The Witch bids me leave my desk and curl up in the comfy chair to talk to you just now.
She reminds me that I’m barely home from a month of too much travel. She wonders what I think I should tell you – and whether that’s the same as what I want to say?
Just days after the deepest retreat of my summer (deep magic and personal practice with almost 60 of my once-a-year best friends), I’m still buzzing with the joy of the work, the depth of the work, the self-reflection the work has brought to me. Not yet quite back into my mundane life, I spent last night doing chaplaincy at the hospital.
We used to say that the ‘personal’ is ‘political.’ From my perspective today, the ‘magickal’ is ‘medical,’ and vice versa.
Our work in retreat this year was around personal autonomy; questions of ‘us’ and ‘them,’ working with our own racism, ageism, sexism, heterosexism, cissexism, ableism, classism; setting boundaries; speaking up for ourselves; being betrayed and being the betrayer; claiming our own power; dealing with gossip, recognizing our human imperfections, learning and growing in community. It was an extraordinary week, full of painful lows and amazing highs.
My work in the hospital setting is also focused on personal autonomy, helping patients work through the process of setting boundaries, supporting patients in speaking up for themselves and supporting families in speaking up for their loved ones; making choices, claiming what power remains to us, recognizing our bodies’ limitations. It was a night full of intense, deeply personal conversations about what would probably happen next, and how to cope with that. Sadness and acceptance in equal measure, along with planning for the future.
In both settings, any question may have dozens of ‘sides.’ What feels like strong challenge to one can feel like painful betrayal to another, like wimping out to a third, like ‘nothing’s happening’ to a fourth. When we ask Divinity to speak through us, we may hear different things in Divinity’s words. When we ask the doctors for medical or surgical solutions, we also may hear different things. In both cases, what we think we want may simply not be possible; what we ask for, and receive, may turn out to have hidden consequences.
So much of what I do these days involves being a bridge between two distinct places. I’m a Unitarian Universalist, devoted to fairness, egalitarian process, democratic structure and governance, rational consideration. I’m a Witch, devoted to personal responsibility, consensus process, spiritual insight. I’ve been told (more than a few times) that these ideals are in conflict, but most of the time I find they uphold each other and give depth to my ability to be in each community.
Consensus process is difficult to do well, but hugely satisfying when we get it right. The chance for a minority voice to be fully heard is huge; the distinction between ‘it’s not perfect, but I support this choice’ and ‘I disagree and won’t go along’ is huge – and can include 6 or 8 stops along the way – and community is empowered in a different way than in ‘majority rule’ situations. Consensus process often takes longer than either-or voting, but sometimes not much longer. In a setting where there are many viewpoints, consensus process can be a fairer way to distribute power than, for easy example, the elimination tournament that is the modern election process in the US today.
In the hospital setting, medical personnel discuss what is possible for the patient, what is useful and helpful, what guidelines recommend (if guidelines for this situation exist). They don’t vote; sometimes one doctor is the decision maker, after collecting as much input as necessary from others on the team, or sometimes a team reaches consensus. Then they bring their proposals about treatment to the patient. When the patient cannot communicate, the doctors meet with the family instead.
The doctors seek to provide the best care for the patient, consistent with what can be known or deduced about what the patient would want. In the absence of an Advance Directive, that means sitting down with the family. In the absence of a Designated Health-Care Proxy (that is, a named decision-maker who knows what the patient wants and has the patient’s authority to have the final ‘say’), that means sitting down with as many family members as want to participate, especially if they are all of e al legal standing as next-of-kin.
The doctors explain what they know about the patient’s condition, the likely prognosis, and what can be done that might change the prognosis, prolong life, or improve quality of life, or (rarely) all three. The family asks questions, offers insights about what the patient would want. Family members disagree about what the patient would want. They disagree about what they personally want for the patient. One wants the patient to live as long as possible no matter what it takes. One wants the patient to be comfortable with no pain, no matter what it takes. When there’s no clear decision maker, consensus process is the best we can do. (Usually no one in the family is skilled at reaching consensus).
In the meeting, the chaplain breathes slowly, consciously radiating calm and peace. Sometimes that’s all there is to do.
The Witch says I’m speaking in generalities and have clearly not thought enough about what I want to say to you today.
I pause, reflect, light a candle, make a cup of tea.
The Witch is right. Some of what’s here tonight is that I don’t want to say too much. A lot of what I don’t want to say is confidential – patient autonomy includes control over what hospital personnel can reveal (not much), though some of those personal details are much on my mind at the moment. Even though the details are different in every family meeting, and even though the issues and challenges are often the same. Tonight this work is still a little raw.
What I really want to tell you is:
- Have an advance directive.
- Have the conversation with your family members about what you would want if you can’t be asked.
- Have the conversation with your family about what your actual condition is, your real prognosis, what you and your doctor expect for the future.
- You might also consider having that conversation with your pastor, your Pagan leadership, your grovemates.
And the Witch reminds me: Prayer helps.
I want to unpack that last a little bit. Many of my UU-rationalist friends object to prayer on principle; many of my Pagan friends object to prayer but do spellwork or journeying or conversations with Deity instead.
As a chaplain, my job is to let the patient lead. If the patient wants to discuss, we discuss. If the patient wants to ramble on, expressing what’s on their mind until enough has been vented to allow them to sleep, I’m learning to listen deeply and allow their process to go where it will.
If the patient wants prayer, my job is to pray authentically to The Divine as I understand The Divine, using language that is adequately comfortable for both the patient and me, even when our spiritual and religious traditions are sharply different. Sometimes, my job can even be to pray silently, in my own fashion, while the patient and family members pray silently in theirs.
Once in awhile a young medical professional will ask if I really think prayer has any effect. I tell them it does; at the very least, praying calms the patient or family member who asks for prayer (and yes, prayer can also upset the patient who doesn’t want it). At the very most, it appears to me that prayer can set an intention out into the universe like an anchor, holding the vessel pointing into the waves for the smoothest ride available – or, if you prefer, directly invoking The Divine to make the waves gentler.
The Witch asks me to look into the candle flame awhile longer and tell you what is present for me just now.
Just now I am grateful. I am grateful for this life I have been living, and for the lives my patients have led so far. I am grateful for the training I have received and for the ability to synthesize new abilities from training in different, apparently-unrelated fields. I am grateful for trust and trustworthiness.
And I am grateful for Principles to live by:
Work to limit the harm I do and accept responsibility for it.
Honor the inherent worth and dignity of every being.
Seek justice, equity and compassion in all my relationships.
Experience a free and responsible search for meaning.
Honor the interdependent wonder of everything.
Don’t coddle weakness.
Say what I mean, mean what I say, and keep my promises.
The Witch wants you to notice that some of these are UU, and some are not. This is as it should be.
The Witch wants you to notice that Death is natural, and will come to all of us – even me, even you.
But: nothing about dying-in-hospital is natural unless the patient has communicated what the patient wants. The Witch wants me to tell you, exhort you, beg you: Have the conversation. Designate a Health-Care proxy. Write and sign an Advance Directive. You can always tear it up if it’s never needed. You can always write a new one as things change. But don’t leave it up to a midnight meeting over cold coffee in a conference room with crying family members. Your family, if it’s ever needed, will thank you for it.