“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

Gerald May: The Chaplain as Physician

I’ve been reading the excellent book Simply Sane by Dr. Gerald May, primarily for my personal benefit but secondarily for professional benefit. It wasn’t recommended to me by anyone, and I honestly can’t remember how I stumbled upon it, but I’m glad I did.

Dr. Gerald May

It’s an excellent book for those doing pastoral care as well as teachers and educators. I recently read a passage that struck me as to how well it spoke to the position that many Chaplains find themselves in: wondering what to do.

I had an older woman come on service a few days ago who appeared to be greatly depressed. When I introduced myself and gave the usual opening “how are you today?”, her response was “I want to die. Can you give me a shot?” Continue reading

A. James Rudin: Clergy education for end-of-life questions inadequate

Rabbi A. James Rudin recently wrote about the growing need for clergy of all faiths to be prepared to help those dealing with tough choices related to end of life care. He asserts that often the questions being asked at the bedside of the dying are not as much related to deep metaphysical questions but are much more pragmatic and ethical:

Rather, [the] questions, usually asked in a hospital room, go like this. “My beloved family member is gravely ill. The doctors are recommending some extraordinary and complex medical treatments. I am confused and I am being asked to make a decision. As my spiritual leader, please tell me, what should I do?”

Unfortunately many clergy are not provided much opportunity for education in medical ethics and how it relates to their particular faith. Some denominations require some clinical pastoral education which, depending on the training center, would provide invaluable insights into the day-to-day decisions encountered in trauma units and hospices. But this represents only a very small group of those in ministry training, and an even smaller percentage of those currently in ministry. Other seminaries offer courses in medical ethics, but these are almost always elective. Because of these deficits, Rudin concludes:

Medical science and technology will move forward with or without the religious community. Major decisions about health care in the U.S., including the staggering question of withdrawing and withholding life support systems from desperately ill or comatose patients, will be made with or without the “benefit of clergy.”

If the best thinkers within our faith communities do not address these issues in a thoughtful and informed way, others will decide for us, and that would be an abdication of religious leadership. If that happens, rabbis, priests, pastors and imams will have no one to blame but themselves, and worst of all, desperately ill patients and their troubled families will be the losers.

What has been your experience as a minister or as a chaplain? Did you have adequate training to help others cope with complex end of life issues?

Improving Clinical Documentation for Heathcare Chaplains

Cedars-Sinai Medical Center head chaplain Rabbi Jason Weiner talks with patient Michele Rauch. Photo courtesy of Cedars-Sinai Medical Center

Documentation is often seen as the bane of Chaplains who work in clinical settings, especially hospitals and hospices. I know when I first started I had no idea what most of those medical signs and symbols meant. I still remember early on in my career putting my hand up to ask our reporting nurse what she meant when she said our patient had a “cabbage” (hint: it’s a CABG, or coronary artery bypass graft). While it can draw a chuckle at team it can also be very intimidating to wander from our world of Greek exegesis into a land of vague Latin contractions and abbreviations. Continue reading

Life Review and Meaning-Making in Hospice Care

**update 9/5/17** Meredith Rogers passed along an excellent resource on depression she wrote on GeriatricNursing.com. I’ve linked it here – it’s well worth your time and is a good summary of types of depression and various treatments.

This article came through my LinkedIn inbox recently and I wanted to pass it along. While it refers to “Dignity Therapy” as a new tool it certainly seems as if many of the tools discussed are open to us already. Good reading after the jump:

Continue reading

Love Does Strange Things, or How I Got a Cup of Cremated Remains From Pittsburgh, PA to Newfoundland, Canada

The following is an essay I wrote for a friend of mine, Shane Blackshear, who hosts the podcast Seminary Dropout. I highly encourage you to check out his page and podcast. Oh – and upgrade your book budget as the authors and speakers he interviews will undoubtedly make you want to fill your shelves with their insights.

view of Fox Island, Newfoundland, Canada

view of Fox Island, Newfoundland, Canada

As anyone who is – or has been – on love will tell you, love isn’t just an emotion you feel for someone else. It sometimes captures you to the point where you will do just about anything for that person. It’s not always romance that produces this feeling, but it’s instead the kind of love that comes from losing yourself, which is what true love is and does. Sometimes it looks like spending hours crafting a poem or writing a song for that person. In this case it looked like smuggling a dead man’s ashes across international boundaries on a passenger jet. 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

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

Pastoral Care and Advanced Dementia

When I first started chaplaincy, I would walk out the door with bible in hand and a planned reading for the day for all my patients.

That lasted about two days.

The reason was not that I gave up or got lazy, but rather that I quickly found that the majority of the patients I saw didn’t benefit from it because they simply couldn’t understand what I was doing due to advanced dementia of some kind. Even if end-stage dementia was not their primary diagnosis, I’d say at least 2/3rds of the people I saw suffered from this. Many could communicate and talk with me, but lived in a world of their own. They would often misinterpret their environment, and in many cases couldn’t remember what I had just said to them a few minutes ago. Some were truly end stage, confined to a chair or to bed, nonverbal or nonsensical, and having no apparent understanding of what was going on around them. Organically, their brains were slowly dying, leaving them trapped in a world that I didn’t know how to enter.

That’s what makes dementia and Alzheimer’s Disease so tragic. A person can otherwise be relatively healthy, but as their brain deteriorates it can seem as if they are lost to us already. Continue reading

Mixed Messages

Every so often you’ll come across a case that’s difficult because of competing messages and needs. For example I have one patient that had declined spiritual support for several months. He was always on the forefront of people’s minds though, because of the many needs he had. He had alienated his entire family and been through most of the assisted living homes in the area, burning his bridges in the process. He suffered from a great deal of depression and anxiety, never seemed satisfied or comfortable (even after massive doses of pain medication), and seemed to be always wanting to change things in his care plan – though nothing made a difference. He had declined chaplain services for months (he was Catholic) but the team thought that he would greatly benefit from support, if only to give him someone else to vent to other than the on-call staff. Continue reading