Kirstin D. Batchelor

Like you, Paul, I found the practical nature of the “Eight Things…” article helpful. I particularly like the humor part. This is something I have definitely found to be effective for myself and in working with patients. Obviously it is not always appropriate and I take my cues from patients as to when a little laughter might be helpful and when it would not.

I also wanted to respond to your reflection on ADs and family members overriding them. We encountered this many times even in the hospice work I did, and it often became frustrating and even painful for the team. We called it “the cousin from California” phenomenon, wherein a distant family member would arrive in town and question why someone was on hospice and would encourage the local family to try different aggressive treatments or therapies. Most of the time we were thankful for the AD that spelled out clearly what a patient wanted or didn’t want and fortunately our Medical Director was very good at standing firm and and not giving in to such demands but met them instead with education mostly about what hospice was and was not. This comes back to the issue we’ve reflected on before about the need to educate about what Palliative Care is and is not. And again, this is where this article was very practical and helpful.

To reflect a bit more on Dina’s prompt regarding palliative needs and the role of chaplains, as several of the articles have pointed out, Palliative Care being primarily about pain management and improving quality of life, obviously spiritual care can be crucial in addressing the pain that has roots in existential concerns. Obviously often that pain manifests in physical symptoms. My own tension has often been in how much to push people to explore and address this. Chris’s essay from last week spelled out clearly that his expectation was for the chaplain to push him to reflect on the bigger life questions and the spiritual pain that a diagnosis or situation can bring about. I certainly have encouraged people at times to talk about those tough things that they may not want to talk about. And I have also found that sometimes people want to talk about the normal everyday things of life. In hospice, it seemed to me that sometimes people wanted a break from thinking and talking about life and death topics. I usually let people take the lead in conversation and followed where they went. This often did lead to fruitful and deep conversations. And sometimes it did not. I have wondered whether this was always the most effective spiritual care or not. I’m curious what approaches others have taken in providing spiritual care to folks who are either on a Palliative Care service or considering it. Have you pushed more or followed patients’ leads more?