By Daniel Waters
The church was warm on a beautiful Sunday morning in July when I saw Sam seated in the section next to ours. I had visited Sam more times than I can count over the past five or more years as a patient in our dual-diagnosis behavioral unit at the hospital, but on this morning he seemed comfortable in the pews of the diverse inner-city parish. I did not approach him, but he came over to greet me and I introduced my wife.
Less than two weeks later, I saw Sam as a patient again. I felt sadness and heartbreak more than anything else. I was filling in for our chaplain, who does weekly spirituality groups in the Behavioral Health Institute, and Sam had been admitted just hours before. A nurse and a recreation therapist rolled their eyes and made comments about Sam being “back again!” and “who knows what he will do for now.” About two-thirds of the way through the spirituality group Sam came to the room. He struggled to keep his eyes open. When the group ended, he told me he was happy to see me but ashamed that I was seeing him like this again. It was tough for him to even make a clear sentence. He did ask for prayer and we asked for God’s light, peace, and forgiveness; Sam was soon heading back to his room to sleep.
I learned later that Sam had been found passed out on the street in the early morning hours. The squad had taken him to the closest hospital, and from there he came back to our BHI unit. It had been more than six months since Sam’s last admission, and he had left us with promise and high hopes. He had a good place to live and he was beginning a new job. Finding work is not easy for someone with Sam’s psychiatric history. We had transitioned Sam to our outpatient program for ongoing support in the hopes of avoiding yet another downward spiral.
I made time to visit Sam over the next several days. The ongoing frustration of some of our staff was very evident. I found myself providing a listening presence to our staff members as much as spending time with Sam. Active listening is an important intervention for staff. Other spiritual care interventions with staff could include exploring healthy coping resources, critical incident debriefing, discussion of meaning and purpose, exploring their definition of hope, exploring their thoughts and emotions, or exploring their relationship with God/the transcendent.
Their frustration around Sam was born out of a genuine concern for him. The social worker had worked hard to line up job interviews and find an apartment complex where he would be accepted. Recreation therapists had worked on healthy coping practices. Nurses had gone forward and backward over the need to stay with his prescribed medications. Now they felt that all of this had been for no reason. As I listened, I could feel their frustration and hopelessness. Sam is not the only one on this treadmill, and it is not hard to see why some staff members become cynical. Compassion fatigue and moral distress can manifest in different ways in a behavioral unit compared to a medical unit, but in either setting, they can be just as real and debilitating. Intentional use of some of the interventions mentioned above can help staff work through fatigue or distress.
When I reflect on my own hopelessness and sadness, I must be honest about whether some of this is my ego. Is this about my ability to change Sam’s life and looking like a hero? Or am I willing to keep Sam’s well-being as the focus and surrender enough and remain open, seventy times seven? The process of allowing the staff a sacred place to vent and talk through their frustration has helped them come to a place of willingness to work yet again with Sam. Perhaps one of the most powerful things chaplains can do is allow the staff to take the initiative of letting go of frustration or cynicism themselves. Only when I can look at a patient and know in my heart “there but for the grace of God go I” can I surrender my emotions to the One who chose to become broken and move forward myself. In Sam’s case, worshiping with him earlier made me aware of my own failings. There was no way I could feel more whole or well than Sam during our time of prayer together.
As the staff and I journeyed through our own frustration, sadness, and hopelessness, we continued to work with and minister to Sam on his journey. He spent about two weeks with us inpatient and then made the transition once again to outpatient support. As frustrating as Sam’s case has been, the one trend he has this year is overall fewer inpatient admissions.
I would be naïve to think I would never see Sam as an inpatient again. The dark emotions that he struggles with can take a different form but can weigh down staff as well. Staff members have their own struggles such as mental illness of their own family or friends, financial issues at home, or staffing shortages, to name just a few. The journey toward the healing peace of our loving God continues for all of us.
Daniel Waters, BCC, is Spiritual Care Coordinator at Mercy Health in Oregon, OH.