Thoughts on Pastoral Presence

 

One of the most frequent interventions a Chaplain writes about is Pastoral Presence.  Just what is involved in Pastoral Presence?  It sounds sort of nebulous, doesn’t it? May I suggest a few ideas on how you convey ‘presence’…

 

Pastoral Presence means:

• Being compassionate and empathetic
• Being respectful and non-judgmental
• Being genuine and authentic
• Being trustworthy
• Being fully present with the patient
• Valuing the worth of the patient
• Maintaining boundaries
• Being emotionally honest
   
  Part of your professional growth and development will be to figure out the “how” on these ideas.  Become a student of body language.  Learn what you are saying with how you sit, how your face communicates, how your arms communicate.  I can promise you that being present is not just sitting there hoping the patient will stop talking, or if the patient is not communicative looking at your watch to see if you stayed long enough to claim a visit.  Being engaged with the patient in ‘presence’ is the goal.  Making that deep inner connection is another way of describing presence.  Your thoughts?

                                                               

The Skill Every Hospice Chaplain Must Master

If I could teach one skill to new Chaplains it would be the skill of listening.  Many Chaplains come into hospice from the pastorate where they do most of the talking. Hospice is just the opposite.  Chaplains must be skilled listeners.  May we learn from these two Masters of life skills: Stephen Covey and Carl Rogers.

“Most people do not listen with the intent to understand; they listen with the intent to reply,” (Stephen Covey).  Isn’t that the truth?  The hospice Chaplain listens for the soul’s deep meaning and not to engage in a debate about death, religious beliefs, or some other subject of interest to the Chaplain.  The patient has the stage or the caregiver has the stage.  The Chaplain listens with the intent to understand.

Carl Rogers gives us instruction through these statements on empathetic listening:  “We think we listen, but very rarely do we listen with real understanding, true empathy. Yet listening of this very special kind is one of the most potent forces for change that I know.”  In Experiences in Communication, Rogers goes on to say “I hear the words, the thoughts, the feeling tones, the personal meaning, even the meaning that is below the conscious intent of the speaker. Sometimes too, in a message which superficially is not very important, I hear a deep human cry that lies buried and unknown far below the surface of the person. So I have learned to ask myself, can I hear the sounds and sense the shape of this other person's inner world? Can I resonate to what he is saying so deeply that I sense the meanings he is afraid of, yet would like to communicate, as well as those he knows?”  Are those not questions we need ask ourselves as Chaplains?

There is much to be said about empathetic listening.  Let’s start with the basics: Empathetic listening helps people feel heard and not alone.  What is the cry of the heart that is fearful, anxious, distracted?  Is it not for someone to listen with interest? with concern? with compassion?  Secondly, empathetic listening involves many skills and components: relaxed yet engaged body posture; eye contact (when culturally appropriate), reassuring touch (when culturally appropriate), listening beyond or beneath the literal words said by a person to the deeper emotions, meaning, and needs. What may seem contradictory, empathetic listening may also ask you to laugh, be joyous, and not focus on illness, pain, or dying.  After all, it is the patient or caregiver we are listening to.  They are our focus.  And the results?  In this day of outcomes oriented chaplaincy we need to be clear on the benefits of empathetic listening: Fear, anxiety, despair, and even physical pain frequently diminish when the person feels heard, understood, and accepted.  Personhood, self-worth, and dignity are affirmed. Feelings of isolation decrease.  Persons find their own answers in the new milieu of affirmation.

Chaplain Friend, learn this skill and all the others will come naturally.

Nearing Death Experiences: “Oh, my. A Shocking Experience”

Let me be very clear…What I am about to share with you is not found in the book, Final Gifts.  This is but one of several experiences I witnessed that were absolutely shocking, but very real.

 

It’s been my opportunity to serve as Chaplain to those who either fired their previous Chaplain or were so vulgar that the previous Chaplain stepped out of the picture and I stepped in.  I am not intimidated by vulgar language as I see that more as a defense mechanism to try to ward off the Chaplain.  People need unconditional love, particularly at end of life.  To one patient, who told me to the get the h--- out of his room when I simply knocked on the door of his room at a long term care facility, I simply said, “You’re having a hard time with someone who really cares for you, aren’t you?”  He harrumphed and told me to come in.  It was one of the best visits I ever enjoyed with a patient as he opened up.  He told me he was trying to “bully” me as I was a minister and he wasn’t fond of ministers.  Well, it seemed like it all worked out quite splendidly!

 

Yes, there have been patients at the end of life who died in a shocking manner.  I recall a woman who was portrayed to me as one of the meanest people on earth.  Since I try to meet people with a blank slate and let them design a portrait of themselves, I tucked those prejudicial statements away and went in to meet her.  She wanted to know who I was and what I was doing.  After get past that hurdle, I invited her to tell me her story.  It seemed that she was successful enough, but something (or several things) apparently went horribly wrong in her life. She went from wealth to pauper status.  She was alone in life.  Family?  Yes, she had family, but they were estranged, very estranged.  She just had a Guardian to handle her affairs, however meager they were.  She sort of boasted that people said she was mean.  It sounded like she relished that reputation.  Regarding any type of faith community she embraced, she told me she had none and that had no use for God.  The manner in which she said that indicated the subject was not open for discussion.  I saw her a few times before she died.  The day of her death is one I will never forget.  The Guardian called me and asked that I come to the facility.  It seemed like the patient was dying.  When I arrived, the Guardian was nervous and suggested I pray.  I told her that I could pray for her but the patient absolutely forbad me praying for her.  It was shortly after I prayed for comfort for the Guardian, that the patient came out of her interlude between life and death and jerked up and looked at us with the face of terror.  She then lay back down and died.  “What just happened?  What did we just see?  Did she see something that was so terrifying…?”  Those were the questions of the Guardian to me.  I am not person’s judge.  That look has lingered in my mind for years.  It is in stark contrast to the many deaths I’ve attended when someone of faith died.  That was the most shocking death I have ever witnessed.  Have you had a similar experience? 

Nearing Death Experiences: “Chaplain, I had a visitor…” Part 2

For those who look askance at these “hospice stories”, let me quote from “Final Gifts”:

We found no common cause for what we were seeing and hearing.  Our patients had many different illnesses—varieties of cancer, different heart or lung diseases, birth defects, neurological ailments, AIDS.  In some cases, their brain oxygen, body fluid, and body salt levels had been documented as normal. Their medications varied widely, some were taking no drugs at all, others many.  In short, there was no apparent physiological explanation for their communication patterns.”  (Final Gifts, page 29).

 

I recognize there are some who would say these nearing death experiences are nothing more that the devil appearing as an angel of light.  There are yet others who would attribute these experiences to demon activity.  Others, to delirium.  All I know is that most all of the patients I served that had these experiences were professing believers.  It seems difficult for some to recognize the mercy of God at the most vulnerable time in a person’s life and simply discard the experience as not worthy of serious consideration.  Ok, whatever floats your boat. 

 

I received a call from a patient of mine who asked that I come over as she had something to talk to me about.  When I arrived her husband led me to their bed room where she was spending her last days.  I moved the chair close to the bed so I could hear her weakened voice.  She related two episodes to me and asked what I thought.  The first occurred one evening when the house was quiet and the lights out.  She was lying in bed awake.  What caught her eye was the visage of her Mother standing in the doorway to her room.  They had a conversation.  I asked how she felt about the entire episode.  She stated it was incredibly peace-giving.  Then, she told me of another experience…  She was turning to her left side when she noticed the visage of her long deceased daughter standing next to the bed with her hand on the nightstand.  Again, her response was a feeling of deep peace and comfort.  She wanted to know my opinion.  I told her that I believed God is a good God who provided His children what they needed in the face of impending death.  It was obvious that these experiences provided comfort and peace and she was ready to step into Heaven shortly.  Her faith was a vibrant faith and she passed into life eternal quietly, peacefully a few days later.

 

In speaking to a hospice nurse colleague of mine about what I am writing, she said that these experiences happened frequently with patients she served.  It was not a matter of medication or anything else.  She noted that those who were believers had a very peaceful death, while those who weren’t seemed to have a very hard death.  More on that in the next article.

Nearing Death Experiences: “Chaplain, I had a visitor…”

If you have been a hospice Chaplain very long, there is little doubt one of your patients shared with you something like this: “Chaplain, I had a visitor earlier today.  I would like to tell you about it.”  That has happened in my chaplaincy practice on numerous occasions.  Let me share a couple of those experience.

 

On one occasion I was making rounds at the hospice house.  Some patients were alone and sleeping.  Their family members used this time as a break from the vigil they were providing.  In one room the daughter of the patient was seated on the couch.  While her mother appeared resting, she and I talked about the healthy relationship she had with her Mother.  We then went to the bedside and spoke briefly to the patient and I was asked to provide a prayer.  After the prayer I spoke a blessing of peace and left the room.  Perhaps 15 minutes had passed.  There was a page for me to report to the front desk.  The patient’s daughter was there.  She seemed rather shaken by what she had experienced after I left her Mother’s room.  We sat down in the lobby and I listened as she told me what her Mother said.  “Mom asked me who the little girl was who was holding your hand as you left the room.  I told her that there wasn’t a little girl who held your hand.  She said that ‘Yes, there was.  She was 5 years old with dark hair.  She looked at me as she was leaving the room and smiled.’  Chaplain, help me understand what happened.”  Now that was a tall order to try to explain what seemed to be the unexplainable.  I asked about the daughter’s siblings.  Do you have sisters?  She said she had a sister who lives in another state.  She also stated that she had one other sister who died at a young age…when she was 5 years old.  As she recalled that experience of her little sister’s death, the words “when she was 5 years old” came out as it she realized for herself what had just happened in her Mother’s hospice house room.  “Chaplain, you don’t think that that was her, do you?”  “It just may have been,” I said.  Holding the hand of a servant of God as they called me, then turning and smiling at the patient were powerful symbols of life eternal which brought comfort and peace to both the patient and her sister.  I spoke to the patient about this and she stated that there was no doubt in her mind that this was her little daughter.  Holding my hand then smiling at the patient were so symbolic to the patient.  She was more peaceful than ever. 

 

At this point, I need to make a clear statement to newer Chaplains.  You will discover that this world is far more spiritual than it is physical.  Death is much more a spiritual experience than it is a physical experience.  Your chaplaincy will be wonderfully informed as you hear these type of stories from your patients.  In the next article I will share about a patient that contacted me about what she saw. 

Nearing Death Experiences

I am reading a most informative book, Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying.  If you are not familiar with this work, please get a copy.  Much of what you experience as a hospice Chaplain will be affirmed.  Also, your commitment to active listening will be challenged and deepened.

 

There are so many nearing death experiences that patients I served allowed me to know about that have provided encouragement and comfort, not just to me, but more especially to their loved ones.  I recall Jim (name changed).  He and I had a very deep conversation in his hospice journey.  His wife, Jane (name changed), was not at all prepared for his death as she was very dependent upon him.  This troubled Jim and he made that clear to me.  I took mental note of this as it might be needed in upcoming days. 

 

A few weeks from that conversation, I received a call from our hospice nurse.  She asked if I could come over to Jim and Jane’s home as Jim appeared to be actively dying.  I immediately went and when I arrived, Jane greeted me with tears streaming down her face and with the question, “What am I going to do without Jimmy?”  We walked together to his bedside.  It appeared that Jim’s remaining time was short.  However, he did not die that day or the next or the next.  There was something that kept him alive if only barely. 

 

I was called back to Jim’s bedside one evening.  It appeared that once again he had taken a turn for the worse.  Yet, he refused to die.  I asked to see Jane and her daughter who was now there to support her Mom.  I told them of the conversation Jim and I had had a few weeks earlier.   Jim, in my opinion, needed to hear from Jane that she would be ok after he died.  They hadn’t had that conversation prior to him moving to active dying.  I asked Jane if she could to tell Jim she would be ok.  Jane’s daughter stood by her Mom and I was present with both of them as Jane spoke loving words to Jim and letting him know that she would be ok and that she would be moving in with her daughter.  The finances would be taken care and for him not to worry.  Within 5 minutes Jim died.  After Jane told Jim these words, his body relaxed and his breathing no longer was labored.  He passed peacefully knowing Jane would be ok.

 

Jane took advantage of our bereavement care and she was, indeed, on a path to comfort and inner peace.  This experience informed my chaplaincy by showing me that love for a surviving spouse can be so powerful that the dying can refuse to die until they know their loved one will be ok.  I am sure you have stories like this.  I would like to hear them. Use the Comment section and we will publish your stories.

 

After burn-out, what next?

If a Chaplain becomes so emotionally and physically exhausted that he or she experiences burn-out, there still remains one very powerful tool that will right the ship and head in another direction.  That tool?  Self-reflection.  As the Chaplain reflects on the experience, certain questions rise to the surface.  Why did this happen?  How did I get to this point?  Did I ignore warning signs?  Did I speak with someone?  Why didn’t I speak to someone?  How am I now?  Do I need help?

 

If you’re in burn-out, may I suggest that it might be wise to see a therapist.  There are many layers to an onion and there are many layers to our inner person.  The skilled therapist will help you to be pull them back to help you heal internally.  Yes, you will think of a thousand and one reasons not to see a therapist.  Pride is a brutal task master. 

 

For me to say more would be inappropriate as I would only speak is generalities.  I will say that you will want to take some time to heal before you jump into something else so you don’t repeat the process.

 

With blessings for a renewed sense of hope and well being.