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Taylor Leddin-McMaster (Host): Hello, listeners.Thanks for tuning into the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Taylor Leddin-McMaster. And joining me today is Denise Salem, chaplain with the Riverside Cancer Institute. And she's here today to talk about the role of pastoral care in cancer treatment. Welcome.

Denise Salem: Thank you. It's nice to be here.

Host: Thanks for being here. So first, can you tell us a little bit about yourself and what led you to becoming a healthcare chaplain?

Denise Salem: Well, becoming a chaplain was the route I thought I would least take in my careers later in life. My previous life included around 30 to 35 years of marketing and foundation work and public relations. And I was searching for perhaps a change, I just didn't know what. And out of the blue, a friend calls me one evening and said, "I think you should consider taking clinical pastoral education courses." And that is the gold mark standard, gold standard, if you will, for reaching full credentialing in chaplaincy.

So, I considered it for a bit and thought I would run with it and see how far it took me. I liked the first unit, and then I made plans to locate somewhere for a year-long residency so that I could get fully credentialed.

I landed in Kankakee, Illinois. I'd never heard of Kankakee, Illinois. I've never lived outside Iowa. But here I am, and I finished my residency, and I decided to stay because I was offered a newly created position as the outpatient oncology chaplain for Riverside Medical Center.

Host: So, you must have done well in your residency.

Denise Salem: I did enjoy it. It was very valuable and important work, and I didn't realize, that it would lead me here, much less keep me here.

Host: That's wonderful. So, can you give us an idea of what a typical day might look like here at the Cancer Institute?

Denise Salem: Sure. As to be expected, my days are always patient-centered. I am based out of the Riverside Cancer Institute in Bourbonnais, but I also see patients in our outlying outpatient infusion clinics in Watseka, Frankfort, and Coal City, as I'm needed there and according to the patient volume and so forth. But my days are spent largely with patients and their families.

Host: What's something you wish more people knew about your role?

Denise Salem: It can be somewhat of a confusing role in what we do because I think there's some overlapping or confusion with chaplaincy and being a pastor, who leads their own congregation and who might be ordained in ministry. I am neither of those. That's not the calling that I received.

But one thing I wish that people know and most people do recognize that chaplaincy is a position that allows people to grow and heal emotionally and spiritually. My position does not call for, nor would I do this, but there is no preaching, coercion, proselytizing. That's not what chaplains are supposed to do. Alongside that, I will add too that my role allows me to serve people of all faiths and those without a faith.

Host: Yeah, we'll touch on that a little bit more later too. Going back a little bit, can you give the definition to your best ability of what pastoral care is in a healthcare setting?

Denise Salem: At the basic level, the foundational level, I perceive chaplaincy roles to simply add an extra layer of care for patients and their families and our staff, that allows them to heal and grow in whatever manner suits them best. It might be through sharing a devotion or offering a prayer or a blessing, the opportunity to share a meaning-making story, for example. So, healing and growth happens in a variety of ways that's unique to the individual, whether it be receiving a prayer or blessing or sharing a devotion, perhaps sharing a meaning-making story that's important to them. But most importantly, pastoral and spiritual care gives patients the opportunity to be heard and feel heard.

Host: And you already answered part of this question, and you said that patients don't have to be religious to meet with you. Can you talk a little bit more about who can benefit from pastoral services, and maybe if you have any examples of past patients you worked with that maybe didn't have a specific faith but wanted to meet with you still?

Denise Salem: Anyone who feels they need a listening ear or space given just to them would certainly be worthy of pastoral and spiritual care visits and would benefit from them. As in terms of religious requirements and so forth, involvement or belief in a specific denomination is not a requirement by any means.

Because we serve, like I said earlier, all faiths and those without a faith. And once in a while I will come across someone who hasn't even been exposed to a faith. Because as a young child, they were not introduced to any type of formal religion or faith. So a lot of times, it's simply a matter of wanting somebody to hear them or converse with. Sometimes a hospital bed or chemotherapy room can be lonely, sometimes it's just a matter of me checking in with them to see how they're going. We don't hold boundaries for who deserves it, who needs it. It's open to everyone.

Host: Yeah. That's a really important part of the team, just to have someone who can provide a listening ear and that support. So, that's fantastic.

Before we continue our conversation, we're going to take a moment to talk about the importance of primary care. At Riverside, our primary care providers are right here in your community, offering personalized care for you and your family, close to home and connected to the specialists and services you may need.

Having a primary care provider means having someone who knows you, listens to you, and helps you stay well through every stage of life, from annual checkups and preventative screenings to managing everyday concerns when they pop up, because remarkable care should never be out of reach. Remarkable care right where you live.

To find a primary care provider who's right for you and your family, visit myrhc.net/acceptingnew.

And we're back talking about pastoral care here at the Riverside Cancer Institute. A cancer diagnosis affects much more than just physical health. What emotional or spiritual struggles do you commonly see?

Denise Salem: Well, there are a few of them, depending on each patient's situation. But one of the first struggles that I come across, and it's very common, is fear of the unknown. There may be some anxiety, but there's uncertainty as well. There may also be, from time to time, guilt associated with the diagnosis. "Oh, if I'd only taken better care of myself earlier. Maybe I deserve this for a poor life choice I made previously." Sometimes there's reconciling and reasoning as to why this could have happened. It could have been genetic, for example.

But there is something that's been trending, actually the term is trending, and we call it cancer ghosting. And cancer ghosting is when a patient's family member or friend might disappear from the patient's life for a while, and I believe it to be based out of fear and not really knowing how to support their loved one.

So, sometimes it's easier just to go. They may reappear once the patient regains their health, at which time the patient gets to make a choice about reestablishing the relationship. I was reading an article on cancer ghosting. And a patient was quoted in that article as saying that cancer ghosting took more of an emotional toll on her than cancer treatments did throughout her journey, simply because it was a long-lasting relationship that just dissipated. And it leaves them feeling hopeless and sad. So, we do see a little of that. Thankfully not a lot that I'm aware of.

Host: That's got to be difficult to navigate. And again, I'm glad that they have you here to talk through those things. You touched on this a little bit, somebody receiving a new cancer diagnosis. How can you in your role help someone process that?

Denise Salem: I generally try to reach out to the patients who are here for the first time or the second time. Depending on my whereabouts, you know, I may have missed them. So, I may not be able to have that initial visit till their third treatment sometimes. What I do find initially is there's the acknowledgement of fear and anxiety on my end gives them support. I acknowledge, I see the fear, I know your uncertainty, that type of thing. And this is a good starting point for me to introduce myself.

But I also offer a lot of encouragement, and that's with any patient, whether they're new or have been here for a couple of years. I think we all need encouragement, and I enjoy encouraging. It helps the processing along for the patient. Mostly, my presence is a time for sacred space for them to share whatever they want. And if that's about their upcoming fishing trip or a vacation they just got back from something that brings them some type of ease while being here and being taken care of. So, I gauge each situation.

Host: That's something I've noticed that you're really good with. I'm going to go ahead and plug a separate podcast we have with Dr. Basha here at the Cancer Institute, where he sits down with patients and kind of goes through their journey with them and lets them tell their story, and Denise is instrumental in helping us coordinate those podcasts.

And whenever I have the opportunity to come and do the audio for that, and I hear Denise engage with the patient, and she's pretty up-to-date with their personal lives and checking in on them. So, you're very thoughtful and good with that. Are there moments where patients are surprised by how helpful it can be to talk to a chaplain?

Denise Salem: At times, and I like to think it's a pleasant surprise. I come across people who don't know there's a chaplain in the building. And so, sometimes there's relief, like, "Oh, boy, do I need to visit with you." And others, "No, I'm okay, but thank you for stopping by to introduce yourself." So, you know, we kind of read the room. But yes, I do think that for the most part, there's a sense of appreciation for the role of stepping into their life and taking an interest in their journey and how it's going.

I was reading an article that was a result of a study done where there was a patient, chaplain involvement rather, with patients during visits in, I believe it was a hospital, not necessarily an oncology clinic. But as a result of one or two chaplain visits, patients stated that they were feeling relief, peace, and strength as a result of having somebody that they could trust and develop a relationship with. But also, there's an element of decreased loneliness. Many of our patients don't have a support system. Their families or friends live a distance away. And a lot of times, we are their support system

Host: Well, that kind of leads into our next question. And I also want to go back to the cancer ghosting mentioned earlier because I'm curious what advice you might have for caregivers or friends and family who are carrying a heavy emotional burden with a cancer diagnosis. What advice do you have for them as they go through this, and how do you support family members that come along here with patients?

Denise Salem: In this clinic, we advocate for self-care for our patients. It's important to get the rest when they need, eat as they can, you know, as it is tolerable, and try to carry on as stress-free as they can, which I know can be difficult. I would offer that same advice to the caregivers. And many times the caregivers are with patients in our clinic, and I always check in with them to see how they're doing. It's important. So when I engage in a conversation with a patient, if there's a family or friend that is there, I bring them in because they're important too, and they shouldn't be on this journey alone.

A lot of times, the caretaker is involved in handling the medical appointments, the prescription protocol, the list of ongoing questions. So, it is important too that they take care of themselves, self-care, in whatever way that looks like for them. And also, connect with a support system. Sometimes that's leaning on another family member to do something for them so they can rest or get to an appointment with the patient. Whatever the case is, it requires adaptability. But also, its support is very critical for the caregivers.

Host: Yeah. Absolutely. Kind of what we were touching on with the ghosting you had mentioned. What advice would you give to someone who wants to support a loved one who may be going through a cancer journey but they don't know what to say?

Denise Salem: that's common, and it depends on the relationship with patients and their family members.

But generally, simply showing up is invaluable and important. there are no perfect words you can ever say. And sometimes getting creative in how you show up in an unexpected way is a real gift to the patient. For example, there is or has been a patient that I visited with in the past who had a sibling that lived a distance away and couldn't be with them personally. But every morning, they sent the patient a text with a funny meme, a scripture, a word of encouragement, and it gave the patient something promising to look forward to when they turned their phone on the next morning.

There is another patient who, with a close circle of friends, chat each night about 9:00 before they all turn in for the night and do a devotion together. I don't know how large the group is, probably four or five or six. And they group chat via phone every evening. And they not only check in with the patient, but with each other. So, it's encouraging all the way around. And I wouldn't be surprised if this is a tradition that continues down the road because it seems to be very joyful and important for all of them.

Host: Yeah.

Denise Salem: Yeah. So yeah, so my suggestion there would be it's okay to get creative and use your imagination as to how you're going to show up for someone.

Host: I like that. Yeah. In your experience, what gives people hope during difficult seasons of life?

Denise Salem: I believe that initial hope is anchored in the recognition that our patients have a really great medical team that they can trust and depend on. Once you believe in your medical team, your provider, the whole staff here, it makes the journey a little easier. That's one less thing they have to worry about and I hear that on a consistent basis. "I love my doctor. The nurses are great. The radiation team is wonderful." We're very proud of that here, and I think that is the first step of offering hope.

Supportive relationships are critical. I know we've touched on that a little bit. But one thing I notice that really brings excitement to the patient is anticipation of a future milestone or event. If they know there's a family wedding coming up in a year, or there's a vacation that's been booked, or something really important to them is waiting for them, it shores them up. It provides something to look forward to, and it gives them a good reason to keep fighting the fight

Host: We're at the end here. Is there anything else you'd like to add or share with listeners?

Denise Salem: Chaplains are doing their work because they love helping people and being there for others. And I like that too. I love doing that. But one thing I've come to realize is it's also a fluid position. And by that I mean being adaptable to the present moment and what's in front of us. So if I know that I'm walking into a room where the patient has gotten less than encouraging news, I know how to approach the visit. There may also be a circumstance where there's just really exciting news.

The ability to meet the patient where they are is key and adapt to continually changing circumstances and situations. But beneath all of that, what I do is provide encouragement, no matter the situation. And it's given freely to patients, their families, and our staff. And it's something our staff does as well for everyone. So, that is the one thing we're very proud of. We are an encouraging team.

Host: Yeah, I've seen it with my own eyes. Thank you not only for being here today to talk about this, but just for the work that you do in general. It's certainly invaluable, so we appreciate you.

And thank you all for tuning into the Well Within Reach podcast. Be sure to like and subscribe to Well Within Reach on Apple, Spotify, or wherever you get your podcasts. To learn more about cancer services at Riverside, go to riversidehealthcare.org/cancer.