Bearing Witness To Faith
My first mistake was trying to shake my patient's hand. She smiled, looked at mine and shook her head.
"We like you," my patient's friend said with a smile. She was standing at the patient's bedside in the intensive care unit. "But we don't touch."
Then I noticed their similar dresses, long and plainly designed with only solid, dark colors for decoration. Their traditional clothes, next to the beeping alarms and flashing lights of our ICU gadgets, looked like the result of someone meddling with a time machine.
The embarrassment from my initial infraction kept me from asking any more questions, though I had many. Where are you from? What do you believe? What can I do to treat you? What can't I do? I wouldn't gather until later, as the Yiddish phrases began tumbling out, that she was an Orthodox Jew.
"Can I listen to your lungs?" I asked my patient.
"Of course you may," she said. "Touching for medical care is fine."
Ah, now I was getting it.
Patients have a variety of beliefs that guide their daily activities and interactions with the world. They hold these beliefs as sacred, sacrificing all kinds of pleasures and conveniences and even social acceptance in order to follow their cultural guidelines. But when it comes to health, to medicine, we can brush all that aside, at least for the moment. A handshake was too intrusive, but my physical exam-much more intimate-was allowed for the sake of survival.
To me, that made perfect sense.
I encountered something like this once before. Last summer, when the heat of the day scorched on for hours into the evening, my patient collapsed. No one really knew why, but since she was so dehydrated it seemed like an easy fix. But I had wondered why this woman, already fragile from age and comorbid disease, abstained from food or drink on a day like today. The answer is only simple if you ask.
She had fasted for religious purposes, from sun up to sun down. The Muslim holiday of Ramadan fell during the longest days of summer, but that didn't stop the devout from practicing their faith.
Intrigued, I met with Muslim leaders in the community and with chaplains at my hospital. I learned that, according to Muslim beliefs, there were plenty of exemptions from the fasting requirement. One of the exemptions allows the sick to skip the fasting ritual. While my patient saw herself as an able-bodied woman of even stronger faith, medical providers like myself could suggest taking advantage of the exclusion. We just needed to open the conversation.
Yet again, it seemed that faith was willing to take a back seat to the medical needs of the faithful. As medical providers, we can stand proud and know that our care takes priority over eons of established religion. As a testament to the progress of the modern age, our judgment truly comes first.
Except when it doesn't.
Except when the patient in question isn't an Orthodox Jew or a Muslim, but a Jehovah's Witness. Except when maintaining his faith trumps all, even life itself. Except when he looks at you with soft eyes and tells you "No blood products, ever," and thanks you for obliging. Except when his hematocrit drops and he becomes dizzy and falls over. Except when he vomits a cascade of bright red blood down the front of his hospital gown and the color drains from his face.
Except when the one thing that can save his life is forbidden.
Then we merely stand aside and bear witness to faith.