Paul C. Edwards
It seems our experiences are quite similar in terms of the tension I also feel regarding how far to “coach”/guide folks in talking about the existential concerns. I have experienced many who have no desire at all to discuss those issues with me when consulted for those matters, despite others on the team discerning that such issues are a concern of the patient may have actually verbalized a fear or a wondering. I never push, but take my cues, like you, from the patient. In CPE, we are always challenged about our avoidance of some things and what triggers our own stuff. I tend not to think I am avoiding, but rather respectful of that person’s right to explore painful spiritual issues or not. Part of my core spiritual belief system is that I do not need confirmation or affirmation of the certainty of someone’s eternal destination. My role is to represent, as best as I can, through presence, active listening, compassion, etc., the divine, and allow the divine to do the rest. I don’t have to have all the details and proof of anything. That viewpoint does not always sit well with family members who are from traditions that sees that different and who believe that my role, (as Chaplain) is to “get it done” and certify that it is done. (I don’t think it sits well with my Baptist tradition also! Oh well!)
Here is another real challenge, that brings me much sadness. I receive a consult, and, by the time I get to the patient, the patient is unresponsive and unable to engage in conversation regarding anything. The window of opportunity to explore life/death/the great beyond with the patient (if she/he were willing to do so), is closed before I get there. I choose to still incorporate, in my prayers, the hopes and longings of the patient, for a peaceful end, in a place of eternal rest. Again, my belief system is that we, (humans), don’t have to final word. Just because I can’t have a conversation with an individual, it doen’t mean God can’t. Knowing that patients do hear us, even when comatose, I will tailor my prayers, specific to their concerns/needs, and name their concerns in the prayers I pray.
As a team, we have noted that many of our consults should have been received far upstream in terms of addressing values, beliefs, pain management, etc. I feel the same with regards to my role on the team. We have no control over that. Then there are the ones that are discharged before I can get to see them, (after numerous prior attempts), when they were not in their rooms, out for testing, rehab, etc. My hope, and prayer, has been that whatever needs I could have addressed, will be addressed somewhere post-discharge, since it was not possible while an in-patient.