What Does a Chaplain Do?

 This last week I had a friend call to see if he could see me at the chapel of the hospital. I told him my office was elsewhere, and we could meet there. 

I let him into my office, invited him to sit. As we began our conversation the doctor I work with walked by, joined in for a moment, then left. My friend looked at me and said, "I don't think I know what it is you really do." And, "Is this a paid job or are you a volunteer? How many hours are you here?" 

I began to explain that yes, this is a career, not a volunteer job, that I do get paid, that I've had more than 2000 hours of generalized and specialized training, and just as someone would most likely not allow someone who likes blood to draw their blood, rather waiting for a professional, it is the same with chaplaincy. Just because someone likes religion or spirituality, does not make them trained to spend time with patients who have so many needs in time of crisis. 

My friend and I have folklore in common, and he wondered how I had transitioned from teaching folklore and writing at UVU to being a fulltime chaplain. So I shared with him my passions - listening to others talk about their beliefs, their rituals, their traditions, and being a companion to others along this path we call life. And as a chaplain I get that opportunity. 

First - why on earth are there chaplains in the medical field? I thought they were only for the military. 

The best answer I've read in quite some time comes from: 

Sojourn Chaplaincy at San Francisco General Hospital and Trauma Center

Hospital chaplains provide non judgmental spiritual and emotional support for people facing some of the most difficult times in their lives. We are committed to caring for people of all walks, faiths and backgrounds with love and compassion. We are a key part of the whole person care.

And then I had to answer to what was my education like. And I replied, Clinical Pastoral Education, often referred to as CPE, a 40 hour a week program with course work and on-the-ground internship. Along with more training for my specialization in Palliative Care (another time).

This past month I've spent a significant amount of time working on a document that not only shows what a chaplain's role is, but also the similarities and differences between the roles of a chaplain and a social worker. 

And I'll end today's post with that document and the differentiation in just a few words: 

A social worker provides resources, a chaplain provides relationships. Oversimplified, and as you can see below, we both do both. 

Social Worker	Shared Collaboration	Chaplain
Professional Clinical Counselor (Licensed)	While providing similar services, pastoral counselors integrate spirituality, faith, and theology with psychotherapy to help patients and families (pastoralcounseling.org)	Professional Pastoral Counselor (Certified)
Conduct a psychosocial assessment		Conduct a spiritual assessment, as well as assessing spiritual and existential ethical/moral questions which have an impact on end-of-life decisions or treatment options (where do they draw strength, hope; as well as religious practices)
Coordinate with psychiatric staff as needed	Identify emotional concerns: grief/loss, fear, sadness/depression, nervousness/anxiety, anger, guilt/shame, hopelessness, loss of interest; Consult in Interdisciplinary Team for appropriate referral as needed.	Coordinate with members of the team in aligning patient’s values with care plan
Substance use evaluations and interventions	Identify problems associated with substance use, mental health issues, and behavioral issues and coordinate with SW who will find appropriate resources for patient and family	Provide interventions for spiritual and emotional distress and pain: loss of faith, feeling alone, loss of direction, lack of peace, despair, searching for meaning, etc.
Refer to Neuropsych for capacity determination		Refer to SW for substance abuse, mental health, and behavioral issues
Complete comprehensive assessment with patient and caregivers, refer to resources based on assessment, screening patients for transition planning and psychosocial needs	Identify psycho-spiritual variables that contribute to patient’s care; that is patient-centered and family-focused, that respects diversity in all its dimensions/demographics	Identify patient’s values, i.e. relationships, meaning, making, sense of peace and needs in these areas
Provide brief therapy interventions for patients and families that may include support in treatment decisions	Emotionally support patients and families during times of difficulty including grief, loss, burnout, secondary trauma, compassion fatigue, etc.	Provide spiritual care including deeply listening to all languages – body/verbal/emotional, supportive dialogue, pastoral counsel, and supportive presence
Advocate and refer to community resources to include social determinants including housing, finances, mental needs, substance use, safety, medical follow up, dental, health literacy, and transportation, as well as APS, DCFS, and Guardianship Services	Advocate for quality of spiritual care across the service continuum	Liaise with local clergy for religious rituals and sacraments as well as to provide for unmet spiritual needs of patients and families
Counsel for grief and loss as a result of demise, chronic disease, or trauma	Identify relationship concerns: partner, family, caregiver support, isolation, loneliness	Counsel for grief and loss as a result of diagnosis, disease, hospitalization, death. How will this life be celebrated and loss be grieved?
	Provide bereavement support to patients and family; including: Anticipatory grief, ambiguous grief, complicated grief	Mindfully be present and sit with patient, connect patient with self; allow experiences to arise without needing to act on them
POLST preparation shared with clinical team members	Advanced Directive preparation	Coordinate and support Legacy work, i.e. life review, sharing memories, reflection
Lead hospice and end of life family meetings with providers	Develop, lead, and participate in appropriate support groups, follow-up	Provide care to team members and offer suggestions as well as encourage team members to have practices of self-compassion and kindness. Lead reflections that teach care for self and care for others. Educate team on multiplicity of spiritual care practices. Advocate for spiritual care practices in the system.
		Provide education about spiritual care to caregivers. Participate in/facilitate patient care conferences, meetings.
	Demonstrate, and then provide appropriate coping and relaxation techniques to alleviate stress and situational anxiety	Engage in narrative approaches to finding meaning, identifying fears, hopes, conflicts/coping. Share memories and reflect on legacy. Assist family in ways of preserving these memories.
	Document all visits and interactions in a timely fashion using documentation in iCentra, as well as role specific (FICA, HOPE, SIP, SOAP); use secure messaging forums for inter-team communication

Lent and Such -

 Although I'm not Catholic, I love learning about and participating in customs and traditions and rituals of other faiths and cultures. This year Lent began yesterday and ends on April 14. This year for Lent I am: 

Adding Yoga to my morning. 

Spending two minutes meditating each day. 

Not buying in to anyone's crap (see New Year's Resolution). 

Removing the panic of must-do, must-have. 

Wait - Lent is about self-sacrifice, giving up, repentance, self-reflection, to be closer to God. And that is what I intend to do - giving up my "Must's" and giving to my "Self." 

Tuesday I read, 

Meditation

We’re going to be taking our time this Lent. Hurry can wound a questioning soul.¹ And many of us have questions about how to integrate and reimagine practices and observances like Lent, particularly if even the words ‘repent’ or ‘sin’ or ‘fasting’ only conjure up negative emotions and experiences. So even if you have felt like you are in a rush to name your fast from one thing and repent of another, I invite you this Ash Wednesday to simply commit to a beginning.

Deep breath.

Here you are, at the beginning of something. Isn’t that a sacred place to be?

You don’t have to have it all figured out. You certainly don’t need to know where you will end up by the end of this experience. But being willing to begin takes great courage especially when your heart is a bit battered and broken.

A lot of us are entering into Lent exhausted and scared, sad and angry. Let’s bless your real self and your real feelings and this world’s real moment all careening into a sacred season without pretence or performance for once.

And let’s just begin together, shall we?

When our four kids were tinies, I found that when they were distraught or upset or hurt (which happens more than you might think with toddlers) that it helped if I simply reflected back to them what they are feeling, almost as a validation. It could be as simple as: “You want to stay at the park, you’re sad that we have to go.” Or, “You fell and hurt yourself, it really hurts, you poor lamb.” Even, “You are mad because you wanted to play with that toy. I can see that.” Hiccups and snotty noses and tears usually turned towards rest, towards calm or resolution, towards their mum’s arms.

This can seem counter-intuitive - most of us have an instinct to correct or reason or distract or (my personal favourite) aggressively cheering up. If you need a silver lining to be found, I’m your gal. Remarkably, no one has ever magically become fine simply because they are told “you’re fine, it’s fine, everything’s fine” by this Enneagram Nine.

Yet I saw in those years how the then-tinies relaxed and exhaled when I named and affirmed their experience in recognition of their suffering - yes, you are sad; yes, this hurts; yes, I can name with you what you feel and love you in it. I remember how they leaned in, craving my acknowledgement of their pain, that naming, before they could even begin to turn towards healing or rising.²

It can be utterly exhausting to live in a world that relies on performance and pretence and perfection. I don’t know who has landed at this point in our collective apocalypse without wounds and bruises. There is literal war raging. We’ve lost people we love to a pandemic or politics or both. Our world is groaning and we are groaning, too. We can no longer pretend to be fine - it is too costly.

Telling the truth is its own holy comfort. Lent gives you room for the satisfaction of simply naming things as they are - including ourselves. It’s Mother God’s arms holding you as you admit that you and this world are not fine, in order to be able to rise in faith, in hope, in justice, towards the co-creation of making things right…eventually. Just not yet...

Sounds like just what I need. What about you? 

In Praise of "Good Enough" -

"Calm down," my husband hollers at me when I'm just a little stressed or over-stretched. 

"Ronda, stop! That's 'good enough,' you don't need to do more," can be quite the challenge when I want to spend a little more time. 

"Take it easy," I hear when I'm pushing toward a self-imposed deadline. 

"Don't forget to take time for yourself," the phrase shared at work, daily. 

"Make time to rest this weekend," is often the final statement in my Friday work email collection. 

"Go to bed early," is a kind challenge, again. 

While these directions are meant to be kind and thoughtful, rather, they are riddled with patronizing, "mansplaining" words that are easy to offer, difficult to act on. 

I'm already giving these directives to myself, and hearing them from someone who seems to know me better than I do, is disheartening, and depending on the day, quite frustrating. 

This is what I've learned about myself in the few weeks of 2022 - 

"Good enough" is my New Year's Resolution. I have no desire to do anything more than necessary; "easy does it," "the path of least resistance," and "take it easy," are places I need to be for my own sanity this year. I am goal-driven, project-pushed, yet I have no desire, or energy, to do any more than I can do, today, tomorrow. "No pressure" is all the pressure I want to put on myself.

I know how and when to calm down, and I'm doing the best I can to monitor my level of anxiety; hopefully this keeps the "calm" in and "calm down" out. 

In order to "take it easy" I need to give myself permission to say no, set boundaries, go to bed and read, watch a movie, and simplify wherever I can. 

Time for myself includes a longer shower, leaving work at exactly the 8 hour mark, and being more methodical, rather than frantic, in my actions and thoughts. Time also includes silky pj's at 6pm, "clean the fridge" dinners, and gentle yoga for exercise. 

Gonna be tough, yet I can do hard/easy things! And that's good enough. 

For The One Who Is Exhausted

You have been forced to enter empty time.
The desire that drove you has relinquished.
There is nothing else to do now but rest
And patiently learn to receive the self
You have forsaken in the race of days.

…

You have traveled too fast over false ground;
Now your soul has come to take you back.

… 

Draw alongside the silence of stone
Until its calmness can claim you.
Be excessively gentle with yourself.

…

Gradually, you will return to yourself,
Having learned a new respect for your heart
And the joy that dwells far within slow time.

John O’Donohue

 

Space Shuttle Challenger Explosion -

Thirty-six years ago the Space Shuttle Challenger exploded. I was living in Brigham City, with my husband and two children. My husband worked for Thiokol, working on the o-rings for the space shuttle. 

That morning, after getting Tyler off to school, and Jenna down for her morning nap, I crumpled down in my bed, sick with a sinus infection, thinking I would rest while Jenna napped. 

And with the TV on to see the Challenger lift-off, with a school teacher on board, the world was able to see the disaster that was quickly judged to be Thiokol's fault. 

There were Thiokol dignitaries in Florida for this event and NASA dignitaries in Utah for this event; as were media folks from all over the nation and beyond. And oh boy, what a toxic mess this turned out to be. 

Within moments, our entire town was overrun with news vans and cameras and reporters interviewing any person on the street. 

And thank God there wasn't social media in those days. Because half truths were told, assumptions were made, and fingers were pointed before any authority could speak. Oh gosh, what a frenzy that would be today! 

In our neighborhood in Brigham City there were many folks (mostly men) who worked at Thiokol. In fact I think Brigham City survived as well as it did because of Thiokol's employee base, its proximity to Thiokol (40 minute drive, typically car-pools), and the decent salaries of those employed, with a great cost of living in the area. 

Many of the employees came home from work early that day, and an eerie silence settled on the town. The celebratory energy that had surrounded the town dissipated to dust. My husband came home in a shock. There were so many words to say and nothing to share. 

Several men who lost their jobs because of this disaster, and they became the scape goats for all things Challenger-related. 

One of the over-looked tragedies of this was that of grieving families who were were stunned by the event, floored by the horrible press Thiokol, and in turn the employees and families, were given, and absolutely no help processing what this meant to their future, their employment. 

And a year later, because of these events, layoffs, contracts re-routed, and changes to the Space Shuttle plan, our little family moved to Northwestern Alabama, where my husband took a job with Thiokol in Northeastern Mississippi, to work on the redesign of the Space Shuttle and its engines. 

You know, there's so much more to a story than what is presented in the news, online or otherwise. We jump to conclusions so fast when there is an event that is public and publicized. And even though there were so many naysayers at Thiokol and in Florida at the Kennedy Space Center, the "show" had to go on. And the story will never be complete. 

We had two neighbors who were "convicted" without a jury and blamed and shamed for this event. We have a deep love and respect for Allan (Al) McDonald, who gave his life telling the truth.

This was such a disaster, and yet it wasn't only Thiokol's fault - yes, the o-rings were faulty, and many people were opposed, and many people were pressured to giving their "go-ahead." And many hearts ache, still, after 36 years, because of errors. Mine is one. 

David Archuleta and Being True to Self -

So many times throughout my life I've been shamed for decisions I made. 

Shamed for being too much or not enough. 

Shamed for dressing to "together," shamed for not putting on my company outfit. 

Shamed for not getting an education before having children, shamed for getting an education while having children at home. 

Shamed for working outside of my home, shamed for not contributing to the family income. 

Shamed for having "only" two children, shamed for over-populating. 

Shamed for staying too long in a marriage, shamed for leaving a long marriage. 

Shamed for remarrying so soon, shamed for remarrying at all. 

Shamed for speaking my truth, shamed for being too bold. 

Shamed for being too assertive, shamed for not standing up for myself. 

And still, today, I think before I act. I think "Is this worth the risk," before doing nearly anything that may be misunderstood or misinterpreted, or that I'll have to explain. 

And yet here's 30 year old David Archuleta, sharing his deepest thoughts, in a way that can create his future, or can destroy so much of what he holds dear. And he shares. Without shame. 

The BEST 50 minutes I have spent on a Sunday in many many years. Please listen. Mormon or not, his  vulnerability is powerful, poignant, poetic, and gut-wrenching. And I'm sad that he feels as though he needs to explain himself. And grateful he does. 

Oh to be so brave - 

                                                                David Archuleta Shares -                             

                                            

Dying in the Days of CoVid -

Over the past 3 weeks I have witnessed more than 12 hospital deaths - being a member of a team who talks with the dying person and their loved ones about their Goals of Care, sharing with these folks that their prognosis is not "good" (even though they typically know), and then, in many instances, being with the families as their loved one dies. (Mind you, this does not include the patients I have seen in our clinic who have recently died - probably 8.)

As a family comes to the realization that death is imminent, a multi-colored butterfly is placed on the outside of the room's door, the observation blinds are closed. Privacy is granted. 

I am fascinated by the ways loved ones react and act to the news and the dying process - who they want notified, or not. Death bed reconciliation is real, as is death bed arguing and fighting and bickering and taking sides. Regardless, grips loosen, and death becomes, ready, or not. Lights are dimmed, or not. Blinds are opened, or not. Some in the room sob uncontrollably, others surround the bed, telling stories, singing songs, laughing. Some stand as far away from the bed as possible, with hands in pockets and heads bowed. Some mourn angrily, bitterly, regretfully. Others walk out of the room, choosing not to be near the room. Some families want every relative and friend in the room with them, while others don't want anyone to be there, or they want to be alone with their husband/wife. Loved ones rotate through the rooms and the waiting area, taking their turns saying good-bye while also holding vigil.

And who?

Three young men, under 40, of CoVid complications. Two elderly women of CoVid, one fully alert one day, dying the next. One woman, just a wee-bit older than me, unexpectedly, and her husband made it to the hospital just in time to be stunned by the news, not even able to tell their children. One woman had been hospitalized for weeks, alone, with visitors having ceased nearly 4 weeks before she passed. Another died just days after his wife died. Another died, with her daughter by her bedside, and this daughter having now lost both parents, an uncle and a brother within 2 months. One woman had been sick since just before Christmas, with only one son in the States, who had recently recovered from hospitalization. He had the role of calling his siblings and holding the phone to his heavily sedated mother's ear as they all said their good-byes. 

For the most part, the dying are comfortable and those remaining are truly the ones in pain. 

I am often asked to pray, often for the dying, occasionally for the ones left behind; find someone to give a Priesthood blessing, hold the loved one's hand while they die, be a comforting presence, validate their choices and decisions. 

I try to slip out of the hospital room as the patient takes their last breath, and then slip back in to hold, hug, stand silently near, all the time holding the happenings sacredly. 

After? It's tough to talk with family about what happens after their loved one has died, while they're in the midst of being present with their family member/friend. And yet questions abound - what's next? Where do they go? How do I pick a mortuary? Can Mormons cremate? I can't afford a burial. Where is the least expensive place to go? I want to honor, and we will spare no expense. Can I dress them? Do I get CoVid funeral assistance? Can I go now? How long can I stay here? 

I don't ask if the person was vaccinated, I don't really care. My role is to carry no judgment, even for the family who were prominent on social media as anti-vaccine, who brought their loved one to the hospital too late, and were angry with healthcare providers for not "doing all they could" to save them, and "what are we going to tell our friends." Even with healthcare providers barely alive themselves some days, and some days stepping away to shudder, sob, swear, and then returning to give their very best. 

And while not all of the deaths I've witnessed have been CoVid deaths, all deaths these days are affected by CoVid, and all the loved ones remaining have been witness to the protocols CoVid has demanded of us all. 

And my summary - my role, really, when it's all said and done, is incidental. I don't administer medications, monitor oxygen levels, deliver feedings, change sheets. And yet, as I stand quietly behind that invisible curtain, always available, always out of the way - I like to think that I am the defender of their story, the one who is present, who sees the entire story unfold, and validates - the dead, the living, the caregivers, real events, not statistics. 

As soon as I am able, I walk outside, tear off my facemask, turn east to the mountains, taking deep breaths of the frigid air - filling my lungs with real.

When my day is finished, I arrive home, my drive home not long enough to let the emotions of the day wash away, eat, attempt to sleep, get up, and do it all over again. And yet tonight - with the remains of the day still weighing heavily, I turn to pen and paper, and purge, praying for sleep, for myself and those I hold in reverence. 

 

Looking Back while Looking Ahead -

2021: 

Scott had eye surgery the first week of January. Good news is we met our yearly deductible quickly! 

Which was good because the first of March Scott, thinking he was sitting back on a tree limb to rest, after pruning our daughter's orchard, fell to the ground, because there wasn't a limb, dislocating his right shoulder and tearing the tendons in that shoulder. After a trip to the ED, surgery was scheduled for two weeks later. 

By mid-March Scott was in a sling with the directive to not move his arm. Ha! 

At this same time a new work colleague decided it was his role to look for the bad in everyone on his team, which he did, and I was "written up." This included the bizarre, "I just want to come to meet you and have a short conversation." Which turned into a 90 minute bullying session with 99% of every bit of "evidence" taken out of context. There were 2 people delivering this news to me, while I had no one, and I have to say, this is probably the most hurtful 90 minutes of my life. To be wrongly accused, to be told what I wasn't - with no evidence to show who I am, only one person's inability to talk with me face-to-face rather than call in the army to beat me up. 

And, if there's still a tone of anger in my writing, and a lessening of blog posts for this year, it's because it has taken me nearly the rest of the year to find some peace with myself, confidence with my skills, and finding a place with this youngster colleague who thought he knew best. 

I did decide to address his issues with me, with him, delivering a cactus and a card stating, "I apologize for any times you have felt disrespected or under-mined by me. This has never been my intention. Please feel free to talk with me - I have so much to learn, and I am always willing to grow." We've developed a tolerable working relationship, and my keys to being able to do this are 3 things: 

1. Our Weaver Family 2021 motto - Seek to understand before being understood. Where was he coming from? His motives? His strengths? His weaknesses? 

2. What is my role in all of this? Certainly there were wrong-doings on my part. Can I learn from these? 

3. Sometimes we have to shut up and put up - with ourselves, with others, with no answers, only sitting with ourselves and the information we have, and putting that information where it can best serve us - head, heart, soul, trash can. 

And on that note - 

A dear friend gave us her condo in Hilton Head Island, and Scott and I spent several days on the beach, exploring the seaside towns, and visiting Savannah GA, longtime on my bucket list. 

During the early spring, just prior to Scott's fall we decided to re-landscape our yard, bringing it up to the standards we would need as we grew old in this home. The designs came in just as he took his fall. This became my project, which I'm forever grateful for. Great stress-reducer, something to look forward to after work, and I really love gardening, yet our yard has been quite a hodge-podge for several years, and this change has been for our greater-good! Many thanks to nieces, grandchildren, children, and a few friends for their help. 

So our summer was spent loving our yard - continuing to care for it and watching it evolve. 

Toward the end of June the Walker siblings determined that Mom needed to be in a place where she could get 24 hour care. She is now living at a Beehive Home in Provo - and finding this perfect place was nothing less than miraculous. She is as happy there as she can be any place, and the siblings know she is safe and cared for. She continues to decline - her dementia is worse, her physical abilities are lessening. Dang. 

Mid-August Scott and I headed to Sweden and Denmark for 2 weeks. And even with masks and vaccinations and lengthy flights, those 2 weeks were heavenly. Spectacular. And seeing the areas of my heritage were life-affirming. 

We came home just in time for the Swedish and Danish borders to close to Americans! 

And Scott had shoulder replacement surgery on Sept. 19th. 

As he began his re-recovery, chaos began to reign at work. Within a short time we added 3 new social workers, a new nurse, and more managerial mandates (vague ones at that). As well, discontent was so thick that one person quit, others refused to work with others, one gave birth to a gorgeous baby girl and took maternity leave, and office changes had to be made just to get some peace and some work done. And these are professionals! 

Yet, it's not just caregivers at hospitals who are feeling the emotional disease of CoVid and other dividers (I have personally attended to the dying and their families, witnessing more than a dozen deaths). My own practice has doubled in size, without soliciting, and women of all ages are feeling negative energy and crisis in their lives. I am grateful for the opportunity I have of caring for them. 

However, this stress can be been debilitating, and coming home to peace has been my top priority. Yet with Scott's nearly continual pain and his isolation from all that he loves, our tempers have flared, and we are constantly learning how to be patient and tender with ourselves and each other. 

We've had family members, vaccinated and un, who have had CoVid, and watching them hurt, while keeping ourselves healthy has been tough; we have remained relatively healthy, and they are healing. And I am damn tired of the harm, rather than healing, that has taken place because of this CoVid discontent.

Walking out of the stressors that have been soul-draining, I decided I needed a new tattoo - a bright orange sun on the inside of my right wrist. I WILL NOT allow anyone to take my sunshine away anymore. I will be the light - first for myself. 

Scott is healing; kids are healthy; holidays not so filled with family and parties; work still tumultuous. 

And to end the year, one of my very best friends, a physician whom I've worked with daily for 7 1/2 years, who has taught me so much about medicine and life, left our team yesterday. Not the best way to end the year. And his journey to his leaving - well, read my story above and amplify it. Yet the lessons I've been taught this year, and have chosen to learn, are that with good-byes there are hello's; friendships change, yet remain; learning is a life-long process; and life goes on. Self-reflection has been my top priority, and with that, I have peace (most of the time). But gosh darn it, I'm gonna miss him. 

I'm grateful for the limited stability I've had this year - a great job (even with CoVid and conflicts), a beautiful home and yard, 5-HTP that has been a huge blessing in my life - giving me energy, clarity, and calm; great therapy, and the ability to create - whether that's cooking, baking, sewing, gardening, visiting. 

I hunger to read - finding good novels is tough, and I'm tired of self-help and spirituality books; I hunger for friendships - yet creating new friendships and renewing others takes more energy than I have some days. I hunger for Peace on Earth, and I want it to begin with me, my loved ones, my space.

So here's a nod of respect and namaste to 2021, and a flicker of hope and optimism to 2022.