Utilizing Poetry as Spiritual Care for Hospital Staff

Abstract

This personal reflection emphasizes the potential benefits of poetry for interfaith spiritual and pastoral support of medical professionals. Details are provided for the implementation of several successful practices, including an Intensive Care Unit Poetry Basket, Portable Poetry with Aromatherapy Towelette Hand Blessings, and Presenting Poems to Nurse Practice Council. The references include the poetry used in the spiritual care activities and the author also provided a helpful “Further Resources” section.

Poetry as Sacred

In my practice as an interfaith chaplain that draws primarily on Zen Buddhism, I have used poetry as a form of nondenominational scripture. Poetry's form inherently includes gaps between words, lines and stanzas, places where meaning-making requires silence or where traveling along a line of thinking ends where the horizon beyond it is not yet seen. This form can accompany times of grief and loss not only for patients and their loved ones, but for hospital staff tending to suffering daily. Poetry is a potential aid toward grieving, as letting go of loss in our hearts can create space for continued tenderness.

As a poet, I often write my way back to tenderness from a starting place of numbness, pain, or sadness—poetry, for me, is a way of organizing experiences as a chaplain. I try to bring poems to patients, families, and staff that touch upon or accompany their grief in accessible ways. Poet Gregory Orr (2020), who credits poetry with aiding him through trauma says in an online interview, “Shaping Grief with Language”:

We ordinary people, in our daily lives, we experience enormous amounts of disorder and confusion. It's inside us. It's in our past. It's in the unknowable future. And we just navigate our lives with this kind of interplay of disorder and order. And what poetry says to us is, turn your confusion, turn your world into words. Take it outside yourself into language. Poetry says, I’m going to meet you halfway. You just bring me your chaos. I’ll bring you all sorts of ordering principles.

This notion of being met halfway while experiencing inner turmoil provides the other half of an embrace otherwise left existentially empty. To bring what haunts us inside to the outside allows a relationship with it. When turmoil no longer only resides in internal isolation for the bearers, but outside them as well, the distance between the bearer and what is held makes space for potential healing. Poetry reaching back is reminiscent of the way some feel God reaches back when cried out to in pain; poetry can constitute a form of prayer.

Reading and writing poetry can aid in expression that feels fragmented rather than a linear organization of time—poetry's form holds and provides containers for brokenness. The Italian word “stanza” translates as “room,” and one guiding metaphor I practice in chaplaincy is that of a pilgrimage—moving from story to story, mystery to mystery, room to room. Poetry can accompany us when a story is hard to form when meaning-making involves interruptions and uncertainties. Elizabeth Davies (2018) expresses how poetry can allow people to deal with difficult emotions in a way that helps coping and brings coherence in the face of disruptive events.

Familiar language takes us only so far in some experiences, and then there is an edge, a cliff, where there is nothing to say or something cannot be said—that feels, to me, to be the place where prayer and poetry reside and from which they arise. Poetry is made as much of wordlessness as words, and sometimes the words/voice feel present to accentuate the silence/space around them. A place where we have nothing to “say” can be gathered in poetry, like the way tree branches gather falling snow.

As a Buddhist, I do not hold a traditional prayer practice in my life (though liturgy and dedications feel like prayer), and yet I find praying with patients and families authentic and deeply meaningful. When I offer a spontaneous prayer during a visit, it feels to me like a poem built from active, reflective listening; I want to hand them something back that they have handed me, in a framework of pulling the eternal into time, pulling light into the hospital room, or understanding and accompanying the darkness expressed. I often hear, “those were the perfect words,” and I tell them, “You actually said all of that.” A visit itself can feel like a cocreation of prayer.

I also find poetry to be like scripture in that, when finding a suitable poem to read a patient at the moment based on what that person is sharing with me (the goal here is to find text as a companion), expressing the poem situates my own heart at ease, provides it warmth, and makes me more available to the other. Understanding what allows our own disposition of heart to turn toward others and their experience aids us in chaplaincy work.

Poetry feels like an antidote to the ways language is manipulated in the political and capitalist dimensions of our world, and an antidote to the ways everyday language imports habitual energy involving conditioning and reflex within societal power structures. Coulehan and Clary (2005, p. 384) write, “Using poetry, we can reframe the negative war mentality and ‘death as failure’ metaphor that pervade so much of medical practice.” Words can become part of the network of symbols/association with healing in a hospital, along with other instruments.

Like the Psalms, poetry holds human experience and helps people feel less alone in their most isolated and painful times. (That which knows sadness can accompany sadness.) In my own personal life, writing poetry has helped me organize experiences as a chaplain, and supports my grieving process. Given this, I want to make it accessible and offer the same possibility to other staff.

Provided Poems Are Often Shared From Patient to Staff

I first met J, a woman in her mid-50s who had come through the Emergency Department with back pain and suffered a stroke while in the hospital, through her partner M, when she was in the intensive care unit (ICU), intubated and sedated. M would tell me stories of how they met, sharing tears and laughter with me. M kept showing up for J, day after day, reading her comfort level through her body language. I continued to show up, too. It was a case in which palliative care was surprised the patient lived, and one of the nurse practitioners told M he had saved her life by being there by her side, giving her something for which to live. Some months later, after being discharged to rehab, J returned to the hospital in preparation for an invasive and painful back surgery (she had woken from sedation and intubation paralyzed from the waist down—possibly from the stroke), in hopes of more mobility.

It felt amazing to be able to speak with J, and each time I visited she had such a generous personality—getting to know those around her, telling me stories of her life and friends, and naturally drawn to talking about values, goals of care, life and death. On one visit, she looked out the window and told me she was not afraid to die. “If I have this surgery and I don’t wake up from it, I don’t think it's such a bad way. It's like the trees,” she said, “death is a part of life.” She was concerned about the amount of care she might need after the surgery and if her partner understood that. She remembered me from the ICU though she had not been awake for most of my visits. “He has the humor of a middle scholar, but somehow you can talk to him. He trusts you. If I don’t wake up, I want you to be the one to tell him.”

Later that day, I found a poem by Cid Corman (2021) to bring to J. I wrote a note on it telling her it reminded me of our conversation. J was raised Catholic, though identified as more spiritual at that point in her life. M was not religious. The poem felt akin to scripture, accompanying the human experience J had expressed to me earlier.

Sometime later that week, J told me she read the poem every day and had been sharing it with her caregivers, asking them what they think. One day, a nurse in J's unit stopped me in the hallway. She was a float nurse, and I had learned her name, which surprised her. In a previous encounter, she had thanked me for saying hello, so the beginning of a gentle rapport was in process. She said: “That poem you gave [J], she had me read it, and it gave me goosebumps, but I don’t understand poetry.” I told her that poetry can make sense in different ways, including to the body, and goosebumps is a beautiful way of understanding something. I also shared a well-known idiom in Zen Buddhism, that sometimes teachings can be “dark to the mind but radiant to the heart.” I affirmed her receptivity to the poem.

Poetry can have a reputation for being inaccessible, though there are moments when linking a poem to the right person means that the human and poem can speak to one another as companions.

Intensive Care Unit Poetry Basket

One day, new to the hospital and burnt out from a Chaplain Residency during Covid, I had a moment of internal criticism from those age-old stories we accumulate about ourselves through time: “You’re too quiet!” A gentler thought followed: “How can I use my quietness?” I went back to the office and printed poems/blessings to place in a basket in the ICU. Nurses approached me about the poems they read from that basket, some telling me they put a poem in their pocket to consult through the day, and others put some on their own nightstands. This enkindled within me the courage to utilize poetry more in my chaplaincy roles.

Davies (2018) speculates that one reason medical journals do not publish more poetry is because of a fear of “opening the floodgates.” This sounds similar to the ways that individual and collective fear of grief (both holding it and letting it go) can operate in our own lives and bodies. Some examples of the poems in the basket, which I chose in an effort to speak to difficulty from different angles and in different ways, include: “The Way I Must Enter” by Shikibu (1995), “Calm” by Upasama (2021), “Kitchenette Building” by Brooks (1963), and “Heavy” by Oliver (2014). Full references for these example poems are included at the end of the article for those who would like to consider them for their own poetry basket.

The many nurses who shared with me that they treasured these poems helped motivate me to replenish the supply and provided space for conversational staff support in asking what resonated about the poem. It became a way for several staff to speak with me about their spiritual lives and how it relates to (or felt disconnected from) their work.

Poetry With Aromatherapy Towelette Hand Blessings

One of the most meaningful elements of prepandemic chaplaincy work for me had been massaging and blessing the hands of nurses, nurses aids, doctors, etc. I had restructured a conference room into a space lit with electric candles and music, warm towels, oils, and lotion, and massaged hands for an afternoon. With Covid hindering touch, I needed to become creative, so the spiritual care director found single-packaged towelettes with aromatherapy oils in them. I would hand them out individually—going to the person rather them needing to be in my location at a particular time. The invitation included opening the towelette and taking some breaths when they needed a pause in their day. These were accompanied by poems and/or blessings, including “Blessing for the Morning Light” by Whyte (2018) and “Ode to Buttoning and Unbuttoning My Shirt” by Gay (2020).

One meaningful interaction that arose from an aromatherapy blessing utilizing the above Ross Gay's poem happened with an attending physician in the ICU. He stopped me during my rounds, saying: “Hey, can you explain that poem you gave us yesterday?” Gay's poem does not turn from suffering to focus only on joy, but instead, articulates an understanding of suffering and illumines joy that occurs in the midst of it. I explained how that made me think of the hospital and what we encountered. The attending physician then opened up to me about his life, and we shared commentary on systemic pressures that make work/life balance challenging and the burnout hospital staff can feel. Curiosity about the poem opened a dialogue that made it living, leading to reflections such as “How does this apply to our lives as caregivers in the ICU?” In making the poem alive, allowing it to breathe and fit into our context, the process became a catalyst for dialog about ritual, grief, small intimacies, and rote daily tasks that can take on new significance.

Words as Instruments of Healing

Understanding the benefits of poetry in spiritual care support can provide chaplains with important tools. Davies (2018) articulates that “poetry and writing may enable people to reconnect with small elements of everyday life acquiring deep meaning and deep hope,” an expression reminiscent of Ross Gay's poem. Davies also affirms that poetry can sharpen skills and allow acceptance of ambiguity in life experience.

In the churning seas created by grief and loss, poetry can act as a guide or lighthouse as those ambiguous experiences transform us. Poetry speaks to temporality not only in content but also in form. On the page, it can mirror, in a more compact timeframe, our own mortality. In considering that lines end and also hold continued beginnings, poet Catherine Barnett (2011) writes, “Mortality confronts you at every line. Is this it? Is this it? Is/this/it?” (58). Christina Davis (2011), too, addresses mortality: “We drive words, meaning, attachments to the verge of what we know not, toward the blank page and mortal margin” (72). In Zen meditation, each moment comprises arising and falling away, a small beginning and death we attune to through noticing inhaling and exhaling. Such a reminder of mortality keeps clinicians humble—self and others, clinician and patient, poet and listener, we are all of the nature of perishing. Even while we hold professional boundaries, we will all be on “that side” at some point, and we are all dying as we are living.

In “Healing the Healer: Poetry in Palliative Care,” Coulehan and Clary (2005) write about two married poets, Jane Kenyon and Donald Hall. Despite the fact that Kenyon suffered from leukemia, many of her poems referencing illness were written in response to caring for her husband, Donald Hall. Toward the end of Kenyon's life, Hall writes, “I don’t know anyone who can do this [caretaking work] that doesn’t write poetry” (389). The authors ask: “How can any clinician care for the dying without access to [their] own inner life?” (389). Poetry is only one avenue into that inner access, though it is one more possibility for an interfaith chaplain to consider while working with caregivers. The authors recommend memorizing a poem if it feels opaque or difficult, as knowing it “by heart” makes the body a kind of living library and may prove a way to understanding.

In Zen practice, there's something called a Koan which involves active practice with paradox: the practitioner receives a kind of puzzle through an anecdote, but “presents” a response through spontaneous wisdom arising in the body rather than through logic or reasoning. This practice can cultivate deeper tolerance for paradox (simultaneous non-identical truths). This level of knowing beyond words is similar to what can happen during an encounter with poetry.

Reading Poems to Nurse Practice Council

Nurse Practice Council (NPC) occurs monthly in the hospital in which I work. It is a full day of workshops and discussions for nurses across different units. My role there is to offer a guided meditation, and I also bring a poem for reflection depending on things that have been happening in the hospital. Poems I have brought to NPC include “What I would Give” by Rafael Campo (2012), a physician as well as a poet. I also use “Blessing for One Who Is Exhausted” by John O’Donahue (2008). I have also shared the compiled resource, "A Care Package for Caregivers," with them. I have included the references for these at the end of the article. Before reading a poem, I lead a guided meditation. Then, I facilitate discussion about the work of the nurses based on the foundation of that poem while our attention is all directed to the same text. This structure has created rapport in the group and opened several of them to the benefits of poetry in a clinical setting.

Conclusion

Poems can accompany life's experiences during times of grief and trauma, whether from a clinician's perspective tending to suffering or the patient's perspective in the mid of suffering. Interfaith Chaplains can utilize poetry for supporting hospital staff, which aid in burnout and its prevention.