A question about advance directives and who oversees them -

A question for those chaplains who are one-person departments: How are the discussions and completions of Advance Directives accomplished in your setting? Who initiates these conversations with patients? Is this the task of chaplains, social workers and/or patient representatives? Feedback information can be sent to: angela.lowe@lmh.org It would be helpful to know the number of beds in your setting, primary chaplain responsibilities and the ratio of chaplains to social workers.

Chaplain Angela Lowe
Lawrence Memorial Hospital
Lawrence, Kansas

Scripture in Counseling?

How do Chaplains feel about the use of Scripture in counseling or in visits to the sick? I can say that I almost never used Scripture as a response to a question, as an explanation, or for giving advice. This doesn't mean that I never read Scripture; often I would read the "daily readings" or short passages or even passages from tracts, but without applying them to "specific cases". Also, I would read Scriptures as part of prayers over the communications system for a daily short prayers. I feel that the use of Scripture in counseling is too open to misinterpretation, misunderstanding, and coercion to be used as a standard form of answering questions or giving advice. Although I believe that Scripture has power and is the "Word of G_d", it is easily twisted into the intention of the user and instead of G_d speaking, it becomes the word of a human with bias and power speaking. If a person asks a question about a particular Scripture, I would, if I
felt capable in a particular case, do my best to try to give a caring possible explanation, knowing that I need to keep in mind my own bias and inability and vulnerability.

Thank You,
John P. Stangle, Chaplain Advanced Emeritus, NACC

Re: Do Clothes make the Chaplain? Sandra Katz (PlainViews, 2/15/2006, Vol. 3, No. 2)

Thanks to Rabbi Sandra Katz for speaking to the issue of dress for chaplaincy. I am an ordained Lutheran clergyman, who served in congregations for 13 years prior to chaplaincy. In those years I wore a clerical collar regularly, and found that it readily identified me and my purpose when visiting my own parishioners in health care settings. However, now into chaplaincy for almost six years, I have found that wearing my collar while serving as chaplain, is a hindrance. I suspect that a lot of that has to do with being in the South, where the majority of Christians are, distinctly non-liturgical. Further, I have found that wearing business suits also a barrier for some who confuse me with someone from hospital administration. I have found that I receive the best receptions when I wear slacks, shirt and tie (I wear bow ties) and in the winter, usually a sweater. Of course, clothing has little if anything to do with how we relate to those patients who have need for pastoral care. It just seems to me that, considering location and setting, clothing can cause some to have to work a little harder when we first present ourselves in a patient’s space. I, for one, have chosen to minimize the effect of clothing or "uniform" as much as possible.

Bill Boldin
BCC Retreat Hospital
Richmond, VA

Hi, I am responding to Rabbi Katz's article in your most recent issue. I am a volunteer with the Spiritual Care service at Stanford University Medical Center and although not orthodox, I made a decision to always wear a Kippah (Yarmulke, skullcap) when I am at the hospital as well as dressing in a suit and tie. I find that putting on the "uniform" does a couple of things for me. First, it helps me to put myself into that important mindset to do the visitations in the right frame of mind, second it gives me instant identification to both hospital staff, patients and even people in the corridors. I think it is important to dress in a nice manner to let the patient know that they deserve respect, and when you dress properly your clothing is not a distraction. A funny incident, one day I was at the hospital and I was wearing a bright red Kippah, and as I was waiting for the elevator a little boy looked up at me quizically, finally saying "Good , afternoon Father". Needless to say I was flattered and when I recounted the story to the Catholic Chaplain, he asked me if I had blessed him. I enjoy your publication.

Jon S. Levinson
San Carlos, CA

Rabbi Sandra Katz's article on what to wear at work interested me because I have thought about the question ever since a woman in my first congregation told me I looked too much like a male pastor in my black clerical shirt. (Either she didn't notice the black and white skirt I was wearing with it, or she'd seen more of the world than I had!) A quarter century later, that same black clerical color would be appropriate in my current call, as Chaplain in a Lutheran retirement community. Certainly, the few Lutherans and Episcopalians who live there wouldn't blink an eye. But I find myself wearing my collar less now than I did during my twenty years of parish ministry. First of all, the facility is filled with Baptists, who gladly see me as their chaplain but whose own clergy wear no identifying clothes. Many of the residents and staff refer to me as "Pastor," not because I ask them to, or because I look like one, but because in this part of the Bible belt, religious leaders still hold a place of honor. Secondly, though I strongly identify with my denomination and its institutions, I make myself as available to those with no religious connection as to those with strong religious ties. One of my most important tasks, as Chaplain, is to meet the residents, families, and staff on their spiritual turf. For me, that means "civilian wear." Finally, I am comfortable doing my work in street clothes most of the time, donning a clerical shirt for particular religious services and funerals. Like all employees, I follow the mandatory dress code. I dress comfortably but appropriately for my work. Perhaps that is what matters most: reflecting with integrity who we are to those we serve. Yes, our dress matters. It tells others that we are loyal to our religious heritage, or committed to the dignity of our work. It can also convey how we feel about ourselves, whether or not we are drawing attention to ourselves, and how careful we are to represent our profession. "Appropriate" dress for a chaplain, as far as I can tell, may vary greatly. But most of all it means that the wearer has thought through the implications, as has Rabbi Katz. I thank her for bringing it to our attention.

Deborah D. Steed, M.Div.
RoseCrest Retirement Community
Inman, South Carolina

I appreciated Rabbi Katz's article very much. I am a Catholic female lay chaplain and find that I live in a strange world. Sometimes it feels like even my own denomination isn't really sure who I am or what to do with me! Virtually all of my peers carry a title--Imam, Sister, Father, Pastor, Reverend--while I do not. Often when people refer to me as "Pastor" or "Reverend" I simply smile and say "probably not in my lifetime..." and explain to them that I am a Catholic Chaplain.

When I began my training, all of the female chaplains (who all also happened to be Catholic) I worked with wore a white coat or jacket. Ostensibly this was for the pockets--but I believe that the real reason was they needed a way to claim their identity that the men did not. I too tried wearing a white coat. It lasted about one week: it was not a comfortable identity for me. Rather, as I have grown more comfortable in my own skin, I have found that my badge and my presence are enough.

I am growing to believe that the things that seem to help us claim our identity (collars, crosses, even white coats) also may separate us from the people we serve. It may be easier for me to "connect" precisely because I come with empty hands, rather than one in a position of implied clerical authority. I suppose, as is true in so many things in life, that the things we struggle with most--in this case my lack of external identity--also can become the greatest gift.

I would be interested in hearing from other women how they experience and claim their own identity in chaplaincy.

Blessings,
Bev Beltramo, Chaplain
Oakwood Southshore Medical Center
Trenton, Michigan

I appreciated the sensitivity and logic that Rabbi Katz used in explaining why she dresses as she does for her various roles as a female rabbi. The background comment from another female clergy and Rabbi Katz's thought process in her response were very affirming for me. I am a woman minister in the denomination of Christian Church (Disciples of Christ). We do not wear collars. We do oftentimes wear robes and stoles for worship services and other services. When I first started in chaplaincy, I never wore slacks except when I was off-duty and paged in for an emergency. Now I wear pants all of the time mainly for two reasons: one is that I do not have to buy and pay for pantyhose anymore, and the other is that they cover up the unsightly varicose veins in both of my legs. I had a Lutheran hospital administrator and a Lutheran surgeon suggest to me on a couple of occasions a few years ago that I wear a collar to give me more authority and identity. A few years before that my CPE supervisor had felt me out about why I did not wear a collar. For me the answer is simple, I like Rabbi Katz feel like I have enough authority by my presence. I also feel that sometimes wearing a collar can get in the way of my ministering to people. They may put me on another level that is less approachable for them to communicate with me or they may only talk God-talk with me because seeing my collar that is what they think I want to hear from them. I do most of the time wear a cross necklace and a prayer wheel as I make rounds. In our hospital where the majority of the patients I serve tend to come from Christian backgrounds, I think this helps them to identify with me. I have not found that it has been repulsive to any of our patients who are of other religious persuasions and sometimes it helps some of our folks who speak little English to identify my role in the hospital setting. I think our responsibility as chaplains is to be open and friendly and establish a presence that brings comfort to the patients and their loved ones. I also feel that my appearance needs to be one that helps people to feel like they can talk to me and that I will understand where they are coming from in our conversation. Thus, I keep in mind to try and dress in a manner that will let them feel I am on the same level as they are.

Jennie Malewski
Staff Chaplain
KU Hospital
Kansas City

Rabbi Sandra Katz wrote about "Do Clothes Make a Chaplain". I have a couple of responses I would like to make.

First, I remember vividly in seminary in 1967 our pastoral care professor saying, "We have only one chance to make a first impression." Of course, I have heard that many times since then! When we walk into a person's room all they have to go on until we open our mouths is what they see. Because of that awareness I was very intentional about choosing clothes that would "make a good first impression" given that I was working in an academic medical center. If my appearance makes a negative first impression, it means that I have to work just to get the relationship back to neutral, say nothing about making it positive.

Second, NLP has determined that 7% of our communication is the words we say, 38% of our communication is the way we say the words, and 55% of our communication is non-verbal, which I believe definitely includes what we wear. I always ask myself, what is my 55% communicating!
Thanks to Rabbi Sandra Katz for raising a very important communication issue!

Rev. Rod Seeger, BCC, ACPE Supervisor

While reading Rabbi Katz’s article, I was reminded of my own person struggle. As a child I was self-conscious of my appearance. I had received the message that beauty was sinful –to care for one’s appearance was Biblical wrong. During my first CPE residency, I was continually told by patients, families, and staff, “You don’t look like a chaplain!”It took me years to respond, “How should a chaplain look?”As I processed these experiences, a CPE supervisor suggested that I wear a collar to solve my problem. But in my tradition (Baptist), male ministers do not even wear collars. So why should I, as a woman, alter the way I look in order to “be”a minister?

Over a long journey of struggling with my own identity while trying to “fit”into the expectations of the ministerial look, I came to a place where I was confident in myself as an ordained Baptist woman created and called by God. I embraced my own sexuality and called myself minister –including the long hair, the petite build that I inherited from my grandmother, and my own femininity. I choose my clothes carefully, out of my choice to present a welcoming presence. I add the use of a stole when leading worship and memorials, when offering a blessing or baptism, and during prayer at a patient’s bedside. By wearing a stole, a “priestly”dimension is added to the sacrament that I am offering. It becomes a symbol that we are together entering into a time that is sacred and holy.

It is important for us to be conscious of our appearance as ministers. However, I am not willing to compromise who God has created me as an individual in order to fit into what society has said that I am “supposed”to look like in order to be a minister.

Rev. Renée Owen, M.Div.
Senior Chaplain, Pastoral Care Services
Patient and Family Services Department
Miami Children's Hospital

Re: Love is All We Need, Mark LaRocca-Pitts (PlainViews, 2/1/2006, Vol. 3, No. 1)

Mark LaRocca-Pitts is close to the mark with his comments about pastoral care as an expression of love. However, what he presents is a little thin at times as when he comments: “Our love is therapeutic in that it engages patients where they are and journeys with them toward hope and healing as needs, contexts, and capacities change.”Mark poses only a love that journeys towards hope ending in healing and yet many of the patients we are called to journey with are in despair. Despair is a valid religious experience and a valid response to certain of life’s circumstances and is the other side of the coin of faith. A love that is only journeying towards hope and healing is more like sentimentality than the agape. Chaplaincy that has no place for a theology of despair is a rather thin soup. There has been much written over the years about pastoral care and love which is substantial and significant and which challenges us all in terms of the practice of our various ministries some examples of which follow:

Summing up the teaching of the Law and the prophets Jesus commented,"Love the Lord your God with all your heart, soul and mind—love your neighbor as yourself."

Richard Niebuhr comments in, The Purpose of the Church and Its Ministry, "When all is said and done the increase of-----love of God and neighbor remains the purpose and the hope of our preaching of the gospel, of all our church organizations and activity, of all our ministry."

Pastoral care is "A Kind of Loving" comments Alastair Campbell in his book Professionalism and Pastoral Care. The question which Campbell seeks to engage is; How can pastoral care be both professional, what one does for a living as one demonstrates competence and consistency,
and a kind of loving as indicated by Niebuhr's comments reflecting upon the role of the church and ministry?

And there's the rub - its how we professional chaplains make our living - there is a cost to the love that we provide. Myron Madden indicates "Our own healing, if we are honest with ourselves, is caught up in helping others" The love we offer, if un-reflected upon,is not love at all but an expression of our own to need to be needed.

Tillich reminds us that "It is a rare gift to meet a human being in whom love—and this means God—is so overwhelmingly manifest. It undercuts theological arrogance as well as pious isolation. It is more than justice and it is greater than faith and hope. It is the presence of God Himself. For God is love. And in every moment of genuine love we are dwelling in God and God in us."

Blessings
George Hankins Hull
Director Pastoral Care &
Clinical Pastoral Education
UAMS Medical Center
Little Rock, AR

Mark's response to George:

George Hankins Hull has pointed out some excellent shortcomings in my article. Any love that cannot journey with a patient wherever they are and wherever they are going or not going would indeed fall short of the agape love that forms the heart of our pastoral care tradition. A love that only embraces a path of hope at the expense of those in despair would be, as Mr. Hull puts it, “a rather thin soup.”Despair is indeed a valid response to many of life’s situations and we need a good theology of despair. However, since I have encountered few people who want to remain “in the valley of the shadow of death,”and since my pastoral tradition sees hope as important for one’s spiritual health, then as I journey with them as a chaplain, I might gently point out those places where hope resides in the passing landscape. Also, as a clinical chaplain, I might consider a referral for a psychological evaluation just to insure that the patient’s despair is not pathological. Thank you Chaplain Hull for thickening the stew in what is of necessity often watered down due to length requirements.

As for the bibliographical notes: thank you. Love is not only biblical, but, as you point out, it forms an important core of our theological tradition. I would even venture to say that it forms the core of a wide variety of spiritual traditions from time immemorial and is the basis for all spiritual care. Nonetheless, it is easy for us to forget the core of our spiritual traditions when we get so caught up in the peripherals and this article was intended more as a reminder than an attempt to be original. Also, it is especially rewarding to get paid for what we are called to do, though I would argue that the loving professions such as ours seem to pay less than other professions.

I want to thank Chaplain Hull for taking the time to write such a thoughtful and thought provoking response. It is in the dialogue that we learn and not in our published positions.

Respectfully,
Mark LaRocca-Pitts, PhD, BCC

Re: Reflections on a Move North, Valerie Storms (PlainViews, 2/1/2006, Vol. 3, No. 1)

It was neat to read Valerie Storms' essay about her transition from Florida to Long Island, NY. Years ago, she preached at my church two or three times that I remember (1st Pres., Gainesville). I am sad for Florida that she has left us, but delighted to see that she is progressing in professional attainment as well as in service. The comments and questions she has encountered made me recall my move from California to NW Ohio years ago, in time for the worst blizzard in 50 years, especially "You left there to come here?"

Thanks.
Tim Ray, M.S.W., JD,
Hospice of Marion County

Re: ...two pastors from the hospital, Rob Ruff (PlainViews, 1/4/2006, Vol. 2, No. 23)

My thanks to Pastor Ruff for sharing his and Helen's experience of sharing a burden. It brought to memory all the late night visits to unknown family homes made with the County Coroner. More importantly, as the physician did for the two of you, I was able to reflect upon the duality of purpose and call of a hospital chaplain. Whatever the title our own religious community confers upon us, we practice the art of balancing our own faith traditions while offering encouragement to others to live out of their own values and spirituality.

Rev. David Monsen, Director
Pastoral Care Services
Grays Harbor Community Hospital
Aberdeen, WA

Re: The Widow's Might, William Zeckhausen (PlainViews, 1/18/2006, Vol. 2, No. 24)

This journal item in PlainViews made me think of myself where I have also done a few funeral services with only the director and 'burial crew' there to pay final respects. I did feel like you would state at the end of the article 'the amount of envelope money was...." Thanks for your comments and insights.

Dan Russell, D. Min., LPC
Fulton State Hospital
Pastoral Services
Fulton, MO

I was very touched by the recounting of the funeral service for the lady who took her own life. Each of us, I believe, has stories like this that on the surface seem unimportant, but they have a huge impact on our life. Whatever the reason she took her life, your fulfilling her request has had an immeasurable impact on your life and many of those whom you touch. Thank you for sharing.

Blessings,
George H. Richardson, M.Div.
Director of Pastoral Care and Counseling
The University of Texas Health Center at Tyler

Just read this story in PlainViews and had to respond! Thanks for the memories. As part of my Boston University School of Theology Th.M. almost forty years ago I had occasions to visit various churches, among them Old South Church. And before focusing my ministry in psychotherapy and mental health chaplaincy I certainly had funerals like that one. We surely do not always understand the power, do we? I'm not an overt evangelist but am convinced that God works through us anyway!

Keep up the Good Work!
Paul R. Darnell, D.Min.
Fellow, AAPC
OPCC, Inc.,
Syracuse, NY

I am a lay person interested in the Chaplaincy and read the article on the funeral of a suicide. I can identify with suicide plus my mother's family has roots deep into Massachusetts history. My grandmother living in Buffalo seems to have been a Presbyterian and composed a book of bereavement on the very premature death of a child. In her nineties after many years in Florida she passed away. Undoubtedly very few in Florida would be interested in her last rites. Some of our family though not my immediate family must have been at the Florida funeral. An announcement of this funeral was printed and sent round, a beautiful commemoration of last rites at a Congregational Church in Florida [certainly somewhat unusual] I find this statement of her end of life to be meaningful, connecting me with a remote event in a virtual world. I have more thoughts but is difficult to articulate and be relevant. I value your contribution to the Chaplaincy.

Paul Allersmeyer
Bloomsfield, NJ

Thanks for sharing the article of your experience with the elderly widow. In my ministry at a Psychiatric Hospital in Montreal I had many occasions when it was I and the funeral director at the grave side for prayers. I always felt very sad and lonely but I was often impressed with the dignity that the funeral director gave to this person that they never knew - one funeral home was particularly attentive and I would send them all the business I could because they would bury people I sent them with no money.

Douglas Wilson
St Paul University
Ottawa, Ontario, CA

Thank you for the article in Plainviews - for me it serves as a reminder of the desperate loneliness in which some (perhaps many?) people live. Remaining aware raises my listening skills so that I can "hear" when someone I am with is one of those people.

Gratefully,
Chaplain Marty Koontz
St. Mary's Health System
Knoxville, TN

I just read the article in the PlainViews newsletter, and was very moved by it. Beautiful reflection on how a bad situation became better, and how it could have been even better. Thanks so much for writing and sharing.

Sincerely,
Ruth Stevenson
Edmonton, Alberta, CA

I appreciated this article very much and could identify with the inner struggle you articulated. Thanks for sharing your story.

Blessings,
The Rev. Dr. Glenn A. Robitaille
Duty Chaplain
Mental Health Centre Penetanguishene
Penetanguishene, ON

I'm a full-time chaplain going on sabbatical from 12 to 15 months beginning in May,2006. I'm looking for a replacement chaplain for the time I'm away. Please contact me if you are interested.

Thanks,
Ann Brangan, BCC
Beaumont/Port Arthur, Texas
ann.brangan@christushealth.org
409.899.7368

I just want to reiterate my thanks for this great newsletter/online journal. The articles have continued to be thoughtful, helpful, educational, and inspirational. Thanks to all for the work and effort you put into it!

Rev. Caroline Patterson
Women and Infants Hospital/The Chaplaincy Center
Providence, Rhode Island

Dear Staff of PlainViews:

I just want to say "thank you" to all of the staff at PlainViews. I am no longer able to be the volunteer chaplain at Memorial Hospital in Pawtucket, RI, because of the long distance by car since moving two years ago. This was very difficult for me to "cut the cord." One of the nurse managers said to me: "Louise, I just know that there are people in Little Compton just waiting for you to be their chaplain." Well, dear fellow chaplains, yes that was a prophetic statement: I connected with Hospice & Palliative Care of Fall River, MA. For the last two years I have served both as a Volunteer and also on a Pastoral Care Team. I am very happy.

I am very grateful for your ministry as I do so like to keep "sharp" in my skills i.e. "Appropriate Chaplain Boundaries." I was most fortunate to do my four units of CPE in Providence under the direction of Bill Nisi and Sister Dorothy Cotterell, 1993-94. Perhaps some of you recognize the names. Bill went to be with our Saviour about 10-years ago after relocating in Chicago. Very sad. The Providence site asked Duane Parker, the originator of the site and also the director for CPE, to return, and he did for a short time and then retired. Perhaps this is newsworthy to some of you.

Again, thanks for being there...

Blessings,
Louise M. Hutchinson (Mrs.)
Chaplain
Fall River, MA

I note that the European chaplains network defines itself on its web site as relating to one religious tradition, saying. "It is rooted in Christianity, as expressed in European Cultures." This raises questions on which North American chaplains might be able share perspectives.

Chaplaincy grows out of faith, and there certainly is an important role for chaplaincy organizations relating to one religion. To me, this self-definition raises the questions of how or whether the European chaplains see their role as working with/serving patients, families, and potentially chaplains who are Jewish, Muslim, or from other backgrounds.

Rabbi Robert Tabak, PhD
(Board member, National Association of Jewish Chaplains)
Staff Chaplain, Hospital of the University of Pennsylvania
Philadelphia, PA

Thank you for the outstanding article by Chaplain/Professor Vandenhoeck on the struggles and challenges that the European Network of Health Care Chaplaincy faces with the politics of the European Union. I have forwarded this on to the newly formed International Advocacy Committee of APC in hopes that we can be in better and more frequent dialogue with our colleagues overseas.

Chaplain Dick Cathell, BCC
Chair, APC Advocacy Committee

Re: Audio Meditation Review - Radical Prayer (PlainViews, 11/16/2005, Vol. 2, No. 20)

Macky Alston's discussion of "Radical Prayer" reminded me of a quote I treasure and carry in my calendar. Perhaps inspired by "radical prayer," Rabbi Chaim Stern of blessed memory published this in the "Gates of Prayer" on page 215: "May I make of my life an act of reverence - a prayer: the prayer that is its own answer."

Rabbi Sandra Katz
Chaplain,Golden Slipper Uptown Home
Philadelphia, PA

Request for Assistance from Fellow Chaplains

I am working on my Master's thesis and would like to ask for help from my fellow chaplains.

For my thesis, I am looking at the impact of spirituality in end of life decision making. I am building on some work done by a team at our hospital where they surveyed 85 critical care physicians, asking them information about their own spirituality, and then asking them to respond to a series of end of life vignettes, vignettes which presented ethical and moral dilemmas. While their analysis in on-going, there have been some interesting preliminary findings. It is my intention to replicate that work with health care chaplains and clergy.

If you would be willing to complete the survey, please email me at firesmom2003@yahoo.com and I will email you the survey packet, which I would ask you to print and then return, anonymously. The survey should take no more than 15 minutes of your time.

Thank you very much,
Bev Beltramo
Oakwood Hospital and Medical Cente
Dearborn, MI

Family Presence during Resuscitation - a request for information

I am a Staff Chaplain at Providence St. Vincent Medical Center in Portland, Oregon. I am serving on a committee within our facility to look at the impact of family being present during resuscitation efforts for their loved ones.

I am wondering if PlainViews readers have come across any articles regarding this subject and if so, would you kindly forward them (or the citations) on to me via my e-mail: jean.mcquiggin@providence.org.

Thank you,
Chaplain Jean McQuiggin
Providence St. Vincent Medical Center
Portland, Oregon

Re: Book Review –Living Through Pain and the Search for Wholeness, David J. Zucker (PlainViews, 10/19/2005, Vol. 2, No. 18)

Rabbi Dr. David J. Zucker reviewed Living through Pain: Psalms and the Search for Wholeness by Kristen M. Swenson. There's a need for honest criticism in a review, and Rabbi Zucker has certainty made his point about how terribly written this book is. I wouldn't think of ever buying it. However, the style of the review reminds me of a comment from someone in the stands at a college football game. The ball carrier for the other team had been tackled hard... when that fan yelled out, "Hit him again, he's still breathing." There must have been one thing positive in the book the good Rabbi could have commented on. But even if it is as bad as he indicates, his writing style crosses the line into humiliation, which was unnecessary in expressing his opinions.

Wm. Zeckhausen, D. Min.
Diplomate, AAPC
Laconia, New Hampshire

Re: A Chaplain’s Identity and Immigrant Communities, Titus George (PlainViews, 10/19/2005, Vol. 2, No. 18)

Titus George's contextual response to my article shows how a traditional "pastoral identity" is "intimidating" to "relating to the post-colonial, non-Christian immigrant patients from India" in his work in the Bay Area California hospitals. Titus correctly observes that my article does not directly address spiritual care with such an immigrant population.

Remember, my question had to do with "the value of a chaplain rooted in and representative of a faith-based theological tradition when it comes to talking about spirituality." Given what he wrote, it appears that Titus' answer to my question is "not at all." In his clinical case, Titus makes it clear he "was not a representative of Western Christianity." In this context, I have to agree with him. But I cannot tell from this example what value, if any, Titus' own faith perspective plays in assisting his meaningful intervention? And while I would hope every chaplain would be the "curious learner" he describes so beautifully, is it not fair to ask if a social worker or another allied professional have done this? My question, picking up on Harding, is why have a theologically trained chaplain on staff at all?

Also in his article, Titus suggests that I spend too much time on Christian stuff in a way that does not speak to his non-Christian context. Just to be clear: I was of course tracking the North American history of pastoral care, which reveals a Christian background essentially because Christian theologians and pastors were the founding parents of the CPE movement.

What I think Titus' and my article serve to provide are examples of what happens when the context of chaplaincy changes. I was looking at the "I'm spiritual but not religious" phenomenon; he is looking at immigrants recreating "their post-colonial
Indian identity." I am pleased that Titus has shared his experience in an admittedly new context for chaplaincy. It raises significant questions about who the chaplain is.
Christopher De Bono
Director of Spiritual and Volunteer Services,
Mental Health Centre Penetanguishene
Ontario, Canada

I appreciated the reflection of Mr. George. Since coming into chaplaincy from parish ministry 4 years ago, I have often felt the pressure to carry on my work in a manner consistent with the way the other disciplines in health care carry on their work. The problem has and forever will be that the sol does not yield to the same techniques as the body. I have come to believe that listening, connecting, respecting are the central work of chaplaincy. Agenda driven spiritual care often depersonalizes the recipient and leaves them feeling with spiritual care the same way they feel with the lab or the chemo-clinic –just one more body to process. Thank you for your reflection.
Larry Hirst, Steinbach, Manitoba, Canada
Chaplain Specialist in Pastoral Care

I very much appreciated Chaplain George’s reflection on “Pastoral Care”to those from the Indian subcontinent. Although the population of people from the Indian subcontinent is almost nil in Dubuque, Iowa (and most of those here are already highly “westernized”) I found that the process Chaplain George talks about is also applicable to many other populations.

Even though we are a highly Roman Catholic populated community (approximately 60%) and we have almost as many churches as gas stations, we also have a high percentage of persons of no particular church orientation. Some consider themselves “Catholic”because that’s what their parents or grandparents were. Some consider themselves “Protestant”because their parents or grandparents weren’t’Roman Catholic. A few make no pretense and say they don’t have any religion - quickly followed by, “But that doesn’t mean I don’t believe in God.”

I find the same process is needed here as what Chaplain George suggests. It takes time to get to know them and, more importantly letting them get to know me as one who will not judge, as one who is trying to understand their situation, as one who is trying to walk with them through whatever it is they are trying to face. They also learn that I am not there to try to proselytize them or to judge their life-style. If I take time to do that, they will let me minister with them. We walk together through many dark valleys confident in the source of strength and assurance that let’s us face the future only a little afraid.

David A. Pacholke, Chaplain
The Finley Hospital
Dubuque, Iowa

Re: A Chaplain’s Identity and Immigrant Communities, Titus George and The Times In Between, Rev. George Burn (PlainViews, 10/19/2005, Vol. 2, No. 18)

I want to let PlainViews, George Burn and Rachel K Taber-Hamilton how much I appreciated their respective pieces. I am about to leave my position here in Columbus, Ohio, where I have been the Director of Spiritual Care for 16 years. I have accepted the position of Director of Religious Life for the Council for Jewish Elderly in Chicago. It is a new position, with all of the accompanying challenges and opportunities. Not only am I in an "in between time," but I will also being working with a host of volunteers –so the points that both George and Rachel make resonated deeply with me. Thanks and G-d bless...
Rabbi Cary Kozberg
Columbus, Ohio

Re: Continuing the Discussion on Theology, Rev. Stephen Harding (PlainViews, 8/3/2005, Vol. 2, No. 14)

I concur with Rev. Harding's thoughts, as I've faced them myself in our team meetings. I believe I felt the 'growing sense of frustration' as I listened to others discuss the restlessness of a dying client and felt it had to do with unresolved issues, so send in the social worker, OR prescribe some medication as ativan. Then the children had some anxieties about grandpa dying so send in the bereavement person. I did speak up to say (and I did know the family as I had been visiting them) that there is a spiritual restlessness that occurs as, at times, one seems to struggle between letting go of this life as they move toward the next. At the previous days visit this client had been 'visiting' her mother, sister who had died, but was also waiting for a new grandchild to be born. We had spoken of that restlessness and found prayer and singing hymns helped, along with discussing the families beliefs on life after life, God's will, etc. . As for the children their anxiety had to do with: what happens when grandpa dies, does it hurt to die, and what if grandpa doesn't get to see the new baby.
So we had discussed those issues. And well, in a matter of days, the baby was born, grandpa got to see and hold the baby, and in between times we shared children's books on dying, stories of faith stemming from Sunday School lessons, those scary movies about dying, life and death issues, and all in all it was a rich theological experience.
More and more I find myself saying the family has faith issues vs spiritual issues. It has made a bit of difference. It is a matter of education, again.
I do believe the word spiritual has become as the word love became back in the sixties, almost meaningless as the depth and richness of the definition became lost in overuse.
Rev. Barbara J Lindeman, MS, Mdiv, BCC, FT
Chaplain, ISJ-MHS
Mankato, MN

Re: Proselytizing –A Disturbing Word, Rev. Emanuel Williams (PlainViews, 10/5/2005, Vol. 2, No. 17)

While I appreciate Rev. Williams concern, I am "disturbed" by his acceptance that "Conversely evangelism was defined as the making of an open, honest statement about the Gospel that leaves the hearers entirely free to make up their own minds about it". The power we have as chaplains, especially when dealing with patients and family facing life threatening illness, negates to a large extent the notion of "entirely free to make up their minds etc". We have a tremendous amount of influence on these people! Additionally, as a Jew, I would most certainly experience any reference to the Gospels as proselytizing. Lastly, Rev. Williams writes that the chaplain, "should make an effort to determine what G-d is doing in that particular situation and become a participant in the process". I for one, don't EVER speak for G-d. It keeps things simpler this way.

Rabbi Joel Levinson, BCC
Brookhaven Memorial Hospital, Patchogue, NY
& Good Shepherd Hospice, Port Jefferson Station, NY

Request for Prayers in New Orleans

I am the head of Pastoral Care at Ochsner Clinic Foundation in New Orleans. We are wanting to send an emailed interfaith prayer to our employees each day. I was wondering if I could get some chaplains from around the country to write prayers for us during our time of recovery which we can send to our employees. Prayers can be sent to JnThomas@ochsner.org.

Thank you,
Jennie

Accessing a New Model of Staffing

•Are you looking for objective support or documentation when speaking to your administrator about the need for additional pastoral care staff?
•Could you use helpful guidance in decision making about where and how to allocate chaplaincy time and presence?
•Are you seeking to balance pastoral care staffing in multiple settings?

The pastoral care department at Grant Medical Center and Riverside Methodist Hospital is developing a staffing model which addresses each of the above concerns. This model begins with a comprehensive assessment of unit acuity relative to pastoral care demands. It then provides specific chaplain-to-patient ratios based on the unit acuity. We are now seeking to strengthen and extend this model by benchmarking it nationally. If you would like access to this model as part of our benchmarking process, please contact Orin Newberry: phone number: 614-566-5307 or e-mail: newbero@ohiohealth.com.

Re: More on Harding, Christopher DeBono (PlainViews, 9/21/2005, Vol. 2, No. 16)

Responding to Christopher DeBono's piece on spirituality vs. religion translated into Chaplain vs. other professionals, I would like to make two observations; one is a definition of terms as commonly perceived, the other has to do with titles.

1. Using the NCA's historic and classical definition of spirituality [1]: the affirmation of life in relationship with God, with self, with others and with the environment that nurtures and celebrates wholeness, one concludes that the essence of spirituality is an active awareness of one's powers beyond the physical to maintain relationships and to grow thereby. Now, that's a mouthful!

Religion, however, is a bite-size formulation of an historically and culturally based spirituality and comes in many forms. Religion is the brand version of the generic spirituality. As I put it to patients and others, when you buy oatmeal you can purchase General Mills, Quaker Oats, Trader Joe's .....or generic !
Therefore, there is no discrepancy between the two.

2. The title CHAPLAIN, especially in non-denominational facilities, can be misleading and at times off-putting. Coming from the word CHAPEL, it smacks of "denominational functionary", hence of belonging to a distinct 'brand' of spirituality.

Granted that health-care related spiritual services were originally offered by ordained ministers, "chaplains", that title was by default extended to anyone, clerical or lay who ministered to patients etc.

To the Chaplain's greeting at the patient's door, "Hello, I'm Chaplain Joe or Jane", the patient may ask and want to know "What church are you with", and really wonder quietly "What religion are you peddling?" The chaplain then resorts to all kinds of explanations justifying his/her presence there as a professional on the health team supporting the patient's search for the healing resources of his/her spirituality framed by his/her religion or distinct beliefs.

To the point, I'll relate how an atheist patient was insulted by my presence as "Chaplain" but came to appreciate my presence as a respecter of his spirituality and his life accomplishments that gave meaning to his existence.

Therefore, can we find a more meaningful title for the function of today's health-care related Chaplain?

Lawrence Valentine
NCAA accredited lay Chaplain
Resurrection Retirement Community
Chicago, Ill

[1] The history of the definition can be found at www.ncoa.org/content.cfm?section ID=121. NCA (NCOA) has a constituent body, NCIA (National Interfaith Coalition on Aging) which formulated the definition around 1970/75 through the collaboration of Dr. James Ellor and Dr. Melvan Kimble.

Responding to Melvin Ray who wrote in response to George Handzo and James Stapleford who wrote to TalkBack about Office Space: Profit or Presence, Chaplain Richard Lopez (PlainViews, 8/3/2005, Vol. 2, No. 13)

A number of years ago I entered the offices of one of my colleagues where I happened to be the Director of the Department. He pointed to a newly framed certificate on his wall. The certificate declared that he was now a fully certified Alcoholism Counselor. He was very proud of this accomplishment and I shared his accomplishment with him. I did raise the question with him as to where was his Certificate of Ordination, as it was no where to be seen. A few years later, he came to my office and told me of the profound impact that my question had on him and that he went and looked for his Certificate of Ordination.

It seems to me that this story identifies the tension that we in "secular ministry" have. The tension between the demands of the institutions we are employed by (hospitals, businesses, treatment centers, hospices, etc.) and our personal historic roots –the church that "through the imposition of our hands" authorized us to preach, interpret the scriptures, provide the sacraments and a host of other pastoral services including being a prophet. The medical center where I work does not authorize me to do any of these pastoral offices, the church did that through the Elders and laity that ordained me.

I would agree completely with George Handzo that we are not a bankrupt profession and that we as a profession need proper education and certification. That is the reason that I have dedicated my professional ministry to such pursuits. However, I believe that we need to hold our faith heritage in equal, if not greater, respect. Therein lies the tension that I would hope could be folded into one that can become a banner for all of us.

In direct response to Melvin Ray, Board Certified Chaplain, I was not one of the writers for the White Paper. I am a former Regional Director along with a lot of other "formers". It is true that I have given a lot of my time, energy and love to the leadership of the Association For Clinical Pastoral Education as well as the old College of Chaplains. I have likewise given a lot of my time, energy and love to the United Methodist Church who ordained me. Similarly, I have given a lot of time, energy, and love to the various medical institutions who have provided my financial sustenance.

We in the professional chaplaincy owe a great deal to persons like George Handzo who take their time and energy to provide leadership. Thanks George for providing leadership as the Past President of The Association of Professional Chaplains.

D. James Stapleford, D. Min., MBA
Director of Spiritual Care and Education
Phoebe Putney Memorial Hospital
Albany, GA

Re: Are You Compassioned Out? Rev. Martha R. Jacobs (PlainViews, 9/7/2005, Vol. 2, No. 15)

Martha Jacobs' article is a good reminder of some self-care basics. It reminded me of this quote from the late Chief Justice William Rehnquist, which was printed in our newspaper couple days after his death: "There are dangers that come with successful careers. One can slide almost imperceptibly into a situation where the demands of the job are automatically accorded priority over other, more personal commitments."

Mark Pruitt, M.Div., BCC
Staff Chaplain
Department of Pastoral Care
Centra Health
Lynchburg, VA

I just finished reading Martha Jacobs' article in "Chaplaincy Today" and her comments in PlainViews. Thank you, Martha, for sharing your deepest musings of your soul as you worked toward renewing your soul and spirit. You have given us a guide and an example of what to watch for and what actions to take to make our own journey's back to that "unquiet Soul" that you speak of. Thanks again for letting us hear your soul-work.

Jim Stephens, M.Div. BCC
Senior Staff Chaplain
Providence Alaska Medical Center
Anchorage, AK

Kudos to Martha Jacobs as editor, not only for her article, “Are You Compassioned Out?”but also for the excellent article she penned in APC's Chaplaincy Today, ("The Unquiet Soul," Spring/Summer 2005, 33-36). She shared some thoughts and experiences she had to navigate to revive her own soul in the aftermath of the work she did with and for others following the World Trade Tower destruction in September 2001.

Cordially,
Rabbi David J. Zucker
Chaplain, Shalom Park, Aurora, CO

Re: The Bronze Boot, Rev. Charles Lopez (PlainViews, 9/7/2005, Vol. 2, No. 15)

I just want you to thank Charles Lopez for sharing “Harry”with us. (His own e-mail address was not listed) It makes me wonder how many “Harry’s”there are in the faces of the homeless, the poor, the “biker gang”crowd, the druggies, et.al., et.al. Besides forgiveness the article engenders some soul-searching.

Peace,
David Pacholke, Chaplain
The Finley Hospital
Dubuque, Iowa

I found 3 of the articles very useful and helpful to me. i made a copy of Dr. Hilsman's "Seven Love-Life Spiritual Needs and Hoped-for Outcomes" and plan to share with pastoral care students and volunteer chaplains.

I found Rev. Jacobs "Taking a Close Look at Ourselves" indeed right on the mark for me. I recently minister to the family of a nurse friend who committed suicide and remember how hurtful it was to hear about his death and know the pain he had caused his family and friends as I listened to them and
supported them at his memorial service that I presided at in a local funeral home.

Also Dr. Lopez's article about "the Bronze Boot" was so poignant of an example of how forgiving people can be that we encounter and come to love in our ministries.

I appreciate the quality and variety of PlainViews. Keep up the great work!

Chaplain Jennie Malewski
KU Hospital
Kansas City, KS

A response to the Catholic Church and reiki:

Rev. J.P. Doll would like to hear about the Catholic Church and reiki. He mentions that a " woman religious" (I assume he means a Catholic woman religious) introduced him to the practice. Now, I couldn't recall what reiki was although I've often heard the word. A short Google search and reading two introductory sites about reiki impressed me that it and the whole concept of energy flow and controlling it is rather flaky and not to be incorporated as a "Best Practice". While I applaud the pioneering spirit of Catholic women religious and others to reach out and try to incorporate alternative practices and knowledge, still all that glitters is not gold. Yes, I saw reiki or something like it practiced in the 1970's - along with crystal gazing. No, I don't believe there is much value and I think there there is harm in this and many other so-called alternative healing methods and psychologies. I can imagine that one benefit of reiki is individual attention and encouragement being given to a person seeking healing; something the medical practice in this country sorely lacks. However, couching this in demi-spirituality and it's system of energies is counterproductive in my mind. This reminds me of the story of Naaman the Syrian Army commander who sought for a cure for his leprosy from Elisha the prophet. When told to wash himself and he would be clean Naaman grew angry that Elisha wouldn't appeal to G-d and make incantations for his cure. While I don't doubt Rev. J. P. Doll's desire to be a healer and his (and women religious's) abilities to bring healing, still, wouldn't a technique more understandable to both science and religious tradition be more acceptable and accepted?

John Stangle
Certified Chaplain Advanced Emeritus, NACC

Thank you for the challenging words of Chaplain Mark La Rocca-Pitts' article "Pastoral Presence: Navigating the Flow." Pitts takes us on a wonderful and evocative journey as we weave our way between "voice and presence," between doing and being, in our encounters with patients, residents, and clients.

Pitts quotes the 13th Century Sufi mystic Jalaluddin Rumi, whose poetry lends imagery to the work we do on a daily basis. "There is a way between voice and presence/ -where information flows," Rumi writes. Further, "In disciplined silence it opens. / With wandering talk it closes." Pitts offers a concise and convincing interpretation of these words. Well done!

Cordially,
David J. Zucker
Rabbi/Chaplain
Shalom Park
Aurora, CO

Re: Continuing the Discussion on Theology, Rev. Stephen Harding (PlainViews, 8/3/2005, Vol. 2, No. 14)

In regards to Rev. Stephen Harding's articles on this topic, I would like to share a somewhat different view about spirituality, theology and religion, taking a bit of exception to the phrase, "merely spiritual". The common thought about spirituality is that it is limited to the personal experience one has with what they find to be transcendent. While this is true, it is also true that we are all "spiritual," whether we have a
personal apprehension of that or not.

Simply put, spirituality is our common base as human beings. In other words, we are spiritual beings with physical bodies. Some are more aware of their spirituality, while others are less so. In that sense, spirituality is personal. In the other sense, though, spirituality is profoundly a shared experience by all of humanity.

I would think that theology and religion are the more limited experiences of humanity. In that sense, we are "merely theological" when our focus is upon how to explain the trinity, or the unity, of God. Or, we are "merely religious" when our attention is drawn to how we pray and offer rituals toward the end of life.

Theology is the formal language we create to express what we experience at the spiritual level of our being, while religion is the community structure we create to give ritual and meaning to that theological language. Therefore, we can, and most certainly often do, disagree about theological topics and religious practices. But, our one common point is that we are spiritual, in whatever way we approach or avoid that reality about
ourselves.

The chaplain does have theological language and religious community as their background. I agree with Rev. Harding that the chaplain can, should, when invited, share that language and community texture in their care for those who grieve. In fact, chaplains should be able to do so in the skillful manner that allows those who grieve to talk in their own theological language, no matter if it is refined or otherwise. And, our experience with a community of faith should serve as a context for others to utilize their own community, or begin the search for such a resource to support them, should they desire to do so.

Once again, thanks to Rev. Harding for this thoughts on this, as it goes to the heart of much of what we do.

Marilyn Morris, M.Div.
RMH Staff Chaplain
Ohio Health

I'm sorry that I did not respond to the original dialogue presented. However, I am in favor of thinking and discussing theological issues and framing those issues didactically with other clergy. I believe it helps us in our own processing as we assess issues such as being or/and doing.

I am not in favor of clarifying our theological authority with staff. Doctors and nurses may talk in clinical manner and for those of us, who do not fully understand the language they use, has little to do with the authority we carry as pastoral caregivers. Using language that they understand helps us minister to the patients and the staff alike. If we use our language as they use theirs, then the only outcome is more confusion. I believe we need to use language that everyone understands and the authority we do carry will blossom. I find the continuity of visitation helps build relationships with staff and that includes doctors as well as the rest of the staff. Being open, honest and servanthood goes a long way in establishing pastoral authority with the authority within the medical community. Let's keep our language simple so that God's grace in which we represent may be better understood by all.

Rev. Rick Hope
Chaplain, Methodist Specialty and Transplant Hospital
San Antonio, Texas

Re: Responding to George Handzo and James Stapleford who wrote to TalkBack about Office Space: Profit or Presence, Chaplain Richard Lopez (PlainViews, 8/3/2005, Vol. 2, No. 13)

It seems to me there is role confusion among professional health care chaplains. In the context of the issue (interrelationship of pastoral care and profit margin), Mr. Stapleford declares that,”…as a provider of spiritual care, I am a guest in the hospital. …because I receive my authority to do what I do from an authority [my church] outside the medical center. …I try to be a good guest and understand the ‘rules’of the house. One of these rules is the profit margin.”

Mr. Handzo seems to present another facet which reflects the role of a credentialed, professional health care provider who is accountable to a recognized set of Practice Standards (Authority). This is the role of a health care team member practicing clinical interventions, whose education and professional standing is recognized (defined) by an overarching authority such as the JCAHO and Health and Human Services. Quite a contrast to what is usually considered a guest.

It seems to me, this primary identity of who we are and what we do could be interpreted as a “hat-in-hand, tail-between-the-legs, the-church-sent-me”approach. That is a clear message –“this job can be done by nice religious volunteers”–and supports the erroneous identification of “Chaplain”as a community clergy serving in the hospital.

Acknowledging of my own growing identity edges and role challenges, and with due respect to the leadership of Mr. Stapleford (who helped design the White Paper and is an ACPE regional director), I feel the existential impact of seeing chaplaincy as (predominantly) a guest in the health care arena is holding back our profession. I encourage, and join, our profession’s leadership and strategic planning efforts to heed Mr. Handzo’s prophetic words, “The only way we will survive as a profession is to have and adhere to a recognized set of standards for how professional pastoral care givers are credentialed and how they practice. We have to demonstrate as a profession that we do have a ‘best practice’and that we will disavow anyone who doesn’t practice at that level.”

I do not see our status as respected religious house guests. I will plan for vested health care professional ownership recognition.

Melvin Ray, Board Certified Chaplain
Director of Pastoral Care, Hunt Memorial Hospital District
Greenville, Texas

A question about the Catholic Church and reiki:

I am an ordained protestant minister in the Midwest. I have been trained as a reiki (energy work) provider and have incorporated use of reiki in my personal life and in my ministry with others. I was trained by a woman religious, who has trained many others in our community. Our small community hospital has recently opened a cancer center to provide for the care and treatment of cancer patient coming from a wide distance in this rural community. They plan to offer services of complementary therapies and have looked into having reiki available.

There is a strong catholic population in the community. The local priests have spoken out loud, strong and actually in hurtful ways to some about what they see as the “evils”of energy work. They have used their pull and influence with catholic contributors to the new cancer center and have caused the complementary therapy review committee to decide not to offer reiki to persons in our community.

I would like to hear from anyone about your understanding of the use of complementary therapies and the Catholic churches views of the use of them, particularly reiki.
Thank you,
Reverend JP Doll
justjpdoll@yahoo.com

Re: Office Space: Profit or Presence, Chaplain Richard Lopez (PlainViews, 8/3/2005, Vol. 2, No. 13)

Chaplain Richard Lopez’piece raises several myths commonly held by chaplains which are actively holding back our profession from serving patients, families and staff as fully as we might.

Myth #1 The hospital industry is a “desperate industry.”Many hospitals are failing financially and closures will continue to occur. However, the profit margin for the industry overall is rising. The number of hospitals whose bond ratings are being upgraded is rising. In the most recent reporting period, the number of hospitals in the US rose for the first time in years. Hospital construction is a booming business.

Myth #2 Hospitals must make a choice between quality and margin. Smart hospital administrators know and research is increasingly demonstrating a strong positive correlation between good quality care and positive margins. Those who provide better care make more money. The Malcolm Baldrige National Quality Award is the most prestigious quality award in the country. Of the four hospitals that have won it, all have strong margins and strong pastoral care departments.

Myth #3 Pastoral Care cannot contribute to margin. While it is often true that pastoral care does not contribute to a hospital’s margin, that doesn’t mean that we cannot contribute. Staff retention and cost avoidance around adverse events and end of life are prime areas where pastoral care can help the hospital make money. Even raising patient satisfaction can be argued to be a contribution. The problem is that, by buying into this myth, we do not put ourselves in a position to demonstrate our financial worth. We are not on the accountants’radar screens mostly because we have not done the work to put ourselves there.

Myth #4 Raising Standards Makes Pastoral Care Less Attractive. See Myth#2. Good hospital administrators appreciate that quantity without quality is useless. An overarching theme in this health care environment, is a flight to quality. The only way we will survive as a profession is to have and adhere to a recognized set of standards for how professional pastoral care givers are credentialed and how they practice. We have to demonstrate as a profession that we do have such a thing as “best practice”and that we will disavow anyone who doesn’t practice at that level.

As I consult with hospital administrators, what gets their attention is our demonstration of how pastoral care can actively and intentionally contribute to both the institution’s mission and margin. They pay attention when told that we are not just a bunch of nice religious people, but that we have standards and a rigor to our practice. Many hospital administrators want professional pastoral care. All they need from us is to make the case for how it can suppor