Upheld in Exile: Reflections for the Christian Medical Community

Posted Jan 24, 2022

Upheld in Exile: Reflections for the Christian Medical Community

From Psalm 16 and Psalm 137

Margaret Cottle

This article original appeared in the December 2021 issue of FOCUS.

As Christian physicians working within our society’s upheaval and uncertainty, the Psalter provides a living treasury illuminating the entire range of human experience. We are deeply grateful for these poetic jewels that give voice to our own heartfelt cries. Exultation and lament, encouragement and chastening, joy and sorrow, birth and death, hope and despair, wisdom and destruction, all are represented in these eternal songs.  In the practice of medicine, we are eyewitnesses to it all.  Days that include, almost simultaneously, moments of quiet reassurance and others of profound despair are common in our shared experience.  A closer examination of psalm 16 and psalm 137 will provide an opportunity to explore these contrasting experiences. 

There is much to encourage and to strengthen us in Psalm 16.  We find the Lord Jesus in almost every verse, just as the Apostle Peter did in Acts 2:25-28, stating that, “For David says concerning him [Jesus]…” and then quoting psalm 16. In this context, C.S. Lewis’s ideas about “second meanings” in the psalms are also pertinent.  He suggests and that we may be led in that direction by Christ himself on the road to Emmaus.

On that famous journey to Emmaus he [Jesus] found fault with the two disciples for not believing what the prophets had said. They ought to have known from their Bibles that the Anointed One, when he came would enter his glory through suffering. He then explained, from ‘Moses’ (i.e. the Pentateuch) down, all the places in the Old Testament, ‘concerning Himself’ (Luke 24, 25-27). He clearly identified Himself with a figure often mentioned in the Scriptures; appropriated to Himself many passages where a modern scholar might see no such reference. In the predictions of His Own Passion which He had previously made to the disciples. He was obviously doing the same thing. He accepted–indeed he claimed to be–the second meaning of Scripture.

With Jesus, Peter, and Lewis all supporting us, we are emboldened to see Christ in these psalms.  Starting with a simple cry for preservation in psalm 16, David reminds us that the LORD is our only refuge, the only trustworthy One, and that we have “no good” apart from him.  This is a remarkably apt beginning for those of us in a profession better known for arrogance than humility!  

Because of our daily experience of the vital importance of our communities, we may find it easier to echo David’s gratitude for the fellowship of believers.  Jesus himself reminds us that loving one another is the hallmark of his authentic disciples. And throughout the New Testament epistles, Paul’s pleas for unity and love for one another underline Jesus’ teaching and exhortations.

At the same time, we are cognizant that, even unwittingly, it is treacherously easy to adopt our culture’s twisted perspectives.  Thus, the warning about the sorrowful end for those serving other gods is an important restorative. In the same vein, Jesus and the New Testament writers often warn us to be on our guard.

David’s gratitude continues in the affirmation that the LORD is our chosen portion, holds our lot, that our boundary lines are in “pleasant places,” and that we have a “beautiful inheritance.”  With Peter we know this to be true absolutely, even though at times we may have to choose to believe these assertions by faith, as the “assurance of things hoped for and…unseen,” while offering the “sacrifice of praise.” The psalm continues with thankfulness for counsel by day and night—a vital provision for physicians, especially in the dark hours when our only solace is the presence of the “friend who sticks closer than a brother.” He is our best comforter and our wisest counselor during those lonely, terrifying nights caring for critically ill patients, or when our hearts are shaken by lamentable decisions made by our patients, our colleagues…or ourselves.   

Psalm 16 continues in joyful expectation–rejoicing in heart and flesh, remembering our eternal destiny, having the security of being shown the path of life now, entering his presence in fulness of joy and, finally, eternal pleasure.  How well these promises are echoed by Jesus in his comforting words in John 14:1-3! 

Let not your hearts be troubled. Believe in God; believe also in me. In my Father’s house are many rooms. If it were not so, would I have told you that I go to prepare a place for you? And if I go and prepare a place for you, I will come again and will take you to myself, that where I am you may be also.

David is indeed resting in “pleasant places.”  His simple cry for preservation in verse one is answered in an infinitely rich, comprehensive, incredible way, not only for David, but for us as well.   

In contrast, psalm 137 records the gritty and sometimes depressing reality of our broken world.  Although this psalm commemorates the exile of the Judeans to Babylon and may even have been written by the prophet Jeremiah, Christian physicians in the twenty-first century can find great resonance here.  This may be especially true for those of us who entered the profession when its ethos was very different — when healing was almost our sole focus.  At that time, medical ethics placed the importance of non-maleficence and beneficence well above that of autonomy.  The Judeo-Christian foundations of Western society were endorsed even when not fully acknowledged. The tenets of the inherent dignity and the equality of every member of the human family were intrinsic both to the private thoughts of our citizens and to our public codes of conduct and laws.  These principles are firmly rooted in the imago Dei as taught throughout both the Old and New Testaments. Some of our current sense of exile results from society’s rejection of these truths.  As a result, concepts such as the protection of conscience — for physicians specifically — have been replaced by the imperative that all individuals must be affirmed for who they believe themselves to be — irrespective of immutable physical realities or definitions and mores that have been the accepted norms in most civilizations for millennia.  Treatments are thus mandated in accordance with patients’ desires alone — even when robust, published, scientific evidence shows these same treatments to be harmful in the long term.

Further evidence of this shift is seen in changing attitudes toward abortion.  Until recently, most physicians who supported abortion considered it to be a “necessary evil” not a societal “good.”  In the late 1970s, one of our medical school professors, who performed abortions himself, spoke bluntly to our class.  After explicitly exempting pro-life students, he addressed those who claimed to be pro-choice.  He demanded that they stop denigrating those who performed abortions, and then pointed his finger at the class and almost hissed, “Do your share of the dirty work!”  And now, only a few decades later, this procedure is no longer “dirty work,” but celebrated and defended against even the most reasonable regulations.  At that time, euthanasia and assisted suicide seemed unthinkable, but the door had been opened wider, and exile was looming. 

In the epoch commemorated by Psalm 137, Daniel and his friends Hananiah, Mishael, and Azariah, to use their Hebrew names, responded quite differently to their captivity. Instead of withdrawing, they studied diligently to understand the culture of their captors. They followed the Lord’s instructions through the prophet Jeremiah’s letter, seeking the welfare of the cities where they had gone into exile. And despite many serious trials, the Lord blessed both them and their work. 

Many Christian medical trainees and professionals have followed a similar approach, learning the “professional” culture, becoming proficient in our studies and clinical skills, and engaging our colleagues and preceptors in respectful discussions around contentious issues.  Until recently, there was even some consensus from all sides that our positions were reasonable.  Almost everyone agreed that it was completely unacceptable to compel physicians to participate in something that they found to be morally wrong.  The shadows of Nuremberg reached far into the 1980s.  Although there were still important limits to be drawn, the negative consequences of those days appear very minor in contrast to the penalties today for transgression against the expectations in the medical establishment.  Psalm 137 gives voice to the full range of our present experience.  We are grieving, lamenting, and weeping about the state of our profession, and it is certainly tempting to “hang up our harps” and to stop singing altogether due to sadness and our sense of exile.  I have spent over thirty years caring for patients at the end of life and for their loved ones.  During those years, the most common misconception that I encountered was the fear that palliative care teams would deliberately take the lives of those entrusted to our care.  I spent many painstaking hours attempting to counter this idea which used to be a myth and worked hard to educate my colleagues, patients, families, and the general public about the importance and benefits of traditional palliative care.  And now, tragically, administrators, government agencies, and even some physicians, are systematically re-defining palliative care to include facilitating and deliberately causing the deaths of our patients. This despite the World Health Organization’s assertion that palliative care “Intends neither to hasten nor postpone death.” Sadly, in many jurisdictions, Medical Assistance in Dying (MAiD) — the current euphemism for deliberately ending the life of a patient — uses and thus diminishes financial and other resources that have been allocated to palliative care. In addition, the “MAiD teams” have been forcibly pushed into palliative care departments and hospital palliative care units. Free-standing hospices — many of which have been built with private funding — have been compelled, often against their strongly expressed wishes, to allow MAiD to be performed on their premises or have been summarily evicted., And yet, in the midst of fewer resources and this disastrous “mission shift,” palliative care teams are still expected to provide the excellent care for which we are trained. It very much feels that we are being asked to “sing the songs of Zion” in this “foreign land” and to “make bricks without straw.”

There is also a sense in which those of us who oppose taking the lives of our patients are being mocked by our “captors” — those who hold political or financial power over our careers and livelihoods — and our “tormentors”—those who accuse us of lacking in compassion and “enjoying” being witnesses to the suffering of our patients. In verses 5 and 6, the psalmist is steeling himself not to forget to both do (right hand) and say (tongue) the important things he knows to be true, and to count these things above his highest joy. 

In approaching the “cursing” part of psalm 137,  C.S. Lewis has an interesting interpretation that may have had some inspiration from others, including St. Benedict: 

From this point of view I can use even the horrible passage in 137 about dashing the Babylonian babies against the stones. I know things in the inner world which are like babies; the infantile beginnings of small indulgences, small resentments, which may one day become dipsomania or settled hatred, but which woo us and wheedle us with special pleadings and seem so tiny, so helpless that in resisting, them we feel we are being cruel to animals. They begin whimpering to us “I don’t ask much, but”, or “I had at least hoped”, or “you owe yourself some consideration”. Against all such pretty infants (the dears have such winning ways) the advice of the Psalm is best. Knock the little bastards’ brains out. And “blessed” he who can, for it’s easier said than done.

What “second meanings” might there be for us in our own contexts from this section of psalm 137? It is interesting that the psalmist rails against not only the Babylonians, but against the Edomites who cheered them on. It often seems in medicine, too, when contentious issues arise, that those who initiate the evil are seldom the ones who regulate its practice. Even so, the secondary players who make the more operational decisions seem just as intent on silencing or destroying those who object to the changes. They are not content simply to implement the policies, but in their own ways chant “Down with it” or “Lay it bare” or “Tear it down” … “to its foundations.”   Even though the psalmist knows that these troublemakers are “doomed to be destroyed” (ESV) or to be “wasted with misery” (Coverdale), he is still angry and blesses their downfall because of the destruction and misery they are causing. I can imagine that the ideas that are so pervasive in the culture of death—those ideas that deny that every person is created in the image of God, that every person is infinitely precious, and that every person is worthy of respect, protection, comfort, and love — start small in the thoughts of those who propose them, and these thoughts become their “little ones.”  Blessed indeed is anyone who will dash these wretched ideas, these “little ones” against the rocks — especially against the Rock of Christ.  In the meantime, it behooves all of us to pray that the Holy Spirit will keep our own hearts clean and soft and will strengthen us to dash our own “pretty infants” of thoughts and actions against the Rock of Christ.

Shortly after he counsels them to seek the welfare of the cities where they have been sent, Jeremiah also reports the Lord’s reassurance to the exiles in this passage:

For thus says the Lord: When seventy years are completed for Babylon, I will visit you, and I will fulfill to you my promise and bring you back to this place. For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope. Then you will call upon me and come and pray to me, and I will hear you. You will seek me and find me, when you seek me with all your heart. I will be found by you, declares the Lord, and I will restore your fortunes and gather you from all the nations and all the places where I have driven you, declares the Lord, and I will bring you back to the place from which I sent you into exile.

These oft-quoted promises are extremely unlikely to be fulfilled in my lifetime, but the Lord is eternally faithful. He always keeps his promises. We can indeed expect to face increasing opposition and deepening hardship.  We can also trust him to enable us to stay faithful during our earthly journey and ultimately to take us home to be with him in eternally “pleasant places.”  As Paul reminds us in Philippians, it is Jesus’ ultimate sacrifice that makes this possible, and that there will come a time “that at the name of Jesus every knee should bow, in heaven and on earth and under the earth, and every tongue confess that Jesus Christ is Lord, to the glory of God the Father.” Surely that is “a future and a hope” that is worth singing for–and working for–even, and possibly especially, in this foreign land during our temporary exile.