Chaplain Paul Derrickson and Haan Phelps

Chaplaincy 101: Making Visible the Difficulty of Showing Up and Shutting Up

I have been following with interest the ongoing conversation about the basics of chaplaincy (Peery and Handzo v 7, no. 1 and 2, respectively). What especially caught my attention was George Handzo’s final paragraph comparing the chaplain to a well-trained athlete who is in the zone or with the flow. The preparation and internal workings are usually not seen, known or appreciated in either. “Thus, it is all the more critical, especially with other disciplines in the field of health care, for us to use language that makes it clear how informed, active, intentional and disciplined the practice of chaplaincy care truly is.” (Handzo, PlainViews v 7, no. 2, 2/17/10)

One of our residents recently wrote a verbatim which made this invisible process more visible. The chaplain was called to be with the family of a 75-year-old man who had had surgery and five days later was septic, to the surprise and dismay of the staff. The family was struggling with decisions around end of life care. After spending a fairly long time with the family the chaplain went to check with the staff.

C= Chaplain, W= wife S=son
(As I left the room I had this terrible thought. Is H listed as DNR or not? If not and they have not decided what to do if he codes, the medical staff will do everything they can to bring him back.) I quickly check with the nurse who says that he is not DNR but it does say they have a Living Will. I asked the nurse to page the doctor so they might explain what would happen if he does code. I am thinking a code is the last thing this family needs to witness as they struggle with what to do. If they have a living will that may help them in their decision making. The nurse says she has paged the doctor and looking at me, she says that a code would be really hard on the family.)

C 9 (Returning to the room I speak softly to the son at the bedside.) Do you know if your father had a living will?
S 4 Mom, dad had the living will. Do you have the copy with you?
W6 I have it.
C 10 I think we should look at it as it may help you in making your decisions.

S5 Why do you say that?
C11 It may give you his wishes on his care that he wants or does not want to have in treatment. Do you know if he wants to be resuscitated if he stops breathing?

S6 I don’t think he wants that to happen, (as he looks at the document).

The doctor arrives and S speaks to him.
S7 Doctor I think I know why you are here. This is his living will (giving it to the doctor). We gave it to the staff when he was on the fourth floor. They were supposed to make a copy of it.
(Dr C takes the document and goes to the desk)

(While the doctor is gone they talk about the Living Will).

S8 What does the do not resuscitate really mean?

C12 It means that if he does not have a “do not resuscitate (DNR)” order and he stops breathing right now they will attempt to reestablish his breathing…they may use CPR, and medications to get his heart going again.

W 7 He doesn’t want that to happen. (Looking at her son for concurrence)
S 9 You’re right mom. He doesn’t want that to happen.
C13 Let me talk with the doctor for you. (I was maybe too assertive here but felt the need to be, possibly controller or fixer, but to me necessary.) (What came to mind to me was my past experience with a patient who coded 4 times before the mother made the decision not to resuscitate again. It was traumatic for other family members and the staff. The patient’s chance for recovery was slight if at all.)

I excused myself and brought the doctors and nurse back into the room.

S 9 Doctor we don’t want him to be resuscitated if he stops breathing. I think it states that in the paper?
W8 He does not want that to happen. (tears in her eyes).
The doctors confirm the written document statement and explains what they can do to provide comfort for H and insure that he will not have any pain or discomfort; they will change his status to DNR.”

For me this is a great example of the reflective process that goes on within a chaplain in sorting through what to respond to and what to ignore and how to respond in ways that facilitate the process of decision-making rather than blocking or sidetracking it. The conversation also displays the “linking” and staff support role the chaplain plays on the health care team. And all of these actions were based on a careful assessment of each family member and what they needed individually and as a group during each step of this unfolding (i.e., the rest of the verbatim.) Prior to this verbatim the chaplain had identified wanting to “fix it.” Becoming aware of when acting on that impulse was helpful and when not, became a learning goal. In this instance the impulse “to fix” was disciplined into a valuable resource sensitively applied.

The verbatim is also an example of the invisible “savings” the chaplains creates for the institution. Had the patient coded, the hospital would have spent thousands of dollars in staff time and equipment for no benefit. And at what price the additional suffering for all parties? Any researcher out there willing to try to measure the chaplains’ “saving” to the institution?

For me, this is a “side-bar” conversation and focus. It should not get in our way of focusing on and dealing with the spiritual issues of patients, family and staff. Doing that well will carry credibility with the staff and speak for itself.

Haan A. Phelps, has a Master of Divinity from Lancaster Theological Seminary (2009) and is a CPE Resident at Penn State Hershey Medical Center. He is a member of the United Church of Christ and is in the process of seeking ordination with them. In the hospital, he is responsible for Trauma follow-up, SICU, Orthopedics, and Liver and Kidney transplant patients. He has over twenty years of experience in directing Camps and Conference Centers for the YMCA and the PCUSA. Haan has also served as a Stephen Leader in the Stephen Ministry Program. After completion of his CPE program he will be seeking a position as chaplain and/or pastor.

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