Biomedical Ethics Doctor Will You Pray for Me

Transcript

• 00:25Good evening.
• 00:27Good evening.
• 00:28We'll go ahead and get
• 00:29started. My name is Mark
• 00:30Mercurio. I'm co director of
• 00:32the program for biomedical ethics.
• 00:34And on behalf of the
• 00:35rest of my leadership team,
• 00:36many of which are right
• 00:37up here, and I think
• 00:38many of you have been
• 00:38in touch with Karen Kolb,
• 00:40our manager. On behalf of
• 00:41all of us, welcome.
• 00:42This is our final session
• 00:44of the evening seminar series,
• 00:46for the year,
• 00:47and so we're gonna end
• 00:48it.
• 00:49This is the this is
• 00:50the the denouement of the,
• 00:52of the seminar series, and
• 00:53I'm delighted that it's so
• 00:54well attended, and I'm delighted
• 00:56that my old friend, Bob
• 00:57Klicksman, has agreed to be
• 00:59our speaker.
• 01:00So before we get to
• 01:01some serious business, let's get
• 01:03to some CME business. If
• 01:05you were on the call
• 01:06or in the room and
• 01:07are trying to get CME
• 01:08credit,
• 01:09the phone number
• 01:11I'm gonna wait one second
• 01:12while you is two zero
• 01:13three four four two
• 01:16nine four three five,
• 01:19and the code is four
• 01:20six
• 01:21three three zero.
• 01:23I'm looking around. It's pretty
• 01:24much sure that nobody actually
• 01:26cares, but it's there. Because
• 01:27because oh, there we go.
• 01:28Someone entered it. Good job.
• 01:30Four six three three zero.
• 01:31We have a winner. Get
• 01:33your get yourself a free
• 01:34Panera sandwich.
• 01:36Good job.
• 01:37Good job.
• 01:40To remind you of how
• 01:40these sessions work is that,
• 01:43after a brief introduction, I'll
• 01:44invite our our our our
• 01:46visiting faculty member to come
• 01:47up. Bob will speak for
• 01:49forty five minutes, give or
• 01:50take a little bit. And
• 01:52after that, we're gonna have
• 01:53a conversation, a question answer,
• 01:54which I'll moderate, and we'll
• 01:55just sit up here. We'll
• 01:56have an informal conversation
• 01:58with each other and with
• 01:59you.
• 02:01I'll remind you, I'll ask
• 02:01you, don't say anything until
• 02:03somebody hands you a microphone,
• 02:04either Sarah or Karen or
• 02:06Isaac or someone will bring
• 02:06you a microphone or I
• 02:07will. Please don't speak until
• 02:09I indicate that you're next
• 02:11and then someone brings you
• 02:12the mic because we only
• 02:13speak one at a time.
• 02:14And for the sake of
• 02:15everyone to be able to
• 02:16hear, especially the folks who
• 02:17are in Zoom land, we
• 02:18need you to use the
• 02:19microphone. But we're gonna do
• 02:20that, after we hear from
• 02:22Bob first. So let me
• 02:23tell you wait. I just
• 02:25got a phone call. This
• 02:25is actually pretty embarrassing. This
• 02:27is my son, but I
• 02:27shouldn't take this now.
• 02:29That's good. I can't take
• 02:30a call. I'm working. Sorry
• 02:31about that, dude.
• 02:32Okay. Now I'm gonna turn
• 02:33that off. Sorry about that.
• 02:35Hopefully, he's not in real
• 02:37trouble.
• 02:39We're of the age now
• 02:39where usually it goes the
• 02:40other way where it's he's
• 02:41worried that I'm in some
• 02:42kind of trouble. You know?
• 02:43He he's fine. He wants
• 02:44to make sure I haven't
• 02:45tripped and fallen down the
• 02:46street or something.
• 02:49So,
• 02:52tonight's guest,
• 02:54is doctor Robert Klitzman,
• 02:57who is,
• 02:59very well known to many
• 03:00of you,
• 03:01in the field of bioethics.
• 03:02Bob works out of Columbia
• 03:03at the Vagelos,
• 03:04College of Physicians and Surgeons,
• 03:06my alma mater.
• 03:08And Bob is there, as
• 03:10a professor of psychiatry and
• 03:11also public health. But in
• 03:12addition,
• 03:14he runs their master's program
• 03:15in bioethics. They have an
• 03:16in person and an online
• 03:18program in in bioethics, a
• 03:20little something for well, it's
• 03:21online. So anybody here who
• 03:23feels like getting some advanced
• 03:24training in bioethics, I strongly
• 03:26recommend that. You can take
• 03:27a look at that online.
• 03:29In fact,
• 03:30you you don't have to
• 03:30look at it online because
• 03:32we have placed this isn't
• 03:33meant to be a commercial,
• 03:34but what the heck? We're
• 03:35here. We'll do this. Is
• 03:36it in the back and
• 03:37also over here, there's some
• 03:38things here about the master's
• 03:40in bioethics that you can
• 03:41get,
• 03:42and I and help yourself
• 03:44to that. Also, another CME
• 03:46note, medical students who are
• 03:47on the concentration, you know
• 03:48that there are a certain
• 03:49number of seminars you're required
• 03:51to attend, and the way
• 03:52we keep track of that
• 03:52is the sign up sheet
• 03:53up here. So if you
• 03:55haven't signed up, please, right
• 03:56after the talk, come on
• 03:57up and do and do
• 03:58sign up so that Karen
• 03:59and Nila can keep track
• 04:01of you.
• 04:02But I was talking about
• 04:03Bob who runs the bioethics
• 04:04program,
• 04:05at
• 04:06Columbia,
• 04:07the, the master's program. Now
• 04:09Bob is very well accomplished
• 04:11in our field. He's written
• 04:14over at the number that
• 04:15sticks in my head is
• 04:16a hundred ninety. I read
• 04:17this a while ago. A
• 04:18hundred and ninety articles and
• 04:19ten books.
• 04:21He is very, very highly
• 04:23respected in the field. His
• 04:24most recent book, As Fate
• 04:26Would Have It, is doctor,
• 04:27will you pray for me?
• 04:28Medicine chaplains and healing the
• 04:31whole person. I happen to
• 04:32have a copy right here,
• 04:34and you're thinking, great. I
• 04:36will take that copy. And
• 04:37I'm saying, no. You won't
• 04:38because this one's mine. Bob
• 04:39gave it to me. But
• 04:41if you want one, you
• 04:42can actually get one at
• 04:43a reduced price,
• 04:45and there are flyers to
• 04:46that effect, both on the
• 04:47back table and over here
• 04:48in the front table for
• 04:49afterwards. It's available to you.
• 04:52I heard from someone who
• 04:53said that, just who had
• 04:54just started the book and
• 04:55said it actually brought her
• 04:56to tears.
• 04:58And I'm was waiting for
• 04:59mine from Amazon, but when
• 05:00mine comes, I already know
• 05:01who I'm giving it to
• 05:02because then I got this
• 05:03one from Bob.
• 05:06He's an exceptionally accomplished individual.
• 05:09So Bob
• 05:10educated at Princeton and then
• 05:12here at Yale. He's been
• 05:13on the faculty for Columbia
• 05:14for many years. He has
• 05:16received awards from the Guggenheim
• 05:18Foundation, from the Rockefeller Foundation,
• 05:20from the Hastings Center. He's
• 05:22been on various government agencies,
• 05:24and advisory boards,
• 05:26and, as I said, a
• 05:28very accomplished author. And and
• 05:29and we have representatives
• 05:31here,
• 05:32from chaplaincy here at the
• 05:33hospital and elsewhere as well
• 05:34as so many of our
• 05:35usual folks and students. So
• 05:37So I'm delighted that we
• 05:38have a subject and a
• 05:39speaker that hopefully appeals to
• 05:40all of you. So that's
• 05:41enough of me talking,
• 05:43for the next forty five
• 05:44minutes or so. Let's just
• 05:45hear from Bob, and then
• 05:46let's start a conversation. So
• 05:48please join me in welcoming
• 05:49doctor Bob Klitzman.
• 05:52Thank you. Thank you so
• 05:53much.
• 05:56Well, thank you, Mark, for
• 05:58that very nice introduction also
• 05:59for the invitation to be
• 06:00here, and it's great to
• 06:02have a chance to see
• 06:03you all and see some
• 06:03friends in the audience as
• 06:05well.
• 06:06So I see this as
• 06:06an interactive session, so I'll
• 06:08talk, but please feel free
• 06:10to ask questions,
• 06:11at the end of the
• 06:12remarks, and, it'd be great
• 06:13to engage you with these
• 06:15topics. I think many of
• 06:16these topics are things that
• 06:17that many of you are
• 06:19aware of or care about
• 06:20as well.
• 06:21I think we lost the,
• 06:24screen here.
• 06:26Do I need to do
• 06:27something video? I was looking
• 06:29to see if any good
• 06:29sandwich would work.
• 06:31So you walk away. You
• 06:32have the magic touch. You
• 06:33walk away. Let's Okay. Alright.
• 06:35Great. Flashing back. So let's
• 06:35give it a try. Go
• 06:36forward and back one time
• 06:37and see if you're in
• 06:38business.
• 06:39Thank you. Thank you. Okay.
• 06:41So,
• 06:42I thought I'd first mention
• 06:43how I got interested in
• 06:44this topic, and it's a
• 06:45little bit of a sad
• 06:46story. So,
• 06:48unfortunately, my sister died on
• 06:50nine eleven. She worked at
• 06:52the World Trade Center, and
• 06:53she called her best friend
• 06:55at eight thirty in the
• 06:55morning. She worked at the
• 06:57second and top floor, and
• 06:58no one ever heard from
• 06:59her again.
• 07:00And it was a terrible
• 07:02period for many of us,
• 07:05and, but I was the
• 07:06only person I knew who
• 07:07had a family member, a
• 07:08loved one who had died.
• 07:10And,
• 07:11many of us all over
• 07:12the world were, of course,
• 07:13very upset. I had to,
• 07:15go to the FBI and
• 07:16report her as a missing
• 07:17person.
• 07:18We didn't have a body.
• 07:19We didn't know that she
• 07:20had in fact died. She
• 07:21just no one ever heard
• 07:22from her again.
• 07:23Those of you who may
• 07:24have been in New York
• 07:25at the time know that
• 07:26people put up,
• 07:29printouts of people's faces saying,
• 07:30you know, with the name
• 07:31as if the people were
• 07:32gonna be walking around and
• 07:33not know who they were.
• 07:35And,
• 07:38we had then had to
• 07:39decide, would we have a
• 07:39memorial service for her? We
• 07:41have a funeral. We had
• 07:41no body. We didn't know
• 07:42for sure she was dead,
• 07:43but we decided to do
• 07:45that. We had to empty
• 07:46out her apartment, and then
• 07:47my body just gave out.
• 07:49And for two weeks, I
• 07:50just lay in bed, and
• 07:51I couldn't move.
• 07:52And
• 07:53I thought I had the
• 07:54flu.
• 07:55And it it hurt to
• 07:56move. I didn't wanna watch
• 07:58TV. I didn't wanna read
• 07:59books or go to work.
• 08:00And friends said, well, this
• 08:01is grief. And they said,
• 08:03yes. I know I'm grieving,
• 08:03but I also have the
• 08:04flu. And they said, no.
• 08:05No. This is grief. These
• 08:06are all symptoms of grief.
• 08:08And and in I was
• 08:09trained as a psychiatrist. I
• 08:10went here for med school,
• 08:12had wonderful teachers. And we
• 08:14sort of looked down at
• 08:15people who somaticize,
• 08:16who have sort of physical
• 08:17symptoms. Many of you know
• 08:18as,
• 08:20seeing patients that, some friends
• 08:22of mine who work in,
• 08:25internal medicine as general practitioners
• 08:27say, you know, about half
• 08:28the patients they see have,
• 08:30you know, complain of aches
• 08:31and pains, and there's nothing
• 08:33really medically wrong with them.
• 08:34It's, quote, in their head.
• 08:36And I realized how I
• 08:37had trained as a psychiatrist,
• 08:38but didn't realize how much,
• 08:41grief,
• 08:42anxiety, depression, or despair, or
• 08:44in fact, bodily symptoms. And
• 08:46of course, those of us
• 08:48who know about neuroscience shouldn't
• 08:49be surprised that, of course,
• 08:50these are all encoded in
• 08:51the
• 08:53body and, through
• 08:55chemicals.
• 08:56But I was struck how
• 08:57little I knew. The same
• 08:58time, I,
• 09:00went to my temple, went
• 09:02to a Buddhist service. We
• 09:03rang bells. And then one
• 09:04day just sat in the
• 09:05park and just watching the
• 09:06grass and the wind
• 09:08made me feel, well, nature
• 09:09goes on somehow.
• 09:11But I also wondered why
• 09:12me.
• 09:13So after that, I got
• 09:14interested in how do other
• 09:16doctors,
• 09:17change when they become patients.
• 09:19So I got NIH funding
• 09:20and did a study of
• 09:22doctors who became patients. And
• 09:23I interviewed seventy five doctors
• 09:25around the country who became
• 09:26patients with serious illness.
• 09:29And one thing that came
• 09:30across again and again is
• 09:31when I asked these doctors,
• 09:33how did being a patient
• 09:34change you,
• 09:36in what you do with
• 09:36patients from beforehand?
• 09:38And a lot of them
• 09:39said the following, versions of
• 09:41the following. They said, well,
• 09:41you know, patients used to
• 09:43say to me, doc, would
• 09:44you pray for me?
• 09:46And I'd go, yeah. Yeah.
• 09:47Whatever. I'd poo poo it.
• 09:48And then I became a
• 09:49patient and didn't know if
• 09:50I'd survive.
• 09:52And suddenly, I became aware
• 09:53of how important existential issues,
• 09:55spiritual issues, religious issues were.
• 09:57I found myself wondering why
• 09:59me.
• 10:01Sometimes I
• 10:02went back to a religion
• 10:04I grew up with. Sometimes
• 10:05I didn't. Sometimes I was
• 10:06too much of a scientist,
• 10:08but I realized
• 10:09why was that going on.
• 10:11It was interesting to me
• 10:12that how much this came
• 10:13up.
• 10:14And,
• 10:15I then did a, a
• 10:17study. I had NIH funding
• 10:18and did a study of
• 10:19of issues around genetic testing
• 10:21and ended up writing a
• 10:22book called Am I My
• 10:23Genes?
• 10:24Confronting fate and family secrets
• 10:26in the age of genetic
• 10:28testing.
• 10:29And as part of that,
• 10:30I interviewed a lot of
• 10:30people who had or were
• 10:32at risk of Huntington's disease,
• 10:33which is a terrible neurological
• 10:35and psychiatric disease.
• 10:37Those of you who saw
• 10:38the recent movie about Bob
• 10:39Dylan saw
• 10:41that,
• 10:43Woody Guthrie had this disease,
• 10:44was in a psychiatric hospital.
• 10:46But a lot of patients
• 10:47said to me things like
• 10:48the following. They said, well,
• 10:50I know I have Huntington's
• 10:51disease because I have the
• 10:52gene, but why did God
• 10:54give me the gene and
• 10:55not give it to my
• 10:55sister?
• 10:56Or why did god give
• 10:57my sister the to the
• 10:59gene, the mutation, and not
• 11:00me?
• 11:02And so that stayed with
• 11:03me.
• 11:04And then I,
• 11:05did a
• 11:06I got NIH funding and
• 11:08did a a book about,
• 11:10assisted reproductive technology and infertility
• 11:13and wrote a book that
• 11:13came out a few years
• 11:14ago called Designing Babies,
• 11:16How Technology Has Changed the
• 11:17Ways We Create Children.
• 11:19And then so the I
• 11:20just I interviewed a lot
• 11:21of women who were infertile,
• 11:23and they too said to
• 11:24me, things like the following.
• 11:25They'd say, well, you know,
• 11:26my sister keeps telling me,
• 11:28well, I guess God just
• 11:29didn't mean for you to
• 11:30have a child,
• 11:31or, well, I wonder did
• 11:33God not mean for me
• 11:34to have a child. So,
• 11:35again, these issues of God
• 11:36and religion keep coming up,
• 11:37and so I thought this
• 11:39would be important to look
• 11:39at. So that's sort of
• 11:41background of what led me
• 11:42to this. Of course, there
• 11:43are social taboos against discussing
• 11:45religion. Many people say don't
• 11:47talk about religion and politics
• 11:49with your friends. There's no
• 11:50right answers.
• 11:52And science and medicine are
• 11:53also seen historically as often
• 11:55mutually antagonistic. So Galileo,
• 11:58was forced to,
• 12:01deny and reject his scientific
• 12:03theories because of the church,
• 12:04etcetera, etcetera.
• 12:06More recently, Freud said that
• 12:07religion is an illusion.
• 12:09Marx, Karl Marx, not Groucho,
• 12:12said that,
• 12:13religion is the opiate of
• 12:14the masses.
• 12:16And still today, of course,
• 12:18we live in an age
• 12:19of great political polarization as
• 12:20we all know, and a
• 12:22lot of that is related
• 12:23to religious polarization. So we
• 12:24have the largest group of
• 12:26supporters of president Trump are
• 12:28evangelical Christians.
• 12:30And,
• 12:31there have been recent, bestsellers,
• 12:34relating to religion. There have
• 12:35been books like heaven is
• 12:36for real,
• 12:37Proof of Heaven, where people
• 12:39say, you know, I I
• 12:40died. I went to heaven,
• 12:41and I met God, and
• 12:42he was a guy in
• 12:43a white beard, in a
• 12:44white cloak sitting on a
• 12:46white throne.
• 12:47On the other hand, you
• 12:48have books like The God
• 12:49Delusion by Richard Dawkins.
• 12:52Heaven is Not So Great
• 12:53was another such book. So
• 12:55I was interested in how
• 12:56do people, when they face
• 12:57death and dying today, where
• 12:59do they come down?
• 13:00This is part of why
• 13:01I got into this. And,
• 13:04this I mentioned.
• 13:08Right. So at the same
• 13:09time, also, we know that
• 13:10the religious landscape of America
• 13:12is changing. So increasingly,
• 13:14the number of people who
• 13:15say they are none of
• 13:16the above, when asked if
• 13:18they are,
• 13:19you know, Catholic, Protestant, Jewish,
• 13:21Muslim, they'll say none of
• 13:22the above,
• 13:23is rising. The number of
• 13:24people who say that they
• 13:25are nothing in particular or
• 13:27spiritual but not religious is
• 13:28going up,
• 13:30etcetera.
• 13:32We know that these doctors
• 13:33these topics make doctors uncomfortable.
• 13:36So attention to religious and
• 13:37spiritual issues is increasing slightly
• 13:39in medical school, but still
• 13:41not sufficiently.
• 13:42Forty eight percent of doctors
• 13:44in surveys say they're uncomfortable
• 13:46with religious or spiritual issues.
• 13:48Forty four percent say that
• 13:50they don't raise the issue
• 13:51because they're afraid that patients
• 13:52will be uncomfortable.
• 13:53Yet those,
• 13:55data when looked at, in
• 13:56terms of associations, it turns
• 13:58out the biggest predictor of
• 13:59doctors not raising the issue
• 14:01was, in fact, doctors' own
• 14:02discomfort with it, which relates
• 14:04partly to their lack of
• 14:05training.
• 14:06However, seventy percent of dying
• 14:08patients want their doctors to
• 14:10ask about their religious beliefs.
• 14:12Interestingly, surveys show that only
• 14:14half of those who want
• 14:15it get it, but those
• 14:16who get it, regardless of
• 14:18whether they want it or
• 14:19not, that is having doctors
• 14:20or someone talk about their
• 14:21spiritual beliefs, are much more
• 14:23satisfied with their care.
• 14:25Seventy two percent of cancer
• 14:26patients say the medical system
• 14:28supported their spiritual needs minimally
• 14:30or not at all. Nurses
• 14:32tend to be more aware
• 14:33of these issues than doctors,
• 14:34perhaps unsurprisingly.
• 14:36And chaplains play important roles,
• 14:38but often see limited numbers.
• 14:40So in one study, only
• 14:41four percent of ICU patients
• 14:42saw a chaplain or their
• 14:44family saw a chaplain.
• 14:46There are questions of spirituality
• 14:48affect health. There have been
• 14:50a few study a few
• 14:51people have claimed that there
• 14:52is, quote, intercessory prayer, which
• 14:54is that if if I'm
• 14:55praying for you, even if
• 14:56you don't know it, you
• 14:57will get better.
• 14:58There's no clear evidence to
• 15:00support that.
• 15:01But there is data showing
• 15:02that spirituality
• 15:03can help with coping, provide
• 15:05a sense of hope. Religion,
• 15:07we also know, buffers against
• 15:08depression. There are studies that
• 15:10show that attendance at religious
• 15:11services lowers depression and suicidality.
• 15:15It can help keep help
• 15:17with, coping, and social support,
• 15:19and some of this may
• 15:19be placebo effect, but that
• 15:21is a real thing. We
• 15:22know that positive thinking can
• 15:24aid wellness.
• 15:25We know that anxiety and
• 15:26depression could also biologically
• 15:28impair the immune system and
• 15:30immune responses.
• 15:31And
• 15:32twelve step programs, which are
• 15:34far more effective than anything
• 15:35we as psychiatrists have to
• 15:36offer for addiction, very much
• 15:38value people
• 15:39choosing a higher power. And
• 15:41so, again, spirituality can play
• 15:43an important role there. But
• 15:45I was interested in how
• 15:46are patients of varied backgrounds
• 15:48and conditions confronting these issues,
• 15:49as I mentioned?
• 15:51What issues do they face?
• 15:52And as I got interested
• 15:53in this, I began to
• 15:54realize how much chaplains play
• 15:56crucial roles,
• 15:57but are often underappreciated.
• 15:59So I was wondered wondered
• 16:00how are chaplains addressing these
• 16:01issues and what the implications
• 16:03are for educating doctors, nurses,
• 16:05chaplains,
• 16:07patients, families,
• 16:08future
• 16:09institutional, and other policy and
• 16:11future research.
• 16:12So I,
• 16:14conducted studies of chaplains. And
• 16:16then, over the years, I've
• 16:17studied a number of other,
• 16:19disorders with NIH funding.
• 16:21Remember the
• 16:24NIH?
• 16:26Used to be an organization.
• 16:27Never mind.
• 16:30I won't get ahead of
• 16:31myself.
• 16:32But I'd I'd done studies
• 16:33looking at, patients with HIV,
• 16:36substance use, genetics, assisted reproductive
• 16:38technologies, etcetera.
• 16:40So,
• 16:41I for chaplains, I first
• 16:43had preliminary discussions with fifteen
• 16:44chaplains and then did formal
• 16:46interviews with twenty three board
• 16:47certified chaplains around the country,
• 16:50recruited through the Association of
• 16:51Professional Chaplains and word-of-mouth. I
• 16:53did one or two in-depth
• 16:54interviews with each one for
• 16:56about an hour each. I
• 16:57had them content coded.
• 16:59Apologize for the small size
• 17:00of this, but, just for
• 17:01the, of the twenty three
• 17:03chaplains, fifty six percent were
• 17:04male, forty three percent female,
• 17:06seventy eight percent Caucasian. They
• 17:08were around sixty three years
• 17:09old was the medium. Fifty
• 17:11two percent from the northeast,
• 17:12but forty eight percent from
• 17:14elsewhere around,
• 17:16mostly Protestant, but not all.
• 17:17I included Muslim, Buddhist,
• 17:19and,
• 17:20humanist chaplains.
• 17:22The modal degree was a
• 17:23master's, and they practiced around
• 17:25eighteen years.
• 17:27So
• 17:28I'm gonna talk somewhat about
• 17:30the the relevant data from,
• 17:32the interviews I did with
• 17:33doctors as well as with
• 17:34chaplain. So as I should
• 17:35just mention that,
• 17:36from the book of Job
• 17:38in the Bible, you remember
• 17:39may remember,
• 17:41people asking why me.
• 17:43And what I found is
• 17:43that with patients even,
• 17:45and chaplains told me this
• 17:47as well. A lot of,
• 17:48patients ask why me. They
• 17:50say, I know I shouldn't
• 17:51wonder why me. I know
• 17:52there's no answer, but I
• 17:53still wonder.
• 17:54And I think it's almost
• 17:55evolutionarily
• 17:56adaptive that we wonder why
• 17:57me, that we think is
• 17:58there something we can fix
• 17:59when we have a problem.
• 18:01Of course, often there isn't.
• 18:03Many doctors are unsure what
• 18:05to do. They say they
• 18:06would refer patients to Chaplains
• 18:07where they should, but they
• 18:08don't.
• 18:10And,
• 18:11doctors who I interviewed as
• 18:12as part of this also,
• 18:14some more informally,
• 18:16told me very pointed stories.
• 18:17So one doctor said to
• 18:18me that he was,
• 18:20one of the most disturbing
• 18:21things in his career as
• 18:22a surgeon
• 18:23was that he was willing
• 18:24a young boy into the
• 18:25operating room and thought that
• 18:27the kid probably wouldn't survive.
• 18:29And the last minute, the
• 18:30family who were Catholic said,
• 18:32doctor, would you pray with
• 18:33us?
• 18:34And they were Catholic, and
• 18:35they were standing there in
• 18:36a circle. And he said,
• 18:37no.
• 18:38He said, because, you know,
• 18:39I'm Jewish, and they're Catholic,
• 18:41and so I walked away.
• 18:42And that bothered me. And
• 18:44but I I'm still not
• 18:45sure. You know? What could
• 18:46I have said to them?
• 18:47And I said, well, you
• 18:47could have said, you know,
• 18:48well, I'm happy to stand
• 18:49here with you. I'm happy
• 18:50to be supportive, something like
• 18:51that. But it struck me
• 18:52that that he didn't know
• 18:54that.
• 18:56Then doctors tell me stories
• 18:57like the following. Doctor will
• 18:58ask, how are you doing?
• 19:00Patient says, I just hope
• 19:01that God will get me
• 19:02through this. The doctor says,
• 19:04well, did you make your
• 19:05follow-up appointment?
• 19:07You know, did you take
• 19:08your medicine this week?
• 19:10On the other hand, other
• 19:10doctors I interviewed, were much
• 19:13more able to respond in
• 19:14an authentic way. So,
• 19:16this is a a doctor
• 19:18who's a pediatrician
• 19:19who says he's atheist, but
• 19:22very warm compassionate person
• 19:24as most pediatricians I know
• 19:25are.
• 19:27I was going to pediatrics
• 19:29when I was here. Yeah.
• 19:30Actually.
• 19:31So pediatric doctor says, how
• 19:33are you doing? The pediatric
• 19:34patient says, I'm just hoping
• 19:35I'll be good enough for
• 19:36when I meet god.
• 19:38And the doctor said, well,
• 19:39I could have ignored it,
• 19:39but I said, I'm sure
• 19:40you will be.
• 19:42So, again, some doctors are
• 19:43able to respond to this
• 19:44more than others.
• 19:47A Muslim doctor I interviewed,
• 19:49said that he he said,
• 19:50I'm very upset. I'm very
• 19:52concerned because,
• 19:53patients ask me, doc, am
• 19:55I gonna die? And I
• 19:56say, well, it's all in
• 19:57god's hands. Because in my
• 19:59belief, that's what I believe,
• 20:00that it's all the will
• 20:01of Allah. But my patients
• 20:02get upset, and I don't
• 20:03understand why.
• 20:05And I said, well, I,
• 20:06you know, I have to
• 20:07say what's consistent with my
• 20:08faith.
• 20:09And I said, well, you
• 20:10know, you could say instead,
• 20:11you know, we're doing everything
• 20:12we can,
• 20:13but in the end, it's
• 20:14up to God or whatever.
• 20:16But I think if you
• 20:17say, well,
• 20:18you know, is you know,
• 20:19how am I doing well?
• 20:20It's all in God's hands.
• 20:21Patients may hear that as
• 20:22meaning, well, there's nothing you're
• 20:24doing or you can't be
• 20:25helping me,
• 20:26etcetera. So I think there's
• 20:27a lot of miscommunication
• 20:29across beliefs, and people mean
• 20:31different things when we talk
• 20:32about
• 20:33God, prayer, etcetera.
• 20:36So just as background, about
• 20:37two thirds of hospitals have
• 20:38chaplains. One third of hospitals
• 20:40have no chaplains.
• 20:42Among hospitals with chaplains, many
• 20:44rely just on volunteer local
• 20:46clergy. So we'll have a
• 20:47priest, a rabbi coming from
• 20:48the community,
• 20:49who are generally not trained
• 20:51in more than their own
• 20:52faith,
• 20:53and they're not specifically trained
• 20:54to assist patients in hospitals.
• 20:56They may not know anything
• 20:57about medical terminology, what a
• 20:59stage four cancer means versus
• 21:01stage two cancer, etcetera.
• 21:03Chaplains, I found in the
• 21:04interviews, though, play really important
• 21:06roles. And, they're increasingly nondenominational,
• 21:09but they often get rejected,
• 21:11and there's a lot of
• 21:11misunderstanding of what chaplains do.
• 21:14I remember when I was
• 21:15an intern,
• 21:16I had a Catholic patient,
• 21:17and I thought she was
• 21:19dying. I can tell Catholicism
• 21:20was important to her.
• 21:22So it was, like, my
• 21:23second day of internship. I
• 21:24said to the resident, well,
• 21:25should we call a chaplain?
• 21:27And I didn't know because
• 21:28I was afraid she would
• 21:29think, oh, you know, he'll
• 21:30give last rights or something,
• 21:32and think that we're dying.
• 21:33And the my resident said,
• 21:34well, you know, what do
• 21:35you care? You know, how
• 21:36is that important for what
• 21:37you're doing? You're we're here
• 21:38to sort of take care
• 21:39medically of the patient.
• 21:41But that gave me a
• 21:43sense of how there's really
• 21:44a distance.
• 21:45One chaplain I interviewed said,
• 21:47every day when I go
• 21:47to work, I have to
• 21:49decide which ditch do I
• 21:50wanna die in, because we're
• 21:52really treated as second class
• 21:53citizens in the hospital.
• 21:55So they often work in
• 21:56a very different world. Doctor
• 21:58will enter the room, the
• 21:59chaplain leaves. Or the doctor
• 22:00leaves a room, the chaplain
• 22:01enters. They're not included on
• 22:02rounds. I should say this
• 22:04varies a bit by specialty.
• 22:05So certainly in
• 22:07hospice and in palliative care,
• 22:09chaplains are more included often
• 22:11in oncology, but in many
• 22:12other areas, they're not.
• 22:16In terms of prayers or
• 22:17good wishes, one of the
• 22:18first chaplains I interviewed was
• 22:19a nun,
• 22:20and she,
• 22:21was sort of in her
• 22:23late eighties. And I said,
• 22:24well, what do you do?
• 22:25That's what I asked chaplain.
• 22:26What is it that you
• 22:26do? And she said, well,
• 22:28she said, I just knocked
• 22:29on a patient's curtain.
• 22:31And I said, I'm sister
• 22:32so and so. I'm with
• 22:33the chaplaincy department.
• 22:35And the patient said, the
• 22:36guy in bed said, we
• 22:38don't need your sister. We're
• 22:39okay.
• 22:40But, his wife said, no.
• 22:42Why don't you come in?
• 22:43And she went in. She
• 22:43said, well, she said, I
• 22:44can either give you prayers
• 22:46or good wishes.
• 22:47And he said, well, we
• 22:48don't want prayers. We'll take
• 22:49good wishes.
• 22:50And she turned to me
• 22:51and said, I basically say
• 22:53the same thing either way.
• 22:57I said, you know, may
• 22:58the forces of the universe
• 22:59help Joe here. May the
• 23:01forces of the universe give
• 23:02the doctors knowledge as they
• 23:04help Joe to know how
• 23:05best to help him. May
• 23:06this the beginning of a
• 23:07new life for Joe.
• 23:09And afterwards, Joe sort of
• 23:10grabbed her hand and said,
• 23:11thank you, sister. Thank you
• 23:12so much.
• 23:14But that made me realize
• 23:15how, if even the word
• 23:17prayers, right, or good wishes
• 23:19has different meanings to different
• 23:20people,
• 23:21and we need to be
• 23:22careful about the language we
• 23:23use. Some again, because these
• 23:25are sensitive issues.
• 23:27Chaplains also learn on the
• 23:28job. They go through extensive
• 23:29training, and I should say
• 23:30that profession is becoming more
• 23:32board certified becoming more professionalized,
• 23:34more board certified,
• 23:37and they go through a
• 23:38lot of training board certified
• 23:39chaplains who but they also
• 23:40learn on the job. So
• 23:41I was interested in finding
• 23:42out what is it that
• 23:43they learned they didn't know
• 23:44earlier,
• 23:44and can these lessons be
• 23:46transmitted.
• 23:47So chaplains possess relatively unique
• 23:49characteristics. And I should say,
• 23:51given how fractured many of
• 23:53the medical systems we work
• 23:54in are, chaplains are filling
• 23:55in a lot of the
• 23:57space, a lot of the
• 23:58room.
• 23:59So at least in many
• 24:00hospitals in New York,
• 24:02the if you were just
• 24:04diagnosed with terrible cancer, the
• 24:05only person to really say,
• 24:06well, you know, how you
• 24:07doing? What's it like for
• 24:08you? Is the chaplain.
• 24:10Often doctors are too busy,
• 24:11nurses are too busy, etcetera.
• 24:13So they engage in active
• 24:15listening. There's a ministry of
• 24:16presence where they're sort of
• 24:17just being there with the
• 24:18patient, sort of bearing witness,
• 24:20communicating in open ended patient
• 24:22centric ways.
• 24:24And I should say that,
• 24:26chaplains sort of occupy a
• 24:28so called liminal space between
• 24:29sort of medical staff on
• 24:31the one hand and patients
• 24:32and doctors on the other
• 24:33or and doctors on the
• 24:34other where they sort of
• 24:35can communicate with each other
• 24:36because they're neither one nor
• 24:38the other.
• 24:39And they have time. In
• 24:40other words, this chaplain can
• 24:41spend two hours with a
• 24:43family who's just lost someone,
• 24:44whereas doctors have, you know,
• 24:46an average of eleven minutes
• 24:47per patient.
• 24:48So they demonstrate interest, respect,
• 24:50support, empathy. They help patients
• 24:53and families reframe
• 24:54quandaries. They gain respect, I
• 24:56think, as as spiritual religious
• 24:58figures.
• 24:59They have more time, less
• 25:00medicalized and rigid agendas. They
• 25:02hope in understanding patients and
• 25:04families' perspectives, values, and goals,
• 25:06and I'll give some examples.
• 25:08They can convey medical providers'
• 25:09points of view to families
• 25:10and patients and vice versa,
• 25:13provide fresh eyes, address conflicts,
• 25:15but they vary also in
• 25:16how they exercise these roles.
• 25:18So,
• 25:21in terms of reframing issues,
• 25:23for instance, one
• 25:24the chaplain told me a
• 25:25story of, he went to
• 25:27see a patient who was
• 25:28this old grizzly guy who
• 25:29just had a few months
• 25:30left to live and had
• 25:30been a in his own,
• 25:33words, I've been a mean
• 25:34son of a bitch my
• 25:34whole life. I haven't been
• 25:35in touch with my adult
• 25:37kids in years. You know,
• 25:38I'm divorced.
• 25:39You know, what's why am
• 25:40I still here? What's the
• 25:41point? You know, what am
• 25:42I doing? I've done nothing
• 25:43with my life. You know,
• 25:44why am I here? And
• 25:45the chaplain said, I didn't
• 25:46know what to say, but
• 25:46I I picked up a
• 25:47piece of bread on his
• 25:48meal tray,
• 25:50on the plastic tray. And
• 25:51I said, you know, let's
• 25:51talk about bread for a
• 25:52minute.
• 25:53You know, bread's an amazing
• 25:54thing. You know, it tastes
• 25:55good, nutritious. It comes from
• 25:57the earth. Jesus said, you
• 25:59know, I'm the bread of
• 26:00the earth. You know, maybe
• 26:01the point of life isn't
• 26:02to sort of do great
• 26:03things, but just appreciate the
• 26:05moment.
• 26:06You know, appreciate the things
• 26:07we do have in the
• 26:08moment. And the patient was
• 26:09like, wow. And the patient
• 26:10then sort of perked up
• 26:11and and felt much better
• 26:12with sort of the remaining
• 26:14time he had.
• 26:16Evangelicals
• 26:17often wonder, is God punishing
• 26:18me? So one chaplain said
• 26:20that, I as as I
• 26:22said, I spoke to chaplains
• 26:23all over the country. One
• 26:24chaplain said, you know, she
• 26:25said, you know, I live
• 26:27in the bible belt. I
• 26:28live in the belt of
• 26:30the bible belt. And, she
• 26:32said she had a patient
• 26:33recently who had had a
• 26:34daughter who was born with
• 26:35Down syndrome who then developed
• 26:37cancer.
• 26:38And the mother said, you
• 26:39know, I I she said,
• 26:40I feel terrible because I'm
• 26:41I'm wondering, you know, is
• 26:42god punishing me by giving
• 26:44my daughter cancer? Because when
• 26:46she was born, I prayed
• 26:47that she would die because
• 26:49she had Down syndrome.
• 26:51And that is weighing on
• 26:52me. And the, the chaplain
• 26:54is able to sort of
• 26:55talk to her about that.
• 26:58So a lot of people
• 26:59wonder is god punishment, is
• 27:01this punishment in some way?
• 27:04One chap another chaplain told
• 27:05me of a patient who
• 27:06was suicidally depressed saying, you
• 27:08know and and one of
• 27:09the issues was that,
• 27:10his mother had,
• 27:13committed suicide,
• 27:14and, he felt that it
• 27:16was because of him. And,
• 27:18his the chaplain was able
• 27:19to sort of call the
• 27:20the sisters and say that
• 27:22no mom was always depressed.
• 27:23She had prior suicide attempts,
• 27:24and he didn't know that.
• 27:26So, again, I think chaplains
• 27:28can sort of find out
• 27:29and interact with patients in
• 27:30important ways.
• 27:33Patients also
• 27:34vary widely in their beliefs.
• 27:36One chaplain said there's a
• 27:37thousand kinds of atheism.
• 27:39One patient I interviewed said,
• 27:41you know, I'm not at
• 27:42all religious. I'm against religion.
• 27:43I'm against spirituality, but I
• 27:45believe in the first law
• 27:46of thermodynamics,
• 27:48that energy is neither created
• 27:50nor destroyed in the universe.
• 27:51It just goes on,
• 27:53which to me is a
• 27:54very sort of spiritual notion.
• 27:55So, again, even though he
• 27:56said I'm not religious, I'm
• 27:58not spiritual,
• 27:59Right? He has sort of
• 28:01belief system, if you will.
• 28:02And I think being aware
• 28:03of that is important.
• 28:06So mediation,
• 28:07is something also I was
• 28:08struck,
• 28:09how much chaplains engage. And
• 28:11then there's a literature, as
• 28:12as Mark knows, about mediation
• 28:14being used in bioethics.
• 28:16And mediation, there's also a
• 28:17large literature on mediation. There
• 28:18was a book a number
• 28:19of years ago called Getting
• 28:20to Yes that was sort
• 28:21of a bestseller.
• 28:23So mediation
• 28:24are skills in addressing conflicts
• 28:26that could be conflicts among
• 28:28patients, families, and providers,
• 28:30involve several approaches and skills
• 28:31in which chaplains also engage,
• 28:33creating an atmosphere of trust,
• 28:35acting as an impartial neutral
• 28:37third party.
• 28:38The only study I found
• 28:40on chaplains and mediation
• 28:41was one from Poland that
• 28:43showed that,
• 28:44in Poland, thirty percent of
• 28:46chaplains had received requests to
• 28:47mediate between doctors and patients,
• 28:50twenty five percent among family
• 28:51members, sixteen percent among medical
• 28:53staff, most, so not all,
• 28:54accepted the role.
• 28:56But there's a number of
• 28:57ways in which this kept
• 28:58coming up in the interviews
• 28:59I did. And I should
• 29:00say, I asked chaplains, you
• 29:01know, what have been the
• 29:02most challenging cases that you
• 29:03faced?
• 29:04What are the most difficult
• 29:05cases? What are the cases
• 29:06that you've learned the most
• 29:08from? What are the cases
• 29:09in which you feel you
• 29:10were able to help patients
• 29:11the most?
• 29:12So this is a chaplain
• 29:13saying, quote, an Orthodox Jewish
• 29:15family had a loved one
• 29:16die in the early morning
• 29:18on Shabbat.
• 29:19The Jewish burial society ordinarily
• 29:21comes to get the patient's
• 29:22remains directly from the room,
• 29:24but we're not gonna come
• 29:25on Shabbat.
• 29:26The hospital can't, however, let
• 29:28the body sit in the
• 29:29room for sixteen hours.
• 29:31Yet the family couldn't get
• 29:32in touch with anyone from
• 29:33their community to say it
• 29:34was okay to let the
• 29:36body go to the morgue
• 29:37in the interim. So they
• 29:38literally barricaded themselves in the
• 29:40room. Hospital security came and
• 29:42was gonna have to remove
• 29:43them by force.
• 29:45So the chaplain ended up
• 29:46serving as a key negotiator
• 29:47and said, you know, the
• 29:48way I tried to build
• 29:49a caring relationship with them
• 29:50earlier worked, that I was
• 29:52able to say, you know,
• 29:52they'd met me earlier, and
• 29:53I was also deescalate the
• 29:55situation.
• 29:57This is another example. So
• 29:59a young sedated, intubated patient's
• 30:01family appeared to resist having
• 30:02DNR conversations,
• 30:04causing tensions and frustrating the
• 30:06medical team. A chaplain finally
• 30:08called the patient's daughter,
• 30:10and
• 30:11the the the the, the
• 30:12doctor and the the family
• 30:14were loggerheads.
• 30:15And the chaplain said the
• 30:16daughter was really receptive and
• 30:18said, yes. I don't think
• 30:19she's gonna live much longer.
• 30:20I asked, what's the hardest
• 30:22part for you? She said,
• 30:23I don't want her to
• 30:24die next week on my
• 30:25birthday.
• 30:26She always gets sick on
• 30:27my birthday.
• 30:28What do you think your
• 30:29mom would want?
• 30:30She made me promise not
• 30:31to put her in a
• 30:32nursing home. How do you
• 30:33think she'd feel about being
• 30:34in a hospital for a
• 30:35while? She wouldn't like that
• 30:36either. I just don't want
• 30:37her to suffer.
• 30:38So the chaplain called the
• 30:39doctor and said the family's
• 30:40fine. Just wait a week.
• 30:41And he was like, what
• 30:42did you say to them?
• 30:43How did you get the
• 30:44daughter to back down? Because
• 30:45we've been fighting with her
• 30:46for, you know, two weeks.
• 30:48So, again, like, the chaplain
• 30:49having a more moderate approach
• 30:51and not being part of
• 30:52the medical team per se
• 30:54or, you know, being a
• 30:56a patient.
• 30:58Also finding common ground. So
• 30:59this is when the family
• 31:00of a brain dead ICU
• 31:01patient wanted to continue aggressive
• 31:03treatment causing conflict with providers.
• 31:06And so there was, again,
• 31:07at loggerheads. And a chaplain,
• 31:09in the family meeting said,
• 31:11she told me this quote,
• 31:12I hear how much you
• 31:13love your mom, but also
• 31:14that the staff here also
• 31:16cares very much from your
• 31:17for your mom. So everyone
• 31:19is trying to do the
• 31:19same thing.
• 31:21Suddenly, though, when love was
• 31:22introduced, the whole mood in
• 31:23the room shifted. It became,
• 31:25okay. We've got some common
• 31:26ground here. We're not on
• 31:27opposite sides of the fence.
• 31:29That was very helpful. Families
• 31:30say, okay, as long as
• 31:31the staff knows that we
• 31:33just need more time.
• 31:34So, So, again, I think
• 31:35chaplains have the ability to
• 31:36intervene in ways that that
• 31:38many of us don't.
• 31:40Addressing
• 31:42spiritual concerns. So,
• 31:44this was a,
• 31:45there was a a young
• 31:47adolescent male, and,
• 31:49the the, he was brain
• 31:50dead. So they were going
• 31:51to,
• 31:53donate his organs. And the
• 31:54doc, the surgeon said, okay.
• 31:56What we're gonna do is
• 31:56have you say goodbye here
• 31:58in the room. We'll then
• 31:59wheel your son into the
• 32:01operating room. We'll unplug him
• 32:02there. He'll die there, and
• 32:03we'll harvest his organs there.
• 32:05Horrible work. And the family
• 32:07said, well, we wanna be
• 32:08there when our son dies.
• 32:09And the surgeon said, you
• 32:10can't be there when your
• 32:11son dies because in the
• 32:12operating room, you need to
• 32:13be sterile.
• 32:14And it needs to happen
• 32:15very quickly. You'll get emotional
• 32:17because, you know, the organs
• 32:18need to be fresh. And
• 32:19the family said, well, then
• 32:20we don't wanna donate the
• 32:21organs.
• 32:22So, again, loggerhead. So the
• 32:24chaplain said, well, let me
• 32:25talk to everyone. So the
• 32:26chaplain arranged that the family
• 32:27would go in, and they
• 32:28gown up in sterile garb.
• 32:30They'd go in for just
• 32:31three minutes. They you know,
• 32:32the son would die, then
• 32:33they'd leave.
• 32:35So they got they all
• 32:36got into the operating room,
• 32:37and the chaplain said, I
• 32:38didn't know what to do.
• 32:39But I I said to
• 32:39the mother, did your son
• 32:41have a favorite song?
• 32:43And she said, yes. Amazing
• 32:44Grace.
• 32:45So they sang Amazing Grace.
• 32:47All the doctors joined in.
• 32:49All the nurses joined in.
• 32:50Everyone started to cry.
• 32:52Then at three minutes, they
• 32:53left. And as they left,
• 32:54the mother said to the
• 32:56chaplain, took her hand and
• 32:57said, thank you so much.
• 32:59We got to sing my
• 33:00son into heaven.
• 33:02And I think those are
• 33:03kinds of moments that chaplains
• 33:04can do that many of
• 33:06us as physicians cannot do
• 33:08or won't do or don't
• 33:09have time to do it
• 33:10or aren't sensitive to do,
• 33:11etcetera.
• 33:13Also, overcoming staff biases and
• 33:15labeling of patients. So this
• 33:16is another chaplain told me,
• 33:18quote, a young pregnant African
• 33:19American woman came in multiple
• 33:21times for pain management, but
• 33:23was not being evaluated
• 33:24and getting the care she
• 33:25needed. She was being framed
• 33:27as a drug dealer. I
• 33:28connected
• 33:29with her. Luckily, I had
• 33:30a very good connection with
• 33:31the maternal fetal specialist. We'd
• 33:33worked together on the ethics
• 33:34committee, so I called him
• 33:35and he came in. We
• 33:36found out she had a
• 33:36kinked bowel, which can come
• 33:38and go, but gets stuck.
• 33:39The patient ended up having
• 33:40a profound infection in her
• 33:41gut because it had leaked.
• 33:43The chaplain's role is very
• 33:44powerful. We can see people
• 33:45beyond labels.
• 33:46So the chaplain had seen
• 33:48the patient before and said
• 33:49something was different. The doctor
• 33:50said, oh, she just wants
• 33:51she's just here for pain
• 33:52meds,
• 33:53etcetera.
• 33:56Another story here. A Caucasian
• 33:57man was in a car
• 33:58accident and had no identification
• 34:00with him and was covered
• 34:01with tattoos.
• 34:02The staff treated him as
• 34:03though he was drugged out
• 34:05and had OD'd. They didn't
• 34:06even really wanna touch him
• 34:07because he could have anything
• 34:08because of his tattoos.
• 34:10I said, my son has
• 34:11tattoos all over him and
• 34:12has a PhD. I think
• 34:14I know about people who
• 34:15have tattoos.
• 34:16Sometimes tattoos tell a lot
• 34:17about a person. Maybe his
• 34:18name's on the body.
• 34:20We found his name. He
• 34:21happened to be the chair
• 34:22of a department at a
• 34:23nearby state university.
• 34:24So this prejudice, there are
• 34:26biases. And, again, I think
• 34:27because chaplains don't have a
• 34:28medicalized agenda, they're able to
• 34:30see people in a more
• 34:32holistic way in a way
• 34:33that I think many of
• 34:33us also as physicians can
• 34:35learn from
• 34:36and as nurses.
• 34:38So here's another case. A
• 34:39Muslim patient a Muslim woman
• 34:41wanted everything done for her
• 34:42husband, and the staff was
• 34:43frustrated, and they wrote in
• 34:44the chart she's being unrealistic.
• 34:47And the, the the chaplain
• 34:49called in a Muslim chaplain
• 34:50who spoke with her, and
• 34:51it turns out she felt
• 34:52that her husband wouldn't go
• 34:54to heaven unless she'd done
• 34:55everything for him, and he
• 34:57had sort of, attested to
• 34:59his belief in God. But
• 35:01the chaplain, the Muslim chapter
• 35:03was able to tell her,
• 35:04look. God, wouldn't want your
• 35:06husband to suffer.
• 35:08And so that's also important.
• 35:09So she agreed,
• 35:10to make her husband DNR.
• 35:13But, again, the medical staff
• 35:15saw her and wrote in
• 35:15the chart, you know, unrealistic.
• 35:16She's in denial, etcetera, etcetera.
• 35:19Yeah, chaplains vary in how
• 35:21often they perform these roles,
• 35:22how comfortable they are.
• 35:24They may take on these
• 35:25roles informally and implicitly without
• 35:27thinking about them, de facto
• 35:28rather than explicitly.
• 35:30They don't always plan to
• 35:31take on these roles in
• 35:32advance,
• 35:33not asked to do so,
• 35:34but end up doing so.
• 35:35And, again, I think this
• 35:36speaks to needs. I think
• 35:37chaplains do a great job,
• 35:38but I think as with
• 35:39many of us, I think
• 35:40they can gain more, skills
• 35:41and training in some of
• 35:42these areas.
• 35:43They face rejections, though, which
• 35:45could be very upsetting,
• 35:47various kinds of rejections.
• 35:48One chaplain I interviewed said,
• 35:50when I asked a few
• 35:51chaplains, when I said, what
• 35:52are the most challenging issues
• 35:53that they faced,
• 35:55they said getting rejected.
• 35:57And also when I asked
• 35:58what are the cases in
• 35:59which you've learned the most,
• 36:00many have said getting rejected.
• 36:01So one chaplain said, for
• 36:02instance, I knocked on a
• 36:04patient's door. I said, I'm
• 36:06from the chaplaincy department. And
• 36:07she put up the sign
• 36:08of the cross and said,
• 36:09get out. You're anathemy.
• 36:11My religion, she said, is
• 36:13CNN.
• 36:14I believe in facts, and
• 36:15I believe in politics.
• 36:17And he was like, woah.
• 36:18Okay. And he left.
• 36:19But he said that she
• 36:20was sort of a lonely
• 36:21old woman who was dying,
• 36:22basically, that no one visited.
• 36:24So he went back the
• 36:25next day and knocked on
• 36:26the door
• 36:27and said, remember me?
• 36:29And she went, yeah.
• 36:31And, he said, well, I
• 36:33know your religion is CNN,
• 36:34but but what do you
• 36:35think what's going on politically
• 36:36now?
• 36:37And they ended up having
• 36:38a conversation, and over the
• 36:39next few weeks, they'd talk
• 36:40quite a bit, and then
• 36:41she died. But she was
• 36:41he was the only one
• 36:42who visited her in the
• 36:43hospital, basically,
• 36:44and really played an important
• 36:45role.
• 36:47So, again, I think rejection,
• 36:50a lot of chaplains use
• 36:51as an opportunity to learn
• 36:52and and or able to
• 36:53over address that.
• 36:56They face challenges in how
• 36:57to end meetings, how long
• 36:58to stay.
• 37:00One chaplain site when I
• 37:01asked, you know, what have
• 37:02you learned as a chaplain
• 37:03over the years? She said,
• 37:04you know, well, when I
• 37:04was a trainee,
• 37:07I was shadowing an older
• 37:08chaplain, and we went into
• 37:09a patient's room, and the
• 37:10patient had just died. And
• 37:12the family was there grieving.
• 37:13And I thought, well, we'll
• 37:14just leave.
• 37:16And the older chaplain,
• 37:18sat down on the floor
• 37:19and motioned for me to
• 37:19sit down. I thought, well,
• 37:20what are we doing here?
• 37:21What are we gonna say?
• 37:22And they were grieving, and
• 37:24there was silence. They were
• 37:25crying. And then at a
• 37:25certain point, they opened up
• 37:27to the chaplain, who ended
• 37:27up being very helpful.
• 37:29And so,
• 37:31there was that in terms
• 37:32of how long to stay,
• 37:33but also ending meetings. So
• 37:35chaplains could spend a long
• 37:36time. They can spend two,
• 37:37three hours. They can spend
• 37:39two minutes. They have to
• 37:39decide,
• 37:41you know, how much time.
• 37:42And,
• 37:43patients will ask chaplains, you
• 37:45know, can I stay in
• 37:46touch with you after I
• 37:47leave the hospital? Can you
• 37:48visit me in the hospice?
• 37:50Can we call? Can we
• 37:51Zoom?
• 37:52Can,
• 37:54can we text each other?
• 37:56Can we be, you know,
• 37:56Facebook friends? And, again, I
• 37:58think, in psychiatry, boundaries are
• 38:00very important, and chaplains, I
• 38:01think, often end up struggling
• 38:03with this. Some of in
• 38:04their training had less training
• 38:06on where to draw boundaries,
• 38:07and it could become quite
• 38:08complicated because you're,
• 38:11quote, dealing with someone's soul,
• 38:12so to speak. Right? It's
• 38:13either very intimate relationships often.
• 38:15You don't wanna be cruel
• 38:16and say no. But I
• 38:17think being able to say,
• 38:18you know, look. There are
• 38:19people on the outside who
• 38:20can help you, etcetera.
• 38:22And, again, a lot of
• 38:23communication, verbal, nonverbal,
• 38:26choreography.
• 38:28I sort of mentioned this.
• 38:29A lot of chaplains get
• 38:30asked to,
• 38:31preside at funerals, memorial services,
• 38:33etcetera.
• 38:35LGBTQ
• 38:37patients, also raised,
• 38:39a set of issues that
• 38:40chaplains varied in their comfort
• 38:42with.
• 38:43So, one chaplain said that
• 38:45she got a call in
• 38:45the middle of a night
• 38:46to, a patient was asking
• 38:48for a bible.
• 38:49So she went and bought
• 38:50the bible and,
• 38:52turned out the patient was,
• 38:54transitioning,
• 38:55and, was transgender and but
• 38:57came from an evangelical family
• 38:59and said and this is
• 39:00around midnight. She said, the
• 39:02patient asked me, if god
• 39:03is so perfect, why did
• 39:05he put me in the
• 39:05wrong body?
• 39:07And I didn't know what
• 39:08to say.
• 39:09And a lot of LGBTQ
• 39:11patients have been rejected by
• 39:12churches. There's a lot of
• 39:13homophobia in churches, so they
• 39:14feel they can't go to
• 39:15their church, but they still
• 39:16have spiritual needs and sort
• 39:17of figuring out how to
• 39:19navigate that. They may be
• 39:20especially wary of chaplains,
• 39:22high rates of anxiety, depression,
• 39:24suicidality, etcetera, and that,
• 39:26some chaplains feel more comfortable
• 39:28than others with those issues.
• 39:31Hospitals vary widely. Some are
• 39:33religiously affiliated.
• 39:35As I mentioned, may depend
• 39:36on volunteer clergy who not
• 39:38only may not be trained,
• 39:39but as chaplains, but maybe
• 39:41evangelical and may be there
• 39:42to sort of convert the
• 39:43patient before they die,
• 39:45which can be a problem.
• 39:50Chaplains also do a lot,
• 39:52to help with staff distress.
• 39:54And I did a number
• 39:55of these interviews during COVID,
• 39:56and I was struck by
• 39:57the number of rituals that
• 39:58chaplains developed on their own.
• 40:00So one chaplain said that
• 40:01during COVID, she said, I
• 40:02developed chocolate rounds.
• 40:04They're grand rounds, so I
• 40:05did chocolate rounds. I went
• 40:06around with a box of
• 40:07chocolate and said to the
• 40:08staff, I'm doing chocolate rounds.
• 40:10Would you like a chocolate?
• 40:11And staff would invariably say,
• 40:13sure. I'd love a chocolate.
• 40:14And so, the chaplain would
• 40:16say, you know, and how
• 40:17are things going? And the
• 40:18pay the staff would say,
• 40:19well, you know, we just
• 40:20had three deaths this morning.
• 40:21We think there's gonna be
• 40:22three more deaths this afternoon.
• 40:23It's really hard, etcetera, etcetera.
• 40:26Another chaplain said that during
• 40:27the COVID pandemic,
• 40:29she created a wreath in
• 40:30the nursing station, and she
• 40:32said she put out pieces
• 40:33of paper and said everyone
• 40:34can write the name of
• 40:35someone who died of COVID,
• 40:36either a family member, friend,
• 40:38or patient, put it on
• 40:39the wreath. And the wreath
• 40:40soon filled up.
• 40:42And afterwards, she was gonna
• 40:44take this down and throw
• 40:44it out, and the staff
• 40:45said, no. You have to
• 40:46leave this here because this
• 40:47is really a sort of
• 40:48memorial for what we've been
• 40:49through.
• 40:50So, again, I think chaplains
• 40:51sort of can create rituals.
• 40:53Some have just,
• 40:54conversation groups, what matters at
• 40:56the end of the soul,
• 40:57at the end of the
• 40:57life, at the end of
• 40:58the day, refreshment for the
• 41:00soul.
• 41:00They get different support. So
• 41:02one chaplain said, for instance,
• 41:04that, she thought the nurses
• 41:06are really in moral distress
• 41:07and want to have a
• 41:09sort of tea and coffee
• 41:10break with cookies in the
• 41:11the nursing station to talk
• 41:13about it.
• 41:14So she asked the head
• 41:15nurse who said, absolutely not.
• 41:16The nurses need to be
• 41:17here on the floor.
• 41:19But the chaplains persisted. So,
• 41:20well, you know, let me
• 41:21just can we just try
• 41:22it once and, you know,
• 41:22why don't you come?
• 41:24So they did it, and
• 41:25all the nurses burst out
• 41:26into tears.
• 41:27And the nursing supervisor said,
• 41:28please keep doing this. I
• 41:30see this as important. I
• 41:30didn't realize it. So, again,
• 41:32administrators even may not appreciate
• 41:34staff distress that may be
• 41:36there. And I think chaplains,
• 41:37again, in our fractured systems
• 41:39can play important roles.
• 41:41Terms of context, there's a
• 41:42lot of institutional geographic differences.
• 41:45At first, I thought, well,
• 41:47hospitals that are religiously affiliated
• 41:49will value chaplains more, but
• 41:51it varied. On many cases,
• 41:52chaplain said, we know the
• 41:53head of the hospital, not
• 41:54particularly religious, but really believes
• 41:56in holistic care and sees
• 41:58this as important and so
• 41:59gives chaplaincy a lot of
• 42:00support.
• 42:02Chaplaincy, I should say, a
• 42:03major problem is that insurance,
• 42:05Medicare and Medicaid cover chaplaincy
• 42:07in the VA system,
• 42:09and say that for hospice
• 42:11care and palliative care, chaplains
• 42:13should be part of the
• 42:14package that patients get, but
• 42:16there's no specific reimbursement. Otherwise,
• 42:18chaplains don't get reimbursed. And
• 42:20so hospitals really cover chaplaincy
• 42:22out of its own pocket
• 42:23and especially when there are
• 42:24cutbacks or financial distress in
• 42:26hospitals,
• 42:27chaplains, you're often the first
• 42:28to go,
• 42:29which I think is unfortunate.
• 42:32Except, they face challenges. So
• 42:34part of the reason for
• 42:35the lack of reimbursement is,
• 42:38insurers have said, well, prove
• 42:39to us quantitatively that chaplaincy
• 42:41works,
• 42:42that it helps.
• 42:44There have been a few
• 42:45studies that have tried to
• 42:46show that if you see
• 42:46a chaplain in the hospital,
• 42:49that when you then get
• 42:50a satisfaction
• 42:51scale one to five in
• 42:52the email two weeks later,
• 42:53how satisfied are you with
• 42:55our service?
• 42:56One study showed, well, it
• 42:57it went up.
• 42:58Other studies show that that
• 42:59was not the case. And
• 43:00the reason is because chaplains
• 43:02are more likely to see
• 43:03patients who are dying.
• 43:04And so when the family
• 43:05gets the stay, the patient
• 43:07the email doesn't work when
• 43:08the the hospital sends a
• 43:10five point satisfaction scale or
• 43:12the family when asked one
• 43:13to five, how is your
• 43:14stay? They're not gonna say
• 43:16five, it was great.
• 43:18Recommended for everyone. You know,
• 43:19my father just died. I'm
• 43:20not gonna you know, they're
• 43:21they may have mixed feelings
• 43:23about it. So,
• 43:24but I think that stories
• 43:26and narratives
• 43:27of the experiences that chaplains
• 43:29have and the the power
• 43:31of what they're able to
• 43:31do, I think, says a
• 43:32lot. And it's partly why
• 43:33I wrote this book is
• 43:34to try to convey that
• 43:36that I think chaplains can
• 43:37do a lot to help
• 43:38patients even if it's not
• 43:39directly quantifiable.
• 43:43So, this is a picture
• 43:44of Epidaurus. So a few
• 43:45years ago, I went to
• 43:46Epidaurus is the largest intact
• 43:48theater in the ancient world.
• 43:50It seats ten thousand people.
• 43:51It's in the Peloponnese. It's
• 43:52a UNESCO World Heritage Site.
• 43:55Famously, if you drop a
• 43:56pin
• 43:57on the stage, all ten
• 43:58thousand people can hear it
• 43:59perfectly.
• 44:00But what I didn't realize
• 44:01is that Epidaurus
• 44:02was in a hospital.
• 44:04It was at a center
• 44:05of Ascopeus,
• 44:06a center of Hippocrates,
• 44:08and it was surrounded by
• 44:09a wall.
• 44:10And in the compound, there
• 44:11were three structures. There was
• 44:12a theater,
• 44:13a hospital, and a temple.
• 44:16And I thought what a
• 44:16wonderful idea that if you're
• 44:17gonna build a hospital, you
• 44:18should also build a theater
• 44:19and a temple with it.
• 44:21And I think historically what
• 44:22happened is that,
• 44:24in the nineteenth century,
• 44:26with Koch's postulates and discovery
• 44:28of germ
• 44:29causing disease,
• 44:30American medicine said, well, we're
• 44:32gonna be scientific,
• 44:33and all this other stuff
• 44:34is quackery.
• 44:36And we'll just be biomedical,
• 44:37and all this stuff is
• 44:38we're gonna poo poo it
• 44:39a bit. But that's not,
• 44:40as I found, the way
• 44:42patients experience their illness. And
• 44:44when patients are in the
• 44:45hospital, they're not saying, well,
• 44:46I'm just focused on my
• 44:47blood values today and my,
• 44:48you know, sodium potassium levels.
• 44:50To them, it's a whole
• 44:51experience of what is my
• 44:52life, what is the purpose
• 44:53and meaning of my life.
• 44:55And I think that's something
• 44:55chaplains speak to.
• 44:57So inclusion, I think, especially
• 44:59given our fractured health care
• 45:00system, chaplains can act as
• 45:02mediators, go betweens, create important
• 45:04spaces and forums,
• 45:06progressing a lot of issues.
• 45:07A lot of this lies
• 45:08outside the traditionally described roles
• 45:10of chaplains. Chaplains, I think,
• 45:12traditionally, a number of years
• 45:13ago, were thought just to
• 45:14pray with patients.
• 45:15But I think in our
• 45:17fractured hospitals, as I've said,
• 45:19I think there are these
• 45:20other needs that they can
• 45:21importantly fill.
• 45:22And these suggestions could be
• 45:23easily misinterpreted. So I wrote
• 45:25a piece for The New
• 45:26York Times a few years
• 45:27ago outlining some of this,
• 45:28just saying that, you know,
• 45:29doctors should be more aware
• 45:30that for some patients, at
• 45:32least,
• 45:32spirituality is important.
• 45:34And it got the the
• 45:35piece in the Times got
• 45:36four hundred and eighty eight
• 45:37comments online.
• 45:39And some of the comments
• 45:40were, quote, doctors should not
• 45:42force their religion down patients'
• 45:43throats.
• 45:45I didn't say patients' doctors
• 45:46should force their religion on
• 45:47patients' throats, and some of
• 45:48the other comments came to
• 45:49my defense saying, no. That's
• 45:50not what Klitzman was saying.
• 45:52But I think these are
• 45:53sensitive issues.
• 45:55And some people say, well,
• 45:56doctors should provide spiritual care.
• 45:58I'm not sure about that.
• 45:59But I think it's getting
• 46:00to to know their patients.
• 46:01Doctors could say to patients,
• 46:03you know, spiritual issues are
• 46:04important for some people, some
• 46:06people not. What's that like
• 46:07for you?
• 46:09See what this patient says
• 46:10and then could say, you
• 46:11know, if you want, we
• 46:12have spiritual care providers who
• 46:13can help to talk about
• 46:14these issues with you. I
• 46:16should say the term chaplain
• 46:17itself is a Christian term.
• 46:19It comes from Saint Gregory
• 46:20of Tours who,
• 46:22had a cloak, a chapeau
• 46:23of,
• 46:25or actually it was Saint
• 46:27Martin's,
• 46:27in Tours, his cape.
• 46:29And the cape was then
• 46:30kept in a little place,
• 46:32and the person who cared
• 46:33for it was the chaplain.
• 46:35But I think that,
• 46:38particularly people from other faiths,
• 46:39I think,
• 46:40might, be wary of chaplains
• 46:42because
• 46:43of that. So I think
• 46:44a a more general term
• 46:45is better. I think chaplains
• 46:46should be more aware of
• 46:47these issues. Many are, not
• 46:48all. Chaplaincy education varies. Some
• 46:50is great, some not so
• 46:52great or can be improved.
• 46:54I think medical education could
• 46:55be better. I think there's
• 46:56need for sort of more
• 46:57assessments and narratives looking, trying
• 46:59to figure out what chaplains
• 47:00do.
• 47:01I think
• 47:02this is just beginning of
• 47:03research. I think there's need
• 47:04for more research on chaplains.
• 47:06This is really the first
• 47:07book that I was struck
• 47:08how little was has been
• 47:09published about the experience of
• 47:11chaplains. There have been quantitative
• 47:13studies. You know, what percent
• 47:14of time do you pray
• 47:15with a patient? What percent
• 47:16of time do you address
• 47:17end of life issues? But
• 47:18not what is the content
• 47:19of what's going on, and
• 47:20what does that mean?
• 47:23I think a lot of
• 47:24chaplains, I think, are trained
• 47:25to be humble, which is
• 47:26a virtue, but I think,
• 47:28as a profession often, I
• 47:29think one needs to be
• 47:31advocate for oneself, which sometimes
• 47:33does not come naturally to
• 47:34many chaplains, but could be
• 47:36helpful both in institutions and
• 47:37beyond. And, I had the
• 47:39fortune of meeting with some
• 47:40of the chaplains here earlier
• 47:41today, and we talked about
• 47:42some of these issues. I
• 47:43think medical education could also
• 47:45address these issues more. Cultural
• 47:47competency, cultural humility is taught
• 47:49in medical schools increasingly, but
• 47:51tends to focus on,
• 47:54race and ethnicity, which is
• 47:55important, of course, but I
• 47:56think it doesn't include as
• 47:57much about religion. I think
• 47:59even having a a lecture
• 48:00in comparative religion, many of
• 48:02us know, very little about
• 48:04other faiths.
• 48:05You know, what is it
• 48:06that Muslims or Buddhists or
• 48:07whatever you are,
• 48:09you know, other people feel.
• 48:11I think using vignettes can
• 48:13help,
• 48:14encouraging doctors to refer to
• 48:15chaplains more. At the same
• 48:17time, I think given the
• 48:18political and religious divide we're
• 48:20facing as a country, as
• 48:21I mentioned earlier,
• 48:23you know, there's a lot
• 48:24we don't know. I got
• 48:25in a discussion with Richard
• 48:26Dawkins, who's a fierce saying,
• 48:27you know, absolutely god does
• 48:28not exist. It's all delusion.
• 48:29I said, you know, the
• 48:31absence of evidence is not
• 48:32evidence of absence. You know,
• 48:33we don't know.
• 48:35Sam Harris is another
• 48:37popular writer, has written bestsellers,
• 48:40God is not so great.
• 48:41He says, we just need
• 48:42meditation. We don't need religion
• 48:44or spirituality. Just meditation.
• 48:46Meditation is important, but I
• 48:47think people also have a
• 48:48sense of the content
• 48:50of, you know, what's gonna
• 48:51happen to me.
• 48:53You know, is there a
• 48:54beyond,
• 48:55why me? I think we
• 48:56also need to be aware
• 48:57of that.
• 48:58And, I think, insights from
• 49:00patients, and I I was
• 49:01really struck by despite all
• 49:02the differences whether people are
• 49:04atheist, agnostic, evangelical, really are
• 49:06cross cutting issues of people
• 49:07looking for meaning and hope
• 49:09and purpose and connection to
• 49:11something beyond themselves. And I
• 49:12think chaplains really
• 49:14evoke that and speak to
• 49:15that in powerful ways.
• 49:17That's the book. These are
• 49:18the other books, and I'd
• 49:19be happy to answer any
• 49:20questions. And, again, thank you
• 49:21so much for the invite
• 49:22to speak with you.
• 49:31Thank you, Bob. Do you
• 49:32wanna have a seat? Do
• 49:32you wanna sit here? What
• 49:33are you performing? Sit. Should
• 49:34we sit? Alright. Yeah. I'll
• 49:35sit with you. Okay. Fair
• 49:36enough. I need some water
• 49:37first.
• 49:39Lots to to talk about,
• 49:41Sean. We have
• 49:43we have some medical students
• 49:44here.
• 49:45We have some medical students
• 49:47here.
• 49:48And one of the concerns
• 49:49that I've had, and I'm
• 49:50wondering what your experience at
• 49:52Columbia is, and certainly it's
• 49:53gotten a lot of attention,
• 49:55nationally in recent times,
• 49:58is that and I just
• 49:59from conversations I've had with
• 50:00some individual medical students,
• 50:02I think sometimes
• 50:04it's my impression, and if
• 50:05any students agree or disagree,
• 50:07you know, please feel free
• 50:08to say so, that perhaps
• 50:11some students of faith,
• 50:13perhaps,
• 50:15feel a little bit outnumbered.
• 50:17And it might be different.
• 50:18It's at, Southern Methodist
• 50:20than it is,
• 50:22at Yale or or Columbia.
• 50:24I'm not sure.
• 50:26But I wonder what your
• 50:28sense is with that in
• 50:28modern education. It's something I
• 50:30I think
• 50:31we need to one reason
• 50:32why I'm so happy you're
• 50:33here is is that
• 50:34without accepting or rejecting anyone's
• 50:37faith, it's something we need
• 50:38to be sensitive to that
• 50:39that not everybody feels the
• 50:41same way about such things.
• 50:43Is it your sense that
• 50:44in medical schools in general
• 50:46that the students of faith,
• 50:49can sometimes feel outnumbered?
• 50:51Yes. So I spoke to
• 50:53one doctor. Who's that? You
• 50:54got you got I have
• 50:55a little thing. People can
• 50:56hear me? Yeah. You're good.
• 50:58So,
• 50:59one doctor I interviewed said
• 51:00that she was from the
• 51:01South,
• 51:03and went,
• 51:04for training in the North.
• 51:05And in the South,
• 51:07and I was quite struck
• 51:08the way with the roles
• 51:09that religion plays in hospitals
• 51:11in the South. So in
• 51:12the South, a number of
• 51:13chaplains said,
• 51:14people everyone knows what church
• 51:16you go to. It's common
• 51:16common. You know? Where do
• 51:17you live? What church do
• 51:18you go to? You know?
• 51:19And doctors and nurses and
• 51:21patients and families will see
• 51:22each other in the church,
• 51:25and it's a much bigger
• 51:26part of life. So this
• 51:27was a woman for whom
• 51:28faith was important. She went
• 51:29to the north and
• 51:30was surprised that it wasn't,
• 51:33and she felt uncomfortable,
• 51:35and then she went back
• 51:36to the south.
• 51:37And I think that,
• 51:40I
• 51:41I went to college in
• 51:42the late seventies and came
• 51:43here. I was class of
• 51:44eighty five at the medical
• 51:45school. But when I went
• 51:47to college,
• 51:48you know, Freud and Marx
• 51:49were big. You know, religion
• 51:50was, you know, the opiate
• 51:52of the masses or was
• 51:53an illusion. And I think,
• 51:55there was a lot of
• 51:56wariness of organized religion.
• 51:59And we live in it.
• 52:00There's there's,
• 52:01a huge amount of diversity
• 52:02in religion today in America.
• 52:04Right? As I said, so
• 52:05the number of people who
• 52:06are none of the above
• 52:07spiritual and art religion is
• 52:08going way, way up.
• 52:10I think America,
• 52:12about thirty years ago or
• 52:13so, eighty six percent of
• 52:14people said they were Christian.
• 52:15Now it's about thirty percent
• 52:17or or I'm not sure
• 52:18the numbers, but it's maybe
• 52:19fifty percent. It's gone way,
• 52:21way down.
• 52:22But I think we need
• 52:23to be tolerant. I think
• 52:24that, we need to recognize
• 52:27that people have different beliefs
• 52:29and respect those beliefs.
• 52:31So I think that I
• 52:32think some people of some
• 52:34students of faith may feel
• 52:36outnumbered. They shouldn't. I mean,
• 52:37when I was here, we
• 52:38had a wonderful chaplain.
• 52:40I wanna say Stewart Miriam.
• 52:41Was that is that was
• 52:42it not stu Alan Miriam.
• 52:43Alan Miriam. Yes.
• 52:45Who is great.
• 52:46Some of the other folks
• 52:47my age, I may remember
• 52:48that. So,
• 52:51so I think that,
• 52:52allowing them to
• 52:55be supported in whatever their
• 52:57faith,
• 52:58is important.
• 52:59You may be asking something
• 53:00else beyond that, though, I
• 53:01sense.
• 53:02No. I just wanted to
• 53:03point out that Alan Merman
• 53:04was also a pediatrician. Yes.
• 53:06And so it's consistent with
• 53:07your theme that the pediatricians
• 53:08Yeah. Are the best people.
• 53:09Right.
• 53:11Except that all those really
• 53:12good ones are gone now,
• 53:13just so you know. There's
• 53:14no more good pediatricians here.
• 53:17No. Your your your points
• 53:18are are well taken and
• 53:19appreciated.
• 53:21That said, I'd like to
• 53:21open it up. If anyone
• 53:23has a question or a
• 53:24comment,
• 53:26yes. There's someone in the
• 53:27back there. Please can, Karen's
• 53:29right behind you. She'll be
• 53:29there in one second.
• 53:34Hi. Hi. My name's Anna.
• 53:36I'm one of the pediatric
• 53:37chaplains here. I didn't get
• 53:39a chance to have lunch
• 53:40with you today, but I've
• 53:40read some of your book.
• 53:42And I I two things
• 53:43that I wanted to bring
• 53:44up.
• 53:45First, I kinda wanna
• 53:48I kinda wanna push you
• 53:49a little bit. And you've
• 53:50you've you've asked us to
• 53:51be less little less humble.
• 53:52So I'm gonna take you
• 53:53up on that. Okay.
• 53:55And I changed my mind.
• 53:59So I have to say
• 54:00that,
• 54:03so full disclosure that the
• 54:04person who told Mark that
• 54:05your book brought tears to
• 54:06my eyes was me. Okay.
• 54:08I I read your introduction.
• 54:10You you write that we're
• 54:11unsung heroes. I thought that
• 54:12was so beautiful. And
• 54:14to have somebody,
• 54:17name the fact that we
• 54:18have so much to offer
• 54:19but still are often marginalized
• 54:22was very validating,
• 54:24to read and
• 54:26I guess it speaks to
• 54:27our situation within the hospital
• 54:29system that it feels so
• 54:31so needed and validating to
• 54:32hear that.
• 54:35But I also feel slightly
• 54:37I feel a little torn
• 54:38in terms of your overall
• 54:39project, and I wanted to
• 54:40know if you wanted to
• 54:41speak to this a little
• 54:42bit because I'm struck by
• 54:43the irony
• 54:44of listening
• 54:46to a physician and a
• 54:47psychiatrist
• 54:48talk about chaplains
• 54:50and what chaplains do.
• 54:52And
• 54:53in a in a way,
• 54:54it's it it is kind
• 54:56of replicating
• 54:57the fact that doctors are
• 54:58sort of speaking for chaplains
• 55:00or we have we have
• 55:01rather, I guess, like, a
• 55:02doctor has to say that
• 55:03we matter for us to
• 55:04matter or for our work
• 55:06to matter or be noticed.
• 55:07And I wanna also give
• 55:09tremendous respect to your project.
• 55:10I'm I'm very glad this
• 55:12book exists, but I do
• 55:12think that's an interesting question
• 55:14that it brings up.
• 55:16And I'm grateful for all
• 55:17the Chaplain voices that you
• 55:19lift up in your book,
• 55:20but ultimately I think there's
• 55:22still a question that is
• 55:23brought forward in terms of,
• 55:25this hierarchy that exists in
• 55:27the hospital that sometimes feels
• 55:28a little bit inescapable.
• 55:30And the second thing I
• 55:31wanted to bring forward just
• 55:33because it's close to my
• 55:34heart is in all of
• 55:35the kind of things that
• 55:36you mentioned about what chaplains
• 55:38do and offer,
• 55:40there was one thing that
• 55:41you didn't talk about that
• 55:42to me is kind of
• 55:43what I think is
• 55:45kind of most
• 55:47special and unique about what
• 55:48I think we bring to
• 55:49the table in a hospital
• 55:50system. And that is that
• 55:52we and our and our
• 55:53training in our lives
• 55:54have done a lot of
• 55:56work and thinking and reflection
• 55:58on our own relationship
• 56:00with suffering, with loss, with
• 56:01grief. And I'm sure you
• 56:03know that from talking with
• 56:04the chaplains.
• 56:05But I even when I
• 56:06work with students, when I
• 56:07work with,
• 56:09when I work with, residents
• 56:10and fellows, I talk about
• 56:11that because I actually think
• 56:13that is really what is
• 56:14quite unique, and that's why
• 56:16we can kind of get
• 56:18called to any room in
• 56:18the hospital where something maybe
• 56:20horrible has happened and walk
• 56:22in.
• 56:24We get called to some
• 56:25of the hardest things and
• 56:26have to find a way
• 56:27to walk into that room
• 56:28and also know what's walking
• 56:30in with us so it
• 56:31doesn't get in the way.
• 56:33So I just want to
• 56:33bring up those two things,
• 56:34and I'd love to hear
• 56:35your thoughts. Thank you. Well,
• 56:37thank you for that.
• 56:38So first of all,
• 56:40the book is filled with
• 56:42all kinds of themes and
• 56:43stories and issues, and I
• 56:44just chose a few to
• 56:45talk about here. So this
• 56:46is what I talked about
• 56:47is not a
• 56:49full cross section of what's
• 56:51in the book. So I
• 56:51go into
• 56:52a whole section, which is
• 56:54surprising and I should say
• 56:55some of the,
• 56:56the chapters here, I first
• 56:58published them as separate journal
• 56:59articles. So I was quite
• 57:00struck by the issue of
• 57:01why people become chaplains.
• 57:03So I did some research,
• 57:04and guess how many articles
• 57:06had been published on why
• 57:07people become chaplains?
• 57:10Zero.
• 57:11But I was struck how
• 57:12often chaplains
• 57:14went into chaplaincy
• 57:16many as second careers,
• 57:18many because of their own
• 57:20loss, experiences of loss,
• 57:22etcetera.
• 57:24And that was quite powerful
• 57:25to me.
• 57:26So I wrote a paper
• 57:27called Becoming Chaplains, which is,
• 57:29you know, on PubMed, etcetera,
• 57:31that's, been cited quite a
• 57:33bit because it's just I
• 57:34was I was so I
• 57:35was struck one that there's
• 57:36so little research done on
• 57:37chaplains. Right?
• 57:38That, yet they do all
• 57:40this incredible work. So I'll
• 57:41just say that.
• 57:43In terms of the hierarchy
• 57:44of the hospital,
• 57:47as probably everyone in this
• 57:48room knows, hospitals are incredibly
• 57:50hierarchical. So as a medical
• 57:51student here, you know, I
• 57:52started as a
• 57:54first year, then a second
• 57:55year, the third year for
• 57:55the an intern. Over the
• 57:57in so there's a medical
• 57:58student,
• 57:59the third year medical student,
• 58:01the sub intern, the intern,
• 58:03the resident,
• 58:05the chief resident, the attending,
• 58:07the chairman, the head of
• 58:08the hospital.
• 58:09Right? So it is incredibly
• 58:11hierarchical. It's sort of like
• 58:12the army.
• 58:13Right?
• 58:14And,
• 58:16I'd love to say that
• 58:17it's not that way, but
• 58:18that's kinda just the way
• 58:20it is. So,
• 58:22I wish I I I've
• 58:23sort of said, I think
• 58:24chaplains and I said this
• 58:25at lunch, actually, with the
• 58:27chaplains. Chaplains should do more
• 58:28research, I think. I mean,
• 58:29you have chaplains, a few
• 58:30people Nathan mentioned, sort of
• 58:32example of sort of a,
• 58:33you know, a situation he
• 58:35got involved with and working
• 58:36with a unit that was
• 58:37really successful. I think even
• 58:38case studies like that are
• 58:39incredibly important to add to
• 58:40the literature.
• 58:42So I very much encourage
• 58:43other,
• 58:45you know, chaplains to do
• 58:46it. Now, of course, chaplains
• 58:47don't have protected time. I
• 58:48think they could argue for
• 58:49that. I think there are
• 58:50grants available to do some
• 58:51of this work or
• 58:53said, remember the NIH? There
• 58:55used to be NIH grants
• 58:56to do some of this
• 58:57work. Hopefully, that'll come back.
• 58:59But so I I'd encourage
• 59:01chaplains to route these issues
• 59:02as well.
• 59:03I mean, I don't
• 59:05I saw a need to
• 59:06sort of write this, and
• 59:06a number of chaplains around
• 59:08country have said they've given
• 59:09the book to their, you
• 59:10know, the head of the
• 59:11hospital, the chief medicine, you
• 59:13know, the the the the
• 59:14chair of the department of
• 59:15medicine saying, well, this is
• 59:16what we do. So,
• 59:17you know, I hope that
• 59:18good comes from it.
• 59:21I I would add also
• 59:22may I? Yeah. I would
• 59:23add also that that,
• 59:25since this is the program
• 59:26for biomedical ethics,
• 59:28that that I absolutely
• 59:30agree with you, Hannah, and
• 59:31with you, Bob, about the
• 59:32hierarchy. There's no question it
• 59:33exists. In the world of
• 59:35bioethics I'm looking right here
• 59:36at my co director. In
• 59:37the world of bioethics,
• 59:38it's there as well.
• 59:39And there are you know,
• 59:41you can be a PhD
• 59:42in bioethics and know this
• 59:44much or an MD in
• 59:45bioethics and know this much,
• 59:47But sometimes, for reasons that
• 59:48aren't entirely clear or valid,
• 59:50that that particularly other physicians
• 59:52wanna hear it from a
• 59:54physician. And there is a
• 59:55sense within our field of
• 59:56bioethics
• 59:57that,
• 59:59I would say that there
• 60:00is not enough
• 01:00:02respect for or acknowledgment of
• 01:00:04the fact that just as
• 01:00:05there are plenty of chaplains
• 01:00:07around that know a lot
• 01:00:07of stuff that the physicians
• 01:00:09don't Right. And have skills
• 01:00:10that the physician don't. In
• 01:00:11bioethics, it's much the same
• 01:00:13way. There are plenty of
• 01:00:14people who are bioethicists
• 01:00:16who have knowledge and skills
• 01:00:17that the physicians even physicians
• 01:00:19in bioethics may not have.
• 01:00:21And so, you know, we
• 01:00:21have to just kinda face
• 01:00:22it. And and particularly for
• 01:00:25again, I don't mean to
• 01:00:26make this just about the
• 01:00:27students on the bioethics track.
• 01:00:28I truly don't with the
• 01:00:30concentration.
• 01:00:30But it's good to remember
• 01:00:32that this,
• 01:00:34this hierarchy is
• 01:00:36is a reality, but it's
• 01:00:38also
• 01:00:38trying to think of the
• 01:00:39right philosophical word. Oh, yeah.
• 01:00:41It's bullshit. Okay?
• 01:00:42So
• 01:00:44so you need to keep
• 01:00:45that in mind as going
• 01:00:46forward in your careers that
• 01:00:48sometimes you'll see it and
• 01:00:48sometimes there's good reason for
• 01:00:50it. Don't get me wrong.
• 01:00:51But I do think that
• 01:00:52it starts with recognizing that
• 01:00:53the chaplain or the PhD
• 01:00:55bioethics or this person in
• 01:00:56the bioethics committee,
• 01:00:58these there there's various people
• 01:01:00here just to know all
• 01:01:01kinds of stuff that we
• 01:01:02don't. And it's a difficulty
• 01:01:04in admitting that that I
• 01:01:05think sometimes gets in the
• 01:01:06way of the chaplains doing
• 01:01:07their work. Yep. What do
• 01:01:08I need them for? I
• 01:01:09already know what I'm doing.
• 01:01:10So I would just I
• 01:01:11agree everything you just said.
• 01:01:12I would add to that
• 01:01:12that publishing is very important.
• 01:01:14It's something we really encourage
• 01:01:15in the master's
• 01:01:16bioethics
• 01:01:17program that I teach. We
• 01:01:18have a course of journalism
• 01:01:19in bioethics. We have our
• 01:01:21a wonderful student run journal
• 01:01:22called voice in bioethics that
• 01:01:24gets half a million hits
• 01:01:25a year, and you're all
• 01:01:26welcome to to, you know,
• 01:01:28send stuff in and,
• 01:01:29you know, to be published,
• 01:01:31etcetera.
• 01:01:32But I think because,
• 01:01:34the PhD who publishes a
• 01:01:36paper
• 01:01:37on the issue,
• 01:01:38whatever it is, then moves
• 01:01:39up in the hierarchy. I
• 01:01:40think the hierarchy is there.
• 01:01:42But if you publish,
• 01:01:44you know, it gives you,
• 01:01:45sort of the coin of
• 01:01:46the realm is publication. We
• 01:01:48have a former student here
• 01:01:49who could vouch for that
• 01:01:50from my program. But,
• 01:01:52so,
• 01:01:53so that helps. And, actually,
• 01:01:55that's a lesson I learned
• 01:01:56here at Yale is it
• 01:01:57was a psychiatry professor who
• 01:01:58wrote a book on,
• 01:02:00the history of cocaine in
• 01:02:02America.
• 01:02:03Fuck in the guy's name.
• 01:02:04So I went and talked
• 01:02:05to him in the history
• 01:02:06of library, you know, street
• 01:02:07medicine library one day, and
• 01:02:08I said, well, I'm interested
• 01:02:09in kind of ethics and
• 01:02:10policies. And the key thing,
• 01:02:12the most important thing is
• 01:02:13to write about it. Lots
• 01:02:14of people have these interests,
• 01:02:15but if you write about
• 01:02:16it and publish,
• 01:02:18that is what distinguishes you,
• 01:02:20will enable you to sort
• 01:02:21of build a career on
• 01:02:22this.
• 01:02:23So I am I I
• 01:02:24channel that to my students
• 01:02:26and to you. So,
• 01:02:29that helps.
• 01:02:30Thank you. Yes, sir. Doctor
• 01:02:32Doolittle. Yeah.
• 01:02:37Oh, so hey, Ben Doolittle,
• 01:02:39local church pastor who does
• 01:02:40some medicine as well.
• 01:02:44So I'm always struck by
• 01:02:46how
• 01:02:48medicine
• 01:02:49looks like a pretty good
• 01:02:50religion.
• 01:02:51Right? Like, we have the
• 01:02:53hierarchy. We have the liturgy.
• 01:02:54We have grand rounds. We
• 01:02:56have,
• 01:02:58sacramental moments like white coat
• 01:03:00ceremonies and stuff.
• 01:03:01It always strikes me that
• 01:03:03right when we really need
• 01:03:04a good religion,
• 01:03:06medicine collapses
• 01:03:08that we don't do a
• 01:03:09great job in reconciliation,
• 01:03:12suffering, forgiveness.
• 01:03:14And I as a program
• 01:03:15residency program director, I'm struck
• 01:03:17by
• 01:03:17the,
• 01:03:19sort of
• 01:03:20chronic,
• 01:03:21frenetic anxiety
• 01:03:22around this place
• 01:03:23that is also mixed with
• 01:03:26astounding joy and marvelous accomplishment.
• 01:03:28But it's it's a soup,
• 01:03:30if you will.
• 01:03:33So I have two questions.
• 01:03:34One,
• 01:03:36in
• 01:03:37visiting with all of these
• 01:03:38chaplains, which sounds like pretty
• 01:03:39awesome that you got money
• 01:03:40for that.
• 01:03:43So
• 01:03:44how did those conversations
• 01:03:47inform your own personal faith
• 01:03:49journey, your own inner life?
• 01:03:51And did you learn any
• 01:03:53lessons from those conversations
• 01:03:54that might
• 01:03:56that you could lend to
• 01:03:59this group good group of
• 01:04:00people who came out wondering
• 01:04:02about praying with patients?
• 01:04:04Is there some lesson that
• 01:04:05these chaplains taught you personally
• 01:04:08in your own journey?
• 01:04:09And is there anything that
• 01:04:11perhaps could be conveyed to
• 01:04:12the rest of us?
• 01:04:14So great question. So I
• 01:04:15think the tolerance of other
• 01:04:17people I mean, hearing
• 01:04:19I'll be blunt. I mean,
• 01:04:20I I've been with wary
• 01:04:21of evangelicals.
• 01:04:22Right? I mean, they're Trump's
• 01:04:23biggest supporters or evangelicals. You
• 01:04:25know, how could people believe
• 01:04:26this stuff?
• 01:04:28But in talking to chaplains
• 01:04:29who work with them, I
• 01:04:30saw, you know, similar themes,
• 01:04:32pain,
• 01:04:33you know,
• 01:04:35struggles.
• 01:04:36So I became,
• 01:04:38and similarly, I have to
• 01:04:38say, you know, I grew
• 01:04:39up knowing
• 01:04:41very little about Islam.
• 01:04:43Right?
• 01:04:44But in I was struck
• 01:04:45hearing, you know, the the
• 01:04:47the Muslim the woman who
• 01:04:48was, you know, describing the
• 01:04:50chart as being, you know,
• 01:04:51unrealistic in denial because she
• 01:04:53was following her Muslim belief
• 01:04:54and how little we know
• 01:04:56about that. So I came
• 01:04:57away
• 01:04:58thinking how much we really
• 01:04:59need to try to understand
• 01:05:00other people's faiths or lack
• 01:05:02thereof and the wide variety.
• 01:05:04I mean, the people who
• 01:05:04said you know, one woman
• 01:05:06said to me, you know,
• 01:05:07you know, I I'm against
• 01:05:09all religion. Religion is evil.
• 01:05:10But sometimes I get on
• 01:05:11my knees and pray to
• 01:05:13the god I don't believe
• 01:05:14in.
• 01:05:16So what does that mean?
• 01:05:18Right? So people have, you
• 01:05:20know, needs and,
• 01:05:22you know, we have these
• 01:05:23terms, but, you know, what
• 01:05:25if we say what is
• 01:05:26religion, everyone in this room
• 01:05:27is gonna give a different
• 01:05:28answer. Right? And so I
• 01:05:29just we need to be
• 01:05:30sort of open to other
• 01:05:31people's
• 01:05:32beliefs and journeys. I mean,
• 01:05:34I I know that sounds
• 01:05:35a bit trite.
• 01:05:39What else did I learn?
• 01:05:40I mean, I was just
• 01:05:40incredibly moved by as I
• 01:05:42said, I mean, the biggest
• 01:05:44lesson to me is all
• 01:05:45the amazing work chaplains do.
• 01:05:47You know? I mean, you
• 01:05:48know, as I tried to
• 01:05:49convey, I mean, they you
• 01:05:50know, you know, the the
• 01:05:51woman's,
• 01:05:52you know, singing, you know,
• 01:05:53amazing grace there. Right? I
• 01:05:54mean, you know, and that's
• 01:05:55just one of, you know,
• 01:05:56dozens and dozens and dozens
• 01:05:58of, you know, stories that
• 01:05:59I found that I put
• 01:06:00in the book of, you
• 01:06:01know, these amazing things,
• 01:06:03you know, that chaplains
• 01:06:04are able to do and
• 01:06:06that we just, in medicine,
• 01:06:07just
• 01:06:09don't know, don't appreciate,
• 01:06:10both don't care.
• 01:06:12You know, that that's a
• 01:06:13huge gap that we need
• 01:06:14to work on.
• 01:06:17There's a gentleman right back
• 01:06:18there. If you could give
• 01:06:19him that, please.
• 01:06:21Hi, doctor Klitzman. Nathan.
• 01:06:24In your
• 01:06:25you mentioned
• 01:06:27religion and spirituality
• 01:06:28in your discussion today.
• 01:06:31And in your book, you
• 01:06:33you cite some studies that,
• 01:06:36people who
• 01:06:37might identify as spiritual but
• 01:06:38not religious
• 01:06:40might experience more distress,
• 01:06:43possibly suggesting that people who
• 01:06:45are religious might have more,
• 01:06:47ability to cope with,
• 01:06:49crises.
• 01:06:51Now as many of us
• 01:06:52might know, religion being religious
• 01:06:54but not spiritual is a
• 01:06:55huge statement, very broad, all
• 01:06:57sorts of people in that
• 01:06:58spectrum. My question to you,
• 01:07:00and I know as chaplains,
• 01:07:01we kinda talk about this
• 01:07:03all the time. How in
• 01:07:05your interviews and maybe even
• 01:07:06in your own opinion,
• 01:07:08do you distinguish or relate
• 01:07:09these terms, religion
• 01:07:11or spirituality?
• 01:07:13So
• 01:07:15both words are from Latin,
• 01:07:18and religio,
• 01:07:19religion is from religio. It's
• 01:07:21it's your bond, your your
• 01:07:22ligaments, your your connection to
• 01:07:23other people. Right? So it
• 01:07:24becomes sort of institution, where
• 01:07:26spirit
• 01:07:27is from the Latin spiritus,
• 01:07:29which means breath, like inspire.
• 01:07:31Right? And so to me,
• 01:07:33what that suggests is breath
• 01:07:34is sort of the invisible.
• 01:07:36Right? So one is sort
• 01:07:37of your social connections. Right?
• 01:07:38Your connection to an institution.
• 01:07:41And then spirit I see
• 01:07:42as being,
• 01:07:44you know, the,
• 01:07:46the invisible
• 01:07:48that can be internal. It
• 01:07:49doesn't have to be as
• 01:07:50external. So I think that's
• 01:07:51sort of the simplest way
• 01:07:52of putting it. Interestingly, the
• 01:07:54term religion really didn't get
• 01:07:55used until sort of the
• 01:07:57the
• 01:07:57early middle ages,
• 01:08:00as referring to originally, it
• 01:08:01was used sort of in
• 01:08:02Roman legions. Like, you had
• 01:08:04your your religion was your
• 01:08:05linkages were to your general
• 01:08:07or to Caesar, things like
• 01:08:08that.
• 01:08:10So I think that's that's
• 01:08:11the way I would I
• 01:08:12would distinguish it.
• 01:08:15Yes,
• 01:08:17sir.
• 01:08:19And and this gentleman right
• 01:08:20here after that, please. Sure.
• 01:08:22Thank you so much for
• 01:08:22your talk and your book.
• 01:08:24I was one of the
• 01:08:24people you interviewed of all
• 01:08:26the chaplains, you know, so
• 01:08:26it was really kind of
• 01:08:27interesting. It was a while
• 01:08:29back.
• 01:08:30I know you don't remember
• 01:08:31it or anything, but, I
• 01:08:32didn't meet you in person.
• 01:08:33I think That's right. It
• 01:08:34was over the phone. It
• 01:08:35was really delightful. I'm just
• 01:08:36and I know I'm I'm
• 01:08:37hesitant about asking this question
• 01:08:39because of all the doctors
• 01:08:40in the room, probably.
• 01:08:43Where's the door? The door
• 01:08:44chaplain is here. Where's the
• 01:08:45door?
• 01:08:47So
• 01:08:48I'm I believe in the
• 01:08:49power of prayer. I always
• 01:08:50have. And there's something I
• 01:08:52can't explain it. It's there.
• 01:08:54It really is there.
• 01:08:56And I'm wondering sometimes when
• 01:08:59we as chaplains come in
• 01:09:00and we pray with the
• 01:09:01patient,
• 01:09:02and they get better, and
• 01:09:04the doctor says, yeah, I've
• 01:09:05been doing this, I've been
• 01:09:06doing that, nothing's happened.
• 01:09:08And, you know, I'm not
• 01:09:10looking for the credit. I
• 01:09:12don't know if the power
• 01:09:13of prayer worked for this
• 01:09:15person. But I'm wondering sometimes,
• 01:09:17when the doctor,
• 01:09:19you know, oh, he comes
• 01:09:20in and prays, you know,
• 01:09:21and
• 01:09:22now they're better. The doctor
• 01:09:23thinks, oh, the doctor did
• 01:09:25that in the power of
• 01:09:26prayer. Nothing.
• 01:09:28You know, it doesn't give
• 01:09:29any credence to that at
• 01:09:30all.
• 01:09:31So I guess it's,
• 01:09:33it comes down to what
• 01:09:35is the religious practice and
• 01:09:36faith belief of the doctor
• 01:09:40if they recognize that power
• 01:09:41of prayer and attribute to
• 01:09:43the cure
• 01:09:44besides their work too?
• 01:09:46So great question. Thank you.
• 01:09:47I tried to say that
• 01:09:48so there's quite a bit
• 01:09:49of literature that shows that
• 01:09:51spirituality
• 01:09:52and religiosity
• 01:09:54helps health. It helps well-being.
• 01:09:56Some of this and this
• 01:09:56gets back to Nathan's question
• 01:09:58earlier.
• 01:09:59One we were suggesting earlier,
• 01:10:01people who are religious versus
• 01:10:02spiritual,
• 01:10:03does one help more than
• 01:10:05the other?
• 01:10:06So,
• 01:10:08one thing that helps as
• 01:10:09part of religion, religiosity are
• 01:10:11the social connectors, social support.
• 01:10:13So there's a lot of
• 01:10:14people get social support from
• 01:10:16their religious organization or from
• 01:10:18something else. I mean, so
• 01:10:19as chaplains told me, sometimes
• 01:10:21people just get support. And,
• 01:10:22again, I did some of
• 01:10:23the interviews during COVID during
• 01:10:24their you know, from their
• 01:10:26book group, you know, from
• 01:10:27their book discussion group or
• 01:10:28from their knitting club or
• 01:10:30from their Harry Potter discussion
• 01:10:32group or whatever it is.
• 01:10:33So I think those I
• 01:10:34so I think that,
• 01:10:35my own sense is that,
• 01:10:37in terms of prayer, it
• 01:10:39I think of it more
• 01:10:40it helps with it builds
• 01:10:42mindfulness, calm, hope, meaning, purpose.
• 01:10:45So it's I don't think
• 01:10:46that it in itself, I
• 01:10:47I see it through the
• 01:10:48lens of sort of coping,
• 01:10:49if you will. And and
• 01:10:50you may I don't know
• 01:10:50if you just you disagree.
• 01:10:52Do you think it does
• 01:10:52more than that? I'll ask
• 01:10:54you. Yeah. I think it
• 01:10:55does more than that because
• 01:11:09I mean, there are times,
• 01:11:11especially when I come in
• 01:11:12and pray for people who
• 01:11:14are
• 01:11:15they're intubated, they're, in an
• 01:11:17induced coma,
• 01:11:18and we're talking about,
• 01:11:21you know, end of life
• 01:11:23treatment, and
• 01:11:24and and they come out
• 01:11:25of it.
• 01:11:26So
• 01:11:28it may be I'm open
• 01:11:29to I'm open to whatever.
• 01:11:31I mean, I you know,
• 01:11:32but,
• 01:11:34you know,
• 01:11:35I feel more comfortable seeing
• 01:11:37it through the lens of
• 01:11:38psychosocial
• 01:11:38coping, and, you know, placebo
• 01:11:40effect is very powerful. And
• 01:11:42and I I don't mean
• 01:11:43to diminish,
• 01:11:44you know, but,
• 01:11:46you know, Mae, that that's
• 01:11:47great. You know,
• 01:11:50so one of the doctors
• 01:11:51I interviewed told me a
• 01:11:52story that there was a,
• 01:11:54patient and no one can
• 01:11:55get the blood out of
• 01:11:55the patient. Just, you know,
• 01:11:57and the patient the the
• 01:11:58doctor was signing out,
• 01:12:00and,
• 01:12:02the,
• 01:12:03it was famous. It it
• 01:12:04was so hard to get
• 01:12:05blood from this patient, and
• 01:12:06so the doctor said a
• 01:12:08prayer.
• 01:12:09And then the blood he'd
• 01:12:10be able to get blood.
• 01:12:11And so he signed out
• 01:12:12and said, you know, I
• 01:12:13had so much trouble getting,
• 01:12:14to to a doctor who
• 01:12:15was really an atheist. And
• 01:12:16so I had so much
• 01:12:17trouble getting blood from this
• 01:12:18patient. But then I said
• 01:12:19a prayer, and it worked.
• 01:12:20And the doctor who was
• 01:12:21gonna be coming in said,
• 01:12:22what was the prayer?
• 01:12:24So,
• 01:12:26there was,
• 01:12:27apparently,
• 01:12:29Heisenberg,
• 01:12:30Werner Heisenberg had a horseshoe,
• 01:12:32over his door. And I
• 01:12:34think it was Niels Bohr
• 01:12:35came and visited and said,
• 01:12:37you know, you have a
• 01:12:38horseshoe there. Like, do you
• 01:12:39really believe that? You know,
• 01:12:40horseshoe gives a go. He
• 01:12:41says, well, I heard that
• 01:12:43it works even if you
• 01:12:43don't believe it.
• 01:12:47So
• 01:12:50maybe it works. Guys than
• 01:12:51the this gentleman right here
• 01:12:52was next.
• 01:12:53Thank you. Oh,
• 01:12:55thank you so much. Oh,
• 01:12:57sorry.
• 01:12:57Thank you so much. I'm
• 01:12:58Ivan. I'm, medical a little
• 01:13:00bit closer if you could.
• 01:13:01Oh, I'm Ivan. I'm a
• 01:13:01medical student from the University
• 01:13:03of Hong Kong.
• 01:13:04In Hong Kong, it's hard
• 01:13:05to imagine,
• 01:13:06many of my friends even
• 01:13:07know that chaplains exist.
• 01:13:09I'm wondering if you looked
• 01:13:10into hospitals that don't have
• 01:13:12chaplains,
• 01:13:13and,
• 01:13:14who are the people that
• 01:13:15tend to, you know, substitute
• 01:13:17the roles of of what
• 01:13:18chaplains do here, like mediations
• 01:13:19and, conflict resolutions?
• 01:13:21And, Great question. I I
• 01:13:23don't know. I, it's a
• 01:13:24great question. There's a lot
• 01:13:25that hasn't been studied about
• 01:13:27chaplains. So what happens in
• 01:13:28hospitals without chaplains is a
• 01:13:29great question.
• 01:13:31I only I only know
• 01:13:32the universe of hospitals with
• 01:13:33chaplains whom I interviewed. Well,
• 01:13:34that and and Isaac and
• 01:13:35Isaac, let me just say
• 01:13:36that
• 01:13:37What a wonderful opportunity for
• 01:13:39someone like yourself to try
• 01:13:40and, help sort this out.
• 01:13:42You having one foot in
• 01:13:43both worlds.
• 01:13:44We could talk after. Yes,
• 01:13:46please.
• 01:13:47Yep. You. As my pastor
• 01:13:49growing up would say, no
• 01:13:50good deed goes unpunished. So
• 01:13:51I'm sorry that you just
• 01:13:52got a research project on
• 01:13:54tonight.
• 01:13:55But you could publish it.
• 01:13:56It'll it'll move up in
• 01:13:57the hierarchy.
• 01:14:00My name is Bailey. Thank
• 01:14:01you for coming. I'm a
• 01:14:02first year medical student.
• 01:14:04And,
• 01:14:05you know, our first ever
• 01:14:07lecture was given by doctor
• 01:14:08Mark, Mark Mercurio, who Lucky.
• 01:14:11Yes. We're very lucky. I
• 01:14:13can recite it to you,
• 01:14:14but I won't. And I
• 01:14:15also made my husband watch
• 01:14:16it, and he can recite
• 01:14:17it.
• 01:14:19I don't make him do
• 01:14:19that.
• 01:14:21And he mentioned faith to
• 01:14:22us, and then I was
• 01:14:23in a bioethics seminar. And
• 01:14:25I was fortunate enough that
• 01:14:26one of my facilitators was
• 01:14:28doctor Doolittle,
• 01:14:29who does not know he's
• 01:14:30a spiritual guide to me,
• 01:14:31but now he knows.
• 01:14:33And I'm lucky enough to
• 01:14:34go to church with a
• 01:14:35few of the students who
• 01:14:36are in this room.
• 01:14:38And I had an attending
• 01:14:39physician on my clinical experience
• 01:14:41who is of a different
• 01:14:42faith than me, but we
• 01:14:43got to have a lot
• 01:14:43of good conversations.
• 01:14:45All of those were incidental.
• 01:14:48We are being taught as
• 01:14:49part of our patient history
• 01:14:51taking
• 01:14:51to ask about a patient's
• 01:14:53spiritual beliefs,
• 01:14:55but not so much about
• 01:14:56what to say when they
• 01:14:58respond.
• 01:15:00And
• 01:15:01my life before this was
• 01:15:02for fifteen years as an
• 01:15:03educator,
• 01:15:05so I am obsessed with
• 01:15:06instructional design. It's important to
• 01:15:08me that we're explicit
• 01:15:10and that we teach skills.
• 01:15:12So I wondered if you
• 01:15:13can share any best practice
• 01:15:14or examples you've seen in
• 01:15:16medical schools where students are
• 01:15:17being taught
• 01:15:18explicitly how to engage with
• 01:15:20spirituality,
• 01:15:21setting aside whether they share
• 01:15:22the faith practice of their
• 01:15:24patient.
• 01:15:25And,
• 01:15:26if not best practice, any
• 01:15:27ideas that you've had that
• 01:15:28you think could be an
• 01:15:29explicit part of curriculum?
• 01:15:33So,
• 01:15:37so there have been a
• 01:15:38few
• 01:15:40demonstration
• 01:15:41projects. One had medical students
• 01:15:45work, have, you know, a
• 01:15:46four hundred hour curriculum.
• 01:15:48I don't know where they
• 01:15:49found the time on this
• 01:15:50stuff, which I don't think
• 01:15:51is realistic. I think there
• 01:15:52should be at least a
• 01:15:52lecture on some of this
• 01:15:54stuff.
• 01:15:55And I think doctors should
• 01:15:56develop scripts to answer the
• 01:15:58following kinds of questions.
• 01:15:59Doctor, will you pray for
• 01:16:00me? Doctor, will you pray
• 01:16:01with me? You know, doctors
• 01:16:03should have
• 01:16:04you know, not feel uncomfortable,
• 01:16:05but say whatever they feel
• 01:16:06comfortable. They could say, yes.
• 01:16:07They could feel I'm happy
• 01:16:08to support you.
• 01:16:10Do you believe in God?
• 01:16:11So I again, there are
• 01:16:12a lot of things in
• 01:16:13the book that I didn't
• 01:16:14talk about here. So,
• 01:16:16one,
• 01:16:17doctor said that he had
• 01:16:18a Muslim patient actually who
• 01:16:20would just come over from
• 01:16:21the Middle East. And the
• 01:16:23the patient was very nervous
• 01:16:24and said, do do do
• 01:16:25do do
• 01:16:26you believe in God?
• 01:16:28And he's like, he didn't
• 01:16:29know what to say. And
• 01:16:29finally said, well, I I
• 01:16:31I do, but I'm Protestant?
• 01:16:33And the the patient grabbed
• 01:16:34his hand and said, thank
• 01:16:35God you're a person of
• 01:16:36the book.
• 01:16:37Because
• 01:16:38the Islam tradition recognizes the
• 01:16:41Old and New Testament.
• 01:16:43And he was taken aback
• 01:16:45by that. Another doctor I
• 01:16:46interviewed,
• 01:16:47said,
• 01:16:48you know, a patient recently
• 01:16:49asked me, do you believe
• 01:16:50in God? And I said,
• 01:16:51well, you know, I'm I
• 01:16:52I used to be an
• 01:16:53atheist, and now I'm an
• 01:16:54agnostic. And when I say
• 01:16:55agnostic, I don't mean this,
• 01:16:57I mean that. And, you
• 01:16:57know, there are different kinds
• 01:16:58of agnosticism. And she said
• 01:17:00she said, I realized I
• 01:17:00wanted this whole long thing,
• 01:17:01and the patient just wanted
• 01:17:03me to know, you know,
• 01:17:04you know, can I trust
• 01:17:05you, basically? Like, do you
• 01:17:06believe in something bigger than
• 01:17:08money here in medicine today?
• 01:17:09And I think a lot
• 01:17:10of the conversation when patients
• 01:17:11ask these questions, a lot
• 01:17:12is, you know, who the
• 01:17:13hell are you? Can I
• 01:17:14trust you? You know, I
• 01:17:15don't know anything about you.
• 01:17:16So I think doctor and
• 01:17:18I realized I I didn't
• 01:17:19but I didn't know what
• 01:17:20to say. You know? And
• 01:17:22in retrospect, she said, I
• 01:17:23probably should have said something
• 01:17:24like, you know, I believe
• 01:17:24that, you know, in a
• 01:17:25higher power or whatever it
• 01:17:26is. So I think
• 01:17:28doctors should have the answer.
• 01:17:29Do you have,
• 01:17:30you know, whatever the question
• 01:17:31is, sort of something that
• 01:17:33they feel comfortable
• 01:17:34saying about that, not being
• 01:17:35afraid of this. And I
• 01:17:36think that,
• 01:17:37there should be vignettes. You
• 01:17:38know, patient comes in and
• 01:17:40says,
• 01:17:41you know, pay you know,
• 01:17:42patient you ask how the
• 01:17:43patient is. The patient says,
• 01:17:45I hope God is ready
• 01:17:46for me when I meet
• 01:17:46him. What do you say?
• 01:17:48And, you know, small group
• 01:17:50discussion, got to patient dot
• 01:17:51medical students, you just say,
• 01:17:52what would you say?
• 01:17:53You know, so at least
• 01:17:54they have some they they
• 01:17:55feel more comfortable with it
• 01:17:56because they're uncomfortable,
• 01:17:58because they haven't been trained
• 01:17:59in it, and I guess
• 01:18:00there's also this larger tradition.
• 01:18:03Can I just add a
• 01:18:04couple of things? And, Jen,
• 01:18:05I want you to go
• 01:18:06next after I read a
• 01:18:07comment here, and I also
• 01:18:08comment on what you said
• 01:18:09that that there is
• 01:18:11I think part of the
• 01:18:12issue is is remembering,
• 01:18:14you know, who this story
• 01:18:16is about. You know?
• 01:18:17So, I mean, just to
• 01:18:19the punch line to the
• 01:18:20story that I told you
• 01:18:21guys the first year, and
• 01:18:22I I mean, is that
• 01:18:24it's it's it's not so
• 01:18:25much what we're into. I
• 01:18:27mean, if the patient asks
• 01:18:28me a direct question about
• 01:18:29what I'm into, I think
• 01:18:30they deserve an answer if
• 01:18:31they've asked me a question.
• 01:18:32Yeah. Yeah. But short of
• 01:18:32that, the focus is not
• 01:18:34so much what I'm into.
• 01:18:35Correct. What what they're into,
• 01:18:36and and I would you
• 01:18:37know, my opinion is I
• 01:18:38think prayer falls in the
• 01:18:39same category. Right. It's it's
• 01:18:41it's
• 01:18:41supposed to be more about
• 01:18:42them than a plot of
• 01:18:43us. Yeah. But if they
• 01:18:44ask a direct question, then
• 01:18:45they they deserve I like
• 01:18:47but I like that's a
• 01:18:47classic medical answer about, well,
• 01:18:49I used to believe this,
• 01:18:49then I thought that that's
• 01:18:50a good way to make
• 01:18:51sure they don't ask any
• 01:18:52more questions. Yeah. Right.
• 01:18:53Right. I have a comment
• 01:18:54here, and then I want
• 01:18:55Jen to say something. But
• 01:18:56I have a comment here
• 01:18:57from one of our faculty
• 01:18:59who says and please feel
• 01:19:00free to comment if you'd
• 01:19:01like or not.
• 01:19:02She simply says to us
• 01:19:03that seems like in our
• 01:19:05polarizing society, seeking commonality
• 01:19:07and common truths is the
• 01:19:09likely path forward. Yes. Thank
• 01:19:11you. I agree with that.
• 01:19:13Yes. Thank you.
• 01:19:15Jen.
• 01:19:16I'm a neonatal intensive care
• 01:19:18nurse. I've had the privilege
• 01:19:19of working with Mark for
• 01:19:21years. And, but before I
• 01:19:22was here, I was at
• 01:19:23Norwalk Hospital and worked with,
• 01:19:25Stuart Danoff, who I know
• 01:19:26that Mark knows, neonatologist.
• 01:19:30Yeah. Columbia.
• 01:19:31Wonderful human being who used
• 01:19:33to make us laugh. You
• 01:19:34know, he was wonderful man.
• 01:19:36And I
• 01:19:38remember from the very beginning
• 01:19:39of my knees knocking career,
• 01:19:43standing next to a bedside,
• 01:19:44and he, you know, would
• 01:19:46would be trying to get
• 01:19:47blood or do an LP
• 01:19:48that had been unsuccessful multiple
• 01:19:49times. And then he would
• 01:19:51say,
• 01:19:52okay. You say your prayer,
• 01:19:53and I'll say mine. Right.
• 01:19:55And I just loved that
• 01:19:57line, but I also didn't
• 01:19:58know if he was fully
• 01:19:59joking. Right?
• 01:20:01But I always did my
• 01:20:02job, you know, and said
• 01:20:03my prayer. Eventually, we got,
• 01:20:06you know, got the goods.
• 01:20:07So
• 01:20:09but there was a moment
• 01:20:10in my career that was
• 01:20:11absolutely pivotal.
• 01:20:12And,
• 01:20:13so you imagine a neonatal
• 01:20:15intensive care nursery, parents grieving
• 01:20:18because their baby is gravely
• 01:20:19ill
• 01:20:20on a ventilator, on all
• 01:20:22the drips, all the things,
• 01:20:23central lines, and
• 01:20:26grieving parents, grieving grandparents, all
• 01:20:28at the bedside,
• 01:20:30been called in, baby's been
• 01:20:31baptized,
• 01:20:32and,
• 01:20:33we've done everything we can.
• 01:20:35And,
• 01:20:36doctor Danoff said,
• 01:20:38now it's time to pray.
• 01:20:41And
• 01:20:43it was the most comforting
• 01:20:45thing you could ever imagine
• 01:20:47because it said,
• 01:20:48we are not in charge
• 01:20:50of this chaos now. You
• 01:20:51know, we we can hand
• 01:20:53this over Yep. And know
• 01:20:55that we are doing our
• 01:20:57Right. Best.
• 01:20:58It was
• 01:20:59pivotal, absolutely pivotal,
• 01:21:01and,
• 01:21:02and a privilege to then
• 01:21:04carry that on.
• 01:21:06And I I try to
• 01:21:07use,
• 01:21:08I work with Anna, our
• 01:21:09chaplain over there, try to
• 01:21:10use
• 01:21:11prayer in places that
• 01:21:14just saying to families, you
• 01:21:15know, it's Mother's Day. Would
• 01:21:16you like me to call
• 01:21:17the chaplain and have them
• 01:21:18come up just to say
• 01:21:19a family blessing? Because today's
• 01:21:21a really good day. And
• 01:21:23and to bring it into
• 01:21:24the good days, it doesn't
• 01:21:24have to be in just
• 01:21:25those grave dark moments.
• 01:21:27But our babies in the
• 01:21:29NICU don't always have lots
• 01:21:31of good days. So when
• 01:21:32there's a quarter of an
• 01:21:33inch of good
• 01:21:34Right. Let's call the chaplain
• 01:21:36and celebrate that quarter of
• 01:21:38an inch. You know? Thank
• 01:21:39you for sharing that. Thank
• 01:21:40you for your comments.
• 01:21:42So I agree. I think
• 01:21:43that,
• 01:21:44you know, many of us
• 01:21:45give gratitude prayers. I mean,
• 01:21:46just, you know, I think
• 01:21:47I think well, I mentioned
• 01:21:48reframing, which is a bigger
• 01:21:49part in the book, etcetera.
• 01:21:50But, you know, the notion
• 01:21:51of we think of, well,
• 01:21:52the problem is this is
• 01:21:53you know, we're gonna do
• 01:21:54this and it's gonna solve
• 01:21:55the problem. And reframing it
• 01:21:56is, look, there's uncertainties.
• 01:21:58You know, I mean, why
• 01:21:59do,
• 01:22:00you know,
• 01:22:01you know, I almost called
• 01:22:03the book What Do We
• 01:22:03Talk About When We Talk
• 01:22:04About God.
• 01:22:05There's another book with that
• 01:22:06title, so I didn't use
• 01:22:07it.
• 01:22:08But,
• 01:22:10you know, in many ways,
• 01:22:11God is a standard for
• 01:22:12look. There's stuff we in
• 01:22:13the end are limited in
• 01:22:14our power.
• 01:22:15Right?
• 01:22:16In the end, it's forces
• 01:22:18beyond us, whether it's just
• 01:22:20chance, randomness,
• 01:22:21the universe,
• 01:22:22you know, other factors that
• 01:22:24we can't control.
• 01:22:26These are all involved, and
• 01:22:28we, you know, we may
• 01:22:29use the word, you know,
• 01:22:31god or prayer to speak
• 01:22:32to that. But a lot
• 01:22:34is that we are ultimately
• 01:22:35limited in what we can
• 01:22:36do. I mean, we can
• 01:22:37do I think doctors can
• 01:22:38do a lot in many
• 01:22:39situations, but, I mean, there
• 01:22:40are times when,
• 01:22:42you know, we're only human.
• 01:22:43And, you know, there's chance
• 01:22:45events. There's randomness. There's, you
• 01:22:47know, why me? There is
• 01:22:48no answer.
• 01:22:51This time went by
• 01:22:53much too quickly. Oh, are
• 01:22:54we over? I'm afraid we're
• 01:22:55well, no. We're not over.
• 01:22:56We're we're just about there.
• 01:22:58K.
• 01:22:59If there's one more question,
• 01:23:02I'll be yes, please.
• 01:23:04This is now I'll put
• 01:23:05some pressure on you here.
• 01:23:06This and I'll talk for
• 01:23:07a minute after you're done.
• 01:23:08This is the final session
• 01:23:09of the year. So this
• 01:23:10will be the final question,
• 01:23:13of the academic year. I
• 01:23:14I feel like we're on
• 01:23:15jeopardy or something. Now as
• 01:23:17much pressure as that puts
• 01:23:18on you about the importance
• 01:23:19of the question, Bob, you're
• 01:23:20the one under pressure because
• 01:23:21it's your answer that we're
• 01:23:21gonna be looking for.
• 01:23:23Yeah. So I just wanted
• 01:23:25to share my experience and
• 01:23:26maybe grab some advice from
• 01:23:28you guys. Talk a little
• 01:23:29louder into the mic. Sure.
• 01:23:30My name is Dana. I'm
• 01:23:31a pediatric resident in training.
• 01:23:34I came all the way
• 01:23:35from Saudi Arabia. I did
• 01:23:36medical school in Saudi Arabia,
• 01:23:38and I came here for
• 01:23:39training.
• 01:23:40And as you can tell,
• 01:23:42religion is a big part
• 01:23:43of my identity.
• 01:23:44I'm somebody that, prays five
• 01:23:46times a day, and it's
• 01:23:48something very essential in my
• 01:23:49daily rituals.
• 01:23:50Brings me peace and it
• 01:23:52helps me go on with
• 01:23:54my daily activities, especially when
• 01:23:57you're in the chaos of
• 01:23:59residency.
• 01:24:03I came from Saudi where
• 01:24:05prayer was the normal thing.
• 01:24:06Like, in Saudi, we have
• 01:24:08structured time for prayers. Even
• 01:24:10sometimes stores will close. Everybody
• 01:24:12will go and pray, and
• 01:24:13that was the norm. But
• 01:24:14then I came here as
• 01:24:17and unfortunately, I never felt
• 01:24:19although, like, I'm I would
• 01:24:20now finish two years of
• 01:24:22my training here.
• 01:24:23And I met with my
• 01:24:24program director yesterday, and she
• 01:24:27told me, what feedback do
• 01:24:28you have for us, Dana?
• 01:24:29And I said, one thing,
• 01:24:31you guys worked on my
• 01:24:32professional development, my education, my
• 01:24:34personality traits, but never did
• 01:24:37I feel like somebody invested
• 01:24:39in my spiritual
• 01:24:41identity.
• 01:24:42I never was I never
• 01:24:44was,
• 01:24:45like, educated that there there
• 01:24:47was a, like, a place
• 01:24:48for us to pray in
• 01:24:49the hospital. And I used
• 01:24:51to, like,
• 01:24:53on busy nights, excuse myself
• 01:24:55and say to my co
• 01:24:56residents, I'll be somewhat ashamed
• 01:24:58to tell them that, oh,
• 01:24:59I need to go pray.
• 01:25:01I'll tell them, oh, I
• 01:25:02need to go use the
• 01:25:02restroom for a quick minute.
• 01:25:04And it just takes two
• 01:25:05to three minutes for me
• 01:25:06to pray, but it just
• 01:25:07brings me so much energy.
• 01:25:08But I just felt, like,
• 01:25:09always embarrassed because
• 01:25:12never
• 01:25:13was it was it something
• 01:25:14normal. Like, I'm the only
• 01:25:16Muslim girl. I'm the only
• 01:25:18hijab in our program.
• 01:25:20I'm the only person that
• 01:25:21prays. So to them, it
• 01:25:23might be something foreigner. And
• 01:25:24I felt ashamed to share
• 01:25:26my identity.
• 01:25:27And it's just so sad
• 01:25:31and I keep a prayer
• 01:25:32rug at my closet to
• 01:25:34pray when I have the
• 01:25:36time and keep it in
• 01:25:37my own courtroom. And I
• 01:25:38was saddened last week when
• 01:25:39I discovered it was thrown
• 01:25:40away.
• 01:25:43And this is the truth
• 01:25:44as somebody that practice.
• 01:25:47So,
• 01:25:48I still think
• 01:25:49there is a long way
• 01:25:51to go for us here
• 01:25:52as training programs to
• 01:25:55build a safe space for
• 01:25:56us that practice, as you
• 01:25:57said, as students,
• 01:26:00or persons of training from
• 01:26:01different cultures, different backgrounds, different
• 01:26:03religions to feel welcomed
• 01:26:05and accepted.
• 01:26:07Never was it in, like,
• 01:26:10we get
• 01:26:11information booklets when we come
• 01:26:13in about which,
• 01:26:16you know, restaurants to go
• 01:26:17to, which parks to go
• 01:26:18to, which Abdul Majors to
• 01:26:20choose, but never we will
• 01:26:21be educated that there was
• 01:26:22a, a place for us
• 01:26:24to prayer, that there was
• 01:26:25an imam for me to
• 01:26:26ask help for. And I
• 01:26:28think that there is still,
• 01:26:30like, a very long way
• 01:26:31to go. And this was
• 01:26:32the only feedback that I
• 01:26:33gave my program director yesterday,
• 01:26:35is that I wish that
• 01:26:36I was more welcomed in
• 01:26:37that sense so that I
• 01:26:38don't have to be ashamed
• 01:26:40to ask
• 01:26:41for a few minutes to
• 01:26:42go pray and say that
• 01:26:43I need to go to
• 01:26:44the restroom.
• 01:26:45That was my
• 01:26:47experience.
• 01:26:48Salamikum.
• 01:26:51So, a few things. Well,
• 01:26:52thank you for sharing that.
• 01:26:54So, unfortunately, there is,
• 01:26:57Islamophobia
• 01:26:59or perceived Islamophobia and Islamophobia
• 01:27:01in a lot of hospitals.
• 01:27:02So there are I interviewed
• 01:27:04several,
• 01:27:05Muslim chaplains who told me,
• 01:27:06for instance, that
• 01:27:08a lot of Muslim,
• 01:27:09patients, when they come to
• 01:27:10the hospital and ask what's
• 01:27:11your religion, will not say
• 01:27:13Muslim because they're afraid they'll
• 01:27:15be discriminated against.
• 01:27:16And so Muslim chaplains often
• 01:27:18say, I just I looked
• 01:27:19the last names.
• 01:27:20You know, if it's an
• 01:27:21Arabic name, I'll go visit
• 01:27:22the patient. So I'm sorry
• 01:27:23that that's happening.
• 01:27:25You know, I would hope
• 01:27:26that,
• 01:27:27this getting back to what
• 01:27:29I've learned is sort of,
• 01:27:30you know, tolerance and appreciation
• 01:27:32of other faiths, but I
• 01:27:33think that,
• 01:27:34you know, there should be
• 01:27:35accommodation,
• 01:27:37for,
• 01:27:38people's faiths. And, you know,
• 01:27:41that is a legitimate
• 01:27:44accommodation, it seems, you know,
• 01:27:45to to, you know, to
• 01:27:46have the hospital work as
• 01:27:47much as they can to
• 01:27:48accommodate that. You know, I
• 01:27:50would assume there are other
• 01:27:51Muslim
• 01:27:52providers here at Yale New
• 01:27:54Haven, and so there may
• 01:27:55even be a group. You
• 01:27:56may wanna sort of reach
• 01:27:57out to them or sort
• 01:27:58of their strength in numbers.
• 01:28:00And I don't know I
• 01:28:01don't know if there's a
• 01:28:02Muslim chaplain or any mom
• 01:28:03in the community works with
• 01:28:04The other brand have a
• 01:28:06chaplain's office, but it would.
• 01:28:08Yeah. Yeah. She brands. I'm
• 01:28:09sure they said Yeah. You
• 01:28:10may wanna reach out to
• 01:28:12other Muslims just to
• 01:28:14There's a chat
• 01:28:15with.
• 01:28:19If you I think what
• 01:28:20you're getting at too is
• 01:28:21it's not just in a
• 01:28:22combination. Right? Not to but
• 01:28:23but but that that if
• 01:28:25the institution itself says we
• 01:28:28value this as much as
• 01:28:30we value you finding an
• 01:28:31app. Exactly.
• 01:28:32I said Right. This is
• 01:28:34important. I think go on
• 01:28:35and search for myself. And
• 01:28:36eventually, I found my people.
• 01:28:38I found my community. Yeah.
• 01:28:39Yeah. Okay. But I wish
• 01:28:40the leadership
• 01:28:42paid much attention to it
• 01:28:43as they pay attention to
• 01:28:45other aspects of our mental
• 01:28:46health.
• 01:28:49Thank you. If you if
• 01:28:50you like. Afterwards,
• 01:28:51we can talk about who
• 01:28:53we can talk to, you
• 01:28:53know, because I know you
• 01:28:54have some specific requests we
• 01:28:56can figure out. Because I've
• 01:28:57met in this room,
• 01:28:59and I think I know
• 01:29:00some people to ask,
• 01:29:01to to to try and,
• 01:29:02make the situation better.
• 01:29:05But, you know, let's let's
• 01:29:06see if that's what we're
• 01:29:07supposed to be about is
• 01:29:08making the situation better. I
• 01:29:10was having a conversation today
• 01:29:11on a related note.
• 01:29:13I think this was with
• 01:29:14you, Jen, but I couldn't
• 01:29:15swear to it. We were
• 01:29:16having a conversation on lunch.
• 01:29:17I think that
• 01:29:19that the whole
• 01:29:21enterprise here,
• 01:29:23the whole enterprise really comes
• 01:29:24down to, if I had
• 01:29:25to put it in one
• 01:29:26sense, to try to reduce
• 01:29:27suffering
• 01:29:28to try and reduce suffering.
• 01:29:30And this is and there
• 01:29:31there's other pieces. I'm sure
• 01:29:32someone could add a half
• 01:29:33cents to it and make
• 01:29:34it into a long ass
• 01:29:34mission statement that no one
• 01:29:35wants to see. But I
• 01:29:36I think I think reduction
• 01:29:38of suffering is where we
• 01:29:40live. Yep. And I think
• 01:29:41that's exactly I would presume
• 01:29:43to say, and, Anna, you
• 01:29:44can tell me if I'm
• 01:29:44wrong. This is so much
• 01:29:46where
• 01:29:47the chaplains live as well
• 01:29:49Yep. To try and ease
• 01:29:50people's pain. We were actually
• 01:29:51talking today about palliative medicine,
• 01:29:53and it was in that
• 01:29:53in that context. Again, the
• 01:29:55reduction of suffering. And so
• 01:29:57this is a place where
• 01:29:59I think the the the
• 01:30:00the chaplains
• 01:30:01and the medical and nursing
• 01:30:03folks
• 01:30:04can all be on the
• 01:30:05same page and can actually
• 01:30:06help each other and bring
• 01:30:07some expertise.
• 01:30:08And your visit, I think,
• 01:30:10has gone a long way
• 01:30:11toward,
• 01:30:12promoting that partnership that I
• 01:30:14think that we wanna,
• 01:30:15keep promoting. But, if I
• 01:30:17can help, I'm glad. But
• 01:30:18it's but you you all
• 01:30:19are doing the work, so
• 01:30:21kudos to you. I think
• 01:30:23there's some concern that your
• 01:30:24wardrobe is lacking, however. Oh,
• 01:30:25okay. So we have Oh,
• 01:30:27great. Yale School of Medicine
• 01:30:28program for biomedical medicine. I
• 01:30:30love it. I love it.
• 01:30:31I love it. The world
• 01:30:32and and
• 01:30:33and, of course, you can.
• 01:30:34Thank you. And a mug.
• 01:30:35Great. Good. Mug too to
• 01:30:37to
• 01:30:38have a round of applause.
• 01:30:39Thank you.
• 01:30:41Thank you.
• 01:30:44Don't forget you're a Yale
• 01:30:45e, pal. I I know
• 01:30:46I'm a Yale. It's very
• 01:30:47important to me. Thank you,
• 01:30:48folks. We'll be back in
• 01:30:50September with this seminar series,
• 01:30:52and we look forward to
• 01:30:53welcoming you back then. Have
• 01:30:55a great summer.
• 01:30:57Well, thank you. Great questions.
• 01:31:00You have a great group.