He had been in the hospital for 3 months. A rocky 3 months, much of it in the ICU. Now, when it looks like he will be leaving on his way to a near full recovery, his wife tells me she can’t thank me enough telling her husband “she never lost faith in you.”
I felt as if my medical practice had suddenly been realigned. All the recent years of practice guidelines, quality reporting, and length of stay discharge planning settled into their appropriate places. I was once again where I should be at the compact a physician makes with the patient; I will care for you, I will bring you the best I have and you can have faith in me.
Just what had pulled this man through? At first he was completely at our mercy connected by tubes to machines. His family had a test of faith: to maintain faith in the nurses, physicians and technicians through weeks of a gloomy prognosis. His healthcare team had their own crisis of faith and needed to have confidence in the protocols and their own abilities as well as in the patient’s own strength. Many time that faith would waver and we would ask “Are we doing too much? Can he survive this to be with his family?” But during this phase, the attending physician had to be the Rock of Gibraltar for this family. He had to provide answers, plans and clarity when, in fact, much was still in speculation.
Now it is different. The patient is better and the outlook is much brighter. Now begins the patient’s own test of faith as he must trust his physicians, the nurses and his own body which had so recently let him down. He may need to be given the symbols of his faith: whether they be his religion, his family and pets, or alternative medications and treatments to support him. The more the Healthcare team can utilize these, the more strength and trust he can have to hoe the long road ahead.
Time to readjust our focus a bit, I think. Talking to patients and families about guidelines, labs and lower levels of care doesn’t provide the faith or the comfort. What would you want to know if your loved one was in the hospital? You would need to hear the Diagnosis and Prognosis but also: Why did this happen? How can we prevent it from happening again? Is it going to change our life?
A modern day version of the Hippocratic Oath, written in 1964 by Louis Lasagna (Academic Dean as the School of Medicine at Tufts University) contains a section that sums up the lessons this wife taught me:
I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
I do not know why the patient’s wife focused on me as helping her to keep her faith in her husband’s recovery. I’m glad to have helped and to have provided that comfort. But I’m grateful to her for reminding me of what is and always has been the main purpose of medicine.
To relieve suffering.
Laurie Mortara is an infectious disease physician.