Hospital Handbook. James T. Wagner

in the patient's understanding of her situation.

      Another question, “How sick are you?” lets the patient share a feeling as well as a clinical diagnosis. It quickly establishes how much the patient knows of her own condition. There have been times when I was told that a patient did not know of a malignancy. When I have asked such patients how sick they were, they often replied, “I have cancer.” It was a relief for them to say it and a welcome opportunity for both of us to deal with their illness realistically.

      It is good to compare the response you recieve from the patient to that of medical personnel and even family. Your own plan for pastoral care should take discrepancies into account. This may mean talking further with doctor and family to facilitate communication and hear other concerns.

      When the patient describes his condition with technical medical terms, ask the patient to explain them. This can clarify understandings for the patient and you. Verify explanations later to make sure both the patient and you have a correct understanding. The glossary in the back of this book is a reference. Other resources for medical terminology are listed in the annotated bibliography at the end of this chapter. Neither the glossary of this book nor any medical dictionary should be a substitute for gathering complete medical information from a physician.

      After you have gathered primary data about the patient's condition, take time to listen to other stories the patient wishes to tell. Resist the temptation to tell of your own hospital tales. Follow the level of disclosure the patient presents. Be careful of denying deep fears and concerns. Hospitals are frightening places. Even a brief visit for a minor illness can be scary. Listen for this concern, and accept it.

      A patient in the hospital for a long-term illness has different needs from the short-term patient. If you will be making numerous visits, then it is important to encourage a variety of stories, memories, and topics. With elderly patients, memory is a golden link with life, and it is good to ask about stories of specific times in their lives.

      Many of the current resources on wholistic health report the importance of joy and laughter in healing. Here is a place for great sensitivity and balance. Laughter can be for the spirit of the hospital patient what jogging is for the person of good health. Gentle, joyful news and stories are good gifts for any patient. And as with any good thing, there are limits to the benefits of joy and laughter, especially for patients with abdominal sutures.

      Having listened to the patient's immediate concerns, it is also important to ask about needs the patient has outside the hospital. Who is taking care of other family members? Are there people at work who need to be contacted? Are there household chores that need to be taken care of? Use the congregation to respond to these needs. Clergy too often take on these tasks themselves, and this is what the church is for.

      Find support tasks suitable to the size of your church. Most clergy in this country serve churches of under 200 members. One of the gifts of the small church is the special, personal care that can be given to patients and family in times of illness. These are opportunities for deep sharing between pastor and parishioner and for good churchwide support. The church can be the enabler of truly wholistic care.

      In a larger church extended care will have to be structured. Lay care teams let church members share hospital support with staff. Good organization can keep hospital care personal.

      It is important to close the visit with a purpose rather than to just act like you have run out of time. Here the question arises: To pray or not to pray?

      There is a stereotype of the graduating seminarian as one unwilling, unable, or unprepared to pray at the hospital room. It was true for me, and many journal articles still proclaim it. There is good reason to be somewhat wary of substituting prayer for good pastoral care. We have seen the opposite stereotype, the “pray at the drop of a hat” pastor. We have seen clergy hide behind sanctimonious prayer rather than engage people in honest struggle over painful issues. We have seen glib, self-serving prayers forced upon unconsenting bed-bound victims. Thus I was hesitant to institutionalize prayer into my hospital visits when I began my ministry. For some people an offer to pray was a suggestion that they were dying. Others found it unnatural or intrusive. But I also had to admit that much of my hesitancy was grounded in my own discomfort and uncertainty in offering prayers. My style is informal and the transition into prayer often felt clumsy. As a result I limited my prayers too severely.

      In time, people I have visited taught me how to pray and showed me the power of it. The consensus of virtually all clergy surveyed for this study is that the patient should be asked if she wishes a prayer.

      The important step is to ask. The patient's condition, situation, and room environment all contribute to whether or not the patient may desire a prayer. But ask, and offer. Clergy roles are confused. Sometimes we feel out of place in a hospital, not knowing what to do when everyone else has a task to perform. Many of us have rebelled against a tradition of piety. Prayer is what we can and should share.

      A simple scripture passage often has deep meaning for the hospital patient, and the clergy person should be prepared to offer this as well. This is not a time to preach or evangelize. This is a time for practicing the presence of the Holy Spirit, opening with gentleness this time and place for grace.

      Guidelines for hospital prayers and suggested scripture references appear in later chapters. Here it is important to simply remember to offer prayer and scripture to the patient. Pray out of what you have heard in your visit. Offer the hopes and fears through the strength of faith and tradition.

      There is one final point to remember about the visit. You have gathered data, listened to the concerns of the patient, found concrete things to do, and offered prayer and scripture. One thing more to remember is to touch the patient. The hospital patient is poked, jabbed, injected, cut open, sewn up, jostled, and inspected. He may feel totally manhandled. But your gentle touch on the hand or cheek can be grace.

      Etiquette and Protocol

      1. When others are in the room. A room full of visitors presents a dilemma when you pay your call. One minister simply says hello and leaves when other visitors are present. His feeling is that the patient with the full room has all the support she needs, and the pastor could better spend time with patients who have no visitors. Other clergy make a point of announcing that they will be visiting other patients, planning to return at a given time. This gives sensitive visitors a suggestion of when they might leave and give pastor and patient some time together. There are others who just join the crowd, dealing with everyone present, and some ask the visitors to leave so the pastor may have some privacy with the patient.

      What should you do? Consider the specific situation and your personal style. In order to make your decision, gather specific data. Who are the people in the room? How is the patient feeling, and does he specifically need time with you alone? What are the needs of visiting family members? How will you connect with them?

      In a non-critical situation with an easy flow of visitors, the pastor need not add to the crowd. But in difficult times, the patient needs some privacy with the pastor. If it does not come soon, ask for it. I have been in situations where the patient has directly asked her other visitors to leave so we could have some private time. If the patient cannot do this herself and seems to need this, you may be the person to interpret to others the patient's need to have a crowded room cleared out.

      Sometimes a family member keeping close contact with the patient needs special attention. To a friend or family member who has been keeping a long vigil, suggest a cup of coffee or a walk together. Or offer your time to visit with the patient as an opportunity for the family member to take a break.

      Your knowledge of the hospital can help a family member find the cafeteria or coffee shop. Often a family member is afraid to venture off the patient's floor simply because he does not know how to find these other facilities. Some of the best pastoral care can be done by sharing a meal with the worried companion of the patient.

      The issue of the crowded room raises the question of when the pastor makes a crowd. Just as there are times you need privacy with the patient, so there are also times a