When Ziki Hexum’s score begins its woodwind lament over the closing credits of A Still Small Voice, it’s a kind of sigh, a letting go. For the preceding 90 minutes we’ve been invited into intimate, searching conversations and profound silences in the offices and inpatient rooms of a New York hospital. Within the discussions observed by filmmaker Luke Lorentzen, it’s hard to find a comment that isn’t packed with complex questions and spiritual longing as humans grapple with the intertwined journeys of body and soul.

The conversations that unfold in this challenging and sometimes wrenching documentary are the ones that few doctors have with their patients and few people have with their family, particularly in a culture as unwilling to look illness and death in the eye as the American one is. Lorentzen, who offered an intense ride-along portrait of Mexico City emergency medical workers in Midnight Family, spent most of a year filming a group of four women completing their residency in spiritual care at Mount Sinai, a teaching hospital in Manhattan. He focuses on one of these candidates for chaplaincy, Margaret “Mati” Engel, and the group’s supervisor, the Rev. David Fleenor, as they bear witness to suffering and wrestle with physical, emotional and mental exhaustion and the limits of empathy.

Their group meetings begin with David leading Mati, Michele Gourley, Jessica Mitchem and Fumiko Sakakibara in a brief, centering meditation. The discussions that ensue go deep, structured though they are within the cautious boundaries of the language of therapy: “validate,” “resonates,” “acknowledgment,” “what I’m hearing.” Eventually, though, the two central figures, depleted, snap, and the guard rails come off, a turn of events that the film has led us toward but which still comes as a shock between two such caring people, like a bandage being ripped off a wound without ceremony.

Lorentzen’s approach is vérité and collaborative. According to an end-credits note, Engel and the filmmaker engaged in “a process of rigorous discussion … regarding ethical considerations,” and the patients who appear onscreen chose to do so and could nix the use of their footage “prior to picture lock.” One of those patients’ words of wisdom give the film its title; another closes the documentary on a note of breathtaking gratitude and joy. They’re unforgettable.

The doc opens to the sound of a machine, one of the dreaded pieces of equipment in an intensive-care hospital room. At the center of all the tubes and monitors lies a patient who can’t speak. Mati, beside the bed, tries to interpret hand gestures and facial expressions. It’s an almost unbearably private moment, the stillness and respectful distance of the camera — Lorentzen shot the film himself — acknowledging its importance and delicacy. “Can I hold your hand?” Mati asks, and it soon becomes clear that doing so is not just an offer but a request, the contact a comfort for her as well as for the patient. That reciprocity is at the heart of what Lorentzen captures through his lens as he shadows Mati and essentially goes through the program too.

Along with the exchange of energy, ideas and feeling between the aspiring chaplain and patients is the weight of pain and loss. Patients come to grips with devastating diagnoses, family members struggle with guilt and sorrow and, in one case, threaten suicide. Adding to the tension is the risk of COVID in the early, uncertain months of the pandemic; Lorentzen began shooting in September 2020, and many of the conversations in A Still Small Voice are conducted from behind surgical masks. Beyond how distracting those thin coverings look to an N95-savvy viewer, this places the accent on what the eyes reveal.

There are, of course, Zoom calls too: check-ins between Mati and David and his meetings with a psychotherapist, A. Meigs Ross. In the first such session we see, David wants “to sit more easily in the role of authority”; by the second, all he can say of his supervisory role is that “it hurts,” and he’s ready to quit.

As for Mati, for all her courage, commitment, intelligence and compassion, she’s not always likable. And that only enriches the film. This is no two-dimensional portrait of heroism. Her story packs a whole lot of offscreen drama — backstory as well as workplace stress and conflict — into the brief running time. The chaplains minister to people of all faiths, and Mati, who’s Jewish, struggles to reconcile the idea of a loving God with her ancestors’ experience at the hands of the Nazis. Her mother’s act of courage in leaving the Orthodox community, mentioned briefly, suggests a story worthy of its own documentary. Her father’s sudden death left her gutted and struggling for three years.

Perhaps this explains the tough love she administers at one point. “We cannot save our parents,” she says to a patient’s son or daughter, someone we can’t see, deep emotion and impatience rising in her voice. She’s almost certainly addressing herself as well.

Whatever Mati’s intellectual qualms about religion, she believes in the “nourishing” attributes of ritual and prayer. It’s hard to argue with their value, their necessity even, after watching the tenderly framed sequence in which she baptizes a Christian couple’s deceased newborn. A Still Small Voice is about listening for inner truth and bearing witness. Sometimes the chaplain needs to be pointed toward the appropriate prayer, and sometimes the holy water is in a Styrofoam cup.