By Elaine Chan, MSW, MDiv, BCC
Cynthia X. Pan, MD, chief of the Division of Geriatrics and Palliative Care Medicine at New York Hospital Queens in Flushing, NY, created an in-patient palliative care program in September 2010 that has helped more than 2,600 patients and their families. She works collaboratively with hospital leadership and community agencies to optimize palliative care and transitional care for patients with serious illnesses. She has presented in both geriatrics and palliative care national societies and international audiences, and works to bridge the gap between the two fields. In the diverse Queens community, Dr. Pan is able to use her Chinese and Spanish language skills to facilitate communication with patients and families.
Q To what extent does spiritual care participate on the interdisciplinary team in your clinical setting? What role does the chaplain play?
A The palliative care program at New York Hospital Queens (NYHQ) has worked collaboratively with the spiritual care team from the start (since September 2010). We have shared in the care of many patients and their families. Because the palliative care program cares for patients with serious or life-threatening illnesses, and their families, these populations often need strong spiritual care and support. Chaplains can play a variety of roles for seriously ill patients. These include: offering emotional support, spiritual and/or religious guidance about decision-making, helping to answer spiritual or existential questions, performing prayers, supporting patients and families at the end of life, and much more. However, chaplains perceive that they are called very late in the course of illness and wish they could participate in patients’ care earlier, so that they can form more solid relationships and be in a position to offer more help. More recently, Rabbi David Keehn (director of chaplaincy services at NYHQ) has offered for the chaplains to play a more active role within the palliative care program. We began by inviting chaplains to join our team in morning sign-out meetings to learn about patients on our service. Chaplains also round with the clinical team to see patients together, allowing the patients to benefit from the medical visit as well as the spiritual visit.
Q Can you give an example of how a chaplain’s involvement made a critical difference with a patient or family?
A Yes. One example was an elderly woman who had end-stage respiratory failure and did not want to live on life support; she was ready to accept she was at the end of life. However, her son insisted that the patient be intubated and live on life support. The rabbi was instrumental in joining our family meeting, helping to counsel the son, communicating with the son’s rabbi to clarify concerns, and work through the decision-making process. Another example was an elderly man with advanced heart failure who enrolled in hospice services. He spoke with the chaplain about many regrets in his life and broken relationships. The chaplain helped this man coordinate his last birthday party, inviting many of his friends and family members, to be able to say the most important things: “I love you,” “Forgive me,” “I forgive you,” “Thank you,” and “Goodbye.” As a result of this farewell party, the man influenced his estranged brother to take a second chance at repairing his marriage and change his life for the better.
Q Do you engage patients in conversations about their spirituality or faith? How do the patients and families respond?
A I always keep in mind that everyone has a “spiritual” dimension. I often ask my patients about their spirituality or faith. Not everyone wants to discuss this matter with their physicians. Thus, I have experienced a wide variety of responses. Some patients do not want to engage in this conversation. Some patients want us to pray for them; some patients offer to pray for us. Some patients become very animated and tell me all about their spiritual or religious experiences, about how they turned over their struggles to God, and made peace that way. I do teach our doctors- and nurses-in-training about how to ask about spiritual orientation and how clinicians can help facilitate their spiritual care. I also teach our trainees about how to access the chaplains for our patients and families.
Q What aspect of caring for patients is the most emotionally/spiritually challenging for you?
A When I see patients who are so ill and struggle, I feel grateful for my own health and well-being. I learn not to take things for granted. I try not to take life or myself too seriously. One challenging aspect of palliative care work is the balance between caring, but not caring so much that you lose your perspectives or boundaries. Another challenging aspect is not to take things too personally. If a patient or family becomes angry or upset, there are often underlying frustrations or fears. Also, we must always listen actively, and really hear what the patient is saying, rather than imposing our own opinions and values on them. Many times, it is all about shared decision-making, and allowing time for emotions to settle.
Q How do your colleagues look at spiritual care as part of interdisciplinary care? Is there discussion in professional circles about the value of spiritual care in the clinical setting?
A My palliative care colleagues (whether it’s physicians, nurses, or social workers) very much value spiritual care as part of interdisciplinary care. It is a given. We often wish that spiritual care counselors could write notes and communicate through the medical chart, so that we understand what is going on at the spiritual level with the patient. Among colleagues in general medical practice, I find that their knowledge about the role of spiritual care counselors is limited, probably because their training did not incorporate or emphasize this aspect of care. Now that we have medicine residents rotating with our palliative care program, hopefully this will change.
Elaine Chan is staff chaplain at New York Hospital in Queens, New York, and is a member of the NACC’s Editorial Advisory Panel.
