For more than 50 years, Dr. Rachel Naomi Remen has helped other physicians cope with the psychological pressures of treating patients with life threatening diseases even as she has steadfastly faced her own medical crisis.

Remen has Crohn's disease that led to the loss of her intestines. She also deals with vision problems. Crohn's disease is a form of inflammatory bowel disease. It was named after Dr. Burrill B. Crohn, who first described the disease in the 1930s.

After nine operations and after counseling thousands of physicians "to bring their heart and soul to work as well as their cognition and skills," Remen, 76, said she knows first-hand that the practice of holistic and integrative medicine is not a luxury but a critical addition to the practice of traditional medicine that can increase the likelihood of positive outcomes for both patient and physician.

"Our modern medical techniques are only the branches of a very old tree," Remen said.

Remen, a clinical professor of family and community medicine at UC San Francisco School of Medicine, authored Kitchen Table Wisdom: Stories That Heal, a New York Times best seller, and My Grandfather's Blessings: Stories of Strength, Refuge, and Belonging, a national best seller.

Some of the best physicians, Remen said, "experience work as a calling." Instead of focusing primarily on achieving prestige, power and wealth they are more concerned with integrity and work that aligns their personal and professional ethics as they serve others.

"Not violating your values and discerning meaning in your work is a form of self care that reduces stress and helps prevent burnout," said Remen who is the founder and director of the Institute for the Study of Health and Illness at Commonweal in Bolinas.

According to Remen, many doctors think they must be stoic as they confront pain and disease. "They understandably concentrate on alleviating suffering and providing successful treatment; the work can be uplifting but also disheartening," she said. "Too often physicians forget their own courage, loyalty and love for what they do. Recognition of their contribution is the best antidote for possible depression and it is cheaper than Prozac."

Although pain and suffering are unavoidable for both physician and patient, Remen said they could be transformative, "cultivating perspective, meaning and wisdom."

She recalled a 5-year-old boy who was in the end stages of leukemia whose extraordinary spirit and presence taught her, the nurses and resident doctors to view death not "as personal failure but as universal mystery."

Remen, then director of the pediatric inpatient division at Mount Zion Hospital in San Francisco, arrived to work one morning greeted by a dismayed and emotional staff in a quandary about how to respond to the boy's wish to go home even though that was impossible given that he had no platelets or white cells and consequently could bleed to death from the slightest injury.

In Kitchen Table Wisdom, Remen wrote that she entered the fragile child's room uncertain of what to say, ashamed for the care she provided that inadvertently brought him pain but no relief or cure. As they made eye contact "there was a deep sense of acceptance and mutual respect." She waited quietly for the child to reveal his state of mind.

"In a voice filled with joy" the child told Remen that he was going home and the doctor responded, "I am so glad." Later that day the child said he was tired and laid down on his bed, "pulling his sheet over his head, and quietly slipped away."

The staff, which had cared for the child and hoped against all odds to literally grant his last wish, mourned his untimely death but perhaps more importantly learned to expand their perspective and to be receptive to the underlying meaning of a patient and doctor interaction. "This child had known that he was going home,'' wrote Remen, "in a much more profound sense than the staff was prepared to appreciate."

For months, Remen awakened sobbing from dreams about the children she could not save. In the dreams she noted their lab values, favorite stuffed animals and conversations about their fears and hopes. The feelings of sadness and loss remain but she honors their lives and those of other patients by continuing to counsel physicians "to help them expand their awareness of the affective domain while validating the creativity and intelligence that they bring to their work."