This new resource for clergy, lay leaders, and health care providers will help them address end-of-life care in congregations, says director Richard Payne, a physician with many years experience caring for terminally ill patients.

How We Die in America
Eleanor Clift and Richard Payne discuss issues surrounding how we die in America.

“The model that Ray is creating and the toolkit we’ve developed for congregations make a powerful combination,” Payne says. “We’re giving children and families a better opportunity to find the support they need from the church, as well as from medical practitioners.”

An associate professor of pediatrics and Christian philosophy, Barfield grew up wanting to become a doctor. But in college, he discovered philosophy and literature and decided to become a philosopher/novelist.

Jon Gardiner/Duke Photography
Ray Barfield examines a cancer patient at Duke Children’s Hospital. Doctors must learn to be truly present with patients during short visits and despite the hectic hospital schedule, Barfield says.

He deferred graduate study in philosophy at Columbia University for a year of travel in Europe with a backpack full of books and his guitar.

“During that time I occasionally stayed with the father of a friend — a professor of obstetrics and gynecology in Tübingen, Germany,” says Barfield. “Those encounters reintroduced me to the thrill of medicine.”

During a six-week stay on a Greek island in the Aegean Sea, he decided to do both medicine and philosophy, starting with medicine.

“Now I practice medicine on one side of Duke’s campus, do Christian philosophy on the other side, and scribble novels secretly from 5 to 7 a.m. at home.”

Barfield began his work at Duke last semester with a flurry of one-on-one meetings across the university. In six weeks he sat down with more than 40 doctors, professors, nurses, administrators, chaplains, and others whose work intersects with the care of chronically or terminally ill children.

His goal was simultaneously simple and profound: to sow the seeds for a culture of care that focuses on the whole child rather than simply attacking disease.

“Physicians are devoted, committed, good people,” Barfield says. “But often they haven’t been given the tools to think about whole people.”

This manifests in many ways, he says. Sometimes children are given treatments without enough, or any, attention to relieving their pain. Overwhelmed by a huge number of patients, doctors may visit a child’s hospital room without really being present with the patient and family. And both physicians and parents often fail to see when a different kind of care, such as hospice, is needed.

“We become myopic in the hospital,” he says. “We think in terms of treating organ systems instead of how people experience illness. The way you achieve a good end of life is thinking about how to live well.”

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