In the morning

My most active clinical day is Monday, which is usually true given the structure of my weeks. I see more patients on Monday than other days and Friday follows. I don’t usually work weekends anymore.

I genuinely enjoy the ministry with patients. Always grounding, it reminds me of what my work is, why it is, and how it goes. There is preparation and surprise. I know some of what to expect, including the part of me that knows most of a conversation is, essentially, under the category of the unexpected.

I do not like this but it is true. In fact, most of me strongly dislikes the unexpected. The spontaneous and surprising. The things that you can only prepare for when cultivating a posture of relaxation and openness. If I can relax and breathe, if I can be open to what comes, I’m prepared. But that preparation feels different than memorizing or following procedures. You prepare differently when you know disruptions to plans naturally emerge.

Preparing for the unexpected, then, is not a procedural preparation. Earlier this year, I was in a training with medical providers and we were learning about difficult conversations. The training is built around treating those conversations as procedures. I found it both intriguing to learn for a week with physicians and nurse practitioners and also thought the approach confounding. I learned a lot about what can be done as a procedure and, perhaps, what cannot.

Surprises and their cousins don’t cooperate with plans and so preparing for encounters has to be generous, and this keeps me flexible in the work of spiritual care. When I saw a particular patient on Monday, we talked for a while. We were in the busiest part of the hospital and it was noisy. We spoke for a touch less than an hour, which surprised me, and a lot was heard and held. There were words and things.

I have told students are others that the universe is in an encounter, and that’s always true, in some form, when I sit with a patient in the hospital. I felt that when I was with this person. It reads as dramatic but I’m convinced that sitting with a person in a genuine encounter is absolutely sacred, that it connects those present with holiness. It’s all there. Even if we can’t appreciate it. It’s all present.

The next morning, my colleague saw the same patient who sent word back to me. This happens once a week or so. Our department is large and lots of chaplains can see patients who stay for days. This week, my patient’s message was, “joy comes in the morning.”

Immediately, I went over the encounter in my head, doing what I often do with students in verbatim seminars. I walked back through the main points and movements of conversation, reconnected with my emotions, listened again to the noises and shifts that helped me remember. I asked my colleague with my eyes what our patient could mean and she was stumped, even though both of us knew the biblical origin of the phrase.

It was funny, the exchange between us as we considered the phrase, pulled out and given. But I went to mental and spiritual work. I used the message in another message, in partial response to someone who texted me the next day, still working to place the phrase, to accept the message. I am still sitting with the gift.

And then, as it was and is still speaking to me, it occurred to me to, while in my particular searching to fit this gift and message, to hold the phrase. To do nothing with it. I’m trying.

I woke this morning, earlier than I planned, something I should plan since it happens half the week! You’d think I’d notice the pattern at some point. And as with all mornings like this, I heard how time occurs to me in the dark of pre-sun rays. The birds, as before, told me what time it was and how long it would be until I saw light.

I thought to my patient’s message, to the preacher’s message, to the psalmist’s message. The whole phrase, the part she relayed, the entire musical selection. I held and checked the impulse to do that interpretive work that seminarians are trained to do. I tried to wait and listen.

I tried to let the birds, in darkness, sing into me what the message could be.

Something You Said

When I left you, I thought to myself that patient rooms are the best classrooms.

Better than graduate seminars and intensives. Better than syllabi with supplemental reading lists so long they make your eyes hurt.

The simple wisdom coming from the lives of pained people is exquisite, expensive truth that I get for showing up as a chaplain. I didn’t have to pay tuition or get reimbursed for my travel. I didn’t have to buy a book or copy an article. I, simply, answered a page.

You told me something I’ve heard in different ways by other people. You said, my words not yours, that our conceptions of God are ours, that they are personal, and that they can be taken only so far. You used the image of the stars and suggested that we ought to be humble as humans because we “perhaps just stumbled upon the ability to think.”

You said that our ways of understanding God should be humbled by such things. And I’m considering the depth of your words. We ought to be humbled by such things.

Giving & Receiving Hugs

I approached her the way I would anyone in her situation. Softly. Gently. Quietly. My head was bowed. It was a form of what I’ve explained to my wife is my chaplain walk.

The woman was crying. It’s not all she was doing but crying sums it up. More broadly she was at the side of her dead father. I had already been with him. Now, I got to meet his daughter and stand with her to witness life once father is gone.

I came to her side. I asked her if I could touch her shoulder. I did so, recognizing the tender permission you give to a stranger you realize is only there for you. You may never see him again. You may never have to explain yourself. You may never have to re-live that moment. So you say yes with a shrug that can be interpreted as a grief heave, even though it’s the answer to his question.

My hand was on her and at some point, she turned to me. She asked me if I could hug her. My arms were already open. That opening was not planned, though it was intentional somewhere in my soul. My posture knew what it meant to be there, knew those tears. I knew something about that woman’s grief. And we both gave and received each other’s hugs.

Isolating Root Causes

I was reading materials in preparation for a class on safety and quality improvement. It’s a multiple months-long course with a lot of physicians and statistics. It’s not material I’m naturally good at. I have a part to play as a spiritual caregiver in what we’re planning. I am useful even if I’m not a nurse or respiratory tech or, certainly, not a doctor.

I’m learning interesting things. I’m hearing even more interesting things about our hospital and about hospital systems in general. I’m learning more than I thought I would when I joined the team to work on our project.

In the pre-course work for our session on analyzing data, the final sentence on the slide was this: Please create two to three visualizations in an effort to isolate root causes / key drivers. This was a sentence about measures and hypotheses and graphs and tools.

As I think of it now, this sentence can go in many directions. What would it look like if you prepared a visual to capture the things that were causing you trouble? What would the visual addressing those causes and drivers include?

My Blog: Trauma 3

When we were checking in with each other the Wednesday after Election Day, my supervisor described our having been through a trauma. Traumas take some getting used to. He said in swift Strening fashion, “It takes time to learn what can be trusted.”

Perfect. Accurate. Compelling. I thought at the time how grateful I was for his supervision, for his way of putting things, and for his open spirit that feels. He is as great a pastor as he is a supervisor. And there he was summing up a decisive collective experience. Trauma.

I’ve learned in CPE that traumas take many forms. They are often unexpected. They leave us feeling brutalized and sometimes tired, spent. Traumas require a response when we have little energy for it. Traumas pull the soul through thick, murky sludge, and no matter when we emerge, we’ll be different.

The look of it will be up on us. The smell of it distinct. Trauma can’t remain hidden. At least at first. Naming it for what it is helps.

Calling an election trauma matters. Distinguishing the singular event – that had all those earlier moments attached it – as trauma separates it and brings it to our collective consciousness for what it is.

As you recover, take the time you need. Visit the reality of what’s happened in our country. See the fractures and fears. Witness the same in you. Slow down to appreciate how hard life is for you and for us. It will take time to learn what can be trusted.

My Blog: Trauma 2

The quickest responders are the ones who count. That’s what I usually say to myself.

Those are the medical personnel. Together, the team is between 15-20 people: physicians and nurses and respiratory techs. Security and a chaplain and a hospital administrator. We rush within minutes from all quarters in the hospital.

The medical folks address the medical crisis. They attempt to stabilize the patient all while deciding if and where the patient will be moved to a different unit in the hospital.

That could mean transporting someone from the lobby to the Emergency Department. It could mean a patient, once stabilized, is taken from a medical floor to one of the intensive care units. In most cases, movement for the patient is presumed. Even if it takes time to accomplish.

Chaplains come with the primary focus on the family in order to support anyone present who may be with the patient and with a secondary concern for our care providers. Watching trauma unfold is its own participation in trauma.

Participating in trauma does things to people. It anchors you and disrupts you. Both happen. In a trauma, someone else’s and your own, the world that you knew flips.

Time changes. People move quickly and they don’t move quickly enough. The room is noisy and the floor cluttered with needle caps and clothes and ripped packages that once held tubes and lines and other medical implements.

It is an essentially upsetting, unsettling, and uprooting experience. Have you experienced something like this? Perhaps not a medical crisis but another version of trauma? What’s helped?

My Blog: Trauma 1

In our hospital when a trauma happens, a page is sent through the system to a team. Chaplains are part of the rapid response team so our on-call chaplain gets the page and responds within 5-10 minutes to the scene. The same team responds to cardiac arrests and visitors who fall unconscious unexpectedly on the campus.

Because our hospital campus includes several buildings over several city blocks, it can take time to arrive to a trauma. It may take effort to leave a conversation that you’re in as a spiritual caregiver, for instance. A doctor may need to leave a patient’s room immediately. A nurse may need to grab a crisis cart and place some things in the hands of a colleague.

Some trauma calls turn out to be seizures, relatively bland events for the amount of resources “coming at a person” when the page is called. Still, being a part of a rapid response assumes a readiness to encounter the worst. It assumes that we’re prepared to stick around and labor through what’s next.

A family who’s grieving demonstrably. A patient who is unaccompanied and whose chest is being pumped, whose ribs are being broken. Being there assumes that we’ll see and that’ll we’ll do our work. That we’ll be steady.

It is its own walk of faith, responding to those traumas. You know and don’t know what you’ll see. Being steady is a hard job when pain is winning. How do you keep yourself steady? How do you see the traumas unfold and still show up?

 

 

My Blog: Waiting

I have occasion to stand as a witness before, after, and when people die. The first time this happened, in my residency year two years ago, I was in the medical intensive care unit where I still spend most of my time as a chaplain.

I sat with a sister as her brother died. He was a scientist, believed nothing about the supernatural, and sitting with his sister was undoubtedly a holy moment to me. We talked together, mostly her talking and me listening. She laughed as she told stories.

Explaining that she had never imagined being a sister in this way, I heard her walk through the upset of thinking it’d be the other way around, that he would be the one who watched her breathe her last breaths. She was faithful to him in those last moments. “I won’t ask you to pray,” she had said earlier that morning. “But will you come back and wait with me?” Waiting is what I did.

My Blog: Good Decisions

I was in a room listening to physicians talk about intensive care and how timelines were important to patient care and to providing health care. Patients get better when they’re treated. Or they don’t.

If they get better, doctors know why. And the same is true if patients don’t get better. If certain things were going to happen, like recovery, then they would have happened.

The importance of recognizing that trend along with all the other information available is freeing. It can free you to choose well. It can enable a person to have a good death and a good life in the sense that there’s life to live after the next decision.

My Blog: Sparkling Eyes

When I heard your explanation of your new position, it made me leap inside my heart. I can see you being a chaplain over there, seeing your patients, pushing the borders of your pastoral identity. I could see you praying and preaching and leading.

Your eyes sparkled as you spoke. I noticed it even though I kept my listening face. I guarded the treasure of your brightened countenance. I thought of the other residents and students in our CPE program. I thought of my chaplain colleagues and the pastors I know who are open to call. I saw them and the fulfillment of their hopes in your sparkling eyes.

You weren’t entirely happy with everything–and who’d expect that given your description of the social climate of the place–but you possessed a vision of what could be. That’s what came through your speech, through your eyes.

The vision of your next days, the long moments with others where you’d have an impact, where you’d do some more good in the world. Good for you. Good for them. Good for us.

My Blog: Things You Don’t See

One of the earliest things I learned when I started working as a chaplain is that things I don’t see can sicken me, take away my strength, and cause me harm. There are more pathogens in the world than I’ll ever see.

On one hand, that’s enough to send a non-medical person nuts. Everywhere you look and everywhere you touch, you’re wondering, “What’s on this?” You change your habits. You watch your six-year-old and test him by secretly counting how long he washes his hands. You do this to everyone in the bathroom, too. Until the results depress you.

On the other hand, this unseen presence makes the human body that much more remarkable. We walk around well, and that’s miraculous! And we also need to care for ourselves as much as possible in appreciation for ourselves. How will you appreciate yourself today, amazing sustained miracle that you are!

“good news for all of us”

by Tim Marshall

Walking into a room and meeting another person wherever they are. To show up and shut up and be present. To move through the human desire to say something to make it all okay and just be. To be a reflection of God-in-flesh to those who are suffering.

Also, my patients reflect God to me. People who are dying share visions of angels and whispered messages from the hereafter. Patients who are undergoing intensive rehab therapies after a stroke speak of wrestling with God in the dark hours like Jacob and emerging with a limp, but having touched God.

Chaplaincy is not a cerebral ministry of long hours spent in a pastor’s study in preparation for preaching. It is holding hands through bed rails and wearing isolation gowns and being willing to literally stand in suffering with God’s beloveds. It is not about translating Hebrew or Greek from ancient texts, but about translating scripture into something now that matters to the mother who is delivering her stillborn child or the son losing his father to cancer.

The theology of the cross is particularly apparent to me in my hospital work. This theology holds that God’s love for all of creation is most clearly seen in the act of dying on the cross.  That God did the most human thing of all, which is to die. The theological conviction that shapes my ministry as a chaplain is that God knows what it is to suffer and to die, and there is no place that God is unwilling to go, even death. This is good news for all of us who feel immersed in suffering, our own or that of others.

Read Amy Hanson’s full post here.