Learning to have faith in themselves
Date: September 3, 2010
A residency program for hospital chaplains teaches them belief in their ability to handle complex ethical and emotional issues.
As Hopkins chaplain Ty Crowe listens to his student’s script, one scene seems painfully awkward: A terminally ill patient mentions that she is ready for hospice, but that members of her family are against it. Instead of encouraging her to say more, the visiting chaplain steers the conversation in a more hopeful direction.
In discussing the re-created encounter, Crowe brings up a key point: Is the chaplain uncomfortable acknowledging the patient’s approaching death? As a supervisor of clinical pastoral education at Hopkins, he guides student chaplains through the territory they face as spiritual comforters of the sick, injured and dying, a terrain that exposes conflicted thoughts about end-of-life decision-making.
At Hopkins, part-time chaplain interns and full-time residents have become an important part of the pastoral care team. Already possessing religious training and graduate degrees, these students improve their ability to minister to the sick through the hospital’s program of Clinical Pastoral Education (CPE), a nationally accredited method of “experiential learning.”
While some may select hospital ministry as a vocation, others will explore it as part of their general pastoral education. Recently Crowe facilitated a meeting with a group of interns that included a Roman Catholic priest, a deacon in the African Methodist Episcopal Church, a Jewish cantor, a Baptist minister, and a postulant preparing for the Episcopal priesthood.
The chaplains were discussing a “verbatim,” a script that a student prepares from an actual patient visit. Sitting in a circle, they read aloud different parts—the chaplain, the patient, the nurse—then reviewed how the author handled the situation. Such conversations are usually intense and lively, according to Crowe.
Residents struggle to find the balance
“Sometimes there are disagreements based upon people’s different faith traditions; sometimes people will have issues about their own authority,” he says. “It’s common for our students to struggle to find the balance between being an adult student and discovering their role as a chaplain in a large institution.”
CPE students practice bedside ministry, rotating through different units while they learn crisis and bereavement care. However, the program’s cornerstone is its group processing. Reflecting upon and discussing patient and family encounters with peers and supervisors brings the self-awareness students need to develop insight and empathy.
“I want our students to be the best listeners the patients have ever encountered,” Crowe says.
At 35, Crowe is an ordained teacher in the Shadhiliyya Sufi Order, often described as the mystical side of Islam. He also is the first Sufi to be certified as a CPE supervisor by the Association of Clinical Pastoral Education, a credential that requires five to seven years of training.
When Crowe began working at Hopkins in April 2009, he was following a vocational quest that began after the Florida native graduated from college. Travelling to Nepal and India to learn more about Buddhism and Hinduism, he eventually found his spiritual calling in a Sufi community in California.
He began his CPE training in 2001, working as a CPE coordinator at Sutter Medical Center in Sacramento and as a program supervisor at various hospitals in Florida. His own spiritual background speaks to the richness of CPE’s interfaith discussions.
Uwe Scharf, director of Hopkins’ Department of Pastoral Care, is a Disciples of Christ minister who grew up in Germany and also serves as a CPE supervisor. He says his chaplains are as interested in patients’ spirituality as in their religious practices.
Faith comes in many forms
“My primary purpose is to establish a genuine, empathic, and mutual relationship with a patient,” explains William Bell, a second-year CPE resident. “We try to see where someone is, and engage them there. For some, faith is very important, while others may look more to family and friends for meaning and comfort.”
Because it attracts patients from diverse cultural and religious backgrounds, Hopkins is an excellent training ground for student chaplains, says Paula Teague, an architect of the hospital’s CPE program who now directs pastoral care at Johns Hopkins Bayview Medical Center.
When Teague came to Hopkins in 2002, the hospital shared three CPE students with two other Baltimore medical centers. She helped the program receive accreditation the following year and hopes that Bayview’s CPE program, currently a satellite of Hopkins’, will be similarly approved.
The addition of pastoral care interns and residents allows the hospital to offer a 24-hour on-call service. Resident chaplains are assigned critical care units and share overnight sleeping quarters with medical residents. When on call, they respond to emergency codes throughout the hospital.
“When called to a code, our chaplain offers encouraging words to the patient or quick prayers for the medical team,” Scharf says. “We’ve found that the presence of the chaplain is an important symbol.”
Expanding their exposure
In addition to its own pastoral staff, the hospital has a full-time Catholic chaplain supported by the Catholic Archdiocese of Baltimore and an advanced CPE resident funded by the Episcopal Diocese of Maryland. A rabbi visits regularly. Patients can also request to see chaplains in such faiths as Buddhist, Muslim, and Jehovah’s Witness.
Although Crowe visits patients occasionally, he devotes most of his time to supervising CPE interns and residents and helping to arrange new opportunities for them. This year, for instance, residents observed meetings of the hospital’s ethics committee, an interdisciplinary team that includes a chaplain to help resolve impasses that can occur between families and medical teams over end-of-life treatment.
CPE students also joined pediatric residents for role-playing exercises in mock crises presented by actors in the hospital’s Simulation Center. When the doctors were charged with telling the “parents” about the sudden death of their children, the chaplain residents were present as an on-call resource.
“So much of the spirituality in the hospital is coupled with grief and loss,” Crowe says. “We also want to help treatment teams be sensitive and inclusive of the spiritual dimension of what families go through.”