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Pastoral care at a distance

This list was started to support a webinar presentation on providing pastoral care during a time of quarantine. It will be updated regularly. 

My premises:

  • God is in the room before I am (and when I am not). I’m joining God’s work. 
  • Our notions of “what counts” are often inaccurate. E.g. spiritual care has to come from a pastor.
  • Some of what we believe is important reflects our own needs more than the needs of people. E.g. hugging, showing up in the crisis. 
  • Human beings are built to need other human beings. But they aren’t necessarily built to need me. 
  • This challenge is new, but challenges aren’t new. 
  • Our calling is pastoral care, not political care or medical care. 
  • All will be well, but people do die. 

So what do we do to provide spiritual support? 

The secret of using technology –

  • Something is usually better than nothing
  • the richer the information the better – face-to-face video is richer than a text. 
  • the more interactive the better – which means shut up. 
  • the more responsive the better – a text at the moment of need is better than a face-to-face video three weeks later. 

General pastoral care

This is what Eugene Peterson calls “the ministry of small talk”. Maintaining regular connection with and between people.

Regular counts. Listening counts. Conversation counts. 

During this season, listen for fears before discounting them. “That Discomfort You’re Feeling is Grief.” 

“Listening is easy. When you want to walk away, you keep sitting there.” Young Sheldon

Anyone from the congregation can provide this kind of care. Offer people Caring for the well-being of seniors – a tip sheet from the HDI

Coping with anxiety in the age of COVID (Jamie Aten)

Choosing to work around the edges – Karl Vaters

Illness when you can’t walk in. 

Listening counts. Remembering and following up counts. Praying counts. Realism counts. On the phone, you can listen. With email and texts, you can follow up. In any medium, you can talk with God and include the person in the conversation. 

Don’t emphasis how much you can’t do. “I’m so sorry that I can’t give you a hug, this crazy virus, blah blah blah.” 

Instead, spend the words on understanding and conversation with God. “I bet that’s hard. Let’s ask God to meet with you.” 

Chaplains can’t go in the room, either. This CT article gives an overview of challenges and alternatives. 

Care at end of life

What you should know before you need a ventilator.

Now doctors are the ones saying goodbye

Death

The reality is that people are dying without a last chance for family to see them face to face and hand to hand. That is hard. So our challenge is listen to the pain they are expressing and respond to that fear with compassion. 

“I hope he didn’t die alone.” 
“I wanted to tell him one last time.”
“I wanted to thank her (apologize to her.” 

Listen. Acknowledge. Don’t offer cliches. Wait. 

Be proactive about going in ways you can: have someone drop off a box of tissues. Put a sign in their window. 

See the post “Funerals These Days” for a list of resources. 

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Here’s a link to all the resources from the HDI COVID-19 Conference

How To Talk With Sick, Dying, and Grieving People: When There are No Magic Words to Say Patrick Riecke.

Here’s a review of the following books which deal with end-of-life decisions from a Christian worldview. 
The Art of Dying: Living Fully into the Life to Come. Rob Moll. 
Departing in Peace: Biblical Decisionmaking at the End of Life. Bill Davis. 
Between Life and Death: A Gospel-Centered Guide to End-of-Life Medical Care. Kathryn Butler.

I’ve Seen the End of You: A Neurosurgeon’s Look at Faith, Doubt, and the Things We Think We Know. W. Lee Warren. And a review of this book. 

 

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Funerals these days.

Life – and death – continue. Having just written about how to lead funerals and memorial services – and working in the hospital – we’re getting questions about what happens to services in the current health situation. I wanted to do some writing about that, but others are creating helpful resources. Here are some of the best so far. I’ll keep updating this list.

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  • Loss in a pandemic: Supporting grievers. – this is very helpful perspective on how to offer support in a variety of ways.
  • This article to funeral directors from Alan Wolfelt, a grief expert, talks about why services matter for the process of grieving and how people can be helped as their uncertainties are addressed.
  • Also by Alan Wolfelt, “Coronavirus and the Six Needs of Mourning“points out that there is loss involved in all the changes we’re expereincing.
  • The National Funeral Directors association has these suggestions about visitations and funerals, drawing on CDC guidelines. Because of its audience, it talks about the challenges of streaming, but it’s helpful for the rest of us to know.
  • A story from the northwest suburbs of Chicago about funeral homes addressing the concerns.
  • A global perspective on funerals during the pandemic
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    What’s changed, what hasn’t – starting to think about caring for people.

    The other day Bill Rice, a digital marketing guy I know, sent a series of tweets that talk about how to respond in these moments of change and crisis and uncertainty. 

    He wrote:

    1. Write down what has actually changed. I’m always amazed how little things have to change to cause anxiety and overreaction.
    2. Write down what hasn’t changed. This is a great way to ground yourself as you write your response plan.
    3. Build a plan that first deals only with moving forward against the current reality.
    4. Don’t be overly optimistic, but consider the likely new normal. Start watching and positioning for new opportunities.  
    5. Know that it will be better, but don’t give it a deadline. Survive and let it come to you. 
      (Here’s his full post on “Thinking in Uncertain Times.“)

    It’s a great framework for thinking about offering pastoral care in times of change, like this.

    1. So, for example, as we think about helping people grieve in a time of isolation, what has actually changed about grief and the ways we help? 

    What has changed is that we can’t touch. We can’t be in the same geographic space. We can’t hand people tissues. We can’t sit silently with them in the same room. We can’t hug. We can’t make eye contact. All the typical life patterns that might help them has changed, too. People can’t put themselves in spaces that could offer comfort. 

    2. What hasn’t changed? 

    People are still facing loss. People still need tissues. People still need to be seen. Walking still helps with getting stuck in brain loops. Knowing that someone sees you can help. Having someone be quiet with you helps. Mail still is delivered. Meals can still be delivered. Videoconferencing still exists.

    3. What’s your plan given the current reality? 

    We could simply deliver a box of tissues to the house of someone who is grieving. We could use Zoom and simply sit quietly with someone because when they see you, you can be quiet together. We can walk together with someone as we keep our distance and the exercise can help the body.  

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    This isn’t a comprehensive list. It is a way to start our thinking. I’ll be doing more work with this as we keep moving. As you have insights, please add here or email to drjon@socialmediachaplain.com

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    The people behind the percentages.

    I serve at Parkview Regional Medical Center as a chaplain. In that role, all the percentages become people. For example, when a treatment has a 99% success rate, we are the ones who talk with the family members of the 1%, who went from being a risk to being a person. And now a person who left behind people who cared.

    In the middle of all the debating of what percentage and how many and who’s creating what kind of panic, those of us in healthcare will be doing our best to provide care, not for percentages, but for faces. These restrictions from our health system may feel hard. But we’re already pretty busy each shift with the regular flow of patients, people like you, people that you love. And any percentage increase because of illness that could be prevented actually means more faces that we see.

    I understand the arguments about other causes of death which we should care about, the 1000s of deaths from those. I understand them because I see them, one face at a time. I’d love to stop lots of behaviors which lead to our intensive care units and eventually to our morgue. So argue away about what we should do.

    But please remember that after all the arguments and accusations are over, there are still faces with eyes closed and faces with tears. And one health system working on restrictions intended to help us and to help you. And a team of chaplains there all the time.

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    Remember your dress pants.

    Last month, I released a book about how to lead funerals. The book was barely out and my friend Dan said, “Did you remind people to make sure they have pants?” 

    I told him that I had neglected that reminder. And then I asked him why he believed that was a necessary requirement.

    He told me his story of pants falling off a hanger, unnoticed. He told me about the puddle they landed in, about the call from his wife about the pants. 

    When it comes to leading funerals, we each have our list of things we will always check. We each have our safety net of people who care about us and for us. We each have our moments of personal misadventure. (I thought about the word “shame” or “embarrassment” or “chagrin”. But it’s not like Dan walked out on the platform without any pants.) 

    And we can each have courage. 

    Though Dan had that moment with (or without) the pants, he still leads funerals. He is on call for a couple funeral homes to lead services when there isn’t anyone else. It’s a compassionate thing to do.

    He always remembers his pants, now. He has never forgotten to care for the people who need it.

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    When you are asked to do a funeral and you aren’t sure where to start, you could ask Dan. Or you could start here: Giving a Life Meaning: How to lead funerals, memorial services, and celebrations of life is like an email from a pastoral mentor.

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    Four ways to offer clarity to families in a funeral.

    I’ve done words for a long time. I’ve talked, I’ve earned three degrees about words. I’ve been around funerals and memorial services for a long time, too. I want to give you a secret that I am constantly telling myself because I keep forgetting it.

    Here’s the secret: people forget what you say. 

    You can offer the best words, the clearest outline, the most articulate phrasing and stories and people will forget what you say.

    The only reason we remember that Dr. King talked about having a dream is because the speech is called, “I have a dream” and he says, “I have a dream” nine times in four short paragraphs, and that’s the phrase used to describe the speech for more than fifty years.[2]

    Don’t overestimate your responsibility and opportunity in the funeral service.  It isn’t our responsibility to fix anything, to calm everything. People will forget much of what we say, unless we are rude, insensitive, or thoughtless.

    But that’s not you. Because you are here, reading this book. (Giving a Life Meaning: How to lead funerals, memorial services, and celebrations of life,)

    So, how can you and I be most helpful in THIS moment in ways that help people move to the NEXT moment?

    In your closest conversations with the family, as a thread through all your conversations with the friends, as fabric for your work, offer them clarity about four things:

    Be clear about what to expect with grief.

    Tell them that it is different for everyone, that grief is our response to loss and everyone has lost a different relationship. Tell them that there will be waves–tears one minute, laughter the next. Tell them that’s how it is and that they are not wrong or bad.

    Be clear about what to expect from others.

    Tell them that some people are thoughtful and others aren’t. Tell them that people don’t understand what to do, but that they are trying. Tell them that it’s okay to ask people to step back. Tell them that people will say stupid things, and it’s because they don’t know any better. Tell them that some people will be awesome and listen and be present. Tell them it’s okay to seek those people.

    Be clear about what to expect from God.

    Tell them that God will offer comfort and presence and compassion in unexpected ways. Tell them that God will work through random conversations and strange timings with other people. Tell them that God can handle them pounding on his chest, hollering at him in the darkness.[3] Tell them that there are things we simply do not understand. Tell them that God will endure.

    Be clear about what they can expect from themselves.

    Tell them that they will be exhausted, and that’s to be expected. Tell them that they will be confused about how to feel. And that’s okay. Tell them that there isn’t a right way to grieve because no one has ever lost this person before. Tell them to breathe. Tell them that this is hard, and it’s acceptable that it hurts.

    If you say these things while looking them in the eye, they still won’t remember what you said. But they will remember that you were with them.

    And that’s really all you need to do.

    Except for the service, of course. But now that you’ve done the important work, we can go on to the hard work.

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    From the first chapter of Giving a Life Meaning: How to lead funerals, memorial services, and celebrations of life.

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    A working list for life after a difficult diagnosis.

    When you receive a hard diagnosis with a likelihood of death, people are glad to tell you what do to. They do it with intense certainty: “Do this treatment. Try this tool. Be courageous. Be strong.”

    And they do it with the best of intentions and the most anecdotal of data. “This worked for my uncle, it will certainly work for everyone. After all, what do researchers know?”

    But many of us don’t need more obligation. We’ve never been through this before and what we really need is to know the areas to consider.

    We could use a working list.

    So, with humility, I’d like to suggest a list of areas you can consider in the middle of all the chaos and uncertainty.

    I will confess, I don’t believe in jinxing. If you talk about something, that conversation won’t make it happen. And, I will confess, I do believe in God, though I also believe that belief often makes people more strident than they are helpful.

    So here are some things to consider working on, at your own pace and with your own situation.

    Work on the diagnosis and treatment.

    Ask for clarity about the diagnosis. Ask for all the treatment options. Ask for percentages and numbers (“Is this a study of one person or 5,000?”) Ask about side effects, particularly in light of what matters most to you (“Will my body get better but my brain get worse?”) And ask the questions of people who have done research and reflection.

    It helps, though it’s hard, to be more diligent than desperate. And to build allies more than adversaries.

    Work on the support system.

    Who will take care of the person who is ill? Who will take care of the caregivers? Who will take care of those taking care? This includes shoveling and mowing and rides, but this is also emotional care. And being willing to ask for help early can mean that your emotional and physical and financial resources last a little longer.

    Work on the living.

    I am often involved in conversations with people planning for difficult times by asking, “What’s a good day?” Knowing the answer to that question and then working to have as many of those as possible is life-giving. This probably includes learning to not make the diagnosis the center of every conversation. It also includes not excluding the diagnosis from every conversation. It also includes having pointless conversations about things we love. This is also a good time for conversations about faith questions a person may be themselves asking.

    Work on the details.

    If we have been meaning to get around to the insurance, the passwords, and the paperwork, now is a good time. Finishing what needs to be finished, getting rid of what doesn’t is always a healthy thing to do. Establishing power of attorney, health care representatives, insurance and retirement fund beneficiaries are all part of the details.

    Work on the remembering. 

    You know how you always wanted to drink coffee and talk with someone about what they learned while growing up? Now is the perfect time to make time. Tell stories, label pictures, find out about the weird uncle that no one talks about. It can be fun and interesting and clarifying and relaxing and restorative.

    Work on the dying.

    For many of us, at some point someone will have to make healthcare decisions for us. What do you want to be true about the decisions in treatment, in the short term, and in the long term. This include specific interventions like a ventilator, other treatments like chemo, still other contexts like hospice. Informed conversations about these hard topics are helpful. The Conversation Project has material you can use on your own.

    Not just for sick people

    True confession. In the past year I’ve been working on most of these. We’ve been doing some traveling. I’ve been taking care of paperwork. I’m trying to attend to people. Not because there is a diagnosis other than being human. I think I’m healthy. But after watching the chaos before and after expected and unexpected death for a couple hundred families in the last few years, I want to remove as much uncertainty as possible for my loved ones while I can.

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    A helpful book for some of these topics is 101 Ways to Find Meaning in Suffering. Patrick Riecke looks at things to say and do while walking through these tough situations. But the time to look at his book is early in a terminal process, not late.

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    Coming soon: How to lead funerals, memorial services, and celebrations of life.

    Nobody looks forward to leading funerals.

    But when a friend or family member asks for your help, it’s hard to say “no”.

    You can do it. Your words and actions will help family and friends give meaning to this life. And this book will help you find those words, even if you’ve never done this before. 

    Giving a Life Meaning gives you confidence in planning and leading a service by explaining the elements, emotions, and options of funerals, memorial services, and celebrations of life. 

    Written with the feel of guidance from a trusted mentor, there are answers to questions we all have about services:

    “What do I say first? Do we have an open mic for stories? How do we write eulogies? How do you build a message? How do I deal with my own tears? What do we do at the graveside? What if this is for a baby?”

    There are samples and lists throughout the book and full message samples at the end.  More resources can be downloaded at socialmediachaplain.com/servicebook 

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    Rev. Jon Swanson (PhD, University of Texas) helps people find words and perspective in really hard moments. As a hospital chaplain, he has been with families as loved ones die and struggled to discern the words to say next. As a communication scholar, writer, and mentor, he has helped other people find those words, too. And as an associate pastor, he’s been involved with many funerals.

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    This is the current draft of the back cover. The ebook is available for preorder. The paperback will be available for preorder soon. And publication day is February 28, 2020.

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    What not to say after someone dies.

    “It IS a good morning.” 

    That’s what the minister said. 

    A woman died an hour earlier. Her death was both sudden and unexpected. The family was gathered in a hospital consult room, waiting for the next steps, waiting for the minister. 

    He walked into the room, aware of the death. 

    “Good morning,” said a family member, probably a child of the woman.

    “It IS a good morning,” he answered. 

    It was probably a habit. It may be technically true, theologically true, true for many people outside this room at this moment. 

    But at this moment, in this room, it is not emotionally true. 

    Even “trained professionals” miss sometimes. Most pastors, most people outside healthcare workers and first responders don’t have much experience being so close to death so soon after death. 

    But in case you are ever in that situation, the proper response to “Good morning” is 

    1. Hi. 
    2. I’m sorry.
    3. I got here as soon as I could. 
    4. This is hard. 
    5. {a tear}
    6. Almost anything other than “It IS a good morning.” 
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    When there’s no hope of recovery, how do you recover hope?

    When there’s no hope of recovery, how do you recover hope? 

    You and I both know that question, I’m guessing.

    I wrestle with it regularly as a hospital chaplain. When I’m called to a room after Eddie hears his diagnosis. When the ambulance brings in 5-year-old Bree. When you hear that the treatment isn’t working like it used to. When the Alzheimer’s moves ahead bit by irreversible bit.

    As a neurosurgeon, Dr Lee Warren often can offer remarkable hope for recovery. He’s been looking inside brains for years, doing the work that we can’t imagine but are grateful for. But with glioblastoma multiforme, a particular kind of brain tumor, the prognosis is always grim. Eighteen months, on average, from diagnosis to death.

    So what do you say to the person in front of you with a growth that can’t be eliminated? What do you say to families who can’t believe there isn’t some kind of cure? And, if you are honest about your faith, what do you say to God?

    In I’ve Seen the End of You, Lee takes us inside his head and heart as he wrestles with these questions. It’s as if we get to see in real time how a physician, father, and follower of Jesus tests his faith, his training and his experience against each other. Which do we use to make sense of what is happening in front of us? And, by the end of the book, we are able to see one person’s well-reflected answers to the question of hope in really hard places.

    This sense of processing, of journey, is unusual and is true. This is how we live, each of us. But we don’t expect to read about it from someone who should know the answers. And yet, the best of the physicians I work with as I sit with families in difficult situations has this kind of humility. In a gift to us, Lee opens his life to us enough to understand his struggle, and for us to know that we’re not alone in ours.

    The reason I included father in that list a few sentences ago is because Lee and Lisa have to wrestle through the grief and struggle for meaning when their son, Mitch, died. Lee brings us into that journey as well.

    This isn’t an easy book to read. Which is why it’s important to read this book when we’re not in easy situations.

    Chaplains, pastors, healthcare workers, first responders, people who care for other people will all benefit from this book.

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    So here’s where in a review, you should talk about having received a copy. My disclosure is a little different. I read an early manuscript of this book a few years ago, shortly after I started being a chaplain. It helped me understand several things medically. It helped me understand the faith struggles of healthcare colleagues. And it pushed me to think beyond the diagnosis I read in the charts into thinking about the needs of the people I sit with.

    I’ve been encouraging Lee to push through this process because of how helpful this book has been to me. And in the process it’s gotten better and better.

    So yes, I’ve received a copy or two. I’ve not been pressured to make any kind of review. But I am a better chaplain because of this book.