How to Help by Not Helping

Ever wonder what is inside a chaplain’s head as they ply their trade? How they counsel grievers and persons facing their own end? In a Homestead Hospice radio interview, I explain how I “help by not helping,”  a Zen-like concept which meets with some resistance from the host, a hospice professional. The interview is about 50 minutes long, which I realize is quite an investment of time compared to reading my written posts. So I most recommend it to: (1) aspiring chaplains (2) aspiring bereavement therapists, (3) anyone who wants to understand what might go through chaplains’ minds in the middle of interacting with you  and (4) anyone curious about what I sound like!

The Youtube link is as follows: https://www.youtube.com/watch?v=D8VsIb1rKcA

 

 

The Holding Cell

If you want to make  hospice workers wince, just tell them about an unresponsive patient with no discernible quality of life alive only on account of feeding tubes and the like. And not only that, some family members insist on this even with no anticipated increase and possibly even a decrease in the patient’s quality of life. As one of my clients who did not request this for his own dying loved one said, “There is a difference between living and between merely existing.” However, the common wisdom is that the motive for family members who do beg to differ and wish to “do everything possible” to maintain their loved one’s life, stems from their own fears of death. Or that by pulling the plug they are sinning or at the very least will feel guilty about giving up.

I think a different fear drives some families to keep their loved ones nominally alive. It is the fear of launching probably the hardest task one can undertake: grieving. Let us suppose for the moment that we are looking at a case where avoiding grief is the primary reason the ventilator and whatnot are plugging away with no end in sight. As awful as that is, it is a way to psychologically stall time. It sticks the patient in the twilight zone between living and being dead. He is being put on hold if I may say. But the family too is in suspended animation, no longer relating to their loved one in the usual understanding of “relating.” Yet, neither can they go full swing into grieving because the patient is not dead. No funeral can take place to do its job of acknowledging the end of a life and of lending public support to the family’s grief. No friends can affirm how sad it is and be there to offer condolences and ongoing offers of help. Whatever grieving does leak through “in advance” is lonely and unarticulated and unsupported.

Fear is so powerful that it can cause cruelty and unethical behavior. A supervisor’s fear of being outperformed by a subordinate can result in that subordinate’s dismissal. Fear of grieving can result in keeping someone alive even when there is a “negative” quality of life due to pain. Let us release them and us from our holding cells. Let us a face the repercussions on our own souls and our own reduced quality of life if we let fear rule over us. Muster enough strength to let our loved ones rest in peace.

The Very Odd Couple

One circumstance even more intimidating for me as a chaplain than offering pastoral care to other clergy is to do so for Holocaust survivors and their family members. I imagine it must be daunting for Jewish burial society volunteers as well. The “prime directive” for chaplains is to say little and listen a lot, but in the presence of Holocaust survivors I have to make sure I do not take refuge behind that rule rather than use it for spiritual healing.

“Spiritual healing?” Are we kidding ourselves? Surely it is presumptuous of us to think we can offer that to people who have faced absolute evil.  I feel absurd talking with them about such things as God and the sources of evil unless of course they are the ones who bring it up. Who am I, so unschooled in evil with my petty experiences of sorrow? I remember a phone call I had with a deceased Holocaust survivor’s sister who I will call Madge. The subject had surfaced somehow in reference to her brother about how Kabbalah (Jewish mysticism) accounts for the existence of evil. The gist of the explanation is that when elements of existence are out of balance, then what is normally wholesome gets distorted into evil. When Madge dismissed that as “rubbish,” I certainly was not going to argue the point or even explore it to gain a deeper understanding of why she felt that way. Just as trying to make sense of the Holocaust is absurd, it felt ludicrous to bring in any theology surrounding it. She was expressing anger, and my job was to accept and affirm her emotion, nothing else.

What also gives our efforts to comfort Holocaust survivors a false note is what their very existence implies: they suffered, and we have had it so easy (“Survivor guilt” is the term for this feeling, as when a child dies but the parent lives on in perfect health). We may have felt that God is present in our own privileged lives, which may feel like nothing more than a conceit on our part given God’s lack of presence with Madge let alone with her brother.

We cannot offer comfort in the midst of our own discomfort. We cannot give answers to unanswerable questions. But the paradox that can lead to spiritual healing is to acknowledge the lack of it in people like Madge. We help by not helping, as a Kabbalist might say. When we make no pretense of offering answers to their laments, when we do nothing more than hear their distress and not attempt to ease it, the very act of making ourselves vulnerable and entering their overburdened world is precisely what renders it more bearable to them.

–Reprinted from my guest post entitled “The Very Odd Couple.” This appeared in the blog “Expired and Inspired” (hosted by the Jewish burial society Kavod V’Nichum) in the online Los Angeles Jewish Journal December 17th, 2014

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Additional note: It is especially fitting to post an article at this time related to the Holocaust; January 27th, was the 70th anniversary of the liberation of the concentration camp Auschwitz.

A Spiritual Olympics

I think the majority of people engage in or at least admire physical challenges, such as how many pushups they can do or how many days they can fast. Even I, normally completely apathetic towards sports, am drawn to the prowess of the participants in the Olympics because of the beauty of their performance and the ardor that brought them to that pinnacle. In my last post, I spoke to a minority: aspiring chaplains and others who are drawn to other sorts of challenges: emotional and spiritual ones. We peculiar people admire the strength of listeners who can calmly yet attentively hear a sufferer speak at length about the nature of their suffering. We admire the dexterity of healthcare colleagues who can intuit when and how to put in a word or two to let such sufferers know that they are understood and not alone and not crazy to feel as they do.

In my last post, I described what it is like for aspiring chaplains to get their training in a program called Clinical Pastoral Education (called “CPE” for those in the know). In a very timely manner, author and doula Amy Wright Glenn recently sent me an excerpt from her book which describes her own experience as a CPE student and why she took up that challenge:

“We were an eclectic bunch. Presbyterians, Baptists, Catholics, evangelical Korean Protestants, and rabbis joined me for this journey. I was the only UU. Most of my fellow students were completing their CPE unit as a requirement for their future in church ministry. My goals were more personal. I wanted to experience the bookend of doula work. Knowing how powerful it had been to hold the hands of the birthing, I knew that much wisdom was to be gained from standing at the other end of life’s threshold. One learns much about life by witnessing death.

Every Wednesday night, we gathered for a five-hour training session… Together, our group considered the following questions: What does it mean to enter a patient’s room and be a compassionate witness to his or her pain? What does it mean to embody an open heart in the presence of great and unimaginable loss? What does it mean to die?

We spent many hours discussing the stages of grief and the process of dying, which provided ample material for sleepless nights’ reflections. For nine months, we tried to befriend, or at least acknowledge, the fear that is death’s companion. Author and teacher David Deida writes, ‘Almost everything you do, you do because you are afraid to die. And yet dying is exactly what you are doing, from the moment you are born.’ I had encountered this sentiment before during my time in India. According to the philosophy of Advaita Vedanta, all fear is rooted in abhinivesh, the fear of death. For example, we fear shame because it is a death to the ego. We fear aging because it is a death to our youth. In Buddhist teaching, all moments are born and die into each other. Leaving the womb is a death of one state of existence and a birth into another realm. Childhood dies into puberty and the elderly have experienced the death of their young adult years…

We were each assigned a direct supervisor. The stars aligned and I considered myself lucky to be assigned to the only Quaker in the mix. I received extensive feedback and superb supervision. Weekly reports detailing encounters with patients were read aloud and processed as a group… Sometimes the feedback challenged my ego’s pride. Sometimes the feedback opened the door of my heart, facilitating a deeper experience of compassion.

In many ways, our training was uncannily similar to group therapy. Until chaplains deal with their own grief, life traumas, and individual fears around death, they won’t be able to clearly respond to the difficulties that hospital patients encounter. The danger is that we will project our personal issues and dramas onto those we are called to serve. For example, we risk walking into a hospital room and seeing our own ailing grandmother or grandfather rather than the person actually lying in the bed. Processing our own fears is a tonic that enables us to be of service. We can hold an open heart for others only to the extent that we are able to do so for ourselves.” [Excerpt from Amy’s book, Birth, Breath, and Death: Meditations on Motherhood, Chaplaincy, and Life as a Doula (reissued 2014), available on Amazon. A regular contributor to PhillyVoice, she also has a stunning website that includes insights about birthing and chaplaincy, and even an advice column. www.birthbreathanddeath.com ]

Amy Wright Glenn

Amy Wright Glenn

We hereby invite all aspiring chaplains to go for the gold!

Dear CPE Students: Leave Your Assumptions at the Door

Someone about to start her first Clinical Pastoral Education unit (CPE; a chaplain training program) emailed me some provocative questions recently: “What would you have said to your younger self when she started this course to train healthcare chaplains? What would it have benefited her to know sooner? What needs to be in place in one’s life besides a close walk with God, and a burning desire to help the hurting and the sick in their darkest hour with the ministry of presence?”

Another such student wrote me, “What can I expect from CPE? I feel insecure about not having much ministry experience and feel like my theological and biblical background is not as strong or deep as most people’s.”

I told both of them that CPE is full of paradoxes. First, what is more important than the factual content of their questions is what the questions reveal about the students themselves. Thus when we think we are communicating one thing, we are implying another, often deeper one. CPE instructors (called “supervisors”) might zero in for instance on the first student’s concern about what “needs to be in place in one’s life.” She might in turn ask the student, “How important is it for you to feel that things are ‘in place’ for you?” As for the second student, she might focus on his word “insecure” and ask why not having much experience would make him feel that way. (It is not a given that all people who do not have much ministerial experience would feel the same. They might be excited by starting fresh for instance.)

Now such reactions from a supervisor would not imply a judgment of any kind, but rather a way to get their students to become more self-aware. This is the name of the game of the educational philosophy of CPE. The more we are aware of our assumptions and feelings, the better we can serve our patients. The less we are self-aware, the bigger the blinders are that will interfere with our understanding what a patient needs. Suppose for example you grew up with a lot of criticism from one of your parents. So when a patient says something about you such as how your hat looks, you might erroneously interpret that as a criticism, even when it is not. Such a misunderstanding would naturally throw off the conversation and perhaps make you act as you did when your parent criticized you, such as by emotionally hiding. (Dear readers who are CPE supervisors: Yes, I am aware that my examples are not random and are letting you in on my own issues.)

Another paradox I am fond of pointing out is a Zen-like adage: chaplains help patients the most when they are not helping. Part of what this means is that one of the prime rules of good chaplain care is NOT to give advice or try to “fix” a patient’s problem. Nope, not even when they ask for it! Often the very best thing to do, which requires restraint and no wish to say something clever, is to listen as undistractedly as possible until the patient is clearly finished venting. Chaplains are not there to give answers, but to pose questions. We are there to give the patient a safe sacred and nonjudgmental space for them to talk about whatever they need to talk about, from golf to God, from divas to death. The emptier we are of our own agendas, including assumptions about what we ourselves think patients should be discussing, the more they will convey what they most need for us to hear. And if I may tuck in one last paradox, our goal is to do all that exhausting intense listening and be what supervisors refer to as a “non-anxious presence.” To paraphrase that CPE mantra, you have to be connected with your patients yet maintain a distance from them at the same time.

If you are a CPE beginner, do not stress about how much knowledge you have or “what to say” in a given instance to a patient. Rather, you will get “points” for how much you are willing to be vulnerable, thus narrowing the divide between the well and the sick.

On Not Being Afraid to Death of Death

A columnist with the Hudson Reporter interviewed me for an hour in December 2014 and captured the complexity of what hospice chaplains do, and why people are chary of reading about this subject. An excerpt of the interview follows:

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Most people shy away from the subject of death. Not Karen Kaplan. She made a career out of it, serving for seven years as a hospice chaplain, tending to the spiritual and emotional needs of people as they approached the end.

“A lot of people look at my book and say, ‘No, I’m not going there,’” said Kaplan. “Most people are very uncomfortable talking about death or afraid to see a person close to death. It makes you confront your own mortality. But we have to be aware our lives are finite. What’s the legacy you want to leave? There are many healthy questions to ask to make our lives more meaningful and stronger, for people to overcome their fear and enrich their lives instead of shrinking away.”

That was the impetus for writing the book. Then she had to find a way to make it approachable. “I try to write in a strangely humorous way, handling a forbidding subject in a gentle manner,” she said. “It usually revolves around some kind of story.”

For example there’s the 28-year-old ex-policeman with ALS who craved a beer. Although she couldn’t grant that wish, Chaplain Kaplan, as she was known, instead sang songs to him about beer, which brought a smile to his face. “One time he talked about getting a tattoo that would show his police ID,” Kaplan recalled. “Like he wanted to have an obituary on his arm.”

Another patient had parents who were going through a divorce and each visited separately. “There was a journal where they would each make an entry like, ‘I was here, this was what we talked about,’” said Kaplan. “Each parent would read what the other wrote. That’s why the job is so complicated. All the dynamics, the tension between people. All the complexities of life stirred together with this added layer of impending crisis. You have to be sensitive to all the dynamics, what people need, and when and why. That’s what’s intriguing. It’s not just about saying a prayer.”

The circuitous route to hospice

Sometimes, though, a prayer was called for. And when it was, Chaplain Kaplan was up to the task. Prior to becoming a hospice worker she was ordained as a rabbi and served congregations in New York and New Jersey. In fact, it was while serving as a rabbi that she discovered her affinity for hospice work and decided to make the career move.

“I found I was most helpful one-on-one, when they were in some kind of crisis or another,” she said. “Losing a job or bereaving a family member or having to be in a hospital. I was really there with them and felt very comfortable and effective.” Part of that she attributes to her own difficult childhood, with a challenging family dynamic. “Just surviving was kind of the goal at that point,” she said. “That’s partly what shaped my identity. I had so little nourishment of my own, which made me sensitive to the needs of others.”

As a young teenager Kaplan wrote stories and poems before putting aside the writing to concentrate on a career. Graduating from the University of Texas at Austin in 1984 with a PhD in linguistics, she first taught Spanish at Denison University before joining the ESL staff at Hudson County Community College in Union City about 15 years ago. Then came her rabbinical study, including a year in Jerusalem, and eventually hospice care.

Sharing secrets

Kaplan trained for a year in Clinical Pastoral Education to become certified as a health care chaplain. “There’s not only the practice, there’s theory,” she said. “We would meet with supervisors and other chaplain interns to discuss our role and what the climate is like and how to listen and keep our own personal baggage out of the way. We’re not supposed to preach. It’s all about learning how to listen in a nonjudgmental, open-ended manner and really be where the patient is.”

Encountering people on the brink of death wasn’t new to her, however. “I had visited plenty of people in the hospital and been around plenty of death and funerals,” she said. “Even back in my student rabbi days I felt very comfortable and not afraid with people close to the end. I was providing a calming presence. The difference was working with a whole interdisciplinary team.” That included nurses, therapists, social workers, and more, all tending to the needs of the dying.

Kaplan still remembers her first patient after taking a job with United Hospice of Rockland. He was completely nonresponsive. “A fair number of people are like that, sleeping or possibly in a coma or they don’t have the energy to talk,” she said. So how does one provide comfort to a patient when there’s zero response? “I try to get a sense of any energy or if they sense my presence,” she said. “I try singing. Maybe I’ll just stay and hold their hand. I try to find something they may find meaningful.”

The job requires a unique skill set, which Kaplan equates to a detective searching for clues. “You learn to observe and appreciate subtle things like someone opening an eye,” she said. “That means they were interested enough to look at me. They wanted to invest the energy to open their eye as opposed to just ignoring and keeping their eyes closed.”

More often, though, patients welcomed the personal interaction.

“It is part of the appeal of feeling that I’m doing something so meaningful for people, providing that sacred open space for them to bring up the most personal types of things, sharing so much of their personal life,” she said. “They’re telling me the most intimate things they may not even share with their own families.”

It can be an unburdening for the patient, a way of winding down, of letting go. “I might be one of the last people they’re going to see before they pass on,” said Kaplan.

Serving in another way

After seven years as a hospice chaplain, Kaplan decided it was time to take a break. “It’s draining,” she said, noting that the average length of time a chaplain remains in the profession is eight years…She began writing again. And what better subject than hospice care? For her first book she chose to craft “a safe, open place for people to explore these important issues on their own terms. I’m just serving in another way.”

Art Schwartz did this interview. This reporter can be reached at arts@hudsonreporter.com

The preceding interview is reposted courtesy the Union City Reporter. For the full story in this regional weekly, see http://hudsonreporter.com/view/full_story/26232227/article-Last-words-UC-teacher-s-book-details-her-experiences-caring-for-the-dying-?instance=latest_story

 

 

 

The Wish for On-Demand Revelations

The worse the situation, the more we yearn for a script to explain it all, and for the victim to find redemptive value in their ordeal. Dying or narrowly missing that status ranks right up there at the top for such a demand, and Los Angeles Journal columnist Meghan Daum writes that people want the poor suffering soul to be the star of the show. She should know, because she herself almost died from a disease and recovered virtually completely. The title of her article very clearly shows that she rejected such stardom: “I Nearly Died. So What?” (LA Times, November 14, 2014) She hated how a friend asked her if “surviving such a close call had made me think differently about life.” She scoffed at how people expect a spiritual or moral overhaul from such an experience. Just like me, Daum hates platitudes like  nearly dying “puts things into perspective.” I’m with her. After all, the teaser for my own book says it is “unencumbered by religious agendas and pat answers.” (I actually had the gall to Tweet to her that we are thus kindred spirits.)

The columnist not only raises the question of why people react this way to people who might die or who surely will soon, but she also posits a motivation for such behavior: People above all want to find closure, to feel that the senselessness of disease does in the end make sense on some level. That is, we get to have the consolation prize of a spiritual revelation on account of dying soon or coming close to it, as part of our grand finale. Bottom line: The loved ones who are emerging unscathed (this time) want to comfort themselves by saying, there is a silver lining in there somewhere or other…Um isn’t there?” Daum does not buy it. She reminds us that crisis can “bring out the worst in people as well as the best.” I for one cannot deny that. I have experienced that firsthand as I imagine many of you have.

I agree with Daum that we might burden patients with demands that have far more to do with our own agendas and our own anxieties. I agree that fears about ourselves getting sick or not surviving getting sick can drive us to push ourselves away from reality via scripted explanations such as “God does not give us anything more than we can handle.” (Argh!)

But perhaps she and certainly I should look at such reactions with more forbearance. When death crouches by a loved one, nothing can make us feel more helpless and out of control. From sophisticated theology to folk theology such as the platitudes above, we are grasping at anything that can give us a sense of control. Wanting closure is our way of doing the impossible: of containing chaos within the confines of an orderly story that we tell ourselves.

You might protest that this does not address the burdens we are leaving at the feet of the patient. They do not deserve to have our anxieties displaced onto them. The fact is, Daum’s article and anything I or anyone else happens to say about this is not going to alter how we act in the future. As Daum herself said, she acted the same fool way when her mother was dying, hoping that her mother would bestow some special wisdom presumably available to her only at the end of life.

So what can be done? I think the answer lies in why else we seek revelation besides gaining control and controlling anxiety: we think that when people are close to death, they and thus the bystanders are getting an advance glimpse of what it is all about. (Some people have faulted me for misleading them into believing they would get such answers due to the subtitle of my book, i.e, What People Told Me Before They Died.) Thus we yearn for clues and wistfully hope to penetrate the ultimate mystery. I hope that when I am in dire straits and people ask me about my perspective on life, that I will see myself as their joint searcher as to what it was all about for me and for them. I hope that I will gracefully take on my role as the tenured partner in this search for meaning.