The following is an excerpt from a Level II verbatim I did several years ago to give you an example of how I wrote toward the Level II standards.

This case ended up being one of my most difficult, in that the patient was a child and I was good friends with his mother. His death was hard on all of us. As I have children this child’s age, it cut very close for me. Perhaps a bit too close. This visit is a follow-up regarding her son’s death. I think you’ll see several themes at work:

1. who is caring for whom?
2. recognizing defensiveness
3. allowing space for authenticity and giving permission to be authentic
4. theodicy – how does God work things out for the good when a child dies?
5. self care

While I see these themes at work, I don’t think I touched on all of them in the conversation.

Feel free to comment!

Background: This visit in particular is significant in that involves the mother of a young patient we had on hospice with us who died a year ago. She is my age and she often came to me with theological questions she was struggling with. When her son Ben came on hospice, she left work but asked me to be her chaplain. This felt honoring to me, but at the same time I felt quite overwhelmed and anxious. It was one thing to work with the elderly dying and their older children, and quite another to care for a child close to the age of my own whose parents I knew very well and who I was close to.

After Ben died Eliza didn’t work for a few months. Originally she came back into marketing but found it horrible as she felt that she was going through the whole initial process of bringing Ben onto hospice over again. She felt more drawn to bereavement, but our management was concerned about how this would affect her own grief. Eliza then settled in to a part-time position in human resources, which has become more full-time.

Eliza is white, middle-class, about 38 with a thin, athletic build. She has always been focused on health and exercise and routinely runs in races and marathons. She and her husband Dave have two surviving children, the oldest being Tanner (about 14) and the youngest being Tia (about 8). Tia is an African-American girl whom they adopted after having her as a foster child.

I initiated this visit because I’ve seen that Eliza has been struggling more, at one point saying that she thought she might quit. She said this in an informal context so I didn’t know if she meant it, but it made me concerned. My initial concern is her stress level, and I’m not sure if this might be due to some grief issues, stress from work, or both. But I want to make sure that I address what’s going on and let her know that I’m concerned and available. I asked her earlier that morning to meet with me at the end of the day.

This visit lasted about 20 minutes and we met in my office. We met at the end of the day, and I was feeling a bit tired and ready to go home. However this visit was important and I was looking forward to it. I was at the office and Eliza sent me a text that she was running late. We had canceled once already and I didn’t want to cancel again so I encouraged her to get here whenever she could.

Visit Narrative & Comments:

Clinical Assessment: The visit went well for both of us. I was a little bit surprised at first in thinking about how Eliza reacted to my questions. She deflected and diverted quite a bit, and she’s usually very up-front. However I initiated the visit and so this might account for at least some of the defensiveness. I also think that by keeping most of the talk focused on feelings and not facts this also made her a bit defensive. Usually when she brings up a question or problem, it’s more of an academic discussion. So keeping this on the feeling level was new for both of us.

I noted several times how tired I felt, and this seems to be common with me a good deal of the time. However I didn’t feel discouraged and was able to stay with the visit until around C24. I felt some frustration and confusion when she tried to turn the topic away from herself, but I used that frustration to take some control and authority over the situation. Had this been in a different context, say just a chance meeting or some other unstructured visit, I would not have done the same. I was very hesitant to talk about her son’s death, which was the initial trigger for the visit. It is a very sensitive subject for me, but I did not avoid it for fear of upsetting her. My own perception has been that she is dealing with her own grief well, and we have had very open discussions about him in the past. I think that grief was there obviously, but it wasn’t my main concern. Whether this is my own avoidance or not is unknown but is a direction I could have gone. However I did bring it up in discussion of her anger and how unfair his death was.

I felt pastoral during this visit, not because I did anything necessarily religious or because I was dealing with an overtly spiritual issue, but because I felt that my role was very much that of a shepherd. I felt like I was going after one of my sheep that was sick and needed help. I didn’t use any of the resources I typically use: touch (which I don’t think would have been appropriate in that context), prayer or scripture. But I did listen and offer support, and tried to show her what I saw.

I felt like my initial concern was on target. I didn’t get a whole lot of clarity as to whether the underlying pain is due to grief or work, but at this point I think that is secondary. I identified anger and I think that was on target. I don’t think Eliza wanted to admit she was angry, but I think she did more toward the end of the visit.

I felt that the visit ended well, in that I didn’t just say “bye” when Eliza ended the visit. I left the door open which was one of the things that I’ve intentionally been trying to do now as I work in to my new role.

Theological Reflection and Learning Issues: Theologically this touches a very difficult issue, the apparent unfairness of the world, which is mentioned in Ben’s death. Does God work all things out for the good? How do we respond to evil and unfairness? Sometimes our only response is to be angry and to vent that anger. The Psalms are an excellent reflection of this, as David contemplates the apparent triumphs of the wicked and their eventual downfall. However the “eventual” is the pregnant word here: we often have to hope and trust in the eventual triumph of God’s justice without having that justice apparent. Some wrongs are never righted on this side of eternity. How we carry that with us is an important part of our walk with God.

This visit was an experiment of sorts and one that I found to be more fruitful than previous, recent visits. I felt more engaged and more “in the moment”. It was a different role for me to take and one which I am continuing to work in to with Eliza and others. However I find that my feelings were more positive during and after the visit.