Dr. Christina Puchalski is familiar with death. The palliative care doctor and founder of the George Washington Institute for Spirituality and Health (GWish) has seen countless patients facing the end of life ― but there are still moments that shake her foundation.
Several years ago, Puchalski went into a checkup with a patient previously diagnosed with a terminal illness. Puchalski knew the appointment might take a while, and she was already running behind schedule. She was nervous.
“I felt the anxiety as I walked in the room,” Puchalski told The Huffington Post. “They started quibbling with each other. The husband was clearly anxious, and we were going nowhere. So I stepped out of the room for a minute because I felt myself getting sucked into the dynamic.”
In that minute, she continued, the veteran doctor took a deep breath and thought to herself: “I need to get out of that energy and be really present.”
“When I went back in, I sat down and just offered my love. That’s what I do. They had quieted down, and I asked them, ‘What are your deepest concerns?’ The husband started sobbing and said, ‘I think she’s going to die, and I don’t know what to do without her.’”
The wife, Puchalski said, expressed fear over how her death would come about and whether she would suffer at the end. “They just cried, and I sat with them. We’d gotten to the heart of the visit, and it wasn’t about the medication or the pain. The real issue was the bereavement and the fear of losing each other.”
Sometimes, Puchalski noted, the most crucial thing a doctor can offer a patient is their presence and a willingness to listen. With these tools doctors can attend not only to their patient’s physical needs but to their spiritual concerns as well, she said.
The definition Puchalski uses for spirituality at GWish, which marked its 15th anniversary this year, focuses less on religious affiliation and more on a person’s “search for ultimate meaning.” How patients make sense of their illnesses, and even their aches and pains, should be part of the “whole person model” doctors employ, she said.
That model isn’t always championed within the medical establishment. But Puchalski is among a host of doctors, medical students and chaplains working to change that.
Theologian and Harvard University psychiatry instructor Dr. Michael Balboni has dedicated his career to researching the spiritual dimensions of health care. His research has uncovered the profound impact religion has on patients’ medical decisions ― but he’s found that health care professionals are often socialized starting in medical school to “ignore or avoid spirituality and religion,” he told HuffPost.
The medical community skews slightly less religious than the general American public. But many doctors, like University of Chicago’s Dr. John Yoon, pursue medicine precisely because of their spiritual convictions. What awaits them, as a 2015 study found, is often disillusionment with the field.
“Once I started medical school it was a culture shock,” Yoon told HuffPost. “There really wasn’t any space for exploring the spiritual and religious aspect of medicine.”
Yoon graduated from medical school in 2005, having studied medicine in the middle of a 20-year period during which the medical field made greater efforts to incorporate spirituality into health care.
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