Spelling out The “Prime Directive” of Spiritual Care

If I had to inform Captain Picard or Captain Janeway of the “Prime Directive” of being a chaplain, I would say, “Communicating with the patient by any means, and therefore connecting with them, provided they wish to do so.” The part of this bland statement that makes it not so bland is, “by any means.” If a person can’t hear well, I might write notes to them when the conversation comes round to my turn. Unlike most visits, I can leave those with a telltale trail of my side of the conversation. Yes, it is cumbersome, but: remember the Prime Directive! Kidding aside, if the patient is game for a slow-motion interaction, then so am I.

One of the more unusual lengths I had gone to with a patient I had known for a long time was to use the alphabet to spell out words, one letter at a time. Maxine (invented name) was able to speak for many months. But eventually she no longer could, although she was entirely “with it” and had unerringly nimble reasoning powers. She was just as unerringly a devout Christian and found my Jewish orientation a stimulating challenge. She once told me the imaginative but chilling idea that she hoped she would die during the High Holy Days so that I would remember her each time they rolled around (I often do.) She also designated that I should sing a psalm at her church for her funeral, giving her one last postmortem chance for me to come under her  benign influence. I must say I got a kick out of being introduced as a rabbi up there by the altar in front of all those “brothers and sisters in Christ” and singing a Jewish melody for, “May the Words of My Mouth and the Meditations of My Heart be Acceptable unto Thee.”

As I implied, once Maxine could no longer use her muscles to speak, she felt that an alternate means, even slower than writing notes, would be worthwhile. The way this worked was I would go through the alphabet to get the first letter of the first word she wanted to say. As I reached the correct letter, in one instance, “I,” she would nod her head. Then I started the alphabet again to get the second letter, or the first letter of the next word, which in that same instance happened luckily to be an “A.” Sometimes I could save a little time and guess a whole word, so in that same conversation, I or the home health aide hovering by, guessed “I am.”  The third word, it turned out, was “cold.” This turned out to be supremely important, for the aide then put some more layers of blankets on her before I could say let alone spell “blanket.”

I invite all my readers, chaplains or no, to discover the fruits of this Prime Directive for themselves. Have you ever communicated with someone by “unusual” means?


4 thoughts on “Spelling out The “Prime Directive” of Spiritual Care

  1. John Dieker says:

    Karen..beautiful post. A heart of compassion to care for the patient and not our own agenda, regardless the time or effort involved. Love was ministered. Wow. Powerful. Thank you


    • Whew! Now that I have recovered from your accolades, let me say that getting our own agendas out of the way is the hallmark of a professionally trained chaplain. It’s definitely not easy to do, especially since the intrusion of hidden agendas can happen subconsciously. -Karen


  2. Poignant story, Karen. Wise words with compassionate action. I admire that. I smile at you speaking in church. I sense they all learned something from “the Rabbi in the Room”! You show the true heart of chaplaincy–to go where no one has gone before. Ah, the torah, gospel, dharma, ethic of Star Trek. Great stuff!


    • Chris, you have captured my heart by extending the Star Trek metaphor. I think for everyone, when one person meets a new person, or communicates anew with someone they know, they too, have gone where no one has gone before.-Karen


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