Program Particulars
*Times indicated refer to web version of audio

(01:46–03:48) Music Element
"The Multiples of One" from Awakening, performed by Joseph Curiale

(01:54) Reference to Integrative Medicine
Integrative medicine combines the discipline of modern science with alternative and complementary forms of healing practiced in many non-Western cultures for centuries. In treating disease, complementary therapies are not substitutes for mainstream medical care; they are used in concert with medical treatment to help alleviate stress, reduce pain and anxiety, manage symptoms, and promote a feeling of well-being. Oftentimes, this involves exploring the physical, emotional, and spiritual dimensions of patients' lives who are living with a chronic illness or are facing a terminal disease. Within the last several decades, major medical schools and hospitals across the country are creating new models to treat mind, body, and spirit as elements of disease and health.

To learn more about a cardiovascular surgeon's approach to what he calls "global medicine," listen to Speaking of Faith's "Heart and Soul: The Integrative Medicine of Dr. Mehmet Oz." Included on the Web site are exclusive interviews with two physicians, Kayvon Modjarrad and Tracy Gaudet, who share their thoughts and experiences on the role of religion and spirituality in the medical care of patients.

(02:34) Definition of Crohn's Disease
Named after the physician who identified the disease in 1932, Crohn's disease is a chronic disorder that causes inflammation of the digestive or gastrointestinal tract. The disorder most commonly affects the ileum, the end of the small intestine, and the colon, the beginning of the large intestine, because of abnormal immune response. The immune system mistakes microbes, such as bacteria, normally found in the region for foreign substances and attacks them. Inflammation and ulcerations result.

Although a definitive cause for Crohn's disease has not been identified, research attributes it to a complex interaction of several factors: genetic inheritance, the immune system, and undetermined environmental substances. Statistics show that the rate of occurrence is four to five times higher in American Jews of European descent than the general population.

(03:08) Citation from Remen's Writing
Krista cites a passage from the introduction to Remen's book, Kitchen Table Wisdom. Following is an expanded version:

Sometimes the same teammates who so painstakingly treated me as if I were a man called on me in situations that made them uncomfortable. When we were all working the clinic or the emergency room, each seeing patients in our own examining rooms, there would be a knock on my door. Opening it, I would find another doctor standing there ill at ease, who would say something like, "My patient is crying … can you come?" I was no more comfortable than he in such situations but I realized early that this was part of my ticket to acceptance and so I would go and listen while someone shared with me their concerns and their experience of actually living with the disease we had diagnosed.

At first, I was surprised that people with the same disease had such very different stories. Later I became deeply moved by these stories, by the people and the meaning they found in their problems, by the unsuspected strengths, the depths of love and devotion, the rich and human tapestry initiated by the pathology I was studying and treating. Eventually, these stories would become far more compelling to me than the disease process. I would come to feel more personally enriched by them than by making the correct diagnosis. They would make me proud to be a human being.

(03:50–04:47) Music Element
"Wiggle Town" from Agada, performed by the Flying Bulgar Klezmer Band

(04:21) Tradition of Kabbalah
Kabbalah (see an online introductory course series) includes the teachings of Jewish mystics that have evolved since the building of the second Temple in 538 BCE. In particular, kabbalistic teachings draw on the forms that evolved during the Middle Ages, such as the awareness of the transcendence of God and his immanent presence within each person. In "The Tragedy of the Believer," Nobel laureate Elie Wiesel talks to Krista about his Hasidic religious background and the power that stories played in his upbringing and in his current work. Hasidism incorporated many of the ideas and insights of Kabbalah, and made them available and accessible to a wider audience of believers.

Written in the 13th century in mostly Aramaic, the Zohar — the Hebrew word for "splendor" — is widely considered the most important work of Jewish mysticism. It is a mystical commentary on the Torah, written in Aramaic and Hebrew. It contains a kabbalistic discussion of the nature of God, the origin and structure of the universe, the nature of souls, sin, redemption, good and evil, and related topics.

Remen describes her grandfather and his influence on her life in the introduction to Kitchen Table Wisdom:

My grandfather had early on, in a manner worthy of Socrates himself, engaged me in the search for what is Real. His world, inhabited by an immanent and personal god, was one of the two worlds of my childhood. He was a grave and scholarly man, elderly by the time that I was born, an orthodox rabbi who spent much of his time studying the texts of mystical Judaism. The books of the Kabbalah he had brought with him from Russia were old, written out by hand in Hebrew on very thin paper. As a small child, I would sit under the table as he studied them, stroking his purple velvet carpet slippers and daydreaming.

The other world of my childhood was the world of medicine. Among two generations of my grandfather's children there are three nurses and nine physicians. When I was young I thought you became an adult and a doctor as part of the same process. I learned early the right thing to say when I was asked what I wanted to be when I grew up. I was the only pre-med in kindergarten. When my grandfather died he left me in his will the money to go to medical school. I was seven years old.

As I grew older, the weight of these family expectations began to grow heavy. My uncles and cousins were men of science, distant, cultured, intellectual, and successful. Like my father, they rewarded me for having the right answers. My grandfather rewarded me for having the right questions. I admired these doctors but I had loved my grandfather and his way of questioning life. At twelve, my closest male cousin and I both wanted to be rabbis. We both became doctors.

(06:11) The Story of the Birthday of the World
In My Grandfather's Blessings, Remen describes the story of the beginning of the world:

In the sixteenth century the great Kabbalistic rabbi Isaac Luria offered a profoundly beautiful cosmology of the world, a sort of mystical version of the Big Bang theory. In the beginning there is the Ein Sof, pure Being without manifestation, the Infinite, Absolute Source of the world. The world as we know it begins with the Or Ein Sof ["God's infinite light"], an emanation of light from the Source. Rabbi Luria explains the fragmented nature of this world by postulating an accident of cosmic proportions: the vessel holding the Or Ein Sof shattered and broke open, and the light of God was scattered throughout the universe into an infinite number of holy sparks. These countless sparks of holiness are hidden deep in everyone and everything.

And, on a more intimate level, she recounts her grandfather's retelling of that story and how he gave a more personal meaning to the creation myth:

My grandfather was a scholar of the Kabbalah, the mystical teachings of Judaism. My parents and my aunts and uncles took a dim view of this study, some seeing it as an embarrassment, a paternal idiosyncrasy, and others as something highly suspect, a sort of dabbling in magic. When he died, the old handwritten leather-covered books he had studied daily simply disappeared. I never discovered what had happened to them.

According to the Kabbalah, at some point in the beginning of things, the Holy was broken up into countless sparks, which were scattered throughout the universe. There is a god spark in everyone and in everything, a sort of diaspora of goodness. God's immanent presence among us is encountered daily in the most simple, humble, and ordinary ways. The Kabbalah teaches that the Holy may speak to you from its many hidden places at any time. The world may whisper in your ear, or the spark of God in you may whisper in your heart. My grandfather showed me how to listen.

(07:52) Concept of Tikkun Olam
Literally meaning "world repair," the Hebrew phrase tikkun olam connotes social action and the pursuit of social justice in modern Jewish culture. In the Speaking of Faith program, "Religion and Our World in Crisis," Rabbi Harold Schulweis discusses this brokenness in the world, and how religion created by man has played a role in this fragmentation.

But, working for the common good, Remen says, is only one aspect; the other aspect is blessing life because it is holy. She recounts one of her grandfather's stories to illustrate her point:

Often, when he came to visit, my grandfather would bring me a present. These were never the sorts of things that other people brought, dolls and books and stuffed animals. My dolls and stuffed animals have been gone for more than half a century, but many of my grandfather's gifts are with me still.

Once he brought me a little paper cup. I looked inside it expecting something special. It was full of dirt. I was not allowed to play with dirt. Disappointed, I told him this. He smiled at me fondly. Turning, he picked up the little teapot from my doll's tea set and took me to the kitchen where he filled it with water. Back in the nursery, he put the little cup on the windowsill and handed me the teapot. "If you promise to put some water in the cup every day, something may happen," he told me.

At the time, I was four years old and my nursery was on the sixth floor of an apartment building in Manhattan. This whole thing made no sense to me at all. I looked at him dubiously. He nodded with encouragement. "Every day, Neshume-le," he told me.

And so I promised. At first, curious to see what would happen, I did not mind doing this. But as the days went by and nothing changed, it got harder and harder to remember to put water in the cup. After a week, I asked my grandfather if it was time to stop yet. Shaking his head no, he said, "Every day, Nashume-le." The second week was even harder, and I became resentful of my promise to put water in the cup. When my grandfather came again, I tried to give it back to him but he refused to take it, saying simply, "Every day, Neshume-le." By the third week, I began to forget to put water in the cup. Often I would remember only after I had been put to bed and would have to get out of bed and water it in the dark. But I did not miss a single day. And one morning, there were two little green leaves that had not been there the night before.

I was completely astonished. Day by day they got bigger. I could not wait to tell my grandfather, certain that he would be as surprised as I was. But of course he was not. Carefully he explained to me that life is everywhere, hidden in the most ordinary and unlikely places. I was delighted. "And all it needs is water, Grandpa?" I asked him. Gently he touched me on the top of my head. "No, Neshume-le," he said. "All it needs is your faithfulness."

This was perhaps my first lesson in the power of service, but I did not understand it in this way then. My grandfather would not have used these words. He would have said that we need to remember to bless the life around us and the life within us. He would have said when we remember we can bless life, we can repair the world.

(09:47–10:15) Music Element
"Wiggle Town" from Agada, performed by the Flying Bulgar Klezmer Band

(11:53) The Stories of 9/11
The Sonic Memorial Project provides an online archive of hundreds of personal and historic audio artifacts and stories related to the events of September 11, 2001, the World Trade Center, and its neighborhood. Also, the public radio collaboration Understanding America After 9/11 serves as another repository of personal and public stories about the events and their aftermath. And, as of August 12, 2005, the city of New York released the oral histories of firefighters, paramedics, and emergency medical technicians that witnessed the events.

(15:59–15:04) Music Element
"Nocturne, in C major, Op. 41/1" from Blackwood Plays Blackwood, performed by Easley Blackwood

(14:27) The Commonweal Cancer Help Program
Remen serves as Medical Director of the Commonweal Cancer Help Program. Located in Bolinas, California, the program is a week-long retreat for people with cancer who strive to learn more about the choices in healing and therapy, including alternative options such as exploring the emotional and spiritual dimensions of cancer.

(16:44) The Hospice Movement
Hospice is specialized care for people facing death, which is aimed at comfort and quality of life and not at curing a person's illness. During the 1960s, two pioneering women established the beginnings of palliative practices many dying people benefit from today: Elisabeth Kübler-Ross and Dame Cecily Saunders.

Elisabeth Kübler-Ross, a Swiss-born physician, brought attention to the hospice movement with her 1969 publication, On Death and Dying. The book introduced the Kübler-Ross' model outlining the five progressive stages a person experiences when one learns he or she is terminally ill: denial, anger, bargaining, depression, and acceptance.

Two years earlier, Cecily Saunders opened the first modern hospice, St. Christopher's Hospice in London. For further insight into this movement, visit "The Hospice Experiment" from the documentary radio program American RadioWorks and listen to the Speaking of Faith program, "A Midwife to the Dying" with medical anthropologist and Buddhist teacher Joan Halifax, who discusses hospice movement and the profound impact of palliative care on those who are dying.

(18:26) "The Pursuit of Perfection"
In Kitchen Table Wisdom, Remen devotes a chapter to living outside the bounds of perfection:

Wholeness lies beyond perfection. Perfection is only an idea. For most experts and many of the rest of us it has become a life goal. The pursuit of perfection may actually be dangerous to your health. The Type A personality for whom perfectionism is a way of life is associated with heart disease. Perfectionism can break your heart and all the hearts around you. …

The pursuit of perfection has become a major addiction of our time. Fortunately, perfectionism is learned. No one is born a perfectionist, which is why it is possible to recover. I am a recovering perfectionist. Before I began recovering, I experienced that I and everyone else was always falling short, that who we were and what we did was never quite good enough. I sat in judgment on life itself. Perfectionism is the belief that life is broken. …

Few perfectionists can tell the difference between love and approval. Perfectionism is so widespread in this culture that we actually have had to invent another word for love. "Unconditional love," we say. Yet, all love is unconditional. Anything else is just approval.

(20:43–21:50) Music Element
"Intermezzi, Op. 117: No 1 in E flat major" from Brahms: Pieces Op. 118; Intermezzi Op. 117, composed by Johannes Brahms and performed by Dubravka Tomsic

(21:03) Reading from Kitchen Table Wisdom
The following extended version of the story, excerpted from Kitchen Table Wisdom, conveys a story about a man in one of Remen's cancer support groups at Commonweal:

Dieter was the first to speak after the silence. In his soft, deep voice he told us how important it was to him to be together with other people who had cancer, people who could understand how it was for him. He was silent for a while and then he started talking about his doctor, an oncologist, who had been giving him chemotherapy for some time.

Every week he would go to the doctor's office for his injection. Afterwards he and his doctor would sit together and talk quietly for a while. Fifteen minutes, no more. Until he came to Commonweal his doctor was the only person to whom he could talk honestly, who understood the experiences that he was going through.

Cancer had changed his life. He now lived so far beyond the usual, the normal, the ordinary in life, that he often felt alone. Many people did not want to hear about how it was with him, or couldn't understand things that had never happened to them. Some were so upset by the pain of it all that he felt the need to protect them from it through his silence. But his doctor understood. For fifteen minutes every week he was able to talk to somebody who listened, who didn't need him to explain, who was not afraid.

Dieter's life had been different even before his cancer. Born and raised in East Germany, he had escaped across "no-man's land," leaving behind him all that was familiar and dear. For years he had felt isolated and homeless, a refugee. Then he had met Lila, an American, who gathered him in and helped him belong again with her love. Shortly after he married her, he had been diagnosed with liver cancer.

For some time now Dieter had suspected that the chemotherapy was no longer helping him. Convinced at last of this, he spoke to his doctor and suggested that the treatments be stopped. He asked if he could come every week just to talk. His doctor responded abruptly. "If you refuse chemotherapy, there is nothing more I can do for you," he said.

Dieter had felt closed out and pushed away. "When I talk about not doing more chemotherapy, my doctor becomes all business. We are usually friends, but when I mention this his friendship cuts off. He is the one I talk to. His friendship means a lot to me." And so Dieter had continued to take the weekly injection in order to have those few moments of connection and understanding with his doctor.

The group of people with cancer listened intently. There was another silence, then Dieter said softly, "My doctor's love is as important to me as his chemotherapy, but he does not know."

Dieter's statement meant a great deal to me. I had not known, either. For a long time, I had carried the belief that as a physician my love didn't matter and the only thing of value I had to offer was my knowledge and skill. My training had argued me out of my truth. Medicine is as close to love as it is to science, and its relationships matter even at the edge of life itself.

But I had yet another connection to Dieter's story: his oncologist was one of my patients. Week after week, from the depths of a chronic depression this physician would tell me that no one cared about him, he didn't matter to anyone, he was just another white coat in the hospital, a mortgage payment to his wife, a tuition check to his son. No one would notice if he vanished as long as someone was there to make rounds or take out the garbage. So here is Dieter, bringing the same validation, the same healing to his doctor that he brought to me, but his doctor, caught up in a sense of failure because he can not cure cancer, cannot receive it.

(23:10–25:30) Music Element
"Sundust" from Unspeakable, performed by Bill Frisell

(26:00) Rates of Depression in Healthcare Professions
In a 2007 study published the U.S. Department of Health, healthcare professionals had the fourth highest rate of "major depressive episodes" among members of the workforce. The three professional categories with the highest rates of depression all had a component of service involved. (By contrast, the same study lists engineers, architects, and surveyors as the professional groups with the lowest rates of depression.)

According to a 2003 report in The New York Times, depression among healthcare professionals often is often underreported and goes unaddressed because it may signify a perceived weakness rather than considering it an illness.

…the rate of depression among doctors — about 12 percent suffer an episode of clinical depression at some point in life, according to one study &151; parallels that of the general public, and research suggests that they are at higher risk for suicide. An analysis of 14 international studies conducted from 1963 to 1991, for instance, found that men in medicine had a risk of suicide 1.1 to 3.4 times as great as that of the general population. Among women, the risk was 2.5 to 5.7 times as high.

contends that medical professionals fear their credibility will be damaged and career aspirations thwarted if they admit having depression.

(26:13–26:53) Music Element
"String Quartet No. 3 Op. 22: III Ruhige Viertel. Stets Fliebend" from Weill, Schulhoff, Hindemith: String Quartets, performed by the Brandis Quartet

(26:34) Second Reading from Kitchen Table Wisdom
In the following extended passage from Kitchen Table Wisdom, Remen writes about some of her lessons from practicing medicine and living life by way of stories:

It is not possible to be in a twenty-four-hour-a-day intensive training program for many years and not be changed by it. We worked seven days a week, thirty-six straight hours on and twelve hours off, for most of it. When we were off we slept. Denial of the body, its needs for sleep, comfort, and even food, was the very foundation of the schedule. No one complained. It was just the way that we all lived. Many of the rooms I worked and studied in had no windows. Often I did not know what day it was or even the time. I remember watching the nursing shift going past me, day after day. I would look up and see Miss Harrison and know it must be morning again. Often I had not slept since I had last seen her. Once during my internship, my mother, visiting me in the house staff residence, was horrified to open my closet and find that I did not have a winter coat. "Where is your coat?" she gasped. I had not known it was winter. I had not been outside the hospital and its underground tunnel systems in over a year.

On one very rare summer afternoon off I remember traveling home to visit my parents on the subway, realizing only after a while that I had been unconsciously scanning the veins of the bare-armed people around me, wondering whether my skills with a needle were good enough to allow me to successfully draw blood from them. This sort of training changes the way you see things, the way you think. Gradually things that had been central in my previous life became vague and faded into the background and other things more heavily rewarded became overdeveloped. After a time I just forgot many important things.

(27:49–28:21) Music Element
"String Quartet No. 3 Op. 22: III Ruhige Viertel. Stets Fliebend" from Weill, Schulhoff, Hindemith: String Quartets, performed by the Brandis Quartet

(28:17) Course: "The Healer's Art"
"The Healer's Art: Awakening the Heart of Medicine" is a medical school curriculum designed by Rachel Naomi Remen and was first taught at the University of California - San Francisco in 1993. The course addresses the growing loss of meaning and commitment experienced by physicians nationwide under the stresses of today's health care system.

(33:39–34:38) Music Element
"Pavane Pour la Belle au Bois Dormante" from Modern Mandolin Quartet, performed by The Modern Mandolin Quartet

(33:46) Third Reading from Kitchen Table Wisdom
In this extended excerpt from Kitchen Table Wisdom, Remen questions the concept of scientific objectivity in the chapter, "Healing at a Distance":

People who are physicians have been trained to believe that it is a scientific objectivity that makes them most effective in their efforts to understand and resolve the pain others bring them, and a mental distance that protects them from becoming wounded by this difficult work. It is an extremely demanding training. Yet objectivity makes us far more vulnerable emotionally than compassion or a simple humanity. Objectivity separates us from the life around us and within us. We are wounded by that life just the same; it is only the healing which cannot reach us. Physicians pay a terrible price for their objectivity. Objectivity is not whole. In the objective stance no one can draw on their own human strengths, no one can cry, or accept comfort, or find meaning, or pray. No one who is untouched by it can really understand the life around them either.

(38:07–40:46) Music Element
"When April May" from Adams Cox Fink Fox, performed by Rick Cox

(39:01) Fourth Passage from Kitchen Table Wisdom
This passage was excerpted from Rachel Naomi Remen's Kitchen Table Wisdom.

I teach a course now at our local medical school to the first- and second-year students. In one of the evening seminars, we explore our attitudes toward loss, uncover some of the beliefs about loss we inherited from our families, identify our habitual strategies with loss, and examine what we do instead of grieving. This is often a rich and deeply moving experience which allows the students to know themselves and each other in different ways.

At the close of one of these evenings, a woman student stood and told me that her class had already been given two lectures on grieving by the department of psychiatry. I had not known this and I apologized, saying that it might have been better to choose another topic for the evening's discussion. "Oh no," she said, "it was different. They taught us grief theory and how to recognize when our patients are grieving a loss. And be respectful of that. They just didn't say that we would have anything to grieve."

The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. This sort of denial is no small matter. The way we deal with loss shapes our capacity to be present to life more than anything else. The way we protect ourselves from loss may be the way in which we distance ourselves from life.

Protecting ourselves from loss rather than grieving and healing our losses is one of the major causes of burnout. Very few of the professionals I have treated for burnout actually came in saying that they were burned out. I don't think most of them knew. The most common thing I've been told is, "There's something wrong with me. I don't care anymore. Terrible things happen in front of me and I feel nothing."

Yet people who really don't care are rarely vulnerable to burnout. Psychopaths don't burn out. There are no burned-out tyrants or dictators. Only people who do care can get to this place of numbness. We burn out not because we don't care but because we don't grieve. We burn out because we have allowed our hearts to become so filled with loss that we have no room left to care.

(46:54–47:21) Music Element
"Nocturne, in C major, Op. 41/1" from Blackwood Plays Blackwood, performed by Easley Blackwood

(48:32–52:38) Music Element
"Adams: Hymning Slews" from Steve Reich/John Adams: Variations/Shaker Loops, performed by The San Francisco Symphony and conducted by Edo de Waart

(49:08) Final Reading from Kitchen Table Wisdom
In the final reading from Kitchen Table Wisdom, Remen reflects on mystery in everyday life:

The most important questions don't seem to have ready answers. But the questions themselves have a healing power when they are shared. An answer is an invitation to stop thinking about something, to stop wondering. Life has no such stopping places, life is a process whose every event is connected to the moment that just went by. An unanswered question is a fine traveling companion. It sharpens your eye for the road.

As a freshman in medical school, I had been randomly selected as class photographer and given a camera to take pictures for the yearbook. I took pictures for four years. At first I felt burdened by the responsibility, the need to carry the heavy camera with me to class, to remember to look at things. But in time, the camera caused me to see my ordinary surroundings far more clearly, to become aware of beauty around me in some very unlikely places. It had given me new eyes. A good question is like that Zeiss.

In some fairy tales there is a magic word which has the power to undo the spell that has imprisoned someone and free them. When I was small, I would wait anxiously until the prince or the princess stumbled on the formula and said the healing words that would release them into life. Usually the words were some sort of nonsense like "Shazam." My magic words have turned out to be "I don't know."