They come from all over Northern California. Broken, wounded, and scarred, they arrive strapped to a gurney –three, four, sometimes five in a day. Frightened, exhausted, perhaps in physical pain, they often come directly from short stays in ICUs, where for a while they abided in the space between life and death.
Almost all arrive alone, accompanied solely by medical transport personnel. Many will have family members arrive minutes or hours later, to join them. Some arrive with little or no local support and may have few visitors during their stay.
Most speak English but others do not, limited to the use of Spanish, Tagalog, Chinese, and other languages. They are of all ages, races, genders, ethnicities, religions and income levels.
They have suffered strokes, brain tumors, car accidents, amputations, head or spinal cord injuries, and sometimes gunshot wounds. A few have chronic and incurable conditions of the nervous systems.
Upon arrival, almost all are unable to walk, many are unable to talk or have cognitive challenges due to traumatic brain injury. Some cannot swallow food. They are often incontinent.
Welcomed by caring but busy nurses, they are processed into the system. Within a few hours they will be examined by various doctors, therapists and specialized nurses. Within a day their regimen of daily therapies - physical, occupational, speech - will begin as acute rehabilitation - “boot camp” - moves into high gear.
Their stay will be perhaps a week, or up to a month. At some point during their stay, at least once, they and their loved ones will be visited by a hospital chaplain.
The Kaiser Foundation Rehabilitation Center (“KFRC”) is a 50-bed acute rehabilitation facility, a sort of hospital within a hospital, at Kaiser Medical Center in Vallejo, California. Thirty miles northeast of San Francisco, Vallejo is a mid-sized, diverse city– the most diverse city in the United States, according to recent studies.
At first, the KFRC, with its reputation as a premier rehabilitation facility, clean, bright, and cheerful, with large modern patient rooms, a state of the art gymnasium, the latest rehabilitation equipment and facilities and highly trained staff, can feel oddly out of place, more suited for larger cities like San Francisco or New York. Most people may not know that Kaiser Permanente has deep roots in the local community, and that the KFRC has been headquartered in Vallejo for over 70 years.
Today, the KFRC is staffed by (approximately) 30 physical therapists, 20 occupational therapists, 10 speech therapists, nine doctors, seven case managers, 11 administrative personnel, two medical social workers, and one clinical chaplain. For the past six months, that chaplain has been me.
It’s a chaplain’s workday like any other, as I head to Room 302, a large, light filled two-person room, intending to see S., a 75-year-old stroke survivor. S’s bed is empty. She is likely in one of her many therapies. In the other bed lies a much younger woman, flat on her back, alone and unattended. She is not on my list, indicating she arrived within the hour since I printed it.
“Hello. I’m sorry, I didn’t know you were here. You must have just arrived. My name is Peter, and I’m a chaplain serving on this floor. What’s your name?”
As I approach her and reach out my hand, she lifts her own with difficulty. Holding my hand, looking deeply into my eyes, she begins to cry.
“Are you able to speak? She moves her head very slightly from side to side letting me know she can not speak.
“Can you understand what I am saying?” She nods her head ever so slightly.
I pull up a chair to be next to her, looking directly into her tear drenched eyes, leaning closer.
“I need to tell you something important and I hope you can trust I’m telling you the truth.”
Her eyes widen.
“You are safe now. You would not be here unless you were out of danger.”
At these words she begins crying more intensely, and her cries are accompanied by a wordless wailing sound, the only sound she apparently can make given her condition.
“I need to tell you something else”. Her wailing stops, even as her tears continue to flow.
“I don’t know anything about you, who loves you and who is supporting you. But I mean this with all my heart. I love you and I am here for you.”
With this, she begins to wail again, this time louder, deep toned, incredibly mournful, animal like. The sound of inconsolable loneliness and grief.
One of the nurses enters and tries to calm her, “It’s alright, you don’t need to worry.” I gently cut her off. “Let her cry, she needs to and I’m with her.”
For the next 20 minutes I sit with her as she cries. I say to her, “Let it out,” “I feel you must be missing a loved one, maybe your mother,” and other words, not meant as comfort but rather as acknowledgment of what she has lost.
A new nurse comes in, to give her pills and otherwise to attend to her. She stops her crying. I tell her I will see her the next day. What I want to tell her is this: “You are feeling your grief. That grief will take a long time to heal. But tomorrow the healing will begin.”
Unlike chaplains in acute care settings, I have the opportunity to meet with patients and families repeatedly, over two , three or four weeks. While our patients have been severely damaged and have suffered a traumatic event, few are “actively” dying. Most will live lives of normal length. But for many, adapting to their condition – be it a lifetime bound to a wheelchair or walker, or needing assistance in activities of daily living – will be an ongoing process for years and decades to come.
Many arrive with the fantasy that “rehabilitation” means “getting back to the way I was before.” This is not usually the case and whatever their physical and cognitive improvements over time, to me this is a myth, entirely elusive. Their damage is in all cases a defining moment in the arc of patients’ lives and that of their loved ones as well. Phrases like “before Billy had his accident,” “before Dad’s stroke,” “after he had surgery for his brain tumor” are routine in the KFRC. They become the markers of a changed life. The idea of returning to life “before” resembles the denial common to patients and family members as they anticipate or confront death.
The rehab patient and their family members experience, consciously and unconsciously, a deep sense of loss and, with that loss, grief. The person they imagined they were, the narrative of their lives up that point, is over, forever gone, “dead”, never to return. Unlike with the dying, there is also a secondary grief, the loss of the person they imagined they would be and become in the future. Many a patient has told me that they had recently retired and they had this or that plan for the next 20-plus years, the so-called “golden” years, often for travel, exploration, or fulfilling a bucket list of aspirations and dreams. Sometimes just days or weeks before or after this retirement plan and their “new life” is to begin – Bam! – a stroke or other event strikes! Never expected or rarely even imagined, their lives are forever changed.
As with death, if we are to truly move through and transcend its life changing effects it is important in the face of loss to acknowledge grief, to fully experience it, to feel it at its core. The denial of loss – a coping mechanism we often seem to readily embrace – takes a heavy toll, creating limits on our intimate relationships, accompanied by fear and, perhaps worst of all, the “demons” of shame and self-loathing.
Only by accepting and then moving through grief can we fully begin the process of healing. Thus, here at the KFRC, even while those in our care are processing the immediate grief in the loss of their own imagined life story, they have an opportunity to be reborn, to choose who they will be in this new life ahead.
It is the next day and I come to visit the woman again. She again tears up, but this time her eyes suggest a shyness that I interpret to mean a kind of gratitude for my presence and the moment of intimacy we shared the day before. She still cannot speak a word, but her face holds all she needs to say for today.
After speaking to her for a couple of minutes about the busy day she has ahead, I tell her, “I believe that before you leave here you will be able to tell me all about yourself. And I can’t wait to learn who you are and who you hope to become.”
The KFRC is a place of loss, grief and rebirth. Like midwives, we accompany patients through the fear and anticipation of birthing a new life and embracing the challenges, joys, sorrows, and uncertainty that life uniquely holds for them, as it does for each and every one of us.
Peter Meadow is the Clinical Fellow in Pastoral Care at Kaiser Permanente in Vallejo, California, and currently serves as chaplain to the Kaiser Permanente Rehabilitation Center. He is a member of the Sacramento Chapter of the College of Pastoral Supervision and Psychotherapy.