PlainViews

Caroline Walles on Disaster Chaplains who provide Spiritual First Aid

The "Dance of Disaster"

For almost three years, Nebraska has been viewing disaster behavioral health as an integral component of the response which takes place at the time of a disaster. In fact, the need for disaster behavioral health as part of the immediate or first response to a disaster has been written into the state’s formal disaster plan. However, because there is a shortage of behavioral health providers in Nebraska (88 of 93 counties are considered shortage areas) partnerships with “natural helpers”–including clergy and faith leaders –are being forged. Out of this necessity has come the Nebraska Disaster Chaplain Network, a creative expansion of the first responder resource pool.

Disaster Chaplains are providers of “Spiritual First Aid.”In essence, they are like providers of physical first aid –recognizing that they do not have the qualifications of CPE trained chaplains –but they do have the capacity to be present, listen, support and comfort. They have to undergo an elaborate screening process, including an interdisciplinary interview, a background check and an agreement to abide by a code of ethics and guiding principles which establishes that proselytizing is not acceptable.

There is a body of disaster spiritual care training material available, and over the course of the next few years we will attempt to incorporate that into our regular training schedule. There are other key components of disaster spiritual care that are not easily captured in a curriculum formula; the ability to not be overwhelmed by the chaos; the ability and willingness to network with a broad array of other responders and build those relationships; and the capacity to recognize that no matter how much training you have, you will be affected by the disaster. In Nebraska we talk about the “Dance of Disaster,”which means that we are flexible in our relationships and graceful with everyone we encounter –and especially with ourselves as we grow into this ministry of caring for others.

The Nebraska Disaster Chaplain Network is in its infancy. There are many lessons yet to be learned, and many relationships yet to be developed. The cadre of chaplains who are currently credentialed is small, but growing. There is an understanding that the question is not “if”a disaster will happen, but “when”will the next disaster occur, and “where.”Many of those who want to join the network feel that they have not been adequately trained for this ministry, and are anxious to learn more and apply it, even in the everyday small scale critical incidents which confront their congregations and communities. We are learning that we will never be fully prepared –but even that knowledge is an important part of the process of becoming a Disaster Chaplain.

Caroline Walles works with Interchurch Ministries of Nebraska as a liaison between community organizations and the faith community. She also works as a research associate at the University of Nebraska Public Policy Center, with a special focus on the development of the Nebraska Disaster Chaplain Network. Caroline has completed advanced training in STAR (Strategies for Trauma Awareness and Resiliency) through Eastern Mennonite University. This training has created a lens through which Caroline recognizes that the trauma of disaster calls for spiritual care. Caroline and her husband Harry live in Lincoln, regularly visited by their four grandchildren –who bring love and laughter into their lives.

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Editor’s Note: The European Network for Health Care Chaplains (ENHCC) held its 9th consultation in Lisbon, Portugal from May 18-21, 2006. Fifty-one representatives of chaplaincy organizations from 27 European countries gathered in a charming retreat center of the Franciscan sisters in the Lisbon hills.

The central theme was: Building Bridges - Growing Hope. APC had two observers in Lisbon: Jo Schrader and George Burn. George continues his dialogue about his experience in Lisbon with Anne Vandenhoeck, committee member of the ENHCC and representative for Belgium.

Anne, in what ways do you feel that we in the US, can be most helpful in support of the promotion of chaplaincy in Europe?

First I want to express here how proud I was that we managed to work, pray and share together for three days despite having so many languages, and having four different religious traditions present (Protestant, Catholic, Orthodox and Muslim) and having such cultural differences. Imagine 27 countries! But what unites us is stronger and bigger than what divides us. We were overjoyed that for the first time the Russian Orthodox Church was represented. They even brought their own translator to Lisbon!

I think the U.S. can be most helpful by sharing its research in the field of chaplaincy, by supporting the European chaplains that come to the U.S. to learn and by learning from us, too! I think we can learn from the standards you developed, from the way chaplains are integrated into care teams, and from the way you are organized and certified.

My guess is that you can learn from us how to deal with secular societies and how to get integrated on a political level in health care, especially in palliative care. Would you agree on that, George?

I couldn't agree with your more. Not only can we learn from you in the ways that you deal with secular societies, but also we can learn about how Europe has dealt with integrating a multicultural approach to pastoral care. I was most impressed with the leverage that the Eurochaplains have within the European Union in terms of modeling palliative care and initiating the dialogue about this state-of-the-art practice at the highest levels of government. I also feel that, as a growing organization, you are feeling the financial burden of supporting those who are recovering from the era of Soviet domination. I for one am committed to raising funds to support your efforts and, as I mentioned in the closing session, my plan is to post a figure on our U.S. Chaplain's listserve and challenge our organization to provide matching funds.

There is an additional thing that I learned at the conference, one that needs to be addressed in each of our minds. The world is growing smaller. It is changing rapidly and often in conflict. I believe that we as chaplains are uniquely positioned to assist by being interpreters of change to the people we serve, and I believe it is imperative that we understand the implications of changes that affect all of us by creating these opportunities for dialogue between the U.S. and Europe. Therefore, it is my intention, if I am invited once again, to attend the next session in Estonia in 2008. My hope is that the ENHCC (and I will try to promote this from our end) will also be given an opportunity to address the APC convention in Burlingame California in 2007, perhaps formally but also informally. PS. Please bring more chocolate!

Consider it done, George! All the participants of the 9th consultation wish to thank you and Jo Schröder for your time, your enthusiasm, your sharing and your presence! See you in California or Estonia!

Anne M. Vandenhoeck, a member of the PlainViews Advisory Board, is a research assistant at the Faculty of Theology, Department of Pastoral Theology, of the Catholic University of Leuven, Belgium. Her academic formation includes a master degree in Religious Studies and a master degree in Theology. A Catholic lay woman, she served as a chaplain for more than 13 years in several hospitals in Belgium and the United States. Currently she divides her time between working on a PhD, teaching Pastoral Theology and supervising theology students. She is a CPE supervisor in training. Anne is a member of the European Network of Health Care Chaplaincy.

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In my first unit of CPE, my supervisor asked, “What would you like to learn?”

What in the world, I thought! How am I supposed to know what it is I want to know when I don’t know what I am supposed to know? I was called by God to do this? Can I just become the best chaplain that I can be? Will you please help me learn how to do that?

I soon discovered my blind spots, growing edges, CPE levels I & II, the art of the spiritual assessment, the clinical method of learning; action, reflection, and new action. I was inundated with all types of formulas about how to become a chaplain. I was blown away.

Then my supervisor said, “By the way, did I tell you that you have to write verbatims reflecting conversations that have taken place between you and a patient?”

What??????????? I can’t even remember what I was supposed to get from the grocery store three minutes ago and you want me to remember intrinsically what took place between myself and someone who was in pain, suffering, and possibly medicated! I’m sorry, but did I mention that I was called by God to do this?

“That’s nice,”my supervisor said, “but let’s work on these learning goals.”

What! There is more than one goal? Oh boy, I thought, I’m really in trouble now.

Then I heard: “Did I tell you that you also have to learn to disclose who you are, what you are, and how you are? OK, sit down, catch your breath. But, how old were you when that happened and how does that impact upon who you are and how you will chaplain others? In fact, who are you?”

Excuse me! But, I am pretty sure that I mentioned that I was called by God to do this.

“That’s nice”my supervisor said, “Why don’t you say this about that and why did you say that about this? You have great potential to be an effective chaplain—if you would just work on these 102 small growing edges that I have outlined for you.”

My initial notion was, “What happened to the rule, First do no harm, because you are killing me.”But I decided to save that for this thing called IPR.

“Hmm …we really need you to work on your feelings. In fact, how do you feel in this moment?”

“That is a good start. Tell me, do you remember the first time you got angry? If you don’t remember, what are you suppressing? Let it out. Let your emotions flow. Stay in the moment.

Excuse me, but I’m positive that I told you that I was called by God to do this.

”I am so happy for you. Now, if you would just work on that and consider this, it would help you profoundly in your pastoral formation.”

Pastoral formation? What’s that all about? I want to be a board certified Chaplain, not certified in an insane asylum!

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The motel cleaning staff received no response to their knocks. After unlocking the door, they found a woman unconscious. Police and Emergency Services were called. The paramedics immediately intubated her. Upon arrival in hospital it was determined she had no spontaneous respiration, no gag, absolutely no neurological response; she had track marks over her arms and legs –urine cocaine screen was positive; she was thin, her body was dirty, her hair was tangled.

L. was 39 years old. She was someone’s daughter and sister; she had been a wife; she was a mother; she was God’s child. Initially, as she was moved from the ambulance, to the Emergency Room to the ICU, she was called the “39-year-old addict.”

How do we look at the “other”? Why does society need to have the “other”? Who becomes the “other”? Is it the person of different color, the person of different faith? Is it the person with AIDS, or is it the person with drug addiction? In the few hours she spent in our intensive care unit, staff were moved one step closer to care that held no judgment; we were professional as expected. God’s grace allowed us to have compassion for her, for her family and for each other.

Her 14-year-old daughter lay prostrate over her: “Mommy, please don’t die, Mommy, you said you’d get better this time.”Her son sat on a chair, crying, crying, ”It’s just not fair.”Her sister, long estranged, wept over the pretty child and teenager she had once been. Her father spoke about how tired he was. Over the years he had battled in court for custody of the children; each time she had entered treatment he had been filled with hope –maybe this time, maybe this time she’ll be strong enough. “Do you know what my daughter does to pay for her drugs? I’m not naïve; can you understand what she’ll do for drugs? Will you help us pray? Let God have her back, let her finally be at peace.”

“God grant me the strength to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference.”Neibuhr’s words are prayed at the end of all ‘meetings’but on Monday morning they were the strength this family needed to accept that L. could not recover and that life support measures had to be withdrawn. The family remained with L. as each drug was discontinued; each machine was stilled. The respiratory therapist removed the intubator and, for a moment, all tears stopped. The room was absolutely still.

Hope is one of the twelve steps. We are a people of hope. When we can no longer hope for recovery, we hope for forgiveness; we hope for the life to come.

Be at peace, L. Your struggles are over. May the Lord’s great name be blessed forever and ever. Amen.

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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.

Louisiana’s attorney general is capitalizing on a national obsession to “blame, slander, and sue”as he second-guesses the decisions of medical personnel at New Orleans’Memorial Hospital during the Katrina crisis. PlainViews CaseConference # 11 outlines the situation.

Why are actions of a doctor and two nurses who voluntarily remained with critically ill patients of greater concern than the inaction of absent primary providers responsible for the patients who died? [1] The ethically challenging questions center not on the professionals who stayed at Memorial, but on those who left –doctors, nurses, technicians, chaplains, administrators.

What prompts some people, with or without specialized skills, to choose to assist in crises? What ethical and legal precepts support or discourage assistance?

If an adult passively watches a child drowning in shallow water, people are horrified. Most assume the adult has moral and legal duties to rescue. While the former surely exists, in most U.S. jurisdictions no legal obligation attaches absent a special relationship between child and adult.[2] Unlike France, Portugal, Spain and other European civil law countries, neither U.S. common nor statutory law requires assistance to endangered persons.[3]

Historically, helping the stranger in distress has been a religious or moral precept, not a legal imperative. In the Good Samaritan parable (Luke 10:29-37), neither priest nor Levite violated Roman law by ignoring the wounded stranger. As Jews, they transgressed the commandment –neither shalt thou stand idly by the blood of thy neighbor (Leviticus 19:16). However, they did not risk criminal sanctions because “their breach involved no action.”[4] Medieval English Common Law and its modern U.S. progeny follow the Roman model.

American “Good Samaritan statutes”do not compel action. They provide immunity from liability for voluntarily assisting someone in distress.[5] Autonomy –an individual’s right to decide whether or not to intervene –trumps beneficence. Individual rather than communal interests are preferenced.

1. Can any person, with or without specialized skills, be expected to make uniformly “perfect”decisions in highly charged, even toxic, emergency situations? If so, will prudent persons decline to volunteer assistance in high-risk environments?

2. In war zones, wider latitude of judgment is given to soldiers who “mistakenly”kill civilians than when such killings occur during peacekeeping missions.[6] Should similar latitude apply to decisions of medical personnel during systemic crises?

3. Should Good Samaritan statutes be re-written to include professionals in medical facilities during times of local/national emergency?

4. At what point are the values of patient autonomy and informed consent subsumed by safety and survival concerns of other patients or even medical providers?

5. What would it say about our national character if Thomas Aquinas' theory of "double effect"[7] were assumed to apply to the Memorial doctor's action rather than the attorney general's theory of homicide and, as a result, the prosecutions were suspended?

6. In the fourth Christian gospel, Jesus admonishes, “Let he who is perfect cast the first stone”(John 8:7). What response does your faith tradition suggest to the prosecution of those who made decisions most of us will never be forced to consider under circumstances most of us would have chosen to escape?

[1] Twenty-four of fifty-five patients who died, including those on whose deaths the prosecution focuses were patients of Life Care, a corporation separate from but using Memorial’s facilities. Life Care’s chief administrator and medical director were not at Memorial during the crisis. Memorial’s staff was caring for Life Care patients. The New York Times, 08/01/2006.
[2] A parent or other caretaker is expected to rescue a child unless to do so would cause that person’s death or serious injury.
[3] The majority of U.S. jurisdictions provide no legal duty in civil law to assist another in danger, “even though a moral obligation might exist. This is true even ‘when that aid can be rendered without danger or inconvenience’to the potential rescuer.”8 Touro Int’l L. Rev.93 (1998) [FN 11] Exceptions to the above do exist in seven relationships: (1) duty based on personal relationship (parent-child); (2) duty based on contract (physician to patient); (3) duty based on creating the risk (driver who hits jogger); (4) duty based on voluntary assumption of care (once rescue is commenced); (5) duty based on statute (hit and run accidents); (6) duty to control the conduct of others (employer to control harm to others from employees); (7) duty based on being a landowner.
[4] Kirschenbaum, Aaron J.D. The Bystander’s Duty to Rescue in Jewish Law, citing Maimonides (1135-1204) Code. www.daat.ac.il/daat/kitveyet/assia_english/kirschenbaum.htm
[5] In 1959, California legislated the first Good Samaritan law. All states followed. The intent was to encourage medical professionals to render care in emergency situations outside a hospital where limited resources and adaptation of skills would affect quality of care. Providers were immunized from resulting problems as long as: (1) the situation was outside of a hospital and a genuine emergency –loss of life or limb at stake; (2) no remuneration was expected; (3) care was given in “good faith;”and (4) once commencing assistance, personnel remained until someone comparable took over. Eventually, most states extended this legislation to non-medical providers of emergency assistance with the criteria adapted appropriately. [Ordinary negligence standards apply and may be waived for ordinary citizens whereas gross negligence standards may apply to medical personnel unprotected by Samaritan statutes]. Cf: Good Samaritan Statutes: Are Medical Volunteers Protected? Cameron DeGuerre, www.ama.org/ama/pub/category/12191.html. The medical actions at Memorial are outside Good Samaritan protection according to Louisiana’s statute LSA-R.S. 37:1731.
[6] An investigation cleared the U.S. soldiers who shot and killed the rescuer of an Italian journalist when her car sped towards a check point in Iraq in 2005.
[7] “Double effect”principle holds that actions may have both good and bad effects. If the intention is for the good effect and it outweighs the bad effect (which must be tolerable, foreseeable and unavoidable), one can engage the action. This theory supported the U.S. Supreme Court decision in 1997 which said it is acceptable to sedate a dying patient even if unconsciousness follows. The same decision prohibited physician-assisted suicide. Many medical ethicists weighing in on the Memorial prosecution argue that the drugs found in the four patients in question fit within this principle and practice. Cf. "The Fuzzy Gray Place in the Killing Zone," Denise Grady, The New York Times, Sunday, August 13, 2006, Ideas and Trends section.

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.

A 16-year-old delivered a baby by caesarian section. The baby had cardiac anomalies which were discovered earlier in the pregnancy.

A large number of persons were present with her and the father of the baby at the hospital. The family identified themselves culturally as Gypsies.

After delivery, the baby was transported to the Nursery Intensive Care Unit. While numerous family members remained in the hallway outside the LD operating suite, several others went to the NICU demanding to see the baby.

Staff in both units attempted to explain the need for family to wait in the designated waiting areas, to lower their voices, and that medical information about the baby's condition could only be provided to the parents. Family members, including the patient's mother, became even more vocally upset in the units and connecting hallway. The nursing supervisor paged the chaplain to respond.

Does the fact that the family "members" identify themselves as Gypsies affect how you deal with them?

My obligation to staff is to help them deal with patients and families. I believe staff has called me because the family is less likely to see me as aligned with NICU/LD. The staff hopes I can bring peace to the group.

My obligation to Pt and family is to provide spiritual care within the context of their culture-as nearly as possible--and to help negotiate between them and hospital "authorities/rules."

Sometimes crowd control IS a chaplain's business; sometimes not. In this case, I believe I am obligated to try.

The fact that the group self-identifies as "Gypsy" raises some possibilities in my mind, based on "generalities" I have read about Gypsies, and based on the behavior (as reported to me) of these Gypsies:

1) Gypsies stick together, in loose family groupings, trying to be autonomous from the Dominant Culture
2) Often there is mutual distrust between Gypsies (counter-culture) and the Dominant Culture
3) Dominant Culture acquiesces to "appeals to logic;" and thinks Gypsies don't "act right"
4) Gypsies have been frequently persecuted
5) Gypsies have a reputation-deservedly or otherwise-of lying and stealing (which, of course, raises the question of what "careers" that fit within their culture are available to them... Which came first--?)

All of these things suggest that the people outside NICU and LD are probably behaving in a culturally correct manner. They are worried about mom and baby, and wonder what is going on that they cannot see. They may wonder whether staff is treating mom and baby properly, if staff really cares about a gypsy mom and baby. They truly do not understand somebody's "rule" that the family cannot be with young woman and baby. Their culture says they should be together. Being together may be more important than specialized medical care. They are probably fighting the "rational logic" of the Dominant Culture with their own tactics, that are based on the truth inherent in this statement: "When (a minority) gets loud, white people get nervous."

My first tactic would be to do my own assessment of noise-level and "disruption."

Next, I would want to locate the cultural "leader" and talk to that person. What are the issues? What is at stake? What needs to happen?

Finally, I would offer to serve as the go-between or negotiator between hospital and Gypsy cultures: How can each "side" flex in order to reach a mutually agreeable solution?

Chaplain Kate Zon
Carondelet Health's Saint Joseph Medical Center
Kansas City, MO.

Christian Mysticism and the Monastic Life heightens spiritual awareness through words handed down from the great Christian mystics. Narrated by Gordon Gould, these messages are intercut with breathtaking footage filmed close to three decades ago of beautifully maintained cathedrals and monasteries in Europe and the U.S. and of cathedrals in ruins.

The monastic belief that love leads to enlightenment shines through the serenity of the monks featured in Christian Mysticism and the Monastic Life, through the rituals of their daily life and their openness. The monastic life is also beautifully illustrated in this film through their music and spiritual appreciation of their environs.

Scenes in Christian Mysticism and the Monastic Life of monks gardening, creating stained glass windows, milking cows, and in solemn chapel prayer illustrate in a vivid way the belief that contemplation and work are paths to God. Chaplains will find solace in this visual meditation on the monks’belief in “a union too overpowering to express in words.”

If you are interested in purchasing this film, you can do so at www.hartleyfoundation.org. Just click on “Hartley Classics”on the homepage for more information. The cost of the film series is $19.95 for a VHS.

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.

Deborah Patterson has written a book which is “a source of healing and peace for you and those with whom you minister, as one of God’s healers, in a world so much in need of the gifts that you have to share.”(Pg. 10) Through her nursing and theological perspective, she has written an easy to read and practice resource for those in parish nursing as well as in caring ministries in local congregations. While written from a Christian perspective, she invites the reader to adjust the meditations and prayers for multifaith use. She has divided the book into two sections; one on meditations and one on prayers. These can be used with individuals or in services.

The framework for the meditation portion of the book is an identified theme, scripture, a brief meditation with relevant theologians and writers, and a closing blessing for the reader. From her personal and professional life she draws stories that demonstrate her theme. Themes include hospitality, relating with the stranger among us, faith, trust, and being in relationship. But the main theme permeating her writing is that of the life-giving ways for us to “connect”with our selves, each other, and with God. The connections are essential for both religious leaders and laypersons in service and ministry with individuals, groups, and communities. The piece on hospitality is particularly appropriate for the parish nurse and others who, in their ministry, welcome the one who waits for healing.

The “healing words for healing people”contains words healers will find nourishing for their soul as well as words the healer may offer to others for their healing.

The prayers in the prayer portion of the book are written for direct use or adaptation based upon the specific needs of the one in need of healing of body, mind and spirit. Prayer as spiritual practice supports her call for connecting through relationship. The context for prayer is the spiritual relationship the healer establishes with the one to be healed. She has captured simple yet authentic words in prayer that will be received with comfort, hope, strength and trust in a God who loves us.

In both the meditations and prayers, she invites us to “remember our roots”. (Pg. 51) What better way to be connected than by remembering our roots in the God who provides more than we can imagine, and who in every circumstance is trustworthy. Patterson has provided a resource that has integrated spiritual practices into our life experiences in a gracious and truthful way. She invites us to healing words and relationships on behalf of God.

Patterson, Deborah L. Healing Words for Healing People. (Cleveland: The Pilgrim Press, 2005) pp 144.

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