To Linger in an “AMEN”

By Sarah Nadarajan, MD
Loma Linda, California

“Be anxious for nothing, but in everything by prayer and supplication, with thanksgiving, let your requests be made known to God; and the peace of God, which surpasses all understanding, will guard your hearts and minds through Christ Jesus” (Philippians 4:6,7) (1)

Medicine is filled with rounds. There are pre rounds, rounds, post rounds, afternoon rounds, evening rounds, grand rounds, and at LLUMC (2) – whole person care rounds. Internal medicine is notorious for prolonged rounds which may conclude with your mind going “round and round.”

One evening while doing my “goodbye rounds” I decided to be intentional about offering a prayer before I prepared the sign out for the oncoming team. This was my first time doing “goodbye rounds,” and one experience would forever change the way I viewed prayer as a resident.

She was admitted for dyspnea in the setting of recurrent stage IV breast cancer. We were trying to keep her alive long enough to start an experimental trial at UC Irvine. After 2 thoracenteses and bronchoscopy, the results revealed her deepest fears. The right lung had a suspicious mass and the left lung reported malignant exudative effusion. For a woman who has experienced the full breadth of the health care system – double mastectomy and chemoradiation, this new revelation was an unwelcome shock.

We seem to be experts in comfort but not cure. Too often, our best efforts fall short in meeting patient expectations. As I stood at her bedside, I was plagued by a timeless question: “what more can we do, that we have not already done?”

How do you tell a patient that the correct answer for all her questions is “I don’t know.” Even if I offered to pray, what would I say? There are no prescriptions or procedures to reverse her pathology. Then I realized, where words fail, the Holy Spirit intercedes. I reached for her hand and committed her case to the care of the Great Physician.

Normally patients let go after I say, “amen.” But this time was different. With her eyes closed, her face relaxed, her breathing comfortable, and her demeanor peaceful, she held on long after the prayer was finished. Not even the flurried activity on the ward could interrupt the healing that embraced that moment. When she was ready, she let go.

What if more physicians were intentional about lingering in an “AMEN” with patients? There will always be patients to admit, pages to answer, orders to place, notes to write, families to call, procedures to do, diagnoses to make, plans to change, nurses to update, and patients to discharge. While the work never stops, we can pause to bring heaven one step closer to earth. Prayer is easy, but to linger in an AMEN of unease, unrest, and uncertainty is more difficult.

As the sun set over the hospital, I was gently reprimanded that God is not surprised by medical perplexities. Neither is there a case He cannot manage. It’s okay if I don’t know the answer, because I can always refer to One who knows the end from the beginning. As I persist with patients in doubt and distress, I can always count on heaven’s presence to linger long after I left the room. Now that is evidenced based medicine!

1 = New King James Version
2 = Loma Linda University Medical Center