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The Yale Journal for Humanities in Medicine |
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Spirituality, Religious Wisdom, and the Care of the PatientDenial: A Hindu/Protestant Dialogue: Introduction Alan B. Astrow, M.D. The topic for discussion on November 8 at the Westchester Medical center was denial in the context of illness. Denial plays a large role in our work as health care professionals. For instance, I recently sent a fourth year medical student in to see one of my outpatients, a 67 year old man with stage IB non-small lung cancer who had just completed a four month course of "adjuvant" or preventative chemotherapy. The student told me that the patient was unaware that he had cancer; that he thought he had some kind of "growth" but that it had been removed. Now I knew that I had discussed the patient's diagnosis with him many times, in uncomplicated language, and in front of family witnesses. But for whatever reason, perhaps to help himself bear through the difficult program of chemotherapy, he had chosen to deny that fact. On the morning of the conference, I had seen a patient with newly diagnosed stage IV non-small cell lung cancer. She was short of breath and has been losing weight. These were her first words to me: "I am anxious, scared, and I am going to beat this." Each of us can think about how we would have responded to that statement. This is not to mention the two patients who were then hospitalized on my service in St. Vincent's. Both were in their 50's with widely metastatic breast cancer. Both were likely have weeks to at best a few months to live. One, with widespread brain metastases was being discharged to a hospice the next day. She asked our palliative care team today why she could not be cured. The other had refractory pancytopenia from bone marrow metastases and severe shortness of breath from refractory pleural effusions. She wanted to know when I would be re-starting chemotherapy. Both patients wanted to believe that they would get better. I would have liked to have told them that they would get better. These are painfully difficult human situations in which we need to balance the obligation to be truthful with the obligation to try to sustain our patients' spirits. When the attending physician avoids facing the realistic situation of the patient, others often bear the consequences. A fourth year medical student doing a hospital sub-internship was nearly in tears one recent morning. A patient of hers, with pancreatic cancer metastatic to liver, advanced liver failure and advanced AIDS had bled to death in front of her in the medical intensive care unit. The patient's attending had been by to see the patient that morning and commented that he had appeared weaker but failed to address the obvious point that the patient was dying. The poor sub-intern was left alone to deal with the consequences. I need to acknowledge as well the larger context for those of us involved in organizing this series. We had just suffered a devastating loss with the death three weeks earlier of my dear friend Dr. Steven Miller in a plane crash in Missouri. Steve was the co-host of the series at Columbia and with characteristic generosity and openness helped make the September session one of our most stimulating. We returned to Columbia in December and dedicated that session to Steve's memory. Steve was the Director of the Pediatric Emergency Room at the Children's Hospital at Columbia University Medical Center and Arnold P. Gold Professor of Humanism in Medicine at Columbia University College of Physicians and Surgeons. He was 46 with a beautiful wife, the accomplished pediatrician and Director of Community Pediatrics at Columbia, Dr. Dodi Meyer, and three beautiful young children, Jesse, 11, Maya, 9, and Nico, 7. Steve was flying to a college of Osteopathic Medicine in Kirksville Missouri, north of St. Louis, deep in the heart of the so called red states. These distinctions, I believe, meant very little to Steve. He had a special way of making people from all sorts of backgrounds feel comfortable. He and a colleague from Buffalo Medical Center, Dr. Richard Sarkis, were going to be leading a workshop and helping to develop a curriculum for the school on how to be more caring as a physician. Their plane crashed just short of the runway, killing Steve, Richard and 11 other passengers. In the light of this terrible loss, we can think about the uses of denial-about how were each of us to maintain steady awareness of our tenuous status we likely would be unable to function. We can also see why, whatever temporary solace denial may offer us, it ultimately falls short as a strategy for addressing those deeply distressing aspects to human life that we would prefer not to dwell on. Love may be what makes life worth living, but love creates the potential for shattering loss. What loss demands of us, what we owe each other, is full presence to the disconsolate other, that we support those who grieve with our full bodies and souls. As physicians and nurses this implies that we acknowledge the losses that our patients suffer, even if doing so is painful, time consuming, and emotionally draining. Returning to the theme of one of our earlier sessions, it may be that to find our way back to the possibility of genuine joy, which Rabbi Seidler-Feller told us we are obliged to do, we must first follow Father Richard Rohr's advice and allow ourselves to "go into the sadness" that our patients experience. Where does one find the strength to do so, to "go into sadness," to offer one's full presence to the suffering other? The burden of this series is that a crucial source of spiritual strength for this task can be found in the collected wisdom of our religious traditions. Siva Subramanian, M. D., Professor of Pediatrics & Obstetrics and Gynecology at Georgetown University Hospital, and Barry Clayton Black, Ph.D., D. Min., Chaplain of the United States Senate, will address these difficult issues in living and in care for our patients from the standpoint of the Hindu and the evangelical Protestant traditions. Chaplain Barry C. Black, "Denial in the Context of Illness- An Evangelical Protestant Perspective" Published: February 5, 2005 |
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