Thursday, September 30, 2010

Pastoral Theological Question

The Kingston General Hospital provides spiritual care services to a variety of patients, including Roman Catholics.  I wonder how I might effectively meet some of these patients’ spiritual needs through a ministry of Christ’s presence, in conjunction with the spiritual care team.  Specifically, how might I bring a compassionate presence to patients who are experiencing illness at the KGH, including those who are visiting the clinic of the Palliative Care Centre?
    In order to address the pastoral theological question, I volunteered with the hospital’s spiritual care team, led by Rev. Bob Hunt.  The Roman Catholic arm of this team was led by Fr. David Collins and his able staff of devoted retirees.  Fr. David’s volunteers met each morning for prayer and discussion, then received assignments of patients who wished to receive holy communion.  After two weeks’ training, I was given my own daily list of patients to visit and to celebrate communion with.  Concurrently and complementarily, I was working in the Palliative Care Department with Dr. Joshua Shadd on a medical research project which hoped to delineate the tasks of dying.  For this project, I also spent time in the outpatient clinic meeting with oncology patients.
Background on the Experience
    What follows here is a small sample of my experiences at the KGH, which should serve to locate my reflections in their empirical base.  Samples from both the Palliative Care clinic and the Eucharistic volunteer service are included.
June 27, 2008
8:30 AM – 3:30 PM
    Today I accompanied Dr. Schroder to visit 3 patients in the morning.  All of these were near the final stages of life.  The first was alone, and seemed to be in quiet prayer when we arrived.  The doctor thought he was asleep, but he opened his eyes without trouble once he sensed our presence.  A feeling of peace was in the room.  The doctor talked with him for a few minutes to find out how he was doing.  As most rooms in the hospital have more than one patient I felt somewhat torn upon passing others by, as though my cursory glance or nod of greeting were insufficient for these poor suffering souls. Our second patient was asleep, but his wife was present.  She seemed to have faced the reality of her spouse’s impending death with calm and reserve.  When asked whether the family had any church affiliations, or whether they would wish a referral to spiritual care, she responded ‘no’.  In my heart I said a prayer for the patient. Our third patient revealed a human touch.  There was a slight smell in the room, which I associated with the commode which had not yet been emptied by staff.  The patient’s wife asked if someone could come by and clip his toenails, as she was not able to.  I sensed at once the frailty and dignity of this family.  The wife stated with some nostalgia how just a short time ago, her husband had been such a strong and vibrant man.  She noted how his multitude of problems had come all at once, as though unbidden. During lunch the Palliative Care team had a seminar on how to care for vulnerable patients who wished to travel.  A nurse expressed dismay at those who acted in a manner she thought irresponsible for those with a terminal illness.   A patient of hers, upon seeing a magazine fall open to a page on the silk road, had flown overseas and climbed Asian mountains to her heart’s content, bringing home silk from which she made a purse for the nurse.  She died shortly thereafter.  Someone remarked about how dying wishes often included extravagant travel plans.  It seems that some of those with families overseas made long and arduous treks to say farewell, while others struggled to perform pilgrimage rites. In the afternoon I accompanied a nurse, Cathy, to see a new referral to Palliative Care.  Although it was felt that the patient was not immediately at death’s door, her attending physician thought that she lacked the supports she needed to make decisions about impending end-of-life care.   Cathy, on the other hand, thought the patient had sufficient assistance from the family to help her through.  One point which troubled me somewhat during this encounter was the patient’s denial of any religious affiliation.  She did not appear to be far from the Lord’s peace, however, a point of grace which reminds me of Lonergan’s exposition on implicit versus explicit faith.  Perhaps for many, God is, after all, a private affair. I returned home to my wife, exhausted physically and drained emotionally.  Paradoxically I am full of hope and wonder at our child, who is to be born in the Fall.  To see the stages of life so juxtaposed makes one sit up a little, in contemplation of God’s ongoing work in the world and in His children.

July 8, 2008
1 – 4:30 PM
    ...Many palliative patients are taking morphine, often in very high doses.  I remembered the verse, “Give drink to those who are perishing”.  Afterwards, I went in to see Mrs. W., who also needed an increase in her morphine.  She seemed a little depressed, so I asked her how she was handling the emotional part of her illness.  She said that she was trying a Vietnamese meditation technique which helped one focus on one’s breathing.  I mentioned prayer but she did not respond.  It seems, on one level, that many people were turning with ‘itching ears’ to teachers who did not follow Christ.  I was sorry that perhaps Mrs. W. had left or reduced the importance of church in dealing with her illness. The last patient we visited was Mr. H., who I had seen previously.  I remember he and his wife had indicated earlier that they did not wish for us to discuss spiritual matters.  On the one hand, I wondered if they belonged to another church, and perhaps my crucifix had deterred them from opening up to me on this front, being associated with what might be for them, an alien rite.  On the other hand, I had been discussing with Dr. Shadd through a conversation about faith and medicine, what one would do if a patient refused to believe in Jesus.  I had explained that on the one hand, we might ‘kick the dust off our feet’- a tender mercy which often leads others to repentance.  On the other hand, I wondered if one ought not to plough even deeper, but with prayer and kindness, to soften the earth a little more.  I wondered at the tension in Scripture around this topic, and suppose that one often needs wisdom to guide.

July 9, 2008
8:30 – 11 AM
    Today I went on rounds with Mike, who is a retired hospital administrator.  Mike’s cheery and outgoing personality helped make patients more willing to talk about their day.  I found that each Eucharistic ministerial volunteer has a unique approach to visits with individual strengths and advice, as well.  One patient thought that the two of us were priests.  “Father,” she said to me, to which I replied, “I am going to be a father, but I am not a priest”, referring to the baby my wife and I are expecting.  I think she did not understand, and when we were leaving, again she called me Father.  Yesterday Pat explained that many patients will not take communion unless it is from the priest.  Religious traditions are slow to change sometimes.

Describing the Experience – The Feelings
Wonder:  This was my first experience as a Eucharistic minister; never before had I been so aware of the power and presence of God in this holy sacrament.
Responsibility:  The daily routine of visitation according to an assigned schedule was an adjustment for me.
Existential Angst:  Meeting with dying patients was a sobering experience, which edged in on my plans for living.
Anxiety:  At times presenting my faith was a battle, mostly with staff, not so often with patients, although when some were unwilling to discuss God, it stuck in my heart like a dagger.
Joy:  Seeing patients who radiated love and peace was a welcome part of my routine.  Some of those who were dying in the context of a strong faith also gave the sense of impending fulfillment rather than of doom.

    As my wife was expecting at the time, a good image which captures the feelings of this placement is that of a foetus:  those who were frail and elderly in long-term care and receiving daily communion were as infants in the womb, their struggles giving refinement to their spiritual being, while those actually on the point of dying were as those about to be born, with all of its blood-and-guts soon forgotten with the appearance of new life.
The Heart of the Matter
    In working with sick and dying patients at the KGH I was confronted with two intertwined realities:  that of physical and emotional suffering and that of God’s loving presence in the midst of such apparent tragedies.  Within myself, I found a mix of emotions when seeing this dynamic:  from anxiety over the pain and abruptness of death, to fascination over faith’s power to carry, to wonder at God’s intimate connection with His children in their time of need.
Lessons from Tradition
1 Corinthians 11:25-26 (NKJV):  “In the same manner He also took the cup after supper, saying, ‘This cup is the new covenant in My blood. This do, as often as you drink it, in remembrance of Me.’  For as often as you eat this bread and drink this cup, you proclaim the Lord’s death till He comes.”
    In celebrating communion with patients, we had a point of common reference which served to prepare the way for deeper conversation and fellowship than would have otherwise been possible in a regular hospital visit.  One often wishes for a way to reach a person’s heart when working with patients, and in the Eucharist, God is the touchstone.  The presence of the divine is made clearly manifest when we share in communion.  By remembering the Lord’s death we are also healed of many ills and given strength for the voyage ahead, knowing that the suffering we feel was also felt by love made flesh.
    Much of my anxiety over ministering in the KGH setting was allayed by the presence of God in others.  Part of my own spiritual growth took place when I realized that the burden was not solely on my shoulders – God was immanently real in the suffering of the sick and dying.  It was also a revelation to me, particularly from the perspective as a Catholic medical student, that the celebration of the Eucharist and of Mass on Sundays goes on ‘in the background’ amidst the regular scientific and administrative machinery of a modern hospital, providing a much-needed salve to the souls of patients.  It seems now that the volunteers buffer the patients from the rigors of tests and from the loneliness of a sick bed. 
    Since completing my hours for the placement I have become more sensitive to patients’ needs while visiting as a medical student.  The training I received with Rev. Bob Hunt and with Fr. David and the volunteers has taught me to be sensitive to the social and spiritual context of medical care.  By participating in both the joys and the pain of sick and dying patients, I have grown in my faith, as well, seeing light and becoming more aware of God and His mysterious workings in seemingly desperate circumstances.

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