1. When to consider a patient’s spiritual wellbeing:
For several years, the senior physician at the Appalachia community health center where I worked before coming to Barnes-Jewish Hospital and I met weekly to review his most perplexing and burdening patient encounters. Below is a summary narrative of one such case:
Imagine you and your medical team are looking down a hallway with patients in most of the rooms. Whether or not the patients in these rooms share similar definitions of or approaches to spirituality is immaterial to each patient. The patients are not together in the hospital as a community. What does matter to each patient ultimately is her own particular spirituality. However, you and your medical team – moving from room to room – need a definition of and an approach to spirituality that prepare you to meaningfully integrate the ‘spiritual’ and the ‘physical’ in caring for each patient. Finding/embracing such a definition of and approach to spirituality is no simple task.
Most hospitals and outpatient clinics exist to respond to patients’ physical needs and, therefore, are centered by scientific/clinical language and perspective. Scientific/clinical language is the ‘first language’ of health care settings. With symptoms, with injuries, with diseases, . . . – patients come (or are brought) anticipating that their physical conditions can be corrected or brought under control. The expansion/deepening of the scientific knowledge base and the introduction of increasingly sophisticated technologies continue to concentrate attention on patients’ physical interests in health care settings.
Patients hope that entering a hospital or a clinic will be no more than a pit stop or, at most, a repair shop delay in their day-to-day routines and life journeys. The circumstances that lead patients to seek medical attention are often benign and/or quickly resolved. In these situations, assessing a patient from a spiritual perspective may remain (by patient choice and/or by caregivers’ choice) on the periphery. By ‘periphery’ I mean that caregivers remain attentive to subtle or incidental indications that, in addition to the patient’s immediate problem, there may be a deeper ‘wound’. Such indications put the caregivers in the tough position of deciding whether they have the time and emotional capacity to determine if indeed there is a deeper ‘wound’. And the circumstances that lead patients to seek medical attention may in fact have to do with a deeper ‘wound’. In these situations, a spiritual language and perspective should be more centrally and intimately present for caregivers as they attend to the patient’s needs.
For several years, the senior physician at the Appalachia community health center where I worked before coming to Barnes-Jewish Hospital and I met weekly to review his most perplexing and burdening patient encounters. Below is a summary narrative of one such case:
It was a busy Wednesday afternoon. The patient was in her late-20s, had four children, and was now 32-weeks pregnant. The fetus’ fundal height was smaller than expected. She had sought no prenatal care. A colleague asked David to do an ultrasound. The patient was sitting on the edge of the exam table when David and his nurse entered the room. David helped the patient into a supine position. She was covered with a sheet up to her blouse. The nurse turned down the light. As David began the exam, the patient said barely above a whisper, “I have a lot of scars.” David’s first thought – “surgery . . . perhaps a previous c-section”. Once he saw the scars, he thought – “accident . . . perhaps a burn”. He asked the patient, “Did you have a car accident or . . .?” She interrupted and, as she starred at the wall, said quietly, “My mother set me on fire when I was three.” David had no response. It turned out the baby was fine. As we later reflected on the case, David explained to me, “Her life is so far removed from my range of experiences. I didn’t know how to respond. She will never be free of this childhood experience, these scars. If my mother had . . .” His voiced trailed off.When the patient said “I have a lot of scars”, she was making a figurative as well as a literal observation. Simply put, she was saying, “My story is broken. Can you help me fix it.” (Howard Brody, MD/PhD, is my source for this way to frame a patient’s meaning.)
Imagine you and your medical team are looking down a hallway with patients in most of the rooms. Whether or not the patients in these rooms share similar definitions of or approaches to spirituality is immaterial to each patient. The patients are not together in the hospital as a community. What does matter to each patient ultimately is her own particular spirituality. However, you and your medical team – moving from room to room – need a definition of and an approach to spirituality that prepare you to meaningfully integrate the ‘spiritual’ and the ‘physical’ in caring for each patient. Finding/embracing such a definition of and approach to spirituality is no simple task.
Most hospitals and outpatient clinics exist to respond to patients’ physical needs and, therefore, are centered by scientific/clinical language and perspective. Scientific/clinical language is the ‘first language’ of health care settings. With symptoms, with injuries, with diseases, . . . – patients come (or are brought) anticipating that their physical conditions can be corrected or brought under control. The expansion/deepening of the scientific knowledge base and the introduction of increasingly sophisticated technologies continue to concentrate attention on patients’ physical interests in health care settings.
Patients hope that entering a hospital or a clinic will be no more than a pit stop or, at most, a repair shop delay in their day-to-day routines and life journeys. The circumstances that lead patients to seek medical attention are often benign and/or quickly resolved. In these situations, assessing a patient from a spiritual perspective may remain (by patient choice and/or by caregivers’ choice) on the periphery. By ‘periphery’ I mean that caregivers remain attentive to subtle or incidental indications that, in addition to the patient’s immediate problem, there may be a deeper ‘wound’. Such indications put the caregivers in the tough position of deciding whether they have the time and emotional capacity to determine if indeed there is a deeper ‘wound’. And the circumstances that lead patients to seek medical attention may in fact have to do with a deeper ‘wound’. In these situations, a spiritual language and perspective should be more centrally and intimately present for caregivers as they attend to the patient’s needs.