My father’s academic career propelled moves to college communities across the country, from northern Maine to Seattle, and eventually back to Nebraska. With my mother’s love of reading, every move had us boxing up hundreds of books and systematically reshelving them in our new places.

I always had a book in hand, whether nestled at home or in the dusty stacks of the college library waiting for my father to finish his work day. I was fascinated with the stories that explored the edge of what might be possible in the world: mythology, fantasy, biography, and eventually philosophy and theology.

When I decided to pursue a medical career, I knew I could manage Physiology and Pharmacology and the basic sciences, but what I loved was story-telling about the Big Questions. I hoped to find those stories and to hold them in ethical action as a physician.

I was not disappointed; in fact, I was overwhelmed. As a medical student in Chicago, my first clinical experiences occurred at the height of the AIDS epidemic. At that time, AIDS was the number one killer of people my age in the U.S., and it turned the health care system inside-out with questions that challenged old authorities, power structures and dogma.

My patients were incredibly diverse: veterans, homeless, adolescent mothers, immigrants, professionals, working people. As they brought me their stories and needs, the city’s hospitals were full of almost unfathomable suffering and despair, as well as beauty and generosity.

And there were no stories like the ones in Psychiatry, which suited my passion for deep listening, ethics, and mystery. No matter how many of my instructors wanted to insist that neuroscience and standardization of treatment was the future of psychiatric medicine, story-telling was always the yin of heart and spirit that balanced the yang of diagnosis and therapies.

“When the uncarved block goes to the craftsman, it is transformed into something useful.”

I hoped that specializing in Psychiatry would shape me into a useful partner to my patients’ suffering story-telling. But in the 1990’s, the impetus to sub-caption each mental health story with “This is a Broken Brain,” and to restrict inquiry and observations to that which learned-others had categorized and manualized as “evidence-based” was too-often tedious and dehumanizing.

Senior colleagues were sympathetic, and with their support for a pivot to bioethics, I balanced ongoing clinical work with a re-immersion into Religious Studies, finding my way to the wonder of phenomenology and existentialism.

At the same time, my hospital-based psychiatric practice increasingly turned to the mental health care of patients who were struggling with severe physical co-morbidities like cancer and other life-threatening illnesses, and to palliative medicine. In these healing spaces, existential questions are not armchair philosophy.

“Academia confuses knowledge with knowing.”

So while studies and books fed my curious nature with a generosity of ideas, it was sitting with patients facing sickness-unto-death that called forth the ongoing metamorphosis from head-knowledge to a deeper knowing-together. Who am I? What is the meaning of my life? Or of my death? Why am I suffering? Where is love? And meaning?

But the practice of academic medicine was becoming increasingly standardized, codified, commodified, risk-managed and loaded into electronic databases. I was scheduled into short slots with long lists of patients to be seen and told to leave the humanistic questions to others.

Third-party payers don’t reimburse for much humanism at the bedside. Burnout has been called “an erosion of soul,” and I arrived at that edge.