I heard about Sandra in whispers at the nurses station, before meeting her face to face. “Such a lovely woman,” they would say in hushed, sorrowful tones. “Such a tragic story.” Sandra was my patient during my night shift rotation, meaning she was one of nearly fifty souls for whom, between sunset and sunrise, I addressed all complaints and crises.
Sandra, in all her loveliness, never had either.
I first met Sandra on my fifth night of being her overnight doctor. Her nurse called me around 2AM to report she was experiencing pain after a daytime procedure and needed some extra medication for relief. I reviewed the basics of her story before going to see her—a middle-aged woman with a new diagnosis of colon cancer and a few months to live—and expected to enter a room full of sadness, anticipated a pair of empty eyes.
Instead, I arrived to find a frail but grinning woman curled up in a bright red fleece blanket, surrounded by piles of books and beads that she was methodically, almost joyfully weaving into bracelets. The chair at her bedside was void of friend or family, but she seemed unbothered by this solitude. As I approached her bed, she looked up at me warmly, her eyes shining sweetly through grimaces of pain, her greying, frizzy hair bursting outward like a halo around her forehead, and apologetically requested a small dose of medication to tide her over for the night. “I’m so sorry to bother you with this doctor,” she offered, “I know how busy you must be.”
I was instantly struck by the calmness of Sandra’s presence, which persevered even in this moment of pain she was experiencing. “Please, don’t apologize!,” I replied, feeling compelled to return her smile, “We’re here to help you be comfortable and safe.”
Sandra’s authenticity made it easy to be kind in return. Her bedside was an oasis of peace in an otherwise stressful shift, where the chance of night-time strokes or heart attacks kept me constantly on edge, where I worried about not knowing my fifty patients well enough to treat them all with the precision of care they deserved (a daytime doctor at this hospital cares for 8 patients, for reference). Her peacefulness was so magnetic that I found myself always passing her room on my way elsewhere, even to absorb her from a distance. But Sandra had me puzzled as well: how could a woman this close to death, with such poor prognosis for survival, be so happy and full of life?
Over the next few nights I made it a point to have at least one conversation with Sandra before the inevitable nocturnal chaos ensued (and before she dozed off, swaddled in her fuzzy, red blanket). In those few interactions, she opened her life to me without hesitation. She spoke lovingly of her Buddhist faith, and her mantra “Nam myoho renge kyo” meaning (to my best interpretation of her lengthy translations) “let us devote our mind and body to the manifestations of the mystic nature of life.” She spoke with passion about her accomplished career milestones, exciting travels in international trade and fascinating properties uncovered in local real estate, and about her recent mecca to a sacred hilltop in Japan, which she took immediately after learning about her terminal diagnosis. She also shared about her beloved relationships, including her dear husband, and her secret hope that he would fall in love again one day after she passed, so that–as she deeply hoped–she could be reincarnated as his grandchild.
Sandra was a remarkable woman. I could have stayed by her bedside all night, living vicariously through her storied adventures, exchanging energies of solace through what seemed like a more harrowing reality for me, than for her.
I never asked her, point-blank, how she was facing death with such positivity. But I didn’t really need to. She showed me: in the way she treated her fellow patients (asking permission before turning on her lights at night), her doctors and nurses (after answering our questions, asking us how we were feeling), her family and friends (insisting they not ‘waste time’ at the hospital with her and instead live their lives). Sandra emanated love—the kind that breaks boundaries of this world and the next, leaving one to be remembered long after they are gone.
On my last evening of being Sandra’s overnight doctor, I stopped by for a formal farewell, in case the opportunity didn’t present itself before dawn. She greeted me with her signature open-arm embrace, and beckoned me to sit beside her bed. “Open up that drawer there,” she motioned, with her signature excitement for even the smallest happiness. I pulled the metal handle, looking inside at a pile of beaded treasures; she had been crafting handmade bracelets for her doctors and nurses for two weeks straight, and decided to hand them out tonight. “Pick whichever one you’d like,” she offered, and smiled with satisfaction as I placed a string of bronze beads around my wrist.
“I’ll think of you every time I wear it,” I replied, in awe of the generosity of a woman from whom so much was being taken.
“We’ll see each other again some day,” she reassured me. And though she meant it in a different way than most people mean it, her belief made me a believer, too.
Meeting Sandra prompted me to wonder: what component of her strength and resilience was attributable to her faith and spirituality? While there have been dozens of studies in scientific literature observing the impact of faith on our health and well-being, these studies are notoriously difficult to design, and results are often difficult to draw meaningful conclusions from. We cannot objectively measure, for example, how much prayer impacts longevity in the same way we can measure how a certain dose of chemotherapeutic agent extends life. (How to ensure all people receiving ‘prayer’ are being prayed for in the same way? Does that variation matter? What if someone randomized to a non-prayed-for control group is secretly being prayed for unbeknownst to the study managers?)
One of the most rigorous meta-analyses on this topic was published in American Psychologist in 2003 by Dr. Lynda Powell (1), and it’s full of fascinating conclusions. She and her team examined nine core hypotheses about the effect of faith on health, and of these nine, only one hypothesis—namely that “attendance at religious services protects against death”—showed consistently strong evidence of being true; the other eight had either a lack of evidence, or showed evidence of being false. (2) Notably, she found that:
“Seven independent studies, most of which drew on large, representative populations, found that healthy church/service attenders had approximately a 30% reduction in risk [of death] after adjustment for important confounders and a 25% reduction in risk [of death] after further adjustment for established risk/protective factors…This suggests that church/service attendance confers some generalized type of protection against mortality.”
When discussing the possible reasons why this might be, Dr. Powell and her collaborators had several thoughtful suggestions about what regular church/service attendance could offer, including opportunities to have social roles “that provide a sense of self-worth and purpose through the act of helping” (versus simply being the recipient of help), and opportunities to observe, “vicariously yet consistently those who model a variety of positive, hopeful, compassionate, and caring behaviors, attitudes, and beliefs that are highly conducive to living a healthy lifestyle.” They also considered that being a member of a faith community could offer a lifeline of important social resources to marginalized or disadvantaged individuals.
My patient Sandra endorsed regularly attending services at her local Buddhist temple, though she also had her own robust private spiritual practice (a habit that does not yet have a strong scientific evidence base for contributing to longevity). She was also not necessarily experiencing any improvements in objective health and longevity (she was expected to pass away within six months), but her quality of life certainly was far superior to most people in the hospital.
Most studies, understandably, need to measure quantifiable outcomes like years of longevity, days in a hospital, or months of survival with a deadly disease. It is indeed difficult to measure subjective notions of happiness, satisfaction, peace, and quality of life; but most people on or near their deathbed might argue that these factors matter as much (if not more) to them than simply how long they live. There is also a dearth of research about the effects of non-Judeo-Christian religious activity, and it is difficult to design robust cross-faith studies that can be meaningfully account for factors that may be specific to each faith community.
While there is still much research to be done in this field, and though it is a field in which it is difficult to design high quality studies, Sandra’s impact on me suggested that there is a positive role religion can play for believers, even if not lengthening, at least brightening, their remaining time left.
- Powell, L. H., Shahabi, L., & Thoresen, C. E. (2003). Religion and spirituality: Linkages to physical health. American Psychologist, 58(1), 36-52.
- The other eight hypotheses, which the study finds no evidence to support, include:
- Religion or spirituality protects against cardiovascular disease.
- Religion or spirituality protects against cancer mortality.
- Deeply religious people are protected against death.
- Religion or spirituality protects against disability.
- Religion or spirituality slows the progression of cancer.
- People who use religion to cope with difficulties live longer.
- Religion or spirituality improves recovery from acute illness.
- Being prayed for improves physical recovery from acute illness.