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EEnndd--ooff--LLiiffee CCaarree aanndd tthhee CChhaappllaaiinn’’ss RRoollee oonn tthheeMMeeddiiccaall TTeeaamm

Mary Lahaj, MA, CPE

Clinical Pastoral Education (CPE) CertifiedChaplain, Groton SchoolGroton, Massachusetts

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KKeeyy wwoorrddss:: IIssllaammiicc eetthhiiccss,, cchhaappllaaiinnccyy,, ppaassttoorraall ccaarree,,iimmaamm,, ccuullttuurraall ccoommppeetteennccyy..

Muslim chaplaincy is a new profession for menand women in the field of religion.

On the authority of Anas bin Malik, the servant ofthe Messenger of Allah, the Prophet Muhammadملسو هيلع هللا ىلص s aid:

None of you [truly] believes until he wishesfor his brother what he wishes for himself.1

This hadith underscores the degree of empathy aMuslim should feel for another human. Whether or

not a Muslim chaplain is in the hospital to help fam-ily members make meaning out of tragedy or to cel-ebrate a life, he or she embodies Islam’s eternal val-ues of empathy, respect, and love of God’s creation,dignity, modesty, compassion, and patience inadversity.

Although I have written a few articles about myexperiences, there are no statistics or research as yetabout this new profession. For example, I was thefirst Muslim woman to be accepted into the rigorousnine-month residency program at Brigham andWomen’s Hospital in Boston, Massachusetts, whichgives the maximum number of units in clinical pas-toral education (CPE). I did my first CPE unit at SaintVincent Hospital, a small, Catholic hospital inWorcester, Massachusetts, and three CPE units atBrigham and Women’s, a much larger, acute traumahospital.

I studied to become a chaplain to realize a life-long desire to connect deeply with individuals. I amusually standing before an audience giving a speech,but in doing that I am only talking about Islam. After25 years, I wanted to practice Islam in my every daywork. I felt I needed a softer heart and deeper love ofGod and His Creation. Encouraged by two imams topursue chaplaincy training, I soon learned about thedeep listening and compassionate response requiredto visit the sick, comfort families, and be presentwith those grieving, suffering a loss, or experiencingdying or death.

A chaplain’s role varies from reminding someoneof his or her soul while the thought of the soul isobscured by physical pain to guiding someone to Godwithin their present circumstances. The spiritualdimension can be applied to every aspect of life. Forexample, when you choose a spouse, you do not justmake a spreadsheet of qualities. When you purchasea house, you do not purchase it based on squarefootage alone. Instead, you are driven by emotionand say, “Ah, this really feels like home.” That is thedimension that chaplains nurture in their work.Here, the Qur’an speaks about remembrance of Allahand the effects that has on the heart. The Qur’ansays:

Article DOI: http://dx.doi.org/10.5915/43-3-8392Video DOI: http://dx.doi.org/10.5915/43-3-8392V

Correspondence should be directed to

Mary Lahaj, MA, CPEmarylahaj@gmail.com

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Those who believe, and those whose heartsfind their satisfaction in the remembrance ofAllah... for without doubt in the remem-brance of Allah do hearts find their rest.2

In my life, I wear many hats. Whether acting as achaplain, speaker, or teacher, I have always beendedicated to participating, initiating, and advocatinginterfaith relations and dialogue. One of the things Iloved about being a chaplain was being able to workon an equal footing with people of other faiths andprofessions. The position presents yet another open-ing for Muslims to increase non-Muslims’ under-standing.

As a new profession for Muslims, chaplaincy rais-es some important questions about the foundationsfor pastoral care in Islam. As a Muslim chaplain, itwas difficult to form a pastoral identity with nopredecessor, no role model, and no research in thefield to inform me. In order to form a pastoral iden-tity, students generally draw from a Christian tradi-tion. Therefore, it was incumbent upon me as a stu-dent to discover the roots of pastoral care in my owntradition as well as in my personal life.

My identity was imbued by my Arab-Americanheritage and its value of hospitality. Finding a newpurpose for this quality, I saw my role as someonewho would welcome and reassure patients. Throughthe eyes of a new patient, especially an internationalone, the hospital was a huge, alien, and impersonalinstitution. I tried to reassure Muslim patients thattheir religious life would be accommodated duringtheir stay in the hospital, if they wished. For allpatients and staff, I tried to provide pastoral care,rooted in the Islamic tradition, as described by M.Fethullah Gulen, who said: “Loving and respectinghumanity merely because they are human … is anexpression of love and respect for the AlmightyCreator.”3

I also encountered the very basic question ofwhat I should call myself; i.e., a title that would indi-cate to the Muslims what I did and who I was. I spenta lot of time trying to come up with a leadership titleother than “iman” to which Muslims could relate. Inthe end, my authority as a staff member at the hos-pital sufficed.

Although there is no word in Arabic for “chap-lain,” chaplaincy has roots in Islamic teachings. Awell-known hadith encourages Muslims to visit the

sick and comfort them:The Messenger of Allah ملسو هيلع هللا ىلص s aid:

Allah هلالج لج will s a y on the D a y ofR es urrection: ‘S on of Adam, I was s icka nd you did not vis it me . The ma nexclaimed: Lord, how could I vis it You,You are Lord of the worlds ! Allah will s ay:D id not you know that My s ervant, s o ands o, was s ick and you did not vis it him? D idnot you realize that if you had vis ited him,you would have found Me with him? ’4

I found this hadith to be true. As with any con-scious act of charity, the act is accompanied by asense of the Divine presence. Sometimes, I experi-enced that while meeting patients who displayed astrong faith. They seemed to glow with acceptance,cheer, submission, and made me realize that myfaith was not half as strong. Of course, there werethose who were ambivalent about faith and forgetfulof God. In this case, my job was to be the light in theirday, listen to their concerns, uphold their dignity,encourage patience in adversity, and of course, behopeful for the best outcome.

It was early on when I learned that part of mypastoral formation would involve being a discerningvoice for non-Muslims who were caring for Muslimpatients and communicating with their families.Many Muslim patients present with three barriers tocommunication: language, culture, and religion. Inoticed that when health-care providers were facedwith even one of these differences, it impacted thecare of their patient and pace of their treatment. Oneof the benefits of having a Muslim chaplain on staffwas the satisfaction and convenience of consultingand providing whole patient, culturally competentcare. Although there seemed to be a prevailing mis-perception that all Muslims were the same, regard-

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less of differences in practice, culture, education, orlanguage, I was still able to provide some degree ofinformation about a patient’s religious, cultural, andhistorical background that was enlightening andhelpful.

For example, I was drawn into a family meetingconcerning a 34-year-old, non-English speaking Iraqipatient. In chaplaincy training, the family meeting isa special event where one learns how to assess thedynamics between the family and the medical staff,advocate for the family and the staff to ensure thatthe communication is going well on both ends, andknow when to jump in, or when to back off. This wasmy second meeting, and I was very skeptical that Icould be of any help whatsoever because I had onlyprayed with the patient a few times a week andnever had a conversation with him.

The patient had a bone marrow transplant andwas suffering from graft versus host disease. He hadbeen sick for months, and it became apparent that hewould not get better. Yet, he was being treatedaggressively, as per his family’s request. It was thenurses on the floor who contacted the hospital ethicscommittee and asked for a meeting with the family.They complained that in caring for the patient formore than 100 days, his suffering was “unimagin-able” and too great to ignore. They threatened toshow the family what the patient was really dealingwith underneath the covers.

The meeting involved the ethics committee, fiveof his doctors, a social worker, case manager, two ofhis nurses, and me, his “chaplain.” They asked me toexplain to them what religious and cultural influ-ences they should consider as they informed thefamily that any further medical treatment would befutile.

The patient’s wife was invited to the meeting butmade it clear to me that she did not want to be thehealth proxy. The role was a cultural stretch for her.As a result of my interaction with the patient’s wife,the committee was prepared for a distant cousin tospeak for the patient at the meeting. In my conversa-tion with the wife, I also learned that they were fromsouthern Iraq, where Shia Muslims were persecutedand killed by Saddam Hussein’s regime. I shared thisinformation with the committee in advance.Knowing the background somewhat prepared themfor the cousin’s argument to keep treating thepatient. The family listened to the committee’s

report, or “reality check,” but then concluded thatthere was no way they could give up hope on thepatient. The cousin begged the doctors to continueto treat him. He claimed it was the “Islamic” waybecause Muslims value life so deeply. He explainedthat the patient had survived Saddam Hussein’sgenocide and deserved our continued hope andefforts.

Countering with my limited knowledge of Islamand newly acquired chaplaincy skills, I tried tochange his mind, as did every member of the com-mittee. I did not contradict his statement about “theIslamic way.” It was, after all, true that we are taughtto value life. I did, however, ask if the family had animam to speak to about the patient’s situation. Thecousin said they did have an imam and had alreadyspoken to him several times on this matter. Aftertwo hours, the meeting ended with the familyremaining steadfast and the doctors agreeing tokeep treating the patient. When the family left, oneof the doctors likened the notion of “never giving uphope” to that used by the families of holocaust sur-vivors. “They never gave up hope then, why shouldwe give up on them now?” After another month, Iwent to visit this Iraqi patient, only to learn that hehad succumbed while I was on vacation.

Chaplains are asked to make notes of each visit ina patient’s chart, describing the visit and indicatingfor the record that they are following the patient.The family of a dying patient might call for a chap-lain. If the chaplain is not on duty and the patient isdischarged or dies, the family has to settle for a sub-stitute or on-call chaplain at the bedside.

In general, knowledge of a patient’s case out-come remains incomplete, except in rare occasions.The main reason is there are too many patients andtoo few chaplains on the hospital staff.Consequently, the chaplain has to prioritize dailyvisits. Visiting new patients is a priority, and secondvisits are discouraged. If a patient leaves the hospi-tal, chaplains generally do not have time to followup. If a patient dies in the hospital, the chaplain whowas with the patient at the time of death makes abereavement call to the family a week later. In somecases, when the chaplain has had a long relationshipwith the patient and the family, he or she might beinvited to preside over the patient’s funeral.

Another thing I learned in my training was theimportance for patients to identify their religion as

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soon as they are admitted to the hospital. In additionto dietary and modesty needs, knowledge of apatient’s religion can impact treatment. As part ofour education, we used to attend the “SchwartzRounds Program” at Brigham and Women’s Hospital.The program was founded by a patient, KennethSchwartz, a health-care lawyer at MassachusettsGeneral Hospital in 1995, days before he died of lungcancer.5 This program’s mission was to advance com-passionate health care through strengthening rela-tionships between doctors and patients.5

The guest speaker demonstrated how culturaland religious incompetence can directly impact thepractice of medicine. We watched a video about anelderly Muslim patient from Bangladesh who hadcolon cancer. The patient wanted to avoid wearing acolostomy bag and asked his doctors not to take outmuch of his colon. After much discussion among thedoctors and with the patient, they agreed to do whathe asked. A month later, his family brought him backwith evidence of a recurrence. His adult childrenblamed the doctors for not taking out “all” the can-cer. What the children and the patient’s doctor didnot know was the patient did not want a colostomybag because he feared he would not be “clean” andtherefore would be unable to pray his five dailyprayers. I learned that this example underscored theneed for a Muslim chaplain on staff. He or she mighthave clarified a simple misconception and preventedthe situation from becoming life threatening.

This case exemplified a communication break-down, not only culturally between the doctors andthe patient, but also between the adult children andthe patriarchal, immigrant patient. It is a good exam-ple of why it would have been best to employ animam. As a man, he might have gained the confi-dence of the male patient. As an imam, trained inpastoral care and experienced in patient care, hemight have elicited the patient’s true concerns andaddressed them.

Another issue to discuss is the role of the chap-lain viz-a-viz that of the imam. I was contacted by asocial worker at Children’s Hospital, where a familyhad requested an imam be present at an impendingfamily meeting. Because the imam was unavailablethat day, the social worker called the Brigham andWomen’s Hospital to see if the Muslim chaplaincould fill in. The purpose of the meeting was for thedoctor to inform the family that their baby, whom

they had treated for 80 days, was ready to go home,basically to die, because there was nothing moreanyone could do.

Speaking with the social worker, I learned asmuch about the case as I could: the parents had emi-grated from Somalia, requested an imam be presentat the meeting, required an interpreter for the deaf(father), and another for language. My first reactionwas to say, “I think that since they asked for animam, you need to have an imam present.” Althoughmy statement seemed obvious, the social worker’sresponse surprised me. She said, “But what does animam do, and what is an imam?” She said, “I think itwould help me to know more about this in order toknow what I should do now.”

I explained that an imam would be best in thissituation because he was a traditional authority fig-ure with expert knowledge of the religion and thathis legitimacy, education, and status in the commu-nity could automatically bring comfort to the familyand strengthen their faith. I pointed out that askingfor an imam was indicative of a custom that neededto be respected. With me substituting for an imam, itmight elicit uncomfortable questions like: “Who areyou? What is a chaplain? Can a woman do it?” Insome circumstances, but not all, these were thequestions I heard from the Muslims.

In the end, having been given this information,the social worker was confident enough to postponethe meeting until the imam was available. I made thereferral for the imam, so he could be present at thenewly scheduled meeting on the next day. Later theimam told me what happened. He said, “It was luckyI was there because the men didn’t understand whythe baby was going home. They got angry andblamed the mother for wanting to take the babyhome of her own volition. I had to explain to themthat it was not the mother’s idea to take the babyhome.” They listened to him, and I was glad that hewas there to advocate for the woman.

In another case, a 38-year-old woman, aMoroccan immigrant, who was having her fourthchild by cesarean, confided in me that she did notwant to have any more children. She asked me to askthe imam if it was acceptable for her to have a tuballigation at the time of the cesarean. She saw me as anintermediary for the imam. As a traditional woman,she did not want to see the imam. So, I arranged forher doctor (a woman) to meet with the imam, and

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they discussed all of the options available, includingthe tubal ligation. My role there was to facilitate themeeting. When all the information was made avail-able to the woman, she and her husband were betterable to decide what they wanted to do.

Because I was asked to speak about the role of thechaplain in the end-of-life care, I will share with youa case about an elderly Muslim woman whom I fol-lowed for several months as she struggled with ter-minal congestive heart failure. As there was no curefor this condition the hospitalist suggested to herdaughters that they consider hospice at home. Herecommended a local hospice group. The patient tac-itly agreed.

I was present when the family consulted with apersonal family friend, who was an internist. Inessence, she told them not to put their mother intohospice under any circumstances. She said, “Yourmother will think you have given up hope.” She alsosaid that the hospice people came with a “bag ofdrugs,” and warned that at the first sign of thepatient failing, they would slip her the drugs, andthat would be the end. The doctor-friend carried alot of weight in the family because she was loved,and she loved and knew the mother well.

Next, they called on the patient’s cardiologist,who had been treating her for 20 years. To para-phrase his remarks: Hospice is a beautiful thing.Your mother deserves to have dignity at the end ofher life. All her life, she has been fighting and com-ing back. But now, because there is nothing morethat can be done about the heart condition, it is theend of the battle for her. You should honor her byletting her die with dignity.

I sat with the family as they agonized over theirdilemma, deciding between two highly respectedfriends and professionals, who held opposite opin-ions about hospice. As the family discussed theiroptions, my role was to be a good listener and tomake sure everyone’s questions were answered andconcerns heard. It helped that the patient was ofsound mind and made her wishes clear: She did notwant to return to the hospital in this condition again.

The patient went home. The case ended sadly,however. A few days later, she fell and broke her hip.She was brought back to the hospital but could notbe operated on and died 20 hours later. I was withthe patient and her family as she was dying andwhispered “Lā ilāha illā Allah,” (there is no god but

God) for her because she could not say it out loudand her family was nonpracticing. I also consoled thefamily and facilitated the funeral arrangements sothe patient could be buried as soon as possible in theIslamic tradition.

As for the future of the profession of Muslimchaplaincy, it is a growing profession at all venues.At this time, interest in the Muslim patient, student,prisoner, and soldier is steadily increasing, as theMuslim population grows, assimilates, and thedemographics change. I have received manyrequests to consult and teach on the topic of cultur-al competency and the Muslim patient and student.

Being hired by a hospital, however, is still on thehorizon for a Muslim chaplain, for two reasons: 1)the population of Muslim patients in any one hospi-tal is still very low. In an informal two-month surveythat I conducted in my first few months at theBrigham, there were never more than 15 patients inthe hospital at any one time. 2) Because hospitalbudgets are tight, especially in the Pastoral CareDepartment, directors are forced to choose betweenhiring a part-time imam or a part-time Muslimchaplain. Although there is a scarcity of imams andfewer still CPE-trained imams, the conventional wis-dom in the department is that the hospital is betteroff hiring an imam, likening the choice as between apriest and a nun. The imam is more traditional, moreauthentic, and a man. The irony is that it was the twoimams I knew who urged me to enter the profession,insisting to me: “We need a woman in the hospital.”Although no one has been able to make a strongenough case at this time, most Muslims would agreethat women are also needed in the prison, the mili-tary, and on college campuses.

As the respective roles of the chaplain and imamcontinue to evolve, there will always be a need forboth in the hospital setting. The chaplain’s role inthe hospital lends itself to be more of a discretionaryone, guiding medical staff as to when to call in theimam. The chaplain’s limited role would be compli-mentary for the overworked imam (in scarce sup-ply), leaving him more time to perform other impor-tant functions in the Muslim community.

I also see a role for the Muslim chaplain in themosque community, where families are beset with abevy of domestic, social, and psychological prob-lems. The Muslim chaplain could provide counselingand pastoral care for adults and children, maintain-

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ing confidentiality and giving space to communitymembers who currently suffer silently and needless-ly from shame, stress, grief, or sickness.

I hope that young men and women will choosechaplaincy as a profession because it is a unique wayto serve Allah and His creation. I believe it is anavenue especially suited for women to offer counsel-ing.

RReeffeerreenncceess1. Related by Bukhari and Muslim. Found in the book,An-Nawawi's Forty Hadiths by Yahia bin Sharaful-Deen An-Nawawi. http://islamworld.net/docs/nawawi.html

2. The Glorious Qur’an, Chapter 13, verse 28.3. Fethullah Gulen, M. Respect for humankind.http://www.fethullahgulen.org/recent-arti-cles/2124-respect-for-humankind.html [Updated2007 Feb 8; Accessed 2011-Dec-22]4. Forty Hadith Qudsi. Revival of Islamic HeritageSociety, Islamic Translation Center, Kuwait.http://www.guidedways.com/qudsihadith.php?hadith=185. The Schwartz Center for Compassionate HealthCare. Ken’s Story. http://www.theschwartzcenter.org