Spirituality, Religious Wisdom, and the Care of the Patient

Fear in the Context of Illness: An Islamic/Protestant Dialogue: Introduction

Alan B. Astrow, M.D.
aastrow@maimonidesmed.org

On April 19, 2004 the conference series moved back to the St. Vincent's Comprehensive Cancer Center for an Islamic/Protestant dialogue on fear in illness.  Our speakers were Akbar Muhammad, Ph.D., Associate Professor of Islamic and African History, SUNY Binghamton and Pamela E. Klassen, Ph.D., Associate Professor, Department for the Study of Religion, University of Toronto. 

 

There are several dimensions to fear in illness. The first and most obvious is the patient's fear:  fear of the physician or what the physician might uncover, fear of an imposing institution or of a difficult to negotiate medical system; fear that beliefs and customs will by disrespected by scientifically minded physicians and nurses-all these may inhibit a patient from seeking needed medical attention.   For those patients who are receiving treatment, there is the fear of potential side effects and the fear of the possibility or at times likelihood of dying from an illness.

 

Fear, in this setting, may sometimes serve a salutary purpose.  I patient I saw last week told me that she had become deeply fearful about impending minor surgery on her eye.  The fear motivated her to complete the day before the scheduled surgery a book that she had been procrastinating over for some time. 

 

A second, and less talked about expression of fear, is the fear that the physician or nurse may feel.   This can experienced at the level of fear for one's physical safety.    The New York Times Magazine from Sunday April 18 featured a story about infectious illness subtitled:  "When a 10-year-old contracted monkey pox, medical professionals had to confront their own fears."   There was a similar issue recently in Toronto, when physicians and nurses feared exposure to the infectious agent in SARS.     

 

But the health care professional's fears may be expressed in a subtler, and often disguised form.  Several years ago, I treated a man in his 20's who had a non-Hodgkin's lymphoma.  He relapsed a few months after completing standard chemotherapy and radiation.  The lymphoma progressed rapidly and within a week, he was hospitalized, deeply jaundiced with massive enlargement of his liver.  He was disoriented because of liver failure and was bleeding because his liver could no longer synthesize needed clotting factors. 

 

I referred him to the head of our bone marrow transplant program at the time, a senior, highly experienced, careful, thoughtful physician.  But in this instance, I thought that though he would never admit it, he was a little scared, as frankly I was.  Given the severity of the patient's illness, my colleague thought that perhaps we should retreat the patient with a standard chemotherapy regimen (which I would administer), but I remember telling him that I thought that we had only one shot with this patient (that meant that he would treat him.) 

 

He agreed and gave the patient a highly intensive chemotherapy cocktail, roughly 10 times the standard dose.  That was seven years ago.  The patient now has a three-year-old daughter with a second child on the way. 

 

Clearly we are dealing here with issues both of individual psychology and of professional training.  But these are also issues that involve deeply personal encounters with others-with our patients and with our colleagues as we support each other when ultimate issues of meaning and purpose and living and dying are at stake.  These sorts of inter-relational concerns may be the spiritual dimension to the problem of fear in the context of illness.


Pamela E. Klassen, "American Protestant Fears"
Akbar Muhammad, "Fear in the Islamic Tradition"
Table of Contents

Published: September 17, 2004