Wednesday, March 22, 2017

On Talking to Children About Death and grief

Recently, some of my online groups have been talking about how to talk to children about death and grief. I realized that I am in a unique position with my work at the intersection of life and death to share what I have learned, since I visit with many children and their families about death and grief.

I have found that the resource, "What Will I Tell the Children?" published by the University of Nebraska Medical Center has been one of the most useful pieces of literature for me.

Here are some of the things that I have learned in my work as a hospital chaplain about how best to support children with regards to the death of a loved one.

1. The importance of security and secure attachments cannot be stated enough. If the child is experiencing the death of a parent, they need security that they will be cared for.  They need to know that adults will meet their needs. It is best to explicitly say this. It can be as simple as, "I know your mom has cared for you up until now, but now we, your aunt and uncle, will be taking care of you. You will live with us."  If the child is experiencing the death of a grandparent or other relative, they might feel like their parents could die too.  Listen to these fears because they are real. Share that while everyone will die someday, that time will likely not be for a very long time.

2. Help your child to say goodbye  This can take place at the bedside or at the funeral service. Encourage the child to say goodbye in their own way.  The Four Gifts of Dying ("I love you", "Thank You", "I'm Sorry" and "Goodbye") are as appropriate for children as they are for adults. If the death was sudden, encourage the child to write or dictate a letter to the person that died. It can be buried or cremated.

3. Give accurate, age-appropriate information about the dying process Use simple concrete language. Do not use euphemisms such as "lost" or "passed." Do not be afraid to say "Dead" or "Death." Talk about how once someone has died, they do not hurt anymore. Be prepared for questions like "What happens after death?" and "Where does the body go?" It is okay to let your child know that you do not have all the answers.

4. Keep the lines of communication open  Let your child know that they are always welcome to talk. Talking about the loss of their loved one is important and won't cause additional pain. You can say, "I miss Grandpa too. Do you remember some fun times we had together?" 

5. Enlist the help of outside resources  Involve your child's school (principal, social worker and school psychologist), church (if relevant), and therapists (such as play therapists or family therapists).  Let your child know that they are many people who care about their well-being.

6. Normalize Grief  Let your child know that it is okay to feel sad, angry, or happy. Sometimes it is possible to feel all those feelings at the same time. Say that the intensity of these feelings will come and go and whatever they are feeling is okay.

7. Understand the long-ranging concerns Children and teenagers who are losing loved ones might be concerned about the future. They might ask, "Where will we spend Christmas now that Grandma is dead?" or "Who will walk me down the aisle at my wedding if Dad is dead?" Provide love and reassurance. Recognize that birthdays, holidays and other special days such as graduations, proms and weddings will come with grief.

Monday, March 06, 2017

On listening

My online friend, and fellow worker at the intersection of life and death, Caleb Wilde, said something profound the other day.  He said, "Sometimes the only answer is a deeply listening ear."

One of the things that Clinical Pastoral Education (CPE) trains out of you is the impulse to fill spaces with words. It is a human impulse to want to say something comforting or meaningful or give an answer. People of faith are particularly terrible about doing this.  The motivation behind it is generally pure, to offer comfort, but it shuts people down.

I spend lots of time sitting in silence.  People often tell me, "your job must be so hard" or "how do you do it?" And my answer is that nothing that I do is exceptionally difficult, but it is not easy.

There are many, many times that I say nothing at all. I bear silent, compassionate witness to suffering.  I speak words of comfort, but I give no answers. Because they are not mine to give.  I provide education, such as about the physical symptoms of dying, but I never provide predictions. But most of the time I just listen.  Perhaps this is what makes my job difficult.

I believe it is possible to be accustomed to the physical challenges of this job (to cease being disturbed by trauma or the sights, sounds and smells that accompany hospital chaplaincy. Or if I am disturbed, it no longer keeps me awake at night.) but the spiritual and emotional challenges are another thing entirely.   It is absolutely contrary to human nature to say nothing sometimes.  But part of being a spiritual caregiver is knowing when to speak and knowing when to listen.

And in the deepest suffering, words provide little comfort.  But showing up, being fully there, and not being repulsed by suffering (as it is human suffering to want to run away) is the essence of chaplaincy.  Whenever someone starts wailing in the ER or on the floors, I run toward the sounds of human grief.  I take so many grieving mothers and weeping children into my arms.  I hold the hands of dads and husbands who are crumbling in the face of trying to be strong. I listen not only with my ears, but with my soul.

Chaplaincy is when I listen to your soul with mine.

On Hope

Hope is a tricky thing when you are a chaplain. There is always the fear of "offering hope" when there might be none. Or that when people ask for hope they are really talking about something else, like extending life. 

Or they are praying for a miracle, which is a whole different topic. And begging for its own blog post.

The other day on my rounds on the behavioral health unit, a patient asked me for hope.  This was one of those moments (among many) that i stop and pray for God's guidance and that God would give me the words that I needed, because I did not want to screw this up.

But sometimes, when people ask about hope, they are asking for existential hope.  In that moment of conversation with God, where God led me was existential hope. Not the far off hope of "things will be made okay in God's time" but a hope for now.

Our behavioral health units are really good. The staff is incredibly caring. The rooms are private. But if you are there, hope is in short supply. As someone who has struggled with the existential despair of depression, I understand all too well the lack of hope that comes at times with mental illness.

What I offered to my patient was a reframing of this experience as a season. Just as the grim winter days of Minnesota slowly give way to spring, so too the grim days of depression give way to a different season. Just as we must simply hold on until spring comes, we must simply hold on until a new day dawns with depression.

This is not a passive waiting around for time to pass.  It involves making the best of what is in front of you at the time. With winter, it is about warmth and coziness and fighting back despair with hot chocolate and sledding and being with loved ones.

With mental illness, the season waiting for the season to pass is about being engaged in therapies, taking medications if that is your choice, and doing the things that have helped in the past, because odds are, they will help again.

In the situation with this patient, and in many situations that cry out for hope, hope is cyclical. It has existed once, it will likely exist again.  Sometimes we need to be reminded of that. Sometimes we need someone to hold our hope for us.  That is yet another function of that many that a chaplain performs.

When it feels like hope is far away, I can remind you that it has been there before and odds are, hope will again return.