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Healthcare as a Ministry
By Verna Benner Carson, Harold G. Koenig
Templeton Foundation PressCopyright © 2004 Verna Benner Carson and Harold G. Koenig
All rights reserved.
Healthcare as a Ministry
A life devoted to things is a dead life, a stump; a God-shaped life is a flourishing tree. —The Message
HEALTHCARE AS MINISTRY
This chapter presents stories told by doctors, nurses, chaplains, physical therapists, and other health professionals, discussing the concept of ministry as it pertains to healthcare, exploring the sense of call that led them into their chosen fields, examining how they define spirituality and religion, and describing how their spirituality and/or religious beliefs influence their daily work.
Many may react with discomfort to the idea that healthcare is a ministry, believing that the term "ministry" belongs to the clergy—priests, ministers, chaplains, rabbis—and to members of religious orders. Many would argue that years of professional education and training serve to mold the scientific, objective, and sometimes interpersonal distance that contributes to "good" science.
Yet for many healthcare professionals, there is so much more. Ministry is at the heart of what they do, and at the heart of ministry is service, comfort, relief of pain, healing, and support when healing is not possible. This ministry, supported by prayer, is descriptive of healthcare rooted in spirituality.
Oncology nurse Miriam Jacik believes that the focus of a profession and a ministry are slightly different, and that with the profession comes a "setting apart" of the helper from the person being helped. Catholic theologian Henri Nouwen, in a similar vein, observes that with increasing professionalization comes a widening space between the professional and the patient. This widening space tends to produce in the patient feelings of intimidation, fear, and apprehension toward the more powerful professional. Patients may believe that the education and training of the professional have endowed him or her with mysterious power. Patients view healthcare providers with a mixture of fear and awe, accepting that the professional uses a language that cannot be understood, does things that cannot be questioned, and often makes decisions about patients' lives with no explanations. The poor, who already bear a disproportionate amount of suffering, are especially subject to these emotions. Many leave places of supposed healing feeling physically better but hurt by the interpersonal treatment they received at the hands of a healthcare provider.
This situation is not totally the fault of the healthcare professional, who is often the first to recognize the challenge of remaining interpersonally open to patients. The healer is under increased demands to do more, see more patients, complete more paperwork, deal with more bureaucratic requirements for payment, be aware of changing healthcare regulations, and remain current on advances in healthcare. The challenge to healthcare providers committed to ministry is great and requires constant striving to develop a personal spirituality that energizes them with purpose and meaning, enables them to find the time to ease the interpersonal pain experienced by so many of their patients, and protects them from excessively absorbing and becoming immobilized by that pain.
CHARACTERISTICS OF A MINISTERING PERSON
Carol Story, a parish nurse, shares an experience of ministry:
On one occasion I was talking to a patient dying with cancer. This man had earned his Ph.D. and had dedicated his life to teaching. He was questioning the value of his life—had he made a difference? What did his life mean? We spoke for a long time about his life. He shared a painful experience that occurred when he was fifteen years old. A pastor had embarrassed him in front of the congregation by berating him, predicting that he would never be anything or anybody of significance. He reflected that he had taught a few students who moved on to be leaders in sports and education.
As I listened to all he shared, I synthesized what I was hearing. "What I am hearing you say is that you always felt unworthy of any praise because of what one man said to you as a young man." He looked at me and said, "Yes, you have put into words something that I have struggled with for years—but it is true. I have always wondered if I measured up and felt unworthy. Thank you." Then I simply said, "May I give you a message from God?" He replied, "Yes." I said, "God loves you, and I believe he is going to say, 'Well done, thou good and faithful servant!'" He grabbed my hand and said with tears, "Thank you," and then asked me to pray with him.
Carol Story provided good nursing and good ministry.
Thankfully, there are many who practice every day, in hospitals, clinics, offices, homes, nursing homes, and professional schools, motivated by a powerful call—a sense of rightness about what they do. Each of these professionals draws from a deep personal spiritual well that keeps them nourished and allows them to minister to patients, families, co-workers, and even institutions.
In her examination of medicine as a ministry, Margaret E. Mohrmann, a physician, believes that the care of suffering persons requires that caregivers, drawn from within and beyond the ranks of the medical profession, acknowledge and honor the life stories of those to whom we provide care. Mohrmann emphasizes that God loves us as unique persons, each precious in his eyes. We have different needs, different problems, and different stories, so that honoring each of our stories requires a personal approach and a relationship that recognizes and responds to our uniqueness. At the heart of being a ministering person is seeking to hear and understand the story of the suffering person standing before us and to encourage hope in that person in developing the next chapter of the story.
Let's examine the specific characteristics of ministering healthcare professionals who seek to hear and respond to the stories of patients.
The first characteristic is the ability to enter into a relationship with another and share that individual's pain, to listen even when it causes some inconvenience, to say little or nothing and at other times to raise questions for reflection. Physician Jack Hasson states, "My own spirituality makes me more sensitive to others. When I recognize that a patient or family has a desire to express their spiritual needs, I try to allow this expression without applying my own belief system. They know best what works for their spirituality, and I allow myself to be a conduit for their feelings and pain. I will then amplify and confirm their belief if possible." This is a good example of allowing space for the other's beliefs and pain. It is in this space that the patient and healthcare provider can reach out to each other and "connect as fellow travelers sharing the same broken human condition."
The second characteristic of ministering persons is that they take the role of companion to another's journey rather than problem solver or rescuer. This involves serious reflection about the concerns of the patient, being present when needs arise, and sensing that we share a sense of helplessness and brokenness with the one we are helping. Miriam Jacik recounts:
As an oncology nurse I had frequent occasion to see and experience patients and their family members grappling with the meaning of illness, suffering, and death. Helping them ask their own questions and arrive at their own answers in time was a spiritual service that I could offer. Seeing them turn from anger at a God who would let terrible things happen to good people, to seeking strength and comfort needed from that same God, always strengthened the faith of all of us. Helping family members let go and release their loved ones to the process of death and into the arms of the God of their beliefs was a spiritual service that my personal beliefs and values allowed me to provide.
The third characteristic of a ministering person is the ability to love the unlovable, the ungrateful, the uncooperative, the aggressive, and the unreachable. Charmin Koenig tells a story of a challenging patient for whom she provided care.
There was one patient, a woman who suffered greatly from migraines. I had such compassion for her—I understand what it is like to suffer from migraines. The rest of the staff were angry with this patient because they believed that she abused the system—she came in so often for pain medication. I saw something different. I wanted to work with her, and of course no one argued with me about this. They were glad that they didn't have to care for her. She was a very angry woman, angry at life, but most of all angry at God. Even though we did not share the same beliefs, I had opportunities to pray with her. I prayed for her healing, but more specifically I prayed for "heart healing." When she came in for care, she always asked that I be her nurse. Over time there was a dramatic change in her attitude—she seemed to soften, to harbor less anger.
The fourth ministering characteristic is that we accept our own brokenness, humanness, and fragility so as to enter into relationship with those who are burdened by the difficulties of life. This allows the freedom to cry with a person in sorrow, to rejoice with one who meets success, to share anger in the face of injustices, and to accept the doubts and confusion caused by the events of life.
Kelly Preston shares a story from early in her nursing career.
I was working in oncology. One night a man was admitted with a serious heart condition but also terminal leukemia. Within twelve hours of being admitted, he was dead. We were unsure of his code status, and when he experienced a cardiac arrest, we initiated a code on him. We shouldn't have. I felt awful about the whole situation, that he died so quickly, that we put him through the trauma of the code. I just felt the pain of it. When I saw his wife and daughter, they embraced me, and we cried and prayed together. They told me that it meant so much to them that I was present to them and not afraid to share my emotions.
The fifth ministering characteristic is to be a facilitator of change in others but not assume responsibility for that change. Let's listen to Chaplain Robb Small's story.
I ministered to a middle-aged woman who suffered from mental health issues, including depression and anxiety. When I first met her, she talked constantly, ending every sentence with a catch phrase, "But God will never put more on a person that that person can bear, don't you agree?" For some reason, I chose not to verbally answer her and instead sat and listened attentively for a long time with only occasional head nods or other gestures. After about an hour of this, the patient stopped and asked me if this was the way I ministered, just sitting and saying nothing. I replied that I felt that she needed to talk more than listen to me. At first she became angry and stated that I was supposed to be the helper and that I was called to fix her problems. Over time she became angrier that I would not respond with "God talk."
After a few visits, she asked me one day what gave me the ability to resist telling her what to do or believe. It was easy at this point to explain that in my spiritual experience, her greatest need was to discover the answers from within herself, and my job was to facilitate that process with whatever resources I could bring to the relationship without giving advice. The most important role I could offer was to listen attentively, be present, unconditionally accept her condition, and share God's love and grace.
The sixth ministering characteristic is to allow others to make decisions and support them through that process. Martha Loveland shares a story about a hospice patient who preferred not to have further medical treatment or heroic care.
The patient's spiritual beliefs allowed him to be accepting and peaceful about his impending death. He did ask to have his pain reduced as much as possible. However, his son insisted that he participate in a research protocol. The son did not state his motives for this position, and his insistence was distressing to his father. Because of my spiritually based valuing of both of them, I was able to bridge the gap between them. I assured the patient that what he wanted could be arranged and would be the basis of the plan of care. I assured the son that his father loved him and the family, was not desirous of dying, but didn't want to be an unnecessary burden. I also stressed that his father had the right to choose the manageable conditions surrounding his impending death. I explained to the son that this right was extended to everyone and protected by federal law, the Patient Self-Determination Act. I taught the son ways he could support his father and enjoy the remaining time as much as possible.
The seventh ministering characteristic is to accept that solutions to problems are best arrived at by the person being served. Cynthia Ann Poort describes an experience of working with a patient with AIDS and how, through her presence and nonjudgmental listening, he was able to resolve painful personal memories and restore broken relationships.
When I was a staff nurse, I cared for an AIDS patient who was slowly dying. He received a two-hour intravenous infusion daily. My job was to start the infusion, remain in the home, draw blood work, and leave after discontinuing the infusion. I was in his home for two hours daily for about two months. We spoke of many different topics as we waited for the IV to infuse. He expressed a great deal of anger toward his father, who had been a church deacon. The patient believed his father was a hypocrite because he had an affair with another woman while his mother was dying. The patient stated that he hated "Christians" for this reason. He told me that his father had married the woman with whom he had the affair, and to show his anger toward his father, the patient showed up in "full drag" at the conservative church wedding.
My patient was alienated from all his family members except for a grandmother who occasionally called on the phone. His former significant other had died of AIDS about one year earlier. I was able to listen to my patient and help him deal with his anger, grief, and alienation from his spiritual upbringing and his family. He came to realize that spirituality and the form of religious beliefs that one espouses may not be the same thing. He reconnected with his grandmother, who had great faith, and was able to come to terms with his anger toward his father. He really had not wanted to deny his faith, but had done so out of his anger toward his father. He was able to forgive his father even though his father was now dead and was able to prepare for death and feel some peace in his life.
The eighth ministering characteristic is the ability to recognize that one cannot put an end to others' psychological pain and suffering, but can be a witness to it and give voice to that suffering. Dr. Gunnar Christiansen shares his experiences as a volunteer working with the mentally ill: "It is not uncommon to have questions from those with a serious mental illness, such as, 'God, why me?' and 'What did I do to deserve this?' Although I do not feel that we have answers to these questions, I feel that it is helpful to discuss the questions. In my experience, I believe I have been more helpful in these discussions with those individuals who share my faith."
The ninth characteristic of a ministering person is the ability to accept others the way they are and make no attempt to fashion them into different people.
Carol Story shares her experience working with an elderly gentleman who expressed views very different from her own beliefs.
On one occasion, I was talking to a ninety-year-old man who told me that his mother had been Catholic. He asked me if I was Catholic or a nun. When I said no, he launched into his story. He was cognitively alert, very expressive and direct as he told his story. "When I was a little boy of ten, someone at my school made me bow down on my knees, and I had to kiss his ring. I vowed that I was never going to bow down to another man. So I refused to go to that school anymore. But I was faithful to my mother. I took her to church up until she died." He paused and said, "Her face glowed when leaving church." I asked him, "Where did that glow come from?" He said, "You know where it came from."
He continued with his story as tears began to roll down his cheeks. He told me how he had raised his children around the table on the Bible. "You know there are some parts of that Bible that aren't true. For instance, God made man in his own image. Well, you know that isn't true. God is spirit and we aren't." He then changed the topic to tell me that he learned to meditate from his daughter. I asked him, "Would you tell me how you meditate?" He explained this to me, and then we sat in silence.
I began to pray that the Lord would give me something to say, and suddenly I said, "Can we talk about your mom for a minute?" He said yes. Then I gently touched his chest and asked, "What were you feeling in here when those tears came down your cheeks?" He looked at me, and, with tears again, said, "Broken." And I asked, "What would it take to fix it?" Brushing the tears away, he looked at me, shook his finger in my face, and said, "You!" I said, "Me?" He said, "Yes! You sitting here listening to me, believing that I am not just an old man who doesn't have a brain and that I can't think for myself. No one has to tell me what I believe, because I know what I believe."
We both sat there for a minute, and then I thanked him for sharing with me. He asked me to pray for his wife, and during the prayer I asked God to bless this gentleman for sharing his faith with me.
Excerpted from Spiritual Caregiving by Verna Benner Carson, Harold G. Koenig. Copyright © 2004 Verna Benner Carson and Harold G. Koenig. Excerpted by permission of Templeton Foundation Press.
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