“Powerful Strangers”: A Reflection on Spirituality and the Chaplain–Doctor Partnership

What is Spirituality?

Spirituality is the way your humanity expresses itself. Spirituality is the backdrop against which your spirit engages with others—people, nature, the universe, and the Divine. It is sometimes housed in buildings of worship, but it is often housed around a table of friends, in an art gallery, in a concert hall, or unhoused beneath the stars or on a sandy beach. It is the way that your being, your center, gets renewed day by day, year by year, and finds replenishment amidst the routine and dramatic griefs of this life. It is what brings you joy. It is what brings you to tears. It is what fills you with a sense of wonder or feeds your appetite for beauty. It is the inarticulable, unpredictable “something” that occasionally lets you look at another human being and think, “Beautiful.” It is the gift of gratitude. It is the release of being forgiven, and forgiving another being. It is listening to a piece of music and catching a glimpse of some other kind of language for being that eludes our rational minds. It is cradling a cup of coffee on a cold winter morning and feeling a blanket of peace descend upon you. It is the way you can sometimes know, in some deep place within you, that you can be at peace without feeling peaceful. It is what allows you to hear your name and, very occasionally, feel an affection for what that name invokes. It is what connects you to a handful, or a roomful, or a universe full of tiny, miraculous reasons to be here, and it is acknowledging that “you must treat your ‘here’ as a powerful stranger.” ¹

We are all “here,” in a ‘here’ that is both shared and different from anyone else's. We co-create a “here” with our patients when we meet with them as chaplains and physicians. We know that there is a space between us and them, a chasm that need not be menacing, but that should be treated with respect and caution. When we introduce ourselves and ask them questions, we are finding ways to communicate across that gap, to let the emptiness it holds be transformed into generative space, space that can listen as much as it speaks; space that is curious; space in the shape of cultural humility and non-certainty. We must remind ourselves that our goal must not be to close that gap, to erase that fissure completely. The temptation to understand is great, and some depth of understanding is necessary for trust and empathy—“nothing human is alien to me”—but the ability not to understand is equally vital.

In this mysterious meeting of practitioner and patient, self and other, our own questions and values and experiences encountering their own questions and values and experiences, something inchoate is created—and it is that space where patient-centered spiritual care happens. It is the specialty of chaplains who are trained as experts in this area, but it is the work of every clinician who walks into the room and meets the patient in their territory and in their story. To attend to the whole person and the story they are telling about their sickness, and the story their sickness is telling about them, requires paying attention to their body and their spirit—and just as chaplains need to be aware of the body as much as the spirit, so also the doctor needs to be aware of the spirit as much as the body. The mind–body–spirit trichotomy no longer holds up as an accurate model; we know the three are connected and are constantly shaped by and shaping the others, and they spill into each other so that clear distinction becomes impossible. To care for one is to care also for the other two. In this way, our roles are necessarily intertwined, partnered like a trellis beneath which our patients can stand and be fully seen and treated in their humanity. Patients need doctors to pay attention to the story of their illness, and to care for them with compassionate expertise, because doing so is an act toward health and a statement about what it means to live in our mortality. Patients need chaplains to listen with particular attentiveness to the way they narrate their emotional experience, and to bear witness to the way their spirituality plays out against the backdrop of their illness (and vice versa)—for illness and spirituality are in turns both the actor and the setting. The ways a patient narrates what is happening to them and the ways they hold the questions, thoughts, and feelings their illness provoke are all essential to the process of recovery—as well as the why of the recovery, which necessarily impacts the how; their beliefs about who they are and why they are not only inform their medical decisions, but also their will to live or not to live, how they relate to their loved ones, their medical providers, and the hospital system as a whole.

Thus, chaplains and doctors need each other in order to best be who they are in their vocations, and our partnership itself becomes an embodiment of spiritual care—we practice with each other the kind of care we should give to our patients, for ours is a relationship of care that depends upon cultural humility, a posture of generosity, the ability not to understand, and respect for the other's expertise and the way that our distinct interventions with/for the patient express themselves in ways that touch and inform the interventions of the other. Together, we treat the patient holistically, incorporating their whole being and sense of self, healing what we can and at the last turn, when healing has reached its natural end, bearing witness—with our creative and vulnerable selves no less than our competent or professional selves—to the mystery of “the end of life, which has its own nature also worth our attention.” ²