Making Chaplaincy Work

Practical Approaches

Laurel A Burton

• Publisher: Taylor & Francis
• Year: 2014
• eBook ISBN: 9781317941033
• Edition: 1
• Topic: Social Sciences
• Subtopic: Religion
• Index: Social Sciences

With compassion and commitment, practicing chaplains draw on a wide range of professional experiences and discuss principles, themes, and guidelines that have enhanced their ministries. These practical and successful approaches are aimed at helping others face the daily professional challenges of health care chaplaincy. The issues and responsibilities of chaplaincy work with a variety of patient populations--AIDS sufferers, long-term care patients, stroke victims, and the terminally ill--are thoroughly explored.
Contributors provide creative and innovative methods of meeting the needs of hospital patients and their families as well as health care personnel, such as implementing a volunteer clergy program and establishing a surgical reporting plan.

Stroke: Its Mechanics and Dynamics in Ministry to Patients

Cecilia Baranowski, RSM

Sr. Cecilia Baranowski, Chaplain, Pastoral Care Department, St. Anne’s Hospital Corporation, 795 Middle St., Fall River, MA 02721-1798.

SUMMARY. Strokes are one of America’s major health problems. While there is progress toward prevention, the health care chaplain must understand the basic mechanics of stroke as a context for theological reflection and ministry. This article outlines the physical dynamics and effects of stroke as well as the stories of ministry to three stroke patients.

Stroke … say this word slowly and be aware of the sound it makes; be aware of any feelings that may surface in you. In the course of my ministry I have found that stroke is a word that strikes terror in the heart of a family who has just heard the physician tell them their loved one has suffered a stroke. Immediate thoughts center on mortality, on paralysis, on how much recovery to expect. And the grieving process, described by Elisabeth Kübler-Ross, begins not only for the family but also for the patient who rebels against his/her losses.

Strokes are one of our major health problems. They afflict hundreds of thousands of people every year. Yet today the outlook for stroke patients is more hopeful than ever before. Because of advances in treatment and rehabilitation, many patients are being restored to a useful life.

Progress has been made toward prevention. Often doctors can detect warning signs and symptoms and take measures to reduce the risk of a serious stroke. In some people preventive surgery can be performed.

This paper has a dual purpose. The first is to present the stoiy of three stroke patients and the theological implications of their losses. The second is to define the mechanics of stroke and its effects.

Ministry to Patients

I would like to introduce you to three people— Bill, Elsie, and Tom—who have suffered a stroke. These people are left hemiplegics, the most recent patients with whom I have had extended contact. Their names have been changed to protect their privacy. This is not only their story but also my story as I ministered and continue to minister to them. All quotes are from verbatim accounts of my visits.

Patients with a right CVA are predominant in Leader North where I work. In conversation with members of the rehab team I was informed that this was the most common type of stroke. I would have liked to include the story of a right hemiplegic but lacking such a patient to work with I was unable to do so.

Ministry to Bill

Bill is a 56-year-old married man who suffered a mild myocardial infarction on September 11, 1985. He was admitted to The Williamsport Hospital. Following his cardiac catheterization he stroked on September 27. I met him November 13 when he was admitted to the nursing home for a proposed stay of two months of rehab before returning to his home. His actual stay was two weeks for reasons which will become evident as his story unfolds.

I was particularly interested in Bill because he was, at that time, the youngest stroke patient whom I had seen. He made me aware of my own vulnerability. As we initially talked he said, “It was terrible. I just couldn’t believe it. My arm and leg were gone. There was nothing there.”

For me I could only imagine the horror of waking up one day and feeling half of my body had disappeared. The fear, the frustration, intermingled with the denial of what is, can only lead to a deep seated anger. It takes time for the patient to accept the fact that he is not okay; that there is something wrong; that he can improve with effort. The length of the depression immediately following a stroke is individualized and Bill resisted therapy for about three weeks while in the rehab program at The Williamsport Hospital. He told me, “It took a long time to realize I had to cooperate with the therapists. They couldn’t get me walking until I realized it depended on me.”

Realizing he could regain some of his independence, he became determined and made sufficient progress within the next month to be discharged to a nursing home for further rehab. His wife was determined to take him home and care for him when he was ready to go.

Bill has organic flattened affect. It was difficult to determine what emotion he was feeling as he spoke. As for his wife, she fluctuated between depression and lack of realism in the two weeks I had seen her, bursting into tears each time we spoke, torn between her desire to take him home and the realization that he was going to be more difficult to care for than she had initially realized.

Both husband and wife were in denial, desperately wanting to believe the situation would be greatly improved when Bill returned home. During one visit Bill told me, “A little movement came back to my leg. If I can just lock the brace (long leg) I will walk.” And his wife confided, “I’ll be able to get him in and out of the car okay. Then we can get out.”

He was a smoker and several times had cigarette burns on his left arm. (He had left neglect.) When questioned he would reply, “I scratched myself. That’s okay.” His wife, too, would concur with what he said even though she sat with him in the smoking room each day. Perhaps this came from the fear that he would not be discharged if the truth were known.

At times I became frustrated with the denial of both patient and wife. Everything was not okay and things would not return to normal when Bill went home. Bill will never be the man he was nor would she find it easy to live with his impulsiveness and lack of insight into his disability. On the other hand I felt sorry for Bill knowing that at home he would still be facing anger, frustration, and loneliness. It would be difficult for his wife, too, but together they had to discover this.

One week after his admission, Bill was overcome by feelings of isolation and loneliness. “It’s not fair for me to be here with all these old people. I don’t have any company. My friends won’t even come and visit me here. They did at the hospital—every night.” As we talked about the loneliness his real fears began to surface. “These old people are pathetic. No one wants to see them.”

So I tried to get him to project into the future. He became fearful of losing his control; of losing his independence; of becoming more debilitated. I asked him what he thought of when he saw all these older people around him and he sat in thoughtful silence. Then I ventured to ask him how he saw himself in 30 years. In a monotone voice he replied, “I’m never going to be like that. I’ll never give up my house. I’m not going to get old like they are.” And he sat and cried and my heart ached for him.

Concerning his feelings about being in the nursing home he said, “I have nothing to look forward to. I have nothing to do—therapy in the morning and then again in the afternoon. After that it’s just sitting.” His desperation being evident and concern for his mental health prompted the staff to draw up discharge plans and Bill went home.

Bill is a man who needs to be in control. He was a church goer until he had a difference of opinion with the pastor several years ago. Not being able to have his own way, he stopped going to church.

Organized religion was, for him, a chance to get together with his friends. He still looked to his friends for company, for support, for recreation, for affirmation. “I liked to go to church. I would meet my friends there.”

I suspect Bill has unresolved feelings about God. He has lost his independence, his sense of control, his sense of who he is. He can’t have his way. He is severely limited.

As for myself, it upset me to see such a young man so incapacitated; a young man who refused to accept the reality of his situation and was consequently unable to compensate for his losses; a young man who believed that going home would solve all his problems.

Biblically I think of Jesus being tempted in the wilderness (Matt. 4:1-10). After every great moment in life there comes a reaction. It is in the reaction we must be careful for it can make us or break us. Jesus spent 40 days in the wilderness. The devil tempted Him in His weakened condition. And in the weakened condition He was able to withstand the tempter. Jesus’s struggle with the devil was an interior one. The tempter comes through our thoughts and desires.

Bill struggles with the temptation that life as he now experiences it does not have to be, that it will get better when certain conditions will be satisfied. I see him adding more conditions as he continues to meet more frustrations. Unlike Jesus he cannot say to the tempter, “Be gone. I am who I am and will use what I have.”

Ministry to Elsie

Elsie is an 87-year-old widow who was married for 58 years and is childless. In October of 1984, while residing in Atlantic City, she suffered her first stroke and was placed in a nursing home. When she became ambulatory she returned to Williamsport to live with her sister. Upon the death of her sister she moved in with a sister-inlaw. On December 2, 1985, she stroked again.

I first met Elsie when she came to the nursing home on December 20. The left side of her mouth drooped, she had a blank look on her face; she did not converse but answered questions with a yes or no only with much encouragement. She was paralyzed, lethargic, confused, forgetful, and aphasic.

Two months after her admission she still remains paralyzed, lethargic, forgetful, confused, and aphasic. Her affect is flat and her face is expressionless. She is unaware of her deficits, has not regained any feeling on her left side, has gross left sided neglect, has a very short attention span, and is unmotivated.

Due to her deficits my ministry to her takes a different form. When visiting Elsie I sit on her right side, facing her. Even then I must sometimes shift my position slightly to get her attention. Touch is very important. It reassures the patient and establishes contact. In Elsie’s case it is my best means of communicating with her. When I have her attention I hold her hand and talk to her. Initially there was no response. Recently she has begun to squeeze my hand.

My verbal communication with her is simple. I ask questions to which she can respond with a yes or no or one word. Knowing some of her history from her chart I talk about her past. Her long-term memory has not returned. She appears to be forgetful.

She consistently tells me she is fine, has no problems, is doing well in therapy, and walks fine. When asked to let me hold her left hand she gives me the right. If I visit when she has returned from therapy she is much too tired. Her eyelids are closing; she yawns; her head droops. Yet she tells me she hasn’t done anything in therapy that tired her.

I take the time to sit with her and let her know she is not alone; that I care about her. I can only presume that she may be frightened, anxious, frustrated, lonely, discouraged. By my attentiveness I hope to bring her some comfort.

At this point in time I can not help her to struggle to find meaning for her life; to struggle with the question of why this has happened; to clarify her relationship to God. Through my ministry I try to bring her a sense of the love, the gentleness, the care, the concern, the comfort of a loving God.

Elsie reminds me of Peter denying Christ. “And the servant girl, seeing him in the light of the fire said, ‘This man was with Him.’ He denied it saying, ‘Woman, I do not know Him’” (Luke 22:56-57).

This was not the real Peter who cracked beneath the tension; the real Peter who protested his loyalty in the upper room; the real Peter who drew his sw...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• Introduction
• The Chaplain as Hospital Ethicist in the Cost Containment Struggle
• Issues in Long Term Care
• Caring for Those Who Wait: The Chaplain’s Role as a Member of a Multidisciplinary Surgical Team
• Decision-Making in the Seriously Ill: Facing Possibility and Limitation
• AIDS and Pastoral Care
• Stroke: Its Mechanics and Dynamics in Ministry to Patients
• The Use of Volunteer Community Clergy as Hospital Pastoral Care Staff