"Defining Love"

As I waited in my doctor’s office, I heard Mariah Carey’s voice through the speakers singing, “I Want to Know What Love Is.” She isn’t the only one who seeks a definition of love. Dr. Jean Watson wrote an entire theory defining love (though she terms it caring) for medical personnel. Her in-depth theory is called “The Ten Caritas.” Fortunately, she recognized the necessity of teaching medical students how to care for patients. When someone becomes a cancer patient (or any patient), it is a time when they definitely need to be treated with love!

During times of fear and confusion, our fragile hearts can be wounded if we encounter rude and indifferent medical personnel. On the other hand, we thrive with authentic caring when we are in the vulnerable position of having to trust doctors and nurses we just met. The Ten Caritas explain abstract principles of caring in terms of their application to patients. When a nurse told me she studied the Ten Caritas in a graduate-level class, I wondered how compassion is defined in an academic setting. In other words, I wanted “to Know What Love Is.”

Simplicity is a fine beginning, so we can first reference the Merriam-Webster Dictionary. In the sense of benevolence, love is defined as “unselfish and loyal concern for the good of another.” The Ten Caritas amplify the dictionary definition with a list of lofty principles. As a layperson reading the Caritas for the first time, I was struck by how Dr. Jean Watson was basically rephrasing a two-thousand year old definition of love from the Bible. The Biblical definition in 1 Corinthians 13 is briefer and includes what love is not. Yet both attempt to define the core concepts of caring. The parallels are numerous and support the truth of Ecclesiastes 1:9. “There is nothing new under the sun.”

The first Carita directive is to “Practice loving-kindness. 1 Cor. 13 includes in verse 4: “Love is patient, love is kind.” What is lacking in mere definitions is the explanation of how that looks in actual practice. I’ve selected examples from my cancer journey for a deeper understanding of “What Love Is” in action.

A friend of mine who also has cancer told me about an instance of kindness. When the oncologist she had been seeing discovered another medical issue, without hesitation, he suggested she go to a different doctor, who specializes in such cases. He gave her a choice, but said the other doctor would be able to do more for her rare condition. She appreciated his decision was driven only by kindness and concern for her well-being.

The second Carita is “Being authentically present, enabling faith and hope and honoring others.” Verse 7 of 1 Cor. 13 is [Love] “…always hopes, always perseveres. And verse 5: “…It does not dishonor others.” On the subject of hope, I have read many negative experiences in my online support group. The most insensitive ones that crush hope are the doctors who state with certainty a time-frame for living. I understand if a patient is truly near death, reality must be faced in terms of weeks or months. However, I read about doctors predicting (as if they were fortune-tellers) that a patient would not live two years. No one can know for sure, and if some hope isn’t offered, the person may succumb to a downward spiral of depression.

The third Carita tells people to be responsive to others’ needs and feelings to create trust, beyond ego self to transpersonal self.  ICor 13:7 similarly describes love. “It does not envy, it does not boast, it is not proud. …it is not self-seeking.”

At my second appointment with my oncologist, he demonstrated what was meant by going “beyond ego self.” At that time, the biopsy results were available to inform a course of treatment. I listened to his suggested protocol and then I asked if he minded if I got a second opinion. He was sincere in his response: “Of course not! Please get a second and even a third opinion so you feel confident.” I could tell he meant it without letting his ego get in the way. When a doctor doesn’t take personal affront at a patient wanting to know more, it means the patient’s best interests are at heart.

The next two Caritas are correlated. The fourth Carita: Developing and sustaining loving, trusting-caring relationships. The Biblical parallel in verse 7: “It always protects, always trusts…” The fifth Carita is: Supporting and accepting positive and negative feelings—authentically listening to another’s story. Verse 4 is similar: “…Love is patient.”

This part of the definition is so important in the medical field where one of the most common complaints from patients is that doctors do not listen to them. It may be difficult for a physician to “authentically” listen when having the knowledge and training to apply to the case in front of them. But, we are not cases; we are individuals with feelings and thoughts which need to be validated before proceeding. Even “People with serious illness have priorities besides simply prolonging their lives,” recognizes Dr. Atul Gawande, surgeon and professor.* Therefore, the patient’s wishes for their quality of life, among other considerations, need to be taken into account in planning future treatment.

My doctors included me in decision-making and took time to listen. My surgeon would use phrases such as, “What do you think is best for you?” He would explain what he thought was medically indicated, but left the final decision up to me when possible. For example, did I want reconstruction or not? Of course doctors can’t always give treatment choices, but the patient should be allowed to give input as part of the “team.”

The tenth Carita* advises to be: Open to spiritual, mystery, unknowns—allowing for miracles. Verse 6: “Love does not delight in evil but rejoices with the truth.”  Frankly, I was surprised to see Dr. Jean Watson use the word “miracles.” Many doctors are reluctant to talk about spiritual matters, especially healing miracles.

My experience is embarrassing to me, but it does illustrate a doctor’s ability to allow for miracles. After I had been diagnosed with Stage 4, Triple Negative Breast Cancer and told of my tumor’s large size, I had an appointment to set up chemotherapy treatment. The night before, I had tried to feel my tumor, which had previously been easy to do since it was just under my breast. I couldn’t find it. I’m not certain of how hard I tried because I was terrified of the impending chemo. I tried again. I felt no lump of any kind. I’m open to miracles, so I rejoiced. When I saw my oncologist, I told him that I thought the tumor was gone since I couldn’t find it. He could have reacted with disbelief, or worse, dismissive assurances that I must be deluded. He even could have rolled his eyes. No. He chose to be open to the spiritual and unknown. Treating me with dignity, he said, “Let’s check.” He asked me to put on a top gown and left to summon his nurse in for a physical exam. He found the lump immediately and guided my hand to it so I could know for myself. I felt silly and mumbled something. He assured me sometimes tumors are difficult to feel due to their location. That, of course, was said to ease my embarrassment. He didn’t say a word about such a circumstance not being possible. In fact, after that, we had a discussion about the mysterious and he admitted he had seen things he could not explain. By saying so, he showed support for my belief system. I left his office, disappointed in my diagnosis, but heartened by my doctor’s respect.

The Caritas are an exhaustive list for anyone to master, especially doctors or nurses usually having only a brief relationship with a patient. Nevertheless, some in the medical profession manage to accomplish the incredible feat of demonstrating calming patience and authentic caring. A person certainly requires more than one class in graduate school to become a loving person, selflessly looking out for the needs of others. It usually takes a lifetime of learning and growing to live up to even part of the definition of love. Still, it is encouraging that many in the medical field are trying to find out what love is and actually put that definition into practice.

Reflection:

1. Give an example of love in actual practice, not flowery words.

2. Recall a time someone’s kindness genuinely affected you.

3. How could you show others you are “authentically present” and “authentically listening”?

* Quotation from Being Mortal by Atul Gawande

*For a list of all Ten Caritas, see the silverlining.vegas website, page entitled, “Human Caring”