Tag / Spiritual Care

by Michael

Soul Stuff: Entrusting Yourself

I shared this quote as part of a presentation I led last week with physician-fellows in palliative care. They are finishing up a year with their fellowship; they’ve come to palliative care from a variety of disciplines. For three years I’ve been shadowed by different fellows, working side to side to care, to listen, and to participate in the sacred sendings of patients.

Palliative care doctors are a good group of people, and our work as chaplains borders a neighboring region if I can put it that way. Unfortunately palliative docs are often thought of as last resorts and though that view is changing, their import is only beginning to emerge for addressing pain, discomfort, and the large matter of the unanswered. The affinity between their work and ours in spiritual care makes me think of the word integration.

My talk was on cultivating patience in the medical intensive care unit. The MICU is my primary pastoral context these days outside of my supervision of ministry students, and I pulled materials together for a similar group last year. Toward the end of our discussion, I was reflecting upon the wonderful work of Rachel Naomi Remen, whom I’ve quoted before on the blog.

Dr. Remen is among a small circle of life sustainers for me, especially from this last calendar year. She works with caregivers, teaches physicians of the body and physicians of the soul. And she helps me see better some of the portions of what’s ahead in my own future. That said, this quote was toward the end of my presentation with the staff from My Grandfather’s Blessings:

An oyster is soft, tender, and vulnerable. Without the sanctuary of its shell it could not survive. But oysters must open their shells in order to “breathe” water. Sometimes while an oyster is breathing, a grain of sand will enter its shell and become a part of its life from then on. Such grains of sand cause pain, but an oyster does not alter its soft nature because of this. It does not become hard and leathery in order not to feel. It continues to entrust itself to the ocean, to open and breathe in order to live. But it does respond. Slowly and patiently, the oyster wraps the grain of sand in thin translucent layers until, over time, it has created something of great value in the place where it was most vulnerable to its pain. A pearl might be thought of as an oyster’s response to its suffering…Sand is a way of life for an oyster. If you are soft and tender and must live on the sandy floor of the ocean, making pearls becomes a necessity if you are to live well.

I hope these words and anybody’s words which sit in your ears give you an anchor in the oceans of your life. Being an oyster, being a giver of hope, being a caregiver can irritate you until you release your own soft nature. Remen doesn’t likely mean by soft nature anything but a positive description of the best part of you and me.

When my training supervisor wrote my evaluation from February to September, he remarked upon my growth that he’d seen from two years, though he’s only supervised six months of that time. He gave a high compliment when he said that he’d seen me soften over these months, over these years. I had read these words but forgot about them until the other week. In working on this presentation, I reread that the oyster softened, too.

May your nature only soften. May it never harden. May you be as soft as you need to be to produce the pearls that await the context of your own soul. May every sand grain get used to your softness rather than your softness falling into hard, gritty sharpness. Don’t clamp your shell. Don’t give up. Don’t harden.

by Michael

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.

by Michael

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.

by Michael

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?

by Michael

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?

 

 

by Michael

“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.

by Michael

Stuff I’m Writing (3 of 3)

Photo Thanks to Aaron Burden

Photo Thanks to Aaron Burden

When I started the supervisory education program in CPE, I noticed that there were hardly any meaningful trails about the process on the internet. I decided to write through my process. So I have some “public process notes” on the blog in order to keep track of some of my experiences.

Related to that, I’ve been working on materials for a committee appearance in early April. While I won’t go into much about the appearance on this side of the meeting, I want to put up a few thoughts from the three papers I prepared for submission to the committee.

This is a part of my theology theory paper—a major paper for the supervisory process. I’ll get feedback and work on it until it sings and is ready for the subsequent processes. This portion is around the mini-section on contextual theology and the incarnation, a major second step in the paper after I talk about sources of theology which emerge out of the narrative tradition of my African-American experience. There are quotes from James Cone’s God of the Oppressed and Smith and Riedel-Pfaefflin’s Siblings By Choice: Race, Gender, and Violence.

My experience shaped how I arrived at scripture, how often I visited the Bible, and how basic encountering the passage has been to how I encountered the God behind it. In that sense, I’m a contextual theologian. In my pastoral theology there are roots of contextual theology. Having sources like experience from which to draw theological language eventually brings me to God, the content rather than the periphery. God is who we were singing about in my younger days.

Traditional Christian formulations of God are Trinitarian. They are more than that for sure because God cannot be captured by our formulations. As is true in the grand historical human experience, God has been disclosing God’s person in many ways. I’ve “met God” through conversations with an addict named Lawrence who talked to me about beauty while painting the church. I’ve met God through the silence of a person who was struck by a loved one’s sudden death. God’s come in those moments and come to me. Always sensitive to me, to us, to the audience, God meets us in our specific conditions.

The incarnation where “God becomes flesh” is the striking example of this. Thurman called the incarnation “the great disclosure.” Through the incarnation God is at work, revealing, disclosing, and opening to others who God is. James Cone reminds us that Jesus is not a theological proposition restricted to the conceptual. Jesus matters because he is matter, because he exists outside of our heads.

He is an event of liberation, a happening in the lives of oppressed people struggling for political freedom…Jesus is not simply a doctrine or even a particular event limited by time. He is the eternal event of liberation in the divine person who makes freedom a constituent of human existence. There is no existence apart from him because he is the ground of existence without whom nothing is.

I think of God as eternal, as essentially loving, as relatable. I think of the inextricable way that justice is the avenue whereby God’s loves. “In short, God is manifest to us through material means.” God expresses all that God is through particular means. We never is love without justice, mercy without reconciliation. One is the expression of the other, the explicit exhibiting the implicit. As Kelly Brown Douglas, a womanist theologian writing Christology, says, there is a compatibility between Christianity and acts of justice.

Spiritual care, then, as an incarnational act is an expression of God’s intention toward human beings, and that care is at the bottom of our work in CPE where we attend to our selves and our ministries. As an expression of love, our work is also an expression of justice. As necessary as people are to that theological articulation, the first actor is Divine. God acts, expressing love and justice—expressing God’s self—and people receive that action, respond to it.

People are created by God, and as created beings have a host of ways through which we interact with the world; we are emotional, intellectual, and physical beings. Each element of a person’s makeup is grounded in the Creator’s initiation and desire. Seen and unseen elements compose us. All of these avenues become vehicles through which God can reach, heal, teach, and transform us.

God touches the world through us, connecting with us—the incarnation, again, being an exemplary portion of this, a clinical encounter is another—and then connecting with the creation through us. God cares for creation in other ways which we cannot see. A chaplain’s role is to participate in God’s work in the world by, variously, cooperating with God to care for, protect, preserve, challenge, and observe the work of God through human interventions, through silence, and through the variety of ways we care. People are the means for and recipients of that care. Care is aware of the past.

In Siblings by Choice, the authors tell us the truth about the power of the past:

The past represents ways of knowing that emerge from struggle and can inform us today. The complex and ambiguous present is the result of the experiences, thinking, and struggles of our ancestors who were born and raised in civilizations and circumstances different from our own. Their struggles birthed the conditions under which our consciousness develops and our life narrative unfolds. From them we may gain wisdom for patterns of living that extend an otherwise limited perspective on the present.

Care isn’t beholden to the past. It honors the past, holds the past and present together, particularly as people struggle with the present crises of life such as death, sickness, loss, and change. But care is future-oriented, always looking for the right now connections between humanity and divinity.

by Michael

Form of Conversation

Tree of 40 Fruit

I love this picture and this description of Sam Van Aken’s Tree of 40 Fruit. According to CNN, the tree was created by grafting buds from various stone fruits onto the branches of a single tree in order for it to produce multiple types of fruit.

The Tree of 40 Fruit is an ongoing series of hybridized fruit trees by contemporary artist Sam Van Aken. Each unique Tree of 40 Fruit grows over forty different types of stone fruit including peaches, plums, apricots, nectarines, cherries, and almonds. Sculpted through the process of grafting, the Tree of 40 Fruit blossom in variegated tones of pink, crimson and white in spring, and in summer bear a multitude of fruit. Primarily composed of native and antique varieties the Tree of 40 Fruit are a form of conversation, preserving heirloom stone fruit varieties that are not commercially produced or available.

Learn more here and here about this ongoing series and this form of conversation.

 

by Michael

Public Process Note

I spend time with people who are dying, actively dying, and I spend time with the people who love them. It does and doesn’t get easier to listen to the rises of hope and the slips into sadness as some son imagines the soon-coming death of his mother or to the patient who looks ahead and thinks about not existing anymore.

I know how to stand and sit with a nurse whose patient just died or expired or passed away. I know how to acknowledge the connection between myself and a doctor I met only around the grim and delightful experience of a patient who died late that night a few months back, the recognition between us like a secret we keep to ourselves.

The medical intensive care unit, the on-call experience, the jacket that identifies me in the hospital all lend themselves to wearing the experience of somebody’s grief. Of course, I have my own because I learn something of these good people, I am known in little bits, and I know them in little bits. And then, I carry and hold the grief of others. And it does and doesn’t get easier.

This post isn’t about the skills necessary to carry the grief of others, and it’s not about the ways in which I support people up to the edge and just before the dark unknown that is death. Of course, for the Christian, the reality is that death is a step or slip or movement. Like the shift of one’s body in a gracious dance, death is supposed to be a movement into another life, another part of life. In the words of a young woman who said something I’ll never forget: Whether we live or die, we win. That is a Christian view of death.

The lived experience is murkier. Living with the stories and words and prayers of another as she approaches that existential doorstep into eternity is grounding.

When I woke up this morning, I heard myself say of one of my patients, “He’s not going to die over the weekend” and, shaking my head at the unbidden thought, “He’s not dying today”. Of course, when I arrived for our morning report where we discuss the issues of the previous day, where we talk about who needs to be followed or continually given care, that patient was on the lips of my colleague. She dropped her head and her tone and said she had sad news. It was brutal for that to be saved until the last relay.

I had been right up until that moment. He had not died. In my mind, he was still with us. In truth, his spirit or his intention was waiting on the perimeter of my unconscious, even before I woke, telling me in his own way–or in God’s own way–that he was, in fact, gone.

I was glad, made glad really, that my chaplain colleague was with him when he died. Knowing of his faith and seeing the notes that had been charted, she sat with him and played gospel music for him. She sang to him, held his hand. She was there when he breathed his last breath.

This morning became for me another moment to grieve, another patient I had cared for, another person I had gotten to know. He was another person whose story, in such a compressed time, I learned to appreciate.

I spent the day doing the same things I always do in the hospital. And if you weren’t a colleague of mine or a nurse from my unit, you wouldn’t know that this gentleman was now added to my mental picture of deceased patients. I would remember that he had been in that room. I would associate the number with the first meeting and then the second until I captured what my last prayers for him had been. Had I prayed a prayer of benediction? I generally tried to.

He joined a different cloud of witnesses and not just the one the scriptures speak of. His face became associated with his room so that when I walked by, I said another goodbye, and it was like that on the unit. He was still a teacher to me, a teacher in how to acknowledge what was happening in me, a teacher of remarking on a man’s grace-filled transformation, and how to continually respect the boundary that we give all that we have when we’re there and that when we’re not there, somebody else is.

He became an occasion for me to remember the other patients who I thought of in similar ways, even if there was one or two profound ways that distinguished him forever in my memory. He will be one of the people I look for when I slip through the split in the veil myself one day. I will anticipate him as a host quite like he was when he welcomed me at the hospital, and I believe he’ll be smiling widely and probably calling me by a title and a last name.