What Are We Doing Here?: Chaplains in Contemporary Health Care

It can be really hard-or really easy-to explain what I do for a living. Chaplains share academic training with clergy, but we complete clinical residencies and work in health care organizations. Our affinities are with the patient and family, but we may also chair the ethics committee or serve on the institutional review board, and we spend a lot of time with staff. We must demonstrate a relationship with an established religious tradition (in my case, United Church of Christ), but we serve patients of all faiths, and of no faith, and seek to protect patients against proselytizing. We provide something that may be called "pastoral" care, "spiritual" care, or just "chaplaincy"-but even among ourselves, we do not always agree about what that thing is.

There are many, many definitions of "spiritual care" in the context of health care.¹ They all tend to have something to do with transcendence: how the suffering individual grapples with issues of identity, meaning, and purpose. They may or may not be expressed in terms of religion or culture. While any caregiver can tend to the spiritual needs of a suffering person, the chaplain is the health care professional expert in providing spiritual care.²

Chaplains do what needs to be done, in the setting in which they find themselves, to ensure that care is focused on the emotional and spiritual needs of the patient and the patient's family, particularly in times of suffering, stress, or grief. When I worked as the solo chaplain in a community hospital, I was paged to the emergency room for codes. If the patient did not survive, I would help the nurses clean the body-and also the room-as part of caring for the grieving family, who were about to come in and say their goodbyes. I had learned from experience to see this scene through their eyes: Had we treated their loved one with respect? Had we tried hard enough? In that job, I also became experienced at translating the signs and symptoms of imminent death for families sitting by the bedside: What is happening to the body as the organs are shutting down? What do those lines and numbers on the monitor mean? Why does the breathing sound like that? Nurses and physicians know these things without having to think about them; the chaplain is often the one who observes what the family does not know, and who offers comfort by explaining what can be explained.

And sometimes, we sit with the patient and family and say nothing. Our presence seems to comfort them, and remind them that they are neither alone nor forgotten during this most difficult time.

Sometimes, too, chaplains do what needs to be done simply by showing up, hanging around, and making time for staff. Sitting with staff, even joking with them, may help them defuse and debrief after a difficult clinical situation. A chaplain tends to know if a particular death-an unexpected death, or the death of a well-liked patient-was a hard death for a team, and will check in with them. Sometimes the staff members for whom chaplains make time are senior administrators, who rely on chaplains to help them keep the patient, and the family, and the staff, and the community in mind, lest any be forgotten in the ever-tightening reimbursement market. In my community hospital, our CEO had me sit in on all disclosures of medical errors: as he put it, my presence in the room was a reminder that the institution took the patient's and family's suffering seriously. Among ourselves, chaplains may consider this a part of our "prophetic" role, although it is a role we do not always claim for ourselves.

There was a time when chaplains got their jobs by default because they could not lead a congregation. This may say something about how religious denominations used to view the care of the sick: as a fall-back option, rather than as a vocation in its own right. Today, professional chaplains-like physicians, nurses, mental health professionals...