Chaplain Kaplan’s Complaint

As a chaplain, I am a servant of two masters: my patients and the government.  On the one hand, I want to give patients all the room they need to talk about whatever they want, and not to talk about anything they do not want or need to bring up. On the other, the government (via the hospice agency) requires my best efforts to get the answers to certain questions in my documentation, such as, “What is your religion? Do you belong to a house of worship?  Tell me about your career or hobbies.” Having these questions at least in the back of my mind as I meet a new patient or family member nags at me. At a minimum, even if I do not ask them,  they might be influencing our interaction with each other. At worst, they may be a hindrance rather than a help to anyone but the government.

When people ask me to succinctly define what chaplains do, I say something along the lines of, “We provide a sacred and safe space for clients of any faith background, free of our own agendas, to express their emotions and gain a better understanding of whatever they are facing at the moment.”

You might say despite the fact that these questions force me to have an agenda,  the questions are good ones for finding out what the patient needs and for priming the pump for them to begin talking. But I think more often than not, people find such questions, and questions in general, as intrusive, especially upon a first meeting. I remember when I was a chaplain intern I read an article that suggested that chaplains ask no questions at all during the whole encounter. That might be an extreme, but aiming towards that through open-ended comments and reactions  is a good corrective.

Then there is the issue of trust. Even the government acknowledges the importance of that at least. They require that I conclude my documentation of  my first contact with each new patient, (for every single patient, mind!) with the words, “A trusting relationship is being established,” whether that really happened or not. Building trust takes time even in the speeded-up world of hospice where even a few minutes later can count as “taking your time.”

I am reminded of my talk with Vanessa (pseudonym) over the phone a week ago, when I asked if she wanted me to contact a church on behalf of her loved one. She said, “no, there’s no church.” I felt awkward, and switched to some small talk for a moment. But then several minutes into the conversation, Vanessa brought up that they did belong to a church, and that she would appreciate it if I contacted them. I found that very interesting that at first she was guarded about revealing that information and was uncomfortable entrusting me with it. But after  she got a better sense of my intentions, she felt she was in a safe space to share it. Also she was a member of a minority, which I think adds to the negative impact of having to answer questions. Question-askers have power. The ones answering are vulnerable and struggling to protect themselves.

In an ideal world, my initial question during a visit to my patients  would always be, “How can I best be of service to you at this moment?” O Government, please document  and process my complaint!

The Rosary And The Rabbi

It was not a promising start. I had left a voicemail in Spanish with a new patient on hospice and her family. The patient’s daughter sent me a text message in Spanish saying I could visit whenever I wished. I called back, and after I said in my obviously flawed Spanish who I was and that I could come now, she said, “I don’t understand English.” Yikes. Was my Spanish all that bad?

But when I replied that I was speaking in Spanish to her, she giggled and the conversation at last had a future, however fragile it might be. So I considered it a victorious leap past the communication barrier when she agreed that I could come over right away.

The patient, who I will call Margarita, was seated on the couch, and her daughter Gabriela sat next to her as she put my Spanish comprehension to the test with a complex story of woe. A couple of other family members were present as well. I then turned to her mother, who had not said anything or even looked at me much during this lament. Because Gabriela mentioned that Margarita went to Spanish Mass at a church around the corner, I asked her mother if she would like a prayer. It just so happens I come prepared with prayers written in Spanish for such visits, including a prayer for caregivers (which caregivers sometimes scan into their phones because they like it so much), and the prayer for the Rosary. Margarita found it worthwhile to tune in to me and take the energy to communicate since I brought out the magic word Rosary as one of the prayers I had on hand. At my request, the family found a set of white rosary beads for her to hold.

I felt comfortable enough saying the words themselves of this prayer in these circumstances, but as a rabbi I could not make the sign of the Cross or say “amen,” so I felt I first had to let on that  I was not Catholic, but not only that, I was–were they ready for this?– Jewish. This only added further spice to the spectacle of a gringa like me with fractured Spanish reciting a prayer of utmost sanctity alien to her own beliefs. But they were alright with this, grateful for a spiritual presence that could cut through their linguistic isolation at this time of acute need. As I started to say the words, “En el nombre del Padre, del Hijo, y del Espiritu Santo…” I saw that Margarita could say much of the Rosary by herself by heart. I only had to resume here and there to prompt her along. She teared up at the emotion of expressing this prayer, and I saw the others brushing off their own tears. And as I was engaged with this task, I thought about how odd and how glorious it was that we could transcend language and religion and nationality and race to provide this salvation of release and of God’s comforting closeness.

No Reservations Required

alzheimers-daughter

 

Author Jean Lee faced the bizarre coincidence of having both her parents diagnosed with Alzheimer’s on the very same day. She wrote about this in her book, Alzheimer’s Daughter. Her parents had married on a five-day furlough during WWII and remained passionate about their relationship until their last breaths 60 years later. Jean says, “The blessing of their dual diagnosis was that they faded away together.” In the following excerpt from her book, where she, her sister Annette and her dad face the ultimate loss of her mother, we find out how Jean could call this a blessing:

 

“Around dinnertime, the Hospice doctor spoke with us explaining that a blood infection had started in Mom’s foot. It was something simple that anyone would be able to fight off with a normally functioning immune system but since Mom had stopped eating and drinking, she had no body reserves with which to battle this infection. It would end her life. They acknowledged Mom was having difficulty letting go. Hospice advised us to leave Mom alone during the night so she could come to terms with her own passing, promising to call us at any turning point.

We brought Dad to visit one last time that evening. He whispered sweet things and kissed Mom on the cheek. However, seeing her waxy-faced without her smile, and unconscious without recognition of him­­––he was confused.

As we walked with him back to his room, he asked, ‘Is that my mother?’

We replied, ‘No, Dad, that’s Ibby. The angels are taking her to heaven.’

My sister Annette and I sat on either side of her bed. Her head was turned toward the window, even though it was still dark. As gray dawn came into the sky, her eyes were open just a slit. The Lodge was waking up. Aides came to say their goodbyes and tell her they loved her.

A favorite aide brought Dad to Mom. He stood by the bed, held and stroked Mom’s hand. We knew he wanted to be closer––one last time. We lowered the rails. He leaned his body into hers and kissed her dry lips, whispering, ‘Ibby, I love you.’

Nearly seven decades before, Edwin Church had kissed Elizabeth Naegle at the end of a roller coaster ride in the dark tunnel of love––he now gave Ibby her last kiss. Caressing her cheek, then straightening to stand––shaking and bewildered, Dad looked at us. Annette and I hugged him. The aide approached, putting her arm around his waist to steady him and asked, “Ed, do you want to go back to your room?” He nodded.

Annette and I stayed, leaned over her bed on either side, holding her hands and holding hands with each other, completing a circle. We told her what a wonderful mother she’d been to us. We told her she’d been an amazing grandmother to our children. We told her she’d made us the women we were today. We told her she was beautiful and smelled so sweet. Lastly, we said, “We’ll take care of Dad until you can be together again in heaven.”

With every exhale she labored, as if more and more of her soul was expelled with each respiration. The circle from birth to death was now completing itself.

Annette and I stayed in the sanctuary-like quiet of the room, hearing only our own breathing, stroking her skin, knowing Mom was gone but not wanting our time with her to end.

What was left of Mom was simply her earthly shell. I had seen her birth her soul to heaven.

I returned to the locked unit to get her glasses and dentures. As I walked through those locked metal security doors knowing I had to tell my dad that Mom was gone, I did so with my back erect and a large stride, having great peace, telling myself my mother was now free and restored. She’d never have to live behind locked doors again.

When I entered Mom and Dad’s room, he struggled to stand. I hugged him, smiled and said, ‘Dad, Mom has gone to heaven.’

With a mystical expression on his face, he replied, ‘Really? I just saw her. She came to tell me she’d wait for me there.’”

 

Jean Lee lives with her husband in small-town Ohio, twenty minutes from anything. Although she worked full time while her parents were ill, she is now retired after twenty-two years of teaching elementary school. Her children are married with children of their own. Five grandchildren are her greatest blessings.

Here is the link to Alzheimer’s Daughter

You may contact Jean by email:

jean@alzheimersdaughter.com

Alzheimer’s Daughter blog:

http://jeanllee.blogspot.com

Alzheimer’s Daughter Facebook page:

https://www.facebook.com/AlzheimersDaughter

Twitter:

https://twitter.com/JeanLee18

 

 

 

 

 

Made Sweeter By The Bitter

I never could understand why someone would sweeten their tea or coffee if they were drinking it with dessert. It seems so redundant! Contrasting the bitterness of the beverage with the sweetness of the dessert, and vice versa, is for me part of the pleasure. Nor are the two sensations all that separate. As I sip some tea after a bite of the brownie or other indulgence, the sweetness mixes into the flavor of the tea, and as I take my next bite, the tea in turn makes the treat less cloying.

My work with patients is like that sometimes. Today I saw an aunt untangling and combing her niece’s hair. Then I visited with a learned lady who told me her memories of living in Paris. “I got to see Edith Piaf, in a black dress, up on the stage all by herself. I was absolutely mesmerized.” And I in turn was entranced to hear of someone who had seen The Little Sparrow in person. Later in the day, I visited someone who was watching the news from her bed, all tucked in and motionless except for her face, making cynical commentary about  the FBI and their role in connection with the suspect who was arrested for making bombs found in Elizabeth, Seaside Park, and Manhattan.

I had  all these encounters with people doing ordinary things: relating memories, combing hair, and acting as experts about the latest news, but all against the bitter backdrop that death could very well be around the corner. Combing hair is so ordinary, but becomes so poignant in the context of hospice because I know not many combings may be left for the niece. Was the aunt thinking about the tragedy of her niece preceding her in death? Or was she purely engrossed in the moment, pulling out “all these darn snags”?

Death’s proximity gives a bracing quality to the ordinary, and being engaged in the ordinary postpones the bitterness of contemplating death .

Consolation Prize

You would think that being non-Catholic, let alone Jewish and female, would disqualify me from standing in for a priest for a patient when none are handy. And that is usually what happens: no priest, no service. My husband jokes that all I need to do is put on a beard and wear a robe and say a few Latin words to be the next best thing. Hmm; impersonating a priest simply does not sound kosher.

However, there were two occasions  where I was better than nothing; a lot better they assured me. The first was when Julia ( name pulled out of the air) wanted me to hear her confession. I made sure she fully realized what flavor religion I was, and of course my untraditional gender. No matter. She found peace by unburdening herself of regrets in front of someone who symbolized God’s loving forgiveness. As I learned online, confession is also called the Sacrament of Reconciliation. Feeling reconciled with people and with God is a crucial task that many dying people wish to accomplish, so I am glad I could make it happen for Julia. Thankfully she did not ask me how many Hail Mary’s she had to do or any other such penance.

The other day, a family was with a patient who was not many breaths away from his very last one. They asked me over and over every half hour or so about getting a priest for last rites, and getting one right away. They had to ask me over and over because embarrasingly enough, I could not find one even after calling several. Finally I found one, but not one who could rush over literally at that moment. He said he would be there about two hours later. I explained this to the family members, who were all crowded into the patient’s room just waiting, and they decided that just in case it would be too late (it was, it turned out) to get the priest, that they would like me to offer a final prayer. The patient had only been on hospice for about five hours and could no longer respond in any way.Their distress felt so extreme, that I left out the distracting details of my religion and only let them know I was not a Catholic. I hoped that as I offered spontaneous prayer standing together in a circle holding hands with each other and with the patient, they would not notice too much that I left out words like “Jesus” and “Christ.” Perhaps they wondered to themselves several hours later what that was all about, but this family was comforted  that I recited a prayer that for them, put the finishing touches on the man’s soul at the critical moment.

I Was Stumped

Tammy (a pseudonym) was an African American and very young. Very young to be on hospice that is. This new patient  immediately took notice when I entered her room. I peeked in to see if she’d like to partake in some conversation. She was in bed and I drew up a chair. About the first thing she brought up was her quest for honesty. “You know, people they keep asking me how I deal with having cancer like I can beat it and all. There is no cure, I tell ‘em, and I –am– dying. You hear that? The doctors they lie and tell me about cures but I know that isn’t so. I just go with the  flow of each day and I accept it.” She then addressed how repugnant pity has been for her and introduced it with the same opener: “My friends say, oh, you have cancer, how can you deal with it. I tell them I don’t want their  pity. “

After I affirmed her feelings and opinions, and reaffirmed them a few times more for good measure, the visit was getting to be much longer than average for a hospice patient. I had been there close to an hour and she still had the energy to talk, despite nausea.

When I am not sure how long to stay, it is tricky to negotiate the length of a visit. Are they getting tired from the effort of interacting? Do they want some privacy? Are they just being polite by not letting me know it is time for me to go? There are plenty of polite ways for them to signal this. A patient often says something like “Thanks for coming” and I get the idea alright. Or they start to close their eyes, or tell me they need to rest. But if I bring up leaving before they do, I run the risk that they will  think I myself am the one who is getting tired or upset by what they are telling me, or that what I am doing is “just a job” and  am only concerned with having to get my quota of patients done for the day. So it is a tricky balancing act between leaving prematurely with the patient thinking I am rushed or not interested, versus overstaying and imposing on that patient.  This is the chaplain’s version of skirting the “damned if you do damned if you don’t” scenario. Nurses and social workers do not wrestle with this problem as much because they have an agenda of things that must be done or asked and it is less ambiguous when they are finished.

As I was saying, the visit was turning into a long one, so I asked Tammy whether she would like me to stay some more, and this is where communication went awry. She said, “That’s your decision, not mine.”

“Um mine?” (I thought about how I like to give the patient, who has so little control, at least some choice regarding when and whether I should visit and for how long.)

Tammy propped herself up in the bed to talk more emphatically: “You, not me, decide to stay with me. You’re the one to decide if you are going to visit me again.” Many possibilities flooded my mind. Was she challenging how sincere I was about wanting to stay and wanting to visit in  general?  She did, earlier in the visit, pointedly ask me why I do this kind of work. Was she questioning my motivations for visiting and the role I was playing of being the helper vs. the one being helped?  Did she feel besides my being in the “superior” role as the helper that  I was treating her as even more unequal because she is an African American ? (That is, there is automatically a power differential between me and my patients because they are sick and I as a professional am healthy, which I write about in Encountering The Edge.) Did she feel I was the one to decide if she were “worthy” of my attention? Did she really want me to take control? After a few rounds of my assuring her she was the one who could decide and her telling me no I was the one, I then tried out, “I think you and I should decide together.” That did not satisfy in the end either, and she went back to telling me to choose what to do. Finally I dropped it after assuring her I would see her again, because I could not figure out what was going on and I did not want to distress her. Because she was religious, I switched gears and told her I could sing hymns. She perked up at that idea, and I sang “He’s Got the Whole Wide World in His Hands.” After  I and then both of us sang together, she said, “Now I’m getting into the spirit of this.” Thus the visit began and finished on track, but the middle was dicey. Assuming Tammy was clear-headed, what do you, O Reader, think was going on?

The day Col. Sanders met Lyndon Johnson’s dog

In acknowledgment of the commencement of the general presidential campaign, I am featuring a guest post about First Dogs. Author Mindy Quigley’s post in this case is only remotely connected with the themes of my own blog in that the protagonist in her books is a healthcare chaplain!

Mindy Quigley

A reviewer once opined that, though she loved my books, she found the speaking in tongues scene in A Murder in Mount Moriah unbelievable. I laughingly noted that that scene, along with the notorious squirrel in the bathroom incident, are just about the only events in the book that are based on true incidents. This reader had happily swallowed the miles of yarn I’d spun and choked on the single nugget of truth.

I was reminded of this recently during a long road trip with a colleague, who I travel with several times a year. You can only talk shop for so long, so we often end up telling stories of our younger days to pass the tedious hours trekking back and forth along I-81. We were regaling one another with tales of pets our families had kept over the years–the bird who angrily demanded everyone in the house go to bed at 9pm, the…

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