Agents of Hope
Through prayer, a compassionate touch, or just "being there," pastoral chaplains across the hospital quietly go about the business of bringing comfort.
Date: October 1, 2010
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.
“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. For some, faith is very important while others may look more to family and friends for meaning and comfort.”
It is a new path for Bell, a 58-year-old who devoted his earlier career to medicine. Trained as a pathologist, Bell served on the staff 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.
“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. (His 2009-2010 colleagues are Joanne Bedford, an African Methodist Episcopal elder from Long Island; Pamela Adams, a nondenominational Christian minister from Fayetteville, N.C.; Claire Matheny, a United Methodist minister from Memphis, Tenn.; Emmanuel Saidi, a Roman Catholic priest from Malawi; and Barbara Thomas-Reddick, a Pentecostal minister from Greenville, Fla.)
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.” Using a system similar to medical residency, students practice bedside ministry while also learning crisis care, bereavement care, and how to facilitate decision making at the end of life. At Hopkins, two supervisor/managers oversee residents as well as part-time interns.
Group processing, the opportunity to reflect and discuss patient and family encounters with peers and supervisors, is the program’s cornerstone. It gives student chaplains deeper self-awareness as well as insight into the needs of those they serve. It can also provide crucial support for situations that seem overwhelming.
In one such biweekly session, second-year resident Claire Matheny recounted a grim situation that occurred when she was called to help a team treating a woman who had been raped and was in a state of shock. The chaplain was momentarily seized by her own horror at such a devastating violation.
“I wasn’t sure how to help someone who was still processing what had happened,” Matheny said. “The patient was trying to figure where she was and what the heck had happened. As part of that team of first responders, I tried to provide balance, to sit and wait with her, and at the same time still be a spiritual voice while others tried to get the information they needed.”
More typically, residents discuss how to sharpen their best tools: open-ended questions and empathic listening.
“One of our mantras is ‘Follow the patient’s lead,’” says Uwe Scharf, the 48-year-old director of Hopkins’ Department of Pastoral Care and a CPE supervisor. “Because our service is not reimbursed, we have the luxury of lingering. We might spend 45 minutes if a patient has additional crises on top of medical ones.”
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 share such thoughts with someone who isn’t focused on their illness, even if it’s someone they are meeting for the first time.
“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 Montgomery County, Md., resident 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 is the chaplain at the Sidney Kimmel Comprehensive Cancer Center—an energetic, upbeat woman whose warm accent reflects her years spent as a United Methodist minister in east Tennessee and southwest Virginia. After undergoing CPE training, she arrived at Hopkins in 2005 ready to serve a different kind of parish. She found a diverse population with different beliefs, different crises, and a universal need to find meaning and purpose, and to reconcile and strengthen their relationships.
Instead of promoting the Gospel, the 56-year-old pastor began offering a form of spiritual sustenance she calls “unconditional positive regard.”
“Isn’t that quite a phrase?” she laughs. “But it does kind of 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 know I can’t be all things to all people, but when I can make that connection with someone, that’s grace.”
Physician John Fetting has found that many of his patients cope with illness more successfully because of the strength they draw from their religious faith. He believes hospital chaplains supply an important dimension of treatment.
“There’s plenty of data suggesting that patients are more religious than their doctors,” notes the Hopkins oncologist who specializes in treating breast cancer. “These beliefs are as crucial to many of our patients as their marriages and their work. They often understand what is happening to them by how their faith asks them to respond. And we need to pay attention.”
In addition to Hopkins’ pastoral care team, a full-time Catholic chaplain, Paul Sparklin, is supported by the Catholic Archdiocese of Baltimore, while the Episcopal Diocese of Maryland funds the CPE residency, which William Bell holds. Rabbi Tsvi Schur of Baltimore visits regularly. Patients can request to see chaplains in such faiths as Buddhist, Muslim, and Jehovah’s Witness.
During the past decade, Hopkins Hospital has acquired two full-time family advocates, chaplains who help families deal with unexpected, catastrophic deaths from brain injuries. At Hopkins, all too often those deaths come from gunshot wounds. Families arrive feeling anger, hostility, disbelief—“all the difficult emotions you would have about such a criminal activity,” says surgeon Pam Lipsett, a key architect of the family advocate program.
“I’ve seen family advocates hold someone’s hand, listen to their anger, and eventually be able to help them achieve some sort of understanding about the grace of the life that is leaving them,” she says. “They could literally be with the family for 18 to 24 hours, go home for rest and come back for another 18 hours. Their investment is extraordinary. But imagine how comforting it is for the family.”
Hopkins family advocates Yollande Mavund and John Ponnala also serve as unbiased intercessors on organ donation and other end-of-life issues. They receive help from two second-year CPE residents—most recently Pamela Adams and Joanne Bedford—who apply to learn this clinical specialty.
While William Bell has spent much of his final year of residency in the Kimmel Cancer Center, Claire Matheny has focused on the needs of psychiatric patients.
“I’m very interested in the intersection of spiritual health and mental health,” she says. “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 40 or 50 years. Some may question what their purpose is.”
As Hopkins’ youngest pastoral care resident, 29-year-old Matheny describes herself as a “double PK” (preacher’s kid); her parents are pastors at Memphis churches two miles apart. Her special interest in the elderly stems partly from her family’s parish work and partly from her love for and concerns about her own grandparents. She holds master’s degrees in both divinity and social work.
Matheny says it’s often easier for psychiatric patients to explore their feelings imaginatively than it is for other patients—a situation she attributes to treatments they have already received for emotional and behavioral illness.
“In some ways, I look at every hospital visit as a ‘psych visit,’” the chaplain says. “Just entering the hospital is a stressful event [for patients]. 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.”
In order to cover the needs of a 1,000-bed hospital, the dozen or so members of the pastoral care team at Hopkins welcome help from volunteer clergy as well as from the part-time interns in the CPE program. Referrals often come from staff members who observe crises developing, although patients can also indicate a religious belief—and interest in a pastoral visit—on their hospital admission form.
Residents are assigned critical care units and take turns at overnight duty; they share sleeping quarters with medical residents. When on call, they respond to emergency codes throughout the hospital.
“When called to a code, our chaplain offers encouraging words to the patient or quick prayers for the medical team,” Scharf says. “We’ve found that the presence of the chaplain is an important symbol. Caregivers feel supported by the presence and silent prayer while they are trying to revive someone.”
Scharf, a Disciples of Christ minister who grew up in Germany, began working as a CPE supervisor during his previous job at Duke University Medical Center. He’s 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 to families and staff.”
Group discussions help students learn why they react more intensely to certain patients than others. “We want them to recognize that there is some transference going on, that something in a patient’s story may remind them of a difficult chapter in their own life,” Scharf says. “When they understand their own response, they can get on track with the patient more successfully.”
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.”
The chaplain is talking en route to meeting the family of a cancer patient who suddenly required a breathing tube. As he hurries through the hospital hallways, he often waves at colleagues, some of whom he knows from his student days at Duke University Medical School.
“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 begins 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.”
He has learned that patients’ spiritual needs can change dramatically over the course of an illness. “How a visit works depends on where patients are in relationship to their disease at the time,” he notes. “They may be in shock and denial and not want to talk. Or they may be in spiritual crisis, desperately looking for someone wearing a collar.”
The latter vision, in particular, touches the vulnerabilities of this wounded healer. 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, I didn’t want to talk to 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.”