Tag: #Chaplain

Women on the Verge

On By Greg Morgan2 Comments

Making rounds one morning, a nurse suggested I look in on Viola, age 74, who was having a procedure later that morning.  I reviewed her chart and saw that she’d appreciated visits from chaplains in the past.  I also saw that tests completed the day before had revealed advanced metastatic cancer.

Her room is dimly lit but she is sitting up in bed.  As I knock and enter, I see her eyes are closed. 

“Good morning, Viola, it’s Chaplain Greg,” I say softly.  “I know you have a procedure later this morning, so let me know if this isn’t a good time for you.”

“No, you’re right on time, Chaplain.  I’m just lying here praying.”

“What’s on your heart this morning?  I know you got some difficult news.”

Viola nods.  “I’ve been listening to the Lord, and the Lord’s telling me that He’s got this, just like always.  He’s telling me that there’s no work for me to do here, that it’s all in His hands, and all I need to do is relax and enjoy the ride.  So that’s what I’m focusing on doing.”

“Isn’t it wonderful,” I ask, “the ways God shows up for us in times of need?”

“You got that right, Chaplain.  I have been so blessed all my life, and I know I will continue to be blessed.”

We share a lovely time of prayer together, filled with gratitude for God’s presence and caring, and for the light God brings into our lives.

“Thank you, Chaplain,” Viola closes.  “Now you go carry some of that light to the rooms of other patients you see.  Thank you for the work you do.”

“And I thank you, Viola, for the gift of your prayers.  They give me the strength to keep doing this work.”

◊

It is always a gift to me to be in the presence of bedrock faith, something I often find in black women of a certain age, like Viola (or Aunt Julia).  Their faith has withstood crises and losses the likes of which I have never known.  It gives me hope that my own faith will carry me through the losses that undoubtedly lie ahead—that with faith, all things are possible, even if it’s a mystery as to how this is so.

◊

The next day I visit Maggie, age 88, who had learned two days before of the spread of long-dormant cancer.  Dressed in street clothes, she is trim and fit and looks at least 10 years younger than her chart indicates.  She’s on her phone but waves me in.

“I’m discharging soon—my son’s on his way—but I need to make sure my pharmacy has my prescriptions straight,” she says in a tone that is all business.

She soon hangs up, then looks at me.  “Are you here to say a prayer?”

“I certainly can, if that’s what you’d like.  What would you like me to know about your faith?”

“I’m an active Christian, raised Catholic but I’ve spent most of my life in non-denominational churches.  I’ve led music in many of them.”  She continues in the same matter-of-fact tone.

“And how is your faith showing up for you today?”

A long silence, then, “I don’t know.  I’m so confused.  I’ve had lower back pain for a long time, which I chalked up to aging.  But it got so bad I came to the ER, and now they tell me I have cancer in my bones and all over, and it’s not treatable.  I just didn’t see this coming.  I don’t feel at all prepared.”

“That’s really hard, Maggie.”  I extend my hand and she takes it.  “Shall we sit in silence for a moment?”  She nods, then begins to cry—weeping quietly at first, then with heaving sobs.

“This is the first time I’ve allowed myself to cry since I got the news,” she shares, as her sobs subside. 

“I think tears can be one of God’s ways to make us stop and pay attention, and to remind us of His presence.”

“That’s helpful.  I do feel God’s presence, I just hadn’t taken the time to notice …”

“So, is now a good time for that prayer?”  Maggie smiles, nods, and we join together in prayer.

◊

While charting my visit with Maggie I receive another request from the oncology floor.  Once again, it’s for a woman, Donna, whose condition has just been declared terminal.  I finish my note on Maggie and take a short walk to gather myself, then I knock on Donna’s door.

Donna is bald and a bit bloated, not unusual for someone who has been undergoing chemotherapy.  She thanks me for coming but then turns away.

“They told me the chemo I’ve been on, which was my last hope, isn’t working and there’s nothing more they can do for my cancer.  I’ve been praying so hard, and lots of people at my church have been praying, too.  My pastor and everyone is calling and texting and I don’t want to talk to any of them.”

“Does it feel like God has let you down?”

Donna nods and begins crying.  “Yes, that’s it exactly.”  We sit in silence for a minute, then she continues.  “Actually, no, that’s not how I feel.  I know God is here for me.  I’ve been through so much already, and God has never left my side.  I guess what I’m really feeling is that I let the people praying for me down.  I don’t want them to lose their faith in God because their prayers didn’t work.”

“Is that how you think prayer works?”

“Well … no.  I’ve known that I would come to this point eventually.  We all do, no one lives forever.  It’s just a shock to realize that I’m now at that point.”

“I think it’s probably shocking for everyone, no matter how strong their faith is.  It’s just really hard being human.”  She nods, and we sit quietly for a moment.

“As we’re talking, though, it occurs to me that you have a chance to show people what true faith looks like by letting them see how your faith supports you now, at this most difficult time.”

Donna brightens at this thought.  “Yes, it’s better for them to see how God really works.  I can do this.”

◊

In the span of just two days, I encountered these three women on the verge of life’s final chapter, each having just crossed the threshold from hoping for a cure to surrendering to mortality.  While their faith manifested in different ways, each had built, through a lifetime of faith, a storehouse of gratitude to see them through the rest of their days.

And, as I shared with Viola, each of these women energizes my own faith, adds to my storehouse of gratitude, and gives me the strength and motivation to keep doing this work.

I Can’t Believe This Is Happening So Quickly

On By Greg Morgan1 Comment

I received a call one morning from Jacob, a nurse on the oncology unit. He said Sue, a patient I’d built a warm rapport with during an earlier stay (Telling Our Life Stories), had just arrived back on the unit and was not doing well; Sue’s wife Andrea recalled my name and asked Jacob if I could visit.

I arrive and find Sue in distressing pain, with Jacob doing all he can to make her comfortable. Andrea, whom I’d never met, rushes over to greet me.

“I knew this day would come, but I can’t believe it’s happening so quickly.” She collapses into my arms, sobbing. All I can do is quietly acknowledge the truth: dying is hard, for patient and family, no matter how ready you think you are.

After a moment Andrea straightens up and announces brightly, “Sue, Chaplain Greg is here to see you. You remember how much you enjoyed your visits with him?”

I move bedside opposite Jacob, take Sue’s hand, and greet her warmly. But Sue is past the point where comforting words and touch can ease her distress.

“I feel like I’m burning up inside. I need pain meds NOW!” Sue struggles to get out of bed, and Andrea and I restrain her while Jacob administers pain and anxiety meds. Soon Sue’s struggling diminishes, and she lays back in bed.

Jacob begins to start IV lines and prepare Sue for her stay. Andrea reaches for another hug and repeats, “This is all just happening so quickly.” As Andrea’s sobs subside, I agree to return later in the day, once their children arrive.

◊

Death sometimes arrives with no forewarning: a massive heart attack, a brain aneurysm, an accident. Past a certain age, though, we are more likely to die from conditions that progress relatively slowly: cancer, congestive heart failure, or simply old age. This is largely a blessing, I think, as it gives both the dying person and their loved ones time to prepare, and to share conversations that can be among the most intimate and meaningful of their lives.

But this blessing brings with it a challenge: navigating many difficult decisions around whether to pursue treatment(s) for the condition(s) or to cease curative care and let nature run its course, with treatments focused solely on comfort and quality of life. In my experience, there is no “right” way to do this—so many considerations are specific to each situation and individual.

Many factors influence patients in the direction of curative care, even when the odds seem small. First, of course, is our own desire to enjoy more time and postpone death, as well as our loved ones’ desire for us to continue living, postponing the loss they will suffer when we die. Our healthcare system is also incented toward curative care: doctors and other providers are trained to treat illnesses, after all, and they make their livings—and derive professional and personal fulfillment—from providing curative care, not discontinuing it. Our prevailing cultural narrative is one of “fighting” and “battling” illness, not “giving up hope” until the bitter end.

For some, this is the course they choose, and I can understand why. A family friend was diagnosed at age 87 with lymphoma and fought it tooth and nail, undergoing excruciating treatments against medical advice—and was rewarded with 6 more years of life, replete with weddings of grandchildren and births of great-grandchildren, dying suddenly while still pursuing an active life. This outcome was far from foreordained, however, and others facing the same circumstances might wish to choose differently.

Sue’s story is more representative of my experience as a chaplain, and in life. When first diagnosed with cancer, Sue pursued curative treatments that gave her several joyous years. When I first met her, she’d exhausted most options, but told me “there’s an immune therapy treatment I could try; it might make a difference, but even if it doesn’t, it could give me more time with my wife, children, and grandchildren.” A solid choice for her, I thought then. Unfortunately, it didn’t buy her the time she’d hoped for.

There’s a term we use on my chaplaincy team: transforming hope. Not giving up hope—life is meaningless without hope—but refocusing the goals one hopes for as circumstances evolve. Sue’s hope for more time didn’t seem unrealistic when we spoke, though I don’t know what prognoses her oncologist gave her regarding pursuing immune therapy vs. discontinuing curative care—or even whether a candid discussion of these alternatives took place. It can be so hard for patients, families, and providers to refocus goals of care even when the evidence suggests they might want to.

The result of failing to do so, though, can be a crisis like what Sue and her family experienced. Andrea shared with me that it had quickly become clear Sue’s immune therapy treatments weren’t working, but their hope did not evolve to align with this reality—until Sue’s crisis made such hope untenable. Instead of gradually transforming their hope, it all had to happen so quickly …

◊

By afternoon Sue is resting comfortably. I gather with Andrea, their sons, and an adult grandchild—a lovely family wanting only the best for Sue. Andrea says she and Sue planned for her to die at home—in the not-so-near future. Now she wants to know my thoughts. I offer that, while dying at home is an ideal we often hope for, it can be stressful if the patient has high care needs, as Sue does. I watch Andrea flash back in her mind to the scene in Sue’s room earlier that day, then shudder at the thought of trying to manage this at home.

I continue, noting that the hospital setting frees family members from most caregiving activities, so they can focus on simply being present. Andrea quickly agrees, and the other family members breathe a sigh of relief—they will approve Sue’s transition to comfort care. They share a few warm reminiscences of Sue with me, then head off toward her room. Hope is transforming before my eyes …

Sue died peacefully just before dawn the following day, surrounded by her family.

Damon

On By Greg Morgan1 Comment

My pager buzzed: “The patient in 757 wants to see a chaplain ASAP.” Damon, in his early 20s, is undergoing withdrawal from multiple street drugs. A nursing note, just posted, says he got a distressing call and now wants to leave AMA (against medical advice) to go OD and kill himself. Deep breath …

I find Damon sitting cross-legged on his bed, a nurse seated beside him. She looks at me with relief; I take her seat and she departs. Damon glances at me through disheveled hair.

“Greetings, Damon. I heard you wanted to speak to me. I’m here to listen.”

“Yeah. I heard you might have an iPad I can use. I need something to distract myself. I just found out that my girlfriend—ex-girlfriend, now—has taken my phone and money and disappeared.”

“I’m sorry, Damon—that’s rough. We have two iPads people use to attend online 12-step meetings or worship services. I can see if one is available.”

Just then a lab tech comes in to draw blood. Damon asks me to stay.

“Can I find out my blood type from this test?” he asks the tech. She says no, not unless there’s a reason to run that specific test.

“If you donate blood at the Red Cross you find out automatically,” I blurt out before catching myself, “… provided you pass their screening checks.”

“I’ve donated before, when I’ve been clean. It makes me feel good to help someone who needs it.”

The lab tech leaves, but this exchange has broken the ice.

“Everything is just so shitty right now,” he begins. “I’d been doing OK—stayed clean for nine months, got off the streets and into transitional housing. My girlfriend—ex-girlfriend—helped me stay clean, but then my mom died and I relapsed, and she dumped me and took my things. Now I have nothing.”

“That’s a ton of hard stuff coming at you all at once—no wonder you’re upset.”

“I just don’t know where to go from here.”

“Are there other people in your life who are helpful to you?”

Damon launches into his life story, filled with loss at every turn. Born to an alcoholic mother, removed from her custody soon after by his father, a recovering IV drug user. Taken to be raised by his father’s parents, who were abusive and forbade him to speak of his mother. Lost his father to Hepatitis C in his early teens. Moved to Portland when he graduated high school, fell into drug use and homelessness. Sought out and reunited with his mother in Ohio, who’d gotten sober and remarried but had never stopped looking for Damon. Inspired by his mom he got clean but then she died and his world fell apart.

“Now it’s just my stepdad, but he’s dealing with his own grief from my mom dying, and we’re struggling to get along. So, really, nobody.”

◊

At the time of this encounter I’d been reading Demon Copperhead, the prize-winning novel by Barbara Kingsolver. It is closely patterned on Charles Dickens’s David Copperfield, but set in a world she knows well: contemporary Appalachia. I couldn’t help noting the similarities between my patient’s tale and that of Damon, the protagonist of Demon Copperhead, so I chose that as my patient’s pseudonym. Whether in 19th century England or 21st century America, these stories are all too common.

The moral challenge posed by patients like Damon is “What is my responsibility to help?” It’s the question each of us faces when we encounter people on the streets suffering from mental illness, substance use, and/or homelessness—or simply driving past tents by the side of the road. This question must have tormented Kingsolver as well as Dickens—David Copperfield was semi-autobiographical. Their response was to write these novels, perhaps hoping that enlightening readers to the conditions they experienced might open their hearts and spur them to support social reforms.

I don’t have a good answer to this question for myself. I have no illusion I can solve the problems on the streets of Portland, any more than these novels could fix the places in which they were set. At the most basic level, I simply try to encounter people where they are, in their full humanity, as fellow children of God. It often scares the shit out of me—“Deep breath …” in my first paragraph is an understatement—but I’m usually rewarded by the person transcending any stereotype I may have formed in my head.

I don’t think this question will ever stop challenging me, and I hope it doesn’t. The calling to “comfort the afflicted and afflict the comfortable” resonates deeply for me. It forces me to acknowledge my own comforts and it spurs me to comfort others any way I can. I don’t have the gift to write great novels, so I do this. All that most of us can do is try to enlarge our comfort zones bit by bit to encompass an ever-larger swath of humanity. They all need what we can offer—and we need what they can offer us.

◊

Damon and I talk about places where he might be able to build supportive relationships. He says there are a couple of good people in his transitional housing situation that he might be able to look to for peer support. We also talk about work.

“It’s so frustrating. I’m getting interviews, even second interviews, but still nothing. I’m a good worker and I have a good resume. I’ve just got to keep trying.”

I offer words of encouragement without minimizing the difficulty of the place in which he finds himself.

“Don’t worry,” he responds, “I haven’t given up hope. I know what that looks like, I’ve seen it in people on the street. You just look in their eyes and see there’s nothing there, they’ve given up. That’s not me.”

◊

As I write this I still haven’t finished reading Kingsolver’s novel, so I don’t know how things work out for Demon Copperhead. I don’t know how things will work out for Damon, either. I do know that, when I saw him, he was being kept safe and was receiving medical and psychiatric care as well as social services, so that encourages me. When our eyes met before parting, I saw a determination, however fragile, to get better, to do better, and to serve others like himself.

I’d like to think my conversation with Damon helped him pull back from despair to a place where he could get better and emerge stronger. I don’t know that, though, and the odds are against him. I feel the same way about so many patients I see. But, as Damon said, I haven’t given up hope—that’s not me.

Telling Our Life Stories

On By Greg Morgan3 Comments

It was a lighter day at the hospital, so I reviewed charts on the oncology unit to identify patients who might welcome a visit. Sue, in her 70s, had lived with metastatic breast cancer for a few years; she’d been admitted for intractable nausea, which was starting to settle down. After ruling out other causes, her doctors had concluded it was the spread of her cancer itself that had caused the nausea.

I knock and introduce myself, and Sue welcomes me in.

“It’s nice of you to stop by. I was raised Catholic but haven’t really followed any religion as an adult.”

“That’s true of a lot of patients here. We chaplains are here to discuss matters of faith for those who want that, but mostly we’re here just to offer company and to listen to whatever is on your heart.”

Sue thinks quietly for a minute, then speaks. “I was hoping my nausea was something else, but they tell me it’s my cancer moving to a new phase …” She begins to tear up.

“I’m sorry, Sue, that’s hard news to hear.”

“I’ve been through surgery, chemo, and radiation, but those aren’t options now. There’s an immune therapy treatment I could try; it might make a difference, but even if it doesn’t, it could give me more time with my wife and our children and grandchildren. I think I want to try it.”

“I can understand why you might. What would you like me to know about this family you love so much?”

“Well, my wife and I both have children from previous marriages who are about the same age, and they have all become close, especially as they had their own children.”

“That’s wonderful!”

“I should back up a minute. I grew up in a family that was loving but very conservative … I’m sorry, you don’t really want to hear all this, do you?”

“Oh yes I do. This is what we do. I love hearing all about the interesting lives people have lived.”

“OK, then …” and Sue is off and running with a beautiful tale of how she and the family who loves her today came to be.

◊

More and more each day, as a chaplain and as a human being, I appreciate the power and beauty of what we call “life review”: one person sharing with another a story of their journey through life that brought them to the place they find themselves today.

Engaging in life review is by no means limited to the later stages in life. It is precisely what people in the budding stages of romantic relationships share with each other, whether as teens or starting anew in their fifties. Most of us remember the thrill of this well. Regardless of the hard parts along the way—or perhaps especially because of them—it is immensely meaningful to tell one’s life story to another person who demonstrates genuine interest. We are wired for this, as storytellers and as listeners.

That said, I think life review takes on greater significance as we age, yet often the need for it goes unmet. “Yes, dad, we know that story about the time your car burned up on the turnpike” is a classic. I know I’m as guilty as anyone of repeating my stories, yet I’m always grateful for new ears to tell my stories to. I’ve come to believe that telling our life stories—and having them validated by listeners—is one of our principal means of reassuring ourselves of the significance of the lives we’ve lived.

Sadly, we often wait too long to make time for engaging with our elders in life review. My favorite memorial services feature people telling stories about the departed, but often many in attendance—even close family members—say to themselves, “I had no idea.” Years later we might ask, “I wonder what Mom felt when she first saw Dad after he came back from three years at war,” but the opportunity for that conversation is gone.

These thoughts have whetted my appetite for seeking out and listening to the life stories of people of any age, and I try to encourage others to do the same. It is gratifying to know that, in doing so, we are helping them feel the benefits of having their stories heard. Just as important, though, is what we can gain from it. In a recent column Anne Lamott said, “When my friend Pammy was dying at the age of 37, her doctor told me, ‘Watch her now, because she’s teaching us how to live.’”

◊

Three days later I’m back on the oncology unit and I pop in to greet Sue again before she discharges home. She appears momentarily confused, asks me to repeat my name, then smiles.

“You’ll have to forgive me, these meds make my brain a bit foggy. I do remember you visiting me.”

“No problem at all, the meds can do that. I really loved our conversation, and I wanted to see how you are doing today.”

“I’m definitely feeling better. My nausea is gone, though I’m still pretty weak. I’ll start immune therapy treatments on Monday, and I’m hopeful they will do some good. But I’m sad that I won’t be able to return to my work—it’s just too demanding.”

“When we spoke last time you didn’t mention your work. It sounds like it’s been an important part of your life. Would you be willing to tell me about it?”

“I’d love to. I’ve done a lot of things, always having something to do with photography. It all goes back to when I was in high school. I was always good in art, but then I had this teacher … I’m sorry, you don’t really want to hear all this, do you?”

I smile and say, “Of course I do.”

Sue smiles back. “That’s right, of course you do. As I was saying …”

Peace

On By Greg MorganLeave a comment

Betty was in her early 80s, admitted for a bleeding mass in her esophagus that seemed likely to prove malignant and inoperable. She’d requested a chaplain visit overnight, so I made her my first priority that morning.

“Greetings, Betty, I’m Chaplain Greg. Thanks for inviting me to be with you.”

“I’m so happy to see you. I’m doing well this morning. I have been blessed to know Jesus Christ as my Lord and savior since I was a little girl.”

“What a joy that is! I’m happy for you!”

Betty proceeds unprompted with “life review,” sharing about her 60-year marriage to her husband, a retired pastor with several chronic medical conditions, and their children and grandchildren, who continue to play an active, supportive role in their lives.

“Now it seems my time may be coming … I’m excited to finally meet Jesus face-to-face, though I worry a bit about my husband. We’ve always talked that he’d be the first to go, given his health, but now it looks like I may be. Still, I trust God to care for him as He always has, and our children will be there for him, too. And it won’t be much longer until we are together in heaven.”

◊

My friend John asked me at dinner recently, “What percentage of the people you see nearing end of life are at peace with their situation? What factors seem to make the difference?” I am under no illusion that I have definitive answers to these questions, but I’ve seen enough to offer a few thoughts.

My answer to John’s first question was, “Maybe 60%, maybe more.” Betty is just one example among several since our dinner. I will continue to keep this question in mind over the coming months as I go about my rounds, but it feels right, at least for the population I see in the hospital where I work. John’s second question—“What factors seem to make the difference?”—is harder.

Religious faith is an important source of peace for many facing death, but it’s no guarantee—for some, their faith can elicit a sense of having fallen short of what was expected of them in life, and fear of the consequences. And I’ve seen plenty of patients with no active religion, or even explicit atheism, who seem fully at peace with their imminent deaths (Clark, The Science Teacher, is one example).

One factor uniting Christian Betty with atheist Clark is a sense of wonderment about the source of their existence and the universe we inhabit, as well as deep gratitude for the life that this source provided. Gratitude is a theme that runs through so many of the patients I see who are at peace, even (or perhaps especially) in those whose lives have been remarkably difficult (for example, Dean in From The Ashes).

◊

Lucy, in her 50s, was a new admission to the oncology unit but no stranger to cancer. Her lung cancer, diagnosed 10 years earlier, had been managed with surgery and chemotherapy, but after recent headaches and dizziness she was re-evaluated and found to have tumors throughout her brain. She made a request for a chaplain visit the night she was admitted.

Lucy greets me warmly as I arrive, guessing correctly from my attire that I’m the chaplain she’d requested. She gets right down to business.

“It looks like this is it,” she begins. “I’ve had a good run and gotten a lot of extra years, but I’ve always known this day would come and now it’s here.”

“I’m sorry, Lucy—that’s difficult news, even if you are prepared for it. How’s that sitting with you this morning?”

“I’m mostly OK. I’ve got my affairs in order, and I’ve discussed this possibility with my kids for years, so they’re as prepared as they can be.” Her voice trails off but her eyes remain engaged. I wait for more.

“What I really wanted to talk to you about is my sister, who I haven’t spoken to in years. We got along well enough growing up, but as an adult she became really mean and cruel to me.” Lucy relates an escalating series of events, culminating in an act of betrayal that led Lucy to cut off communications between them.

“That’s heartbreaking, Lucy,” I reply, “but I can understand why you felt you needed to set that boundary in order to protect yourself.”

“I don’t regret it, but I realize I’m still angry about the way she treated me. I don’t want to die angry. I wanted to talk with you about how I can forgive her—I think I need to find a way to do that in order to die in peace.”

So we talk about how forgiving another person is something one can do on one’s own. It doesn’t require anything of the person being forgiven, no matter how much one might wish for an apology or just an acknowledgement of hurt. It doesn’t even need to be communicated to the other person. Forgiveness is something one can offer for the sole purpose of putting one’s own heart at rest.

“I never thought about it that way at all, but now that you say it, it makes perfect sense. I think I’m ready to start writing down what I want to say. I’ll figure out later if I actually want to send it to her.”

◊

Every time we chart a spiritual care encounter, we are prompted to assess the patient/family regarding “Forgiveness/Peace.” At one end of the scale, 1 = “Sense of reconciliation” and 2 = “Still have some things to reconcile.” In this context, reconciliation means “Is the patient/family reconciled with and at peace with their situation?” It doesn’t necessarily mean “Have they reconciled with the important people in their lives?” but it certainly can. In fact, the other end of the scale is 4 = “Distanced from others” and 5 = “Alienated from others,” reflecting the importance of relationships in finding peace.

Betty and Clark are good examples of “1” but I’d say the “2” I gave Lucy is more common, especially in the early days of a hospitalization. Most of us have some Unfinished Business (to cite yet another post) that we need to take care of, and a medical crisis can prompt us to take steps to heal relationships that we may have long been putting off. One of the most important things we can do as chaplains is to serve as a sounding board to help others identify the unfinished business in their lives so they can begin to move forward toward peace.

That night at dinner, I told John I thought one of the biggest factors impacting a patient’s sense of peace is having enough time to prepare for end of life. I would now frame that differently: it’s having very little unfinished business—especially unreconciled relationships that need to be set right in order to be at peace. It’s a helpful reminder that it’s never too soon to begin that work …

We’re All Human

On By Greg Morgan1 Comment

During my clinical internships, a patient request came in to the chaplain’s office, where several of us were gathered.

“It’s for Willy,” one of the chaplains announces to the room. The others nod.

“Hey, Greg, this would be a good one for you,” she continues. “Willy’s in and out of the hospital a lot, we all know him. He’s a nice guy and loves chaplain visits, but he can be demanding so we try to share the load. Your turn today.”

I review Willy’s chart, which reveals a history of IV drug use and homelessness, though he is now clean, sober, and housed. He has several chronic medical conditions, including a heart condition I’m not familiar with: endocarditis. I mention this to one of the chaplains.

“Ah, yes, we see a lot of that, especially with patients like Willy. You’ll want to read up on it at some point. But you don’t need to know anything about it for your visit.”

So I head off, and Willy is just as advertised: Grumpy to see yet another new chaplain, but softening slowly as we engage. Grateful for company, happy to share about his religious upbringing and the twists and turns of his life, and appreciative of prayer. While difficult to disengage from, he leaves me hoping I will see him again—which I do. A beautiful, complicated human.

◊

Endocarditis is an inflammation of the lining of the heart, characterized by lesions, called vegetations, that are as strange as anything I’ve seen in medicine. Visualized via echocardiogram, they remind me of strands of kelp floating in a sea bed. Needless to say, that’s not a good thing for one’s heart valves or overall health, and it can be difficult to treat.

Endocarditis is usually caused by bacterial or fungal infections, and there are many risk factors that make people susceptible to it. The most prevalent, at least in the population served by my hospital, is IV drug use. That’s one of the reasons my chaplain colleague thought a visit with Willy would be a valuable part of my training experience.

◊

A year later I am called to a “rapid response” for Vivian, a patient on the floor where I’d visited Willy. This term means there has been an unexplained change in a patient’s condition. While often not serious, chaplains always respond in case visitors are present who may be distressed by the change in the patient or by the flurry of responders. This time there are no visitors, but it’s clear Vivian’s situation is not good. I stand aside as she is whisked down the hall on a gurney to the ICU. I check with her bedside nurse and learn that Vivian is visited daily by her husband as well as other family and friends.

I return to the chaplain’s office to scan Vivian’s chart, where I learn that, in addition to cancer, she’d been receiving treatment for endocarditis, possibly caused by an infection in her chemo port. I then head to the ICU, where providers of all kinds are rushing in and out of her room. The charge nurse spots me quickly and says, “We need you to take point with the husband, who’s on his way.” She paused to get an update from another nurse, then turns back to me. “He just arrived in the waiting room.”

What follows is some of the most difficult work I’ve done as a chaplain: Conveying the gravity of Vivian’s condition without prematurely extinguishing hope. Accompanying her husband through shock and grief while helping him spread the news of Vivian’s situation to loved ones. Welcoming family members to the ICU waiting room and gathering them for updates from doctors working to save Vivian’s life. Steadying them through new waves of grief as they receive the news that nothing more can be done. Keeping vigil with them in the waiting room as the staff prepare Vivian’s room for all to gather to say their good-byes, then accompanying them back to see her. Through it all, we share many tears and prayers.

In the agonizing waits between updates, I ask her loved ones what they would like me to know about Vivian. I learn that she is a committed life partner, a hard worker, a person of bedrock faith, a loyal friend, the life of a good party. All I can say in response is that she sounds like someone I would like to know. Yes, they say, everyone loves Vivian.

◊

I step outside of Vivian’s room to speak with Dr. Weiss, who’s been leading the charge to save Vivian’s life. He is busily charting the care that had been provided to Vivian.

“This might take me a while,” he says tersely, without looking up.

“I understand, I will wait,” I reply as calmly as I can manage.

After 30 seconds or so he stops typing, hangs his head for a moment, then turns toward me. “I’m sorry. What’s your question?”

“I’m trying to prepare the family for the next step, which I suspect is you explaining the process of disconnecting life support.”

He nods. “I need a few minutes, but I don’t want to wait too long, either. What do you think?”

“Five minutes is probably about right. Give me a couple of minutes, then come in whenever you feel ready.”

He nods again, then pauses. “You know, when I saw she had endocarditis, I just assumed she was a drug user, though I realize now that she’s not. I’m sitting here feeling like a complete asshole that this thought even crossed my mind, because it shouldn’t—and didn’t—change the care we gave her. Still, I feel terrible that I thought it anyway.”

“Well, if it’s any consolation to you … I went through the same thought process. I don’t think that makes us assholes, I think it just means we’re human.”

We share a brief nod and smile, then resume our duties.

◊

The Trappist spiritual leader Thomas Merton urges us “to resolutely put away our attachment to natural appearance and our habit of judging according to the outward face of things … Our job is to love others without stopping to inquire whether or not they are worthy.”1

Like many spiritual teachings, I hold this as an ideal to which I fervently aspire, but most days I fall short. I’m only human, and this habit of judging has usually run its course before I even recognize it happening. Dr. Weiss is only human, too. Same for Willy, for that matter. I know we’ll all keep trying, but we’ll also keep failing. We’re all human, and that’s the best we humans can do.

I’m just grateful we have each other to look to for support when we do fail, and a Creator with infinite compassion for our limitations.

  1. For the full context of this quote please see: Thomas Merton on Loving Others ↩︎

Toxic Theology

On By Greg Morgan3 Comments

I was paged to a “Rapid Response” on my hospital’s inpatient rehab unit, as Carla, a patient engaged in physical therapy, had suddenly become unresponsive. As usual, I sought out family and was quickly introduced to Carla’s husband, Randy, and his brother. They seemed unusually calm.

“It’s probably just a medication imbalance,” Randy began. “This has happened before. But thank you for coming, Chaplain. We’re Christians and we believe in the power of prayer—Carla’s got an army of prayer warriors pulling for her.” Randy’s brother nodded.

“Can you tell me what brought Carla to our rehab unit?” I asked.

“She was shot two months ago in a robbery at a grocery store in the small town where we live. The bullets did a lot of damage, and after the wounds healed they sent her up here to Portland to regain as much function as she can. She’s been doing well, though there have been setbacks … like this.”

“Oh, I’m so sorry. That’s just terrible.”

“The hardest thing …” Randy said, “is that we saw the whole thing on film from the security cameras. I guess she didn’t get down fast enough for the robber. He shot her once and then, when she was lying on the ground, he shot her two more times for no reason at all. I just can’t understand evil like that.”

Just then Randy needed to provide information to the medical team treating Carla, so I told him we’d keep them all in our prayers, then departed.

◊

The problem of evil has challenged thoughtful people from the beginning of time. We humans have an instinctive impulse to try to understand cause and effect, to find meaning or make sense out of our experiences. When a person dies unexpectedly or has a life-shattering experience, we can’t help but ask why. Often, there are no answers available.

The problem of evil has an extra dimension for people who believe in a god with the power to influence human affairs. This problem has its own term, theodicy, used by philosophers and theologians who wrestle with it. No one gets through seminary without studying different schools of thought on this topic, and no one graduates without having to develop a personal point of view on it.

I was forced to reckon with the flimsiness of my own fledgling theology more than 25 years ago, when the spouse of a work colleague was brutally murdered. I wrote about this experience during my first year of seminary (God Not Feeling Omnipotent), and I have continued to test and refine the point of view expressed in that post ever since.

◊

A few days later Carla was on a medical unit I was covering, and I looked in on her. During previous visits she’d been surrounded by family and appeared confused, but this evening she was alone and alert.

“Oh, hi, Chaplain. Thank you for coming to see me.”

“Greetings, Carla. It looks like the fog of the past few days has cleared. I’m glad to have a chance to meet you properly.”

“Yes, it was the meds, but they adjusted them and now I can think again. Do you have a few minutes?”

“Absolutely, that’s why I’m here.”

“I’ve been sitting here thinking about why this happened to me. I’m grateful that lots of people are praying for me, but they keep saying things like ‘Everything happens for a reason’ and ‘This must be part of God’s plan.’ Those sayings don’t make any sense to me right now.”

“Can you say a little more?”

“Well, if this is God’s punishment for something I did, I can’t figure out what I did to deserve this. I know I haven’t lived a perfect life, but I’ve tried to follow God’s commandments. I probably won’t ever walk again. How is that fair?”

“I agree, it really doesn’t seem fair.”

“And how is this supposed to be part of God’s plan? Would God purposely do this to me so that I might learn some lesson, or so that other people might benefit from my example?”

I pause, then reply. “The God I believe in doesn’t act that way.”

“The God I thought I believed in wouldn’t act that way, either, which is why this is so confusing.” Carla’s eyes fill with tears, and her voice quivers. “Why did God do this to me? What do you think, Chaplain? Tell me.”

I offer my hand and Carla takes it. We share silence together as I let my own feelings rush in, and then I try to gather my thoughts.

“Carla, I’ve had to change my understanding of God over time in order to make sense of situations like yours. The only God I can believe in is always on the side of love, always working to heal our brokenness. That God would never say ‘Let’s put a couple of bullets in Carla to teach her some humility.’”

Carla laughs through her tears. “Thank you for saying that. I can’t imagine God being that way, either.”

“On the contrary, I believe God was doing everything in their power to stop the robber from shooting you. But I’ve had to conclude that God doesn’t have the power to stop something like that. I’ve had to let go of the idea that God is all powerful in order to hold onto the idea that God is all loving.”

“That’s a lot to take in …” Carla responds uncertainly. “But I do believe that God is all loving.”

“And I believe that God has been with you throughout this ordeal, including tonight, working to heal your body and, especially, your spirit.”

We close with a time of prayer, giving thanks to a God who loves us through our pain and doubts.

◊

Toxic theology is all around us. It may wear the cloak of religion (“It’s all part of God’s plan”) or it may simply be part of the cultural air we breathe (“Everything happens for a reason”). It often arises as we try to make sense of things that make no sense, as we try to assert control over events or emotions that feel out of control, as we seek safety when we feel vulnerable. While it may at first be benign, we often give it power over domains where it can be destructive without ever realizing what we have done.

Any theology, whether religious or secular, can become toxic when we seek to apply it to other people. Carla’s prayer warriors were no doubt well meaning, but they assumed their theology applied equally to Carla without having any experience of Carla’s suffering. I always have trepidation when a patient asks me about my own theology, especially from a place of vulnerability, as I don’t have their life experience and don’t know what conflicts it may create for them. I can only speak from my own experience and hope they find something of value in my words.

We live in a time when, as much as ever, people are seeking to impose their world view on others without first seeking to understand the experiences of others that shaped their different world view. I am grateful for every opportunity I get to listen deeply to the life experiences of others. I always come away convinced of the power of love to bridge our differences.

Safe Passage

On By Greg Morgan2 Comments

A year ago I shared the story Courage and Grace, featuring an inspiring patient named Elyse.  She’d landed back in the hospital with shortness of breath after a four-year remission from breast cancer, and we visited and prayed together as she awaited the results of diagnostic exams. 

During that visit, Elyse told me that her cancer diagnosis was the best thing that ever happened to her, because “the moment I got my diagnosis, I felt this powerful presence within me and outside of me, letting me know that, whatever happened, I was not alone and I’d be safe … and that comforting presence has never left me.” 

Elyse’s story did not end there—I had several more opportunities to visit with Elyse and her family.

◊

Elyse’s husband Keith asked me to join a goals of care conference.  Elyse’s shortness of breath had been caused by a large mass in her chest, and her cancer had metastasized to other places in her body.  As Elyse was still in her 50s, she and her family pursued treatments to extend her life, but none had borne fruit.  Elyse had now drifted out of consciousness, but she’d previously made clear to her family that she was ready to go if it was her time.

We gather and listen as Elyse’s doctors summarize the cascading problems causing her decline, how attempting to treat one will likely make another worse, and the lack of any clear path forward.  She is being kept alive through medications that keep her blood pressure up, and will likely die within minutes if they are withdrawn.  Keith lifts his head and speaks:  “Time to let her move on to her eternal reward.”  

Keith then turns to me and asks, “Pastor, would you join us in Elyse’s room and offer prayer as we say our goodbyes?  I know your presence would be a comfort to her—and to us all.”

As we enter Elyse’s ICU room, her favorite Pentecostal praise singer is streaming loudly from an iPhone near her bed.  Keith, their two daughters, their husbands, and Keith’s brother surround her bed.  They take turns expressing their love for her and praising God for the gift of her life and for His everlasting love.  At their request, I read the 23rd Psalm and offer my own prayers in a manner aligned with their faith and concerns.

The music and prayers continue, mixed with tears and sobbing, as we watch Elyse’s blood pressure and heart rate fall to zero.  There are hugs all around, accompanied by expressions of joy that she is now in God’s arms, and how wonderful it will be to join her one day.

◊

One’s beliefs need not align with those of Elyse and her family, or hold any religious beliefs at all, to recognize this as a “good death”:  accompanied through life’s final passage by the people most important to you, who respect and honor your wishes for end-of-life care, and stand by you to the end.

The 23rd Psalm is one of the most commonly recited texts in Judeo-Christian traditions, for good reason.  For me, the heart of the psalm is verse 4:

Even though I walk through the valley of the shadow of death,
I will fear no evil, for you are with me.

The “you” the psalmist refers to is “The Lord [who] is my shepherd”; for many, including Elyse, this image of divine protection is powerful, but for others it feels remote or meaningless.  To my mind, though, each of us has the ability to bring comfort and safety when someone we know has entered their “walk through the valley of the shadow of death.”  In my experience, accompanying those we love through this valley is a powerful antidote to the fear and anxiousness surrounding the mystery of death.

Many, though, find this accompaniment difficult.  Some friends of my father declined to visit him in his nursing home, saying “I’d rather remember Jack as he was,” and I have spoken with patients many times about loved ones who keep putting off visits.  On one level I find this understandable—seeing someone who was once vibrant but is now frail can be a painful reminder of our own vulnerability and mortality.  But it is also tragic—the one who is dying is denied the comfort that loved ones can bring, and the loved ones who keep a distance deny themselves of one of life’s most meaningful experiences.

This isn’t “chaplain work”—it’s for everyone, at every stage in life.  I recently shared time with a 10-year-old boy and his father as they visited the boy’s grandmother in the ICU, and I marveled at how natural the interactions among the three of them were despite the setting and circumstances.  The boy brought joyous smiles to her face, and he was absorbing valuable lessons about aging and dying.

Even with repeat experience, though, it never stops being hard.  Accompanying Elyse and her family was definitely hard, and it’s harder yet with the people who mean the most to us.  Still, I always feel a bit more completely human every time I show up for someone—and a bit more prepared for my own inevitable passage through the valley of the shadow of death.

Leaving Home

On By Greg Morgan7 Comments

I knocked on the door and was welcomed in by Mike, a man in his 70s who’d been hospitalized with a lung infection.  I’d had a good previous visit with him, and I’d noticed in his chart that he was making sufficient progress that he would soon be discharged to his home.

“Greetings, Mike,” I begin.

“Greetings, Chaplain,” he replies.  “I’m glad you stopped by—they won’t be keeping me here much longer.”

“So I hear … you look great, much stronger than when I last saw you.  I’m sure it will be nice to be home with your wife, and to sleep in your own bed.”

“Yes, it will …”  Mike’s voice trails off as he turns his gaze toward the window.  His face flushes a bit and his eyelids quiver almost imperceptibly.  I quietly take a seat by his bedside and wait.

“An hour ago I signed off on the sale of our home.  We’ve lived there for 50 years.  It’s where we raised our family, and it’s the only home our children have known.  I know it’s the right step for us, but I’m sitting here feeling the weight of it—that this is finally happening, and there’s no turning back.”

“That’s a huge milestone in life, Mike.  I can understand why your emotions would feel so strong.”

Mike launches into “life review,” sharing stories about he and his wife buying the house, raising their children, and special events they celebrated there.  He also remarks how their house has become too much for them, and how much easier life will feel in their new home in a retirement community.

“With all this, it seems ridiculous for me to get so emotional—we’ve been so fortunate compared to so many others, and we’ll do fine in our new place.”

“Those things can all be true and it can still feel like a big loss,” I offer.

“I suppose more than anything it’s a reminder that most of my life is behind me now. There’s no denying we’re getting older.”

“Also true, hard stuff.  It’s good that you can name it like that.”

At Mike’s request, we close with a time of prayer, celebrating all he had been granted in life thus far, and seeking blessings for all that was yet to come.

◊

When Mike and I spoke many months ago, I had no idea I was about to embark on a similar journey.  My wife and I had spoken from time to time about how we couldn’t stay forever in our beloved house of 41 years, but the timeframe for moving kept shifting.  After all, age 70 seems safely distant at age 60, much less so at age 69.

This spring we agreed we should begin getting familiar with options that might fit with our family priorities and finances.  Quite serendipitously, the first house we looked at—just to get a sense of the neighborhood, we said—we fell in love with and agreed we could imagine our future there.  Just as serendipitously, an unsolicited letter arrived in our mailbox from what turned out to be a perfect buyer.  Before we knew it, we were sprinting to make the purchase and sale happen, and uprooting our lives to a new home 15 miles away. 

Only now is the enormity of what we have done settling in … and the story of Mike has bubbled to the surface.  Many of the feelings and memories Mike experienced that day now stir within me.  I find myself trying to listen to that chaplain’s voice.  It’s one thing to speak such words when playing the disinterested third party, quite something else when it’s first person singular.  I can’t deny the weight of the transition, nor should I try (says the chaplain again).  Getting through this move, and the process of absorbing its meaning, is the reason behind Elder Chaplain’s three month hiatus.

An acquaintance whose work I admire uses the phrase “befriending mortality” to capture the heart of her practice.  This resonates strongly for me, as it captures one of my deepest hopes for my work as a chaplain, and for my writing in Elder Chaplain.  Mortality is like an uninvited guest in one’s house, one that may at first reside unobtrusively but over time becomes increasingly disruptive, and eviction is not an option.  The great Sufi mystic Rumi teaches us to befriend such guests:

Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.[1]

We have now swept our former house empty of its furniture, and we are preparing our new house in hopeful anticipation of new delights.  Mortality made the move to the new house right along with us, and will undoubtedly be a disruptive guest in the future, as it has been in the past.  I’m not ready to say we’re friends, but we are learning each other’s ways and accepting that we’re in it together for the long haul.

[1] The Guest House, by Rumi.

Hoping Against Hope

On By Greg MorganLeave a comment

“All I know is that six days ago I was perfectly fine, then I had some tingling in my feet, and now I can’t even walk.”

I hold the hand of Rachel, a 40-year-old woman, and absorb the story of her mysterious illness.  I listen to her describe the light of her life, her 18-month-old son, Joseph, and speak of her maternal grandfather, now deceased, who inspired her son’s name.  I create room for her to sob as she tells me how much she misses them both right now.  Near the end her mother, Sally, joins us, and together we pray.

Dear God – We pray for your deep sense of presence as we gather in your name.  We ask for wisdom for Rachel’s doctors, that they might discover the cause of her affliction and restore her to health.  Please comfort her heartache for those she is missing, and grant her peace as she awaits your healing touch.

◊

“If you could come see Rachel today, it would mean the world to her.  She told me you remind her of my father, that you comfort her the way he always did.”

Sally has stopped me in the hall; while Rachel’s unit is not on my rounds today, I accompany her back to Rachel’s room.  Rachel’s husband, Dan, is feeding her lunch, as Rachel can no longer lift her arms.  We speak briefly and agree that another time might be better.  Back in the chaplains’ office, I look up Rachel’s chart and see a new working diagnosis:  Guillain-Barre Syndrome.

Dear God – What a terrible condition to befall Rachel.  I’m sure it grieves you even more than it does me.  Please give her strength to battle her condition.  Help me, too, to be the chaplain she deserves.

◊

“Rachel appreciates your coming, but she’s too exhausted to see you—she just needs to rest.  She’s a real fighter, though—she’ll get through this.  We have her church and ours praying for her recovery.”

Sally has intercepted me outside of Rachel’s nursing unit.  I ask Sally how she is holding up.  Her lip quivers, but Sally’s a real fighter, too.  She says they just need to get Rachel’s sodium levels back up and she can move to the rehab clinic to rebuild her strength.  I review her chart and confirm this prognosis.

Dear God – It’s been more than a week now, and the light at the end of the tunnel seems always around the next bend.  I know you are doing your best—Rachel’s family says they feel your presence at all times.  Please bring strength to them all—and to me as well—to be ready for whatever may be required.

◊

I check the census and find Rachel in the ICU.  There, I find Sally, Dan, and Rachel’s sister gathered to one side of Rachel’s bed.  Sally waves me in, then collapses in my arms.  I close my eyes to feel her pain, then open them.  I see Rachel asleep in her bed—unmoving, intubated.  Dan and Rachel’s sister look on with me, in stunned silence.  Sally lifts her head to speak.

“The good news is she is finally getting some deep rest.  The doctor was just by and said her labs were a bit better.  We might have hit bottom at last.  We just have to hope.”

Sally thanks me for coming, then takes another long hug.  It is afternoon before I can chart my visit.  I learn that Rachel has been transferred to the ICU of a big hospital downtown, which her doctors feel can better address her continued deterioration.  And that is all I will ever know of Rachel and her family.

Dear God – What work this is that you have called me to?  You bring me into the midst of deepest pain, which I can do little to relieve, then pull me out without resolution.  You teach me that accompaniment is my primary medicine, but that I am only one thread in the fabric of care.  I must trust you to heal what I cannot, and I must accept that my care, while it feels insufficient, is nonetheless all that you ask of me.

◊ ◊ ◊

This story, now three years old, still chills me.  As I said in an earlier essay, Practicing Hope, it can be so difficult to be fully present to and engaged with loss while, at the same time, not losing faith that light remains in the darkness.  I draw inspiration from Sally’s continued expressions of hope, which were not simplistic wishful thinking but rather a powerful, determined search for light, for the strength to move forward despite daily discouragements. 

Hoping against hope, when our desired outcome seems increasingly remote, requires us to shift our focus away from that outcome toward a goal that feels more achievable.  If not improvement with symptoms, then perhaps an improved lab result.  If not restoration of the ability to walk, then perhaps increased ability to navigate by wheelchair.  If not remission of cancer, then perhaps reduction of pain and the peace of acceptance.  Hoping against hope is an imaginative reframing of goals within the context of what seems possible in order to restore a sense of agency to those who are suffering.  It is the opposite of giving up hope—it is an accommodation to reality that allows us to continue to hope.

To my mind, this is difficult work to do alone.  The accompaniment of others in our darkest moments can pull us out of a vortex of discouragement and help us consider more broadly the spectrum of possibilities.  The world’s great religious traditions do much the same by placing our personal crises in a larger spiritual and historical context, and by inspiring us with examples of others who have maintained hope despite equally difficult circumstances.

When supporting someone confronting a situation that feels hopeless, our task is to walk a fine line that neither encourages false hope nor discourages the work of hoping.  Often that is best accomplished just by being present, listening to and acknowledging the difficulty of the situation, communicating our love, and supporting the person in their work of evaluating and reframing their goals.  And, if one is a person of faith, trusting that God is present and active in all of this work without ever presuming that we know the outcome.  If we can show up and do this, we will have done our part.

In these shortest days of the year, as many of us prepare for the long winter ahead, it can be difficult to find reasons for hope. Yet we often find it in the unlikeliest of places, including among those whose suffering is greatest.  For me, the most profound message of Christmas is this:  the light shines in the darkness, and the darkness has never overcome it (John 1:5).