Month: July 2015
One of my goals during my time at the hospital has been to help the full time chaplains and chaplain residents think about how they “chart.” Yes, just like the medical staff we are required to document our visits with patients, families, and staff in the medical charts.
As part of team of family support services, the chaplains work with the social workers and child life workers in the hospital. What is sometimes hard to discern is how the work of the chaplain is different from what these other professionals are doing for children and families. We know we are there to support their spiritual lives while they are being treated for physical issues, but how do we write and talk about that in meaningful ways.
I experimented with this when I wrote a verbatim – a word for word report of a visit I made with a family, complete with my analysis of the visit. By way of an analysis I “combed through” the conversation to look for the ways the patient and the mom were expressing their spirituality, and how I was supporting it by what I did, said, or by what I didn’t say or do. I used Rebecca Nye’s description of children’s innate spirituality which she calls “relational consciousness” – an awareness of our relationships with the self, others, the transcendent, and the environment to guide me. The conversation revealed this awareness in the patient in many ways. As I considered how I supported and nourished her awareness of these relationships, I looked for how I used Rebecca Nye’s six principles in the visit – Space, Process, Imagination, Relationship, Intimacy and Trust.
I also looked through the conversation for the times when the patient or her mother were grappling with existential issues such as aloneness, freedom, questions of meaning, and death; looking specifically for how my actions or words (I told a Godly Play story) helped give voice to these issues. The staff and residents in the pastoral care department took that work and began to think about how they might better chart these things on a daily basis. I wonder what their chart notes will look like going forward?
I think this kind of thing could go far beyond the hospital and the work of chaplains. The goal of the chaplain is to support the child’s spiritual life while they are being treated in the hospital, but of course all of us who love children want to do this whether they are in the hospital or not. We need to “tune our ears” to hear the child’s spirituality and then set to work to find ways to support and nourish it so it can flourish. As we get better and better at hearing our children, we can find more and more opportunities to nurture that spirituality.
We know that “relational consciousness” comes naturally to young children. But as children move through adolescence and into adulthood they often repress or discard it altogether as the values of the culture press in on them. If the adults in their lives can listen for it in their daily conversation and encourage it, perhaps that can change – perhaps the children will begin to feel as if this awareness is valued by the world and theirs will grow stronger and stronger as they move into adulthood.
This past week I have had some wonderful or “sublime” moments with children and some perfectly tragic ones – and some sublime moments mixed in with tragic ones. I suppose every sublime moment has an edge of the tragic mixed in since just being in a children’s hospital means something is seriously wrong – something that requires the family to come here. Even so, let me try to describe what I mean.
One day last week as I was working with a family whose child was actively dying, I went and visited a child on the general pediatric floor who was sick and sad, but obviously getting well. The little girl was resting in her mother’s arms so at first I visited with the mom, but then I noticed the little girl peeking at me. I said hello and told her my name. I said, “Did you hear me tell your Mom that I’m a chaplain.” She nodded seriously. I said, “Do you know what a chaplain is?” She shook her head no. I told her that sometimes I pray with people, or just talk with them – that I’m here to talk about how they are feeling in their hearts not to poke and prod them or give them shots. I said, “How is your heart feeling today?” She said, “Its sad.” I said, “I’m sorry its sad. It is hard being sick.” She nodded. Then I said, “You know, chaplains also tell stories. Would you like to hear a story?” She sat up and said, “Yes!” enthusiastically. She told me she had to get “cozy” first. She arranged the blankets and puffed up her pillow and then settled back down.
I pulled my miniature Creation story out of my bag and began to tell it. She was entranced and engaged on all levels, touching the material, wondering with me about what might be the most important gift and where she was in the story. When I finished she said she was ready for a nap. I said, “That’s great. I hope you have a good nap. Can I come another day with a story?” She smiled and said yes. I turned to say goodbye to her Mom who whispered, “Can you come every day?” I smiled and said I would try.
In the meantime I found my way to the Emergency Room where a little girl was being treated for a broken bone. She was alone, since it happened while her Mom was at work, and she was terrified. I sat with her while we waited for her mother. She slept a little, but she was in a lot of pain and needed her Mom. I said, “I know how scary this must be. Would you like me to say a prayer?” She whispered, “Yes.” I said a short prayer and then asked, “Do you know any prayers?” She drew a deep breath and started, “Our Father…”, and together we prayed the Lord’s Prayer together. It was a holy and precious moment – and blessedly her mother arrived shortly after that.
All of this happened as I was also caring for the family whose child was actively dying. And the last “sublime” moment for me was when I stood with the staff at the very end of that long sad day. The drama and emotion of the day was exhausting for us all, but as we stood alone in the room (the family had been escorted to their cars) we gathered in a circle around the child and prayed. I prayed the Prayer of Commendation from the Burial Service in the 1979 Book of Common Prayer. Those simple words were a “sublime” way to end what had been a long and difficult day.
Into your hands, O merciful Savior, we commend your servant. Acknowledge, we beseech you, a sheep of your own fold, a lamb of your own flock, a sinner of your own redeeming. Receive him into the arms of your mercy, into the blessed rest of everlasting peace, and into the glorious company of the saints in light. Amen. The Book of Common Prayer, p. 499
Twice a week a chaplain from the Pastoral Care Department at Children’s Medical Center leads a “Meaning and Purpose Group” for patients being treated on the Psychiatric Unit. The goal of the group is to provide inpatients with a developmentally appropriate way of reflecting on and expressing their own sense of identity, purpose and meaning within the personal, social and spiritual milieu in which they identify themselves as members. Patients carry a variety of diagnoses including depression, suicide ideation, self-harm, and other medical psychiatric diagnoses. The chaplain uses the Godly Play® approach, bringing a story to the circle each week, sharing the story, and allowing some time for the patients to respond to the story in the group and individually.
I have been privileged to observe this group a few times, and last week they let me “drive” – that is I was the storyteller. I chose to tell the story of the Exodus which, for those of you unfamiliar with Godly Play, is told in the desert box (a large box of sand) with small wooden people figures and blue felt to represent the “Red Sea.”
I cannot begin to express how incredible Godly Play is in this particular setting. The children sitting in this circle range in age from 10 to 17, and the existential issues that all of us grapple with in some way or another are fierce and threatening for them. I am speaking of questions of meaning and purpose, freedom (both the need for freedom and the fear of it), aloneness (the need to be alone, and the need for others to come close), and death. We “bump up against” these things throughout our lives, but for these children they have become all too real and powerful, and they are hungry for a way to talk about them. The children, no matter how religious, immediately recognize the power of this language and begin to use it to make meaning.
Jerome Berryman refers to Godly Play as “the chaplain’s strange language” in his book, The Spiritual Guidance of Children: Montessori, Godly Play, and the future. He writes:
The play therapists at Texas Children’s Hospital, especially Jackie Vogel, in the mid-1970’s were the first to understand Godly Play and what “the chaplain’s strange language” had to do with children’s ultimate concerns, which are obvious in a hospital setting. The play therapists knew quite well how to help children cope with the fear of the unknown. They could help children play this out, for example, with a model of the hospital’s surgical suite to make going there more familiar and to help the children talk about their fears. However, when children asked, “Am I going to die?” something changed in the communication. This was not a questions about the unknown. This was about the unknowable, so a whole different kind of language was necessary. The parable of the Good Shepherd needed to replace the model of the surgical suite to make the existential meaning required to adequately respond to such a question. (p. 111)
Berryman goes on to talk about how helpful it is to be present to a child with those types of concerns as a storyteller rather than an expert about religion. And really any Godly Play story works, not just the Good Shepherd. What makes this work, suggests Berryman, is that the story is not “explained.” Instead it is placed between the storyteller and the children, and then together we enter the story to be with God and each other as meaning is created.
The Exodus held many connections for the children in the psych group. They connected powerfully with the feeling of being trapped, or pushed up against the Red Sea as the Pharaoh’s army pursued them. During the art response time one child drew herself as the Pharaoh saying, “I’m the Pharaoh in my life. I’m keeping myself trapped – not letting myself go free.” The story also gave them hope, e.g. saying that they knew that even though it felt awful right now, God would show them a way through just as he showed Moses how to get through the Red Sea.
Over the years I’ve heard Jerome Berryman say, “Godly Play has the power to change the world.” I’m not sure about that, but I know it has the power to help children, and the adults who love them, draw close to God, to each other, and to grapple with the difficulties of life whether large or small. And I guess when you think about it, that could most definitely change the the world!
Throughout my time in the hospital I have gone to visit children and families, only to discover a little one all alone in his or her room, staring up at a mobile, or fussing with no adult to comfort them. This is disconcerting for me, as a parent, and I often wonder how best to help. I yearn to pick the little one up and cuddle them, but I don’t know how sick they are and if this is even permissible. I look for a nurse to tell me something about the family, but often they are busy with other patients.
In the beginning I would simply walk past and look for a patient or family with whom I could talk, but it never felt right just walking past those little ones all alone in the hospital. After a while I started going in to visit anyway, and would play with the little one or sing little songs. I sing all the little songs I used to sing with my children: “The Itsy, Bitsy Spider”, “Twinkle, Twinkle,” “Jesus loves me,” and even some of the made up songs we used to sing to the tunes my daughter learned when she took Suzuki piano. My children will appreciate knowing that I made a little two year old laugh yesterday when I sang, “Wake up, Shake up, Take off your pajamas. Eat your breakfast, time to go to school”, one of those silly little songs our family sang for weeks as our daughter learned to play it on the piano. When I sing, the children stop fussing. Their eyes shine and if they are old enough they will clap at the end of each song. Still, I have struggled with the worry that a parent would be offended in some way that this strange chaplain was singing and playing with their child without permission.
I’ve been here long enough, I guess, that I have stopped worrying about that. And lately, I have been trying something new. Knowing that often the best thing for a baby developmentally is for a parent or caregiver to simply talk and tell stories to them, I’ve started doing just that. I still sing “Twinkle, twinkle little star” and “The Itsy, Bitsy, spider.” But then I quietly begin to tell them a parable – sometimes more then one.
No matter how old – just a few months, or a year or more – I have discovered that they love this storytelling. They get very quiet and look intensely at me, sometimes smiling, but usually just seriously listening. I firmly believe that God is made present to us when we read or listen to Scripture. I know I feel God’s presence as I speak the words and look into those little eyes. I wonder….how does that work when the person is too young to understand the words? Do you need to understand in order to feel God’s presence? I wonder…
My prayer each morning as I exit the garage and walk across the sky-bridge to the hospital is, “God, guide my feet today. Lead me to the families and children who most need me.” I believe these encounters with these babies are answers to that prayer, and I am grateful for these holy moments.