I couldn’t even describe what it meant to be a spiritual person or put words to what spirituality is, yet I would be facilitating a class for MS1s on the importance of and how to take a spiritual history. I was looking for some thinking space; my girls kept telling me I should quit my job as a primary care physician and just bake, and there was something telling me I should bake some babka. The Jewish equivalent of a coffee cake, it could be a segue to sharing my own religious and spiritual background in class.

The first loaf, tasty but homely, we kept at home, sharing with neighbors in the spirit of community. The second babka would go to share in our small weekly course on clinical skills development. Barely a month into medical school, more a mentor than an instructor, I enjoyed fostering that spirit of collegiality early – I remembered those challenging times. Chocolate sugar cake can make it briefly slightly better.

The last babka needed to go into the break room in my clinic. What speaks to the spirit of a functional health care team more than a pastry in the break room as a temporary retreat from the ever-demanding and slowly collapsing world of primary care?

The summer sun already bore down in the triple digits as I plotted my walk to clinic, then grand rounds and back to school for class. Draped in my messenger bag for the clinician’s ever-present laptop, two babkas, utensils, and leftover “You Are Magical” napkins, the sweat beaded down immediately as I walked the two blocks down the street.

I strode right past the entrance to the emergency room. I often see people there, still wrapped in temporary scrubs and wristbands, lying in the shadows, dispirited and lost. But what I had not seen before was a man in a wheelchair, arms outstretched, head fixed and gazing at the unforgiving clear August sky.

The “Hey, buddy’s” started pouring out, hoping for an answer that never came. I checked his wristband and started calling his name, glanced at his nearby discharge paperwork, frantically looking for some pearl that would fix this. I called 911 and waited on hold.

One minute. An older man walks past, straining to avoid eye contact. Two minutes. I am pacing. He breathes like a guppy – is this agonal breathing? His pulse is thready. I try to move him, but I cannot. I run to the ER and tell the security officers that he needs help. They have heard about him – he discharged earlier, and a cab was supposed to get him. Their jurisdiction for helping people ends at the bridge, and someone pushed his wheelchair two feet past it. They ask if I called 911, as I show them my phone, still on hold at 5 minutes.

Guys, he looks like he is dying, and he is too big for me to move him on my own.

They reluctantly talk to their supervisor. I return to check on my … patient? Fellow citizen/human? It is not a position I know how to describe well – trying to help someone as a passerby but feeling like all I can do is try to get others to help.

Three security officers walk sternly towards us. They do not want or need my medical opinion – they can see the gravity of it. They wheel him back towards the hospital in the same wheelchair they pushed him out in hours before. Two women walk by. They saw him earlier and told the security guards too.

Drenched in sweat and anger, I still did not know what being spiritual was, but I did not feel spirited. A disheveled, wet mess, I stomped into clinic with the babka, announced its arrival, and sat. People wanted to hear the story – several of them had seen the man in that same spot hours before on the way into work. Hours. The babka baked at 350 for 35 minutes. The man had been baking at 90 to 100 in the sun nearly naked for more than three hours, not fifty yards from an emergency room. People kept asking if he was homeless, as though that would change something about how they should feel.

At grand rounds, I found out the hospital was just named the most socially responsible hospital in the state. I tell the head hospitalist how recently discharged patients dying in front of the hospital thusly seems bad from a PR standpoint.

How do you take a spiritual history when someone cannot speak? A chaplain today augments our class and draws my story out – the students, only weeks into their courses, just stare. They see the entrance to the ER from our classroom. They had just broached the topic of inequity in the health care of those experiencing homelessness that morning. They wanted to know if he was homeless. They liked the babka.

After we finished reading bedtime stories that night, I checked with the hospitalist of the day to see what happened. He had been the one who discharged the man the night before. He had looked okay then. Now he was intubated and on vasopressors. He had not wanted to leave the hospital back to his encampment on the outskirts of town.

I think I learned that spirituality is a connection to something bigger than us, a group united in a cause bigger than one person. I could not find it in the eyes of all the people who passed by this man without helping. I always thought of spirit and spirituality as an ever-present force but did not appreciate the variability of its intensity. Spirit undulates, attracting people to the highs like a mountain top, but needing a little extra push to get through the lows. I am not sure I would have figured that out without the babka.

Scott Selinger is an internal medicine physician.