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Thursday, September 07, 2006

Ask the Matriarch: In Sickness and in...

One of the things I absolutely adore about editing Ask the Matriarch is that the insights our beloved Matriarchs share are so comprehensive. I learn a tremendous amount from them even as laity, and lately there have been calls from my home parish about becoming a Lay Eucharistic Visitor. Perhaps, I think, when life slows down a little—but the more I learn, the more I am called!

So I'm doubly sorry to have missed last week for having been swamped—literally—by Tropical Depression Ernesto, who kept me offline upon my return from San Francisco. And this is the question you should have seen then, submitted by Bedside Manner Pastor. Jan, St. Casserole, and Rev Abi all stepped up to share their wisdom, and what wisdom it is. I have other questions that came up as well, but you can rest assured that they will be published in future editions, with equally insightful answers.

Also, look for Ask the Matriarch to be posted earlier in the day in future editions, now that our introductions have moved to Monday.

Onto the question! Here's what Bedside Manner had to ask:

I would like some guidance on doing a hospital visit. I've done them and I know there's no blueprint, and you have to be responsive to the person's situation and needs, but there are some basic guidelines that I somehow managed not to get.


Do you call first?

J: Probably not. If you make an appointment (“I’ll be there about 4”), that doesn’t mean technicians and others won’t drop by and whisk your parishioner off to x-rays or something. The only reason to call might be if you hear that no visitors are permitted and you want to check on that.

St. C: I show up at the hospital unless I do not know the person I am to visit. I may call the unknown patient’s family (whoever appears to have the closest relationship with the patient, if possible) if I feel I need more information.


Do you have to check in at the nurse's station or just walk in like you own the place?

J: If the patient is in ICU, CCU, NICU, or the ER you probably have to get past a nurse or even a guard before you can enter that unit. Most nurses will let a pastor enter unless the patient is in the middle of some highly embarrassing procedure. Otherwise, you can venture on in, assuming you know which room your patient is in.

St. C: If I am going to an unfamiliar hospital, I will introduce myself at the nurses’ station as a courtesy. Otherwise, I just go to the room. If the door is closed, I may go ask a nurse if the patient is in the room, off for tests or sleeping. If the door is open or cracked, I stick my head in and announce myself. If the room is loaded with family members, I ask if they would like for me to come back at a later time. Most want the preacher to come in for a visit.

Rev Abi: Some hospitals enforce the HIPAA Act in such a way that the patient has to put you on the visitation list, but when they are traumatized or there is an emergency, that is not always possible. I bring a card for the nurses if they don't know me, or I am new in town, and as well as one for the patient, as sometimes they are sleeping or gone to a test of some sort. That way I can leave a note if they are gone to let them know I was there.

Visiting hours only?

J: It’s kind to visit during these hours so patient can attempt some rest during non-visiting hours, unless you’ve been called in the night, it’s a life-threatening thing, etc. Again, most nurses and doctors are happy to have the pastor there, especially if there’s something critical going on.

St. C: I don't pay much attention to visiting hours unless I’m forced to do so. Intensive Care and similar units control all of the visiting time. If you want to see the patient in Intensive Care, go open the unit door, identify yourself and ask to visit the patient. In some situations, this will be fine. If the patient is "out of it," put your hand on their arm—probably the upper arm where there aren’t any tubes—and tell them who you are. If you don't get a response, pray for them in a POSITIVE way so that you do not add to their anxiety or give the impression that you are doing a stealth version of Last Rites. If they are responsive, visit briefly.

Rev Abi: Visiting hours are to protect the patient. But I have gone early morning and late night if that was the only time I could go. Usually those are short visits, maybe before surgery or after as well. Interestingly those have been some of my best visits with patients.


How long do you stay?

J: Don’t stay long—maybe 10 minutes? So much depends on the situation. Patients need their rest. The exception would be the rare times when a patient or family has asked you to stay because of special circumstances. I was once asked to stay all night with a dying man because his family couldn’t get there until morning and they didn’t want him to wake up and find himself alone.

When my mother was dying, the pastor (whom she didn’t even like much) stayed way too long, which was difficult for family and close friends who wanted to say good-bye with a little privacy.

St. C: All hospital visits should be brief. Unless the patient is chatty, don't stay long. A few minutes is enough time to show your support and pray. Do not sit on the patient's bed. Do not kick the pee bag. Do not ask to eat their treats or pick a few flowers from their floral arrangement. Be aware of how comfortable they are—that if the patient is gassy, he or she will do their best to refrain from pootage while the Holy Preacher Of God is in the room. Do not stay long. Gas held in hurts; gas released produces shame. Abdominal surgery means gas. So does most else.

Rev Abi: I try to keep the length of stay to a minimum, but sometimes I stay longer. You can ask or sense that, or tell them.

Do you bring a card, or anything else with you?

J: A business card is handy, especially if the patient is asleep when you arrive to visit. You can write a note on the back and put the card in a place where someone will find it, such as by the phone. Also, that way the family will have your number if they need it. I also bring a small Bible if I think someone will want scripture. And I bring communion, especially if it’s Sunday and the rest of the congregation just celebrated communion.

St. C: You don't have to take the patient anything. You are the gift. For children, I take a gift because as a child, I received gifts in the hospital and I loved them.

How and when do you pray?

J: Don’t wait until the end of the visit to pray. Sometimes a heartfelt prayer opens up the discussion and frees people to address fears/hopes/needs that a simple “friendly visit” wouldn’t. If you wait until the end of your visit, you might not have enough time before your next appointment to address things that it feels easier to say having prayed together.

I generally begin by asking, “Could I say a prayer with you?” or “Would you like me to pray?” Sometimes they say “No,” which we need to respect (especially if patient is ticked off at God). That’s okay. Also, I’ve found it helpful to ask them, “What should we pray for?” It gives you a window into their issues. (Are they most worried about dying? Their kids? Pain?) I always touch them when I pray. (Gently—and not near the sutures! )

St. C: I do not leave a patient’s room without offering to pray or leave a blessing. I give the patient a choice because I am aware of how emotional a hospital stay can be for the patient. I ask, "I’d like to pray for you. Is this a good time or would you like me to pray later?" Pause for a second. If they are unsure if they can maintain their dignity or control if you pray for them, then you’ve allowed them to refuse prayer gracefully.

Rev Abi: Prayer is such an interesting thing. Too many of us, including myself, use it as closure, but people seem to be okay with that. I do tend to ask if I can pray, but I have had people say, "Pastor, can we have prayer before you go?" Sometimes I ask for what they need prayer for, and sometimes I don't if I already know they are going in for or the surgery was completed.


How often should you visit?

J (and echoed by Rev Abi): Since hospital stays are notoriously brief these days (barely 24 hours for a mastectomy; 2-3 days for open heart surgery), one visit will probably be all you need. If someone is seriously ill and in for a lengthy stay, once a week or once every 10 days might be appreciated. If someone is literally on the cusp of eternity, you can probably sense if the family or patient wants you to check in every day.


Is it better to visit a new mom in the hospital or at home (or both)?

J: Moms seem to prefer a brief in-hospital visit, maybe bringing along a treat not available in the hospital cafeteria (such as a really good decaf latte). Once home, the baby’s adjustment and the presence of others in the house make things so hectic, it seems best to let mom and family get used to each other in peace. Just visit briefly, say a prayer of thanksgiving for a healthy baby, and offer lots of comments on the little one’s cuteness quotient.

The exception would be the situation of a sick/dying baby. Still bring the treat to the hospital (and maybe something for dad), but be prepared for a slightly longer visit with some theological discussion: “Am I being punished for something?” “How could this happen?”

Be prepared to baptize a sick baby. Nurses can get sterile water for you. (I’ve even baptized a dead baby.) These moments are clearlly not the time for a theological debate on the efficacy of baptism for a dead or dying child. Just bring comfort and a shoulder and keep reminding mom and dad how much that baby is loved.

St. C: As a woman, you can visit a new mom in the hospital with more ease than I think a man is able to have. Then visit her at home, too, after reassuring her that she is not to prepare ANYTHING for your visit and that you do not care if she hasn't had a bath in 5 days!

Anything else I should know?

J: Just love your people, especially in these weakened moments as patients. It is extraordinarily holy to be the one called in for such milestones: the births, the deaths, the life-altering surgeries. It is an enormous privilege. Oh, and it’s okay just to sit and say nothing. Be real.

St. C: It may be helpful to wear your clericals. The clericals identify you as a person who is authorized to be in the hospital. Try to avoid wearing perfume. Put out your cigar before you go into the room and keep a breath mint in your pocket. If you see gushes of blood and guts, ask God to keep you from reacting with a dead faint or nausea. When a patient tells you that her boyfriend's "thing" untied her tubes, try to keep a straight face. This happened to me and I was dying to see the boyfriend! I can recall every person who every visited me when I've been hospitalized. That's how important these visits are. God bless you for going to see the sick.

Rev Abi: Dress comfortably but look professional. There have been times when it was a crisis and I had to drop everything to run to the hospital—in shorts! It's not a problem—just bring your nifty card. Wear comfortable shoes, you are going to have to walk. If hospital visits are hard on you, take deep breaths and visualize yourself being able to visit this person with ease. Or, take someone with you. Go see your patients, sit down, touch them, hold their hand, listen, pray and then leave. But leave your anxiety at the door. Bring your presence. If you haven't had Clinical Pastoral Education, go take it, you will learn a whole lot about hospitals, visitation, facing your fears, and be more comfortable with yourself, or not, and then do more CPE or get some counseling to face you.

Me: I've asked RevAbi to share her handy "Guide to Hospital Visits" over at her blog, too! You are welcome to use them for your congregation, yourself, or to share with others. Thanks to revabi, and her friend Rev. Amy Raser.

Happy Thursday, all!

24 comments:

  1. Wonderful! Hubby starts CPE (sorta) in two weeks! So I printed this for him!

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  2. Thanks for the helpful hints. I started CPE last week. So far, I have learned that I have much to learn. One other note, if it is a large hospital with paid parking, stop by the chaplain or pastoral care office to have your permit stamped, or to pick up a hospital registration card for clergy.

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  3. OK, I totally adore these responses. They are all so different yet the pastoral compassion shines through. I would love to have any of you visiting me!

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  4. I ditto reverendmother!
    I would add that I always check in at the Nurse's Station, for two reasons:
    1) The patient may have been moved. Maybe it's just me, but this seems to happen fairly often on my watch.
    2) Particularly if the patient is intubated or non-communicative, I want the staff to know that people care about him or her. It's the same principle that guides nursing home visits to folks with Alzheimer's or other forms of dementia. The patient may or may not know you have been there, but the staff will note that this is a person who has not been abandoned by the world. That was the advice given me by my field ed pastor and one of the best things I learned that year, because those visits can be very hard to make.

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  5. I do a good deal of visitations. I think the most important thing to remember is to LISTEN. If it's time for you to go, you probably will hear hints about that. If they really don't want you to go, most people will give hints about that, too. I've had clergy visits in the hospital that seemed like "pray and run." Boredom cannot be underestimated in the hospital.

    I like St. C's answer about prayer -- one of my first hospital visits as clergy was a retired seminary professor -- he taught pastoral care. He lovingly told me to ask if it's OK for prayer -- it actually can be problematic with heart patients. If they think that you are praying b/c they are sick, you can actually cause a heart incident.

    And if you are an introvert, go with someone else who has more experience and see what they do. Just go along for the ride.

    I have thoughts about baptizing babies in the NICU (I did some of that this summer) and I may post that on my blog....

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  6. And I'll echo my thought from last week -- this is my very favorite day!! I love gleaning the wisdom of my more experienced peers.

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  7. Here's my challenge: How sick is too sick to visit? I mean,if you have a cold, how big a cold does it have to be to prevent you from visiting? Last week I had 4- count 'em- 4 people at three different hospitals on the same day. I called them all that night before to tell them I wouldn't make it because I didn't want to infect them, then I called a reliable and sensitive elder who made her way by at least 3 of the four. Opinions?

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  8. One of my greatest regrets is not visiting a heart patient because I had a cold. I sent a Deacon instead, and when he came from the visit to a meeting at church, it was clear from the look on his face that the situation was dire. I wish I had gotten in the car then. My parishioner died around dawn the next morning.
    So I think the judgment call for me now is as much around the condition of the patient as around the condition of me. My cold couldn't have made things worse for him at that point. Wash your hands right before you go in and don't touch your face. Use common sense. But make the decision in the double context of your health and the likelihood of the patient's demise.
    JMHO.

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  9. Presence, I have found, is the most important thing. Just knowing you are there means so much.

    As to the illness thing--that's a tough call. Most hospitals will tell you not to come if you have had a cough, runny nose, etc. for 48 hours beforehand. This is for the protection of all their patients, not just the one you are going to see. It's amazing how easily germs can be spread by railings, elevator buttons, etc.

    On the other hand, there is the tug of pastoral care.

    I do wish I had had CPE--my biggest regret about seminary. It wasn't required, but I think it should have been. As soon as I can scrape the ducats together, I'm going back for it.

    At least I worked in a hospital (as a ward clerk) for a while, so I'm comfortable in a hospital, I know the routines, etc. Tubes and bags hanging on poles do not faze me.

    Hmm, come to think of it, that was part of God preparing me for this work, wasn't it?

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  10. I have had l8 months of CPE..but the comments are terrific. These are "everything I wished I knew about hospital visits but was afraid to ask--" and the answers are great, helpful (and from my l0 years in ministry "right " No one every forgets that the pastor came and visited them...pastor girl (called this by 3 year old--in spite of my being in my 7th decade!)

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  11. Having been on the receiving end of pastoral care this year during my mom's hospitalization and death, I can only say "Bravo!" to all the great advice.

    When my mom was taken from our small county hospital to a large metropolitan hospital, our pastor met us there; that meant a lot. He arrived while dinner was being served, and after talking with us he incorporated the Eucharist into Mom's dinner...it was very moving and appreciated.

    On the morning my mother died they couldn't reach my pastor right away, so one of the hospital chaplains, a Benedictine nun, stayed with me until he got there. I wasn't very coherent, but I do remember her just being there with me and not forcing conversation or theology on my experience of the moment. When my pastor arrived we spent some time in Mom's room saying goodbye, and then he drove me home -- told me to leave my car in the lot and he'd get someone from church to drive it back to my house for me. That was most helpful, because I really wasn't in a frame of mind for an hour-and-a-half drive. And, like the sister, he didn't lay a theological trip on me; we prayed together, but he didn't attempt to "explain" why this happened, nor did I have any desire for him to do so.

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  12. My "other" vocation is in music therapy, and I want to echo the importance of validating the 'personhood' of the person you are visiting. Speaking to the staff is a courtesy - you don't have to preach, just let them know who you are, AND that someone cares about this particular patient (who may be hard to manage because of behavior and language issues from their disability!) You are giving the staff member encouragement too, by doing that.

    My dad, who was a physician, noted that he felt like his pastor was not 'in a hurry' when he came to visit Dad when he was terminally ill. The pastor was only there about 5 minutes, or less, but he SAT DOWN or found a place to perch, would take off his coat and just chat. He would frequently visit in the morning, and then on his way home from the church office. We would call it "fully present" - but Dad felt like he was giving every bit of those times to him, and him alone.

    And -- do I have to say it?? TURN OFF your cell phone or put it on vibrate.

    I'm looking forward to taking CPE after I pay my "dues" with all the prereq's. :)

    Deb

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  13. I've done 8 months of CPE (two units plus the pastoral care practicum) and I want to echo the comment about sitting down. standing there just makes you look uncomfortable and anxious. have a seat, if there is one. it may turn a five minute visit into a ten minute, but it might be worth it. And ditto again on the asking what people want to pray for--it opens conversation and it also helps you to pray for them later!

    i love this feature. thursdays are my fave day!

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  14. You will find the guidelines for hospital visits that GalleyCat referred to at revabi's blog. Here is the link for it: St.John's Rev Abi: Hospital Visits

    You are welcome to use them for yourself, your congregation or share them.

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  15. These responses and comments are so wonderful! Thank you!

    I wanted to add -- so often I have realized that my presence, as pastor, is so much more important than I think I am. However, I've also had occasion to realize that sometimes we think our presence is more important than it
    actually is. Especially in situations where a patient has a prolonged surgery, I have found that some folks would love me to be present with the family from beginning to end and some families would rather not have the pastor around after the initial prayer. I generally ask a family how present they wish me to be, making sure they know how present I am willing to be, but allowing for their familial preferences.

    I realized this after my own family went through my grandfather's prolonged heart reconstruction and the pastor kept appearing every couple of hours. It was terribly awkward and felt very intrusive and the pastor didn't seem to pick up on my grandmother's suggestions that he needn't be there. Finally, I had to gently tell him that Grammy needed him to not come back. He was fairly offended by that, but it taught me a good lesson about self-importance vs. respect of family wishes, regardless of how weird they may seem to us from the outside.

    Thanks again for these lovely thoughts. I appreciate your wisdom!

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  16. terrific, terrific answers. Thank you all for doing this. It's helpful but it's also fun to read (esp you St C ... you crack me up!)

    We had an interesting discusssion in seminary about prision visits (prison chaplaincy is a big thing in ex soviet countries) and I'd love to hear your experiences on that too.

    blessings and love

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  17. One of the most pastorally significant relationships for me happened because when I asked "would you like for me to pray with you before I go?" he said, somewhat apologetically, "no." I said, "That's just fine. It was a real question. I'll check on you another time." He had so many preachers visit (that's a different story) that didn't ask and he was very uncomfortable with the assumed familiarity. When I respected his "no," he let me be his pastor.

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  18. Oh, I do wish there was something like CPE available here. There really doesn't seem to be any equivalent.
    This is all great stuff, and very helpful timing for me as the Gloucester NHS Trust is currently one hospital chaplain down due to ill health, which means that there is a single full time chaplain covering 4 major hospitals (with some part time support) . As a result, local clergy have been asked if we are willing to join an on-call rota for the weekends, and I'm on the list.Generally, hospital visiting seems to be a diminishing part of ministry here. Patients have to specifically request a visit before even the hospital chaplain is allowed near them, and so often people are home before anyone even knows they've been in hospital. Before ordination, I was part of a lay hospital chaplaincy team. So often, people would comment that we were the only visitors who came without a specific medical agenda. In those situations, I rarely mentioned God; presence seemed the only thing needful, then I'd pray like crazy as I drove home.

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  19. Our local hospital has one fulltime Protestant chaplain, and she is supplemented by local pastors covering nights and weekends, mostly out of the goodness of their hearts (weekend chaplains receive the not-very-massive stipend of $15 per 24-hour shift). I volunteer once a month and probably get a call 4 or 5 times a year. These are almost always middle-of-the-night calls, for which you definitely go in with ID badge and report to the nurse's station. It's different in that having been called in as the staff chaplain, you are on the medical team and therefore privy to patient information that a pastor does not get anymore due to HIPAA. The first task is triage, determining who called and what their relationship is to the patient--it might be a staff or family member, sometimes the patient him/herself, often the call doesn't come until a person has already died. I always come with a Bible in these cases, and I use it 90% of the time. On these calls, I always offer prayer, and it has never been refused, since that is usually what they are looking for when they call for the chaplain. These are also usually quick visits, although at least twice the staff has called on me to convince a family to leave the dead loved one's side so the room can be cleared, and that takes more time. (On one of those calls, a fight had broken out among the family members just before I arrived, and the situation remained tense.)
    It can be high adrenaline ministry.

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  20. Well done... both post and comments.

    Thank you.

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  21. A hearty thank you and an enthusiastic "Amen!" for both the responses of our matriarchs and the comments too.

    This is just so helpful!

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  22. Hospitals are part of life for me, I would say, don't be afraid, people are still people, they are often vulnerable and feel disconnected, be yourself and don't worry about being insensitive... it usually helps to smile and laugh

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  23. CPE - the best thing on earth for getting rid of hospital phobia. I discovered that doctors were oh too human like everyone else and that patients - not all - but most were way happy to see someone who just wanted to listen to them and who had no desire to stick them with a sharp object.

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