Charles Krauthammer wrote an excellent column in the Washington Post, 8/21/09 entitled "The Truth About Death Counseling." Perhaps the most important aspect he pointed out is that the Living Will you write for yourself while you are healthy is often not the Living Will you will want carried out when you are dying. As a doctor, I have witnessed this many times.

Mrs. J wrote a Living Will expressing her desire not to have any life saving measures carried out, if and when she should have a stroke. For three years she had given intensive care to her own mother, who had a stroke. She did not wish to burden her family in the way she had felt burdened.

In the weeks after graduating from medical school and preceding my internship, I went to the beach with a suitcase full of books (this is a lot easier now thanks to Kindle). One of the first books I read was a novel about of group of interns called "House of God." It turns out this was in fact based upon true anecdotes from a group of real life interns at Beth Israel Hospital (hence, the title) in New York. One sentence has always stuck with me, "The first rule in the House of God is -- first, do no harm."

This important maxim should be remembered in current discussions surrounding health care reform, which have devolved into brawls with half-truths and downright lies being hurled left and right.

The much reported "Cambridge Incident" in which a white police officer, Sgt. James Crowley, arrested an agitated African American, Professor Henry Louis Gates Jr., in the professor's home has sparked a national dialogue about race. This is indeed a teachable and potentially healing moment.

I woke up at seven in the morning. I had this pain like I never had experienced before. I was away from my partner sitting, standing, and writhing in pain in Paris. I found my way to a friend, Pedro-Paolo, who managed an antiques store in the St. Germain des Pres. He directed me to Hotel-Dieu, a hospital and ER, adjacent to the Cathedral of Notre Dame.

I checked in, and, for two hours, groaned in pain on a dirty floor until I was unclothed and put on a stretcher, left unattended for two more hours next to a door (cold--it was January) where hospital staff would go out to have a smoke--tobacco or otherwise.

I was examined, reexamined, ultrasounded, CT-scanned, EKG'd, and, well, the list goes on. After eleven hours, I was told that I had a kidney stone most likely related to the fact that I had consumed "dirty" spinach and had not been adequately hydrated.

It didn't matter that the vote was eleven to one, for that one vote had "the right ear of the Pope."

In November 1985, the Pontifical Academy of Sciences convened to examine the question of whether in-vitro-fertlization (IVF) was licit and consistent with the Catholic doctrine. The Portifical Academy was created soon after Galileo's time in order to prevent the duplication of the Vatican's Galileo fiasco. The purpose of the Academy is, from time to time, to convene experts to discuss scientific developments and have these scientific developments interpreted by moral theologians of the Vatican and made available for suitable action by the Pope.

At the meeting held in November 1985, twelve were present--President Carlos Chagas and three gynecologists, Dr. Rene Frydman of Paris and Drs.Howard and Georgeanna Jones, who had brought into the world the first IVF baby in the Americas. The other eight were moral theologians or scientists, half from the Vatican.

At the first organizational meeting, the participants were told that everything that was said would be recorded and each participant would receive a transcript of the recording. The transcript would be published, as were all deliberations of the Academy, and would be made available to the Pope, as well as the other members of the Vatican to incorporate into the doctrine of the church.

The participants had lively intellectual discussions for five days. The discussions revolved around the process of IVF with many questions asked by the theologians.

I grew up in a family that always celebrated birthdays. We all looked forward to each one that was coming along. My daughter's husband and his family never celebrate birthdays. I have become her celebrator. Last week I gave her a card to send to her husband. It pictures a woman entering her house loaded down with packages and saying to her spouse, "Surprise, it's my birthday."

Why are birthdays important. Birthdays say "Thank you for being born and being among us." Birthdays are more important than celebrating a successful exam, promotion or victory. Birthdays celebrate and exhalt you as a human being, not what you did, said, or accomplished.

Birthdays celebrate the present--not what happened in the past, nor what we think will happen in the future. But on this special day, we get to say, "We love you."

"From inability to let well alone,
from too much zeal for the new and contempt for what is old,
from putting knowledge before wisdom, science before art and
cleverness before common sense,
from treating patients as cases
and from making the cure of the disease more grievous than the
endurance of the same,
good Lord deliver us. Amen."
-- Sir Robert Hutchinson

Harriet was diagnosed with colon cancer at age 82. She had her cancer surgically removed. The surgery alone probably cured her disease. However, an oncologist told her that surgery had given her an 80 percent chance of cure, but a year of chemotherapy would increase that chance to 90 percent. She opted for the chemotherapy.

I could not understand why she said yes to the debilitating chemotherapy regime at her age with her already 80% survival rate. However, she had an undying faith in the skill and wisdom of her doctors--to a fault.

The names have changed: Gingrich, Livingston, Clinton, McGreevey, Vitter, Spitzer, Ensign, Sanford. The pain is almost always the same--like a knife, a relentless one, going into the heart of the betrayed spouse or partner over and over again. Some months ago, a young man, recently married, sat in my office and said, "I forgive my wife for cheating, but I cannot get that tape inside of my head to stop rewinding and playing again and again and again."

A week before I was to marry for a second time, I was reviewing the service with my future husband. I realized that I could not possibly say, "This is my solemn vow." To me a solemn vow is a promise and no one can keep a promise. It is the human condition to break promises. Yes, I know there are couples who have been married for 60 years and it is probably their "solemn vow" that got them through the rough times of marriage. But I had broken my vow once and my future husband had broken his twice.

So I looked up the word "vow" in the Oxford English Dictionary, hoping there would be another definition that would allow me to use the word. There was. "Vow" could mean "desire, intention, wish." So applying this definition, I got through the marriage ceremony.

Martin Marty, the imminent religion historian, once observed: "Physicians are men and women of science...they tend to be dismissive of the transcendent, the eternal, the spiritual. They...cannot always attend to the things of the spirit."

Not so, says a study from the University of Chicago which surveyed the spiritual leanings of 2,000 physicians. According to the survey: "Seventy-six of the physicians polled professed belief in God, only seven percent fewer than the general population...fifty-five percent believe that their religious beliefs influence their practice of medicine." The study goes on to assert, "You are likelier to find physicians at worship than you are to find non-physicians: forty-six percent say they attend religious services twice each month or so." They found that only forty percent of non-physicians as a whole attend worship services.

O.K., so physicians are rather likely to be people of faith. But are they worthy of the faith and trust that their patients put in them?

In 1995 a Gallop poll found that 90% of Americans believed in something greater than themselves--God, Allah, Buddah, a higher power, or the Almighty -- and 80% stated that their faith helped them to cope with disease. That same Gallup poll found only 43% of doctors admitted believing in something greater than themselves, and 25% indicated they were atheists.

Dr. Larry Dossey declared that doctors were the most spiritually deprived people on Earth. He began to travel to medical schools talking about the healing power of prayer. He drew large crowds. In 1999, Dr. Herbert Benson of Harvard University held the first conference on "Spirituality and Medicine"; over 1,000 doctors and nurses attended the conference. Schools became aware of the need to include spirituality in their curriculum. Today 90 out of 120 medical schools do so.

As part of that effort, Dr. Christina Puchalski of George Washington University developed a quick tool to obtain a spiritual history from a patient. It's called the FICA assessment.