S T A N F O R D M E D I C I N E
18 Number 2 Fall 2001
Bruce Feldstein, MD
Takes: Attending to the spirit
In 1997, when he was an emergency room physician at Kaiser-Permanente Medical Center in Santa Clara, Bruce Feldstein, MD, found himself compelled to respond to a patient’s distress in an unorthodox fashion: He prayed with her. The 86-year-old woman, previously diagnosed with lung cancer, had come to the hospital complaining of nausea, vomiting and dehydration. A CT scan revealed that the cancer had spread to her brain. When Feldstein told the patient the results, she looked pale and stricken, declaring the news to be a “death sentence.”
Feldstein, who had met the patient just 15 minutes before, did not know how to respond at first. Then he noticed a large cross hanging at the woman’s throat and realized what he had to do. He would pray with her. Though they were of different religious backgrounds — he is Jewish, she is Catholic — he asked if she would like to pray with him, and she said she would. Sitting on a stool next to her, Feldstein closed his eyes, took her hands and spontaneously offered a prayer as a Stanford intern stood by, mouth agape. The patient slowly repeated Feldstein’s words. Then she began the Lord’s Prayer, and he joined in. She concluded with a prayer in Spanish to Saint Jude, the patron saint for the destitute and homeless.
When their prayers had concluded, Feldstein noticed that the woman seemed calmer. She looked him in the eye and thanked him as a tear fell down her cheek.
The unusual encounter proved to be a vision of things to come, for Feldstein now prays daily with his patients in his role as a full-time chaplain at Stanford Hospital. He came to the job through an unconventional route: Chaplains typically are theologians or members of the clergy. Indeed, few U.S. physicians have been willing to relinquish the prestige and financial security of a medical practice to enter a career built solely within the spiritual realm of caregiving. But Feldstein, whose 19-year career as an emergency physician was punctuated by many spiritual questionings and journeys, seems remarkably well-suited for the role.
“For me, state-of-the-art medicine must include explicit attention to meaning and spirituality,” he said recently while making his rounds of the hospital. “That’s the piece I’m a champion for, because it’s what physicians and health care providers are pledged to do — to fix and cure when possible, to relieve sometimes and to comfort always.”
Though Feldstein is a doctor by training and experience, his approach to patients is not that of a traditional Western physician.
“The typical paradigm of medicine is to find the problem and fix it using a mechanistic approach. With me, it’s to respond to a patient’s pain and suffering through service and relationship. I join patients in their world and help them connect with their sense of meaning, hope, faith, support, love, courage, purpose and dignity. As a result, healing occurs,” he says.
The son of a general practitioner, Feldstein, 47, entered medical school at 20. In his final year, he accepted a prestigious psychiatry residency at Harvard. But after an expedition to the Himalayas, where he was moved by the teachings of Tibetan Buddhists, Feldstein had a change of heart. He subsequently found a new direction after spending three months as a volunteer physician in a Cambodian refugee camp in Thailand. At that point he decided to go directly into a career in emergency medicine. He became board-certified through his day-to-day practice, obtaining specialty training through courses at major medical centers.
This was the early 1980s, when the human potential movement was gathering steam, and Feldstein got caught up in the fervor. He returned from work at the hospital one day to find a brochure for a course led by Jean Houston, the well-known spiritual psychologist who later became an advisor to Hillary Clinton.
“I know it sounds crazy, but while I was sitting there, the picture of Jean Houston came to life. Her arms were outstretched, and she was moving for a few seconds,” Feldstein recalled.
He attended Houston’s “Mystery School,” a program that immerses participants in various spiritual and religious traditions. As a result of that experience, Feldstein decided he wanted to build a greater sense of spirituality into the medical care system. He applied for a grant from the National Endowment for the Humanities to develop a class in ethics and values for first-year medical students at Harvard. But he was ahead of his time. It would take more than a decade — until the spring of 2001 — to see that class come to life, in the form of a required course developed by Feldstein and colleagues at Stanford. The course, “Spirituality and Meaning in Medicine,” designed for first- and third-year medical students, is the first of its kind offered at Stanford.
Feldstein came to California in 1991 and worked in the emergency department at Kaiser-Permanente in Santa Clara. There he directed the department’s peer review and quality improvement program and helped start the Stanford-Kaiser emergency medicine residency program. He spent seven years at Kaiser — until he tore two discs in his spine while helping a friend move. He limped his way through the emergency room but gradually came to realize the injury meant his day-to-day practice as a physician was nearing its end.
Feldstein began to search for a less physically demanding way to use his skills. He considered the conventional options, such as administrative medicine and quality improvement, but decided to go the way of his heart.
“I went off my map,” he says. “It’s like the Biblical exodus. When the Jews left Egypt, they could have taken the well-traveled Philistine trade route and arrived in the Promised Land in 11 days. Instead they went the opposite route, through the wilderness, where there was no map, following God’s lead. I decided that’s what I would do — go the way of the wilderness.”
During this soul-searching period, he spent two years as a visiting scholar at the Stanford Center for Biomedical Ethics. He found his calling while attending a conference of Jewish ethicists and chaplains from around the country.
“I never felt so at home as I did sitting there and talking about pastoral care,” he says. “I had found my home.”
In 1999, he entered the Clinical Pastoral Education Program at Stanford, a nationally accredited residency program for hospital chaplains, directed by Stanford Hospital’s chaplaincy. The day Feldstein was accepted into the program, he visited the hospital chapel for the first time. He entered the peaceful space to discover a back-lit waterfall with rocks and plants on the right side, facing an arc of symbols representing the religions of the world. The room mirrored a dream Feldstein had had three or four years earlier, in which he had envisioned a waterfall, rocks and plants facing a group of people from diverse religious groups. Feldstein saw this as more than sheer coincidence; it was one of the many synchronicities in his life.
“When I walked in, it was such a confirmation. I knew I was in the right place at the right time.”
As a hospital chaplain today, he is responsible for the spiritual care of patients on the coronary care unit, regardless of their religion. He also visits the roughly 700 Jewish patients who come to Stanford and Packard Children’s Hospital each year. In addition, he teaches spirituality and religion in the School of Medicine and trains medical students in spiritual care. Because of his background as a physician, Feldstein is often called upon to counsel other physicians and nurses who are facing difficult issues. Feldstein’s efforts are making a difference, notes Joan Mersch, RN, nurse manager in the coronary care unit.
As a result of working with Feldstein, “Some of the physicians have made a quantum leap in understanding how the mental, physical, emotional and spiritual are all parts of a human being, and if any one of those is out of balance, the other will be too,” Mersch says.
Feldstein says his knowledge of medicine allows him to tailor his pastoral care to the patient’s condition. For instance, one day he visited a patient in the coronary care unit who was awaiting a heart transplant. Veins in the patient’s neck were bulging with fluid, and his breathing was fast and labored, with a bubbly sound to it. Feldstein says he immediately recognized the signs of congestive heart failure, in which the fluids back up into the lung.
“One of the most marvelous things happened. We got to talking, and he told me he had just become a Christian and had begun to read the Bible. He asked if I might make some suggestions for him. So I took the Bible. It fell open to Psalm 69, which says, ‘Save me, Oh God, for the waters are up to my neck.’ Inside his body, the waters were literally up to his neck. He knew at that moment that God was with him, and he was deeply comforted.”
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