Conversations: Luke Lortenzen and Mati Engel

This episode features a conversation with Emmy award-winning filmmaker Luke Lawrenson and hospital chaplain Mati Engel, discussing their documentary "A Still, Small Voice."

1. The documentary highlights the crucial role of chaplains in providing spiritual and emotional support in healthcare settings.
2. Filming in sensitive environments like hospitals requires careful consideration of the impact on all involved.
3. The episode emphasizes the importance of meeting patients' spiritual needs in diverse religious contexts.
4. It discusses the personal growth and challenges faced by healthcare professionals in emotionally charged environments.
5. The conversation also touches on the broader implications of storytelling and witnessing in healthcare.

1: Introduction to Guests

Host Emily Silverman introduces Luke Lawrenson and Mati Engel, discussing their backgrounds and the making of the documentary. Luke Lawrenson: "I wanted to learn from someone deeply embedded in the craft of spiritual care."

2: The Role of a Chaplain

Mati Engel explains the role of a chaplain and her path into the chaplaincy, highlighting the emotional and spiritual availability required. Mati Engel: "A chaplain is essentially a witness to the patient's journey."

3: Filming Challenges

Discussion on the ethical considerations and challenges of filming in a hospital setting, focusing on patient interactions and maintaining authenticity. Luke Lawrenson: "Bringing a camera into such intimate spaces always changes the dynamics."

4: Personal Impacts

Engel and Lawrenson reflect on how the project affected them personally and professionally, emphasizing the emotional toll and learning experiences. Mati Engel: "This project allowed me to connect more deeply with patients and their experiences."

1. Always respect patient privacy and dignity when in healthcare settings.
2. Be open to learning from the experiences and stories of others in challenging environments.
3. Engage with spiritual care professionals to understand diverse patient needs.
4. Consider the ethical implications of documenting real-life stories in sensitive settings.
5. Use storytelling as a tool to enhance empathy and understanding in healthcare.

Documentary filmmaker Luke Lorentzen and hospital chaplain Mati Engel discuss their award-winning film, "A Still Small Voice," which explores the rewards and challenges of providing spiritual care in the hospital setting.

People

Luke Lawrenson, Mati Engel

Companies

Mount Sinai

Guest Name(s):

Luke Lawrenson, Mati Engel

Content Warnings:

None

Emily Silverman
Support for the Nocturnist comes from the California Medical association. At the Nocturnist, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.

You're listening to the Nocturnist conversations. I'm Emily Silverman. Today we're joined by two very special guests, Luke Lawrenson, an Emmy award winning documentary filmmaker, and Mati Engel, a hospital chaplain. Together, Luke and Mati made a documentary film called a Still, Small Voice, in which Luke follows Mati during her year long hospital chaplain residency in New York City. The film, which explores the challenges and rewards of practicing spiritual care inside a hospital, won the US documentary best director award at the 2023 Sundance Film Festival and has been recognized as one of the best ten films of the year.

Mati Engel
By the New York Times.

Emily Silverman
Today, Luke and Monty sit down with me to chat about what it was like bringing cameras into the doctor patient interaction, how they found the right narrative arc for the documentary, and what it means to bring spirituality and religion into the healing process.

But first, let's hear a clip from their award winning documentary film, a still, small voice.

I recall you saying, I cannot believe what my body can endure. And I just needed to share that with somebody to let them know. And what I felt in that moment, through the tears, was awe.

It was this quiet strength.

Mati Engel
I checked in for one thing. I got four other things happened since I've been here. We got pancreatic cancer, COVID, then liver failure, aneurysm, bacteria in the stomach. Did I get that somewhat right? Yeah.

Girl, your body, it's been through a lot. Yeah.

Mati Engel
I'm sitting here with Luke Lawrenson and Mati Engel. Luke and Mati, thank you for being here today. Thank you for having us. It's good to be here. So this is a beautiful film.

It's a slow paced film that takes its time. It's very intimate. For me, as someone who has spent a lot of time in hospitals, it was nice to experience the hospital in that slower paced way, since I usually experience it through a much more frenetic lens, and I just really enjoyed it. And I'm wondering how the two of you met and got the idea to make this film. My sister was doing a lot of work as a hospital chaplain, and she was the one that first introduced me to the field.

Luke Lawrenson
And the idea to make a film about chaplains came from talking with her April of 2020. I started to focus on it more seriously, and reached out to maybe 100 hospitals around the country, trying to meet as many people as I could in the field and get a sense of, is there a program out there that would be open to this and invite me to be part of their team? And I eventually met Amy Strano at Mount Sinai, who runs their program and did a one week scout shoot where I met Matti and her cohort. And that's where I met Mati. I remember it very vividly.

She has this weight to her in terms of how she approaches the work and the amount of care she puts into it. She immediately stuck out to me as somebody that I wanted to learn from, spend time with. And it took us many months of talking and getting to know each other before we were on the same page and were able to sort of film some of the things you see in the movie. And did you know, Luke, that you wanted Mati to be the protagonist of the film? And did you have any sense of what the story would be or how did that all unfold?

So, no, I did not know. When I first got to Mount Sinai, I actually spent one day with every different person in the department. And then from there, I decided to focus on the residency, which was still four residents, and spent more or less equal time with all four of them throughout the year, watching them all learn the work in different ways and all grow. And I really believed that the film was going to be sort of a weaving of four different approaches to spiritual care. And when we got to the edit, there was something with Mattis material that really had a depth to it and just a quality to it that we decided to focus on, which was a really big shift for me, for Mati, for everybody.

It was a moment of really making the film much more specific than we first thought it would be. Mati, what is a chaplain, and how did you end up in a chaplain residency program? My immediate answer is, a chaplain is a witness. It's like the person who's available to give testimony or available to receive the event that's happening in front of them. And part of that availability is emotional availability, I guess you could say spiritual availability, but it's really availability to the soul, like what a soul is going through at a given moment.

Chaplains are trained with a background in theological education, so I got my master's in divinity at the University of Chicago. That was a choice for me to, as Luke said, stay kind of engaged with the questions. For me, it was like life questions, existential questions, without becoming a rabbi. I didn't want to be a rabbi, but I wanted to ask rabbi like questions. My introduction into chaplaincy was kind of through the back door.

And I would even say, like, working in a hospital was through the back door. Like, I never thought of myself as somebody who would find their workplace in a hospital setting. It was quite kind of a strange scene to appear on. I decided to do my divinity training at the University of Chicago after meeting Reverend Cynthia Lindner. And that encounter was brief and somewhat spontaneous and unexpected, and it turned my life around.

I met her while I was just traveling. I was curious about the city of Chicago and decided to step into the divinity school. And when I met her, we had a long conversation and I knew once I left the school building, I started crying and I was like, I hate the cold and I'm moving here and I'm so pissed about it. That started my ministry trajectory. I would say I didn't exactly know what I was getting myself into.

I didn't know that an MDiv led to CPE residency. It was kind of like, okay, I have this very ambiguous degree and how can I apply it practically? And CPE clinical pastoral education is what folks do. You either go on and get a PhD in theology, or you go and you work as a chaplain. I would love to hear more about the theological dimension of this work because there's a great scene in the film where you're performing a baptism and holding a bible and coming from the jewish tradition.

Mati Engel
Obviously, that's a different tradition. And so do mdivs and chaplains have to be fluent in multiple different theological traditions? Do they focus in one? Do they practice all flex to different spiritual orientations in your patients? What is that spiritual bedrock of the education like?

And then how do you think about applying it? I would say there's the ideal and then the practicality of what is. So, generally speaking, the educational track that I took was to train as a chaplain that orients to multi faith demographic. And even the department at Mount Sinai also had this ethos of being multi faithful. Though there are multiple chaplains on board that had different theological orientations, I came in with an orientation towards humanism along the lines of choosing not to become a rabbi.

I wanted to be a minister to humans, plain and simple, period. When it comes to certain rituals or practices that are faith specific, that's where things get a little bit more tricky or weedy. Theres an element of listening to what the patient needs, what the moment is asking for, and also whos available. I think that that scene is probably one of the more controversial scenes. Is that a moment of ritual appropriation, or is it a moment of this is what is needed and who else is available to do it?

So I think that thats interesting, and im quite happy that that scene occurred, if not only for this conversation. I loved that scene, and it's context dependent that those people probably wouldn't go to a rabbi for a baptism outside of the hospital. But the hospital is a special place, and like you said, there's a limited number of people on call. And so how were you called into that space? From my memory, it was towards the end of a long day.

It might have been just me and one other chaplain in the office at that point. There were two calls that came in. There was one that was a patient who was actively dying and a couple who had just given birth to twins, but one was a stillbirth. And I remember this moment between Johnny and I kind of like, okay, who's taking what? Like, which one do you want?

Mati Engel
Which is a conversation doctors have all the time. It's like, do you want the UTI or do you want the pneumonia? Exactly. So chaplains are having similar conversations in some way. It's interesting because that was a moment where Johnny said to me, it would be good for you to learn how to do that.

And for me, I felt like. I feel really available to do it. It was just like a, yes, let's go. There was also the moment of entering into the room and meeting the patients and kind of getting a sense of what's needed. It actually felt like the call was coming from the medical staff.

It was just like this awful thing happened. We need a ritual. It was like grasping for ritual in a way. There was like a collaboration that was happening outside of the patient's room in that. Just getting the names right, which baby is alive?

Which baby didn't make it? The intricacies of just. That was so important, I believe, just coming into the room, getting a sense and a feel emotionally for, like, is there an invitation? Are we welcome our sense? My sense was, yes.

Luke Lawrenson
I mean, there's two levels to this. There's Matti as a practitioner, feeling her way into the room and, as she said, finding out what's needed and figuring out how to offer that. And then there's the documentary that's happening alongside. And I think this was a moment of offering the filming to this family as something that was possible and having them very quickly invite me into the room as well. Throughout the filming, Matti would define a chaplain as a witness.

And that's really what we wanted the film to be as well, was sort of an extension of that witnessing. And this is one of those moments that came as a result. But there's, I think, a controversy to the interfaith element of these rituals. And from my perspective, there's such beauty in meeting people where they are. Matty's ability to walk into a room, ask a few questions, and have this experience and toolkit of all of these different ways in which people perform ritual and make meaning, it's awesome.

And there's not a way to have a rabbi show up immediately or a priest show up immediately, but Mati can, and with experience, really palpably bring something spiritual or a whole new feeling into the room. I thought it was awesome. I wasn't even. Fortunately, I wasn't the one dealing with the tragedy, thank God. There was a way in which I felt comforted by watching you comfort them.

Mati Engel
There was a secondary element of calm that came over me watching that. And I'm wondering, when you bring a camera into that space, does it change? You know, I'm thinking about this law from physics. You know, just by observing something, you change it. I think the short answer is yes.

Luke Lawrenson
I think it varies patient to patient. What it feels like in the room changes really widely. And I think Matty and I very patiently tried to find people where that change was positive and where it added something to their feeling of being listened to and understood, and where they were aware and very on board with their story being included and being hyper sensitive to scenarios where it would potentially change things for the worse and not go there. And typically, that involved several conversations with patients before the camera even showed up. You know, the more that I make films like these, the more I ask myself this question.

And for a long time, I was trying to be invisible and trying to be what they would call a fly on the wall. And this project really taught me how leaning into a presence when it can be a positive one can actually lead to material that's really special. That question that you asked, how and does bringing a camera into the room change the encounter? That was a very high stakes question, especially when the craft of a chaplain, at least, like a good half of it, is witnessing, if not ritual. How can the camera be used as a spiritual intervention, as a tool, so that witnessing gets magnified and a patient's story gets uplifted?

A moment that might fall through the cracks, like giving birth to twins. And one of the children not making it can be caught or at least ritualized and held in time. I think that's where filmmaking and chaplaincy kind of doing something similar but different. It's holding up an eye or like, having that witness. How does it make something come to life?

Or how do we feel like we exist when we know that there's somebody watching SA?

Mati Engel
There's another scene in the film where a patient calls you on the phone, or you call them, and the two of you are having a conversation, debriefing a death that occurred. We don't receive a lot of details about the death that occurred. And I think there's a moment where the patient asks you, what do you think? What advice do you have? And so its this moment where it flips a little bit from witnessing and receiving to giving you being asked to say something.

Ive been thinking about this a lot, not just as a doctor, but just as a person in the world who wants to be a good friend, a good family member, when someones going through something tough, wanting to be a support and wanting to say the thing thats going to comfort them. And I like to think that I'm decent at that. But there are definitely some moments when it's amiss. I'll say the wrong thing, and you can tell that it didn't land, or there's just no way to know what is the right thing to say, if there is such a thing. And so I'm wondering, in a job like this, when you're holding people and suffering, how do you know what to say?

And does the knife ever slip? Yeah, that's an interesting moment, clinically, to look at, one that I look back on and say, I probably could have said to the patient, well, what do you think happens? And for the audience, the question is, I think, what do you think happens after we die? Was that the question that the patient asked you? Yeah.

So a skillful pivot would have been, well, what do you think? In that moment, the question was just, like, so unexpected. And that's part of this work. You have no idea what's gonna come at you, like, quite literally. And so my reaction was, well, I can tell you what the jewish tradition says, because I believe that they were from the jewish faith.

Mati Engel
And she was like, no, no, no. I want what you think. Right. Which, in a way suggests that, like, the place that the question was coming from was, I'd like for your input. And I don't know.

My instinct in that moment was to share, and I think it's up to maybe the audience, the viewers, and the patient to reflect on whether or not that was the right move. Whatever right means. But was it comforting? Did it offer comfort? Did it offer relief?

I would agree that it's tricky when we give our input. Will it land? Will it be resonant? But perhaps there is something to be said about offering words of either wisdom or encouragement or words of comfort and words of one's own lived knowing. And that was the reflex that I went with.

But perhaps this underscores the work of chaplaincy at its core, which is there's no script. So the best you can do is just really clean out your vessel, be available, and try not to project when you're in relation. And of course, we're always working with projections. I look to Iris Murdoch as my north Star, and she's like an irish british poet and novelist and philosopher. And she talks about prayer from, like, a non religious perspective.

And she says that prayer is a technique. It's a tool, and it's a tool to reorient the self away from selfishness and orient towards the good. It's literally like an exercise to clean out the body, the mind, consciousness, to look at the sun, even though you cannot take in the sun because it's way too bright, but at least looking towards the direction of the sun, which is towards the direction of good, to see the patient in front of you as clearly as possible and to act from a place of justice. So it's like to see clearly and to act justly. Prayer is a vehicle and the technique to clean out the body, to do that well.

But the craft of chaplaining is non scripted, and I think, I believe that that's what's so complicated and hard. Luke, as you were observing Mati practice this craft, was this new to you, or did you already have a sense for all of this since your sister is a chaplain? It was very new to me, and I think that's why I gravitated towards being with the residents instead of the staff chaplains and grounding the film in the learning of the work. These are not just techniques that apply in life and death situations. It's how we relate to one another in the biggest and smallest ways of how much to listen, how much to talk, what questions work, sometimes advice, sometimes not.

Luke Lawrenson
It's not a self help movie, but there's this underlying theme of deeply, deeply engaging with what it means to be in relation, what an interesting place to. Be in, to be so immersed, but to be an observer and to not be the one taking the phone call and to not be the one going into the room and doing the baptism. Because at first I wanted to say, oh, maybe they should just give you an honorary degree. They did give me one. Oh, did they?

Mati Engel
But it's also a different role. And so I'm wondering, what did you take away from that? So many things. The first thing that comes to mind is just a sensitivity. Being there sort of broke me in half and then put me back together with a bit more tenderness and awareness.

Luke Lawrenson
I really grew my own capacity to feel, my own capacity to experience ups and downs of life and pay attention to them. I think there is a very close parallel between chaplaincy and documentary filmmaking. So I think there was a. A big part of me that wanted to go through this residency to just learn better how to witness people, and knowing that that would make my filmmaking stronger. This just attention with which I listen to the feelings that I have and the people around me are having is really heightened.

And that can be painful and really shitty, and it can be really, really nice. Well, I wanted to get to that. Here at the nocturnus right now, we're working on a podcast documentary series on the topic of uncertainty in medicine. And I've been reading this book called a framework for tolerance by doctor Paul Hahn. And there's a part in the book where he speaks about this painting that Picasso made that's called the head of a medical student, and it's in the Picasso style.

Mati Engel
And one eye is shut and one eye is open. And he talks about that paradox of when you're in the healing profession, you have to keep one eye open. Like, you have to see, you have to witness, you have to observe. And that often includes painful things like suffering, uncertainty. But then there's also a need to keep one eye closed and protect oneself and not become consumed.

Maybe keep a healthy fear or a healthy distance. I was thinking about this when I was watching the film, because, Mati, in the film, you have some conversations with your supervisor about boundaries, and how do you weather the day to day of work thats as intense as this and come out in one piece? And so Im wondering where you landed on that. You know, that scene where I come to work late and Im scolded for coming in late. I actually chose to take a Zoom call that we had.

It was like grand rounds. I decided instead of taking the train with my duck mask on my face, I want to walk through the park. I want to breathe. My body needs to breathe. And so I took that Zoom call on my phone and walked through the park from the west side to the east side.

And I think residents, whether chaplain residents, medical residents in general would probably agree that the word resident absolutely lands in terms of what you're doing. It's like as if you're like, living at the hospital. I mean, the on call shifts that we had to do and the clocking in either nine to five or one to nine, there's a certain expectation of work and labor that is reproducible daily. And I absolutely still stand in question around. Can I ask my body to be available for such moments of intensity without giving it proper downtime and rest, especially if I'm a very deep feeler?

There's so many different kinds of interventions, but when we talk about emotional or spiritual intervention, a big piece of it is being felt fully in your experience, so that you're not holding it alone. And the question that I kind of left with was like, my body needed more space to bounce back to be able to complete emotional cycles. So what is the right context, if not the medical healthcare apparatus? Are you still in the medical healthcare apparatus? No.

So now I choose to work with clients in a different way. I set my own schedule. I have more agency over how many patients or clients I can see in a given week. I can just kind of map out how much stamina, momentum, rest, recovery as part of that process. In medicine, we have our own rituals.

Mati Engel
We have rounds, and it's a ceremony. You start with the first patient somebody presents. They present the information in a standardized format. It's a performance in a way, and I don't mean that in a bad way, necessarily, but there's a choreography to it, and there's something about that ritualized practice that I think does something positive for the provider while also organizing the day and ensuring that we get to every patient and so on. I was really curious about these roundtables that we see a few times in the film, and, Luke, it sounds like you sat in on those.

Is that a form of rounds? And is that container designed to be a decompression valve for some of that emotional buildup? I kind of felt like I was a fly on the wall watching rounds, just for a different specialty. Once a week, the cohort would meet on Tuesdays for their education day, and two of the four chaplains would come with a case called a verbatim, where they would, to their best of memory, sort of rewrite a visit. That brought up a big question that was challenging.

Luke Lawrenson
They wanted to share with the group. The group would read it almost like a play and then workshop different things that came up. And after those two cases were shared, they would do something called SPG small Process Group, which was intended to be placed to share the different feelings that were coming up through doing the work, and through that, a container to learn how to hold all these different feelings. It was both a place for decompression and an exercise of sorts to reflect one another back and do the work with David there supervising. So for me, as a filmmaker, it was this really powerful space where the cohort was engaging with these big questions in a way that wasn't an interview or wasn't me excavating anything, but just witnessing the feelings and questions that the work brought to the table.

The words, choreography and performance land. There's a way in which. And maybe this comes up more in the role of the shaman as a healer, the way in which my work now is moving more towards the artistry of healing. To even know how to enter a room and take on a role is one thing. To figure out your place in a room is another.

And then when it comes to being amongst colleagues, you would hope that that's a space where performance is not required. Actually, that's where you can take your mask off. And I think that it necessitates a certain amount of trust and connectedness and vulnerability. And that is not always found. It's this really uncomfortable setup, at first, of needing to share these really difficult feelings with your coworkers.

Luke Lawrenson
Like, it's on one hand, sort of a staff meeting, and on the other hand, a therapy session. And it's like nothing I'd ever seen before. I think at times it provided real emotional release, and at times it created levels of discomfort that were intended to create more capacity and understanding. And I always found that sort of duality really confusing, of, like, is today going to be healing, or is it going to be a tricky situation that I'm going to have to hold? And I think you see both in the film.

I think you see the group sharing in the beginning, really holding one another. And then some of the boundary questions that come up. There's disagreements and really difficult feelings. Well, I'm just thinking about the title, a still, small voice. And there's a scene early on where a patient talks about her way of coping with illness is just to keep listening to that still, small voice, and it tells her what to do next.

Mati Engel
And I heard you talk about that too, Mati, with the voice that told you you're moving to Chicago, or the voice that told you you're welcome here in this room with this couple. And just these ways of knowing, these still small voices that we're listening to all the time. And I just noticed that, again, this film to me felt like slowing down so much in such a good way, quieting down so that we can listen to that still, small voice. And I'll definitely be thinking about that as I move forward, and I know the listeners will too. So I just want to say thank you so much both for coming.

Maybe before we end, do you want to say a word about what's coming up next? I will say that we're doing a series of educational screenings with the film, so if there are any institutions out there that want to invite us to show the film and talk about it with their teams, that's something we're doing. And it's been incredibly meaningful and sort of where the film feels most alive. The film's website, astilsmallvoice.com, has a way to sort of set all that up. Awesome.

Well, we'll drop links in the show notes so people know where to find you. And I just want to thank you again both for coming. I have been speaking to Luke Lawrenson and Mati Engel about their film a still, small voice. Thanks again.

Emily Silverman
This episode of the nocturnist was produced by me and Sam Osborne. Sam also edited and mixed. Our executive producer is Allie Block. Our head of story development is Molly Rose Williams, and Ashley Pettit is our program manager. Original theme music was composed by Joseph Monroe, and additional music comes from Blue Dot Sessions.

The Nocturnus is made possible by the California Medical Association, a physician led organization that works tirelessly to make sure that the doctor patient relationship remains at the center of medicine. To learn more about the CMA, visit cmadocs.org dot. The Nocturnus is also made possible by donations from listeners like you. Thank you so much for supporting our work in storytelling. If you enjoyed this episode, please like, share, subscribe, and help others find us by giving us a rating and review in your favorite podcast app.

To contribute your voice to an upcoming project, or to make a donation, visit our website@thenoctrenist.com, I'm your host, Emily Silverman. See you next week.