The Accidental Chaplain and the Practice of Compassionate Presence

In my early 20s, I was an evolving yogi and working in the field of chronic pain as a manual therapist; doing energetic healing work, myofascial release, and cranio-sacral therapy within a multidisciplinary practice. Occasionally, we would receive referrals for house calls for hospice patients. Driven by the pain of the body and of a life soon ending, the humans behind these referrals were often labeled "difficult" patients, non-compliant, or argumentative. They often included a concern for which the standard treatments were exhausted. Family and friends would sometimes explore alternatives, of which my practice was one. The time I spent with one particular individual was special and impactful for me, and it continues to inform my lens of compassionate presence to this day. I would like to believe that I also had an impact on his final days on earth.

V.K. was a renowned physicist who was suffering from a terminal disease. The chances of survival were zero, and V.K. had decided to stop most all life-sustaining treatments. I was called to help alleviate the now excruciating, chronic pain he was enduring every minute of his waking day. His life expectancy was determined to be about a month. When I arrived at the address listed on the referral, I found a grand Victorian home. Inside, I encountered a stoic, frail individual, his body beginning to waste away. Mostly confined to a bed in his living room, his only view of the outside world was the infrequent visitor and a large picture window in the living room. Although he did not initially let on, he was in immense pain and had very little mobility. His remaining family found it difficult to visit and witness his declining condition. As a scientist-atheist, he had declined chaplaincy or any other type of spiritual care.

After my first visit, he began to open up to me, first expressing his beliefs about his end, his objections to beliefs about the afterlife, and his belief that there was nothing beyond his current existence. I believe "soapboxing" would be an appropriate descriptor. He believed he had led a good life and made an impact, which was good enough for him. He carried on this way for some time, as if reaffirming his own beliefs to himself to soothe a worried soul.

At one point, he paused as I was moving his IV stand closer to his bed, and asked, "What do you believe?" My beliefs were very different from his, and standard training is to reflect back. I replied, "I'm here for you, and vocalizing my beliefs is inconsequential to your care." As a good professor and scientist does, he countered and pushed. He debated. Eventually I shared, believing that he had a spark to understand and explore alternatives before his passing. I noticed he listened with intent and asked questions, not to dissuade, but to ponder. The days went by, and we spent a number of afternoons exploring his views of spirituality and some of my own throughout each treatment.

Some memories remain visceral, and I distinctly remember the sun shining through the front bay window, the rays hitting the dust in the air, the smell of the medical equipment, the faint hiss of the oxygen tank and hose, the room, and, most importantly, the presence and existence that we shared together. I grew to look forward to our chats each week, and at some point, despite his declining health, I began to forget that our time together was finite.

I awoke one morning eager to spend time with him again that afternoon, to chat about energy, meditation, yoga, and their intersectionality with science. As I drove up the street to his home, I could see a white coroner's van in the driveway, the front door of the grand Victorian wide open, and a gurney visible; I knew that he was gone. Although I missed his actual passing, I was blessed to be able to say goodbye to his body before they took it away. Om Shanti.

Later, I began to realize that the experience with V.K. was foundational to an approach known to chaplains and spiritual care providers of holding of space and time in which the sacredness of human connection is allowed to flourish.⁶

Chaplains and scholars of pastoral care have a specific name for what unfolded in that Victorian living room. In an interview conducted during my chaplaincy training, Fire Chaplain Jim Cook of the California Fire Chaplains Association told me that a chaplain's primary responsibility is precisely this, a ministry of presence.¹ The word ministry carried, for me, a certain residue, recollections of proselytizing encounters from my youth, and it took time to arrive at a different meaning for it. With V.K., I had already been practicing something like it, before the specific lexicon arrived.

Author David Brooks has argued that attention should function like an on/off switch rather than a dimmer switch that gives a person only sixty percent of attention while the rest drifts toward distraction.² Sitting at V.K.'s bedside, moving his IV stand, listening to him lecture, then debate, then genuinely ask, I was, without knowing the term, practicing the on-switch. I brought the whole of my attention into that room, with its bay window and the hiss of the oxygen tank. I have found that when a spiritual care provider manages this consistently, the recipient is left with an unmistakable message that they are valued and fully seen, and the outside world has, however briefly, ceased to exist.

Sonny Guild, writing as a Christian pastor rather than a chaplain, describes a ministry of presence as a commitment to give others a personal presence rather than simply give them words. When there is less concern for the right words and more concern for being present in another's life, he writes, ministry becomes more meaningful.⁵ I think of this whenever I recall V.K.'s question, "What do you believe?", and my own instinct to deflect. My training told me to reflect the question back to him, but he was a scientist and he pushed past the reflection and insisted on an actual answer. I realized later that the question was merely a door, and my answer mattered less than the willingness to engage and stay in the room and present moment.

I find philosopher Martin Buber's distinction between the I-It and the I-Thou relationship useful here. An I-It relationship is transactional, oriented entirely toward outcome, e.g., pain reduction, symptoms managed, and the visit completed. An I-Thou relationship is something else, a full encounter with the other, one that Buber believed invited the Divine into the space between two people.³ At my young age, my visits with V.K. began with an open mind, and a genuine desire to help, but probably for both of us, it leaned towards an I-It relationship. I was there to manage his pain, and his family hired me to do so. Somewhere in those afternoons of conversation and caring, the relationship became I-Thou, and I stopped identifying the visits as appointments, they were opportunities to suspend time and space, to invite the Divine, and to simply be.

In theory, a ministry of presence, or compassionate presence sounds simple. In practice, it is difficult to resist the compulsion to fix, or to fill silence with reassurance, or something else that the care recipient has not asked for. V.K. had already made his position clear that he was an atheist, and he did not want chaplaincy or spiritual guidance. He had also settled on his decision to end life-sustaining care. Any impulse on my part to "adjust" that stance would have undoubtedly collapsed. The practice of cultural humility encourages a spiritual care provider to hold their own tradition firmly enough to draw on it when invited, while setting aside any need for the other to arrive at the same conclusions. Hindu wisdom has long made room for this kind of plurality, understanding truth as something approached from many paths rather than "owned" by one. Indeed, there are many ways up the spiritual mountain.

Researchers studying what chaplains themselves regard as markers of a successful encounter found that meaningful connection was among the most consistently cited hallmarks of the work, alongside a felt, often wordless, sense that a visit had met a patient's needs.⁴ I did not have a name for this at the time I sat with V.K. I only knew that I looked forward to our conversations, that I left each one feeling something had happened between us that mattered. This, I have come to believe, is close to the center of what compassionate presence is. It is not just an intervention technique, but more of a willingness to be fully met, and to fully meet another, without needing the encounter to resolve into anything beyond itself. It is also inviting the sacred into a relationship with another soul. To walk alongside them.

V.K. died without changing his own beliefs, without ritual, and still as a self-described scientist-atheist, as he had well intended. Yet, I do not think our time together was without a sacred quality. In the Hindu tradition, seva, selfless service, asks nothing of the one being served in return; it is unconditional. The selfless offering itself, not the outcome, is enough. I did not arrive at V.K.'s bedside as a chaplain, and I did not leave one, though I joke that this was my first experience as an "accidental" chaplain. Sitting with him taught me what spiritual care providers are asked to hold at the center of their work, a presence offered without condition, holding space and time for whatever may come.