Embodying the Compassionate Spirit of the Good Samaritan in Health Care – A Pastoral Perspective

Whether you are practicing Christian or not, I am sure it is deep in your heart to desire to be as compassionate as the Good Samaritan.  I believe that those who want to make their careers and to find their vocations in light of the Good Samaritan tend to seek their professional development paths in health care, social services, and ministries.

As a pastoral consultant, as well as a psychotherapist,  I want to share a bit of my own perspective – prompted by Jesus’ Parable of the Good Samaritan (Luke 10:29-37) in the reading of the  15^th Sunday Ordinary Time (Year C). 

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Being like the Good Samaritan is what clinical pastoral care strives for. Hospital chaplains reach out to any patients, patients’ families and friends, hospital staff – regardless of their background or status.  

Let’s face it. Hospital can be a quite discriminatory place.  Arriving patients are always asked what kind of insurance plans they have.  Based on their answers, they receive certain payer “codes”, and the way they are treated upon this phase of admission is affected by the “codes”. 

Patients with good insurance plans always receive favorable “codes” and are treated really well, like VIPs, because treating such patients means generating more incomes to the hospital.   

I have seen how physicians and nurses talk to and about patients with certain payer “codes”. To patients with unfavorable payer “codes”, especially if they are no family members to be contacted, physicians and nurses tend to engage less conversation. It is also true that many of these patients are not easy to start a conversation with – at least at the beginning.

Behind the sight ….behind the counter of a nurse station, physicians and nurses often “chat” with each other about patients. Sometimes, this conversation sounds like gossiping.  Though physicians and nurses may not necessarily use a contemptuous  word on patients with unfavorable payer “codes”,  there is something disdainful in the tone of their voice as they speak about such patients.  This phenomenon can be a reflection and manifestation of their presumptions and biases about such patients. .  It leads to minimalistic care, given to them – just to meet the minimum standard of care.

Patients with unfavorable payer “codes” are medically treated. But, physicians and nurses in treating such patients do not seem as engaging as treating patients with better payer “codes”. 

This reality in the hospital always bothered me, and it prompted me to pursue a path to become a hospital chaplain, besides my deep desire to engage in conversation with patients on their spiritual level.

Probably, chaplains the only hospital clinical staff not so affected by the hospital’s “patients classification” culture, unlike physicians and nurses.  Chaplains’ services are not subject to billing.  While physicians and nurses have to spend an enormous amount of time and energy in billing of their services, chaplains do not.  This not only keeps chaplains relatively free from the hospital’s “coding” culture but also enables to reach out to more patients beyond the payer “codes” and spend more time with each patient.  This is truly a blessing to be a hospital chaplain. 

One effort I made during my CPE (clinical pastoral education – clinical training to become a hospital chaplain) was to visits charity care patients (meaning, patients who can neither pay nor have no one or insurance to pay), who have no family member or friend to visit them in the hospital.  Such patients usually lay on beds alone all day pretty much alone. Such patients were with unfavorable payer “codes”.

Physicians and nurses tend to engage in less conversation with such patients, compared to favorable payer “code” patients, whose family members and friends often visit.  Such patients must be feeling extremely lonely. Perhaps, they may feel “forgotten” or even “abandoned”, as the robbed and beaten man in the parable of the Good Samaritan could have felt.  If this is the case, then, clinical pastoral care shall reflect the compassionate spirit of the Good Samaritan. 

Oftentimes, I found it difficult to engage in conversation with such patients, as their hearts tend to be so guarded, perhaps, as a result of living alone, feeling isolated and lonely, for a significant amount of time.  I also learned that I cannot approach them with a naïve nation of bringing a human contact to them.   I was rejected by them quite often – as they must have felt that I was also one of these hospital staff, who bear scornful notion toward them. 

One patient said to me, “Go away.  Leave me alone. I don’t want to talk to nobody”.  Another patient said, “Why in the hell you want to talk to me?” 

I sure sensed some anger in these patients’ voices. 

But, anger toward what? 

Obviously, their anger was projected to me.  But, is that mean they were angry at me, or they were simply projecting their anger toward something else (or someone else) toward me – because my presence or attempt to reach out to them invoked something relevant to the objects of their anger? 

It took me a while to learn what was behind their angry initial rejecting reaction to my presence. 

Even though they rejected me, I always kept my eyes on them.  If they had other patients in their rooms, I always tried to initiate an opportunity to strike a conversation with them – though it was not always successful.  But, with my persistent attention to them, many of them gradually began opening their hearts to me.  Instead of responding to my “hello” with their verbal rejection and silence, they began asking me some questions, such as, “Hey, are you a priest?”, “Are you Chinese?” and so forth.  They must have become curious about me.  I suppose that any Asian-looking guy in the United States are first assumed to be Chinese. 

Actually, these were great moments to make real human connections with these patients.  Maybe, otherwise, such patients would have to leave the hospital without having real human conversations and remain angry, lonely and disconnected. 

Through these ice-breaking moments, I also ask them what really turns them on, what they are passionate about, and so forth.  Through such questions, I tried to touch on something that can take their minds from illnesses to things that may invoke meaning of life. Choosing such topics, rather than anything that may strike fears on their illnesses or what they are angry at, I found it helpful to engage in conversations about something that make them feel who they really are. 

Prompted by their curiosity about me and my invitation to speak about their passions in life, these patients usually began to open their mouth and speak, as their hearts also gradually become opened toward me.  As conversation gained built momentum, they also started asking me about my passion and hobbies. 

 

So, we enjoyed talking about food we like, things we like to do, and such and such.  And, patients who looked sad, worried and angry began to smile as our conversation went on. 

Then, some of them also talked to me about their fears and worries about illnesses and prognoses.  They also shared their anxieties about their lives after being discharged from the hospital, because they feel they would be living without much human conversations, again. 

I expressed my gratitude to the patients for sharing their stories, allowing me to learn about their passion in life, as well as fears and anxieties. Then, it was a good moment to guide patients discern meaning of their lives in the context of being in the hospital and being discharged.  For this, those who believe in God expressed their desire to pray together. Some religious patients asked me to help reconnect themselves to God.  And, I was so honored to serve God by serving such psychospiritual needs of these patients.

It is not to say that I was playing a role of the Good Samaritan – though my commitment to pastoral care was certainly, in part, inspired by the Good Samaritan.  I was simply striving to make my service as reflective of the Good Samaritan, as I could, by the grace of God.  And, God sure sent grace to help me serve patients, who were least reached out before.

In fact, the Parable of the Good Samaritan (Luke 10:29-37) echoes  these words of Jesus in Matthew 25:35-40:

For I was hungry and you gave me food, I was thirsty and you gave me drink, a stranger and you welcomed me,  naked and you clothed me, ill and you cared for me, in prison and you visited me.’  Then the righteous will answer him and say, ‘Lord, when did we see you hungry and feed you, or thirsty and give you drink?  When did we see you a stranger and welcome you, or naked and clothe you?  When did we see you ill or in prison, and visit you?’ And the king will say to them in reply, ‘Amen, I say to you, whatever you did for one of these least brothers of mine, you did for me.’

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While physicians and nurses tend to talk about symptoms, diagnoses, test results, prognoses, and so on, I wanted to focus on things unique and important to patients to assure that they are not just diagnoses or objects of health care businesses’ money making or economic burden.  In fact, more physicians and nurses these days, especially those trained in narrative medicine,  make efforts to speak not just about patients’ diagnoses and illnesses but to elicit patients’ unique leverage factors in the context of their life histories. However, working in high-pressured and high-demand managed-care environment, physicians and nurses find it extremely difficult to engage in their patients in their life context. 

That is why roles hospital chaplains play are very important.

Though chaplains do not bill, they do chart their services in each patient’s medical record. So, it helps physicians and nurses to understand patients’ whole-life pictures beyond diagnoses and symptoms to read supplemental narratives inserted by chaplains in each patient’s chart. 

Greenhalgh and Hurwitz, in their ‘Why study narrative?” (BMJ 1999; 318:48.1) argue for the importance of getting each patient’s life history, through patient’s narrative, by comparing health care professionals’ roles to the roles historians play, in terms of getting to patients beyond their diagnoses and illnesses.  In this regard, my attempts to engage in conversations with patients, who tend to be emotionally isolated, was also my efforts of applying narrative medicine in my pastoral care service.