PlainViews

Dr. Angie Panos on the imperative to learn about PTSD

Supporting Our Soldiers

Our country is facing a crisis of gigantic proportions. Tens of thousands of young US soldiers, male and female, have been maimed in the wars in Iraq and Afghanistan. Even if they come home with their physical bodies and health intact, there is another war that they must fight within themselves. Large numbers of these returning veterans are showing signs of posttraumatic stress disorder (PTSD). The average age of combat personnel is only 19. Their lack of life experience and early stage of emotional and spiritual development leave them feeling like there is no way to cope with the atrocities they have witnessed. Once called “shell shock”or “combat fatigue,”PTSD symptoms include flashbacks, nightmares, panic attacks, feelings of detachment and estrangement from others, irritability, rage, trouble concentrating, emotional outbursts and sleeplessness. PTSD in veterans often coexists with other disorders such as clinical depression and substance abuse.

Another serious psychiatric fallout from the war that we are seeing in mostly young, lower-level enlisted soldiers is suicide. While there are numerous reports of suicides, exact statistics are difficult to gather as many of these veterans have declined to participate in programs that could monitor them. Services to veterans are severely under funded and are challenged to handle the overwhelming numbers of injured soldiers. Parents of the veterans that have committed suicide often report that their son or daughter could not get images of dead bodies and injured children out of their mind.

Soldiers typically have lower rates of PTSD in wars that have clear missions, clear enemies, time frames, achievable objectives and adequate resources to carry out the mission. Soldiers typically have higher rates of PTSD in wars with confusion about the enemy—such as in Iraq. Combat against the insurgency happens in crowded streets, marketplaces and neighborhoods, places where innocent children are likely to be at risk of injury and death. Other factors that increase PTSD are unspecified or changing lengths of deployment, lack of clear mission, high civilian deaths, and lack of substantive rationale for the war.

What can you do in your role as a chaplain to rise to the challenge facing our countrymen and women? First, educate yourself on PTSD and the need for comprehensive treatment strategies, which include spiritual support. Next, develop resource networks that do outreach to veterans and provide linkages to comprehensive care. Finally, the great need for spiritual support, renewal and healing of the tens of thousands of veterans must be answered by all of us. We must reach out to these soldiers and assist them in returning to productive lives.

For education and resources go to www.giftfromwithin.org

Editor's note: In an effort to keep this conversation going, we decided to post the comments to "Learning from the Fingerprints on Our Hearts" here and not in TalkBack. It is my hope that our readers will take seriously this challenge and begin to document what it is we do and how we do it. As one responder put it: "Chaplains are silent witnesses and what a gift it is to be able to share how we find ourselves in the presence of the Divine."

The image of the chaplain arriving in the hospital chapel by happenstance and the flood of memories that a quiet space evokes, opened within me a storehouse of rich memories. In the middle of a full and busy day, I stopped for just a moment to catalog my own similar experiences with patients, family and staff that I had encountered as a chaplain. Professional Chaplaincy indeed, gives us that gift.

Like a child home from Halloween night trick-or-treating, I could have spent the rest of the article savoring this collection of life’s lessons learned, but Martha Jacobs raises greater concerns for the future of chaplaincy. Noting the wealth of our experience, she rightfully points out the vacuum of literature to document what we’ve learned. Her challenge to all of us is undeniably true, “We need to grow our body of work so that we can not only claim our rightful place alongside our medical, nursing and social work colleagues, but continue to grow and serve our teachers –our patients, families, and hospital personnel.”

As a profession we have recently made significant strides to be recognized for the work we do. Now that we have a seat at the table, it is time for us to have something to offer alongside our colleagues. In terms of quality, no other discipline has the depth of training and clinical experience dealing with religious and spiritual issues than professional board certified chaplains. Our CPE training, our interfaith models of care and our professional ethics make us uniquely suited to champion the spiritual dimensions of care and speak/write from an informed position. Thank you, Martha, for reminding us that we have been given a wealth of learning, and for challenging us to further our profession through the discipline of writing.

The Rev. Jon A. Overvold, M.Div., BCC
Chair, APC Quality Commission
Director of Pastoral Care and Education
North Shore University Hospital
Manhasset, NY

I just read Rev Dr. Martha Jacobs article, "Learning from the Fingerprints on Our Hearts." I could not agree more!

Others are telling the story of spiritual care. Our colleagues in nursing and medicine are publishing research and documenting the inspirational stories regarding the power of the spiritual in the healing process. Chaplains are, for the most part, silent. I am a member of the editorial board of Vision, the NACC publication, and a frequent contributor to the same. As a board we struggle to find chaplains willing to contribute to the publication.

I'd like to take expand the notion of writing. Chaplains must document patient encounters and interventions! In spite of charting being a minimum standard of care, the vast majority of chaplains do not chart in the medical record. Chaplains can begin to claim their rightful place on the interdisciplinary team by charting their patient interventions using the venue in place in their settings. Skillfully written chart notes forwarded to physicians and others on the care team makes chaplaincy visible within the institutional setting. Its primary value is the difference it makes to patient care.

I applaud your article. I pray that others take it to heart and pick up their pens or boot up their computers and start writing!

Linda F. Piotrowski, MTS, NACC Certified
Pastoral Care Coordinator/Chaplain
Palliative Care/Norris Cotton Cancer Center
Dartmouth Hitchcock Medical Center
One Medical Center Drive
Lebanon, NH

Martha, I just wanted to say thanks for the excellent issue of PlainViews which arrived today and I read immediately. I especially liked your article regarding your memories of your first CPE experience as you reflected upon it in the chapel. My own memories of CPE experiences came back as I resonated with you and your musings. Remembering is truly a way to honor those who we have walked with, cried with, and stood beside in that experience of being on "sacred ground". Now that I am retired all I have are those memories, and they are often what give my day meaning and purpose. It is humbling to ponder how I have made a difference in someone's life just by being there, and perhaps simply saying a prayer.

For eight years during my ministry as Chaplain at Providence Alaska Medical Center in Anchorage, I would annually receive an anonymous note from a woman who had requested a chaplain to come and pray with her and her husband before she had surgery for Cancer. She and her husband would come by the hospital, in the following years, and drop off the "Thank You" note when I was not in the office. Just before I retired I was able to identify the patient, and I was able to thank her for her kind thoughts, and annual notes. It is very humbling to actually know that my ministry had had such an effect in her life. Thanks for the opportunity to share these thoughts.

I applaud the recent excellent article by the Editor of PlainViews, the Rev. Dr. Martha R. Jacobs, in the Advocacy section, “Learning from the Fingerprints on Our Hearts.”It reminded me once again, how important it is to name and claim who we are as chaplains and pastoral caregivers.

We readily admit how important our work is to others and to ourselves. We know inwardly within our souls, and outwardly (because we are often told) how we “make a difference”in people’lives. We bring spiritual healing; we lift up people when they are down; we are there to walk with them in the narrow places.
Doing the good work we do is vital. Spreading that word, describing our activities is likewise important. We do this not to be self-serving, not to brag, but because our work is crucial to the wellbeing of so many.

In their proper place modesty and humility have value. On the other hand, if people are not aware what we are doing, should we fault them for not appreciating our significant contribution?
Stories can be powerful tools for conveying messages. Consider the sacred literature of the world’s religions. Often through stories about women and men, seminal lessons teach the values of that tradition.

Stories inspire. Stories encourage. Stories motivate us and they motivate others. Please, as Rev. Jacobs invites us to do, please share your stories, thereby honoring those with whom you have served, those with whom we will serve, and honoring us, your colleagues, as well.

Rabbi Dr David J. Zucker, PhD, BCC
Director of Behavioral Services Shalom Park
Aurora, CO

I read your piece in the current PlainViews reminding us to continue to be teachers of the human condition. In synagogue and temple, we have what is known as the 'Kol Nidre Appeal', which takes place on the eve of Yom Kippur, a time when most of the Jewish brethren are in attendance. The appeal is a major fundraiser. Although you did not ask for money, you asked for jewels! You reminded me that Chaplains are silent witnesses and what a gift it is to be able to share how we find ourselves in the presence of the Divine.

I'm sending you a submission. My last submission was in 2005. It would be a privilege if it would be considered for PlainViews.

Peace and blessings,

Chaplain Rosalie M. Osian
Derech Chayim-Cycle of Life Pastoral Services
205 West End Avenue, 21M
New York, New York

Thank you, Martha, for encouraging our writing about the chaplaincy stories in which we have been players. Journaling has always been a tool for me to process challenging situations and emotions in my life.

In fact, at the suggestion of my CPE supervisor, I had planned in 1999 to write up for publication an inspiring visit with an elderly woman at Calvary Hospital. We met during the first of my four units of CPE. Our basic way of communicating was my starting to sing the first few lines of a classic gospel spiritual. She would join in with all the words I had forgotten. Her memory as well as her five teeth producing a child-like voice carried us through verse after verse. It was a joy to be with her in her final days doing what she loved. It brought her back to her youth, her home, her family and her strong faith. Needless to say, I only planned to write the story so never did.

My CPE residency ended in May 2005 and there were a number of “stories”from that experience also. Your article allowed me to put myself back in the chapel of Westchester Medical Center and recall many of them. Perhaps I will have the opportunity to commit them to paper as I move through this semester’s course at Union Theological –The Journey of Development: Psychological and Religious. It lends itself to that kind of reflection. I will mail it to you if I do!

With appreciation for the encouragement your article provided

Not long ago I conducted a memorial service for a kind man I had never met. I think it went well, but I can't know for sure. I only knew the son-in-law and the daughter slightly. The man who passed away was a non-observant Jewish person, but his widow was a devout Roman Catholic. I knew he had a rough childhood and that he was a big kid at heart. I don't know the ethnicity of the widow. She might have been Portuguese American, for there are many people of Portuguese descent (mostly for the Azores) in the Central Valley of California where I work.

This article is not about the family. It is about the pronounced difficulty of providing proper pastoral care in a cross-cultural or interfaith situation at a time of grief, especially when we are asked to do a memorial service. I have found it is inappropriate to be too curious about family details, for although counseling is part of the caring we provide at a time like this, it is more about giving a framework for them to say goodbye. I see the pastoral task at the time of a memorial service as sewing together the threads of the life of the person remembered, eternal and other stories, and the volatile emotions of the bereaved. Sometimes this has to be done with very little background information. Having done quite a number of culture-specific services over the years, there are a few things I have learned:

First, remain rooted in the tradition you represent. Those present will accept who you are. However, avoid being formulaic and scripted in your approach. It can be helpful to use traditional language, but make sure those present do not get the impression you are using a cookie-cutter approach.

Second, remember that what you are doing must help the bereaved say goodbye and to move on with dignity. Any obstacle to achieving this goal must be removed.

Third, prepare by asking questions about the person so that she or he can be remembered in an open-ended way (starting with "why," "how," etc.) Listen for the essence of this person, the seeds present in their life story that the bereaved can collectively carry with them. For example, if the person had a great sense of humor, don't be afraid to use humor.

Fourth, see if you can tie in some meaningful reference to the cultural heritage of the one remembered.

Remain aware that the bereaved tend to be gracious, for at the moment of saying goodbye they need to surrender in some way to an order that someone from the outside has control over. They will filter out what they don't agree with as long as they feel you care about them, validate their feelings of loss, and show them that you are truly trying to serve them the best way you can.

Do you have thoughts about education & research you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.

5:45 P.M. I am riding my 30-year-old racing bike through Lost Creek Park. Whipping through several turns, the limbs of the tree race past me like memories of the day.

One patient recently lost his wife. “I am ready to die,”he says. He complains of being weary of life. I don’t blame him. He has seen much, having won his citizenship by fighting for the USA in the Second World War. He weeps still at the memory of his best friend being killed while on patrol. “Don’t forget me,”he pleads. I have taken to greeting him with the words, “I have not forgotten you.”

When I leave, I assure him, again, that I will not forget him. The words come easily. He has left an imprint on my heart and soul. Recently, as I was departing from a long visit, he took my hand and covered it with his kisses. A lump formed in my throat when I climbed into my car to leave. The patient is Catholic and the impact of his affection is not lost on me. I am awed at the power of compassion to move patients to such gratitude.

The trees are a blur. Another memory flashes by. Today, I spoke with a woman who is 112 years old. She is hard of hearing, but hears well enough to repeat my name when introduced. I think to myself, “Surely there is a misprint on her face sheet regarding age.”No. (Born 1894)! After an internet search, we find she is the second oldest person in our young country. To the receptionist in our office, I boast, “A 112-year-old woman spoke my name today.”I am struck by the power of that voice that can call my name. After all, her voice spoke in moments over 100 years ago. I felt as if I had stepped into a time machine.

The wind glides past my face as I round the next curve. I ponder the funeral that I did today. After telling the family that no one is perfect (but the deceased had much strength we could focus on), a nine-year old great granddaughter came to the podium with her grandmother to proclaim that her great grandmother was indeed perfect. My heart was warmed to hear her unequivocal love for “granny.”We were both right, of course, but she spoke with more power. It was a beautiful moment.

The spokes on the wheels hum a sweet melody. The song resonates with my heart, where I find satisfaction. It has been a long day, and the sweat from the Houston heat feels good on my skin. Not every day will be like this, but I know there will be some…and that gladdens my spirit. I hope and pray that you, too, will find meaning in your walk today.

In preparation for the 2006 Pemigewasset Choral Society Christmas concert series, choral society members were invited to offer their personal written reflections on peace, the theme of the concerts. Judith's reflection caught Rev. Dr. WIlliam Zeckhausen's heart and he asked her to submit it to PlainViews.

Do you have thoughts about spiritual development you’d like to share with your colleagues? Send an e-mail of any length to info@PlainViews.org.

EthicsWalk addresses spiritual care as an ethical enterprise. It explores why relationships between spiritual care providers and those they serve need protection, and examines what that protection entails. PlainViews invites our readers to share their responses to each EthicsWalk column, which will be published in the following issue.

If you’d like to respond to EthicsWalk, please send a comment of no more than 100 words. You can use the e-form below (click on "hearing from you," link) or submit your commentary to the editors in the body of an e-mail (or as a Microsoft Word attachment) sent to Info@PlainViews.org. Please put the phrase “EthicsWalk” in your subject line.

We look forward to hearing from you.

Anne, in responding to your comments and footnotes concerning Attorney Ethics... In this case, with a POA-HC "clearly" dictating the patient's wishes and an proxy/agent willing to follow them, it is interesting that your assessment solely burdens the chaplain with the ethical responsibility to advocate for the autonomy and beneficence of the patient, and that you limit the spouse's attorney with the responsibility of following the autonomy of the spouse.

This scenario reminds me of the all too common situation of a family member demanding CPR for a patient who has requested DNR/AND resulting in the raw “autonomy”of the family member dictating the medical response (resulting application of CPR) to the patient. Is this not the same permissiveness attributed to the principle of “autonomy”by the attorney to their client in this case?

Rev. KC Schuler, MDiv, BCC
Theda Clark Medical Center
Pastoral Care Dept.
Neenah, WI

What I hoped the assessment conveyed was the different way each professional is obligated by the practice codes of the particular profession to manifest his or her ethical responsibilities. In this case, the chaplain as a health care employee had a duty first to the patient's interests. The attorney was hired by the distraught wife and had her interests as first duty. The attorney would have counseled the wife about the rules and the likely outcome that the POA's determination would be followed. However, that is not what the wife wanted. As client, her wishes dictated the attorney's advocacy duty. Due process in the U.S. means that people accused of crime get their "day in court." "Fair process" enables people to address civic, business, family, etc. disputes in civil courts. Similarly, administrative proceedings, like the hospital's, provide an opportunity for people challenging decisions in non judicial forums to be heard. Sometimes their concerns produce different results, frequently they do not. But ethical attorneys are advocates for, not judges of, their clients. Were this not fundamental to legal ethics, in many divorces, both spouses would never be able to obtain legal representation!

Patient Autonomy v. Family Comfort: The Provider’s Dilemma (PlainViews, 12/6/06, vol. 3, no. 21) portrayed a family divided over withdrawal of life support in a medically futile situation. The accident victim’s wife disagreed with the health care proxy’s decision for withdrawal. Advance directives clearly demonstrated withdrawal would be the patient’s wishes. The family’s minister and the hospital chaplain said “beneficence”dictated giving the wife more time to accept the situation. She hired an attorney who challenged the validity of the proxy and threatened suit if withdrawal occurred before determination.

The column elicited this response from Chaplain Gordon Putnam: “I am confused about the duty of the wife’s attorney. With an advance directive that seems so clear, isn’t there an ethical responsibility for the attorney to explain the law to the wife rather than threaten a lawsuit?”

Both chaplain and attorney had ethical responsibilities to counsel the wife. The chaplain’s duty flowed from the principles of autonomy and beneficence. Those principles attached to the patient whose wishes the chaplain needed steadfastly to articulate to the wife.[1]

The attorney’s duty was to the goals of the client-wife. Client autonomy is foundational to the attorney-client relationship. The attorney’s obligation is to advocate what the client believes to be the client’s best interests. Ethically, the attorney had to advocate for slowing the withdrawal process in spite of patient directives. Threatening a suit bought time for the wife’s grieving process.

Attorneys can educate and counsel clients, indeed plead and prod, but once a case is accepted, attorneys are ethically bound to advocate for their client’s wishes. Attorneys cannot knowingly permit clients to break laws or commit perjury. But attorneys must advocate for the interpretation of law or facts that best meet a client’s interests.

Most attorneys take seriously their role as “counselors at law.”They maneuver through clients’emotional and psychological attachments recognizing those that can be compromised and adapting to those that cannot. They attempt to inform, educate and guide clients to reasonable decisions. The American Bar Association Model Rules[2] state: “In representing a client, a lawyer shall exercise independent professional judgment and render candid advice. In rendering advice, a lawyer may refer not only to law but to other considerations such as moral, economic, social and political factors, that may be relevant to the client's situation.”[3]

However, the client, not the attorney, ultimately determines the goals and chooses the course of action to achieve those goals. An attorney is the client’s alter ego, not the client’s super ego. Quoting again from the Model Rules: “a lawyer shall abide by a client's decisions concerning the objectives of representation and…shall consult with the client as to the means by which they are to be pursued. ... A lawyer shall abide by a client's decision whether to settle a matter. …(b) A lawyer's representation of a client, including representation by appointment, does not constitute an endorsement of the client's political, economic, social or moral views or activities.”[4]

Health care providers must provide competent medical services for patients in their care regardless of judgments about the patient’s values or life choices. Attorneys must represent the positions of their clients regardless of the attorney’s own feelings about those positions. A surgeon cannot walk out in the middle of an operation unless an equally competent surgeon is present to take over. An attorney cannot withdraw from representation in a case unless another attorney has entered an appearance on the client’s behalf.

The United States judicial system for all its flaws works because people can obtain legal representation regardless of their psychological quirks, emotional entanglements, political proclivities, or alleged crimes and misdemeanors. Judges and juries render findings and decisions, not attorneys. Ethically, attorneys can render only their professional advice and vigorous advocacy and must do both without publicly criticizing their clients.

Next month’s column will suggest ways in which people can work effectively with attorneys –their own and another’s –to prevent or to resolve conflict.

[1] Arguably, the chaplain breached ethical responsibility to the patient by supporting the wife’s contrary position. The chaplain should have welcomed the intervention of the attorney as an ethically proper means of advocacy for the wife.

[2] The American Bar Association Model Rules of Professional Conduct are the basis for each state’s ethical conduct code for members of its bar.

[3] The American Bar Association Model Rules of Professional Conduct, Counselor Rule 2.1, Advisor

[4] The American Bar Association Model Rules of Professional Conduct, Client-Lawyer Relationship, Rule 1.2, Scope of Representation And Allocation of Authority Between Client and Lawyer.

We post an ethical or situational concern that has arisen in a facility where one of our readers works. It has no identifiers included. It gives you only the facts of the case. Then, you can respond to that concern. This is an ongoing dialogue, with comments added as they come in. In the following issue, assuming it has been resolved, we give you the outcome from the facility where the incident took place. Please send any cases that you would like considered for inclusion to: info@plainviews.org

We hope that this new addition will help to inform not only those who are dealing with the issue, but will enable all of our readers to learn from the experiences and perhaps mistakes of others.

PLEASE NOTE: Due to unanticipated continuing responses to both the case and the resolution of the case, added responses can be viewed in the archives. Click HERE.

No cases were submitted for this issue of PlainViews. Cases have not been submitted with as much regularity as we thought they would. The Advisory Board of PlainViews and the Managing Editor have discussed possible reasons for this:

–chaplains are loathe to have someone "armchair quarterbacking" what then did or did not do

–fear of even trying to submit a case, thinking that it is unimportant or that no one would be interested

I want to address these possible reasons because I hear from so many chaplains and supervisors how helpful it is to have these CaseConferences and so we do not want to discontinue this section.

When it happened (if important to the case - e.g. overnight, week-end, end of a long shift)

You can send the case in whether or not it is "resolved". Send it to info@plainviews.org.

The editor and staff will then review the case and make sure that it has no "identifiers" that link it to a particular institution, chaplain, or individual. It will then be sent back to the submitter for final approval.

"Armchair quarterbacking" fear: it is understandable that one would worry about this. But consider that all of us, at one time or another, have been or will be where you are now with your case.

Fear of being found out: another understandable concern, but one that is a highly unlikely to ever occur since only the managing editor knows who submitted what and she is not telling....

A case may be "unimportant" or not interesting enough: another understandable concern but consider this –since most of us operate within a confined area, it is hard to determine how what you are dealing with will impact someone else. Chances are, either they have been through something similar already or will go through it in the future. We learn from each other –from our mistakes as well as from our successes.

So, please consider submitting a case from which all of us can and will learn. We deal with situations that may seem "normal" or "usual." To someone else, however, they may be a wonderful learning experience.

Please check the archives below for comments made about the last CaseConference.

Truth is a Pathless Land highlights the essential teachings of Jiddu Krishnamurti in a compelling 2½ hour audio session.

Krishnamurti, who passed away in 1986, continues to be widely regarded as a powerful spiritual teacher. He traveled the world espousing the core belief that individuals can transform themselves through self-knowledge, by being aware of their thoughts and feelings in daily life.

He was born in 1895 into a family of Brahmins who lived about 150 miles north of Madras, India. He was raised from the age of 13 by leaders of the international Theosophical Society called The Order of the Star. Theosophists built the organization around Krishnamurti after selecting him as what they called “the vehicle for the return of Christ.”

Interestingly, as a young adult Krishnamurti disavowed this destiny and also dissolved the Order of the Star. In his departing speech to the Theosophists, he maintained “…that Truth is a pathless land, and you cannot approach it by any path whatsoever, by any religion, by any sect…Truth, being limitless, cannot be organized; nor should any organization be formed to lead people along any particular path...A belief is purely an individual matter.”

For nearly 60 years, from 1929 until his death, Krishnamurti, during his travels, engaged with people from all walks of life. The author of many books, Krishnamurti spoke with religious leaders, professors, writers, psychologists and scientists of all faiths and, at the age of 90, he addressed the United Nations on the subjects of peace and awareness. He was awarded the UN Peace Medal two years before his death.

Krishnamurti maintained that truth is arrived at through concerted inquiry into one’s own experiences and through “watching closely whatever is occurring.”A world of peace and love, a new society, can emerge only through a radical change in the individual, according to this spiritual teacher. Krishnamurti urged listeners to be, rather than to become.

Chaplains may find particularly useful Krishnamurti’s discussion of how to mend the “broken parts of ourselves and society.”His final message was a very positive one. The pursuit of self-knowledge, he said, is not a solitary venture, but can be achieved only “in the mirror of relationship”to people, to nature, to things and to self. He believed that as individuals come to understand the content of their own consciousness, they will discover that their individual consciousness “is common to humanity.”

If you are interested in purchasing this audio series, you can do so at www.hartleyfoundation.org. Just click on “Sacred Sounds”on the homepage for more information. The cost of the series is $24.95.

Sarah Masters is the Managing Director of the Hartley Film Foundation, a non-profit foundation dedicated to cultivation, support, production and distribution of the best documentaries and audio meditations on world religions, spirituality, ethics and well-being.

As we all can attest to the intensity and fullness of our daily lives as chaplains, Father/Doctor Sulmasy reminds us that physicians and other healthcare professionals also “inhabit multiple spheres of discourse, and spirituality touches them all.”In A Balm for Gilead, Father Sulmasy shares his unique journey, integrating his personal spirituality with his medical vocation.

Put another way, he brings his humanity and compassion to us all, whatever our specific role in the healthcare field.

Father/Doctor Sulmasy should be invited to teach at our medical schools to engage our new physicians and guide them in the early days of their vocation. Indeed Father/Doctor Sulmasy brings great empathy to our medical practitioners who entered medicine with great purity of purpose, but have been diminished by the need to survive in their practices by dealing with the bureaucracies of insurance companies, the AMA and the like. Indeed he proposes a four-step program to enable doctors to renew themselves to the nobility of their profession.

Even though this book is smoothly written, I found myself going back to certain sections to ponder further on several themes. The reading became more of a meditation than an intellectual evaluation of the book.

The writing is clear and well organized. I was thoroughly engaged with the book and would heartily recommend it to anyone. It’s a “mini-retreat”for all of us who spend our days running up and down hallways. It’s a book that I will “gift”to my fellow healthcare professionals, and I will keep a copy of it next to my computer to pull out and read a few pages during challenging times.

My only suggestion is that I think the words from the African American spiritual should be printed on the front cover:

Sulmasy, Daniel P. A Balm for Gilead, Georgetown University Press:Washington, DC (2006), pp 154.

Do you have thoughts about these reviews you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org