Faith and Medicine: Week Four

I remember one day towards the end of my senior year at Notre Dame sitting in my dorm room contemplating my path after graduation and asking myself if I could have any job what it would be?  I still remember the answer the came to me of to work at a children’s hospital.  The answer surprised me as I had not pursued pre-med and was not sure what other jobs I might be able to qualify for in that setting.  I smiled at the surprise of that moment and the thought of spending my life in that type of work, held the answer in my heart for a few moments, and then continued my applications for the postgraduate volunteer programs that I was applying for. 

After graduation I went on to be a high school teacher with the ACE program, an experience I am deeply grateful for and cherish.  After my experience with ACE I was blessed to be hired to work for the Notre Dame Vocation Initiative, which included the ND Vision program.  In this incredible experience I learned more deeply of the lives of the saints, and took very much to heart the premise of the program “Their gifts (the saints) changed the world… how will yours?”

As my experience with the ND Vocation Initiative unfolded, one day I head a prayer form in my heart and began to pray it daily:  Lord, let me glorify you through the gift of my free will. 

About a year later I found myself sitting on an ambulance floor in Calcutta, India en route to the Missionaries of Charity Home for the Dying, alongside of my dear friend Danielle, and beside a man who was dying and being brought to the home for care his last moments or days.  It was the first time I was in the presence of someone who was dying. It is difficult to translate the moment into words, but I can say that in that moment I experienced an unexpected but clear call to become a physician.

After returning to the US, I began exploring the reality of returning to school to take pre-med classes, and began them at the beginning of the next semester.  In 2007 I entered medical school, and from the beginning had a deep interest in the field of palliative care.

It has been eleven years since the moment in the ambulance in Calcutta, and I have since completed medical school, residency and fellowship in hospice and palliative medicine.  I am working now as a palliative medicine physician, and predominately work with people who are undergoing treatment for cancer.  I am often asked if I find the work depressing or sad.  It certainly is difficult at times, but not unlike most callings, I believe, which call us in some way to die to ourselves and to spend our lives for others. 

The beauty is that if I am attentive to it, each day is an opportunity to encounter Christ in disguise in the person in front of me.  I have reflected often that working so often and closely with people confronting their own illness and mortality it is a refining fire of sorts, that helps to burn away the things that keep me from an eternal perspective. 

The prayer still guides me:  Lord, let me glorify you through the gift of my free will.  It is also joined now by another prayer, written by Saint Mother Teresa of Calcutta:  “Mary, my dearest mother, give me your heart so beautiful, so pure, so immaculate, so full of love and humility that I may receive Jesus as you did and go in haste to give him to others.”

May God bless you all as you seek your callings, and the ways that your gifts will bless others and glorify God.  If I can be of any service to you in your journey, please do not hesitate to be in touch.  My prayers are with you, and I thank you for your sincere and earnest efforts for promoting compassion in medicine.  God bless you!

Nicole Shirilla received an undergraduate bachelor degree in 2000 and Master in Education in 2002 from the University of Notre Dame.   Several years after college she felt a calling to become a physician, and enrolled in medical school at the University of Pittsburgh, graduating in May 2011.  At the University of California Irvine she completed a residency in family medicine in 2014, and fellowship in palliative medicine in 2015.  She currently works in San Diego, California  as a hospice and palliative medicine physician.  

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Faith and Medicine: Week Three

I recently had my first medical school interview.  After noticing that I had attended Catholic schools for most of my life, my interviewer asked whether that would have any impact on my ability to interact with patients from diverse religious and cultural backgrounds.  I should have anticipated the question, but I was a bit thrown off nevertheless.  I have always seen my Catholic faith and education as having a positive impact on my ability to interact with others, and having that perspective questioned at first bothered me and caused me to think more deeply.  Upon further reflection after the interview, I am further convinced that the impact of my faith and religious upbringing are, in fact, positive.  Yes, my faith will not interfere with my medical practice, but furthermore, it will actually help me to be a better doctor.

Most people in America are religious.  According to a Pew Research Center survey in 2014, approximately 70.6% of Americans consider themselves Christians, 5.9% are of non-Christian faiths, and 22.8% consider themselves unaffiliated.  The latter number is growing, but it is still clear that they average doctor will see many patients on a daily basis who are religious.  Thus, religious faith and spirituality do have a place in medicine.  Of course, they do not necessarily come up often in a clinical setting, but they operate beneath the surface, influencing patients’ perceptions of disease as well as their ability to endure challenges.  Knowledge of various religions is useful in a medical setting, but having a personal religious backgrounds can help medical professionals to show empathy when a patient’s religion impacts his or her medical decisions, even when they go against the wishes of the doctor.  For example, if a Jehovah’s Witness refuses to receive a blood transfusion even in dire circumstances, a religious physician, even if from a different religious background, will likely understand the importance of this decision to the patient and likely will not be hard on him or herself if that decision has negative consequences.  A physician’s primary concern should be for the health of the patient, but a religious physician might find it easier to realize that a patient’s wellbeing involves more than just health.

Of course, a religious mentality that rejects and works against different faiths or life philosophies does not belong in a medical setting.  Doctors must be prepared to help a diverse patient population coming from countless combinations of religious, socioeconomic, cultural, and national backgrounds.  Although it might not be the case for all, my Catholic education has motivated me to meet and learn from people from different backgrounds.  In high school and especially in college at Notre Dame, I have been encouraged to participate in many service and extracurricular experiences that exposed me to diversity, even if I did not always find it in the classroom.  Through these experiences I have traveled to various countries including Nicaragua, Ecuador, Ireland, Scotland, and Australia.  I participated in service domestically, getting to know many people who are poor or homeless, learning about their needs and the realities of their daily life.  I even was able to study abroad in Puebla, Mexico for a semester, learning Spanish while living with a Mexican host family and attending a Mexican university.  Of course, these sorts of experiences are possible anywhere, but the Catholic institutions I have attended have especially emphasized their importance while reminding me that I was not helping others lower than me, but learning from equals.  Through my various activities, I learned solidarity, not superiority.

Lastly, my faith and Catholic upbringing have helped me to develop compassion, which is much-needed in the medical field.  As a Catholic, I have learned to see all people as having intrinsic dignity and worth.  Additionally, I have been taught that I am called to serve other people.  Having this sense of vocation and purpose can only help me to better treat my future patients.  Non-adherent or angry patients are common in medicine because illness can be extremely frustrating and healing can often be just as or even more difficult.  Without a sense of meaning in their work, medical professionals can easily find themselves in despair, bogged down in the daily struggles of their work.  Personally, I believe in a loving God who wills that all people grow closer to him and eventually live united in him for eternity.  Therefore, I am on the same road as my patients.  No matter what their backgrounds are, we share a common destiny.  Instead of separating me from my patients, this stance brings us together and encourages me to learn from them as much as they learn from me.  In a career that requires one to observe the various determinants of health, my faith helps me to have this holistic perspective.  Thus, I am thankful to have it as part of my identity and my upbringing.  I hope that I am asked about it again in my next interview.  I am sure that I will now be better able to explain my perspective.

Joe Wolf is a Science Pre-Professional Studies major with a supplemental major in Theology and a minor in Catholic Social Traditions. He is currently applying to medical schools and is interested in the relationship between medicine and Catholic Social Teaching. In his free time he is working on a project involving poverty medicine and is involved in the Notre Dame Folk Choir.

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Faith and Medicine: Week Two

Lois* had been in the hospital for weeks. She had multiple medical conditions, many of which had uncertain cause and most of which were only temporarily treatable. Her husband, whom she married at age 18, was dedicated to doing everything possible to save her. Her three children slept outside in the waiting room and told me “She is everything to us. She holds the family together”. She had recently taken turn for the worse and was now intubated (meaning she had a tube in her windpipe so that a mechanical ventilator could assist her breathing). She was so sick that she no longer was able to interact with her family and was taking multiple medications to keep her blood pressure high enough so her organs could at least get some blood flow.

The family frequently mentioned God and wore clothes that mentioned faith or God. When the doctors shared how sick Lois was, the family acknowledged this, but informed us they were praying for a miracle and not going to give up.

I was a player in Lois’s story as an intern, a first year resident, on the team of doctors who were caring for her in the Intensive Care Unit. Not only was it my first year as an “official” doctor, but my very first month of residency.

On a particular bad day for Lois, on my way out the door, I approached one of her daughter’s in the waiting room and asked if I could pray for Lois with her. I knew it was okay to pray with patients and families, but I had rarely seen this modeled. I had been a Eucharistic minister in the hospital during medical school with the opportunity to visit patients and have short prayer services with them at their bedside, though this was slightly different than that as I was wearing my “doctor” hat and not my “church volunteer” one.  At gathering of Christian physicians called the Global Health Missions Conference in Louisville Kentucky, I heard Dr. Walter L. Larimore speak on taking a “Spiritual History” from patients alongside the medical, surgical and medication histories we assess at every visit. With this he shared that the “Joint Commission, a regulatory body for hospitals, actually requires hospitals to assess spirituality with each patient”. From what I have seen, this is often done by asking a single question, amounting to “Do you have any spiritual needs?”. These prior experiences gave me the boldness and at least a bit of skill to initiate this.

Lois’s daughter did not find this offer strange, but instead called her father and siblings over to join us. I praised God for Lois’s life and all the people she touched, prayed for her comfort, asked God to guide the hands and minds of doctors and nurses. Afterward, her children and husband added their own prayers. As an intern, I often feel that what I did really did not make a difference, but I left that day feeling so thankful I could contribute by offering to pray.

Days later, Lois continued to decline, but the family,and her husband in particular, were still struggling to accept this. The husband was frustrated with the doctors for not being able to do more for his wife. If my grandparent were in the same scenario, I too would wonder, was everything done that was possible?

It was at this stage of frustration when the job fell to me to give the family the routine update for the day. Walking into the conference room to meet them, I was surprised to find about 15 family members crammed in waiting for me, rather than the 3 or 4 that were typically present. Yikes! Often my senior resident gave the update so I was a bit unsure if I was prepared – especially for such a large audience!

My update was simple and unchanged from the past few days: her kidney function was not getting better, her heart was not pumping well and her lungs were filled with fluid. Every medical intervention that could possibly help was being done.  As they asked a few questions, there was a tension of accusation in the room – “Why can’t you fix this? “What if this or that would have been done sooner?” and I did my feeble best to answer. I could understand the thoughts running through their head, and might have asked the same ones in their position. It was becoming more clear that all the medical interventions we could do were not going to stop Lois from dying. I sensed a  tone of denial and anger. Admittedly these are part of the grieving process, but it was sad to see that hinder them from cherishing the last moments with Lois.  

When I sensed that continued questions were taking us in circles, rather than really helping, I transitioned to end the conversation. A thought crossed my mind to offer to pray again – but I was unsure. I took the plunge – offered to pray, said a short prayer. What happened next was, in my opinion, the “miracle” that the family had been praying for. No, Lois did not start to recover, but as I watched they started to accept and process that she was dying.  The tone in the room changed from accusation and anger to sad, thoughtful processing and acceptance. Many family members in tears prayed for their mother, wife, mother-in-law, aunt – celebrating her life. A son-in-law walked across the room to give a hug to the tearful husband of Lois.  Someone encouraged, “it is okay to let go”. For the first time, the husband said that if her heart were to stop beating, it would be okay to not do CPR and try to restart her heart. This mattered because the chance of CPR actually allowing someone as sick as her to live well again was ~0.0001% and would likely do more harm than good. Though we had tried to communicate this for days, it was not until now that he was able to accept this.

I believe in miracles, in faith healing, in God’s power over this earth. Yet, I have seen many wonderful people with great faith die. So I have come to think that miracles do not always look like a cure-against-the-odds, but sometimes as an acceptance of life and death.

It was not a happy day, but it was a good one. As an intern, this was one of the first times I felt I really may have made a difference. As a believer in the Holy Spirit, this yet another instance on my mental list of when I saw the Spirit at work.

The next day Lois died. She now knows if there is a God. What God is like. If there is heaven or hell.

I believe in God, a loving, forgiving, just, personal high power. I believe that this God responded to my choice to make other things my highest value (accomplishment, food, comfort, pleasure, independence) – and instead of turning from me, sent his Son Jesus to make a way so that I could be back in full relationship with Him. And so that I could have hope that as I sat praying with Lois’s family, a power bigger than me was entering into this icky broken world of death, and bringing some comfort, light and hope.

This above story is one way my faith has impacted my work in the medical field. God’s overarching gospel of grace, restoration and love can be intertwined in all careers, though. My friend who is a lawyer works daily for justice for the people least respected by society. Another friend who is pursuing her Ph.D in environmental engineering works to protect and value the creation that God has made. Yet, for me as a new physician, I see God’s healing and presence in suffering as the gospel within the medical field. If I look I see the gospel interwoven in even the most mundane of days, those that are not life-and-death, but rather filled with  paperwork  for ordering someone’s allergy medication. Whatever your current daily life is, I challenge you to see if you can find it as well.

*named changed to protect patient privacy

Dr. Brittany Shrefler is a first year resident in Internal Medicine/Pediatrics at The Ohio State University Medical Center. A native of Willoughby Hills, OH, she also earned a bachelor's in Biomedical Engineering and her medical degree from Ohio State. After completing her residency, she hopes to practice in the Cleveland area.

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Faith and Medicine: Week One

                When someone asks what my major is (Pre-health and Theology), my response is often received with a look of bewilderment and a remark to the effect of, “don’t those contradict each other?” Sometimes I have the chance to kindly explain that no, I believe theology and the physical sciences compliment each other, such that my understanding of the human person is more complete having studied both. If their interest has not wavered by this point, I might add that theology, which is defined as “faith seeking understanding”, encourages new knowledge and understanding in any field, even the sciences. I believe that studying leads to understanding, which leads us to the truth, which in turn leads us to God, because “God is the way, the truth, and the life” (John 14:6).

                  Before coming to Notre Dame, I had never taken a formal Theology course and had no thoughts of majoring in Theology. Fortunately, I took my first theology course as a first-semester freshman and found myself gravitating towards the subject matter. Amidst the demands of general chemistry and adjusting to life in college, I recall thinking any time I spend learning about God has a purpose and is worth my time. Although I initially declared Psychology and Pre-Health as my majors, I was just three days into my sophomore year when I knew something was missing. I knew that college was the time to ask big questions and ponder topics that have no black and white answers. I felt that in order to receive the well-rounded education I desired, I should delve into a field that involved less memorization and more synthesis of themes. I have been happy with my decision ever since.

                  Perhaps the most prominent instance of overlap between my studies in theology and pre-medicine was in a course I took last spring, entitled Spiritualities of Caring in the Helping Professions, taught by Dr. Dominic Vachon. We were honored to hear ten care providers speak about their personal spiritualities of caring. This course was incredibly relevant and shaped how I envision incorporating my faith into my practice of medicine. Allow me to share a few salient points that I took away from this course.

·             Compassion transcends religion.

·             Informed by the course, my definition of spirituality: the inner component of the lived human experience, which infiltrates all areas of a person’s life and gives meaning to it all.

o   While not everyone uses the same language to describe what gives them meaning, purpose, and joy, all human beings are capable of cultivating these things, which is a person’s spirituality.

·             A spirituality of caring, specifically, allows care providers to encounter the sacred in their work. When a care provider has a spirituality of caring, even without necessarily articulating it, he or she has the ability to be engaged with, but not burdened by, patients’ suffering.

·             Praying the work: a phrase first introduced to me by Dr. Paul Wright in 2013. This concept is the answer to my question, “How can I incorporate faith into medicine?” This is a field in which I will consistently encounter opportunities to emulate Jesus’ love. When we live from a place of prayer, recognizing each person’s dignity and recognizing our dependence on God, compassion flows naturally into our work.

By cultivating spirituality, becoming more in tune with the sacred in this world, we gain perspective. In the process of discerning my career path, a friend reminded me that I am defined by God’s love above all. Before I am “Brooke the physician” I am “Brooke, child of God.” The moment I lose sight of this reality, I risk defining myself by the success of my treatments for patients or by the role I assume in society. Successful treatment will certainly be important to me, but my faith reminds me that I am not God, and therefore sometimes my work will not be enough.

I choose to enter the medical field because I believe God calls us to leave the place where we feel comfortable and bring His love and compassion to the places that need it most. I don’t doubt that I will be discouraged, disheartened, and challenged at times to maintain hope in the medical field. After all, I don’t think anyone has ever used the word “easy” to describe the healthcare professions.  However, I feel that my education in Theology and Pre-Health at Notre Dame is God’s way of equipping me to go out and show others the love that I receive from my relationship with Christ.  

Brooke is a Senior Theology and Pre-Health major from San Diego, CA. She feels honored to serve as Co-President of the Compassionate Care in Medicine this year, and also volunteers at Memorial Hospital and has been involved in Campus Ministry in a variety ways. Brooke has applied to both MD and DO programs, and hopes to begin medical school after graduation. 

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