Monday, July 23, 2007

Confessions of a Healthcare Chaplain

Somewhere along the thin line between Friday and Saturday, I was walking the halls of the hospital, singing the theme to “Mr. Rogers’ Neighborhood:”

“It’s a beautiful day in the neighborhood,
A beautiful day for a neighbor.
Would you be mine?
Could you be mine?”

Friday was a “chaplain night,” the like of which I haven’t had in a while. My workday began at 0830 Friday and ended at 0345 Saturday. When I was taking nights once or twice a month at the central referral hospital in my system, such nights weren’t uncommon. Since I’ve been out in my suburban community hospital they haven’t been unknown, but they have been rare.

When I was younger – say, twenty years younger – such nights were a positive joy. I have often said that chaplains are the “adrenaline junkies” of the clergy. We take on long hours, walking through emotional hurricanes, as a normal part of business. “Fools rush in where angels fear to tread;” and chaplains wade in when even fools know better. That’s not to say my colleagues in congregations are protected from such events. They happen to parish clergy, too. But for us, they are normal operating procedure, and, in the health care phrase, “standard of care.”

But they are more than that to us, too. To some extent they are marks of accomplishments, and even of machismo. As I said, twenty years ago they were a positive joy. I could work 32 hours straight and recover with one good night’s sleep. Nowadays I can’t do that; but working 20 or 24 hours, even if it takes me three days to recover, is for me recovery of past glories, not unlike someone more athletic remembering a high school football career.

Twenty five years ago I was a young priest, the Associate Rector in a large parish. I was a husband with a wife and infant son at home. I was also a very part time chaplain, taking night call at the local regional medical and trauma center once a month. Why? In part because I had already completed a CPE residency, and I wanted to keep my skills. In part because it was a significant help to a local hospital. But the real reason was that I liked it. It certainly wasn’t money. They did pay us, as we used to say, “car fare ‘ – perhaps a hour and a half at minimum wage - and they provided supper, breakfast, and a place to sleep if we could. But it wasn’t a salary, and it certainly wasn’t enough to think of it as supplemental income, even then.

No, I did it because I liked it. (I was told then, and have been told since, that I have perverse tastes.) You have to, you know. You have to want to be awakened at 2:00 a.m. to go to the bedside of a deceased patient and care for a family you’ve never met. You have to want to walk the halls at night, sustaining energy with coffee and chocolate, to share tumult and grief with the suffering. You have to like it.

And there is something there to like. Now, every profession has its moments of success and triumph. We identify it with athletics or military heroism or scientific discovery; but even those professions that seem more mundane have their moments. Think Al Pacino's character in “Glengarry Glen Ross” talking about a good sale; or Annie Sullivan in “The Miracle Worker” when Helen Keller grasps the connection between those odd finger movements and the experience of water. For the chaplain it is walking with the suffering through disaster, and especially through loss and grief, staying with them from the immediate trauma through the denial and the wailing, to help them find enough acceptance to go home and begin the next steps. And, not unlike my literary examples, the more stressful the events and the longer it takes to get there (at least up to a point), the greater the satisfaction, and even the rush, when it’s successful.

Now, I also think liking it is a matter of vocation. One of my professional stories (one I might tell at length another time) involves being in a small consultation room supporting a trauma surgeon as he told a family of perhaps twenty that the youngest adult child, the family hero, had died in an accident in a car driven by an older sibling. The family was close and intense, and their grief was explosive. All cried; many screamed; a few fell to the floor. Hospital security officers were preparing for violence, putting on leather gloves. In that chaos, I had a moment of clarity, a moment I have always since associated with the Spirit, that this was where I was supposed to be, this was what I was supposed to do. I was supposed to be with this family in their grief, to help them get past the emotional tornado to take the first steps of grieving. I waved off the security guards, and began moving through the room, praying silently as I went, to touch person after person in one way or another.

But, like all matters of vocation, and especially in identifying vocation by identifying one’s gifts, there’s also a real pleasure in doing the work. There’s a pleasure in being in the moment with people, touching them and being touched by them empathetically. If I’ve done my work well, by the grace of the Spirit, the people know I’ve loved them as best I know how in the time and the circumstances we share.

Now, I’m not particularly noble. I have to maintain some self-doubt, some awareness that because I enjoy it I can’t claim to be angelically altruistic. As I pray with some frequency, “Thank you, God, for a sense of your presence; and if it’s my own ego, my own emotions that cause this feeling, thank you anyway.”

But I will admit there was a rush, functioning as a competent, compassionate chaplain, caring for family member after family member, and watching over the staff in the process. There is a profound satisfaction in having walked through the night with those folks, seeing them off and then settling into my own exhaustion, even as I’m too wired to rest for a while. It is in its way absurd – as absurd as singing the theme to “Mr. Rogers’ Neighborhood” in the middle of the night, in the middle of a crisis, walking the hospital halls. But it is also a big and important part of what I do. I am a healthcare chaplain. It’s what I’m supposed to do; it’s where I’m supposed to be.


Unknown said...

I just wanted to express my deep appreciation for this post. I am a health care ethicist by vocation and have worked for many years at the hospital bedside mediating and resolving conflicts between providers and patients and their family members.

Many a time I have witnessed the calming influence a hospital chaplain brings to tense situations. Many a time I have witnessed the expertise chaplains have in communications brought to bear on difficult and confusing situations.

I have come to understand that chaplains are the hub of a subculture that exists in every hospital. They exert enormous influence and have a wealth of contact.

Patient and their families would do well to call pastoral care first, immediately upon admission in beginning to build a network of relationships with key hospital personnel. I say as much in my latest work, 3 Secrets Hospitals Don't Want You To Know: How To Empower Patients.

Chaplains know everyone, and everyone knows and loves chaplains. When you befriend a chaplain, you befriend staff.

Your post illustrates perfectly the reason why!

Thank you for your work.

Mark E. Meaney, PhD
President and CEO
National Institute for Patient Rights

Marshall Scott said...


Thanks so much for your comments. We work hard as chaplains to develop just the systems of support and communication that you describe. I'm glad that it's visible to professional colleagues.

I took the time to look at the NIPR website and the blog Empower Patients. Your work looks very interesting, and I will continue to look in.

Unknown said...

Don't thank me too quickly Marshall. If people follow my advice, you'll be a very, very busy person.

Seriously though, since I have had access from the bedside to the boardroom, I am shocked at how little people in administrative postions know about the nature of the work of chaplains.

If we talk strickly in quantitative terms, the chaplaincy saves hospitals enormous sums of money just in terms of the availability of bed space.

Moreover, chaplains provide a sense of continuity for patients/families in these days of component management (a specialist for every organ). So, again, patient satisfaction translates into money.

Unfortunately, most of the evidence for my supposition is anecdotal. There is as yet no hard evidence for what I'm saying, but anyone who has spent anytime at the bedside knows exactly whereof I speak.

Just in terms of efficency, I can't count the times I've seen chaplains advise a case manager or a social worker to stop in on a patient, and thereby same time (money) and lives!

I can go on. The evidence is overwhelming. If administrators want to figure out how to abide by the new 'communications standards' issued by CMS, they would do well to look under there very own noses to see exactly what chaplains do to improve communication between "team" and patients/families and how they do it.

The only other advice I would give administrators is, PAY CHAPLAINS FOR WHAT IT IS THEY ACTUALLY DO: clear up problems of communcation and mediate/resolve conflicts through alternative dispute resolution, and help patients/families deal with medical error and thereby keep the hospital out of court!

Enough of the soap box for now.

Dr. Mark