Like all good registered nurses, Kristin Kraus keeps up with the latest in technological developments, so when a terminally ill older patient entered her operating room one night, she was as ready as ever with the required monitors and meds.
She wasn't ready for the question he asked her.
Out of the blue, the man confided that he'd once killed a person.
"Will God forgive me?" he asked.
"I just stuttered and stammered," recalled Kraus, who works at Mercy Medical Center. "I felt completely unprepared."
As health care providers know, critical illness can bring out the difficult, often unanswerable questions that usually lie unasked at the core of human existence: What does it mean to live well? Do I have regrets? Am I ready to die?
Professionals educated in the biomedical model are rarely trained to handle such matters, but a program at Kraus' workplace goes a long way toward trying to remedy that.
Called Literature and Medicine, it's a seminar-style class that draws together professionals from all areas of the hospital to discuss poetry, literary journalism and classic novels once a month.
The readings are chosen to spark conversation about aspects of health that can't be quantified, from the power of faith to the importance of caregiver-patient relations.
Class participants are "professionals who work in a very pragmatic field, and literature can be very much open to interpretation, but it also provides a means of exploring the bigger issues that lie behind what appear to be pragmatic problems," said Dan Collins, a hospital spokesman who has been a member of the Mercy group since it began 10 years ago.
Modeled after a program the Maine Humanities Council began in 1997, Mercy's course was the first in Maryland, one of the 26 states in which versions of Literature and Medicine are now offered.
It's conducted under the auspices of the Maryland Humanities Council.
Mercy's group, which includes physicians, nurses, human resource managers, chaplains, lab technicians and others, has delved into poetry by W.H. Auden, Ernest Hemingway's short stories, the novels "Home" by Toni Morrison and "Monday Mornings" by Dr. Sanjay Gupta, and other works over the past two years. Members say the readings have triggered discussion on life endings, the intersection between science and faith, and how to bridge communication gaps between cultures.
"It makes me read books I would never have thought about, and it's interesting to listen to other people's opinions and see how they interpret these things differently," said Dr. Deborah Weber, a Mercy pediatrician who has been attending the class for a decade. "And hearing from others, you learn more about what they do, how important their work is in this mission of getting people better."
The Maine group monitors participants nationwide via an annual survey. Nearly 80 percent of those who have taken some version of the course say they have experienced a great or medium increase in empathy for patients, according to a study conducted at the University of Southern Maine.
Dr. Lenny Feldman, an internist who directs training for medical residents at Johns Hopkins Hospital, has studied such hard-to-measure qualities in health care.
Improvement in those areas has been shown to benefit patient health.
"A healthy doctor-patient relationship is vital for patients to receive the best care, and it's necessary for patients to make the difficult lifestyle changes … required to treat and/or prevent chronic diseases like diabetes, hypertension, coronary artery disease, emphysema and obesity," Feldman said.
On a recent Tuesday, a group of 15 batted around ideas about "The Death of Ivan Ilyich," an 1886 novella by Leo Tolstoy, and selections from "Being Mortal," the recent book by surgeon and New Yorker medical writer Dr. Atul Gawande.
The moderator was Karen Arnold of Columbia, who has a doctorate in literature. The readings touch both directly and indirectly on health care-related matters.
"Ivan Ilyich" is the story of a man who suddenly develops a terminal sickness that his doctors can't diagnose.
As Arnold points out, the protagonist's family views his condition mainly through the lens of how it affects them. A string of physicians exude aloofness, marginalizing Ivan Ilyich through their use of esoteric medical language.
Carole Rybicki, a chaplain at Mercy, said she was "appalled" by the family's attitude but said it's not unusual for family members to try to tailor a loved one's treatment to their own convenience.
Esty Daly, a human resources generalist, said one of Ivan Ilyich's doctors was "using a lot of jargon to keep him in the dark" and "talking to him in terms he won't remember," but Jacqui Jones, database manager for the Mercy Health Foundation, said the jargon problem exists beyond hospitals.
"I go to the auto mechanic and get this vocabulary I don't understand," she said. "It's horrible when you're on the not-knowing end."
As the conversation shifted to the Gawande selection, some appeared struck by the commonalities of works written by two very different authors 128 years apart.
"Both pieces looked at the dichotomy … between those of us who are well and those of us who are sick," said Collins, who was an English major in college. "Illness does put down that wall between us."
Kraus, the nurse, said she eventually told her terminal patient that she believed God would forgive him, but she felt awkward about the outcome, and it wasn't until she took the class that she learned how better to handle such situations.
One woman, she recalled, had lost the power of speech and was scheduled for surgery. When time for the procedure drew near, the patient gestured in a way Kraus perceived as a request to stop. Her family wanted to press ahead.
Kraus called for an "ethics consult," a meeting of experts from across the hospital.
The panel sided with the family, but Kraus said it reassured her and her team to know the matter had been discussed in depth — and, she added, she wouldn't have had the courage to take that step without her experience in the class.
"It's more about the heart of nursing than the science," she said. "It helps me think of the patient as a human being."