The Intersection of Faith and Medicine
Temple’s Palliative Care Office on Ontario Street is easy to miss. It’s situated in a row home across the street from the main hospital. It has the look of a typical North Philadelphia house: a small front porch shared with the adjacent residence, sealed in with a metal gate. On the front, an unimposing red sign: “Palliative Care Office”. Within a few seconds, Jim Ingalls was at the door, shaking my hand. Looking at Jim, you’d never know he was an ordained minister. “People just call me Jim,” he said on the phone, after I, a practicing Catholic, carefully asked him what pastoral title I should use to address him. Jim was wearing an aqua colored dress shirt with an earthy-toned jacket. No collar, no pious jewelry or any religious identification anywhere besides his Temple ID badge: ‘Rev. Jim Ingalls’. He has whispy white hair, blue eyes, a warm face, and a calming disposition. He would later tell me he wanted to be a DJ, and he certainly would have had a good voice for it-the kind of voice you want to hear when you’re driving home late at night and you need some inspiration.
Jim took me upstairs to his office before he realized his things were no longer there. “I’m retiring,” he said, “so I switched rooms.” He led me to a room just down the hall, with no religious icons or sacramentals in sight. I don’t know what I was expecting, but there were no giant crucifixes on the wall or beady-eyed saint statues anywhere. I sat down, took a breath, and asked, “Well, how did you get here?”
Jim was born and raised in North Jersey in a Catholic family. “Back when they were still doing it in Latin,” he stressed. He left the faith in high school because he simply “didn’t get it.” He was in college during the Vietnam War with a student deferment, during a time when the counter-cultural hippie movement of peace and love was ending on a sour note. One day, someone handed him a Bible on the street, and he started to read it. He said that the Bible started to give him what he “thought the hippie movement was going to give [him],” which helped him to start scratching the surface of his relationship with God--a personal relationship which would become rooted in caring for the poor and sick.
Jim’s first career was in TV, radio, and film at Temple University, but two deaths in his life changed his outlook on the world. For one, his dad died, and his family never talked about it. “We’re Irish, we don’t talk about our feelings.” His mother would hide in the basement so the family wouldn’t hear her crying, and the kids wouldn’t bring up their father to her because they didn’t want to upset her. He said that this experience, plus the death of one of his friends, made him realize the danger of unresolved grief--how the ache of sorrow can erode at you like gangrene if you don’t do anything about it.
Jim later went to a Presbyterian seminary in the Philadelphia area and began working in hospice at Fox Chase. He said he realized that “my family was lost in the valley of the shadow of death, and so were a lot of the people at Fox Chase.” He said “we need Sherpa guides in the valley of the shadow of death.” After a stint at Fox Chase, he spent 20 years at Einstein, came to Temple over 10 years ago, and is finally retiring in January. “It’s time to say enough,” he said, “it’s time to let someone else pick up the baton.” He said he averages around 6 visits or so a day; his kids did the math once and figured out he has gone into 70,000 patient rooms since he started. He said his deeply ingrained “Catholic humility” often made him regard what he does as no big deal, even though he tries to remember that he is truly making a difference. I could tell this about him early on, as he kept telling me he really wasn’t used to talking about himself so much.
Jim spoke about the importance of faith in one’s life, especially during hardships. “Family and friends,” he said, “stop visiting because they don’t know what to say--or because they want to remember you the way you were.” He added that often when patients are sick, “God feels very far away. You’re a good Catholic girl, you know what Jesus said on the cross-- ’why have you forsaken me?’ --if God can handle this coming from Jesus, he can handle it coming from you.”
Jim spoke lovingly of his appreciation for pastoral care. “Every door I knocked on was something different, a challenge, an adventure. People feel better when they realize someone is going to walk this path with their loved one,” he said. “When you walk in and someone is dying, you can sense the difference you’re making.” But he didn’t sugarcoat things, either. He told me that once he was talking to a woman who was dying, and he looked at her and said “this sucks.” “The entire tone of the room changed,” he said, “because I addressed it.” He went on, “People don’t expect a chaplain to say the word ‘sucks’, but there are worse words to say.”
I asked Jim about his lack of clerics. “Do you have a uniform?”
“You’re looking at it,” he said.
He also told me he doesn’t tell people he’s the chaplain a lot of the time, he just says he’s one of the counselors, a spiritual counselor. He said it freaks people out when you say you’re the chaplain; people expect a “ghostly theological spectre” to come in the door. He said they gave him a white lab coat to wear, but he only wears it when it’s cold and he has to run across the street because “I’m an older white guy, people think I’m the attending and start asking me questions about titrating drugs.” He wants to retire without “ever having seen a bed sore--I never lift the sheets.” He said his approach with patients is “not a big ecclesiastical pompous thing--it’s more listening: how can I do this in the most nonjudgmental way possible?” Jim remarked that his goal when he talks to people is to leave them with the “sweet scent of God” rather than with nothing, or turned off from God.
I asked him about the House Staff Appreciation Award presented to him by the Department of Medicine Residency Program. He was honored and humbled, and he acknowledged that so many people helped him along the way. This was his Catholic humility talking. His wife, however, made a big deal out of it and called his mom.
Jim talked to me about his retirement. He was worried he’d have nothing to do, so he started typing up a list and had 25 things in 5 minutes. He’s writing a book about adventures from his life, and he wants to make a documentary about people’s experiences with racism, as he leads a racial unity group with his wife at his church. He’s excited to take naps in the middle of the day, travel more, and play guitar. Nonetheless, Jim will miss watching M1s slowly become chief residents, since “everyone is somebody else’s kid.”
Jim and I left his office and headed to the hospital. As we navigated a windy route to the ICU, he greeted multiple people by name as though he were the popular guy in the high school halls. They greeted him warmly; he knew many of their patients, he knew their stories.
The first patient on Jim’s list had a great view of the winter sunset and quiet midafternoon Philadelphia side streets from her window. The patient was in her 80s: pleasant and coherent but a little forgetful, and she didn’t seem to understand the full picture of what was happening to her. Her niece, on the other hand, was a firebrand, and she was doing most of the talking to the attending and resident in the room. Every time a physician said something, the niece would take what she said and turn it back around to place blame on previous doctors who had conducted a procedure on the patient, who was now dealing with a serious infection.
There was palpable friction and frustration in the room.
Jim was standing at the foot of the bed listening to the conversation, doing what he said he does best. Dr. Mary Kraemer, a palliative care physician, at one point asked the patient if she visited any senior centers, and the patient said “yeah, Sugarhouse” (I think she misheard ‘senior center’ for ‘casinos’). The entire room laughed. Jim finally chimed in, “Do you win?” The patient laughed and shook her head no.
During the course of the meeting, the niece said the patient had always called her on Sunday mornings to wake her up for church; the patient was like the niece’s alarm clock. As Dr. Kraemer continued to speak with the patient, Jim turned to the niece and quietly asked her about what church she attended. She responded with an obscure name. “I think I know the pastor,” Jim said. “Of course he does,” I thought.
After half an hour of often difficult conversation, the doctors managed to calm the relatives and left the room. Jim stayed behind and asked the patient and her loved ones if they would like to pray, to which all of them said yes. Jim asked the patient if he could put a hand on her shoulder before the entire room bowed their heads. As Jim was making up an impromptu prayer, I heard some sniffling. I looked up, and I noticed that the patient’s niece, who had been leading the tirade moments earlier, had tears running down her face. I was stunned; the entire tone of the room changed from tense to warm in a matter of moments, and Jim had barely said anything. Sometimes, I concluded, it’s just being there, offering support, and placing a hand on someone’s shoulder that makes all the difference. Leaving the room, Jim assured the patient that he would pray for her.
The second patient Jim saw was unconscious and intubated. There were several clinicians in the room obtaining x-rays, so we waited for them to leave before we entered. The room was dim with a melancholy view of the hospital’s adjacent brick wall out the window. Over machines beeping, Jim introduced himself and me to the patient. “Today is December….” he looked at me for an answer, my good Catholic girl self knew it was the 12th, the feast of Our Lady of Guadalupe, so I chimed in. “It’s Thursday,” he added, “it’s pretty cold outside.” Jim went on to explain who he was, and why he was there. “I don’t know if you can hear me, but just in case you can, your family wanted me to come pray with you, so I’m here to do that--if it’s okay with you I’m going to put a hand on your shoulder.” He paused for a minute and then did so, making up a prayer on the spot. I bowed my head, listening as he improv’d some words of hope to no response, no resounding ‘amen’. Jim paused for a moment upon completing his prayer, as if to give himself a chance to digest what he had just said. We walked out of the patient’s room, bid farewell to the other nearby medical personnel, and started on our way back outside.
As we walked out of the hospital, parts of his final prayer echoed in my head; “I don’t know what the future holds, but God does.” I shook his hand and thanked him, and he headed back to his tiny little office on Ontario Street, going off into a future known only to God, but closing a chapter in a career that was lived for others.