Hospital Chaplaincy

Spiritual care volunteers and staff at Stanford Hospital Chapel

Before an Episcopal priest can be ordained, he or she must complete several months of Clinical Pastoral Education (CPE). In CPE the students minister to non-Christians as well as Christians, much as priests do in the real world.

Clergy that I have spoken to have said that their most intense and rewarding experiences have occurred while they did their CPE as hospital chaplains. [bold added]

Hospitalized patients and their families often struggle with religious and spiritual quandaries but can’t attend their houses of worship or don’t have one. Chaplains thus fill crucial gaps. As the religious makeup of the U.S. has changed in recent years, their profession has begun to do so too. Board-certified chaplains are now increasingly trained to help patients of diverse beliefs. To learn about their vocations, I [note: Columbia prof. of psychiatry Robert Klitzman] recently conducted an in-depth study, speaking with 50 chaplains from across the country and from different faiths.

While chaplains aid countless patients, they are in many cases marginalized and underfunded. The Centers for Medicare and Medicaid Services allows for direct reimbursement for spiritual services only within the Veterans Affairs system. Offering spiritual care for hospice patients enrolled in Medicare is mandatory but not directly billable. As a consequence, many hospitals have no chaplains; some rely on local volunteer clergy, who know only their own faith, or on other healthcare professionals to fill in for spiritual care...

Chaplains are often the only staff with time to talk to patients, whom they can therefore get to know well. I learned of one patient who phoned the on-call nurse every day at 2 a.m., complaining of pain. The staff tried altering his medicine without success. Finally, a chaplain spoke to the patient, who turned out to be carrying significant guilt from his mother’s suicide when he was 18. When the chaplain arranged for the man’s elder siblings to talk about it, they were “aghast,” the chaplain told me. “They reminded him that their mother had mental-health issues: ‘Don’t you remember?’ It was like a 50-pound weight had been lifted. After that, he never again called the nurses at night.”

Chaplains also serve as critical mediators in conflicts among patients, families and physicians. At another hospital, a teenager who was dying wanted to donate his organs. Soon he was brain dead and on life support, which surgeons planned to remove in the operating room. The boy’s family wanted to be present when he died, but the surgeons refused for fear that they’d disrupt the procedure.

Presented with an impasse, a chaplain negotiated a solution: The family would dress in sterile gowns and stay in the theater for three minutes. The family and physicians sang “Amazing Grace,” the boy’s favorite song. When he died, the mother said to the chaplain: “Thank you for that gift. . . . We got to sing my son into heaven.”

In my research it wasn’t uncommon to learn of medical professionals wary of spiritual care, which they saw as having no medical benefit. Yet spiritual counseling can help patients choose palliative care when the treatments available are both futile and painful.

In facing serious disease, millions of patients find themselves pondering the eternal. Most of us will die in hospitals, far from any religious institution, and might benefit from chaplains’ care. Our healthcare systems would do well to recognize and value them more.

Spending one or two nights in a hospital changes a person. Although WiFi is now commonplace, the hospital environment is not conducive to endless Internet surfing or scrolling through social media. The patient confronts thoughts he may not be accustomed to having, especially if he is non-religious.

In his hour of need, there may not be family members the patient is comfortable talking with, and he can't bother medical personnel, whose focus is usually confined to the health of our physical bodies.

That leaves the hospital chaplain, whose job has expanded to being ready to converse with those who are members of different faiths-or no faith at all. In an increasingly irreligious society the irony is that the need for chaplaincy services has never been greater.