By Dr. Thomas Duffy

My quest or query on the subject of grace in a secular profession has its origins in the circumstances surrounding the care I offered to a patient near the end of his life. The patient was an elderly gentleman with far-advanced leukemia of five years’ duration, during which he had undergone multiple remissions and relapses of his disease. His final hospitalization proved the most harrowing and tortured experience for him as well as for his caregivers. After treatment with an aggressive chemotherapeutic regimen for his recurrent disease, he experienced worsening of his already debilitating physical condition. He developed a bacterial super-infection with Fusarium which had several devastating effects, including blindness and numerous painful ulcerations over his entire body. The recommendation to move from a curing to a caring stance was accepted by the  patient and his family. The decision – his decision – to withdraw therapy was considered appropriate in light of the advanced stage of his disease and the degree of his suffering.

What was unknown to me during this challenging period was a meta-text that was  occurring in parallel to my care of the patient. A hospital chaplain had befriended and counselled him beginning from the onset of his illness and subsequently provided me with an essay describing her experience ministering to him. Her essay describes her painful accompaniment of our patient in word and silent presence as he moved from “roaring against the dying of the light to an acceptance of his journey through the valley of the shadow of death.” She appeared to be empowered and energized from her encounter with the dying patient. In striking contrast, I had come through his illness with feelings of disappointment and defeat, of being bruised and saddened. I was forced to ask why I had come away exhausted and limp whereas the same experience was a source of apparent transcendence for the chaplain. Upon reflection, I entertained the thought that she had access to a resource that I lacked in the encounter.  Her accompaniment had graced the dying of a human being and she had in some way shared in this grace through her actions. Her role as a chaplain afforded her a strength which eluded me. I was left to ponder whether I could share in this resource.  Grace was a fuzzy concept for me. It was an entity that involved the presence of God and a belief in God. And if God is essential for grace where does that leave grace for a non-believer in a secular profession? Had I, in entering that profession, cut myself off from grace and the power it imparted? Is grace an option for non-believers? I couldn’t answer any of these questions until I corrected my woefully inadequate knowledge of grace. This was the initial query which the encounter stirred up and initiated a journey in search of possible sources of grace in the secular procession of medicine.

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By Tracy Balboni

In 2006, the same year I was completing my training in radiation oncology and embarking on a career of caring for patients with incurable cancers, I first read this quote from Dr.DanielSulmasy in The Rebirth of the Clinic: An Introduction to Spirituality in Health Care:

“Illness is a spiritual event.  It grasps persons by the soul as well as by the body and disturbs both. Illness ineluctably raises troubling questions of a transcendent nature-questions about meaning, value, and relationship. These questions are spiritual.”

At that particular time in 2006, Sulmasy’s words contrasted starkly with my experience as a trainee in scientific medicine. Medicine was largely blind to the reality that illness is a “spiritual event”. And yet, I knew viscerally in my nascent experience as a physician that Sulmasy’s words were correct.  In the clash between my training and the truth expressed so poignantly by Sulmasy, I discerned a calling to translate this reality into words that medicine could hear and understand — the language of empirical research.

And so I embarked upon an academic career dedicated to translating the spiritual realities of patients into the language of numbers and the format of scientific manuscripts. I also had my own questions to pose and answer. Do patients want for their physicians and other members of the medical team to recognize and attend to the spiritual aspects of their illness experience? If we do embrace the spiritual aspects of illness, how does this influence patients’ well-being and medical care decisions?

With the above questions in mind, I embarked on research within the Coping with Cancer studyunder the mentorship of Holly Prigerson, PhD, the study’s principal investigator, whose vision and creativity have been transformative to the understanding of psychosocial and spiritual factors in end-of-life care. The study involved interviews and observations of 343 patients with advanced, incurable cancers and their family caregivers.

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By Michael J. Balboni

This is the second entry in a four-part series examining the social and historical forces that have led to the current divide between religion and medicine. Drawing on Peter Berger’s theory of plausibility structures (particular social processes that legitimize social beliefs and practices, giving them a matter-of-fact quality), this series examines key factors that lie behind the current state of spirituality in medicine. This post focuses on our cultural beliefs about physicians as scientists, and how the late nineteenth century alliance with science has transforming the meaning of the medical vocation.

Throughout the history of Western medicine, physicians viewed themselves as invested with a divine mission and purpose. In fact, according to sociologist Jonathan Imber, the initial ascendance of the medical profession during the middle of the Nineteenth century was due in part to the fact that physicians were allied with and morally commissioned by Protestant clergy. Imber suggests that Protestant clergy empowered the medical profession with a moral and spiritual vocation, resulting in a deeply held public trust of physicians.[1] A vivid depiction of this spiritual/medical vocation can be seen in Luke Fildes’ 1891 painting, The Doctor. In this painting, the physician leans pensively over the sickbed of an ill child. The tools of his trade are pushed to the side, as illness takes the upper hand, whereas a light shines on his thoughtful face and gentle expression. He is here not only to offer his medical skills, but also to shepherd the family through a difficult and painful experience. (more…)