Spiritual Care giving
“Sometimes, while in the mountains, we see on the edge of a precipice a tree whose trunk and branches are oddly twisted. This tree has had to withstand bad weather, and the struggle is reflected in its trunk and branches. In the same way, in life we meet people whose faces are tortured and asymmetrical, but what gifts, what talents! This proves that they too have had to endure very difficult conditions, which they have overcome. But in order to do so, they have often developed their mind and will to the detriment of certain qualities of the heart, and these efforts, these tensions, have eventually deformed their faces. Beauty in human beings speaks more of the qualities of their heart than of their intellectual faculties or their will. This is why very beautiful people are often predestined to be victims. Because beauty, true beauty, has a much greater affinity with goodness than with intelligence, they often lack adequate means to defend themselves against the desires their beauty arouses in others. To ‘stay young’ has now become an ideal, and yet our contemporary culture teaches people to age as rapidly as possible. Oh, not physically, to be sure! Everyday, quantities of products and methods are invented to keep the body fit, to maintain the figure, to smooth away wrinkles and so on. But inwardly, psychologically, men and women age earlier and earlier, because it is earlier and earlier that they forsake simplicity, spontaneity and confidence to become suspicious, calculating, blasé and dull. Do you want to stay young? There is only one way: remain young at heart, forever alive, loving, interested in everything, quick to forgive, delighted by the slightest thing, and ready to forget insults, sorrow and failure. Maintain a heart that is always ready to love and embrace the whole world, a heart that does not shrink and grow cold. As long as you maintain a warm heart, you will never grow old. …We all like to give or receive flowers, to put them in our houses and plant them in our gardens. We go to admire them in parks or in the countryside and are enchanted by their forms, colours, and scents. But we consider flowers primarily as decorative elements which help to make life more agreeable, and as such, our admiration remains superficial, and we gain very little from their presence. In actual fact, flowers are living beings with which it is possible to relate. Yes, a flower is not simply a morsel of coloured, scented matter, it is the dwelling place of a spiritual entity who has come to speak to us of heaven and earth. If we know how to look at a flower, how to create a bond with it, we enter into relationship with the forces of nature, and with the entities who work to render it such a vibrant and poetic presence.”
– Omraam Mikhael Aivanhov
LENGTH OF VISIT: 10 minutes
MARITAL STATUS: Widow
RACE: African American
RELIGIOUS PREFERENCE: Baptist
ADMITTING DIAGNOSIS: Pancreatic cancer
NUMBER OF VISITS: 1
WHICH VISIT IS THIS? : 1st
CONSULT PLAN: This encounter happened during one of my cold-call visits. I asked the clinical manager for a list of patients she thought would like a visit, this patient’s name came up. Usually during cold call visits, I often visit the patient first and then check the chart afterwards. Most of the time I usually do not know what is going on until I get there.
ADDITIONAL INFORMATION (FAMILY, STAFF MEMBER, CHARTS)
The patient had her daughter and granddaughter present when I entered the room. Her attending nurse later told me that the granddaughter, who must be in her early 20s, has literally been there beside the grandmother the whole time.
I was surprised to learn that the patient is 83 years old because she looks unusually youthful, I would have guessed in her late 50’s or early 60’s. She was extremely alert and other than the tubes in her arm, she looked quite vital, robust and healthy. The granddaughter was in the corner observing and listening to the visit while the daughter came in as I was leaving.
EER: Ms. Smith?
Ms. Smith: Yes (she nods)
EER: Hi, my name is EER, I’m one of the spiritual caregivers here, I’m just coming by to see how you’re doing…
Ms. Smith: Oh, Hi! Thank you for coming by, come in…how are you?
EER: I’m fine thanks, but more importantly, how are you?
Ms. Smith : Oh, I’m doing fine (smiles) ….(slight pause) Now, did you come here on your own or did someone send you?
EER: (I smile because I know what she’s getting at) No, no, no Ms. Smith, No one sent me here, it’s part of my job to go around and see how patients are, we’re mostly here to offer and provide support to patients and their families.
Ms.Smith: Oh! (Now, she and grand-daughter both chuckle heartily)…I thought someone may have sent you to tell me “something” because quite frankly, I feel just fine.
EER: No, no, no. I’m not the harbinger of bad news. I’m just here to see how you are and what I can do to help.
Ms. Smith: Oh, good. (she settles into her bed and pillows a little more) Now…what religion do you practice?
EER: (This one always is a test to answer so I try to give one that’s as diplomatic as possible.) Well, it’s not so much religion that’s so important here, the caregivers here come from all faith traditions and we try to address the needs of all faith traditions, so you can kind of say it’s non-denominational. That’s my approach also.
Ms. Smith: Why, that’s lovely because I believe in the same.
EER: You believe in a non-denominational approach?
Ms. Smith: Yes, you see I grew up Baptist but what I really believe in is in the beauty and hope of God and that it extends to everyone.
EER: (I realize that she may be a bit of a universalist but continue listening.) That God is for everyone?
Ms. Smith: Yes…you know, most people think that God and religion is some building but I really think faith is something inside (touches her heart area). All our journeys, our paths, our reasons are different which is why I don’t believe in denominations and all that. What I believe in is beauty and that we are all to share in it. That we should live for and in beauty. What I really enjoy is talking about it with people who understand. You know… most people don’t get it…
EER: (I nod)
Ms. Smith: I can tell that you get it, you’re very beautiful, that understanding is in your face. You can tell, especially in the eyes.
EER: (I smile) How?
Ms. Smith: Well, life experience mostly, you know 83 years ain’t just a snap of the fingers… I’m no spring chicken…. You see lots of things in that time…. you learn over time from folks and from things…. You learn over time we’re like different flowers… different colours, smells, shapes and all, but still… flowers.
EER: (I smile) It’s a beautiful thought. (I’m thinking about her present illness and wondering what does this illness mean to her). You seem to be a very strong lady. (Here, her grand-daughter just chuckles and nods). I guess what I’m curious about is how does this illness fall in with your faith?
Ms. Smith: What? This? (points at the tubes) It just one of those things you have to go through in life. You get old, the body breaks down. It doesn’t affect my faith too much… I know I’m in the palm of God’s hand, I’m only here because of His will. I feel fine… I feel safe…(And indeed she speaks this very peacefully and knowingly, I don’t detect any fake bravado or sense of dismissiveness.)
EER: You sound very peaceful with the whole thing…
Ms. Smith: I am.
EER: You also seem to have the support of some good people around you (motion in the direction of the grand-daughter)
Ms. Smith: (Smiles) I do.
EER: I can see that you’re a woman of faith… If there’s anything we can do, the nurses here know me, they can call me.
Ms. Smith: Thank you (she takes my hand). Really, thank you. I really do appreciate you coming up and seeing me and for your concern. Thank you.
EER: Thank you for letting me listen. I learned something new from you today (she leans over and hugs me, I hold her hand and gently squeeze it and take my leave)
I experienced this visit more as an exercise to just listening to a person and of being present. I think what made it easier was that this woman is an uncommon Baptist and holds a more universalistic stance theologically than those of her brethren. The patient was initially hesitant and suspicious of me but once it was clear that I was not being sent to her to tell her something bad, she became very forthcoming with me and that made the visit easier.
I experienced the visit as initially amusing but listening to her was encouraging in several aspects. She really did seem at peace with the whole illness and she seemed so abnormally alive and alert, it served as a testament to faith bringing peace, true peace in the midst of physical and medical turbulence.
I’m not sure if the visit did anything for the patient but I tried to echo back to her what I was hearing. Maybe somewhere along the line having that reflected back to her, that maybe something encouraging was heard but I could not tell.
With respect to inclusiveness, the patient and I are both members of visible minorities and both of us are female. The patient is suffering from pancreatic cancer. The patient is a Baptist, however she is not active in her church or faith tradition. I consider myself more of a secular Muslim. Perhaps because of some of these inclusiveness issues, she was able to open up very quickly with me. She definitely changed in demeanor and attitude when she learned that I had a more non-denominational approach.
My main concern was to listen to the patient and help her be aware of our presence here in the hospital. As the conversation between us developed, I was able to see that this woman lived her faith. This woman’s spirituality was not based on a single figure or book or label, but rather, was based on a theme of respecting differences and seeing the beauty thereof. The interaction between us was very open and jovial.
I think the peace the patient was feeling came in the realizations she has made during her long life and that these realizations are no doubt assisting her in her present circumstance.
This is the first of a series of encounters I will be posting up from my time as a hospital spiritual caregiver/chaplain. I had hundreds of encounters in the wards and in the trauma bay over a space of 2 years while I attained certification with the ACPE but I’ll only be posting about 20 of the encounters here. I won’t be posting them up all in a row or else that would really be a downer. Instead, I’ll still be posting my other stuff as well as topics pop up.
Names have been changed for obvious reasons, but all the encounters were real and not made up. I made mistakes at times and I realize people may have dealt with these situations differently. As I wrote before, I’ve sat on these stories a long time and think it’s time to let them go in the hopes that maybe others can also learn something from them, how to connect to others in an authentic and genuine human-to-human way, beyond differences in race, class, background, religion and nationality.
DATE OF VISIT: December 25, 2003
RACE: African American
MARITAL STATUS: Single
RELIGIOUS PREFERENCE: Baptist
ADMITTING DIAGNOSIS: Renal complication (HIV-related)
NUMBER OF VISITS: 1
WHICH VISIT IS THIS? : 1st
This encounter happened during one of my cold-call visits. It was Christmas Day and I went up checking my various units asking the nurses and clinical managers specifically for patients who were NOT expecting visitors that day. The nurse suggested visiting a patient in Bed B, when I went in to look, Bed B was fast asleep so on my way out I said “Hi” to Bed A and we ended up talking instead.
ADDITIONAL INFORMATION (FAMILY, STAFF MEMBER, CHARTS)
The patient is a former drug addict, and the addiction was a part of her lifestyle. She did prostitution for many years to support her habit and essentially lived off the streets.
I saw the patient earlier before the visit, while I was visiting the other patients I saw this patient walking along the hallway with her IV, getting some exercises so her muscles would not become atrophied. My guess is that she had been bed ridden for a while. She also had many, many marks on her forearms including what looked like really ugly cigarette burns. This turned out to be correct as she later told me.
C1: (walking past her bed on my way out and making eye contact) Hi, looks like she’s sleeping (motioning to Bed B) , I’ll come back later.
P1: (Standing by her bed, fiddling with the portable IV) Who’re you so I can tell her when she wakes up?
C2: I’m one of the hospital spiritual caregivers here and I was just checking up on her since it’s Christmas day and all…
P2: Like a chaplain? Oh, how nice of you! (Her face softens up considerably) Mmm-mmm (shaking her head) God is good, God is good, I know that for a fact, I’m only alive because of God.
C3: (I get the feeling that this woman has a lot more to say so I stop and walk over to her) We all are, really.
P3: That’s right, but I tell you, ever since I’ve turned to God, I’m more peaceful about this.
C4: Could you tell me more about this peaceful feeling?
P4: Well, you know, I’ve lived through some really bad things, I mean real bad… I had a bad drug habit for years (she showed me her arms and there are heroine scars on the inside of her elbow from shooting up as well as what looks like some rather deep cigarette burns) and I had a man, who was my pimp, he used to bust me up pretty bad…for so long I was far from God and when I got infected, it forced me to look at my life and I had no one else to turn to but God. And the moment I did, I felt like I was returning home for the first time in years. (Her eyes start welling up with tears but she’s smiling at the same time) So I tell you… God is good.
C5: (I intuitively get the sense that this discovery of faith has some sort of redemptive element here for her) Do you think you found your salvation?
P5: I know I have, I haven’t felt this peaceful, happy and…excited (with emphasis) in such a long time. Now I want to work for God, I want to go out there on the streets and talk especially to women and girls.
C6: Do you?
P6: Mmm-hmm (nodding) I think that’s where the real work needs to done, out there (points out the window).
C7: Sometimes before we need to work out there, we need to work in here ( I point to my heart).
P7: That’s true too, I wouldn’t want to do this work if I wasn’t ready.
There’s just one thing which bothers me.
C8: What’s that?
P9: Well, I met a social worker about doing this sort of work and she said that I had to be based with some church.
C9: That’s usually true.
P10: Well, you see now, I haven’t belonged to a particular parish in years, I grew up Baptist and I’m not really sure if that’s for me anymore. How do I know what’s the right church for me?
C10: You’ll feel it. You’ll just know. It might require some shopping around on your part, you might need to sit in on some sermons and visit various churches and talk to some people. It really depends on how open you are. Some people have hang-ups about not going to specific churches, but I say use what works for you. Go with what feels right and where you feel comfortable. If you find a Baptist church you like, then that’s it, if it’s non-denominational, Episcopal , whatever.
P11: (She looks very thoughtful) You know, it wasn’t no coincidence you came here today…I’m so happy I met you….Jesus is good since he brought you here today (sighing, she starts tearing up again, she looks at me and asks) Is it alright if I ask for a hug?
C11: No, of course not. ( I go over to her and give her a hug, we remain quiet for a moment)
(A few thoughts run through my mind, she must be awfully alone in this world, she’s starved for genuine affection and connection instead of relationships based on sex, money and drugs, she looks at me as some sort of agent of intercession)
P12: Thank you.
C13: You’re welcome.
P13: Are you here a lot?
C14: Well, I’m here today, I won’t be tomorrow but I’ll be back on Saturday. Will you be here then?
P14: I’m not sure, the doctors say my swelling has to go down so maybe.
C15: Alright, when I come back, I’ll check in on you if you’re still here.
P15: Oh, would you? Alright.
C16: OK, so I guess I’ll see you on Saturday.
P16: Yes, and thanks again for coming. (I checked up on her on the following Saturday and she had been discharged the day before.)
I experienced this visit as an exercise in being at the right place at the right time. That I met her was by pure chance and coincidence since I went in trying to meet someone else. As the visit progressed many theological themes popped up. Finding a sense of the holy, rediscovering religion and spirituality, valuing and reassessing things presently in life and finding what your life’s work may be. Clearly this patient has gone through a lot in life. A life on the streets as a prostitute in the seedier sections Washington DC in order to support a drug habit cannot be something most people would take pride in but, rather would most probably be a source of shame. This patient seemed to be past that (with me anyway). Instead she had somewhere along the line found an anchor of peace which is helping her keep afloat. I think what made it easier was that this woman was very forthcoming with me, almost immediately and that made the visit easier. I did not have to do too much digging to speak of.
I experienced the visit as an exercise for myself in the mysterious powers of coincidence and timing. It just served to remind me that the universe will send you where you’re wanted in unexpected ways and places.
I think the visit was good for the patient in some ways. As stated earlier she saw me as some sort of agent of intercession as in her opinion, she seemed to say that somehow , it was not a coincidence that I was brought to her room and this was some sort of blessing from Jesus. With respect to inclusiveness, the patient and I are both members of visible minorities. The patient is also female. The patient is suffering from some sort of renal problem related to her HIV. I have never had the illness. The patient is a Baptist, however she is not in her church or faith tradition. I consider myself more of a secular non-observant Muslim. I’m not sure exactly why she opened up as quickly as she did but she really opened up immediately when it came out that I was visiting people for Christmas. Maybe she read into something there and that allowed her to open up and trust me.
My main concern as a spiritual caregiver was to listen to the patient and be present with her. As the conversation between us developed, I was able to see that this woman had found some sort peace in all of this with her recent discovery of spirituality. The interaction between us was very easy and trusting.
I think something positive was present here for this patient in some of the realizations that she has made as well as the fact that she’s fully aware that she’s still on a journey of sorts and no doubt some more realizations will most probably be on the way for her.
To those of you who don’t know me personally, there was a time when I was a spiritual caregiver at a very busy hospital in a very violent city in the United States. Once upon a time they used to call it pastoral care or chaplaincy but since the term “pastoral” has a very Christian connotation to it, they decided to call it spiritual care-giving instead in order to be more inclusive of other faith traditions and paths.