A hush fell over the ballroom at the Washington, D.C., Cosmos Club as Daniel P. Sulmasy, MD, PhD, MACP, André Hellegers Professor of Biomedical Ethics and senior research scholar at Georgetown University’s Pellegrino Center and Kennedy Institute, told the audience about one of his patients, Meg.
“I find that the best way to talk about spirituality and medicine … is to talk about specific patients,” he explained. Meg, he went on to say, was a 38-year-old woman who had been diagnosed with an atypical adenocarcinoma of the cervix and had a large tumor mass in her abdomen. Meg, Sulmasy explained, was alone. She had never been married, lost her mother to illness years before, and was estranged from her father. Sulmasy helped her on her journey through various treatments and stages of illness. Toward the end, she asked to be moved from hospice to her home, where she passed away.
“Practicing a finite and a fallible craft, we serve finite and fallible creatures,” Sulmasy said. “[Meg] was no saint, I was no hero. We merely developed an attachment that’s common for physicians with some of their patients. And this is one story among thousands of other stories. And yet telling at least some of these stories, routine as they might be, is necessary to remind us on occasion of who we are as people practicing medicine and the other human arts.”
The keynote address, part of a dinner during the 9th Annual George Washington Institute of Spirituality and Health (GWish) Summer Institute, encompassed all that GWish stands for: compassionate care by restoring the heart and humanity of medicine through research, education, and policy work focused on bringing increased attention to the spiritual needs of patients, families, and health care professionals.
The institute comprises four days of insightful presentations and discussions by and for leaders in spiritual care and palliative care from around the world. GWish, founded by Christina Puchalski, MD ’94, FACP, FAAHPM, professor of medicine at the GW School of Medicine and Health Sciences (SMHS), is the first university-chartered institute of its kind and has made its mark as a global leader in promoting compassionate approaches to patient care. Under Puchalski, GWish is pioneering changes in health care through innovative programs for physicians and other members of the multidisciplinary health care team, including clergy and chaplains.
At the start of the dinner, Robert Miller, PhD, senior associate dean for research, Vivian Gill Distinguished Research Professor, and professor of anatomy and regenerative biology at SMHS, thanked Puchalski for the work that she does through GWish.
“It’s a unique organization, a unique institute within the School of Medicine and Health Sciences,” he said. “[And] because it’s unique, it doesn’t fit easily in any of the silos, and actually Christina doesn’t fit easily into any of the silos either. It’s a huge strength.”
The dinner featured the presentation of two honors. The first was the Award for Excellence in Interprofessional Spiritual Care, which was received by Carolyn Jacobs, PhD, MSW, Dean Emerita and Elizabeth Marting Treuhaft Professor Emerita at Smith College’s School of Social Work. “I am humbled and honored,” Jacobs said. “I have loved working with GWish, for you are a place that truly understands that whole person care means being a whole person providing care for others.”
The second award was given to honor The John Templeton Foundation, a philanthropic organization established by Sir John Templeton, an American-born British investor and philanthropist, that funds interdisciplinary research about human purpose.
“On behalf of my father and grandfather, thank you for this recognition,” President Heather Templeton Dill said to the audience upon accepting the award. “But all we have done, as a funding institution, is to scatter a few seeds of funding. You are the ones who have taken those seeds and watered them with your work. I applaud your efforts, and I wish you success as you continue to keep spirituality and religion at the forefront of medical education, research, and practice.”
Spiritual Care Past to Present, East to West
Monday’s summit session kicked off with a presentation by Tracy Balboni, MD, MPH, associate professor of radiation oncology at Harvard Medical School, on “State of the Science of Spirituality in Palliative Care.” Balboni spoke about the history of medicine and spirituality’s role within in it. In today’s health care space, there can often be a “fixed gaze” on the material aspects of care to the detriment of spiritual health, she said.
“This really is a time for building community with one another,” she said. “Forging the development of spirituality and the embrace of spirituality as part of health care really requires us [to be] a community of persons dispersed throughout the world to impact change in health care institutions, in how we embrace patients, and how we embrace ourselves as caregivers.”
Attendees also heard about spiritual health and care as a public health issue. In his remarks, Richard Egan, professor of health promotion in the Dunedin School of Medicine at the University of Otago, New Zealand, asked “how does spirituality fit into public health?” While most people think of public health issues as alcoholism, smoking, and obesity, he said, spiritual distress also needs to be addressed through health policy and other means.
Egan, a New Zealander, was just one of the presenters who offered insight into spiritual care provided in other countries. Nareen Chan, from Singapore, spoke about how culture there impacts spirituality and religion, and Piotr Krakowiak followed with a presentation about his country, Poland, and its transition toward hospice and palliative care.
The summit also featured many discussions among attendees about spiritual care and the right and wrong ways to address patient spirituality.
Rev. Kathleen Ennis-Durstine, senior chaplain and manager of pastoral care at Children’s National Health System, gave a case presentation on a 1-month-old girl named Carmen. The infant was brought to the hospital suffering from Ventricular Septal Defect, a hole in her heart, but her parents declined the surgery. Carmen’s mother just wanted her daughter to be able to come home, and said she trusted in God to protect and heal the child.
The neonatologist decided to ask for a palliative care consult, during which a palliative care physician and interpreter were present with the parents. The physician told the mother that he understood that her faith was very important to her “so perhaps it’s time for you to understand that God has a different plan for your child than you do.” The mother reacted angrily to his words, kicking the physician out of the room and telling him never to talk to her about her God again.
After Ennis-Durstine presented the details of the case, she opened the floor up for discussion, releasing a flood of comments and suggestions from the attendees ranging from the right ways to show compassion in a difficult situation to the importance of creating trusting relationships between caregivers and the care team.
Care and Compassion through Standardized Patients
Julie Adams, a stage 4 colon cancer “patient,” reached for a tissue from her purse as she told her palliative care team about the death of her son while he was serving in Iraq. The chaplains, social worker, and physicians sitting at the table listened intently to her story, and offered words of support and comfort.
The activity was part of the summit’s standardized patient session, which aims to have attendees work together to identify health and spiritual needs of the standardized patient, and come up with a treatment plan for him or her.
The care team members in Julie’s group had to slowly draw her out, untangling her fears and concerns to better understand why she had not made a choice in the treatment of her cancer: a surgery that offered hope of a cure but had a 15 to 20 percent mortality rate, or chemotherapy. “I’m not sure which way to go,” she said. “My faith says God will take care of me.”
Julie had not told anyone how serious her condition was, not even her family members or pastor. She didn’t want to be a burden on her loved ones, and did not want to be judged for her previous anger at God over her son’s death. Maybe, she said, her illness was punishment for that anger.
The team was able to make Julie feel comfortable talking with them, and she admitted that her illness scared her. On the suggestion that she tell someone about her illness, possibly her pastor — something Julie said she hadn’t considered — she started to open up more. Julie began to question whether chemotherapy might be the right next step, despite lingering uncertainties. Toward the end of the session, she agreed to come back to meet with the team again, and this time bring someone whom she trusted enough to be fully open about her diagnosis.