Worth Reading

by Danny Fisher

I read a few articles this week that might be interesting to other who work in hospital chaplaincy.

The first is a personal essay from this week’s <a href="http://www.msnbc.msn.com/id/19851490/site/newsweek/
“>Newsweek, written by hospital chaplain Toni Weingarten. It really resonated with me as one who has offering spiritual care in the same setting. Weingarten also offers some useful insights to chaplains old and new.

    The first time I assisted a family in losing a parent, I put on a long face as I thought that was expected of me as a chaplain—to share, and feel, the family’s pain. My supervisor, with me at the time, later took me aside and told me not to do that. “You’re there to be a centering force for them, not to take on their pain,” said my supervisor, a longtime chaplain. I was taken aback as I thought I’d appear unfeeling if I didn’t look as though I, too, suffered along with them. Over time, I’ve come to see the wisdom of my supervisor’s words.

    The time both before and after the death of a loved one is so intense that people experience the full spectrum of emotions from laughter to grief, from joy to despair; it is as if people are transported to a special realm where stages of life overlap and the regular boundaries separating life events melt away, leaving people streaking across decades and back again in just a few minutes. As chaplain, I serve as their witness–one grounded in the present to bring them back to this moment, being their anchor as it were.


The Washington Post ran a special report by Joanne Kenan, a Kaiser Family Foundation media fellow, about the expanding field of palliative care in U.S. medicine. Because hospital chaplains are often involved in palliative care (as we see in the piece) this article is worth noting.
    About a third of U.S. hospitals now offer some form of palliative care, which adapts aspects of the hospice philosophy without requiring patients to forgo curative care or to have a life expectancy of six months or less. Late last year the American Board of Medical Specialties recognized palliative medicine as a specialized field — a move that will expand training, said Cameron Muir, a palliative care physician at Capital Hospice, the Washington area’s largest hospice organization, and the president of the American Academy of Hospice and Palliative Medicine, based in Glenview, Ill.

    Throughout the Washington region, palliative care is also taking root. Interdisciplinary palliative care teams, such as GW’s, often devote much of their time to working with the dying — and helping them face death, a skill that many doctors lack. But as palliative care programs expand and mature, the teams often begin to see patients earlier in the course of disease, creating a continuum of care from diagnosis on.

    The main goal is to improve a patient’s quality of life. But at the same time, by moving patients out of intensive care — and even out of the hospital–sooner and by managing pain, nausea or respiratory problems better, palliative care teams often keep hospital costs down. “We save a lot of money by providing the right care to the right patients at the right time,” said Sean Morrison, director of the National Palliative Care Research Center at New York’s Mount Sinai School of Medicine.

    Not all health economists or policymakers are yet persuaded that those savings are substantial or that they occur in all cases. (Savings, some note, may prove elusive in certain settings, such as cancer clinics.) But Diane Meier, head of the Center to Advance Palliative Care, which is also based at Mount Sinai, said the field’s explosive growth shows that hospital administrators see bottom-line benefits.


The Post ran another story last week, this one just as relevant to hospital chaplaincy, about race and hospice care.
    Blacks seek hospice care in disproportionately smaller numbers than whites partly because of cost, health insurance and cultural factors, including a sense of being denied medical care on the basis of race, according to health care specialists.

    [...]

    In 2005, 82.2 percent of those receiving hospice care were white, while 7.5 percent identified themselves as black or African-American, according to the National Hospice and Palliative Care Organization. About 75 percent of the country is white, while about 12 percent is black, according to the Census Bureau.

    The California HealthCare Foundation issued a report in March that found some minorities and immigrants view hospice care as a way for doctors to deny them the medical care they’ve been fighting to get.

A couple of interview subjects discussed the importance of outreach to faith communities about this issue.

    “While I hate to generalize, African-Americans tend to rely a great deal on their spirituality and faith communities when dealing with serious illness,” [Jon Radulovic, vice president of communications for the National Hospice and Palliative Care Organization] said. “Further education to the faith leaders is an important part of outreach to that community.”

    David Stone, executive director of the Alabama Hospice Organization, said hospices also are trying to get information to Hispanics, including Spanish-language materials and making contact in faith-based community settings and gathering places.