Wednesday, December 31, 2014
In reading the Hospice Foundation of America December 2014 e-newsletter, I was captivated by the article "A Resolution Worth Exploring". I hope you will be, too! A Resolution Worth Exploring As you ponder resolutions for 2015, taking better care of yourself professionally should be close to the top of the list. Ronald Epstein, MD, professor at the University of Rochester School of Medicine and Dentistry, practicing palliative care doc, and published researcher on self-care, says such things as getting rest, eating well, getting exercise, taking vacations, and spending time with family are great to do but don't necessarily translate into better care for patients. Instead, Epstein suggests learning skills that promote mindfulness. What does Epstein mean by mindfulness? "I guess you would say mindfulness is an attitude of mind and mindful practice is what you do in everyday work," he says. "If you are practicing mindfully, you are aware of your own reactions, you are aware of the dynamics in the family, you are aware of how this is affecting you, you are able to monitor the way that you react and also to regulate your own reactions to stressful circumstances so that actions are better aligned with your values." This informs hospice chaplaincy in that if we are practicing our discipline mindfully, we will be self-aware, aware of the family dynamics around us, how our work affects us (positively and negatively), and how we respond to the stressful circumstances surrounding the hospice environment. Living and practicing our ministry means we do not deny our emotions or reactions and seek feedback from colleagues when we feel a bit off balance. I urge hospice Chaplains to practice not just good self-care but 'mindful' self-care. Our work is too demanding to do anything less. May 2015 be your best and most rewarding year in your hospice career.
Monday, December 29, 2014
Last week I had the opportunity to read an article in AACN Advanced Critical Care, Volume 18, Number 1, pp.19–30 © 2007, AACN, that had to do with the The Reina Trust & Betrayal Model. This article used as its focus “a difficult case study involving repeated health crises and irreversible organ dysfunction [that] illustrates the challenges critical care professionals face in caring for patients and their families. In such cases, trust is especially fragile, and coexists with its counterpart, betrayal. The Reina Trust & Betrayal Model defines 3 types of Transactional Trust. The first, Competence Trust, or the Trust of Capability, requires that clinicians practice humility, engage in inquiry, honor the patient’s choices, and express compassion. The second, Contractual Trust, or the Trust of Character, demands that clinicians keep agreements, manage expectations, establish boundaries, and encourage mutually serving expectations. The third, Communication Trust, or the Trust of Disclosure, must be rooted in respect and based on truth-telling. Particularly in life-and death situations, communication requires honesty and clarity. Each type of trust involves specific behaviors that build trust and can guide critical care professionals as they interact with patients and their families. In reading this article with its case study I came to the conclusion that the three types of transactional trust fit what a hospice Chaplain does in his/her relationship with a patient and family. In hospice, every patient is in a health care crisis and, indeed, trust is fragile. The first and most important task of the Chaplain is to win and build trust with the patient and family. This illustrates the Competence Trust. By nature a Chaplain conveys humility, honors the patient’s choices, and expresses compassion. When a Chaplain’s competence is established in the relationship, a bond of trust, though newly established, begins to form. The next transactional trust is that of Contractual Trust. The relationship can crumble: 1. If the Chaplain cannot keep agreements (is late for appointments, does not call to reschedule, forgets names of patient and family members, is cold and aloof, for examples); 2. If the Chaplain tramples on boundaries by trying to rush the conversation toward converting the patient or violates confidentiality. The third trust is the Communication Trust. While the Chaplain will not deal with the medical side of the patient’s experience, it is absolutely fundamental that the Chaplain will respect the patient’s autonomy. I urge the reader to look for this article and superimpose upon it the role of the hospice Chaplain. Friends, you are a clinician and hold a revered place on the IDT. Blessings, Chaplains, for your work!
Thursday, December 25, 2014
In 2015 I want to explore with a subject that will enhance your chaplaincy ... Providing Spiritual Care According to Disease Process. As you know, I do not believe in a "one size fits all" style of spiritual care. In this study, we will look at the most common disease processes patients present with in hospice care, and look at common spiritual characteristics associated with those disease processes and how to address them. Until then, finish out 2014 giving your best to the patients and families who look to you for comfort and strength.
Wednesday, December 24, 2014
Welcome to those from France who visited this blog yesterday. I would enjoy getting to know your approach to chaplaincy. Please feel free to comment on any of the posts. The way to do that is to click "No Comments" (I know that is an odd way to invite Comments, but it is simply how this blog works). My blog statistics indicate that there were more visits by those from France than anywhere else in the world including the US. Blessed Christmas and New Year to all!
Tuesday, December 23, 2014
Twas the night before Christmas and all through the house no one was stirring but the hospice Chaplain in Grandpa’s room. The family was bowed low by the chimney in prayer, in hopes that God’s intervention would soon be there. The grandchildren were nestled all snug in their beds, with visions of life without Grandpop coursing through their troubled heads. And Mamma with her ‘kerchief, and I in my cap, wished we could settle our brains for a nap. When from the bedroom there arose such a clatter, we sprang from our knees to see what was the matter. The Chaplain sat holding Grandpop’s hand as he said, “Yes, Lord, I am coming home.” I knew in a minute he must be leaving and headed to Heaven. We wept, we hugged, we thanked the Chaplain for her care. Death comes to all, hospice is there. On Nurse, on Physician, on Social worker, on Home Health Aide, on Chaplain, on IDT, “We care. We love. We serve.”
Thank you, Chaplains, for all you do. Your work is so essential. Have a blessed Christmas celebration. To my Jewish Chaplain friends, May the spirit of Chanukah continue bless.
Thank you, Chaplains, for all you do. Your work is so essential. Have a blessed Christmas celebration. To my Jewish Chaplain friends, May the spirit of Chanukah continue bless.
Thursday, December 18, 2014
In many cases a Chaplain documents a narrative style describing what happened in a visit. That is fine as far as it goes, but it can leave out gaps of information that are essential: pain score and scale used; observations of decline; and interventions employed to reach the Goal/Expected Outcome. I have been ok with Chaplains using a narrative style, but have grown uncomfortable with continuing with that simply because of the demands of auditing firms that review hospice charts. Years ago I learned to document using the FAIERS template. F=Focus or purpose of the visit; A=Assessment of patient; I=Interventions used; E=Education presented to patient; R=Response of patient to the visit; S=Subsequent visit information. I mulled switching to this tool, but can’t through such things as Assessment and Education. A Chaplain is not licensed to perform an Assessment. A Chaplain may only observe or record such things as pain levels and decline. As far as Education is concerned, this seems to be intertwined with the Interventions we use and would be a waste of valuable time on the part of the Chaplain. While one can pronounce this acrostic of FAIERS, it seems inadequate for our use. Instead, I wrote the following to more fully describe what happens when a Chaplain visits a patient or a family member/caregiver: Purpose of the visit—The Chaplain can state that this was a routine visit to comply with the terms of the Plan of Care or state that this was an On Call visit or a Return visit due to an emergency or whatever description that fits the circumstance of the visit. Observation—Again, Chaplain do not assess, they observe. A. Pain level/scale B. Decline—MAC C. Spiritual concern(s) Intervention(s) A. What interventions did you use to address the spiritual concern(s)?—The Chaplains have 21 possible Interventions from which to choose for this section. They should have already have chosen one or two from the Initial Spiritual Assessment (this is the only place Assessment can be used). B. What evidence can you give that this helped the patient?— Response of the patient/family-- I will provide our Chaplains with plenty of examples of verbiage to use to document this piece. Subsequent visit—This section should be brief and summed up in one sentence. A. To fulfill the terms of the POC B. Within 30 days Your comments are welcome. This is not an easy process and one I approach lightly. Bless you, Chaplains, for your fine work. You are God’s hands of peace and support.
Wednesday, December 17, 2014
In my reflections about this Holy Day, holiday season, the hymn “I Heard the Bells on Christmas Day” came to mind. Why? It seems to be juxtaposed with some of the goings on in our nation and world. We look at the relics of Ferguson, Missouri, and other cities that have been torn apart by rioters. We hear cries to kill police officers. We see and hear of the barbarism of Pakistani terrorists. Can we help but say with Henry Wadsworth Longfellow in verse 3: “And in despair I bowed my head: "There is no peace on earth," I said, "For hate is strong and mocks the song ‘Of peace on earth, good will to men.’" It leads to a simple prayer of “Kyrie among all nations”. Would you join me in this prayer at this juncture in history, please?
“Along unfamiliar paths I will guide them…” In the Old Testament book of Isaiah 42:16, we read “Along unfamiliar paths I will guide them; I will turn the darkness into light before them and make the rough places smooth. These are the things I will do; I will not forsake them.” Note the words ‘unfamiliar paths’, ‘darkness’, ‘rough places’, ‘I will not forsake them’. Hospice patients and families are traveling very unfamiliar paths. This is a fact that sometimes gets lost among us who are hospice professionals. Death seems almost commonplace to us. But, it isn’t for our patients and their loved ones. Their ‘path’ is fraught with darkness and rough places. They may even feel forsaken by the Almighty. Our work is one of comfort. In the previous chapter of Isaiah, there is a cry from God to, “Comfort ye my people!” Being a comforting presence will go a long way to helping our patients and families on their journey through ‘unfamiliar places’. Perhaps you might read this verse to those who are open to it. May this beautiful passage bless you as you bless those you serve. May the wellspring of compassion be opened in you as you reach out in care. May soothing words find a home in you. May tenderness bless you as you reach out to comfort body, mind and spirit. In the midst of fear and frustration may courage be given to you. When difficult decisions confront you, may wisdom inspire you. May patience keep vigil with you and may peace of mind calm you. May your heart find a song to sing, even when you are weary. May abundant life lift you and gratitude bless you as you live the mission of care entrusted to you. Amen, so be it. Pat Bergen, CJS
Monday, December 15, 2014
Musings on a Monday Morning … The need to laugh … In my line of work as a manager of spiritual care in a large hospice, very often stress is palatable. You can feel it, sense it, and hopefully deal with it. I must say that stress can diminish one’s sense of humor. You can know for certain when you are running low on humor … you get irritated at the people you love the most, you get irritated with people you work with, you just get irritated … period. I find that laughter cuts the stress down to size. It puts things into perspective and cheers my soul. I don’t know about you, but I need stress cut down to size and a happy soul. For instance, at church one recent Sunday night the choir was presenting their Christmas musical. The place was packed with people. The pastor took a moment to greet those in attendance and asked us to greet one another. My wife and I shook hands with several people close to us and then a sweet, little lady came up to me and welcomed me as if I were a guest. My eyes met my wife’s and I just smiled and told her how glad I was to be present for this musical presentation. My, my, my … Just grin and laugh. With the joy of the season comes sad and distressing situations … Have you noticed that life gets complicated at the absolute worst times of the year. I’m not sure I understand why that it, it just happens. What holds things together at work? When chaos strikes, embracing the mission, embracing my call, and embracing my colleagues works for me. What holds things together at home? This is a one word answer … love. Love for my wife keeps the relationship strong. I try to tell her frequently that I love her and show it so she sees by my actions that my words are true. What are you chewing on this Monday?
Three ways to safely navigating through the holidays … The holiday season is in full force. Have you noticed how unbelievably busy life has become in such a short while since Thanksgiving? There are some things that I know have not changed one bit: 1) Your caseload and the needs of the patients has probably gotten larger and more complex; 2) The patients’ families are as stressed if not more so because this will probably be the last Christmas/Chanukah/Kwanzaa their loved one will be here; 3) The changes that Medicare is bringing make your work that much more complex. So … what can you do to keep your head squarely on your shoulders and get good spiritual care done? First, do not get behind. If you get behind in your visits, it will be incredibly difficult to catch up. No doubt, you are already penciled in for PTO and as we all know, staying in compliance is a monthly challenge, but never has the challenge been greater than this month. Second, honor the spirituality of your patients as never before. I get phone calls from nurses and home health aides wanting to know how to help their patients celebrate Christmas and Chanukah. Their biggest concern is not to offend the patient. Here are at Cornerstone Hospice, we are accredited by the National Institute for Jewish Hospice and as part of the accreditation we receive a Jewish Holiday information sheet which gives sage advice on how to assist our patients with Chanukah. On Sunday I sent out the information sheet to our entire staff. They are now equipped to assist our Jewish patients. Regarding Christian patients, reading the nativity passages from Matthew and/or Luke is usually well-received. Third, practice wise self-care. You are pressing to get your entire caseload visited before PTO. You are attending church or faith community functions. Things happen that keep you awake at night. Life presses forward whether you are ready or not. I urge you to practice smart self-care. Getting rest, eating right, exercising, being able to say “No” to just one more invitation, and so forth are all pieces of the puzzle at holiday time. Be safe on the road. Take time to love your family. Do what you feel you can and no more. Remember the days when you were a parish pastor and drove hard through the month of December and then wondered where the wonder of the holidays went? You missed the wonder because you were too busy helping everybody else experience it. You are no longer a parish pastor, so slow down and enjoy it. If you’re a Type A personality, you may feel you just HAVE to do more of this or that. Baloney! Relax! To your holiday celebration, I say be blessed!
Thursday, December 4, 2014
I had the privilege to speak at one of our Celebrations of Life programs in Sebring and presented what I hoped would be a comforting, healing message. This passage might seem a bit odd for a memorial type of program, but I really believe it speaks to the many issues of grief and bereavement. First, a bit of background on my life. When I was 10, my father died. He had a coronary thrombosis. The whole sequence of event surrounding his death sent our family into a terrible tailspin. Hospice care was not even a flicker in America at that time (1964). Hospice care was 20 years away at that time. So, families were left to their own ways to handle grief. My grief ‘counsel’ was “Brave boys don’t cry”, and “You are now the man of the house”. What a heavy burden to place on a 10 year old’s shoulders! It took me until I was 30 to come to grips with the mourning aspect of my father’s death. As Alan Wolfelt reminds us, mourning is grief gone public. I never mourned, never wept over his death. In fact, by the time I was 30 my emotions were so bound up with pain when the month of May came that I wished that the 24th could be erased from the calendar. So, I met with a counselor friend of mine who advised that I write a letter to my father expressing whatever came to mind. What an awkward thing that was … at first. I remember beginning the letter, “Dear Dad”… But, I also remember how I closed the letter, “I give you permission to die.” I then went to my home and read the letter aloud to my wife and as I did, the grief and pain gushed forth from within me like a tidal way. The little boy, who was told to be brave, was now a man who did cry. What a necessary catharsis this was for me. After 30 more years of life, I honor my father’s life and his contributions to the family and to me. With this background in mind, I shared my thoughts on Isaiah 35:1. The desert experience reminds me of our grief experience in several ways: a. The desert is a place of Exhaustion. The journey of grief is exhausting mentally, emotionally, physically, and spiritually. b. The desert is a place of Thirst. As people thirst for water to quench this need for hydration, those in grief thirst for comfort, peace, and normalcy. c. The desert if a place of Mirage. People in a desert see things that aren’t there. In the grief experience there are times when we think we see the end of our pain only to experience what Wolfelt calls a grief bomb. And, we are reminded of the challenges in our journey. Thankfully, in 2014 we have hospice to provide support during the patient’s illness and after the patient’s death to provide bereavement support. Hospice’s time is now. People are hurting. We are here to lend a hand of support.
Tuesday, December 2, 2014
Upon reading the following story found at http://www.passionprovokers.com/blog/the-woodcutter-how-to-embrace-the-presence, I found there was great truth in the fable. I hope you are made to think and identify with the Woodcutter ... The Woodcutter: How to Embrace the Present By Jami Keller Long ago, there was once a wise Woodcutter who lived in a small village. He would go out each day looking for wood to bring back to village, prepare it for carpentry, and sell it to his fellow Villagers. While out on one of of his wood finding exhibitions, he sees the most beautiful stallion he has ever seen in a nearby field. Oddly, the stallion boldly comes towards him without fear. As the Woodcutter continued on his work, the stallion continued to follow him all the way back to the village. Over the next several weeks, the stallion allows him to ride him, and soon he makes his daily trips with his new friend. The horse becomes a great help, and the Woodcutter is soon able to triple the amount of wood he can prepare in a day. The villagers come to the woodcutter to praise him for this great blessing that is this horse. They in fact benefit from this as well, in the form of cheaper wood and better building materials. The Villagers began visiting regularly to admire the stallion, and to each compliment the Woodcutter would respond "I don't know, is it a good thing or a bad thing? I like the horse and having the companionship, plus the advantages that this horse brings to us all." The Villagers would often agree to his face in admiration, and later question his response. Of course it was a good thing! It was nothing but great, was it not? The Woodcutter must have been a man who had vision. Vision is having a bigger picture of himself, and those around him, in order to realize the value of good communication. This was useful to him in that he was able to understand his role and value in the community. To gain this vision, he first had to see the value in all living things. The Woodcutter did not let his feelings rule his life, but was able to feel the full measure of feelings and navigate his choices with full awareness of his feelings. He was able to actively choose to not let what happened to him dictate his outlook on life. He was aware that his happiness was dependent on his own choices, not strokes of (what the Villagers thought were) luck. News spread about this horse, and one day the King came to visit. The King was so impressed with this majestic animal that he offered the Woodcutter half of the gold in the kingdom because "This stallion needs to be the stud of my stables." The Woodcutter was shocked and told the King "Your Majesty, I am honored that you like the horse, but I regret to tell you that I can not sell you the horse. He is a friend, and not a possession that I have the right to sell." The King was very impressed that a villager could turn down such an offer while having a respectable reason to do so. The King agreed with the Woodcutter and went on his way. The Villagers were were angry and frustrated. "Why would you not take the gold? We could have all been rich. What is wrong with you? You are a fool!" The Woodcutter responded. "I do not know, is it a good thing or bad thing? I have kept my honor and my friend the horse." Time passed and one day the Woodcutter went out to collect wood and found that the horse was missing. The Villagers noticed and confronted the woodcutter: "Not only do you not have the gold the King offered you, now you have no horse!" The Woodcutter replied, once again, "I do not know, is it a good thing or a bad thing?" The Villagers walked away shaking their heads mumbling that the Woodcutter may not be fit to be in their village. When this kind of loss happens, there has to be a foundation of joy in our hearts that prevails even when there would be no reason for joy. These lessons are never easy, and require a level of wisdom that not everyone will allow themselves to achieve. Not long afterword, the horse reappeared, along with 20 other horses. The stallion had gone out and won the leadership as the heard of horses. Now, the Woodcutter had 21 horses and was scrambling to care for them. Word spread like it does in a community, and most of the village came to help and witness the unusual circumstance. The Villagers went to the Woodcutter, hats in hands, hopeful to benefit from the new fortune. "Forgive us most wise Woodcutter, this is a huge blessing to you and all of us." The Woodcutter, who now was responsible for feeding and shoveling up after the horses, told them once again: "I don't know, is this a good thing or a bad thing? I am glad to have my horse back but this is overwhelming." Because of the value of the horses and the need for them to be trained, the Woodcutters only son began training the horses with him. Tragically, the Woodcutters son was thrown off a horse and broke both his legs. It was unlikely that he would walk again or be able to continue to Woodcutters lineage. The Villagers brought food and helped with chores, while giving their condolences about this terrible thing. The villagers kept telling him how unlucky his son was, and how unlucky it would be to not see his name continue. The Woodcutter was full of gratitude that his son lived, and replied to the villagers comments by saying "I don't know, is it a good thing or a bad thing?" The Woodcutter gives us insight for when tragedy happens. Finding hope in these times is often the difference between becoming bitter and working towards being fully present. The loss of the ability to walk, especially in this long ago time, was vital to all life. The son would need care for as long as he could not walk, and the Woodcutter was willing and ready to do this care with gratitude for the service; Loving what is means being present to the miracle of all life. Shortly after his sons accident, the King returns to the village. He is there to recruit all the able bodied young men to fight in a gruesome war. Most do not return from the war, and those that did were never the same. Many mothers and fathers of the sons who did not make it would often visit the Woodcutter's son, always commenting on how lucky the Woodcutter was to still have his son. The Woodcutter and his son lived their lives as an example of what is truly good. They continued to have many hardships, but also had much success. I've been telling this story for many years, and each time I am reminded of just how well it captures several of Passion Provokers core beliefs, to name a few: 1. The Villagers in our lives rarely know what is really going on and almost always have their own agenda. Be wary of the Villagers in your life, because they will always have an opinion that is based on their needs, not necessarily yours. 2. No matter how positive or negative something may seem, you always have a choice in how you feel and respond. 3. Be present to all the relationships you have, because love is the only reason for life. ________________________________________
Monday, December 1, 2014
This inspiring verse written by Steve Maraboli fits in well with what we teach in CPE ... focus on "being" and not so much "doing". I hope you are blessed by it. “Dare to Be” When a new day begins, dare to smile gratefully. When there is darkness, dare to be the first to shine a light. When there is injustice, dare to be the first to condemn it. When something seems difficult, dare to do it anyway. When life seems to beat you down, dare to fight back. When there seems to be no hope, dare to find some. When you’re feeling tired, dare to keep going. When times are tough, dare to be tougher. When love hurts you, dare to love again. When someone is hurting, dare to help them heal. When another is lost, dare to help them find the way. When a friend falls, dare to be the first to extend a hand. When you cross paths with another, dare to make them smile. When you feel great, dare to help someone else feel great too. When the day has ended, dare to feel as you’ve done your best. Dare to be the best you can – At all times, Dare to be!” ― Steve Maraboli, Life, the Truth, and Being Free
I live in the Tampa Bay area of Central Florida. Yesterday was another Sunday with another loss by the Tampa Bay Buccaneers. If you live in the Cincinnati area, you are pleased with the win even if it was by a point. The papers and, especially the comment section of the papers, as well as the independent bloggers online are saying the same thing ... the modern game of football in the NFL has passed Coach Lovie Smith and he is but an "old school fossil." That is quite a damning statement considering the Coach spent one year out of the NFL (last year). Is this coded language to indicate that he perhaps is too set in his ways to accept change or too stubborn about how he manages the team? I really don't know, but my point is this... Can a Chaplain or Chaplain Manager/Supervisor come to the point when he or she is so set in their ways that new ideas of ministry or management can find only resistance? Can a Chaplain or Chaplain Manager/Supervisor be so old school that methodologies that really help a patient are simply missed. I have no problem with sticking by the tried and true, but I always want to be open to new ideas and perhaps even develop one myself so that the ministry of hospice spiritual care can go forward with greater effectiveness. In these current days, Chaplains will be looked to for providing guidance to their IDTs in how to respond to current cultural crises ... Ebola and the aftermath of Ferguson. Chaplains' pride and prejudices will have to be worked through to provide a coherent message for reconciliation, hope, and inner healing. I would like to wish those of other faith persuasions the best and most joyous of holy day celebrations: Ashura (Muslim); Bodhi Day (Buddhist); Hannukah (Jewish); Boxing Day (Canadian); Kwanzaa (African-American). To my Christian community, Merry Christmas. Bless you, Chaplains, as you carry out God's good work.
. It was at a conference entitled "Empathy, Altruism and Agape: Perspective on Love in Science and Religion – A Research Symposium," she gave the evening dinner talk, entitled "Why I Can Never Retire." She pointed out that while she was 83 years of age, she still goes into St. Christopher’s hospice in London every morning and changes bedpans for an hour with the nurses before spending at least several hours sitting on the ends of beds and listening attentively to dying individuals as they might wish to speak of their lives and situation. She said that attentive listening is a form of love, and it makes people feel that their lives are significant, even if there is just a short while left before they pass on. Dame Cicely always included chaplains and pastoral care on her hospice teams, and that became the model worldwide as she trained all the leaders of the modern hospice movement. She stated with some emotion that while “In the nursing and social work text books they talk about me as the woman who founded hospice, they talk about what I did, but not why I did it. I did it for God and to help dying people to be absorbed in God’s love.” Dame Cicely often spoke of compassion. What does “compassion” add to “care”? It adds an element of stronger affective response and deeper awareness of the concrete reality of the patient’s “illness” experience. Bernard Lown, MD, one of the greatest cardiologists of our time, the inventor of the defibrillator, and recipient of the Nobel Peace Prize for founding and developing International Physicians for the Prevention of Nuclear War, wrote a classic book entitled The Lost Art of Healing: Practicing Compassion in Medicine (Houghton Mifflin, 1996, Ballantine Books, 1999). It is a powerful statement about how compassionate care, often in the form of attentive listening, creates a “healing relationship” with patients that improves diagnostic clarity, patient outcomes, patient adherence with treatment, and brings immense gratification to the professional as well. It also makes healthcare systems successful. In our system of hospice care, each of us is personally responsible to nurture a culture of compassionate care in which: • patients will not experience humiliating insensitivities or rudeness, but rather compassion, respect, hospitality and attentive listening; • interactions with patients are uniformly recognized as having the significance of any other important clinical intervention; • physicians, nurses and all staff will find patient care more gratifying and meaningful; and, • benevolent and respectful interactions between members of the healthcare team will be understood as establishing the secure base from which the compassionate care of patients unfolds. There is a beautiful passage in the book of Isaiah, chapter 35, verse 1, “The desert shall rejoice and blossom like a rose.” Let your work be guided by this idea. Patients and families experience many deserts, burning deserts, scorching deserts that leave them empty of meaning, empty of content, empty of substance. Help them to sing Hallelujah in a new key, and to be witnesses to the transforming power of love. When you are in the desert, plant a rose… a rose of peace, a rose of reconciliation, a rose of faith, hope and love. And the desert will blossom. You, as a clinician, will blossom, patients will blossom, whole hospitals and facilities and homes will blossom. And as the Psalm reads, “Those who refresh others will themselves be refreshed.” Never forget that the affirmation of the patient’s significance is profoundly important in times of severe illness. In the words of E.E. Cummings: “We do not believe in ourselves until someone reveals that something deep inside us is valuable, worth listening to, worthy of our trust, sacred to our touch.”