 Hello my friends and welcome to my show, Elderhood, Aging Gracefully. Thank you so much for joining me. I extend to you an Hawaiian spirit of aloha. Hawaiian spirit of aloha means that we all share in one breath, we share in one endeavor. And I'm glad to have you here sharing in this endeavor with me a man named Wilbur Butler Yeats, I think was his name, also said something similar. He said, you know, there are no strangers here. They're only friends we have yet to meet. And that's the way I consider all of us too, especially as I do my online coaching, friends that I only have yet to meet. So I'm glad you're here to start that relationship. I hope you'll follow through. And if there's an interest that you have in coaching, personal coaching online, contact me with Larry G at live-connections.com. I'll repeat that later. I'm also serving as here in Hawaii on Honolulu in the Oahu Island as chaplain with Bristol Hospice Hawaii. And I'm proud of Bristol Hospice Hawaii because I think they live their tagline, which is living a reverence for life. We really do share in a reverence for life at Bristol Hospice. And we're joined together in this mission of providing the highest level of compassion and personal care and medical care for our families and friends and terminally ill patients across the island of Oahu in their homes and in facilities. But in addition to my chaplaincy work, I also do online, the online coaching for personal life and faith. I'm particularly focused on elderhood. You know, we have a childhood. We have adolescence. We have an adulthood. And most of us don't want to talk about it, but we have an elderhood. And I look at it as a stage because looking at it as a stage of life gives an opportunity for us to think about the tasks that are involved, just as there are tasks involved in growing and maturing in childhood, adolescence and adulthood. There are tasks, particularly applicable for our consideration in adulthood or in elderhood, excuse me. And so I have five spiritual tasks that I haven't identified that kind of come up in our lives. They insist on being considered. And if we pay attention to them and respond to them, I believe we can make our elderhood really real and wonderful. And so my coaching is to enable people to do that because I have a passion for life and living fully until I die. And so I'm committed to that and I want to be with people in making that happen as well in their own lives. So the five spiritual tasks that you see here are grieving the first. We've touched on that in our first program here. The second is sorting out stories. There are stories that we sort out that tell us who we are, by which we tell ourselves who we are, and we can sometimes rewrite those stories and create a new life. It's really a powerful, powerful tool. The third is forgiving. We touched on this the past Friday. And we're engaged in forgiving because it just becomes a personal human need. It's not necessarily a solely religious tenant or a religious demand. It's something that comes up from within that we need to wipe the slate clean. We need to get forgiveness and give forgiveness. The fourth thing is preparation. And by preparation, I'm thinking of the external preparations. We have an exterior external life. We have wills, we have finances, we have preparations for how we're going to have medical care done, what kind of options we have. We want to research all of that. And that's going to be very extensive in this program. Take up many, many Tuesdays. And then there's an internal preparation also that goes on. How do we handle that internal life, that interior life, and what comes up in the interior life as we move through this stage of life? It's very much important. And I want to focus on that today. The last one is letting go, another powerful, powerful event to consider. To focus on the preparation today, and particularly internal preparation, I've asked one of my colleagues, Stefan Prusinski, if you'll join at the table. Steven, welcome. Wow. Thanks so much for being here. Yes. And thanks for having me on your show today. You're welcome. Steven and I have had a special bond, a special relationship as we work together, providing spiritual care to our patients, Terminalio, and to their families, offering it to them. One of the things about preparation is that I'm concerned about, Steven, is that people don't get a chance to see the internal workings of some of these institutions. Even hospitals, we don't really see the internal workings necessarily. We may go to a hospital and get treatment, but then we leave, but don't always get to see the whole system. And hospice care is a unique opportunity for people in this time of life to have a particular kind of medical treatment, medical care that goes on, palliative is the word we often use. And in that, the subset of spiritual care is even less well-known. So I wanted to invite you to share with our audience some thoughts about that. Would you begin, please, by introducing yourself and your skill base and your experience in spiritual care? Sure. Sure. Thank you. First off, I'd like to say I am truly living my dream as a chaplain. That's great. I had a former careers engineer. I moved from Wisconsin to Arizona. Did clinical training. I did seminary training. And I had a series of events that really helped me feel led and empowered to be right where I'm sitting today. It's been a wonderful journey. And we have a saying in chaplaincy, you really can't help somebody else go further than you yourself have gone and inwardly to understand what's involved with that. So I've had about 18 years working in hospitals and nursing homes, retirement communities. And then it's really been this last year that's been specifically hospice. And as you say, I agree that very much in hospitals, the clinical path is to keep you alive. It's to do extraordinary measures. I was working at Mayo Clinic where they had world-class doctors there that would do all sorts of transplants, also at a tertiary hospital in Arizona, worked at Banner Health, which is a big system between some states. And then when we moved to Hawaii, was also the chaplain at the main psych hospital for Hawaii. So I had a real background in psych. And now this last year is been in hospice. And as it pertains to elder care, it's very important. I've had really years of experience working with senior adults. And it's all contributed towards me moving forward in helping seniors move forward through these very facets that you're describing. And Stephen, you were a chaplain at a retirement community here on the island? Yes. Which one? So I spent almost a year at Pohanani. And prior to that, I helped pastor in retirement communities, also for homeless shelters. It's been real broad. Wide range of population, people in a wide range of situations, that's great, great background experience. And all of which really is present, those same populations are present in the hospice care. Yes. So spirituality, what is spirituality? Well, you know, it's fun. If you went to the dictionary, you'd probably maybe find nine or 10 definitions. And it's so I wanted to bring up an aspect that would be easier, I think to understand spirituality. It's just like we have a body, the doctors take care of our physical health. And maybe you see a counselor or psychologist for your mental health. Well, in chaplaincy, we believe we have a spirit. And so chaplaincy and spiritual care are about how we care for our spirit. And specifically today as we go through the different stages or phases of life, spirituality in general has to do with a sense of how we make meaning overall. We all are wearing a pair of glasses where we have a worldview. And in that worldview, we have beliefs. We have passions. We have values that are really emanate out of our beliefs. We develop attitudes of which we create a life. We also assign meaning to symbols. Spirituality also has to do with the things that are transcendent, things that are above and beyond us. For example, like nature, some folks connect with nature. And that's the, I think the last piece is it has to do with the of how we connect in relationships. How do I connect with myself? How do I connect with those around me? And then when it comes to transcendence, how do I connect as I'm going to say a higher power, a divine being? And when we do our work as spiritual practitioners, we are really assessing for the degree of how a person is connected inwardly. Maybe the short definition of spiritual care would be how a person, we come alongside or enter into their journey to help them find strength, inner strength. So the doctors and nurses, the healthcare is fixing or working on the body. Yet in chaplaincy, we like to say we are spiritual beings having a physical sort of experience. So Stephen, if I am coming into hospice care and I am a Latter-day Saint, or I am a, what, some denomination that's not, you're not familiar, you're not, are you going to talk to me about your denomination? No, as a board certified or a chaplain, we are trained to be inner faith. And what that means is our work is to inductively play detective on how you make meaning. And so you mentioned one religion. You could look at the major religions of the world. And so religion is really like a subset of spirituality. It has doctrines and has specific ways a person believes that they make meaning and they have rituals. As a chaplain, we honor those. I'm ordained, you're ordained. We have to have ecclesiastical endorsement to be where we are. Yet we're there to journey with them to help them often validate their pain and assess the spiritual connectedness that they do have, or even sometimes help them discover what it is, and to find that inner strength to get through whatever it is they're going through. And in hospice, it does involve a lot of suffering for not only the patients, but the families. So you're coming alongside to help me figure out how I'm making meaning, how I'm using my resources internally to make meaning out of what's going on in my life. Is that right? It's just true. However, we understand they're not thinking that. We do our work often without folks even knowing it. So and yet by the time we're done with our visit, we've basically established our relationship, which begins to develop trust that we can be with them. And often they will begin to, I say, open the virgin soil of their heart about things that are deeply meaningful to them. And they're trying to firm that up, because perhaps their struggles or pain is testing their previous beliefs or assumptions about reality. There are somewhere between 15 and 20 different practices of Buddhism on the island. And are you comfortable going into a Buddhist family? Well, sure. Sure. So we serve with our training. And it doesn't mean I'm an expert Buddhist. It doesn't mean if I'm with a shaman who's in the bed that I have to know everything they do. No. What I'm tuning into, though, I'm working with a Buddhist patient right now who basically is name only, and she likes to keep it that way. And she likes to really just talk about her family. Our work is to go where we're invited, where a person is asking for more exploration. If they're very content, then we're with them in that. So yes, there's a myriad of Buddhist denominations I'm aware of. If I was at a Buddhist person who died recently at the bedside, we're there to be with them in that moment. Wonderful. We're going to take a minute break and then return. I'm going to ask Steven to get a little more specific about some examples of spiritual care in hospice. Thanks, Steven. Hello, my name is Becky Sampson, and I'm the host of It's About Time on the Think Tech Hawaii, a digital nonprofit organization that's raising public awareness. Join us on Wednesday at 2 p.m. where we talk about real issues. Some of the topics will include entrepreneurship, health, life skills, and growing your business. So once again, this is Becky Sampson on It's About Time on Wednesday at 2 p.m. on Think Tech Hawaii. Mahalo. Aloha. This is Rob Hack. My show is exporting from Hawaii every other Thursday from 12 to 12.30 p.m. where I bring in people involved in the entire exporting infrastructure in Hawaii, including government, academia, and manufacturers and shippers themselves. Please join me every other Thursday, 12 to 12.30 p.m., and exporting from Hawaii. Mahalo. Welcome back to Elderhood, aging gracefully, and I want to give my thanks to Think Tech Hawaii and the wonderful job that they do, all the staff here, all the equipment, everything is given really a gift to the community and gives the intellectual community here an opportunity to think about things that otherwise we might not get a chance to explore. So thank you to them for providing this, and thank you to you for joining with me and with Stephen this morning, too, or with this afternoon to explore the internal life and internal preparation for our life for Elderhood and our journey through Elderhood. It strikes me, Stephen, that most people think they really don't need any kind of spiritual help. Now, some people have a great deal of background in spiritual life. I had one friend, you know, the phrase that's popular these days is, I'm not religious, but I'm spiritual. I have one friend who's a pastor in Denver, Colorado, who used to say, I'm not very spiritual, but I am religious. And the two go together, and certainly when we have, my position is when we have any kind of religious exposure, it affects our inner life, our orientation, our sense of making meaning and transcendence. But I wondered if you would more specifically focus in now on sharing a description of just general terms, nothing personal, but I mean, no names, of course, but something that's about a spiritual care experience that you've been involved in in hospice care. Okay. Well, I'm just going to use the one I had yesterday. I've had somewhere over 130,000 visits and encounters with patients and families. And before I describe how this works, I would say as a board certified chaplain, we need to go through a commissioning, a written and oral certification process that involves demonstrating competency in 31 competencies that involve, it breaks down everything that you're talking about, age, stage, development, psychologically, spiritually, we look at how we begin a relationship. How do we bring closure to a relationship? How do we honor and respect the person's different worldviews? Maybe they're religion or their brand of spirituality is something that might cause an internal reaction within me. Does that mean I still am able to be present? And if not, do I need to get another professional chaplain? So there's a series of competencies to work through to truly be able to be present with a person. So I'll give you an example. I think in chaplaincy, I'm going to resist saying a typical example, because we know better. There is no typical. The first rule in chaplaincy is we don't assume the moment, and I tested this and it was true, the moment I assumed I was wrong. So we do have our preparation before we begin a relationship, have a visit is to be a blank slate. It's really to wipe the board clean and go in and truly be with this person in a nonjudgmental way. And hopefully, we create the context of unconditional regard in law, because we feel this is evidence shows that this is the environment that helps people be relaxed and begin to open up to what they believe or what is their concern. So because we're in a clinical setting, we have competencies, then we identify spiritual needs, we identify a person's spirituality through assessment, and then based on what we see the needs and assessment is, we craft interventions based on evidence based outcomes. Palliative care is palliative, the word palliative means to cover. So palliative care covers pain. And we think of it mostly of course as opioids or something to cover the pain of the physical pain. What about spiritual pain? What does spiritual pain look like? That's a great question. I think the long and short of it is as we do our assessment, we're following a pain trail. We're listening for where are those connections between myself, my relationship with others and my higher power, where there's been breaks, where have there's been breakdowns of that. Where you find those breaks is most often where you'll find a level of distress of separation, something maybe between a loved one, maybe especially for seniors as they've lost their significant other of many, many years. They feel like a part of me is gone, part of my identity. But we're looking, we're sensitive to that. And then how do they recovery involves a part of letting go and also finding how do their beliefs, their spiritual beliefs, support them in that? Will they, so for some in the Christian world, they believe I'll at least see my spouse, my significant other again as we grieve, it gives them a source of hope. Hope is part of our spirituality. I've seen that there are four basic stories in human culture about afterlife. And I don't mean to jump to afterlife necessarily, but in terms of preparation, one of the things we think about is what is going to be after I'm dead. One is that there's nothing after the afterlife. Second is that we live on in the legacy that we leave of people remembering us of people. There was a village in Kenya that said, as long as one person in our village remembers you, you're still alive. There is a notion of a total rebirth or reincarnation or revivification of the body, a resurrection motif. And then finally, there is going to live with God in eternity or with a divine presence. So somewhere, I find that all of my patients fall within those four stories, narratives in some way, if they've given any thought to it. But then one of the things that's so great about your experience, even with people is that you give them a chance to explore that, where they are in those stories. Sure, sure. And what's part of the journey, if you will, of spirituality itself, of how it unfolds. And I'll just back up when I'm doing an assessment. I am thinking, is this person spiritually at risk? Or do they have, sometimes I'll chart, they have a robust spirituality. They have experience that's really working for them. And sometimes, I remember the first time I had a sudden infant death syndrome, baby, a beautiful little three month old who died. And horribly difficult to be with the family and grandparents came in, extreme pain. Certainly, everyone's beliefs were being tested that day. And I sat with them. And this was in the beginning of my clinical training. And of course, I felt inept inwardly from me, my own story was playing. And yet at the end of the visit, the patients, the family, rather the parents, I sat with them and asked them, I said, really, I said, how may I, how may I be of support? And I had been present and hadn't quite realized that just my presence with them, without offering trite phrases or somehow some antidote for how to fix this. What they said to me, no chaplain, we're atheists. And we believe our child has gone to a better place. And it was very interesting to me, and I'm going to use this as an example, because in spirituality, spirituality is as part of us, that we're also trying to understand that we're coming to terms with, and it informs our worldview, it informs how we make meaning. And sometimes it gets tested. But for them, an atheist is traditionally a person who says very concretely, there is no God and agnostic says, well, there might be, maybe there isn't, I don't know, I'm working it out. So they had moved from being atheists to agnostic, because they, through this pain of the death of their child, they now knew, experientially, no, there's something greater, without even knowing it. Yet as chaplains, we pay attention to those kinds of things. I like what you say about it being a part of us. And we're working it out. It's a given. I mean, our assumption is it's a given. And I don't say everyone agrees with that. But we are alert. And I do this in my coaching to be alert to the fact that it is given, their spiritual life is a given. And my clients, my patients, are working out to discover what its significance is. Very good. And how they, well, you said it beautifully. I think that's the givenness of it. And being alert to the givenness of it, puts us in a position of, of service and servanthood that we, that not many other people will get into that position. Yeah. And I would add, so for us, one of the outcomes that we're looking for is an increased sense of love. We talk about these connections, love and surrender. These are things that when we've done our interventions, hopefully we're going to see a little bit more of that. And I'm just going to tie it back now to the elderhood and seniors. So often seniors have so many losses. They just have so many losses, spouses, good friends. Sometimes they're feeling all alone, even though they have children there. And like with the person I was with yesterday, they feel, now I'm a burden for my children and the children love them. And there can sometimes be a separation from themselves because I don't want to be a burden to anyone. Right. And we want to help close that gap. We want to be present with them in a way that they can realize, no, you're still, you're of extreme value. You are lovable. And, and though things have changed, your life has changed, you're experiencing these losses. We're there to be with them. We validate that pain, help them to understand, know what you're experiencing. It's painful. And, and we're with them in it, in a way that really dignifies their humanity to realize they're worth loving. So the experience of pain is an opening to the faith. It's an opening to the spirit. It's an opening to that internal life. But otherwise, we may not pay much attention. Thanks, Stephen. Thank you so much. We're having to close now. It's going to be, it's been a wonderful, wonderful show with you. And thank you so much for your help. Really appreciate you coming. Appreciate being on the show. The show will be on in two weeks again, next two weeks of, from this Tuesday, two o'clock Hawaii time. And I will welcome you back then with aloha spirit, the spirit of Hawaii. Thank you so much for being a part of this. And come back, join us again. We've only begun to scratch the surface of these sick, these five important spiritual tasks.