The Finals Week Results Are In. Everyone Passed!

To celebrate finals week, my last post consisted of a real dialogue between a chaplain and her patient. I gave all of my readers a test to see if they could identify problems with how the chaplain did her job. I am reproducing the dialogue here for everyone’s convenience followed by my evaluation of the answers that over a dozen people gave. Smart but tough crowd! To see their original comments, please see my previous post. Here is the dialogue:

Chaplain: interaction #1   (The patient seemed alert and was sitting up in bed reading a book. The chaplain knocked on the door.)

Patient: interaction #1     Yes, come in.

C2     Mrs. Jones, I’m So and So, the chaplain-on-call.   I understand that you wanted to visit with a chaplain.

P2     (She smiled.)  I like the way you said that…”to visit with a chaplain.” Our minister said that there would be chaplains available to talk to if I wanted to.  (She winced some. I sensed that she might be in some pain.  I waited a moment and then responded).

C3     Indeed, I am here to visit with you, Mrs. Jones.  Am I picking up that you are in some pain right now?

P3    (Smiling but still wincing some.)  You observed accurately, Chaplain. I am having some pain.  Not a lot but some.  By the way, it’s Mary. (A slight pause).  I hate being in the hospital. The nurses are very sweet, and I have a very competent oncologist.  But being here is such a waste of time.

C4    Mary, you sound like a busy person.  It’s no fun just to lie here, especially in some pain, when you could be doing…what?

P4     I’m a manager of a large real estate company…Oh (she winces again).

C5     Mary, are you sure you feel like visiting now?  I could come back another time, say, in the morning.

P5      Chaplain, you don’t need to stay.  I know there’re probably some here worse off than me.

C6     Mary, if you want me to stay, I will.  You’re important, and you did have the nurse page me.

P6     (Smiles slightly).  Thanks, Chaplain.  I would like to talk…I really don’t want to talk about it…But (winces slightly…pauses.)…I know I need to…My family physician came by while my daughter was here earlier… [She then tells her concerns in the rest of this transcript]

My steller class picked up on three issues. The first was about the patient’s physical pain. Nancy makes the pun that the chaplain “wasted time” by discussing pain. Not only once, but three times she refers to it. Cathy acknowledges that the chaplain can ask about pain, but that she should then ask the patient what the patient herself wanted to discuss. Cathy by the way also picked up on the patient’s hesitation to ask for help, manifested by her saying to the chaplain that she probably has other patients to visit who are “worse off.” This hesitation was made worse by the chaplain’s ambiguous signals about her availability.

Vicki correctly explains that to be fair, pain must be addressed. The whole hospice team is supposed to address the issue of pain during a visit, and to report it to the nurse right away if necessary and if the patient gives permission to do so. But then, anyone visiting is free to address other issues. Peg says the chaplain shows discomfort through all this talk about pain and wants to run away from it. Now that’s an astute answer. Perhaps the chaplain was focusing on physical pain to avoid dealing with emotional and spiritual pain! DJ speaks to that as well.

Another issue was how the chaplain responded to Mary’s assertion that being in the hospital was a “waste of time.” Many of you said the chaplain should not have tried to guess what the patient meant by that. Let the patient do the explaining. You get an “A” for that extremely important point. As Gydle said, maybe the patient wanted to talk about nearing the end of her life and could think of far better ways to spend her time. Sande thinks the chaplain’s guess as to what wasting time meant was a lot more about the chaplain’s own issues than the patient’s. Right you are! Jessica said never to assume what the patient needs. Instead, ask an open-ended question. Jane got that right too. As for Elizabeth, she is being very very generous to us chaplains.

The biggest issue in my opinion is the mixed signals the chaplain gave about wanting to be there. Strangely enough, she is basically asking the patient if she is sure she wants the chaplain there. This wrong signal definitely came across because the patient takes it as a hint that the chaplain rather be elsewhere. I give Leah kudos for the following perceptive answer: “Maybe the chaplain was looking for assurance that Mary wanted her there.” Talk about having it backwards! Chaplains should be reassuring patients, not the reverse. Thus the chaplain was showing her own discomfort, which almost got in the way of a successful visit when she gave the chaplain a way to get off the hook basically by saying to her: “Chaplain, you must have more pressing cases than I to take care of.” The good news is that despite all of these problems, the patient went on at length about what she needed to say. (I did not show this part of the dialogue.) One lesson here is when we badly need to vent, we will take any listener, no matter how flawed, as long as some compassion is present (and maybe not even much of that quality).

My thanks to all for participating. We’ll have to do it again sometime. 🙂

Celebrate Finals Week: Take This Test

When chaplains write down conversations they have with patients to share with other professionals, the dialogue may reveal a heap more about themselves than about their stellar patient care. We like to think we are showing off our expertise and resultant comfort, but as any chaplain in training knows, our own issues can subconsciously leak out, especially when we show the transcript for other chaplains eager to hunt for our rooms for improvement. That is why we write these verbatims: to find out what gets in the way of better care and work to get it out of the way in the future.

I took a portion of the following verbatim from an article in the chaplain literature. Since the article did not allude to what I saw as a problem, partly out of curiosity, and partly as a challenge, I now invite my readers to look through the transcript and identify the issue, or the principal issue. So if you can stand the suspense, read through it, comment if you can, and you will hear my answer in my next post. I will also wait until then to respond to comments, so everyone has a chance to take this “test.” Good luck! Whoever gives a great answer will get honorable mention.

Chaplain: interaction #1   (The hospital patient seemed alert and was sitting up in bed reading a book. The chaplain knocked on the door.)

Patient: interaction #1     Yes, come in.

C2     Mrs. Jones, I’m So and So, the chaplain-on-call.   I understand that you wanted to visit with a chaplain.

P2     (She smiled.)  I like the way you said that…”to visit with a chaplain.” Our minister said that there would be chaplains available to talk to if I wanted to.  (She winced some. I sensed that she might be in some pain.  I waited a moment and then responded).

C2     Indeed, I am here to visit with you, Mrs. Jones.  Am I picking up that you are in some pain right now?

P3    (Smiling but still wincing some.)  You observed accurately, Chaplain. I am having some pain.  Not a lot but some.  By the way, it’s Mary. (A slight pause).  I hate being in the hospital. The nurses are very sweet, and I have a very competent oncologist.  But being here is such a waste of time.

C3    Mary, you sound like a busy person.  It’s no fun just to lie here, especially in some pain, when you could be doing…what?

P4     I’m a manager of a large real estate company…Oh (she winces again).

C4     Mary, are you sure you feel like visiting now?  I could come back another time, say, in the morning.

P5      Chaplain, you don’t need to stay.  I know there’re probably some here worse off than me.

C5     Mary, if you want me to stay, I will.  You’re important, and you did have the nurse page me.

P6     (Smiles slightly).  Thanks, Chaplain.  I would like to talk…I really don’t want to talk about it…But (winces slightly…pauses.)…I know I need to…My family physician came by while my daughter was here earlier… [She then tells her concerns in the rest of this transcript]

 

Write your answer here, under “Comments.” I will give a passing grade to all who try, and an “A” and special mention for the best answer!

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:

——————————————

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

 

 

 

A Student Prank

Usually my stories are true, but one time as a gag I wrote a fictitious dialog, putting one over my chaplain school supervisor and the other chaplain interns. I dated the dialog April 1st, but nevertheless they were fooled. The heart of the program at the school (called Clinical Pastoral Education) was for students to write word for word as accurately as they could remember, some of their visits to patients. Afterwards with our supervisor, we would analyze the dialogues and look for ways we could serve patients better in the future. As the true dialogs I wrote are too full of embarrassing flaws from me as a rookie chaplain, I now share this invented story to amuse you and to give you a taste of what it was like to be a chaplain intern.

                               The Dialogue

(Context of visit) I was on my regular rounds at Cornell University Medical Center when I visited Norman. The patient was seated on his bed, with a bandage near his elbow. As I enter, he is reading A Farewell to Arms. I notice a fixed look in his eyes. One of the social workers had told me that Norman is a “strange bird.”

Karen: Good morning. I’m Chaplain Kaplan.

Norman: Oh, are you and Charlie Chaplin related? Then you’d be Chaplain Chaplin. (K: I laugh. that SW had something there.) You won’t believe why I’m in here. It’s kinda ridiculous really.

Karen: No, no, not at all. Tell me your story.

Norman: You’ll think I’m pulling your leg. It’s not important enough for being in a serious hospital.

Karen: Not important enough?

Norman: I’m here because a cat helped itself to a portion of my arm for lunch. (K: I grimace  and say, ooh, ouch!) Now see that?  Here I am now having to comfort the chaplain.

Karen: (Oops. What went wrong here? I was trying to reflect back his feelings and show some empathy.) Oh, it’s not that. I…

Norman: Well, I’ll give you another chance. (K: How nice of this clown and out loud I say, “Oh, I see.) Anyway, this arm hurts like hell. And you know what? I’ve been a major patron of the Society to Prevent Cruelty to Animals for many a year. But after what that worthless scrawny tabby did to me, that’s it.

Karen: That’s it?

Norman: No more donations from Yours Truly to the SPCA. Not from this victim.

Karen: So you feel betrayed. Bit to the quick. Angry.

Norman: Sure! There should be a Society for the Prevention of Cruelty to Humans.

Karen: (Is this guy for real? I laugh. I join in the fantasy.) I wonder how many dogs and cats would join?

Norman: (Is this girl for real?) This has gotta be the most unusual conversation I’ve ever had.

Karen: (as he dozes off, I make my getaway.)

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In my next post, I will follow up with a theological analysis and an evaluation. No, no, just joking.