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June 18, 2014 Volume 11 No. 11 Bed or Chair? Does Spiritual Care Look the Same? I serve as the chaplain for the Simms/Mann-UCLA Center for Integrative Oncology. We are a multi-disciplinary team tending to the psychosocial and spiritual needs of UCLA cancer patients and  their  families  in  the  outpatient  setting.    Primarily,  I’m  visiting  patients  in  the   infusion  clinics  while  they’re  seated—some would say trapped, in a recliner getting their chemo, often not even a few feet away from another patient in another chair— another story and another universe away. I also spent many years working on the inpatient side, in the bone marrow transplant unit at the UCLA Medical Center. It seemed to me that it might be worth exploring some of the differences between these two worlds and how that context of the ambulatory care setting can shape the spiritual care one provides. The most obvious difference in these two worlds is that here in the infusion clinic, the patient is sitting up and in her own clothes. While perhaps seeming an obvious yet insignificant detail, I think the implications can be profound. On one hand the patient may seem more empowered, less vulnerable, while anchored to  some  degree  in  the  “normalcy”   of her world and identity. While the patient lying in the hospital bed, draped in a flimsy hospital gown may seem more vulnerable, exposed, isolated, and detached from all the familiarity of her world and the context that reminds her who she is. All of that is true in many ways-- and  in  some  ways  it  isn’t.    And  sometimes  I  find  the  assumptions  we  make  in   these settings can blind us to the spiritual needs beneath the appearances. I used to be amazed, making my rounds on the bone marrow transplant unit, introducing myself to the sickest of the sick, and hearing back—“Oh  no  thanks.    I’m  fine.”    Fine?     Really? How is that possible? In American culture in particular, it seems we value selfreliance and independence so deeply that such a response would seem almost expected if not admired, no matter the circumstances. To admit that I need help would make me feel more vulnerable and perhaps even more embarrassed than I already feel—so,  “No  thanks,   I’m  fine.”  That  response  can  seem doubly commonplace then, in an infusion clinic, where the patient not only has no privacy, but his immediate concerns of the moment may have little to do with his cancer, much less his spirituality. Build a Relationship Since the ambulatory patient is often very much anchored in his world, his immediate mood and concerns may be tied just as much to the traffic that made him late, problems at work, or getting done with chemo in time to pick his kid up from school as it would be tied to concerns about his illness. Unlike the hospital setting, in the clinic, introducing myself to a patient on day one of his chemo, may be the start of a years-long relationship for him and

1 PlainViews® is a publication of HealthCare Chaplaincy Network™.    For  information  on   permission to reprint this article and the credit to be provided, contact us at PVSupport@healthcarechaplaincy.org


me. I find we need to start where we are and first build a relationship—commiserate about the parking, ask about the work, sometimes long before we mention cancer, let alone God and spirituality—that may be weeks from now. Because these relationships are often longer term, I find there is a whole other dimension to the spiritual care I provide. What does it mean to  “walk  beside”  for  the  long  haul?     I’ve  seen  Stan  every  two  weeks  for  the  last  three  years  as  he  gets  treated  for  metastatic   colon cancer. For the last few months, he has been in intractable pain. While a dyed-inthe-wool Catholic,  week  after  week,  he’d  much  prefer  to  be  distracted  from  his  pain  during   our visits and talk about his passion—cars. In the hospital setting, the context is crisisbased. In the clinic, there is an aspect of riding the wave beside the patient over the long haul of the journey-- through the hopes, the struggles, the successes, the disappointments...  and  back  to  perhaps  a  new  definition  of  hope.    The  thing  is,  I  can’t  ride   that  wave  if  there’s  no  relationship.    For  Stan,  spending  time  with  me  talking  about cars is more powerful than any prayer. Yet sometimes appearances can be deceiving. A patient may be consumed today with work or family issues, or they may physically appear to be as healthy as you or me—and yet they could have a terminal diagnosis with a very aggressive disease and a life expectancy of only months. Those deceiving appearances can also shape how the larger circle of life responds to them, and in turn can constrain their access to available support, spiritual or otherwise. Suzanne has metastatic breast cancer and outwardly appears healthy, and yet she expresses  frustration  that,  “people  don’t  realize  I’m  a  cancer  patient  too!  I  need  help!”  On   the inpatient side, there was never any doubt about who the sick ones were. Assessing vulnerability can be a tricky business. On the inpatient side, while yes, one can be visibly weakened and isolated, it is also true, that for the time being all her needs are being tended to, around the clock by a team of the best professionals available. Clara, 73, fiercely independent and self-reliant by nature, unmarried, with no children, sits in her recliner alone in the infusion clinic wondering about how she will get a meal prepared tonight or make it up the stairs to her apartment. Through another lens, that isolation in the hospital affords a patient a kind of anonymity, invisible to their everyday world if they so choose. The infusion clinic is a very public place. While yes, a patient in the clinic can still choose to maintain a kind of privacy from her everyday world, the clinic setting demands that her sense of herself in her everyday life confront this inescapable reality of cancer in a public place. Ralph was diagnosed months ago and has undergone surgery for his cancer and been undergoing radiation,  but  it  wasn’t  until  his  first  day  of  chemo  that  he  was  slapped  awake  to   this reality—“Oh,  now  I’m  a  cancer  patient!    Look  at  all  these  sick  people!”    Up  until  then  he   could kind of pretend it was something he was just going through, an inconvenience.    “I   wasn’t  a ‘cancer  patient.’    Now  I  am.”  

2 PlainViews® is a publication of HealthCare Chaplaincy Network™.    For  information  on   permission to reprint this article and the credit to be provided, contact us at PVSupport@healthcarechaplaincy.org


Exploration of Identity is a Key Component I find that that exploration of identity is a key component to the spiritual journey of the cancer patient in either the hospital or the clinic setting. When all of those labels of identity to which  we  have  attached  ourselves  are  no  longer  true,  or  not  in  the  same  way,  who’s  left?   Is there even an essential me beneath all those labels? Is she worthy of love? Is she capable of giving love? Then again, the infusion clinic sometimes affords another kind of intimacy, not possible in the hospital—that is patient-to-patient…comparing  notes,  passing  the  time,  sometimes   developing deep friendships. Particularly in a teaching institution such as UCLA, there are often multiple patients on the same day treated by the same oncologist for the same exceedingly rare cancer. Out there in the world Ruth and Janice would find little occasion for their paths to ever cross. They are rooted in different generations, geography, class, race, politics, and religious viewpoint. And yet here in the infusion clinic, dealing with the same diagnosis, they became  soul  sisters  in  a  way…meeting  on  the  most  intimate  ground  of  all,  fighting  the  same   battle for more life. And because of the intimacy of that sisterly journey, when Ruth arrived to clinic one day to find out that Janice had died, her grief was equally profound and layered with  meaning  and  implications  for  herself.  Weeks  later  she  shared  incredulously,  “Michael  I   didn’t  grieve  like  this  when  my  own  sister  died!” There’s  another  aspect  to  this  public  space  that  can  affect  one  in  a  deeply  spiritual  way,  and   that is coming face-to-face with the comparisons of circumstance and suffering—you see them  all  as  you’re  escorted  to  your  chair.  Some take this opportunity to snap themselves back  into  an  “attitude  of  gratitude.”    “Hey,  look,  it  could  be  worse,  right?  At  least  I’m  not  in   as  bad  shape  as  she  is!”  That  particular  reading  of  the  scales  of  justice,  or  one’s  faith  in  a   just universe cuts both  ways.  Because  the  very  next  sentence  after,  “It  could  be  worse,”   might  be,  “Why  am  I  such  a  crybaby?  What  have  I  got  to  complain  about?”  Where’s  the   grace and compassion in that? Getting up close to those who are worse off can also really stoke the fear  of,  “Is  that  what’s  next  for  me?” I  find  that  one  of  the  hallmarks  of  my  ministry  in  this  setting,  (one  in  which  the  lion’s  share   of  patients  would  identify  as  “spiritual  not  religious,”)  hinges  on  this  theme  of  offering   oneself grace to be a human being--to be where I am, as I am, feeling as I do. It seems so many of us come to an experience like cancer, already invested in a narrowly defined scorecard  on  what  it  means  to  be  a  “good  cancer  patient.”     When  we  don’t  measure  up  to  those  preconceived  notions, the suffering earns compounded interest.  It  doesn’t  help  when  the  larger  culture  can  relentlessly  reinforce  those  notions.   “You  MUST  stay  positive!  Attitude  is  everything!  You  must  pray  harder!”  Whether  in  a  bed   or a chair, for me the essence of spiritual care boils down to--being a witness, walking beside, offering the grace to be a human being,—it  seems  so  simple.  And  it  is.Though  it’s   not easy.

3 PlainViews® is a publication of HealthCare Chaplaincy Network™.    For  information  on   permission to reprint this article and the credit to be provided, contact us at PVSupport@healthcarechaplaincy.org


Michael Eselun, BCC, serves as the chaplain for the Simms-Mann/UCLA Center for Integrative Oncology. He has worked extensively in oncology, hospice, palliative care and with acute psychiatric patients. Board certified by the College for Pastoral Supervision and Psychotherapy (CPSP), he's been invited many times to speak to students, doctors, nurses, social workers, and to dozens of faith communities across the country about his work as a chaplain. He recently spoke at the national conference for Young Women Affected by Breast Cancer, and was the keynote speaker at the Promising Practices for Mental Health and Aging Conference at the California Endowment. Michael is also a co-founder and chair of a non-profit, volunteer anti-homophobia speakers bureau called GLIDE, Gays and Lesbians Initiating Dialogue for Equality. Over the last 20 years, Michael and his fellow speakers have spoken to an audience of over 150,000 students, teachers, and other various groups and agencies in the LA area about homophobia. He sees both pursuits as closely related in that both fields have to do with creating safe spaces for people to fully tell their truths and be received with respect.He has a TED talk available on-line via You Tube, called “It’s Magic”  and  you  can  find  out  more  about  him  at  www.michaeleselun.com.

4 PlainViews® is a publication of HealthCare Chaplaincy Network™.    For  information  on   permission to reprint this article and the credit to be provided, contact us at PVSupport@healthcarechaplaincy.org

Profile for Michael Eselun

Bed or Chair? Does Spiritual Care Look the Same?  

I serve as the chaplain for the Simms/Mann-UCLA Center for Integrative Oncology. We are a multi-disciplinary team tending to the psychosocia...

Bed or Chair? Does Spiritual Care Look the Same?  

I serve as the chaplain for the Simms/Mann-UCLA Center for Integrative Oncology. We are a multi-disciplinary team tending to the psychosocia...

Profile for mleselun
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