A Chaplain's Painful Rite of Passage

By DAVID VAN BIEMA

"Everything's quiet." "Everything's cool." "Don't worry--if we need you, we can page you." One by one, the late-night nurses for each intensive-care unit politely tell Michael Baker to get lost. Baker understands. "Basically," he shrugs, "the staff doesn't know me from Adam's house cat."

Baker is a chaplain, a new one. Chaplains train at DUMC much as doctors do. There are interns like Baker, residents, supervisors and administrators. But while medical interns spend years in painstaking study of death's repertoire of plague, bone break and bodily corruption, the chaplaincy interns are Duke Divinity School students. They learn on the job.

Baker has never done a death. He is 25, tall, with solemn, deep blue eyes and a wispy Vandyke. A divinity grad student from Roxie, Miss., he has spent his first two weeks here on a ward that has thus far seen no deaths. But tonight, from 6 p.m. until 6 a.m., he is the on-call chaplain for the entire hospital. In his pocket is a sky-blue beeper that will sound the moment someone's vital signs fail. He wonders how he will respond. Last night's on-call was faced with the death of an eight-year-old boy mangled by dogs. "I don't know if I could have..." Baker begins and then trails off.

"Mikey! These folks might be able to use your services!" On the second floor, just as another nurse is telling him nothing is going on, a voice rings out from down the hall. It is a divinity-school colleague who also pastors a local church. Some congregants are here with an uncle. Exploratory surgery has just shown that he's riddled with cancer and has perhaps four months to live. When he wakes, they will tell him. Baker asks if he can help. Not just now, the family says gently. Later he will write neatly in the chaplain's log that tomorrow "family and patient may need to verbalize this matter."

One floor up, a woman crouches, shaking, at a window. Her husband entered the hospital for what she thought would be a "1-2-3" heart-valve operation. There were "complications," and he is back in the operating room. Baker fetches tissues and asks if they can pray. She says yes. He crouches by her in the dark hallway. He prays for God's presence and for the surgeon's hand.

He walks away red-eyed, talking about empathy. Women in distress are especially troubling to him. His mother was found to have lung cancer in 1984 and got radiation treatments. When the disease returned in 1988, "when it was hopeless," she fled back to the Southern Baptist roots of her childhood. The hellfire sermons and finger-pointing bothered the 15-year-old Michael, but he felt they might be worth it if God cured her. One morning, "at about 2:45," her coughing was loud enough to wake him. His father told him "it was nothing"--that he would just take Michael's mother to the hospital. When she never came out, Michael was furious--at God: "a bastard. This woman had run back, saying, 'I'm sorry I'm sorry I'm sorry,' and now he had killed her."

Baker is back in the chaplain's sleeping room, a monk's cell with a TV on gimbals. He left the Southern Baptists but eventually found God again in Methodism, which he felt downplayed sin in favor of God's grace. In Baker's theology, illness and death are not divine punishment on one woman for her weaknesses but rather a symptom of our collective distance from God. Our first disobedience let chaos into our world: chaos can be human sin; it can be a genetic predisposition for cancer. We are all shattered vessels, and death must come. Yet God's grace, like Super Glue, can begin to restore wholeness before death, and grace may flow even through a lowly novice chaplain. Baker apologizes for running on; he is tired and retires to sleep.

He is dreaming--the images look like TV cartoons--when the beeper goes off. It is 2:55 a.m. Marilyn Yopp, a police detectives' secretary in Jacksonville, N.C., suffers from thymoma, a rare cancer. She was admitted to the oncology floor recently with an even rarer symptom, a disfiguring full-body rash that, her sister Doris Del Castilho explains, "started as tiny flakes of skin and then got bigger and opened up like a flower." A few minutes ago, she asked Del Castilho to help her turn over in bed, when suddenly "her eyes rolled up. I heard them say, 'I don't get a heartbeat. I don't get a pulse.'"

As Baker arrives, CPR is still going on; the code team has shoved a tube down Marilyn's throat to pump air into her lungs. Baker prays with Del Castilho as the doctors push epinephrine and atropine through an IV. Briefly, there seems hope of stabilization, and Yopp is wheeled to the medical ICU. But two hours later, after multiple IV infusions, resident Timm Dickfeld takes one last turn at CPR, punishing Yopp's chest almost savagely, then stops. "Call the code," says someone. "Call it." Dickfeld finally accedes. "Over," he says. He makes a chopping gesture. Yopp is dead. It is 5:29.

Baker is looking at Yopp's lifeless body. But he is seeing a different woman--and feeling an unexpected rage. "Why, Dad?" he is thinking. "Why in hell didn't you drag me out of bed? I was thinking, well, at least they get to see their mom." The sequence lasts "about a twentieth of a second" before Baker enters the room where the Yopp family waits. Before God takes over.

"Father, be with us in this time of loss," says Baker, standing at the head of a cluttered table, his hands joined with those of Del Castilho, Yopp's husband Horace, the couple's daughter Lora Marshburn and son Trey. "Help us as a family to feel your presence near to us. Paul said God never places more on us than we can bear. Help us to be each other's strength, and to support each other during this time of hurting. Help us to know that it is O.K. to cry."

And they are helped, to the extent a broken vessel can be helped. Later Del Castilho will send "Chaplain Michael" a note thanking him; Horace will agree, "Yessir, to me he seemed young, but I guess we all got to start somewhere." Tonight the new widower says simply, "She's gone to a much better place." Then the family, Michael Baker at their side, enters Marilyn Yopp's room, where Marshburn lays her head against her mother's face and cries, and cries, and cries.

--By David Van Biema