Four D’s: A Guide to Integration of Spirituality in Patient Care, by Zishan Samiuddin M.D., Houston Psychiatrist
By John Graham
May 19th, 2014
The guiding principles of my professional life have been gleaned from my unique but contradictory life experiences. I grew up a Muslim woman with a first name usually given to men (Zishan) and a last name claimed by both Muslims and Hindus (Amin), attending Catholic schools in India, a secular country populated mostly by Hindus. As if those are not enough inconsistencies in one sentence, I have spent the better part of my professional life as a straight, brown woman treating the psychiatric disorders and chronic pain of mostly gay, white HIV+ men. As a medical student I relied on mnemonics and alliteration as prompts for my sometimes unreliable memory. Decades after walking the walk without awareness of what was driving me, I have come to realize the significance of the particular alliterations, the four D’s that have guided my course.
- Dawaa- an Urdu word meaning medication
- Dua- an Arabic/Urdu word meaning prayer or supplication, an intimate aspect of Islam
- Daya- a Sanskrit word meaning compassion
- Daawa- an Arabic word meaning service, an obligation for all Muslims
Five days a week I write prescriptions (Dawaa) for my patients, but every day I pray (Dua) for their welfare and to be given the skills to treat them. I pray for the compassion (Daya) and empathy I will surely need to treat the man sitting across from me in my office. This HIV+ man is someone I see almost every day, just with a different name each time- he is chronically depressed, occasionally psychotic, continues to use cocaine and alcohol sporadically, has fathered 10 children from five different women and asks for the magic pill that will solve all his problems. I know I will need a healthy dose of compassion to overcome my initial judgmental attitude and impulse to lecture him about all that is wrong with his picture. I pray for enough compassion to allow me to consider the journey he has taken that has brought him to my office. A journey that started with physical abuse at the hands of his alcoholic almost never- present father, the inevitable neglect from his mother who worked two or more jobs to put food on the table, the trajectory of drug and alcohol abuse culminating in his HIV+ status.
I recognize several associations and struggle to educate my uninterested patient about those associations so clear to me but about which he may be in denial- drug and alcohol abuse, depression and severe mental illness, PI’s, DWI’s and incarceration, unprotected sex and the spread of HIV. I use no surgical instruments, no fancy MRI or CT scan machines, can only order a few blood tests; I am just a short woman in a small room where my patient can leave behind his sorrows and pain and absorb the hope and understanding that is in short supply in every other area of his life. Words become my weapon to beat back the demons of despair and despondency even before he takes the first dose of medications I prescribe.
The tenets of my faith dictate that both the intent and the action must synergize for an act to be virtuous and pious. Today, my intent must be to improve my patient’s quality of life by the act of prescribing medications with a prayerful and compassionate attitude; to empathize with him, understand his experience without judgment and attend to his needs. Thus does the service (Dawaa) I provide, become an act of worship and faith.
Zishan Samiuddin M.D.