If Christ were in charge of health care.

EARLY LAST SUMMER, MY WIFE, Denise, and I were in California working on the practical details of a move from Oklahoma. A significant one of these details was arranging for a new oncologist. The questions, issues, and judgments that arose prodded us to consider the shape of an adequate future health-care system. What would a helpful Christian theology of health care entail? How should Catholics think about living and dying, health and sickness, patients and doctors, and the body, the mind, the spirit?

Why do we need a theology of health care? First, because we need a theology of everything and anything--all things come from God and only find their proper niche under God, against the unlimited horizon of God. Second, because the going horizon of medicine, doctors' offices, and hospitals is still mechanistic. It does well by the body. But by the mind and the spirit, with questions of meaning and peace of soul, the going horizon is at best amateur. Patients and health-care professionals are more than their bodies. The crux of any sane, mature person's life is not a sparkling cholesterol score but meaning. To get to the meaning--what life is for--you have to pass by death, the dark gatekeeper. Theologians are often foolish, but their work itself, their discipline, dances with death.

Catholics ought to think about dying and living in light of the hopeful high Christology at the center of their tradition. For faithful Catholic Christians, the view of Christ laid out in the Gospel of John and the Council of Chalcedon makes human existence sacramental: the Word became flesh. After entering all proper historical and theological nuances, I find this high Christology and sacramentality to be the Catholic core. Because Jesus is both fully human and fully divine, he is the center of material creation--the primal sign of what the world means.

I call this Christology hopeful because it provides clear theological reasons to think that God has opened the divine hand, the divine heart, to offer us what only divinity itself possesses--deathlessness. The life brimming from the Christ in John's gospel, the Word become flesh, is the very life from which issues anything that is. If Christ is not divine (if Christology is low), we have from him no deathlessness. With no deathlessness, our hopes are meager.

On the oncology ward, theologians, such as myself, can easily find themselves thinking about measures. Are their days numbered, and if so, by whom? Who is the ultimate agent of the rotting in their marrow? Beyond the mindless cloning, who is running the universal machine? Such theologians or less convoluted laypeople will get no more than startlement if they take their musings to a typical physician. A typical physician is trained to deal with toxins and steroids, melphalan to whack the myeloma here, dexamethasone to boost the marrow there. How the mind handles these chemotherapeutical assaults and what the spirit makes of the cancer that defeats them fall into a great silence. Sherwin Nuland, currently the hot guru on how we die, barely croaks about ultimate meaning. In his work nothing transcendent redeems death from waste and ugliness. We live and die in a flat land.

Different indeed is the round, sacramental view of the human being--body, mind, and spirit--that a Catholic Christian theology can sponsor. In virtue of the divine Word's becoming flesh, all flesh is holy--matter is capable of sacred meaning. Minimally this faith says that God cares for human flesh, knowing it as God's own. People whose flesh is breaking down can let God anoint it with a balm of promise. The promise is that God will not let any of our accomplishments or our losses go to waste. Somehow God will wipe every tear from our eyes, and death will be no more.

Serious illness pushes physical reality in your face. Pain, pus, fractures, feces--serious illness is primitive. In ministering to the broken body, alleviating physical pain, those providing medical care lay hands on our primitive condition. We are dust that is somehow given a breath that rounds us into flesh. This is wonderful--truly mysterious--as the best physicians know. The intricacies of the immune system, the circulation of the lymph, create an impressive dignity. The precisely medical dimension of health care works best when it works from this dignity. From a Catholic perspective, such work is liturgical--a provision of powerful signs. The meaning of sickness comes to include a breakdown that invites compassion. The meaning of health gains an appreciation of many graces that invite gratitude.

THE HEALTHIEST OF BODIES BREAK DOWN, the best of physical specimens can end up unable to crawl. We all die--doctors and nurses included. Therefore, we all ought to think about death, to be realistic. We all are obliged to probe what life can mean. Most of the people one meets in a hospital, either caregivers or patients, have taken up this obligation.

Yet, to date, the mental dimension of sickness goes undertreated. To neglect a full consideration of death dilutes the experience of sickness. I believe that patients ought to take the initiative if they want their doctors to discuss death with them. I also believe that a Christian theology of death should remain modest. The resurrection of Jesus is stunning, nothing that any of us will ever comprehend. The experience of heavy pain is sobering, nothing that any of us ought to take casually. When you hurt so badly that you cannot think, you despise pious phrases. Here the milieu is mystery and the clouds create unknowing. Here we try to love beyond what we can understand and let God deal with us as God chooses. Often silence works better than speech. Often those who know mainly listen.

But regardless of what you think or feel, Christ hangs crucified in all Catholic chapels. The cynosure, the main attraction, of a Catholic theology of death will always be Christ's experience. After Jesus, we can think of death as our own necessary passage into the deathlessness of God.

We only exist, draw breath, come out of the big bang, and enter the stream of life through what Cardinal John Henry Newman called a "particular providence." Science cannot get excited about our individual characteristics or histories, but God has to put into place every pleat and stripe. Each action in my marrow, cancerous or healthy, is like a note under the hand of God the pianist. This can seem to make God my enemy, or it can seem to make cancer my friend. The human spirit can come to love these paradoxes. The simple abiding in the mysteriousness of God can bring a wonderful relief. For 15 or 20 billion years God has been guiding the mesons. It's child's play for God to make my last days the apple of her eye.

HOW CAN WE MARSHAL PRACTICAL MANEUvers toward more adequate future health care? Start with this exercise. Suppose that there are three major dimensions to human reality: physical, mental, and spiritual. Do not separate them or forget that they overlap and interact constantly. Face squarely the obligation to provide for all three. Each has its claims to preeminence. There is no necessity that they all compete and become antagonistic. At the end of your exercise, look at all the actors in the drama of health care--medical personnel, patients, conceptualists, and mystics--as simply people. The lives of all are short. None has ever seen God.

A Catholic Christian theology of health and illness counts nothing human as foreign. The Word became flesh, and as a result, died. In the room of a very sick person, on the wall, the mystery of his icon can seem endless.