The patients Alisa Danon works with expect to be heading home within a few hours, maybe to the office or to shop for groceries or other mundane activities of life.
But their lives can be complicated, as they suffer from serious illnesses, like cancer or kidney disease.
As the first chaplain serving patients at the Cancer Center, Infusion Center, and Radiation Oncology Department at Saint Barnabas Medical Center in Livingston, N.J., Danon councils men and women trying to cope with pain, discomfort, fear, and sometimes the weight of confronting their own mortality. Sometimes the services she offers are as simple as sharing a song while patients undergo an infusion, or laughing as they eat an especially delicious piece of chocolate. Other times it can be as difficult as helping them reassess their lives.
“They might not be as sick as the people who’re hospitalized, but they face other challenges,” she said. After all, not only do they have to contend with their illnesses and treatments, but also their complicated home and family lives.
As healthcare shifts toward outpatient treatment over hospitalization, there has also been an increased focus on improving services delivered outside of hospital settings. Providing chaplains to offer spiritual guidance is one such example.
Research confirms the benefits of tending to a patient’s spiritual needs. A study of 31 patients with advanced cancer showed improvement after just three sessions with chaplains in their outpatient setting. They reported increased spiritual wellbeing, strengthened faith, and the ability to use their religion to cope with adversity, according to a November 2017 article published in the Journal of Pain and Symptom Management.
“The need is so clear, it’s hard to see why it has taken till now to introduce,” said Cecille Asekoff, longtime director of the Joint Chaplaincy Committee of Greater MetroWest in New Jersey, the organization partnering with Saint Barnabas in what she calls a “trail-blazing” program. Asekoff is also executive vice president emerita of Neshama: Association of Jewish Chaplains.
Though Danon is Jewish, she is available for people of all faiths, or even those with none. She’s a careful listener who is devoted to her patients, so much so that she invites those who come in on her off days to call her if they want to talk. For Danon, her accessibility is part of encouraging healthy communication, and creating the best possible environment for the patients, however brief their time in the treatment center.
She describes her approach as “one-downsmanship,” which she defines as a determination to listen, to be comfortable with silence if need be, and to allow patients to open up about their feelings, their concerns, and their beliefs. Some choose to keep the exchange superficial; others want her to pray with them or talk about heaven.
“I let them know, ‘Yeah, this is hard,’” she said. “They can feel hurt and scared and not know what is going to happen next.”
She is also mindful that they are going back into the outside world, talking with them about issues like going out in public with a wig, or trying to hide symptoms from colleagues. “I don’t leave them there. I’ll ask them about obstacles they’ve faced in the past, and what gave them strength then.”
Danon has been at the job for more than a year, but the seed was planted in Asekoff’s mind several years ago when a friend terminated her dialysis treatments and realized she had just days to live.
“She mentioned how much she would have welcomed spiritual support during the long hours of her treatments,” Asekoff recalled. “She said she was starting to think about end-of-life issues and she had hours to lie there and think about it.”
That was Asekoff’s a-ha moment. She had never heard of hospitals providing spiritual guidance for outpatients, and she was someone who would know if they were: Asekoff has worked for decades with programs across the country and in Israel that promote clinical pastoral care at places as varied as hospice centers and prisons.
In 2016 she approached the Jewish Community Foundation, the planned giving and endowment arm of Jewish Federation of Greater MetroWest N.J., with the idea, and they responded with alacrity, offering a one-year grant, to cover a chaplain’s salary for two days a week. Now the position is funded by Saint Barnabas Medical Center, an RWJBarnabas Health facility.
After a search through the National Association of Jewish Chaplains, Danon was hired. Her background matched Asekoff’s criteria: a person with clinical pastoral training and experience working within a hospital setting. For 15 years Danon worked as the religious and intergenerational programs coordinator at the Hebrew Home at Riverdale and as an associate chaplain at Palisades Medical Center.
With treatments that can run as long as eight hours, sometimes Danon has generous stretches of time to talk with one person. Her goal, she said, is to enhance their sense of being a valued part of a caring community. “I give them an opportunity to create and tell the story that makes sense to them, that remind them that they matter and what they have done matters, and that they will be remembered,” she said. “Everyone has a story.”
Danon is available to the center’s staff as well. For the professionals charged with the weighty responsibility of caring for the sick, the challenges can be similar to those of her patients. Some of them seek her out for advice on facing stresses in their home lives. She councils them “to open up a safe, sacred space, to help them identify their own sources of strength.”
According to Angela McCabe, director of Psychosocial Support Services at Saint Barnabas, patients have been enthusiastic about meeting with Danon and have remarked that she is easy to talk to. McCabe recalled one instance in which Danon helped a patient reconnect with her faith. Another told McCabe “I needed to work through some guilt that I was harboring about my relationship with God,” and Danon helped the patient throughout that process.
McCabe called Danon “a tremendous resource.”
Of her outpatient services, Danon said, “I feel incredibly blessed to be part of it. I can’t think of anything I’d rather be doing than visiting these people, and helping them find the strength and meaning in the gentlest way possible.”
As for those who aren’t spiritually inclined or simply don’t want her ministration, that’s all right, too.
“With those who say, ‘No, I’m not interested,’ that’s a gift too. In so many ways, with their families and with their doctors, they can’t say no. This is one moment of control and I’m happy to give it to them.”