By Linda Piotrowski
The roots of my chaplaincy ministry lie deep within long term care. My first job as a professional chaplain was ministering to retired Sisters of St Francis Assisi at Marian Franciscan Home in Milwaukee. They were the first religious in the United States to place their infirm sisters in a nursing home. I was honored to be a part of that new venture.
I learned from the sisters and other residents in the nursing home how to face diminishment and death with courage and grace. Being a witness to their tenacity, love of life, declining health, and eventual deaths taught me that while death is often painful, it is not to be feared. I learned that human beings can gracefully embrace their final days with hope and courage, all the while teaching those of us around them how to support them.
That experience, along with others who mentored me, helped inspire me to specialize in palliative care. Nursing home ministry is an excellent example of palliative care long before we called it that or had specializations such as the new palliative care certification. But the foundation is the same as that for any chaplain. A good building block is the transcendental imperatives taught by theologian Bernard Lonergan: to be attentive, intelligent, reasonable, responsible, and committed to love. If we forget these principles, we do so at our own peril and that of the people we seek to serve.
Not everyone we meet embraces a religion. However, at the core we all are spiritual beings. As Ira Byock, MD, my former boss and mentor, writes, “Human spirituality arises in response to the awe-inspiring and terrifying mystery of life and the universe. We reflexively seek to make meaning of our experience in the world and make or strengthen our connections to others.”
Ira Byock sought to develop a team both interdependent and interdisciplinary. Team members held deep respect for each person’s discipline. We learned to share our vulnerabilities as well as our strengths. We learned from one another. We called each other out when necessary.
We cultivated deep respect for the individual. Yvonne Corbeil, a team member, often reminded us that words have great power, and while team meetings were a time to share successes, failures, and frustrations, we needed to speak about a patient or family member as if that person were present in the meeting with us. Respect for the uniqueness of each individual is the cornerstone of good ministry and palliative care. This extends to teammates and all staff.
For every team member, but especially for the chaplain, our journey with each person begins self-awareness. We don’t bring God into any situation. God is already there. God is already and always present with each person before we show up.
In the face of suffering and death, we must ask ourselves what our own faith teaches about life and death, suffering and pain, and how this might affect how we interact with the patient and family. What is your personal history with suffering and death? Where do you draw strength in the midst of great challenges? With what space of privacy and trust do you surround yourself? Whom do you allow into your circle of beliefs, feelings, hopes, and fears? What rituals, beliefs, and practices help you to cope? Being aware of this enables you to decide how to invite the other to share their feelings and beliefs about their own illness, suffering, and impending death.
Before everything else, palliative care is ministry to and with patients and families. Having an open and compassionate heart is what allows another to have the sense that you are someone they can trust with their story. Helping others to maintain hope in the face of defeat and disappointment is a sacred trust. Not giving false hope, but reframing hope for the right thing rather than for the impossible, is most important.
Ministry to the dying is not for the faint of heart. Rejection is a part of this ministry. When I was held at arm’s length or outright refused, I learned that each story is to be respected and honored whether or not I am invited in.
When patients’ lives are out of their control and they are powerless to hold people at bay, at times the chaplain is the only staff member they can refuse. This ministry is not about the chaplain — it is about the person undergoing this life-changing experience.
Ira Byock, more than any other mentor of mine, impressed upon me the need for a chaplain to think and behave as a true professional. Respect, he taught me, is gained by doing research, making presentations at conferences and workshops, as well as publishing articles and chapters in professional publications. He taught me and other team members to respect and partner with other disciplines, to publish and speak not only in our own membership groups but for other professional organizations.
As I look back over my years of ministry with those who are standing at the threshold of life and death, I feel a deep sense of gratitude and wonder that I was invited into such an intimate and personal time.
Linda Piotrowski, BCC, is a retired palliative care chaplain at Dartmouth Hitchcock Medical Center in Lebanon, N.H.