As William Bell tapped gently on the patient's door, he carried the burden of a day already weighted by an unexpected death. Earlier that morning, when the Hopkins chaplain answered a page, he had found a man in the first moments of grief, grappling with the suddenness of his father's passing.

I don't believe this, the man repeated again and again. Just yesterday he was fine. I phoned all the relatives and told them that he was recovering well. How can I tell them what's happened now?

Bell spent more than an hour with the distressed son, sometimes sharing silence, sometimes offering words of comfort and faith. Now, three pastoral visits later, he was walking into the room of a cancer patient described as "actively dying."

The middle-aged patient, his color gray and breathing labored, lay unresponsive as nearly a dozen family members and friends formed a protective circle around him. Gently placing his hand upon the patient's, Bell said a prayer to prepare him, and his loved ones, for the next stage. Then he turned to the man's wife. Taking her hand, gazing steadily into her tear-filled eyes, he prayed for God's strength and consolation. The mood of the room seemed to lift momentarily like a sigh of relief or gratitude.

During the two years he has spent as a pastoral care resident at Hopkins, the Episcopal priest has also dealt with anxiety, rage, denial, and regret. He has visited those without faith and those who fear God may have abandoned them. His ministry extends to patients' families and loved ones, helping them find ways to cope that correspond to their spiritual beliefs.

“The seeming anonymity of the interaction between chaplain and patient creates a strong intimacy. It’s a very real paradox that anonymity can create momentary intimacy, and that it can be very, very cathartic.”
— Uwe Scharf, director of Hopkins’ Department of Pastoral Care

"My primary purpose is to establish a genuine, empathic, and mutual relationship with a patient," he says. "We try to see where someone is, and engage them there."

It is a new path for Bell, 58, who devoted his earlier career to medicine. Trained as a pathologist, Bell served at a Florida hospital as a physician and administrator until the pain of chronic cervical disc disease forced him to retire in 2002. Now he travels hospital corridors dressed in black clerical garb, carrying a fanny pack with oils for anointing the sick.

Uwe Scharf (top) urges chaplains to nurture their own stories as “wounded healers.”

"It's a privilege to be allowed into intimate situations with patients and their families," he says. "At the minimum, we're offering hospitality and courtesy, but we often get into really deep moments of meaning, or grief, or joy."

Bell is the oldest of six chaplain residents who are currently part of Hopkins' interfaith team of pastoral care. Already possessing graduate theological and divinity degrees, these students work at the hospital full time, improving their ability to minister to the sick through Clinical Pastoral Education (CPE), an accredited national program of "experiential learning" that uses a system similar to medical residency.

"One of our mantras is ‘Follow the patient's lead,'" says Uwe Scharf, 48, director of Hopkins' Department of Pastoral Care and a CPE supervisor. "Because our service is not reimbursed, we have the luxury of lingering."

Scharf says that he and his fellow chaplains are as interested in spirituality as in religious practice. "Our chaplains are happy to talk to someone who says he practices yoga and meditation but doesn't like to go to church."

Some patients are more worried about how their illness is affecting family members than about their own health, Scharf says. In fact, at least half of patients want to discuss other concerns. The chaplain says it can be "tremendously healing" for patients to talk with someone who isn't focused on their illness, even if it's someone they are meeting for the first time.

Claire Matheny (left) looks for creative ways for patients to express their spirituality—“whether through prayer, conversation, or telling their own stories.”

"The seeming anonymity of the interaction between chaplain and patient creates a strong intimacy," he says. "It's a very real paradox that anonymity can create momentary intimacy, and that it can be very, very cathartic."

Sometimes such encounters stand out as turning points. Peggy LeBlanc, who received a bone marrow transplant for multiple myeloma last March, says Chaplain Rhonda Cooper provided a lifeline of perspective.

Two weeks after her transplant, the 44-year-old contracted pneumonia. Weakened by nausea and painful mouth sores, debilitated from a lung biopsy, she plunged into a spiritual "black hole," a state she felt betrayed her Catholic beliefs.

"When I told Rhonda how guilty I was about feeling that way, she just sat with me and listened," LeBlanc recalls. "Then she told me that it was OK, that people go through this, that sometimes you must feel the dark before you see the light. What she said was so important and inspirational to me."

Cooper, 56, is the chaplain at the Sidney Kimmel Comprehensive Cancer Center—an energetic woman whose warm accent reflects her years spent as a United Methodist minister in east Tennessee and southwest Virginia. Today, instead of promoting the Gospel, Cooper offers a form of spiritual sustenance she calls "unconditional positive regard."

"Isn't that quite a phrase?" she laughs. "But it does sum up what I'm charged to bring to patients. We chaplains will do our very best to meet a spiritual need of those in our charge. I know I'm limited; I can't be all things to all people, but when I can make that connection with someone, that's grace."

Second-year pastoral care resident Claire Matheny has focused her work on psychiatric patients.

"I'm very interested in the intersection of spiritual health and mental health," she explains. "On some wards, patients may have ongoing thoughts of suicide and wonder if God is judging them because they want to die. With the elderly, there's a lot of grief and loss, whether it's the loss of a spouse or leaving a home someone has lived in for 50 years. Some may question what their purpose is.

"No matter where I go, I look for creative ways that patients can express their spirituality, whether through prayer, conversation, or telling their own stories."

As a CPE supervisor, Uwe Scharf has found that an important aspect of training is helping chaplains recognize and nurture their own stories as "wounded healers" so that they can relate better to patients.

"We all carry wounds," he says. "Some are psychological and some are spiritual. These can be a point of contact with patients and families. Even though we may not know cancer or a heart attack from direct experience, we know a form of suffering that can lead to an empathic connection."

In group discussions with pastoral care students, he emphasizes one cardinal rule: "You must never say, ‘I know exactly how you feel.' That's about the most distancing and devastating thing a patient can hear. No one knows exactly how someone feels." Instead, chaplains should think of themselves as midwives, helping patients deliver unique stories that may also reveal inner reserves of strength.

"We want to be agents of hope," Scharf says. "Not hope in the cheap sense of optimism or disregarding a devastating diagnosis, but hope in the sense of, ‘What has helped you in previous crises?' Helping patients to connect with their own resources, whether spiritual, religious, or entirely secular, is more helpful than giving them advice."

In medical school, William Bell was dissuaded from specializing in psychiatry because of the exhaustion he often felt after seeing patients. "A psychiatrist said it was because I was being empathic," he recalls. "He said that I shouldn't go into that work unless I could completely objectify the patient."

Now he spends his days building and refining his empathic abilities, gauging patients' well-being through conversation about "The Four F's: Facts, Family/Friends, Faith, and Feeling." "Asking questions as a scientist doesn't get to the feeling part of the patient," he says. "I have to be emotional because the emotional is where the spiritual exists."

“There’s plenty of data suggesting that patients are more religious than their doctors,” says Hopkins oncologist John Fetting, who specializes in treating breast cancer. “These beliefs are as crucial to many of our patients as their marriages and their work. We need to pay attention.”

The chaplain is talking en route to meeting the family of a cancer patient who suddenly required a breathing tube.

"I never thought I'd end up back in the hospital," he says. "Now I'm free to visit patients without any time constraints or the need to do something billable. Listening to them and addressing their emotional and spiritual needs is lovely and extraordinary." After retiring from medicine eight years ago, Bell took theology courses, eventually entering Yale Divinity School. It was during a summer internship at Yale-New Haven Hospital that he discovered his calling. Ordained as an Episcopal priest in 2008, he moved to Baltimore last year with his wife to enter Hopkins' residency program. This fall he began the additional three to five years of training required to become a CPE supervisor.

Although Bell still contends with the chronic pain that ended his medical career, it has also become a key source of his empathy. "When I see someone in pain, I have an intuitive knowledge of that experience," he says. "It's one of the wells of compassion that I'm able to draw from."

Under the care of a doctor from Hopkins' Department of Physical Medicine and Rehabilitation, Bell must sleep in a certain position and limit his work hours as well as the amount of time he spends sitting—a restriction that is particularly challenging. "A lot of this work is sitting with people at the time when they're feeling most helpless," he points out. "You're not necessarily able to do something or fix something. It's a ministry of presence: you're just there."

If he needs a reminder of the importance of his work, Bell can recall the first surgery he underwent to relieve his own painful neck condition. "I was terrified that I was going to die," the chaplain says. "I didn't want to talk to my wife or my parents, I just wanted to talk to the priest.

"When he finally showed up, I crushed his hand and said, ‘Please pray with me.' I wanted that connection with God. I wanted to know that things were all right with my soul, and that the next step, whatever it was, was going to be OK."