Learning from Dying: What My Patients Have Taught Me about Religion and Spirituality

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When I learned that I had received this award, I was quite daunted about what I might talk about and I considered avoiding the issue of religion and spirituality altogether and talking about something else. But something kept pulling me back to engaging with this issue and so that is what I have done.

I have spent the past thirty years living in the shadows of other peoples’ deaths, in my work as a palliative care physician and psycho-oncologist. In this work, I have frequently felt overwhelmed in the face of terrible pain and sorrow, and regularly experience a sense of awe and amazement at the human capacity for love and resilience and growth in the face of tremendous difficulty.

I’ve been intrigued by the power of religious faith for people I care for and respect, even if I don’t understand it. It is an answer, or solace, for the pain and uncertainty of existence, especially about death, and a framework for meaning-making. Illness forces a profound confrontation with aloneness, and faith seems to offer, for many people, companionship. My patients have also taught me about doubt and the ways that illness raises questions about belief, and about the healing that comes in being able to express these questions. 

I think about the people I’ve cared for and what was important for them, and feel deeply grateful for the lessons I learned from them. 

David, a 22 year old college student with, of all things, pancreatic cancer, who came to Harvard Medical School 3 days before he died to teach a class of first-year medical students with me, because he had always wanted to be a teacher, and wanted to still feel like a contributor to the world.

Or Tabitha, a 23 year old mother with three young children, dying of metastatic cervical cancer, in intractable pain in spite of every pain management intervention we could dream up, asking for me to pray with her right before we initiated palliative sedation, wanting to feel that peace and connection in the final moments of her conscious life.

Or Guilia, a 35 year old lesbian woman with metastatic breast cancer, who I went to say good-bye to as I was going on vacation, knowing that she would be gone by the time I returned, and who, for the entirety of my visit, was sitting on the commode, unable to get off it, urgently asking me to check in regularly with her partner to make sure she was taking care of herself after Guilia was gone. 

What I take from these stories is the importance of contributing, connecting, being at peace, loving as the end comes. And maybe we don’t have to wait until the end to live this way. There are many stories, and all of you who have worked clinically have your own.

I’ve learned that the work of doctoring for patients with serious illness is most centrally about creating a sense of security, companionship, and connection that allows people to feel that they can face whatever comes. This phenomenon reminds me of my children, as toddlers, exploring the world, learning to tolerate the noxious noise of the vacuum cleaner, or the feeling of smallness in encountering a large, rambunctious dog, or the scariness of my being in the next room. Security and connection are an antidote to terror. 

Most profoundly, mixed in with all the fear and anger and sense of unfairness and loss that most people feel, and express when given the chance, what I find most remarkable and meaningful about this work is that through my patients, I can be in touch with the power of love. Patients allow those of us who care for them to be in the presence of ultimate, essential feelings and concerns, including love. 

I thank you for the honor of this award, and the journey it has taken me on in confronting some of my own beliefs about religion, spirituality, faith, and meaning.

Dr Block is chair of the Department of Psychosocial Oncology and Palliative Care at Dana-Farber and Brigham and Women’s Hospital, co-director of the Harvard Medical School Center for Palliative Care, and professor of psychiatry and medicine at Harvard Medical School.

This text was originally published on the HealthCare Chaplaincy website, along with a video of Dr Block’s speech and photographs of the convocation.

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