EP. 71: THE SPIRIT AND THE BODY

WITH KERRY EGAN

Jul 18

WITH KERRY EGAN

A hospice chaplain and author discusses how she helps patients navigate through the “spiritual work of dying”—and shares lessons learned on suffering, pride, redemption, regret, and hope.

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Episode Summary

"All dying is a spiritual process," says our guest on this episode, hospice chaplain Kerry Egan. By this, she means that each person's death is more than just a biological event; it's an opportunity to reflect on the culmination of our human experiences, the lessons we’ve learned, and the impact we've had on others. The recognition of our impermanence prompts us to grapple with questions of legacy and purpose, infusing our mortal existence with depth and significance. Over the course of our conversation, Kerry describes how she became a chaplain, how she supports patients and other clinicians through difficult times, and the process of reconciling the strength of the human spirit with the limitations of the body.

Kerry Egan is a hospice chaplain and a graduate of Harvard Divinity School. Her hospice work has been featured on PBS and CNN, and her essays have appeared in Parents, American Baby, Reader’s Digest, and CNN.com, where they have been read more than two million times. She and her family live in Columbia, South Carolina.
In this episode, you will hear about:
• An overview of hospice care and the role of the chaplain - 1:53
• The difference between hospital chaplaincy and hospice chaplaincy, and what led Kerry to this work - 7:15
• A discussion of the distinction between the person’s physical body and their intangible soul, consciousness, or spirit - 26:00
• How a chaplain offers spiritual counseling to clinicians in addition to patients - 32:51
• How years of being a chaplain has taught Kerry to love her own body - 34:20
• Why viewing the body as a machine and the physician as a mechanic leads to harm - 39:01
• Kerry’s advice to doctors for keeping compassion alive - 49:08
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to the Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across health care, from doctors and nurses to patients and health care executives. Those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:02] "All dying is a spiritual process," says our guest on this episode, hospice chaplain Kerry Egan. By this, she means that each person's death can be acknowledged as more than just a biological event; it's an opportunity to reflect on the culmination of our human experiences and the impact we've had on others. The recognition of our impermanence prompts us to grapple with questions of legacy and purpose, infusing our mortal existence with depth and significance. Over the course of our conversation, Kerry describes how she became a chaplain, how she supports patients and other clinicians through difficult times, and the process of reconciling the strength of the human spirit with the limitations of the body. Kerry, thank you for joining us and welcome to the show.
Kerry Egan: [00:01:51] Thank you for having me.
Henry Bair: [00:01:53] I think many of us have an incomplete or incorrect understanding of what hospice chaplaincy is. So to start us off, can you tell us what this work looks like?
Kerry Egan: [00:02:03] I think it's probably easiest to break it down into the two pieces of the title. Hospice is a program for people who have a life limiting illness. So traditionally, if you're if you're going to pay for hospice, which is an awful way to start talking about this, but if you're you're going to pay for hospice through Medicaid or Medicare, you need to have a prognosis that you'll live for about six months or less. But hospice itself doesn't limit, I think, specifically to that six months. That's that's a reimbursement thing. Hospice is for anybody with a life-limiting illness. And that runs the gamut. Right. You know, a lot of people think of hospice and they think of cancer. But you can be on hospice services with Alzheimer's disease and you can be on hospice services with congestive heart failure. Any any disease where we know you are not seeking a cure for the disease and that that disease, if it runs its course, will eventually result in in you dying. That is what hospice is for. And it's a way to approach care that is a little bit different, I think, than the traditional medical model. It's not so much interested in in cure as it is in really expanding the quality of life that a person has. So however much life you have left on this earth, people in hospice are going to make sure that every day is as great as it possibly can be. They're no longer seeking to reverse your illness. They're seeking to mitigate the symptoms. They're seeking to find out what your goals are, to make sure that you can meet as many of them as possible. And your goal is not even in terms of what is your goal medically, but your goal for your whole life, your whole life.
Kerry Egan: [00:03:54] What is it you want with the time that any of us have left on this earth? What do you want to do? And let's see if we can make that happen. So the best of our ability. So hospice is very much a group, a team approach. It was founded as a team approach. A chaplain is a person who cares for the spiritual life of the patient and family and helps them whatever goals they may have. The chaplain is going to help them meet them in the spiritual realm. Hospice understands dying to be a spiritual process as well as a physical process. Dying is not simply the body shutting down its systems. Dying is also a process by which your mind -and your soul, your heart, whatever words work, the part of you that is you and not just your body- dying is a process in which we need to come to understand what that soul is, what it has been doing here on Earth for the last...how many years did you have? Were you lucky? Did you have 90 years? Did you only have 20 years? How long did you have? You know, on hospice, there's a big range. It's a big range of how much time people got to have on Earth. So the spiritual process of dying is looking at that time you had and trying to come to understand. What did it mean? What do I still want to do? What did I learn? Who do I love? What relationships are in a good place? What relationships may maybe need still need some healing.
Kerry Egan: [00:05:33] What can I heal before I leave this earth? How do I understand the purpose of my time here? How do I understand the purpose and meaning of the fact that I'm leaving? I'm leaving this body, I'm leaving this this earth. It's a spiritual process as well as a physical process. And hospice very much understands that. And I always joke around and say the chaplain's job, you know, the spiritual care of the dying, which is what the chaplain does. The spiritual care of the dying. It has to be shared by every member of the team. It has to be because if you're the hospice nurse and you're examining the patient that day and and they need to talk about it, you know, you have to be ready to to listen. And that goes for the social worker and that goes for the volunteer and that goes certainly for the aides. So often the aides are are the people who actually are become closest to the patient. Right. It's it's it's very hard. I think it's somewhere between hard and impossible to physically care for another person to have that sort of intimacy. And it is intimate. It's not sexual, but it's intimate care of another person day after day after day for months, you know, giving them a bath and shaving their cheeks and, you know, helping them eat food. And you can't do that for days after days without creating a relationship. And all relationships are spiritual, so. On some level, sometimes deeply spiritual, sometimes not so much, but but that spiritual work of dying. Everybody on the hospice team shares that. But the chaplain sort of the go to.
Henry Bair: [00:07:15] That's a very wonderful encapsulation of what you do. And I definitely want to come back to what that looks like on a day to day level and what that work has taught you. But now that you've given us a sense of what you do, can you tell us what led you to chaplaincy in the first place? This is a realm of medicine that we don't hear a lot about, even in medical school. I think I only saw the hospital chaplain at work maybe twice throughout all my rotations, and only then because I specifically found opportunities to be in the patient room when I knew the chaplain was going to be there. I've just started residency, so I don't know what that will look like, but I have a suspicion it will be more of the same.
Tyler Johnson: [00:07:57] I can tell you that it's the attending and having gone through residency and fellowship. This sounds so almost crass that I'm embarrassed to admit that it's true. But it's true. The most reliable encounter that I have with chaplaincy at the hospital is that I have no idea how it is in other states, but at least in California or at least at Stanford, and this is strange even to say this is a procedural thing, but the the chaplaincy department is in charge of the logistics for the death certificate when patients die. And so the most reliable encounter that I have with the chaplaincy department is with some poor chaplain trying to chase me down through the halls of the hospital because they have a death certificate that they have to get signed by our 72 or whatever. There's some regulation on the California books and they're paging me trying to figure out where I am so that I can sign the death certificate for a patient that died on my service, which is just so, as I said, backwards and crass that it's embarrassing that I can even admit that that's true. But but it's just to Henry's point that the like the overlap in the Venn diagram between what the people who are doing the medical care of the patients in the hospital do and what the people who are working on the chaplaincy service do is shockingly and maddeningly small.
Kerry Egan: [00:09:20] That doesn't surprise me. So hospice chaplaincy and hospital chaplaincy are very different. They shouldn't be, I don't think, in my opinion. Right. This is all my opinion. In my opinion, they should not be very different. But in reality, in practice they are worlds apart. In the hospital it feels like chaplaincy is siloed off to the side, kind of a little bit like these unknown, maybe even a little bit weird kind of people that you call as a last resort when this patient will not stop crying, you know, or they're dying. They're literally. And in that case, what you really need is a Catholic priest and not even necessarily a chaplain. But people don't even know that, Right? So when I was in training, once I had I got a call, you know, this was back in the days of beepers. Right. And the beeper goes off and. And I call the nurses station. It's like 3:00 in the morning. And and the nurse was like, It's three in the morning, remind you. And the nurse is like, I don't know what to do. This patient has been crying for about five hours, so I thought I'd call you and I said, Five hours. You waited five.
Tyler Johnson: [00:10:28] Hours. I shouldn't laugh. That's really terrible. Laugh.
Kerry Egan: [00:10:31] Yeah. And I said, okay, let me come over and see what's going on. And you know what? She was sad. She was in her 40s and she had pancreatic cancer and she was dying and. She was really sad. She was really sad. And of course, she was crying. She had two small children. But it took five hours for the nurse to think, oh, you know, maybe I'll call the chaplain. So I feel like, at least in my experience and I have not worked in a hospital in a very long time, but what you're saying makes me think that things have not changed all that much. When I worked at a hospital, chaplaincy was very poorly integrated into the life of the hospital. Why is that? I'm not sure. I'm not sure. I didn't honestly, I didn't work in hospitals long enough to find out because I got a job at hospice and it was this. It felt like the sun came out. I don't know how else to describe it. People are always like, that. Must be so depressing. You work for hospice? And I'm like, Oh, you know, it's sad. There's a difference. It's sad, right? You love your patients and your patients die. And as a chaplain, very often I used to do the funerals, but it's not depressing. Hospice, really. It's such a corny thing to say. I feel like I'm a marketing brochure, but it's the God's honest truth. Hospice is about life. Hospice is about living like, okay, you know, all of our lives are limited, right? All three of us sitting right here. Our lives are limited. We might not have a life limiting illness, but we're life limited. We just are. And so hospice is about. All right, You know that. Now, what are you going to do with the time you have? Let's make it the best time possible. It's hard to express how joyful it can be sometimes in hospice. That's the truth. We're not fighting anything. We're not battling anything. We're not failing chemotherapy. We're not losing our battle against congestive heart failure. You're not. You're living. You're living.
Tyler Johnson: [00:12:42] So I want to get back to Henry's question, though, about how did you end up here?
Kerry Egan: [00:12:46] Oh, gosh. Okay. So I was a hospital chaplain, didn't really know anything about chaplaincy in general.
Tyler Johnson: [00:12:52] How did you end up in general?
Kerry Egan: [00:12:53] Okay. Wow. You really want to go all the.
Tyler Johnson: [00:12:55] Way back to be a chaplain?
Kerry Egan: [00:12:57] So, okay, I'm going to go all the way back to college. So I was a religion major in college, sort of by accident. I had. A requirement I had to take and I took a class. I was a philosophy and religion requirement. I thought I wanted to be an English major because I liked reading novels. I didn't really know what an English major did. I just figured that sounds good, read books all day. So I took this required class on religion and I loved it, right? I was like, Holy cow. There is a whole world of study where you just look at why do people believe what they believe?
Tyler Johnson: [00:13:32] Were you religious coming into that or was that really just sort of a okay, so this was just a sort of like someone might be interested in biology or English or whatever.
Kerry Egan: [00:13:39] Yeah, I mean, I grew up Catholic. Not particularly religious. No, not atheist either. You know, just sort of sort of there. Sure. I sort of grew up Catholic, sort of whatever. It wasn't a big part of my life at all. And then I was like, This is really, really fascinating. So I was a religion major, and that question really is kind of the guiding question of everything I've done is, you know, why do people believe what they believe and how does that belief shape how they live their lives? And that's really the question in some ways of religion. And so I thought, well, I've thought I'm going to get a PhD in this because I didn't know what else you could possibly do with it. Right. You know, I knew I didn't want to go into like, marketing. I definitely didn't I didn't want to be a doctor.
Tyler Johnson: [00:14:24] Though many churches could probably use a good marketing person.
Kerry Egan: [00:14:27] But sometimes, yeah, they sometimes have a hard time explaining what it is they do a lot of misconception out in the world about what religion does, what religion is, but that's a whole that's a whole other listen, that's a whole other interview. So I thought I was going to get a PhD in religion and I went ahead and I went off to Harvard Divinity School to start that process. And while I was there, I guess I should say, was I religious? Not really, but my mom was a public health nurse, so I sort of had that floating in my background. And I knew she loved her work and that she did really amazing things and she would come home. Let me tell you, with amazing stories, that woman, she was a public health nurse in the suburbs of New York. The 70s, 80s and 90s. Right. So she was there, you know, when HIV burst on the scene and nobody knew what it was. Right. She was public health nurse back then. And so she would talk about, you know, she would do, you know, visits in all sorts of crazy places. And she was really, really involved when crack cocaine became horribly endemic in in our communities. And she was there when the psychiatric hospitals were closed and all of the psych patients were released into the hospital. And she would do home visits for psychiatric patients. I mean, she did like the gamut as a public health nurse, and she always had these really, really great stories.
Kerry Egan: [00:15:49] But I wasn't I didn't really like science all that much. So I sort of thought that avenue was closed to me. Why? Don't know. It's not like I had a hard time in science. I just don't know. You know, you're 18. You don't. You know you're 18. My goodness. It's crazy. We ask people at 18 to make these decisions. So I had that in my background. And my father was also very sick. And that's another really important part of my background. My father had type one diabetes in my house. We always called it juvenile diabetes back then, So he had juvenile diabetes since he was a teenager and he was a brittle diabetic. At least that's the term my parents used. I don't know if that's a medical term, but what that basically meant was, you know, I have these vivid memories of sitting at the dinner table and it was either going to be a good dinner or a bad dinner, depending on what the blood sugar was. Right? So if the blood sugar was, you know, 100, it's going to be a good dinner. I'm going to throw out some numbers and you're not going to believe me. But this is the truth. You want to talk about a brittle diabetic? This was my father. If the blood sugar was like an 800, it was going to be a really bad dinner and mom was going to be furious and Dad was going to be like, calm down.
Kerry Egan: [00:17:00] And there was going to be yelling. And if the blood sugar people tell me like, No, you can't be alive at that number. And I'm like, I remember that number. If the blood sugar was like 20, that was also going to be a really bad dinner because then my mother was also going to be angry. Jim, how could you let this happen? So I grew up with a chronically ill father, and how did that change me and shape me? I mean, in every way. And in some ways I don't even really know. In some ways I can't even really figure it out. But it certainly shaped me that that you can't take for granted that your body is going to do what you want it to do. You can't take for granted that you have a healthy body. But that was not my question. I thought I wanted to get far away from that. I was going to study belief and religion, and so off I go to divinity school. My father dies my freshman year of divinity school. He died of sepsis. It was a really difficult death he had before that. I mean, every complication you can think of with juvenile diabetes, the man had it. I mean, everyone, you know, blindness and amputation of toes and kidney failure and you name it, the heart.
Kerry Egan: [00:18:06] You know, he needed multiple heart bypasses. Everything you can think of. He had It's such an awful disease that I think it's better now. I think they have better technology now. But technology was the treatment was not very good back then. So he dies my freshman year of sepsis. And that, of course, just sort of changed my world. I always said, you know, my dad was in and out of the hospital my entire life growing up, and that was just sort of normal. And I never actually expected he would die. Right. People people were like, You must have known it was coming. And I was like, No, no. When you have a parent who's been in and out of the hospital so much, going to the hospital is not a big deal. You know, the fact that he actually died this time was shocking, shocking, shocking, shocking, shocking. So I had a really, really terrible reaction, as anybody would. When you're 24 and your father dies and it's hard for me to now connect the dots here. That's all the background. The dots are a little bit harder to connect. Somehow, even though I thought I wanted to do the academic route. I ended up applying to do an internship at Dana-Farber Cancer Institute, which was sort of the last place I thought I'd want to be because I'd never wanted to go to a hospital again.
Kerry Egan: [00:19:23] And I remember standing outside the hospital for my interview and having a little bit of a panic attack outside the window and thinking, What am I doing? I don't belong here. I don't want to be here. But I didn't have a phone. This was before cell phones, so I couldn't call. His name was Reverend Moshinsky, Walter Moshinsky. I couldn't call him to cancel. And I thought, well, I at least need to just pull myself together and calm down and go in and tell him I made a terrible mistake. And I don't know why in the world I ever thought I ever wanted to step foot in a hospital again. So I went in to go tell him that. And it turns out where I was having my panic attack was a plate glass window. That was his office. So he was kind of watching this panic attack the whole time, like waiting for me because I was late for my appointment. And I finally came in and he was like, know I was wondering if I should go out there. And he said, Well, just come. Just come and sit down. Take a breath before you get back on the bus, you know, and go back, back across the river. And by the end of that hour, somehow I had indeed signed up to be a hospital chaplaincy intern, just a little part time thing while I was in school.
Kerry Egan: [00:20:29] And then during that process, I realized, holy cow, working as a chaplain intern had this realization that you don't have to go to school and just read books to ask this question of what do people believe? Why do they believe it and how does it shape their lives? There's a whole job. There's a whole job where you can do this all day long. You can talk to actual real people, find out what they believe and how it has shaped their lives and what beliefs were helpful and what beliefs were harmful and what beliefs just kind of weren't true that you picked up along the way. And turns out that that doesn't match with reality. It was just great. I just loved that job. I just loved it. So I did hospital chaplaincy and then I ended up with hospice just because I applied for a job at hospice. And then I found out, Oh wow, this is really great because hospital chaplaincy, you do feel a little bit as a chaplain. I didn't really ever feel completely like part of the team. I just didn't. I felt kind of like a weirdo outsider in the hospital, you know, like the person you call five hours later when there's no other hope. And guess we'll call that weirdo. See if they can stop the nonstop crying, you know? Whereas in hospice, you know, you start from day one, you go around and everybody everybody talks about every patient, you know, the nurse starts because she's she's the manager.
Kerry Egan: [00:21:57] But, you know, how is this patient, you know, the nurse speaks and then the social worker speaks, you know, and then the volunteer coordinator speaks and the chaplain speaks. And if you have everybody who might have something to share about the patient shares, it's really lovely in hospice. You know, you're not in a hospital, you're in your car, basically, and you're driving around to nursing homes, to the hospital sometimes if that's where people are. But you're on the phone constantly with your team members and it's lovely. It's wonderful, frankly, because you're coming together. You know, one of the things we talk about in hospice is this idea of that pain is not simply physical. That seems obvious. There's emotional pain, there's spiritual pain, there's physical pain. That's not really all that obvious in the hospital. There's this idea of, you know, of total pain that if you've dislocated your shoulder, it doesn't really make sense to ice your ankle, right? That's not where the pain is coming from. It's the same thing, you know, in hospice that if you have, you know, emotional pain that is coming from the fact that your relationship with your children is totally unreconciled, it doesn't matter how much morphine you give someone, that's not going to help that that familial pain. If you're terrified, if you have spiritual pain of I I'm afraid I'm going to go to hell when I die, it doesn't matter, you know, how much morphine you give someone and at the same time, if someone has bone cancer - I had a patient once who had bone cancer. And I'll never forget this. You know, I came in, you know, very quietly, gently. She was in bed. And I said, you know, how are you? And she said, "I am pain." The chaplain can't help that. Right. I am pain, That's all I am, right at that point. You know, I called the nurse because that's. It doesn't matter. You know, it doesn't matter how much unreconciled spiritual stuff you have going on, if you are pain right now, that's that's your entire experience of life, then the chaplain can't help you. So. What I love about hospice is this understanding that it has to be a team effort. It has to be a team effort, right. Because the nurse may or may not, you know, the nurse can listen, but the nurse doesn't have the kind of training and experience that the chaplain does to talk about like, if you really want to get someone really wants to dive in deep about spiritual pain and about theological dilemmas that happen at the end of life, you know, you need the chaplain if you are talking with someone who, you know, has very, very complicated and difficult and painful family system issues with abuse and all sorts of terrible things that can happen in families, you know, you need the expertise of the social worker to come in there.
Kerry Egan: [00:24:47] If this is a medical diagnosis problem, you need the doctor. You you know, if this is they don't have groceries, they have no one to go grocery shopping. You need the volunteer. It's such a team effort. And I wish I wish the hospital were more like hospice. That's the truth. I think the medical model and hospitals could learn so much from just spending a week shadowing a hospice nurse to see how this works, to see how a different model of how this could work. It's not a surprise to me. It's a surprise to a lot of people, but it's not a surprise to me that very often people on hospice with the same prognosis, same diagnosis, people on hospice live longer than people who choose not to go on hospice. It's an understanding of the person as a. As a whole. That pain and that pain is is is has many components and that life has many components and that they all need to be treated and supported. So that's how I ended up in hospice because I had this big burning question of why do people believe what they believe? And then I found hospice and I found sort of this sense of this total recognition of the human being. It's just about totality. And I love that.
Tyler Johnson: [00:26:00] Let me ask you a question that relates to something that's been sort of implicit in a number of things that you've mentioned. So every year there's some company I don't know who it is that puts out these books that are like the best science essays and the best short stories and the best whatever in America from, you know, 20, 22 or whatever. And a number of years ago there was one of these books that was had science essays in it and one of the essays. So from the point of view of the author of the article, it the point of the article was to try to explore "why children across many different cultures hold this clearly false belief" was sort of the that was the vantage point of the author and the false belief that all of these children from many different cultures held was the idea that there is an "I" that is separate from the biological body. So in other words, children in many different languages and and whether they grew up in a religion or no religion or whatever, they refer, for example, to "my body. This thing is happening to my body." Right? So that may not sound like a very I mean, that doesn't sound like a remarkable thing to say, except that if you think about it for a minute, if you refer to my body, that assumes the idea that there is an entity that owns the body or inhabits the body or whatever, but that is not the body. Right. That there is something separate from that. And and so, as I said, the person who is writing the article was trying to use these very sort of complicated, neurobiological explanations to try to arrive at an understanding of why children have this clearly false belief.
Tyler Johnson: [00:28:02] Right. So that's point number one. And then point number two, all the way on sort of the other end of the spectrum. So Yuval Noah Harari, is this now-fairly-famous historian of civilization, right? So he's written a number of books. But the the most famous recent one is one called Homo Deus. And in Homo Deus, he's trying to make this argument that he believes that these different kinds of biotechnology will eventually allow at least those who have enough money to pay for it to become these sort of superhumans or these kind of like chimeras between, quote unquote gods and humans, because we might be able to make ourselves functionally immortal or, you know, give ourselves replacement organs for when our organs start failing or, you know, enhance our own abilities. You could imagine, right, if you could somehow, like pipe in general artificial intelligence into a human brain or whatever. Anyway, there's all these different things. And he talks about all this. But the thing that's very interesting to me, so he's an avowed atheist and, and I think it would be fair to say that he's an avowed biological determinist, meaning that he believes that just, you know, we are our bodies and that our bodies determine everything about us. But there's one point in that book where he talks about, even as an avowed atheist and as an avowed biological determinist, he recognizes that one thing that science just has absolutely no explanation for is consciousness. And in fact, science can't even agree on what consciousness is, let alone what it means or where it comes from, or what constitutes it, or how it's determined or any of those things.
Tyler Johnson: [00:29:44] And so the reason that I bring those two things up in here in this same point is there is more to a person than just a body, Right? And you have referred to this multiple times when you've said that. So, for example, when you were talking about who treats what, right? If the body is in pain, then a nurse needs to bring pain medicine. But if the person is in pain, especially existential pain, then morphine or whatever is not going to help. Right. And then they need a chaplain. The other thing, though, that goes along with that, that I have recognized as a doctor who works with a lot of patients who are dying, is the qualitative difference between a living person and a dead body right there. There seems to be if you have experienced someone going through that transition, it's not like they're just less of the same thing than they were before. Right? There is something constitutionally different about a dead body from a living person. And so I guess all of that is by way of introduction to then ask you to say what, what what can you sort of reflect on as far as all of that goes in terms of that fundamental question, like what have you learned or what have you observed as a chaplain about what makes up the difference between us and our bodies?
Kerry Egan: [00:31:24] Oh, my goodness. So I agree with you. I Tyler, I was thinking when you were talking about how it doesn't matter how many times you're with someone when they die, it's shocking. It doesn't matter. It doesn't matter how many times you've seen it. You're right. There is something qualitatively different and it's shocking every time you see it. I mean, this can be a person who is breathing, you know, once a minute, you know, who is purple all over who is. But when they die, something changes. I agree. It's something. The shift is it's. It's never not shocking to me. It's never not shocking. When someone dies, it's something changes. I couldn't agree more. It's. Yeah. It's not like you're dying. You're dying. You're dying. You're dying. You're dying and you've died. It's like you're dying. You're dying. You're dying. You're dying. You're gone. What is that mean? Listen, poets and novelists have been writing about this. This is not. This is not just you and me who have noticed this. And Henry, I don't know if you've ever had. And it is an honor. I don't know if you've had the honor yet to be with someone when they die. But don't be shocked. I mean, you will be shocked. You will be shocked, but don't freak out. I guess that's that's my advice. Understand, it will be shocking, but you don't need to freak out.
Henry Bair: [00:32:51] I had the chance to to to work in hospice, especially in the pre-clinical years. So I have seen that happen. I've also seen. A failed resuscitation in the ED. Oh, very different. There is no acknowledgment. Right? It's like you try for 20 minutes and then whoever's running the code says, okay, time's up. And then the body just disappears. And then they clean the room and then it's like, ready for the next body to come in. Wow. Anyway, another another discussion.
Kerry Egan: [00:33:20] I was going to say, if I had a whole hour, I have so much. I have so many thoughts about how we train young doctors and what it does to them. So many thoughts about how we train young doctors and how not taking care of the spiritual aspect of being a doctor. Really harms medical students, like not not giving medical students. And this doesn't mean, God, you don't have this is what people don't realize. You don't have to believe in God. There's still a spiritual aspect to you. This is what Tyler is trying to get at, right? This is this is actually related to the question you're asking about the spiritual aspect of of being a human being. When we ignore that. And I do think it's very often ignored in the training of medical students. It's not good. It's not good because then you can't you can't ignore this fundamental part of you as a human being. So you ask me, what what do I think that is.
Tyler Johnson: [00:34:20] Or not even necessarily mean? I get that, like, you know, trying to give some sort of dictionary level definition of what that is. Unless you are a priest or rabbi or whatever. I mean, you know, there are different formulations for that. But I guess my question is more sort of. Like. It's almost more than what have you learned about it? It's more like, how have you learned about it? Or like what has being with people at that time of transition and recognizing the difference between the body and the person? Like, what has that experience taught you or how has it changed you or what light has it infused into you is more of my question rather than what is that difference, which, you know, is probably an unanswerable question, largely unless you belong to some particular faith tradition.
Kerry Egan: [00:35:13] I guess what it has taught me is it's actually taught me to love my body. I just did that, that, you know, quote, quote unquote, false belief, which I don't think is a false belief.
Tyler Johnson: [00:35:25] I don't either.
Kerry Egan: [00:35:26] Yeah, I don't. But it's taught me to love my body. Massively. I love being embodied so much. So much. And that's not to say I haven't had, you know, my body hasn't sort of let me down at times. Believe me, I've had, you know, two very difficult births. I've had a something crazy called a cervical pregnancy, which is a very life threatening. You know, it's bad. I was in the emergency room. I thought I was having a miscarriage. And, you know, it's bad when you've been in the emergency room for hours. And finally and I said to the nurse, a former Army medic, just a wonderful young man, and I said, listen, I feel so much better. I'm so embarrassed. I think I was just dehydrated because they had me on IVs. I said, I think I was just dehydrated. That's why I collapsed. I'm going to leave now. I have to go home and make dinner. I said, I'm just going to check myself out. This is a busy E.R. I don't belong here. It's been hours. And I remember he got down on one knee on the side of the bed and said. I can't tell you anything more than this. But I will tell you, if you were my wife, I would beg you with every ounce of my being to stay in this hospital.
Kerry Egan: [00:36:40] And I was like, okay, I guess I will stay in the hospital. So I had this cervical pregnancy, you know. You know, it's bad when a team of doctors comes in and it was like an E.R. doctor, an GYN, a surgeon. The radiologist like all these people, and they were like, We have never seen this before. Most doctors will never see this. And I was like, Well, that's a bad sign. So I can't say like my body has like, functioned perfectly. It hasn't. And I can't say that, you know, especially as a woman, there's a lot of pressure on you to look a certain way in the world. And I don't look that way. You know, I don't have a model figure. And yet. I love being in a body. I love dancing and I love eating and I love having sex and I love hugging people and I love going to Zumba class. I just love having a body because I'm very aware it's limited. I think that more than anything, being with people and this separation of soul and body, like no matter what happens to you after death, whether or not you believe in an afterlife or whether or not you believe when you die, you just.
Kerry Egan: [00:37:52] That's it. That's it. Doesn't matter what either of those beliefs. Atheist or fully theologically, you know, on board. You're leaving your body and you're not coming back. You're giving it up. You have to at the end of life. What changes? That's what changes. You don't get to be in your body anymore. And so, man, do I love being in it, having it, using it, getting to be a body. That's what I love. That's what I've learned. So many people are like, you know, like you just don't care. You just, you know, like, how do you, how are you? How do you just not care? Like, you don't wear makeup and you don't, you know, you don't dye it. And and I because I realized, like, ultimately, like, who cares what it looks like? Like you got this machine, this great thing that right now feels good. Right? And I'm aware of that, too, right now. My body feels great. And it might not always. It might not. Some people some people have a lot of pain for a lot of years and I don't. So I appreciate that. Maybe that's not the answer you were looking for, but.
Tyler Johnson: [00:39:01] No, no. Well, no, I was looking for any answer except for whatever was true. I think the two points that I'll make sort of in response to that are that one, hopefully by the time this episode airs. So I'll give a little bit of background. A few months ago, Henry was invited to give a Ted talk based on if you think about what we've done with the podcast as kind of research field research, he was invited to give a Ted talk on, you know, like what has the research told us, right? Like what? What do we think that doctors should know from all of the conversations that we have had? And Ted talks have very strict time limits. And so Henry had to do this sort of, you know, incredible amount of work to distill and distill and distill and distill and distill and distill and distill. And we talked a lot, the two of us, since we're co-hosts, we talked a lot about sort of what are the things that we have learned and what would he say in the talk and whatever. But then the, you know, the first draft was he wrote on his own, which is just to say that, um, you know, and to be clear and he talks about this in the talk Henry, I think is a religious seeker but hasn't grown up like inculcated in any particular religion that he belongs to now. So that's not like a, you know, a big part of shaping, you know, where he's coming from here.
Tyler Johnson: [00:40:28] But it was just so interesting to me that when he had to put into sort of two sentences or a sentence with a semicolon, depending on how you want to punctuate it, sort of what is the take home point? After 80 hours of discussions with all different kinds of health care folks, like what's the take home point about that? People need to learn to re infuse meaning into medicine. The take home point was people are not machines and doctors are not mechanics. Um, and and by the same token, I think that the, the precise reason that that idea is so powerful is because within the world of medical training, it is so distinctly countercultural because of course no one ever says to you when you're learning to when you're a medical student or nobody ever says people are machines or people are just their bodies, or it all comes down to organ function or whatever, right? Like no one articulates it that way. But the reason that they don't articulate it is because it is so universally understood. It's so like it's so baked into every assumption about every way that we approach every problem that there's no reason to say it right. It would be like going around and talking about how oxygen is important. Like nobody goes around talking about how oxygen important is because it's just what you're breathing, right?
Kerry Egan: [00:41:53] And the problem is, if you here's here's my thought is that if you believe that and you teach people to believe that we are our bodies and those bodies are machines, then when the machine fails, you have failed. Right when the machine. So when the machine fails, the patient has failed. And that's all over medical terminology, right? I can't tell you how much it bothered a patient of mine who got her chart and was reading it. And the chart said patient failed chemotherapy. I cannot tell you how much spiritual work had to go into unpacking that and whether or not that was true, because she believed it was true because the doctor said it was true. So if you believe you are a machine and a doctor is a mechanic, death is a failure. And I think a lot of doctors do believe that you failed as a mechanic. You failed as a patient. The machine failed. If you say I am not a machine and I am not simply my body, I am. I am a consciousness. I am a mind. I am a soul. I am a heart. I don't care what word you use. People get hung up on words move beyond. Which is funny.
Kerry Egan: [00:43:02] I'm a writer and I'm saying move beyond the words. Move beyond the words to the experience that we have. Of knowing. Since we're small children, we are beyond our bodies. Move to that experience. Don't get hung up on the word. Don't get hung up on who created the consciousness. Just be okay that we have it and understand that you get to have a body. And that eventually that body will wear out. But it doesn't mean you've worn out. It doesn't mean you have failed because you are larger. You're larger than that. Now, does that consciousness die when the body dies or does it continue? I don't know. And honestly, I actually don't really care that much. In some ways we can't know. And so. What do you do with something you don't know? Right. Well, you let it sit there and you don't let it control your life. You just continue to live as much as you can. The other problem with that way of teaching is that not only are you teaching young doctors that the patient is a machine. But the doctor has internalized it to believe that they too, are a machine. They're not just a mechanic. They are also a machine who will fail.
Kerry Egan: [00:44:11] Right. You've baked into this whole model, bakes into everybody involved in it. Failure. You are destined to be a big old losing failure in this model. If you get rid of the entire model, if you say, wait a minute, wait, wait a minute, this is insane. I mean, of course you have, you know, the transhumanists wanting to extend life forever because those tech people tend to be a lot of them overachievers. And they don't want to lose. And so if they believe that dying is is losing because your body failed, therefore you failed, of course, of course they're going to be interested in uploading their consciousness a horrible episode of Black Mirror to the Internet. Imagine if all of our consciousness were on Twitter. Oh, my God, what a nightmare. Um, so, yeah, I mean, if you can. If you can. Set aside the entire model. Now, how are the two of you? Listen. Number one. Henry, congratulations on the Ted talk. That's wonderful. And I love. I love your tagline. It's brilliant. And I sincerely hope the two of you are able to not just revolutionize medical education, but to completely overhaul the entire belief system undergirding medicine today.
Tyler Johnson: [00:45:33] That's Henry's job. Good luck. All right.
Kerry Egan: [00:45:35] Henry, you're on.
Tyler Johnson: [00:45:35] Henry's job.
Kerry Egan: [00:45:36] You're on it, Henry. No, I'm really glad to hear that. Because, like I said, I have been. So this is another example of when I was a young chaplain in a hospital. And I was working with young doctors in the hospital. And as you may or may not know, Henry, there's a lot of flirting that goes on in hospitals, especially when you're young. Oh, just you wait. There's a lot of flirting, and...
Henry Bair: [00:46:00] I don't know if that's still the case now.
Kerry Egan: [00:46:03] Oh, no, it's not the case anymore.
Henry Bair: [00:46:05] No idea. I have no idea. I know that. I don't know.
Kerry Egan: [00:46:09] There used to be a lot of flirting.
Henry Bair: [00:46:09] Medical dramas on TV certainly make it seem that way.
Kerry Egan: [00:46:15] I love this story because I remember one time being called again in the middle of the night to a floor. Someone was dying and going up to the nurses station. There was no nurse there, but there was a doctor and the doctor was like, Hey, who are you being very flirty? And I was like, Well, I'm the chaplain. And he was like, Oh, God! Like the flirting ended.
Kerry Egan: [00:46:39] But we became friends and. The same guy a couple. A couple of weeks later, we had a patient who had something called Stevens-Johnson syndrome. I'll never forget, never forget the name of it. And she was dying. She was in the ICU. Her skin was sloughing off. It was an allergic reaction. And he at one point was walking down the hallway and he literally opened a door to a closet, like a supply closet, like, come here, come here, come here. And I was like, No. He's like, Come here, please, come here, come here. And I was like, Dude, no, I'm not going in the closet with you. No. And and then I realized he was crying and I was like, oh, okay. So we step inside and he closes the door and he bursts into tears, and he was like, I can't do this anymore. And I said, What? And it was about that patient. He said, I can't hurt her anymore. I'm hurting her. Every time I go see her, I'm hurting her. And and he was beyond he was beyond consoling at that moment. And so he you know, he wanted to talk to me as a chaplain, even though, you know, two weeks ago he was like, oh, God, the chaplain, you know, now all of a sudden he wanted to talk. And, you know, we were able to talk it through. And he had such a tender heart, this young man, he had such a tender heart.
Kerry Egan: [00:47:49] And I will say, though, by the end of the year, he had changed. Drastically. And he had sort of put on this armor because he didn't have. The right training and support for how to protect and how to move through the world of the hospital with a tender heart. Now you can. Chaplains do, right? You can. Some nurses do, some doctors do. You can have a tender heart, but no one is teaching you to do that. And it can be taught. It can be taught how to deal with the big, painful emotions of being a doctor. That can be taught how to do that in a healthy way that doesn't involve becoming a jerk. Becoming cold, becoming unfeeling, drinking, you know, all sorts of things that people do to try to cope with really big, difficult realities of being a doctor in a hospital. But they're not given that training. And so so they do let themselves become a machine because they've been told you're a machine to these people. These bodies, these people are bodies, these bodies are machines. And these machines fail. And they believe that about themselves. And they say, all right, I'm just going to become a machine. And you see it so often in young doctors. And it doesn't have to be that way. It doesn't.
Tyler Johnson: [00:49:08] So so let me let me ask you've been so generous with your time. And I know that we're about at our hour, but I want to ask in closing, so we're going to leave to Henry to revolutionize the entire undergirding philosophy of Western medicine. We'll check back in ten years, Henry. And you can tell us.
Henry Bair: [00:49:24] Try 40.
Kerry Egan: [00:49:24] I actually believe in you, Henry. I really do.
Tyler Johnson: [00:49:28] Plus one. So. But in the meantime, while Henry is still working on that transformation, I think the the the we try to get really practical down to brass tacks at the end of every episode. So here, I think is the question. You know, one of the ironies of medical training, sort of more to your point, is that a lot of people feel like that medical training, if anything, either actively or passively sort of trains that tenderness out of people. Right. That they come in with these sort of high hopes of like, well, I'm going to be the doctor that is tender or is empathetic or whatever. And then either just the, you know, being worn down by the rigors of the training itself or actually the unwritten curriculum that we've been talking about here eventually takes that away. So the question that I have is if you were talking to a like a room full of, let's say, incoming first year medical students and they're looking at you with these big bright eyes or incoming residents or whatever, and they're saying, hey, look, we know that this is what happens to most people who go into this training program, but we want to be the exception to the rule. We don't want that to happen to us. What concrete day to day things do you think that any doctor, but especially doctors in training, can do to try to keep the flame of that tenderness or empathy or whatever you want to call it, alive?
Kerry Egan: [00:50:57] I think, number one, uncovering and being really open about this secret curriculum is the number one thing to do. The fact that it's a secret curriculum is the problem. You need to be really open and say, hey, we have. A problem in Western medicine. Which is this? The problem is we see the body as a machine and we are not leaving space for the idea or we just don't care. Maybe it's not that there's no space left. Maybe it's simply we are not going to talk about the consciousness, the self, the soul. That's a problem. If you can unearth that problem, if you can excavate it, uncover it, and just sort of bring it to the light of day and say, here's how it developed. Here's where we are. Listen, on some level. I don't want my doctor acting like my chaplain, right? If I go into the emergency room with a gunshot wound or a car accident, I do want that doctor to be like stone cold, man. Stone cold, calm. I don't want them thinking deeply about, you know, how is this impacting their soul? So that's that's the dilemma, right? On some level. On some level, you do want your doctors to be able to focus focus on the body. So what what does that need to look like? So I think you need to uncover the curriculum, the the hidden curriculum and say, do we think this is true? Why is it here? Why are we training doctors this way? Let's talk about it. Have someone teach classes about this. Right. There's plenty of people who talk and study about healing versus, you know, the sort of the history of healing, a theology of healing, a philosophy of healing.
Kerry Egan: [00:52:43] How do you want to do it? Psychology of healing. There's a million different ways you can approach it. But to to look, you know, history of science a million different ways. Look at, okay, here's the invisible curriculum. These are the problems with the invisible curriculum and then maybe, you know, give people a place to talk about the question. We started the whole podcast with Why do you believe what you believe and is that true? Is a doctor. A mechanic. Why do you believe that? Is it true? Is a patient, a body. And is the body a machine? Is that true? You know, go back to those. Go back to those questions. I'm not as familiar with what happens in medical school. But certainly that first year of internship. Which is wonderful and exciting. And Henry, I'm excited for you. And I just think I just have a feeling you're going to be a great doctor. But do know that I think for a lot of and now I'm 50 years old. I have a lot of friends who are doctors, right. Who over time get to sort of mellow out over time, over, you know, 20 years, 25 years, get to reintegrate. They get to reintegrate the soul and the body. But in those early years. When you're sort of thrown into the fire and you're trying to cope. Right? So much of it is like just coping. Think about what those coping mechanisms are because there's adaptive coping and there's maladaptive coping and is thinking of another human being as a machine.
Kerry Egan: [00:54:19] Is that adaptive or maladaptive? And I think it would be really, really helpful. And again, I don't I can't speak to medical school, but certainly that first year of internship, I think would be really helpful to make people. I don't know how much time do they have as interns, but. Sit down for 45 minutes a week and talk that through. To force them to take a step back and think about you know, you always hear in emergency rooms, again, as a hospital chaplain, you spend a lot of your time in an emergency room. Back then. Again, this was 20 years ago. They had these things called the term gomers. Get out of my E.R.. And these were these tended to be very, very, very needy people who would show up in the E.R.. Frequent fliers, you know, all the time. And they were dehumanized, too, to think about and to talk about like, okay, let's talk about that word. Let's just talk about it. Do you think that's true? Why do you where's your frustration coming? It's not even like therapy, but like, I realize I'm making this sound like I want them in group therapy, and that's not what I want. But I think I think it could be helpful to have a class once a week to think about what do you believe? Why do you believe it? Is it actually true with your experience? I think I think what you call the hidden curriculum is one of the most brilliant descriptions of it.
Henry Bair: [00:55:37] Well, with that, we want to thank you so much again, Kerry, for your time, for coming on and sharing your story, your your insights. You know, there's there is honestly so much we could have talked more about. You know, as you were speaking, I couldn't help but put mental kind of bookmarks along. All the things I if we had time, which we didn't, I wanted to get back to. We didn't even talk about your book, which is great, of course.
Kerry Egan: [00:56:01] Oh, thank you.
Henry Bair: [00:56:02] Yeah, I read it. I read it a while ago, actually. I read it before this podcast was started and it's always been in my mind like, Oh yeah, we should definitely reach out. Well, thank you. I'm so glad that you responded and that you are here.
Kerry Egan: [00:56:12] Oh, my gosh. Of course.
Henry Bair: [00:56:13] And that we got to talk to you.
Kerry Egan: [00:56:14] Had any if I had any last thought to say, I would say this, that for people who and doctors, you know, who worry about, you know, is there something beyond the body, Is there consciousness? There is the experience of love. Right. And that that more than anything is something that cannot be quantified. It cannot necessarily be explained in the medical sort of mechanistic model. And if you can just continue to to to just ponder that, to think about that, to keep that at the forefront of what you're doing as a doctor, right. That ultimately. Right. You you there's far better ways to make money in the world than being a doctor, right? You're you're super smart, Henry. You have to be to be a doctor. You could have gone into investment banking, right? You you could have done that. You could be working on Wall Street. Right. But you didn't. You went into medicine. And so to think about, you know, why was that and. And the centrality of love. Right. The centrality of of love in those interactions between, you know, between doctor and patient, between patient and family. Even if you don't believe in a soul or an afterlife or any of that, you do believe in love. And maybe, maybe that's that's one of the ways you can. Talk to people, right? Even if you don't believe in the things you believe in. Everybody has had that experience of love, or at least of wanting it, of wanting it, even if they didn't get it. So.
Henry Bair: [00:57:39] Well, I think that's a wonderful distillation of all the themes that we've been talking about. And thank you so much for ending us on such a lovely note.
Kerry Egan: [00:57:49] Thank you for having me. I really enjoyed meeting you too.
Henry Bair: [00:57:53] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at www.thedoctorsart.com. If you enjoyed the episode, please subscribe rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.
Tyler Johnson: [00:58:12] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:58:26] I'm Henry Bair.
Tyler Johnson: [00:58:27] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.