Our worth in public places…

Oswald Chambers once stated, “My worth to God in public is what I am in private.” That’s a strong statement that urges us to have a strong and well-centered spiritual life. We cannot do this work of hospice chaplaincy without a deepening spirituality. What are your spiritual development practices? A few years ago I spoke to a denominational leader and one of the questions he asked me (which showed his feelings about chaplains), “Where do you go to church, if you go.” Wow! That was a shocker. I told him where my wife and I went to church and how we were growing and so forth. That satisfied his curiosity, but what a shame that his experience with chaplains led him to believe that most do not worship on a regular basis at a faith community. Frankly, I can’t do without worship, be it corporate worship or private worship. Chaplaincy has the uncanny ability to drain one’s soul. If you don’t get re-filled, you dry up and blow away like dust. A corollary thought has to do with the benefits private and corporate worship have upon our lives. Last time I checked, I wasn’t able to walk on water, which indicates to me that I need God to work in my life and help me deal with the inner me. Francesco Guicciardini dropped a nugget of gold when he reminded us, “To rule self and subdue our passions is the more praiseworthy because so few know how to do it.” If we are to be of use to our patients and their families, we must have our inner man settled. My worth to my colleagues, patients, and their families, let alone my wife, children, and grandchildren is based in large part on my private devotional life. Bless you, Chaplain Colleagues, yours is a sacred work that will have wonderful success as you deepen your soul.

7 Challenges of Soul Care

David Benner is one of my favorite authors. His book, Care of Souls: Revisioning Christian Nurture and Counsel, is one of his finest works. I came upon a list of challenges that must be confronted by Christians who seek to care for the souls of others. 1. Guard against the erosion of the personal in soul care. 2. Develop an integrated inner core. 3. Continuously renew [your] own inner psycho-spiritual resources. 4. [Don’t] allow professionalism to dilute a sense of Christian vocation. 5. Rediscover the formative and transforming power of story. 6. Recover the uniquely Christian resources of soul care. 7. Avoid sacrificing being on the altar of doing. Mull those over and see where your thoughts lead you. Bless you, Chaplain Colleagues. Yours is a sacred profession.

“Let’s play keep-away!” On second thought, let’s not.

Did you ever play the kids’ game, Keep Away? You know, the game the bigger kids played and stuck a younger kid in the middle and threw the ball just over the younger kid’s head. It was a game of teasing and power. I never liked being the kid in the middle. Adults play a similar game of keep-away. It’s done with knowledge that should be shared. Someone once said, “Knowledge is power.” Yes, that is true. But, while true, knowledge in the hospice environment must be shared. Unfortunately, my experience has been that there are some on an IDT that play that game. They have a tidbit of knowledge that would benefit another Team member, but they keep it to themselves. Poor self-esteem may be a reality to some on an IDT, but self-esteem is never made better by withholding necessary information. This behavior is called Conversational/Relational Violence. Silence or not sharing information is most violent of conversational acts. Other acts of conversational violence include: • Masking—selectively showing our true opinions with sarcasm, sugarcoating, or couching • Avoiding—staying completely away from sensitive subjects • Withdrawing—pulling out of communication altogether • Controlling—coercing other through how we share our views or drive the conversation itself. Cutting others off, overstating our opinions, speaking in the absolute, forcefully changing the subject, or using directive questions to control the conversation (“Don’t you believe that…? You should…) • Labeling—identifying people or ideas as objects that can be dismissed as a category or general stereotype • Attacking—punishing another person by belittling, name-calling, and threatening. So, these issues are what are behind the adult version of keep-away. Not such a nice game. Chaplains cannot and must never start that game or be a part of the game. Bless you, Chaplain Colleagues, yours is a sacred work with many a twist and turn. Be pure, be honest, be transparent.

Parallel Process

One of the most challenging circumstances of hospice chaplaincy is that of parallel processing what is happening in your life with what is happening of what happened in the life of your patient. On several occasions, I have been in patients’ homes who were carrying issues and concerns that reflected my own. This has provided an opportunity for self-reflection that has both benefited my patients and propelled my own inner growth. Perhaps an illustration will enlighten the subject… Background: My father died when I was 10. Back in that day the common grief solution was for the boy to not cry as ‘brave boys don’t cry.’ The other ‘counsel’ was ‘you are now the man of the house.’ Both suggestions or commands (depends on how they are stated) are against human nature. It seemed socially acceptable for adult to cry, but not the male child(ren). It took 20 years before I cried over the loss of my father. My feelings about the ‘counsel’ to not cry and so forth used to cause me anger. Now, I just shake my head at the stupidity of that guidance. Chaplaincy impact: There have been several occasions when a patient would share a life review and share the pain of the loss of a parent when he was at a young age. The patient would share how emotional crippled he felt and how abandoned he felt because he, like me, was told brave boys don’t cry and to be the man of the house. I found it interesting to note that the exact words I was told were the exact words the patient was told. It is at this point that I knew I had choice in my patient relationship. I could have gotten drawn into my patient’s spin on things which would have gotten very messy or I could use my own process to benefit the patient, and my patient's process to propel my own. That's parallel process, and it's a powerful tool that benefits everyone when employed judiciously. It is a teacher, a guide and a mentor. I remember learning this term in a series of Clinical Pastoral Education sessions under the tutelage of Dr. D. James Stapleford, my CPE Supervisor. Jim was a great student and guide into truth about the human condition. His teaching on this subject was not lost on me. I use it today to both benefit my patient’s and to set boundaries so I know when to back off and respect the patient and my own emotions. However, I can say with confidence that in this example my own inner person has healed to the point that I honor the father who I had for 10 brief years rather than grieve his loss. And, I have been able to use my process to effect inner healing in the lives of my patients who struggle at this point. Do some study on parallel processing. It will benefit your chaplaincy and perhaps help you understand why you feel the way you do after visiting with a patient whose life events are similar to yours. Bless you Chaplain Colleagues as the work you do is sacred and we all want to keep our efforts pure in ministry.

Holy Days Blessing

To my Christian readers, May you have a Blessed Good Friday and Easter. To my Jewish readers, May you have a Blessed Passover Season. To All of my readers, Thank you.

8 Very Helpful Questions

Along the journey of hospice chaplaincy a Chaplain discovers nuggets of gold that greatly enhance the pastoral care relationship. I found such nuggets published by the University of California at San Francisco in their article dealing with caring for AIDS patients. You can find it here… http://hivinsite.ucsf.edu/InSite-KB-ref.jsp?page=kb-03-03-05&ref=kb-03-03-05-tb-03&no=3. It is expected of Chaplains to be able to initiate and sustain a conversation. Also, experience indicates that patients desire conversations about other subjects besides religion. A Chaplain must be conversant about sports, world events, local events, taxes, education, child-rearing, family dynamics, and a plethora of other topics. To accomplish this, a Chaplain must be well-read and in tune with his or her world. Generally speaking the following 8 questions are very effective in getting a spiritual care conversation started and moving. Please use these in your next visit and let me know how the conversation turned out. Getting Started "Tell me how things are going for you." "Can you tell me about your understanding of about your illness?" "What is the most difficult part of this illness for you?" "As you think about what lies ahead, what concerns you the most?" "As you look ahead, what do you hope for?" Continuing phrases "Tell me more about that." "Sounds like you're really worried about..." "What do you mean by '__' ('futile,' 'vegetable,' 'hopeless,' 'giving up,' 'everything')?" Bless you Chaplains for yours is a sacred work. May you have wisdom and compassion as you serve the spiritual needs of patients, their families, and your colleagues.

3 Guidelines to Organize Your Work

It almost sounds silly to even talk about the importance of organizing your work as a Chaplain. But, in this day and time of hyper-vigilance on the part of Palmetto and other accrediting agencies it is an absolute must. First, what tools do you have to help you organize? By now, most all hospices are charting with a computer program. Most programs hospices use have a scheduling piece. Second, how many patients are on your caseload? Third, how many meetings are you required to attend and when are they? Fourth, what is your productivity requirement? Now that you have the basics, you have to put some time into the scheduling piece of your program. 1. Your patients are grouped according to nurses. Each nurse has 15-20 patients on average, so let’s begin at this point. The nurse’s patients on home teams are usually grouped together geographically. This suggests that if you are going to be efficient with your time that you also group your visits geographically. Contact your patients in that geographic area with visits for Monday. Place the name of the patients and the time agreed upon in your scheduling program. Do the same for each nurse on your team. And, keep in mind, the industry standard is for a Chaplain to make on average 4 visits per day. 2. If you are a facilities team Chaplain, then you want to visit patients according to the facilities on your caseload. My experience taught me that when I had 8 patients in a facility that I would drive to the facility, park my car, and spend the day visiting and charting. I would group the facilities with fewer patients geographically and make visits and chart. The benefit of facilities is that you can find a place to do charting. Finish your work by 4:30 and go home. 3. By now, you have thought, “Ok, my world is not as perfect as yours! This is not working for me.” Gotcha! I understand for sure. You will have the occasional emergency that will ruin the best of plans. You take care of the emergency and do one of two things: go back to your home patient plan or visit some of your facility patients and then re-work your plan. Please don’t throw out the baby with the bathwater. Your scheduling program allows you to change who you visit and when. It’s not a set-in-stone thing. Flexibility is a required virtue for hospice Chaplains! Working and re-working your visitation schedule is normal. The most helpful process I followed was to lay out a 2-week plan, and then begin to work it. I knew who needed visits and when to stay in compliance and prioritized accordingly. If, when I called to set an appointment with a patient whose compliance visit was close and they couldn’t see me before that date, I charted that and set an appointment for when they could see me. Diligence, initiative, and determination form a good acrostic: DID. My grandson is learning to talk and when he does something he considers difficult, he yells, “I DID it!” And, you will do likewise when at the end of the month all your patients are in compliance. YOU did it, too! Bless you Chaplain Colleagues. Your work is difficult not only in providing the face to face spiritual care, but organizing your work to meet compliance requirements.