Two women dressed in scrubs, on the steps inside a hospital


Chanting through the Spring Surge

An Interview with Sarah Byrne-Martelli

Rev. Erica Rose Long, MDiv ’16 (left) and Sarah Byrne-Martelli, MDiv ’02. Courtesy photo

On May 2, 2020, Harvard Divinity School published a Q&A with two chaplains who serve at Massachusetts General Hospital in Boston. Titled “A Joyful Sorrow,” the article was wildly popular, so we decided that Bulletin readers would appreciate follow-up interviews with these illustrious HDS alumnae. In late August, editor-in-chief Wendy McDowell had separate Zoom conversations with Sarah Byrne-Martelli, MDiv ’02, and Erica Rose Long, MDiv ’16, to find out more about the role of a hospital chaplain, how they are coping personally with the stresses of a pandemic, and in what ways their faith traditions inform the work they do each day.

I can imagine things must feel different now than the last time you were interviewed. There has been at least a little bit of calm, so what is it like now to reflect back on the thick of the surge in the spring?

That time was so hard, and we were all being extremely intentional in doing our best, and trying to take each day as it came. There were shifting sands beneath us in terms of protocol, visitor policy, PPE requirements, and even what floors patients were on. A lot of the normal ICUs became COVID floors. It became very quiet in the hospital.

And then around late June and July, things felt more normal-ish, so sometimes when I look back to that time in April and May, it almost feels like a separate time. At the same time, we all carry some dread that there’s going to be another surge. I started wearing scrubs in April, and I’m still wearing scrubs. I haven’t changed back to my normal clothes, let’s put it that way. I always wonder if or when things will change, so it’s still difficult in that way.

The thing that was so amazing during that time is that, as tough as it was, the whole hospital came together. Everyone was sharing and connecting and trying to build in resilience and be intentional in an everyday way, acknowledging how hard it was, being compassionate with one another, and giving each other the benefit of the doubt as staff, as nurses, etc. It was beautiful seeing people support each other and holding that space for one another.

As a chaplain, it was an interesting and even fruitful time, because suddenly chaplaincy was all over the news. It was everywhere—in every major magazine, newspaper, and website. So this time has called chaplains to step up and really use our training to do what we do best, and also to do it in a way we’ve never done it before.

That sounds like a lot. This pandemic is something you could never have imagined would happen, and all of a sudden you were in the spotlight because of it.

Right, and for a time, I was the only chaplain in the whole hospital. I was focusing on patients specifically under the Division of Palliative Care, and there were a lot of other end-of-life situations that I was called to. And the important thing to note is that even for non-COVID patients, it was affecting our normal end-of-life palliative care patients in terms of restricted visitor policies and things like that.

It seems to me chaplains have also been called on to help support nurses and doctors during this time. My understanding is that chaplains already do this, but has this been heightened?

We always think of our community as patients, family, and staff. That has always been the case. It depends on the staff person; some people are more willing to talk to chaplaincy and some people are less so. But I think during this time it became clear that we were doing everything we could to support staff, and that we could listen and really support them, to not judge them but really give them the space to lament and process how hard this is.

Everyone in the hospital is weary right now. Some people have been able to get little vacations here and there, some time off, but there’s a collective sense of weariness and grief. And obviously, everyone is still in a place of uncertainty. There’s so much uncertainty. It’s made me think a lot about what can I rely on? There’s so much we cannot control, and you see that lack of control coming up in different ways.

Are there any practices that have helped you with the grief and uncertainty?

One thing that has been an interesting experience for me is that I’m one of the few chanters for my church, St. Mary Orthodox Church in Central Square in Cambridge. I’m an Orthodox Christian, and we pray with Byzantine chant. Even before the pandemic, we’d already been streaming our services for something like 10 years, and I’ve been one of about four people who are the regular chanters. We kept doing this, though we only do it two at a time now, keeping very distanced and with masks. (It’s not a choir, to be clear!)

Sarah Byrne-Martelli

Sarah Byrne-Martelli. Courtesy photo

Despite all the stress, it’s been an honor to be able to go to church and sing these special hymns. I chanted all the way through Lent, through Pascha (Easter), through Pentecost. I’ve learned a ton by chanting through all the different feasts and about the different Tones you have to use. There are all of these special Byzantine melodies that you only use maybe one Tuesday a year! Just having the chance to sing those special melodies and to create that continuity for people at church who were watching from home has been a blessing.

Music is so important to me personally, and the music is vital to these services. I know these rituals are grounding and familiar to people, and they provide comfort.

How have you been able to juggle everything and take care of yourself, and your family, during this stressful time?

My husband, thankfully, has been able to be home with our six-year-old son. He’s a professor, so he has been teaching online from home in the evening, allowing us to “tag team” with caring for our son. And it’s been important for me to really have boundaries as much as I can. When I’m not at work, I’m not at work.

It’s also become quite clear to me how important it is to exercise and move my body. I swim, I run around the yard. I hose down my son every night after dinner. We go outside in my yard, we do the sprinkler. I chase him through the sprinklers, and we do laps around the house.

I am being so intentional with my self-care. I have a therapist that I meet with via telehealth once a week. I actually started commuting to work on my bike, and now I ride 40 to 50 miles each week. Never in a million years would I have thought I’d become a bike commuter! I did it to build exercise into my routine, and I find it gives me time to process stuff on the way home. It feels good to get out of breath. I’m doing all the self-care things: I’m a gardener, I’m making sourdough bread, I’m playing with my kid.

I’ll say again that I’m very thankful that I have a faith that is rich and broad and that allows for all this uncertainty, and that allows us as a community to walk through this time together.

Did your chaplaincy practices have to change, and did they evolve more between April and August?

Initially, the hospital had to close everything down, so visitors were mostly not allowed and we used Zoom for everything. Now, for COVID patients who are at the end of life, even they can have a visitor. And regular patients can have a visitor during the day, still just one visitor per day, but there is a whole system in place to make this happen.

That’s one of the things that was incredible for me to see here in the hospital—how quickly systems evolved, accommodated, and changed to respond to the situation. There was so much rapid innovation to manage people, visitors, PPE, and many other things. New protocols were put in place, technology was used to connect people. It was remarkable.

Now we understand that it’s so important to do everything we can to enable people to have visitors, so we’ve made a process for it. It’s not ad hoc or no visitors at all as it had to be at the beginning, so that piece has improved. But still it’s really hard, and for people who are admitted to the hospital, there is even more uncertainty.

When you were interviewed the first time, I was struck by how you seemed to have reached a level of acceptance about possibly getting sick yourself. Did you end up testing positive or getting sick?

I have not, to my knowledge, gotten COVID. I had one test, which was negative, before we rented a house for a week in Vermont. We quarantined on vacation, anyway, once we got there. But I wanted to see what the test was like so I could understand what people were going through when they were getting tested.

Early on, we all thought we would probably eventually be exposed, and maybe I have been—I don’t know. But now that I see the host of complications and challenges the virus can create for patients of all ages, and all backgrounds, and all health profiles, it scares me more. I am not resigned to getting it. I don’t want to get it.

We don’t have a lot of COVID patients here at MGH right now, but we have a lot of post-COVID patients. For instance, a couple of weeks ago we discharged a patient who had been here for over 100 days, a person in his 40s who had been hospitalized with COVID and had almost died a few times. He experienced incredibly complex complications and it was truly miraculous that he was discharged. One of my doctor friends who is not a religious person called it a miracle. But, boy, it’s going to be a long road for him in recovery, and he was a healthy guy before.

I don’t think I’m hypervigilant, but I continue to be appropriately vigilant.

Of course, there are still people with other illnesses who are dying from other causes during this time. What has it been like as a chaplain to continue to support them, as well as to support others working in the hospital?

In many ways it has heightened everything I was already thinking about. I’m always thinking about death and grief, and facilitating the grief process, and supporting families, and how to honor and address spiritual distress. This is what we always do as chaplains. Now, oddly enough, I think the value of chaplaincy has become clearer to non-chaplains.

In terms of caring for caregivers, we’ve provided memorial services, we’ve done Zoom services for our staff. I’ll be leading a Zoom memorial service in October for the families of our palliative care patients. We have the skill set to do things like this, and frankly, I’m thankful that we’re able to do this work and offer what we can.

There’s so much unnamed grief happening right now, collectively. It’s this slow, ongoing ambiguous loss, and it’s unclear when it will end or when we will be able to process it and move our way through it. I’m hopeful that eventually something will change. It’s hard to talk about it, because in some ways it’s intangible. I think back to the early COVID days and it’s almost like a blur. I have a selective memory about it.

That makes total sense, because it was a collective trauma that was happening, and yet you had to keep doing your job.

Right, and we’re not even in the “after” yet, we’re in the current, and how will we know when we make it through? I don’t know. I think the reality of that comes in waves.

The Orthodox Assembly of Bishops put together a mental health video series, and one of the questions my bishop asked me was, “What would you say right now during this time to someone who is struggling?” All I could say was, “God is with us,” as a prayer and a reminder to be gentle with each other. In so many ways this time has brought out truly the best and the worst in people.

I’ve had to limit my social media consumption. I did share some anonymous stories about patients on Facebook, especially during the early days, and I don’t usually put a lot about work on Facebook because it’s so heavy. What’s insane is that hundreds of people commented on it and at least 50 people shared it, and many lauded the work of chaplains and all those who were in the hospital. I think the hardest part for people was knowing that people were dying alone; that cut right to everyone’s core. They were heartened by the idea that at least someone like me, or a nurse, or whoever is showing up, is trying to be there for a person who is dying.

We did try to nuance the conversation, because some people do die alone—we can’t control that—but we tried to talk about preventing people from dying lonely. We try to support them, we want them to know they’re safe and loved—we try to do our best in those ways.

One thing about faith is that it’s like a muscle, and one of the things that gets exercised is what to let go or give over to God, or to a higher power. Do you find it is disorienting for patients, or staff, who haven’t yet “exercised” this part of themselves?

I often see this with palliative care patients who are confronted at the end of life with all of these existential questions and don’t really have a framework to get their mind around them. Sometimes we have to do a lot of deep work in conversation, but that doesn’t always come easily. We discuss things like: Who is God for you or what is the holy for you? How do you think about the meaning of your life? What is a human? What do you think about the afterlife? All of these very big questions hit you like a brick wall when you are critically ill, and suddenly this is happening to a lot of people. Is this God’s will, and how do we think about disease and suffering in the world?

As an Orthodox Christian, I have a particular worldview and way of thinking about and praying through these questions. But I love working with patients of all different faiths; for me, it’s so important in this role. So many of my patients—and the hospital staff—would be considered spiritual but not religious.

I was raised Presbyterian, half my family is Catholic, and I have Jewish cousins, so in some ways I came from the perfect family to become a chaplain in a multifaith setting.

I’m thankful that I’m here, because I can be a person that someone who is spiritual but not religious can talk to. They don’t have to go find support somewhere else. I can talk to a nurse or staff member at the nurse’s station about grief about their family or child or their existential distress, and I can show up and be compassionate and not judge.

That leads me to the question of inequality. One of the things that’s hard is that it’s not just about this particular virus—which does what it does—but that so much suffering is being caused by human factors. It’s due to deep, systemic inequities that were in place before the pandemic hit and are being exacerbated, and revealed for all of us to see. How do you handle being a witness to this every day?

It’s really hard. Sometimes I just want to punch a wall! I’m only human. One thing that has been encouraging is we have been having lots of conversations about these issues. Every department, including the palliative care division and the leadership of the hospital, is having conversations about racism and inequity and language accessibility and cultural humility all the time. We are trying to build that in and talk about it openly, and to acknowledge areas where we are lacking.

During COVID, MGH has done a good job of having a whole team of physicians and nurse practitioners who speak Spanish—we have a lot of patients who are Spanish speaking, particularly with the surges in Chelsea, Everett, and Lynn, so we made sure they had a Spanish-speaking medical provider and we had a Spanish-speaking priest available to offer Mass and say prayers over the phone.

Right now, our attitude has to be that we can’t change what got you here, but while you are here in the hospital, we can do everything in our power to respect your needs and to not make you feel even more alone. And if you can’t communicate or pray with someone, it will only deepen the loneliness you’re feeling.

As a department, we are always striving to educate ourselves and to ask what systemic barriers and health disparities are contributing to the experience of our patients. At the same time, I always have to remind myself that I have one person in front of me. I can and do challenge myself and relearn, but for the person in front of me, I always want to be present for them and get to know them. I am intentional about being present for that person in front of me, hearing their needs, hearing their spiritual distress and their hopes and their joys.

There is another piece in the current issue of the Bulletin that discusses whether calling health care workers ‘heroes’ might get in the way of what they need, and what they need to feel.

It’s an interesting point and I thought about it a lot. I don’t know if anyone called me a hero, but certainly there was the idea that I was on the front lines and sacrificing myself. A part of me feels appreciated for doing the work that I always do, in this heightened pandemic situation where we don’t have enough PPE and there’s no end in sight.

I think anyone who manages to put one foot in front of another during this pandemic is a hero. Everyone is called to different roles right now. Some people are suddenly full-time caregivers for their children when they used to go to work. Suddenly my husband is with my child all day long every day, bless his heart. I’m doing hard work, but so is he. We’re all doing the best we can.

I do still experience a wide range of feelings. I process them more privately, I guess, and I certainly don’t express those big things on social media. But among my friends and family, they know what’s going on with me.

Certainly people do think I have a hard job, and we are bearing an awful lot right now. It’s hard, and it’s tiring. So I appreciate it when people can be gentle with me. At the same time, I know that some of my friends and family don’t want to see us, even for a socially distanced visit with masks, because I’m a health-care worker. Not a lot of people are trying to “pod it up” with us. I understand it, I get it—I wouldn’t pod with a bunch of health-care workers right now, myself—but it can be isolating for us health-care workers and our families.

Also, the people who say it’s a hoax or are adamant about “no masks”—that’s the most demoralizing stuff that I hear. I’ve limited my consumption of that kind of sentiment. But there is a sense that it didn’t have to be this way, which is really hard to wrestle with. It’s one thing when you’re confronted with a trauma or a new situation and you decide to show up and be present and do your job, but when it keeps going on and you feel like it should be ending and it’s not, it’s especially tough. That’s where I do my best to be humble, to be thankful, to take it one day at a time—or sometimes an hour at a time!

It’s another layer of grief, isn’t it, not just about the unprecedented situation we were all thrust into, but grief around how it could have gone differently?

The thing is, my patients feel this way all the time about their own illnesses. “It didn’t have to be this way, I should’ve gotten treatment, I lived this way, I did this, I didn’t do this,” and they have so much regret and shame. So we have to hold that and acknowledge it, and still try to be compassionate and kind to ourselves and show up with a fresh start every day! You can’t come in trudging to work each day. I still love my work and I love my team. I’m so thankful that I’m able to do this work.

Because there are so few pictures of the inner life of a hospital, is there one thing you wish everyone knew about working in a hospital during the last six months?

There’s a certain quiet camaraderie right now, and there is a sense that we’re in this together. There’s also frustration, because it’s hard.

Everyone is in scrubs, no one is wearing nice clothes these days. I’m still wearing scrubs, and the kinds of shoes that all the doctors wear.

It sounds like it’s an equalizing uniform?

Exactly, which I actually like, because chaplains are clinical. I’m a clinical member of the interprofessional team. So it’s OK that we show up in scrubs. If I go visit a COVID patient and suit up in all the PPE, I won’t just stay at the door. Some other chaplains were more limited because of the availability of PPE and things like that, but because I’m a part of the palliative care team, I went right into the rooms.

There have been a few joyful moments that we’ve all needed, like when I officiated a wedding. We had another patient who was a paramedic who was here for weeks and weeks, and it seemed like she wasn’t going to make it but she did, and that was a joyful moment for the whole staff.

I just had a paper accepted for the Journal of Pain and Symptom Management, about the grief of a patient who had survived COVID but his wife had died.

That’s what strange about this time: it’s meant that I’ve turned on the chaplain part of myself really high. I was interviewed by the Chaplaincy Innovation Lab, and I’m joining the board of the Association of Professional Chaplains, so these good things have happened in the midst of an exhausting, difficult time.

I already know that chaplains aren’t necessarily what people think they are, but what would you want people to know about chaplains?

Chaplains are cool! I definitely do not adhere to the stereotypical ways that chaplains tend to be seen. Maybe because my other work is in theater, and I’ve done a lot of music directing and other creative work. I teach voice and play piano for different shows.

I want to say, “Chaplains—they’re just like us!” There’s such a richness to religious and spiritual traditions, but what can sometimes be challenging is that I see a lot of people who throw religion out the window. I totally understand why people would reject traditional religious practices that have been hurtful or discriminatory or caused undue shame. I guess I just wish that people would take the time to think about these big existential questions before they become a crisis. That’s what I think about a lot.

And while it’s true that we’re just like you, we do think about death all the time. There’s this line from the musical Hamilton where he says, “I imagine death so much, it seems more like a memory.” I thought, “Oh—that’s us—that’s me!” I could totally relate. I felt so seen!

How do you help those who are not traditionally religious develop a framework for meaning and think through the big questions?

There are many ways to do this. There is so much beauty, and music and art, and all the religious practices like prayer and meditation—everyone has a way to connect to that source or inner wellspring—whether that source is God or something else.

There’s so much space to do meaning making with all kinds of people. We appreciate when people are open to doing that work and not closed off to those ideas. Chaplains have spent a lot of time trying to educate our fellow staff about when to refer to us. It’s not as simple as a Catholic patient needing a rosary. I certainly can deliver a rosary, but I spent this morning talking with the daughter of a dying cancer patient about when do you change your prayers. When do you change your prayers from praying for a miracle and for bodily healing, and shift to praying for a good death? The patient is very religious, the daughter is less traditionally religious, but it was like she woke up and realized, “I think I need to start praying for my mother to have a peaceful death.”

What a good, deep conversation we had for her to think through that process of what it’s like to start letting go and saying goodbye.

How have people responded to the first Q&A you did for HDS in the late spring?

Everyone liked the joyful sorrow thing. That was not my original concept, to be clear! I inherited it. I converted to Orthodoxy because I found the liturgical tradition to be so rich and nuanced. Musically, Byzantine chant challenges any normal emotional associations you have with music or that you might have with tonal harmony, major versus minor. When you’re singing with these different Tones, something that’s a joyful feast might feel like a more minor Tone.

This idea of having a balance between joy and sorrow and constantly reinforcing that you can hold multiple emotions, not just psychological emotions but theological or existential emotions, including joy—that’s how participating in liturgical life helps me. Some of the resurrection hymns might not sound joyful to someone who hasn’t heard Byzantine chant before, but I hear them that way.

In researching what I wanted to write in my introductory essay for the issue, I learned that the etymology of the word “care” includes lament or grief. That seems appropriate right now, and appropriate to the hospital chaplain’s job at all times.

Interesting . . . Naming a grief is hard, but it can be freeing, especially when you have someone with you who can hold and bear the grief with you. Chaplains really go there with people, we don’t just sit quietly and hold their hands.

Every day is different. Then I come home and I rip up the weeds in my garden. So much gardening . . . so many metaphors!

Sarah Byrne-Martelli, MDiv ’02, is the inpatient chaplain for the Massachusetts General Hospital Division of Palliative Care and Geriatric Medicine. She has been a board certified chaplain since 2004 and is endorsed by the Antiochian Orthodox Christian Archdiocese of North America. She holds a doctor of ministry from St. Vladimir’s Orthodox Theological Seminary and a BA in religion from Haverford College. She is on the Board of the Association of Professional Chaplains and is secretary of the Board of the Orthodox Christian Association of Medicine, Psychology, and Religion.

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