Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Near death


Overcoming anxiety about the end of life allows one to explore concerns with empathy and openness. A willingness to learn about patients’ spiritual beliefs can help clinicians provide compassionate and holistic care.

I was fortunate to spend significant time with three of my four grandparents, but I steadfastly avoided being with them at the end of their lives. When my maternal grandmother was in hospice for chronic obstructive pulmonary disease, I dreaded visiting her. When my 92-year-old paternal grandmother was blind and nearing the end of her life, I didn’t want to take time away from college to be with her. During my winter vacation, I felt irritated by having to drive my maternal grandfather to medical appointments. With hindsight and maturity, I now understand that my behavior stemmed from discomfort with illness and death. 


As a second-year medical student, I’m keenly aware that my chosen profession will mean that I regularly encounter illness and death. How will I respond? Will I rise to the challenge? At Hopkins, my formal medical education included a course in end-0f-life and palliative care. I was pleasantly surprised that we were also invited to focus on patients’ spiritual and religious concerns. I found myself reflecting on three key themes: the importance of spiritual/religious values in the lives of some patients, the need for physicians to be comfortable discussing these values, and practical approaches for addressing these concerns. 


Although I was raised with some religious training, my maternal grandparents were very observant Catholics. I saw firsthand the strength my grandmother’s faith provided her and she viewed death as a transition to heaven and reunification with God. My grandfather, in contrast, feared death, worrying about being judged and condemned to hell. This dichotomy reminds me of a patient described by Bernard Lo and colleagues in “Discussing Religious and Spiritual Issues at the End of Life.” The patient, Mr. R, responds to questions about CPR by saying, “I trust that God will decide when it’s my time.” The authors suggest responses like, “Tell me more . . .” This allows for an open-ended dialogue that prioritizes the patient’s beliefs and values. 


Here are some things I hope to practice in patient care:  


1. Be present. 

Always convey engagement through words and body language. 


2. Learn about the patient’s religious/spiritual beliefs by asking open-ended questions if they bring this topic up.


3. Learn about various religious/spiritual traditions to provide sensitive care.


Formal instruction in end-of-life and palliative care inspired me to consider death and dying in ways I previously avoided; I now feel a little more confident addressing death and dying. I’ll continue to prioritize learning about different spiritual and religious practices to bring compassion and understanding to the next stage of my educational journey. 











This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.