Chaplain: Rev. Daniel A.

Burnett
Date of Visit: 12/19/2022
Ministry Location: Good Samaritan Regional Medical Center, Corvallis, Oregon.
Supervisor: Dan Weiser
Unit 3 - 1/5/2023

Case Study #4 -
All the names except mine have been changed to protect patient confidentiality.

KNOWN FACTS/PREPARATION/OBSERVATIONS -
I had decided to clock out two hours early because I was going to come back to the
hospital later that evening to have a new chaplain shadow me as I visited patients.
However, as I was walking back down the hill to the guest house where I stay, I got a page
from an RN. I called, and she said there was a patient actively dying and that a family
member (the patient's sister) had requested a chaplain. Doing a 180-degree turn, I walked
back up the hill directly to the room. As I walked, I prayed that God would give me the words
(or the compassionate presence) to comfort the family member of our dying patient. There
were two beds in the room separated by a screen. The man in the first bed (closer to the
door) was awake, so I assumed the patient actively dying was in the other bed. I could
hear a woman’s voice quietly singing, “The Little Drummerboy.” The room was dark; the
only light came from the window, but there were cloudy skies that day, so it was particularly
gloomy. The woman, seated on a folding chair, acknowledged me as I entered but didn’t
stop singing. She was wearing blue jeans and a nondescript oversized hooded sweatshirt.
She was fighting back the tears. I observed the patient, a white male in his early fifties; his
eyes and face were swollen and puffy from his aggressive cancer treatments that had
stopped earlier that day as he was transitioned to comfort care measures only. He was
under a blanket, but his foot was poking out, and it appeared black with necrosis and
sepsis. She continued the song, and I joined in quietly as I stood bedside. When she
finished, she apologized profusely.

THE VISIT:
(C)haplain, (S)ister, RN, (H)ospitalist
S1 - I am sorry, but I promised him I would be here, but I think I had another stroke last night,
and I feel all kinds of crazy today.
C1 - You don’t have to apologize. Did you say you think you had a stroke, had you told
anyone else about that?
S2 - No, they are mini-strokes; they happen a lot. Thank you for coming, I just had some
questions to ask you about what’s going to happen next.
C2 - Are you asking about his death physically, or are you asking about the afterlife?
S3 - Both, I guess.

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C3 - It may be best to have a physician explain all the physiology, but his breathing will
become shallower and slower, his brain activity will diminish, and when his time comes, his
heart will stop. It should be very peaceful. He looks good now. Don’t you think? (Just then,
the patient’s RN came in to turn off an alarm on one of the infusion pumps that had started
beeping. (To the RN) Can you ask the patient's physician to come by? His sister (to the
sister) I’m sorry, I didn’t catch your name......
S4 - Amy
C4 - (to the RN) Amy has some questions for the Physician.
RN4 - Yes, he is in another room on this Unit. I will ask him to pop in.
C5 - (to RN) Thank you, that would be great. And is there another chair so I can sit? (She
nods and leaves the room, but a few seconds later, a CNA brings another chair. I turn back
to the patient’s sister) It’s nice to meet you, Amy; I’m Daniel. Now, you were asking about
the afterlife, and while the Bible gives us some clues, we don’t have a definitive answer.
Scripture tells us that being absent from the body is to be present with God. (2 Cor 5:8) So
I hold to the idea that if our brother were a believer, his spirit would be with God the instant
it leaves this earthly body.
S5 - Will he see our parents and the rest of our family there?
C6 - Absolutely. Jesus said he is going to prepare a place for each of us who believe in
Him. The whole company of saints from all history will be waiting for him, including your
previously departed family members.
S6 - (to the patient) You hear that, baby brother? Mommy and Daddy are waiting for you.
It’s okay to go and be with them. Please go soon (she cries - I hold my hand out, and she
takes hold of it.) Can we sing another Christmas song? I know he will like that.
C7 - Sure, do you or he have a favorite? I’d love to sing for you.
S7 - How about “O Holy Night”
C8 - (I begin to sing the song. She tries to sing along, but I pitched it too high for her, so
she just listens with her eyes closed until I finish the song)
S8 - That was beautiful. I know he liked it.
C9 - I’m glad; it's my pleasure. Would you like me to pray with you?
S9 - Oh yes, please!
C10 - Let us pray together - (I pulled up the BCP2019 PDF on my phone and have the
“prayers for the dying” bookmarked, and I pray:)
O Sovereign Lord Christ, deliver your servant, “Dennis,” from all evil, and set him free from every
bond; that he may rest with all your saints in the eternal habitations; where with the Father and the Holy
Spirit you live and reign, one God, for ever and ever. Amen.
Depart, O Christian soul, out of this world; In the Name of God the Father Almighty who created
you; In the Name of Jesus Christ who redeemed you; In the Name of the Holy Spirit who sanctifies you. May
your rest be this day in peace, and your dwelling place in the Paradise of God.
Into your hands, O merciful Savior, we commend your servant ‘Dennis.’ Ack nowledge, we humbly
beseech you, a sheep of your own fold, a lamb of your own flock , a sinner of your own redeeming. Receive
him into the arms of your mercy, into the blessed rest of everlasting peace, and into the glorious company
of the saints in light. Amen. (I continue to pray extemporaneously)

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 Father, be with Amy as she sits in vigil for her brother. Give her strength and peace
during this difficult time. Encourage her with your spirit and give her the confidence to know
that her brother is going to a place of perfect peace and rest. We ask these things in the
name of your Son, Jesus Christ. Amen.
S10 - Can I ask you for one more thing? Can you sit with him while I go to the cafeteria and
get a snack and use the bathroom? I just don’t want him to be alone. (As she is asking the
Hospitalist she had requested enters the room)
H10 - Hello, you had some questions for me?
S11 - Yes, is he in any pain? What’s wrong with his eyes? Is he suffering? (The Dr uses his
stethoscope to listen to the patient’s heart and lungs. He looks at the plethora of pumps
and bags attached to his IV)
H11 - He does not appear to be suffering. He does not react to pain stimuli. (He shows
the sister that he doesn’t react when his arm is pinched) His eyes are puffy from the steroid
treatment, but since we ended that earlier, that should go away, depending on how long he
stays with us.
S12 - How long will that be?
H12 - It’s hard to say, but a reasonable estimate is a few hours to a few days, not weeks or
months.
S13 - (she is beginning to break down emotionally) Is there something we can do to make
it faster? Compassionate suicide or putting a pillow over his face and being done with it?
C13 - (Looking at the Dr first, I say) We can’t do that. Assisted Suicide has to be initiated
by the patient.
H13 - We are doing everything we can to keep him comfortable. I know it’s hard to see him
like this, but it won’t be much longer now. Is there anything else I can help you with?
S14 - Thank you, no, there isn't anything else. I’m tired and didn’t sleep well; I think I had a
stroke last night.
H14 - Really? Have you been checked out? We could have someone look at you in the ED
downstairs.
S15 - No, it’s happened before. I just need to rest and get some food. (The Hospitalist
excuses himself)
C15 - I’ll stay here until you come back unless I have to go for another patient.
S16 - Thank you, Pastor. If you have to go before I get back, thank you for coming.
(I sit for a couple of minutes, and then the RN and CNA return)
RN16 - We are just going to check if he is wet. (they look, he is not wet, meaning he hasn’t
urinated all day. To the CNA, she says) grab the Ultra; we can check his bladder. (The
CNA returns momentarily. I watch as they measure the amount of fluid in the patient’s
bladder. They decided to place a catheter because the patient was not voiding by himself.)
(I take the opportunity to excuse myself.)

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ANALYSIS:
ANALYSIS OF PERSON (sister): The patient’s sister has been through a lot. She has
seen her parents die during COVID, and now the only other person she has in her life is
about to pass away. She was distraught but also at peace with the knowledge of the
patient’s eternal home and that before too long (in the grand scheme of things), she would
be with them as well. She shared with me her guilt for not being able to be with him 24/7,
but I explained that she shouldn’t. Caregivers must care for themselves (eat, sleep, go to
the bathroom). I was a little taken aback by her question about pillow smothering, but she
didn’t want to do that but wanted to see an end to her brother’s suffering.

ANALYSIS OF SELF: I felt like I was able to establish a bond with the patient’s sister
quickly. I sang with her and sat next to her, and was open and concise with my words. I
advocated for her to get answers from the Dr. and for her to care for herself.

TRANSFERENCE: The patient called me “Pastor,” even though I never introduced myself
that way. She saw me as her shepherd. Maybe she is transferring from a previous
Trauma/Crisis where she had support from a member of the clergy.

COUNTER-TRANSFERENCE: When the patient asked if someone could smother her

brother with a pillow, I remembered a time while I was sitting with my own grandmother, who
was actively dying. I had a similar thought. But my grandmother looked and acted like she
was suffering a lot (moaning, involuntary moving, expression, and a much longer period of
active death. “It would be better for someone just to end it.” But I know the LORD makes all
things beautiful in his time, and I wasn’t going to be the one to alter the will of God.

THEOLOGICAL REFLECTION:
Several passages came to mind while caring for this patient and his sister:
Psa 139:16 ESV - Your eyes saw my unformed substance; in your book were written,
every one of them, the days that were formed for me, when as yet there was none of
them. - God has ordained our time on earth and it is he who gives and takes away (also
see Job 1:21 and Mar 13:32 KJV - But of that day and [that] hour knoweth no man, no,
not the angels which are in heaven, neither the Son, but the Father.)
Luk 23:42-43 NIV - Then he said, "Jesus, remember me when you come into your
kingdom." Jesus answered him, "Truly I tell you, today you will be with me in paradise."
I would have liked to give a blessing and anoint with oil, but those are sacraments that, in
my tradition, are only done by ordained priests.

CONCLUSION:
I was happy that I was able to reverse course from the original plan (to get some rest) and
serve the patient and his sister. She was comforted by my presence with her and the
answers I was able to give her from scripture. I am not sure there is anything I would have
done differently, but would appreciate any feedback from my cohort in this area.