Prison Chaplaincy

This summer I have had the wonderful privilege of being placed with the Division of Prisons through the North Carolina Department of Correction. My initial contact was through Chaplain Betty Brown, Director of Chaplaincy Services, and after hearing about my particular passions and interests in ministry, Chaplain Brown placed me at the Raleigh Correctional Center for Women (RCCW).

RCCW

Chaplaincy services at RCCW are provided by Presbyterian Prison Ministry (PPM) in a building on the prison grounds called the Hope Center for Worship and Education (donated by White Memorial Presbyterian Church in 2001). The executive director of PPM is Rev. Caroline Craig Proctor. Rev. Proctor is my direct supervisor, and I have found her to be a wise, insightful, and caring minister. My supervision time with her has been one of my favorite parts of my field education. Chaplain Nathaniel Boykin is the primary chaplain on the grounds at RCCW, and he has a deep care for the women there. He has been very generous in sharing his wisdom with me this summer and helping to make my time at the prison meaningful.

Rev. Caroline Craig Proctor


Chaplain Nathaniel Boykin and his wife, Gwen

For quite a while now, I have felt called into the ministry of chaplaincy, but until this past year, I had never considered prison chaplaincy. For whatever reason, I had not heard much about this type of ministry. And while I was attuned to the needs of the hungry, thirsty, naked, and sick people that Jesus spoke of in Matthew 25, I often overlooked the part that says "I was in prison and you visited me." What is interesting is that many of the homeless people that I met last summer during my field education with HomeStar Fellowship were people who had not successfully transitioned from prison to society. We as the church must not overlook prisoners. We must embrace and care for least of these as we would embrace and care for Jesus. I am grateful for the opportunity to explore the possibility of prison ministry being a part of my call to chaplaincy.

a much-needed distraction

Yesterday morning's sermon text was from Genesis, the story of Abraham's sacrifice of Isaac.  My supervisor preached a wonderful sermon about God not just being warm and fuzzy, but demanding and awesome. It was a convicting sermon, but I could still sense that I was letting myself get in the way too much.  I prayed during the early service, and asked God to send me a distraction, something to get my mind off of myself.  I asked God for an opportunity that would shed some light on what it means to be a true servant of Christ because I was feeling irritable and selfish. 

I was by myself in the office in between services, and a member of the church, looking confused, walked past and pointed into the office.  She was talking to someone else, and I soon saw who it was.  Into the pastor's office walked a young woman from Kryzykstan, whom I will call Nadia in this entry.  It is a Russian-speaking country close to the Chinese border.  She needed help, and so I asked her to sit down and tell me her story.

Nadia began to tell me about her journey to the United States this summer.  She and her younger sister came here to work and see the States, but they have experienced something very disheartening instead.  The woman who made their arrangements is mistreating them, so much, that Nadia and her sister feel they have to leave the Outer Banks, maybe even the country.  They were told that they would have private living arrangements for the summer.  Upon their arrival, the woman showed them what she meant by this.  Nadia and her sister have been crammed into one tiny room, with another roommate.  At night, they are kept awake as they feel bed bugs eat away at them.  They are to use this same space as their living area, and for entertainment, they have a television set that does not work.  And, it's not as if these ladies are staying for free.  They are being charged monthly for their stay.

This same woman decided that because gas prices had gone up, that she would no longer drive the girls into work anymore, that they could take a taxi.  They are living on the other side of the Wright Memorial Bridge, and working in Duck.  Taxi rides are expensive and hard to come by in this part of the country, and the bridge goes over an entire sound, not a tiny creek.  Everywhere the girls have gone for help, it seems that this woman was two steps in front of them, telling other employers that she was giving them plenty of hours and nice accommodations.  The fast food establishment across the street from the church has been letting Nadia and her sister work, in spite of their original employer's efforts.  The manager at this fast food restaurant told the girls that the woman with whom they are living has a reputation for being cruel to the exchange students who come and live with her.  Nadia met a friend, who early yesterday morning, pointed across the street at the church and told her that "they help people there."

So there Nadia was, sitting in the office, asking for a way to get to the bus station in Norfolk, VA on Wednesday morning so she and her sister could travel to New York City, and eventually, home.  She also needed a ride to Wal-Mart, to buy a temporary phone so that she would be able to contact her parents.  I knew that Duck UMC had helped other exchange students get to the bus station before, so I told Nadia that we would wait until the pastor returned to the office to work something out.  When my supervisor arrived, he was troubled by the situation and told Nadia that we would have things set up for her this (Monday) morning.  Having misunderstood Nadia, he handed her a $20 bill to help her buy a phone.  Nadia put the money back into his hand and explained that she could not honestly take his money, because it was transportation that she needed.  Stunned, he looked over at me and said, "Can you take Nadia to get her phone after the late service?"  I agreed, while years of training circled in my head, reminding me not to talk to strangers, not to be alone with them, to be suspicious of those who ask for help because they always want something more.

After the 10am service, Nadia and I departed on our journey to Wal-Mart. She bought her phone and 240 minutes for the rest of the summer so that she could contact her parents.  I asked her if she wanted to get lunch, and she mentioned that she had found a Chinese place across the street and loved eating there because it reminded her of home.  She allowed me to buy her lunch, and it really was an honor.  After a few quiet moments of eating our food, Nadia looked up at me and asked, "Why is it that people in that building are people who help others?"  Nadia had no experience of Christianity, and so we sat for awhile and talked about what it means to be a Christian, what it means to see people as human and not as cheap labor.  We drove back to the fast food place and sat in the parking lot programming her phone.  I gave her my number and told her to call me if she and her sister wanted to do something fun and relaxing for a change.

I was thrilled when Nadia gave me a call.  I also had great news.  My supervisor had agreed to let me drive Nadia and her sister to Norfolk.  We decided to go see a movie that would make us laugh.  Before the movie began, Nadia's younger sister showed me her leg that was covered in bites from the bed bugs.  I felt what some might call a righteous anger at that point.  We went for more Chinese food after the movie, and the sisters told me more about themselves.  Nadia is majoring in business administration, and her younger sister is majoring in law.  Here, they are not treated as humans because they have accents and at times, broken English.  They are called lazy for not being able to be ten places at once.  Nadia asked why I am going into ministry.  I was then able to explain what it means to be called to do something.

The sisters will be staying with me Tuesday night and then we will drive to Norfolk together.  I'm looking forward to it.  What is troubling about this situation is that I know some people think that too much help is being provided for these two girls.  Questions like, "What if every student in trouble depends on the church for help?" are being asked.  How sad.  Wouldn't it be wonderful if the church was a place to depend on?  Wouldn't it be great if the church always practiced radical hospitality?  Isn't that what we are called to do as Christians?  I am thankful for the support of my supervisor and my family in Virginia as I help Nadia and her sister.  I am even more grateful that God placed these two wonderful people in my life, so that I could be distracted--distracted from myself and my dwelling on things I cannot change.  Nadia and her sister have provided me with more than I could ever pay them back for.  Praise God.

letting God preach

Yesterday was a rough day. No personal details are coming up, so no worries. But it was rough. I was dealing with sadness, anger, betrayal, guilt...you name it. On top of everything, I had to preach at the Wednesday night service here at Duck UMC.  My text was Matthew 20:1-16, the parable of the workers in the vineyard. How appropriate.  I didn't know how I was going to preach.  So, I decided that I wouldn't.  I told God early on in the day that if He didn't preach, no one was going to hear anything.  

It was probably the best sermon that has ever come out of my mouth.  Go figure.  I had a written sermon in front of me; I had things to say just in case I needed them, and I think I probably said a lot of those things.  But I was honest.  I told the congregation that I didn't want to preach, that I was identifying with the laborers at the beginning of the day who were frustrated by the eleventh-hour workers receiving the same pay.  By the end of the sermon, God had told these people, by way of my mouth, about the beauty that is free grace. By the end of the sermon, I identified with a new character in the story, the eleventh-hour worker. And the congregation was there with me.  It was a beautiful evening, where the people gathered in that room all realized just how undeserving we are of the grace given by God, that we are all eleventh-hour workers.  And for those who didn't identify with the eleventh-hour worker, they were given a message about the joy of working for God, that doing the work of the kingdom is part of the grace received, that it is cause to rejoice.

I learned a few things yesterday.  For one, I learned a little about how to preach. Letting God do it is a great idea.  Preparation is important; I would not approach the pulpit not having carefully examined the text, but I will now always leave room for the Spirit to move.  It can say more than I could ever hope to say.  I also learned how to preach on a really difficult day.  My father is a minister, and it always baffled me that after a terrible, tragic Saturday night, he was able to preach.  I learned that having a challenging day personally was no reason to approach the pulpit as if it were a couch in a psychiatrist's office. I prayed fervently that that would not happen, and it didn't. I also learned that being vulnerable is important. Standing in front of others to preach while admitting to being a broken human being is powerful.  People respond to that kind of honesty, and I thank God for my personal trials because of that.

Time has gone by incredibly fast this summer. It is hard to believe that in five weeks, I will no longer be at this church (I am staying an extra week because I attended a UMC conference in May).  This has been a transformative time, one that I wouldn't trade for anything.

Mime Communion

This is my first blog, so before I jump into my story, I'll give a little background about my placement this year.  I am serving at Duck United Methodist Church, in the Outer Banks of North Carolina. It is a beautiful placement, right on the beach.  I haven't seen too much of the beach because I am constantly on the go here. I'm preaching at least every other week, serving as a liturgist, preparing and leading a course on Methodism, training members to lead Wesleyan Class Meetings, directing and leading music for Vacation Bible School, and working on a youth service project.  Throw in the thirty-seven dinners I'm having with members of the congregation along with regular visitation and 9-5 office hours, and there's not much time left for the beach.  It sounds like a lot, but I'm really having a fabulous time. The people here are wonderful and eager to be active in their congregation- something that seems a bit of a novelty these days in churches. This summer has already been transformative and I expect that it will only continue to be so.  

This past Sunday, The Rev. Dr. Laura Early visited Duck UMC.  She started All God's Children UMC, in Aulander, NC. She also does mime communion.  I'll make a confession, and it's the same one I made to Dr. Early- I have never liked mime communion, or clown communion, its close relative. It has always seemed a bit tacky and while I believe there is joy to be found in the Eucharist, it has always almost made a joke out of it.  Dr. Early's response surprised me. She told me that clown or mime communion, poorly done, made her want to vomit.  Well, all right. I prayed for an open mind and to not come to the service with any sort of bias against this type of communion. Dr. Early's spirit really made that quite easy.

I was not surprised to find myself completely in awe of this practice of mime communion.  There was no painted face, no silly gimmicks, no words. The story was told. The elements were consecrated. The difference was that people had to stretch their thinking, use other senses to be involved in the Eucharistic service. It was absolutely beautiful.

Did I mention that she preached? Boy, did she preach. It was so good to have a positive example of a female clergy person.  The majority of experiences I've had have been with women who were so focused on being allowed to preach, that they lost the gospel somewhere in the middle. Dr. Early never tried to defend anything about herself. She preached the gospel, and she did so dynamically and with grace.  I encourage you to check out what goes on at All God's Children UMC in Aulander. It is a beautiful ministry. I can't for the life of me find a link to the church's website, but this article pretty much sums up a few of the things that go on there: 

http://www.erskine.edu/news/early.2.2.99.html

Dr. Early's visit and one of the pastor's (Rev. Ray Wittman) recent sermons have the congregation shifting in their pews, uncomfortable with doing the same old thing, and ready for church to be a lifestyle, not just a Sunday obligation. I can't wait to see what happens!

forgiven...forgiver

A couple of weeks ago I had the opportunity to participate in Partner in Caring’s PETS program. PETS is a three-level training program that educates and prepares people who are HIV positive to be peer mentors to people who have been diagnosed with HIV. Level two and three of the program consists of a week long retreat that provides the students with information related to HIV/AIDS, other STI’s, and substance abuse, and it trains them to utilize various practical tools while mentoring.

My week at the PETS retreat proved to be a very positive experience. It was the first time that I have taken the opportunity to spend an extended period of time with people who are dealing with this illness. I can’t get over how radically open and hospitable this group of people was. There have been few occasions where I have felt such genuine community and fellowship in the midst of a diverse group of people. I felt welcomed from the start and knew it was a safe place where I could let my guard down and just love people (and do the electric slide). And that has been my challenge thus far when I’m confronted with the gracious opportunity of relationship with those who are often overlooked: to suspend all obstacles and seek to love…but not the kind of love that uses "love" to mask some kind of ulterior motive, but the kind of love that is willing to look someone in the face and embrace them for who they are, even if that might mean “suffering with” them.

Well, the week presented some unexpected opportunities for me. The moment I walked in on the first day, one of the leaders of the retreat asked me if I’d be willing to lead the “self-care” session that is part of the curriculum. I agreed, and found myself towards the end of the day trying to teach about the benefits of focused breathing and meditation.

I was asked to lead another self-care session on Thursday afternoon on the topic of forgiveness. We were a little rushed to finish the day out, so I didn’t have as much time to discuss the topic as is needed. Reading through the curriculum, I decided to try to focus the short session talking about 1) being people who are forgiven and 2) being forgivers. As I approached the session, I kept remembering the audience with which I would share: these were people who had potentially been treated as if being forgiven was impossible and being forgivers was irrelevant. I began the session discussing all the ways un-forgiveness affects us, how it becomes a weight that bogs us down and often affects all our relationships. I illustrated “forgiven and forgiver” citing an example from “my faith background.” I told them about how we often, in our time of worship, will confess our sins before God and others, and the priest/pastor will then say “In the name of Christ you are forgiven.” Then, as those who are forgiven and reconciled, we go and extend the hand of reconciliation, forgiveness, and peace to others. We are graced to be forgiven and to be forgivers. After I shared for these brief moments we concluded the session by taking a few moments to sit in silent reflection, and I encouraged each person to reflect and/or pray about being both forgiven and forgivers.

Well, as we were concluding the last day of the retreat, one of the participants asked to borrow 30 seconds of my time. I said “of course” and we went around the corner to talk. This person told me that for a long time he had been carrying around a burden because he had not been able to forgive the person who had infected him with HIV. He told me that during the session on forgiveness he had been able to forgive that person for the first time, and that consequently he felt as if a weight had been lifted from his life.

This was quite a powerful experience for me. The opportunity to talk about forgiveness in that setting was something I never could have planned or sufficiently completed. In light of this opportunity as well as a few others that randomly occurred throughout the week, I really felt as if the Spirit was at work and had graced me to participate in that work. It was one of those opportunities that wouldn’t have happened without the Spirit and one of those circumstances where I found myself saying “If You don’t show up in the midst of all this, I will certainly mess something up.” I’m scared of such opportunities and circumstances but I guess they are what I should pray for.

"Tuesdays With Morrie"

Over the weekend I picked up a book I had heard I should read and I now recommend it to others, Tuesdays with Morrie, because I think it does a good job at showing the journey for one man as he approaches death, but is a very short read.  In reading Final Gifts and how what is truly important to a person is what becomes the focus for them as the approach the end of their life.  It has really gotten me to start thinking about what is truly important in my life and how I choose to give my time and energy.  Many of us have heard, and even used, the cliches about living life to the fullest, and "live like there's no tomorrow," but I wonder how much we take that to heart and transform our lives if we really were going to die tomorrow?  What would we do differently?  What would we spend our time doing?  Who would we spend it with?  Is there someone I need to reconcile with to die peacefully?  I think we take our lives for granted thinking we have all the time in the world, and we get caught up spending our time and energy on things that aren't that important to us.  In my exposure to hospice work there is talk about how, although someone may be in hospice care and thus facing the end of their life in a real way, their life is not over yet, they are not just a "dying person," but a life with a very beautiful gift, the gift of time.  Because they are becoming more aware of their own mortality and the end of life the things that are the most important to them become more aware and the important things can fade into the distance.  They have the gift of time to do what they need to do and say what they need to say to die peacefully.  Some never have this chance due to a sudden tragedy, so might we learn from those living our their final days as to what is really important in our life so that we might not wait until we don't have the opportunity anymore to say or do what we need to do.

I offer some passages from Tuesdays with Morrie that struck me...

~ "The most important thing in life is learn how to give out love, and to let it come in."

~ "It's horrible to watch my body slowly wilt away to nothing.  But it's also wonderful because of all the time I get to say good-bye."  He smiled.  "Not everyone is so lucky."

~ The first time I saw Morrie on "Nighttime," I wondered what regrets he had once he knew his death was imminent... he nodded, "It's what everyone worries about, isn't it?  What if today were my last day on earth?"... "Mitch," he said, "the culture doesn't encourage you to think about such things until you're about to die.  We're so wrapped up with egotistical things, careet, family, having enough money, meeting the mortgage, getting a new car, fixing the radiator when it breaks - we're so involved in trillions of little acts just to keep going.  So we don't get into the habit of standing back and looking at our lives and saying, Is this all I want?  Is something missing?"

~ "Everyone knows they're going to die," he said again, "but nobody believes it.  If we did, we would do things differently."

So we kid ourselves about death, I said.

"Yes.  But there's a better approach.  To know you're going to die, and to be prepared for it at any time.  That's better.  That way you can actually be more involved in your life while you're living."

~ "I believe in being fully present," Morrie said.  "That means you should be with the person you're with.  When I'm talking to you now, Mitch, I try to keep focused only on what is going on between us.  I am not thinking about something we said last week.  I am not thinking of what's coming up this Friday.  I am not thinking about doing another Koppel show, or about what medications I'm taking.  "I'm talking to you.  I'm thinking about you."

~ "In the beginning of life, when we are infants, we need others to survive, right?  And at the end of life, when you get like me, you need others to survive, right?"  His voiced dropped to a whisper.  "But here's the secret: in between, we need others as well."

~ "As long as we can love each other, and remember the feeling of love we had, we can die without every really going away.  All the love you created is still there.  All the memories are still there.  You live on - in the hearts of everyone you have touched and nurtured while you were here."  His voice was raspy, which usually meant he needed to stop for a while.  I placed the plant back on the ledge and went to shut off the tape recorder.  This is the last sentence Morrie got out before I did: "Death ends a life, not a relationship."

"A Hard Day"

"I'm having a hard day..."

This afternoon I visited with one of my patients, Peter* (as mentioned in an earlier post) and the first thing he told me when I asked how he was going was, "I'm having a hard day."  This was my second time seeing Peter*, but my first time going to see one of my patients by myself.  I had been looking forward to seeing him because the last visit with him was so special and touching, but as I entered the facility and made my way through the building to the elevator I felt some anxiety about this visit.  Peter* had been in isolation contact on my first visit so I wondered if that was still the case where I would have to wear gloves and a gown to enter his room for my own protection, the gloves and gown being a physical barrier between myself and Peter* that disturbed me on my previous visit.  It had really disturbed me having to wear gloves and a gown to enter his room because I worried that he was already feeling isolated by living in a facility and not being able to see his family as often as he liked.  The physical interaction he seem to so desire and could have with me, to hold my hand, was suddenly interrupted by the sterile latex gloves covering my hand, again not for his protection, but for my own.

While Peter* did not remember my name from my first visit, and again struggled with understanding how to say "Denise" he did recognize my face and thanked me for coming by to see him.  I felt as if he was quite frustrated during our visit by his comments of it being "a hard day" and there was "a lot going on."  As I asked him questions and tried my best to simply be present to him to listen to anything he wanted to say or talk about I grew sad at seeing how frustrated he was becoming with trying to answer my questions and share things with me.  Peter* would begin to respond, saying a few, and then stumble on his words as if his mouth would just not say the word he wanted to say so badly.  He would try a few more times and then say "I'm going to try it one more time," and unfortunately he would still struggle to finish the sentence he wanted to say to me.  I wanted desperately to hear what he was trying so hard to say, and I could see great frustration as his blue eyes penetrated mine.  He kept apologizing to me that he wasn't doing a good job explaining himself or taking care of himself.   I was saddened to see this was happening more now than my visit a couple weeks ago. 

With sitting in volunteer training and reading Final Gifts (for the second time) as part of my placement I have begun to see how those that near life's end go through a lot as sickness and disease cause them to begin facing their own mortality, something most of us try our hardest not to think about, begin grieving various loses (ie, jobs, health, physical ability, control, ability to do things they once enjoyed, and ability to take care of their basic needs), and it is "hard work."  I'm not sure any of us can ever completely realize how hard that work might be and other hard work that may be going on internally that as "observers" we're not even aware of.  Near the end of my visit with Peter* he told me "I'm full" but was unable to say any more about what he meant by that.  I was given the privilege again to be in prayer with him as I offered some words of intercession to God for him, and Peter* surprised me by adding his own prayer after mine.  We talked for a few more minutes and suddenly Peter* squeezed my hand tighter and began to pray to God again.  I'm not sure what prompted his need to pray again while I was there, but I felt privileged to be part of that intimate moment with him as the words of his second prayer seem to show a small change within him that he felt more assured of God's power and presence, and asked for strength from the Holy Spirit.  

I left soon after the second prayer because he seemed to be tired from my visit with him, although he did not want me to go.  He thanked me several times for coming and said that he would see me later.  I did not want to leave because he seemed to desire human interaction and a simple touch of holding his hand, and I do hope to see him again soon and that communication in our next visit would be easier for him the next time.

(*name has been changed for confidentiality)

hard love

Loving people is hard work. Even loving your friends at times is hard work. But I think God calls us to love people as He loves us. In knowing myself it must be hard for God to love me at times with the crazy stuff I do, except that God chooses to love us unconditionally even as we continually fail to love God back unconditionally. Because we are called to love all people, God's people, we in turn allow ourselves to become vulnerable with people when we love, which at times results in being hurt.

I received a call on Saturday from my mom during which she let me know that Drew had passed away. Drew had worked in the same office as my mom for many years, and so when I worked there various summers I also got to know Drew a bit. Over the past year to year and a half Drew was diagnosed with cancer and began the hard fight of battling cancer. He had to discontinue work, but from what I hear attempted to maintain as much normality of life as possible until the end, doing the things he had been doing as much as he was able. Since my mom found out for certain about his diagnosis we have been praying for him, and so it is hard to hear that he has passed away. Drew had such a sweet, quiet and gentle spirit about him that just radiated from him. Our prayers continue for his wife Sandy, and the rest of his family and friends as they mourn his passing.

But it is hard to know someone, love them and lose them, and so how do you remain joyful in the midst of so much suffering and pain? How do we continue to find and see the beauty in life when we are surrounded by so much pain, disease and death?

On Thursday of last week I got to see the In-patient Care Facility (ICF) for Duke Hospice out in Hillsborough and spend some time with another chaplain, Rachel. While I was out there Rachel took me by to visit a patient, Lazarus*. During our visit with Lazarus* he commented about how "everything was hard" and "if you can't trust God who can you trust?" Over and over again I've been amazed at the openness of the patients I have met. His comment about how "everything is hard" triggered my memory from hospice volunteer training about how those near the end of life describe it as a hard process. We are not entirely sure what that means or what exactly they are referring to, but that nearing the end of your life can be hard work. Rachel and I stayed with Lazarus a little while longer and offered to read him some Psalms. When asked if there were any in particular that he would like us to read he said "anything you want to read" as if he cared more about our just being present with him, than what we were doing. As I read to him Psalm 91 he laid still and closed his eyes as if to take in every word. Rachel offered a prayer with him before we left and he thanked us for visiting with him.

Upon checking work voicemail a message had been left that Lazarus* had passed away last night. Although I had only met him a few days prior and spent maybe a half and hour with him it is still hard to hear that he had passed. As a chaplain we offer compassionate caring for patients and being part of hospice we know that our patients are coming close to the end of their life, but it is hard to not be affected by the death of any patient you meet. How do we faithfully follow God's instructions to love people? I am reminded of one of my favorite quotes from CS Lewis:

"There is no safe investment. To love at all is to be vulnerable. Love anything and your heart will be wrung and possibly broken. If you want to make sure of keeping it intact you must give it to no one, not even an animal. Wrap it carefully round with hobbies and little luxuries; avoid all entanglements; lock it up safe in the casket or coffin of your selfishness. But in that casket -- safe, dark, motionless, airless -- it will change. It will not be broken; it will become unbreakable, impenetrable, irredeemable. The alternative to tragedy, or at least to the risk of tragedy, is damnation. The only place outside of Heaven where you can be perfectly safe from all the dangers and perturbations of love is Hell."

The call to love people is a call to be vulnerable because when we love we open ourselves up to being hurt, but we must continue loving while we are on earth and we look forward to Heaven where our love will be perfected and there will be no more sorrow and no more tears. "Death will be no more; mourning and crying and pain will be no more, for the first things have passed away" (Rev. 21:4b NRSV).

As a hospice chaplain we love people through offering presence and providing their spiritual care and needs, so I think it only natural that you would be affected by their death. As a hospice chaplain how do we continue on in hope in the midst of people facing the end of their life? And how do we find the beauty in life with those suffering from terminal illness and disease? I'm still struggling with those questions because I believe there is beauty and God's presence in the midst of suffering and death, even though it may be hard to see. I can say from two weeks of field ed that is has been beautiful to spend time with people who are suffering offering presence to be with them, and journey with them a bit in their suffering. This isn't to say suffering is beautiful, because it most definitely is not, but I am saying in the midst of journeying with someone suffering there is something beautiful about opening up to one another even in a mere 30 min visit. It is beautiful for one to be present with someone dying, being present for the patient despite your insecurities about what to say and anxiety about seeing someone suffer from a disease because you want to help them live well even if they are facing death. It is also beautiful see someone dying in being allowed to enter sacred space of being with them in their possibly final hours and days of living, and to share with you about their life, what they are experiencing, or anything! It is truly a privilege to be invited into such an intimate time and moment with them, but it is also hard love for those of us who remain.

(* names have been changed for confidentiality)

agency vs. parish placement

My previous two summer field ed placements have been parish placements in rural towns of North Carolina, so this summer is the first time I have served in an agency placement outside of the church since I worked with Confrontation Point Ministries (Crossville, TN) during undergrad. Going into this summer I can say that I have definitely felt called to and led to serve in this area of ministry to those who face terminal illness and the end of their life due to my involvement of working at ICEOL this past school year which led to a growing desire to be ministry to/with the sick in a hands-on way. The part of ministry I missed over the past school year working with ICEOL was that my time was spent in an office where my work affected the training of doctors, nurses, social workers, chaplains, ect who would in turn work with the sick, but not getting to be with sick myself, not getting to hear their stories, hold their hand and journey with them. I was very excited that my field ed placement for the summer worked out so that I could continue my work with ICEOL, but also that a majority of my time would be with Duke Hospice (on the front lines, so to say) journeying and being with people.

As I sat in field ed orientation, watching my friends and classmates get pumped for their parish field ed placements (I'd say over 90% of students are in parish placements), I began to wonder if I would miss being in a parish placement this summer, as I had the previous two summers. Would I miss preaching? Would I miss leading worship? Would I miss assisting with communion? Would I miss being involved with ordering the life of the church? These questions began to swarm around my head as I sat in Goodson Chapel for orientation and carried with me as I prepared for my own field ed placement. Since I first identified God's calling on my life for ministry I come back to the question of parish ministry time and time again, and over and over again I have "decided," possibly convincing myself, that God is not calling me to parish ministry, to pastor a church. Why does this question continue to surface time and time again so that I have to wonder if I really am running away from parish ministry.

It is amazing how God really does talk to us when we take time to listen, and by listen I mean really listening. I am still struck at how although I consider myself more comfortable with silence than most that I still do a good job of filling my life with noise and distraction leaving little to no time of real silence for meditation and reflection. I recall my time with CP and going caving where we got to the devo spot deep in the cave, sat in a circle, turned out our lights and sat in silence. The ringing in our ears showed us how weird it was to have the absence of noise, noises we pay little attention to but saturate our lives, and it seemed almost as if our ears were straining to hear some noise because they were so used to being bombarded. The first week of field ed I spent a lot of time alone because my roommate is gone for her summer placement and many of my friends from school are dispersed across the country (and world) or were out of town, so I was left to actually face my own thoughts and questions.

I think I am realizing how much I miss being in a parish placement this summer, and while I do feel called to be in the placement I am this summer, that my heart may in fact be for parish ministry. One evening that first week I was struck clearly as to the reason if I am in fact running away from being a pastor. It is simply because I am scared. Being the pastor of a church is scary, especially as a young single female pastor. I catch myself every so often desiring to live in a rural area and my heart is definitely for the smaller churches (no mega churches for me please!) and while pastoring a small rural church doesn't sound very exciting for some it sounds like a wonderful life to me (despite the many challenges). This passion for the rural church is a major part of the reason for my transfer in membership to the Western North Carolina Conference of the UMC. Obviously these are questions I will probably continue to discern for the rest of the summer, and even for my lifetime, but I do hope and pray God will continue to shed light upon my questions as to where He will lead me next. I covet your prayers as I discern a calling to parish ministry following graduation from seminary.

What is Hospice???

I realized that some may know little or nothing about what hospice care is and so I've decided to post some general info about hospice to educate folks about hospice, and possibly dispel any misconceptions floating around about hospice.  I think hospice is pretty amazing and not sure why people would not want to "take advantage" of this great care which is available.

The following is some brief information about hospice found on theDuke Hospice website:

What do we do?

At Duke Hospice, our goal is to help patients and their caregivers face the end of life with comfort, dignity, and compassion.

Duke Hospice provides palliative care to meet the physical, emotional and spiritual needs of our patients and their loved ones. We provide care in patients' homes, nursing homes, assisted living facilities, hospitals, and our hospice inpatient facility in Hillsborough.  Duke Hospice is JCAHO accredited. 

What is Palliative Care?

Palliative care specializes in managing the symptoms associated with a terminal illness - physically, emotionally and spiritually. Patients are given comfort oriented care rather than curative care. 

Our Services

Terminal illness can be exhausting for both patients and caregivers alike. The demands may simply be too great for loved ones to manage alone. Our interdisciplinary team ensures that all patient and family needs are met.

Nurses

Our Registered Nurses and Licensed Practical Nurses provide direct patient care and collaborate with the interdisciplinary team to ensure symptoms are managed effectively. 

Social Workers

Our social workers will assess the psychosocial needs of the patients and their loved ones to ensure that their needs are met.  They can also provide assistance with locating community services and resources that appropriatly meet their needs. 

Chaplains

Our chaplains are available, upon request, to assess patient and family spiritual needs.  They can also coordinate with local clergy to provide support for patients, families and the community.

Nursing Assistants

Our Nursing Assistants provide personal care assistance and support for patients and their families. 

Volunteers

Provide a broad range of services to meet patient and family needs.  Volunteers provide a caring presence to patients and emotional and practical support for families and caregivers.

Bereavement Counselors

Support family members/caregivers up to one year following a patient's death.  Our Bereavement Counselors provide both group and individual counseling for family members and friends.

Additional Services

• 24 hour on-call RN, Social Worker and Chaplain
  
• Medical consultations with Hospice Medical Director
  
• Medical supplies and durable medical equipment related to the terminal illness
  
• Medications related to the terminal illness
  
• Therapy consultations by Dietary, Physical, Occupational or Speech Language Therapists
  

The following are some FAQs hospice, also found on the Duke Hospice website:

What is Hospice?

Hospice care addresses the physical, emotional and spiritual pain of terminally ill persons and their family members. Hospice focuses on "palliative" measures (comfort-oriented measures as opposed to cure-oriented measures) to enhance the quality of life, for both patient and family, during their remaining time. A key focus in Hospice care is to keep the patient in familiar and comfortable surroundings. Managing symptoms in a home environment (whether "home" means their personal home or a facility) avoids lengthy hospitalizations and serves to make Hospice a more cost-effective alternative to unnecessary, and often expensive, interventions.

Hospice incorporates the patient's family into the unit of care. Their psychosocial needs, as well as those of the patient's are addressed by social workers. Hospice chaplains are also available to address spiritual issues or concerns. Bereavement professionals have contact with the family to guide them through the difficult transition that accompanies the death of the loved one. Volunteers expand Hospice services in a variety of ways, such as providing respite to patient family members or running errands for the family. In addition, the presence of volunteers is a mandated Medicare standard wherein five percent of the total annual patient care hours are volunteer hours.

Is Hospice like home health?

Well, yes and no. . ."yes" in the respect that home Hospice care, like home health care, focuses on caring for the patient at home. Also "yes" in the respect that both are cost-effective alternatives through their decrease in or elimination of costly hospital stays. But, there are more differences than similarities.

The primary difference is that home health care is largely focused on rehabilitative care, while Hospice is appropriate only for those with limited life expectancies. Hospice also specializes in controlling the pain and symptoms unique to terminal illnesses. Over the years, Hospice methods of pain control and symptom management have come into their own as a specialized body of knowledge. Hospice considers the entire family, not just the patient as the "unit of care."

Where does the idea of Hospice care come from?

The modern concept of Hospice care began with a young woman named Cicely Saunders who, as a clinical aide, became very close to a gentleman for whom she was caring. As the man's condition progressed, they had many conversations concerning the needs of a dying person. They discussed the need to address pain on all levels -- physical, emotional and spiritual -- and how by doing so, the quality of life would be enhanced for those with limited life expectancies. When the gentleman died, he left Cicely Saunders a portion of his estate to carry out their ideas. Cicely Saunders used the money to complete medical school, knowing she would never have the credibility to advance their Hospice concept as a lay person. Dame Cicely Saunders began the first modern-day Hospice, St. Christopher's, in London in 1967.

"Hospice," incidentally, comes from the same Latin root from which words such as "hotel," "hostel" and "hospital" are also derived. During medieval times, a Hospice was a place of shelter for travelers. The idea remains in the modern use of the word - "Hospice" as a place of shelter for those journeying through the final months, weeks and days of their lives.

Is Hospice a sort of Kervorkian-type thing?

No, Hospice neither hastens nor postpones death. The National Hospice and Palliative Care Organization has responded officially to issues surrounding the Jack Kervorkian case in particular and physician-assisted suicide, in general. Hospice care is designed to control pain and symptoms associated with terminal illness, neither prolonging life nor hastening death. In this way the degree of suffering which might prompt some to consider assisted suicide would be lessened. The time patient and family spend together in the patient's last days can be a very positive experience.

Hospice is about choice and maintaining quality of life in the face of death. When looking at the issue of physician-assisted suicide, the issues are far from black and white. While recognizing this issue in present day thought, we maintain that good Hospice care controls the suffering of a large percentage of those who might opt for suicide to end or avoid pain. Even so, many people remain unaware of Hospice care and how Hospice can help.

Is Hospice just for cancer patients?

No, Hospice care is appropriate for anyone facing a limited life expectancy. Approximately half of people on Hospice are dying from illnesses such as emphysema, cardio-pulmonary problems, Alzheimer's disease, and other system disorders.

How is a person referred to Hospice?

Referrals to Hospice come from a variety of places: the patient's physician, discharge planners at hospitals (in consultation with the patient's attending physician), nursing homes, family members, friends, members of the person's church, co-workers, home health agencies. All a person has to do to make a referral is to call our office, with the prospective patient's permission. Hospice will contact the referred person's physician to see if in fact they have a terminal prognosis. (Hospice cannot contact the patient's physician without the express approval of the patient.) Only then is the family contacted to explain the Hospice program and asked if they are interested in our assistance. If so, an assessment visit is arranged, at which time, if appropriate, the person may elect to be admitted.

Who is eligible?

As a Medicare/Medicaid provider, Duke Hospice is subject to guidelines for admission which require: 1) the patient has a prognosis of 6 months or less IF the disease runs its normal course, and the physician confirms that prognosis: 2) the patient, patient's family and the physician agree upon a non-aggressive course of treatment. In other words, there has been agreement that curative measures be ended and comfort-oriented treatment becomes the focus of care.

Hospice evaluates each referral for its "appropriateness." Hospice does not provide 24-hour in-home care, but does have nurses on-call twenty-four hours a day. Hospice social workers can help arrange 24-hour care through hired nurses’ aides or similar contract personnel. It is not mandatory that a patient have a primary caregiver, but this factor along with the patient's physical condition and support system, is taken into consideration at time of admission. When remaining at home is no longer feasible for a patient without a primary caregiver, arrangements can be made to admit the patient to one of many local care facilities with which Hospice works.

If you sign on with Hospice, do you give up your own physician?

No. The intent of the Hospice program is to help the physician with care at the end of life. The doctor is notified of patient status changes, and is involved in the care plan. Patients may make visits to their doctor's office or clinic if needed.

Do physicians get paid if their patients become Hospice patients?

Physicians are reimbursed for office visits as usual. Time spent on the phone in consultation with Hospice staff concerning status or prescription changes may also be billed to Medicare. The doctor is responsible for billing that time to Medicare.

Why do you have a Hospice program for nursing homes?

Nursing homes are no longer places where "old folks go to die." Many focus on rehabilitative care and nursing home staff are not always familiar with terminal/palliative care needed by residents with limited life expectancies who choose this approach to care. The Duke HomeCare & Hospice's PARTners (Palliative Care in Alternative Residences) Program allows people who call a long-term care facility "home" to receive the benefits of Hospice care and avoid relocation to hospitals. Our staff works with nursing home staff on issues of death, dying and bereavement so that they, as the primary care givers for their residents, can offer care for terminally ill residents.

How many people do you serve a year?

During 2006-2007, Duke Hospice served 865 terminally ill persons.

How is Hospice funded?

Approximately 85% of our Hospice receipts come from patient care reimbursement, including Medicare, Medicaid, private insurance, State Employees Health plan and patient fees. The remaining 15% comes from community support.

How do you raise money from the community?

Hospice receives many donations in memory of Hospice patients. The Duke HomeCare & Hospice (DHCH) development office is responsible for additional fund raising. They accomplish this through direct mail campaigns, the Service of Endearment Program and other person-to-person fundraising events, including the annual Oh, What A Night gala.

When I give a donation, where does the money go?

Donations to Duke Hospice are used exclusively by DHCH for hospice and help provide care to Hospice patients in our area who are uninsured and underinsured. Such contributions are critical to our mission that no one ever be turned away from hospice because of an inability to pay.

Does Hospice provide bereavement support only to family members of Hospice patients or are there programs for the public as well?

Hospice offers support to the families of Hospice patients for a year following the death of their loved one. Bereavement Counselors are in touch to evaluate the survivor's grief process, and to direct them to additional counseling if they experience complicated grieving. Bereavement Services are offered to the community at-large as well as to Hospice families throughUnicorn Bereavement Center in Hillsborough.

What is Camp ReLEAF?

Camp ReLEAF is a bereavement camp for children in grades 1-8 who have experienced the death of a family member or friend. The camp is designed to allow kids to express their feelings about the loss, and meet peers who have endured similar experiences. Camp ReLEAF has been held by Hospice for the last ten years and is not limited to children of hospice patients.

Does Hospice use volunteers?

Volunteers serve Hospice by working with patients and families, working in the office, helping with special events or other fund raising efforts, manning booths at health fairs and speaking on the behalf of Hospice. Volunteers are needed in every department of the agency in addition to those who train to serve patients.

How do I become a volunteer?

By calling the Volunteer Supervisor for information. Volunteer training classes are held several times a year for those who wish to volunteer with patients and their families. Office volunteers and others do not need to go through patient care training (although it is still very informative).

Why does Hospice need an Inpatient Care Facility?

Hospice at The Meadowlands provides service to individuals in need of acute care. In recent years, what Hospice has been asked to do is provide intensive physical, emotional and spiritual interventions for dying patients and their families during an increasingly limited time between admission to Hospice and death. Hospice service is most intense during the first two weeks of admission and the last two weeks of life. Additional patient care costs include expenses for medication and equipment supply. Initial nursing, social work, and chaplain visits require thorough assessment as well as documentation processes for patient data initialization. The Inpatient Care Facility is devoted to patients in need of symptom management that cannot be handled at home, i.e. when death is imminent and the patient and/or caregiver is unable to cope at home or if there is the need for complex patient and/or family instruction to prepare for transfer from the hospital to the patient's home. The facility at The Meadowlands is a cost-saving alternative to admitting the acute patient to the hospital. Thus, service at the Inpatient Care Facility is geared for shorter rather than extended lengths of stay.

Where is the Inpatient Care Facility?

Hospice at The Meadowlands is on an 11-acre tract near the Sportsplex in Hillsborough. A century-old farmhouse currently stands on the property, and has been renovated to serve as the Unicorn Bereavement Center. The six-bed Inpatient Care Facility is located directly behind the old home and admitted its first patient in April, 1996. Volunteers play a key part in the services offered by the Inpatient Care Facility.

The new Durham Inpatient Care Facility will be build beside of the historic Teer Home on Roxboro Road.  It will be centrally located in Durham County, and on the DATA bus line to allow more patients and families the opportunity to take advantage of the benefits of inpatient hospice care. 

Partners in Caring - Kevin's first blog

Well, this is my first venture into the world of blogging. I'm Kevin Todd and am an M.Div student entering into my final round at DDS. This summer I’ve received a placement at an agency called Partners in Caring. Here’s a brief description of the organization taken from its webpage:
Partners In Caring (PIC) is a grant-funded component of the Duke University Medical Center Pastoral Services Department and the Duke University AIDS Research and Treatment Center (DART). It was initiated to bring an end to the personal and spiritual isolation experienced by people living with HIV/AIDS (PLWHA), their families, and their friends, particularly in rural North Carolina.

Partners in Caring has a variety of programs through which it serves those living with HIV/AIDS. If you’d like to check out some more information about Partners and Caring and its programs see www.dukehealth.org/Services/partners_in_caring.

My first week at PIC I was glad to find out that I had some time to read up on HIV/AIDS. Artie, my supervisor, provided a few quality resources that helped me establish a foundational understanding of the disease and some of its social factors and statistics. Some of the statistics are pretty staggering:

North Carolina stats
Statewide: Since 1983 there have been 32,582 reported cases of HIV/AIDS in North Carolina. Currently there are 21,593 known cases of people living with HIV/AIDS in NC.*
Durham: Durham is listed as having the fifth highest amount of HIV disease cases out of all the counties in NC; there are 1,240 people that are known to be living with HIV/AIDS in Durham county.* (These and other stats can be found at: www.ncpublichealth.com)

*Note that these are known cases; estimated figures account for the fact that around 25% of people living with HIV/AIDS do not know they are infected. (www.cdc.gov/hiv)

US stats:
At the end of 2003 there was an estimate of 1 to over 1.1 million people living with HIV/AIDS. And as of 2006, the cumulative estimated number of deaths of people with AIDS in the US was 565,927. (www.cdc.gov/hiv)

International stats:
At the end of 2007, it was estimated by UNAIDS that there were 33.2 million people infected with HIV worldwide. On a global scale, everyday almost 6800 people are infected with HIV and nearly 5700 die from HIV related illnesses. (More global statistics and information can be found at www.UNAIDs.org)

It is quite evident that there is a great need in the area of HIV/AIDS; it is a need that calls us to work toward treatment and prevention, and it cries out to us to respond with compassion, genuine care, and solidarity. Unfortunately it seems that many parts of the Body of Christ have tended to turn the opposite way, responding in ignorant judgment, anti-hospitality, and perhaps the most damaging and pervasive response…silence.

This past week we had a joint commissioning service with the interns and residents from the pastoral services department. Part of the litany with which I was commissioned said:
We wish to affirm and bless your call to serve as an intern in the wider community with those deeply impacted by HIV, STD's and substance abuse. You have been chosen to offer pastoral care and other worthy services with those who face discrimination and isolation because of the stigma of their conditions. You are commissioned today to live the words of the Christian Testament, "Just as you did it to one of the least of these who are members of my family, you did it to me."

I hope and pray that my time with Partners in Caring will give me the opportunity to learn how to respond to the needs of those living with HIV/AIDS and others like it, primarily as it will open my eyes to see those whom we tend to look past and to hear the ones we often ignore. May God grant me grace to look and listen. And I hope that the availability, openness, and obedience of “Here I am”—that phrase often heard in response to God’s voice in the OT—will be evident and true of my posture this summer.

For those not familiar with the words to the two songs I mentioned in the previous post...

"Precious Lord Take My Hand"

Precious Lord, take my hand,

Lead me on, let me stand,

I am tired, I am weak, I am worn;

Through the storm, through the night,

Lead me on to the light:

Refrain:

Take my hand, precious Lord, Lead me home.

When my way grows drear,

Precious Lord, linger near,

When my life is almost gone,

Hear my cry, hear my call,

Hold my hand lest I fall

Refrain

When the darkness appears

And the night draws near,

And the day is past and gone

At the river I stand,

Guide my feet, hold my hand,

Refrain

"It It Well With My Soul"

When peace, like a river, attendeth my way,

When sorrows like sea billows roll;

Whatever my lot, Thou has taught me to say,

It is well, it is well, with my soul.

Refrain:

It is well, with my soul,

It is well, with my soul,

It is well, it is well, with my soul.

Though Satan should buffet, though trials should come,

Let this blest assurance control,

That Christ has regarded my helpless estate,

And hath shed His own blood for my soul.

Refrain

My sin, oh, the bliss of this glorious thought!

My sin, not in part but the whole,

Is nailed to the cross, and I bear it no more,

Praise the Lord, praise the Lord, O my soul!

Refrain

And Lord, haste the day when my faith shall be sight,

The clouds be rolled back as a scroll,

The trump shall resound, and the Lord shall descend,

Even so it is well with my soul

Refrain

These happen to be two powerful songs in my own life that have spoken to me before, but I think the words are very appropriate for this setting, for those facing the end of their life and the peace and comfort that God can give to us on our final journey.

Where did the week go???

I can hardly believe that the first week of field ed is already over and there's only nine more to go!  I'm gonna have to get on the ball with this blog to keep you folks updated more often because I have so much to say! ;o)  Well with one week under my belt I can say that this will be an amazing summer because I have already been pushed far out of my comfort zone and witnessed many beautiful moments in merely a week's time.  

Much of my work at ICEOL remains the same as it has been during the academic year working on the APPEAL conferences.  The next APPEAL conference will be in Dallas, TX on July 11-12th so we are now beginning to feel the crunch of time as we make sure marketing material goes out, finalize logistics and work on making this conference happen.  A majority of my job for APPEAL is spent in working with the faculty who will be presenting in putting together the various powerpoint slides in a master show, having them double/triple check to make sure those are the slides they want to use and that they are in the correct order, and what portion(s) of the DVD they would like to show and where in the presentation it will be shown.  We have decided to continue to improve the flow of the presentations, which is the conference, by embedding the movie segments into the actual presentation.  This means working a bit more in advance on deciding what portions will be show because it takes time to make these files and not something that can be changed the night before the conference.  The faculty also vary from conference to conference, and though same remain the same there will be new faculty so there are significant changes for each conference.

As much as I enjoy my time with ICEOL I am looking forward to spending most of my field ed time with Duke Hospice where I get to be with people.  The work I do with ICEOL contributes to educating doctors, nurses, chaplains, social workers, ect in the APPEAL curriculum and in turn hopefully affecting their work with those in palliative care, but I also desire to be on the "front lines" with those being affected by palliative care.  There is much to share about my first week with Duke Hospice.  My time each week will consist of visiting patients and writing documentation about the visit, meetings including a weekly supervisor meeting, writing a verbatim for weekly supervisor meeting (much like a verbatim for CPE), researching pediatrics and hospice (Duke Hospice hopes to be able to do more of this), reading several books my supervisor has selected and writing a reflection upon them, and various other tasks.  In preparation for being given four patients to be in charge of for the summer (meaning, taking care of their spiritual needs) I attended hospice volunteer training last weekend (Fri-Sun) to get a good overview of hospice and see the role of the hospice volunteer.  I will also be spending significant time shadowing Jodi and Danny, the two chaplains, as well as a nurse, social worker, ect to see the various parts of hospice that come together to care for each patient.  Hospice care is based around an interdisciplinary team consisting of the doctor, nurse, social worker, chaplain and volunteer who care for the patient, so if you go on hospice care you get all of this!  (If you want it, of course)  I will also spend some time at the ICF (In-patient Care Facility), a short term stay facility, and the bereavement staff in charge of bereavement care, which is available to the family for up to thirteen months following the death of their loved one.  More about the different things I do and have learned about hospice in general as I go through the summer, but for now onto the stories!

On Tuesday I shadowed Jodi to get a taste of what the role of the hospice chaplain is, and the identity I will be putting on for the summer.  The role of the hospice chaplain is to care for the spiritual needs of the patient and patients are typically seen by the hospice chaplain once a month, and more if requested or a crisis occurs.  Hospice believes that everyone has spirituality, which is different than religion, and so it is the chaplain's job to address their spiritual needs.  I met a woman who I will be visiting with this summer named Esther* who is an elderly African American woman with lung cancer.  Esther has been in hospice care for over a year and has a fairly positive outlook on life despite living with this terminal illness and the pain that comes with it.  Since she came into hospice care her ability to walk around and care for herself has decreased, but she is still able to do much for herself.  She is quite talkative and excited to meet with me so I am looking forward to my time with her.  She was very excited to tell me about herself and show off her oxygen machine.  While we were there Jodi got Esther to sing "Precious Lord Take My Hand" with her and it was incredibly touching moment to see this woman join Jodi in song that was familiar to her.  Although Esther felt as if she couldn't sing anymore because her voice was weak she knew the words and joined in when she could.

The next woman I met is Deborah*, and elderly woman with dementia who lives with her son and daughter-in-law, but is primarily cared for each day by her granddaughter who lives next door with her family.  Deborah only speaks a few short sentences a day, but seems to still recognize her name and be aware of what was going on around her.  As Jodi and I sat talking with her granddaughter, keeping Deborah involved in the conversation, I noticed that she seem to listen to us and respond somewhat through making eye contact and smiling.  I was struck at how easily the granddaughter continued to keep Deborah as part of the conversation even if we were not speaking directly to her.  Being told Deborah only speaks a few sentences a day I considered it a very special moment that as Jodi and I took turns saying goodbye to her that she responded to each of us with a clear "goodbye" accompanied by a smile.  She had been quiet during our entire visit, talking to her and each other so to experience her words was very special.

Our next travels brought us to a facility where I met a elderly woman, Rachel*, who is "actively" dying of congestive heart failure, and has continued to hang out over a week longer than expected.  As I held her hand and Jodi sang "It Is Well With My Soul" she closed her eyes and continued to grasp my hand.  At that moment I felt as if I were standing on holy ground, truly sacred space, to be invited into a place with someone so close to death and so appreciative that we have come to be there with them, even as a complete stranger.  I was amazed at how eager she was to hold my hand tightly, not wanting to let go, and let me be close to her and look into my eyes and thank me for being there.

Also in this facility Jodi and I met with an elderly man, Peter* who greatly impacted my day.  This was the first time meeting Peter for the both of us, and Jodi received an important call as we stepped in the room so she let me stay with Peter.  I was struck when Peter was not satisfied with holding my hand but gently grabbed my other hand and arm as well as if he needed human touch.  Later we realized we had walked into his room without the needed gloves and gown (more for our protection due to a small infection) and I was saddened as I re-entered the room now covered with gloves and a gown which would interrupt the physical touch he seem to eagerly desire.  While the gown and gloves were for my safety, and possibly his own, it hurt that this may continue to lead to his feeling of separation from people as he approached the end of his life.  His family was unable to visit much except for short visits on the weekends and so it seemed that Peter was very lonely.  During the time Jodi was away Peter struggled to talk to me.  He told me that I was a beautiful girl, and that he was having a hard day, he seemed to be frustrated with not being able to say what he was feeling.  It was as if the connection between his thoughts/feelings and being able to speak about that had been broken.  We found out that Peter was a retired minister and so we asked if he would like to lead us in prayer, and he did so very willingly.  It was a beautiful prayer because it was so honest and real, as he prayed to God about not understanding what was going, and for not understanding the not understanding.  His prayer brought me to tears and a man I had known for 10 minutes would be so real and honest in front of complete strangers, and that even as a minister he was able to be honest about his struggles.  Peter told Jodi that God was working on him through her and there was a sense that our visit greatly impacted him.  Also noteworthy was Peter's humor, despite his great frustration with what he was experiencing and not being able to say what he needed/want to say he joked with Jodi, I and his aid.  On a personal note, his humor reminded me greatly of my own father's humor, and how my dad had continued to keep his humor even as he drew close to his death.  I feel as if Peter will play a special role in my summer and I look forward to meeting with him again. 

Our last visit on Tuesday brought us to a man, *Gideon, who everyone thought was going to pass away several days earlier but continued to hold on.  We visited some with his daughter before going in to see him.  When I met Gideon he remarked to me about the sunshine coming through the window, how he loved it and wished he could be outside in it.  Jodi asked Gideon what he wanted her to pray for and so Jodi led us in a prayer for relief of pain and for life.  Gideon also surprised me by adding his own words to her prayer, praying to God for strength, and again, as a completely stranger, I witnessed a very real and honest prayer.  I stood on sacred ground as Gideon was so thankful for our presence and saying that he believed it was "the beginning of the end."  As we said goodbye to him he told Jodi that he loved her, and he also told me that he loved me.  The look in his eyes as he held my hand, looked at me and told me he loved me said that it meant a great deal to him that we had come to see him.  I again was amazed by the openness and the great impact of simply being present with people.

And that was just Tuesday :o)  On Wednesday I shadowed Danny, the other hospice chaplain.  We visited a different facility to check on one of his patients and meet another woman I will be "in charge of" for the summer.  With our first visit I witnessed how the role of the chaplain can involve being an advocate for the patient in making sure they are properly cared for.  Part of hospice care involves pain management, not doping people up into some drug induced fog so they can't feel pain, but controlling and managing their pain so they can live out the rest of their days as comfortably as possible, and the patients have control over the extent they would like their pain managed.  The first woman was in obvious pain and so Danny made sure the nurse was notified and would address her pain, and find out what exactly was the cause of her pain.  Something I learned from sitting in the APPEAL training for ICEOL (and briefly in hospice volunteer training) is that pain is more than just physical, it can also be emotional and psychosocial.  When one is in pain it may be one or all three parts of pain, but being in pain can affect the rest of our being and so this is why hospice sees pain management as highly important so that patients' pain is not interfering with their ability to live out the rest of their life as well as possible.

The next patient we saw was Tabitha*, and active elderly woman with dementia.  During our brief visit with her she was very outgoing and eager to communicate.  Tabitha may be my most difficult patient to visit with because of how the dementia affects her ability to communicate, and this makes me a bit anxious because I have never been around someone with dementia before.  As we were at the facility Danny was contacted by a family and asked to come for a visit.  Although he had been by their house just two days before the family felt as if the end were near and would like him to come by and so we left the facility quickly to get to the family's house.  The woman we would be seeing was 54 years old with colon cancer.  When we arrived I was quickly introduced to the family, meeting her sons and their fiances, and her mother, along with the hospice nurse who happened to be there.  Once the introductions were made we went upstairs to see her and as soon as Danny approached her bed the woman took her final breaths and passed just as I was entering the room.  After knowing this family for five minutes I was thrust into a very intimate and personal time in their lives as they witness their mother/daughter die.  I had no words to say, especially as a completely stranger, but I think in that moment what the family needed the most was our presence, and not our words.  Luckily Danny was there and offered a blessing over her as she passed, some scripture (Psalm 23, John 14, Revelation 21) several minutes later and led a prayer for the family.  I felt somewhat helpless watching them grieve and also somewhat awkward being a completely stranger in this intimate moment of their lives, not knowing them and not getting the chance to meet her before she died.  Danny and I ended up staying for the next couple hours with the family sitting/standing with them, talking with them, and waiting for the funeral home to come remove her body.  It is a bit hard to describe all the emotions I felt in that experience having witness a woman die right before me and be amidst a grieving family.  My heart went out to them as I stood around them crying over her and standing by her bedside, but I questioned what was appropriate to do as a complete stranger and wanting to respect their space.  As we stayed with them and were leaving it seemed that the family desired Danny's presence because  he had been with them before, but they were also thankful for my presence.  They even hugged me as we left although I had only known them for a short two hours, but that two hour journey was a most sacred and intimate time of their lives.

This entry is already so long so I will break for now, but definitely more to come later!

(*names have been changed due to confidentiality)