chaplaincy

Jesus loves you, but you’re still going to die

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Every so often in hospice you get asked a baffling question, one that you don’t have a ready answer for. Sometimes it’s because the answer is simply beyond fathoming or beyond a simple explanation: “why is this happening to me?” or “why does God allow so much evil in the world?” Other times I’m baffled because the answer seems so obvious that I’m trying to understand why it’s asked at all. Such was the question I had posed to me a while back:

“Why does God have to take my mom? She never did anything wrong!”

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Chaplain certification and other nightmares

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Before I completed my last unit of CPE several years ago I was encouraged to go for my certification through the APC. It’s the “gold standard”, the “union card”, the key to get you in the door of any Chaplain job in the country.

Only I didn’t go for it.

I have plenty of excuses now looking back. I already had a job that didn’t require certification and they didn’t really care if I was. I was the Director of Spiritual Services already and none of the chaplains I supervised had their certification either, so I didn’t feel that pressure. As Director, I was also really really busy and didn’t feel like investing any more time then toward putting all the papers together and so on. I also felt really secure in my position and didn’t feel like certification would really help me where I was. Plus, I also got the feeling that although my job had supported me through part of my CPE, they were done with giving me time and financial support to pursue certification.

Then I got let go. Continue reading →

Cancer from both sides: Joanie Baldwin Branch

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I wanted to feature a post and blog from a friend of mine who is dealing in her own way with terminal cancer. I worked with her in hospice, she as a nurse and I as a chaplain. After she was diagnosed with her own cancer I encouraged her to write about it. This post I thought would be a great introduction. You can catch up with her at joanbaldwinbranch.blogspot.com.

More Cancer Lessons:
I have so many thoughts running through my mind with the underlying theme being; I must start writing all of this down. So, here I go not knowing what will come out of my head or where to start this.
Since I have cancer, I think a lot of the things one thinks of if they know their time here on earth is limited. It was then that I discovered what a blessing this time is. If you know you don’t have all that much time, you tend to, at least mentally, write a ‘to do’ list. On that list are things like funeral arrangements, writing letters to my children, thinking about what songs you want played at the service, etc. The introspection is phenomenal. I am getting to know me at last. Just knowing me has been something that I have often pondered doing. Now it becomes a reality. I find so many things funny. I laugh long and often. Poking fun at yourself & this disease is so freeing. It has been influential with having my family members stop denying that I am going to die. They are learning to accept this diagnosis. There is no ‘elephant in the room’. We make jokes about my baldness and my chemo brain although my grandson, Ryan, says that I was forgetful before I ever had cancer & chemo!

Handling authority and conflict: another CPE verbatim

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In the beginning…

First I want to thank those of you who read my posts. I have two blogs that I write on, and while this is the one which I update the least (until recently) it is definitely the more popular one. That said I am going to look in to ways to make posts easier to find and rework the design a bit in the process.

That said, I wanted to post another CPE verbatim as an example. This is one that I wrote in my 3rd unit at the Pittsburgh VA which I took at level II.  I chose this particular one because I think some might find it helpful to see how to write toward the competencies (I used footnotes) and also because of the context. Most chaplain interactions are seen within the chaplain-patient context, but this one happened within a supervisor-supervisee context. So I also wanted to include this an example of how you can use the CPE environment to look at many different areas. It also included several people, so it was pretty complicated. Feel free to comment.

I don’t deal well with conflict and my main question going in was “did I handle myself appropriately?” If you’re interested in familial roles, handling personal and professional authority, trust and handling conflict you’ll find this interesting. Oh – and I later on ended up firing this person (ok, if you ask her she resigned before I could fire her but that was only because she hadn’t made it back in to the office that day). Intrigued? Read on-

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Do seminaries teach practical ministry?

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In seminary much of the coursework, depending on where you go, is geared toward making you an effective preacher, evangelist or scholar. You can’t get out without studying original languages (except at Yale Divinity School, which was why I went there!), systematic theology, preaching, church history and so on. But are schools that train ministers effectively training them for practical areas of ministry, such as pastoral care and counseling?

I use the term “practical” here as a way to distinguish between the more typical idea of ministry from the pulpit from the ministry that happens outside of it, such as chaplaincy and counseling.

Is there a gulf between ministry and counseling? Are they seen as not incompatible but effectively separate fields?

I’m interested to find out people’s experiences in terms of their training in and for the more practical parts of ministry that they had in seminary. At YDS for example, CPE was an option but not necessarily a requirement. There were a smattering of courses offered in the areas of pastoral care and counseling, but again these weren’t a requirement and the classes were rather small.

So what were your experiences? Please comment below and keep the conversation going…

The good stuff

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I realize as I write this that it’s tempting to dwell on the difficulties of this position. Yes there are many, but the positives are just as numerous. Here’s just a few I’ve experienced:

A stroke patient who, while she is only able to say “yeah” most of the time, forces out “I’m glad to see you” when I visit.

My dementia patent who holds my hand like I’m her boyfriend every time I visit.

Every veteran who has shared a story about their service. I’ve known a man who survived days at sea after being torpedoed, another who was supposed to have lifted the flag at Iwo Jima if he hadn’t hurt his ankle, and another who was the only one in his platoon who survived the landing at Normandy because he was stateside getting married.

Baptising a patient just a few weeks before he passed, then passing the framed photo on to his widow.

Seeing folks’ faces light up when we present them with a birthday cake.

Having a patient tell me that they want me to do their funeral.

To reassure someone that, after 80 years, they’ve done a good job.

To appreciate the silence and quietness of God’s presence in a room as someone sleeps.

To give someone the final blessing they will ever have in this life.

I’ve met one of Frank Lloyd Wright’s secretaries, an engineer who helped design the World Trade Center, and a man who ran the drill that dug the Holland Tunnel.

I’ve heard stories and met people that will be with me all my life. And that is good.

 

Standing in the hallway

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once again I haven’t written in a while. once again due to feeling incredibly busy.

We had a speaker at our hospice a few days ago who talked about how social workers and chaplains tend to be seen as mildly irrelevant in hospice care. Many chaplains, for example, routinely carry caseloads of over 100 as well as on call duties. I know one chaplain who has over 100 patients and a church. That to me is insane.

Given the fact that I have about 80 patients, and only about 60 of those I see regularly, I should feel like I’m on a luxury cruise. However that’s hardly the case. Admissions happen on an almost daily basis, and these require quick attention even though the impulse is to put them off until absolutely necessary. A quick phone call to the family or patient can usually tell you how much of a problem there may be, so that can help to prioritize things.

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Hospice Chaplain Interview: Reblog

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I picked this up of the Web and wanted to repost it; the original is here.

A reverend’s rounds: Hospice chaplain ministers to the terminally ill

October 30, 2013  6:30AM ET
Demand for hospice chaplains grows as more Americans seek deathbed spiritual counseling
NEW YORK — Sunlight permeates the Upper East Side apartment of hospice patient Kam Hi Tse, 78, as he arranges himself in a half lotus position on the sofa and places his hands, facing upward, on his thighs in what’s known as open-palm mudra. The former chef explains in Cantonese to the Rev. Mary Chang, an ordained Lutheran minister sitting next to him, that this pose makes him open to receive blessings from the Buddha. Chang, 70, nods and opens her palms upward, too.

A hospice chaplain for MJHS, the largest hospice and palliative-care program in the Greater New York City area, Chang makes daily visits to the terminally ill and dying, offering conversation and prayer to patients and grieving loved ones. She typically sees at least four patients a day, in hospitals, nursing homes, hospice centers and private homes. Unlike clergy of the past who usually only served people of their own faith, hospice chaplains take a multifaith and sometimes even secular approach. Chang meditates with Buddhists and sings hymns with the Russian Orthodox. She prays with atheists and speaks with people uncertain of their faith.

“I am here to listen, to be present, not to convert or judge,” says Chang, a sprightly Chinese-American woman who on Sundays leads a congregation at the Lutheran Church of the Incarnation in Cedarhurst, NY. Favoring brightly colored clothes when she visits patients, she usually eschews the formal collar and title of her Protestant calling.

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Hospice Chaplain fact #1: We work too hard

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Earlier this year I attended a conference for the Association of Professional Chaplains in Chicago. During the day there was a breakout session for hospice chaplains to get together and network. One thing we all found out was that most of us are stretched incredibly thin. It was relatively common for a single chaplain to have 75 or even over 100 patients on their caseload. Personally I can attest that we all tend to work too hard, myself included. For a while I had a caseload of about 100 patients which were spread out over four counties. There was no talk of hiring another chaplain, but after a while the management did hire one part-time which soon became full time. I ran into another chaplain locally who said that he had over 150 patients that he saw, and he also had his own church to manage!  Continue reading →

Up for comment: when is doing “enough” too much?

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I have a particularly hard case that I wanted to share. It’s hard not only due to the nature of the disease but to the difficulty of how to approach it. I thought it would be a good ground for discussion.

This particular case is a man in his with Huntington’s Disease who lives in an assisted living community, which is comprised of much older adults. He has adult children and is married. He has a history of some suicidal ideation and has had two attempts that both failed. This disease claimed his father so he is well aware of what is in store for him. He is currently receiving medication to help with his depression and this seems to be helping. I see him twice monthly and our hospice social worker visits regularly for support as well. His wife is recovering from a traumatic injury that nearly killed her. He tends to keep to his room watching TV and movies most of the day. He doesn’t go to activities and has few if any friends at the facility.

The disease is the big elephant in the room. He refuses to talk about it and the family refuses to talk about it. They acknowledge it but it is not a topic to be discussed. This gentleman also never really opens up about anything. For some time I felt that it was me, but after a conversation with his wife this is his norm – he has never been that open about his feelings or thoughts. In fact neither has she or anyone else in the family. During most of my visits we sit in his room and watch TV or movies, maybe talk a little sports. I brought him some Christian music once and he gave it back to me the next visit. My thought was that he didn’t like it, but his wife told me he loved it.

I spoke with his wife yesterday to follow up on a visit and to check in as to how a visit with his psychiatrist went. It didn’t go well at all. The psychiatrist wanted to talk about the “elephant in the room” which was the disease and this man’s eventual death, and he wanted everyone to talk about it. Nobody did of course, and the end result was that everyone left angry and offended, and this man’s children felt even less like going to see him (as they are also prone to the disease). His wife told me that nobody in the family talks about things, especially their feelings, and that they are fine with this.

Hearing this was a bit difficult for me. I agreed with the psychiatrist that the family did need to talk about the elephant in the room! However the push-back made me rethink this position.

Personally this reminded me of the fine line we walk sometimes between managing our own agendas against – or along with – our patients. Even when my agenda is valid and helpful, at least as I see it, it’s important to remember that it is still my agenda. This psychiatrist wanted to use a more Rational-Emotive methodology to break through barriers that he saw and bring the family to his own picture of health. Is this family healthy? Well that depends on your picture of health. Is it functioning? That depends on your picture of functioning.

This story also touches on a key element of chaplaincy – that the chaplain both is and isn’t a psychotherapist. As I have a background in both psychology and ministry I feel this tension strongly. In chaplaincy, the primary agenda is set by the other, where as in psychotherapy it is often set by the therapist. In my own experience of receiving counseling, I’ve had periods of strong resistance and anger that I had to work through, and my therapist (as well as my CPE instructors) had to hold my feet to the fire while holding me up at the same time. I understand the resistance to resistance this family feels. I feel my own resistance as well, and question my motives as well as my actions at times. Am I doing enough or is my version of “enough” too much? I feel that I want to be helping, but it is hard to know when you are helping in this situation. It makes me feel caught in a bind, sad and frustrated. Plus this man’s life stage is much closer to my own than are my other patients’!

So let me know what you think. Use this as a jumping off point for discussion. Feel free to comment below and see where this goes. What do you see here? What would you do? Was the psychotherapist wrong, right or neither?