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Graduation: Clinical Pastoral Education

I was asked to give the reflection for the graduation ceremony of the Clinical Pastoral Education program in the hospital where I work and teach. CPE provides theological and professional education for ministry in the hospital setting. Many seminaries require a unit of CPE; some denominations require it. Here is the talk as I gave it, followed by the original ending which I chose not to use but still think relevant.

I am honored to be asked to speak today to our graduates of the Clinical Pastoral Education two-year residency, and, like the rest of you, I will miss having them with us. But of course the feeling is a dual one for all of us: we are happy in the achievements, we are sad at the parting. We rejoice in the new beginnings each will have, and we regret that we are at an ending of shared work and discovery, shared success and shared frustrations. At a graduation, we are all at a border—one we know how to cross and will put behind us, though not forget.

What I want to think about with you today are the borders of our work. “Our”, because I believe that all of us have some share in the work you, Jan and Diana, have been called to learn and do these past two years. You may notice that I am wearing both a collar and a white coat for this occasion; I am a physician and I am a deacon. I am a deacon and I am a physician. One of my priest mentors points out that there is no “I” in “preach”, but this is not a sermon. What I can try to say comes out of my experience and reflection on the two roles I fill. My roles may be distinct, if not always separate: the employee of the government who teaches and heals and the servant of God who listens and is present. In a hospital, whatever our primary role, I think this is a border we all face—you who are hospital chaplains, part of the hospital team; we who are physicians, unless we have shut our selves down to “healing you pain, not feeling it”.

Let me make a quick side point: I will probably say “physicians” when I mean not just physicians, but nurses and aides and social workers and therapists and techs and all the people who provide care in the hospital–even the physicians. We all are providers of medical care, and all important—I just haven’t found a short way to say all that, so I will say “physicians”; “health care providers” might do, but it’s so impersonal that it is not a term I find endearing.

I start with a story: when I was in the process of becoming a deacon, the committee who worked with me wanted me to go away from Iowa City for a while, leave my professional credentials behind, and work with people who are homeless. I was amused: did they think I’d succeeded as a psychiatrist all these years if I could only talk to people who had also read Shakespeare? But I went—to Boston, to work with an established street ministry for a month. Before I left Iowa, a friend—also a physician–said,

Judith, I want you to think about one thing: you’re going to see all those unfortunate people living on the streets, and you’re going to say to yourself, “yes, but what this guy really needs is Haldol”. What are you going to do?

So I did. I listened to men and women, some who talked about which shelter they were in, or where their friends were, or which park the police were sweeping people out of, or how the Red Sox were doing, or being with a friend just released from detox and treatment who drank herself to death the same night, or the loneliness of being housed after living on the street, or where they had come from, or any of a great many things. And yes, once I listened to a man who rambled on about the government and being followed and a good deal more that made less sense. With him, I thought, “most of my colleagues back home would give you Haldol. But I don’t think it would make your life better, I think my listening to you and accepting the poem you’re giving me is what you need.”

And since then, increasingly, I walk through psychiatric wards and think, “the medicines we’re offering are probably a good thing—but what this man or woman in front of me really needs is pastoral presence.” The real question comes when I am wearing the white coat—without the collar—and realize, “What this guy really needs is pastoral presence.”

If I were giving a very short talk, I’d stop here, and say, “see? Chaplains are really needed; please let us have more of them for the patients.” But I am not going to speak quite that briefly, because that realization is not the end of the story.

The first thing my class was told in psychiatry residency was, “Every encounter is therapeutic”. Over the twenty or so very odd years I’ve been a psychiatrist, I have had patients whom I saw regularly for many years. None had illnesses I could really cure; “heal rarely, alleviate often, comfort always”. I could help, some. I realized that what I gave these patients was presence and relationship that was, by the grace of a greater Power, was sustaining and comforting to them. In that relationship they were more real, more alive, because they had my whole attention (or nearly so), and were valued in their whole being. “All actual life is encounter”, says Martin Buber—I think this relationship with patients where we take the long walk of Alzheimer’s disease together is something like what he was talking about. It is encounter, and it feels trivial only if I look at the surface of our conversations.

So here, I could argue, I hover between the border of physician and deacon (or chaplain, or whatever term you wish). So what? It is not, alas, a thing I can do with everyone. As a physician, I must as Buber says

. . . abstract from [the human being to whom I say You] the color of his hair or the color of his speech or the color of his graciousness; I have to do this again and again; but immediately he is no longer You.

As physicians, we must abstract from the human being the signs and symptoms, the suicidal ideation, the stabbing or crushing pain, the rales and rhonchi in the lungs, the tracing of an EKG or the specimen jar of body fluid or excised organ. We must do this, and as chaplains, you have learned some of our jargon, something about the process of these diseases and what the patients will be going through. For you, I hope, it is that you are drawn reluctantly from a natural focus on the whole of the patient to the particulars which make objects of us all. For physicians—we can forget that there is a human being and a potential relationship in which the alleviation and comfort can happen.

And those relationships are not guaranteed us by having friends. There was a NY Times Op Ed on Tuesday this week stating that when you have devastating illness in your family, your friends drop off the planet. Or they give you meaningless help, such as “Let me know if I can do anything” or “I’ll pray for you,” and then they leave relationship. Well, most of them do. As chaplains, you stand in for the friends who don’t show up, who don’t know how to say, “let me pray with you”. And you must do it short term; you have not had the luxury during your two years here of following patients and their families through repeated visits over many years. You are the ones who make the encounters therapeutic.

And I wish, finally, to lay another charge on you (not a new one): it is not just the patients who need you. You stand to challenge us to remember that neither the patient nor the physician, nurse, phlebotomist, tech—whomever—is an It.

All of us, the providers of health care, need to be reminded that full healing takes place where there is relationship. That relationship demands that we give of ourselves and encounter others wholly, with our hearts as well as our heads.

You walk the border for us, for both patients and healers, as you are allowed to see the divinity, or the spirit, or whatever term holds meaning for you and for those you encounter—you help find it, and nurture it, and help it be in relationship not only with whomever the Higher Power of the world is, but also, I hope, to be in relationship with those of us who are too distracted by the particulars of illness to be very good at it.

I wish you all joy, labor, ongoing and new friendship; I wish you all success in helping us all encounter each other as sons and daughters of our Creator so that healing of each other and the world can go on.


And here is the ending I decided not to use–though I printed it out and gave it to the new graduates:

For many years I have carried and given to patients, families, and CPE classes this prayer from Teilhard de Chardin. I will close with it now, suggesting that it is in practicing this wholeness of relationship with each other that we are prepared to enter relationship with our Creator so powerfully described here:

When the signs of age begin to mark my body (and still more when they touch my mind; when the ill that is to diminish me or carry me off strikes from without or is born within me; when the painful moment comes in which I suddenly awaken to the fact that I am ill or growing old, and above all at that last moment when I feel I am losing hold of myself and am absolutely passive within the hands of the great unknown forces that have formed me; in all those dark moments, O God, grant that I may understand that it is you (provided only my faith is strong enough) who are painfully parting the fibres of my being in order to penetrate to the very marrow of my substance and bear me away within yourself.

[from my well-worn copy of the Oxford Book of Prayer; I’ll add a citation when I have the book in hand]

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