Beautiful Amy, thank you. The concept of losing the soul of healing by prioritizing only what we can measure really resonates with me. It’s the intangible, the subtle, the soft science that often makes a profound difference in healing, or letting go.
Thank you Linnea! It's the same in so many fields, I know education has run into this a lot as well, where they get so focused on metrics that we forget about the humans.
As a healthcare chaplain, THANK YOU. Especially the part about staff care. While I love and obviously value the care I provide to patients and their loved ones, perhaps the greater value is on the staff—the ones who are in the face of suffering day in and day out yet bringing healing with gentle kindness. I met a man early on in my training who told me the patients were the visitors and the staff were his congregants. The longer I serve as a chaplain, the more I see this to be true.
Thank you Alyssa! I love that idea of healthcare staff as congregants. I haven't experienced having an ongoing relationship with a chaplain in my hospital since we don't have one in house most of the time, but I would love to.
Your post reveals the spirit controlled health care system much more gently than I would.
I'd categorize the removal of chaplains from a hospital as a decision to "remove" both patients and caregivers before their time.
It's part of the management and distribution of health-care resources made purposely scarce.
You brought up an important aspect of chaplains coming into the situation from outside, often unprepared to deal with the circumstances. I have definitely seen the prayers for healing result in some communication and decision making breakdown. It takes a special person to do the this work.
Please say more about what you mean about the decision to remove patients and caregivers before their time. I don’t think I understand you.
I agree that there are many realms, particularly the difficult to measure ones where resources are made artificially scarce. We’re told that it must be this way, even though if we have eyes we can see it can be many other ways simply by looking at health systems in other countries, not to mention the other healing modalities that could be used/incorporated.
And yes, there are emotional and spiritual gifts that are often undervalued until you, personally, need to receive them that are key to success as a chaplain.
More on artificial shortages: FDA and other regulatory foot dragging have further impaired availability of drugs for the last 15 years or so. Resources and money at each health care institution is diverted to handling the shortages, allocating drugs to those who need the limited supplies the most, and finding substitutes for the those in short supply. Also blanket proclamations that pharmacies can change the expiration of shorted drugs are routinely made by the FDA. (Suddenly epinephrine lasts longer, etc.) Compounding pharmacies have sprung up everywhere to divide drugs into needed dosage forms because the FDA can't get sterile products manufacturing facilities recertified to continue production. Hospitals do extra compounding. All of this is added risk for failures to maintain integrity of sterile products. The FDA couldn't even maintain a database of the shortages which they were exacerbating, but Lexicomp could.
People with means routinely are traveling outside the U.S. to get cheaper health care and to get treatments that can't be allowed here. It seems to me that people were promised that they could pick their doctor and keep their doctor affordably, and the exact opposite was delivered.
The effectiveness of treating patients with respiratory problems decreased during COVID. The medical staff was constrained in their choices of care for the patients. The magical 6mg/day dexamethasone was protocol during this time, and fortunately our ICU docs started giving more.
The flu disappeared. For 2020, I saw only the ObGyns still testing their sick L&D patients for it. Practically no one else was ordering that for a good long while. Antivirals were started after their mechanism could not operate. I felt lucky that part of the stupidity was skipped where I was employed, but treatment was still suboptimal and I think dishonest.
Cooperation was given in order to get close to 100 million dollars in grants per hospital facility, in addition to maximizing the payout per patient.
Making health care scarce has been in the works for a good long time, because it could allow for determinations of who should preferentially be helped, and who could be denied care. Each time the TPN components were in short supply, the remaining stock was allocated to NICU. I couldn't imagine starting chemo with no idea whether there was enough to complete the regimen. Why go through the discomfort or waste the money? I've just heard that some local infusion centers and specialty pharmacies have been afflicted with shutdowns due to issues with maintaining sterility in the compounding environments. That's definitely a problem for those on chemo regimens.
(This article lit me up way back when it first appeared, even before the shortages started in earnest.
(Lancet. 2009 Jan 31;373(9661):423-31. doi: 10.1016/S0140-6736(09)60137-9.
Principles for allocation of scarce medical interventions.)
Cutting out the chaplains seems to me to be just another means to keep people away from the hospitals when they need help. It's reasonable to conclude that it's better to die at home with family and friends than alone in a hospital under the care of an overworked, abused and beaten staff, with no one around to offer a prayer or some spiritual solace.
In my opinion, the patients and the health care workers are being encouraged to die sooner.
I hear what you’re saying. The LEAN management practices of only stocking as much as you need for X amount of time and only producing something at one or two factories has clearly been proven profoundly problematic, yet we’re still doing it. Even the things that are in stock have been priced so far beyond their actual cost to try to manipulate a corrupt insurance system, that they are inaccessible for a huge swath of the population. I think there are many aspects of our culture that are actively limiting life span and quality of life (which foods are affordable and accessible), the quality of our air and water, the way we recognize and process emotions, how we treat addiction and mental illness, etc.
Definitely it’s worth reading and pondering the timing of that Lancet article ahead of all that has gone on in shortage land. We stopped making the bulk of drug active ingredients in the U.S. We had a faulty, cobbled together program that that, at the outset couldn’t decrement removals correctly. Everyone in the supply chain had to prevent holding expensive inventory which gets taxed and can expire. The big problem for over 15 years being able to get products at all. The biologicals are usually ordered as needed or kept on consignment. It’s crazy, and has wrecked the ability to deliver care.
People get billed for engineered failure.
I wish you the best in delivering an alternative to this.🙏🏽 I’m focused on teaching people to help themselves a bit.
Thanks for writing this. I had a brief stint at a tiered nursing home. I spent a lot of time sitting on a bench listening to the elderly people there. The facility was understaffed, medicated the crap out of the people there. I found out it was owned by a Chicago hotel company. What? The residents wanted to talk about their impending death, perhaps to an impartial party. I did not have much to add, I just listened a lot. Sad to hear about Mass General. Harvard Med was my client some time ago. There needs to be “soul” in healthcare for sure. And teaching…and everything I can think of, frankly. Excellent essay.
Often the listening is the most important part when people are grappling with big things. And totally agree, there is this movement toward cost-effectiveness and efficiency and away from tending, witnessing, and relationship in almost every aspect of our culture, including education. It’s really tragic.
I think my friends escaped the field of medicine for that reason as well as the stress they endured. An anesthesiologist and a neurosurgeon. They got into medicine for all the right reasons but it morphed into the antithesis of the care and relationship part that they hoped to be a part of. They described their residencies and ER “stories” to me, some of which sounded literally crazy and traumatizing thus I thank you for being a doctor who actually cares about the things that truly matter. Have a great day.
Thanks Elizabeth. I think the health and wellbeing of our healers says a lot about the health of our culture. I would argue that neither is doing too great right now. I’m glad your friends had the courage to take the leap outside of medicine. There so much time, money, energy, and identity tied up in that, that it can be a really difficult decision. It’s amazing what becomes normalized in the regular day to day work of an ER because it’s so easy to find someone who has it worse and use that to minimize the significance of your own suffering. I honestly think most doctors went into medicine to care about these things, but we grow really disillusioned when we realize how far away from our ideals we are most of the time.
You are exactly correct. I was trying to be delicate. Unfortunately, my friends rather took themselves out of medicine, one by suicide, the other via addiction. Their environment at work was not healthy at all and they could not get the support and help they needed. Suffering was indeed what they were doing. It is happening all too often in this society. I’m rather “geeky” (engineering) and was helping a friend in med school study for exams. When he showed up to study with a bag of donuts, I asked how he was taking care of himself. He said, “we only live to be about 57 on average”, meaning pediatric neurologists. I was stunned. He was pretty young but I was creeping up closer to that age. I would really like to see a reversal of the things we have normalized. I don’t know how to facilitate that change but I do listen well and have made more of an effort to be quiet and simply listen to others so they feel like someone cares.
Oh, I'm sorry I misunderstood. And yes, the field is full of dark humor, fatalism, and unhealthy coping mechanisms. At least for me, it's really hard to explain what it's like to people who haven't been there, but people who show up and listen without trying to fix it or me are so important. I think the ways to fix it require an overall of the whole culture and economy.
So you’ll get it when people ask me what I “identify as” and reply, “A listener”. I finally got the memo on how important that actually is even though I cannot fix things for others…aside of basic home repairs (ha). My friends were fantastic people and I think the hospital hierarchy and patients forgot that they were first and foremost human beings. I concur….an overhaul of the entire culture and economy is overdue.
Gladly Christine! It really feels like it is part of a bigger campaign to dehumanize medicine. I’m starting to imagine people using Chat GPT as their doctors. It may get good enough that it is more accurate than doctors, but I don’t think outcomes will be better because there is more to healing than just “pop this pill”.
Yes I can see how quickly that will happen, especially given how people interact with entering symptoms into Google and looking up WebMD. I've heard some talk of physicians using AI for listening to visits and then generating notes allowing the docs more time for patient care.
It does reduce the time burden of documentation, but I imagine it's a lot like working with a scribe where you still have to edit pretty closely. I also use the time where I am writing my medical decision making/assessment and plan part of the note as one of the main points that I stop to synthesize data and make sure I'm not missing anything. AI is happening whether I like it or not and there are certainly benefits, particularly in time saved, but I think that we are avoiding looking at what it costs.
Amy, I recently took a (pre-recorded) continuing ed course taught by a chaplain, and was struck by how much of what she described as being part of her work is woven into my work as midwife. I struggle to comprehend the why behind devaluation of connection within medicine and broader realms of healthcare, but am grateful for every human reaching for a different way of being in whatever context they find themselves. Thanks for drawing attention to this.
Thanks Jan, I really think that tending to people and witnessing their suffering is a core tenet of healing and the fact that we are rapidly losing the autonomy to take the time to do that is profoundly problematic.
I was curious if you are aware of the Minnesota Holistic Medical Group? It was founded by Bill Manahan about 30 (?) years ago for the purpose of getting integrative-minded practitioners to get together and better understand each others services. The group has transitioned to new leadership, and they are having an in-person meetup this Saturday May 3rd with a focus on holistic mental health. There are more details here: https://www.wecarenonprofitfoundation.org/wecareconference2025-0-0?hs_preview=BldaxOCX-185191075115&hsLang=en
Thank you! I was not familiar with the Minnesota Holistic Medical Group. Definitely interested in learning more. This weekend is a bit wild with kid activities, but I’ll check out the website to find out about upcoming events or if you hear of others, please let me know.
As a hospital corpsman during the Vietnam war I had little but some interactions with Navy Chaplins. Thus, I have mixed feelings about this post.
I believe there may be many good chaplains out there, however, I’m not sure I met any of them.
I was young and biased since I did not believe in the Vietnam War with all its carnage. The few Chaplins I met were commissioned officers in the Navy who were gung-ho for the war or at least appeared to me to be so. To them we were fighting God’s war against the evil atheists. Therefore, as an atheist I deduced that in their eyes I was evil.
Again, I was young and viewing the zeitgeist of the time with jaundiced eyes.
I can understand the apprehension. I actually had some degree of it early in my medical career as well because I was very resistant to organized religion and I’m not sure I can articulate it well, but it just felt sort of superstitious maybe, or like an opportunity to prey on the weak and vulnerable. Fortunately, with more exposure and experience with them, the ones that I have worked with don't seem to be pushing an agenda and approach patients in a very non-dogmatic way. Certainly, it sounds like the chaplains you interacted with in the Navy definitely sound like they lack the neutrality, openness, and curiosity that makes the best chaplains so good at their jobs.
Thanks, in the grand scheme of healthcare catastrophes, it is but one, but I think it demonstrates a really damaging mindset that is becoming increasingly prevalent in the VC version of hospital care.
It’s so very sad to watch what’s happening with the corporatization of medicine, hospitals, doctors, and healthcare in general. As a former ER and ICU nurse I know exactly what you’re saying about the importance of a chaplain— they are indispensable and yet they are being dispensed. When my daughter was born she stopped breathing 24 hours after birth and was placed on a ventilator— I wanted her baptized and the hospital called in the priest on call to baptize her. In times of crisis we turn to our faith for guidance and support. It is our faith that gives hope. And that’s often what will pull a patient through.
As someone who has received training as a chaplain, I endorse this post 100%! Thank you for writing it, Amy.
Thanks Maia. If we can’t value the importance of relationship and spiritual care in healthcare, I’m not really sure what we’re doing here anymore.
Exactly. As you put it so beautifully in the article, ultimately it's not about numbers. It's about people.
Excellent post Amy!
Thank you John!
Beautiful Amy, thank you. The concept of losing the soul of healing by prioritizing only what we can measure really resonates with me. It’s the intangible, the subtle, the soft science that often makes a profound difference in healing, or letting go.
Thank you Linnea! It's the same in so many fields, I know education has run into this a lot as well, where they get so focused on metrics that we forget about the humans.
You phrased this so beautifully, Linnea!
🙏
As a healthcare chaplain, THANK YOU. Especially the part about staff care. While I love and obviously value the care I provide to patients and their loved ones, perhaps the greater value is on the staff—the ones who are in the face of suffering day in and day out yet bringing healing with gentle kindness. I met a man early on in my training who told me the patients were the visitors and the staff were his congregants. The longer I serve as a chaplain, the more I see this to be true.
Thank you Alyssa! I love that idea of healthcare staff as congregants. I haven't experienced having an ongoing relationship with a chaplain in my hospital since we don't have one in house most of the time, but I would love to.
Your post reveals the spirit controlled health care system much more gently than I would.
I'd categorize the removal of chaplains from a hospital as a decision to "remove" both patients and caregivers before their time.
It's part of the management and distribution of health-care resources made purposely scarce.
You brought up an important aspect of chaplains coming into the situation from outside, often unprepared to deal with the circumstances. I have definitely seen the prayers for healing result in some communication and decision making breakdown. It takes a special person to do the this work.
Please say more about what you mean about the decision to remove patients and caregivers before their time. I don’t think I understand you.
I agree that there are many realms, particularly the difficult to measure ones where resources are made artificially scarce. We’re told that it must be this way, even though if we have eyes we can see it can be many other ways simply by looking at health systems in other countries, not to mention the other healing modalities that could be used/incorporated.
And yes, there are emotional and spiritual gifts that are often undervalued until you, personally, need to receive them that are key to success as a chaplain.
More on artificial shortages: FDA and other regulatory foot dragging have further impaired availability of drugs for the last 15 years or so. Resources and money at each health care institution is diverted to handling the shortages, allocating drugs to those who need the limited supplies the most, and finding substitutes for the those in short supply. Also blanket proclamations that pharmacies can change the expiration of shorted drugs are routinely made by the FDA. (Suddenly epinephrine lasts longer, etc.) Compounding pharmacies have sprung up everywhere to divide drugs into needed dosage forms because the FDA can't get sterile products manufacturing facilities recertified to continue production. Hospitals do extra compounding. All of this is added risk for failures to maintain integrity of sterile products. The FDA couldn't even maintain a database of the shortages which they were exacerbating, but Lexicomp could.
People with means routinely are traveling outside the U.S. to get cheaper health care and to get treatments that can't be allowed here. It seems to me that people were promised that they could pick their doctor and keep their doctor affordably, and the exact opposite was delivered.
The effectiveness of treating patients with respiratory problems decreased during COVID. The medical staff was constrained in their choices of care for the patients. The magical 6mg/day dexamethasone was protocol during this time, and fortunately our ICU docs started giving more.
The flu disappeared. For 2020, I saw only the ObGyns still testing their sick L&D patients for it. Practically no one else was ordering that for a good long while. Antivirals were started after their mechanism could not operate. I felt lucky that part of the stupidity was skipped where I was employed, but treatment was still suboptimal and I think dishonest.
Cooperation was given in order to get close to 100 million dollars in grants per hospital facility, in addition to maximizing the payout per patient.
Making health care scarce has been in the works for a good long time, because it could allow for determinations of who should preferentially be helped, and who could be denied care. Each time the TPN components were in short supply, the remaining stock was allocated to NICU. I couldn't imagine starting chemo with no idea whether there was enough to complete the regimen. Why go through the discomfort or waste the money? I've just heard that some local infusion centers and specialty pharmacies have been afflicted with shutdowns due to issues with maintaining sterility in the compounding environments. That's definitely a problem for those on chemo regimens.
(This article lit me up way back when it first appeared, even before the shortages started in earnest.
(Lancet. 2009 Jan 31;373(9661):423-31. doi: 10.1016/S0140-6736(09)60137-9.
Principles for allocation of scarce medical interventions.)
Cutting out the chaplains seems to me to be just another means to keep people away from the hospitals when they need help. It's reasonable to conclude that it's better to die at home with family and friends than alone in a hospital under the care of an overworked, abused and beaten staff, with no one around to offer a prayer or some spiritual solace.
In my opinion, the patients and the health care workers are being encouraged to die sooner.
I hear what you’re saying. The LEAN management practices of only stocking as much as you need for X amount of time and only producing something at one or two factories has clearly been proven profoundly problematic, yet we’re still doing it. Even the things that are in stock have been priced so far beyond their actual cost to try to manipulate a corrupt insurance system, that they are inaccessible for a huge swath of the population. I think there are many aspects of our culture that are actively limiting life span and quality of life (which foods are affordable and accessible), the quality of our air and water, the way we recognize and process emotions, how we treat addiction and mental illness, etc.
Definitely it’s worth reading and pondering the timing of that Lancet article ahead of all that has gone on in shortage land. We stopped making the bulk of drug active ingredients in the U.S. We had a faulty, cobbled together program that that, at the outset couldn’t decrement removals correctly. Everyone in the supply chain had to prevent holding expensive inventory which gets taxed and can expire. The big problem for over 15 years being able to get products at all. The biologicals are usually ordered as needed or kept on consignment. It’s crazy, and has wrecked the ability to deliver care.
People get billed for engineered failure.
I wish you the best in delivering an alternative to this.🙏🏽 I’m focused on teaching people to help themselves a bit.
Thanks for writing this. I had a brief stint at a tiered nursing home. I spent a lot of time sitting on a bench listening to the elderly people there. The facility was understaffed, medicated the crap out of the people there. I found out it was owned by a Chicago hotel company. What? The residents wanted to talk about their impending death, perhaps to an impartial party. I did not have much to add, I just listened a lot. Sad to hear about Mass General. Harvard Med was my client some time ago. There needs to be “soul” in healthcare for sure. And teaching…and everything I can think of, frankly. Excellent essay.
Often the listening is the most important part when people are grappling with big things. And totally agree, there is this movement toward cost-effectiveness and efficiency and away from tending, witnessing, and relationship in almost every aspect of our culture, including education. It’s really tragic.
I think my friends escaped the field of medicine for that reason as well as the stress they endured. An anesthesiologist and a neurosurgeon. They got into medicine for all the right reasons but it morphed into the antithesis of the care and relationship part that they hoped to be a part of. They described their residencies and ER “stories” to me, some of which sounded literally crazy and traumatizing thus I thank you for being a doctor who actually cares about the things that truly matter. Have a great day.
Thanks Elizabeth. I think the health and wellbeing of our healers says a lot about the health of our culture. I would argue that neither is doing too great right now. I’m glad your friends had the courage to take the leap outside of medicine. There so much time, money, energy, and identity tied up in that, that it can be a really difficult decision. It’s amazing what becomes normalized in the regular day to day work of an ER because it’s so easy to find someone who has it worse and use that to minimize the significance of your own suffering. I honestly think most doctors went into medicine to care about these things, but we grow really disillusioned when we realize how far away from our ideals we are most of the time.
You are exactly correct. I was trying to be delicate. Unfortunately, my friends rather took themselves out of medicine, one by suicide, the other via addiction. Their environment at work was not healthy at all and they could not get the support and help they needed. Suffering was indeed what they were doing. It is happening all too often in this society. I’m rather “geeky” (engineering) and was helping a friend in med school study for exams. When he showed up to study with a bag of donuts, I asked how he was taking care of himself. He said, “we only live to be about 57 on average”, meaning pediatric neurologists. I was stunned. He was pretty young but I was creeping up closer to that age. I would really like to see a reversal of the things we have normalized. I don’t know how to facilitate that change but I do listen well and have made more of an effort to be quiet and simply listen to others so they feel like someone cares.
Oh, I'm sorry I misunderstood. And yes, the field is full of dark humor, fatalism, and unhealthy coping mechanisms. At least for me, it's really hard to explain what it's like to people who haven't been there, but people who show up and listen without trying to fix it or me are so important. I think the ways to fix it require an overall of the whole culture and economy.
So you’ll get it when people ask me what I “identify as” and reply, “A listener”. I finally got the memo on how important that actually is even though I cannot fix things for others…aside of basic home repairs (ha). My friends were fantastic people and I think the hospital hierarchy and patients forgot that they were first and foremost human beings. I concur….an overhaul of the entire culture and economy is overdue.
AMEN! Thank you so much for being an advocate for the important work we do as chaplains!
Gladly Christine! It really feels like it is part of a bigger campaign to dehumanize medicine. I’m starting to imagine people using Chat GPT as their doctors. It may get good enough that it is more accurate than doctors, but I don’t think outcomes will be better because there is more to healing than just “pop this pill”.
Yes I can see how quickly that will happen, especially given how people interact with entering symptoms into Google and looking up WebMD. I've heard some talk of physicians using AI for listening to visits and then generating notes allowing the docs more time for patient care.
It does reduce the time burden of documentation, but I imagine it's a lot like working with a scribe where you still have to edit pretty closely. I also use the time where I am writing my medical decision making/assessment and plan part of the note as one of the main points that I stop to synthesize data and make sure I'm not missing anything. AI is happening whether I like it or not and there are certainly benefits, particularly in time saved, but I think that we are avoiding looking at what it costs.
Amy, I recently took a (pre-recorded) continuing ed course taught by a chaplain, and was struck by how much of what she described as being part of her work is woven into my work as midwife. I struggle to comprehend the why behind devaluation of connection within medicine and broader realms of healthcare, but am grateful for every human reaching for a different way of being in whatever context they find themselves. Thanks for drawing attention to this.
Thanks Jan, I really think that tending to people and witnessing their suffering is a core tenet of healing and the fact that we are rapidly losing the autonomy to take the time to do that is profoundly problematic.
Hi Amy, this is a beautiful piece.
I was curious if you are aware of the Minnesota Holistic Medical Group? It was founded by Bill Manahan about 30 (?) years ago for the purpose of getting integrative-minded practitioners to get together and better understand each others services. The group has transitioned to new leadership, and they are having an in-person meetup this Saturday May 3rd with a focus on holistic mental health. There are more details here: https://www.wecarenonprofitfoundation.org/wecareconference2025-0-0?hs_preview=BldaxOCX-185191075115&hsLang=en
Thank you! I was not familiar with the Minnesota Holistic Medical Group. Definitely interested in learning more. This weekend is a bit wild with kid activities, but I’ll check out the website to find out about upcoming events or if you hear of others, please let me know.
I hadn't given this topic any thought before, but you've demonstrated its importance.
As a hospital corpsman during the Vietnam war I had little but some interactions with Navy Chaplins. Thus, I have mixed feelings about this post.
I believe there may be many good chaplains out there, however, I’m not sure I met any of them.
I was young and biased since I did not believe in the Vietnam War with all its carnage. The few Chaplins I met were commissioned officers in the Navy who were gung-ho for the war or at least appeared to me to be so. To them we were fighting God’s war against the evil atheists. Therefore, as an atheist I deduced that in their eyes I was evil.
Again, I was young and viewing the zeitgeist of the time with jaundiced eyes.
I can understand the apprehension. I actually had some degree of it early in my medical career as well because I was very resistant to organized religion and I’m not sure I can articulate it well, but it just felt sort of superstitious maybe, or like an opportunity to prey on the weak and vulnerable. Fortunately, with more exposure and experience with them, the ones that I have worked with don't seem to be pushing an agenda and approach patients in a very non-dogmatic way. Certainly, it sounds like the chaplains you interacted with in the Navy definitely sound like they lack the neutrality, openness, and curiosity that makes the best chaplains so good at their jobs.
I remain open to not paint all Chaplins by the brush of my limited experience. I recognize that we are in a different time than then.
Thanks, in the grand scheme of healthcare catastrophes, it is but one, but I think it demonstrates a really damaging mindset that is becoming increasingly prevalent in the VC version of hospital care.
It’s so very sad to watch what’s happening with the corporatization of medicine, hospitals, doctors, and healthcare in general. As a former ER and ICU nurse I know exactly what you’re saying about the importance of a chaplain— they are indispensable and yet they are being dispensed. When my daughter was born she stopped breathing 24 hours after birth and was placed on a ventilator— I wanted her baptized and the hospital called in the priest on call to baptize her. In times of crisis we turn to our faith for guidance and support. It is our faith that gives hope. And that’s often what will pull a patient through.
I hadn't given this topic any thought before, but you've demonstrated its importance.