Spirituality and Medicine

Fort Wayne M EDICIne Fall 2019 • Volume 17, Issue 3 Official Publication of the Fort Wayne Medical Society Quarterly

Lutheran Hospital Lindley J. Ninde House, 1904 Hospital origins Spirituality and Medicine

Saint Joseph Hospital Rockhill House, 1868 Parkview Hospital Fort Wayne City Hospital 1878-1891

Fall Guest Contributors: Health Commissioner, Dr. Deborah McMahan Judge Wendy Davis Rev. Dr. Dennis Goff Dr. Matthew Farber John D. Eckrich Dr. Ryan Singerman Rev. Patrick Riecke Brenda Jank Dr. William R. Clark, Jr. Susie Cisney, RN Dr. Micah Smith Gina Bailey Dr. David Donaldson Dr. Amy Dawson Dr. Prevesh Rustagi Marcia Haaff, CEO, The Lutheran Foundation Meg Distler, St. Joseph Community Foundation Vision

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Society Officers

President: Board of Trustees: Sara Brown, MD Isa Canavati, MD Donald Giant, MD David Pepple, MD President-Elect: David Donaldson, MD Brian Herr, MD William Pond, MD Erin Jefferson, DO Francis Esquerra, MD Steven Ko, MD Abhijit Shukla, MD Immediate Past President: Ryan Singerman, DO EX-OFFICIO: President FWMS Foundation: Michael Yurkanin, MD—President, Parkview Hospital Medical Staff Sharon Singleton, MD Joseph Kosnik, MD—President, St. Joseph Hospital Medical Staff Chairman of the Board: David Paris, MD—President, Lutheran Hospital Medical Staff Fen-Lei Chang, MD, PhD Andrew Offerle, MD—President, Dupont Hospital Medical Staff Secretary: W. David Pepple, MD—Trustee, 12th District Medical Association Geoffrey Cly, MD Erin Jefferson, DO—Alternate Trustee, 12th District Medical Association Treasurer: Zachry Waterson, DO—Dir ector, Fort Wayne Medical Education Program Scott Stienecker, MD Betty Canavati, MS—Editor, Fort Wayne Medicine Quarterly Executive Director: Cammy Sutter—President, FWMS Alliance Joel Harmeyer Dave Albin, MBA—ISMA, Director of Membership & Marketing Indiana State Medical Association ISMA President: Delegates: Lisa Hatcher, MD Patricia Bader, MD Tom Gutwein, MD William Pond, MD Jed Thompkins, MD Sara Brown, MD Jason Hanna, MD Abhijit Shukla, MD Zachry Waterson, DO ISMA Past President: Isa Canavati, MD Erin Jefferson, DO Ryan Singerman, DO Alternate Delegates: Stacey Wenk, DO Kathryn Carboneau, MD Tyler Johnson, MD Sharon Singleton, MD Brianna Serbus, MD Fen-Lei Chang, MD Steven Ko, MD David Sorg, MD Deborah McMahan, MD ISMA President Elect: Sampath Ethiraj, MD Mary Ann Meo, DO Scott Stienecker, MD Barbara Schroeder, MD Roberto Darroca, MD Don Giant, MD David Pepple, MD Do You Have Malpractice coverage Questions About is about smart choices and excellent service... HOSPICE? because you deserve both. We’ll provide you with tailored quotes from the nation’s Contact Visiting Nurse Today leading insurance carriers, giving you options, expertise, and the ability to make better informed decisions. 260-435-3222 It’s what we do. 800-288-4111 www.vnfw.org 888.51AEGIS [888.512.3447] aegismalpractice.com • Palliative Care • Hospice Care • Hospice Home • Grief Support

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4 Fall 2019 AEGIS QtrPg-ChestnutHills.indd 1 2/19/19 3:21 PM Contents Society Officers �� 4 Fort Wayne Editor’s Note �� 6 About the Cover �� 6 Medical Society Legislative Meeting �� 7 Staff Annual Holiday Luncheon and Bazaar �� 7 Spirituality and Medicine – Why Now? �� 8-11 Spiritual Assessment Tool �� 12 Mindfully Stewarding Your Patient’s Whole Health �� 13-15 Dangerous Inclinations �� 16-17 Hearts and Minds – Religion and Spirituality in Medicine �� 18-19 Faith in Medicine �� 19 Calming the Pre-op Atmosphere with Prayer �� 20 Joel Harmeyer Reflection, Awareness, and Acceptance �� 21 Executive Director LookUp 2019 Faith Conference �� 22 [email protected] The Way Out of No Way – Physical, Mental and Spiritual Wellness �� 23-24 Hope Meets Faith in the Allen County Courts Lindsey Luna to Begin Restoring Lives �� 24-26 Administrative Assistant Thank God, We Live In Good Times �� 26 [email protected] Mission of Hope and Miracles �� 28-29 Restorative Wellness �� 30-31 By No Accident… �� 32 www.FWMS.org Incorporating Spirituality – IU School of Medicine Fort Wayne �� 33 Addressing Spirituality �� 34-35 Fort Wayne Medicine Quarterly Spiritual Origins: Lutheran Hospital �� 36-37 is the official publication of Parkview Hospital �� 38-39 the Fort Wayne (Allen County) Medical Society, Inc. Saint Joseph Hospital �� 40-41 For advertising rates and Faith-Based Counseling �� 42 information, contact Joel at the Executive Office: List of Advertisers Phone: 260-420-1011 Shawnee Construction & Engineering �� IFC Fax: 260-420-3714 709 Clay Street, Suite 101 The Towne House Retirement Community �� 3 Fort Wayne, IN 46802 Visiting Nurse �� 4 [email protected] aegis Malpractice Solutions �� 4 Dulin, Ward & DeWald, Inc. �� 14 The views expressed in Fort Wayne The Lutheran Foundation �� 24 Medicine Quarterly articles are Sperry Van Ness Parke Group �� 27 those of the authors and do not necessarily represent those of the Turnstone �� 29 Fort Wayne Medical Society. Run Hard. Rest Well �� 30 Editorials are welcome and members Parkview Physicians Group �� 31 are encouraged to respond to an opinion that might be different from Hoosier Physical Therapy �� 32 their own. Cancer Services �� 33 References from articles will be NeuroSpine & Pain Center �� IBC included, if space allows. When not included, references can be Breast Diagnostic Center �� OBC obtained through the editor.

Fall 2019 5 Editor’s Note Elizabeth J. Canavati, M.S.

Spirituality and medicine is a topic When my mother was in about the same physical shape at that illicit excitement in some around 100 years old, her children would take turns caring people and caution from others. for her but she didn’t ask us to say the rosary with her. She Spirituality is such a personal issue did want it in her hands at bedtime. It seemed to reduce and some people want to keep that her anxiety and help her fall asleep. aspect of their life private. I suspect for many saying the rosary or nightly prayers is a My grandmother was a very reli- form of meditation, which shifts the mind from daily wor- gious woman. She fell when she ries to something relaxing and spiritual. It aids many in was 90 years old and broke her hip. falling asleep with positive feelings and reduced anxieties. I Replacements weren’t available then and she never really find identifying what I am grateful for each evening a good walked unassisted after that. She gradually lost her eye way to end the day. sight and spent the last few years (died when she was 98) When soliciting contributors for the Spirituality and in a rocking chair all day. Medicine issue, we were blessed with many great respons- She was blessed to have two daughters to care for her dur- es. I hope you find this Quarterly informative and worth- ing these final years. One thing that was a given was the while. Dr. Deb McMahan and Rev. Dennis Goff were the afternoon rosary. It provided her with so much solace dur- force behind this topic/issue and were invaluable for its ing her long day. completion. We owe them many thanks. I remember taking care of her as a young teen when my The deadline for the Winter edition is November 10th. aunts would leave town for a few days. My mother was Editorial Board: working and I was the designated gramma-sitter. I didn’t Elizabeth Canavati, M.S. – Editor mind spending my days there because my aunts had won- William Argus, M.D. derful books that I could read. I wasn’t much company for Isa Canavati, M.D. my grandmother or her for me but I did know I was to say James Heger, M.D. the rosary with her every afternoon. I would sometimes Sage Lee, M.D. stumble on the mysteries that would introduce a decade David Sorg, M.D. of Hail Mary’s but she never admonished me on my lack Jonathan Walker, M.D. of knowledge. She was happy I helped her fulfill her daily obligation. Quarterly Contributor: Deborah McMahan, M.D. – County Health Commissioner

If we are creating ourselves all the time, then it is never too late to begin creating the bodies we want instead of the ones we mistakenly assume we are stuck with. – Deepak Chopra

About the Cover: In researching the origins of the hospitals, I was quite The hospitals in Fort Wayne are a major source of fascinated by the rapid evolution of the hospital struc- employment, healing and spirituality. This was the case tures and the need for more nurses to assist the physi- from the first day they opened their doors up to the cians with caring for the sick in Fort Wayne. The two present. Their origins are a tribute to the importance of major nursing programs – St. Joseph School of Nursing having a place for optimal medical care and healing but and The Lutheran Hospital Training School for Nurses – also addressing the spiritual needs of the patients and started after each hospital was dedicated. their families. Each of the three major hospitals started Although the hospitals have changed many times over in as a result of the various religious communities recog- the past 150 years, they are still dedicated to the health nizing a need for good, quality patient care. and well-being (physically, mentally, emotionally and spiritually) of all who seek such help.

6 Fall 2019 Fort Wayne Medical Society Membership Physicians and 12th District Membership Physicians The Fort Wayne Medical Society and the Fort Wayne Medical Society Alliance invite you to be present to learn about proposed legislation and issues important to your practice and your medical community, as well as the health and well-being of all citizens in our state. Annual Legislative Workshop Wednesday, October 16, 2019 Fort Wayne Country Club This well-attended, fun event offers a chance for our members to celebrate the 6:00 pm – 7:00 pm Holiday Season with friends and guests, Legislative Panel while also providing the opportunity to shop with local vendors, who graciously 7:00 pm – 8:00 pm Meet & Greet Legislators and Physicians donate 10% of their sales back to our organization! Casual evening of networking and visiting Hors d’oeuvres to enjoy Wednesday, ISMA Representatives and Local Legislators will welcome this time to visit and share thoughts December 4, 2019 and concerns. Ceruti’s Banquet &

PLEASE NOTE: Event Center In appreciation for your continued support and dedication 6325 Illinois Rd. to the FWMS and FWMS Alliance there will be NO CHARGE for this evening. Shopping from 10:00 am – 11:30 am It is our pleasure to welcome you. So that we might have an idea of the number of guests Lunch from 11:30 am – 12:15 pm who will be attending, please RSVP by October 4, 2019, More shopping – concluding at 2 pm in one of the following ways: Mail: FWMS, 709 Clay St., Ste 101, Fort Wayne, IN 46802 Email: [email protected] Phone: 420-1011 • Fax: 420-3714 Fort Wayne Medical Society ALLIANCE CONNECT. PROMOTE. SUPPORT. www.AllianceFW.org

Fall 2019 77 Spirituality and Medicine – Why Now? Deborah McMahan, M.D., Commissioner and Rev. Dennis Goff

Why start a community/professional “Dennis, from a pastor perspective, why do you discussion on spirituality and health/ think the time is right to begin this kind of profes- medicine? Well to answer that ques- sional community dialogue?” tion I need to disclose that I am a I’m a pastor, so the church is the person of faith; not just on Sunday setting where I serve. And it’s in faith, but take it to work faith. I the church that experiences like the know many of my colleagues are one below reinforces for me why like minded. We may not share the collaboration between the faith and same faith, but I think you also lead medical community is important. a life driven and guided by your beliefs. So why now? A few months ago, I preached a Medicine to me is as much a calling as it is a profession. I sermon based on John 5:1-15 (see love the science of medicine. I love the process involved in page 23). The focus of the Biblical making a diagnosis but I am also very aware that this is a text is on physical and spiritual healing. As I prepared the physical and spiritual person before me. To that end, for sermon, however, I saw an opportunity to address mental the first 20 years of practice I silently incorporated prayer health as well. into my appointments and I also included an informal spiritual history for my patients. But things have changed Realizing the importance of reducing stigma associated in medicine, healthcare and society over all. with mental illness, particularly in the faith community, I said in the sermon how important it is for us to talk to our The data supports that people are more stressed than ever doctors about our mental health needs. More specifically, and that is very much reflected in their behavior. Who it may be necessary at times to see a counselor or therapist, would have ever thought that most of the workplace and if prescribed by a doctor, take medications. For people violence that occurs, happens in the healthcare setting? of faith, all of that is important as we also seek God’s help In my opinion, the demands on doctors and nurses have through our prayers and petitions. never been higher and the patients’ attitude has never been worse. And that is my answer to “Why now?”. After church that morning, I was surprised by the number of people who said they appreciated the specific references I made to the integration of seeking appropriate medi- “I need my faith now to hold me to a higher cal care, along with their faith, as a part of mental health standard and equip me to provide the same treatment. But what surprised me the most happened a few level of care to all patients, regardless of their weeks later. attitude.” A woman came out of church and said she was in church a few weeks earlier when I mentioned mental health in Frankly, that is not easy. I am getting older, tired and frus- my sermon. She said she has been suffering from severe trated, all of which creates the opportunity or even justifi- panic attacks for quite a while because of a traumatic situ- cation to do less than. And less can have significant conse- ation she experienced several years ago. However, she’s quences in this profession. been reluctant to seek medical or clinical care because she thought as a Christian she should be stronger in her faith Spiritual health has been demonstrated consistently to lead than that. to better outcomes for our patients. Thus improving my spiritual health will likely contribute to better outcomes for She went on to share that when she heard me say what I my patients. So from my perspective, that is another reason did a few weeks earlier, she called a counselor that very for “Why now?” week, and had already had several appointments. She wanted me to know that as a result of that, she is feeling But like every other issue, I find that collaboration among better than she has in years. “Thank you,” she said, “for experts strengthens any initiative. I reached out to Pastor talking about mental health in the church Dennis Goff to look at spiritual health from their perspective and to see how he views medicine and spirituality.

8 Fall 2019 The reason I share the story is because what I did that Spirituality and Medicine Sunday as far as mental health is concerned was permis- Deborah McMahan, M.D., Commissioner sion giving. As someone who represents the voice of the church, I said publicly that there is no shame in going to Throughout history, religion and see a therapist. In a way, my words gave permission to her spirituality and the practice of to seek clinical care, in addition to seeking God’s healing. medicine has been intertwined; in The counseling care the woman received was not a fact many hospitals were started replacement for her faith in Christ. Likewise, having faith by churches and staffed by nuns. It in Jesus is not a replacement for the appropriate clinical/ seems however, medicine has evolved medical care she needed. Rather, the two fit together. to be more a business and we have In the July 2018 edition of the American Medical adopted the biomedical model for Association Journal of Ethics, there is an insightful article patient care. The biomedical model about spirituality/faith and medicine. The authors of the usually does not include an accounting for psychological, article (Aparna Sajja and Christina Puchaslski) conclude, sociological, and spiritual factors that play a role in most diseases. However, in the last 10 to 20 years research continues to identify social determinants of health, adverse child- “We cannot serve our patients well if we only hood events, and spiritual health as issues that really impact focus on the physical aspects of their illness, and measurable health outcomes. Perhaps it is time to develop neither can we rely on others on the team to take a model or a system that facilitates healthcare providers in care of the psychosocial and spiritual issues as collecting the evidenced based information that allows us to ancillary luxuries. The core element of the healing more completely understand and support patients in their relationship is our ability . . . to work in partner- experience of health and illness. In this article, I would like ship with experts in each of these domains.” to provide a brief overview of spirituality in medicine. Terms Let me be clear, I know my place and my place is not to While spirituality and religion are often used interchangeably provide medical care to members in my congregation. for the purposes of this article I would like to define these Likewise, I suspect that most doctors are not clergy. They words. In general, spirituality is more individualistic whereas are not necessarily in a position to convey spiritual insights religion typically involves shared beliefs and rituals. A reli- to their patients (unless they have a personal faith from gion organizes the collective spiritual experiences of a group which they can speak.) But nevertheless, this doesn’t mean of people into a system of beliefs and practices whereas we can’t recognize the importance of our mutual disciplines spirituality is a broader concept that is primarily a dynamic, and how they work together for the benefit of the patient personal, and experiential process. Features of spirituality entrusted to our care. include: quest for meaning and purpose, transcendence, con- nectedness, and values. So you can see that some people may be spiritual but maybe not committed to a formal religion. However most of the research done thus far has focused on religion because there is so much more agreement about its meaning and the associated behaviors can be more readily quantified. The Evidence That’s the point of this Fall . Quarterly There is an excellent article by Dr. Paul Mueller et al in How can the medical and the faith communities work which they review published studies, meta-analyses, system- together in addressing the physical, mental and spiritual atic reviews, and subject reviews that closely examined the needs of people in our area? connection between religious involvement, spirituality and I first want to say I am so grateful to Betty, Joel, Alice, physical health, mental health, and health-related quality of and Jennifer for assisting Dennis and me in putting life (HR QOL). I would strongly encourage that you take together this special Medical Society Quarterly on spiritu- a moment to review this concise article. According to Dr. ality and medicine. Mueller, the majority of the nearly 350 studies of physical

Continued on page 10

Fall 2019 9 Continued from page 9 health and 850 studies of mental health – that have used conversations. You and I have no dog in the fight except religious and spiritual variables have found that religious to help our patients in developing a plan that assists them, involvement and spirituality are associated with better health in feeling physically, mentally, and spiritually balanced and outcomes. This would include cardiovascular disease, hyper- prepared to live an intentionally, purposeful life. I think tension, and the adoption of health promoting behaviors, that many of the questions we ask a patient are meant to depression, anxiety, suicide, and substance abuse. In addi- not only obtain factual information but also to provide an tion, religious involvement is associated with fewer hospital- opportunity for a patient to think about things that are izations and shorter hospital stays. Research has also demon- either difficult or really require some, pardon the expression, strated that spirituality is associated with greater functioning soul-searching. among those who are disabled, and improved health related When Should You Take a Spiritual History? quality of life in folks with cancer, HIV, heart disease, limb amputation, and spinal cord injury – all have high levels of I would imagine many people would think it quite natural HR QOL, if they have religious involvement and spiritual for a physician to talk to a patient about spiritual issues at well-being. the end of life. And while I think that’s important, the earlier in your professional relationship you have this conversa- How Do Patients Feel? tion the better it may influence the medical interventions a Research suggests that most patients have a spiritual life and patient is willing to consider. In terms of clinical decision- regard their spiritual health and physical health as equally making, one study revealed that faith in God was second important. only to a physician’s recommendation on whether or not to take chemotherapy. And decisions regarding withdrawal In fact, research studies have demonstrated up to from life support are also made by patients and families on 94% of hospitalized patients believe spiritual health the basis of religious beliefs. It can become even more com- is as important as physical health, that 40% of plicated when a patient desires a medical intervention that patients use faith to cope with illness, and 25% of goes against their religious communities beliefs. From blood products to antibiotics to antidepressants, it is important to patients use prayer for healing each year. understand the patient’s thought process, including religious But do patients want you and me to ask about their spiritual beliefs, when prescribing or referring – this might be par- health? The answer is very dependent on the type of visit and ticularly important in diseases that may have some type of the setting. The percentage of patients that would like a phy- stigma associated with it. sician to inquire about their spiritual health ranges anywhere Spirituality and religion also affects how patients process from 10% to 70%. And of course, I think this makes sense. and cope with chronic and/or terminal disease. In one study When physicians have such limited time with patients for at Duke University of patients who were admitted to the even routine visits, most patients would not want to trade medicine, cardiology or neurology services, 90% reported off an important medical conversation addressing a physical using religion to some degree to cope and more than 40% or mental health situation to discuss their spiritual health. indicated that it was the most important factor that kept Predictively, as the severity of illness increases or they are them going. Patients often report that religious beliefs and admitted to the hospital, the percentage of people who desire practices are powerful sources of comfort, hope, and mean- this conversation increases. ing particularly in coping with a medical illness. Realistically, how many issues that you and I discuss with Obviously, a spiritual health assessment does not need to be patients do they really want to talk about? Obesity, smoking, done at every appointment. According to Dr. Harold Koenig, addiction of any kind, marital strife, code status are all topics the best time to take an initial spiritual history is when you that are personal, revealing and sometimes uncomfortable for are: both of us! But this information is important when developing • performing a new patient evaluation, a holistic treatment plan that really facilitates a patient feeling • admitting a patient to the hospital, nursing home, hospice well. And, as you will see below, getting comfortable taking or palliative care, or a spiritual history can really help a patient feel better understood and actually deepen the provider-patient relationship. • doing a health maintenance visit as part of a well person evaluation. Why You? Spirituality plays a significant role in a patient’s identity, In my opinion, no one but a physician or NP/PA has the sense of purpose, and defines the rules that they follow when objective intimacy that allows for such direct and personal

10 Fall 2019 nobody is looking. Taking a spiritual history from a young with respect to health. We have worked to develop a list of adult has the potential to actually make them think a bit resources for you and your staff to utilize (see page 42). --- long after the appointment is over. And in general, when The Healthcare System a patient feels a sense of purpose, they are much more likely to be compliant with the often laborious recommendations For you and I to do such an assessment requires that the business aspect of healthcare also recognize the importance you and I make to achieve or maintain balanced physical and of this and builds the necessary time into their approach to mental health. providing healthcare services. I think Allen County may be How to Take a Spiritual History ready to embrace this approach to healthcare. I know many If you’ve read this far, I hope you’re at least somewhat con- of you also feel this is an important part of healthcare deliv- vinced that this is an important issue, which is likely to lead ery, I think we just need to find a consistent way to incorpo- to better health outcomes for your patients, it often strength- rate this into our practice. ens the provider-patient bond, and finally, you’re the person I realize that I’m asking you to take a spiritual history in to do it! There are a number of ways you can do this and addition to previous requests to screen for mental health on on the following page, you will find three different examples top of the routine medical screening that you normally do. that I have seen recommended. One is very factual and one is But when the life expectancy for the American population is more open-ended. I think this could be incorporated into the decreased for the first time in decades due to deaths by sui- medical record and be completed while the patient is in the cide, drug and alcohol overdose, and liver disease from drug waiting room or you could actually do it one on one in the and alcohol abuse, I would argue the healthcare system needs exam room. As long as the information is collected in a sensi- to at least consider changing. If not you and I, who will ask these important questions? tive and respectful manner, I think that whatever makes you comfortable will work. You and I may be the only people having these conversations with folks one on one. But it doesn’t mean that we need to be Dr. Koenig recommends that if a patient indicates at the the ones to solve them. We also need our colleagues in men- beginning of the spiritual history that he or she has no inter- tal health and the faith community to become a consistent est in religion then you focus on spirituality; you might ask partner to whom we can refer patients who have such issues. about: • how the patient copes with illness Lest you think this is too lofty a goal – I have seen the power • what gives life meaning and purpose in the setting of their of functional collaboration – really working with each other current illness – among different professions around the addiction issue. Judges, police officers, CEOs, pharmacists, doctors, research- • do they have cultural beliefs that may impact any treatment ers, nurses, counselors, families, peer recovery coaches – all plan that you generate. working together to create a team to address a patient’s/ It is very important that you support and encourage religious offender/client/child/peer’s journey to recovery right here in beliefs that bring your patient comfort and help them cope Allen County. So I think we can expand this multidisciplinary with difficult situations. It is not the expectation that you and approach to the rest of healthcare. I will address spiritual struggles or spiritual questions or even provide spiritual counseling. Unless you have received spe- My Last Thought cial training, your role is to refer or confer with the patient’s There’s one more role for faith that I would like to share. As spiritual leader and if the patient is not affiliated with a spiri- I get older, a little more tired, and patients become a little tual organization, a hospital chaplain might be able to assist more difficult I find that my faith is what holds me to a con- as well. Dr. Koenig has written an excellent book that is a sistent standard. Most patients don’t know all that I should relatively quick read that discusses the details of the spiritual be doing or all the questions I should be asking. I could easily slip by with doing just a little less than. Unfortunately my exam, what to do with that information, and some of the pit- little less than can result in a misdiagnosis that could easily falls that you will want to avoid. I found it to be immensely affect the quality of life or health outcome for my patient. helpful: https://www.amazon.com/Spirituality-Patient-Care- And they might never know. But for me, the Holy Spirit When-What/dp/1599474255 would know. So I use faith to strengthen my resolve, patient If you find beliefs that are unfamiliar, which is likely in a by patient, to ensure that I do my best; that my 4 o’clock diverse community such as Allen County, again it is impor- patient gets the same treatment my 8 o’clock patient gets. So tant to be respectful. It is important for you to reach out if from my perspective spiritual health is an important function you are struggling to understand different religious practices for not only my patients but for me as well.

Fall 2019 11 Spiritual Assessment Tool

Example #1: FICA Spiritual History Tool Category Sample question Faith and Belief Do you have spiritual beliefs that help you cope with stress? If the patient responds "no" consider asking: what gives your life meaning? Importance Have your beliefs influenced how you take care of yourself in this illness? Community Are you part of a spiritual or religious community? Address in Care How would you like me to address these issues in your healthcare? Adapted with permission from the George Washington Institute for spirituality and health. FICA spiritual history tool

Example #2: HOPE Questions for Spiritual Assessment Category Sample Questions H: Sources of hope What are your sources of hope, strength, comfort, and peace? What do you hold onto during difficult times? O: Organized religion Are you part of a religious or spiritual community? Does it help you? How? P: Personal spirituality and What aspects of your spirituality or spiritual practices do you find most helpful? practices E: Effects on medical care Does your current situation affect your ability to do things that usually help you spiritually? and end of life issues As a doctor, is there anything that I can do to help you access the resources that usually help you? Are there any specific practices or restrictions I should know about while providing your medical care? If the patient is dying: how do your beliefs affect the kind of medical care you would like me to provide over the next few days/weeks/months? Adapted with permission from Anandarajah G., Hight E. Space E. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment

Example #3: The Open Invite Mnemonic Category Sample Questions Open (i.e. open the door May I ask your faith background? to the conversation) Do you have a spiritual or faith preference? What helps you through hard times? Invite (i.e. invite the Do you feel that your spiritual health is affecting your physical health? patient to discuss spiritual needs) Does your spirituality impact the health decisions you make? Is there a way in which you would like for me to account for your spirituality in your healthcare? Is there a way in which I or another member of the medical team can provide you with support? Are there resources in your faith community that you would like for me to help mobilize on your behalf?

12 Fall 2019 Mindfully Stewarding Your Patient’s Whole Health John D. Eckrich, MD, Founder, Grace Place Wellness Ministries, St. Louis, MO

A physician is a steward. He/she is Scriptures: “And the Lord God formed man of dust from the not the owner or master of his/her ground, and breathed into his nostrils the breath of life; and patient’s wellbeing, but is a guide, a man became a living soul.” (Genesis 2:7, KJV) caretaker and a good manager of the Rev. Dr. Robert Kolb, Emeritus Professor of Systematic health of those who place themselves Theology at Concordia Seminary, St. Louis (sister seminary to under the physician’s watchful eye. Concordia Theological Seminary, Fort Wayne) frames human- Mindful stewardship is an active and ness in this format: intentional process; you need to be 1. We have a physical nature (body) vibrantly and joyfully working at your craft and specifically focusing 2. We have a psychological/cognitive/emotional/volitional on whole health. nature (mind) 3. We have a relational nature of the whole person to our There is a noticeable shift in our calling, the art and science of Creator (spirit) medicine, these days. If you were trained in the 20th century, like me, I suspect you were similarly schooled to categorize Another contemporary perspective comes from Dr. Teresa your patient’s health and unhealth into increasingly finite cat- Iglesias, medical bioethicist at Trinity International University, egories. Dublin, and the University of Chicago: 1. A human has a body, is organic CATEGORIES 2. A human is an integrated-unity-of-life, a whole entity from the beginning, and simultaneously an individual • physical signs and symptoms describing body ills (heart disease, GI distress, neurologic pathology), 3. A human is a temporal continuity, a being with a history, a being in time • cognitive signs and symptoms (perception, intellectual function, memory, emotions), and We are not machines, built in installments. We are formed with all the genetic blueprints to grow physically, cognitively • soul distress (the purview of religion; triage to theolo- and spiritually from the beginning of life. We grow as a gians and clergy, i.e. generally not our job!). whole, we interact with others as a whole, and we deteriorate and eventually die as a whole. (What happens to the “soul” or We still expend much energy looking at atomic and subatomic “spirit” at death is an entirely different and important discus- sparks and quarks, DNA sequencing and genomes that com- sion beyond the scope of this article.) pose life. Physician-stewardship “best practices” calls us to care for From the time of Greek doctor Hippocrates through the each other, therefore, as whole beings. French philosopher/scientist Rene Descartes, physicians have Perhaps 21st century medical training and practice need a been compartmentalizing disease to better understand diagno- rebooting to the importance of being a whole doctor treating ses and therapy. However, we may well have been indirectly a whole patient. After all, we are seeing the dramatic rise in doing disservice to our patients by assessing them more as the use of medical robotics, artificial intelligence, 3D printing component parts and less as whole beings. of personalized drugs in exacting doses. Patients are bypass- Reflect with me on more than the physiology, but rather the ing their doctors by finding volumes of health information theology of being human. Let’s begin with the foundation that on-line. They’re wearing Fitbits to personalize their every data we are still a spiritual society, diverse in the details, but still point. Where does that leave us, the human physicians caring anchored in religious beliefs. The fact that 90% of Americans for other human beings? believe in a divine power and 75% say they communicate Furthermore, does all this technological advancement make with God and 50% pray daily would suggest that we under- our patients healthier and happier, longer-lived and more func- stand a source of power, and I would say healing, outside of tional into old age? Perhaps. Again, I would ask, what could a ourselves. That suggests the spiritual component of wellness is human advocate, a personally-focused steward, offer to better crucial for many. the care for another human being? Allow me, as a physician Physicians and philosophers from ancient to modern have who is Christian, to share with you a Christian perspective wrestled with what it means to be human. Monotheists that hopefully will be helpful to physicians of any faith in car- (Jewish, Christian, Muslim) turn to the description from the ing for their patients.

Continued on page 14

Fall 2019 13 Continued from page 13

God creates us as whole beings, ones with bodily, mental/emotional and spiritual elements. These elements are mysteriously and integrally related, interactive and interdependent on each other to produce well-being or dysfunction. This means that every physical disorder has consequences for cognition and for our spirit. Mental distress affects the way our bodies function and our souls soar or dive. Spiritual turmoil or calm can influence the workings of our heart, lungs, GI tract, emotions, thinking and immunity. As ones created by God, we are also called to be stewards of not only what is around us, but also of our own beings.

WE CARE FOR OUR: • physical bodies – so we can work and serve one another, care appropriately for all of God’s creatures and the whole of Creation. • minds – so we can perceive and think clearly, remember and relate to ourselves, family and neighbor, connecting in relationships that are helpful rather than harmful. • souls – by the power of God’s Spirit, by being in His Word, receiving His Sacraments (physical signs of His forgiveness and grace), conversing in prayer, and living with the support of faith communities.

As Christians, we believe that because of the fall into sin, all disease, dysfunction and death itself has been brought on by the doubt and disobedience of our ancestors and ourselves. We will die. Our physical bodies are actively growing, but also decaying toward death as we age. As Christians, despite the death that is imminent, we believe that life simultaneously is at work within us because God’s Son Jesus is at work within us. Although we have been created, made perishable by sin, live as “jars of clay”, we also know that God loves us enough to redeem and restore us through His Son. Jesus redeems not just our souls, but he redeems our bodies and our minds. One day, Christ Jesus is coming back for us and he will resurrect and restore not only our souls, but our physical bodies as well. Those resurrected bodies will be “glorified,” imperishable and will never die again. These are some of the spiritual tenets you should understand at least as you care for the Christian patient. So for Christian patients, that complete restoration and salvation is the deepest of promises we cling to. We hold to this certainty of eternal life in Christ in the midst of the most destructive cancer, the darkness of mental illness and confusion, the loss of function or loved ones. Christians are also called by God to be good stewards with all the physical, mental, emotional and spiritual gifts with which God blesses us. We are expected to be actively caring for ourselves by exercise and movement, healthy plant-based foods, adequate rest to recuperate and heal, focus on closeness and accountability to loved ones and family, and living selflessly rather than selfishly with our energy moving outward into service.

14 Fall 2019 Here are several concrete examples you may wish to complement your whole care: • Ask the simple question: Is your faith important to you as we 2. Do you feel there is something you have done that led face this medical distress together? If so, how can I as your to your illness or that your illness is some kind of punish- physician help you? ment? (While there may be consequences at times for 1. Do you have a pastor or spiritual guide that can be help- certain life choices and subsequent illnesses, i.e. smok- ful? ing and cancer, Jesus took upon Himself all sin with His death and therefore God does not punish us for sin.) If 2. Would it be helpful for me as your physician to share your patient struggles with this issue, assure them you some aspects of your care with that spiritual counselor? are there to care for their health regardless of the cir- 3. If you share your patient’s faith and are comfortable, you cumstances, and encourage them to speak with a trust- might ask: Can I, as your physician, pray with you? ed pastor or spiritual leader to ease their conscience. 4. Would you pray for me as your physician that I care for 3. Do you believe God has authority over your illness? How you with the best of medical knowledge and with sensi- might God be involved in your care? tivity and compassion? 4. Do you pray, and if so, what do you pray for regarding 5. Do you need chaplaincy, social services or Hospice care? your illness? • Have literature and internet resources to connect with your 5. What spiritual resources are you aware of to patient’s cognitive and spiritual needs as well as physical complement the medical and emotional care you questions. are receiving? • Connect your patients to prayer-partner groups. There are specific spiritual resources such as Cancercompanions • Chronic illnesses provide a particularly fruitful venue #30dayscancerprayer. This is 30 days of prayers focused on to consider the spiritual nature of your care for patients. all aspects of cancer: fear and diagnosis; surgery, radiology You and your patient may understand there is no cure; and chemotherapies; pain and suffering; comfort; healing there may be a weariness and sense of hopelessness. and facing end-of-life. The body’s ability to be resilient often is severely compro- mised. Chronic bathing of stress hormones (cortisol r • Remember that all illnesses have substantial components eleasing factor, ACTH, cortisol, adrenaline) from the of fear and anxiety associated with them. Fear, anxiety, HPA-axis deteriorates our defenses physically, mentally guilt and shame often impede access to early diagnosis and and spiritually. Guided mindfulness, meditation and prayer full healing of emotional and spiritual scars along with the appear to offer help in the healing process, but studies organic dysfunction being treated. still require more extensive research to offer adequate • Do a spiritual inventory. These are difficult to find in the conclusions. Meditation, whether religious-based or not, literature, but here are a few questions that can provide you appears helpful in the treatment of pain, fatigue, insomnia as physician with valuable insight: and nausea. 1. Do you believe God is present and active in your illness?

Physician, you read that correctly. Your Christian patients We can help people find meaning and purpose in their dis- can best be served by you through helping them be effective tress: can the way I deal with suffering influence and be stewards of God’s creation. Co-steward their health by incor- a legacy to my loved ones? I want my child or my grand- porating into your care not merely the “best physical and child to remember me as strong, faithful and positive, not mental health practices” on the frontline of medical therapy, remorseful, angry or sad. but also encouraging their spiritual stewardship, whether or not you share their exact religious beliefs and practices. There is also a difference between curing and healing. Cure, I believe, is predominantly an organic result. Healing is at While we may not be able to cure an illness, we may be the very core of spiritual life. Here is where you as a physi- able to compassionately care for and walk with patients cian-steward can have your greatest impact. through their pain and suffering. • Be present. • Be honest. KEEP IN YOUR • Be persistent to walk the entire journey with your patient, TOOLBOX offering compassion and empathy. Avoid disconnecting your heart from your patient’s heart OF RESOURCES even after you have exhausted all the medical innovations, smart chemicals, gene-splicing, gamma knives and micro FOR YOUR MENTAL AND robots to deliver therapy. BEHAVIORAL HEALTH NEEDS. Your hand of mindful stewardship at the bedside still For more information contact us at is “best practices.” [email protected] Visit indiana.org today

Fall 2019 15 Dangerous Inclinations Rev. Patrick Riecke, Director of Chaplaincy & Volunteer Services, Parkview Health, Fort Wayne

There are five natural inclinations also didn’t stay inside his wife’s room. He started walking the for those of us who want to help a hall, yelling at God. person in the midst of a difficult time. I started wishing that I was in the ED with the other family. But they are dangerous for the people Little did I know how difficult this was going to be. we are helping. Perhaps it’s our way There I was, walking with him up and down the hall of this to grasp for magic words. If you find unit full of other patients and staff while he was screaming at yourself alongside someone in a lot of the heavens. pain, try to avoid these five common mistakes: Inside, I felt some responses rising: “Sir, your wife wasn’t elderly, but it seems you had a long life together.” Or, “Your 1. Defending God brother-in-law said you have known she had a terminal condi- As the leader of a large team of chaplains, I do what lead- tion for several months, how can you be so surprised?” But ers usually do. I go to meetings, answer emails, and perform most of all, “God didn’t kill your wife, he gave you your wife other administrative and leadership tasks. But sometimes, I for many decades. Cancer is what took her life, not God.” get the call, and I am intimately involved with the care of a And, remember, the only thing the grieving spouse knew patient or family who is in a dark time. about me was that my name was Patrick, and I was a chap- One such day, one of our chaplains called me because he had lain. So, what did I say to him? Not much. been paged to two deaths at the same time. The patients’ I just walked with him, listened to him, and kept saying, rooms were on opposite sides of the building and their time “I’m so sorry.” Why? Because his question was an emotional of death was almost the same. He was in the ED with one of one--and quite a natural response. To respond with a logi- the families. The other patient had died in our cancer unit, cal answer would not have helped him. Perhaps he could which is near my office. have had a logical conversation later. Probably months later. I offered to see the patient in the cancer unit. As all our At that time maybe someone could have said some of those chaplains know, deaths in the cancer unit are usually a bit things I felt rising inside of me. But twenty minutes after his easier from our standpoint. No one expects a person to die wife died was not the right time to defend God. in the ED (not even the staff). But the cancer unit is differ- Defending God is one of the natural inclinations at a time ent. Families have had more time to prepare—usually. As like this. Actually, let me be more honest. Our inclination is such, they know what funeral home they are going to use, to defend our understanding of God and faith, life and death. the appropriate family is already on site, and they have even But we have to ask ourselves, done some of their grieving before the patient’s death. In this unit death comes as less of a shock… usually. “Am I defending God, my faith, my point of view, as My visit to this family started out in the usual way. The a way of helping this person, or justifying my own patient wasn’t old, but wasn’t terribly young either. The fam- internal thinking and belief?” ily at the bedside shared how long ago the diagnosis had been delivered. They also shared that her husband was on If it’s the latter, then we are helping ourselves, not the person his way—he had not been there at the time of her death. in the midst of their dark time When he arrived, it became clear that this was not going to be a simple situation after all. The man’s emotion and 2. Teaching Theology volume began to escalate immediately when he entered the Similar to defending God, sometimes we are inclined to teach room. And he wasn’t just sad. He was angry. Not angry at theology to people who are in pain. We want to tell them the staff or me or his family or his wife. what our faith says about times of difficulty, or about how He was angry at God. He began yelling at the sky. He shook God is good all the time, even when it doesn’t feel that way. his fist. He sobbed. These things may be true, but we are making a mistake when we follow this inclination. “Why, God?” is a question many of us ask during these times. It’s just that most of us keep this question buried in Again, their questions at this time are usually emotional, not our hearts, making us sick from the inside out. This man theological, such as “If God is good, why is he doing this to didn’t keep the question inside. He was yelling—loudly. He me?”. When we give a theological answer to an emotional question, we aren’t really communicating. We aren’t really helping.

16 Fall 2019 3. Only Focusing on the Afterlife Fortunately, a couple of my other chaplains were in the I hope you have never had to go to a funeral where someone room. Jon raised his hand and carefully shared that he found stood up and told everyone, they’re not to be sad because that even people who had great faith seemed to sometimes the person was in heaven. Even if the family and friends still be scared to die, and their loved ones were just as sad to are 100% sure that the person is enjoying an eternal life of see them die. extreme bliss, trying to tell someone not to be sad, for any 4. Cheering People Up reason, seldom helps them. Young people usually understand the emotional nature of For several months, my daughter was plagued by night ter- difficult times better than the more mature among us. rors. Not simply nightmares, but night terrors. If you have ever been around someone having a night terror, you know I can remember a young man who was a part of my youth the difference. It’s like a combination of sleepwalking and a group years ago. When he learned that a good friend’s mom nightmare, and multiplied by ten. had died, he told us all he just wanted to punch the wall. At the funeral service, he stood with his friend over to the side, A couple hours after we put her to bed, she would wake just talking and laughing. up screaming uncontrollably. She would repeat one or two words over and over, usually “Mommy…” followed by That kind of ebb and flow of emotions is totally natural dur- another word or phrase. At first, we would try to wake her ing dark times. Don’t try to cheer people up. Just ride the up and tell her everything was ok. Every time she would call waves of emotion with them. If they are sad when you are for me or my wife, we would tell her we were there and ask with them, let them be sad. If they are happy don’t try to what she needed. We would try to reassure her and ask her talk them out of that, either! what was wrong. She could never respond to these attempts 5. Praising People for ‘Being Strong’ or to communicate. ‘Moving on’ We bought a camera for her room so we could see what Sometimes at a funeral, the family isn’t crying and seem to was precipitating these episodes. The answer—nothing. She be doing better than expected. We can be tempted to think would just wake up with her tears flowing, chin quivering, that means they are really strong. We can make mini-heroes and flailing about. When we realized she was having night out of them. I can tell you as someone who has often been terrors, we changed our approach. behind the scenes in situations like this—many times they are We no longer tried to dialogue with her or ask her what was medicated so they can make it through a few of the worst wrong. We didn’t get as frustrated. We just tried to be close days of their life. If not, the adrenaline of the experience to her, give her what she needed, and wait it out. Usually in of being the family at a funeral can gloss over some of the about ten minutes, she would be able to go back to sleep. deeper feelings they face when the crowds are gone. Trying to convince my daughter that ‘everything was okay’ What do we communicate when we praise people for being during these episodes is similar to trying to tell the grieving strong (i.e., not crying uncontrollably at the funeral)? We are that everything is okay because their loved one is in heaven. telling them that this is a more appropriate or admirable way It might be true, but it’s not helpful. to respond when someone dies. Which it isn’t. If I die tomor- Notice, the danger here is only focusing on the afterlife. row, I hope my kids, wife, family, and friends cry uncontrol- Considering the afterlife is important, but if it is our only lably at least once or twice! tool in our attempt to help someone, we will find that we are Not long ago one of my teenage sons was at a party when not helping that much. another boy accidentally pushed a piece of furniture into his I often speak to groups on these topics. Sometimes those bare foot. The result was that the nail on his big toe lifted groups are staff at a healthcare agency, sometimes they are like a trunk lid, and there was blood everywhere. When I community members, and sometimes they are connected arrived at the house he was still crying. And that’s what he with a faith community. One time while speaking to a group should have been doing. He was in pain, and he deserved that was mostly comprised of faith leaders, one experienced to cry. pastor said something I have heard many times. “I have It’s the same with people in emotional pain. It’s totally okay always seen that Christian people approach death much for them to cry and not be strong. And when we praise them differently than people with no faith. They have peace and for being strong and moving on, we are basically saying, assurance that they are going to be with Jesus.” And while I “That’s the preferable response. If you are sad or depressed somewhat wish this was true (as a Christian clergy person), that is less desirable. It’s more convenient for me if you are it certainly is not always true. As the leader of the work- less sad, because I am not confronted with as much pain shop, I didn’t want to shoot down one of the participants. when I think about you.”

Fall 2019 17 Hearts and Minds – Religion and Spirituality in Medical Practice William R. Clark, Jr., MD

Considerable time has passed since There has accumulated an extensive body of information about my removing the white coat for the this topic in the medical literature. Clinical studies have docu- last time. Since then when entering mented an association between one’s self identification as being the out-patient clinic or a hospital, religious or spiritual with more favorable medical outcomes it is as a patient, not a doctor. The and overall health. Excluding supernaturalism, investigators commentary that follows will thus be speculate on possible mechanisms involved, but confounding from the perspective of both. variables make difficult drawing conclusions about causes and effects. Some authors cite an association of being religious with This writing will open with a per- personality traits such as optimism or an adherence to healthy sonal vignette about a patient from behaviors in general. early in the practice. Approximately eight decades previously her parents had christened her Madonna. As attending phy- Published surveys indicate that a large majority of people in sician I first came to know her during the final year of her our society identify as being religious, and a majority of those life. Progressive deterioration of chronic congestive heart indicate their religious beliefs are important to their daily lives. failure symptoms necessitated periodic admissions to St. Joe Furthermore, a significant percentage express that they would Hospital for adjustment of the medication regimen. During at times like to discuss their spirituality with those from among rounds on one such stay there was present at the bedside a their health care providers. priest. Madonna exclaimed: “Oh doctor, I am so happy you Some surveys indicate that many physicians are reluctant to have come just now; I want you to meet my son the Father open a discussion with their patients concerning the subject. To - my son the Father”. On another occasion she was asleep the extent that is true it may reflect the profession’s commitment when I entered the room. Upon gently touching her shoulder as a whole to distinguish itself as a provider of scientifically and softly calling her name, she startled and seeing me said: validated care well separated from ‘non-scientific’ approaches. “Oh, Father - yes Father?” Feeling ill prepared for such discussions or simply time-con- There could be no doubt that Madonna was secure in her straints could be other factors. However, failure to incorporate Catholic faith - the ever-present rosary on the bedside-stand this important element in the comprehensive care of a patient is yet another indication. She had most certainly from an early an opportunity lost. The timing and extent to which a physician age been told about Jesus - “the Son of God, begotten, not engages the patient varies with the circumstance – be it at the made – being of one substance with the Father by whom time of first visit to the primary physician to establish care or at all things were made”, the Jesus of Bethlehem, Galilee, and later times to discuss living wills and end-of-life care. Jerusalem, the Jesus of the empty tomb, and the Jesus who Cognizance of and sensitivity to a patient’s beliefs is important, in one person was seen to be both a healer of the body and but in my opinion a physician should also be cautious and fol- savior of the soul. Madonna was justly proud of her atten- low cues when treading upon what some patients may consider tive son. And, it is not surprising that she might easily con- to be private ground. Furthermore, what it is persons do most flate – especially in a half wakeful state - the image or role is probably what it is they do best – an adage true for doctors of doctors, priests, Fathers and (S)ons. But it was abundantly and clerics alike. When walking with a patient on the narrow clear that her faith was a significant source of comfort dur- balance beam between the reality of a grave prognosis on the ing that difficult time toward the end of her life. one side and the human yearning for hope on the other, having The link between spiritualism and medicine extends back to a clergyman join in the walk if the patient so desires is to be the dawn of history. Somewhere along the evolutionary path appreciated. from early Homo sapiens to our becoming modern human So how best can any physician functioning primarily in their beings there emerged the capacity to conceive of the tran- role as a physician further take advantage of the potential posi- scendent. Try as we might for convenience sake to separate tive effect that patients’ religious beliefs or spirituality might the physic from the psyche, it is not possible. The two are in have upon their response to medical care? Perhaps one answer fact intrinsically bound biologically. Although knowledge of is to be found by examining the nature of the doctor/patient what happens where the two realms interdigitate is fragmen- relationship itself. tary, it is clear that one’s ‘state of mind’ can result in measurable physical changes in our physiology or chemistry and by As a matter of professional ethics what is the appro- extension our physical well (or not so well) being. If further priate place for a physician’s personal religious beliefs interested in mind-body relationships, look up the topics in this dynamic? What is it that primarily motivates of placebo effect, shamanism, hypnosis in medicine, or the any physician to be a physician? What is most impor- rather obscure but fascinating topic of voodoo death. tant to patients in their relationship to the doctor?

18 Fall 2019 What follows is a modest proposal – a concept anyone reading this piece already Faith in Medicine David Donaldson, MD knows about – the element of trust. As a patient, what do we hope our physician Faith in medicine can have a palpable impact for patients, to be? Two words might come to mind: physicians, and community. Studies have shown the positive competent and compassionate. The for- effect of a prayer network, faith community, and fellowship mer is predicated upon the four year pre- on healing, recovery, and mental health. Its positive impact medical college curriculum, four years of and importance to patients materialized to the point that medical school, three to five (or more) JACO now requires a spiritual assessment for patients in years of residency/fellowship, and career- hospitals and nursing homes. long CME. Personally, as an anesthesiologist, I have been blessed with The roots of compassion lie somewhere the opportunity to comfort anxious patients with a prayer else – not in text books, lecture halls, prior to their operation. Whether it is a verbal expression of appreciation on a three day symposia in far off cities, or post-op visit or a mailed thank you card, patients have extended their gratitude for on-line tutorials prepared by one’s spe- this spiritual gesture on many occasions. One noteworthy occasion came when a cialty Society. Perhaps its origins are very anxious gentleman presenting for open heart surgery had lost his will to pro- genetic and flow naturally. However, ceed with surgery since close family members had passed away years prior on the there are outward manifestations of its same date. Upon discovering our common faith, his well understood apprehensions existence – behaviors that are too eas- and anxieties were mitigated after a prayer. Where fear paralyzes faith propels and ily sacrificed for the expediency of time. his peace eclipsed panic as demonstrated by his calm compliance to proceed as These things fall under the label of The scheduled. Art of Medicine. “As physicians, the coalescing of exhaustive schedules, difficult patients, and Put compassion in a bottle and hold it up stressful circumstances can easily empty our energy tanks.” to the light. What does it look like? Does God’s strength can save us from those tempting low compassion moments and soar viewing empathy through the lens of a above the winds of adversity in the milieu of a challenging medical environment. magnifying glass reveal the constituent Being able to endure, and sometimes, even discern higher purposes in the midst parts? Eye contact, a smile, a handshake of physician and patient suffering, I believe, exceeds human capacity. Though far take little time. Spending at least as much from perfect, a keen awareness of a heavenly accountability to the ultimate Law time listening as talking can convey the Giver inspires faith driven physicians to a new level of personal and moral respon- primacy with which the physician holds sibility. the patient. Washing hands in the pres- Brevity forbids the extensive list of hospitals, charities, clinics, and care ministries ence of a patient even before examining that had their embryological underpinnings inspired by scriptures commands is noticed. A follow up call if not by the and celebration of compassion, charity, and other-oriented ethics of “love thy doctor then by the nurse to see how a neighbor”. The living practical application of the Golden Rule is evident in both patient is doing does take time but sig- domestic and foreign medical missions to the impoverished and destitute. This nals caring. Also not to be forgotten is a benevolence to mankind can extend to present societal ills, such as the epidemic of legacy from ancient spiritual traditions opioids, substance abuse, and despair. The availability of faith and willing spiritual - the power of the touch – a gift from the counsel should be a part of a comprehensive restorative program for restitution mystics. Embracing the Art of Medicine and renewal from these maladies that have claimed so many lives. For some of the in medical practice is humbly suggested despaired, knowing there is a God that unconditionally loves them may do more to to represent a first-door- of-entry to heal an ailing, hurting, and lonely heart that feels no sense of purpose or belong- enhance how doctors and patients alike ing than medications. Just as it has been shown that relapse is less in prisons with feel about each other and themselves. spiritual help and faith-based opportunities, its extension and vitality with present In closing, the following quote is day addictions is not impertinent. I have always believed that the true longings of appended: man’s heart are ill satisfied with worldly measures. Locally, we are entering our eighth year of the Christian Medical Dental Association at the IU School of Medicine Fort Wayne. As campus advisor and “I’ve learned that people will forget chapter sponsor, I have observed the excitement and desires throughout our fellow- what you said, ships these students have to integrate their faith in their medical practice as well as people will forget what you did, being inspired to participate in domestic and foreign missions. As they mature in their faith, these students recognize not only there is more to life than money, but but people will never forget how there is more to medicine than medications. This growth incites caring and extend- you made them feel.” ing themselves in meaningful ways to patient populations. – Maya Angelou It is my hope and prayer that with the patient comfort, personal peace, and community benefits of a vibrant faith, all care facilities will encourage and allow faith to be an important part of medical and community care.

Fall 2019 19 Calming the Pre-op Atmosphere with Prayer Micah Smith, MD

Boy, am I cold!” As a spine surgeon, I have the privilege of having an intimate relationship with my As, I wipe the dry crusties from my eyes, I can’t patients. Every patient when I see them in the believe they made me get to the hospital at 5:30am. I pre-operative area, I offer to say a prayer with am NOT a morning person! My stomach is growling. them. I don’t force it, I simply offer it. “Why can’t I eat before surgery? Ever since I started doing that on my first case This makes no sense. I am having surgery on my out in practice, I have been honored to enter spine, not my belly. into an aspect of the patient-doctor relation- And seriously, no coffee? ship that I think is under-rated and under-uti- I mean, come on!” lized. So many patients when I offer, respond I would at least look like I am more awake if I could with something on the order of, “Doc, I have had X-number of have coffee. surgeries and no one has ever offered to pray with me. Thank you I am stuck in this gown with my backside open and so much!” exposed. I offered one patient, who later told me that his grandson who was I am feeling cold and vulnerable right now. there in the pre-op bay, was so happy that I prayed with his grand- “Oh, you are going to stick me to start an IV line? father. His grandson (10 years old) had just finished his last round Just a little prick?” of chemotherapy and wished that any of the many doctors who he I will show you a little prick (after the tenth attempt). had seen for his leukemia, would have offered to hold his hand and Yes, you can’t get my veins because I was not allowed pray for him. For me, it’s common when I talk to the family in the to eat or drink this morning, so yes, I am dehydrated. post-operative consultation room, that they immediately thank me No, YOU try to hold still! for the prayer before surgery. Do you realize that you are the thirtieth person to This brings me to the question of why don’t we do this more? come into my room? Many patients and family members all comment to me that they Anxious? wished more doctors prayed with them. Are you too busy? With the hassle of EMR, the feeling that I have “Wouldn’t you be anxious if someone was going to be to get to the next patient looms over me. Or will my rating by the working on your spine? Yes, of course I am. Someone patient or on Healthgrade be affected if I take too long? Do we is about to go inside my body. Cut my spine open. simply feel that it’s not our place to address that need for a patient? Expose my nerves and work on my spine.” Are we afraid of offending someone? Are we scared? These last two You might be a little on edge too if that was the train questions were both things I didn’t want to be a reason. I felt a call coming down your tracks, sorry if I have a “deer in to be bolder in my faith, and frankly it’s appreciated. Honestly, I headlights” look on my face. have never had someone act offended. I try to be humble, kind, and Boy I hope this is going to work. compassionate in the way I ask. I do have people decline my offer, How much pain will I be in after? and it’s simply ok. But, for the most part, the majority welcome it Am I going to be paralyzed after? with a smile. It’s a moment when their look of worry and anxiety What if I die? changes to a smile. I can see it in their eyes. Many times, there is a Will I be missed? palpable change in the atmosphere of the room afterwards, as the Who is going to take care of my significant other? patient totally changes. Finally, a familiar face. It’s at this moment when a new aspect of patient-doctor relation- “Hi doctor. ship is opened. At this moment, regardless of whether they accept Yes, I am doing ok. or decline, they at least know I care about them. They understand Yes, I still want to do this. that I am a person, a human-being, and I care. It places me, in their eyes, more on their level. They also know, that I answer to a Ready? higher power. I don’t just answer to people, or a court, but to my Not really, but I am here, there is no turning back God. Whether they believe in a God, or the same God, or not, they now.” understand I have a separate checks and balance system, so to say, Prayer? in my life and my clinical decision making. “You want to say a prayer with me? Praying with my patients has become one of the most important Wow, no one has ever offered to say a prayer with parts of my profession as a physician. I think as medical providers me. That would be great! I feel so much better now. it’s an aspect of care that is over-looked, and patients, on the inside, Knowing that you care, knowing you understand and are seeking for us to address it. I pray it finds a spot in your heart that you are a human being also means so much.” and practice.

20 Fall 2019 Reflection, Awareness, and Acceptance Prevesh Rustagi, MD

Sometime in the 1930s, a woman possible way how an individual copes with their finitude and came to Mahatma Gandhi, asking their sense of vulnerability and insignificance. Some may be him to instruct her son to stop eating extremely well defended against this vulnerability and could sugar. She had come from far away therefore present a façade of being invulnerable. They may under difficult circumstances and was express their vulnerability only after a fairly prolonged thera- hoping for Gandhi’s quick interven- peutic relationship. They need to have a sense of comfort and tion. Gandhi, however, turned her safety before they can express a sense of vulnerability. Some away saying that she should come may never get to that, however, and should be supported in back with her son in two weeks. She their journey to the extent possible, nevertheless. For some, left confused but followed through. At patients, their faith may be very abstract. Other patients may the second meeting, her son was instructed by Gandhi to stop only be able to discuss this issue in very concrete terms and eating sugar right away because it was bad for his health. The concepts. Wherever a patient is on this spectrum, they deserve boy agreed to give it his best effort and his mother left happy our respectful attention in the dialogue around faith. but she had to ask the Mahatma about the need for the sec- Faith plays a major role in various structured programs help- ond meeting. Gandhi said that he could not possibly tell the ing with recovery from chemical dependence. I have watched boy to stop eating sugar when he was eating sugar himself. with great interest how diverse patients have responded dif- He may have wanted to make sure that his conviction and ferently to various dimensions of spirituality in a variety of sincerity came across transparently in his demeanor. programs. The concept of higher power in 12-step programs has been variously interpreted in concrete or abstract terms Before we explore faith and spirituality in our patients, by different patients and different 12-step groups. While we must reflect quite deeply on the status and evolution the Celebrate Recovery program is also spiritually-based, it of our own faith. attracts a different set of patients, who do not feel comfortable with traditional twelve-step programs. Interaction with Only such reflection can transmit the sincerity and depth in benevolent and malevolent figures in very early childhood can our inquiry into such a deeply personal matter of a fellow sometimes impact a patient’s attitude towards the concept of human being. Such matters should not be explored super- a higher power. We must remain sensitive to verbal and non- ficially because we do not want faith and spirituality to verbal cues that our patients send us in expressing their beliefs be just another box to fill in the already bloated electronic and attitudes surrounding these programs. health record. We don’t want it to be a ritual to be followed. Why must there be a discussion of faith in the medical set- Moreover, when we engage in this discussion, we ought to ting? Faith, spiritual contemplation, existential reflection, be respectfully receptive to whatever answer we get back prayer and participation in group religious activities can be from our patients. They need to feel safe in expressing their source of support in times of vulnerability. They can broaden thoughts and feelings about faith and spirituality openly. Our perspective and engage healthier, higher level thinking leading nonverbal language, which stems from our own emotions to wholesome living and healthier habits that impact physical and convictions, would convey the safety better than any and mental health. Discussion of faith, religion, spirituality, words possibly can. Their faith or lack thereof may be entirely meaning and purpose elevates the physician-patient dialogue incongruent with our own. It is almost better not to raise the and thereby, the patient’s internal dialogue in healing, health issue at all unless we can feel and convey respect for diversity enhancement, and broader constructive and creative engage- of faith in its myriad forms that we may encounter in our ment in life. patient interactions. Spirituality is often an evolutionary pursuit for some and a As a tiny mortal creature with a small lifespan on a tiny plan- static one for others. There are many personal, family, social et, it is more a rule than exception for one to gain a sense of and religious variables that affect this dimension. We need to strength and comfort from someone or something larger than meet the patient where they are and customize our question- oneself. It is not uncommon even for atheists and agnostics ing, interventions and expectations as we pursue their best to create a “private religion” where they defer to an entity, physical and mental health interests. In exploring spiritual- an idea, a movement or a personality larger than themselves. ity, it is important to be aware of conscious and unconscious This “private religion” concept has been discussed beauti- intrapsychic dimensions, and verbal and nonverbal commu- fully by Ernest Becker in his famous book Denial of Death. nication dimensions. It is only with such broad awareness The discussion of faith for some may have to go beyond tra- that we can give faith and spirituality its deserved place in the ditional religion. The idea is to understand in the broadest practice of medicine. It could be a deeply enriching experience for the patient as well as the physician.

Fall 2019 21 ADVANCING MENTAL HEALTH MINISTRY.

OCTOBER 7 8:30AM - 4:00PM GRAND WAYNE CENTER FORT WAYNE, IN

KAY WARREN WARREN KINGHORN Saddleback Church Duke Divinity School

The Lutheran Foundation is collaborating with mental and behavioral health experts to promote mental wellness and reduce stigma around mental illness throughout our community. As a part of that, the Look Up Faith Conference on Mental Health is planned with the faith community in mind. Hear from nationally recognized leaders, including Kay Warren of Saddleback Church and Warren Kinghorn of Duke Divinity School, and a dozen breakout presenters. Local and national exhibitors will also be on hand.

22 Fall 2019 The Way Out of No Way — Physical, Mental and Spiritual Wellness Rev. Dr. Dennis Goff, Director of Ministry Programs, The Lutheran Foundation, Fort Wayne IN

Do you want to get well?” While I suppose all of that could have been the man’s (John 5:6). approach, maybe those interpretations are tainted by cur- That seems like such an odd question rent cultural examples. Instead, I would suggest, the man’s to ask someone who appears to be response was spoken out of a sense of hopelessness. not well. Isn’t the answer obvious? It’s easy to understand how he could feel hopeless. After The above question is asked by Jesus all, it’s been thirty-eight years. A feeling of hopelessness can who one day encounters a man who often be characteristic of depression. If indeed he needed is lying by the pool of Bethesda (John someone’s help to get into the water, maybe no one bothered 5:1-15). This pool was a place where to help him every time the water stirred. And so, time after people who were ill would often go because they believed time, day after day, week after week, month after month, the water had healing qualities. Periodically, the water year after year no one has offered to help. would stir. The reason for that was because of a natural When Jesus asked the question, “Do you want to be spring underneath that would occasionally cause movement well?” perhaps the man’s response was simply spoken out in the water. However, the belief in those days was that of a hopeless spirit. After all this time, maybe he believed when there was movement in the water it was because an there was no way out of living with this physical ailment. angel from heaven was tipping its wing into the water stir- Nevertheless, Jesus heals the man. He says to him, “Get up! ring the water. When that happened, people believed the first Pick up your mat and walk.” And at once the man picked person in the water would be healed of whatever infirmity up his mat and walked. However later, Jesus finds this man they had. Consequently, the gospel writer John tells us there in the temple and says to him, “See, you are well again. Stop were a “great number” (or multitude) of disabled people sinning or something worse may happen to you.” who were regularly lying by the pool of Bethesda. John describes them as, “the blind, the lame, the paralyzed.” Now, what did Jesus mean by this? Well, first it’s important to realize what he is not saying. Jesus is NOT saying Imagine the mass chaos every time the water showed signs the man’s physical condition (before he was healed) was of movement. Everyone wanted to be first in the water. It’s the result of a certain sin in his life. The man’s illness was unlikely there was any kind of orderly process. It was more not some kind of divine punishment for something he did like, every man for themselves. Imagine the pushing and wrong. That’s not what Jesus is saying. shoving each time someone saw a hint of movement in the water as each ailing person desperately tries to be the first one in. But what Jesus is saying is that while living with a physical disability for thirty-eight years is bad enough, One day, Jesus walks by the pool and sees a man, “who had what’s worse is not knowing the love God has for you. been an invalid for thirty-eight years.” Thirty-eight years. What is worse is to live your life separated from God. That’s 13,870 days! What is worse is to be spiritually unhealthy. When he sees him, Jesus asks, “Do you want to get well?” Surprisingly, the man doesn’t reply with an enthusiastic, While not minimizing the man’s physical ailments, Jesus is “Yes.” Instead, he laments that every time the water is pointing out that living in spiritual distress is worse than stirred, no one is there to help him into the water. his physical affliction. I find it interesting that in reading several Bible commentar- Collectively, this story highlights the relationship of physi- ies about this story, many scholars accuse the man of simply cal, mental and spiritual well-being for each person. They being lazy. They conclude that he has come to rely upon are inter-related. Being well means being well physically, people having pity on him. They believe, he counted on mentally, and spiritually. people giving him a small coin or a bite of food daily to help him get by. Because this was the man’s way of life, some I’m not suggesting that medical doctors need to become scholars suggest he really didn’t want to get well. It would Biblical or theological scholars. Personally, I want my alter his lifestyle. It would require him to get a job and be physician to be the best medical professional who can independent. Continued on page 24

Fall 2019 23 Continued from page 23 HOPE Meets Faith in the appropriately and accurately identify and diagnose whatever may be going on with me physically or Allen County Courts to Begin mentally. Restoring Lives Judge Wendy Davis But I also want my physician to know that there is a connection between my physical, mental and spiritual wellness. In fact, God has created us with body, It is 8:30 on a Monday morning at the Allen mind and spirit. County Courthouse. Allen Superior Court Judge Wendy Davis, a prosecutor, a defense In the lawyer, probation and community corrections same officers and treatment providers are huddled gospel around a conference room table, discussing record as the cases they will hear when Court convenes the story in an hour. where At first glance, it could be a meeting in any Courthouse in any Jesus county in Indiana. However, this one is different. heals In almost every way possible, the community itself is huddled the man around the table, too, offering offenders a hand up from the lying at the pool of Bethesda, Jesus is referred to despair of addiction through the most powerful tool they cannot as, “the way, the truth and the life” (John 14:6). see, touch or purchase – the power of faith. Interestingly, there is an old African American expression that refers to Jesus as “the way out of When people arrive in the criminal justice system, their mindset no way.” is often, ‘It’s all about me.’” said Marvin Vastbinder, a volunteer I can imagine that after thirty-eight years, the man with Faith Based Mentoring Ministries. “What we try to show lying at the pool of Bethesda thought there was no them is that it’s not about any individual. It is about knowing way he was ever going to be healed. But then, here God and serving Him. That’s the answer to how to do life.” comes Jesus who demonstrates he was, “the way out of no way.” Every Monday, Vastbinder joins the team that provides staff support to Judge Davis’s HOPE (Hoosiers Opportunity Probation with The story in John 5 highlights the miraculous physi- Enforcement) probation program. HOPE is a probation model cal healing of Jesus. It also surfaces the significance born in Hawaii that Judge Davis brought to Indiana in 2011. It is of the man’s mental wellness (demonstrated by his geared toward offenders who pose a low threat to the community, sense of hopelessness). And too, Jesus addresses the but threaten their own wellbeing through drug and alcohol addic- man’s spiritual needs. Here in this one story, Jesus tion or repeated probation violations. addresses the connection of physical, mental and spiritual needs for each one of us. The HOPE probation initiative is an alternative to jail that includes random drug and alcohol testing. Those who test positive are Likewise, there may be times when any one of us subject to immediate, brief incarceration, before being released to may be dealing with physical or mental or spiritual treatment and continued supervision by a probation officer. Studies struggles and we too feel as if there is no way out of show that HOPE programs are effective in reducing drug abuse and the situation. And while every appropriate avenue recidivism. In Allen County’s case, HOPE is a “post-conviction” of medical care needs to be explored at times like court where offenders land because they have been arrested before this, it’s important for both practitioner and patient and violated the terms of their probation. When they land here, to recognize that as a part of the healing process offenders are running out of options – and running out of hope. God is our, “way out of no way.” “I had a guy in front of me recently who said he needed HOPE probation because he’d either get another case or wind up dead,” Judge Davis said.

When it comes to addiction, in particular the opioid epidemic that has descended upon communities across Indiana and around the country, these offenders might be anyone. That is where HOPE

24 Fall 2019 comes in – and where faith based mentoring is making a difference between success and recidivism. The Faith Based Mentoring Ministries’ team of volunteer men- “These are low-level, non-violent offenders,” Judge Davis tors all attend different churches said. “But if we are not careful and we fail to get them the and come from different back- kind of rehabilitation they need, this crisis is only going to grounds. But they all come to the spread. This crisis is only going to get bigger.” program with the same mission: Mallory Kuter, senior high-risk case manager for Allen To encourage healing and recovery by showing addicts that the world is bigger than them- County Community Corrections, described a typical story selves and their interests. of someone who might land in HOPE probation. She recalled a college student who suffered a shoulder injury One key element of that is coming to a men’s and women’s in an accident. After surgery, he became dependent on group meeting Mondays at 6:30 p.m. at Tabernacle Baptist painkillers and his life spun out of control. He wound up Church. The offenders are the guests, but faith is in the in and out of jail and began using heroin. After having his spotlight. previous probation revoked, he wound up in HOPE. The meetings are built upon Christian teachings. However, This is the familiar story of many walking into the HOPE all faiths are welcome because the message is universal or program. They have alienated friends and family. They a higher power can help individuals from the depths of might steal from loved ones to support their powerful despair, if they are willing to open their minds to it. addictions. Addicts can also tax community resources and “They don’t care how much you know until they know unintentionally create a public health risk as their habits how much you care,” said Donnie Foster, founder/chaplain potentially result in Hepatitis C and even HIV infections. with M.I.S.F.I.T.S Ministry, Inc., an ex-offender himself. According to Judge Davis, evidence-based practices demon- “Whether you’re homeless or an ex-con or just someone strate that offenders who violate probation repeatedly need struggling, my motto is ‘Gently lead them to the cross.’” something different in order to succeed the next time they Kristin Litzenberg, adult probation supervisor for Allen are released from custody and into a probation officer’s Circuit and Superior Courts, said that faith-based mentor- supervision. In HOPE court, that something different – ing helps break people out of the cycle that got them into offered, but not mandated by the court – is the opportunity trouble. It introduces people to others in the same situa- to call on the power of faith to heal their life. tion they are in. It builds networks and provides offenders with new resources, such as transportation. Litzenberg said Vastbinder, who joins the criminal justice professionals the mentoring program goes beyond the Monday evening each Monday morning to discuss unique ways to help the meetings. She said that Vastbinder takes people to break- people about to appear in HOPE court, is one of 11 men- fast or lunch, and even drives people without licenses long tors (nine men and two women) available through Faith distances to get them to meetings or appointments. Based Mentoring Ministries. He is often located near the front of the courtroom during hearings. Judge Davis intro- “They don’t have a lot of people in their lives anymore,” duces him to defendants, while making it clear that the Kuter added. “They have these guys who are willing to be person about to be released for perhaps their last shot at there for them. They show them there are ways to enjoy life other than drugs and alcohol.” recovery does not have to talk to him. Danielle Edenfield, assistant director “Do you want to get clean?” Judge Davis might ask a for Allen County Community defendant. “Meet Mr. Marvin. He doesn’t work for the Corrections, said the mentors Court, nor do you have to speak with him. However, provide two-way communica- he will help you when you are released to treatment. He tion that can be vital to the wants to ensure that you beat this and not wind up back in success of a probationer. The court.” mentors are not just available Vastbinder is one of the few non-attorneys permitted by to their clients, they make the Court to interact with offenders while they remain in themselves available to staff custody. If an offender is interested in trying faith-based as well. The personal connec- mentoring, he or she leaves court with a green flyer with tion the mentors have can give an information on how to connect with the program. early warning that a probationer needs help.

Continued on page 26

Fall 2019 25 Continued from page 25 Thank God, We Live In Offenders come into faith-based mentoring from all walks of life and all denominations. While most Good Times Matthew Farber, MD are Christian, the program has welcomed Muslims, agnostics and people who are simply mad at God. They come anyway, and have been doing so for There have been huge advances in science 10 years, because others have given up on them. It and medicine. For that we are blessed. In is a group of people who, more often than most, the 21st Century one of the miracles is the frustrate and disappoint those trying to turn their use of Anti-VEGF medicine in treating mac- lives around. However, regardless of faith, offend- ular degeneration, vein occlusion, diabetic ers find a way to reconnect and find people going macular edema, iris neovascularization, and through the same things they are. neovascular glaucoma. The results of treating patients with intra-ocular injections of The numbers prove the program’s reach and per- Avastin (bevacizumab), Lucentis (ranibizum- haps the scope of the problem it tries to address. ab), or Eylea (aflibercept) has enabled us to preserve or in some Over its history prior to 2019, about 900 people patients even improve vision! participated in meetings. During the first 6 months of 2019, Vastbinder said, 190 new par- Macular degeneration is the leading cause of blindness in those ticipants have come through the doors. Between over 65 years of age. Diabetic retinopathy is the leading cause of 30 and 40 people are attending the meetings at blindness in those younger than 65. Now we have very effective Tabernacle Baptist each Monday night. treatments available. After treating a patient by injecting one of the above medicines Part of the reason behind the increase is the grow- into their eye, often multiple times, there have been some patients ing positive reputation of Faith Based Mentoring that return and thank me. I respond by saying, “No, thank God, Ministries. More and more professionals and treat- we live in a good time.” Some patients state they have done well ment facilities are sending their clients to the min- because they have a good doctor, but I explain, that we were never istry alongside those who are encouraged by the able to obtain such results prior to these medicines. court. However, there are also some patients that have told me that they “When people want to work on their lives, have done well because they, their family, and their friends prayed they’ll come to faith-based mentoring,” he added. for them. I express that pray is always beneficial, especially in sup- “Anybody who comes and comes regularly, they’re port of the patient going through this treatment as well as for their trying to move forward with their lives. If they’re family’s and friend’s efforts in supporting the patient. Frequent heading in a different direction for some reason, return follow up visits monthly, with intermittent treatments is they won’t keep coming.” demanding. I always thank the family and friends for being there Nevertheless, they keep coming. with the patient. Yet I do point out that just praying alone, did not cure patients with their disorder prior to this treatment, nor did That college student, who became addicted after prayer cure many of the plague in the Middle Ages. an accident and wound up in HOPE, eventually decided to change his life. He is now a parent and We need to help patients as well as their family and friends navi- back on track, one of many success stories that gate through difficult times. For those that are religious as well as come out of the program. Rarely if ever is the suc- those that are not, they may need to find a balance between recon- cess sudden or easy to come by. ciling the attribution of an outcome to their religion, skilled physician, and the advancement in medical science. I often may point Vastbinder said that some people simply are not out that we are incredible creations that are complex. This calls interested in a faith message. But they will still for greater understanding that will enable us to improve our treat- spend time with him, talk and break out of the pat- ments, certainly there are very few patients that enjoy receiving terns that sent them on a path that ended in front injections in their eye or even both eyes. This will require greater of a judge. support for investing in medical and scientific research and the patient and their family and friends need to help in this effort. In my mind, there are three things that I would like to see people doing,” Vastbinder We too must be humble. We can help many through our skills due added. “Read the Bible daily, spend time in to our education as well as scientific advances. However, not all prayer and meditation, and change who they patients improve. Sometimes people pray and the answer maybe hang out with. They need to hang out with no. Support for medical and scientific research is a necessity if we people who love Jesus more than they do.” are to have a better future for ourselves and our children.

26 Fall 2019 Fall 2019 27 Mission of Hope and Miracles Ryan Singerman, DO

October 12th, 2017, my first patient carotid pulse. We continued as she started flinching and of the day was a dead baby girl. weakly coughing, her hands and feet began moving. We had just arrived at the site in I was absolutely overjoyed when I heard her weak cry! Fovo, Haiti where we’d been yes- She was far from danger as her grasp on consciousness was terday. The trucks were unloaded tenuous at best, we had to keep agitating her to keep her and the tables had just been set awake. She was moving and breathing on her own, but it up beneath a massive mango tree. was so feeble, even the term “death warmed over” would be Today was already tipping the scales generous. I asked for a blood sugar check while I evaluated on 90 degrees and the sweat was her in the arms of Callie, who was holding her as if by her freely beading on my forehead when I saw a commotion sheer will alone she’d keep that little one’s heart beating. across the compound. A mother was wailing and clutching Lungs were completely raspy making me certain she’d aspi- the lifeless form of a roughly one year old baby girl, she rated. Mouth was finally clear, abdomen distended with and the girl were both covered in a white mucus vomit. I hallmark signs of malnutrition and her belly button made was one of the first to reach her and I scooped her limp enormous by a very large hernia. She also had nauseatingly body from her pleading and frantic mother, who was cry- terrible double ear infections. ing “Help me, help me!” Her blood sugar came back at 306, which both surprised I’m not sure the prayer that went out from my heart me and immediately painted a picture in my head as to actually contained intelligible words. Something along the what had happened. Maybe it was just clinical experience, lines of “Please God, no”, “Give me wisdom”, “Help her, but it was as if God placed a CSI montage in my head. help us”. I could see her being an undiagnosed diabetic, sugars She wasn’t breathing, no palpable pulse, her eyes were already soaring compounded by the recent double ear flat, glassy, and staring. Her mouth hung agape as mucus infection making matters that much worse. Feverish and pooled. her body not being able to process her sugar, it reverted to breaking down her proteins which put her in a state of acidosis. It’s dangerous in adults who are admitted to the hospital for this condition, let alone an infant in a third world country miles away from any sort of hospital without transportation. The state can make people lapse in consciousness, and while being fed she passed out and aspirated. I ordered (fell into doctor mode) an IV start, while I cal- culated a fluid infusion to lower her sugar. Last night we had discussed taking insulin to the mobile sites and had planned on bringing it, but since it had to be refrigerated it had been accidentally left behind. Bobbi, a neonatal intensive care nurse, was able to get a line in this girl whom we were still fighting for every breath. With fluids running we made a plan that, once stable, one of our nurses and translators would go with the mom and baby and take them to the local hospital, about I started chest compressions as other team members rec- 45 minutes away. ognized the crisis and came to respond. Her clothing was Lauren, head of the mobile medical side for Mission of slick with emesis as I rhythmically pressed her chest, forc- Hope, approached me with a look of shock on her face. She ing blood through her heart and trying to get oxygen to had stumbled across a single, perfectly chilled vial of insulin. her brain. Callie, a nurse from Florida was at my side and No one remembers picking it up or taking it with us. she took over while I continued to assess her. I cleared her mouth and noted that I was starting to feel a thready NO ONE!

28 Fall 2019 With the fluid going her blood sugar fell to 246 and she had begun to vigorously cry, screaming her head off at being held down by a bunch of freaky white people, and I hadn’t heard such a beautiful sound in a long, long time. Several units of insulin were given and her sugar went down to 206. She was extremely active, feverish with a temp of 101F (initially she was 97F). The team gathered around them and prayed for mom and baby, who’s names I actually never got. Then Christen, a NICU nurse from Fort Wayne, went with them in the truck to take them to the hospital, money and treatment having been arranged. The number of miracles that occurred that day are unreal! First that we were even there. Secondly, that we had

the insulin. Thirdly, and TURNSTONE’S SERVICES AND ITS TEAM OF EXCEPTIONAL PROFESSIONALS WORK I can’t stress this enough, INTENTIONALLY AND PASSIONATELY TO MEET THE NEEDS OF YOUR PATIENTS WITH DISABILITIES OF ALL AGES. TURNSTONE CLIENTS HAVE ACCESS TO THE that we were able to RESOURCES THEY NEED TO LIVE THEIR MOST ACTIVE AND HEALTHIEST LIFE. resuscitate her AT ALL. TV and movies makes Turnstone’s breadth of services include: CPR appear trivial, •SPEECH THERAPY common, nearly always •OCCUPATIONAL THERAPY successful. According to •PHYSICAL THERAPY most shows, CPR brings •PHYSICAL AQUATIC THERAPY people back roughly •EARLY LEARNING CHILD CARE 90% of the time. In •PARALYMPIC PIPELINE SUPPORT truth, if someone stops breathing and loses their heart •ADAPTIVE SPORTS & RECREATION •HEALTH & WELLNESS beat in a perfect hospital setting they have roughly •ELITE FITNESS TRAINING 10% chance of surviving. Of those that live, 90% have •ADULT DAY SERVICES significant loss of mental function. That she survived •MEMORY CARE with apparently all her faculties is an amazing display •CASE MANAGEMENT of God’s love and timing. Why He chose to intervene that day I’ll never know, but it was awesome! I have since learned that three years later she continues to thrive with weekly visits by a local nurse from the Mission of Hope.

Fall 2019 29 Restorative Wellness Brenda Jank, Founder of Run Hard, Rest Well, Albion, IN

To thrive, the soul needs room to Wellness Paradigm breathe. Modern day life offers little What emerged from two decades of my medical and mental breathing room with few models or health crisis was a holistic wellness paradigm revolving around mentors to show the way. A prayer four every day rhythms. Transformational in every way, it written by King David 3,000 years positioned me to flourish and gave birth to the nonprofit, Run ago speaks to the basic tenants of Hard. Rest Well-RHRW. The definitions below shed light on soul care and well-being. the role these four rhythms play in vibrancy and soul care.

He (the God who King David • Sabbath is a guilt-free, care-free time set apart to recon- loved) makes me lie down in green pastures, he leads nect with God and the people you love. me besides quiet waters, he restores my soul …. • Sleep positions people for vibrancy. When seven to nine Psalm 23:2-3a hours of sleep are prioritized most nights, it physically rejuvenates and plays a critical role in the prevention and King David recognized that for the soul to flourish, a time recovery of physical and mental well-being. and place for rest is needed. Professionals committed to the • Stillness , planned and unplanned, is a pause with a cause well-being of their patients know that the journey toward to ponder, process, or pray in a way that cultivates joy health and vibrancy includes attention to the body (physi- and gratitude. Stillness spiritually replenishes. cal health), the mind (mental health), the heart (relational • Solitude is time off the beaten path, free of demands and health), and the soul (spiritual health). The medical and distractions. Solitude emotionally recharges. mental health communities have an opportunity to help their patients and clients find, feed, and fuel their soul. These four rhythms, practiced routinely, give individuals per- Soul Care mission to rest, attend to their souls, and position them to thrive and flourish. Americans live in a soul-crippling environment of overload, exhaustion, and emotional autopilot. The repercussions of In addition to the wellness paradigm, positioning people for this chronic state unravel people, plans, and priorities—and vibrancy and lasting transformation requires two more ingre- sabotages physical, mental, relational, and spiritual health. dients: self-awareness and shared support from others. Joy resides in the soul. It involves contentment, connection, and a growing sense of gratitude. The emotion of joy is the target of a new and growing body of research. This research is discovering that the experience of joy is an indicator of well-being. The presence or absence of joy in a person’s life impacts preventative health care and the treatment of medical and mental health conditions. Joy is often an early casu- alty of overload and no one is immune. Physicians, patients, and clients feel the impact. Restorative Wellness (spearheaded by Run Hard. Rest Well.) is a new and revolutionary approach to wellness. Restorative Wellness (RW) cultivates joy by reintroducing people to four timely and timeless rhythms of rest: Sabbath, Sleep, Stillness (a pause with a cause), and Solitude (stepping away from the fray). RW equips people to make rest simple and strategic, reduce guilt, restore joy, and navigate each day in a way that fosters strength, vitality, and sustainability. Most wellness programs target bad habits and poor choices, focusing on food, fitness, and medical markers. While addressing bad habits and poor choices is worthwhile, it is not enough. These programs tend to be high on information, low on transformation. RW targets the root issues and core beliefs that drive our overload and exhaustion by introduc- ing people to a new view of rest and rhythm that attends to the body, mind, heart, and the soul.

30 Fall 2019 Self-Awareness Self-awareness is a critical tool when positioning people to attend to their well-being. RHRW utilizes short inventories that highlight transparency and honest reflection. While there are numerous inventories to be used, physicians often use a number of questions to help a patient become self-aware of The region’s most their overall wellness: comprehensive community of care Physically • How are your sleep habits? • How many hours a night do you usually sleep? • What kind of medical or physical issues are causing you concern? Mentally • In the past two weeks, how often have you felt down, depressed, or hopeless? • Have you had any thoughts of suicide? Relationally • Do you have supportive relationships in your life with whom you regularly connect? If so, who are they? Spiritually • Are there any spiritual practices you utilize regularly (i.e. attending worship, prayer, Bible reading, meditation, etc.)?

Shared Support Change theory informs us that change happens when groups Parkview Physicians Group of people form new social norms. New insights are critical, but unless they are incubated in a group, change is often mini- is the largest medical group mal and only short lived. in Northeast Indiana. RHRW works with groups of people who know each other: staff, teams, organizations, church groups, or groups of people Parkview Physicians Group o ers whose life experiences are similar, such as single moms, foster a comprehensive array of medical parents, those struggling with addiction, cancer, depression, obesity, etc. specialties, including everything from When a group begins to explore RW together, encouragement cardiology to urology, family medicine and accountability become natural byproducts positioning to sleep medicine – nearly 50 di erent people for lasting change. specialties in all. Our team of over 800 Transformation providers ensures that patients have RHRW has been working with Dr. Nate Lowe, Asst. Professor access to our entire community of care. in the School of Educational Leadership at IN Wesleyan University. Together with Dr. Lowe, the staff of RHRW are actively interpreting data by gathering pre and post Call 877-PPG-TODAY (774-8632), or visit retreat surveys and monitoring the impact of RW practices. us online to learn more. Participants are saying: • They feel less guilt about taking time to rest • They are making intentional plans on how to rest • They feel equipped to help others rest well Overall, they are finding that RW impacts people physically, mentally, relationally, and spiritually. Together, they form a wellness paradigm that creates traction and transformation. Do you feel equipped to help your patients feed, fill, and fuel ppg.parkview.com their soul? Solomon understood the importance of RW. He wrote “Above all else, guard your heart, for it is the well- spring of your life.” Proverbs 4:23

Fall 2019 31 By No Accident… Susie Cisney, RN

Coming from a surgical trauma nurs- And we pray for them, in our own way, in our own private ing background, I would respond to time, not as a job responsibility but as personal responsibil- the most traumatic physical injuries ity to our fellow man. that human beings may experience in One of my favorite writings, that I feel sums up my health- life, throughout the first two decades care practice, is as follows: of my nursing practice. I was trained to respond quickly, assess injury efficiently and move into “People are often unreasonable and self-centered, action to mitigate loss of life without forgive them anyway. hesitation. With teamwork, we saved many, many lives, If you are kind, people may accuse you of ulterior however, those are not the people that made the biggest motives, be kind anyway……….. impact on me. The good you do today may be forgotten tomor- The ones I remember are the patients that we lost; the ones row, do good. I stood by during their final breath, the ones that I cared Give the world the best you have and it may never for and then sat with their loved ones for the final good be enough, give your best. bye. The ones I cried alongside their families with as the We are chosen to serve in the capacity of health- shock of their loss became real. Finally, the ones that gra- care providers to care for God’s broken people. ciously had arranged for donation of their “organs of life” To offer, not just the tangible service of disease as they were delivered to others. mitigation and health treatment, but as a servant In my current Public Health nursing practice, I witness a to others. different kind of dying. One of my responsibilities is over- It is our duty to serve, faithfully. seeing the clinical team of public healthcare providers of For you see, in the end, it is between you and God. the Allen County Syringe Services Program. It was never between you and them anyway.” – Mother Teresa of Calcutta

The responsibility of this group of healthcare providers is to mitigate the spread of disease within the community, but I believe the mission of this dedicated staff is to walk alongside clients in the troughs of despair; through the brokenness of addiction; in the often-slow descent into a deeper darkness, emotionally and physically robbed of a life that was created to be lived to the fullest. I understand and I believe, that it is by no accident that we are where we are, serving whom we serve, at this very time. We are the “boots on the ground” instead of stepping away, instead of thinking these are other people’s problems, as it is hard to serve and support these individuals that are often slowly dying - physically, mentally and spiritually - a little bit every day. Michael F. Barile, D.C., P.T. Through our healthcare delivery, the responsibility is prac- Chiropractor & Physical Therapist ticed and met but it is the mission that is carried out gently, • Over 25 years of spine care • Most insurance plans with dignity and respect for our fellow human beings. Our experience accepted staff look deeper into the people, not what is evident on • P ost operative rehabilitation • Reasonable rates for cash the surface, to better understand their journey, their hopes, • P ersonal injury cases welcome paying patients their disappointments, their desperation; to build relation- • Early morning and late • Cold laser therapy ships to help bind the wounds of social isolation. Often, evening appointments it is the first time in a long time that healthcare providers don’t require something from them, but truly want to serve 260-420-4400 them, to benefit them and the community as a whole. We 3030 Lake Avenue, Suite 26 • Fort Wayne, IN 46805 welcome them with open arms.

32 Fall 2019 Incorporating Spirituality – IU School of Medicine FW Gina Bailey, Assistant Director of Program Development IU School of Medicine recognizes that patients are multifaceted with physical, emotional and spiritual needs. Students are too. The curriculum at IUSM enables students to explore the impact of spirituality in patient care and provides support for student spirituality through the IUSM wellness program. The curriculum at IUSM provides lectures, online modules and small group activities that enable students to recognize the impact of spirituality in regards to patients’ health. In the courses throughout the first two years of the program, students learn about the role of spirituality and religion Cancer Services of Northeast Indiana in preventing, coping and recovering from illnesses. These experiences prepare students to be more comfortable when offers your patients emotional support, discussing spiritual issues with patients in the clinical setting practical help and the skills and tools to live and recognizing that each patient’s spiritual needs are differ- a healthier life. Working together, we can ent. reduce your patients’ stress enabling you Outside of the curriculum, local physicians have discussed and your staff to concentrate on providing their experiences with patients’ spirituality in their practices. the best medical care for each individual. For example, Dr. Rudy Kachmann provides a lecture annually to students about wellness and the mind-body connection. During the lecture, he describes how he has witnessed Celebrating 75 years of service better outcomes with patients who he has asked to pray with prior to their surgeries. The IUSM wellness program includes students’ spirituality as one of the eight dimensions of wellness. The other seven dimensions of wellness recognized through this program are emotional, environmental, financial, intellectual, occupational, physical and social. This program provides students with support mechanisms they need to be successful throughout medical school and as a physician. Additionally, spiritual care and chaplaincy services are available through the Medical Student Education office to meet the spiritual needs of students. (260) 484-9560 (866) 484-9560 Toll Free Health is no longer defined as just the absence Check out our full list of resources at of disease, but it is a joyfulness that should be inside of us at all times—it is a state of positive www.cancer-services.org well-being which is not just physical, but also psychological, emotional and spiritual. —Deepak Chopra

Fall 2019 33

CS Survivor Academy ad.indd 1 12/11/18 10:03 AM Addressing Spirituality Amy Dawson, M.D., M.P.H., Fort Wayne Medical Education Program

Can physicians address for depressed inpatients, those with moral objection to patient spirituality? suicide may be protected against suicide attempts. There Should we? is evidence that religious belief improves resilience to the As Dr. McMahan introduced, there psychological effects of terrorism in Israel. Certain religious has been much work in the area of practices, such as mindfulness meditation and forgiveness, spiritual well-being and mental and improve symptoms of depression and may prevent depres- physical health. Physicians as a whole sion relapse. Studies on the effect of prayer on physical are reluctant to address patient spiri- healing have not shown a consistent improvement, but also tuality for fear of offending patients are problematic to study – how could we designate a con- or awkwardly putting the patient or ourselves on the spot. trol group? Patients, however, expect their physician to be able to Study of religious and spiritual factors are complicated see them as a whole person, including their psychological because of confounders, such as social support from shared and social contributors as well as their spiritual health. In faith groups and definitions of positive spirituality that some cases, patients may be reluctant to share about their significantly overlap with assessments of positive mental beliefs out of fear that we will look down on them for health, such as statements of purpose, meaning and fulfill- their beliefs, or if their beliefs are different from ours, that ment. Effects of religion on psychological health are not we will ask them to stop certain cultural healing practices. universally positive, however, and in one instance was asso- Opening a conversation with a patient about their beliefs ciated with increased psychosis during the Welch revival of and practices can relieve patient stress, reassure them of the early 1900’s. Dr. Harold Koenig presents an updated the importance of their individual beliefs and may even comprehensive review of the literature on religion and increase adherence to proposed medical therapies through health in his manuscript: “Religion, spirituality, and health: simply feeling understood. a review and update. Advances in mind-body medicine”. Evidence Biomedical Model of Disease vs Holism Can religion make a difference in patient health outcomes? Patients are now presenting to their doctors with an expec- There is some evidence for positive effects of faith in the tation of holistic care: being addressed as a whole person, literature. In studies on religion and suicidal behavior including physical, mental, emotional, spiritual health and

Factor 1 Factor 2 Factor 3 ITEMS (RWB) (EWB) (NFS)

I believe that God is concerned about my problems 0.92 0.197 -0.248

I have a personally meaningful relationship with God 0.915 0.15 -0.28

My relationship with God contributes to my sense of well-being 0.902 0.157 -0.27

I believe that God loves me and cares about me 0.891 0.233 -0.22

I feel good about my future 0.136 0.845 0.039

I feel very fulfilled and satisfied with my life 0.152 0.836 0.099

I believe there is some real purpose for my life 0.222 0.76 0.054

Life doesn't have much meaning -0.18 0.235 0.769

I don't know who I am, where I came from, or where I'm going -0.188 0.132 0.749

I don't get much personal strength and support from God -0.243 -0.229 0.532

RWB= Religious well-being EWB= Existential well-being NFS= Negative formulated statements This commonly used spiritual assessment tool tries to broaden the definition of spiritual involvement, but by including items in the “Existential Well-Being” category that are evidence of positive mental health, results in confounding studies that attempt to show positive spiritual scores correlate positively with mental health. Malinokova, 2016.

34 Fall 2019 social factors. They want to be recognized for their part look up and see a tear in the patient’s eye and realize I’ve in their care and empowered to care for themselves. These been buried in my EMR, losing the person in the list of tenets of comprehensive assessment, care management and conditions? patient self-management are core functions of new, holistic approaches to care such as modeled in the patient-centered Sometimes I just need a reminder of my patient’s medical home. We now know that the biomedical model of humanity in the midst of my busyness. disease is limited and at best only 15% of patient outcomes depend on this model; yet as physicians we are still more comfortable managing the biological model. Facilitators We know that medical care needs to be holistic care in order What tools can I use in my office to help me address my for patients to be successful, but as physicians we are often patient more holistically, including their spiritual needs? unprepared to be holistic healers. It is worth our time to 1. Perspective: I can maintain a perspective that the person educate ourselves about the role of spiritual encouragement? in front of me spends 99% of their disease-managing time outside of a medical context. Their empowerment It seems appropriate when writing this piece to start out to manage their illness is dependent on many things, with true confessions. When I heard that social determi- among them their spiritual sense of hope, purpose and nants of health account for 85% of health outcomes, I self-efficacy that empowers them to make difficult, sus- was a bit relieved. I thought, “Well, now I’m not respon- tained lifestyle changes. sible for the other 85% of my patients’ health outcomes and I can focus on the 15% that is truly biomedical.” But 2. Screening: We all have screening questions that we use the biomedical concept of disease is an illusion based on for patient encounters, especially for physical exams ancient French philosopher/scientist René Descartes, who and other preventive care encounters. There are pro- thought that the whole was merely a sum of its parts. posed spiritual questions that can be used to expand our When it comes to human beings, we know that we are far patient intake and start a conversation about religious greater than the sum of our individual biomedical parts; as beliefs. a result, being a physician is more than a biomedical exer- • Is religion a source of comfort or stress? cise. Like poets and priests, we live at the intersection of • Do you have any religious beliefs that would influence hope and despair in our patients’ lives and they expect us decision-making? to be able to speak to that moment. • Do you have any spiritual needs that someone should In accordance with our training, we are well prepared to address? handle the biological basis of disease. However, we have 3. T eam-based Care: Working with a care team can known since the 1970s that the biopsychosocial model is allow us to address patients in a more holistic manner a more robust model of disease processes and outcomes, than physician time alone can allow. Identification of including treatments. Unlike nursing training, physician spiritual needs, acknowledgement of their importance training has been reluctant to train us to treat holistically. and compassionate counseling, connecting patients to In addition, insurance companies are also reluctant to reim- appropriate resources is more easily accomplished as a burse physicians for their role in holistic care, seeing physi- team. We see great examples of team-based care in end- cians exclusively as biomedical experts and reimbursing of-life situations at hospice homes, where a chaplain, them for only that expertise. behavioralist and social worker are available to assist The patients are well aware of the impact of “the rest of the patient and their families. It is less common to have life” on their health and are hopeful that physicians can such a robust team to help patients with their pressing treat them in this comprehensive context. spiritual and social needs when they are facing issues like lifestyle changes, chronic disease management and Operationalizing Spirituality in the Office mental health concerns, but incorporating a team in In an era of increasing physician workload and expecta- these situations may be the key to improving patient tion, presenting spirituality is one more thing that phy- outcomes. sicians are responsible to address. We struggle to offer 4. Physician Training: And preparedness in the area of holistic care to patients with complex needs in 15 minutes, spiritual life can go a long way in comfort broaching all the while typing furiously in an EMR. Reductionist topics with our patients. The goal is to support, affirm strategies to limit physicians to biomedical intervention and encourage patients as they find strength for their leave patients dissatisfied, but incorporating holistic models journey. Dr. Koenig’s extensive work on physician train- takes time we don’t have. How often have I started dron- ing and spirituality can be very helpful as we seek to ing away on medication adherence for diabetes, only to better address this topic with our own patients and can help us avoid the dual pitfalls of offense and negligence.

Fall 2019 35 Spiritual Origins: Lutheran Hospital

Within the first six months, the hospital was deemed too small. In 1906, a new addition was completed and the hospital capacity increased to 75 beds. By 1913, the hospital expanded its capacity to 125 beds. The home of Judge S.R. Allen, which was adjacent to the hospital, had been purchased Plans for Lutheran Hospital began as early as 1878 by members and remodeled to of several Lutheran congregations in the area. In 1901, become the new the Evangelical Lutheran Hospital Association was formed, nurses’ residence. led by Rev. Philipp Wambsganss, pastor of Emmaus Lutheran Church and historically recognized as the founder of the hospi- Lutheran added a tal, to raise funds for a new hospital. Two years later, they had four story, 90-bed enough money to purchase the large brick homestead of Judge unit known as the Lindley J. Ninde on Fairfield Avenue. West Wing, which faced Wildwood On a sunny, yet chilly afternoon, of November 24, 1904 Ave., in 1927. (Thanksgiving Day), Fort Wayne’s third hospital, Lutheran Hospital, was officially opened at the corner of Fairfield and This was the Wildwood Avenues. The Rev. Wambsganss dedicated it “to the basic structure at service of suffering humanity and to the glory of God.” Lutheran until the 1956 expansion At Lutheran Hospital the spiritual as well as the physical health project was com- of its patients was a matter of concern. The program of minis- pleted. tering to the hospital’s patients began immediately upon dedication of the hospital in 1904. Rev. Theodore Hahn served as the The “new” 400-bed capacity, $3 million building hospital’s first Chaplain. expansion was dedicated on Sunday, April 15th. Thus began a series of building projects in subsequent Following the dedication held on the hospital’s lawn, those in years, mostly under the leadership of Dr. Herman A. attendance were invited inside for a tour of the new 25-bed Lutheran Hospital. The remodeling also provided one operating Duemling. room, reception area, kitchen, dining room, and living quarters In 1981, Lutheran Hospital purchased 40 acres of land for Louise Hitzeman, matron, the hospitals’ first administrator. at the intersection of US 24 and I-69. It took eleven A heavy influx of patients at Lutheran Hospital following its years before Lutheran officially relocated to that site in dedication created an immediate need to develop adequate nurs- 1992. ing staff. To alleviate this acute problem, The Lutheran Hospital It was in this spirit of giving that Lutheran Hospital Training Schools for Nurses was quickly inaugurated. (The had its inception, its widespread financial support nurses lived in the attic of the new hospital.) and rapid growth through the years becoming one of A week following the hospital’s dedication the first student Indiana’s leading health care facilities. enrolled with six others soon enrolling, thus comprising a senior On July 31, 1995 Lutheran Hospital was sold. The class of seven. They graduated Thanksgiving Eve in 1907. proceeds from that sale, more than $137 million formed The symbolism in the nursing pin is a reminder of how spiritu- the corpus of The Lutheran Foundation as we know ality and medicine intersected in those beginning years of Fort it today. The Lutheran Foundation has assets of Wayne patient care.

36 Fall 2019 Championing Mental Wellness in Northeast Indiana Marcia Haaff, CEO The Lutheran Foundation

“Hi. How are you?” “I’m fine. How are approximately $225 million, and has invested more than $169 million you?” in northeast Indiana through grants to Lutheran Churches, Lutheran “I’m good.” Schools, Lutheran Ministries, and non-profit organizations throughout Every day, we greet the community. people with polite hellos. The old Lutheran Hospital buildings were demolished in 2000. It’s part of our culture A park with the statue below was developed/installed in its place. to exchange pleasantries, but we don’t really expect someone’s answer to include an honest evaluation of their mental health. What would you do if someone’s answer to “How are you?” was “Not so great. I’m really overwhelmed and not sure how I’m going to get through another day.”? Wow. Awkward! There is stigma surrounding the discussion of mental health and The Lutheran Foundation wants to change that. In 2013, our board of directors sought to narrow its focus in order to become a more impactful investor in our community. A study revealed that mental and behavioral health and wellness was a significantly under-funded area in our community. Since that time, mental health has become the focus of The Lutheran Foundation’s grant awards. The Lutheran Foundation invests in making Christ known, promoting mental wellness and reducing the stigma of mental illness. We look forward to the day when it’s as acceptable to talk about what is happening “from the shoulders up” – topics like depression, anxiety, mental illness, and addiction – as it is to talk about what is happening “from the shoulders down” – ailments like heart disease, cancer, diabetes, the flu and the common cold! This focus is an ideal fit for The Lutheran Foundation, a Christ- centered organization that is striving to show compassion and make Christ’s love known in our community.

Fall 2019 37 Spiritual Origins: Parkview Hospital

From Hospital to Parkview’s Origin: 1878 to 1954 Health System: 1878 – A small group of community-minded women banded together to raise money for a A History of Faith community-owned hospital. “Fort Wayne City Hospital” opened on Oct. 29, but quickly at Parkview closed at the objection of neighbors. The hospital was relocated to the Tapp residence at the Parkview’s history starts corner of Lewis and Hanna streets. and ends with the faith 1883 – The hospital moved to the Olive S. Hanna homestead, a former rooming house at of our community. If not Barr and Washington streets. The building was purchased outright, with financ- for the people, churches ing made possible by donations from three Lutheran congregations, and Jessie L. and businesses of Fort Williams, who donated one-third of the price to honor his wife Susan. Wayne stepping up, 1890 – A major addition was time and time again, the constructed, with two- organization could have thirds of the funds ceased to exist years ago. donated by the children of the late Jessie Thanks to not only the and Susan Williams. faith-based community, The board offered to but also the faith of rename the hospital people who believed in in honor of Susan the original “Fort Wayne Williams, but the fam- City Hospital,” the mod- ily declined and sug- ern-day health system gested the new name “Hope Hospital.” has become an integral part of the city – and 1898 – Miss N.A. Mayheu, superintendent of the Hospital Ladies, helped to raised $3,500 northeast Indiana. to construct a new surgical unit. 1902 – Hope Hospital was remodeled and expanded to almost double its patient capacity. While the entire 141- The new addition cost $14,178 and was covered by donations from local churches. year history of Parkview 1903 – Area Lutheran congregations decided to shift their support and founded Lutheran is fascinating, the first Hospital. 75 years – long before the name Parkview was 1915 – Due to financial uncertainty, the hospital’s demise seemed imminent. Board Chairman Andrew G. Burry organized meetings with leaders of local churches and adopted – especially synagogues to discuss the hospital’s future. demonstrate how faith, trust and the spirit of 1916 – A board of representatives from 24 Protestant churches and two synagogues took the community became over hospital management. In November, the hospital property was sold to the YMCA for $36,500, which nearly covered the hospital’s debt. ingrained in its culture. 1917 – Hope Hospital moved into the Ways Sanitarium building at Harrison and Lewis streets. While this was the largest facility in the hospital’s history, medical and nursing staff opposed the move. After learning of an impending nurses strike, the board voted to discharge the entire nursing staff. Nurses were brought in from Hope Methodist Hospital in Indianapolis. 1918 – In January, the hospital board voted to close the hospital, but reopened immediately as “Ways Hospital.” The Methodist Hospital Association later purchased the hospital, and the Methodist Episcopal Hospital and Deaconess Home Association took control. The hospital was renamed “Hope Methodist Hospital” and later “Methodist Hospital of Fort Wayne.”

38 Fall 2019 1932 – A local Methodist From Parkview church invited Dr. Ezra Memorial Hospital to T. Franklin (who had a Parkview Health PhD in divinity and a Parkview Memorial reputation for turning Hospital, now known around struggling insti- tutions) to Fort Wayne. as Parkview Hospital He was hired as hospi- Randallia, grew from a tal administrator and 242-bed facility in 1954 moved quickly to fix to a 332-bed medical cam- several problems. pus today. After decades 1936 – The Methodist of growth, Parkview’s Hospital Association presence soon extended offered to sell back the hospital to the community, provided they could raise the beyond Fort Wayne, with money within five years. Huntington Memorial 1939 – Dr . Franklin facilitated the purchase of 18 wooded acres at the corner of State Hospital joining as the Street and Randallia Drive for $18,000. Though it was intended as a site for a first community hospital new facility, it wouldn’t be home to a hospital for another 15 years. affiliate in 1995. 1941 – The Fort Wayne community officially bought back its hospital, which has since been run by a local board. Several weeks later, “Methodist Hospital Park” was Since then, four more dedicated at State and Randallia. community hospitals have joined what is now known 1943 – Plans were established to build a new hospital, but pledges came up short and World War II delayed construction. After the war, estimated costs skyrocketed. as Parkview Health, a health system with two 1949 – The hospital board grappled with a decision to build an addition or a new hospital. After learning of federal grants to build a new facility, plans moved forward hospital campuses in Allen for “Parkview” hospital. County and a total of five community hospitals in 1950 – A fundraising campaign collected $1.25 million in community pledges for the new facility. surrounding counties. A sixth community hospital, 1951 – The construction site at State and Randallia was cleared by 234 community Dekalb Health in Auburn, volunteers in January. The ground-breaking ceremony for “Parkview Memorial Hospital” was held in August, but the Korean War drove construction costs even is anticipated to join later higher. this year.

1952 – Lutheran Hospital also needed funds for an expansion, so the hospitals launched an Today, Parkview Health unprecedented joint fundraising drive. In just two months, they raised $2,662,494 remains a community- in community pledges, which were split evenly between the two hospitals. owned, not-for-profit 1953 – After three fund drives health system, indebted and 26 months of to the people who have construction, Parkview supported its mission for Memorial Hospital more than 141 years. opened in November, on the 75th anniversa- ry of Fort Wayne City Hospital. The community came out in force to help with the relocation of patients in “Operation Big Switch.”

Fall 2019 39 Spiritual Origins: Saint Joseph Hospital

By the time of the Civil War, it was quite apparent that Fort Wayne needed a hospital. There was a smallpox epidemic in 1865 but nowhere to treat the victims. In 1868, Bishop John Luers purchased the 65-room Rockhill House hotel for a hospital. The St. Joseph’s Benevolent Association was formed to assist with raising funds to make the new hospital operational. Bishop Luers commissioned pastor Rev. Edward Koenig of St. Paul’s parish to negotiate with Katherine Kasper, the Mother Superior of a relatively new German religious order-The Poor Handmaids of Jesus Christ, to move from Germany to Fort Wayne and assist with caring for the sick. A few months later, eight sisters Five of the original sisters, led by Sister Rosa. arrived in America and settled in Hessen Cassel for a short period of time. On May 4, 1869, the sisters assumed control of the Rockwell House and St. Joseph Hospital opened for business. Dr. Isaac Rosenthal, a German immigrant, performed the first surgery at St. Joseph within a few months. Fifty years later, Dr. Maurice I. Rosenthal became the first President of the medical staff. The Poor Handmaids were dedicated to assisting the poor. They set up a program whereby poor people could stay there rather than going to a “poorhouse”. The charge was $3/week per patient and the fee was paid by the city and township trustees. A doctor’s clinic opened in 1876. Dr. Friscus Operating room in 1904. becomes the first resident physician. In 1929, the last remnants of the 90-year old Rockhill House was St. Joseph Hospital is approved and registered demolished and a new seven–story building was constructed along by the American Medical Association in 1906. Berry Street. The new hospital had a bed capacity of 350. In 1966, a In 1912, the hospital built an addition and the nine-story wing was added along Broadway Street. main door was relocated to Broadway Street. In 1998, Quorum purchases St. Joseph Hospital from the Poor St. Joe started a hospitalization program which Handmaids of Jesus Christ. They reorganized St. Joseph Community entitled a patient board and medical treatment Foundation with a significant amount of the proceeds to go towards for $7.50/year. improving access to health care and the health of the poor and power- The 3-year nursing school started in 1918. The less in Allen County. first graduating class was in 1921 and consist- St. Joseph was sold to Triad Hospital, Inc. in 2001 and became part of ed of seven graduates. This program continued Community Health Systems in 2007. It is now part of Lutheran Health until 1988, when it merged with the University Network. of St. Francis.

40 Fall 2019 Catherine Kasper was born in Germany in 1820. She was one of eight children and helped on the family potato farm. As a child, she and her friends would walk to a local Marian shrine and sing religious songs. Catherine would tell stories about God and Mary. She gained a reputation for helping others and young girls were attracted to her. In 1851, she and four other women formed the religious community called the “Poor Handmaids of Jesus Christ” (PHJC). They vowed poverty, chastity, and obedience with an emphasis in caring for the sick, poor and children. Their ministry grew and spread throughout areas of Europe, India, Mexico, Brazil, and Africa. In 1868, they were asked to come to Fort Wayne, IN and help the German immigrants settled there. She sent eight sisters, who started St. Joseph Hospital in1869. Last year, St. Joe celebrated their 150th year serving the sick and poor in Fort Wayne. Catherine, known as Mother Mary, died in 1898. The Catholic Church named her Blessed in 1978. Pope Francis canonized Saint Maria Katharina Kasper in Oct. 2018.

What Does “Spiritual” Have to Do with Health? Meg Distler, ED, St. Joseph Community Health Foundation

The sponsor of the St. Joseph Third, it can be difficult to determine the right ques- Community Health Foundation, the tions for a spiritual assessment of a patient’s hope, sense Poor Handmaids of Jesus Christ, has of purpose, or ability to accept and grow with the chal- a rich tradition of nearly 170 years lenges and changes they are facing in their lives. However, in healthcare globally. In America, almost everyone that has learned to carefully listen to their they owned over 39 hospitals and patients’ “back story” and assess their spiritual health even started Fort Wayne’s first hospi- report improved patient relationships and outcomes. As the tal – St. Joseph’s 150 years ago. care providers have better understanding of their patient’s Today, the Sisters no longer operate needs, they are better at helping their patients heal. Patients hospitals in the U.S., but do have operations around the who can report an improved hope in their future and are world. In their sponsorship of the St. Joe Foundation in motivated to also take better care of their physical health. Fort Wayne, they have challenged the primarily local, vol- As an example, the St. Joe Foundation is proud to support unteer Board of Directors and the staff to define health as Lutheran Social Service’s ECHO program, which provides “Mind, Body, and Spirit”. case management services for high school teens struggling As the Foundation invests $1.6M annually through grants with unintended pregnancies. As they began measuring the into and partnerships with local non-profits who provide spiritual health of these teens, they learned that initially healthcare and services that address the social determinants 23% of the teens felt hopeless and 20% said their lives of health to vulnerable populations, we are learning a lot were not worthwhile. After 6 months of support from the about “spiritual” health. ECHO team, only 7% were struggling with hopelessness and 100% said their lives were worthwhile. Simultaneously, First, our definition of “spiritual health” is evolving. For the health outcomes of these teens have also reflected posi- us, “spiritual health” is the state of well-being of how one tively. 92% of the ECHO participants gave birth to children experiences meaning, purpose and hope in their life through at or above the national birth weight and 95% were up to connection with self, others, and a Higher Being. date on well checks and immunizations. Second, many of the community non-profits into whom we Lutheran Social Services is but one excellent example. We invest serve very low income and vulnerable populations regularly see from those we invest grants into that being filled with individuals who are “spiritually distressed”. attentive to the spiritual health of a patient can yield large Simply, they lack “hope” and frequently, feel little “sense of improvements to physical and mental health of the patient. purpose”. These clients and patients without “hope” have little motivation to live, much less live a healthier life style or be compliant with any health care procedure until they believe in their own self-worth and purpose. We believe it is important for organizations to also listen carefully and assess the “spiritual” health of those they serve as they also assess their physical “mind” and “body” conditions.

Fall 2019 41 Faith-Based Counseling

Provider Phone Address County Website Catherine Jantzen 6334 Constitution Dr, (260) 209-1209 Allen www.catherinejantzen.com and Associates Fort Wayne, IN 46804 Christian Counseling 1213 St. Mary's Ave, Centers of Indiana - (260) 478-7320 Allen www.cccoi.org Fort Wayne, IN 46808 Avalon Cornerstone Vision Counseling 3948 New Vision Dr, (260) 407-7285 Allen www.corvision.org/ & Psychological Fort Wayne, IN 46845 Services 4618 East State Blvd, Cross Connections, (260) 373-0213 Suite 300, Fort Wayne, Allen www.crossconnectionscounseling.com Inc. IN 46815 4150 Illinois Road, Crosswinds (866) 706-2167 Allen www.Crosswinds.org Fort Wayne, IN 46804 Hand In Hand 9426 Lima Road, Suite Comprehensive (260) 497-0328 A, Fort Wayne, IN Allen www.handinhandtherapy.com/ Therapy Specialists, 46818 Inc. Harvest Counseling 4216 Flagstaff Cove, (260) 485-4357 Allen www.harvestcounselinggroup.com Group Fort Wayne, IN 46815 1747 N. Wells Street, Hope Alive, Inc. (260) 420-6100 Allen www.hopealivefortwayne.org Fort Wayne, IN 46808 6202 Constitution Dr., LifeWorks Counseling (260) 432-0066 Suite D, Allen www.lifeworks-counseling.org & Consulting, Inc. Fort Wayne, IN 46804 The Lighthouse - A P.O. Box 8746, Biblical Life Recovery (260) 255-6413 Allen www.BiblicalLifeRecoveryCenter.com Fort Wayne, IN 46725 Center 2112 Inwood Dr, Living Free Recovery (260) 209-4596 Allen www.livingfreerecoveryac.org Fort Wayne, IN 46815 1415 Magnavox Way, Wieland & (260) 483-7207 Ste. 120, Allen www.wielandassociates.com Associates, Inc. Fort Wayne, IN 46804 www.facebook.com/Grace- Grace & Truth 1936 College Ave., (260) 356-2642 Huntington Truth-Counseling-Services- Counseling Services Huntington, IN 46750 LLC-337151989755860/ LifeSpring Counseling 479 Campus St., Center, LLC – (260) 454-5500 Huntington www.lifespringllc.org Huntington, IN 46750 Huntington Wabash Friends 3563 S St. Rd 13, Counseling Center – (260) 563-8452 Wabash www.wabashfriendscounseling.com Wabash, IN 46992 Wabash Brickhouse Family P.O. BOX 311, Bluffton, (260) 824-4774 Wells www.brickhousefamily.org Ministries IN 46714

42 Fall 2019

Fort Wayne Medical Society PRSRT STD 709 Clay Street, Suite 101 U.S. POSTAGE Fort Wayne, IN 46802 PAID FORT WAYNE, IN PERMIT #182

Wear 3D It PINK Mammograms Available

PINKt ber better known as Breast Cancer Awareness Month provides us the opportunity to highlight the importance of breast cancer awareness and show our support to patients, family and friends touched by breast cancer. Breast Diagnostic Center believes that early detection is your best protection and the key to saving lives. You can trust our specifically trained and certified technologists in mammography and our board certified radiologists with expertise in breast imaging to provide the highest quality of breast imaging available.

Visit our events page at FW-BreastDiagnosticCenter.com to get a glimpse of several events our staff will be participating in during PINKt ber. Your breast health is important to us.

To schedule your appointment, call: 260-266-8120 or visit us at FW-BreastDiagnosticCenter.com