A PATIENT CHAPLAIN
LOOKS AT CHAPLAINS MINISTERING TO PATIENTS
(A Very Subjective Assessment)
By Ames K. Swartsfager
Back to the hospital again! Ever since I was diagnosed as a myasthenic (one with Myasthenia Gravis, a neuromuscular disease) I visit hospitals regularly. Sometimes for serious problems such as a thymectomy (removal of the thymus gland located between heart and lungs), kidney failure, pneumonia, or pancreas problems. Sometimes for less serious reasons such as plasmapheresis (a five to seven day stay), medicine problems, or bronchial infections.
Having several years in hospital chaplaincy at Lutheran Medical Center, Brooklyn, NY, as a resident Clinical Pastoral Education student and at Parkland County Hospital, Dallas, TX, as a resident in Advanced CPE and Acting Supervisor, I have wondered what patients felt on the receiving end of pastoral care.
I mention the above as curriculum vitae for what I am about to relate from the patient’s viewpoint as a result of my experiences with hospital chaplains. I have attempted to categorize them experientially: “The Invisible Chaplain,” “The Long Visiting Jabbermouth,” “The Well-Meaning Ineffective,” “The Inadvertent Chaplain," and “The Chaplain Who Hits the Mark.”
The Invisible Chaplain:
I am in the hospital shortly after being diagnosed with Myasthenia Gravis and only a few months after arriving in town. I will be receiving plasmapheresis for a few days and then I will have my thymus removed, which I am told is opening the chest, moving the heart to the side and cutting and scraping the thymus out. I am frightened, so when I arrive at the hospital I ask to see a chaplain.
Several hours later my neurologist visits and I request a chaplain again. He tells me he has written an order in my chart for one. Still no chaplain. The surgeon comes in to place the catheter for my pherisis and has a difficult time of it. Finally, with the help of the head surgeon, they get the catheter in after an hour and a half struggle. Part of the problem was my own fear and my inability to relax my muscles. They wanted to give me Valium, but myastenics don't cope with Valium very well.
I have always wondered if a chaplain's visit might have helped. How many times in the past I begged physicians to chart the need for chaplains, or to leave a message for us when a patient needed to see us. Here we have a request --several requests-- but no chaplain.
The next morning I woke up with shingles, but a few days later they were gone. Giving up on the hospital chaplain, I contacted a priest from the Cathedral to visit and administer the sacraments. I felt prepared for the operation the following week but still no hospital chaplain. Everything went smoothly and I was ready to be released. Out of curiosity I asked the nurse to see if she could find out what had happened. She came back and said the chaplain had told her she couldn't visit me because I had shingles. I wonder what happened to telephones? Also, I did not have shingles when they operated on me. It may be cheaper to hire invisible chaplains, but they don't help patients very much.
The Long Visiting Jabbermouth
"Hi. My name in John Doe, and I'm the chaplain of this hospital. Looks like they're taking good care of you. I hear you're an Episcopalian (he looks down at a notepad) priest. That's just great. I like to talk to other ministers, I bet you're from St. Francis church. Such a pretty building. Hear they have a good choir too (ad infinitum.....)"
"Chaplain Doe?" I try to intervene.
"Well, we also have a good choir. We're doing Handle's Messiah tomorrow night." He looks at me and then continues sorrowfully. "Don't suppose you could come to that." He notices I have closed my eyes and turned away.
"Suppose I need to go now. God bless you!"
The Well-Meaning Ineffective:
As a patient I go through hours of boredom. It's hard to sleep when you're wakened all hours with nurses shooting heparin in your stomach, insulin in your arm, changing the IV, taking blood pressures and temps, drawing blood and doing blood sugar stabs on your fingers. In between most people read or watch TV. I can do neither more than a few minutes at a time because of my double vision problem. When I do not have my Tapes for the Blind and Handicapped (A Library of Congress program) I usually lie with my eyes closed, dying of boredom. Sleep makes the time pass faster.
I am in the hospital this time for what seems like a heart attack, but thankfully has turned out to be two medicines which did not like each other and took it out on me. The first day the chaplain dropped by during one of my naps, according to the nurse. He dropped by the following day and, although the nurse told him to wake me, he said he didn't want to disturb my "peaceful sleep." This chaplain either did not want to do any ministry unless she had to, or she was too timid. She certainly didn't take the opportunity to help me.
Why do chaplains think they can't disturb a patient when nurses, aides, doctors and even custodians have no fear? The patient is here to get well and keeping the floor clean, taking blood pressures, checking or replacing IV needles, etc. are all part of the healing process.
There are other parts of this process too: sociological, mental and spiritual. Chaplains are part of treatment, especially if the spirit or faith of the patient is hindering his/her improvement. For this reason, a chaplain should not be afraid to wake up a patient (after checking with a nurse first).
Another time I was in a substandard hospital. The nurses kept bringing me the incorrect medicines. I take about 15 different medications and 35 pills a day, so I admit that it is difficult to get them organized. For this reason I keep a list in my wallet at all time and it is from this listing that the doctors write their orders for medications. I give a copy to the nurses to help them administer the medications on time. Some, like Mestinone, have to be given every four hours during the day or my muscles stop working. Others, if given too close together, make me very ill. So its a real problem when the wrong medicine is given at the wrong time.
I told the nurses I would help them, but they did not want to take (or because of short staffing, did not have) time. I had to argue to get my Mestinone when it was needed. I talked to the charge nurse, who evidently did nothing, and I finally asked to see my doctor, but he wasn't available. If I had not been clearheaded, I would not have survived (or at least that is how I felt.)
The hospital chaplain came to visit me, or at least she said she was the Hospital Minister. She said she was ordained and had taken CPE. I explained my problem and asked if she could talk to someone to get me help. She replied that it was not her job and I should talk to the nurse again. I always thought there were times when the chaplain was an ombudsman. At least I did a lot of that, especially at Parkland Hospital.
The result was I survived, but only barely.
The Inadvertent "Chaplain":
I was lying on my back, depressed, near to tears as I looked forward to a life as a paraplegic. I had become paralysed the night before. Nurses had to turn me every two hours, they had to help me have a bowel movement ... I was humiliated, and very frightened. So I stared at the ceiling trying not to cry.
Someone entered the room and, looking up, I saw it was the cleaning woman. She was older with many wrinkles on her face telling of her own trials and tribulations. We had talked before I had suddenly become paralyzed. I tried a smile and a greeting. She come over to the bed and looked at me. "What's wrong?" she said after a space of silence.
"I can't move my legs," I replied, still fighting back the tears.
"Oh, son," she said, "Go ahead an' cry. God means for us to cry when we are sad or hurt or in trouble. Crying is a form of prayer…a call for help. You go ahead."
The dam broke and tears flooded down my face. I choked on my sobs and all the while she was still and held my hand. After what seemed forever I felt better and my tears subsided.
"Son," she said, "would you like to pray with me?" I don't remember her prayer, but I do remember her caring sensitivity and her love which seemed to come from God.
Sometimes, however, the Inadvertent "Chaplain" is not very helpful. My roommate in a hospital recently received news he had cancer and although an operation might help him, there were no guarantees. His family had gathered around him, grieving. He remained strong and told his family to think about the future, and that he would fight the cancer as long as he could.
After they left, he began to cry. I wanted to help him, but I was very sick and attached to oxygen, an IV and a C-PAP. Soon a nurse came in to take our vital signs and she noticed his soft weeping. "Don't cry," she said. "God will take care of everything. Now be quiet." When she left I attempted to talk to him and told him to go ahead and cry. Then I had another fit of coughing. Perhaps God was telling me to shut up!
Another time, when I had gone in for an IVIG (Intra-Venos Immune Globulin) infusion, the regular nurse had been transferred. The new nurse was young and did not seem to have a lot of confidence in placing the needle for the IV. I watched her work on two other patients. One of the patients she had to stick repeatedly. The patient, an elderly, grey haired woman, began to cry. "Don't worry honey," the nurse said. "God's in charge. I read the Bible every day and you should too." I remember thinking, "I wish she read her anatomy of veins every day."
Many hospital staff are sensitive people and have strong religious beliefs, which is perhaps why they are in a helping profession. It would be better, however, if they were taught to contact a chaplain when they discover a person undergoing extreme anxiety or stress. When doctors give a patient bad news it would be helpful to the patient for the doctor to have a chaplain with him, or to at least inform the chaplain that he had given a patient bad news.
The Chaplain Who Hits the Mark:
Among my many stays I have run across one chaplain who was able to help me immensely. He was not a hospital chaplain as such but was assigned by the Diocese to visit people in hospitals. I remember greeting him cheerily as if I had no problems. However, my kidneys were failing due to a medication I was taking and the doctors thought I might lose them.
After greeting me he asked what was happening, what I was feeling, and many other questions which led me to unmask my fear, my sadness, and the fact that I was really depressed. He suggested that I might find some help through counseling with a psychologist. (I had never felt the need for counseling. After all, I was a strong person. I had attended CPE. I surely didn't need any help from that quarter.) But he was correct in making this suggestion, as my defensive barriers had been pealed away layer by layer. Looking at myself, using the chaplain as a mirror, I saw that my nerves were raw and I was near the end of my rope. He referred a hospital psychologist to visit me and the psychologist recommended me to a doctor near my home. Seeing this doctor started me on the road to mental and spiritual healing. I will ever be thankful for his visit and his sensitive expertise.
I thought I understood the need for chaplains in the hospital ministry. However, it was not it was not until I became ill with MG that I understood the real necessity of well educated and well trained chaplains; chaplains who are not afraid to face patients and wrestle with their problems. Chaplains who are not afraid of being assertive and confronting the system when needed. And chaplains who will let God's love and forgiveness infiltrate their spirits and shine forth to those to whom they minister.
All these subjective views are just that -- subjective meanderings of a onetime chaplain now doomed to patientry. Some chaplains might see themselves in one of these portraits and, if so, hopefully will take steps to improve their ministry.
It would seem a good idea for chaplaincy departments to do an occasional study to see how patients appraise their work, and what problems they need to correct. Attached are some sample questions that might be asked.
QUESTIONS CHAPLAINS COULD ASK OF PATIENTS
1. Have you seen our hospital chaplain? Yes___ No___
How long have you been in this hospital? _____
2. Have you requested to see a chaplain? Yes___ No__
How long was it before the chaplain came? ______
3. If you have seen a Chaplain: Always Sometimes Seldom Never
Did you feel that your problems
were important to the chaplain? _____ _____ _____ _____
Did you feel the chaplain listened to you? _____ _____ ______ ______
Did the chaplain assist you in any way? _____ _____ _____ _____
4. Did the staff talk to you about your religious
needs? _____ _____ _____ _____
5. Did the staff ask you if you wanted to see a chaplain? Yes___ No___
6. Did the chaplain ask you if you wanted prayer? Yes___ No___
7. Would you want that chaplain to visit you again? Yes___ No___
 Chaplain Swartsfager was also a chaplain with the Federal Prison Service for 21 years.