The morning's work was set for the Rev. John Pennington, a Catholic priest and chaplain at Cook County Hospital, the sprawling inner-city Chicago hospital fictionalized on the TV drama "ER."
A chaplain from a Peoria, Ill., hospital has called Pennington and asked him to find the family of a 2-year-old boy who's been badly burned over 80% of his body and flown to Cook County for treatment.
As luck would have it, Pennington finds the boy's family in the hallway outside the hospital's burn unit.
Pennington passes along the message from home he was asked to deliver: "They're sending a lot of love and a lot of prayers," he tells the boy's parents and grandmother.
Then Pennington leads the boy's family in an impromptu prayer service, holding hands with them in a circle.
"We pray that you will give him relief from pain," Pennington says. "Please Lord, hear all these prayers."
The child later died.
For Pennington, these spontaneous prayer services are a special part of what it means to be a chaplain at Cook County, which is the cornerstone of Chicago's public health system.
"Where it happens, you pray," Pennington says.
The chaplain's life. While some aspects of the chaplain's world remain unchanged, time has altered others. The 21st century chaplain must deal with increasing religious and ethnic diversity. Chaplains, too, have changed, with many more lay people tending to the spiritual needs of patients.
And unlike most aspects of the hospital business, observers say chaplains appear to be largely untouched by fallout from reimbursement changes imposed on providers by both government and private payers.
Pennington, 63, who hangs his hospital identification badge from an "I Love Jesus" cord worn around his neck, is in his sixth year as a chaplain at Cook County.
But Pennington isn't paid by the hospital for his work. Rather, his work as a full-time chaplain is supported by his religious order, the Chicago province of the Jesuits.
Pennington is one of nine chaplains at Cook County who cover a gamut of religions. Recently, MODERN HEALTHCARE spent the day with Pennington to a get a glimpse of what life is like for a chaplain at an inner-city hospital.
On this particular day, besides praying with the family of the Peoria boy, Pennington also checks on a two-pound premature baby he had baptized after its birth on Mother's Day.
After a trip to the hospital's neonatal intensive-care unit, Pennington learns the baby is "still with us." (More than two months later, the baby remains at Cook County.)
Like many of the physicians at Cook County, Pennington wears a beeper and is on-call 24 hours a day several days
His uniform this day is dark pants and shirt, a white priest collar and black athletic shoes.
Having the right shoes is a must, says Pennington, who sports a buzz haircut and aviator glasses.
"We do a lot of walking," says Pennington, who prefers to take the stairs to travel between floors of the hospital rather than wait for a spot in the overcrowded and slow elevators.
In spite of the two heart-tugging cases he's dealt with this day, Pennington says life at Cook County little resembles what viewers see on TV.
On the NBC drama "ER," Pennington says, viewers see "10 days' worth of trauma in an hour."
In continuous use as a hospital since 1914, Cook County admits 34,000 patients annually and has an average daily census just shy of 600 patients.
In spite of its state-of-the-art trauma and other healthcare services, some areas of the mammoth public hospital show their age and the impact of never-ending patient traffic.
Paint is peeling off some of the walls and giant "bug zappers" hang from the ceilings in hallways.
But all that will change soon.
Construction is ongoing for a new $551 million replacement hospital. The new 464-bed facility is expected to open in two years.
A stable profession. Work that's done in hospitals by chaplains is mandated by the Joint Commission on Accreditation of Healthcare Organizations.
The JCAHO requires that hospitals provide pastoral care and services for patients, such as through volunteer chaplains like those at Cook County, or employed chaplains, says Carole Patterson, director of the standards interpretation group at the JCAHO.
"Your belief in a greater being is a comforting thing to get you through some of these medical crises," Patterson says.
Larry Burton, president of the Association of Professional Chaplains, a Schaumburg, Ill.-based group that board-certifies chaplains, says an increasing number of chaplains are seeking certification. Though Burton says he's heard some anecdotal evidence suggesting some programs are reducing the number of chaplains they use, he adds that job opportunities for chaplains appear to be growing at many hospitals and healthcare systems.
"In a time when healthcare has been doing some fairly dramatic downsizing . . . the jobs are not disappearing," says Burton, who also is dean of the Methodist Theological School, a seminary in Columbus, Ohio.
The average starting salary for staff chaplains, Burton says, is about $40,000 to $45,000 a year and depending on levels of management responsibility within a hospital can exceed $80,000.
Later this summer, 517-bed University of Chicago Hospitals plans to begin outsourcing its chaplaincy services, but it's not a cost-cutting measure, says spokesman John Easton. In fact, outsourcing could wind up costing more money.
By outsourcing, Easton says, the hospital hopes "to get a stable of chaplains that better reflect our patient population."
Burton says chaplains have much to offer patients. For instance, research has found a correlation between spirituality and health that may provide hospitals a financial benefit.
A story in the Chicago Tribune last year chronicled a study funded by the National Institutes of Health that found heart surgery patients who were visited by chaplains averaged a stay of two fewer days in the hospital, saving about $4,200 per person.
In a hospital, having a chaplain available can be particularly reassuring for patients, says the Rev. Joe Driscoll, a Catholic priest and executive director of the Milwaukee-based National Association of Catholic Chaplains.
"It's the one person on the team whose primary focus is to listen to the patient, to listen to their emotional and spiritual needs," he says.
Driscoll says his group has about 3,600 members, the majority of whom work in hospitals, hospices and long-term-care facilities.
Since the association's founding in 1965, Driscoll says the ranks of its chaplains have grown--and changed. When the group started it had about 200 chaplains, all of them ordained priests.
Today, Driscoll says more than 30% of its chaplains are lay people, almost twice the number who are priests. Another 47% are nuns.
"We've empowered the laity," Driscoll says.
Burton says the three major professional chaplain associations represent about 8,000 chaplains.
Spiritual forces. At Cook County, Pennington is not alone in his work.
Besides the other chaplains, Pennington has a loyal following of about a dozen volunteers, including a friend from high school and a 31-year-old Latino man who volunteers as Pennington's assistant on days off from his job at a local furniture store.
The chaplain's office on the hospital's sixth floor is shared by all of Cook County's chaplains.
The office is better described as a long walk-in closet, sparsely decorated with an open window that provides light as well as fresh air.
Pennington meets his assistant, Francisco Romero, at the office so the two can decide which patients will be seen that day.
For Romero, his work with Pennington at Cook County is a real calling.
"I want other people to feel how I feel now," Romero says. "I'm so happy to let them know that God loves them."
The two know which patients in the hospital are Catholic because the hospital supplies them with a daily census that identifies people by religion.
"Part of my role is I'm kind of like a train dispatcher," says Pennington, who coordinates his volunteers.
Culture gap. On this particular morning, the two head off to see two Spanish-speaking women who are sharing a hospital room; then it's off to see a 67-year-old man in one of the hospital's intensive-care units.
"We've been praying for him," Pennington says.
To visit the man, Pennington and Romero don protective gowns and gloves. "Do I look like a doctor or what?" asks Romero, who then heads over to the man's bedside to speak with him in Spanish.
Pennington, who speaks some Spanish, says having volunteers like Romero helps bridge the cultural gap with patients.
For other non-English speaking patients, Pennington and other chaplains get assistance from the hospital's on-staff interpreters, who speak Chinese, Polish and Spanish. Other interpreters are available on an as-needed basis.
Omar Gobby, a Polish interpreter, says he has used his language skills to help Pennington baptize "a sick baby who pulled through."
An interpreter for seven years, Gobby has accompanied another priest at the hospital in giving last rites to a dying patient.
Pennington says he often doesn't know what is ailing the patients he sees because he doesn't ask.
"I want to listen to what they want to tell me," Pennington says.
But not every patient knows that Pennington or another chaplain has been to visit them because they may be unconscious following a severe injury or accident.
"Sometimes, it provides more comfort for the families because the patient many not be aware the chaplain is there," says Margaret Walker, a trauma nurse.
During his years at Cook County, Pennington says that he has learned never to speak in the presence of unconscious patients as if they don't exist because, he says, you never know what they might be able to hear.
"But if you tell them that you love them 10 times, maybe they'll hear you once," Pennington says.
And there's no standing on ceremony in the hospital's trauma unit, particularly if a chaplain's prayers are for a dying patient.
"We can do them in the hallway if we have to," says Richard Wojtanowicz, a trauma nurse. "God doesn't care."
Most vulnerable moments. Pennington came to Cook County Hospital six years ago after a stint doing parish work in Lagos, Nigeria.
Before that, Pennington worked for four years as the night chaplain at Loyola Medical Center in Maywood, Ill.
For Pennington, the death of his mother 17 years ago is a motivating force behind his work as a chaplain.
He was living in Ohio when his mother became gravely ill at a home for the elderly in suburban Chicago.
Afraid that he would not get to her bedside in time, Pennington called a former nurse's aide his mother was friends with and asked her to be with his mother so that she would not be alone in her final moments.
His mother died before Pennington could reach her, but her friend was with her at the time of death.
Pennington remembers the woman telling him: "What a thrill it was to know she was looking at me and the next moment she was looking at God."
It's that experience that Pennington uses as the model for the work he does as a chaplain.
"At their most vulnerable moment, you can bring some beauty into people's lives and make it a prayerful experience," he says.
For Pennington, a highlight of his day is the noon Mass he celebrates in the hospital's chapel, adjacent to the chaplain's office. Mass is said every day; Pennington officiates four times a week.
Some of the music for the liturgy comes from a small portable stereo, which has to compete with the sound of the air-conditioning, a welcome relief in a hospital that still has some uncooled areas.
About 15 people are sitting in the pews in the sparsely decorated chapel, many of them wearing white coats or scrubs.
Jim Seeberg, who is one of Pennington's volunteers, handles the scripture reading; the singing of the congregation fills the small chapel.
During the service, Pennington addresses worshipers in a variety of languages, including Gaelic, Spanish and a specific dialect for people from India.
For Pennington, working with Seeberg is very familiar.
A retired businessman, Seeberg graduated from Loyola Academy in the Chicago suburb of Wilmette, Ill., with Pennington in 1954.
Seeberg has been volunteering at Cook County for about a year. When he is at the hospital, he focuses his work mainly on the cancer patients.
"(Pennington) saw a need in the oncology-care (unit) that nobody on the spiritual side was attending to," Seeberg says.
Seeberg adds that the good feeling he gets from his volunteer work is "God's way of telling us it's a good thing to do."