as someone with one foot in the collective experience of health and healing through my professional work as a midwife and the other planted in the personal experience of continued (often messy and confusing) self-actualization through enquiry and exploration, the ideas of holistic care and tending are always in the forefront of my mind. culturally, it's something we do quite poorly, and that's both wild given its importance and completely predictable in a world of privatized and profit-driven healthcare.
as a personal example, in the time that i underwent ivf treatment (which spanned from a consult in april to a heartbeat viability ultrasound in september), i'm pretty sure one single solitary provider (a stellar nurse on the call line) asked me how i was doing--not as in conversationally, but genuinely. how are you, really? ivf was so incredibly hard on my body, heart, and mind, and like many patients, while i was encouraged to reach out with any concerning physical symptoms, almost no one outside of my own loved ones inquired about my mental, emotional, or spiritual well-being. no suggestion from my care team to recruit a therapist. no chaplains provided.
and this wasn't because i had a bad practice--this is incredibly common and totally normal. there was a doula practice that partnered with the clinic, but i didn't need rah-rah cheerleading, help with visioning, or motivation to keep going--i needed someone to sit in it with me. i needed someone to listen to why pregnancy was important to me. i needed someone to ask me how i felt after learning that only 3 fertilized embryos came of 13 hopeful follicles. i needed someone to listen to my utter neurosis on day 8 of 9 spent waiting for genetic results of our one hopeful embryo.
have you been in a situation like this? one where your body was tended to as if it were an island or the primary or most important part of you, and at the expense of the other parts of your wholeness?
what was that like for you?
which parts of you were overlooked or de-prioritized?
what could have improved it?
one area of medicine where we do tend to meet holistic needs really, really well is in hospice care, but i'm a firm believer that we shouldn't have to wait until we're dying to be treated like multidimensional beings.
and then there's the problem of capturing the facets of these dimensions language. physical--ok that descriptor is fairly straightforward. mental and emotional often blur into one another but both are incredibly familiar. and spiritual--what does that even mean? if you've read the faq on this site, you likely encountered the story of my being offered a visit by a chaplain years ago when i went in for a major surgery. (tl/dr: i didn't know what chaplains were but knew i wasn't catholic or dying so i declined.) spiritual care sounds like something for religious people, and even the word chaplain is rooted in the early and bloody religious wars fought in the name of christianity.
and the truth is, spiritual care is for religious people, but it's not only for religious people. and chaplains are typically christians, but they're not only christians. so oftentimes, what we mean when we say spirituality or when we talk about chaplaincy is almost completely obscured by language.
in the work that i do, i would say that perhaps a quarter of the people i work with identify as belonging to a specific religious tradition. the overwhelming majority would tell a census-taker at their doorstep that they were "spiritual but not religious", a category that even those of us who claim it occasionally have trouble describing in any succinct way.
to me, "spirituality" is a basket that can, for some people, include participation and personal investment in an organized religion. for some of us, it doesn't. it's sort of like how all squares are rectangles but not all rectangles are squares (mind-blowing flashback to high school--you're welcome).
so if our particular baskets don't contain religion, what do they contain? (fun fact: baskets that do contain religion also contain these things i'm about to share.) i talk about this a lot when i reference aspects of self like beliefs, values, and systems of meaning-making, but i want to take a minute to dive a little more deeply into what spirituality actually encompasses.
the following framework was shared with me in a professional training by counselor brian bass-riley, and i found that it gave clarity and organization to all of my amorphous knowings about what we mean when we say "spirituality".
spirituality is the aspect of our self that deals with meaning, purpose, ontology, values, and relationships. (compare/contrast this to our physicality, which concerns things like anatomy, physiology, and our bodies' interactions with their environments.) so whether or not we are religious, we think about, wrestle with, and navigate each of these spiritual dimensions of self, on some level, from our first breath to our last. for each point, i will give you some reference questions, and i will present one example of how this dimension of my spiritual self was affected by ivf treatment both as illustration of the point and in order to make the case that spiritual needs are indeed part of healthcare.
why is this happening?
how do i pull the events of my experience together into a coherent story or narrative?
how do i make sense of what i'm experiencing?
rooted example: as a midwife experiencing infertility, i would occasionally get stuck in the loop of "why me?". why on earth would someone who devotes their life to helping other people grow their families not be able to grow her own? a christian might wrestle with this and decide that it was a test from god. for me, i knew that it was simply ironic bum luck, and i felt incredibly fortunate, due to my career, to have the medical knowledge that i needed to navigate my options for solving the issue.
i also worked to make meaning of my experience by becoming a comfort and a resource to others experiencing the same thing. without the experience, i wouldn't have had the opportunity to connect with so many amazing humans who, like me, needed companionship from someone who understood. i often imagine how powerful it would have been to have someone on my own care team sit with me and listen as i processed these questions.
who am i?
why am i here?
what motivates me to get up and go every day?
what's the ultimate point of all of this?
i did a lot of personal work, leading up to our one and only shot at ivf, around just who i was going to spend the next phase of my life being/becoming. parenthood takes over absolutely everything in a person's life--it doesn't eliminate but certainly trumps other identities, both for better and for worse. going into my 40s not having kids would be a completely different me. i wouldn't have the larger family or new role that i'd envisioned, but i'd have more money, my independence, and the ability to really dive so much more deeply into growing my professional and vocational skills as a chaplain. more training, more experiences, more vocational growth.
a tough task was "letting go and letting the universe" when it came to which of these would ultimately come out on top. i tried to create a win/win for myself, a scenario in which i'd step into one of two next versions of my evolution, rather than a win (become a parent) or lose (don't become a parent). i represented this with two tarot cards, which i propped up on my desk: the empress and the high priestess. no matter what happened, i'd either step into motherhood (the empress) or more deeply into spiritual service to others (the high priestess). it took me a long time to see the process as win/win, and i can't help but think that a chaplain could have helped me get myself there faster.
what even is the nature of reality?
what's real and true in the world?
what does it mean to exist?
what does "becoming" look like?
let me step deeply into my imperfect humanity and say i have no effing clue how to answer this one! no easy rooted example--just a lot of amorphous thoughts. maybe my inability (for a long time) to imagine life without being pregnant and giving birth represents an ontological dilemma, but that also touches on purpose and meaning. for a christian, someone who believes that God exists in relationship to us, is all powerful, and knows our hearts, an ontological question might be, "in my understanding go reality, god helps people, so why isn't god helping me?" or "if god knows my heart and does nothing, am i being punished? is that coherent with my view of reality?". many of the people i talk to wonder about the place and reality of divinity in their struggle, and oftentimes they've never before found a safe place to explore these thoughts. chaplaincy can be that safe place.
what are my values and morals?
how can i make decisions that are moral?
according to my own morals, am i a good person?
how do my life choices reflect what i value, and where is there dissonance?
this aspect of spirituality is intensely tied up with family building and assisted reproductive technologies. as someone who struggled with infertility, i had to ask myself things like:
do i value biological parenthood enough to avoid donor eggs, sperm or embryos, even if it means a better chance?
is it moral to adopt, when so many adoptees are beginning to speak up about the traumas and grievous harms they've experienced as part of that system and experience of life?
is it moral to spend thousands of dollars on the chance at a bio kid when so many kids need safe and loving homes?
if i create lots of embryos, how will it feel when some of them inevitably need to be destroyed?
would i offer "extra" embryos for adoption to another couple knowing that dna analysis would allow the offspring to find me later? would i worry they'd feel abandoned?
so many values-based judgments come up in the lead up to and process of infertility treatment. they're often not addressed in care because providers assume that starting care means having wrestled with and settled on those issues. how amazing it would be to have a person not to tell us what to do but to help us figure out what's most aligned with our own moral and values?
who makes up our sense of "we"?
who is "in my club" and who is "out"?
who is part of my web of connection, and how do my decisions impact them?
is there consonance or dissonance between the sense of values, purpose, meaning and ontology of the people with whom i am in relationship?
which connections are lateral and which are hierarchical, and how does that affect my experience of life?
my most obvious example here is that, while i can only write from my own perspective, i was not the only person experiencing or deeply invested in the treatment process and outcome of fertility care. my partner, who wants very much to be a parent and whose values and outlook aligned with my own, was also involved. ivf is always interesting when it comes to relationships, because all the medications, all the blood draws, all the painful/vulnerable/invasive procedures, all the side effects, and all the tests (save one) happen to the egg parent (or in the case of reciprocal ivf, parents). a sperm parent (or donor) needs a semen analysis, and barring something that needs surgical correction, procurement of a fresh sample for fertilizing retrieved eggs. masturbation in a medical bathroom may be awkward and undignified, but it's just a tiny snapshot of time, and no one causes you physical pain the process. you aren't legs-up on a table for it.
the incredible lopsidedness of ivf, no matter whether the issue is egg-parent-factor (blocked tubes, endometriosis, etc.), sperm-parent-factor (low sperm count, varicocele, etc.), or unknown, has the potential to put strain on a relationship. we both want it--it's just that i have to work so much harder for it no matter the reason for the hold-up. that can cause resentment-based strain on a relationship, and i see that a lot with the clients who share with me. this of course will look different depending on your family constellation.
in my own particular case, i was fortunate to have a partner who always checked in, always wanted to know how i was feeling, always acknowledged and wished it weren't so one-sided, and who massively picked up care and keeping of me and of our home through the whole process. i measured my hours by the meds i needed to take and the appointments i had to drive to. he cooked me dinners, did most of the chores, gave me my progesterone shots, checked in with me all the time, and basically kept regular life running during ivf and the dark days of early pregnancy. this is what ivf in right relationship looks like, and for that i am thankful.
so if we zoom back out from these specifics, we see that any type of care that doesn't include a spiritual dimension overlooks, well, basically everything about us that makes reflective, existential, and communal beings. interaction with medicine guarantees us some type of body care, and sometimes we have mind and emotion care thrown in (usually we have to seek it out separately), but rarely ever do we have anyone just to sit with us in the weeds while we do the work of parsing things out. and that parsing isn't just nicey-nice--it's what defines us on a day to day level, and it's necessary for us to heal and be whole.
backing even further up out of the realm of healthcare and into, well, just being human, i hope i've been able to shed some light on the things that fall into the category of "spiritual". my goal here has been to illustrate how spirituality exists regardless of religiosity. for those who believe, religion provides a template for answering some of the big questions, a lens through which we see the world, and a community of likeminded individuals, but we who aren't religious aren't without our own templates, lenses, and communities--they're just more organic, personal, and unassuming. often they're unassuming enough that we don't even imagine that they're there (like past me declining spiritual care because i wasn't catholic or dying).
using the outline that i've passed along today, what are the aspects of meaning, purpose, ontology, values, and relationship that constitute your spirituality today? how do you explore and tend those things? who helps you do it? how does it work towards keeping you well and whole?
and when you've filled up a whole ream of paper with thoughts, explorations, wonderings, and descriptions, let out a big sigh of relief knowing that, if nothing else, you can always just check the unassuming little box next to "spiritual but not religious".
be well, keep growing, keep going.
abby hall luca
the hearth chaplain