Spiritual conflicts and concerns often accompany serious illness, but many family physicians are slow to recognize these concerns or unsure how to address them. The case of a patient with spinal cord injury and who later developed an astrocytoma is used to illustrate a team approach that involved a family physician, a spiritual counselor, and a psychologist. Narrative writing exercises in which the patient was encouraged to tell his own story also played a role in treatment. We present a case report demonstrating the role of a spiritual counselor as an integrated member of the team caring for the patient and the benefits from explicit attention to the spiritual dimension in the care of this patient. Our report differs from most academic presentations because the patient himself (JC) is a co-author and provides a firstperson account of this experience. To better represent the realities of practice, the next 3 sections of this article represent 3 different voices-first, the voice of the physician as modulated through the medical record; second, the voice of the patient; and third, the voice of the spiritual counselor. (The psychologist caring for JC was invited to contribute to the discussion also but elected not to do so.) Medical Case ReportJC was 35 when he first presented to HB at the Family Practice Center. At age 16, he had been struck by a car while riding a bicycle, sustaining fracture and dislocation of T3 through T5 with transverse myelitis. He also suffered from severe facial lacerations that required enucleation of the left eye and extensive repair of the forehead; a pneumothorax; and 4 broken ribs. During hospitalization lasting more than 3 months, he underwent laminectomy, tracheostomy, and insertion of a suprapubic catheter. He suffered residual ptosis of the right eyelid. Stage IV pressure sores developed that were surgically revised 6 months after initial hospitalization. He was discharged from rehabilitation with what the record described as "excellent mental status."At the time he sought care from Family Practice, JC was working as promotions director for a local TV station and living with his wife and two adopted children. He was seeing a urologist at a referral center for ongoing bladder management. Initial care was directed at diet and exercise management of obesity related to his wheelchair confinement.Six months later, JC was hospitalized for 12 days for urosepsis. The hospital course was complicated by emotional distress and lability, explained by the patient as being related to flashbacks to his spinal cord rehabilitation experiences. After hospital discharge, the patient continued to function well socially and emotionally, and mental health care was not initiated.
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