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by Father John A. Marshall, M. Div.
Mon, Sep 16th 2013 08:00 am

I'm loitering this morning. I just poured a cup of coffee and I'm looking at the newspaper, just hanging around. I'm at work, doing what I should be doing. Sure enough someone saunters in and begins the familiar banter about the day, the news or nothing much. I may ask, "How are things going?" or, "Who are you here with?" A half an hour later we're chatting about how it feels; being here at a hospice residence, being with someone you love. I'm a chaplain with Niagara Hospice and doing my job; loitering with a purpose.

The Niagara Hospice spiritual care team is one of only two spiritual care departments in Niagara County. Spiritual care is a specialized practice and a part of the interdisciplinary medical team; working with doctors, nurses, social workers and others.

No one is ready to hear, "You're not going to outlive this; this is very serious. This is terminal." That place where we live, inside ourselves stops and backs up. We speak about it in terms of hitting a brick wall. Your life is not going to go beyond a certain point; your plans aren't going to happen. When you're the patient it is one set of challenges, and when you're the loved one or caregiver it is a different but linked set of challenges.

Not everyone is religious, nor is religion a requirement for spirituality

When you're living with a disease or condition that will eventually bring your life to a close, something on the level of our being, something spiritual ends up in distress. The patient has run out of treatment options, beyond being comfortable. That does not mean that treatment stops, its focus shifts. While the physical pain we feel can often be treated with medication, there is emotional and spiritual pain that cannot go untreated. As much as 70% of the pain people suffer is not physical.

Niagara Hospice chaplains engage in the care of the emotional and spiritual distress people suffer. All people are spiritual by nature; some of them are religious and some are not. Anxiety, worry and stress can cause all the reasons that made a patient's life make sense and have meaning to be called into question. Work, personal causes, relationships with friends and family may have shifted or vanished. We can face the loss of being independent or being effective.

This is distress on the level of our being; spiritual distress. It is individual and can affect everything we believe in and everything that helped us to search for the meaning and purpose of life. On this level it may have nothing to do with religion, but everyone still feels that distress on the level of what makes them an individual.

The same is true for the caregivers and their emotional and spiritual needs. Sometimes the focus is that the caregiver is enduring remarkable stress. Other times it is worries and "trying to make sense" of what's happening to someone they love that brings distress. Kushner's book, When Bad Things Happen to Good People, was written more about the caregivers, then the patient. Good spiritual care should help anyone work through the denial, bargaining, anger, guilt, and blame to find a level place - a more peaceful or calm place.

Not everyone is religious, nor is religion a requirement for spirituality. It is important to remember that someone may not practice a religion, but still have spiritual needs that should be met, in whatever form they take. The team at Niagara Hospice responds to the patient's requests and needs. We are companions on this journey and the guiding principle is to serve the needs of the patient and caregivers, often while they are going through pain or distress.

Seventy percent of the pain we treat at Niagara Hospice is not physical, it is spiritual or emotional. When one is sick or dying, the disease becomes a lot more than the physical condition. It is the fear that doesn't let us sleep, the worry about what will come next or how will I go on without you. Being weighed down by losses; as an individual I may question the loss of my independence, my hair, my strength, my ability to control my bowel or bladder functions. Everyday life can be less than comfortable. As chaplains we can't fix it, but our non-anxious presence can be a companion on this journey that no one should have to make alone.

When spiritual care means a religious connection, Niagara Hospice chaplains often form a link with clergy and faith communities of all types. "Never there to replace; always there to assist," is our focus when it comes to a family's clergy and faith community. Not everyone who leads a congregation well is ready or equipped to deal with someone else's dying process. In the end, our chaplains can help by being mentors and teachers in the best practices of how to approach patients and their families at this difficult time.

Religious people choose to follow a belief system. That often involves rituals, codes of conduct and outlines of faith. Chaplains coordinate with all types of faith communities and their clergy, and in that way support the beliefs of the patient and the caregivers. 

Everyone is naturally spiritual. Each of us has an inner belief system. It helps us to search for meaning and purpose in life, and it helps us to experience hope, love, inner peace, comfort and support. Many people find spirituality through communing with nature, music, the arts, the quest for truth, science and philosophy, or a particular set of principles or values.

Oftentimes, patients never know my religious background. They simply have other needs and as a chaplain I'm here to address their needs, not mine. It is a wondrous experience to learn that others may not believe what you believe, but still find their way. It is the journeying together that is important.

Father Marshall is the Director of Spiritual Care at Niagara Hospice. He is an endorsed Chaplain and a member of the Association of Professional Chaplains. Father Marshall was trained as a resident in Clinical Pastoral Education at Abington Memorial Hospital in Philadelphia. He is also the Pastor of Saint Michael and All Angels Episcopal Church in Buffalo.

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