June 25 interview with Reverend Jane Jeuland, a palliative care chaplain at the Yale-New Haven Hospital in New Haven, CT. The answers recorded below were offered by Rev. Jeuland in her own words regarding her experiences in hospital chaplaincy.
To start us off, can you provide a general description of your job and the responsibilities it entails?
As chaplains in the hospital, our responsibility really boils down to meeting people where they are and offering spiritual support. Chaplains do not impose our personal faith traditions onto people and offer answers to these questions, but help people discover their faith, learn how it might be changing in the context of their current illness and situation, and help people find meaning.
Chaplains also help patients accomplish goals and events before the end of life, like marriages or baptisms; and help people connect with their faith communities and spiritual leaders. We also attend all of the deaths and codes, and in those situations, we focus on just being present with the family and patient, and being there to talk and pray if folks would like prayer.
There are some aspects of my work that are unique to palliative care chaplaincy. The aim of a palliative care team is to help alleviate physical, emotional, and spiritual pain. We can work with folks who are newly diagnosed and working toward a cure, but are experiencing a lot of harsh side effects from their treatments or the disease. We also work with people who have gone through a great deal of treatment and who have little or no further curative treatment options. Patients and families at this stage often have many existential questions. People will ask, “Why is this happening.” That distress, that asking “why,” can often be related to their faith tradition. I’ve heard people ask questions like, “I don’t understand why this is happening now—Where is God?” “Why is God giving this to me?” “I’ve never had faith, and now I feel like I really need it, but it feels too late for me to be asking,” “I had a lot of faith and now I’m not sure I do anymore,” “I think there’s no more treatment, but is it against God to stop treatment,” “I’m scared of choosing hospice because I’m scared God won’t accept me into heaven.” As the chaplain I again meet people where they are and help them discover what fear or anxiety might be underneath these questions. I also talk with people about their understanding of God. For a patient who is worried that God will not accept him or her into heaven because of past misdeeds, I will often ask what their understanding of God is and they will talk about a loving and accepting God who forgives. Often folks believe God has forgiven them but then they haven’t forgiven themselves. I will then talk with them about what might be preventing them from forgiving themselves and what they might do to work through this.
Do the patients normally open up easily to talk about their experiences, or do you have to work slowly with them to bring out their thoughts?
It depends; it totally depends on the patient and their family.
And when you are present at the death events, you said your work is mostly just the presence of being there—Is that the majority of your responsibility?
It’s the majority, for sure. I often do offer prayer as well, unless I have assessed that it isn’t appropriate—For example, in regular visits if there’s an interruption in our meeting, or if the patient is too tired, or they have told me they do not pray, or they have a faith tradition that does not pray openly with others. At a death, I’ll attend to the family and talk with them about how they feel, depending on the circumstances around the death. Sometimes the death is a shock to them, and we’ll talk about how it is so shocking. For other families, they have been at the bedside for weeks and it’s not a sudden event, and they will say things like, “It seems odd to feel relieved, but I know my loved one is in a better place.” After a patient’s death, I usually offer to pray with the family again if it is appropriate.
It seems like a lot of your work requires intuitive action; do you think the majority of your ability to do that comes from your training, or from the practical experience of working with different people and feeling out different situations?
It’s a combination. For our training, we have an internship first, which is usually about ten weeks, followed by a nine-month residency. Throughout the internship and residency, we have twenty-four hour on-calls, in-services, groups, verbatims, individual supervision, theological papers, and regular written and oral evaluations. The groups are open-ended, with five training chaplains and a supervisor who helps facilitate a discussion. One of the big goals of our training is to understand what it is that we are bringing into the room so that it doesn’t get in the way of helping the patient understand where they are—So we also deal with our own grief and our own personal history in groups. For the verbatims, we do a word-for-word document of interactions with patients, and your group gives you feedback. For example, someone in your group might challenge you to reflect: “I heard you saying this particular thing, and I know that you’re going through this in your life; do you think maybe you’re talking about yourself rather than focusing on the patient?” It’s really deep, it’s really intense, and I think that it’s really good training for going out and doing the work.
Having said that, though, I have learned a lot since my training. After training, you need to complete two thousand hours of work, submit a hundred-page document and sit before a board to become a “Board Certified Chaplain” or BCC. This year the Board of Certifying Chaplains has released the first specialized certification, and it is in Palliative Care. This certification is in addition to the BCC. But I think the whole model of Clinical Pastoral Education, whether you’re in the training or out as a chaplain, is action-reflection. We’re trained to go out, do the work, learn from the work, and reflect on what we’ve learned, so I think our training builds in us a practice of reflecting and seeking ways of improving our work with patients and families.
Do you think that this career has met the expectations you had for it, or has it been different from the way that you pictured it being when you started?
I would say that I feel called to do this work, that I was led to do this work. The doors were opened for me, and I’ve seen God at work in that. So my initial “expectation” was really just to be open to whatever the experience would bring. I think changing from oncology chaplaincy to palliative care chaplaincy was more of a shift than I expected. Now I round with a team every morning. As a result, I know so much more about our patients than I did before, and I have more responsibility and accountability to a team. It’s a bigger jump than I was expecting.
What would you describe as the most difficult part of your job, and what would you describe as the best part?
Just being present to the suffering is really hard. And it’s particularly hard when you can identify with the patient or the family. For example, I’m a young mom, and if I have a young mom who is dying as a patient, it can be really hard on a personal level to hear her talk about leaving her children on this earth. Being deeply present to people’s suffering in general is difficult. I find myself at times asking the same existential questions as the patients. But at the same time, the greatest part is seeing God at work, and just again and again the way that people’s faith carries them through. So often, I hear people say, “I couldn’t do this without God.” Just seeing the calm and presence that comes with prayer is amazing.
Are there particular things you do to keep yourself steady even as you witness so much suffering?
I think the biggest thing is, I try to really cherish the present. I just had a patient who told me, “Never put anything off—Don’t put it off.” And I’ve internalized that from a lot of the patients I talk to. For example, recently, I really celebrated my dad and husband for father’s day, making them a big dinner. I took a vacation day for my son’s second birthday. These are simple things, but I think it’s so important to really cherish the present and live in the moment.
What have you learned through your experience as a hospital chaplain about the process of dying and how people experience death?
Something we say a lot in palliative care is that people die the way they live. People grieve the way they live. I think I’ve seen some commonalities across patients and their families, although everyone’s experience is different. People are so resilient in the face of the greatest adversity we ever face. Patients and families again and again demonstrate such courage. It is easy to have faith and courage when we are healthy or the love of our life is healthy, but to have courage as you face your own death, to have strength as you watch your loved one die, is sacred. Whether you believe in God or not I think most people I meet would agree that that kind of strength, courage, and love is sacred.
Now having said that I want to say that it is also very normal to have moments of fear mixed in with that immense courage. People will often talk at some point about being afraid of dying or losing their loved one. Even people who have accepted that they are dying and say that they are at peace still sometimes say, “I’m scared to do this. I’ve never done this before.” It’s very normal to be afraid, for the patient and for the family. Dying is the biggest change anyone ever goes through, and as many of my patients say when they talk about their fear, “death is such an unknown.”
Do you have any advice for people considering hospital palliative care chaplaincy as a career, or even just considering palliative care in general as a career?
For anyone going into palliative care, it’s good to have a sense of what you’re bringing into it. I find that palliative care practioners are a very self-selective group, so it brings a lot of people who are intuitive and are incredibly dedicated, what I would describe as “called” to this work. It is not the easiest work in the world, so again and again we rededicate, we are called back to the work. I think you really need to drawn to the work. As David Eppley, my brother and professional artist, would say, it needs to be something that “you cannot not do it.” I also think it is so important to find what it is that nurtures you and then actually do it. I don’t know about other people, but it’s so easy for me to not do the things that nurture me. I meditate almost every night for ten minutes, but sometimes I just don’t feel like doing it. Then if I neglect it for long enough, I find that I am not as centered and more exhausted. When I get back into the routine, I am much more rested and much more peaceful the next day. These are the best pieces of advice I can give: find your calling, the thing you cannot help but do, and actually do the things that nurture you.