ministry

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?

Hospice Chaplain Myth #2: Fulfillment

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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.

What are You Fasting From?

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Ok, maybe my grammar is a bit sketchy title-wise, but I like it.

I never fasted in my life, save for bloodwork or the occasional operation. Most of this came from my Presbyterian/Calvinist upbringing, which saw fasting as something a bit too “Catholic”, which is code for works-oriented. It was spiritually good but unnecessary at best, idolatrous at worst. Lent tends to be interesting at times because, as I’m the hospice chaplain in a secular company, I’m seen by some as this pillar of sacredness. Especially by our Catholic staff. It freaks them out when on a Lenten Friday I pull out a ham sandwich and dig in. It has provided some opportunites to teach what I know about grace and works.

But I’m rethinking things a little this year. Not so much about abstaining from food or drink or whatever. I understand why fasting from things that are pleasurable is supposed to connect us with the suffering of Christ. However there have been plenty of folks who, rather than fast from something, try to increase the good that they do. I think that’s a good way of looking at things and not quite so self-centered. But I was thinking today that if I’m going to fast, I’d rather fast from the things that pollute my life…worry, fear, self criticism. Life without chocolate only promotes misery and desire. But life without worry for 40 days? Hallelujah! What would it be like to not be afraid for 40 days, or critical of myself or others, or anxious? What can be more enriching and spiritual than that?

So I’m going to fast from worry. What are you fasting from?

Notes to a New Chaplain: 1

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I thought it might be interesting to pass on some thoughts on chaplaincy to those who might be thinking of it as a career.  It’s a pretty specialized field, and it’s hard to find someone who is a chaplain at times to talk about the position. Plus I think there’s a lot in chaplaincy that can – and should – carry over to ministry in general.  So here goes-

First of all, don’t take yourself too seriously.

I know that might sound a little strange as this blog comes off as really serious most of the time. This is where I get that serious stuff out. However I’ve found that the best approach to ministry, especially with the dying, is lightness. Things are dark enough already, and adding weight to weight just doesn’t help.

I take my position seriously, but I don’t have to take myself seriously. I don’t wear a collar or anything else that readily identifies me as clergy. If I do come to work wearing a suit people usually assume I have a funeral or a job interview. Others wear clerics and that’s fine – in some places like the VA hospitals it’s a requirement. I can see times where adding weight and seriouslness to my position is beneficial, as when I need to take on a position of authority in a situation or with a family. However I have seen many times when that collar doesn’t even get you through the door.

Then again, it isn’t just the collar but how it’s worn that makes a big difference. I’ve had some chaplains be so tied to the externals of their position, whether through collars and vestments or even through how they pray, that it gets in the way of their calling, which is soul care. I think if your identity is too tied in with externals it can be a hindrance. Your identity as a chaplain and as clergy in general needs to be tied to who you are and what you bring to the situation. And what you as a chaplain bring to an encounter is, at it’s core, yourself and Whom you represent. Yes we are often called to do things that only we can do because we have been given the external mantle of clergy, whatever that mantle looks like. But if you can’t divest yourself of all those same things and lay them at the cross in service of another you aren’t a minister of Christ.