Meaning in a Half-Opened Eye: Reaching the Unresponsive

When I interviewed for hospice chaplain jobs, a question I got just about every time was, “What do you do when you visit an unresponsive patient?” By that my prospective boss meant patients who would not respond to anything I did, like touch their hands, talk or sing. Usually they could not talk, or if they did, it was to themselves or to the world at large. During such visits I could feel invisible. If that is so, you might wonder why an interviewer would ask such a question. But rather than being a gratuitous curve ball, it strikes down deep at the essence of a chaplain’s role and to what it means to exist as a person.

While some patients truly could not respond because they were in a coma or were asleep, I often found many so-called unresponsive patients did respond if I loosened the definition of communication, or spent a long enough time to give the patient enough chance to respond. I remember one time when I introduced myself to a lanky man as I sat down in a metal chair by his bed. He did not reply, and after several seconds, I figured he had not heard me or did not understand me, so I drifted off into my own thoughts and guessed this would be a very short visit.  Luckily I lingered in my own reverie. I say luckily because after a full 30 seconds at least, he had processed what I had said, and gave an answer that a normal person would give after just a second or two max. I said something else, waited another 30 seconds as if that were the normal way to talk, and again he gave an appropriate answer. I thought to myself, “I bet most visitors casually stopping by would give up before they found out he could converse.  I wonder how long he went without having a chance to talk.”

The key task of a chaplain is to find a way to reach people. This means slowing down enough to see details that the average visitor would miss. Like an eye half opening or a finger moving in response to my voice. Like more rapid or more relaxed breathing when I hold the patient’s hand, or their turning their head towards or away from me when I sing, indicating their yay or nay to hearing it. (Believe me, there were plenty of “nays” to the music option.) It is not I who is invisible with these patients. It is the patients who are invisible to those who too automatically designate them as “unresponsive.” The patients’ essence as persons, I believe, is their ability to reach back in return, to connect with others.

Interviews are not the ideal environment for nuances, so my answer to what I did with unresponsive patients ran along the true but more superficial lines of, “Well if I knew they were religious, I would say a prayer. Otherwise I would touch their hands, sing a calming song, or say something friendly and soothing. Sometimes I would just sit by their side, in case they could sense the presence of another human being who cared enough to notice them.” Perhaps my interviewers liked this answer (at least the ones who hired me did) because they thought that kind of patient gave nothing for the chaplain to do. On the contrary, finding the key that will breach what separates them from me takes the observational skills of a Holmes and the deliberateness of an artwork restorer.

A board certified member of the NAJC (Neshama: Association of Jewish Chaplains) Rabbi Karen B. Kaplan served as a hospice chaplain for 7 years, including Princeton Hospice in New Jersey. Now a writer and teacher, her book Encountering the Edge: What People Told Me Before They Died (Pen-L Publishing, 2014) is available on Amazon and can be useful for caring committees. This post was taken from her blog, offbeatcompassion.com, a useful resource as well.