MID-CITY — A 54-year-old patient at the Santa Monica-UCLA Medical Center was dealing with a cancer that had spread. It had started in the abdomen and then moved into the lungs.
The patient had a history of abuse within the Southern Baptist Church and wasn't open to spiritual support, but was in need of emotional help, Lori Koutouratsas, palliative care chaplain in the Spiritual Care Department, said. Last week, Koutouratsas continued to work with the patient as he was dying.
The patient ended up passing away with friends by his side last week.
Koutouratsas, who has been at the hospital for the past three years, has been a palliative care chaplain for the last year. In that job, she provides comfort for patients who are facing more critical and difficult situations including grim prognoses or possibly transitioning to hospice care.
"At the end I was present for his death and there's always a lot of tears and emotion and I was part of offering support through questions or being present with them," she said.
Koutouratsas said one friend told her how he was grateful she was there. She considers her work as "internal."
"They felt empowered to give their loved one permission to die," she said. "It was a very beautiful and loving transition. The chaplain works on healing on the soul or the essence of the person."
Spiritual care at the hospital has evolved into something more contemporary, broader and inclusive — some call it post-modern — that focuses on every patients' need and providing guidance, regardless of specific religious orientation. Chaplains, who are clinically trained, are able to put aside their particular beliefs, and help support and listen to patients of any creed.
The change and emphasis in becoming a partner in patients' recovery is thanks to Tim Thorstenson, who joined as manager of spiritual care at the hospital a year ago. He is also an ordained Lutheran minister and supervisor of the Clinical Pastoral Education Program, providing clinical training for people in seminary or theological schools who are not yet professional chaplains.
"Chaplains become the primary go-to sources in the clinical setting to work with patients on how they're adapting with their changing circumstances and facilitate that process of making meaning out of their illness and accommodating the shift in what's commanding their energy and focus in life," Thorstenson said.
Ted Braun, hospital spokesperson, said chaplaincy programs were more religious specific and are now in transition to have more of a spiritual care focus. That was true for the hospital's spiritual care program prior to Thorstenson's arrival, he said.
The shift is in line with becoming more inclusive and respectful of all individuals.
"Religious ministry in hospitals, which is a public setting after all, used to be exclusive, meaning Catholics would take care of Catholics and Jews would take care of Jews," he said. "It's more inclusive now [as] we attempt to appeal to the universal dimensions of every human being for care and comfort and hope."
People aren't used to thinking of chaplains in broad terms, said Valerie Storms, who serves as president of the Illinois-based Association of Professional Chaplains, which serves chaplains in all types of health and human service settings. Storms is also manager of chaplaincy care at the Moffitt Cancer Center in Tampa, Fla.
"If I had a dollar for every time I asked a (patient), ‘What kind of spiritual support have you had?' and they respond ‘I haven't been to see a rabbi or church for awhile.'"
As an ordained Baptist minister, Storms said she's not interested in whether patients have been to church, but instead what spiritual support they've had through their illness.
Storms said when patients realize chaplains are there to help, they open up and share their inner most thoughts as well as deepest spiritual struggles.
Chaplains, of which there are two full-time and one part-time at the hospital, help patients process feelings, emotions and anxieties, fear, guilt and sorrow, Thorstenson said
They function through referrals or requests from doctors, nurses and patients and their families. The staff tends to see 10 to 15 percent of the inpatients at the hospital.
"If a patient is weepy or withdrawn or non-complaint with their medical regiment or pushing back on what's in their best interest, the nurse will say ‘I can really use some help here,'" Thorstenson said. "Whenever there's a behavioral problem, we can get called."
The spiritual care program does provide for patients who want to have communion, a private devotion or prayer service, Thorstenson said. For example, there is a Jewish rabbi who works with the program one day a week and St. Monica's Parish also responds to the needs of Catholic patients, he said.
Other patients may just need to open themselves up to the care and support of a chaplain.
Thorstenson remembered a young patient in his 20s who had been diagnosed with a new type of cancer and was feeling overwhelmed. He was still in college and realized his senior year was going to be interrupted by treatment.
"Frankly, he was scared to death he wasn't going to survive the treatment to go back to school," Thorstenson said. "He was having trouble sleeping and acting out with his nurses."
When Thorstenson saw him, it wasn't for any specific religious need, rather it was for the patient's difficulty in accepting and working with his diagnosis. In three conversations, the chaplain was able to work through the anxiety and distrust and the patient began to draw from his own childhood religious framework.
"He then learned how to pray in a new way and that became very important to him to open himself up to the sense that his understanding of the divine was working for him to bring about his future and to make it whole and full," Thorstenson said.
For Koutouratsas, she helps a patient re-frame their reality as they go forward in life and help them come to peace about what their future may hold.
Each person is unique, said Koutouratsas, who calls herself "Presbyterian Christian with a lot of broad strokes."
"I take somebody's identification and I walk in, but it's about an exploration of what's their understanding of their faith, if that's what their questions are about, and what their needs might be," she said.
ameera@www.smdp.com
