Excellent Excerpts: Nursing the Spirit by Don Grant

Welcome to our series, “Excellent Excerpts,” where we share selections from recently or soon-to-be published books we think you should check out! In this post we are featuring Nursing the Spirit: Care, Public Life, and the Dignity of Vulnerable Strangers by Don Grant, published May 2023 with Columbia University Press. You can learn more about Don in our interview series here.


Don Grant investigates the subtle ways that nurses at an academic medical center incorporate spirituality into their care work. Based on extensive fieldwork and an in-depth survey on spirituality, this book finds that many nurses see themselves as responsible for not only patients’ physical health but also their spiritual well-being. They believe they are able to reconcile science and spirituality through storytelling and claim that they can provide more spiritual care than chaplains. However, nurses rarely talk about religion among themselves because they are concerned that their colleagues are uncomfortable discussing spirituality. Nevertheless, by seeking to honor patients’ ultimate worth as human beings, many nurses are able to instantiate spiritual values of care.

From the Introduction Nursing the Spirit

For most of human history, care was restricted to family and friends.  It was not until the Axial Age (800-200 B.C.E) that communities first began to recognize all humans, including foreigners, immigrants, enemies, and other strangers, as spiritual beings deserving of protection and nurture.  In the years since, however, this fundamental principle of the world religions has increasingly been questioned as societies have modernized and developed care systems grounded in scientific approaches that are indifferent, if not hostile, to the notion that humans possess a transcendent quality.  This book seeks to discern the fate of this principle by investigating how an academic medical center’s nursing staff variously integrates spirituality into its care work.

This book offers a third approach that focuses not on religious authorities or religious individuals, but on the principle of caritas, which is what the Axial ethic is often referred to in the West.  Caritas describes a love, reverence, and care for all people grounded in a belief that every individual has a spiritual dimension of ultimate importance. When we place caritas at the center of our attention, we can see that religion is important in a society when its most vulnerable members are revered through acts of care.

            In developing this approach, I draw heavily on the foremost social theorist of the past century – Max Weber.  Weber was not only the first to argue that the religious principle of caritas was at risk in contemporary society, but in other writings also suggested that five key social mechanisms – authority, language, emotions, actions, and narrative – will determine whether values like caritas “stick” in modern settings.  To determine if this moral principle can still take hold, therefore, I investigate whether nurses assume responsibility for patients’ spiritual care, make spirituality a part of their everyday discourse, feel more authentic when viewing their care in spiritual terms, put spirituality into practice when interacting with patients, and treat spirituality as credible and important in the stories they construct about their work experiences.  To the extent that they do, caritas, as a cultural and social phenomenon, can be said to endure. 

            Determining whether caritas can be transmitted through these mechanisms is especially urgent today.  The rise of despotic leaders, divisive and hateful rhetoric, manufactured outrage over critical race theory, indifference to racialized acts of violence, and diatribes against mask mandates suggest that Axial values about honoring and protecting strangers are being rejected and replaced by virulent forms of parochialism.  Compounding this problem is the development of biotechnologies and radical medical procedures designed to “improve” humanity, ranging from cloning, cryonics, and gene therapy to nanotechnological implants, stem cell research, and organ transplants. These developments encourage us to approach the human being as a set of physical components to be transformed, optimized, and commodified instead of an intrinsically dignified and worthy spiritual whole. On top of this is the climate crisis brought on by society’s continued burning of fossil fuels, which most immediately impacts the poor but ultimately threatens everyone. Indeed, the chief question before us today is, as Erich Fromm once suggested, not whether God is dead but whether the sanctity of humanity, if not humanity itself, will soon be.

I cannot see the doctors, only their shadows beneath the door as they prepare to enter and deliver their decision – a death sentence or permission to go to the next round. I am alone in a room lit by shafts of sun that reveal on the clock opposite me that the time is 6:05 a.m. Stripped down to my socks and underwear, I have been sitting on an aluminum observation table, gripping its edges, and awaiting their arrival.  

When they finally open the door, artificial light precedes them, stretching out into this dusky, holding cell of sorts. I squint as the light crosses my face. It then quickly retreats as they make their entrance and the door swings shut behind them. They momentarily disappear in darkness until my eyes adjust.

I first make out their white lab coats and then their facial features. The youngest of them – interns I presume – are wide-eyed, well-groomed, and scarcely able to conceal their fascination. Clutching folders of printouts, they huddle behind their older superior who I am meeting for the first time. Like so many others I have encountered at this place, he seems to be scrutinizing my mid-riff, as if wanting to ask it questions.

Having undergone extensive blood work and other preliminary tests, I am so exhausted at this point from trying to read others’ faces and guess their assessments that I do not look into his eyes either. I peer instead over his shoulder at the group of interns, annoyed by their curiosity, wondering how they respond when the verdict is bad, as it often is.

But to my surprise, the verdict this time is positive.

At first, I do not clearly hear or comprehend what the group’s leader is saying to me. But as he continues giving me the results of our tests, it becomes obvious that we have passed them all. “Your liver is a match and you are a suitable donor for your father,” he says. “We have scheduled his transplant to begin at midnight.”   

“You mean in just eighteen hours?” I ask.


I am struck by how matter-of-factly he delivers the news. Maybe it is because living donor liver transplants have become commonplace at this center – it now performs over thirty such procedures a year. Or perhaps he is trying to be reassuring.

Whatever the case may be, no sooner am I relieved to hear we qualified to have the transplant than I start to feel unsettled.  It is hard to fathom that a portion of my liver can be cut out and transplanted into my father and what little remains in me will grow back to its original size and shape. I worry that the team’s assessment has not been sufficiently thorough and there are complications they are unwilling to acknowledge and maybe incapable of addressing.  I am only told that I am qualified for the procedure without being informed about the odds that it will work.  I am also told that I will not get to speak with the lead surgeon, Amadeo Marcos, until the day after the procedure. So, I ask his chief assistant, whom the interns are gathered around, what is the most difficult case his team has ever dealt with.

He flashes a grin and replies, “The most difficult involved a transplant recipient with a tattoo of Jesus on his abdomen. He made us swear that we would make Jesus’ face look exactly like it did before the surgery. It took us an extra two hours – twenty hours total – but we did it.” 

I chuckle at the thought of exhausted surgeons having to reset the Son of Man’s disjointed nose, lips, and eyes. I then try to imagine what kind of person on the verge of death could make such a request. Perhaps someone who wanted to make sure his admission stamp to heaven would still be valid. Or who was not religious at all but was just into eternity art. There is no telling. Whatever his motives, there was apparently a sublime quality about the tattoo that he wished to preserve and have forever affixed to his being.

I gather from the surgeon’s comments that with most inked-up patients, the transplant team runs roughshod over tattoos, leaving them disfigured, perhaps beyond recognition. But they made an exception for this person and kept his holy inscription intact. What I do not fully understand, though, is why that would require extra time and effort. Wouldn’t the surgeons want to realign the skin exactly as before, regardless of whether a patient had a tattoo? Wouldn’t they have to for the procedure to be a success? Or are they slapdash butchers racing to process the next slab of meat coming down the conveyer belt? 

I would like to know so much more about what we have gotten ourselves into, but we have run out of time and options. The fact is that I never had much time to ask questions.  Therefore, I have no real idea how the transplantation procedure actually works, let alone what can be done if they botch the transplant or if the graft does not take. Who will help us pick up the pieces? Obviously, not these meat packers, adorned in their white robes. For them, it’s a struggle to just preserve some semblance of the sacred.

I try to stop going further down this rabbit hole by reminding myself how fortunate my dad and I are to qualify for this life-saving operation. It works for a while until the chief assistant and his interns give me one last medical gaze and exit the room. I am now supposed to get dressed and fill out additional paperwork two floors below. But I remain seated on the exam table, staring at the clock.

It dawns on me how foolish my family and I were to let our desperate situation, the fact that my dad is too old to have a reasonable chance of getting a “normal” transplant,  distract us from learning more about the surgery, its mortality rates, and its possible long-term complications. The day before, a medical social worker quizzed me about my mental and emotional preparedness for the procedure. She quipped that she knew of donors who went into hiding after being told their liver was a match. Her remark did not make sense to me then but it begins to now. The ceiling vent above seems to grow louder as I reflect on how my dad and I are probably little more than cash cows to this place, half million cash cows to be more exact. 

I eventually ease myself down from the table and slip into the gown left for me. Tightly holding its rear flaps together, I walk to the exam room door and poke my head out, looking down the corridor for someone, I am not sure, anyone. Several people pass by – a janitor leisurely pushing a mop and bucket, a tech pulling an IV pole with a wobbly rear wheel, and several family members hastily searching for their loved ones’ room numbers.

None of their eyes meet mine until a nurse, rooting in her purse, comes down the hall. She pulls out car keys and a pack of Esse cigarettes as she slows to find out what I am doing. She is the first staff worker today to look me directly in the face. I am taken back by this and uncertain how to begin.

I blurt out, “This is quite a center, isn’t it? I overheard that the new transplant chief, Dr. Marcos, is really ramping up operations.”

“He is ramping things up alright…  Look, I hate to say this, but I am sort of in a hurry. Is there something you need or I can help you with?”

“I am not sure. I guess I wanted to know a little more about the risks involved in a living donor liver transplant. Do you know anything about that? If things go wrong during the operation or afterwards, can anything be done? Should the surgery fail and things fall apart, will there be someone to help us?”

“Sure as hell not Marcos,” she mutters.

Her look quickly softens. “Listen, we will be there with you at every step to make sure you get through this. But if you are having doubts about the operation itself, you probably should consult one of the surgeons because I have to leave right now.”

“That’s okay. I just spoke with one of them, the chief assistant…  Thanks anyway.”

As I withdraw back into the exam room, I catch a glimpse of a white and pink button pinned to her purse. It reads, “Nurses may not be angels, but they are the next best thing.”  Not the warm and fuzzy message I was seeking, but it’s comforting nonetheless in this otherwise sterile environment.

Excerpted from Nursing the Spirit: Care, Public Life, and the Dignity of Vulnerable Strangers by Don Grant. Copyright (c) 2023 Don Grant. Used by arrangement with the Publisher. All rights reserved.

For more information and to purchase the book, click here.