How A Family Doctor Uses Faith To Navigate Suffering, Service, And The System

A house call in the morning, a hospital admission by noon, and a seminar on suffering by night—that’s the rhythm our guest lives as a family physician in direct primary care and a fellow with Duke’s Theology, Medicine, and Culture Initiative. We open the door on what happens when you shrink a patient panel, ditch the phone tree, and trade 2,300 names for relationships you actually know. The result is time to listen, continuity across settings, and space to ask the questions most clinical checklists skip: What is medicine for? What do you hope for when life narrows? Who stands with you when the news is bad?

We revisit a formative service learning trip to Belize and confront the uneasy line between formation and medical tourism. He shares how attention became his most valuable skill, how reflection and community keep the work honest, and why the real test of any trip is what changes back home. From there, we talk about faith not as a bolt‑on but as a way of seeing that shapes every clinical move—breaking bad news with spiritual hospitality, honoring a patient’s tradition without vagueness, and naming truths without hiding behind autonomy alone.

Burnout and moral injury thread through the story, reframed by a larger narrative that makes room for grief and meaning. You’ll hear about kneeling beside beds to shift power, holding tears as a disciplined form of courage, and building parallel communities where weary clinicians read, eat, and remember why they began. We close with practical book recommendations on death, beauty, and care, and with candid advice for students on the fence about global health: discern in community, go humbly, and bring the lessons home.

If this conversation resonates, follow the show, share it with a colleague, and leave a review with one insight you’ll carry into your next patient encounter.

Book Recommendations:

1. When Breath Becomes Air - Paul Kalanithi
2. Severe Mercy - Sheldon Vanauken 
3. The Anticipatory Corpse - Jeffrey Bishop
4. Lincoln in the Bardo - George Saunders

I also want to thank our listeners for joining us as it is our goal to not only share with you our guest’s introduction to international healthcare, but also to share with you how that exposure to international healthcare has shaped their future path in healthcare. As true patient advocates, we should all aspire to be as well rounded as possible in order to meet the needs of our diverse patient populations. 

As a 50+ year nurse that has worked in quite a variety of clinical roles in our healthcare system, taught healthcare courses for the past 20 years at the university level, and has traveled extensively with my students on international service-learning trips, I can easily attest to the fact that healthcare focused students need, and greatly benefit from the opportunity to have hands-on experiential healthcare experiences in an international setting! I have seen the growth of students post travel as their self-confidence in their newly acquired skillsets, both clinical and cultural, facilitates their ability to take advantage of opportunities that previously may not have been available to them. By rendering care internationally, and stepping outside one's comfort zone, many more doors of opportunity will be opened.

Feel free to check out our website at www.islonline.org, follow us on Instagram @ islmedical, and reach out to me @ DrH@islonline.org

Transcript

Welcome And Guest Introduction

Dr. H 0:11

Well, hey there, I am Dr. Patrick Hickey, or Dr. H, as many of my students refer to me. I want to welcome you to another episode of the International Service Learning Experiential Medical Education Podcast. During each episode, I will be interviewing healthcare-focused students and faculty from high school to university that have had an opportunity to participate in an international service learning trip. Additionally, I will be discussing the benefits and challenges to international service with healthcare professionals that have served abroad, as well as industry leaders in healthcare, education, study abroad, spirituality, and those living in the countries being served. I'm very excited to have Dr. Brewer Eberly as my guest today. I've had the privilege of having Brewer as a former student and I'm very eager for him to share with us his unique journey in healthcare. Brewer graduated in 2013 from the University of South Carolina with a Bachelor of Science in Biology and the USC School of Medicine in 2018 with his medical doctorate degree. During his med school journey, Brewer took some time off to pursue a Master of Arts in Christian Studies and a certificate in theology. During his undergrad years, Brewer joined me on a service learning trip to Belize, and presently he works in clinical practice in Raleigh, North Carolina. Well, good morning. I'm real excited today to have Dr. Brewer Eberly with me. Full disclosure, Brewer and I have known each other for quite some time. And Brewer went on one of my service learning trips, I believe, was to Belize, way back when. This has been a walk down memory lane for me of sorts and speaking with a lot of uh former students who who are now in great positions. And Brewer is now an active MD working in the community and real excited to reconnect with Brewer. He's had a very unique path in in healthcare. And I'm uh I'm excited for him to share that path and excited to reconnect with him. And and Brewer, just starting off, just tell us a little bit about yourself, where you're from, and and what you're doing.

Brewer’s Role And Direct Primary Care Model

Brewer 2:22

Thanks, Dr. Hickey. It's it's a delight to be with you. And uh for anyone who's listening, Dr. Hickey is one of the uh men who more or less made my vocational life possible as an undergrad. And so it's a delight to sit with you, Dr. Hickey. It really is. So my name is Brewer Eberly. I'm a family physician working at direct primary care practice called the Fisher Clinic in Raleigh, North Carolina. And then I'm a McDonald Agape fellow serving the Theology, Medicine, and Culture Initiative at Duke Divinity School. And that has me seeing patients in a clinical context, at home, sometimes for house visits in the clinic. And then I also have admitting privileges, which is a great gift as a family doc to sort of follow our patients through all three of those domains of care. And then my academic life is spent asking questions at the intersections of Christian theology and aesthetics and bioethics and working with friends and colleagues to think about things as wide-ranging as, for example, medicalization today. What does it mean to have a kind of symptom framework when we look at issues of loneliness or isolation that plague folks today? So big questions. I love that part of my life. Most of my life is clinical, but have this kind of unique space set aside for intellectual work and writing and thinking.

Dr. H 3:47

Well, Brewer, you you bring up a lot of great themes and topics that that few have discussed before. And you know, I'm writing notes. First of all, I wrote home visits. Doctors still do home visits? Tell me about that.

Brewer 3:59

Yeah, it's a great, you know, I don't want to, I don't want this to feel like it's uh sucking the air out of the room of the of your podcast to talk about direct primary care or something, but so we work in a DPC context called direct primary care. It's a model that's not necessarily familiar to most folks. A lot of people immediately think of it as concierge, but it's it's important to distinguish it from concierge in several ways. But it's a basically a membership model of medicine in which we have completely disentangled ourselves from the system, quote unquote, meaning we don't take insurance. But that does not mean that we don't take uninsured patients. In fact, we still a lot of our patients are uninsured. And part that's because our membership fee is less than 75 a month for adults and 25 for kids, so less than what a lot of people pay for their cell phone bill or for Netflix.

Dr. H 4:57

What a wonderful opportunity. I mean, how active is that part of your practice?

Brewer 5:02

I mean, it's my you know, we're always on call, so I would say it's the FTE language doesn't apply to us. So it's kind of 100% FTE to speak in those terms. But I take Tuesdays for academic time. I've got 610 patients. My two partners have around 700 to 800. And I could, you know, I could talk about this at length because it's a part of my research life and academic life. But you know, the average family doc today, average primary care doc carries something like 2,300 patients. But if you use the USPSTF's own guidelines for that, you'd have to take care of patients 18 hours a day, every day, 365 days a year to accommodate that panel. So, in some sense, the direct primary care movement is inspired by reflecting on the carrying capacity of a physician sitting with suffering people who often require far more time than they would if you were only approaching them from, let's say, what is fillable or what could be clinically actionable that day. So I'm rambling, but it's it's been a profound privilege to practice with these guys and to enter this form of care. And it does, it opens up the possibility for home visits to kind of do the old school family doctor thing where you can see someone at home, see them in clinic, and then also admit them yourself and follow them in the hospital.

Panel Size, Access, And Home Visits

Dr. H 6:21

And Brewer, from your perspective with direct primary care, where where do the mid-level providers fit in? I mean, we hear about shortages of doctors. We we see now more nurses seeking their doctorate and nursing practice, and we have the physician assistants, of course. Where do they fit into this part of your primary care practice?

Brewer 6:41

Yeah, it's a complicated question, as you might anticipate. So we the maintenance of the relationship between us and our patients is so sacred to us that in some sense we're trying to remove any other people from that relationship. So we work on a kind of dyad system that favors as literally just me and my my nurse and the patient. And so a lot of this would quickly become a kind of thicker conversation, but the role of NPs and PAs within the direct primary care family medicine, internal medicine, pediatric world is not clear to me. And right now I would say it favors not partnering with folks in those disciplines. And that's not to make any claim about value or worth. My most of my pediatric surgery uh rotation in medical school was given to me and taught to me by a PA in surgery. So my gratitude and love for mid-livel mid-levels is real, but it would be in a different context. In our model, it's not clear to me it would serve patients in the way they're wanting to be served, which is a kind of direct access to one person who is caring for them, who can make sense of the hurricane of healthcare and all the other specialists and folks they're talking to. And unfortunately, a lot of our patients have been frustrated by experiences, not just with med-levels, but with MDs, in the sense that they often feel buffeted about by a group of 10 to 15 people that don't know them.

Mid‑Level Providers And Care Continuity

Dr. H 8:11

So um, I hear you, Brewer. And I think it's a very interesting yet challenging time in healthcare. Yes. I've been in the business for over 45 years, and I I've seen so many changes. I've seen the advances of practitioners to seek higher education. You know, back in the day, it was always that the MD was the captain of the ship. You know, all the responsibility fell fell on the MD because they had a terminal degree. But now you've got nurse practitioners, you've got pharmacists, you got PT, OT, everyone with terminal degrees as doctorates in their practice setting. So I think we're still trying to feel our way with who does what and and where does the responsibility end. And a lot of it comes down to basic communications. I'm I'm I might be misquoting Jaco, but years and years ago, I think they said that 60% of medical errors happen just because of simple miscommunications between the care providers.

Brewer 9:10

Yeah, I'm I'm certain that's true. You could make an argument that a lot of our model is trying to limit the possibility of miscommunication because it is so direct. So, I mean, a lot of my patients have complained about, for example, fighting a phone tree, having having conversations with people that quickly you begin to discern that they don't really know who you are, that they're kind of skimming the chart beforehand to get a sense of who who you are.

Dr. H 9:41

Brewer, let's let's I mean, I've got a lot of questions to ask you, but but and I want to delve into more of your practice, especially your work in divinity. But before that, uh I'd like to take a little walk down memory lane. Uh, I know it's been quite a few years since you you took that that that trip to Belize. Can can you recall it all? I mean, what prompted you to go on that trip? Did you have a service heart already at that time in school? And is there anything that stands out about that trip so so many years later?

Brewer 10:12

It's always tricky to claim a servant's heart. That probably means you don't fully have one. So I would say I was probably, I was probably, frankly, Dr. Gayet, it probably was you kind of encouraging me to do it or inviting me. But I can't remember exactly what prompted it. I had grown up in a in a church context in which short-term mission work was just a part of what you did as a Christian in the South. Maybe we can talk about that as being both both good but also bad in some ways. But no, I think I was I was following your lead and following my peers and friends who were also interested in the in the trip.

Dr. H 10:52

Brewer, expand on Christian in the South. I'm I'm a transplant. I I grew up in Canada, I grew up as a Catholic boy in Canada. And and when I grew up in the in the Catholic school system, our priests actually encouraged us to go out and go to other faiths and and go to their practice sites, which for me was intriguing. I mean, I I recall going to a junior synagogue, and then I recall going to a Baptist church. And for me, it was very, very exciting. And I'm not sure if we did it when we went to Belize, but on on most of my trips, I would always try to take my students to a local church to see a service just so they could reconnect with the people in that capacity. But Christian in the South, that that's a new expression for me. What is that all about?

Brewer 11:37

Yeah, goodness. I mean, that could be a this could be a six-hour conversation. I mean, you know, f Flannery O'Connor talks about the Christ-taunted South, right? The the sense in which the southern Bible-belt culture is its own ecosystem of Christian thought and practice that sometimes does and sometimes does not align with Christian tradition. And you could say this about like other parts of the, probably every part of the planet, right? In terms of the different ways that Christians gather and sing and worship and so forth. What I mean by what I was saying is that there's been a ongoing discussion that's become more, I would say, a buzz topic over the last five years of the extent to which short-term Christian mission work uh is or is not actually helpful to the to the folks that we would hope that it serves. It's it often, unfortunately, and this has been my experience sometimes, is that it acts more like a a kind of medical tourism, you know, spiritual tourism model, right? Where you're not really being formed in such a way that would call you back to that community. The case in point for me on this is um like cleft clef lip, cleft palate surgeries, where often folks will fly out to do the first part but won't come back to complete it. The the other kind of classic trope, I guess, of this is uh the mission, the the youth group that comes to help build a building, and they do so at 10% the pace of the folks who are already there trying to build the building. And so it ends up kind of wasting a lot of time and resources. So there's just a tension. There's a tension in in the kind of Christian subculture, I suppose you could say, of what does it mean to participate in things that will actually form you to be the kind of person that loves your neighbor where you are, and uh versus forming you to be that kind of person that dips into service in a kind of vacation context once every few years, but that doesn't necessarily change how you then come back home and and love and serve the neighbors that are actually right next to you. Well, it's an important-winded answer.

Medical Tourism And Service Learning Tensions

Dr. H 13:51

No, no, that's an important point, and and I appreciate that because I always share with my students that that we've had this wonderful opportunity to travel abroad and to render care internationally, but there's more work to be done in our own backyard. You know, we we can do the same thing that we did in Costa Rica, Nicaragua, Belize in our own backyard, so we don't need to go internationally. The challenge, though, for our healthcare-focused students who, as you know, maybe learn some of their basic skill sets by taking blood pressures or vital signs or diagnosis, it's very challenging to get those same experiences here in the United States. So, so we kind of sort of double dip. You know, we we take advantage of an opportunity where there's an underserved population, we do render health care. And a lot of students, Brewer, feel it it's just a band-aid on a bigger problem. And as you know, we we treat, we leave two weeks, three weeks later, the medicine is gone and they're they're they're back to where they were. But but I feel the most important thing we can do is educate and empower the people to try as best they can to take care of themselves in the situation. So if we simply went down, put a band-aid in a problem and walked away and thought we did good, we'd we'd be making a big mistake. I and that's something I've tried to reinforce with all my students, all my courses, that that you know, what we don't want this to be medical tourism. We're not experimenting, we're not working outside our scope of practice. You know, as you know, we do work very closely with faith-based groups when we go into these homes. And when when we do go into the homes, it's not unusual. In fact, it's normal to see pictures of the Virgin Mary or Jesus. And and there is a strong faith in the groups that in the homes that we go into and the communities that we serve. So I I agree, you know, we we have to be very careful. It's a fine line on on the medical tourism and and are you doing as good as what you can do.

Brewer 15:43

Yeah, I mean, I think just being aware of it and naming it is obviously the first first step. So the very fact that you're you are making it a conversation in the room is is critical.

Dr. H 15:52

Brewer, how uh how important is faith in healthcare? I mean, that's that's a that's a huge question, but but you know, I I I uh you know, being brought up Catholic and and having taught nursing at the University of South Carolina, you know, Florence Nightingale is is is you know representative of nursing and is is a nursing leader that that we look to. And she said, and I don't know if you if you know this or not, but she said it was a calling from God. And and a lot of nurses have felt that the profession of nursing, I'm not sure about medicine, but they have felt it's a calling. And and you know, I I didn't go into nursing on my own volition. It was a a faculty member in my high school that saw something in me that I did not see in myself. And I I can still recall to this day when she said, Patrick, I think you'd make a great nurse. So I I believe that my my faith in my case, my Catholic upbringing and the want to help people helped to drive me into this profession. But going back to the question, how important is your faith in healthcare?

Faith’s Place In Care And Nightingale’s Vision

Brewer 16:55

Well, my goodness, I mean, there's so much to say there. And in some sense, it's really two questions. The sort of first question you asked of how important is faith in general to healthcare writ large, and then how important is my personal faith? Um, and in some, and those are those are two different questions, of course. And just to riff a little bit on the Nightingale passage, we we have our fellows read that as a part of the theology, medicine, culture initiative. And it is a beautiful piece, like Nightingale's vision of the nursing profession, as I mean, she literally just sort of bursts into the doxology, insofar as she's claiming nursing as fundamentally the care of the suffering other. And insofar as it is that, in this radically embodied way, and often far more embodied than most MDs experience, it's like a fundamentally Christian act. And that's not meant to make non-Christian nurses uncomfortable. It's it's actually just to say that the practice itself is that beautiful, it's that worthy of praise. So, faith, how is my faith important to me? It's this is the kind of question that is so big that it's that it's actually very hard to answer succinctly. But the best way I would say it is that it's it's it's like asking me how important is being a father to you, or like being married and having children, you know, like it's inseparable from all of my life. It's faith is not a pair of glasses I put on one day and take them off the next, or that I put on if I'm sitting with a Christian patient and then take off if I'm sitting with a skeptical patient or something. It is all it is everything, right? So yeah, I would I would just say that for for for me and for for many, it's it's not a drawer one dips into when they sense they have to activate the spiritual parts of the bio, psychosocial, spiritual model. It is the whole game. And then in terms of is faith's importance in healthcare in general, and maybe we can talk back and forth about this. I mean, it's all over the literature. Patients actually do desire that their clinicians be able to speak with them at the plane of their spiritual practice. And most patients long for it. And it can be profound when you enter into those questions of hope and life and death with someone, um, especially someone who may not uh share your tradition. One of my favorite memories of residency was kind of talking about different ways of viewing the body between the Christian and Islamic tradition with one of my Muslim patients. And it actually required a willingness to go there, so to speak, in order to help this patient think about what choices she could make to better support her eating and her health.

Dr. H 19:47

Well, Brewer, you you bring up so many good good points. You you talked about, I believe you just talked about terminal disease. How how how does your faith help you with someone that's got a terminal diagnosis and and how do you approach that when you do have to initially break that news and then care for that patient through that process?

Breaking Bad News And Spiritual Hospitality

Brewer 20:09

Yeah, huge question. It's not formulaic. I mean, I think that'd be the first thing I'd say is that the Christian tradition at least teaches us to approach every patient as being, in some sense of of infinite, of infinite human worth, meaning that you can't know all you need to know simply by showing up and looking at them and making your clinical assessment in 20 minutes. That would be approaching the patient as an idol versus approaching them as what we would call an icon, as a living presence that reads you back, so to speak. So that's the first thing I'd say is like approaching someone with a terminal diagnosis or someone where I'm nervous that that's the case. I mean, this is not a huge part of my life in family medicine, but it has been the case a few times. And then just talking with colleagues who work in hospice and palliative, you're you're making space. That's the first move. So a kind of abundant capacity for spiritual hospitality, as now and would say to receive the person in front of you as they are and to let them unfurl before you at their own pace before you start sort of forcing them to enter into your framework of questioning. And then I'd say I like to ask people what they stand on, what do they hope for? I find can be a really helpful way to approach the question. There's all sorts of like spiritual tools, the FICA, for example. But I think sometimes those strike patients is forced and kind of contrived. And so just approaching them as a moral friend where you are trying to seek their good and being candid and gentle with questioning how they're thinking about what might happen. You know, if it's a if it's a Christian patient, I will sometimes ask them what tradition they are coming from and how their tradition thinks about suffering and death. Because you know, Christian, Christianity is a big tent. And so getting a sense of how, for example, or a Southern Baptist or a Roman Catholic or Greek Orthodox patient thinks about suffering will be really helpful. And I could say way more, I don't want to ramble. This is like, again, this is the kind of thing that we actually do, in fact, spend months talking about at the TMC because it's such a vast, I mean, death and suffering, my goodness.

Dr. H 22:27

Well, Brewer, it's it's it's so thought-provoking. And and I've found through through the years of teaching and and being in healthcare that it's a topic that's not discussed that much and and not openly. And I don't feel that we're well prepared enough in the in the college setting in curriculums to teach about it. And yeah, back in the nursing program, I've had uh the hospice nurse come in as a guest speaker, and I try to prepare my students, and I I kind of sort of half-jokingly say, bring a box of Kleenex, because I mean she's gonna be going over some, he or she's gonna be going over some stories that that are really gonna touch your heart. And I also share with my students, going back to what you said about Christians in the South, I also share with my students because we have a lot of transplants like myself from the north and all over the United States, that it's not unusual in our local hospital settings that a patient would ask you to pray with them or to hold hands with them. And having worked in a variety of settings in the hospital, most specifically in the operating room setting, I've seen many, many a time in the holding area, right before the patient goes to surgery, that the physician and the family and the nurses will all hold hands and have a prayer. And then Brewer, one of the most stunning things that I'll never forget was a physician that I highly respected, the pediatrician, Dr. Glasser, who I believe had done some mission work in Africa. I can't recall his history. But at one point, just before he was to make the incision on a young child, he stepped back and he started praying in the operating room for God to give him the strength to save this child's life. It was a wow moment that I've never experienced since then. I mean, it's just amazing. But but you spoke to that earlier about the Christian in the South. And I've I've tried to prepare my students, but sometimes I get flack, I hate to say that, from the students, that you know, Dr. Hickey teaches uh speaks too much about religion in class. And I guess where I'm coming from, I'm just trying to prepare them as best possible. And what I say is if you're agnostic or you or if you can't meet the needs of the patient, simply go out and find someone else that can serve the patient, that can help them.

Training Gaps, Autonomy, And Moral Guidance

Brewer 24:45

No, I think that's wise. I mean, I I agree. Although I, well, first of all, I'm glad your students are raising the flack. I think that's important to be able to be able to receive pushback from learners, obviously. I do think we're in a I mean, I hear this all the time from educators, especially with medical students, is the kind of perennial fear of foisting your religiosity onto the patient. And then every interaction becomes marked by a kind of relentless respect for the patient's autonomy, where you end up arguably sacrificing them on the altar of their own autonomy. You kind of extricate yourself from any sort of moral responsibility to guide the patient. And that's not good medicine. It's not good medicine to let a patient self-actualize their own suffering and defeat. And I do actually think we're in a season in medical training in which that idea has become more and more feasible in the mind of the learner to just let a patient self-direct everything, including even perhaps their own suffering. So when you bring up something like religion, it's a threat to that vision of a kind of contract-based autonomy at all costs way of viewing people, kind of consent-based, contractual-based obligations, over and against any kind of moral obligation, any kind of like bare human goodness obligation to each other, to approach each other in a sense of love, if I may. So yeah, I think I think the the wisdom of encouraging students to at least find someone who can speak from within that patient's own tradition is great, because you'll you'll also see in the literature that, for example, the kind of the kind of uh melting pot approach to these questions, in which you treat in which the kind of one size fits all chaplain approach, for example, and I have great respect for chaplains, I'm thankful for for them, so please don't hear what I'm not saying by this. But it often does not serve patients who have religious and spiritual traditions to partner them with someone who is speaking vaguely in a way that would imply that it all kind of doesn't matter and it's all true, and it all depends on what you think and your perspective and all this. That's often alienating to people in their times of suffering. So, again, being willing to have an open pluralism model where you can entertain multiple ways of viewing the world and seek out the patient's good while being candid and direct about what you think and being inviting the patient to be candid and direct with you.

Dr. H 27:26

Brewer, I know the theme of our our talk today is heavy on the spirituality side, but uh, but I do that intentionally because your path in in med school is a little different. Tell us about that that path in in med school, and and uh you took a little bit of time off and you and you had a different focus and and and where you're at now with your theology.

Brewer 27:47

Yeah, thank you. And and again, I don't I don't mean to hog the time, so please just interrupt me if I'm rambling. But I I struggled in med school. I really did not encounter the rich vision of medicine that I heard and and folks like my dad and my grandfather, who are both family doctors. And and and frankly, Dr. Ricky, not not necessarily the vision that I was given in undergrad, not not necessarily from you, but just this sort of high metaphysical calling that I felt like I was building, that trips like the ones we took to Belize only further kind of romanticized, probably. Now, that a lot of that might have is is likely just due to my naivete at that age and sort of lack of maturity. But I was a kind of textbook idealist, enchanted medical trainee who had not yet been properly disenchanted, I would say. So I uh I struggled a lot to to buy the vision of it. And you know, you don't buy the vision, you don't perform well, and no one wants a clinician whose heart isn't in it. So I didn't want to give up, but I took a year off. Um I had met a guy named Far Curlin at a uh medical ethics seminar through the Witherspoon Institute at Princeton, and he invited me to come and study with him in this new thing called the Theology, Medicine, Culture Initiative, and it totally changed my life. And it gave me the resources of what you're talking about, which is philosophy of suffering, like theological anthropology. Are we machines? At the end of the day, it's remarkable how one can go through all of medical training and, for example, never entertain the question of what medicine is and what medicine is for, or even what health is. So that year was spent interrogating those questions, and it just totally rejuvenated and overjoyed, ready to redouble commitment to the practice, but not in an idealized way. I think now what C.S. Lewis would call the re enchanted way, which is where you can hold the horror and the glory in tension. You can hold the hard things about medicine in tandem with. the things that are joyous and worth celebrating.

Dr. H 30:05

Now, what do you do with the divinity school, really? What what's your role there?

Brewer 30:10

So, you know, the Theology Medicine Culture Initiative is a space that welcomes clinicians of all disciplines, not just MDs. So public health students, nurses, PTs, OTs, anyone called to the healing arts to gather together in fellowship to study and pray and think about all these topics I've been talking about. And that has me doing all sorts of stuff. A lot of it's kind of just bare bones academic fair, leading papers, editing other papers, kind of just contributing writing. A lot of it's more kind of think tank type stuff. A lot of my the biggest part of my life at Duke Divinity School is is parallel curriculum and parallel community design. Meaning I spend a lot of time thinking about how weary, burnt out, morally injured clinicians join together and how to write curricula that set a table for them to literally eat together, but then also to discuss these questions we're talking about of what what what is medicine, what does vocation even mean in a time in which people are increasingly skeptical of the language of calling?

Med School Detour Into Theology And Re‑Enchantment

Dr. H 31:15

Well Brewer, that I appreciate that that actually is a great segue into my next question for you. When you look at your peers, at your fellow clinicians and their their spirituality and their their dependence on their spirituality, do you see that as being very prevalent or do you see a a void in in clinicians depending or or or using their their deep faith? And also question number two, that's that's for your peers what do you see in the patients and the families that you care for because you know what I've seen in the news and you've probably seen it a lot too is there seems to be less and less people going to church now. There seems to be less and less people that are that are practicing in in in the faith that they're that they were brought up in. So I I just wonder if you see a a void in in your peers with with the uh practice of spirituality and then do you see equally that same void in in your patient population uh I do I I'd have to I'd have to slow down and think a little bit on the extent to which they overlap and the ex in the extent to which they bear and I don't mean to say void. Oh no no I'm saying that there is a void. I mean you know what I mean I know very much what you're saying.

Brewer 32:31

I mean you're describing something that's been that that has been well described the the kind of great unmooring of creaturely life. I mean read read people like Wendell Berry or Charles Taylor or Alistair McIntyre. These are philosophers and thinkers agrarian essayists poets who who have talked over the last 50 years about the ways in which we have you might say gained the world but lost the home that that we have lost a sense of a sh of a shared story or tradition and if you can't articulate the story that you're in then it's going to be really hard to know where you've come from and where you're going. And you're going to feel adrift and and lost and I think that marks certainly clinicians who I would argue in general struggle to tell the story of medicine, struggle to tell the story of what it is we're about here. And then with patients there's a similar malaise you know there's a kind of I mean I see this in clinicians too a a kind of heartache if you will a sense that something is greatly off about medicine that we all seem to feel but can't quite perfectly articulate. You know things like burnout and moral injury describe really important features of that conversation but they're insufficient to fully capture what's going on. You know burnout ultimately is a kind of it comes from the language of industry, right? You need resiliency to be tanked up enough to be able to go back to the system that's burning you out. It's a it's a machine based vision of the human person, a work-based vision. And I can say more about that but I won't I'll I'll pause.

Building Community For Weary Clinicians

Dr. H 34:08

Well well Brewer, you know, having been in healthcare forever you know uh I see that a lot of healthcare practitioners build walls or they toughen up so to speak and they have leathered skin because as you know when you deal with deaf dying pain and suffering on a daily basis it's hard not to get burned out. It's hard not to let each and every one of those patients and their families get to you. So we collectively as healthcare providers sometimes have to build a wall to our emotions to where seemingly we don't get connected. We are connected but on the exterior sometimes we're not showing it and we push it deep down inside I mean what do you say to that?

Brewer 34:51

I think there's well lots lots of thoughts come to mind there's competing data on this like I've read multiple studies that suggest that people that are for example more engaged are more likely to burn out. Whereas I've also read studies that would say that the person who has thickened their skin actually is more likely to burn out because they have not they they have not been freed to practice emotional flow you might say throughout the day and just respond properly to the things in front of them.

Dr. H 35:20

Oh I I like that that's great. I I appreciate that because that I I I share that with my students quite a lot that I I I often give the uh example of when I first had to tell a patient's family member that we had lost their significant other. And I wasn't prepared to do that. I was a nurse in a level one trauma center I remember walking in to tell this poor lady that we'd lost her husband and she just jumped up started crying wrapped her arms around me at that point in my life I was young I was a new nurse I didn't know what to do I was like a robot. I I didn't serve her well. I my emotions were trapped inside me and and I didn't know how to cry I didn't know how to console. I didn't know how to comfort I didn't know how to hold no one had prepared me for that. So I I I try to share my stories with my students because I know that every one of them are so fearful how am how am I going to respond? What am I going to do? You know there's no classes there's no right or wrong and I I tell them each of you in your own way are going to have to learn how to do it. But here's how here's how unfortunately I was not able to respond hopefully you know God bless at that early age they've they've not had a lot of pain and suffering death and dying in their lives they all want to ask the question but they're so fearful to ask the question. And Brewer how do you how do you prepare? I mean I know we talked about how do you how do you deal with someone that's that's got a terminal disease but how do you actually prepare someone for that how would you counsel an up and coming healthcare provider on how to best prepare for that potential situation.

Burnout, Moral Injury, And Lost Story

Brewer 36:56

I think I would well thank you for first of all for the story. That's a beautiful story. We need more stories like that to my point that people we just need more stories that capture a sense of what can happen. I think I would start with actually a word you just used with which is not meant to not not meant to be scrupulous about it but do you see yourself this is what I would say to a training a medical trainee or a learner do you see yourself as a provider who is whose job is fundamentally going to be to pro to provide a product to a healthcare consumer insofar as it is legally available sincerely sought by the patient and insofar as you are ultimately a gatekeeper of healthcare goods and services is that your vision of what's going on here? If that's your vision of what's going on here, it'll be very hard to practice what you're talking about. If you see yourself as as on the other hand a moral practitioner as as a practitioner of this healing art that's been handed down and changed for centuries that has always had this relationship with calling that has fundamentally changed even the kind of base assumptions we have as a society for example that sick people deserve care regardless of their ability to pay that suffering children should never be abandoned ever. And these are profound ethical assumptions that we often take for granted. If you see yourself as operating on that plane in which you are uh bearing with and witnessing wounds and sitting with suffering people then the kinds of stories you're talking about Dr. Hickey will be critical for all of us to hear and to share with each other and to learn ways of what Stanley Harwass calls suffering presence with suffering people. I'll share I mean some of the most profound moments in my my career as short as it's been so far I've only been out of residency for a little over three years. But some of the most beautiful moments of my practice have been the times in which tears were shared. And I do not sincerely do not think that was quote unquote crossing some line or not maintaining some kind of professional boundary or a failure of grit.

Dr. H 39:11

In fact I actually think it requires a kind of grit to enter into those spaces and be willing to practice tears you might say but without exception patients find that to be a moving form of accompaniment and solidarity well I I appreciate you also bringing bringing that up because that is another topic that that I address with my students is is crying. You know I've had so many students ask me before is it okay to cry? And it's interesting on one of my earlier podcasts I interviewed one of my my students Maddie who is in her gap yeah right now and she shared that one on one of her service learning trips they did reflection in the evening and they went around the room and a couple of students shared some very tearful stories and all of the young ladies that were in the room cried and they had a couple of males with them and they cried and she said that was so unusual to see that but she was so happy to see it also. And you know I bring that topic up in in my class quite frequently that in the beginning I did not know how to cry. I did not know it was acceptable. I did not know how the family would receive that but as I grew into my profession as I grew into nursing and and caring for people I found as you shared that it was such a joyous moment that I felt like I was part of the family and the family appreciated that. And I think it's it's genuine from the heart when you open yourself up and you can allow yourself to cry and to experience that and and that's such a a genuine joy that I think so few people have experienced because we bottle it up and we keep it inside yeah I I agree I agree. Yeah Brewer going back jumping back just a few years to Belize do you do you think or do you recall of anything on that trip that has affected you in your daily practice as you practice now in in your in your family is can you can you connect the dots so to speak maybe maybe not a specific situation but but a general theme from something you experienced there that that has has helped and changed you informed you and into the practicing physician that you are today.

Emotional Presence, Tears, And Boundaries

Brewer 41:28

I think so to to be transparent I I don't know that I would have been able to say this in response to that question without actually opening up that journal and just kind of flipping through it. But but I had the same I had the same question for myself. I was like here I am being invited to walk down memory lane with Dr.

Dr. H 41:46

Hickey who who I mean you know you made so much of my life and so and this is a 13 year old document right so it's sort of fascinating to open it and a lot of it's overwrought and kind of embarrassing to read really but I had the same for our listeners what well I was going to say Brewer for our listeners just be just well just before we jumped on uh it's a zoom video but it's going to be an audio podcast and and and I uh I shared with Brewer that that one of my earlier podcast interviewees Katie who was actually on the same trip with Brewer made my day by showing me her her two journals that she journaled in and when I brought that up to Brewer just before we we went live he pulled his journal out. So it really it really warmed my heart that here we are 13 plus years later and and and that journalist still there to reflect on. So that that's what he's talking about.

Brewer 42:35

But I'm sorry go ahead no no I'm glad you gave that that framing i i j just to say like I'll say three things the the breadcrumbs if you will connecting the dots I think just how how important it is to pay attention I found that fascinating in the journal the art of attention and it gives a completely new definition to the to the at least from the medical side of things that the physician is attending you know it's not not merely one who shows up on rounds but has mastered an art of attention which in Latin means to to reach or stretch out towards. And then discernment of calling and communion with other people in community to to to your point bringing up Katie it was a delight to see Katie Lucas's name next to your name at the end of my journal basically talking about how critical it is that this whole thing change how we come back and pay attention to our backyard. And so that that you already said that at the beginning of this conversation but it was fascinating to me to see that concluding in the journal of like yes this was beautiful felt like living in a dream in some sense but if it's not changing how you then return back to the work then you know what are we doing here? And how that's the reason I name it that way is because that's not I think often especially in medical circles there's this pressure that you've got to figure it out in yourself alone. Like you've got to go in some cave and determine your calling. But calling's actually discerned in community and and that actually can free you from the pressure to have it like perfectly figured out you know you can field your vocational questions to others and trust the people that have loved and guided you to kind of set you on the right path, which is what you and and friends like Katie did for me in that season. And then I'll say one final connect the dot, which is just this principle of subsidiarity which is fancy jargon for like local love, basically that like the the the question of changing the world begins with the neighbor right next to you and and how you treat them. And that's a huge principle what we do in direct primary care. We're well aware the model is not a panacea it's not going to fix all of healthcare but for those in our city who are crying out for a different form of medicine and for weary clinicians right next door to us it it it is a form of taking our love to the ground if you will right in our own backyard.

Belize Reflections: Attention, Calling, Local Love

Dr. H 44:54

So Bru, I I truly feel blessed to have met you. Oh likewise sorry this is this is so this is so good for my heart and soul to to to see where you're at and and and what you're doing and how you're making a huge difference and I feel very privileged to just have had a little part of of being a part of of you and that that's that's huge for me and it it's so amazing you know 12 13 years later here we are and I mean I'd love to pull a chair up and sit down with you and we could we could talk for hours over a cup of coffee. One thing one thing I want to ask you and I talk a lot about this and and and then I'll I'll go to a final question. How important let me preface this I I spoke to one of my former students Naamick Patel a few days ago on a podcast and he did a lot of work on on physician communications and and the lack thereof and everything from medical charting to to getting at eye level with your patients and and human touch how important is the the human touch aspect of of when you're when you're meeting with a patient for example when I meet with a patient I usually reach out and I just put my hand on their shoulder I touch their arm and I make in my mind I'm making a physical connection because as you know most of the time the patient that's in the hospital setting they really don't want to be there number one they'd rather be home with their family and they feel that they're in a sterile environment how important is that connectivity getting down to their level you know again human touch or eye contact between the healthcare provider and and the patient yeah it's a beautiful question.

Brewer 46:35

Thank you for asking it it's one I I wrestle with a lot because in the hospital I would say I'm very quick to reach out and touch. One of my practices is I'll often kneel I mean literally like put put my knee on the ground and kind of sit in this awkward half seated kneeling posture next to the bed if I can't find a chair. I don't I don't try to do that in some awkward way, but I just think it signals like I'm I'm ready to just kind of stay here and like I'm often below their eye level at that point. So it changes the power dynamic and all that stuff. And I as a Christian frankly I also there's something about the practice of kneeling that that I think signals something sacred is happening here. In the clinic I I wrestle with this a lot I I almost never touch patients I I think because at least in the clinical space I'm often creating a space for the first time for people to share wounds they may have never shared before. And that's actually a profoundly intimate thing already. And so I my my style I suppose but although if I was teaching a resident I would probably still encourage something like this would would be just to be very careful how you then combine someone talking about you know I mean everything a broken marriage to to abuse or something if if they're talking about that the way that you then reach out and touch them could make things much harder for them.

Dr. H 47:59

You know oh totally and I agree that I it's time and place and and understanding of where you're at and you don't want it to be misinterpreted totally true. But but it is good. I mean I appreciate you bringing it up and talking about it because it is something I believe that we all deal with because depending upon depending upon your upbringing I mean some people came from families where they they hugged all the time some people came from families where they shook a hand so you know it it's hard you know to to bring whatever your experience was into the clinical setting and and then try to change things up depending upon the scenario but but it is a good point. I I appreciate that. Brewer one of my one of the people that I interviewed some time ago actually interjected at the very end of the podcast interview favorite books that they've read. So I've I've been asking that question ever since and and I've so it's a wonderful opportunity and and I don't have enough paper or or ink here to write down all the books that you're probably going to recommend. But if if there are some powerful books that have uh guided you in your practice or that you recommend and and there's been some good ones that have you know atul Gwande and some of his books but if there's a few uh two or three that that come to mind I apologize I didn't prepare you for that but you've already mentioned some authors and and other uh topics if you do have a few i i think our listeners would really appreciate it sure uh in and and in particular for a clinical audience is is that the books that listen either or either or I mean you know would would any anything medical related or spiritual related that that you feel our listeners would uh would grow grow from reading sure I mean I'll I'll say I mean I'll I'll just rattle off some that are coming to mind.

Brewer 49:44

I mean I think Paul Kalinithi's When Breath Becomes Air probably probably the most important medical memoir in the last 10 years.

Dr. H 49:50

I mean it's just exquisite yeah definitely one of my favorites and I think that was on my syllabus for my course and again I never I never know if my students are reading those books but again highly highly recommend that book.

Human Touch, Eye Level, And Power Dynamics

Brewer 50:01

Yes yeah one yeah Sheldon Vinokin A Severe Mercy this is an exquisite book about every it's one of those books that's kind of about everything beauty death faith God doubt medicine it's kind of all there I've read it seven times I mean it's profoundly shaped my life Severe Mercy Mercy. I think for for someone who's philosophically minded getting at some of these questions that we've talked about Jeffrey Bishop's The Anticipatory Corpse Medicine Power and the care of the dying it's it's one of the most important I think philosophical books written about the practice of medicine the last last 15 years completely changed how I think about how medicine malforms people often and what it might mean to to discover ways of being counterformed if you will or or reformed to care for others, especially in settings like the ICU and then I'll say I mean this is what's popping to mind that my favorite book over the last 12 months has been George Saunders Lincoln in the Bardo. It's a fictional account of the death of Abraham Lincoln's son where the entire story unfolds where basically ghosts in the graveyard that Lincoln's son is buried within sort of debate with each other how to help Willie's ghost who's Lincoln's son move on and not Terry in the graveyard. And it's just an exquisitely tender imaginative way to think about the death of children.

Dr. H 51:37

So I know it's a heavy heavy recommendation to no no no no but but it but it but actually I I really appreciate the the recommendations because you know when when when I first started teaching in the college of nursing one of my one of my students was working in in pediatric oncology and I said to her I said I recall saying how can you work in that environment when when a good number of these young children probably aren't going to see their next birthday and and I I I always recall what she said Dr. Hickey just imagine how much love I can give them in the little time that they have so you know it's a way you know the tears and and the love and and the connections with your spirituality and and knowing what words to say and being there in their presence I mean all of that together is just and this is from a young student. I just she was she was older than her years she was so mature to be able to say that. Just imagine all the love that I can bring. So I think what it boils down to Brewer you know at the end of our conversation is just you know that deep passion and that love for for others you know that if we have that it'll it'll get us through whatever scenario and I think some of the books that you've recommended will probably better prepare us. I mean when breath becomes air huge how do you how do you deal with something like that and and I've read it many times myself and I look forward to reading some of these and and sharing them with with our listeners. And Bru, if there's anything that you can reflect on for those people that are sitting on the fence whether they're pre-med or pre-nursing or PT pharmacy OT that that have an opportunity to do a a service learning medical mission trip like what you did so many years ago what what would you recommend when when they're on the fence? Is this you know when they're scared of going to another country they may have never flown before they're worried about the language or the food or or the culture is there anything that you would recommend and and could you share with them what that experience has has helped you to do in your existing practice?

Brewer 53:39

Sure I I would say if you're on the fence take a step back and discern why why I mean this seems like such an obvious thing to say but but I but I mean it seriously like pass that question to trusted advisors and friends who love you and care about you. Because if that community cares about you and loves you and knows you they're gonna guide you where you're struggling to get off the fence. So who's going on the trip, you know, who's who would be with you that's the first people I'd talk to with that question. And then just to say you you have no idea how these trips can become load stars in your story and might crack open possibilities of vocation and possibilities of virtue that might not otherwise have been there. They might hold some tensions like the medical tourism thing we mentioned earlier. But even that might equip you to see things you had not seen before and to maybe reform the very practice of international service learning or short term missions to be more faithful to the communities that we serve. And so that's what I'd say.

Books On Suffering, Death, And Meaning

Dr. H 54:49

Well bro I appreciate that you know one one thing one last thing bro I keep saying last thing but one last thing is I I kind of struggle a little bit myself with with legacy you know when when I wrote my when I wrote with my Seven Summits book you know my chapters weren't one two three and four they were balance wellness potential success and and and the last chapter being legacy and and I I I you know at at the age of 70 you know maybe on the downhill slide a little bit but but I reflect on life a lot more obviously now than than maybe 10 or 15 years ago and and I kind of struggle personally with the legacy part in that have I done enough you know what more can I do? And and you know and at the end of the day I I know you don't think about it when you're younger or even at your age but but when you're older I I don't know if it's if if it's common I mean because you you may have an older population but I kind of struggle myself and and I I try to continually put myself out there but how much is enough and and and when do you settle on what you've done and and I mean I'm not doing it for the recognition but but but I I I continually see a need excuse me in my case I continually see a need for mentoring and I still today in retirement mentor a lot of healthcare focused students. How do you address Legacy?

Brewer 56:10

Yeah well first of all Dr. Ike I think you are a you know you're you're you're a nurse not only of patients but but a nurse of folks discerning their vocation right and that's a great gift and and as I see it just a part of the gift of who you are who you've been to me and who clearly you continue to be it just kind of pours out of you. So your your legacy is easily traced by all sorts of folks who I suspect are going to pop up on this podcast in spades. I think to the to the larger question you're making me think of my patients I mean when I I sometimes break down when patients are asking the questions you're asking I I like to draw on a sociologist who talks about how, for example, the 30s or the decade of editing for for most people certain life options are going to begin to close down. You can't bear fruit on every branch of your life you're gonna have to make some commitments some places and prune some places back and so forth. It's not that that doesn't stop when you're 50 it's just that in the 30s it's tends to be particularly true. Likewise in the 60s and the 70s I sometimes will talk about the language of harvesting and imparting that the 60s are often not always but often a decade where you are taking in all that you've done and kind of bundling it for preparation in the 70s of now imparting all you've done. Kind of summarizing you know writing the sequel to seven summits I don't know what it would look like for you. And and then the 80s and 90s are I I like the language of of savoring and preparing. I'm getting this from John Tyson by the way if folks are curious but the the 80s are a time in which you can uh savor all that life's brought and then the 90s almost again not always but almost without exception are preparing to die well. And again these decades some people of course are thinking about preparing to die well in the in their 70s or even their 60s so so I don't mean to be strict with the the numbers but you see the point I'm making.

Dr. H 58:13

I think later oh that's great. Yeah oh no I I look forward to reading Tyson I mean I I've often wondered that I I think I'm in a good place. I hope I'm in the place where I need to be right now imparting a lot of knowledge and yeah expertise and yet savoring savoring what we've done in life and and and preparing i i think that's that's perfect and and again we don't see enough of that i i wish that was more open i wish more people spoke openly about it i wish more people were were as well prepared and and i appreci i appreciate that that you send you one thing you mentioned was a gift one of the people i interviewed uh earlier was blake and blake's doing his emergency room residency he said how wonderful it is in healthcare that we have this gift we have a gift in healthcare to make a difference in people's lives to get up every single day and know that we're going to make a difference in people's lives and I thought how refreshing to hear that because you know I've I've often shared and I have a lot of hickeisms but I've often shared that I want all of my students to have two things in life and it's two things that I have number one I love what I do number two I know I'm making a difference. If you can find your future career path your future profession where you love what you do and you're knowing you're making a difference you you've made it because if you look around you there's way too many people that greatly dislike their job greatly dislike going to work but but I think in healthcare you know we have this wonderful gift as as as Blake shared with us and and you've mentioned that gift also.

Why Go Abroad: Discernment And Formation

Brewer 59:47

Yeah I love that language of gift I I yeah one of my one of my professors Ellen Davis she she says that the op the the the alternative approach to life to carpe diem is is Not seize the day, it's receive the gift. That that that's a different disposition to life, an open-handed reception of all of life as a gift, and to realize that, especially in medicine, what a yeah, what a profound privilege. And we need more stories that capture that. And sometimes I tell what if I'm counseling, for example, teenagers or kind of folks on the cusp of college, or or stepping back into the shoes of where I was 13 years ago, I'll I'll often draw on Frederick Bugner, which parallels exactly what you just said and the in the two things you shared, I think, of where does your deep passion, your your deep joy and longing meet meet the world's deep need? You know, where where do you see wounds that are crying out for healers? And and where does your deep gifting and talents align with those wounds? And if I if I may, just maybe offer one final thought that's that's come to mind is I I I do think that's part of what I perceive in medical training today, is that for some reason this image of at least when I don't think this is necessarily true of nursing, I I don't see that at all, but in terms of MDs, this image of the physician as a someone of high social prestige, who will have a lucrative and stable career, who's good at science and and has a sense of wanting to help people, those are all fine things, but those are external goods to the practice of medicine. They're not internal to the practice versus the kind of the kind of student who says, you know what, I really just want to tell the truth as much as possible about what I see. I'm willing to work really hard doing something that may not often be thanked in the ways that I might expect. And when I see suffering people, I want to I want to enter into that space and and and make that suffering, um, help help that suffering to cease or at least be present to it. That's that's what I'm often looking for when medical trainees or or folks interested in medicine ask me if they should do it. I try to probe the extent to which they actually want to be around suffering people, the extent to which they can work really hard at doing something that's not always rewarded, the extent to which they can tell the truth. But I'm not so much as interested in the the numbers and the social prestige stuff.

Dr. H 1:02:20

That's so thank you for sharing everything today, Brewer. Thank you for the gift that you've given me, the gift of friendship and and the gift of knowing that we have wonderful individuals like you that are making a huge difference on on the lives of others. So again, very blessed to to know you and and very excited for you and and where you're going in the future.

Brewer 1:02:41

Thank you, Dr. I. It's it's been a gift to sit with you and and I I I really there's no flattery in this. I mean, we we stand on the shoulders of those who formed us, and you you are among that group that has formed me. So thank you.

Dr. H 1:02:57

Well, that's it's a it's a true honor to have been a role in in my students' lives. And you know, I've been so blessed to be able to travel with my students and to make a deep connection when we're working shoulder to shoulder. It's that experiential education that's so integral, I think, to our success. I mean, I can teach culture in the classroom, I can teach language, I can teach a lot of things. I can tell you how to hold a person, but until you actually get there and do that, you're never going to really understand. So again, very, very blessed to have shared that with you and thank you again. Yeah, thank you. I want to sincerely thank our guest Brewer for his willingness to join us today on the International Service Learning Experiential Medical Education Podcast. But most importantly, I want to thank Brewer for the passion that he has shared with us, specific to his own unique journey in healthcare. As a doctor engaged in clinical practice, Brewer has already touched many lives. And due to his extensive training in theology, he's been able to create even more positive outcomes for patients and their families.