Things people say ...

Today I was talking to a patient who is dealing with the death of a family member. There are cultural differences as the family is East Indian. So I was asking about the different traditions and what is normally done, or expected, and what they are doing that is different from their cultural norms due to the circumstances related to the death. In listening to the person talking about all the family dynamics that go along with this and the expectations that go with this situtation, I was reminded of some questions people ask me when I give talks/seminars about my work in healthcare. My areas of specialty have been dementia, grief related to chronic loss and grief related to death. So inevitably I get asked what to say to grieving people. How can we be pastoral to those in grief? I remember starting with "well, here's what not to say" before I could come up with what to say.
Often people mean well, but say things that aren't appropriate, or aren't helpful to the grieving person(s). I have always hated when people say "S/he is in a better place. .. is not suffering." and the clincher "It was God's Will." I shudder at that one. I will admit. I used to be an offender and use these exact phrases ... but since I took a course in my training where we used a book call "The Will of God" I have learned what that really means. The Will of God.
For centuries, the human mind has sought to understand the meaning and purpose of existence. How did the world/universe come to be? Why? What are we to do here? What is the meaning of life? of suffering?Throughout the years, humanity has answered these questions with various theories.. Let's look at the question of meaning and purpose of life, and the place that suffering/death have in it. This could go anywhere, I know. But I will look at it from a theological perspective as pertains to the concept of Will of God put forth in Weatherhead's writings.
He basically says that God did not intend for these "things" to happen. That this is not the world that He created and thus this is not how we were meant to live. Is God in control now? Yes. Why doesn't He just fix it then? Wave the magic wand and make it all different...? Because that would go against the laws set forth in Creation.
In the words of another writer

Dr. Weatherhead separated God's will into three parts: 1) Intentional; 2) Circumstantial, and 3) Ultimate (ICU).

1. God's INTENTIONAL WILL is for our good. This is Adam and Eve in the Garden. When God created Adam and Eve, it was His intention that they live forever and be happy. But they sinned and were expelled from Paradise.

2. His CIRCUMSTANTIAL WILL is because of the circumstances in our lives. It is within this will that we find God's permissive will. This is Jesus in the Garden of Gethsemane. This is Job 42:2: "I know (faith) that you can do all things; no plan of yours can be thwarted."; It is the all of Romans 8:28, that glorious rod and staff of the grieving: "We know that God causes all things to work together for good to those who love God, to those who are called according to His purpose." I know (wisdom) I can (possibility) do (accomplishment) all things whatsoever He asks!

3. His ULTIMATE WILL is for His glory and our good. This is Christ's resurrection and our resurrection. It is us all in the New Earth.

The wonderful revelation as I read this book is that God's intentional will finally becomes His ultimate will, even as we go through the circumstances of our life. Dr. Weatherhead gives the example of the young man in London whose intention was to be an architect but, because the war changed his circumstances, he joined the Army. At the time this was the honorable course. The young man could not control the evil circumstances of Hitler and his desire to conquer the world, but he could control his reaction to them.

As I read the book I was comforted in the fact that nothing falls outside the circle of Divine Providence:

1) the knowledge of God embraces it;
2) His power is sovereign over it;
3) His mercy holds it creatively.

The key here is God's goodness. The parent does not will evil for his or her child; neither would a perfect God will evil for His children. At the time Dr. Weatherhead gave his talks, the people in England needed desperately to know that there was a living and loving God in spite of the horror going on. We need to understand God's will and its components before we tell the person prostrate with grief that "It's God's will." As I read this incredible treatise, I viewed us as being in God's ICU unit and God taking care of us as only He can do, no matter what our circumstances.

From reading this book by Weatherhead, it changed my thinking about "will of God." I was taught as a child that God is in control. I was also told about fairies, magic, and superheroes. I thought God was like a superhero, trying to save His doomed Creation from messing up even more of their precious existence. Irony is that God is in control but not the way we think He is... I will write more on this... (when my wedding is over!!)

Change and waiting in the "Space in Between"

There is a saying that is something to the effect "there are only 2 sure things in life; death and taxes." Or something like that... But I think there is another one that says " the only sure thing about life is change". Change is inevitable. It is a part of life. Without change, we grow bored, and unchallenged. Change is good. That's why we move the furniture, or go to another room/place. But too much change, especially all at once is not good

This involves some degree of stress. Stress is healthy, and stress is unhealthy. Depends on what kind you get, the type of personality you have and how you cope with stress. Me... I don't cope will with extreme amounts of stress. (In case you haven't noticed.) I tend to get sick. When I first got this job, I moved across the country to a new city, a new job, a new community, ... a new life. I was only here in Vancouver for 3 weeks, and I got sick. So sick that I had to stay home for the third week of my job. And every so often, when life /work got heavy.. I would get sick. A cold, the flu, strep... With all of this change and stress, I wonder if it isn't a 'grief reaction'. In the case of what I just described,I had lost my home, community, support group, security of the job that I knew, .. so that is a lot of losses.. cumulative. I have a patient who is not doing so great. He was described as being a "bit down". Well let's figure out why. He's had numerous medical issues, heart issues, stroke, fractures, and now he is told that his functioning has declined so much so that he is not allowed/able to return home to the place where he was living. I am sure that when a psychiatrist goes in and does the scale to measure depression, they will say that "yes he is depressed". Often what is missed is that is a normal part of a grief reaction, and not just that the patient needs what we call " a happy pill". Sometimes people need to be depressed. It is hard to face changes and it is harder when you don't have time to adjust to old ones before new ones are added.

Change is inevitable... and it is how you approach/handle change that counts. Well. Once again, there seems to be extreme amount of change/stress in my life. I will get married in 9 days. I will then move the rest of my stuff (futon, TV, VCR, computer, clothes and dishes) from my apartment of 3 years to a townhouse. I will learn the joys and annoyances of living with my new spouse. He will learn the joys and annoyances of living with me. I will go away on a honeymoon trip and return to a house crammed with wedding presents and freshly renovated rooms. I will return to work after 3 weeks of being away and scramble to make sense of what has gone on while I was away -- with my patients, staff and colleagues.

So I take a breath.. and I think about all the change that has occured in my short time here in Vancouver. Just this past year has been monumental with some major changes -- losses and transitions. And I remember that there is always a constant regardless of the situation. God says I AM the same, yesterday, today and tomorrow. I will never leave you nor forsake you..

I was regretting the past
And fearing the future.
Suddenly my LORD was speaking,
“My name is I AM”.

He paused.
I waited. He continued.

“When you live in the past
with its mistakes and regrets, it is hard. I am not there.
My name is not I WAS.

When you live in the future,
With its problems and fears,
it is hard. I am not there.
My name is not I WILL BE.

When you live in this moment,
it is not hard. I am here.
My name is I AM.

Helen Mallancott.

Irony is that we spend our lives waiting. Waiting for that event, this job, this illness to pass, graduation, moving to new place, .. we are always waiting for the next good thing. In the meantime, we exist in the "space in between" the good thing we had and the good thing that we want. That is what life is .. waiting for the fulfillment of God's Kingdom in our lives. Waiting til we see God at the throne on Judgement day, waiting till we begin the eternal journey of living... in the meantime, we anticipate the change that till come, obsess about the changes that did occur and that changes that are happening now. I have been waiting for this day.. my wedding day for 7 months since the engagement.. but I have anticipated it for my whole life. I hope that I have as much excitement and hope about other events to come as I continute to wait and exist in this "space in between",

Sick as a dog...

I don't deal with stress very well in case you don't realize. I am at home from work again because once again I sound like a dying frog. Add to that, the fact that it ts like 30 something degrees out. It is not easy to sleep, or pack, or clean or do anything except be sick. Sit on the couch like a bump and be sick. On a Friday. When it is bright and sunny outside. Sick at home with too many things to o and not enough energy to do them....

This is an article published in today's edition of the Vancouver Sun. It relates to my renal unit and the work that I do. It tells a bit about what the donors go through with the process of donating a kidney. There are more live donor transplants then cadaveric (deceased) donors. Relatives or friends get tired of seeing their loved one suffering through the process and pain of dialysis that they agree to be tested and give a kidney. There are often guilt issues that result with this process. It is not always a guarantee that the transplant will be successful, as you read below, and I wonder about how the persons involved feel about this. How the recipient feels, putting their hope on this transplant only to have it not work and now there are 2 people that don't have working kidneys...(the donor has given up a working kidney and now only has one), and the guilt they feel. The disappointment the recipient has, or the anger the donor might feel. Often the persons donating are family or known to each other, but it is rare that there may be an anonymous donor.

The article is talking about social justice. The fact that the government will focus on giving free drugs to addicts, but won't assist with live giving operations... Irony indeed.

Kidney donor puts job on hold to help chum
Woman could benefit from new plan that helps with costs of donating
Glenn Bohn, Vancouver Sun
Published: Thursday, July 20, 2006

Brenda Cote of Burnaby found a friend who is willing to donate the kidney that Cote desperately needs to stay alive-Jo Wright, a self-described "tough chick" who lives in the West Kootenay town of Nelson, is willing to sacrifice one of her two kidneys, but she doesn't think it's right that she should also have to foot the cost for lost wages, travel expenses and other bills. A new $300,000-a-year program announced Wednesday by the Kidney Foundation of Canada and the BC Transplant Society is aimed at helping Wright and other live donors of kidneys or livers.The three-year B.C. pilot program will compensate donors for reasonable out-of-pocket travel and accommodation costs, as well as lost wages. The two non-profit groups say the initiative makes B.C. the first jurisdiction in Canada and North America to reimburse living donors for expenses related to organ donations. A living donor faces big expenses in a pricey place like Vancouver, where all organ transplants in B.C. are performed. And the sacrifice doesn't end after the operation. Living kidney donors may have to stop working for six to eight weeks; the recovery time for liver donors is longer, usually eight to 12 weeks.Wright, who will be eligible for compensation under the new program, has already put out money for her altruistic offer, even though she hasn't gone into an operation room and doesn't yet know when that might happen."I'm putting my job on hold and raising two teenagers on my own, but I'm determined not to worry about the money and just focus on the fact that I may be able to help," Wright said during a telephone interview from Nelson. Last week, Wright went to Vancouver for the final round of tests needed to determine whether she would be a suitable donor for her friend. Wright drove to Vancouver instead of flying to save money, but estimates she's out about $500 because of costs and lost wages for the three days of work she missed. She left Nelson in the evening and drove at night, to keep the number of missed work days to a minimum."There's been a little bit of wear and tear but I'm a tough chick or I wouldn't take this on," Wright said.Then she made a pointed reference to a Vancouver medical study that offers free heroin to selected addicts: "The thing that really burned my britches is that I can go to Vancouver and get a free shot of heroin, but I can't get help to take someone off a medical dependency list."Cote, 43, had a kidney transplant in 1987 and subsequently gave birth to her daughter Erin, now 13.But she's been back on a life-saving kidney dialysis machine for several years and she needs another kidney transplant.Cote said Wright was willing to donate a kidney last November but she had just started a new job and didn't have the money at that time to go to Vancouver and take time off after the operation. "She would have come in a heartbeat, if she was able," said Cote, who has been on an official list for a transplant for two years.The Living Donor Expense Reimbursement Program was outlined Wednesday at a Vancouver news conference. Half of the $300,000 annual budget for the three-year pilot program comes from the B.C. government, through the Provincial Health Services Authority, which is matching contributions from pharmaceutical companies. The province says it expects to recoup its $150,000 contribution within five years because additional live kidney transplants should reduce dialysis costs.

gbohn@png.canwest.com- -

-The gift of life

Some facts about kidney transplants in B.C.-

The first living donor kidney transplant in B.C. occurred in 1976.- Since then, there have been 862 living donor transplants.

- Each year, there are twice as many living donor transplants as transplants from deceased donors.- Almost 300 B.C. residents are now waiting for a kidney transplant.

- Depending on blood type, the wait for a transplant from a deceased donor could be as long as eight to 10 years.

- On average, about five or six per cent of the people in need of a transplant die while they are on the waiting list.

Sources: BC Transplant Society (www.transplant.bc.ca) and Kidney Foundation of Canada (www.kidney.ca)

Things we don't like to think about until we have to .. but then it is usually too late.

I will be the first to admit guilt..that while this comes up from time to time, I do not like to think about this either. I hope that after sweetie and I are settled into married life, that when we look at the important papers, this will be one of them. Advanced Health directives or DNR orders or living wills, as people call them, are important for everyone. But no one wants to write one. It's that "what if" that no one really wants to think about... like "what if ... I had an amputation, what if I lost my job, what if my spouse left me, what if I was told I had a fatal diagnosis and there was no cure...." No one really wants to face this, until we do. It is things like a funeral, or some other story in the news that sparks our thoughts on "that which we do not wish to think about ..." . Sometimes it is easy to turn off the TV and think about something else, and at other times we can't. The Terry Schiavo case sparked great debate on a national and international level. Where I work in the hospital I see/hear horror stories of 70 or 90 year old patients brought in yet again, and because there is no health directive, they are given CPR (a procedure that can be long and actually breaks ribs..) and are intubated. "Is this what Grandma/mom wants?" To be kept alive on a respirator, and when/if she wakes up will have to go through pain and struggle through rehab. Would she want this? Maybe she does.
In the end, I think it comes down to one question. At what point, do I think that my quality of life will suffer? How much pain is too much? At what point do I stop enjoying my life?
There are different levels of intervention. i.e comfort care only, intermediate care, or full treatment. There's even different ones if you are in the community versus a facility.

So if someone does not have an advance directive, and let's say they have a bad stroke or a car accident and it doesn't look very good for the outcome, the family is often asked what to do. In ICU, this often is the case. We (medical team) aren't asking you (family) to "pull the plug". In the end, it is the medical team that determines the prognosis and the course of treatment. But if it looks good for recovery but the patient will have severe to moderate side effects/trauma, it may be that the individual would not want to live this way. Although there is nothing on paper, someone might know that this is what s/he wants. Or it may be that family are in too much shock to process what is going on. The written directive is a guide to medical team, is a way for a person to speak when they verbally aren't able to.

True, there is always a chance that things change. That the person thought one thing but when a trauma hits they change their minds. Like my lady who died in February. She was a very strong personality, but when it came down to it. She said "you know, despite what I seem to say.. I have decided that this pain is too great for me. That living this life of dialysis every other days, not sleeping in a bed because I'm in pain... I've decided enough is enough. This is no life for me." Or when you decide you would rather not be resuscitated, you may have the "near-death" experience and decide that you aren't ready to meet your Maker. It is possible, but then, isn't it still better to think about these things before you really have to.. and then it is too late?

Words we say ..

The "How are you?" question has been a challenge for my ministry. It is a question that rolls off my tongue as I am a Maritimer (Eastern Canada). We ask "Hi. how are you?" as a greeting. Sometimes, it is in passing, sometimes in concern. I was reading another blog. It brought to mind one of the first clients/residents I had in my Clinical chaplaincy training. One of my residents said to me..."do you really want to know?" I remember telling her, "of course I do, I wouldn't ask if I didn't mean it". That was a learning moment for me. To learn the value of the words we say.

Themes that surface...

Have you ever been going through your daily life and you're struck by this realization? There are themes that repeat. Subtle at first and then they yell at you in the face. I wonder about these things... is it that your journey of life, that is just what happens to surface.. what you are focused on? or is it because God says you need to learn this lesson? Have you ever had to learn a "lesson" more than once? .. because you didn't "get it" the first time. That used to happen a lot when I was younger, and I would look up at the sky and say "Sorry God. Did it again didn't I? I'll try to do better."

Well the theme that seems to come up in my work right now is family dynamics. Yesterday I listened to a woman tell me that her family doesn't care about her. They are too busy with their lives and family isn't important to them. It is hard to know what to say as there is obviously conflicting ideas of living. She is "Old World" and cooked for her family and looked after them. Doesn't understand why they don't have the same ethic. I wonder how much is that she is lonely as her husband has died and her identity was likely looking after her family, and how much is that she isn't able to let go and let her children live their lives. That is a hard thing about being a parent.. family. Letting go and letting the children live their lives and make their own mistakes.

Today, I heard another longtime client was talking about her children. One of them blames her for everything that is wrong and the other has drug problems showing up only when it is convenient or when they can get money. It is hard to throw a child out of the house, but sometimes necessary. There are also cultural issues that I wonder about as well. In every generation, we are considered a product of the generation past. You have likely heard or said "I hope I never become my parent" and then later we hear something come out of our mouth or see ourselves do something and shriek in horror.

The thing about hearing the "story" or concerns of one's family is I am only hearing one side. I don't know what the "family" experience is. I asked the second person about possible responsibility that she may have in the actions/inactions of her family. She is willing to concede some of her part of this story. The irony is that is so easy to critique when one is not involved.. but when it is YOUR family or situation, that is harder. When I heard the story yesterday, I felt guilt that I do not write to my grandparents enough, and wondered at how my family sees my function/role in the family.

It is a life-long struggle. We seek to belong and when we are secure, we seek to find our own identity away from our structured environment. That is what we do as children. We develop attachment to our parents and we are affected by the type of attachment we have. Love is an essential need for any child. A child needs to feel loved and cared for to feel secure. If they do not form attachments or felt secure, they are affected in their development This is according to Erik Erikson's theory of development. He posited that every stage is affected by the previous one. Once we have gained that security, we attempt to break from that to determine/find our own way. This is typically adolescence, early 20's. The problem is, that as parents, it is hard to watch our children make mistakes and suffer failure. We want to protect them. But sometimes we over do and the child isn't able to develop a sense of autonomy or has unhealthy dependence on the parent. It is a complex web.. and hard to balance. When to pull and when to let go. So many times, I want to tell my patients what I think they should do.. my opinion. But I can't do this due to the type of counseling we offer. We can't say as chaplains or pastoral care professionals that we think they are being idiots and we wish that they would smarten up. But we can love them and help as we are able. Sometimes we have to let them fail before they succeed. And sometimes it is easier to say what we think, then to do.

Image.. is it so important? Part 2

When I was first told that I was going to be a chaplain in a nursing home, I said No thanks. My idea of a chaplain was
that guy from MASH. No thanks, did not need to be associated with the blumbling character like him. Since moving here from the East Coast to the West Coast, I have had to deal with changes and different ideas of how things are done, but image is one thing I can't get over. It is bad enough that I have a hard time to find clothes that fit. Everything seems to be made for women that are size 0-2, which I am not. But the office places are not as business oriented as I am used to. Here, everyone is so casual. Even at church. People show up in sandals, open toe shoes, t-shirts, jeans, shorts, you name it. I have often been asked if I am one of the doctors because doctors do not tend to dress in suits as they used to. It is up to individual taste/style nowadays. It is very rare that I see a man wearing a tie at work. When I do, it is usually an older man who is likely a doctor.

When I introduce my self as chaplain, as this is the most common word/understanding, I suppose that patients aren't expecting me to look as I do. I am young, I am blond, and I don't look like a nun.


No, instead I am mistaken for medical or administrative personnel. I suppose that one would assume in a Catholic facility that one would be visited by a nun. That is if you understand the tradition. But instead
they get me and my colleagues.I tend to dress more formally. And my
patients have expectations I guess, of what a "chaplain"
should look like, act like, etc. So when I walk in the room dressed in
my usual style ..


Well they are a little surprised that this is what the chaplain, pastoral care worker looks like.. Well you know what? We are all God's people, just that there are certain expectations with certain positions. How one should act, dress or talk... we have certain expectations about what a doctor is to do, what a sales clerk is to do.. role responsibility is understood, but it is difficult sometimes to gauge as the standards change. In my line of work, it is not known what an individual's experience with organized religion has been and hence there are certain expectations about what the "religious" or "holy person" is supposed to be like. Not easy when you don't fit the mold. Some people embrace my "uniqueness" while others are wary. This still a work in progress. I am basically telling my staff and my patients that I am as God made me, and this is a good thing. God loves us as we are, but we must love and own that too. Still working on this.. but loving who I have become.

Image .. is it so important.. ? Part 1

So let's talk about image... What is a "pastoral image"? or "pastoral identity"? One definition is

Pastoral Identity - Increased self-awareness and participation in the community process of pastoral participation in the community process of pastoral identity formation through sharing of personal stories

Pastoral identity is largely wrapped up in the issue of authority. I'm not talking about the "do as I say" authority, but rather the authority given by the education or position that one holds. We given certain person authority simply on the merit of their position.. doctors, lawyers, mothers, police, teachers.. and the list goes on. The authority of that person is partly earned, and sometimes given. Nowadays, it seems that our society has little respect for various positions due to the problems with systems. Healthcare is failing, education/class room sizes are suffering, the law has good days and bad.. the same goes for the Church.

The Church or faith traditions don't seem to hold the same respect as they did in days gone by. True, change is inevitable and necessary. The Church has failed to change with the times and in some cases has been the leader in establishing change. (Unfortunately, these innovations were taken over and "owned" by other groups.) One such "innovation" or change that I heard put forth by the Church occurred in my faith based hospital. It used to be operated by nuns. It was the nuns that decided to take in and treat the patients afflicted by AIDS. It was also our hospital that took in the SARS victims as well. Taking the "untouchables". But I'm getting into a new topic.

Let me start with my first introduction to the word "pastoral identity". My first year of my Masters degree was a year of liberation for me in many ways. I was free from scrutiny of family and others who might "report" my actions to my parents. We laugh about it now, but my friends will remind me that I used to dress unbecoming of the profession to which I aspired. I believe one of my guy friends said that when he first saw me, he wondered if "that girl knew where she was. This was the seminary... and you dressed like.." like I going to the bar, or clubbing. One of my colleagues, (we went to the seminary together and later work in the same office. She spoke at my ordination and will officiate at my wedding) said it best. "You looked like a hooker." Our CPE supervisor tried for 2 years to pound into me what pastoral identity meant, and the impact that it had on my ministry. As far as I was concerned, I was still me. Why did I have to put on a false self to minister? Why couldn't I be myself and still be a minister?
Of course we know the answer to that. You can be yourself. You have to learn to censor your full thoughts.. There are some things that cannot be said or done, especially nowadays with the whole sexual harassment laws, scandals and all. ANYthing can be miscontrued and people, even the Church, get sued.

Now that I am ordained. There is even more scrutiny of my behavior. People that I work with, attend church with, people I don't even know will feel it their duty to point out my shortcomings. The fact that I am a Baptist minister working in a Catholic organization, the fact that I am in the sometimes misunderstood profession of chaplaincy, the fact that I am a woman and not allowed to call myself a Chaplain, and the fact that I am me, I don't fit the stereotypes of "what a chaplain is supposed to be like... all of these things frustrate me immensely. Some days it is hard to forget the politics and just do my work. (breathe)

There are times when I know that my presence is valued by my patients. But I sometimes wonder if they understand it all. Am I there as chaplain..Pastorall presence to them, representing God, or am I there as friend? Lines tend to blur when you do the indepth work of pastoral care/counseling. There are funny times/moments and not so fun moments;when I have to talk to people about dying, be it their loved one or their own death, when I meet patients who are entering the world of dialysis and organ failure, when I talk to the man who feels his life when end because the medical team has to amputate toes, or limbs to save their life. The irony of some of the relationships established with patients is that I am the chaplain, I bring God to their life, but often these people are not of the same faith tradition. I had a Jewish lady that was in hospital for a long time. She would get upset if I did not come at lest every second day to see her.

I had an Aboriginal woman who was an ecclecticc mix of Anglican, Buddhist and nativespiritualityy wrapped into one. When I told her that I was to be ordained as a minister in the Baptist Church, she laughed!! Belly aching, loud laugh. Everyone in the dialysis room stared at us. I was mortified!

"YOU? A minister? OH that makes me laugh." she said. "Yes I see that" I replied. "Why is that so hard to believe?" Her response was "Honey, you don't fit the bill. You don't look like one, you don't act like one, and you certainly don't TALK like one." "I can fix that if you would like." I told her. "God, no!" She gave me this look like death. "oh no," she says. "You do that, and I won't talk to you anymore. You are real, you see. Not stuffy and pretentious like some of them ministers I meet." I looked at her.. "so this is a good thing for you? that I am not what you thought a chaplain should be.." "oh yes, oh yes honey. You better believe it". She then went on to tell me of her bad experiences with the Church. I still don't know what she really thought of my ministry. I did walk with her throughout her time with us until her death earlier this year, but I will always wonder what she really thought.

In the end, I would like to pose the question. How much of the pastoral identity has to be owned and how much has to be earned?