Mid CPE Evaluation

     I’m about halfway through Clinical Pastoral Education in Westminster, CO just northwest of Denver. Here’s an overview of what the experience has been so far.

     I have primarily served in the Family Care Center dealing with patients who have acute illness and need medical tests, time for diagnosis, and skilled nursing care. There are also patients who are postoperative from knee, hip, and other surgeries. While some patients have a terminal diagnosis, they are usually currently in the FCC for a corollary illness. Many patients also have family and friends with whom I meet and interact.

     I have also served by either filling in or while on call in the ICU, Cardiac Care, Progressive Care, and the surgical units. On call, I have attended several deaths and STEMIs, assisting families in the trauma of illness and death. STEMI stands for ST segment elevation myocardial infarction or heart attack.

     I have been able to attend rounds about a third of the time on my unit. I have begun to build relationships with the nursing staff by listening to their reports, asking for their advice and direction, and relaying positive comments by the patients. I have decided to carry the ‘compliment cards’ so patients can write their positive comments in addition to my charting them. The support staff has been very responsive to my requests for information so I could assist patients—such as where to plug in phones, where more Kleenex stored is or are there warm bath wipes; how can we turn off that demanding beeping machine, etc. I have some concern that nurses and staff may find me annoying as I relay patient requests and needs, yet I also know that we share the same value of patient care and comfort. I don’t want to be seen as demanding but I also want to have patients be as comfortable as possible and to have these little needs met since there are so many other needs we can’t meet.

     The end of life and death process affects me deeply. Even when I am called for death attendance without having known the patient or patient's family, it is a privileged intimacy. I like being helpful, understanding, and supportive. I am beginning to understand how to hold sacred space for others. The ingredients seem to be listening to both stories and feelings, reflecting back, joining in those feelings from the sidelines-without being consumed by them—in some way honoring all the feelings that are present whether expressed or not. Also included is speaking with and for the gathering in prayer if appropriate. I have used the Book of Common Prayer several times, which I sense speaks to the families by giving form and voice to inner feelings and yearnings.

     I spend most of my clinical time visiting patients. There is a wide range of interactions from a short introduction of the services provided by the chaplains to delightful conversations that feeling like budding friendships, to difficult witnessing of suffering and pain—physical, emotional, and spiritually. This work really tires me out and that continues to surprise me. Even the ‘easy’ days are tiring. I need quite a bite of time alone and time to sleep to feel refueled.

     I treasure my time with patients who are altered mental status, suffering from dementia, or semi-comatose as I read the psalms from the Book of Common Prayer, which feels like it feeds us both. I’ve developed a list of psalms that seem to articulate my feelings and my intuitions about their feelings. I usually spend about 15 minutes in reading and being quiet together. It feels precious. I usually conclude with prayer from the Book of Common Prayer.

     Last week [or so] I’m experiencing a bout of clinical depression. The slide to the ‘black dog’ is slow and I am unaware of the downward movement until I hit something—not really bottom, just when the pain is acute enough to be present in my consciousness. The most pressing and informing symptom was how I could hardly connect while visiting with patients last Thursday. I wanted to be a nursing assistant so I could empty bedpans or something actually helpful rather than go from room to room talking inanely. The idea that my presence could in some way be a gift evaporated. On Friday, I wore the house pager and that helped as ED paged me to assist a family member. With the sharper need, I could respond and it helped put my own needs into a better perspective. Clearly, my own mental and physical health affects my ability to do this work.
     Here are my learning goals, which I established early in CPE.

• To help people connect their stories to the Divine story

I am improving at mutual or joint reflection on stories. I still wonder if I am fluent enough in biblical stories. I hope to increase my metaphorical vocabulary and biblical themes to make it possible to share the connections. This may be more applicable in parish work and preaching but I’m dedicated to pursuing this more fully.

• To increase my evaluation & assessment skills

I think I am learning to be more patient with myself here. As I’ve watched myself, I think I move too quickly to trying to understand what’s going on. My next strategy is to hold quiet longer and respond from some inner sense or intuition. I also have been acquiring skill in asking open questions so I gather more information and create more intimacy.

• To release tension/stress absorbed from pastoral care encountersI have a nightly ritual of watering a plant by the entrance of my brother’s house using water, cares, patients, and prayer. The group helped me design this ritual. I think it is effective. Also, my family has been working long hours and I’ve had time to myself, which is helpful. I can take a bit of time to think and pray about work and release my tensions to God.
  
  
  
  • To expand my theology of suffering
  I’m doing a good job of gathering data about suffering but I need to step back and reflect on what I’ve learned. This might be a good topic for journaling. It certainly would be a great topic for group discussion.
  
  
       How do I think I’m doing? I genuinely like people and I think this is apparent to the folks I visit. I am curious about how they understand their lives and I love hearing their stories. I carry few negative judgments about people’s choices, yet think I can speak about the consequences with truth and love. I believe most of us are doing the best we can at the time. I have a good sense of humor and can laugh at myself. I have done therapy and reflection and I think this increases my empathy for others. I feel like I am a mature person. I have a good understanding of my own shortcomings. I come to pastoral care as a full person and offer a big heart. 
        I think my weaknesses are perhaps the same as my strengths. As I come to pastoral care as a full person that means I bring my occasionally bouts with clinical depression, which limits my functioning; my energy and enthusiasm, which leads me to judgments too quickly; my positive attitude about people, which leads me to naivety; a big heart, which leads me to over functioning on other’s behalf. Because I connect to the world through my emotions I can be empathic and intuitive, but when people are annoying to me it is almost impossible to move to the empathetic position. I am continuing to learn to set aside my annoyances and irritabilities.
       The disruption of hospitalization, illness, or surgery, a snafu, brings difficulties but also gifts. The messiness of illness makes a time or space to see ourselves differently, to evaluate, and to stop in the busyness of life to discover what we value. It also provides opportunities to find out who values us and how they express their care. Being present to these possibilities can be a path to greater growth. This crisis can also help us see what our needs are and new ways to get them met.
       A significant part of the CPE experiences are is the interaction with my cohort or peer group. I am delighted and impressed with the group dynamics. While still at school, I asked others about their CPE experience. I did hear stories of competitive, mean-spirited, and harsh groups. And stories of disconnected and unhelpful groups. I’m impressed with the kindness, open heartedness, and high level of expertise our group has. I have the sense that each of us is pulling for the other’s successes. After crying in my verbatim, I found myself embarrassed the next day. When I shared this with the group, Michael told a story on himself to let me know that tears are part of the process for most of us. I felt accepted.
       The group, and I include Janet, our supervisor, in these comments, demonstrates a range of approaches to the same goals. I think adults learn most frequently in conversation, in the give and take of mutual reflection. I see this in my circle of friends when we discuss relationships. The group conversations, both formal and informal, are focused, kind, and instructive. All of these people are good and great teachers.
       All of my colleagues appear to hold thoughtful theologies based on an authentic relationship with a loving Creator, in which I can find common ground and learn new ways of knowing God. The other most impressive characteristic of our group is the delightful sense of humor, a sincere joy in the paradox of creation. Their playfulness expresses what a good and joyful thing it is to worship God in our lives and our work. Another outstanding quality is the kindness and giving of grace that occurs in our interactions. Perhaps this is because so many of us are artists—writers, musicians, builders and trade workers along with the visuals artists.
       Katie has a wide repertoire of open-ended questions. I find her solid, caring, and kind. She’s taught me about gentle strength combined with perseverance. Katie is generous in sharing her teaching experience.
       Carol is also generous in sharing her experience and unique perspective. I experience her as thoughtful, imaginative, with deep pastoral skills that are part of her very fabric of being.
        Michael brings a confidence in God’s providence that’s impressive as is his ability to express it. His accepting energy must be a salve to concerned patients. He takes what people say seriously and respond with care.
       Elizabeth is out going and intrigued with people and their stories while willing to self disclose. She is precise and a hard worker. I would like to experience her as she makes music. Elizabeth approaches the world with her hands and heart wide open.
        Each week I have an hour of supervision with our supervisor, Janet. I wondered if supervision would be the time when the supervisor would tell me things he or she thought would be too painful for me to hear in our group work. I’m delighted to report that’s not the case. It has been for me a time to focus on my own journey as in spiritual direction with the added benefit of a shared context of work. It’s been an opportunity to delve more deeply into the process of learning and growth that comes with pastoral care. I would like to map out my theology of suffering in the group and perhaps that is more appropriate for supervision time.
       What changes would I make to the program? The biggest improvement to the program would be the addition of therapy dogs to the chaplaincy. I’d be delighted to be the first chaplain with a pooch. Also, we could work with local churches to provide clothing to those who come to the hospital through the ER. If there has been a trauma of any sort, the medical team cut off their clothes, leaving them without clothes when they leave care. The folks at St. John’s help with a similar project in Springfield.
       The other project that might be helpful is to buy several universal cell phone charging kits. Many patients come to the hospital with their phones and without their charges—an easy piece to forget. The cost would be about $10 a charger. We have six units at the hospital so for $180 we could provide three charging sets on each unit.
       The most helpful parts of the program for me have been group reflections on our work, our reading, and our discussions of patient interactions. I am an external processor so this learning style is a great fit for me. I love the wide variety of printed materials and feel like I’m able to create the beginnings of professional pastoral care resources. I’m also an aural learner so listening to the discussions is also a great fit. We have become good mutual teachers, a learning community.