Health & Medical Question

To complete this assignment, you must seriously consider the journey you have been on so far as an undergraduate to explore various religio-cultural backgrounds both in and beyond the classroom.

• You will need to consider how your exposure to examples of patients from different religious and cultural backgrounds via your healthcare experience as well as your initial survey of our course modules has helped you to understand the person-centered nature of patients’ healthcare needs.
• This will entail reflection on what approaches you can use to gain awareness, understanding, and respect for patient-specific values.
• In light of all this, an exemplary assignment submission will provide substantive answers to the following questions:How do you comfort those who are suffering when you’re not allowed in the room?What might it look like for you to provide care in moments of suffering that goes beyond concern for the body and mind to also include care for the spiritual/religious dimension of patients?Based on your experience and what you have read for class today, how might this additional component of spiritual/religious care be explained as an essential feature of taking a person-centered approach to patient care?

On Religion
The Plight of a Hospital Chaplain During the Coronavirus Pandemic
How do you comfort the suffering when you’re not allowed in the room?
By Elizabeth Barber
April 14, 2020
Kaytlin Butler
The hospital chaplain Kaytlin Butler says the work that health-care providers do is sacred.Photograph by
Caroline Tompkins for The New Yorker
Kaytlin Butler, a chaplain at Mount Sinai Hospital, often tells the sick that they do not have to be alone.
She says it to them even now, when hospitals have barred many patients from receiving visitors. In the
past few weeks, Butler has been saying it to them over the phone, reaching the suffering in rooms that
no one can enter except masked medical staff. She has been saying it to patients’ families, also over the
phone. And, if a patient is sedated and no family can be found, she has prayed outside the door, trusting
that the person in the bed will feel connected—to her, to everyone—by that ineffable thing that she
calls God, but for which many people have many names. Butler does not care if they call it God. She
cares that they feel loved.
Butler, twenty-six, is one of eight chaplains on Mount Sinai’s Spiritual Care team. The team, which also
has four residents, includes two rabbis, a Jewish woman who is not ordained, a Seventh-day Adventist, a
woman who is inspired by Buddhism, and an evangelical Christian. (The hospital is also served by two
Catholic priests, who are sent by the New York archdiocese.) The staff are divided by unit: pediatrics
chaplain, cardiology chaplain. Butler, who expects to be ordained as a Presbyterian minister later this
year, is the hematology and oncology chaplain. Right now, though, all of the chaplains are also covid-19
chaplains.
Chaplains, who provide existential support in secular contexts—from prisons to colleges to airports—
have been working, in some way or another, since ancient royals staffed their courts with priests. Their
job, as Butler sees it, is to accompany people who did not want or expect to be where they are, and to
comfort their loved ones. Her priority, when doing that job, is to listen. Butler wants to hear any story
that the people she is working with might want to tell, or any fear or hope or desire that they might be
ready to express. Her goal, as she listens, is to help people make meaning of their circumstances. That is
true if the diagnosis is cancer, or if the diagnosis is the novel coronavirus.
Butler has a cubicle on the second floor of Mount Sinai, upstairs from the chapel and across the hall
from the synagogue. Her window used to look out on Central Park. Now the view is of the tented field
hospital run by Samaritan’s Purse, an evangelical organization led by Franklin Graham. Each day, medical
staff refer patients to Butler for chaplain visits, or relatives call the hospital to ask for chaplain services.
On a recent Friday morning, Butler had received three requests. One was to make a call to a covid-19
patient’s daughter, since the patient, who was intubated, could not speak. Butler got on the phone and
prayed with the daughter, who wondered if there was any way that she could address her mother, who
spoke a language besides English. Butler stood outside the mother’s room with her cell phone on
speaker. The family was Catholic. From a cardboard box, Butler chose a scapular and a rosary and put
them in a plastic bag for a nurse to take to the patient’s bedside.
The other two calls were to covid-19 patients. Both of them were Pentecostal Christians. Butler dialled
one, a woman, from her office phone. The woman told Butler that, though she was afraid, she also felt
loved by both her family and God. Butler affirmed the woman’s feelings, and then she made the other
call. This time, the patient told Butler that he was afraid that God was punishing him. The man wanted
to tell Butler how he had angered God: he had done something of which he was ashamed, he said, and
he was sure that this was God’s retribution. Butler listened to him as he explained what he had done.
She asked him if he could forgive himself.
No, he replied. He couldn’t.
“God has a lot more grace for you than you have for yourself,” she told him. “When I listen to you, I hear
someone who really loves the people in his life, and is deeply faithful, and takes responsibility for his
actions.”
They said a prayer for peace together, and when Butler hung up she felt uneasy. She was sad for the
man, and she felt powerless. But what more could she do than call again and hope that he would still be
there to pick up the phone?
Recently, a nurse asked Butler where God was in all this. Butler does not believe that there is one right
answer to that question. “For myself, I don’t see the disaster as something that is made or wrought by
God,” she said. “I think God shows up in the places where people are trying to save lives and clean up
this mess that others have mismanaged.” Butler told the nurse that God was right here, crying with us.
That afternoon, Butler got a call from a group of doctors. A covid-19 patient, intubated and sedated,
didn’t have long to live, the doctors told her, but no one could identify any family members. Would she
go to his door and say a prayer for him? Upstairs, Butler could see the man through the door’s glass. She
put a hand on the door and closed her eyes. Butler calls God “She,” and it’s in the love that people show
others that Butler sees Her. But when families request prayers for loved ones, she honors their
traditions. For Muslims, she says the Shahada. When the patient or the family are Christian, she says an
extemporaneous prayer, and sometimes an Our Father, which she finds particularly beautiful. If they are
not religious, she says a neutral blessing.
No one knew if the man in the room was religious or not. Butler decided to sing an Irish blessing: “May
the road rise to meet you / May the wind be always at your back. . . . And, until we meet again / May
God hold you in the palm of his hand.” Butler hoped that, if he could hear her, he would not object.
Butler lost her mother when she was eight years old, in a dune-buggy accident near Pelham, Georgia.
The town was small: four thousand people, maybe fewer. When she was in middle school, her father, a
Southern Baptist, got married again, to a woman who had grown up Mormon. In a peculiar compromise,
the two agreed to attend a Presbyterian church outside Atlanta, where Butler was moved by ministers
who spoke about equality and justice. In college, in Georgia, she majored in international affairs and
religion, minored in Arabic, and studied abroad in Morocco. Then she went to the progressive Union
Theological Seminary, in New York, where she hoped to study both her faith and those of others. Butler
wanted to do all the things that her mother, who died at twenty-eight, did not get to do. Next, Butler
thought, she would go to law school.
Instead, she found that she was called to ministry. After seminary, she began a chaplaincy residency at
Mount Sinai, where her clinical supervisor was David Fleenor, an Episcopalian priest who directs the
hospital’s clinical pastoral education program. The residency was something of an accident—Butler had
needed a job, and this one had presented itself. She had never spent much time in a hospital, and she
had one year to learn a new profession. But, one day, when Butler was going through something hard,
she was moved to see Fleenor crying along with her. She understood, then, that this was the job: sitting
with someone in their pain.
Recently, Fleenor has been acting as the director of Mount Sinai’s spiritual-care program; the usual
director, Fleenor’s wife, is out sick, with what the couple assumes is the virus. (Fleenor had come back to
work in late March, after being out sick himself.) Usually, the team’s eight chaplains and four residents
are not enough for the patient volume at the hospital, which has more than eleven hundred beds. Now,
the team was down by three—two were out sick, presumably with covid-19; the other was on maternity
leave—and the hospital was fashioning extra rooms out of tarp in its atriums, to accommodate more
than six hundred covid-19 patients. The need had become tremendous, and Fleenor and Butler had
developed a new deployment plan to triage care. The plan divided the hospital’s patients into three tiers:
covid-19 patients in the I.C.U., other patients with the virus, and everyone else. The tiers weren’t
hierarchical; the idea was merely that categories might help the chaplains reach those who were most in
need. For example, it might not make sense to dial a virus patient in the I.C.U., if that person couldn’t
pick up; instead, the staff could call lonely people in tier two.
The care itself had its own complications. For weeks, Mount Sinai’s covid-19 chaplaincy has been
conducted exclusively by phone. Some staff, like Butler, still come into the hospital. Other chaplains are
working from home. But, when making phone calls, all of them have modified their usual language.
Chaplains help the dying and the recovering alike, but Fleenor knows that many people perceive them as
angels of death, bearing last rites or bad news. He asked his staff to describe themselves as members of
the patient’s care team, there to provide spiritual support, rather than as chaplains. This seemed to be
working well.
Like Butler, Fleenor grew up in a conservative tradition. By eighteen, he was a Pentecostal preacher, in
southwestern Virginia. But, in seminary, in Tennessee, he did an internship in clinical pastoral education
that changed his ideas about what was true. “It was the first real thing I had experienced in my life,” he
said. “Preaching and praying, and being a charismatic preacher, there’s a lot of illusion in all that. There’s
not much illusion in walking into the room of a dying person. You can’t bullshit that.”
Fleenor discourages chaplains from using platitudes when talking about awful things. When training
them, he has a favorite icebreaker: How would you like to die? “Nobody says, ‘I’d like to die gasping for
air, alone,’ ” he said. The fear of a lonely death is foundational to palliative care, and hospitals all over
the country have No One Dies Alone volunteer programs. “Now we have a pandemic that requires you
to die alone,” Fleenor said. “It is very distressing to hospital staff. It is very distressing to patients, God
help them.” And yet, in many ways, Fleenor has found that chaplains are doing the same work that they
always do. In ordinary times, Fleenor tells his trainees to “pay deep attention, and listen, and let people
know that they have been heard by you, and, in some mystical way, have been heard by God.” He still
tells the residents that. But now he also tells them to be present, and to do so by being absent.
Butler lives alone, in Harlem, and on a recent Thursday morning she took the bus to work. She wore
burgundy Uniqlo pants, a navy shirt, and old, peeling Clarks heels. At the hospital, Butler knows that the
stream of doctors, nurses, and tests can be confusing, and she often tells patients to ask for the chaplain
with the big hair, if they forget her name. But sometimes her work only tangentially involves a patient.
That afternoon, for example, Butler took a call: a man had died, suddenly, of covid-19. His nurse was
distraught, and the rest of his medical team wondered if Butler could comfort her. Butler found the
nurse crying in a stairwell.
Butler believes that the work that health-care providers do is sacred. Since only providers can enter
patients’ rooms, they are—at least during the pandemic—called upon not just to attend to patients’
physical needs but to help facilitate their goodbyes. Chaplains, meanwhile, are meant to focus on
patients and their families, but they have deep, trusting relationships with their colleagues, and they
want to help. When care teams lose longtime patients, Butler sometimes hosts meetings at which to talk
about and grieve the loss.
Butler sat down near the nurse. The two women wore masks over their mouths. Butler told the nurse
that her tears were a gift to her patient—they affirmed how much she cared for the man. “It’s so
honoring of who he was,” Butler said.
The nurse asked Butler if she was going to Hell. In the coming week, many nurses would ask this
question. Their patients were dying. Would God hold them responsible?
Butler was stricken. She told the nurse that her patient had died in a crisis that was bigger than her care,
and that she had done everything she could to save him.
“I and your team will know that for you, until you are ready to know it yourself,” Butler said.
Inside, though, Butler was angry, even scared. She was worried about getting the virus, and she was
worried about her family getting it in rural southwestern Georgia, where there are few medical
resources. It was almost Holy Week. In a few days, Christians would commemorate Jesus’ death on the
Cross, and then celebrate his resurrection. “It’s one thing to say that love always triumphs over death,”
Butler said. “Some years that you’re saying it, you’re not living it. This year, we all are. And this is one of
those years that you kind of need other people to believe it with you.”
Butler finds it easiest to believe when she sees nurses and doctors holding iPads over patients on
ventilators, insuring that the sick can speak with their families. She believes it when she sees her fellowchaplains working beside her, and when she checks her phone and sees all the messages from family,
and from friends who are like family, checking in to tell her that she, too, is not alone. They remind her
that suffering is outside her control. “The thing about all apocalyptic seasons of life, whether it’s a
pandemic or a cancer diagnosis, is that the things that were already true become more true,” Butler said.
“The connection between people—I have more faith in that than I have ever had.”
After comforting the nurse, Butler left to call the dead man’s wife. The medical team had already given
the woman the news, and had asked if she’d like to talk to a chaplain. She’d said yes. Often, Butler likes
to ask the bereaved about the person they’ve lost. But the woman was devastated, and all Butler could
do just then was promise to pray for her husband. She got off the phone and stood at the door to the
man’s room. She could see his body inside. Then she prayed that God would bless him and keep him,
and hold his family, and that they would be comforted by one another.