't like it. I don't like what's going on. It's wrong." And I think God would agree. "Yeah, you're right. It's wrong. I will put it right one day, but probably not in your lifetime." Cherie Harder: Julia, I'll toss this next question from an anonymous attendee to you in that it seems like this picks up on some of the things that you had talk about. And our viewer asks, "How can you bear one another's suffering and pain when you are emotionally and spiritually drained yourself?" Julia Wattacheril: You can't. It becomes— it's a well that needs recharging, and that sort of harkens back to what I was saying before. It is not selfish; it's actually one of the best things that one could do. So to invoke what Philip just said, that's an opportunity to cry out to God and say, "Lord,"—and I've done this a gazillion times—"these are the demands that are placed on me. This is what I have in my reserves. I need filling." And that requires a huge amount of faith. When you're depleted, it's hard to have. When you know that there are some basics that you need: sleep, a little bit of food, nourishment, a safe roof over your head. So I don't take those things for granted either. And so, to the person who's asking that question: God's not asking you— remember Jonah. Remember the nap, remember the pillow, remember the sustenance. I would be very curious with you as to where you feel you're being called and how you're being called in that direction and sit with God. And that is an opportunity for you to hear from him directly as to what his expectations are. And he really cares so much more about you and sustaining you to do the long work of, one, being a reflection of him in this world. And then what that looks like in terms of service to others is an outpouring of that, not at your expense. Cherie Harder: We have quite a few questions that deal with empathy and compassion and pain avoidance, and I want to combine just two of them and toss them your way, Phil. We have one question from Claire Likert who asks, "How can you be a comfort to someone who is grieving if you have never gone through serious trauma yourself?" And somewhat related: John Dozier asks a question addressed to you saying, "Following the suicide of my father on Christmas night back in 2002, I wrote about suffering—the audience Christians living in a culture of comfort." And John asks, "What are the dangers of the church often avoiding pain as much as the world does?" Philip Yancey: Well, I'm impressed if this person really hasn't experienced much trauma in their lives, the first person who wrote. And I would say, don't try to speak into something you don't know about personally. Just try to be supportive and caring and loving. There are a lot of helps available online; there are grief support groups. There are all sorts of communities that the person can join to hear about grief particularly. But mainly they need to know "I'm not alone, somebody cares for me and somebody is there when I need something." Boy, the one on suicide. That is so hard, and the bromides don't help. It doesn't help to say things like "God needed him more than you did." Oh, my goodness. That does more harm than good. Again, the best thing that we can do is to show love and care and to show you're not alone and to be a listening ear. So many times when people go to a hospital, they think they have to say something. And actually, most people just need a sounding board. They need a listening ear, as Julia said earlier on. We don't need to go with answers. In fact, when we go with answers, often we have the wrong answers. I think back to the book of Job. These terrible things are happening to Job and his friends were— his friends who cared about him. They were his friends. They loved him. For seven days, they sat there and grieved with him. And then they started talking. It's when they open their mouths that the problem started. Because for seven days, Job knew "I'm not alone; they care; they know what I'm going through." And then they started with these philosophizing comments about "You must have done something wrong. God is punishing you." The typical bromides that people get. So I would say the first advice to people who want to help is to keep your mouth shut as long as possible. Cherie Harder: That's great. So another question comes from Gerald Whiberley, and I'll throw this one to Julia. Gerald asks, "If you are suffering from an incurable disease and know that your time to live is limited, what merit is there to endure the suffering any longer when you can no

longer converse and barely think?" Julia Wattacheril: That hits on a lot of different issues. Thanks for asking that question. So each one of those aspects needs unpacking a little bit. So the aspects of suffering, if you're cloudy-headed or in inexorable pain, you know, medical teaching helps us try to alleviate some of that pain and cloudy-headedness so that we know to the best of our ability that that individual is speaking of their truest sense, of their truest desires, because any aspect to which we don't address their suffering, even when they're maybe not asking for a direct end to it, there's the subtext there. How do you help someone who doesn't see a purpose to living, basically? You know, we in medicine typically do mortality-based decisions, even though morbidity and quality of life matters very much to our patients. The system is sort of wired to think about things in terms of life and death. And so that's where you can see some of the differences in opinion about what meaning is and what survival is and what metrics we're trying to pursue. So for that individual, oftentimes when I've gotten that question myself from a patient that's in a profound degree of suffering, we have to tackle each aspect: the physical aspect; oftentimes the brain-lucidity or clearness of thinking is more detrimental to the family than the individual who's undergoing that. Obviously with this individual they sense it. But the degree to which we can address—even though it's not compartmentalized in an integrated human being—that's our strategy to try to help it get better is work with a person dealing with each of the aspects. Oftentimes—I hate to label it depression or anxiety because oftentimes it is unaddressed trauma that's manifesting itself in that way. So that's where our counseling techniques and engaging someone to help specifically deal with some of those questions as to what is worth living for. What am I pursuing with this? And is it to my own benefit or am I serving someone else's? And I think Dr. Dugdale got into this a little bit as well. Cherie Harder: So, Phil, the next question comes from Ron Boyd and Ron asks, "How can people of the church be more understanding to those who suffer and to those who experience pain? It just seems that if we don't experience it, we often lack an understanding of the problem." Philip Yancey: I just haven't run into that many people who haven't experienced pain and suffering, I guess. There are ways to intentionally visit hospitals, visit hospice groups. I remember I had a neighbor who had a terminal illness and she invited me to go with her to a group called Make Today Count. And I went regularly with her. One by one people in the group would die. And it was a very moving experience for me to be invited into such sacred times where we didn't talk about sports, we didn't talk about the economy or daily news. We talked about the things that matter most. Like, if you have a little bit of time left, how should you spend it? How do you say goodbye to the people you love? How do you make amends to the people you've had problems with? And there are groups like that. AA would be a whole different kind of suffering, but it also teaches. And I think I would recommend that this person intentionally find a group—could be visiting prisoners—but deliberately to put yourself in the place of those who are—around—those who are suffering. They are great teachers. They just need somebody to listen to them. And you can learn a lot. It's a very moving experience. Cherie Harder: So we have had several questions—I'm just going to combine them into one—about suffering from injustice. We have one viewer, Peggy Narlock, who wrote in about struggling with the fact that her mother passed away because she wasn't given the right pain medicine. We have other questions from anonymous attendees who want to ask how one deals with anger that comes from suffering as the result of injustice. Julia, any thoughts on that? Julia Wattacheril: So many. I'm glad you're asking this question. I was going to dovetail off of, or piggyback off of, Philip's response with regards to lament. So we can work with anger, just like he said. I would say the inflection point for spiritual formation for me specifically relates to being angry over things. And there are some great Psalms. I was in Finland coming back when the episode in the history of the United States with Charlottesville happened, and I listened to a sermon called "Pray Your Anger" six times on repeat on that [flight], because I was like, Lord— I almost— There's an aspect to this which is freeing, that was very reminiscent of how I grew up. There was an aspect to it where I said, how long, how long is this going to continue? And I think we see that, you know, these isolated incidents of LinkedIn stories, Facebook stories, from patients or providers who are hospitalized, etc., these stories that are emerging about how they're interacting with the health care system, what our incentives are, how those incentives are not necessarily made to serve them or their group of self-identified individuals or group-identified individuals. There is a rift there and we have to be angry about it. And the mechanisms for being angry are both first time angry, waking up, but also healing. I can honestly tell you some of the protests that were going on in New York last year, I never thought I'd see that in my lifetime. And solidarity and an aspect of hope emerged for me. So for people that are— this is where we get at systemic suffering or group suffering in the collective. There's an individual aspect to healing and processing, but there is a strong collective aspect that the church can really have an opportunity to excel at because the tools are there. We are equipped. So injustice writ large in every arena. I pray for my friends in the FBI that are dealing with it as much as I pray for the nurses and respiratory therapist that are dealing

with it across across the street. Because there is a reckoning within us, just like suffering, is that I can enter into seeing that and being angry, not in a depleting way, but in an empowered way and discerning that requires a lot of spiritual sophistication sometimes in order to enter into that process with you. And that is profoundly healing to communities and generates some of that hope that needs to be there as this arc starts to curve in order for some corrective action. Cherie Harder: The next question comes also to you, Julia. Claire asks, "To what extent does understanding a medical situation scientifically help you make sense of it in a spiritual sense?" Julia Wattacheril: Thanks for that question. Is it Claire? Claire, so this is a key component—and I encourage all of you to do this with your physicians if they don't do it; I just sort of template this into my discussion—is the role of information in your care. What information sources have you historically gone to from a scientific or medical basis? How can I teach you about which ones are good and what are red flags, to tell you that's disinformation or misinformation? Those are the types of things you should feel free to talk about with your health care provider, with your doctor. So information for some can be anxiety provoking and be too much information at one time. So when I pull up labs with my patients, I tell them: these are the things that we're paying attention to. As a federal law, everyone soon is going to have access to their own labs, their own reports, etc. To the degree that receiving that information makes you anxious and uncertain and more than anything contributes to distrust in your team, that may not be good for you to look at by yourself. You absolutely need to understand it, but in the context of what your disease means. And if your team—if you work on it piecemeal—it won't feel overwhelming to them. They can't go through 20 years of data necessarily in 3.2 minutes, but we parse it, based on what the need is at the time. So that leverages a lot of trust in your health care team. And whoever that is needs to understand if you are getting information that moves you in the negative direction from building trust or if it's a trust enhancer. In the same way our posture with God is: is the repentance bringing us towards God, or is there shame that's sort of distancing from him? It's a good little discernment tool that I use with my patients. So if information— you know, digging up medical information or scientific information from mouse models that are not necessarily relevant to humans is one aspect that we can actually teach. We can do commercials that tell people about phase zero, phase one, phase two, phase three, phase four. This is part of teaching. And we can do that as commercials or public health messages. Bring everyone up to some sort of health literacy capacity. And then you can start to learn to parse the data with your provider. What's relevant? What should I lose sleep about? Generally, you shouldn't be losing sleep. Your team should be taking care of you. But if you are losing sleep, if it is provoking anxiety, you should feel comfortable bringing that to your team and saying, "I don't know how to deal with this information. It seems detrimental." And they'll tell you, "Stay away from it. We'll help you figure out what sources are going to be helpful to your care." Cherie Harder: So I think we'll take one more question from our viewers and I'll address this to Philip. This question comes from Ember Liddiard, and Ember talks about what seems like perhaps an emotional or spiritual conundrum. She asks, "How can acceptance of physical illness and pain, and allowing God's grace to be sufficient, coexist with faith, hope, and the belief that God is all-powerful and could heal? Is it that we just keep praying for healing, but in the meantime, if God hasn't healed us, we trust him? Essentially, how does one reconcile the belief that God could heal if he wants to, with trusting that he may not?" Philip Yancey: I remember a statement that G. K. Chesterton made about the book of Job. He said the first part of Job is Job saying, "I don't understand!" and the last part of Job when God speaks is God saying, "You don't understand!" And there are some things that we can't reconcile. Miracles do happen. I believe that. But they're miracles. They're not everyday occurrences. And Paul's thorn in the flesh is a good example. I've interviewed a lot of people who have gone through trauma and most of the people I've interviewed have not had that kind of miraculous resolution; they have learned through it. And as I reflect back on the various people I came up with this phrase that "pain redeemed impresses me more than pain removed." It would be great if we just prayed and everybody immediately got a healing. It would be wonderful. It doesn't happen that way. But the Bible, and all the great passages about suffering in the New Testament, has us look forward to what it can produce. It can produce good things. Go back to Romans 5, Romans 8, 1 Peter, the book of James. They all talk about, there are some things that can emerge out of this difficult time—patience, compassion, these kinds of things—and later we can look back and say, "God recycled stuff that I wish had not happened." Paul wished that he didn't have the thorn in the flesh at all, but it turned into good, and God can take the things that we most resent. I think of Joni Eareckson Tada, for example, who prayed like crazy and had every person with a gift of healing pray and anoint her with oil. She didn't get deliverance in a miraculous way, but she became a prophet to the rest of the church. She reached out, formed an organization to help those with disabilities. That's an example to me of pain redeemed, impressing me more than if Joni had been healed miraculously of her quadriplegia. Cherie Harder: As promised, the last word to Philip and Julia. Julia, let's start with you. Julia Wattacheril: This is from a section of Martin Luther King Jr.'s speech called "The American Dream," in a section called "Overcoming Loss": "All this is simply to say that all life is interrelated. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Strangely enough, I can never be what I ought to be until you are what you ought to be. You can never be what you ought to be until I am what I ought to be. This is the way the world is made. I didn't make it that way, but this is the interrelated structure of reality." Cherie Harder: Thank you, Julia. Philip? Philip Yancey: I would go back to that phrase in 2 Corinthians 1: "the God of all comfort and the Father of compassion." A lot of people stumble over their image of God. Even some people have a hard time saying "Father," "Our Heavenly Father," because they have memories from childhood of abuse. There are other people—I was one of those—who grew up with the image of God as kind of the scowling super-cop, just looking for somebody doing something wrong so they could smash them. And we have a different view. We believe in the God of all comfort and the Father of compassion. And I wish— This phrase from the Bible, "the great physician," has become for me a good reminder of who God is. God is one who wants the best for us, who came to give us life, abundant life, beautiful life. And if we can get to know that God of all comfort, the Father of compassion, and spread abroad that comfort, as Paul tells us to do in 2 Corinthians, we can change people's image of God. God is on our side. God is on the side of the one who is suffering. I'm absolutely convinced of that. And the proof is the way Jesus went out of his way to be among those who are suffering and bring them that comfort directly. Always he responded with healing and compassion and care. Cherie Harder: Philip and Julia, thank you so much and thank you to each of you for joining us. Have a great weekend.