Monday, November 15, 2010

“The Forgetting: A Portrait of Alzheimer’s!”

“The Forgetting: A Portrait of Alzheimer’s” is a 2003 Public Broadcasting Service Documentary that was patterned after a book by David Shenk by the same title. The made-for-television special portrays the entire spectrum of Alzheimer’s history from the ancient legends of demented folklore to its original diagnosis in 1903 by Dr. Eloise Alzheimer and on to the cutting edge of Alzheimer’s research today.  I highly reccommend this series for all who are interested in Alzheimer and is available on youtube.com. I will focus my reflection upon this relentless disease and how it will impact in the future my work as a hospice and/or hospital chaplain.

Alzheimer’s can be separated into two broad categories: early-onset Alzheimer’s and old-age Alzheimer’s. Behaviorally, early-onset Alzheimer’s can be defined as dementia that begins prior to the seventieth birthday, and conversely, old-age Alzheimer’s is everything else. Clinically, all forms of Alzheimer’s are caused from the interruption of synapse (electrical brain connections) secondary to the accumulation of plaque (starchy deposits). This interruption ultimately results in the death and shrinkage of brain tissue. Of the two, early-onset Alzheimer’s is more aggressive and the progress from diagnosis from onset to death can be very rapid (<5 yrs.), while old-age Alzheimer’s takes much longer (13-20 yrs).

In 1987 Alzheimer’s was already considered epidemic with 500,000 living with the disease in the United States alone. By 2002 the ranks of those diagnosed with Alzheimer’s were well over 5 million people (more than 10 times). While this number is alarming, it should not be construed to be spreading to new populations. Rather consider this: in 1980 there were 2,250 people in the United States that were over 100 years old. In the year 2000 that number had swollen to 250,000 people over 100 years old (also more than 10 times). This fact is solely responsible for the increase in the vast number of those diagnosed with Alzheimer’s, because the increase is in the old-age Alzheimer’s category.

Ten percent of all 75-year-old Americans have Alzheimer’s. The number is a little harder to determine (due to other forms of dementia being present as well) in Americans that reach the age of 85. However, studies show a range between 25 and 47% of all 85-year-old Americans as having Alzheimer’s. Due to advances in other areas of health care, more and more people are living to such a ripe, old age, and therefore the number of Alzheimer’s patients continues to grow. This growth is at an unprecedented cost to Americans with 100 billion dollars being spent in 2002 for the treatment and care of Alzheimer’s patients alone. With baby boomers soon to reach ‘old-age,’ the number of Alzheimer’s patients is expected to multiply by 10 again, reaching 25 million by 2030. By this time the cost of treatment and care for Alzheimer’s will be larger than the United States government’s entire annual budget. It is obvious that something must be done, and research is at a furious pace, with many new breakthroughs in recent years.

While praying for a cure and/or an effective treatment for the disease is prudent, there is little doubt that there is (and will be increasingly so) a great need for chaplains who will be willing, prepared, and qualified to provide spiritual care to those demented patients walking in the shadows of their old age.

Friday, November 5, 2010

The Man Who Plays the Music!

“Even marginal people within the church receive the social benefits of church involvement (Paragament, page 56). By marginal, Pargament meant people that live on the peripherals of the church such as non-attending relatives of members, non-attending maintenance personnel, local business employees or owners, and/or possibly rarely attending visitors. They all receive the social benefit of being loosely associated with the church. For example, the non-attending relative might be able to call on the ministry to pray in times of sickness, preach funerals, enjoy the camaraderie of passing fellowship, or have marriage ceremonies performed. The local business employees or owners benefit from the increase in business, and the morality propagated by the church decreases theft and vandalism. Many non-members, non-attending marginal people, benefit from the community of the church, and often they are unaware of such benefits.


These thoughts and more can be related directly to clinical ministry in either the hospital or hospice setting. Many ‘marginal’ people benefit from the ministry of the chaplain, and often neither the chaplain or the benefited are cognitively aware of the benefit. For example, I was called out to see a client who was actively dying last night. Her granddaughter was all alone with her grandmother as she died, and the hospice nurse was concerned about the unhealthy nature of this aloneness. I, as the on-call chaplain, was called to provide support. The focus of my ministry was the client and her granddaughter. However, while there, I was able to minister to the lady in the next bed who was scared of all the commotion and to the aide who had cared for the client for 4 years and was as emotionally distraught as the granddaughter. Many times my ministry touches medical staff on the peripherals of the situation such as doctors, nurses, aides, and other medical professionals. Even at times this blessing is extended to volunteers such as the cookie ladies or non-medical staff such as maintenance personnel and janitorial staff.

The idea of the mere presence of the chaplain is well established as an effective treatment modality among medical literature. It is true that the wherewithal to why presence is effective remains difficult to explain. Nevertheless, none would deny the value of presence. I had a patient one time that rejected spiritual care outright upon my arrival in the room. As I immediately backed out of the room, the patient called me back to the room. For some reason he felt safe to ask me some questions. He stated, “I believe in God… but really now… what exactly do you think you can do to help me in a few minutes that will change the outcome of my situation?” At this time I had yet to even say anything beyond, “Hi! My name is Joey, and I am the chaplain…” before being thrown out of the room.

I asked him, more from inspiration than planned cognition, “What are you thinking about right now?”

He said, “Well I’m thinking about how I am not sure prayer works… and what motivates you to spend your time coming around to our rooms…”

I replied, “First you say you are thinking about prayer and that you are considering my motivations. Earlier you volunteered quickly, without my saying anything, that you believe in God.” After he affirmed what I said was right, I followed up with a second question, “What were you thinking about before I came in?”

With a chuckle, knowing I had him, he replied, “I was thinking about how mad I was at being sick and how much bad luck I have.”

With a knowing smile, I too joined him in chuckling, “I guess I could leave now and consider that the job I came to do has been done. When I arrived you were mad about your sickness and thinking about your bad luck. Now you are chuckling and thinking about the God you believed in, wondering if prayer might work, and considering one’s motivations. I would say just my presence has done good work here. I really could not have accomplished more if I had preached a sermon!”

When the chaplain walks into the room, the very presence of the church community surrounds him, and even people on the margins benefit. Immediately people’s thoughts, of both the target patient and bystanders, go to more spiritual things, and they began to draw strength from spiritual resources. If an off-color story or joke is being told, it is hushed and apologies are made. If doubt has permeated one’s thoughts, hope is often birthed anew. There is nothing mystical about presence. When one is introduced as a chaplain, the mind gravitates to all of the things you associate with such a word. The word and work of a chaplain evokes a wide array of thoughts in patients, such as: hope, love, gentleness, Christ, church, prayer, strength, healing, scriptures, hymns, and more. If the chaplain is familiar, even an introduction can become unnecessary to blossom thoughts and memories. I can even see this in patients with dementia. They often don’t remember who I am, but one such lady said, “I know you, you are the man who plays the music!” That and more is presence…