PlainViews

Chaplain Derek Brown, D. Min., on cable cars, crabs and collegiality

A Scottish Chaplain’s View of the 2007 APC Conference

Frank Sinatra got it about right when he claimed to have left the seat of his emotions in a West Coast city. I too have fallen for the charm of San Francisco. It wasn’t just the location that won me over, appealing though the attractions of the Bay Area undoubtedly are. I was also captivated by everything the APC conference had to offer.

If I’m honest I’d have to say that the scale of things took me more than a little by surprise. Keeping 850 delegates and speakers occupied for five days is a mammoth task. Whatever dramas were going on behind the scenes were not evident, as everything looked pretty smooth from ground level. So congratulations to all those involved in organising and running the show and thank you for letting me be there!

Being a participant touched me at different levels. At a personal level I was greatly blessed by the warmth of welcome I received from all those I met. I quickly and easily found myself at home among new friends and catching up with one or two old ones, making what could have been a daunting experience very agreeable indeed.

At a professional level I found myself engaging deeply with the topics at the plenary sessions and in the workshops. It was hugely stimulating to discuss with fellow chaplains the issues that arose for us out of the presentations, helping us to lay bare the real reason for us being at a patient’s bedside.

I was also struck by the level of commitment and dedication shown by all the newly qualified Board Certified Chaplains. At present we have nothing comparable in Scotland to the CPE programmes common in the US and progress towards reflective practice is slow. However, it is coming slowly but surely, and I know that we can learn a great deal from you about how things are organised. Listening to the experiences of these newly qualified chaplains made me feel a little bit in awe at what they had done to achieve certification. I couldn’t help wondering if I’d make the grade!

At a spiritual level I was keenly aware of the unity in diversity that was evident throughout the proceedings. Despite the large number of faith groups represented, I sensed that what brought everyone together –our commitment to the patients, relatives and staff in our care –was a fundamental unifying factor. Our labels don’t really count when we enter into the sacred space of another’s suffering. What matters to everyone I spoke with was the engagement with people in a holistic way at the bedside or in the home, so as to fashion a meaning-full encounter at a time of crisis or anxiety.

I left San Francisco much encouraged and enlightened. We have so much in common and so much that we can learn from each other. In our sharing may we continue to build bridges across continents and oceans.

Chaplain Derek Brown, D. Min., has been in chaplaincy for nearly 20 years both in the acute and palliative care sectors and currently works in the major hospital in the Scottish Highlands. He completed a doctor of ministry through Princeton University in 2000 focusing his thesis on helping hospice staff deliver spiritual care. He was ordained by the Church of Scotland . Derek has been president of the Scottish Association of Chaplains in Healthcare for the past four years and served on the committee of the European Network of Healthcare Chaplains for two years. He is currently undertaking research in the delivery of spiritual care in an intensive care unit. Another passion for him is working with bereaved children through the Crocus child bereavement group which he was involved in setting up. When not working, Derek likes cycling and climbing hills or walking the dog on the beautiful beach where he lives. He and his family live in Dornoch, a 50 minute drive north of Inverness, famous for its cathedral, where his wife is parish minister. They have two children.

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Rev. Martha R. Jacobs, D. Min., with important information for 9/11 spiritual care providers

I am the president of the New York Disaster Interfaith Services, an organization that works to help those who have been impacted by 9/11. One of the services that NYDIS provides is hosting the NYC 9/11 Unmet Needs Roundtable where case workers present cases of those who are in need of financial assistance as a result of the events of 9/11. As president, I sign the checks that are sent out. Several weeks ago, one particular check caught my attention. It was a check for about $6000 to a funeral home. When I looked over the back-up materials, as I am required to do, I noticed that this was someone who had worked as a recovery worker at Ground Zero. I happened to notice his birth year. He was only 3 years older than I. I sat there stunned and saddened as I considered how close in age we were. I could not get this man out of my head and heart for several days.

I finally realized that there was a question haunting me. Could this have been one of the workers with whom I had spent time in one of the respite centers over the months that I served as a spiritual care volunteer? It then dawned on me that it was possible that those with whom I talked, cried, laughed, or played cards, could now be sick and dying. That brought tears to my eyes.

This connection brought me to another realization –I too had been out in that air, breathing what the workers had been breathing (on a lesser scale, but breathing it nonetheless) as I walked with workers to visit the "cross" that had been found amidst the rubble. As I traveled to and from respite centers, I too had breathed that air. While I am healthy now, there is no way to know if I will always be healthy. There is a chance that I was exposed to the toxins in the air at Ground Zero that could cause permanent and fatal health issues in the future.

I am neither an alarmist nor a pessimist. I am however, through my work with NYDIS, coming to understand the magnitude of the latest tragedy from 9/11. The illnesses and deaths of so many workers who refused to take days off, refused to sleep as they worked on “the pile,”trying to find survivors, and then working tirelessly for months afterwards to recover the remains of those who perished on 9/11. And then there are those who volunteered –including chaplains –who may also be at risk.

This connection made me realize that I needed to register through NYCOSH for workers' compensation. This way, if I become ill and it is determined that it is a result of the quality of the air that I breathed in 2001, my health needs will be take care of and financial assistance will be provided.

I strongly encourage anyone who came to New York and served at one of the respite centers for any length of time to go to this website and download the form and send it in. It will only take a few minutes to do so. If you do not register before August 14, you can never file a claim for health costs and financial assistance if you do develop an illness that could be linked to something that you took into your lungs and body while volunteering at Ground Zero. One chaplain has already died. Be your own advocate –register.

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“Viola”was in distress. Her spouse of 48 years lay in critical condition in the ICU, septic with respiratory failure. The chaplain was paged by the RN to see Viola who was tearful and seemed to have lost hope. Filled with regret and guilt, Viola was responsive to the chaplain’s presence. The chaplain listened attentively, beginning her assessment upon entering the room. What Viola needed most was to embrace the strengths she already owned –spiritual grounding, a supportive faith community and a future of hope and healing during a time when life hurts.

A few yeas ago a colleague and I were discussing how he could offer patients something more “concrete”in a pastoral care visit, even though spiritual caring is an intangible, a service, and much more. But as a team member working with a music therapist, a massage therapist and an art therapist, the chaplain was thinking –if there were some sort of way to offer something concrete as a result of his visit, something like relaxed muscles or a picture of one’s life in primary colors, would pastoral care be utilized more? We began to wonder out loud, what if we could provide a “product”such as a patient-centered assessment which would help the patient or caregiver discover their spiritual strengths? How might something like this create new space for sacred conversations enabling patients to own their gifts of faith, hope, community and experience?

In a quality-driven, patient-centered health care culture, it is worth exploring new ways to more fully integrate the patient and family into the pastoral/spiritual assessment process. As we are often aware, pastoral or spiritual assessment is commonly done intuitively or implicitly, sometimes not affecting either the interdisciplinary plan of care or the patient’s understanding of how spirituality relates to their current illness, pain or suffering.

Some might say that re-visiting spiritual assessment is cumbersome, time consuming, and unnecessary. We have a variety of tools based on validated research that gives us all we need to offer a professional, accurate snapshot of a patient’s needs. However, as we review the tools provided we often find that it is difficult to apply an in-depth model to our current in-patient culture which often consists of one or two brief intervention visits with a patient or distressed family member. I would propose that we explore a new model that would offer the following:

Viola did discover some important things about herself as the chaplain explored her spiritual strengths. She discovered that through past experiences she could rely on her faith, find hope for the present and journey toward the future with a dependable community of faith, family and friends. Not a bad place to end up after a thirty minute chaplain visit. Now if only she could take that home in writing . . .

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As I was leaving the Neuro-Trauma Intensive Care Unit recently, I encountered a gentleman in the hallway who appeared to be lost. He was looking for the ICU but recalled it had been downstairs. Someone sent him to the third floor. I assured him this was the unit he was looking for and that we had moved due to construction at the hospital.

He began to tell me who he was and that his son had been a patient in the unit thirteen years ago at the age of sixteen. He told me about his son’s accident and his injuries. He also told me that the staff had saved his son's life.

He said that his son is doing well and that he has his own landscaping business. He was so filled with gratitude. He said the doctors indicated that his son would not live –but he did. He said they told him his son would never walk again –but he does.

I contacted the Nursing Director so he could hear this story and the thankfulness that the father was expressing. The father again told his story and the Nursing Director listened intently as he also experienced the father’s thankful heart. None of the present staff were in the unit thirteen years ago, but the Nursing Director said he would tell those who would recall taking care of his son how well he was doing and how the care they provided was appreciated.

Gratitude! Thankfulness! What a wonderful thing to come back after thirteen years and tell “the rest of the story.”

The father told me that he had prayed so hard for his son to live and nothing seemed to happen. He then prayed saying, “God, whatever happens, I will accept it. You love my son, too.”The next day, his son opened his eyes.

I was reminded of the scripture that relates to the healing of the ten lepers. Only one of the ten lepers came back to say “thank you”to Jesus after being healed. It is so touching when former patients and their family members come back to give us an update on their progress and to say “thank you”for the care they received.

Hopefully, we will all practice the habit of taking time to say “thank you”daily. G. K. Chesterton said it well: “We need to get in the habit of taking things with gratitude and not taking things for granted.”

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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.

“The Imus virus”,[1] an insidious social infection, is much in the news. Characterized by toxic humor, it infiltrates educational and religious institutions, health care facilities, and most work places, as well as the media, the last which the others blame for the virus’presence in their midst. The resistance, by otherwise sensible souls, to examination and inoculation of their own environments against infestation is an ethically perplexing aspect of the virus.

Humor, according to Webster’s, “implies an ability to perceive the ludicrous, the comical and the absurd in human life and to express these, usually without bitterness.”[2] The definition ought to give pause to anyone who assumes a routine role for humor in an educational program or work place. One person’s perception of “ludicrous”or “absurd”may be another person’s lived reality.

Shock jocks like Imus mine the proclivity for turning another’s demographic profile, social stratum, economic status or personal attributes into toxic humor. When people in positions of power or influence mistake degradation for comedy, the wound spreads wider than the immediate audience. Following Imus’characterization of the Rutgers women, a Brooklyn police sergeant reportedly used the same words during roll call.[3] No one goes to school or work with the expectation of being comedic fodder for rapper-imitators.

Most people appreciate good jokes, communal laughter, and times of shared bemusement at life’s quirks, but the class clown can morph easily into the office bully. Astute teachers and supervisors should be asking: what’s missing in this person’s life, what is he or she not receiving from this environment? And, when humor is toxic, it must be stopped.

To begin a dialogue about healthy humor, the following guideline is proposed. Please submit additions that clarify how we can engage education and work place humor delightfully rather than hurtfully.

1) Like the person(s) to whom and about whom you are speaking well enough to know and care about their sensibilities.

2) If it’s not language you would use with your mother or child, don’t use it at work.

5) Most spiritual care providers are neither rappers nor street folk. Don’t adopt the language or attitude of either in the work place.

6) Stories or “jokes”in which the subjects or objects are people of different racial, ethnic, religious, gender, or sexual orientation than you, are never appropriate in the work place, no matter how well you think you know the listener(s). Racist, sexist, ageist, and homophobic comments are never appropriate, clever, or funny anywhere.

7) Stories or “jokes”targeting physical or mental conditions are never appropriate anywhere.

8) Stories or “jokes”about patients or students are never appropriate without their express permission for the particular occasion.

9) Stories or “jokes”about your colleagues should be saved for retirement “roasts,”and then told with loving discretion. What you consider “funny”may not be to the colleague.

10) Remember: the measure of appropriateness is the impact on others, not your intent.

[1] New York Attorney Bonita Zelman’s phrase as quoted by Bob Herbert in “Words as Weapons,”The New York Times Op-Ed section, Monday, April 23, 2007.

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.

We are always looking for cases. Please send any cases that you would like considered for inclusion to: info@plainviews.org We will ensure that it is stripped of any identifiers. For further guidance about how to write up a CaseConference, please refer to the CaseConference Archives, Vol. 4, No. 3 "How to Submit a Case for CaseConference." (Click HERE)

We hope that this 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.

I was recently hired as a hospice chaplain. My supervisor commented that I needed to obtain a "clinical jacket" that would readily identify me as a employee of this specific hospice. These jackets are the same as those worn by the clinical staff. I am appalled at the idea of wearing clinical garb for pastoral visits. I objected, noting that although the roles of clinician and chaplain might at times overlap, the focus of their work is quite different, and that pastoral care may be compromised by a uniform. (I also know the bereavement counselor and volunteer coordinator do not wear clinic jackets.) My supervisor spoke to the Human Resource Director, who backed down; although it was reported she was not happy about my refusal. Of course, I have no objection to ID badges or distributing information with the agency name on it. I am also specifically not referring to the collar/no collar conversation.

My feeling is that this issue is about "branding" the agency, not about security or role authority. There is tremendous competition among hospices –non-profit and for-profit –for visibility and clients.

What other trends are in the "marketplace" that are likely to affect agency chaplains?

What came to mind while reading of the insistance that the chaplain wear a "uniform": If the Hospice is dogmatic about its uniforms, is it also dogmatic about the kind of care it provides?
Rabbi Cary Kozberg
Columbus, Ohio

I have never been asked to wear a particular uniform in my work with Hospice and was surprised to hear of the request.
Jonathan Scott
Putnam, CT

Why not have uniforms that have disciplines noted on the front? It would clarify the roles to have differing uniforms.
Rev. Amy Jo Jones, BM, MM, MDiv., BCC
Chaplain/Grief Support Center Coordinator
Big Sky Hospice
Billings, MT

My question has to do with why this chaplain is "appalled" at the request that he/she wear a clinical jacket. Healthcare chaplaincy is a clinical discipline, as well as a pastoral one. I am aware that many hospice organizations do not require any CPE (and some not even Master's level theological education) for chaplains they hire. That this chaplain is "appalled" by such a request may indicate that he/she may not have any or much CPE or be aware of the clinical nature of what chaplains do. It's hardly unheard of for chaplains in hospitals to wear clinical jackets, especially in "on call" situations in which visibility is important.

I'd also ask the clinical/theological question about why this is a "cross" on which this chaplain is willing to "crawl up and die." The choice, for good or ill, has already been made by this chaplain in this organization. It hardly seems central enough to whether this chaplain can function "pastorally" to be worth the issue he/she made of it.

Jon Altman
APC Associate Chaplain
Petal, MS

I suspect that the wide range of responses indicates the breadth of experiences in the field. Today, the agencies offering hospice services run the gamut from small, local community non-profits to Fortune 500 "agra-businesses" that are looking to "horizontally integrate their services" with a continuum of care that takes grandma from discharge home care with her first wrist or hip fracture to assisted living to skilled nursing care and finally hospice as a way of maximizing the client interface.

I, too, work for a very large for-profit hospice that requires chaplains to wear a "uniform" as a matter of branding, not as a matter of presenting oneself as a qualified professional.

Chaplains were only exempted from the requirement of wearing "scrubs" when confronted with the argument that to do so would simply raise the facility's expectation that we ought be giving personal care, when of course we are unable to do that.

Perhaps the writer's strong feelings about being made to wear a uniform had more to do with the total ethos of his or her agency and the motivation behind being reduced to another generic representative of the monolithic service provider.

I doubt that it reflects his professional qualifications--as a rule of thumb, the big three for profits still prefer seminary trained, ordained M.Divs with CPE to less formally educated or uncredentialed religious, not because of the superior service they may or may not provide but because they tend to reduce the possibility of exposure to CHAPS violations by evangelizing or not being well equipped to deal with diversity.

If you are a chaplain for whom this all sounds strangely "corporate", be glad. It is a growing reality among the increasingly dominant major players whose first concern is to project competency rather than supply it and whose "high view" of the chaplain's contribution is to assure frequency compliance for Medicare billing.

Charlotte Ellison
Battle Creek, MI

Huston Smith, a leading authority on comparative religion, describes for the listener in this 2-CD set, the “journey we are on: how deep is the longing within us for a larger world than our everyday senses and common sense, even when amplified by science.”

Smith, author of the classic The World’s Religions (formerly Religions of Man), interweaves contemporary scientific data with the underlying commonalities found among the world’s great religions in terms of their spiritual traditions, mystical visions, and concepts of the afterlife. He discourses on the ability of science to enhance our appreciation of life and spirituality as well as the inability of science to wrestle with “values and purposes.”

This comparative religion scholar comments that the modern age has moved past the “half-worlds”resulting from a schism between religion and science, and he describes a “more complete world”in which individuals no longer have to choose between the two.

Huston Smith discourses in The Big Picture on what he describes as “the widest-angle view of the world that is available to the human mind at this point in history.”It’s a journey worth taking.

If you are interested in purchasing this audio series, you can do so at www.hartleyfoundation.org. Just click on “Masterworks”on the homepage for more information. The cost of the 2-CD set is $24.95.

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.

This is a brightly illustrated book to help parents speak about death with children.

While the predominant theme of reassurance for young children at a very confusing time is helpful, I question the lack of tears in the illustrations and the sometimes too upbeat stance of both daddy and mommy in the face of such a gut-wrenching experience for the entire family.

The book reassures children that they are loved and will always be cared for and that heaven is a good place. But there is something about the bluntness of the message, “My life on earth with you and daddy will be over. I will live and stay in heaven forever and I will never be sick or tired again!”which might lead children to fear that fatigue and sickness will surely lead to death.

While the author alludes to people coming over who whisper or cry, I would recommend that this be dealt with more openly. It’s okay for daddy and adults and mommy and the family to cry out loud together.

The concluding suggestions at the back of the book, “How to Talk to Children About Death”is a necessary inclusion to round out the author’s sincere attempts to deal with a very difficult discussion.

Copeland, Kathe Martin, illustrated by Elissa Hudson. Mama’s Going to Heaven Soon, Augsburg Fortress Press, Minneapolis, 2005, pp 32.

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