My First Clinical Placement: Praying for Patients, Palliative Care and Prophecy

In 2011, I was in my second year of Medical School. It was the holidays and I was at a Christian church camp listening to a visiting minister named Dylan Knight. He was preaching a sermon about the life of Jesus when he suddenly paused mid-phrase.

“Just a couple examples where Jesus responded…”

Pauses.

“You sitting down there – what’s your name?”

He pointed halfway down the crowd at someone in front of me.

“No sorry, just behind you,” he said.

I realised he was pointing at me. I told him my name.

I now quote verbatim what he said.¹

Preaching to the congregation (Photo Credit: Sarah Ross photography via Compfight cc )

“The Lord said to me to say to you – you need to keep your eyes fixed on Jesus… The Lord is going to cause you to be like the sun. When people are going through a tough time, you’re going to shine.  You’re going to be in their life and you’re going to shine so bright… and burn off the oppression. When they’re going through a tough time, you’re going to set people free from the pain. You’re going to be like an anti-inflammatory type of tablet. You’re going to give people relief…”

“Are you studying at the moment?”

I told him I was studying medicine.

“Is that really?”

He paused again before resuming, “The Lord says, you’re going to become a friend. Jesus said to us, ‘I once called you servants, but now I call you friend.'” [John 15:15]

“You’re going to be a friend of Jesus and of many people in your life that lay before you.  You’re going to have words of comfort and love. You’re going to stand before people who are sick, who have been called terminal, and you’re going to make them well, not just by your capacities as a doctor, but by the word of God that you speak. You’re going to set people free. People with terminal problems, whether it be diseases, or some kind of rejection for many years…those are terminal [problems] – they last for life.”

Tears streamed down my face and he prayed for me. No one had prophesied over me before in such a dramatic manner and I didn’t know quite what to think. Though the words faded to the back of my mind after a few weeks, I treasured them in my heart, wondering if they would come to pass.

TWO YEARS LATER

Two years passed and I found myself at the Queen Elizabeth Hospital for my first ever hospital clinical placement as a 4th year medical student. No longer would we be learning in classrooms: for the first time, we would learn on the job working with doctors and their real patients. I was excited but nervous as hell! We received a tour of the hospital: I remember feeling lost in endless white corridors and constantly in the way of staff who looked stern and busy.

Hospital Corridors (Photo Credit: wilding.andrew via Compfight cc )

Each student was given a slip of paper listing the first hospital unit that we would be attached to. Students were assigned to cardiology, gastroenterology, general medicine, and so forth. I read my paper and my heart sank: the very first unit of my medical career would be palliative care.

Ignorantly, this was certainly not the type of medicine I was at all interested in at that point. My idea of the medicine I wanted to do was curative treatments. The romantic notion of saving lives, or at least halting the progression of disease. My immediate thought was that this experience would be extremely depressing and wouldn’t be for me, despite having never experienced palliative medicine.

FIRST DAY OF CLINICAL PLACEMENT

My first week was certainly a ‘culture shock’. Patients were no longer artificial constructs in books – they were real and in front of me. Furthermore, every single patient on this ward was terminal. Almost all had end-stage cancer. Many were elderly, but many were not. One young Greek man in his late 20s was dying from end-stage kidney failure. He wanted to live to make it to his upcoming birthday, but steadily grew weaker and the doctors didn’t expect him to make it. Against the odds, however, he did end up celebrating that day. He was too weak to go home for the party, so around 30 of his friends brought the party to him with loud music and drinks. Later some hospital security guards shut them down. They promptly began partying again when the guards moved on. He died a few days later.

Dying Young Patient (Photo Credit: AloneAlbatross via Compfight cc )

It was very sad to see so much death, and cases like that felt especially emotional. There were times where I had tears in my eyes during ward round. But I also began to see the powerful relationships formed in the palliative care setting. Many patients felt abandoned by their previous doctors once they became terminal, but expressed incredible gratitude to the palliative care doctors for becoming bastions of hope and compassion as they entered their last phase of life. I witnessed how a significant difference could be made to a patient’s quality of life through medications which minimised their pain or breathlessness or swelling. I remember one patient saying after her treatment – “I’ve never felt so good in my whole life!” She was obviously exaggerating, but the truth was that the palliative care doctors had noticeably helped her symptoms such that she could continue to smile and enjoy her last days. I was always amazed that whilst there were times of tears on this ward, there were also times of smiling and laughing. Families were so appreciative: flowers and cards were constantly being given to the staff for their skill and sensitivity.

thank you card (Photo Credit: House of Joy Photos via Compfight cc )

BIG QUESTIONS

I also began to notice the elephant in the room which I’m sure everyone on the ward faced: what would happen to these people after they died?

I always felt incredibly sad and helpless when I witnessed the death of patients who I knew had no belief in God. I pondered the fate that awaited them. Every patient on that ward was facing the question of the afterlife. There was a spectrum of attitudes – from those who were peaceful and comforted in their knowledge of heaven, to those who believed that a state of non-existence awaited them. That notion was incredibly scary and distressing to some patients. I was also shocked when one patient said she had nothing to live for, nothing to hope for in the afterlife and asked the doctors for a pistol so that she could bring on the inevitable.

In Australian society, where mention of the word God is taboo in most circles, the plainly visible dimension of spirituality on this ward felt surreal to me. It was not uncommon to see Bibles on bedside tables, pastors and spiritual men of other religions visiting the ward and families praying emotionally with their loved ones. One Chinese woman’s family set up a vigil around her, burning incense, playing music and chanting loud Buddhist prayers until she passed away. One would be on ward round and hear the sounds of beating drums and eerie singing coming from the patient’s room on the other side of the ward. I began to realise that each patient’s spirituality (or lack thereof) was made more evident in those last days than perhaps any other time of their life.

I found the overt spirituality displayed on palliative care exciting, but also confronting. Although studies show that the vast majority of patients want their doctor to at least acknowledge spiritual issues in their care, the atheist Australian medical education chooses to ignore this.² My medical school never taught about patients and spirituality. I felt inadequate and unsure how to bring up the topic of spirituality with patients who wanted to discuss it. Most of all, as the most junior member of the palliative care team, I was scared of being ridiculed or told off by my higher-ups for being out of line.

LAST PRAYERS

Soon after, however, one experience significantly influenced me to take my eyes off my fears and inadequacy. One patient on the ward was an elderly man dying from liver cancer. He was a Muslim from Bosnia. He had no family and no friends, and was dying a lonely death. Since he had no loved ones with him, there was also no one to pray verses from the Qur’an with him as per his dying wishes. Knowing the situation, our RMO (resident medical officer), who was also a Muslim, took it upon himself to pray with him instead. The patient was extremely grateful, but I wasn’t sure how it would be received by the other doctors. It was a highly unusual and bold act to my eyes! To my surprise, however, they wholeheartedly approved that this young doctor had taken the initiative to fulfill the spiritual desires of a patient.³

Death bed (Photo Credit: joeldinda via Compfight cc )

In that moment, I thought to myself – if a Muslim can pray openly for Muslims, then why shouldn’t a Christian pray openly for Christians on the ward? If I didn’t have the guts to do that here on a unit where spiritual conversations were socially acceptable, then when would I ever have the guts to do it? I resolved in that moment to push the boundaries of my comfort zone and intentionally seek out opportunities to pray for patients. That night I wrote in my journal: “Lord – I pray that you would guide me. Here is my desire, but I admit and confess my lacking, my lack of ability. But you are the God that will pour out wisdom and understanding… I pray that you would teach me what to do!” (verbatim from my journal)

Then I met Emily Kowalski.

PRAYING FOR PATIENTS

Emily was a pleasant, gentle window in her 60s who was sadly suffering from metastatic cancer. Though terminal, she was stable and predicted to have many more months left. However, unbelievable back pain from cancer in her spine had brought her to hospital and left her mostly bed bound. Our job was to optimise her medications to control her pain so that she could return home and live out the rest of her days in the comfort of her own house.

My boss asked me to examine her and report back. She was effectively my first ever patient! I took a history – asking about her symptoms, her medical history, her family history. When I got to her social history, I saw the opportunity to put my money where my mouth was after what I had seen the RMO do.

I cautiously asked: “For some people, their religious beliefs are a source of comfort and strength in difficulty – is that true for you?” 4

I expected her to find the question strange, or to answer curtly. Instead, she began to speak freely about her beliefs. The conversation was not awkward at all, unlike what I had anticipated.

patient in bed (Photo Credit: presta via Compfight cc )

She explained that she had grown up a nominal Methodist, then became a nominal Roman Catholic when she married her husband. Her faith hadn’t played a significant part of her life. But now in her dying days, she had begun to seek Jesus anew.

“With all that is happening to me now,” she said, “faith has become a lot more important to me.”

I thought to pray for her, but still struggled with the inner conflict. What if the other doctors or nurses see me praying for her? What if I get in trouble? 

I suppressed my doubts and asked: “Some patients like their doctor to pray with them. I’m a Christian and would like to pray for you. Is that something you would like?” 4

She smiled and said, “Yes, of course you can pray for me in your own time.”

I paused. “I meant… Could I pray for you aloud right now?” I sheepishly suggested.

She seemed surprised. But then a big smile came on her face and replied, “That would be a privilege”.

I didn’t know exactly what to pray, but asked God for his peace to be upon her, that she would be without fear and anxiety, but that she would encounter the love of Jesus Christ in a personal way in this time. I concluded by praying one of the Psalms over her life.

I was about to say, “In Jesus’ name, Amen”, when she interrupted me: she began to pray for me! I went in expecting to minister to her, but had become the one being ministered to.

We both lifted our bowed heads and she had tears in her eyes.

“Your prayer was beautiful,” she said. “Thank you for being a friend to me. Can I call you that? Because that’s what you’ve been to me today.”

FRIENDSHIP

That prayer began a lasting friendship. Every 1-3 days for the next 5 weeks, I would check up on her progress and pray for her. I could tell she truly valued my company and was always very happy to see me. I slowly learned about her life and she learned about mine. Some days she would be in so much pain that she struggled to talk, but she received much encouragement from Bible passages I shared with her and my prayers. Some days we would pray and talk about what heaven would be like. It seemed her faith in Jesus really had become something very real in the last period of her life.

She said she liked reading so I gave her one of my favourite books to encourage her: “The Upside of Adversity” by Os Hillman. I apologised as I had marked the pages with my annotations and underlined phrases – but she said that meant more to her than if I had given her a new copy.

“You’ve made it personal,” she said.

patient in hospital (Photo Credit: sonofabike via Compfight cc )

I was wonderfully encouraged to see God’s comfort so practically displayed in her life and the joy I was able to bring her by showing her God’s love. But part of me also asked – how long will you keep this up Nathan? This is taking up more and more of your time – is it still worth it? I felt like I was in new territory: I had never thought about how long you should keep praying for a patient, and following up on that! I had always envisioned praying for patients as a once-off event and was now faced with the question: how long do you keep following up for? I admit it did take a lot of time to keep visiting her. I often stayed back past my dismissal time or arrived at hospital early so that I could visit and pray for her. But I reasoned that if I was still able to make time as a student, then why shouldn’t I keep visiting. I reasoned that I may not have that time to give when I’m a senior doctor. So I kept visiting.

LAST DAYS

Sadly, as the weeks passed, she began to deteriorate. It appeared increasingly obvious that she actually only had weeks left, rather than the initial prediction of months. My allocated time with palliative care also came to a close, and I was rotated to another unit – general medicine. Again, I was faced with a dilemma. I now belonged to a completely different team and was located on another floor of the hospital. I wasn’t sure what to do. Would it be absurd to keep visiting her even though I was on another team? If I visited, what would the palliative care doctors and nurses think about me? Is this effort still really worth my time? But again, I could not think of any rational reasons to stop doing what I was doing, besides ones stemming from fear of judgement, selfishness and laziness.

Some of my colleagues who knew what I was doing told me to not become too emotionally involved with the patient. They warned that it was dangerous and lead to ‘compassion fatigue’. But as I searched the scriptures, I couldn’t help but observe how emotionally involved Jesus was in all of his relationships. Jesus is the great physician, yet he never interacted with people in a detached way. He simply poured out the love that he received from God unto others (John 15:9). He told us to do the same (John 13:34). How did he avoid compassion fatigue? By being renewed each day with the love of God – the same renewing love that God offers us each day (2 Cor 4:16). Thus, I decided to copy Jesus rather than the common principle that many medical personnel adhere to of remaining emotionally distant from patients. I couldn’t see how you could pray for someone in an emotionally uninvolved way. That’s not how I saw Jesus praying. I remember always that even Jesus wept for those he ministered to (John 11:35). Yes, I did maintain a certain professional separation as part of the doctor-patient relationship, but when I prayed, when I listened, when I encouraged, I did it with all my heart.

Image Credit http://biblia.com

Image Credit http://biblia.com

CONCLUSION

Thus, I continued to visit her, leaving my home medical team to pray for her regularly. She was surprised and told me I needn’t now that I was on another team – but I could see she was so happy to see me still coming. Sadly, I also witnessed her growing weaker each day. We both could see what was coming and our discussions grew increasingly towards accepting that she would be with the Lord soon. She approached it with some anxiety, but with a great deal of dignity, faith, and a rare and beautiful serenity. She truly trusted Jesus Christ as her great shepherd (Psalm 23).

Finally, one day I arrived at hospital early in the morning to check on her before my morning rounds. I found her with the nights intern, semi conscious, and acutely unwell. She had developed a severe pneumonia, and had fallen over overnight.

“Good morning Emily,” I said to her. She opened her eyes, obviously drowsy and weak. She recognised me and weakly whispered a greeting. I placed my hand in hers. She closed her hand around mine and held it for a while. That would be the last time I saw her. She died a few hours later.

Holding Hands (Photo Credit: samcaplat via Compfight cc )

I was extremely surprised – I expected to feel sadness but I honestly did not. Perhaps my knowledge that she was at peace and in paradise with the Lord gave a closure that trumped the potential for sadness. When I see those without God dying, I find it the most awful thing. But when those in Jesus Christ die, I feel at peace. I could see Jesus saying to her:

“Truly I tell you, today you will be with me in paradise.” (Luke 23:43)

A PROPHECY REMEMBERED

I reminisce fondly of those times. I am thankful to have witnessed, and been part of the work of God in someone’s last days. Whilst I had expected to bless her, it was in fact myself who was blessed so much through her in many different ways. I have prayed for many patients since, but she was the one who gave me the confidence to do so. Through her, I witnessed first hand the amazing good that the Lord can provide to any patient who desires prayer. All we have to do is offer it to them.

Empty Shoes (Photo Credit: 27147 via Compfight cc )

Only in a moment of quiet reflection did I later recall Dylan’s words from the back of my mind from two years earlier:

“The Lord says, you’re going to become a friend. Jesus said to us, ‘I once called you servants, but now I call you friend.'”

“You’re going to be a friend of Jesus and of many people in your life that lay before you.  You’re going to have words of comfort and love. You’re going to stand before people who are sick, who have been called terminal, and you’re going to make them well, not just by your capacities as a doctor, but by the word of God that you speak. You’re going to set people free.”

Man Contemplating

FOOTNOTES

*Names in the story have been altered for confidentiality.

¹ I was able to copy this verbatim because all his sermons were recorded by the church. I received a copy for myself to listen to after the service.

² American Family Physician – Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment (http://www.aafp.org/afp/2001/0101/p81.html)

³ I later learned that the palliative care doctors were probably approving because spiritual care is a worldwide recognised key element of palliative care. The WHO Definition of Palliative Care states that palliative care “integrates the psychological and spiritual aspects of patient care”. (http://www.who.int/cancer/palliative/definition/en/)

4 See footnote² – I based my questioning on the “HOPE Questions for a Formal Spiritual Assessment in a Medical Interview” from the AFP article which details how to incorporate spiritual questions into the social history.

4 thoughts on “My First Clinical Placement: Praying for Patients, Palliative Care and Prophecy

  1. Nathan, thank you so much for sharing your experiences with us.. They have been truly uplifting and encouraging.. I really wished I had come across your blog much earlier in med school, and not in my final month.. But you have reminded me to set my eyes on Jesus and seek his kingdom first, even during this final exam period.. Thank you so much, and please keep on writing!

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