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

 

 

 

Meaning in a Half-opened Eye

When I interviewed for hospice chaplain jobs, a question I got just about every time was, “What do you do when you visit an unresponsive patient?” By that my prospective boss meant patients who would not respond to anything I did, like touch their hands, talk or sing. Usually they could not talk, or if they did, it was to themselves or to the world at large. During such visits I could feel invisible. If that is so, you might wonder why an interviewer would ask such a question. But rather than being a gratuitous curve ball, it strikes down deep at the essence of a chaplain’s role and to what it means to exist as a person.

While some patients truly could not respond because they were in a coma or were asleep, I often found many so-called unresponsive patients did respond if I loosened the definition of communication, or spent a long enough time to give the patient enough chance to respond. I remember one time when I introduced myself to a lanky man as I sat down in a metal chair by his bed. He did not reply, and after several seconds, I figured he had not heard me or did not understand me, so I drifted off into my own thoughts and guessed this would be a very short visit.  Luckily I lingered in my own reverie. I say luckily because after a full 30 seconds at least, he had processed what I had said, and gave an answer that a normal person would give after just a second or two max. I said something else, waited another 30 seconds as if that were the normal way to talk, and again he gave an appropriate answer. I thought to myself, “I bet most visitors casually stopping by would give up before they found out he could converse.  I wonder how long he went without having a chance to talk.”

The key task of a chaplain is to find a way to reach people. This means slowing down enough to see details that the average visitor would miss. Like an eye half opening or a finger moving in response to my voice. Like more rapid or more relaxed breathing when I hold the patient’s hand, or their turning their head towards or away from me when I sing, indicating their yay or nay to hearing it. (Believe me, there were plenty of “nays” to the music option.) It is not I who is invisible with these patients. It is the patients who are invisible to those who too automatically designate them as “unresponsive.” The patients’ essence as persons, I believe, is their ability to reach back in return, to connect with others.

Interviews are not the ideal environment for nuances, so my answer to what I did with unresponsive patients ran along the true but more superficial lines of, “Well if I knew they were religious, I would say a prayer. Otherwise I would touch their hands, sing a calming song, or say something friendly and soothing. Sometimes I would just sit by their side, in case they could sense the presence of another human being who cared enough to notice them.” Perhaps my interviewers liked this answer (at least the ones who hired me did) because they thought that kind of patient gave nothing for the chaplain to do. On the contrary, finding the key that will breach what separates them from me takes the observational skills of a Holmes and the deliberateness of an artwork restorer.