New York Chaplains Association

New York Chaplains Association

Topic: SELF CARE FOR CHAPLAINS

By: Rev. R. Michael Stuart, HR, M.Div., M.A., BCC, Spiritual Care Manager of Home Care and Hospice of Western New York, Inc.

BREATHING EXERCISE:

To get us started le us center ourselves to bring us into union with God’s Spirit. Close your eyes or keep them open whichever is most relaxing. Begin to make your breaths fuller and deeper. You should be feeling more and more relaxed as you inhale and exhale each breath. Now continue breathing and meditating as we listen to this verse sung by the psalmist. BE STILL AND KNOW THAT I AM GOD/BE STILL AND KNOW THAT I AM/BE STILL AND KNOW/BE STILL/BE. (Psalm 46:10) Hopefully, you feel more relaxed so can hear about self care. This exercise can be done with any sacred word or phrase on the ‘in’ breath and silence on the ‘out’ breath.

Self Care is important to chaplains in all specializations of ministry. What little I know of prison chaplains comes from the Rev. Shiela Campbell. I am projecting but I imagine you have many stressors in your ministry with prisoners, staff, and yourself. I can’t imagine going to work with all the security and locked in with the prisoners. I would expect that you have to be alert and oriented as well as extra vigilant. I would also wonder about being fearful and if that is an issue and possible stressor. What I can share with you is not from your context but from mine, health care chaplaincy. It began in 1984 when I served as a health care chaplain intern through Health Care Chaplaincy, Inc. in New York City. I was assigned to pediatrics at both New York Hospital Cornell Medical Center and Memorial Sloan Kettering Cancer Center. This was during the AIDS Epidemic in the city. All the kids I had at Sloan Kettering died and the AIDS kids across the street, too. My professional ministry includes: serving as elected national General Assembly staff directing two Presbyterian international mission service programs; serving as pastor of three congregations; serving as an interim presbyter of a presbytery; and serving as a volunteer chaplain in two VA medical centers in Portland, Oregon and Louisville, Kentucky. I did my CPE training at the Portland VA. I will be talking about my journey to a healthy self care the past ten plus years when I served as staff chaplain to a level II trauma center in Bend, Oregon, St. Charles Medical Center and now as spiritual care manager for Home Care and Hospice of Western New York, Inc.

A few months ago a lawyer friend of mine posed the question, “What’s the difference between self care and self abuse? He likes to play the devil’s advocate and tease but as I thought about it, he asked a very good question. I say that because I have personally experienced both in my attempts to take care of myself in my work as a chaplain. I believe there is a fine line between self care and self abuse. For example, in my own case I have used alcohol, tobacco, and comfort foods in excess. I have worked too much in unhealthy stressful environments and didn’t pay enough attention to achieving a healthy balance. I didn’t stop to listen to myself and spend time in prayer and meditation. My psychiatrist at the VA says that I have always been busy doing. A few years ago I began to address self abuse and work towards healthy self care. I began to explore my leaning towards a commitment to the contemplative life and contemplative prayer which works for me. It took a painful second flare up of pancreatitis and a diagnosis of Type II Diabetes to help me move towards a healthy self care.

When chaplains contemplate self care it needs to be defined. In the competencies of the Association of Professional Chaplains; Section II: Identity and Conduct, it states, “Attend to one’s physical, emotional, and spiritual wellbeing.” In the critical juncture for candidates being considered for board certification, a Certification Committee makes the decision if the candidate is ready. One of the questions which the candidate must answer to the satisfaction of the committee is this one addressing self care. Now it is one thing to be able to articulate how one will take care of oneself in professional chaplaincy but another to actually practice a healthy self care. Stated succinctly in Chaplaincy Today, “Self care is about health and wholeness, being well spiritually, emotionally, physically, and mentally—for the purpose of renewal and personal and professional growth.”

I will use myself as an example of a professional chaplain who has practiced both self abuse and self care in my ministry. When I was asked to be your speaker on the subject of self care, I accepted knowing that maybe I could be helpful to some of you who are still early in your chaplaincy work. The first thing I did was to e-mail a good friend, mentor, and former chaplain colleague I worked with at St. Charles Medical Center. He is the senior chaplain with over 25 years of experience. He is a year younger than myself and board certified through National Association of Catholic Chaplains. I asked him to reflect on how we struggled to stay healthy in a very stressful work environment. Since my departure, I asked if our department had developed any policies or practices regarding self care of chaplains. He said no which is not unusual for spiritual care departments. But that doesn’t mean that self care shouldn’t be intentionally encouraged by institutions employing chaplains. What he did write came out of his CPE experience. He responded to my question saying, “Sounds like an enneagram 2! Timing for this talk should be good for you though with the tending to self your docs have demanded. CPE gave us ‘Love yourself as much as those you spend your time and energy and health on. All things in moderation or you will pay the price. The five rules of homework for chaplains are: (1) Don’t drink more than you should; (2)Don’t eat more (or types of food) than you should, (3) Keep your prayer life up; (4)Make sure you get all the sleep you need; (5) Always have someone you can really talk to. Someone who will let you yell, cuss, and/or cry and forget all about it.’ He was that person for me. He concluded, ‘As we have experienced – fall short in any one of those categories and you pay the price.” Of course, I know these rules and so does he. But I have broken them and paid the price; loss of health, inability to focus on those who I am called to serve; inability to continue my ministry, and to inability to maintain healthy relationships.

Next I want to provide a context for ministry at St. Charles with 260 beds. There was always a shortage of chaplains to do the work, not unlike nurses and other professionals in our institutional setting. We had 4 full-time staff chaplains and several on-call chaplains. But 1 of the full-time chaplains worked at the Redmond hospital with 40 beds. We reported to a Social Worker (LCSW) Administrator who was also an LDS Bishop. He supervised social work as well as spiritual care. Prior to that we were supervised by a B.S. Nursing MBA supervisor on Medical floor. She reported to one of the Vice-Presidents who reported to the CEO. Chaplains had always played a major role in this former Catholic hospital which was more than just meeting JAHCO standards. Having said that, we didn’t have much say in decision making which is a stressor. Of the four staff chaplains, two were board certified and two were certifiable having completed their CPE requirements. There was one Roman Catholic male, two Protestant (ELCA female and Presbyterian male) and one Jewish male. One on-call chaplain was a retired Catholic priest (NACC), two UCC pastors, and a Unitarian pastor all certifiable. We were open for business 24/7 and a chaplain was on duty during the weekdays from 6 a.m. to 10 p.m. After hours a chaplain was on call weeknights and weekends. My shift the last couple years were 3-12s, W-F, 10-10 p.m.

The geographic context for the hospital spanned Central and Eastern Oregon. We also responded to trauma in Southern Oregon. This is a huge area of sparsely populated towns, ranches and wilderness. The region is recreational with the Central Cascades and other mountain ranges, lakes, rivers and streams, and high desert. The largest population is in Bend (100,000), home to many retirees of the 1%ers from Southern California and the Bay area mostly. There are also summer and winter sports enthusiasts: skiers, rock climbers, triathletes, mountain climbers, bicyclists, hikers, hunters and fishermen. Many young people are in this group who work in the service industry and/or attend the local community college. The hospital is situated near reservations so we served the Native American communities. There are also many Hispanics who work on the ranches and farms, some documented and some undocumented. There are many homeless who drift through Central Oregon and some permanent residents. Bend relies on the building industry, residential and commercial, for its economy and it has been severely depressed for since we relocated in 2007.

St. Charles is a busy hospital, with high acuity. As a level II trauma center, the ER is hopping with helicopters, fixed wing aircraft and ambulances bringing in patients. Most patients can be treated except for burn patients and babies from the NICU. Patients are sent to Portland or Boise. Chaplains receive pages and referrals. As part of each medical unit team, overhead pages send codes to be responded to and individual pagers go off at the same time. Chaplains offer a calming presence and provided spiritual and emotional care. If there is family, the chaplain will sit with them in a waiting area. In crisis situations, chaplains are called upon to offer pastoral support. It is understood among the caregivers that chaplains diagnose and treat spiritual pain and distress. St. Charles averages about 5 deaths a day in the hospital. Chaplains are assigned to the different units: Medical, Ortho-Neuro (me), MedSurg, Pediatrics ER, PES, CCU, NICU (all of us); Cancer (me), Nursing Rehab (me); OR and SurgiCenter; Family Birthing, Psychiatric In-Patient. Our chaplains do not see all the patients on the floors. It is difficult to keep up with the pages and referrals. A stressor is to know that there are patients who might benefit from a visit from a chaplain. But it is a spiritual triage and there is the need to prioritize.

Another major stressor in working at St. Charles and the VA is to have to take call. None of the full-time chaplains liked it but we each had to take one night a week and sometimes two or a shift on the weekend. This includes covering the Redmond center 20 miles north of Bend. On the average chaplains are paged about every hour and have to go in at least once per night. From my house it was a 20 minute drive. Road conditions could be treacherous with black ice and snow. I was struggling more and more with sleep deprivation on my nights of call. I very intentionally got myself into a prayer and meditative mode enroute to the hospital. I prayed for the patient, family, caregivers and myself that I would do no harm and that God would give me the words and presence that would be helpful and healing. I never knew what I was walking into which was always a stressor. And so after prayer I breathed deeply and meditated.

In later reflection, I felt that I had the best training possible to do this work, preparing me to do this ministry calling in chaplaincy. I had years of life and ministry experience as preparation. But like anything else, training is training and there is no substitute for direct work experience. I drew strength and guidance for my service to others and for self care from contemplative prayer and meditation. The psalms provided the contemplative readings I most need to reflect on for self care. Monks pray them daily in their offices of prayer and complete the psalter each week. Like anyone, there are particular psalms that speak to me and fill my spirit with God’s love and compassion. I want to share the 91st psalm which speaks to me in a very personal way. Let it speak to your soul. If you wish you can hear YHWH (I am who I am) the unspoken name for God in place of LORD, which is rendered in the English translation in place of it in capital letters. Listen.

You will live in the shelter of the Most High, who abide in the shadow of the Almighty, will say to the LORD, “My refuge and my fortress; my God, in whom I trust.” For he will deliver you from the snare of the fowler and from the deadly pestilence; he will cover you with his pinions, and under his wings you will find refuge; his faithfulness is a shield and buckler. You will not fear the terror of the night, or the arrow that flies by day, or the pestilence that stalks in darkness, or the destruction that wastes at noonday. A thousand may fall at your side, ten thousand at your right hand, but it will not come near you. You will only look with your eyes and see the punishment of the wicked. Because you have made the LORD your refuge, the Most High your dwelling place, no evil shall befall you, no scourge come near your tent. For he will command his angels concerning you to guard you in all your ways. On their hands they will bear you up, so that you will not dash your foot against a stone. You will tread on the lion and the adder, the young lion and the serpent you will trample under foot. Those who love me, I will deliver; I will protect those who know my name. When they call to me, I will answer them. With long life I will satisfy them, and show them my salvation. NRSV

Self care addresses the same spiritual issues for chaplains as for patients, loved ones, and staff. But most often employers don’t include self care in an intentional way for chaplains and other staff. Chaplains chart stressors for patients after a visit and in hospice charting can extend to primary care givers. For chaplains, a common stressor is compassion fatigue. Hudnall Stamm calls it secondary traumatic stress. He writes, “There is soul weariness that comes with caring, from daily doing business with the handiwork of fear. It lives at the edge of one’s life, brushing against hope and barely making its presence known. At other time, it comes crashing in, overtaking one with its vivid images of another’s terror…” Compassion fatigue, spiritual and emotional fatigue, can surface in feelings of ‘helplessness, anger, irritability, sleep disruption, fear, anxiety, guilt, grief, etc. It can also lead to burnout and heightened stress.’ Your chief stressor as a New York state prison chaplain has to be the unknowing about who will receive termination notices. That has to be a huge source of stress now that you are considered “non-essential employees.” Other stressors for chaplains related to the job can be “insufficient resources, disrespect, lack of pay, lack of security, and perceived lack of opportunity” and relationships with peers and supervisors.