We’ve been fortunate to have had such a thorough discussion with spiritual counselor Donna-Marie Terranova on the importance of spiritual care at the end of life. This installment will conclude our three-part series, and I highly encourage those who are interested in the topic to revisit parts one and two to get up to speed with the discussion thus far.
This time we touch on a number of practical issues including dealing with religious beliefs that differ from your own, sound therapy (particularly relevant to what we do here at HSTL), and how spiritual counselors are paid for their services.
It’s another interesting read, so sit down, relax, open your mind, and read below!
On reconciling differences in religion or belief systems among family members
It is important for the Hospice Chaplain to remember, as well as any hospice team member, that when encountering a patient and their family members – they have been living with each other for a long time and have created a healthy or unhealthy family system. It is not the job of any hospice team member to impose upon that family system with an agenda of therapeutic change, but to gently find the most critical areas that will help the patient/family cope and accomplish a quality of life with the time left and peaceful death as possible.
Religious/belief differences, in hospice care, are respected. This means the Chaplain presents him/herself by modeling respect for diversity and, in the best of circumstances, knowledge of the religions/beliefs involved in a particular family.
For the most part, those families that have healthy family systems will respect any religious/belief difference of the patient. Problems arise in an unhealthy family system when, in most situations, the family has a specific agenda for the patient – namely, they want the patient to accept their beliefs before he/she dies. This can create great trauma for the patient who is already dealing with end-of-life issues. So, as a Chaplain, if I am in this situation, I will work with the family’s beliefs and try to create acceptance of the patient’s right to believe what he/she needs to believe, especially at this time of pending death. I typically focus on a God of loving mercy for all His creations – and that we do not know what is in the heart and mind of the dying person as he/she takes his/her last breath. Nor do we know the heart and mind of God and how, in the moment that our loved one meets his/her Maker, what that encounter will entail. Obviously, I’m using an example here from my own tradition, as a Christian – where there is an expected outcome for the dying person of a life in paradise with God or a separation from His kingdom… either outcome depending on the life lived and the acceptance of Jesus Christ as Lord. With other religious beliefs, it would be very important to understand the specific concerns and, undoubtedly, I would seek the assistance of the family’s religious community or the expert advice of a religious leader of their faith tradition if they were not affiliated with a religious community.
On dealing with religious or belief systems that differ from your own
This is a very critical question because without one’s own soul in the “home position straight and at peace,” there are only the “mechanics” to offer – be that scripture, rituals, or sacraments. If one is not fortified by their own religion/beliefs, which involves some type of daily communion or practice, the Chaplain has no genuine spiritual nourishment of his/her own to draw upon.
For myself, as a Catholic Christian, I rely on daily prayer as the basis of my spiritual life. Meditation is also necessary, as is attendance at Sunday Mass and receiving the Sacrament of Holy Eucharist. Besides these basics, making time for spiritual retreats, walking in nature, and spiritual reading – anything that nourishes my soul and gets me away from my daily routine and encourages silence and contemplation – will give me the necessary balance to do my job as a Chaplain.
On her personal experience with sound therapy
I am a strong proponent of music therapy for those in need of terminal care. For many people, music is not just a cognitive experience, but reaches into the soul bringing great joy – especially when the music creates beauty.
Spiritually, music reaches beyond words. Music has easier access into the unconscious and subconscious than words and therefore can bring deeper experiences, in many instances, than words.
I believe there is research that proves hearing is the last sense to go in a dying person. It is said that we can reach our dying loved ones, even in their unconsciousness, with our words. Imagine the impact of specific music created especially to accompany the dying in their spiritual departure from this world to the next! There are music therapists who are trained to do just that – as you can read about, on this website, in the interview with harp therapist, Linda Hill-Phoenix.
On the most challenging issues faced in this practice setting
Based on my experience, the most challenging thing is potential burnout. As a Chaplain, I am exposed to human suffering on a day-in and day-out basis. While keeping a professional distance, I also have to engage, in a most genuine way, to the significant needs of patients and families. It is difficult acknowledging the powerlessness to, sometimes, not be able to impact a person’s most feared human experience – death – with all its physical, mental/emotional, and spiritual pain. So, the challenge actually becomes a surrendering of my will in how things turn out and relaxing into a relationship with the patient/family that generates the most peace possible in the situation.
On the payment model for spiritual care
Chaplains are typically paid an hourly salary for a 40-hour week. Salaries vary depending on education and years of experience beginning at a low of $40,000s to a high of $60,000s. Also, worthy of mention, is that Chaplains are usually expected to take on-call hours besides working their typical 40-hour week. On-call hours are paid at a rate of around $5 per hour for carrying the on-call pager; if the Chaplain is called out for an emergency, then the pay rate is typically their hourly rate, sometimes time and a half.