Upper Outer Quadrant

by Elaine Thomas

Much of what hospital chaplains do involves listening. Today differs in one enormous way: I am the patient. Chaplain, hear thyself.

I listen as a highly skilled, thoughtful surgeon explains options for treatment. I am embarrassingly unable to wrap my mind around the complexity. Not the complexity of his words, painstakingly chosen, clear and direct in a manner that reinforces rather than detracts from his kindness, but by the enormity and intensity of discovering, once again and yet for the first time, and even more certainly now, that I am human, vulnerable and frightened. I listen but do not absorb. In the face of choices I must make, responsibility that only I can take, I find myself overcome with uncertainty. Then, miraculously, the doctor seated before me speaks my language, breaks down all that complexity into a single simple metaphor that encapsulates my story in this moment:

“Think of it as a walk through the woods,” he says. “You can take any number of paths. All will get you to the other side, but you have to choose and move forward.”

I’m a country kid. I know how to walk through the woods. I may be scared, but I can do this.

Ah, the power of the metaphor… God, after all, appeared to Moses in the form of a burning bush, something he might encounter without being destroyed on the spot, which, looking upon God’s face, would surely do.

Nowhere are the stakes higher than in medicine. I have worked in colleges and I have worked in hospitals. In academia, I encountered brilliant writers who could spin metaphors in the air, then set them free to soar. Among the sick, I witness far more commonplace metaphors, such as my walk through the woods, enable ordinary flesh to face questions of ultimate concern.

As a hospital chaplain, I work not in conflict with, but not exactly within, my own particular spiritual beliefs. Patients need caregivers who can hear and speak their language, maybe even more so in the spiritual realm than in the physical. Chaplains are called to enter into the internal world of another, not as a minister per se and certainly not as a psychologist, but to walk alongside them as they make meaning during their or a loved one’s trauma or illness. It is painful and beautiful work, evoking in times of crisis or death an intimacy as deep as the human soul and an empathy that can only be rooted in the infinite. We care for individuals from all faiths and from none; it isn’t about conversion experiences, to use language that feels totally alien to me. The work does enable questioning and requires willingness to explore spiritual suffering, often on both sides, caregiver as well as patient. Always, there are the metaphors.

The meaning, the story of the illness, belongs to the patient. We try to be present as they shape it, not shape it for them. We help patients listen to themselves. Surprisingly, only once have I been fully unable to contain my own tears while in a patient’s room. A dying man, of unguarded innocence and sweetness, told me about crying over his dog’s grave. I heard him saying, “Please weep for me.” And I did. I had no choice.

Animal metaphors never fail to move me. Years ago, I was called to the bedside of an elderly gentleman with dementia who kept attempting to flee his hospital room. He did not request a chaplain, but we have a reputation for calming distraught patients, so he got one. A young woman, a relative, left the room to allow us to talk. I asked him why he wanted so badly to leave. He became instantly coherent and talked at length about his cat — let’s call her Bitty — and his concern that no one would feed her while he was hospitalized. She was a small black-and-white cat that he loved greatly. “I have to feed Bitty,” he reiterated, struggling to get out of bed. I knew he lived in a nursing facility, but in his mind, Bitty needed him. I promised I would see that someone checked on the cat and as we shared a prayer asking God to hold both him and Bitty close, he fell asleep. As I left the room, I walked past the young woman in the hall. “He was concerned about his cat. It seemed to calm him to hear that someone will look after her,” I said. She responded that he didn’t have a cat. “Yes,” I said, “I know.”

We all have our metaphors. Over a period of time before my diagnosis, my hair grew long, the longest it’s been in many years, past my shoulders, down my back. For decades I kept it cropped short, so much easier in the mornings. Now, letting the flow go felt deliciously rebellious. No more coloring it, either — I decided a while back that, as the child of a woman whose life was reduced by a brain tumor, regularly bathing the head in chemicals might not be smart. Damn the gray, I thought, full speed ahead! The joke was on me: Coincidentally, or perhaps not, as the hair grew, my body also worked overtime growing its own form and location of estrogen-enhanced tumor. Certainly coincidental, yet it does seem almost as if my subconscious knew I might soon lose my heretofore most prominent secondary sexual characteristics. I hate makeup. Fashion-defiant, I live in jeans, have never been a girlie-girl. Yet my first question when the doctor delivered the biopsy result: Will I lose my hair? No, that’s chemo, he explained. I would require surgery. I strongly considered going back to shorter hair for ease of care as I recovered. For some reason, I thought of a couple of lost idols from my youth: David Bowie died. Prince died. Clearly androgynous beauty carries its own risks. The hair stays.

Chaplaincy training requires specialization. As you no doubt would guess, I trained as an oncology chaplain. Every patient presented a metaphor for how to live in the face of our ultimate vulnerability. While I attempted to care for patients, they unknowingly mentored me, instructing me with their courage and concerns, preparing me both for the work ahead as chaplain and for that essential work of becoming a more caring human being. It is no exaggeration to say I loved them all. To steal a line from John Keats: “Do you not see how necessary a world of pain and troubles to school an intelligence and make it a soul?”

Giving voice to “pain and troubles” and knowing someone hears is necessary solace for each of us, a part of why we seek connection and each in our own way seek the divine. I’m a poor stand-in for the latter, but if it helps with the making of a soul I am willing to answer that call and withstand whatever is necessary in the process. I am, however, admittedly confused by those who hear the divine literally speak to them. Working with rural southern populations during my training, I encountered patients who honestly believed they heard God’s voice, speaking out loud and outside of themselves. None of my peers at the time encountered this phenomenon, despite the fact that the group thought me the rational one, likely the least mystical chaplain ever admitted to our program. The more supernatural aspects of some forms of religion just aren’t part of my constitution, yet patient after patient confided hearing God’s voice. As I tend to do, I searched for metaphorical meanings, maybe a battle within the psyche, the more overt battle against disease, a sideways approach to that which cannot be approached directly. No, they insisted, God spoke audibly and directly to them.

In one case, a patient described twice hearing a voice say, “I have a purpose for you,” first as a teenager, again when diagnosed. He knew it would be all right, he said, because he had a job to complete. “And what is the task?” I inquired. He shrugged. “I’ll let you know when God tells me.” When I bid him farewell on his final day in the hospital, the question remained unanswered, but the curative effect of what he understood to be his undisclosed mission had seen him safely through. He conveyed unshakeable confidence.

My confidence tends to shake. I went immediately to my supervisor, a woman I admire and trust.

“What does this mean to you?” she asked

“Either they’re all delusional or God just doesn’t like me enough to want to talk to me,” I joked.

“Maybe God speaks to you in other ways,” she suggested.

The conversation never left the topic of me, my role and growth as chaplain, or how I might make sense of something I found alien and perplexing. Months later, when I was no longer her student, she handed me an article, “Somebody’s Calling My Name.” She had written years earlier about hearing a voice speak her name aloud in an empty house. That voice in the night later led her toward seminary and mainline ordination in a time when such a journey might have proven daunting to another woman, one who did not so distinctly hear such a call and carry its courage. After my diagnosis, she was the first person I reached out to, the one I needed to tell my Keatsian “pain and troubles,” to hear me as I wove them into the soul I continuously strive to make. God does indeed speak to us in different ways.

When I finally made my decision on how to proceed through the metaphorical woods, I left the oncology surgeon’s office with a furrowed brow and walked to my car. Before I turned the ignition key, someone tapped on the window. Startled, I rolled down the glass to see what she needed. “I saw you walk by and thought you looked worried,” she said, “I wanted to tell you everything will be fine. Just a few weeks ago I went through the same thing I think you may be going through. You’re in wonderful hands.” She asked if she might give me a hug.

The need wasn’t hers. I have always considered myself a Matthew 25 Christian: whatever you did for one of the least of these, you did for me. At that moment, I understood fully that I, too, am “one of the least of these.” We all are.

In times of serious illness, medical caregivers, be they doctors, nurses, technicians, or chaplains, all become intimate strangers, as can anyone who has traveled a similar path. Only I could choose how to proceed through the woods before me, but once I made that decision, I never felt for a minute that I walked alone. My caregivers mattered greatly. In trying to capture here some of my thoughts about the experience, I consciously and carefully have avoided until now writing the words breast and cancer. Maybe I needed to reinforce that the illness was not the important takeaway — although my quite wonderful doctors indeed took it away once I finally mustered the courage to make my surgical choice. My hopes and prayers obviously include that it is gone for good, but I hope just as fervently that the lessons it taught me remain, both for the sake of the work and for the making of the soul.


Work by Elaine Thomas has appeared in numerous literary journals and magazines, including The Dead Mule School of Southern Literature, moonShine Review, Blue Mountain Review, and Pembroke Magazine. She lives in Wilmington, NC. A retired college communications professional, Thomas also holds an M.Div. from Duke Divinity School and now works with New Hanover Regional Medical Center as an on-call hospital chaplain.

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