All Bets Are Off

In our chaplaincy work, we have all been working on "getting in the hole" with patients. (See EM's blog about this and NR's too.) I think this phrase comes from the idea that when someone is suffering, they are in a hole of sorts. Well-meaning friends and family may walk passed the hole and say how it will get better, or ask what it's like down there, or say 'call me when you can,' but few actually get down in the hole and invite the suffering person to share, really share, what it is like.

It's a dark, dingy place that hole. It takes guts and honesty and rigor to get there. And, when we are fully present to one another's suffering, the emotional connection dissipates the suffering and Spirit's healing can be brought to bear. It takes time and trust.

That is to say, instead of feeling "sympathy" or feeling "sorry" for the care seeker, we chaplains have been learning (and pushed by our supervisor) the experience of empathy, where we really connect at the feelings level. For me, this is one of my growing edges - this art of getting-in-the-hole.

I continue to be baffled by my need to dodge the deep emotional issues. I have found an enormous capacity to change the subject or not invite God’s spirit or even my own sense of self to the moment to inform how to share the person’s feelings. As a learning edge, I know that I need to stay aware and awake to how I am feeling, right then, right there and try to connect with the patient.

The other day, I visited with a patient who was down in a dark hole. I sat in a chair across from her and listened about her situation. She was very animated and as I found myself getting in the hole with her, she became more animated, angry, talkative and agitated. I felt that same way! As I encouraged her to say more about how she was feeling, she pulled me right into the hole.

I felt like I was making progress... until...thankfully, a nearby therapist came over, tapped me on the shoulder and asked me to step out for a minute. Folks with this type of mental illness, he shared, will do anything they can to get you to buy into their feelings. People with this diagnosis often have highly unstable patterns of social relationships and may switch unexpectedly to the another extreme, angrily accusing the other person of not caring at all.

Here I thought that I was getting in the hole with her and it might actually help. Trouble is, I was completely manipulated to get in the hole and was on the border of becoming the target for this patient's anger. Basically, all bets are off in terms of getting in the hole with patients on this unit. Mr. Therapist recommends letting this kind of patient "roll off you like water off a duck." Oh, this goes so against my training and my nature.

This unit will definitely challenge me. When I think that I am "connecting" with a patient, I cannot ever assume it had anything to do with my newly honed art of getting-in-the-hole. Surely, I will begin to experience a different way of being with patients through this rotation that will be different from all other units.

The crowd rebuked them and told them to be quiet, but they shouted all the louder, "Lord, Son of David, have mercy on us!" Jesus stopped and called them. "What do you want me to do for you?" he asked. "Lord," they answered, "we want our sight." Jesus had compassion on them and touched their eyes. Immediately they received their sight and followed him. - Matthew 20:31-34

How are you changing your approach, in this moment?

Don't Ask, Don't Tell

Apologies for using this quite common phrase in a new way. This post has nothing to do with the military's policy on homosexuality. That said, I think it captures what I learned the other day in Behavioral Health.

Don't ask if you really don't want to know. Don't tell if you really don't want them to know.

So, in our chaplain training we learned about some simple questions we might often ask a patient when assessing their understanding of their possible stroke. We chaplains receive a printed notice to go talk to a patient about their stroke and we go to assess it. It's a fairly straight forward formula:

1. what brought you to the hospital or why are you here? (their understanding of their diagnosis)

2. what are the docs saying about how long you'll be here or what is the next step? (their understanding of their prognosis)

3. who is your support group - you know, family? friends? (support systems)

4. what kind of faith community includes you - church? other? (faith community)

After we have the "assessment" chat, this also opens up the discussion for other kinds of topics as per whatever the patient/family might have on their minds and hearts.

I learned yesterday that this formula doesn't really help in Behavioral Health. Don't ask unless why they are here unless you want to see the self-inflicted wound and staples along the wrist which are accompanied by bruising where the police had to restrain him to get him in the ambulance. I don't think that having the patient re-live that whole scene was particularly helpful for his spiritual health, but then again, he freely told me. And told me. And told me. And told me.

So perhaps I served as a loving listener, but I did find myself feeling annoyed after about 20 minutes of it. I was afraid that I was going to slit my wrist if I heard the story one more time. But I wasn't going to tell him that.

Something to learn there. Something about boundaries? Something about manipulation? Something about being a door mat? I think I'll pray about this one.

After Jesus had gone indoors, his disciples asked him privately, "Why couldn't we drive it out?" He replied, "This kind can come out only by prayer." Mark 9:28-30

What is best left unasked, untold in this moment?