The Push and Pull of Empathy

Chaplains can find themselves in some sticky situations among family members. While our primary focus is often the patient or other person we are working with, we can be brought in to situations where family members are at odds with one another, with staff, or even with the patient. We may be brought in to help defuse a volatile meeting or try and get the family on the same page. The reasons for this often comes down to two of the most important skills we have in our toolbox: our capability of empathy and our ability to listen non-judgmentally. Some people though have a knack of turning those skills against us. Continue reading

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In Defense of “Feel Good” Theology

I need this mug

I want to first state that this is not going to be a bashing of traditional, orthodox Christian theology. Orthodoxy certainly has its place, and has earned it over thousands of years. Lately it’s come under quite a bit of fire in spots, especially regarding such things as its view of homosexuality, penal substitutionary atonement, the doctrine of hell and so on. This is not about the merits or problems with conservative theology against progressive theology. Neither is this about defending “health-and-wealth” theology, which is an entirely different subject altogether I think. What I do want to do is give a (qualified) defense of what many call “feel good” theology, “me-ology” or “watered down” theology, which for the sake of discussion is teaching or theology that tends to favor the emotional over the intellectual, and minimize talk of God’s judgment (sin, hell and so on) in favor of God’s love (grace, forgiveness). It’s one of the most derided forms of faith, and often for good reason. However I am going to say that in some circumstances it’s not a bad thing. Continue reading

Why We Get Complicated Grief Wrong

I recently switched positions in my company to help manage our bereavement services. Don’t worry – I’m still in the field as a chaplain as well (with a very limited caseload – something I asked for)! I had a great deal of experience working in bereavement in my prior company so this has been a good fit so far.

However this move has brought up something that has always bothered me. That is even though that the staff I work with on a daily basis has years of experience in hospice care we still struggle with measuring and even recognizing complicated grief and bereavement. Continue reading

When All is Said and Done: Death and “Magic Words”

Your average hospice chaplain. Probably had 3 units of Level II CPE.

Recently I had a family whose mother was on hospice with us. When Isabel* had a sudden decline and became active her family gathered around the bedside and all started to say the things that families and caregivers – including hospice staff – feel that they need to say in order for the dying person to “let go”. They all said that they loved her and that they would be OK. They had out of town family come in and say good-bye in person and on the phone. They told her over and over again that it was OK for her to go. The priest gave last rites. This went on for well over a week.

Needless to say it was rough. The family came and went, said what they needed to say, and still Isabel seemed to hang on. There were a lot of thoughts and questions: “What haven’t we said? Is there someone that hasn’t said goodbye yet? Is she waiting to hear from someone? What are we missing? Why is she still here?

My best response was, “I don’t know.”

Continue reading

“Hope can harm dying patients”: F. Perry Wilson on Doctors, Families and Misplaced Hope

Our humanity, as well as our caring nature, often calls us to be sources of strength and encouragement to those who are in crisis. This is true of Doctors, Chaplains, Nurses – in fact the whole hospice team. We hate to be the ones delivering bad news, especially when we feel like the other needs comfort rather than reality when reality most likely is going to be awful.

F. Perry Wilson, MD, MS

Dr. F. Perry Wilson, in a video report on MedPageToday, reports on a recent study concerning what doctors and surrogates believed a terminal ventilator patient’s chances of survival to be. The study found major discrepancies between doctors and families, and while doctors were often more accurate in their assessment that knowledge was rarely transferred to the families in the study. Families were often too optimistic regarding chances of survival. There were several factors involved in this, including religious belief or hope for a miracle, the need to not “give up”, and even magical thinking (“If I circle 50% it might be true”).

The study and analysis reveal how medical clinicians and supporters, including Chaplains and Social Workers, can reframe “hope” to mean hope in a peaceful death rather than hope for a full recovery.

One piece of the puzzle that was not addressed was that this unwarranted optimism could easily be seen as part of the grieving process for families. While education about realistic expectations is certainly necessary and needed, resistance to this advice in favor of “hope” shouldn’t just be written off.  Denial, bargaining and magical thinking are part of the grieving process and may show that they are trying to wrestle with acceptance rather than avoid it.

 

Why Roy Focker’s Dead and Wolverine Isn’t (At Least Really): Death in Anime and American comic culture

Marvel Comics’ cash cow Wolverine has been dead now since 2014. At least until he isn’t dead anymore.

Yes, Wolvie died when his healing factor was turned off and, in an epic fight with a mad scientist, he’s now entombed in the unbreakable metal adamantium. It’s a poetic tragedy in that adamantium was what originally coated his bones and trademark claws making him basically unbreakable. Now the metal is on the outside and Wolverine has suffocated to death.

Probably.

I’m actually impressed that Marvel has kept him dead this long. He’s died on at least 40 occasions after all. Granted, many of those are in alternate timelines and “What if?” titles, so you can’t really count them. But the 2014 Death of Wolverine story seems to be the first time Wolverine has died and stayed dead. Continue reading

“What do these stones mean to you?” Reflections on Joshua 4

The following is from a remembrance service I did at a facility some years ago. At the end of the service we passed out stones to the families and staff in attendance. I hope you enjoy it.

…Joshua said to them: “Cross over before the ark of the LORD your God into the midst of the Jordan, and each one of you take up a stone on his shoulder, according to the number of the tribes of the children of Israel, that this may be a sign among you when your children ask in time to come, saying, ‘What do these stones mean to you?’ Then you shall answer them that the waters of the Jordan were cut off before the ark of the covenant of the LORD; when it crossed over the Jordan, the waters of the Jordan were cut off. And these stones shall be for a memorial to the children of Israel forever.” Continue reading

Too Close to Home: Hospice workers and personal loss

Within the past 6 months two of the nurses I work with lost their mothers. In both of these cases, they chose to have their mothers on our hospice.

This is a very hard thing to do. It was awkward for a while for all of us at team especially to be referring to and discussing someone in a very clinical manner, yet knowing that this was a team member’s mother. Yet it was also a good reminder for all of us that all of our patients are someone’s mother, father, brother, sister, or even child.

The awkwardness goes away after a brief time. However when that loss finally happens it can be devastating, not only to the family member but to the whole team. Continue reading

Why I’m a Chaplain – II: Connecticut Hospice

Last time I talked about how my dad’s illness and death helped guide me toward hospice. What I hadn’t mentioned was that he was never on hospice – we didn’t even have time to consider that. My first experience in hospice care came while I was in seminary at Yale Divinity, where for a time I volunteered at Connecticut Hospice.

This was my first experience with any kind of hospice. My responsibilities were pretty light – empty the garbage cans by the bedside, make sure the water pitchers were full. But it was quite an interesting experience and one that, along with many others, pointed me in the direction where I am headed now.  Continue reading

Why I’m a Chaplain – I: My Dad

I thought I’d start a series talking less about the practicalities of hospice and chaplaincy and share a bit about what got me to this place in life. Even these are going to be numbered don’t think of them being in any particular order.

So first is my dad.

I grew up in rural western Pennsylvania on a 50 acre farm with my three sisters, mom and dad. My dad, besides running the farm, worked in a sintering plant. The steel industry in the area was on the decline, and I remember my dad alternately being laid off, then working odd shift hours, then being laid off again and so on. But something significant happened when I was in about middle school: my dad was diagnosed with Acute Lymphocitic Leukemia (if I remember all that correctly). Initially this came as a huge blow to our family, but our doctor said that if you were going to get Leukemia this is the type to get. It was not itself fatal, and could be managed fairly well. Continue reading