New York, USA - In an unadorned room with a panoramic view of the East River, doctors at Bellevue Hospital Center had toiled for days trying to cure Dennis Barcelona of a neurological illness.
Annette Cruz listened to Psalm 23, read to her by Pastor Dennis Trellis, a chaplain intern at Bellevue.
But Mr. Barcelona had also been struggling privately with a condition that science could not remedy and stethoscopes could not detect: his fear of the wrath of God.
That was a job for a rabbi.
"I feel it's like God talking to me," Mr. Barcelona told Rabbi Dennis Math, saying that he thought his sickness was divine punishment for drinking too much. Rabbi Math, one of seven intern chaplains in a program started this year at Bellevue, held hands with Mr. Barcelona as they bent their heads together to pray.
"Dear God, bless Dennis Barcelona, who lies in this bed," the rabbi said. "Be with him as he goes home. Strengthen him in his commitment for a better life; a life, you, God, would approve of."
In a training program reinstated after a five-year absence, the intern chaplains - one Jew and six Christians - try to soothe the spiritual wounds of patients, going forth on their rounds with books of testament and verse.
"Doctors take care of the easy stuff - the physical," said Rabbi Math, striding through the neurology ward. "We take care of the hard stuff - the spiritual."
Hands-on education for student chaplains started at Bellevue in 1940 and was supported by Episcopal Social Services of New York until December 1999, after a longtime supervisor retired and no immediate replacement was found.
It began again in January 2005, with the support of a Lutheran organization and the city's Health and Hospitals Corporation.
"The variety of humanity that comes through Bellevue is completely different from most hospitals," said the Rev. Paul D. Steinke, the supervisor of the one-year Clinical Pastoral Education program. More than 400,000 people are treated at Bellevue each year. "It's just terrific for training. An undocumented person from Guatemala is getting the same medicine as a guy who works on Wall Street."
The program allows the interns to obtain certification from the Association of Professional Chaplains, which improves their opportunities for full-time chaplaincy jobs. The interns pore over the mental state of ailing people in literature, like Tolstoy's Ivan Ilych. They also take turns reporting to each other on their meetings with patients, rehashing the interactions in critique sessions.
But the most crucial part of their training is during rounds on the floors of the 25-story hospital. With prayer or the patience of a good listener, they spend 15 minutes or more with people clinging to life, battling illness, crying or just staring blankly out the windows, on the psychiatric floor, the intensive care section, the prison ward and other units.
Their job is to encourage a patient to talk. They have done this by holding a hand or hearing about a divorce. Sometimes they are asked to turn off lights, pay for television service or simply return after a soap opera is over. Sometimes they are scared of a patient. Sometimes saddened by one.
"It is a boot-camp experience," said the Rev. Chloe Breyer, a priest at St. Mary's Episcopal Church in Harlem who wrote about her time in the intern program in her book, "The Close" (Basic Books, 2000). "Anything that doesn't kill you makes you stronger, and the experience of being at Bellevue certainly bore that out. You had no idea what you were going to encounter that day."
While there were already three full-time chaplains at the hospital and more on call, the interns provide the bulk of bedside care, praying with anyone who is willing.
"We can't sit there for hours with each patient," said Dr. Marc Moisi, during his rounds at Bellevue. "There are many different levels that we cannot treat as doctors."
Recently, Rabbi Math, a 59-year-old chaplain trainee who has already spent 25 years at a Reform synagogue in Greenwich Village, took the hand of Mohammad Soumare, a young Muslim from West Africa anxious over tests that might explain the pains in his chest.
"Do you want a psalm or a prayer?" said Rabbi Math, his book in hand.
"Both," Mr. Soumare said.
It was the first time Rabbi Math had prayed with a Muslim, and Mr. Soumare's first time with a Jew.
"Anyone who is praying for me is wishing me well," Mr. Soumare said. "Any way the message gets to me; that's what is important."
The interns often must overcome, or try to overlook, painful experiences in their own lives, which sometimes emerge during their critique sessions. One intern, whose parents had separated, backed off from a discussion with a patient who said his wife had left him.
Another intern, Jaeyoun P. Chang, 42, a pastor with a Korean Presbyterian Church, had been discussing his conversation with an AIDS patient when he mentioned that he had asked him how he got the disease. That drew an immediate response from the others in the group.
"There is a general tone of bias on your part," said one intern, Michael Killfoile, who is planning to enter a Presbyterian seminary.
"What if he had heart disease?" asked Rabbi Math. "You would not have asked him how he got it."
Mr. Chang said that the man blamed a woman for giving him H.I.V. and that he had a heart "full of resentfulness."
"Why is that pastoral care?" Mr. Steinke asked. "You are seeing the person in the bed as a moral failure, instead of as a sick person."
Mr. Steinke is an even-mannered, quiet man who watches the interns on some of their rounds and listens as they recount their experiences afterwards.
His bottom line of advice: Do not be "sunshine boys." Many interns come to the program thinking that they are supposed to make the patient feel better, he said. But, Mr. Steinke said, "If you use all this positive talk he will never get to his fear. You have to give people an opportunity to talk about their suffering."
Much suffering could be found in the bustling emergency room at Bellevue when Pastor Dennis Trellis, 37, a Seventh-day Adventist intern, arrived for what he calls "hit and run" ministry.
Orderlies wheeled patients to and fro, and leaned into stretchers to maneuver them on the cramped floor. Life-sustaining machines beeped and doctors pulled curtains around patients lying on their backs.
A prisoner was shackled to a bed, two correction officers nearby. Nearby, an old man, his hair and beard matted and clothes black with dirt, was sprawled across a mattress, passed out. A woman who had miscarried when she was five months pregnant first lay composed but then shed quiet tears.
"Sometimes there is time for a prayer," said Mr. Trellis, sidestepping doctors and nurses. "And sometimes not. So I just say a few words."
He approached a man with an abscess in his arm from shooting heroin.
The patient, , 34-year-old Raymond Ramos, said he wanted to get clean of drugs.
Mr. Trellis offered to read a prayer to him.
"I'm not a very religious man," Mr. Ramos said.
"There's no problem, man," said Mr. Trellis. They clasped hands. "It's just nice to have an ear to talk to," Mr. Ramos said. "It doesn't have to have anything to do with religion."