The most important thing that we learn as caregivers is how to practice mercy. Our patients are sick and the provision of medical care goes beyond the dispensation of medicines or medical procedures. As health care providers, we are more than technicians in a modern medical machine, but people that must recognize loss, limitation and suffering and to minister to these essential elements of humanity as much as we treat the biology of the underlying disease.
Mercy is the recognition of suffering and loss and a response that provides support, care and healing. The act of mercy requires an understanding of the individual and engagement of the care-giver. With time in the practice of medicine, we learn that mercy is not given in a hasty or unmeasured response to a patient in need, but requires participation in the illness and in the emotional response that lifts the patient. Mercy requires an additional level of care—a commitment from the caregiver to support and to healing that demands careful consideration and time. In the rush of the modern medical system, governed often by performance metrics and cost considerations, the act of mercy may not be economical and easy for the care-giver. When the call from the emergency department about the unexpected illness of a long-term patient comes in the early hours of the morning, or an urgent request for an add-on clinic visit hits a day filled to the brim with patient visits, mercy demands consideration of the human need and also the sacrifice in providing this care.
A professor at UCLA recalls a realization of mercy that influenced a career. In a busy Tuesday clinic, already running behind from last minute visit add-ons, a mother and her two young sons came in, pushing their severely disabled husband/father in a wheelchair. The man experienced a catastrophic subarachnoid hemorrhage (a brain bleed) many years before, and was paralyzed, mute and responsive only with minor head and face movements. With many years of detailed neurological follow-up in his past, there was seemingly not much that could be offered in this latest visit. Through a long discussion with the patient’s wife, and an examination of the patient, it was clear that his care was excellent, but his prognosis for further recovery was minimal—dependent in feeding, dressing, bathing and toiletry, he would not be able to meaningfully engage others or his environment. The mother asked additional questions, and lingered over the responses. She was over-burdened with care, taxed to the limit with raising her children, loving and obligated to her husband yet suffering in her own health and that of her family. The professor wondered what else there was to offer, and then slowly realized: this woman was seeking permission to place her husband in a home, to discuss whether this could be an act of love, or an act of selfishness. This clinic visit required consideration of suffering and loss, the meaning of love and devotion, and a sharing of clinical advice that went well beyond just medical care. Mercy demands engagement, demands both from the giver and receiver the price of emotional commitment but offers both a fuller path of healing.
In ancient Greece, in a metaphor for the response to suffering, the muse Charity had three daughters. The youngest, Sympathy, stood apart and pointed. Empathy, the middle daughter, rushed in to help, feeling connection to the suffering and loss of another. Without considering self or situation, she was often over-committed to many such demands. The eldest, Mercy, patiently considered the situation and then embraced the suffering, aware of the personal cost and the sustained needs of the individual.
The practice of mercy is not convenient and the decision to offer mercy necessarily means a decision to turn from something else. Mercy is not limitless. Mercy differs from compassion because mercy comes from a position of power as a care-giver to a person of need in a patient. But the merciful recognize that all such positions are transitory. We will all be in need of mercy in our lives.
In this issue of the UCLA Neurology Chair’s Report we explore acts of mercy and the motivations to provide care in three of our outstanding staff, residents and faculty.