NEW YORK — It was 8 a.m., and the subject was death.
A 55-year-old man was wasting away from lung cancer and cirrhosis. His weight was plummeting and his brain was swelling. But he was in denial, refusing to discuss hospice care or consider a "do not resuscitate" order.
A bright pink vase filled with yellow mums sat near the window, belying the grim task facing the healthcare workers at Beth Israel Medical Center who had clustered around a conference table.
"This has been really sad," said the Rev. Robert Chodo Campbell, a large man with thick brows who was wearing what appeared to be a cross between a judo outfit and hospital scrubs. He told the group that when faced with a similar case in the past, he had decided to disclose his personal battle with alcoholism to the patient -- also an alcoholic -- in hopes of spurring a conversation that might help ease the man's mental anguish and prepare him for whatever lay ahead.
"Is that a good technique?" asked a doctor, sounding slightly incredulous.
A psychologist interjected. "In this case, it could have been a gift," she said. "Psychologists don't disclose anything. Chaplains operate under a different set of rules."
And Chodo operates under a different set of rules than most chaplains as he spreads the spirit of Buddhism through the halls of Beth Israel, a 1,368-bed medical center in Manhattan. "If it seems appropriate in the moment and one is sure of one's motives -- the well-being of the patient -- then why not?" the Zen chaplain asked.
According to the American Hospital Assn., about 68% of public hospitals have a chaplaincy program. But few have Buddhist monks, and none compares with the program at Beth Israel -- where more than 20 Buddhist chaplains and chaplains-in-training offer bedside meditation, interdenominational prayers and other assistance to pregnant women, dying cancer patients and even stressed hospital workers.
"There is one rabbi and two Catholic priests. They're great people, but the rabbi sees Jewish patients. The Catholics anoint the sick. Then there's everybody else," said the Rev. Koshin Paley Ellison, co-founder with Chodo of the New York Zen Center for Contemplative Care.
Last year, Chodo and Koshin began bringing students into the hospital as part of the country's first Buddhist chaplaincy training program accredited by the . "We're really trying to create a cultural shift," said Koshin, who like Chodo uses the name given him when he took his vows to become a Buddhist priest.
Advocates say the availability of alternative treatments is crucial at a time when millions of Americans are struggling to pay for healthcare. Instead of relying on drugs and hospitalization, the Zen center encourages stress- and pain-relief through meditation, breathing exercises or simple conversation. Even if such methods cannot provide a cure, they can make patients more comfortable. And the Zen chaplains are able to spend more time with patients, time that busy doctors and nurses often cannot spare.
"We focus on listening," said Bob Allen, a chaplaincy student who has spent much of his training time on Beth Israel's oncology floor.
Not everyone, however, has welcomed him.
"I just started eating!" Allen recalled one patient yelling when he entered his room on a recent day. "I'm Jewish! Get out!"
In the tranquil manner that is pervasive among the Buddhist chaplains, Allen put a rosy spin on the patient's reaction. For someone facing death, throwing an unwanted visitor out of the room "can be empowering," Allen said. So if it made the sick man feel better about his situation, that's a good thing.
Some doctors too are skeptical about so-called integrative medicine, the melding of alternative care with traditional Western medicine.
Teaching relaxation and pain management is good, said Dr. Bruce Flamm, an obstetrician-gynecologist at Kaiser Permanente in Riverside, who has been an outspoken critic of studies suggesting prayer and spiritualism can heal the sick. But, he said, encouraging patients to pursue "kooky" approaches with no scientifically proven benefits would be a problem.
Flamm said integrative medicine programs reflected the competitive nature of the healthcare industry. Some mainstream medical centers, he said, have introduced alternative approaches in hopes of "trying to recapture some of those patients that are veering off."
"You can get your chemotherapy . . . and also get your acupuncture and therapeutic touch and reiki healing," Flamm said, drawing a picture of one-stop shopping for the ill. "The question is, is that really ethical?"
Beth Israel's Zen chaplains say they are careful in approaching patients and would never dream of countermanding a doctor's advice. But their differing approaches are clear.