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
I’m involved in an interesting discussion with colleagues regarding the relationship of chaplaincy to our corporate environments. The discussion started off with an article about how folks in business need to “over deliver” in order to move up the corporate ladder. It was put out as to how we as Chaplains can do this and what it might look like.
It drew some pretty heated remarks. Some considered that Chaplains should not even consider advancement in their work. The general idea was “I’m here to please God, not men! If you’re in it for advancement, get another job.” And that’s not much of a paraphrase. Continue reading
One of the things I learned through reflecting on and getting feedback to pastoral encounters through verbatims is that many times I am counseling myself without knowing it. It’s only in reflection, sometimes long after the fact, that you start to hear yourself talk to yourself. I decided not to go the whole CPE verbatim route, buyt I like this format for reading.
For an example I included part of a dialogue I had with one of my regular patients, an older woman on hospice. She typically has a lot of pain but rarely tells anyone about it. She puts on a pleasant front but typically doesn’t let much out. I decided one day to press her a bit.
C8: So how’s you’re back been? Better or worse or about the same.
P8: No, about the same.
C9: About the same? Just not a good day today.
P10: (pause) I’m not complaining too much. Stick around though.
C11: You’re not too much of a complainer though.
P11: Seems like I’m always complaining.
C12: Really? I’ve never seen you as much of a complainer.
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.
I wanted to feature a post and blog from a friend of mine who is dealing in her own way with terminal cancer. I worked with her in hospice, she as a nurse and I as a chaplain. After she was diagnosed with her own cancer I encouraged her to write about it. This post I thought would be a great introduction. You can catch up with her at joanbaldwinbranch.blogspot.com.
More Cancer Lessons:
I have so many thoughts running through my mind with the underlying theme being; I must start writing all of this down. So, here I go not knowing what will come out of my head or where to start this.
Since I have cancer, I think a lot of the things one thinks of if they know their time here on earth is limited. It was then that I discovered what a blessing this time is. If you know you don’t have all that much time, you tend to, at least mentally, write a ‘to do’ list. On that list are things like funeral arrangements, writing letters to my children, thinking about what songs you want played at the service, etc. The introspection is phenomenal. I am getting to know me at last. Just knowing me has been something that I have often pondered doing. Now it becomes a reality. I find so many things funny. I laugh long and often. Poking fun at yourself & this disease is so freeing. It has been influential with having my family members stop denying that I am going to die. They are learning to accept this diagnosis. There is no ‘elephant in the room’. We make jokes about my baldness and my chemo brain although my grandson, Ryan, says that I was forgetful before I ever had cancer & chemo!
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.
Earlier this year I attended a conference for the Association of Professional Chaplains in Chicago. During the day there was a breakout session for hospice chaplains to get together and network. One thing we all found out was that most of us are stretched incredibly thin. It was relatively common for a single chaplain to have 75 or even over 100 patients on their caseload. Personally I can attest that we all tend to work too hard, myself included. For a while I had a caseload of about 100 patients which were spread out over four counties. There was no talk of hiring another chaplain, but after a while the management did hire one part-time which soon became full time. I ran into another chaplain locally who said that he had over 150 patients that he saw, and he also had his own church to manage! Continue reading
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.
I thought I’d pass this recent message from a memorial service our hospice hosted at a personal care facility. They had started a rock garden and we donated a tree to serve as a memorial marker.
…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.” Joshua 4:4b-7
This scene marks a pivotal point in the history of Israel. This nation of former slaves has survived forty years in the wilderness, scraping by only at times by means of miraculous intervention, to arrive at the land promised to them several generations before. Nobody who heard that promise is alive to see it fulfilled. Even Moses, who lead the bedraggled group for those 40 years and who was for all that time their closest connection to God, died before this scene. This nation of nomads has finally arrived at the end of their journey from slavery to freedom.
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