by Sunita Puri
Lord Ganesha, revered as the merciful destroyer of obstacles, glowed in this particular drawing, a gold crown atop his elephant’s head, his round body swathed in a pastiche of gold, red, and green cloth. In his four hands, he held both weapons and flowers. One broken and one unbroken tusk flanked his trunk. He sat majestically in the center of a pink lotus. He appeared to be both loving and menacing, peaceful but ready to defend himself if needed. My mother grabbed a roll of hospital tape, the same tape she used to secure a breathing tube in place, and fastened Lord Ganesha directly over my father’s heart, kissing the picture before the nurse wheeled my father behind a set of double doors that, this time, my mother couldn’t enter.
* * *
My parents believe in both science and God, and never understood why that might seem strange to people. They were raised in the Hindu and the Sikh faiths, though they would teach my brother and me that all religions are simply different pathways to the same place, that every faith is built around similar lessons: live kindly and compassionately, with regard for the well-being of others. My mother introduced me to human biology and physiology, but she and my father also taught me that the body, imperfect and impermanent, is the home of the soul. And the soul, the eternal spirit within each body, is immortal, indestructible, immune to the cycles of birth and death that our mortal bodies experience. We are not these bodies, my parents would tell my brother and me. We are the souls within. Part of our journey on earth is to learn that birth and death may be the beginning and end of the body, but not of us. And a spiritual practice can help us to remember the truth of who we are, and to recognize the unified quest of all beings: seeking to understand themselves and their own innate divinity. Doctors could treat disease, my mother told me, but only God could shape the soul’s journey. This was why some patients survived when nobody expected they would and others died when their survival was assumed. Prayer, my mother told me, was more powerful than medicine, and a necessary part of any treatment plan.
My mother usually met her patients for the first time in the preoperative area, a collection of beds separated by thin curtains, similar to where my father had been prior to undergoing his catheterization. She talked to them about their medical histories, reviewed their lab results, examined them, and answered any questions they had. They wouldn’t speak to her again until after their surgeries were complete and they had recovered from the nausea-tinged haze that followed anesthesia. But in the brief period between meeting patients and taking them to surgery, many would share their fears with my mother, worries that ranged from dying during surgery to finally knowing and confronting a diagnosis that surgery might unmask.
Do you pray? my mother routinely asked her patients.
Of course, many would tell her.
Would you like to pray together before your surgery? she would ask, and many of her patients would brighten, nod, and begin to speak to God. Her patients were any combination of terrified, overwhelmed, hopeful, hopeless, desperate, confident, nervous, grateful. My mother pressed her palms together, bowed her head, and listened as they prayed to Jesus, Allah, Ganesha, Guru Nanak, Zoroaster, and the Universe. She observed that everyone, no matter what their religion, prayed for similar things: God’s mercy, survival, minimal suffering. And no matter what name they used to call out to God, she told me, what they really longed for was love and protection. God, she would tell me, is not a deity in the sky, looking down upon and judging us. God is pure love.
As my mother wheeled each person into the operating room, she asked for God’s blessing. Please help me to keep my patient well through surgery and anesthesia. Her surgical colleagues, who eventually learned of her practice, turned to her in moments of frustration during surgery, asking, “Rita, where’s your God when we need Him? Call Him right now!” I don’t think my mother understood their sarcasm, because she’d answer as though their questions were genuine: “Don’t worry, He’s been here the whole time.”
As my mother told me her stories, I rolled my eyes at what I called her “obsession” with God, yet secretly admired her for believing in both science and spirituality, for considering that both systems of belief were equally true, even complementary. There had been moments in my life when I’d felt the intense presence of divinity: observing flowers turn toward the sun in our backyard, watching migrations of whales across a stretch of the Pacific, even noticing the healing of a bruise or a paper cut. I knew that each phenomenon had a scientific explanation, but they also seemed to share a certain mystery that struck me as divine.
But I hadn’t experienced divinity the way my parents had. I had been born into comforts distilled from their sacrifices, which in turn were made possible, in their eyes, by God. Their faith gave them a way to understand both joy and hardship as part of God’s plan, and a way for them to grow. God is how they found hope and peace, especially in circumstances as overwhelming as health crises. I wanted desperately to believe the way they did, rather than forcing myself to sit through the hours-long prayers we held in our home on Sundays and Thursdays. I recited every mantra I was taught, sang devotional songs at the top of my lungs, and participated in every community service project our spiritual community organized. And yet, going through the motions of certain rituals and reading translations of holy texts didn’t liberate me from my skepticism. I sat with my mother as she recited mantras 108 times. I followed my father around the house every evening as he touched each picture of God on our walls before going to bed at night. Imitating my parents didn’t give me instant access to the devotion they’d cultivated over a lifetime. I’d hang out after prayers with other girls my age whose parents belonged to the same spiritual community. We’d scoff at our parents’ insistence that we attend prayers; after services ended, we’d sit together and talk about the movies we’d seen and the boys at school we thought were cute.
My parents knew that I didn’t share their strong faith. I sensed that this broke their hearts. “Nobody can teach you to have faith,” my father told me one day when we argued about why God didn’t eradicate poverty, war, and famine if He really existed. Wasn’t that God’s purpose? “God’s purpose is not to erase human suffering, but instead to teach you how to overcome whatever life might bring. If you turn to Him, you can learn much about acceptance and surrender and real joy.”
* * *
About midway through my fellowship year, I met a physician who taught me how to talk to patients about God. A five-foot-tall Vietnamese woman, Dr. Christina Nguyen probably barely tipped the scales at ninety-five pounds even after having three children. She was tiny but mighty, exacting but deeply compassionate in her conversations with patients. She carried around folded camping chairs from REI during rounds so that she could always sit down to talk with patients without having to scramble for chairs from the nurses’ station. She kept packets of soft tissues in her pockets during family meetings, offering them immediately after the first appearance of tears. She wore a perpetual expression of peace and tranquility that put even the most squirrelly patients and skeptical physicians at ease with her role. I tried to emulate her expression by twisting my mouth into a gentle half smile, teeth slightly visible. Perhaps by adopting her expression and mannerisms, I thought, I could also channel her presence with patients. But I couldn’t sustain it no matter how many times I tried. Dr. Nguyen’s spirit—loving, empathic, and completely present—was inimitable. In trying to emulate her, I missed the more essential point she demonstrated: she was completely herself with her patients, not at all preoccupied with the performance of a specific, stereotypical physician authority. As I watched Dr. Nguyen speak with patients, I felt certain parts of myself—frozen in the long hibernation of residency—thaw and reemerge, like blades of grass through melting snow.
I felt my mother’s presence, too, when Dr. Nguyen spoke. On rounds, I’d shake my head in disbelief when one of our young patients died of the flu, or a seemingly healthy marathon runner was diagnosed with pancreatic cancer. Dr. Ng
uyen urged me to look at these situations with a wider lens. “We have plans as doctors,” Dr. Nguyen told me as she peeled tangerines from her yard over lunch, “but maybe God has another plan. Could we possibly be open to that? To the idea that we can’t control everything?”
If God had a plan for the thirty-one-year-old whom I’ll call Jack, I didn’t understand it. Jack’s parents, both devout Catholics who held constant vigil at Jack’s bedside, reminded me of Rajiv’s parents. Their lives, like those of Bajwa Ji and his wife, took on a new shape, both smashed and scathed by the explosive tragedy of Jack’s illness. Six years earlier, Jack had suffered a massive bleed from his esophagus for reasons his doctors would never understand. He lost so much blood that his heart, deprived of essential oxygen, stopped. Even though his heart began to beat again after fifteen minutes of CPR, his delicate brain never fully recovered. He had remained on a ventilator ever since then, living in a facility specifically for patients on ventilators. He could open his eyes, but could not speak. A feeding tube in his belly provided him with nutrition, the ventilator assumed the work of his lungs, and a Foley catheter in his penis collected his urine. Nurses turned him from side to side several times a day to prevent bedsores, and changed his diapers.
Over the past six years, Jack had shown no signs of neurologic recovery. He was unable to breathe, eat, urinate, or move independently; his survival depended on tubes and machines that predisposed him to recurring infections. His urinary catheter led to bladder infections. Being connected to the ventilator for so long caused several serious bouts of pneumonia. The skin around his feeding tube became blistered and red from recurrent skin infections. The more infections he had, the less effective the antibiotics became. There was now only one antibiotic left that could treat the bacteria causing Jack’s latest pneumonia. The medical team worried that it was only a matter of time before Jack developed a devastating infection that no antibiotic could treat. And, according to the resident taking care of Jack, his parents seemed totally unprepared for that scenario.
“We could use your help talking to the parents, because I don’t think they get how sick their son is,” the resident told me when he called me to discuss this consult. “They keep talking about how a miracle is going to happen and he’s going to get better, but soon he’s going to get an infection we can’t treat. He’s resistant to almost every antibiotic known to man since he’s been treated with basically each one over the past few years.”
“Have you told his parents what you’re worried about?” I asked as I clicked open Jack’s electronic chart to read through the team’s notes.
“Yeah, I’ve told them he will probably die from his next infection, and his dad talks about how God will pull him through,” the resident replied, frustrated. “And the conversation just stops there.”
I noticed quotes from his parents, Mary and Steven, in several of the medical team’s notes. Patient’s parents say they are hoping for a miracle recovery. Patient’s father refused to discuss goals of care, said no need for discussion because patient is doing better. Patient’s mother says that God will save patient, declines visit from chaplain.
And the conversation stopped there. I could understand why. Even though several studies found that patients wanted their physicians to ask about their faith and how it influenced their health, other studies suggested that physicians felt entirely unequipped to do so. Though my mother had openly engaged her patients in discussions of faith, I felt sheepish doing so. In retrospect, there had been times when my awkward silence had probably stung patients who had been trying to communicate a specific type of pain to me.
These patients weren’t necessarily terminally ill. There was the young woman who suffered a terrible infection after getting an abortion. This must be God’s punishment, she told me when I met her in the women’s clinic after she left the hospital. There was the accomplished painter with a rare autoimmune disorder who could no longer grasp or lift a paintbrush. Painting is everything to me, he told me. I don’t know why God would do this to me. I asked an elderly patient how he was coping with his new cancer diagnosis. Maybe this is God’s punishment for my years of boozing.
Do I deserve to suffer from this cancer? What is the purpose of my life in my diseased body? Am I suffering because God is testing my faith? I hadn’t considered that these spiritual and existential questions probably caused my patients just as much—if not more—anguish than the surgeries, the cancers, the endless invasive procedures and incremental loss of dignity. What was my duty to my patients in those tender moments? If I was to respond to these questions, where would I begin? And what if I said the wrong thing? These moments of reckoning deserved more than my hasty offer to call a chaplain, which all three patients declined anyway. “Forget I said anything,” my elderly patient said. “It’s not that big a deal.”
Patients in the throes of serious illness clung to the hope that medicine could offer them, but many simultaneously reached for God. Some had never prayed before they’d gotten sick. Others stopped praying when they did. Still others continued the prayers they had always said every day, no matter what their life circumstances. Over the last few months, I’d noticed rosaries, crosses, prayer beads made of sandalwood, and figurines of Buddha on the same tables where patients ate their lunches and kept medications they hadn’t yet taken. Some slept with a copy of the Bible under their pillows. Others played gospel music or Gregorian chants or Tibetan Buddhist chants off their phones or computers, drowning out the hospital’s daily noise with the audibly sacred. I wondered how Jack’s parents expressed their faith, how they reached out for something infinite and invisible.
Jack was just two years younger than me at the time, though he appeared strangely childlike, with innocent but expressionless brown eyes, a smooth face free of wrinkles, and shoulder-length black hair accentuated by a solitary braid woven together by his nurse. His mother, Mary, a short, plump woman with dark hair and deeply etched worry lines on her forehead, bent over him, dabbing his feverish forehead with a cool towel and pulling apart clumps of hair dampened by sweat. “We try to make this room like a home,” she told me. Her son’s head rested on the pillow from his childhood bedroom, Mary told me, and I marveled at the hand-stitched red-and-blue plaid cover with his initials and birthday stitched in green on one side. Instead of hospital blankets, he had a matching plaid blanket that Mary sprayed with a citrus-scented air freshener to remind him of his favorite fruit. “One day he will have an orange again,” she told me, nodding and smiling weakly.
I don’t think they get it. I turned over the resident’s words in my mind, knowing that I had used this phrase hundreds of times during my own residency, not pausing to think about how unrealistic I must have sounded. Perhaps no conversation, no matter how precisely clear and exquisitely compassionate, would “help them to get” that their child was slowly dying—initially from tragic complications of a medical procedure, and now from medicine’s limited ability to outsmart bacterial resistance. There is no freeway between the mind and the heart; a statement of medical facts didn’t lead easily to acceptance. Acceptance is a small, quiet room, Cheryl Strayed wrote in an essay that I read and reread somewhere around the start of fellowship. I knew that neither I nor anyone else—no matter how skilled a physician—could walk them to this room. It was a place they had to find on their own, though I could support them along the way.
On my drive home that evening I talked with my mother about Jack, looking mostly for her to listen rather than give me advice. My mother remained skeptical that palliative care was a field I could handle emotionally; she was right that I was sensitive, given to feeling too deeply and crying too easily, so I chose my words carefully, talking mostly about the horrible pain I’d see patients endure, and how I’d use many of the medications she used in anesthesia to ease their suffering. Today, I vented about the injustice of young patients dying early. A slew of my recent patients had all been my age or younger; talking with par
ents about their child’s mortality day in and day out weighed on me, though I mentioned that fleetingly to my mother. But she wasn’t good at listening without offering advice or solutions. As I spoke about Jack, she cut in.
“I would tell his parents to pray if they believe in God,” my mother told me. “There is nothing God cannot heal. We doctors can only do so much but He can make anything possible.”
My mother encouraging a patient to pray before an operation was very different from encouraging the parents of a young man to pray for a miraculous recovery from six years of life with a devastating brain injury.
“Yes, but how can I tell them that?” I said. “Don’t you ever feel like that’s not a doctor’s place to say? And why are we talking about this anyway? It’s not why I called you.”
“Why shouldn’t I say that? Why shouldn’t you?” she replied, her voice slightly muffled by the screeching of a pressure cooker in the background. I imagined her in the kitchen in her blue hospital scrubs, recently home from work, mincing garlic and ginger while watching the lentils she had placed in the pressure cooker. Just as she had done most days when I was growing up, even right after a twenty-four-hour-long overnight shift. “If you believe it and they believe it, then I think it is good to comfort them in this way.”