Being the Gap: Chaplains and COVID-19

By G. Jeffrey MacDonald

Until recently, the director of spiritual wellness at St. Luke’s Health System in Kansas City had not seen her staff chaplains equip nurses to perform sacred rituals at the bedside. Such measures hadn’t been needed before now.

But these are not normal days at St. Luke’s, where about 200 beds at the downtown hospital were set aside in April for patients battling COVID-19. Bracing for rising death rates among contagious patients who can’t have visitors, suburban chaplains now fill paper bags with prayer cards, cotton balls and scented oils for nurses to use.

Chaplain Sarah Byrne-Martelli | Photo courtesy of Byrne-Martelli

“If a chaplain is not available at the time of death, a nurse could go ahead and do something for the patient – say a prayer or maybe anoint them with some oil,” said the Rev. Susan Roberts, an Episcopal priest who oversees chaplaincy for the 18-hospital health system. “That’s new. It gives them something else they can do in the time of death when they know there’s not family” present for comfort or support.

Chaplains are finding new ways of being a non-anxious presence in healthcare settings, often without being physically present at all, as they guard against contracting or spreading the virus themselves.

Such an endeavor — to be present but at a distance — involves incorporating physical items into their ministries, from masks and gowns to candles and iPads, in attempts to create barriers and bridges alike. They’re hoping such physical tools will allow them to minister effectively despite restrictions at a time when suffering and isolation are surging along with COVID-19 cases.

“I see the weariness on some of my chaplains with the emotional weight that they are carrying,” said Roberts, who is president of the 250-member Assembly of Episcopal Healthcare Chaplains, a professional association. “It’s from their concerns about their own families and from filling the gap for families that can’t be together. We are the gap.”

At Massachusetts General Hospital (MGH), palliative care chaplain Sarah Byrne-Martelli is wearing a mask and gown for the first time in her 17 years in chaplaincy. On the COVID-19 floor to which she’s assigned, she stays outside patient rooms most of the time. That’s for two reasons: to avoid the virus and to conserve the hospital’s personal protective equipment (PPE), which is needed for nurses and others who must attend to patients directly.

Such barriers are necessary, chaplains acknowledge, but it’s still hard to feel close to a patient without being physically near. And it’s hard for even the most intuitive to interpret what family members are longing to say or do when facial expressions are hidden.

“We’re all wearing masks now,” said the Rev. Gretchen Steffenson, a staff chaplain at Tucson Medical Center in Arizona. “It used to be that how someone set their mouth or the way their nose wrinkled meant you might be able to anticipate [a family member’s need]. Now you can’t see those things. The nonverbal cues that used to be guideposts are different now. A lot of chaplaincy is nonverbal, but we’ve had to shift that.”

For safety’s sake, even the recently deceased now have their heads covered during final rites. The Rev. David Fleenor, director of clinical pastoral education and a chaplain at Mount Sinai Health System in New York City, notes how ministry in the morgue has changed. On a recent morgue visit with a chaplaincy student, he kept the cover over the face of a woman who had died of COVID-19, while he said prayers and gave the Commendation from the Book of Common Prayer. That was for two reasons: her adult son, who had requested the visit, was with Fleenor only via telephone, which meant he couldn’t see her anyway; and Fleenor had been advised by a pathologist to take precautions in case the corpse had a high virus count and might still be contagious.

He recalled what the son said after the prayers.

“The son was apologizing to his mother that he couldn’t be there,” Fleenor said. “He was saying that he loved her. He thanked her for all that she had meant to him. It was just a really interesting moment where I’m standing there with my student, holding an iPhone with this son on the phone, grieving.”

Fleenor was mindful that he ordinarily would have been looking at the woman’s face with the son by his side for such a ministry moment. But nothing has been routine lately.

“Under normal circumstances, we would uncover the head of the deceased person as a way of personalizing and honoring the dignity of this person,” Fleenor said. “This time, we laid the rosary on top of the woman’s body, which was covered. But we didn’t actually see her face.”

Chaplains say their hospitals sound very different as well. Visitors used to be a constant presence; now the hallways are eerily quiet. COVID-19 patients are generally allowed no visitors. Instead, hospital staff act as proxies for family members, even if death is imminent. Other patients face strict limits, such as 15-minute durations or just one visitor at a time, among other constantly changing guidelines. The quiet stands in stark contrast to the heightened pace and intensity of the medical work.

These restricted environments take a toll even when a patient’s illness is unrelated to COVID-19. Byrne-Martelli recalled finding a young wife alone at the bedside of her nearly unresponsive husband who was dying of cancer. “Normally she would have been there with her mother-in-law and father-in-law,” Byrne-Martelli said. “Thankfully I was able to be with her, to sit with her and to pray. I encouraged her to put on their favorite church music. At one point, the singer sang, ‘alleluia’, and the patient squeezed her hand really hard. The wife just burst into tears. It was really heartbreaking.”

Chaplains find they need to “be the gap” for staffers, too. At MGH, they’re highly trained health professionals serving at a level one trauma center, but they haven’t ever dealt with anything like this.

For example, before the pandemic, nurses on Byrne-Martelli’s COVID-19 floor had seen almost all their patients recover. They would leave the hospital feeling better and expressing gratitude. Now death is all too frequent. In one recent 18-hour stretch, one-third of all patients on Byrne-Martelli’s COVID-19 floor died, she said.

To help staffers cope with the magnitude, Byrne-Martelli and her colleagues established a structured time in the afternoons for nurses to gather for 30 minutes, read the names of patients who had passed, and share from their experiences of caring for each one. Chaplains at MGH have also created new “serenity spaces” where staff members can sit with candles and other soothing accoutrements.

“It’s almost like a little break room, but we’re making it nicer than usual with readings, snacks, and that kind of thing,” Byrne-Martelli said.

Creative chaplaincy initiatives are helping family members as well. Because Tucson Medical Center is a one-level facility, Steffenson encourages loved ones to make use of the courtyard, where they can find a patient’s room from the outdoors and have conversation through a closed window. If anyone has trouble hearing in that set up, cell phones can be used for amplification.

And in institutional settings where COVID-19 has been kept at bay but precautions have been nonetheless disruptive, chaplains are doing what they can to transform physical spaces where residents can no longer gather.

At Saint John’s on the Lake, a retirement community on Lake Michigan in Milwaukee, chaplain Jana Troutman-Miller set up a YouTube channel to deliver morning prayer from the chapel. She also delivers uplifting and encouraging videos filmed at other familiar, comforting spots around the St. John’s campus.

In a dining area that’s now closed for meals, Troutman-Miller has laid a floor covering with a labyrinth design on it. Now residents who drop by for the majestic lake view aren’t as saddened by the empty space that they’ve long associated with meals among friends and family. Individuals now walk the labyrinth’s winding paths to feel grounded and connected.

“It looks like the labyrinth should be there,” Troutman-Miller said with a chuckle. “It’s taking a space that otherwise wouldn’t be used and really being able to utilize it in a special way during this time.”


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