Things People Say to Hospice Chaplains
So, I’ve been working as a home hospice chaplain for about 6 months. I visit the homes of hospice patients and provide pastoral care to patients and families. I find the work very rewarding and a fulfillment of the call from God that I perceive.
When I talk to people (friends, family, acquaintances, people from church, etc) I often get one of a small number of responses. Here they are in no particular order, with my answer for each.
(A post for another day is “Things Patients and Families Say to Hospice Chaplains”)
It Must be So Hard
It is sometimes. Let’s face it – I have a near 100% death rate for my patients. By definition my hospice patients are not expected to get better. And I’m working with people who are emotional about the death of their loved one (or patient, for caregivers and our staff) whether they express it or not. It is certainly an emotional charged environment.
On the other hand, one of my important roles is to help the patient and family and staff make meaning from the illness and death of their loved one (or self). Finding the personal meaning of the event is one key to integrating the event into your continuing life (yes, even for the patient). I have to do that every time, with every patient. And I have to do it for myself too. I have to be able to find the meaning for me, for my place in the system that includes the patient, their family, their caregivers, their own clergy, our staff. I have to have a sense of why I’m there and what it means for me.
Beyond the individual patient, I have to find a meaning for doing the work in the first place. Why do I choose to visit a dying patient or four every day? Why do I walk into a room with strong emotions, varying dramatically from person to person? Why do I endure anger and grief and individual baggage that causes people to mistrust clergy? What keeps me going? Often the answer to this meta-question is the answer to the question for each patient for me.
The answer is that this is what God has called me to and equipped me for. I’ve been working hard for the past 8-10 years to listen for God’s call on my life. Over and over and over I have received affirmation that chaplaincy is my call, and that hospice work and end-of-life work is my particular specialty. And God has given me what I need to do that work – personal emotional make-up, life history, skills and gifts, training and education.
I believe that God has called me to stand in the place of shepherd for the journey to death for some of God’s sheep, and for their fellow flock members. It’s my place to listen to them, to hear the words they say and the words they do not say and the emotions that they feel, to let them know that what they are going through is real and usually a normal reaction to the final stage of life, to pray and read scripture sometimes to help people feel the presence of God. It’s my place to care for these people, and for them to feel that care. Sometimes it’s my place to serve as a stand-in for God or for others so that people can release the thoughts and feelings that have been stuck in their heart and soul.
The meaning that I take from this is that they are being cared for (if not by me by someone, and always by God). They are being guided through a time that we will all experience – not directed but guided, in the hospice time and the death and the time after death and the grief that comes in each of those times.
In my core I feel a strong need and call to help people. The primary reward that I get from this work is feeling that they are helped, by me or by someone else.
Don’t You Get Sad?
Yes. I do. Not with every patient, and sometimes there’s no obvious explanation for why I get sad with one patient and not with others.
With those patients who do not cause sadness for me, it’s usually because I feel a sense of joy. Joy that they are grieving as expected. Joy that they are not experiencing some of the dysfunctions that death can cause, or that they are receiving the help that they need. Joy that the patient is NOT experiencing a painful, neglectful, or premature/delayed death. In essence, I am sometimes not sad because the death is going well.
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We as chaplains (and this is also true of clergy) are expected to feel some detachment from their flock. We are expected to suppress our emotions about a situation in order to help others with theirs. Our own questions about death and why it comes and why God permits certain things to happen to people – we are expected to deal with our stuff on our own time so that the patients, family, etc. can deal with their experience of these same issues. My therapist once said to me that I have a strong ability to put my emotions on the shelf (we actually talked of Tupperware in a virtual refrigerator) and get through a situation and then deal with my emotions later. That is true, and helpful. It works that way for my theodicy too.
Sometimes I am sad. It comes in two flavors. One flavor is easy to understand – I come to feel some affection for my patients and their families. They have a big loss and I have a smaller loss that goes with it. I will mourn their death and their grief in my own time. The second flavor is more complicated. Sometimes a death just comes across as wrong. Perhaps the patient is too young (someone under 60 is a good rule of thumb, and it increases in intensity as the patient is younger. In my hospital residency, it happened with violent deaths. It also happens with deaths where the family is unable to reconcile their conflicts long enough to get through the patient’s death, and to make that death as peaceful and painless as possible. I remember one hospital patient who was estranged from his children for decades because of his abuse of them as children. His family ultimately chose not to provide comfort care, leaving him as a “Full Code” with full resuscitation required, and then left the building not to return. That certainly looked like an intentional infliction of pain. And the one that shook me soundly after the fact was a hospital Emergency Room death of a two-month old child. Nobody was to blame; it was a crib death. But it’s hard to understand why that would happen. In all of these cases, there was something wrong with the situation, something that could be fixed but wasn’t.
So yes, it does make me sad sometimes. And please don’t take any lack of sorrow or even signs of being pleased as a lack of care for the patient. In hospice circles there is a sometimes-spoken concept of a “good death”. Those I celebrate rather than mourn.
I Don’t Think I Could Do It
You might be right. There is a very unusual set of skills and attributes necessary to do this and do it well. (Short version: chaplains are weird, hospice chaplains exceptionally so.) Or maybe you could do it. If you want to talk about chaplaincy careers or training let me know. (And if it’s still early April 2016, and you want to do this in Ocean County NJ, my company has an opening.)
You might also be in that role in your own life. We often hear stories of people who have capabilities that they did not know about until they were called on to use them. You may be the person who reconciles people in your family or job, or you might be that middle-kid glue that holds the family together.
Chaplains aren’t hatched. We aren’t born with special chaplain powers. We develop them over time. Our birth and formation do need to include and foster certain traits and attributes. Chaplains do need some religious connection. But beyond that we train. Certification as a clinical chaplain in my organization (CPSP) requires at least two units of CPE and many go for the certification that requires four units. Some certifications require a Masters degree in something relevant (the MDiv is used as the template). That CPE training includes experience. So no – we aren’t born doing this.
There is a real need to be able to keep your feet and your wits and your focus in the face of strong emotions – theirs or yours. That can be learned too. But beyond that, maybe you could do it. Maybe you don’t want to, and that’s fine too. We don’t need a world full of chaplains. We just need enough of us.
I’m Glad That Someone Is Doing This
Thank you.
No, really. This is one of those jobs where compliments come less often. Where we often are unable to see the effects of our work in people because it only shows after we’re gone. Where an angry family member or patient is actually expressing emotions rather than suppressing them and that’s a victory, but we’ll never hear a thank you. Rejection is a constant. Some people feel funny about their lack of church attendance, or never grew up with religion, or had a bad experience in the church or with clergy – those people tell us to go away, politely or not so politely.
I’m glad that someone is doing this too. I’m going to need it someday. Either for myself, or for my parents, or for someone else in my life. And I will have to resist the temptation to fix my own family and myself. Just as a lawyer should never represent themself, and a doctor should never self-diagnose, we should not self-chaplain. We have to be able to feel what we are experiencing when the situation comes home, and we need other chaplains for that.
There are many guides in life. Teachers, pastors, police officers, therapists, mentors. Hospice chaplains are a specific kind of guide in a specific situation. All are needed.
Open Letter regarding PCUSA 2015 One Great Hour of Sharing materials
Filed under: Chaplaincy, Current Affairs, Religion, Shoot Yourself in the Foot
Dear Linda Valentine,
I am very concerned about the posters for the 2015 One Great Hour of Sharing campaign that were highlighted in the December 3 PNS story: https://www.pcusa.org/news/2014/12/3/special-offerings-take-new-look/ I find that these posters are quite offensive towards two groups that I minister to – those with addiction issues and people of color.
I am a Candidate for ordination and I am currently serving as the Resident Chaplain for the Capital Health hospital in Trenton, NJ. Our hospital is an urban trauma center and is also the designated mental health in-patient crisis center for the county. My particular floors include the trauma ICU and the in-patient mental health unit.
On both floors I work with patients suffering from addiction. Some are victims of violence as a result of their addiction and are in the ICU. Others are suffering from mental health issues including and related to their addiction. Other patients are in the ICU because they have literally drunk or drugged themselves to death.
Those patients who survive and who will be released into the community generally express a desire to avoid the substance that they are addicted to. They want to stay clean. Those who come from a Christian background speak of needing God’s help to overcome their addiction. I often recommend that these people connect with a church – either with the pastor or with the groups (AA, NA, Al-Anon, etc) that use the building. On learning that I am Presbyterian, these people often express interest in getting help from a Presbyterian church. In our area, there are many.
I would be horrified if any of these children of God that I spoke with walked into one of our churches and saw one of these posters. Instead of the church providing a place of refuge for them, the church would reinforce the stigma that they already feel. These ironic “jokes” aimed at addictions might be enough to send those church attenders with mental health issues back into the hospital.
Then the word brutiful started making sense sildenafil generic cheap to me, and I was getting the idea. If you have truly succeeded at moving your awareness-energy down into your body, your will likely notice your thoughts cheap viagra from usa are negative, you attract negative people and events into your world to match that inner image. A number of the issues that could be http://mouthsofthesouth.com/wp-content/uploads/2018/03/MOTS-03.24.18-Turlington.pdf levitra generika efficiently remedied are very different varieties of discomfort, stress and anxiety, psychological disorders, despression symptoms, hypertension, menopausal and a few Acupuncture Ny alternative gynecological problems. All these ingredients are blended and processed in the decoction of Semal Musli, Gokhru and Sya Musli. cheap tadalafil no prescription Beyond the issue of addiction, these posters all include people of color, women, or the elderly. I have also seen the presentation deck used by the ad agency back in September. Only one of the five people presented was a white male, and he was middle-aged to elderly and his “drug addiction” was for a health issue. The remaining figures were all people of color or women. Are we really trying to imply that Asian girls have a drinking problem? That Latino men get high? At a glance, that’s exactly what these posters are implying. If our aging Presbyterian audience suffers from presbyopia, the small print will never be read – those “ironic” messages will be all that people see.
I urge you to pull these posters from the campaign, and any other materials that use the drug addiction play on words. I hope that an apology will be forthcoming for people with addictions and people of color. And I hope that in light of this issue, and the 1001 New Worshiping Communities outside corporation debacle, that you will change procedures in Louisville to implement tighter program review. It is my understanding that this campaign was presented to groups that highlighted these issues, and that their concerns were ignored.
Sincerely,
Mark Smith
Hamilton, NJ
cc: Marilyn Gamm, PMA
Sam Locke, Special Offerings
Terri Bate, Funds Development
A Holy Moment
This has been a long week at work. In the past six work days, I have had four CMO patients. CMO = Comfort Measures Only. Other sites call this AND (Allow Natural Death) or DNR (Do Not Resuscitate) or just removal of life support. The comfort care part is when the doctors order medication that causes the patient to fail to experience their death, and eases their pain and breathing. I will not give further information on the individual cases because that would violate the law and hospital policies.
In each of these cases, things went rather well. The family was in agreement on taking this step, owing to the irreversible and deteriorating condition of their patient – or at least the family was able to come to agreement without acrimony. The staff worked flawlessly to make the process peaceful, smooth, and as painless as possible for patient and family. The patients who were Catholic received the Anointing of the Sick (aka “Last Rites”) before the process started. Things went as well as they can.
This is not to say that these events were painless. The families grieved and showed a number of emotions including sadness and sometimes anger. These deaths weighed on the medical staff as well, and on me. As I said above, it was a long week for me.
But at the same time, these moments were holy. I’ve been at this chaplain thing for a while and I’ve watched people die and families mourn. Sometimes there are angry moments and fights with each other or the staff or even God. But still, there’s that moment when the patient passes from alive to not alive. From a living creature made by God to a person-shaped collection of dying cells. This week I was able to see the last breaths of most of the patients. Some were obvious. Others were notable only in that there was not another breath that followed. But I feel like the families and I were given a gift.
We talk about the joyous moment when a baby is birthed – the magic of bringing a new life into the world. A new child of God is born. In my Reformed tradition, we believe that for those who will someday join the church, that birth is the moment that God recognizes them as God’s own – a baptism is not necessary for that to happen. And we will later baptize the baby (if Christian) and officially welcome him or her into the church, taking vows ourselves to care for that child’s spiritual life.
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Death is the other end of that vow. Death becomes the moment when we are relieved of the responsibility for the spiritual life of a person and God takes over completely. We don’t exactly know what happens next, because we haven’t been there and we can’t know. But we believe and know that God is present in that other holy moment.
Of course, we are still responsible for our baptismal vow to the family who are still here, and they are the focus of a chaplain’s work at the end of life for a non-communicative patient. Their needs vary widely from simple acts (providing tissues, helping to guide them through the process) to help making meaning of the event for them. And we give to them what they need, as best we can, being the face of Christ to them.
But what about those who are not Christian? Aside from common decency, we do these services because everyone is a part of God’s creation. We are responsible to care for God’s creation regardless of whether or not we agree with the beliefs of the person who is a part of it. Also, as a Reformed chaplain, I believe that those who are chosen by God are not exclusively in the church or even believers at a given moment. Calvin teaches us that some outside of the church are chosen, while some inside are not. We need to assume that all are chosen, and treat them appropriately.
This job is a privilege sometimes (ok, oftentimes really) even though it’s tiring and emotionally stressful. I believe that nothing is more holy and a greater privilege than to witness to the death of someone, and to support their family through that death. I’m so glad that I have the chance to do this work for God.
Capital Health Systems Pastoral Care Newsletter, October 2014
Here is the October 2014 edition of the Capital Health Systems Pastoral Care Newsletter. It mentions my arrival, and includes a reflection that I wrote.
Newsletter
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Charge to the Candidate
Filed under: Candidate Process, Chaplaincy, Princeton Seminary, Seminary, Work
At Tuesday’s meeting of the Presbytery of New Brunswick, I was moved from Inquirer to Candidate in the ordination process. This moves me closer to ordination, sometime starting a year from now. I am also pleased to announce that I will be serving as a Resident Chaplain at Capital Health System hospitals in Hopewell and Trenton, NJ from September 2014 to September 2015.
My Session Liaison, Gooitzen van der Wal (pronounced HOYT-zen), delivered the Charge to me. It was lovely, and therefore I post it here:
I am Gooitzen van der Wal, Mark’s session liaison for the Presbyterian Church of Lawrenceville.
Mark, I have witnessed your growing sense of call to ministry starting from the time you joined our church in 2006. You quickly became active in our church, including work with our “Green Team,” with hospitality ministry, and youth ministry. When you came back from Montreat serving as a youth advisor you were so excited! You wanted to switch from your IT job to ministry in the church. Shortly after that you were laid off. You then became even more involved and served as president of the Board of Deacons, were our communion coordinator and our webmaster. But the biggest transformation we have seen in you is during your CPE Chaplaincy at Robert Wood Johnson University Hospital (RWJH), bringing Gods love in serving the sick and terminally ill, and their families, and your ministry of almost two years at the Watchung Avenue Presbyterian Church (WAPC), where you further developed your skills in serving God by serving people in that congregation. You built strong connections in pastoral care and helping others in that church develop the skills in pastoral care in that community.
I charge you, Mark Smith, to continue your personal sense of God’s call to the ministry of His people. This coming year you will bring your ministry in Chaplaincy at Capital Health. Bringing the Love of Christ through the pastoral care of the sick, terminally ill, and their families is where you feel your call the strongest.
I charge you to continue your pastoral care in small group settings as you demonstrated in our church, and at Watchung Avenue PC, ministering to people of all ages. I highly commend your open understanding and compassion for people with different ethnic and personal backgrounds.
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I charge you to seek opportunities to preach, translating your faith in Christ and your understanding of the Word of God, to real world settings, as you have done so well at Watchung Avenue Pres Church.
I trust that you will continue to be involved in the Presbyterian Church as an organization. Your great respect and detailed knowledge of the Presbyterian polity is recognized and much appreciated.
We at PCOL are eager to support you in your growth path as a servant of Christ. We will prayerfully and faithfully continue our covenant relationship with your on your path to ordination.
Lastly, I want to commend your relationship with your wife Carolyn, the faith you share, and her dedication to support you in Gods ministry to His people.
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