Daniel Nuzum's audioboos

Saturday, November 17, 2012

Born too soon... World Prematurity Day

It was a Tuesday afternoon when with nervousness and excitement we met our twin boys Rory & Killian face to face for the first time in an operating theatre. "If you want to see them look now as we need to go" was the opening line that went round and round in my head as two teams of paediatricians and neonatal nurses disappeared out through the theatre  doors with our two little boys born at 32 weeks. Sitting beside my wife behind a surgical drape as tears flowed down our cheeks we felt helpless and vulnerable as the obstetrician quietly closed up the wound through which our little men had entered the world. And silence is the strongest memory. There was an eerie silence punctured only by the beeping on various machines and the muffled words of the team through surgical masks.
All I could see were the eyes that made contact with each other across my wife's body which had no feeling save for tugging and pulling as they did their handiwork. Looking to the ground were the blood and iodine stained wellington boots of the team. The mess on the ground was but a fraction of the messiness of uncertainty which we could do nothing about.

"If you want to see them look now as we need to go" kept going round and round like a mantra. We only got a very quick glimpse before they were whisked away...

After what seemed like an age we were brought to the NICU to see our boys who were now attached to breathing tubes, wires, technology and lying on their tummies on what seemed to us like mini spaceships. Tubes, wires, probes, lights, noises, beeps, needles. As healthcare professionals we were used to all these things but never had I felt so helpless or vulnerable. There is no feeling quite like that sense of helplessness that a parent feels when their baby is so fragile and vulnerable.

Every year 15 million babies are born prematurely, that is 1 in 10 babies worldwide. To be born prematurely means that you are born before 37 weeks gestation. It is a terrifying experience for parents as they accompany their baby day by day. Today, 17 November is World Prematurity Day when just for one day we stop to think about the enormity of this issue. Prematurity brings with it a future of many potential hurdles and complications and every milestone is a huge achievement.

We were thrilled today to return to the hospital where our boys were born for a coffee morning to mark the day. This day five years ago they were in incubators five floors below where today they coloured in paper stockings and played with balloons. We owe so much to a great team who are now colleagues. The presence of so many 'Neonatal Graduates' today was such fun and each was a beacon of hope to the parents who joined us from the Neonatal Unit.

Tonight around the world we remember those who were born prematurely and who did not survive. A painful reality for too many. As we tuck our little men into bed tonight we think of those who would give anything to do the same.

Friday, November 2, 2012

The leaves of death: the carpet of grief

Today, watching once-green leaves now turned to russet fall from the trees with random carelessness and somehow form a carpet  on the ground I am reminded of the power of creation to point us to the reality of life and death. It is at this time of the year while children have been 'trick or treating' that many of us remember our loved ones who have died. This of course brings with it a perplexing sense of the pain of loss and absence as well as the very comforting sense of presence and connection. They are conjoined companions on the journey of grief.

Today, 2 November -commonly called 'All Souls'- in the Christian tradition many people will be attending services of remembrance in honour of someone close to them. At many services we will be reminded that "the souls of the faithful are in the hand of God" Wis 3:1 For some it will be to pray for them, for others it will be to ask for prayer, for others it will be to acknowledge that their loved one is now in God's hands and embrace, and for others there is a bewildering sense of not knowing what is happening or why they remember -a sense of hollowness where it is hard to know what or how to feel. Whatever our beliefs, what unites all humanity is the experience and pain of loss. Remembering together in community is a powerful experience that in itself provides a deep carpet of love, hope, support and care where there is space for the traditions and needs of all to be cherished and respected. 

Grief is an untidy journey. There is a temptation to try and package up our grief and tidy it away into some sort of ordered and controlled bookcase of emotion where we can take it out when we feel like it. Those who would try to tidy grief up have usually either never experienced loss or have run away from their grief. The reality though is that grief is an uncontrolled, untidy experience that rustles us often in the most unexpected ways and places. It can be like the whirling of a wind that scoops up scattered leaves and then creates a new carpet underfoot until the next gust appears. This carpet of grief becomes our comfort and path for the time being -however long that will be. Grief is a 'work in progress' that continues for as long as is necessary. 

Over these days as we think of our loved ones we think of our continuing sense of love and connection as well as marking the pain we feel because we miss them. Their voice, their smell, their physical presence, their companionship, even the things about them that irritated us. Grief can at times can make us feel a sense of loneliness like we have never experienced before. This is indeed the valley of the shadow of death Psalm 23:4 Only yesterday a family member told me that the 'shroud of loneliness fell off' when they attended a service of remembrance in the hospital where their mum had died. It was the very fact of being with so many others who were also grieving that they felt less alone.

As we tread on the leaves of loss let us tread gently because we tread on holy ground. These leaves, although dead, contain within them the marks of life and nourishment for the future. These leaves of death are for now, the carpet of grief.

Father of all, we pray to you for those we love, but see no longer. Grant them your peace, let light perpetual shine upon them, and in your loving wisdom and almighty power, work in them the good purpose of your perfect will; through Jesus Christ our Lord, who lives and reigns with you and the Holy Spirit, one God, now and forever. Amen

Saturday, September 29, 2012

Learning to breathe underwater...

Every so often we get to meet with someone whose work has inspired us. This happened for me this week at the Education Centre, St Luke's Home, Cork when I met Dr Michael Kearney at a workshop entitled "Learning to Breathe underwater: A self-awareness based model of caring for self while caring for others." Michael was just as I had expected him to be: calm, gentle, deep.

Michael Kearney has contributed enormously to the world of palliative medicine through his holistic and expansive sense of care that attends to the whole person. His early years at Our Lady's Hospice in Harold's Cross, Dublin and St Christopher's Hospice London inspired Kearney to write about his experiences of spiritual angst and soul pain as he met it in those who were terminally ill. His publication of "Mortally wounded. Stories of Soul Pain, Death and Healing" has inspired countless practitioners and therapists in palliative care.  A graduate of University College Cork, Michael Kearney is currently Medical Director of Palliative Services at Santa Barbara Cottage Hospital, USA.

At the workshop at Northridge House, St Luke's Home Kearney used the image of a möbius strip to illustrate the seamless continuity between our inner and outer worlds. The outside becomes the inside and vice versa. Kearney's thesis is that self-care and clinical practice are joined together in a seamless whole: or they should be!

Working in a healthcare environment brings us in daily contact with high emotion, stressful situations and above all into the close range of deep pain. Coping in such an environment is demanding and leaves most of us exhausted. The traditional models of coping usually mean we erect protective barriers around ourselves that are hard to penetrate. We become detached, distant and unable to be emotional available to those who are in pain. We get through the day and come up for air when we are home. The result is that those in deep pain feel that they meet an emotional wall that can be characterised by a white coat, a clipboard, a clerical collar, a medical chart, a large desk diary and so forth. In fact it can be anything that we use as a prop to avoid being available to someone who needs us to hear what they are really saying. Before I have an avalanche of complaint from those who wear a uniform let me be clear that there is nothing wrong with any of the things I have just listed: it is how the person using or wearing them is. Put simply, if we develop a high level of self-awareness we are then able to come close to those in pain. And this is the learning to breathe underwater bit: the pain that we might have avoided in the past now gives us oxygen. It allows us to remain emotionally available even in the most stressful and painful situations and for it to be regenerative, fulfilling and healing. 

This workshop was co-sponsored by the Irish Hospice Foundation and is part of the growing reputation of the Education Centre of St Luke's Home under the direction of Bruce Pierce to contribute to the care of many.

Sunday, June 10, 2012

The Mennorode Statement of the 12th ENHCC Consultation 2012

The Mennorode Statement of the 12th ENHCC Consultation 2012
1. Integral view
As chaplains, we understand the human person in a holistic and integral way. This means that four dimensions are essential in the human person: the physical, psychological, social and spiritual. In healthcare, the spiritual dimension is not always fully recognised, and even if recognised, it is not always put into practice. In a diverse society, it is a challenge to make the importance of the spiritual dimension understandable.
2. Inter-disciplinarity
All professionals have a shared responsibility in the care for the whole person. Therefore, collaboration is essential. In working together the different professional groups have a special responsibility. Chaplains are specialists in the care for the spiritual dimension. Chaplains should be aware of their own beliefs, tradition and the culture in which they live in order to respect and to understand the patient and the other caregivers.
3. Intra-disciplinarity
Chaplains should also work in an intra-disciplinary way within chaplaincy. This implies a clear identity of all chaplains, a lived relation with their Church, faith community or organisation and enough freedom to organise their work. It also implies a common identity of all chaplains as being responsible for the spiritual care of all in the healthcare community.
4. ‘Multi-linguality’
Working in complex and continuously changing healthcare systems, chaplains, like all professionals, need professional training, including knowledge of and a critical attitude towards the system. Chaplains should be able to explain the specific nature of their work in a common language that is understandable for all people involved in the care system and in wider society. Chaplains should be ‘multilingual’.

5. Integration
There is a full spectrum of involvement from complete isolation to total integration. Chaplaincy should be integrated in the healthcare system, but there is no golden rule for the degree of integration: this is dependent on the people involved and the context. In any case, there must be a guarantee of the particular confidentiality linked to chaplaincy.
6. Evaluation
Chaplains work as professionals in a professional context.  Some aspects of spiritual care can be evaluated, therefore chaplaincy should develop its own standards of measurement based on validated methods.
7. Prophecy
Chaplaincy and the chaplains’ prophetic task is to enable the healthcare system to be person-centred and to contribute to the ongoing development of the healthcare system and the Church or faith community.
8. Hope
In the awareness that human life is subject to many uncontrollable events, chaplains may give expression to incurable, irresolvable or tragic situations in life. They may help people to make a connection between their own life story and stories of sacredness or human wisdom in relation to meaning and hope.

Remembering Dad as light perfuses mist...

On this day, 10 June 2011 I gathered with my mum, siblings and our families around the bedside of my Dad as he journeyed through his final earthly hours. These final hours were spent in hospital. The evening before we were on a journey of interrupted recovery, still holding hope that he might recover, that treatment was still possible. However between the darkness hours of 01:00 and 03:30 it became painfully real to us that recovery in earthly terms was not possible. In hindsight I am only beginning to appreciate the depth and distance of that journey from one future to another. This was telescoped into a very short period of linear time and yet its consequence is for ever.

I have journeyed with so many families at a time such as this and yet only now do I realise what it is to be in that lonely place where we can be presented with options when in effect there are no real options. The only option is to be a companion with the one we love. The mists of life and death, of reality and disbelief come down like a thick fog veiling and numbing past, present and future. In this fog past, present and future become as one. We live in a misty 'now' and stay there for whatever length it takes. Somedays the fog lifts, and on others it descends again -often when least expected.

I am so grateful that our last two hours or so were spent loving my Dad form this world to the next in a tender and gentle way. Each of us played our part as we saw our worlds changing in front of us, in the presence of the one, who with our mum had supported us for all the years that had gone before. She of course misses his presence more than any of us. Now in a timeless metamorphosis everything was changing for each of us during those few hours, the impact of which will unfold for each of us in different ways in the time ahead. There in an Intensive Care Unit where the rising sun lit up my Dad's bedspace as its beams flooded through the fan-light above his bed. The sun rising above the Irish Sea just after 5am that Friday morning brought a hopeful radiance and strength into what was for those few hours our little world.

Today a year later I am pained to be away from my family, my mother, my brothers and sisters, my wife and children as they gather to honour my dad. In the quietness of a wildlife park in the Netherlands it is strangely apt to think of Dad as this place, like him is close to the rhythm of nature and the land. I will remember him and my family at the eucharist here.

So now a year later, a new journey is beginning with so much still to unfold. However the sunlight that filled Dad's bedspace that morning continues to pierce through the mist with light and hope, warmth and strength.

So while separated by distance I am delighted to post this photo from yesterday of my three youngest who play in the grass at home on the farm this weekend. It evokes so many memories of a treasured and carefree childhood on the land (coupled with very hard work too!)

The other is a special memory of dad accompanied by one of his grandchildren and a dog as he went about his work...

Saturday, June 9, 2012

European Healthcare Chaplains: Our common purpose

It has been my privilege to represent the National Association of Healthcare Chaplains at the 12th Consultation of the European Network of Healthcare Chaplains meeting at Mennorode Conference Centre in the beautiful National Park De Hoge Veluwe, about an hour from Amsterdam. The theme of the consultation (which meets every two years) is 'Working together -The challenge for chaplaincy in an interdisciplinary era'

53 of us have gathered from 23 countries and regions from across the ecumenical spectrum to share, receive, pray, learn and reflect together. The diversity of tradition, practice and outlook is very rich, yet at they same time there is a very powerful sense of the common practice of spiritual care-giving that unites us all. We have been challenged to reflect on how we minister and work in the context of the wider healthcare discipline working with fellow professionals and colleagues to offer the very best holistic or 'total' patient care and experience.

We have been exploring how we best place ourselves in what for many of us is two different worlds - the world of a Faith Community and the world of the Healthcare Institution. We have explored how we contribute to and work with and within the whole team of carers in a healthcare setting to contribute to the well-being of the person we care for -after all they are at the heart of all our work and care.  Dr Ewan Kelly in his presentation challenged us to engage at both the systemic and the operational level to influence and shape patient and healthcare.

We visited some healthcare institutions in Amsterdam to see how chaplains work in integrated team settings. I visited the Academisch Medisch Centrum and was very impressed with the 'Silent room' that was a space for all faiths in the middle of a very busy hospital and to see in particular the role of the chaplain in the paediatric and neonatal area.

At this stage in the consultation, what strikes me most is the deep level of care and professional expertise that is evident in so many places. The sharing of our stories and insights reveals a common sense of purpose and professional 'connectedness' across so many cultures, traditions and health systems. It is a reminder that as 'spiritual care-givers' -the term most used in the Netherlands- we have something distinctive to offer to the healthcare community and not just amongst patients. We are called to nurture the soul of the health system and to humanise it when there is a strong emphasis towards 'technologising' it. In the words of Professor Ruard Ganzevoort our care is in the 'relational not technical'.

We care for people and not illnesses. In the words of our Network Co-ordinator Dr Anne Vandenhoek  we need as healthcare chaplains and spiritual care-givers to be able to speak many languages -of faith, of spirituality, of healthcare, of economics, of management, of humanity and so forth.

Our hosts, and in particular Gabrielle Gies,  Joost Verhoef, Simon Evers and Robert Koorneef have been wonderful examples of hospitality and grace.

As I sit outside the beautiful eco-chapel at Mennorode, in the middle of a national wildlife park, there is a water feature that is visible from the inside through the glass front. From inside we can see the water rising from within a tree trunk but outside we hear it bubbling in the midst of birdsong. It is a constant reminder of the never-ending source of all life and care that we as chaplains seek to identify with those we care for.
This is a privileged ministry, vocation and profession within healthcare.
It is our joy -with others- to nurture, cherish and celebrate the gift that is humanity and along the way discovering meaning, value and purpose as we embrace our human story with the story of the sacred.