Three Little Birds

Dr. Kristin Collier shares a deeply personal story about her friend Jake, a talented physician whose battle with cancer profoundly impacted her understanding of medicine, suffering, and spirituality. Through her reflections, she explores the limits of medicine, the importance of recognizing the humanity in patients, and the need for healthcare professionals to engage with their own emotional and spiritual well-being. Dr. Collier emphasizes the significance of creating sacred moments in healthcare, where deep connections can foster healing and understanding amidst suffering.

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Transcript

Prelude

Kristin Collier (00:00)

And I saw three little birds come down one by one in a beautiful arcing swoop. And one by one, each one of their wings just brushed the water as they did so. And it was so beautiful and magical that I sat up to see if anyone else had seen it. And everyone else was asleep on their chair. It was just me. And I knew in that moment that Jake was gone.

Show Introduction

Nate Houchens (00:40)

Hi and welcome to Boundless Moments, the storytelling podcast that brings sacred moments to life through the voices of those who lived them. I'm Nathan Houchens. Support for Boundless Moments comes from the Sacred Moments Initiative. 

At Boundless Moments, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality.

All views expressed are those of the person speaking and not their employer.

Some stories featured on Boundless Moments may contain themes or content that could be upsetting for some listeners. We encourage you to use discretion and take care of yourself while listening.

Introduction: Kristin Collier

Nate Houchens (01:24)

In this episode, we hear from Dr. Kristin Collier. Dr. Collier is a Michigan lifer. She received her medical degree from the University of Michigan Medical School in Ann Arbor and completed her internship, residency, and chief medical residency at the University of Michigan hospitals. She is currently an Associate Professor of Internal Medicine at the University of Michigan. There she serves as the Director of the Medical School's Program on Health, Spirituality, and Religion, as well as Associate Program Director of the Internal Medicine Residency, where she oversees the primary care track. Her academic interests are in the overlap of spirituality, religion, and medicine, and her peer-reviewed work has been published in high-impact journals such as JAMA Internal Medicine, Annals of Internal Medicine, and the British Medical Journal. She also has had writings published in Notre Dame's Church Life Journal, Theopolis, America Magazine, and Public Discourse. She is also a wife and the proud mother of four sons. 

Introduction: Three Little Birds

Nate Houchens (02:27)

In the conversation that follows, Dr. Collier shares a deeply personal story about her friend Jake, a talented physician with whom she trained and whose battle with cancer profoundly impacted her understanding of medicine, suffering, and spirituality. Through her reflections, she explores the limits of medicine, the importance of recognizing the humanity in patients, and the need for healthcare professionals to engage with their own emotional and spiritual wellbeing. Dr. Collier emphasizes the significance of creating sacred moments in healthcare when deep connections can foster healing and understanding amidst suffering.

The Story: Three Little Birds

Kristin Collier (03:26)

So I'd like to tell the story of my friend Jake, what he taught me about living, about dying, and the limits of medicine. So it's hard to believe, but the time we spent together as residents here is now over 20 years ago. I was a resident in internal medicine here at Michigan Medicine and did my residency here from 2001 to 2004. During that time, one of my colleagues, who was a year older than I was, was Jake Deerhake.

He was the doctor everyone wanted to be and the colleague everyone wanted to work with. He was super crazy smart, funny, kind, compassionate, and cared deeply about medicine, his patients, his friends and colleagues. And he was the consummate internist. He knew the deep differential for peripheral eosinophilia at the tip of his tongue, but also could interpret ABGs, read films, and run a code. Given his talents, he was chosen to be one of our four chief medical residents. And the year before his chief year, we noticed something different about Jake. He had been losing weight, looking tired, but we all knew he had been busy. He kept telling us that he had been busy. 

And one night, shortly after arriving home from a flight where he had been interviewing for cardiology fellowship out of state, he couldn't breathe. He presented to our emergency department with shortness of breath and was found to have a massively enlarged liver due to the presence of multiple terrible masses. We were hoping that this was something easy, or at least easier than what he ended up having, which I won't even name here because my anger at his particular disease has decided that its name doesn't deserve a place in the story about my friend. But what we had was bad and what he had ended up taking his life.

And this brings me to the first moment I would like to focus on here, which is the moment I found out about his diagnosis. I was a burned out, overworked, tired senior resident about to take night call for our cardiology service. I was in a call room upstairs in the hospital and realized I hadn't seen Jake in a while. And there were murmurs around the program that he was ill. So I texted one of our mutual friends and he called me back, and told me that Jake had been diagnosed with something horrible and that the situation was bad, really bad. And it was at that moment that time sort of stood still for me for a brief while. 

Afterwards, I hung up and I cried and cried and all the while answering pages from the nurses that would not stop. At one point, I felt like I was going to throw up in the trash can in my call room, but I knew I had patients to take care of and I had to get myself together. People were depending on me. But all I wanted to do was run around shouting, but Jake, our beloved Jake has cancer and it's effing not fair. 

I was burned out and this was the thing that really I think tipped me over the edge. I felt like here I was giving my best years of my life in my 20s, sleeping at the hospital every fourth night sometimes, exhausted, taking care of patients at the time who I often felt, in my mind, were trying their very hardest to do everything possible not to live. Yet here was our shining star of our community who got something terrible and was going to die and not be here to take care of patients and do all the good, amazing things he had the potential to do. How was this fair? How could this happen? Why him? 

It was in this moment that I really realized how unfair things are, how real it is that bad things happen to good people and that none of us are immune. I mean, as a doctor, of course, I knew that people died. But this was the first moment that one of my people, one of our best people, was going to die. And it was so real and so raw and so terrible that I almost couldn't bear the weight of it all. And it was in that moment in my call room that night that my very real struggle with making sense out of suffering began.

And it was over the course of the year that our institution watched our friend die. But we also saw him live. And it was painful. He continued to work. He got married to his lovely wife, Laura. He sat through grand rounds. He loved his work and the people here. I remember when he was my chief resident, he was my attending at the VA. He would leave after rounds and go get transfused. I would hear updates from time to time about Jake having a clinic appointment or ER visit, when some new catastrophe related to his disease came up. And the piece by piece unfolding of it was horrific. 

And what was even more shocking to us at some level was that we couldn't save one of our own. Here we were at one of the largest academic hospitals in the world with all the technology and treatments at our disposal. The chair of medicine at the time was an oncologist for God's sake, and we had a worldwide expert in his rare disease at our institution at the time. Yet Jake got sicker. We couldn't cure him and he died on our watch. 

And this brings me to the second moment of when I knew. I was in Italy with my husband and his family for vacation in my third year of residency right before I was to start my own chief resident year here. Jake had been fighting his terrible disease for months. 

So our family was outside at the place we were staying all in chaise lounges around like an old pool. And I was staring at the water and I saw three little birds come down one by one in a beautiful arcing swoop. And one by one, each one of their wings just brushed the water as they did so. And it was so beautiful and magical that I sat up to see if anyone else had seen it. And everyone else was asleep on their chair. It was just me. And I knew in that moment that Jake was gone.

About an hour later, I got a text from a co-resident back in the States that I should call her. And I found a payphone in town and called her and she told me Jake had died. But she confirmed what I already knew to be true, that he was gone. And it was in that moment that I truly realized the limits of medicine and started my subsequent exploration of religion. 

So we lost our friend and the world lost a great son, a husband, brother, and doctor. Those of us, his colleagues, here who survived lost additional things. Collectively, many of us lost the deeply held belief that medicine could be our savior. And what had happened in part is that many of us, including myself, had made medicine into what theologians call an idol. We had placed, I had placed, unrealistic hope onto something that medicine didn't deserve, couldn't hold, and couldn't live up to. And when our idols come crashing down, pain ensues. But the right order of things shines out of that darkness. 

I've since grown to understand the limits of medicine that are important for me to realize as I grow into the physician I need to be. And it was after those moments with Jake that I started my subsequent what I call wrestling with God. Medicine had been my God for so long. It was something I worshipped, shaped my life around, and I looked to it for all the answers. 

So with that deep error now revealed to me, something else had to fill its place. I had not been raised in a religious home, and if anything was raised with an anti-religious bias that was only cultivated more strongly during my time in the academy. The God of the Scriptures wasn't even really on my radar, and religion was only something other people were concerned about. But after those moments with Jake, I started wrestling with God.

At first, wrestling with the false god of medicine, but then after that, the true God. I believe we're closer to God wrestling with Him than we are when we ignore Him completely or otherwise, unengaged. And the wrestling I've had is mostly around the concept of suffering and the theodicy. If God is all good and all powerful, then how in the world do I make sense of all the suffering I see in medicine? And how do I trust a god or love a god who would do that to Jake? 

And for those listeners not familiar with the story, in Genesis 32, we are told a story of Jacob wrestling with a divine being. And after the wrestling, the angel asks Jacob his name, and he replies, Jacob. But the being responds and says, your name will no longer be Jacob, but Israel. End quote. And Jacob, now Israel, leaves that encounter with a new name and also a limp.

I have also left this years’ long wrestling with a new name and a limp of my own. And I wish I could have come to know these painful truths in a different way, in an easier way. But I still talk about Jake and what he taught me about medicine and the limits of the vocation to which I have chosen to dedicate my life. Thank you for letting me tell this story.

Interview

Nate Houchens (13:14)

I'm here with Kristin Collier. I just wanted to say thank you, Kristin, for sharing that really powerful story about your friend and colleague Jake. I'm so grateful that we have this time together to hear that story and bear witness to what you experienced.

Kristin Collier (13:30)

Thanks for having me on the podcast and allowing me to share his story. It was such a transformative time, our time together, not just myself and Jake, but the way that Jake affected our entire training program and those he worked with. So I appreciate the opportunity decades later to talk about him still.

Nate Houchens (13:50)

I can tell how impactful it was just by the words that you used and how you shared the story. I wonder if you wouldn't mind sharing a little about Jake as a person, what made him stand out as a colleague, as a human being.

Kristin Collier (14:04)

Yeah, I mean, even before I think I knew the term like whole person care, I saw it in Jake. You know, even though I didn't really like know what that was called. I was like, he, he's the type of doctor that I want to be. 

I remember so distinctly that ⁓ I think I was a probably a mid-year intern and he was my second year resident. We were in the CCMU and there ⁓ were two codes going on at the same time. ⁓ And one was an older man and one was a younger woman. And we were sort of going back and forth between the rooms and we had some assistance. The way he not only attended to the needs of these two people, but the needs of the people who were addressing this situation, who were all very distressed about these two patients who were on the brink of dying. I've never seen someone so attuned to not just, of course, the biomedical needs of the patients, but the emotional, spiritual, social needs, you know, sort of in the moment somehow that he was able to sort of like try to like provide hope to people and guidance and recognize who maybe needed some help from a nurse. And he just embodied what it meant to take care of people as whole persons. 

And afterwards, we lost one of the patients, one of the patients made it. And of course, as a good doctor, I think you're always thinking like, what could I have done differently? Is there something we could have done? 

And not that I voiced that, but he found me like the next day, you know, and I think he recognized something on my face and he took me aside. And he just had, he always had words of wisdom and he said something like, you know, we did our best in there. And it was that person's time and we're going to do things right in medicine and people are going to do great. And we're going to also do things right in medicine and we're going to lose people, you know, we're not in control here. We need to take care of ourselves because you need to be here for these patients not only today, but tomorrow and next year and 10 years from now. 

And I didn't say anything. I don't know how he knew that I needed to hear that from him. When I think of Abraham Heschel, who's a Jewish theologian, I love his quote where he says, we're not in medicine to take care of ⁓ sick bodies in some kind of impersonal practice. But medicine should be a personal practice on ill persons.

And I really feel like that's how he saw people, really as persons, not like just as sick bodies. But not only in the patients, he saw us as persons too, in medicine, and really cared about people deeply and showed that, not just with his actions, but with his words and the way that I would say that he ministered to people in all the ways that we're called to do. He was a really special person.

Nate Houchens (16:39)

He sounds like a really consummate caregiver to everyone around him.

Kristin Collier (16:44)

He was. He was, absolutely. And I think that's why I made it so hard. Right. I think I mentioned that in my story about, which I now know is a wrong way of thinking about things. But I think in my mind, I had started, you know, I think we put ourselves in the place of God sometimes. Right. And we decide like in our hubris of who we think deserves to live and who we think maybe doesn't. I just couldn't believe it. I was taking care of patients – again, in my hubris and in my wrong way of thinking – I just was like, I can't believe some of these patients are trying their hardest, right, not to be here, not taking care of themselves and, you know, abusing their bodies and. Again, not realizing at the time, my goodness, like there are so many systems that have set people up to like not be able to have the choices available to them to live the healthiest life. I was just angry, right? And I was like, here's like our shining star person. Like this is not fair, right? And the anger that I had, because I knew he was such a great person in my mind, right? This world, the world was divided into great persons and not great persons. In my hubris, I was like deciding like who these people were, and how I couldn't believe that this this person was not going to be here and all these other people, in my hubris that I determined like maybe should have been in Jake's place, were still going to be here, you know. And it was all that all that way of thinking is disordered and part of my anger and burnout that I had, but he was such a shining star that I couldn't believe he was the person that we were losing.

Nate Houchens (18:02)

Right. It's in these intensive moments in these really high-pressure situations like residency that just set us up so intensely for that hubris, sort of good and not good. It really is challenging since we don't know everyone's stories. 

In those high-pressure environments like residency where burnout is so prevalent, what was it like to witness someone you respected so deeply battle such a devastating illness while continuing to work and be that caring person for others?

Kristin Collier (18:42)

I trained in the time where we didn't even have half the attention we have now on concepts that ⁓ gives us a language to talk about these things, concepts around resilience. ⁓ I'm not even sure we had even the research we have now on burnout and what it means to debrief and concepts of moral distress. Those concepts resonate with me deeply now because I'm like, that gives a name to what I had back then that I didn't know what it was.

And there's no time. There's even no time now, even within, I think, the various structures that we have, oftentimes, for the plus one thing that happens to you. The work is so unending and so grueling and requires so much of you to pour into that your well is often so empty and you're barely making it. There's no room for the plus one of a chronic illness in yourself, a chronic illness in a family member, a pet that is ill. Some event, it’s so hard.

I get why physicians ⁓ are unhealthy, why we drink too much, why physicians have bad mental health outcomes, why suicide, the tragedy of suicide is so high, why physicians have oftentimes failed marriages, failed relationships. 

And I think about all the times where I think medicine, the vocation is formative, gives shape to people. And it forms you in a way that to be able to survive and do it cultivates qualities in you that yes, while they're very helpful in quotes to like adapt to the vocation of medicine, those qualities are often maladaptive in other situations, like in marriages or relationships and in real life, you know, where you become callous and you just sort of compartmentalize to the best of them. 

And so we did not handle it well. ⁓ And I think part of it was the time. Part of it was the lack of time to be able to debrief. But I think also for myself, I had no roadmap or language to be able to process really what was going on with me, which is really existential distress. I understood Jake's disease. I understood this is what happens when people get this disease and the biomedicine I wasn't struggling with, right? Like I know all about what he had. What I was struggling with was grief, like the reality of God in the face of evil, the concept of suffering. I had no way to process that in a way that was healthy, and so therefore turned to unhealthy habits. And part of that, think, just there's a multifactorial problem. But I don't think those of us that survived during that time (barely) handled it well.

But many of us then were, I think, forced into recognizing that this can't go on. And for ourselves, went through a period of discernment about what it means to sort of grow as a person in a space that was sort of the catalyst of this moment.

Nate Houchens (21:39)

Yeah, that really resonates so much with me. It's I remember very vividly just bottling up these really existential questions and challenges that I faced in residency over and over again and just didn't let them out because I didn't want to burden others with them. And so I can absolutely see how these evolve into maladaptive behaviors for those who are caring for people. 

And what a what a phenomenal full-circle moment of empathy for those who we take care of. When we suspect that they are not treating themselves in the best ways, we can see ourselves in them, I suspect. But perhaps only after the fact.

Nate Houchens (22:40)

I’m curious, looking back on your journey as a resident, now as a physician, as a leader in this space, what would you say are the most important lessons you've learned about the relationship between our vocation and suffering and the limits of human power in the face of life and death?

Kristin Collier (22:58)

Yeah, I mean, this is something that I've thought a lot about. And I think back before I had this period of discernment, I used to think of medicine as a vocation of mastery. I just need to be able to master this vocation. Collectively, as a vocation, I thought, you know, if we just had enough time, enough resources, enough money, enough research, that we are going to be able to solve the problem of death. 

And a couple things now that I've realized. One is that I now see medicine not as a vocation of mastery – again, what kind of hubris led me to think that ever – but really now as a vocation, really of submission. And I'm just part of this process. And I'm not the healer. I don't heal people, right? I would say that in my faith, worldview now as a baptized Christian, you know, life and death belongs to the Lord. And I am grateful to be part of a vocation where we're given the tools by God to be able to be in a place where we can be the hands and feet of the Lord and help people through a time of greatest need. But this is a process of submission, a submission to God's will and understanding Him as creator and not mastery.

I'm so thankful actually that I'm not in control, right? I think that would be like the worst thing in the world. Like realizing, I think it was actually Michael Lukela also who one time I heard this and Jake had already said this to me a few years before. We think that like when patients get better, like it's because we did all the right things. And sometimes like that's the case, right? But it's like sometimes like we do all the right things and people don't get better. Or like we actually like they get better like despite us.

So understanding the mystery that's inherent within medicine and understanding who the real healer is, I think was really important for me to realize. 

I think also through this time, understanding what it means to have a professional identity as a physician. And I thought that if I just trained hard enough and saw enough that like, because I was so disturbed about what happened to me and the way that I felt so shaken by Jake's death. And I'm like, I don't want to go through this again. And so instead of learning how to deal with it at first in a healthy way, my hope was that I would just become immunized to death. If I saw enough, it would just stop bothering me. And so I definitely built this callus up. But then realized that then there was this distance between myself and my patient, which wasn't helping at all with my burnout and actually was like the opposite of like what I wanted to do within the vocation of medicine. 

So there was a moment where I ripped off that callus. When you rip off a callus, it like really hurts, you know? And actually, I think now I'm actually more sensitive than I used to be. And I think that's okay. Like I'm older, my parents are older, like I have children. And I think now like if there's a time in this work that I do, if I ever feel like I'm not bothered actually by the death of a brother or sister, you know, ⁓ of member of the human race, like, I need to leave or I need to take a break. Like that should always bother me. ⁓ So I think about professional identity. I think again, back in the day that I trained, there was like this very sterile professional identity and like, you know, there's this we're taught, right, this detached concern that's talked about in the literature. 

⁓But my role model now is actually Jesus Christ is the right physician. And I think of the passage in John where it says Jesus wept. And if Jesus can weep over the loss of his friend, I can too. I'm not going to be ashamed about it. Obviously, I need to be able to manage my own emotions in the moment so that the patient is taken care of. But I'm not going to become a robotic machine with a callus five inches thick. That is absolutely dehumanizing, not only to me as a living provider, and not a robot, but also the patients deserve better. And so I think that's the other thing that I really wrestled with this professional identity formation and what does it mean to be a doctor? 

And I think lastly, you I think there's this other concept that, you know, I think I've, my biggest theological wrestle has been with the concept of suffering. And, you know, there, this, this isn't the way things are supposed to be. And I always sort of felt that. But now I know that this isn't the way things are supposed to be. And with my, obviously the faith that I'm so blessed to have now, I don't fully understand the suffering that I see still. I don't understand why babies are born dead and fathers of 10 are struck down by hemorrhagic strokes. All your perfect theology falls flat on its face in the presence of these tragedies. 

But what I do have now is a hope ⁓ that St. Paul talks about in the letter to Thessalonica where he says, we don't grieve like people who have no hope. Like I have hope in the resurrection of bodies and someone that sees broken bodies all the time, I'm so thankful for the reality that our bodies will be resurrected and healed fully. And that eventually as C.S. Lewis says, every sad thing will someday become untrue. Like that's the kind of hope that I have that is sustaining hope for me that I didn't have before.

Nate Houchens (28:12)

It sounds like that hope and the removal of the callous that you describe sort of paved the way for, I'm guessing, meaningful connections with those who you treated and those who you were around in life later on. That seems like ⁓ a natural next step for many and that residents, especially when they see so much suffering and grief and death, really grapple with. 

And that leads me to my next question actually. I'm curious, you mentioned anger, you mentioned grief. How did you and your colleagues, your resident colleagues, cope with such a significant blow to the community, such a significant loss? And did you find any unexpected sources of comfort during that time?

Kristin Collier (29:02)

Yeah, I think, you know, it was really a really hard time. And I think, you know, so many physicians are not comfortable, right? I think sometimes sharing vulnerabilities or weaknesses with each other. But there were groups of us who, with our shared love of Jake, came together and supported each other. And again, like all of these tragedies, like we're not meant to handle these things by ourselves. And I just remember, you know, that the community, the sense of solidarity we felt around our love for Jake and that that was stronger than any evil or any forces, right, that we maybe didn't understand fully and we never understand fully, but like that palpable, embodied love amongst his family and colleagues and our friends was really life-saving, you know, for those of us at the time.

Nate Houchens (30:05)

You mentioned in your story two sort of discrete moments. The moment when you learned of the diagnosis for Jake and then the moment you had learned he had passed. It sounds like those were really profound moments for you. We talk in the Sacred Moments Initiative about sacred moments or boundless moments as the name of the podcast implies. And I'm curious, when you hear the term sacred moment, how do you define this type of moment?

Kristin Collier (30:35)

It's so cool to be on the podcast because it was pre-pandemic actually that my Program on Health, Spirituality, and Religion hosted Dr. Pargament in to talk about sacred moments, which, and actually Sanjay (Saint) was in the audience and then got him interested in sacred moments and he visited Dr. Pargament and now like all of this has happened out of that connection, right? Just highlighting connections with him. And so I'm very familiar with like how the literature defines it. And I think it's a wonderful concept. 

So for listeners, right? A sacred moment is defined in the literature as sort of this brief period of time in which people experience some kind of deep interconnectedness that oftentimes possesses some kind of spiritual or transcendent quality. A transcendent moment where it feels really out of the ordinary, almost, I would say, holy or profound in a way that normally doesn't happen in most mundane moments. I think of, I can't think of the name of the philosopher right now, but he was a writer and he talked about this sacred, profane dichotomy. Or sometimes people call it sacred mundane. And I think that's exactly right. Like there are these most of time is ordinary time or mundane time, but then there are these sacred moments, which again are transcendent. They feel almost too holy to name. ⁓ So yeah, that's how I would define a sacred moment.

Nate Houchens (31:53)

One of the things that we struggle with in this work is really defining what a sacred moment is and finding the words that characterize such a profound instance of a person's life. 

I know that I have had these sacred moments with others, and I know that others have as well in our talks with individuals who have experienced them. I wonder if you might share any rituals or practices within healthcare that you do that contribute to creating a sacred space that might foster these moments to happen more frequently.

Kristin Collier (32:31)

There's a writer, he's a physician, he's an MD-PhD, Dr. Jeff Bishop, that some of your listeners might be aware of. He's an internist, but also has a PhD and runs the ethics group over at SLU. He wrote a fascinating book that I read when I was first on this journey called The Anticipatory Corpse. And he says that medicine has divorced itself from all metaphysical or transcendent goods, and that all that we have left is this raw, bioreductionist materialism. And so his thesis in the book, which is a radical one, is that because medicine has divorced itself from all transcendent goods, that actually the dead body is the normative body in medicine. That's why he calls it the anticipatory corpse. Like all medicine is mapped onto this dead body. And so because there's no eschaton, like there's nothing beyond death, like death is the end, you know? And so he says that's why actually the first patient that the medical students get is a corpse in their gross anatomy course, because like that's their first patient because the dead body is normative. It's sort of a radical thesis. 

⁓ I think when we sort of think that God isn't real or that transcendent things are not really here, our lens isn't sharpened to see them. We're not going to be attuned to them or make space for them or consider them in the moral structure of reality of the hospital. And I sometimes see this being played out, for example, when I have talked to patients and families who, for example, have said with their providers, “I think there could be a miracle.” And sometimes they'll say that the providers roll their eyes at them. You know, again, that's again, making no space for metaphysical or sort of transcendent realities to be there. Because we just think it's like, just nonsense. 

So I think the first thing is with, you know, creating safe and space, like, do you believe that this is possible? Do you believe in something outside of the raw materialism of science? And then if you do, like how can you sort of tune your lens to be able to see these or make room for sacred space? 

So maybe I would say a couple of things is that, you know, when I came to the realization of, I would say the moral structure of reality, the idea that my patients that I take care of first and foremost, ⁓ bear the image of God, like they are the Imago Dei, they bear God's image and they are loved by God. That automatically translates into my encounters with patients into sacred space. I made it sacred space because I'm taking care of one of God's image bearers, loved by Him and made by Him. 

And so, how do you keep that? How do I keep that reality in the forefront of my mind? Well, there has to be some ritual around that. I agree. And so I think for me, intention setting has been something that's been really important for me. So before I begin my clinic half day, before I step into one of my clinic rooms with a patient, or maybe sometimes people can do it before they start a shift, like stopping just for a brief moment or two and thinking about the intention that I wish to have when I'm in that room with a patient. And for me, this requires giving my patient all my attention, focusing on their needs, and remembering that they are someone's most favorite person. They're not a diabetic. They are a person with diabetes, made in God's image, loved by Him, but someone's mother or father or sister, best friend. And if I at least take a moment to sort of pause and try to remember that and set myself well up to be unencumbered otherwise in that time, which includes my ritual of pre-visit planning and looking at my patients ahead of time and all that, then I think my lens will be more attuned to see the reality of who they are.

And again, when we think about making meaning in the clinical spaces that we're in to help prevent burnout, I think having us be attuned to people as persons made in God's image, if that's part of people's worldview and not just biomedical machines, that's the way in which I think we're going to try to cultivate meaning in this vocation going forward, because none of us went into medicine just to take care of a disease or a symptom, but a human being or a person made in God's image.

Nate Houchens (36:32)

It sounds as if these rituals allow you to be fully open and present with the other person in order to connect.

Kristin Collier (36:42)

I think here, I think often about Mother Teresa who talked about this distressing disguises. That so many of our patients, so many people that we encounter day to day have some kind of disguise, she would say, right? And oftentimes that disguise is distressing to us. We recoil sometimes literally at the sight of people because either they remind us of something in ourselves that we don't want to face, or they remind us of the reality of how really truly frail and vulnerable we are. We don't like to be reminded of our mortality and our frailness. And so there's something about some people whose dignity either we find deeply inconvenient to us or that remind us of something we really, really don't want to think about. So we avoid them. We dehumanize them or we marginalize them. You can't see through that distressing disguise until you tune yourself to the reality of who's under that. And for me, I had to reorient myself around the reality of like who I'm taking care of and to be able to see through that distressing disguise and remember like actually who I've been charged to take care of.

Because otherwise, I think we're going to have a medical system, again, without recognizing the inherent worth and viable dignity of all human beings, because they're made in God's image… I think we're going to have a system where we have tiers of patients who we give certain care to and certain privileges to and certain accommodation to and not to others. And I think medicine should be a place where we take care of all persons because all persons matter ⁓ inherently because of who they are and whose they are.

Nate Houchens (38:05)

You mentioned your own rituals and you mentioned how they impact your interactions with your patients and those that you're charged to care for. Recognizing that these are incredibly personal decisions and behaviors, what advice might you have for healthcare professionals of any kind aiming to create these sacred moments between themselves and the people they care for?

Kristin Collier (38:31)

Yeah, I think probably my biggest piece of advice, one that I had to take a heavy dose of my own medicine, was that you got to get yourself out of the silo of biomedicine to be able to understand, I think, the limits of science and understand really the fullness of the moral structure of reality, of who you're taking care of and the meaning in this work, and to be able to explore the deep, deep questions that science cannot answer. Like, how do you make sense of the suffering? How are you going to not, maybe make sense of it, again there's hubris in that sentence, but how are you going to despite the suffering that is always going to be here, will always be here until Jesus himself returns, how are you going to not be destroyed by it, you know, in some way? And that I call that productive wondering, that productive wondering shouldn't happen alone. It should happen with others and community and can't happen within the echo chamber of and sort of the narrow silo of biomedicine. 

And I think there's this quote by William Osler, who said something like, man cannot be fed on the dry husks of facts. Right? So he said something like, fed on the dry husks of facts, the human heart has a hidden want, which science alone cannot supply. And that's William Osler, right? Who we look to, right? He's the father of medicine, some of us do. So thinking about getting yourself out of the dry, you can't survive on a diet of dry husks of biomedical science. It's just, going to be an impoverished diet. You'll develop scurvy or whatever, right? You have to get out and you have to think about connecting yourself with people who live in other spaces, theologians, philosophers, anthropologists, sociologists, and be like, I have some big things to think about because this is part of the work I do every day. For me to show up and be real and be a human being not mechanized within the biomedical machine. I gotta get out and talk to people and productively wonder outside of the biomedical sort of silo of science. That's my biggest piece of advice.

Nate Houchens (40:29)

I'm so grateful for that advice and for your time today, your willingness to share this incredible story about your friend and colleague. Thank you, Kristin Collier, for joining us.

Kristin Collier (40:40)

Thanks Nate for having me on.

Postlude

Nate Houchens (40:52)

We would love for you to be a part of this movement, and we would be honored to hear your story. If you have experienced a moment of grace, connection, or empathy that changed you, we invite you to submit it for consideration to be shared on Boundless Moments by sharing, you not only contribute to a collective celebration of human connection, you may also inspire others to recognize and cherish the sacred moments in their own lives. To discover more about sacred moments and to share your own story, please visit sacredmomentsinitiative.org.

This episode of boundless moments was produced, edited, and mixed by Nathan Houchens. Our program manager is Jessica Ameling, and our publishing and social media manager is Rachel Ehrlinger. Our podcast is made possible by the Sacred Moments Initiative, a humanistic project whose aim is to study, catalog, and share sacred moments. Learn more at sacredmomentsinitiative.org. Boundless Moments is also made possible by donations from listeners like you. Thank you so much for supporting our work in sharing sacred moment stories. If you enjoyed this episode, please subscribe to the show wherever you get your podcasts and drop us a rating or review to help others connect with us. I'm your host, Nathan Houchens. Thank you for joining and until next time, be well.