Linda S. Golding and Walter Dixon, Spiritual Care for Non-Communicative Patients: A Guidebook. Jessica Kingsley Publishers, 2019.
By Christina Mayer
As a younger chaplain, I wondered if my presence in a non-communicative patient’s room would even matter. Can patients who cannot speak, write, or share non-verbal cues even hear me? Would my time be better spent ministering to communicative patients? What if a nurse saw me sitting quietly with a non-communicative patient, or even talking or humming—would I be questioned or judged?
Consider these scenarios:
Scenario 1: Death was imminent. Although the patient, an elderly woman, was COVID-negative, the hospital had imposed a strict visitation policy. I escorted family members to the patient’s room one by one, informing them that their loved one was non-communicative, but could most likely hear us and feel our touch. Entering the room, I said, “Mrs. J., I am here with your granddaughter, Molly. Molly may want to talk to you, or hold your hand, pray with you, or even sit silently. She is sitting in a chair on your left side. I will leave you two alone for a few minutes.” I left the room, and the charge nurse called me over. She showed me a wall of monitors and pointed to lines on the screen. “When the patient was alone, the line was like this,” she said, making a horizontal sweep with her hand, “but when you and the visitor entered the room just now, the line went up. Her heart started beating again.”
Scenario 2: A homeless patient was very ill, greatly medicated, and probably asleep or even unconscious. But I knocked, called the patient’s name, and asked to enter. In my usual voice, I clearly said, “Mr. K., I am Chaplain Chris. Your nurse, Jess, who has been caring for you thought you might like a visit. I am sitting in a chair at the foot of your bed. I plan to be here for a few minutes, and I hope that’s all right with you.” I continued: “I want you to know that your nurse cares about you, and I do, too. I want you to know that you are a wonderful creation.” Before leaving the patient’s room, I thanked him and wished him peace.
In Scenario 1, would my younger self have merely ministered to the patient’s visitors, escorted them in, and brushed past the patient herself? In Scenario 2, would my younger self have even visited the patient? Because I read Spiritual Care for Non-Communicative Patients: A Guidebook by Linda S. Golding and Walter Dixon, I learned to respond to patients’ needs more effectively. I learned that a chaplain’s presence does indeed matter in these situations.
There is a reason this book is called a guidebook, for it kindly and gently guides chaplains to reflect on obstacles, fears, and concerns — before, during, and after working with non-communicative patients. Similar to CPE, this book encourages a pre-visit visualization/actual visit/post-visit reflection methodology.
Happily, this book also includes practical exercises, worksheets, small group activities and case studies. It encourages us to use all of our senses while in the patient’s room, as we hear the beeps and buzzes, smell the odors, and see the tubes and gowns and patient’s pallor. Cultivating presence and embracing stillness are also key. The book encourages shadowing nurses to see how they interact with non-communicative patients.
Because chaplaincy is becoming so research-driven, I would have enjoyed seeing research studies of non-communicative patients. And I would have enjoyed reading some verbatims or narratives that enact some of the suggestions.
And our new COVID era presents new obstacles in these situations, since in most systems we cannot enter the patients’ rooms, or if we do, it requires full PPE. In systems where those supplies are rationed, it may be harder to justify a visit to a non-communicative patient.
Even so, my ministry has benefited from this book. The one thought that stays with me is summed up in one chaplain’s post-visit reflection: “To spend regular time with a patient who does not respond … is to trust, and even to quietly suggest to those witnessing, that there is always more going on than meets the eye.”
Christina Mayer is a chaplain at Mercy Hospital & Medical Center, Chicago, IL.