I was called to go to a patient's bedside to sit vigil...he happened to be Catholic.
Sometimes the bedside vigil happens - but less than you might imagine. The conditions of hospice are chaotic. We pretend we are in control, and we are of some things, but life happens. Today, the IDG (or IDT) team communication was well oiled and functioning as it should be. And we had time to respond appropriately, which is mostly out of our control.

Previously, this patient had several ups and downs as it typical of the end of life. Last week, when she came onto our service, she was talking about getting back to her old neighborhood and house...I thought she might make it, too, which does happens.

​The Catholic Faith Tradition and the Sacrament of the Anointing of the Sick
As a devout Catholic who went to mass three times a week, there was a question that I immediately looked for an opportunity to weave into our beginning conversation.  This is tricky–because she does not know me. We do not yet have a relationship of trust. But when an opening did present itself, last week she was very clear with me that she did NOT want a priest to visit. A eucharistic lay minister to give her communion was good but no priest.

When any patient comes onto hospice service, as a clinical chaplain, Medicare asks us to open the subject, as gracefully as possible, of any spiritual anxiety they may have. It is a beginning point to help them explore their inner landscapes.  Have they made peace with this condition they are in? Or are they still wrestling and resisting ? The questions are more important than the answers...and that they know the chaplain or the medical social worker is able and trustworthy to speak with them, should they wish.

​Family is not always easy for the patient to talk with for so many reasons. I am Switzerland and an interfaith chaplain.  I respect all faith traditions. Either I don't have a dog in all the religious diversity and contentions or they are ALL my dogs. The answer probably doesn't matter because it is the same result.  I respect them as voices of the Holy One of Many Names.

The relief that some patients have in having the conversation is what matters.

Essential Chaplain Superpowers: a Bluetooth Speaker and iPhone
I studied while in seminary with a wise and eloquent Dominican Nun.  I know a lot but am quite humble and without assumptions to be complete support.  Generally speaking, this is a healthy assumption for all. However, I speak a dialect of fluent 'Catholic" with the help of my Bose Bluetooth Speaker and iPhone superpowers.  

The patient was non-verbal at the point I arrived.  It was going to be a couple of hours until his people arrived so I called up YouTube and put on a high mass which lasted for an hour and a half.  It was amazing.  The patient seemed to like it - not because he said so (he was non-verbal but not unresponsive...).  I explained who I was and what I was about to do and checked in with him regularly.

​I wiped his face with a wet cloth and sat with him.

Questions of Readiness or Denial?
But to respect the Catholic faith, the question of 'would you like a blessing from a priest?' is an essential one.  The phrasing is a 'softball' way of asking if they want an Anointing of the Sick sacrament.  A 'yes' can be an admission of readiness to pass from this life or not.  The answer is always illuminating of their process. (Are they in denial? Are they hoping for a miracle? Do they really want to try and cure this illness...which at least one of their doctors has already recommended to them as an unwise use of their hope?)

The conversation about spiritual anxiety or spiritual readiness is an important conversation for all patients, but there are different ways to gently inquire of a patient who is not Catholic.   But, that is another post.
​

A hospice wedding can be a beautiful thing.
It is not common to be asked to perform a ceremony in hospice, but when a chaplain is there are many things to address before you say yes. I performed a wedding last week and it was amazing but only after I had done my homework.

First the your IDG (IDT) team must be consulted...
Hospice runs on our interdisciplinary teams. Each of us have a point of view and we need them all here. Your medical social worker (MSW) might have insight as to what the underlying psycho-social situation is.  Money and inheritance issues can complicate the simple loving decision to want be married.  Doctor, MSW, Case Manager (CM), and aides may have deeper (and different) insights into the possible complications and motivations which may or may not be achieved by a wedding.

Review your hospice's policy and procedures
Ask your administrator to sign off on the wedding. Do they have any concerns or written policies which they can offer as guidance?  This can be tricky ground, but better for those who have tread it before you.

Find out more about what the bride and grooms want or need.
What are their expectations about ...the surviving spouses needs.  If it is social security they are out of luck.  It takes a year or year and a half before widow's or widower's benefits may be bestowed.  If the spouse dies before that time period, the surviving spouse does not receive benefits.

Why now? The question's answer is not always obvious.

Logistics: Can both parties actually ambulate... for the license?
The good news here, (and not well known) is that most county registrars who deal with marriage have a process where a sick bride or groom may not attend to the license. 

The ceremony can come to them but there is a bit of paperwork to do to get them there. In addition to all the usual marriage license paperwork and information, you will need:

1.  Affidavit of Inability to Appear and Request for Issuance of a Marriage License which is usually notarized.
2. The hospice medical director (aka doctor) letter affirming that patient is unable to appear due to infirmity on hospice stationary.
3. Whatever else your County decides it wants. Hence the research needed to be done by your team.
   
   

And it could just be love...

A wedding ceremony in hospice can be a beautiful moment...
It can be a place to say I love you, to resolve important issues, to say a good bye and to have comfort from pain while you do.

Statistically people live longer in hospice with a terminal illness and with a better quality of life. And sometimes they live long enough to get hitched.   Amen.