People often ask me what a palliative care chaplain does.  It can be hard to describe, but I’m hoping to have a pithy answer before I retire.  We use phrases like, “a ministry of presence,” or “empathic listening,” or perhaps, “offered a safe space for expression of feelings.”  The science-based, money-minded gestalts that dominate our medical system just don’t grok these sorts of qualitative encounters, and ResolutionCare seeks to be a haven from this kind of medical math.  But sometimes my job isn’t abstract, and things get very practical indeed.

A recent admission, Sam Howard, is a tall, soft-spoken man, stooped at the shoulder, with deep smile lines around his eyes.  He is fifty-two years old, with thinning hair and myeloma that will probably end his life.  He is an only child, who lived with his parents until they died.  Sam never married and has no kids.  Sam has worked various odd jobs through the years, and had a drivers license for a time, but didn’t care for driving.  He still walks miles every day, to the library or the pharmacy.  He is unfailingly punctual and polite.

Sam lives in a small housing complex in Eureka, where he moved with his parents twenty-one years ago.  Walking around the place with him as he collects recycling materials from the various waste removal stations, every person we encounter addresses Sam by name, asks how he is, thanks him for some service he has provided, or asks him for help with moving a potted plant or mailing a package.

Sam and I are both members of the Global Recycler’s Guild.  I tell him that I drove recycling trucks for the city of Berkeley and worked at the Arcata Recycling Center when I was in graduate school.  He gives me a tour of his accumulated cardboard, plastic bottles, aluminum cans, glass, etc.  It is stacked in the kitchen of his tiny efficiency apartment, jam-packed on the porch, with drifts of cardboard accumulating around the bottom of the outside staircase.

“Usually,” he explains, “I’d take this stuff to the recycling center with my cart, but the cart was stolen.”  When he started recycling, there was a collection center close by Sam’s house, but now it is a six mile round trip.  For years he made this journey on foot, hauling his worn out, all-steel garden cart loaded with glass, aluminum, cardboard, and plastic.  That was before the scissors of chemotherapy trimmed his Samson-like strength and energy.

Dr. Fratkin has prescribed Sam a little red wagon with wooden stake sides, rated for a three hundred pound payload.  The pharmacy didn’t have one, so we went through another supplier, and the wagon arrived completely disassembled.  At Dr. Fratkin’s request, I’ve put on my overalls and packed up some tools to help Sam put it together.

Carl and wagon

As the various parts come out of their packaging, Sam and I fall into the easy rhythm of two people working on a shared hands-on project—handing each other parts and pieces, anticipating which tool will be needed next, figuring out which parts go where, backtracking and redoing things that didn’t go together quite the way they should.  Sam’s dad worked in the sawmills, did odd jobs, and was a landscaper, he tells me.  I imagine that Sam often helped his dad repair a mower or clear a drain.

When the little red wagon is assembled, we test drive it around the housing complex.  Sam is pleased with it, and says that he will paint “Radio Flyer” on the side, like the wagon he had as a kid.  He talks about cancer and chemo, understanding that at some point the trade off of fatigue and neuropathy caused by the medicine might not be worth it.  His father died of an aggressive colon cancer, and Sam helped care for him.

Sam’s love of history and genealogy puts the “ama” in amateur,  and he wants help with his cremation and final arrangements, in part so that future students of genealogy will know where to find him.  He has no close family, though I suspect that his housing complex family will populate his funeral.  I let him know that I’ll perform whatever memorial he wants, make sure that his cremains are placed where he wants them.  We make an appointment with the funeral home.  Sam seems very satisfied with having this settled and paid for with money he had set aside from social security and recycling revenue.  We haul some recycling back to his apartment and sort it in a companionable silence.

As I’ve said, it’s hard to quantify what I do on any given day, even for me.  There’s a movement in medicine towards “outcome based spiritual care” with measurable results.  There can be a dynamic tension between this linear, Cartesian conceptualization and the nebulous “ministry of presence” that chaplains practice.  For my part, I hope that the charts, graphs, and legume inventory never succeed in getting spiritual support “down to a science.”   If they do, I hope they add a dropdown checkbox in the electronic medical record for “Chaplain Helps Assemble Radio Flyer.”