Today in worship my pastor preached on the instance where the Pharisees asked Jesus if it was allowed in the law to pay taxes to Caesar.  Jesus asked them to produce a coin to pay the taxes and asked what image was on the coin.  The answer of course is: Caesar!  The picture above is the front and back side of the type of coin Jesus was referencing.  The moral of the story is that the Pharisees were asking the question in hopes of giving them grounds to ridicule or arrest Jesus.  They really did not want an answer about proper tax payments.

As I reflected on how this applies to my ministry as a chaplain I started to remember questions I have heard people ask in that setting.  Many times the questions really don’t have an answer.  That is okay if there is not an answer.  In those cases the person asking the question is processing their emotions and just asking the question, without receiving an answer is helpful to them.

I realize the previous paragraph may seem confusing so I want to use an example to illustrate my point.  In this example the spouse has just learned the patient died.  The spouse had wanted to be there for the moment of death and only missed being there by less than 5 minutes.  The question the spouse asked was, “Why couldn’t _________ (fill in the name) have waited until I arrived?”  We don’t know for certain why the death was not delayed for 5 more minutes.  Some theorize the person wanted to die alone and waited for a moment when no one else was in the room.  Others theorize that it was kinder on the spouse for them not to have watch and listen to the “last breath” being taken.  I am sure there are other answers people propose for this question.

When I am with a family and listen to their questions, I listen for the emotions that are contained within the questions.  In the example I have used many times the spouse states they did not want their mate to die wondering how much she/he was loved by the survivor.  The surviving spouse suddenly feels a reason to feel guilty because they were not there at the last moment of life.  There is always something I know about how the spouse attended to patient prior to the moment of death and I try to use what I know to remind the survivor that they were attentive to the patient.  One example is this, “I know you wanted to be here at the moment of death, but last night when the patient had a fever and you put cold compresses on the forehead to bring comfort, you were there in a way that I am sure the patient knew and valued even though the patient was too weak to speak”.  The survivor usually smiles and says something to the effect, “Yes I was there for that and you know I was needed then”!

I encourage you next time you hear a question think for a moment and decide is the person asking the question as a method of gaining information? Or is the person asking the question as a method of sorting out what has happened to them?  Many times affirmation of what we know is a lot more comforting than speculating on a reply that can’t be proven!

After having my dog, Cooper, at the kennel for 8 consecutive days as I traveled it was a joy to be reunited with him again.  Part of the joy is watching him discover that the things he loves about our home are still here waiting for him when he returns.  We have a normal path we walk most of the time.  He has learned that path and now makes the proper turns even if he is several feet ahead of me on the leash.  I like the fact that I can expect in most cases that he will make the proper turn.  He has two places on our route where he stops and sniffs intently for several minutes.  I am assuming he is finding the scent of another animal in those locations but then not being a dog, I really can’t say for sure.

When we were in the back yard I attached him to a “tie out” so I could move the car into the garage.  Afterward I went to connect back onto the leash and in the process he was not connected to either the leash or the “tie out”.  Being the smart pup that he is, as soon as he realized he was unanchored he began to run.  I knew outrunning him was a futile attempt on my part so I called to him “STOP”.  He did the right thing and waited, even lying down on his side, until I got to him and could attach the leash.  I was thrilled that I was able to avoid a chase scene and that he was safely tethered to the leash.  Had he been home for days in a row I doubt he would have laid down and waited for me the way he did.  But since he missed me, he did lie down and we had a happy reunion on the driveway and also the rest of the evening when we were in the house.  I am so thankful that Cooper did not get away from me when I brought him home!  I think Cooper is also glad we are reunited!

The circle is one of the universal symbols we use for completeness because it has no beginning and no end.  In chaplaincy I often refer to the shape of a circle when we form a prayer circle of family holding hands around the patient while the patient is in the hospital bed.  These prayers are always powerful for me and families respond positively to them.

Today I want to talk about another way that the image of circle sometimes describes my family encounters as a chaplain.  I am the type of person who likes to have closure.  So when I meet a patient and/or their family during their hospital stay and then realize they have been discharged before I have seen them again I wonder how things went for them after I saw them.  Sometimes I am given the gift of being able to see patient and family before they are discharged and learn how things are going and details about the prognosis.  Today I was paged to the death of a patient.  This particular patient had suffered a code blue several weeks earlier.  I was just around the corner when the code was paged and moved to the area and was able to offer immediate comfort to the spouse who was there.  The patient was moved to ICU where I was able to continue to have encounters with the spouse and other family members.  As the family and I said our good-byes to the patient, I was able to feel the emotional bond that we had developed over many visits.  As I left the encounter I was sad for the family because of the journey of grief they were beginning.  I also had a better sense of closure than I often get because I had been able to follow the family through nearly the entire hospital stay.

Relationships are important.  They always have a beginning.  Sometimes their ending is defined and other times the two parties just don’t get the chance to see each other again.  I am even more thankful now for relationships I have with patients and families where closure is part of the outcome.

Today I gathered with medical professionals including chaplains from all over the state of Maryland.  We met at Johns Hopkins Hospital in Baltimore MD.  The event focused on community health partnerships.  In community health partnerships health care delivery is structured to overcome the barriers that prevent people who need health care from receiving it.  The most intriguing concept presented is that more health care is provided in private homes and apartments than any other setting, including hospitals and clinics.  If the care provided is our homes and apartments are done well, the need for office visits and hospital admissions DECREASES!  As the Baby Boomer generation enters the Medicare phase of their lives the old health care provision model will produce costs that are unsustainable.  Moving to an increased focus on health care being provided outside the hospitals and clinics is the key to containing health care costs.  For this to happen each community will have to develop plans that are designed for their locality that include partnerships with medical, governmental, and faith-based organizations who will all work together for the common good of their community and its citizens.

If you are reading this and are thinking, “This won’t be easy”, you are correct!  We have learned in life that other important changes that were necessary are not easy, and this important change is no different in that regard.  I encourage you as you learn of discussions of new programs in your area arise to get involved in the discussion.  This is a grass roots effort and there is a role for everyone in making it work!

The image above is “The Cross” it is in Effingham, Illinois along Interstate Highways 57 & 70.  I am using it as today’s image as we look at advance directives and the whole issue of “quality and quantity of life”.  I recently dealt with a family that was in agreement on what care plan they wanted for their patient.  The problem was that the advance directive, which was completed for the purpose of aiding the family actually created problems due to the wording in some of the sections.  As medical professionals in good faith read the document some came to opposite conclusions on what should be done to honor the wishes of the patient.  After some discussions the interpretation of the health care agent was honored.  A few days later the patient died.  It was a peaceful death, in just the setting the family knew the patient wanted and that they wanted.  Sadness was in plentiful supply.  But faith was present in event greater supply!  The family was Christian and they were able to claim for the patient the promises that God makes through the sacred writings of the Christian faith.  The family did not want the patient to linger in the weakened condition that existed.  While I would have loved to pray for a total healing in this earthly life, it was clear the total healing was going to come in the heavenly realm.  The family gained comfort from my presence and prayers not just at the moment of death but along the way in the decision making process.  I am still struck by how well the family coped with the reality of death and being in unison of opinion as they decided how to provide end of life care that honored the patient’s wishes.  I also offer this as an encouragement to all readers to have an advance directive and discuss it with your family.  If it has been more than 5 years since you drafted it, it is time to review to see if what you wrote in the past still represents your desires for the present and the future.  A well-crafted advance directive can be a blessing to family members as death approaches.

This is not a picture of my desk.  I found it on the Internet to illustrate my day.  A volunteer came to my desk today asking to have a piece of scotch tape.  I was in the process of trying to catch up on 8 items at the same time.  She went on to tell me she had a sympathy card for someone who works in our office suite.  That is when and how I learned that my friend’s father had died.  The funeral was to start in less than an hour, and I had missed the visitation the night before.  In my heart and head, I knew where I needed to be: at the funeral home to support my friend.  My desk work was not more important than my friendship.  So I immediately put my work away and rushed to the funeral home.  I am so glad I did not miss out on the funeral and the luncheon that followed.  Her father would have been so happy to see his family come together to remember, honor, and commend him to the Heavenly kingdom.  Her Dad and I met many times.  The first time we met he did me a favor at watched my dog so I could go to work.  Then I met him as he volunteered at the Information Desk at the hospital.  Later I spent time with him during several hospitalizations.  I will always remember his smile and the accent of his voice.  He is at peace with the Lord and no longer limited by the health issues he faced.

I could have skipped the funeral and later told my friend I cared.  That would not do for me because I feel that part of caring is taking the time be with someone at significant moments in life.

The image above is one I downloaded from the Internet.  It is supposed to depict a lung transplant surgery.  Saturday I helped very good friends of mine with a Spaghetti Supper that is a benefit to raise money for a local woman who needs a lung transplant.  She has been approved for the transplant and is now on the waiting list.  She could get a phone call any time and have 3 hours to get to the regional out of state hospital where the surgery would take place.

I had a very small role in the whole process.  I was at the table collecting the requested donation of $ 7 per meal.  That day I assisted 250+ people contribute to her cause and also enjoy a great meal.  The patient and her family were there for the event and were very moved by all the support given.  They had people they had never met helping raise money for the costs associated with the surgery and recovery process.  People who came knew the purpose of the dinner.  Many made donations over and above the cost of their meal ticket.

As I look back on the event the part of the event that leaves a lasting impression on me is how people, so of whom had never met previously, came together to help in cause they all mutually supported.  There was no maneuvering for positions of prestige.  There no attempt to “climb the ladder” to gain importance.  Every job was viewed as equally essential to the overall goal.  I came away tired, but I also came away touched by the power of loving people working together in a loving way.  I will remember this for a long time!

I visit as many as 40 hospital rooms a day.  I was paged to a room and scrambled the number in my mind and entered the wrong room.  I could tell from the calm demeanor in the room that this was not where I was supposed to be.  While I was there I noticed a service dog sitting in a chair next to a visitor.  Because I was needed urgently, I had to politely excuse myself and learn where I was supposed to be and then get there as quickly as possible.  Later I encountered the visitor and the service dog in the hallway and had the luxury of leisure and engaged the visitor in a conversation.  The visitor told me about all the ways the dog helps her deal with her hearing deficit by sounding a bark.  Here is a partial list of things the dog will alert her to:

• A whistling tea pot.
• The doorbell.
• The telephone.

I was most impressed with how the presence of the dog gave her joy and a sense of independence.  As we talked she did not complain once about lack of hearing.  She continually praised her service animal for all the ways he helps here.  I was impressed with his behavior.  The dog did not seem the least bit nervous being in a hospital or upset by all the sounds that are a part of the hospital setting.

As I walked away from our conversation I wondered how I would behave if I was the one with the service dog.  Would I praise the dog?  Would I complain about how hard life is without the ability to hear in a normal manner?  I will probably never know the answers to these questions.  But as I remember this visitor, I am going to remember her spirit and example to be thankful and adjust to new ways of dealing with life rather than complain about what I can’t do.  It was a good lesson for me and helped me examine the whole role of thankfulness vs. complaining that all of us can face in life.