Chapter Five: Sarah
This is a Reflective Practice Exercise whereby the team members are invited to write about a real incident or encounter that can be reflected on theologically and for personal and group learning.
Objective: to present a reflection on a recent encounter focussing on ethical and practical issues that arise relating to the nature of chaplaincy and then suggest wider Theological themes that emerge.
Format:
A. Presenter gives a description of the selected encounter
B. Ethical and practical issues that arise relating to the nature of chaplaincy
C. Wider Theological theme that emerges
D. My personal engagement
E. Allow for comment and questions from attendees
Timing: Allow 45 minutes
Description of the encounter
A ‘Chance encounter’ in the hospital Canteen during lunch break when I was having lunch is the case that I wish to reflect on.
I was spoken to at lunch by a couple on the adjacent table. They were staying in a Hotel nearby. They were from Gillingham and visiting their daughter who was critically ill and on one of our oncology wards. They described themselves as ‘Evangelical Christians’ and said they were concerned that their daughter had ‘backslidden’ from her Christian faith. Mother and father spoke about their concerns for daughter Sarah, age 43, especially because they had to leave her and return to Gillingham the following day. They asked the Chaplains to visit.
I visited Sarah on an HDU Ward 45 minutes later. Her mother and father were at the bedside. I asked if it was OK to join in with their visit and spoke with parents and Sarah about her condition and generally introduced myself and the Chaplaincy dept. I stayed about 10 minutes and told the patient I would return tomorrow.
I visited Sarah the following day, she informed me that she had bowel cancer but was hopeful that her operation and treatment had been successful. She was in a lot of pain from the operation and was on morphine. The effect of the pain relief was making her hallucinate and she described the experience especially when her eyes were closed. We spoke about her upbringing and Sarah explained that her parent’s overt evangelical Christianity had caused her to retract from organised religion but that she still had a personal faith and still prayed nightly with her children. She added that the chorus ‘Turn your eyes upon Jesus’ which she learnt in her childhood was still with her and she had been singing it constantly while in hospital. She also spoke about a difficult divorce and that she still had problems with her ex-husband who had restricted access to their children.
While Sarah was in hospital, a nurse (friend) was staying in Sarah’s house and looking after the children, a boy aged 17, a boy aged 11 and a girl aged 9. The youngest was disabled and had ‘sleep apnea’ and had to be constantly monitored during nighttime sleep. I shared with Sarah that I was married and had three children of similar age to hers.
At the end of the visit I asked if she would like me to pray with her and that was accepted. I asked if I could hold her hand and she offered her hand. The prayer seemed to bring peace and the patient said she was blessed by the prayer. I gave her a prayer card and a Christian magazine ‘Inspire’ to read. I reassured Sarah that I would continue to visit her regularly and arranged to visit again in three days.
On my next visit Sarah told me she had read the prayer card and had begun to pray again in a more personal way. I gave her a ‘holding cross’ and prayer leaflet. I explained how it could be used as a ‘tactile prayer.’ Sarah spoke again about her parents and started to explain that she had learnt to forgive her mother but in the past she had held her responsible for sexual abuse that occurred at the hands of her grandfather when she was a child. I clarified that she wished to continue to speak to me (male) about this rather than a female chaplaincy colleague. She confirmed. Sarah said that she had not spoken openly about this for a long time and ‘just wanted to let it out.’ I felt myself being drawn into a deeply personal counselling encounter that may have been better with a female colleague. I reflected on the wisdom of my Muslim colleagues who have a policy of male to male counselling. On the other hand, Sarah had started talk to me about this and I had to make an immediate decision to continue to counsel her. She stated that her grandfather was now deceased and that he had not been prosecuted. ‘It was just one of those things in those days,’ she added.
We prayed again at the conclusion of this visit. This visit lasted over 45 minutes.
I visited Sarah a further two times before she was discharged. I spoke to the chaplaincy Ward volunteer about Sarah and he said she had been discharged home and was much improved. I was strangely disappointed that I would not be visiting her again and decided to telephone her at home and assure her she was still in my prayers. She thanked me and I believed the telephone conversation brought closure to the encounter with Sarah.
Issues that Arise relating to the nature of chaplaincy
The issue of ‘chance encounters’ and coincidence that brought this referral to our attention is something I have learnt to reflect on and be thankful that God chooses to intervene by bringing strangers together in order to meet the spiritual and physical needs of another. My reflection juxtaposes the possibility of God’s sovereignty against the probability of a coincidence.
The initial encounter suggested that the referral would be about pastoral support for the parents as they waited at the bedside of their critically ill daughter. That appeared to be the pastoral need until the second visit when the daughter's health had improved remarkably and it became clear that there was a rapport between the chaplain and the patient Sarah. This was a chemistry that needed to be acknowledged as potentially ethically dangerous and could corrupt my good intentions. The encounter was aiding healing, not just pathologically but also healing of past hurts.
In Chaplaincy the visits can be very intense and a lot of information and personal and family detail is shared and close personal relationships can develop over a short period of time. In this case over a period of two weeks.
Impromptu decisions are required by Chaplains who are trying to react to the immediacy of the pastoral needs. In spiritual care, gender issues, good counselling practice and the healthcare Chaplains code of practice can get blurred in response to each unique situation. Spiritual care is ‘responding to the uniqueness of the individual’ (p.8 Stoter, 1995). There is an issue of contact and holding hands in prayer. My approach was to clarify with the patient, then document the contact on our referrals system and finally to mention it to a senior colleague. I believe I fully complied with our code of conduct but acknowledge the risks and dangers I put myself under.
It was important to maintain an open mind. Despite the claims of the parents that Sarah was ‘backslidden,’ as Chaplain I visited the second time determined to invite Sarah’s side of the story and to listen intently to that. This strategy proved that she had indeed a personal faith but had developed a different spirituality or Christian tradition to that of her parents. It was vital that, as Chaplain, I did not judge Deborah’s situation before I actually met her irrespective of the information I had been told. (Matthew 7:1)
In addition, confidentiality was an important issue. I took the decision that no feedback could be offered to the parents in Gillingham. My prime responsibility was to the patient who had confided in me. I wrote in the medical notes that I had visited but made no reference to past hurts shared – again, this was to maintain confidentiality.
A final issue to reflect on is the matter of learning to let go. When an encounter develops with such rapid intensity it is equally important to let go when the patient is discharged. Sometimes, with permission, it is appropriate to contact the local minister of religion for ongoing support and follow-up for the patient. In this case, I could possibly have done more to ensure Deborah had that spiritual support in place. I spoke to her about her local church and she was an occasional church attendee. She knew the vicar personally but as I did not ask permission to make contact with him, I did not do so. I pray that God’s spirit will continue to nurture and protect her and her family.
Wider Theological or Ethical theme that emerges
In Acts 8:26, Luke retells the story of Philip meeting an Ethiopian on the road to Gaza. The encounter could be described as a ‘chance encounter’ not dissimilar to my meeting with Sarah’s parents. Philip ‘noticed’ the Ethiopian was reading from the scriptures and spoke to him. The Ethiopian asked for spiritual guidance (v31) and Philip draws close and sits with him as he explains the scriptures to the ‘seeker.’ As they journeyed together (v35) Philip ‘proclaimed to him the good news about Jesus.’
The outcome of the encounter was the Ethiopian’s conversion.
There are clear echoes between this story and my own encounter with Sarah. The first similarity is in Philip’s obedience to go down the Gaza Road and then to respond to the Holy Spirit’s leading in seeing someone searching the scriptures. This is perhaps a far cry from a referral from Sarah’s parents but I can connect with prompt obedience and then responding to Sarah’s seeking after Truth and her decision to open up about past hurts.
Secondly, the immediacy of the Baptism, from the Ethiopian’s request to Philip’s response was without delay. For reasons of health I did not wish to delay Sarah’s visits and visited within the hour and then visited every three days.
My personal engagement
Meeting Sarah on the oncology Ward was the beginning of a journey together, a journey of pastor and patient and a developing friendship. True, it was a professional relationship, but the immediacy caused by her intensive care the HDU Ward plus her prognosis and the intensity of her story rapidly drew me into her world. Inevitably I became part of her narrative, one of Sarah’s family and friends who were touched by her warmth and reciprocally enveloped her in our love. As Jean Vanier says
‘you must go deeper ….in order to understand people both in their pain and in their grief’ (p.27 Stoter, 1995).
From the outset it was important to establish some professional boundaries. There are a wide variety of boundaries relating to such things as ‘confidentiality, time, degree of involvement, frequency of meeting, personal beliefs, and the amount of our own life experience that we may share with the other person’ (p.19 Speck, 1988). This, of course, raises issues of what is appropriate pastoral support in friendship, time and touch. Sarah was in a 4 bed bay and usually there were other female patients visibly present. None the less male counsellor and female patient were by and large ‘alone.’ In our early conversations we exchanged information about our spouses and children, as if we were stating how high the stakes were if boundaries were crossed.
Godly wisdom is needed in dealing with such situations and as I explained above, at the end of life, textbook rubrics on counselling, time and sacraments become blurred in order to be the Good Samaritan as opposed to the Priest in the same parable.
By the end of this three-week journey Deborah and I had become close friends, no longer pastor and patient but in no way did I believe I had crossed professional boundaries. I had the privilege of being with her when she spoke about getting close to Christ again. I was her counsellor for her shared burden of past hurts of sexual abuse. In the visits that followed we held hands and cried together I anointed her with oil and prayed for healing (James 5:14).
It is impossible not to be changed by such intensity and it is important for Chaplains to realise that when the patient is discharged or by death there is separation and loss and learning to let go is a lesson which includes Spiritual Directors, psychotherapists together with colleagues in the department for reflection, support and direction.
My telephone call to Deborah’s home felt a little awkward and was probably unnecessarily intrusive. However it did help me accept closure of the pastoral encounter and taught me to trust God for her future health and physical and psychological well-being.
