To my surprise, tears welled up in my eyes as the voice on the line said a soft prayer for my future success and safety. That voice belonged to Reverend Angela Johnson, former Spiritual Health Fellow and current provisional elder in the United Methodist Church; we were finishing up our discussion of the role of the chaplain and spirituality in medicine. In that moment, I remember being touched at once by both the compassion required to call on a higher power for a stranger and by the comfort I received from the words themselves. At the time, I assumed that my tears were a product of being overcome by the sentiment of her words. Her prayers had been a final, heartfelt plea for me to take seriously the content of our conversation. Her earnestness could have softened even the most staunch skeptic.
However, after I had spent some time processing everything she had told me, I realized that part of what I had felt then was shame. I felt foolish for needing to be reminded about reintroducing something so fundamental into my daily considerations. In my quest to clarify how to approach spirituality as a future provider, I recognized that I had been ignoring its place in my own life.
My struggle is one shared by the medical field at large. Throughout much of history, medicine belonged almost solely to the domain of spirituality. People went to their pastors and healers for prayers and rituals to free them of their afflictions. Before there were germs, there were demons that needed casting out. It was understood that care of the body and care of the spirit were inexorably linked. Until the rise of science began to transplant medicine from the world of souls into the world of biochemistry and physiology, healing and spirituality were melded together as one.
There is no doubt that there have been many benefits from this paradigm shift. With scientific advancements came cures and treatments that the healers of antiquity could have never imagined. However, these advances may have also come at the cost of appreciating a holistic approach to health. How pitiful is it when a profession which was once completely focused on healing the whole person must now devote entire conferences and countless seminars to finding ways of injecting that back into both its practitioners and the people they serve?
In modern times, this disconnect is often bridged by the chaplaincy and pastoral care team. I understood this when I first reached out to Reverend Johnson. I hoped that she would be able to shed light on her profession and provide insights on the role of spirituality in medicine.
Going into the call, I could recognize when a consult to a chaplain might be warranted, but I didn’t exactly know what the job entailed. I was surprised when one of the first things Reverend Johnson spoke about was how her religious training and background in the Christian spiritual tradition informed her practice but did not take away from who she was able to help. She discussed encounters with people from all backgrounds while within the hospital, ranging from devout Christians all the way to lifelong atheists. She pointed out that every person has a spiritual core that responds to the idea that they have a place in this world, even if that core is not recognized by one of the major religious traditions.
One story that stood out to me was her encounter with a very ill patient who had been referred to pastoral services but did not hold a specific religious creed. The patient’s source of spiritual connectedness lied in her appreciation of nature and the beauty of the world around her. Instead of walking through scripture or wrestling with the afterlife, Reverend Johnson recalled sitting with the patient and spending time bringing some peace to her by meditating on the strength and stillness of trees and the Earth. In my opinion, this encounter embodies the role of the chaplain for many patients: chaplains support the part of patients that cannot be reached with medicines, surgeries or analytics.
As Reverend Johnson put it, one of the most important roles of the chaplain is to simply be present with patients. This principle provides the undercurrent on top of which each chaplain’s specific theological concentration can build. When these skills are used in tandem, it allows chaplains to serve as symbols that signal to patients that they have permission to be human in the moment. A chaplain can become the hand that beckons patients to feel their fears, doubts, and frustrations as well as their joys and gratitude. Chaplains offer the presence of someone who will not only refrain from judgment but who will also be by their side as they feel.
Chaplains are also responsible for their more well-known role of tending to people at the end of their lives. Reverend Johnson spoke of a number of heartbreaking experiences she had with patients over the years. She recounted the countless hours she spent sitting with patients and their families, trying to support them as a loved one transitioned out of life. I was struck by how people like her could endure the weight of so many lives day after day and not find themselves buried underneath waves of despair or slowly falling victim to existential crises.
When I asked how she copes with the emotion and the weight of her work, she pointed to her personal spirituality. She explained that inherent in her beliefs is both a calling to service and the reassurance that there is a higher power in charge of everything that is going on. Recognizing that not all providers are religious, she explained that inside most healthcare providers is a set of beliefs and values that motivate them to wake up in the morning and do their best work for their patients. In her opinion, one of the keys to avoiding burnout and handling those difficult days is to lean on these beliefs. Striving towards deep seated values brings a kind of fulfillment that is life-giving and not predicated on grades, money, status or any of the other common distractors in life.
She also pointed out the importance of having people in her life that could support her. It would almost guarantee burnout to hear and see the things that she did on a daily basis and not have anyone with whom she could debrief or decompress with. For her, fellow chaplains and a few specially chosen friends served as her support. For the heaviest issues, she advocated seeking formal therapy, a helpful tool that is slowly losing stigma in society but remains a largely untapped resource, especially among provider-types who feel that they have to be “strong” (whatever that means) in order to be successful.
As I continued to probe for advice, she made a special effort to explain that her process of handling the emotionally taxing aspects of medicine is an approach that would benefit all health care providers, including medical students and physicians. We both agreed that the nature of caregiving combined with the heavy work demands of medicine (or medical school) creates an environment where it can become easy to forget about ourselves and our own needs. To combat this, she recommended the daily (as needed or “prn”) time out where a person takes anywhere from a few seconds to a few minutes to stop, breathe and become more present in the moment. This can take the form of formal meditation, or it can be as simple as taking a moment of silence to check-in with yourself and feel whatever emotions or thoughts are alive inside of you at the time.
“Before you are a medical student or doctor or nurse, you’re a person,” she told me about two-thirds of the way through our call. It was a sentiment that I had heard many other times, but it carried much more weight when hearing it from someone who was so invested in the truth at the core of that statement. We often forget that when something traumatic occurs while on duty (such as witnessing a death), it impacts us beyond our roles as health care providers or students and forms an impression on the person underneath the titles. We invest time into patching the hurt inflicted on our professional selves but stop short of healing the whole person once we have reached a certain level of functionality. As Reverend Johnson underscored throughout our conversation, this approach is woefully incomplete.
To turn to metaphor, we all tend to our lives like gardeners to fruit-bearing trees. If we only ever care for it enough to be fruitful but never take time to examine the roots and the soil, our trees are doomed to never be as tall, as productive, or as long-lasting as they can be.
At the end of the call, I thanked her for her prayers and insight. As I laid my phone down and began to quietly reflect on her words, I was saddened by how seldom conversations like ours took place. Part of me cannot help but see some of the blame for this laying at the feet of our institutions. Everyone jokes and pokes one another with sarcastic elbows when we are forced to sit in a mandatory wellness lecture, and we lack buy-in because we can feel its tacked-on nature, even by the most well-meaning institutions. In a field dominated by the sterility of modern science and idolatry of the bottom-line, it is no surprise that being concerned for the immaterial part of all of us becomes an obligation rather than a truly integrated component of our education and workplace. As I mentioned previously, there are efforts to change this, but I doubt we will ever fully escape the after-effects of that first divorce between science and spirituality.
Society at large also holds some of this blame. It makes the twofold mistake of equating spirituality with religion and equating religion with mysticism and superstition. Lost in this logic is the truth that to understand spirituality is to understand what motivates, worries and comforts people at their deepest levels. For this reason, I believe that it is key for health care providers (and their superiors) to realize that appreciating the whole person, including their spiritual side, is the only way to care for people from a truly grounded position. The transcendence represented in the concept of the soul is the same transcendence that allows a health care worker to care for all kinds of different people. I implore my fellow medical students and future colleagues to not forget this as they strive to become better practitioners in the world. I hope they join me in this difficult but fulfilling journey to attempt to practice soulful medicine.
Author’s note: I wrote much of this before the COVID pandemic descended upon the world and brought life to a halt. In the midst of so much uncertainty and panic, I think it is even more paramount to take time to explore or express whatever form of spirituality that people believe. The only way to weather a storm is to have a shelter strong enough to stay stable in the winds. Regardless of whether that is a traditional religious practice or your own self-discovered beliefs, now is the time to remember and lean on those beliefs, for our spiritual survival in the middle of this and for our health once this has passed.
Image credit: Moreton Bay Fig Tree (CC BY-NC 2.0) by Prescott
Contributing Writer
Emory University School of Medicine
Eric Bethea is a fourth-year medical student at Emory University School of Medicine class of 2021. He graduated from the University of South Carolina in 2016 with a Bachelor of Science in economics. Before entering medical school, he spent a year serving with AmeriCorps in Jacksonville, FL. He is looking forward to writing about topics that don't often come up in medical school. In his free time, Eric enjoys running, basketball, movies, and cooking with his favorite crockpot.