That’s the Spirit

Podcast Transcript

Steph Bayer: Welcome to another episode of Studies and Empathy, a Cleveland Clinic podcast exploring empathy and patient experience. I'm your host, Steph Baer, senior director of the Office of Patient Experience here at the Cleveland Clinic in Cleveland, Ohio, and I'm very pleased to have with me today Reverend Lisa Morrison. Lisa, welcome to Studies and Empathy.

Lisa Morrison: Thanks so much for having me.

Steph Bayer: Lisa's the director of spiritual care at Cleveland Clinic. In her role, she leads the Center for Spiritual Care, whose hospital chaplain show up for patients and their families by leading prayers, offering healing touch techniques, or just listening. Lisa also leads our healing services programs, which provide support to patients and caregivers as well as our family liaisons, which we'll talk about in a bit. Lisa has 20 years experience in healthcare chaplaincy and administration, and she's committed to advocacy, support and work for equity and inclusion. Hey, I'm excited to have you here today.

Lisa Morrison: I’m excited to be here with you.

Steph Bayer: Now as we get going, I know that I had to get you here fighting and pushing and screaming and thank you Chaplain. Thank you Reverend for making the time.

Lisa Morrison: You are so welcome. 

Steph Bayer: Can't wait to talk about this with you.

Lisa Morrison: This'll be fun.

Steph Bayer: You've been in your role how long now?

Lisa Morrison: Just over a year.

Steph Bayer: That's so awesome. It feels like it's been forever because you're so good at it. Let's start with telling a little bit about yourself, your background and how you became, and I think it's actually the senior director of spiritual care.

Lisa Morrison: So to get started, I wasn't raised in a particularly religious household and yet still faith and spirituality became really important to me as I navigated some life challenges. I saw what a difference it made in my life and then the first time I ever saw a chaplain show up was sadly when my grandfather died really unexpectedly, and this chaplain showed up in the emergency department and although he couldn't change any outcomes for us, just his presence in being there was really impactful to me. I always knew that I wanted to do something that gave back to others and it just seemed to be such a natural fit.

Steph Bayer: How old were you when that happened?

Lisa Morrison: Oh, probably in my early twenties. Wow. Yeah, so then at that time I decided to get an advanced degree in theology at Boston University and then really just continue to fall in love with the idea of chaplaincy and wanting to be able to help. And so I enrolled in my first unit of clinical pastoral education or CPE, and that is a professional training program that combines professional education with hands-on experience in a multi-faith clinical setting. So it really allows you the opportunity to learn how to work with all different types of people and in different settings. I completed four units of that, clinically trained chaplains all have an advanced theology degree and four units of CPE. In fact, I did my residency here at the Cleveland Clinic way back in 2002. It looks a lot different now, but I did my residency here then and after I finished that, I worked as a hospice chaplain and in hospital chaplaincy and as a coordinator of spiritual care. And then I got to come back to the Cleveland Clinic about six years ago, first as an on-call chaplain at Fairview, and then the director of the department there. And then that led to my current position,

Steph Bayer: Which we're so glad to have you in.

Lisa Morrison: Thank you. I'm so glad to be here in it.

Steph Bayer: For those who might be listening and don't know exactly what spiritual care is, how is it different or similar to religion?

Lisa Morrison: Yeah, I'm so glad that you asked. I think sometimes there's this misconception that chaplains just do religious things and sometimes if we knock on a door, the patient might say, I'm not religious, or I haven't been a very good religious person, and that's not really what we're here for. Spiritual care certainly encompasses religious care, and so we might support a patient who gets their strength and support through a particular religion or through practices like holy communion or certain prayers, and we certainly can provide that for folks, but spirituality and spiritual care is bigger than that. It really is about assessing and supporting a patient in whatever it is that gives them a sense of strength, a sense of support. A sense of connection. I always say that spiritual care is first and foremost about having presence. It's about being able to be present and supporting the patient, allowing them to define what that looks like for them, whatever it is that supports them and connects them. We want to be there for it, whether it's religious or not,

Steph Bayer: That patient centricity is such a key differentiator. Absolutely. It's also, as I've learned from you and from your team, why CPE and getting these trained chaplains in with their education units are so important because it helps maintain the patient's religion and the patient's needs, whether or not religious.

Lisa Morrison: That's exactly right, and it keeps our own stuff, our own stuff so that we don't transfer it to the patient. We never want the agenda of the visit to become about us. It needs to stay central to what is important and supportive to that particular patient. Even patients who are religious, we can't ever assume that two, say Catholic patients or Methodist patients or Hindu patients would want the same thing. So we really want to make sure that we have the training to understand how to maintain that patient centricity.

Steph Bayer: I think that neutrality is so important and it really makes our patients the center as we need to do in patient experience. So it's such a natural fit to get to work with your team often, and I think historically we thought of spiritual care as chaplaincy in just the chaplain role, but I know that our team is broader than that actually here there's a broad breadth that includes definitely our chaplains, but there's other services too. Can we talk more, and we kind of mentioned the introduction, but can you talk more about what else is encompassed within your department?

Lisa Morrison: Absolutely. I'd love to. So certainly staff chaplains who are trained to either support religiously or non religiously who can provide good sense of listening and empathy. Also, our chaplains serve with our healing services department along with our holistic nurses who utilize a holistically based approach to support the mind, body and spirit and emotional wellbeing of our patients, family members and also our caregivers. And that's really important here too. Our healing services team really takes lead on supporting our caregivers through initiatives called Code Lavender. A code Lavender is a different kind of code. Sometimes codes give a sense of everyone goes running to the room, it's really stressful and there's a lot of anxiety. A code lavender, think about that light purple color. It's sort of like, let's just take a breath. Let's see what we can do to support this team that's in need. Maybe there's been a really difficult death of a long-term patient or something unexpected.

Lisa Morrison: Something's happened to a long-term caregiver. We'll come in and do an assessment to see how we can best support that team. And it might be some group debriefing, some one-on-one support. We might loop in some other departments or even partake in some different types of rituals. One that's a team favorite seems to be, it's called a water bowl. So we have a beautiful crystal bowl and caregivers can write down something maybe that's been on their heart or that they need to let go of, and they write it down on water dissolving paper and we lead them in a process of being able to let that go into the water and have it dissolve. And it can be, it's so simple, but it can be such an important ritual for them as they learn to process some really, really challenging and difficult things.

Steph Bayer: And that caregiver, and I want you to keep going, but that caregiver component is so important in today's healthcare environment. Absolutely. We've been talking with some other guest recently about how the residue of the pandemic and we just kind of rush to the next fire and it's what's next. We've never really taken time to assess ourselves and to make sure that we're okay. We're putting on our own oxygen mask first. The code lavender and the modalities that you offer our caregivers are so key for burnout, for resilience, and we hear it in our engagement surveys too about how important it's and how they just want more of that support. So I would encourage anyone who's listening not part of the Cleveland Clinic family, if they have questions and how to introduce us to their own environment that we certainly would love to help you connect with them because it's key to all of healthcare. We need more and more healthcare workers, not

Lisa Morrison: Less. It absolutely is. It absolutely is. The stress level for caregivers has been higher than ever and post pandemic, we're at a point now where when you're running from fire to fire, you don't even realize that you haven't had a chance to catch up. But now we're at a point where it's like, Ooh, it sort of has all cut up with us and more and it feels overwhelming. And so finding ways to debrief with your team just like practice that pause and take a breath together can be really helpful. Our caregivers are incredible human beings and we need to do the best we can to help care and support them. Some other members of our team that I want to highlight are our family liaisons. You talked about them in our introduction, and they are a team of folks who really to preserve the dignity of the patient even after a patient dies, right?

Lisa Morrison: And so when that happens, family members can feel really lost. They don't know what to do next. Family liaisons come alongside to help make sure that the steps are maintained, go ahead and continue to best give dignity to that person who has lived and whatever needs to happen as they make those next steps. That can be particularly challenging if there's an international patient, if we're having trouble locating family and for family members to know that we don't just drop them or leave them if their loved one does die, that we're still there to come alongside them really makes a huge difference. And I'm so grateful for our family liaisons. And then I also don't want to forget to mention first of all, our education department. We have a robust education department of certified educators who train chaplain interns and chaplain residents and even students who are training to become educators. And that's really special. And we have this great team that continues to further the mission of education with the Cleveland Clinic and then also our administrative coordinators. They are our glue. They do so much for us. And so often Steph, they're the first face and first voice that a grieving family member or an afraid patient might come across. And just to have their sense of care and empathy makes such a difference. I lead the best team in this entire place and I'm so grateful

Steph Bayer: And I take credit for this team, even though you're the leader, I like to claim this is my wide family because you guys are so special and the work you do matter so much. And thank you for thinking of all the components of the team when I asked about that because you're right. There's so much there that we need to celebrate and recognize. There was something you also said that I just want to make sure that we touch upon because it just hit me that it's a really beautiful practice that your team has and that has bubbled up throughout our organization now. But you said often that we haven't taken a pause for ourselves since everything's been going on and that we just need to pause. One of the techniques that I learned from spiritual care and has now been adopted all the way to our executive level in our daily huddles is a pause. Yes. Can you talk to us about what that pause is?

Lisa Morrison: Absolutely. So a pause can happen at the time of death at a bedside where after a patient has died, the caregivers who are still around the bedside and any family who are present gather and the chaplain or any of the caregivers can just take a moment to say, let us pause for a moment. And it really is simply a moment. And in that time, we give thanks for that person's life. We give thanks for the caregivers and the work they have done, and we bring to mind those who have loved that patient. And again, Steph, this takes probably less than a minute, but it is so meaningful and so impactful for the caregivers as well as any family who happen to be there, to just take a moment to acknowledge that something really important has and to give thanks for that life is deeply meaningful for everyone.

Steph Bayer: It's so important. I've been present at the pause of the bedside with the family and our caregivers, and I've also been present with the executive level pauses where we will read the names of all those that trust us with their care and died in the last 24 hours. And we'll read the first names. And at that executive level daily at this huddle, our leaders from our CEO on will take a second and recognize and honor that person. And again, like you said, it doesn't take more than a few seconds, but it does ground you so importantly to the work we do and why we do it.

Lisa Morrison: Absolutely. And I love that our executive team does that daily. Our spiritual care team does too, and it is just so meaningful and it helps us to really stay connected and to remember the importance of the work that we do. It's not just about seeing big numbers of patients, it's about caring for each individual person and recognizing and validating that human connection that we have had with them.

Steph Bayer: And there's empathy, right? This is the setting empathy. So I'm very interested in the power of empathy and it's what you guys do every day. What are some ways also that our hospital chaplains show empathy? Can you give me an example of a time when empathy played a crucial role in impacting a patient or a caregiver? I love stories.

Lisa Morrison: Absolutely. I've got stories for days. I think of the Nike slogan from a while back or maybe even now. The don't just sit there and do something and in spiritual care, it's actually the opposite. It's about don't just do something, sit there. And so when I think about empathy, I think about what it means to show up and sit down and just to be able to listen deeply. That is empathy in spiritual care. It's about being able to be present with the one that we're listening to In chaplaincy. We talk a lot about holding space. And holding space is about letting something simply be so that if I come alongside of you and you're having a rough day, I'll let you share. Thank you for sharing. I'll support you in that. But I don't, again, I don't make it about me. I don't try to fix it for you.

Lisa Morrison: I don't tell you, Steph, there'll be worse days or Steph, come on, someone's going through something worse than you. That's not empathy, right? I'm willing to be with you in the midst of the messiness of life that I don't need to feel like I have to put a bow on it or try to change it. I hold space with you. And I think that has a lot to do with empathy. I think about one of the visits I've had with a patient. She was a young mom and she was not religious, and she invited me into her room toward the end of her life and she said, I'm not religious, but I just don't know what to make of what's happening. I have two young toddlers at home and I don't know how to say goodbye. So I listened and as I listened deeply to her story and to what she was looking for, I ended up helping her to write letters.

Lisa Morrison: She wanted to write some letters to her children that could be read afterwards. They were older. I mean they were both under five years old. And then as she kept talking, she said something about her voice. It was sad to her that they would never hear her voice. And so in the midst of that time in joining alongside of her, I realized how powerful it could be if we could record that. And so we got her one of those Build a Bears that you can do, and there's a little voice recording, and she was able to record messages to her children that they were able to keep after she died. And I just remember how powerful that visit was for me as well as for her, but also the sense of peace that it brought her. I think sometimes people think that empathy is about being nice.

Lisa Morrison: It's not just about being nice, it's about being willing to recognize that each person we meet is probably going through a lot and we often don't know what it is that they're going through, but if we can trust that and really value them as a unique human being and be willing to share in their journey, I think we can actually relieve suffering in that. And so it's really important. And Steph, the stories don't have to be so dramatic as writing letters and doing build Tobe voices. I was thinking about the other day, there's a Panera just outside my office, which is very convenient, and I went to get a cup of coffee and this woman in front of me sighed really deeply. And I looked at her and I said, that's a big sigh. And she said, yeah. I said, it sounds like you're going through some stuff.

Lisa Morrison: And she ended up sharing in that Panera line how her daughter was having a very significant surgery and it was going to take hours and how she didn't even know what to do in the time of waiting. And so we walked around and I showed her the gift shop and the wellness store, and we had some time to sit and talk. And she was so grateful in that moment because someone dared to just care and to be willing to sit and hear a little bit about her story. So I think those are some examples of just being able to accompany people amidst whatever they're going through and really being willing to connect our hearts to each other.

Steph Bayer: This is why I'm so honored to work with you and your team. These are the stories and what I heard you, I just want to reinforce because I felt so powerful what I heard you say about empathy and spiritual care. It's about holding space and I can't imagine better examples than you gave and easing suffering, and if big and small ways, and I love that coffee example as well as the big ways. Not everyone can do that. It takes special people, but I think we all can show up in our own way that ease suffering and to show up for each other in space. So thanks for inspiring

Lisa Morrison: There. Thanks for letting me tell the stories.

Steph Bayer: One of the things that I'm very proud of you for is that you identify as having a strong commitment, and it's not just an identity, it's action to equity and inclusion. Can you talk about what that looks like with spiritual care?

Lisa Morrison: Yeah, absolutely. I think that we're better together. We're the best teams. We are when we really support each other and really support the fair ways and the full participation of all people. And when we think about folks who have been historically underrepresented or hurt in some way, spiritual care has an opportunity to really stand in that space. I feel like we have the opportunity to really help people to recognize that they're okay just as they are. And some folks have been hurt along the way. And so a couple of groups that generally come to my mind in my own experience is I can remember what it was like to be called to a patient's room. And this young woman really wanted to see the chaplain, but she apologized when she walked in because she was gay and she had been really hurt by the church and she knew she needed to process some stuff.

Lisa Morrison: And she also knew she really wanted a prayer, but she didn't know if it would be okay. She didn't know if she was okay. And so that really awakened my heart in a way that kind of broke my heart, but also really impassioned me to be able to want to do this work. We have so much work to do and it happens one patient in one connection at a time. I remember when I was at Fairview, one of our volunteers, she was one of our volunteers who visits our Muslim patients, and I was talking with her one day about the Muslim patients at the hospital, and she really helped me to become aware of something I had never thought of. She said to me that there were likely more Muslim patients than showed up on the census, but that often Muslim patients are afraid to declare their religion because of different retribution and how they might be treated. And again, it broke my heart. But when you think about it, these are culturally or religiously underrepresented folks who have had experiences of trauma, of discrimination and are fearful because of it. And that's not when we shine. We shine when we can show up in those spaces and let people know we're here for you too. And that really matters to people.

Steph Bayer: One of the great things that you do, and I just talked to Jackie Robertson recently. I love

Lisa Morrison: Jackie's

Steph Bayer: The best. Jackie's great. And Jackie was saying, it's so important for our caregivers to look like our diverse patients. And I would imagine in middle America and Ohio that our chaplains are probably Christian. Is that true or is it not?

Lisa Morrison: I'm so glad you brought that up. We are just so fortunate. We have a beautifully diverse chaplain team.

Steph Bayer: Yeah, we do.

Lisa Morrison: Oh, we have Christian chaplains and Greek Orthodox chaplains and Muslim chaplains and Hindu chaplains and Buddhist chaplains and Jewish chaplains. And is every religion represented? Of course not. And do we ever assume that all Muslims need the same thing? No, of course not. But you're right. It does matter. Representation matters, and I especially think about those patients who come from different places and might not be English speaking, and I can then call on one of our chaplains who might look similar to them, practice the same faith and speak the same language. In fact, that did happen recently, and I watched this patient's face just settle when someone came in the room speaking her language and she could understand, and she knew that this chaplain understood her prayers in a way that even though I'm trained to work with patients of all faiths and traditions, this chaplain really knew it. It's just so beautiful to be able to connect people that way. I'm so grateful. I think it's one of the best parts of the team is just watching them shine and really celebrating who they are with their beautiful richness of diversity.

Steph Bayer: I do love how our team, first, they're trained to not put their own religious values and others, so I recognize that, but I do love the diversity of experiences they can bring. Yes. And the way it can serve our patients differently.

Lisa Morrison: Absolutely. Can I tell a story? Please. Alright. So we had a patient recently who was Christian and requested a Christian chaplain. And so we sent someone to that room, a Christian chaplain, and it happened to be the unit of a different chaplain who was of a different faith. And that chaplain who initially responded was just so perfect. He had a wonderful visit with this patient, built a beautiful relationship, and then the unit chaplain happened to be walking by. And so the first chaplain brought the second one in and made the introduction. And this patient was just so thrilled and invited that unit chaplain to come back the next day realizing that she would be cared for by any of the team, that these are professionally trained folks who are willing to care for them. But I celebrated that with my team way to make that connection and continue just to help to build trust. This is such a phenomenal place to receive care and when we can help patients to know they're in good hands every step of the way, it matters so much. I was just so proud of the team and so grateful for that patient's experience. I love

Steph Bayer: This. Thanks for sharing. Yeah. I'm going to move us a little bit and talk about a common phrase. It's the little things that make the big difference. How does that show up in the context of spiritual care, even as goals of care for a patient individually may change?

Lisa Morrison: Yeah, that's a great question. I do think it is those little things that can make such a big difference. And you and I have talked before about the power of moments. Those power of moments matter so much. They do. Yeah. So sometimes patients are here for quite a while. I think about our transplant patients, for example, they can be here for more than four, six months. And recently there was a patient who had been here for that long and his wife happened to mention that her birthday was coming up. It was like the patient's birthday coming up and her birthday coming up. And so one of our chaplains showed up the following week on the birthdays with a card for the patient and the spouse. And it was such a little thing, but it meant so much. And that spouse gave a call to the office just to say thanks.

Lisa Morrison: It was a little thing that just made such a difference to her and it really celebrated her. You talked about even when goals of care change, and I think that's true. Sometimes the outcomes aren't what we would all hope for. And sometimes patients do have to accept difficult prognosis and it can be really challenging. We still can show up in those spaces to be able to be with people for those little things. And I think about a story of a mom who recognized that she would not still be here for her daughter's graduation, her high school graduation. And it was a really difficult situation. It was about a month before and her time here was running out. And so the chaplain team decided to work together with some other folks and they pulled together a graduation gown and cap for the daughter who was all in on this.

Lisa Morrison: And we had an early graduation so that the patient could be present for it in the hospital room. We didn't give a diploma, but we celebrated this young woman's achievements and her mom got to be there for it. And the pictures from that day that the family took were just so special, so very special. I also think about the little things that make a big difference for our caregivers. And I know I talked about Tea for the Soul before, but recognizing what's important to the caregivers in the midst of difficult situation really matter as well, and being able to give honor to that, celebrate that mourn with those situations. I don't know that there really are little things, right? I mean, those littlest things just make such a big difference.

Steph Bayer: Well said, Hey, spiritual care is hard. Your team practices and supports in some really difficult moments, and you show up again and again. I want to talk about how you show up for yourself. What can we as individuals do to show empathy towards ourselves and each other around us? Do you have any daily habits or rituals that you can share with us?

Lisa Morrison: Yeah. Thanks for asking. So the first thing that I do every day when I walk into my office is I light a candle. Don't worry, it's battery powered. It is not a real flame.

Steph Bayer: Jen Commission should be glad to hear that.

Lisa Morrison: Quality and safety friends. So yes, I turn on my battery operated candle and I take a moment simply to pause for gratitude for the day and to recognize that in this space, really important things are happening and really beautiful people are in our care. And that moment it makes me smile every day. I have it next to a little jar of water and some really beautiful rocks in a plant just to kind of symbolize nature, as you talked about, the daily huddles where you recognize names. That is also an important part. Every morning at eight o'clock, our team gathers for huddle and we have an opportunity to name those names. We also process a lot as a team. We share the joys of our visits. We process with each other when we've had a difficult visit. We offer each other space or presence during those more difficult times.

Lisa Morrison: I think those simple things really, really matter. I know when I was doing more patient care, I had a ritual. Whenever I would walk into a room, we wash our hands or we foam in, and that was my opportunity to give thanks for the opportunity to be with that patient. And then when I would wash my hands or foam out at the end, that was my opportunity to give thanks for what the visit had been. And then most importantly, for me to recognize that that patient is held in a bigger love than I can ever provide. And it was my CP educator 24 years ago or so that taught me that I needed to find a ritual because burnout is so high, and I adopted it really early on, and it's just made such a difference for me to recognize that it's not all about me.

Lisa Morrison: I'm part of a great team here of spiritual care providers, interdisciplinary team. I'm part of that team. It doesn't all rest on me. And so I would really encourage folks listening to remember that you're not alone. You're part of this fabulous team. Lean on your team. Find people to talk to because I think it makes a huge difference, Steph. I also think that it's really important that we recognize that we live in this culture that sometimes tells us we need to do more. We're not enough. We need to figure more out quicker. And it can be so overwhelming. And sometimes I think we just need again to pause and to give ourselves a little bit of a break to recognize that we are okay, that we're enough. And it can seem a little countercultural, but I think the practice of self-compassion, which is a little bit different than self-care.

Lisa Morrison: I think self-compassion is actually really hard work when we're trained to be so hard on ourselves. But I think it's so key to this work that we do, and I didn't check this out with you ahead of time, but I wondered if we could do a brief self-compassion exercise that our readers could, listeners, our listeners could follow along with, and also embrace for themselves if that would be appropriate. Well, I'm a little nervous, but I'm also very excited. You trust me on that all do I? But let's do it. Alright, so I'll invite you and anyone else listening to just take a moment and allow yourself to exhale fully. I'll invite you if it's comfortable, for you to close your eyes, to feel your feet grounded on the floor, and to take a moment to just place your hands over your heart.

Lisa Morrison: Take a moment to feel your heart beating this connection to your body. This heartbeat is purpose. It's the sign of life within you. And as you pause in this moment to bring these words to mind, whatever is happening around me, I will be present. I have what I need. I let go of that which I can't control, or that which is holding me back or not serving me. I receive that I am enough, that I am held, that I am deeply loved, I am courageous. I am strong. I am enough. I am beloved. May I trust the gift of this moment and I trust in the gift of my life. May you breathe deeply, open your eyes as you are ready, and may it be. So thanks for letting me do that with you today and lead that practice. I think it can be helpful to just simply pause and recognize that this being human is not always easy and that we have this gift of our life that touches so many, and sometimes we do just need to give ourselves a break and maybe a pat on the back and just take some deep breaths.

Steph Bayer: Thank you for the gift of that exercise, and thank you for the gift of you. We're so lucky to have you here.

Lisa Morrison: Thanks, staff.

Steph Bayer: This concludes the Studies and Empathy podcast. You can find additional podcast episodes on our website, my cleveland clinic.org/podcast. Subscribe to the Studies and Empathy podcast in iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcast. Thank you for listening. Join us again soon.