chaplain | Hank Dunn

Compassionate, informed advice about healthcare decision making

Posts Tagged ‘chaplain’

Me: “I’m the chaplain.” Patient: “Oh God NO!”

Posted December 9, 2021 by [email protected]

I started our first meeting as I have hundreds of times before and since, “I’m Hank. I’m the chaplain.”

The response from our new hospice patient took me aback, “Oh God, NO!”

One of the great things about being a chaplain is that, generally, people are glad to see you.

…Let me restate that: People are not glad that they are in hospice and need to see a chaplain. People who are seriously ill and dying are usually pleased to see the chaplain. My standard greeting on a first meeting is, “I am glad to meet you but sorry for what has brought us together.”

An invitation to revisit my experience as chaplain

A recent “GeriPal Podcast” has caused me to reflect on my years as a healthcare chaplain. That’s “GeriPal,” as in geriatrics and palliative care. “Spiritual Care in Palliative Care” is discussed by three chaplain educators and trainers and the two physician hosts.

Years ago, by chance, I became part of an experiment to find out how people actually felt about the prospect of seeing a hospice chaplain. I was the only chaplain working out of the Loudoun/Western Fairfax office of the Hospice of Northern Virginia.

When a new patient came into our service, the admitting nurse would ask the patient or family, “Would you like to see the chaplain?” About 30% said, “Yes.” Even at that low rate, my caseload was getting too much for me to cover adequately.

Then, something very fortuitous happened. We merged with another hospice, and suddenly, we had another chaplain to cover the whole eastern half of the region.

Now, we were looking to find a way to increase the caseload to fill this new abundance of chaplain hours. We changed from a question (“Would you like to see the chaplain?”) to a simple statement from the admitting nurse — “The chaplain will be calling to set up an appointment in a few days.” Bingo! We went from seeing 30% of the patients to seeing more than 75% overnight.

Why would so many people go from saying “No” to a question to so willingly accepting a call from a chaplain?

There are all kinds of reasons people said “No” to the question. Perhaps saying “Yes” implied, “I am not spiritual enough and need help.” Or people think of chaplains as “religious” and “I am not religious.” Or maybe accepting a visit from the hospice chaplain means, “I don’t think my pastor is good enough.”

Or, maybe it’s the reason the man who said, “Oh God NO!” had when I introduced myself. I asked him, “Why did you respond like that?” He immediately said, “I don’t want to die.”

Oh my goodness. He was equating meeting the chaplain as meaning he is going to die. In his mind, you only see the chaplain when you are dying. In truth, to be admitted to hospice, he had to acknowledge that his physician was estimating that he had only six months to live. Perhaps, he had seen too many movies with a chaplain escorting a prisoner to the gas chamber or a chaplain comforting a dying soldier.

I used that first visit to assure the man he didn’t have to die just yet. I told him people flunk out of hospice all the time by their condition improving. In my mind, I could explore his fear of death in a future visit. But it was not to be.

He had another stroke and never spoke another word. His pastor and I could provide general words of comfort and encouragement in the face of the fear of death, but we had no idea what he was thinking.

So, people refuse to see the chaplain because seeing the chaplain means, “I am dying.” The ill-founded logic goes, “Asking to see the chaplain means I am dying. I don’t want to die. Therefore, I will refuse the chaplain visits and will not die.”

I wish it were that simple.

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Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

The “Serenity Prayer” Both In and Out of Jail

Posted November 18, 2021 by [email protected]

What word could I possibly bring to the men in jail? That was the question.

Each Wednesday afternoon, I join three other men from my church, and we sit in silent meditation with a group of inmates. These men at the Lafayette County Detention Center are awaiting trial or sentencing or transfer to another, more “permanent” place of incarceration.

Prayer on Alcoholics Anonymous medallion

Both our leaders were going to be out of town, and so leadership had fallen to me. We always start the group with a reading, usually from the Psalms. Surely, the psalms of lament ring true to those behind bars — “My God, why have you forsaken me?”

I could have defaulted to the oft-quoted and ever-favorite Psalm 23, “The Lord is my shepherd,” but I wanted to go a different route.

I have no idea what it is like to sit in jail. Guilty or not, these men face uncertain futures and life challenges of which I know nothing. The “Serenity Prayer” came to mind. Long a favorite of those in A.A., this simple prayer has given guidance to alcoholics and addicts for generations. Heck — it has given me guidance.

Originally, it was written as a prayer for worship at a small Christian congregation in Heath, Massachusetts, in the 1930s. Theologian Reinhold Niebuhr wrote it as part of a sermon for his flock. The most common version is just three lines asking for “serenity,” “courage,” and “wisdom.” I included these words in my book, Hard Choices for Loving People, to help those facing the end of life.

In the full prayer below you can see the influence of eastern thought with suffering as a “pathway to peace” and accepting the world “as it is.” This reminds me of the current cliché, “it is what it is.” These are words for all of us, jailed or free.

Here is the complete prayer:

Prayer for Serenity

by Reinhold Niebuhr

God, give us grace

to accept with serenity the things that cannot be changed,

courage to change the things which should be changed,

and the wisdom to distinguish the one from the other;

living one day at a time, enjoying one moment at a time;

accepting hardship as a pathway to peace;

taking, as Jesus did, this sinful world as it is,

not as I would have it;

trusting that You will make all things right if

I surrender to Your will;

so that I may be reasonably happy in this life and

supremely happy with You forever in the next. Amen

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“God has told me my wife is not going to die!”

Posted October 13, 2021 by [email protected]

“God has told me my wife is not going to die!” That’s how my new hospice patient’s husband greeted me.

The nurse warned me that this was coming. The patient had breast cancer that had metastasized to the bone — a usually fatal prognosis.

Photo by National Cancer Institute on Unsplash

He went on to say, “I don’t want any talk about death or dying, only hope and healing.” Months before, I was asked not to return to a home where I had pushed a family to discuss possible death before they were ready.

I was wrong then, and I did not want to blow it again. As a chaplain, I was a guest in their home, so I would abide by his rules. I did say that if the topic of death came up, I would pursue it but would leave it up to them to introduce it. Until then, hope and healing.

Hope and optimism are all around us

There is hope at weddings. I have led many couples to repeat the phrase, “Till death do us part.” One pair deleted this phrase from their vows. It was his third marriage and her second. Another bride asked me to remove, “for richer, for poorer.”

The couples who didn’t edit their vows were being optimistic. The truth is half of all marriages end in divorce.

There’s hope in business. Would entrepreneurs start new ventures if they were not hopeful? Sure, they have a business plan and capital. Yet, there has got to be some self-deception, a bit of hopefulness in the face of long odds.

People who study such things call this self-deception the optimism bias. “The optimism bias is defined as the difference between a person’s expectation and the outcome that follows. If expectations are better than reality, the bias is optimistic; if reality is better than expected, the bias is pessimistic.”

Diversifying hope

It turns out optimists are happier and live longer than pessimists. I wrote in a previous blog about how the self-deception of the placebo effect can take away pain. With these kinds of benefits, so what if an optimist’s expectations are better than reality?

The Journal of the American Medical Association recently published an opinion piece, “Holding Hope for Patients With Serious Illness.” It is about doctors who encounter patients or family members who are hopeful for a happy outcome in the face of a fatal illness. What do they do? They don’t take away the hope but diversify it. Here is their summary:

“How can clinicians help patients hold multiple hopes? One approach may be to ask patients what they have heard about their prognosis from their clinical team. Patients could then be asked, ‘Given what is coming, what are you hoping for?’ It is not necessary to contest the answers nor convince patients to consider other futures. Instead, the clinician could acknowledge the response and ask, ‘What else are you hoping for?’ And then again, ‘What else?’ The point is to help patients balance and diversify their hopes, providing flexible future directions and possibilities.”

“Satan is trying to get me to doubt it.”

I stumbled onto this idea of diversifying hope on my own with the husband who heard a message from God. As I arrived for one visit, he was about to leave for work. He said, “Hank. You know how I said, ‘God told me my wife is not going to die’? Well, I still believe that, but Satan is trying to get me to doubt it. Would you pray for me?” I said I would, and he left.

I turned to the wife, who had just found out the cancer had spread to her liver. “Do you have as much confidence as your husband that you will not die?” She burst into tears and said, “I am afraid if I die, my husband will be disappointed in me.” My heart sank for them both.

Photo by Gus Moretta on Unsplash

On the next visit, I sat with the two of them. I told the husband about my conversation with his sick wife. He immediately got up from his chair, took this poor woman’s hand, and said, “I would never be disappointed in you. You have done all you can to fight this.”

I told them I had two concerns about people in their situation not contemplating the possibility of death. One was some people, believing a patient is not dying, refuse narcotics for extreme pain. (This was not the case with these two.) My other concern was that they might miss some crucial conversations. Conversations about their love for one another, saying good-bye, or finding ways to live fully in the limited time she had left.

The couple assured me they had been doing that, too. They were still hoping for a cure, but they also hoped for enough time to say all that needed to be said. They hoped for freedom from pain by accepting pain medication.

They had already diversified their hopes.

The Spiritual Side of “Grey’s Anatomy”

Posted December 16, 2020 by [email protected]

“Chaplain Dunn, we need you in the emergency room,” the nurse started her call to me on a Saturday morning. “An eight-day-old baby died at his mother’s breast at home and the family needs your support.” This family had no minister to call. I did what I could for them. It was a sad, sad situation. A few hours later the funeral home called, and the family asked if I could conduct a graveside service for the child.

For twenty years, for one week each quarter, I volunteered as the on-call chaplain at the Loudoun Hospital Center in Virginia. During normal business hours, there was a full-time chaplain ready to handle emergencies. I almost always got a few calls each week I was on duty. Often, it was for deaths in the ER. Sometimes, it was for stillbirths or neonatal deaths. The staff knew they needed to provide spiritual support in times of crisis. Who could they call after hours?

The mysterious absence of chaplains

As I wrote in my last blog, we have been binge-watching Grey’s Anatomy during the pandemic. In the over 300 episodes of Grey’s Anatomy I have watched, I can’t recall a time when a chaplain was on camera. Isn’t that curious? Like all medical dramas, the show is filled with crises and death. Where are the chaplains? Full disclosure here: I am a chaplain and could be protecting my turf.

One past TV medical drama, M*A*S*H (1972-83), cast a chaplain in a significant role. The Mobile Army Surgical Hospital amid the Korean War might make the presence of a chaplain seem more acceptable. After all, it was the Army in the middle of a war. The chaplain, Father Mulcahy (a Catholic priest), was one of only four characters who appeared in all eleven seasons of the hit show — along with “Hawkeye,” “Hot Lips” Houlihan, and the crossdressing Klinger.

There was one Grey’s episode when two doctors talked about needing to get a chaplain. A patient was asking for forgiveness. He was the landlord of an apartment building that had collapsed resulting in multiple injuries and some deaths. He said he was trying to save up the money to make repairs to the structural damage the building had suffered in an earthquake. Now, people had died because of his procrastination and he wanted to be forgiven.

Dr. Ben Warren said, “The chaplain is M.I.A. and I heard there was a rabbi in geriatrics.”

Dr. Leah Murphy encouraged Ben to go see the patient and act as chaplain, “All you have to do is listen and nod your head.”

Dr. Warren did see the patient and told him he was not a priest. The guilt-ridden landlord said, “I just need someone to listen.”

The spiritual side of Grey’s Anatomy

Just because the show is absent chaplains or other clergy does not mean it does not tackle some very important spiritual and religious topics. More than once did a child need life-saving medical treatment when one parent wanted to trust the doctors and the other wanted to take the child home and trust God only. Similarly, a Jehovah’s Witness patient refused to accept a blood transfusion that could have saved his life but would violate his strongly held religious belief. A new intern felt compelled to use her hijab to stop the bleeding in a patient. It was later was returned to her, cleaned, by a fellow physician who knew the spiritual importance of the head covering.

Rabbi Eli, a dying patient, comforts Dr. April Kepner

For nine seasons of Grey’s most of the “spiritual teaching,” centers around the character, Dr. April Kepner. She starts out on the show as a conservative Christian and something of a prude. Gradually, life seems to interrupt her strongly held beliefs and morals. She loses her virginity and then recommits to a chaste life in an effort to “re-virginize.” She gets married, has a child die soon after birth, gets a divorce, and has another child as a single mother. Her own painful life story and the random tragic stories of her patients causes a crisis of faith in Dr. Kepner.

The journey we’re all on

Kepner’s breakthrough to a more mature faith is helped by a dying patient, Rabbi Eli. He is dying because of a mistake made by Dr. Miranda Bailey. Kepner views Eli’s case as just more evidence that God does not care for us. She wants a guarantee that if you are faithful good things will come your way.

The rabbi will have none of the guarantee talk. He recites a long list of faithful biblical characters who were tragic victims. Eli says it’s also in “the sequel” (by which he means the New Testament). He argues that if only good things happened in these stories, the bible would not have been a best-seller.

Rabbi Eli helps Dr. Kepner through her crisis of faith

“Who are you to know why some people live and some people die?” the dying man tells Dr. Kepner. “God’s not indifferent to our pain…the world is full of brokenness and it’s our job to put it back together again.” He asks her to tell Dr. Bailey he forgives her for her mistake. He dies confusing Dr. Kepner with his wife who is out of town. Get out the tissues.

Occasionally, the hectic scenes in Grey’s O.R. and E.R. shift to the quiet of the chapel. Doctors pray, light candles, or just sit silently. Here, Kepner walks in on a distraught Dr. Bailey who is lighting a candle and seeking solace.

Dr. Kepner comforts Dr. Bailey, who made the medical mistake that led to Rabbi Eli’s death

Dr. Kepner tells her, “Eli forgave you. Some things just happen, and we don’t get to know why.” She came to a point of acceptance and was able to comfort a fellow traveler in this seemingly unfair world. Is this not the journey we are all on?

“Grey’s Anatomy” and CPR on Television

Posted December 9, 2020 by [email protected]

True confession: I have joined my 22-year-old daughter in binge-watching Grey’s Anatomy during the pandemic. Over 300 episodes viewed and counting. I now know about “10-blade,” “clear!” and the importance of declaring “time of death.” Also, I never knew there was so much romance and sex going on in hospital supply closets and on-call sleeping rooms. Now I know.

Grey’s Anatomy (currently in its seventeenth season) follows Dr. Meredith Grey and her fellow surgeons at a Seattle teaching hospital. She started out as a young, single intern and is now a widowed mother of three small children as well as the chief of general surgery. The show is very engaging, depicting extremely dedicated and hard-working doctors. Most are compassionate, empathetic and caring.

CPR is on TV…but it is not realistic

A staple of medical dramas is the “code.” A heart monitor starts beeping loudly, a doctor starts chest compressions, another grabs the paddles of a defibrillator and yells, “Clear!” Sometimes the first shock gets the heart back in rhythm but most often it takes a couple.

While it seems like all of the cardiac arrests on Grey’s are with a “shockable rhythm.” In real life only about 10% of cardiac arrests are shockable. Medical journals have exposed the unrealistic depiction of CPR on medical dramas.

Why dedicate medical research to the topic? The general public develops a distorted view of the success of the procedure. In 1996, the New England Journal of Medicine looked at CPR on Rescue 911, Chicago Hope and E.R. and found survival rates vastly higher than the actual 17%. On Rescue 911, 100% of those receiving CPR survived.

In 2015 the journal Resuscitation calculated the CPR survival-to-discharge success rate at 50% for House and Grey’s Anatomy. That doesn’t happen in real life. But if 83% of the CPR patients died on TV, not many people would watch it and the sponsors would probably complain.

I have written before about the futility of CPR for large categories of patients. In the years between the fifth (2009) and sixth (2016) editions of Hard Choices for Loving People, the survival rate inched up from 15% to 17%. It is not that the procedure has gotten better. The clinicians are getting better at advising patients and families about who will NOT benefit from CPR. Survival rates have improved because we are doing LESS CPR.

DNR is a big deal

Occasionally on Grey’s, the characters discuss “code status” — whether a patient should have a Do Not Resuscitate (DNR) order. (See my blog on my preference for AND — Allow Natural Death.)

On the show, it’s the patient who is often ready for the docs to write the order so they can have a peaceful death. The family — or even the physicians — sometimes resist. In my experience, this is very realistic. Real-life patients usually come to the conclusion that they are dying before their families or doctors. Their own bodies tell them it is time. This is information others do not have.

The DNR is a big deal. It serves as a sign that it is time to prepare for a comfortable and dignified death. And, on this, I do give Grey’s credit for getting it right.