DALLAS – At 83, Carl Smith found himself facing quadruple- bypass surgery and the real possibility that he might not survive.
Within hours on this spring morning, Dr. Mark Pool temporarily would bring Smith’s heart to a stop in an attempt to circumvent its blocked passages.
To help his patient confront the uncertainty, Pool also did something unusual in his profession: He prayed with Smith.
The power of healing: Medicine and religion both have had their days, and they haven’t always been able to coexist. But as today’s medical treatment becomes more holistic, doctors increasingly are taking spirituality into account.
Studies show a majority of patients want their faith recognized, and most medical schools now have classes related to the topic. In general, the new thinking asks doctors to note their patients’ spiritual leanings and open doors to expression, especially when life is at risk.
Pool, a highly regarded heart and lung surgeon at Texas Health Presbyterian Hospital Dallas, is fervent about his Baptist faith. For about a year, he’s routinely asked patients if they’d like him to pray with them before surgery – a gesture he said is always appreciated but one that exceeds advocates’ suggested bounds.
“A physician should be open to a patient’s spirituality but shouldn’t push religion on patients,” said Nathan Carlin, assistant professor at the University of Texas Health Science Center at Houston. “That’s confusing personal and professional roles.”
An inherent power differential divides doctors and patients, said Christina Puchalski, director of George Washington University’s Institute for Spirituality and Health and co-editor of the recently published “Oxford Textbook of Spirituality in Healthcare.”
“They’re coming to us for something other than prayer,” Puchalski said. “If I, as a patient, perceive (a surgeon) as having my life in his hands, and he asks me to pray and I say no, he may not treat me well. And that’s putting undue pressure on the patient.”
As the saying goes, there are no atheists in foxholes: The idea that your fate is out of your hands offers fertile ground for re-examination.
“The moment somebody tells you that you have cancer, you’re going to believe in something,” said Dr. Rohan Jeyarajah, a gastrointestinal surgeon at Methodist Dallas Medical Center who prays with patients.
But the situation, he said, requires caution: “We have to be careful about being in a position of perceived authority and not overstepping that bound. This is like a teacher-student relationship. There’s a chance you could be inappropriate.”
Pool pushes forward, eager to share the belief that drives him without making people feel awkward or flouting that power imbalance.
“I don’t want to exploit their situation,” he said. “At the same time, I want to give them the opportunity to explore the faith that I know.”
The push has met with some backlash – from busy doctors reluctant to take time away from other concerns or others who don’t like talking about it.
“Some staff are more comfortable with it than others,” said Mark Grace, vice president of mission and ministry for Baylor Health Care System.
He doesn’t reject the idea of doctors offering to pray, but, “If you don’t listen to the answer, that’s where you get into problems. ... The doctor needs to be prepared if the patient says no.”
George Washington University’s Puchalski said the bottom line is doing what’s best for the patient.
“Physicians are generally not trained to lead prayer,” she said.
To illustrate the power differential she said exists, she recalls a patient who also was a fellow parishioner. One day, she noticed the woman hadn’t been to church for a while, then realized the woman hadn’t come into her office either.
When the patient finally resurfaced, Puchalski pressed the matter.
“She told me, ‘I thought you’d be upset that I switched churches.’ That gives you an idea of the power we have over patients. So I would really caution against (taking advantage of) that,” Puchalski said.
Pool gleans his patients’ spiritual beliefs at their initial meeting. Then, on the morning of surgery, he said: “This is a time when a lot of people turn to faith. Would you mind if I prayed with you?”
No one, he said, has ever declined, not even those who believe differently or not at all.
It’s 6 a.m., and Pool, shiny black boots poking from beneath blue scrubs, briefs Smith on his surgery. At 83, Smith is fit, mowing the yard occasionally and still an active driver.
But coronary artery disease caught up with the retired Farmers Branch, Texas, pharmacist, slowing his blood flow and causing chest pain. Over time, it could lead to a heart attack.
Madge Smith, his wife of 63 years, and Leah Wilson, his youngest daughter, are near. Scott Smith, his son, would join later.
Pool explained his plan: He’ll make an incision down Smith’s breastbone, then take arteries from his left and right side, and a vein from his leg, to form new channels for blood to flow through his heart.
“So,” he told Smith, “you told me you’re a Sunday school leader. Would you mind if I said a prayer for you?”
Smith was touched. Pool placed his hand on Smith’s shoulder and began:
“God, thank you for Mr. Smith. We ask that you would guard his life, keep him safe and bring him through this operation. Replace any anxiety that he may have. Give him a great assurance of your love and your power.
“I ask you to watch over our team, that you give us all clarity of thought, that you guide my hands as they move. We pray these things in Christ’s name. Amen.”
“Amen,” Smith said.
Later, as Smith’s family awaits the outcome, his wife said: “I have never had a doctor do that. It just meant so much to us. We just thought it was sent from God.”
Out in the family waiting area, Smith’s son Scott said: “God has his hand on everything. He’s in control. We’re not. It’s in God’s hands.”
Pool initially wondered if his praying might give patients pause, whether they’d worry he wasn’t confident enough in his own skills to get through the surgery.
“It’s been the opposite,” he said. “They value the humility.”
Smith’s operation was a success. Six weeks later, Pool met with him one last time.
“You’re doing extremely well,” Pool said. “I’m going to fade away now. You don’t have to come back and see me.”
“I’d be 6 feet under if it wasn’t for you,” Smith said.
Pool dismisses the thought. “I’d like to say a prayer with you,” he said.
Smith bows his head and closes his eyes.
“Lord,” Pool begins, “thank you for getting Mr. Smith out of the hospital and getting him home. We ask that you continue that process of healing and give him a spring in his step once again. In Jesus’ name we pray.”
Smith is upbeat. He believes the gesture will help him get better. And in the end, that might be the most important thing of all.