According to a pithy Hasidic statement, God is anywhere that man lets him in. I park my religious views outside of the exam room. But many patients have strong religious or spiritual orientations, and their health concerns can only be understood and appreciated in that context.
My office makes new patients fill out a three-page questionnaire, but it only pays lip service to understanding their spiritual orientation. The review of systems takes up half a page. Relationship status and questions regarding sexual orientation take up an eighth of a page, and on page 2 the form asks, "Are there any cultural or religious beliefs that need to be considered in your care? Y/N If yes, explain." There follows a blank space that is so small that most people would have trouble squeezing their full name into it. I guess a really motivated soul could write on the back of the page, or attach a separate sheet of paper, but most people just ignore that question.
By Dr. Larry Greenbaum
Many of my patients see the hand of God in their lives, but wouldn’t necessarily describe themselves as religious. For example, an older man told me that he had decided to drink himself to death. He had gone through a difficult divorce, losing a new home and a lot of money to his ex-wife. In the most matter-of-fact fashion he described downing shot after shot of whiskey in his kitchen. He was raising his glass yet again when he heard a voice say "Don’t do that." Convinced that God had just spoken to him, he poured the remainder of the bottle down the kitchen sink, and he never drank again.
Another lady told me how important gardening was for her. She mentioned that her friend had suffered a stroke but still managed to work her garden, even though she had to lie down in the grass to do it. Living in Indiana has accustomed me to the enthusiasm of gardeners, but this seemed a bit "over the top." In the summer it feels as if practically everyone grows tomatoes. Everyone is trying to give away their supernumerary tomatoes because it is a shame to waste a good home-grown tomato. This woman wanted me to understand why her garden was so important to her, but she wasn’t going to come right out in my office and say it, unless I gave her an opening in the discussion.
I was browsing through her chart and I made an offhanded comment that my wife and I garden also. She told me that gardening was very important to her because she felt close to God in her garden. I don’t suppose that exchange solved any of her problems, but it was clear to her that I wouldn’t belittle her beliefs or her tomatoes.
Another one of my elderly patients became depressed. Her family told me that she stopped going to church on Sundays, and this was completely out of character for her. I started her on sertraline. At her follow-up visit I asked her if she had gone to church the previous Sunday, since this was the best way to determine if her depression was improving.
She had gone to church, and the medication was clearly helping her. But for many of my patients, antidepressants and religious faith are mutually exclusive. For these patients, explanations about chemical imbalances in the brain could never make them accept these medications. In this mind-set, a person with true faith couldn’t possibly need medication to get through life’s tough spots. One elderly lady told me indignantly that her son was a pastor, but he was on fluoxetine. She told me that she pitied his flock. She asked indignantly, what kind of pastor takes antidepressants?
Not all of these God and religion discussions are somber or sad. Another old lady told me that her husband had passed away. I put on my best sympathetic face, and I told her how sorry I was, but I need not have bothered. I had to stifle a chuckle as she told me that she wasn’t sorry at all. Her second husband, she explained, had used up all her savings, and just wanted someone to wait on him! Another patient told me that his father’s dying wish had been for a cigarette and a cheeseburger. After these simple wishes were fulfilled, he died peacefully. I had been after this patient to quit smoking for as long as I could remember. His wife had never smoked, but she developed emphysema from his secondhand smoke. I looked at my patient describing his dying father’s last smoke and last cheeseburger, and from the reverential and goofy look on his face, I could easily discern that he felt this was a good way to die. How could I ever hope to get him to quit smoking? It would be almost sacrilegious.