More than the Last Rite

What does a chaplain actually do?

During college and for several years that followed, I was already known as an “adrenaline junkie” — someone who loved being an EMT, running hot in emergency vehicles, extricating people from wrecked cars, and going on search and rescue calls. There is a term that may more accurately describe people drawn to that kind of work: chaos coordinators.

I was on a call to a motor vehicle accident as a member of the rescue squad in a rural northwest Arkansas county. It took us almost twenty minutes running hot to get there, and we had no idea what the scene looked like. We found a Schwann’s truck about a hundred feet from the highway in a pasture, apparently rolled in place, with no one around. I looked inside the cab and found the driver — still alive, pinned beneath the entire weight of the truck.

As my partner worked to stabilize the truck, I climbed inside the cab to assess him. The entire weight of the truck was on his abdomen. I wasn’t medically qualified to declare what I already knew, and my job was to assume otherwise — but one look in his eyes told me he was dying. I spoke to him, but he couldn’t speak back. When I told him we were working to get the weight off of him, he blinked in acknowledgment, then gestured toward the dash. There was a photograph of his family. I handed it to him and positioned my light so we could see each other. I could think of only one thing to say.

I’m here. That’s it.

He died while I was in that cab with him. I didn’t know it then, but that moment became the foundation for everything that followed. I learned to be a non-anxious presence long before I ever heard that phrase.

I have thought about that man many times since. What I keep returning to is the thread that runs through that moment and every moment like it: we want to be connected to another. At the end of his life, my job wasn’t to fix anything. It was to help him stay connected — to his family in that photograph, and to another human being beside him in the cab. I hope it gave him something calm in the midst of his last moments.

That night, I was not acting as a chaplain. But I learned something I have never unlearned: healing comes through connection. Connecting people to what and who matters most. That is chaplaincy. And that is where this story begins.

What People Think We Do

The stereotype is understandable. Chaplains are the ones people call when someone is dying. I cannot count the number of times I have walked into a room and watched panic cross someone’s face — because in their experience, a chaplain only appears when the end is near.

That assumption contains a grain of truth, because the end of life is indeed a time when spiritual connection matters most. But it misses almost everything else.

Chaplaincy is not the soft edge of healthcare. It is a clinical discipline with its own training, competencies, and measurable outcomes — one that operates in the domain of meaning, spirituality, and human connection. Those things are not peripheral to health. They are central to it. Psychosocial care, of which chaplaincy is a part, is clinical care. It does not step in when medicine runs out of answers. It runs alongside medicine, doing what medicine was never designed to do — and doing it with the same rigor, the same intention, and the same accountability. In my setting, chaplains are part of the psychosocial team of social workers, psychologists, child life specialists, with each bringing distinct clinical competencies to the same patient and family. We round in the ICUs. We are present at the bedside and in the waiting room. We show up at the beginning, not only at the end.

Searching for a Handle on the Moment

There is a scene in Men in Black where Detective Edwards has just discovered that everything he thought he knew about reality is wrong. Aliens are real. The universe is far larger and stranger than he imagined. As he struggles to make sense of it all, Agent K looks at him and asks: Searching for a handle on the moment?

Most of us — when we receive a devastating diagnosis, when we sit in a waiting room during a surgery, when we lose someone we love — do not ask medical questions first. We ask human ones. Existential ones.

Why is this happening? Who am I now that this has happened? How do I tell my other children? What does any of this mean?

These are the questions chaplaincy is built for. Meaning-making is one of the core competencies of board-certified chaplaincy. Chaplains who complete Clinical Pastoral Education — a rigorous residency that moves toward national board certification — are trained to sit with questions that have no answers. We are trained to resist the very human impulse to fix, to explain, to resolve. We listen more than we speak. Sometimes we do not speak at all.

We are trained to walk with someone while they search for a handle on the moment — not to name it for them, but to stay present while they find it in the way that makes most sense to them. That looks different from one person to the next. It always does. But staying present with questions that have no answers requires a particular kind of discipline, and it one that runs counter to almost everything else in a clinical environment.

Presence Is Not Passive

In the wide variety of traditions around prayer, stillness, and contemplation, I have learned to sit differently with a word I used to misunderstand: wait. I used to think waiting was passive — sitting until something happened. But waiting is an active verb. While we wait, our minds continue to process, our bodies continue to respond, and something in us longs for connection. That is where chaplains live. Sometimes it is sitting quietly with another. Sometimes it is simply listening while they speak. Sometimes it is helping them frame their own words in a way that connects them to something important. Rarely is it explaining what is happening to them.

Embodied presence — being fully present, not merely physically in the room — is an active clinical intervention. This is supported by what we understand about the nervous system, about trauma, about the way human beings regulate one another.

When a person is in crisis, their nervous system is activated. Fear, grief, shock, and uncertainty flood the body with stress hormones. The clinical environment, for all its competence, is itself a source of anxiety — the noise, the equipment, the unfamiliar language, the relentless pace. A regulated human being, one who has learned to bring a non-anxious presence into a highly anxious environment, changes the room. This is not a metaphor. This is polyvagal theory. This is what trauma-informed care is pointing toward.

A board-certified chaplain is trained to be that regulated presence. Not to absorb the anxiety of the room, but to remain steady within it — and in doing so, to create a space where the patient or family member can begin to breathe again.

The delivery driver did not need me to say anything wise. He needed me to be fully present, unhurried, unafraid — and to hold that photograph so he could find his deeper connection, his deeper meaning, in his last moments.

Spirituality Is Not What You Think It Is

Based on that deep need for connection, I want to offer a definition of spirituality that I have arrived at slowly, through years of sitting with people of every faith tradition and no faith tradition at all.

Spirituality is relatedness — the way we understand, nurture, and repair our relationships with ourselves, with others, with the world around us, and with whatever matters most to us. It is the search for connection that transcends circumstances and helps us understand our place in something larger than ourselves.

A Christian may express it through the sacraments, scripture, or prayer. A practicing Jew may express it through Shabbat and Mitzvot. A Muslim may express it through the Five Pillars. A Buddhist expresses it through presence and the release of clinging. A secular humanist may express it through community, beauty, and the irreducible fact of human solidarity. The Twelve Step community speaks of a higher power while allowing each person to define what that means for themselves. Even someone who identifies as a committed atheist wrestles with questions of meaning, with grief, with the hunger for connection that never fully goes away.

Chaplaincy is not about steering any of those people toward a particular tradition. It is about accompanying them in their own search. Chaplains are, at our best, witnesses — people trained to be fully present to another person’s spiritual journey, whatever form that journey takes.

The thread running through every tradition, every path, every framework I have ever encountered is this: we were made for relatedness. The sense that we are not alone. The experience of being known by something or someone larger than ourselves. That is the irreducible core of spirituality — and it is precisely what illness, trauma, and loss most threaten to take away. And this is what makes the chaplain’s presence more than logistical. It is also very clinical in nature.

What If We Called Earlier?

At Arkansas Children’s Hospital, we try to visit every patient admitted to one of our intensive care units within the first seventy-two hours. We want families to meet a chaplain early — not because a crisis is imminent, but because connection matters throughout the journey, not only at the end. We visit weekly in the ICU after that, because prolonged hospitalization is one of the loneliest human experiences there is, and loneliness compounds suffering in ways we are only beginning to measure.

Now imagine something different. Imagine a chaplain present not just at ICU admission, but at the moment of diagnosis. At the moment a family is told their child will need major surgery. At the moment a teenager receives news that will reshape their entire understanding of their body and future. Not to perform a ritual. Not to offer platitudes. Simply to be with that person — to help them stay connected to meaning when meaning is the first thing that begins to fracture.

There is a growing body of evidence that this kind of presence has measurable clinical effect. A 2024 systematic review of twenty-five randomized trials found that compassion-based interventions — focused on emotional support, intentional listening, and individualized attention — reduced anxiety and depression in seventy-two percent of studies, while also improving patient satisfaction and shortening hospital stays (Wootton et al., 2025). The Veterans Health Administration’s Surgical Pause initiative, which added a brief preoperative goals-of-care conversation for frail patients, increased documentation of patient preferences from seventy-five to ninety-two percent and was associated with a thirty-three percent reduction in 180-day mortality (Cooper et al., 2023; U.S. Department of Veterans Affairs, 2022).

These are not soft outcomes. They are the kind of numbers that change how institutions think about what clinical care actually includes. They are the basis for significant experience in patient experience, healing, and resiliency for patients, family, and staff.

The Long Walk

At the end of all of this, it is important to return to that initial image that many people have when a chaplain arrives as someone who walks with them through times of loss. While chaplains are much, much more than a presence during times of death, the presence of a chaplain during times of death is often an embodied presence of something greater than death itself– life! The most effective chaplain is one who walks the long walk, not just the final steps.

I have been with dozens of families and several people in their last moments of life as we understand life. That includes my own mother and my son. In each one, I felt a privilege to be a witness to something that is greater than death – a transition, a release, a resolution that is beyond words. I have found the greatest sacredness in life and death when I was able to be with someone not just during their last steps, but during the long walk we call life. Whether that is a few hours or many decades, there is something deeply profound and spiritual in walking together, no matter the distance of the journey.

That is the walk of a chaplain.

This is the long walk.

Even the day I was with the delivery driver, I was able to be present for more than that moment. I was with him at his death, looking back through his walk with his family. And in some way I am still walking with him, because that moment became the seed of everything I now know about presence. We have walked together into every room I have entered since, whether the people there were facing death or not. I was there — and I am there today – unhurried, unafraid, fully present. While I didn’t realize then how transcendent that moment was until much later, we continued to walk together. Many more have joined me, in life and in death. I wasn’t changed by his death. I was changed by his life, and I continued the long walk with him..

We are not the last rite. We are the long walk — present at the beginning, present in the middle, and yes, present at the end.

Because no one should make that walk alone.

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References

Cooper, Z., Acree, L. L., Meddings, J., Rosenthal, G., & Englesbe, M. (2023). Surgical Pause quality improvement initiative. Journal of Surgical Research. https://pmc.ncbi.nlm.nih.gov/articles/PMC10125643/

U.S. Department of Veterans Affairs Health Services Research & Development. (2021). Frailty screening increases palliative care consultations. https://www.hsrd.research.va.gov/research/citations/pubbriefs/articles.cfm?RecordID=679

U.S. Department of Veterans Affairs. (2022). Surgical Pause program impact report. https://www.hsrd.research.va.gov/impacts/surgical-pause.cfm

Wootton, J., Rubin, M., Eliason, K., & Hansen, M. (2025). Prehabilitation interventions and surgical outcomes: Systematic review and meta-analysis. Journal of Perioperative Care. https://pmc.ncbi.nlm.nih.gov/articles/PMC11752451/