The central task of the chaplain is to care for the human spirit.
The Merriam-Webster dictionary  defines spirit as "an
animating or vital principle held to give life to physical organisms."
It is that part of us through which we relate to God. Chaplains
differ from other health-care professionals in that they are publicly
people of religious faith who believe in a god and hold that belief
as central to their lives. Chaplains offer people alternatives
to beliefs that cause suffering and help people strengthen beliefs
that ward off distress.
A diagnosis of cancer invariably elicits a patient's ultimate
existential and spiritual concerns.  For pancreatic cancer
patients, these existential questions can be quite pronounced
because of the extent of disease at diagnosis and the short life
expectancy. This leads to a profound awareness of death as potentially
imminent. Regardless of the patient's ethnic, religious, or cultural
background, the chaplain can address these issues, both in terms
of the common human experience and with an informed perspective
on and reverence for the specifics of the patient's background.
Spiritual care essentially is touching the spirit of another person
in an intense and purposeful way. With a diagnosis of pancreatic
cancer, life itself is threatened. The chaplain acknowledges the
"everlasting" aspect of the patient and guides the patient
through the exploration of meaning and hope that arises as a result
of such an extreme diagnosis. Commonly, a patient may define his
or her spirit as "the inner person," "the real
me," or "the part of me that nobody can see." 
It is to this part of each person that the chaplain devotes his
or her attention.
Spiritual care essentially is a supportive process. Efforts are
directed toward maximizing the ability of the patient and family
to use religious faith as a source of coping. When patients feel
in touch with a god who is loving and comforting, they gain the
hope that they will be able to deal with the pain and suffering
of their disease. 
The word "suffer" literally means "to endure more."
The answer to the implied question, More than what? can only be
supplied by the sufferer. Whether an experience qualifies as suffering
depends essentially on the meaning that a person gives to it.
Pancreatic cancer patients experience many physical symptoms--epigastric
pain and profound weight loss, among others. It is critical to
teach patients that symptoms can be aggressively managed so as
to decrease pain. This knowledge, in and of itself, can be very
healing. Physical discomfort obstructs the patient's ability to
devote energy to fundamental existential or spiritual questions.
Pastoral counselors view spiritual or existential suffering as
the core of the experience of suffering. The focus from a chaplain's
vantage point is spiritual distress, a deeper disease than anxiety
or depression, which has roots in the soul of the individual.
For cancer patients, spirituality takes on a pronounced meaning.
Depression, anguish, despair, anger, and/or deep sorrow may rise
to consciousness at a never-before-permitted level, but so, too,
may gratitude, awe, peace, and a sense of mystery.
A major goal of chaplaincy is to engender hope. Hope may be strengthened
by learning that the physical pain can be controlled; it may be
reflected in patients' knowledge that their particular rituals
are valued and understood within the American hospital system;
or it may come from patients' discovery of new ways of thinking
Historically, hope has been largely misunderstood with regard
to its relationship to terminal illness, and it has become intertwined
with the concept of denial . One's ability to transcend the
facts of the seriousness of one's illness is not denial. As Callan
 noted, "Denial is a defense mechanism that consists of
avoiding the facts, whereas hope accepts painful facts but places
them in a wider perspective . . . ."
It is important to know both the content of a patient's beliefs
and the meaning that the patient ascribes to these beliefs. Some
patients may believe that having an illness may actually mean
that they are being blessed by God; they may further believe that
the illness is essentially good, although they may not be able
to see the goodness at the moment. If, on the other hand, the
patient's beliefs dictate that God can remove all cancers from
one's body and it doesn't happen, that person may feel abandoned
and reject God as unloving . Many people use God as a meaningful
resource when they view God as Comforter rather than focusing
on God as Doer . The popular Twenty-third Psalm does not say
that God will keep us away from the valley of the shadow of death,
only that God will walk with us through the valley. The chaplain
seeks the patient's permission to actively revisit theological
At first glance, the notion of a spiritual assessment may seem
to violate the noninvasive, patient-directed approach of chaplaincy
. However, religious and spiritual activities are used by a
vast majority of patients to cope with illness and suffering.
It is therefore fitting that spiritual assessment be done on every
patient as soon as he or she enters the health-care setting.
Spiritual assessment encompasses three important areas: religious
practices, religious community, and spiritual issues. Religious
practices include rituals, such as going to services, contemplating
a line of scripture, chanting, fasting, lighting candles, performing
sacred dances, engaging in reverent bowing, praying, reading from
Koran, wearing special clothing or jewelry, studying the Torah,
and practicing meditation. Even an apparently small ritual may
have great meaning for a patient; it makes him or her feel secure
Religious community is a central factor in helping people cope.
Access to one's religious group or leader is very helpful. Support
groups are also useful in helping people cope with cancer. Properly
structured worship in the hospital helps create a support group
. Hospital chaplaincy departments, knowing the value of contact
with one's community in worship, hold regular services.
The concept of "spiritual distress" is of great value
to members of the helping professions as they seek to minimize
patient suffering. The Pocket Guide to Nursing Diagnosis  defines
"spiritual distress" as follows: "Disruption in
the life principle which pervades a person's entire being and
which integrates and transcends one's biological and psychosocial
nature." It is considered a state in which the patient is
"at risk" due to a disturbance in the source of strength.
Although comprehensive assessments may be optimal, current health-care
conditions allow time for obtaining only very specific assessment
data. Chaplains can teach nurses and other professional staff
members to perform quick assessments, to refer patients at high
risk to chaplains, and to recognize the spiritual components of
coping. The emphasis in assessment is placed on the function of
the patient's belief system.
The newly diagnosed cancer patient frequently grapples with feelings
of anger and betrayal. This is frequently the case with pancreatic
cancer, since its early symptoms often are attributed by the patient
to other, less serious conditions. The body did not forewarn the
patient and yet the patient has advanced, even life-threatening
disease. Susan Sontag wrote about this aspect of cancer--its surprise
emergence--as an important part of the essential cancer experience
. Patients frequently need help dealing with intense feelings
of betrayal and anger at the time of diagnosis.
A survey was conducted at the Memorial Sloan-Kettering Cancer
Center to ask patients about their perception of the most important
services that chaplaincy could offer. Preoperative prayer was
the item selected by most respondents (75%), along with visits
during a crisis and sacraments for Christians. When people are
highly anxious, they often need someone to pray with them. At
Memorial Sloan-Kettering Cancer Center, a chaplain visits all
preoperative patients to join them in prayer, if so desired.
Many chaplains have served in local congregations prior to their
service in a medical center. Counseling family members of dying
patients, planning funerals, arranging for cremation, and providing
for the cultural and ethnic customs related to death and dying
are some of the skills that chaplains have acquired from their
former service that are invaluable in the medical setting.
Chaplains consider themselves to be ministers to patients, family,
and staff. The analogy of the small town clergy-person is appropriate:
Everyone in town knows who the rabbi, priest, or minister is,
and the clergy is always on call. The religious leader is concerned
about the spiritual well-being of every member of the town, even
though not everyone in town is a member of that leader's congregation.
In a medical center, ritual and discussions about hope or suffering
apply equally to staff and patients. The chaplain, in caring for
the human spirit, ministers to the health-care team members, ever
reminding us of God's presence.
1. Webster's Tenth New Collegiate Dictionary, p 1134. Springfield,
Massachusetts, Merriam-Webster, 1993.
2. Handzo G: Where are the children: Ministry in pediatrics. The
Caregiver Journal 10:23, 1993.
3. Handzo G: Where do chaplains fit in the world of cancer care?,
in Burton LA, Handzo G (eds): Health Care Chaplaincy in Oncology,
p 29. Binghamton, New York, Haworth Press, 1992.
4. Sontag S: Illness as Metaphor. New York, Farrar, Straus and
5. Stoll RI: The essence of spirituality, in Carson VB (ed): Spiritual
Dimensions of Nursing Practice, p 4. Philadelphia, WB Saunders,
6. Callan DB: Hope as a clinical issue in oncology social work.
J Psychosoc Oncol 7(3):31-46, 1989.
7. Kim MJ, McFarland GK, McLane AM: Pocket Guide to Nursing Diagnoses,
2nd ed, p 55. St Louis, CV Mosby, 1987.