April 22, 2020

Chaplains at the pandemic’s forefront are striving to offer solace, even if from afar.

By Katja Ridderbusch

When Beth Jackson-Jordan comes home from work these days, she often feels torn. She's saddened by the waves of sickness, death, fear and loneliness that well up around her. But she's also encouraged and grateful. 

"Sometimes, health care can wear you down. And you wonder if you are making a difference," she says. But the people she's working with do, she adds – there's "no doubt about that."

Jackson-Jordan is a hospital chaplain with Emory Healthcare in metro Atlanta. Across the country, providers like her are in high demand as the coronavirus pandemic tears through communities. Yet they are limited in how they can offer spiritual care that is inherently physical, often prevented from entering a coronavirus patient's room due to a dearth of protective equipment like masks.

The situation is forcing hospital chaplains to come up with creative solutions. They rely heavily on technology, speaking with patients and family members over the phone, for example. Nurses and doctors are helping them facilitate prayers, Scripture readings or conversations via FaceTime, Zoom or Skype.

"The spiritual care providers can play a key role in providing comfort and offering ways to cope and be resilient during the COVID-19 crisis," says Nadine Kaslow, a psychologist at the Emory University School of Medicine.

Emory Healthcare, with 10 hospitals in the Atlanta area, is one of Georgia's major health care providers. There are about 100 chaplains on staff across the Emory system.

As director of spiritual health at Emory Decatur Hospital and two other area hospitals, Jackson-Jordan oversees five full- and part-time chaplains, and five chaplain interns.

"None of the technology can replace the human touch," says Jackson-Jordan, who's also an ordained minister in the Alliance of Baptists, a progressive faith group. "But we're trying to adapt the best we can to keep the personal connection."

She remembers, for instance, recently writing a note by hand to a COVID-19 patient. She sealed it in a plastic sleeve and handed it to the nurse who then gave it to the patient.

Chaplains' support can be both emotional and practical. Rabbi Jason Weiner – the senior rabbi and director of the spiritual care department at Cedars-Sinai Medical Center in Los Angeles – says right before Passover, he put a sign at the glass door of an intensive care unit room where a patient had been intubated for several weeks, wishing him a happy holiday.

"When these patients come off the ventilator and out of sedation, and many of them do, they are totally disoriented and have no idea where they are, when it is, and what's going on," Weiner says.

The patient did wake up. The sign was a warm gesture that Weiner says helped the man, who was an observant Jew, reorient to the real world. It also reminded him to adhere to Judaism's strict dietary rules as he started eating again.

"And the first thing he requested was matzo," Weiner recalls, referring to unleavened bread that's eaten as part of Passover.

Keeping a personal connection with patients during a pandemic becomes particularly challenging in end-of-life situations. For Roman Catholic chaplains, a particularly weighty dilemma lies in the sacrament of anointing the sick, which involves touching the patient.

The Rev. Brian Conley, a Jesuit priest and staff chaplain at Brigham and Women's Hospital in Boston, says the shortage of personal protective equipment, especially N95 respirator masks, has made it difficult for him and his colleagues to visit critically ill COVID-19 patients. He adds that when a mask is available, he goes into a patient's room to administer the sacrament.

Also, if a patient is already intubated, an N95 is not necessarily needed, Conley says. Aside from the sacrament, he has administered last rites to more than 20 COVID-19 patients, including "one or two a day" in the stretch of about a week.

In Judaism, a type of last rites ritual can be performed as well, and mainly involves saying a set of prayers. Weiner has done this for a number of COVID-19 patients while standing outside their ICU room, he says, "in the hope that the patient could hear or somehow perceive it in a spiritual way."

Aloneness in dying during the pandemic is often mirrored by isolation in grief, as the crisis has disrupted the normal structures that would support a person through the initial stages of mourning, Conley says. A grieving family member often can't call a friend to come over, for example, or plan a traditional funeral or memorial service. 

"There's the person dying alone," he continues, "and then there's a family member going home alone."

But it's not just the coronavirus patients and their families who suffer. Stringent no-visitor policies are isolating patients who are hospitalized for other serious illnesses or injuries, potentially hampering their mental and emotional healing, Jackson-Jordan says.

The chaplains typically can still see non-coronavirus patients. Jackson-Jordan tells of a patient she recently visited, an older woman who'd had a stroke. Before going in, the chaplain called the woman's daughter and learned that the patient had taught Sunday school most of her life.

The woman was hard of hearing and had gotten used to reading lips – an additional challenge for chaplains wearing surgical masks. So Jackson-Jordan gave her a large typed note with a greeting from the daughter and some Bible verses.

"She didn't seem to understand who I was, but when she started to read the note, her face just lit up," the chaplain recalls.

Along with tending to patients and family members, these spiritual care providers also support front-line clinical staff – doctors, nurses and technicians.

"The level of ethical and moral distress among health care professionals is intensely high right now," says Emory psychologist Kaslow. "Nobody who went into health care as a provider wants to use some algorithm or some formula for who's going to get what kind of support."

Fear of the unknown is another stressor for clinical staff, Jackson-Jordan says. "Information about the virus keeps changing, and people feel like they're operating in the dark," she says.

"Not understanding the enemy clearly is stressful," says Regina Duncan, an oncology nurse and unit director at Emory Decatur Hospital. She adds that it's been an emotional challenge to remain "upbeat, calm and present through all of this."

For clinical staff in COVID-19 wards, it's compounded stress, says Brigham and Women's Conley. Not only are they working 12-hour or even longer shifts in an infectious disease environment, but they're often sitting at a dying patient's bedside, saying words of comfort as the patient passes on – roles normally filled by relatives or chaplains.

From Atlanta to Boston to Los Angeles, social media, video apps and internal television channels have allowed hospital chaplains to provide spiritual first aid to the wounded healers. Some doctors and nurses use Instagram accounts to share their personal stories, and chaplains post non-denominational prayers, inspirational quotes or videos of guided meditation in response.

Sometimes, comfort is offered through a simple face-to-face encounter on the go. Conley says he often stops by a unit and lingers for a little while, asking the staff how they're holding up.

"Right now, there's no time for hourlong, in-depth spiritual care conversations," he explains.

Many chaplains expect the creative and flexible use of technology to remain a part of their work once the crisis is over.

"I couldn't have imagined chaplaincy over the phone two months ago," Conley admits with a laugh. "Yet here we are."

While her work may look a little different in the future, Jackson-Jordan yearns for the day when she doesn't see doctors and nurses at the constant brink of exhaustion and despair – the day when she can go into a patient's room, sit by their bedside, touch a face, hold a hand.

"I will be so happy when I can do this again and not have to worry," she says.

© U.S. News & World Report / Katja Ridderbusch