How the Medical Field and Pastoral Care Work Together

Updated: Nov 27, 2021

By Cindy Dube, Certified Thanatologist Pastoral Care Specialist - November 27, 2021

Early on in my career as a paramedic I discovered differences in how various medical professionals cared for their patients. Each had different passions and reasons why they entered the health care field. Those passions became expressed as different aptitudes for remembering facts, acquiring knowledge, and the application of those things into skills regarding treatment for the suffering patient. I saw physicians, nurses, paramedics, and diagnostic testing experts use honed state of the art equipment and procedures to save lives and reduce detrimental outcomes thus giving hope to patients. Often, these procedures fixed or healed patients enabling a return to normal life.

I remember a significant event in my paramedic career that stands out to me regarding the care of those close to death. During that time my mindset was always rushed; always trying to save lives, reduce injury and get patients from point A to point B as quickly as possible.

One day another more seasoned paramedic was riding in the back of the ambulance with me. We were transporting a palliative care patient that was expected to die soon. This paramedic slowed down. She held our patient’s hand. She smiled. I did not quite understand what she was doing, but I observed. She did not follow the medical standards that had been drilled into my head: airway, breathing, circulation, bleeding, complaint, history, treatment. Watching that interaction between caregiver and patient in the ambulance, I suddenly understood that my partner knew something I did not. At first, I thought maybe someone close to her had recently died. I realized she was not trying to implement any medical procedures other than to be present. Nothing else mattered at that moment. The back of the ambulance somehow took on a holy atmosphere.

It has been over 20 years since that life changing moment. This encounter and other life experiences has led me to the specialized work of thanatology. Thank you, Joan Desabrais for showing me something different.

How does the medical profession and what Joan did in the back of that ambulance work together? We do need both. We need those that will attend to our physical bodies and help us fight for health and life, but we also need those who recognize when fighting may not be the best course of action. Without the balance of both, sometimes life for those with terminal illness can be lonely, fearful, and hopeless.

We may be fortunate enough to have a health care professional like Joan who in some way has been afflicted and carrying personal memories in her body and soul which enable to show compassion and share the burden of suffering. For the health care professional offering care to the dying, it’s not just a matter of getting your medical tasks completed, although those things need to be done, It’s about acknowledging to the dying person that she or he is able to handle the unbearable as others are genuinely alongside, bearing the burden with them, affirming their intrinsic worth even though they can no longer do the things they once did or look the way they used to, and that they soon may die.

Those who are dying may need help preserving their dignity; gentle reminders that although things have changed, their dignity has not fallen below any type of threshold. The dignity of a person should remain intact no matter what their circumstances may entail. Sometimes we all need help to remember that. Pain, wasting, and inability does not mean a person is devalued of worth. Psychiatrists have often said that when people start to talk about assisted death, they are testing to see whether others will confirm their own fear about becoming worthless.[1]

So how does the health care professional offer compassionate care but still maintain competence in often difficult circumstances on a repetitive daily basis? They cannot continually absorb the pain of each person they give care to. They need to move onto the next person who is suffering and offer hope using whatever means they have available. In this way, the caregiver fulfills their inner calling and passion. This is where pastoral care accompanies the health care professional. We need health care professionals to run the intricate and high-tech tests, administer medicine and procedures to help patients recover from accidents and illness. Technicians, physicians, nurses, and paramedics need to keep their heads in the ever-evolving game of diagnostics and treatment. There is little time to spare for the emotional burdens of each patient.

Many people have commented to me over the years about the mystery of how health care professionals can witness such tragedy and remain sane. Often these front-line workers practice a certain type of emotional detachment from their patients. This helps with objectivity, performance, medical intervention, and procedures. This impartiality helps prevent burnout. It is a fine line between opening oneself up to carry the heavy burdens of others and completing the job of attending to the healing of the physical body. C. Airing, and others have argued for a more intellectual engagement to infer what patients are experiencing to avoid the pitfalls of entering or joining the patient and feeling what they feel because this prevents errors in clinical judgment, over identification, and projection. [2]

I realized the difference between the health care professional’s role and the pastoral role one day as a student chaplain. I walked down the hallway of a nursing home feeling helpless that I could not fix someone who was going to die. So here I was, a past health care worker now offering pastoral care. What was I to do in a seemingly hopeless situation? As a paramedic my mind was trained to look at the positive to reach into my bag of tools and apply the treatment necessary to save lives. Here I realized that I needed something very different. I could no longer give a hope of life. Hope needed to come from another place.

Hope is important, especially to the dying person. It’s a different type of hope. I remember one of my professors in seminary explained that even if the hope is having a good sleep or meal, humans need hope. In Viktor Frankl’s book Man’s Search for Meaning[3] he talks about his experience as a Holocaust survivor and that without some type of faith in the future, he was doomed. With his loss of belief in the future Frankl also realized that he would lose his spiritual hold on things.

This is how health care and pastoral care work together. Hope means different things to different people, and it often changes as we progress through life to death. Hope does not necessarily mean optimism. For example, by focusing on hope for a cure we can avoid other important aspects of life that make for a good death or an abundant life. The way our bodies work, render hope for immortality impossible. The pastoral approach for hope that I use is expressed well by Thomas Aquinas, a philosopher and Catholic priest. He says “Hope should seek the good. Hope should seek the good that is in the future. Hope should see a possible but difficult kind of good. Hope should seek a good that is possible to attain, thereby distinguishing it from despair.”[4] Hope helps us find a way through, not always a way out.

Sometimes as healthcare professionals we can give hope in a difficult or negative situation even without knowing the diagnosis or prognosis. In a way it makes the uncomfortableness of the situation better when both the health care provider and the patient are both hopeful for healing and recovery. Some believe that up-front and honest discussions could lead to a loss of hope, thereby altering the potential for healing. Jodi Halpern a psychiatrist and philosopher who researches how the emotions of physicians and patients shape healthcare decisions says that truth can be a comfort when it comes with empathy. [5]

A different way to respond to patients is by empathic engagement and reframing hope to communicate something different. The pastor keeps themselves open and vulnerable to the pain and misery of others. They can do this because they rely not on their own strength, but on the One who reveals the most compassion, Jesus Christ. This is the only protection they have when hopelessness threatens. This enables the pastor to love, exude compassion, and share the burden of the distressed.

Many times, when hope is reframed, patients experience less hopelessness, depression, feelings of being a burden, spiritual distress, anger, hostility, guilt, and requests for assisted suicide.

Health care and pastoral care experts partner together to help life and death become more meaningful, less worrisome, more peaceful, and restore dignity when needed. Medical attends to the biology of our bodies and pastoral care comes alongside, shareing in the suffering, and offering hope and meaning in the face of death, suffering and difficult situations.

[1] Herbert Hendin, Seduced by Death. New York: W.W. Norton, 1996. p. 156 [2] Halpern Jodi, From Detached Concern to Empathy: Humanizing Medical Practice. Oxford University Press, 2001. pp 67-68 [3] Frankl Viktor, Man’s Search for Meaning: an Introduction to Logotherapy. Boston: Beacon Press, 1962. [4] Payne Richard, “Reframing Hope in the Face of Terminal Illness”, in Living Well and Dying Faithfully Christian: Practices for End-of-Life Care. Grand Rapids, Michigan: Wm B. Eerdmans Publishing Co., 2009.p220 [5] Halpern Jodi, From Detached Concern to Empathy.