This is an AI-generated transcript from auto-generated subtitles for the video Learning to Help: A Buddhist Journey into Chaplaincy with Reverend Max Hokai Swanger. It likely contains inaccuracies, especially with speaker attribution if there are multiple speakers.

Chaplaincy Series: Learning to Help - A Buddhist Journey into Chaplaincy - Max Hokai Swanger

The following talk was given by Max Hokai Swanger at The Sati Center in Redwood City, CA on October 22, 2023. Please visit the website www.audiodharma.org for more information.

Chaplaincy Series: Learning to Help - A Buddhist Journey into Chaplaincy

Introduction

Vanessa Able: Good morning, everybody, and welcome to this very exciting first event of a new speaker series that we're offering here from the Sati Center. My name is Vanessa Able. I'm one of the faculty of our Buddhist chaplaincy training program, and I lead the online training program. This year, for the first time, we've had this idea to make a space here at the Sati Center for Buddhist chaplains and for conversation around Buddhist chaplaincy. We'll be having this series for the foreseeable future, and we'll be inviting Buddhist chaplains and people working in and around Buddhist chaplaincy to come and talk about their work, their experience, their training, and the things that are important to them. We welcome you all to join us in these conversations.

Kicking off for us today, I'm so happy to let you know that we have the Reverend Max Hokai Swanger with us. Max was raised Jewish and Presbyterian, and he later converted to Buddhism when he was in college. After college, he lived in a Buddhist community for fifteen years, and he ordained as a Zen Buddhist priest. Later, he began training to be a chaplain. He is a former participant of our Buddhist chaplaincy training program here at the Sati Center. He went on to complete his Clinical Pastoral Education (CPE) as a resident for a year at UCSF. While starting to work as a chaplain, he earned a Master of Divinity degree and became board certified. Prior to serving at his current job at the Santa Clara Valley Medical Center, he worked at the Stanford Children's Hospital and the VITAS hospice for three years. In addition to being a chaplain at Valley Medical, Max also provides Buddhist ministry and teachings. He lives with his wife Katie in the San Francisco Bay Area. Max, without further ado, nice to see you this morning.

Max Hokai Swanger: Nice to see you. Nice to see everybody. Let me try to get my slides going. Good morning or good day; I guess people are zooming in from other places. It's a beautiful morning here in Santa Cruz, California. Vanessa, thanks for the introduction. My sister saw my bio and reminded me that my grandmother was Lutheran, but I tend to think of it as Presbyterian because when she came, we would go to the Presbyterian church. I do have some Christian and Jewish background, but in general, we were not a religious family. I'm the only one who became interested in religion.

In this talk, I will share a little bit about my journey to becoming a Buddhist. I'll also talk about the Sati program, clinical pastoral training, my current work, and ongoing training. As Vanessa was saying, you see my name there with the letters. I'm not doing that to be pretentious, but because I want to talk about things that are helpful for us as chaplains in our field. For example, getting a Master of Divinity (MDiv) and becoming board certified are helpful, but neither is necessary to work as a chaplain. I had neither of those degrees when I started in hospice, and ordination is also not necessary, but can be helpful.

Opening Reflection

I wanted to start out with a reflection. Working as a chaplain, often if you're leading a group—I work in a hospital, so if I'm starting with a palliative care group—I'll have a reflection in the beginning and often something at the end as well. This reflection I picked has to do with the Buddha. As you can see on the slide, the Buddha is there with a sick monk, which has to do with chaplaincy.

One day, the Buddha was visiting a monastery and came across a room where a monk was sick and in pain. Although there were many other monks at the monastery, not one of them was concerned with their sick brother. The Buddha, beholding this woeful situation, began to look after the suffering monk. He called Ananda, his cousin and assistant, and together they bathed the monk, changed his dirty bed, and eased his pain. The Buddha admonished the monks of the monastery for their neglect and encouraged them to nurse the sick and care for the suffering. He concluded by saying, "Whosoever serves the sick and suffering serves me."

Discovering Buddhism

My Buddhist journey began in college during my freshman year. I was around eighteen years old, adjusting to being a freshman, experiencing some anxiety, and having trouble studying. I was introduced to yoga, which was helpful. I was also introduced to MBSR, which many of you know is Mindfulness-Based Stress Reduction. I learned this at a hospital where it was taught by a doctor. MBSR was developed by Jon Kabat-Zinn¹, who is a practicing Buddhist, but it is taught in a secular way.

The big teaching for me there was the very first thing they put on the board: there's pain and there's suffering. We can't avoid pain, but we can avoid some suffering. Many of you probably know the teaching of the second arrow. One arrow can hit us, and we become sick. Instead of just trying to get better, we shoot another arrow into ourselves, wondering, "How long will I be sick? How did I get sick? When will this end?" We add to our pain with suffering. MBSR was the beginning of these learnings, and in some ways, it was a gateway to Buddhism for me.

I was then given a book by Pema Chödrön² called The Wisdom of No Escape. I really liked that title because whenever I had anxiety, there was a feeling of fight or flight, or wanting to escape. I learned that we can sit with whatever is coming up. As Buddhists, we can sit with our pain. We can sit with our anxiety. We can sit with that second arrow and watch those thoughts go by. One thing we learn out here in California as junior lifeguards and surfers is that if a big wave is coming at you in the ocean, it's very scary. But what we learn is that you can actually dive underneath the wave. In the same way, we can let our thoughts go by.

In my Tibetan Buddhist studies, I began learning to meditate and learning the teachings of karma and rebirth. I really connected to Buddhism—so much so that I wanted to go to Nepal to study and actually had a ticket to Bangkok. But then I found the San Francisco Zen Center and ended up at Tassajara. The San Francisco Zen Center consists of Green Gulch Farm, Tassajara, and City Center. I spent three years at Tassajara, five years at Green Gulch Farm, and half a year at City Center.

I bring this up because, in this way, I was training to be a Zen Buddhist priest. I know some people on the call might be secular Buddhists or from the mindfulness tradition. For me, having a base in religious training has been helpful as a chaplain. I had a base in ceremony, practicing in a religious setup with priests, laypeople, incense, and robes. I sewed my robes at Green Gulch, which took a year. I chanted, "Namu Kie Butsu" ³—taking refuge in the Buddha with every stitch.

After I left Green Gulch, I went to Spirit Rock and became a vegetarian cook there for five years. I loved working there. I was able to sit many retreats, including a couple of month-long retreats, which I highly recommend if you have the time. Being in the Insight tradition was an amazing change from the Zen tradition for me. The style of Vipassanā⁴—actively noticing thoughts—differed from Zen, which involves more of a Śamatha⁵ or concentration practice.

Being there was also where I met Gil Fronsdal⁶, who spoke to me about the Sati Center. I started doing the training that some of you are enrolled in this year, and that training set me on this career.

Training to be a Chaplain

Before being a chaplain, I was a "Dharma bum," a Dharma person living at Green Gulch and Spirit Rock. I knew cooking wouldn't be for the rest of my life, so I was ready to try something else. At the Sati Center, my volunteering was at Laguna Honda Hospital in San Francisco. It's a hospital, but it functions more like a long-term care center. I would go once a week and see six or seven patients, spending a lot of time with them. If you are thinking about volunteer experiences, it's a great place to start because there is no trauma center; it's a slower pace, almost like visiting a nursing facility where people are there for a longer-term stay.

After the Sati program, I applied for Clinical Pastoral Education (CPE). I highly recommend this for anybody who wants to work as a chaplain. You generally need to complete four units. I did mine at UCSF at Parnassus on the neurology unit. You can do a one-year residency training, or you can do a single unit for ten or twelve weeks. UCSF also had an extended unit for nine months, where students would come in once a week, learn during the day, and then be on call at night. If you have the time to do a full year of training, it is highly recommended.

If you do the one-year training, you can't work another job at the same time. You're there full-time, Monday through Friday, eight hours a day, plus a 24-hour on-call shift once a week. They paid a stipend of about $35,000 or $40,000. In San Francisco, that wasn't really enough to live on, but I stayed at a small Buddhist temple and was able to rent a room for quite cheap. It's something you have to factor in. Also, if you apply now, that would be to start next September, so you'll have to wait a year. I waited a year after the Sati program, went to Japan for three months to be a teaching assistant, and did whatever I could while waiting for the program to start.

During CPE, I started on the neurology floor. The first week you get to pick what you're interested in—oncology, neurology, pediatrics, etc. Neurology was interesting to me as a meditator interested in the mind. My floor consisted of an ICU with about eight patients, a step-down unit, and a general neurology floor.

When you're in CPE, you're not a volunteer; you're actually a chaplain on the floor, learning on the job. We would arrive around 8:00 AM for a non-denominational reflection. Our group consisted of thirteen people, including a Catholic priest, a rabbi, and unusually, five Buddhists. Chaplaincy has typically been dominated by Christians. Even the name "chaplain" comes from the Christian tradition. At my hospital now, my official title is Spiritual Care Coordinator, although I wear a badge that says "Chaplain" because people understand what that means.

At UCSF, I was also able to lead a mindfulness group for the neurology residents. If you have experience in mindfulness, that's something you can offer. The schedule at the hospital is intense. In the morning, I'd visit patients on the floor or in the ICU. In the afternoon, you would meet with your covenant group—a small group of chaplains. This group helps you see what you're doing well and what your growing edges are. For example, I like to talk. People in my group told me, "As a white male, you have this sense of privilege. Learn about your social position." I hadn't thought about that before in the Dharma centers. I learned to step back and let somebody else speak before me.

You also have a mentor who goes on visits with you. With chaplaincy, we often make cold calls, knocking on doors: "Hi, I'm Max with Spiritual Care. I just wanted to check in." You don't know what you're going to get. Some might say, "Wonderful, come in," and others might tell you to get out. If they said, "I'm fine," I used to just say okay and leave. But my mentor once went in when someone said "I'm fine," pulled up a chair, and sat down. She talked with him, and I watched as he opened up like an onion. Ten minutes into the visit, tears were coming down his cheeks. I thought, "This is the magic of chaplaincy." You can sit with somebody, be attentive, and gently ask, "Tell me about that. How is it to be fine?"

In CPE, you also learn to work with many different faiths. Having been a Buddhist learning meditation and chanting, I had to learn how to pray in a Christian way. If a Christian patient asked me to pray for their health, I learned to say, "Heavenly Father, I'm praying for Ms. Jones. We want to lift her up and give strength to her partner. We are grateful for what you do, Lord, in the name of Jesus Christ. Amen." I'm okay with doing that, though some of my Jewish colleagues wouldn't use "Jesus Christ." I also read the Lord's Prayer or Psalm 23.

We worked with verbatims. You go into a visit, and right when you come out, you write down exactly what you remember. Then your group analyzes it to help you. Once, a patient was interested in Buddhism, and I went on talking about it. My group correctly pointed out, "This visit is about the patient, not about you or your Buddhism."

The on-call shifts were very difficult. You'd work from 4:00 PM until 4:00 PM the next day. If a Code Blue (cardiac arrest) was called, it was a very intense experience. Inside the room, the medical staff is feverishly working, doing CPR, breaking ribs. The family is distressed. If the patient dies, the staff does a moment of silence and leaves the room. The chaplain goes in, and you are there with that dead person and the intense grief of the family.

Another eye-opening experience for me in CPE was when a Christian woman exactly my age died in the ICU. You learn to be around dead people and grief, but it was different when someone was my age. Somewhere in my subconscious, I just assumed people died when they were much older. I had to learn that people die at all times. I also remember a thirteen-year-old dying when I was on call. Getting to know people and then having them die is really hard. We also have Code White at my hospital, which is a pediatric death. I remember one pediatric death that will always stick with me. Just being with the family in their intense grief and providing care. They were Catholic, so I brought the Catholic priest over. As chaplains, we do the best we can to support any patient from any tradition.

I learned a lot that year from the patients; they were my teachers. You make mistakes in CPE, and you have a lot to learn. You learn hospital Latin, like NPO (nil per os—nothing by mouth). If someone going into surgery asks, "Chaplain, can you get me some water?" you have to know not to give it to them, or their surgery will be postponed.

Working in Hospice

After CPE, I was hired in Patient Relations at UCSF, which is like the customer service department. They were happy to hire new chaplains because we had good listening skills. I was on the phone a lot with people who were angry about huge medical bills. I did that until I landed my first job doing hospice.

I worked at VITAS hospice for three years. In hospice, each team consists of a doctor, nurses, a social worker, home health aides, and a chaplain. I had an average of sixty patients, though about half the families declined visits. I saw three or four people a day. You're in your car driving around a lot. I'm a community-type person, so I often did visits with the social workers.

A lot of hospice patients have dementia. With advanced dementia, they might not be able to talk to you, but you can still hold their hand and provide prayer. My mom was on hospice and had dementia. We'd have joyful visits; she wouldn't remember what we talked about five minutes later, but in that moment we had joy. People with dementia can be your teachers on what it is like to be in the present moment. You can also work with them on life review.

There are nonprofit and for-profit hospices. Hospices receive about $300 a day per patient, and it's less expensive to hire staff like chaplains and home health aides to visit than to pay for nurses. That's something to look at if you apply for hospice—make sure they're a valid, reputable hospice.

Everyone in hospice has a six-month diagnosis by two doctors, but that doesn't mean they will die in six months. People can graduate from hospice, but the majority do die. Working there brought death to mind often. From the Buddhist tradition, Maraṇasati⁷ (meditation on death) can be a very powerful practice because it can lead us to reflect on how miraculous it is to be alive in this moment. Realizing we are all going to die makes you think, "Look at this life that we have, look at this gift." While there, I performed quite a few funerals.

Working at the Hospital

After hospice, I went back to the hospital. I worked at Stanford Children's Hospital part-time, mostly with long-term care kids. Working with children is very special, and much of that work is with the parents, or learning how to communicate with teenagers.

After that, I went to my current job at the Santa Clara County Hospital in San Jose. It is a Level 1 Trauma Center, so everyone in the area involved in a car accident or with a gunshot wound comes to that hospital. Hospitals, unlike hospice, have a sudden intensity. You might be relaxed in your office, and then a code is called over the speaker, your adrenaline goes up, and you're thrown into a situation where someone might not make it. The grief can be so intense and raw.

How do we deal with that? Take care of yourself. Have someone to talk to. We learned to deal with secondary trauma and vicarious trauma. You can get compassion fatigue, which is the physical, emotional, and psychological impact of helping others. At my current hospital, I experience quite a bit of moral distress. I provide care for an uninsured, unhoused person, and then I realize there are four hundred other people in the hospital who also need this care. We are very understaffed.

But there is joy in the work, too. I performed a wedding for a couple in their thirties while the bride was undergoing cancer treatment. She came down the aisle in her electric wheelchair. That gave me quite a bit of joy. There is sadness, but there is also joy in seeing someone get a tumor removed and witnessing their family's relief.

Advice and Ongoing Trainings

For ongoing trainings, getting a Master of Divinity is helpful. I worked through the Shogaku Institute, put together by Reverend Grace Schireson⁸. Becoming board certified is really good if this is going to be your career. To maintain it, I have to do fifty hours of continuing education every year. I didn't pass my first board because of misunderstandings regarding the suffering of Christ versus suffering in Buddhism, but I passed the second time. We are breaking into this world as Buddhists; the majority of chaplains nationwide are Christians.

I also completed a death doula training. If you haven't done CPE, it's a helpful program to learn about dignity therapy and doing life reviews. Palliative care training is another excellent option. Palliative care focuses on helping to ease pain for people who have severe diseases, not just those at the end of life.

I highly recommend learning the Lord's Prayer and Psalm 23. You'll learn how to do an emergency baptism if you're comfortable with that. Try to figure out what God means to you, because as a chaplain, you will need to pray to God for people. I came to the conclusion that God represents all that is divine. Always champion someone else's faith. Be curious and open.

Don't take rejection personally. I once went into a room, and a suffering patient gave me the middle finger. She died later that night, and I didn't hold it against her. I feel with all my heart and loving-kindness that she is wherever she wants to be, whether it's a peaceful rebirth or heaven.

Find support as needed. Find mentorship. And you will make mistakes. Luckily, our mistakes aren't usually life or death. We come with a good heart and a heart of kindness and love for those people, and our mistakes are forgiven. Thank you very much. [Laughter]

Q&A

Vanessa Able: Thank you, Max. We have just over five minutes still, if there are any questions.

Edward: Hi Max. I'm a hospice volunteer and I'm at the Institute of Buddhist Studies. I was curious what criteria you used for choosing a CPE program? I'm looking at Stanford and John Muir.

Max: At that time, I wasn't partnered, so I applied up and down the coast, as far north as Alaska and as far east as Colorado. I interviewed in Colorado Springs but felt it would have been a bit of a culture shock. I whittled it down to the Bay Area. I applied to Stanford, UCSF, and John Muir. Stanford only has six students, while UCSF has thirteen or fifteen, so there's more of a chance to get in there. I picked UCSF because of the location and because I really think they have a great program. Definitely apply to multiple ones.

Jim: Hey Max. In the hospital environment, how do you find that you relate to the staff? It often feels like the spiritual care department is never really that well integrated. How do you provide spiritual care for the staff as well as patients?

Max: In CPE, I did my charting at the nurses' station, crowded by nurses. I charted there so I could check in, get to know them, and provide care informally rather than hiding away in a small office. Building those relationships helped people open up to me. At the County Hospital, I schedule time into my day to go sit down with the staff on different floors and visit. You won't know everyone because it's a huge hospital, but showing up, making the effort, and asking about their lives helps build those connections.

Nancy: I wanted to ask a little bit more about death doula programs. Some of them seem to be very short.

Max: Mine was a ten-week program. For me, it wasn't as helpful because I had already learned a lot of the same skills in CPE. But if you're not going to do CPE, it could be a helpful program to learn about things like dignity therapy and ways of doing life review to raise up a person's dignity at the end of life. I recommend it if you haven't done CPE.

Vanessa Able: We're at time. That hour just flew by, Max. Thank you so much. You gave a detailed account of the work and didn't pull any punches about the challenging sides, but also reminded us that there is joy in the work. Thank you, everybody, for being here.