Spiritual Care at the Front Lines of the Pandemic

Fifteen years ago, if someone was dying inside Duke Raleigh Hospital, medical staff would run to the overhead PA system to ask, “Is there a pastor anywhere in the hospital?”

Back then, the hospital didn’t have a spiritual care program. Today, as COVID-19 pushes hospitals toward capacity, chaplains are essential — at least according to Rev. Amy Canosa, a clinical pastoral educator and chaplain at Duke Raleigh Hospital.

In a typical work week, members of her spiritual care team spend about 70 percent of their time attending to patients and 30 percent offering care to staff. COVID-19 has nearly flipped that ratio. The chaplains wear masks and have their temperatures checked upon arrival so that they can continue to safely care for both patients and staff.

On the day I interviewed Canosa, she had just finished praying for a few staff members after they expressed a need for her to ask God for some hope, and for this to end. Four women gathered, and Canosa offered up a prayer that — as best she can remember — sounded something like this:

God you’re hearing your children who are showing up to work every day and seeking to be faithful. God we are tired. And we are worried about our loved ones. And we’re worried about the people in this place. And we need some hope.

And we need you to show up in ways that we can see. And we need you to help us see the ways in which you are already present, even now. Because God, it is so hard to see you sometimes in the midst of what’s happening. So help give us signs and symbols to help us feel that we are not alone.

Canosa put together a “Chaplain Compassion Cart” full of things that she hopes might bring staff comfort — paper mache flowers, lavender aromatherapy balls, worry stones — and she posted a bulletin board that offers resources and asks staff to share, “In this time of COVID-19, what is getting you through?”

Doctors and nurses have Sharpied in answers ranging from prayer and family to “Tiger King” and red wine.

Canosa sees her job as both ministry and hospitality: At times she’s offering water to loved ones awaiting scary news, at other times she’s giving patients permission to be mad at God. And in these pandemic days of visitor restrictions, Canosa has also played the part of tech support, teaching an 85-year-old-patient how to FaceTime her grandson. In many ways, COVID-19 has pushed the spiritual care team to be nimble and creative, as doctors and nurses are pressed to the limits and don’t have the time or training to take on the added emotional burden.

“We walk in when everyone else is ready to walk out,” Canosa said. “Doctors didn’t get trained to do all that emotional work. And the reality is they have to numb themselves to some of these feelings in order to do their job.”

But chaplaincy isn’t just about compassion, Canosa says, though that’s essential. It’s also about health outcomes. Stress is linked, for instance, to prolonged recovery periods and decreased pain thresholds.

“When there’s a code blue or a stroke — when there’s pandemonium and crisis — everyone goes running,” Canosa said. “We joke that chaplains don’t run. Part of what we do is offer that calm and compassionate presence.”

‘Now is not the time for perfection’

Since 2018, Alyssa Adreani, the manager for the Department of Spiritual Care at Newton-Wellesley Hospital, has kept a Post-It Note on her desk that reads, “compassionate, non-anxious presence” — a daily reminder of what she wants her interfaith chaplaincy to look like. But once the coronavirus grabbed hold of her hospital in the Boston suburbs, she made a slight revision.

“Right now our role is often to provide a compassionate less-anxious presence,” she said. “What I am telling other people, I am telling myself: Now is not the time for perfection.”

But she’s still learning what that less-anxious presence looks like when it comes to spiritual care within the chaos of a pandemic.

“These clinicians are responding to terrible trauma,” Adreani said. “A lot of people have likened our situation to nurses being on a battlefield.”

So she wanted to learn from a spiritual care provider with war-zone experience. The Chaplaincy Innovation Lab, which facilitates conversation between chaplaincy leaders, theological educators, clinical educators, and social scientists, connected her with Andrew Shriver, an Army chaplain, via phone.

Shriver told her that spiritual care in times like these can look quite casual — like gently showing up. It looks like following up with staff and making yourself available. Nurses and doctors usually don’t have time for a heart-to-heart when they’re on the clock.

“For clinical staff, there’s a level of functional compartmentalization.” Adreani said. They just need to get through the task in front of them. “And if [they] break stride, [they] won’t be able to get through the day. And so I want staff to know that they have my support on their terms. Not on my terms.”

As doctors, nurses, and other frontline health care workers throughout the country see increased workloads, chaplains adjust with off-hours support, offering cell numbers and social media inboxes.

Practicing presence via Zoom

Right now at Duke Raleigh Hospital, visitors are only allowed to visit patients during end-of-life situations, one guest at a time.

“Chaplains are the ones walking in with a phone so that loved ones can convey love and care,” Canosa said.

But in other hospitals across the country and world, the regulations are more stringent: Chaplains don’t have an opportunity to be in patients’ rooms at all, a huge obstacle for a person whose primary goal is to offer active presence. Tele-chaplaincy has played a role in spiritual care for years, especially for immune-compromised patients, but the highly contagious coronavirus has proliferated the practice. So what does active presence look like via Zoom or cellphone?

In March, when it was becoming clear that tele-chaplaincy would have to replace in-person care in many situations, the Chaplaincy Innovation Lab put together a virtual town hall to brainstorm. About 1,200 spiritual care providers signed up for the Zoom call, where they learned scripts  that might help facilitate intimacy in the absence of physical presence. These scripts help communicate that they’re available to offer care, regardless of the patient’s faith background. For instance:

One of the things that I am here for is spiritual support. That can mean different things for different people. Sometimes it means supporting people in a certain religion and praying for them. Sometimes it means helping them connect to their meaning and purpose, but not a certain religion. Are you of a certain religious or spiritual orientation?

According to Canosa, tele-chaplaincy can’t replicate the connections formed from sitting in the same room, but at times, the medium can foster a certain anonymity that gives patients and the loved ones of patients permission to be more vulnerable. She likened it to the Catholic confessional set-up.

“Because people can’t see us, there’s that freedom of being more emotionally intimate,” she said. “If I can’t see you, I can pour out a little bit more.”

That being said, both Canosa and Adreani believe tele-chaplaincy is ultimately less impactful than in-person care. Silence over the phone feels different than silence in a hospital room. Hand holding during prayer is impossible.

“But this is so much better than nothing,” Canosa added. “I can’t imagine nothing. Your loved one dying and no one reaching out. And no one offering any care. And no one checking in. So while this isn’t the active presence I would want, this is still a gift.”

Chaplaincy in the time of COVID-19 is about figuring out what “good-enough” care looks like, Canosa explained. This is a loaves-and-fish scenario, she added, invoking the story in the Gospels in which Jesus feeds the multitudes with just a few rations.

The disciples look at the bread and say “there’s no way we can feed all these folks!” Canosa said. “It may not be a four-course meal, but we can feed people, if we have the faith and the imagination to do that kind of work.”