My Dual Role - and how I realised EVERYONE can benefit from spiritual care

 

This is the talk I gave at the EMBT UK NAP conference on Friday 18th October.

Good morning, I’m Fi and I‘ve been a haematology-oncology nurse for 24 years. I started work as a newly qualified D grade in September 2000 on the haematology and transplant unit at The Christie in Manchester (my hometown) after falling in love with haem as a student in Liverpool. 

In January 2007, after returning from maternity leave when I had my second child, I became a band 6 and I’ve now been a sister for over 17 years – and my baby has just turned 18. 

So, I’ve been around a while, I’ve seen a lot of developments, I feel like I have a lot of knowledge and skills, and I’m still completely in love with haem and transplant, and I’m particularly passionate about supporting early career nurses so that they hopefully stick around like I have. It’s so important to have skilled and experienced staff on our units and if we nurture our teams, we’ll hopefully retain those who like me find the most job satisfaction at the bedside.

I’m also a Church of England priest. 

 

I was brought up in a church-going family, which was already a bit weird 30 odd years ago when I was still in school, and like a lot of teenagers I stopped going as I had better things to do and many of the things I perceived as the teachings of the church didn’t sit well with my own values, particularly those around the role of women and the inclusion of the LGBTQ+ community. 

But then, compelled by something and newly married, in March 2002 I started attending my local church, which had a woman vicar – one of the first – and I learnt I was allowed to believe in things like evolution and that there’s an incredibly wide breadth of beliefs in the Church of England - so wide that I’m sure there’s a C of E community for anyone who follows the Christian faith. I was incredibly lucky that my local church was, and continues to be, progressive and inclusive.

It became a huge part of my life, I had the kids, and I was feeling compelled again, this time drawn to a more formal leadership role in the church, and it felt like that was a call to the priesthood, which made no sense with my vocation as a nurse – I’m sure many of you feel that nursing is your vocation and you can’t imagine being anything else.

I subsequently learned about something called an MSE or minster in secular employment. MSEs are priests or accredited lay people (lay means someone who isn’t clergy) where it’s recognised that their priestly work or ministry is actually in their place of employment, and I met MSEs who were nurses, solicitors, vets, dentists and even tax officers! I went through a very lengthy selection process (it took about 3 years), started training in September 2013, was ordained in 2016 and priested in 2017.

I’m also now a Chaplain at the Christie. 

I’d worked as a staff adviser with the team since 2010, so when I was ordained I took up an honorary chaplaincy role. I have to be very careful and very strict with boundaries, so the honorary contract formalised and authorised the work I was already doing. 

In 2019 the opportunity arose for a paid role within the team, I dropped my nursing hours to 30 per week – the biggest career decision I’ve ever made - and I work one day a week as a chaplain - I’m now the deputy lead for the service.

So that’s a whistlestop tour of how I got here, and I guess what I’ve been asked to convey is how the dual role informs each of my jobs, where there’s overlap, where’s there’s clashes and how it can benefit patients and staff in a transplant setting. I’m pretty sure this is an entirely unique combination of roles within the same trust, but I truly believe that each makes me better at the other.

My personal belief is that each one of us has a spiritual life that needs to be fed, what this needs is as different and unique as we are. For some it may be our faith. If like myself you work in a tertiary or regional centre, you’ll know the joy of working in a diverse, multi-faith and multi-cultural environment. Those of us with a religious faith might practice or express that in vastly different ways.

 

For others our spirituality might be fed by music, literature, nature, poetry, pets, craft, hospitality, baking, meditation – it’s vast, and as a nurse who’s always worked with patients in isolation I’ve always been keenly aware of how our patients can feed and care for their spiritual life whilst isolated from most of the things which nurture and ground them, and what we can do to help.

 

Spirituality is anything that helps us connect- with ourselves, with others, with our world, and (if we have faith) with God or a Higher Power. Spiritual need, and even distress, kicks in when these connections are compromised or broken. 

The role of a chaplain is in essence to walk alongside the patient and assist them in whatever way is right for them to care for their spiritual needs, which keeps a person grounded in who they are at their very core. 

 

They way I explain to people how our chaplaincy service at the Christie works is that we’re the one person who goes to the patient’s bedside with absolutely no agenda, each of us who goes to see a patient in our various healthcare roles has an agenda to meet- an assessment to do, information to obtain, bloods, tests, observations, something to administer, and this is true of the wider MDT as well.

As a chaplain you’re meeting your patient where they are, as who they are as a complete person, not the one aspect of their care I may be concerned with as a healthcare professional but as someone who just wants to check “how are you today, is there anything you want to talk about?” 

We’re the privileged witnesses to and holders of people’s stories, the number of times I’ve gone to a bed side and felt the overwhelming honour of someone sharing their story or that of their loved one.

There can be misconceptions of why we’re there due to perceptions of what a chaplain is, we introduce ourselves as being there for spiritual support, and very little of what we do is religious care. Mostly we give pastoral support, and around 1/3 of the patients under our care are not religious.

 

In 2023 we had a total of 1138 patient contacts, from 10 different faiths or world views, we had 398 new referrals, assessed 127 patients in the last days of life and this was between our 3 paid team members, who between us make up 1 full time equivalent, our Roman Catholic cover 2 days per week and 2 honorary chaplains from minority faiths. This year the numbers are already much higher as our volunteers have finally returned post covid, we try to have a volunteer assigned to each ward and visiting weekly to help build those therapeutic relationships.

 

So, does being a chaplain make me a better nurse? 100% yes. In chaplaincy you’re journeying alongside someone in a different way to how you do as a nurse, and it changes your perspective. The patients who as a nurse we find the most difficult or frustrating -  you know the ones I mean - are often the ones that as chaplains we do the most work with, it helps you to understand their complexities, the origins of those complex, frustrating and obstructive behaviours and therefore how they need us to work with them to achieve the healthcare goals necessary.

I may have known a person for months or years as a nurse, but then the richness of what I learn about them through their significant chaplaincy conversations teaches me things about them I would never have otherwise known and might in some cases transform how we care for them medically. 

One of my boundaries is that, unless it’s an emergency I don’t give religious care on the ward I work on, but this is one of the important ways my work as a nurse informs my chaplaincy – by identifying those patients I’ve worked with as a nurse who will benefit from chaplaincy input, and I’m almost always right! Giving that opportunity for someone to open up and release into the world the things they’re holding inside is transformative.

We’ve very carefully chosen the chaplains who do see the patients on the transplant unit. We have Rabbi Lisa (who sadly has just left us to take up a Rabbinical post in Birmingham), who has extensive training in mindfulness and was employed with a specific focus on the teenage and young adult patients on my unit, which alongside our haematology and transplant programme houses the regional TYA oncology unit.

Our volunteer chaplain is Mary, a retired GP who’s a humanist, she focuses on the adult patients and as well as her medical knowledge has the unique perspective of just returning to us after fighting for her life in ICU. It’s had a huge impact on how she empathises with patients. 

When we recruit Rabbi Lisa’s replacement our focus will be on the needs of the TYA and non-religious patients, including the many going through transplant under our care.

For my chaplaincy work with the oncology patients in the rest of the hospital my nursing knowledge gives me the ability to quickly assess where a patient is at medically as I often don’t even know their diagnosis. I process what they’re attached to, how they look or the snippets of medical information we’re given about them. All these things I’ll interpret in a much more clinical way than my non-clinical chaplaincy colleagues. 

Most of the patients who end up in our care are long stay – at least 3 weeks – and my long experience with long-stay and isolated patients has created the empathy to hopefully understand where they’re at and what they may need. 

The other way the roles complement each other is in my passion for staff support, which is part of my focus within chaplaincy and a huge part of my nursing role. I’ve recently completed PNA training, and the skills honed through this seamlessly feed into chaplaincy, where we also offer debrief after complex or traumatic events, and support staff as individuals and as groups.

Since coming into post, I’ve tried to raise our profile amongst staff as another means of support, entirely separate from nursing structures. We’ve supported staff through cancer and other illnesses, through caring for family members, abusive relationships, disciplinary hearings, pregnancy loss, the death of colleagues, racist abuse, financial struggles and many other things. All our staff data is anonymously recorded.

Chaplaincy might not be someone’s first choice through difficult life events and traumatic work experiences, but chaplains work at the cliff face of trauma and grief. And we have a ritual for any occasion! Something deep within us as humans seems to crave ritual, and we can come up with something religious or secular for any purpose. My colleague Andrew developed a secular service for staff to use to say goodbye to patients who’ve died, knowing that with our long-stay patients staff often grieve deeply. 

Every November I take part in a day where we invite the families of TYA patients who’ve died to collectively remember their loved ones.

In conclusion, in my experience, my two roles seamlessly inform the other, how could they not if I’m to be an authentic practitioner within each role? I’ve avoided clashes by ensuring my boundaries are firm within each role and by helping raise awareness of what good spiritual care can look like.

20th December

But Mary treasured up all these things and pondered them in her heart. -Luke 2:19

How fitting that this is today's verse when it's the Sunday in advent that we particularly think about Mary.

This morning marked the end of my placement at St Peter's House, the university chaplaincy which covers the University of Manchester, Man Met and the Royal Northern College of Music. I went in there knowing very little about the team and what they did. The placement was to experience a place of secular or sector ministry and after 19 years in the NHS I felt it was necessary to experience something outside of healthcare. I hoped this would enrich my calling to secular ministry.
What I've encountered over the 4 months I've been at St Peter's has been surprising, encouraging and endlessly fulfilling. The thriving, inclusive, and diverse worshipping community was the biggest surprise. I've often felt on the outside edge of my own branch of Christianity, not quite sure where my own slightly unusual calling and indeed my personal theology sat within the parish system the Anglican church seems to be built upon. I've always felt at home in secular ministry and finding a church as inclusive and accepting as I find chaplains to be was remarkable.
Chaplaincy and sector ministry is about accepting people in all their brokenness. It's not about making disciples, growing churches or sermonising. It's about being there for people and accepting them and loving them, because that is what God does.
The service this morning at St Peter's was beautiful, with a wonderful sermon preached by URC minister in training Alex Young, who prior to training was part of the St Peter's team. The sermon reflected on Mary's beautiful hymn of Praise, The Magnificat, but aimed to uncover the truths; how did her soul, and by extension our souls, magnify the Lord (as she says) when we are fearful, broken people?
For me it's about accepting truths- the truth of who we are and the truth of our purpose, which I believe is to be a loving and worshipping community of people.
We can look at ourselves, being honest about what is broken in us, what we are struggling with and be secure in the knowledge that, no matter what, we are reflections of God, our souls magnify him and we are loved in all our brokenness.

What's Your Story?

As always I found today's sermon difficult to write. The challenge this time was having a different audience, as I'm on placement at St Peter's University chaplaincy in Manchester. The congregation are educated, ecumenical, multi cultural and many don't have English as their 1st language. It's a bit longer than I'm used to as well- aiming for 15 minutes instead of 8.
The readings were Jeremiah 31:7-9, Psalm 34 and Mark 10:46-52.

I’m a massive fan of the writer Terry Pratchett. I started to read his books when I was 11, so for most of my life the world he created- the Discworld- has grown and developed alongside me. The narrative of this imagined world actually contains a lot of commentary which I think has shaped how I look at our world- his books contain social commentary, philosophy, ethics, satire of organised religion and even exploration of difficult theories of quantum physics but it’s all woven within a fantasy world and its imagined characters- all of whom, like real people have evolved and changed over the course of the narrative.

Stories matter. We’re a race of story tellers. Novels, fairy tales, family stories and bible stories. We remember them, we share them, and we pass them on to our children. I couldn’t wait until my children were old enough to start sharing the Discworld with. Our story telling expands far beyond books or even the more ancient tradition of oral story telling. Our lives are packed with narrative- TV, cinema, DVDs, online streaming, gaming- we may be more often immersed in imagined worlds than the real one.

Every culture has its important stories, those which are deeply imbedded in our history. They may go some way to encapsulate the core beliefs of that culture or society, family stories may do the same. This is who we are, where we’ve come from, this is what we believe. Stories may reinforce the stereotypes we buy into, or serve to challenge them. The stories our leaders tell us may shape how we view our national identities, and those of other nations. The media too like to use narrative to challenge or strengthen how we view the world or particular groups or issues.

What stories did Bartimaeus, the blind beggar, grow up with? What narrative? “Son of David have mercy on me!” he calls out. He’d heard the rumours- this Nazarene, this Jesus, was rumoured to be the long promised Messiah, woven into the narrative of the Hebrew Scriptures, the stories passed on orally from generation to generation.

It’s a stereotype that those born blind compensate with other senses or skills, but just maybe Bartimaeus had a keen memory for the stories he’d heard from his father or the rabbi. Maybe he’d grown up hearing Jeremiah’s words:
“The days are surely coming, says the LORD, when I will raise up for David a righteous Branch, and he shall reign as king and deal wisely, and shall execute justice and righteousness in the land. In his days Judah will be saved and Israel will live in safety.”
This narrative of the coming messiah was woven into Bartimaeus’ life. The long awaited righteous Son of David. Is it these words “son of David” which cause Jesus to stop and act? Why? What purpose does this gospel story – the healing of Bartimaeus- have in Jesus’ narrative?

I believe that the very last thing today’s gospel is about is a physical healing. Yes it’s part of the narrative, but it’s a device which serves another purpose.

I began training as nurse in 1996, 19 years ago. I qualified in 2000 and ever since have worked at Christie hospital caring for patients undergoing high dose chemotherapy and stem cell transplants. 19 years in healthcare has taught me that illness is indiscriminate of age, race, gender, social standing, religion and righteousness. Some people do badly without explanation and likewise some people do well when you wouldn’t expect them to.

On very rare occasions someone’s recovery could be described as “miraculous”. Do I think God healed them? I honestly don’t know. Consultants generally don’t like giving anyone else the credit. I believe all healing has Gods hand in it, but the established church is very reluctant to take ownership of what might be seen as miraculous healings. At times I’ve prayed- lamented- on my knees for miracles that didn’t come.

So what comes into my mind when I read today’s gospel is why him? Why Bartimaeus? What purpose did Jesus have in healing him? When we look at this healing, and other healing stories in scripture, what we come to understand is that when God miraculously heals someone he’s making a point. Healing glorifies God, reveals his power, fulfils his promises and shows his mercy. It’s part of an ongoing revelation of the character of God and our relationship with him. We must think then what does Bartimaeus being healed reveal about God, within the over-arching narrative of Mark’s gospel.

Son of David, promised Messiah. The king who would come and save. A righteous judge, but also a military leader- he’d have to be to deliver the people from their Roman occupation. By responding to the cry of “Son of David” Jesus is saying “yes. I admit it- that’s me, the messiah” but Jesus admitting he’s the Messiah subverts the expectation of what the messiah will be. This is part of Mark’s wider narrative- the reinterpretation of messiahship. The expected military leader or political king becomes prophet, teacher and miracle worker. Messianic expectations are subverted further later in Mark’s narrative when we see that it’s central to Jesus’ ministry for him to suffer and die.

Jesus chooses this point in the plot to reveal he’s the Messiah as it comes at a pivotal point- straight after today’s gospel, according to St. Mark, Jesus enters Jerusalem. The passion narrative begins. Bartimaeus is healed and immediately follows Jesus, but where is that leading him except to the cross?

Bartimaeus doesn’t need to be healed of his blindness. Physical sight makes no difference to faith. But Jesus knows the importance of a good story, we see this recorded in the gospel parables. What Jesus is doing with Bartimaeus, instead of revealing God through telling a parable, is physically acting out a parable. In this morning’s reading from Jeremiah we hear of the God who will “gather them from the farthest parts of the earth, among them the blind and the lame” and the psalmist “cried, and was heard by the LORD, and was saved from every trouble”. The God revealed in prophecy and poetry in confirmed in this acted out parable. The story arch reveals not only something of God’s character, but signposts what we who follow Jesus are committing to.

Blindness to sight, dark to light, veiled knowledge to true insight. What Bartimaeus receives is a gift from God, but it’s not his physical sight. It’s the true insight, the knowledge, of who Jesus is, and that he must follow him, even if that means following him to the cross. The Messiah will know suffering, as the blind beggar has known suffering. He’ll be rejected as the blind beggar has been rejected.

How did the reality of Jesus compare to the messianic stories heard as a child? Did Bartimaeus really think the Son of David would hear his cry for mercy? The character of God he knew from scripture, the God who wants to gather to himself even the most marginalised and vulnerable in society, is revealed through Jesus responding to his cry and through the narrative device of a physical healing, gifts him with the insight to follow him no matter what.

The bigger picture, the overall sweep of the narrative, and therefore the purpose of this healing, is the revelation of the God who hears the cries of his people, knows what they need, has concern for those suffering but also invites us- even requires us- to follow Jesus and see him suffering, to see Jesus cry out, because only then do we know that this is a God who really understands us and human suffering. And because if we don’t follow Jesus to the cross, we can’t be party to his resurrection. If the narrative ends at Good Friday the story’s incomplete, and without Good Friday there can be no Easter Day.

So how, indeed, is this the word of God for us today? Stanley Hauerwas is a writer on the subject of Christian ethics, and he’s a big believer in the power of narrative. He writes that Christianity rests not on abstract philosophical principles but on stories, that God has indeed revealed himself narratively in the history of Israel and in the life of Jesus. These stories shape the character of the individuals and communities where they’re still repeated today. We tell and retell the stories in order to maintain our identity and we see the narrative of our lives within this wider narrative.

By telling and retelling the stories about Jesus and his life we build that narrative into our lives and try to emulate it. To return to Terry Pratchett he once wrote “Goodness is about what you do. Not what you pray to.” I believe there’s truth in that. If we’re Christians but not attempting to be Christ-like it doesn’t really matter what we label ourselves.

So, what story do we here want to tell? Where do we want to fit in the narrative? Will the story of our lives be part of the ongoing revelation of the God who has concern for the least, most vulnerable members of our society?

The refugee, the abused, the despised, the rejected. As Jesus wove the narrative of his life into the lives of the marginalised so must we. It’s then that our lives touch that of Jesus, and we tell the best story possible.

Listen More Carefully

I am a terrible listener. I have zero concentration span, but at least I recognise my short comings! Anything that helps me to try and focus my listening can only be a good thing, as those closest to me can often feel like I have my mind elsewhere (which I usually do). I'm also an interrupter, not because I think what I have to say is more important than other people but because my short concentration span means if I don't say what's on my mind, as it comes into my mind, I'll forget it again within 30 seconds. I probably seem very rude sometimes.
Just spending a few minutes properly listening to someone benefits you both- they feel valued and you may learn something! Last Thursday I spent the day with the Wythenshawe Hospital chaplaincy team and one of the places they took me to was the dementia ward. Frank, one of the chaplains, told me to have a wander and chat to the patients- and what a wonderful and valuable experience it was.
If you really listen to someone with advanced dementia, whilst to begin with the conversation may not seem to make much sense, as you go on you pick up on cues, words and phrases that give you an insight into what they are trying to communicate to you. When talking to someone with dementia listening is the key to effective communication. It's something I really pray I can be better at.