It's imperative that it's part of it. Throughout my whole career, I've said that the pain and symptom management part of it is the easy stuff. It's the existential suffering that is always the hardest. There are so many things we can do for all the other symptoms, but at the end of the day, this is a monumental time in that person's life and for their family.
We pull apart religion and spirituality. More and more in our country people have moved away from organized religion, but inevitably everybody has some sense of spirituality. It's imperative that's brought into the picture. Otherwise, you've missed the boat completely. Even when we teach about managing pain, we talk about something called “total pain” and that's part of it. If you're not addressing that component, you sometimes can't get their physical pain under control because we're missing that piece of the puzzle.
When you said Alberta's cutting it—and I understand that wasn't quite accurate—my first comment to Kathryn Downer from Pallium, who was sitting beside me, was, “There's someplace in this country that gets funding for spiritual care?” It's not in most places. We rely on the generosity of spiritual care providers, who we identify to work with our teams, and they see this as a real need.
Honestly, they're a challenge to find. Across the spectrum, we talk about education and needing to have our nurses well-educated, as well as physicians, and so on. From the spiritual care community, they need to have education in palliative care. I've been in some situations where a spiritual care provider has come in and completely traumatized the situation. They decided that everybody needed to pray for a miracle when the rest of the family were at peace with, you know, Dad is dying. There are small children in the home, and somebody comes in and says, “We need to pray for a miracle that this doesn't happen now.” That wasn't helpful at all and we had the wife come out crying saying, “Please pull him out of here.”
It's important that you find the right provider who can do this kind of work. No matter in what area we go through, including spiritual care, it's imperative that it's there.