The real voyage of discovery rests not in seeking new landscapes, but in having new eyes.
-Marcel Proust

I met Marie on a long cross-country flight. She was returning to her home in California after a business trip. We spoke about oceans and beaches, and I told her how much I was looking forward to a few days of long walks by the sea. After a heavy sigh she said, "I've lived near the beach for the past year and I haven't been able to take one walk." Although she didn't know I was a physician, she continued to speak with some intensity "I've had asthma for two years, and now it is so severe that I have to stay indoors as much as possible." She continued, "I'm too young to stop doing all the things I love to do." As I listened, I wondered whether physicians have a subtle way of attracting those who are ill, or whether it was my smile of encouragement that invited her disclosures. Either way, I put my work aside to listen.

In the past two years she had seen numerous physicians, had undergone complete allergy testing, and had taken the usual prescribed medicines. Despite these efforts her symptoms were getting worse. "It's the pollen," she said. "I know it's the pollen." She continued with this thought in a rather persistent way even though I pointed out to her that she had lived in the same area for many years without any previous problem with asthma. I took another tack, asking "Was there something that happened in your life before the asthma began?" A bit set back by what seemed to be an irrelevant question, she responded, "No, nothing."

Because I have heard so many similar stories, I pressed on with some ambivalence (after all I was taking an airplane flight, not conducting an office visit). "Think carefully," I told her, then asked again, "Did anything unusual happen in your fife?" After a pause she spoke. "Well, now that I think about it my mother died around the time I got my first attack."

What happened?" I asked. She responded, "I've never been close to my mother, but on the day she died she had complained of some chest pain. She had similar pains many times before, but I told her I would come over. She insisted that it wasn't necessary, but I knew I should have gone. She died that night, and I feel guilty."

Noticing her sadness, I asked, "What have you done about the guilt, and sadness, and anger?" "What do you mean?" she answered. "Well," I asked, "when did the asthma start?" "About a month later," she responded, not making the connection between the events in her life and her disease.

As we talked it became clear. Marie had come to believe that disease generally has a single cause, one that is usually outside of ourselves. In her case it was pollen. A single cause calls for a magic bullet, which for us means drugs. And even though all her efforts at such treatment had failed to heal her asthma, she persisted in using that treatment.

Through their experience, physicians learn that there is a time to join an individual compassionately in his or her pain and suffering, and a time to confront. With only an hour left on the flight I realized that I would have to take the path of confrontation. I let her know that I was a doctor, and stated my view as clearly as possible. "Disease is not caused by one external agent," I said, "nor is it ever isolated to one part of ourselves. Disease results from the combination of many issues that lead to a disunity in our mind and body. Disease is a disorder of our whole being. Your asthma," I stated, "can be fully healed."