Magical, Oh So Clinical

On the job, I feel like the person described in Supertramp’s 1979 hit called “Logical Song.”  The song describes a happy existence that is later in life replaced with an impersonal emotionless one. The difference on my job is that both halves of the excerpt quoted below are true simultaneously, every day. Part of me is the chaplain who with no agenda engages in dialogue with patients, reacting on the fly to whatever they wish to share. I am there sometimes facing the most intense emotions and sometimes I am there to savor life with them or just sit with whatever mundane moment is in progress. But then a separate part of me goes to my office to document the visits. Documenting involves a very strict set of rules and I have to write out a description of the visit in a detached tone. There are countless lists of things to put check marks by, and there are some words I must use no matter what the visit was like, for example, “A trusting relationship is being established.”

The first lines of the “Logical Song” symbolically correspond to the actual visits:

“When I was young, it seemed that life was so wonderful,
A miracle, oh it was beautiful, magical.
And all the birds in the trees, well they’d be singing so happily,
Joyfully, playfully watching me.”

Even in hospice, sometimes patients look back to “wonderful” and “beautiful” memories, and ponder the miracle of existence. They communicate this to me and I feel the poignancy of it and am in awe that they are letting me in on this ultra-personal dimension of their being.

The next lines correspond to the completely structured paperwork I must do:

“But then they sent me away to teach me how to be sensible,
Logical, responsible, practical.
And they showed me a world where I could be so dependable,
Clinical, intellectual, cynical.”

The song actually says “clinical!”  Yep, that is a part of who I am. When I forget to put in a certain detail or do not do it on time, my supervisor may say, “You are out of compliance.” Ouch! (She does like and appreciate me, though, it’s not that she doesn’t.)

On one level, this may seem to be too painful a conflict. I have seen budding chaplains who found they could not reconcile these disparate identities, and ended up leaving their jobs, or doing one part well and the other not well at all. On another level, I try to see the paperwork as two things: superficially, it can be a nice neutral break from the intense emotions and deep thoughts I must respond to: Good! I can do something mindless for a little while. Beyond that, I think of it as the tax I must pay for the privilege of being present with people who are giving of their most intimate selves, who are revealing to me their innermost beliefs as they risk getting nothing back in return.

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!