Faith on the Ward: Pastoral care and health workers
From health care ministry to pastoral care with health care workers
The health professions, like so many other vocations, can be a privileged springboard and an open pathway to God. Doctors, psychologists, nurses and those involved in care reflect on the profound mystery of the human being who suffers and loves, resists and hopes, trusts and fights. They touch the very mystery of God, even if only for a moment.
This is the basic thesis of this article, which we could summarize thus: pastoral care involving health care workers must help them to perceive and recognize, in the exercise of their profession, the living presence of the Risen Lord, who comes to meet them through those who suffer. In other words, to be a health care worker, is for those who believe, a way of proceeding toward God and being able to be reached by Him.
Consequently, a pastoral ministry to health care professionals that seeks to interact through all aspects of their work and life will have to take into account both the prophetic and communitarian dimensions of faith. It cannot be satisfied with exhortations to service and sacramental celebration. Undoubtedly, service and prayer – diakonia and leitourgia – must be an integral part of this apostolic approach, but the proclamation that the Kingdom and fraternity – kerygma and koinonia – are already present in health care centers, nursing homes and hospital wards must not be forgotten.
In this article we want to consider health care professionals not only as agents, but also as recipients of evangelization. Indeed, very often the health care professionals are insistently invited, under various capacities, to become “missionaries.” However, sometimes they find they must recognize themselves as “disciples” at the same time. Therefore, here we will speak of pastoral care with health care workers, rather than health care ministry or health care workers who do pastoral care, that is, of the path that the “disfigured” open – for those who care for them – toward the contemplation of the One who is the “transfigured” of God.
Do health care professionals still believe in God?
It would be presumptuous and completely unrealistic to provide a detailed map aimed at describing who today’s health professionals are and what they believe in. Like any other human community, they constitute a heterogeneous and diverse group. Some come from believing backgrounds (family, school, university) where the experience of faith has played an important role. Among them there are those who have continued to actively cultivate the religious dimension they have learned, deciding to participate in groups, movements, associations or parish activities. Others, however, have progressively distanced themselves from the religious dimension.
The motivations that animate the majority of believing health professionals are based on elements of altruism and humanism. A percentage of health care professionals feel that their vocation in caring for the suffering is rooted in religious principles. Among them there is no lack of people who undertake a path of approach to spiritual activity of various kinds, starting either from previous positions far removed from religion or from institutionalized religious affiliations.
In this light, the report on “Wellness, Burnout, and the Impact of Covid-19 on Physicians,” published by Medscape in 2020, provides ample data for us to reflect on. For this latest edition of the annual study, more than 1,100 Spanish physicians from 32 different specialties were surveyed about their lifestyles. Some 55 percent of them declared themselves to be believers in some way; specifically, 42 percent said they had religious beliefs, while 13 percent said they had spiritual beliefs. In contrast, 35 percent said they were non-believers. Furthermore, within the first group, 67 percent of respondents said that their religious faith or spirituality helped them when dealing with problems in their healing activity.
Beyond the data reported, it can certainly be seen, as a fairly generalized environmental phenomenon, that questions related to meaning are practically a taboo topic of conversation. As is the case with the subject of death, in the same way it is difficult for health professionals, in the work context, to engage in deep and sincere conversations about questions concerning the ultimate meaning of what they do, the existential motivations that drive them, the source of their hope, the questions that nag at them, the value they place on those who suffer, the passion with which they encourage the sick and the fears that assail them.
This taboo about discussion of meaning in health care hinders openness to the religious dimension. The importance of religious belief which some health care professionals want to emphasize during the whole of their lives is mostly relegated to the realm of private and confidential matters. Among fellow professionals, the faith of those who claim to be practicing arouses perplexity, wonder and even incomprehension, attracting comments such as, “Do you really still believe that?” or, “How can you talk about God after all you have studied and all you see?”
The ‘disfigured’ is the ‘transfigured’
Therefore, when faced with questions such as these, mature pastoral proposals are needed. Health care professionals must not fall into the temptation of giving Manichean answers, in order to deceptively deal with that which is undoubtedly much more complex. Pastoral care with medical personnel, if it is to be attentive to the world and open to people’s questions, must first of all be “cooperative” and not “adversarial,” that is, it must go more along the path of “and” than that of “or.”
In fact, one can be a doctor, nurse or auxiliary who believes in God and accept the postulates of evolutionary theory; or go to Mass and be aware that the Lord does not send diseases and does not decide at his whim who is to be healed and who is not; or pray devoutly, knowing that the Bible does not replace medical research, but neither is it challenged by the latest advances in research, because religious faith and science are different fields.
These statements might appear simplistic and naive, but it is essential that they be articulated correctly, together. On this will depend the greater or lesser harmony of pastoral action with the divine face that is proposed to us by Scripture, by the Magisterium and by tradition. This is the face of a God who, by becoming incarnate, brings together the divine and the human; who, on the cross, unites suffering and promise; who, by rising, assimilates forever the disfigured and the transfigured. In fact, it is not possible for God to place himself in an attitude of opposition to humans. In the same way, it is not compulsory for the health care worker to put faith aside in order to work with professionalism and rigor.
Caring with eyes closed: mysticism in the world of health care
Several years ago, when I was in my final year of medical school, a professor asked us a question that still resonates in my mind: “What is healing for you?” I remember we struggled to answer. After a few seconds of silence – the time it took him to cast a serene gaze on each of us – the professor surprised us with this statement: “Treatment is what happens to patients while their doctor is studying.”
I recently ran into that professor again. He is now retired but reminded me of that aphorism that had us thinking. At the time, there were many of us in the class who were embarrassed, realizing that we had learned a lot about Medicine, but little about what it means to be a doctor.
I must say that on many occasions I have experienced that – to paraphrase the professor – “really the cure is what happens to the patients while their doctor gives up believing himself to be God.” In fact, we already know that the difference between God and a doctor is that God does not believe himself to be a doctor. So health workers, perhaps today more than ever, alongside the undeniable need for study and training, need spaces that allow them to connect with the transcendent dimension that runs through all human realities, including those related to health and illness.
In fact, beyond religious and faith differences, these professionals share without exception the experience of working days that are usually intense and marked by an often hidden emotional burden. It is not difficult to come across feelings of helplessness, frustration, emptiness, loneliness, and even anger and meaninglessness. At other times, however, the outcomes of battles won will prompt euphoria, a sense of triumph and pride in a job well done. This is a good and desirable thing, within limits.
However, when one lives only “from the roof down,” there is the risk of being continually tossed between the most undisputed heroism and the – apparently – most resounding failure. In other words, there is the risk of becoming exhausted by dint of climbing to the top and then falling irreparably, time and again, to the bottom of the abyss. On the other hand, when skylights of transcendence open up in the roof of science and the profession, it becomes possible to step out of oneself and get rid of those constraints that force health professionals to see themselves superficially as heroes or impostors. In fact, a sort of mystique of success and failure opens up, which does not imprison or enslave, but liberates and encourages.
The task of a pastoral ministry that seeks to open up health care professionals to the transcendent dimension of their vocation consists in helping them to see themselves as humble instruments who are called to give their lives to heal the sick and to care for them. To this end it will be indispensable to offer them spaces of silence and recollection in which they can quietly entrust the various experiences of daily life to the silent hands of God, but also to provide elements that will enable them, over and above the various techniques of psychological support, to make a spiritual reading of all that characterizes life, both in terms of joys and bitterness.
This closed-eyed and seemingly distracted gaze turns medical personnel into witnesses to cures and healings that are ultimately not dependent on them, although they require their presence and actions in many parts of the process.
Six dimensions ‘under the white coat’
Who are today’s believing health care workers? What characterizes them? What elements do they have in common? These are legitimate questions, of great interest for those who want to imagine a proper pastoral care aimed at health professionals. However, it would once again be pretentious – and very naïve – to try to propose here a complete account, showing the essential characteristics of people working in the health care field. First of all, this is because their enormous diversity already constitutes a relevant fact; secondly, because it is not always easy to face the profound questions that inhabit their innermost being.
In fact, the nurses to whom patients turn do not always feel as efficient as they are seem; the physician is not as confident; nor the psychologist as sharp; nor the aide as understanding. In fact, what happens to medical staff behind the uniform, or “under the white coat,” sometimes diverges from the perception that patients, families and even colleagues themselves have of them. Ultimately, they are no different from any other individual: no one knows fully what goes on in another person’s innermost being.
This is precisely what the pastoral care of health care professionals should aim at: the profound questions that surface in the silence of a night shift; the fundamental questions that emerge after a time on call; the questions that arise when one is exhausted or defeated; the desire to do good – always more and better – that follows a consultation or that arises after visiting patients in the hospital ward.
In this context, we now want to propose some fundamental dynamics that seem to us to accord with, in one way or another, the existential experience of believing health care workers. We therefore present six dimensions that we believe are important for a pastoral understanding of the human beings whose lives are dedicated to health care. These are elements that can be used to identify, stimulate and accompany the growth of physicians, psychologists, nurses, auxiliaries and other members of the health care workforce who wish to live their profession in the light of faith.
What we call ‘vocation’
We often hear that the health care professions imply a vocation, or that it is necessary to have a vocation in order to dedicate oneself to the world of health and to do one’s job well, or in order not to fail in one’s profession. In this sense it is true that the activities of care reach such deep layers of life that they configure, at least in potential, a certain common way of considering oneself and of appearing in public. In fact, when doctors and nurses meet in a group, it is easy for them to huddle together and soon end up talking about patients, symptoms, cases or diseases.
We can state in broad terms that vocation is equivalent to finding one’s place in the world and discovering to what one wants to dedicate one’s time and, even more, one’s life. For Christians, this is manifested in the desire to respond to a call from God, a call that conquers you and excites you. However, a vocation is not something you come across; nor do you always experience it in the same way. Rather, it is something that is intuited, cultivated, enriched, doubted, feared, and that grows, develops and is elaborated.
Therefore, pastoral care will have to help people discover what their vocational motivations are; their individual nuances; what sources nourish them; what constitutes the fertile soil in which they take root and become fruitful. It will also have to accompany the hesitations that are part of any vocation. In fact, what doctor has not sometimes thought about hanging up his stethoscope and changing profession? Finally, caring for the vocational dimension should include transforming it into stimulation and encouragement, but without giving up its components of mature responsibility, confident perseverance and serious commitment.
A wisdom of time
Like that of every human being, the life of the health care professional is full of ups and downs. Success and failure, doubt and certainty, expectation and impotence, energy and fatigue, satisfaction and disappointment, joy and sadness, all are encountered. Yes, “times to laugh” and “times to cry” are part of every existential challenge, if you want to face them with maturity and seriousness. This sometimes torments, generates questions, doubts and can even create stress. At the same time weeping and laughing form a dancing couple that is united and inseparable.
Therefore, it is important to help the health care professionals cultivate a sapiential dimension in their experience of time. That is to say, it is important to encourage them to immerse themselves in the fragments of meaning that emerge in the moments of laughter and weeping; to push them to demolish the false clichés that lead them to move in the mere immediacy of a life “from the roof down”; to urge them to climb the peaks that will allow them to visualize the horizon and resist in hope.
Good pastoral care with health care workers must aim at the meaning, the sometimes penultimate meaning, that sustains and runs through both the joyful periods and those marked by fatigue. Indeed, we certainly need to keep our feet firmly planted on the ground or, in other words, engage in the details of our personal history, but at the same time we also need to look up to the heavens, that is, to transcend in some way the immediate task in order to glimpse what gives meaning to our lives. In the perspective of faith, we understand that we will not find this in an abstract idea that takes us into the clouds, but in a personal God who, in Jesus Christ, is the way, the truth and the life.
Strengths and weaknesses
Health care workers are not superheroes; they need not be, we should not ask them to be, nor can they demand it of themselves. To assume this creaturely dimension, which is true of every human being but must often be called to mind, implies that we accept our own merits and flaws as part of the spiritual journey toward God. A good dose of loyalty is needed. In fact, those who want to observe themselves in an impartial way must highlight often embarrassing aspects: insecurities, complexes, fears, humiliations, breakups, unrealistic ambitions, disappointments and wounds. But they must also trust that salvation is achieved even with these limitations.
Health professionals treat and care for the sick by what they do, by what they know, and by who they are. A relationship becomes therapeutic when it becomes an encounter between two individuals marked by truth and humility (two virtues, these, that always go together). Then everyone will have to engage in the task of discerning what makes them feel strong and what makes them tremble. The first dimension is to embrace with gratitude what one has received as good, avoiding excessive pride; the second is to situate the shocks in God’s saving plan and transform them into opportunities to live professionally, rooted in truth.
With the task of helping
Medicine, psychology, nursing and other health-related activities are the ways that health care professionals have chosen to love. For them, such activities acquire a missionary dimension. This determination to “help souls” – to use the expression of Saint Ignatius of Loyola – is an essential element of the commitment of believing medical personnel who realistically trust in a God who is love. Today we would use other terms to express the same idea: today “help” has acquired a particular focus that relates to service and caring; and the concept of “soul” is understood in personalist and existential categories that encompass the whole human being and all human beings with whom we come into contact.
Ultimately, we want to reiterate that being a health care professional can turn into a way of being a Christian. Pastoral care with health care professionals must aim for a harmony between love and faith.
However, alongside this hermeneutic of hope, there is also a hermeneutic of suspicion, because the life of a helping professional can also be lived in a disordered way (for example, with masochistic, narcissistic or even guilt-ridden aspects). Therefore, pastoral care will consist in knowing how to propose means for accompanying the health care profession in a mature, diligent and serious manner. To this end it is important to examine the origin of the deepest motivations that drive someone to help; to make a discernment of the world of needs, desires, calls, and anxieties; and to understand the specific way in which each person lives this mission. The help that health care workers thus offer can come to be an intrinsically human and humanizing act for them and for the patients they care for: in the words of Otto Kernberg, “the result of our instinctive propensity to love.”
Obstacles and aspirations
Behind all these reflections are the people. Yes, people who fight and desire, resist and believe, strive and hope. Many of the obstacles and aspirations that healthcare professionals face relate to the relational dimension inherent in their profession. These should be taken into consideration and given careful attention.
Among the possible difficulties, some are recurrent. For example, those related to managing patients’ wishes; paying appropriate attention to their families; discontent and discomfort sometimes generated by these first two reasons; being judged; worries and inconsistencies; tensions with some colleagues; activism; neglecting the inner life; fear of death; and misunderstanding of one’s values and beliefs.
But there are also many opportunities that open up a pastoral path of encounter with the transfigured God through the thousand faces of pain. First, because the fragility of the disfigured arouses the desire to heal the wounds of the world and opens up a privileged space for communion of life with Christ the Lord. Second, because, if we look at some of the most dramatic and profound moments that human beings find themselves living, it becomes evident that our heart is made to allow itself to be embraced by the presence of God and will not find peace until it is able to rest in Him.
The Trinitarian Dimension
The five dimensions we have mentioned – vocational, sapiential, creaturely, missionary and relational – run through the lives of health care workers and converge in another category that gives them meaning and unity, the Trinitarian dimension, which goes beyond merely religious or spiritual elements and transcends limited psychological, anthropological, sociological and cultural analyses.
Many health care workers perceive the need to experience the meaning, encouragement, closeness, the word and peace that come from God, that is, to live at the same time with their eyes fixed on the patients (facies infirmorum) and with their faces in the presence of God (coram Deo). This is a God whom we confess as Father, because he sustains all his creation with love; as Son, who teaches us to live life to the ultimate consequences; and as Holy Spirit, the breath of love experienced every day by so many doctors, psychologists, nurses, auxiliaries and other health care workers.
DOI: La Civiltà Cattolica, En. Ed. Vol. 5, no.11 art. 14, 1121: 10.32009/22072446.1121.14
. In the book Do No Harm (2016), which is like a personal confession at the end of his professional life, British neurosurgeon Henry Marsh questions, with subtle irony, the difference between God and a doctor. He gives this answer: what distinguishes them is the fact “that God does not think of himself as a doctor.”
. Cf. Qoh 3:1-8.
. O. Kernberg, “La patología narcisista hoy”, in Cuadernos de psiquiatría y psicoterapia del niño y del adolescente, no. 13-14, 1992, 101-154.
. “Lord, you have made us for yourself, and our heart has no rest until it rests in you” (Augustine, The Confessions, I, 1).