Verbatim: Ms. F, “Maybe it’s not so bad”

(watch the video above before you read on: it’s funny, creative and has cute doggies)

I wanted to share my most recent verbatim which I’m also using for my certification. It’s in a bit of a different format and is definitely longer than most of my posts. Read on and I hope you benefit from it. You’ll catch why I included the video at the end of the paper. Continue reading

Chaplain Tom Becraft on Caregiver Burnout

***Update*** Additional resources added below: 2/7/18

I recently read a fantastic article by Tom Becraft on managing the seemingly unmanageable barrage of stress and grief that can come in heathcare chaplaincy. He begins with the summary of the first hour of one day:

  • 6:30 a.m.   The morning shift is just starting. I have just entered the office and am taking off my coat. The desk phone rings. It is from the nighttime hospital supervisor regarding an unfolding situation in Room 1040. A 34 year-old mother of four small children has had a massive stroke apparently caused by a sudden dissecting carotid artery. Brain death is likely. Considerations: how to emotionally and spiritually support this large non-English speaking family; how to facilitate the organ donor requester process; how staff, some of whom are young mothers, might experience this death; how to prioritize. I clip my cell phone and pager to my belt and head out.

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The Caregiver’s Dilemma

A week or so ago I sat down to plan some things out. I find that I don’t tend to be a planner unless I feel the need to have something concretely in front of me to refer back to. This was less of a planning than a brainstorming session, really. Brainstorming to develop the plan. The plan was how to fix myself. The brainstorming was to figure out how.

Caregivers rarely take the time to consider their own needs. They are constantly putting others’ needs before their own, in some cases to their own detriment. Sometimes it’s saintly, and sometimes it’s sick. After talking with a few people I found that I was teetering toward the sick end of the spectrum myself. Continue reading

What Does it Mean to “Trust the Process”?

In any kind of Clinical Pastoral Education experience, you will probably hear this phrase at least once: “trust the process”. I know I heard it several times in my own CPE classes, and it was never spelled out what it meant to “trust the process”.

That is part of trusting the process.

Many seminarians enter CPE because they have to, because they want to enhance their pastoral care toolbox, or enhance their resume. I’m not going to pan these reasons at all. They are all good reasons to take a CPE unit. However this is only part of what CPE does. The tools and materials used in CPE to help develop interpersonal caregiving skills – books, group work, role-play, writing essays and reports, films – are also designed to work intrapersonally as well. When entering in to the work at first, the focus is outward. We come to learn to help others, to manage others’ crises better, and see how caregiving fits in to our theological and scriptural paradigms. Continue reading

Verbatim: Being good to the person in the mirror

At my recent CPSP meeting I presented this verbatim and got some new insights from the group. I’m going to shorten it a bit just to make it easier to read.

This happened quite some time ago and when my colleagues asked why I brought it up I responded that it deals with things that I still deal with today: self-care, tiredness, and burnout.

The patient in this visit, Mrs. S, is 67 years old and has been on hospice now for a few months. She has a history of alcoholism and is on hospice for chronic pain and malnutrition. She is extremely thin and emaciated even though she eats fairly well. She smokes regularly 3-4 times a day. She is a widow and has children but they are not involved with her and she does not want them contacted. Mrs. S is Roman Catholic but has not attended church in some time. She maintains her own prayer practices and she says that she finds these comforting. She almost always presents herself as happy and content unless she is in pain, and even then she tends to minimize her pain. Her pain is regularly 8 out of 10. She is very friendly but not always open regarding her own feelings, family and past. She tends to use humor to divert attention and make light of her situation. She is frequently in bed as this is most comfortable for her. Continue reading

What counseling others reveals about yourself

One of the things I learned through reflecting on and getting feedback to pastoral encounters through verbatims is that many times I am counseling myself without knowing it. It’s only in reflection, sometimes long after the fact, that you start to hear yourself talk to yourself. I decided not to go the whole CPE verbatim route, buyt I like this format for reading.

For an example I included part of a dialogue I had with one of my regular patients, an older woman on hospice. She typically has a lot of pain but rarely tells anyone about it. She puts on a pleasant front but typically doesn’t let much out. I decided one day to press her a bit.

C8: So how’s you’re back been? Better or worse or about the same.
P8: No, about the same.
C9: About the same? Just not a good day today.
P9: eh..
C10: eh…
P10: (pause) I’m not complaining too much. Stick around though.
C11: You’re not too much of a complainer though.
P11: Seems like I’m always complaining.
C12: Really? I’ve never seen you as much of a complainer.

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Sample CPE Verbatim: Allowing for authenticity

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!

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Self care is part of your work

As important as self care is for Chaplains and other caregivers, it’s probably one of the most neglected parts of our job. And self care is part of our job, because if we don’t care for ourselves we will be unable to do our job.

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On Donald Miller and Christ outside the church

image: Amy Corron Power

Donald Miller recently wrote in his blog, “I don’t connect with God by singing to Him.” Well Don, I don’t either.

That doesn’t mean that I don’t sing to God. But I find that the only time I do is in church on Sunday for about 20 minutes. At times I find myself being drawn closer to God by music, including Christian music, but those songs somehow never make their way into the worship center.

Plus I don’t sing well. While I knew this all along, it became glaringly obvious to me when I attended a Reformed Presbyterian church in college. At RP services no hymns are sung, and there is no musical accompaniment. The congregants sing the Psalms a-capella, often breaking into multiple lush harmonies as the verses change. I just stood and listened. It was beautiful, but I was a spectator, not a participant.

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Hospice Chaplain Myth #2: Fulfillment

Being in hospice means having to travel quite a bit some days. I’ve learned all the places – grocery stores and gas stations especially – that have places to sit down and eat my brought lunch on the go. I remember walking in to a grocery store to sit down and have lunch during a particularly hectic day. I still had my ID on and when the person at the counter noticed that I worked for hospice, he said “you must have a very fulfilling job”.

I remember thinking for a minute, saying “yes it is”, paying for my coffee and sitting down, knowing that I wasn’t sure if I meant what I said.

The truth is that this is a very fulfilling job, some days. But not always, and not often most. Personally, many days are filled with anxiety beforehand about how I’m going to get done what I need to, planning my route so that I don’t end up downtown after 3pm and so on. Some days I can see half a dozen people and feel like I accomplished little else but meet the medicare requirements for my position. Other days I hear of a death of a patient and my first thought is “well at least that’s one stop off my list today!”

Does all this point to burnout? Maybe. Hospice has a high rate of burnout among staff and I’ve seen it happen. Individuals are drawn to hospice work because they are caring and want to make a difference no matter what the cost. This can mean crossed boundaries, late night calls, and overextension. And more often than not it’s those individuals that get the rewards and Kudos – rightfully so for putting themselves out there, but it can also feel to those that try to guard their boundaries and time that they are getting the short end of the stick.

I also feel that sometimes chaplains especially can feel that what they do doesn’t matter all that much in comparison to other disciplines. Nursing runs the show and calls the shots. Social workers can provide counsel and care as well as crisis intervention. Everyone can pray with and for their patients. Medicare doesn’t even necessitate that there is a chaplain on staff – only that spiritual counseling be available. This can make a chaplain feel as if he or she is a bit of a wallflower.

But can chaplaincy be a fulfilling job? Absolutely. The flip side of this myth is also a myth – that what I do doesn’t matter that much. When chaplains do what they are specifically trained to be good at – being present spiritually with another – this can be the most fulfilling job on the planet. Even when you’re sitting at a comatose patient’s bedside for an hour, or taking a demented patient outside for a breath of fresh air that he hasn’t had in probably six months, when it’s done in the proper mindset these can be incredibly fulfilling.

But the day-to-day often gets in the way. Being mindful of my own cares and worries and trying to put them aside when I’m with a patient makes a big difference in terms of how I perceive my contribution to their care.