Tuesday, September 28, 2004

Back in operation

Well, It's been a long wait, but I got my new laptop. The old man was arthritic and freezing up a little to often. I can begin posting again tomorrow. Thanks for your patience.

Sunday, September 12, 2004

Endings I

This and the next two posts are from a document that I pulled together from a small collection of my assessments of patients. It was interesting to see them together as one document and I thought my readers might find it interesting as well.

Pt. was deeply reflective today, talking almost non-stop through the entire visit. The conversation turned to his most private and precious dreams concerning his belief that he was called to minister. The pt has elaborate dreams of ministry that display a generous spirit and deep need for recognition. There was in this session a sense of bargaining as if he were offering his dreams as something he would carry out if God would give him time. From time to time the pt was teary and wiped his eyes when he spoke of his dreams.

The pt also needed reassurance that his sins were forgiven and God loved him. He may have believed that his disease was punishment but changed his mind thinking, perhaps that it is a mire from which God will raise him to prove to others that miracles can occur if one has faith.


This patient is difficult to assess because of her advanced stage of brain disease. She is an accomplished artist yet she states that she can no longer make art because she “wouldn’t know where to begin anymore.” This tells the chaplain that her greatest skills of deep expression are no longer available to her. When asked questions for spiritual evaluation such as “What do you hope for,” the pt gets lost in thought and fails to reply unless prompted. At the more shallow level of religious training she affirms that she wants to go to heaven but after stating so, she returns to absently picking at specks and lint within her view. Prayer comforted the pt and the chaplain sensed that his presence was comforting as well.
The pt’s Patient Care Giver was responsive to the chaplain as well but as a lapsed Catholic and a nominal church attendee has few religious skills. He was, however, open to the chaplains comments and listened carefully to chaplain’s words. When the chaplain offered him support, he began weeping and excused himself ending the visit.

Thursday, September 09, 2004

Back Seat to Science

Science is eating away at the soul. It seems that with every new discovery there is less and less need for faith in a creator. Biochemistry, DNA and pharmacology explain the mysteries that are built into belief systems. When I announce in team meetings that this or that is happening with a patient, the reaction from the medical staff is that the medication is working, period. They are well trained and adept at using chemistry and skill to heal and the work of God in the patient’s healing is crowded more and more to the corners. I often feel like a second-class member of the team, or the middle child who is always struggling for validation and approval.

This is a problem for people of faith in all religions in our time and it’s a problem for our patients. It seems that the knee jerk response is to throw one baby or the other out with the bathwater. Fundamentalists and conservative Christians pick through science and throw out according to how much it threatens their beliefs. Scientists often throw out religion as superstition or fairy tales. Of course there are degrees of both of those on either side. While the nurses that I work with are practicing Christians, they usually don’t integrate their faith and medical science as well as they could. Perhaps it's because no one has suggested it or, for that matter, the church is so stuck in past eras that its leadership is unaware that there is a need.

It seems safer to maintain a schism between religion and science because nobody is healing the rift between the two. The church is responsible for the split between science and religion and in this day, it is either yielding too much ground to science or denying its place through sentimentalism and irrational thinking. The fear of Darwin’s theory is quite paranoid and irrational just as one example. To attack scientific inquiry as if it were itself an attack on God is ludicrous. It’s as if God were some Greek mythological character that needs protection from his enemies. Such anthropomorphic and thin concepts of God are probably at the base for why some scientists scorn religion in the face of rational thought at the start.

Monday, September 06, 2004

The Peace that Passes all...

Great comments from Sparky and Beppe on the last post. Your words were really encouraging. Thanks.

The social worker called me the Friday before Charlie died. She asked if I would be willing to make a joint visit with she and the RN. “Of course.” I said. "Just let me grab a burger and head out that way.” She wanted us to be there because the RN said that Charlie was in what we call, “terminal agitation.” That means that he was confused and moving around everywhere not being able to rest. The medical people who do “Palliative Care,” know that there are several problems with terminal agitation. One is that it takes some one to watch a patient 24/7 to make sure that they don’t get hurt and usually that person is the patient care giver (the husband, wife, adult child, etc.) In the hospital or nursing home, the patient is usually tied down to prevent injury but with hospice care, families are reluctance to do that. Another problem is that the agitation prevents the patient from dying a quiet, peaceful death. So, the patient is disturbed, the care giver is disturbed and the process becomes painful and suffering is increased.

Charlie was in terminal agitation and he was able to get out of bed so I knew that it must have been pretty wild around the house for he and Beverly. I dreaded it because I’d gotten attached to Charlie and I knew that this was going to be hard for me. I didn’t want to see him in the last stages of his disease. I got there before the rest of the team and Beverly and Charlie’s daughter, Cathy were literally herding Charlie out of the way of harm. He would get into bed, then get up and go to the bathroom but he’d head the wrong way. He had O2, so the tube would get tangled and someone would have to guide him around the obstacles to keep him safe. Then he’d sit in his chair, forgetting that he wanted to go to the bathroom.

Charlie was skin and bones. He was a skeleton and I was sick at heart when I saw him. Finally, after trying to get his attention, Beverly said, “Look, Charlie. Ken’s here, why don’t you go sit with him.” Charlie suddenly saw me and came across the room like a drunken man and I caught him as he nearly fell into my lap. He sat on the sofa next to me and I rubbed his back. God- he was all bones! Charlie sat there for the longest time and I took full advantage of the time by talking quietly to him to try to ease his agitation.

Soon after the social worker arrived, Beverly and Cathy got him to lie down for a while. By the time the RN arrived, Charlie was sound asleep. We gathered in the living room and our team RN explored the options with our support. The family was relieved when they heard what we could do for Charlie. The RN tried to talk to Charlie about it but she couldn’t ‘rouse him. There was so much relief in the home that in time, the social worker and I were able to leave. The RN worked late into the evening getting doctors on the phone and lining up the pharmacy to get her the medicationthat Charlie needed to control the agitation. Charlie died two days later about as peacefully as anybody could with his disease.

Wednesday, September 01, 2004

Harley Davidson Spirituality

After the suicide threat, things started getting a little better for Charlie and Beverly. The Hospice team was able to make them more comfortable – he with the appropriate level of medications and she with coping strategies. The social worker on the team came up with a new blender out of our special funds so that Charlie could begin eating again and he put back on a little weight. I was able to do some gentle spiritual care with Charlie.

It wasn’t easy doing pastoral care with Charlie. He was almost devoid of any spiritual development and what he did have was shattered by the behavior of the church. Charlie’s soul was severely traumatized and there was no spirituality left to help him cope. I was walking on thin ice with him spiritually from day one. If it hadn’t been for my style as a minister, I’d never been invited back after the first visit. Fortunately, the subject of Charlie’s chopper kept coming up. I’d ask him to take me to the shed to start it up and we’d stand there and listen to it run. One day it occurred to me that the closest experience that Charlie had to a genuine spiritual experience was in the saddle of that Harley. I started encouraging him to ride and mentioned it to the rest of the team as well. Our conversations started to center around how it felt to be in the wind and free. It seemed to me that Charlie’s attitude, sense of humor and general coping ability was improving. He was becoming more hopeful even in the face of the horrible death that was just around the corner.
One day when he and Beverly and I were sitting around talking about dying and what eternity meant, Charlie said, “I think I believe in reincarnation.” I was pleasantly surprised because this offering from him was totally opposite of his bitter stated position that when we die-we die just like the other animals. It pleased me because it seemed that Charlie was in the process of pulling the pieces of his fractured soul together and he was spiritually healing. It was bittersweet for me because I knew that we didn’t have much time and I contemplated the possibility of this healing under healthier circumstances and how far it could have gone. I grew attached to Charlie because he’d responded to me and gave me the supreme pay-off for doing Hospice work – ultimate healing even in the face of death. I was elated to see it and his work fed my soul.
Not that Charlie was thinking like me or that he was following my beliefs or theology. None of that matters to a chaplain anyway (or it’s not supposed to). We are not evangelists. God knows there are enough of those around in every shape and form. Evangelism is the easy work. Most have a canned message that takes a salesman’s attitude and the memory of a few simple verses. Evangelists don’t have the burden of nurturing people after they’ve scared the hell out of them and left them with a rudimentary system of faith. They drive to the next “revival” and all but forget about the new converts they’ve left at the altar. Fundamentalist evangelists are particularly annoying because they think that everything revolves around their beliefs. They are usually so ignorant to everything but the subject of salvation that they are able to spread as much damage as they do the “gospel.”
Chaplains work with the doctrine and theology that is given to them by the patient. If the church evangelists and pastors haven’t done their jobs by the time they come into the clinic, there’s very little that can be done except heal the wounds left over from a very dysfunctional church experience. Charlie was no exception. He was deeply wounded from wacky fundamentalist behavior. If I’d had time with him there might have been far more healing.