Flattery will get you everywhere

Ugh! What a way to start the week. Expected snowfall for this area is upwards of 6″. I didn’t relish the thought of driving around visiting patients today, but driving around I nonetheless did. But not before stopping to see a patient in the inpatient unit of our hospice organization. Having seen him before, I knew he was struggling with what the future holds for him. Unfortunately, he is not symptomatic enough to stay in our inpatient unit because – in his words – he’s “not dying quick enough.” I have encountered this scenario many times, and I am always saddened by it.

Many, if not all, hospice organizations are beholden to Medicaid/Medicare and organizational guidelines, which have specific rules regarding what qualifies a patient to a) be on hospice; and b) stay in an inpatient unit. The organization may not be designated as a “nursing home” or other extended care unit, so patients are only able to stay in the unit if they are symptomatic (and don’t get me started on the difference between symptoms and disease processes). So, once symptoms are under control, a patient may need to be returned to their home or care facility. That is often difficult for patients and families to understand.

In the case of my patient today, that’s precisely where he landed. He was under the impression he was coming to the inpatient unit to die and now because his symptoms are under control, he will now not be able to stay. He can still remain on hospice, but just not at the inpatient location. What a disappointment to him! I can’t imagine having to come to terms with the idea of my own death, but being moved around from facility-to hospital-to hospice-back to facility has got to be maddening. Quality of care notwithstanding, that sucks!

Yet, my patient is trying to take it all in and not let things get to him. He is attempting to just accept his circumstances the way they are and is giving everything over to God to take care of. I am always amazed at the strength of faith I see in some of my patients. It makes me wonder if I will have the same strength or if I will be a blubbering idiot when my time comes. Our whole healthcare/government system is so complicated, it seems like we just throw up our hands in defeat most of the time.  I’ve seen several of my social worker colleagues spend hour upon hour upon hour trying to secure Medicaid for a patient in order to get them into a facility for care, just to secure said Medicaid 2 days prior to the patient dying. Hundreds of hours lost because of a slow system that ultimately may result in placement in a facility with staff shortages and sub-par care. This is also precisely what my patient today was worried about. He came from such a facility and has no desire to return. Ugh. And I thought the snow falling today was a downer.

To my utter surprise though, my patient had a wonderful sense of humor and was a delight to talk to. Despite all of his concerns – not to mention his physical issues surrounding his disease – he was able to laugh, smile, and even make me blush. Yes, flattery will get you everywhere. At one point in our conversation, he asked me, “So how old are you, late 20’s?” Be still my beating heart! I almost fell off the chair in laughter. “Nope,” I said, “Turned 43 two weeks ago.” His eyes widened and he said, “Your skin is lovely, you look very young.” My cheeks reddened and I, of course, said Thank You.

Amidst the pain he has, the dark cloud of death hanging over him, and the uncertainty of where he will be in his immediate future, this man offered a gift of kindness and love to me. He was showing Jesus to me by making me smile and by understanding that, despite all he was going through, he is still able to bring something wonderful to this world.

The Fairy Tale Ending

So as I sat with my patients today, one thought played over and over in my mind: Why can’t we all have the fairy tale ending to life? I mean, really, who wouldn’t want to be completely cognizant of self and loved ones one minute, then fall asleep and “wake up” in heaven the next? Isn’t that the way it happens in the movies? Like in Titanic, when the adult Rose drifts blissfully into sleep and dies after throwing the necklace overboard. Or when Forrest Gump’s mama dies shortly after having a conversation where she encourages him and tells him all will be fine. Tragic death scenes not withstanding (the ones where someone is shot, hurt, blown up or otherwise killed), Hollywood and television portray death as this peaceful and gentle thing. Well, sometimes it’s not.

Each of the patients I saw today were in very different points of decline. One patient was not responsive at all, meaning no longer able to wake up, eat or drink, move her limbs or even open her eyes. I sat with her, playing peaceful music and praying. I was reflecting on how peaceful she seemed, despite the audible secretions I was hearing (sounding much like phlegm in your throat) and the occasional several seconds of apnea (where you stop breathing for a time). I was wondering what, if anything, she was thinking or dreaming about. What goes through the mind when the body is no longer functioning as it should? I could not come up with anything that made sense, and defaulted to praying that she was comfortable and at peace.

Another patient was very much awake, but was suffering from the effects of a very recent stroke, so her body was not working well and her speech was slurred. She is still very much aware of her surroundings and who and where she is, but her speech and mobility are now severely limited. As she attempted to talk with me, I was pondering what it must be like to WANT to do more, but knowing no matter how hard you try, you can’t. How difficult and disappointing that must be!  I resolved to offer her affirmation of what she was going through, and empathy for her situation.

The next person I visited was a delight to talk to, but was so confused that she didn’t make much sense. She was very much able to carry on a conversation, but she was not aware of where she was, what time of the day it was or what was going on around her. She could offer no details about herself or her life, other than generalities such as “I used to travel,” or “I still work, taking care of what they told me to do.” She has a lovely sense of humor and could say the funniest things at the oddest moments. I was reassured that in her stage of decline, she was not understanding what was going on, and yet she was still able to enjoy herself.

My final visit today culminated with a kind woman who is content with where she is in her life, although she also is confused about what year it is, how old she is and how long she has been in the facility where she resides. That doesn’t stop her from putting a smile on her face and saying she has lived a good life. Her comment, “If I closed my eyes tonight and did not wake up tomorrow, that would be fine with me,” was a true blessing for her. We talked about heaven and what she hoped heaven would be like. We talked about how God has been part of her life from the very beginning, and she shared many of the gifts God provided through the years. I left her today feeling content that she is true in her faith and is well taken care of.

Each of these individuals left an impression on me. Which was the better situation to be in? Not responsive and unable to do anything, but being comfortable? Aware of oneself and surroundings but slowly declining because of a stroke and physical limitations? Confused, but happy and able to participate just a little more in life? Or content and peaceful and ready to go to the other side on a moment’s notice? Or maybe all of these patients today have or will go through each of these experiences at one time or another. That remains to be seen.

These several individuals are definitely not representative at all of the vast numbers of ways someone’s soul departs the earth. I have been in dozens of hospital and hospice rooms where restlessness takes over the body and arms and legs are moving about. I’ve watched patients struggle with breathing until medications were given to calm the gasping. And I’ve watched CPR being performed without success, and gun shot wounds so severe blood was pouring out faster than it was able to be infused back in.

Why don’t we all get the fairy tale ending? If you believe in free will (as I do), then our endings can very much be a product of the choices we make. Not entirely, that is, but at least some of it. A pastor friend of mine once said to me, “When your children were born, their births were not the same. Each one was a different experience and each came into the world differently. The same is true for everyone, no two births are exactly the same. If this is the case, why would we expect every death to be the same?”  I find myself thinking about this very often and wondering what my death experience will be like. The blessing I find in it all is my faith that something much better awaits me once my death is finished.

Sausage and Tomatoes

Another day, another opportunity to see where God places me in the world. And I have to admit, I wasn’t feeling it today. For some reason, I was just tired and not feeling up to visiting, listening and just being social in general. Might have something to do with not being able to fall asleep until 12:30am last night, but what do I know?

And why is it, on the days when I lack motivation, my morning time in the hospice office flies by, but on the days when I’ve got visits scheduled back to back, the day drags on forever? Is there some law of the universe that makes this happen? I got to the office on time, even after dodging some pretty crazy drivers who seem to not know the concept of how traffic signals work. My usual time in is 8:30am and after updating my computer and viewing new news about patients, checking voicemail and reading emails, all of a sudden I look at the clock and it’s 10:30am! What the heck?!?! Despite my lack of giddy-up and go, I got up and went…to my first visit.

I wish I could say each visit is fulfilling and worthwhile, and if you believe that, I have some land in Greenland I’d like to sell you. Sometimes visits are not productive, which causes me to re-evaluate the necessity of my presence in a patient’s life. Today was such a time. I’ve been visiting a tiny, grey-haired older woman, at the request of her son, who thought “mom could use some spiritual support.” Mom, on the other hand, really doesn’t understand why I’m there. Mom doesn’t want to talk about her faith, her life, or anything for that matter. Not to mention, she’s hard of hearing so conversation already takes twice as long. So for the past three visits, I’ve brought up about every topic I can think of which may interest her, and the only responses I’ve gotten are smiles, nods and the occasional, “Oh, I don’t know.” And while she will, at times, make comments about the other residents in her facility, the food, or the weather, none of these things warrants a chaplain’s visit or support.

So I find myself at a crossroads – continue visiting, despite the lack of interest, or discontinue visits and spend more time with the patients who want a chaplain there? Experience has led me to believe that family who request a chaplain “because mom/dad would enjoy/need it,” are really saying they, themselves, are the ones who need a chaplain’s ear. Yet, those family members are MIA when it comes to visits or accepting calls. The request for presence seems to be made out of a sense of guilt or anxiousness about the loved one’s decline. Maybe if the chaplain can make mom feel better, I will feel better about the fact that she’s dying. If wishing made it so… In the end, I decided to discontinue visits with this patient. Fortunately, since she forgets who I am after each visit and I need to keep reintroducing myself, I don’t feel it will be a loss to her. And I know God will continue to provide a support for her by way of the facility staff, the hospice nurses and her family.

So on to my next patient – an initial visit. These are often the most enjoyable, as they are a like playing a combination of the Dating Game and 20 Questions. Only, in the end I don’t end up with a date with an eligible bachelor. Instead, I learn invaluable information about my patient, and hopefully a bit about their faith and how it plays a role in their illness and decline. Today was no different. The lovely lady before me was 90 years old, but did not look a day over 70. Her brightly painted nails and ruddy cheeks belied her age, and it was a delight to be able to point this out to her. She, in turn, loved talking about her faith and her family. She receives wonderful support from her pastor and other members of her church, but asked for a chaplain because, in her words, “more spiritual support can’t hurt.” The best part of the visit happened when she shared how she had two boys, born 17 years apart. My jaw hit the floor!! I had to know how and why there were so many years between them. My patient told me the first was planned, but the second just kind of happened. When I commented that it must have been difficult having them so far apart, she replied, “Well, whether the two sausages are linked together or separate, there are still two sausages!” I haven’t laughed that hard in a long time! I can tell this patient will be a joy to visit. As conversation continued, she was able to reflect on her life and commented, “I’ve been around a long time, haven’t I? I’ve done so much.” I agreed and told her I would love to hear more about her life each time I visit. She agreed and I made plans to return soon.

My last visit was with a lovely octogenarian (plus some), a former farmer and former military man. His most pressing concern – one he shares with the majority of the older patients I see – is why God has allowed him to still be living. When someone is dying and they know and feel themselves declining, this question arises quickly. It has to do with suffering and how God can allow that suffering to continue. In life there are varying degrees of suffering as we make our way through the years. When we are in decline and approaching death, that suffering can be amplified because we know the end result is death and we just want it over as quickly as possible. For this man, he feels he should already have died, because now that he has outlived his siblings, there is nothing else he feels he needs to do. He touches on this at least one during each of our visits. When pressed though, he admits he does not want to leave his wife or his children. He is, simply put, questioning the “why” of his decline and suffering, and tired of living through it.

As a chaplain, and as a human, I have no good answer for him. Suffering is something we all go through in one form or another, and it cannot be avoided. But the question of why there is suffering in the world is a question the human race will struggle with for eternity. As a person of faith, I choose to believe that we live in a fallen world and because of the choices we made – and continue to make – suffering will always be present. Suffering will only cease when we choose to fully live and act in love, as God created us to. But again, I digress…

The wonderful highlight of my visit with this gentle man was his sharing with me his knowledge of growing tomatoes. Every day with lunch, he orders the same sandwich, and every day it comes with two slices of tomatoes on the side. No matter the day, when asked, the tomatoes are never ripe and always bitter. Today was no different. As he talked about the tomatoes he enjoys the most (pineapple tomatoes), he eventually shares a story of starting his own farm, and not having the money to afford equipment. Crops were planted by hand and harvested by hand. I learned today that seed corn used to be sold by the bag and bushel, but now is sold by the kernel. I learned that automation in planting and harvesting crops made the job easier in some ways and more difficult in others. Most importantly, my patient was able to say out loud that he worked hard during his life and he had done a great deal. For him, realizing this meant he has no regrets about his life, and he knows once his life is complete it was a worthwhile life lived. As a chaplain, I got to witness this realization and support it with affirming words and presence.

Sometimes the most important things happen in someone’s life amidst conversations about sausages and tomatoes. Sometimes merely witnessing to someone’s life can bring a sense of completion and peace. Sometimes, God is just that big that He puts into your lap the opportunity to learn something new and to affirm what has already been learned. Today was that day for my patients and for me.

Of Gospel Music and Birthday Cards

This job, as I have learned, moves from one unique circumstance to the next, and does so on the turn of a dime. (And that phrase alone should tell you something about how old I might be.) Today was no different and as I sit here pondering and reflecting on what I’ve gained, one thought comes to mind: One grouchy person has no power over me.

But alas, we should start at the beginning, with the morning new and fresh – and downright windy for a day in March. My chaplain work began with a hospice team meeting, one in which all the patients on the week’s caseload were discussed. After I open the meeting with a prayer, I, for the most part, sit in attentive silence, as the intent of the meeting is to review medical concerns and any needs to be addressed. Never fear though, as I do speak up when the need arises, and offer the chaplain’s perspective on a difficult patient situation or my insights as to how to reach a patient who is struggling with EOL (end of life) concerns.

My compatriots – consisting of nurses, social workers and an MD – are, after two months of my joining their team, still not sure how to take my contributions, as the previous chaplain who attended this particular meeting did not say much. So when I do offer a thought or two, I generally try to make sure what I am saying is worthwhile and essential to the patient’s care. More often than not I am met with confused looks or blank stares – but they are respectful confused looks and blank stares!. No matter how important spiritual care is to the hospice philosophy, the general public and general hospice staff still do not seem all that sure of the need for it. That challenge, it seems, is on-going and I am forever working to change the culture. But that topic is for another day. I digress…

Today’s meeting highlights consisted of mainly routine concerns about medications, extended care facility staff not providing good care, and patients’ family members who aren’t giving pain medications as often as they should because they would rather have their loved one “awake” and restless instead of comfortable and most likely sleeping. Yet another topic for another day. But mixed in with these typical patient reports were revelations of a phone sex operator living in a care facility we visit (not our patient), bed bugs in another facility, and a patient who on any given day is high from illegal substances. The chaplain me pondered these interesting tidbits, and considered how difficult our patients have it when dealing with a terminal illness or condition while also navigating the difficult circumstances they live in. The “regular every day” me was wondering how our world and society has gotten as far as we have, considering the less than brilliant minds we encounter every day. (But hey, even if you live in an extended care facility you still may need to make a living – why not a phone sex operator?)

All of these ponderings aside, the day was running as usual. My first patient visit went very well, as I was able to meet my patient’s spouse for the first time. Conversation was fruitful and I learned a lot about the patient I had been seeing for the past few months. As a chaplain, much can be gained from both patient and family conversations. Patients are only as forthcoming as they are comfortable, but family members tend to share much more because they want the best for their loved one. They also tend to share more because they do not know how to express their anxiousness about their loved one’s eventual death, and they are reaching out to anyone who will listen to their story.

Such was today’s encounter with my patient’s spouse. I listen more than I speak during my visits, allowing silence to linger, even when it grows uncomfortable. The uncomfortable space always seems to get filled, and usually with fruitful information. This time, that silence was filled with the explanation that my patient has never liked to be the center of attention, and has always tended to be quiet and unassuming. I also learned that my patient can seem extroverted when in one on one conversations, but in a group, will give control and focus to others. As I listened to the spouse talk, I recalled earlier conversations with my patient and this new insight fit with what I had come to observe thus far. Alas – a new tool I can use in future visits! This revelation brings to mind many questions I can ask my patient once I am visiting alone next time: How do you find peace amidst the chaos that goes on around you? How is God helping you through this – or do you feel God is missing? I am looking forward to visiting again for more conversation.

My next patient was a bed-bound person whom I have visited on multiple occasions. My first visit with her was interactive an definitely interesting, as she shared many details with me about her life as we talked at a table outside of her room during lunch. Despite having dementia and not being aware of the current time or place, she was able to tell me of her family history and the things she enjoyed while growing up. Over time, and leading up to today, she has grown weaker, is not eating and sleeps the majority of the day. Today when I walked in, she was awake – a wonderful sight! She immediately said, “I know you – you’re my mother!” As I sat down, I smiled in return and just said, “I am?” My ministry of presence, support and affirmation allows me to be whomever my patients need me to be. For a dementia patient, arguing against what they see and feel to be true is a losing battle. The compassionate care I can provide is done through letting her lead the visit and just being supportive. Today I was also able to feed her lunch, which only consisted of a few bites of food and a small glass of water. Nevertheless, it was an important part of her care and one I am humbled to be able to provide.

Over the next hour, she talked as if I were her mother and she was sharing her day with me. Her smile was beautiful, and she was enjoying having a visitor. The best, most fulfilling part of the visit was when I played gospel hymns for her and sat back while she sang with the music, tapped her toes to the beat and repeated, “Praise Jesus!” I could tell this brought her to a place of comfort and peace, which is exactly what she needed. When I finally ended the visit, I heard a string of Thank Yous, which told me she had received something truly special today. This was affirmation to me that I am doing what God has called me to do.

But on to the next part of my day…working in the hospital. This is where the birthday card portion of today’s entry comes into play. It’s my turn to get the birthday card for the chaplain whose birthday is coming up next this month. I also get to plan a small party for that person – and who doesn’t love parties? The thing is, the next person with a birthday is my boss. So quite a conundrum I have in selecting the appropriately themed card. Do I go with the traditional style card, with the usual “Happy Birthday! May your day be filled with…” blah, blah, blah? Or do I select something more my speed, which is generally slightly off color and funny? Of course, I went with my gut and got the funny card. I mean, really – don’t we all want our bosses to lighten up and smile more? And I think my boss has a good sense of humor.  -SIDEBAR-  A couple years ago during a meeting my colleagues and I were discussing the merits of the comedy The Big Bang Theory. I just shake my head at the absurdity of the show, and have never watched a full epidode, while my colleagues had been pulling me into endless rounds of Rock-Paper-Scissors-Lizard-Spock.  Anyway, we were in a heated discussion about the show and I off-handedly made the comment that smart people don’t watch that show.” (I wasn’t being serious, it was a good-natured argument and we were having fun.) Little did I know that my boss, who had been standing at the other side of the room, was listening to our exchange. She then chimes in with, “I watch the Big Bang Theory.”  Bazzinga!  The room fell silent and I was emphatically put in my place, followed by tons of laughter directed towards me from my colleagues. Therefore, I do know my boss has a good sense of humor.

Anyway, so I now have this great card, which is funny and which I know she will like. As I hand it off to the first of several colleagues who will be signing it, I am met with a shocked look as this person reads the card. I am then somewhat scolded because of it’s inappropriateness. Immediately I am internally wondering if I made a mistake in my choice. But I decide to stick with it and reply that our boss has a sense of humor and I think she’ll like it. Fast forward 10 minutes and this same colleague comments to me how they would be offended if they received the card. Again, I pause, rethinking my choice. Again, I reiterate that I’m ok with the card and it’s fine. I receive a disapproving look before my colleague leaves for the day. (Mind you, I get along well with this person, so I’m chalking it up to a one-off.) As the card gets passed around, all who read it give a hearty laugh and I know I picked the right card.

But as the afternoon continues, I feel myself getting more and more annoyed. Why was this person being a grouch about the card? Why can’t people just have fun? How come one person needs to be a buzz-kill when it comes to humor and enjoyment? By the time I ended my day, I decided that since I don’t have to go home with that person, I will be in charge of my mood the rest of the day. Who knows what was going on with this person. Maybe it was a bad day for them. Maybe a bad week. Maybe their relationship with our boss is different from my relationship with our boss. Who knows? I did say a prayer for my colleague though. For whatever is going on in this person’s life, I hope God is able to bring some peace to it. We all deserve peace in our lives, regardless of what is going on. So whether we’re just going through our work day, slogging along from minute to minute or we’re laying alone in a bed just hoping for a visitor to stop by, may God place before us those who will help us to prosper and see Jesus just a little bit more clearly.

Where to begin?

I’ve been thinking about blogging for quite a while now, and tonight I took the plunge and set it up. I was hoping for a more dramatic entrance into the blog-o-sphere, but alas, it’s almost 9pm and my drama quotient is nil.

Mainly, I feel God is pushing me to share with the world some of the experiences I’ve had as a chaplain, both the good and the bad. There are many days I come home with a burning desire to tell anyone and everyone about a conversation I’ve had or a patient I spent time with. But as I walk in the door, I realize my personal life needs to take over and my family responsibilities come first. Then, it’s 9pm and I still haven’t said a word about what happened during my day.

I hope you’ll follow along and respond with questions and comments. Maybe God is nudging you to consider pursuing chaplaincy as a vocation. Maybe you end up volunteering at a hospice or hospital. Or maybe something you read here will bring some peace to you after you’ve lost a loved one of your own. I pray God touches you somehow and some way for the good.

Shalom.