Amidst the burdens placed on the healthcare system in the U.S. by COVID-19, chaplains in hospitals and healthcare centers are facing a new learning curve: how to “show up” for patients when physical distancing is crucial for all who enter into public spaces.
Especially problematic is the need for human contact and support called for when a patient is dying and at the end of life. These concerns have been at the center of recent class discussions in the HDS course “Compassionate Care of the Dying: Buddhist Trainings and Techniques,” co-taught by Cheryl Giles, Francis Greenwood Peabody Senior Lecturer on Pastoral Care and Counseling, and Chris Berlin, Counselor to Buddhist Students and Instructor in Ministry and Pastoral Counseling.
In the reflection below, Giles and Berlin share their thoughts on how, as classes shifted to a Zoom format mid-semester, the realities of remote caregiving became an important theme in class discussions and highlighted the challenges of end-of-life support during the present pandemic.
Giles and Berlin: We typically ask students to consider their own mortality as a way to process fears around being with dying as a way to be more fully present with those at the end of life. We set this work within a context of Buddhist contemplative practice and views of impermanence and death. This has also included processing fear and aversion to death together in small groups and “council practice,” all of which rely on an intimate interpersonal dynamic within a shared holding space.
With the global virus as a backdrop to this work, and then a shift to online teaching, what we were asking students to do in class took on a new significance in both adapting to remote processing together as well as considering the means of remote caregiving for the sick and dying.
The realities of the pandemic became more profound later in the course when a beloved friend of Chris’s died suddenly from COVID-19.
Berlin: This loss was compounded by a feeling of helplessness in not being able to be present with him during his final hours. In many ways, this highlights the overall challenge in spiritual caregiving chaplains are facing at this time: a lack of direct human contact and the grieving in isolation this can cause in those who are dying and among their friends and families. How does one grieve together in a time of physical distancing? How can one support a friend, loved one, or patient dying in isolation?
For my friend, the chaplain in the hospital agreed to talk to him by phone call. As kind and compassionate as the chaplain was, and as necessary as this was for physical distancing, it still felt hollow to know that he would die alone.
Giles and Berlin: For many caregivers, as well as for those training to be hospital chaplains, the need for physical distancing has produced a learning curve in how to do the work of chaplaincy during our present pandemic. In many ways, we are now working with what feels like a non-intuitive approach to doing spiritual care, an approach limited by an absence of in-person physical presence and direct human contact.
The relational process is so key to the work we do as chaplains. We are trained to “show up” by providing a compassionate presence in a clinical space that often feels sterile, cold, and vulnerable for the patient who may be coping with uncertainty, fear, or physical pain or discomfort. And in the case of serious illness, which is often accompanied by existential, spiritual, or emotional crises, chaplains seek to convey understanding, warmth, and a compassionate presence at the patient’s bedside.
This experience of inter-subjective relating in an intimate way holds deep meaningful human value and potential comfort in the encounter between patient and chaplain. The notion of sharing grief remotely or with those in isolation, whether between a patient and their family members or the chaplain, runs counter to a caregiver’s aspiration to enter into the experience of the patient’s own heart and mind.
One adaptive challenge is in the use of technology to accomplish these goals. As participants in the course tracked the unfolding pandemic, learning shifted to the Zoom platform, as has much of spiritual care visits with patients.
Berlin: The Zoom platform became an invaluable tool to arrange a vigil for our dying friend and then a memorial service the following week. The service turned out beautifully and allowed for an inclusive and intimate media experience for all. Another event on Facebook Live involved a candlelit chanting and prayer session for our friend in which many people could participate from their own homes. These events still felt meaningful and provided much-needed chaplaincy encounters for the community.
Giles and Berlin: These kinds of needs ask us to become more savvy with technology in the age of remote chaplaincy. Mourning can still be possible in community with little intimacy lost among participants. In other words, despite the times, there are aspects to remote chaplaincy that signify a kind of artistry through technology.
That said, though, for those who are dying alone, a lack of human contact or the inability to grieve with others remain as challenges to caregiving posed by physical distancing. Yes, bearing witness is still possible; being a companion in a time of grieving through a screen or a phone may offer some comfort; deep listening and conversation about meaningful things can happen. Nevertheless, the growing edges and opportunities posed by this time of pandemic do make us question whether a deeply felt presence is possible at a distance.
And much like we ask our students to do, perhaps the answer lies in both how we might adapt to our own experience of remote learning and our own experience of being supported remotely by others during this time of physical distancing. And then there’s the question of how this pandemic is impacting long-standing inequities in our society, particularly around grief and loss.
Giles: As grief continues to be the new normal, we are acutely aware of the profound suffering of those who experience longstanding disparities: immigrants, African-Americans, and Latinx. During this pandemic, their inequality has been magnified by the sheer number of deaths across the country. For many of us, it’s too painful to turn away. We can use this time to be fully present and ask ourselves: What is my work in the world?
—by Cheryl Giles and Chris Berlin