Clinical Pastoral Education

Initial reflections on 9 months of chaplaincy

Posted on by Lutheran Zephyr

Earlier today I completed my 9-month hospital chaplaincy (a three-unit CPE residency).  All ELCA seminarians are required to complete one unit of Clinical Pastoral Education, usually in a hospital setting as a chaplain, and usually over 12 weeks during the summer.  My experience was just like that standard summer experience – only longer and, because of the cumulative, snowballing nature of the learning on CPE, much more intense.  A few thoughts:

  • My future ministry will be greatly impacted by this experience.  As a hospital chaplain, I was not called to be a Lutheran chaplain, or a Christian chaplain, or even a religious chaplain.  In our hospital the emphasis was to offer "emotional and spiritual support" to patients, families and staff.  My starting point for care was not religion or faith – it was most often the human experience of pain, suffering, and loss.  Empathy, listening, compassion, conversation, presence – these were my primary tools.  If religion was part of the other’s milieu, then that was part of my caregiving.  If religion was not part of the other’s milieu, then it never entered our discussion.  This radical emphasis on the other (rather than placing a priority on religion or my role as clergy-type vis-a-vis a layperson) will shape the way I engage in ministry as a Lutheran pastor.
  • In one of my many struggles with pastoral identity over the past year, my supervisor encouraged me to imagine myself sitting with the patient at a bar, making authentic, natural, real conversation.  The problem was that I was over-thinking, working too hard at the task of pastoral conversation, preventing me from simply offering myself in these encounters.  I was trying to "be" a chaplain rather than simply be authentic.  As a result, I’m now looking to purchase two bar stools for my church office, to remind me of the real nature of pastoral work.  (I’m not sure that I’ll be installing a wet bar, however!)
  • I’ve learned about the tyranny of the 9-5 schedule over these nine months.  For all the (justified) complaining we clergy-types do about our schedules – we work nights, weekends, and holidays, after all – I much prefer the flexibility of the clergy work schedule than I do the unforgiving inflexibility for a 9-5 job.  Miss a train by a minute and I was 40 minutes late to work.  Show up late to work, and I’ve screwed up the chaplain before me who has been waiting.  Ours was a strict schedule with shifts, daily report meetings and weekly schedules for clinical reports, didactics and group reflection.  There was little wiggle room in the schedule.  Together with a 90-minute commute in each direction, I was away from home 11+ hours/day – and saw very little of my children each day. 
  • I’ve thought much more about my own health, death, and have often imagined the loss of my wife and girls.  I’ll be glad to get away from such direct and vivid reminders of my mortality, but I’m grateful, too, for the education.  I now know much more about death and grief, and can clearly state now from experience what kind of measures I want taken if I am ever in a critical or life-threatening condition.  (And I’ll write a post soon about what measures I want taken if I’m on a ventilator for a prolonged period of time – it killed me to see patients who were unable to communicate suffer through hours bad television shows.  Please, if I’m semi-conscious in a hosptial bed, do not put Maury Povitch on my TV!  Get me some ESPN or NPR, please!)
  • I’ll miss the intimacy of entering into people’s lives during some of their most difficult times.  There’s something about a hospital gown and IV tubes that really prevents a patient from putting on airs about how they’re feeling.  Sunday mornings are a different kind of experience, filled with too many fake smiles and perfunctory "I’m fine, thank you" responses.  In recent weeks if a patient said, "I’m fine, thank you," to me, I was likely to gently call their bluff: "Yeah, except for the fact that you’re in a hospital rather than your home."  That often led into some conversation about their pain, their worry, and their hope for recovery and the future.
  • My supervisors have encouraged me on a few occasions to explore becoming a Board Certified Chaplain.  This thought intrigues me, as I have come to greatly appreciate and even love the chaplaincy approach to pastoral ministry.  Some Board Certified Chaplains serve in congregations after or while they also serve in a clinical setting (hospital, nursing home, prison, etc.).  This is one of those discernment pieces that will stick with me for a while.

Many more thoughts later.  It is getting late.  G’night.

Blog Interrupted

Posted on by Lutheran Zephyr

I haven’t been posting much, and will likely not post for several more days.  Several reasons:

  • My computer is acting up.  My email and blogging routine usually takes place at my dining room table.  But with my computer on the fritz I must banish myself to the second floor to an old desktop computer if I want to go online.  This is not condusive to frequent writing.  I hope to get the computer fixed soon.
  • My CPE Residency is coming to an end.  Woo hoo!  Thursday, May 31 is my last day.  I have been wrapped up in my chaplaincy work both physically and emotionally in recent weeks, pushing this blog and a contract writing project to the back burner.  I hope that the end of this program – coupled with a solution to the aforementioned computer problem – allows me to resume my old writing ways soon.

And other news, in brief:

  • Today I took two of my psych patients out on a day pass.  We had an excellent time at Reading Terminal Market, Love Park, and City Hall.  Of all my units in the hospital, I’ll likely miss the psych ward the most. 
  • Visited the YMCA tonight.  We’ll likely get a family summer membership, enrolling our big girl in a week or two of camp and/or a tumbling class, and allowing me to exercise three days/week (they have child care, free for members!).
  • Did I mention that I’m almost done my CPE Residency?

Whistling with Elmo

Posted on by Lutheran Zephyr

My nine months as a Resident Chaplain end on Thursday, May 31.  Over this time I have learned to pick up on cues, to be sensitive to signals spoken and unspoken, as I attempt to care for a patient or family member.  This evening, I noticed a cue of my own.

I am on my final overnight shift at the hospital (I arrived at 4:30pm on Saturday, and I’ll be here until 8AM on Sunday morning).  In doing rounds I met the grandmother of a man in his twenties who was severely injured following an auto accident.  He may permanently lose many bodily functions, if he survives this ordeal at all.  And so I sat with this woman and listened to her cries.

After a little bit my beeper went off – another trauma in the Emergency Department – and I left her.  As I entered the elevator on my way to the Emergency Department I found myself whistling the song from "Elmo’s World."  Immediately my girls, particularly Tali (our 3 year-old), came to mind.  I could see her giggling at Elmo’s antics and laughing with Mr. Noodle.  A big smile came across my face.

But then a tear entered the corner of my eye.  Too easily I was able to imagine myself in that woman’s position – in a hospital, grieving over the pain of my child.  What would I do if I were here, with my daughter in the Intensive Care Unit?  Holy God, what a wretched thought.  Please, take it away from me!  Perhaps that’s why I was whistling.  Rather than drag me into the emotional morass of pain and suffering, my subconscious moved toward silliness and laughter instead.

I feel twisted and torn.  Surely my transference-induced pain is nothing like the angst that woman is experiencing.  I merely put a toe in the water of parental pain.  She has plungled in it deep.

I’m looking forward to going home tomorrow morning and seeing my girls.  Perhaps we’ll watch some TV together.  Perhaps we’ll watch Elmo.

Authenticity & Pastoral Identity

Posted on by Lutheran Zephyr

Over the past nine months one of the keywords in my CPE Residency has been "authenticity."  We have sought what it means to be "real" and "authentic" in the practice of chaplaincy.  I got appropriately grilled when my peers and supervisors sensed a high dose of phoniness in a patient encounter that I presented in a clinical verbatim report.

Surely we’ve all met pastors who have tried to hard to play the role of clergyperson.  Surely we’ve all heard religious platitudes that did little to comfort a sin sick soul.  Surely we’ve all run into clergy who are so busy wearing funny shirts and dolling out rites and rituals that they forget the humanity of their parishioners and even themselves.  But perhaps you have also met the pastor who is so "down to earth" that there is nothing "set apart" about her.  Do I want my pastor to be like me, or somewhat different?  To be human or to be just a rung lower than the angels?

What do you make of authenticity and pastoral identity?  Can you "be yourself" and be a pastor?  How is being "pastor" different than being "you"?  (BTW, Barbara Brown Taylor touches on this issue in a major way in her book Leaving Church: A Memoir of Faith, particularly chapter 12. I owe you all a review of the book.  Want the short version?  The book is worth reading.)

Baptism Without a Faith Community?

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In the hospital chaplains are occasionally asked to baptize babies, particularly those who are very sick or deceased (an issue for another blog post).  Recently, however, I was asked to baptize an adult.  He is not in immediate danger of death but rather is a long-term patient on a closed psychiatric ward.  In his mid-50s, this patient has a history of being abused, some drug use, multiple suicide attempts, and borderline personality disorder, among other things.  Despite this laundry list, he is a highly functioning individual when properly monitored and medicated.  However, when released from a controlled environment he often attempts suicide, bringing him back to the hospital.

Except for the patients and staff of the psych ward he has no community, no family, no place to call home.  He is unable to leave the floor to go to worship, and will likely move to another facility in the coming months that will be equally limiting.  It’s not that the medical staff doesn’t want him going to church, but that they don’t have the resources (nurses, aides, social workers, etc.) to accompany patients to various churches on Sunday mornings.  It’s a small ward full of diverse folks – not likely "worth the time" of a church to come in and do services (sad but true).

So, given that this man does not have a faith community and will likely not have one any time soon, but has an honest desire to be baptized, what would you do?  He tells me that his mother didn’t care enough about him to get him baptized or to take him to church.  He has occasionally gone to church as an adult, but his disease and transience has made it difficult for him to truly and actively participate in a community of faith.  He prays and reads the Bible as he is able.

Baptism is an entry into a faith community, a grafting into the body of Christ, a cleansing of sin, and a promise of salvation.  Yet without a community, how would this person be encouraged and nurtured in faith or reminded of these baptismal promises?  Does a hospital baptism become an empty gesture, a feel-good ritual that wears off in a few days? 

What would you do?

I’m here. Really.

Posted on by Lutheran Zephyr

Though I haven’t blogged in a week – a longer hiatus than most of my declared blogging hiatuses – I’m here. The CPE residency has been particularly powerful yet draining over these past few weeks, both on the floor with patients and in the pastoral formation/self-learning side of the program.  I also preached last Sunday, attended two nights of food and drink at my seminary reunion, will preach this Sunday, and will have the girls all to myself this weekend (The Reverend Mommy is off to co-lead a women’s retreat).  It’s a busy time. 

I’ll be back.

Learning About Self

Posted on by Lutheran Zephyr

This has been one of those tough weeks that, nonetheless, yields a whole bunch of learning and insight.

On Monday I forgot that I was to present a Clinical Report (ie, a verbatim) of a pastoral encounter to my group.  Not good.  Luckily, one of my CPE peers was able to present a report she had written in advance of her next presentation, and we switched dates.  Later that same day I had individual supervision with my supervisors in which we talked about the ways in which forgetting to prepare a Clinical Report may be a product of my excitement about next year’s congregational internship and eagerness to move through the Candidacy Process toward my goal of ordination.  "OK Pastor Chris, where are you right now?  Here or in the parish?" my supervisor asked with a smile.  (I blogged about this earlier in the month: Always Looking Forward).

Today I presented the Clinical Report that was to have been presented on Monday.  It was about an encounter with a patient’s family in which I over-identified with the patient’s son and became emotionally enmeshed in the family system.  Upon hearing my presentation and analysis of the encounter, the group questioned my authenticity in the encounter.  Many of my peers felt I was distant or phony in the encounter, and that I was enmeshed only in my own transference issues, not in the family’s issues.  The encounter wasn’t a train wreck, but it was, well, imbalanced.  And though it was hard to hear and harder still to admit, they are probably right.  In this encounter I found myself falling into a role that allowed me to remain distant and react to issues that were more present in my past than in the patient’s room.

And then the real learning took place.  I began to reflect on how I relate to others in my personal life – my wife, my friends, my family – and to admit how emotional patterns formed in childhood continue to shape and influence my relationships today.  When I relate to my wife or my best friend, for example, there is part of me that is responding not only to these people, but also subconsciously to my mom, dad, and the complicated emotional realm that was my childhood existence.

And so, today was a reality check, a reminder that No Chris, you haven’t purged all the demons from your past yet (is a complete purging even possible?), and also a reminder that Chris, you don’t even have all those demons contained (again, is a complete containment even possible?).  My stuff comes out, and today I learned that though I likely will not ever contain it, I need to be aware of it. 

As I prepare to go out on internship, this is a good lesson to review.

1 Thessalonians 2:8

Posted on by Lutheran Zephyr

If there is a Bible verse to encapsulate what I have learned in my hospital chaplain residency this year, this is it:

. . . we are determined to share with you not only the gospel of God but also our own selves . . . [1 Thessalonians 2:8]

At the beginning of my residency I struggled with, but quickly accepted, the not-specifically-religious nature of my chaplaincy work (see The Cross and Hospital Chaplaincy).  That is, as a hospital chaplain in a diverse setting, I am not there to be a Christian or a Lutheran chaplain.  Rather, I am there to be a compassionate presence who can provide spiritual support (if requested), either by directly providing for religious needs (read Scripture, say a prayer, etc.) or by connecting patients with resources from their tradition (reading material, clergy, volunteer visitors).

It was hard, in one sense, to put down my Bible and my prayer book, for they symbolize the two sources of wisdom and teaching in my faith – Scripture and the Church’s tradition.  But as 1 Thessalonians 2:8 shows, we share not only the Gospel but also ourselves.  In my line of work as a hospital chaplain, but I imagine also as a parish pastor, it is the sharing of the self that comes first.  I walk into a room and I present to the patient not my prayer book nor my Bible, but myself.  "Hello, I’m Chris, one of the chaplains in the hospital.  I’m here to check in with you, to see how you’re doing, to offer you some support while your here.  How are you doing?"  I think I have used my prayer book about four times since I began this program on September 1, and my Bible perhaps a dozen times.  I have prayed more often, but even then it is not as much as I thought I would.  For most of my patients it is relationship, not religion, that they’re looking for from a chaplain.  (Why?  That’s stuff for another post, but briefly – I imagine that the majority of my patients are not overtly religious; and the ones who are religious often have friends, family, church members and clergy who provide them with their religious needs.  I do provide some religious services, but not nearly as much as I originally thought I would.)

As a congregational intern and eventually as a pastor, I will use my Bible and prayer book in pastoral care.  But I think that I will use them less, and differently, than I would have prior to this residency.  I have learned in this residency the power of a pastoral relationship, and have felt the incarnate love that is shared in such encounters.  If tended with care, such relationships can become channels of comfort in which the living Word of God breaks in, the prayers of the saints echo, and the witness of the church shines brightly.  Each situation is different, of course, but too quick a turn to Scripture or the prayer book can result in a disembodied religiosity that might dot holy i‘s and cross sacred t‘s while doing a disservice to the incarnate, living Word which comes to us in the flesh and demands of us a relationship.

The Company of Saints

Posted on by Lutheran Zephyr

I was recently with a Roman Catholic family in the final hours of their loved one’s life.  A priest came and administered the Anointing of the Sick (what we used to call "Last Rites").  During the prayers the priest called on various saints to pray for the patient – from Abraham and David, to Mary and Peter, to John of the Cross and Francis of Assisi.  In fact, after the priest named each saint, the family responded with this plea: "Pray for him."  At least 10 times the family called out to different saints to "pray for him." 

I have never been so comforted at someone’s death as I was in this experience.  The thought that these saints of old, from the Bible and from the Church’s tradition, are praying for this dying man – what a comfort!  Surely all we did was ask these saints to pray – I guess we don’t know if Francis and his friends actually got on their heavenly knees and began to pray – but even the thought that such a company of saints would bring this man to God in prayer was amazing.  It was as if that room were filled with saints standing alongside the patient’s wife and children, calling out to God for mercy and peace.  Amazing.

After the priest finished the rite, he asked me to step out in the hallway with him for a minute.  "You’re a Lutheran, but, but . . . you were praying the ‘Hail Mary’."  "Yes, Father, I did.  I learned it in college and, though protestant, I find much comfort in the hope that perhaps the saints are praying with and for us.  Anyway, if I’m not mistaken, Martin Luther had a quite a dedication to Mary the Mother of our Lord."  Before walking away, he hugged me and gave me a look that combined confusion with a newly found admiration.  Who knew that Lutherans could pray the Hail Mary?

I don’t understand why we shouldn’t call on the saints to pray for us or for those in need.  They are our ancestors and predecessors in the faith whose witness has inspired us and whose wisdom has taught us.  They are part of the eternal and timeless body of Christ, and as such are worthy to be asked to pray, just as I might ask you or my pastor to pray.  Going even further, I can’t believe it would hurt to ask these people – these saints, after all, who had a special relationship with God – to pray as well.  It might even help.

I admit that my belief about the role of the saints is not entirely worked out and probably has some unintended consequences for other aspects of my belief in God and the church.  The above paragraph has slippery theological slopes for a protestant.  But . . at that patient’s bedside I was comforted by the image of the company of saints praying for my patient . . . and I believe the family was comforted, too.

Holy Mary, Mother of God, pray for us sinners now, and at the hour of our death.  Amen.

A Chaplain’s Grief

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Yesterday I witnessed the most gut-wrenching, horrific expression of grief that I could ever imagine.  I accompanied a doctor in his horrible task of telling a patient’s wife that her husband did not survive a rather routine, minor surgery.  His death was unexpected and tragic.  Immediately the woman burst into howling screams, heaves, gagging, gasps for air, convulsions.  It was raw, primal, unrestrained – unlike anything I have ever seen. 

Yesterday, I grieved, too – I grieved her loss, yes, but I also grieved my wife, my daughters, my dearest loved ones.  Do not worry – my wife is still with me, as are my daughters and dearest loved ones.  But in witnessing this woman’s grief I tapped into some of my worst fears about losing those I love the most.  As she later stood by her husband’s body, holding his head, weeping on his chest, I pictured myself in the same position at my wife’s body, holding her head, weeping on her chest, gripping her hands with all my love – how could I not?  How could I not watch this scene and place myself in it?  Tears formed in my eyes as I grieved for this woman, grieved for myself.

Following the two hour ordeal I sat among my chaplain peers who were gathered for our daily afternoon report.  As soon as I walked into the room they stopped what they were doing, turned in my direction, and asked how I was feeling.  I told the story, wept, and sat in silence, surrounded by their caring presence.  For about 20 minutes they allowed me to dwell in the grief, to unpack the emotions that were stirred up by such a horrific encounter.

But my grief was interrupted yesterday, cut short due to the fact that this man died near the end of the work day – it was soon time for me to go home.  And though I could have stayed at the hospital to remain in and reflect on the myriad emotions of that day, I needed to get home to embrace my wife and girls, and – frankly – to care for my girls as my wife went to a church meeting.  Life for me went on, taking away the opportunity to grieve.  Time to move on.

And so this morning, on the day after, I found myself grieving my grief.  During and immediately following the encounter I was immersed in intimate, raw, primal feelings, the kind of which I would generally avoid or bury somewhere deep in the subconscious.  The situation was so chaotic and the emotions were so turbulent – I wasn’t ready to let them go, to move on, to forget about it. 

But I did.  I had to.  Life had to go on.  I put on my jacket, walked outside, and began my 90-minute commute through city sidewalks, a crowded commuter train, and the short drive home from the train station.  I left – I lost – that moment.  And now I find myself wanting to return to yesterday, to the depth of feeling, to the intimacy of the moment, to the awesome and awful power of grief.

It will return to me, I’m sure.  Perhaps I’ll be walking down the hall, or visiting with a patient, or hugging my wife, or playing with my girls, or standing at a graveside, or . . . I do not know when, but those feelings, that experience will always be with me.  I will never forget that woman’s grief – nor will I forget mine.