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“Around the time of the coronavirus outbreak, 2019 also marked a full century since the death of Sir William Osler, who revolutionized medical training. Despite some lingering debate over whether Dr. Osler’s pneumonia-related death should be counted among the 50 million lost to the 1918 influenza pandemic, his notes suggest that he believed the flu precipitated his demise.
As a chaplain who teaches medical humanities and professional identity formation in a medical school, I’ve been thinking about how Dr. Osler might have guided medical students during COVID-19. Here, the evidence is a little clearer. Dr. Osler advocated for trainees to ‘let no day pass without contact with the greatest literature in the world,’ and to spend 30 minutes each night reading from a bedside library of ten classics. Included among these recommended texts were the Old and New Testaments and Sir Thomas Browne’s Religio Medici, a physician’s spiritual testament.”
Elizabeth J. Berger is an advanced practice board-certified chaplain and a narrative medicine specialist.
She shares her story and discusses her KevinMD article, “Why spiritual health is so important for medical students.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Elizabeth Berger. She’s an advanced practice board-certified chaplain and a narrative medicine specialist, and she wrote the KevinMD article “Why spiritual health is so important for medical students.” Elizabeth, welcome to the show.
Elizabeth J. Berger: Thank you so much for having me.
Kevin Pho: Thank you. So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?
Elizabeth J. Berger: Yeah, a little bit about what I do and how I got here. I teach medical humanities and professional formation at the Zucker School of Medicine at Hofstra/Northwell, here on Long Island. In my capacity as the burnout chaplain, I work with health systems, clinicians, aspiring clinicians, and chaplaincy departments to demystify spiritual health, which really refers to a sense of connectedness, meaning, and purpose, which is essential to clinician well-being, and to underscore the connection to patient-centered care.
I trained in an ICU, which was invaluable, because what I found is that the chaplain is unique. I’m the only person on the clinical team who is there as much for the staff as I am for the patients and the families. What I found is that no one ever approached me in public, but if I sort of hung around the break room in between visits to patients, somebody from the staff would inevitably find me, and they wanted to talk. I really saw an important need.
So at the end of my training, I actually pursued a master’s in something called narrative medicine, where we use literature and reflective writing to deepen awareness and improve relationships in medicine and health care. I did this because I recognized it as really an invaluable vehicle for the delivery of spiritual care to health care professionals in a way that transcended religion and would not be threatening, no matter what the person’s belief system was. This is something that’s poorly understood about chaplains: We are not trained to preach to the sick about God. We are trained to read the subtitles of human interaction and accompany people by doing that. So there’s enormous overlap between the disciplines of chaplaincy and narrative medicine.
That was the academic part of my background. The thing about me that probably surprises most people is that I had a secular Jewish upbringing. I didn’t come into this until well into my adult life, and I was raised on science. So I have sort of a unique background for doing this work, and I feel very well prepared to do it.
Kevin Pho: All right, let’s transition into the KevinMD article that you wrote, “Why spiritual health is so important for medical students.” Now, for those who haven’t read your article, can you just walk my audience through it and maybe share a story of why you decided to write it?
Elizabeth J. Berger: So everybody has a story about what didn’t happen when the pandemic struck, right? This is the story of what happened when the pandemic struck for me. I had been asked to participate in a session at the conference of the AAMC, the American Association of Medical Colleges, in Chicago, which was of course canceled in March. It had to do with integrating spirituality as a dimension of clinician well-being and clinical practice, and it was directed to medical education, obviously.
So when that was canceled, I was invited to write this piece in support of medical students, which I was very happy to do. I had written a companion piece for people already in medical practice for Medscape, so this was an opportunity to sort of change the focus and write something specifically to support medical students.
Kevin Pho: So why is spiritual health important for medical students, and what are some of the things that you can do to teach them?
Elizabeth J. Berger: So spiritual belief, again, may or may not include religious practice, but we know that 95 percent of Americans believe in God, a universal spirit, or a higher power. What surprises most people in health care is that among physicians, it’s 76. There isn’t a lot of room in medical culture to talk about that, because again, there’s so much emphasis now on scientific mastery, and the consequence of that is an association with anti-intellectualism and professional embarrassment. So people know how they feel. They may have these beliefs, but they’re not really encouraged to talk about them.
So there is an obstacle to drawing upon the cache of resources that we each have inside. Again, it may have to do with connecting to nature. You may be better served by meditation. If religious practice is your preference, that is helpful too. But we need to begin to make space to allow medical students, while they’re still in training, to attend to their spiritual health. We know this because, irrespective of whether or not they’re religious, whether or not they believe in a divine being, people are very frequently called to medicine.
Kevin Pho: Medical students, they have a lot of coursework, they’re very busy. What are some of the things that they can do to increase their spirituality?
Elizabeth J. Berger: Again, it depends on the individual. There’s no prescribed way. We accompany people; we don’t direct them. But narrative medicine is a very good start in reflective practice, because it draws upon the same things that we experience in prayer or in meditation. We find meaning, we find purpose, we find connectedness. There are things they can do individually, and there are things they can do in groups to attend to their spiritual well-being.
I think it’s important to say that we are in the moment of a lifetime right now, but even before the pandemic, if you are going to spend your career on the threshold separating life and death, you’re going to have experiences that rock you back on your heels. We need to encourage aspiring clinicians to draw on the inner resources that they have available to them, whatever they are, to sustain themselves and, distinctly, to sustain their patients. We know that clinicians who attend to their own spiritual health are going to be better prepared to attend to the spiritual needs of their patients.
Kevin Pho: We’re talking to Elizabeth Berger. She’s an advanced practice board-certified chaplain and a narrative medicine specialist. She wrote the KevinMD article “Why spiritual health is so important for medical students.” Elizabeth, there’s an increasing amount of burnout, both in medical students and in physicians. Studies say that approximately 50 percent of physicians are burnt out from their jobs. Now, is there a connection between burnout and spirituality?
Elizabeth J. Berger: There is a connection between burnout and spirituality, because I think that today especially, there’s an enormous emphasis on resilience, but we have to think very carefully about what resilience means. OK, should we just bounce back when there have been insults to our being, to our sense of purpose, to our sense of meaning? Not a lot makes sense right now. So the moment really calls, even before now, but especially now, the moment really calls for us to encourage clinicians to engage with their own spiritual health and to help make sense of what is going on around them. That’s what the work of spiritual health really is. It’s about making sense of what’s happening.
Kevin Pho: Elizabeth, is there something that you know now that you wish you knew back before, when you were starting out?
Elizabeth J. Berger: Yeah. So when I began my training in New York, I was trained under people in a program that was accredited by the U.S. Department of Education, and I was very specifically trained for clinical care. I was unaware at that time that this is not necessarily the standard everywhere in the country. There are plenty of places where they may rely on community clergy, whose training might be directed more to faith-specific pastoral care.
This really came to light for me about a year ago, before the pandemic. In 2019, there was an article in a very prestigious medical journal, and it was written by someone who is a national figure. It highlighted professional chaplaincy in health care, and I was very excited about it. But when I read it, I saw immediately that this article was about someone who had not really trained the way I had trained, and, most importantly, I saw evidence that there was an agenda that is not necessarily the agenda of professional pastoral care in clinical settings. It’s very important not to come with an agenda; we’re really there to accompany people. This is really sort of the first tenet of verbatim, no-no, in clinical pastoral care. It’s the first “do no harm” of spiritual care.
So I wrote a commentary in response, because it was so important to me that this not be representative of all spiritual care in the medical literature. But the thing that it really underscored for me is that people from other disciplines really don’t know what we do, and even more so, they don’t know that they don’t know. We know this because the article was peer-reviewed. So closing this gap and demystifying what it is that people who work in spiritual care and health care do is very, very important going forward.
One of the things is that a lot of the work in spiritual care was started by people in palliative care, and this has sort of become the purview of end of life, and that’s not really the way it works. The existential crisis of illness happens more in the beginning: at the moment of injury, at the moment of diagnosis, at the moment you cross over that threshold. Susan Sontag very famously wrote about that, that we hold dual citizenship in the kingdom of the well and the kingdom of the sick. At that moment that we change over from one to the other, where you were walking around in life and now you’re not OK, you know you’re not OK, and you don’t know if you’re ever going to be OK again, is the real moment of existential crisis. We tend less to focus on spirituality at the beginning of the illness; it’s saved more for the end.
So I think it’s very important to recognize a few things. One is that medicine is a scientific discipline, but Daniel Sulmasy at the Kennedy Institute very famously said, “Illness is a spiritual event.” I would take it even one step further. I would say that witnessing illness is also a spiritual event, and we need to be conscious of this so that we’re our best when we take care of patients.
Kevin Pho: And my final question, Elizabeth: What is the take-home message that you want to leave with the KevinMD audience?
Elizabeth J. Berger: We’re in an unusual place in 2020, because we’ve doubled life expectancy, and we’ve traveled in space, and we can clone sheep, but not one among us can artificially reproduce a single blade of grass. I think it’s helpful to be mindful of that when we work in medicine, that unexplainable events happen all the time. I know this, having trained in an ICU: People made it who were never supposed to make it, and we lost people we were never supposed to lose.
So my take-home message is essentially: Find ways to attend to your spiritual health in ways that are meaningful to you, stay curious about what lies in the shadow of our epistemological grasp, and know that chaplains are here to help and to accompany you according to your own agenda, in ways that are helpful to you.
Kevin Pho: Thank you so much for sharing your time and insight, and thanks again for being on the show.
Elizabeth J. Berger: Thank you so much for having me.
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