The Place of Religion and Doctor-Patient Relationships at TCC
Each week or so when Raphy sends me his next installment of posts on his time at Terence Cardinal Cooke Medical Center, I open the files, begin to read, and am immediately taken in by the candidness of his observations. Almost all of Raphy’s posts include one or more vignettes concerning the life and experiences of a patient at TCC. He is able to share with us not only the physical trials they have faced, but the emotional and spiritual experiences that have occurred in response to the patients’ toils. In these following posts on the place of religion at TCC and the trick to maintaining a reciprocal doctor-patient relationship, Raphy explains to us how he builds trusting relationships with patients at TCC and brings us the stories that he is privy to as a result of these unique relationships.
10- Religion at TCC
I want to describe the role that religion plays in a facility like TCC. Obviously, as a Catholic institution run by the Archdiocese, there are crucifixes and other votive objects hung in every room and office. I want to describe something more subtle, however, and that is a few personal stories and observations that illustrate the role that G-d plays once a resident has realized that there is not much more that man can do for him:
Jim Miller is an elderly resident who suffered a right-side stroke a few years ago. He is wheelchair bound and has only very limited use of his left hand. Jim is quite talkative and will lecture almost anyone who will listen about the grace of G-d and the miracles that he has experienced. He told me that when he was younger he was not religious at all, in fact, he spent time in prison for drug usage and dealing. Since then, Jim has searched for meaning in his life and has found it at TCC in the form of eclectic religious observance. Jim, originally a Baptist, attends Protestant, Catholic, Jewish and Muslim services. He has proudly shown me his Yarmulke numerous times and often carries with him books about religion. Smiling, Jim told me that “he would be part of any religion that worships G-d and that with a useless left hand like mine, I can use all the help I can get!” He also told me that he prays over his hand, washes it with holy water and that it he is slowly regaining sensation and control over his hand. On a rational level, I am rather skeptical of his rosy self-prognosis, but on an emotional level, I am deeply impressed with Jim. He has changed what sounds like a crime-filled past into a present of religious reflection and study.
In addition to religious revivals later in life, it is fascinating to see what elements of one’s religious life that people remember. Max Simon is a blind middle aged Jewish resident with HIV/AIDS. While he was not an observant Jew during his younger years, he is very impassioned about the Shabbat services run by the facility rabbi. When he arrives for services, he can barely contain his cantorial voice and regularly interrupts services with the soulful liturgical song Adon Olam that he remembers from his youth. I suspect that this does not stem strictly from religious fervor like Jim Miller’s but instead from the exquisite pleasure of remembering one’s hallowed youth. Max is equally enthralled to tell us about his hairdressing career or his favorite deli on the Upper West Side as he is to engage in prayer service. Since Max has AIDS-related blindness, he recites the prayer from memory. His memory of this song represents a link to his brighter past, one that he has precious few reminders of. I wonder when I am older and my memory begins to fade (moreso than it has already, if possible) what elements of my current life will stick with me through whatever decline my body undergoes. I doubt that Max’s Jewish schoolteacher from the 1950s appreciated that the song that he was teaching him would be his strongest link to his religion and his past.
11- Advice on Talking to Patients
As much as I would like to think that my enjoyment here has been due to a natural propensity to interpersonal contact, especially with the geriatric community, the truth is that I have had some useful advice along the way.
A few weeks before I started work here, I met, Rabbi Alan Shif (name changed), an aged rabbi who had worked for many years as a chaplain at a large prison in New York. Among other things we talked about, I told him that I would be working at TCC and that I would undoubtedly get first hand exposure to the types of work that chaplains do. He gave me a few pieces of excellent advice before coming here that have guided my interactions with the residents.
First, he said that if a resident offers you anything, be it a hat, food, drink, etc, you must accept it regardless of if you are cold or hungry. He explained that when a resident proffers you something, he/she is trying to forge a relationship of equals. In a facility like TCC, the visitor is almost always more able-bodied than the resident. For that reason, in an effort to be kind, the visitor will often rearrange the resident’s pillows, hand them something out of reach or other such minor favors. Even the act of visitation itself— taking time out of one’s day to sit and chat with a resident is clearly a one-sided act of charity done to the patient. Rabbi Shif explained that a resident wants to feel like they are reciprocating in some way by giving the visitor a token of some sort, whether the visitor wants it or not. By accepting and enjoying the gift, the visitor does the truest act of kindness— making the patient feel empowered and helpful. I applied this particular gem of wisdom when visiting Tatiana Chechelnitski, a Hungarian geriatric patient. Tatiana keeps a store of bananas in her room and offers them to her visitors. I made sure to accept the banana and eat it in front of Tatiana so that she could derive the grandmotherly satisfaction of watching a young boy eat and so that she would feel that she has done something for me, personally, as well.
In my conversation with Rabbi Shif I added that one of the areas I would be studying is the area of advanced directives and End of Life care. He cautioned me to remember that when visiting a patient, I must allow them to direct the flow of the conversation. Some people want nothing more than to vent about their condition. They show me their wounds, feeding tubes, discolorations and lacerations at the drop of a hat. Others love talking about their families (be careful with these or they will show you more pictures than you imagine possible to fit in a wallet). Other patients want nothing more than to make small talk about Puerto Rico or Obama or the inhumanly hot summer. The point Rabbi Shif was making is that even if I have grand ideas of discussing hugely consequential moral, emotional and spiritual issues with a patient and contributing to a patient’s acceptance of their inexorable demise, I must not impose my agenda on a resident. It is possible that after we have created a relationship regarding other matters, a resident will feel sufficiently comfortable with me to discuss important life (and death) issues. Others may just not want to talk about it, and that is ok too.
I have tried to let his advice guide my interactions with patients so that my chats with them are for their benefit as well as my own.