One Christmas eve, the pager attached to Dick Beattie’s hip erupted: pediatric intensive care unit. Beattie arrived within minutes and scanned the ward for his patient. It was a newborn, so small and brittle and blue, swathed in a tangle of tubes and encased in glass. Beattie baptized the infant quickly — sprinkled holy water, murmured a line of prayer.
“In the name of the Father, and of the Son, and of the Holy Spirit.”
Eventually, when it became clear that the baby would not learn how to breathe on its own, the parents agreed to remove life support. Beattie sat with them for some time afterward — listening to them grieve, praying with them, holding their hands as they cried. He stayed long after the bustle of nurses had subsided, long after the doctors had gone.
Reverend Dick Beattie has been a chaplain at Yale-New Haven Hospital for 15 years, performing emergency baptisms and visiting countless bedsides, offering communion and prayer. The notion of a hospital chaplain — engaged in a sort of spiritual triage amidst the chaos of medical crises — might seem secondary in an institution explicitly devoted to the mending of bodies. And at Yale-New Haven Hospital, it often appears that the only results are visible results: platelet counts up, fevers down, a deep incision sewn smoothly shut.
As the daughter of an atheist physician father and a deeply spiritual mother, I’ve long considered medicine and faith to be as polarized as my parents’ religious ideologies. But Beattie believes that healthcare has changed in recent years. “It’s not just focused on the body anymore,” he tells me.
A hospital used to be a quieter, simpler place. There were moments of idle conversation between patients and doctors, doctors and nurses, nurses and patients. “There were no pumps on the floor, little technology when I first started working as a nurse 25 years ago,” said Dale Copeland, a nurse in Yale-New Haven’s general medicine unit. “Back then, you had time to sit with the patient, hold their hand, and talk.”
But now — as patients live longer and illnesses become more complex — hospitals are overcrowded and healthcare staffs are inundated. “We need chaplains to pick up that slack,” Copeland said. Today’s chaplains take time to listen, echo, and offer insights. They are a sounding board for patients’ fears and existential doubts. And while the medical community is, in Beattie’s words, entirely concerned with “expeditiousness,” chaplains help to humanize and personalize the cool protocol of hospital care.
***
Reverend Peg Lewis — director of religious ministries at Yale-New Haven Hospital — has a smooth, gentle voice and a creased face that seems softened around the edges. Today, she is wearing a peach-colored blouse and small gold earrings shaped like ducks. Across from her, a woman with painted-on eyebrows and a blonde wig is seated in a big blue armchair next to a hospital bed.
“My children grew up with a fire in their belly. All five of them.”
“That’s because you are such a good mother, Carol.”
Carol smiles. “Men are always harder to raise.”
“Your children love you so much.”
“I know. I know. My daughter called this morning. She’s calling again this afternoon, she says, so I’m looking forward to that.”
A nurse sweeps into the room. “You need blood work done, Carol,” she says. “And your doctor wants to know what the stats are now.” She slides paperwork onto Carol’s nightstand.
“This is the most efficient nurse in the whole hospital,” Carol laughs.
When the nurse leaves, Carol leans back in her chair and reminisces. She talks about her mother, her grandchildren, her church, and the neighborhood where she grew up. Lewis listens intently.
Finally, Reverend Lewis takes Carol’s gaunt hands in her own. “I look forward to seeing you again soon,” she says sincerely.
And so Lewis drifts in and out of rooms in the oncology ward, stopping to sit and listen and nod. Sometimes the women discuss the cancer, the surgery, the horror of the treatments they’ve endured. But usually they speak of their families and friends, the smells and sounds of home.
In one room, Lewis finds a woman dressed and sitting, waiting for her husband to pick her up. Her room is strewn with the evidence of a long hospital stay: discarded magazines, torn envelopes, a profusion of flowers turning brown on the windowsill. Her cheeks are flushed and her eyes are bright with excitement at the prospect of home.
“I admire you so much, Jean,” Lewis tells her. “You’re in my prayers a lot.”
“Thank you, Peg. Thank you.”
“I’ve enjoyed having a chance to talk to you.”
“I’ve enjoyed it too. But I don’t want to repeat it.” Jean laughs ruefully. “We’ll meet somewhere else, I hope. Please God, not here.”
The last room Reverend Lewis visits is dimly lit and quiet, except for the drone of medical equipment and the steady drip of the IV. Esperanza Diaz — 82 years old, toothless, and engulfed in a too-big hospital gown — sits in a chair by the window. Esperanza is recovering from serious surgery. She is wearing red socks and her small feet dangle. A threadbare Bible sits on her nightstand.
When Lewis enters, Esperanza’s face brightens.
“Peg,” she says, “I saw Him.”
Reverend Lewis is quiet, nodding for her to continue.
“After my surgery. He came to me.”
She was unconscious, Esperanza says. She saw an old man emerge from whiteness. “He had a graceful look on his face,” she remembers.
“He asked me, Esperanza, where are you going?
I don’t know, I said.
Well, you have to go back.
I don’t know the way.
I’ll take you, he said. You have to go back. It’s not time for you today.”
And then, with a jolt, she returned to her body.
When she finishes the story, her cheeks are shining. “That was a beautiful experience,” she says. “Even though I was in outstanding pain, my spirit was at ease.” Her voice is steady and sure.
“I am not scared. But I really want to stay with my family. Just a few more years before I go to Him,” she adds, her eyes fixed on the window as the clouds shift under the sun.
***
Hospital chaplaincy has not always consisted of quiet, unobtrusive bedside ministering. In 1924, a Presbyterian minister and former mental patient named Anton Boisen became the country’s first hospital chaplain at Worcester State Hospital in Massachusetts. Believing that certain illnesses arose from “problems of the soul,” Boisen aimed to “break down the dividing wall between religion and medicine,” according to records from the Association for Clinical Pastoral Education.
In 1930, Boisen developed the Council for Clinical Training of Theological Students, a system for educating chaplains that has now grown into a network spanning the United States. In a 1950 speech before the Council, Boisen said, “We are trying to call attention back to the central task of the Church, that of saving souls, and to the central problem of theology, that of sin and salvation.”
Fifty-eight years later, about 60 percent of hospitals in the United States have on-site ministries. But crusading to “save souls” is no longer part of the mission; most hospital chaplaincies classify themselves as “interfaith” and make a concerted effort to bridge the ideological gaps between all denominations.
Yale-New Haven’s chaplaincy currently includes two Episcopal priests, a Presbyterian minister, a Roman Catholic priest, a nondenominational Christian chaplain, and a Reform Jewish rabbi. “We are trained to link patients specifically to a person of their faith if they so wish it,” Reverend Lewis said. The goal of religious ministries, she said, “is to provide spiritual care to patients, families, and caregivers,” and “spiritual care” is not always rooted in any particular doctrine.
“Oftentimes it has a transcendent quality — not just their one little life but their life in a larger context, which might be multigenerational, multi-religional, communal,” Lewis said. “Spiritual care means exploring with another person what it is that gives their life meaning.”
The chaplains interact with patients in several ways: they perform bedside visits — listening to the stories of the critically ill, easing patients through a process of life review and exploration of what has been meaningful in their lives — and respond to the on-call pager. Pastoral students must endure 400 hours of interfaith training and five periods of 24-hour on-call pager coverage at the hospital before they can apply to be certified by the Association for Professional Chaplains, the national certifying board. Only one on-call pager circulates in religious ministries; it is passed among the full-time chaplains 24 hours a day. “You can never leave the pager alone,” Lewis said. “The medical staff calls it and we respond. Trauma. Death. Code blue when someone goes into cardiac arrest. When someone is dying and they want us, we’re there.”
The hospital pays chaplains’ salaries, and — though they are considered part of clinical services along with the dietary, social work, and rehab departments, Lewis said — they work closely with nurses and physicians. And today, hospital chaplaincies and medical staffs are collaborating more than ever in patient care. According to the American Hospital Association, there were about 32 million inpatient admissions to community hospitals in 1998. By 2005, this number had reached 36 million. “Due to the pressure of rapid medical care delivery, staff is stressed to the limit checking numbers, data, and new findings,” said Thomas Stewart, a psychiatrist on the medical and surgery floors at Yale-New Haven. “Few people are in a position to find out thoughts going on emotionally with a patient.”
The evolving role of chaplains in the medical sphere may be due to a variety of changes in the field of medicine. “Medicine has cycled from paternalism — where doctors assume they give orders and make all decisions — to an enormous stress on patient autonomy from the seventies until the beginning of this century,” said David Smith, director of the Yale Interdisciplinary Bioethics Center and author of Partnership with the Dying: Where Medicine and Ministry Should Meet. “Now, the limits of the great stress on autonomy and individualism have become clear. People do want to make their own decisions, but they also want support. A doctor today is more likely to ask a patient if he’d like to see a chaplain.”
Lewis’s office has salmon-colored walls that are lined with spiritual relics: a Hebrew prayer, a picture of the Western Wall in Jerusalem, the framed message, “The glory of God is the human person fully alive.” She tells me, “I love my work. I fell in love with the privilege of being with people at important moments in their lives.”
Lewis is curious about my background: she asks what I study and why I’m interested in it. Even though she tells me several times that being a chaplain means one must always be open to discussing religious matters with different kinds of people, she never asks me about my religion, and I’m relieved — because I’m not quite sure what I’d tell her. I’m Jewish, agnostic, skeptical, hopeful. My mother grew up in an Orthodox home, steeped in rituals and a blind, pervasive faith that she embraced unquestioningly. My father is a neurologist — a clinical, logical thinker who has never taken religion seriously. I’ve long thought of religion as a cultural rather than spiritual identification: a nostalgic fog of holidays and family traditions that I’ve come to take for granted.
Reverend Lewis tells me that she was not particularly religious until she lost her parents, her grandfather, and her father-in-law within a three-year period several decades ago. She was then drawn back towards her church, ultimately attended Yale Divinity School, and is now an ordained Baptist minister. She had studied literature in college, as I do now, and she thinks this is why a vocation that involved hearing human stories appealed to her at first.
“They were holy stories,” Lewis said. “It felt like holy ground.”
***
Reverend Dick Beattie wears a clerical collar and a burnished metal cross around his neck. He has a pink face, deep dimples, and a wide, warm smile. In conversation, he winks frequently and tilts his head towards me in an impish, conspiratorial way. And as he strides down the halls of the hospital, calls of “Great to see you, Reverend!” and “Come visit more often, alright?” — from both patients and medical staff — echo in his wake.
Before he became a chaplain, Beattie was a comptroller for a social service agency in Stamford, Connecticut. “On the side, I was doing workplace chaplaincy before that became a common phrase,” he said. His co-workers would come to talk to him to unload their problems and concerns. Beattie enjoyed counseling his co-workers more than being a comptroller, so he decided to go though the Episcopal ordination process. “I just had a gut feeling that I needed to be doing something else with my time,” he said.
Reverend Beattie is now the chaplain for the geriatric ward at Yale-New Haven, and he spends his days listening to elderly people recount tales from their past. “Stories are often told in metaphor,” he said. “You have to unbundle the metaphor to figure out what’s wrong.”
For instance, one man kept repeating a story about playing semi-pro baseball in his youth. He was the catcher. It was a sunny day. The batter hit a high foul ball. “I looked away,” the man said, “and the coach hollered at me for taking my eye off the ball.”
The man was in the hospital because he had recurring congestive heart problems. He hadn’t been feeling well, but he thought he could deal with it himself and it would go away. Now, Beattie realized, he was upset because his daughter had become his coach — scolding him for losing focus on his disease — and he felt that he had failed her.
“If you don’t understand the story,” Beattie said, “you lose a lot of understanding of the process. People are realizing that medical facts don’t give total insight.”
Once, a woman was brought into the emergency department because she was showing signs of a heart attack. Her breathing was shallow and her heart was pounding. The cardiologist approached Reverend Beattie and said, “Why don’t you go talk to her to see if you can figure anything out?”
So he did. Her son lived nearby, the woman told him. But he was going to New Jersey for the weekend. Beattie asked her if she was afraid. She wouldn’t have anyone to take care of her, she said. Her other son lived in Hartford and that was too far. So Beattie called her son in Hartford and explained the situation, and he gladly agreed to come stay with his mother.
Meanwhile, the doctor motioned Beattie towards him.
“Whatever you’re doing, keep it up,” he said. “Her vitals keep coming down.”
As it turned out, pure anxiety had been causing the symptoms; the woman’s heart was fine.
***
Sitting across from Reverend Beattie in his cluttered office, I find myself envisioning what it might be like to be a patient at Yale-New Haven — imagining how I, as a nonreligious person, might react to an interfaith chaplain wearing a clerical collar and cross. At first, the thought makes me a bit uneasy. But then Beattie says, as though reading my mind: “There’s a vulnerability people feel here. We have to be careful not to proselytize or evangelize. To do interfaith you have to be well-grounded in your own faith.” Beattie grins warmly, and I nod.
Nurses routinely ask patients whether spirituality is important to them upon admittance to the hospital, and patients who answer “yes” are then referred to hospital chaplains. “But if someone says, ‘I’m not religious,’ it might mean they don’t go to church,” said Susan Asher, a chaplain and coordinator of pastoral education at Yale-New Haven. “It doesn’t mean they’re not sitting in a bed going, ‘why am I sick, I’ve been a good person all my life.’ That’s a spiritual question.”
Some patients, however, are still wary of the chaplaincy and clearly want nothing to do with prayer or faith. One patient yelled, “I never asked to see you,” when Lewis entered her room. And an elderly Jewish man once told Beattie: “I can’t believe you didn’t try to convert me.” Chaplains admit that being truly “interfaith” takes practice. “In the beginning, it was a little hard to leave Jesus out of it,” one chaplain said.
But the staff of Yale-New Haven’s religious ministries is trained in the art of neutralizing or shelving personal religious backgrounds when interacting with patients. “Though my understanding of the transcendent is Christian,” Lewis said, “that’s just the particular way I enact my spirituality.” Hospital ministry is more about listening and repeating, she says, than imposing any kind of doctrine.
In fact, the origin of the word “chaplain” suggests a certain sacrifice or personal restraint. “Chaplain” is derived from the Latin capella, a reference to the cloak that St. Martin — in Christian tradition — once ripped in two so that he could give half of the garment to a beggar. The small remaining portion of St. Martin’s cloak was guarded in a sanctuary by priests called capellani, a term that eventually came to refer to clergymen who devoted their lives to a greater good but were not attached to any particular church.
A few years ago, a local college student died from alcohol poisoning. He was found unresponsive in his bedroom the following morning. Later that day, Reverend Lewis was paged and asked to sit with the parents as they said goodbye to their son. They gathered in the hospital’s “bereavement room,” where bodies are arranged so that the family members can spend their final moments with the deceased.
They all sat in silence for awhile, taking it in. The mother rocked in her chair.
And then Reverend Lewis watched the woman approach her son and say — Lewis knew — what she needed to say:
“How could you do this? How could you be so stupid? What did you do? What did you do?”
Eventually, they all said a prayer together. Lewis helped them call their other child. “It was important just to be another human presence for them,” Lewis said.
Through it all, sitting next to that boy’s mother as they prayed, witnessing her wrenching grief, Lewis could only think of one image: Mary at the foot of the cross of Jesus. But she never said this out loud. And when the boy’s parents left, Lewis took a moment to compose herself before her next visit. Then a nurse came to prepare the bereavement area for the next family, and the room was again quiet and clean.
***
In early November, the Hastings Center — a nonprofit dedicated to exploring bioethical issues — published a report called “Can We Measure Good Chaplaincy?”. It included an essay entitled “Lost in Translation: The Chaplain’s Role in Health Care,” which said, “Chaplains often describe their work in health care as the ‘translation’ between the world of the patient and the world of hospital medicine.” The chaplain thus serves as a liaison between two worlds: the antiseptic orderliness of medicine and the emotional chaos that serious illness inflicts.
Another chaplain in the Hastings Center report wrote: “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.” Since the chaplain exists outside the framework of institutional medical care, Dr. Stewart said, “his ministrations will be perceived differently than mine will be. I’m wearing a white coat. I could say the same thing but the meaning it has will be different.”
Today’s chaplains work to bridge the gap between the daily procedure of hospital trauma and the staggering force of emotional response. “We work with sane people under insane conditions,” said Dr. Stewart. “People are just so hysterical here. They’ve lost many of the anchorages in their life, and chaplains help to reconnect people with their spiritual roots, which can be enormously stabilizing.” Ideally, chaplains offer some shred of solace to people left reeling under the grip of tragedy so total that all sense and structure collapse.
“Doctors help people transition to death. But when you get to the point when you can’t help, we ask a chaplain,” said Dr. Jose Salvana, an HIV specialist at Yale-New Haven. “In a depressed patient, talking to a chaplain can be therapeutic. It’s sort of like another medical intervention.”
Dr. Salvana remembers one instance in which an elderly man’s health had deteriorated so much that the patient was delirious with dementia and spiking fevers sporadically. The patient’s daughter was very attached to her father, but the medical staff ultimately convinced her that the least painful option was to ease him into comfort care. But the patient held on; though he’d been expected to die within 24 hours, he was still alive three days later. Dr. Salvana began to worry that he’d made the wrong decision by abandoning aggressive life support measures. He asked Reverend Beattie to come in and talk to the elderly man. The patient died the next day.
His daughter, Dr. Salvana says, finally felt at ease. She left thinking that the chaplain’s visit was what let her father go, what he had been waiting for.
***
It’s a beautiful November afternoon — one of those brisk fall days when the leaves explode in oranges and reds. The view outside the hospital windows is dizzying. You can see beyond New Haven, past the trim, glossy hospital buildings, past Yale’s imperial spires. The rooftops are sharp against an incandescent sky. I’ve never seen the city look so fresh and bold and bright.
Reverend Beattie is on call today, and he’s chatting jovially with the nurses in general medicine when the pager rings.
“Neuro ICU,” he says, and he’s off, taking the hallway in long strides.
In the neurological intensive care unit, an elderly woman is dying. She has suffered a massive brain bleed, and her family is gathered at her bedside to turn off life support.
Reverend Beattie walks to the foot of the bed and begins the pastoral blessing.
“God the Father, have mercy on your servant.”
The woman has thin white hair and is swallowed in blankets. Her chest rises and falls faintly.
“God the Son, have mercy on your servant.”
The room is dark and silent, except for the beeping of the heart monitor and the occasional shuddering breath of a brother or daughter or son.
“God the Holy Spirit, have mercy on your servant.”
Her cheeks are smooth and her face looks very calm.
“…That it may please you to grant her a place of refreshment and everlasting blessedness.”
A nurse enters quickly to adjust a dial. She squints at the heart monitor, makes a note on her clipboard, and leaves. The woman’s relatives put their arms around each other, murmuring softly. The air in the room seems to have settled. Beattie steps out into the hall and exhales.
“As a chaplain,” he’d said earlier, “You are representing the presence of God.”
It’s getting late, and Reverend Beattie has to head back to the geriatric ward to pay a few bedside visits. For now, at least, the pager is quiet. Beattie stuffs a prayer scrawled on loose leaf into his pocket and wishes me luck. Then he smiles — that melting grin that puts me, like his patients, instantly at ease.
As I walk through the neuro ICU — past the rows of whitewashed rooms, past stretchers and IV equipment and family members clustered in the halls — I remember something Reverend Lewis had told me that morning: “Working here,” she’d said, “has made me more spiritual.” I step through the glass doors that open onto the busy street. I close my eyes, just for a moment. And I think of Esperanza and Carol and Jean in their hospital rooms, waiting for test results, or a phone call, or a visit from someone, looking out the window at the leaves and the roofs and the sky.