Yesterday, I stubbed my toe on an IV pole. Though not uncommon for someone working in a hospital like myself, this particular IV pole was located not in a cancer ward, but in a synagogue—the synagogue that is part of our hospital.

While living in the US, I expected church to be separate from state. Most US citizens regard religious liberty as a core value guaranteed by their country’s Constitution. Although in practice that may not always be the case, conceptually, this is the American way.

When I moved from Philadelphia to Tel Aviv 19 years ago, however, I realized things were different. As there is no separation of church—er, synagogue—and state in the deeply Jewish nation of Israel, I’ve since given up the inviolable principle of religious liberty. Today, I reside in a country where religion is inserted into government as well as life in general: Buses don’t run here on Saturdays because it’s the Jewish Sabbath, prime minister Netanyahu dines with president Obama exclusively at kosher restaurants, and every one of Israel’s hospitals (each an extension of the ministry of health) contains a synagogue.

I was initially surprised the synagogue in my hospital was not a source of protest for local residents. After all, could you imagine an urban medical center in the US hosting discussions about candle-lighting times for the upcoming Sabbath? Secular Israelis, however, seem to have a live-and-let-live attitude about that sort of thing.

For me, a practicing Orthodox Jew, it is convenient to worship where I work.

But I quickly acclimated to this new way of doing things. For me, a practicing Orthodox Jew, it is actually quite convenient to worship where I work. Orthodox Jews pray thrice daily, so a busy physician would never be able to participate in services if not for this geographical expedience. What’s more, seeing IV poles, blood-tinged urine bags sticking out of institutional pajamas, and—oy—little kids wearing neurosurgical headgear helps me upgrade my prayers to a higher level of meaning.

Don’t get me wrong—I’m not advocating schadenfreude. But if we’re being honest, prayer has a way of becoming formulaic, if not perfunctory. But when I see others in need, there is a clear spiritual goal that I can keep in mind. As I sidestep a wheelchair that blocks the aisle between the pews, I no longer clench my teeth in frustration but rather chant one of the psalms designed to alleviate the suffering of others.

When I obtain permission from a patient prior to prescribing a course of radiotherapy, I must document three of their identifying features on their consent form: the patient’s name, their social-security-number equivalent, and their father’s name. This prevents mistreatment, lest there be two Irving Finkelsteins running around in my department.

I, however, also request my patients provide me with their mother’s name. I explain that I would like to offer up a special prayer on behalf of the patient—the Misheberach—which is a benediction that requires inserting the mother’s name. I emphasize that this is purely optional, and they will experience the same medical treatment regardless. Indeed, when I spoke to the ethics committee at my hospital, they didn’t deem my request as “coercive”—a dreaded label in modern medicine—because of my reassurance to patients that the question has no impact on their treatment.

An occasional patient has muttered, “Doc, it must be really bad if you have to pray.”

An occasional patient has muttered, “Doc, it must be really bad if you have to pray,” and one or two have questioned my technical competence if I need to pray. But since coming here, I have treated more than 3,000 patients with a variety of tumors and a diversity of religious backgrounds, and to date, not one has declined to provide their mother’s name for use in my prayers.

Perhaps this is a manifestation of the old saying about why there are no atheists in foxholes; maybe when face to face with their own mortality, all patients hope for good news from some higher power, even if it isn’t their own. Or maybe it represents a safety net in the spirit of Pascal’s Wager—better to assist your doctor in praying for you than to find out at the pearly gates that you should have. I’m OK with all of those reasons, as long as no patient feels like rejecting my overtures might result in an excessive radiation dose as payback.

But my patients, I sense, are more insightful and open-minded than that. I think they see the value in letting me feel that I’m doing everything in my power to help them. I think they appreciate knowing that our medical staff is willing to expand its therapeutic horizons—even with unconventional measures—on their behalf.

Within myself, though, am I being inconsistent? I support the concept of religious freedom, yet I ask my patients to let me pray for them. Thomas Jefferson, with his “wall of separation between church and state” would certainly object. Or would he?

Jefferson appreciated the Bible’s divine wisdom. However, he advocated for separation of church and state because he believed that negatively biased, human interpretation could be found interspersed among those divine teachings. He therefore sought to keep the two separate. In praying for my patients I am drawing on that divine force and requesting that they trust my motives. While I can’t justifiably pursue that in a country like the US, in Israel I don’t feel guilty about doing something that does not defy the laws of the land and also seems to be mutually beneficial.

But then, it’s a different culture. Separation of church and the United States may serve its purpose. Here, my blurring of the lines produces what I believe to be positive results; it helps me to keep my mind focused on doing good for my patients and, I think, consoles even the non-believers whom I serve.

That is not to say that the Jeffersonian Democrat in me isn’t slightly troubled by the absence of religious liberty in the country that I now call home. But perhaps one size does not, in every circumstance, fit all. By juxtaposing values of church and state, I continue to discover new insights about patients, physicians, and the delicate dynamics between them.