Saturday, December 02, 2006


When I first started volunteering as an ER chaplain, what made me most nervous was the pressure of composing extemporaneous prayers: of coming up, on the spot, with something that sounded lucid, graceful and compassionate.

That may seem odd. I'm very comfortable with most kinds of public speaking. I'm a college professor. I preach at church. I'm extremely verbal -- too verbal, according to some people -- and I'm a writer. And, after all, one of a chaplain's primary jobs is to pray with people who want prayer. So off-the-cuff composition shouldn't be a problem, right?

And yet, for quite a while, it was. There are two reasons for this. The first is that I'm new to the church, and prayer language, especially public prayer language, doesn't come easily to me. (Nor, I suspect, to many Episcopalians: we are, after all, "God's frozen people.") For most of my life, public prayer has made me squirm, and I've often had to suppress the fear that the person praying was about to start juggling rattlesnakes. After I started going to church, well-meaning friends would sometimes ask me to say grace before meals: this always mortified me, producing instant prayer's block.

The second reason is that I know I sometimes talk too much, and I was afraid that if I became too comfortable with spontaneous prayer, I'd never shut up. This is also why I always preach from a printed text: if I tried to preach off the cuff, the poor congregation would be stuck in the pews all morning. Limiting myself to four printed pages is an act of mercy for everyone involved.

Well, I got over all that. After two years as a volunteer chaplain, I'm now comfortable praying with patients. For one thing, I've developed my own toolbox, phrases I use in almost every prayer. They're mine, but at this point, they're also familiar territory, so I don't have to invent everything from scratch. I'll use a preexisting prayer -- usually the Lord's Prayer -- if a patient asks for it, but personalized prayer means much more to most people.

I've also discovered that praying with patients is nothing like saying grace. At least in the homes where I eat, most of the other guests look as self-conscious and embarrassed about the whole grace thing as I feel. But hospital patients who ask for prayer really do want prayer (although sometimes their friends or relatives look uncomfortable), and when they thank me for praying with them, I can tell that they're speaking from their hearts. Prayer truly makes people feel better.

And, oddly, the hectic environment of the ER makes the whole process less pressured. Certain kinds of formality simply aren't possible when you're standing next to a beeping monitor and liable to be interrupted any second by someone who's arrived to draw blood or check vital signs. Some medical staff will wait for me to finish a prayer, but most won't (and this is completely appropriate). Most of the phrases in my toolbox can be used as endings, and I've learned to wrap up prayers very quickly indeed when a doctor or x-ray tech shows up.

Through a combination of training and experience, I've developed a set of tips, strategies and guidelines for praying with hospital patients. I offer them here for anyone who may find them useful.

1. Don't pray unless asked. This was the number-one rule in my training: chaplains don't impose anything on anybody.

2. If a patient or relative does request prayer, ask, "What are we praying for?" Medical concerns aren't always foremost: sometimes people will ask for prayers for family issues, for financial problems, or for other patients in the room who are suffering more than they are. Pet owners may fret about finding care for dogs or cats during a hospitalization. Youngsters with athletic injuries are often worried about whether they'll be able to finish out a season, or play again at all. Several patients have asked me to pray for world peace. And even when medical issues are first on the list, it's important to pay attention to how the patient voices those concerns. Some want pain relief. Some want courage and strength in uncertainty. Some want miracles.

This is where things get tricky, because praying with someone for something that almost certainly won't happen -- "a spontaneous remission of my metastasized stomach cancer" -- is bad pastoral care. If that outcome doesn't happen, the patient's faith could be damaged. The same holds for patients who want to pray for lottery winnings or specific football outcomes (and I've gotten such requests). If I suspect that the patient is praying for something that probably won't happen, or trying to use God as a vending machine, I pray for acceptance of God's will and for "the best possible outcome." I'll also often include a phrase about how God always heals, but not always in the way we expect, reminding the patient that even when a physical cure isn't possible, emotional comfort and healing are.

The most difficult prayer requests I've gotten are from elderly people who want to die. "Please, God, take me, I want to die, why won't you just take me, Lord?" In these cases, I always pray for acceptance of God's will.

3. Don't assume that patients who ask for prayer are Christian. I always ask "What's your faith tradition?" or "What kind or church do you go to?" Obviously, if a patient says "I'm Jewish" or "I'm Wiccan" or "I'm not religious, but a prayer right now couldn't hurt," I avoid specifically Christian language. A few weeks ago, I was asked for prayer by the Muslim and Buddhist friends of a sleeping Mormon patient. Even when all the people involved are Christian, asking about their tradition may help me prepare for how they'll respond. Catholics usually close their eyes and wait quietly for the prayer to end; Pentecostals interject fervant exclamations of "Yes, Jesus!" or "Thank you, Lord!" The first time that happened, I nearly jumped out of my skin -- Episcopalians just don't do this kind of thing, donchewknow -- which probably didn't reassure the patient.

4. Do pray for everyone involved in the situation. I always pray for guidance and discernment for the patient's doctors and nurses. If family or friends are there, I include them (by name, if possible). I offer thanks for anyone who's come to the hospital with the patient; I'll often say something like, "And we ask special prayers for [patient's spouse/parent/child], because sometimes it's harder to be the person at the bedside than the person in the bed." This almost always elicits nods, and sometimes tears, from both the patient and family members.

5. Do use humor when appropriate. I once had a patient who'd broken both arms -- one of which required surgery -- in the process of chasing a pet bird. (Note to self: While trying to put Tweety to bed, do not climb on top of tall, unsteady furniture.) When the patient and spouse asked for prayer, I included prayers for the bird and for the trials of pet ownership; this made the couple laugh, which was very much one of the things they needed at that moment.

This set of guidelines may seem daunting; I suspect it would have made me more nervous if I'd read it two years ago. But after a while, the process really does become smoother. It just takes practice, like anything else.

On Thanksgiving, Gary and I went to the house of a friend whose father is a minister. Even though he was there, she asked me to say grace. I had a panicky moment of the old stomach-clenching, self-conscious embarrassment, but then I thought, "Come on, you do this all the time at the hospital." So I bent my head and prayed.

Afterwards, one of the other guests said, "That was really nice. Was that extemporaneous?"

Maybe I've finally gotten the hang of this?


  1. Well done, Beloved. I would agree with your guidelines. Two thoughts:

    First, I've been known to pray, "Lord, we can hope for ______, but we'll trust you to give the patient wholeness according to your will." When a patient is dying, I often pray, "for health and wholeness, whether in this life, or wholeness beyond our conceiving in your kingdom." We can acknowledge even difficult and medically unlikely outcomes, and still hold to trusting that God loves the person no matter the outcome.

    Second, (and this is for your readers, because I know you know this already) we can pray for a lot of patients we don't pray with.

    Well done.

  2. Thanks, Marshall! Yes, I often pray with people for faith in reunion beyond the grave (although not usually in those words). And one of the standard chaplain-departure-lines -- a genre unto itself -- is, "I'll pray for you as I walk."


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