I never used to ask my patients about their spiritual beliefs, but now I do. I think my reticence sprang from a (possibly misguided) respect for privacy, as well as a slight discomfort with the whole topic. I would describe myself as optimistic and hopeful, but not a believer in the religious sense. My meanings are more secular: I'm committed to improving patients' lives, and I feel anchored by the scientific knowledge that helps me help them. But I've learned by listening to patients; they've taught me that their faith-- in God, or in strongly held cultural or ethnic values-- has lent them strength, nourished their hope, and sometimes improved their health. An ill patient is more than his illness, and more than "a body." When a doctor sidesteps the matter of spirituality to focus solely on physical matters, he is omitting an essential element of healing.
Jasmine, a patient of mine with nephrotic syndrome, a kidney condition marked by many crises and fraught with the specter of future decline, told me that she talks to God every day. "What do you pray for?" I asked. She said, "Good doctors." I was impressed by her practicality-she wasn't asking for miracle cures, just good medicine. Her conversations with God also gave her the strength to do her own part in fighting her illness. The way Jasmine described it, God set the stage for the healing work that she and I did together.
Another patient, Charlotte, brought me a quote from Proverbs: "Yea, my reins shall rejoice when thy lips speak right things." Underneath the quotation, she added a note: Reins- literally, kidneys; i.e., seat of emotion. She explained that "reins," as used in the Bible, referred to kidneys but more generally to the penis, the source of feeling. I was skeptical. Wouldn't the heart be the natural seat of the emotions? But she said, no, the Bible says "reins." When I looked in the Oxford English Dictionary, lo! I found reins defined as kidneys-an obsolete word coming from the Latin with the same root, "ren," as renal. Sub-definitions included "the region of the kidneys; the loins" and "In or after Biblical usage, the seat of the emotions or affections." Maybe Charlotte was being a little too specific, penis instead of loins (particularly since she didn't have a penis); but I understood what she was trying to say. She was telling me that the kidneys-source of her illness, area of my expertise-were hugely important to her. She was telling me there was a link between her body and her emotions. There was more to her kidneys than her kidneys.
Many people routinely, if sometimes subconsciously, link their bodies with their souls; I've had patients refer to "biblical hernias" and "bowel resurrections." I've also had patients who sought spiritual comfort from eastern religions when western medicine failed to bring a cure. One man, a steelworker with malignant melanoma, had been told by the National Cancer Institute that he should go home to die. He sought out a Korean healer who performed moxabustion, a ritual burning of the skin with a stick of moxa, a medicinal herb. Despite the burns, for which he in fact needed intravenous antiobiotic treatment, and despite the ultimate inevitability of his death, he told me the ceremony gave him a sense of peace and meaning as his days waned.
Patients don't just want life; they want a life worth living.
