Theory & Practice
The following entries are a “journal” of one chaplain’s experiences during the first wave of COVID-19 infections in her workplace. These entries were curated to exemplify the connection between CPE outcomes and certified chaplain competencies. Our hope in sharing these with those interested in professional chaplaincy, is that these entries will show the “practice of theory” in relation to spiritual care.
This work is owned by the author and may not be reproduced without explicit written authorization. We extend our thanks to Rev. Sarah Knoll Sweeney for her incredible work as a chaplain, educator, and contributor to the mission of professional chaplaincy.
March 16 A Word for Spiritual Caregivers:
The Less-Anxious Presence*
Remember family systems theory? Rabbi Ed Friedman wrote in Generation to Generation that a well-differentiated leader:
"is someone who can separate while still remaining connected, and therefore can maintain a modifying, non-anxious, and sometimes challenging presence... is someone who can manage his or her own reactivity to the automatic reactivity of others."
My own forming educator was fond of challenging Friedman’s concept of the non-anxious presence. She would say, “The only truly non-anxious presence is a dead person. However, we CAN be a LESS-anxious presence.”
Right now, you are seeing some people in full panic mode, and some in a numbed dismissal of the impact of this virus, and lots of folks in-between. Neither extremes are the posture of a competent chaplain. Instead, an effective chaplain is a presence who makes space for a range of feelings in others, while maintaining a sense of her own groundedness. Only in this way can we offer a sense of calm to others.
Today, watch for the less-anxious presences around you. Who is offering calm without being numb and dismissive? See if you can emulate this posture in your work of spiritual and emotional support today.
Again, thank you for your work; if you can’t see it clearly, hear us tell you: You are making an important difference in the lives of people.
*ACPE Outcome 2.6: demonstrate competent use of self in ministry and administrative function which includes: emotional availability, cultural humility, appropriate self- disclosure, positive use of power and authority, a non-anxious and non- judgmental presence, and clear and responsible boundaries.
March 17 Chaplaincy during Corona: Tuesday
Compassion is a Renewable Resource:
Outcomes 1.7, 2.3, Competency PPS2
Dear Chaplains,
Our vocation has always included showing up to the places of deepest suffering. Unlike our interdisciplinary colleagues who come bearing thermometers, administering medication, or interpreting test results, spiritual care practitioners’ primary instrument is ourselves. This is why we talk so much about use of self in CPE.
Often we think first of empathy in the way we use ourselves as chaplains. We commit to sit with another in their suffering, to feel with them. We strive to put ourselves in the shoes of another, just for a moment, and to see the world the way they see it. In times of heightened and collective crisis, I wonder about the limits of empathy. Trying on others’ shoes all day long will leave our feet sore, squished, unprotected, and drains more of our energy than we may have for the weeks ahead. And, it turns out, the shoes we most like to try on are the ones that are closest to ours in length, width, and style. It’s easiest to get inside the perspective of another if that perspective is most like ours.*
Compassion is different. Taking a beat to send our loving-kindness to those we serve is a renewable resource, and moves us to caring action rather than burnout.** Between visits today, while you are washing your poor little dried-out germ-free hands for twenty more seconds, visualize the careseeker you just encountered. In silence, send them loving-kindness. Then, send it to the next person who will encounter them — their tech, their nurse, their one single visitor for the day. As the soap goes between your fingers, your thumbs, and under your nails, send that same love out to the person whose shoes you least want to try on right now. As you rinse off your blessed hands, send one more push of kindness to that difficult, irksome person. Be sure to notice where your own feet are when you shut off the water. Breathe out the kindness that arose from within you.
You are an amazing person to sign up to do this work every day. You are a precious renewable resource when you take loving care of yourself. Today, my loving-kindness goes to each of you students. As you make your visits, know that you are the destination of the faculty’s compassion.
ACPE Outcome 1.7: Initiate helping relationships across diverse populations.
APC Competency PPS2: Provide effective spiritual support that contributes to the well-being of care recipients, their loved ones, and staff.
(link to * and ** in comments)
* https://www.researchgate.net/publication/265909916_Empathy_and_Compassion
** http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.210.5348&rep=rep1&type=pdf&fbclid=IwAR1A7dZp82EMrPJzMY7VIb8h3i8UkBz6XnsUaNNj_N7NZWciGJIn3T2qW9s
March 18 A Belief and A Practice: Our Whys
Outcomes 1.1, 2.1, Competencies ITP1
Dear Spiritual Caregivers,
In my first year as a healthcare chaplain, I worked the ER as we received a small child who had died in their sleep. It was a horrific night in every way, one that stayed with me forever. One of this trauma’s aftershocks is that I still sometimes get up in the night to check if my own child, now 12, is still breathing. That night is one of many that made me the chaplain I am.
In the wake of the event, I asked myself WHY I would continue to get up every day and go to the same ER, and a new ER after that, and another. For me, this became a regular self-check: What is a central belief and a central practice that fuels my ongoing desire to show up at these places of suffering and transformation, of life’s most holy beginnings and endings. It was one way that I could stay grounded in my work.
As spiritual caregivers, we approach the secular trend to “find our why”* in the beliefs and practices of our respective traditions and philosophies. In the tough decisions I am helping make as leader right now, my why looks like this: I believe we are interdependent, and I pray in a daily rhythm. In my tradition, the Daily Office keeps me mindful of the dawn, midpoint, eve, and end of each day. I hold in prayer all those from whom I come, and those who have been entrusted to me as a parent, a friend, and an educator. Our interdependence has never been clearer to me than it is now, in both alarming and comforting ways.
What is your why? Find one belief and one practice that keeps your feet on the path right now. Be sure it is simple enough to fit on a post-it where you can see it. Find a way to practice something for five minutes before you head into the next encounter. Practice shapes belief. Both become your fuel.
Your showing up makes the difference to the patient who has no visitors, to the nurse who doesn’t know if anyone sees how hard they are working. Your witness is a light shining in the darkness. As the sun starts its rising on another day, I am giving thanks that we are connected, and sending you strength.
APC Competency ITP1: Articulate an approach to spiritual care, rooted in one’s faith/spiritual tradition that is integrated with a theory of professional practice.
* https://www.sloww.co/find-your-why-simon-sinek/?fbclid=IwAR0uLX0BH-SLpIUtoAxDsmxlhdmyogOkkhPaypsPou2fEFDT490nKXA-YAo
March 19 The Toxicity of Reassuring Distress
ACPE Outcomes 1.6, 2.9, APC Competencies PIC4, PIC5
I haven’t talked with a single person who is not in some form of distress. Yesterday alone: One is in physical distress, wondering: Are my symptoms THE virus, or just a coincidental ailment? Another is in moral distress, wondering: Whose protection matters most now—mine and my family’s, or the persons I serve at work? Another is in spiritual distress, lamenting the daily growing death toll and no end in sight.
In your current distress, whatever it looks and sounds like, which helps more: someone who says, “Don’t worry, it’ll be over soon,” or someone who listens intently, capturing and reflecting that they actually heard you, and doesn't try to put a lid on it, dismiss it, or minimize it?
As a spiritual caregiver this day, you are a witness to all these and many more forms of distress. You have no power to take away physical illness, to solve moral dilemma, or to spin lament into joy. When you go from room to room, you may be the only one who can focus long enough and well enough to actually capture and reflect distress. You may be the only human mirror someone sees all day.
James Dittes wrote* that in our work, we renounce many of the usual ways we were socialized to converse. As chaplains, we don’t fear and fill silences, because we know that important internal work happens when there is a minute to think in the calm presence of another. In a spiritual encounter, we don’t jump to gathering facts and trying to fix, because we were not sent to the room for our power to treat illness. And for me, the million-dollar renunciation in a day like ours is that we don’t reassure distress. If we say, “Oh! I’m sure you don’t have it, you’ll see,” or “Calm down, you’re all worked up over nothing,” we tell the person, your distress is wrong. Your distress is invalid. Your distress isn’t worth hearing. That’s a toxic message in any encounter, but right now, we all have to let our distress be real and keep going anyway.
If you want to be allowed to have the distress you feel right now, please, for the love of ____, let the patient have theirs. Let the nurse have his. Let the doc, who doesn’t know you saw her shoulders slump in the hallway, have hers. Don’t reassure it or invalidate it. Reflect it: “You’re at your wits' end.” “This doesn’t feel right to you.” “You need some relief.” See how you’re not even in that sentence? In not insisting on solving it, you have held an actual moment of space for the other person. Right now, this kind of encounter is priceless. That kind of moment is gold.
When your shift is over today, find someone who can do this for you.
PIC5: Use one’s professional authority as a spiritual care provider appropriately.
* https://www.amazon.com/Pastoral-Counseling-Basics-James-Dittes/dp/0664257380?fbclid=IwAR2cymlkpEdQC0KPgq412Xx9868G_hbtT6-YdtdgvjFJlm_fnta4uOmax34
March 20 Our World of Exceptions
Outcomes 1.1, 2.4, Competencies PPS4, PPS6
Several of my Christian colleagues found out yesterday that they won’t have in-person Holy Week or Easter services. Some are charting new minyan territory. Others are scrambling to safely bury their dead. Many spiritual leaders are seeing this virus consume any semblance of our normal rhythms. I have been privy to so many conversations this week about what is permissible and what is legitimate when it comes to our most sacred rituals.
As chaplains, this is old news to us. We’ve always made our home in the world of exceptions to the rule. I’ve witnessed more Vidui among gathered families than I have presided over Easter Eucharists. I’ve had more Easters inside hospital rooms than I have surrounded by white lilies and incense. I know how to sit with a Catholic patient who needs to unburden and not call it the rite of reconciliation. I’ve said Ministration at the Time of Death more than I have baptized babies.
You know how to bless the hands of a nurse who aches to see her kids right now; you know that the holy water across her palms keeps her going. The words you say are nowhere in your tradition’s central ritual manual, but you know its power because you’ve seen it again and again.
More than ever, those we serve will be looking for a sign. On your units, you are the ritual expert. You are the walking symbol of sacred. Patients and staff will need to hear something holy; they will want something that feels like home. Not YOUR home—theirs. How well can you gather what they long to hear? How spiritually agile can you be when things are changing, minute to minute? Y’all, we’re the champs at this.
My prayers are with you as you go out, show up, and preside over our world of exceptions. You are needed more than ever if you can truly listen and hear.
PPS6: Provide religious/spiritual resources appropriate to the care recipients, families, and staff.
2.4 assess the strengths and needs of those served, grounded in theology and using an understanding of the behavioral sciences.
https://www.bcponline.org/PastoralOffices/death.html https://cebudailynews.inquirer.net/.../patient-no-40-to... https://www.jta.org/.../conservative-movement-leaders-say...
March 21 Mine and Theirs: Ambiguous Loss Edition
Outcomes 1.2, 2.1 Competency PPS5
"You can only accompany someone where you yourself have been willing to go."
My students grow weary of my mantra after awhile. I am constantly connecting the way they’ve related to themselves and the way they care for others. I call BS on that popular false humility: "I’m so nice to everyone else but I’m so hard on myself.” We treat others *exactly* how we treat ourselves. Ever had a boss that encouraged you to take time off but never did themselves? It gives you that sneaking feeling they resent you when you’re gone. Ever had someone preach grace to you when you knew they were harboring a grudge? In your role as chaplain, when you sit down (6 feet away, or via phone) to really listen to another person, you will only invite them to go as far as you’ve gone within yourself.
It’s time for a loss and grief check. We are surrounded by loss right now. Illness and death, of course, but look closer: physical separation from beloveds, financial insecurity, loss of control and certainty. Remember the six types of loss**? Take 10 minutes and make yourself a list.
Right now, there’s an added layer to the losses surrounding us: we don’t know the end-game. For the physician who has started sleeping separately from their partner, how long will that go on? The musician has no idea when the next gig is. How many online lessons should the teacher prepare? Ambiguous loss* creates complex grieving; you may notice yourself avoiding even acknowledging some of your losses right now because what’s the point? You don’t even know where all this is headed. It feels extra grim to name an ambiguous loss because it might get worse than it is right now.
Watch that closely, though, because the danger of *not* naming it is greater. If you numb it in yourself, your care will ring numb as well. Instead, if you make yourself a tiny margin to name your loss, you also make a little space for grieving it. If you don’t, you’ll surely pass that avoidance onto the staff you are serving. When the tech moans, “I couldn’t get extra TP! The store opens during my shift now,” can you make a little space for how much that sucks for her?
Cut yourself a break today on the big and little things you miss. Ask yourself, when it comes to loss, what’s mine right now? If you do, it’ll widen your capacity for theirs.
You know how it feels when someone’s care rings hollow, when the words are there but you can tell they don’t mean it. Don’t be that guy.
PPS5: Provide spiritual care to persons experiencing loss and grief.
https://www.google.com/books/edition/All_Our_Losses_All_Our_Griefs/oElLmY9KMxkC?hl=en&gbpv=1&dq=six+types+of+loss+mitchell&pg=PA35&printsec=frontcover#v=onepage&q=six%20types%20of%20loss%20mitchell&f=false
March 22 Full Tilt Clinical Method of Learning
Outcome 1.8
I shared with two colleague groups this week that I’ve always loved being a chaplain among chaplains because we are the people who can show up to any situation and be like, "No problem, we got this, we can make this work.” All my life in circles with religious types, I can sense the chaplain-types: alert, responsive, creative, resilient.
As a teacher of chaplains, I’m looking to catalyze those qualities within my students, so they show up to who-knows-what trusting their ability to assess, intervene, and observe the outcome. That way, they go into the next encounter with a plan to do that even better. They learn to self-reflect, get honest feedback, and head right back in again. In CPE, we call it the clinical method of learning. We revere the cycle of action—> reflection —> new action. Chaplains have always privileged learning from experience as well as theory. Many of us signed on because we saw Experience as a teacher informing our tradition.
In comparing notes with so many of you this week, this learning-from-experience thing is at full tilt. Almost on the hour, new policies reach to reflect new realities; it feels like by the time we figure out how to handle one part of this, something changes and we are pivoting again. We figured out how to get creative with PPE; we’re sharing resources live as we develop and test them. Another thing I love about y’all is that you have no interest in reinventing the wheel. We know how to put our heads together on the fly.
That’s our jam, so for awhile I noticed some us were all: “We were made for a time such as this!” Now, though, it’s also starting to wear some of us out. Lest we forget, Fatigue is another Experience teaching you. What will you learn from it?
I admire the collective spirit in us right now, and I want that flame to stay lit and burn long. So keep pivoting, and be sure to bench yourself often enough you can stay in the game.*
ACPE Outcome 1.8: use the clinical methods of learning to achieve one’s educational goals.
*Yes, no March Madness is killing me slowly.
March 23 Many Faces Suffer, Many Faces of Suffering
Outcomes 1.7, 2.2, 2.6 Competencies PPS3
It was over two weeks ago when I saw it: I was on the elevator with a young Asian woman and her elder, both wearing face masks. We traveled several floors down together, stopping more than once to let on new passengers. When the doors opened, people started to step on, saw the women and their masks, and stepped quickly back out. This was before we had any confirmed cases in our state (now in the hundreds). In the Times this morning, our Asian siblings are describing being spit on and yelled at, from coast to coast.
When stress runs high, our embedded theology rises to the surface. The oldest messages we received tend to run the deepest, and are least in check in crisis times. What were you taught, unofficially of course, about how the world works? Some of us were taught that for every bad thing that happened, someone should take the responsibility and blame. Some of our elders modeled staying quiet, keeping to ourselves, when the outside world grew scary. When they thought no one was looking, our elders sometimes leaked out a worldview that we have spent our adult lives revising.
Anytime someone draws meaning from their experience, we are in spiritual territory, and that’s your turf. Keep your eyes and ears open for these elevator moments, remembering that suffering has many faces right now. It has the face of a patient who finally gets word that they tested positive for COVID-19. It also has the face of a woman who already worried she wouldn’t get the same level of care as her white neighbor, because disparities in healthcare are real and documented. As much as we see this virus as universal, we who have attended to collective suffering know that some groups will suffer more than others.
As chaplains, you may be the only one who says to a person, "I saw that," "I heard that.” You may be the only one who notices that those loaded comments and actions cause suffering invisible to many others. What will you have the eyes to see and the ears to hear today?
2.2 provide pastoral ministry with diverse people, taking into consideration multiple elements of cultural and ethnic differences, social conditions, systems, justice and applied clinical ethics issues without imposing one’s own perspectives.
PPS3: Provide spiritual care that respects diversity and differences including, but not limited to culture, gender, sexual orientation and spiritual/religious practices.
March 24 You’re Always Having an Impact: What Kind?
Outcomes 1.5, 2.3 Competencies ITP5, PPS9
When we are in crisis and surrounded by this level of crisis, it’s easy to lose track of where we still have agency. For those of us in healthcare, things are changing so rapidly we may feel helpless to take any meaningful action. And yet, we are not reduced to passivity. Good old family systems theory reminds us we can each be a healthy influence on the system when we self-supervise. Here’s some simple takeaways for today:
Hey, Look! Here Comes Your Role in Your Family of Origin
When we’re under pressure, our oldest roles try to take over because in our lizard brains, we still believe these will get us through (for better or worse, they did!). Those with whom you’re working closely are wrestling their own. Watch out yours is not allowed to go unchecked. Ask a trusted colleague to help you watch for it.
Let Go of Expectations of Others
At any time really, but especially at a time like this, trying to get those around you to think or act more like you is pure futility. People are going to be deeply entrenched in their favorite ways of coping right now. Recognize that this is a time for utilizing and highlighting others go-to gifts, not asking them to eliminate their limitations.
Lower Reactivity
Being a spiritual caregiver means adapting to rapid change even in the most normal of circumstances. Notice any less patience with the internet speed? Feel extra short with that person who already irked you? You know what keeps you grounded right now; it’s up to you to crank the dial on whatever that is. It’s not easy, especially for those of you who come to the end of a long day of decision-making in response to your leaders, only to find circumstances have changed and you’re going to need a new plan in 8 hours. Whatever takes you from reactive to responsive, do that.
Develop More Objectivity
If you could crawl up to the ceiling of the emergency room right now, what would you see? Just for a minute, inch your way out of the five pressing problems that need immediate solutions and get some perspective. What is reasonable to get from today to tomorrow?
Self-Focus
In the end, you have agency with your actions right now. When we’re feeling out of control, remembering that we can self-supervise our responses to the next big thing reunites us with the truth: we can have a healthy impact on our system right now, or we can raise its anxiety and drag it down. How will you manage what arises within you today, so that you might serve others to the best of your ability?
ACPE Outcome 1.5 recognize relational dynamics within group contexts.
Outcome 2.9 demonstrate self-supervision through realistic self-evaluation of pastoral functioning.
March 25 What the Judge Said: The Importance of Spiritual Care
Outcomes 1.7, 2.1 Competency ITP1
Yesterday morning was our city’s turn for “Stay Home / Work Safe” — a version of shelter-in-place that apparently doesn’t put post-Hurricane Harvey Houstonians into the wrong kind of panic. Judge Hidalgo gave her press conference and answered the usual questions, questions we chaplains have voiced around the world: who and what is considered essential?
And then Judge Hidalgo said* the most striking thing — she said that our city would make an exception for ministers, because they need to see their people. She said ministers need to move freely in the city for mental and spiritual health purposes.
We who are chaplains don’t need our Mayor or our County Judge to legitimize us — we know our worth because we see the value of what we do every day. But the truth is, I’ve never heard a local elected official, at a time of unprecedented crisis, take the time to emphasize the importance of spiritual care. It took my breath for a minute.
A lot of the care you’re providing is outside the news ticker: you have remembered that people who were already lonely are even more isolated. Those who were already sick are still sick, likely with added doses of uncertainty. You are showing up to stand in the gap of family and chosen family who can no longer get into the building to visit their loved ones. You are, more than ever, the intimate stranger*.
Some institutions have deemed their chaplains non-essential, others essential. The truth is, not everyone is like Judge Hidalgo; there is no universal agreement on how vital you are. Take a minute today to picture someone seeing “Chaplain” on your badge in the elevator and asking, "What are you doing here? Why are you essential?” With Judge Hidalgo and me and countless others at your back, what would you say?
ITP1: Articulate an approach to spiritual care, rooted in one’s faith/spiritual tradition that is integrated with a theory of professional practice.
March 26 Dying (Not Very) Well: Corona Deathbeds
Outcome 2.2, Competency OL4
Many of us who are called to deathbeds — spiritual caregivers, chaplains, religious leader types — have ideas about "dying well." Ira Byock’s book** and the hospice movement laid a foundation for us. This notion that we can facilitate "the good death” has formed many of us in our approach to blessing, praying, and anointing our people as they lay dying. Some of us see end-of-life care as our most vital function, and it turns out most healthcare staff see us that way, too.***
In just September of last year, Byock wrote* “When people are competently cared for, many can feel a sense of peace — well within themselves and with others — as they leave this life. Preserving this opportunity is the fullest expression of community. Depriving people of the opportunity to die well seems the final social injustice.”
As more of us around the country move to Zero Visitor policies for our COVID-19+ patients, we are scrambling for the good death, working to prevent Byock’s final social injustice. We pull beloveds up on ipads for the dying to see. We call them from the other side of the glass to offer their comforting words. As chaplains always have, we make do with what we have, advocating for the sanctification of an otherwise horrifically clinical moment. We hold up the staff as they move on to the next bed. We have learned to communicate with our eyes; the rest is behind a mask.
The idea of dying well is under immense challenge, and I suspect we will have much to say about it in the months to come. For now, thank you for continuing to show up as creatively and safely as you can to mark what is holy. My prayers continue with you.
APC Competency OL4: Promote, facilitate, and support ethical decision-making in one’s workplace.
https://irabyock.org/.../Byock-Wellbeing-in-dying...
https://www.amazon.com/Dying-Well-Peace.../dp/1573226572
https://www.amazon.com/Paging.../dp/B00AOJ9IKK/ref=sr_1_2...
March 27 Birth in the Time of Corona: Chaplains as Midwives
Outcomes 1.7, 2.3 Competency PIC5
I can’t stop thinking of the babies who will be born during this pandemic. Parents are still gestating and laboring, of course, and right now, many are dreading going to the hospital. I can feel their fear of bringing new, vulnerable life into the world at this moment. Today, I read that the CDC recommends* all infants born to infected parents be separated immediately. I couldn’t take it—this latest recommendation for distancing. I wept.
Chaplains have long been compared to midwives** for good reason. We accompany; we facilitate. We don’t push the babies out, and we don’t extract them. We witness and we encourage. We carry wisdom but we don’t lord it over our careseekers. We hold it for when it is needed. We hold the room safely so that vulnerable, incredible transformations can happen, not by the skill of our hands but by the wisdom of our solidarity.
Like midwives, we chaplains are essential not because of the degree we hold or the vaccines we develop. A patient is less likely to survive due to our interventions than most members of the team. But anyone who has had a midwife will tell you: there is *nothing* extraneous about what she does. She empowers you to give birth because you realize it was up to you all along. As chaplains, where and when permitted, we empower patients and staff to do what they need to do.
You may increasingly feel your hands are tied. You may feel constricted in where you can go and what you can do, and because we are embodied practitioners, the phone and the ipad may feel like poor substitutes for hands grasped for prayer or the kneeling at a bedside. Remember: your solidarity is your skill. You will continue to witness transformations despite your distance. Babies are still being born all around us. What new life will you see today?
PIC5: Use one’s professional authority as a spiritual care provider appropriately
https://kutv.com/.../cdc-moms-should-be-separated-from...
March 29 One Size Rarely Fits All
Outcome 2.4, Competency PIC4
Over the weekend it has become more personal for many of us. We know someone who is infected or who has died.
Day by day our institutions make quicker and more substantial decisions; we use our voices in those huddles however we can.
Those of us comparing notes across institutions have found we can feel in lockstep one minute and worlds apart the next. In our particular shop, it feels so much has changed since the beginning of this week: visitor policies, priorities of care, dress code.
Those of us keeping social distance outside of work hold varied interpretations of CDC guidelines or how rigidly we should heed them.
In a crisis, one size rarely fits all. Each nursing unit has to flex according to its particular needs; each household has to set the boundaries that work for them. I’ve started to turn to colleagues and friends less for a universal agreement and more to hold each other up in our particular circumstances.
As spiritual caregivers, our best assessments look closely at particular needs and resources. The nurse in the COVID-19 unit might need you to show up in a very different way today than he did yesterday, because his patient has declined significantly. The family member that dismissed your phone visit on Friday has spent a weekend in separation and may need you to follow-up more than ever.
Today, let us renew our strength and our attention to the unique and particular needs of those we serve. Don’t forget to check in on yourself as well; it’s likely yours have shifted too.
Ongoing thanks for all you are doing; my daily prayers for you continue in earnest.
PIC4: Function in a manner that respects the physical, emotional, cultural, and spiritual boundaries of others.
March 30 The Shame Contagion
Outcomes 1.1, 1.2, 2.1 Competency ITP2
However you are rationing your news and social media intake, you contend with strong opinions about what you should and should not be doing right now.
It’s in-person, too: just this weekend, standing outside in a socially-distanced group of 7, I was approached by a stranger and told what I was doing was “illegal.”
You might feel shame that you didn’t start social distancing sooner, that you kept going into work when you didn’t need to. On the other hand, you may have been shamed for taking early precautions. Opportunities to feel bad about yourself right now are legion, and contradictory sentiments are in circulation: positive tests mean you were reckless, and negative results mean you wasted a test for someone who really needed it.
Shame is not only distressed consciousness of wrong-doing, it’s accompanied by feeling unworthy of belonging.* Psychologically, an abundance of shame keeps us quiet and it keeps us isolated. And in that emotional petri dish, it grows and spreads. This pandemic is breeding both virus and shame, and as spiritual caregivers, we are called to vigilance for the shame contagion. When we hear the patient or their beloveds speak shame about their contraction, we can hear them out and make it safe to disclose their wrestling with us. When we catch ourselves and our IDTeammates whispering judgment over folks who didn’t follow guidelines, we can interrupt our blame spiral and return to the refrain I have heard ringing across our institutions: we’re all in this together.
Take care that in your responsible caution you don’t get entangled in shame yourself, either for doing too much or too little. Redirect that awareness to the space-holding work of the chaplain. Remember: exposing shame to the fresh air and light of day is its remedy. Allow it to be spoken in your careseekers without trying to dismiss it or resolve it. Like the rest of their feelings, they need an ear who can really hear.
ITP2: Incorporate a working knowledge of psychological and sociological disciplines and religious beliefs and practices in the provision of spiritual care.
* Theologically, I challenge the idea that shame is wholly destructive, but that’s for another day.
March 31 Scrubs are the New Gowns: Staff as Primary Careseekers
ACPE Outcomes 1.7, 2.7 Competencies PPS2, PPS4
Most chaplains have seen a substantial shift in day-to-day focus. We have always cared for staff alongisde our patients, families, and visitors. Now, with our halls emptied of all but patients and staff, with contact precautions putting a virtual end to cold-call patient rounding, and with the pandemic stressing our systems to a lifetime high, our care of staff is more critical than ever.
But the reality is, there isn’t time or space for a lot of long heart-to-hearts right now. You’ll have to be quick, clever, and creative.
After reviewing the literature from 1981 and 2004, Brown-Haithco wrote* in 2012 that staff needs and struggles were much the same. In 2020, in the midst of this pandemic, her list is still right-on in caring for nurses, techs, physicians, administrators, and others still reporting in. In supporting your staff today, watch for these things:
Moral Distress: when our jobs take us against our own ethics, morals, and integrity.
Compassion Fatigue: when the overwhelm of the job burns us out of the original energy of our calling.
High Patient Volume and Acuity / Staff Shortage: speeding up licensure processes to get retired healthcare workers on the floor means we are gathering all the staff we can for the surge in our midst or on our horizon. This novel coronavirus has us catching up to an unfamiliar disease process at unprecedented rates, not to mention that folks are still falling ill and dying for all the usual reasons, just as they were before.
Lack of Appreciation and Affirmation: planned applause**, bells ringing out***, food delivery****, and other gestures are all ways I’ve seen folks showing love to our IDTs.
Organizational Change: bringing on retired staff to formerly cohesive teams, redistributions of staff in a labor pool, new policies each day, rapidly adjusting care protocols, and the backdrop of unprecedented cultural and economic upheaval — I’ve said it before: we’re always ready for change in healthcare, but this has us at our limits. Try to offer simple solidarity on the way constant change means never finding a routine, loss of sense of control and certainty, simple things being more challenging. Surely, you can relate!
What are you finding your staff teams need more than ever? How might you share that with your colleagues so that we can all rise more skillfully to this occasion?
Outcome 2.7: establish collaboration and dialogue with peers, authorities and other professionals.
https://www.amazon.com/Professional.../dp/1683362446
https://www.eater.com/.../restaurants-donate-meals-to...
https://www.wdbj7.com/.../Local-churches-ring-their-bells...
https://www.aljazeera.com/.../coronavirus-worldwide...
April 1 Do You Remember That You Have a Booty? And Other Important Questions
Outcomes 1.2, 2.1 Competency PIC3
I’ve always been hopeless at the embodiment stuff. When someone asks, “Where do you feel your stress in your body?” I usually want to say, “In the rolling of my eyes.” For most of my life, I treated my body like a machine: basic maintenance, take it to a pro when it breaks, and keep it moving. Recently, I realized a relationship between chronic stomach pain and unnecessary hurrying. Begrudgingly, I acknowledged personally what I have long known and taught professionally — our bodies keep the score.
Telling my close friend and her 7-year-old daughter about this, we came up with a plan. Rather than the sterile question,"How is your body right now?”, we decided to ask, "Do you remember that you have a booty?" This question made me smile instead of roll my eyes. It worked. I would suddenly remember I had a body again, and it would change my day for the better.
Bodies mostly feel dangerous right now. We are intensely aware of our physical vulnerability to this virus, but we also are working in uncomfortable new positions, straining our bodies with longer and different shifts, stuck at home against our will, or bent over our kids’ laptops where they are “going to school.” We are stiff with vigilance and anxiety. Some of us are eating less or more, moving less or more. We may be paying closer attention — “was that sneeze the VIRUS?” — or we may be dissociating from our bodies because our trauma histories are right. under. the surface.
Hospice chaplain Kerry Egan wrote:
There are many regrets and many unfulfilled wishes that patients have shared with me in the months or weeks before they die. But the time wasted spent on hating their bodies, ashamed, abusing it or letting it be abused—the years, decades, or, in some cases, whole lives that people spent not appreciating their body until they were so close to leaving it—are some of the saddest.
Today, can you remember that you have a booty? If you can, you are better equipped to help your staff remember, too. Finally, for those attending to the dying right now, via phone and tablet and through glass, how can you honor these precious bodies at their final moment? How can you keep watch over the age-old, sobering, sacred reality that someone is about to separate from their body, the only home they’ve ever known?
PIC3: Attend to one’s own physical, emotional, and spiritual well-being.
April 2 This is Your Brain. This is Your Brain on Emergency: Any Questions?
Outcomes 1.2, 2.1 Competency PIC1
You know the basics: limbic systems, amygdala, fight-flight-freeze. You may already know that first responders have override functions; by repetition, they’ve learned to push past fight-flight-freeze in the same kinds of crises over and over. During our training, we chaplains worried that we were becoming calloused to suffering and death, until we realized that being ready and capable was not the same as being calloused. We shifted from judging nurses’ gallows humor to joining them (out of patient earshot) because we realized this was part of how we were going to get through, too. Things that used to feel like an emergency when we first started became routine.
But dig this: "An emergency is a novel situation, not something we deal with on a regular basis. Therefore, we don’t have a 'mental script' on how to handle it.” We’re dealing with a novel virus, and that means, to various extents for each of us, this is a novel emergency. It doesn’t quite compare with past crises, the ones we built scripts around. I noticed this here in Houston, when I joked that Houstonians know only one kind of crisis — hurricane. Stockpiling water as though the virus threatened our water supply, even a run on some of the lumber used to board your house before a storm hits! For New Yorkers, comparisons to September 11th abound. You’ve read articles quoting folks describing ERs as a war zone. We’re coming up with the best similes we can. But none of them quite fit. So, as with other trauma, our brains keep whirring in the background, cycling through fight —> flight —> freeze, again and again.
When you listen to the staff you are trying to support, you’ll notice them compare this to the past crises they can remember. I noticed my kid bringing up past childhood injuries. Around a socially-distanced meal, I noticed adults telling younger folks about times of scarcity and fear in past generations. How can you hold space for what our people's brains are working hard to contain?
It’s no wonder you’re tired; your brain is trying to help you find the right frame for this. We are all making a new frame right now, in addition to whatever our bodies are doing. Grab some rest when you can; you’ll need your brain for what’s ahead.
ACPE Outcome 1.2: Identify and discuss major life events, relationships, social location, cultural contexts, and social realities that impact personal identity as expressed in pastoral functioning.
April 3 Dignity Inshallah
Outcomes 1.7, 2.2 Competencies PIC4, PIC6, PPS3
I fear we may be tempted to neutralize our differences at a time like this. During a crisis, an insidious sentiment can circulate: “we’re all just human in the end.” We are all human, of course, but this move to neutralize important differences, for example, at the end of life, can venture into implying that religious and cultural differences don’t actually matter. The truth is, what you think of as end-of-life dignity may be very, very different from the person to your left or right.
Chaplain Khurram at Stonybrook Hospital in New York was asked by hospital staff how best to care for Muslim patients who will die in isolation, surrounded by non-Muslims. In the comments, please see the attached resource as a guide. This is our reality, on a grand scale, for some time ahead. In my health system's onboarding education, chaplains are identified as a main source of information and guidance in navigating cultural and religious differences in patient care.
Those of us from dominant cultural backgrounds and religious traditions have a special responsibility to advocate for those in minority traditions and cultures. In a crisis this massive, some may move to minimize the needs of minorities. Our role is to keep them in the front of our mind. It is our Common Code of Ethics. It is all over our learning Outcomes and our Core Competencies.
Today and in the days ahead, may we be mindful of the dignity of every human body, in its uniqueness. At a time such as this, it may fall to us to advocate for the nuances of this dignity.
312.2 provide pastoral ministry with diverse people, taking into consideration multiple elements of cultural and ethnic differences, social conditions, systems, justice and applied clinical ethics issues without imposing one’s own perspectives.
April 5 Risk Vectors and Ghosters: The Chaplains of COVID-19
All my friends have forwarded me the New York Times opinion piece, "The Men and Women Who Run Toward the Dying.” How about you?
In our shops, you have been told you are essential, and you’ve been given the freedom to attend to your units’/hospital’s unique circumstances. You’ve been told the staff need you desperately, and that you, in turn, must rely on the staff to tell you which rooms to enter. If you’re on duty, you respond to the multi-patient task list, just like always, only now, you have to strategize how to connect with that patient across contact precautions or potential contact precautions. In some ways things have been radically simplified, because it is staff. and. patients. Even though we are in unprecedentedly busy and chaotic times, the unit halls in our two locations can have a dissonant, eery silence.
Not all chaplains have been given the freedom you have. Across the country, some were mandated to stay home weeks ago. Some have been told to only communicate with patients via ipad or phone. You are told to show up, consider yours and others’ safety, and be the chaplain you were called to be. That level of discretion is a window into your staff chaplain future. Soon, it may very well be you who decides what is safest and what is best for the people you serve and serve alongside. For this and many other reasons, being a CPE student means you are learning to be a chaplain at an historic time. The truth is you are crash-coursing disaster chaplaincy; this is OTJ training most CPE students never get.
But I want to make space for another truth: this freedom can also be deeply unsettling, perhaps particularly as a student. Even onsite, you face choice after choice: "How closely should I approach the nurse I really want to check in on?" "Is it more connective to call the patient than to shout a prayer at them from 6 feet away?” On the one hand, you know you are a risk vector: you know that 1 in 4 are asymptomatic carriers, that you are asymptomatic and interacting with many patients and staff daily. You do your part by increasing precautions for your cohabitants and fellow resident office-mates. Likely you have loved being needed and central to this action — many of us got here via some fun version of that song. But on the other hand, you may feel like a ghoster: chaplaincy is embodied work. We don’t just talk about ministry of presence, we live it every day. If you are not physically visible to the patient, or seem like you’re stand-offish to the staff, if you’re absent in any interpretation of that word, have you failed?
There’s no one answer to the Risk Vector vs. Ghoster dilemma. The faculty and your staff coaches have your back as you deftly navigate work ethics right now, and we are navigating with you. I disclosed to you my deep guilt for not being on the frontlines with you, my ambivalence about being a teacher first, chaplain second for this moment in time. It feels so wrong, and yet, if I were there, I would model a need to be needed rather than clarity and humility in my role. So, my prayers continue with you. My every spare thought is on your goals, your home life, your discernment, the minutiae of your daily work. As you continue to exercise your freedom, know that it is not without the support of a great cloud of witnesses, both visible and invisible. I am proud to be your teacher and your colleague.
April 6 Ye Olde Feeling Wheel: A Daily Practice
Outcome 1.6, 1.9, 2.1 Competency PIC2
I asked our staff chaplains what they thought you should focus on right now, as CPE students experiencing this firsthand. More than one of them said the simplest and most powerful thing: journal your feelings each day. Later, when this is “over,” you’ll want to go back and remember how you felt as this unraveled, day after day.
So, in case you forgot, here’s the good old Feeling Wheel There’s a lot of these out there, and you know my feelings on some of them (begin rant:: love is not a basic emotion, “bad” is not a feeling:: end rant) but this one I approve.
In my house, we have this wheel on the fridge, with a magnet for each person. At the beginning, middle, and end of each day, we move our magnet to the appropriate place. We also have Todd Parr’s feeling flashcards for added fun (pray for Ira, raised by a CPE Educator).
For your weekly reflections for individual supervision, consider bringing a week’s worth of feelings in addition to your other prompts. Make this simple on yourself. Don’t expect a daily novella. Don’t make it harder than it is. But do that feeling check, and write that sucker down.
In the midst of all this it can just feel like too much. So do things for yourself that keep you invested in your learning without increasing overwhelm. Keep track of yourself, and a lot of the rest will follow.
PIC2: Articulate ways in which one’s feelings, attitudes, values, and assumptions affect professional practice.
https://drive.google.com/file/d/1iXS69k6z3WDXJSIRIuLWyxvOgfAeWE5U/view?fbclid=IwAR0ITRHHPRJ2xZxXdbx4jw6TyYptdfEmCzsG7fwP1QBIHOv-N9tcScDXxm4
https://www.amazon.com/Todd-Parr-Feelings-Flash-Cards/dp/0811871452?fbclid=IwAR342VgR1xOreYU6b_0HGcVpKJSB8yq8cAYJJBz1BknnbTg7b7WihEHs0vA
April 7 Bodhisattvas, Prophets, Saints: Carrying Us Through
Outcomes 1.1, 2.1 Competency ITP1
Your tradition has lifted up exemplars of faith and practice, spiritual leaders who shine a light on your path for today. In a time that can feel overwhelming or confusing, when the next right thing can feel fairly obscure, who are the paragons in your spiritual lineage?
Today, in one of my many saint calendar resources, we lift up Patriarch Tikhon. I don’t remember ever reading about him before Morning Prayer today. Even this encouraged me; there is always someone amazing and new to inspire us. Countless people are making the world a better place right outside my line of vision. Today I learned that in the midst of terrible famine, Archbishop Tikhon sold church property to buy food for his people. It reminded me of St. John the Divine converting itself to receive patients on the Upper West Side.
When you look around, past and present, whose example brings you comfort and inspiration? In your observances today, how can you mark the good weight of their influence? When you look back on this time, you may see that they lessened your burden in the witness of their life. It may be your contemporary, in which case, how might you let them know?
ACPE Outcome 1.1 articulate the central themes and core values of one’s religious/spiritual heritage and the theological understanding that informs one’s ministry.
April 8 Trauma and the Betweentime
Outcomes 1.1, 1.2, 2.1 Competency ITP1
While we continue to endure this crisis, it is important that we think of trauma not only as singular past events which intrusively replay themselves into the present, but also a term inclusive of ongoing threats to survival, void of start- and stop-points. We are in this kind of collective trauma, whether we have been furloughed, report in, take the day off, or work from home. We are facing an overwhelming, ongoing sense that our existence is under threat. We are traumatized and don’t know yet when it will be over.
In my pod, we have started using three terms: the Beforetime, the Betweentime, and the Aftertime. When we are frustrated that we can’t run freely, we grieve our autonomy in the Beforetime and we make plans for the Aftertime. We dream of restaurant patios, the smell of the pews, the hug of our friends. We talk about the renunciations required of us in the Betweentime, so that all of us, known and unknown, can be safe. We are sometime scared to acknowledge that we don’t know how long the Betweentime is going to last. We can dream of the Aftertime, but we can’t find it on the calendar yet.
For (liturgical?) Christians, one way we enter this experience is via the slowly unfolding drama of Holy Week. Particularly, we might zoom in on and hang out in Holy Saturday. This day, unlike any other, is our built-in acknowledgement of the place between a singular awful event and the promise of new life. Between crucifixion and resurrection, it is the space where, if we commit to entering it through Mary Magdalene and the other disciples' footsteps, nothing feels quite real, we don’t know what to look forward to, and there is a visceral nothingness. No white lilies, no lamb cakes. No veiled crosses, no solemn collects. Just space, really.
In your faith and practice, what accounts for Betweentime? How might you use a part of your spiritual tradition as compass in the face of nothingness, collective trauma, and a decided absence of triumph? This compass may center you in or release you from your hamster wheels and your numbness, however it is you have tended to cope with trauma. In this never-ending graveside vigil, may we be a witness and find a witness. For now, for me, this is the only comfort that doesn’t ring cold.
ITP1: Articulate an approach to spiritual care, rooted in one’s faith/spiritual tradition that is integrated with a theory of professional practice.
April 9 Things Have Most Definitely Fallen Apart, so We Might As Well Listen to Pema
or the 6 Kinds of Cool Loneliness
Outcome 2.6, Competency PPS1
If we’re going to survive this emotionally, we better draw all our resources to us, right? Every word of Pema Chodron's book When Things Fall Apart is useful, I admit it. Her loudest wisdom for me today addresses loneliness. Not "hot loneliness”—restless and full of desire to escape and find someone to fill it up for us. Because, good luck on that right now. You are surrounded by people, but you can’t get physically close to them. No, today, we’ll focus on “cool loneliness,” which means accepting that we are lonely right now, being adults about it, and finding a way through it. Lucky you: it has 6 faces.
Less Desire: instead of rushing to fill our loneliness, we sit with it for 1.6 seconds. We look to be less driven by our Very Important Story Lines. We could never do this all at once; we do it little by little each day.
Contentment: we settle into the idea that not everything can be resolved. We give up the idea that filling out loneliness will automatically lead to happiness.
Avoiding Unnecessary Activities: are you staying super busy at work and home as a way to not feel? Since you can’t hug your kid when you come home, are you avoiding them by fixing all the things?
Complete Discipline: we just keep bringing ourselves back to the present moment, each time we’ve gone AWOL in ourselves. A million times a day, if you’re me, you say, oh hey, I left again. Let’s come back.
Not Wandering in the World of Desire: food, drink, online shopping, other people, you name it. What did you find yourself wandering in to get away from that unsettling feeling that comes with being alone?
Not Seeking Security from one’s Discursive Thoughts: if you’re like me, a lot of your inner-chatter is not your friend. It can be pretty harsh, and really loud! Letting those voices exist (try demolishing them, see you next year) and not obeying or following them can be liberating.
Since we’re already going Buddhist today, it’s time for a painfully hard truth: we are all alone. We will all die alone. Rabbi Kara Tov, being interviewed about being a chaplain in NYC during COVID-19, said it well. In response to the interviewer asking about the horror of death in a no-visitor-policy world, she said,
Dahlia, dying is something no one can do with us. We all die alone. Being “with someone” (as in, physically present when they die) is an idea we love because it gives us closure and peace. It is about us, not the patient. The patient is dying. That is their work alone. But not having the closure you want is very hard and sad and a frightening thought.
So there it is: we are alone and we are lonely. The virus focusing our heightened awareness of this could break us, or it could wake us up. Your emotional availability with careseekers is not dependent on physical touch; you are more creative and skillful than that. You know how to work with all kinds of boundaries and make meaningful connections with others. Use your loneliness as a resource today. When you actually accept it, it can become a powerful source of connection.
2.6 demonstrate competent use of self in ministry and administrative function which includes: emotional availability, cultural humility, appropriate self-disclosure, positive use of power and authority, a non-anxious and non-judgmental presence, and clear and responsible boundaries.
https://www.amazon.com/When-Things-Fall.../dp/1611803438
https://slate.com/.../chaplain-nyc-coronavirus-interview...
April 10 Suffering Together
Outcomes 1.1, 2.1 Competencies ITP1, ITP3, PIC2
I will never forget the night Michael and Ali came with me to Maundy Thursday services. We had committed to spending a year together eating, studying, and attending each other’s important observances. We started with 9/11, which that year fell on Eid. Later, Ali and I stood silently on Yom Kippur as Michael covered his family. Near the end of our year together, we shared iftar in Ali’s home; that summer night I knew that Michael was sick again. Our last observance together was Michael’s own funeral, shortly after Hurricane Harvey had come mercilessly, destructively over our beloved city. Michael's cancer returned swiftly and decisively. The three of us were at his bedside the night he died.
In the middle of that most sacred year, this Rabbi and imam joined me for Holy Week observances. I drew them into the drama of the Last Supper, the meal where Jesus began his goodbyes, where he lifted bread and wine, where he washed his disciples' feet. Michael placed his bare feet in the basin, and a teenager of my parish washed them. We didn’t know then that he, like Jesus, was being prepared for burial, that lavish acts of service were perfect for the time and place. I cried then because he was so willing and never hesitated to participate; I had no idea how prescient my tears were.
In my tradition, we are in the middle of the Three Days, the touchstone of my theology of suffering. My God is one who suffers-with, who knows human anguish in their body. As a chaplain and educator, I know my calling is to solidarity in suffering, after the example of my willing, unhesitant, co-suffering God.
I no longer need to hyperlink examples of suffering together. You are in the grasp of it. For each of you as chaplains, you must be able to articulate why you move closer to these experiences. Beyond your natural instinct to help, for which you’ve been recognized and rewarded throughout your life, what does your spirit and heritage tell you about the nature and call of suffering? Take a moment to know your quickest, easiest answer to this question. Later, when you have more time, mix the yeast into it. See what rises.
All my love to you on this Good Friday,
April 11 Pedestal Pressure and the Chaplain’s Work: Staff Care vol. 7,983
Outcomes 1.3, 2.7 Competency PIC8, PPS2
When I asked nurse and physician friends from around the country to tell me what they want chaplains to remember right now, the theme was definitive:
“that our fuses are shorter just like everyone else’s,”
“that we are scared and struggling too,”
“that we are a mixed bag of emotions—fear, pride, grief, anger, and happiness.”
No question: our healthcare teams are the real MVPs right now. We have called them heroes because that is what they are. As those entrusted to care for these heroes, it’s up to us to think critically about what that means. Ever been labeled a hero? Right on the heels of a swell of pride, a moment of gratitude for recognition, that relief in feeling appreciated, you may have detected another set of feelings: pressure, anxiety, and even shame.
For some staff, the hero designation can be just another high expectation. Now, not only must they pull their shift, they must pull it heroically. Superheroes rarely discuss sleep deprivation, childcare stress, missing their favorite foods, a tough boss. As chaplain to staff, how might you recognize the very fragile and exquisite human inside that hero, and give them a safe minute to talk about their beloved pets, how they miss their own bed, their financial concerns. You know well that all the stress you carried in the Beforetime is still there, and they may feel guilty for talking about it. How might you recognize the pressure of the pedestal?
Our staff chaplains are hearing a lot of gratitude for written support as well as verbal. Sharing a daily inspiration with nurse managers and house supervisors, so that they can care for their teams, is another layer of your skill. Resources for this are everywhere and growing all the time, from our own internal shared drive to the Chaplaincy Innovation Lab. If Saturday is a moment of rest for you (thank you, Duty Chaplains!) take it to think intentionally about how you can diversify your ways of showing staff support.
2.7 establish collaboration and dialogue with peers, authorities and other professionals.
PIC8: Communicate effectively orally and in writing.
https://chaplaincyinnovation.org/.../chaplaincy-coronavirus
https://drive.google.com/.../1XN.../view...
April 13 New Policy? No Problem! ()
Outcome 2.5, Competency OL3
During most of our check-ins, we touch base on policy changes. Each day has brought a new protocol, a revision of the one we just got used to following. Who wears a mask, where to wear it, how you’ll get your temperature taken, what kinds of rounds to do. The faculty have been really grateful for and impressed by how adaptive you’ve been to the constant change. Healthcare chaplaincy, like all of chaplaincy and all of healthcare, is full of continuous flux. The best chaplains are experts in pivot and adaptation. Some of you have expressed liking this part of your Residency year; you are getting an unforgettably extreme case of this hallmark of our work.
If you are talking regularly with chaplains at other institutions, you know that every place has approached the CDC recommendations differently, in response to our unique context. At some point, if not in the busy-ness of your Monday, it is worth reading these rec’s alongside our administration. The closer you look at the way our own policies have unfolded, the closer you get to understanding the culture of our particular hospital and health system. What are you learning as you observe our institution’s culture? What differences do you notice in the way physicians and nurses discuss this?
When you spread your wings to another institution and function as a staff chaplain, what you took time to observe and learn here forms your ability to assess and adapt there. Bring your observations to group and individual supervision. Use family systems theory to conceptualize your observations. Bring a verbatim of a staff encounter in which you demonstrated your understanding of the system’s culture and your role in it.I know it’s supremely annoying to keep hearing from me, “This is going to prepare you so well!” but truly, it is. And I’m thankful for grit, your commitment, and your resilience.
OL3: Understand and function within the institutional culture and systems, including utilizing business principles and practices appropriate to one’s role in the organization.
2.5 manage ministry and administrative function in terms of accountability, productivity, self-direction, and clear, accurate professional communication.
https://www.cdc.gov/.../hcp/hcp-hospital-checklist.html
April 14 Will 'Ministry of Presence' Change Forever?
Outcomes 2.3, 2.6 Competencies PIC4, PPS2, PPS4, OL1, OL3
In the DNA of most chaplains dwells the phrase “Ministry of Presence.” It has shaped most of us definitively. We learned the phrase in CPE or in pastoral theology courses in seminary, or from the first books we read about spiritual caregiving. Somewhere along the way, we decided that “being present” was the heart of what we do.
It’s no surprise that some chaplains have interpreted this as a mandate to our physical presence in the heart of the action. If we are the Presence People, and we are in any way absent, then we are less than a chaplain. I’ve heard some of my elder colleagues cite their experience during the AIDS crisis, remembering the powerful witness of showing up and physically accompanying the sick, the dying, and the staff through a time of incredible stigma. COVID-19 is a very different kind of dilemma, because of its transmission. Many of us are asymptomatic carriers, visiting folks who, by the nature of being a patient in the hospital, have a compromised immune system. Some chaplains have now become patients in the ICU. A ministry of physical presence is also a potential ministry of transmission — to ourselves and others. Any theological hints of martyrdom concern me greatly, because it minimizes our potential to infect others.
Many chaplain teams have not resigned themselves to the mandate of physical presence in light of the risk. We too have joined the ranks of the safer and more creative, calling our infected patients and their families, being swift to make contact before someone is ventilated, so that, before they cannot communicate, they know someone is accompanying them through barriers of glass and PPE. We call non-infected patients who are trapped in mandatory pandemic isolation, because, as one of our colleagues put so well: “a call is often more intimate than a prayer shouted from 6 feet away.” The staff has shared that seeing you on the floors, even if they are too busy to engage you much, has brought them comfort. Thoughtfully, you choose physical presence with them, knowing two things: you all share high probability as carriers, and that fear is as present and invisible as the virus itself. Chaplains of vulnerable populations (>65, underlying conditions, immunocompromised) or otherwise very anxious about their own health or the health of their families, may recognize that their best offering will not be physical presence, because they add more anxiety than they can relieve.
I won’t be sad if “Ministry of Presence” gets more nuanced as a result. May we bring a theologically and ethically sound ministry of presence, one that questions the assumptions built on previous pandemics and crises. May we respect the uniqueness of this pandemic, so that we will look back and see that we did not barrel ahead thoughtlessly, but rather understood ourselves as risk vectors and found a way to be the balm we were called to be. May we see ourselves take our place in the line of chaplains past, who weren’t afraid to learn and share scientific wisdom, who were self-aware enough to recognize which kinds of presence brought help or harm. My two cents? That’s what real courage looks like.
2.6 demonstrate competent use of self in ministry and administrative function which includes: emotional availability, cultural humility, appropriate self- disclosure, positive use of power and authority, a non-anxious and non- judgmental presence, and clear and responsible boundaries.
From New York Times interview with Jack Kornfield:
It’s a particularly tough time for health care workers and their families. How might we ease their thinking? So my daughter’s husband works in an urban fire department. Like many first responders, he does not have masks. About 80 percent of his work is emergency medical calls. And today I spent time talking with someone who’s been advocating on behalf of hospitals and healthcare workers in order to get them the personal protective equipment and ventilators they need. He’s in a family of physicians, and they’re going in without protective equipment. So what could I say to all these people? My eyes tear up. I can say that in spite of the fear and the real possibility of dying or infecting others around you, this is what you trained for. This is the oath you took. We’ve tended one another through epidemics before, and now it is our time to do it again. And do not feel that you’re alone. Let your heart open, and feel the web of physicians and nurses and front-line responders around the world who are willingly placing themselves at the service of humanity. You are showing how we can care for one another in a crisis. You have a team of a million who are voluntarily linking hands and saying, “We know how to do this.” I could weep as I say that, because it’s not something glib. It’s true.
April 15 The Pastoral Neglect of Children
Outcomes 1.7, 2.2 Competency ITP3
As spiritual caregivers, you interact with children in a wide variety of ways: on call to labor/delivery and the children’s hospital, or in a regular clinical placement there. Rarely now will you see any children on campus who are not patients themselves. At home, you may have children crossing your path regularly, or you may be more likely to see them on neighborhood walks, since they are “schooling from home” and without access to playmates.
In our city’s context, most of the givens in children’s lives are upended, just like yours. School has become something they never imagined. They are suddenly with their parents all the time, and their parents have become Stress Monsters, trying to juggle their own shifted positions, caregiving routines, and all the new normal that is upon us. How have you found yourself attending spiritually and emotionally to them, inside and outside hospital walls?
Andy Lester remarked that when he asked seminarians to write about their significant life crises, many of them chose a pre-adolescent event or experience, and they reflected that while the spiritual caregivers at the time often attended to the adults around them, clergy never spoke to them directly at all. In this Western cultural context, we’ve spent a few decades idealizing childhood, leaving us desperate to protect an innocent, joyful view of the world. Unfortunately, we often forget that our own childhoods were full of fear, sadness, anger, and grief. We erase this from the children in front of us, celebrating their resilience because it’s so much easier than moving close to their pain.
Mark my words: the children and young people in your life are wrestling with this crisis just as you are, with fewer experiences and resources from which to draw, dependent on the adults around them to model coping, grieving, resilience, and reflection. When you acknowledge them directly, you communicate your awareness of their personhood, their agency, and their contribution to the world NOW. Try to remember that they communicate often in play, and that they, like you, have been socialized to believe no one may be interested in their take on the matters at hand. When you take the time to notice them, look at them, speak to them, and communicate curiosity about their inner worlds, prepare to be amazed at their depth. If you are up for the work it takes to get past their excellent judgment of character and authenticity, they may believe you that they matter.
The world will be different as today’s children grow. How will you attend to them?
ITP3: Incorporate the spiritual and emotional dimensions of human development into one’s practice of care.
https://www.amazon.com/Pastoral-Children.../dp/0664245986
April 16 Nerd Out: Journal-Combing and Responsible Practitioners
ACPE Outcomes 1.6, 2.8 APC Competency IPT6
When you encounter something on the floors and you think to yourself, I wonder if anyone’s thought about this before?, what do you do with that question?
Yesterday in group, one of you brought up a connection between a careseeker’s theology and the script they may use to engage with us. As we explored Pruyser’s concept of pastoral diagnosis, we wondered whether using his decidedly Christian grid would encourage playing a game: The Good Christian Pleases the Chaplain.
This sparked my curiosity about the connection between theology and grieving, another theme of your unit. Turns out, the previous issue of the Journal of Pastoral Care and Counseling has an article about this very topic. Any member of ACPE and APC has access to this journal anytime.
Besides your peer group, coaches, Educators, and other chaplain colleagues, a very important companion in your self-improvement is the literature of our field. I want you to bring these questions up in group and individual supervision, of course, but I also want you to go start poking through our journals. This is the habit of a responsible practitioner in any vocation. Next unit, we will further explore research literacy as a primary competency of our vocation.
I’ve reminded you often that we are in unprecedented times for chaplains. As the surges ebb and flow, as we turn our heads more and more to the Aftertime, we will begin to find margin enough to address what it was we just experienced, and how these experiences change what we understand about the work of the spiritual caregiver. It will be an especially thrilling time to have journal-combing in your professional habits. Does that sound nerdy? Join me.
ITP6: Articulate how primary research and research literature inform the profession of chaplaincy and one’s spiritual care practice.
April 17 Acute Loss Calls for Acute Care
Outcomes 2.4 Competencies PPS4, PPS5
Collectively, as we face our mortality worldwide, many of us are leaning on what we learned in past hard times. Unless we are in full-on numbing mode, many of us are remembering how we have coped with past crises. Some of us are recalling the acute stages of our life’s losses. As spiritual caregivers, we ponder: how were others helpful to me in that horrible moment? We want to be calibrated and effective in caring for those who lost their income, got sick, mourn a loved one, and feel trapped in their homes.
“God is…”
“You’ll look back on this and…”
“Keep up the…”
When you put yourself back in a time of acute crisis, it may become more clear that several things are unhelpful: teaching, premature meaning-making, and advising. These are things that that bring *you* relief, and questions *you* are pondering as the outsider, but they are insensitive to the throes of acute grief and trauma. Remember when you were still asking yourself if what just happened was actually real? Imagine someone coming in and asking you to think about the lifelong meaning of that event in the same moment that you are still pinching yourself. It’s just too early. It’s not time for that yet.
In the acute phase of loss or trauma, your work is compassion that inspires self-compassion. This is not telling someone to be compassionate with themselves; that’s just another command that’s unhelpful in the moment of crisis. Instead, this is the time for *embodying* compassion, which signals they are worthy of it. You create and hold a momentary safe space for them to exist, you reflect their thoughts and feelings, you are clear about your availability, and you stick to what you say. Later, as the acuity lessens, and you have built rapport, you may have the chance to reflect on God’s presence with them in the midst of their distress. Again, you are listening for it in what *they* say, not telling them where you think God is. It is out of their own understanding that they will continue on their journey, not of our yours.
Keep up the good work out there.
2.4 assess the strengths and needs of those served, grounded in theology and using an understanding of the behavioral sciences.
https://www.iliff.edu/carrie-doehring-shows-spiritual.../
April 20 New Boundaries: Telechaplaincy for Inpatients’ Loved Ones
Outcomes 1.7, 2.2 Competencies PPS1, PPS2, PPs4, PPS9
When I have offered mini-didactics about boundaries for hospital chaplains, one of the things I emphasize is discouraging ongoing relationship outside the walls. Because many of you came from congregational leadership contexts, it was important to emphasize that your pastoral oversight aligns with the census. (Some chaplains work with outpatient populations and that’s a whole thing, but for you, your careseekers are inpatients, their loved ones, and the staff.) Most of hospital chaplaincy has assumed the in-person, face-to-face connection of visiting actual rooms. Until now, supporting friends and family of the patient has meant seeing who has decided to visit the patient’s room that day.
Some of you are wondering how to restructure your day. After rounding with staff, visiting solitary patients at safe distances, and checking in with coaches and colleagues, some of you are wondering what else you can do with a lowered census, no visitors, and 6-10 feet of space between you and those you see. I could not envision that making spiritual care phone calls would become an important opportunity of your Residency year, but here we are. At a time when you are still practicing the art of deep listening and response, when the foundational conversation skills are still making their way within you from stilted to second-nature, increasing your ability to offer spiritual care by phone is a new layer of challenge.
Remembering that loved ones are isolated from their patients, you may be one of a very few people who can offer a bridge of connection. You will not have the medical information they seek; you will need to practice clarifying what you can offer and what you can’t, but making a concerted effort to offer the same care to the patient’s beloveds that you did the first half of this year may make a huge difference in this time of extended isolation. Use the skills you’ve been practicing in person as you use the phone; leave room for silence, reflect feelings and needs, share perceptions and observations. I encourage you to bring examples of these conversations to group and individual supervision.
Thank you again for your pioneering spirits. The faculty is grateful for your curiosity and determination!
PPS2: Provide effective spiritual support that contributes to well-being of the care recipients,
their families, and staff.
April 22 “You’re too _____ to be my Chaplain” : Evocative Presence
Outcomes 1.2, 2.1 Competency PIC5
You’ve noticed that before you’ve even finished introducing yourself, some people are vigorously welcoming you into the room and others are full of side-eye. When you say “Chaplain,” some brighten up instantly, some stiffen, and some go blank.
You’ve noticed that people make assumptions about you based on your race, your gender, your age, your physique, and now, when you call them, the sound of your voice. You’ve either had to soften your booming tone or you’ve had to speak up to be heard and understood. You’ve gotten used to the fact that you have to navigate those assumptions if you want to make a real connection with the person.
What you are navigating is what Steve Nolan calls Evocative Presence The careseeker has instant associations with the look and sound of you that may have nothing to do with who you actually are or what you’re really like. (In psych terms: transference.) If you remind the careseeker of their beloved grandchild, guess what? You start out from Grandchild and go from there. If they’ve never actually known someone of your race, you start out from their stereotypes or their desperation to prove they aren’t racist. Either way, you’re starting from whatever they think you look and sound like. You go from there.
When anxiety and fear are high, when trauma histories are kicked up, as they are in illness, your evocative presence may illicit an even stronger reaction than usual. When the careseeker has no visitors, each person who approaches them can feel like more of an invasion. Sometimes you bring positive associations but they aren’t actually aligned with the work of the chaplain, ("Oh good! The religious person is here to tell me God’s plan for me!”), so you work within their welcome to clarify your role. A negative evocative presence (“This fundamentalist pastor is here to try to convert me!”) leaves you to deftly clarify why you’ve come. It’s possible to use both positive and negative associations to be a source of accompaniment and comfort. Some of you have to work harder at this than others on a daily basis.
What have you learned about the first three minutes of your visit in clarifying your role from the projections you’ve stirred? The more awake you are to your evocative presence, the more likely you’ll be able to navigate into spiritual caregiving. Evocative presence is often surmountable, but not if you’re in denial that your presence is embodied and that is having a very decisive impact. Get real about what people are assuming about you and get savvy about it, so that you can focus on the careseeker’s needs, losses, and struggles, and get yourself out of the way.
1.2 identify and discuss major life events, relationships, social location, cultural contexts, and social realities that impact personal identity as expressed in pastoral functioning.
April 23 Helpers’ Shadow: Existential Debt
Outcomes 1.2, 2.1 Competencies PIC1, PIC2
Central to the work of the chaplain is self-awareness, because, as I’ve been relentlessly reminding you, *you* yourself are the primary tool of your work. Knowing your tendencies, your triggers, your strengths and liabilities are all critical to your use of self.
It is highly likely that you became a chaplain because you are a natural helper, but is also highly likely that there is a shadow to your helpfulness. Usually, those of us who devote our lives to serving others carry a strong desire to right some wrongs of our past. This shadow usually sprouts unconsciously, but as a professional caregiver, it is vital you be acquainted with this Existential Debt — your sense of making up for wounds, for traumas, for shortcomings of others that you experienced long ago.
For me, being the big sister to two little girls who really needed me shaped me irrevocably. I grew up fast in the chasm left by our mother’s mental illness and abuse, and became a protector and a primary nurturer at the tender age of 9. The shadow that sprouted in me was, “If you don’t help, something bad will happen.” Now decades from that reality, the shadow still has power, but because I was willing to face it and name it, I can learn to see the actual needs in front of me. If I didn’t do this work, I would project the needs of the past onto the world of the present. Our existential debt is a delicate beast, because it is absolutely the roots of our giftedness in caring for others; it’s just also that, unchecked, it's a dangerous reason to get up in the morning.
When the need for good helpers is so drastic as it is now, your shadow can loom larger and louder. Since the pandemic started, did you catch yourself thinking you were Wonder Woman yet? In your genogram, your mining of your personal history, your therapeutic work, and your spiritual direction, what have you learned about your existential debt? What have you learned about what lurks in your helper’s shadow, and how have you learned to manage its power?
2.1 articulate an understanding of the pastoral role that is congruent with one’s personal and cultural values, basic assumptions and personhood.
April 27 Comment Card Inspection: the Art of Walking Around
Outcomes 1.7, 2.6 Competency ITP 2
Last week, our TMC department was named Heroes of the Day. Several emails of gratitude came rolling in, pointing out how we make the community feel “grounded,” by "the support that underpins our collective body of caregivers.”
Every spiritual caregiver I know is trying to reach our people in meaningful ways. This was that rare, tangible confirmation that you are doing just that.
In the hospital, we can tend to look for the best programs available to accomplish our goals: the Best Staff Care Initiative, the Best Telechaplaincy Model, the Best Spiritual Assessment Tool.
The notes I read did not mention any official programming. Over and over again, the word i read was “presence.”
To be the best spiritual caregivers we can be, we maintain our excellence in what my friend Rob calls The Art of Walking Around.
When we want reassurance of our excellence, we can trust that rounding on the units, remembering folks’ names, asking after pets-partners-progeny in meaningful ways, and showing up again the next day is the best program around.
In Organic Community, Myers writes that “people want to participate in organic ways, not in 'strategic' ways.” Out of his research and experience in healthy communities, his summary of five key markers shapes my work as a chaplain on a team that serves a larger team:
How do People Participate?
as individuals, not as teams or groups.
in a decentralized, local way.
with the whole of their lives.
in a way that is congruous with the way they are asked.
so that the aggregate of their participation becomes “known” as the team or group acts, thinks, and makes decisions.
In other words, groups are simply what the individuals together do. As a caregiver on your campus, you are both a member and a steward of your groups. As you attend to folks today, focus on the Art of Walking Around. Remember that the notes we received proved this is central and vital to our work; this is what people will remember about what you bring.
ACPE Outcome 1.7: initiate helping relationships within and across diverse populations.
April 28 Wear Your Mask While You Get a Tattoo: Two FST Questions for Confusing Times
Outcome 1.5, Competency ITP5
In our city, these are now not only deeply sad* times, they are increasingly confusing times. Our city-wide mask order took effect yesterday, on the same day that our governor issued graduated reopening plans. Never was there so great a need to pause and ponder the difference between what is legal/illegal and what is safe/unsafe. Crushing economic forces may obscure your discernment. As a Midwestern transplant to the South, I have to keep pinching myself: individualism is a fiercely-held cultural value. This yankee hears cowboys with government titles saying, “I’ll do exactly as I please.” And indeed, even if you prefer a more collective approach, you are left with city- and state-wide order in opposition: everyone is a cowboy now.
This staunch focus on individualism may make family systems theory more relevant than ever for your place in the hospital, the city, and the state. Since it is up to you whom you believe and what you do with that information, the call for healthy differentiation may be more pressing than ever.
Pick a system where you are a regular participant:
Where do you see the forces of togetherness and the forces of individuality? More than who wants to stay home and who wants to get back into their favorite restaurant: from whence comes the pressure to think and act as a unit vs decide and move on our own?
Who is over-functioning and who is under-functioning? Be sure to take note how both camps are making sure the other keeps doing exactly that.
Your tendencies in this system are ensuring homeostasis. As a CPE student, I ask you to find correlations between how your role in your early family systems is showing up in your current group life. What does this tell you about your own differentiation in a time of high anxiety?
ITP5: Articulate a conceptual understanding of group dynamics and organizational behavior.
* As of Monday evening: statewide COVID-19 case total went from 25,091 to 25,786. That’s an increase of 695 cases (2.8% increase). An additional 27 new deaths makes a total of 688 statewide (4.1% increase). The Houston region's count is 8,434, up 149 from yesterday (1.8% increase). Harris County added 98 new cases today (1.7% increase) and is now at 5,827 cases total. There have been 160 deaths in the Houston region, up 11 from yesterday. —Houston Chronicle
April 29 Reopening (Yourself) at 25%
Outcomes 1.2, 2.1 Competencies ITP3, PIC1
Key to our governor’s plan on reopening the state is the idea that occupancy of any given establishment limited to 25% of the normal capacity. I’m not advocating for this plan, but I do think it’s worth considering it on a personal level.
If our peak danger levels plateau on campus, we cast our eyes to the new normal. We’ve talked about trauma brain, coping with stress, and the critical nature of caring for ourselves — all in the height of crisis. The time is coming for us to consider what all these look like in the *wake* of crisis.
Studying the enneagram as part of your pastoral education has given you valuable tools for understanding what your tendencies will be in the days ahead. Some of you conserve your energy naturally and protectively; others of you are spendthrifts of your own reserves. What will proactive energy management look like for you in particular in the days ahead? You’ll want to have a plan.
We can’t rush the movie theater if we want to avoid another lockdown; similarly, we can’t go full-force on the new normal if we want to survive. Your body and brain have more catching up to do than you probably imagine. It won’t be intuitive or fun to take things really slowly for the foreseeable future; but it might mean a longterm thriving.
PIC1: Be self-reflective, including identifying one’s professional strengths and limitations in the provision of care.
April 30 Fasting and Feasting: Holy Observance in the Time of Corona
Outcome 1.1, 2.1 Competency ITP1
Just as my Muslim friends checked on me during Holy Week and Easter, I am reaching out to them as they embark on a holy month like no other. My biretta is always off to them for fasting in the heat of Houston spring, but this year especially: for many of us, food is the great comforter during a time of so much uncertainty.
During COVID-Lent and Easter, we are forgoing receiving communion. While painful, it has been a powerful spiritual experience of solidarity and sacrifice. To fast from our greatest feast reminds us the whole earth is longing for connection, for nourishment of all kinds. My siblings in Allah are also seeing unity and fasting through the lens of solidarity: online call and response, intimate iftars across the table from just your household. We are finding the spiritual gifts in the devastation, and we are pouring our longing into the service of others.
In both our cases, going without our traditional nourishment runs right alongside our push for food security for everyone. Gathering food for the thousands in our city whose last paychecks came a month ago, whose rent is overdue, whose whole world is held together by the generosity of neighbors. Our small and symbolic sacrifices are their own kind of nourishment — fuel for giving all we can. Islam has long taught me the correlation between almsgiving and fasting, pillars that hold up a faith together.
This Ramadan when I pick my three puny pathetic days to join in fast with my Muslim siblings, my mind and spirit will shift from interfaith solidarity to hunger solidarity. When the sun goes down and her corona is obscured from me, by the light of the moon I will pray for a sunset on this virus, when feasting will mark our days again.
ACPE Outcome 1.1 articulate the central themes and core values of one’s religious/spiritual heritage and the theological understanding that informs one’s ministry.
May 1 Picasso’s Pastoral Care: Betweentime Embodied Listening
Outcomes 2.3, 2.6 Competencies PIC8
A substantial part of your skill in caring for others is not the words you say, but the way you say it and what your body communicates. You can say, “I wanted to come check on you,” in about 1,000 different ways: warm and cold ways, thoughtful and robotic ways, ways that make it clear the person is one of many on your list, and ways that communicate you actually want to hear the response.
I’m intrigued when folks say their work is less embodied now. I would invite instead that we are embodying differently, and stretching parts of our bodies we haven’t relied on as much before. Behind a mask, you rely more on your eyes than your whole face. Over the phone, your voice signals your intentions more than the rest of you. From 6 feet away or on Zoom, your body tells a story differently than you did 2 months ago. But still, this is embodied caregiving. It is radically altered, but your obscured, fragmented, distant body is still your body, capturing and communicating your care. Perhaps this is Picasso’s pastoral care; parts of us are much larger, emphasized, others obscured, invisible. No one would say Picasso’s figures were not people. In fact, we came to think of figures differently as a result of his work. I think it’s very possible I will teach embodied listening differently from now on.
Some of us are tired of communicating care this way, but there’s a lot more of it to come. Even as we relax restrictions, the days of sitting shoulder-to-shoulder with the Tearful One stretch farther into the past and future. A mark of the skillful caregiver has always been to adapt to the needs in front of us. We are doing that. Our resilience in doing so indicates our agility and competence in these strange times.
PIC8: Communicate effectively orally and in writing.
https://www.christies.com/.../pablo-picasso-1881-1973...
https://www.abebooks.com/Practice.../30564604166/bd...
May 4 Back to the Future, but not: More and More New Normals
Outcomes 1.9, 2.6 Competency PIC3
Now that states are easing restrictions when new infections and death tolls are still rising, we may have started to feel like we did when this all started: how much data should we track and how to make a myriad of personal decisions as a result. We can look at this as a new third stage of the Betweentime, after Stage 1: Follow the Data and Start Social Distancing and Stage 2: Follow City and State Regulations and CDC Guidelines. This third stage is like Stage 1 except that many of us are tired of isolation and the constant filtering and distinguishing between what applies to all of us and what is most applicable to “my area.” Universal guidelines may have been a comforting idea at one time—no more. Where we work, what little ones need and whether they are as contagious as we thought, where we live and how many folks we have to brush past to buy food, whether our elder family needs us, on and on and on. You’ve had to build your own set-up; with each new stage that involves revisiting the original architecture. It reminds me of Back to the Future II: the time travelers go “back” to 1985, but because of shenanigans in an alternate 1955, there’s a whole new 1985, and it’s bleak. Stage 3 of Betweentime should feel like Stage 1 but it’s all cranky and brittle and worn out, like the suburbs of Biff’s Palace. We’re back to making most of the decisions on our own again, but it doesn’t feel very novel and our emotional reserves more depleted.
It reveals what’s been true all along: folks are doing what they think and feel is right whether or not it’s recommended. The truth is, of course, that it’s always mostly been up to us. There is no going back to an earlier stage. Even the Betweentime has a new normal within it.
I love when Carrie Doehring writes about returning to the ordinariness of life. After the primary steps of establishing safety and naming and grieving losses, one marker of moving through a grieving process is reconnecting with the rhythms of daily life again. We are still very much in the middle of this pandemic. As caregivers, we can’t yet let up on all that marathon-not-a-sprint stuff. It might be time to look at the sustainability of your current rhythm; this continuously unfolding series of losses means we are reconnecting with ordinary life in some places and ways and others not at all. When stuff is all over the map like this, we go to our inward architecture. We check the stability of our foundations while we keep plodding along.
As you continue to name and grieve losses, may you also find reconnection to the ordinariness of life, at this most extraordinary time.
PIC3: Attend to one’s own physical, emotional, and spiritual well-being.
May 5 Your People are Your Theology
Outcomes 1.1, 2.1, 2.4 Competencies QUA1, ITP1, PIC2, PPS8, OL5, MNT3
Who is your spiritual or religious community right now?
I’m not talking about online worship: whomever is giving your life a sense of meaning is your spiritual community.
Locate who and what is nurturing your current sense of belonging. At any quiet minute you can grab for reflection, identify whose voice are you trusting to help you find meaning in the midst of so much uncertainty and chaos. We know that several people are attending online services and participating in meetings of a former religious community, or a group they’ve been curious about but never visited. Some feel just plain bereft of community altogether.
What does that community do to show care for others?
Whatever activities are underway in the voices that you trust to make sense of nonsense, those actions will become your theology of caregiving. In other words, however your people are helping others will form your understanding of what you are called to do.
Emmanuel Lartey says:
"Pastoral theology, which by its very nature reflective practice, can be found in the various caring activities of persons and communities.
As communities have faced particular traumas and tragedies, pastors and other caregivers have tried to find the best ways of helping people with their personal and communal needs."
Whatever your people are doing, there your treasured beliefs are. As professional spiritual caregivers, the community that supports you will tell the story of your values. What story is it telling this week?
OL5: Foster a collaborative relationship with community clergy and faith group leaders.
https://www.amazon.com/Pastoral-Theology.../dp/1620329735
May 6 Scrubs, Coats, Kippot, Hijab: Reviewing Chaplains’ Visual Markers in Pandemic
Outcomes 2.1 Competency PIC9
I’ve worked with a lot of chaplain dress codes in my career: mandatory hosiery and covered elbows, long heavy white coats, collars, and presently, relaxed and reasonable.
Our chaplains were given the green light for scrubs several weeks ago, with the freedom to scrub or not scrub (a practical, compassionate shift for those disrobing in their garages and washing their precious betabrands in scalding hot water). Lately among colleagues, I’ve seen a resurgence of discussion about what visual markers are appropriate: the black mask with the white tab collar is a particularly hot debate (pardon my giggles), and yesterday I even saw a remix of the evergreen Lab Coat Question on your Grandparents’ Favorite Social Media Platform.
As a professional spiritual caregiver in *any* context, there’s a dress code. It tells you how your organization categorizes you (read: what they think of you). Your particular tradition may have bestowed upon you a separate additional code, and depending on your gender, age, branch, and local leadership preferences, it may come with its own stringency. Some combination of these codes and your sense of agency in them will determine how you present yourself to your careseekers today. According to our certifying bodies, being “professional” in “appropriate attire” “and grooming” is the minimum expression of competence.
I had a chaplain student who was a former nurse take it upon themself to wear scrubs on call. We never knew until 3/4 of the way through the year! Once, when I spilled coffee all over myself in the middle of a weekend shift, I only had jeans to swap out, and I swear I gave the best spiritual care that day because I was comfortable AF. The coat was a whole mood, and the collar was a wash — 50% of the time it catalyzed my connection, 50% repelled it. Even my students in kippot often go undetected, since looking up from a hospital bed, the angle is just right to never see the back of their head.
While my male-identified Muslim students usually pass un-outed, students in hijab never do. Their identity is proclaimed, and they navigate the highest evocative presence of all chaplains I supervise. (Racially, Black students bear the most in my Texas context: Black Muslim women, I see you). For the first 5 minutes of every new visit, their badge may as well read “HI I’M MUSLIM LET’S TALK ABOUT THAT FOR THE WHOLE VISIT K THANKS.”
In our context, you get to choose your outfit, but you don’t get to choose what people think it means. Take care with whatever agency you have. People don’t necessarily know what your sacred symbol means anymore, and if you seem weird, it might be tougher to build rapport. I’m no friend of neutralizing your identity; if you face different requirements in your next context you’ll just have to take them into account in forming relationships. I’m just saying it matters. Remember: while you’re trying to enjoy getting dressed for work, your careseekers are trying to figure out who you are, at a time they are stressed, vulnerable, desperate for answers, looking for comfort, and vigilant for harm. How do you want to carry yourself into that cluster? How might your spiritual caregiving begin with your visuals?
PIC9: Present oneself in a manner that reflects professional behavior, including appropriate attire, and grooming.
May 7 Saint Flo, Patron and Icon
Outcomes 1.7, 2.7 Competency PPS2
Never a better time to think about Florence.
St. Florence Nightingale was born 180 years ago in Italy. In *Florence*, to be exact: just think about being named Houston in this town. (Just for that alone: tip of the hat, dear Flo.) We celebrate nurses’ week this week because we remember her life and her death as one lived in service, using her distinct privilege to elevate the plight of those in need. Hailing Florence today is to hail all nurses for their tirelessness, their dedication in the midst of every bananas day in healthcare, and yes, in the extra that is Coronatime. Some nurses in my life incarnate that for me daily; they are every bit as Florence as Florence herself. Holding up St. Flo today also feels like holding up our beloved Italy, in their deep devastation and grief.
Florence’s most famous quotes are problematic in countless ways; like all our saints, she was blessedly flawed. But this one, oh, this one:
"Let whoever is in charge keep this simple question in her head—(not, how can I always do this right thing myself, but) how can I provide for the right thing to be always done?"
Behold how taking the focus off your legacy and shifting to provision for all is a true mark of love. Florence’s wisdom is sustainability, a word we might gloss over if we’re not careful. Out of the tumult of every day a new wearying saga, she reminds us: everything we’re doing is groundwork for those who come after us.
For today, two things:
1: which nurses can I thank, directly, by name, spontaneously, in the course of the regular day?
2: How am I laying groundwork for those who come after me, to provide that the right thing always be done?
We raise our water bottles to you, Florence; we follow your lead, we honor your witness.
PPS2: Provide effective spiritual support that contributes to well-being of the care recipients, their families, and staff.
May 11 We’re All on Disaster Assignment
Outcomes 2.1 Competency PIC3
I used to teach self-care in a 1- or 2-part seminar in a student’s fourth unit. That idea seems now. It seems dangerous and neglectful to think of self-care as an add-on. I doubt I will ever teach it that way again.
The US Department of Health and Human Services Substance Abuse and Mental Health Services Administration (HHS SAMHSA!) released the attached resource for first responders preventing and managing stress during disaster assignment.
We are all on disaster assignment.
The resource says (among other great stuff like having a personal disaster plan involving people who care about you) that stress management is your #1 priority right now. That means your first responsibility every day, in order to serve anyone else effectively, is to keep your stress in check.
As you continue to practice with the models of spiritual assessment, take a moment and self-assess. Hopes, Needs, Resources :: Physical, Emotional, Relational, Spiritual. What pops up right away?
As you go out and take on another week in the Betweentime, cherish your health and well-being. Protect it with everything you’ve got.
PIC3: Attend to one’s own physical, emotional, and spiritual well-being.
https://store.samhsa.gov/.../Preventing-and.../SMA14-4873
May 12 Text and Context: Staff Care Volume 7,495
Outcomes 1.7, 2.7 Competencies PIC5, PPS1, PPS2
We can throw resources at each other all day long. You’re collecting memes, articles, links deemed “useful.”
I’m attaching a staff care resource* because you are all still voicing your desire to care for staff more creatively, more connectively, more effectively.
Suggested approach: Search the text with your context in mind, rather than going to your context armed with text.
Context First: Your assessment of your unit staff’s particularities — from the physical set up of the unit to the relationships between managers and nurses — informs which approaches you take. Your coach, who has been on the unit longer, has valuable background and insight. Make a list of the main particularities you’ve observed on the unit.
Now Text: Now approach the resource with your context in mind. Which parts of it are especially suited to the way this week has gone for them, or the struggled you’ve heard them mention over and over again?
2.7 establish collaboration and dialogue with peers, authorities and other professionals.
https://chaplaincyinnovation.org/.../Staff-care-eBook...
May 13 Attunement in Pandemic
Outcomes 2.3, 2.6
Wordstuff: “attune: to bring into harmony” and see also “atone: to bring into agreement, reconcile.”
We are listening to our bodies tell us that we are overzoomed. Recently heard a pastoral caregiver bemoan how we are “all stuck on the internet” as we check on our people. Some of us are balancing the overzoom with abundant outside-time: I’m still setting my clock by the daily 6pm walk with my isolation pod, now 9 weeks strong. Many of us are acknowledging that our bodies are trying to teach us something during this time of worldwide quarantine.
When it comes to somatic wisdom, I have eyeroll for the term but faith in the concept: our bodies know a lot more than most of our cultures of origin would like us to believe. As you practice spiritual caregiving, it may be tempting to worship the art of the words you use, and neglect the art of every other way you communicate you are listening and hearing.
In Trauma-Sensitive Theology: Thinking Theologically in the Era of Trauma, Jennifer Baldwin writes that “attunement requires fully embodied presence with awareness of the multitude of means of communication, including verbal and the non-verbal communication forms of movement, posture, affect, energy resonance, and timing.”
I’ve mentioned before that these aspects matter more than ever: your posture at a distance may be even more striking a communication tool than it was in February. The affect of your voice is communicating your level of comfort with the mask, and over the phone it tells someone even more than the words you’re saying.
Listening and Responding is about so much more than the words you say. Next time you bring a verbatim, take extra care to show in your ( ) how you worked to attune yourself to the careseeker with Baldwin’s list: movement, posture, affect, emergency resonance, and timing.
L2.3. demonstrate a range of pastoral skills, including listening/attending, empathic reflection, conflict resolution/ transformation, confrontation, crisis management, and appropriate use of religious/spiritual resources.
May 14 Happy Music, Sad Eyes: Complex Grieving
Outcome 1.6 Competency PPS5
For me, it started with footage of the 7:00 round of applause: in the five boroughs or narrow winding paths of Northern Italian towns, and across other continents. Then descriptions from our staff chaplains getting folks to dance in their hallways. I connected this to our pod’s weekend dance parties in the garage. I remembered other times in life when things were just awful, individually or collectively, and the only thing we knew we could still do was dance our hearts out. (Grey’s Anatomy, anyone?) Now I see it when music plays and folks clap as recovered COVID patients wheel out of the building. We’re finding things to celebrate.
For spiritual caregivers, this dance is a delicate dance. We know that while we’re dancing and clapping, someone nearby is coding, someone just got their positive test, someone lost their pregnancy, someone cancelled a bucket list trip. Someone in the clapping, raucous Discharge Congo line hasn’t seen their aging parent in months now, and isn’t sure they will again. I think of this as I clean up all the cups at the end of the dance party. I think of how each member of my pod is staring down a Big Grief, from the 7-year old to the 53-year old. We’re all healthy, but a lot of people we know aren’t. We press on, but we don’t avoid or forget.
Being a chaplain means being willing to sacrifice getting totally swept away in joy, because we mourn with those who mourn, and someone is always in Big Grief. Conversely, for me, it also means we nurture a strange kind of eternal hope, hope in what is right now, in what has given meaning to the Congo Line and positive test existing together.
The delicate dance is totally fine with me, because it’s way more real. Grieving sometimes looks like happy music, sad eyes. Remembering this may help you not chaplain-voice* someone (*verb, to lay it on so thick that someone is supposed to be having a cathartic experience just by the gift of your waltzing in to their presence).
Dance on.
PPS5: Provide spiritual care to persons experiencing loss and grief.
May 15 Be Kind, for Everyone You Know is ... not just in pandemic but trying to do their regular suffering at the same time
Outcome 1.9, 2.9 Competency PIC3
Maybe it’s just me, but in my little pocket, suddenly everyone I know is either suffering themselves or adjacent to a great sufferer. Starting Week 10 of Betweentime has launched some kind of heightened level of crisis; dying family members, horrible fights and battles, new diagnoses, tumbling prognoses, financial breaking points, fresh hells of trauma.
So, here’s this. Use it as your time allows. It is helping some folks right now. It might be a break you can use.
https://socialwork.buffalo.edu/.../emergency-self-care...
PIC3: Attend to one’s own physical, emotional, and spiritual wellbeing.
May 19 What’s the story; what’s the need?
Outcomes 1.5, 2.3 Competencies ITP6, PPS2
I’ve been reading up on moral injury screening, toward an increased intentionality around staff care for the years to come. How to best ask ourselves, our chaplain colleagues, our interdisciplinary teams, and even our patients how we've balanced forced decisions with our most cherished values is a big hairy audacious goal in front of me. A lot of moral injury work is longterm work, with time and space set aside to facilitate discovery and disclosure. Perhaps it’s not ethical or advisable to open questions like “how was it to collaborate on vent distribution?” unless you have the time and skill to really unpack and accompany. It has taken me back through screening for spiritual distress, only more involved. Duh: the work of spiritual caregiving is sacred work; there is a reason we demand 1600 hours post-master’s to learn it. (And that never feels sufficient.)
So, on my quest for a deeper understanding of both screening and accompanying through moral injury, it won’t shock you that a standout theme of proposed models involves listening to the need inside the story the careseeker tells. There is always a reason for the stories that people choose to share with us. It may feel completely random to hear the story of a childhood birthday in an elderly patient’s hospitalization; it isn’t. Isolation, endless waiting, and vulnerability brings narratives to the surface. Our great honor is to receive these surfacing stories, to trace and track them, to mine them for sources of strength and meaning.
Today, as you listen to stories, ditch your questions. Let go of “tell me more” and “can you say more about that?” and recognize they are telling you everything you need to know. Simply reflecting back the significant words you hear, embodying the deepest possible listening stance, naming the feelings that charge the words, and wondering with the careseeker the meaning of this story is far more powerful than any question you can ask.
ITP6: Articulate how primary research and research literature inform the profession of chaplaincy and one’s spiritual care practice.
Gem on spiritual distress: “Spiritual distress has a nursing diagnosis (NANDA International) of impaired ability to experience and integrate meaning and purpose in life through the individual’s connectedness with self, others, art, music, literature, nature, or a power greater than oneself.7 This definition corresponds well with the consensus definition of spirituality: spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.
May 20 COVID from a Kid’s Eye View: What Do Chaplains and Chaplain Educators Do?
APC Competency OL5
My goddaughter interviewed me for her podcast. She wanted to hear how my work and, more importantly, my students’ frontline work, has changed. 13-minute breakdown.
Grateful to you Residents for doing all you do, and for the honor of serving as teacher.
OL5: Foster a collaborative relationship with community clergy and faith group leaders.
STITCHER.COM
Episode 4 - Sarah Knoll Sweeney
May 19, 2020 - Today I'm interviewing Sarah Knoll Sweeney.Sarah is an instructor for hospital chaplains in Houston, Texas. I talked with her about what it's like teaching chaplains and some challenges that her students face. She tells us how life and work in a hospital has changed because of COVID.
May 26 Therapy, Yo
Outcomes 1.9, 2.1, 2.9 Competencies PIC2, PIC3
If you haven’t been to therapy since the pandemic started, let’s chat.
Maybe it’s for cultural reasons; there are plenty of messages out there that counseling is for the “crazy,” and you’ve thought to yourself you’re not crazy, because you’ve kept coming to work and being a functional human.
The truth is regular counseling is linked to increased well-being for all individuals. The Joint Commission recognizes that you may be nervous to ask for mental help and vouches for you. Our system has free accessible options for you.
Get on it.
2.9. demonstrate self-supervision through realistic self-evaluation of pastoral functioning.
2.9 Memorial Hermann behavior: I initiate consultation for continued self-learning and improved pastoral functioning.
https://www.mentalhealthfirstaid.org/.../four-ways.../
https://www.jointcommission.org/.../statement-on-removing...
https://memorialhermann.portal.dovetailnow.com/page/1228
May 27 Reconsidering "How Are You?” When We’re All "Not-Fine"
Outcomes 1.7, 2.3 Competencies PIC8, PPS10
I’ve never been a fan of “How are you?” as a hospital chaplains’ opening line. It rings falsely casual to me — as though we were meeting on the sidewalk instead of approaching a hospitalized person. Of course, how you say it makes all the difference: try saying it quickly with a cheap smile, and then saying at .5 speed with eye contact. It’s like two different questions altogether.
Often when we talk about spiritual assessment our brain goes to models like FICA, 7x7, The Discipline, but remember, spiritual assessment is as simple as what the spiritual caregiver is listening for when you listen to someone. So, if you ask, “How are you?” you have begun your spiritual assessment.
The New York Times just ran a piece on the obsolescence of “How are you?” in these times, because the standard expected answer — “fine” — no longer applies. In the hospital, I’m not sure this question, even when you’re truly open for a big complex answer, communicates your intentions. If you were stripped of casual pleasantries when checking on your staff and patients, what opening lines would get at what you’re really asking?
Read the NYT piece, review your spiritual assessment models, and then experiment with a different opener during your clinical week next week. Take care that the first words you say communicate your intentions for the conversation. I look forward to hearing what you discover.
PPS10: Formulate and utilize spiritual assessments, interventions, outcomes, and care plans in order to contribute effectively to the well-being the person receiving care.
https://www.nytimes.com/.../coronavirus-small-talk.html...
May 28 Cookies and Mindfulness: 2 Minutes of Family Systems Theory
Outcomes 1.5, 2.2, 2.4 Competencies ITP2, ITP3
(To my students after presenting their evals:)
Now that you’ve finished evaluations, how about some cookies? Here’s two minutes of family systems theory using cartoon cookies. (Apologies in advance for the scary-eyed white lady.)
Which unconscious rules and roles are you working with on your units, in our department, at home? Are these roles letting people grow and change for their well-being?
Enjoy!
YOUTUBE.COM
Mind Matters : Family Systems
What is the family system? What is Family Systems Theory? How does our family really impact who we are, our day-to-day lives, and our happiness? Learn more a...
June 1 Release Valves, Burst Pipes: Emotional Plumbing
Outcomes 1.5, 2.4 Competencies ITP2, ITP3, ITP5
Spiritual caregivers go into each new encounter knowing our role may be like a release valve; we are told time and time again that no one has really listened to them like that for a long time. Perhaps you have a memory or two of spiritual care relationships marked by the never-ending need for a release valve. It seemed no amount of your listening and creating a holding environment would create a sense of relief. You came to need your own release valve.
There are times when you have been willing to enter the world of the careseeker. You have seen how they manage an incredible amount of emotional energy, pressure, dysfunction, grief, anxiety. If you looked closely enough, you saw how they couldn’t take their woes here or there because they were already someone else’s release valve.
Like a plumbing system, emotional energy needs somewhere to go. When one pipe is clogged, the water finds a new path of lower pressure. When someone’s sadness or rage or anxiety is given no valve, it doesn’t dissipate into thin air, it finds a new path. It may boil underground, waiting, seemingly submerged. It may displace onto unsuspecting others, who seem less threatening. Eventually, when all the pipes are clogged, when the emotional energy builds and builds and has no release, the pipes will burst, the system will break.
Sometimes you take on the release valve role because you know it will allow smoother plumbing with the rest of the team and ultimately, the patient’s actual well-being. This doesn’t mean you take abuse; it means you offer a release that other folks can’t at that moment.
Pandemic, oppression, disparities, unemployment, isolation. All these stressors are connected to your careseeker’s current health experience, whether either of you acknowledge it or not. A person will get well slower if they feel unsupported or afraid how they will pay their bills. If work was their identity, your 20 minute conversation will not restore them from that grief. All systems are on overload, for POCs, the working poor, the newly unemployed, all the more. People can only bear so much before lashing out.
Every one of us is strained right now, but not equally so. Take care that you offer release to those most needing it, lest you erase real suffering thinking this has all been the great equalizer. The streets of Houston, Minneapolis, New York — all of them reminders that people can only take so much. There’s only so many pipes that can be clogged before they burst. Keep your ears open.
ITP5: Articulate a conceptual understanding of group dynamics and organizational behavior.
https://www.thenation.com/.../minneapolis-rebellion-floyd/
The following entries are a “journal” of one chaplain’s experiences during the first wave of COVID-19 infections in her workplace. These entries were curated to exemplify the connection between CPE outcomes and certified chaplain competencies. Our hope in sharing these with those interested in professional chaplaincy, is that these entries will show the “practice of theory” in relation to spiritual care.
This work is owned by the author and may not be reproduced without explicit written authorization. We extend our thanks to Rev. Sarah Knoll Sweeney for her incredible work as a chaplain, educator, and contributor to the mission of professional chaplaincy.
March 16 A Word for Spiritual Caregivers:
The Less-Anxious Presence*
Remember family systems theory? Rabbi Ed Friedman wrote in Generation to Generation that a well-differentiated leader:
"is someone who can separate while still remaining connected, and therefore can maintain a modifying, non-anxious, and sometimes challenging presence... is someone who can manage his or her own reactivity to the automatic reactivity of others."
My own forming educator was fond of challenging Friedman’s concept of the non-anxious presence. She would say, “The only truly non-anxious presence is a dead person. However, we CAN be a LESS-anxious presence.”
Right now, you are seeing some people in full panic mode, and some in a numbed dismissal of the impact of this virus, and lots of folks in-between. Neither extremes are the posture of a competent chaplain. Instead, an effective chaplain is a presence who makes space for a range of feelings in others, while maintaining a sense of her own groundedness. Only in this way can we offer a sense of calm to others.
Today, watch for the less-anxious presences around you. Who is offering calm without being numb and dismissive? See if you can emulate this posture in your work of spiritual and emotional support today.
Again, thank you for your work; if you can’t see it clearly, hear us tell you: You are making an important difference in the lives of people.
*ACPE Outcome 2.6: demonstrate competent use of self in ministry and administrative function which includes: emotional availability, cultural humility, appropriate self- disclosure, positive use of power and authority, a non-anxious and non- judgmental presence, and clear and responsible boundaries.
March 17 Chaplaincy during Corona: Tuesday
Compassion is a Renewable Resource:
Outcomes 1.7, 2.3, Competency PPS2
Dear Chaplains,
Our vocation has always included showing up to the places of deepest suffering. Unlike our interdisciplinary colleagues who come bearing thermometers, administering medication, or interpreting test results, spiritual care practitioners’ primary instrument is ourselves. This is why we talk so much about use of self in CPE.
Often we think first of empathy in the way we use ourselves as chaplains. We commit to sit with another in their suffering, to feel with them. We strive to put ourselves in the shoes of another, just for a moment, and to see the world the way they see it. In times of heightened and collective crisis, I wonder about the limits of empathy. Trying on others’ shoes all day long will leave our feet sore, squished, unprotected, and drains more of our energy than we may have for the weeks ahead. And, it turns out, the shoes we most like to try on are the ones that are closest to ours in length, width, and style. It’s easiest to get inside the perspective of another if that perspective is most like ours.*
Compassion is different. Taking a beat to send our loving-kindness to those we serve is a renewable resource, and moves us to caring action rather than burnout.** Between visits today, while you are washing your poor little dried-out germ-free hands for twenty more seconds, visualize the careseeker you just encountered. In silence, send them loving-kindness. Then, send it to the next person who will encounter them — their tech, their nurse, their one single visitor for the day. As the soap goes between your fingers, your thumbs, and under your nails, send that same love out to the person whose shoes you least want to try on right now. As you rinse off your blessed hands, send one more push of kindness to that difficult, irksome person. Be sure to notice where your own feet are when you shut off the water. Breathe out the kindness that arose from within you.
You are an amazing person to sign up to do this work every day. You are a precious renewable resource when you take loving care of yourself. Today, my loving-kindness goes to each of you students. As you make your visits, know that you are the destination of the faculty’s compassion.
ACPE Outcome 1.7: Initiate helping relationships across diverse populations.
APC Competency PPS2: Provide effective spiritual support that contributes to the well-being of care recipients, their loved ones, and staff.
(link to * and ** in comments)
* https://www.researchgate.net/publication/265909916_Empathy_and_Compassion
** http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.210.5348&rep=rep1&type=pdf&fbclid=IwAR1A7dZp82EMrPJzMY7VIb8h3i8UkBz6XnsUaNNj_N7NZWciGJIn3T2qW9s
March 18 A Belief and A Practice: Our Whys
Outcomes 1.1, 2.1, Competencies ITP1
Dear Spiritual Caregivers,
In my first year as a healthcare chaplain, I worked the ER as we received a small child who had died in their sleep. It was a horrific night in every way, one that stayed with me forever. One of this trauma’s aftershocks is that I still sometimes get up in the night to check if my own child, now 12, is still breathing. That night is one of many that made me the chaplain I am.
In the wake of the event, I asked myself WHY I would continue to get up every day and go to the same ER, and a new ER after that, and another. For me, this became a regular self-check: What is a central belief and a central practice that fuels my ongoing desire to show up at these places of suffering and transformation, of life’s most holy beginnings and endings. It was one way that I could stay grounded in my work.
As spiritual caregivers, we approach the secular trend to “find our why”* in the beliefs and practices of our respective traditions and philosophies. In the tough decisions I am helping make as leader right now, my why looks like this: I believe we are interdependent, and I pray in a daily rhythm. In my tradition, the Daily Office keeps me mindful of the dawn, midpoint, eve, and end of each day. I hold in prayer all those from whom I come, and those who have been entrusted to me as a parent, a friend, and an educator. Our interdependence has never been clearer to me than it is now, in both alarming and comforting ways.
What is your why? Find one belief and one practice that keeps your feet on the path right now. Be sure it is simple enough to fit on a post-it where you can see it. Find a way to practice something for five minutes before you head into the next encounter. Practice shapes belief. Both become your fuel.
Your showing up makes the difference to the patient who has no visitors, to the nurse who doesn’t know if anyone sees how hard they are working. Your witness is a light shining in the darkness. As the sun starts its rising on another day, I am giving thanks that we are connected, and sending you strength.
APC Competency ITP1: Articulate an approach to spiritual care, rooted in one’s faith/spiritual tradition that is integrated with a theory of professional practice.
* https://www.sloww.co/find-your-why-simon-sinek/?fbclid=IwAR0uLX0BH-SLpIUtoAxDsmxlhdmyogOkkhPaypsPou2fEFDT490nKXA-YAo
March 19 The Toxicity of Reassuring Distress
ACPE Outcomes 1.6, 2.9, APC Competencies PIC4, PIC5
I haven’t talked with a single person who is not in some form of distress. Yesterday alone: One is in physical distress, wondering: Are my symptoms THE virus, or just a coincidental ailment? Another is in moral distress, wondering: Whose protection matters most now—mine and my family’s, or the persons I serve at work? Another is in spiritual distress, lamenting the daily growing death toll and no end in sight.
In your current distress, whatever it looks and sounds like, which helps more: someone who says, “Don’t worry, it’ll be over soon,” or someone who listens intently, capturing and reflecting that they actually heard you, and doesn't try to put a lid on it, dismiss it, or minimize it?
As a spiritual caregiver this day, you are a witness to all these and many more forms of distress. You have no power to take away physical illness, to solve moral dilemma, or to spin lament into joy. When you go from room to room, you may be the only one who can focus long enough and well enough to actually capture and reflect distress. You may be the only human mirror someone sees all day.
James Dittes wrote* that in our work, we renounce many of the usual ways we were socialized to converse. As chaplains, we don’t fear and fill silences, because we know that important internal work happens when there is a minute to think in the calm presence of another. In a spiritual encounter, we don’t jump to gathering facts and trying to fix, because we were not sent to the room for our power to treat illness. And for me, the million-dollar renunciation in a day like ours is that we don’t reassure distress. If we say, “Oh! I’m sure you don’t have it, you’ll see,” or “Calm down, you’re all worked up over nothing,” we tell the person, your distress is wrong. Your distress is invalid. Your distress isn’t worth hearing. That’s a toxic message in any encounter, but right now, we all have to let our distress be real and keep going anyway.
If you want to be allowed to have the distress you feel right now, please, for the love of ____, let the patient have theirs. Let the nurse have his. Let the doc, who doesn’t know you saw her shoulders slump in the hallway, have hers. Don’t reassure it or invalidate it. Reflect it: “You’re at your wits' end.” “This doesn’t feel right to you.” “You need some relief.” See how you’re not even in that sentence? In not insisting on solving it, you have held an actual moment of space for the other person. Right now, this kind of encounter is priceless. That kind of moment is gold.
When your shift is over today, find someone who can do this for you.
PIC5: Use one’s professional authority as a spiritual care provider appropriately.
* https://www.amazon.com/Pastoral-Counseling-Basics-James-Dittes/dp/0664257380?fbclid=IwAR2cymlkpEdQC0KPgq412Xx9868G_hbtT6-YdtdgvjFJlm_fnta4uOmax34
March 20 Our World of Exceptions
Outcomes 1.1, 2.4, Competencies PPS4, PPS6
Several of my Christian colleagues found out yesterday that they won’t have in-person Holy Week or Easter services. Some are charting new minyan territory. Others are scrambling to safely bury their dead. Many spiritual leaders are seeing this virus consume any semblance of our normal rhythms. I have been privy to so many conversations this week about what is permissible and what is legitimate when it comes to our most sacred rituals.
As chaplains, this is old news to us. We’ve always made our home in the world of exceptions to the rule. I’ve witnessed more Vidui among gathered families than I have presided over Easter Eucharists. I’ve had more Easters inside hospital rooms than I have surrounded by white lilies and incense. I know how to sit with a Catholic patient who needs to unburden and not call it the rite of reconciliation. I’ve said Ministration at the Time of Death more than I have baptized babies.
You know how to bless the hands of a nurse who aches to see her kids right now; you know that the holy water across her palms keeps her going. The words you say are nowhere in your tradition’s central ritual manual, but you know its power because you’ve seen it again and again.
More than ever, those we serve will be looking for a sign. On your units, you are the ritual expert. You are the walking symbol of sacred. Patients and staff will need to hear something holy; they will want something that feels like home. Not YOUR home—theirs. How well can you gather what they long to hear? How spiritually agile can you be when things are changing, minute to minute? Y’all, we’re the champs at this.
My prayers are with you as you go out, show up, and preside over our world of exceptions. You are needed more than ever if you can truly listen and hear.
PPS6: Provide religious/spiritual resources appropriate to the care recipients, families, and staff.
2.4 assess the strengths and needs of those served, grounded in theology and using an understanding of the behavioral sciences.
https://www.bcponline.org/PastoralOffices/death.html https://cebudailynews.inquirer.net/.../patient-no-40-to... https://www.jta.org/.../conservative-movement-leaders-say...
March 21 Mine and Theirs: Ambiguous Loss Edition
Outcomes 1.2, 2.1 Competency PPS5
"You can only accompany someone where you yourself have been willing to go."
My students grow weary of my mantra after awhile. I am constantly connecting the way they’ve related to themselves and the way they care for others. I call BS on that popular false humility: "I’m so nice to everyone else but I’m so hard on myself.” We treat others *exactly* how we treat ourselves. Ever had a boss that encouraged you to take time off but never did themselves? It gives you that sneaking feeling they resent you when you’re gone. Ever had someone preach grace to you when you knew they were harboring a grudge? In your role as chaplain, when you sit down (6 feet away, or via phone) to really listen to another person, you will only invite them to go as far as you’ve gone within yourself.
It’s time for a loss and grief check. We are surrounded by loss right now. Illness and death, of course, but look closer: physical separation from beloveds, financial insecurity, loss of control and certainty. Remember the six types of loss**? Take 10 minutes and make yourself a list.
Right now, there’s an added layer to the losses surrounding us: we don’t know the end-game. For the physician who has started sleeping separately from their partner, how long will that go on? The musician has no idea when the next gig is. How many online lessons should the teacher prepare? Ambiguous loss* creates complex grieving; you may notice yourself avoiding even acknowledging some of your losses right now because what’s the point? You don’t even know where all this is headed. It feels extra grim to name an ambiguous loss because it might get worse than it is right now.
Watch that closely, though, because the danger of *not* naming it is greater. If you numb it in yourself, your care will ring numb as well. Instead, if you make yourself a tiny margin to name your loss, you also make a little space for grieving it. If you don’t, you’ll surely pass that avoidance onto the staff you are serving. When the tech moans, “I couldn’t get extra TP! The store opens during my shift now,” can you make a little space for how much that sucks for her?
Cut yourself a break today on the big and little things you miss. Ask yourself, when it comes to loss, what’s mine right now? If you do, it’ll widen your capacity for theirs.
You know how it feels when someone’s care rings hollow, when the words are there but you can tell they don’t mean it. Don’t be that guy.
PPS5: Provide spiritual care to persons experiencing loss and grief.
https://www.google.com/books/edition/All_Our_Losses_All_Our_Griefs/oElLmY9KMxkC?hl=en&gbpv=1&dq=six+types+of+loss+mitchell&pg=PA35&printsec=frontcover#v=onepage&q=six%20types%20of%20loss%20mitchell&f=false
March 22 Full Tilt Clinical Method of Learning
Outcome 1.8
I shared with two colleague groups this week that I’ve always loved being a chaplain among chaplains because we are the people who can show up to any situation and be like, "No problem, we got this, we can make this work.” All my life in circles with religious types, I can sense the chaplain-types: alert, responsive, creative, resilient.
As a teacher of chaplains, I’m looking to catalyze those qualities within my students, so they show up to who-knows-what trusting their ability to assess, intervene, and observe the outcome. That way, they go into the next encounter with a plan to do that even better. They learn to self-reflect, get honest feedback, and head right back in again. In CPE, we call it the clinical method of learning. We revere the cycle of action—> reflection —> new action. Chaplains have always privileged learning from experience as well as theory. Many of us signed on because we saw Experience as a teacher informing our tradition.
In comparing notes with so many of you this week, this learning-from-experience thing is at full tilt. Almost on the hour, new policies reach to reflect new realities; it feels like by the time we figure out how to handle one part of this, something changes and we are pivoting again. We figured out how to get creative with PPE; we’re sharing resources live as we develop and test them. Another thing I love about y’all is that you have no interest in reinventing the wheel. We know how to put our heads together on the fly.
That’s our jam, so for awhile I noticed some us were all: “We were made for a time such as this!” Now, though, it’s also starting to wear some of us out. Lest we forget, Fatigue is another Experience teaching you. What will you learn from it?
I admire the collective spirit in us right now, and I want that flame to stay lit and burn long. So keep pivoting, and be sure to bench yourself often enough you can stay in the game.*
ACPE Outcome 1.8: use the clinical methods of learning to achieve one’s educational goals.
*Yes, no March Madness is killing me slowly.
March 23 Many Faces Suffer, Many Faces of Suffering
Outcomes 1.7, 2.2, 2.6 Competencies PPS3
It was over two weeks ago when I saw it: I was on the elevator with a young Asian woman and her elder, both wearing face masks. We traveled several floors down together, stopping more than once to let on new passengers. When the doors opened, people started to step on, saw the women and their masks, and stepped quickly back out. This was before we had any confirmed cases in our state (now in the hundreds). In the Times this morning, our Asian siblings are describing being spit on and yelled at, from coast to coast.
When stress runs high, our embedded theology rises to the surface. The oldest messages we received tend to run the deepest, and are least in check in crisis times. What were you taught, unofficially of course, about how the world works? Some of us were taught that for every bad thing that happened, someone should take the responsibility and blame. Some of our elders modeled staying quiet, keeping to ourselves, when the outside world grew scary. When they thought no one was looking, our elders sometimes leaked out a worldview that we have spent our adult lives revising.
Anytime someone draws meaning from their experience, we are in spiritual territory, and that’s your turf. Keep your eyes and ears open for these elevator moments, remembering that suffering has many faces right now. It has the face of a patient who finally gets word that they tested positive for COVID-19. It also has the face of a woman who already worried she wouldn’t get the same level of care as her white neighbor, because disparities in healthcare are real and documented. As much as we see this virus as universal, we who have attended to collective suffering know that some groups will suffer more than others.
As chaplains, you may be the only one who says to a person, "I saw that," "I heard that.” You may be the only one who notices that those loaded comments and actions cause suffering invisible to many others. What will you have the eyes to see and the ears to hear today?
2.2 provide pastoral ministry with diverse people, taking into consideration multiple elements of cultural and ethnic differences, social conditions, systems, justice and applied clinical ethics issues without imposing one’s own perspectives.
PPS3: Provide spiritual care that respects diversity and differences including, but not limited to culture, gender, sexual orientation and spiritual/religious practices.
March 24 You’re Always Having an Impact: What Kind?
Outcomes 1.5, 2.3 Competencies ITP5, PPS9
When we are in crisis and surrounded by this level of crisis, it’s easy to lose track of where we still have agency. For those of us in healthcare, things are changing so rapidly we may feel helpless to take any meaningful action. And yet, we are not reduced to passivity. Good old family systems theory reminds us we can each be a healthy influence on the system when we self-supervise. Here’s some simple takeaways for today:
Hey, Look! Here Comes Your Role in Your Family of Origin
When we’re under pressure, our oldest roles try to take over because in our lizard brains, we still believe these will get us through (for better or worse, they did!). Those with whom you’re working closely are wrestling their own. Watch out yours is not allowed to go unchecked. Ask a trusted colleague to help you watch for it.
Let Go of Expectations of Others
At any time really, but especially at a time like this, trying to get those around you to think or act more like you is pure futility. People are going to be deeply entrenched in their favorite ways of coping right now. Recognize that this is a time for utilizing and highlighting others go-to gifts, not asking them to eliminate their limitations.
Lower Reactivity
Being a spiritual caregiver means adapting to rapid change even in the most normal of circumstances. Notice any less patience with the internet speed? Feel extra short with that person who already irked you? You know what keeps you grounded right now; it’s up to you to crank the dial on whatever that is. It’s not easy, especially for those of you who come to the end of a long day of decision-making in response to your leaders, only to find circumstances have changed and you’re going to need a new plan in 8 hours. Whatever takes you from reactive to responsive, do that.
Develop More Objectivity
If you could crawl up to the ceiling of the emergency room right now, what would you see? Just for a minute, inch your way out of the five pressing problems that need immediate solutions and get some perspective. What is reasonable to get from today to tomorrow?
Self-Focus
In the end, you have agency with your actions right now. When we’re feeling out of control, remembering that we can self-supervise our responses to the next big thing reunites us with the truth: we can have a healthy impact on our system right now, or we can raise its anxiety and drag it down. How will you manage what arises within you today, so that you might serve others to the best of your ability?
ACPE Outcome 1.5 recognize relational dynamics within group contexts.
Outcome 2.9 demonstrate self-supervision through realistic self-evaluation of pastoral functioning.
March 25 What the Judge Said: The Importance of Spiritual Care
Outcomes 1.7, 2.1 Competency ITP1
Yesterday morning was our city’s turn for “Stay Home / Work Safe” — a version of shelter-in-place that apparently doesn’t put post-Hurricane Harvey Houstonians into the wrong kind of panic. Judge Hidalgo gave her press conference and answered the usual questions, questions we chaplains have voiced around the world: who and what is considered essential?
And then Judge Hidalgo said* the most striking thing — she said that our city would make an exception for ministers, because they need to see their people. She said ministers need to move freely in the city for mental and spiritual health purposes.
We who are chaplains don’t need our Mayor or our County Judge to legitimize us — we know our worth because we see the value of what we do every day. But the truth is, I’ve never heard a local elected official, at a time of unprecedented crisis, take the time to emphasize the importance of spiritual care. It took my breath for a minute.
A lot of the care you’re providing is outside the news ticker: you have remembered that people who were already lonely are even more isolated. Those who were already sick are still sick, likely with added doses of uncertainty. You are showing up to stand in the gap of family and chosen family who can no longer get into the building to visit their loved ones. You are, more than ever, the intimate stranger*.
Some institutions have deemed their chaplains non-essential, others essential. The truth is, not everyone is like Judge Hidalgo; there is no universal agreement on how vital you are. Take a minute today to picture someone seeing “Chaplain” on your badge in the elevator and asking, "What are you doing here? Why are you essential?” With Judge Hidalgo and me and countless others at your back, what would you say?
ITP1: Articulate an approach to spiritual care, rooted in one’s faith/spiritual tradition that is integrated with a theory of professional practice.
March 26 Dying (Not Very) Well: Corona Deathbeds
Outcome 2.2, Competency OL4
Many of us who are called to deathbeds — spiritual caregivers, chaplains, religious leader types — have ideas about "dying well." Ira Byock’s book** and the hospice movement laid a foundation for us. This notion that we can facilitate "the good death” has formed many of us in our approach to blessing, praying, and anointing our people as they lay dying. Some of us see end-of-life care as our most vital function, and it turns out most healthcare staff see us that way, too.***
In just September of last year, Byock wrote* “When people are competently cared for, many can feel a sense of peace — well within themselves and with others — as they leave this life. Preserving this opportunity is the fullest expression of community. Depriving people of the opportunity to die well seems the final social injustice.”
As more of us around the country move to Zero Visitor policies for our COVID-19+ patients, we are scrambling for the good death, working to prevent Byock’s final social injustice. We pull beloveds up on ipads for the dying to see. We call them from the other side of the glass to offer their comforting words. As chaplains always have, we make do with what we have, advocating for the sanctification of an otherwise horrifically clinical moment. We hold up the staff as they move on to the next bed. We have learned to communicate with our eyes; the rest is behind a mask.
The idea of dying well is under immense challenge, and I suspect we will have much to say about it in the months to come. For now, thank you for continuing to show up as creatively and safely as you can to mark what is holy. My prayers continue with you.
APC Competency OL4: Promote, facilitate, and support ethical decision-making in one’s workplace.
https://irabyock.org/.../Byock-Wellbeing-in-dying...
https://www.amazon.com/Dying-Well-Peace.../dp/1573226572
https://www.amazon.com/Paging.../dp/B00AOJ9IKK/ref=sr_1_2...
March 27 Birth in the Time of Corona: Chaplains as Midwives
Outcomes 1.7, 2.3 Competency PIC5
I can’t stop thinking of the babies who will be born during this pandemic. Parents are still gestating and laboring, of course, and right now, many are dreading going to the hospital. I can feel their fear of bringing new, vulnerable life into the world at this moment. Today, I read that the CDC recommends* all infants born to infected parents be separated immediately. I couldn’t take it—this latest recommendation for distancing. I wept.
Chaplains have long been compared to midwives** for good reason. We accompany; we facilitate. We don’t push the babies out, and we don’t extract them. We witness and we encourage. We carry wisdom but we don’t lord it over our careseekers. We hold it for when it is needed. We hold the room safely so that vulnerable, incredible transformations can happen, not by the skill of our hands but by the wisdom of our solidarity.
Like midwives, we chaplains are essential not because of the degree we hold or the vaccines we develop. A patient is less likely to survive due to our interventions than most members of the team. But anyone who has had a midwife will tell you: there is *nothing* extraneous about what she does. She empowers you to give birth because you realize it was up to you all along. As chaplains, where and when permitted, we empower patients and staff to do what they need to do.
You may increasingly feel your hands are tied. You may feel constricted in where you can go and what you can do, and because we are embodied practitioners, the phone and the ipad may feel like poor substitutes for hands grasped for prayer or the kneeling at a bedside. Remember: your solidarity is your skill. You will continue to witness transformations despite your distance. Babies are still being born all around us. What new life will you see today?
PIC5: Use one’s professional authority as a spiritual care provider appropriately
https://kutv.com/.../cdc-moms-should-be-separated-from...
March 29 One Size Rarely Fits All
Outcome 2.4, Competency PIC4
Over the weekend it has become more personal for many of us. We know someone who is infected or who has died.
Day by day our institutions make quicker and more substantial decisions; we use our voices in those huddles however we can.
Those of us comparing notes across institutions have found we can feel in lockstep one minute and worlds apart the next. In our particular shop, it feels so much has changed since the beginning of this week: visitor policies, priorities of care, dress code.
Those of us keeping social distance outside of work hold varied interpretations of CDC guidelines or how rigidly we should heed them.
In a crisis, one size rarely fits all. Each nursing unit has to flex according to its particular needs; each household has to set the boundaries that work for them. I’ve started to turn to colleagues and friends less for a universal agreement and more to hold each other up in our particular circumstances.
As spiritual caregivers, our best assessments look closely at particular needs and resources. The nurse in the COVID-19 unit might need you to show up in a very different way today than he did yesterday, because his patient has declined significantly. The family member that dismissed your phone visit on Friday has spent a weekend in separation and may need you to follow-up more than ever.
Today, let us renew our strength and our attention to the unique and particular needs of those we serve. Don’t forget to check in on yourself as well; it’s likely yours have shifted too.
Ongoing thanks for all you are doing; my daily prayers for you continue in earnest.
PIC4: Function in a manner that respects the physical, emotional, cultural, and spiritual boundaries of others.
March 30 The Shame Contagion
Outcomes 1.1, 1.2, 2.1 Competency ITP2
However you are rationing your news and social media intake, you contend with strong opinions about what you should and should not be doing right now.
It’s in-person, too: just this weekend, standing outside in a socially-distanced group of 7, I was approached by a stranger and told what I was doing was “illegal.”
You might feel shame that you didn’t start social distancing sooner, that you kept going into work when you didn’t need to. On the other hand, you may have been shamed for taking early precautions. Opportunities to feel bad about yourself right now are legion, and contradictory sentiments are in circulation: positive tests mean you were reckless, and negative results mean you wasted a test for someone who really needed it.
Shame is not only distressed consciousness of wrong-doing, it’s accompanied by feeling unworthy of belonging.* Psychologically, an abundance of shame keeps us quiet and it keeps us isolated. And in that emotional petri dish, it grows and spreads. This pandemic is breeding both virus and shame, and as spiritual caregivers, we are called to vigilance for the shame contagion. When we hear the patient or their beloveds speak shame about their contraction, we can hear them out and make it safe to disclose their wrestling with us. When we catch ourselves and our IDTeammates whispering judgment over folks who didn’t follow guidelines, we can interrupt our blame spiral and return to the refrain I have heard ringing across our institutions: we’re all in this together.
Take care that in your responsible caution you don’t get entangled in shame yourself, either for doing too much or too little. Redirect that awareness to the space-holding work of the chaplain. Remember: exposing shame to the fresh air and light of day is its remedy. Allow it to be spoken in your careseekers without trying to dismiss it or resolve it. Like the rest of their feelings, they need an ear who can really hear.
ITP2: Incorporate a working knowledge of psychological and sociological disciplines and religious beliefs and practices in the provision of spiritual care.
* Theologically, I challenge the idea that shame is wholly destructive, but that’s for another day.
March 31 Scrubs are the New Gowns: Staff as Primary Careseekers
ACPE Outcomes 1.7, 2.7 Competencies PPS2, PPS4
Most chaplains have seen a substantial shift in day-to-day focus. We have always cared for staff alongisde our patients, families, and visitors. Now, with our halls emptied of all but patients and staff, with contact precautions putting a virtual end to cold-call patient rounding, and with the pandemic stressing our systems to a lifetime high, our care of staff is more critical than ever.
But the reality is, there isn’t time or space for a lot of long heart-to-hearts right now. You’ll have to be quick, clever, and creative.
After reviewing the literature from 1981 and 2004, Brown-Haithco wrote* in 2012 that staff needs and struggles were much the same. In 2020, in the midst of this pandemic, her list is still right-on in caring for nurses, techs, physicians, administrators, and others still reporting in. In supporting your staff today, watch for these things:
Moral Distress: when our jobs take us against our own ethics, morals, and integrity.
Compassion Fatigue: when the overwhelm of the job burns us out of the original energy of our calling.
High Patient Volume and Acuity / Staff Shortage: speeding up licensure processes to get retired healthcare workers on the floor means we are gathering all the staff we can for the surge in our midst or on our horizon. This novel coronavirus has us catching up to an unfamiliar disease process at unprecedented rates, not to mention that folks are still falling ill and dying for all the usual reasons, just as they were before.
Lack of Appreciation and Affirmation: planned applause**, bells ringing out***, food delivery****, and other gestures are all ways I’ve seen folks showing love to our IDTs.
Organizational Change: bringing on retired staff to formerly cohesive teams, redistributions of staff in a labor pool, new policies each day, rapidly adjusting care protocols, and the backdrop of unprecedented cultural and economic upheaval — I’ve said it before: we’re always ready for change in healthcare, but this has us at our limits. Try to offer simple solidarity on the way constant change means never finding a routine, loss of sense of control and certainty, simple things being more challenging. Surely, you can relate!
What are you finding your staff teams need more than ever? How might you share that with your colleagues so that we can all rise more skillfully to this occasion?
Outcome 2.7: establish collaboration and dialogue with peers, authorities and other professionals.
https://www.amazon.com/Professional.../dp/1683362446
https://www.eater.com/.../restaurants-donate-meals-to...
https://www.wdbj7.com/.../Local-churches-ring-their-bells...
https://www.aljazeera.com/.../coronavirus-worldwide...
April 1 Do You Remember That You Have a Booty? And Other Important Questions
Outcomes 1.2, 2.1 Competency PIC3
I’ve always been hopeless at the embodiment stuff. When someone asks, “Where do you feel your stress in your body?” I usually want to say, “In the rolling of my eyes.” For most of my life, I treated my body like a machine: basic maintenance, take it to a pro when it breaks, and keep it moving. Recently, I realized a relationship between chronic stomach pain and unnecessary hurrying. Begrudgingly, I acknowledged personally what I have long known and taught professionally — our bodies keep the score.
Telling my close friend and her 7-year-old daughter about this, we came up with a plan. Rather than the sterile question,"How is your body right now?”, we decided to ask, "Do you remember that you have a booty?" This question made me smile instead of roll my eyes. It worked. I would suddenly remember I had a body again, and it would change my day for the better.
Bodies mostly feel dangerous right now. We are intensely aware of our physical vulnerability to this virus, but we also are working in uncomfortable new positions, straining our bodies with longer and different shifts, stuck at home against our will, or bent over our kids’ laptops where they are “going to school.” We are stiff with vigilance and anxiety. Some of us are eating less or more, moving less or more. We may be paying closer attention — “was that sneeze the VIRUS?” — or we may be dissociating from our bodies because our trauma histories are right. under. the surface.
Hospice chaplain Kerry Egan wrote:
There are many regrets and many unfulfilled wishes that patients have shared with me in the months or weeks before they die. But the time wasted spent on hating their bodies, ashamed, abusing it or letting it be abused—the years, decades, or, in some cases, whole lives that people spent not appreciating their body until they were so close to leaving it—are some of the saddest.
Today, can you remember that you have a booty? If you can, you are better equipped to help your staff remember, too. Finally, for those attending to the dying right now, via phone and tablet and through glass, how can you honor these precious bodies at their final moment? How can you keep watch over the age-old, sobering, sacred reality that someone is about to separate from their body, the only home they’ve ever known?
PIC3: Attend to one’s own physical, emotional, and spiritual well-being.
April 2 This is Your Brain. This is Your Brain on Emergency: Any Questions?
Outcomes 1.2, 2.1 Competency PIC1
You know the basics: limbic systems, amygdala, fight-flight-freeze. You may already know that first responders have override functions; by repetition, they’ve learned to push past fight-flight-freeze in the same kinds of crises over and over. During our training, we chaplains worried that we were becoming calloused to suffering and death, until we realized that being ready and capable was not the same as being calloused. We shifted from judging nurses’ gallows humor to joining them (out of patient earshot) because we realized this was part of how we were going to get through, too. Things that used to feel like an emergency when we first started became routine.
But dig this: "An emergency is a novel situation, not something we deal with on a regular basis. Therefore, we don’t have a 'mental script' on how to handle it.” We’re dealing with a novel virus, and that means, to various extents for each of us, this is a novel emergency. It doesn’t quite compare with past crises, the ones we built scripts around. I noticed this here in Houston, when I joked that Houstonians know only one kind of crisis — hurricane. Stockpiling water as though the virus threatened our water supply, even a run on some of the lumber used to board your house before a storm hits! For New Yorkers, comparisons to September 11th abound. You’ve read articles quoting folks describing ERs as a war zone. We’re coming up with the best similes we can. But none of them quite fit. So, as with other trauma, our brains keep whirring in the background, cycling through fight —> flight —> freeze, again and again.
When you listen to the staff you are trying to support, you’ll notice them compare this to the past crises they can remember. I noticed my kid bringing up past childhood injuries. Around a socially-distanced meal, I noticed adults telling younger folks about times of scarcity and fear in past generations. How can you hold space for what our people's brains are working hard to contain?
It’s no wonder you’re tired; your brain is trying to help you find the right frame for this. We are all making a new frame right now, in addition to whatever our bodies are doing. Grab some rest when you can; you’ll need your brain for what’s ahead.
ACPE Outcome 1.2: Identify and discuss major life events, relationships, social location, cultural contexts, and social realities that impact personal identity as expressed in pastoral functioning.
April 3 Dignity Inshallah
Outcomes 1.7, 2.2 Competencies PIC4, PIC6, PPS3
I fear we may be tempted to neutralize our differences at a time like this. During a crisis, an insidious sentiment can circulate: “we’re all just human in the end.” We are all human, of course, but this move to neutralize important differences, for example, at the end of life, can venture into implying that religious and cultural differences don’t actually matter. The truth is, what you think of as end-of-life dignity may be very, very different from the person to your left or right.
Chaplain Khurram at Stonybrook Hospital in New York was asked by hospital staff how best to care for Muslim patients who will die in isolation, surrounded by non-Muslims. In the comments, please see the attached resource as a guide. This is our reality, on a grand scale, for some time ahead. In my health system's onboarding education, chaplains are identified as a main source of information and guidance in navigating cultural and religious differences in patient care.
Those of us from dominant cultural backgrounds and religious traditions have a special responsibility to advocate for those in minority traditions and cultures. In a crisis this massive, some may move to minimize the needs of minorities. Our role is to keep them in the front of our mind. It is our Common Code of Ethics. It is all over our learning Outcomes and our Core Competencies.
Today and in the days ahead, may we be mindful of the dignity of every human body, in its uniqueness. At a time such as this, it may fall to us to advocate for the nuances of this dignity.
312.2 provide pastoral ministry with diverse people, taking into consideration multiple elements of cultural and ethnic differences, social conditions, systems, justice and applied clinical ethics issues without imposing one’s own perspectives.
April 5 Risk Vectors and Ghosters: The Chaplains of COVID-19
All my friends have forwarded me the New York Times opinion piece, "The Men and Women Who Run Toward the Dying.” How about you?
In our shops, you have been told you are essential, and you’ve been given the freedom to attend to your units’/hospital’s unique circumstances. You’ve been told the staff need you desperately, and that you, in turn, must rely on the staff to tell you which rooms to enter. If you’re on duty, you respond to the multi-patient task list, just like always, only now, you have to strategize how to connect with that patient across contact precautions or potential contact precautions. In some ways things have been radically simplified, because it is staff. and. patients. Even though we are in unprecedentedly busy and chaotic times, the unit halls in our two locations can have a dissonant, eery silence.
Not all chaplains have been given the freedom you have. Across the country, some were mandated to stay home weeks ago. Some have been told to only communicate with patients via ipad or phone. You are told to show up, consider yours and others’ safety, and be the chaplain you were called to be. That level of discretion is a window into your staff chaplain future. Soon, it may very well be you who decides what is safest and what is best for the people you serve and serve alongside. For this and many other reasons, being a CPE student means you are learning to be a chaplain at an historic time. The truth is you are crash-coursing disaster chaplaincy; this is OTJ training most CPE students never get.
But I want to make space for another truth: this freedom can also be deeply unsettling, perhaps particularly as a student. Even onsite, you face choice after choice: "How closely should I approach the nurse I really want to check in on?" "Is it more connective to call the patient than to shout a prayer at them from 6 feet away?” On the one hand, you know you are a risk vector: you know that 1 in 4 are asymptomatic carriers, that you are asymptomatic and interacting with many patients and staff daily. You do your part by increasing precautions for your cohabitants and fellow resident office-mates. Likely you have loved being needed and central to this action — many of us got here via some fun version of that song. But on the other hand, you may feel like a ghoster: chaplaincy is embodied work. We don’t just talk about ministry of presence, we live it every day. If you are not physically visible to the patient, or seem like you’re stand-offish to the staff, if you’re absent in any interpretation of that word, have you failed?
There’s no one answer to the Risk Vector vs. Ghoster dilemma. The faculty and your staff coaches have your back as you deftly navigate work ethics right now, and we are navigating with you. I disclosed to you my deep guilt for not being on the frontlines with you, my ambivalence about being a teacher first, chaplain second for this moment in time. It feels so wrong, and yet, if I were there, I would model a need to be needed rather than clarity and humility in my role. So, my prayers continue with you. My every spare thought is on your goals, your home life, your discernment, the minutiae of your daily work. As you continue to exercise your freedom, know that it is not without the support of a great cloud of witnesses, both visible and invisible. I am proud to be your teacher and your colleague.
April 6 Ye Olde Feeling Wheel: A Daily Practice
Outcome 1.6, 1.9, 2.1 Competency PIC2
I asked our staff chaplains what they thought you should focus on right now, as CPE students experiencing this firsthand. More than one of them said the simplest and most powerful thing: journal your feelings each day. Later, when this is “over,” you’ll want to go back and remember how you felt as this unraveled, day after day.
So, in case you forgot, here’s the good old Feeling Wheel There’s a lot of these out there, and you know my feelings on some of them (begin rant:: love is not a basic emotion, “bad” is not a feeling:: end rant) but this one I approve.
In my house, we have this wheel on the fridge, with a magnet for each person. At the beginning, middle, and end of each day, we move our magnet to the appropriate place. We also have Todd Parr’s feeling flashcards for added fun (pray for Ira, raised by a CPE Educator).
For your weekly reflections for individual supervision, consider bringing a week’s worth of feelings in addition to your other prompts. Make this simple on yourself. Don’t expect a daily novella. Don’t make it harder than it is. But do that feeling check, and write that sucker down.
In the midst of all this it can just feel like too much. So do things for yourself that keep you invested in your learning without increasing overwhelm. Keep track of yourself, and a lot of the rest will follow.
PIC2: Articulate ways in which one’s feelings, attitudes, values, and assumptions affect professional practice.
https://drive.google.com/file/d/1iXS69k6z3WDXJSIRIuLWyxvOgfAeWE5U/view?fbclid=IwAR0ITRHHPRJ2xZxXdbx4jw6TyYptdfEmCzsG7fwP1QBIHOv-N9tcScDXxm4
https://www.amazon.com/Todd-Parr-Feelings-Flash-Cards/dp/0811871452?fbclid=IwAR342VgR1xOreYU6b_0HGcVpKJSB8yq8cAYJJBz1BknnbTg7b7WihEHs0vA
April 7 Bodhisattvas, Prophets, Saints: Carrying Us Through
Outcomes 1.1, 2.1 Competency ITP1
Your tradition has lifted up exemplars of faith and practice, spiritual leaders who shine a light on your path for today. In a time that can feel overwhelming or confusing, when the next right thing can feel fairly obscure, who are the paragons in your spiritual lineage?
Today, in one of my many saint calendar resources, we lift up Patriarch Tikhon. I don’t remember ever reading about him before Morning Prayer today. Even this encouraged me; there is always someone amazing and new to inspire us. Countless people are making the world a better place right outside my line of vision. Today I learned that in the midst of terrible famine, Archbishop Tikhon sold church property to buy food for his people. It reminded me of St. John the Divine converting itself to receive patients on the Upper West Side.
When you look around, past and present, whose example brings you comfort and inspiration? In your observances today, how can you mark the good weight of their influence? When you look back on this time, you may see that they lessened your burden in the witness of their life. It may be your contemporary, in which case, how might you let them know?
ACPE Outcome 1.1 articulate the central themes and core values of one’s religious/spiritual heritage and the theological understanding that informs one’s ministry.
April 8 Trauma and the Betweentime
Outcomes 1.1, 1.2, 2.1 Competency ITP1
While we continue to endure this crisis, it is important that we think of trauma not only as singular past events which intrusively replay themselves into the present, but also a term inclusive of ongoing threats to survival, void of start- and stop-points. We are in this kind of collective trauma, whether we have been furloughed, report in, take the day off, or work from home. We are facing an overwhelming, ongoing sense that our existence is under threat. We are traumatized and don’t know yet when it will be over.
In my pod, we have started using three terms: the Beforetime, the Betweentime, and the Aftertime. When we are frustrated that we can’t run freely, we grieve our autonomy in the Beforetime and we make plans for the Aftertime. We dream of restaurant patios, the smell of the pews, the hug of our friends. We talk about the renunciations required of us in the Betweentime, so that all of us, known and unknown, can be safe. We are sometime scared to acknowledge that we don’t know how long the Betweentime is going to last. We can dream of the Aftertime, but we can’t find it on the calendar yet.
For (liturgical?) Christians, one way we enter this experience is via the slowly unfolding drama of Holy Week. Particularly, we might zoom in on and hang out in Holy Saturday. This day, unlike any other, is our built-in acknowledgement of the place between a singular awful event and the promise of new life. Between crucifixion and resurrection, it is the space where, if we commit to entering it through Mary Magdalene and the other disciples' footsteps, nothing feels quite real, we don’t know what to look forward to, and there is a visceral nothingness. No white lilies, no lamb cakes. No veiled crosses, no solemn collects. Just space, really.
In your faith and practice, what accounts for Betweentime? How might you use a part of your spiritual tradition as compass in the face of nothingness, collective trauma, and a decided absence of triumph? This compass may center you in or release you from your hamster wheels and your numbness, however it is you have tended to cope with trauma. In this never-ending graveside vigil, may we be a witness and find a witness. For now, for me, this is the only comfort that doesn’t ring cold.
ITP1: Articulate an approach to spiritual care, rooted in one’s faith/spiritual tradition that is integrated with a theory of professional practice.
April 9 Things Have Most Definitely Fallen Apart, so We Might As Well Listen to Pema
or the 6 Kinds of Cool Loneliness
Outcome 2.6, Competency PPS1
If we’re going to survive this emotionally, we better draw all our resources to us, right? Every word of Pema Chodron's book When Things Fall Apart is useful, I admit it. Her loudest wisdom for me today addresses loneliness. Not "hot loneliness”—restless and full of desire to escape and find someone to fill it up for us. Because, good luck on that right now. You are surrounded by people, but you can’t get physically close to them. No, today, we’ll focus on “cool loneliness,” which means accepting that we are lonely right now, being adults about it, and finding a way through it. Lucky you: it has 6 faces.
Less Desire: instead of rushing to fill our loneliness, we sit with it for 1.6 seconds. We look to be less driven by our Very Important Story Lines. We could never do this all at once; we do it little by little each day.
Contentment: we settle into the idea that not everything can be resolved. We give up the idea that filling out loneliness will automatically lead to happiness.
Avoiding Unnecessary Activities: are you staying super busy at work and home as a way to not feel? Since you can’t hug your kid when you come home, are you avoiding them by fixing all the things?
Complete Discipline: we just keep bringing ourselves back to the present moment, each time we’ve gone AWOL in ourselves. A million times a day, if you’re me, you say, oh hey, I left again. Let’s come back.
Not Wandering in the World of Desire: food, drink, online shopping, other people, you name it. What did you find yourself wandering in to get away from that unsettling feeling that comes with being alone?
Not Seeking Security from one’s Discursive Thoughts: if you’re like me, a lot of your inner-chatter is not your friend. It can be pretty harsh, and really loud! Letting those voices exist (try demolishing them, see you next year) and not obeying or following them can be liberating.
Since we’re already going Buddhist today, it’s time for a painfully hard truth: we are all alone. We will all die alone. Rabbi Kara Tov, being interviewed about being a chaplain in NYC during COVID-19, said it well. In response to the interviewer asking about the horror of death in a no-visitor-policy world, she said,
Dahlia, dying is something no one can do with us. We all die alone. Being “with someone” (as in, physically present when they die) is an idea we love because it gives us closure and peace. It is about us, not the patient. The patient is dying. That is their work alone. But not having the closure you want is very hard and sad and a frightening thought.
So there it is: we are alone and we are lonely. The virus focusing our heightened awareness of this could break us, or it could wake us up. Your emotional availability with careseekers is not dependent on physical touch; you are more creative and skillful than that. You know how to work with all kinds of boundaries and make meaningful connections with others. Use your loneliness as a resource today. When you actually accept it, it can become a powerful source of connection.
2.6 demonstrate competent use of self in ministry and administrative function which includes: emotional availability, cultural humility, appropriate self-disclosure, positive use of power and authority, a non-anxious and non-judgmental presence, and clear and responsible boundaries.
https://www.amazon.com/When-Things-Fall.../dp/1611803438
https://slate.com/.../chaplain-nyc-coronavirus-interview...
April 10 Suffering Together
Outcomes 1.1, 2.1 Competencies ITP1, ITP3, PIC2
I will never forget the night Michael and Ali came with me to Maundy Thursday services. We had committed to spending a year together eating, studying, and attending each other’s important observances. We started with 9/11, which that year fell on Eid. Later, Ali and I stood silently on Yom Kippur as Michael covered his family. Near the end of our year together, we shared iftar in Ali’s home; that summer night I knew that Michael was sick again. Our last observance together was Michael’s own funeral, shortly after Hurricane Harvey had come mercilessly, destructively over our beloved city. Michael's cancer returned swiftly and decisively. The three of us were at his bedside the night he died.
In the middle of that most sacred year, this Rabbi and imam joined me for Holy Week observances. I drew them into the drama of the Last Supper, the meal where Jesus began his goodbyes, where he lifted bread and wine, where he washed his disciples' feet. Michael placed his bare feet in the basin, and a teenager of my parish washed them. We didn’t know then that he, like Jesus, was being prepared for burial, that lavish acts of service were perfect for the time and place. I cried then because he was so willing and never hesitated to participate; I had no idea how prescient my tears were.
In my tradition, we are in the middle of the Three Days, the touchstone of my theology of suffering. My God is one who suffers-with, who knows human anguish in their body. As a chaplain and educator, I know my calling is to solidarity in suffering, after the example of my willing, unhesitant, co-suffering God.
I no longer need to hyperlink examples of suffering together. You are in the grasp of it. For each of you as chaplains, you must be able to articulate why you move closer to these experiences. Beyond your natural instinct to help, for which you’ve been recognized and rewarded throughout your life, what does your spirit and heritage tell you about the nature and call of suffering? Take a moment to know your quickest, easiest answer to this question. Later, when you have more time, mix the yeast into it. See what rises.
All my love to you on this Good Friday,
April 11 Pedestal Pressure and the Chaplain’s Work: Staff Care vol. 7,983
Outcomes 1.3, 2.7 Competency PIC8, PPS2
When I asked nurse and physician friends from around the country to tell me what they want chaplains to remember right now, the theme was definitive:
“that our fuses are shorter just like everyone else’s,”
“that we are scared and struggling too,”
“that we are a mixed bag of emotions—fear, pride, grief, anger, and happiness.”
No question: our healthcare teams are the real MVPs right now. We have called them heroes because that is what they are. As those entrusted to care for these heroes, it’s up to us to think critically about what that means. Ever been labeled a hero? Right on the heels of a swell of pride, a moment of gratitude for recognition, that relief in feeling appreciated, you may have detected another set of feelings: pressure, anxiety, and even shame.
For some staff, the hero designation can be just another high expectation. Now, not only must they pull their shift, they must pull it heroically. Superheroes rarely discuss sleep deprivation, childcare stress, missing their favorite foods, a tough boss. As chaplain to staff, how might you recognize the very fragile and exquisite human inside that hero, and give them a safe minute to talk about their beloved pets, how they miss their own bed, their financial concerns. You know well that all the stress you carried in the Beforetime is still there, and they may feel guilty for talking about it. How might you recognize the pressure of the pedestal?
Our staff chaplains are hearing a lot of gratitude for written support as well as verbal. Sharing a daily inspiration with nurse managers and house supervisors, so that they can care for their teams, is another layer of your skill. Resources for this are everywhere and growing all the time, from our own internal shared drive to the Chaplaincy Innovation Lab. If Saturday is a moment of rest for you (thank you, Duty Chaplains!) take it to think intentionally about how you can diversify your ways of showing staff support.
2.7 establish collaboration and dialogue with peers, authorities and other professionals.
PIC8: Communicate effectively orally and in writing.
https://chaplaincyinnovation.org/.../chaplaincy-coronavirus
https://drive.google.com/.../1XN.../view...
April 13 New Policy? No Problem! ()
Outcome 2.5, Competency OL3
During most of our check-ins, we touch base on policy changes. Each day has brought a new protocol, a revision of the one we just got used to following. Who wears a mask, where to wear it, how you’ll get your temperature taken, what kinds of rounds to do. The faculty have been really grateful for and impressed by how adaptive you’ve been to the constant change. Healthcare chaplaincy, like all of chaplaincy and all of healthcare, is full of continuous flux. The best chaplains are experts in pivot and adaptation. Some of you have expressed liking this part of your Residency year; you are getting an unforgettably extreme case of this hallmark of our work.
If you are talking regularly with chaplains at other institutions, you know that every place has approached the CDC recommendations differently, in response to our unique context. At some point, if not in the busy-ness of your Monday, it is worth reading these rec’s alongside our administration. The closer you look at the way our own policies have unfolded, the closer you get to understanding the culture of our particular hospital and health system. What are you learning as you observe our institution’s culture? What differences do you notice in the way physicians and nurses discuss this?
When you spread your wings to another institution and function as a staff chaplain, what you took time to observe and learn here forms your ability to assess and adapt there. Bring your observations to group and individual supervision. Use family systems theory to conceptualize your observations. Bring a verbatim of a staff encounter in which you demonstrated your understanding of the system’s culture and your role in it.I know it’s supremely annoying to keep hearing from me, “This is going to prepare you so well!” but truly, it is. And I’m thankful for grit, your commitment, and your resilience.
OL3: Understand and function within the institutional culture and systems, including utilizing business principles and practices appropriate to one’s role in the organization.
2.5 manage ministry and administrative function in terms of accountability, productivity, self-direction, and clear, accurate professional communication.
https://www.cdc.gov/.../hcp/hcp-hospital-checklist.html
April 14 Will 'Ministry of Presence' Change Forever?
Outcomes 2.3, 2.6 Competencies PIC4, PPS2, PPS4, OL1, OL3
In the DNA of most chaplains dwells the phrase “Ministry of Presence.” It has shaped most of us definitively. We learned the phrase in CPE or in pastoral theology courses in seminary, or from the first books we read about spiritual caregiving. Somewhere along the way, we decided that “being present” was the heart of what we do.
It’s no surprise that some chaplains have interpreted this as a mandate to our physical presence in the heart of the action. If we are the Presence People, and we are in any way absent, then we are less than a chaplain. I’ve heard some of my elder colleagues cite their experience during the AIDS crisis, remembering the powerful witness of showing up and physically accompanying the sick, the dying, and the staff through a time of incredible stigma. COVID-19 is a very different kind of dilemma, because of its transmission. Many of us are asymptomatic carriers, visiting folks who, by the nature of being a patient in the hospital, have a compromised immune system. Some chaplains have now become patients in the ICU. A ministry of physical presence is also a potential ministry of transmission — to ourselves and others. Any theological hints of martyrdom concern me greatly, because it minimizes our potential to infect others.
Many chaplain teams have not resigned themselves to the mandate of physical presence in light of the risk. We too have joined the ranks of the safer and more creative, calling our infected patients and their families, being swift to make contact before someone is ventilated, so that, before they cannot communicate, they know someone is accompanying them through barriers of glass and PPE. We call non-infected patients who are trapped in mandatory pandemic isolation, because, as one of our colleagues put so well: “a call is often more intimate than a prayer shouted from 6 feet away.” The staff has shared that seeing you on the floors, even if they are too busy to engage you much, has brought them comfort. Thoughtfully, you choose physical presence with them, knowing two things: you all share high probability as carriers, and that fear is as present and invisible as the virus itself. Chaplains of vulnerable populations (>65, underlying conditions, immunocompromised) or otherwise very anxious about their own health or the health of their families, may recognize that their best offering will not be physical presence, because they add more anxiety than they can relieve.
I won’t be sad if “Ministry of Presence” gets more nuanced as a result. May we bring a theologically and ethically sound ministry of presence, one that questions the assumptions built on previous pandemics and crises. May we respect the uniqueness of this pandemic, so that we will look back and see that we did not barrel ahead thoughtlessly, but rather understood ourselves as risk vectors and found a way to be the balm we were called to be. May we see ourselves take our place in the line of chaplains past, who weren’t afraid to learn and share scientific wisdom, who were self-aware enough to recognize which kinds of presence brought help or harm. My two cents? That’s what real courage looks like.
2.6 demonstrate competent use of self in ministry and administrative function which includes: emotional availability, cultural humility, appropriate self- disclosure, positive use of power and authority, a non-anxious and non- judgmental presence, and clear and responsible boundaries.
From New York Times interview with Jack Kornfield:
It’s a particularly tough time for health care workers and their families. How might we ease their thinking? So my daughter’s husband works in an urban fire department. Like many first responders, he does not have masks. About 80 percent of his work is emergency medical calls. And today I spent time talking with someone who’s been advocating on behalf of hospitals and healthcare workers in order to get them the personal protective equipment and ventilators they need. He’s in a family of physicians, and they’re going in without protective equipment. So what could I say to all these people? My eyes tear up. I can say that in spite of the fear and the real possibility of dying or infecting others around you, this is what you trained for. This is the oath you took. We’ve tended one another through epidemics before, and now it is our time to do it again. And do not feel that you’re alone. Let your heart open, and feel the web of physicians and nurses and front-line responders around the world who are willingly placing themselves at the service of humanity. You are showing how we can care for one another in a crisis. You have a team of a million who are voluntarily linking hands and saying, “We know how to do this.” I could weep as I say that, because it’s not something glib. It’s true.
April 15 The Pastoral Neglect of Children
Outcomes 1.7, 2.2 Competency ITP3
As spiritual caregivers, you interact with children in a wide variety of ways: on call to labor/delivery and the children’s hospital, or in a regular clinical placement there. Rarely now will you see any children on campus who are not patients themselves. At home, you may have children crossing your path regularly, or you may be more likely to see them on neighborhood walks, since they are “schooling from home” and without access to playmates.
In our city’s context, most of the givens in children’s lives are upended, just like yours. School has become something they never imagined. They are suddenly with their parents all the time, and their parents have become Stress Monsters, trying to juggle their own shifted positions, caregiving routines, and all the new normal that is upon us. How have you found yourself attending spiritually and emotionally to them, inside and outside hospital walls?
Andy Lester remarked that when he asked seminarians to write about their significant life crises, many of them chose a pre-adolescent event or experience, and they reflected that while the spiritual caregivers at the time often attended to the adults around them, clergy never spoke to them directly at all. In this Western cultural context, we’ve spent a few decades idealizing childhood, leaving us desperate to protect an innocent, joyful view of the world. Unfortunately, we often forget that our own childhoods were full of fear, sadness, anger, and grief. We erase this from the children in front of us, celebrating their resilience because it’s so much easier than moving close to their pain.
Mark my words: the children and young people in your life are wrestling with this crisis just as you are, with fewer experiences and resources from which to draw, dependent on the adults around them to model coping, grieving, resilience, and reflection. When you acknowledge them directly, you communicate your awareness of their personhood, their agency, and their contribution to the world NOW. Try to remember that they communicate often in play, and that they, like you, have been socialized to believe no one may be interested in their take on the matters at hand. When you take the time to notice them, look at them, speak to them, and communicate curiosity about their inner worlds, prepare to be amazed at their depth. If you are up for the work it takes to get past their excellent judgment of character and authenticity, they may believe you that they matter.
The world will be different as today’s children grow. How will you attend to them?
ITP3: Incorporate the spiritual and emotional dimensions of human development into one’s practice of care.
https://www.amazon.com/Pastoral-Children.../dp/0664245986
April 16 Nerd Out: Journal-Combing and Responsible Practitioners
ACPE Outcomes 1.6, 2.8 APC Competency IPT6
When you encounter something on the floors and you think to yourself, I wonder if anyone’s thought about this before?, what do you do with that question?
Yesterday in group, one of you brought up a connection between a careseeker’s theology and the script they may use to engage with us. As we explored Pruyser’s concept of pastoral diagnosis, we wondered whether using his decidedly Christian grid would encourage playing a game: The Good Christian Pleases the Chaplain.
This sparked my curiosity about the connection between theology and grieving, another theme of your unit. Turns out, the previous issue of the Journal of Pastoral Care and Counseling has an article about this very topic. Any member of ACPE and APC has access to this journal anytime.
Besides your peer group, coaches, Educators, and other chaplain colleagues, a very important companion in your self-improvement is the literature of our field. I want you to bring these questions up in group and individual supervision, of course, but I also want you to go start poking through our journals. This is the habit of a responsible practitioner in any vocation. Next unit, we will further explore research literacy as a primary competency of our vocation.
I’ve reminded you often that we are in unprecedented times for chaplains. As the surges ebb and flow, as we turn our heads more and more to the Aftertime, we will begin to find margin enough to address what it was we just experienced, and how these experiences change what we understand about the work of the spiritual caregiver. It will be an especially thrilling time to have journal-combing in your professional habits. Does that sound nerdy? Join me.
ITP6: Articulate how primary research and research literature inform the profession of chaplaincy and one’s spiritual care practice.
April 17 Acute Loss Calls for Acute Care
Outcomes 2.4 Competencies PPS4, PPS5
Collectively, as we face our mortality worldwide, many of us are leaning on what we learned in past hard times. Unless we are in full-on numbing mode, many of us are remembering how we have coped with past crises. Some of us are recalling the acute stages of our life’s losses. As spiritual caregivers, we ponder: how were others helpful to me in that horrible moment? We want to be calibrated and effective in caring for those who lost their income, got sick, mourn a loved one, and feel trapped in their homes.
“God is…”
“You’ll look back on this and…”
“Keep up the…”
When you put yourself back in a time of acute crisis, it may become more clear that several things are unhelpful: teaching, premature meaning-making, and advising. These are things that that bring *you* relief, and questions *you* are pondering as the outsider, but they are insensitive to the throes of acute grief and trauma. Remember when you were still asking yourself if what just happened was actually real? Imagine someone coming in and asking you to think about the lifelong meaning of that event in the same moment that you are still pinching yourself. It’s just too early. It’s not time for that yet.
In the acute phase of loss or trauma, your work is compassion that inspires self-compassion. This is not telling someone to be compassionate with themselves; that’s just another command that’s unhelpful in the moment of crisis. Instead, this is the time for *embodying* compassion, which signals they are worthy of it. You create and hold a momentary safe space for them to exist, you reflect their thoughts and feelings, you are clear about your availability, and you stick to what you say. Later, as the acuity lessens, and you have built rapport, you may have the chance to reflect on God’s presence with them in the midst of their distress. Again, you are listening for it in what *they* say, not telling them where you think God is. It is out of their own understanding that they will continue on their journey, not of our yours.
Keep up the good work out there.
2.4 assess the strengths and needs of those served, grounded in theology and using an understanding of the behavioral sciences.
https://www.iliff.edu/carrie-doehring-shows-spiritual.../
April 20 New Boundaries: Telechaplaincy for Inpatients’ Loved Ones
Outcomes 1.7, 2.2 Competencies PPS1, PPS2, PPs4, PPS9
When I have offered mini-didactics about boundaries for hospital chaplains, one of the things I emphasize is discouraging ongoing relationship outside the walls. Because many of you came from congregational leadership contexts, it was important to emphasize that your pastoral oversight aligns with the census. (Some chaplains work with outpatient populations and that’s a whole thing, but for you, your careseekers are inpatients, their loved ones, and the staff.) Most of hospital chaplaincy has assumed the in-person, face-to-face connection of visiting actual rooms. Until now, supporting friends and family of the patient has meant seeing who has decided to visit the patient’s room that day.
Some of you are wondering how to restructure your day. After rounding with staff, visiting solitary patients at safe distances, and checking in with coaches and colleagues, some of you are wondering what else you can do with a lowered census, no visitors, and 6-10 feet of space between you and those you see. I could not envision that making spiritual care phone calls would become an important opportunity of your Residency year, but here we are. At a time when you are still practicing the art of deep listening and response, when the foundational conversation skills are still making their way within you from stilted to second-nature, increasing your ability to offer spiritual care by phone is a new layer of challenge.
Remembering that loved ones are isolated from their patients, you may be one of a very few people who can offer a bridge of connection. You will not have the medical information they seek; you will need to practice clarifying what you can offer and what you can’t, but making a concerted effort to offer the same care to the patient’s beloveds that you did the first half of this year may make a huge difference in this time of extended isolation. Use the skills you’ve been practicing in person as you use the phone; leave room for silence, reflect feelings and needs, share perceptions and observations. I encourage you to bring examples of these conversations to group and individual supervision.
Thank you again for your pioneering spirits. The faculty is grateful for your curiosity and determination!
PPS2: Provide effective spiritual support that contributes to well-being of the care recipients,
their families, and staff.
April 22 “You’re too _____ to be my Chaplain” : Evocative Presence
Outcomes 1.2, 2.1 Competency PIC5
You’ve noticed that before you’ve even finished introducing yourself, some people are vigorously welcoming you into the room and others are full of side-eye. When you say “Chaplain,” some brighten up instantly, some stiffen, and some go blank.
You’ve noticed that people make assumptions about you based on your race, your gender, your age, your physique, and now, when you call them, the sound of your voice. You’ve either had to soften your booming tone or you’ve had to speak up to be heard and understood. You’ve gotten used to the fact that you have to navigate those assumptions if you want to make a real connection with the person.
What you are navigating is what Steve Nolan calls Evocative Presence The careseeker has instant associations with the look and sound of you that may have nothing to do with who you actually are or what you’re really like. (In psych terms: transference.) If you remind the careseeker of their beloved grandchild, guess what? You start out from Grandchild and go from there. If they’ve never actually known someone of your race, you start out from their stereotypes or their desperation to prove they aren’t racist. Either way, you’re starting from whatever they think you look and sound like. You go from there.
When anxiety and fear are high, when trauma histories are kicked up, as they are in illness, your evocative presence may illicit an even stronger reaction than usual. When the careseeker has no visitors, each person who approaches them can feel like more of an invasion. Sometimes you bring positive associations but they aren’t actually aligned with the work of the chaplain, ("Oh good! The religious person is here to tell me God’s plan for me!”), so you work within their welcome to clarify your role. A negative evocative presence (“This fundamentalist pastor is here to try to convert me!”) leaves you to deftly clarify why you’ve come. It’s possible to use both positive and negative associations to be a source of accompaniment and comfort. Some of you have to work harder at this than others on a daily basis.
What have you learned about the first three minutes of your visit in clarifying your role from the projections you’ve stirred? The more awake you are to your evocative presence, the more likely you’ll be able to navigate into spiritual caregiving. Evocative presence is often surmountable, but not if you’re in denial that your presence is embodied and that is having a very decisive impact. Get real about what people are assuming about you and get savvy about it, so that you can focus on the careseeker’s needs, losses, and struggles, and get yourself out of the way.
1.2 identify and discuss major life events, relationships, social location, cultural contexts, and social realities that impact personal identity as expressed in pastoral functioning.
April 23 Helpers’ Shadow: Existential Debt
Outcomes 1.2, 2.1 Competencies PIC1, PIC2
Central to the work of the chaplain is self-awareness, because, as I’ve been relentlessly reminding you, *you* yourself are the primary tool of your work. Knowing your tendencies, your triggers, your strengths and liabilities are all critical to your use of self.
It is highly likely that you became a chaplain because you are a natural helper, but is also highly likely that there is a shadow to your helpfulness. Usually, those of us who devote our lives to serving others carry a strong desire to right some wrongs of our past. This shadow usually sprouts unconsciously, but as a professional caregiver, it is vital you be acquainted with this Existential Debt — your sense of making up for wounds, for traumas, for shortcomings of others that you experienced long ago.
For me, being the big sister to two little girls who really needed me shaped me irrevocably. I grew up fast in the chasm left by our mother’s mental illness and abuse, and became a protector and a primary nurturer at the tender age of 9. The shadow that sprouted in me was, “If you don’t help, something bad will happen.” Now decades from that reality, the shadow still has power, but because I was willing to face it and name it, I can learn to see the actual needs in front of me. If I didn’t do this work, I would project the needs of the past onto the world of the present. Our existential debt is a delicate beast, because it is absolutely the roots of our giftedness in caring for others; it’s just also that, unchecked, it's a dangerous reason to get up in the morning.
When the need for good helpers is so drastic as it is now, your shadow can loom larger and louder. Since the pandemic started, did you catch yourself thinking you were Wonder Woman yet? In your genogram, your mining of your personal history, your therapeutic work, and your spiritual direction, what have you learned about your existential debt? What have you learned about what lurks in your helper’s shadow, and how have you learned to manage its power?
2.1 articulate an understanding of the pastoral role that is congruent with one’s personal and cultural values, basic assumptions and personhood.
April 27 Comment Card Inspection: the Art of Walking Around
Outcomes 1.7, 2.6 Competency ITP 2
Last week, our TMC department was named Heroes of the Day. Several emails of gratitude came rolling in, pointing out how we make the community feel “grounded,” by "the support that underpins our collective body of caregivers.”
Every spiritual caregiver I know is trying to reach our people in meaningful ways. This was that rare, tangible confirmation that you are doing just that.
In the hospital, we can tend to look for the best programs available to accomplish our goals: the Best Staff Care Initiative, the Best Telechaplaincy Model, the Best Spiritual Assessment Tool.
The notes I read did not mention any official programming. Over and over again, the word i read was “presence.”
To be the best spiritual caregivers we can be, we maintain our excellence in what my friend Rob calls The Art of Walking Around.
When we want reassurance of our excellence, we can trust that rounding on the units, remembering folks’ names, asking after pets-partners-progeny in meaningful ways, and showing up again the next day is the best program around.
In Organic Community, Myers writes that “people want to participate in organic ways, not in 'strategic' ways.” Out of his research and experience in healthy communities, his summary of five key markers shapes my work as a chaplain on a team that serves a larger team:
How do People Participate?
as individuals, not as teams or groups.
in a decentralized, local way.
with the whole of their lives.
in a way that is congruous with the way they are asked.
so that the aggregate of their participation becomes “known” as the team or group acts, thinks, and makes decisions.
In other words, groups are simply what the individuals together do. As a caregiver on your campus, you are both a member and a steward of your groups. As you attend to folks today, focus on the Art of Walking Around. Remember that the notes we received proved this is central and vital to our work; this is what people will remember about what you bring.
ACPE Outcome 1.7: initiate helping relationships within and across diverse populations.
April 28 Wear Your Mask While You Get a Tattoo: Two FST Questions for Confusing Times
Outcome 1.5, Competency ITP5
In our city, these are now not only deeply sad* times, they are increasingly confusing times. Our city-wide mask order took effect yesterday, on the same day that our governor issued graduated reopening plans. Never was there so great a need to pause and ponder the difference between what is legal/illegal and what is safe/unsafe. Crushing economic forces may obscure your discernment. As a Midwestern transplant to the South, I have to keep pinching myself: individualism is a fiercely-held cultural value. This yankee hears cowboys with government titles saying, “I’ll do exactly as I please.” And indeed, even if you prefer a more collective approach, you are left with city- and state-wide order in opposition: everyone is a cowboy now.
This staunch focus on individualism may make family systems theory more relevant than ever for your place in the hospital, the city, and the state. Since it is up to you whom you believe and what you do with that information, the call for healthy differentiation may be more pressing than ever.
Pick a system where you are a regular participant:
Where do you see the forces of togetherness and the forces of individuality? More than who wants to stay home and who wants to get back into their favorite restaurant: from whence comes the pressure to think and act as a unit vs decide and move on our own?
Who is over-functioning and who is under-functioning? Be sure to take note how both camps are making sure the other keeps doing exactly that.
Your tendencies in this system are ensuring homeostasis. As a CPE student, I ask you to find correlations between how your role in your early family systems is showing up in your current group life. What does this tell you about your own differentiation in a time of high anxiety?
ITP5: Articulate a conceptual understanding of group dynamics and organizational behavior.
* As of Monday evening: statewide COVID-19 case total went from 25,091 to 25,786. That’s an increase of 695 cases (2.8% increase). An additional 27 new deaths makes a total of 688 statewide (4.1% increase). The Houston region's count is 8,434, up 149 from yesterday (1.8% increase). Harris County added 98 new cases today (1.7% increase) and is now at 5,827 cases total. There have been 160 deaths in the Houston region, up 11 from yesterday. —Houston Chronicle
April 29 Reopening (Yourself) at 25%
Outcomes 1.2, 2.1 Competencies ITP3, PIC1
Key to our governor’s plan on reopening the state is the idea that occupancy of any given establishment limited to 25% of the normal capacity. I’m not advocating for this plan, but I do think it’s worth considering it on a personal level.
If our peak danger levels plateau on campus, we cast our eyes to the new normal. We’ve talked about trauma brain, coping with stress, and the critical nature of caring for ourselves — all in the height of crisis. The time is coming for us to consider what all these look like in the *wake* of crisis.
Studying the enneagram as part of your pastoral education has given you valuable tools for understanding what your tendencies will be in the days ahead. Some of you conserve your energy naturally and protectively; others of you are spendthrifts of your own reserves. What will proactive energy management look like for you in particular in the days ahead? You’ll want to have a plan.
We can’t rush the movie theater if we want to avoid another lockdown; similarly, we can’t go full-force on the new normal if we want to survive. Your body and brain have more catching up to do than you probably imagine. It won’t be intuitive or fun to take things really slowly for the foreseeable future; but it might mean a longterm thriving.
PIC1: Be self-reflective, including identifying one’s professional strengths and limitations in the provision of care.
April 30 Fasting and Feasting: Holy Observance in the Time of Corona
Outcome 1.1, 2.1 Competency ITP1
Just as my Muslim friends checked on me during Holy Week and Easter, I am reaching out to them as they embark on a holy month like no other. My biretta is always off to them for fasting in the heat of Houston spring, but this year especially: for many of us, food is the great comforter during a time of so much uncertainty.
During COVID-Lent and Easter, we are forgoing receiving communion. While painful, it has been a powerful spiritual experience of solidarity and sacrifice. To fast from our greatest feast reminds us the whole earth is longing for connection, for nourishment of all kinds. My siblings in Allah are also seeing unity and fasting through the lens of solidarity: online call and response, intimate iftars across the table from just your household. We are finding the spiritual gifts in the devastation, and we are pouring our longing into the service of others.
In both our cases, going without our traditional nourishment runs right alongside our push for food security for everyone. Gathering food for the thousands in our city whose last paychecks came a month ago, whose rent is overdue, whose whole world is held together by the generosity of neighbors. Our small and symbolic sacrifices are their own kind of nourishment — fuel for giving all we can. Islam has long taught me the correlation between almsgiving and fasting, pillars that hold up a faith together.
This Ramadan when I pick my three puny pathetic days to join in fast with my Muslim siblings, my mind and spirit will shift from interfaith solidarity to hunger solidarity. When the sun goes down and her corona is obscured from me, by the light of the moon I will pray for a sunset on this virus, when feasting will mark our days again.
ACPE Outcome 1.1 articulate the central themes and core values of one’s religious/spiritual heritage and the theological understanding that informs one’s ministry.
May 1 Picasso’s Pastoral Care: Betweentime Embodied Listening
Outcomes 2.3, 2.6 Competencies PIC8
A substantial part of your skill in caring for others is not the words you say, but the way you say it and what your body communicates. You can say, “I wanted to come check on you,” in about 1,000 different ways: warm and cold ways, thoughtful and robotic ways, ways that make it clear the person is one of many on your list, and ways that communicate you actually want to hear the response.
I’m intrigued when folks say their work is less embodied now. I would invite instead that we are embodying differently, and stretching parts of our bodies we haven’t relied on as much before. Behind a mask, you rely more on your eyes than your whole face. Over the phone, your voice signals your intentions more than the rest of you. From 6 feet away or on Zoom, your body tells a story differently than you did 2 months ago. But still, this is embodied caregiving. It is radically altered, but your obscured, fragmented, distant body is still your body, capturing and communicating your care. Perhaps this is Picasso’s pastoral care; parts of us are much larger, emphasized, others obscured, invisible. No one would say Picasso’s figures were not people. In fact, we came to think of figures differently as a result of his work. I think it’s very possible I will teach embodied listening differently from now on.
Some of us are tired of communicating care this way, but there’s a lot more of it to come. Even as we relax restrictions, the days of sitting shoulder-to-shoulder with the Tearful One stretch farther into the past and future. A mark of the skillful caregiver has always been to adapt to the needs in front of us. We are doing that. Our resilience in doing so indicates our agility and competence in these strange times.
PIC8: Communicate effectively orally and in writing.
https://www.christies.com/.../pablo-picasso-1881-1973...
https://www.abebooks.com/Practice.../30564604166/bd...
May 4 Back to the Future, but not: More and More New Normals
Outcomes 1.9, 2.6 Competency PIC3
Now that states are easing restrictions when new infections and death tolls are still rising, we may have started to feel like we did when this all started: how much data should we track and how to make a myriad of personal decisions as a result. We can look at this as a new third stage of the Betweentime, after Stage 1: Follow the Data and Start Social Distancing and Stage 2: Follow City and State Regulations and CDC Guidelines. This third stage is like Stage 1 except that many of us are tired of isolation and the constant filtering and distinguishing between what applies to all of us and what is most applicable to “my area.” Universal guidelines may have been a comforting idea at one time—no more. Where we work, what little ones need and whether they are as contagious as we thought, where we live and how many folks we have to brush past to buy food, whether our elder family needs us, on and on and on. You’ve had to build your own set-up; with each new stage that involves revisiting the original architecture. It reminds me of Back to the Future II: the time travelers go “back” to 1985, but because of shenanigans in an alternate 1955, there’s a whole new 1985, and it’s bleak. Stage 3 of Betweentime should feel like Stage 1 but it’s all cranky and brittle and worn out, like the suburbs of Biff’s Palace. We’re back to making most of the decisions on our own again, but it doesn’t feel very novel and our emotional reserves more depleted.
It reveals what’s been true all along: folks are doing what they think and feel is right whether or not it’s recommended. The truth is, of course, that it’s always mostly been up to us. There is no going back to an earlier stage. Even the Betweentime has a new normal within it.
I love when Carrie Doehring writes about returning to the ordinariness of life. After the primary steps of establishing safety and naming and grieving losses, one marker of moving through a grieving process is reconnecting with the rhythms of daily life again. We are still very much in the middle of this pandemic. As caregivers, we can’t yet let up on all that marathon-not-a-sprint stuff. It might be time to look at the sustainability of your current rhythm; this continuously unfolding series of losses means we are reconnecting with ordinary life in some places and ways and others not at all. When stuff is all over the map like this, we go to our inward architecture. We check the stability of our foundations while we keep plodding along.
As you continue to name and grieve losses, may you also find reconnection to the ordinariness of life, at this most extraordinary time.
PIC3: Attend to one’s own physical, emotional, and spiritual well-being.
May 5 Your People are Your Theology
Outcomes 1.1, 2.1, 2.4 Competencies QUA1, ITP1, PIC2, PPS8, OL5, MNT3
Who is your spiritual or religious community right now?
I’m not talking about online worship: whomever is giving your life a sense of meaning is your spiritual community.
Locate who and what is nurturing your current sense of belonging. At any quiet minute you can grab for reflection, identify whose voice are you trusting to help you find meaning in the midst of so much uncertainty and chaos. We know that several people are attending online services and participating in meetings of a former religious community, or a group they’ve been curious about but never visited. Some feel just plain bereft of community altogether.
What does that community do to show care for others?
Whatever activities are underway in the voices that you trust to make sense of nonsense, those actions will become your theology of caregiving. In other words, however your people are helping others will form your understanding of what you are called to do.
Emmanuel Lartey says:
"Pastoral theology, which by its very nature reflective practice, can be found in the various caring activities of persons and communities.
As communities have faced particular traumas and tragedies, pastors and other caregivers have tried to find the best ways of helping people with their personal and communal needs."
Whatever your people are doing, there your treasured beliefs are. As professional spiritual caregivers, the community that supports you will tell the story of your values. What story is it telling this week?
OL5: Foster a collaborative relationship with community clergy and faith group leaders.
https://www.amazon.com/Pastoral-Theology.../dp/1620329735
May 6 Scrubs, Coats, Kippot, Hijab: Reviewing Chaplains’ Visual Markers in Pandemic
Outcomes 2.1 Competency PIC9
I’ve worked with a lot of chaplain dress codes in my career: mandatory hosiery and covered elbows, long heavy white coats, collars, and presently, relaxed and reasonable.
Our chaplains were given the green light for scrubs several weeks ago, with the freedom to scrub or not scrub (a practical, compassionate shift for those disrobing in their garages and washing their precious betabrands in scalding hot water). Lately among colleagues, I’ve seen a resurgence of discussion about what visual markers are appropriate: the black mask with the white tab collar is a particularly hot debate (pardon my giggles), and yesterday I even saw a remix of the evergreen Lab Coat Question on your Grandparents’ Favorite Social Media Platform.
As a professional spiritual caregiver in *any* context, there’s a dress code. It tells you how your organization categorizes you (read: what they think of you). Your particular tradition may have bestowed upon you a separate additional code, and depending on your gender, age, branch, and local leadership preferences, it may come with its own stringency. Some combination of these codes and your sense of agency in them will determine how you present yourself to your careseekers today. According to our certifying bodies, being “professional” in “appropriate attire” “and grooming” is the minimum expression of competence.
I had a chaplain student who was a former nurse take it upon themself to wear scrubs on call. We never knew until 3/4 of the way through the year! Once, when I spilled coffee all over myself in the middle of a weekend shift, I only had jeans to swap out, and I swear I gave the best spiritual care that day because I was comfortable AF. The coat was a whole mood, and the collar was a wash — 50% of the time it catalyzed my connection, 50% repelled it. Even my students in kippot often go undetected, since looking up from a hospital bed, the angle is just right to never see the back of their head.
While my male-identified Muslim students usually pass un-outed, students in hijab never do. Their identity is proclaimed, and they navigate the highest evocative presence of all chaplains I supervise. (Racially, Black students bear the most in my Texas context: Black Muslim women, I see you). For the first 5 minutes of every new visit, their badge may as well read “HI I’M MUSLIM LET’S TALK ABOUT THAT FOR THE WHOLE VISIT K THANKS.”
In our context, you get to choose your outfit, but you don’t get to choose what people think it means. Take care with whatever agency you have. People don’t necessarily know what your sacred symbol means anymore, and if you seem weird, it might be tougher to build rapport. I’m no friend of neutralizing your identity; if you face different requirements in your next context you’ll just have to take them into account in forming relationships. I’m just saying it matters. Remember: while you’re trying to enjoy getting dressed for work, your careseekers are trying to figure out who you are, at a time they are stressed, vulnerable, desperate for answers, looking for comfort, and vigilant for harm. How do you want to carry yourself into that cluster? How might your spiritual caregiving begin with your visuals?
PIC9: Present oneself in a manner that reflects professional behavior, including appropriate attire, and grooming.
May 7 Saint Flo, Patron and Icon
Outcomes 1.7, 2.7 Competency PPS2
Never a better time to think about Florence.
St. Florence Nightingale was born 180 years ago in Italy. In *Florence*, to be exact: just think about being named Houston in this town. (Just for that alone: tip of the hat, dear Flo.) We celebrate nurses’ week this week because we remember her life and her death as one lived in service, using her distinct privilege to elevate the plight of those in need. Hailing Florence today is to hail all nurses for their tirelessness, their dedication in the midst of every bananas day in healthcare, and yes, in the extra that is Coronatime. Some nurses in my life incarnate that for me daily; they are every bit as Florence as Florence herself. Holding up St. Flo today also feels like holding up our beloved Italy, in their deep devastation and grief.
Florence’s most famous quotes are problematic in countless ways; like all our saints, she was blessedly flawed. But this one, oh, this one:
"Let whoever is in charge keep this simple question in her head—(not, how can I always do this right thing myself, but) how can I provide for the right thing to be always done?"
Behold how taking the focus off your legacy and shifting to provision for all is a true mark of love. Florence’s wisdom is sustainability, a word we might gloss over if we’re not careful. Out of the tumult of every day a new wearying saga, she reminds us: everything we’re doing is groundwork for those who come after us.
For today, two things:
1: which nurses can I thank, directly, by name, spontaneously, in the course of the regular day?
2: How am I laying groundwork for those who come after me, to provide that the right thing always be done?
We raise our water bottles to you, Florence; we follow your lead, we honor your witness.
PPS2: Provide effective spiritual support that contributes to well-being of the care recipients, their families, and staff.
May 11 We’re All on Disaster Assignment
Outcomes 2.1 Competency PIC3
I used to teach self-care in a 1- or 2-part seminar in a student’s fourth unit. That idea seems now. It seems dangerous and neglectful to think of self-care as an add-on. I doubt I will ever teach it that way again.
The US Department of Health and Human Services Substance Abuse and Mental Health Services Administration (HHS SAMHSA!) released the attached resource for first responders preventing and managing stress during disaster assignment.
We are all on disaster assignment.
The resource says (among other great stuff like having a personal disaster plan involving people who care about you) that stress management is your #1 priority right now. That means your first responsibility every day, in order to serve anyone else effectively, is to keep your stress in check.
As you continue to practice with the models of spiritual assessment, take a moment and self-assess. Hopes, Needs, Resources :: Physical, Emotional, Relational, Spiritual. What pops up right away?
As you go out and take on another week in the Betweentime, cherish your health and well-being. Protect it with everything you’ve got.
PIC3: Attend to one’s own physical, emotional, and spiritual well-being.
https://store.samhsa.gov/.../Preventing-and.../SMA14-4873
May 12 Text and Context: Staff Care Volume 7,495
Outcomes 1.7, 2.7 Competencies PIC5, PPS1, PPS2
We can throw resources at each other all day long. You’re collecting memes, articles, links deemed “useful.”
I’m attaching a staff care resource* because you are all still voicing your desire to care for staff more creatively, more connectively, more effectively.
Suggested approach: Search the text with your context in mind, rather than going to your context armed with text.
Context First: Your assessment of your unit staff’s particularities — from the physical set up of the unit to the relationships between managers and nurses — informs which approaches you take. Your coach, who has been on the unit longer, has valuable background and insight. Make a list of the main particularities you’ve observed on the unit.
Now Text: Now approach the resource with your context in mind. Which parts of it are especially suited to the way this week has gone for them, or the struggled you’ve heard them mention over and over again?
2.7 establish collaboration and dialogue with peers, authorities and other professionals.
https://chaplaincyinnovation.org/.../Staff-care-eBook...
May 13 Attunement in Pandemic
Outcomes 2.3, 2.6
Wordstuff: “attune: to bring into harmony” and see also “atone: to bring into agreement, reconcile.”
We are listening to our bodies tell us that we are overzoomed. Recently heard a pastoral caregiver bemoan how we are “all stuck on the internet” as we check on our people. Some of us are balancing the overzoom with abundant outside-time: I’m still setting my clock by the daily 6pm walk with my isolation pod, now 9 weeks strong. Many of us are acknowledging that our bodies are trying to teach us something during this time of worldwide quarantine.
When it comes to somatic wisdom, I have eyeroll for the term but faith in the concept: our bodies know a lot more than most of our cultures of origin would like us to believe. As you practice spiritual caregiving, it may be tempting to worship the art of the words you use, and neglect the art of every other way you communicate you are listening and hearing.
In Trauma-Sensitive Theology: Thinking Theologically in the Era of Trauma, Jennifer Baldwin writes that “attunement requires fully embodied presence with awareness of the multitude of means of communication, including verbal and the non-verbal communication forms of movement, posture, affect, energy resonance, and timing.”
I’ve mentioned before that these aspects matter more than ever: your posture at a distance may be even more striking a communication tool than it was in February. The affect of your voice is communicating your level of comfort with the mask, and over the phone it tells someone even more than the words you’re saying.
Listening and Responding is about so much more than the words you say. Next time you bring a verbatim, take extra care to show in your ( ) how you worked to attune yourself to the careseeker with Baldwin’s list: movement, posture, affect, emergency resonance, and timing.
L2.3. demonstrate a range of pastoral skills, including listening/attending, empathic reflection, conflict resolution/ transformation, confrontation, crisis management, and appropriate use of religious/spiritual resources.
May 14 Happy Music, Sad Eyes: Complex Grieving
Outcome 1.6 Competency PPS5
For me, it started with footage of the 7:00 round of applause: in the five boroughs or narrow winding paths of Northern Italian towns, and across other continents. Then descriptions from our staff chaplains getting folks to dance in their hallways. I connected this to our pod’s weekend dance parties in the garage. I remembered other times in life when things were just awful, individually or collectively, and the only thing we knew we could still do was dance our hearts out. (Grey’s Anatomy, anyone?) Now I see it when music plays and folks clap as recovered COVID patients wheel out of the building. We’re finding things to celebrate.
For spiritual caregivers, this dance is a delicate dance. We know that while we’re dancing and clapping, someone nearby is coding, someone just got their positive test, someone lost their pregnancy, someone cancelled a bucket list trip. Someone in the clapping, raucous Discharge Congo line hasn’t seen their aging parent in months now, and isn’t sure they will again. I think of this as I clean up all the cups at the end of the dance party. I think of how each member of my pod is staring down a Big Grief, from the 7-year old to the 53-year old. We’re all healthy, but a lot of people we know aren’t. We press on, but we don’t avoid or forget.
Being a chaplain means being willing to sacrifice getting totally swept away in joy, because we mourn with those who mourn, and someone is always in Big Grief. Conversely, for me, it also means we nurture a strange kind of eternal hope, hope in what is right now, in what has given meaning to the Congo Line and positive test existing together.
The delicate dance is totally fine with me, because it’s way more real. Grieving sometimes looks like happy music, sad eyes. Remembering this may help you not chaplain-voice* someone (*verb, to lay it on so thick that someone is supposed to be having a cathartic experience just by the gift of your waltzing in to their presence).
Dance on.
PPS5: Provide spiritual care to persons experiencing loss and grief.
May 15 Be Kind, for Everyone You Know is ... not just in pandemic but trying to do their regular suffering at the same time
Outcome 1.9, 2.9 Competency PIC3
Maybe it’s just me, but in my little pocket, suddenly everyone I know is either suffering themselves or adjacent to a great sufferer. Starting Week 10 of Betweentime has launched some kind of heightened level of crisis; dying family members, horrible fights and battles, new diagnoses, tumbling prognoses, financial breaking points, fresh hells of trauma.
So, here’s this. Use it as your time allows. It is helping some folks right now. It might be a break you can use.
https://socialwork.buffalo.edu/.../emergency-self-care...
PIC3: Attend to one’s own physical, emotional, and spiritual wellbeing.
May 19 What’s the story; what’s the need?
Outcomes 1.5, 2.3 Competencies ITP6, PPS2
I’ve been reading up on moral injury screening, toward an increased intentionality around staff care for the years to come. How to best ask ourselves, our chaplain colleagues, our interdisciplinary teams, and even our patients how we've balanced forced decisions with our most cherished values is a big hairy audacious goal in front of me. A lot of moral injury work is longterm work, with time and space set aside to facilitate discovery and disclosure. Perhaps it’s not ethical or advisable to open questions like “how was it to collaborate on vent distribution?” unless you have the time and skill to really unpack and accompany. It has taken me back through screening for spiritual distress, only more involved. Duh: the work of spiritual caregiving is sacred work; there is a reason we demand 1600 hours post-master’s to learn it. (And that never feels sufficient.)
So, on my quest for a deeper understanding of both screening and accompanying through moral injury, it won’t shock you that a standout theme of proposed models involves listening to the need inside the story the careseeker tells. There is always a reason for the stories that people choose to share with us. It may feel completely random to hear the story of a childhood birthday in an elderly patient’s hospitalization; it isn’t. Isolation, endless waiting, and vulnerability brings narratives to the surface. Our great honor is to receive these surfacing stories, to trace and track them, to mine them for sources of strength and meaning.
Today, as you listen to stories, ditch your questions. Let go of “tell me more” and “can you say more about that?” and recognize they are telling you everything you need to know. Simply reflecting back the significant words you hear, embodying the deepest possible listening stance, naming the feelings that charge the words, and wondering with the careseeker the meaning of this story is far more powerful than any question you can ask.
ITP6: Articulate how primary research and research literature inform the profession of chaplaincy and one’s spiritual care practice.
Gem on spiritual distress: “Spiritual distress has a nursing diagnosis (NANDA International) of impaired ability to experience and integrate meaning and purpose in life through the individual’s connectedness with self, others, art, music, literature, nature, or a power greater than oneself.7 This definition corresponds well with the consensus definition of spirituality: spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.
May 20 COVID from a Kid’s Eye View: What Do Chaplains and Chaplain Educators Do?
APC Competency OL5
My goddaughter interviewed me for her podcast. She wanted to hear how my work and, more importantly, my students’ frontline work, has changed. 13-minute breakdown.
Grateful to you Residents for doing all you do, and for the honor of serving as teacher.
OL5: Foster a collaborative relationship with community clergy and faith group leaders.
STITCHER.COM
Episode 4 - Sarah Knoll Sweeney
May 19, 2020 - Today I'm interviewing Sarah Knoll Sweeney.Sarah is an instructor for hospital chaplains in Houston, Texas. I talked with her about what it's like teaching chaplains and some challenges that her students face. She tells us how life and work in a hospital has changed because of COVID.
May 26 Therapy, Yo
Outcomes 1.9, 2.1, 2.9 Competencies PIC2, PIC3
If you haven’t been to therapy since the pandemic started, let’s chat.
Maybe it’s for cultural reasons; there are plenty of messages out there that counseling is for the “crazy,” and you’ve thought to yourself you’re not crazy, because you’ve kept coming to work and being a functional human.
The truth is regular counseling is linked to increased well-being for all individuals. The Joint Commission recognizes that you may be nervous to ask for mental help and vouches for you. Our system has free accessible options for you.
Get on it.
2.9. demonstrate self-supervision through realistic self-evaluation of pastoral functioning.
2.9 Memorial Hermann behavior: I initiate consultation for continued self-learning and improved pastoral functioning.
https://www.mentalhealthfirstaid.org/.../four-ways.../
https://www.jointcommission.org/.../statement-on-removing...
https://memorialhermann.portal.dovetailnow.com/page/1228
May 27 Reconsidering "How Are You?” When We’re All "Not-Fine"
Outcomes 1.7, 2.3 Competencies PIC8, PPS10
I’ve never been a fan of “How are you?” as a hospital chaplains’ opening line. It rings falsely casual to me — as though we were meeting on the sidewalk instead of approaching a hospitalized person. Of course, how you say it makes all the difference: try saying it quickly with a cheap smile, and then saying at .5 speed with eye contact. It’s like two different questions altogether.
Often when we talk about spiritual assessment our brain goes to models like FICA, 7x7, The Discipline, but remember, spiritual assessment is as simple as what the spiritual caregiver is listening for when you listen to someone. So, if you ask, “How are you?” you have begun your spiritual assessment.
The New York Times just ran a piece on the obsolescence of “How are you?” in these times, because the standard expected answer — “fine” — no longer applies. In the hospital, I’m not sure this question, even when you’re truly open for a big complex answer, communicates your intentions. If you were stripped of casual pleasantries when checking on your staff and patients, what opening lines would get at what you’re really asking?
Read the NYT piece, review your spiritual assessment models, and then experiment with a different opener during your clinical week next week. Take care that the first words you say communicate your intentions for the conversation. I look forward to hearing what you discover.
PPS10: Formulate and utilize spiritual assessments, interventions, outcomes, and care plans in order to contribute effectively to the well-being the person receiving care.
https://www.nytimes.com/.../coronavirus-small-talk.html...
May 28 Cookies and Mindfulness: 2 Minutes of Family Systems Theory
Outcomes 1.5, 2.2, 2.4 Competencies ITP2, ITP3
(To my students after presenting their evals:)
Now that you’ve finished evaluations, how about some cookies? Here’s two minutes of family systems theory using cartoon cookies. (Apologies in advance for the scary-eyed white lady.)
Which unconscious rules and roles are you working with on your units, in our department, at home? Are these roles letting people grow and change for their well-being?
Enjoy!
YOUTUBE.COM
Mind Matters : Family Systems
What is the family system? What is Family Systems Theory? How does our family really impact who we are, our day-to-day lives, and our happiness? Learn more a...
June 1 Release Valves, Burst Pipes: Emotional Plumbing
Outcomes 1.5, 2.4 Competencies ITP2, ITP3, ITP5
Spiritual caregivers go into each new encounter knowing our role may be like a release valve; we are told time and time again that no one has really listened to them like that for a long time. Perhaps you have a memory or two of spiritual care relationships marked by the never-ending need for a release valve. It seemed no amount of your listening and creating a holding environment would create a sense of relief. You came to need your own release valve.
There are times when you have been willing to enter the world of the careseeker. You have seen how they manage an incredible amount of emotional energy, pressure, dysfunction, grief, anxiety. If you looked closely enough, you saw how they couldn’t take their woes here or there because they were already someone else’s release valve.
Like a plumbing system, emotional energy needs somewhere to go. When one pipe is clogged, the water finds a new path of lower pressure. When someone’s sadness or rage or anxiety is given no valve, it doesn’t dissipate into thin air, it finds a new path. It may boil underground, waiting, seemingly submerged. It may displace onto unsuspecting others, who seem less threatening. Eventually, when all the pipes are clogged, when the emotional energy builds and builds and has no release, the pipes will burst, the system will break.
Sometimes you take on the release valve role because you know it will allow smoother plumbing with the rest of the team and ultimately, the patient’s actual well-being. This doesn’t mean you take abuse; it means you offer a release that other folks can’t at that moment.
Pandemic, oppression, disparities, unemployment, isolation. All these stressors are connected to your careseeker’s current health experience, whether either of you acknowledge it or not. A person will get well slower if they feel unsupported or afraid how they will pay their bills. If work was their identity, your 20 minute conversation will not restore them from that grief. All systems are on overload, for POCs, the working poor, the newly unemployed, all the more. People can only bear so much before lashing out.
Every one of us is strained right now, but not equally so. Take care that you offer release to those most needing it, lest you erase real suffering thinking this has all been the great equalizer. The streets of Houston, Minneapolis, New York — all of them reminders that people can only take so much. There’s only so many pipes that can be clogged before they burst. Keep your ears open.
ITP5: Articulate a conceptual understanding of group dynamics and organizational behavior.
https://www.thenation.com/.../minneapolis-rebellion-floyd/
