A spiritual treatment?

The doctor said a blood vessel in the nearly unconscious woman's brain had ruptured, filling her skull with blood. In a slow, loud voice he described how the pressure was pushing her brain into the hole at the base of her skull, according to Kathie Culhane-Pera, a St. Paul, Minn., physician who witnessed and took notes on the exchange. The condition, known as a brain stem herniation, would cause a fatal stroke. The only solution was drilling holes in her skull and draining the blood, the neurologist said, his impatience beginning to show.

The family members began debating in their native Southeast Asian language. Her children urged immediate surgery. But in Hmong culture male elders hold authority, and her husband said he would rather let a Hmong priest heal her with chants and prayers.

The real problem, said the husband, was that one of her souls was lost.

"If you take her home, she'll die," the exasperated neurologist shouted. The suffering woman, who requested that her name not be used but who confirmed her experiences through a relative, remained quiet as her husband argued. Then the surgeon, a devout Christian, entered the room. "It is up to this family to connect with its own spiritual needs," he told the group, according to Culhane-Pera. He turned to the father. "If your prayers don't help, I'll be here waiting for you."

Culhane-Pera was certain the woman would die without surgery. In response to the questioning looks, she remained silent. "I felt the decision had to be up to them," she said.

The family left.

Medicine, spirituality and religion have long been intertwined. The Hippocratic oath -- a code of ethics that still guides contemporary physicians -- originally pledged fidelity to Apollo, the Greek god of medicine. In the Middle Ages, priests in monasteries learned about anatomy and the pharmacology of plants. The first hospitals were attached to churches.

But tensions quickly emerged: Clerics were forbidden to perform surgery in 1215. Soon after, priests were ordered to stop accepting payment for medical services, giving rise to a professional class of doctors.

By the early 1800s, British epidemics pitted government scientists who blamed water sources against priests claiming that disease had celestial origins. The struggle came to a head in 1854, when a cholera outbreak ended after government workers dismantled a well.