Holding Out Hope

When doctors can speak about faith with their patients, it brings new light, and hope, to dark days.

Every Tuesday morning, neurosurgeon Stephanie Einhaus makes her rounds at Le Bonheur Children's Medical Center, examining babies with brain conditions and trying to ease parents down a difficult road. Today, she walks crisply into the neonatal critical care nursery, where a 20-something couple wait for her consultation. Initially, it is only the mother who is visible. She sits alone, motionless, her arms empty of the new baby she's only recently delivered. Instead, her newborn lies beside her, filling up barely half his incubator.

As Einhaus enters, the girl motions to the father, a tall, handsome young man who steps out from behind a partition at the back of the dimly lit room. All around them, medical machinery whirs, keeping fragile infants like theirs alive during the first critical months of life.

"Good morning, I'm Dr. Einhaus," the surgeon says warmly. "I'll be taking care of your baby today."

Next to the young woman, a perfect, pecan-colored foot peeks out from a cloud of white blankets. No bigger than a man's thumb, this tiny foot belongs to the couple's infant son, born too early, just 27 weeks. Because of his extremely low birth weight, he has suffered a brain hemorrhage and developed hydrocephalus, a common side effect.

As one of only two female neurosurgeons in Memphis, Einhaus specializes in treating children with problems like hydrocephalus. After the introductions, she briefly explains the procedure scheduled for this morning. "The baby has too much spinal fluid in his brain, so I'm going to have to insert a partial shunt," she says. Shunts drain away excess fluid from the brain, she tells them, diverting it to the abdominal cavity where it will be absorbed into the blood stream. If left unchecked, the excess fluid can swell a child's head, severely diminishing brain development.

She doesn't tell them that hydrocephalus is a lifelong condition, or that their child may also be left with cerebral palsy. For now, she gives the new parents just one piece of information at a time. It is enough.

They listen, wide-eyed, unblinking.

"Is this your first child?" Einhaus asks. The mother's worried expression is momentarily eclipsed by a smile. "Yes," she answers shyly. "He is a twin. Our other child is in a hospital down in north Mississippi."

Einhaus looks surprised. "So you're trying to keep up with two babies in two different hospitals? I'm so sorry," she says. As she continues, a team of nurses and anesthesiologists begin streaming into the room to prep the newborn for the operation. She keeps her explanation brief. The conversation takes less than 10 minutes.

But instead of turning to leave, she looks at the couple steadily and asks, "Would you like to pray?" They nod. As the three bow their heads, the conversation in the room wanes until only the rhythmic shushing of machinery is left to fill the void.

"Dear God," Einhaus says quietly. "We pray for your blessings on this surgery, that the proceedings will go well. We know you're here with us, oh Lord, that you are a greater force than we are. Please help this family feel comfortable, help them know your power as they wait."

The couple glimpse their child one last time before the staff surround the bassinet and begin their work.

"I will send up a balloon that says, 'I'm a person of faith . . .'"

It's not unusual for Einhaus to pray with the patients she treats. She views sharing her Christian faith as part of her ministry as a doctor. It sometimes catches people off-guard, her willingness to talk about spiritual matters. But Einhaus says asking families about their faith has proven to be both welcome and helpful, particularly since some of these surgical cases present such difficult, life-and-death decisions for parents.

"I feel it's part of my responsibility to not only help them through the illness, but also in coping with [the diagnosis] because that's huge," says Einhaus. "Yes, it takes more time but it's worth it. That's part of caring for a family, helping them deal with these larger issues instead of simply handing them a hanky and walking out the door."

She didn't always feel comfortable talking about her faith at the hospital, or praying with families when other practitioners were nearby. The evolution has been a gradual one, a journey that has taken place over the course of several years. "I don't force my views on anybody. But I will send up a balloon that says, 'I'm a person of faith and a believer in Jesus Christ and it's okay to talk to me about this.'"

Discussing questions of spirituality and faith is not something people generally expect from their doctor. Yet a growing number of studies indicate many patients today desire this conversation, especially during times of crisis. When patients and their families are grappling with an illness or diagnosis that significantly impacts their health, they are often searching not only for medical answers but for spiritual consolation as well.

"The medical community is catching on that folks who have religion cope better."

For many years, the connection between medicine and spirituality was seldom made. Instead, the body was viewed as being separate from the mind and spirit, a machine to be fixed by doctors and nurses, the mechanics for healing. One nurse, speaking to the secular nature of the children's hospital she worked at years ago, described the installation of a stained glass mural of Jesus surrounded by little children as part of a new wing. This depiction created such a controversy that in a matter of weeks, a stethoscope was added to Jesus' neck. Such was the divide between science and religion. Yet in the past two decades a flood of research has looked objectively at the role spirituality plays in the healing process, with studies that have asked patients what enables them to cope with illness.

"And they talk about religion and faith. To ignore this is to be shortsighted," states Dr. Harold Koenig, co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center.

Studies find that when people are faced with difficult obstacles, such as being diagnosed with a serious medical condition, those patients who are more spiritual or religious fare better. They are also found to have lower mortality rates, reduced stress, and overall better physical and mental health.

"The medical community is catching on," continues Koenig. "They are realizing that folks who have religion cope better, have less depression, and they find more meaning and more hope in life. And when you do better psychologically, then your physical health improves as well."

Better than 80 percent of patients say they want their doctors to ask about their spirituality, according to Dr. Jerome Groopman, chief of experimental medicine at the Beth Israel Deaconess Medical Center in Boston, professor of medicine at Harvard Medical School, and author of the book The Anatomy of Hope. But in reality, doctors are trained foremost to detect and treat disease, and are woefully undertrained in relating to the spiritual needs of their patients. They prefer to leave that work to hospital chaplains. Koenig speaks on this topic to hundreds of doctors around the country each year, and finds 90 to 95 percent of physicians "don't engage these issues with patients."

But Koenig asserts, "Every doctor needs to be informed. It's related to the patient's health, so we must make time to ask our patients, 'How are things in your religious life? Are you doing okay or do you need to speak with someone?'" Einhaus echoes Koenig's view: "People want to know you're well-trained but they also want to know you care about them. When there are life-altering problems, people get stressed. They need help besides the medical facts. They need hope, and the only way I know how to do that is through my faith."

"Not all healing is through me; there are other forces at work."

Perhaps it won't come as a surprise, here in the Bible Belt, to learn that speaking about faith in Memphis is more readily accepted and embraced by both patients and their caregivers than elsewhere in the country. Dr. Scott Morris, the founder of the Church Health Center and a minister with the United Methodist church, takes an active role in examining the intersection of faith and health. For the past several years, his organization, in partnership with Methodist Healthcare, St. John's United Methodist Church, and Memphis Theological Seminary, has encouraged a dialogue between the medical and religious communities by bringing in national speakers for the biannual speaking series, "Faith and Health."

"A fundamental flaw in health care is not recognizing that there's a spiritual dimension to life," says Morris. "We believe everything is biological. If you can't do a lab test, then there's no physical evidence. Then it's all in the person's mind and there's nothing wrong with them. But that's often not true."

In the journal Community Oncology (June 2006), Dr. Alva Weir III, an oncologist at the West Clinic, writes that medical professionals need to broaden their understanding of the role faith plays in medicine. "One could suggest that religious faith has nothing to do with our jobs as science-based clinicians, but that notion both narrows our definition of 'healer' and denies the truth that religious faith is a powerful tool for improving the well-being of our patients."

Those doctors who allow their spirituality to inform their practice recognize and take solace in knowing that a higher power is at work. "I do believe in prayer and I try to do my best, but the rest is up to God," notes Dr. Alim Khandekar, a cardiothoracic surgeon with the UT Medical Group who is of Islamic faith. "Not everything is done through me, not all healing is through me, there are other forces at work. I also believe people with faith have better healing. In 32 years of practice, I have seen people with a positive sense of self and spiritual life do better. They're not as anxious, because of their willingness to make a decision, and then try hard to leave it up to God. Science doesn't have all the answers. Sometimes healing happens in spite of us."

Doctors say conversations of faith typically arise either at the beginning of establishing a relationship with a patient or at a crisis point, when the individual or family must make an important decision or come to terms with a diagnosis. Khandekar says, "I'll often advise a patient of their condition and they will ask me how long they have to live. I say, 'I don't know, that's not in my hands.' I don't believe we should be the ones telling the patients [what the future holds], that's not my job. And I think people understand where I'm coming from."

Einhaus concurs. "When a family is making a big decision, I will ask them questions and if they're undecided, I'll suggest they pray about it, because some people have a difficult time making a decision. But as the saying goes, there are no atheists in foxholes. In times of trouble, people often start thinking about God. They might not pray regularly, but when times get tough and you're looking for hope, the only hope you have, really, is God."

"You do take cues from the patient because you don't want to be intrusive."

Doctors also stress the importance of having such discussions patient-led and patient-focused. Because of the fiduciary nature of the doctor/patient relationship, physicians have a responsibility to keep their patients' best interest in mind, without proselytizing.

Dr. W. Clay Jackson, who is both a physician and minister, characterizes the doctor/patient relationship as a "therapeutic alliance." "Healing is something that happens between two people; it's not something that's given by one or taken by another," observes Jackson, the comprehensive primary-care medical director for Methodist Alliance Hospice and Palliative Services.

During office visits, he often asks his patients to talk about what brings hope or meaning to their lives and listens closely to their responses. "It's important to be patient-focused. We have to be careful not to put in our own perspective on that conversation, one that doesn't take into account where the patient is in their life. We have to respect the power and balance in that fiduciary relationship and see things from the patient's viewpoint."

Clinical director Pam Turner, who works in the neuro intensive care unit at Methodist University Hospital, agrees. "You do take cues from the patient because you don't want to be intrusive if they don't share the same religion. But often patients will be open about that part of their lives and you can tell if the patient's family comes in and prays or sings hymns or maybe references that God is in control." She had one patient, a man in his late 40s whose lung cancer had metastasized to his brain and was fearful as he waited for surgery. "So I asked if it was okay for us to pray together. We prayed for the surgery to go well and he told me three or four times how much he appreciated that act. I felt he was calmer and less frightened as he went into surgery."

Leaning on one's own faith also enables doctors and nurses to better relate to their patients and help them cope. For 31 years, registered nurse June Weiss worked nights at Le Bonheur, tending to sick children and their families. She said it was often at night, when the floor became tranquil, that parents would unburden their grief with those willing to listen.

As a young wife and mother, she had experienced loss of her own, two sons, both of whom died shortly after birth. Her suffering was compounded by hospital rules at the time that didn't allow parents to be with their sick infants until after they had died. Yet growing through that experience strengthened her faith and enabled her to empathize with families.

"I could understand why parents would take a picture [of their dying child] and think of the future, even when staff would say there is no hope. I would listen and let them talk and share with them that there's always hope. You must wait until the Lord speaks to you and prepares your heart for what will happen."

"It is God who is all powerful and I am limited, as all humans are."

"I can't keep people alive," acknowledges oncologist Steve Besh, one of the founders of Christ Community Medical Clinic and now at the West Clinic. "It is God who is all powerful and I am limited, as all humans are. So the question is, how do I work within that framework?

As an oncologist, Besh is frequently faced with having to acknowledge the limitations of medicine. While chemotherapy drugs have improved greatly over the course of his lifetime, the reality remains that many patients stricken with cancer eventually die from the disease.

"Often, chemotherapy doesn't make them better. People will say, 'I'm going to do everything I can to beat this,' but they must know there are limits, that more isn't always better. One tension in oncology is realizing the limitations of treatment. It's not a faith issue but a reality. We must accept that we're not all powerful, that treatment won't always go our way. I tell my patients that we must pray for wisdom and hope things will go well but that's different than ignoring reality."

"We now understand what the limits of science are and that there are limits to the human, rational understanding of our world," adds Jackson. "I don't feel ultimately that human health is limited by human understanding. It's not just what the patient and doctor bring but other forces are also at work: hope, meaning, encouragement, friends. All of these things are important to moving the patient away from illness and towards health, and not just physical health, but emotional and social health as well."

Ultimately, Einhaus says, "I want to give other doctors the message that it's okay to talk about faith. People appreciate it. And when you're delivering hard news, it gives our patients something to hold onto. It's difficult, but holding out hope, that is what's important."

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