HLOL Podcast Transcripts

Health Literacy

How Chaplains Help Patients Make Meaning of Illness (HLOL #194)

Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z: Practical Ways to Communicate Your Health Message. I also produce and host this podcast series, Health Literacy Out Loud.

Today, I’m talking with Reverend Christiaan Beukman, who is a native of the Netherlands and moved to the Boston area decades ago. He attended Harvard Divinity School and Andover-Newton Theological School, and was the Protestant Chaplain and Diversity Specialist at a community hospital in Boston.

He now serves as the Pastoral Ministries Manager at a large retirement community. He also is an Archdeacon in the Episcopal Church. But I know him more simply as Chris.

Chris and I worked together on the psychiatric unit of that hospital in Boston, and have remained friends ever since. Although our life experiences differ a lot, Chris and I share a commitment to helping patients throughout their healthcare journeys.

Chris, welcome to Health Literacy Out Loud.

Reverend Beukman: Good to be on your podcast, Helen. I’m excited to be here.

Helen Osborne: That’s great. Chris, back in our hospital days, I was an occupational therapist. You were the chaplain. I was always intrigued by looking in on what you did. I didn’t quite get it. Can you explain to me and to all our listeners what a chaplain is?

Reverend Beukman: Sure. What is a chaplain? I would say that a chaplain is a person who has undergone religious training, but rather than working in a church or a synagogue, is working in a secular setting or a public setting.

If you think about it, there are chaplains in all kinds of settings. There are college chaplains and chaplains in industry. Usually, your local fire department will have a chaplain, and so will your police department.

Helen Osborne: Really? I didn’t know all that.

Reverend Beukman: You didn’t know that?

Helen Osborne: No. I’m always learning from you. Twenty years now I’ve been learning from you. There are chaplains and it’s not just in hospitals or hospice?

Reverend Beukman: All kinds of settings. The list goes on. All four or five branches of the military have chaplains. There are prison chaplains. There are also cruise chaplains, Helen. That’s an occupation I wouldn’t avoid.

You and I both have a healthcare background, and very often in healthcare settings you will find chaplains, especially these days in hospices. Actually, in this commonwealth, it’s mandatory for hospice to have a chaplain.

Helen Osborne: That’s really interesting. You talked about all chaplains have some kind of religious training. I know you are Christian. All faiths, or is it just more of one faith than another?

Reverend Beukman: No. Interesting question. Actually, there are chaplains of all faiths. There are Catholic, Protestant and Jewish chaplains. There are Muslim chaplains especially in the prison system these days. A new phenomenon is nowadays you also see humanist chaplains who don’t really come from a faith perspective.

Helen Osborne: Tell me more about that.

Reverend Beukman: They’re just there to address the spiritual needs of basically everybody.

It’s interesting, Helen. I’ve always liked and admired your view of health literacy because, as health providers, I always think we have a little bit of a translation problem. It’s sometimes hard to really translate and be clear about what it is we do.

Helen Osborne: When you say “we,” you mean chaplains, right?

Reverend Beukman: Any healthcare provider, I think, has to translate, and I think your efforts have helped to make it clear what different disciplines do.

A chaplain sometimes has a bit of an image problem. I understand most of our listeners are healthcare providers. You have this chaplain on your team, but maybe you don’t really know what to make of this person. Who is this chaplain? Why do we have a chaplain on the team?

You might be tempted to think that the chaplain is like the religious guy. That’s the stereotype. He’s the guy that comes to say the prayers, has a little Holy Water and maybe does a service. He’s only there for the religious people. But that’s the image we’re trying to get away from.

As a matter of fact, and you probably are aware of this, our American society is becoming less and less religious by the day.

There is, for instance, a study by the Pew Trust that says that in 2014, 27% of the American population are “nones.” Not a religious sister, but they write as “none” on their surveys. They’re not religiously affiliated.

We’re becoming more and more secular, so if chaplains were just there for the religious people, we’d eventually disappear.

I think that the opposite is true. The chaplain really is there for everybody.

Helen Osborne: Just give me an example, because I can kind of relate to those who might check that box saying none, unaffiliated or non-observant as this moment. What would a chaplain do for somebody like me and the 25% of our population?

Reverend Beukman: Imagine you’re a patient in a general facility or general hospital, and all of a sudden there is a really bad diagnosis. Your doctor will help you interpret that. Maybe your surgeon will talk about surgery.

You asked this question once in a conversation we had. What are the implications for your belief system when you have a devastating diagnosis? What is going through a person’s head?

“Am I going to die? Am I going to live? What is this going to mean? Even if I die, does that mean I live on? Is that the end of everything? What does my diagnosis or my illness mean to my family?” All those questions of meaning come up.

What the chaplain is really there to do is to assist anybody, religious or not, in the process of making meaning out of that illness or event.

Helen Osborne: That’s really interesting. Can you give a story or an example about that?

Reverend Beukman: It’s actually somebody we both cared for. I think it’s a good story. You and I cared for a lady who had some psychiatric issues. She did very well and almost made a complete recovery.

Then the next time I saw her, she was in the oncology unit. She was actually very close to the end of her own life. She had a cancer diagnosis

I did a home visit, which is kind of rare for me, and I asked one question. This is a meaning-making question that I really like to ask, which is the question of “What is there left to do? Do you have any goals or anything left to do?”

I don’t know if you know this story, but she said, “I was in college and I’m six credits away from graduating. I would love to graduate.” We called the college and we moved a couple of wheels, and within a week, the college coughed up a degree for her.

I remember driving that degree to her bedside. That was the day that she died. She died holding her diploma in her hand, having achieved that final goal.

Helen Osborne: Chris, I’m getting goosebumps hearing that story. I’ve always respected your work from afar, but boy, that has so much meaning.

Reverend Beukman: That’s really an attempt to help people in their meaning-making. For her, being a graduate really gave meaning to her life. We all worked together, the college and myself, to help her accomplish that goal. Then she was able to let go and she was able to go on to her next life.

Helen Osborne: Most of our listeners are clinicians, public health folks, teachers, librarians, health communicators or anyone who wants to communicate about health or illness in ways people can truly understand and act on.

From your perspective as a chaplain, what can those of us who are not chaplains do to help those we care for and care about?

Reverend Beukman: We are always a team. I always compare being on a healthcare team as singing in a choir.

I’ve sung in some choirs, and there are two tasks you have in a choir. One is to hold your own line. If you don’t hold your own line, you get lost. The other task is to listen carefully to the other voices, and that’s what we do in teams.

The chaplain brings in these questions of meaning-making, and as we work together on a team, there are all kinds of situations where the healthcare team can draw on the expertise that a chaplain has. I’ll give a couple of examples.

Helen Osborne: Please.

Reverend Beukman: For instance, imagine as a healthcare professional that you are treating a patient whose culture you’re not very familiar with. Say you’re treating a Muslim patient and you need to know a little bit about health attitudes within Islam. Time to call the chaplain.

Hopefully, they’ll have some expertise in this area and can help you research in order to provide culturally-competent care, which we always talk about.

Helen Osborne: The chaplain can help with that? I know back in our hospital days you wore a couple hats, and the other one was on the diversity end. I just thought those were two things that you did.

Reverend Beukman: The culturally-competent care is something we can help with because we have some knowledge about the different faith traditions and what they teach about faith.

The other, if you’re on a healthcare team and you’re wondering how to use the chaplain, ethical dilemmas are often the chaplain’s expertise. If you have a healthcare dilemma that you want input on, then a chaplain is an excellent person to turn to.

Helen Osborne: Would we as a professional do that for our own conflict, perhaps, in a situation, or would we recommend that the patient and family speak to the chaplain to resolve their ethical concerns?

Reverend Beukman: You and I worked in a facility where we had an ethics committee. That was an amazing experience for me. We had a number of chaplains there and a number of religious sisters. The chair was a Jesuit priest. He was very good. Then there were numerous physicians of all different disciplines and a couple social workers.

Usually, the ethics dilemmas would come to a committee, but the chaplain has the important voice there.

I can give you an example of an ethical dilemma where a chaplain would be helpful.

For instance, you’re dealing with an oncology patient. This person is at the end of life, in excruciating pain and is asking for more morphine. You know that morphine depresses respiration and you also know that that next dose of morphine probably is going to depress respiration to the point of death.

That becomes a religious issue. Is that morally and religiously allowed? Are you killing that person? Is your interest to relieve that person’s suffering? That’s a really important question. The person’s faith background probably is very important in that respect.

These are good discussions to have with chaplains.

Helen Osborne: Actually, in our family situation, there was an incident like that. At some point, the chaplain came in and consulted with another family member to help make meaning, that’s your term, about where this path was going to be going until we all came to terms with that. I felt that really important.

Reverend Beukman: Let me just add one thought. Of course, when death occurs, the chaplain’s role doesn’t end there.

Right now, I’m working in a retirement community on the South Shore. We’re a very large facility, so unfortunately death is an almost daily occurrence.

Then when death occurs, the chaplain is there for the family helping them with the grieving process, but maybe more importantly, saying, “What would be an appropriate event for your loved one? How would you like to remember this person?” Then the chaplain can be helpful.

I did that in your family once. I had the great privilege of doing that.

Helen Osborne: You did, Chris. I just want to share that with everyone. You came to our home and we had a memorial for my mother. It was so meaningful. It was a joy that you could be part of our lives at that time.

Reverend Beukman: Thank you. I have fond memories of that, too.

Then the chaplain can be helpful in helping the family grieve. Also, I’m a big believer in ritual, so to also come up with some kind of ritual that will help celebrate that person’s life.

At my facility, that runs the gamut. Some people want a really nice lunch and a microphone where people get up and tell funny stories about the deceased. Other families want something straight from the prayer book, with Bible, scripture, singing, incense and God knows what, and anywhere in between. Anything that works for the patient can be helpful.

Helen Osborne: You can support the family to make all that happen, whatever range?

Reverend Beukman: Absolutely. We have extensive family meetings where we say, “Let’s try to envision an event that really honors this specific person. What were their interests, hobbies and beliefs? What was the poetry that they liked?” Then we try to weave poetry and music, sometimes scripture and storytelling remembrances, into one event that is meant to celebrate that person.

For the healthcare team, that’s another major task for your chaplain.

Helen Osborne: Wow. I’ve seen you do what you do and I’ve been touched by it. But hearing about it has tremendous meaning to me.

I’m trying to think of another situation where listeners might be. Let’s say they’re at a community agency or something. Many of your examples are people at the end of life. We’re in a multicultural society nowadays. Is there a role for the chaplain in a community agency or a public health way?

Reverend Beukman: Interesting question. One of the books that’s been my foundation of my thinking about this, and you’re probably familiar with this book, is a book by Viktor Frankl that came out in 1946 called Man’s Search for Meaning. Are you familiar with that book?

Helen Osborne: No, I’m not.

Reverend Beukman: He was a concentration camp survivor.

Helen Osborne: That will be on your Health Literacy Out Loud web page for sure.

Reverend Beukman: He did research after he survived the concentration camps on ex-prisoners and found that those who had a strong sense of meaning in their lives were much more likely to be resilient and to survive that terrible experience.

I’m thinking about if you’re working at maybe a mental health agency. Then have those discussions throughout the life cycle.

You and I were working in an in-patient psych unit with people who were often very young. Have those discussions about, “What does it mean to live with an illness?”

One of the things that I learned when you and I were both working in that unit was that there’s a difference between being a psych patient and living with a psychiatric illness. That, to me, was a big difference.

Helen Osborne: You mean what? Meaning that there’s a person behind it, not just diagnosis?

Reverend Beukman: It’s a person. Exactly. You’re not a depression case or a manic-depressive case. You are a person with a unique dignity that happens to be living with this disease.

Also, the chaplain can sit with that person. Chaplains are people that read their patients or the people that they treat like a book. I’ve always loved that philosophy.

There was the father of this whole movement, at least in America, for pastoral care and ministry. There was a minister here in Massachusetts in the 19th century by the name of Anton Boisen, who was a great preacher, but he had a psychiatric illness. He had frequent psychotic episodes that landed him in the hospital.

He was, for instance, at Westboro State for long periods of time.

Helen Osborne: For our listeners, that was a large state hospital.

Reverend Beukman: Yes, a large state hospital in Massachusetts.

While he was there, he found that his spiritual needs were completely neglected. When he was cured when he came out of the hospital, he vowed that he would bring ministers and physicians together and to train ministers in clinical settings to make sure that spiritual needs were being met.

His philosophy of treatment is to be very inspirational. He talked about people as the living human document. His metaphor is when you meet a new patient, or when you begin to work with somebody, it’s like somebody is handing you this manuscript, or even better, a scroll. I love that image of a scroll.

They’re handing you this book, and with a lot of reverence, you as the clinician or chaplain get to open this book and read this person’s story. Sometimes you can make some comments in the margin about this person’s book.

It inspired me to be as respectful as I can of the person that I’m working with.

Helen Osborne: Thank you, Chris, for all you do. I do remember our days of working together. Through you and your conversations, and then through our collaborative work sometimes, we got to understand that human person and look at the scroll of their life, no matter what trauma or difficult situation they were going through.

I think I could listen to you for hours and hours. But we need to put a semicolon on this conversation.

You talked about helping people make meaning. I hope that listeners will go out and appreciate that and look for who can help make meaning of whatever situation they’re in, whether it’s severe illness, end of life or even community traumas. Chaplains are a part of that.

Thank you, Chris, for being a guest on Health Literacy Out Loud. I very much appreciated this.

Reverend Beukman: I really enjoy talking about this. I do have a passion about this, and I hope that comes through.

Helen Osborne: It does.

Reverend Beukman: It was a wonderful experience to talk about this on your podcast.

Helen Osborne: Thank you.

As we just heard from Reverend Christiaan Beukman, it’s important to help people make meaning of their lives, and to do that with our colleagues and friends and be part of a team. Our colleagues, indeed, include chaplains. But working as a team and helping people make meaning of healthcare and understanding what they need to do is not always easy.

For help clearly communicating your health message, please take a look at my book Health Literacy from A to Z. You might be especially interested in Chapter 41 that’s about empathy and humanity.

You can also contact me directly at helen@healthliteracy.com.

Health Literacy Out Loud podcasts come out every few weeks. You can get all the episodes automatically for free by subscribing at www.HealthLiteracyOutLoud.com. You can also find us on iTunes, Google Play, Spotify, iHeartRadio, RadioPublic, Stitcher and wherever else you get your podcasts.

Please help spread the word about Health Literacy Out Loud. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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