October 01, 2009

Evidence-based medicine is central to what I do as a physician. Yet, looking back on 30 years of working in long-term care, I know the limits of evidence-based medicine.

In spite of all our scientific efforts, human beings suffer illness and die under our care. Sometimes, we must bring nonpharmacologic as well as pharmacologic methods to pain management at the end of life. I call on Reiki, a healing method with a Japanese name meaning “spiritual energy.”

For me, the path to learning and using Reiki has been a journey. Reiki has ancient roots but was given its current form by Dr. Mikao Usui in Japan in the late 19th century. Reiki is a method, not a faith: It reflects on the common connections that we all share. How often have we seen colleagues and coworkers exhausted at the end of their day? The strains of end-of-life care are spiritual as well as physical as we pour concern and caring into our patients. In teaching Reiki, I focus not only on relieving patient pain but also on helping health care workers receive “energy” from a universal connection. Dr. Usui called Reiki “the secret method for inviting happiness.”

Simple Principles

If we are unable to connect with our patients as human beings, it is difficult for us to help them face an incurable illness. One day, in a youthful part of my career, I was meeting with my facility's gifted administrator, Bud, and one of our nurses called us, “Gurney won't take his medicines, and he won't eat.” We went to visit Gurney, and Bud asked him what work he had done. Gurney was an amputee and totally dependent in all his activities of daily living. He was suffering from terminal heart and lung disease, and we could not heal him. But we listened to him talk about his work as a tool and dye maker. We never did get into an argument about his medicines, but he started to take them.

Bud's sensitive approach rippled to other staff. I was never able to cure Gurney, but I took the time to listen to him tell his stories. In simply connecting with him, we helped relieve his pain and helped him live the final days of his life with more of a sense of being in touch with other humans.

The basic principles that underlie the Usui Reiki method are as follows: Don't get angry today. Don't worry today. Be grateful today. Work hard today. Be kind to others today.

In attempting to fulfill these principles, I have come to prefer focusing on how a patient lives each remaining moment, rather than on how the patient dies. Recently, I spoke with a daughter and granddaughter of a patient who was living her last moments. They shared with me that the day before, “Mom had become more lucid than in years, and she told us that she loved us.” Moments lived near the end of life can be imbued with precious qualities both by our patients and by their loved ones.

Reiki masters refer to the end of life as “transition” rather than “death.” On so many occasions, I have had the honor of being with patients who were breathing one moment and gone the next. As a scientist, I know that the total of the matter and energy—in the physical sense—in their bodies is the same at those two moments. But there is a difference in the quality of the body once death has occurred. The fact that science does not yet know how to measure this departed quality does not diminish its reality or its importance.

Whether we call this quality that departs “spiritual energy” or “soul,” whether we believe that this quality is bound up in eternal life, or whether we pray it has rejoined God and loved ones, nothing changes the awe of this moment.

In caring for patients in transition, it is crucially important to be aware of the spiritual strengths of the person and to honor his or her values. Using Reiki or whatever method is at our disposal, we are wise to reach out to the creator on behalf of the patient. My intention is to do so in the name of the spiritual tradition of the patient, not my own personal values.

It's Not About You

Reiki theory has some similarities to other “Eastern” healing arts. However, the Reiki practitioner takes no credit for healing. The method is about the person being helped, and it focuses on spiritual connections.

I can remember a discussion I had with a colleague who felt that Reiki was, as he put it, a crock. For our patient at the time, this doctor was committed to chemotherapy, he said, even though the tumor continued to grow rapidly. He said that with the treatments, “I am giving the patient hope.” I responded that hope did not require a toxic, expensive substance that was not retarding the tumor and was making the patient vomit.

Now, of course, as an evidence-based physician, I focus on scientific care when it works. Reiki costs nothing, has no toxicity, and even for those who don't see it as healing, it can bring calm and thus relieve pain.

In teaching Reiki, I have found that the simplest aspects of the method—the easiest to learn—make the most difference. Breathing techniques for relaxation take little time to learn. Being in the moment with your patient and respect for his or her spirit are all routine to physicians as healers. One day, I was at my LTC facility and heard nurses and a hospice patient screaming at each other. They were fighting over the timing of this poor emaciated woman's glaucoma eye drops. The nurses were talking to her but not listening, though she still was mentally alert.

I sat and listened first to her side of the story. The situation had become rather convoluted. I asked her for permission to perform Reiki by simply touching her forehead near her eyes. She said yes, and, I sat with her for a few minutes focusing my intention and my breathing on being calm and calming her. She closed her eyes and relaxed, and after a few minutes I took my hand off her forehead, and she looked at me and said, “Now I understand, it doesn't matter.”

I believe that, most important, by using Reiki, I had conveyed to her that I cared about her and respected her. For the moment, she was free of anger and pain. She stopped yelling at her nurses, and they found her an “easier patient to care for.” She died quietly and free of pain and, as is so often the case, the staff truly missed her afterward.

Every day, I see physicians who are unhappy with their salaries, with regulations, with lawyers, and with sleepless nights and stress on their own personal relationships. This is not an easy time in medicine, but being a healer remains a marvelous and unique privilege. I can recall recently—after being up most of the night—I worked all day with patients living the last moments of their lives and family members who were concerned and scared. It was a long and difficult day, but driving home, the only feeling I could remember was gratefulness that I had the opportunity to do this work. Our patients face far more daunting challenges than we do from surveyors and lawyers.

A Way, Not the Way

Reiki is not a religion, and it is not the only method that works. It is a path but not the only path. The method can help us give nonpharmacologic pain relief to our patients living their last days. It can help us be happier within our own lives.

When faced with a patient in the final stages of disease, I start by clearing my own mind and focusing on that person. I do not abandon evidence-based medicine. I use Reiki to complement it. The method supplies hope and compassion. I don't need to offer prescriptions for substances that are expensive, toxic, and unlikely to work. I can care even if I can't cure. In so doing, I become a better physician and happier human being.

Reiki and other spiritual healing arts offer—at the least—human connection and compassion. Pain is a subjective phenomenon, and sometimes, relief of pain can flow from some universal source through one human being to another. Sometimes, writing a prescription is just the right thing to do, and sometimes, especially for a patient in the final days of life, it can place a white coat and a barrier between the patient and the healer. The best physicians I know use scientific knowledge when it works but retain access to a deeper wisdom for those times when science offers no answer.

The Rules of Usui Reiki

▸ Don't get angry today.

▸ Don't worry today.

▸ Be grateful today.

▸ Work hard today.

▸ Be kind to others today.

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