Before I started my internship as a hospital chaplain, the only chaplains I knew about were Father Mulcahy on M*A*S*H, and Charlie Chaplin. When I started my first unit of Clinical Pastoral Education, CPE, about ten years ago, I didn’t know quite what I would find or what I would be asked to do. What I found was a supervisor who just happened to be named Charlie and a new understanding about chaplaincy. I’ve learned about the benefits of good pastoral care. I have done a lot of thinking about why we need humanist chaplains and why humanists need chaplains.

While I didn’t know very much about chaplains, I had all kinds of ideas about them. Ideas that I now know were mostly misperceptions. The several times that I was hospitalized I always refused the visit of a chaplain. I assumed that they had come to pray for me, to offer me salvation, to convert me to their religion, or at least tell me what an awful person I was because I didn’t believe in god. As a sitting duck, sick in the hospital, I didn’t want to deal with that.

After two years of intensive chaplaincy training, I know that that is not what chaplains do.

Well, what do chaplains do?
Chaplains help people who are in difficult situations connect to what is most important to them in their lives, with the possibility of focusing on their spiritual and/or religious values.

Having done my chaplaincy internship in a hospital, I am most familiar with chaplaincy for patients and their families. Yet their are chaplains in colleges and universities, chaplains in prisons, chaplains in programs for troubled youths, even chaplains for sailors on shore leave.

Hospital chaplains are working with people who are in a seriously compromised state. At times, issues of life and death are at stake. The hospital I worked in is a tertiary care hospital, which means that all the patients were seriously ill. Most of them had been in a hospital in their hometown before being admitted to the New England Deaconess Hospital, a teaching hospital of Harvard Medical School. (In the middle of my training this hospital merged with another and became Beth Israel Medical Center.)

What is it like for hospital patients? You may have your own experiences, or people close to you may have been hospitalized. While it is different for each person, some factors which are often present are a sense of dependence, being afraid of the outcome of being in the hospital and for many people there is some sense of regression, feeling like a child, feeling like you are being treated like a child. Being hospitalized might stir up memories of what it was like to be sick as a child and whether you felt cared for or not. There is often questioning - why is this happening?

Families, friends and other loved ones are often in a difficult situation as well. They may be worried, feel very helpless as a loved one suffers or struggles, and wonder what the outcome will be and if their lives will change significantly.

What can hospital chaplains do for patients and their families? The most important thing a chaplain can do for a patient or family member is to be a caring presence. A chaplain is someone who can be there and listen to help the patient feel less alone. The chaplain is someone a patient can tell what it is like for them to be in the hospital. Most staff people in a hospital don’t have time to listen to a patient’s feelings or concerns. A chaplain can help a patient get information about what is going on and be a conduit for communication. A chaplain can help ground a patient in his or her own values and help a patient connect to his or her spirituality as he or she may define it.

The program used in CPE is one in which every chaplain intern is trained to work with patients of all faiths. People are not assigned on the basis of religion, but usually are asked to see patients in specific units of a hospital.

All chaplains trained through the CPE program are expected to be suitable chaplains for people of all faiths or those who identify as having no specific religion.

People with certain faith stances may seek comfort in prayer or readings or trying to accept that what has befallen them is God’s will. Those approaches will probably not be satisfactory for people who identify themselves as Ethical Culturists or Humanists. We’re more likely to want to rely m on reason to understand what is happening to us and in the world around us. We look for the truth of a situation, we want to have an in-depth understanding of why things are happening as they are.

Sometimes, the answers are not easy to see and it is helpful to have another person to explore these questions with us. We might be helped to see a new perspective and be able to make decisions based on a different way of thinking about a situation. A chaplain might help us think about things, or just give us the attention that helps us feel cared for. It is when we are faced with difficult situations or problems we can’t solve ourselves that pastoral care or counseling can be helpful.

I’m just going to take a moment to distinguish between pastoral care and pastoral counseling. I use pastoral care to refer to a situation in which a chaplain offers his or her services to someone who hasn’t asked for them directly. In a hospital this involves random calls to patients and their families. I use pastoral counseling when someone actively seeks out a chaplain or clergy to help him or her with a problem or difficult situation.

Pastoral care and counseling do have some commonalities. In both situations, the chaplain is obligated to do his or her best to be a presence for the person they are working with. Yet, in a situation in which pastoral care is being offered, the chaplain needs to be fully aware that he or she has come into the space of the patient, uninvited and must respect the patient’s rights. They clearly have the right to not have the chaplain visit, but even if they have consented to a visit, the chaplain still needs to be aware that they are in a more powerful position than the patient. When someone is sick enough to be in a hospital, they need support, not advice or judgment.

One of the first patients I had was an Episcopal man who went on and on to me about how sad he was about the path the church had taken - first ordaining women priests and allowing openly gay and lesbian people into their congregations. I couldn’t tell him that I thought those were good developments. Instead I just listened and told him I could hear how upset he was and I was sorry that he was so upset.

In a pastoral counseling situation, it is much more likely that the counselor will offer more specific advice, and perhaps shed some new light on the persons thinking. For particularly difficult situations, ones with lots of ethical and values considerations it can be especially useful to have a pastoral counselor who shares the same or a similar belief system. It is helpful to be able to talk about your questions or problems with someone who is more likely to understand what the crux of the matter is for you, to understand what the critical issues are that make a situation a problem, possibly a moral dilemma.

Yet, there are also times, when having a chaplain who is trained to understand and respect someone’s differing faith stance can help a person think through a problem, or just offer a comforting presence and a sense of connection.

How do chaplains go about doing this work with patients?

The first thing is to ask permission to visit. It is both respectful and empowering for the patient. The chaplain is one of the only people a patient can ask to leave his or her room.

The most important thing is to listen to the person. Essentially you are having a respectful and caring conversation, but not sharing your personal views and experiences. The patient gets to set the pace of the conversation and decide what to share and what not to share.

And a chaplain is looking for ways to support a patient’s spirituality. Sometimes that means praying with a patient. Prayer, meditation or quiet reflection. Yes, I have prayed with people.

Before CPE I never could have imagine praying with someone. How could I invoke a god that I didn’t believe in? Wouldn’t that be hypocritical?

Through my CPE classes I began to understand more about the role prayer has for some people. Just as there are many variations in how people think of the concept of god, there are many variations in how people perceive prayer. Yet I wound up with the understanding that for many people, the act of prayer, and particularly the act of praying with another person, provides a sense of comfort and peace.

Still, how was I, someone who doesn’t believe in god, going to this with a sense of keeping my own integrity and being authentic to the people I was serving? I asked for advice from my colleagues in my CPE class. They were varying denomination; most were studying to be clergy, although some were already ordained. The most helpful advice I received was from a Methodist minister in my class. She told me that when she prays with someone, she asks them what they want to pray about so she can find out what is on their minds and in their hearts, what is important to them. I thought about how when I meet with wedding couple I’m always asking them what is important to them, so I saw a similarity in doing something individualized, specific to the person or people involved.

One day, while visiting with an elderly gentleman, I had a sense that he might like me to pray with him. I asked if he would and he smiled at me and said yes. I asked him what he would like to pray about and he told me he wanted us to pray for world peace and so that his family would not suffer with him in the hospital. That was it, not even something about himself. So I took his hand and we prayed together. All these years later, I don’t remember just what I said. I do know I started by addressing god. I knew it wouldn’t be a prayer for this man otherwise. It was so long ago that I have little recollection of what I said. But what I still do remember, all these years later is that after we said “amen,” a huge smile came over his face which let me know that I had helped him, and done something good for him.

No one has ever asked me to pray for anything that I wouldn’t wish or hope for them. So while the words I say sound like a prayer to the patient, and the patient can find comfort in them, I think of what I am doing as stating aloud the hopes of this patient in such a way that the patient finds as much comfort as possible in my words.

Would I pray with someone who is not in such a seriously compromised position? Probably not. Would I offer a prayer as an invocation to an event? Absolutely not. I would say words to inspire and motivate, or to offer comfort and solace as appropriate, but it would not be a prayer.

Nor would I ever pray for someone who doesn’t ask me to, or I have asked if they want me to pray with them. This is treating the patient as an individual -- respecting her or his unique qualities and allowing them the dignity at this time of great difficulty -- of their beliefs and how they wish to practice them. The familiar and the comfortable have a lot of potential to be helpful to people in their
healing. A time of illness is a time to offer my hopes for patients. It is not the time to tell them that I don’t believe in intercessory or petitionary prayer. You might be astonished at how many people still believe in prayer having direct affect on what happens in this world. But trying to take away someone’s cherished beliefs when they are sick is not appropriate.

Now that works both ways. While I think it is fine for someone who doesn’t believe in god to pray with someone who is ill, I think the beliefs of all patients must also be respected.

In my training, it became clear to me that there are many chaplains who wish to be sensitive to humanist, atheist, and agnostic patients, but just were not very familiar with them and didn’t have a good sense of how to approach a person who identifies as such. None of my classmates had ever heard of Ethical Culture before, though I was surprised and pleased that my supervisor, a Methodist minister, had.

He asked me to lead a session on being a chaplain to people who don’t believe in god, knowing that could be helpful to my colleagues.

I talked about the marginalized position people who don’t believe in god sometimes have in our society. I told of how when I was 12 and went to a camp which had strong Ethical Culture connections I was told by a counselor that “I couldn’t not believe in god.” And I had other examples to share. We’re often left out of the discussion about what people believe. I’m guessing you have your own examples. These days things have changed a bit – now we’re as likely to be vilified for the awful “secular society” we’ve supposedly created. (I don’t know about you, but it doesn’t feel quite that way to me, but that’s another Platform.)

I asked the other chaplains in my class to remember that when they see patients, the patients may have been told that they were wrong or that they couldn’t not believe in god or somehow needed to defend their beliefs. People shouldn’t have to do that when they are sick.

I also told them that I actively dislike terms such as non-believers or unbelievers to describe people who may be atheists, agnostics or non-theists because it reinforces that a belief in god is the norm. In addition, it leaves too much room for the impression that such people don’t believe in anything. That rarely, if ever, is the case.

Although one of my supervisor’s favorite sayings is “don’t just do something, sit there,” I knew that the people in my class would want some specifics about what they might offer humanist patients. You can think about my suggestions. Would they work for you? Are there others you would add to my list?

I stressed the importance of using good chaplaincy practice with all patients. Our role is to be a caring presence; to truly listen to the person. I suggested helping patients focus on what it is they are hoping for and what it is that they fear. Some people might want to talk about why is this happening to me, some not.

I suggested asking patients if there is something they do to calm or center themselves. As we’re finding from people in ESWoW sharing different practices, we know that many people who don’t believe in god have some sort of practice, or might appreciate help in focusing on their breathing or some other form of meditation.

I talked about the notion that some people have stopped believing in god because their prayers weren’t answered or something very bad happened in their lives. My colleagues seemed more familiar with this possibility. Yet it was important to make it clear to them that some people decide not to believe in god or to be agnostic as a well-thought out reasoned choice.

I was clear that it doesn’t make sense to offer to pray with or for someone who doesn’t believe in god. If the chaplain has a strong personal need to pray for someone, they can do that privately, after the visit.

The class was well-received and I appreciated the willingness of my colleagues to learn and understand more about different beliefs and practices. Many said that my information just affirmed for them what they have been doing with patients.

Life review is an important practice for chaplains to offer to humanists, particularly at the end of life. Since most of us who identify as Ethical Culturists, humanists, atheists, agnostics or non-theists believe that this life is all we get, it is often helpful, especially if someone is critically-ill or dying, to be able to look back on a life well-lived, the successes and the regrets. We can think about or talk about the times we tried, but things didn’t work out quite as we expected them to; the times things worked out just as well or even better than we had hoped. Reviewing relationships we have had is of utmost importance. A chaplain can ask if there any unfinished business you have? Is there anyone to whom you need or want to say “I love you,” or “Thank you,” or “I’m sorry?”

I haven’t had many patients who did identify themselves as humanists to me. In my first year of chaplaincy training I actually did have one patient who identified himself to me as a humanist. He was amazed to have a humanist chaplain. He was in his 80’s. He was diabetic so he was in and out of the hospital a lot. In all his times in the hospital he had never had a humanist chaplain and he told me he never expected to have one. He knew about Ethical Culture, but he said he was too much of an atheist to feel comfortable with Ethical Culture. Nonetheless he was quite pleased that I had visited him. His was a short hospitalization and I only got to visit him once. We were both thrilled.

I only visited with one Ethical Culture patient in the time I was doing my chaplaincy training. It was in the Palliative Care Unit of the hospital. I had met this person once, very briefly, but remembered his name. I went into his room and introduced myself as a chaplain. You probably won’t be surprised to learn that he told me he didn’t want to see a chaplain. I told him that was fine, but could I just share with him that I was training to be an Ethical Culture Leader. He was pleasantly surprised and invited me to stay. Over the next two weeks, which were the last two of his life, we enjoyed several conversations and I got to know more about the life of this fascinating man who guided his life with concepts of ethical living. His family was pleased that I was able to officiate at a memorial service for him in the hospital chapel. It was a wonderful experience for us all.

I’ve thought back to the times I was in a hospital and what my response was when a chaplain came around. I always said no thank you. I didn’t want to be blessed or anointed or prayed over. I didn’t realize that I was missing out on good support during scary experiences.

And with the possibility of having more Ethical Culture/Ethical Humanist chaplains we will increase the number of patients and families who will have access to someone with a similar faith stance.

I could wish for you having a life so perfect that you would never need a chaplain or pastoral counseling. But we know that is not realistic. So instead, I wish for you that when you have the times in your life that you do need support, that it is there for you. And it may even be in the form of a chaplain.

 

 

Marion Carson on Dec 30 2006 -- One challenge for freethinking chaplains is
working with pastors from dogmatic religions who may be tending persons from their congregations and resent the attentions of an "outsider" (particularly aa woman minister). Another challenge is creating a cermony on the spot (patient's room, relatives' waiting room, or in an area set aside by the hospital for such mini-services),a cermony that is VERY inclusive.

 

Tom Russel on Jan 01 2007 -- Susan - Thank you for sharing your hospital chaplain experiences, which I found very familiar from my volunteer years as one. When I started, I was firmly Jewish (Reform), but as I more clearly recognized my atheism it was briefly difficult for me to remember that it wasn't at all about MY beliefs - it was about the needs of the patients, staff, and visitors.

 

Leonard Weis on Jan 22 2007 -- Without training, I was expected to play this role beginning about 45 years ago. Most of it was with the families, rather than the patients. The same principles applied: being there, listening well, reflecting what was helpful for the people I tried to help. The rewards are so numerous, too.

 

Margaret Aguilar on May 05 2007 -- As a nurse for many years, periodically I have found myself at the bedside or with patients or family or even occasionally staff, at moments of crisis. As an atheist I am not comfortable with dogmatic religions nor even the “spiritualism” which I see as a manifestation of the superstition and magical thinking that are a part of us, which is often apparent in Ethical Culture groups. However I can be supportive emotionally, which is what it is all about anyway, as a human being. I have gone through significant losses myself. I have watched people die and have watched people in profound suffering and depression. I have also had the privilege of watching childbirth and the most prosaic flowers growing and birds flying. From the profound appreciation of all of these experiences, with some reflection and perhaps training, one learns that to be present in the deepest meaning of that word for the person and/or family is what really matters.

I guess the real upshot of this would be to support your nurses as well as your chaplains. The nurse is the one who will be there at 2 am.