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Vol. 19, No. 5
September/October 2009
Vision is published six times a year by the
National Association of Catholic Chaplains.
Its purpose is to connect our members with
each other and with the governance of the
Association. Vision informs and educates
our membership about issues in pastoral/
spiritual care and helps chart directions for
the future of the profession, as well as the
Association.
ISSN: 1527-2370
Executive Editor
David A. Lichter, D.Min.
Editor
Laurie Hansen Cardona
lcardona@nacc.org
Graphic Designer
Gina Rupcic
The National Association of Catholic
Chaplains advocates for the profession of
spiritual care and educates, certifies, and
supports chaplains, clinical pastoral
educators and all members who continue
the healing ministry of Jesus in the name of
the Church.
NACC Editorial Advisory Panel:
Sr. Michele LeDoux Sakurai; Michelle Lemiesz; Linda
Piotrowski; Rev. Freddy Washington, CSSp;
and board representative Norma Gutierrez,
MCDP.
NACC National Office
4915 S. Howell Avenue Suite 501
Milwaukee, WI 53207-5939
(414) 483-4898
Fax: (414) 483-6712
info@nacc.org
www.nacc.org
By Ruth Jandeska
I have never valued the importance of a good night of sleep as much as I did when I was the chaplain of an Ambulatory Surgery Center (ASC). The word ambulatory comes from the Latin “ambulare,” which means “to walk.” The day starts very early in the ASC. Patients might arrive as early as 5 a.m. and start registering. By 5:45 a.m. they are admitted and taken for lab work and other testing. It is a very fast-paced unit with a heavy flow of patients almost every day. One of the characteristics of this unit is that it has its own natural flow. Like most ASC’s, patients are admitted, evaluated, moved to the pre-operative room and then to the operating room (OR). Once the surgery is finished, patients are taken to the Post-Anesthesia Recovery Unit (PACU).
I quickly felt my need to be well rested so that I would be more intentionally able to pay attention to my feelings and respond effectively and empathically to my patients.
Since ambulatory surgery involves procedures that can be intensive, but not so much as to require hospitalization, one might think that spiritual care is not required in such a setting. But patients’ and families’ spiritual and emotional needs may not arise until that very moment in which the impending surgery has become imminent, and my goal as a chaplain was to provide a safe space for them to raise those needs, to have them acknowledged and to have them addressed whenever possible. I visualized and compared my “ambulatory ministerial work” (“ambulare”) in this unit with that of Jesus, when he just walked around the towns and conversed with the people he met. He cured and healed those he was able to, giving them a message of hope and peace at that moment. I started every day with this image in my mind.
Patients and families are told by the receiving nurses about the flow of the unit as their day begins. I always found that repeating this information to the patients when I visited them, served as reinforcement and security, and helped them reduce their feelings of powerlessness because of the sense of control they gained with knowledge.
I visited patients during the different stages of their intake depending on their availability. In many circumstances, I visited them along with other medical personnel. I quickly learned to pay attention to my own self, since if I was not careful my introverted nature could prevent my “voice” and “pastoral authority” from being heard and could affect my interaction with the patients.
I introduced myself and my services. When patients and families expressed no needs or said they were not interested, I offered them my best wishes and prayers for a successful surgery and speedy recovery, then quickly dismissed myself. Since a patient’s time in the pre-op area can be brief, I could not elaborate on my spiritual assessment. I asked the patients and their families how they were doing, and I addressed their needs according to their responses.
On one occasion, a patient responded that she was upset and afraid. She had missed Mass the day before and she so much longed to be able to have Communion. The patient spoke of how she had almost never missed Sunday Mass and how Communion was such a part of her spiritual life. She described herself as a very devoted Catholic. She felt frustrated because she could not go to church due to physical pain. The impending surgery prevented her from taking anything by mouth. I listened to her and acknowledged her frustration. I wondered if she was more upset this time than the other times that she had missed Sunday Mass. The patient quickly acknowledged she was more upset this time because of her fears of death, and that if she were to die this day she would have loved to have had Communion. I sensed her fear of feeling “disconnected” from God. Had she been an inpatient, I would have allowed her to continue to speak and reflect on her beliefs about death and life after death in relation to her fears. But knowing that momentarily she would be taken to the OR, I ventured to improve her spiritual well-being and offered hope and comfort by speaking of the role of Word and Sacrament for those unable to receive, and that although she was not physically able to receive Communion, she was in communion with God by the intentions of her heart. We reflected on the sacred presence of Jesus in the Word and prayed through the Scriptures. Afterward, she expressed her feelings of relief and being at peace, and then she was ready for her procedure.
In many cases patients said they were fine with their upcoming procedure but acknowledged feelings of distress due to a particular situation at either home or work. They wondered about when they would be able to go back and continue addressing those particular issues. By being present to their current needs without carrying any assumptions, I was able to meet them where they were at the moment and it allowed them to receive comfort as they released their worries.
Moreover, some of my conversations with my patients were about quality of life. During the intake, patients are asked whether or not they have an Advance Directive and are encouraged to write one before the procedure. As chaplain, I witnessed these documents and promoted conversations between patients and families regarding meaning and hope. For example, one day I visited with a 95-year-old lady and her daughter. The patient stated this was the very first time she needed to be in a hospital besides her hospitalizations during the births of each of her seven children. She had never heard of an Advance Directive and was curious to learn about it. I explained to her what an Advance Directive was and the reasons why it was important to have one. She stated that she always had been a healthy and independent woman. She enjoyed her very large family and numerous friends. She felt she had been blessed with a full life. She required at this time a total hysterectomy, without which her health would be extremely affected. She spoke of taking the risks of going through this surgery and expressed her desire that no heroic measures would be taken if her quality of life afterward would not be the same as it was now. Her daughter held her hand all this time and was very gracious to hear her mother’s wishes, of which they had never talked before.
Furthermore, the flow of the unit may be affected by unexpected situations that can lead, for example, to inadequate communication among the staff or delay in surgeries. These can cause anger and distress in both patients and staff. I provided space right in the moment for staff and patients and families to express their frustrations and offered effective listening through reflective statements. I observed how this greatly helped to defuse anger.
The staff valued my interventions greatly, especially when I visited with those who were evidently distressed. I paid attention to their feelings and allowed them to express their fears. This way of receiving comfort allowed them to relax and to be able to continue their conversations with the medical team regarding their procedures. I also supported the staff by making my interventions quick so that the team was always ready to move on whenever they needed to do so.
During the small breaks, I checked in the moment with the nurses and secretaries to provide them with opportunities for talking about their morning experiences. I liked to establish relationships with the hope of increasing trust, so that I would better serve the whole team in terms of professional and personal needs.
My goal in the unit was to be visible, but not an obstacle. For some, the presence of the chaplain is a reminder of God’s continuous presence and care. I aimed to convey that message during my visits and during my rounds throughout the unit and the unit’s waiting room. At the same time, my assessing and addressing the needs were aimed to be seamless with the rest of the care provided by the team, so that the natural flow of the unit was not affected. Being a chaplain in ASC provided me with an enormous opportunity for growth and a much greater appreciation for the work that I do, that is, to always be in the moment.
Ruth Jandeska is a chaplain in the Obstetrics Department and Neonatal Intensive Care Unit at the Loyola University Health System in Maywood, IL She wishes to acknowledge Fr. Andrew Phiri, chaplain, and Jerry Kaelin, director of Loyola CPE, for their comments on this article.