Making It Up as I Go Along

(Published by Herbert Anderson, Editor of Reflective Practice)

By 2006, and especially after 9/11, I had given hundreds of speeches about Islam, at small and large venues. I was fatigued.  A good speaker has to know what’s going on in the world. But my steady diet of world news had stalled my spiritual journey. I felt that my religion was just a thin coat I could easily shed. I was a talking-head, and whatever I knew about the virtues of being a Muslim was coming out of my mouth and bypassing my heart.  But without my heart in the game, I being my lesser self, impatient, short tempered, and unhappy. To be the best person I could be, somehow I would have to pierce the thick crust that had grown over my heart.

Islam is the religion of my parents and grandparents.  But as the next generation of Muslims, I wanted to know how to manifest its true practice.  Luckily, I was guided to a possible means of helping my heart and connecting deeply with others, not just in crowds, but one-on-one. The path led me in pursuit of clinical pastoral education (CPE).

I applied for my first unit of CPE and was accepted at Saint Vincent Hospital in Worcester, Massachusetts.  The biggest challenge for me was getting over my own “issues,” in order to be present for someone else. Throughout the first unit, I experienced only fleeting moments of being present with patients. For the most part, I remained trapped in my own unresolved issues. My pastoral care supervisor, Peggy Kieras, helpfully identified many obstacles preventing me from being present for others. During clinical time, no matter the patient’s circumstances, I kept reverting back to my old ways of “being religious.”  This meant being a teacher; and what I would do is try to solve someone’s problem, by lecturing and educating.

I am eternally grateful to my supervisor for not giving up on me. She knew better than I the challenges I faced; and yet she must have seen some potential. With her encouragement, I applied and was accepted into the Selective Residency Program at Brigham & Women’s, an acute trauma hospital in Boston.  I would eventually complete three more CPE units, and be on track for a career as a professional Muslim chaplain.

Growing up in the 1950s and 60s, I had grappled with my split identity:  being a Muslim and a non-Muslim. At first, being a Muslim in America meant I was an invisible, nonentity.  But decades later, when Islam became synonymous with “terrorism,” my religion was suddenly under a high-intensity microscope. Being a Muslim meant being part of an embattled religious minority in America. In the raging battle, I didn’t feel I belonged in either world—the Muslim or non-Muslim. As I faced the challenge of pastoral formation, my long-standing identity crisis consumed me at my very core.

In the Brigham & Women’s program, we had 10 hours of class time and 30 hours of clinical practice. Clinical practice included being part of a multi-faith staff of chaplains. I had assigned floors, with hundreds of patients to visit, a referral list to adhere to, and on-call requirements once a week.  In addition to that, since the Imam had resigned his position in the same month that I arrived, I was asked to care for the Muslim patients who were scattered throughout the hospital. The demands of the clinical work left little time for self-analysis. But if I was ever going to accomplish the complex task of pastoral formation, I needed more time for self-discovery.

I routinely rounded on my assigned floors. I had no problem praying with the people of other faiths, or of no faith.  That’s because Islam is a tolerant and inclusive tradition. It recognizes all the prophets of God and all their Books. Growing up, I knew more about Christians and Jews than I did about Muslims.

After my assigned floors, I would check on the Muslim patients. This was somewhat more difficult for me. Sometimes I would pray with a patient, or wait with a family, or console a family. I was not an Arabic speaker, so my prayers were limited and self-taught.  But remembering my lessons at home in Arab hospitality, I was enthusiastic about meeting all of their religious needs that I could. I provided prayer schedules, pointed out the prayer space in the Chapel, suggested the kosher foods on the menu, and set up Qur’anic tapes on a recorder for listening.  I imagined myself as the hostess of the hospital, greeting the Muslims with the familiar greetings of peace and treating them as valued guests. I also relied on my small cache of knowledge of Islamic culture and etiquette. But due to the countless language barriers, I could never engage patients or their families in pastoral conversations.

From the beginning of my clinical work, I observed how the differences of language, culture, and religion affected the efficiency and caring of the medical staff and presented layers of barriers to communication. With Muslim patients, all three of these differences generally existed.  Like the medical staff, I spoke only English.

I soon discovered that as the Muslim chaplain on staff, the medical staff was relying on me to be their everyMuslim expert.  At least I knew that all Muslims were not alike. But as a second-generation American (Lebanese), born and raised in a suburb of Boston, my knowledge of the widely diverse Muslim population in the hospital was no better than anyone else’s.

If I had visited or followed a Muslim patient, I would be invited to join a family meeting.  I was excited to have an opportunity to learn from these meetings, but the invitations felt premature. I was apprehensive about how helpful I could be.  For one thing, I was only in the embryonic stages of pastoral formation, striving hard to keep my identity crisis at bay. For another thing, if I was going to be the “expert” on the team, it would be the perfect set up for me to revert to my role as educator, which was something I was trying my best to avoid.  I felt that the medical team expected me to bridge the gap between “us” and “them.” But I felt more like a bridge to nowhere and worried about exposing all my limitations to my superiors.

My first meeting as a chaplain was with an Iraqi family. The hospital ethics committee, at the urging of the nurses who cared for the patient, called the meeting to discuss the ethics and futility of further medical treatment.  The large medical team assembled was treating the man for leukemia for more than one hundred days. He had developed graft vs host disease (GVHD), a serious condition that occurs when donor bone marrow or stem cells attack the recipient. His body was ravaged by bed sores. Everyone was hoping to persuade the family to give them permission to stop treatment.

I was asked in advance about possible cultural and religious influences that might have an impact on the family’s decision. My first reaction to this question was panic.  Was I being asked to fix something? Was I supposed to try to persuade the family? Meanwhile, I had not met anyone in the family and knew nothing about their culture. Even the patient had been unconscious for most of my visits.

I had the benefit of one brief conversation with the patient’s wife.  Over the phone, she informed me that the couple belonged to a local community of Iraqis in Quincy and lived next door to a mosque. I knew about that mosque. When I asked if they attended the mosque, she said no, they didn’t go to “that” mosque.  Given that the mosque was considered by the Shi’a as a Sunni mosque, I figured that these Iraqis were Shi’a Muslims. I also knew they traditionally preferred to attend a dedicated Shi’a mosque.

When I learned that the patient and his wife had emigrated from Iraq in the early 1990s,   around the time that Saddam Hussain had tried to eliminate the Shi`a Muslims in Northern Iraq, it confirmed that they were probably Shi’a Muslims. I pieced together this information about the family and shared my conjectures with the team members. For whatever it was worth, my educated guess was right.  

The family spokesperson was adamant that the doctors continue the aggressive treatment.  He said that the patient had survived the murderous intents of Saddam Hussain and had left his family and homeland, so he could practice his religion freely. “As Muslims,” he said, “We can never give up on a human being.”

The medical team explained the poor chances of the patient surviving GVHD, but in the end, adhered to the family’s wishes. In the post-meeting assessment, one of the doctors commented that the patient’s spokesperson sounded just like a holocaust survivor. She said, “They never would give up hope, even in the worst situation.”

I didn’t think that my insights had contributed much to the meeting. Inexperience left me wondering if I should have done more, like invite a Shi’a imam to the meeting, to council the family. But the spokesperson told us that they had consulted their imam, and he agreed with them.

Eventually, I would see the value of my being there. The presence of an authentic advocate like a Muslim chaplain can be empowering for Muslim patients and families. The chaplain’s presence also reflects well on the hospital’s sensitivity and respect for diverse religions and cultures. In the long run, respect helps build trust between the medical team and the family/patient. The bridge runs both ways, alien to alien.

With no word for “chaplain” in Arabic, Farsi, or Urdu (the three most common languages spoken by Muslims), I was always challenged to introduce myself to the Muslim patients. The word “chaplain” produced blank stares and polite head nodding.  With no predecessor, role model, or handbook of instructions, no one was sure how to properly introduce me to the Muslims.

This gave rise to some embarrassing moments.  I remember being introduced to a Kuwaiti patient by a Christian Arabic interpreter. He told her I was “the Imam.”  Her face reflected shock and disbelief, given that imams in traditional Islam are always men. After that, I decided to introduce myself as a Muslim “sister on the hospital staff.”  Being part of the staff was the only reference I could tout, to anchor my position, credibility, and authority.

Defining who I was and my role was complicated by an imam’s position at the hospital. Having an imam on staff was relatively new.  Even though our hospital Imam had resigned, it was often up to me to define the role of the imam, at the same time that I was trying to define my own.  Social workers, chaplains, and the medical staff were eager to learn and would inquire frequently: “What is an imam? What do they do?” Both the staff and the Muslim patients would ask, “And who are you, and what do you do?”  

As the first Muslim woman in the residency program, I was pioneering a new profession in religion open to women. This was groundbreaking, and I felt that the future legitimacy for women who would follow in my path depended on my example and performance. Significantly, I wanted to ensure that the chaplain’s role and the imam’s role would be seen as two distinct jobs. The medical staff needed to know the difference, so they would know who to call for their patient.  I thought it was an important part of my job to help the hospital staff develop this level of discernment.

One doctor came to me concerned because he had asked a critically ill patient if she wanted to see an imam. The patient responded by bursting into tears. The doctor was well-meaning, and beside himself. By equating the imam’s role with the role of a priest, who gives the Sacrament of the Sick, the doctor feared that he had conveyed the wrong message to patient.  I had no idea why the patient burst into tears, but later I learned that she was simply responding to the doctor’s kindness and consideration.

Another situation I faced, as a pioneering Muslim chaplain, was being called to bless a Catholic newborn for the first time. I had prepared a blessing that used enough Christology to remain true to my tradition (which honors Jesus as a prophet, but not as the son of god), and be meaningful to a Christian.

I was the on-call chaplain in the hospital, when I was called to the room of the new mother and her baby. As I was reciting the prayer I prepared, I came to the place where the sign of the cross would be made. I paused and waited for an idea to come to me. Then, I turned to the baby’s grandmother, whom I noticed was wearing a cross around her neck. I asked if she would like to participate in the blessing. She joined us, as we stood in a small circle and made the cross. Her tears of joy brought tears to my eyes as well.

Blessing newborns, especially Muslim newborns, was the most gratifying experience I had during my residency.  The traditional blessing is simple. One recites the adhân, or the Call to Prayer, in the baby’s ear.  Muslims believe that when the baby hears the call, he remembers Allah and remains god-conscious for life.

I never expected to bless newborn Muslim babies, because before the Imam left his position, he informed me that I would never have to do it.  The baby’s father would do it, or some other male in the family, or the family’s imam. But that wasn’t my experience. When parents asked me to do it, I would offer to arrange for an imam to do it, if one was available. But nine times out to ten, the parents would plead for me to do it.  So, I did.

There were many young Muslim parents who knew about the tradition, but didn’t know how to perform it.  Actually, some of them were not even married. But this generation was more than grateful and ecstatic to have the blessing done at the hospital. I also prepared an official “certificate of blessing” to give them as a souvenir, signed by the Muslim Chaplain at Brigham & Women’s.  This was the same procedure followed by the Christian chaplains, who led me to the certificates that I customized.

Considering all that I had to overcome, pioneer, and process, I would recommend some changes in a residency program, especially for training Muslim chaplains. I would have liked the program to be longer than nine months. With more time to continue my pastoral formation and more clinical practice, I might have graduated with more confidence.

Another challenge came after completing the course and being certified for three units of CPE.  I found that my training as a multi-faith chaplain, which came natural for me, didn’t count in the job market.  I wanted to continue in the profession and log more hours, but when I tried to get hired as a multi-faith chaplain, I was turned down and discouraged at every turn.  Getting hired as a Muslim chaplain was not an option, since there was no large enough aggregate of Muslim patients in any one hospital or hospice institution.

I was grateful to be part of the discourse of an institution as grand as the Brigham, where diversity is appreciated and leveraged to enrich patient care. I was humbled to serve the hospital community, especially the Muslim community, and to be present to those souls who had sought solace, companionship, and kindness in their darkest hour. It was they who touched my heart.

The program was an intense period of self-discovery, which often leads to god-discovery. My mentor and supervisor at Saint Vincent hospital would have been pleased to know that I finally came to recognize the importance of being over doing.  I learned to listen to the patient; and being in the presence of Allah, I learned to listen to my heart. I surrendered to the love, compassion, and the power of empathy I felt. In surrender, I learned the true practice of my religion. In fact, “islam” is an Arabic word that means “to surrender.” In the religious sense, it is through surrender or submission to God that one finds peace.

To read more from Mary Lahaj, please visit her blog here.