A Doctor's Ministry, Bridging Science and Spirit Forty years ago, long before the recent afternoon when Dr. Joseph Dutkowsky knelt at the warped feet of his 4-year-old patient, he was a small-town teenager approaching his Catholic confirmation and needing to select a patron saint. He made an unlikely choice, a newly canonized figure, St. Martin de Porres, the illegitimate child of a former black slave in 16th-century Peru. Back then, in the early 1970s, as the child of a factory worker and a homemaker, Joseph had no aspiration toward medicine. Nor did he know that Martin de Porres had been elevated to sainthood in part because of his healing miracles. Decades later, something - call it coincidence, call it providence - has bent the vectors of faith and science together in the career of Dr. Dutkowsky. The confluence of these often-clashing ideals has taken him to the top of his profession as an orthopedic surgeon specializing in the care of children disabled from cerebral palsy, spina bifida, Down syndrome and other afflictions. It has also taken him to the healing shrine of Lourdes and to the Lima barrio where his patron saint tended to the poor and broken and cast out. Dr. Dutkowsky's appointment with Christian, his young patient at NewYork-Presbyterian/Columbia hospital in New York, was as emblematic as any other on his calendar: cerebral palsy at birth, canted legs that could not be corrected by braces, muscle tissue softened by Botox injections, and each foot placed in a cast for several weeks to try to reshape it for stable walking. "This is my ministry," said Dr. Dutkowsky, 56. Some people stand next to the ocean to feel the presence of God. I get to see the likeness of God every day. I see children with some amazing deformities. But God doesn't make mistakes. So they are the image. Dr. Dutkowsky is well aware that he occupies contested territory, both intellectually and theologically. He can say, as he does, that he considers both belief and reason to be divine gifts. And he can say, as he does, that a healing miracle can consist of restoring a person's soul to God, not necessarily curing a disease or reviving a paralyzed limb. Words, though, have rarely settled the millenniums-old arguments between sacred and secular, particularly as they pertain to medicine. So Dr. Dutkowsky mostly lives his example. Once chastised by a hospital superior for saying "God bless you" to his patients, he wears a wooden cross carved by a disabled man in Lima, he fingers a rosary as he drives to the hospital each week from his home in upstate New York, and he recites a prayer to the Holy Spirit by Cardinal Mercier as he parks the car and prepares to see his patients. "Only show me," it concludes, "what is your will." Dr. Dutkowsky has found his place working in a zone where medical challenge and religious mystery intersect. He treats people - even those who have grown into adulthood - who were visited with disability as children. When he operates on them, he recognizes that he is, at least in the short term, adding pain to a life saturated with pain. A purely secular physician, someone who accepts the concept of a capricious and random universe, would not face the question that a believer like Dr. Dutkowsky did when he saw an adult patient named Mike late last month. Here was a man in his 30s who, despite a case of cerebral palsy that had consigned him to a wheelchair, earned a master's degree and held a social work job. What kind of God would then allow this man to develop retinitis pigmentosa and gradually lose his sight? As with the 4-year-old boy, Dr. Dutkowsky began his session with Mike on the floor, at the patient's feet, looking less the expert than the supplicant. He swiveled his head and propped his chin on his palm to keep his face within Mike's shrinking field of vision. He was, by choice, "Dr. Joe." Before turning to anything diagnostic, Dr. Dutkowsky spoke to Mike person to person, chatting about the Baseball Hall of Fame, joking about how he mows the lawn to reduce stress. "My psychiatrist," he said, "is named John Deere." Only then did he examine Mike's legs and discuss a regimen of conditioning and strengthening exercises to return some mobility to them. "We have a culture that's addicted to perfection," Dr. Dutkowsky said later. We're willing to spend thousands of dollars to achieve it. The people I care for are imperfect. And I can't make them perfect. I only hope that they can sense that I actually care they're more than skin and bones, that we have a bond. Dr. Dutkowsky has made efforts to bridge the chasm between science and spirit. As president of the American Academy for Cerebral Palsy and Developmental Medicine, he had the Rev. David Farrell, a Catholic priest who has worked among Peru's poor since 1964, address the group's convention last year on the topic of "Poverty and Disability." That same year, on his third pilgrimage to Lourdes, Dr. Dutkowsky took part in a conference on faith and medicine, delivering a speech he titled "Dignity and Disability." He took the occasion to wrestle with the ontological question embodied by the unmerited suffering of patients like Mike and Christian. "For years, when asked why I chose this profession, I had no good answer," he said, "until I came upon the first chapter of the Gospel of John. Jesus and his disciples come upon a man who was blind from birth. The disciples asked Jesus, "Did this man or his parents sin that he was born blind?" Jesus answered that the blindness was not the result of the man or his parents" sin. The man was born blind "so the glory of God might be revealed." Every day in my work I find myself in the revealed glory of God. E-mail: sgf1@columbia.edu.