There is the wet scent of blooming sage after sudden rain, the cold vacant air, the icy stars almost painfully bright, the inhospitable maw of a desert canyon, cut through a thousand feet of rock by the ceaseless churning of the Chama River. And all of it is spread there beneath the shadows of three crosses, looming over the precipice of the canyon.

Lord God Almighty.

It’s been nearly twenty years since I first came to The Monastery of Christ in the Desert as an odd young medical student, raw, and troubled, and yearning. And it’s been years since I’ve been back. But give me a moment and even now, I am there. My hand is on my forehead, wet with holy water and smelling of sulfur and rose. The river is churning, and the hairy thornapple is blooming, and the Benedictine monks all black-clad and hooded are chanting the Compline in the dark in the high desert of New Mexico. And like Wordsworth said, I feel it all.

Back then I wanted to be a doctor who helped people. Like every other med student, I wanted to help people get better, maybe even heal them. But there was something else there too. I was idealistic, and not a bit naive. It wasn’t just patients that needed helping, I thought. Other things were broken too – everyone could see that. And I wanted to fix them.

This idealism of the young – I can only really speak to mine, and well, it was a beautiful thing. It gave off a dizzying light. And it was through the golden flecks of this light that I saw these broken things. What’s more, I saw myself, reflected in a sort of halo. In the orbit of this halo I felt larger. “These things are broken,” my little light would say.

“Easy, no problem, I can fix them. I will fix them. I will fix them.”

But from the first day, I saw so much suffering, felt its weight. Held it in my hand. Good God, it was heavy. It was so much heavier than me. And there was so much of it. These things I couldn’t fix, it was terrible how quickly they clouded over my gorgeous little light.

When it is not iced over, in all four seasons the Chama River is completely opaque, churning thick with the clay, incessant in its work of turning everything, even the rock, back into the dust from whence it came. Once, in the eagerness of that summer I dove under it, following a beaver who cracked her flat tail on the surface of the water and disappeared down. There was full desert sun above. I opened my eyes wide. It was so cold. And it was black as death.

This would happen to me in the hospital too. As I sliced, my gloved hand trembling, into a cadaver, as I pounded on the chest of a dying man, ribs cracking under my folded hands, blood tinge foaming from his motionless mouth. As I lifted a baby wet and screaming into hot surgical lights. At times I could still see by that little light. Sometimes there was so much light. But then, just as suddenly, I would pitch forward into that terrible river, and everything would go dark.

And so I went to the desert. I didn’t know it at the time, but I went to the desert for a blessing. I love being blessed by priests. How they make the sign of the cross over you, or even place a palm on your forehead. How they call you their child. “Bless you,” they say. And sure, they’re strangers, and what’s worse, they’re human, with every holy and terrible thing that entails. There is often an ambivalence that lingers there, between me and that blessing hand. But when they say to me, “God bless you, my child,” usually I believe them.

I wanted to find the peace that passes understanding. And so I went, following trails blazed by artists, writers, Sufi mystics, and vast numbers of sport kayakers, deep into the canyons of the New Mexico high desert.

It’s one of those places where the high could be 90 Fahrenheit when the low is 30. A safe house wrought from desert mud in a canyon filled with all manner of dangerous things like blizzards and flash floods and heat stroke, and snakes.

The Benedictine monks there wear the black robes of the old world. Plumes of frankincense float skyward during vespers and the holy water is scented with rose that mingles with the acrid sulfur of their well. Seven times a day monks chant the hours in one voice. It is a ceaseless rhythm that has been unchanged for hundreds of years. They make their lives amid high canyons cracked full open by a persistent little river that churns opaque with clay. Each day the sun sets majestically over the western rim of the canyon, lighting up the sky with yellows and reds, and then at night the moon comes up over the eastern rim, bathing the whole river in its mysterious light. The church thinks in centuries, the landscape speaks in millennia, and against the severe beauty of all this, if I don’t find answers, I find at least an uneasy sense of something larger at play. A reassurance that if all we can do is try to live good lives filled with kindness for all that suffering, maybe sometimes that will be enough.

My visits to this monastery have made me think about how to approach the practice of medicine with more faith and reverence. To treat the physical exam, and every other moment where I touch a patient, as something profound, maybe even holy.

There is so much touch in medicine, but it is often investigative, cold, and alienating. We use latex gloves, we palpate, we probe, we sometimes even evoke pain with our touch. But early Christians believed that the touch itself could heal. That hands, placed carefully and with right intention, could invoke the Holy Spirit, who would enter the room like a diving dove.

The science and charity of medicine is not the same as the miracle of faith healing, but there have been times when I have sensed its holiness, often in simple acts of touch. A medical student at a free clinic cleaning and bandaging the feet of a homeless man. A pediatrician passing her stethoscope to a sick little girl in a blue hospital gown, switching roles for a moment to calm the tiny hands as they listened for the sound of the white-coated doctor’s heart.

Sometimes even the most high-tech medical interventions could feel holy. “I ask Him to use my hands,” an obstetrician once told me of her surgeries. It was the prayer she sent up before every cesarean. “Don’t get a big head,” she warned, “It’s not you. These things happen through you. He’s using our hands.”

There were mystical times when surgery felt sublime. Once I placed a baby at the breast of his new mother, in the middle of the operating room, while the obstetricians had barely begun to repair her uterine incision. The new father leaned in to touch the baby. A nurse arranged a photo with the insistent and practiced hustle of a tourist guide at the Taj Majal. “Smile!” she demanded. The mother’s open belly was surrounded by a solemn circle of obstetricians – masked, gowned, and gloved. They were expert in their ritual, the novice ones taking their cues from the elders, their hands moving with skill, ceremoniously arranging intestines, and throwing their black suture, everyone’s bloody hands bathed in the hot surgical light.

The family, unphased by the spectacle taking place across the drape, was beatific as their daughter opened her eyes for the first time. “Your name is Bethany,” the mother whispered through tears, “You have a brother. His name is Shepard.” Bethany’s father pressed his face against his wife’s. His hand seemed to span the whole back of the infant girl, her tiny-sister body still marked with blood and vernix.

Of course, there were terrible things too. Once I saw a sweet athletic little girl of maybe ten arrive at the emergency room in florid kidney failure. She was jovial through all this, entertaining her giant family in two languages while the interpreter relayed her unjust sentence, repeating things in Spanish that made her mother weep with a twenty second delay after the nurses would tear up at the English version. The little girl continued like that, smiling and laughing and saying little jokes in two languages, right up until the moment her hapless stoic father, who had been standing through all this, fainted. He fell to the ground and seized, right there on the floor of the hospital. Suddenly, the girl was screaming, flailing wildly in her pretty blue printed hospital gown, hitting her little face against the plastic bars of her hospital bed as her sweet mouth filled with blood. The sky was turning colors outside the hospital and the air roared to life with the sound of the transport helicopter.

And of course, sometimes the things were so terrible I could hardly persist in believing in the godliness of any of it.

Even before med school, I had spent a few months at a midwifery training program, delivering babies in a birth center on the Texas-Mexico border. So I knew human birth as a particularly unpredictable blessing, and one that could turn quickly unforgiving, like the weather on a mountain, or in a desert canyon. I had felt, with a gloved hand, the bony palate of a baby with trisomy 13, felt a shiver in my body as my fingers raked along the bones of her split skull where there ought to be flesh. Her father refused to be in the room, the mother was alone besides the baby, born dying, and her helpless medical team.

Sometimes even the healthy babies couldn’t be saved.

A healthy, full-term little boy was already crowning when they lost the heartbeat, rushed to the operating room for an emergency cesarean section. By the time the baby reached my arms he was pale, floppy, lifeless. I clicked open my laryngoscope, parted the baby’s lips, pushed the metal down into his tiny mouth, but I couldn’t see the vocal cords. The whole mouth was filled with tarry meconium and blood. The nurse practitioner pushed me aside, and she couldn’t get the tube in either. The room was chaos. “Somebody get a pulse ox monitor on!” “Where’s the UVC kit?!” “Has anybody heard breath sounds?” Chest compressions, monitors. The baby had no heartbeat, the seconds pass like scores of years, the neonatologist finally intubated the baby, and at last I felt the cord pulsing under my gloved fingers: a heartbeat. We got her on the oscillator, shipped her off in transport to the Children’s Hospital in the wee hours of the morning. It made no difference: her little body had been without oxygen for far too long.

It was a dark time for me. Because I questioned my skills. Because I worried that I had caused her death.

But also because I knew that hospitals were at their core places of hospitality, that they descended from religious institutions dedicated to the care of sick strangers. I longed to make medicine a place where one could be driven by a great need, as if by a swift hailstorm, into a shelter. A warm place, safe and holy: a place where one might receive a blessing. Instead we took this infant, cut her out of her mother, greeted her with torturous interventions, and then watched her die anyway. I couldn’t make sense of it.

I cried to my mentor, “I know it wasn’t my fault, but …”

Her tough love response was, “Margaret, some day, something terrible will happen to a child, and it really will be your fault. And that’s just medicine.”

I cried to my pediatric resident friend and her surgery resident husband. “I don’t know, Margaret,” he said. “No breathing, no heartbeat. It sounds to me like when you first got that baby, that baby was already dead.” These are two of the most comforting things anyone has said to me.

She was steely from her years of witness. And he was a surgeon, so he said it most straightforwardly.

But I think they only meant that the paradox of learning to be a doctor is working fanatically to change dire outcomes and then in the same breath accepting that there are things beyond our control. Passages we cannot discern. Crossings we cannot prevent and might even hasten.

Mary of Bethany said to Jesus, “If you had been here my brother would not have died.” As important as we doctors might believe our practice is, and indeed, as important as our decisions may sometimes be, we cannot proclaim, like Christ with Lazarus, “This sickness will not end in death,” and then make it so.

The baby died for real a week or so later in the NICU at the Children’s Hospital. I was working endless shifts at our other hospital across the city. But before she died I felt I had to find her, to visit.

Visit. The word comes from the Latin visere, meaning simply “to behold,” and it has definitions as diverse as “to examine, comfort, or afflict.” It’s an expansive word, whose synonyms include both blessing and calamity, because in its original formulation it was used to signify a visit from a deity. In our desire to fashion palatable, approachable religion, we moderns tend to forget what the ancients knew, that gods are best met equally with adoration and fear. It wasn’t until the fourteenth century that the usage was extended to include pastors and, significantly, doctors.

The snowy January before, I had been at the monastery during the feast of the Epiphany, the celebration of the magi, at the conclusion of their long journey seeking the infant Christ. The church was adorned in liturgical white, the canyon stilled in downy snow. Built of glass and steel, loud with alarms, changeable, and almost terrifyingly modern, the Children’s Hospital was in many ways the complete opposite of the New Mexico chapel, quiet and holy. But my visit to that baby was still a pilgrimage of sorts. Because I needed to touch him. I needed to touch him the way that a baby should be touched. As a blessing.

Theologians and bioethicists have talked about the patient-doctor relationship as covenantal. It goes beyond contract. On the best days, it enters into the realm of the spiritual. This occurred to me a long time ago as a medical student. As a student-director of our local free clinic, one of my responsibilities was the “lab run.” I was in charge of ferrying the small tubes of blood, urine, epithelial cells, and vaginal swabs that we collected ourselves from the bodies of the brave and the uninsured. We spun them down in our small centrifuge, sealed them in plastic biohazard bags, and set them in the floorboard of my ramshackle Chrysler convertible, which back then, on Galveston Island, passed for decent hazardous-material transport. Then I drove them straight up the steep incline of the ambulance ramp to the harbor entrance of our big public hospital, avoiding the “Trauma Surgeon Only” spot that belonged to a particularly formidable and terrifying attending.

One evening after lab, after classes, after clinic, and before heading home to study, I stopped for a moment on the high-angled ambulance ramp, turned around, and noticed the ocean. The sun colored up all the western clouds, slipped into the harbor, and was gone. I felt in my hand the weight of all the tubes in the biohazard bags. Blood from their bodies. They entrust this to us, I thought. This is a spiritual practice. And today, so many years later, and despite all the evidence otherwise, I continue to believe it.

This Pentecost, the celebration of the day the Holy Spirit dove down like a dove and blessed the twelve disciples with tongues of fire, I slept late and had planned to go for a walk to the river instead of to the chapel. But the sky decided to unload suddenly, and I was driven into mass by a short-lived but fierce storm, replete with hail and lightning. At communion, I approached the altar, somewhat shyly, with my hands crossed over my chest. I was misty-eyed, and the priest gave me a beautiful blessing. Something about going “deeper into these mysteries.” And I do. Because everything seems meaningful in places like this.

There are rare moments in one’s life, spaces where it’s quiet. Born out of the deep silence, every movement seems benevolent. We are all pilgrims; we are surrounded by hospitality. We act with our hearts open, see the best in each other, and we move and touch with a deep respect and a decency that feels utterly human.

This place is one of those sweet spaces. Whatever your creed, you take one look at the severity of the desert canyon, the way the weather can change in a moment, and you compare it with the hospitality of the candlelit chapel, stolid and warm, with incense floating towards the upper windows. And for that moment, even with the storm raging outside, even before the rainbow, you can’t help but believe. In the covenant, in the blessing.