A palliative care physician writes about the mystery of faith

When I worked in an academic medical center’s intensive care unit, I watched people with diverse belief systems, ethnicities, and social locations struggle to make decisions that felt ethical and loving in the face of the harsh and uncertain realities of illness. Often, it seemed to me that patients and their families were rooting these decisions in various combinations of logic, emotion, and guesswork. At the time, the hospital had only one nurse focused on palliative care, a branch of medicine that treats symptoms like trouble sleeping and shortness of breath even when the disease causing them is incurable. The discipline has expanded widely in the last decade. Now most hospitals have at least one palliative care physician.

Sunita Puri’s luminous, lyrical memoir is a literary introduction to the work of palliative care. She combines vivid detail with profound reflection to give insight into the experiences that unfold between medical staff, patients, and families near the end of life, particularly around medical decision making.

Many health-care practitioners are aware that patients bring their faith, their family, their emotional wounds, their fears, and the dynamics of their family systems into their experiences of illness. When medical professionals cannot grasp the complexity of their patients’ lives, Puri writes, they find their decisions unreasonable, and communication breaks down. “There is no freeway between the mind and the heart; a statement of medical facts does not lead to acceptance.”