By Calin Tamiian
Vulnerability in palliative care is a cumulative experience. The lack of physical and psychological control, spiritual suffering, or cognitive limitations often result in a spiral of ancillary vulnerabilities, not only in patients facing the end of life but also in family and friends. Healthcare professionals also face vulnerabilities accumulating from repeated exposures to dying. Among the team of clinicians, spiritual care providers are most exposed to the intensity of emotions and distresses raining from these cumulative vulnerabilities.
Do you challenge this statement or just take it as a fact?
Neither reaction is correct. The first points to a misunderstood role of the chaplain, or a less than positive experience with one. The second misses the opportunity to explore this valuable resource and put it to good use. A professional board-certified chaplain should lead in identifying and exploring the cumulative vulnerabilities present in every patient facing end of life. A palliative care board-certified chaplain then will become the leading member of the interdisciplinary team to balance out emotional and spiritual vulnerabilities of both patients and healthcare providers, including themselves, in a way that will broker meaningful assessments and build a supportive, caring community around those who are most vulnerable.
During my certification interview for hospice and palliative care chaplain specialty, I realized the importance of being in touch with one’s vulnerabilities and of developing them into something positive. Many of the questions were geared toward my experience of understanding my own vulnerabilities. The experience helped me realize that I am a keeper of the cumulative vulnerability within the interdisciplinary team.
But I also perceived how weaknesses build and develop and can be crushing even for a seasoned chaplain. Usually, people deal with vulnerability by hiding from it or avoiding it. Caring for a terminally ill person day after day requires continuous balancing between care burdens and coping capacity. Even in emotionally stable individuals, the awareness of continuous coping could require too much energy. For a chaplain who witnesses the vulnerability of all that surrounds him or her, there is but one way to cope: embracing the power of one’s own limitations.
Perhaps the word power is too far-fetched, but “strength is perfected in weakness” as St. Paul reminds us in II Corinthians 12:9. A humble chaplain forged in the reality of not having answers and solutions for the tragedies of life can open communication and help everyone face fears, insecurities, and isolation in the face of death. A chaplain who laughs with the communion of saints could help those grieving by reestablishing joy and reducing the risk of compassion fatigue. A hopeful chaplain with the faith only the size of a mustard seed will help all continue with their previous meaningful activities, keep some control, and find satisfaction in good care. All these factors may decrease vulnerability’s grip on patients and caregivers alike.
Palliative care chaplains can lead through example when they are in touch with their own vulnerabilities. The emphasis is not how to get ready for the final moments, but how to be present and fully engaged when that loss is finally taking the life of the one we cared for.
Recently I was called to assist with sacramental ministry at the end of life for a young woman in palliative care. She had recently graduated from nursing school and was the mother of a 10-year-old girl. Shortly after, the patient died, and I responded again to support the bereaved family. I was surprised to see all the members of the palliative care team, including the physician, being caught in the deep grief of the patient’s family. They remained in the room for a long time, interacting not only with the family and each other but also with the care providers in that unit. They were offering support to each other, lingering around to seek some TLC for themselves as they were getting in touch with how vulnerable this loss made them feel.
The chaplain focuses on listening to all. Taking the dimensions of the spiritual distress and suffering present in my colleagues one by one, I knew that my heart was aching because of this tragedy. With the exception of department meetings and patient family conferences, I realized that I never saw the entire palliative care team together after a patient passed away. Later in that week, we all gathered again and debriefed each other on how this case affected us all. The sense of vulnerability surfaced in comments such as, “When I arrived home, I spent extra time with my family” and “Life can be cut off too soon; we must appreciate every moment.” And that is what I suggested that we do as a team as well.
Experience or even cumulative wisdom is not better than the blessing of a chaplain who is in touch with the spiritual distress that unfolds both all around and inside. The experience of hundreds or thousands of deaths is only as valuable as the chaplain’s willingness to revisit emotionally vulnerable spots. The best way to verify whether you have a sound theology or a genuine pastoral presence is to see that in spite of many losses, a bright light exists in the surrounding darkness of those cumulative vulnerabilities. Recognizing limitations sooner and being able to name them in oneself as well as in others allows the chaplain to navigate and lead the patients through those dark valleys of fear and death.
Fr. Calin Tamiian, BCC, is manager of the Spiritual Care Department at St. John’s Hospital in Oxnard, CA.