Why Me, God? These were the sort of feelings and questions that whirled through Candace Henley’s head 11 years ago, when she was diagnosed with stage IIB colorectal cancer. Unbearable pain had brought the 35-year-old single mother of five to an emergency room near her home in Chicago. The last thing on her mind was colorectal cancer. But before she could fully grasp what was happening, she was admitted to the hospital and, the next day, surgeons removed 95 percent of her colon.
As she went into surgery, Henley says, she recalled a verse from Genesis 50:20: “You intended to harm me, but God intended it for good to accomplish what is now being done, the saving of many lives” (New International Version). In the years that ensued, she says she would rely on this verse time and again as “everything fell apart. I lost my house and my car. We were homeless and I was still fighting cancer. … I would cry every day and ask God why am I being punished. And there was no answer.”
Henley says she recalls being asked to speak to a chaplain following her surgery, but she turned down the offer. “I didn’t want to speak to anyone,” she says. “I couldn’t talk without crying. I was emotional. I was a wreck. I was depressed. People would tell me this was my path, and I was like, ‘Seriously, can’t God use me in any other way but this?’ ”
Henley’s spiritual crisis was directly tied to her religion. But a person doesn’t have to be religious to have a spiritual experience, says Jason Mann, who, after 30 years as a practicing oncologist, decided to become a chaplain.
“When I go to see a patient,” says Mann, who lives in Portland, Ore., “I will say, ‘What do you believe in?’ It could be family, it could be artwork, it could be beauty. All of those are manifestations of that person’s spirituality.” A spiritual experience can occur when a person is practicing religion, Mann says, but it can happen outside of religion, too. “A spiritual experience can happen at any time when you are moved.”
Reflecting on this difference, Piderman says of her work as a chaplain: “We provide religious care, prayer, anointing and other rituals. But our work is dealing with meaning, worry, anxiety and anger—within the context of spirituality. Our role is to help people connect to what has been meaningful in the past, what has given them hope in the past, and what can help them feel hopeful today.”
Piderman recalls a cancer patient she saw some years ago. “The first time I saw her,” says Piderman, “she told me she was not religious. When I went to see her a second time, she was in bed and said she felt wrinkled. I straightened her bedclothes and asked if that was better. She said, ‘No.’ Then I asked if she wanted a drink. She said, ‘Yes.’ Again, I asked if she felt better. And she said, ‘No—the wrinkles are on the inside.’ ” Then, Piderman continues, “she spoke to me about a spiritual struggle related to guilt. And after that, this nonreligious person asked me to sing Amazing Grace. She told me that gave her peace.” Shortly thereafter, says Piderman, the woman died.
For other patients, religion can be at the heart of their spiritual crisis. Pamela Randall, the chaplain of Winship Cancer Institute of Emory University in Atlanta, has spent time with many such patients. One woman, she says, “was a teacher. She had been very independent and she was also a woman of faith. She talked to me a lot about how much she loved her job and her church and how she was feeling separate from God” because her cancer diagnosis kept her from doing the work she loved. Over the next two and a half years, Randall says, as she and the patient continued to meet and talk, she saw her “[begin] to get that connection back.” During that time she was living with cancer, she also “suffered many losses, and we would talk about that and how to hold on to God” during such difficult times.
Integrating Spiritual Care
To meet cancer patients’ spiritual needs, chaplains are educating both current health care providers and medical school students about how to attend to this aspect of a person’s quality of life. “There may be 300 patients and three chaplains,” says Ferrell. “So, in the training we do with health care providers, we reinforce that if the only people who are getting good spiritual care are those seen by chaplains, most patients are going to have their needs ignored. … Chaplains are the spiritual experts, and it is important that they are available when patients have spiritual distress or a specific need for a religious leader. But everyone—nurses, social workers, doctors—can attend to spirituality.”
Getting medical professionals to feel comfortable in this role, however, is “fraught with challenges,” says Balboni. “One of the key issues as we move forward is designing evidence-based educational training in spirituality for doctors and other health professionals so that they feel more comfortable engaging with patients.”
Balboni and his colleagues’ research suggests that about 50 to 70 percent of doctors and nurses say they are spiritual or identify with some religion. But because spirituality is often not viewed as part of medical care, he says, health care providers may feel it’s inappropriate to bring it up with patients.
Randall says that because of the work she and her department have done to educate their colleagues at the Winship Cancer Institute about how to address patients’ spiritual needs, new doctors there are now more likely to bring up issues related to spirituality with patients and their families before the chaplain becomes involved. “We speak to doctors during their orientation at the hospital about their role and how they can support patients and family members,” she says. “We teach them that faith and spirituality can be a key component of caring for a patient and that we can help them provide that care.”
When Henley, now 47, was at one of her lowest points after completing her colorectal cancer treatment, she found spiritual strength by volunteering for the Chicago affiliate of the Colon Cancer Alliance, a Washington, D.C.–based nonprofit organization. “I was suffering on all accounts,” Henley says, “so I decided to start helping others. The more I volunteered and the more I did, the more I received.”
Today Henley’s life bears little resemblance to how it looked following her cancer diagnosis. Her new job is stable, her daughters are happy, and she not only has a home but two grandchildren. And, she says, she finally has peace. “I now see what God wanted me to see. … My message is one of hope and having faith.”
When Chaplain Piderman was diagnosed with an early stage breast cancer in October 2013, she had 18 years of “well-ingrained” spiritual practices to rely upon. Even so, she says she didn’t hesitate to seek out another chaplain to speak with. And like Henley, she found the spiritual in those around her. “One of my most spiritual practices was praying for other people who were sitting in the waiting room with me and for the people who were treating me. … Every day I drew the name of someone from our department and prayed for them during my treatment. It got my mind off myself, and I felt like I had some company in that treatment room.”