Hospital Ministry

Working as a hospital chaplain introduces one to the emotionally charged and challenging world of the sick, a difficult world that requires infinite reserves of understanding, patience and humility. Nothing I had done before as a priest prepared me adequately for the task.

Hospitals are notoriously clinical environments with well-established, highly structured procedures that govern all aspects of health care. Everything is digitized with the typical nurse-attendants continually engaged with keyboards and computer screens, monitoring, entering data and accessing information. It is a very businesslike environment. Patients are prodded, poked, tested and shuttled back and forth for various procedures on a daily basis.

It is a bewildering existence that leaves many in various emotional states ranging from total defiance to passive acquiescence, resulting in a variety of behaviors. Some refuse to take medication clamping their jaws firmly shut or hiding their arms under bedding; others demand special meals refusing the prescribed hospital diet; some complain excessively and continually call assigned nurses. At the other end of the scale are those who gaze out their window all day or stare at the ceiling, not wanting much human interaction.

It is all totally understandable. These persons have been literally yanked from their normal human, productive environments where they felt useful and engaged and were thrown into a world where they have practically no control. Their familiar surroundings and usefulness have disappeared, practically overnight. If there is one topic patients are always willing to discuss it is their discharge date. The cruellest information to receive is the news that one may not be going home “anytime soon.” It leaves one feeling socially irrelevant, a difficult thing to deal with under normal circumstances but more so in the hospital environment.

As chaplains we enters these domains with great trepidation. You literally never know what to expect from one visit to the other. On the rare occasion you encounter an engaging, smiling, socially attuned individual who has come to terms with their condition. But equally common is the experience of being asked to leave, with the remark “I don’t want to see any priest.” You learn to leave your hale and hearty attitude at the door, most patients do not really care to be cheered up. You also never ask “How are you feeling today.” Many are not feeling too well, hate being in the hospital and don’t want to talk about it. A good morning is often all that is needed as an introduction.

There are of course the more crucial aspects of hospital ministry which are sometimes not as easily apparent to the occasional or regular visitor, including the long or not so long deterioration of the terminally ill in palliative or critical care, the immanent death of a loved one in the emergency unit, the loss of a new born baby in the birthing suite, an attempted suicide, a murder victim or the decision to discontinue the use of life support aids. All these are immensely stressful to family members and require a pastoral approach which reflects a high degree of care and sensitivity, but also a faith orientation which stresses a providential God. It is often better to say little and rely more on simple gestures and actions that offer hope and reassurance. The simple act of joining hands around the bed side of a dying family member and allowing everyone to pray in turn after the sacrament of the sick is administered helps to allay some of the fear and hopelessness families feel on such occasions. These occasions can be nerve wracking for the chaplain in terms of their unpredictability and the highly charged atmosphere.

But perhaps the greatest challenge hospital patients feel comes from the simple fact that illness and confinement gives one a lot of time to think, typically about one’s mortality. For most it is the first time they consider the sober reality that life comes with an expiry date. It is not that we don’t know this, but in a confined hospital room most of our life “props” are removed. Particularly for the long-term indeterminate patient.

Separation whether from persons or our regular life routines exacerbates this condition and creates tremendous anxiety. Most of the research indicates that there is also a sex difference in response to hospitalization (Aisenberg, Wolff, Rosenthal). Men make physical attempts to control the environment while women use verbal and observational skills to effect control. Be that as it may, it is often a time of severe emotional disturbance for many. John Bowlby who has done extensive research in this area likens the process of hospitalization to grief and loss and proposes three characteristics of this experience which affects both men and women: protest, despair, and detachment. This can last anywhere from one to several weeks.

These emotional states have their corollary in the spiritual life of the hospitalized. Their image of a loving caring God is called into question. “Why did this happen to me? What did I do wrong? Why is God punishing me? Is there really a caring God above?” Many of the hospitalized feel betrayed, abandoned, hurt and angry. Chaplains are often called upon to simply sit and listen as patients “vent.” All part of the process of coming to terms with their changed circumstances. It is all part of a faith journey which Karl Rahner explains in this way: “We never know when lightening will strike us out of the blue. It may be when we least expect to be asked whether we have the absolute faith and trust to say yes.” Our work as chaplains is to enable them to say “yes”, when everything in life is shouting “no”.