by Danielle Davey Stulac
“It’s not the kind of thing you can hang in an office,” says Dr. Brewer Eberly, of his work of art, Sir Luke Fildes, the (Modern) Doctor, featured recently in The AMA Journal of Ethics. His piece modernizes Sir Luke Fildes’ 1891 painting, The Doctor, a “classic portrayal of physicianship” depicting “a physician’s attentive posture and presence toward his patient.” In Eberly’s diptych, the doctor’s gaze is fixed on a computer screen, which stands between him and the patient, “suggesting contemporary frustrations of burnout and bureaucracy in modern practice.” The gold-leaf in the background tells a different story. “A traditional symbol of sanctity among many artists and iconographers,” gold-leaf suggests “the sacred nature of patient-physician relationship.” It is “an echo of the idea of the kingdom of God breaking in to these moments of stark, depressing, empty screens.”
Eberly, a family medicine resident at AnMed Health, and Theology, Medicine, and Culture alumnus, says his passion for recovering beauty as the foundation of wise medical practice began in his childhood. Although he grew up in a medical family, he wanted to be an artist. He found himself fascinated with the beautiful covers of The Journal of the American Medical Association (JAMA), stacked up in the attic of his father’s office. He studied drawing, painting, and photography. At the same time, he says, “I remember vivid moments as a child seeing people in pain and just not understanding, and wanting it not to be the case.”
In high school, Eberly began to enjoy the sciences at the same time he encountered C.S. Lewis’s Mere Christianity, a book he literally could not put down. (When his teacher asked him to, he replied honestly, “I can’t.”) Reading Lewis, he “woke up to what the Christian vision really entailed,” and found his call to medicine awakening as well.
The year he started medical school was the year they stopped putting art on the cover of JAMA. “You can imagine how demoralizing that was,” he says. It’s a “perfect example of the instrumentalization and move to productivity and efficiency in modern medicine.” Anatomy lab, the first place every new medical student goes, became for him paradigmatic of this disenchantment:
“The first day is so profound. You are nudging shoulders with your classmates and you can see wonder and awe hanging in the air. Everyone is quiet and reverent and everyone has a deep sense that there is much more going on than we are even aware of. And the first year ends with us going into church spaces and we talk about gift of body ceremonies and we literally speak in this language of gratitude and gift towards the cadaver, whom we call “the first patient.” That experience is a symbol for what I think medical training could be and also a symbol of how quickly things fall apart literally as the cadaver falls apart— an apt metaphor for what happens to us. You immediately become consumed with worry because the prime drive of medical school is to match to a residency and pass boards, goals that are stripped of any deeper meaning of what’s going on. “Physicianship” is no longer a part of medical training in any way.”
Facing this disenchantment, after his third year of medical school Eberly enrolled in the Theology, Medicine, and Culture (TMC) Fellowship at Duke Divinity School. As a TMC Fellow, he experienced what he calls a re-enchantment with medicine. TMC taught him that, “there’s a beautiful way to look and talk about health. TMC woos people into a vision for what healthcare can look like.” Eberly particularly admires the practical wisdom of his mentors at TMC.
“As medical students, we are always prone to intellectual assent to ideas and to theologies of control; we need ideas; I love ideas. But we also need theologies of wonder and habits and practices. We’re all going to graduate knowing how to diagnose diabetes and answer a multiple-choice question in 72 seconds, but there’s a moral, philosophical, and ethical shaping that’s happening to us, and developing a language for that is vital. The problem with these discursive reasoning based lectures is that they’re never bound to practical action. TMC is rooted in a Christian imagination, which means we care about not vague subscription to core values but living in the world actively and faithfully in virtues and habits.”
Through his experiences as a TMC Fellow, Eberly says, he was changed not merely academically, but also morally and socially. He moved from cynicism and anger to hope and connection through the sharing of stories. He made lifelong friends and began writing about medicine and beauty.
Upon his return to medical school, Eberly started “Phronesis: A Forum for Medical Student Formation,” a monthly humanities forum for his fellow trainees. Gathered in a coffee shop for the first session, a dozen medical students listened together to Wendell Berry’s poem, “The Objective,” about the loss of wonder in modern industrial culture. It begins:
“Even while I dreamed I prayed that what I saw was only fear and no foretelling,
for I saw the last known landscape destroyed for the sake
of the objective, the soil bludgeoned, the rock blasted.
Those who had wanted to go home would never get there now….”
Eberly sees Berry’s “objective” as an apt metaphor for medical school. He says,
“All our presentations start with learning objectives. In our pursuit of these objectives that are helping us master board material we are losing sight of deeper questions that are relevant to what it means to be a doctor, which are questions about suffering and pain, being present with patients, and seeing them as whole persons and not pathological problems to be solved.”
The forum’s name, “Phronesis,” was inspired by the Aristotelian concept of “practical wisdom,” and was designed to offer a “parallel formation” for medical students, a forum for the development of habits and practices that disrupt the malformation he believes can result from conventional modern medical training. The curriculum was built on the premise that beauty, wonder, and awe are the foundation of moral formation. “Wonder orders our desires,” says Eberly. From this ground, Eberly engaged students in reflection on areas of tension in medical training, such as community and autonomy, professionalism and moral formation; and religion, spirituality, and theology in medical care. Texts ranged across genres, from film, to poetry to philosophy, to ethics.
At that first meeting, Eberly recalls, people cried. Fourth-years said they couldn’t believe something like this existed and wasn’t part of the standard curriculum. First-years told him he gave them language for their sense that something was missing, and their fear they might have to leave medical school because of it.
Since graduating from medical school and starting residency, Eberly has continued to write about ethics and beauty, and to create visual art. He is fiercely committed to an ethics grounded in a deeply Christian concept of beauty. The vision, he explains, is neither to “escape ugly things in medicine by baptizing yourself in art” nor to “escape the real world by reflecting on beautiful things that have nothing to do with our suffering neighbors.” Rather, “beauty entails a paradoxical descent into ugliness.” As he writes in a recent article for the Theopolis Institute, we need a cruciform beauty that, like Christ, has “descended into death.”
Eberly believes that beauty calls us to action. “Beauty is that which moves us toward the way things should be.” He imagines a kind of medical training in which passing boards is part and parcel with “being bound in the life of a type of moral community that makes possible the habits and practices we would hope from attentive, joyful physicians.”
Ethical action is not always easy to discern in an invigorating but demanding medical residency “where the good of extra time spent with patients always has to be measured against the good of time spent with my family,” says Eberly, who has two boys under age four at home. While a more comprehensive integration of countercultural practices into the modern medical machine may have to wait, he has found he has been able to introduce a few habits that ground him in the beauty and sanctity of the work.
For example, since he began his residency, the task he has found most difficult is pronouncing the death of a patient. “I was there for the fifth time pronouncing a patient dead, and nothing happened afterward. And you’re often paged to cover the death of a patient you’ve never seen before. It’s terrible.” Eberly realized he needed to recognize the sacredness of that moment in some way. He now goes to the hospital chapel briefly to pray the liturgy for the dead from the Book of Common Prayer. This practice, he observes, “has proven realistic and helped me significantly with closure, especially if it’s the middle of the night and I’m called to a code.”
COVID-19, he says, has been a kind of “clearing ground” for what really matters in medicine:
“Patients don’t want to just be treated as pathological problems. We all know this. It’s repeated ad nauseam. Yet, [the current necessity for] telemedicine has put this into stark relief. There’s something about being with a patient that triggers not only diagnostic and clinical reasoning that is distinct, but also somehow mysteriously bound up in their presence with you….Yes, there are tons of things that are seen in the ED that don’t need to be seen, but there is something about physically being with people that cannot be replaced.”
The pandemic has also brought into stark relief the loneliness of the elderly, many of whom are now abandoned and forgotten two-fold now, in nursing homes. “The nursing home is the loneliest place in medicine, I think, at least how I have experienced it. I’ve seen a few bloody codes, some bad traumas in the ED, and two-hour chest compression sessions in the ICU that are violent and terrible, but there is something about the elderly alone in the dark of their rooms that haunts me the most. I think COVID-19 has brought that immediately to mind.”
Presence and loneliness are among the topics Eberly discusses with medical students in the “Phronesis” forum he revived this summer. (During the session on beauty, “People again teared-up,” he says.) This month, he will launch an ethics forum for residents called ARETE (An-Med Resident Excellence in Teaching & Ethics). Meeting in thirty sessions over the next three years, he and his colleagues at AnMed will engage large questions like, “what is medicine for?” in addition to “cases specific to the community-grounding their ethical conversations in events that pertain to us directly.” Eberly is genuinely curious if a forum like this can make a difference in the culture of medicine. “I still sometimes wonder if ethics really matter,” he admits. But, he hopes that through these conversations and practices, they might behold the gold-leaf behind their patients and computer screens, and rediscover the sanctity of their work as physicians.