Mr Bigg's Blog A blog about politics, theology, education and the rest…

14Sep/141

5 things I’ve learned about healthcare chaplaincy

Posted by Mike

I was very fortunate to have spent a week with the chaplaincy team at Hinchingbrooke Hospital over the summer. I got to spend some time with Scott, the lead chaplain (and cracking good bloke), visiting patients and exploring the nature of chaplaincy in a healthcare setting. Here are some of the things I've learned. They don't all necessarily link into each other and they certainly don't form a coherent theology of healthcare chaplaincy but they are there as food for thought!

(Any names used are made up, but the stories are all real.)

1. Wholeness in healthcare

It's easy to treat illness as a purely physical phenomenon. Disease can be caused by bacteria, or we might break a bone, or have a chemical imbalance somewhere. We can therefore assume that these should all be treated in physical terms and nothing more. Of course the physical aspects of illness must be treated in appropriate medical ways but it is a mistake to suppose that medical treatment is (or should be) the only aspect of treatment. Human beings are complex psycho-physical beings and we inhabit influential social contexts, it is therefore important to consider psychological and social (and yes, perhaps even spiritual) aspects of life when looking for healing in the fullest sense.

Yes, we need our bodies patched up, but it helps when our minds and spirits are patched up too. Chaplaincy has much to offer here as a means of healing the person as a whole.

2. A ministry of presence

Glenda was an elderly lady. She'd been in hospital for some weeks. When I first went to see her she told me not to waste my time on her. Why are the hospital expending so much time, energy and money on looking after her when there were many more worthy patients. She'd had her time - what a waste to treat her at her age! Frankly, she felt like a bed-blocking waste of space. After chatting to her for several minutes it became clear that she was far from being a waste of space; she had a loving family, was good-humoured, had an interesting story to tell and had plenty of life in her yet. It was really difficult for the hard-pressed nurses to give her the time and reassurance that she needed but I, from the chaplaincy context, wasn't there to take her pulse or give her medication. Chaplains are there because they are there, simply to be a presence with people and to hear their voice.

Maud was also elderly and a little confused. When I saw her she was fed up and absolutely determined that she was going home. She was worried about her dogs back at home and swore blind that if her husband and son weren't looking after them then she was going give them an earful. I didn't doubt her for a second! It didn't take long to work out that her family didn't visit her as often as they might and this was clearly a source of great pain for her. A chaplain can be there as a simple presence. I couldn't be her husband but she was heard and valued (and wasn't quite so keen to go home).

3. Back to the roots of religion (aka. healing is more than physical)

I'll never forget the moment of revelation that came when the wonderful Mary Earl told me the etymology of the word "religion": re-ligio. The "re" bit means "again" and "ligio" is the same root as "ligament" (that which holds things together). Thus the word "religion" means something like "that which binds together again". At the heart of Christianity is the recognition that we are all broken and fragmented and we all need to be patched up and bound together again. In a hospital there is often a very obvious physical component to being bound back together and most Christians (rightly) leave this to medical professionals. However, it is often the case that our minds, souls, relationships and attitudes need to be bound back together just as much as our physical selves. Times of physical suffering can, perhaps, be triggers to reconsidering other aspects of our lives and chaplaincy work can be central on looking at this. However, there are also times when the physical is simply beyond binding. Some illnesses cannot be healed. Some wounds cannot be mended. For the bereaved death cannot be undone. At these times (more than ever) re-ligion offers a very different kind of healing and chaplaincy should be there to help that process along. (Michael Arditti's novel Jubilate explores this theme better than I could).

4. Our language can betray us

We (or I do, anyway) often use language carelessly, without really thinking through the implications. The example Scott gave was the use of the term "miscarriage". It's a word in common usage and it's fairly clear to all what it means - what's wrong with it? In most contexts, there's nothing wrong with it at all. However, when used with a woman who has recently lost her child it has the potential to have all sorts of connotations of failure or culpability. In that situation, pastoral sensitivity demands that we are aware of the possible implications of the words we use. It doesn't follow that the term "miscarriage" should be removed from regular usage (can anyone think of a better term?); however, a good pastor needs to be aware that such a word has the potential to bring to the surface those thoughts and feelings that may be underneath.

There are further implications here. I am persuaded that the way in which we use language is shaped by our context and serves to shape our future context. Consider the use of language in ethics: take euthanasia as a starting point. The term "euthanasia" itself means "good death" and the immediate implication is that the alternative is something less than a "good death". We could call it "mercy killing", the implication being that to oppose it would be merciless. We could call it "assisted suicide"; of course the term "suicide" has its own unhelpful baggage. None of these phrases are perfect, and that is precisely the point. Language is rarely value-neutral, particularly when related to sensitive subjects. This is not an excuse for ridiculous political correctness in which "failure" becomes "deferred success", but it is a call to awareness and sensitivity to the implications of the language we choose to use.

5. Being real

One final thing I picked up is the importance of acknowledging reality in the chaplain's role. There are times when it is both important and appropriate to offer hope of physical healing; there are also times when perhaps the chaplain needs to encourage the patient to accept that they are not going to get better. The healing of acceptance can be vital (in every sense), but it cannot necessarily happen unless someone is willing to call out the reality of the situation.

In a similar way, when someone has died there are times at which what has happened needs to be named as death. It's easy to use euphemisms to avoid the reality of death; sometimes these are appropriate and helpful, but at other times a chaplain may need to use the D-word in order to help friends and relatives move forward. There is a finely balanced pastoral challenge here: it is easy to talk of resurrection, but without dwelling in Good Friday for a little while the reality of Easter Sunday is just a white-wash. We can't jump the gun and trivialise death by skipping straight to talk of heaven - a good pastor knows how to be with someone in the darkness of Good Friday, naming it as such and supporting them through it.

To conclude...

One particular privilege of my time at Hinchingbrooke was to join Scott in distributing bedside communion. The gentleman in question was in critical care and he had made the decision to discharge himself so that he could return home to die with his loved ones around him. Before he was discharged he requested bedside communion and it was clear to everyone present that the short service (just 10 minutes) was likely to be the final time this man received communion. Scott didn't explicitly say so, but in his manner and inflection of some of the liturgy made the significance and poignancy of the occasion quite clear. At the end the man's wife was in tears and the man was at peace.

This encapsulated the privilege and importance of hospital chaplaincy for me. There was genuine wholeness and healing in the encounter, even though this wasn't externally visible. The man was bound back together as best as he could be this side of death's curtain; the language used was sensitive but profoundly real; at its root it was a simple act of being present and honest about what was going on. Not as easy as it sounds, and incredibly important.

12Sep/140

Diary of a Friday in Cambourne

Posted by Mike

I spent today at Cambourne Church. What follows is a short commentary on some of the things I have seen and noticed...

When I arrived shortly after 9am there are a good number of mums who've just dropped kids off at school. They have come to 19, the church-run coffee house. They take the opportunity to have a little chat and enjoy a cup of coffee (a bargain £1.20 for an Americano). How fantastic that there's a place for people just to pop in and enjoy each other's company in an open and airy space. I'd guess that there are people here who would, in general, never darken the doors of a church and yet here they are. There's nothing massively "churchy" here but people know where they are; isn't it good that this place can offer the simple ministry of being a space where people can gather?

By 9:30 the final few people are sneaking through the door to get into the first meeting of a new Slimming World group. All of us with bacon rolls (£1.40) feel a little guilty. The group is incredibly well-attended which is great, as the organiser looked a little worried that no-one would turn up. They are using the main church hall - a flexible space - and lots of the members had dropped by earlier to have a cup of (black decaf) coffee beforehand. This is a church which is genuinely seeking to serve its community and this is great to watch.

People come and go in small groups throughout the morning. One lady is a bit upset but can use this space to talk with some friends. An elderly gentleman pops in from over the road for a bite to eat and a drink. He chats to the people behind the counter and I have a little chat too (he's a Yorkshireman, friendly chitchat to all is an obligation).

Two businessmen in shirts and ties come in for a coffee and meeting. They are deep in conversation while some kids scream and play up and down the aisle as their mums sit down and chat for a few minutes.

By 11am the last few Slimmers have left the hall. I spot one or two ordering a bacon roll (brown bread) and they clearly take great pleasure in a well-deserved treat. A solitary lady enjoys a tea cake and a book as the light continues to flood in.

The staff here seem to know everybody who comes in and they take the chance to have a little chat with every one. Some of them have more involved conversations and get some support and advice. One volunteer has brought her toddler along while she helps. Her toddler has a fantastic time with some of the other kids.

Shortly after the coffee shop closes the space is filled with mums and toddlers (and a few dads). Everyone eats together, the kids play, parents swap stories and advice. There are some tears and some tantrums (mostly from the kids). Some music and some craft. It's a very congenial atmosphere.

Next is the youth group. Shortly after 4:30pm there are 20-30 teenagers filling the building. Some get a toasty or a milkshake, others play football, some play on the Xbox 360, one even takes me on at chess (and loses). A few of the kids are regulars at church but a lot of them would never darken the doors. Interestingly, there are a fair few who get themselves into a bit of trouble, but here they are involved and enjoying themselves. It's good to watch. There's lots of good banter.

Nothing groundbreaking or new happened today (although the use of Google Forms and an iPad to self-register the kids at the youth club was neat). Lots of things that happened here will have happened all over the place today. None of the things that I've mentioned involved the vicar (although one highlight of the day was to see him running down the high street this morning - a shame he wasn't wearing his dog collar). The day involved normal people doing normal things, and yet there was a real sense that God was at work in these very simple ministries. It felt like the exactly the kind of thing that a local church should be doing and encouraged me greatly.

11Sep/142

Review: Tado Smart Thermostat

Posted by Mike

Lots of so-called "smart thermostats" have been arriving into the UK market recently. BT have been marketing Hive (complete with nonsense advert), Google have put their money into Nest, if you've got the money then evohome will allow you to set a different temperature in every room of the house. For my money I've invested in Tado and their intelligent thermostat. Here's why and what I've found.

Control your heating from your smart phone

You can download the Tado app for both Android and iOS based devices. The neat little app allows you to control heating and hot water from your device wherever you're connected to the Internet. You can change the temperature, boost the hot water and all of the things you'd be able to do on your standard boiler control unit. So far, so fun. Not a massive value add though (how often do you change your heating temperature or schedule?) and won't save you much energy, unless you forget to turn the heating down when you go on holiday in the dead of winter. This is what Hive and Nest will do for you.

Presence detection

This is where Tado really adds value. If you have a fairly irregular schedule then it's really hard to know when to set your heating to come on and go off. Tado solves this problem by using your smart phone's GPS capacity. The Tado app lets the unit at home know when everyone in the house has gone out and can therefore automatically turn the heating down for you. It uses this geolocation service to estimate how long it'd take for you to get home and therefore lowers the temperature appropriately; when it senses that you're getting closer to home again it'll bring the heating back up for you so it's nice and cosy by the time you open the door. The further everyone is from home the lower it'll allow the temperature to get in order to save more energy.

(It's a common myth that it's just as efficient to keep the house at a constant temperature at all times. It's not just as efficient, it just means that you never come home to a cold house. If maintaining the temperature at an even level were as efficient as letting things go cold and then re-heating then we'd all leave our ovens on at all times to stop them getting cold.)

Other neat tricks

Tado is connected to the internet in your home. That means it can monitor what the weather is like in your area and use that information as a factor in how to heat your home. For example, if it knows that it'll be really sunny outside then it knows that it can leave the sun to heat your home instead of the boiler. Tado also learns how quickly your home heats up and this can help it to be more efficient too. It knows if the residual heat in the radiators will add another 1.5 degrees to the home temperature so can shut off the boiler before it hits the target temperature.

The box also includes a wireless thermostat so, if you like, you can ensure that the target temperature applies in whatever room you're in. Some rooms heat up more quickly than others!

Apparently, they are shortly to release Tado Care which uses the digital interface of the boiler to identify problems early before the boiler packs up. This is a free addition to the Tado package and will be great it if works!

How does it work and how much does it cost?

Tado comes in three bits: a router (which plugs into your router and connects the main box to the internet), a wireless thermostat (solar-powered), and the boiler control unit.

IMG_20140911_201120[1]

The unit was a bit fiddly to install and you need to feel comfortable working with mains electricity. The box replaces your existing boiler control unit and Tado provide comprehensive instructions. I'd never done anything like this before but had it working within about an hour. If you don't want to do it then Tado will arrange an engineer to install for you for £50.

You can get the unit under two payment models. You can either buy outright for £249 (+p&p), or you can rent for £6.99/month. They reckon it'll save £100/year so you should get your money back. When I last checked the voucher code richard_10 got a 10% discount at the checkout. I got mine during August when they were doing a £3/month summer sale, so look out for bargains!

So does it work?

It seems to, although the heating has been off... It successfully detects when both of us are out of the house and adjusts the target temperature accordingly. Had the temperature dropped below 20 in the last month we'd have seen some action!

App Screenshot

App Screenshot

You get a sense of how it works from the screenshot of the app's graph that was generated yesterday. The house temperature is on the y-axis and the time is plotted along the x-axis. The icons show the events that happened throughout the day:

  • The coffee cup at 7am indicates that the target temp moves from night-time mode to day mode. You notice that the temperature soon takes a quick rise because the day-time target is 20 degrees and overnight the temperature had dropped below this. You can just about see an area of solid blue under the graph at this point - this indicates times at which the boiler is actually heating the house.
  • Shortly after 7am is a symbol indicating that someone has changed the settings. Just so you know.
  • Just after 11am there's a green symbol with a person walking. That shows that at this point Tado detected that everyone was out of the house. I'd left at about 8am, but my wife didn't leave until 11am. At that point Tado knows to turn down the target temperature. In this case it knocked the temperature down to 18 degrees because neither of us had gone very far. If we went further it would knock down the temperature further. Tado won't allow it to get so cold that it won't have time to heat up again when you start to come home.
  • At about 3:30pm the "Home" symbol appears to indicate that normal service has resumed because someone has come home.
  • Then, at 9:30pm we move into night mode and Tado will allow the temperature to drop to whatever you set as the night-time minimum temp.
  • You might notice some yellow shading between about 8:30am and 4pm - this is where Tado is detecting that sunlight is keeping the place warm.
  • There's a little blip in the temperature at about 1:30pm - I think that's when the temperature sensor was in direct sunlight for a few minutes.
  • I like it a lot.

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