2019

The Wages of Apostolic Poverty
May 3, 2019 | 1:30pm
Davidge Hall

By the time this patient reached the end of his life at age 44, absolute poverty and disease had reduced him to the condition of a living corpse. He was not, however, born destitute. In fact, the patient’s family was wealthy enough to enable him as a youth to live a hedonist’s life of revelry, song, and nightly escapades about his native city with a multitude of friends. Much later he would refer to that time as his “years in sin,” though an early (approved) biographer insisted that “he never yielded to seductions of the flesh.”

When the patient was 19 his life changed radically. Captured during a battle with a neighboring city, he was imprisoned for a year in a damp and polluted subterranean cell. He languished there in near perpetual darkness on a diet of rancid food and tainted water, while exposed to brutal cold in the winter and sweltering heat in summer. When finally freed, he was so frail he could barely walk or speak. His face was drawn and sallow, and his digestion permanently impaired. He was also wracked repeatedly by protracted episodes of chills and fever. For an entire year, he was bed-ridden. Under his parents’ care, he eventually recovered much of his former strength but for the rest of his life continued to suffer with chronic gastritis and intermittent violent episodes of chills and fever.

In the aftermath of the patient’s imprisonment and partial recovery, he rejected both his family and former life as a popular and endlessly inventive wastrel. From then on, he committed himself to an existence of possessing nothing—not just less than the poorest of the poor, but, literally, nothing. He became homeless and shoeless, dirty, pale, and emaciated. His only possessions were a burlap tunic and walking staff. When he ate, which he did irregularly due to frequent fasting, his meals typically consisted of wild fruits and a few turnips. Rarely did he consume meat or cooked foods, and even when burning with thirst, allowed himself only minimal amounts of water.

In this new life, the patient became a contemplative hermit, itinerant preacher, and restorer of derelict churches. He also ministered regularly to the poor and infirm with simple acts of charity. He had a special affinity for lepers, who he not only embraced but “washed all the filth from them, and even cleaned out the pus of their sores.”

The patient’s health was generally poor though stable until age 31, when he suffered a bout of depression that lasted six weeks. When finally recovered, a barefoot journey from Italy to Spain in inclement weather precipitated additional attacks of chills and fever and episodes of gastritis, manifested as right upper quadrant abdominal pain, dyspepsia, and nausea. For a brief period, he also seems to have been delirious, in that he was unable to speak or to understand what was said to him. He made a gradual but complete recovery from the dysphasia, but was so exhausted by the illness that, for the next four years, he was forced to restrict his activities.

When the patient was 37, he accompanied a military expedition to Egypt. Sanitation was poor and tropical diseases so prevalent that and estimated 1/5 of the expeditionary force perished from disease. The patient survived, but on returning to Italy a year later, a new disorder was added to his attacks of fever and gastritis. His eye lids had become irritated and thickened; his eyes burned and teared constantly; and both bright daylight and nighttime firelight caused intense eye pain. Sometimes he was unable to see at all, and even when his vision cleared, images were frequently blurred.

Thereafter, the patient’s condition spiraled progressively downward. He was now confined to bed, blind with pus oozing constantly from his eyes, while shivering with fever in a state of perpetual physical agony. His color was waxen, his upper limbs rail-thin and his legs and abdomen swollen. Severe abdominal pain and dyspepsia made eating difficult.  Moreover, his skin was now covered with sores and ulcers, which he tried in vain to hide from visitors.

Doctors were summoned and applied red-hot irons to both sides of the patient’s head, from his cheeks to his eyebrows. They also cut open the veins of his temples in a futile effort to cure his eye disorder. Then they inserted red-hot irons into his ears. Throughout the length of his illnesses and desperate treatments, the patient offered no complaint. His suffering finally ended on October 3, 1226.

2019 Participants

Reza Manesh, M.D., is an assistant professor and assistant program director for clinical reasoning for the Osler Medical Training Program at Johns Hopkins University School of Medicine. He works as a hospitalist, treating patients as he trains medical students and residents. Manesh is co-author of a recent study titled “Assessment of a Simulated Case-Based Measurement of Physician Diagnostic Performance.” Born in Tehran, he grew up mostly in Pittsburgh, earning his medical degree at the University of Pittsburgh and completing his internal medicine residency at the University of California San Francisco.


Eliot L. Siegel, M.D., is professor and vice chair of diagnostic radiology and nuclear medicine at the University of Maryland School of Medicine, as well as chief of imaging for the Veterans Affairs Maryland Healthcare System and VISN 5. He has adjunct appointments as professor of bioengineering at the University of Maryland College Park and professor of computer science at the University of Maryland Baltimore County. A 1982 alumnus of the medical school, Siegel created the world’s first digital filmless radiology department and was responsible for the NCI’s National Cancer Image Archive and served as workspace lead of the NCI caBIG In Vivo Imaging Workspace.  His current research and publications are focused on application of artificial intelligence in medicine.



Joanne Schatzlein, OSF,
 is a member of the Sisters of St. Francis of Assisi whose Motherhouse is located in Milwaukee, Wisconsin. She received a BSN in nursing from Marquette University and holds a master’s degree in Franciscan studies from St. Bonaventure University. Schatzlein is director of the office of corporate ministries for her congregation and continues to serve as a staff member for Franciscan Pilgrimage Programs in her area. She lectures internationally, promoting the understanding of Franciscan history and spirituality in ongoing formation, retreat work, and higher education.

Final diagnosis