"With this surgery," a Georgetown University Hospital patient once confided to Ann Hunter, "I stand a 50-50 chance of living. Help me be at peace in case I die."

Together, Hunter and the patient began to review his life. "He went over things he felt terrible about," she recalled, "and I said, 'Okay, some of those things are not too terrific. Now what are the things that make you feel good to help you balance? And then let's celebrate the fact that, no matter what we do, God always loves and forgives us.' "

Hunter is a Catholic lay chaplain. Although not a member of the clergy, she has been trained and certified by the National Association of Catholic Chaplains (NACC) to perform some religious functions, such as giving communion. She is one of 10 chaplains in the hospital's pastoral care department who provide spiritual support to the patients and staff.

They routinely visit every new patient who enters the hospital and then follow up according to need. They make their own rounds, wear page beepers, are called for emergency cases and work long, often crisis-ridden hours.

"Listening to patients and their families," said the Rev. Edward O'Neill, is the department's most important function.

"For many patients, being hospitalized is maybe the first time they've had to be quiet enough and still enough to think about some things in their lives," said O'Neill, who has worked at Georgetown for five years. Once they begin this introspection, he said, "some questions and problems can start turning up pretty rapidly."

"A lot of our ministry here is a ministry of presence," said Ann Hunter. "Just being with someone -- you don't even have to be saying anything. Just so they're not alone." Although most hospitals have traditionally had a chaplain or two on staff, the increasing size and capacity of health care institutions in recent years has prompted the need for more, said Duane Parker, executive director of the Association for Clinical Pastoral Education in Decatur, Ga. About 45 percent of hospitals nationwide now have chaplaincy programs, according to the American Association of Pastoral Counselors. Numerous organizations that certify and train chaplains for institutional or specialized ministries have been founded nationwide, and more and more hospitals are requiring staff chaplains to be certified, Parker said.

Since 1971, when Georgetown launched its program with two priests and two nuns, six new positions have been added. On a given day, pastoral care staffers may be called upon to perform Catholic sacraments, to help to resolve conflict in patients' families, to function as intermediaries between families and medical staff, to attend meetings of the hospital ethics committee and to participate in multi-disciplinary rounds with the medical staff to plan patient care.

"They make Georgetown a little different," said Dr. Robert Wallace, chairman of the hospital's surgery department. "This is the kind of thing that people criticize institutions for lacking."

Peggy Magee, another lay chaplain at Georgetown, remembers a "code," a life-threatening emergency, called in nuclear medicine on a patient who had suffered an allergic reaction to the dye used in a diagnostic procedure.

"When I got there, he was fully resuscitated, he was talking, he was fine," she said. "And they said, 'There's a chaplain here.' And he just reached out his hand. He couldn't even see me. He just reached out his hand and said, 'I'm so glad you're here . . . That was pretty scary. I could feel myself going.' And he talked about that a little bit.

"Then the doctors came in and said they'd looked over everything and checked him out and he could go ahead with the test again. And he said, 'I really want to see my wife first.' There was no one else there who could really go and get his wife, so I went up and got her.

"Then the doctors came and talked to him and said, 'You know, you can go ahead with it.' And he looked at me, and I looked at him and said: 'Wait a minute. You're still in charge here. And if you don't feel like doing this now -- maybe you need a little distance from all this.' And he said yes, that he did, so the doctor said, 'Fine, we'll do it tomorrow.' "

Nurses say the chaplains help in many ways. "They sit and talk with patients a lot," said Kelly MacCarty, assistant nursing coordinator in the hospital's surgery unit, "which we don't always have time for. There's a lot of talking and exchange going on during treatments and when we're teaching patients, but there is seldom opportunity to sit down and talk about something that's maybe totally unrelated."

"They're tremendous at helping with conflict in families," said Rose Donato, nursing coordinator of the hospital's neurology department. "I can recall one incident where we had a wife of a patient and the children were of another marriage and there was a lot of conflict between the two and the gentleman was dying. And the nursing staff and the medical staff is so in tune with taking care of the patient's physical and mental needs that dealing with outside conflict is very difficult and time-consuming for us. So we have the pastoral care department come in and mediate."

Sometimes, said O'Neill, "one child might want a full-court press -- 'Let's do everything, absolutely everything.' Then another child or the wife or husband will be saying, 'No, let them go.' And that's when it's helpful to try and focus the concern on what that person would want."

Hospital staffers say the chaplains are particularly helpful to those who care for long-term and seriously ill patients. Staff members will often stop by the department's ground-floor office to make appointments or will intercept chaplains on their rounds to talk.

"To have someone there to tell you you're doing the best you can helps you cope with this feeling of helplessness you have," said Jill Cunningham, assistant nursing coordinator in neurology. While all staff members of Georgetown's pastoral care department are Catholic, they are there to provide support to all of the hospital's patients and their families regardless of religion. They maintain a list of clergy for patients who request someone of their own faith, including a rabbi and two Episcopal priests who pay regular visits to the hospital and remain on call. "We're ecumenical in the sense that we have a wide range of clergy who visit patients," said the Rev. Daniel Gatti, head of the program at Georgetown and president-elect of the NACC.

Still, some patients' preconceived notions of what it means when a member of the clergy comes to call can be a problem, said O'Neill. "I think there is an impression in the minds of a lot of people that when the priest shows up to visit somebody, there must be something really wrong," he said. And an even more common misconception, he said, "is the idea that you're somehow there with your cookie cutter and you're aiming to convert them or make them think the way you do . . . You really have to reassure the patient that you're there for them."

Hunter and Magee, both lay chaplains who share one job, add a unique dimension to the program, previously staffed exclusively by priests and nuns. Both women are married and have families, which, they say, gives them a valuable perspective into certain problems. One example, said Hunter, is the case of a terminally ill woman who was facing the fact that someone else would raise her children after her death.

Men sometimes relate particularly well to the female chaplains, Magee said, because they are often unaccustomed to the vulnerability and lack of control they may experience as a result of being hospitalized. "They might have difficulty talking to another man about how helpless they feel," she said. "Because men don't talk about those things."

One of the lighter aspects of the job, said O'Neill, is the part he plays in the personal lives of some of the staff. "People get to know you, and when they want to get married, they come to you and say, 'Hey, we'd like you to do it.' People will ask you to baptize their kids . . . We don't like to refer to ourselves as a parish, but there are in fact people on staff who use us that way. They say we have a kind of familiarity with what's going on in their lives."