This last week I was in a conference at George Washington University at the GWish (George Washington Institute for Spirituality and Health) Summer Institute. The theme was “restoring the heart and humanity to health care.” The participants were about evenly split between chaplains and doctors/nurses, with the majority from the US and Canada, but there were a few from Australia, Singapore and Korea. It was stimulating. Fascinating. And mind-shifting (not really mind “blowing” because it speaks to something that I strongly believe is true.)
Among the issues we considered were questions of advocacy, empowerment and responsiveness for our patients, and issues related to ethics and moral distress in caregivers. There are quiet revolutions reported – where physicians, nurses, chaplains and social workers all seek to find ways to make a difference in the wellness of the people we care for, and to make it a patient-centered process, rather than a reimbursement-driven one. This, of course, flies in the face of the requirements by administrators and supervisors… and the dilemma is well-documented.
But what is more striking is that, despite all the advances in technology, medical knowledge and education, there is still a “status quo” that is hard to break… the one that, at least as my medical educator friends describe it, is based on output and competition, and leaves little room for the “humanity” of it all. I have heard surgeons tell their students that “we are not having one of those fuzzy kum-ba-yah moments here,” a snide remark about the “humanity in medicine” programs that are part of medical schools today. The pressure to produce, whether student, resident, fellow, or staff physician, is telling. There are deeper systemic issues, such as the limitations of the number of hours that medical residents are allowed to work (and if they try to work extra, they can put their program in jeopardy with regulators, as this story tells…) And there is the ever-decreasing reimbursement rates from Medicare and Medicaid, which color all of our medical care, whether we use private or government insurance.
Any profession has a common body of knowledge, but in health care there are layers upon layers of information. There is the basic knowledge of anatomy and physiology (and all of the related “-ologies”). There are standards for patient care, communication, and personal/professional development. But the difficult piece to teach — regardless of who you are — is to reflect a compassionate presence.
As I reflected on my own work, theological studies and clinical education, there are some similarities for chaplains. We are grounded (or “ground IN”) the studies of our respective theological belief systems. We get a nod to practical skills (preaching, spiritual care) and there is some time given to spiritual formation. We might get a class on recruiting volunteers and budgeting. In the press of writing theological research papers, there were times that the spiritual formational piece seemed like just “one more task” and not an essential piece of the degree program. The longer I am in ministry, the more I understand that formational emphasis to be essential! The reflective part of my CPE (Clinical Pastoral Education) experience has also been more and more important to me as I spend more hours post-training as a professional chaplain. My times of reflection and personal spiritual formation are what ground me. They are the spaces that I give myself to seek to do a better job, to put away the questions about my work that can haunt me — or make me overly impressed with myself. (Nothing like sitting down to write a verbatim and discover how much of my clinical visit was clearly less than optimal!)
Where do I go from here? I am thinking about research — studies which might draw more insights into the needs of the families of ICUpatients, or ICU staff. I think about grief and grief work, and even the anticipatory grief of end-stage cancer patients. I think about the spiritual needs of the “nones” that are on the increase in this busy metropolitan area, and how they can best be served. And then I try to figure out where, in a 16 hour overnight on call shift, I will have the time (or the presence of mind) to first “do my homework” on the literature available at present, and then to actually DO this research. I know that understanding what I do in chaplaincy and why I do it is important. But I also know who I am, personally and professionally, is just as important.
So while I cogitate on those research projects, I’m continuing to cultivate “the chaplain within”. One of the disciplines I have been reinforcing lately is making time to walk in silence and reflection. There are labyrinths not too far away from our house (about 30-45 minutes in traffic). The hosts of these labyrinths are always friendly and welcoming. (If you are curious and live in the Metro DC area, they are located at Dayspring Retreat Center and St. Luke’s Episcopal Church in Bethesda.) I should note that there are many other labyrinths in the DC area; these are just the ones which are closest to us.
I know it sounds a little… unusual… but I will soon be working on making a labyrinth in our back yard. This corner of the world is secluded, relatively flat, and has enough space for me to set in some pavers as a border for an simple spiral labyrinth. I enjoy being in our back yard, whether weeding or just bird-watching. Rather than having to “go and do” anywhere, I can create a space right outside my back door. And invite others to “take a walk” there, too.
So… in a few months, ask me how this little project is doing. It’s a bit of a daunting task for heat/humidity/mosquito/tick season around here, but I want to give it a shot. If for no other reason, there will be a quiet place to reflect, pray and remember why I do what I do.
An Unfinished Symphony 