Pastoral Report Articles 

  • 13 Feb 2017 2:02 PM | Krista Argiropolis (Administrator)

    The first bi-lingual CPSP event, National Clinical Training Seminar-Central, was held January 14–15, in San Antonio, Texas. At this historical event, forty-five attendees, consisting of members of CPSP, non-members and seminarians joined together for a group relations seminar, case studies, and to listen to guest speaker and CPSP General Secretary, Raymond Lawrence. 

    The first bi-lingual CPSP event, National Clinical Training Seminar-Central, was held January 14–15, in San Antonio, Texas. At this historical event, forty-five attendees, consisting of members of CPSP, non-members and seminarians joined together for a group relations seminar, case studies, and to listen to guest speaker and CPSP General Secretary, Raymond Lawrence. 

    "Over 40 participants, from the United States and Puerto Rico, attended this history-making event," CPSP Diplomate, Juan Loya, stated in a recent letter, "In their evaluations, the overwhelming majority of participants highly praised this training event. As a participant and as the Convener of the Alamo Chapter, I concur with their astute observations."

    The principal organizer for this event was Patty Berron, a member of the CPSP Certification Committee. Patty worked with members of the local chapters to facilitate the event, including the scheduling of fifteen certification candidates, and nine panel members, for a certification review panel on January 13. The candidates approved for certification will receive their certificates at the 2017 Plenary, on March 21, in Orlando, Florida. 

    "This was the first Spanish-English bi-lingual NCTS we've done and it was very well organized by Patty Berron. It seemed to be a success from my observation and reports I have received ," stated Raymond Lawrence. 

    Plans are in the works for a second NCTS-Central event, to be held in the near future. 

    Photo credits: Charlie Spruell and Patty Berron
  • 27 Jan 2017 12:12 PM | Krista Argiropolis (Administrator)

    Raymond J. LawrenceA very useful study was reported in the journal Palliative and Supportive Care in May, 2016, entitled "Documenting presence: A descriptive study of chaplain notes in the intensive care unit." The research was completed in September, 2015. The authors of the report were Brittany M. Lee, B.S.; Farr A. Curlin, M.D.; and Philip J. Choi, M.D. The setting of the research was Duke University Hospital, Division of Pulmonary and Critical Care Medicine, in Durham, North Carolina. The study was done with input from the Director of Pastoral Services, Jim Rawlings.

    The researchers proposed that the recent emphasis on evidence-based practice may be leading chaplains to the use of a reduced, mechanical language insufficient for illuminating patients' individual stories.

    Whatever the cause may be, it is clear that the chaplains in this study are at sea on the matter of what should be appropriately reported in patients' charts.

    The researchers in this study reported that the patients' charts in this particular hospital unit contained both an 18-point checklist section and a free-text section. The checklist section consisted of the following:

    Compassionate presence

    Meaning-oriented presence

    Life review

    Continued presence and follow-up

    Supported patient's sources of spiritual strength

    Inquiry about spiritual beliefs, values, and practices

    Open-ended questions to elicit feelings

    Advocated with staff for patient/family needs

    Used story telling

    Reflective listening, query about important life events

    Facilitated communication with interdisciplinary team

    Facilitated expressions of lament

    Referral to spiritual care provider as indicated

    Celebrated/offered thanksgiving with patient/family

    Advance directive information given

    Spiritual support groups

    Spiritual practice interventions

    Reconciliation with self/others

    This research project did not focus on the checklist above, but on the section of the patient chart where the chaplain was asked to make free-text comments. There were such chaplain comments made on 109 patients in the survey. The free-text opportunity would in fact seem to be the only useful kind of clinical chaplain reporting.

    The summary conclusions of these researchers were not flattering. The chaplains' free-text comments consisted mostly of information already available in the charts. The notes seldom included what would be considered an assessment of needs and resources. The notes rarely referred to any plans or expected outcomes. And the notes did not convey a deeper connection that clinical chaplains, in fact, often have with patients. Chaplain interactions with patients appeared to the researchers more as "products for delivery." The researchers viewed the checklist as actually conveying to chaplains that their work consisted of delivering so many product units of "compassionate presence" and other such ambiguous objectives.

    The research team concluded that chaplains frequently resorted to code language that signified nothing more than the chaplain was present. Many of the free-text notes repeated vague terms already in the checklist itself. Chaplains typically described what they observed rather than interpreting its clinical significance. Chaplains generally indicated passive follow-up plans, waiting for patients or family to initiate further interaction.

    The chaplains often described in the free-text section simply what they observed, such as "family is quite large," or "patient's mother standing and holding patient's hand," observations bereft of any useful interpretation.

    The researchers also found that chaplains' free-text notes often recapitulated what was documented elsewhere in the chart, or readily available elsewhere, such as "patient has lung cancer and has been in hospice." Chaplains rarely made what would be considered a pastoral assessment. And the researchers concluded that the chaplains seldom incorporated in their notes what might be interpreted as "spiritual assessments." The chaplains' notes did not convey the deeper spiritual––or pastoral––connection that chaplains often have with patients and families.

    The free-text notes often described patient's spiritual and religious characteristics without any interpretation of significance, such as stating that "patient is a Presbyterian."

    On the other hand, the researchers found that chaplains did in fact provide what they considered a pastoral or spiritual assessment in three of the 109 cases. In one the chaplain wrote: "I believe the family is aware of the seriousness of their mother's situation." In another the chaplain described an upset wife determined to focus on assisting her ill husband. In the third the chaplain wrote a long note about each of three children of a dying mother and their differing postures toward the dying process. The researchers found such clinical observations promising, though few and far between.

    The researchers also found that follow-up plans for patients were mostly passive, indicating that the chaplains would be available if needed. Of the 109 free-text chaplain notes, only two referred to any prior chaplain visit, suggesting that there was a paucity of follow-up work with patients.

    The researchers argued for chaplains providing clinically relevant communication.

    This study should be examined by all serious pastoral clinicians. I believe that the results of this study are not idiosyncratic to Duke University Hospital. In my travels I have found that clinical chaplains are generally at a loss as to what appropriately belongs in a patient's chart. It should be a fairly easy task to decipher what is important and to orient chaplains to just that.

    We should be clear however, that there are systemic problems in chaplain reporting stemming from the very recent shift in language use, a shift that has resulted in obfuscation of the chaplain's role. I refer to the substitution of "spiritual" for "pastoral" that has been in process on a wide scale for two decades now. (It is heartening to see that Duke still retains a "Department of Pastoral Services.") If chaplains simply can remember that they are pastors or in the pastoral arena and not spiritual gurus, they will be able better to describe what they do. The pastor, like the shepherd of a flock, actually needs to do neither more nor less than to see that the animals and crops are safe, healthy, and in all respects progressing. It is a broad-spectrum task. Much of the time that means doing nothing more than paying close attention. Thus the chaplain can write in the chart, "made myself known to the patient and will follow up as needed." No need to add any fancy new-age language. No need to parse the new fad of "spiritual but not religious." Just present oneself in a pastoral––like a shepherd––posture, establish a potential new relationship, and return later if possible.

    In any case, it is advisable for chaplains to present themselves as pastoral professionals if they want to be understood.

    Thus, in the typical hospital a high percentage of chaplain visits would likely be appropriately charted as "pastoral visit." That is to say, nothing much of significance occurs beyond the simple dramatization of the chaplain's availability. This is, of course, no small matter. Informing the patient by way of a brief visit, rather than by a written announcement, that there is a chaplain available for consultation or counseling, is an important contribution to a typical patient's sense of institutional well-being.

    Paradoxically, the clinical chaplain in making routine visits to patients will find that some of the most receptive and needy patients, in terms of pastoral counseling, are not those with acute medical emergencies in play, but rather those with routine, everyday medical problems. And generally such patients have the luxury of time for talking, unlike those facing critical emergencies. In my own experience through the years, I have found that the most significant pastoral counseling I was able to do was with patients (and staff) who had time on their hands and were happy to encounter a trained person willing to listen to them.

    [Having said that, we should note in seeming contradiction, that it is not unusual for a routine patient courtesy visit to morph quickly into what should be properly labeled pastoral psychotherapy. A competent clinical chaplain is always nimble and ready for surprises.]

    For a minority of patients, where something of note emerges in the chaplain's visit, or a crisis is underway, charting is especially important as a way to notify the staff of what specific action the chaplain is taking. The staff needs to know.  

    Clinical chaplains everywhere should take note of this credible and well-done piece of research. It should be considered a warning shot announcing the danger of the trend toward the irrelevancy of institutional chaplaincy. To counter this impending danger I recommend the following:

    1.     Clinical chaplains move away from "spiritual" as the supposed arena of the chaplains work, seeing it as a recently invented poorly defined category, and move back to the more concrete "clinical pastoral."

    2.     Clinical chaplains recognize that one-time pastoral visits are less likely to accomplish much more than introduction and minimal trust building. Effective pastoral work generally––but not always––comes from repeat visits, after which the patient has learned that the chaplain at least is able to get in and get out of a room and listen, without doing something foolish.

    3.     Clinical chaplains, more than any other professionals, take interest, theoretically, in the whole person, medical, social, mental, physical, et alia.

    4.     Clinical chaplains avoid all flowery language in defining their role, such as "compassionate presence," especially any that is similarly self-aggrandizing.

    5.     Clinical chaplains avoid any prefabricated "outcomes." Any chaplain-patient outcome should be rooted in the idiosyncratic needs and values of the particular patient. Not every patient seeks the same outcome. And most patients seek only an intelligent caring listener to hear his or her story. Most patients want to live, and to live fulfilling lives, but only they know what such a life might look like.

    On a given day most patient visits would likely qualify for a simple documentation of "pastoral visit." Beyond making him- or herself known and available, there typically is not much else to offer on a first visit. In a few cases, especially repeat visits, the chaplain may move into the role of counselor, therapist, confessor, or guide––cases in which persons expose their lives to an intelligent other, with the unspoken hope for both care and wisdom. A competent chaplain has the time, and hopefully the expertise, to fulfill that role where most other medical staff must keep moving. Such in-depth pastoral visits need to be documented for the benefit of the other staff members.


    Raymond J. Lawrence, General Secretary

  • 29 Dec 2016 3:36 PM | Krista Argiropolis (Administrator)

    "I'm creating a safe space for people to tell the truth and tell their own stories without judgement and with respect..." –Michael Eselun

    The fourth edition of our podcast, Chaplaincy Alive!,  is now available. In this poignant interview, host Susan McDougal talks with Oncology Chaplain Michael Eselun about his work with hospice and palliative care patients, his TEDx talks, and his background working in the entertainment industry. 

  • 23 Dec 2016 6:37 AM | Krista Argiropolis (Administrator)

    This special season is dedicated to declarations that give expression to the best of the human spirit such as, "light that shines in the darkness", "good will to all", "peace on earth", etc. 

    It is a season when we want to hold love ones close, remember those we loved but lost, notice the homeless beggar on the corner with genuine compassion in our hearts. We want to give to agencies that feed the hungry and serve the desperate souls who live in the margins of life, relationships and love. Even TV ads that reminds us that abused and abandoned dogs and cats need our help and care touch cords of compassion.

    It is a tender season. It opens our hearts to both hurt and love. 

    Ultimately this season reminds us how desperately we need love and we need to give our love as the core of life that gives meaning and purpose to our being in this world as fragile yet courageous creatures on this earth. 

    Be of good spirit!


    Perry Miller, Editor

  • 05 Dec 2016 9:01 AM | Krista Argiropolis (Administrator)

    Beginning in December of 2016, all site reviews for the accreditation of training centers and programs are the responsibility of CAPPT. The directing of these reviews to CAPPT as an independent accrediting body was made by the Governing Council of CPSP. In fact, the first site review to be performed by CAPPT will be completed before the end of the current year and it is anticipated that there will be more than 12 reviews in the calendar year 2017.

    After careful deliberation the Board of Trustees of CAPPT have initiated a fee schedule for all site reviews. The fees for an accreditation review are as follows:

    • $250.00 per diem for each person performing the site review
      • CAPPT will determine if more than one reviewer is needed based on a number of factors including size of the training program etc.
    • $250.00 for the writing and delivery of the site review report to CAPPT
      • If there are more than one site reviewer this fee will be split by the reviewers
    • All expenses for travel, room and board, parking, and other incidentals
      • Normally the site will arrange for housing if needed and receipts must be rendered for all expenses. Every effort will be made to arrange for the reviewers to be in as close proximity to the site being reviewed in order to keep these expenses reasonable. CAPPT will arrange the identification of the site reviewers and may consult with the AOC or the Chapter of Diplomates for this purpose. The selection of the reviewers is the responsibility of CAPPT alone

    Brian H. Childs, Chair, CAPPTThe payment of the per diem, the report fee and all expenses are the responsibility for payment by the site being reviewed. CAPPT will provide an invoice that the site reviewer(s) can use to facilitate the payment of these fees. CAPPT does not directly bill for these services. However CAPPT will not complete the accreditation process until all of these fees have been paid.

    The process for accreditation is outlined in the accreditation manual found on the CPSP website as well as the CAPPT site. The CPSP Accreditation Oversight Committee (AOC) keeps track of those programs ready for review, mentors those programs in the process of developing the self-study and then refers the application for accreditation to the Executive Chapter of CPSP. The Executive Chapter will then decide if the center is ready for the independent CAPPT review and if it is forwards the material on to CAPPT. CAPPT will then decide on who and how many site reviewers will be needed, recruit the reviewer(s) and then send a contract to both the site being reviewed and the reviewer(s) explaining both the site review process and the fees attended to that review. After the completion of the site review report that report along with the site self-study is referred to a committee of CAPPT for review and then that is sent to the entire CAPPT board for a final decision for accreditation including potential notations for remediation and completion if needed. All reviews are valid for seven (7) years. Again, refer to the CAPPT Accreditation Manual for all of the requirements for a review.

    Brian H. Childs
    Chair, CAPPT

  • 29 Nov 2016 5:06 PM | Krista Argiropolis (Administrator)

    The CPSP Communications Committee is pleased to announce the release of the third edition of Chaplaincy Alive!, a video-podcast, featuring Terry R. Bard, the Editor in Chief of the Journal of Pastoral Care Publications, Inc. 

    Our host, Susan McDougal, talks with Terry Bard about the articles and reflections offered by the Journal of Pastoral Care and Counseling, and some of the challenges that are faced by chaplains today, in our ever-changing healthcare systems in America, and abroad. 

  • 22 Nov 2016 8:49 AM | Krista Argiropolis (Administrator)

    While reading Raymond Lawrence’s newest book, Nine Clinical Cases:The Soul of Pastoral Care and Counseling, I was aware of disturbing contrast. 

    Recently I was reviewing a number of websites conveying the services of the chaplain in various medical and other institutional centers across the country. Certainly not an exhaustive review on my part. I was struck, however,  by how many of these chaplain websites tagged their top service was to provide prayer for the patient and their families. Equally true, they often used a photo of the chaplain at bedside holding the hand of a patient as a means to portray their service. 

    Of course chaplains pray and hold the hands of suffering patients and families. But prayer and holding hands is not the sine qua non activity of the clinical chaplain. After all, an untrained minister and layperson off the street can do so equally effectively. 

    These websites and language I hear from chaplains describing their services seemed to be limited in their effectiveness to stake-out the unique role of  a clinical chaplain beyond that which a non-clinically trained pastor could offer. Chaplains provide “prayer”, chaplains provide “presence”, chaplains “show up”, chaplains provide “spiritual guidance” and help people with their “spiritual pain”, chaplains connect patients with their "faith resources", etc.  

    It might be that having a prayer, holding a hand and reminding people of their faith resources has now become so embedded in the practice of chaplains now offering “spiritual care” that the notion they are clinical chaplains has dropped from their awareness and commitment.  I hope not but there is increased evidence this might be the case.

    Only after a few pages into Nine Clinical Cases  the reader cannot miss Lawrence’s challenge. The effectiveness of a chaplain, even the integrity of chaplaincy, he contends, resides in a genuine clinical approach when engaging people who face overwhelming life alternating/ending situations and human suffering. 

    The work of the clinical chaplain, Lawrence declares, must be informed by psychodynamic/psychoanalytical theory. In addition, the competent clinical chaplain makes creative use of the self. The latter typically means the clinical chaplain in addition to CPE training  has also undergone their own psychotherapeutic investigation in order to gain a healthy degree of self awareness. From Lawrence’s viewpoint, even with all of this, which is necessary, a chaplain without a good dose of "humanity and humility" will only be a performer doing an “official duty”, not a curer of souls. 

    The bottom line: Raymond Lawrence calls all of us in clinical ministry to correct the drift from our historic roots which demand our being well trained and informed clinical practitioners.  He directly and indirectly gives warning to the current lapse into the murky language and practice of “spiritual care”. 

    Nine Clinical Cases:The Soul of Pastoral Care and Counseling, stakes out the necessity that all practitioners of clinical ministry have a firm grounding in psychodynamic/psychoanalytical theory and have participated in a form of psychodynamic clinical supervision that invites depth of exploration; an integration of theory, theology with the person and their clinical practice. Failure to do so, in time, will become our undoing as chaplains and our place as a vital member of the health care team. 

    It could be that the health and well-being of the whole clinical pastoral movement will pivot on our re-consideration of our current emphases on “spiritual care” and its murkiness of definition and practice. 

    Lawrence calls for a more informed and effective clinical practice by returning to our historic roots as addressed in Nine Clinical Cases.This book represents a service, a dent, and possibly a disruption as he calling for a commitment to re-evaluate what it means to be a clinically trained chaplain/minister dedicated to the care of soul. 

    My strong impression is that our medical colleagues: physicians, nurses, social workers, psychiatrist, etc. will welcome such a reconsideration and a renewed commitment for chaplains to truly function as clinical members of the medical team. They want and need for us to be far more clinical and sophisticated in the knowledge and language of the social sciences we use with them as fellow consultants and members of the care team than we currently offer. They need us to have a deeper level of clinical acuity as providers of care and counseling for their patients and families who who are broken not only in body but in mind, spirit and in their relationships. Dr. Lawrence’s Nine Clinical Cases, reflects the same wish, even a plea. 

    Lawrence’s  Nine Clinical Cases:The Soul of Pastoral Care and Counseling should be required reading for all clinical chaplains and ministers. Equally true, it is an absolute  must read for CPE training supervisors and their trainees. 


    Perry Miller, Editor
    NC State Board Certified Pastoral Psychotherapist/Clinical Supervisor
    CPSP Diplomate, CPE Supervision and Psychotherapist

  • 21 Nov 2016 11:14 AM | Krista Argiropolis (Administrator)

    Raymond Lawrence, General Secretary, is announcing the appointment of Cynthia Olson as Associate Secretary for CPSP. In this role, her primary duty will be to assist the General Secretary in any assigned matter. Her major responsibility will be to strengthen communication in the CPSP Community. In that capacity, she will keep the General Secretary, the Administrator, and the Administrative Coordinator apprised of any significant developments appropriate to their tasks. I hope the community will welcome Cynthia to this new role. 

    Meet Cynthia Olson...

    Cynthia traveled some 25 years overseas, initially as an American Peace Corps volunteer and later as the spouse of a diplomat in the US Foreign Service. Her work in Africa and the Middle East involved supporting at-risk mothers and children in those diverse cultures. While on home assignments in Washington, DC, she developed a talent for editing while working at National Geographic Society as a project manager of children’s books and executive assistant to the Editor of National Geographic magazine. 

    Cynthia joined Nautilus Pacific chapter in 2007, and in 2009 she and others started the first CPSP chapter in northern California, which birthed the Sacramento chapter in 2012, where she is convener. Since its inception in 2011, Cynthia has been a member of the NCTS-West planning committee, and for the past three years, until September 2016, she has served as chair of the Accreditation Oversight Committee. 

    Cynthia is an ordained Interfaith minister; and a member of the Disaster Spiritual Care Team of the American Red Cross, deployed in 2013-2015 to support victims of tornados in Joplin, MO, and Moore, OK, and Hurricane Sandy in New Jersey. She has been with VITAS Healthcare for ten years, eight as a hospice team chaplain and more recently as their Bereavement Services Manager.



  • 13 Nov 2016 8:59 PM | Krista Argiropolis (Administrator)

    Greetings from the National Clinical Training Seminar in Morristown, NJ, was held Nov. 7-8!

    Rev. Dr. Francine Hernandez is Diplomate Supervisor with CPSP, former President of CPSP, and currently serves on the NCTS Planning Committee and the Chapter of Diplomates. 

  • 09 Nov 2016 2:33 PM | Krista Argiropolis (Administrator)

    They come from all over Northern California.   Broken, wounded, and scarred, they arrive strapped to a gurney –three, four, sometimes five in a day. Frightened, exhausted, perhaps in physical pain, they often come directly from short stays in ICUs, where for a while they abided in the space between life and death.  

    Almost all arrive alone, accompanied solely by medical transport personnel.  Many will have family members arrive minutes or hours later, to join them. Some arrive with little or no local support and may have few visitors during their stay.  

    Most speak English but others do not, limited to the use of Spanish, Tagalog, Chinese, and other languages.  They are of all ages, races, genders, ethnicities, religions and income levels. 

    They have suffered strokes, brain tumors, car accidents, amputations, head or spinal cord injuries, and sometimes gunshot wounds. A few have chronic and incurable conditions of the nervous systems.

    Upon arrival, almost all are unable to walk, many are unable to talk or have cognitive challenges due to traumatic brain injury.  Some cannot swallow food.  They are often incontinent.    

    Welcomed by caring but busy nurses, they are processed into the system. Within a few hours they will be examined by various doctors, therapists and specialized nurses.  Within a day their regimen of daily therapies - physical, occupational, speech - will begin as acute rehabilitation - “boot camp” - moves into high gear. 

    Their stay will be perhaps a week, or up to a month.  At some point during their stay, at least once, they and their loved ones will be visited by a hospital chaplain. 

    The Kaiser Foundation Rehabilitation Center (“KFRC”) is a 50-bed acute rehabilitation facility, a sort of hospital within a hospital, at Kaiser Medical Center in Vallejo, California.  Thirty miles northeast of San Francisco, Vallejo is a mid-sized, diverse city– the most diverse city in the United States, according to recent studies.      

    At first, the KFRC, with its reputation as a premier rehabilitation facility, clean, bright, and cheerful, with large modern patient rooms, a state of the art gymnasium, the latest rehabilitation equipment and facilities and highly trained staff, can feel oddly out of place, more suited for larger cities like San Francisco or New York.  Most people may not know that Kaiser Permanente has deep roots in the local community, and that the KFRC has been headquartered in Vallejo for over 70 years.  

    Today, the KFRC is staffed by (approximately) 30 physical therapists, 20 occupational therapists, 10 speech therapists, nine doctors, seven case managers, 11 administrative personnel, two medical social workers, and one clinical chaplain.  For the past six months, that chaplain has been me. 

    It’s a chaplain’s workday like any other, as I head to Room 302, a large, light filled two-person room, intending to see S., a 75-year-old stroke survivor. S’s bed is empty. She is likely in one of her many therapies. In the other bed lies a much younger woman, flat on her back, alone and unattended.  She is not on my list, indicating she arrived within the hour since I printed it. 

    “Hello. I’m sorry, I didn’t know you were here. You must have just arrived. My name is Peter, and I’m a chaplain serving on this floor. What’s your name?” 

    As I approach her and reach out my hand, she lifts her own with difficulty. Holding my hand, looking deeply into my eyes, she begins to cry. 

    “Are you able to speak?  She moves her head very slightly from side to side letting me know she can not speak. 

    “Can you understand what I am saying?”  She nods her head ever so slightly.  

    I pull up a chair to be next to her, looking directly into her tear drenched eyes, leaning closer.

    “I need to tell you something important and I hope you can trust I’m telling you the truth.”  

    Her eyes widen. 

    “You are safe now. You would not be here unless you were out of danger.” 

    At these words she begins crying more intensely, and her cries are accompanied by a wordless wailing sound, the only sound she apparently can make given her condition. 

    “I need to tell you something else”.  Her wailing stops, even as her tears continue to flow. 

    “I don’t know anything about you, who loves you and who is supporting you. But I mean this with all my heart. I love you and I am here for you.” 

    With this, she begins to wail again, this time louder, deep toned, incredibly mournful, animal like. The sound of inconsolable loneliness and grief.  

    One of the nurses enters and tries to calm her, “It’s alright, you don’t need to worry.”  I gently cut her off.  “Let her cry, she needs to and I’m with her.” 

     For the next 20 minutes I sit with her as she cries. I say to her, “Let it out,” “I feel you must be missing a loved one, maybe your mother,” and other words, not meant as comfort but rather as acknowledgment of what she has lost.

    A new nurse comes in, to give her pills and otherwise to attend to her. She stops her crying. I tell her I will see her the next day.  What I want to tell her is this: “You are feeling your grief. That grief will take a long time to heal. But tomorrow the healing will begin.” 

    Unlike chaplains in acute care settings, I have the opportunity to meet with patients and families repeatedly, over two , three or four weeks. While our patients have been severely damaged and have suffered a traumatic event, few are “actively” dying.  Most will live lives of normal length. But for many, adapting to their condition – be it a lifetime bound to a wheelchair or walker, or needing assistance in activities of daily living – will be an ongoing process for years and decades to come. 

    Many arrive with the fantasy that “rehabilitation” means “getting back to the way I was before.” This is not usually the case and whatever their physical and cognitive improvements over time, to me this is a myth, entirely elusive. Their damage is in all cases a defining moment in the arc of patients’ lives and that of their loved ones as well.  Phrases like “before Billy had his accident,” “before Dad’s stroke,” “after he had surgery for his brain tumor” are routine in the KFRC.  They become the markers of a changed life. The idea of returning to life “before” resembles the denial common to patients and family members as they anticipate or confront death.

    The rehab patient and their family members experience, consciously and unconsciously, a deep sense of loss and, with that loss, grief. The person they imagined they were, the narrative of their lives up that point, is over, forever gone, “dead”, never to return.  Unlike with the dying, there is also a secondary grief, the loss of the person they imagined they would be and become in the future.  Many a patient has told me that they had recently retired and they had this or that plan for the next 20-plus years, the so-called “golden” years, often for travel, exploration, or fulfilling a bucket list of aspirations and dreams. Sometimes just days or weeks before or after this retirement plan and their “new life” is to begin – Bam! – a stroke or other event strikes! Never expected or rarely even imagined, their lives are forever changed. 

    As with death, if we are to truly move through and transcend its life changing effects it is important in the face of loss to acknowledge grief, to fully experience it, to feel it at its core. The denial of loss – a coping mechanism we often seem to readily embrace – takes a heavy toll, creating limits on our intimate relationships, accompanied by fear and, perhaps worst of all, the “demons” of shame and self-loathing.  

    Only by accepting and then moving through grief can we fully begin the process of healing. Thus, here at the KFRC, even while those in our care are processing the immediate grief in the loss of their own imagined life story, they have an opportunity to be reborn, to choose who they will be in this new life ahead.  

    It is the next day and I come to visit the woman again. She again tears up, but this time her eyes suggest a shyness that I interpret to mean a kind of gratitude for my presence and the moment of intimacy we shared the day before. She still cannot speak a word, but her face holds all she needs to say for today. 

    After speaking to her for a couple of minutes about the busy day she has ahead, I tell her, “I believe that before you leave here you will be able to tell me all about yourself. And I can’t wait to learn who you are and who you hope to become.”  

    The KFRC is a place of loss, grief and rebirth. Like midwives, we accompany patients through the fear and anticipation of birthing a new life and embracing the challenges, joys, sorrows, and uncertainty that life uniquely holds for them, as it does for each and every one of us. 


    Peter Meadow is the Clinical Fellow in Pastoral Care at Kaiser Permanente in Vallejo, California, and currently serves as chaplain to the Kaiser Permanente Rehabilitation Center. He is a member of the Sacramento Chapter of the College of Pastoral Supervision and Psychotherapy.