A reverend's rounds: Hospice chaplain ministers to the terminally ill

Demand for hospice chaplains grows as more Americans seek deathbed spiritual counseling

NEW YORK — Sunlight permeates the Upper East Side apartment of hospice patient Kam Hi Tse, 78, as he arranges himself in a half lotus position on the sofa and places his hands, facing upward, on his thighs in what’s known as open-palm mudra. The former chef explains in Cantonese to the Rev. Mary Chang, an ordained Lutheran minister sitting next to him, that this pose makes him open to receive blessings from the Buddha. Chang, 70, nods and opens her palms upward, too.

A hospice chaplain for MJHS, the largest hospice and palliative-care program in the Greater New York City area, Chang makes daily visits to the terminally ill and dying, offering conversation and prayer to patients and grieving loved ones. She typically sees at least four patients a day, in hospitals, nursing homes, hospice centers and private homes. Unlike clergy of the past who usually only served people of their own faith, hospice chaplains take a multifaith and sometimes even secular approach. Chang meditates with Buddhists and sings hymns with the Russian Orthodox. She prays with atheists and speaks with people uncertain of their faith.

"I am here to listen, to be present, not to convert or judge," says Chang, a sprightly Chinese-American woman who on Sundays leads a congregation at the Lutheran Church of the Incarnation in Cedarhurst, NY. Favoring brightly colored clothes when she visits patients, she usually eschews the formal collar and title of her Protestant calling.

Hospice programs focus on caring for terminally ill people and alleviating their pain; in 2011, an estimated 1.65 million patients in the U.S., equivalent to approximately 44.6 percent of all deaths, were under the care of a hospice program. Professional spiritual counseling of the kind provided by Chang is an optional — and growing — part of the programs. While no figures exist on the number of hospice chaplains per se, the total number of chaplains has risen by 30 percent since 2008 to more than 4,000, says Vivian Storms, president of the Association for Professional Chaplains. For the first time since its founding in 1945, the association is offering specializations in hospice and palliative care.

Chang was born to a well-to-do family in Guiyang, a provincial capital in southwest China. Her parents were involved with the Lutheran Church through the influence of missionaries in their hometown. With the Communist revolution in 1949, Chang moved to Hong Kong, where, at the age of six, she met Helen Gilkerson, a well-known Lutheran missionary. Gilkerson gave Chang, then known as Ling Hsi, her Christian name, Mary. Chang studied in Hong Kong and taught art, music and language in high schools as an adult. She immigrated to the United States in 1990.

Newly divorced with three children, she began her ministry in Philadelphia, working with Southeast Asian refugees and AIDS patients, and was ordained a few years later. Ordination seemed a natural path to her, she says, although entering a largely male-dominated clergy in a new country made the training particularly difficult. For nearly a decade afterward, Chang served as chaplain in the pediatric ward and trauma units of various Lutheran Healthcare hospitals across the country. 

Two years ago, MJHS, formerly known as the Metropolitan Jewish Health System, recruited her for hospice work. Chang’s hiring is part of an effort by the hospice center to reach out to a more diverse population. Nationwide, very few Asian-Americans — just 2.4 percent  — use hospice, compared with 8.5 percent of African-Americans and 82.8 percent of Caucasians, according to a 2012 report from the National Hospice and Palliative Care Organization. In Chinese culture, says Chang, talking about the dead or dying is considered bad luck. It's seen as rude, meanwhile, for the younger generation to speak about death with their elders.

"She comes to the Chinese patients as a spiritual, religious, cultural, ethnic and linguistic insider,” says Rabbi Charles Rudansky, MJHS's director of spiritual care and Jewish services. “This allows her to touch the patient’s and family’s inner soul — 'inner' meaning at a very vulnerable moment in their lives."

Chang believes she has found her calling. "My personal journey as a female in this field," she says, "and my trials as an immigrant in a foreign land allow me to bring my 'entire being' to my service."

Trying to recognize and nurture the faith of people at very vulnerable periods in their lives requires openness and a certain amount of improvisation, says Chang. When David Yang, 70, informs her at MJHS’s inpatient hospice unit at Beth Israel Medical Center, in Manhattan, that he is not religious, she does not miss a beat. "I would be happy to know where you draw your strength from," she says.

A high school mathematics teacher who is suffering from pancreatic cancer and who emigrated from Hong Kong more than 40 years, Yang doesn’t answer. But minutes later, when Chang asks if he knows the origins of his name, he brightens. "Yes I do," he answers proudly. "David was a king from the Bible. I chose this name for myself when I came to America."

"David also fought Goliath," Chang reminds him. 

Rev. Chang and hospice patient Kam Hi Tse.
Andrew Lichtenstein for Al Jazeera America

During the three months that she pays visits to Tse, the Buddhist chef on the Upper East Side, Chang reads sheaths of his handwritten Chinese poetry and songs and chants Buddhist prayers with him. On a recent visit, she and Tse sit at a table among his papers and pick out a folk song about the rain that opens flowers on the mountaintop. Afterward, Tse and Chang sit in the living room for a few minutes of meditation. Tse shows Chang how to hold her hands to receive blessings from the Buddha.

"I meditate for peace and compassion every morning and every evening," he says softly. Chang, clearly moved, holds both hands to her heart and bows her head in response. In the car afterward, she explains that in Buddhist belief, how you live your life, your karma, determines how you will be reborn after death.

"So you attempt to live on this earth and to leave this earth as peacefully and compassionately as possible," Chang says.

Chinese wedding banners appealing for "Double Happiness" and "One Hundred Years of Harmony Together" hang on the apartment door in Manhattan's Chelsea neighborhood of Zheng Bifang, 51. Zheng, a mother of four, was diagnosed with nasopharynx cancer 21 years ago, when her youngest child was 1. She has been in and out of hospice care a few times in the last year. Zheng wears a tracheostomy tube to help her breathe and has lost the ability to speak. But seeing Chang is like seeing an old friend. She shares news with her by scribbling short sentences in Chinese on a notepad.

Rev. Chang and Zheng Bifang.
Andrew Lichtenstein for Al Jazeera America

Chang looks at wedding photos on a computer with Zheng's husband, Xiuzheng Chen. Childhood sweethearts, he and Zheng hail from the same small village in Fujian province. The husband came first to America. For nearly two decades, he scrambled for construction jobs and sent money to China. He was able to reunite with Zheng only three years ago, when she came to America.

The reunion is bittersweet now that she is at the end of her life. Amid the happy news that afternoon, the couple fight back tears. Chang tells Zheng: "The love in your life will continue to have an impact after you are gone."

Often, says Chang, patients ask how they'll recognize a loved one who preceded them in death, especially if one of them suffered from dementia. She, too, has thought about this question. In her vision, there is a heaven, and in heaven, no one is sick or old. Her parents and her siblings will be there.

They will recognize each other "by voice," she says. "That always stays the same."

After a long day of visiting patients, Chang returns to her cream-colored Prius. "There are no professional guidelines for this," she says from behind the wheel. "Some days I am in the car crying. Some things attach. They stay with you forever. The eyes of a 1-year-old child who died and the eyes of his mother. A young lung cancer patient who died with four children."

"The veil between life and death," she says, "is very sheer."

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