Podcast: Trauma, Pain, and Loss: A Doctor’s Story of Faith and Healing (Katie Butler)

This article is part of the The Crossway Podcast series.

Finding Hope in the Halls of the Hospital

In this episode, Kathryn Butler discusses her work as a trauma surgeon working in the ICU. She shares what it was like to be inundated with life and death situations day in and day out, how she coped with the stress of the job and eventually began to see God's grace at work even in the midst of deep pain and tragedy, and what she saw working in a hospital at the height of the COVID-19 pandemic.

Glimmers of Grace

Kathryn Butler, MD

In Glimmers of Grace, Christian physician Kathryn Butler draws from her experience as a trauma surgeon and a Bible teacher to reflect upon how God’s word remains living, active, and trustworthy in the midst of illness.

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Topics Addressed in This Interview:

01:49 - A Trauma Surgeon’s Experience with COVID-19

Matt Tully
Katie, thank you so much for joining me again on The Crossway Podcast.

Kathryn Butler
It’s great to be here. Thank you so much for having me.

Matt Tully
I recently heard that early in the pandemic last year you felt the need to get involved and help out in some way, drawing on your medical background. Can you tell us a little bit about that? What happened?

Kathryn Butler
My background initially is as a trauma and critical care surgeon, and I stepped away from practice several years ago to homeschool my kids, which is a decision that was a personal one, and that’s for another podcast talking about calling and identity! The bottom line is that I felt convicted by Deuteronomy 6, my family was really struggling, and I had to make a decision.

Matt Tully
And part of that was due to just how much you were working?

Kathryn Butler
I was working 70 hours a week, and my husband was trying to juggle his job and the kids. My son has special needs that we did not recognize at the time, and he was really, really struggling. The best thing for him was actually home education; he wasn’t a real good fit for the school system and was having meltdowns on a daily basis. As much as I loved my work to the bottom of my heart—it felt like my calling—it was very clear that I was not able to do both. I was not able to fulfill my role of infusing them with God’s Word on a daily basis and still do my job, and so I had to step away. That’s been my life for the past few years: ministering to them at home, ministering to our neighbors locally, and then ministering through writing. When the pandemic hit in the spring of 2020, Boston was struck by a surge that was pretty significant. We had a super-spreader event at the Boston Convention Center—

Matt Tully
What does that mean? Give us a sense for what you mean by that term.

Kathryn Butler
A super-spreader event?

Matt Tully
Yes.

Kathryn Butler
It spread very rapidly, and this was at a time when we did not know enough about COVID in terms of mask-wearing and precautions, and so it just spread throughout the city like wildfire. The hospitals were really inundated. To give you an example, the hospital with which I’m normally affiliated, normally has 100 ICU beds—which is quite a large capacity.

Matt Tully
What hospital is that?

Kathryn Butler
Mass General.

Matt Tully
At the time of the peak in cases, they had 200 ICU beds filled with COVID patients alone, not counting the usual patients who come in with heart attacks and sepsis and everything else that we would normally treat. Two hundred just with COVID, and then an additional 300 on the inpatient floors, just with COVID. So, that placed a huge burden. I should say, to give a sense for the degree of the impact, Boston is a city that is small but has a number of academic medical centers right in the same vicinity that can usually handle pretty high acuity cases. But the fact that you had that degree of overwhelm in the area tells you how high the cases spiked and how quickly. To try to accommodate this increased volume of cases and very sick patients who needed ventilators, we had to open up recovery rooms and convert them into ICUs. We had to pull ventilators in from operating rooms and use anesthesia machines instead of ICU ventilators. We were really strapped, and so in the setting of this came the need for more staff. Knowing that my role has been with my family over the past years but also knowing that God gave me this unique skill set that I am to steward for the common good and for his glory, I couldn’t sit at home knowing this was going on and knowing that my partners were drowning. It never got to the point where it did, for example, in Europe. I remember in Lombardy, Italy—this is one of the things that really hit me—they were so inundated that they were asking pathologists and other physicians who don’t usually provide any clinical care to run ventilators and giving them a quick primer and then saying, Go do it.

Matt Tully
So these are people who would usually be behind the desk?

Kathryn Butler
Exactly. They were just so overwhelmed. It never got to that point here, thankfully, but there was this sudden huge need for ICU care. Knowing that that’s what my specialty is, I went back just for a few months to help out on the night shifts in the ICUs taking care of COVID patients.

Matt Tully
Does night shift mean all night long?

Kathryn Butler
Yes. Overnight.

Matt Tully
Did somebody from the hospital call you and ask if you would be willing to do that, or did you end up having to reach out and say, I want to volunteer.

Kathryn Butler
I keep in touch with my prior colleagues, and so I was asking them how they were doing and they said, It’s really bad. One thing led to another in a conversation and I said, Okay. I can help.

Matt Tully
How many hours at a time were you working?

Kathryn Butler
It was a 14-hour overnight shift. You get used to it. After enough years doing it, the hours are not a big deal.

Matt Tully
Was there an adjustment period? You mentioned that it had been a few years of not really working in that context; was it difficult to get back into that mode?

Kathryn Butler
It wasn’t. When you spend so many years devoting your mind and your efforts and your energy to one thing, it really becomes ingrained. It was much harder for me to walk away from medicine than it felt to come back, to be honest. It felt a lot like coming home. The harder thing was just to see the degree of suffering that this illness was causing. I think that was really the hard thing. It was coming home each day and feeling sick to my stomach because COVID is different. We’re used to dealing with heart failure, but the patients who get the sickest with COVID just don’t get better. That’s incredibly demoralizing, and was very demoralizing for the people who have been doing this on the ground for the long term in the ICUs that are exclusively COVID ICUs. They come in, they do everything they know to do, and they adjust the ventilators and they restrict fluids, but patients just languish and they’re very, very slow to improve. Additionally, it was heartbreaking because it was very apparent that the people who are suffering the most from this are the under privileged. We saw a very high preponderance of people who are Hispanic and African American when the proportion of those among the population in Massachusetts is flipped. It’s not very high. And they were overwhelmingly the people who were coming in, and it’s because of the disparities in our society. They were essential workers who didn’t have the luxury of working remotely. They were living in situations where you had multiple generations living in one household caring for each other, and so they couldn’t self-isolate. I had one woman who was very sick and I said that we need to get in touch with her healthcare proxy so that we can figure out goals of care and ask how far we are going to go if she has an arrest.

Matt Tully
What’s a healthcare proxy?

Kathryn Butler
A healthcare proxy is someone who makes decisions on your behalf when you’re incapacitated. I wanted to get in touch, basically, with her next of kin to say that she was doing poorly, give an update, and say if she has an arrest—if her heart stops—ask what do we do and have that discussion. The answer was, Her next of kin is in the ICU upstairs intubated. That was the hard part. It wasn’t even so much coming back, it was just seeing how this illness has inflicted so much suffering on people—on the vulnerable especially—and then also placed them in situations where they’re enduring an ordeal that is scary and overwhelming and painful. And they’re enduring it alone. Because of the restrictions, we couldn’t have any family members there.

Matt Tully
It’s not like another disease where people could come and be with them.

Kathryn Butler
Exactly. In the ICU we’re used to dealing with hard, sad situations and having the hard conversations about death and saying goodbye. But it was so eerie because there were so many empty chairs at the bedside, no one to be there while the patient is on a ventilator and struggling, no one there to hold their hand and update them about how their kids are doing and to put photographs on the walls. You always walk into ICU rooms and you’ll see photographs everywhere that family members put up, or hand-drawn sketches by kids in crayon. That’s what you see, and there was none of that. It was just harrowing. It felt different; not because I had been away, but because the disease and the situation was so different, and it felt cruel in a lot of ways.

Matt Tully
I saw a picture of a doctor in an ICU room caring for a COVID patient—this was early on in the pandemic—and it was shocking to me seeing him. He was completely covered in scrubs, or some kind of hazmat-looking suit, his face was completely covered, and you could only see the sliver of his eyes. I remember that it struck me that at a time when you’re suffering and having a hard time, these patients didn’t even have a human face to see.

Kathryn Butler
No. And especially early on we actually would limit the number of times you would go in and examine someone. The nurse was the one who was at the highest risk because she had to be there hour to hour, but the physicians would all come by and look through the glass in the doorway. So, you’re looking at numbers and things, but you can’t even connect it with the person in front of you. And they’re just alone in there. It was gut-wrenching.

Matt Tully
You’re a mom and a wife, so did you have to quarantine away from your family as you were working with COVID patients every night?

Kathryn Butler
It’s kind of humorous now that I look back on it because it sounds ridiculous. I would get changed in the garage. I would come home, take off my dirty scrubs, put them in the washing machine, go up and shower right away, and then I would stay away from them. I would work three nights in a row, so I would sleep and then get up and go back.

Matt Tully
So you weren’t even hugging your kids during this time.

Kathryn Butler
I wasn’t. But I had it easy because I was only doing stretches of nights here and there. The people who have been in this for the long term, I know some who sent their kids out of state for months to live with grandparents because they said they can’t stand the idea of bringing things home. I know others who, as you say, would be stricken because they come home and their kid would run up and want to hug them and they would say, No, no, no! Please don’t come near me! Not until I decontaminate! It just seemed to turn everything upside down.

Matt Tully
What are things in the hospital like now at Massachusetts General?

Kathryn Butler
Much better. We did have a brief surge over the holidays. I’m still credentialed there because they asked me to keep my credentials until people are vaccinated and we think we’re over the hump.

Matt Tully
Until they know they don’t need you again.

Kathryn Butler
Exactly. I have not gone back since last summer, but I reached out and said, Can I pull back on my credentials? And they said, Wait until we know what’s going on with the variants. Thankfully, during the surge over the holidays it didn’t reach anywhere near the levels that we saw. I think it’s because people really are taking the proper precautions. Masks do help. Social distancing really does help. We have figured that out. We had a bit of a spike, but it was nowhere near what we dealt with and they didn’t have to open up any surge ICUs or anything like that. They were able to manage.

Matt Tully
Let’s go back a little bit to before you stopped working full time as a trauma surgeon. What was it that got you interested in trauma surgery in general? That’s one of those areas of work that we’re so grateful that people do that, but I think for most of us, it’s mind-blowing to think of volunteering for that kind of work.

Kathryn Butler
What it boiled down to is that I really loved being able to help people when they were in their most dire situation. For me, it was tied up with ministry and with loving neighbor. To know that when someone came in after having a car accident, being attacked, or even something like appendicitis—something as simple as that—but they’re scared, they’re in pain, and you can be a light of grace in that moment with caring for them and ushering them back to health, but also how you do it. You do it as seeing them as an image-bearer of God, and you’re with them in that moment. That had tremendous appeal to me. I particularly was drawn to ICU care because that provided very rich opportunities to speak kindness and compassion and the truth in love to families, as well as patients themselves because so much of what we deal with in the ICU is really hard and often the patients cannot speak for themselves because they’re usually on ventilators. But the families are often there, as I alluded to before, and you develop relationships with them and try to guide them through what’s happening and see how you can love on the patient and love on the families as well.

16:00 - Finding Glimpses of Grace in the Midst of Trauma

Matt Tully
I want to return to that dynamic of personally investing in the patients and their families and how hard that can be at times, but one of the things you note in your book is that while you were still in surgical training, you write, “a single night’s work in the emergency department shattered my belief in God.” Can you explain what happened there and what you meant by that?

Kathryn Butler
I should give a little bit of background to say that I did not grow up in the church and Christ did not bring me to himself until I was thirty years old. I had an idea of God that was rooted more in sentimentality than in Scriptural truth. I think what happens to many people when they’re confronted with issues in the hospital—and even when they do have a clear idea of faith, to be honest with you—the hospital confronts you with really hard issues of life and death and suffering and the meaning behind it all, and very little context for how to work it out. In my case, I was halfway through my surgical residency in my program where I trained, which is also Mass General, was famous for having a rotation midway through our residencies where we would do 24-hour shifts in the emergency room. Our job was to initially manage and triage everything surgical that came into the ER for that 24-hour period. It was you and a junior resident. So, it was a fantastic learning experience, to be honest. The training was phenomenal because you would deal with traumas, but you would also deal with things like intra-abdominal sepsis and bowel obstructions and people coming in with a cold foot because they had thrown a clot to their foot. It was a huge variety and it was really like being thrown into the fire. It was a very unique experience. I had no real concept of God before, but I just kept thinking over and over, Lord, how could a God be good if this is allowed to happen? How could there be such evil that people could look at someone who’s living and breathing and has dreams and hopes, like we all do, and see no value and be willing to take that life? I had been up for about 36 hours by the next morning and should have gone home, but I was so stricken that I actually drove two hours from home and went out along the Connecticut river and stopped on a bridge there and stood out above the water. It was October in New England, so it was this beautiful day and the mountains were all lit up in reds and oranges. I stood on the bridge and I tried to pray, which I wasn’t in the habit of doing. No words came. If I had known Christ and if I had been immersed in Scripture, I should have known not to look for God out on a bridge two hours away. But when no words came to me and I didn’t understand, I decided he didn’t exist. That’s just my own path of witnessing how trials in the hospital can really bring you to your knees and make you doubt God’s goodness. I know I’m not alone in that struggle.

Matt Tully
I would imagine anyone listening, even strong Christians, would say, I think seeing something like that just once could potentially really shake my faith. How did God bring you through that to a place where you are now?

Kathryn Butler
Because he’s so gracious. I actually struggled with depression, very deeply after that point. One of my favorite books to teach to teenagers is Jonah because they all think it’s about a big fish, and then you dive into and realize there’s so much more. I always think about how he ran from God and was so blind. The moment when he finally turns to pray is when he’s in the belly of the fish in the deep dark, and that’s when finally it stirs him. I realize that’s what the Lord was doing for me too. I was brought very low and I had no place else to look but up to him. He confronted me with his mercy and his grace a year later when I was mired in the state of just existing but not really living. I was doing my ICU fellowship where I was just doing ICU everyday for a year, and I cared for a gentleman—I call him Ron in the book—and he had had an operation. Afterwards, he had an event and went into cardiac arrest; his heart stopped. He received CPR for a prolonged time and they were able to restart his heart, but he suffered pretty significant brain injury from the loss of oxygen during that time. His prognosis was really poor because his physical exam was terrible. We had multiple MRIs that looked awful. It was almost like the brain had been covered with a grey cloak. So much of it had just died. Neurologists thought that the best that he would be able to do would be to maybe open his eyes and track, but not be able to understand or communicate ever, and certainly not be able to go back to the life that he once knew. He was a big Italian guy who had a huge laugh. His family was really struggling with this, as you can imagine any family would. They would stand beside him and they asked questions and they would hope and they would always pepper me with questions of, Have you seen any difference? My heart broke for them. But then one day his wife—they loved cheesy 80s tunes, and their song was Tiffany’s version of “I Think We’re Alone Now.” One day I’m working in the ICU and I hear his wife belting out Tiffany from his room. I go in and she has hung a cross above him that’s about the size of an avocado, and she has another one around her neck. I say, Is everything okay? She said, Dr. Butler, I was praying and praying last night and God told me he’s going to be okay. I thought to myself, in the state that I was in, This is heartbreaking. I don’t think he’s going to be okay. I also don’t think the God to whom you’re praying is real. In my arrogance, that’s what I thought. She said, No. I know it. You’ll see. The next day, they start yelling my name across the ICU, Dr. Butler! Come here! Come here! He moved his toe when we asked him! I still thought, Gosh, I feel so sorry for this poor family. I said, I know it’s easy to get your hopes up. It’s common to have reflex movements. That’s just from the spinal cord. It’s doesn’t mean that his brain is improving. She said, No! That’s not what this was—she got mad at me—Watch! She actually asked me to try first, so I yelled his name into his ear and he didn’t respond. She did, and then he moved his toe.

Matt Tully
And you saw it that time?

Kathryn Butler
I saw it, but I still didn’t put credence in it. Then the next day, he opened his eyes. And then the day after that, he started to blink on command. We would say, Blink your eyes for yes. Then he started to be able to move his hands. A couple of weeks later, he had made a full recovery and was sitting up in a chair and was pointing to his feeding tube and asking for filet mignon. It was a full recovery when it shouldn’t have been. As clinicians, we would say it’s an outlier.

Matt Tully
I was going to ask, what do other doctors who aren’t Christians say about that kind of thing?

Kathryn Butler
Rejoicing and happy, but just thinking, Oh, wow! This must be one of those rare cases. I couldn’t ignore the fact that I had witnessed this and it was in response to prayer. She had prayed and received this answer from the Spirit to say he would be okay, and then there it was. God broke through and used that moment to at least open my eyes to the truth that for how much we know in medicine and how much we lead upon our scientific protocols, that there is something at work that is so much bigger and greater than any of our studies could capture. After that point, I started to dive into study. In my arrogance and ignorance, I figure because I was a nominal Christian growing up, that I knew Christianity. I actually studied the Bhagavad Gita and Buddhism and the Quran and went to all of these—

Matt Tully
You skipped over Christianity.

Kathryn Butler
I did! When I read all these other texts, what I kept coming away with over and over again was that salvation, for all of them, was something we had to accomplish ourselves. I had seen enough in the trauma bay to know that we couldn’t. I had seen people from all walks of life, all different statuses, all different levels of accomplishment come through those double doors on a stretcher, dying, and knew that there was something at work in the world. I didn’t know enough at that point to call it sin, but I knew that there was something at work in the world that corrupted our hearts that we could not fix by ourselves. My husband encouraged me—he had come to faith about a year before—and he encouraged me to read the Gospels, and then Romans, and then that was when it really hit home. God just opened my eyes to who he is and his incredible love for us that he would send his Son to suffer on our behalf so that we might know him. Whatever the reason for suffering, it’s not because he doesn’t love us, because he’s endured it himself. It was really the gospel that just woke me up.

Matt Tully
Are there other examples in the months and years that followed, as you continued to work in the ICU, where you saw glimmers of God’s grace show forth even in the midst of a very dark and difficult context?

Kathryn Butler
Absolutely. I think it’s important to remember, too, to try to glimpse his hand. It’s very difficult sometimes because all you see is the despair and the tragedy. I think to be able to perceive the moments when he’s really at work and showing his kindness to us, we have to remain rooted in his Word. We have to remember who he is and what he’s done, because sometimes in the day to day you can’t understand. I can think of a kid who came in—another teenager who had also been stabbed in the chest—he came in and initially also had no pulse. When I opened his chest in the ER, he had a stab wound to his right ventricle at the front of the heart. The pericardium, the sac around his heart, was tense with blood. When I opened up the pericardium and took the clot out, he got his pulse back, and then I repaired the hole, and we got him to the operating room—

Matt Tully
All that happened before the operating room?

Kathryn Butler
Yes!

Matt Tully
That’s probably not the normal way it’s supposed to work?

Kathryn Butler
It’s chaos! This is what you do only if someone comes in without a pulse. Normally you want it to be controlled. This is a last-ditch effort to save a life. With heart surgery, normally yes, we go into the operating room, we put on drapes, and it’s a very long production. This is reserved to save a life in the most extreme of circumstances, and it often does not work. It really only works for patients who have had penetrating trauma—a knife or a bullet, not a car accident where the damage is often really diffused—and it only works in about 30% of those cases that people actually survive this. So this was one of those cases. I repaired the hole, got him to the operating room, and then took a look around and fixed some more bleeding and everything. It was one of these really tragic scenarios where I called his Aunt, who was the next of kin. She picks up the phone and says, What did he do now? He was a kid who was really a stray. It turns out he had been living on the streets; he was estranged from his mom. He was really lost. I saw him in follow-up and he was wearing clean clothes and was really put together. He told me, I want to do what you guys do. I want to help people the way you guys helped me. He had reconciled with his mom and was back living at home. He was going back to school, and he wanted to be a nurse. I thought about that: it’s a horrible tragedy that this boy got stabbed, but God provided for him. He had been lost and a stray, and God brought him to the ER in the nick of time because his heart rate had stopped in the field, so if he had gone much longer he would not have survived. If the paramedics had gone to a different hospital or been any slower—a minute slower—getting him to us, he would not have survived. The fact that he survived the procedure I did, which 70% of people don’t—all of that was God’s provision. I realized that he used this moment that could have been so tragic and was at work through all of it to help give this kid a chance. You see moments like that where you realize, Lord, thank you. I know that you are present and you remain with us and you are good.

Matt Tully
Even with that perspective, was it hard to deal with the emotional toll that caring for people in those kinds of conditions had on you?

Kathryn Butler
Of course. I think it’s particularly hard for anyone, not just physicians, but even for patients and for loved ones of patients to be dealing with these encounters in the hospital—whether you’re enduring illness yourself or you’re caring for someone—because it’s bringing you face to face with suffering and grief and really hard questions in a setting that is stripped from any dialogue about spirituality. It’s a secular system. Professionally, we don’t talk about God or spirituality.

Matt Tully
Is that something that you weren’t allowed to do? Could you bring that up yourself with a patient who was expressing some kind of fear about what was going to happen to me if I die? What were you allowed to do in that context?

Kathryn Butler
It’s not even so much allowed to do it as much as what you’re culturally trained to do. We’re meant to be very objective and not impose anything upon patients. I think that’s appropriate that we don’t impose, but there are times that I also think we abandon where people are struggling with some very real questions of Where am I going to go when I die? We have resources in the hospital; we had chaplaincy who does a fantastic job. But the studies that have been done looking at spiritual questions that are raised among cancer patients in particular (that’s the study I’m thinking of) and then the response of physicians shows that even though a high proportion of people with terminal illness will raise spiritual questions, the most common response among doctors is silence. They only will refer to chaplaincy in a very small percentage of cases, and usually only in the last two or three days of life among patients who are on a ventilator already and can’t converse. So, I think in our reluctance to impose our values on other people, we also block people off from having discussions and obtaining this kind of support when they’re really struggling.

34:54 - The Emotional Burden Carried by Doctors

Matt Tully
You tell a story about this time when you were at the end of your residency and you had interns working with you, and they made kind of a humorous video sort of joking a little bit about how focused you were and maybe how cold you had become in how you were interacting with other doctors and perhaps even patients. You write, “I’d learned to prioritize efficiency over tenderness, and hard, cold data over the content of people’s hearts.” You’re speaking there as a believer, and I guess I just wonder if there was anything behind that? Is there almost like a defense mechanism for doctors where there’s a reluctance to get too emotionally involved with patients just because you’re seeing so much tragedy all the time? Has that ever been a challenge in your work?

Kathryn Butler
That is a really astute insight. I think there definitely is. Sometimes we don’t know how to handle and process what we’re seeing and what we’re feeling, and so we keep a distance. I think more commonly, and in my own case, it was driven by the pressures of trying to do the work well. The system is set up such that efficiency is really prized and precision is prized. When you have 40 patients to see by 7:30 in the morning, it becomes impossible.

Matt Tully
How is that possible?

Kathryn Butler
You do it, but you do it the way I was depicted in the video. The system is set up to create barriers, in a way, and you have to really step outside of that and make a point of okay, if I’m going to be rushing this morning, I’m going to make a point of going back to that patient and really checking in with them later. You had to make an effort outside of the norm that the day allows. It’s just so busy that oftentimes people just can’t do it. But I think you’re right and you’re really onto something in terms of the struggle with how do I handle anymore grief? I don’t want to get too close because I don’t want to deal with the pain afterwards.

Matt Tully
How do you go home after a bad day and talk with your kids and play with your kids? That’s always struck me as a pretty amazing feat in and of itself.

Kathryn Butler
It really helps to have a supportive family. My husband was always incredibly understanding. He couldn’t talk shop with me, but he listened, and he listened well. I think for those of us who are in a position of partnering with and loving those who are working in healthcare, especially right now in the pandemic with people being so burnt out, I think it’s just very important to be patient and to be loving and to remind people of who they are in Christ and the hope that we have in Christ. Without that, I think the tendency to despair is very high. I think there should be an awareness, too, of praying for physicians because they often struggle with really severe feelings of guilt, and they don’t have any framework for atonement if they don’t know Christ. It is impossible for a doctor to do everything right all the time. Even though that’s what society foists upon them, and there’s often this consumeristic approach to medicine that says, Okay, I’ve got this problem. Your job is to fix it, almost like they’re mechanics.

Matt Tully
I’m paying you a lot of money, so you should perform.

Kathryn Butler
Exactly. But you can do a perfectly appropriate, by-the-book operation and the person’s wound can still fall apart because they’ve got diabetes and they smoke and there’s all these other things. It has nothing to do with your operation, but you still have a bad outcome. Also, sometimes you can just make mistakes because you’re working incredibly long hours and you’re exhausted and you’re strained and you have all of this emotional strain that we’ve been talking about. I can remember one time in particular that it hit me. We have this thing called M&M, which has nothing to do with the candy. It’s not cute. It means morbidity and mortality conference.

Matt Tully
That’s a very different thing.

Kathryn Butler
Yes! It’s this dreaded weekly conference that every specialty has where you get together and you talk about the complications and the deaths and review them.

Matt Tully
Things that went wrong.

Kathryn Butler
Yes. You review them with the whole department. It’s meant for educational purposes and for quality purposes and to try to help with patient care. It’s very important. But as you can imagine, it’s wrought with anguish a lot of times. I can remember this fantastic resident who was just a superstar and so hardworking and so compassionate. I remember her getting up and talking about a case that was a bad trauma—I think it was a car accident—and the patient had multiple injuries and was doing badly from the moment they hit the door and it was pretty clear, from my view, that they would not have survived. When the poor resident was up there, she started to cry and she was convinced that the patient had died because she didn’t call for the right OR table ahead of time, and so there was a delay in having to switch the table over. It really would not have made a difference with all the severity of the injuries, but she was just devastated by it. I think that when you have no understanding that we’re all in sin and that we all need a savior and that we can’t save ourselves, but that Jesus has done it for us, I think all that burden really barrels down on yourself. Many, many doctors really struggle with guilt. The suicide rate among physicians is twice that of the general population.

Matt Tully
Really?

Kathryn Butler
Yes. It’s been studied, and it’s twice. A lack of an understanding of where our hope lies and by whom we are saved—not by ourselves and not by our own hands but through Christ—I think it plays a role in that despair.

Matt Tully
I’m struck that it’s got to be so complicated because there’s probably a lot of misplaced guilt like you were saying, but then we are human and fallible. We actually do make mistakes that have grave consequences, and that, even more so, would be something that if you don’t have Christ, how do you escape from that?

Kathryn Butler
Part of the overwhelm in the hospital—which bleeds into what we were talking about of not being with the patient in the moment but worrying about the next thing in the work—part of that arises from this fear of doing something wrong and hurting somebody. There’s this perpetual I can’t relax ever. I have to always be on point because if I do make a mistake, it could have horrible ramifications and there’s no forgiveness.

41:56 - Encouragement for Those in a Hospital Bed

Matt Tully
Speak to two types of people as we close our conversation. The first would be the person who is currently in the hospital and is suffering from some kind of ailment. Maybe the prognosis for the future for them is not good. It’s just a lot more pain, it’s a very slow recovery, maybe they’re likely never going to leave the hospital. What would you say to the person like that who is struggling with not just discouragement, but maybe even a level of dread and depression at what they’re facing right now?

Kathryn Butler
I think looking to the Psalms can really help in these kinds of scenarios because what you see through the Psalms is that there is a biblical, real premise for lament. Sin is not what we’re meant to be and death is it’s wages, so it’s appropriate to cry and it’s appropriate to be upset and to even ask questions of God of why. How long, O Lord, will you leave me? Why have you turned your face from me? Has your compassion burned away in your anger? All of these questions are things that the psalmist would ask. So there’s a premise for that. And there’s a premise for our tears. Job’s first response when he was so afflicted was to cry. Yet, what you see throughout the Psalms, which I love so much and which I’ve found to be a lifeline, is that they then turn and remember who God is and they praise him for who he is. They say, You are holy. You are my rock and my fortress, my deliverer. They remember him. And then they remember what he’s done. Through the Psalms, it’s usually remembering his provision for them during the exodus, saving them from slavery and providing them manna from heaven. We have also the blessing this side of the cross to see what he’s done for us in Christ, which is the greatest hope of all that the patriarchs placed their hopes upon, but didn’t see the fruition of. I think it’s perfectly appropriate to lament and for people to know that it’s okay to grieve and to be afraid. That’s all normal. But cling, with all your heart, mind, and soul, to the God who has you in his grip even now and has a plan for you and—from Romans 8:28—will work through this, even this, for the good of those who love him and are called according to his purpose—which includes you, if you know Christ. I think it’s also key for us, as the body of Christ when we’re walking alongside our brothers and sisters, to be present with them and to remind them that they are loved, and to pray with them and for them, and to walk with them during such moments. This is so key because it can be really hard to forget what we know and proclaim in church when we’re tethered to a bed in a hospital room instead.

41:56 - Encouragement for Those with a Loved One Who Is Suffering

Matt Tully
That was my second category of person that I thought you could speak to a little bit. For the person who has a loved one who is that first type of person—they are in the hospital, they are suffering in some way. You’ve described all these experiences you’ve had in a hospital context, caring for people who were seriously hurting in some way, and even people who died. I think for the average person listening to us right now, they might have that experience (being with somebody in the hospital in a really serious condition or watching them die) once or twice in their lifetime. That’s a very scary and overwhelming thing that maybe feels like too much to bear. What would you say to the person who does have a loved one who is suffering and wants to love and support them, but maybe feels a level of fear or is thinking, I just don’t know if I can do that?

Kathryn Butler
Fear in terms of being able to support them and not knowing what to do?

Matt Tully
Just fear of witnessing that kind of suffering and being so close to that level of suffering where it just feels like it might be too much?

Kathryn Butler
I think it is important to know your limits. I want to at least make the disclaimer that if you think that it’s going to be too much for you to endure and witness, then that’s okay. You can still pray for someone and support in ways that are maybe not so hands on, and I think that’s okay. But if we’re talking about just how to reconcile things and how to go forward, I think knowing first and foremost that while it’s appropriate and normal to be scared, I find great comfort in my patients in this regard, is knowing that God knows them by name and that their identities as his image bearers isn’t changed based upon their illness, or even based upon impending death. He knows every hair on their heads and he is the one who formed them in the womb before their mother even knew they existed. He loves them. He will work for good because it’s who he is. His steadfast love never ceases and his mercies never come to an end. His mercies are new every morning. Just leaning into the fact that they are still within God’s grip and that in coming alongside someone during such a time, it is a beautiful ministry of mercy and a beautiful way to live out our call to love neighbor as Christ has loved us. To say, I’m going to set aside what I want and what I need to be with you right now as you need me to be is, I think, a beautiful way to love neighbor. And the Lord sees that, too, and says, Well done, faithful servant. Be comforted by the fact that Christ has already overcome, and these moments in the hospital are so anguishing because it’s sin. Christ gave his life for us because this is such a horrific situation. That’s why he came in the first place. So, while we despair, we also look and say, Yes! He has already done it. He has already triumphed. Death is swallowed up in victory through him, so this is not the end. We can cling to the promise that when he returns, in the new heavens and the new earth he will make all things new, and he will wipe away every tear from every eye, and there will be no death and no pain, and all of this will be wiped away. While it’s right and normal to grieve, we also have a tremendous hope.

Matt Tully
Do you feel like that hope for a new heaven and a new earth—full redemption—is that maybe more real to you, in part, because of your experiences?

Kathryn Butler
Absolutely. Because I see how direly we need it. Also, when I consider all the people whom I have seen and witnessed in terms of their suffering, I also just think back to the cross knowing that Christ willingly endured the same for us. What an astonishing manifestation of God’s love that is: that he would willingly endure all the same physically, but far beyond the physical, we’re talking about emotional pain—that he endured that on a cosmic level with all of God’s wrath bearing down upon him. The Father that he had known since before the universe began, with whom he had been in this loving fellowship, with this agape love, the likes of which we have never experienced, that he would willingly be cut off from God in that moment. So I see that he was willing to endure suffering beyond what we even have out of love for us, and it just provides such hope, and I can’t help but praise the Lord.


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