Leading from the Liminal: A Snapshot from One Healthcare Chaplain During a Pandemic

Liminal used to be one of my favorite spiritual terms: betwixt and between. Neither here nor there… Occupying a space on either side of a boundary. Inhabiting transition. But starting a healthcare chaplaincy residency in the middle of the two biggest deadly surges of a global pandemic is so not the romantic, hopeful, juicy spiritual training ground one imagines when they assign the philosophical term liminal to a very visceral and traumatic, drawn out, violent circumstance. I want to know the place inside me where I can step back and pan out beyond the limitation of time and space and know with certainty that there is value and life-giving among all this life-sucking and death. I believe in that space even when it feels distant or absent, or I would not get up and drive into work every day.

I recite this prayer and invite you to say it, bolstered by the faith of survivors of the Holocaust:

“I believe in the sun even when it is not shining.

I believe in love even when I cannot feel it.

I believe in God even when he is silent.”

“Chaplaining” during a global pandemic is a whole new kind of leading from the liminal.  The leading aspect of chaplaincy comes into play when one considers moving and living and working based on a collective soul understanding that God may not be working in the ways we want, expect, or have seen before; but that God is present and active in, through, and with us!

I re-entered the field of healthcare chaplaincy, no longer an intern, but a resident in the Fall of 2020, between the two great surges of hospitalizations, deaths, and staff shortages due to COVID.  We came into a line of clinicians who had never left the battlefield, in order to claim the “P” in PTSD.  Permanent rather than Post Traumatic Stress Syndrome makes more sense.  There are many studies and treatments for living with Post traumatic stress syndrome, but what can be an intervention for ongoing, intense, timeless feeling, life threatening stress and mass casualty in often undignified and unaccompanied circumstances?

Preparing for my own pandemic deployment and coming late to the game, after 8 months of solitude, not working, self-care, and nearly constant long distance contact with my friends and family, I could intuitively feel and anticipate the warranted exhaustion, anger, fear, and frustration.  But imagining it, does not compare to seeing and feeling the intense and intimate suffering of hoards of people who are faced with a reality no one wishes to ever accept; but everyone trying to “fix, heal, and/or cure” the bodies, minds, and spirits of a time such as this must face. 

No one enters civilian healthcare expecting to see mass casualty.  That is relegated to war-time medics.  There are emergency procedures and protocols for things like transportation or natural disaster accidents involving more than 10-15 people at a time.  But I work with nurses who had only seen 2 deaths in the first two years of their hospital careers, who had begun facing two a day, every day during the first and hardest wave of COVID.  Thousands and thousands of people died alone in empty, impersonal, fluorescent lit, sterile environments.  Many units or make-shift facilities have no windows or glass on the doors, and were in corridors surrounded by PPE and life-saving equipment that was only used for emergency circumstances, limiting patient/staff contact as much as possible, and breaking hearts and spirits.  Other units were mobile, and make-shift in parking lots and public spaces, where cots could lined up- yes, like war times. Many people either had no access or were not alert enough to use technology to call or face time with their loved ones.  If they were lucky a nurse, doctor, or respiratory therapist, maybe the occasional chaplain would happen to be in the room to hold the person’s hand through gloves, gowns, masks, and every other kind of physical barrier to intimacy.

While I wrote in a previous blog about my experience of what happens spiritually when a person is transitioned beyond their body, a piece which gives me great peace and builds the foundation of my faith in these times, I now need a piece (and a peace) for the people rushing around outside the empty rooms or crowded wards of rows of beds.  The trauma, cognitive dissonance and moral injury for: being assigned to terminally extubate people. Perform a violent and dangerous full code when the heart of a COVID positive patient stops and there is no chance for recovery but the family says, “Do Everything!” To choose who should get assistance of a ventilator. To be at one bedside feet away from the next person who dies and have just missed holding their hand.  To see body bag after body bag wheeled off a unit and put into a refrigerated truck.  To work in a robust, privileged suburb accustomed to manicured lawns and posh entertainment, which now houses a tent in its hospital parking lot to increase bed space for the sick and dying.  And my friends, that is not even the detailed description of the patients’ experiences…

People in healthcare join to fight and cure illness, to accompany vulnerability, and stretch limits.  No one joining healthcare could have imagined or trained appropriately for a time such as this. Right now I am curating what I call a Purple Binder full of prayers, blessings, centering techniques and aids, and self-care prompts, in order to offer momentary support and solace to healthcare workers when a chaplain can not be physically present with them.  If people have the chance to sit down and use the resources and materials, that alone will be a change from what many experienced before- so over-worked and understaffed they stopped drinking water on shifts because they couldn’t even break to use the bathroom or eat a full meal on twelve hour shifts. 

As a sensitive, intuitive person arriving on scene from isolation and prayer I have struggled deeply with my own meaning-making and my own ability to weather the presence of these heroes who were running on fumes when I arrived and are now digging deep to re-form the front lines against what we are now seeing as the same threat from Spring 2020.  Utter shock, amazement, honor and gratitude is the only response I have emotionally.  Professionally, I keep showing up and asking them each shift how it is for them that day; and saying “thank you”.  Some talk, some don’t. But they are all showing up. 

In chaplaincy we call one of our primary interventions “providing a non-anxious presence.”  Seriously?! Is any human fully awake to the crisis we continue to plow through after these first 9 months truly expected to achieve a state of non-anxiousness?!  I will say, buffered by what I call the Holy Spirit, and people’s supportive prayers, there are moments of it; but as a colleague who braved COVID rooms with her own body and presence suggests: Perhaps it is more appropriate to aim for being “a less anxious presence.”  I love it!  So much more realistic, and kind to ourselves. 

So right now, healthcare chaplaincy for me looks like being a less anxious presence; praying with people wherever they are, and in places they cannot be, like the rooms of all the dying; and holding space for celebrations of any success or joyful moment.  I also recommend focusing on the basic blessings and wonderment of nature- the only safe place to live and move and have our being right now.

I leave you with what is known as the Bathroom Blessing in Judaism, the Asher Yatzar which blesses the wonderous and complex workings of the Body, and the One God who created and can heal it all, which is traditionally prayed after toileting, as a daily reminder of God’s presence and action in our lives:

“Blessed is God who has formed the human body in wisdom

and created many orifices and cavities.

It is obvious and known before You

that if one of them were to be opened or closed incorrectly,

it would be impossible to survive and stand before You at all.

Blessed is God, who heals all flesh and does wonders.”