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.
pastoral care
Jesus loves you, but you’re still going to die
Every so often in hospice you get asked a baffling question, one that you don’t have a ready answer for. Sometimes it’s because the answer is simply beyond fathoming or beyond a simple explanation: “why is this happening to me?” or “why does God allow so much evil in the world?” Other times I’m baffled because the answer seems so obvious that I’m trying to understand why it’s asked at all. Such was the question I had posed to me a while back:
“Why does God have to take my mom? She never did anything wrong!”
Do seminaries teach practical ministry?
In seminary much of the coursework, depending on where you go, is geared toward making you an effective preacher, evangelist or scholar. You can’t get out without studying original languages (except at Yale Divinity School, which was why I went there!), systematic theology, preaching, church history and so on. But are schools that train ministers effectively training them for practical areas of ministry, such as pastoral care and counseling?
I use the term “practical” here as a way to distinguish between the more typical idea of ministry from the pulpit from the ministry that happens outside of it, such as chaplaincy and counseling.
Is there a gulf between ministry and counseling? Are they seen as not incompatible but effectively separate fields?
I’m interested to find out people’s experiences in terms of their training in and for the more practical parts of ministry that they had in seminary. At YDS for example, CPE was an option but not necessarily a requirement. There were a smattering of courses offered in the areas of pastoral care and counseling, but again these weren’t a requirement and the classes were rather small.
So what were your experiences? Please comment below and keep the conversation going…
The good stuff
I realize as I write this that it’s tempting to dwell on the difficulties of this position. Yes there are many, but the positives are just as numerous. Here’s just a few I’ve experienced:
A stroke patient who, while she is only able to say “yeah” most of the time, forces out “I’m glad to see you” when I visit.
My dementia patent who holds my hand like I’m her boyfriend every time I visit.
Every veteran who has shared a story about their service. I’ve known a man who survived days at sea after being torpedoed, another who was supposed to have lifted the flag at Iwo Jima if he hadn’t hurt his ankle, and another who was the only one in his platoon who survived the landing at Normandy because he was stateside getting married.
Baptising a patient just a few weeks before he passed, then passing the framed photo on to his widow.
Seeing folks’ faces light up when we present them with a birthday cake.
Having a patient tell me that they want me to do their funeral.
To reassure someone that, after 80 years, they’ve done a good job.
To appreciate the silence and quietness of God’s presence in a room as someone sleeps.
To give someone the final blessing they will ever have in this life.
I’ve met one of Frank Lloyd Wright’s secretaries, an engineer who helped design the World Trade Center, and a man who ran the drill that dug the Holland Tunnel.
I’ve heard stories and met people that will be with me all my life. And that is good.
Standing in the hallway
once again I haven’t written in a while. once again due to feeling incredibly busy.
We had a speaker at our hospice a few days ago who talked about how social workers and chaplains tend to be seen as mildly irrelevant in hospice care. Many chaplains, for example, routinely carry caseloads of over 100 as well as on call duties. I know one chaplain who has over 100 patients and a church. That to me is insane.
Given the fact that I have about 80 patients, and only about 60 of those I see regularly, I should feel like I’m on a luxury cruise. However that’s hardly the case. Admissions happen on an almost daily basis, and these require quick attention even though the impulse is to put them off until absolutely necessary. A quick phone call to the family or patient can usually tell you how much of a problem there may be, so that can help to prioritize things.
Hospice Chaplain Interview: Reblog
I picked this up of the Web and wanted to repost it; the original is here.
A reverend’s rounds: Hospice chaplain ministers to the terminally ill
October 30, 2013 6:30AM ET
Demand for hospice chaplains grows as more Americans seek deathbed spiritual counseling
- NEW YORK — Sunlight permeates the Upper East Side apartment of hospice patient Kam Hi Tse, 78, as he arranges himself in a half lotus position on the sofa and places his hands, facing upward, on his thighs in what’s known as open-palm mudra. The former chef explains in Cantonese to the Rev. Mary Chang, an ordained Lutheran minister sitting next to him, that this pose makes him open to receive blessings from the Buddha. Chang, 70, nods and opens her palms upward, too.
A hospice chaplain for MJHS, the largest hospice and palliative-care program in the Greater New York City area, Chang makes daily visits to the terminally ill and dying, offering conversation and prayer to patients and grieving loved ones. She typically sees at least four patients a day, in hospitals, nursing homes, hospice centers and private homes. Unlike clergy of the past who usually only served people of their own faith, hospice chaplains take a multifaith and sometimes even secular approach. Chang meditates with Buddhists and sings hymns with the Russian Orthodox. She prays with atheists and speaks with people uncertain of their faith.
“I am here to listen, to be present, not to convert or judge,” says Chang, a sprightly Chinese-American woman who on Sundays leads a congregation at the Lutheran Church of the Incarnation in Cedarhurst, NY. Favoring brightly colored clothes when she visits patients, she usually eschews the formal collar and title of her Protestant calling.
Up for comment: when is doing “enough” too much?
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
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.
How Not to Say or Do the Wrong Thing
I chaplain friend of mine passed this article along from the LA Times:
How not to say the wrong thing
It works in all kinds of crises – medical, legal, even existential. It’s the ‘Ring Theory’ of kvetching. The first rule is comfort in, dump out.
Susan Silk and Barry Goldman
April 7, 2013
When Susan had breast cancer, we heard a lot of lame remarks, but our favorite came from one of Susan’s colleagues. She wanted, she needed, to visit Susan after the surgery, but Susan didn’t feel like having visitors, and she said so. Her colleague’s response? “This isn’t just about you.”
“It’s not?” Susan wondered. “My breast cancer is not about me? It’s about you?”
The same theme came up again when our friend Katie had a brain aneurysm. She was in intensive care for a long time and finally got out and into a step-down unit. She was no longer covered with tubes and lines and monitors, but she was still in rough shape. A friend came and saw her and then stepped into the hall with Katie’s husband, Pat. “I wasn’t prepared for this,” she told him. “I don’t know if I can handle it.”
This woman loves Katie, and she said what she did because the sight of Katie in this condition moved her so deeply. But it was the wrong thing to say. And it was wrong in the same way Susan’s colleague’s remark was wrong.
Susan has since developed a simple technique to help people avoid this mistake. It works for all kinds of crises: medical, legal, financial, romantic, even existential. She calls it the Ring Theory.
Draw a circle. This is the center ring. In it, put the name of the person at the center of the current trauma. For Katie’s aneurysm, that’s Katie. Now draw a larger circle around the first one. In that ring put the name of the person next closest to the trauma. In the case of Katie’s aneurysm, that was Katie’s husband, Pat. Repeat the process as many times as you need to. In each larger ring put the next closest people. Parents and children before more distant relatives. Intimate friends in smaller rings, less intimate friends in larger ones. When you are done you have a Kvetching Order. One of Susan’s patients found it useful to tape it to her refrigerator. Continue reading
What are You Fasting From?
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?
The Chaplain's Report 