I was recently asked in a job interview whether I give my patients advice. Given the context, I had a hunch that the answer they were hoping for was something like, “Yes! And I’m very good at it! People follow my advice and get fantastic results!” Part of me wishes chaplaincy were something as straightforward as that: individuals come to me with problems, I find the appropriate solution button from my theological training, press it, and problem solved. No more existential angst. No more going against doctors’ advice. People give up addictions, exercise more, reconcile with estranged relatives, and get the treatment they need in a timely manner. All because I said so.
But it doesn’t work that way at all.
Recognizing the need to educate my interlocutors, who were not chaplains or even clinicians themselves, on what chaplains actually do, I explained—perhaps overzealously—that advice-giving is something I almost never do. That my goal is to help others find the tools within themselves to cope with the situation in front of them and take ownership of their own healthcare decisions. Moreover, if I ever am giving advice, I’m likely not being my most helpful to the persons in my care, because chances are I’m anxiously trying to “fix” their situation rather than allow them to articulate what they actually need. In other words, when I give advice, I risk missing the needs of the person in front of me in order to fulfill my own need to feel “effective.”
I was not offered the position (and who knows if it had anything to do with my forceful denunciation of advice), but I am very grateful for this particular question because it has invited me to reflect on and define my function as an advisor in a more nuanced way. Indeed, as a chaplain, I seldom offer direction to patients or family members on what they should do (even when they ask me for it), but I do occasionally use my own experience and professional insight to help provide guidance or illumination to those in my care.
As an example, I offer a recent encounter with a family member making end-of-life decisions for a loved one, where I shared my own experience and feelings in related circumstances. The family member still did not do what I hoped she would, and that was okay and actually helpful in increasing her own clarity about her decisions and enhancing understanding and communication between the family and the hospital care team:
The patient in his 80s was dying, unresponsive, and no longer able to be consulted regarding his own wishes for end-of-life care. The physicians were seeking consent from the family to change his status from “full code” to “DNR—do not resuscitate” (meaning, if he were to die, the care team would not initiate chest compressions to attempt to restart circulation), and the family was indecisive on the matter. These circumstances can be particularly grueling for me and for the medical residents who know they will be the ones performing CPR on a very sick, elderly person if a “Code Blue” is activated. We understand how violent it will be, that ribs will be broken, and that even if the dying person temporarily regains a pulse, they will be in much worse condition in their final moments of life. There is no such thing as a peaceful death for a person who is “full code.”
I took the patient’s wife aside and let her know that the only reason the physicians felt some urgency about changing her husband’s status to “DNR” was that they knew what an exacting—even violent—procedure CPR is and they don’t want to do further harm to a person who is already dying. I let her know that I personally felt afraid for her husband, having witnessed many codes and not wanting him to suffer more than necessary.
As it turned out, she already knew all this. She had spent some time in nursing school herself, and also hoped that her husband could pass as peacefully as possible. But it was not only about her. In a voice heavy with pain yet resolute, she explained that her children needed to be on board, too. Even if it meant watching her husband receive chest compressions, she would not make a decision that might leave them harboring doubt as to whether they’d done the right thing for their father. I absolutely respected her decision, and told her so. Then I debriefed the medical staff on what I had learned about the family dynamic, suggesting that broaching the topic again later on with the children might be helpful, but that the patient’s wife was already quite clearheaded about the potential consequences of keeping her husband full code, and that the long-term wellbeing of her children was of utmost importance.
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In a recent, final installation of their advice column, the authors of the New York Times’ “Dear Sugars” explained how they saw their approach as a break from most traditional advice columns, where the authors “pretended to have all the answers, when the more honest responses to human suffering are concern and doubt.” Collaborators Cheryl Strayed and Steve Almond reflected on how the people who wrote into their column over the years generally were not looking for how-to instructions, but rather to be heard; they usually didn’t need advice so much as to be encouraged to take ownership of what they already knew they needed to do.
A friend recently handed me a clipping of this article, remarking that it had reminded her of me and my work. I felt very understood! My role as a chaplain is not so much a spiritual advice-giver as a spiritual witness-bearer. Offering a listening ear and a caring presence, bringing my own experience into dialogue with the challenges that the people in front of me are dealing with—these help to clear some space where hopefully people can feel a little freer to speak their truth, to reconnect with their values, to express their needs and find the resources within themselves to cope with a given circumstance or make whatever decisions they might need to make. It may not be the decision that I, or their doctor, or their health insurer would prefer that they make. But it is theirs. And that is sacred.
