Saturday, July 18, 1998

Hospital chaplains taking on greater roles

By Eric Adler

Knight Ridder Newspapers

You're Jewish. You're in the hospital. You're not a regular member of any Kansas City area synagogue, but right now you're ill and scared and would like to speak to a person of God.

Chances are, before last September most area hospitals would have met this request by asking a local rabbi to visit or by dispatching an ecumenical hospital chaplain who nonetheless would have been Christian.

But now it's Rabbi Nathan Goldberg who comes knocking. At 29, he is the Kansas City area's first full-time Jewish community hospital chaplain.

"Some people are still surprised when I walk in the room. This is so new, they didn't know I existed," said Goldberg who, though based at Menorah Medical Center, travels 1,000 miles a week to visit Jewish patients at most of Kansas City's hospitals. A second Jewish chaplain, he said, is now being trained at Baptist Medical Center. This year the first Jewish Institute for Pastoral Care, designed to train Jewish chaplains, is expected to open in New York.

With chaplaincy's roots deep in Christianity, Jewish chaplains were virtually unheard of a decade ago. But a decade ago, it was also unheard of to have Buddhist or Hindu hospital chaplains. Now, nationally, they all exist. Together they embody just one of the many ways hospital chaplaincy in America is changing.

Just as managed care, life-preserving technology, law and the growing awareness of the importance of spirituality in patients' lives have changed medicine, they've also changed spiritual counsel, said Dick Millspaugh, president-elect of the Association of Professional Chaplains and director of chaplaincy services at Boone Hospital Center in Columbia, Mo.

The time is past, he said, when hospital chaplains mainly sat by patients' bedsides for comfort, to anoint the sick or to confer birth blessing or prayers at death.

Hospitals - unlike the average parish, church, mosque or synagogue - are dramatic places in which life-and-death choices are made every moment of every day:

Do I take my baby off the ventilator? Do I donate my mother's organs? What do I do about this living will? Should I take this experimental treatment for cancer, AIDS, Parkinson's or any other disease?

Increasingly hospital chaplains are asked by patients and physicians to weigh in on such matters. By necessity, hospital chaplaincy over the years has become its own specialized profession, with its own board certification requiring a master's degree and hundreds of hours of postgraduate clinical pastoral education in everything from psychology to law to crisis management to bioethics.

"We have to be more knowledgeable in a great many areas," said the Rev. Jenni Malewski, a nondenominational staff chaplain at the University of Kansas Medical Center.

Moreover, with the economics of managed care designed to treat and release patients quickly, hospital patients tend more and more to fall into two groups. There are those who are treated quickly and released, requiring chaplains to establish spiritual rapport faster than ever before. The second group are patients who are admitted as very sick.

Nearly 80 percent of Americans now die in hospitals, making grief and bereavement counseling an ever-growing part of the chaplain's duty.

"I don't think the general public has any idea how much death there is in hospitals," said Malewski, who estimates that, on average, she counsels someone who is dying or families of someone who has just died at least once every day.

Beyond their duties to patients, chaplains increasingly are extending their duties to the hospital employees and to the surrounding community. Today it's not uncommon to see hospital chaplains involved with area AIDS groups, church immunization programs, health departments and grief counselors.

In Columbia, Millspaugh is now hoping to take the role of chaplaincy even further, beyond the spiritual support of just patients and staff. His hope is to help foster greater spirituality in the institution itself.

His idea, which he plans to present this year to hospital decision makers, is to require hiring supervisors to answer eight or nine specific questions on the spirituality, though not religion, of all of the hospital's job applicants.

He believes that answering such questions as "Do you feel enlivened or drained by the job candidate's spirit?" and "Does the job candidate have a sense of calling for the job, or is it primarily a means to earn money?" - would help ensure that the entire organization is working in the same positive spirit.

To be sure, hospital chaplains know that such demands are pulling them in more directions. But Goldberg and others point out there isn't any other direction they'd like to go.

"I think the hospitals are beginning to realize that there is a certain wholeness to their patients that they have to deal with," Goldberg said. "Each day will be very, very different. But it is very meaningful."

(c) 1998, The Kansas City Star.

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