Paging God: Religion in the Halls of Medicine by Wendy Cadge

Hospitals are spaces of birth and death, and of hovering between the two. For the acutely sick, they are disorienting and frightening places. For medical professionals, they are busy workplaces. In the gap between the expertise of doctors and nurses and the existential anxieties of patients are mixed emotions and strategies of interpretation, including those that invest suffering and healing with religious significance. Buildings where people traverse natality (Hannah Arendt’s term) and mortality, are hospitals also sacred spaces?

Focusing on “formally secular” US hospitals, Wendy Cadge shows how spirituality travels visibly and invisibly for patients and professionals alike. While the chapel is the most obvious space of ostensibly neutral non-denominational spirituality and chaplains its most obvious purveyors, even some nurses and doctors invoke God when at the bedside or holding the scalpel.

Much of Cadge’s book recounts the rise of chaplaincy and the work of contemporary hospital chaplains as a largely liberal Protestant movement - a dominance that may be partly attributable to her northeastern US focus. Despite their professionalisation beginning in the 1920s, chaplains still face resistance and indifference, and are often considered expendable when hospital budgets are tight. Developing a “spiritually vague” brand in an increasingly religiously diverse society, chaplains focus on helping patients, their families and hospital staff to deal with fear and desperation when facing illness and death. Some chaplains continue an older model of pastoral visiting and administering end-of-life rituals, or, as one Catholic priest declared, acting as “the sacramental SWAT team”. Not wanting to be solely harbingers of death, however, many have become “spiritual care” professionals on the payroll, focused especially on intensive care. Armed with concepts such as “holistic spirituality” and with diagnostic tools such as “spiritual assessments”, chaplains hope to de-Christianise chaplaincy by identifying spiritual needs in every patient.

Cadge presents chaplains as lacking a united front in their attempt to demonstrate their relevance, even as some deploy “jurisdictional expansion strategies” to make the entire hospital sacred space. Some chaplains claim to “represent God”, while others assert that they “bring God with us” on their rounds as mediators between hospital personnel and bewildered patients and families. More ambivalently, chaplains position themselves as mediators between spirit and flesh - ersatz medicalised shamans. They often make the first inquiries to a family about organ donation at a patient’s death. They receive and hold the body of a lifeless baby once the grieving parents are finally able to hand over their child and leave the room. Chaplains perform emotionally charged and awkward labour at the juncture of life and death.

From stories such as her opening account of sitting by the bed of a dying Buddhist monk whom she knew from previous ethnographic research, Cadge shows that chaplains and hospital staff, when confronted by unfamiliar religions, may misunderstand patients’ needs or misguidedly translate them into a Christian key. Largely supportive of a growing presence for spirituality in hospitals, she offers recommendations for hospital professionals, including chaplains, to better address patients’ spiritual needs. The expansion of spirituality is also a battle for territory: literally in terms of coveted hospital space and metaphorically in terms of professional turf. When many “secular” US hospitals are still latently Christian (and overtly capitalist), Cadge could have further analysed the politics of hospital spirituality and offered more examples of how religious diversity is shifting chaplaincy on to “spiritually vague” terrain. Her tales of encounters with chaplains, nurses and doctors struggling with the emotional weight of staving off and then “managing” death are powerful reminders that hospitals are much more than just spaces of medicalisation.