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“This Is a Time for Mourning”: Hospital Chaplaincy in the Age of Coronavirus

https://www.theringer.com/2020/5/28/21272390/coronavirus-hospital-chaplains-covid-19-pandemic The Reverend Katherine GrayBuck stood in a crowded hallway on a chaotic afternoon, near the beginning of a crisis to which there still appears to be no end, and prepared to pray over a man as he died. It was March. GrayBuck was in an ICU at Harborview Medical Center in Seattle, where she works as an interfaith chaplain. All around her, nurses and doctors rushed past, working to save lives. GrayBuck stood in their midst, solemn and serene, readying to shepherd another life to its end. For weeks, the novel coronavirus had been spreading across the country. Now, a man lay in a hospital bed inside his room, just footsteps away, ravaged by the virus and its accompanying disease, COVID-19. The man’s family had called the hospital with one request. He was an observant Jew, they said. Could someone go into his room and recite the Shema prayer over him? It is a staple of Jewish practice, a declaration of faith. Prayed daily by millions of Jewish people across millennia; prayed over patients countless times here in this very hospital. Often, in moments before death, a rabbi or a family member would offer the prayer. But this virus has made a habit of warping tradition. At this moment in the pandemic’s spread, the hospital allowed in no outside religious leaders, no family members or visitors of any kind. So GrayBuck would do it. This is her role. To guide the dying toward peace, the families of the dead into grief. To witness and honor the great pain of staggering loss. When the patient’s doctor had come to her with the request, GrayBuck took a minute to think it over. There were a couple of matters to consider. For one, the patient remained highly contagious. But although the hospital had been conserving personal protective equipment for doctors and nurses, it would spare some for GrayBuck to perform the man’s family’s request. Another consideration: GrayBuck is not Jewish. She’s Lutheran. But with no rabbi or family member permitted inside the hospital, she knew that as interfaith chaplain, the job was hers. “A part of me knew I had been preparing for something like this from the moment the crisis began,” she says. So she put on scrubs for the first time in her career. Then the gloves, the gown; she pulled an N95 mask over her head and fastened it around her nose and mouth. She remained for a few moments there in the hallway of the frantic ICU, staring at the Hebrew prayer and accompanying English pronunciation guide she’d printed from an online source. “There was this incredible feeling of powerlessness,” she remembers, talking by phone weeks later. “The medical team felt powerless. The family member couldn’t even be there, at his bedside.” She saw the request for that prayer, even delivered by a chaplain they’d never met, as an acknowledgement of that powerlessness. “I think it was tapping into this sense that, when there’s nothing we can do, we turn to this ancient ritual. We turn to something that can hold us in the midst of this terrible situation.” GrayBuck steeled herself, looking over the words one more time. “As imperfect humans,” she says now, “we rise, and we offer what we can.” She opened the door and walked inside. One hundred thousand and forty-six people have died in America of COVID-19. That number has risen, considerably, since I wrote the first draft of this story. It will rise again by the time a Ringer editor publishes this piece, and still more by the time you read it. Our country’s grief is so vast that it can sometimes turn invisible. You cannot see the mountain when you’re trapped beneath its weight. At many hospitals, chaplains work to help those closest to death grapple with its reality. Doctors and nurses care for bodies; chaplains for minds and spirits. “We usher people through moments of shock, moments of grief,” says GrayBuck. “We try to help them make sense of some of the worst moments of their lives.” I’ve been talking with hospital chaplains from around the country about their lives and their work, and how both have been affected by the pandemic. I’ve talked with Muslim, Christian, and Jewish chaplains, all of whom, like GrayBuck, often work with patients of different faiths or of no faith at all. “We are not trained to be experts in every religious tradition,” says Rabbi Sara O’Donnell Adler, a chaplain at the University of Michigan Hospitals, “but to at least have a basic understanding of various traditions so that we know how to advocate for them.” As they make their rounds, many chaplains do not immediately identify themselves by their own faiths, unless it feels particularly relevant to the patient’s care. Says Adler: “What we need much more than that religious expertise is an ability to encounter somebody with curiosity, with a sense of wonder. An eagerness to say, ‘So, tell me, how is it that you make sense of everything that’s happening?’” Adler and others explained how chaplains are trained and how they approach their work, whether they’re facing a global crisis or merely the pre-pandemic crises that upend their patients’ lives. They care for patients and their families and even the doctors and nurses and other members of hospital staffs. This can mean praying together, reading scripture or poems. It can mean listening to stories, helping family members reflect on their most cherished moments with a patient they may soon lose. It can mean hugging and holding doctors and nurses who sob in the break room after a traumatic death. Or serving as a well of knowledge on matters critical to patients’ well-being but beyond medical workers’ expertise. “Just as I would turn to an oncologist for a more accurate prognosis on a cancer diagnosis,” says Dr. Margaret Isaac, a palliative care physician who works closely with GrayBuck, “I turn to Katherine when issues of existential suffering come up. She’s our expert.” Often, it means simply sitting or standing nearby as a patient draws their final breath. In my conversations with these chaplains, long and meandering phone calls on weeknights after shifts and on Saturday afternoons, the word “God” has also tended to come up from time to time, as one would expect. But there’s another word that seems to come up far more often. A word that speaks to the core of what chaplains do, and to the difficulty of doing that work in a time of social distancing. It surfaces in every few sentences, spoken with equal reverence by members of different faiths: presence. “As imperfect humans, we rise, and we offer what we can.” —The Rev. Katherine GrayBuck There’s Ali Candir, a Muslim chaplain at Baylor St. Luke’s Medical Center in Houston. “What we try to do,” he says, “is be fully present with someone.” Then there’s the Reverend Kate Perry, a chaplain in Providence, Rhode Island. “When someone is distressed,” she says, “when their questions and anxiety are too much to bear, sometimes you just need to show up. Just be that nonanxious presence, there in the room. That by itself can do a lot.” And then there’s GrayBuck. “I think about Virgil,” she says, referring to the character in Dante’s Inferno who travels with Dante, journeying with him into hell and guiding him through layer after layer of torment. “There are circles of hell that people experience in a hospital,” says GrayBuck. “To be that presence, to be the one who is accompanying them on that journey—that can be a powerful thing.” Chaplains are not hired to proselytize. They do not seek converts to their respective faiths. Instead, it is often their job to look, to notice, to listen. From up close during typical crises, and from behind masks and windows and video chat screens during the pandemic. In chaplains’ midst, bodies wilt, souls scar, families break. Amid the wreckage found within a hospital, they bear witness to all that’s been destroyed. Long before the pandemic, chaplains developed certain routines. They would make their rounds, working with other chaplains and members of the staff to triage decisions on whom to visit, often based on which patients face the most difficult prognoses. “Our job,” says Reverend Jill Zimmer, a chaplain at Saint Thomas West in Nashville, “is to always be at the worst thing.” Jill is my close friend. Her stories from work gave me the idea to write this piece. She is small and energetic, the emotional weathervane of every room. Often, I’ve watched her seek out the person who seems most uncomfortable at a party, and then work relentlessly until that person feels at ease. Since I’ve known her, she has shown up for several of my life’s most difficult moments, sometimes to ask the right questions, at others to sit in oddly comforting silence, and at still others, to mutter, with the proper balance of gravity and lightness, the exact right expletive at the exact right time. It is easy to imagine her as that calming presence inside a hospital, and when I talked to other chaplains around the country, I heard shades of that same empathy, that quiet curiosity, that makes Jill so well-suited to her work. Over a FaceTime beer one afternoon in April, Jill explained to me the practices she’s developed during her career. She will walk into the room and introduce herself to the patient. She will not bring up God, or any form of religion, but will start instead by asking questions. “I want to know,” says Jill, “‘What brings you meaning?’ Or I’ll say, ‘Tell me about a time in your life when you got through something hard.’ And then I’m listening for what resources they relied on during that time.” Some mention God or a faith community. Others talk about family, friends, nature, or pets. “Religion is one thing that gives people meaning,” Jill says. “So I’m listening, trying to find out, is religion the thing you turn to? Is it one of three things? One of seven? Or does it not register at all? Because what it is that brings that person meaning—that’s what matters in those moments.” Every chaplain I interviewed told stories of meaningful relationships with nonreligious patients. Perry says she often finds the atheist and agnostic patients refreshing. “They don’t come in with this preconceived notion of what is owed to them by their higher power,” she says. “There’s often either a sense of, ‘I accept that this is happening.’ Or it’s, ‘I hate that this is happening, but I know there’s no reason for it.’ Then it’s just this nebulous frustration and anger. It’s all out there.” “When someone is distressed, when their questions and anxiety are too much to bear, sometimes you just need to show up.” —The Rev. Kate Perry Even now, amid the barriers that COVID-19 has introduced, chaplains work to get to know the patients and their families. In those conversations, they try to figure out what will help them each find a sense of peace. Often, patients will want to reach out to people they’ve wronged, to make amends. Others want to talk to long-forgotten friends. Others want only a few more moments with their families, and a few want only calm and stillness, even solitude. Sometimes, patients get better. “There are a lot of moments of joy,” says Candir. “Those are just as important as the moments of grief. I ask myself, ‘How can I honor that joy? How can I squeeze even more light into this moment?’” Often, though, they don’t. Death approaches. Doctors inform patients and families of where they’re heading. Then chaplains help them find their way. These moments are delicate, often tense. For the dying, it is always, of course, their first time. For their families, the same is often true. Typically, only the chaplains have seen so much death that they’ve developed tools to handle it. Jill has a few tricks. “I walk up to the bed,” she says. “I hold their hand, or I touch them physically in some way. That’s visibly giving the family permission to be close and connected.” This was her preferred approach, though it’s lately been hindered by the restrictions of the pandemic. She would lower the rails of the bed, pull the chairs closer, giving cues that it’s OK to offer physical touch. Then she would try to get people talking. Maybe they’d want a prayer. Maybe they’d tell stories. Perhaps they’d tell the patient something that for many years had gone unsaid. “The best,” she says, “is when they’re laughing and crying and telling the person how much they mean, all at once.” And then, when the temperature in the room feels just right, she’d disappear. “Y’all are doing the hard work,” she would tell them. “I’m going to give you some time alone.” Then she’d step outside the room, where she and a nurse would wait, available if needed, popping their heads in every so often to make sure everyone’s OK. The family would remain together, talking and laughing or sitting in silence, until, eventually, the patient died. Those are the good deaths. Those are from before. Lately, those are rare. “This crisis,” says GrayBuck, “has left all of us forever changed.” For the chaplains themselves, new restrictions limit the bond they can form with patients. They talk through masks, unable to read each others’ faces. Chaplains typically wear civilian clothes, but now some are in scrubs, barely distinguishable from doctors and nurses. “I used to pull up a chair, sit right next to a person, and talk and pray,” says Candir. “I would hold their hand, or put a hand on their shoulder, offer some kind of compassionate touch.” Recently, a patient reached for Candir, to hold his hand while they prayed. Candir recoiled. “It was so painful,” he says, “for him and for me.” Even more difficult, though, has been trying to care for patients’ families. This is a critical piece of chaplaincy—not only working with the person whose life is ending, but also with those enduring the loss. At points during the crisis, many hospitals have allowed no visitors whatsoever. At the local peak of the virus in Nashville, Jill’s hospital was inviting only a single visitor for each of the patients nearest death. Sometimes, though, conditions worsen quickly. Patients die in between the time a loved one is invited to the hospital and when they arrive. Even for that one visitor who can come, the journey through grief can feel all the more isolating. “There’s an extra weariness,” Jill says, “to people not being able to share their grief.” She tells a story. Last month, a COVID patient began to deteriorate. (Like all chaplains interviewed for this story, Jill was limited by HIPAA restrictions in how much she could divulge about any patient’s identity.) During his time in the hospital, Jill had been in regular contact with his family, hearing stories from them about what made the man special, about the ways he made each of them feel loved. As he neared his life’s end, the hospital invited in his youngest son. The man arrived, and he donned PPE and entered his father’s room, but he stayed only a few minutes. His father was unconscious, the PPE was heavy and hot, and because the hospital was trying to conserve the protective equipment, Jill hadn’t joined him in the room. So he returned to the hallway, and there with Jill he stood wearing a mask and watching his father die through a glass window. In most situations, Jill knows she’s more experienced with death than anyone else in the room. But even for her, this felt unfamiliar. “Part of my job is to normalize the dying process,” she says. “I teach them how to do it. But now I’m figuring out how to do this myself.” “Part of my job is to normalize the dying process. I teach them how to do it. But now I’m figuring out how to do this myself.” —The Rev. Jill Zimmer Every now and then, the son would tell a story. For much of the time, though, they just stood together, quiet and still, in a hallway full of frenetic movement. “My presence was just to send the message, ‘It’s OK for you to be here. You don’t have to do this alone.’” She was there, too, to relieve an emotional burden from the doctors and nurses. Her presence by the son’s side allowed them not to worry about tending to his emotions, to instead work on making the patient as comfortable as they could. So together they stood, for three hours, and they watched, until, finally, the man’s father died. In some hospitals, the current restrictions are more severe than at Jill’s hospital in Tennessee. With visitation so severely limited, says Isaac, the physician, “It’s critical to have another point of contact for the family, even if it’s over phone or FaceTime. Someone else to keep them connected.” Still, though the spirit of the work persists, its practice has shifted. At the University of Michigan Hospitals, many chaplains, including Adler, have been required to work from home. When I call Adler one morning, I reflexively ask, in the way of pre-interview small talk, how she’s doing. When she begins to answer, there’s a hitch in her voice, as if she’s unsure quite what to say. And so we decide to table the question for a while, and we talk for around 40 minutes about her path from a relatively secular upbringing to rabbinical school, and onward into chaplaincy. We talk through her formative professional experiences, and her basic philosophy of her work. “Each patient has their own unique relationship with how they make meaning in this world,” she says. “Entering a room, I have to recognize that I am the one who is a guest in someone else’s space and healing.” Finally, we reach a point where it feels like time to talk about the present moment, about COVID-19. “So,” I ask. “How are you doing?” She takes a deep breath, then goes quiet for a moment, and soon she speaks. “It’s been really, really hard,” she says. Every day, she wakes up and has breakfast, then goes into her family’s guest bedroom. There, she sits at a desk she’s borrowed from her 13-year-old daughter, surrounded by her daughter’s tchotchkes and lip gloss, her magnets and stickers from theater groups she’s joined. There, Adler starts making phone calls. “I spend a lot of my day,” she says, “dialing into pain.” She calls patients and families. She tries as hard as she can to do from her spare bedroom what she typically does at their bedside. She works to find meaning. She conjures joys and names fears. But in a profession built on presence, she struggles to work from a distance. “There’s a sense of powerlessness,” she says. Not only for Adler herself, but for patients’ families, too. “Not being able to be there, not being able to hold the hand of a loved one who is suffering—that is excruciating for people.” Not only for the patients and their families, but for staff. “It’s really hard not to be able to do the little things,” Adler says. “Like bringing them snacks. Or noticing their body language in the hallway, and then pulling them aside and helping them process a traumatic death.” “I spend a lot of my day dialing into pain.” —Rabbi Sara O’Donnell Adler For most hospital workers, as for so many others around the country and the world, the last couple of months have been something like a prolonged trauma. “You know the hum of a refrigerator?” says Perry. “It’s like we have that constant hum now, but the hum is anxiety. We’re all living right on the cusp, in this buzzing, anxious place.” Live in that place long enough, she says, “and it affects your entire being and body.” She’s seen hospital workers who are typically reserved, now living on the edge of panic. As time has passed, though, there has been small comfort in pieces of the collective struggle. “Every patient, family, and staff is all living with the same emotions,” she says. “They feel anxious and helpless and this deep sadness. And then there’s this anger. No one knows how to pinpoint where it should go, but we’re all just so angry. And we’re living with this all the time.” During the pandemic, grief has fractured. More than 100,000 dead in America, many without family by their side, many mourned without a physical gathering for a funeral. That’s not to mention the many others who’ve died of other cases during the pandemic but have been mourned the same way. Kamal Abu-Shamsieh, director of the interreligious chaplaincy program at the Graduate Theological Union, a seminary in Berkeley, California, has been overseeing Muslim funerals via Zoom. “In times of mourning,” he says, “our way of comfort is that we are all together.” He stresses that sharia allows flexibility around death rites in times of crisis, but still, “the way we deal with pain, right now, is not the same.” Candir sees the emotional and spiritual wreckage of this moment lasting much longer than the public health crisis itself, devastation lingering long after scientists develop a vaccine. “If your father is dying, and you can’t be there for his last moments, this might leave a huge hole that you can’t fill for the rest of your life,” he says. And with so much chaos in our society, so much disruption to so many lives, “you might experience a kind of disenfranchised grief. Where no one understands what you’re going through. And that takes maybe the hardest thing in your life and makes it that much harder.” The work can be draining, spending day after day inviting others to offload their emotional pain. “People have a very difficult time with grief,” Jill says. “This happens to be something I do well.” In her own life, she has suffered. She has endured moments of catastrophe and others of aching loneliness, moments when she was left unsure whether she could go on. “I know,” she says, “that in those times, that if you have someone who will let you know, even without any words, that they carry for you a deep sense of love, it can change your whole life.” Still, the deaths, one after another, can wear her down. “I don’t always love it,” she says. “Sometimes I joke that I wish I was good at, like, math. But this is my thing. And I believe it makes a difference.” Early in Jill’s career, she worked in a children’s hospital caring for the families of two boys who’d been killed by gunshot wounds. In both cases, she stepped into horror and did her best to deliver calm. She helped one mother to realize that her anger was justified. She helped another to quell her own rage for just a moment, so that she could spend her son’s last few minutes by his side. Afterward, she says, “I was destroyed. I was so angry and hurt. I grieved for those two children as if I knew them, as if I was close to them. And I think that was important, to be human, to let myself feel.” But they were two deaths in what would be a career marked by thousands. To do her work, she needed to be able to step into moments of great darkness. But to keep doing it well, she needed to learn how to step back out. “I had a mentor who said, ‘You have to find a way not to grieve this like it’s yours,’” she says. “No one understands what you’re going through. And that takes maybe the hardest thing in your life and makes it that much harder.” —Ali Candir Many chaplains have their own small rituals, performed daily or as often as needed, to help them let go of others’ pain. When Perry exits a patient’s room, she sanitizes her hands. While rubbing in the hand sanitizer, she takes a moment to reflect. “I honor the time I just had, and I say, ‘Now it’s finished.’ Then I move on to the next thing.” After difficult days, Adler reads and writes poetry. She takes walks. She loses herself in the boundless energy of her children. She connects with colleagues involved in Neshama: Association of Jewish Chaplains, where she’s a board member. “Trying to support those colleagues and allowing them to support me has been a sustaining practice,” she says. But still, “Some days are devastating,” she says. “I’m human. I’m gonna come home and cry about it.” All of these practices, it should be noted, were developed well before the spread of a pandemic. What worked before is less effective now. “In normal times,” says GrayBuck, “boundaries are essential for this kind of work.” Now, though, “there’s no way that what we’re facing at work doesn’t bleed into the rest of our lives.” To her, that feels appropriate. “This is a time for mourning,” she says. Every day, patients and families and staff pour their own fear and anguish into chaplains. They are emotional repositories of grief. But when chaplains leave the hospital, they now find few places to pour out the excess. It can feel like drowning in the suffering they’re paid to swim through. One night a couple of weeks ago, Jill and her husband, Drew, FaceTimed with my wife and me. She was sobbing. There had been a hard death. There are always hard deaths, and there is no way to predict which ones will follow her out of the building, but this one had lingered, then overwhelmed. A man had been hospitalized with COVID. He was an immigrant, and a Catholic, and hospital staff had trouble reaching his family back in his home country. Because of the contagion, Jill had been unable to enter his room. But still, she had followed his progress, had prayed for him from outside in the hall. Sometimes her job is to continue offering presence even when she’s the only one who knows she’s doing that work. “It’s really hard to cry over Zoom.” —Jill Zimmer The man was intubated and put on a ventilator. Before going under deep sedation, one of his nurses later told Jill, he looked at his doctor and spoke with a resolute calmness. “I love God,” he said. “I believe God loves me. But I hope I wake up from this.” He did not wake up. Afterward, anguish over his death rippled through the staff who’d worked to treat him. Jill sat with them in their sadness, and later in the night, she felt her own sadness grow. Typically, in these moments she turns to friends or to members of her church for comfort. She looks for someone to share in her sadness, for the body of a person she trusts to sit nearby, a hand on her shoulder or her head, offering the same kind of presence she offers patients every day. Amid social distancing, though, those comforts have been minimized. “It’s really hard,” she says, “to cry over Zoom.” A few days later, I called her to talk about why this particular loss had been so affecting. She thought back to that story the doctor had told her, of the man’s final words before he was intubated, about his love of God and his fear of death, all spoken so plainly as he lay in that hospital bed. “We all meet death differently,” she said. “We meet it very much based on our own personality. But it takes an enormous amount of strength to meet it like he did. He acknowledged, ‘I am afraid,’ and at the same time he was perfectly at peace. To witness something that pure and beautiful and human sticks with you.” She paused for a second, thinking back on that moment. “Someday,” she said, “I hope I can meet death like that. As a friend.” Back in Seattle, the day she’d gotten the message about the patient whose family requested the Shema prayer, GrayBuck reached for the door to the room and walked inside. Through the window, she saw the sun beginning to set over Seattle’s empty streets. Out in the hallway, she heard her colleagues, in purposeful motion. By the bed, she heard the ventilator, a steady rhythm. She looked down at the patient. He was unconscious, and he looked ill, deeply ill, and yet he appeared to hold within him a stillness, a sense of calm or peace. “It was,” she says, “a sacred space in that moment. It was my incredible pleasure to be there, by his side.” She walked to his bed. With her gloves on, she reached for his hand, and she held it in her own. She spoke, softly, and she told him all that his family had told her, about how deeply they loved him, about how much his life had meant, how badly they ached to be in that room together, sharing this moment by his side. She took the piece of paper she’d printed, with the words of the prayer in Hebrew. She’d taken two semesters of the language in seminary, and she’d struggled. At the time, she did not know when, if ever, she might use it. In the room, in that moment, “I felt humbly and wholly inadequate,” she says. Still, “I knew I would do my best.” She prayed, loud enough to be heard, through the mask and over the ventilator. “Hear, O Israel, the Lord is our God, the Lord is One …” She continued through the full prayer in her very best Hebrew, until it was complete. Afterward, she paused, sitting with the weight of the moment, and for a while she remained as that quiet presence, that other body next to his own. She felt, even then, as if she’d been changed. The work to which she’d dedicated so much of herself had taken on still more meaning. “All of this is devastating,” she says now, weeks later. “And every loss is so horrible in its own ways. But no one is alone. In this hospital, in this community, everywhere—no one is alone.” ■

Interview with New York Chaplain

Recently in Medical Examiner Rabbi Kara Tav is the manager of spiritual care services and a palliative care chaplain at a hospital in New York City. Her Facebook feed in recent weeks has been an almost unbearable portal into the suffering she lives with each day. The pandemic was real to her long before many of us saw its effects. The hospital chaplains who minister to the sick and dying in the COVID-19 era are witness to special kinds of suffering and solitude. I reached out to Tav in the hope that she could share some of her story. Our conversation has been lightly edited for clarity. Dahlia Lithwick: I have a pretty cartoonish idea of what chaplains do. Can you tell me what your days looked like before the COVID-19 era? How are chaplaincies organized? What proportion of patients seek spiritual care? Kara Tav: In health care chaplaincy (as opposed to university chaplaincy or prison chaplaincy or any other kind), I am called a multifaith chaplain. While I was in rabbinical school, I did additional training to become a chaplain. The additional training is very hands-on. I did 7,400-hour units of clinical pastoral education, working in hospitals with multifaith groups. (Basically we were like one of those jokes: A rabbi and a priest and an imam walked into a bar … ) We use an action-reflection model to learn skills—each of us would minister to patients in hospital and then write up our visits (with pseudonyms) as a type of script to review with our supervisor and our group, i.e.: CHAPLAIN: Hello, Mr. Schwartz, how are you doing? I am [X], your chaplain. I wonder if you would like a visit? MR. SCHWARTZ: What the hell is a chaplain? I thought those were guys who came to read you your last rites! We would bring these scripts back to the group and read them together, each of us playing a role from the script. Then we would receive feedback during the reading: “Why did you ignore that question?” “I like that prayer.” “How dare that doctor interrupt you?” “What will you do differently next time?” And so on. In addition to the verbatim, we had intensive group therapy during which the supervisor tried to help us learn about what we personally bring “into the room” and how to “park that outside,” and then later, we learned psychology, some medical terminology and whatnot, educational theory. We visited patients, ran spirituality groups, ministered to staff and families and each other. It was brutal. After this, a chaplain does 2,000 hours of additional work (about two years) in hospital before becoming board-certified, which completes the process. A chaplain offers nonmedical care for the patient, staff, and family. It is much like Father Mulcahy on M*A*S*H, actually. He dealt with the socio-religio-cultural needs of everyone. The entire camp became his flock. I have met ultra-Orthodox men in lockdown psychiatric units who wanted to confess that they didn’t believe in God, and Muslim families who wanted to bury their loved ones in Pakistan but were afraid to ask their nurse to help them because, well, America. I love to advocate for the patient, the staff, the neediest. Love to. This is the second time I have worked as a director of a department. I like the combination of management/mentoring and direct service. And suddenly you are doing this work behind a mask? Behind a Zoom screen? With families over the phone? I’m guessing none of this is how you ever wanted to do this work? No. I hate the phone. I never want to communicate without eye contact or body language. Not about such things as life and death and ethical dilemmas. The mask isn’t new—many patients have infection precautions and you have to “suit up” to go in. That takes practice, but like all things, you learn it. Donning and doffing is a skill like any other. You’ve been posting about ethical challenges, and I am wondering what they are and how they get resolved in the world of chaplaincy. It depends on the times and the hospital system. Generally, ethical dilemmas in hospital are around agency or proxy. As in, does a patient have agency to make their own medical decisions (even if they are weird or unwise medically) or questions about who has proxy to make decisions for the patient? There are issues about transgender patient rites to be called by, treated as, put in units with people of their correct gender, etc. Advocacy. A chaplain’s theological voice adds to the hospital’s business and medical voice, to round out the decision-making, and force it to say about patients as real people. Right now, or leading up to where we are now (keeping in mind that I’ve only been at this hospital for six weeks—yes, started a job at the outset of a pandemic), I was deeply concerned about the institution having a policy so that doctors would feel supported when triaging patients for resources. I was starting to hear docs talk about resources running low and how to behave if that happened. There was terror behind their eyes. And then things changed daily. The system fell back on the policy they wrote around the SARS epidemic that they really didn’t need. And now, our docs have to make very difficult decisions without a lot of guidance. There is an excellent ethics doc with whom I work, but things move very, very, very quickly. He takes calls all day and all night. He calls me once a day and once a night to check in or to tell me what’s happening. And then there are the other nonsexy decisions about resuscitation. If an 88-year-old woman with COPD is on a respirator and coding her will definitively put a team of five young, healthy docs and two or three young, healthy nurses at serious risk of death, but her son says he wants her resuscitated, do you have to do it? He’s her proxy. It’s the law. But the chances that the intervention will save her is .000000000001. … These are not easy calls to make. How can I help? I can tell the docs that the universe decides who lives and who dies, not them. What are the other ways in which the coronavirus has made your job harder? This has made my job hell. Normally my job is to listen, to comfort, to pray for healing. Now my job is to pray for a swift and merciful death for most of my patients. I hold weeping, sweaty-faced nurses through gloves and masks, to whom I promise their work is meaningful and changing lives. I promise them that it’s OK to feel bone-tired, that everyone’s living with nightmares that they’re going to get sick. I have spent this morning making condolence calls (30 deaths over the weekend—we normally have five). A hard question: You write about how different faiths demand different end-of-life rituals. How do you manage that in a time of such need and also such scarcity? Well, we do our best. We know as much as we can about different traditions and we also have distributed a blessing for medical or other staff to offer when no chaplain is available to honor a death. Another hard question: Does any of this affect the way you think about God? Well, there’s a short answer and a long answer to that question. The short answer is: absolutely not! The long answer is that my understanding of God is best summed up by my understanding God not as causing our misfortunes but having created a world of inflexible laws. I do not believe that the painful things that happen to us are punishments for our misbehavior, nor are they in any way part of some grand design on God’s part. Tragedy is not God’s will, so we need not feel hurt or betrayed by God when tragedy strikes. God can be present to help us overcome it, precisely because we can tell ourselves that God is as outraged by it as we are. I was strongly critiqued for holding this theology throughout rabbinical school, for its simplicity. But Harold Kushner’s ideas (that I have represented weakly … sorry) were a foundational comfort to me in my earliest tragic experience and have been consistently dependable. I can’t believe in a God that gives 2-year-olds cancer or kills thousands of fishermen at sea. I just can’t imagine God wanting to destroy God’s own image, God’s own creations. My God is all compassionate, never judging. The patients dying alone, sometimes not speaking English. This is the stuff of nightmares. You have written so powerfully about the aloneness in death. Dahlia, dying is something no one can do with us. We all die alone. Being “with someone” (as in, physically present when they die) is an idea we love because it gives us closure and peace. It is about us, not the patient. The patient is dying. That is their work alone. But not having the closure you want is very hard and sad and a frightening thought. There is a recurring theme in what you write, about how desperately we all need to listen. I wonder what you are listening for and also what you hear? One of my best CPE supervisors taught me that a chaplain “hears differently.” A chaplain hears behind the words and into the heart. I don’t know exactly how to describe it, but it’s true. I was in a family meeting that was very contentious in my first week at this hospital. I visited this very sick woman who hasn’t opened her eyes in several days, whose family is up in arms about how to proceed with her care for her. I witnessed her open her eyes and says in the meekest whisper of a voice: “I want to get off this merry-go-round. I want to go home.” Everyone was shouting about whether she should go home to her daughter’s house or to a nursing home. … I sat in this family meeting in which everyone around the table was arguing and the doctor had lost her cool and the pulmonologist was trying to quiet everyone, and I asked if I could speak. I say, maybe she was asking to go home and we should grant her that wish. Maybe we should “let God’s will on Earth be done on Earth as it is in heaven” (that’s from the Lord’s Prayer). And let her go—hand’s gesture skyward—home. That kind of hearing seems like a no-brainer, but really it is about being not invested in outcome or knowledge or being right. It’s about hearing the patient’s heart.