I know that some hospitals have chaplains. But quite frankly, I haven’t seen a lot of them in the past few years. And thanks to working as a locums (or travel) physician, I’ve worked in about 38 hospitals. You’d think I’d have seen more of them.
My father, who was a pastor, would sometimes spend a night in the local trauma center as a chaplain. He would be available to those who wanted prayer, counseling, comfort or social assistance.
The last time I tried to find a chaplain I had to ask someone to call someone, who then called someone else, and a pastor came by on Sunday morning before going to do his church service. He spent a little time with the family of the dying, gave the family his phone number and left. It seemed perfunctory, not holy.
The time before that the pastor I called recommended the patient go to a different church than his.
Once, a few years ago, a dying Catholic patient in our ER asked for last rites. The priest on call for the parish refused to come until morning.
Maybe it’s that I’ve worked in smaller hospitals with limited budgets and they can’t afford pastoral programs. Although you’d think that in the rural areas where I work you’d have small church pastors knocking at the door to minister to the sick as volunteer chaplains. (You can’t swing a cat without hitting a preacher in Appalachia.)
I find all of this curious. Although perhaps it’s not surprising. We tend to divide the world into the scientific and the unscientific. On the ledger, hospitals fall squarely in the ‘scientific and technical’ column. Maybe even the church has made that assignation.
Perhaps preachers and priests are uncomfortable with the chaos of flashing lights and beeping monitors, the blood on the floor. Maybe they’ve simply come to believe that such places are the responsibility of social workers and counselors, and that they themselves don’t really belong anymore. Maybe they find the people difficult. I know I do. (I mean, both the staff and the patients of course.) Although that seems like an unlikely excuse. I’ve been in church my entire life. Church people are sometimes more difficult to handle than anybody else.
I know they’re out there, A good friend of ours was a hospital chaplain at Mayo. She has retired but was passionate about her work and her patients/parishoners. Maybe I’m just not paying attention and chaplains are everywhere. Maybe I miss them because it feels like all I do is look at a computer screen.
Although it could also be that in the world of medicine, we don’t ensure the availability of chaplains because we’ve become victims of a terrible kind of privilege. Not one of race, gender or nationality, but rather a privilege of hope, capacity and available comfort. It could be that we just don’t think religion is all that important.
These days medical schools talk about the cultural and religious identities of patients. But I fear that far too many physicians identify themselves rather as ‘scientific,’ and as people who have no need of religion, having replaced it handily (so they think) with facts and data.
Religion may seem interesting, but more and more it seems relegated to another column on the ledger above: misinformation. Or should it be ‘mythinformation?’
It’s certainly easy to see why. I mean, obviously religious folks don’t always cover ourselves in glory in our behaviors. The New Atheism took its toll on belief for a while as well. Furthermore, religion is not easily subject to double-blinded, placebo controlled studies. ‘Patients were randomized to Diwali, Ramadan orPassover.’
Also, it’s nearly impossible to dose. ‘Nurse, Mrs. Fletcher needs 50 micrograms of Jesus, stat!’ It’s all very complicated. Some people only respond to Buddha therapy, others require prayers toward Mecca. The list is long. These ancient and mysterious things called religions defy the tidy diagnostic tests and therapies of modern medicine.
But there’s more, I fear. Because many of us who work in healthcare have lives which, to our ancestors, would seem inconceivably rich in both health and goods. We have access to medicine, we have homes, we can afford therapists, we can feed our children. When we are struggling we have a bit of money for crisis (or at least access to credit…yeah, we’re bad with money). And now and then we can just get away for vacations, engage in hobbies or can afford a Chihuahua-Mastif-Doodle to comfort us. (If you have one, please send photos…)
I think this may be one reason why we can so easily say things like ‘there’s no need for religion. Just live your best life now!’ However, for a lot of our patients, this life is not going to be much of a best life at all. Not now. Not ever. And neither science, nor social progress nor economic advancement will be much comfort to them.
In hospitals we see the gravely injured who may not survive surgery. Or those injured who may find themselves permanently paralyzed. We care for lonely widows, the abused seniors, the broken women and children, the depressed and trapped men, the unbelievably poor families who cannot ‘rise up’ from their circumstances. Their bootstraps just aren’t ever going to be long enough.
In hospitals we care for the mentally ill who are trapped in asylums of their own minds. We resuscitate the addicted who overdose and die, and rise again, over and over and over until one day the stone is not rolled away by Narcan.
In our clinics, nursing facilities and ERs we see those with brain injury who can never move beyond their beds, or those with diseases like cerebral palsy whose minds are crystal clear but who are betrayed by contracted, weak bodies.
So what many of these people need, and desire, is a chaplain. Well,that’s not really true. They want actually what a chaplain represents. This life will not necessarily offer a lot of comfort for them. But the hope that their suffering has purpose? The desperate need to be forgiven for their haunting mistakes? The belief that a creator God of whatever tradition loves them and will offer them another chance at existence? The knowledge that they can still be of service, in whatever small or large way? The assurance that even in their broken state they have intrinsic value? That’s better than a Z-pack or a shot of steroid any day of the week.
Simply the comfort of words they consider holy, and the belief that they can close their eyes and pray, whether in anger or joy, in hope or hopelessness, in supplication for self or others, can be of enormous comfort. Especially to those who lack the delights that our modern age can offer to the ‘privileged’ who have things, and health and hope.
And the other hard truth is that even those of us who have temporal delights, who have work and money, health and friends, who can do and go, even we have wounds and struggles that require more than the comforts of prosperity. Physicians have quite high suicide rates. Furthermore, we get sick and injured, addicted and terminally ill like everyone else. Science and success rarely offer the ultimate hope we think they do. It only seems like they do when we’re very young and vibrant. We need the transcendent just as much as our patients; it’s sometimes just harder for us to admit it.
None of this means, of course, that we abandon science. That we stop making social progress. That we cease to advocate for those hurting and lonely. Our religions generally tell us not only to believe but to do. But it does mean that comfort and hope come in many flavors, and that they don’t have to taste like prescription medications.
I’d love to see more chaplains, for a variety of reasons. They can help patients get into social programs. They can just sit and hold the hands of the frightened. Sometimes they bring fried chicken….the list is long.
But most of all I’d just like for us, as physicians and medical educators, to remember how important it is that we offer people the best we can. And to acknowledge that rejecting the relevance of faith and resting in the (dubious) comforts of modern ease can be a remarkable exertion of privilege.
Sometimes it isn’t a surgery or a drug that gives our patients healing. It’s the very real power and hope of religious faith that gets them through the long days and longer years of difficult lives.
Thanks for writing this. I'm a hospital chaplain and write about my work in my substack publication - https://journeyingalongside.substack.com/
I lead the Spiritual Care department at a large, Level 1 Trauma Center as well as run training programs for chaplain interns/residents and teach spirituality and religion in our medical school.
I could go on for paragraphs about the lack of resources and professionalism in the field of professional chaplaincy. I am sure the rural hospitals ran into a lack of funding, as that is true for so many places and not seeing spiritual support as a regulatory requirement - which it is - not just a "nice thing to have." It also gets into problems when we use volunteers (most of whom are untrained) to do a job. We would never expect nurses or social workers to volunteer their time.
Thank you for being an advocate for the importance of chaplaincy. There are more research studies being done about the impact of spiritual care on clinical outcomes, which I find encouraging and can point you in that direction if you'd like to learn more.
Thank you for this excellent post Dr. Leap. And thank you for your work Christine. As a former nurse as well as a patient I can attest to the importance of spiritual care practice.