Difficult Seasons

I received this the other day from my friend Allen Thyssen.  Normally I wouldn’t just cut and paste, but this article is so good I want you to get to read it, and it’s not possible for me to just link to it.  I’ve done a little editing to make sure the folks involved can’t be identified.

The following posting was made by the daughter of a cancer patient who is currently in ICU.  It is a touching testimony to the value of a ‘ministry of presence.’  Please pass it on as you see fit. (Allen)

Update…well we are about the same.  We are just waiting to see if the liver will decide to get to work.  As we sit here with broken hearts we see just how merciful God is.  Even with all of this going on we received a good word from an unsuspecting source.  We were going through a difficult time and I guess this individual could hear me crying.  He comes up and says “I know I am a total stranger but I just wanted you to know I am here for you”.  Then his first question was “does your father know the Lord?”  We then began talking and he said “if we spent as much time praying for lost people as we did to keep the saved here with us…what a different world it would be”.  This fact has been evidenced by dad and his life.  If you remember, just a few days ago dad was witnessing to his nurse.

We then learned his grand-daughter has been fighting cancer,  and in the last 7 years she has had 11 surgeries.

While his grand-daughter is in ICU facing additional surgeries he took the time to reach out and comfort me.   I want to take the time to thank this man.  I don’t even know his name but God sent him to comfort me at just the right time.

In Part 1 and Part 2 I provided general information about making an ICU visit and the preparations I usually go through prior to walking into the ICU area.  In this post, I’ll talk some about the actual visit.

At M.D. Anderson, where I regularly make chaplaincy visits, the ICU units are organized as Pods, with rooms enclosed by glass sliding doors arranged around the stations where the medical staff works when not in a room.  That allows a visitor to see into the room before entering, and get some idea of what’s going on and who’s in the room.  After washing my hands, and sometimes putting on required protective gear such as gloves, a mask, and a gown, I gently knock on the door to let those inside know that I’m present.  I open the door and walk in, at the same time trying to get a picture of what’s going on.

I’ve learned to introduce myself clearly and slowly to give the patient and family members a chance to figure out who this new person is and why he’s there.  They’re used to people coming in and out frequently, but it gets confusing to figure out who’s who and why they’ve entered the room.  I also hand the patient or family member one of my business cards, as that also helps them process who I am.  The words I usually say are, “Hi, I’m Jim Hughes from Lifeline Chaplaincy.  We’re the church of Christ chaplaincy here in the Texas Medical Center, and I just wanted to come by and see how you’re doing today.”  Most of the folks I visit have identified themselves as members of the church of Christ, so that provides an immediate connection, even if they’re not familiar with Lifeline Chaplaincy.  Sometimes I add a little more information, especially if they’ve been referred to us asking that we visit.  I’ll tell them that, and mention the name of the person that asked us to come by.

Sometimes just that introduction is enough to start a conversation.  But most of the time, I ask a couple of questions to stimulate the conversation.  One that nearly always works well is, “So, what’s going on today?”  That gives them an option to say as little or as much as they want to, and I just listen, and try to respond in a way that they know I’ve heard them.  I find that I use words like, “Wow!” or “Oh My” a lot.  Sometimes my response may be, “Sounds like things are getting better, right?”  Other times I may respond, “Sounds like you’re having a tough time right now.”  Again, those are not only words to let them know I’m hearing what they’re saying, they’re also invitations to say more if they want to.  If they don’t bring it up in their conversation, which is maybe half the time, I’ll inquire about how they’re doing emotionally and spiritually.  Sometimes I’ll just ask using those words.  Other times, depending on how the conversation has gone to that point, I’ll use a phrase that’s a little different, like “How are you and God getting along these days?”  That’s a different question to many folks than “How’s your relationship with God?”

The conversation may be quite short, depending on circumstances.  Or it may go for a lengthy period.  We may talk about a lot of other things, and they may be important.  It’s not uncommon that the patient has a question that they’ve been thinking about, and want to have a discussion around that.  I’m there to go where they want to go — they lead, I follow.

At then end of the visit, I usually say something like, “I’d love to pray with you if that would be okay.”  Most of the time, the answer is “Please.”  But sometimes it’s not, and that’s okay.  If they want to pray, I also like to ask them, “What would you like to pray about today besides the medical issues going on?” or simply, “What would you like to pray for today.”  I’m surprised by how often there are other issues that are weighing on them that need prayer as well.

Then we pray, and what we pray about is what we’ve talked about during our visit.  In addition to carrying their needs and concerns to God, I want my wording of the prayer to convey to the patient and family that I’ve heard what they’ve shared with me, and that I am also concerned.  We generally then visit for another minute or so to close out the visit.

Sometimes, I’ll also have a visit with a family member in the waiting room.  That conversation usually follows the same general path, but with some additional conversation about how things are for them in the role of caregiver.  That gives an opportunity to talk about issues that the family member might not want to talk about in front of the patient.

No two situations are ever the same.  I remember one patient I visited weekly for a couple of months.  He couldn’t talk, but was awake.  I’d reintroduce myself, say a few words of encouragement, and pray with him. Sometimes the patients are delirious.  Sometimes they are alert and feeling good.  Sometimes their church experience has been good, sometimes it hasn’t.  Sometimes they’re getting better, sometimes they’re in the process of dying, or anywhere in between.  But what they all have in common is that they’re going through difficult days, they’re anxious, and they’re glad to have someone stop by and for a few moments share their life.

So what’s it like to make an ICU visit?  Seeing the pain, seeing people in such critical situations, seeing the effects of cancer up close and personal is not fun, sometimes even shocking even though I’ve been doing this for a while.  But making a deep connection with someone, even for a few minutes, is an amazing feeling.  And the more of life I experience, the more certain I am that making deep connections with others is what this life is all about.  Learning to love, as God is love.

Originally published in my personal blog.

In Part 1, I described in general what an ICU is like and and a number of the conditions you are likely to encounter when you make a visit.

In this post, I want to describe some of the preparation I use to help me be effective when I enter the ICU.  Hopefully, the information I presented in Part 1 helps you understand that an ICU is not a place you just walk into lightly.  It’s a very serious place because the patients there have serious medical conditions, they and their family members are anxious, and the medical staff has important work to do.  My presence in the ICU will hopefully be calming, encouraging, and non-intrusive.

Preparation is further important because I really have no idea what I’ll encounter when I walk into the patients room.  I have minimal information, usually just the patient’s name and room number.  I don’t know their condition, what they’ve been going through, or what family members may be present.  Sometimes I have visited them before, and so I may know something of their story.  But basically I go into every visit pretty much blind as to what I’ll find and what the needs are.  Surprisingly, that’s enough.

My goal is to go into each room neutral so that I can match — and not contrast with — the mood of the patient and family members.  That requires that I be able to put aside whatever else I’ve been thinking about, worrying about, enjoying, or whatever has happened earlier in the day.  I want to be able to give the patient and family my complete focus while I’m with them.

Sister Alice Potts, who was the first chaplain at M. D. Anderson, was a mentor to all of the staff chaplains that followed, and also to a lot of us who do lay chaplaincy.  She’s the one that impressed on us the importance of being neutral going into a room.  Her message to us was that if the patient is angry, then we should reflect their anger.  If the patient is frustrated, then we should reflect their frustration. If the patient is rejoicing, then we should reflect their joy. If they are speaking slowly and quietly, then we should speak slowly and quietly.  You get the idea.  “Join the patient where they are,” was her constant admonition.

My training and my mentors have also impressed on me the importance of being present for the patient.  Being present has many facets, but important to me is that I go into their room with no set agenda except to meet their needs as they express them at that moment.  That means going into the room with all my senses heightened.  I need to sense whether this is a good time for a visit, whether a conversation is appropriate, make a split second assessment of what’s already going on in the room, and many other things.  Being present can mean just leaving a card and slipping out quietly.  Or it can mean spending significant time engaging the patient and/or family.  Being there, though,is the most important thing I do, whether I say or word or not.

It’s also important to me that I enter the room as God’s representative, with the purpose of ministering to the patient and family.  I’m still me, with my skills, knowledge, and intuition — and with all my baggage too.  The visit is to be about the patient and family, and not about me.  I’m there to listen to them, not to tell them my stories.

My preparation is simple.  Since I generally make these visits on Monday afternoons, I’ll spend some time Monday morning reminding myself why I’m making them.  At some point during the morning or while driving to the medical center, I’ll pray for my effectiveness.  After arriving at the hospital, I’ll review my list of folks that I’m to visit, and if they are folks I’ve visited before, try to jump start my memory about their story.  I generally try to make my ICU visits first, before making visits to patients in regular rooms, to be sure I can spend whatever time is needed with them.  But sometimes I’m led to visit elsewhere first.  And occasionally, I find that I need to take a few minutes in a quiet place to re-center, to get ready to engage another patient.

That gets us to the point of entering the unit.  In Part 3, I’ll describe how I conduct the visit and some of the common tools I use.

Originally published in my personal blog.

As a lay chaplain, I’ve gotten to make a lot of ICU visits. At MD Anderson where I provide pastoral care for Lifeline Chaplaincy, a whole floor is devoted to ICU, with some of the units focused on treating patients needing intensive care because of surgical causes, and other units focused on other medical crises.

You always know that ICU is a serious place. People are there because their lives depend on receiving specialized, life stabilizing, intensive medical care. There are all kinds of machines in the rooms, lines and tubes running everywhere, monitors with flashing lights, and sometimes breathing support devices and even more. Sometimes the patient is in isolation because of infection, and gowns, masks, and gloves have to be worn by everyone entering the room. And of course, hand sanitization is standard before and after leaving the room.

Sometimes the ICU room is almost erily calm, while other times it is a hive of activity with medical staff performing procedures or doing assessments. Sometimes a family member is present (many spend the night in the room with their spouse/relative who is the patient at MDA), sometimes a family member is in the waiting room and the patient is alone in ICU, and sometimes there’s no family member at all.

The patient may be feeling pretty good, be anxious to talk, and be on the upswing. Or the patient may be comatose and/or on life support, unable to communicate. Or the patient may be at any of the variations in between these two conditions. Their prognosis may be optimistic, some variation of guarded, or nearing death.

The family providing support is generally exhausted, stressed, anxious, but coping. Some days are better for the family than others, depending on the course of what’s happened and what’s expected to happen.

When I first started making visits, I have to admit, heading into the ICU was intimidating. Part of it was because I knew the person I was to visit was seriously ill. Part of it was because it was entering an alien space. And part of it was recognizing that the patient and perhaps family I was to visit were in the midst of a crisis, and that although I’d had good training, knowing how to best respond to their needs was still a mystery.

As with most endeavors, experience is a great teacher. I’m much more comfortable and confident these days as I step off the elevator onto the seventh floor. I know that I’m just there as a person to be used by God to minister to others, and that He always steps up to make that enough. And I know how important it is to patients and family to have someone just walk in the door and say, “I came by just to check on you today.”

(More to come)

Originally published in my personal blog