"The Doctor's Art" is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.
Matters of faith and spirituality are seldom openly discussed in medicine, but for this week's guest, pediatric palliative care doctor Elisha Waldman, MD, they are a daily fixture of his work.
Waldman is associate chief of the division of pediatric palliative care at Ann and Robert H. Lurie Children's Hospital of Chicago and former medical director of pediatric palliative care at Columbia University Irving Medical Center. He is also the author of the memoir This Narrow Space, in which he describes his 7 years working as a pediatric oncologist at Hadassah Medical Center in Jerusalem, Israel, while grappling with the ethical and political complexities that came with treating his Muslim, Jewish, and Christian patients.
Over the course of his conversation with Henry Bair and Tyler Johnson, MD, Waldman discusses his formative religious upbringing, delves deep into what it means to be present with patients in moments of suffering and existential anguish, and examines what his experiences have taught him about the enigmas of life, death, faith, and identity.
In this episode, you will hear about:
- 2:12 How Waldman's early interest in religious studies influenced his pursuit of a career caring for children with cancer
- 7:00 Waldman's religious upbringing as the son of a conservative Jewish rabbi
- 13:49 A discussion of spiritual care in medicine and what it means to be a "spiritual generalist" versus a "spiritual specialist"
- 23:01 Reflections on what brought Waldman to Jerusalem and what it was like to practice medicine in such a diverse and politically complex city
- 26:11 How Waldman finds the emotional fortitude to continue giving care and comfort to children who are seriously ill
- 33:40 A discussion of powerful and beautiful moments in accompanying patients through suffering
- 48:13 How pain differs from suffering and what physicians can do once they recognize that difference
- 57:25 Waldman's advice to young clinicians on being present and curious with patients
Following is a partial transcript (note errors are possible):
Bair: To start us off, can you tell us what led you to a career in medicine and then specifically to pediatric palliative care?
Waldman: To lay that out, I would go all the way back to undergrad, where I majored in religious studies. Clearly, medicine was somewhere banging around inside my head because I bothered to take the pre-med courses. But the truth is, by the end of undergrad, what I really wanted to do was get an advanced degree in religious studies, and I sort of had this idea of wanting to be an Indiana Jones-type figure of archaeology in the summers and dusty libraries in the winters.
I studied undergrad in the States, but I went to medical school in Israel, less to learn medicine and more as a vehicle to live over there. For a few years I had grown up back and forth. My dad's a conservative rabbi and as often happens in those sorts of families, we spent many summers there and there's a strong pull to that country. My intention was to spend those years there and then return to the States to go to divinity school.
And it was really only in the middle of medical school when we got to actual patients in the hospital that I said, whoa, this is actually really interesting. That has been a double-edged sword throughout my career, I have to say. You know, I decided to move ahead with a residency in pediatrics because I always sort of felt that I had an affinity for the pediatric world. And then afterwards went on to do a fellowship in pediatric hematology-oncology at Sloan Kettering in New York, which all sounds very funny for someone who started off saying I was uncertain about what I was going to do.
I chose oncology, I think for a number of reasons that I think are relevant to where I've landed. I was really interested in not dealing with one specific organ and dealing with the whole body. I was really interested in dealing with family units, with how people relate to each other. And I don't know if I would have articulated this at the time, but I was really interested in serious illness and maybe even suffering. I definitely don't think I would have articulated that at the time. But in retrospect, I think that was, that was there.
And I went on from there. I moved to Israel where I took up a practice at Hadassah Hospital in Jerusalem in their department of pediatric oncology, where I mainly cared for children with sarcomas. Over my first few years there, I realized more and more that the stuff that was really driving me was less the minutia of chemotherapy and protocols and more this sort of bigger picture, naughtier stuff, around how do families make decisions. How do you think about, do we use all our money to go to Europe for a trial? Do we go ahead with option X or option Y? Or even more broadly, how do patients and families make it through the fire, you know, go through this stuff and somehow come out on the other end.
It was only after a couple of years that I realized there was this thing, palliative care, which existed already. Although pediatric palliative care was still in its very early years. I did a brief course in Boston, a 2-week course in general palliative care, and that sort of acted as a gateway drug. I did that course thinking it was going to help me think about palliative care in the context of my patients. And in the end it led me to apply for a full hospice and palliative medicine fellowship, which I did about a year ago.
And that was really the pivotal point. I mean, I think landing in that fellowship was really the first point where I turned around, looked over my shoulder at that career arc, and said, oh, there's an arc that makes sense here, starting with religious studies as an undergrad and moving through the care of children with serious illness and families facing serious illness together and landing back in this specialty that aims to think about how to live well in the face of serious illness, how to manage suffering, how to unknot some of that stuff.
And so I do miss, I don't practice primary oncology anymore, and I do miss it. But I have spent the last decade really focused primarily on pediatric palliative care, and it's been deeply, deeply fulfilling.
For the full transcript, visit The Doctor's Art.
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