PlainViews

Chaplain Joan Keiser on the power of the unspoken word

Do You Hear What I Hear?
Listening with the Heart

I received a page to the Emergency Room: a two-month old baby was arriving, coding. My thoughts were focused on how I would find the baby and the parents. What I had not considered was that the parents would be deaf.

The baby was in an exam room with the medical staff working to resuscitate her. I went to locate the parents who had been placed in a consultation room. The local police had been called to the home so they were on site and outside of the consultation room. I learned that a person would be arriving soon to sign for the parents. As I started to open the door to check on the parents, I was told by the officer that it might be best to wait for the person that could assist us in communicating with the parents.

I chose to open the door and check on the parents. As I opened the door, I saw the mother and father clinging to each other and heard them sobbing uncontrollably. I walked over and wrapped my arms around them. The mother, I discovered, could read lips and speak some. I told her who I was and that we would get them back to see the baby as soon as possible. She thanked me and hugged me. They needed something to drink, some tissues for their tears and someone to be with them in their grief and waiting. This was their child they had given life to.

The person who came to sign for the parents had been with them when their baby was born. That was a real blessing as they were familiar with her. The baby did not survive. When I asked the “caring question”about tissue donation, I was very touched that the parents immediately said: “Yes.”The baby was eligible to donate heart valves—a beautiful gift.

As I reflected, I thought about cultural diversity and how many times we think of it in terms of language—the spoken word. I thought about the message that a simple act of kindness such as a “cup of cold water”can convey without spoken words. The language of love and caring can be communicated in so many different ways.

Being gifted with hearing, I wondered what it would be like to never hear your baby cry, laugh, or utter sounds of contentment?

I cannot imagine what it must be like to live in a “world of silence.”Most of us seek silence because of all the noise we are exposed to as we go through our daily lives, but what if that was a way of life for us? I also thought of how God speaks to us through the silence. I believe there are blessings for those of us who can hear with our ears and for those of us who hear with our hearts as well.

I am thankful for the many ways that Chaplains hear the needs of others.

Chaplain Joan Keiser has been the chaplain at St. John's Hospital, Springfield, MO, for the past 10 years. She completed her four units of CPE at St. John's Hospital. Joan has a certificate of Religious Studies from Loyola Institute for Ministry, Loyola University, New Orleans. She is a Certified Lay Speaker and is commissioned as Lay Missioner with The United Methodist Church, Missouri Conference. Her areas of hospital ministry are: Neuro-Trauma ICU, Neuro-Intermediate/Stroke Center, Breast Center, and Endoscopy. Joan also serves on the Springfield Stroke Coalition and is a member of the Mid-America Transplant Collaborative for Organ Donation, representing St. John's Hospital. She is currently applying for Board certification. She is married, has two children and six grandchildren.

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At the recent APC Conference, a colleague said with passion, "We shouldn't have volunteer chaplains. We don't have volunteer doctors. We don't have volunteer nurses." This colleague was not the first I have heard make this assertion.

But in fact those professions have developed levels of practice, with varying levels of training, responsibility, and licensure. RN, LPN, Nurse Tech, and Certified Nurse Aid each has its own level of function.

These distinctions grew out of a model of bedside nursing defined by hands-on care. While there are exceptions, much of the hands-on care has been delegated to less-trained but supervised practitioners –including volunteers. Passing ice water, transporting patients, organizing blank forms, distributing literature, delivering meals, feeding patients –these are all functions delegated by nurses and all are done, at least sometimes, by volunteers. Yet they are still considered nursing functions.

Do chaplains have this separation, this designation of levels of function? At first it would not appear so. However, that reflects our failure to recognize ourselves within the context of ministry. The normative context of the believer is the local congregation, and the normative clergy is the clergyperson of the local congregation. Like the registered nurse, there are a variety of educational paths to becoming a clergyperson in a congregation, depending on the specific requirements and culture of each faith community. Still, there is so much in common across those specificities that ecumenical community clergy groups can become important sources of support.

I would suggest that we think of ourselves as are advanced practice ministers. There are others—academics, spiritual directors, monastics—but that is where we are in the context of ministry.

Where does this put us in the context of health care? Our peers in medicine, nursing, and elsewhere have found it necessary and appropriate to develop “extender”roles, some licensed or registered, and some that can be filled with trained, supervised volunteers. We should not be surprised if some expect us doing the same. We would do better to follow the practice of our professional colleagues by ensuring that we take responsibility for training and supervising the volunteers we use to extend our ministries. This would address the expectations of some administrators that “any sincere believer”can appropriately meet patient needs. It would establish that professional chaplains, as advanced practice clergy, are best trained and suited to direct and oversee spiritual care in our institutions. It would allow a more pervasive experience of pastoral concern in many of our institutions, while allowing us perhaps greater opportunities to prioritize, establish boundaries, and care for ourselves.

It would also, to some extent, take us away from the bedside. For many that is already an established fact. Supervising the ministry of others is different from providing ministry ourselves. However, as professionals in health care and as advance practice clergy we are uniquely suited to shape the culture of care in our institutions. We are specially prepared to respond to those situations that are medically, spiritually, and morally most acute. These are functions of our practice that we cannot delegate. Extending ministry as a part of the culture of care through proper use of trained, supervised volunteers is an opportunity to extend spiritual care within our institutions while maintaining those professional pastoral functions for which we are uniquely suited.

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According to a 2000 census, there are 1.9 million Asian Indians living in the United States. We are the third largest group (after the Chinese [2.7 million] and the Filipinos [2.4 million]) and one of the largest growing populations [1]. Consequently, it is likely that all chaplains will have opportunities to offer pastoral care to Indians. I offer these reflections to those of you who are non-Indians to consider when you care for compromised individuals who live in an India-based culture while also in the U.S.

In 1993, when I first came from India, I experienced a big cultural shock. Among the many ways that life here is different is the fact that the elderly tend to live alone, even when they have a handicap. This still puzzles me.

Two months ago, I chaplained a 55-year-old female patient. In our pastoral conversation, she mentioned that her mother-in-law has dementia and lives alone. Her husband calls his mother every evening to ensure that things are going well. Over the phone, gives his mother step-by-step instructions for preparing dinner: go to the refrigerator, remove dinner, microwave it, and eat it. My patient also mentioned that she visits her mother-in-law often to help her. Their home is only 15 minutes away! This was strange to me because, in Indian culture, elders are never left alone. The son would either live in his mother’s house or move her in with him.

A few weeks ago, I provided pastoral care to an 84-year-old female patient who went blind seven years ago from glaucoma. Her children live elsewhere. I was shocked to hear that she lives alone. I could not imagine how she could learn life all over again—at her age—with this handicap.

At times I feel sorry for these elderly folk. However, they do not seem to feel sorry for themselves. I asked the 84-year-old blind woman, “How do you manage to live by yourself?”I was surprised to hear the answer. “I have no problem; I have been living in this house for 40 years. I know where things are.”I said, “I would not be able to do that.”She replied, “Well, when there is a need, you will learn.”This was a good learning experience for me.

In my chaplaincy work and in my life in the U.S., I also come across many young, single men and women who live alone. This is also very foreign to me because, in Indian culture, few live alone. Young people usually live with their parents until they are married–and few remain unmarried. Often, a married couple continues to live at home until the next son gets married.

[1] Satya R. Pattnayak. “Challenges for Asian Indian Americans in the 21st Century”(www.nriol.com)

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The creek was confined and could only flow where the banks directed it;
There were large rocks in it;
A dead tree stretched to the middle;
A shoal heaved the water above its natural flow.

Did any of these elements destroy the water or alter the purpose of the creek?
No! Instead, as the water swayed from bank to bank, it gently soothed;
As it meandered around the large rocks, it gathered beauty;
By flowing under the dead tree, it lifted the tree, keeping it afloat.
As it cascaded the shoal, the water leaped with joy and
playfully splashed down again to be carried to another place,
another time where other unknown circumstances lie in wait.

I saw a creek which held a bounty of wonder, joy, and pleasure
created only by the things which disrupted it.

As my life is confronted by obstacles which cannot be avoided,
may I show to others

My wonder, not my worry;
My joy, not my grief;
My pleasure, not my pain;
May I show to others my Heavenly Father!

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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.

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.

With the recent decision by the Louisiana Attorney General to ask a grand jury to indict a doctor and two nurses for "administering lethal doses" to patients who were under their care during the aftermath of hurricane Katrina, we thought we would invite chaplains to comment on the situation. For those of you not familiar with the situation, we will give you the "details" as they were presented in The New York Times (July 20 & 21). Since there has not been an indictment nor a trial, no "facts" are yet established. The "details" below are those that have been released to the public.

It is 4 days after Katrina. The temperature is over 100 degrees and 5 feet of water surrounds the hospital. Only one wing remains usable for patient care. Most patients have been evacuated but the most acute have been moved to the available wing and left with the staff that agreed to stay on duty. Over-heated patients are dying. Medicines are running low and there is no electricity. Machines that are being used to keep patients alive are running on batteries and the batteries are beginning to run out. There is no way to know if or when the remaining staff and patients will be evacuated. The doctor who has stayed pulls you aside and asks you to consider the alternatives she and the medical staff have for caring for these acutely ill patients in this crisis situation.

What is your role as chaplain to this doctor?”

As the chaplain, how would you approach a discussion about making the patients "comfortable," even though it might hasten their death?

What is your role with the patients? The rest of the staff? Does this particular crisis make your role different than it is under "normal" hospital conditions?

My first priority would be to assess the doctor. Is the physician in seeking an ethical consult asking indirectly for emotional spiritual and physical relief? The fatigue and stress in such a setting could well take a bitter human toll on the caregivers. The doctor may need more support for personal suffering than advice on the management of the patients' suffering. The first ethical question for me then is "Does the doctor need to be rescued?"

While as a culture we can easily understand the failure of machines and the final consumption of supplies, we are less likely to accept failure in our caregivers. Yet it is not impossible for me to imagine that the doctor can be in very real danger of failure and at some point the welfare, perhaps even the survival of the physician and staff, has to be triaged into the scenerio. Lacking clear guidelines, the immediate leadership may need to rethink the situation. Did their willingness to stay and care for these most fragile patients imply an expectation that the staff or any of its members would give the best possible care or to give it all?

To my thinking, the best possible care does not include self-destruction and the physician should not be asked to choose between the barest minimums of self care and patient welfare. The life of a patient does not take priority over the life of a doctor. Heroic measures should not include physical, emotional or spiritual martyrdom for the caregiver. And if, at the moment when the staff reaches the conclusion that euthanasia is the only remaining option for best possible care, then I believe they would have fulfilled their oaths and their obligations to their patients.

I can imagine that my response in this situation would depend in large part according to the degree to which staff are open to being companioned and the level of acuity in the remaining patient population.

I would see my role to the healthcare team as both a member of the team as it affected patient care discussions and distinct among the team, being present to help the remaining doctor and the rest of the staff name their own experience in the moment. Naturally this sort of debriefing would have to be bracketed, but enabling the team to speak to their experience could also be huge, in terms of caring for the team. Likewise, I would see my role with the patients as helping them speak to the present moment and enabling them to claim their spiritual needs and attending to these needs as best I could.

Ideally my input to the team would be in the context of some sort of consult in which a range of ethical considerations would need to be brought forward, beneficence/non-malfeasance, common good and autonomy playing a large role, but common good would seem, in some ways to be the driving ethical consideration. There are limited resources, people are dying, people are going to die but all deserve to be treated with respect and dignity. And, all deserve the best care that can be given to them as best as the situation and resources allow. There would be a natural role here for Palliative Care, including comfort care that might hasten death.

Does this particular crisis make my role different? Yes and no. None of the principles/practices are different from every day practice; however, given the situation tension and anxiety must be higher with more immediately at stake.

Andrew Schoenfield, M.Div.
Priest-Chaplain, Archdiocese of Seattle
Department of Spiritual Care
Harborview Medical Center
University of Washington Medicine

Although it is important to consider the ethical and legal questions that arise from this case, we must also consider the luxury we have of looking at this situation from a distance. In the days after Katrina
our healthcare colleagues on the Louisiana, Mississippi, and Alabama Gulf Coast faced emotional, spiritual, and physcial distress that is unimaginable to those of us who were not there. We who look at the situation from a distance can only speculate how we might react in such a situation. One would hope that our ethical judgement would remain intact or even be enhanced under such stress. But how can any of us who were not there know for sure? This uncertainty does not excuse illegal or unethical actions, but does remind each us of how easy it is to judge from a distance. We also cannot escape the questions of social justice that arise from this case. Why were people not evacuated sooner, thus leaving the healthcare community in such a situation? Were the poor and disadvantaged left to bear the brunt of the hardship? If wrongful acts were committed, do we as a society share the responsibility? What is our societal responsibility to the victims of this crisis? What is our societal responsibility to protect others from ever having to face such a situation again? Hurricanes Katrina and Rita have called us to an examination of our ethical barometer as a society.

We all are servant of the living God but was it ethical to respect the life and dignity of a person or are we acting like gods? We know when the conditions are dificult we have to make dificult decisions but the best is ask our self is it correct to kill? We all know the answer so was it an bad decision. Yes we can't play the paper of God even in bad situation we need to depend in his grace an do our best and wait for him to act and then he will show us an better way.

Pastor Samuel Santos, Gods servernt and yours.
Iglesia Evangelica Bautista de Bayamon Inc.
Bayamon PR

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

Thomas Merton, hailed as a prophet by some, censured for his outspoken social criticism by others, was a Trappist monk, student of Zen teachings, and author of writings on both Eastern and Western spiritual thought.

Dr. James Finley, who lived with Thomas Merton at the Abbey of Gethsemani near Bardstown, Kentucky, explores in this 8-hour CD set his memories of the renowned monk and his writings. They shared the traditional Trappist way of life involving prayer, silence and solitude. During his years at Gethsemani, Merton evolved from an inward-looking monk to an internationally recognized writer and poet who promoted dialogue with other faiths. Merton also advocated for non-violence during the Civil Rights era and Vietnam War. Chaplains may find of interest Merton’s internal struggle between his desire for a quiet, contemplative life and his need to heed the call for dynamic contact with the outside world, in Merton’s case through international travels to meet with religious leaders such as the Dalai Lama.

The title of these musings on Merton are attributed to the Taoist sage Chaung Tzu, who described the “the Palace of Nowhere”as a place “where all the many things are one.”In Path to the Palace of Nowhere: the Contemplative Teachings of Thomas Merton, Dr. Finley uses Merton’s spiritual teachings in an interactive way to guide the listener “to disappear into G_d, to be submerged into his peace, to be lost in the secret of his fact,”a place “where all the many things are one.”

Completed: 2002
Running Time: 8 Hours –8 CD set
Publisher: Sounds True, Boulder, Colorado

If you are interested in purchasing this audio series, you can do so at www.hartleyfoundation.org. Just click on “Sages of Our Age”on the homepage, then scroll down and click on Thomas Merton for more information. The cost of the audio series is $69.95 for an 8-CD set.

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.

Barbara Brown Taylor tells a searchingly honest story of her struggle between wanting to serve God as an Episcopal priest and wanting to love God as one of God's beloved children. She had no idea at first that the two desires are in conflict, but over time she found that they are. This book is her account of that profoundly wrenching conflict and how she has tried to resolve it.

Taylor, who as a child first fell in love with God as revealed in the beauty of nature, became a famous preacher and famous writer in the Episcopal Church. She describes how much she loved the people both in and out of the churches that she served. She also describes how much she loved God, and how the busy-ness of her ministry came between her heart and God. As Taylor writes about her own sharply curtailed spiritual practices during the height of her busy-ness, "I pecked God on the cheek the same way I did [husband] Ed, drying up inside for want of making love." Finally she got to a breaking point, and she chose: she ceased her "professional" ministry and became a college professor of religion. And after a dark night of the soul she found herself where she believes she needs to be -- back in "right relationship" with the Divine. But this all came at a high price. She is quite unsparing in her description of what she's lost as well as what she's gained.

She's also eloquent about the pressures on the Episcopal Church and sounds a prophetic warning about its future if it continues in the hierarchical way it currently follows.

The relevancy of this book for chaplains should be readily apparent. Most of us are drawn to chaplaincy at least in part as a way of serving God through serving God's people. Yet as time goes by we find we get busier and busier, often so busy that we skimp on our own spiritual practices. Burnout, compassion fatigue, and/or depression can result. This is a sobering book to read, and an important one. It calls us back to making love.

Barbara Brown Taylor, Leaving Church: A Memoir of Faith (New York: HarperCollins Publishers, 2006) 256 pp.

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