Abstract
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A dying patient that I will choose to call “George,” was such a person. Since George was a child his mother took him to the church building at least twice a week for as long as he could remember. As a result, at a very young age he found himself admiring the sermons that were preached and the music ministry that was presented, and both helped him to develop a spirit of faith, endurance, and hope. Little did he know at such a young age that much later in life he would need all three of these spiritual pillars as he faced his biggest challenge—a life-threatening illness. George was deeply involved in his faith and was very active in the life of his Church. His service and dedication to his faith community spanned almost seven decades. As a result he was well rooted in the doctrine of his faith and throughout his life always heavily leaned on what he learned from his spiritual experiences to help him in personal times of trouble and despair.
At the core of his faith was the hope that Jesus would help him to overcome anything that he faced. He would draw upon his faith in Jesus when he was diagnosed with prostate cancer at age 73. Unfortunately, he had not been to see a doctor prior to this point in his adult life. Reason being, as an older African American man, he did not trust physicians due to the nature of the historical encounters with the health care system that Blacks have had over time which have included some health care providers who did not act in the best interest of Blacks. Such history resulted in what has now been documented as medical mistreatment, disrespect, and experimentation. Additionally, he was very aware of current health care disparities in society, so George did not desire to go to a doctor to receive any form of routine physical exams. He also learned from the experiences of the men in his family that journeyed before him, and these experiences dictated that seeing a doctor was something that was only to be done in the case of an extreme medical emergency. Even then, he felt that God would have the last word, not the doctor. Nevertheless, at this point in his life the encounter that he managed to avoid became unavoidable as he found himself in immense pain that would not subside with home remedies or over-the-counter medications. It was now time to go and receive formal medical care.
During his encounter with his assigned physician at the hospital, everything that George had learned about why he should not trust physicians seemed to be true, but not just because of the historical reasons of mistreatment, disrespect, and experimentation. There was an additional reason why his trust wavered in his physician. George felt like he could not trust his physician because, with all of the medical questions the physician asked while informing him that his prognosis for living beyond the next 12 months was very poor, George was not asked anything about his faith. Therefore, the single most important thing in George's life was never addressed, and in turn, was not going to be a part of his care plan. Research documents that many patients have spiritual beliefs that influence their medical decisions and that a majority of patients, with or without such beliefs, would want their physicians to ask about their beliefs if they were gravely ill. 1 Additionally, in a study in the Journal of General Internal Medicine, patients who had conversations about religion and spirituality with hospital personnel were the most satisfied with their overall care. 2 Needless to say, at this point George was completely unsatisfied.
When caring for patients approaching the end of life, it is imperative to recognize that many patients depend on the hope that their faith experience developed over time to help them when facing their own mortality. George was not recognized as such a patient. With his over 60 years of spending at least six hours a week attending Sunday morning worship and Wednesday night prayer and Bible study, he had experienced over 20,000 hours of hearing messages of hope preached by his pastors in an atmosphere that reflected hope in music, prayer, and fellowship. Consequently, when health care providers have family meetings and informational sessions with patients about care plans and decision making, but fail to acknowledge spirituality as possibly being a vital part of a patient's life, what's lost is realizing how incredibly short the amount of time spent (approximately 5 to 10 minutes in most cases) in explaining the patient's prognosis is when stacked up against the patient's powerful investment of several thousand hours of spiritual hope development.
What could the health care team have done to better support George's faith? When patients like George who are highly supported by their religious communities also receive spiritual support from their medical team, they receive higher quality of end-of-life care through greater use of hospice and fewer aggressive end-of-life interventions. 3 When spirituality is vitally important to patients, as they are introduced to an unexpected life-threatening prognosis, it is reasonable that they will begin to draw upon the hope of their faith, which can result in verbalized expressions of words such as “miracle” and “healing.” Physicians and other health care providers who are uncomfortable with these types of spiritual expressions should not be dismissive of such language, but journey with patients in a way that will not strip them of their hope. Ultimately, physicians and other health care providers should let their patients know that their spiritual views are respected, and every effort will be made to help him or her on their spiritual journey during this challenging time in their life.
Even though George felt his physician lacked respect for his faith, whether it was because of his physician's discomfort with the subject or the physicians failure to see it as important, he chose to hold on to the hope that he had. The hope that would help him face the obstacle of his medically predicted death. Hope that would carry him throughout his painful journey. Hope that would comfort him. Hope that could produce the possibility of a miraculous healing of his body. Hope that could produce peace in his soul in the absence of such a miracle. Unyielding, unwavering, unapologetic, and undying hope. Many African Americans that embrace faith in God as a vital part of their lives when facing end-of-life circumstances depend on such hope to bring serenity to an otherwise surreal situation. This hope is best understood in the words of Vaclav Havel who said, “Hope is definitely not the same thing as optimism. It is not the conviction that something will turn out well, but the certainty that something makes sense, no matter how it turns out.”
Ultimately, when a patient reaches out with the hand of faith that is filled with hope, that hand must be met with a hand of care, concern, respect, acknowledgment, and love from the medical community, allowing the two to journey as one with mutual respect down the path of the patient's physical transformation or transition. George eventually lost his fight against his disease, but he never lost his hope. It's just a shame that he may only be remembered by his physician and others in his health care community as an African American man whose hope may not have been enough.