Where We Are: COVID-19 Update

So it’s been a while, hasn’t it? Many of us working in healthcare have been strained to say the least. Even if we aren’t dealing directly with patients with the coronavirus or their families, the rapidly changing and always dramatic day-to-day events in our country and around the world are more than enough for anyone to handle.

Rather than post an essay or some helpful “how-to-cope” stuff, I’m just going to write. Which is a way of coping in itself. Pardon any possible incoherence. Continue reading

Chaplaincy Today Isn’t Chaplaincy Yesterday: Chaplaincy in COVID-19

Dawn Malone, a lay chaplain for the archdiocese of Galveston-Houston, ministers to cancer patient Austin Bond, via video conference on Thursday, March 19, 2020 in Houston. Coronavirus has limited local chaplains the ability to minister to the sick or elderly. Chaplains have also been told not to minister to any group more than 10. Photo: Brett Coomer, Houston Chronicle / Staff photographer

Our CPSP chapter met by Zoom last evening and it was clear that we all needed to vent. The past few weeks have been quite tumultuous throughout the world, our country, our county and our workplaces. Where we would usually brought cases to discuss and receive feedback, we found ourselves becoming the cases to present. Many felt lost. One member who had just taken a new paid position was now told to stay home because she was in a high risk population. Another member was caring for an ill husband and struggled with the inability to do what he felt such a strong call to do. Another member was constantly bombarded with work calls during the meeting. One member, a Rabbi, spoke of trying to figure out how to have a Passover Seder via Zoom (which she called a “Zeder” – I laughed for about 5 minutes). Continue reading

Choice, or Lack Thereof: Lenten Reflections in a Pandemic

You have no idea how important this choice is (from The Stanley Parable)

I started a computer game last night that spoke to the times in an interesting way. No, not The Walking Dead or Plague, Inc.: it’s The Stanley Parable (and it’s free for a limited time as of this writing on Epic). Sure TWD and Plague, Inc. certainly share the paranoia and dread of today, but The Stanley Parable deals with something that has affected us all around the world, and that choice – and the lack thereof. Without giving too much away, TSP is game in which the isolated protagonist office worker Stanley discovers that he has suddenly stopped receiving directions from his boss. The parable that ensues makes you consider whether or not the choices you make are really your own and how much control do you have of the story being told – if there even is a story.

I’ve been very aware of choice over the past week, as have all of us I expect. We are all now much more limited in where we can go and what we can do. Some choices are made for us, like what stores are open, and others are made on our own. Others’ choices impact our own lives as well, from refusing to follow precautions to hoarding paper towels. The idea of choice and the lack thereof has impacted my life most significantly in my work as a hospice chaplain and bereavement counselor. Continue reading

528 Hertz

“You know that the universe vibrates at 528 Hz, right?”

This was only part of the first conversation I had with Neil*, who had just come on hospice and was living at home with with his mother. It was my initial assessment with him, and it was already off to an interesting start. When I arrived for our meeting time he wasn’t available. The neighbors in his apartment building who were sitting outside said that he had just gone out to the local Rite-Aid with his girlfriend. So I waited on the patio until he arrived.

Neil right off the bat struck me as an interesting guy. He was in his mid-50’s, and his long white hair, thin build, pale Hawaiian shirt and straw fedora made him look like a wandering beachcomber. He carried a portable oxygen concentrator, the only visible indicator of his end-stage lung cancer. “Hey man! Sorry I’m late. I had to go get my meds and some toothpaste.” He introduced me to his girlfriend who was with him and neighbors and then escorted me inside, chatting the whole time. Continue reading

NPR Show Discusses Hospice and “Comfort Care”, Advance Directives

Joshua Johnson, host of NPR’s 1A

The NPR show and podcast 1A recently held a discussion with former radio personality Diane Rehm and medical experts, prompted by the news that former First Lady Barbara Bush had chosen “comfort care” in the last days of her life. Continue reading

Countering Hospice Myths: A Response to John Neihof and the American Family Association

A recent article by Dr. John Neihof on the American Family Association website caught my attention recently. I find that I’m often at odds with the AFA, and try to counter some of their more off-base proclamations (the biblical mandate for border walls for example) in their comments section. It’s been a fool’s errand I think, and this fool has run his final errand with the AFA. 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

Getting Your Foot in the Door: 8 Ways to reduce “declines” for chaplains

the chaplain makes his rounds

One issue that I see frequently coming across chaplain discussion boards is that many have increasing numbers of those declining chaplain support. One poster, a hospice chaplain in Georgia, said her declines went from 10% five years ago to about 35% now.

Many believe that the refusal of spiritual support is due to a decline in religiosity overall in our country and culture. That may be true, but I don’t think it accounts for the majority of declines. Even though the Pew Research Center found a nearly 8 point percentage drop in those professing Christianity between 2007 and 2014, about 70% of Americans still identify as a member of some Christian church or faith group. From my own experience I can say as that I have had many accepting of chaplain support who were atheist or agnostic, or believed in God but did not consider themselves religious.  And no these were not millennials, these were your typical elderly hospice patient. 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.