Chaplains trained at hospital for the poorest

 

Issue Date: September 14, 2007
Chaplains trained at hospital for the poorestBy EILEEN MARKEYIf Christ arrived in a distressing disguise, in the face of a stranger, Sr. Christine Setticase in her role as a trainee hospital chaplain in New York City met him many times. Thrust onto an intensive care ward at New York Hospital and a psychiatric unit at Bellevue Hospital, her challenge was to be a caring presence for patients who requested her services, and to help them become closer to the divine, however they defined it. Setticase, a Pauline sister who now does research at the order’s publishing house in Boston, said her chaplaincy training summer remains among her most moving experiences of ministry.“There were quite a few moments in that mental ward when I could see their soul,” she said.Chaplains are an innocuous part of the hospital landscape, as familiar under the florescent lights and in the labyrinthine corridors as speed-walking orderlies or gift-shop chrysanthemums. But chaplains perform a unique service, able to dip into the most essential bits of people’s lives and care for them in profound ways.

The Association for Clinical Pastoral Education, an interfaith training organization, maintains more than 300 education centers in the United States, each affiliated with a hospital, nursing home, hospice or prison. Many seminaries, rabbinical schools and other outlets for clergy formation require at least one unit of chaplaincy training before ordination. The program in which Setticase was enrolled now operates exclusively at Bellevue, a large public hospital on the east side of Manhattan that treats the poorest New Yorkers: homeless people, chronic drug users, people held in the city jail at Riker’s Island. Bellevue patients rarely have visitors, said Paul Steinke, director of the Clinical Pastoral Education program there. They are often forgotten people.

“I want [the students] to learn how to minister to suffering people,” said Steinke, a soft-spoken Lutheran minister. “Everyone has spiritual issues. ‘What is the meaning of this illness?’ ‘What is hope?’ You can’t be in a hospital and not think, ‘Why?’ ”

For 10 weeks at a time, Steinke trains groups of seminarians to be a caring, humane presence for these strangers. During the summer of 2007 the Bellevue group included Episcopalians, Methodists, and Conservative and Reform Jews. In past summers Steinke has guided Catholics, Muslims, Buddhists and evangelical Christians, he said.

Training consists of visiting patients, then recounting those pastoral conversations to fellow trainees for analysis and critique. The goal is always to approach the patient as a sympathetic listener who can help them elucidate their spiritual desires. The chaplain is not sent to evangelize, improve their religious practice or tell them how to sin no more. Throughout the training period students pray together, read about pastoral care and engage in intense self-study to discover and overcome barriers to open ministry.

“I needed to understand the difference between [social work] and pastoral care,” Deborah Magdalene, a former social worker who is studying for ordination at Union Theological Seminary in Manhattan said when the chaplain trainees were discussing their program in July. Social workers “are there to fix problems. We try to come up with concrete solutions. But there is not necessarily a concrete solution in this work. There’s not necessarily a solution. The ministry is just to be with people in their suffering.”

Benjamin Spratt, who is in rabbinical school at Jewish Theological Seminary, said the opportunity to commune with people beyond the mundane or distracting details of life is profound. “What we do is really different than what everyone else on the floor does. They are interested in fixing them, in fixing the broken body. We don’t see them as a machine. We are the people who see them as people,” he said. “Some of the most profound help one can do is by being with them.”

The chaplains minister to patients regardless of religious identification, though if a patient specifically requests a rabbi or a Catholic priest, they will send one. At Bellevue though, most patients are without strict religious affiliation. Many will talk to a minister, imam or priest with equal candor. The issue is simply to have the ear of someone able to talk about God.

“My most successful chaplain moments are when I don’t categorize people or put them in boxes,” said Sean Wallace, an Episcopal priest. “I’m just walking with the patient for a few minutes of their journey.”

National Catholic Reporter, September 14, 2007

Forgiveness Project

by The Rev. Paul D. Steinke, Supervisor Clinical Pastoral Education, Bellevue Hospital Center, NYC

The young woman* sitting at the head of the table nervously cleaned her glasses. She was meeting the certification committee for Readiness to Supervise. The candidate was queried about her nation of origin, Australia.

The question seemed to settle her and the conversation proceeded.

One of the committee members asked her about a phrase in her personal history: “You talk about your ‘forgiveness project’ in your history. Could you tell us more about that?”

The woman looked surprised and said: “Oh that. Several years ago I lived with a man. I allowed him to abuse me. My forgiveness project is trying to forgive myself for allowing such abuse.” A tear started to stream down her cheek. “I’ve been working with my therapist on it for awhile.”

The room quieted. No one spoke for what seemed like several minutes. Then Jack Gleason spoke. I can’t remember whether he stood up or it just seemed like his words were spoken like he was standing up. He looked at the woman and said, “I forgive you.” More silence. “I forgive you.” I don’t know about the rest of the committee members but I felt like I had just received absolution. Jack continued: “I know for me I can’t forgive myself unless someone else concurs in my forgiving myself.”

The woman said; “Thank-you.” I don’t remember anything else of what was said that morning. I’ll always remember that moment of grace –so pure, so amazing, so CPE.

I propose to the ACPE family a long over due forgiveness project.

In the last ten years we have had good and smart counsel in bringing our association up to snuff ethically and legally. Who would have ever thought that we would come to a time where some of our hospitals run a complete security check on potential CPE students. Were you ever arrested? is a common initial interview question. We have also learned how to operate as men and women in a professional setting. We have learned about the proper boundaries between students and supervisors. We sign documents about our ethical standards. We have come so far from those days in the 60s and 70s when the Cultural Revolution found its way into CPE. Our house is in order. We have covered all the legal and ethical bases. The Ethics Commission has done its job. Processes are in place to deal with offenders.

The Forgiveness Project I have in mind is to develop a process that will allow us to reclaim some of the offenders. And the wonderful thing is that we have seated on our Board of Reps 20 forgiveness experts. This isn’t a job for them to palm off on lawyers. This is a job clergy know more about then lawyers. Let the lawyers check out the finished product. Let the product come from the forgiveness experts on the Board of Reps. I am sure we cannot reclaim people convicted of felonies (even though Jesus did). I don’t see why we can’t reclaim supervisors who stepped over sexual, financial and administrative boundaries.

Why doesn’t the Board of Reps develop a process that will allow some of our fallen colleagues back into the fold? Develop criteria. Prepare a process. Get started on the ACPE Forgiveness Project. It won’t be easy to do.

Remember John Patton’s book Is Human Forgiveness Possible? (Forgive me John if I over-simplify your argument): Through several cases in which clients were unable to forgive a parent or sibling John reveals that they only came to the point of forgiving the parent or sibling when they became aware that they were no different than the person who was so unforgivable. The clients had to over-come their self-righteousness and recognize their human condition in order to forgive the unforgivable.

Many will say, “Oh, that’s the counseling situation. You can’t expect an organization to forgive people.” Hell, yes, we can. We all belong to organizations that are forgiving people everyday. The members of ACPE can expect our elected representatives, all forgiveness experts, to get started on our ACPE Forgiveness Project.

When I first came to NYC in the mid eighties I lived in the rectory of St. John the Evangelist Lutheran Church in the Williamsburg section of Brooklyn across the street from the oldest public housing in NYC. I paid for my domicile by conducting the Sunday liturgy for this little African-American church. The congregation had its own corps of deacons who assisted in the ornate, high church services. One Sunday Deacon Booker said to me, “Reverend, Deacon Johnson needs to say something after you read the Gospel.” I agreed and after the Gospel Deacon Johnson came to the lectern and said:

Fifteen years ago I was the treasurer of this church. You didn’t

know, but I embezzled $12,000 of your money. This week I paid back

the last dime. I am not proud of what I did. I am sorry for taking

advantage of you.”

Deacon Booker stood up and asked the congregation: “Do you forgive Deacon Johnson?” In one voice the congregation shouted, “Yes.”

As I sat there in the pulpit chair I thought to myself, “Holy Moly! This stuff really works!”

* The candidate gave written permission to use the story. All names, locations and people have been fictionalized except Jack Gleason’s. He ain’t no fiction. He’s the real thing.

Black Milk; Literary Resources for Learning Pastoral Care

by Paul Steinke

Paul Celan’s parents disappeared in the Holocaust. He narrowly escaped the Nazi extermination camps. Celan’s poem Deathfugue is organized around an insistent chorus that begins each stanza:

Black milk of daybreak we drink it at evening
we drink it at midday and morning we drink it at night
we drink and we drink1

Milk, which is life sustaining, is transformed into something repellant and sinister –black milk. How can we live with the terror of unremitting suffering? How can we go on? Celan suggests that “we drink and we drink.” We do not choose this cup of woe. Drink we must. How can we survive otherwise? The grim opposites “black” and “milk” are bound together and suggest we cannot have one without the other.

Black milk is my metaphor for the literary resources that can enrich pastoral learning. Celan’s black milk was the Holocaust, an event so horrific it can barely be described in words. I do not intend to diminish his meaning by borrowing his image to describe other terrible suffering in people’s lives. Every day pastors witness patients drinking this scary potion – black milk.

The story, whether in narrative or poetry, alerts us without sentiment to the tragic in everyday life. Literary resources provide us intimations of our own mortality, our own tragedy. Peter DeVries’ novel, Blood of the Lamb is the story of Don Wanderhope who loses his faith as a child when his brother dies, and tries to recover it in adulthood when his daughter is dying of leukemia. Don Wanderhope drinks the black milk that life offers again and again. In his frustration he throws a pie at the statue of Jesus around the corner from Sloan Kettering Cancer Center. His eleven-year-old daughter, Carol dies. The story ends with Wanderhope’s recognition:  “how long, how long is the mourning bench upon which we sit, arms linked in undeluded friendship, all of us, brief links, ourselves in the eternal pity.” 2 Our enlightened culture of niceness, optimism and positive thinking tends to sponge up the black milk of a tragedy with a super absorbent paper towel.

Why would we need literary resources when we have clinical resources?  Clinical resources – the verbatim, the case study, and the self-study – are the bedrock of pastoral learning. Literary resources provide a common language. When students read Tolstoy’s The Death of Ivan Ilych and discuss it together it becomes a common point of reference throughout the training unit.

“She’s no different than Ivan’s wife.”  “Gerasim was too good to be true, just like you.”  “My patient was like Ivan in that he waited till the last to look over his life.”

The verbatim gives us a snapshot of the patient. We see the patient in a small frame. Literary resources provide a longer look at a person; provide not snapshots, but more of a series of photographs. Clinical language is short-cut language. Clinical language might describe a sad, anxious person as depressed. A word like depression doesn’t come close to the description of this mood as we find it in a poem like Psalm 88:

For my soul is full of trouble
and my life draws near the grave.
I am counted among those who go down to the pit;
I am like a man without strength.
I am set apart with the dead,
like the slain who lie in the grave,
whom you remember no more,
who are cut off from your care

The poem describes the black milk that the sad, anxious person drinks – “in the darkest depths,” “the lowest pit,” “eyes dim with grief.”  In William Styron’s, literary non-fiction masterpiece, Darkness Visible, an account of depression, he calls melancholy “a true wimp of a word for such a major illness.”3

Another advantage of using literary resources in pastoral learning is that it can enrich pastoral language. Instead of the universal CPE student responses – “that is hard” or “that is difficult” – why not a metaphor? “It sounds like you are drowning.” “It must be hell”. “You are down in the pit.” It’s as if God is on vacation.”  Donald Capps says: “pastors who take their pastoral care work seriously are deeply concerned with how things are said, and with why this rather than that word or phrase was chosen in a given context.”4 Language matters and literary resources show us the use of metaphor. Metaphor literally means, “to carry beyond.” It is the way language carries itself past its own powers, to enter new realms. A metaphor is a receptacle for diverse and deep experiences of suffering and joy.

Another use of literary resources is beauty. Literary art takes the worst black milk situation you can think of and puts it in a narrative or a poem. The most chaotic experience is given form, structure and beauty in poetry and narrative.  Poetry, novels and short stories do not diminish the suffering. They encase the terrible in beauty so that we can see it anew and from a different vantage. Gregory Orr observes, “its possible to say that the enormous disordering power of trauma needs or demands an equally powerful ordering to contain it, and poetry offers such order.”5 When you are bringing pastoral care to people down in the depths, where black milk is the drink of the day, beauty rests the soul.

The black milk metaphor looms a powerful reminder of the resilience of evil. It also seems a religious metaphor for slavery/salvation, suffering/redemption, death/life and as a Lutheran Christian, Good Friday, Holy Saturday/Resurrection. Black milk also stands next to another drink I imbibe, the cup of salvation offered to me in the Eucharist. That cup is a reminder of a suffering and dying God that offers life, sustenance and strength for the daily drinking and drinking of black milk.

The literary resources now suggested are grouped around what might be called pastoral care themes. The four units of CPE each year at Bellevue, for example, have a theme. The themes are discussed and written about each week in smaller groups we call Integration Groups.
Fall:  The Pastors’ and the Patients’ Illness Stories: literary resources: At the Will of the Body, Arthur Frank (creative non-fiction), and two short stories, Eudora Welty’s A Worn Path and Charlotte Perkins Gilman’s The Yellow Wallpaper.
Winter: Pastor as Person: Peter Devries, novel, Blood of the Lamb and the short story, Departures, John L’Heureux.
Spring: Pastors’ and Patients’ Grief and Loss: Leo Tolstoy’s The Death of Ivan Ilych and Anton Chekhov’s short story, Gusev.
Summer, Pastoral Response in a Multi- Cultural World: Anne Fadiman’s creative non-fiction, The Spirit Catches You and You Fall Down and short stories by Bharati Mukherjee, the Management of Grief and Nora Zeale Hurston, Conscience of the Court.
Poetry that befits the occasion is interwoven throughout the integration units sometimes in a formal way, often on the spur of the moment.
Most of the short stories can be found in The Norton Anthology of Short Fiction, R.V. Cassill and Richard Bausch, Editors, Sixth Edition, (New York: W. W. Norton and Company, 2000) On the list below I will only signal short stories not listed in the Norton Anthology. Novels and literary non-fiction will also be referenced. At the end of each section I will list poetry appropriate to the theme, which will be followed by one of the poems. At the end of the article I will include a bibliography of poets, titles, and publishers.

1.Pastoral Caregiving:
Alan Gurganus, It Had Wings: This two-page story from Harpers via Winter 1985 issue of Paris Review is a parable about CPE. It usually provokes a good orientation week discussion.
Eudora Welty’s A Worn Path is a moral story of conscience and unrelieved suffering – and redemption – by the poorest of the poor.
Charlotte Perkins Gilman’s, The Yellow Wallpaper depicts the terror of mental illness and the societal forces that keep it hidden from public view.
Arthur W. Frank’s creative non-fiction At the Will of the Body provides an illness narrative of Frank’s journey with cancer. The nature of being ill with its pitfalls and emotion is nowhere more beautifully said. Students see the course of an illness and reflect on how pastoral caregivers may have interacted with Frank on his journey. (Arthur Frank, At the Will of the Body, (New York: Houghton Mifflin Company, 1991).
Poetry: Langston Hughes, Sick Room; Abraham Sutzkever, Prayer for a Sick Friend; Sharon Olds, His Terror; William Stafford, Consolations.

Sick Room
Langston Hughes
How quiet
It is in this sick room
Where on the bed
A silent woman lies between two lovers-
Life and Death,
And all three covered with a sheet of pain.

2.Grief/Mourning:
Tillie Olsen, Tell Me a Riddle reveals many twists and turns as an older couple tramp through a thicket of life review and pre-mourning.
Bharati Mukherjee, The Management of Grief is the talkative excursion of an Indo- Canadian community’s response to a Lockerbee like plane crash that consumes many of its members. The nuances of grief revealed here is a welcomed relief from the canned responses to grief prevalent in self-help books.
Lee Smith’s Intensive Care chronicles the grief of a dying patient in the ICU. The nature of hope whispers from every page.
Poetry: Tess Gallagher, Yes and Wake and Moon Crossing Bridge; Gregory Orr, After a Death; William Stafford, Circle of Breath and In a Corner and Consolation; Jane Hirshfield, “Nothing Lasts.”

After a Death
Gregory Orr 6

I heard the front door close
and from my window saw
my father cross the moonlit lawn
and start up the orchard road.
Then I was with him,
my mittened hand in his,
and Peter, my brother, his dead son,
holding his other hand.
The way the three of us walked
was a kind of steady weeping.

3.Death/Dying:
Leo Tolstoy’s The Death of Ivan Ilych provides a cast of characters who respond in idiosyncratic ways to Ivan’s dying. His dying is meticulously recorded.  How would a pastor respond at each stopping place along the way? (Tolstoy is always in print at any bookstore.)
Anton Chekhov’s Gusev depicts a sick man returning with other sick men to the motherland. The men contend with each other, remember their lives. express strong opinions. Death is depicted in a surprising way at the end of the story.
Poetry: Raymond Carver, Gravy and No Need; Jane Kenyon, Otherwise and In the Nursing Home and Now Where; Sharon Olds, The Lumens and His Terror and His Stillness; Bertolt Brecht, To My Mother; Wendell Berry, A Meeting; Adam Zagajewski, To…, and Elegy for The Living

To My Mother
Bertolt Brecht

And when she was finished they laid her in earth
Flowers growing, butterflies juggling over her…
She, so light, barely pressed the earth down
How much pain it took to make her as light as that!

4.Vocation/Identity:
Joseph Conrad’s novella, The Secret Sharer tells the tale of a new sea captain and how he achieves his identity as a person and his vocation as a mariner through action. (Conrad’s novella is always in print at any bookstore.)
John L’Heureux’s Departures depicts the changing identities of a Roman Catholic priest as pastor, son and friend. Anthologized in Vintage Contemporary American Short Stories, Editor, Tobias Wolf, (New York: Vintage, September 1994).
Jonathan Rosen’s (the husband of a CPE Supervisor) Joy In the Morning may be the only novel whose protagonist is a woman rabbi and hospital chaplain.
Rosen is a teacher and the book offers a clear view of Jewish life and practice.
(Joy In the Morning, Jonathan Rosen, (New York: Farrar, Strauss and Giroux,
2004).
Poetry: Dietrich Bonhoeffer, Who Am I ? Mary Oliver, Wild Geese and Magellan and the Summer Day; Denise Levertov, Vocation and A Cure of Soul; Jane Kenyon, The Pear.

The Pear
Jane Kenyon

There is a moment in middle age
when you grow bored, angered
by your middling mind,
afraid.

That day the sun
burns hot and bright,
making you more desolate.

It happens subtly, as when a pear
spoils from inside out,
and you may not be aware
until things have gone too far.

5.Suffering/Redemption:
Eudora Welty’s A Worn Path challenges most of us privileged folk to envision anew a perspective on life and suffering through the eyes of a poor old woman and her sick grandson.
Flannery O’Connor’s A Good Man Is Hard to Find depicts the human condition in all its self-righteousness and violence. This is the human stripped to the bone.
Poetry: Bertolt Brecht, Everything Changes; Sharon Olds, The Struggle; Jane Kenyon, Notes From the Otherside; Gregory Orr, Three Biblical Songs; Denise Levertov, Strange Song.

Strange Song
Denise Levertov

Yet the fear nags me: is the wound
My life has suffered
Healing too fast,
Shutting in bad blood?
Will the scar
Pucker the skin of my soul?

6.Faith/Doubt:
Peter DeVries’ The Blood of the Lamb is the only full-length novel I use in my CPE curriculum. It has been out of print for years but can be found on the Internet at used book sites. (Blood of the Lamb, Peter DeVries, (New York Little Brown and company, 1961).
Poetry: Denise Levertov, Psalm Fragments and Suspended; George Santayana. Faith; Adam Zagajewski, In the Past; John Updike, Seven Stanzas at Easter.

Faith
George Santayana

O world, thou choosest not the better part!
It is not wisdom to be only wise,
And on the inward vision close the eyes,
But it is wisdom to believe the heart.
Columbus found a world, and had no chart,
Save one of faith deciphered in the skies;
To trust the soul’s invincible surmise
Was all his science and his only art.
Our knowledge is a torch of smoky pine
That lights the pathway, but one step ahead
Across a void of mystery and dread.
Bid, the, the tender light of faith to shine
By which alone the mortal heart is led
Unto the thinking of the thought divine.

7.Community:
Robert Condon’s Christmas at Bellevue appeared in the New York Herald Tribune, December 19, 1965. It depicts an unusual community bound together by hardship.
The Prologue to Scott Pecks The Different Drum: Community Making and Peace is a remarkable parable of multi-faith cooperation.
Poetry: Adam Zagajewski, In The Beauty Created By Others

In The Beauty Created By Others
Adam Zagajewski

Only in the beauty created
by others is there consolation,
in the music of others and in other’s poems.
Only others save us,
even though solitude tastes like
opium. The others are not hell,
if you see them early, with their
foreheads pure, cleansed by dreams.
That is why I wonder what
word should be used, “he” or “you.” Every “he”
is a betrayal of a certain “you” but
in return someone else’s poem
offers the fidelity of a sober dialogue.

8.Cross-Cultural:
Bharati Mukherjee, The Management of Grief.
Zora Neale Hurston’s Conscience of the Court looks at the interplay of the many cultures in a small southern town where Laura Lee Kimble, the daughter of slaves is on trial for roughing up a white man.
Anne Fadiman’s The Spirit Catches You  and You Fall Down is the harrowing story of an Hmong girl’s clash with modern American medicine in Merced, California. Fadiman is a must read for understanding our multi-cultural existence.
Poetry: William Stafford, Distractions and In the All-Verbs Navaho World and Is This Feeling About the West Real? Tu Mu, Kenneth Rexroth, trans., LXVIII, View From the Cliffs.

In the All-Verbs Navaho World
William Stafford

Left-alone grow-things wait, rustle-grass, click-
trunk, whisper-leaf. You go-people miss the hold-still
dawn, arch-over sky, the jump-everywhere glances.
This woman world, fall-into eyes, reaches out her
makes-tremble beauty, trolls with her body, her
move-everything walk. All-now, our breath always
life extends, extends. Change. Change your live-here,
tick-tock hours. Catch all the flit-flit birds,
eat the offer-food, ride over clop-clop land,
our great holds-us-up, wear-a-crown kingdom.

Bertholt Brecht asks somewhere “In the dark times will there be singing? Yes, there will be singing -  about the dark times.”  In the dark times, the times when black milk is the only brew being served, a distant song may be heard, a hand may be proffered, a tear may be shared, a groan may be the only telling, darkness may be the only friend. Literary resources provide the language we need when pain and suffering destroy language.

Poetry Bibliography
Wendell Berry, Collected Poems, 1957 – 1982,(SanFrancisco: North Point Press, 1985).
Dietrich Bonhoeffer, The Cost of Discipleship, (SanFrancisco: The Macmillan Company, 1978).
Bertolt Brecht, Poems 1913 – 1956,  (New York: Routledge, 1956).
Bliss Carmen, Editor, The Oxford Book of American Verse, (New York:  Oxford University Press, 1927).
Raymond Carver, A New Path to the Waterfall, (New York: Atlantic Monthly Press, 1989).
Tess Gallagher, Moon Crossing Bridge, (St. Paul, Minnesota: Graywolf Press, 1992).
Jane Hirshfield, Given Sugar, Given Salt, (, New York: Harper Collins, 2001).
Langston Hughes, Dig and Be Dug In Return, Selected Poems, (Seattle: Scriptor Press, 2002).
Jane Kenyon, Otherwise, (St. Paul, Minnesota: Greywolf Press, 1996).
Denise Levertov, Evening Train, (New York: New Directions Books, 1992).
Denise Levertov, Oblique Prayers, (New York: New Directions Books, 1984).
Denise Levertov, Poems, 1960 –1967, (New York: New Directions, 1967).
Denise Levertov, The Stream and the Sapphire, (New York: New Directions, 1997).
Sharon Olds, The Father, (New York: Alfred Knopf, Inc., 1992).
Mary Oliver, New and Selected Poems,  (Boston: Beacon Press, 1992).
Gregory Orr, The Red House, (Cambridge: Harper Colophon Books, 1980).
Kenneth Rexroth, Love and the Turning Year, One Hundred More Poems from the Chinese, (New York: New Directions, 1970).
William Stafford, Stories That Could Be True: New and Collected Poems, (New York: Harper & Row, 1977).
William Stafford, A Glass Face In the Rain: New Poems, (New York: Harper & Row, 1982).
William Stafford, Passwords, (New York: HarperCollins, 1991).
William Stafford, The Darkness Around Us Is Deep, (New York: Harper Perennial, 1993).
William Stafford, Even in the Quiet Places, (Lewiston, Idaho: Confluence Press, 1996).
John Updike, Telephone Poles and other Poems, (New York: Alfred A. Knopf, 1963).
Adam Zagajewski, Without End, New Selected Poems, (New York: Farrar, Straus and Giroux, 2002).