Monday, May 07, 2012

End of an Era

1: Background

My hospital has been sold.  All of the hospitals in this area – like so many hospitals across the country – are having terrible financial problems.  If my hospital hadn’t been sold, it would have had to close.  In everything else I say here, keep in mind that closure would have been worse.

The sale’s been percolating for many months.  At one point, it looked like we’d be sold to a particular company: I got online and checked out the websites of the hospitals in their system, and a number of them had spiritual-care departments, and when I spoke to my supervisor, he confirmed that they were sympathetic to spiritual care.  So we were happy.

But that sale fell through, and we were sold to another entity, and when I checked that entity’s hospitals, none of them had spiritual care departments.  And my supervisor confirmed that fact, too, and said it didn’t look good.

2: The Plot Quickens

A few weeks ago my supervisor told me that he had been fired and that there would no longer be a Spiritual Care Department.  He didn’t know what would happen to volunteer chaplains.

This past Friday, I passed his office on my way to sign in for my shift, and ducked inside to say hi.  “Anything new?” I asked.

“Oh, yeah.  There won’t be volunteer chaplains anymore.  The last date they can work is, uh . . . “ – he checked his calendar – “the 18th.”

“Of May?  That’s in two weeks!  We haven’t gotten a letter!”

“It will go out Monday.”

I felt like I’d been sucker-punched.  I reeled through my shift, fighting periodic tears, venting to a few staff.  One doctor I hadn’t even talked to came up to me (very unusual, but it was a slow shift) and said, “I just heard. I’m so sorry.  You guys are so important.  Please let me know if there’s anything I can do to help.”

I kept wondering aloud if there’d be some way for me to stay in the ED, maybe as a patient advocate, but everyone told me I’d have to talk to the hospital’s volunteer coordinator about that, and she was on vacation.  So I finished up that shift and came home in tears, heartsick and furious.

3: Big Picture

A lot of my anger was political.  My hospital is the only one in the area that still has in-house Spiritual Care; after the change, there won’t be any.  The importance of spiritual concerns in illness and healing is pretty general knowledge these days, and after seven and a half years of doing this work, I know firsthand how much prayer, comfort and conversation mean to patients.  I literally can’t count how many patients have wept in gratitude during my visits with them, how many of them have told me that they feel better just from talking to someone like me.   I may even have played a tiny role in helping save a life or two, simply by – for instance – offering suicidal patients a different perspective on their despair.  I know for certain that during the time I’ve been volunteering, ED staff have asked at least twice for more chaplains in the department.  Emergency-medicine people are the ultimate empiricists: they aren’t going to ask for something unless they know it works.

It absolutely infuriates me that this crucial aspect of patient care is being abandoned because it doesn’t meet a corporate bottom line.  There’s no billing code for prayer.  Over the weekend, I talked to a professional chaplain who confirmed that it’s not just us: Spiritual Care Departments are being dismantled, and chaplains fired, all over the country.  This is only one more indication of the country’s economic slough.  Once again, I’d rather see departments dismissed than see entire hospitals close, although I have to wonder if Spiritual Care actually has a positive effect on the bottom line that no one’s bothered to try to measure.

4: Also, It Feels Personal

So I spent a lot of the weekend weeping and raging, not just over the dismal swamp of healthcare in general, but also over my own loss.  In case it wasn’t already obvious, I love being a volunteer chaplain, and I think I’m good at it, not least because my somewhat spiky personality is an asset, rather than a drawback, in the ED.  It’s often very difficult for me to see progress in the classroom, and I’m often despondent about my writing, but after any given volunteer shift, I can point with certainty to places where I did good work and produced palpable results.  Losing that role felt like having a body part torn off.

And this loss comes close on the heels of many others.  Over the last five years, I’ve lost both of my parents, Gary’s father, two cousins, an especially beloved cat, and my church.  The world feels a lot thinner than it did five years ago, and (like so many other people), I’ve also suffered losses connected to the inexorable tightening of standards in the university and the church.  Five years ago, I believed I would one day be both a deacon and a full professor: now I know that I won’t be either, because the level of insane hoop-jumping required to reach those spots - a function of nationwide changes in professional expectations - simply isn’t anything I want to attempt.  These decisions are choices, of course, but I’ve heard a lot of anecdotal evidence that this kind of bar-raising is happening in many other fields as well, placing a lot of jobs out of realistic reach of people who’d be very good at them.  Losing my cherished volunteer gig at the hands of a faceless corporation isn’t quite the same thing, but it pushed some of the same buttons: the powerlessness any of us feel in a world of moving targets we can’t map or predict.

Let me say here that I am also very blessed, and know it.  I’m very grateful for everything I have in a world where so many people have so much less.  That doesn’t change the fact that I’m also grieving.

It was not a good weekend.  I sent wailing e-mail to three of my clergy, cried a lot, went through some PTSD-ish bouts of anxiety when I started wondering what I was going to lose next – I probably drove Gary nuts with my clinging – and, not to put too fine a point on it, was a mess.  To be fair, I also did research.  My supervisor had recommended that I move over to being a hospice volunteer, and I talked to a hospice chaplain who said that I’d be very welcome.

5: Cautious Optimism and Tentative Plans

Today was much better.  I talked to the hospital’s volunteer coordinator, who sympathized completely and gave me a huge hug; I once visited her and a sick family member in the ED, and she’s a fan. She said that I should indeed be able to remain in the ED as a “patient advocate.”  I’ll have to reapply, as everyone else at the hospital will.  I’ll have to be retrained.  I won’t be able to say the word “God:” she said there are very strict rules about that.  But I’ll be able to stay in a place I know, where people know me, and I’ll be able to keep helping patients.

She also told me that the last day for volunteer chaplains isn’t the 18th.  It’s the 11th: this Friday, not next.  I have one more shift.

Today’s shift was full and busy and confirmed, yet again, the value of volunteer chaplains.  I prayed with a newlywed whose spouse was on life support, and who thanked me copiously.  I prayed with a woman who wept in gratitude and squeezed my hand.  I cheered up a lot of people just by popping in and asking if they needed to talk.

The doctor who’d come up to me on Friday was working today, too.  I told her about the patient-advocate gig and said, “I could move to hospice, but I’d rather stay here.”  She smiled and said, “We’d rather you stayed here!” which of course made me feel good.

I saw another doctor and filled her in.  When I said, “I can stay here, but I can’t say the word ‘God,’” she rolled her eyes and said, “You have got to be kidding me.  Well, just do what you always do and call it something else.”

Exactly.  And again, lots of what I do – talking to people about advanced directives, giving out the number of the crisis-call line, calling shelters to try to find beds for homeless patients – doesn’t involve explicit mention of God anyway.  Preach the Gospel without ceasing; use words when necessary.  The trick now will be finding safely secular words.

When I went upstairs to sign out, I ran into a social worker who usually works in the ED.  I briefed her, and she said, “We’re going to need advocates, big time.”

So that’s sounding like a plan, but I won’t believe anything until it happens.  I have no idea how long it will take for the new volunteer training to happen.  In the meantime, I’m going to call hospice and check on their training schedule, since they only do trainings once or twice a year and I’d hate to miss out.  I’m hoping that their training will be far enough down the road that I can try the patient-advocate role first, see how I like it, and switch to hospice if it doesn’t work out.

Over the weekend, I got supportive, sympathetic responses from two of the clergy I e-mailed.  Today the third, my rector, called.  He told me that he always needs pastoral-care help in the parish, people to help with hospital and home visits.  So that’s another possibility.

I really do love the ED, though.  I love the clinical setting, the snippets of Cool Medicine I get to overhear, the sheer diversity of the department.   So I’m really hoping that being a godless patient advocate will fill the bill for me, although there will certainly be challenges.  Today – as happens fairly often – a patient recognized me from a previous hospital visit, and thanked me for praying with her then.  What will I do if that happens after the changeover and the patient asks me for prayer now?

“Point at the ceiling,” said Gary, my creative nondenominational pagan.  “Use the Voldemort strategy:  Pray to He-She-It Who Must Not Be Named.”  

Actually, I’d probably break the rules, say the G-word, and hope that no one called the cops.  But it’s going to be very interesting to see how all this works!


  1. I'm so sorry, Susan, for patients and for you. My sense has been from reading your posts that you are a compassionate and effective chaplain and feel a true call to this role. I pray that you'll find another place to use your gifts.

  2. So heart-wrenching to hear these things happening. Your passion is so obvious here; you'll find your place again, I'm sure.

  3. Anonymous6:16 PM

    I'm so sorry for your loss. The current climate in healthcare is scary and some days it seems that the last consideration is what is best for the patient. For what it's worth, I think you would be a great patient advocate. Hospice is difficult but so rewarding. I'm glad you have options.

  4. I am so sorry that you are faced with another loss, and I hope the new directions work out well for you. I loved the expression "godless patient advocate"

    You are so good with words. And I appreciated reading about the possibilities you are looking at because I have suddenly achieved time to spare by being surprisingly retired

  5. Thank you, Stacey and Jill and Annette. And Annette, Congrats on your retirement!

  6. Anonymous4:46 AM

    I am so very very sorry to hear this. It seems especially poignant on the heels of your Brief Visits being published. I hope patient advocate works for you. Maybe you can adopt some of the Quaker terms for God/Grace: the Light, Inward Light, Inner Light, Spirit, etc. Of course, with no religious context, people will probably think you're being new-agey.

  7. Susan, I'm sorry to hear that you're losing this wonderful gig but glad you've got a couple of alternative plans in the works. Compassion is so helpful when you are scared as lots of hospital patients are.

    Prayers ascending that things work out for the best and that God lights the way for you.


  8. Damn, I'm sorry to hear that. There's no doubt in my mind that a few minutes of emotional/spritual care can make a huge difference in the quality of a patient's hospital experience (ugh, that sounds so marketing-buzzwordy I can't believe I said it), not to mention the family & friends. (Not to mention the other services you mention providing, which hospitals ought to hire people for, and can't afford to.) But there's no balance sheet for quality, damn it.

    If you're stuck for how to "not mention" God, you could always use the agnostic's prayer from "Creatures of Light & Darkness" :)

  9. oh, susan.

    i am so sorry. i was thinking of you this week and wondering how you are.

    i saw a stone in the water in a lake out in the wilderness of northern maine and i almost picked it up to send to you, but then didn;t because it seemed to me silly to start sending you an annual package of small stones.

    but of course i have been saved by hospital chaplains, once by a chaplain they called out of bed to come tend to me.

    i like to think that if a patient asked you to pray as a secular advocate, you could legally do so.

    the last hospital i was in had no chaplaincy; it was an emptiness i felt too keenly.

    these days i've been caught in a spiritual crisis. i have thought sometimes i wished to hear your voice in it.


  10. I also work as a hospital chaplain and, in my experience, 95% of what we do is empathetic listening. That won't change for you, so keep doing the good work, regardless of what it's called.

  11. Dear Susan,
    I'm so very sorry this is happening to you -- and to the hospital's patients and their families! Your work is the very essence of compassionate advocacy. You are in my warmest thoughts and prayers.


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