End of Life Management- a Chaplain’s Role within an Holistic Approach

Rev Lindsay Johnstone, Chaplain at Royal Prince Alfred Hospital Sydney

 

Recently I took part in a seminar at Balmain Hospital, on end of life management, organised by Tracy Greer, Sydney Local Health District End of Life Project Officer. Two scenarios were presented and input was provided by a geriatrics medical officer, a nursing unit manager, a palliative care clinical nurse consultant, a social worker and a chaplain (myself).

 

This reflection focuses only on the chaplaincy response. A chaplain might not be aware of the interactions between a patient and the others in the medical team, and in my case this is mostly as it is.

 

The first scenario was to do with a 76 year old male, Bill, who has been offered pastoral care. He says he “never goes to church”, but it wouldn’t hurt to see someone now. His only daughter Barbara also says she “isn’t religious, but it would be good to talk”. I am asked, “Chaplain, what can you do for this family?”

 

1              First, I would enquire if they would like my support as a chaplain. If they would, then how may I help?

I would then listen and run with what they say.

In my innermost being I am at the same time listening spiritually to God, silently praying that he will help me respond appropriately to what they are saying.

 

2              While either or both are talking I shall be making some spiritual assessment as to what they are saying discerning any pastoral or spiritual concerns that they may have. Through brief discussion they may affirm or correct any impression I may share.  Here this (imaginary) circle (which I draw in the air) represents what Bill or Barbara is saying. A second circle represents what I perceive God is saying. It is wherever those circles intersect that I can operate with them.

 

3              I am there to facilitate emotional and spiritual wellness. In that process I shall not try to argue or persuade, but to be guided by how they supervise in the dialogue.

 

4              From what we know, it is possible that Bill may be thinking about eternity and accountability. He may be concerned about how God might view the key performance indicators in his life. In this case he might be in need of reconciliation or peace with God. If this is how Bill sees it all, I shall aim to help him receive spiritually, drawing on my faith understanding which focuses on what Christ has achieved for Bill by dying on the cross.

 

On the other hand, his presenting concern might be about receiving pastoral care to cope with the process of dying, or concern about how his daughter will cope with his passing.

 

Barbara may have spiritual concerns that are different to those of Bill, and I shall aim to listen for these and to respond to them. She may be seeking reassurance.

 

5              Either or both Bill and Barbara might just want me to listen and respond. Either or both may want me to pray aloud, in which case I shall check if there is some specific way in which they want me to pray. Prayer is not something I shall do to manipulate or control.

 

6              In summary – I want to listen, stay with where they want me to go, and have the freedom to take some initiative in making suggestions, whilst staying within the boundaries that they allow.

The second scenario was to do with a 70 year old female, Glenda, who is likely to die in the next week. In this case the need for a chaplain is raised after she dies, with regard to her nurse. When Glenda passes away peacefully, the nurse looking after Glenda is having emotional difficulties looking after other patients who are dying. She tells a colleague that her faith is something that usually helps. I am asked, “What can you do for the nurse and who else can the nurse speak to about bereavement issues?”

                                 

I mention that the local health district has a Bereavement Counselling Centre, and produce a brochure.

When it comes to talking with the nurse:

1              First I would enquire how the nurse would like me to help. The fact that someone else said she might like spiritual help does not necessarily mean that she wants it. She can decide if she want to give me a “contract”. If so, I want to help her to express what is on their mind.

 

2              Meanwhile, I am silently and inwardly asking the Lord to guide our discussion.

 

3              Inwardly make a spiritual assessment. Discussion may lead me to adjust this.

 

It may be that the nurse has new questions about her faith, or perhaps she is traumatised about the processes of the palliative care. She may be wrestling with exhaustion, or inappropriate guilt feelings. “Did I do enough?” “Did I do too much?”  “Did I make the right decisions?” “Am I just worn out by it all?”

 

It seems that faith may, possibly, be her issue and she may feel her faith has let her down. Does the evidence in what happened support her faith? Is faith evidence-based in Christian understanding? Does she now have a crisis over the righteousness of God, or even his existence?

 

4              In summary, listening and sensitive responses will be the key. The use of prayer cannot be presumed in advance, just because she told someone her faith usually helps. It will again depend on how the conversation goes and what she wishes.