While making rounds one day, I got paged to the surgery prep area, knowing nothing of the patient but the bed number.  I arrived to find Ursula, in her 40s, lying on a gurney, with her husband Roger seated beside her.  They said they had no pre-surgery worries, they simply wanted support with an Advance Directive form.  They had filled out very little of it, and time was short before Ursula would be wheeled off to surgery.  I reviewed the form with them at a high level, then suggested that, unless they had concerns regarding Ursula’s procedure today, they should complete this important work when they were not pressed for time.  They agreed, and said they would take care of it soon.

As they had expressed no interest in further support, I simply offered Ursula my wishes for a successful surgery.  As I often do in this situation, I also noted that the one who waits can find this time more challenging than the patient—who is asleep, after all—and I offered my good wishes to Roger.  He laughed and said he’d be fine, and he thanked me for the kindness.

When I finally looked at Ursula’s chart two hours later, I realized her surgery was complex, including a hysterectomy and much more.  I could see she was still in the OR, and it got me thinking about Roger sitting in the waiting room.  I thought about checking in on him, but then I looked at the list of other patients I had identified for visits, and I decided I needed to chart this one quickly and move on.

I wrote up my encounter and was about to post it when I got a second nudge to visit Roger.  Just then a “rapid response” was called so I locked my screen and started out the door.  A colleague offered to cover it, as he was heading that way anyway.  I gratefully accepted and went back to my desk.  As I unlocked my screen, my eyes fell once again on the unfinished chart note—and my thoughts returned to Roger in the waiting room.  I headed down.

Roger recognized me and closed his laptop quickly as I walked toward him.  Disarming any concern, I said I brought no news, I was simply thinking of him sitting here, having recognized how complex Ursula’s surgery appeared to be.  He relaxed and smiled appreciatively. 

“It is quite involved, but we both feel good about it.  It’s a big day for us, as it represents the end of our journey to have a second child.  Our daughter was born 10 years ago, but since then we’ve struggled to have another child, with multiple attempts at IVF.  We recently made peace that a second child is never going to happen for us.  This cleared the way to proceed with this surgery, which should relieve a lot of pain and suffering that Ursula has endured.  We know many others have gone through IVF and never had even one child.  We now feel free to focus 100% on what a blessing our daughter is and to move forward with our lives.” 

Roger thanked me for my interest in their story, and for making the time to see him.  I updated my chart note and resumed my work with other patients.

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In my Quaker meeting we talk a lot about nudges of the Spirit, one of many ways to describe fleeting thoughts like the ones I experienced regarding visiting Roger in the waiting room.  They can fly in and out of our heads without our really noticing them; if we do notice them, they are easily dismissed in favor of other more “important” priorities.  Sometimes, as on this occasion, they can return or persist, requiring more effort to put them out of our mind.  Nonetheless, we often do.

What are these nudges, as I call them?  From where do they arise?  Why do they sometimes persist?  How much do they matter?  There are many schools of thought, generally aligned with one’s theology or philosophy of mind.  Other possible terms for them include random thought, creative insight, epiphany, intuitive perception, voice of conscience, and movement of the Spirit.  The unifying theme is that they do not arise from conscious reasoning or any intentional process, but seemingly out of the blue or as instinctive reactions to an external stimulus.

The question that interests me is:  What significance should we accord such thoughts, and how should we decide whether to take a given thought seriously?  It’s easy to be dismissive, as I was initially, letting my rational mind prevail.  After all, so much of our education and development trains us to suppress our impulses or to think through their ramifications before acting.  But I, like many, have done so only to look back later and say, “I wish I’d gone with my first instinct on that one.”

If one believes, as I do, in the existence of a power beyond our understanding that brought our universe into existence and seeks to guide that creation toward a purpose (“God” for those of the Judeo-Christian persuasion), then the question arises: How does that power guide our actions?  It might be nice to have voices come from burning bushes or bursts of light, but no one I know has ever experienced such things.  Instead, to my own way of thinking, that guidance comes from little nudges like what I described.

Not every one of them, of course.  We have random thoughts all the time that, if followed, would lead nowhere good.  But a few tests can be helpful.  Is it significant?  Is it about something that might make a difference, to myself or someone else?  Is it persistent?  Does my mind keep coming back to it despite attempts to dismiss it?  Is it aligned?  Would pursuing the nudge be aligned with my goals and values?  Might others whose goals and values are aligned with mine encourage me?  Does it feel right?  Not based on reasoning, but on what resonates in one’s heart.

One might propose other tests, but these simple ones separate out a lot of chaff.  The nudges to visit Roger in the waiting room passed all of these tests.  I can’t say I applied them formally at the time, but at this stage in life I’ve had enough practice that it was fairly automatic.  After the third nudge I said to myself, “This feels real.  Are you going to honor it or not?”  I smiled inwardly in gratitude for its persistence despite my obtuseness.  Then I headed down.

Over the years I’ve gotten better at noticing and honoring these nudges but, as this story shows, I’m still a work in progress.  Most of the time, if we ignore these nudges, nothing bad happens, at least that we ever know.  If you have a nudge to drop a note to someone you know is carrying a concern, but then you never do it, they’ll probably be OK anyway.  I think Roger would have been OK without my visit.  But I think the world moved a tiny bit in the right direction because I honored that nudge, and I think it moves a little bit closer every time any of us honors such a nudge.

I think nudges are, in fact, one of the most important ways God offers to make us instruments of healing and peace, but they are so easy to miss.  I like to think that the guidance is there for the taking, and the universe is patiently waiting for us to sharpen our wits—our skills of discernment—so that we can better perceive the guidance and act on it.

For me, these nudges feel like one of the principal ways God reminds me of their presence and availability in my life, and invites me into active relationship.  Every time I’m graced with a nudge, and, more importantly, take notice, I am grateful.  My hope is to keep getting better at noticing them and honoring them.

Tonight, on the occasion of the Pink Moon of 2024, I feel led to republish a post from April 2020 by the same name. Then, the horrors of the COVID pandemic were still just unfolding, leading those of us who could to retreat to safe bubbles and seek consolation where we could find it. Now, the horrors of COVID seem manageable but much else about the world does not. I republish this tonight with the hope that it helps you to find consolation and hope despite our current uncertainties.

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Last night my friend Kathy posted about the wonder of the full moon.  A month ago she was visiting her daughter, helping put her two granddaughters to bed, when the full moon rose.  One at a time, she hoisted each granddaughter, already in her nightgown, onto her shoulders, and walked down to the end of the gravel driveway to marvel at the moon.  Last night, she gazed at the full moon again and reflected on our current quarantine, “that I can’t go and get a little girl to marvel with me,” and reminded us to “Say yes every way you can” to the gifts that each day presents us with.  A friend of hers commented, “Pink moon tonight … beautiful!”

This morning I awoke at 6:00 and noticed an unusual light piercing the translucent west-facing shade in our bedroom.  Remembering Kathy’s post and recognizing the source of that light, I hopped out of bed and soon was pedaling down the Springwater Corridor, heading west toward the full moon hanging in the dawning sky.  It was as big as I can ever remember, and pink—very pink.  This was not the first time I have enjoyed a setting full moon on a morning ride, and it never fails to fill me with a sense of accompaniment by my creator.

The moon spoke:  “I see you, and I see the entire planet you live on.  I see fortunate ones like you, and I see your neighbors sheltering in tents near you.  All around the world, I see people rushing toward emergency rooms with tightness in their chests and fear in their hearts, and I see health care workers heading in to those same hospitals with a commitment to serve, and fear in their hearts, too.  I see you all, and I love and care for every one of you, for you are my children.”

The moon continued:  “I have been watching your planet closely for billions of years now.  I have seen civilizations come and go, and I have seen species come and go, and I have loved you all.  I live in every moment with you, I share in each smile and each tear, I know the depth and urgency of your passions and your fears.  Having seen so much gives me a perspective you can only imagine, but it does not diminish in any way my caring for you and those you love.

“I love that you are following after me as I head west over the horizon.  Soon you won’t be able to see me, but remember that I am there whether you can see me or not.  I will always be speaking my wisdom into your heart and your condition, and I pray that you will be listening for my voice.”

Upon returning home, I learned that “pink moon” refers to the full moon of April, so named for the blooming of ground phlox, one of my father’s favorite flowers.  This year, the pink moon is the largest supermoon of 2020, the closest the moon will come to earth during its full phase.  The pink moon is associated with rebirth and renewal, in keeping with the season; I pray for these things now more than ever.  They say the pink moon, however, is not pink—but that’s my story and I’m sticking with it.

Like many, this season has brought us a unique mix of challenges and blessings.  We faced a family health crisis that necessitated my daughter’s family moving in with us, but navigating this has brought us closer together.  The coronavirus crisis put an end to my chaplaincy work for the time being but extended our new living arrangements, so now I get to share each day with my five-month-old granddaughter.  She is still too young to appreciate the pink moon, but I look forward to the day when I can hoist her onto my shoulders to gaze at the moon, and to tell her of the things the moon spoke to me this morning.

Photo credit – Bruce Alber

What’s in a name?  That which we call a rose
By any other name would smell as sweet.

William Shakespeare, Romeo and Juliet, Act II Scene II

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I got a text recently from a friend in their 30s who for a time attended my Quaker meeting but has since moved away from the area—and away from participating in any religious community.

“I got some unexpected news last week.  Doctors found severe compression in my spinal cord and I have to get neurosurgery on my spine this week to avoid potential permanent damage.  I’m scared shitless.

“I feel lucky they caught it in time, and my neurosurgeon is supposed to be one of the best in the area.  I’m trying to put as much positivity out as I can, but I definitely need some help.  Can you please send positive thoughts my way this Friday—that the surgery will go well, that I will have a speedy recovery, and that I will still be able to go on my long-awaited trip to see family overseas.”

“Wow,” I texted in reply, “that’s a lot coming at you quickly!  Of course, I’m in your corner all the way, with positive energy and deep hopefulness.  You are a dear person to me, and I’m holding you in my heart.”  On Friday morning, I shared these sentiments again. 

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As a chaplain, I regularly offer prayer to patients and families who request it—it’s part of the job, and I love it.  But I live and work in Portland, Oregon, a theologically diverse community.  Many of the patients I see practice religions outside of the American “mainstream”; many others don’t practice any traditional religion at all.  Yet they still seek prayer, even if they don’t call it by that name.  My goal, always, is to listen and respond in a way that respects and is aligned with their beliefs.

Fortunately, this meshes well with my own approach to prayer.  A core Quaker belief is that the Light (or Spirit of God) is present in each person, and is at work in the world seeking to guide us toward healing.  When we pray, then, we don’t recite verses we know from past experience, but instead listen closely to discern the movement of the Spirit within us and among us so that we can respond in accordance with its leading. 

In a hospital (and elsewhere), the sentiment underlying many requests for prayer is “Help!”  When something threatens our sense of security (or that of a loved one) and we cannot manage the threat ourselves, our vulnerability is laid bare and our instinctive response is “Help!”  As a chaplain, or simply as a caring human being, the challenge becomes listening for what help is being sought and then offering help in a way that is … well, helpful.

Petitioning for help in situations that feel overwhelming is foundational to religious practice around the world and throughout time.  Paraphrasing the writer Anne Lamott, one way to think of God is simply as a name for whomever it is we are speaking to when we cry “Help!” into an empty room.^[1]  But one need not believe in any notion of God at all to seek prayer; most of us know the feeling that Lamott refers to, or someday will. 

That day came for my friend whose story begins this post.  While there is no religious context to frame their petition for help or to guide a response, that doesn’t make it any less “prayer.”  There is still a theology at work here, one that acknowledges a source of power outside of themself, one that believes comfort and strength may be available by beseeching that power to engage on their behalf—while also acknowledging that their hoped-for outcomes may or may not be realized.  This is the heart of prayer.

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On the day of the surgery, I was included in a text thread initiated by my friend’s partner to keep family and friends informed of progress.  The contributions of others, many also in their 30s, were touching.

“You got this!  Thinking of you big time.  You’re the GOAT—remember that!”

“Sending positive thoughts and love your way.”

“Sending love and positivity and light your way!  You are in my thoughts and heart today!”

“Sending positive vibes for a successful surgery!”

And things went very well indeed.  My friend went home that evening and continues to recover, though it’s not yet clear whether the hoped-for family reunion will happen as planned.

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In seminary I spent a lot of time trying to wrap my head around the nature of prayer, and I still do.  The conventional view is that we are seeking the intervention of an omnipotent deity to grant us something we dearly want.  I discarded that view as a young adult, for many reasons, but even traditional religious figures question the wisdom of that approach.  Jesus wisely said, “Not my will, but yours,” and Teresa of Avila commented, “More tears are shed over answered prayers than unanswered ones.”

I was struck by a piece of dialog from the movie Shadowlands (1993), in which the character of C.S. Lewis says, “I pray because I can’t help myself.  I pray because I’m helpless.  I pray because the need flows out of me all the time … It doesn’t change God, it changes me.”  This has stuck with me all these years because it feels true.  Prayer is about moving away from self-reliance and opening oneself to external support and guidance, human and divine.  In my theology, God isn’t changed by my prayers—God is always present and available, I just need to remember to engage.

The Buddhist monk and teacher Thich Nhat Hanh has a helpful perspective on prayer.  He says (paraphrasing slightly) that “When we sit down to practice unifying our body and mind [pray] … we are producing a new energy.  That energy immediately opens our heart …  We are gathering our strength from within and combining it with the strength that lies outside us.”^[2]  For him, prayer is participating in a flow of energy among all of us, including God, who are not distinct but one being.  This captures my experience of praying with patients and families across all belief systems.

It also describes well the prayers that arose on the text thread for my friend.  Their words may not arise from any religious tradition, but they produced new energy that strengthened the spirits of my friend and their partner as they faced surgery.  They created a sense of being part of a fabric of love that would hold them up no matter what.  I have no doubt that my friend fared better physically and emotionally because they knew they were supported in this way.  For me, this is the healing power of prayer—by any name.

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[1] Anne Lamott, Help, Thanks, Wow: The Three Essential Prayers, 2012

[2] Thich Nhat Hanh, The Energy of Prayer, 2006

My friend Sam texted me out of the blue.  “Just heard a moment ago that Ben passed away.  I’m still processing this one.  Would you have time for lunch?”

“This is the first I’ve heard of this, so I’m still processing it, too.  The last time I saw him was in June, the last time we spoke by phone was October.  I’d heard he’d been in the hospital, and he never replied to any notes I sent him after that wishing him well.  So I guess I’m not shocked, just sad.”  Ben was 48.

◊

Sam, who is my age, introduced me to his brilliant young friend Ben about 20 years ago, and I knew they had remained good friends.  A few years later Ben took over a business relationship I’d had with Sam, and I became very fond of him.  He listened well to my needs, responded with creative solutions, and was always a pleasure to work with.

Several years back Ben shared that he was going through a divorce and asked if we could meet over coffee.  When we did, he said he was going into therapy to cope with this transition as well as to deal with some underlying depression that had plagued him for years.  Ben remained actively involved in his school-age kids’ lives after the divorce, and always shared joyously about them whenever we spoke, but that’s as far as our personal relationship ever went. 

When Ben’s business associate told me last fall that Ben had been hospitalized for two weeks and was easing back into work from home, I assumed he’d been treated for cancer and was recuperating from the ordeal.  After all, that seems to be the pattern with so many of my friends and family members these days.

◊

Sam and I met for lunch two weeks later.  Once we got our sandwiches, I raised the topic on both of our minds.  “I’ve already told you all I know about Ben, but you were much closer to him than I was.  I’m happy to listen to anything you feel like sharing, or simply to be here for you any way I can.”

“It’s just so sad.  It’s probably been a year since I last saw him, it was getting so crazy to be around him.”

“How so?  When I saw him in June he seemed fine.  I knew he had some mental health challenges, but it sounds like there was more.”

“Let me back up.  Ben was one of the smartest people I’ve ever met.  Top of his class in school.  Could see things no one else saw.  I had another friend, Arnold, who was a similar kind of genius.  The three of us used to meet every month to discuss problems and opportunities, and I would watch these two feed off each other and just try to keep up.

“One evening I got a call from Arnold, who said, ‘I just got off the phone with Ben.  He sounded really drunk—dangerously drunk.  I’m worried.’  So I went over to Ben’s place.  He didn’t answer when I rang, but his door was unlocked and I found him passed out on the floor.  I told him I wasn’t leaving his side until he checked into a rehab facility.”

“I’m sorry, Sam, I had no idea.  I never saw him drink, but we were never in a setting to do so, either.”

“You wouldn’t have known—he never drank socially after rehab.  But he drank alone, a lot, and over time I could see it was killing him.  I confronted him about it but I could never get anywhere.  It was so hard to watch.  When they found his body there were 30 empty bottles beside him.”

“Ugh … that is so sad.”

“I’m sad, but I’m also angry, and I don’t even know what I’m angry at.  Ben?  Alcohol?”

“Honestly, both are fair game,” I offered.  “It’s so complicated.  Ben’s problem with alcohol was clearly a disease—a disease that kills lots of people.  But it can be hard to let go of the sense that if he’d handled it differently—or even if somehow you’d handled it differently—he’d still be alive.  I get it.”

“Then there was his depression.  I’ve never seen anything like it.  I’ve watched as this lovely grown man cried out through tears, ‘It just hurts so much to be alive.’  I have no idea what it’s like to feel that way, but it helps me understand why he might turn to alcohol to numb that pain.”

Sam reflected quietly for a moment, then continued.  “I went to his memorial service last week.  Many people spoke about what a wonderful guy Ben was—loving father, kind friend, smart as all hell, great companion in the outdoors.  All true.  Finally I decided I had to share.  I affirmed all of what had been said, but I spoke about Ben’s struggles, too.  I tried to choose my words well, but any picture of Ben would be incomplete without his darker side.  Afterwards people came up to me and thanked me for saying what hadn’t been said.  They clearly knew, but no one wanted to say anything.  I find that sad, too.”

We emerged from the restaurant into the bright sunshine of a beautiful spring afternoon.  Sam returned home with a long process of grieving still ahead, leaving me to ponder my own feelings about the death of my friend Ben who, as it turns out, I barely knew.

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The tagline of Elder Chaplain is “practicing hope amid loss,” but sometimes hope can be hard to find.  It’s simply tragic to watch a beautiful, gifted person struggle with a disease that one feels powerless to combat, and which takes them from us far too soon.  It is especially tragic when that disease feels preventable but nonetheless proceeds inexorably, leaving behind a wake of broken relationships, grief, and longing for what might have been.  Life feels too precious for it to end this way, but too often it does.  For many of us, people like Ben occupy important places in our lives, and they break our hearts every day.

Practicing hope, though, doesn’t mean we achieve the outcome we hope for, only that we keep seeking a way forward.  Sam practiced hope by taking Ben to rehab, and by challenging him to maintain his sobriety.  This type of caring has helped people like Ben turn their lives around, even if it didn’t for Ben.  Sam never gave up hope for Ben, though, even if he needed to create space between them for the sake of his own well-being.  After Ben’s death, Sam continued to practice hope by sharing truthfully at Ben’s memorial, and by working to create meaning through the conversation he invited me into.  As we parted that day, Sam was still practicing hope.

I believe that practicing hope is best done in collaboration with others.  While suffering and death are inescapable parts of life, they are made more bearable when we accompany each other through them.  It’s tragic that Ben did not have the company of others in the midst of his suffering—whether he felt he couldn’t let anyone in or he could find no one he felt safe to invite in—and that he died alone.  But I’m grateful to Sam that he invited me to accompany him in his anger and grief—it has helped me to process my own similar feelings, and to continue to work toward practicing hope.

I was finishing ICU rounds, where the nursing supervisor gives other teams a succinct rundown on all patients on the unit, when a nurse entered and took me aside.  “The patient in room 7 is about to get some bad news.  They appear to be people of faith, so we thought it might be helpful for you to be there.  Can you come right away?”

I arrive to find Dr. Jonas, a palliative care doctor with whom I often work, standing outside the room, speaking with a nurse.  We confer briefly.  Joe, in his 50s, had been diagnosed with lung cancer more than a decade ago, but with medication it has been kept at bay.  He collapsed over the weekend, and the results of tests conducted over the past 12 hours are grim.  The nurse informs us that his wife, Louise, and their two daughters—one a young adult, the other only 14 years old—are gathered bedside. 

We nod, take deep breaths, and enter.  Joe is a large man in obvious discomfort, with very labored breathing.  After introductions, Dr. Jonas moves closer to Joe, then addresses Joe and his family.

“I’m here because we need to talk about some difficult news and make some hard decisions.  Before saying more, I want to make clear that no one needs to be part of this conversation who doesn’t wish to be.  It’s up to each one of you.”

The family members exchange nervous glances among themselves.  Louise and her adult daughter both seem clear in their desire to remain.  All eyes turn to the younger daughter holding Joe’s hand at the side of his bed; she clasps him more tightly and says, “I’m not going anywhere.”  Joe smiles weakly, then returns his gaze to Dr. Jonas.

“OK, then … thank you.  Joe, as you know, the cancer that was diagnosed 13 years ago never went away, though its growth has been managed.  The scans we’ve done since you arrived yesterday show it has now grown and spread.  What’s more, the pericardial sac surrounding your heart has become calcified, impairing your heart’s ability to pump.  The weakness in your heart is causing fluid to build up around your lungs, which is why your breathing is so labored.  Your cancer and heart conditions have advanced to a stage where treatment options are limited, and your decline is likely to continue.”

Joe takes this in without overt emotion, then asks, “How long do I have?”

Dr. Jonas pauses, then replies.  “A few days … at most.  Perhaps only hours.  We can continue to treat your symptoms with the goal of prolonging your life to the extent feasible, or we can discontinue treatment and make our primary goal maximizing your comfort during the time you have remaining.”

Joe’s eyes brim with tears as other family members begin silently weeping.  Dr. Jonas allows time for the news to settle, then continues.  “Please take the time you need to decide your goals of care.  I’m happy to address any other questions you might have—just let me know what you need.”

“I need prayer.”

“And that’s why my colleague Greg is here,” Dr. Jonas responds.  Joe nods, and I switch places with Dr. Jonas.  After inquiring about their faith and learning they are evangelical Christians, we join hands and I offer what words I can muster to bring God’s presence, comfort, courage, wisdom, and love into the room.

“Dear God—We know you are with us always, but we ask you to make your presence deeply felt in this room, that we might feel your accompaniment in this moment.  You know all of what Joe and his family are facing today, and the deep pain in each of their hearts as they confront the end of Joe’s life.  Please help them remember that your love transcends death, that you will welcome Joe into eternal peace with open arms, and that you will remain a comforting presence to his family when he is gone.  Please fill them with your courage and wisdom as they make decisions about Joe’s plan of care.  We ask all these things in the name of your son Jesus Christ.”

Joe died in comfort later that afternoon, surrounded by his family and their longtime pastor.

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One of the things I love most about the hospital where I work is its commitment to compassionate care and to treating the whole patient—physical, emotional, and spiritual.  As this story illustrates, our hospital chaplains are considered an integral part of patient care, not an afterthought.  Our staff grasp that the care that we offer, whether explicitly religious or simply a calming presence, is something distinctly different from any other care discipline in the hospital, something deeply valued by many patients and their families.  It is a privilege to be included in this way.

Of course, part of what comes with this privilege is the need to be present and helpful in difficult situations like the one in this story.  Friends sometimes comment that they don’t understand how I do this work, and some days I don’t understand, either.  As I switched places with Dr. Jonas and looked deeply into the eyes of a man who had just received his death sentence, I wondered what I could possibly say that would meet the hope and expectations Joe and his family had for my prayer.

Fortunately, Dr. Jonas and other caregivers have modeled for me how one can balance directness and compassion when discussing difficult matters.  There is a stereotype of heartless doctors conveying news of terminal illness as if it were an update on the weather, then walking out as if their job were done.  Sadly, I’ve heard plenty of tales that support this stereotype.  But that’s not what happened here or in other situations in which I have participated.

Dr. Jonas set the tone at the outset that this conversation would be difficult, but then let each family member opt in or out of participation.  This consideration of each person’s needs offered them a sense of agency, and their informed consent to remain present braced their hearts to hear more.  Dr. Jonas used non-technical language to the extent feasible to explain Joe’s condition and options, and extended an open-ended offer of support.  Joe and family, while unavoidably in shock, nonetheless felt respected, cared for, and empowered.  That preparation laid a strong foundation for effective spiritual care.

In asking for prayer or any kind of compassionate presence in a time of loss, people are usually seeking a reason for hope.  Sometimes that hope is grounded in a religious vision of afterlife, sometimes it’s in the prospect of being released from prolonged suffering, sometimes it’s in the knowledge that they will not be left to die alone.  In my experience, it is almost always about a desire to feel connected to something greater than themselves, whether a religious deity or a universal creator or simply other humans—to sense that they are not alone, that they are beloved.

The first step for someone offering spiritual care is to directly acknowledge the difficulty of the situation, the reality of the loss being felt.  Failing to do so disrespects the patient and, by distancing the caregiver from the patient’s pain, undermines the process of spiritual healing.  It is then crucial to inquire about the patient’s faith or spiritual beliefs, so that the care being offered is aligned with the patient’s beliefs, whatever they may be.  With that foundation, spiritual care is then often a matter of making that source of hope deeply felt, present, tangible, and comforting—in spite of the loss.  Even if the patient cannot articulate any source of hope, the presence and accompaniment of another person in the reality of the patient’s loss and grief can bring solace to an otherwise bleak situation.

And that is what I sought to do for Joe and his family that day.  I might have fallen short of the prayer they would have received from their pastor, but I left with the sense that they felt the comforting presence of the God of their faith there in the room with them, and that this helped prepare them as a family to face the difficult decisions in front of them.

Mitch, a 37-year-old sportswriter, learned that Morrie, a beloved professor and mentor from his college days, was dying from ALS at age 78.  He decided to visit Morrie to pay his respects while he still could, which led to weekly visits during which Morrie shared the wisdom gained along his journey through life.  One day their conversation drifted into our cultural biases surrounding youth and aging.

“All this emphasis on youth—I don’t buy it,” Morrie said.  “Listen, I know what a misery being young can be, so don’t tell me it’s so great.  All these kids who came to me with their struggles, their strife, their feelings of inadequacy, their sense that life was miserable …”

“Weren’t you ever afraid to grow old?” Mitch asked.

“Mitch, I embrace aging.  It’s very simple.  As you grow, you learn more.  If you stayed at 22, you’d always be just as ignorant as you were at 22.  Aging is not just decay, you know.  It’s growth.  It’s more than the negative that you’re going to die, it’s also the positive that you understand you’re going to die, and that you live a better life because of it.”

“Then why do people always say, ‘Oh, if I were young again,’” Mitch replied.  “You never hear people say, ‘I wish I were 65.’”

Morrie smiled.  “You know what that reflects?  Unsatisfied lives.  Unfulfilled lives.  Lives that haven’t found meaning.  Because if you’ve found meaning in your life, you don’t want to go back.  You want to go forward.  You want to see more, do more.  [It gets so] you can’t wait to be 65.”

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As some readers no doubt recognize, this story is excerpted from the 1997 classic Tuesdays with Morrie, by Mitch Albom.  I read it shortly after it came out and have kept it close at hand ever since, but I hadn’t read it since deciding to become a chaplain.  A good friend recently prompted me to revisit it, and I’m so glad I did.  Morrie was an amazing student of life, which is what made him such a great teacher as well.

It has been my privilege to sit in Mitch’s place at the feet of some great teachers like Morrie.  When I was 25 and feeling like a misfit in my chosen profession as a mathematician, my wife and I took the summer away from my university grind to go back to a small town we’d lived and worked in for two summers in college.  My wife returned to work at a restaurant that she adored, while I tried fitfully to prepare for my dissertation.  We lived in a tiny cottage behind a home occupied by a retired couple whom we’d grown close to during previous summers.  Her father, Harry, a former Presbyterian minister, had recently moved into the house with them after his wife died.  Harry was 87, blind, and had spells of dementia, and they asked if I could fix him lunch and sit with him on occasion so they could get some time away.

This turned out to be a blessing for us all.  Harry had lived a rich and varied life and, like Morrie, he was a close student of human nature.  Over lunch, he shared stories about his experiences and the wide variety of personalities he’d encountered.  Like any good minister, he asked me thoughtful, open questions that spurred me to reflect on what I wanted out of life, and why.  He exuded gratitude for the life and loves he’d been granted, and he embraced the unknown that awaited him.  The saying “All I have seen teaches me to trust my Creator for all I have yet to see” crystallizes Harry’s perspective on life.  It took me many years to develop this level of trust in how life might unfold for me, but it took me less than six months to leave my life as a mathematician and move a step closer to my true calling.

But Harry was not my first great teacher of the wisdom that comes with age …

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I didn’t grow up with grandparents who were active in my life—three died before I was born, and the fourth was a remote figure who died when I was 10.  But I was blessed by the strong presence of Sarah Magee, who spent two days a week at our house helping my mom with the challenge of feeding six children.  GeeGee, as we called her, was born in the Ozarks in 1887, so she was already past 70 when she came into my consciousness and 80 when I entered my teens.  She was tender and yet a force to be reckoned with when crossed, and she remained sharp as a tack until her death at age 105.

Shortly before GeeGee’s death my sister Chris was visiting with her, and GeeGee was reminiscing about her early years—what a fetching figure she cut as she rode bareback across the farm country of southern Missouri at age 13 (in 1900!), how she caught the eye of the boy who would become the love of her life.  As GeeGee drifted off in reverie, Chris had the presence of mind to ask, “If you had one age to be all over again for a year, what would it be?”

GeeGee perked up and thought about it for a minute, then said “I’d really like to be 80 again.”  Chris, surprised and amused by her answer, probed for her reason.  GeeGee replied, “When I was 80, my body still basically worked, and I just wasn’t as stupid as I was when I was younger than that.”

◊

I was 37 when Chris shared this story with me, shortly after her conversation with GeeGee—the same age as Mitch Albom when he sat with Morrie.  I was excited by the thought that, from GeeGee’s perspective, I was still young and stupid, and had at least 40 more years of learning and growing ahead of me.  Today I’m 68 and happy to no longer be 25 or 37—or even 60.  “Older than I once was, younger than I’ll be—that’s not unusual,” in the words of Paul Simon.  

Still, I don’t feel I’ve yet reached the perfect age.  It’s a fact that my body will stop working one of these days, but in the meantime I’m trying to use this knowledge get the most from each day.   I am blessed that my life today is filled with so many teachers—including the people who inhabit the posts of Elder Chaplain—and there are many more I’m sure I will meet.  With their help, I can keep working toward the goal of not being as ignorant in a few years as I am today.  Now that is something to look forward to!

A collaborative post with Steve, a longtime friend (and Elder Chaplain subscriber) living in Springfield, MO.

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One Sunday last September, four days after my 75^th birthday, I grabbed a snack while Shelly put a strawberry rhubarb pie in the oven, and we settled in to watch the Kansas City Chiefs play—with the TV muted and Jason Isbell on the stereo.  As I was about to sit down, it felt like I’d stepped on something.  I rubbed the carpet, but nothing; still, the ball of my right foot felt funny.  Half an hour later it was the same thing with my left foot.

After the game I put my shoes on to go for a walk and check on my garden, but my ankles and feet felt tingly—pins and needles.  Taking a shower, the soap felt weird against my body; I cut my shower short and told Shelly we needed to head to the ER.  My walking was getting shaky as we headed for the elevator.  After checking in and heading off for a CT scan, my memory gets very murky.

The next thing I remember is awakening the following morning—paralyzed from the shoulders down, unable to move anything.  I never got a bite of Shelly’s pie.  It was 38 days until I made it back to the apartment.

◊

On anyone’s list of “Things I Hope Never Happen to Me,” what happened to Steve would rank highly.  Plummeting from vibrant health—12,000 steps a day average—to total paralysis in under 24 hours, with no idea if or when he might hit bottom.  Sensing the uncertainty in caregivers’ eyes and voices as they run tests and grasp at possible diagnoses.  Undergoing panic-inducing MRIs and a spinal tap.  Total dependency on others for feeding and brushing teeth, and total loss of sensation and control over bodily functions from the mid-torso down.  Just like that, an ordinary Sunday afternoon turned into a nightmare with no end in sight.

A few days later, a diagnosis: “transverse myelitis.”  The link can tell you all about this rare condition, but a few things stand out.  In many cases, like Steve’s, there is no known underlying cause.  It is often acute, taking only hours to set in.  And recovery is highly variable—sometimes complete, sometimes reaching a plateau of partial disability, sometimes none at all.  To receive a diagnosis of transverse myelitis (TM) is to embark on a journey where many fundamental questions will remain unanswered. 

◊

Such a journey is, by its nature, a journey of the spirit, and there are a few things you should know about Steve’s spirit.  He grew up in a fundamentalist Christian home and his family keeps that faith; Steve left that path long ago, but remains in relationship with family by finding a way to “disagree without being disagreeable.”  Steve takes inspiration from the famous 1993 speech by coach Jim Valvano who, shortly before dying from cancer, endowed a cancer research foundation and instructed the world: “Don’t Give Up … Don’t Ever Give Up”—words that Steve has since maintained as a personal motto.  Transverse myelitis may be a tough diagnosis for the spirit, but after four months I’m beginning to think it may have met its match in Steve.

It’s been my privilege to accompany Steve on this journey, even if from afar—I learn and grow every time we talk.  Steve was an early subscriber to Elder Chaplain, and he has offered many great comments, including claiming he was stealing “Best. Life. Ever.” as another personal motto.  When Shelly was able share the news of Steve’s condition with friends, I responded, “Tell Steve to give me a call if he wants to talk to a chaplain who won’t try to save his sorry soul.”  Shelly said that elicited one of his first laughs since hospitalization.  Ever since Steve could actually hold a phone again, we’ve been off and running.

◊

Recovery looks like it’s gonna be a loooong haul.  Duration of PT currently undetermined, but lengthy.  Below the waist I’ve got lots of issues … my balance is pretty shaky, and I have constant nerve pain in my legs, with spasms at times.  With a therapist hanging onto my gait belt I can walk slowly with a cane, but I’ll be using a walker when not in therapy.  Still, my walking is getting better, and I’ll be breaking in a spiffy new rollator soon.

I’ve learned that very few people say “I had transverse myelitis” … it’s more a matter of just how much ongoing challenge one has.  Living with TM requires a paradigm shift, which so far hasn’t been easy.  I’m learning to celebrate my “cans” and “can stills”, not focusing on my “can’ts” or “used to be able to’s.”  Because of the encouragement from my therapists, but most importantly from Shelly, I’m working on being proud of myself and appreciating what I’ve accomplished.

When I look around at my current rehab, I consider myself lucky.  I’m not a 25-year-old who, after a motorcycle wreck, may be confined to a wheelchair for life with challenges to communicate.  I’m not a stroke victim who may never again be able to put together a sentence or use one side of their body.  I’m a 75-year-old hoping for healing to continue.  I’m a lucky old coot.

I’ll keep listening to and loving music … just not as much of it live as I used to.  I’ll keep on texting and e-mailing and making phone calls … and enjoying being on the receiving end of each.  I’ll keep enjoying each bite of every sandwich.  The adventure and the experiences continue … one day at a time.

◊

Steve wrote the passage above as part of his New Year’s greetings to friends.  In email exchanges that followed, I marveled at his capacity for gratitude and his ability to find joy in the smallest details of everyday life.  I told him his journey has pushed me deeper into the central questions of Elder Chaplain:  Where and how do people find hope amid loss?  Where does gratitude fit in the process of finding hope?  What role does religious faith/spiritual identity play in this?

Steve replied, “My gratitude perspective began before you and I met—40 years ago!—when I slowed my drinking … thanks to getting drafted!  But the perspective really hit home the night of Oct 30, 2002, sitting in a hotel in Virginia Beach, watching Warren Zevon on Letterman.  My craziness was minor league compared to his, but the phrase he uttered that night has been a part of me ever since.”

For those who don’t know this story, I urge you to click on the link above—it’s truly remarkable.  The short version is that Warren Zevon was a gifted musician who never made the A-list, but counted Letterman as an avid fan.  Having been diagnosed with terminal lung cancer, and anticipating only a few weeks to live, Zevon offered to come on the show, talk about his new perspective on life, and perform—and Letterman devoted the entire show to his appearance.  His final words to Letterman as he walked off the stage were “Enjoy every sandwich.”  It was his final public appearance.

I’ll close with Steve’s words from his Christmas letter:  “I’m not planning on going away anytime soon, but Warren Zevon was when he wrote this.  It’s the last song on his last album:  Keep Me In Your Heart.¹ Hold your friends close. Don’t wait until tomorrow to make the call, send the text, or write the e-mail. Tomorrow never comes.”

1. If you only click on one link, make it this one … a very sweet song, especially given the context. ↩︎

“Two are better than one, for if one falls, the other can help their companion up again; but how tragic it is for the solitary person who when down has no partner to help them up.” (Ecclesiastes 4: 9-10)

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A nurse called to request a chaplain; her patient, Eleanor, in her early 70s, was quite withdrawn, and she thought a chaplain might be able to engage her.  Reviewing her chart, I learned that Eleanor had fallen in her apartment and had remained down for three days, until a neighbor noticed her absence and called 911.  After two days in the hospital she was emerging from delirium, but she had other underlying health issues.  No personal contacts had been identified.

As Eleanor had tested positive for MRSA, an antibiotic-resistant infection, I first don a protective gown and gloves, then knock and enter her room.

“Greetings, Eleanor, my name’s Greg, I’m one of the chaplains here.”

She turns slowly toward me, squints, and says, “You’re a what?”  As I draw closer, I note her ashen complexion and several open sores on her arms.

“I’m a chaplain.  I’ve come by to offer to spend a little time with you.  Is that something you would like?”

She smiles gently and closes her eyes.  “A chaplain!  That’s so nice.  Yes, please stay.”  I pull up a chair by her bedside.

“It seems you’ve had a rough few days.  I’m glad you are here now so we can help you get better.”

“Oh, if you only knew the stories I have to tell …”

“I’m here to listen, and I have the time.  It’s really up to you to say whatever you want to say—or not.”

“It’s too hard, and I’m too tired to talk.  But would you stay here for a bit?”

“Of course!”  We sit quietly for a time, then I ask, “Would you like me to hold your hand?”  I place my hand a few inches above hers.  Wordlessly, she reaches up and clasps my hand, then brings our hands down together beside the bedrail.  I quickly sense the coldness of her hand through my glove.

“Ohhh …” Eleanor sighs and smiles.  “Your hand is so warm!”  I lay my other hand on top of hers.  “Even better!” she responds.  We sit in silence, gently squeezing each other’s hands every once in a while.

Gradually, Eleanor offers a few details.  She was raised Catholic but left the Church while still young, retaining only a sense of a God who loves her.  She has a brother but they fell out several years back and she’s lost touch.  She’s grateful to have an apartment—she hasn’t always been so fortunate—but she keeps very much to herself.

“If you only knew the stories I have to tell …” she repeats more than once but never continues.  It appears those will have to wait for another time …

◊

In preparing to visit a patient, I always look to see who is listed as a contact—and I make a special note to myself when that section is blank.  As with any patient, I listen for them to mention other people who are involved in their lives; if no one surfaces after a few minutes, I will ask directly:  “Who are the most important people in your life?”  More often than I wish, they answer, “I have no one.”  It never fails to break my heart.

Decades ago, before our current housing affordability crisis, I took a training class on root causes of chronic poverty and homelessness.  One instructor said something that stuck with me:  Homelessness is less about running out of money than running out of relationships, for if one is rich in relationships then help—even if just a sofa—is often available.  However, behavioral problems—including substance use—have a way of burning through relationships and wearing out one’s welcome, and the street becomes the only remaining option.  While this risks oversimplifying a complex problem, it captures an important dimension of the interconnectedness between mental health, substance use, and homelessness.  It’s a story I have heard many times at a patient’s bedside.

Of course, the problem of loneliness extends far beyond those living on the streets.  Loneliness has been declared a public health epidemic by the US Surgeon General,^[1],[2] and it is estimated to afflict up to half of the US population.  Studies have documented the health impacts of loneliness, including increased risks for heart disease, stroke, type 2 diabetes, and premature mortality.  None of this surprises anyone who spends significant time with patients in a hospital.

What can a chaplain (or friend) do?  As is often the case, not much and yet maybe a great deal.  The simple act of showing interest can open the door a crack for a lonely person unaccustomed to attention, as it appears to have done for Eleanor.  As I held her hand while we sat, I wondered how long it had been since she’d felt any kind of meaningful touch.  We humans are hard-wired for loving touch, as anyone spending time with young children can’t help but observe.  While prolonged isolation or trauma can make touch uncomfortable or even unbearable—and therefore it can only be offered, never presumed—we do not come into the world that way.  We all need connection.

In Eleanor’s case, our time together appears to have been therapeutic.  I never had a chance to hear her stories, but she began to open up and trust other caregivers and staff.  She engaged with a social worker who was able to track down her long-lost brother, and after some reticence, they agreed to a call.  It turned out to be a bittersweet reunion, as both were on their deathbeds in hospitals many miles apart, but afterwards Eleanor expressed appreciation for this chance to bring closure to that relationship.  She did not die alone.

When I retired from my full-time consulting career 11 years ago, I, like many new retirees, feared the loss of the relationships that had made my work life meaningful.  I decided to create a simple spreadsheet I call “Friends for Lunch,” which lists the relationships—business and personal—that I don’t want to let stagnate, along with the date when we’ve last been in touch.  It’s had many additions and deletions over the years, but the friendships this tool helps me keep alive are among my greatest treasures in life.

---

[1] “Surgeon General: We Have Become a Lonely Nation. It’s Time to Fix That.”  NY Times, April 30, 2023.

[2] “Our Epidemic of Loneliness and Isolation: Key takeaways from the U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community.”  US Department of Health and Human Services.

The first two patients on the schedule for the free dental clinic shared the same last name, so I called out both first names.  Two people rose and approached my table; as they drew closer I could see they were younger than I’d expected.

“We heard this clinic is open to everyone so we got here early,” Tina begins.

“That’s great!” I reply.  I hand them each an intake form on a clipboard and tell them to let me know if they have questions.  Tony looks puzzled by the form; Tina leans over and explains a few things, and he slowly begins filling it out, with occasional assistance from Tina.

“Are you two sister and brother?” I ask, noting family resemblance.  Tina smiles and nods.  “And I see you came all the way from Tigard,” I continue.  “That’s quite a drive.”

“We both really need to see a dentist,” Tina says. “Our teeth hurt so bad we can’t sleep at night anymore.  The nurse at our high school found this clinic for us and helped us get on the schedule.”

“Well, I’m glad you’re here, we can definitely help you.  If you don’t mind my asking, what’s your living situation at the moment?”

Tina brightens up.  “Really good!  We’d been living in a motel, which wasn’t great, but a social worker at school helped us find an apartment.  I work at a Subway after school and on weekends, and with the money I make from that we can afford the apartment.”

“Wow, that’s a lot of responsibility for you to manage.  I’m really impressed.”

Tina smiles proudly.  Then she comes to the place on the form that asks about drug and alcohol use, and looks up.  “I’m not sure what I should put here …”

“It’s super important that you are honest—it helps them give you the safest and best care.”

“It’s not like I never go to a party and have a couple drinks, but it’s not the way it used to be.  I could see the path that the kids I used to hang with were on, and it’s no good.  I’m much happier now just doing school and working at my job.  And helping Tony …”

“Is your mom or anyone else like that in the picture?”

“We see our mom sometimes, it depends on how she’s doing.  Sometimes she’s OK to be around, other times …” she trails off.  “It’s better this way.”

Tina and Tony have finished their forms, but the dentist isn’t ready yet, so I continue.  “What interests you in school?  What are your hopes?”

“I love art!”  Tina whips a notebook out of her backpack and shows me colorful sketches.  “I hope to go to college some day and do more.  I don’t really love math, but it’s OK.  I work hard at it and I get A’s.”

The clinic manager pops her head in and says she can take both Tina and Tony out to the van now. 

“Keep up your amazing work, Tina!  I hope you both are feeling better soon.”

A bit later I step onto the van, and I find Tina and Tony seated on the bench where patients are asked to rest for a few minutes after care.  They each hold up a clear plastic and display a bloody tooth—and big smiles.

◊

In addition to part-time work as a hospital chaplain, I have served for several years as a consultant with the Care & Connect program at Medical Teams International.  This program provides free urgent dental care and basic medical screenings to marginalized populations and, to the extent possible, connects patients with providers who can address their needs more comprehensively.  It’s a privilege to work with this amazing team and their safety net partners to serve those facing the greatest barriers to accessing care.

Medical Teams is a faith-based nonprofit grounded in the belief that every person is made in the image of God, and deserves love and the chance for a better life, health, and wholeness.  I believe this, too.  While most of Medical Teams’s work is overseas, they have long acknowledged the needs here at home, and the Care & Connect program works to fill a critical gap in the U.S. health care safety net.  Currently active only in Oregon and Washington, the challenges of operating and funding Care & Connect often feel overwhelming, yet we share a vision that this type of care will someday be available everywhere.

One piece of this vision is spiritual care, so I’ve served as an intake coordinator to assess the needs and opportunities for chaplaincy in this setting.  Tina and Tony were among the first patients I encountered, and I felt with them the same connection I feel with many patients in the hospital.  Living in circumstances that break my heart, but with a spirit that fills me with awe and admiration.  Suffering the ill effects of our dysfunctional health system, where so many go without care that most of us take for granted.  Sharing only a brief conversation that leaves most of their lives shrouded in mystery, but connecting in a way that feeds my hope that the care we provided that day helps them move their lives in a good direction.

After a few clinics a new mantra rose for me:  chaplaincy isn’t a role, it’s an attitude.  In this setting we could never afford paid chaplains nor consistently staff volunteer chaplains, but that’s not what’s really needed.  For the most part, all that’s required is the attitude expected of every chaplain: 

• Belief in the inherent worth of each person
• Desire to know each person’s journey, no matter how difficult
• Compassion for each person’s suffering, and the belief that accompanying them in their suffering may in some way help ease it; and
• Understanding that one can offer little in return, but that it may nonetheless be enough. 

So now, instead of trying to figure out how to assign chaplains to clinics, we’ve decided to focus on building chaplaincy attitude and skills in all who serve in these clinics.

Really, though, chaplaincy attitude shouldn’t be limited to such places.  My vision for Elder Chaplain is that it serves as a forum where we can all learn and practice chaplaincy attitude, with each other and with all whom we encounter.  I don’t want to minimize the importance of the training chaplains receive, nor fail to acknowledge the settings (like hospitals) where that training is required. That said, for the most part we don’t need those skills in order to show up well for others.  Whether it’s a colleague at work or a person like Tina standing in line next to you, a little bit of chaplaincy attitude just might make a big difference in their day, maybe even in their life.

Wishing healing and peace to all this holiday season …

As I made rounds one weekend morning, checking in at each nursing station to see if there were patients that might welcome a visit, Renee—a nurse I’d never worked with before—paused to consider my offer.

“You might want to check on the patient in 720.  She’s having a really hard time.  I’m not sure if she’ll be open to a chaplain visit, but she could really use some encouragement.”

I added her to my list, finished my rounds, and returned to our office to review patient charts.  Ruth, in her early 40s, had no known address and no contacts.  She’d been admitted for an intestinal blockage, but it was quickly determined that she also smoked fentanyl daily.  She’d had surgery to address the blockage, but managing her post-op pain was proving tricky, as she was undergoing opiate withdrawal while simultaneously needing pain relief.

Ruth was asleep the first two times I came by, and Renee had urged me not to disturb her, but on my third try Renee was just leaving her room and gave me the thumbs-up.  I entered the dimly lit room.

“Hi, Ruth, I’m Chaplain Greg.  I’m making rounds, offering company to any who might want it.  Your nurse Renee suggested I drop in to see if that’s something you’d like.”

“OK,” Ruth said listlessly, “she’s a really nice nurse.”  Summoning a bit more energy, she made eye contact and asked, “How is your day going?  Did you have a good Thanksgiving?”

“Thank you for asking, I did!” I responded, returning her energy.

“I’m glad to hear that,” she replied sincerely, then paused.  “I didn’t really have a Thanksgiving,” she went on in a matter-of-fact way, without self-pity.

“I know life’s been hard for you recently, and now you’re in here with problems that are no fun at all.”

“No, it’s been awful, but I’m doing better now.”  After silence, she continued.  “My mom died suddenly two years ago.  She was my best friend, and it hurt so bad to lose her.  That’s when I started using fentanyl, which was stupid.  It’s ruined everything.”

“Sometimes we do things to fix a problem that end up just causing bigger problems.”

“That’s the truth.  But they’re telling me they can help me start getting clean.”  I nod, more silence.  “I have two girls in their teens, they live with their dad now, it’s been a long time since I’ve seen them.  I need to get clean before they should have any reason to want to see me.  I just hope they can forgive me.  I want to be in their lives again, to be for them what my mom was for me.”

“Trust can be a hard thing to rebuild … they may want to see if you can stay clean over time.”

“I know it will take a long time, and I have a lot of things to figure out to set things right.  But you know what they say, you have to start sometime, so why not now?  That’s what I’m trying to do.”

“I admire your heart and your attitude so much,” I responded, and I offered my hand.  Ruth took it, and we held hands in silence for a bit, sharing hopeful energy and prayer.

As I left I saw Renee at the nursing station, and she asked how it went.

“She’s a lovely person with a big hill to climb,” I said.  “I tried to offer her what encouragement I could.  She said she’d like more chaplain visits, that this was helpful.”

“I’m so glad.  Sometimes a person just needs a lift at the right time, it can make all the difference.”

“But this fentanyl shit, I just hate it,” I went on.  “It ruins lives, and the recovery is so long and so fraught with relapse.”

“I know … I lost my brother to fentanyl this time last year.  Holidays are the hardest time of the year for so many.”  Her eyes brimming, we shared a tender side hug, but couldn’t let it linger.  We both had to move on—there were other patients needing our care.

◊

I have no advanced training or expertise in addiction or substance use disorders, nor in how to treat them at the individual level or address them as a matter of public health.  But in my work as a chaplain I have watched the scourge of fentanyl explode in front of my eyes.  I have seen the pain it has inflicted on so many patients and families I have cared for, and I just can’t let it pass without comment.

The affliction is wide.  The numbers one sees in the news are abstract, but what I see through the lens of a chaplain is not.  One day, when 15 of our ICU beds were occupied, three of them held men in their 30s who had OD’ed on fentanyl and were now on ventilators, fighting for their lives; I had the grim task of escorting the mothers of two of them from the waiting room to their bedside, and listen to them weep as they said, “A mother should never have to see her son like this.”  Two other beds held the brain-dead bodies of fentanyl overdose victims, awaiting the harvest of their organs for transplant.  That’s one third of our ICU beds—5 of 15—occupied by the victims of this scourge.  I wish I could say this was an extraordinary day, but it wasn’t.

The affliction is great.  I was called to the Emergency Department to help with Sandy, a patient in her 20s experiencing a fentanyl-fueled psychotic episode that had pushed the ED nurses, social worker, and security guards to the brink.  For 40 minutes I held her hand, worked with her on deep breathing, and tried to calm paranoid hallucinations that made it impossible for anyone to care for her, until she bolted back out onto the streets where she was living.  While other mental illness was likely involved, the sheer terror I felt in her eyes and in her grip seared my heart.

Then there is Ruth, who is a composite of patients with similar stories that I have sat with this past year.  Bodies and brains damaged, families destroyed, parents lost to children, children lost to parents.  Some from backgrounds with evidence of trauma, others not.  Often there is a precipitating event that could happen to anyone, like the death of someone close, that starts a downward spiral, but when fentanyl is involved the descent seems especially precipitous and the ability to pull out especially difficult. 

The toll of fentanyl on caregivers is also steep.  It’s not just patients like Sandy, though some shifts there can be multiple patients like her in the ED, some of whom don’t survive.  It’s not just patients like Ruth on the nursing floors, who, while their stories are sad, are at least trying; it’s also the ones whose bodies are so ravaged that they won’t survive another dose, yet they refuse all offers of treatment.  And it’s nurses like Renee, where the scourge of fentanyl isn’t confined to the hospital, but has claimed family members or friends.

Really, it’s all of us—this scourge respects no bounds of geography or class.  Some who read this have already experienced it; others may soon.  As I said, I’m not qualified to propose solutions, and I have none.  I only offer this: Ruth is a beautiful soul who, before being hospitalized, lived under an overpass, but before fentanyl was a devoted mother to her daughters.  Sandy is a beautiful soul trapped in addiction, struggling for release. The patients in the ICU—dead and alive—have families who love them and grieve for them. I keep at this chaplaincy work in the hope that, by receiving kindness and encouragement, the goodness inside Ruth and Sandy might return to the forefront of their lives, and that loved ones might feel comfort. I tell their stories in the hope of deepening our understanding that this crisis is everyone’s problem.

Video: The Faces of Fentanyl

So this holiday season, as you see people on the street you suspect may be struggling with addiction, or as you spend time with those engaged in caring for them, my hope is that you follow the dictum of Henry James, popularized by Fred Rodgers:  “Three things in human life are important.  The first is to be kind.  The second is to be kind.  And the third is to be kind.” And think about what you might be able to do to help.

Sending love and wishes for peace and healing to all …