[ Music ] >> Why talk about stories as
we think about the integration between mental health
services and chaplain services. Stories are important as
we think about who we are as providers and how the care
that we provide to the veterans and service members
fits into a narrative. We tell ourselves narratives about how the care we provide
contributes to the health and wellness of our patients. And in our different fields of
mental health and chaplaincy, we have approached
stories differently over the past 70 or 80 years. And I think by exploring these
differences, we can think about the strengths and
potential weaknesses of both our disciplines in a
way that ultimately brings us to a place of providing
patient-centered care that brings the best of what
scientific mental healthcare approaches put on the table,
as well as what approaches within chaplaincy
can bring to the care of our veterans and
service members. We think in stories.
And we're taught from a
very early age to do this. For anyone who's been a parent
of a young child, you can think about what is a young
child's favorite question? Why. And why do children ask
this question so frequently? They're trying to construct
stories, stories that tell them about how the world
is constructed. About who they are in the world. And about how they
should behave. We call folks who expect
good stories optimists. And optimists are
likely to have a range of better outcomes
in their lives.
Their immune systems are even
stronger than the rest of us. And they tend to live longer. Believing good stories is
powerful and allows us to live into those kinds of stories. Now there's a flipside
to stories. Stories can also be profoundly
destructive and dangerous. Many could argue that
the most important event of the 20th century was World
War II and the holocaust. And this of course
caused humanity to ask many probing questions
of itself that we asked in lots of different ways.
You may remember Stanley
Milgram's famous shock experiments where
Milgram was really trying to answer the question, could Americans behave
in the same way? Could the average person
off the street be persuaded to tell themselves a story
about how this was okay? >> Under what conditions
would a person obey authority when commanded actions that
went against conscious? >> The victim according to plan
provided many wrong answers. As verbal responses were
standardized on tape, and each protest is coordinated
to a particular voltage level in the shock generator. >> That is incorrect. [ Buzzing Nosie ] This one will be 195. This will be at 330. [ Screaming ] >> Now what Milgram concluded is that you could easily
get a large proportion of average individuals
who when instructed by an authority figure
can do something that they never thought
they would do under normal circumstances.
>> Let me out of here. Let me out of here. [Inaudible] Let me out. >> Experiments like Stanley
Milgram's represent a larger movement within psychology
where we really became consumed, examining all the
different ways that we as human beings deceive
ourselves with the kinds of stories that we tell. A major way that we looked at this has been termed
cognitive bias research.
One of the most popularly
known biases is hindsight bias. Simply put, hindsight bias
is being more confident that you would have known an
outcome once you actually know the outcome. We see this often in how
people interpret science. So, folks will frequently say, oh I can't believe we spent
another million or $2 million to find what I easily could have
told you would be the result. As another example of one
of the cognitive biases that we're prone to, I
invite you to take a second and consider the story
of Steve and think about whether it's more likely that he's a librarian
or a farmer. [ Music ] You probably guessed that
Steve is a librarian. The reason why Steve is in
fact more likely to be a farmer than a librarian is because
for every single librarian, there are approximately
20 farmers. You were asked to think that
Steve was selected at random from a representative sample.
So it's more likely that
at least three or four of these farmers are going
to have characteristics of being shy and withdrawn
and seeming like a librarian than it is that we randomly
happened upon the one librarian that exists for every 20
farmers in the population. So this error is called
the base rate fallacy. And there are a number of errors
like this that illustrate how we as human beings are not
inherently good statisticians. Yes, in fact, we are
susceptible to many of these cognitive biases. We're susceptible to things
like the recency effect. The recency effect being
that as clinicians, we tend to remember the most
recent patient that we saw and think that that patient
was more representative than in fact they are.
We're also susceptible to something called
confirmation bias. Which means that we tend
to look for the places where our treatment has
worked and discount the cases where it hasn't worked. We end up using a treatment
that may not be as effective as it feels like to us
because confirmation bias. In addition to that, we're
susceptible to a number of different statistical biases. Patients tend to come see us
when they're at their worst. When people are at their worst, they tend to get better
automatically to an extent. Because there's no
other direction to go. As clinicians, we can begin
to tell ourselves a story that our treatment is
what is contributing to a patient's improvement,
when in fact some of that improvement may
have happened without us. One of the significant
players around the time that clinicians were
grappling with the extent to which evidence should
inform their clinical care was Paul Meehl.
In 1954 he came out with
a book entitled Clinical Versus Statistical Prediction. And in this book, Meehl
demonstrated we do a better job of predicting our
patient's behavior when we use data instead of using our expert
clinical judgment. And over time Meehl has been
categorized I think somewhat unfairly as relying solely
on data, when we think about the care of our patients. Meehl in fact pointed out
on a number of occasions that we should use data
when data are available. But data are often not available when we're conducting
clinical care.
For large systems like the
Department of Veterans Affairs and Department of Defense, they need to make large
scale utilitarian decisions about their patient populations. And scientific healthcare
epitomized and randomized controlled trials
can tell us about the sorts of decisions that we need to
be making at a large level. By using a randomized
controlled trial approach, we can see if newer
treatments are more effective than existing evidence-based
treatments. It allows us to take our
best guess at what sort of treatment is most
likely to be effective for the individual that's
sitting in front of us. And finally, scientific
approaches to healthcare also
help us test treatments that we suspect may
not be efficacious. Scientific approaches to
care and the way that we set up randomized control
trials tells us about the average patient. But there's a lot of
variability within these trials. Within that variability,
there are lots of different patient stories. There are ways that we can
handle some of that variability from a scientific vantage point, but at the same time relying
solely on this approach to understanding our patient
can sometimes lead us to a place where we may not know what to do with the patient
who doesn't improve.
And we may become overly
dogmatic in how we think about alternative ways to
approaching patient suffering. What really underlies
our thinking about evidence is what we
consider appropriate outcomes. We often term that our
dependent variable. So in trials where we're
looking at depression or PTSD or dependent variable,
understandably, is the amount of depression or amount of PTSD that a given patient is
experiencing at the beginning of a trial and then is
experiencing at the end of a trial as a result of
receiving the intervention. Outcome variables are an
important place for us to consider whether
there are other outcomes that are important in the lives of our veterans and
service members. Of course, we want to help
reduce their suffering. But as we invite
chaplains into conversation with mental healthcare
providers, might we also want to think more broadly about
what it means for veterans and service members to live
lives that are meaningful and valuable for them? Might we want to think beyond
just measures of depression and PTSD, to thinking
about other ways that we might conceptualize
the fullness and richness of what it means to
live a flourishing life? [ Music ] >> I'd like to just briefly
go through a treatment with an individual Vietnam vet
who came back from Vietnam, had a number of traumatic
experiences, and one in particular
that involved a bunch of dead bodies that
troubled him.
And because he was married
and had kids and he had to find another job after
he left the military after he returned to the states, that need to accomplish those
things sort of kept him going. He was still troubled. He still had a lot
of nightmares. He'd still wake up in
the middle of the night with intrusive thoughts
of these events. But once his kids grew up and
left home, and then it got to the point where he no
longer needed to work, he was up in years, his PTSD
symptoms got much worse. And it got to the point where
he couldn't even sleep at all. And it got so bad that his wife
basically gave him an ultimatum. If you don't seek
help, I'm leaving you.
So you know, he was desperate. His symptoms were severe. His wife was going to leave him. His kids were gone. So under those dire
circumstances, he sought treatment. And when I saw him I asked him
what he did any time he had these painful recollections of
these events, and this one event in particular again
involving lots of dead bodies. And he said everything he could
to push them out of his mind. And I asked him well would you
consider an alternate approach? And he looked at me in a weird
way, but he didn't say no.
And I suggested to him, well
how about if we do this. How about if you tell me
a place you like to relax and in a little bit
you close your eyes and you imagine being there. And then when you're
feeling relaxed, you will see yourself go into a
very comfortable movie theater. And it has very comfortable
seat and you will find a seat that you'll sit down in. And after you're there
comfortably seated, you'll see a remote control.
And when you're ready, you'll
press play and the goal will be for you to watch that entire
horrible event involving a bunch of dead bodies from
beginning to end in however much detail
is necessary in order for you to heal from it. And you'll have total
control over this because you can hit stop. You can hit pause. You can fast forward. You can reverse it. You can control the volume. You can even control
whether the picture is in color or black and white.
But the goal of this will
be for you to make it through the entire event
from beginning to end in however much detail
is necessary in order to heal from it. So he agreed to do this. And he was able to
relax a little bit. He was still somewhat agitated. But he relaxed a little bit. You know, had his eyes closed
and imagined the theater. Walked into the theater. Found a comfortable seat to sit. Saw the remote control. And when he was ready,
he pushed play. And the moment he pushed
play, he turned red. He just had intense emotion. And then he started describing
the scene out lout to me.
And it was a struggle for him. You know, he stuttered. He coughed. He, you know, was very
emotional during it. But he managed to
watch the whole scene from the beginning to the end. And when it was over, I
asked him if he would get up from his seat in the theatre
and walk down the aisle and walk into the movie screen and
say whatever he wanted to say to his younger self that went through that horrible
event decades ago. And he went like this
when he did that.
Telling me that he was
actually hugging himself. And he didn't describe in
great detail what he said. But you could see an
incredibly sigh of relief, and his body was more
relaxed than before. And then he opened his eyes and
we talked about what happened. And that night he
slept incredibly well. >> Narrative medicine is
to take from med students who are training to
become interns, residents and attendings [phonetic],
that if they want to care for the sick as doctors,
they must understand that there's more than just
diagnostic codes that we put into the computer for
Medicare and Medicaid billing. The care of the sick
unfolds in stories. The effective practice of
healthcare requires the ability of the doctors, and I would also
say the chaplains, to recognize, absorb, interpret and act on the
stories and plights of others.
>> The approach that a
chaplain takes when talking to a veteran isn't like many
disciplines where you have to ask questions and get answers
in order to justify a diagnosis. A chaplain purposely will
take a more holistic view in a more patient-centered view. They will ask the veteran,
hello Don, how are you doing? To establish a dialogue, and then give the
veteran an opportunity to share their story. It's a human living document if
you will of who that person is and what that person's about. >> Narrative competence
is a model, not just for what is called
logical scientific medicine but a model for humane and
defective medical practice.
It addresses the need of
patients and their caregivers to voice their experience to
be heard and to be valued. And it acknowledges
the power of narrative to change the way care is
given and care is received. What are the elements
of narrative competence? Narrative is a source
of information that goes beyond the diagnostic
differential diagnosis. So narrative is a
source of information, but narrative is also an
instrument of knowledge. Where the doctor and indeed
the chaplain see the patient in front of them as a story
unfolding before their very eyes. >> While the veteran
is sharing that story, the chaplain is thinking
of what is the lament? What is the most important thing
that that veteran is sharing that would give some
clue or some indicator of where the chaplain needs
to focus the attention. So the story becomes the
paramount interaction each time a chaplain visits
with a veteran.
>> Narrative competence serves
professional functions beyond the treatment of illness. I mean beyond the physical
aspects of the disease. Narrative competence inspires
trust between doctor and patient to promote empathy and
relationship and connection between the physician
and the patient. >> Sometimes a combat soldier or
marine will hold on to things. They will not readily share. They've learned long ago to get that information
and put it to sleep. And as long as they don't deal
with it, it won't hurt them. But as a trust level develops,
it becomes easier and easier to share with another individual who I believe understands
what I'm going through. Who I believe will be there to
help me and not try to medicate and not try to, you know, tell
me what I should be feeling. >> It is indispensable for the
professional use of narrative that it finds a clear
illustration in the concept of narrative situation.
A narrative situation shapes
every story by governing who speaks and what
is that story about and to whom they're
telling the story. And at what time. And where they are
telling the story. The meaning of any narrative
must be judged in the light of its narrative situation. And these are the questions
that we should ask ourselves.
Who is telling it? Who is hearing the story? And why and how is it told? >> That's the beauty of
listening to the veteran's story because everything
you're getting from that story is
coming from the veteran. I mean you don't
have to edit it. You don't have to change it. You don't have to manipulate it to make it fit a
particular diagnosis.
So for a chaplain, that veteran's story is
probably the most important part of pastoral care
that can be provided, and it gives the
veteran the opportunity to share what they
want to talk about, not necessarily answer
the questions that the clinician
wants to talk about. >> When the doctor meets the
patient in the exam room, and is ready to listen to the
heart with the stethoscope, and to [inaudible] and
to percuss the chest, and to get the pulse
and all of that we have in physical examinations,
there is more or should be more that is happening between the
caregiver and the patient. And that is the relationality between two persons
in that exam room. Narrative discourse is
someone telling someone else that something happened. Emphasizing narratives
requirement for a teller and a listener. A writer and a reader. A chaplain or a physician
or a nurse or a social worker
with a patient. And most importantly, a communion of some
sort between the two. Ultimately, narrative medicine and narrative chaplains both
utterly depend on the concept of inter-subjectivity.
Narrative considerations probe
the inner subjective domains of human knowledge and activity. That is to say those aspects
of life that are enacted in the relation between
two persons. The narratively competent
reader or listener realizes that the meaning
of any narrative, instead of being monolithic
and hierarchically given, meaning from the top down, meaning is apprehended
collaboratively by the reader and the writer. The observer and the observed. The physician and the patient. The chaplain and the patient. And we've heard a lot about
patient-centered care. It's no longer the
physician being the knower of medical expertise. The patient is the
center of our focus. And medical decisions and
treatment decisions have to be made in a shared way, which is called shared
decision-making.
How do chaplains hear
or how should they hear and understand patients? Clinical pastoral education
or CPE pays close attention to illness stories surfaced through intersubjective
encounter between the chaplain
and the patient. And all chaplains who have gone
through the CPE process know that one of the elemental
aspects of CPE is writing verbatims. The verbatim is a major
educational experience in CPE. Verbatim seminars
involve a student in CPE presenting a
pastoral encounter. Or, what we might call the
narrative to other students and the CPE supervisor
for discussion, both with affirmation
and critique. When I say verbatim,
I don't mean that the CPE student
is a stenographer.
It is not literally
every word that came out from the patient's mouth,
from the chaplain's mouth, and from the family's mouth. The verbatim is the subjective
presentation of the visit. The visit by the
chaplain to the patient and how the chaplain
remembers what was said and what the issues were. And writing it up. >> So that when I go back to
the interdisciplinary team, I can go back and say,
this is what I learned from the veteran at this time. Even though we. Even though he's here
for PTSD or depression, he's really focused
on this issue. Which may be something
completely different than what that person was admitted for.
>> What do our different
religious traditions offer to us in understanding
patients' stories? Since I'm a rabbi,
I am most familiar with the Jewish tradition. So I want to talk a
little bit about Midrash. Midrash is the body of
homiletic stories told by Jewish rabbinic sages to
explain passages in the Tanakh. Tanakh is the Hebrew Scriptures,
which is the five books of Moses, the prophets
and the [inaudible]. Midrash goes beyond the
surface of the words. It looks and fills
in the gaps left in the Biblical narrative
regarding events and personalities that
are only hinted at. So let me give you an example
of a Midrashic illness story. There is a tradition that
dates back to the Talmud, that there was no sickness in the world before
Jacob became sick. And Midrash retells the
story of Jacob's illness.
And the Midrash says,
from the day the heavens and earth were created, a person
was never ill before they died. When a person's time came, he or
she would spread out on the bed and their soul would depart. No pain, no suffering,
no medications, just lying back and
dying peacefully. Like a whisper. But Jacob said to the
Holy One, blessed be he, master of the universe,
it isn't good that a person doesn't feel
anything before their death. People aren't careful to write a
Will, to speak their final words to their children and family.
That is, leaving a legacy of
meaning what my life was all about and what heritage I
can pass on to my children, grandchildren and the
future generations. So Jacob said, thus I pray of
you Lord, let people become ill and feel that their
days are numbered so that they will be quick
to speak with their families and to give over to
them their final wishes. And this is what we
who work in hospice and palliative care say
unfinished business. What was God's answer? The Holy Blessed One
replied to Jacob, your request is a worthy one,
and I will begin with you. Thus, our father Jacob was
the first one to fall ill. And then he was able to gather
the different generations that would come after him and give each child
a message tailored to that particular child. >> In the 1950s Corrie ten Boom
a Dutch Christian who was jailed for helping Jews that had
escaped Nazi-occupied Germany during World War II visited
the Dutch Reform Church where my grandfather
was the minister. And it had an influence on my
uncle who was there and who went on years later to track down
three different survivors of what was called
the Kinderlager.
It was a section of Auschwitz
where the children were held. And his purpose in tracking
down these women was to help them tell their stories. And these women understandably,
some of them were conflicted about telling their
stories and felt like, do I really want to do this? What's my motivation
for telling this story? And on the dedication page,
each one of these three women who ultimately did decide to tell their stories provided
a reason for why they did it. And one of the survivors
of this Kinderlager writes this dedication. She says, in memory of my
sister, my grandparents, aunts, cousins, friends, teachers,
and the destroyed world of my childhood, and in the
hope that such tragedies and traumas still
happening can be stopped, and that no child will
experience them again. Let that be the world's
future work. And as a clinical psychologist,
when I went back and looked at this dedication and this
motivation for Corrie ten Boom to tell her story, it struck me
that it's so important for us to realize that the veterans and
service members who are coming to us with their
stories of trauma, with what we sometimes call in clinical psychology,
trauma narratives.
For us to think about why are
they bringing these stories to us. And we've made a number of
advances in clinical psychology to approach these trauma
narratives in a way that can lead to healing for
veterans and service members. And when we talk about
healing, we're often talking about a reduction
of PTSD symptoms. And that's excellent. But can we also think more
largely about these stories and the motivations of
veterans and service members who are bringing
us their stories. Can we think about
what it means for them to bring their stories
to us in memory of? Whoever it is, whoever
they may have lost as part of the war experiences. Or a memory of a
time in their life or a person who they used to be.
What does it mean for us to
handle their stories in a way that we can honor that memory? And what does it
mean for us to think about how we can also hear
their stories in a way that brings hope and to realize
that they tell their stories so that they can bring hope. Not only to themselves,
but possibly to others. >> I would like to share
a brief story with you. It's a story about a young
man that I was involved in that I was involved
in the care of this young man while
he was hospitalized. And I hope this story helps
to illustrate for you some of the aspects of narrative
medicine, pastoral care, and the synergy and
effectiveness that might be the outcome
of good communication and collaboration between
the different disciplines and providers as they consider
the story that they've learned about this particular
individual. A few years ago, I met
an intelligent young man who had been admitted
to the hospital. He was coming in for tests
regarding some symptoms that indicated that
he may have cancer.
The tests did prove
that cancer was in the bone of his upper thigh. And it seemed that the
best course of action at that time was at least one
surgery and ongoing treatment. He remained somewhat
optimistic about it. When I met him his
mother was at his side, who remained steadfast
throughout his care during the time that I knew him. And she had traveled over
halfway across the country to be with her son, who was
in his mid-twenties.
And she gave him
a lot of comfort. It was apparent that as she
was there in the room with him that he felt less alone and
that it gave him some comfort. She was limited in her
ability to communicate with the medical
providers as well as myself because of her difficulty
in speaking English. One of the things
that I learned early on that while she gave him
comfort during his care, what really seemed to make
a difference for him is when someone from his
unit that he was serving with in Iraq before he was
admitted to the hospital. When someone would make contact
with him or the occasional but not frequent visitation
by somebody from his unit, it seemed that that really
brought a lot of light into the room and a lot of life
in him and a sense of relief and connectedness
that was missing. In my initial conversations
with this young man, I learned that he had been
raised in a Catholic family. But he was now exploring other
faiths, including Buddhism. He hadn't really landed
anywhere, but it seemed that he was forming new
questions that might help decide about what religious
or spiritual teachings and practices that he would
want to employ in his life.
He also indicated that right
now in a moment of dealing with the newly discovered
cancer and all the dynamics of being separated from
his unit and his sense of really not having much
control about his fate at the moment, it didn't seem
like the best time for him to explore that avenue
of spirituality. Yet it was on his mind. And he shared quite
openly about that. The expectation was that the
treatment that he was going to receive was going to
involve some surgery, of course, and then hopefully
after a little bit of treatment be discharged,
and he would go back into his normal routine in life. Instead of the brief kind
of surgery and treatment that he had hoped for, he ended
up having multiple surgeries. They began with an
amputation of his leg. And as he was beginning
to recover from that, further tests revealed that
they had not been successful in removing all of
the cancerous cells.
And so the radiation and
chemotherapy did not seem like a conclusive way to
really rid him of the cancer. So further surgeries
occurred until he had begun to lose a good portion
of his hip. For now he was looking at a
much more complex recovery, many more complications
in his life medically. Prosthesis was not really
available to be able to replace that much of what he had lost. And so there were lots of complications
that came into play. Depression became
a part of his life. Anger, a sense of
being out of control. A loss of hope. And we reached a point to where
the pain management team was listening to him, but in his
constant pain and their striving to respond to that, they had
reached a point where all of the medications that were
at their disposal and the level of dosage that they could safely
provide had been exhausted.
The oncologist was
running out of options. The orthopedic surgeons
were frustrated because they felt
so badly for him. But yet they continually
were forced into a situation where it was very difficult
to really provide him the kind of solutions that anyone
would want in his state. And from my perspective
as a pastoral caregiver, I could only hope that
my continual visiting, my continual listening, the
times that we spent together in silence, the prayers that
were offered, that they would in some way give him a glimpse
or a vision of hope in the midst of very, very difficult
circumstances. The social worker was working
diligently to make sure that his mother was supported
during this difficult time. With all of the challenges
that come when there are language
barriers during medical care. With the financial
restraints that she had.
She was a woman of
very modest means. And there was much that
had to be done socially, both for the patient
and his family. So that the greatest source
of comfort that he had, so that they would be supported. So, you had all of these
different disciplines. All of these different providers
that were listening to his story and trying to come up with the
best solution for his care. What was interesting
is while some of those providers would cross
each other's paths during the course of the day, and
they might mention his case to one another and
share some knowledge, the entire team had not
assembled and discussed at any length their
understanding of his story. What happened is when
push came to shove, and we were all running
out of options, and the patient had
reached a point that he had been hospitalized
so long that he kind of by observation, I'm sure
some of you have seen this type of occurrence, he had really
learned how the system work and how the providers,
the nurses and the staff on his floor, how
they functioned and what perhaps may even
be their buttons to push.
Well when you're totally out
of control, you don't feel like there's anything
in your life that you can manage very
well, and your hope is dashed, it's very easy to fall to
the temptation to begin to manipulate people
in your anger. So he began to test the nurses. Nurses that he once
had a very cordial and friendly relationship with, now he was becoming
very demanding and quite angry towards them. To where even staff
reassignments had to be made. There were some real challenges
because he was starting to act out of his frustration
and sense of helplessness. So we decided it was time
that we had reached a wall of options, and now we
needed to assemble and figure out what was the next best step.
So we all allocated,
agreed to allocate an hour, the mental health
provider, the social worker, the oncology team, the
pain management team, the orthopedic surgeons, myself. We all got together, and we
sat down and began to share with one another what we
had heard from this person and the story that
we had learned. And it was different
from each person. Certainly there was commonality
throughout all of them. But the reality is that
patient was sharing with each of us what he thought
we would want to know based on
why we were there. His interpretation. Why is the chaplain here? What would he want to hear? What would be helpful to him
and helpful to me and on and on through the various
different disciplines. So we each heard a little
different version of his story. But when we came together and
we were able to compare notes, we assembled a much more
comprehensive story. And I think probably a more
honest and truthful story about what was going on with him and what would truly
be the course of action that would acknowledge and
respond to what his values were, what his beliefs were about, where he was emotionally
and physically.
And truly what is most
meaningful to him and his life. At this point, I really believe
he had already written the last chapter of his story. I think he was pretty
much without hope and didn't have a vision
for what life might, could be somewhere
down the road. I think it was just
survival at this point. But by assembling
his story and coming up with a more comprehensive
picture by sharing our knowledge with one another, we were
able as a team to actually put into place what I think became
the most optimal outcome in his mind, as well as ours. And considering his
medical, his psychological and his spiritual health, it
seemed to make the most sense to get him back home
as safely as possible, to arrange for a good
living conditions in his home back
home, and to set it up where he could be
surrounded by his loved ones, the people that he
knew, his friends. And even be closer to his
unit command headquarters so that it would be easier for
those he served with to come and visit when they could.
So, those arrangements
were made. And while there was a
considerable amount of work that was performed by the social
worker to coordinate that, she did so with all
the other providers. And also, at the end of the day,
probably the most moving part for me, the evidence
that he gave to me the day before
he was discharged is when he told me he had
enrolled in two college courses at the suggestion of
the social worker. Which told me that the result
of us all getting together and sharing the stories
that we had learned, to build that comprehensive
human story about this individual, gave
us the information we need to where now I believe the
last chapter to his book, of his story, is much more open. And he is more open to the
possibilities and the options that may be there
for him to live in the midst of his suffering.
We couldn't end the suffering,
but maybe we did something to help contribute to
his ability to live. [ Music ].
