When a Patient Just Says No

Chaplains, like anyone in the helping professions, can do more harm than good on a given occasion. Oftentimes a patient will let me know I “flunked” by not inviting me back for subsequent visits. This could be a matter of “bad chemistry” or my inadvertently making an infelicitous statement.

I vividly remember one such “thanks but no thanks” visit where my intense curiosity probably was the culprit. Sally lived in a mobile home. Not having been in one before, I was all eyes when I drove into the mobile home community. At least in that particular block, the home owners were very creative. All sorts of handmade and otherwise quirky decorations marked the outside of the homes there. Once I got into Sally’s home, I looked all around at the layout and at various pictures on the walls. I suppose I also asked some intrusive questions. Thus, curiosity got the better of me over focusing exclusively on the patient and on what she wanted to talk about. I did focus on that to be sure, but not exclusively. I was too distracted by the venue. Of course that might not have been the reason. For one thing, she had to talk in a whisper, and due to my auditory processing disorder (I hear, but my brain processes speech sounds slowly or partially), the noise of a machine she had to use for breathing competed for my attention as well. Unlike the visual stimuli, this aural competition was involuntary.

At any rate, the other chaplain working at the same hospice emphatically gave me Sally’s message the following day that from now on she wished to see only that other chaplain. I felt embarrassed about how my curiosity got the better of me. And I felt conflicted about balancing burdening a patient with an explanation of my disability, versus the inexplicable confusion she might have felt about why I had trouble listening to her.

As much as I felt ill-at-ease for disturbing the patient in some way (many ways?), I knew it was not a question of rejection, which is how many of my colleagues construe such experiences. There is in this a sorrowful irony in feeling dismissed by those who are themselves so vulnerable and hurting. It is as if such colleagues are saying to themselves, “Gee, even the neediest don’t find I make the grade.”

But sometimes saying no might not be a matter of flubbing up the visit at all. It can be a way for patients to express anger at their disease at whichever chaplain happens to cross their path that day, or even as a way to exercise the power of sending someone on their way. Anyone in the helping profession who takes a request to stop providing services has to ask themselves what the deeper personal issue is that makes them frame such a request as a rejection in the first place. As with the rest of humankind, chaplains and allied colleagues have their limitations, some of which can be modified such as overt curiosity, and some of which cannot, like the lack of ability to hear speech in the face of competing sounds. I suggest we reframe working with our limitations as a learning opportunity and as a reminder to be humble in the face of a fellow human’s turmoil. A “no” is just a “no.”



Encountering the Edge is now available on Kindle on Amazon.com 

A reporter from The Observer, a regional newspaper, interviewed me about hospice care and some anecdotes from the book. You can see what I look like nowadays plus the story here: http://www.theobserver.com/?s=%22karen+b.+kaplan%22&x=13&y=10

And thanks to the exemplary citizens of the women’s Queen Adelaide Club in Australia for the impromptu book signing!

11 thoughts on “When a Patient Just Says No

  1. Liz Adams says:

    This is a great reminder that we don’t need to take this kind of decision personally, other than by considering whether we had any part in it at all. And it can be that accepting the patient’s decision is a gracious way of allowing that much power to her to make even a negative decision.


    • Patients are powerless in almost every way, including who needs to see them such as a doctor, friends and family. And not only is the chaplain the rare exception of who a patient can decide to see or not, refusing a chaplain may symbolically be their only self-granted opportunity to reject or express anger towards God.


  2. Once again, your thoughtful and honest reflections are appreciated, Karen.


    • Thanks. And now a thought reflection question for you to take on for both of us, guessing that you have had the same reaction: many have thanked me for honesty in my posts and in my book, but not only that, have referred to it as “brave.” Is there some risk I (we?) am taking that I have been unaware of? 🙂


  3. When all is said and done, everyone is just human, with natural curiosity and their own burdens to deal with. Don’t beat yourself up over it… and don’t forget that it is the same compassion that you feel for this lady, and the fact that you fear that you might have offended her, that makes you good at your job (and which is often a compensation for APD in many people).


    • Many thanks Alyson for spelling out your frank reaction. Interesting that you thought my tone indicated that I was beating myself up.You should have seen my ironic smile behind the pen (ha ha). Part of my intent was to remind colleagues that such “lapses” are often much more about the client than about them, and as you pointed out, the mere fact that we do feel such chagrin indicates that we are terrific chaplains, counselors, etc.

      To my readers: Alyson runs an equally terrific group for adults with APD called oldapds@yahoo.com


  4. Great post Karen! I’ve seen this happen with volunteers over the years and sometimes, it’s just that patients prefer or gravitate towards a certain personality. I tell the volunteers up front that they will not make a deep connection with everyone, but not to despair, because another volunteer with a different “style” will make the connection.


    • That’s one way to remind them to keep their ego out of it. There is so very much that can be going on, especially with persons in crisis, that has absolutely nothing to do with the volunteer, chaplain, etc. HOWEVER, if a few clients in a row don’t like our “style,” some self-examination, preferably with the input of an insightful person, is warranted.


  5. Hi Karen, Great post, loved the honesty and the introspection that’s involved when one has been rejected. As you might imagine, we all go through such experiences. How many of us actually examine them from both angles? I would venture to say not many. Thank you for given me a different perspective to work from.



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