This subject of suffering is neither abstract nor trivial to me, but it is very, very personal, and it really first became personal to me around 15 years ago.

When I was in medical school, my wife, who suffers from a malady associated with her in utero exposure to diethylstilbestrol, (D.E.S.), became pregnant. I was privy to the fact that many women who have the anomalies associated with D.E.S. exposure have what's called an incompetent cervix, which leads to miscarriages. Thus, although everyone else was seemingly giddy with excitement, I struggled with a sense of foreboding about her pregnancy.

At 16 weeks' gestation, it appeared that Laura was going to have a miscarriage and she was consigned to bed rest. From then throughout the next 4 months, we wondered daily if this would be the day we lost our precious child.

Thankfully, with the help of our church coming to help care for her during the day and the weekly prayer meetings, things went well at each check-up. One child in particular we remember, (who's now graduated from high school), but then, age 3 to 4, used to pray every week that Laura's baby would "stick", by which she meant that the baby would not come out until he was ready. Much to our delight, God, in his kindness, granted her request. As a new father, I ran to the store to buy some balloons and a few other things, but I came back only to find my wife crying.

It seemed that there was a problem. My oldest son, my only son, my newborn child, was not breathing properly. He had episodes of apnea, where he would stop breathing for a minute or two and there was concern whether he had a serious infection, a bleed into his brain or some other kind of brain damage.

We had been up all night in labor and it was late in the evening. We still had not seen the pediatrician, who was making his rounds. I sat there holding my son shaking him, trying to get him to breathe. I remember crying out to God, "How could you do this? How can this happen to me?" I wondered if he would survive.

It was that evening that we had a visit from our pastor and his wife. They were very supportive, very kind and pledged to stand by us. Debbie, who came and prayed, looked at us in the eye and with as much authority as I have ever heard said, "I do not believe God would bring you through this pregnancy only to allow your child to die now. He's going to be okay."

I took great, great comfort from those words, and in our case, as my sons condition improved, her words turned out to be prophetic, because he did turn out fine. In fact, at 15, my son Jonathan is as normal as any 15-year-old can be.

Since that time, I have had the opportunity to sit at-the-bedside, hold the hand, and look into the eyes of other folks, many others who have had the same thing said to them, but for whom it did not turn out to be true. At least not the way we wanted it to be.

When that happens, I struggle with God's goodness. I am deeply troubled by questions of how these things can happen. So once again let me reiterate, this is not primarily a philosophical or an abstract question, to me, but rather deals with what I do everyday and is very, very personal.

An Honest Expression of the Problem

A resident in our department said several years ago, "The universe is random, meaningless, and cruel."

For those who have been in an academic environment for some time, words like that sound very familiar because it is a sentiment frequently expressed by those in our community. I will come back to those words in a few minutes, because I think we find within them a key contradiction which helps point us beyond the cynicism being expressed.

The Problem

If God is all powerful, all good, and all knowing, why does he allow pain and suffering in our lives? Although phrased here in philosophical terms, this is not primarily an intellectual question. In fact, it is rather a question that torments real people as they suffer in their own private anguish and pain. So for those of you sitting here this evening or reading this transcript that are suffering, please recognize, I do not take this lightly. This issue touches us deeply in places where frequently words lose their meaning. In fact, many of my patients have confessed that they thought they knew what they believed, until their comfort zone was shattered. What do I tell these folks?

What do you tell them?

What do I tell my friend whose 3 or 4-year-old child develops double vision, is found to have, after an extensive evaluation, an inoperable brain tumor and despite the best medical therapy, dies at home? How do you comfort a mother who's child has been torn from her arms; a mother who stares at the wall, unable to even express emotion?

What do I tell the young lady my age who comes up to me at church one day and says, "Jay, I'm seeing a surgeon this week because I found a little lump in my breast. He said it's probably nothing...." But of course, it wasn't nothing, it was breast cancer.

She went through all the appropriate treatment and within a year, had a recurrence. Then even though going through extremely aggressive chemotherapy, including bone marrow transplantation, a year later she departed this earth, leaving two young boys without a mother.

What about perhaps my most memorable patient since I've come to Gainesville. A young lady, loved by everyone, full of joy, with an unusual form of cancer that initially responded to treatment but despite hours and hours of prayer vigil and encouragement, ultimately succumbed to the disease. Has God abandoned these people and their families? I hope by the end, we will have a glimpse of the beginning of the answer to this question.

What is Suffering?

Since we're talking about suffering, let's go ahead and define suffering.

We'll call suffering any physical or emotional pain, more broadly, anything which we don't get that we desperately want, or anything we get which we desperately don't want. I use the term "desperately" to distinguish it from something trivial such as, what kind of coffee will I have or what will I have for dessert? There are things that all of us perceive as our own necessities, and when we are denied those or when our worst fears or worst nightmares come true, that's where suffering begins.

But even defining suffering that way is not entirely satisfactory because we all know there are levels of suffering. Let's start with that which we have the least trouble with.

There is a certain amount of suffering we all encounter because of our own foolishness or our own evil choices. If I drink and drive and wrap my car around a tree and break my arm, you might feel sympathy for me, as you probably should. But it doesn't disturb your sense of fairness as much because there is a true sense in which I deserve what happened to me. I was a fool and did something no one should do and I have suffered the consequences for it. Here our senses of justice remain relatively unchallenged.

There is a second level, one that bothers us a little bit on an everyday level, what I call "general frustration." Such things as computers crashing, which happened to me this summer. I was too foolish to back up my files, so I lost everything I had written.

It also seems that lights turn red as soon as I'm approaching them. My secretary accidentally schedules two meetings at the same time, so no matter what I do, I've made somebody mad. It sometimes seems that because of the state of the world, there will always be 10 to 20 percent of the people who are mad at me no matter how hard I try. Everybody can identify with this degree of frustration.

I believe there is a purpose to this kind of suffering. I believe that how we respond to these kinds of day-to-day frustrations is a reflection of what's going to happen to us when we come across the larger things. If you will, it's a training ground for us; to test our faith. When I can't find a parking place and I'm getting aggravated, doesn't that really betray something about how I think about God in my life? I'll leave that as a thought for you to consider.

The next level we come to is injustice: suffering which is caused by someone else's evil choices or which may result from what is referred to as "structural evil." Under the heading of evil choices, if I drink, drive and kill a pedestrian, then I have caused an injustice. Because of my own evil choices, another person "unjustly" suffers.

Structural evil refers to systems, which by their intentional or even unintentional design produce evil. For example it could be argued that the way we train physicians, making them stay up 36 hours at a time and then telling them to be nice to everybody, is a form of structural evil. It may not be any one person's fault but it's a system that pushes people to do that which is wrong. I hope I don't have to tell you that it is difficult to be compassionate when all you can think about is going to bed, let alone the question of thinking clearly.

Injustices can range from something as terrible, horrible and personal as child abuse, all the way to genocide, such as took place in Nazi Germany or Cambodia. In each situation, there is usually someone or something to blame, a perpetrator, if you will. In such cases we feel betrayed by God--if not for ourselves, then on behalf of others.

Finally, we come to the category that is the world that I live in; suffering where there frequently is no obvious perpetrator. Illness is the most frequent offender in this category but it also includes such things as natural disasters. This category raises questions about God's goodness and power. Some are even called "acts of God." I find it interesting that we refer to disasters as acts of God rather than the good things that happen, but that is another subject.

It's not enough, however, to merely describe these things. What I would like to do is take someone that many of you are familiar with and read some of his words.

C.S. Lewis was touched by cancer twice in his life. Many of you know that his wife died of cancer shortly after they were married, but many people do not know that when he was only a child, his mother died of cancer. As an adult, he recounts his recollection of this event in his life.

Children suffer not, I think, less than their elders, but differently. For us boys the real bereavement had happened before our mother died. We lost her gradually as she was gradually withdrawn from our life into the hands of nurses and delirium and morphia. And our whole existence changed into something alien and menacing, as the house became full of strange smells and midnight noises and sinister, whispered conversations.

With my mother's death all settled happiness, all that was tranquil and reliable disappeared from my life. There was to be much fun, many pleasures, many stabs of joy; but no more of the old security.

I read this to my son over the weekend as I was preparing for this talk. He then looked at me, somewhat stunned, and asked, "Is that really the way it is for most people?"

I had to think about it. I must say, no. Fortunately, most people do not have that kind of experience with the destruction of all that is tranquil by the loss of one close to them. But I read Lewis' words because he does, in an eloquent way, catch the anguish that a child may feel.

From another point of view, listen to the pain expressed by David Beibel, describing what it's like to struggle with the death of his child.

In that moment, my well-constructed world began to splinter into myriad pieces. Like a pane of glass shattered by a pebble, the fractures fanning out from the hole, I felt an overwhelming sense of unreality . . . Like a canopy shrouding me in isolated disbelief, a sense of desolation and despair descended. I felt as if a flood had cascaded from a broken damn and swept me in its flow.

Let's go on to the next question, which I would like to pose to you today, and that is, "Why do we care so much about this issue?"

The fact that it's not like every other intellectual puzzle--that it touches us deep where we live--points us in the direction of the solution, because the problem has both an intellectual and a personal side. Consider the quote at the beginning: "The universe is random, meaningless, and cruel." If the gentleman who uttered that quote really believed that the universe was truly random and truly meaningless, it could not be cruel because cruel is a notion that implies that there is some good that is absent. Something is "not the way it's supposed to be." The fact that even as one part of his soul wants to profess that he doesn't believe in anything, at the same time, he knows there is something deeply disturbing about the events of the universe.

Now, not everyone cares. I said, "Why do we care?" but it is true that not everyone cares. There is a reason for that. Which brings me to my next topic, namely Western culture.

Western culture is an interesting phenomenon, a sharp two-edged sword. We have some amazing comforts and conveniences. We have great medical care. We can modify our energy levels, our mood, and the temperature of our environment at whim. That's my own personal Achilles heel, if you will: I'm always hot. I like to say God made my body for Toronto and placed me in Florida, but I digress.

We have entertainment between television, movies, books, music to occupy every second of our waking lives. This isn't necessarily a bad thing. We all look at these things and say, "look at our problematic Western society"; but before you say you want to live back a hundred years ago or 200 years ago, I urge you to walk through the graveyards of old churches and see that many buried there are children. So there is much good that has come from our modern society, and health is part of it. But health also creates, if you will, an aura of invincibility.

One of my own experiences is that many educated professionals, when they become ill, have been so deceived by their faith in modern medicine that they know a cure must be right around the corner. They seem to believe that, if they can simply do all the right stuff, that whatever is wrong with them will be fixed.

It's almost a tacit notion of immortality in this life. They wouldn't phrase it that way, but in essence, that is sometimes what they believe. There is a presumption that many of us have that we can be and should be in control of our lives, and when we lose that control, it is very, very unnerving.

There is also a subset of people who try to insulate themselves from any exposure to suffering at all. Now all of us do it to a degree, and certainly, we would like to be comfortable as much as possible, but some people simply want the "dream life" all the time. You can define that however you want to. I'll cynically define it, if you will, as good times, good health, good weather, no pain, no toil, drinking beer by the pool side looking at babes. To these folks, suffering should be avoided at all costs and they would never, ever consider doing anything to have contact with the sick; that would be just far too depressing. I call this the "Homer Simpson" view.

When I say that, most of you can think of people that would fall into this category, particularly if you're students, because age has a way of bringing reality to bear on our lives such that these such notions lose their grip on us.

I have coined a term for these folks: apathostics. They are apathetic about their belief system, so rather than agnostics, they are apathostics. They don't care what they believe. I'm grateful, however, that most of you who are here tonight are not in that category, and many who will be reading this are not in that category.

Nonetheless, there is a degree to which all of us share a feature of thinking about our life with those who are apathostics. I call this the grand pretense. It goes something like this:

The Grand Pretense

1. Everyone knows that death, and suffering is ultimately inevitable.

2. We don't think it's going to happen to us today, and we don't think it's going to happen to us tomorrow, and so therefore, we can pretend, for all practical purposes, if we're busy all day, that it will never happen to us.

3. Since everyone else is pretending, it "seems" true. Much of what we believe, by the way, is not so much because it's true or false, but because it's popular to believe it. As a result of this, we are almost always surprised when suffering comes our way.

C.S. Lewis wrote his spiritual autobiography from which I'm going to quote in a moment, called Surprised By Joy. R.C. Sproul has written a book on suffering, taking that title and turning it around called Surprised By Suffering.

The last point about our Western culture is we believe pleasure and happiness are to what we should aspire to get the most out of life. There is a big difference between pleasure and happiness, and what C.S. Lewis calls "Joy."

Early in his book, Surprised By Joy, Lewis describes three experiences: one was a memory of a memory; another was a story; and the third was a poem. Whenever he read these or thought about them, he had what he called "Joy"--and he does capitalize it:

It was something quite different from ordinary life and even from ordinary pleasure; something, as they would now say, 'in another dimension' . . . an unsatisfied desire which is itself more desirable than any other satisfaction. I call it Joy, which is here a technical term and must be sharply distinguished both from happiness and from pleasure. Joy (in my sense) has indeed one characteristic and one only, in common with them; the fact that anyone who has experienced it will want it again. Apart from that, and considered only in its quality, it might almost equally well be called a particular kind of unhappiness or grief. But then it is a kind we want. I doubt whether anyone who has tasted it would ever, if both were in his power, exchange it for all the pleasures in the world. But then Joy is never in our power and pleasure often is.

Now, what is the evidence that all of us are in some sense captive to the grand pretense? Maybe you say "Not I." Well, maybe you're not. But I'll tell you the evidence that it's true in my life.

The best evidence is my complaining. Frequently, I find myself in a state where I overlook all of the things that are wonderful and beautiful in my life and I seem to focus on the things that are wrong and I complain about them. All of us know how disturbing it is to be around a chronic complainer and how uplifting it can be to spend time with folks of a grateful heart. Complaining betrays my lack of faith and my presumption that I don't deserve anything but "happiness and pleasure."

Another way to phrase it is, I have an attitude where I expect good things from God rather than accept good things from God. You see, one attitude is presumptuous and looks at God as somehow the cosmic Santa Claus who must give me everything that I want, and Christmas is every day. The second realizes that I have many good things in my life, but they are gifts for which I should be grateful. So then, one could say, the degree to which gratitude is absent in my life is the degree to which I am captive to the Grand Pretense.

I'm going to point the finger for a moment at those who call themselves Christians.

Here is a contrast from David Beibel's book on the problem of suffering, and how the western church frequently betrays the Biblical view of true faith.

Dateline: China, circa 1967.

The 80-year-old grandmother, lame for many years, is driven down the town's Main Street, lean, half-shaved, face painted, sign hung around her neck. At the sound of the gong, she is forced to announce her crime . . . 'I am a Christian.' The children grab at the soldier's legs, begging for an end to this abuse. 'Be quiet, children . . . Be quiet,' she says. 'I've been waiting for years for the chance to testify to my village like this.'

Dateline: U.S.A., circa 1987

I see no point in suffering, the wife of a once famous TV preacher announced. And many American couch-potato Christians probably nodded in agreement. The gospel of health and wealth, a vain self-deception, has given birth to a generation of spiritual pygmies, powerless pretenders longing for protection from life's harsher reality. For them, suffering is when the extra Mercedes is broken down or the dishwasher isn't working or the grocery store has run out of kiwi's . . . Painless suffering is a modern phenomena . . . Until very recently in history, people expected pain and knew how to live with suffering.

If that sounds a bit harsh, please forgive me, but I have learned from my patients just how captive I am to the grand pretense, because they have the true view of life. They can no longer afford to allow pleasure, happiness, work, entertainment, etc., to distract them from the reality of their own mortality. One can see in them the joy to which C.S. Lewis alludes in the quote that I read you earlier.

You might ask, "Well, what's the evidence that there is a connection between suffering and joy? That's a very nice thing to say, Jay." I'll tell what you the evidence is and you can ask the people sitting on the front row, my students.

Almost invariably, when students come to the oncology clinic, their first thought is, "Oh, this is going to be so depressing. I'm going to see all of these people who have cancer. Many of them are not going to live very long. How am I going to deal with this"? But do you know what they almost all say as they walk away from that experience? "These were the kindest, gentlest people I have ever met. There is something about your patients that just make you want to be with them. There is a joy in their life that I don't understand."

When people ask me why I do what I do--how I can do it--I will tell you there are times that I wonder. My wife will reiterate this. But when I'm not exhausted, and have the chance to sit, think, pray and remember the faces and names of those I've had the privilege to care for, I can honestly say to you, I have learned more from them than I have ever given to them. There is a profound and mysterious connection between grief, suffering and "Joy," and my patients are a living testimony to that truth.

Solutions to the Problem

Having defined what I mean by suffering--the intellectual and personal dimensions--I turn to some of the philosophical answers to the question.

The first would be, "If God is good and all powerful, why is there evil in the world?" is simply to say there is no God. That solves the problem quite quickly.

It's a popular view in academic circles, as I mentioned. Let me read you a quote that Rabbi Kushner alludes to from Catch 22 of a conversation between a relatively bitter atheist and a woman trying to defend her view of God.

"Good God, how much reverence can you have for a Supreme Being who finds it necessary to include tooth decay in His divine system of creation? Why in the world did He ever create pain?"

"Pain?" Lieutenant Shiesskopf's wife pounced upon the word victoriously. "Pain is a useful symptom. "Pain is a warning to us of bodily dangers."

"And who created the dangers?" Yossarian demanded, "Why couldn't He have used a doorbell to notify us or one of His celestial choirs? Or a system of blue-and-red neon tubes right in the middle of each person's forehead?"

"People would certainly look silly walking around with red neon tubes in the middle of their foreheads."

"They certainly look beautiful now writhing in agony, don't they?"

There is a harsh cynicism that one feels in this quote. However, not all those who would hold to atheism as a world view have such a sharp edge to their beliefs.

Listen to Bertrand Russell, who, as many of you know, was earlier this century one of the most influential writers of atheism and humanism. In his essay, "A Free Man's Worship," which is contained in a collection of essays called, Why I Am Not A Christian, he makes the following description of what humans are all about.

That man is the product of causes which had no provision of the end they were achieving; that his origin, his growth, his hopes and fears, his loves and his beliefs are but the outcome of accidental collocations of atoms; that no fire, no heroism, no intensity of thought and feeling, can preserve an individual life beyond the grave; that all the labors of the ages, all the devotion, all the inspiration, all the noonday brightness of human genius, are destined to extinction in the vast death of the solar system, and that the whole temple of man's achievement must inevitably be buried beneath the debris of a universe in ruins--all these things, if not quite beyond dispute, are yet so nearly certain that no philosophy which rejects them can hope to stand. Only within the scaffolding of these truths, only on the firm foundation of unyielding despair, can the soul's habitation henceforth be safely built.

Now, one of the things that I appreciate about Russell, even if I'm not sympathetic to his view, is his honesty. He doesn't try to make more out of human existence than there is, by importing some kind of sentimentality to make us feel good about ourselves. He says that we are all nothing more than the "outcome of accidental collocation of atoms."

So Mr. Russell, I appreciate your honesty but I must beg to differ. The problem, again, goes back to the individual, the resident, who tried to say that the universe is random and meaningless and cruel. We know that there is a way that the universe is supposed to be no matter how we try to deny it.

The second solution is that God is not good. God is all powerful, he's there, but he's not good. He is a malevolent entity.

Now, fortunately, at least in the West, there are few organized religions that believe in malevolent deities that control our lives, although numerous animistic religions hold that view. So we would be tempted to just walk past this and not say any more about it, but if we stop for a moment and think, we realize that we have more trouble here than we think. When we become angry with God because of injustice or the suffering in our lives, we struggle, and wonder whether God is malevolent.

The book of Job has many of these thoughts, and it should be comforting to us that the Scriptures are full of God's people uttering the same things that we are sometimes afraid to say. C.S. Lewis penned his description of what it was like to feel the pain of losing his wife to cancer, whose name, oddly, was Joy, in his book, A Grief Observed. He originally wrote it under a pen name, presumably because he was afraid people would associate it with him and lose respect for him. In it, he struggles with the notion that God is a "cosmic sadist."

So take comfort, if you are struggling with these things, that you're not the first person nor the last, as long as we don't stay there and become captive to bitterness. More about that later.

The next solution to the problem of evil is to say that pain and suffering are not real. They are illusions. This is frequently tied to the idea that life is not real, a notion commonly found in many Eastern religions, which teach that the material world is a delusion. I've had the privilege of sitting in my living room and having those who espouse the teaching of these Eastern religions confirm that this is so.

A Haiku poet expressed it very well. This man lost several children and when he went to his monk to ask what it meant. He was told, "Life is dew, life is dew."

In his poem, he says, "Life is dew, life is dew, life is dew, and yet, and yet, and yet." Do you see his point? He's expressing his own reservations about the notion that what he's feeling inside isn't real. The idea that all our pain and suffering is a delusion, if you will, simply does not offer comfort to the afflicted.

Well, the fourth answer is that God is all powerful and all loving, and you're getting just what you deserve. It is the oldest and perhaps the most pernicious of views on this subject, and it is also one of the more difficult to stamp out. No matter how many times, even within the Christian church we go through descriptions of why this is not the case, it comes up over and over again. It's the belief of Job's friends. You will recall, we'll go over this again, but you will recall that they simply said to him, "Well, God is obviously punishing you for something that you've done."

This view assumes a very naive way of thinking about the world. Specifically, that there is some sort of direct linear relationship between how virtuous and good you are and how many good things happen in your life; and conversely, how evil, wicked and otherwise unspiritual you are, and your degree of pain and suffering.

This mathematical view of material wealth and health is destructive, and I have seen it personally. Let me read you a quote here from a gentleman, Joe Bayly, who lost two children to leukemia and had his older son die in an accident.

A month or so after our 5-year-old died of leukemia . . . a sincere, well-educated Christian told me that our son need not have died, if we had only possessed faith.

'Do you really believe that?' I asked.

'Yes, I do,' he replied.

'Do you believe it enough to pray that your own child will become sick with leukemia so that you can prove your faith?'

After a long silence, he replied, 'No, I don't.'

I do not object to such zealots when they are dealing with other adults. I do object to the traumatic effect they may have on children and teenagers.

The summer our 18-year-old son died, our 16-year-old daughter was at a Christian camp. A visiting minister, in the presence and with the silent acquiescence of the camp director, told this grieving girl, 'Your brother need not have died, if your parents had only had faith for his healing. It is not God's will for anyone to die before the age of 60.'

When our daughter told us this in a letter, I thought about the one who died in his early 30's; one who loved children enough not to hurt them.

In my own experience, early after I came back to Gainesville from the National Cancer Institute, I had seen a young lady who was dying of breast cancer. She had severe pain in her bones from bone metastases and was on pain medicine, but she, at the admonition of those who were in her community of faith, discontinued her medications. They insisted that by taking medications for pain, she was showing that she did not believe that God would take care of her and heal her.

She ultimately had to leave this city and move back home because she was shunned and could only be cared for in an environment outside of the community of faith that was supposed to be caring for her in her last days here on this earth.

Let's leave that. It's obvious error, and go to the fifth option.

If God is all good and all powerful, why is there evil in the world? Well, one could argue that God is not all powerful. Although one has to read the book a little bit to sort this out, a very popular book makes this point. Rabbi Harold Kushner had a child with progeria, which is a disease of premature aging, that you may have heard of. In his book, "When Bad Things Happen to Good People," he articulates his own struggles and offers some solutions, or what he believes are solutions to the problem of evil. From all reports Rabbi Kushner is a wonderful man. He has even spoken to our national society, the American Society of Clinical Oncology.

The book has many good insights. He appropriately is critical of the point of view that I just expressed to you, that there is a mathematical relationship between suffering and evil. He encourages honesty of feelings and being honest with God and being honest with your friends when you're struggling with God's goodness.

He affirms the need for pain referring to this entity of congenital dysautonomia, which some of you may be familiar with. In this disorder children do not feel any pain and their lives are horrible, frequently using self-mutilating behavior as a means of coercing their parents to do what they want.

In other words, a life without pain far from being beautiful is warped and terrible.

But he also says some things that I would respectfully take exception to.

If we can bring ourselves to acknowledge that there are some things God does not control, many good things become possible. Can you accept the idea that some things happen for no reason, that there is randomness in the universe?

Some people cannot handle that idea, striving to make sense of all that happens. They convince themselves that God is cruel or they are sinners, rather than accept randomness.

I would say the two solutions he offers are wrong, and I think he's created a bit of a straw man. I would say, too, that if God is not in control, many bad things become possible, too. And there is another way that you can solve the problem. It's simply by saying, "I don't understand and I don't have to."

Proximate vs. Governing Cause

It is important to make the distinction between the notion of proximate cause and ultimate or governing cause. In the idea of proximate cause, the entity, in this case, God, is the absolute cause who brings evil to bear. I do not believe that God is the "proximate" cause of evil in this world.

But the notion of a "governing cause," that is, that God incorporates the evil, even if we don't understand it, into his ultimate good purposes, at least offers us a way to think about why evil might be in the world.

So the sixth and final solution, at least at an intellectual level, and the one that I ascribe to, is that God is all powerful, all knowing and loving and just, and he will make it right in His time.

This notion that we are in a period where God's goodness is not absolute, but we are coming to a time when all ultimately will be rectified is a key concept to understanding the Christian view of suffering.

Biblical Version of Suffering

Just as there are two sides to the question, there are two sides to the answer that the Scriptures give. The first is Job and the second is revealed in Jesus Christ himself.

Let me review and paraphrase the story of Job. Job was a man who, according to the description in the Scriptures, was righteous and devout. He was God's chief man. God even pointed him out to Satan as the prime example of a human who had an intact, good relationship with him.

Satan comes to God and says, "The only reason he obeys you is because you're so good to him. Let me have him. Let me assault him. Let me take away the things that he has and he'll curse you."

So in the first iteration, God says, "You may do what you want but don't harm the man."

So in one day, as the story goes, Job's children were all killed in a freak accident where the house collapses while they are having a party. Neighbors steal all his livestock. Everything that he has disappears in a very short time, and even his wife turns to him and says, "Curse God and die."

Job still doesn't dishonor God and says,

Naked I came from my mother's womb, and naked I will depart. The Lord gave and the Lord has taken away; may the name of the Lord be praised.

In all this, Job did not sin by charging God with wrongdoing.

But as Job's situation gets worse, God allows him to become sick. He then expresses that which I hear not infrequently from the people who I care for and their families: despair and anger.

3:1 After this, Job opened his mouth and cursed the day of his birth.2 He said:3 "May the day of my birth perish, and the night it was said, 'A boy is born!4 That day--may it turn to darkness; may God above not care about it; may no light shine upon it.5 May darkness and deep shadow claim it once more; may a cloud settle over it; may blackness overwhelm its light.6 That night--may thick darkness seize it; may it not be included among the days of the year nor be entered in any of the months.

20 Why is light given to those in misery, and life to the bitter soul,21 to those who long for death that does not come, who search for it more than for hidden treasure who are filled with gladness and rejoice when they reach the grave?23 Why is life given to a man whose way is hidden, whom God has hedged in?4 For sighing comes to me instead of food; my groans pour out like water.25 What I feared has come upon me; what I dreaded has happened to me.26 I have no peace, no quietness; I have no rest, but only turmoil."

After that, Job realizes that he's struggling and he wants to maintain his integrity. Consider the following passage of his description of his relationship with God. He is concerned, fearful that because of the unrelenting pain, he will curse God.

Oh, that I might have my request, that God would grant what I hope for, that God would be willing to crush me, to let loose his hand and cut me off! Then I would still have this consolation--my joy in unrelenting pain--that I had not denied the words of the Holy One.

Job then goes so far as to accuse God of injustice in fairly crass, disturbingly bitter words. But he still refuses to confess to "hidden" sins he is accused of. Job says,

As surely as God lives, who has denied me justice, the Almighty, who has made me taste bitterness of soul, as long as I have life within me, the breath of God in my nostrils, my lips will not speak wickedness, and my tongue will utter no deceit. I will never admit you are in the right; till I die, I will not deny my integrity.

Then as his predicament goes on and as his psychology evolves, Job then maintains faith mixed with despair. I'll tell you, here is a point to which I can relate. I can in one moment be sure that God is in control, taking care of me, taking care of my family, taking care of my patients, and in the next minute, just fall flat on my face. Listen to what Job says here.

17 My breath is offensive to my wife; I am loathsome to my own brothers.18 Even the little boys scorn me; when I appear, they ridicule me.19 All my intimate friends detest me; those I love have turned against me.20 I am nothing but skin and bones; I have escaped with only the skin of my teeth.21 "Have pity on me, my friends, have pity, for the hand of God has struck me.22 Why do you pursue me as God does? Will you never get enough of my flesh?23 Oh, that my words were recorded, that they were written on a scroll,24 that they were inscribed with an iron tool on lead, or engraved in rock forever!25 I know that my Redeemer lives and that in the end he will stand upon the earth.26 And after my skin has been destroyed, yet in my flesh I will see God.

As Job has more and more time to think he then begins to realize that what he needs here is wisdom, and he recognizes that wisdom can only be found in the Lord.

20 Where then does wisdom come from? Where does understanding dwell?21 It is hidden from the eyes of every living thing, concealed even from the birds of the air.22 Destruction and death say, 'Only a rumor of it has reached our ears.'23 God understands the way to it and he alone knows where it dwells.

As Job's arguments with his friends and his soliloquies come to an end, he moves towards resolution. There is a softening of his spirit. This is a critical thing that happens to those who suffer. There is anger, the notion that God is unjust; there is faith mixed with despair; there is the idea that wisdom is found in God, and then Job looks back, even wistfully, at his relationship with God before he became so ill.

2 How I long for the months gone by, for the days when God watched over me,3 When his lamp shown upon my head and by his light I walked through darkness!4 Oh, for the days when I was in my prime, when God's intimate friendship blessed my house,5 When the Almighty was still with me and my children were around me.

So we've looked at Job for a moment, those of you who have been through suffering or are going through suffering, can no doubt relate to the things Job says.

Let's look at Job's "friends" for a moment. They were very good friends for about seven days. Why? Because, for seven days, they didn't say anything. Then they started to talk and they ruined it. What did they do? They accused Job of occult evil. To paraphrase:

We may not see it, Job, but the fact that you're suffering means that you're hiding it from God, and you can't hide from him. You're getting what you deserve. You had better repent.

When Job then denies that he has gross evil in his life, they then accuse him of lying about it, adding to his suffering rather than relieving his suffering.

Some of you have had an experience like Job's, and you will relate to what he says. The rest of us should hear this and take it to heart.

16:1 Then Job replied:2 "I have heard many things like these; miserable comforters are you all!3 Will your long-winded speeches never end? What ails you that you keep on arguing?4 I also could speak like you, if you were in my place; I could make fine speeches against you and shake my head at you.5 But my mouth would encourage you; comfort from my lips would bring you relief.

May those things never be true of us, as we deal with those who are suffering.

Finally God speaks out of the storm. Let me preface this by saying this is uncomfortable to read. For 20th century modern Western man, the things that God says do not sound very nice to us, but nonetheless, I read them because this is the Biblical answer to our suffering

38:1 Then the Lord answered Job out of the storm. He said: 2 "Who is this that darkens my counsel with words without knowledge? 3 "Brace yourself like a man; I will question you, and you shall answer me.4 "Where were you when I laid the earth's foundation? Tell me, if you understand.5 "Who marked off its dimensions? Surely you know! Who stretched a measuring line across it..

40:1 The Lord said to Job,2 "Will the one who contends with the Almighty correct him? Let him who accuses God answer him!3 Then Job answered the Lord:4 "I am unworthy--how can I reply to you? I put my hand over my mouth.5 I spoke once, but I have no answer--twice, but I will say no more."6 Then the Lord spoke to Job out of the storm:7 "Brace yourself like a man; I will question you, and you shall answer me.8 "Would you discredit my justice? Would you condemn me to justify yourself? 9 "Do you have an arm like God's, and can your voice thunder like his? 10 "Then adorn yourself with glory and splendor, and clothe yourself in honor and majesty....

We have to understand that at some point, when we try to understand the mysteries of the universe, we bump up against our own finiteness. It's a ceiling which we can't go beyond, and it's only faith that allows us to accept that God who is not finite, who is infinite, has our best interests at heart.

The epilogue is very, very important to Job, because a number of things happen. First of all, God condemns Job's friends. Even though they spoke great theological sounding stuff, it was wrong. It was evil. It was destructive. Job is forgiven. He is restored and honored by God.

You see, in the midst of the suffering, Job was honest with God about his feelings. Even though he rebuked Job for accusing him of injustice, God's recollection of Job was only one of grace. Listen to what Job says to God, and then God's response.

42:1 Then Job replied to the Lord: 2 "I know that you can do all things; no plan of yours can be thwarted.3 "You asked, 'Who is this that obscures my counsel without knowledge?' Surely I spoke of things I did not understand, things too wonderful for me to know. 4 You said, 'Listen now, and I will speak; I will question you, and you shall answer me."5 "My ears have heard of you but now my eyes have seen you.6 "Therefore I despise myself and repent in dust and ashes."7 After the Lord had said these things to Job, he said to Eliphaz the Temanite, "I am angry with you and your two friends, because you have not spoken of me what is right, as my servant Job has."

You see, God's view of Job is one of grace and forgiveness, and ultimately, although Job is never told of the heavenly wager or the reason for his suffering, his relationship to God is restored, and that's what's important.

God Visits His People

Now we come to the second half of the Christian answer to suffering, the incarnation. I call this God visits his people. God did not remain abstract, aloof, above us, telling us, I am God and you're not and you can't understand. Instead, he decides that he will come to this earth as a man, who suffered with us and for us. Here's what Jesus says to his disciples.

I tell you the truth. You will weep and mourn while the world rejoices.

Now, he's saying this about his own crucifixion, but I believe the sentiments that he expresses here give a wonderful capsule of God's view of suffering through his son.

You will grieve, but your grief will turn to joy. A woman giving birth to a child has pain because her time has come; but when her baby is born, she forgets the anguish because of her joy that a child is born into the world. So with you; now is your time of grief, but I will see you again and you will rejoice, and no one will take away your joy.

In the Christian view, the crucifixion and resurrection of Christ is the evidence that God has not forgotten us. If you will, Jesus' death and resurrection is the down payment on the promise that he will ultimately wipe away every tear from our eyes as he says he will do when he returns.

In college, I met a gentleman whom, when I first saw him, had no hair on the back of his head. As a stupid 18-year-old, I thought, that's a strange haircut, and I was then informed by a friend that he had just completed radiation and chemotherapy for a malignancy.

We became close friends. He married and because of his treatment, was unable to have children and ultimately, adopted several children. I wish I could say that the happy story ended there, but it's not necessarily a happy story, because, you see, several of his children have serious medical/behavioral psychiatric problems. I'm not talking about minor problems. I'm talking about serious ones, with multiple hospitalizations, grief that I can't even describe to you.

In an email to me, he describes his struggles with Gods goodness when his child was gripped again by illness and hospitalized again. He was exasperated and called to God, much like Job.

"I can't go on like this, God. Why is this happening?" And from God, no answer. "If this is love, then I don't want love. I don't like it." No answer. "How can you be doing this to me? You're going to have to show me something because I don't get it and I can't keep this up." No answer. But then I asked, "Do you have any idea what it's like to see your son suffering?" And then, I stopped. I had my answer. We have a strange religion. God's answer to our suffering was to become one of us to suffer with us and for us. I cried buckets.

I can't put it any better than that. What I can say to you as I say to myself, in the meantime, suffering is inevitable. Don't kid yourself. It is inevitable. It is incomprehensible on a human level, but joyfully, it is endurable.

Suffering is Not for Nothing

But, you know that's still not enough. Knowing that I can endure it and get through it almost like a hazing for a fraternity that has no purpose is not sufficient. And the Scriptures go on to tell us that there is a purpose for suffering. In fact, Elizabeth Elliott, who lost one husband who was killed on the mission field and another to cancer, has a book called "Suffering Is Not For Nothing."

Purpose

Let's now discuss some, but not all of the purposes of suffering. I don't have time to go into all of them tonight, but first, it exposes our presumptuousness.

There was a patient, whom I remember when I was in Washington, who used to say, "I have no intention of dying, kicking the bucket, cashing in my chips." Each day he would use a different phrase to express his absolute certainty that he was not going to succumb to his disease. He was a wonderful man, and I enjoyed knowing him, but, in fact, he did die of his disease. All his protestation to the contrary only served to alienate him from his family as they were trying to prepare for his death.

Second, there is a perfecting and purifying effect in our suffering. We have to walk by faith and not by sight, to use a Pauline expression. It moves us out of our comfort zone and it drives us to God for comfort.

One individual, who comes to mind as I think of this topic, is the minister in my parent's church in Virginia, who was a very self-sufficient individual. He was an excellent public speaker and very healthy. He initially was diagnosed with colon cancer, had that cured, and ultimately started losing strength in his arms and legs and was diagnosed with multiple sclerosis.

Over the 10 years that he struggled with his disease, I had the opportunity to hear him speak about how his body failing him brought him closer to God and allowed him to do writing and teaching that he would otherwise never have done.

And I heard him say with the sweetest and most sincere expression, that there was no way that he would trade his healthy body that he had before for the sorry state of his soul, and that he had no regrets.

The story even became more twisted because 10 years down the road, it now seems clear that he had been misdiagnosed. He did not have multiple sclerosis. In fact, he had what's called spinal stenosis, a disorder that could have been reversed years before by surgical intervention.

Even after finding this out, his comment was very similar to what Joseph said, "Although it was intended for evil, God turned it for good," and he has not an ounce of bitterness. You see he knows the purifying and the perfecting nature of suffering.

Third, suffering also gives us a heavenly perspective as opposed to a worldly perspective. Another lady I cared for several years ago was one of the more amazing miracles of modern medicine. She was one of the first people to receive an organ transplant at the University of Florida and ultimately developed a malignancy. She had a great deal of difficulty dealing with the fact that her two daughters would be without a mother. But just before her death, she was able to understand that if she had faith that God could heal her from her disease, this same God was also able to care for her children when she left this world.

A fourth purpose of suffering is that it brings us compassion and empathy for others who are suffering when we recover.

There was a lady, another very memorable lady who, several years ago came to me with a relapse of her lymphoma. She was treated on one of my bone marrow transplant studies. She had an initial excellent response. While she was in the transplant unit, she became friends with a little boy who had another form of cancer that was being transplanted in the hopes that it would cure his disease, but with little realistic expectation that it would. She became his surrogate mother so that when his real mother had to leave for a time, she would be in there with him. Mind you, this was while she was receiving treatment for her cancer.

Unfortunately the child relapsed and was being cared for with the help of Hospice, when her disease also recurred and was incurable. I held her hand and she asked me how long she had. I explained to her weeks, not months. Tears came to her eyes and she explained to me that the tears were because she wanted to see her son graduate from law school, which she ultimately did.

And then she looked at me and she said something I'll never forget. "Dr. Lynch, don't you understand. God wants me to be in heaven so that I can be Randy's mommy until his real mommy can join us."

You see she knew the meaning of compassion and empathy in her suffering.

The fifth purpose of suffering is that we learn the true depth of our faith. It's frequently not during but after the crisis. Read what David Beibel says as he looked back on the horrible experience of his life, namely watching his second child die of a progressive degenerative disease.

Yet in the midst of it--awful and overwhelming as it really was--inside, I experienced a certain peace, or a calm that has made this time around so much different. Perhaps it is knowing that I have come close to cursing God, and then discovered that I could not do it. My faith is real. It has true substance and it is secure--I am secure--because of a family relationship with the Almighty God who will not let me go even if I consider letting go of Him. It was something I needed to learn, that I needed to know, and it's through your pain--our pain--that I've learned it. I know that no matter what happens I cannot go past the point where I was that night, and that is what gives me peace.

Sixth, suffering also prepares us for his joy. There is a difficult to describe and yet real relationship between pain, grief, and joy. I have seen it over and over in my life. I have seen it over and over in the lives of my patients. If you talk to folks that you know, many will tell you that at the time that they were at the bedside, when their mom was actively dying, was the time that they felt so at peace and the family members held hands and prayed together. This is a truth that we don't like, but nonetheless, it's real and it's glorious.

Finally, there is a very mysterious way in which, as we suffer, to use Paul's phrase, "We complete the suffering of Christ", or in Peters words "We participate with him in his suffering". The New Testament writers speak of this as if it's a privilege, which certainly is a mystery to me and it's perhaps best summed up by a quote from, "The Hiding Place."

Some of you are familiar with the story of Corrie Ten Boom, whose family hid Jews who were being pursued during the Nazi occupation. They were caught and she and her sister, Betsy, were sent to a concentration camp. There Betsy died, but, by a clerical error, Corrie was released, and since that time has born testimony to what went on there. This is the quote of her remembrance of Friday inspections.

Fridays--the recurrent humiliation of medical inspection. The hospital corridor in which we waited was unheated, and a fall chill had settled into the walls. Still we were forbidden even to wrap ourselves in our own arms, but had to maintain our erect, hands-at-sides position as we filed slowly past a phalanx of grinning guards. How there could have been any pleasure in the sight of these stick-thin legs and hunger-bloated stomachs, I could not imagine. Surely there was no more wretched sight than the human body unloved and uncared for. Nor could I see the necessity for the complete undressing. When we finally reached the examining room, a doctor looked down each throat, another--a dentist presumably--at our teeth, a third in between each finger. And that was all. We trooped again down the long, cold corridor and picked up our X-marked dresses at the door. But it was one of these mornings while we were waiting, shivering in the corridor, that yet another page in the Bible leapt into life for me. He hung naked on the cross. I had not known--I had not thought--the paintings, the carved crucifixes showed at the least a scrap of cloth. But this, I suddenly knew, was the respect and reverence of the artist. But oh, at the time itself, on that other Friday morning--there had been no reverence. No more than I saw in the faces around us now. I leaned toward Betsy ahead of me in line. Her shoulder blades stood out sharp and thin beneath her blue-mottled skin. "Betsy, they took his clothes too." Ahead of me I heard a little gasp. "Oh, Corrie. And I never thanked Him."

The Dangers

I would be remiss if I did not point out that there is a dark side to suffering. There are dangers. Dangers, that I have tragically witnessed, feeling quite helpless in some circumstances.

Let me articulate just a few of them if you don't mind. The first is guilt. Many ask, "What did I do to deserve this?" If you will, this is a permutation of the argument that there is a relationship between how evil we are and the kind of suffering that we experience. With cancer patients, it becomes, in a sense, a battle at many levels. There is the theological level. "Is God angry with me?" There is the practical level, "Did I not eat the right stuff? Should I have exercised more? Was it that I lived under a power line?" With these kinds of questions, and particularly if there is a child involved, the guilt can be very complex and it needs to be dealt with in a loving and gentle way. I learned today of a new kind of guilt. One of my patients said to me that she had learned during her illness that if she had a good attitude and was happy, that she would live longer. Her reaction was "Great, now I have something to feel even guiltier about. I have to have cancer and be happy about it or I'm not going to live as long."

As I said, this can be very, very complicated and must be dealt with in a loving, understanding, and gentle way.

The next is blame. This can be extremely destructive. It must be somebody's fault. Imagine if a child dies in an accident, family members may begin to, in anger, strike out. "If only you had been watching more," or when someone has been neglecting their spiritual responsibilities and has something befall them--if only you had gone to church or read your Bible. This kind of blaming is an extremely destructive force and interferes with any effort to come to resolution.

The next is bitterness. Bitterness would have been the result had Job gotten stuck in his initial anger and frustration. If you will think about it, unresolved anger ultimately bears the fruit of bitterness which destroys the soul, the heart and, any happiness or joy in the life of the individual afflicted.

The writer of Hebrews warns against the "root of bitterness." Sadly, some of the folks who I have seen consumed by bitterness in its most unpleasant form are highly trained professionals who simply can't understand why modern medicine and modern science can't deliver them from the fate of their disease.

The next is emotional death. Some refuse to express their emotion. You must keep in mind that people express their emotions in different ways. They have different ways of showing grief and anger. Sometimes, however, friends discourage individuals from venting their emotions as if this were somehow unspiritual.

I would point to Job and to the Psalms as evidence that this is not true, and I would submit, rather, that not to be honest with God about anger denies the essence of our faith, which is an honest and open relationship with the living God.

Finally, in an effort to protect loved ones, patients sometimes hide the truth from them. This was done in the case of my aunt, who died of complications of treatment of Hodgkin's disease when I was in college. She had been ill off and on for over 10 years, and it was only shortly before her death that she told her two children all that she had been through. Her daughter, my cousin, who now lives in San Diego, had lunch with me several years ago and made me promise that I would share her message with my patients and so I share it with you now.

She only wished she had known of her mother's illness so she could have helped. Instead for years, after her mother died, she struggled with guilt over her insensitive comments, her criticism, saying things like, "Other mothers do this, why don't you do this?" And it just tormented her because she had no idea what her mother was going through. And so the effort to protect often condemns to years of guilt and frustration.

Conclusion

So let me conclude by saying that the topic that I have addressed tonight is one that is even in evolution in my own mind and heart because it's a day-to-day struggle for me.

Suffering and the struggle with the goodness of God remain perhaps the greatest challenge to any person who takes faith, truth, and life seriously. What I have attempted to do is to articulate my intellectual, emotional and spiritual journey through faith in Christ. My intention has not been to offend anyone or to pretend that I have all the answers. Such arrogance cannot be a part of this discussion. I hope you will, rather, view me as a parched wanderer in the desert of suffering who has found an oasis, whose water here is living water.

Although the path may be the most bitter, the water is the sweetest. If, you're here tonight because you know all too well the reality of suffering, may you, too, drink from this fountain and know the life, the truth, and the way. Thank you.

References
1. Elizabeth Elliott, A Path Through Suffering, Servant Publications, 1990.
2. Harold S. Kushner, When Bad Things Happen To Good People, Avon Books, 1981.
3. R.C. Sproul, Surprised by Suffering, Tyndale House Publishers, 1988.
4. Joseph Bayly, The Last Thing We Talk About, Life Journey Books, 1969.
5. David B. Biebel, If God is so Good, Why Do I Hurt so Bad?, Navpress, 1989.
6. Corrie ten Boom, The Hiding Place, Barbour,1971.
7. C.S. Lewis, Suprised by Joy, Inspirational Press, 1994.

Special thanks to Susan Bryan and Lorilynn Roberts for their assistance in preparing this manuscript.