8/2/2006 Vol. 3, No. 13

Professional Practice

Rev. Dr. Neville A. Kirkwood on preparing clergy and others to face disaster

Preparation for Disaster Care Givers

Daniel Coleman’s article “Care for the Care Givers”(Vol. 3, No. 12) has given me itchy fingers.

In 1977, a major rail disaster uncovered the inability of many rescue personnel and other close workers to emotionally cope with the horror and extent of their suffering. The state government realized the need for some restructuring of the State Emergency Services (SES). A Welfare and Personnel Committee of the SES was established. Fellow Chaplain Jim Hamilton and I were appointed to one of the regional subcommittees. We were both on the executive committee of the State CPE Council when we realized the need for the training of people likely to be involved in future emergency situations.

We organized seminars and workshops and were also invited by a university to give several lectures to their nursing students. A similar program was conducted for students training for welfare qualifications at another university. [1] More importantly we organized simulated disasters over the weekend period with the cooperation of the police, fire and ambulance Services. In this program we had 30-plus social workers, 30-plus youth and community services district officers and 30-plus. parish clergy. The exercise was made as realistic as possible, with the last session on Sunday being a debriefing session.

These weekends showed just how traumatized the participants were even though it was not the real thing. Extra time had to be spent with several who were deeply affected. One wondered how useful many of them would have been in a real emergency, yet these individuals would have been amongst the first called upon to be involved in the disaster.

When I had opportunities to speak to seminary students on death education topics, I had arrangements with the city police for the students to visit their morgue. The reason for this was to acquaint them with death, a dead body and the gruesomeness of some accident scenes. This morgue held up to 250 cadavers at any one time. They also had facilities in one area for conducting 16 autopsies at a time. Usually there were six to eight autopsies being conducted simultaneously.

After police identification of the bodies at 9:30 a.m., the students were taken into the refrigerated area to see the waiting bodies, then to view the autopsies. In the lecture theatre, questions, reactions, and debriefing took place. These future clergy all valued the experience. Often, years later, when visiting them in their parishes, they reiterated their appreciation of the experience and how it had equipped them to cope with some pastoral encounters.

Chaplains in teaching hospitals have an opportunity to help those training for any community ministry to be able to face future traumatic scenes with strong, positive, and helpful support. We never know when they may be called to witness some roadside carnage and be the only one able to offer assistance before emergency services arrive.

Chaplains should consider the preparation of careers to face disasters as an important arm of their ministry.

[1] “Welfare qualifications”is a Diploma of Welfare Studies in the Humanities Department. It was a requirement for welfare workers in certain government and other organisations.

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Advocacy

Chaplain responses make a difference

Responses to the Spirituality/Medicine Interface Program Make a Difference

Editor’s note: Again, we have chosen to highlight the on-going dialogue around the article by Dr. Hamdy entitled, “Spirituality and Medicine”that appeared in the June 21 issue of PlainViews (Education & Research,Vol. 3, No. 10). These responses continue to raise this issue that is of great importance to the profession of chaplaincy. As you will read from APC President, Robert Kidd, some progress has been made! Dr. Hamdy is to be commended for his willingness to be open to re-considering some of the plans for the program.

It was clear that some within the chaplaincy community were distressed that the Southern Medical Association's Spirituality/ Medicine Interface conference did not include professional chaplains in its faculty. After reading the letters on this topic from APC members, I contacted the SMA myself. Following that conversation, during which I expressed my pleasure at the SMA's interest in the medicine/ spirituality connection, I also shared chaplains' general frustration when other medical professionals speak publicly about spiritual care delivery without including professional chaplains in the dialogue. During my conversation with the SMA, I offered to assist them in publicizing their event on the APC website and having the conference's content approved for CCEs. Following this conversation, I received the following email from Dr. Ronald Hamdy, the conference chair:

I am delighted to hear from Mandy Stone and Jean Lambert at the Southern Medical Association Office that you are interested in the conference we are organizing in September on the Spirituality/Medicine Interface. I am particularly appreciative of your willingness to help us get continuing education credits for chaplains.

I wonder whether you might be interested in moderating one of the sessions, joining the faculty of the conference and being a co-discussant in one or more of the case discussions. It is too late to change the program, but it should not be too difficult to add a flyer to the brochure.

Please do not hesitate to contact me should you need any further information or wish to discuss any issue.

I look forward to hearing from you and hopefully meeting you in Atlanta.

At this writing, I have accepted Dr. Hamdy's invitation and will soon begin discussions about the details of my involvement. While I am aware that my participation on behalf of the APC does not address the more generalized concerns about chaplains' regular involvement in events like this, Dr. Hamdy's invitation is still gracious and most welcome. I see the APC's inclusion in this event as an additional stepping stone toward our strong collaboration with the national medical community.

Chaplain Robert Kidd
President
Association of Professional Chaplains

I write with a somewhat different “spin”on the issues raised about the Spirituality/Medicine program sponsored by the Southern Medical Association. My initial response was excitement about the conference and an eagerness to learn more. I will attend and still am very eager to be a part of the conference.

I deeply share the frustration that professional chaplains were not included in this faculty and typically are not included in conferences such as this. I am frustrated and territorial when those from outside our profession claim expertise in spiritual care and appear to not know that chaplains exist. I do not want physicians and nurses to increasingly claim spiritual care as their area of expertise. Having claimed all of this, I would like to present some other issues for consideration:

1. The sharply worded responses for Chaplains Wintz and LaRocca-Pitts seemed to have elicited from Dr. Hamdy defensiveness rather than dialogue. When my comments to a patient, family, or staff member elicit defensiveness I ordinarily think I have stepped over a line and have likely become unhelpful. I think we should not be placating but should exercise wisdom and patience as we seek to “find our places at the table”.

2. What I know of Chaplain Wintz’s program and professional environment is very different from my own. I deeply respect the thoughtful and developed professionalism that seems to be displayed in her personal work and the apparent organization of her department. I am a one-person department in the heart of the Bible Belt [as is the Southern Medical Association]. My experience is that “here”a minister is a preacher is a saver-of-souls to most people, lay and professional alike. And there are preachers everywhere! Issues of confusion and/or ignorance about professional expertise and collegiality are far more deeply entrenched than mere physician and chaplain relationships. This reality drives me crazy, but it is reality as I experience it!

3. Another reality is that “we chaplains”don’t do much research and writing for publication. Despite frequent pleas from those few chaplains who do research and write, those endeavors are pretty low on the list of priorities for the chaplains I know. The profoundly inadequate patterns of staffing for spiritual care rarely allow for comprehensive care to patients, families, and staff; research is just too much to add to the mix. Therefore, we don’t have much of a forum to be recognized as having important knowledge to contribute.

4. I believe that concerns about faculty being dominated by white males and the clear Christian reference for Dr. Koenig raised by commentators in the 7/19/06 issue of Plain Views warrant discussion. Having recently planned a major conference, I am very aware that focus is required to meet stated objectives. Are there non-Christian researchers who have the knowledge to contribute to this anticipated audience that Dr. Koenig has? Each will have to decide where the line is drawn between consciousness-raising and mere sniping. However, again I think we need to be very careful that we don’t jump to unwarranted conclusions about the ability of this faculty to be open to many kinds of spirituality. We certainly don’t appreciate it when someone uninformed about professional chaplaincy jumps to the conclusion that a chaplain is likely to be a pushy, pious religionist because we are ministers!

5. Finally, I believe that we must first take responsibility for ourselves and must start where we are. Perhaps, as Dr. John Nelson suggested at the APC conference in Atlanta, we need to seek ways to initiate more collegiality with physicians at local, state and national levels. Perhaps we need to plan conferences which would attract physicians to participate and experience our expertise. As for this physician-planned conference, I plan to go and participate as one who knows himself to be a qualified professional peer to any and all the participants. I hope to learn something; I hope to share myself and my experience/knowledge, and I hope to plant some seeds of collegiality.

Gary Batchelor, D. Min., BCC
Chaplain, Floyd Medical Center

Like many others, I read with disappointment the agenda and selection of speakers for the conference and with interest the ongoing conversation about the intent versus actions in the conference planning. There is an easy remedy for Dr. Hamdy and the conference planners to apply to this situation that would accomplish much more than defensiveness over what was clearly an error in planning. For each session, invite a board-certified chaplain to respond to the physicians’presentations in whatever way s/he sees fit, give her/him a fair amount of time to do so (15-20 minutes), see to it that each respondent is provided the text of the presentation in advance in order to prepare a thoughtful response, and let the dialogue genuinely begin. I would gladly volunteer to be a respondent to one of the presentations and I’m confident that many other chaplains would do the same.

Jeanne Tessier Barone
NACC Certified Chaplain
Palliative Care Chaplain
Kosair Children’s Hospital
Louisville KY

I hope to attend the workshop on spirituality/medicine interface and appreciate your invitation to Chaplains to attend a dialogue about spirituality.

I did want to offer a couple of words of encouragement and advice.

I went to fill out the registration for the workshop and found the designated categories of physician and non physician. I had a physician, once identify medical professionals( me included) in the same manner, and in a snit of anger I told him that I was a Chaplain not a non physician.

The other thing I immediately saw was the first case study on the docket. The one in which the patient and family wanted the family minister to come to the hospital but the minister was too far away so the chaplain was called and of course the family did not want to see the Hospital Chaplain but instead asked the Physician to save the day by praying with the family.

I hate to join the chorus but both examples do not show evidence to me of an inclusive invitation to dialogue.

If I get to attend the workshop maybe we can talk about these perceptions.

Thank you.

Larry Austin, D.Min
ACPE Supervisor, BCC
Director of Pastoral Services

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.

Education & Research

Dr. Diane Bridges on teaching our children about life and death

Talking with Children about Terminal Illness, Death, Dying & Grief

As a parent, relative, friend, or chaplain, one of the most difficult experiences is talking with a child about someone’s terminal illness. It doesn’t happen in a moment or a sentence and it’s not about the language of religion or faith traditions. It’s all about precious, loving relationships, security and hope. It’s about metaphors and hugs and tears and truth and hope for the future. It’s about holding onto and cherishing meaningful relationships of those touched by the process of death and dying in the life of a child or adolescent.

It’s important to remember that perceptions of death vary with developmental stages of a child’s life: 3-5 years, 6-10 years, 10-18 years. You can help a child by acknowledging his or her feelings, thoughts or fears about what is happening. Recognize signs of confusion, anger, acting out, silence, lack of appetite, sleeplessness or even apparent lack of feelings.

Ask yourself what you think is most important right now to this child in a context which will provide hope and help while dealing with the pain and fear. As parents we often want to protect children from the pain of grief. Because we have difficulty dealing with death, we wonder how a young child could possibly cope with it. But children can and do! We have an enormous responsibility to be there for them in the midst of our own grief to ensure that they do not feel bewildered and abandoned.

Don’t feel that you need to provide all the answers. Feel free to speak about what is happening, e.g., “Mommy is very sick right now and we are giving her all our love. Our love as a family lasts forever and ever and we don’t need to be afraid. We’ll help each other and we’ll all be safe and strong together. It’s okay to cry because we feel sad. Crying will help us. It’s okay to laugh, too, when we hear or see something funny.”

Be simple, direct, and honest in terms that your child can understand. This, along with warmth and your physical presence and affection are so helpful. It is also important that we reassure children that death is not contagious and that the death of one person doesn’t mean that someone else will die soon. During these very difficult times try and maintain order and stability and security in your child’s life as much as possible.

As much as you may feel so inadequate in the face of impending or realized death, you have incredible parenting instincts and you may find that your child can actually comfort you as all of you struggle with the realities of your losses.

Children have a great deal to teach adults about grief and we need to encourage them to ask questions, explore their feelings, draw their images with color and participate in the processes of living and dying as a natural part of life. I have found that Leo Buscaglia’s book The Fall of Freddie the Leaf to be very helpful in explaining death to young children.

Certainly there are no magical approaches or answers. You are the front line; and there is your circle of friends, professionals and family members on whom you can rely. Your personal wisdom and faith, even if they feel shattered at the time, will eventually enable you and your child to move forward in hope with the strength of your love.

As a hospital chaplain, grief counsellor and grandma in our precious family, I would say to you very truly, “Try not to worry about tomorrow, God is already there.”

Do you have thoughts about education & research you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.

Spiritual Development

Chaplain Sarah Byrne on simply showing love

The Word Became Flesh

A handsome, charming twenty-eight year old, “Michael”, had spent recent years living the high life. I met Michael in the locked psychiatric unit where I served as chaplain. Michael had attempted to take his life the previous night.

What a soul-shock it must have been to awaken from an anticipated death. My heart felt full with the heaviness of his story as I entered his room.

Once he decided that I was a non-threatening presence, Michael shared his pain. Raised by a zealous Christian mother, he saw her faith as legalistic and superstitious. Michael devoted himself to understanding his experiences from a non-religious perspective. He took in a confusing world and tried to formulate a worldview from it. Not surprisingly, this, along with a tendency toward depression and a series of losses, led him into despair.

Michael wanted to die because he thought life was meaningless and that, in the grand scheme, his existence didn’t matter. He concluded that if there was a God, He was horribly strange, and if there wasn’t a God, then life was utterly fleeting and empty. Either way, non-existence seemed better.

As I sat with Michael, I felt his despair in my body and heart. Stunningly, Michael’s mother had yelled at him that morning, telling him that he was now guaranteed a place in Hell for his suicide attempt. He was vulnerable, a wounded soul.

We cried on behalf of life lost and found. We cried because it is easy to lose sight of joy when the world is overwhelming. We cried because there is so much brokenness. We cried with questions: Should we disengage from the struggles inside us and around us, or live through them? Should we risk joy, heartbreak? Where is hope, at the end of the day, when all is still?

And I cried inside myself because sometimes I don’t know how to speak of God when the weight of the world is too much to bear. I want to say something real. I want to minister as I have been ministered to in times of need.

But I gradually remembered, while perched on the wooden chair beside Michael’s bed, that I must not be a mouthful of good intentions. I must be a whole person sharing Michael’s space of suffering. I must, simply, show love.

This God-given love is one thing I know in my heart to be true. We are called to speak it in ways beyond words. An unwavering presence, even a silent one, would speak volumes more than any words. No ideas for a better life would honor the depths of Michael’s pain or drag him out of it. No, I needed him to know that for this day, I would stay.
No fancy words were needed. The Word was all that was needed –the indwelling presence of God. It is a nearly silent presence, a still, small voice, a fullness in the midst of emptiness.

This love sits with us in our grief. It cries with us as Jesus did for Lazarus. It speaks creation into being. It seeks us out amidst the chaos of unknowing. This Love stays with us in a stark, white hospital room.

Do you have thoughts about spiritual development you’d like to share with your colleagues? Send an e-mail of any length to info@PlainViews.org.

EthicsWalk

EthicsWalk addresses spiritual care as an ethical enterprise. It explores why relationships between spiritual care providers and those they serve need protection, and examines what that protection entails. PlainViews invites our readers to share their responses to each EthicsWalk column, which will be published in the following issue.

If you’d like to respond to EthicsWalk, please send a comment of no more than 100 words. You can use the e-form below (click on "hearing from you," link) or submit your commentary to the editors in the body of an e-mail (or as a Microsoft Word attachment) sent to Info@PlainViews.org. Please put the phrase “EthicsWalk” in your subject line.

We look forward to hearing from you.

Anne Underwood is on a break for the summer. If there is a particular issue that you would like her to write about this coming fall, please send your ideas to: info@plainviews.org.

CaseConference

We post an ethical or situational concern that has arisen in a facility where one of our readers works. It has no identifiers included. It gives you only the facts of the case. Then, you can respond to that concern. This is an ongoing dialogue, with comments added as they come in. In the following issue, assuming it has been resolved, we give you the outcome from the facility where the incident took place. Please send any cases that you would like considered for inclusion to: info@plainviews.org

We hope that this new addition will help to inform not only those who are dealing with the issue, but will enable all of our readers to learn from the experiences and perhaps mistakes of others.

PLEASE NOTE: Due to unanticipated continuing responses to both the case and the resolution of the case, added responses can be viewed in the archives. Click HERE.

CaseConference #10 Resolution

The patient was transferred to a step down vent unit when a critical need arose in CCU. This move took much negotiating and discussion with the patient's wife and son. They felt that, if moved, he would not get sufficient care. The family was shown the area and met with the nurse manager. They eventually accepted the move. The Chaplain was supportive of the team throughout this process..

Upon transfer to a semi-private room with another vent dependent patient, the two families began to talk. Sometimes people sharing similar paths minister to each other. After ministering to her for a week to ten days, the patient’s wife slowly began to accept the fact that the man in the bed would never recover.
Her acceptance of his death came slowly. Still she continued to sit by his bedside for many long hours. Some of the staff felt that once she was able to accept that concept, she was able to lessen her hold on him and free him from the liminal state he was in.

In the early morning hours, about two weeks after his transfer, Mr. M. died. His wife was not present.

CaseConference #10

Mr. M is a 65-year old male of Russian Jewish ancestry who immigrated to the US after the SEcond World War. End-stage renal disease placed him on dialysis. Recently he made the decision to go on the kidney transplant list. In early March 2006 he suffered chest pains. A cardiac cauterization was scheduled. The results of this procedure showed cardiac by-pass surgery was necessary. The following day a quadruple cardiac by-pass was performed.

Mr. M survived surgery, however he had great difficulty being removed form the ventilator. Once weaned from the ventilator he had a cardiac arrest. He was anoxic for a prolonged period of time.

Multiple complications followed the arrest: various infections, septic wounds, and decubetus, repeated replacement of central lines and feeding tubes and dialysis problems.

EEG’s have determined limited brain activity; but is not considered brain dead.

More accurately Mr. M can be described as existing in a permanent vegetative state - PVS. He remains a full code. He was recently transferred from the Coronary Acute Care Unit to an Advanced Ventilator Step Down Unit. His wife refuses to accept a Skilled Nursing Facility placement.

His wife and brother keep a vigil at his bedside during visiting hours believing he will come back to a fullness of health. They seek a miracle.

The family will not listen to the medical staff as they attempt to address the issue of withdrawal of life support.

The patient’s wife who is by training a dentist, calls to him at all times “wake up –come back –do not leave me.”She has repeatedly stated that she would kill herself if he should die, as she has “nothing.”

She refused to accept anything other than the ministry of presence. When Psychiatry sought to intervene, she physically ejected the doctor from the unit. She speaks only of her love for her husband. She feels the hospital is not treating him aggressively enough.

What is the chaplain's pastoral role with the patient? The wife? The other family? The staff?

What are the ethical issues in this case?

What is the chaplain's role in helping to resolve these ethical issues with the wife? The other family? The staff?

Please check the archives below for comments made about the last CaseConference.

Send your comments about CaseConference to info@PlainViews.org.

Reviews

Sarah Masters reviews the documentary

Sacred Sacred

The director of this award-winning documentary wanders the globe on a five-year odyssey, in search of what he calls today’s “Ground Zeroes.”Velcrow Ripper seeks individuals who continue to hope in the dark places of the world ranging from Bhopal to Sarajevo to Kabul to Phnom Penh to Jerusalem.

Winner of the Special Jury Prize at the Toronto International Film Festival, Scared Sacred focuses on individuals driven to turn tragedy into generosity. A child soldier of the Khmer Rouge decommissions land mines. A Sufi musician banned by the Taliban from playing his lute fills his house with songbirds. A human rights worker confronted with the Bhopal disaster builds a unique health clinic for victims of the toxic Union Carbide gases.

The inspirational stories visualized over and over through the camera lens are a reminder for Chaplains of the resilience possible within each human being.

Completed: 2006
Running Time: 104 Minutes
Director/Producer: Velcrow Ripper

If you are interested in purchasing this film, you can do so at www.hartleyfoundation.org. Just click on “Masterworks”on the homepage for more information. The cost of the DVD is $29.99.

Sarah Masters is the Managing Director of the Hartley Film Foundation, a non-profit foundation dedicated to cultivation, support, production and distribution of the best documentaries and audio meditations on world religions, spirituality, ethics and well-being.

Book Review

The Rev. Dr. William Zeckhausen reviews

Letters to Sam: A Grandfather’s Lessons on Love, Loss,
and the Gifts of Life

For twenty years, Dan has hosted a psychology call-in radio show, “Voices in the Family,”broadcast from Philadelphia’s NPR affiliate. For ten years, he has written a column for the Philadelphia Inquirer. Through letters and persons calling in, plus his psychotherapy practice, he has listened, observed, and learned about the cruelties, courage and compassion that touch us all. And as he writes in his introduction, “Books taught me a bit about psychology. But paralysis taught me to sit still and keep my ears and heart open so I could listen.”

You see, Dan has also for over twenty years of his fifty plus years been quadriplegic. In his introduction, Dan explains that quadriplegia puts the body at risk, and he feared he wouldn’t live long enough to share with his grandson Sam lessons of life, or to be known by him. When Sam was two, it was discovered that he was autistic. Dan wrote: ”I wept for Sam. I realized that I had more than ever to tell him. . . I wanted to teach him what I’ve learned about fighting against the kind of adversity that I face almost daily and fear he will face also. And I wanted to tell him how peace often happens when we simply stop fighting.”

I have heard Dan speak at two Healing and Spirituality Conferences, so I know his ability to penetrate our defenses and reach those soft spots that many of us intentionally or unconsciously hide, i.e., the very places where we are most deeply human, compassionate, sensitive, and wise. So it’s not surprising that Dan is able to do the same in his writing. Nor is it surprising that his publishers believe the books coming impact will be similar to “Tuesdays with Morrie”. David Elpern, M.D., who has created physician wellness conferences over 20 years that included countless nationally recognized presenters, describes Dan as a modern day Buddha.

At one Conference where Dan presented, he told about how after his accident he didn’t know if he could make it as a quadriplegic, nor if he wanted to. But he would give it two years, and decide whether to go on, or check out. After two years, he had a conversation with his god, not the god of his religion, but of his spirit. He asked his god if god would give him the hope that he might be cured. His god said he wouldn’t, so choose. He tried again, and asked his god if he would give him the hope of good health. And god repeated the previous answer. His god then said to him, “There is only one thing I expect from you, which is faithfulness, and one thing I will promise you, which is presence.”

Dan also said his struggle before his accident was to be part of the “in”group. But after the accident, when sitting in his wheel chair, he noted that most people would not look at him, as though he were a non-person. He understood that. He was everyone’s worst nightmare, being helpless and dependent, 24/7. He realized he could never be part of the “in”group…which freed him, to be himself.

Dan’s speaking, and his writing, have the potential to enable us to find, enjoy, and live our deepest self. Dan is truly a powerful wounded healer. In Letters to Sam, Dan writes to all of us.

Dan Gottlieb, Ph.D., Letters to Sam: A Grandfather’s Lessons on Love, Loss, and the Gifts of Life (New York: Sterling, 2006) 178 pp.

Do you have thoughts about these reviews you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org