Sunday 28 September 1997

How the spirit tends to the body

Care of the soul saves lives and money, hospitals discover

Bob Harvey
The Ottawa Citizen

Barry Drefke has relied on visiting chaplains to keep his spirits up during his stay at the Ottawa Heart Institute.

Canadian hospitals are beginning to recognize that spiritual care saves both lives and money.

"It's not just medical teams that are going to get a patient through," says Wendy Nicklin, chief operating officer of the Ottawa Civic Hospital.

She says the spiritual care provided by chaplains and lay volunteers is a "critical aspect of health care," a conviction that she says is shared by teams who survey hospital care for the Canadian Council on Health Services Accreditation.

There is a growing recognition that spirituality is broader than just religion and rituals, says Mary Carson, director of geriatric and mental health services at the Queensway-Carleton Hospital. Physicians and nurses are beginning to realize that it's not only the deeply religious who can benefit from spiritual care. Ms. Carson says they are also becoming convinced that spiritual care can improve physical and psychological health, and allow patients to go home earlier.

Hospital chaplains used to be priests and nuns and ministers. Today, they may be Hindus, or Jews. They may even lack any affiliation with formal religion, and they definitely don't preach.

"We're not there to do it to them, we're there to be with them," says Dennis Wiginton, one of three staff chaplains at the Civic.

He says that in a hospital, pastoral care can mean arranging a wedding for a patient who is close to death and wants to formalize a long partnership. Or the naming and blessing of a baby that miscarried four months premature. Or wafting the smoke of a sweetgrass ceremony for an aboriginal woman about to give birth. More often, it just means listening to patients' stories, and providing comfort or helping them understand "Why me?"

"When you're lying on a hospital bed in your gown, you're reduced to thinking about basic fundamental needs, and that includes spiritual needs," says Marguerite Mondor, acting director of pastoral care at the Ottawa Civic Hospital.

She says chaplains and the many lay volunteers who visit patients at Ottawa-area hospitals are there to encourage and sometimes to help patients work through the issues brought out by an illness or accident. Such as: "Am I a good person or a bad person?" Or regret: "I haven't done what I wanted to do all my life." Or maybe: "Is there a God, and if so why did He do this to me?"

"I was afraid, I was alone, and I was feeling helpless." Carrol Joinar is misty-eyed as she talks about getting a call from the University of Ottawa Heart Institute at 3 a.m.

Her partner of 15 years, Barry Drefke, had had a heart valve replaced, and the operation had gone well. But now he was in a crisis; among other things, he could no longer speak. The medical staff didn't understand why they had an emergency, but they did know she had better come in to the heart institute.

"I was afraid for Barry. I knew God would help. It was the only help I had," Ms. Joinar said.

She called the pager number for the pastoral care team at the Civic Hospital, next door to the heart institute. Two pastors got out of bed to help: Rev. Ray Erickson, an evangelical, and Rev. Virgil Amirthakumar, a Catholic. Both came and sat with Ms. Joinar, and prayed for Mr. Drefke.

That was two weeks ago. Now Mr. Drefke can talk again, and he's on the mend from what has tentatively been diagnosed as a stroke.

He says regular visits from chaplains have helped him get through his two months at the heart institute, and helped him heal. "They have given me physical strength," he says.

Ms. Joinar is more emphatic. She wants to thank everybody who has helped. Doctors, nurses, chaplains, churches who were recruited to pray, and, of course, God.

"God healed Barry," she says. Ms. Joinar and Mr. Drefke are not regular churchgoers. "But he needs spiritualness and so do I," Ms. Joinar says.

Ms. Joinar's faith may not be misplaced. A number of recent studies show a strong connection between spirituality and healing. In one study at the San Francisco General Hospital, cardiologist Dr. Randolph Byrd divided 393 patients into two groups, and asked outsiders to pray for one of the groups. Those prayed for had less congestive heart failure, fewer cardiopulmonary arrests, and less pneumonia.

There is growing evidence that pastoral care also saves money.

One recent study tracked 700 cardiac patients in Brockton, Mass., over 30 months and found that those who received daily chaplain visits left hospital an average three days earlier. The author of the study, Dr. Elizabeth McSherry, estimated the savings at $4,000 per patient, versus a cost of only $100 per patient for the pastoral care.

In the United States, Jewish and Christian groups have joined together in a National Interfaith Coalition for Spiritual Healthcare and Counselling. Caesar Giolito, the executive director, told Catholic World News there is a mounting body of evidence that spiritual counselling helps physical and mental healing. The coalition hopes to persuade health insurers in the U.S. that it will be financially worthwhile for them to pay for more spiritual counselling in health care facilities.

Josef Denys, who teaches pastoral care at Ottawa's Saint Paul University, says, however, that the benefits of pastoral care can't all be quantified or reduced to cash terms. In one study he did with senior citizens at a health facility in Kitchener-Waterloo, weekly visits by chaplains over a period of 14 weeks produced marked changes in the patients' self-esteem, zest for life, concern for others, and desire to live in the present instead of the past.

Virtually all of Ottawa's health care institutions have a pastoral care department, or what a few institutions have begun calling simply "spiritual care", to make it clearer that there's help available not just for churchgoers, but for all.

One of the region's largest users of pastoral care is the Ottawa Civic Hospital.

The hospital employs three paid chaplains, and the Roman Catholic archdiocese has assigned two priests to the hospital. The Civic also benefits from the help of many volunteers: nine community clergy are on call for emergencies 24 hours a day, and about 160 lay volunteers from the Jewish community and from the Anglican, Roman Catholic, United, and Presbyterian churches. These lay pastoral care teams visit members of their own denominations. They take a 10-week course on listening, death and dying, and other subjects before they're accredited as regular visitors.

Hundreds of other clergy and lay members of religious groups also come to visit just their own members.

Between them all, they manage to visit about a third of the 500 patients checked in at the Civic on an average day.

Nearly every event at the Civic and other hospitals is a spiritual crisis, as well as a physical crisis.

The patients include the wounded, and the sick, those with black eyes, new canes, wheelchairs, bruises, and missing limbs, as well as happy mothers, and tiny babies. An average of one person a day dies or is also pronounced dead in the emergency room, and pastoral care staff are called in to help families, and sometimes staff, deal with the emotional after-effects.

Kathy Slattery, a clinical nurse educator who works with intensive care and emergency staff at the Civic, says she sees the connection between body and spirit almost every day, because the hospital allows families into the emergency and trauma units, provided they're accompanied by pastoral care staff.

"Patients are brought into emergency, and they're afraid and anxious. You can see their pulse and blood pressure going up. Then the family comes in and the pulse and blood pressure go back to normal.

"Pastoral care saves lives," she says.

Gladys Girling's husband, Bert, died July 20 in the Civic Hospital, two months shy of his 84th birthday. "His last 20 days of life were appalling," Mrs. Girling says. Her husband was tormented by seizures, and the pain medications were destroying his veins, and burning his arms.

Mr. Girling had been a big, gruff man, a printer and designer, and he had a grudge against organized religion. But Connie Clark, a chaplain at the Civic, had begun visiting him two years earlier, when he was first admitted after several strokes. She kept on visiting him after he left the Civic, often on her own time. Mrs. Girling says her husband told Ms. Clark things he had never told anyone else.

Now, in his last days, Mr. Girling was back in the Civic and he was incoherent. Ms. Clark could no longer talk to him, so she sang to him instead.

Mrs. Girling sobs as she says "He was just a shell of a man . He couldn't see. But I felt he heard." The music calmed him down in a way that nothing else did.

Ms. Clark also helped the family talk through the medical staff's recommendation to withdraw life support, then came to the hospital early in the morning when Mr. Girling died, and later officiated at a memorial service.

"I don't think I can ever express her magic," says Mrs. Girling.