LEARNING GOALS REFLECTION 8/3/2021 3:01:35 PM, Roper Hospital, Charleston, SC

A Window Into My Clinical Pastoral Education Experience At Roper Hospital

Cam Swanson

1- Theological Understanding– How does my theology of a God of Belonging & Connections  inform my pastoral care? I believe in a God who brings us into his family, his place of belonging. I believe in a God who uses language such as adoption, and redemption, to be in relationship with us:

Song of Solomon 6:3

I am my beloved’s and my beloved is mine.

Assessment: visited an 80 year old patient that I’ll call “Rusty,” in Rm 4040 on 4HVT East. Rusty was recovering exceptionally well from a heart attack. When I entered the room, Rusty’s pastor was inside. It turns out that he was Anglican. I’ll call his pastor, Fr. DI. Interventions: DI and myself intervened with Confession, Absolution, and Communion from the 1928 Book of Common Prayer (BCP). DI was gracious enough to invite me to join him in administering the sacrament of Communion to Rusty.  I will readily admit that I was very emotional during this patient encounter, thinking about the beauty of some of the older styles of communion. I definitely shed tears, but still maintained my pastoral authority, bearing and composure.

I prayed a prayer from the BCP called the Anointing of the Sick, and anointed Rusty’s hands while DI anointed his head. Outcomes: Rusty was grateful, stated that he felt more at peace.  Rusty expressed confidence about his condition, and was content whether he recovered, or if his condition worsened. Rusty also described his relationships with his children and grandchildren, and stated that they were close to him and were successful.  Plan of Care: I planned to visit Rusty at least once more, and continue to pray for him under my “Patients Encountered” list on my Prayermate app.

This scenario was an example of how the three of us as males were able to identify with each other, in spite of our differences in age, race and culture. The symbolism was not lost to me….these were southern Euro American males who invited me into their Sacred Space. We connected through our faith, and love of liturgical worship.  I believe it was powerful and healing for all involved. I believe I was an Intimate Stranger, Ascetic Witness, and a Wounded Healer at different times during this encounter.

            2- Personal Self-Awareness – How can I continue my inner work and emotional growth while balancing work, friends and family?  Assessment: Had an 80 year old patient in 4045 E whose blood kept pooling in his legs and swelling his legs up. He is Euro American and I’ll call him RH. I spoke with RH for a bit and then his wife and stepdaughter entered the room. Doctors were not sure if RH would be able to walk again, and he wept openly and asked me how he could possibly enjoy life again. Interventions: I asked RH if he could take things one day at a time, and referenced where Jesus said the same thing in his own words Matthew 6:34 NRSV 34 “So do not worry about tomorrow, for tomorrow will bring worries of its own. Today’s trouble is enough for today.Basically Jesus is saying “be present” in that passage. RH’s daughter told RH not to be anxious…and I had also thought about that passage. I asked RH if I could read it from my iPhone. So I read Philippians 4:6-7 where it says to be anxious for nothing and God’s peace will guard your heart and mind. But then I felt some strong intuition, or an impression to read verse 8: Philippians 4:8 NRSV 8 Finally, beloved, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is pleasing, whatever is commendable, if there is any excellence and if there is anything worthy of praise, think about these things.  Outcomes:RH got emotional again, and wept when I read the scriptures: RH’s daughter finally showed emotion outwardly for the first time…she shed a few tears and was whispering verse 8 and after I read it, she said that she had posted the same verse on social media earlier in the day! We also prayed in a circle holding hands (I wore my gloves), and RH’s daughter gave me a hug afterwards and said she really appreciated my visit. Plan of Care: I gave the family a business card and told them to please reach out if they needed anything. I also planned to continue praying for RH and his wonderful family. Again, I saw the God of Belonging & Connections at work, as our mutual faith connected us in spite of gender, age and racial differences. My inner work and emotions — I felt deep joy in visiting with RH and his family, and I believe I was an Agent of Hope for this family.  By the time of this visit, I had been seeing a therapist regularly, and was scheduled for my third healing prayer session.  I also have demonstrated more and more vulnerability at home and in group sessions. To balance at (a) work, I will triage by seeing 3-4 patients, then I will do a short devotional at the computer when I chart. I will also sometimes do exercises during the work day. And finally, I am really trying to “read the room” when I am on my floors and in group sessions. Example: I chart at the nurses’ station when the more extroverted charge nurses are working, and chart down the hall when the more introverted charge nurse is working.

(b) home and (c) family — I shared my innermost thoughts with my wife CLS via a letter recently.  My wife stated,”thanks for your openness,” which is a first in 15 years, I think. I started writing letters to her again, and just randomly buying flowers. I bought her tiger lily’s, because that’s what she is!!!   I have been eating much better at work and at home, this has helped with my moods and weight. I have also been doing more recreational reading, inner work reading, and less intense theological study at home. I am leaning into humor. A trusted friend critiqued me as recently as Easter Time, and said I take everything so seriously. This is why sarcasm is so alien to me sometimes. But lately, I’ve felt safe enough to be a little snarky, at home with family, and at work with patients, teammates and peers. It’s okay to laugh.  I’m learning this more and more. (ACPE: 311.2, 312.1, 312.6).

3- Peer Group – How can I grow personally and professionally through the critiques and encouragement from my peers? The whole group is tough on me, but I know there is growth, even in pain. They are summoners to the arena; for sure. This is why I appreciate YM being a surgeon, sometimes. But their critiques have helped me and their encouragement has helped as well.  3a. Personal growth through critiques — JB has commented that I “apologize too much.” JW has asked me what I do with criticism.  CC has asked me how closely I watch over my own soul, since I claim to be a “watchman.” And MF has told me to tone down the self-criticism which I can sometimes get into. So I respect all this input.

3b. Personal growth through encouragement — I appreciate several of my peers naming the growth they have seen in me. That was amazing to hear. I am still learning about myself, because I have been in survival mode from birth up until my late thirties. But two weeks ago, MF and JB challenged me with a question,”what are negative emotions?” Tears came from nowhere.  I think part of my frustration (I have no problems with Enneagram 8s!! Got one at home!) was that I feel like a layer of mud or concrete exists between my heart and my mind, or like my heart is 6 feet underground in a coffin, and I’m having to dig my way out of an emotional grave. Since “coming alive,” I’m grateful for the self-awareness I’ve gained from my peer’s honesty. 

3c. Professional growth through critiques —- I believe the primary thing I’ve been told by my peers is that I am too cerebral or heady at times. I’ve been told that I need to lead with my heart, not just personally, but also in patient encounters. Example: I had a CVICU patient a while back who was a 47 year old Euro American male named JS. He had just had triple bypass surgery.  Assessment: JS was trying to deflect from his emotions by talking about all kinds of random conspiracy theories about the Bible, like giants, UFOs, aliens and demons being on different planets, etc. Interventions: Although I was almost sucked in by this discussion, I was able to get around the deflection and cut to the heart of the matter, which was JS’ fear about his heart, and his concerns over his future health. I prayed for a speedy recovery for JS.  Outcomes: JS was able to be vulnerable, and processed his emotions about his condition. Plan of Care: I visited JS one more time the next day, and he was much more joyful and less combative. I believe I was a Healing & Listening Presence for JS during my visit, and perhaps I was also a Courageous Shepherd during this encounter as well. But the main theme was that I ignored the theories and tapped into JS’ emotions.

3d. Professional growth through encouragement —  My peers have stated that I have grown in my ability to stay focused during patient visits.  They have also commended me in the way I have been able to navigate complex family dynamics and situations in patient visits.  Example: I visited the family of a 24yr old Afro-American male who was pronounced dead on arrival (DOA) at the St. Francis ED on Friday, 2 July 2021. I recieved the call at around 0100 am. When I arrived at the St. Francis ED, there was police tape around the entrance to the ED and an Infiniti sedan was right outside the entrance. There was a handgun in the front passenger’s seat and a bullet hole in the windshield. The friend of the RC who was behind him in the vehicle discharged the gun, killing RC almost instantly. He was charged with involuntary manslaughter.  Assessment: the father of the patient, whom I’ll call RC was distraught–it was an accidental discharge. Interventions:  I offered an empathetic, non-judgmental, calming presence. I ended up being an Ascetic Witness for around 20 family members gathered outside. We all got into a circle and prayed together for peace, clarity and understanding. The family was also upset because they could not see RC until after an autopsy, according to the coroner. Outcomes: But after our prayer, everyone was visibly more at peace, and began to quietly cry and process emotions. Although only one or two family members cried, I have no doubt that they were all grieving. Plan of Care:   During my prayer with this family, I asked for justice to be served, and that the truth of what happened would be revealed. On my next on-call, I found out that the Charleston PD ruled that it was in fact an accidental shooting, and not a homicide. I continue to pray for RC’s family.

(L2.7. establish collaboration and dialogue with peers, authorities and other professionals, 312.7 establish collaboration and dialogue with IDC6 Function within the Common Code of peers, authorities and other professionals. PRO2 Establish and maintain professional and interdisciplinary relationships, PRO4 Support, promote, and encourage ethical

decision-making and care).

4 – Professional Development How do I grow in navigating the diverse personalities within a hospital IDT?

            This seems to be my most immediate growing edge. I have been called an “extrovert,” and my CPE peers are self-titled “introverts.” Yet I believe that the human soul is more complex than these identifiers will allow. Example: I believe that the staff[1] are just as important as patients are, due to my previous CPE training, and the fact that I ministered to nurses who would go to combat zones themselves informs my view of providing pastoral care to staff along with patients. Both are equally important.[2] However, I am slowly and surely realizing how much I can overfunction in this.  Assessment: Up until my Roper residency, I believe that my charisma and joy have “carried me” so to speak, for most of my adult life. My wife and I are genuinely kind, compassionate and generous people.  However, I realized coming here that I would have to dial back on trying to establish a rapport with some of the staff members.  Some nurses would ignore me for days, and then randomly say,”it’s good to see you,” on CVICU.  It seems I really clashed with one nurse we’ll call “JJ.” She is the day shift charge nurse on some days. This was very confusing for me, coming from the environments I came from. Interventions: JJ would yell, and even if I got close to a room just to look at a patient, JJ would yell out,” not now, Chaplain!!.” Eventually, RA pulled me aside and said that he spoke with my clinical manager on CVICU, named DD. So after that, I went and met with DD. Outcomes: It ended up being a great conversation.  I took ownership for my part in the situation. She hugged me afterwards.  Plan of Care: I was more self-aware and had better situational awareness during my CVICU visits afterwards. I also took what happened to heart and tried to triage which team members on 4 East needed more space. In those cases, I would chart down the hall versus charting in front of the nurses station. And when they wanted to acknowledge me or speak, I was content with that. I personally struggle with a sense of injustice when teammates are okay with initiating conversations with me, but not okay with me initiating conversations with them. And to be honest, as an Enneagram 9 wing 8 who longs for connection and follows a God of Belonging, I sometimes struggle with abandonment and rejection when people do not seek the level of connectedness that I seek.  This is something that I’ve struggled with all my life, from childhood, to sitting at lunch by myself in high school, to not ever being able to get a date until I was a junior in high school, etc., etc.  Here at the ICUs, I wasn’t looking for friendships, but

But I have been healed from that and am continuing to grow and heal in that area.  I’m learning to “take the space I’m given,” and to have an “attitude of gratitude,” when it comes to my personal and professional relationships.  But I’m human as well. Leaning into solitude and hiddenness and realizing I don’t have to impose or force my way into the lives of people. And I’m learning to love people enough to let them go.

1 Corinthians 13:13 The Voice 13 But now faith, hope, and love remain; these three virtues must characterize our lives. The greatest of these is love.

Those who want to be in the arena with you or me…simply will be….no matter what.

[1] https://pubmed.ncbi.nlm.nih.gov/26037809/ Identifying the key predictors for retention in critical care nurses, 2015.

[2] https://www.researchgate.net/publication/313148137_Critical_Care_Nurses’_Perceptions_of_and_Experiences_With_Chaplains_Implications_for_Nurses’_Role_in_Providing_Spiritual_Care Critical Care Nurses’ Perceptions of and Experiences With Chaplains: Implications for Nurses’ Role in Providing Spiritual Care, February 2017.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: