Tag Archives: spirituality

A Christmas Story – Part 3

Two days ago, I began a Christmas story that came from my book Bryson City Seasons. Part 1 can be found here and Part 2 here. This is the last of three parts. I hope it’s been a Christmas blessing for you and yours: Continue reading

The Christian divorce rate myth (what you’ve heard is wrong)

It’s been proclaimed from pulpits and blogs for years — Christians divorce as much as everyone else in America. But some scholars and family activists are questioning the oft-cited statistics, saying Christians who attend church regularly are more likely to remain wed. What’s the truth? The answer may surprise you. Continue reading

Interview: Dr. Walt Says Opportunities Abound To Bring Faith Into Medicine

Here’s an interview with me, from HCJB Global, about my teaching time at a large international medical conference in Quito, Ecuador, last month. Continue reading

Dr. Walt Teaches “Spirituality Plays Key Role” at Annual Medical Conference in Ecuator

Last month Barb and I were privileged to travel to Quito, Equator to participate in a medical mission trip and for me to teach at a large international medical conference. Here’s an article from HCJB Global about my teaching and the conference: Continue reading

Devotional for Men – Healthy Through and Through – Part 6 – The Spiritual Wheel of Health

Here’s the sixth of an eight-part devotional for men based upon my chapter on health in Coach Joe Gibbs best-selling book, Gameplan for Life. The devotional was featured by the Men of Integrity ministry of Christianity Today. I hope you enjoy the series. Here’s Part 6 of 8

THE SERIES’ THEME: Healthy Through and Through. What does it mean to be a truly healthy man of God?

THE SPIRITUAL WHEEL

KEY BIBLE VERSE: “The thief’s purpose is to steal and kill and destroy. My purpose is to give them a rich and satisfying life.” (John 10:10) Dig Deeper: Psalm 32

What does it mean to be in a state of maximum well-being as we relate to our Creator? Obviously, for us to be spiritually healthy, any break in our relationship with God must be prevented or treated.

Your spiritual wheel must be seen as the most crucial one, because good physical, emotional, and relational health alone will not make you a highly healthy person. Spiritual well-being has to be a consistent priority.

In the New Testament, the apostle Paul instructs his young disciple Timothy about this very thing: “‘Physical training [the physical health wheel] is good, but training for godliness [the spiritual health wheel] is much better, promising benefits in this life and in the life to come.’ This is a trustworthy saying, and everyone should accept it” (1 Tim. 4:8-9).

Can you see the value of learning to view your physical, emotional, and relational health as secondary to your spiritual health?

Though we’re not promised a perfectly healthy physical life, the Bible does promise abundant life to those who have a vital relationship with God. An abundant life is one that will be full and meaningful—infused with purpose, contentment, and joy.

My Response: What changes might I need to make in order to be more spiritually healthy?

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2)

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THOUGHT TO APPLY: A bodily disease which we look upon as whole and entire within itself, may, after all, be but a symptom of some ailment in the spiritual part.—Nathaniel Hawthorne(writer)

You can learn more about this principle in my book, 10 Essentials of Happy, Healthy People: Becoming and staying highly healthy. Autographed copies are available here.

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Here’s the entire series:

Adapted from Game Plan for Life (Tyndale, 2009) by permission. All rights reserved by the copyright holder and/or the publisher. May not be reproduced.

Yoga: Should Christians Be Concerned?

Yoga is an alternative therapy that raises difficult questions for Christians. The physical and breathing exercises taught in yoga classes may improve general well-being. However, as a deeply religious practice with the goal of union with the divine, it is antitheti- cal to biblical Christianity.
In spite of its reputation as a simple calisthen- ics program, reports of physical and spiritual harm continue to surface. A debate between Christian practitioners and opponents of yoga was triggered by Holly Robaina’s 2005 article in Today’s Christian Woman. The author interviewed a woman who was introduced to destructive beliefs through yoga. Ro- baina noted that terms commonly used in “secu- lar” yoga have religious meanings. The “salute to the sun” posture used to begin many classes pays homage to the Hindu sun god, and namaste, used to end yoga classes, literally means “I bow to the God within you.”
However, a faithful user of yoga responded that her faith in Christ is invigorated by yoga. As she goes through the positions, she reflects on Christ and his character. While some people’s faith may be too weak to resist the temptation to explore the worldview behind yoga, this person’s faith is strong and she claims she benefits from yoga. Robaina responded that the bottom line is not whether we are strong enough to practice yoga but whether we should refrain from yoga for the sake of those who may be too weak to withstand its spiritual lure (1 Corinthians 8:12 – 13).
We agree with Robaina’s view. There may not be clear reasons for Christians to condemn all forms

In the book on alternative medicine that I co-wrote with Donal O’Mathuna, PhD, we have an extensive chapter on the topic of yoga. The book, Alternative Medicine: The Christian Handbook, has gone on to become a best-seller and is endorsed by the Christian Medical Association as “medically reliable and Biblically sound.” In the book, we have an entire chapter on our evaluation of yoga. We conclude, “Given its origin and the potential for spiritual problems, the burden rests with the yoga advocate to demonstrate why this form of exercise should be chosen when so many other breathing, exercise, and stretching routines exist that have no spiritual underpinnings.” Here’s the basis for our conclusion:

Yoga: What It Is

Yoga in the United States has frequently been presented as a gentle exercise and relaxation therapy. It is frequently taught at health clubs, senior citizen centers, adult education programs, and similar lo- cations. And it is increasingly available in Christian churches. It is also used for stress management and may be recommended to business executives.

However, yoga is more than an exercise program. The word yoga literally means “union.” As an integral part of Hindu religion, it implies union with the “divine.” It is fundamentally a spiritual exercise designed to bring spiritual enlightenment.

Yoga incorporates both asanas (physical postures) and pranayamas (breathing exercises). The asanas are assumed to relax the body and the mind and bring them into spiritual harmony. The pranayamas, while focused on physical breathing, are designed to regulate the flow of prana, the Hindu term for life energy. The exercises are to help bring a person into a meditative state from which union with the Great Unconscious occurs, leading to spiritual enlightenment.

Advancement in yoga is expected to bring moral and character changes, with the ultimate goal being the realization of one’s divine nature. Given these Eastern roots, yoga is a deeply religious practice.

However, yoga is viewed by many as simply a set of breathing and posture exercises designed to improve strength and flexibility and promote relaxation. The different exercises address breathing, movement, and posture. Certain movements are done while exhaling, others while inhaling. The breathing is coordinated to help maintain various postures.

Different forms of yoga exist, each with its own set of positions of varying difficulty. The form most commonly practiced in the West is called “hatha yoga.”

Yoga is an alternative therapy that raises difficult questions for Christians. The physical and breathing exercises taught in yoga classes may improve general well-being. However, as a deeply religious practice with the goal of union with the divine, it is antithetical to biblical Christianity.

Claims

Most commonly, yoga is promoted as a way to reduce stress, increase flexibility, and promote better blood circulation. Other claims have been made that yoga can relieve back and neck pain and treat epilepsy and asthma.

Those committed to the spiritual roots of yoga claim it leads to spiritual enlightenment and union with the divine. The pinnacle of such enlightenment is called “Kundalini arousal.” In Hindu mythology, Kundalini is the serpent goddess who rests at the base of the spine. When aroused, the serpent travels up the spine, activating a person’s prana and clearing the person’s chakras (“energy transformers”). The latter action releases psychic abilities, including healing powers. Ultimately, Kundalini reaches the head chakra that opens practitioners to enlighten- ment from occult sources and spirit guides.

Study Findings

Clinical research shows that yoga exercises can improve physical fitness. Studies have shown it can reduce stress and help relieve chronic pain. Numerous studies have been done with yoga for specific conditions, but many of them have had methodological flaws. A few small studies examined the impact of yoga on asthmatic patients. (Our chapter) on Breathing Techniques gives more detail, but the results have been inconsistent. Overall, these studies have not been able to determine whether any beneficial effects came from the stress reduction and breathing exercises or from the life energy and spiritual nature of yoga.

An important point to keep in mind when evaluating these studies is that the benefits came only with sustained, regular practice. The most encouraging study had asthmatic patients practice yoga daily for one hour for six weeks. If yoga is practiced less consistently or for shorter periods of time, there will most likely be less benefit, if any at all.

Cautions

Yoga, it must be remembered, does not cure illness. Using it in place of effective conventional therapies may exacerbate problems. If people believe yoga and meditation can prevent diseases, they may resist seeking help for serious illnesses until the disease has progressed too far. In addition, some of the postures and the physical exertion may cause physical problems. As with any exercise program, people should ensure they have no underlying health problems and start slowly.

The spiritual dimensions of yoga must also be kept in mind. People who start yoga as a form of exercise may find themselves exposed to its religious teachings. Gradually, people may find themselves seeking the spiritual enlightenment that yoga was originally designed to produce. Apart from the spiritual dangers, intense involvement with Eastern spiritual practices is known to cause psychological and emotional problems. People who have progressed to the point of Kundalini experiences have been known to have psychotic breakdowns.

Recommendations

In spite of its reputation as a simple calisthenics program, reports of physical and spiritual harm continue to surface. A debate between Christian practitioners and opponents of yoga was triggered by Holly Robaina’s 2005 article in Today’s Christian Woman. The author interviewed a woman who was introduced to destructive beliefs through yoga. Robaina noted that terms commonly used in “secular” yoga have religious meanings. The “salute to the sun” posture used to begin many classes pays homage to the Hindu sun god, and namaste, used to end yoga classes, literally means “I bow to the God within you.”

However, a faithful user of yoga responded that her faith in Christ is invigorated by yoga. As she goes through the positions, she reflects on Christ and his character. While some people’s faith may be too weak to resist the temptation to explore the worldview behind yoga, this person’s faith is strong and she claims she benefits from yoga. Robaina responded that the bottom line is not whether we are strong enough to practice yoga but whether we should refrain from yoga for the sake of those who may be too weak to withstand its spiritual lure (1 Corinthians 8:12 – 13).

We agree with Robaina’s view. There may not be clear reasons for Christians to condemn all forms of yoga. Some people may be able to practice it beneficially and without spiritual problems. But the results are not all that matter.

Paul gives some helpful advice in 1 Corinthians 6:12: “ ‘Everything is permissible for me’ — but not everything is beneficial.”

Given its origin and the potential for spiritual problems, the burden rests with the yoga advocate to demonstrate why this form of exercise should be chosen when so many other breathing, exercise, and stretching routines exist that have no spiritual underpinnings.

Taking a Spiritual Inventory of Your Healthcare Professional

Take a Spiritual Inventory
Finding a doctor and other health care team members who share your spiritual foundation and practices may be crucial for you—and thankfully it’s fairly simple. You can use a spiritual inventory.
Doctors are increasingly using spiritual inventories in their care of patients. In fact, when I make presentations at medical centers, medical schools, and professional meetings, the question I most often hear is, How can doctors take useful spiritual inventories of their patients?
In the same way a doctor can inquire about a patient’s spiritual beliefs, a patient should feel free to ask about how a doctor’s spiritual beliefs and prac- tices relate to his or her medical care. A winning health care provider should be perfectly willing to let you know where he or she stands on these issues. Furthermore, when it comes to alternative or complementary care providers, these questions can be critical, because some have been known to use their therapy to actively recruit unsuspecting patients into spiritual belief systems I think are highly unhealthy.
Here are a few questions you could ask at your interview of the prospec- tive health care provider—or during your first official appointment. I’m sure you could come up with some of your own to add. I’m aware that most people probably won’t follow my suggestion to ask a provider all the follow- ing questions—especially at a first meeting. However, if your spirituality is very important to you, and if you want a provider who shares your beliefs, then each question might by useful for you to discuss with your physician at some point.
1. Are you willing to consider my spiritual preferences as you care for me?
2. Are you open to discussion of the religious or spiritual implications of my health care?
3. Are you willing to work with my spiritual mentors (pastor, priest, rabbi, elder) and other members of my health care team (family, friends, mentor, support group) in providing me with the best pos- sible health care?
4. Are you willing to pray with me—or for me—if I feel the need for prayer?
For those who are working to inflate and balance their spiritual wheel, asking questions 1, 2, 3, and 4 is perfectly reasonable—and, I would expect, acceptable to most physicians and providers. Some might consider the fol- lowing questions 5 through 9 to be too personal and intimate to ask of a total stranger. So if you’re not there—no problem.
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5. What does spirituality mean to you? How much is religion (and God) a source of strength and comfort for you?
6. Have you ever had an experience that convinced you that God or a higher power exists?
7. How strongly religious or spiritually oriented do you consider your- self to be?
8. Do you pray? If so, how frequently? 9. Do you attend religious worship times? If so, how often do you gen-
erally attend?
Even if you decide that asking these questions in an interview style is not comfortable, you may want to look for opportunities to talk informally dur- ing a visit. But at least consider asking the first four questions. Frankly dis- cussing this can strengthen all four of your health wheels, as well as your trust relationship with your health care provider.

This post is excerpted from my book, 10 Essentials of Happy, Healthy People: Becoming and staying highly healthy:

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Finding a doctor and other health care team members who share your spiritual foundation and practices may be crucial for you—and thankfully it’s fairly simple. You can use a spiritual inventory.

Doctors are increasingly using spiritual inventories in their care of patients. In fact, when I make presentations at medical centers, medical schools, and professional meetings, the question I most often hear is, “How can doctors take useful spiritual inventories of their patients?”

In the same way a doctor can inquire about a patient’s spiritual beliefs, a patient should feel free to ask about how a doctor’s spiritual beliefs and practices relate to his or her medical care.

A winning health care provider should be perfectly willing to let you know where he or she stands on these issues.

Furthermore, when it comes to alternative or complementary care providers, these questions can be critical, because some have been known to use their therapy to actively recruit unsuspecting patients into spiritual belief systems I think are highly unhealthy. (You can read more about this in my best-selling book: Alternative Medicine: The Christian Handbook).

Here are a few questions you could ask at your interview of the prospective health care provider—or during your first official appointment. I’m sure you could come up with some of your own to add.

I’m aware that most people probably won’t follow my suggestion to ask a provider all the following questions—especially at a first meeting. However, if your spirituality is very important to you, and if you want a provider who shares your beliefs, then each question might by useful for you to discuss with your physician at some point.

  1. Are you willing to consider my spiritual preferences as you care for me?
  2. Are you open to discussion of the religious or spiritual implications of my health care?
  3. Are you willing to work with my spiritual mentors (pastor, priest, rabbi, elder) and other members of my health care team (family, friends, mentor, support group) in providing me with the best possible health care?
  4. Are you willing to pray with me—or for me—if I feel the need for prayer?

For those who are working to inflate and balance their spiritual wheel, asking questions 1, 2, 3, and 4 is perfectly reasonable—and, I would expect, acceptable to most physicians and providers. Some might consider the following questions to be too personal and intimate to ask of a total stranger. So if you’re not there—no problem.

  1. What does spirituality mean to you? How much is religion (and God) a source of strength and comfort for you?
  2. Have you ever had an experience that convinced you that God or a higher power exists?
  3. How strongly religious or spiritually oriented do you consider yourself to be?
  4. Do you pray? If so, how frequently?
  5. Do you attend religious worship times? If so, how often do you generally attend?

Even if you decide that asking these questions in an interview style is not comfortable, you may want to look for opportunities to talk informally during a visit. But at least consider asking the first four questions.

Frankly discussing this can strengthen all four of your health wheels, as well as your trust relationship with your health care provider.

Positive Brain Changes Seen After Meditation (What is Christian meditation?)

A number of Christian scriptures recommend meditation as a spiritual discipline:

  • Psalm 77:12: I will meditate on all your works and consider all your mighty deeds.
  • Psalm 119:15:  meditate on your precepts and consider your ways.
  • Psalm 119:27: Let me understand the teaching of your precepts; then I will meditate on your wonders.
  • Psalm 19:14: May the words of my mouth and the meditation of my heart be pleasing in your sight, O LORD, my Rock and my Redeemer.
  • Psalm 104:34: May my meditation be pleasing to him, as I rejoice in the LORD.

Now, comes a study showing that positive brain changes take hold after just 11 hours of practicing a form of meditation. Here are the details in a report from HealthDay News:

The study included 45 University of Oregon students who were randomly selected to be in either a study group that did integrative body-mind training (IBMT) or a control group that did relaxation training.

IBMT was adapted from traditional Chinese medicine in the 1990s.

A comparison of scans taken of the students’ brains before and after the training showed that those in the IBMT group had increased brain connectivity. The changes were strongest in connections involving the anterior cingulate, an area that plays a role in the regulation of emotions and behavior, Yi-Yuan Tang of Dalian University of Technology in China, University of Oregon psychologist Michael I. Posner, and colleagues found.

The boost in brain connectivity began after six hours of IBMT and became more apparent after 11 hours of practice, according to the report published in the Proceedings of the National Academy of Sciences.

The meditation-induced changes may be due to a reorganization of white-matter tracts or due to an increase of myelin that surrounds the brain connections, the study authors suggested.

“The importance of our finding relates to the ability to make structural changes in a brain network related to self-regulation. The pathway that has the largest change due to IBMT is one that previously was shown to relate to individual differences in the person’s ability to regulate conflict,” Posner said in a university news release.

In my book, Alternative Medicine: The Christian Handbook, I write this about meditation:

What it is:

Meditation is a word that has been so broadly applied to an array of both healthy and harmful activities that it is difficult to get consistent agreement about its impact on health.

For example, one person’s idea of meditating may be to sit quietly while encouraging his body to relax. He will inhale deeply, exhale slowly, and create a moment of restful quiet in the midst of an otherwise hectic day.

Another person’s idea is to tune out everything while daydreaming or concentrating on something that is not the primary concern of the moment.

When discussing meditation, it is crucial to make sure that everyone knows what everyone means by the term.

In general, it refers to a whole range of practices generally designed to take our minds off everyday business and stressful activities, helping us become more relaxed and reflective. Some use it to reduce or eliminate rational thoughts.

The type of meditation recommended as an alternative therapy sometimes has its origin in Eastern religions and mysticism.

Transcendental Meditation (TM) is a recent adaptation of these older concepts.

In general, the meditator wants to relax in a peaceful environment. Most sit comfortably, focusing their thoughts on something that minimizes troubling or distracting thoughts.

Some focus on their own breathing, concentrating on the movement of air in and out of their lungs. Others repeat a mantra — a sacred word or formula given by a spiritual master — or just an ordinary phrase. With practice, people can consciously relax their muscles and learn to control other bodily functions not usually under their control.

What the research shows:

Clinical studies have confirmed that meditation can provide short-term benefits in reducing stress, relieving chronic pain, and reducing blood pressure.

Studies also have shown that meditation can give some people a better sense of happiness and control of their bodies.

However, what has not been shown is whether these changes have long-term health benefits.

For example, a 2001 review found twenty-seven studies examining the impact of patients’ anxiety levels before surgery on their recovery after surgery. These studies didn’t examine the impact of any relaxation techniques, just whether anxiety was related to recovery.

Clear connections were shown between pre-surgery anxiety and post-surgery mood and pain. However, no clear associations were found between anxiety and more objective measures of recovery such as length of stay in hospital or rate of wound healing.

The field of research examining the impact of anxiety and relaxation on physical recovery and healing is relatively new, with evidence not yet available for many interesting issues.

CAUTIONS

Meditation has been documented to cause problems.

Transcendental Meditation, initially promoted by Maharishi Mahesh Yogi, was very popular in the 1960s and did much to familiarize Americans with meditation and Hinduism. But studies have found that its results are not always positive.

Almost half of those active as TM trainers reported episodes of anxiety, depression, confusion, frustration, mental and physical tension, and inexplicable outbursts of antisocial behavior.

Other studies have documented adverse effects as serious as psychiatric hospitalization and attempted suicide.

Problems can arise when meditation is viewed as a simple exercise, when in fact it has considerable power to deeply impact a person psychologically and spiritually.

The spiritual enlightenment some maintain occurs in meditation can involve contact with spirit guides.

The desire to rely more on one’s own intuition contrasts with the biblical declaration that our intuition can lead to falsehood and deception.

In many ways, humanity’s problems stem from our reliance on ourselves to know what is best. God told Moses to have the Israelites sew tassels onto the corners of their garments to remind them of this important teaching. “You will have these tassels to look at and so you will remember all the commands of the LORD, that you may obey them and not prostitute yourselves by going after the lusts of your own hearts and eyes” (Numbers 15:39; see also Deuteronomy 12:8; Judges 17:6).

Insight received during meditation is especially problematic.

Divination and visions are altered states of consciousness used to gain spiritual insight. Yet unless this insight comes from God, it only reveals the futility and deception of people’s own minds.

“Then the LORD said to me, ‘The prophets are prophesying lies in my name. I have not sent them or appointed them or spoken to them. They are prophesying to you false visions, divinations, idolatries and the delusions of their own minds’.” (Jeremiah 14:14; see also 23:16 – 17, 25 – 32).

God spoke through the prophet Ezekiel to warn the Israelites about “those who prophesy out of their own imagination” (Ezekiel 13:2).

What is learned during meditation must be evaluated, both medically and biblically.

Recommendations:

Christians should relax and reduce unnecessary stress in their lives. “Be still, and know that I am God; I will be exalted among the nations, I will be exalted in the earth” (Psalm 46:10).

The Bible tells us to meditate: “Do not let this Book of the Law depart from your mouth; meditate on it day and night, so that you may be careful to do everything written in it. Then you will be prosperous and successful” (Joshua 1:8; see also Psalms 1:2–3; 19:14; 49:3; 104:34; 119:97, 99).

But Christian meditation is not emptying one’s mind or focusing on one’s inner self.

Rather, it is filling one’s mind with biblical truth while focusing on the Creator God of the universe.

We will gain insight when we meditate on biblical truth. But this insight is based on the revealed Word of God and should lead to a life more in conformity with his ways.

Christians should make every effort to retain control over their thought life. “We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ” (2 Corinthians 10:5).

Altered states of consciousness can open people to spiritual suggestion, making them vulnerable to demonic or other unwholesome influences. Meditation should therefore be seen as a method of promoting reasoned reflection on God and his Word.

For my book, Alternative Medicine: The Christian Handbook:

  • You can order an signed copy here.
  • You can see the Table of Contents here.
  • You can read the First Chapter here.

When discussing meditation, it is crucial to make sure that everyone knows what everyone means by the term. In general, it refers to a whole range of practices generally designed to take our minds off everyday business and stressful activities, helping us become more relaxed and reflective. Some use it to reduce or eliminate rational thoughts. The Bible’s teaching on meditation will be examined below.
The type of meditation recommended as an alter- native therapy sometimes has its origin in Eastern religions and mysticism. Transcendental Meditation (TM) is a recent adaptation of these older concepts. In general, the meditator wants to relax in a peace- ful environment. Most sit comfortably, focusing

Belief in God Relieves Depression

I wanted you to read an excerpted from, “Belief in God Relieves Depression,” an interesting article in the The Washington Times by Jennifer Harper:

The “Big Man Upstairs” is getting accolades from mental health specialists who say they are finding that a belief in God plays a positive role in the treatment of anxiety and depression. University of Toronto psychologists reported last year that “believing in God can help block anxiety and minimize stress,” their research showcasing “distinct brain differences” between believers and nonbelievers.

In patients diagnosed with clinical depression, “belief in a concerned God can improve response to medical treatment,” said the new research, which has been published in the Journal of Clinical Psychology. The operative term here is “caring,” the researchers said.

“The study found that those with strong beliefs in a personal and concerned God were more likely to experience an improvement.”

“In our study, the positive response to medication had little to do with the feeling of hope that typically accompanies spiritual belief,” said study director Patricia Murphy, a chaplain at Rush and an assistant professor of religion, health and human values. “It was tied specifically to the belief that a Supreme Being cared,” she said.

“We found that religious people or even people who simply believe in the existence of God show significantly less brain activity in relation to their own errors,” said Michael Inzlicht, assistant psychology professor at the University of Toronto, who led the research. “They’re much less anxious and feel less stressed when they have made an error,” he said.

A fellow member of the Christian Medical and Dental Associations with me, lawyer and psychiatrist Robert Rogan, DO, JD, wrote this in response:

Faith is “the substance of things hoped for.”

Many of us can still recall what living without Christ was like – everything was up to us. Striving and uncertainty were the norm for many of us. A serious disease was terrible and overwhelming with seemingly no chance of hope.

Realizing there is Someone infinitely greater who really cares about us, even loves us, brings great assurance and relief.

Today, unfortunately, we’re taught to be an “army of one.”

As per the article the belief that a Supreme being cared for the patient made the difference in healing and recovery. We can even believe that our mistakes and failures are for a good (perhaps divine) purpose.

Have we not as physicians noticed the trend that patients with faith recover sooner and may even have ‘thinner’ charts?

Of course the researchers did not cover the actual experience of salvation through Christ and the freedom associated therewith. Also the article did not specify the actual brain responses revealed in the study.

Nevertheless, for us as Christian physicians we need to stay alert to the patient’s faith and work with that faith to develop the best treatment plan for them.

Our faith is in that same Supreme being (in most cases). But, our current politically correct environment makes our work more challenging and that is where our faith comes into play.

Let us not forget that God designed our brain’s neurochemistry too.

All I can say, is, “Amen.”

Increased spiritual support may be linked to higher quality of life in cancer patients

This headline is likely not news to most of the readers of this blog — or likely to most people. We all seem to know intuitively that terminal diagnoses cause people to begin to think about spiritaul and eternal issues. HealthDay reports, “Addressing the spiritual needs of someone with advanced cancer could be just as important as taking care of their medical needs.” This is based upon a study appearing in the Journal of Clinical Oncology.

The study of 670 patients showed that 60 percent “said that their spiritual needs either hadn’t been met or were minimally supported,” even though patients ranked “pain control and being at peace with God” as the two most important factors “at the end of their lives.”

Patients who received “greater spiritual support from their medical team” said they had “a higher quality of life as they neared death.” Addressing the spiritual needs of someone with advanced cancer could be just as important as taking care of their medical needs, a new study suggests.

The take home for us healthcare professionals is that we all need to do a better job of taking a spiritual history on our cancer patients. In fact, the Joint Commission requires a spiritual history or assessment for all patients admitted to long-term care, home care, behavioral care, and hospital admission.

What should the assessment include? The Joint Commission says that it “should, at a minimum, determine the patient’s denomination, beliefs, and what spiritual practices are important to them.”

Why? They say, “This information would assist in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment is needed.”

The take home for the rest of us is to be sure that our family and friends who receive the diagnosis of cancer have the spiritual support upon which their health and well-being may depend.

The famous Johns Hopkins medical professor, Sir William Osler, writing in an editorial, titled “The Faith that Heals,” printed in the first edition of the British Medical Journal (BMJ 1910;1:470-2), wrote, “Nothing in life is more wonderful than faith … the one great moving force which we can neither weigh in the balance nor test in the crucible …” He wrote that faith is”… mysterious, indefinable, known only by its effects, faith pours out an unfailing stream of energy while abating neither jot nor tittle of its potence …”

Psychotherapist Arthur Kornhaber said, in a 1992 interview published in Newsweek magazine, “To exclude God from a medical consultation is a form of malpractice … spirituality is wonder, joy and shouldn’t be left in the clinical closet.”

I was the chief author of a systematic review (Annals of Behavioral Medicine 2002;24(1):69-73) that concluded, “The current evidence would encourage physicians, health-care providers and systems to learn to assess their patients’ spiritual health and to provide indicated and desired spiritual intervention. Clinicians should not, without compelling data to the contrary, deprive their patients of the spiritual support and comfort upon which their hope, health, and well being may hinge.”

“This information would assist in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment is needed.

Here’s the HealthDay report:

When asked what was important to them at the end of their lives, people dying of cancer ranked two factors highest: pain control and being at peace with God, the study found.

“Medicine tends to focus on the more scientific aspects of the person, and we’ve made wonderful strides in improving patient care, but there’s another important component of patient health: spirituality,” explained Dr. Tracy Anne Balboni, a radiation oncologist at the Dana-Farber Cancer Institute in Boston and the study’s lead author. “This is clearly an area where some important advancements can be made.”

The researchers discovered that people with advanced cancer were far more likely to choose hospice care when their spiritual needs had been addressed. And among those who were very religious, meeting spiritual needs increased the odds that a terminal patient would choose to forgo aggressive, yet often unsuccessful, medical treatments, the study found.

However, at least six of 10 people with advanced cancer reported that their spiritual needs were only minimally or not at all supported.

The new study involved 670 people with advanced cancer from seven treatment centers in the Northeast and Texas. The final analysis included information from 343 people who later died and whose caregivers completed a post-death interview. The average time between the start of the study and the person’s death was 116 days.

For purposes of the study, spiritual care was defined as patient-perceived support of their spiritual needs by their medical team and the receipt of pastoral care services.

Most people (60 percent) said that their spiritual needs either hadn’t been met or were minimally supported at the start of the study, and 54 percent had not received pastoral care visits. In the final week of life, 73 percent of the participants received hospice care, and 17 percent received aggressive care.

Those who had greater spiritual support from their medical team, including doctors, nurses, chaplains and more, reported a higher quality of life as they neared death than did those who felt unsupported spiritually.

People who felt they were getting better spiritual support were 3½ times more likely to receive hospice care. And among highly religious people, those whose spiritual needs were supported were five times more likely to receive hospice care and five times less likely to receive aggressive medical care, the study reported.

“We found that patients whose spiritual needs were well-supported seemed to transition to hospice more frequently and had a marked reduction in the use of aggressive care,” Balboni said.

Yet despite the findings, said Dr. Harold G. Koenig, co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center, “few people are getting their spiritual needs met by the medical system.”

“Many doctors are uncomfortable discussing spirituality and haven’t been trained to do so,” he said. “And churches have a role, too. Although it’s not a popular topic, churches need to talk about the end of life in the pulpit. People don’t know theologically what they’re supposed to do.”

Religious people, Koenig said, are often left to think they should always have hope and should always “give God a chance to provide a miracle.” Hospice care, though, can often provide spiritual guidance and help people prepare for death, he said.

Doctors don’t need to actually provide spiritual care, Koenig said, but it’s important for physicians to acknowledge their patients’ spiritual needs and make sure they’re addressed by pastoral care or hospice. “The doctor does have to be the one to orchestrate this,” he said.

But if someone’s spiritual needs are not being met, Koenig and Balboni agreed that the person — or a friend or family member — needs to speak up. And if the patient’s doctor doesn’t feel qualified to discuss end-of-life spiritual issues, the doctor should be able to refer you to someone who can.

Dr. Walt’s Testimony Before Congress on Faith-based Perspectives on the Provision of Community Services

Back in 2004, while serving as Vice President of Medical Outreach at Focus on the Family, I was asked to testify before the Subcommittee on Criminal Justice, Drug Policy and Human Resources on the topic of “Faith-based Perspectives on the Provision of Community Services.” Recently someone asked me to post my comments, so here they are. You can also read them in the Congressional Record here.

Mr. Chairman, I am Walter L. Larimore. Prior to joining Focus on the Family in Colorado Springs, Colorado in February 2001 to become Vice-President of Medical Outreach, I practiced family medicine for over 20 years in small rural towns in North Carolina and Florida. In both practices, I was actively involved in teaching medical students and residents. I was also involved in medical research and writing and four adjunct clinical academic appointments at the medical schools of the University of Colorado, Duke University, the University of South Florida and the University of Florida.

In addition to my practice and research, I have been a medical journalist since 1995. Since January 2002, I have been hosting the nationally syndicated Focus on Your Family’s Health news features on radio and TV stations across the U.S.

My testimony today, as a physician, researcher, lay and professional educator, medical journalist, and author, is on the impact that positive spirituality can have on individuals and a society.

Positive spirituality, as I and my research colleagues have defined it in the medical literature, is distinctive from faith, morality, or religion in that it involves an ever-evolving, authentic, and personal relationship with God that is not bound by race, ethnicity, economics, or class. This relationship promotes the wellness and welfare of others and of self. It includes the beliefs and values by which an individual lives and results in the visible spiritual “fruit” of love, joy, peace, patience, kindness, goodness, gentleness, and self-control, referred to by the apostle Paul in his letter to some of the first Christians. Positive spirituality is positive and internalized – it changes one from the inside out. Positive spirituality is clearly outlined in the Bible and is also called true spirituality by Christian theologians.

Over the last forty years, researchers have increasingly shown that those with positive spirituality (i.e., those who internalize biblical teachings by frequently praying, applying what the Bible says to their lives, believing they have a close and personal relationship with God, and “practicing what they preach” or believe) have high levels of satisfaction in life, a sense of well-being, and overall happiness. Positive spirituality is also more likely to be associated with a wide variety of positive physical and emotional health outcomes.

The Handbook of Religion and Health, published by Oxford Press, examined the religion-health relationship by documenting more than 1,600 research studies and thirty-five medical review articles that have explored the relationship between religious or spiritual activity and emotional, social, and physical health outcomes. The vast majority of these studies demonstrated that a patient’s religious and spiritual beliefs can be clinically beneficial and have an important role in both coping with and recovering from illness.

One systematic review on this topic concluded: “…the published empirical data suggest that religious commitment plays a significantly beneficial role in (1) preventing mental and physical illness, (2) improving how people cope with mental and physical illness, and (3) facilitating recovery from illness.” The social impacts of this evidence are staggering. Just a few of the many, many positive findings include longer life, lower blood pressure, improved surgical outcomes, shorter hospital stays, improved mental health, improved overall well-being and improved coping with illness.

Positive spirituality may also postpone the development of physical disability in later life, and chronically ill people with true spirituality perceive themselves as less disabled than they really are.

Positive spirituality also results in optimism, hope, purpose, and meaning, even in the midst of negative life circumstances. These beliefs and attitudes frame a response to disease and disorder. The trust and confidence in God, with whom those with positive spirituality are in constant communication via prayer and Bible study is likely a crucial mechanism in the results discussed above. Further, for those with a positive spirituality, whether an illness gets better or not, having such a powerful ally and companion as their God, has an enormous impact on relieving loneliness and isolation and, again, assisting them in maintaining or regaining a sense of control. As long as God is with them, leading and directing them, the person with positive spirituality can rest. A person with positive spirituality can experience peace and healing, even when a cure is not forthcoming.

Relationships between mental health and strong faith, devout prayer, and religious socialization may have consequences that are far-reaching and perhaps greatly underestimated. Positive spirituality is associated with improved attendance at scheduled medical appointments, greater cooperativeness with medical treatment plans, better compliance with medical recommendations, and improved medical outcomes.

Faith-based, community-serving organizations rely greatly on volunteers that are drawn largely from churches, synagogues, and other religious institutions. Positive spirituality, as measured by frequency of church attendance and membership in church organizations, correlates strongly with voluntary service.  People who attend services once a week or more are approximately twice as likely to volunteer as those who attend rarely if ever. Even one third of persons who volunteer for specifically secular service activities also relate their service ‘to the influence of a relationship based in their religion – or, a positive spirituality.

As George Gallup has observed, “Churches and other religious bodies are the major supporters of voluntary services for neighborhoods and communities. Members of a church or synagogue tend to be much more involved in charitable activity, particularly through organized groups.”

Community-serving faith-based organizations are the “army ants of civil society, daily leveraging ten times their human and financial weight in social good. They are the paramedics of urban civil society, saving lives and restoring health, answering emergencies with miracles.”

Let me close my testimony with a few suggestions for how the facilitation of faith-based organizations in health care may be beneficial to individuals and society. Although many suggestions could be offered, let me offer the subcommittee three practical suggestions for promoting positive spirituality via faith-based organizations:

1) Encourage healthcare organizations and caregivers to incorporate positive spirituality into clinical care

For the past several years, I have attempted to meet this need by teaching a Continuing Medical Education (CME) course to more than 6,000 health care providers (and, another 4000 via a small-group video curriculum). Most of the learners were primary care physicians. The course teaches caregivers how to incorporate positive spirituality into their clinical practices. These learners seem interested in the ethical and practical “how-to’s” of incorporating basic spiritual skills (“How to take a spiritual assessment”; “How and when to provide a spiritual consult or referral”; and “How and when to pray with a patient or family”) into their practices. In post-course surveys, over 97% of attendees reported satisfaction with the training and over 95% predicted that they could use one or more of these spiritual interventions in their practice. When attendees are surveyed 6 or 12 months after the course, over 90% report that they were able to incorporate and have continued to incorporate this training into their practice.

Since 1996, the Joint Commission on the Accreditation of Healthcare Organizations (JACHO) has required a spiritual assessment upon hospital admission. And, increasingly, professional organizations are calling for greater sensitivity and better training of clinicians concerning the management of religious and spiritual issues in the assessment and treatment of patients.

Promotion of such faith-based activity by healthcare givers can only improve doctor-patient relationships and the very powerful faith factor in physical and mental health.

2) Encourage education in the proper implementation of the HIPAA regulations so as to not prevent patients from receiving the positive spiritual care they desire and need

In times of personal crisis, many people want and need spiritual support. And perhaps few crises can shake one’s foundation more deeply than a confrontation with possible death from a serious illness. For as long as there have been hospitals, visiting the sick has been an important part of every pastor’s mission. Hospitals today are even required by uniformly accepted operational standards to provide chaplains. But new regulations may have messed up something that wasn’t broken.

A combination of a new, vaguely written health privacy laws and changes in Medicare rules appear to be making it needlessly more difficult for pastoral professionals to visit patients in hospitals and for hospitals to provide training for in-house chaplains.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes language originally intended to prevent electronic patient information from being sold and used for marketing. But it has tied the health care industry in knots and prompted most prudent providers to err on the side of zero access to patient data.

For many pastoral professionals, it means they can no longer stop by a hospital in search of members of their congregation without having permission or a specific list of names of people to visit. Hospitals generally try to accommodate pastoral professionals by asking patients upon admission if they would like a pastor to visit. The bottom line is that in many areas bureaucracy is getting in the way.

It has been contended that these bureaucratic snafus could be readily fixed by the federal Department of Health and Human Services with a clarification of the privacy rules and the intent of HIPPA.

3) Continue and expand clinical pastoral education (CPE)

One area of savings in the Medicare program would include the rollback or cutback in the training of hospital chaplains. A move in this direction was The Center for Medicare Services (CMS) publication of a revised ruling regarding Medicare funding of CPE centers. Effective October 1, 2003, Medicare reimbursement to hospital CPE programs was significantly altered in that only first year intern or residency CPE programs would qualify for the funding. All other program will be excluded from reimbursement. This exclusion represented a major change of policy.

Yet, we are hearing that this regulation may result in either CPE programs closing or reducing the number of chaplains trained. If this anecdotal feedback is accurate, it could negatively impact patient care. For example, a cross-sectional survey of medical-surgical inpatients and psychiatric inpatients at Rush-Presbyterian-St Luke’s Medical Center in Chicago found that 76% of medical-surgical and 88% of psychiatric inpatients had 3 or more religious needs during hospitalization. The most commonly expressed needs were: (1) A desire to speak with a chaplain or other clergy, (2) An opportunity to attend a hospital worship service, and (3) Spiritual reading materials or someone to pray with.

Let me conclude by quoting one of the most renowned physicians of the last century, William Osler of Johns Hopkins. In 1910, in the first editorial published in the British Medical Journal, Sir William Osler wrote about “the faith that heals” when he said, “Nothing in life is more wonderful than faith…the one great moving force which we can neither weigh in the balance nor test in the crucible, – mysterious, indefinable, known only by its effects, faith pours out an unfailing stream of energy while abating neither jot nor tittle of its potence.”

Positive spirituality is not only a path to wholeness – it is associated with improved physical and mental health outcomes and increased ability to cope with and recover from medical difficulties.

Positive spirituality does not happen overnight. For most of us it is a lifelong pursuit. And, positive spirituality is the foundation to the hope, health, and well being for which we all long. How could we want any less for ourselves, our families, our communities and our country?

The evidence to date tells us that it is clear that clinicians, communities, and Congress should continue to encourage positive spirituality. Health policy makers, healthcare givers, and faith-based organizations should assess the spiritual needs of people and provide indicated and desired spiritual interventions – along with other forms of indicated care and caring.

Our faith-based programs should not, without compelling data to the contrary, deprive people of the spiritual support and comfort upon which their hope, health and well being may hinge.

“Christmas Firsts” – A Christmas story from “Bryson City Seasons”

My most popular books, at least based upon sales and letters, are the Bryson City series, made up of:

In the second book in this series, Bryson City Seasons, I published an account of caring for my first patient with HIV/AIDS (even before that horrible disease was named). It was in December 1982 and occurred in Bryson City, North Carolina.

I’ve excerpted the story for you and hope it will be a Christmas blessing for you and yours:

The week before Christmas, I saw Ella Jo Shell for a routine office visit. Ella Jo and her husband, John, were the proprietors of the Hemlock Inn and had become a major source of referrals to our practice. Therefore, I wasn’t surprised when Ella Jo said, “Before you run off to your next patient, I need to tell you about Evan.”

I cocked my head. “Evan?”

“He’s become a good friend. He’s an older man—I’d guess sixty or so—and he and his partner own a shop in a nearby town.”

“I bet Barb’s been there, but I don’t think I ever have.” “Well, it’s a great shop. I like browsing around there.” “Who’s his partner? Do I know her?” Ella Jo smiled. “I would guess not. Evan’s partner is actually a guy whose name is Richard.”

“A guy?”

“Yep. Where they live they’re pretty well accepted—although I’m not so sure they’d be well accepted over here in Swain County.”

I nodded.

Ella Jo continued. “Anyway, Evan is concerned about his health. He’s been losing some weight and has some funny-looking moles developing on his legs. He asked me to look at them. Walt, I’ve never seen anything like it. They look like purplish lumps. Can you think of any sorts of special rashes that occur in homosexuals?”

Frankly, I had never cared for a homosexual—at least none that I knew of—through all of my training in the 1970s.

“Other than the sexually transmitted diseases, I don’t think I know of any.”

I was quiet for a second, developing in my mind what doctors call differential diagnoses—a list of possible diagnoses. Usually I would try to think of the most common diagnosis or diagnoses that would fit the history and exam (and any tests that had been ordered).

But at the same time I’d been taught to always think of the worst possible diagnoses—so that I wouldn’t miss something bad in its earliest stages. In Evan’s case the worst diagnosis I could think of was some form of cancer. For internal cancers to cause fatigue and an unexpected loss of weight, as well as changes in the skin, was not unusual.

“Walt, I told Evan he should get a skin biopsy—for safety’s sake—just to be sure it’s not some sort of melanoma or something like that. Anyway, I told him about you and Rick. I think he’s will- ing to come over here for an evaluation, if you’re willing to see him.”

“Ella Jo, I think it’s a compliment that he’s willing to come over here. Seems like most folks from their town get their care in Sylva or Waynesville—many even travel to Asheville.”

“Yep. But it seems like folks are more willing to stay here for their care. And I think that’s good.”

I agreed. We finished our visit, and I asked her to wish her family a Merry Christmas from Barb and me.

The morning before Christmas, I was on call for our practice.

After I had finished seeing patients for the morning in the office, I was dictating charts when the phone rang. It was Louise from ER. I greeted her with, “Hi, Louie!” when I picked up the phone.

“Dr. Larimore, don’t you start with no ‘Hi, Louie’ to me. You need to learn to respect your elders!”

I grinned as she continued without a breath between sentences.

“In the meantime, I’ve got a patient here with a pretty bad pneumonia. He’s got a temperature of 102, a productive cough, a low white blood cell count, short- ness of breath, and a low oxygen level.”

She paused for a breath and then lowered her voice. “Dr. Larimore, he’s an older white man, and he’s all skin and bones. He looks cachectic, and I bet he’s got ’im a bad cancer. I’ll begin writin’ up some ICU admission orders for him.”

She sighed and then continued. “The respiratory therapist is down here, and I’ve got him on oxygen.”

As Louise paused to take a breath, I couldn’t resist the temptation. “Louise, why is the RT on oxygen? Is he sick also?”

Louise didn’t reply. I was sure she was trying to process what I was saying, so I struck while the striking was good.

“Oh my goodness. Is some plague sweeping over the hospital? The county? Oh dear, Louise! Should I come work at your side, risking life and limb? Or should I flee for my life to Franklin or parts asunder? And if I do come, do you and I need to be on prophylactic oxygen ourselves? And, Louise, what if the hospital runs out of oxygen? Then what? Oh dearie me!”

I paused to chuckle.

However, Louise apparently did not share my sense of humor. “Dr. Larimore, you ain’t funny one bit. This man’s sick, and you best be givin’ me some ICU orders.”

I agreed and gave Louise the admission orders. I wanted him cultured up and started on high-dose antibiotics.

“Does he have family?” She and I both knew this case probably did represent some sort of end-stage cancer.

“Not that I know of. Just a friend who brought him in.”

Loners were not at all unusual in the mountains, and loners who came to the doctor only after their disease process was pretty far along were very common.

You see, to most of the mountain people, the hospital was a scary place. They would tell me that they knew people—friends and neighbors—who would come to the hospital only to die.

The result was that, instead of coming in early in the disease process when treatment and sometimes a cure were at least possible, the locals would often wait to come in until it was too late for us to help them.

“I’ll be up to see him just as soon as I’m done with my patients. That okay?”

“Sounds good, Dr. Larimore. I’ll let you know if you need to get here any quicker. And . . .” Louise paused.

“And what?” I inquired.

“And you can leave your smarty-pants side down there in that office before you come here to my ER!” Before I could respond, she hung up.

hen I arrived at the hospital, I paused in the lobby to look at the Christmas decorations. The tree was actually a live tree from Greg Shuler’s Christmas tree farm. The lobby, strung with beautiful lights and freshly cut evergreen garland, smelled exhilarating— it looked like a scene from a Christmas card.

I thought for a moment of how hospitals were places of death, without a doubt, but also places of new birth and healing.

In a very real sense, the events most of us celebrated at Christmas—the birth of the Christ child—and then on Good Friday and Easter— Jesus’ death and burial—were represented in my day-to-day life in the hospital caring for patients.

No wonder, I thought, God calls himself the Great Physician. I suspected that today I’d have to tell an old man of his impending death. I had no idea of the birth that would occur.

I passed through the lobby and went first to the X-ray suite. Carroll, the radiology technician, was there. He found the patient’s films and put them on the viewing box.

“Looks like an atypical pneumonia, Walt.”

I nodded. Carroll was as good at reading films as any radiologist I knew.

“I went ahead and did tomograms of the hilum,” he commented.

I nodded again, as Carroll was thinking just what I was—this pneumonia was probably caused by a cancer.

The tomographic X-ray allowed us to look at the area between the lungs—in this case, for lumps of cancer.

Carroll replaced the plain films with the tomograms. “But I don’t see any cancer. Maybe it’s a small-cell carcinoma.”

I smiled to myself. Small-cell cancer of the lung was a name that described a deadly type of cancer—but in no way did the name imply that it didn’t form masses that could be seen.

“Thanks, Carroll. I’d best go take a look at the patient.”

“He’s interesting, Doc, I’ll tell you that.”

Aren’t they all? I wondered to myself.

“Hi, Peggy!” I called out as I entered the nurses’ station. Peggy had been at the hospital for many years. She led the choir at the Presbyterian church when she wasn’t working at the hospital. She was married to Joe Ashley, a longtime ranger at the national park.

“Hi, Dr. Larimore. Here to see the new admit in ICU?”

“Yep.”

Our ICU was really just a former four-bed ward located close to the nurses’ station and converted into the place where we cared for our sickest patients.

“You gonna tell him what he’s got?”

“Guess I’d better figure out what it is first, don’t you think?”

Peggy smiled to herself. It wasn’t unusual for the nurses to know what was going on far before the doctors did, and in this case, Peggy, like Carroll, strongly suspected cancer.

She handed me the chart. The name on the front was Evan Thomas. Could this be the Evan that Ella Jo was talking about? I thought to myself.

As I entered the room, the patient looked worse than I could have imagined. He was fairly emaciated. The oxygen had normalized his color, but instantly I knew this was a very sick man.

Another man was sitting by Evan’s bedside. As I entered, he stood.

“Hi, I’m Dr. Larimore. I’m the doctor on call today.”

“I couldn’t be more delighted!” the man exclaimed. “My name’s Richard White. Evan and I know about you and your partner, Dr. Pyeritz. Ella Jo Shell often visits our shop and has told us so much about you both. We were hoping either you or he would be willing to care for us.”

“Richard, Evan, it’s good to meet you.”

I turned my attention to Evan, taking a complete history and then doing a complete physical. When I was through, I pulled up a chair. I always felt it was better to communicate face-to-face, and sitting with patients helped me accomplish that.

“Evan, I think you know you’ve got pneumonia.” He nodded. “But it’s not a typical pneumonia. It’s atypical. Given your weight loss and fatigue, I’ve gotta be honest with you.” I paused for a moment.

Evan reached out and took Richard’s hand. He looked fleetingly at his partner and then back to me. “Is it cancer?”

I nodded. “To tell you the truth, that’s my guess. We would need to do tests to be sure. But that’s what I suspect.”

“Is it treatable?”

“It depends on the type. But my guess is that it’s probably already widespread. So we’ll just have to see.”

“When can we start?”

“Well, let’s get the infection under control, and then we’ll talk about getting started.” I was quiet and let them absorb the information. When it was clear they didn’t have any more questions, I left the room.

The next morning was Christmas, and I made early-morning rounds—well before our children, Kate and Scott, would wake up to celebrate Christmas.

I found Evan alone but awake. I greeted him and sat on the bed. His breathing was labored and shallow.

“Evan, how are you feeling?”

“Not so good, Doc. Didn’t sleep well.”

“Seems you’re breathing harder than last night. I’d better get Carroll to take another X-ray.”

“He’s already been here—along with Betty the Vampire.”

I smiled at his reference to Betty Carlson, the director of our laboratory.

“Let me go take a look at it and let you know what I see, okay? Anything else I can do?”

“Doc, I’ve been told you’re a man of faith. I’ve also been told you’re a very good doctor. But I’ve got to tell you, I was worried about coming over here to see you.”

“Why’s that?”

Evan didn’t answer for a moment. Then he looked deeply into my eyes. “Doc, lots of Bible-thumpers call people like me evil and nasty things. I was worried you might think the same.”

Now it was my turn to be quiet for a moment. I was trying to think about how to respond to this man’s honesty and transparency. It was an unnerving moment for me. But, cautiously, I continued.

“Evan, my faith teaches me that the most important thing in life is a personal relationship with God. Everything else pales in comparison to that. And I found that when I began that relationship with God, he was fully able and willing to guide me into doing and thinking the right things. So the real issue isn’t what I think or what you think, but what he thinks.”

Evan smiled, and I saw tears forming in his eyes. “When I was a kid, church was important to me. I really enjoyed going—but never did I enjoy it more than on Christmas Eve. But when I grew up I just grew away from it. Do you think your God would even want a relationship with me?”

For a moment I thought about the Bible verse “Always be prepared to give an answer to everyone who asks you to give the reason for the hope that you have. But do this with gentleness and respect.”

I was pleased Evan felt comfortable enough to ask. But I’d always been taught in medical school that it was unethical to discuss religion with patients.

However, Evan had asked—in essence, he had given me permission to share with him. So I decided to proceed—albeit carefully and very uncomfortably.

Spiritual discussions were simply not something I had been trained to provide in the medical environment, but I’d begun to carefully incorporate them into my practice during my first year in Bryson City.

Furthermore, a still, small whisper was encouraging me to harvest this opportunity to share an intimate part of myself with a very, very sick patient.

“Evan, I know God wants to have a relationship with you. My understanding of the Bible is that it tells us that God loves each of us. Actually, he loves us so much that he sent his only Son, Jesus, not just to be born in a manger but to live a perfect life for us as an example and then to die a torturous death for us—for all of our wrongdoing. Evan, if you’re willing to believe that, God’s willing to begin that relationship with you—today—but only if you want to.”

Evan looked out the window of the ICU. The daylight was just starting. For just a moment, I was concerned he might have been upset, but instead he turned back to me and whispered, “It would be a good day to start.”

I was quiet. The tears began to flow down his face, and he sniffled. I reached out and took his hand.

He gave my hand a squeeze and then looked back at me. “Doc, I’ve done a lot of wrong things. Guess you thumpers would call me a pretty bad sinner, huh?” He smiled as he wiped his tears with his free hand.

I smiled back at him. “Evan, that puts you and me in the same exact crowd.”

He cocked his head and looked at me. “Dr. Larimore, are you …? Are you like me?”

“I am.”

“You are?” he asked.

“Yes, but let me explain. The Bible explains that the sexually immoral and idolaters and adulterers and homosexuals will not inherit the kingdom of God. But, Evan, it also says in the same verse that the greedy and slanderers and swindlers won’t either.”

Evan was quiet in his thoughts, so I continued. “You’re a homosexual. And I’m greedy and a slanderer. I’ve been far more selfish than I should have been, and I’m certainly guilty of gossiping more than I should. So, according to the Bible, you and I are in the same exact crowd.”

Evan smiled and squeezed my hand. I felt an acute sense that God was gently leading my thoughts and words.

“Evan, the Bible describes many names for Jesus. My favorite is that he was known as a friend of sinners. All he requires from us, if we want to have a personal relationship with him—if we want to be his friend—is for us simply to admit that we’ve missed the mark, that we’ve sinned and done wrong.”

“I guess I would qualify.”

“Me too, Evan.” I paused to let him think for a moment.

“I think I’d like to be his friend. That would be nice—especially on Christmas Day,” Evan whispered between labored breaths. “How do I start?”

Dear Lord, I thought, what do I say now?

Then I had an over-shadowing and extremely comforting sense that God had been at work in Evan’s life for a long time.

Evan’s spiritual journey and awakening had, in point of fact, started long before today. I wasn’t exactly sure who had been involved in his life up to this point, but I was sure God now had a small part for me to play in Evan’s story.

“Actually, Evan, it’s pretty easy. You just talk to God—what we thumpers call prayer.”

We smiled, and I continued. “Just let God know you’re ready—invite him into a relationship with you, into your heart, and he’ll come in. First you have to realize that you’ve done wrong. Then you have to be willing to trust him with your life and your choices.”

Evan nodded and closed his eyes. “Lord,” he whispered, “I begin.”

It was the shortest and sweetest prayer I had ever heard.

He looked up at me and smiled.

We were both silent—sitting together after a conversation we had begun as doctor and patient and con- cluded as spiritual brothers.

“Evan, the Bible says that when we admit to God our wrongdoing—just agree with him that we’ve missed the mark— he will instantly and eternally forgive our sins. And based on that forgiveness, he’s willing to become your friend and your Lord and to reserve a room for you in heaven.”

The tears were still flowing down his cheeks. He nodded.

“The Bible also says that when we receive Jesus, when we believe in his name, he gives us the right to become children of God, not like when we’re born physically but when we’re born spiritually—of God.”

Evan nodded, tears still running down his cheeks.

“So, my friend, if you’re a child of God and I’m a child of God, then what does that make us?”

He thought a moment and then smiled. “Brothers?” he whispered.

I smiled and nodded.

“I’ve never had a hug from a brother,” he said quietly.

I slowly pulled him up and felt his arms encircle my shoulders.

He was very, very weak, but his hug was very, very real. After we hugged, I eased him back down.

“Would you like to see a pastor today to talk a bit more about this?”

He smiled, nodded, and squeezed my hand.

We were quiet for a moment as I thought about our extraordinary encounter. I hadn’t been trained to incorporate spirituality into my medical practice, and despite my initial discomfort, my time with Evan had seemed so spontaneous and sincere. Once Evan gave me permission to share all of who I was as his physician, it had seemed natural.

“Evan, I need to go check that X-ray, okay?”

I went to the X-ray reading room, and on my way back to ICU, I saw one of the RTs running toward the unit. I walked quickly into ICU and arrived just in time to see Evan surrounded by nurses and in the process of being intubated by the RT.

“What happened?”

“He just had a respiratory arrest. BP has bottomed out. Bradycardia. Okay to get him on a ventilator?”

I nodded my assent and went to work.

But from there, things went downhill fairly quickly.

Evan’s pneumonia quickly evolved into ARDS—a severe form of respiratory disease that is very difficult to treat—and then he went into kidney and liver failure. He died late that afternoon.

The autopsy report confirmed the pneumonia but blamed it on a bacterium I’d never treated before—Pneumocystis carinii.

The report also confirmed multi-organ failure and a form of cancer—Kaposi’s sarcoma—but said the cancer was confined only to his skin.

I could only assume, with what I knew then, that this unusual infection had overwhelmed his immune system and caused his death.

I called Richard’s shop to give him the results, but the number had been disconnected.

I then called Richard’s home—but, once again, the number had been disconnected.

Ella Jo told me she heard that Richard had closed the shop soon after Evan’s death and left the area. I was never able to find him, but I wondered if he didn’t know, even then, that Evan’s death had in some way been related to their relationship.

For Evan had not died of cancer. Nor would such a mild bacterium have overwhelmed an intact immune system.

I now know he died of a disease that was then unnamed—HIV/AIDS.

So Evan was my first patient with this horrible disease.

But he was also the first patient with whom I shared my personal faith so forthrightly—and the first to so openly ask me to do so.

Looking back over a long career in family medicine, Evan’s case and his decision to give his life to Christ represented one of the high points.

But what his autopsy did not show, and could not show, was that Evan died a new man—spiritually.

He had become a friend of God. He had been born as a son of God on the day we celebrated the birth of the Son of God.

And his life truly began the morning of the day it ended.

I know I’ll see him again one day. I hope he’ll give me—his brother in the Lord—another hug.

How to Keep Normal Labor Normal – Part 12 – Prayer

This blog series is designed to help women who are developing a birth plan join together with like-minded birthing professionals so as to have a shorter and safer labor and birth. Although written primarily for professional birth attendants, I hope information will be helpful to lay women planning their birth. Today we’ll look at the tenth “P” of my 10 “P’s” of keeping labor shorter and birth safer — prayer.

Although labor and delivery has been considered a “spiritual event” by midwives at least since the publication of Spiritual Midwifery(82) in the 1960’s, there is some recent literature that looks at the influence of spiritual beliefs on labor and delivery outcomes.

One study which examined whether family physicians were aware or not of their patient’s spiritual belief systems stated, “these results suggest that family physicians are infrequently aware of faith beliefs and experiences among their patients.” (83)

Others have commented on how important a component spirituality is to medical care in general: “We emphasize the importance of understanding the relationship between patients’ religious beliefs and their ability to deal with stress,” (84) and that, “Spirituality is an important aspect of health care that is not often addressed in modern day primary medical practice.

The authors conclude that, when appropriate, spiritual issues should be addressed in patient care since they may have a positive impact on patient health and behavior.” (85)

One excellent review shared with practitioners a method for reviewing a patient’s spiritual belief systems using the acrostic SPIRIT where:

  • S = Spiritual belief system;
  • P = Personal spirituality;
  • I = Integration and involvement;
  • R = Ritual practices and/or restrictions;
  • I = Implications for medical care;
  • T = Terminal event (delivery) planning. (86)

Although prayer and strongly internalized religious belief systems have been shown to have a positive association with positive health outcomes, very little data is available for maternity care outcomes.

For an event that midwives consider “intuitively spiritual” (82) the paucity of research is surprising.

However, one study did examine the influence of religious belief on maternity care outcomes and concluded, “Maternal and neonatal complications occurred significantly more often in women who identified themselves as having no religious preference than in women who had a religious affiliation … We conclude that a small positive influence of religion … appears to be a directly beneficial effect.” (87)

Here’s the entire series:

  1. Philosophy,
  2. Partners,
  3. Professionals,
  4. Pain control,
  5. Procedures,
  6. Patience,
  7. Preparation,
  8. Positions,
  9. Payment, and
  10. Prayer.

    Citations:

    (82) Gaskin IM. Spiritual Midwifery. 3rd edition. Summertown, TN : The Book Publishing Co., 1990.
    (83) King DE, Sobal J, Haggarty J 3d, Dent M, Patton D. Experiences and attitudes about faith healing among family physicians. J Fam Pract 1992;35:158-62.
    (84) Sherill KA, Larson DB. Adult burn patients: the role of religion in recovery. S Med J 1988;7:819-24.
    (85) McKee DD, Chappel JN. Spirituality and medical practice. J Fam Pract 1992;35:201-8.
    (86) Maugans T. The SPIRITual history. Arch Fam Med 1996;5:11-6.
    (87) King DE, Hueston W, Rudy M. Religious affiliation and obstetric outcome. South Med J 1994;87:1125-8.
    (82) Gaskin IM. Spiritual Midwifery. 3rd edition. Summertown, TN : The Book Publishing Co., 1990.
    (83) King DE, Sobal J, Haggarty J 3d, Dent M, Patton D. Experiences and attitudes about faith healing among family physicians. J Fam Pract 1992;35:158-62.
    (84) Sherill KA, Larson DB. Adult burn patients: the role of religion in recovery. S Med J 1988;7:819-24.
    (85) McKee DD, Chappel JN. Spirituality and medical practice. J Fam Pract 1992;35:201-8.
    (86) Maugans T. The SPIRITual history. Arch Fam Med 1996;5:11-6.
    (87) King DE, Hueston W, Rudy M. Religious affiliation and obstetric outcome. South Med J 1994;87:1125-8.

    Faith-Based Health and Healing – Part 5 – What Causes Sickness?

    Theologians tell us that, in one sense, from a Biblical perspective, all sickness has its ultimate origin in sin because human suffering stems from the fall and the sin of Adam and Eve (Genesis 2:15 – 17; Romans 1:28 – 32). But that’s not the way many people think of sin causing sickness. It’s very common for me to see patients who believe that their sickness or disease is caused by a specific sin or wrong decision. There are others who believe that all illness is due to specific sin. Is this true or false?

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    Faith-Based Health and Healing – Part 12 – Biblical Principles on Which to Base Medical Decisions and The Power of Faith

    This is the last entry in this series — which has been one of the most popular I’ve written. I hope it’s been helpful for you and hope you recommend this blog series to your friends as the Bible gives clear principles on which we can rely when making decisions about alternative therapies with spiritual roots. Some have noted that most of the passages condemning occult practices come from the Old Testament. Most theologians teach that Christians are not bound by many of the Old Testament laws, such as those related to worshiping in God’s temple. Does that mean that prohibitions of divination and magic no longer apply to Christians?

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    Faith-Based Health and Healing – Part 11 – Look to the Bible, Not Inner Voices, for Guidance

    When investigating an alternative therapy, be concerned about those that involve listening to other spirits. But what about listening to an inner guiding voice? Guidance by intuition and inner voices has become more in vogue today than guidance through reason and objective evidence. Postmodernism has contributed to this acceptance with its notion that we all create our own reality, that whatever we believe is OK. But, is it?

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    Faith-Based Health and Healing – Part 10 – Biblical Characters Condemned for Pursuing Certain Forms of Healing

    The Bible recognizes the great temptation inherent in healing by evil spirits and illicit healers. The Old Testament describes an intense conflict between legitimate and illegitimate approaches to healing and spirituality. An incident involving King Ahaziah, the eighth king of Israel, clearly demonstrates this:

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    Faith-Based Health and Healing – Part 9 – Life Energy and Medical Magic

    Alternative therapies based on “life energy” use principles just like those generally attributed to magic. Although “magic” is difficult to define concisely, magical practices do have common features. Magic involves specific techniques or rituals by which people attempt to manipulate supernatural powers to meet their immediate needs. How should Christians respond?

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    Faith-Based Health and Healing – Part 8 – Illegitimate Spiritual Practices.

    Alternative medicine as a whole is not rooted in any particular religious tradition, but some therapies are. A number of healing rituals and traditions are part of the Wiccan religion (also called “white witchcraft”). Eastern religions often view healing as dependent on the movement of “life energy” through nonphysical channels that coincide with the physical body. Native-American religion uses herbs as part of its healing rituals. In a number of nature religions, shamans contact spirit beings or guides to get advice on how to treat and heal those under their care. Should Christians be concerned about these practices?

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    Faith-Based Health and Healing – Part 7 – Not All Healing is From God

    How we pursue health and healing is very important. Our concern, as Christians, is that there are wrong ways (even evil ways) people can pursue and receive healing. We wish to make the case that healing achieved by inappropriate means is healing that is not good and, in our view, is healing that is not from God.

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    Ironically, the most devout are the most likely to utilize death-to-the-end treatment

    The New York Times reports, “Terminally ill cancer patients who drew comfort from religion were far more likely to seek aggressive, life-prolonging care in the week before they died than were less religious patients.” What does this story mean?

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    Faith-Based Health and Healing – Part 6 – Why God’s Response to Prayer Isn’t Always to Heal

    Despite what many television preachers tell us, the Bible does not teach that God’s response to a prayer to cure illness is an immediate physical healing. The overall teaching of the Bible is that sickness can have different origins. Therefore, claims that all illnesses can always be cured by “believing prayer” or “casting out demons” are simply not biblical. Let me explain why.

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    Faith-Based Health and Healing – Part 4 – Can Faith be Unhealthy?

    While faith can have positive effects on health, it can also have negative effects. Although religious beliefs are a source of comfort and support for many people, for others they are a source of stress and emotional turmoil.

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