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Good Letters

The following is excerpted from Attending Others: A Doctor’s Education in Bodies and Words, a new memoir by Brian Volck.

I don’t recall when I first learned of lectio divina, a reading practice rooted in Christian monasticism still followed by contemporary Benedictine monks, nuns, and laypersons. Lectio divina is traditionally divided into four parts: lectio (reading), meditatio (meditation), oratio (prayer), and contemplatio (contemplation).

Simply put, it asks the reader to attend, to notice the details of the text and name the responses they engender.

In lectio, a passage is read slowly, paused over, and read again—aloud, if possible, engaging the body through eye, mouth, and ear—while asking, “What words, phrases, or images stand out?” In meditatio, the passage is considered in relation to the reader’s life, without theoretical abstraction or aggressive interpretation. This is a conversation to be entered, not a puzzle in need of a solution.

Oratio is where true conversation begins, an opening of the heart in prayer. Contemplatio is the attentive silence that follows, when the fleshy confluence of mind and heart stands before Divine mystery: receptive, aware, listening.

It sounds deceptively cerebral, but listening and reading are embodied actions: words received through physical senses, bending the ear of the heart. A friend of mine leads workshops in lectio divina. A day or so into the course, he asks learners if they’ve noticed any changes in their social dynamics. The most common responses include, “We’re listening better and talking less,” or “We’re more present to one another than when we started.”

Practices become habits. What my own attempts at lectio divina offer is a habit of presence and focused attention. Both “presence,” from the Latin root “to be before or at hand,” and attention, “to stretch toward,” engage the body.

Lectio divina doesn’t end in listening or reading. Laborare et orare is the Benedictine motto: “work and prayer.” Word becomes flesh in the daily performance of scripture. For much of human history, houses of prayer and houses of healing were closely connected. In receiving all guests as Christ, Benedictines relied on embodied habits of attention to welcome the stranger, care for the sick, and comfort the dying.

Today, however, no one I know checks into the hospital for quiet contemplation. If I arrive in the Emergency Department complaining of crushing chest pain that started in my left shoulder, I want the medical team to treat my heart attack right away, not stand idly by pondering what phrases in my chief complaint resonate with their life. Certain occasions in medicine demand rapid and efficient response. That’s why doctors and nurses frequently practice advanced life support techniques. We must respond quickly if delay means death.

Yet most medical practice requires a more deliberate pace. Doctors listen to the patient and read the chart to reach a diagnosis and propose a treatment plan. Medical training emphasizes utilitarian aspects of the patient’s story: the history upon which doctors impose useable significance. Physicians make things happen in the physical world in service to the bodies of patients.

A doctor in training, anxious to prove herself, can’t help but view the patient’s story as basic raw material in need of a prepared mind to solve the diagnostic puzzle. She will come, with experience and time, to understand that humans are rarely simple and few tell their stories straightforwardly.

It’s 8:15 a.m. and the team crowds into a darkened patient room on the general pediatrics inpatient unit. There are nine of us: a senior resident, three interns, three medical students, the patient’s nurse, and me, the attending physician. We’ve wheeled three laptop computers on mobile stands into the room as well.

Tori, the fifteen-month-old we’ve come to see, awakens as we enter and starts to cry, pulling at the oxygen cannula at her nose and reaching through the bars of her crib for her parents. Tori’s mother rises from the bedside couch to comfort her while Dad rubs his sleepy eyes.

The presenting intern starts to tell Tori’s story. She’s doing a good job, speaking to the parents without lapsing into Medspeak, but it’s not clear if they’re awake enough to understand. Tori arrived after midnight and her parents’ first chance to sleep was four a.m. The senior resident eyes Tori’s breathing as he listens for the intern’s assessment and plan, which he will comment on.

Another intern types orders into a computer while a third updates the patient’s hospital summary for discharge. Pagers go off. Monitor alarms sound. The nurse is called away to care for another patient.

I stay in the corner by the door, letting the team show me what they can do. I know if I stand up front, the parents and intern will defer to me, not allowing the senior resident to make his own decisions before I chime in. In my corner, I focus on the ongoing conversation, and try not to think about the fifteen other inpatients we still must see before noon.

Beneath these tasks and distractions lurk the dynamics of Tori’s illness. Her mother’s worried. This is her third hospitalization in two months, each for a respiratory infection severe enough to require supplemental oxygen. Mom wants to know why Tori keeps getting sick. She fears we’re missing something when the intern explains it’s another viral infection. She wants Tori to get and stay better, and grasps for explanations to restore a sense of control.

The family’s understandable anxiety widens the existing power gap them and us—the medical professionals who speak in mystifying jargon, wield near-magical technology, and spend long hours far from the patient’s room. Emotions gather like storm clouds, garbling communication and turning trivial misunderstandings into full-scale battles.

It’s precisely then that presence is needed: a practice to banish distraction, dial down emotion, return attention to the exchange happening right now, and note my responses—mental and physical. That’s when I live into the role of attending physician.

I stop slouching in the corner and step forward. My body grows fully engaged, my senses focus on the words, gestures, and posture of those speaking. I choose my words carefully, strain to listen, and clarify ambiguities before offering my opinion.

I try to model this for learners. I remind them later that listening to the patient includes noting silences between words and asking awkward questions. Difficult encounters become opportunities for understanding if one knows how to respond. Without practices of attentive presence, the patient’s real concerns will be overlooked, important information remain hidden, diagnoses missed, and complex therapies wasted.

Listening is often our first and best therapy.


To be continued tomorrow.

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Written by: Brian Volck

Brian Volck is a pediatrician who received his MFA in creative writing from Seattle Pacific University. His first collection of poetry, Flesh Becomes Word (Dos Madres), was released in 2013. He is coauthor of Reclaiming the Body: Christians and the Faithful Use of Modern Medicine (Brazos). His essays, poetry, and reviews have appeared in America, The Christian Century, DoubleTake, and Health Affairs. His newly released Attending Others is a highly personal account of what the author learned about medicine after he completed his formal education. Attending Others: A Doctor’s Education in Bodies and Words, published by Cascade Books is also available at Amazon.

Image above by Victor Dia, used with permission under a Creative Commons license.

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