The Plight of a Hospital Chaplain During the Coronavirus Pandemic

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 fellow-chaplains 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. (Copied from the New Yorker)

Author’s bio: Elizabeth Barber is a member of The New Yorker’s editorial staff.