DALLAS – At 83, Carl Smith found himself facing quadruple-bypass surgery and the real possibility that he might not survive.

Within hours on this spring morning, Dr. Mark Pool would temporarily bring Smith’s heart to a stop in an attempt to circumvent its blocked passages.

Additional Photos

Dr. Mark Pool and patient Carl Smith are all smiles following successful bypass surgery at Texas Health Presbyterian Hospital Dallas – an delicate operation preceded and followed by prayer. Mona Reeder/ The Dallas Morning News

And to help his patient confront the uncertainty, Pool did something unusual in his profession: He prayed with him.

The power of healing: Medicine and religion have both had their day, and they haven’t always been able to coexist. But as today’s medical treatment becomes more holistic, doctors are increasingly taking spirituality into account.

Studies show a majority of patients want their spirituality recognized, and most medical schools now have classes related to the topic. In general, the new thinking asks doctors to note their patients’ spiritual leanings and open doors to expression, especially when life is at risk.

Pool, a highly regarded heart and lung surgeon at Texas Health Presbyterian Hospital Dallas, is fervent about his Baptist faith. For about a year, he’s routinely asked patients if they’d like him to pray with them pre-surgery — a gesture he says is always appreciated but one that exceeds advocates’ suggested bounds.

“A physician should be open to a patient’s spirituality but shouldn’t push religion on patients,” says Nathan Carlin, assistant professor at the University of Texas Health Science Center at Houston. “That’s confusing personal and professional roles.”

An inherent power differential divides doctors and patients, says Christina Puchalski, director of George Washington University’s Institute for Spirituality and Health and co-editor of the recently published Oxford Textbook of Spirituality in Healthcare.

“They’re coming to us for something other than prayer,” Puchalski says. “If I, as a patient, perceive (a surgeon) as having my life in his hands, and he asks me to pray and I say no, he may not treat me well. And that’s putting undue pressure on the patient.”

REASON TO BELIEVE

As the saying goes, there are no atheists in foxholes: The idea that your fate is out of your hands offers fertile ground for re-examination.

“The moment somebody tells you that you have cancer,” says Methodist Dallas Medical Center’s Rohan Jeyarajah, a gastrointestinal surgeon who prays with patients, “you’re going to believe in something.”

But the situation, he says, requires caution: “We have to be careful about being in a position of perceived authority and not overstepping that bound. This is like a teacher-student relationship. There’s a chance you could be inappropriate.”

Pool pushes forward, eager to share the belief that drives him without making people feel awkward or flouting that power imbalance.

“I don’t want to exploit their situation,” he says. “At the same time, I want to give them the opportunity to explore the faith that I know.”

You could say Pool comes from a religious background. His father, his grandfather, his father-in-law, his brother-in-law: all ministers. The family joke was that he started going to church nine months before he was born.

By age 6, he was well versed in Bible basics, but then something odd happened. One day at a prayer meeting, Pool says, he was touched by — well, not quite a vision, but an awareness.

“I had already understood that Jesus came to save the world,” he says. “That was nice. But then I understood: Jesus came to save me. And that changed everything.”

He’s pursued a path of faith ever since. Medicine seemed like a good way to help people. Even so, as a med student, Pool pondered ditching the whole thing to go to seminary instead.

As a member of First Baptist Church of Dallas, he and wife Jessica lead relationship classes on Sundays for dozens of young married couples. Even in his black-patterned suit, Pool is impossibly youthful — lean and rosy-cheeked, posture straight as a fence post.

And as a cardiothoracic surgeon, another realization has set in: “I have a ministry. I don’t need to be standing in a pulpit. I have found a ministry I did not expect. I am able to minister to people in times of need.”

Since Texas Health is a faith-based hospital system, he felt at ease taking that step.

“The vast majority of people believe in God,” he says, “and yet when people come to the hospital, that’s completely ignored by doctors. If anything, they call the chaplain. It’s unfortunate that more doctors don’t try to engage that part of a patient’s life.”

That’s starting to change. Two decades ago, barely a few med schools offered classes on spirituality. Now, three-fourths of them do.

“Medicine has figured out that we ignore the more human sides of health care at our own peril,” says Craig Borchardt, interim chair of humanities and medicine at Texas A&M University.

A SPIRITUAL MAJORITY

Studies show 60 to 80 percent of patients want their beliefs noted, he says — not as affirmation but as a sign that the doctor actually cares. But fewer than 20 percent of doctors bring it up.

The push has met with some backlash — from busy doctors reluctant to take time away from other concerns or others who don’t like talking about it.

“Some staff are more comfortable with it than others,” says Mark Grace, vice president of mission and ministry for Baylor Health Care System.

He doesn’t reject the idea of doctors offering to pray, but “if you don’t listen to the answer, that’s where you get into problems. The doctor needs to be prepared if the patient says no.”

George Washington University’s Puchalski says the bottom line is doing what’s best for the patient.

“Physicians are generally not trained to lead prayer,” she says.

To illustrate the power differential she says exists, she recalls a patient who was also a fellow parishioner. One day, she noticed the woman hadn’t been to church for a while, then realized the woman hadn’t come into her office either.

When the patient finally resurfaced, Puchalski pressed the matter: “She told me, ‘I thought you’d be upset that I switched churches.’ That gives you an idea of the power we have over patients. So I would really caution against (taking advantage of) that.”

Pool gleans his patients’ spiritual beliefs at their initial meeting. Then, on the day of surgery, he says: “This is a time when a lot of people turn to faith. Would you mind if I prayed with you?”

No one, he says, has ever declined.

It’s 6 a.m., and Pool briefs Smith on his surgery. At 83, Smith is fit, mowing the yard occasionally, an active driver.

But coronary artery disease caught up with the retired Farmers Branch pharmacist, slowing his blood flow. Over time, it could lead to a heart attack.

Madge Smith, his wife of 63 years, and Leah Wilson, his youngest daughter, are near. Scott Smith, his son, would join later.

Pool explains his plan: He’ll make an incision down Smith’s breastbone, then take arteries from his left and right side, and a vein from his leg, to form new channels for blood to flow through his heart.

“So,” he tells Smith, “you told me you’re a Sunday school leader. Would you mind if I said a prayer for you?”

Smith is touched. Pool places his hand on Smith’s shoulder and begins:

“God, thank you for Mr. Smith. We ask that you would guard his life, keep him safe and bring him through this operation. Replace any anxiety that he may have. Give him a great assurance of your love and your power.

“I ask you to watch over our team, that you give us all clarity of thought, that you guide my hands as they move. We pray these things in Christ’s name. Amen.”

“Amen,” Smith says.

Later, as Smith’s family awaits the outcome, his wife says: “I have never had a doctor do that. It just meant so much to us. We just thought it was sent from God.”

At 6:45 a.m., Pool starts in, using a tiny electric saw to patiently work through Smith’s chest and breastbone.

The arteries he wants dangle inside like strings of soaked twine above Smith’s quivering lungs. He snips one end of each, then applies small plastic clamps to stop the thin spurt of blood.

PRAYERS ANSWERED

“See that?” he says. “That’s the blood flow that will be going into the heart.”

A shot of potassium literally stops Smith’s heart cold, temporarily abdicating its work to a heart and lung machine. To the heart, Pool will divert the snipped arteries, and repurpose a vein taken from Smith’s leg, to offset the blockages within.

But first he has to open the heart’s protective sac, unveiling the still-beating organ as it heaves inside. Pool eases it to one side, to reach a portion underneath — and in that moment, Smith’s heart, the force pumping blood and oxygen throughout his body, rests in Pool’s cradling grip.

Out in the family waiting area, Smith’s son Scott says: “God has his hand on everything. He’s in control.”

Pool initially wondered if his praying might give patients pause, whether they’d worry he wasn’t confident enough in his own skills.

“It’s been the opposite,” he says. “They value the humility.”

Smith’s operation was a success. Six weeks later, Pool meets with him one last time.

“You’re doing extremely well,” Pool says. “I’m going to fade away now.”

“I’d be 6 feet under if it wasn’t for you,” Smith says.

Pool dismisses the thought. “I’d like to say a prayer with you,” he says.

Smith bows his head .

“Lord,” Pool begins, “thank you for getting Mr. Smith out of the hospital and getting him home. We ask that you continue that process of healing and give him a spring in his step once again. In Jesus’ name we pray.”

Smith is upbeat. He believes the gesture will help him get better. And in the end, that might be the most important factor of all.

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