Tuesday, March 04, 2008

The Chaplain on "The Chaplain"

Updated Tuesday afternoon.

I’ve been caught up in Anglican stuff this past week. However, I wanted to come back to a question I had. In responding to a post last week, I received this comment:

anonymous said...
I apologize for using the comment box for an off-topic inquiry I'd normally do through email, but I didn't see an email address for you and I'm curious to hear your response to a Hollywood depiction of chaplain interacting with a terminal patient that is being touted as "typical" of "liberal" chaplains by a certain self-proclaimed "orthodox Anglican" website.

If you find it beneath commment, I certainly understand, but I thought someone who has actually has some expertise in this area (and is not merely trying to erect a straw man to score political points) might offer some useful insight.

Link to Annoyingly Tendentious Website

Rather than send you back to the “Annoyingly Tendentious Website” (and remember, that was the poster’s comment. not mine), let me send you to this. This is the better YouTube clip, and it provides more information than that to which “anonymous” pointed. Take the time to view it and come back.

I don’t watch “ER” – haven’t in years. I enjoyed it at the beginning, but eventually it failed to hold my interest for the same reason that all medical dramas have failed with me for more nearly thirty years: they just don’t portray real life in hospitals. Fact is, life in hospitals, and especially life in emergency rooms, involve occasional excitement with a lot of daily grind in between. It’s not exactly like that comment from the pilot about “hours of boredom punctuated by moments of sheer terror,” but it’s not too far. Most of us who live in hospitals don’t want as much drama as a TV show would need. At the same time, there’s usually enough drama in our real world to go around. I’ve worked in inner city trauma centers most of my career, even if I now work in a smaller, suburban hospital. People don’t bang doors open, and they don’t come running and screaming. Indeed, these days emergency rooms are secured, and doors wouldn’t bang now matter how hard someone tried.

Most especially, hospital dramas don’t commonly have chaplains or social workers, and so physicians – all too frequently Intern and Resident physicians – and nurses get written as providing a lot of emotional support and social service. That just doesn’t happen. It’s not that they don’t care. It’s that there aren’t enough physicians and nurses around to do what physicians and nurses are trained to do, and they don’t have time to stop and do what chaplains and social workers are trained to do. Doctors and nurses don’t always understand how we do what we do, but they’re absolutely ready to give us room to do it. They generally don’t have a choice: they just have too much else to do.

So, I will say up front that I didn’t see this episode of “ER” broadcast. However, I was able to find more and discover more than the first link provided. That will become important.

When I looked at the link that my anonymous respondent suggested, I noticed how many folks commenting at that site were critical of what they described as “New Age” or “progressive” or “liberal” pastoral care. One or two even blamed CPE. Well, having looked at the selection that I recommend, I don’t like those labels, but I also don’t like the mistakes obviously made in getting to this point.

Here is the setting: Chaplain Julia Dupree sits in an ER room with a patient, one Dr. Truman. While injured himself, Dr. Truman is also concerned about another patient in ER, a young boy whose life the doctor saved. However, the Chaplain learns there is more to the story. Dr. Truman is a prison doctor, one who carried out a number of executions by lethal injection. One of the prisoners so executed was in fact the father of the child whose life the doctor saved. Worse, that execution was complicated. The patient’s IV infiltrated – it got backed up and blocked – and the patient didn’t die. Following procedure, Dr. Truman started a new IV, started new drugs, and the patient died. Dr. Truman is terribly aware of all of this, as is the child’s mother. She confronts him during the show, saying, “This doesn’t make up for it. I will never forgive you.” And so by the time he meets the chaplain, Dr. Truman has decided he can’t forgive himself, and he can’t expect God to forgive him.

Let’s be clear: right from the beginning the chaplain made a significant mistake. She fails to assess who and where her patient is, emotionally and spiritually. Right at the beginning of the scenes in the link I prefer, a rosary is quite visible in the patient’s hands. That would suggest the patient is Roman Catholic, and would raise questions about his participation in executions in the first place. Moreover, as he tells his story he makes clear that in hindsight he has interpreted the infiltration of the IV as divine intervention. “God sent me a sign, and I ignored it.”

The chaplain does not believe the patient is beyond forgiveness, and so she jumps to offer words of comfort, and to suggest, without being explicit, that God has already done what the patient only needs to accept and appreciate. But, the patient isn’t there. The chaplain appears unable to wade into the patient’s pain and guilt and be there with him. She isn’t prepared to let him guide her in meeting his needs, even to let him decide what he thinks he needs. She doesn’t consider whether this would be an appropriate referral, if he might benefit from sacramental penance. She doesn’t consider whether to confront him, to ask whether he really believes he is more powerful than God, that his sin is beyond God’s capacity to forgive. She simply asserts that he is forgivable, and even already forgiven, a thought that, true or not, the patient is not prepared to hear. His ability to trust her collapses, and he throws her out. Nor can she see this as something that at least validates and empowers the patient (after all, who else in that setting can the patient actually throw out?). We learn later in the next clip that this is for her a major defeat, one that prevents her from trying again.

It’s in that clip that we realize why she made the mistake. Talking with a supportive physician, she says, “People in crisis want rules, structure, something to lean on, I get that; but it’s not me.” But, it’s not supposed to be about her. It’s supposed to be about the patient. She speaks about her education, and her varied spiritual background and experiences. She says, “I thought an inclusive approach to spirituality would work in a place like this.” She’s right, and the physician affirms it. But in this instance she failed in being inclusive of this patient. As much as she wanted to be there with him, she failed to be there for him.

This highlights a mistake made by the writers. This young chaplain has education and training, but appears to have little foundation of her own. I’ve found it very difficult to find any backstory for this character, but in this instance she seems uncertain of her own foundation, her own tradition. This is something missed by advisors to the writers. The professional organizations that educate and certify for chaplaincy require ecclesiastical recommendations and endorsement: evidence that in fact the chaplain or student come from a specific faith tradition and is conversant with that faith tradition. To be available to someone else, the chaplain needs some clear sense of who she or he is, of where he or she comes from emotionally and spiritually. It helps me as a chaplain to encounter even those most different if I know the tools of my own faith, and my own limitations. There are no “generic” chaplains. Instead, there are chaplains from various traditions prepared to care for and support, to the best of their ability, patients and families across the spectrum of human beliefs. And a long time ago a student taught me profoundly that enthusiasm is no substitute for groundedness, something that education and training in themselves won’t necessarily provide, and certainly won’t replace. In that room this chaplain couldn’t be there for this patient because she couldn’t be there for him instead of for herself. My fear is she couldn’t be there because she wasn’t sure where she was in the first place.

But let me note this: unlike most of the commenters at conservative blogs, I don’t think the problem was the basic technique. This chaplain did not fail because she took a nondirective approach, or because she held a progressive faith. This chaplain failed because she was not prepared to accept this patient where and as he was – something that throughout my career I’ve seen from clergy across the Christian spectrum, conservative and progressive, “left” and “right,” High and Low and Broad. Some of the commenters, so delighted to find fault with her, make exactly the same mistake.

This is just a short reflection. I’d love to see a transcript, to take this to a group of CPE students and see what they do with it. Perhaps folks commenting here can add, as Malcolm+ did in responding to anonymous’ initial comment. The presence of a chaplain is not likely to bring me back as a viewer of “ER.” On the other hand, any presence of a chaplain (or any other clergy, for that matter) in the media who’s trying to help and not to manipulate or control is worth our attention, and perhaps an opportunity to reflect and to learn.


If you're interested, there are two other web pages reflecting on this character on "ER," one of which refers to this episode. At PlainViews Chaplain Julia Allen Berger comments on "Chaplains in the Media." And she cites the Hastings Center's Bioethics Forum, where Nancy Berlinger, editor of the BioethicsWalk at PlainViews, has posted this interesting article providing some historical context.


Ann said...

CPE was the most helpful training for Parish Ministry - I served in a VA Nursing home - very much like a congregation with older members. Getting to know where people were coming from - their backstory- is important. Thanks for your thoughts on this show - I think it would be a great tool for pastoral care training.

Young fogey emeritus said...

Hello again, Father.

I semi-regularly watch 'ER' (never saw it in its golden age), essentially a soap opera for people who think they don't watch that sort of thing, and did see this episode.

I agree with some of the conservative criticism but not of course with abusing the poor chaplain!

Also what struck me was the depiction of the remorseful, despondent old prison doctor/executioner. I'm sure there are people who get caught up in his way of thinking - scrupulosity leading to spiritually deadly despair (after all suicide, which he tries, is a mortal sin just as much as knowingly, wrongfully killing somebody else) - but I wonder if the writers meant to show somebody ignorant of aspects of the Catholic faith, or if they, perhaps ignorant themselves, intended to mock Catholicism as much as the well-meaning chaplain's liberalism. He didn't need the convict's wife's forgiveness; he had God's forgiveness for the asking (not far from what the chaplain was saying!) in the cleansing sacrament of confession and absolution.

Marshall Scott said...

ann, my colleague, thanks for the comment.

I do think there's no substitute for CPE in providing clinical experience for folks in training. Not all experiences are good, unfortunately; but there is nothing else as good, even when things don't go as we'd like.

Jon, my young friend, I hoped you'd look in.

I agree that he has God's forgiveness, and that he could access that through sacramental confession. Unfortunately, that was a clue the chaplain character missed. As for the writers: I can well believe they were ignorant, more than mocking. I know that mocking happens; but in general I think this would come under the rubric, "Do not attribute to wickedness something that can be explained just as well by stupidity."

Andrew Gerns said...


I have been out of clinical chaplaincy for a few years now, but I still consider myself a chaplain and all the ways that matter the most.

Your analysis of the "ER" episode and using the vignette as a way to reflect on the task of the chaplain in the clinical setting (ED or anywhere) is first rate. I could not agree more.

I will pass this along to my parishioners who are doing or will be doing CPE as a worthwhile teaching.

We have all, at one time another, so sought to be with the patient that we have forgotten to be there for the person. All of us have, at times, forgotten that it is not about us but about the person God has given us at the moment. Every clinical chaplain has at one time or another been hooked into reassurance. With God's grace, we have all learned from our patients and colleagues and grown through it.

Those who held up this episode as indicative of the state of pastoral ministry today just aren't paying attention.

thanks for your words.


Anonymous said...

Thanks for your helpful commentary on this episode! I am currently fulfilling a CPE residency and am using one or two clips from this show during a didactic presentation I'm preparing on the role of theology in pastoral care. The focus of the didactic is on discovering our own theological framework, and so your comments have been especially helpful to me.