Remembering is powerful act.
Join us for the 11th annual service of remembrance honoring those who are no longer with us but are still very much alive within us...
As a Hispanic-American friend put it, "For this evening, we make them live again..."
Remembering is powerful act.
As my 108 year old friend said several years ago, a few months before she died...
"You are not dead, when people remember you.." Albertina was feisty and loving right up until her end.
I remember her...and many, many more...
Join us and we will remember together.
Bring a short story to share
Bring a photo for the altar.
Bring your whole self.
Bring a friend.
7PM Thursday 31 October, 2019
Unity San Francisco - (Come see our new location...Between Octavia and the Zen Center)
240 Page Street
San Francisco, CA
Link to MORE INFO: Making Space Sacred site description
Link to MORE INFO: Unity San Francisco site description...
A few of you asked me to clarify what I said in my last post.
Re-making health care to be about health, as hospice makes death about hope, is an earthquake to the medical model of fixing ....
How can death be about hope?
I slipped that in because it is a truth about good hospice and palliative care. It is also the roots of reconciling with loss of any kind.
• It is NOT about putting on a happy face sticker (...over an empty gas tank dash indicator).
• It is NOT about accenting the positive...like the musical
• It is about grounding in the truth of where we are, and asking the question:
What is it you hope for?
Where we go from here... depends upon where we are at.
Most hospice teams tend to disrespect and disregard the benefits of denial. In my training for 'companioning' those in loss, the professor says:
Denial is useful and self-protective... to a degree.
- Dr. Alan Wolfelt, Center for Loss and Life Transitions
It takes time to gather ourselves, to approach the unknown...and death is the great unknown. How do we live with uncertainty?
We need practice at it. What is, really, just another day of cleaning out your closets...or vacuuming the dust bunnies. But if you have NEVER cleaned the closets, it is going to be a bigger job than if you did had done it regularly. Dust bunnies can be overwhelming when you when you have avoided and accumulated them for a lifetime.
Metaphysical dust bunnies
I am attempting lightheartedness here, but it is also true. If you are a hoarder of dust bunnies, your task at the end of our days here will be tougher.
Why do we spend our days pretending that we will not get old, never get to our end on Earth, or leave this existence? I see a direct relationship between denial at the end of life (EOL) and messy closet hygiene. Like anything, we need practice for these big milestones. Many people do their best NOT to show up for death - anyone's death - even their own. They don't visit sick family members; they try not to visit even their own mother at the end because they 'don't want to remember her THAT way'.
I am saying...this life is practice for our own good end.
I have seen many family members collude in this EOL denial by multiplying it by THEIR OWN denial. Or holding out 'for a miracle' until that dying breath...so there is not time to reconcile, to say goodbye, to forgive the dust bunnies of feud and disconnection which are blocking the door.
It is the door to a 'good death'. (This is not an oxymoron.)
In hospice, we say a good death is a peaceful death where the pain is controlled. The measure of pain is TOTAL pain. This includes emotional pain and 'spiritual' pain. We are now back to the original question of this post:
How might hospice make death about hope?
The answer here is:
• Hope meets between the possible and the probable.
• Hope is common ground
• Hope takes many forms...
The A.M.E.N. Protocol*
Many folks look for a miracle. They pray that they be spared the bitter pill of loss. It can look a lot like denial. It may be and it may not be. Statistically, prayer beats most miracle drugs for beneficial outcomes. As a chaplain it is important to stay engaged in this difficult, INCREMENTAL and iterative conversation. In fact, there is a palliative protocol for it. It is called the A.M.E.N. Protocol.
• Affirm the patient's belief. (I hope with you...)
• Meet the patient or family where they are. (I join you in hoping and praying...)
• Educate from the role as a medical provider (...and here are some medical issues..)
• No matter what: assure the patient and family you are committed to them...no matter what happens...(We will be with you every step of the way...") which tends to be more doable in hospice than palliative...
It asks the question: "For what purpose is this miracle?"
"The physician may respectfully inquire. He or she might learn,...that a man's first grandchild will be born in a few months. The hope may be to simply cradle that baby for a few sacred hours before succumbing to his disease. The physician, on inquiring, may learn that a mother hopes for remission to see the last of her children graduate from high school or college. Hope takes many forms. 'Even dying people have work to do or work to finish: relationships to enjoy or mend, goodbyes to say, lessons to teach their families.' The only sure way to know what hope means for the individual is to inquire, respectfully and reverently."
Even if the patient (and or family) are insisting on a miracle. The miracle may be just another day to wait to see their daughter flying in from the East coast. It is what hope looks like at the end.
Please find the PDF for further reference. This is a brilliant and useful study.
* Cooper, Ferguson, Bodurtha, and Smith. The Sidney Kimmel Comprehensive Cancer Center, John Hopkins, Baltimore, MD. Download PDF here:
My employment has changed. I have always been entrepreneurial (thanks Mother...). I am working for several hospices at this point, in bereavement and spiritual care. Change is in many ways... thin ice.
"When skating over thin ice, our safety is in our speed". - Emerson
Change is thin ice (and it happens to chaplains too.)
Happily for me, change is less world-shattering than it used to be. Personally, that is progress. What used to feel like a self-annihilating earthquake, I now see as a river. My shift is not just from solid to liquid; it is from me to something much bigger and higher. I see myself as the river and the Earth is shore.
It is the shore and my view of it which changes.
The useful (...and maybe even the actionable)
This blog is about what it is like as a hospice chaplain (AKA spiritual care coordinator). How is it to stand by and watch with others as their world implodes and change happens. I don't offer my metaphysical views to patients or their families. They are desperate. They are full of earthquakes and the cracking of worlds.
I only offer what might be accessible for them and useful. That changes moment to moment as I look them in the eye or listen to them over the phone. It could be a familiar bible quote, or a poem or a rose from my garden, or a trinket of hope but mostly I offer my attention, and intention for a bit of peace in the storm of loss.
I offer what I am.
The Force (...may it be with you).
Sometimes words come into play but it is mostly this mysterious force called "Presence". As a CLINICAL chaplain, I live in and beside the "Medical Model" of healthcare. I try and use language that anyone will understand - especially the other disciplines that work beside me. We all have our different point of views, this is what makes us an INTER-DISCIPLINARY TEAM or an IDT. To see with many eyes is about seeing the whole patient and offering whole person care. It is our goal, we don't always get there.
When the medical model of fixing has (or in the case of palliative) is in the process of running its course, all sorts of endings show up. Palliative is infiltrating the hospitals and medicine itself with the idea that whole care is "evidence-based". There is a lot of hocus-pocus in big pharma / medical bio biz. IMHO, it is not about health...but your body is.
Predator: predating the Medical Model.
It is hilarious, really, that the new research about the benefits and efficacy of "alternative" therapies such as meditation and yoga (especially in trauma...and) in health are being studied and documented. These new alternatives pre-date the medical model by thousands of years. Who does not want to be seen as a whole person? It is the gift of the ages - to be seen as valid, good, and a loving and lovable work-in-process. This new, ancient and timeless view of healing is threatening the medical model in the holiest of its own shrines: the hospital. Palliative is beginning to threaten the medical model as a predator threatens prey. Hospice and its powerful offspring, Palliative medicine, is a focus on a good end and whole-person care.
Re-making health care to be about health, as hospice makes death about hope, is an earthquake to the medical model of fixing with the giving of another pill or operation.
Change will continue to happen and it will unearth us because ...well it is quantum reality. Change reminds us of what does not change.
As humans, we tend to forget. Time reminds us who and what we are. But in change, there are those people who stand by. We are not alone...or we do not have to be alone. We are accompanied by those we love, those who love us, and Love itself. (AKA: Presence)
Take a walk in nature... Go watch a river.
Ask it what it knows to be true. Ask it about change. I believe it will surprise you with the answer...if you listen with the whole of you.
I have just completed a training for the last four days about how to lead ritual / ceremony within the diverse soup of religions and the many kinds of spiritual seekers we have in California and the nation. Many are the spiritual not religious folks and those who do not consider themselves anything (i.e. the infamous 'Nones").
It was a fun immersion, which taught me much and pushed a few of my buttons, too.
Touching the sacred, (whether you want to or not)...
My plan is a self-care, caregiver workbook created from the Fieldguide. Part of those workshops might involve touching on the sacred and timeless. Whether we want to or not, when we show up for the big ticket items in life such as caregiving of our loved ones, we get up close (and too personal) to our own mortal fire. This involves the always dynamic equilibrium of loyalty, and authenticity balanced with compassion for all concerned.
Let me tell you what to do...
Religion works, if you trust your intermediaries i.e. the gurus, priests, ministers, pastors, rabbi, imans etc. After all, benevolent dictators can be quite effective and the most efficient forms of government. They can be wonderful leaders–or not. Keeping them honorable in the long term is the tricky part.
But the spiritual not religious folks, are demanding a bit more autonomy and efficacy. They do not wholeheartedly trust their leaders which is what pushed them out of the fish bowl and into the ocean at large. I had excellent leadership at this seminar but the subject came up over and over, for me, what kind of leader do I want to be in this new place I am growing into.
Serving (not fixing or helping)
As a chaplain, I reside each day on the side of service. I companion people as a clinical hospice chaplain. I am part of a team of clinicians who focus on comfort. I have no agenda other than that. Though, as part of the job title/description I sometimes get projected upon by people who have been wounded by the authority structures of organized religions. Not complaining...it's all part of my job, really. Sometimes the only service I can be, is to give my patient a last shred of control to throw their offending religious symbol (that would be me...) out of the room. Ahem. It does not happen very often. Most times, I can overcome their initial mistrust by being hospitable, kind and simply standing by. Even then, some people will not, or are unable to accept support. Sometimes it is me, (I could have done that call better...or something else triggering to them, which could be a bad hair day on my part...).
Many times it is not me at all.
A Workshop Servant Leader?
That said, as a hospice chaplain, I am guided by a 1996 essay by Dr. Rachel Naomi Remen, In the Service of Life. She says serving is different from helping or fixing. It is not about pushing through or controlling, but allowing things to open up by service (and good, open-ended questions).
Helping is based on inequality. It is not a relationship of equals - when I use my strength to help those of lesser strength...People feel this inequality...We don't serve with our own strength, we serve with ourselves. We draw from all of our experiences. Our limitations serve, our wounds serve, even our darkness can serve. The wholeness in us serves the wholeness in others and the wholeness in life...Service is a relationship of equals.- Dr. Rachel Naomi Remen,
The beautiful old mama crone in the habit, got it right, again:
We serve life not because it is broken but because it is holy. - Mother Teresa
The other's highest priority needs...
The idea of servant leadership goes back at least a couple thousand years. The modern servant leadership movement was launched by Robert K. Greenleaf who was in turn inspired to write it by Herman Hesse's book Journey to the East (says Wikipedia). In this classic essay, The Servant as Leader, it said:
The difference manifests itself in the care taken by the servant-first to make sure that other people's highest priority needs are being served. The best test, and difficult to administer, is: Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? –Robert K. Greenleaf
The sacred/secular leader's question
And that is the governing and orienting question a sacred/secular leader can trust. It is the balancing question that I will keep returning to: seeing the wholeness in the apparent brokenness...or simply that we are better healed to wholeness and health by being treated as a whole person with integrity.
This is the kind of peer leadership I am planning...in my future self-care caregiver workshops. It's a dynamic balance and the way I, myself, want to learn. But the point of these workshops are to model, in a fun and joyous way, that caregiving is a circle of care. To be sustainable, we, the caregivers must also be fed. The biggest, baddest, blackbelt servant leader, Jesus, had the fine print worked out:
Love your neighbor as yourself. - Mathew 22:39
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