Beyond Dispensing: A Palliative Care Pharmacist’s Experience With Integrated Spiritual Training

A whirlpool of thoughts

On a crisp October morning, I walked across a university campus and thought, what am I doing here? I was heading to a 2-day train-the-trainer interprofessional spiritual care educational session.¹ I was the lone pharmacist among chaplains, physicians, nurses, social workers, and administrators.

A storm in the soul

Days prior to arriving on campus, I reflected on my spirituality. As a child growing up in central Vietnam, I was exposed to Pure Land Buddhism, a branch of Buddhism that focuses on rebirth into the spiritual realm through chanting, faith, and compassion. Otherwise, I have not delved deeply into my spirituality. I was unsettled about coming to this training because I am not a spiritual person, nor do I have any deep understanding of any specific spiritual teaching. However, witnessing the profound and complex journey of patients with cancer offered a new perspective. These individuals endure prolonged suffering from their disease and treatments and require a whole-person approach to their care. This insight affirmed my purpose, which was further supported by a fellow chaplain and the leaders of our palliative care program, who encouraged me to attend this external training.

A raindrop of truth

On day 1 of the training, I was attracted to the presented material. It reviewed the role of spirituality, developing communication strategy and assessment skills, practicing compassionate presence, and recognizing clinicians’ spirituality as an integral component of professional development. It satisfied my science-oriented mindset. I often described this opportunity to others by saying, “I felt like a kid in a candy store,” realizing how much I had to learn and cherishing the new knowledge. It facilitates integration of care that unites physical health with psychosocial and spiritual dimensions to attend to the whole needs of patients.

On day 2, we shifted from intellectual conception to making human connections and contemplation. As innovative ideas flowed freely, enriching the mind and soul, the experience simultaneously deepened the capacity for reflection and meditation. The mind became like a still pool for introspection, prompting a question of why this type of information was not encountered before, either personally or during clinical trainings.

Before heading home, I approached the faculty chaplain and asked how I could be a trainer if I were not a spiritual person. He responded that merely asking this question showed I was on the right path forward. I was encouraged by his response, but I did not fully understand its significance. I knew that to be an effective trainer, one needed a personal grounding in what one believes before sharing with others. Even so, I left the program eager to develop new skills and share with colleagues what I had learned.

Go with the flow

I returned to my clinical duties, caring for patients with cancer and rounding at the bedside with other palliative team members. A deep and profound connection with these patients was surprisingly found. It became clear that their needs are far more extensive than for other illnesses. Cancer is a complex collection of diseases with numerous life-altering ramifications. The intense range of emotions and acute-on-chronic distress from the disease and anticancer treatments continues even after remission. By applying new assessment skills, learning to gain insight into patients' needs, whether medication-related or not, led to a deepened understanding of comprehensive care.

Medications can alleviate suffering and improve quality of life. Morphine is an essential medication in palliative medicine. The appropriate use of morphine can lead to miraculous improvements in patients' physical comfort and emotional well-being, although the administration of morphine can be associated with potential adverse effects, including constipation, nausea and vomiting, sedation, pruritus, and the increased risk of physiological and psychological dependence. Pharmacists can counsel and facilitate management through supportive care, dose adjustments, medication rotation, or addition of another medication to alleviate the effect. Through close monitoring and proactive management, we can ensure optimal patient experience and treatment adherence.

All medications involve trade-offs, a reality particularly stark in oncology. Chemotherapy, for instance, not only targets malignant cells but also damages healthy ones, causing a range of unique adverse effects. Both the disease and its treatment can inflict lasting harm, including cognitive changes, cardiotoxicity, pulmonary fibrosis, peripheral neuropathy, chronic pain, and infertility, all of which demand extensive and ongoing support.

In clinical practice, we routinely ask patients to accept these potential risks and limitations. Effective medicine requires more than just weighing risks vs benefits. It demands an evidence-based and individualized approach that honors each patient's needs, values, and preferences. This holistic practice recognizes the deep interconnectivity of the body and mind. Psychosocial and spiritual factors can profoundly influence physical health, just as a physical illness can lead to spiritual distress and psychosocial challenges. This existence prompts a crucial question: What approaches can be clinically relevant, minimize adverse reactions, and offer synergistic outcomes?

A rising tide

My formal education focused on all things related to medication and physical health. Professionally, I knew how to serve as a faithful member of the hierarchical medical system. Initially, I believed that managing the physical symptoms with medications would allow other clinicians to address psychosocial and spiritual well-being.

Now, more than ever, I know I am more than just a medication manager.² I am capable of learning new knowledge and developing skills to care for the whole being. I should not limit my abilities within the traditional scope of being a pharmacist. The transition from swimming within a designated lane to navigating the open waters has, at times, invited self-doubt and professional skepticism. Nevertheless, the discovery of the ability to impact patients and caregivers genuinely and collectively beyond medication has been deeply liberating.

A river flowing into the ocean

Weeks and months later, I experienced a gradual shift in perspective when I realized the impacts of incorporating these spiritual skills into my daily practice. Two decades of education, experience, and aspirations in optimizing medication management—previously the sum total of my professional identity—now felt like a limited current within the broader flow of patient care. This recognition, in which innovative ideas surged forth and enriched my being, also brought a period of intense contemplation. I pondered my identity as a pharmacist when medication was no longer the primary focus.

Rising from the deep

A desperate and unexpected yearning for inner harmony prompted seeking shamanic coaching and spiritual guidance. My deepest desire was to cultivate a profound sense of belonging and to forge a harmonious connection with my human condition. My spiritual guide, an initiate in the ancient wisdom of the Inca Medicine Wheel, offered a profound framework for self-understanding and for harmonizing with both nature and spirit.

This process unfolded as an unforgettable experience, initiating and concluding with uncontrollable tears, yet yielding the most gratifying release of lifelong hidden burdens. Under the mentor's guidance, a powerful journey of self-discovery was embarked upon, exploring distance travel, unleashing innate strength, and learning to attune to higher wisdom. Through this journey, the various facets of my being have been integrated, confidently embracing life's changes and opportunities.

A sea of possibilities

For certain, I am not the same person I was on that October morning. Through the ebb and flow of my personal and professional life, I have navigated various currents and tides, always moving forward. This training has not only provided me with a wellspring of inspiration but also prompts reflection on my past, present, and future, activating a renewal in lifelong learning and curiosity that extends beyond medications and spiritual care. I realized that we could either adhere to disciplinary stereotypes or open the floodgates of our empathy to learn and care across the spectrum of patient needs.

REFERENCES

1. Puchalski CM, Ferrell B, Bauer RW. et al. Interprofessional spiritual care education curriculum. J Pain Symptom Manage. 2024;67(5):E548-E549. doi:10.1016/j.jpainsymman.2024.02.334

2. Bui T. More than just meds: what a palliative care pharmacist learned from the bedside. Pharmacy Times. 2025;7.