Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Travelers on an Unfamiliar Road


A rabbi once taught me the distinction between curing and caring. As I accompany patients on the rough road of illness, I consider ways to make their journey a little smoother. 

I recently gave a talk about how clinicians can guide family meetings. I was very worried. Most of the participants were pretty experienced clinicians and I was nervous. I started talking—a lot. When I finally stopped to ask for questions, one of the first was about responding to the comment, “She’s a fighter.” 


The battle metaphor for coping with illness causes harm whenever it’s used. Instead, I try to help patients see themselves and their loved ones as travelers on an unfamiliar road in an unfamiliar place, driving an unfamiliar vehicle. Or maybe they’re passengers and the bus driver is a  bit dyspeptic. Or maybe it’s a small plane and the wind is whirling around them. The point is—it’s hard. We don’t have control. We don’t have foreknowledge or foresight. Lots of stuff is going to happen, and we can’t control it.  


The only things we can can control is in how we react to what happens. What we choose to do when the road turns muddy or the bridge washes out. Sometimes we can’t keep going down the road and we have to get out and walk, or we might even have to stop and camp out. If we get lucky, we might find a nice enough place to camp for a while. Occasionally, we get really lucky and find the road that takes us home. Often, we can’t find a road to take us to home on earth, but we may be lucky enough to find a peaceful and dignified path to a final resting place. 


I hope this extended metaphor of journeying through illness, rather than contesting it, shows how we can talk to our patients about something very difficult and even talk about unwanted outcomes, without leading them, or ourselves, to think that we’re weak, or—worse—a loser.  


Many years ago, a rabbi taught me that we can’t confuse seeking healing with seeking a cure. Sometimes, are able to cure; however, many times, particularly in palliative care, I help with healing by making a rough road smoother, or by helping someone find a new destination (goal), or a new path to an old destination. 










This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.