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.

◊

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.

◊

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.”

◊

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 …

◊

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.

◊

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)

◊

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 …

I always find it interesting to ask other chaplains about what led them into this work.  It is, after all, a distinctive calling, one many people think they are not well suited for.  Chaplains often have an “origin story” or two that they can identify, in retrospect, as pivotal to their journey.  Here is one such story.

◊

Pat was the daughter of Irish immigrants who grew up in the Jackson Heights neighborhood of Queens, in New York City.  During World War II she met Jack, a young Navy officer from the Midwest, at a USO dance.  She succumbed to his charms despite their religious differences—she a Roman Catholic, he aligned with the spirituality of Ralph Waldo Emerson—but they agreed that their children would be raised in the Catholic Church.  And so the children were, all six of them, but they came of age in the 1960s and their religious upbringing was far from smooth.

When the younger son, Greg, neared middle school, he was pulled from the parochial system that was generating conflict with the older children and placed in a secular school.  Soon he lobbied his mother to be released from obligations to attend Mass and catechism classes, repeating the criticisms of the Church he’d heard from his siblings.  She insisted on a series of debates regarding religion, challenging the platitudes Greg spouted and pushing him to think substantively about matters of faith.  When she was finally convinced, she released him with this admonition: “I’ve never confused the Catholic Church with Jesus Christ, and you shouldn’t either.  Don’t throw the baby out with the bath water.”

After Greg’s sophomore year in college, Pat travelled to New York for the ordination of a nephew as a Jesuit priest.  She struggled with shortness of breath and weakness during the trip, and upon her return was diagnosed with advanced lung cancer and heart disease.  After considering the options available in 1975, she declined treatment, accepting the prognosis that she had less than six months to live and choosing to make the most of it at home among family and friends.  She and Greg, who was living on the other side of the country, resumed their discussions about religion by phone, and she impressed him deeply with her faith, her courage facing death, and her gratitude for what life had given her.

Greg traveled home to see her as soon as he could, but she declined suddenly during his trip and was on her deathbed when he arrived.  After a time at her bedside, holding her hand and saying his goodbyes, he took his place with his father and other siblings around her bed.  He remembered thinking, “It’s amazing to see such confidence in her final moments.  I wish I could believe what she believes—that she will soon be face-to-face with Jesus—because it’s so powerful for her right now, but I just can’t imagine believing any of that.”  Pat died a few hours later.

It took Greg years to process this experience—especially the full meaning of losing his mother—but on that day death was transformed from an abstract notion to a concrete reality.  Thanks to Pat’s example, he came to understand that mortality is something one can not only accept but embrace, that acknowledging the finite time one has to live can open the door to candid, meaningful conversations, and that the best way to go through the experience of death is in the company of loved ones.  This gave Greg the foundation for accompanying others through their own experiences of the death of loved ones, first with family and friends, and, later, with patients as a chaplain.

◊

In writing Elder Chaplain stories, I change many patient identifiers—name, age, diagnosis, even gender or race—to protect patient confidentiality, while still seeking to capture the essence of our encounter.  I have no need to do so in this post.  Pat was my mother, and this is my story.

I decided Pat’s story needed telling because it is both extraordinary and ordinary.  It is extraordinary in that stories like this were far too rare in in America in 1975.  In the years following World War II, death—and childbirth—became increasingly medicalized, taking place primarily in institutions, and attended to more by medical professionals than family members.  The idea of hospice was not introduced in the US until 1971, and it was a foreign concept to those treating Pat in 1975.  Still, she chose that approach for her own death—without today’s more effective pain management—and it was a gift to all of us in her family to experience her death at home, by her bedside.

As I reflect on why Pat embraced this approach, one factor surely was On Death and Dying, the 1969 book by Elisabeth Kübler-Ross, MD, that introduced the now-familiar stages of grief:  denial, anger, bargaining, depression and acceptance.  My sister was in nursing school in the early 1970s, when the book was required reading; my mom decided to read it with her, and I joined in as well.  When she received her diagnosis three years later, I think this book gave her the framework she needed to argue back to her doctors, who were still of the mindset to treat at all costs.  More importantly, for me, it gave us shared language to talk about her experiences approaching death.  I still have her yellowed copy of the book—her signature inside the cover is the only thing written in her hand that remains with me today.

Now, almost 50 years after Pat’s death, dying at home with supportive hospice care is no longer extraordinary.  The use of advance directives outlining one’s wishes for end-of-life care is now more widespread, and hospitals regularly conduct multi-disciplinary “goals of care” conferences with patients and families (and chaplains, if desired) to discuss options for treating advanced illness—including no further curative treatment at all.  Patients increasingly understand that such life-and-death decisions are theirs to make, not their doctors.  It remains a struggle for some elderly folks—who formed their attitudes about aging and death in the 1950s and ‘60s and often equate hospice with “giving up on life”—but we have come a long way toward Pat’s story becoming ordinary.

Still, if “normalizing” death—giving people as much agency as possible to dictate the setting and circumstances of their own deaths—is a goal we seek for ourselves, then we also need to normalize the work of accompanying others in the process of aging and dying.  I often hear statements such as, “I could never do what you do—I would find it too depressing.”  While I grant that a steady diet of this work is not for everyone, the work of accompaniment shouldn’t be delegated to chaplains any more than decisions surrounding end of life should be delegated to doctors.  My hope for Elder Chaplain is that it helps all of us become more comfortable, skilled, and experienced with this work.

Fortunately, nowadays I see many more people like Pat making thoughtful, courageous, and spirit-filled choices to face end-of-life on their terms—and, in doing so, providing gifts to their family members like Pat gave us.  It is my hope that they are not only planting the seeds of future chaplains, but also building “chaplaincy attitude” in all with whom they engage, so that as a society we can reclaim the skills we once had before the medicalization of death.

When I arrive in the surgery prep area, I find Julia, a black woman in her late 70s, sitting upright on her gurney, legs spread in front of her under a blanket, with a despondent look on her face.  I greet her and confirm she’d requested a chaplain visit; she looks at me, nods, then stares away again.

“Nobody seems to care about me.  Nobody here, nobody anywhere, nobody but Jesus.”  I look at her as compassionately as I can, but I say nothing.

“I’ve got four sons but two of them are dead, the other two got their own health problems.  I don’t want to bother them with mine—that’ll just make their problems worse.”

“I’m sorry, Julia.  That’s really hard to have lost two sons—it’s not supposed to be that way.”

“No, it’s not.  And I’ve been let down by my church, too.  People I thought were friends, pastors—I tell them what’s on my heart and it turns into gossip.  No, I got nobody to listen to me.”

“Well, Julia, that’s why I’m here.  Let me grab a chair.  I can sit and listen until it’s time for your procedure.”

When I return, her face brightens a bit and she stares into my eyes intently.

“Jesus is my rock.  Without him I wouldn’t have anything.”

“Jesus is my rock, too,” I reply, “but we need other people, too, to listen to our stories.”

“Yes, we do,” she affirms, then takes my hand and begins sharing from her heart.  Born in rural Georgia with a club foot that left her with a limp, leading other children to ridicule her.  Being labeled the “black sheep” among her “perfect” siblings, ultimately being disowned by her father.  Making her way west, working hard, bearing children, finding purpose but also heartbreak.

“But through it all,” she sums up, “Jesus was always there, telling me I’m not alone, telling me he’s got my back.  That’s something no human could ever do.”  She pauses.  “I’ve got a song on my heart today—Precious Lord—do you know it?”

I smile broadly.  “Julia, we just sang that at my church yesterday.”  She wraps both of my hands in hers and begins to sing, and I join in.

Precious Lord, take my hand
Lead me on, let me stand
I am tired, I am weak, I am worn
Through the storm, through the night
Lead me on to the light
Take my hand precious Lord, lead me home

When I look up, her eyes are brimming with tears.  “You are God’s way of telling me that I am not alone today, that he’s still got my back.  Thank you so much for coming to see me.”

My heart swells, too.  “You are a gift to me as well, Julia.  I’m so blessed that you asked me to come visit you today.”

“I’m Aunt Julia to you now, honey—that’s what everyone who knows my heart calls me.”

◊

Contrary to commonly held notions, many chaplaincy encounters—maybe most—do not explicitly involve religion.  Looking back over previous Elder Chaplain posts, the majority consist of simply being present with people experiencing stress or loss, giving them space to speak freely and authentically, and validating their condition and their humanity.  I find joy in meeting people wherever they may be, and using the language and frameworks they are most comfortable with to bring them solace and hope.

But often religious faith and practice are central to a chaplaincy encounter, because these are what many people turn to in times of stress or loss.  They seek comfort in the cadences of familiar psalms or prayers, finding strength in feeling connected to something greater than themselves.  People of many faiths believe in the efficacy of prayer as a means of drawing the divine closer and invoking their protection in the face of uncertainty and vulnerability.  “I’ve got lots of friends praying for me, but there’s no such thing as too much prayer” is a common refrain I hear.  So I ask them about their faith traditions and what prayer means to them, then I offer prayers aligned with their faith and concerns.  I always invite them to add prayers of their own, but they usually reply, “What you said was all I need—thanks.”

Less frequently, I encounter someone like Julia, for whom a relationship with the divine is central to their identity and to their way of seeing and engaging with the world—as it is for me.  They speak of being called personally by God to follow the precepts of their religious tradition.  A Hindu woman told me, “God slapped me across the face and told me to wake up.”  Julia told me, “Jesus said, ‘Julia, you are mine.’”  I have felt that call, too, and when I validate the reality of their call, the conversation moves to a yet-deeper level.  The shared experience of such a call can bridge religion, race, culture, gender, time, and everything else that separates one human being from another.

Joining voices together in song or chants is part of almost every religious and cultural tradition because, among other reasons, it creates a sense of unity among the participants.  It was a special gift that the song on Julia’s heart was one I know and love well.  “Precious Lord” is a gospel song written in the 1930s (full lyrics here) that was Dr. Martin Luther King, Jr.’s favorite song, often sung at civil rights rallies.  He asked that it be sung at his funeral, and Mahalia Jackson did so; Aretha Franklin sang it at Mahalia’s four years later.

When Julia and I joined our voices together in the humble, curtained-off space in the pre-surgery unit, we did not ascend to the heights of these singers, but the unity it created between us in that moment could not have been more powerful.  The memories and images that “I am tired, I am weak, I am worn” conjures up for Julia are doubtless vastly different than those it conjures up for me, but these feelings are universal to the human experience, and to share them in song is to feel fully connected to one another.  Such connection is a rare and elusive experience, but few things can do more to give us hope and strength for what is to come.

Laverne, a woman in her 90s, was chatting with her daughter Bonnie when I checked in on her one morning.  She’d recovered well from the pneumonia that had landed her in the hospital, and she was expecting to discharge back to her independent living apartment later that day. 

Laverne greets me warmly, remembering our previous visits, and introduces me to Bonnie.

“Bonnie flew all the way from New York to make sure I was OK, and to help me get settled back in to my apartment.  She’s a famous mystery writer!”

“That’s wonderful!  I don’t mean to interrupt your conversation, I just wanted to offer my good wishes for your transition home.”

“No, please join us,” Laverne requests, pointing to an empty chair.  “We were talking about whether I’ll be making the trip down to Arizona to spend the winter at my condo there.  I’ve spent every winter there for the past 25 years, but I haven’t decided whether I’m going this year.”

“Mom,” Bonnie interjects, “I think you’re just tired from being in here.  A few days of rest at home and you’ll feel better, and once you’re down in Arizona you’ll be glad you went.”

“I don’t know, it feels like a lot of work.  And I’ve been thinking about this since before I got sick.  I think I might actually enjoy spending the winter up here.  Like I said, I haven’t decided yet.”

Bonnie presses on.  “You’re getting around well, even without your walker.  You can get all the help you need during the trip.  I’m sure it will go smoothly.”

Laverne fixes Bonnie with a firm glance.  “You have no idea what it’s like to live in this body.”

“No, but your mind is sharp, and from what you’ve told me you shouldn’t have trouble making the trip.”

“You have no idea what I haven’t told you.”  Silence descends, and both Laverne’s and Bonnie’s eyes brim with tears.

After letting the silence settle for a moment, I gently probe.  “Laverne, is there anything you’d like to share about what it’s like to live in your body?”

She draws in her breath.  “My mind’s still sharp all right, the problem is … this thing,” she says, gesturing with both hands up and down the length of her body.  “It doesn’t work anymore, and it’s exhausting to live in it.” 

Bonnie’s face softens as she listens intently, and Laverne resumes.  “I guess I’ve got one of those bodies that just keeps on living, but I’m so tired.  I’ve made arrangements to move to assisted living when I need it, and to skilled nursing after that, but I’d be perfectly happy if I didn’t wake up tomorrow morning.”

Bonnie startles, and Laverne reassures her.  “Don’t worry, I’d never take my own life.  Besides, even that feels like too much work right now.  I’m content just taking each day as it comes, not making plans beyond the next day.  That’s why I can’t even think about Arizona.”

With the tension broken, I thank Laverne for her heartfelt sharing and leave mother and daughter to carry on from there.

◊

“I know how you feel.”

This unfortunate saying often emerges after someone shares from their heart.  We mean well—we want the other person to feel understood, we want to establish common ground.  But the honest response, if the feelings are complex, is “No, you don’t”—our personalities and experiences are too unique for anyone to know what life feels like for another person.  Many might hesitate to respond so bluntly, but Laverne, at least with Bonnie, did not, and her “You have no idea” responses moved the conversation to a new and helpful level of candor.

“I know how you feel,” or its equivalent, can be such a reflexive response that it flies out of our mouths without thinking.  However, it often has the opposite of our intended effect:  the person does not feel listened to, and it can shut down any further desire to share their feelings.  We often compound this error by sharing experiences of our own that we see as similar, but this usually just reveals how much our experience differs from theirs.  Worse, it turns the focus of attention from their sharing to our own—the ultimate invalidation.

Due to my own bad habits in this regard, I’ve had to work very intentionally to let go of “I know how you feel”—with friends and family as well as patients—and instead invite them to tell me more about how they feel, in their own words.  For people seeking to be understood, this invitation is more validating than anything we could share from our own experience.  Once someone feels well listened to, sharing a related experience might be helpful indeed, but until then it takes things in the wrong direction.

Rewiring these impulses has been among my greatest challenges in becoming a chaplain, but also among my most valuable learnings for work and life.  My new habits get reinforced regularly as I engage with people about whom I could never say “I know how you feel.”  People suffering the effects of a stroke, relearning how to speak or walk.  People living on the streets, struggling with addiction.  People hearing the news that they have at most a few days to live.  The best thing I can do for them is give them the chance to share what it’s like from their perspective.  And I learn so much from what I hear …

Which is a good thing, because while I may never have to deal with any of these particular situations, I am certainly growing older.  I’m just beginning to get a sense of how it feels to live in an older body, so I treasure hearing about what it’s like from people like Laverne.  I have been blessed many times by wise elders sharing their perspectives as they near end of life, and I eagerly seek out as many of these conversations as I can.  What they have to tell us isn’t always easy to hear, but they help me make sense of my own aging process, and I leave each conversation feeling a little bit better prepared for the journey ahead.