Thursday, March 17, 2016

The work of chaplaincy and "emotional labor"

A. Kumm-Hanson Minneapolis 2016
I stumbled across something the other day comparing the physical labor to what is called "emotional labor." This idea resonated with me, because of the emotional intensity of chaplaincy. Work of this nature has ramifications for the chaplain's personal life and perhaps an honest appraisal of the toll of emotional labor can contribute to resiliency and health for the chaplain.

Chaplains dwell in the realm of the not-quite-tangible. Our practice involves spiritual and emotional concerns, not physical or social issues to be addressed. Our tools of assessment are not stethoscopes or CT scans, but our ability to listen deeply, our intuition, and our own emotions. In order to assess our patients, we literally use our own souls. We check in with what we are feeling to "take the temperature of the room" (to quote a CPE supervisor). We reflect back the emotions of our patients using mirroring techniques. We do not feel in full the trauma or death or pain of our patients, but we do go into those spaces with them and surround ourselves with that suffering.

Chaplaincy does not involve physical labor like industry, but it involves labor. One of my wise colleagues mentioned that the main difference between a healthcare chaplain and a parish pastor is that while pastors can and do enter into spaces of suffering and dying, they may only do so a few times a year. Chaplains go into the places of deep suffering many times per day. It is emotional labor to center one's self again and set aside whatever might be happening in the next hospital room over or the ER or whatever the chaplain witnessed already that day to be FULLY present with each patient.

It is tremendous emotional labor to be able to walk into a trauma room (I have the privilege of working in a level 1 trauma center) and exude calm. It is human nature to react to extremely stressful situations with "fight or flight" responses. It is a matter of training and experience to be able to observe calmly what is happening, with heightened senses, and be a source of calm and steadiness for others.  Instead of "fight or flight"chaplains "focus and feel." One of my favorite ER nurses said about chaplaincy, "Your physical presence in a trauma room is a rock for the patient, but also for the staff. We know you are going to be calm and we look to you for that strength." It is not physically possible to hold onto all the pain that we take in, but it takes emotional labor to release that pain also. When we come home from that night shift or that day of visiting nursing homes, we often just want to eat and turn our brains off. And in our sleeping or our reading or our netflix binge watching, that pain seeps out slowly like sap from a tree. It hurts a little, but it is necessary to relieve the pressure.

Our conversations with patients are deep. We talk about the sorts of things that many of us would rather ignore. Death and suffering and aging and tough decisions. We are called into ethical dilemmas and to bear witness to patients gasping for air and to offer comfort to family members. We are called to sit with patients so they do not die alone. Sometimes we forget how to have light conversation, because so many conversations in chaplaincy are serious. We might have little tolerance for small talk in our personal lives because we bear witness to the most sacred and painful moments of the human experience. But we want you to know that nothing you might say will scare us, because honestly, we have heard it all before.

We might not want to be social butterflies during our off time or we might want to surround ourselves with a close network of people who "get it." Because it is so hard to explain what we do, why we do it, and how we can possibly continue to do it day in and day out for years. We love our work, but it changes us. We think way more than the average person about the ravages of cancer or the slow death of dementia or the violent randomness of trauma. We are constantly thinking about the lives (and deaths) of our loved ones and we are constantly faced with our own mortality.

We might not always have the emotional energy to be fully present to our own spouses, families and friends at the end of the day. This is the greatest consequence of emotional labor for me. I am an introvert and sometimes I just do not have the emotional reserves to be a wife and family member without time to recharge.

For me, the most important tool in managing the toll of emotional labor is ritual. I symbolically put aside the day by changing out of my work clothes immediately upon returning home. I pray silently in my car that God would hold the concerns of those whom I serve in my work, so that I can let go of them. I visualize all of the trauma and suffering that I hold in my body draining out of me and into the earth. Sometimes I literally lay on the ground and do this. I worship in a faith community that sings its prayers and holds hands together, and I derive strength from the great cloud of witnesses each week. I cry when I need to, because sometimes it is all too much to bear.

Another important part of my resiliency is self-care. I relax HARD on my days off. I sleep a lot. I work out. I eat good food and enjoy good coffee. I try to do creative, generative activities like art and knitting, that allow me to create something tangible. I derive enjoyment from physical activities like yard work and cleaning, because it allows me to use my body instead of my mind. I ask for help when I need it. I love my spouse deeply and enjoy the company of my dogs and their enjoyment of the present moment.

I am not perfect at any of these things, and I still find myself getting worn down at times, but they are disciplines and they get better with time.

Fellow caretakers and chaplains, how do you counteract the toll of emotional labor?

Thursday, March 10, 2016

Vigil with the Word: Year C, Fifth Sunday in Lent

The texts for the Fifth Sunday in Lent are:

John 12:1-8
Isaiah 43:16-21
Psalm 126
Phillipians 3:4b-14

I have chosen to focus my commentary on John's Gospel.

Six days before the Passover Jesus came to Bethany, the home of Lazarus, whom he had raised from the dead. There they gave a dinner for him. Martha served, and Lazarus was one of those at the table with him. Mary took a pound of costly perfume made of pure nard, anointed Jesus’ feet, and wiped them with her hair. The house was filled with the fragrance of the perfume. But Judas Iscariot, one of his disciples (the one who was about to betray him), said, ‘Why was this perfume not sold for three hundred denarii and the money given to the poor?’ (He said this not because he cared about the poor, but because he was a thief; he kept the common purse and used to steal what was put into it.) Jesus said, ‘Leave her alone. She bought it so that she might keep it for the day of my burial. You always have the poor with you, but you do not always have me.’

This particular text from John’s Gospel is full of themes that make for fascinating sermons. There are themes of Mary breaking gender roles by touching Jesus. There is a discussion about the extravagance of using a pound of “nard” to wash Jesus’ feet. Which means nothing to us now, perhaps saying something like “took a pound of saffron and put it into pancakes for Saturday morning breakfast” would make more sense. Taking something that is extravagantly expensive and using for the most ordinary task. Then there is a discussion about serving the poor and appropriate use of resources.  But I do not want to talk about that. I want to reflect upon this text in my context as a healthcare chaplain.

This story has the title of “Mary Anoints Jesus.” About a week before Jesus is to die upon the cross, Mary anoints his feet with the most pure and costly oil. Anointing, the ceremonial marking of a person with oil or by symbol alone, is a practice with a long history. We hear in the Hebrew Bible about priests being anointed. The disciples are said to anoint the sick after healing them.  And in this passage, Mary anoints Jesus.

The Catholic church has entirely different connotations of the practice of anointing, so I will not go into those here. But in my practice of ministry, anointing is something that I do frequently. It is part of the commendation of the dying liturgy, something that I find myself doing about once a week, as well as part of a blessing that I give to my patients. Anointing happens in the baptisms that I provide for the sick and dying. Sometimes I use oil, sometimes I use water, sometimes it is just my fingers, smelling faintly of alcohol rub from my hand hygiene ritual. Anointing is a physical representation of a holy manifestation. It is a proclamation of “This moment is sacred. God is here. We are setting aside this moment as something outside the ordinary.” Anointing takes the most ordinary of things, one person touching another, and imbues it with a sense of the holy. It is a mark of God’s presence.

Mary is the only one that sets aside this sacred moment in the bustle of a large group dinner and the disagreement about the use of the nard. I think about how I often make eye contact with a dying patient or their family members as I am anointing someone’s forehead. I tenderly make the sign of the cross and resting my palm on their head, I say, “Well done good and faithful servant. To God you belong.” Quiet words amidst the chaos of a trauma room, the alarms of an ICU or the oppressive air of a nursing facility. An anointing of a moment. God is here.

Vigil with the Word: Year C, Fourth Sunday in Lent

The texts for the Fourth Sunday in Lent in Year C are:

Luke 15:1-3,11b-32
Joshua 5:9-12
Psalm 32
2 Corinthians 5:16-21

I have chosen to focus my commentary on the Gospel reading from Luke: 

Now all the tax-collectors and sinners were coming near to listen to him. And the Pharisees and the scribes were grumbling and saying, ‘This fellow welcomes sinners and eats with them.’
 So he told them this parable:

The Parable of the Prodigal and His Brother
 Then Jesus said, ‘There was a man who had two sons. The younger of them said to his father, “Father, give me the share of the property that will belong to me.” So he divided his property between them. A few days later the younger son gathered all he had and travelled to a distant country, and there he squandered his property in dissolute living. When he had spent everything, a severe famine took place throughout that country, and he began to be in need. So he went and hired himself out to one of the citizens of that country, who sent him to his fields to feed the pigs. He would gladly have filled himself with the pods that the pigs were eating; and no one gave him anything. But when he came to himself he said, “How many of my father’s hired hands have bread enough and to spare, but here I am dying of hunger! I will get up and go to my father, and I will say to him, ‘Father, I have sinned against heaven and before you; I am no longer worthy to be called your son; treat me like one of your hired hands.’ ” So he set off and went to his father. But while he was still far off, his father saw him and was filled with compassion; he ran and put his arms around him and kissed him. Then the son said to him, “Father, I have sinned against heaven and before you; I am no longer worthy to be called your son.” But the father said to his slaves, “Quickly, bring out a robe—the best one—and put it on him; put a ring on his finger and sandals on his feet. And get the fatted calf and kill it, and let us eat and celebrate; for this son of mine was dead and is alive again; he was lost and is found!” And they began to celebrate.
 ‘Now his elder son was in the field; and when he came and approached the house, he heard music and dancing. He called one of the slaves and asked what was going on. He replied, “Your brother has come, and your father has killed the fatted calf, because he has got him back safe and sound.” Then he became angry and refused to go in. His father came out and began to plead with him. But he answered his father, “Listen! For all these years I have been working like a slave for you, and I have never disobeyed your command; yet you have never given me even a young goat so that I might celebrate with my friends. But when this son of yours came back, who has devoured your property with prostitutes, you killed the fatted calf for him!” Then the father said to him, “Son, you are always with me, and all that is mine is yours. But we had to celebrate and rejoice, because this brother of yours was dead and has come to life; he was lost and has been found.” ’

This is one of the most intriguing parables for me.  It has drama and “dissolute living” and lots of questions of fairness and justice. Prodigal has two meanings: first, spending money or resources extravagantly and recklessly; and second, having or giving something on an extravagant scale. The younger son squanders his inheritance and comes home. His father is delighted to see him and throws a party. His older brother reacts like I would and is suitably outraged. How DARE this irresponsible one be welcomed home? But the father is also prodigal. He is reckless with his love and acceptance. He says to his older son, “this brother of yours was dead and has come to life!” 

I see a lot of prodigal love in my work as a chaplain.  Reckless and outrageous love. Love of daughters caring for their dying parents. For neighbors who made sure that other neighbors are fed. For a son I met the other night who visits his father every single day in the memory care unit, even though his father has not been able to recognize him for months. For people who love with the heart of God, and who proclaim, “Your brother was dead and has come to life…and his life will again lead to death. But he is living now.”

However, the complexity of human experience also demands that we consider all the ways that we are not able to be “prodigal” in our love for others.  How the demands of caregiving lead to resentment. Of family members who cannot bear to see or speak to the dying. And how that is okay, because we all can only do what we can do. Some of us simply cannot bear it. Because this parable is not intended to be instructive. It is intended to be demonstrative. Demonstrating the prodigal love of God for all of the beloved.