Work as a mode of prayer: reflections of a palliative care physician

A very good afternoon to all—Archbishop Peter Comensoli, honoured guests, Kevin and Margaret Andrews, Dr Edward Simons head of Melbourne Archdiocese Catholic Schools, Mr Fergus Ryan, Bryon Pirola from EY and Angelo Calandra from Veritas Publishing, our generous sponsor for the day.

I acknowledge the Traditional Owners of the land on which we are meeting. I pay my respects to their Elders, past and present, and the Aboriginal Elders of other communities who may be here today.

I must firstly thank you all for attending today’s event. I was genuinely surprised to be invited to speak as I find myself, a palliative care physician, sandwiched between a KC and an AFL footballer. Pall care people are not frequently asked to social events, and public admission of our profession usually is a conversation stopper—though this can work in one’s favour on a long-haul flight.

I have been given a broad brief today. So, I start by thanking those whose conversations inspired me in preparation for today—Julie Fleming, Julia Trimboli, Dr Andrew Mullins, Carmen Parvia and Bella Matthey.

A common question patients ask me is, ‘Where are you from, Dr Michael?’ Most are surprised to encounter an Indian face with an Irish twang, expecting a Russian blond with a name like Natasha. It usually starts an ice-breaking conversation: ‘You have three goes,’ I say. ‘Only 5 per cent thus far have got it right.’ India, Pakistan and Fiji are common choices. ‘Three strikes, and you are out!’

I grew up in a small town outside of the state of Pahang in Malaysia. My early life and devotion of my parents, grandparents and extended family were undoubtedly significant in shaping me. My father was the seventh of 14 children, and the only one to complete a tertiary education, training in teaching and administration. Thus, he took on the caretaker role of his large and somewhat complex family. His childhood was fragmented, and I know little about his early life, though, like many large Catholic families of the time, his older brother Uncle Felix became a diocesan priest and served for many years in the Bronx in New York. His sister, our fun, motorbike-riding Aunty Stella, is an Infant Jesus nun and continues to work in the deeper slums of Kuala Lumpur.

My mother, an English and literature teacher, came from a well-heeled Catholic family. She was the second of eight children. Her maternal family was blessed by the presence of our Uncle Bishop, the late Tan Sri Dominic Vendargon, who was the first appointed Asian Archbishop of Kuala Lumpur. Captured and tortured by the Japanese as a young priest during the occupation, his extraordinary life of service, grace and humility had a lasting impact on many who knew him. He was responsible for the early growth of Catholic institutions, schools and churches in Malaysia. He was mainly responsible for fostering interfaith dialogue early on amongst leaders of the various faith groups. He was my grandma Doris’ loved older brother. As children, we were regularly driven to the Archbishop’s home in Bukit Nanas to drop deliveries of Grandma Doris’ fish cutlets or curry puffs. Likewise, as children, we were regular visitors to the Carmelites in Singapore, where his sister, Sr John Mary of the Cross, was a member of the enclosed order for 80 years.

My early childhood was idyllic. I grew up amongst rubber plantations, fishing in monsoon drains with my sisters, killing snakes and chasing mongoose, and with my father, we sought wild honey and wild boar and picnicked by clear waterfalls deep in the rain forests.

My father was a charismatic man, known for his penchant for dealing with naughty boys, and was the principal of the local Catholic High School, subsequently working with the De La Salle and then the Montfort brothers. As a young child, I asked him, ‘Dad, why do you call the boys “son”? They are not your sons!’ It was only years later that I was informed by the De La Salle boys that if you got into trouble at school and ended up in Rex Michael’s office, he would say, ‘Sit down, son’ and offer you a cigarette and then say, ‘Now tell me what the problem is.’

Kipling says in his infamous poem ‘If’, ‘If you can talk with crowds and keep your virtue and walk with kings and not lose your common touch’—that describes my father. Our home was filled with senior staff members and ministers for meals, and later in the evening, the cleaners, a homeless man he picked up and, over the early years, many of his siblings and nephews who suffered from broken marriages, abandonment or ill health. He did this with the support of my mother, who bore much but was a steady, silent oak.

My parents’ involvement in Catholic education and as activists during the racial riots in Malaysia possibly spurred their early involvement with many Catholic organisations and activities. They were doers and not talkers. As a child, I was taken regularly to the Little Sisters of the Poor in Cheras, where the sisters cared for many of the retired priests and brothers who mentored my father and, subsequently, my Uncle Bishop and my father’s brother Uncle Joe.

My childhood memories of faith were of devotional activities. Prayers and rosaries were said regularly at my grandparents’. There was the annual consecration of the family to the Sacred Heart of Jesus and visits to the shrine of St Jude and St Anne on feast days. Devotional Catholicism forms the basis of much of what we see in faith formation in the East. The regular practice of ritual and devotion provides a rhythm and synchrony to one’s faith, a safe environment where faith can be part of a cultural experience, more so than an individual pursuit.

At age 10 we were moved to the city to ensure a secure education at Assunta Convent. What seemed to me like a simple decision was part of a broader plan worked out by my father. Indians and Chinese were increasingly persecuted, which formed the start of a positive-discrimination strategy devised by the government to support the majority race and religion. My first actual encounter with this was at the age of 11 when an administrator entered the classroom—all those with straight As to stand. Lim Siew Ming and I were asked to be seated again. We failed to meet the criteria of race and creed, and many such examples followed in subsequent years.

Nonetheless, my high school years were happy and possibly the start of the maturing of my faith. This was when my involvement with the Young Catholic Students’ Society started. These societies were the basis for many young people heading off to church camps and fellowships. My exposure to Ignatian spirituality fuelled a contemplative and discerning side of me that I never knew existed.

At the age of 16, I led the formation of the Inter-school Catholic Students’ Council, which brought together all Catholic societies across schools in Kuala Lumpur. Wonderful friendships were formed and continue to prevail as we settled across the globe. The extraordinary thing about my early years is that concurrently I was surrounded by friends who were Buddhist, Hindu, Muslim, Sikh and of other Christian denominations. Since my teens, I have visited temples and mosques and understood ancestry worship, funeral pyres and the burning of effigies. We understood and respected the traditions and customs of each other, and this only deepened the love I have for my own faith. It was in these latter teen years that I frequently visited my church after college on a Friday to attend the exposition of the Eucharist and benediction. It was the start of my understanding that I found God through solitude and quiet.

My subsequent arrival at Leeds University marked the start of many challenging years for our family. Educating four children abroad on a salary of a secondary school principal and a college lecturer was no joke. It was a time of intense realisation for me of my parents’ sacrifices to make a better life for us. I arrived in the UK feeling terribly alone and afraid, but we simply got on with things.

My years in Leeds were undoubtedly some of the best years of my life and a phase where my faith was to grow in yet another direction. Devotional Catholicism of the East does not service the intellectual challenges we face in the West, particularly in the absence of culture and societal cohesion. Churches were cold and empty, and fellowship was non-existent in the local parishes. I found a place at the University Catholic Chaplaincy, where I attended weekday and Sunday Mass and enjoyed the friendship and humour of the chaplain, Fr Peter Clark.

Pete, as we called him, was a jovial, tall and imposing Bradford man. It was clear that the joy and mischief of young people fulfilled him as we teased him relentlessly about his love for Marks & Spencer takeaways and addiction to Coronation Street. I moved in in my second year. Fr Pete became aware of the financial stresses on my family and allowed me to stay on in my 3rd and 4th year, moving into a small room rent-free in exchange for being the resident cleaner!

They were challenging but happy years. We hiked the dales and drank cider and pints by the river. Phone calls home were expensive and occurred infrequently, but regular aerogram letters from my parents were a welcome arrival. I returned home three times over five years. A highlight would have been the three months I spent as a student completing my electives in Zambia and then hitchhiking across Zambia, Malawi and Zimbabwe, much to the despair of my parents.

These years were also a time of intense stress, with a noticeable decline in my father’s health. I recall his tears of anguish one summer as he struggled to find the funds to pay for the next set of university fees due for my sisters in Washington and Minnesota and me. A large bank loan on the proviso that I would pay this off upon commencing my working life alleviated some of his anxieties.

It was at this time that I stumbled across the writings and meditational prayers of St Theresa of Avila.

Let nothing disturb you, let nothing frighten you; all things are passing away, God never changes.

This became and remains a regular meditation for me in times of trial.

It was also during this time at the chaplaincy that I met the Guild of Catholic Doctors. What I admired deeply about the Guild was that they were ordinary Catholic doctors: GPs, physicians or hospital administrators. None worked in Catholic hospitals (which are non-existent in the UK), but they brought to their work the joy, love and professionalism that they cultivated within themselves through their faith. The Guild stayed uninvolved in political matters but nurtured professionalism and intellectual formation within the context of the Catholic faith.

It was at these meetings that I became aware of the Linacre Centre (now known as the Anscombe Centre) and where I received an introduction to the field of bioethics. My final two years of medical school were transformative as I entered the clinical space and enjoyed patient encounters, and realised that I had the ability to make the sick feel at ease. I enjoyed the banter of the Yorkshire people, their simplicity and ordinariness.

But this was also the time I fell in love. In the basement of the Leeds cathedral, amongst a group of young students, I met a chatty Irish lad. Eugene was a breath of fresh air, with his encyclopaedic knowledge of European history and horticulture. We shared a love of music and the outdoors, but my time spent with him exposed a significant gap in my faith formation—which was a formation in the intellectual tradition of the Catholic faith.

The cathedral group became firm and fast friends; faith and friendship were the basis of our fortnightly or monthly gatherings. Over time, we each found our vocations: marriage, a vocation to the Dominicans and, for another, as a theological scholar. The coming together of young people through these means—to exchange ideas, grow in knowledge and sharing of fellowship—is critical for the Church of the future. I was delighted recently to hear Archbishop Comensoli’s St Patrick’s Day address, where he correctly pointed out that despite our laments, young Catholics were present and actively seeking God.

I relocated to Ireland to complete my medical training and commence my postgraduate training in palliative care. Palliative care in Ireland is a magical experience. The Irish do the dying well. The soulfulness of the county, its mystic relationship with poetry, folklore, lyrical beauty and the nadur or nature of the Irish people, lends itself to a unique experience. The process of dying in the west of Ireland is somewhat sacred, with the maintaining of rituals and traditions of bedside prayers, vigils and wakes that lend themselves to the acceptance of the inevitability of death.

My early years there were also a time of sadness, with the sudden but unsurprising loss of my father in my 20s and the short years of watching my sister-in-law deteriorate and die of a brain tumour. I was her weekend driver and companion in my mid-20s as she trawled the markets of Clonmel with me, seeking organic carrots, miso soup and seaweed—a desperation I see commonly in our patients. I spent many a night staying with Noreen and her husband Phil on their farm as steroids ravaged her beautiful Irish frame, and she rummaged through her collection of silk dresses, trying to find a fit for a swollen and now rotund figure. We would sit together in the supermarket carpark, waiting for her seizures to pass before I took her home to her mother. This was our secret.

Noreen’s loss was profound and provided me with a deep understanding of the impact of loss on family cohesion, grief and recovery. It was a time when I experienced the love and care of my hospice colleagues in Limerick. Many were surprised to hear that these experiences were the reasons I left the palliative care training program after a year—I realised quickly that I was too young and needed to mature both professionally and personally if I were to re-enter the space.

I have been blessed to have entered a profession that has been so rewarding. Every patient walks into a hospital vulnerable. A blood test or scan report changes the course of one’s life forever. In my world, this vulnerability is accentuated by a visible horizon. Some come with acceptance, many ambivalence, and not too infrequently, we meet denial. To face one’s mortality requires a tremendous amount of courage. Uncertainty and existential anguish fuel demoralisation and despair. The elixir of hope is critical, and many in health care fail to appreciate that they are the vessels of hope.

I was fortunate to have trained with wonderful mentors, Tony O’Brien and Sinead Donnelly in Ireland, and the late Cynthia Goh in Singapore. They were visions of grace at the bedside. The tools they taught me were simply your eyes, ears, hands and a chair. Working with and training nursing and allied-health staff in the developing world in Malaysia, Thailand and Vietnam was a truly humbling experience. With scarce resources, they tend to the needs of so many. I now gain the greatest pleasure in my evening or weekend rounds. Away from the bustle of ringing phones and interrupted ward rounds, I can simply pull up a chair. Our trainees, young nurses and students are a source of deep satisfaction as we impart knowledge and supervise studies.

The University of Notre Dame, for seven years, provided our service with the pleasure of having students with us at Cabrini. Their curiosity and professionalism were inspiring to watch. Over the last few years, I have enjoyed the privilege of the tutelage of Prof David Kissane. His guidance as I completed my doctorate was invaluable as I gained from his 25 years of scholarship and wisdom.

Building a service and team over the last 10 years has been the most rewarding and challenging experience of my career. I have been blessed to have been part of an organisation that has embraced palliative care. With the approval of the Cabrini sisters 22 years years ago, Cabrini Prahran was built, and with a supportive CEO and Executive, the service continues, and enters a new and welcomed phase.

Nonetheless, I am known for being forthright and having a no-nonsense attitude to ensure the service is sustained and meets the needs of the vulnerable. My favourite description must be, ‘Natasha, you are actually a surgeon, just dressed up as a palliative care doctor!’ When times are tough—and trust me, I have had plenty of this—I have learnt to lower my gaze. Lowering your gaze returns you to your primary focus, patient care. And I pray.

Saying goodbye is hard. On Monday, after a busy clinic of eight patients aged 35 to 83, I visited an old friend in a nearby hospital. I had cared for his young wife seven years ago, his brother four years ago, and for the last two, I have cared for him. His son simply wept as I arrived, possibly recalling my many visits to his home when we cared for his mother. He was half the man I knew, and as he drew my hand to his mouth to kiss it, I stopped short of saying ‘Goodbye, dear friend.’ At the end of the day, I sought solace from an old ritual. I attended a meditation, benediction and sat alone.

One is taught to pray, but how does one learn to pray? For me, the transformation had to be from one of the mind to the heart. St Therese of Lisieux says that prayer is the surge of the heart, and St Teresa of Avila speaks of the reciprocity that occurs between God and us when we pray. But for me, prayer is most notably found in the every day, in the ordinary, in the encounters.

A certain spirit of contemplation is proper in the life of every Christian. We should all be contemplatives in the corner of the world where we work and live. The awareness of the presence of God helps make real to us this supernatural dimension of our lives, never losing sight of him during the rush and activity of human events, the stresses and strains of workplace relations.

The way of living this norm is very personal. The emotional intensity of my job demands that I actively seek this opportunity for contemplation. I sometimes play the piano at work simply to clear my mind, and my academic writing takes my mind to a restful place of creativity.

My constant exposure to the dying reminds me of our divine filiation: the fact that we are daughters and sons of God is a basic truth in the economy of salvation. In a single moment, with the drawing of the last breath, life gives way to death. It is quite a privilege to witness this moment as a family member or clinician. To consider our divine filiation is to become aware of the reality of our situation and to live in the light of God our Father. Divine providence—God’s watching out for us with the love of a Father.

Work, for me, has always been a mode of prayer. The sanctification of work and sanctifiable reality of work: work gives us dignity of life. To live well the norm of work, we need to work well—with intensity and supernatural awareness. This means we must avoid sloppiness, laziness, meanness and pietistic pretence. Each person ought to work at what interests him and what he is naturally suited for, always striving to be a good professional person. Most of us likely have a long way to go to achieve this goal. We need to love our work.

Most important is our need to ensure joy and love are present in our workplace. Cheerfulness is a virtue proper to Christians. This Christian virtue of cheerfulness or joy indicates the fullness or depth of one’s interior life. Our Feelgood Fridays on our palliative care ward manifest this cheerfulness we espouse to achieve. Our multidisciplinary meetings on Tuesday are interrupted with morning tea as we share fellowship, stories of life outside of work and our commonality. I particularly enjoy our two-monthly breakfast sessions with our trainees.

I end today by speaking of the most crucial part of my life: my family. I have been incredibly blessed with a most patient and tolerant (some may say long-suffering) husband and three wonderful daughters.

My youngest stated to me, ‘Why would I want to come to hear you speak, Mum? I have to listen to you every day!’ followed by, ‘You mean people will actually pay $200 to hear you speak?’ A family favourite is, ‘You have to be dying to get any attention in this house’ and ‘You are very good at the start and end of life, Mum, but you are not very good in the middle!’ As a family, we have endured many difficult times. This includes our relocation to Australia following the GFC, and our need to alter our life patterns and plans dramatically following the premature birth of our child Alannah, weighing all but 900 grams.

Our story with her is one of hope drawn out of prayer and her father’s extraordinary sacrifice. Few know the stresses we endured and her tremendous ability to transcend her own sufferings. A source of great pride has been watching her overcome many obstacles, achieving independence and scholastic success and her sister’s willingness to step up to support, encourage and accompany her at the most challenging times. I will freely admit that I endured much spiritual doubt during some of the most difficult years. Herein lies the lesson of seeking the grace of the sacraments and gaining some spiritual direction. Our Lady was my constant companion in these times. As a mother, I turned daily to Our Mother. I simply contemplated her face. My experience with our child was a lesson in the need for optimism and hope, even in the most trying of times.

All Catholic parents at this age face the challenge of passing their faith on to their children. I have learnt that just as my patients have a trajectory of illness, my faith journey has had and will continue to have its own trajectory. Doubt, anger, abandonment and rejection are part of this journey. The beauty is that the compass can constantly be realigned, and the door is always open. We remind our children of the need to use their gifts for others, to serve and seek solace through prayer. As they become young adults, I enjoy watching them discern decisions and make choices of faith, significant others and career paths. This is their journey. As a mother, I have learnt to pray for them and accompany them.

To the young people in this room, and by that I mean anybody under the age of 49: drink from many wells. Work and family alone will not sustain you. Seek opportunities to volunteer, give of your time and be of service. Cancel the words ‘too busy’ from your vocabulary. Life is too short. Surround yourself with greatness—greatness of mind, heart and spirit, kindness and kinship. Foster the virtues of courage, fortitude, hope and love within you. Demonstrate magnanimity and humility in your workplace; they go hand in hand. Make way for others. I gain great joy in the idea of stepping down from my position as Director and handing over the baton of leadership to another. I have relished the opportunity given to me to work with Villa Maria Catholic Homes and the sisters and know that life remains full of possibilities.

Put your hand up. Be doers and not talkers. Share your faith with others and be curious about other faiths. Visit temples, mosques and synagogues. Seek to come together as we have done today. Be creative and imaginative in your ideas and endeavours. Regardless of your personal opinions, support your Church and Bishop. Avoid sectarianism; it serves no one. Remember, the Bishop, too, has a position description. Lastly and most importantly, find a way to be contemplative and prayerful. There are many rooms in God’s house. Be faithful to the sacraments, open your hearts to God and always listen to your mother!