July/August 2008

A physician once told me that when he was in medical school, each student was assigned to a patient who was dying. The doctors-in-training were required to follow the patient from the moment the diagnosis was delivered until death. In discussions, the students were asked: “What does death mean to you?”

The humanities majors would say: “Death is the loss of everything all at once.” The science majors then would say, “Death is the cessation of all spontaneous electrical activity.” Loss versus cessation. What did my physician acquaintance take away from these discussions? “Some people come to medicine because they use science to get to people,” he told me, “and some people come to medicine and use people to get to science.”

Ever-expanding medical technology has made this harder for the humanities majors. The trust required for patients to connect to doctors—and vice versa—is waning. Thousands of studies proclaiming the latest medical advancement are published each year, continually threatening to make the doctor’s body of knowledge outdated. Digital imaging provides more information but also more uncertainty. And patients use the Internet to self-diagnose.

If doctors have trouble coping with the pressures put on them by scientific advancement, imagine what happens when God comes into the equation!

Is it the doctor’s job to probe a patient’s spiritual concerns, especially given the post-9/11 world’s hypersensitivities about religion and culture? But how can the fears of patients—especially those who are dying—be addressed adequately if you ignore their spiritual claims and desires, which may or may not include God?

These questions are not abstract. I learned this firsthand when I spent a year doing research for a book about Maimonides Medical Center in Brooklyn. This large, complex hospital was the perfect laboratory for observing the overlapping, at times conflicting, interests of religion and science. Originally opened a century ago to take care of local residents, mostly Jewish immigrants, the hospital now reflects the changing population. Though Orthodox Jews still make up between 20 and 25 percent of the patient population, the rest come from all ethnicities; sixty-seven languages are spoken by patients and staff.

I often saw collisions between well-meaning attempts to accommodate religious and cultural beliefs and achieve efficient medical practice. Some Jews and Catholics wouldn’t sign DNR (do not resuscitate) orders because they felt such directives violated their belief in sustaining life—even if that life was lived unconscious, with breath and sustenance provided by machines. A devout Muslim woman waited patiently in an obstetrics clinic along with other expectant mothers, covered head to toe as required by her faith—revealing the chicken pox all over her body only when she was inside the examination room. Chinese patients avoided the emergency room because the sheets and blankets were white, believed to be a sign of death.

Certainly things would run more smoothly if medicine was just a matter of tests and procedures (and it often can seem like nothing more). But many decisions aren’t cut and dry, especially the decision to stop treatment because it is futile. When science can do no more, a different kind of healing is needed.

Time and again I saw doctors, nurses, and social workers draw on spiritual reserves when medicine had no more to offer very sick patients.

When a Chinese immigrant patient, a self-declared atheist, was dying, he spent a great deal of time discussing Buddhism with his physician, a former securities lawyer who had grown up Christian in Kentucky. During the patient’s last moments, the doctor read to him from the Heart Sutra, a fundamental Buddhist text. An elderly Jewish man, who said he didn’t believe in God, told a hospital worker he still wanted the Kaddish—the Jewish mourner’s prayer—recited at his wife’s funeral. One patient read history books in the days before his death; another simply wanted to talk.

I have often thought of something a physician who was also a Franciscan friar told me: “Sometimes I feel I should take my shoes off before I enter the room of some patients,” he said, “because what’s going on there is sacred in a real transcendent sense. So much faith, so much hope, so much love. Whether they’re dying or going to recover almost doesn’t matter, because something bigger is going to happen.”

Sometimes help came from God, sometimes from Buddha, sometimes from a good conversation. Transcendence comes in many forms.

Julie Salamon is the bestselling author of six books and a former reporter and critic for the New York Times and the Wall Street Journal.  Her new book, Hospital: Man, Woman Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God and Diversity on Steroids, was published in May 2008 by Penguin Press. Her journalism and essays have been published in several anthologies and appeared in The New Yorker, Vanity Fair, Vogue, Bazaar, and The New Republic.  

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