Relative to my job, it is not uncommon for people to say things to me like, “I just don’t know how you do it.”
I don’t generally answer with the truth, because it would sound insensitive. But the truth is, I approach many visits with a degree of remove. I don’t give my fullest attention. I don’t empathize, or imagine myself in the person’s shoes, but offer compassion, instead. And I don’t invest myself fully in the conversation or ritual; rather, I perform it.
Performing allows me a bit of professional distance, similar to an actor in a play. If an actor does their job well, they draw you into the scene with them. They convey emotion, and you feel what they seem to be feeling.
But that actor doesn’t have to actually become Romeo, for example, in order to convey star-crossed love. He doesn't actually poison himself to drive the point home.
It is this way for me, too. The ability to endure as a chaplain requires me to maintain some distance and perspective. So, I perform chaplaincy. The volume and complexity of stories I witness are simply too great to take them all personally…they would occupy my mind for days if I let them, not to mention the emotional energy they would extract.
The ability to perform my role has come with practice. Initially, being asked to pray out loud for someone else felt like being put on the spot. What if they didn’t like it? What if I said the wrong thing? What if I forgot the person’s name? Eventually I learned to trust that the words would come—and developed enough stock phrases for the times they don't—and it stopped feeling so scary.
It also took a bit of time for me to become comfortable talking about death. What helped in that regard is seeing how relieved many people are when they realize you are not afraid to name the elephant in the room. I’m much less concerned about bringing it up now. The trick is observing how the care recipient reacts, and following their lead. If they’re not ready, I validate their boundary and pivot to something else.
Another action I perform frequently: Soothing Hand on Head. It feels like no big deal to me to put my hand on someone’s head in this manner, though I may be unusual as a chaplain in this way.
Earlier this spring, I was fortunate to have an intern join my department of one for a few months as she completed her first unit of Clinical Pastoral Education (CPE). She verbalized surprise that I touched a patient’s forehead and indicated she would never do that.
“Hold a hand, yes, but touch a head? No way.”
How great that she already knows this boundary for herself. It would feel unnatural, and/or uncomfortable, in which case, I absolutely agree it’s better she doesn’t do it. If she were to perform it insincerely, it would almost certainly backfire.
I’m glad to have physical touch in my toolkit, however, and putting my hand on a patient’s head is something I do with some regularity (after receiving their permission), because I have learned it is incredibly effective in soothing a person. We humans tend to soften when we’re regarded lovingly, and that gesture in particular seems to help people feel cared for quickly, and personally. It’s something meaningful and effective I can do that takes little from me.
Another way chaplaincy is a performance—very similar to acting, in fact—is that there are a number of lines I have somewhat memorized (and deploy frequently). Just like Soothing Hand on Head, these lines are tools in my kit, deployed strategically for specific purposes.
I can tell I’ve become more skillful as a chaplain because they generally seem to achieve the intended outcome. A hammer…pounds a nail. An appropriately timed and relevant observation? This can alchemize the exchange to advance it along a narrative. Doubt is reassured. Fear is validated. Uncertainty finds an answer from within.
Here are a few phrases I’ve come to rely on:
“There is no right or wrong way to do this.”
Can you believe that—more often than not—people apologize to me when they start to cry, even when it’s over the impending death of a loved one? It happens all the time but still levels me. Of course they’re crying. It must not occur to them that I sit with crying people daily.
I try to reassure them that they’re well within the broad margin of (socially) “acceptable” reactions by reminding them they can’t do it wrong, not even if they yell and stomp and wail, which also occasionally happens (less often that I would have imagined, actually). I hope this phrase helps them to know that they’re already succeeding at the most important part of accompanying someone at the end of their life, just by being present.
“I believe we can get through anything if we don’t have to do it alone.”
Sometimes I say this as an explanation of my presence and encouragement for a patient to allow me to stay…it can be hard for people to accept care, especially from a stranger. This statement also nicely affirms my belief in the individual or family’s capacity to meet the challenges they face without being cloying or intrusive.
The other day I walked into a room where a young man was struggling for his life after trying for years to drink himself to death. When I introduced myself, he started telling me his life story, crying continuously. Several times he interrupted himself to say, “I can’t believe I’m telling you all this,” and, “I can’t remember the last time I cried.” He told me about a crime he committed as a young person, and described his remorse and feeling like a piece of shit who even God can’t love because how could he have done that to that girl?
The transformation in this man over the hour I spent with him was night to day, and it required very little from me except presence. By witnessing his experience, I demonstrated his worth. By understanding his trials, I honored his traumatic childhood. When I left he told me he felt, for the first time since his teens, like he wanted to live.
I went back to see him a couple days later and he was sitting up in a chair with a discharge plan on the horizon. The day after that he was smiling, eating lunch, and watching a movie. It required next to nothing of me, but this man’s life was changed because he accepted simple, gentle companionship.
“It seems apparent and worth acknowledging that life is not fair.”
What can you say to a 23-year-old who has metastatic cancer and less than a year to live? What do you tell a young mom who had a stroke and is now paralyzed on half of her body?
Offering this gentle philosophy names reality without creating negativity, forcing positivity, or bypassing the meaning of the experience. It’s an open-ended invitation for the care recipient to lament the unfairness, which can allow them to unburden themselves of their angst so they can move beyond it.
So often we avoid reality by sugar-coating it. For example, I could have told the young cancer patient that “maybe he’d beat it.” Maybe he will, and it goes without saying that’s our mutual hope. But platitudes do nothing to acknowledge or address the person’s feelings.
What he needs more than a saccharine fantasy is to express his fears, wail in rage, and wallow in the injustice. He needs to name it so he can get it out of his system. Then maybe he can muster some hope and start to make meaning of what’s unfolding.
“Families are often complicated.”
This statement is neutral, affirming reality without taking sides. It preserves a polite distance. It’s also simple and objective, avoiding complex narratives. So often people over focus on old stories and end up getting stuck in he-said, she-said. It’s not useful, and in end of life matters, it can prolong suffering.
I don’t know a more useful phrase for compartmentalizing family drama in order to get beyond it.
“…allow natural death”
Where did the phrase “pull the plug” come from? I think it’s time we bury it. Health care providers largely have, yet it persists—I hear families say it frequently.
The phrase haunts me, because I fear it will haunt them. If not the words themselves, the meaning of them. Because “pulling the plug” suggests withdrawing or stopping care. A week after losing a loved one, I would hate for the family to feel like they chose to end that person’s life versus what really happens in these circumstances: the removal of artificial supports to allow natural death.
It’s a heavy burden to have to decide for a loved one whether or not they want to be kept alive when their health has deteriorated precipitously. Learning that your loved one isn’t going to recover or regain function after an illness or injury is a lot to take in, especially if the patient’s decline was rapid.
Using real language, I believe, is helpful for family to come to terms with and integrate what is now true: their loved one has reached the end of their natural life. “Allow natural death” names the process that has already begun when interfering—adding artificial supports—would produce more suffering.
“What I notice at the time of death is that it is exceedingly peaceful and even beautiful.”
I used to think I wouldn’t want to die in a hospital, but now I don’t think I would mind. When it comes to my end, I want to be surrounded by my loved ones…that’s all I really care about.
One of the privileges of my job is accompanying so many people at the end of their lives, which I believe is as sacred as attending a birth. There is a lot more I could say about this and I suppose someday I will, but the most important thing I want people to know is that every death I have attended has been peaceful, and there is something so serene about the decedent. It seems to help people feel more calm to know that someone who has seen a lot of death and dying isn’t afraid of it.
“Life won’t be the same as it was.”
Recently my mom was in the hospital, and I have to say, the experience had me reconsidering whether I think this is a statement I ever want to repeat.
I have used it as a way of naming what is true and inviting the care recipient into their new reality: life has changed. But if someone said this to me the day my mom was admitted, I would have been…unstoked. I would have thought, “how do you know?” or, “how can you say that?” or, “I’m not ready to think about that yet.”
I don’t want to drag someone into a situation they’re not ready to face, because my job isn’t to reconcile anyone to their reality. It’s to offer companionship through a difficult time.
Now that it’s been a few weeks since her initial episode, I am ready to consider what has changed irrevocably for her and our family. But I’m still asking myself whether this is as useful a statement as I used to believe.
“You’re doing a great job.”
Don’t we all need to hear this from time to time (or every day)?
Patients have to give up nearly all of their agency, autonomy, privacy, and control when they wind up in the hospital. They often feel physically shitty and they’re scared. They might also be mad, sad, homesick, lonely…who knows what else?
What does it mean to do a great job as a patient? Personally, I’m fond of anyone who doesn’t swing at nurses, pee in strange places on purpose, harass staff members, or yell or spit. If they’re taking their medication and doing what is requested of them (e.g. holding still), it seems to me they’re winning the patient game. You wouldn’t believe what a difference it makes to tell them this very fact. I would estimate their anxiety goes down…maybe 25%? 50%? It’s a lot! And it’s such an easy thing to offer.
“Peace be with you.”
It’s a blessing of sorts, honors the care recipient’s experience regardless of how things are going, and has the power to contain whatever happened earlier in the visit while also conveying our time together is coming to a close. It is, I believe, is a perfect ending…to a care encounter, or otherwise.
Peace be with you.