Feb 22, 2024
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In this podcast, the Reverend Jane Jeulanddiscusses what people with cancer should know about the role ofchaplains in cancer care, including how chaplains are trained, thetype of support they can provide for people with cancer and theirfamily members and caregivers, and how someone with cancer can askfor spiritual support from their health care team.
Ms. Jeuland received her Masters of Divinityfrom Yale Divinity School. She is an ordained Episcopal priest. Shereceived her chaplaincy training from Yale New Haven Hospital andis a board-certified chaplain. She has served as an oncologychaplain and was the first palliative care chaplain at Yale NewHaven Hospital. She has no relevant relationships todisclose.
Jane Jeuland: Hi, my name isJane Jeuland, and I am the palliative care clinic chaplain at YaleNew Haven Hospital. I'm here today to talk a little bit about whatI do at Yale New Haven Hospital, and also, what is a chaplain? Whatis it that we offer and provide? How are we trained? And some otherquestions that people have for us as chaplains.
So I'll start by just describing a little bitabout what I do at Yale New Haven Hospital in my role. In additionto seeing patients in our clinic, I visit with patients one-on-onethrough video platforms, phone, and I also visit with patients inperson for scheduled appointments. And in those appointments, weget to know each other, we build a rapport and a relationship. AndI help people process how they make meaning, find purpose andbelonging in their lives, and how that is impacting their cancercare, but also how their cancer is really impacting their meaning,purpose, and belonging. In addition to those individual meetings, Ialso visit with patients in group settings. I host several groupsover Zoom where patients get to talk to one another and sharedeeply and support each other.
And last but certainly not least, I also havestarted a podcast with my patients called In the Midst of ItAll, which you can find on Apple Podcasts and Spotify. And inthat podcast, patients share their stories that they've writtenabout their lives, about their cancer journey, and about theirspirituality, and how that has helped them through all that they'regoing through.
So, how do chaplains get trained? I think thisis one thing that people ask me quite a bit. What is your traininglike? Our training is pretty extensive. We need to have a 3-yearMaster's degree, typically a degree of divinity. And then afterthat, we have a year of training called Clinical PastoralEducation, CPE for short. And in that year of training, we are witha cohort of about 4 to 5 other chaplains in training. And we aresupervised by a highly trained supervisor as well who has quite anextensive and long process to get certified to do that. And whatour supervisors do is they help us really go out, visit withpatients, and then reflect on those visits. We do things called“verbatims.”
So what is a verbatim? When we write up averbatim, we're writing up word for word an interaction that wehave with a patient. And obviously, we will keep the patientconfidential. But we do this with our group and with our supervisorto really kind of drill down and see where are the places that weare inserting ourselves, our own beliefs, our own needs, and howcan we really better meet the patient where they are? We talk a lotabout positive use of self so that we become really aware of ourown self in the midst of our interaction with patients. And over the course of theyear, we really learn how to focus on the patient's spirituality,their beliefs, their values, what they need in that moment.
And we're all about helping people discovertheir spirituality and their faith. I think sometimes a lot ofpeople think that we might be coming in to convert someone or tomake them believe a certain belief system or a certain religion.But actually, we're really here to help any patient and caregiverreally figure out what it is that they believe, and how that'simpacting their cancer care or how their cancer is impacting theirbeliefs. So that means that we do visit with people of alldifferent faiths. We visit with people who are atheists andagnostic as well. And really, again, just try to help peoplediscover, what is that value that you have? What are your beliefs?Where do you find meaning, purpose, and belonging?
And so what are some things that come up as wemeet with patients? I, again, work in palliative care in the clinicsettings. I'm outpatient. But a lot of chaplains work inpatient ina variety of settings. And so you'll have chaplains in a medicalintensive care unit (ICU), or you'll have a chaplain in an infusionsuite or on a floor as well. And so we see patients at alldifferent stages. We see patients who are just newly diagnosed andhave a cancer that's highly treatable. We see patients who aredoing really, really well on their treatments. And we also seepatients who are starting to kind of struggle with lots ofsymptoms, pain through sometimes months or years of cancertreatments. And then on the other end of this spectrum, we seepatients who are very advanced in their cancer, have a terminaldiagnosis, and we really see them through all that that entails,the outpatient visits as well as the inpatient, and even as someonecomes to the end of their lives.
And so what can come up in our meetings as Imeet with patients? When someone's diagnosed with a terminaldiagnosis, there is a lot of discussion about fear of dying, whathappens in the process of dying, and then also, of course, whathappens after we die? What is there after we die? Is there anythingafter we die? Or what is the afterlife like? And so often, again, Itry to help people really reflect on what they may think theafterlife is like, if there is one. And then we have richdiscussions around that. For kind of that big question of whathappens as we're dying, that's when I like to pull in other membersof the team. But certainly, chaplains can help process that aswell. We also really do help people articulate their thoughts aboutthe divine and whatever name they give to the divine. And often,what I hear in my appointments is not so much, “Is the divine asGod giving me this cancer?” but, “Why would God allow it?” So as Italk with folks, folks will say, "I really believe in a loving Godand a God that heals and a God that helps us. Why would a God likethat allow me to have this cancer? Why would God allow my loved oneto have this cancer and for their lives to be taken far, far toosoon?" And for that, it's a tricky one. We, as chaplains, don'thave a pill that we can give you and send you home and say, "OK,here's your prescription. Take that, and you'll get all the answersto why would God allow this?"
So it's really a process of talking throughthis. It's a process of kind of discovering a little bit more aboutwhat we believe God is, what the patient believes about God, andGod's character in the midst of it all. And it's also just sittingin the mystery of it that we don't know. We don't know why a lovingGod would allow this, why a God that heals would heal some peopleand not others, why a God who heals would heal at this point inyour life, and then not at a different point in your life, and whythis happens at all. And so chaplains don't rush quick to giveadvice. We allow sitting in that grief, in that suffering, in thesorrow.
But then again, as we talk about who is Godfor this person, I also like to help people see, OK, if God isn'thealing right now, if we can't understand why God is allowing thisto happen, where is God in the midst of it? And this is what I loveabout my job so much is that I hear from such a variety of faithsand people of different values and spiritualities, how they do seethe divine working in their lives. And so for some, "I have a lotof pain, but I know that God is with me, and I don't feel alone inthis." Or, "I was feeling grief and loss over a loved one andwondering what my afterlife's going to be like as I face the end ofmy life and I was having this turmoil. And all of a sudden, I feltthis deep, deep, deep peace wash over me. And I feel like thatmight be God." Or for someone who maybe doesn't have a particularreligion, they may say, "I know that the love of my family andfriends is so powerful. It's helping me through this. It's gettingme through the dark times. And I know that that is what holds ustogether. And it's more than just what we can see and taste andfeel, that that love is something greater and bigger." So it'sreally rich conversations like that that I get to have.
I think also some other topics that come up iscancer is grueling. Cancer, it can be long. And there are things,people talk about scan anxiety. Of course, the side effects andphysical pain. I hear a lot about insurance and how that's just sodifficult and such a struggle to get on the phone, talk aboutinsurance when time is so precious and so short. And for others whoare healing from cancer, it sometimes is a lot of conversationabout, "Well, how do I get back to life? And I used to do thisamazing job, but I don't think that I can do that anymore. I don'thave the stamina. I don't know how I would be able to do that job."And so I help people process that a lot. And again, that goes backto how do we find purpose in life, that meaning, purpose,belonging. And a lot of us find our purpose in work, in what we do.And so chaplains can help people through topics like that aswell.
And for survivors, we're always so happy inour palliative care clinic to help people heal. A lot of peoplethink palliative care is just end of life. It is not. I have a lotof survivors I meet with, and they'll talk about kind of alwayslooking over their shoulder. Is it going to come back? And findinga way to give back and to help other patients. And that issomething I really love helping people with is, how do we giveback? What are some ways to help others after I've had cancer? Howcan I help people?
And so I have to say, I've been really, reallyprivileged in my work as I meet with patients and individually ingroups and help them write their stories and read their stories andinterview on the podcast. I've just been so, so struck by all ofthe beauty, the resilience, the strength that I hear, the reallydepth and the richness of people's spirituality as they go throughcancer care and really do some hard work to unpack and process allthat's going on. And some of the common themes that I've heard ispeople will talk about how cancer has completely changed theirperspective. And so people will talk about how before they hadcancer, they were focused on their wonderful job, but also the payand making sure they get ahead and can have stuff, that newest caror that bigger home. And when they have come through cancer and allthat that entails, they start to think, "Gosh, you know what? Ilike those things, but what's much more important is the peoplethat are right in front of me. It's the things that are free. It'stime. It's talking with a loved one. It's really sharing deeplywhat's on your heart and mind, knowing that time is precious."
And so I really am so struck by some of thethings that people will share with me about their loved ones, theircaregivers. If you are a caregiver, you know that you are loved,and that everything you're doing is really helpful and so, soappreciated, and that the time that you spend together and thethings that you're able to share is so important. It doesn't haveto be a big trip or people think about bucket list things, and itdoesn't have to be all that. It's sometimes just that conversationover coffee or as you're going to sleep at night, those words thatare shared are so important. And so people's perspectives, I think,really do shift and change and deepen. And people also find God inthe midst of everything that they're going through.
I had a patient who heard stories on thepodcast and said, "I really want to write my own." So we workedtogether. And we talked a lot about her faith, and she wasn'treally sure what to believe. She had had a hard time growing up interms of her spirituality. And through her writing, and alsothrough her cancer journey, she was able to really articulate hersense of God as a loving companion to give her peace, not onethat's punishing, but a God that's loving. And now, as she comes tothe end of her life, she's really finding a great more deal ofpeace, thinking about God and knowing that God is with her. I thinkas I share stories like these, though, I'm always so mindful, too,that I think in our culture, we think a lot about things being 5easy steps. You can do this, and you can get better, and you canfind insight and meaning in 5 easy steps. And it's really not that.It's really a process. And so as you hear stories from other cancerpatients who may be in that place of peace and accepting andbelonging and you're not there, also know that they were not thereat a certain point and that it is a process, and it does take time.And so, again, that's what chaplains are really here for. We'rehere to help unpack a lot of that, to help people process that.
And so you might be actually wondering, "Youknow what? I am going through a lot of cancer care here where I am,and I really would actually like to talk to a chaplain. How do I dothat?" So the best way is to simply ask for a chaplain. We're mostoften called chaplains, but sometimes we're called spiritualcounselors, spiritual care providers. So maybe a different termwhere you're located. But you can ask a nurse, your oncologist,anyone on the team, your social worker, to contact a chaplain.There are different levels of care in different settings. So youmay have a chaplain in an outpatient setting, but maybe not. And somost likely, most hospitals have inpatient chaplains. If you areoutpatient, though, and you really want to talk to a chaplain, Istill encourage you to ask for one. And in that case, call thespiritual care or chaplaincy department directly, and you should beable to do that through your information line in your hospital. Butin the hospital, for the most part, the hospitals have inpatientchaplains. Many have 24/7 on-call chaplains. And so always don'thesitate to ask the nurse, and we're happy to come by.
We also do provide support for families. Andso this is something that we do quite often, especially in theinpatient setting, in an ICU setting, at those times when decisionsare being made. What should we do? What we often call in ourhospital setting “goals of care” conversations. What is the goal ofcare here? Are we going to continue with aggressive interventions?Are we going to start to move to aggressive comfort care? And sochaplains help talk through that as well. So you can always call orask for a chaplain when you're inpatient, certainly when thosedecisions are being made. And we're there for you as a patient, butagain, we're also there for your caregivers, your loved ones. Andin those settings, we're often meeting with families sometimesoutside of the room even. And we help your loved ones process aswell. Just like I've mentioned, all the other things that I helppatients process, we also help caregivers with a lot of thosetopics. In addition, of course, for a caregiver, we sit with themin the pain and the suffering and the loss and the anxiety, andtalk through their ways that they find meaning, purpose, andbelonging, and how they're processing all that's going on withtheir loved one, who's the patient.
I've heard from more than one patient thatthey say, "I feel like as hard as cancer is, it's easier on me thanit is on my loved one. I hate to see what they're going through. Isometimes feel like a burden." But whenever I talk to a caregiverabout that, they always say, "Absolutely not. You're not a burden.I wouldn't want to be anywhere else in the world." If they'resitting there in the ICU, long hours, surviving on coffee, verylittle sleep, lots of interruptions, sleeping in a chair besideyour bed. Every single time, those caregivers will say, "I wouldnot want to be anywhere else in the world. I want to be here. Thisis what I want to be doing." If you're the patient, feeling like aburden, know that more often than not, your loved one is reallywanting to do what they're doing.
But caregiver burnout is real, too, especiallyif your care is going on for a long, long time. And so chaplainscan help caregivers process that burden. And we also work with theteam, sometimes social workers and others to find support systemsso that if they need help, so that they can just have a moment tothemselves, go for a walk, that we can help them think aboutresources that may be their faith community, their church, theirsynagogue, their mosque, their faith community can come and helpgive that relief or that respite for them, but also other resourcesin the hospital. So you may have an integrative medicinecomponent.
So I hope that you've been able to learn alittle bit more about chaplains, about how we're trained, aboutwhat we typically hear from patients, and what we can providesupport around. How we also support caregivers. We are inpatient,we are outpatient, we are 24/7 most often, and how you can get intouch with a chaplain. I really encourage you to reach out to achaplain. We're always happy to help. It's what we're here to do.So thank you so much for having me on the podcast today. It wasreally a delight to be here. And I hope you have peace. I hope thatyou find strength, meaning, purpose, and belonging in the midst ofit all.
ASCO: Thank you, Ms.Jeuland. Learn more about the role of chaplains atwww.cancer.net/palliative.
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