What and How Do Not matter Any More

Physicians receive many letters from their doctors, some touching, some insulting. Most of them go unanswered. I also received a large number of notes and letters from my patients, most of which, I embarrassingly admit, went unanswered.

Below is a letter which I received from a patient diagnosed with ALS (Lou Gehrig disease) by five neurologists. I wanted to answer but couldn’t. I didn’t think I really could do so and decided to respond to it in person during the next visit.


Dear Dr. Ali,

I may be doing the last of my handwriting so I decided to write and not type. I have experienced exciting changes over the past couple months. Although I am a little concerned about losing my right arm (my left has been gone for two years) and some/most of my independence, I feel like the good things far outweigh the bad. I have discovered spirituality for the first time in my life. I was always running—I was ambitious and aggressive as many others are in business USA. I always thought God was man-made in order to squelch our fear of death. But now I know something is inside me—I found that non-thinking/all-knowing place—maybe its heaven ? I believe the power to cure is there. I don’t know if I can tap into it—but if not, I still have found my soul. No matter what, the rest of my life is changed.

I only regret not discovering this place sooner. I feel full of light and I no longer (most of the time) judge people as much. There are people that hurt me, but it just seems to me that they are not in touch with their souls. They really are good in spirit, they are just out of touch. I know I can’t change them and wouldn’t try. I have enough to handle right now. I only wish my wife & kids could know the “steel”! feel so they will feel good about life and accept changes in me. You talked about cancer the other night—this seems a bit different to me. I have never had cancer, but I think it would be easier at first but more difficult as time goes on. I was told at diagnosis, unconditionally, that I will die of ALS by about five neurologists.

At first I had no hope. I could and did finally accept this for me—we all must die anyway. But I fought and fought for understanding because (I think now) of my children. They are 2, 4 and 6 years old. My work is not finished and this is the only remaining frustration I have. Also, I feel terrible about the tremendous burden on my wife, Denise. I have watched you now for several months and I have learned so much. I know you do not have much time for individual patients. I see how hard and long you work and I know you do not do it for ambition or ego.

You really care and try to reach as many patients as possible. I believe this. Also, most important, you gave me hope. There is no greater gift than hope. Ironically, now I no longer need the hope so much. And I no longer need the understanding. Why or how do not matter-when the bigger picture starts to form. One more thing (now that I have complimented you)-someone in your office missed a $250 service charge on me for vitamin shots. (I figured if I wrote a long and very dull letter with many thoughts poorly organized you might not get to this part and I would keep my money & be morally justified (ha). But if you are still reading than I may be a better, more interesting writer than I thought.)

Early on when we first met-you told me to write to you on occasion about what I am feeling. Well you asked me for it. Take care-you & your family.

Sincerely, Bob Z.


“I may be doing the last of my handwriting so I decided to write and not type.” I had felt a chill when I read Bob’s letter for the first time. And I feel a chill again now that I write about it. A patient chooses to send his last handwritten words to his physician! What greater honor can any physician ever hope for? Bob knew he may not be able to write again as the paralysis of his hand became complete, and he chose to honor me with his last hand-written words! His physician of all the people! Where does one draw the grace to do such a thing? Has any physician ever received a note from his patient more overwhelming than that? I wondered as I felt a crushing weight of gratitude. “I was told at diagnosis, unconditionally, that I will die of ALS by five neurologists. ”

I feel a lump in my throat as Bob’s words reverberate in my mind. “But I fought and fought for understanding because (I think now) of my children—they are 2, 4 and 6-year old. “I tried to understand too—make sense of what could not be made sense of. How does one understand what Bob was going through?

The big picture!

How did any of Lou Gehrig’s fans understand what he must have gone through? An image of Gary Cooper at Yankee Stadium rose in my mind. He played Gehrig in a movie (I think it was Pride of the Yankees) and made a moving speech—Gehrig’s farewell to his fans. He must have made many of them weep—just as Cooper did in the movie. “Also, most important you gave me hope. There is no greater gift than hope. Ironically, I no longer need hope so much. Bob’s words returned with a rush of sadness and confusion. “And I no longer need understanding. Why and how do not matter -when the bigger picture begins to form. ” The big picture!

A prayer rose to my lips: Allah, when it is time for you to take back from me all your graces, please leave me with just one last gift: the grace to accept your will the way Bob has accepted it.

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