Journal of Sacred Work

Days 31-32 Radical Loving Care

"Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices." -From Building A Consensus For Compassionate Care

In an effort to create more compassionate healthcare systems, an international network of clinicians, researchers and educators (in partnership with the Fetzer Institute) are working to integrate spirituality as an essential element in whole person care.  The above definition of spirituality was developed to help guide their efforts.

The current medical model in healthcare focuses on treatment of the person’s physical ailments and while technological advances afford many lifesaving or life prolonging treatments, this focus is myopic in scope. Of equal, importance is consideration of a person’s emotional, mental and spiritual well-being.

Spirituality is about discovering what creates a sense of connection and meaning in a person’s life.  A core component of compassionate care is to listen to a person’s story and resist the need to fix. Too often we are not listening to understand but we are already thinking about how we will respond. This jumping ahead is a hindrance to real communication. When we intentionally offer our full listening presence a safe space for sharing unfolds that is a sacred.

 

Christine Pulchalsky, a renowned physician and social worker recognizes the value of investing time up front in cultivating relationships with patients and family members.  She cautions that "Unless we value the relationship between the physician and the patient, the nurse and the patient – unless we say that is of number one importance and we’re going to invest in that, we’re just going to keep going downhill.”  She also encourages inner reflection as a formative experience for clinicians to keep us grounded in remembering why we entered into a healing profession and to renew meaning and purpose in our work.

It is affirming to discover like hearted individuals who embrace the precepts of Radical Loving Care and I am grateful to Erie Chapman for his pioneering work and visionary leadership in healthcare.

Contributed by Liz Sorensen Wessel

Mandala by ~liz

To listen to a conversation with Christine Pulchalsky go to:

http://wuwm.com/post/argument-why-we-should-include-spirituality-medical-care

Days 26-30 The Right Words II - What to say to the grieving.

“The difference between the right word and the nearly right word is the difference between lightning and a lightning bug.”- Mark Twain

             It was Ash Wednesday. My friend “Dan” was driving his three children home from church.

            A deer crashed through the windshield.  Dan received minor injuries. Two of his children were fine. The third was killed.

             What can you say? Everyone wants the right words. Some do not know those words. Others say the wrong words because they have failed to follow The Platinum Rule (I previously missnamed this The Silver Rule) - What would the other person want to hear?

              Some people around Dan picked the wrong words.

             “If one more person tells me my little girl is in a better place I’m going to scream,” Dan told me. "I want her here!”

            Another example. Steve and Julie had two children. One suffered a fatal heart attack. A visitor told Steve, “Well, at least you have your other child.

             Sometimes, the best thing to say is nothing. A compassionate presence speaks volumes. Fixing food and running errands is healing.

             As with illnesses never tell the grieving daughter, "I know exactly how you feel. My father died too."

              No, you do not know how she is feeling. Her relationship with her father was different than yours. Do not assume her heart is identical.

              In my own family a relative picked the wrong words to say to me when I arrived (from out of town) too late to my father's death bed. "I'm so glad I was here when he died," he said. 

              What should you say? The Jewish tradition offers some answers through the ancient practice called "Sitting Shiva." Two of the guidelines include: 1) When you approach a grieving party say nothing. Let the aggrieved initiate comment. 2) A widow is not allowed to prepare food for seven days. The community does that.

               Other things that seem helpful include: Telling the person how your heart breaks for them. As with serious illness (another kind of loss) tell them they are in your thoughts.

               Liz Wessel sent me an excellent list of helpful and less helpful choices. Click on this link.

Download Right words from liz

               You may feel awkward about visiting a grieving friend. Show up anyway. Live Love. 

-Erie Chapman

Days 24-25 A Defining Moment

I wish that you could see what I see; the radiance of your soul. 

This afternoon a call came in from our hospital liaison nurse, she was asked to coordinate a discharge home for a 50 year old woman with cancer and complex wounds that required a wound-vac, which is very expensive equipment. The hitch, the patient is in the last phase of her life and has significant pain and symptom issues. The family wants and needs hospice care.

The dilemma is that the insurance will not pay for two agencies to care for this patient at the same time. Only one service can bill. The cost of equipment and supplies (thousands per month) is prohibitive for hospice to cover under their reimbursement. The equipment would be covered under  Home Health and we could offer the nursing expertise. We discussed a seemingly viable option for the patient to receive home health palliative care and transition to hospice when the wound-vac was no longer needed.

Our proposal was presented to the oncology case manager. However, she was adamant that the patient needed hospice today! Angrily she said, “We need to think outside the box and make this happen.” I could hear the urgency in her voice.  I asked if I could have 5 minutes and get back to her. There was a lot of pressure to make a decision, NOW. I hurried to consult my boss.

Wheels in motion, we convened a conference with the stakeholders; the hospice director, hospice manager, and home health manager, liaison nurse, my boss and me. Bottom line, we said, “Yes, we will do this!” Next, came the multiple calls and procedural challenges and that are too numerous to mention but they involved a lot of logistics as to who would be the primary service, what doctor would write orders, equipment, billing, authorization, etc. It was complicated with no easy answers and the patient was going home…tonight.

After speaking to the patient’s husband by phone the hospice manager said, “This man was so nice and he said to me, ‘please help us’ ”. It was the defining moment. There was no longer any question in the Hospice Manager’s mind, “This patient needs hospice.” Wheels churning now, schedules were rearranged. The Hospice Manager (a social worker) left the office to relieve a Hospice Nurse on assignment so she could go to the hospital immediately, admit the patient and follow her home.

At 6:30pm, after working a full day, this manager took initiative to venture out to another patient’s home to free up a nurse. I admire this caregiver’s dedication and commitment to Radical Loving Care. Throughout a tense situation she maintained good humor and a loving attitude. Her plans to leave town for the w/e would be delayed.

We all left work with the satisfaction of knowing we came through for this patient and family. We did not let the rules, regulations, barriers or the red tape of healthcare  get in the way. This woman’s wishes to go home would be honored. She will spend her last days at home surrounded by the love of her family and friends. She will have the expertise and support of the hospice team and if problems arise with the wound-vac, a home health nurse will come to the rescue.

 We did not figure out the financial part yet, the insurance verification department was closed for the day. We will figure all that mess out come Monday.

I am grateful to work with  a group of people who will sometimes break the rules and step out of the box in favor of doing the right thing. It makes all the difference in the world, especially to one woman and her family tonight.

Liz Sorensen Wessel 

Days 19-23 - The Right Words - What to say (and NOT say) to the sick

The difference between the right word and the nearly right word is the difference between lightning and a lightning bug. - Mark Twain

 
           After Judy was diagnosed with breast cancer she cried. Her tears burned a path to situational depression.

            In addition, Judy found her type of cancer embarrassing. She resolved to let people know she had it but asked family not to say what kind – simply that it was curable.

            But, after her mastectomy Judy faced encounters she later described as “worse than the depression.”

           Her first visitor plopped down on Judy’s bed & embraced her failing to notice that Judy was too fragile to have her bed jarred & too uncomfortable to be hugged. 

           The next friend also hugged her immediately bumping against Judy's still tender chest.  

           Visitor after visitor asked, “What kind of cancer is it?” When Judy mentioned she would rather not say one looked offended sputtering, “Well! I was just trying to show concern!”

           Judy said that even when her brother, who knew her diagnosis, entered the room he immediately looked down at her breasts. “I guess he was trying to figure out which one was missing,” she said.

           Well-intentioned people often worsen suffering with insensitive comments. Loving people act from love, not curiosity. 

           Long experience as a hospital CEO (& now pastor) has taught me a few of the right (& wrong) words.

The Wrong Words

          1) Do not ask the patient about their illness. Why do you need to know? Is it so you can broadcast your friend’s diagnosis?

           Similarly, do not ask the prognosis!

           The patient will tell you what they want you to know. Do not make things worse by being nosey.

           2) Do not share your stories about everyone you know that has had cancer. The patient’s experience is unique. Offer advice only with permission.

           3) Do not say, “I understand how you feel.” Even if you have had cancer, Judy’s experience is personal to her. Telling her you understand demeans her experience.

The Right Words

           What can you say? As little as possible. Your main role is to be present not to talk.

           1) The Golden Rule: Put yourself in the patient’s position. What would you like to hear? The Silver Rule: The patient may not want to hear the same things you would.

           2) Compassion Not Pity. Signal your compassion with loving presence. Pity language is, “I feel so sorry for you.” Instead, try, “This must be so hard.” Or, “I admire you & your courage.” And, best of all, “I love you.”

           3) Thoughts & Prayers? Rhonda, a breast cancer survivor told me what helped her was people saying she was in their thoughts. Praying for someone is fine if you are certain they want that.

           4) Acts: Acts are often better than words. Run errands, offer child care, bring food.

           These same suggestions work for anyone who is vulnerable. The right words from you can harm or heal.

          If you find this article helpful pass it along. 

 -Reverend Erie Chapman

Photoart - "Patient Resting" - by Erie

Days 17-18 Call Upon Mary

  "In dangers, in doubts, in difficulties, think of Mary, call upon Mary. Let not her name depart from your lips, never suffer it to leave your heart. And that you may obtain the assistance of her prayer, neglect not to walk in her footsteps. With her for guide, you shall never go astray; while invoking her, you shall never lose heart; so long as she is in your mind, you are safe from deception; while she holds your hand, you cannot fall; under her protection you have nothing to fear; if she walks before you, you shall not grow weary; if she shows you favor, you shall reach the goal."  - Saint Bernard of Clairvaux

For my grandmother Katy, the Blessed Mary was always close and she called upon her to intercede in times of need. She knew she could count on Mary. She prayed her prayers and the rosary, faithfully and one by one the answers came. Grandma’s expressed love for Mary, resonated with my mom and she passed on her love of the Blessed Mother to her children. As a meditative practice, praying the rosary offers a peace that surpasses understanding.

This Christmas, I received a special gift, a pendant with an image of Our Lady of Guadalupe. Her image rests upon my heart. She emanates an unconditional Love that connects me to the love of my mother and that of my grandmother.

Through the ages, apparitions of The Divine Mother have manifested in different parts of the world. Our Lady of Guadalupe “Lady from Heaven” appeared to Juan Diego, a Native American man at Tepeyac, Mexico in 1531. Her message was one of love and compassion and a universal promise of help and protection for all humankind.

When Mary first appeared to Juan she told him to build a chapel. Juan shared his vision with the Bishop who was not convinced and wanted a sign as proof.  Once again the Blessed Mother appeared to Juan Diego and directed him to bring the Bishop a bouquet of roses. So Juan gathered the flowers in his tilma (cloak) and returned to visit the Bishop. As he opened his tilma the flowers all fell to the floor and a beautiful image of the Blessed Mother was etched into the rough cactus fibers of the cloak.

Miraculously Mary's image has not faded in over 475 years. Interestingly, depending on where you stand her skin tones change, similar to how the feathers of a hummingbird can change color. At one angle she appears Native American and at another of European ancestry. Another fascinating point to ponder is how the majestic stars on her outer garment are aligned precisely with the night sky constellations.

There are many doors but they all lead to the One truth of unconditional love. Mary offers us a beautiful gateway to heaven.

Contributed by Liz Sorensen Wessel

 

Days 12-16 - "A Flaming Heart" - How Your Enthusiasm & Passion Change the World

   It was a typically sunny Saturday at of our California home. Seven years old, I was running around our backyard excited about something I do not even recall.

   When I stopped to take a breath, my dad spoke words that etched themselves into my heart. "Chip, I hope you never lose your enthusiasm."

   At seven, it never occurred to me that enthusiasm was something you could "lose" - something that might slip out of your pocket & slide down the drain.

   My dad was right about the risk, of course. Many times since then I have tumbled into valleys where dismay shoved enthusiasm into the shadows.

   Fortunately, my passion to accomplish something meaningful never dimmed. It was when that passion rediscovered its enthusiasm that I became an effective CEO. Dozens of staff have told me that it was the bright energy they felt from me that helped inspire them to transform Nashville's Baptist Hospital into the home of Radical Loving Care.  

   "The successful [person] has enthusiasm," President Harry Truman wrote. "Good work is never done in cold blood; heat is needed to forge anything. Every great achievement is the story of a flaming heart."

   High purpose provides the light that illuminates your caregiving. It is passion & enthusiasm that enable you to lift your work from "just a job" to your true calling.

-Erie Chapman, III

Snapshot, "Jill Rutkin & Chip" by Erie Chapman, Jr. 

Days 10-11 Within the Shelter Of Great Belonging

 

 

“The whole idea of compassion is based on a keen awareness of the interdependence of all these living beings, which are all part of one another, and all involved in one another.”- Thomas Merton 

Watch; experience, enjoy.

    

This delightful video illustrates the simple but illuminating power of human connection. What a clever way to motivate people to stretch beyond the confines of self to enjoy a moment of warmth, amid the brisk chill of a Canadian winter.

 Just a little willingness to reach out to a fellow human being in an act of trust and sparks of camaraderie ignite to warm one another’s soul. This cooperative effort creates a synergy that inspires laughter and joy.  Suddenly, the boundary between self and other dissolves into a bond of “we are in this together” versus you or me, us or them, as isolation is transformed through unity.

 A purposeful activity engages people in a common goal. When a family member becomes a caregiver to a loved one, they may find it the most difficult, yet the most meaningful experience of their life.

Similarly, when a nurse (or team member) enters the life of a patient and family in need, they may find it very challenging as well as deeply rewarding. We learn how to love from those we encounter. We learn that there is joy among sorrow, calm amidst chaos, peace in acceptance, and gratitude in caring.

 Although this video is a commercial, I love how they created an experience of connection that is light hearted and fun. Do you see the joy that emanates from their faces? I wonder how far their warmth will travel. Did you feel it?

Contributed by Liz Sorensen Wessel

Mandala by ~liz 

Days 5-9 Want Power - A Way to Become Your Best Self

   Intention can make any encounter sacred. How do you meet yourself in the mirror each morning?

   Fifteen years ago Sondra, a supervisor at Baptist Hospital, saw herself in a family photo. "When I realized how heavy I was I decided it was a sign of self disrespect."

   She choose to change. With hard work, Sondra lost forty pounds.

   "Congratulations on your will power," I told her. 

   "It is not will power. It is want power that works," she told me. "I wanted to respect the person in the mirror so I changed my lifestyle and feel so much better."

   Today, Sondra's "want power" is still succeeding. That is becasue she did not just change her eating choices. She changed her life attitude. Desire, not desserts, drives her life.    

   Will you change any one of your behaviors this year? Did you change any last year?

   Sondra's simple principle can work no matter what change you seek.

   If I think of dieting as punishment I will start thinking of the reward I deserve for suffering - and thus relapse. But if, like Sondra, I change because I want to be healthier my chance for long term success rises. 

   If I focus on not being irritable then I actually risk becoming more so.  But, if I want to live my best self then patience will naturally emerge. 

   Think of yourself as an ordinary caregiver and you become one. Create a new picture of yourself as  more loving & walk into that picture.  

   I like what Liz Wessel has suggested. Pause a moment at the threshold of each day. What are your intentions?

   At this moment, you have not changed a single lifestyle habit. Meet your own needs with love & your best self will enable the changes you seek. 

-Erie Chapman  

Days 3-4 Within The Light Of Your Eyes

Note: This essay is devoted to Doreen Chesebro & Diane Barrows, Mission Services Directors who just retired after many years of dedicated service in healthcare.

Both Diane and Doreen have exemplified for me (and others) how to nurture the sacred in our work and love in community through their reverence of human dignity and acts of compassion.

This week, I have been reflecting upon the meaning of sanctuary. Often, I have thought of sanctuary as a meditative practice in a deeply personal realm.  Images come to mind of the inner chamber of one’s heart and the Sacred Alter of one’s being in communion with the Divine.

As you enter into your own personal sanctuary, a momentary pause is helpful; for you recognize that the place you are about to enter is Holy. You may wish to set an intention as you cross the threshold. Yet, all that is necessary is an openness with attention to the rise and fall of your breath. As thoughts arise let them float away on the ebb and flow of your body’s natural movement.

We all appreciate the moments of calm that bring relief from the stressful demands of everyday life. You may enjoy the sun and wind on your face,  open fields, a walk along a winding forest path or the rhythms of the sea.

We thrive on connection and our experiences are most meaningful when shared. Yet, old hurts, communication breakdowns and patterned behaviors can leave us feeling stuck in a quagmire. When we let down the mask of our persona and risk letting the vulnerable parts of ourselves to be seen, energy  shifts. For me, sanctuary lies in being seen (not as a saint as my friends sometimes tease) but as I am AND loved despite my flaws.  Sanctuary can be found in relationship where trust is born and love restored; As Erie often extols, in the absence of fear love finds expression.

At times we contract in on ourselves and lose our sense of belonging. Sometimes just being able to name our feelings helps to  minimize the pain of isolation. We are both a mixture of light and shadow but our moments of weakness do not define us. Rather they are a part of being human and when touched by light, are drawn into it. Our inner radiance is beyond all measure; true sanctuary is found within the light of your eyes.

Spiritual teachings point to our One purpose, which is to forgive. The following is my favorite Aramaic translation of the Our Father prayer:

O Birther!  Father-Mother of the Cosmos, focus your light within us—make it useful.  Create your reign of unity now; Your one desire acts with ours, as in all light, so in all forms.  Grant what we need each day in bread and insight.  Loose the cords of mistakes binding us, as we release the strand we hold of others’ guilt.  Don’t let surface things delude us, but free us from what holds us back.  From you is born all ruling will, the power and the life to do, the song that beautifies all; from age to age it renews.  Amen.

 On her last day at work, my friend, Doreen shared this insight (paraphrased), “All that seemed so important through the years, the projects, the doing and accomplishing just pass away and what is left? What really matters is nurturing the essence at the core of our being and this happens in relationship.  This is so essential and bigger than any one person, for we cannot do anything alone. We need each other.”

Erie Chapman shared this affirmation in reference to the Journal, “I look forward to being a continuing companion and support to all those who come here for a few minutes during the week and hope this place may continue to be a sanctuary.” 

I am grateful to Erie for creating, nurturing and sustaining this space, this sanctuary and to Journal readers who receive and give this gift by going the way with us.

Thank you, Diane & Doreen for offering me the sanctuary of your friendship and love. 

Liz Sorensen Wessel

Photos by ~liz