Sunday, July 22, 2007

Making Meaning

A few weeks ago, a patient at the hospital started quizzing me about my credentials. "You're a volunteer chaplain? So you're a minister?" I explained that I was a lay minister, not ordained clergy. The patient looked baffled. "So you don't do this all the time?"

"No, I do it four hours a week. My day job is being an English professor."

The patient raised his eyebrows, and then squinted. "How completely bizarre!"

"Why is that bizarre?"

"Those two things have nothing to do with each other!"

The patient's doctor came in at that point, so I didn't have a chance to tell him that actually, the two things have a lot to do with each other. At the university, my bread-and-butter course is a fiction workshop where I encourage students to tell stories and (with luck) give them pointers on telling those stories more effectively. Often this involves helping them decipher what the stories actually mean, either to them or to the reader: identifying patterns, motifs, recurring metaphors.

At the hospital, I encourage patients to tell me their stories, and in the telling, the patient often gains new insights into what those stories mean. Sometimes the meaning of the stories has changed in the new environment of the hospital; sometimes the patient is casting about for a new story, a new way of explaining his or her life in the face of crisis.

But helping other people make meaning is my task in both places. The main differences are that the stories at the hospital are oral, rather than written, and that -- hallelujah! -- I don't have to grade them. And if my title at the hospital is "volunteer chaplain" rather than "volunteer story coach," that's because story-telling is a deeply spiritual act. Stories connect us with our pasts, with our hopes and fears for the future, and with the people we love. Stories are the threads we use to bind ourselves to what's bigger than we are, so that the bigger thing -- whatever we choose to call it -- can help carry us when we can't carry ourselves.

Many months ago, a suicidal patient was brought in by ambulance, in the fetal position. He hadn't eaten for several weeks. He'd been holed up in an SRO, planning to die, but then something moved him to call 911 instead.

Speaking listlessly into his pillow, he told me a long, sad story: struggles with alcohol, no friends or family or job, almost total despair.

"Is there anything that makes you happy?" I asked him.

"Like what?"

"Well, sometimes people who don't have anything else cling to music" -- he shook his head slightly -- "or to art" -- another shake of the head -- "or to a place they love."

He blinked. "A place? Well, there was this lake I used to visit." As he told me about his beloved lake in the mountains, describing fish and birds and trees, his voice grew stronger and more animated. The man who'd been in the fetal position uncurled, sat up, and started using his hands to imitate the movements of the birds as he mimicked their calls. "So my favorite birds, they'd skim along the surface of the water and then they'd dive down for food, but they always dove at the same time. They were perfectly synchronized. It was amazing. I loved watching those birds."

"Would you like to see that lake again?"

"Oh, yes!"

"Then that's a reason to stay alive, right?"

He grew quieter again as he pondered this, but then admitted that yes, it might be.

I ventured to use a metaphor with him; I still don't know if it was the right thing to say. "And, you know, those birds you love had to dive down under the water to feed themselves. They had to dive deep. Sometimes when life is hard, we have to do that too. It may look like there's nothing on the surface to keep us alive, but if we dive down, we'll find food."

"I'll think about that," he told me, although now he sounded more polite than enthusiastic. But at least he was still sitting up.

During that visit, I used skills I've learned in my work as an English professor: identifying the most important element in the story, helping the author identify it too, linking it to desire, which is one of the engines of narrative.

The stories I hear at the hospital are often disorganized and almost always fragmentary; they don't offer the pleasure of the perfect prose passages my students sometimes achieve, especially in revision. But I rarely get to see my students come back to life before my eyes, or wrest significance out of crisis.

I wouldn't give up either arena for the world.


  1. Anonymous11:58 PM

    Health Care Chaplains are professionals who have studied ministry and pastoral care in a graduate school of theology, and who have completed a full year of residency training and supervision in a hospital Clinical Pastoral Education program. Chaplains must have ecclesial approval, with solid grounding in a specific faith tradition as well as specialized training in ecumenism and interfaith proficiency. There are further standards and competencies one must demonstrate to the certifying panel. Only then can one be certified as a professional health care chaplain.

    We Love our Volunteers! They bring their special gifts and spirituality, compassion, a listening presence and a willingness to help hospitalized patients.

    We Honor our Volunteers! They hold a special place in our Spiritual Services departments, and
    they work wonders by their presence.

    Yet, to be called "Chaplain," we have completed specific education, training and spiritual formation. For that reason, we respect our professionality by using the title of Board Certified Chaplain.

    Volunteer Spiritual Caregivers, Volunteer Patient Visitors or Chaplain Assistants are wonderful! Yet, without certification, one really cannot be considered a "volunteer chaplain."

    No matter how much the university might appreciated a skilled writer, without an advanced degree and teaching credentials, if that generous person assisted in the classroom, she probably would not be called a "Volunteer Professor."

    Thank you for the good care that you provide. I honor your contribution, and I enjoy your writings and reflections.

    Bless You!
    Chaplain Virginia

  2. Virginia:

    I've been trained, and am supervised, by professional, board certified chaplains. My hospital name badge says "volunteer chaplain," not "professional chaplain," to indicate the difference. The staff chaplains call me "chaplain." This is specific to my hospital, of course; I know it works other ways in other places.

    There are some aspects of professional chaplaincy for which I'm of course unqualified. But being a caring a presence and a good listener (which is a large part of chaplaincy work in uncomplicated cases) simply doesn't require 1600 hours of CPE plus a related masters degree.

    I routinely refer patients and families to staff chaplains when appropriate.

    The best analogy is probably to physicians and PAs: PAs can't do everything, but they can do a lot.

    I've posted elsewhere, at some length, about the volunteer/professional debate in PlainViews. If you'd like links to those posts, please either e-mail me privately (my e-mail address is in the profile) or search on the "chaplaincy" label.

  3. I think you did a wonderful job here, Susan. I'd be worried too that he might not find the message acceptable. It might sound like a lot of work for nothing. This may be correct or it may not but, I remember when I took a class on psychology in college and they told us that people who attempt suicide do it at the point where things are just starting to look up. That always struck me as important to know. It sounded like if the patient had waited just a little bit longer they would have wanted to live. Have you heard anything different or pertinent?


  4. Lee --

    The most dangerous time is when people are starting to get more energy. When they're in the worst of the depression, they often can't complete any task; when physical energy begins to return but the person's still seeing the world through the dark lenses of depression, the risk of suicide increases dramatically.

    Interesting comment about "a lot of work for nothing." My take was that this was how the patient had been feeling about life; I was trying to substitute a model of "some work for something" instead.

    I hope he's okay.

  5. Anonymous10:37 AM

    Wow, what a story about the the suicidal patient! I've been reading Garrison Keillor (books get me out of the doldrums) and Lake Wobegon might be imaginary but it's paradise, much like the memories the patient had. You have a gift in your volunteership. Have you heard what has happened him?

  6. Anon.,

    No, I rarely get follow-up info, unfortunately, unless the patient comes back to the ED. And if this man's been back, it hasn't been while I've been there.

    Another factor in the apparently dramatic recovery is the healing effect of simply being around people, no matter how they're interacting with you. I believe there have been clinical studies showing that being with others raises serotonin levels. A social worker once told me that another suicidal patient was "a fake" because he'd been having an animated conversation with me. To her, this was evidence that he'd never really been depressed. To me, it was evidence that social contact was the medicine he needed.

    I think social contact is the hidden reason why a lot of patients -- especially the elderly and alone -- come to the ED. In that case, the appropriate response is to find better ways for the patient to spend time with people.

  7. Susan, I guess my comment came from the effect a friend of mine has on my feelings about recovery from depression that severe. He doesn't feel that anything he does will succeed or make a difference. He is also convinced that his life has no value. Thus my comment about the patient feeling like it would be "a lot of work for nothing." I know that when I was at my most depressed I didn't want to do much besides the routine. Working at anything above that seemed like a waste of time and way too exhausting until I got the idea that I could recover. Thank goodness I'm not suicidal. I pray that I never am. I hope the patient takes to heart what you said. I'm going to hope and claim that God's words don't come back empty and that seems to be what you were trying to give him.


  8. Well, Susan, I check back for the first time in a while, and we're still talking about the same things.

    Colleague Virginia, having read a number of Susan's case studies (not exactly verbatims, but close enough), and having been given the opportunity to offer some feedback (none dare call it supervision!), trust me that Susan is doing chaplaincy. She may be unpaid, but she's not unprepared.

    But, then, Susan, folks who've read my stuff know where I stand on this....

  9. LOL! Thanks, Marshall. I appreciate your vote of confidence. But I suspect the debate will continue for a while!


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