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A New Setting for Chaplaincy

“We’re missing both needs and opportunities.” So began a conversation between the director of the clinics where I work and the VP for Mission Integration at the hospital where I am a CPE resident. Then followed the question, “How can we bring spiritual care into our outpatient rehabilitation clinics?” The solution: to place a chaplain in the clinic full-time to evaluate the level of need and opportunity, assess the dynamics of the new environment, and identify the role of a chaplain in an outpatient setting. Because the presence of a chaplain in an outpatient setting was so foreign to patients and staff alike, the first task was to build relationships and gain trust. Once this task was underway, the needs, dynamics and roles began to unfold.

The needs in the outpatient rehabilitation clinic are as varied as the human experience. Some patients have minor debilitations that require minimal physical therapy. In general, these patients have realistic and positive expectations of quickly returning to life as normal. Other patients, however, are facing long term, perhaps life-long, limitations with no realistic expectation of returning to their routine way of life. My CPE supervisor, Jim Gunn, often refers to a concept articulated by theologian Andy Lester, “We all have a future that we’re living ‘toward.’ When a . . . crisis interrupts that future story, we go into a tailspin until we can write a new one.”[1]

Some of patients in crisis are remarkably adept at holding their futures loosely and are effective at weaving their current circumstances into the narrative of their lives. Others get stuck. When the anticipated and hoped-for future is no longer possible, the tailspin results in a hopelessness that may be more debilitating than the original injury. Our clinic has two counselors in place to work with the psychological and emotional difficulties surrounding these disabilities. Some patients, however, experience a crisis of faith that, until now, has gone unaddressed.

Another unaddressed need is support for the caregivers of those whose limitations have come to dominate the landscape of their relationship. For example, I introduced myself to one caregiver who had accompanied her husband to his therapy session and simply asked, “How are you?” She told me that I was the first person to ever ask, and she spoke uninterrupted for twenty minutes on how difficult her life had become. Clearly, the need for spiritual care exists in the outpatient setting.

The opportunity to address these needs is somewhat determined by the dynamics of providing spiritual care in a clinic setting. The first distinctive dynamic that I encountered was that our patients are not “captive” as they are in the hospital; they come and go as their schedule permits. This means that the needs present spontaneously and if the chaplain is not on-site at the moment, there is little opportunity to come back and address the need. Referrals from the therapists do occur, but I must be much more intentional in setting up an appointment than I had been in responding to referrals in the hospital.

A second and related dynamic is that outpatient rehabilitation is an activity that has been worked into the routines of the patients. Patients in the hospital have often experienced a major disruption in their routines and are outside their homeostatic norms. This produces a measure of vulnerability. When a chaplain comes alongside patients in this state, the chaplain may sometimes seem to function as a “lifeguard” in a chaotic situation. By the time patients get to our clinic, they have established a new homeostasis that incorporates their rehabilitation activities. Very often, they have put on a determined mindset to get through their current challenge, and their level of vulnerability is generally lower. When a chaplain comes alongside patients in this state, s/he may function more as a “cheerleader” who enhances their internal resources. Even so, when motivated patients hit a plateau in their recovery, they may need a “life-line” to help them get back on track.

Another dynamic is that much of my interaction takes place in the “fish-bowl” that is the waiting room. Waiting room contact can seem superficial, but that does not mean it is not meaningful. Therapists have reported that my interaction with their patients prior to an appointment serves to defuse tension, and the patients are more ready to engage their therapeutic program. Likewise, patients have commented that there had been a day in the past when they had been pretty low emotionally, and my casual contact with them in the waiting room had been just what they had needed. Repeated casual contact with patients often builds the bridge for deeper conversations later in the course of their recovery.

An interesting aspect of waiting room chaplaincy is that my interactions are observable to everyone present. Once I got beyond my own self-consciousness, I noticed that some who had been observing my interactions, were sending signals that indicated their receptiveness to my introducing myself to them. Some met my eyes immediately and were open for a visit while others buried their heads in their magazines to avoid contact. Learning to read the signals has been vital to my ability to interact. An unexpected outcome to waiting room chaplaincy is that the patients, who had previously been strangers to each other, begin to converse, compare notes, and provide care to one another. When these conversations begin, it is one of my cues to depart and make my way to another area of the clinic. A benefit to leaving the waiting area is that it gives time for a natural turnover of patients to occur. After this happens, I find that I am walking into the presence of new patients when I return, rather than “forcing” new patients to walk into my presence because I am already in the waiting area. The difference may seem subtle, but the dynamics that are established are distinct.

In my role, I enhance and strengthen the sense of community that already exists among the staff. I am available to patients and staff alike who may have need for a spiritual companion on their respective journeys. I am a resource person to whom the counselors may refer their clients when spiritual issues arise. I intermittently throw “life-lines” to those who are stuck and “cheerlead” those who are making progress. Sometimes, I am invited by the physical therapists to engage patients in conversation as a distraction to take their minds off the discomfort of their treatment.

Perhaps most important is that I am commissioned to practice the ministry of hospitality. For our patients to be visited by someone whose main concern is to provide a human touch in an environment that has been described as a “foreign zone which no one can explain,” serves to acknowledge their “vulnerability in an alien social world;” personalized hospitality takes a definitive step toward valuing them as a vital and valuable fellow human being.[2] Hospitality is extended through the obligatory water cooler in our waiting room, but we also have a coffee and cocoa machine, and we bake cookies twice daily for our patients. To walk into our clinic and smell fresh baked cookies sets us apart in the minds of our patients and serves to further put them at ease; it feels a little like home. This ministry of hospitality is important in and of itself, but it also exposes needs, reveals opportunities, and builds bridges for total person care that goes beyond the physical indicator that brought the patient to us in the first place.

The pilot program was initiated to evaluate the level of need and opportunity for spiritual care in an outpatient setting, as well as to assess the dynamics of the new environment, and identify the role of a chaplain. Because the patients have been plunged into difficult real-life situations, there is need for spiritual care, and the opportunities to provide that care exist.

My role arose out of the existing mission of the clinic in which I serve. It is reasonable to imagine that every outpatient clinic has needs and opportunities to provide spiritual care and that chaplains have a role in this new setting for ministry.

Footnotes:

[1] Jim Gunn, as quoted in “Conquering Fear,” Vim & Vigor, Spring 2008, p. 52.

[2] Joanna Bailey, Practicing a Theology of Hospitality: A Style of Pastoral Care, unpublished CPE Residency Project, 1992.

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