God Only Knows

By James S. Goodwin

“You don’t understand,” he said.  “You don’t understand. God understands.” He was a muscular man in his seventies, diagnosed with non-operable lung cancer a few weeks earlier, who had undergone a very unpleasant round of chemotherapy.  He was ready to call it quits.  I had met him for the first time the day before. We had discussed the pros and cons of further chemotherapy versus hospice care, and he had decided on the latter. But today he was transformed. Today he would talk of nothing but God.

“I am dying,” he said. I agreed, but explained to him that he probably had several months to live. I discussed likely scenarios for how his illness might evolve. “You don’t understand,” he whispered again. “God understands. You don’t understand.”

I have never felt entirely comfortable discussing religious topics. I misplaced my faith somewhere during my time at a Benedictine high school.  I figured that I understood why some people were religious, but that it just did not make sense.  I was not all that vocal in my atheism.  I did not pick fights, or engage in nightlong discussions.  It would have been a waste of time.  I respected the opinions of religious people, even if my respect was tinged with condescension.

The condescension did not long survive my marriage to a medical school classmate whose worldview was rooted in religion. There are probably many long marriages stabilized by condescension (the parents in Pride and Prejudice come to mind), but in my situation it would have been suicidal.  My adaptation was to compartmentalize my atheism. I came to see religious belief as a talent, something akin to a deep appreciation for music or poetry (which I also lacked).  This approach has served me well as a husband.  However, it is no help in doctoring.

“Sorry, I don’t have the talent for religion,” seems so inappropriate when a patient grasps my hand and asks me to pray with her. Clearly, this is not the time to talk about me.  Something heartfelt is required, but my mind gets in the way. Sometimes I fake it, telling myself that it really isn’t about me at all. This approach should work better than it does.

“Sorry, I don’t have the talent for religion,” seems so inappropriate when a patient grasps my hand and asks me to pray with her.

My patient was lying across his bed, naked, his head jammed against the bedrail.  I was so overwhelmingly frustrated. This man had decided to die, and he was doing it. “I just want to help you. You look so uncomfortable.” “You don’t understand,” he replied.”“God understands.”

I suppose I could have written it all off as delirium, but he wasn’t delirious. Not really. He was very, very focused, and absolutely certain that what I had to say was of no conceivable interest to him.

The next day I talked less, sitting by his bed, holding his hand. “You are on the borderline of understanding,” he said.  “You are close to understanding. God understands.”

But why did he have to die now?  Why wouldn’t he let me help him? Why stop eating and drinking, and die in a few days (in the end it only took him five days), instead of going home to be with his large, loving family?

“You don’t understand,” he said. It was the third day.  His family had fled. I had spent forty minutes bent over his bed, my back hurting, my left (good) ear close to his mouth, as he whispered about God. My eyes filled with tears.

“You’re right. I don’t understand. I’m sorry. I just don’t understand.” Then he reached up and pulled my head down the final two inches, and he kissed me.

Honest. He kissed me. Maybe that’s how it feels to get a message from God. It’s as close as this atheist is likely to get.

James S. Goodwin is professor and chief medical director of geriatric medicine at UTMB. This essay originally appeared in The Lancet.