There must be more

I was raised in a Presbyterian household. My grandfather was a prominent pastor in Taiwan and my family was always very involved in church and church-related activities when I was growing up. However, once I left for college, without my family around, I stopped attending sermons religiously. I still went every now and then, but it seemed like schoolwork and studying for exams started to take more and more precedence to the point where I was only going for Easter and Christmas. And as shocking as it might be to my father, I sometimes ate without saying grace. I had unfortunately become what the evangelicals would call a wayward Christian.

But I never lost faith. And I never forgot what I was taught – the doctrines, the stories, the miracles.

So once I started third year on the internal medicine floors, I figured I would be able to talk with patients about faith if they needed it. I figured I could say prayers and I knew most of the words to the hymns and songs. Bring it on.

Yet I was never asked to be part of my patients' faith-based healing. When I walked in the door, all my patients wanted were the concrete details. What were the LFTs like today? Were they low enough that the patient could leave? Did the cultures come back yet? Had someone determined the cause of the fevers?

I figured it was because I was lucky. None of my patients were terribly sick. All of them were going to walk out of the hospital. There was no need for prayers from me, really. They weren’t about to go off to that kingdom in the sky. All they needed from me was to know when they could go home. In fact, I think if I were to suddenly ask about faith or spirituality, I would probably scare my patients into thinking that they were about to meet their maker.

Then last week when I was on psych consults, it seemed like we were talking about religion and spirituality with everyone. We had one patient who wanted to leave AMA even though he had osteomyelitis of his sternum. He had refused blood draws and IV antibiotics, convinced that God - who had brought him back from a coma after a terrible car accident - would save him yet again, without our intervention. He wouldn’t cooperate with us, muttering prayers under his breath and tuning us out. We had been consulted to see if he would be eligible for involuntary hospitalization. He was a religious fanatic, to be sure, but perhaps he was delusional as well?

We were also consulted for another patient who was truly on his deathbed, when he told his nurse that he wanted to withdraw care. He was tired of living in the ICU, living on machines, unable to speak to his wife, unable to see his kids. The surgeons had called in the chaplains, and at a family meeting, I was struck by how the trauma surgeon kept referring to how it wasn’t time yet for the patient. That he had to have faith that he would get better. That there was a reason that all this was happening to him. There was a light at the end of the tunnel, and that light had nothing to do with taking him up to heaven.

It seemed like the doctors were using or disregarding spirituality and religion as they saw fit. The patient with osteomyelitis was diagnosed as a delusional schizophrenic. Sure, he was claiming to be a religious man, but my attending believed it was more a delusion than anything. And so we used that to involuntarily hospitalize him. He was a danger to himself and he needed to be kept in the hospital where we could monitor his infection, even if he wouldn’t let us give him meds. On the other hand, the ICU patient was someone who had lost his faith. And so we used that to say that he didn’t have capacity. He was too depressed to be thinking clearly. They had both wanted to withdraw care, but for completely different religious reasons.

One patient had too much religion and so we deemed him to have no capacity. Another patient had none, yet we also deemed him to have no capacity.

We deal with religion but not in the way I thought we would. So, I’m still trying to figure out how spirituality fits into modern medicine. How does hoping for miracles fit into something based on the scientific method? Where does the abstract fit in with something so definite?

I’ve always thought that it was a way of coping. Sometimes for the patient, sometimes for the family. And now I’ve come to realize that sometimes it’s just for me. In a field that is so concrete, I need to be able to hope that things can work out, even when all the numbers and all the images - everything - tells me that it can’t. I need to believe that miracles can happen so that I can get up every morning and keep going.