Introduction

Lawrence D.H. Wood

—A. Einstein

Knowing and doing the right thing for our patients is a goal of our profession. How one arrives at each choice among many is a process worthy of consideration. Yet there are few methods of inquiry to search for new knowledge to help our patients. This introduction discusses the scientific method and proposes a spiritual source of knowledge which complements science. Reflection on my life revealed a lot of science and many beliefs. Seeking to answer life’s questions by living the interface of science and belief, I stumbled on intuition and the still small voice as overlooked contributions to finding answers. I hope that many of you will find part of yourselves in my deliberation.

Science is the evidence-based generation of knowledge. The scientific method was developed to reject erroneous hypotheses because people observe what they expect.¹ Table 1 organizes the sequential steps for science (left column). Step 1 provides the background to the question from observation and experience, and step 2 proposes an explanation—a hypothesis usually expressed in the negative—the null hypothesis (H_O), meaning that any difference observed between groups being studied is not due to one of the groups having been affected by the intervention being studied. Step 3 makes a prediction from the H_O, and step 4 performs experiments to disprove the prediction and so falsify the H_O.^2,3 Living in an age when most new knowledge is generated by the scientific method makes most think there is no other way, but science has limitations. When followed rigorously, the scientific method is tedious and slow, it handles subjective hypotheses of great importance poorly, and the requisite controls make some experiments so cumbersome that the question under study is obscured.

Not too long ago, scientific principles were not known or practiced, so another method of inquiry prevailed. Belief is a habit or state of mind which places trust in an idea or person without convincing evidence. Although many trace their system of beliefs to their mother’s knee, modern neuroscience ascribes to the brain a function to help the organism cope with its environment.⁴ Table 1 (right column) is my attempt to organize the corresponding steps for belief to those of the scientific method. When the brain notices disparate objects not seen together before (see step 1, right column in Table 1), it makes up a myth—a belief to explain the phenomenon (step 2). Beliefs are often subjective and not measureable, such as God or spiritual issues, so step 3 expects to see it again as originally developed. Because it cannot be measured, and falsified, there is no corresponding disproof of step 4 for belief, unless a credible witness can verify the belief. Then we can choose among the innumerable beliefs the explanation most likely to verify the phenomenon, generating an intuitive source of knowledge for those physician and scientists who seek it. I propose that belief most resembles science when the still small voice or intuition verifies that belief. Many look down on such beliefs as a method of inquiry because they are strongly personal, cannot be externally verified, are not subject to falsification and can arise from preconceived ideas. Yet it is compatible with science to keep an open mind about explanations that have not been falsified. Interface is the site or process where two independent systems act on each other, such as science and belief as different methods of inquiry. Many transactions in my life are living this interface where I feel, think and work toward processing the integrated systems with ceaseless striving to understand or with active receptivity for revelation.

It was 10:30 PM when my home phone rang. The dean’s message was terse: “Larry, the 30-year-old daughter of a friend is moribund in the ICU of a nearby hospital. He asks that you see her.” At her bedside an hour later, my examination confirmed her hyperactive circulation and low blood pressure (90/40) likely due to a serious infection (T = 39°C), complicated by excess liquid in her lungs with 4-quadrant air space filling on her chest x-ray, due in part to excess circulating volume as indicated by a pulmonary artery occlusion pressure (PAOP) of 24 mm Hg. She was intubated and ventilated with 100% oxygen, positive end expiratory pressure (PEEP) of 20 cm H₂O, and a tidal volume of 800 mL at 20 breaths/min. She was oliguric, comatose, and receiving a large intravenous dose of broad spectrum antibiotics.

As I examined her, I prayed silently “Lord, Agnes is dying, what can I do to help her get better?” Out of the noisy background of her ICU cubicle, through the bells and whistles of alarm systems and the chug-chug sound of her laboring ventilator came the still small voice “less circulating volume, more dobutamine, less ventilation, less PEEP.”

Recognizing each as plausible interventions not tried together yet in her management, we began. First we cut the tidal volume in half to a volume more appropriate to her size and acute lung disease, and reduced the ventilator rate to 12 breaths/min. Immediately, the auto-PEEP fell from 8 to 0 cm H₂O and her blood pressure (BP) increased without much increase in Pa_CO2.

Then we removed four units of blood from her indwelling arterial line. As her BP decreased, we increased dobutamine from 2 to 12 μg/kg per minute, and PAOP decreased to 4 cm H₂O. Her urine output increased to 80 mL/h. Then we progressively decreased PEEP in small decrements to 8 cm H₂O overnight. By dawn, her cardiopulmonary status was nearly normal.

As I left to make ICU rounds at the University of Chicago, I prayed “Thank you Lord,” still wondering whose voice I heard. So there I was, living the interface of science and belief.

Any comparison of these two methods—science and belief—must take account of the limitation of each, so I review several studies from my research program illustrating such limits of the scientific method.

1. One question we attempted to answer was: How does increased pulmonary blood flow (Q_L) cause increased shunt (Q_S/Q_T) in pulmonary edema? For efficiency, we formulated two hypotheses which we could test in one canine study.

   H_Oa: incomplete diffusion of oxygen between inspired gas and pulmonary blood contributes to Q_S/Q_T in pulmonary edema, and this diffusion defect gets worse when Q_L increases because the transit time for lung O₂ exchange shortens.

   H_Ob: increased Q_L distributes preferentially to edematous lung regions.

   To test H_Oa, we used the multiple inert gas elimination technique (MIGET) in both lower lobes and the whole lung before and after increasing Q_L suddenly and reversibly from 3.0 to 5.5 lpm by opening two systemic a-v fistulas. Unilobar acute lung injury (ALI) was produced by oleic acid injected into the left lower lobar pulmonary artery. MIGET demonstrated no diffusion defect for O₂ at either Q_L, so we rejected H_Oa.⁵ And the lobar distribution of Q_L measured by differentially labeled radioactive microspheres did not change when Q_L increased, so we rejected H_Ob,⁵ and formulated another hypothesis.

   H_Oc: increased Q_L increases edema to increase Q_S/Q_T. The key additional measurement needed to test H_Oc was an in vivo reproducible accurate double indicator dilution estimate of extra vascular thermal volume (ETV) which uses heat as the diffusible indicator. When Q_L was increased from 5.0 to 6.9 lpm by opening a-v fistulas, Q_S/Q_T rose from 30% to 38%, but ETV did not change (7.8-7.4 mL/g dry lung). So we rejected H_Oc⁶ and formulated a fourth H_O.

   H_Od: increased Q_L raises mixed venous P_O2 (Pv_O2), which blocks hypoxic pulmonary vasoconstriction (HPV) to send a greater proportion of increased Q_L to intralobar edematous regions to increase Q_S/Q_T. To test H_Od, we used an isolated blood perfused edematous canine lower lobe. When lobar blood flow increased with no change in Pv_O2, Q_S/Q_T did not change. But when Pv_O2 was increased using an oxygenator with no change in flow, Q_S/Q_T increased. At last, we found an hypothesis we could not falsify, so we concluded that Q_S/Q_T is increased by increased Q_L when the greater Pv_O2 blocks HPV to increase blood flow to edematous intralobar lung regions.⁷

   Pheewf!! That was a lot of work, and the scientific method was slow and tedious despite creative experimentation with optimal measuring devices, in part because there are so many erroneous hypotheses that need to be falsified before the truth becomes evident.

2. A second limit on science is that the underlying mechanism may be misinterpreted, so care must be taken to question each step of the scientific method. An example with clinical implications was illustrated by the observation that O₂ consumption measured by the Fick technique [V_O2F = CO(Ca_O2 – Cv_O2)] increased in septic patients when O₂ delivery (D_O2 = CO × Ca_O2) was increased^8,9 (Fig. 1). This observation could indicate that metabolism at lower values of D_O2 was anaerobic. However, plotting calculated variables having shared parameters (viz CO, Ca_O2) with measurement error produces just such a correlation in the absence of anaerobic metabolism. This was confirmed in the same studies^8,9 by measuring V_O2G [VE × (Fi_O2 ? Fe_O2)], a variable which showed no correlation with D_O2. Unfortunately, earlier studies concluded erroneously that metabolism was anaerobic which led to maximizing D_O2 when the patient didn’t need more O₂, so volume loading and high levels of dobutamine aggravated pulmonary edema and arrhythmias.

3. Sometimes it is difficult to distinguish science from belief in revealing truth. In 2006, a multicenter clinical study of fluid management strategies in 1000 patients with ALI demonstrated that conservative fluids were associated with fewer ventilator days without adverse cardio vascular effects compared to patients with liberal fluid management.¹⁰ Twenty-five years earlier, we had demonstrated in canine models of AHRF that reduction of PAOP by 5 mm Hg 1 hour after ALI reduced edema accumulation by 50% during the next 4 hours.^11,12 In the intervening quarter century, considerable debate was waged between proponents of these strategies. I thought our results and the management goal arising—seek the lowest PAOP providing adequate CO and D_O2—were good science, and I used that goal in all my patients with AHRF (Table 2), while others were worried about causing inadequate cardiac output, so they ensured enough positive fluid balance to maintain or even maximize CO and D_O2. Accordingly, I was delighted that the clinical study confirmed our approach, but asked myself, “was this science or belief?” It was indeed scientifically sound treatment for canine models of AHRF, but it was my belief that these canine results would occur in patients that drove me to treat them with this regime while awaiting the clinical trial results. Perhaps we were lucky, perhaps intuition counts, or perhaps studying an appropriate animal model can provide direction long before the clinical trial can be organized and implemented. The lesson from these studies is that solid science in animal models led to treatment goals for the models, but extension of those goals to treat patients in the ICU is a belief until the clinical study demonstrates its utility in patients, no matter how long it takes.

   Yet, clinical intuition should play a role until controlled clinical studies are performed. In the case reports and textbook guidelines describing treatment goals in AHRF^13-15 we used the least PEEP achieving its goals (see Table 2) and coupled that with the least tidal volume preventing unacceptable acidosis.^13,14,16 As indicated in Table 2, the therapeutic goals were supported by subsequent multicenter clinical trials,^17,18 conducted 25 years later, while all our patients were being ventilated with smaller VT and goal directed PEEP. This practice of ventilating patients with ALI with small VT was based on the intuition that if our patient’s lungs were 80% flooded,¹⁵ we better give smaller VT or we will injure the aerated units further.

   How many other standards of Critical Care cause similar damage until disproven? This important question got greater attention than it deserves when a multicentered trial of low tidal volume ventilation was halted by the concern that one patient group did not receive care according to the “best current standard of practice,” as arbitrary as that standard may be.¹⁹

4. This study illustrates another limit on science.¹⁰ The first protocol intervention occurred on average 43 hours after admission to the ICU. Thereafter, conservative fluid management was associated with a return to spontaneous breathing in 5 days by 255/500 patients, but only 200/500 patients receiving liberal fluids resumed spontaneous breathing. Accordingly, 55 patients were spared ventilator therapy by conservative fluid balance in the first 5 days, and no further difference was seen between groups after 5 days. It seems that most of the benefit of conservative fluid management occurs early, and this study nearly missed and almost certainly underestimated it, by taking so long to get started. A careful look at Fig. 1 in reference 10 explains the delay, for so many controlled variables take time to organize. This early therapeutic effect was evident in our canine studies when the reduction in PAOP was effected 1 hour after the injury, and promptly stopped further edema accumulation and its effect to increase Q_S/Q_T and reduce compliance further.^11,12 In a retrospective study of 40 patients with ARDS,²⁰ the group with reduced PAOP had the effect measured already by 24 hours from admission, so one might expect a greater beneficial effect of conservative fluids than was observed in the multicenter trial. Indeed, we reported an increase in survival from 29% to 75% in the low PAOP group.²⁰ It seems possible to obscure therapeutic effects by delaying the intervention until all the controls are in place. One cannot help but think it wise to lighten up on the controls in large clinical studies when intuition focuses on the important variable; otherwise you might end up with a very well conducted scientific study that concludes erroneously that the intervention had no effect on outcome. In the guise of critical thinking and right reason, the scientific method may cause us to falsify effective treatment.

For all its contributions, the scientific method has provided enough incomplete or erroneous explanations of reality to make us wary. Many ascribe the birth of science to the publication of Issac Newton in 1687 of The Mathematical Principles of Natural Philosophy. For about 250 years thereafter, scientists probed nature with this ingenious theory or way of thinking to reveal more and more discoveries of how nature works. But in the last century, science revealed the world of subatomic physics which moved by different forces not explained by Newtonian Laws, in a world of sub atomic particles requiring a different set of laws describing “quantum physics.” Despite 100 years of focused research, we have yet to develop a unified theory to explain both classical and quantum physics. Though we may just be slow the possibility arises that the scientific method is wrong.^21,22 Similarly, formulation of the laws of heredity of the species by Charles Darwin emphasizes “survival of the fittest” to account for the range of creatures in the world. Recently, the data and interpretations of heredity put forward 50 years earlier by Lamarck demonstrated beyond a doubt that development of new structure and function is promoted by the environment of the species. Accordingly, Darwin’s theory is now questioned as incomplete or even wrong and has been altered while we went looking for a more comprehensive theory.^21,22 And the co-discoverer of the double-helix, Frances Crick, insisted that all reproduction was explained by the arrangement and duplication of four nucleic acids. This dictum excluded, even ridiculed, scientists presenting data suggesting influence on the expression of the nucleic acids by cell membranes, cytoplasmic substances, and extracellular influences. The new science of epigenetics is reversing the Crick dictum and its interpretation to explain these extracellular effects.²²

I cited these three important theories with demonstrated error so that we all, scientists and believers alike, may retain skepticism about scientific evidence and its interpretation. Nonscientists need not feel triumphant about these short falls of science, for it is a strength of the scientific method to make itself vulnerable to criticism by obtaining accurate, reproducible data and interpreting these data in clear unequivocal language. This scientific candor helps the scientific community revise erroneous theories as the most rapid approach to new knowledge.

When we consider the limitations of belief, we do not compare errors for they are hard to detect in the softer language of belief. Instead, we look for outcomes of belief which, if true, provide enhancement of understanding sprinkled around the surface of science. In this sense, there is no war of worldviews for these two modes of inquiry are not competing for the same prize.²³ Instead, they arrive at truth from different points of view: science looks outward to describe accurately how the world works, while belief looks inward with consciousness to find meaning and purpose. Choosing to see these processes as antagonistic perpetuates the human trait of arguing about which approach is best, whereas more knowledge is achieved when the participants admit that each has something to offer the other in the search for knowledge.

In an extraordinary interview, Joseph Campbell tells Bill Moyers about the power of myth.²⁴ A key concept is how myth exposes and explains the mysteries of life, most often inner mysteries through introspection. The far-fetched mechanisms said to underlie these mysteries lead many scientists to skepticism and disbelief. But these same scientists need to recall that many hypotheses to explain reality were equally outrageous before being put to the test without being falsified. Accordingly, it is not scientific to reject beliefs before they are falsified.

In his discussion of the physiology of spiritual experience, Andrew Newberg outlines his attempt to elucidate the underpinnings of the spiritual experience²⁵ using single photon emission computed tomography (SPECT). During spiritual experiences in seasoned meditators, he discovered a neural pathway for spiritual experiences which differs from that used in day-to-day processing of materialistic observation. In particular, both parts of the autonomic nervous system were activated (sympathetic and parasympathetic outputs are almost always antagonistic), and there was a thalamic mediated shift in activation of self-orientation associated areas toward attention-associated areas within frontal lobes. These spiritual pathways help the brain in interpreting concepts like worship, love, prayer and altruism; and are used to process spiritual experiences, like those accompanying meditation, glossolalia and yoga.²⁵ Conceivably, this is how we are wired for spiritual experience. Yet he is quick to point out that the use of neural spiritual pathways does not prove the existence of God nor Her participation in conversation with, or healing of, Her children.^* The “report back” of mystical or spiritual experience “feels real” to the reporter. To understand better, Dr. Newberg invites us to compare perceptions in the awake state with those in the dream state where those in the dream do not “feel real.” This may seem flimsy evidence to validate spiritual experiences; certainly it is much more subjective than is allowed by the scientific method.

So far, we have been discussing two methods of inquiry and knowing—science and belief. But epistemology alerts us to other ways of knowing. One such is the New Archaic based on performative spiritual practices which bind together fragmentary subjective experiences into the one subjective sensation “I am here within the world.” Considerable neuroscience observation parallels this behavioral binding—there are 17 distinct brain areas in both hemispheres and at all levels responsible for religious, spiritual, and mystical experiences (RSMEs) when they are integrated, yet during everyday activities each acts separately.²⁶ This brain activity underlies RSMEs as one form of belief.

A new discipline, neurotheology, studies correlations of neural phenomena with subjective experiences of spirituality as well as hypotheses to explain this phenomena. The principles of neurotheology are described in a new book by Andrew Newberg in which 54 principles are discussed as the foundation for this discipline.²⁷ Taken together, the analysis of myth, the spiritual neural pathway of Newberg, the integrating or binding function of the brain for subjective experiences, and the development of neurotheology seem to invite greater attention to belief as a method of inquiry and knowing. A demeanor of humility and docility seem to me a fruitful soil to grow understanding, for we have only begun to understand the meaning of belief.

Bruce Lipton is a cell biologist whose research focused on the cell membrane. He describes a spiritual awakening while contemplating the beauty and elegance of the membrane’s mechanics: “the fact that scientific principles lead me, a non-seeker, to a spiritual insight is appropriate because the latest discoveries in physics and cell research are forging new links between the worlds of science and spirit.”²² One such link is our growing understanding of fields, the nonmaterial region of influence which surrounds the energy of a system such as a magnetic field. Matter is energy bound within a field. And a field of compassion surrounds the physician and patient during the healing process to provide a space for the still small voice to speak and be heard.²⁸ In his classic series of lectures in 1902, William James’ The Varieties of Religious Experience²⁹ cited numerous accounts of persons who had mystical experiences, often with profound and life-changing effects. He concluded that the beneficial effects of these experiences could not be discounted, yet he highlighted that these experiences were personal, could not be externally validated, and were limited to a select group of persons. Can others tap into this spiritual knowledge? Speaking from an extraordinary background as a healer, Caroline Myss says: “medical intuition can help Physicians to understand the human body to be both a physical system and an energy system, who have a spiritual context for the human experience, to identify the energy state of a physical illness and heal the underlying cause as well as the symptoms.”³⁰

My brief description of Agnes’ complex case probably makes sense to many readers, but I venture to guess that many more are confused or skeptical about the still small voice. For me, there was this background. Some 35 years ago on a spiritual retreat, I was instructed on the use of a spiritual journal.³¹ Each entry began with a letter from me to the Lord of my life, describing my concerns and considerations for that day. But the second part of this experience seemed unusual—I write the Lord’s response. The retreat directors, Matthew and Dennis Linn, outlined the characteristics of the response as: affirming, with a vocabulary of words and concepts not recognizable as mine, but compatible with my nature, usually of scriptural origin, and almost always surprising (Table 3, left column). About that same time, I read two books recording the conversations with God by two listeners.^32,33 Immersed in reading the daily entries, I became habituated to these conversations as a prayer. When I found another compilation of God’s conversations with Neale Donald Walsch 20 years later,³⁴ they seemed perfectly natural.

An interesting corroboration was published last year,³⁵ The Power of a Whisper in which the author describes how his life was favorably influenced by hearing and following the still small voice. Wishing to guide his readers on who was speaking, he offered several filters to ensure it was God’s voice. They matched the Linns’ guidelines (see Table 3, right column). Then he told of writing his parishioners to solicit from those who had such experiences descriptions of God’s conversation. Over one weekend he received 500 replies each describing messages of affirmation, admonition or calls to action. He concluded that we have a communicating God, and hearing His voice is a common experience in his Parish. So I wonder how common it is among my colleagues in Critical Care. Again, I invite you to find in your own experiences any similar occurrences as a basis for exploring further this topic.

My experience with spiritual journaling over the intervening years was repeated, consistently affirming, scriptural, surprising. I recently scanned my ten 3-ring binders in which I had collected those conversations, and selected 10 consecutive conversational exchanges. I compiled these with other stories told in this chapter to get some feedback from some twenty friends. One reply was especially helpful:

In my view, this response articulated well several problems with living the interface of science and belief. First, “if not delusional, dysfunctional or just plain crazy,” what am I? My best explanation is that I am a man living the interface of science and belief, taking the evidence of each seriously. This allows me to experience the joy and awe of discovery through science and the gratitude and blessing of conversation with God through belief. Second, what would we accept as evidence for God’s existence or willingness to communicate? Classical arguments about God’s existence convince believers and cause nonbelievers to look for more convincing evidence.

Listening for and hearing the still small voice is a complex human endeavor. It requires some or all of the following: belief that God can and will speak to me; a quiet spirit free from noise, hurry and crowds; a desire to know God’s answers to my questions, or God’s preference among courses of action in front of me; and a willingness to obey the instructions after putting the conversation to the test. Ceaseless striving for discovering alternative explanations for the still small voice can squelch these subtle movements of the spirit. Alternatively, cultivating these aptitudes for active receptivity is an all-consuming spiritual practice that can interfere with the search for more convincing evidence. So my approach is to go with the flow of the still small voice, choosing to listen rather than search. This choice was supported by several happenings in my life. One occurred early in my relationship with my wife, Elaine, when I told her about the progressive peripheral polyarthritis which I had suffered for the previous year. She listened empathically as I finished the story, and then asked if she could pray for me. “Of course,” I answered, so she laid her hands on my left shoulder saying “Lord, please heal Larry’s arthritis.” Immediately, I experienced warmth spreading from my left shoulder down my left arm and across my shoulders to my right arm, warming all my joints from shoulder to wrist and the metacarpal joints of each finger. This feeling lasted a few minutes, when the stiffness, pain and fluid in the joints disappeared and never returned. I know that I know God used Elaine’s love to heal me, and I expect that this spiritual experience will have no effect on the belief of any others who hear this story—it is my spiritual experience, done for me alone, so anyone hearing this story is unlikely to be convinced—and any of my friends who wish to tap in to the spiritual experience need to have their own. It seems one cannot accept God’s healing presence vicariously; one needs their own spiritual experience.

If I were able to use the scientific method to test my belief that God exists and speaks to his people, I would phrase the null hypothesis “God does not exist/speak to His people.” Then I would examine each of the entries in my spiritual journal for God’s conversational attributes, and finding multiple responses to my inquiries, I would reject the hypothesis and conclude the opposite—God does exist and speaks to his people. I compiled ten such examples which falsified this H_O, provided my subjective evaluation is allowed as evidence. And there is the risk, for as convinced as I am by my subjective evidence, I do understand why the scientific method cannot accept it for lack of objective evidence and reproducibility in the observers. This does not weaken my belief that God spoke to me; indeed, my faith is enhanced and my enthusiasm to hear His word is heightened. Yet I do not expect others to be convinced by my subjective evidence—they must have their own spiritual experience before they become convinced.

So belief becomes a personal choice to act on subjective perception of God’s presence. It seems like my healing and my learning transcend all my understanding of how it can occur, so it is not unreasonable for me to invoke divine intervention. To the extent God did it, it is the polite behavior for me to feel grateful and to express my gratitude to Her. Suspending my search for scientific proof seems like a good idea given my improved health. It is an even better idea given my prior faith experiences, so I have no trouble dealing with God as if She exists. This sets me free to converse with God and to hear Her still small voice. How else can God communicate with Her children? Besides, everything for which I do have scientific proof is so complex and beautiful that it draws out of me wonder and praise, so I get it both ways: my skepticism cannot disprove God in scientific terms because I do not have a Godometer; and whenever I can prove anything scientific, the result causes me to praise God.

We have been discussing two modes of inquiry: science and belief (Fig. 2). With ceaseless striving scientists develop H_Os which might explain phenomena and use the scientific method to falsify these H_Os, such that truth consists of H_Os which could not be rejected. Clockwise rotation from the interface of science and belief depicts the start (and end) of our understanding when we began reading this paper.

But I introduced the notion that belief and its interface with science can be processed with active receptivity to develop innumerable myths to explain reality. Then the still small voice serves as the hammer to nail down the myth which best explains the phenomena under study, verifying it as truth to contribute to our new knowledge as depicted—by counterclockwise rotation from the interface—in the right side of Fig. 2. Accordingly, science and belief are complementary methods of inquiry and knowing, each providing limited understanding, but together increasing the probability of knowing.

Table 4 compares the attributes of these methods of inquiry. The scientific method protects us from bias and erroneous H_Os using intellectual discipline of statistics and logic, while the still small voice requires faith to verify beliefs. Science is objective and measured, but belief is subjective and often not measured. Accordingly, science cannot process phenomena of great importance, but belief can process interior mysteries with active imagination ratified by the still small voice. Science is tedious and slow and too many controls can distort the study, while belief proceeds at a furious pace when the believer is affirmed, presenting innumerable myths for the still small voice to choose from. And even when the chosen belief is wrong, the process of communication builds relationship between the believer and the still small voice.

A clarification of my meaning seems necessary. Standing at Agnes’ bedside examining her and praying for help, I heard the still small voice. Yet it was not clear to me whether intuition intervened at that moment or whether these circumstances facilitated the coalescence of brain activity set up and stored in neural circuits during 40 years steeped in the care of such patients and the 20 studies I published about acute lung injury. Either way, I acknowledge being used to help Agnes. I believe that hearing and acting on this voice is every person’s challenge, not confined to physicians and patients. This is living the interface of science and belief, verified by the still small voice to create a spiritual source of knowing. This viewpoint differs considerably from that of many physician-scientist who believe that science and spirituality are antagonistic,²³ so they must choose between them. Those choosing science often seek to discredit spirituality as if its very existence threatens science and reason, when what it threatens is materialism as a doctrinal worldview. This discussion suggests they are complementary, the one filling the gaps of the other to provide a more comprehensive understanding than either alone.

As often, Albert Einstein has a last word. Consider one meaning of his verse opening this chapter: Acknowledging the rational mind as a faithful servant of the scientific method deserving honor, we risk missing the truth when we forget the sacred gift of intuition expressed as belief verified by the still small voice.