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Thursday, June 19, 2008

Ask the Matriarch — A Modest Proposal

Happy Thursday everyone! I'm posting from Virginia Beach, but not because I'm enjoying the beautiful seaside weather. Here for a conference on behalf of the day job and dashing off momentarily to do my little dance, er, demonstrate the new work blog on the exhibit floor. So I must dash after posting this quickly:

I have a question for the Matriarchs. I am new to pastoral ministry, and have started making hospital calls. I keep finding myself in situations where I am seeing more of my congregation than I wish. And I mean seeing more of them, literally. Something about being in the hospital and being undressed by everyone who walks in the door makes them less cautious, and no matter where I stand or how long I look away, I often see flesh I ought not see. This doesn't even address the problem of nurses and doctors having conversations about body fluids with them and ignoring the fact that I am in the room. I am really and truly trying to plant myself in a place that allows the patients to maintain their dignity, but maybe because that seems impossible in the hospital, their modesty disappears as well. Am I the only person who finds themselves in this position? Or do we just not talk about it? Thanks for the help.

Actually, you're not alone. The way I've always seen it handled (I used to be a nursing assistant) is with a simple knock on the door and a greeting: "Mrs. X? Are you decent?" This would usually prompt a light-hearted reply, but for those that needed "just a second" they had it. And when the doctor or nurse would come in, pastoral folks would usually stay "I'll just step out for a moment, but I'm not going far and will be right back," even if it was just to take their medicine.

Our matriarchs have similar advice. First, from Ann:
It is great that you are concerned about respecting the dignity of those in the hospital. People have so little power to establish boundaries when in this setting. No wonder they just become objects and not people. Medical personnel are often rushed and overloaded, and so used to this odd "normal." Your role as pastor is even more essential to helping them regain their sense of person-ness. When visiting the hospitalized, I draw an imaginary boundary around their bed space and do not enter that without their permission. Giving them some control over the setting and our interaction begins the process of regaining personal power.

Here is from one of my panel of experts:

That’s an interesting one. I never really thought about it, maybe because I was a hospital chaplain for a year and became accustomed to the hospital environment. I do remember thinking my role as chaplain in the healing had to do with reconnecting people with their dignity and respecting their privacy (although that usually translated to respecting their wishes to get the hell out of their room!).

As to the doctors part. I usually try to be pretty forceful when medical staff enters the room – introduce myself, ask how long they need with my parishioner, ask if I might step out of the room during the conference (sometimes the patient wants me to remain). Medical staff get tunnel vision I think and don’t notice that there are things happening outside their focus. I find if I don’t make myself known before the doctor plunges in to whatever he/she is doing, I have lost my opportunity!

And another way of asking the question, from another veteran of this kind of pastoral care:
Try to be clear about what makes you uncomfortable and don't project that onto the patient. If you are not sure you should be in the room during a particular conversation ask. ("Do you need me for this or should I step out?" works
well as a question).

Jacque writes from the bedside of a hospice patient:
Hmmm. Ironically, I've read your question and am writing this while sitting with a church member who is hospice care and is in the final stages of life. (She has fallen off to sleep, and so I write.) Today is my day off and so I am taking the 6:45 AM to noon shift of her care. In this time, there is care of her body including changing her and turning her. In the last 26 years, I have spent a great deal of time in hospitals with church members. Have also worked as a hospital chaplain.

I do understand the desire to afford dignity and privacy to those for whom we care. I think it is true that people in the hospital do often become accustomed to a certain degree of loss of privacy. I always attempt to use discretion and return to them as much of a sense of privacy as possible.

A couple things come to mind: One is that many times when we are very sick, the issues with our bodies take over and we want to talk about what is going on with us. Some people are more selective in what they share than others. I suppose that I have learned to listen to people who are everywhere on the spectrum. Occasionally I have experienced someone who really seems to be sharing a whole lot more than is needed with me, and I just guide the conversation as needed.

The second thought is that, indeed, there are people who either are not aware of how exposed they are (OR there is the occasional bit of "exhibitionist" behavior going on). In those cases, depending on the situation, I have said, "Oh, let's get you covered" and have perhaps just helped get the sheet or blanket over them. Or if they are quite able themselves, but are not really presentable for company, I've said something like, "Oh, I'll just step out in the hall until you're ready." That gives them the opportunity to get back from the bathroom (with gown flapping open), get in bed, etc.

Regarding conversations with Doctors -- if a doctor comes in to talk with a patient, I will often offer to step out into the hall while the doctor is there so that they can have a private conversation. Very often now with HIPAA laws, the doctor will ask who I am before starting a conversation with the patient.

All in all, if you are uncomfortable with the degree of exposure, you can often make graceful changes to the situation. 'Looking away' is certainly appropriate and polite at times, but if you think that your "looking away" is going to communicate to the patient that they should do something about their appearance, I'm afraid you will be disappointed. They are most often not aware of what you are seeing, or that you are uncomfortable with it. Or they are not concerned about your discomfort. You will need to take the action.

That said ... There is just a level of vulnerability and exposure that comes with being ill and being cared for by others. It is not most people's desire or ideal to be ill and exposed, but caring for and loving someone often means that we will be with them -- caring gently and respectfully in their most difficult times. And it is simply not easy for any of us.

From Jan:
I think this is simply part of our professional life. I remember seeing one Bully Member stark naked - literally sitting in a chair without even a little towel - after she called me and an elder to come into her hospital room from behind a closed door. She was apparently on something that made her quite comfortable. All I could think of was how fast I'd be sharing this I-saw-the-bully-naked story with all my friends, until the elder said, on the way home, "She must have really been lonely to have received us in that condition." The elder, a perfectly saintly and wonderful human being, ruined my hopes for juicy gossip.

In all seriousness, it speaks to the intimacy that we share with those in our congregations. Sometimes, we know more and see more than we would like.

God surely feels the same way. And yet God loves us and we get to love the ones whose not-so-beautiful body parts we've glimpsed.

From Karen:
Some of this just goes with the territory of doing hospital calls. Some things you can do to help--knock on closed doors--(seems obvious, I know, but still). Ask at the nurses station if this is a good time to visit. Call ahead--most rooms have phones in them now. I'll sometimes call from my car in the hospital parking lot. This gives folks some time "get decent" if they feel the need. Offer to leave when a doctor or nurse comes in--often the person you are visiting will invite you to stay, but this gives them the option of having a private conversation if they'd prefer that. If the patient seems unaware that they are exposed, try saying, "You seem cold. Could I get you another blanket?" (Or help you arrange your blankets, or get you a sweater, etc.)

Sometimes extreme "exposure" is a signal that something is really wrong and needs to be brought to a nurse's attention immediately. I visited a woman from my church who has dementia. When I came into her room she was completely naked having managed to take her diaper off and fling off her blankets. She had no roommate or other visitor and it was between rounds, so she could have gone on that way for a long time if I had not come by. It took some concerted effort to get someone's attention, but finally someone came to check things out. Then a whole group swung into action. They ended up moving her to a different unit where she would be more closely monitored. So if the level of "immodesty" seems really inappropriate, it could be a sign of a real problem that needs to be flagged rather than simply a bit of embarrassment for the pastor.

And don't forget, we get our questions from you, our readers! Please send your questions about ministry to; we look forward to hearing from you. And happy summer, since it's right around the corner!


  1. Everyday I am learning so much from my fellow RevGals. Thank you for the fun, fellowship, and experiences you each share to help us in our journey of ministry to all God's people. Blessings.

  2. I can tell you that when I was very ill in hospital I had little choice of many things. The staff tried their best to give me privacy while bathing me, etc.
    It was a strange time.

    But there was a time in a very hot summer, that a member of the church I was visiting was in a great deal of pain, to the point of her back being arched. Trying to ease her heat and pain for the short time I was there, I stood back and faced her, taking the top edge of sheet in front of me, waved it up & down to give her a measure of moving cool air. I saw nothing but her face. The relief on her face was visible. Now if it had been a male member, I doubt I would have done that though wishing to.

    In hospital I had never been so debilitated before and many male nurses when I asked what they were doing, or giving me, told me saying I had the right to was my body and I was in charge of it.

    It was encouraging to hear that from them.

    As I got able to do more for myself, I did so carefully. Sometimes the doctors forgot to be so careful, until I spoke up..again it's nothing to them as are so used to 'bodies'.

    I agree with most of what was said.

    Respect for the body, which also 'houses the soul' is paramount and we too often forget that our children learn to trust, or not, from how their bodies are respected..or not.

    We are all created sacred and holy.


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