Times Of Israel
When the spiritual guidance team at Massachusetts General Hospital gathered for the last time 10 days ago, they realized two things: everything about how they practiced would change and nothing about their practice should change.
“The most often used phrase is that we provide a ministry of presence. I had a teacher who told us, ‘don’t just do something, stand there,’” Mass General’s Rabbi Benjamin Lanckton told The Times of Israel via telephone. “Our job is to be a non-anxious presence, and without face-to-face interaction that’s hard. But what I’ve learned over the past week is that virtual visits are not nothing.”
Welcome to the world of “tele-chaplaincy.”
Giving comfort in the time of COVID-19 presents unique challenges for Jewish clergy, who like their colleagues across faiths, are used to connecting in person. Now they must deliver that comforting, quiet presence for patients and hospital personnel from afar. It’s a need that’s only growing as the number of coronavirus cases in the US surges. As of March 25 there were 53,852 confirmed cases nationwide and 728 deaths, according to the New York Times.
On a normal day at Mass General, Lanckton might stop by a patient’s room and offer words of solace, a story, a small joke or perhaps a prayer. He might speak with a member of the custodial team who needs a comforting word or chat with a physician on the surgical floor. Now there is no normal.
Illustrative: Asia, left, looks on as Eva, a Jewish patient takes bread after Rabbi Gabi, right, blesses it with a traditional Jewish blessing at the hospice at the St. Louis Hospital in Jerusalem, April 1, 2008. (AP Photo/Tara Todras-Whitehill)
Instead he checks in with his colleagues each morning via Zoom. Then he’ll begin making rounds on the telephone. Recently he called a patient who was in the surgical intensive care unit.
“I said a prayer for healing and then I waited,” Lanckton said. “It was a long silence and at first I thought we got cut off. Then she spoke, her voice breaking a little. I think if we can still do this, say something meaningful, then we are still doing something for patients,” he said.
Sometimes he and his team can do something more than make a phone call. Last week he worked with his colleagues to make sure an Orthodox patient, whose family could no longer visit because of new restrictions, could at least receive a prayer book from them.
But making the transition to online chaplaincy has not gone without a hitch, said Rabbi Neil Loevinger, spiritual care director and ethics coordinator at Vassar Brothers Medical Center in Poughkeepsie, New York.
“For some patients it’s great. It’s like calling an old friend and feels very natural. For others it can be more difficult, if they have trouble using a phone or technology,” he said.
Loevinger said adaptability is key, and so where a phone call might work for one patient, a video conference might better suit another patient.
At Vassar Brothers, which is part of the Nuvance Healthcare System, Loevinger said he and his fellow chaplains are working together to make this new reality work for their patients — and for the hospital personnel, whom they also serve.
“I look to the story of Passover, which is, in part, about adapting to a new reality,” Loevinger said. “The Israelites went on a journey and it didn’t always go smoothly, but their story gives us a model for how to do that. Throughout history Jews have been tremendously adaptable, whether by choice or circumstance.”
Meanwhile it’s been three weeks since Rabbi Shaul Praver, who is both a prison and hospital chaplain in Connecticut, stood beside someone’s bed. Instead, he counsels patients and hospital staff on the phone.
He said he and other chaplains are learning on the job.
“We know that 90 percent of communication is body language, but we must also remember how much we can convey in our tone of voice, cadence and trope. We are finding ways to compensate, and we are all sharpening our auditory skills,” Praver said.
As these chaplains master new methods of communication, they are also steeling themselves for what’s to come — increasing numbers of coronavirus patients, patients dying alone, and family members unable to visit dying relatives. They are also bracing for hospitals pushed beyond capacity and for hospital personnel to be stretched beyond their limits.
“Our last face-to-face meeting felt very much like the one we had immediately following the Boston Marathon bombing,” Lanckton said. “The difference between then and now is, that incident was time-limited. Now it feels like we’re perpetually at the moment where the bomb is going off.”
That sense of heightened anxiety makes it vital that chaplains check in with each other. Neshama, the Association of Jewish Chaplains, holds regular Zoom check-in calls for chaplains. And as they work to provide spiritual connectedness while social distancing, the spiritual caregivers know they’re not immune to the virus.
Indeed Rabbi Mordechai Katz, a longtime member of the spiritual guidance team at Manhattan’s New York University Langone Hospital, remains in critical condition due to the virus. The hospital couldn’t comment because of privacy laws.
It feels like we’re perpetually at the moment where the bomb is going off
“This is a very challenging time to be a chaplain. The need is so great, and what we do, which is help people find their spiritual and resilient core, is so necessary in the weeks to come,” Loevinger said.
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Bari Weiss
NY Times
[emojis my own]
Few run toward the dying. Even fewer run toward the contagious.
But chaplains do. They ministered to the sick before this pandemic turned their hospitals into war zones. And they will do so after this plague subsides, whenever that day comes.
Doctors and nurses focus on healing the physical; chaplains are there for everything else. They are men and women from every religious background and none. Their job is not to convert, or to convince people to believe in God. Some don’t believe in God themselves [馃槙馃槦] . Their job, in the words of the Rev. Kaylin Milazzo, a palliative care chaplain at NYU Langone Medical Center in Manhattan, is “to be present with people in their suffering.” Theirs is a ministry of presence.
In the world B.C. — Before Covid — the place of the hospital chaplain was at the bedside, holding a patient’s hand, counseling them and their family members, singing with them, crying with them, hugging them, offering a prayer for healing. None of that is allowed now.
Family members are barred from hospitals. There are no masks and gowns to spare for chaplains, so they aren’t allowed into patients’ rooms. The sickest patients can’t speak because of the breathing tubes in their mouths; many are unconscious.
“My new world is faceless,” Rabbi Kara Tav, a chaplain and the manager of spiritual care at NYU Langone Brooklyn, told me. “The patients are intubated, and I can only see them from a tiny window. And the doctors have masks and goggles and gowns and caps — they are all covered up. You don’t get to feel them or see them in the same way.”
There is no touch. There is no body language. Sometimes there isn’t even eye contact.
“A hug is a very big weapon in my arsenal,” said Rocky Walker, the chaplain of the cardiovascular wards of Mount Sinai in Manhattan and a retired Army major. “And I can’t use it right now.”
And yet the essential work of chaplaincy remains the same: to facilitate connection. Between patients and doctors. Patients and families. Patients and God.
“I have to use my words to replace the hug,” said Mr. Walker. “And if there was anyone who wasn’t proficient in Zoom, they are very proficient in Zoom now.”
The Rev. Dr. Beth Glover, who oversees nearly 50 chaplains in the NewYork-Presbyterian Hospital system, told me about one chaplain who stood outside a dying patient’s room with the patient’s wife on the phone, praying and describing to her what he was seeing. It was “a way of being present to her and bringing her husband’s presence to her, even remotely.”
Rabbi Tav calls it “tele-chaplaincy.”
The Rev. Dr. Rachelle Zazzu, a chaplain at Mount Sinai Hospital in Queens, has adapted the bedside memorial to suit the new reality. She will stand outside a patient’s room, put her hands on the door and “pray out loud for God to receive this person with mercy and grace.”
These days she’s showing up even when it’s not her shift, because she works in Queens, “the epicenter of the epicenter” of coronavirus cases in the United States, she said. “I come in on the weekend because I couldn’t say to God: ‘I didn’t come in because I don’t get paid on Saturday.’”
Chaplains told me that the Covid-19 pandemic was unlike anything they had seen before in the intensity of the sickness, the speed at which it can lay a person low, and the sheer number of deaths.
Mr. Walker told me that the pandemic reminds him of serving in the Persian Gulf war — except that “I’m closer to death now than I was on the very front lines of combat.”
He praised the courage of the doctors, nurses and cleaners who work alongside him, saying, “It’s not natural to go racing toward someone or something that is trying to kill you.”
Before the plague hit, the primary job of hospital chaplains was tending to patients and their families. Now the emphasis has shifted to caring for their own colleagues.
Maggie Keogh, a nondenominational chaplain with a Buddhist philosophy based at Mount Sinai in Manhattan, said: “I have never seen doctors or nurses living through anything like this. They are the most profoundly professional group of people, but there is a bone-weariness.”
It’s not just that they’re working flat-out. It’s that they are working flat-out knowing that doing so puts them and their own families at risk.
A chaplain who works at a Veterans Affairs hospital in New York City and asked to remain nameless told me that every morning when he walks into the hospital, the nurses and security guards say, “Pray for us; pray that we make it through the day.”
Dr. Zazzu told me she gets in every morning at 5:45 so she can be there in time for the “change-of-shift huddles, the I.C.U. huddles and the E.R. huddles,” when health care workers catch up on their caseload.
“These are people who are overcoming their own fear and exhaustion to do the job they are called to do,” she said. “I am the safe place to express their sadness, their fear, their grief.”
Mr. Walker said doctors and nurses staff are clearly struggling. “Yesterday I was told, ‘Go to this unit — they had four deaths.’ Then it was, ‘Go to this unit — they had three deaths.’”
“Healing the healers is the core of my work right now,” said Rabbi Tav.
But the line between the healers and those in need of healing gets more porous by the hour. Those who work with Covid-19 patients are acutely aware that it could well be them, or their family members, in that hospital bed.
“If someone has end-stage cancer I can be there for them, but at the end of the day, it’s not my reality,” said Rev. Milazzo. “I can be present but separate. But now we are worried about the same things as our patients and their families; we are worried for our own health; we are worried for our own families. Spiritually and emotionally it’s very difficult.”
One of her own colleagues, Rabbi Mordechai Katz, is in critical condition with Covid-19.
“Some of my chaplains are ill,” said Dr. Deborah Marin, who oversees the chaplains in several hospitals in the Mount Sinai network. “One of my chaplains worked so hard from home she relapsed.” Dr. Marin also worries about her own daughter, herself a Mount Sinai doctor.
If anything can shake a person’s faith, it seems an indiscriminate epidemic like this would be just the ticket. Why does a person in one bed die while the person in the next bed recovers?
And yet not one chaplain I spoke to said this outbreak had done anything to diminish his or her faith or sense of purpose.
“The thing about faith is faith is based on trust, not on understanding,” said Mr. Walker. “I don’t pretend to understand this.”
“My belief system is that we all have a certain amount of life within us, a certain amount of time,” Dr. Glover told me. “Everything we do is a way we are spending that time. I keep coming back to that, in the midst of my concerns and fears. And what feels true to me is to stay true to my purpose in life, which is to be with people when they are sick.”
Ms. Keogh became a chaplain 10 years ago, after her husband died following six months in the intensive care unit.
“It was a real spiritual, existential crisis for me,” she said. For her, healing comes by helping others through the same experience.
“Other people are like: How can you do this?” she said. Her answer is: “This is giving back to me so much.”
Rabbi Tav told me that people think the work chaplains do is “dark” but that good can sometimes come from darkness. “I actually think that when people are in their most broken places they have the most honest conversations and they’re the most open,” she said. “Their hearts are open. Their families are open. Sometimes pain brings people together.”
But the pain remains.
“Yesterday I made the hardest call I had to make as a chaplain,” Mr. Walker told me. He had a phone conversation with the family of a patient scheduled, but just before the call, the man died unexpectedly. The family answered, expecting to hear a regular update, and instead learned their loved one was dead. “To hear the family member scream like that,” he said, faltering, “was unnerving, even now.”
“I just felt so helpless,” he told me. And then “you have to move onto the next patient.”
“Saturday I couldn’t get out of bed,” he said. He has a mentor, a rabbi, and he thought: “It might be time to give the rabbi a call.”
