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.
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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