The Chaplain as Smooth Outrider

What are you talking about?  Chaplain and smooth outrider? 

If you are a rodeo fan, you’ll know the value and importance of the smooth outriders.  When a bunking bronco has completed his efforts to dislodge the cowboy from his back, he’s still a little agitated and kicks and bucks.  He’s forgotten the mission is complete and it’s time to head back to the holding pen.  He needs some help to calm down.  This is where the smooth outrider comes in.  Sometimes it’s one, sometimes it’s two outriders that enter the arena where the bronco is.  They ride up next to their frenzied friend and come along side.  Their manner brings calm to the bronco.  These outriders then guide the bronco to the holding pen for rest and food. 

 

The outriders are in every strata of the horse business.  In a story http://www.paulickreport.com/features/breeders-cup-presents-connections/the-wild-ride-of-an-outrider/ I read of the work of John Garges, an outrider.  He and his horse have brought calm to such a notable horse as American Pharaoh, leading him quietly to the winner’s circle.  Garges then tells an interesting story: “I've had a few people ask what you do when there's a horse running the wrong way, and well, you catch him going the wrong way. That's what you do.”

 

How does this apply to the Chaplain?  Have you noticed that from time to time, a fellow IDT member might get a bit upset at a decision made by the organization or another might be distracted by a personal problem, or yet another get hurt feelings and leave the meeting room in tears?  They need a smooth outrider to come along beside them to calm them.  That, my Colleague, is your role more often than not.  You have a wonderful opportunity to use your kind influence to get them going in the right direction.  You might even save their career.

 

The Chaplain is a peace-maker, a peace-giver.  Your demeanor may just be what that troubled IDT member needs.  As for the Chaplain Team as a whole, we need each other for support and a right perspective on what is happening around us.  While we cannot solve everyone’s problems we can be there as a calming influence.  “Saddle up, Smooth Outriders!”

Controversy, faux-outrage, hyper-sensitivity, and hyper-criticism seem to dominate the landscape of American culture now.  On Memorial Day we gain perspective.

Thank you (a phrase that cannot possibly be enough in expressing the gratitude I feel for our fallen Heroes) for your sacrifice.  We stand on your shoulders to make this country what our Founders dreamed it could be.

Thank you.

Great piece for Blessing of the Hands...

Blessed be these hands that have touched life.
Blessed be these hands that have nurtured creativity.
Blessed be these hands that have held pain.
Blessed be these hands that have embraced with passion.
Blessed be these hands that have closed in anger.
Blessed be these hands that have drawn blood and administered medication.
Blessed be these hands that have cleaned beds and disposed of wastes.

Blessed be these hands that have carried out endless tasks
as part of caring for our community.

Blessed be these hands that have comforted the dying and held the dead.
Blessed be the hands that hold the promise of the future.

It’s OK to be patriotic…

Thankfully, in the hospice environment we have the privilege to recognize and “pin” our patients who served in the military.  There has not ever been a “pinning” ceremony that I’ve attended that has not moved me to tears. 

 

I have witnessed a Marine pin an Army Vet; seen a Vet with dementia who was non-responsive for weeks have an awakening and salute during a pinning.  I have witnessed a Vet tell stories of his experiences in war that his family never knew happened. 

 

At Cornerstone Hospice we have a corps of Cornerstone Salutes volunteers that invest their time and efforts to visit and conduct the pinning ceremonies.  It is wonderful to watch them and sense their patriotic pride as they do their work.

 

As I review my life, I remember how each school day began from the time I was in Kindergarten until I graduated from high school.  The entire school pledged allegiance to the flag of the United States of America…even in the tumultuous 1960’s.  Being proud of my country is part of my fabric as an American.  As a hospice Chaplain, I am very much OK with being patriotic.

 

This weekend we remember those that died that we might be a free nation.  How can we ever repay their sacrifice…

 

Be safe, enjoy your family, and give thanks. 

Time Management

One challenge a hospice Chaplain will encounter is that of time management.  If the Chaplain has transitioned from the parish pastorate this could be quite a challenge.  Therefore, a simple schedule provided by the hospice Chaplain manager will help.

This is what I provide for our facility Chaplains (home team Chaplains are trickier as they work by appointment—there are several ways to make the appointments, so I do not have a standardized format for them.  However, I expect their documentation to be completed by 4:30PM so they have their work done):

 

8AM: Work phone is turned on/Computer is turned on/synchronize Allscripts

 

8:30AM: Read email focusing on ACE Notifications of new patients, deaths, requests for Chaplain

 

9:15AM: Follow your Scheduler, head out to the facility, and begin making visits

 

4:30PM:  Have all documentation completed and have a great evening with your family.

 

 

Disturbing Observations

I had the privilege of presenting a workshop at the Healthcare Chaplaincy Network “Caring for the Human Spirit” Conference in San Diego a month ago.  It’s taken that and another presentation of the material to help me process my observations.

 

While there is no reason to press a Panic Button, these observations certainly should awaken hospice and hospital spiritual care leaders that “Houston, we have a problem”!

 

1.  There is an awareness of fewer chaplain positions across the spectrum of healthcare.  There are pockets of hiring, but those are the exception.
2.  There is uncertainty as to what a Chaplain should be charting by way of a Clinical Note or Narrative or whatever your computer program calls it.  Also, let me categorically state that any hospice that does not use electronic charting is behind the times and out of compliance with Medicare regulations.
3.  When I present the Algorithms for Spiritual Care, the Users’ Guide, and Template for Documentation and ask the audience if their organization has something similar to assist the Chaplaincy Department in putting together a highly professional Clinical Note the answer is “No”.  That is disturbing.  It shows:
1. A lack of education and training… Chaplains thrive on education and training.  To not provide your organization with a philosophy of chaplaincy is to minimize and marginalize the efficacy of chaplaincy. To not provide the Chaplains with a Senior Chaplain or Manager is to guarantee that the Chaplain staff will not be exposed to great educational opportunities which will improve their productivity and their patient/family encounters.
2. A lack of trust in the capabilities of Chaplains.  If organizations are not permitting Chaplains to provide a Clinical Note for fear of HIPPA violations or some other perceived potential legal issues, see the above. 
3. A lack of requirements for Chaplains.  Now, I realize there are Chaplains who are doing a stand up job and do not have the benefit of Clinical Pastoral Education, let alone Board Certification, but I do believe that due to the critical nature of the hospice and hospital environment patients and families are better served by Chaplains who have had at least 3 Units of CPE.  Of course, Board Certification should be the standard, but in lieu of that at least 3 Units means a Chaplain has been exposed to 1200 hours of clinical education.
4. I am absolutely convinced that every hospice organization would benefit from exposure to my presentation on Quality Improvement.  The Algorithm, Users’ Guide and Documentation Template will keep the Chaplain on target with documentation and help the Chaplain to paint the picture of the patient’s experience. 
5. A Chaplain who becomes adept at the Algorithms, Users’ Guide, Documentation Template will take his seat at the table of a medically focused hospice and participate effectively.  This adds to the value of chaplaincy and raises the bar for every Chaplain.  The highly skilled Chaplain will be sought after to provide in-services for the Inter-disciplinary Team and other groups in the hospice.

In conclusion, as a result of a hospice or hospital leader reading this article, I would like to see an in-service scheduled to learn of the Algorithms, Users’ Guide, and Documentation Template.  Self-serving?  Hardly.  My passion is for Chaplains confidently serving the needs of patients, families, and their colleagues on the IDT.  I gave away the materials at the HCCN conference as I did to those in attendance at the CPSP Chapter meeting.  I suggest that once this is fully in place across the continuum of healthcare groups we will see a greater awareness of chaplaincy and higher value placed on chaplaincy.

Special Link

I invite you to cshospice.org/conf to view the Users' Guide to the Spiritual Care Algorithms and our Best Practice pieces for Home Team, Hospice House, and Long Term Care Team Chaplains.  The Users' Guide also has our statement of spiritual care philosophy.  Your feedback is welcome.

Powerlessness, suffering, pain…

Powerlessness, suffering, pain … each of these can be applied to the life of the hospice patient and/or family caregiver.  Can the hospice Chaplain help the patient to make meaning out of this experience?

As you read these voices of the dying, what is your response?  How do they inform your chaplaincy?  The dying need to be heard.  Listen to these voices. 

“Death will soon remove this bitter cup from my lips. I will be free of this life, my family will be free of this hopeless misery.”

“Death is in this house, in the air, in this room.  Each day it is closer to this bed, to me.”

“To talk about death may be very difficult or even impossible for you. You have so much to carry. I wish I could spare you the painful horror of watching me die.”

“What will it be like when it comes?”

“You should rest before dinner.” “Rest from what? Rest for what?”

“When I am gone, the air will fill the space where my body used to be.”

“I love that woman with all my heart.”

“Why don’t you look at me when you do talk? Has the cancer so ravaged my body that it is unbearable to look at?”

Hospice patients are more than victims of disease or patients of medicine; they are wounded storytellers. People tell stories to make sense of their suffering;  when they turn their diseases into stories, they find healing.  There are three types of narratives or stories: the chaos narrative, the restitution narrative, and the quest narrative.  Of the Chaplain is introduced to the chaos narrative which is characterized by an  underlying message is that life does not get better.  And, at the end of life, can life get better?  How does this inform your chaplaincy?

The restitution narrative is the creation of the Western culture built upon the tough cultural fabric that health is always restorable.  "Yesterday I was healthy, today I am sick but tomorrow I will be healthy again".   How do you work with persons in denial?

The patient that journeys through suffering and believes there is something to be gained in the process will engage in the quest narrative.  Quest narratives search for alternative ways of being ill or alternative ways of being well.  Attitude is everything in this story. 

I urge you to read Arthur W. Frank, The Wounded Storyteller, for more on this very important topic.  More on what the hospice Chaplain can do by way of interventions with each of these types of persons telling these stories to come in later articles…

 

 

 

What is the difference between being “clinical” as opposed to “compassionate”?

These concepts are not mutually exclusive.  A Chaplain, in today’s hospice world, must have a clinical mindset, but be compassionate in all that he or she does.

 

The clinical mindset captures vital information about the patient and family members.  Take, for instance, Pain.  The Clinical Chaplain serves as another set of eyes and ears to assist the patient by charting the amount of pain on a 0-10 level and identify which pain scale is used: VAS for verbal patients who are not Alzheimer’s or dementia patients; FLACC for those who are non-verbal but not Alzheimer’s or dementia patients; or PainAD for all Alzheimer’s or dementia patients.  Another example is the Big MAC.  The Clinical Chaplain observes the manner of Mobility: ambulating with or without assistance, or with a cane or walker, or in a wheelchair with or without assistance.  ADL’s: noting the amount of food the patient eats in a percentage format; noting any changes in patient’s sleeping pattern—sleeping more  or less…taking daily naps; needing assistance with bathing, for instance.  And, of course, the clinical Chaplain develops an individualized plan of care.  At Cornerstone Hospice & Palliative Care we have an Algorithm for Spiritual Care that identifies 21 of the most common spiritual concerns, provides potential Goals/Expected Outcomes, and then a listing of potential Chaplain Interventions. The overarching philosophy of our Spiritual Care Department is called Outcome Oriented Chaplaincy which guides us to achieve excellence in spiritual care. 

 

The alleged concept that a Chaplain who is clinical is cold is a fallacious statement.  Being clinical and being cold are two separate issues.  If a Chaplain is cold in his or her approach, that person probably is not a Chaplain with Cornerstone Hospice.  We expect our Chaplains to render compassionate support to patients and families.  Having a working knowledge of the medical issues, social work foci, and a mastering of spiritual care are what we expect of Chaplains.  Having a brain and a heart are two qualities clinical Chaplains use to render spiritual support.  Neither nullifies the other.  It is a “both and” concept. 

 

Your feedback is always welcome.

Hospice Chaplains' Professional Growth Group

Now on Facebook, the Hospice Chaplains' Professional Growth Group will focus on issues of concern for hospice Chaplains.  Please join us for invigorating discussion, encouragement, and support.

Now that you have your Hospice Chaplain position…Here’s how to keep it!

In yesterday’s article I shared some vital information about how to get hired as a hospice Chaplain.  Today, I want to share how to keep it and excel in your hospice Chaplain career.

First of all, let me state unequivocally, getting a hospice Chaplain position is not easy.  Therefore, when you are offered a position and begin your career, I urge you to cherish it.

Here are 4 ABSOLUTES to excelling in your career.

1.  Keep a positive ATTITUDE.  There will be highs and lows in hospice chaplaincy. You will love the face to face work with patients and families.  Most Chaplains enjoy serving people.  However, there will be that “2x4 to the head” moment when nothing you do will satisfy a patient or family.  Also, there will be changes in the way you document, changes in what is expected in documentation, additional information required, changes, changes, changes.  Change is the new normal.  Your IDT colleagues may grouse and complain among one another and even to you as they ask your opinion.  Do not fall into that trap of negativity.  Remain positive.  Trust your leadership to navigate the very difficult maze of Medicare demands.  Create a brand for yourself as being Mr. or Ms. Positive.  That will take you a long way in chaplaincy.
2.  Embrace the highest in ethical standards.  Your time is your own to create your work day.  At Cornerstone Hospice our day begins at 8AM and concludes at 4:30PM.  Most field staff begin their day in their home making phone calls setting appointments.  It is expected that we all put in a full day’s work.  With that said, I urge our Chaplains to make 2 visits in the morning and 2 in the afternoon.  If at all possible they are to complete their charting in their computers after each visit, so they can finish their day at 4:30PM and then be with their families.  We have a mandate to visit our caseload 1-2 times in every 30 day cycle.  The verbiage in the computer may state, “per month”, but it is 30 days.  Beyond staying in compliance, it is expected that Chaplains will maintain confidences within the IDT.  Once you break a confidence, everyone will know.  Your reputation is blown and you have gained a very negative brand.  So, work hard, stay in compliance, advocate for your patients, and keep your word and all confidences.
3.  Make yourself available for projects.  Chaplains are busy with patients and families.  That is a given.  However, from time to time there will be special projects that need a Chaplain.  Be the first to volunteer.  Your willingness will be appreciated, particularly when you make vital contributions to the work team.
4.  Increase your skills and knowledge base.  As I wrote that sentence, I heard voices of complaint and dissatisfaction, because there is usually no added compensation for degrees and certifications.  However, the nature of our work demands highly skilled pastoral care clinicians.  Becoming Board Certified from a nationally recognized organization will help you to excel in your work.  Taking Continuing Education courses will assist your skill development.  Here is my attitude … The better prepared I am to do my work, the better care I will provide a patient at their most vulnerable moments in the course of their hospice journey.  In addition, my skill level will greatly benefit family members.  Please do not succumb to the temptation to be satisfied with where you are.  Growth is an imperative in our field of service.

I am sure I could write much more on this vital topic, but I’ll leave it at what I wrote.  When you have your annual performance evaluation, your personal brand or reputation will precede you.  Your excellent work will be noted.  You just may receive a merit increase in pay as a result. 

How to Get Hired as a Hospice Chaplain

Through the years I have been involved in interviewing candidates for full time hospice Chaplain positions.  If I were to grade the Candidates they would fall into three categories: Candidate 1 would  receive a C-; Candidate 2 would receive an A+; Candidate 3 would receive an F.  What made the difference? : the resume, the warmth and calm of the candidate, and the candidates communication during the interview.

How do you then make it to the top three candidate status?  Let me share 6 essentials that will hopefully get you an interview and that will at least get you a second look and even make you a finalist and, further, get you hired.

1.  When you respond to a posting for a Chaplain position, be sure to complete the application in as detailed a manner as possible.  Tell the truth and nothing but the truth.  If you provide a cover letter, let it speak truth to the Recruiter who will pass it on to us as Managers.
2.  When you send in a resume, the following are absolute MUSTS:

• Choose a resume format.  Word for Windows has several. Make it look professional.  It is a reflection of you.
• Be detailed.  Dates and where you worked previously are necessary.
• Why you left the position is helpful.  We understand if you were to say, “It was not a good fit.”
• I prefer a list of at least 3 professional references.
• Since this is hospice chaplaincy, a cover letter that explains your calling to chaplaincy, your experience in chaplaincy, the reason you want to work at a hospice, if you are moving from another venue of chaplaincy to hospice tell us why.  If you cannot clearly state a sense of calling, that may be a red flag.
• Detail your CPE information.  Where did you get your Units? How many Units did you take?  You would be amazed how many Chaplains do not have that information in their resumes. 

3.   Should you be selected for a face to face interview, please follow these guidelines:

• Have an ‘elevator’ speech detailing who you are.  It should take 3 minutes.  When you are asked, “Tell us a little about yourself…”  NEVER reply by asking, “What would you like to know?” That conveys that you either do not know how to interview or that you are unprepared.
• Convey an aptitude for hospice chaplaincy and a calling to it.  Know what hospice chaplaincy is and share your experiences.  Saying, “Well, I’ve been around a lot of dying people” won’t get you far.  Hospice chaplaincy is so much more than that.
• When answering questions take a moment to reflect on what you are about to say, then say it.  The way you respond to a difficult question will give us some insight into how you will respond to a difficult situation in a hospice pastoral care scenario.  If your body language conveys you are rushed it will come across as if you are wanting the interview to be over.  Talk with us as if we have known each other for years. 
• Give real life anecdotes to illustrate your points.  Keep them brief but use them. 
• Do NOT ever use racial, ethnic, or gender slurs.  That will immediately disqualify you even though the interview may proceed.
• Smile … appear relaxed.  Again, this will let us know how you will respond in a pastoral care scenario.

4.  After the interview, send a “Thank you” email.  That will let us know that you have manners and are professional in your business dealings. 
5.  If you are invited for a second interview, we are looking for even more of a professional manner of response.  We are looking for further clarity on issues.  It could be that there are one or two matters that are unsettled in our minds and we are looking to you for more information.
6.  And, finally, throughout the process we are looking for someone polished, gracious, professional, and skillful. 

And, if you follow the above, you have a great chance of obtaining a chaplaincy career position.  If you have any questions about resume writing, cover letter writing, or guidance in how to interview, please contact me at rbehers@cshospice.org.

 

A Deeper Dive into the Interventions: Finding the Divine/The Divine Finding us

A Deeper Dive into the Interventions: Finding the Divine/The Divine Finding us

 

Finding the Diving in the midst of suffering is often predicated by finding the patient’s source of spiritual strength.  These two interventions can provide a solid foundation upon which the patient may build their faith as they face end of life.  As in all interventions, the Chaplain must be certain that these are congruent with the patient’s desire for spiritual support of this nature.  In this article we are simply calling to the Chaplains’ attention the fact that these two interventions are but 2 of 21 interventions to be employed in the spiritual caregiving dynamic. 

 

Perhaps a review of how the Chaplain arrives at this stage of the Spiritual Plan of Care.  First, relationship is built through trust.  The Chaplain will gain some sense of the Spiritual Concern the patient exudes and confirms or clarifies that with the patient.  From that point, a goal or expected outcome is identified by the patient as the Chaplain skillfully converses with the patient.  At that point, the Chaplain identifies which interventions will benefit the patient the most.  This sounds robotic, but in the dynamic of the pastoral care encounter it is far from that.  Further, the Chaplain has no agenda to force the patient to identify a goal or expected outcome.  In fact, those terms are never used.  It simply is what the patient would like to accomplish in his or her life…no arm-twisting or spiritual abuse ever!

 

What follows is a case study.  I would ask that you put on your Chaplain hat and participate with this family.  What would you do?  Would you use either of these interventions? 

 

One of the most used terms in describing hospice care is ‘journey’.  We join our patients on their journey. We make the journey with them… and so forth.  What exactly are we talking about when we use the work ‘journey’?

A journey is a trek from one place to another.  Is it too graphic to state that the hospice journey is a trek from wellness to illness to death?  Or from living in health to living in the shadow of death?  What then can the hospice Chaplain do to assist this sojourner?  Traveling, for me, has often been fraught with taking a wrong turn, getting lost, losing time, going extra miles when I could have saved time by taking the right route.  Somehow, I see these characteristics of my travels, as holding true with patients.  Could we not liken taking a detour, losing time, traveling extra miles on the hospice journey to denial, emotional distress, anticipatory grief?  And, then, can we truly place a value on these very human responses as a waste of time or a delay in the journey?  I think not because they are a real part of the journey and the stories told in these junctures are vital to understanding the life of the patient.  In the American Book of Living and Dying, one of the key issues of life is ‘meaning.’  What gave the patient meaning and significance in days of health and vitality is no longer the same.  Meaning making at the end-of-life something altogether different.  The wise Chaplain can explore this with his or her patients and family caregivers.  What follows is the story of a husband, wife, and two adult daughters as they made their hospice journey.  As you read, pick out the moments when the Chaplain could have provided an Intervention to explore with the patient or his spouse issues of meaning.  Also, ask yourself what difference could the Chaplain have made with this family.

My husband Tom was 48 when he was diagnosed with pancreatic cancer. He had a very successful home based business and he was determined that his diagnosis would not slow him down. We had two children together, Carrie who was 20 and Kevin who was 21. He had a "successful" surgery in the month after his diagnosis in June, but by July mets to the liver were discovered so he began a series of chemo treatments in hopes of slowing the disease progression down - but nothing seemed to work at all. In the meantime, Tom and I tried to lead as "normal" a life as possible.  We both still worked, took hikes, dinners out, a few short trips, and in general just kept hoping that something would finally work. He continued to decline and the disease to progress, but Tom was amazingly strong and rarely let the disease get to him. In fact, it now seems that he wasn't letting the doctors or me and our kids know how much the disease was taking over. He was always optimistic that another treatment would slow the disease progression down. But nothing did slow it down.

Initially we had some hypothetical discussions about the end. Early in Tom's illness he started talking about cremation and how he wanted to have his remains divided between the two kids for them to each take to some special place.  For example, he wanted my son - who is an extreme skier - to throw the remains off a high ski jump somewhere out west.  We tried to go along with him, though we didn't even want to talk about the end since we were all so optimistic that something was going to come along to "cure" him from the cancer.  Well, over the next several months, my daughter (who is in college) got emails from Tom with his latest thoughts on where he should end up. The last email she received on this subject showed that Tom had changed his mind about his remains being divided - that suddenly didn't seem right to him - but he didn't provide us with where he did want to be. But the vast majority of the time he denied the seriousness of his disease. I really believe that he was so determined not to let the disease win that he denied and denied that it had advanced so far, to the point that it caught him by surprise as much as us.

The month of December he was feeling lousy.  But he was still doing a little work out of the basement office but feeling very tired and having trouble eating He was still looking forward to a new clinical trial that was to start the first week of January We had an appointment on December 22nd to see the oncologist. During the appointment it was made clear that the doctor thought things were going downhill quickly. He told him that at this point he could only treat his symptoms and gave him an IV that afternoon.  The doctor told me he expected Tom had about 2 weeks left. We talked very little about it on the way home.

That evening he was very tired and depressed.  Carrie pointed out to him that the winter solstice was occurring and that the moon was the brightest and closest to the earth as it had been for 100 years. So Tom made an extra effort and he and I went out on the back deck and looked at the moon before he went to bed.

The next morning Tom just barely woke up.  He was disoriented and couldn't communicate.  Several times I found him sitting on the side of the tub in the bathroom when I left the room just for a minute.  My understanding is that the disorientation was caused by decreased blood flow to the brain as the body began to slow down. One thing we explored initially was whether the disorientation was due to brain mets. His doctor ordered Decadron for him to reduce swelling caused by brain tumors if there were any. Unfortunately it didn't help.

Within hours he had slipped into a coma. We hurriedly got hospice care and the hospice nurse suggested that we might receive some final gifts from Tom. My kids and I were in total shock. Although we hadn't talked about it much we knew the disease was progressing, and the end was coming, but we never expected it to go so fast. The nurse also told us that hearing was the last sense to go so that Tom would be able to hear anything we said.  So we talked to Tom and told him how much we loved him for hours and hours. I hope he heard us...in the early hours of his coma he did respond a little bit, but we were unable to understand him.

The next day, Christmas Eve, Tom's mother was scheduled to arrive at 10:30p.m. The hospice nurse suggested he would hold on until she arrived. But that was not meant to be. Tom died at 7:30 p.m. None of us had any last words from him, in fact, we never had the chance to acknowledge together that he was in fact, not going to beat this disease. I have felt cheated of the final days that I expected to have when we would share our love for each other and plan to meet in a better place.

I have a lot of problems with the lack of closure with Tom. While we had gradually acknowledged to each other that he might not make it, we'd never really accepted it or talked about what it meant. I always thought we'd have a period of time when he was in hospice care when we would talk more and say our good-byes. While I, and my kids-said lots of good-byes and I love yous while he was in a coma, he was never able to communicate with us again. I still replay those last few days over and over and wonder how we didn't know he was so close to the end and wonder if he knew? I keep thinking that I might run across a good-bye note or something like that, but I don't think there is one.

Although the suddenness of Tom's death has been very disturbing, I have finally come to see this as a gift. He did not experience a long period of pain and hopelessness. Dying on Christmas Eve, as sad and difficult as that is going to make future Christmas Eves, is probably much better than had it been Christmas Day. Waiting for his mother to arrive was probably too difficult for him, it would have made it harder for him to let go-when he was clearly ready to do so. And he and I did share the winter solstice the night before he went into his coma.

Final gifts come in different forms. They aren't always the last minute moments of lucidity when good-byes are said.  We sure didn't get that, but I have come to feel that we received other messages in other ways.

For now, we have put Tom's remains in a basket, wrapped it in the cozy blanket he always used on the sofa, and surrounded it with mementos. Since we are so sure that Tom’s spirit is in heaven and with us, we are able to disassociate that box from the real Tom, but at the same time, use it as a place to remind us of some of our times together.

Carrie had a hard time deciding whether to go back to school in January. She wasn't sure if she would be able to concentrate on school, but at the moment she is highly motivated as she is studying cell biology and lining up some lab work in a cancer research project.  "Funny" how her dad's disease has helped her find the direction she wants to concentrate on in school. Eleven years ago, my dad died of leukemia and a side effect was that my sister decided to go to medical school at age 32!

I went back to work in mid-January and that keeps me really busy and distracted. But that isn't enough. I try to figure out what I'm supposed to do with my life now that my much loved husband is gone. He and I did just about everything together and we were just getting to the point of planning our retirement and now I don't have a clue what to do.

copyright 2000 Susan Peticolas Lahti

 

 

 

 

 

 

 

 

 

 

Making a Successful Transition From the Parish Pastorate to Hospice Chaplaincy, Part 6

• Get very familiar with two cautionary statements:
  • “Be careful what you think you know.”
  • “You don’t know what you don’t know.”
    The first will keep you from assuming.  The second will keep you from crashing and burning.  I will let you write you own story related to these statements.  Circumstances will appear where you will bump your head on both.
     
    It is my hope that you will succeed in your transition.  It will take work and it won’t happen instantly.  Be open to the transitional elements.  Be a blessing to all you meet on the IDT and in the field of service. 

Making a Successful Transition From the Parish Pastorate to Hospice Chaplaincy, Part 5

• Review your ministry as a Parish Pastor.  What type of Pastor were you?  The answer to that will definitely have an effect upon your work as a hospice Chaplain.
  There are 4 key questions that will help you as you explore the answer.  Looking back over a ministry career in the parish pastorate can bring about feelings of nostalgia.  Nostalgia has a way of fogging one’s memory, it must be warned.  So let’s take a walk back over your parish ministry career and do some kicking around.

1.  Key Question #1:  Do you have any unfinished business?  We hospice Chaplains are fairly well known for exploring with our patients any of their unfinished business.  Do we have any?  Unfinished business drains the soul of energy, creativity, and inner peace.  Is there someone you have yet to forgive?  Beware the quick and thoughtless, “Oh, I forgive him long ago.”  Did you really or is it easier just to say that instead of acknowledging your pain and getting before God in prayer for healing that you may, indeed, forgive?  Spiritual pain in ministry is real and lasting.  Perhaps a church member wounded one of your children.  How are you coping with that, particularly if the damage was so bad that that child (now an adult) will have nothing to do with church?  What about your spouse?  Thom Rainer, President and CEO of Lifeway Christian Resources, has a powerful blog site (http://thomrainer.com/blog/).  He posted a few articles about the pastor’s wife (I apologize to those Chaplains who are female. Perhaps you can add to this discussion through the Comments section to share your perspective).  Did she find any of these to be true when it came to her relationship with the church?  In the January 2014 edition of the blog, Rainer suggests “11 Things I Learned from Pastors’ Wives”: 1.The number one challenge for pastors’ wives is loneliness. 2. These ladies need to know they have the love and support of their husbands.  3. A pastor’s wife does not want a church member to tell her what her “job” at the church is.          4. She would like church members to understand that neither she nor her family is perfect.  5. The pastor’s wife does not want to field complaints from church members about her husband.  6. The pastors’ wives who entered ministry with no forewarning about the issues they would face were the ones who stressed the most.  7. She does not want to be told she needs to work to support her husband and family. 8. While most pastors’ wives affirm their identity as a wife in ministry, they do not want that to be their only identity.  9. Many pastors’ wives believe they need training for their roles.  10. These ladies want to be reminded again and again to keep their focus on Christ.  11. Many pastors’ wives want a means where they can support one another.
   Unfinished business does involve emotional responses to what happened in our past.  For most pastors it has to do with being lied to or lied about; mean and nasty words spoken to or about; a forced termination with the accompanying blood bath business meeting; unending stress; imposed and accepted false guilt about taking a day off, going away for a weekend, buying a nice car or nice clothes or nice anything, being openly criticized at a business meeting, being harassed by the church critic, never feeling accepted into the fellowship, being gossiped about in the community, and the list can go on.  Is there any unfinished business?  Believe it or not, the emotional drain will follow you into hospice ministry.  Changing vocational ministry settings will not erase all of that pain.  Hospice service will give you a wonderful change of pace, affirmation, acceptance, a place at the table, respect, encouragement, and many more great emotional strokes.  But, if you are carrying a refrigerator filled with rotting emotions, you won’t be able to enjoy the positive aspects of the work.
    
2.  Key Question #2:  How did you manage your time?  In the parish pastorate you are master of your own time.  What was your schedule?  Did you have set office hours?  Did you have a starting time and a quitting time or was your day open-ended?  Since you were on-call 24/7, what did you do for self-care?  Have you noticed that there are many out-of-shape Pastors?  When you went to a convention or conference, did you notice how many pastors were obese, on all sorts of medication, nervous, anxious, and unable to focus for more than a few minutes?  I observe these kinds of things with a profound sense of sorrow.  What has church ministry done to these men, many of whom are friends of mine?  I spent twenty five years in the local parish pastorate.  I get it.  I know what it is like to work and work hard to get the resistant to come to church, to give to the church, to reach the lost (SBC language for those who need God’s salvation through Christ), to baptize more this year than the previous year, to increase missions giving, to build bigger budgets, to build bigger buildings, to have more and exciting programs to draw children, teenager, young adults, middle aged adult and senior adults, to hire new staff, to have a day care center, to manage the program efficiently, and on and on it goes.  It’s a pressure cooker.  Does a pastor need time for himself or herself?  You better believe it.  Someone used a play on words when commenting on the manner of Jesus… “He came apart from his disciples to pray”… The play on words is this:  either we come apart to pray or we come apart.  How true is that?  What was your pattern for prayer and getting centered spiritually when you were in the parish pastorate?  What is it now?  In the hospice chaplaincy, you have to build a schedule.  In fact, at Cornerstone Hospice you are required to have your schedule posted for the next 2 weeks. You have to visit your patients every 30 days.  That is a Medicare requirement.  You have meetings to attend.  The bottom line is this; you have to manage your time efficiently.  You have a starting time, 8 AM.  You have an ending time, 4:30 PM. 
3. Key Question #3:  What was your reputation as a parish pastor?  What strengths did your congregation recognize in you?  Were you seen as a man of God with a pastor’s heart? A great administrator? A leader? A successful communicator? A good listener?  All of these will hold you in good stead as a hospice chaplain.  Wouldn’t it be nice if were in our success zone all of the time?  Since we’re human, that means we make mistakes and earn the “stink eye” from time to time.  Here are some qualities that a hospice chaplain definitely does not want to be known for: being a KIA (know it all); sanctimonious; stingy; critical; careless with language; careless with jokes (dealing with race, women, morality, to name a few); argumentative; given to moodiness.  These are not exhaustive in number and description.  Perhaps you have more.  Our readers would profit from your observations.
4. Key Question #4:  What preparation have you made for hospice chaplaincy?  Each hospice organization has different requirements for hiring chaplains.  My observation has been that if the requirements are minimal, so is everything else about that organization.  Stay away from that.  The higher the qualifications, then the higher the standards of the agency. It could also follow that the pay and benefits are higher as well.  When I speak of preparation, my own opinions leak out like a fire hose!  When I was younger and impressionable, I was told in reference to the pastorate to prepare fully for the task.  My response to that was to earn a BA, an MDiv. and a DMin.  I’m not sure all that benefited me financially, but it enable me to function in the pastorate in a prepared manner.  When I transitioned to the hospice environment, I was blessed by two hospice agencies which encouraged and permitted me to take 4 units of Clinical Pastoral Education.  Did they pay for my Units?  No, but in a sense they did as they allowed me to take work time for my studies.  While it was not required, I earned Board Certification as a Chaplain and then certification as a Clinical Fellow in Hospice and Palliative Care.  Did any of this earn me a huge raise in salary? No, not a bit.  But, it gave me inner knowledge that I prepared as best as I could for the task I am charged with.  In the coming days, it is my opinion that in the new healthcare climate, Chaplains in the healthcare field will all have to be board certified.  I believe that will be a Medicare requirement.  For the longest time, hospice chaplains were parish pastors who were good people who cared deeply for the sick and dying.  It’s a different day in 2014 than in 1984 when hospice started.  We have gone from a ‘movement’ to an ‘industry’.  That carries with it a different set of requirements.  Hospice Chaplains, be aware of this and do your best to move forward toward board certification.  If you have questions about how to achieve this, please ask.  I’ll provide you with information.  Bless you, Chaplains, in your work.  

Making a Successful Transition From the Parish Pastorate to Hospice Chaplaincy, Part 4

• Embrace the “we” messages of hospice chaplaincy.  The “we” messages must be embraced as much as the “I” messages must be jettisoned.  Here are several:
  • “We are a Team”—It is not up you, Hospice Chaplain, to make the final decisions about anything.  You serve with a Team and must be a Team player.
  • “We work together”—As a team player you function as a critical cog in the workings of the Team. No, there is no spotlight on you as there was in the church setting.  You are one of many team members.  Shine in  your discipline.
  • “We serve”—Our work is servant based ministry.  What we do has a primary focus on the patients and their needs.  We do what do to serve their needs, not our own.
  • “We plan”—At each IDT meeting we participate in a process of quality improvement as we update and edit our Spiritual Plan of Care along with the rest of the Team.
  • “We are accountable”—There is not a lot of accountability in the parish pastorate.  Perhaps there should be.  There are goals to be met, Care Plans to write, visit requirements to meet.  Each of these is deadline based.  You are accountable.  Also, if you defy accountability you won’t last long as you will cause the hospice organization to be in violation of CMS rules and may cause the organization to be fined severely.
    Here are practical tips on how to make the transition and embrace “we” messages:

1. Major on relationships.  You will be in many meetings with your IDT.  Get to know each by name and develop enduring relationships with them.  You will be visiting the same patients and may need to negotiate times and days when you will be visiting so you don’t bump into one another on the same day and time.  One responsibility you have is to provide spiritual and emotional support to your team.  You may be asked to officiate at the funeral of an IDT member’s loved one or officiate at an IDT member’s wedding or provide brief pastoral counseling sessions.  The relationships you build can last for the entirety of your hospice career.  Embrace your team and allow the relationships to build along a natural path.
2.  Win over your Team Manager and your nurses.  I am talking about skill in this rule of thumb.  Your Team Manager and nurses need to know that you are informed and skilled at what you do.  They do not expect you to know everything about medical jargon and disease processes, but it helps if you have a basic understanding of the process of dying.  Keep your nurses informed if you notice severe and quick decline in your patients.  They appreciate your phone call.  Be supportive of your nurses.  Complement them.  Encourage them.  One day you might happen upon them cleaning up a bloody death scene when the patient’s aneurism burst and claimed that person’s life while you are bringing comfort to the family.  You might happen upon a nurse whose visit took extra-long as they were cleaning the patient whose bowels let loose or the patient was in need of care after vomiting.   Their work is hard.  They need to know the Chaplain notices and extends appreciation their way.  All that you do in a positive manner finds its way back to the Team Manager.  When you speak in an IDT meeting, be brief, be detailed, and be informed in your comments.
3.  Participate in the IDT meeting.  The IDT meeting is not a time when you catch up on your computer work.  It is a time for focus and contribution.  You will be called upon to give a short spiritual care synopsis.  Make it count.  Remember, in every meeting you are building credibility.  Be prepared to explain how your actions are achieving the Goals/Expected Outcomes of your Spiritual Plan of Care.
4.  Excel with your patients and families.  I won’t be naïve to think that every patient and family caregiver will get along perfectly with you.  There will be those challenging patient and/or family caregivers that will give you heartburn.  Just keep in mind that these people are at the end-of-life, they have lost control over just about everything, and they are just trying to live another day.  With that said, excel in your spiritual care giving.  Always remember, we do not bring an agenda with us.  The patient sets the agenda.  We are there to serve. 
5.  Complete your computer work.  A Chaplain in the healthcare environment is going to do computer work of some kind.  The documentation at Cornerstone Hospice (my hospice) uses Allscripts.  Among all the matters that need to be addressed, the Clinical Note, pain score, decline observation are among the top matters that need to be addressed with clarity and excellence.