Monday, August 30, 2004

Spiritual Care and Suicide

Within a couple of weeks of meeting and assessing Charlie, I got a call from triage that he was threatening suicide and Beverly wanted me to come out there. When I arrived, Charlie was sitting in his chair and looking about as ugly - mean as I can imagine he could get. The reality of his prognosis had gotten to him and he was very aware of the horror he was facing. He said that he was just going to walk off into the river. He told me angrily that he never threatened suicide that he was just going to take a walk in the river and never come back. Beverly was in a state of despair and the house was full of tension. I was a little scared myself even though I’m fairly well trained and experienced with suicidal people. I suspected he could be violent and he had a gun cabinet full of weapons. But I heard him out and listened for his ambivalence. When dealing with suicidal people that’s what your looking for. If there is energy pulling the person into self destruction there may also be energy pulling them to life. If there is no ambivalence, it’s an immediate emergency. When I heard where the ambivalence was, I began emphasizing it to build the energy toward life in Charlie. He resisted for some time like a Bass on a hook. I knew my line was a light one and he could break it and run anytime but I gave him slack and reeled then gave him some more.

Finally, the Spirit spoke to me and I confronted him with what I thought would make or break this session. I told him he was acting like a drug addict. When that soaked in, he was angry with me but I told him that he was only thinking of himself and that’s what addicts did. If he had been a well man, he might have hit me at that point but I got his attention. Beverly saw what I was doing and jumped in to help. She agreed with me and Charlie clamped his mouth shut and glared at us. I prayed, God help direct his anger at me and not himself. One thing that I knew about Charlie was that he was proud that he had cleaned himself up without anybodies help but Beverly’s. I’d hoped that calling his attention to that would snatch him out of the river into the boat with us. Finally after a little more time he said through his teeth that he wouldn’t kill himself until he’d said goodbye to some friends and his kids. I grabbed the opportunity and asked him to sign a contract with me to not hurt himself. He signed. I breathed.

Charlie owned one of the most beautiful Harley Davidson choppers I’ve ever laid eyes on. It was featured in one of the motorcycle mags on the front cover. He and I had talked about his bike on the first visit and he’s taken me out to the shed to show it to me. He started it for me and we’d both stood there and let the vibes from that powerful machine sort of massage us. This day, Charlie sat in his chair scowling even after he’d signed the contract and when I got ready to leave, he said, “I know you don’t want what I have. I know you don’t want to go through what I’m going through. You don’t want to be me do you Ken? I was stuck. Then the Spirit spoke to me again and told me that it was Charlie’s sense of humor that would get him through this awful time and I stood up and said, “Your right, Charlie, I don’t want anything you’ve got – except that motorcycle. I want that motorcycle.” He looked up at me and a smile ploughed through his despair and cracked the scow on his face just a little. He took my hand and snarled, “You ain’t getting’ my goddam motorcycle, Ken.” I laughed and when to my car. I prayed that the joke between us was a sign of his innate strength.

Saturday, August 28, 2004

Meet Charlie

Tough day today. I did a funeral for a patient who hooked me. That means that I got involved emotionally because of the way that I identified with him. I know where the hook is and got supervision, processed it all with my peers and got through it OK but it's still a struggle.

It’s not unusual for Hospice Chaplains to be asked to do memorial services and this one certainly came as no surprise. Charlie (I can’t use a patient’s real name) was fiftyish and very much an outsider. He was an escaped felon who was convicted in a southern state for some sort of drug offense about thirty years ago. About twenty-five years ago, he met his wife who informed him that it was either she or the drugs. He chose her, cleaned up his life and set up a construction business in her name. He became successful and landed here in the piedmont of North Carolina. They bought their first home and several acres with river frontage and made a good life. He didn’t tell her a thing about the conviction until he got sick. She didn’t even know all of those years that he was living with an assumed name.

The tragedy came when Charlie was no longer able to work. The business collapsed and there was no safety net because he hadn’t paid social security or income taxes for many years. She did, and of course they filed with the business but Charlie’s name was never used. When I met them they were backed against a wall and this snarling beast of a disease was keeping them pinned. They had no income and no possibility of one. Even Beverly, Charlie’s wife, was unable to work because of her own medical problems. Hospice had no hope of reimbursement from Medicaid either but we did what we usually do and cared for them anyway.

I was referred to the patient by the social worker who saw existential problems and asked me to see him. I did, but Charlie was quite cynical about religion and had been hurt by the church many times. Fortunately, Charlie identified with me early in my first visit because my hair was as long as his. I determined in my spiritual assessment that Charlie had no developed spirituality and his soul seemed traumatized and shattered. I knew that if Charlie was to be comforted existentially, he and I would need to pull at least a couple of the shards of his soul into proximity to one another. I decided to see him once a week.

Wednesday, August 25, 2004


I just discovered blogger. What a great idea! I'm due to go see some patients right now but I'll make an entry tonight.