In an email tonight, someone said she tends to hang out with hospice employees at lunch in the place where she works because, as she said, "...they were the most heart felt people there, genuine, and they 'get it'....whatever 'it' is." She also asked me what my days are like, and this is how I responded:
As for hospice people, I think they do "get it." I've never worked anywhere else in my life where fellow employees are so supportive and caring of each other. I've never felt so appreciated by them -- never mind the patients and families. I think the whole concept of hospice feeds into that. In my office, there are no other men, so I feel like I'm surrounded by a bunch of sisters who just love me! It's amazing! (I have three younger brothers, so didn't experience sisterly love growing up, except from a few older girls with whom I rode horses.) Hospice is all about compassionate care -- for patients, for their families, for nursing home staff nurses and aides, and for each other. So I understand why you would want to hang out with them when you can.
My days…are split between the office, nursing homes, and private homes, so there's a lot of driving about sometimes. At the office I'm currently rebuilding the hospice's bereavement program, which has never really gotten off the ground. So we're completely redesigning it, figuring out systems, setting up schedules for calls and visits, putting all the forms on the computer, making sure everything is Medicare-compliant, and at the same time making the phone calls and visits to surviving family members and friends. We currently have a census of about 70 patients, with maybe up to 5 people dying every week, so it's a lot of work. Once everything is up and in place, I'll be able to concentrate on the visits and counseling, which is the part I love. (I am NOT an administrator!) And there are the inevitable meetings.
As for the nursing homes and home visits, after doing an initial spiritual assessment, I simply am there. We call it "a ministry of presence." I sit with patients, listen to them talk about their lives (if they don't have dementia), answer as best I can their questions about death and dying, grief, God, heaven and hell (no such thing except that which we create for ourselves, I think). If they don't want to talk about any of that (and many don't), we talk about whatever is on their minds. (On Thursday I was with a retired army colonel, and we talked about his years in army intelligence during and after WW2, which was fascinating to me -- and exactly what he needed to talk about.) Sometimes I hold their hands and hold them while they cry over all the people and things they're being forced to let go of usually against their wills. I let them rage against the unfairness, if that's what they need to do. I laugh and celebrate with them over the joys of their lives. I pray with and for them. I read to them -- prayers, the Bible, or anything they are interested in. I sing with them -- hymns, Broadway melodies, the American Songbook, and even Beatles! I bring my iPhone with me and play music as we sing, or just to listen to. One woman loved Cole Porter (as do I) so I played Ella Fitzgerald's album of his songs, and we sang along. Oh, Cath! I have the most wonderful job in the world.
The hospice I work for believes that none of its patients should die alone: Someone -- family member, friend, aide, or volunteer -- should be with them as they go. One of the things I love to do is to "sit vigil" with them at night (remember, I'm a night owl?). Almost always they are asleep or very nearly so, so there's not much to do. I may hold their hand, I always pray -- sometimes silently, sometimes out loud. I use the BCP a lot, no matter the patient's religion, because the prayers are so beautiful, especially in the Compline service. I might read passages from the Bible silently or very quietly. Sometimes I simply meditate. As I said to someone last week, one of the most wonderful things about the job is that I'm spending much more time with God than I ever have before. That seems selfish, but I hope it also makes me a better minister and chaplain.
I had one patient, an elderly woman, who was nearly blind and had Alzheimer's. Her daughter told me that one of the things her mother used to love to do was take her and her siblings to the beach. She'd teach them about the horseshoe crabs, seaweed, birds, sea grass, dunes, and sea shells. So one day I brought in a shallow box I'd filled with sand and then added shells and some seaweed, and periwinkles, a conch shell, and even part of a horseshoe crab. You wouldn't believe what happened…She started talking about each thing she was feeling as she picked them up. With tears in her eyes, she talked about her kids at the beach and how much she loved showing them these things. It was as if for a moment she got her memory back…just from the touch and feel and smell of the beach. I wept myself. Her daughter…well, she likes me a lot for the gift of her mother she had back for a few minutes. But it wasn't me. The idea came, I am sure, from God. I just delivered it.
It's not always so sublime. I was with someone on Thursday afternoon, again an elderly Roman Catholic woman with dementia, partially bed-ridden, though the staff does get her up in a wheel chair daily if she's strong enough. She's also got very high anxiety, which is apparently one of the things that can happen sometimes with Alzheimer's patients. The nursing home hasn't been able to find the right drugs to help calm her down, so she's almost constantly yelling, "Help me! It hurts! I'm dying!" Over and over again. She can be belligerant too. When I tried to calm her with platitudes about God being with her and there's nothing to be afraid of, she yelled at me: "God's not helping! You're not helping! Get someone who can! You're useless! Go away!"
She drives everyone crazy, and no one has been able to help. I was supposed to do an initial spiritual assessment for her to see what her religious background is and what her spirituality is like -- does she believe in God, does she pray, what she needs in terms of pastoral care, etc. -- so we'll know better how to help. I just couldn't do any of it, and had to later call her son to get as much of the information I needed as he could provide.
The only thing that seemed to help a little was to get very close to her, hold her hands, and give her a hand massage. That seemed to calm her down for a while, but it wasn't long before she was off and running again. Finally, because I didn't know what else to do (and knew I couldn't finish what I was supposed to be doing with her), I called in an aide, who got her up into her chair and took her out to the nursing station where there's a lot of activity she could watch. I think seeing all the nurses and aides nearby reassured her.
It's times like that when you feel pretty helpless. I just didn't know what to do, and wasn't getting any inspiration from the Almighty! Calling for help from the aide was my best idea. Sometimes, you just have to let go and turn it over, I guess. I hope they figure out what medication will help, because -- hate to admit it -- nothing I can do will ease her mind.
Still, this ministry is such a gift. I also feel I've been called to it, that it is exactly what I am supposed to be doing. Now, if I can find a full-time position, I will be very happy.
Ironically, one of the really nice things about being a hospice chaplain is that all my patients are going to die. I know that sounds strange, but being the caretaker I am, and having worked for many years as a therapist and counselor, my goal was to help my clients get well. My job was to fix them! If they didn't, I felt like I'd failed (and with alcoholics and drug addicts, unfortunately, there are a lot of failures, including some who die). I don't have that goal here. I know they won't get well, and it's ok. It's the way things are. It's life. My goal is simply to help make this last important act of their physical life as easy and comfortable as possible for them and their families.
I can't even empathize with my patients. How can I? I haven't the slightest idea what they are going through (nor do they) because I've never died before -- as far as I know. It's unsettling sometimes, but I'm learning that simply being is enough. Being present is enough. All I can to is try to be as open as possible so that God's grace can flow through me to my patients. "Lord, make me an instrument of thy peace..."
The ministry of hospice chaplaincy has also, not surprisingly I guess, given me the chance to think and read more deeply about death, my own included, and what it is and what it is not. At the moment, my take on death is that it is a transition from one stage of being to another -- the soul leaving the physical body it inhabits and moving on to...what? Or returning to...what? Some kind of spirit world? Merging back into a larger whole, like a drop of water into the sea? Going to heaven (whatever that is)? Lots to think about, and no conclusions will come until I find out for myself. It's a mystery I'll live with.
So, that's what I'm doing, and I absolutely love it...
