Monday, January 21, 2013

Religion and the Doctor

William would come to see me every three months for his COPD (Chronic Obstructive Pulmonary Disease). We would chat about his disease, his meds, and his grief. He had lost his wife a few years back, but after 52 years he found it very hard to be without her.

On one visit he said, "Doctor deMaine, can I tell you something - and promise you won't think I'm crazy?"

"Sure."

"Well, my wife and I always had a favorite restaurant where we'd go for our dinner on Sundays. Let me tell you why I still go there. I wear my old tie and coat and sit in our favorite booth. And I swear that I see her. Her image is perfect, younger, and smiling. She looks beautiful. She doesn't really communicate except with the smile - which seems to me to say that she's waiting for me."

Other patients related different views. A very sweet British lady told me on an office visit that she had been a widow now for six months.

"That's sad," I said. "Do you believe in an afterlife?"

"Of course", she replied.

"How about marriage in Heaven?"

"Yes."

Trying to tie this together I said, "That's wonderful. Perhaps you and your husband can spend eternity together."

She paused, tilted her head, smiled and said, "Well, I might play the field a bit first!"

There are many views of the afterlife that vary from none to quite fanciful. Harvard theologian Huston Smith gave his views in the Ingersoll Lecture called Intimations of Immortality. He explored the existence of an afterlife and the influence of William James.  In his lecture he highlighted Swedenborg, the Swedish scientist and theologian. Swedenborg broke away from his Lutheran roots in the 1700's and wrote extensively about the afterlife having great influence on the New England transcendentalists and many others.  Also, in Smith's lecture, he discussed the near death experiences in Raymond Moody's book "Life After Life".  Theologians generally seem to struggle with what Heaven might really be like, but many less academic folks simply view it as a spiritual extension of this life joyfully meeting up with loved ones and those with shared interests.

Helen Keller with her blindness and deafness was, in those senses, cut off from the world. Yet she was a great student of the Bible and eventually became very influenced by Swedenborg's writings.  
"Here was a faith [she says] that emphasized what I felt so keenly -- the separateness between soul and body, between a realm I could picture as a whole and the chaos of fragmentary things and limited physical senses met at every turn . . . As I realized the meaning of what I read, my soul seemed to expand and gain confidence amid the difficulties which beset me. ."

The 1998 movie, What Dreams May Come, gives a vivid and possibly realistic picture of what Heaven and Hell could be like. The film has many parallels with Swedenborg's book, "Heaven and Hell." We are alive, active, useful, on the go and finding a home with those we love.

Mark Twain's irreverent views on religion are highlighted in humorously poignant ways: "Go to Heaven for the climate; go to Hell for the company." Further, from Captain Stormfield's Visit to Heaven, .."Now you just remember this - heaven is as blissful and lovely as it can be; but it's just the busiest place you ever heard of. There ain't any idle people here after the first day. Singing hymns and waving palm branches through all eternity is pretty when you hear about it in the pulpit, but it's as poor a way to put in valuable time as a body could contrive. It would just make a heaven of warbling ignoramuses, don't you see?"

Recently a formerly agnostic Neurosurgeon, Eben Alexander III, published a rather astounding book, "Proof of Heaven."  His experiences in the spiritual world while in a coma and near to death are certainly powerful and most difficult to explain away.  I'm sure though that some will remain unconvinced.  Perhaps true "proof" might trump free will, making us less human.

My education along these lines was when I attended Bryn Athyn College for two years. I was immersed in studies of Plato, Aristotle, and others right up though the age of enlightenment including Swedenborg. The emphasis was that there are two capabilities that make us uniquely human: freedom and rationality. We were charged to wisely apply learning to life - heady stuff for a 20 year old.

So does any of this carry over into medical practice? Since we are all in some sense spiritual beings as well as natural beings, it seems logical for a physician to deal with the whole person, particularly around the time of crisis or death. I'm not one who thinks a chosen few have the "inside path" or die easier than atheists. I had some confirmed non-believers in my care who died comfortably believing that "that was that." They appeared to be good people who had led good lives.

But others want to talk, are afraid, or have regrets. All hospitals now have chaplains. Many ministers, rabbis, imams and priests make frequent hospital and nursing home visits. Doctors of course, need to respect all beliefs and understand boundaries. Although I loved having philosophical and religious discussions with patients, I always tried to approach it from their interest and comfort zone.

One Pulmonologist in the area here would ask patients to pray with him before he did their procedure such as a bronchoscopy. Clearly this was inappropriate and boundaries were violated (his group let him go). Patients can, at times, cross boundaries but the "power differential" is much less. I had one very sweet lady who was so sad I wouldn't make it to Heaven because I hadn't been baptized in her faith!

Spiritual beliefs can be, and in my opinion should be, an important part of the conversation when we communicate our choices about end of life care and also as we are nearing the end of our lives. I encouraged my students, interns and residents to become comfortable with this and to not avoid exploring these areas. Healing and caring can occur on many levels.

8 comments:

  1. With an aging population and a science-oriented society, this is a valuable contribution to our thinking and planning for the end of life as a part of a continuing life.

    I just had "Proof of Heaven: A Neurosurgeon's Journey into the Afterlife" recommended to me by an agnostic friend who is a retired Phd. medical researcher in biochemistry. She said that since it was written by a doctor, she wanted to see what he had to say. I am about 50 pages into it and am fascinated.

    Kathy Simons

    ReplyDelete
  2. http://www.kpbs.org/news/2013/feb/05/when-does-end-life-begin-hospice-under-scrutiny/

    ReplyDelete
    Replies
    1. This is a good summary of the "when does the ending of life begin" and also addresses the problem of hospice funding. Hospice is a special program offered by Medicare and some private insurers. It was designed to help provide complete care for those deemed to be in the last 6 months of life. Paradoxically, hospice patients often live longer than expected and Medicare funds are being used well beyond the six months for some. When in hospice the patient's medications, needed supplies and equipment, visiting nurse care, etc. are all acovered. It's become an expensive industry, and your tax dollars are supporting it. Should there be limits? Are the Medicare audits too intrusive? Would a capitation program for hospice be better?

      Delete
  3. Very informative review. I really appreciate how ways were laid. Very interesting.

    ReplyDelete
  4. Some years ago I was evaluated by a neurologist because of frequent headache and other symptoms. He had me get an MRI and did a battery of other tests in his office. Good news! Nothing scary on my scan and everything else appeared normal. But he knew I was having problems for some reason. I'll never forget that as the appointment came to an end, he gently asked me if I would consider praying with him. We bowed our heads and he led in a humble prayer asking for God's help in healing me and in making me feel better. I had never had a doctor do this. I was so touched that to this doctor I was more than just an appointment on his schedule.

    And a few months later I couldn't hardly remember what the problem had been.

    I appreciated this gesture. Maybe some patients would be put off, but he certainly didn't push it at me, and it felt like a full service stop.

    This was in Loveland, Colorado

    ReplyDelete
    Replies
    1. Thanks for your wonderful story. I hope we as doctors can learn from your experience and not be afraid, when appropriate, to ask the patient if they would like to pray for healing. To me this may humanize the medical encounter in a way that would be lost otherwise.

      Delete
  5. Dr. DeMaine, your post reminded me of this recent interview on Fresh Air with Sam Parnia, MD:
    http://www.npr.org/2013/02/21/172495667/resuscitation-experiences-and-erasing-death
    "In his new book Erasing Death: The Science That Is Rewriting the Boundaries Between Life and Death, Parnia examines the experiences patients describe, but whereas much discussion around the experience of death has been philosophical or personal, Parnia is looking at the subject scientifically."

    I would be pretty unhappy if a doctor asked me if I wanted to pray with him or her, but one act of kindness I'll never forget occurred many years ago in a hospital. I was recovering from surgery. I had already refused the stronger pain meds so I couldn't go back on them, and it was the middle of the night and I couldn't sleep. I was miserable and whining, and after listening to me complain the nurse brought me a glass of warm milk. She eased my pain and my mind with that act more than any amount of meds could have done.

    ReplyDelete
  6. Thank you for your interesting comments. Many new discoveries are being made about death and near death. One fascinating tid-bit is that brain cells from a cadaver can be grown in the lab up to 4 hours after death. These cells multiply and differentiate into nerve cells (I always had been taught that all brain cells died withing minutes of no oxygen supply).

    Also, your comment about bedside nursing has been my experience also. A caring nurse laying on hands or bringing a glass of warm milk can do wonders - beyond the technical application of their calling.

    ReplyDelete