On the morning of my first day of chaplaincy internship, I knocked on the first door of the unit to which I had been assigned.  After a pause, I opened it to find Ann, a woman in her 60s, sitting in bed, staring at a plate of scrambled eggs.  She looked over at me, expressionless, and asked me to come back after she’d had time to eat breakfast.  I agreed and departed, excited that someone actually wanted to talk with me.  When I returned 20 minutes later Ann motioned toward a chair near her bed.  I sat down and she began.

“I’m here because my kidneys are failing.  I’ve been on dialysis for years, but that can go on for only so long.  I’ve been on a transplant waitlist for more than a year, but apparently I’m a difficult match.  One of my nephews turns out to be an excellent match, and he eagerly agreed to donate.  I came in yesterday for workups in preparation for a transplant.

“Just before my breakfast arrived, my doctor came in to tell me that my health has deteriorated to the point that I am no longer considered an acceptable risk for a transplant.  There’s nothing more that can be done beyond helping me to live out my remaining time comfortably.”

“I’m so sorry to hear that,” I replied.  “That’s really difficult news to get.  I’m here for you in any way you would find helpful.”

In a flash Ann was painting vivid images of herself as a little girl growing up on a farm.  Dreams of becoming a veterinarian that evolved into a career as an industrial scientist, breaking glass ceilings along the way.  Dreams of finding true love that never came true, “just a bad marriage that I had the sense to get out of quickly.”  Dreams of having children of her own that were replaced by a bevy of nieces and nephews who adored her (including the aspiring kidney donor).  Close friends who had supported her throughout her illness, and were prepared to support her for the rest of her days.

“You know, as I listen to myself telling you all this, I realize it’s been a great life,” Ann said through tears.  “I’m sad that it’s coming to an end, but I really can’t complain—I have a lot to be grateful for.  Thank you for taking the time to listen.  It’s made today’s bad news easier to bear.”

Before I stepped into Ann’s room, I had grand, if vague, notions of what being a chaplain would feel like.  I had learned many dos and don’ts, and how to chart a visit in the medical record.  I don’t think anything could have prepared me, though, for the reality of sitting in Ann’s chair and hearing her news.  I said to myself, “You said you wanted to be a chaplain.  I don’t know what you were thinking, but it’s ‘Game on’—right now.”

At any rate, Ann was the perfect first patient for me.  Her plight stirred my heart but did not overwhelm me, and it took no effort to draw her out.  She was bright, reflective, and insightful, and she glided easily between happiness, wistfulness, pride, sadness, and gratitude as she told the stories of her life.

Fortunately, the essential elements of chaplaincy are compassionate presence and active listening, and most of us come equipped with at least the basics.  There is more than I ever realized to practicing these well, and either can be hard to do in a given situation, but most of us practice them regularly with family and friends.  I am often surprised when people say, “I could never do what you are doing,” when I have watched those same people do this work beautifully—including with me.

As I closed the door on my way out, I told myself, “OK, I wasn’t so bad.  In fact, it seems I was helpful even if all I did was listen.”  I went back to my office to chart my visit.  I reviewed a list of descriptors of what I had helped the patient explore, and I checked a box marked “Life Review.”  I thought, “That must happen a lot,” and subsequent experience has proved that true.  I looked over other descriptors, such as “loss of loved one” and “patient actively dying,” and thought, “These must all happen a lot.”  Also true, I now know.