CARING FOR TERMINAL PATIENTS, DOCTOR STILL DOES ‘ SEE MIRACLES’
Dr. Martha Twaddle, 59, works with seriously ill patients, including many at the end of their lives, believes “we got to take good care of the chassis” — our bodies — but life also is about “growing and developing our spiritual self.”
Aphysician for more than 30 years, Twaddle is medical director of palliative medicine and supportive care for Northwestern Medicine’s north region and teaches at Northwestern University’s Feinberg School of Medicine.
Her main focus is caring for people with terminal or otherwise “serious” illness and helping their families.
“I do see miracles. I see things that confound our ability to explain them.
“I took care of a woman a number of years ago at 50 who had a devastating diagnosis. She had breast cancer that spread into the linings around her brain, and the treatment ... it was more of an offering, so to speak, to appease her anxiety.”
But then the woman “remitted completely of this illness for an entire year, which left all of us with our mouths hanging open and her mother saying, ‘ This was prayer.’
“Whatever it was, it was wonderful. And she was able to achieve some pretty incredible things during that year and to live really well. I can’t explain that.
“And that’s what I love about working with people: There is much that surprises us every day. We’re always learning. And every individual will write their own story. And we get to be there and learn from them as they go through this.”
“Medicine, at its best, is a beautiful balance of art and science.” For Twaddle, it’s “a calling.”
She doesn’t care for patients alone. There also are social work-
ers, chaplains, nurses and therapists, among others.
The focus is “body, mind and spirit ... so it’s the only area of medicine that really pays attention to the psychological aspects of care, the spiritual aspects of care, the physical aspects of care. All these dimensions are equally important.”
“In my kind of perspective ... we are spiritual beings that are having physical experiences and that all the things that happen to us actually contribute to our spiritual growth and have meaning beyond sometimes their first- blush appearance. And every person is
spiritual. How they manifest their spirituality will vary greatly.”
Ailing “people who are living with kind of a big picture in mind tend to make sense of what’s happening to them differently than those who do not nurture and grow that part of their lives.”
“Sometimes, religion can make it harder” for people who are dying because some might believe they are sick because they did something wrong.
But religion also can help people looking at the end.
“I think finding meaning and finding also potentially rituals or comfort in old practices or prayers or sacraments — anything that really ... helps us find meaning and purpose in comfort — will help us navigate a scary time in our lives.”
We should not be “defined” by our physical life and ailments, but instead realize “we are spiritual, and we don’t end” with death.
But “that does not ... lessen the grief and the sadness of loss and connection” that comes with death and catastrophic illness.
“I think there are many physicians who actually have a very deep faith or spirituality.”
“I find great comfort in the sacraments and in prayer and meditation. My faith is my anchor ... faith is a day- to- day journey into the unknown.”
In terms of a faith, when we’re younger, “we like it to be a little bit more predictable.”
But “we live in shades of gray, don’t we? And there are many questions that will never be answered.
“In fact, some of my friends who are of the Jewish faith will say to me, ‘ Martha, don’t ruin a good question with an answer.’ It’s actually not about the answer. It’s about the question.”
And also about the “quest.”
Do dying people unload their regrets, sins on her?
“I’m not a priest where I can say, ‘ And you are forgiven.’ ” But she tries to let people know they’ve been “really heard” and to be with them “in that true place of compassion.”
“Sharing their challenges is truly a blessing for us. ... Wow, what a privilege that they trust us to unload.”
“I was raised within the Presbyterian Church and attended Sunday school ... and was part of a pretty conservative Christian group” in college.
“I’m a ‘ petroleum brat,’ so I grew up all over the United States,” moving because of her dad’s job.
“In this part of my life, the tradition that I find the most sustaining is the Episcopal tradition. I love liturgy ... I love the sacraments ... this sense of being connected with the world when I go to church ... that sense of community.”
Has she encountered cases that challenge her faith and belief in God?
“We live in a broken world. We are not in heaven. This is a place of limitations and sadness and cruelty to one another.
“What inspires me is when I see what people can do for one another. And I have had the incredible privilege of seeing people who are truly transcendent of their physical state to really be in a place of love and amazing compassion.”
One of her patients was 36 when diagnosed with incurable esophageal cancer. He was “a remarkable, kind soul.” She visited him at home one day.
“He looked at me, and he said, ‘ You know, these have been the best days of my life.’ And I was ... just speechless. ... Here’s a gentleman who is facing the end of life within days likely ’ cause he can barely eat and he has this horrific cancer. ... He says, ‘ I’ve never lived like this before where every conversation, every interaction, I am so fully conscious of its importance, and I don’t waste time; I spend time, I give time to those things that matter most in my life.’ And that’s the people that he loves.
“To me, that is transcendence.
And witnessing that — that power of the spirit to move beyond the physical — is such an affirmation that we are spiritual, wow.”
What does she think the afterlife is like?
“I’ve seen the faces of many who have died and even my own father, who, when we closed his mouth, was smiling. I know that it must be about being fully loved.” Sometimes, she refers to herself as “a midwife for the end.”
Has witnessed dying people “reaching out with a look of, just, it’s hard to describe, but unbridled joy. I’ve seen smiles, I’ve seen calmness, people talking to those who have already died is very, very common. ... We can’t see beyond that veil. We can only see how people begin that transition.”
But death obviously is not always peaceful, and some people are more ready than others.
“I think probably 80 years ago we had more doctors talking this way because they didn’t have a lot to offer people. If you think about it, much of health care and improvements in the science remained kind of flat until antibiotics came around and then vaccines.”
The T “burnout rate” among physicians phy is high, but Twaddle says say the connection she forges with wit patients and learning their “stories” sto sustain her.
What W advice does she have for pe people “Here’s who the aren’t irony terminal? ...
we’re all terminal. min And I think that’s where we we — in America, in particular — like to pretend that it’s not going
to end, e and even 90- year- olds will look at me and say, ‘ How is this happening hap to me?’ ”
We need to live with “intention” and “nurture and sustain those relationships around us that matter most — that’s a life well- lived. ... When we don’t pay attention to the fact that we are frail people that will eventually stop, medicine or no medicine, that’s where we get ourselves into trouble.”
Death can conjure beauty, and it can be “really rough.”
“Young mothers leaving their children, there’s a suffering that we all feel.”
No matter whether people are ready to die, no matter the level of suffering or readiness, “what we can reassure people is that they are loved and they will not be forgotten.”
Has experienced “a little kiss of the divine.”
Years ago, Twaddle and a nurse “cared for this amazing woman.”
Twaddle’s colleague asked the woman to send a sign once she passed that she was OK.
With good humor, the woman said, “It’s hard enough to die. Now, you want me to send you a sign? ... Look, I’ll do my best. It won’t be lightning ... or maybe it will. We’ll see what I can do.”
Later, after the woman died with “just this gentle exhalation, and she was gone,” the nurse was driving home in the dark, and “the entire western sky was alive with lightning. No rain, no thunder, just lightning. ... Could it have been a coincidence? Oh, sure. But it had meaning. And it again connected the sense of timelessness with this person that we both loved.”
“We’re all terminal. And I think that’s where we ... like to pretend that it’s not going to end, and even 90- year- olds will look at me and say, ‘ How is this happening to me?’ ” Dr. Martha Twaddle