Infection fears have never slowed down Rev. Moneka Thompson. For more than 10 years, she’s visited patients hospitalized at the University of Alabama at Birmingham with tuberculosis, chickenpox, and any myriad of other contagious diseases.
Last March she began to pull on a mask and other personal protective equipment before meeting her first patient diagnosed with a then novel virus. But a nurse barred her from going inside.
“I had never been in a situation where I could not go into a room. Never,” recalled Thompson, a staff chaplain at UAB Hospital, laughing at her own astonishment. “I was like, ‘What? I’m the chaplain. I go everywhere. That’s my superpower.’”
Nine months would pass before Thompson stood beside the bed of a patient with Covid-19.
For nearly a year now, UAB Hospital and others across the country have struggled to balance medical challenges — from preserving PPE to limiting the spread of a highly contagious virus — with the pressing spiritual and emotional needs of patients with Covid-19. Policies have varied by hospital regarding whether chaplains can enter the rooms and how closely they can approach the patient, even now that many have been vaccinated. Such restrictions, while designed to keep everyone safe, can be gut-wrenching when the patient’s longing for spiritual and human contact remains so visceral, Thompson said.
“People need touch, you just don’t imagine how much they need it,” she said. “They are so isolated.”
Thompson is part of a deep bench of nearly three dozen full and part-time chaplains at the 1,157-bed public hospital, located on the buckle of the Bible Belt. Alabama is ranked by a Pew Research Center analysis as the most religious state in the country — tied for first with Mississippi — based on residents’ belief in God, daily prayer and other measures. From March until December, hospital chaplains weren’t permitted to visit patient rooms, in an effort to help conserve masks and other protective equipment, said Rev. Malcolm Marler, UAB senior director of pastoral care. Instead, they relied on phone calls and video screens to support patients as well as anguished family members waiting on updates from home.
But video screens can only bridge so far, said Marler, who has worked as a chaplain at UAB for nearly three decades. “For some families, technology is not their strong suit especially during a time of great worry and anxiety,” he said. “And some of our chaplains are much, much better in person than we are on technology.”
Late last year, Marler went to a hospital administrator. “I said, ‘We need to get in the room. Can we do that as soon as possible?’”
The chaplains have since switched their street clothes for scrubs, either green or red, to help with laundry and infection control. Roughly three-fourths chose to serve on the green team, the color of their scrubs signaling that they will visit patients ill with the virus. Chaplains on the red team have opted not to, whether due to their own risk factors or some other reason entirely, Marler said. “Whatever it was — they didn’t have to say why.”
Thompson, who has severe asthma and thus faces a greater risk of becoming severely ill, still selected the green team. She and the other chaplains were asked to stand apart from the patients, guidance that was promptly tested when Thompson walked into her first Covid-19 room and recognized a fellow UAB employee.
They greeted each other warmly. Even so, the sense of spiritual distance was palpable, said Thompson, who tells everyone to call her Moneka.
“I was aware of my stance in the room, that you have to be 6 feet away,” she said. “A lot of people, they want to hold hands during prayer, and that’s very common in the Black churches. We always want to touch, we want to hug, we want to hold hands. And so, she reached for me.”
Thompson reluctantly declined. “I apologized for that. I felt bad for that.”
At least 6,000 health care chaplains work in the U.S., roughly half of them in hospitals, according to a workforce analysis published in 2020 in the Journal of Health Care Chaplaincy, which looked at the membership of several professional organizations. Nearly three-fourths of the health care chaplains described their religious affiliation as Catholic or Protestant and 12.1% identified as non-Christian; religious data was missing for nearly 14%.
Health care chaplains are trained to become conversant to some degree in a range of beliefs, both religious and more broadly spiritual, said the study’s lead author Kelsey White, a doctoral candidate in public health at the University of Louisville in Kentucky. The latest Pew data, from a 2014 survey of more than 35,000 Americans, found that nearly 23% don’t identify a specific religion.
“At the end of the day what we see is that chaplains are just caring for the sickest patients regardless of their religious affiliation,” said White, whose doctoral research focuses on how health systems use chaplains.
Rev. Corey Agricola, a UAB chaplain who previously served as a Baptist pastor in Texas, doesn’t wear a cross in the hospital, “or anything that could drive a wedge between me and a patient that doesn’t believe like I believe.”
Spirituality, Agricola stressed, emerges in many forms. “It doesn’t have to include church or God or anything about that,” he said. “It’s about what gives them [patients] that meaning and value and allowing them to articulate it. It’s deeply, deeply meaningful.”
U.S. hospitals have instituted a mix of approaches regarding whether chaplains are permitted to enter patient rooms during the coronavirus pandemic, said Rev. George Handzo, director of health services research and quality at the HealthCare Chaplaincy Network, a nonprofit organization based in New York City. But keeping the chaplains out of Covid-19 areas not only deprives patients, but also clinicians awash in suffering who could benefit from a brief hallway chat with a chaplain, Handzo said. “The doctor doesn’t have time to take out an hour for a support group.”
As the pandemic has persisted, Handzo said, “There has been an increased understanding [by hospital leaders] that, ‘Yes, we have to guard against the spread of the virus, but at what cost?’”
Hospitals have been more reluctant to open the doors to community clergy, such as the family’s pastor or rabbi, as they don’t get the training that hospital chaplains must complete, Handzo said. “Does this clergy know anything about hand-washing? Do they know how to don and doff [PPE]?”
At least several complaints have been filed with the federal government’s Office for Civil Rights about lack of clergy access during the pandemic, such as one by a patient at Mount Sinai Health System that his rabbi wasn’t allowed to visit because of Covid-19 concerns. The New York system, which worked with federal officials to resolve the complaint, said that its policy permitted one of the two daily visitors to be a member of the clergy, but revised the policy to make that more explicit.
When such situations arise, one possibility is that there’s been a communication breakdown between the hospital and the family, said Handzo, noting that hospital chaplains possess the knowledge to hopefully work out a solution. At UAB Hospital, community clergy have been asked not to visit patients since last March. Exceptions are made if a patient is nearing end of life and there’s a spiritual need that a hospital chaplain can’t fulfill, Marler said.
These policies and restrictions have been challenging for patients and chaplains alike, Marler said. Before the chaplains could enter the rooms of patients with Covid-19, Marler would sometimes visit the units, standing just on the other side of the door or glass wall that enclosed each room.
“I would place my hands on the glass and just start to say a very quiet prayer,” Marler recounted. “I have had nurses to come up and stand with me,” he said. His voice momentarily choked up as he described how the nurses would sometimes place their own hands beside his own against the pane of glass.
At UAB nearly all chaplains have been fully vaccinated, an uplifting scenario that Handzo describes as increasingly common at hospitals across the country. But precautions are still advised, Marler said. For instance, if chaplains decide to clasp hands in prayer, the recommendation is to first rub their gloves with hand sanitizer.
To connect with patients, Marler has adopted an alternative prayerful approach, one that he picked up from a friend, a retired Methodist minister. Placing one hand over his heart, he says, “‘I want you to know that I am holding you right here in my heart,’ as I pat my chest.”
But it can be difficult amid so much suffering, said Thompson, who admits to sometimes breaking that 6-foot buffer. The first time occurred about a month after she began to visit with Covid patients, when she met with an older woman who was fretting.
“She said, ‘I have to survive this because I have custody of my grandchildren. I can’t die from this.’” Thompson said. “So I was standing in the midst of her grief and her vulnerability and her worry, that angst.”
As the woman spoke, Thompson found herself closing the gap between them. Together they held hands and prayed. Thompson later learned that the grandmother had survived and was able to return home.
As Thompson and others describe the significance of being in the room, they frequently circle back to the power of presence, just being there for patients who often are alone and untouched outside of clinicians. “That there is a spiritual component to that person that needs to be valued and cared for,” Agricola said. “They are being prodded and poked and moved around.”
Agricola also reminds anyone who will listen that just because a patient appears not to be conscious, don’t assume that they’re not aware. He knows that firsthand. He spent two months in UAB’s intensive care unit in 2017 battling sepsis, a chunk of that time on a ventilator seemingly unresponsive.
“I was 100% self-aware, I just felt trapped inside my body,” he said. “I couldn’t make my body respond. Conversations were happening around me that I knew the answers to.”
When patients are so ill, weakened by the virus in body and spirit, UAB chaplains can now offer more comfort than when they were constrained by audio and visual technology, said Marler, describing a spiritual experience from last month.
The husband of a dying patient had asked Marler to say prayers with his wife. Marler entered the woman’s room and though she was alert, nodding in response to a few questions, she was too short of breath to talk.
But then Marler began to recite the Lord’s Prayer, and she chimed in. “She could whisper the prayer with me, not every single word. But at least some of every phrase,” he recalled.
“We ended and I said, ‘This was a holy moment for me to be with you, praying with you.’ And she just said, ‘Thank you.’ She didn’t have much more breath to give.”
She died within hours.