A Call to a Calling

In his reflections, Dr. Dale Nikkel traces the origins of a calling that emerged through an interruption—an unexpected pager sounding in the midst of an ordinary evening, opening a pathway to extraordinary purpose. Drawn by a longing he could not yet name, he stepped into the sacred space of spiritual care, where his very first encounter was marked not by expertise, but by humility and missteps. At the bedside of a dying man, stripped of training and pretense, he discovered that healing presence can begin simply with one human being willing to sit with another. In these tender, imperfect, and profoundly real moments, he found that the calling is less about knowing what to do, and more about being willing to show up, with an open heart, during life’s most fragile thresholds.

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Transcript

Prelude

Dale Nikkel (00:00)

At the end of the day, we are humans meeting humans and I think we all know when we're meeting someone authentic and that day, you know, this patient, never saw him again and don't know anything about him really, but what I do remember is the graciousness of a human accepting me as this rookie on-call chaplain who knew very little.

Show Introduction

Nate Houchens (00:39)

Hi and welcome to Boundless Moments, the storytelling podcast that brings sacred moments to life through the voices of those who lived them. I'm Nathan Houchens. 

Support for Boundless Moments comes from the Sacred Moments Initiative. 

At Boundless Moments, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality.

All views expressed are those of the person speaking and not their employer.

Some stories featured on Boundless Moments may contain themes or content that could be upsetting for some listeners. We encourage you to use discretion and take care of yourself while listening.

Introduction: Dale Nikkel

Nate Houchens (01:23)

Dale Nikkel is the Manager of Spiritual Care at St. Joseph’s Health Care in London, Ontario, Canada. Dale is a Canadian Association for Spiritual Care Certified Supervisor-Educator and a Registered Psychotherapist with the College of Registered Psychotherapists of Ontario. He earned a PhD in Interdisciplinary Research in Social Issues focusing on the intersection between bioethics and theology with a focus on Advance Care Planning.

A former schoolteacher, writer, and musician, Dale draws on his own life experiences to help deepen reflection regarding spiritual health in the healthcare environment. Originally from Winnipeg, he now lives in southern Ontario with his family including a dog named Penny.

Introduction: A Call to a Calling

Nate Houchens (02:07)

In his reflections, Dr. Nikkel traces the origins of a calling that emerged through an interruption, an unexpected pager sounding in the midst of an ordinary evening, opening a pathway to extraordinary purpose. Drawn by a longing he could not yet name, he stepped into the sacred space of spiritual care, where his very first encounter was marked not by expertise, but by humility and missteps. At the bedside of a dying man, stripped of training and pretense, he discovered that healing presence can begin simply with one human being willing to sit with another. In these imperfect, yet tender and profoundly real moments, he found that the calling is less about knowing what to do and more about willing to show up with an open heart during life's most fragile thresholds.

The Story: A Call to a Calling

Dale Nikkel (03:16)

My experience really is going to be divided into two parts, and they span just a couple years, but I think they're really both deeply meaningful, me as I reflect on my own journey in healthcare. 

The first one takes place in Ontario when I was at a time in my life where I was a little bit restless in terms of my career. I had tried several careers, including a career in teaching, a career in music as an aspiring singer-songwriter, and also a brief career in advertising as a writer, but I was still looking for what I wanted to do with my life. And at this point in time, I remember the day exactly because I wasn't involved in healthcare at all, but we had friends over for supper. Suddenly, after supper, I hear this abnormal beeping going on in my house and I'd never heard this sound before and it turns – this was before the days of cell phones by the way, so this kind of activity was not frequent – anyways, my friend stood up from the table and he picked up a pager off of his belt and he told me that he was on call at the hospital as an on-call chaplain and he was needing to respond urgently to a page.

I really was kind of mesmerized by this moment in that I couldn't believe that, in a hospital down the street, someone was needing spiritual support. They had reached out to someone who was sitting at my dinner table, and he was calling back and he was going to return to the hospital to offer support. 

I sat there. I just remember just being just blown away by this with what was happening.

My friend returned to the table and said, sorry, I need to get going to the hospital. And that was the end of our little dinner party for that night. But he told us, you know, very briefly what was going on, that someone had had a heart attack at the hospital or something to that effect. And he was going to head down there urgently. They needed spiritual or religious support. And off he went. 

This set my mind just swirling with this urgency that happened and this reaching out across the city to help someone in this time of need. And I suppose it called to me something, I want to say, you know, transcendently beyond myself that I was being called into a profession somehow. And a colleague shared a quote with me a few months back that, you know, really kind of dovetails with this experience that I had. And the quote is attributed to Vincent van Gogh who said, “Your profession is not what brings home your weekly paycheck. Your profession is what you are put on Earth to do with such passion and such intensity that it seems spiritual in its challenge.” I really like that. And as I look back on that time, you know, almost two decades ago, I think what was happening is this experience inspired this profession that, you know, of something that I was meant to do. 

Anyways, how it all ends is that I too joined that volunteer spiritual care team as an on-call chaplain and really it set the career path forward as I, you know, went and completed the training to do that, went into supervisory training and so on. I just set the path to this. 

So I guess when we talk about sacred moments, we talk about moments, experiences that are boundless, that are ultimate, that are transcendent and that have a deep interconnectedness. And I think this moment with my friend at the dinner table, the on-call chaplain, and this chance moment that the beeper, his pager, would go off right during our visit. I think it felt transcendent. It felt beyond myself. It called to ultimate parts of myself in a sense of a calling of something more and just boundless in that it is beyond just that moment in time, but it has extended now almost 20 years. You know, when I think back to that, I'm so grateful for that moment. And it just feels like a bit of a fullness of time where, you know, something was happening in a simple beep of a pager.

I think the second part of that story for me is the first time that I was on call. And this moment that I too was carrying the pager. In the day of cell phones right now, it seems really odd to be talking about the joy of a beep or that, just kind of that newness or that curiosity that what is on the other side of that pager. 

But I remember the first time that my pager went off and I too was called to the hospital and I don't remember exactly the situation, but I know enough. It was an end of life kind of situation where someone was struggling spiritually or religiously, and I was coming to join them at the bedside. And here we go again, a moment of learning and I felt that same beating heart and the excitement of this is what I’m meant to be. Like I got down to that hospital so fast and was so excited to enter that room and to be present to that patient and do anything I could.

It's kind of painful, if I'm honest, to think of that as I really had little training, little experience, little theoretical knowledge. And yet, I arrived as a human and being present to this patient as a person. 

I remember the book I brought to the bedside and I shudder a little bit to think of, you know, that I was bringing a prayer book or more religious prayers and did very little assessment of what the spirituality might be of that patient. I had little knowledge of spiritual assessment or safe and effective use of self and this knowledge that has come in the years since. 

But I offered my little prayer in that moment with my naive excitement and that sense of eagerness to really contribute and be present to him. He was very polite, I recall, and he said, thank you. And then we began to have a human conversation about life. And he was so generous to me. And his graciousness as a patient, you know, I will always remember what made that moment sacred. It really reflected to me that, I think in health care, there's all of the apparatus of medicine, of healthcare, of the therapeutic side of things. 

At the end of the day, we are humans meeting humans. And I think we all know when we're meeting someone authentic. And that day, you know, this patient, never saw him again and don't know anything about him really. But what I do remember is the graciousness of a human accepting me as this rookie on-call chaplain who knew very little. 

But, you know, when all was said and done, I was able to meet him as a human and it taught me, I think, at the heart of care really is that human connection and that authenticity. And I think to link that to sacred moments once more, it's that sense, that interconnectedness of that moment that we were strangers, but there was a connection of being part of a human family there. I think that kind of transcended a simple conversation for me, and the fact that I'm talking to you about this almost 20 years later just kind of suggests the transcendence of that moment too. It was beyond that moment and, you know I treasure that, you know even today and it's an ongoing reminder of me of the importance of authenticity of humanness at the core of medicine.

Interview

Nate Houchens (11:56)

I’m here with Dr. Dale Nikkel, who just recounted the story of hearing, in a very chance encounter, hearing a pager, understanding what that meant, and then recognizing its calling for him and the ways in which he has been a source of solace for individuals in need, who are in need of religious or spiritual care. Thank you, Dale, for sharing that really impactful story.

Dale Nikkel (12:23)

Yeah, thank you.

Nate Houchens (12:24)

I'd love to go back to that moment when you heard the pager go off. I know what it feels like when I hear a pager go off, and I'm so glad that we have disparate experiences in hearing that sound, because I know my cortisol jumps immediately. I wonder if we could go back to that time when you heard the pager go off and when you learned more about what it meant. What kinds of things were you feeling and, recognizing that restlessness that you were feeling, what did it stir in you?

Dale Nikkel (12:53)

Yeah, no, that's a great question. It's… to return back to that moment of that beeping happening. and you know, it was at time, probably the din and chaos of the young family life was also happening in the home at that time, but it kind of pulsed right through the whole room. 

Yeah, it's I think the first piece was curiosity, because I actually was not aware that he was a part of this on-call team to my knowledge. I don't have any remembrance of that. And so the first thing was, what was this? And he excused himself from the table and then had to have a private conversation, and that this was the hospital. You know, I knew he was not a medical practitioner of any sort. So what business could he have with the hospital? And you know, I knew of him to be a religious person. And as he shared more, it just, the intrigue in me grew, as I heard more and more of, it’s like, okay, a volunteer spiritual care person, this is interesting, what might they do? 

I think I had a vague sense of a hospital chaplain, but at this point, not a very fleshed out view of what that role might be. You know, I think in Western culture, I think I was raised on TV shows like M*A*S*H where you get an idea of what a chaplain might be from Father Mulcahy or something like this. But kind of a general sense of somebody in my own dining room that is being called to a hospital center. It was really, really intriguing and it just, you know, it called a deep part of myself. Like, wow, that sounds really interesting. But even that word interesting feels like not enough. I was like, huh, that's something that I would like to be a part of. 

And to be called to such an important place of someone's wanting to have a spiritual conversation or a spiritual interaction or some sort of deeper engagement about life because life is short. 

And I think if I'm honest, I think I've always been intrigued by the topic of death and dying and not in a morbid sense, but in a sense that inspires kind of the vastness of our existence, the preciousness of life, and the finality and the irreversibility of it all. How does this all fit together? I always was kind of a bit of a very amateur philosopher or thinker wanting to think through these ideas, but more for reflection and a source of, how am I caring about my life and being present to those around me. 

So I think all that was kind of you know, calling forth to a desire, I suppose, to be present to someone facing some, I would language it now as probably, a spiritual distress or a spiritual moment of wanting to connect with someone. And I shared that quote from Vincent van Gogh of what am I put on earth to do? And I shared a little bit of my restlessness to find a, you know, a career that was home for me. And I think this was a... a little one more breadcrumb on the breadcrumb trail. I think that would lead me, you know, into spiritual care and into this profession that I've enjoyed and continue to enjoy now almost 20 years on.

Nate Houchens (16:23)

I so appreciate your descriptions, and I'm reminded of other service industries and I'll give a couple of examples. Police or firefighters or if you're a comic book nerd like me, like Batman and other sort of superheroes where a lot of individuals would be running from these kinds of challenges. Running from a burning building, running from a crime in progress, running from sort of “evil doing,” right? And yet these service-oriented industries hear the call from across the city, to use your words, and go running to help. And I'm just struck by your descriptions of how individuals with the chaplaincy or in pastoral care or spiritual care can be that source of solace for others. It really is astonishing, and I'm so grateful for the work that you and your colleagues do.

Dale Nikkel (17:19)

Yeah, well thank you for that. I think it's a unique profession, isn't it, in that we often talk in our training about care for the human spirit and what might we bring to care for the human before us. And it's that notion of presence and, you know, considering just the diversity of human belief and, you know, how we make sense of life that together with, we are all sharing a similar human experience, that all those emotions, feelings that we encounter in different situations, we're all humans on a journey at the same time. So there's that, there's the uniqueness of each person, but also that shared sense of, this is humanity, that we're all in this boat together. 

I don't know, I think I can speak for myself. I just have counted it a huge honor to be present to people. Sometimes, you know, we talk about the phrase intimate strangers and it's those moments where you may get called to a situation and it's very perhaps a brief encounter and that's probably it in situations. But what an honor to be there for people where you're facing the starkness of life and healthcare situations. And as you know so well, just the urgency, the uncertainty, all of those things are front and center as you're trying to make sense of this. And trying to hold on to those anchors of meaning, perspective in the middle of it. 

As I, you I do count myself along with many who suggest that healthcare is a, you know, spirituality is central to healthcare. We are encountering situations that inspire thoughts of death. This is, Daniel Sulmasy talks a lot about this, is that we encounter a serious illness, it inspires thoughts of death which also inspires existential anxiety and thoughts. And that in turn inspires one’s sense of spiritual wonder and questioning. What am I doing here? How do I make sense of this situation? How might this affect my family and those around me? 

Yeah, so anyways, it's an honor to be a part of those situations and it's complex. It can be really, really messy too and really intense as life… life comes home, you know, in its fullness. So anyway, it's, yeah, thanks for that reflection.

Nate Houchens (19:49)

Thank you. And we talk a lot about the sort of contexts, the moments that kind of lend themselves to sacred moments. And we often talk about some version of distress or tension as a sort of precursor. And I can imagine that in this role of yours, that that is all it is. Those are those moments where we have those kinds of spiritual tensions and those existential questions arise. Those are the moments I think that really lend themselves well to support from a spiritual sense.

Dale Nikkel (20:24)

Yeah, I really appreciate the work of Ken Pargament and Exline and their talk about spiritual struggles. And I think, you know, there's a lot to be said for those moments where life is in tension. When life has no tension, you know, everything is going fine, you know. There's that phrase, you know, in popular culture, I'm going to live forever, so far so good. But it's that prevailing philosophy. But suddenly, when life is not so good and you find yourself facing serious illness and uncertainty and all that. It's tough and the tensions come to the surface, don't they? Like, what about my family? What about? What will happen? You know, suddenly there's those that, that circle of love around you and what does that mean? What about broken relationships or estranged relationships or tensions that might exist? And what about my own relation to the transcendent? You know, what is my existence? 

And, you know, for some, they have put some of those questions to bed, but for others, these are open questions, that search, that quest for something bigger and serious illness or difficulty. I've experienced that in my life when things are hard. The roots are going deeper and kind of moving towards a source of meaning that I can hold onto and find my way through a circumstance and find those nuggets of wisdom that give me perspective, that help me navigate that. And I think that's really at the heart of spiritual care is that, what is your belief system and how is it helping you? And I think what we're trying to do is shine a light on those spiritual resources that a patient might have and how can we help a patient draw on those resources that they have in their life and to continue to nourish those.

Nate Houchens (22:18)

I want to reflect a little bit about your story when you said you weren't terribly prepared on that first call and how you perhaps would have done things differently knowing what you know now. I wonder if there are any surprises about when you are present as a human with other human beings. Is there anything that surprised you in those early moments of your role?

Dale Nikkel (22:42)

Yeah, think it's just sometimes we talk about the art and the science of spiritual care and what does it mean to carry out a human-to-human conversation with someone? This isn't unique to spiritual care I don't think, I think any practitioner or clinician is talking about that therapeutic relationship and how to be authentic and real and caring and compassionate and all those things. 

In spiritual care, when I think of that first encounter that you were reminding me of, you know, as I was sharing, I think there was in some ways a beautiful child-likeness to it in that I was showing up with that eagerness. And once we moved past that initial stage of the visit, I recall there was a beautiful humanity and authentic conversation that happened. 

But the first part, why it's troubling for me to think about some 20 years later is the danger fraught with spirituality and religious beliefs and being careful with assumptions and the dangers of things like proselytization and boundaries and the power relationships. It's really kind of, in that phrase of safe and effective use of self, and to recognize the power dynamics that do exist and the vulnerability of the patient in that moment and what is their perspective, what are their beliefs and rather than me pulling out my prayer book of what I thought he would like in that situation, you know, I think that's really the assessment moment that was largely missing in that visit is, you know, tell me what's important to you. How do you make sense of life? Tell me about you. Tell me what, how you make sense of the world. Tell me how you nourish your spiritual health. Tell me what I can do to help you.

It's a difference, right? That, instead of me bringing the answers, it's, the assumption is that the patient has the answers. They've lived their life. They've found this meaning and how can I help them, you know, rediscover it or connect them with community partners that might be helpful, religious leaders, spiritual leaders that might be helpful to them in that situation. Maybe broker some of those relationships and help, you know, make those connections.

Nate Houchens (24:59)

It sounds so much more meaningful to be able to meet a person, a patient, where they are and offer solace in what they are seeking rather than to come with that sort of a pre-prescribed method.

Dale Nikkel (25:12)

Yeah, I think there's a key assumption there, isn't there? You know, as there's the beautiful diversity of humanity, there's some dignity there too, I think, that I respect you, you know, as a person and more… I think some, an aspiration to humility that I don't have the answers. But let's talk about how you have found wisdom in your life. Where do you go to for, you know, support? How do you make sense of the world and are those, are there people in your community that can help you walk through a healthcare journey as it's, you know, it's not always an end of life situation, that's a pager and then the situation is done and it resolves in whatever way. But in our world as you know, you know, the healthcare journey can be a lengthy one. It can be a marathon that lasts months, years, decades even.

And what is the spiritual? How do you nourish your spiritual health? We're talking a lot about spiritual health these days. I like that term because it aspires to, how do you nourish spiritual health? If you think of physical health and all the indicators of how one might nourish their physical health, you can think of, you know, you're going to sleep well, you're going to watch your diet, you know, eat less donuts and, you know, exercise and all these things that help us.

I think the spiritual life is similar. How do you nourish your spiritual health? There's gonna be a range of contributing factors to that as well. You know, do you have spiritual practice? Do you have relationships? You know, do you have a sense of the transcendent in your life? What are the ways? And I think today's day and age, it's a very exciting and unique time in that I think there's a lot of diversity in spiritual expression. That is exciting, but it requires, I think, sometimes a bit of work to articulate our spiritualities. Whereas in days past, our categories might have been tidier for many in terms of a specific religious denomination that someone might have affiliated themselves with. I think increasingly what we're seeing is people that have, maybe were born into a certain religious tradition, but they've discovered other things along the way.

So how do you articulate that in terms of nourishing one's spiritual health? I think that's that assessment piece too that I think spiritual care can really help with is, tell me what spirituality might look like for you. And it's beyond those traditional categories, or it doesn't have to be. Sometimes it is within a category, but often, there's a diversity there, overlapping expressions, whether it be music or eco-spirituality or family. How do they connect themselves to the larger world? And that's all those indicators of sacred moments, right? What is transcendent for you? What is boundless? What is ultimate? What starry night kind of moments where we feel, hey, the world is in order. What is that for you?

Nate Houchens (28:46)

Is there anything about your background and lived experiences so far as a teacher or as a musician or as a writer that you think has informed the ways that you show up to patients and their family members in these moments?

Dale Nikkel (29:05)

I think it is, I appreciate that question. I think for me it is an appreciation for the diversity of spiritual experience. I grew up in a Mennonite brethren home and it was a strong spiritual focus to our home and I ended up in the Anglican tradition. But in addition to that, and those are still important sources of spiritual nourishment for me. 

I also, you know, as I mentioned, I spent some time in the music industry trying to make a go of it as a singer-songwriter. And I think it was those decades that sometimes feel like a waste of time. But you know, the kind of, the side effect of those were the guitar and music began to be a key source of my own spiritual practice in expressing, you know, what was in my heart. 

And I think in addition to that, you know, more recently, nature and reflection in nature and family and some of these things that I may not in earlier times of my life expressed them as spiritual practices but I think today I would. Yes, I go to church. Yes, I pick up my guitar and I'm not playing necessarily religious music. Whether it's James Taylor or Bruce Cockburn or David Wilcox or Pierce Pettis or whoever my string of favorite songwriters might be. But it's

it's connecting to that deeper place within me. You know, nature's the same, you know, to include that in my daily practices. So, I think all those experiences, writing would be the same as, like, how do we put words to our experiences and express them, you know, and it could be a form of a reflection, it could be a form of a prayer, it could be the form of just some sort of significant thought. 

I think there is a greater, you know, appreciation in me, I think, for how many different expressions of spirituality might be. I would include philosophy in that now after doing some studies the last five years of just engaging cognitively in some of these larger philosophical conversations. I find that sometimes the existential reflection, it feels spiritual to me, but it's exercising a different part of me that I really in some ways, you know, didn't know that part of me was there. 

So, I suppose I am open to the awakening of different parts of myself that, here I am in midlife, that, you know, I've experienced all of this, but could there be even more iterations of spirituality for me coming down the road and I'm not jettisoning what I have, but just adding to this collection of meaning, you know, as a human. 

So all that to say, I think in terms of people that come to our centers, I think there is a diversity of spiritual expression that's, you know, that's beautiful to me. And I think it's an honor to serve and to try to appreciate all the different ways people express meaning.

Nate Houchens (32:17)

I love how you describe that and I love the term anchors of meaning as well. When people are seeking out what brings them meaning. That is such a powerful metaphor, that anchor piece. And just a couple of other reflections.

Yeah, I love the thoughts about sort of the flow state as some call them. In nature, in music. When you're really just in the zone, in the groove, it can absolutely feel like time has stopped and there is a deeper connection of some kind, internal or with the rhythm or with the music or with the nature. That is just a remarkable time for those who have experienced it.

Dale Nikkel (32:59)

I think so. I'll tell you a story about music and it's, I think it's the communal aspect of music too. I love music. I always have. At Christmas, for instance, in my spiritual tradition in the Anglican Church, the choirs, the hymns at Christmas time have a place in my heart that really invoked tears. I'm often emotional hearing them. And it surprises me, but it's also super comforting to feel those again because it connects to my childhood, it connects to family, it connects to experiences across my life of hearing these Christmas carols. 

I juxtapose that with an experience of, you know, one of my favorite bands, U2, and attending a concert at Roger Centre in Toronto a few years back. And, you know, here I am with 40,000 other people and Bono is at the stage singing “I still haven't found what I'm looking for.” I was just, tears were streaming down my face and I couldn't figure out what's going on here. And I think in some ways, I think it's the same spiritual connection. You know, it's me together with a group of fellow travelers on this journey, the human family gathering in one area was a church, you know, an Anglican church. In another area, it's just a group of concert goers. 

But in hearing that, something touched deep inside and whether it was the honesty of the moment, just being together or me reflecting on my own path, it doesn't really matter. But for me, I think it's, there was that deep sense of meaning. It was a sacred moment, both of those, you know, in terms of, there's something transcendent going on. It was more than that moment in that time, right? You know, there was, there was something ultimate there. You know, I really, like, you know, Paul Tillich's, you know, expression there is something that really moves down to the absolute core, the existence and why am I here? I felt at home there in both of those situations. So I think that's another example of just this… I think this openness to different expressions of transcendence, and I think both of those were transcendent moments that also had an immanent quality in the moment to them too. And I think there's this really interesting interplay, I think, between immanence and transcendence, you know, if we allow ourselves to reflect that way.

Nate Houchens (35:25)

I wonder if you could speak a bit more about that, immanence and transcendence. What's your impression of the relationship between the two?

Dale Nikkel (35:33)

It's a great conversation, isn't it? And I think, you know, I’ve reflected a lot about that the past years in my dissertation, you know, about immanence versus transcendence. And I think in the healthcare setting, you know, there's lots written about immanence, meaning the physical, and the focus in medicine on the physical. And the philosopher Charles Taylor talks a lot about this too, the immanent frame that is kind of closed within, there is not a consideration of the supernatural or a larger picture. Balboni and Balboni also talk a lot about this critique of contemporary medicine and that focus on the immanent, just that physical part of the self. 

But I think we're missing the larger picture. The immanent is important. When I go to a physician, I hope they're immanently focused on my physical needs, and I think the extension of that. There's a transcendent piece as well as, you know, what does it mean to care holistically that is beyond the different kind of parts of a human person, but to the entire piece, you know, of the humanity? What does that look like? I think we've got some work to do there. 

And I think probably it's about transcendence is a little harder to articulate. It doesn't line up very well with the scientific method. There is, you know, it's more mysterious, let's face it. I think we like more certainty, we like the data, we like the empirical aspects, and I totally see why. I want that in my medical care as well. For me, it's an and, you know, and we also be open to the transcendent. And I think this is the Sacred Moments project really, and I think in a nutshell, is encouraging that openness to transcendence. You know, both need to be there and different renditions of that considering. I think people see their lives transcendentally in many religious traditions. There is a reality beyond the physical moment here. And how are we helping people include those expressions in their healthcare journey? We struggle. I think we really struggle with that in healthcare.

Nate Houchens (37:49)

Don't get me wrong, I'm really grateful for all of the training that very much focused on the immanence. And I am exceedingly grateful to be the type of clinician that I can be in order to take superb care of patients that are in need. And to your point, I think we can certainly do a better job of introducing or perhaps fostering a bit more transcendence in our conversations and in our practices.

Nate Houchens (38:34)

I'm curious if there are any lessons from your patients or their families that you would take forward or that you would offer for those individuals who are interested in introducing a bit more transcendence to their own practices.

Dale Nikkel (38:50)

Yeah, it's a good question. I think it's just that openness. I think of those moments, whether it's, you know, I know we're short on time, I know the schedules, I know we've got, you know, we've got some other challenges in healthcare, you know, regarding burnout and wait lists and wait times and just how intense, you know, things are and budget pressures. It's a very complex environment right now.

I think that's the moment where, when I see a card or some feedback about a patient encounter, it's the human piece that comes forward in that feedback. It's that human piece, I think, when someone took a little extra time or they asked that extra question that moved it beyond the moment to their life. Life is so big and it's more than just that human body, I think. One's life is their family, it is their community and you know it stretches. That's that boundless piece here, you know we're talking again that it kind of transcends that moment, but I think in asking about one's life, you're acknowledging the largeness of this, right? And inviting some reflection of the whole person involved in their care but yeah these are good questions.

Nate Houchens (40:14)

I'm always astonished by the incredible things that I can learn from patients when I just ask a couple of non-medical questions, those questions that don't necessarily get me closer to a different treatment plan or ultimate disposition out of the hospital, but really are just connecting questions and ways that I can learn this other person as a person. And I'm just so amazed each day to recognize the power of those questions and also how much patients are craving it and how much they would appreciate recognition of their personhood rather than their collection of signs and symptoms.

Dale Nikkel (40:52)

No, 100%. Yeah.

Nate Houchens (40:55)

I don't have to tell you, but this work can absolutely be very emotionally draining and demanding. How do you care for yourself and sustain your own spirit, especially in the midst of grief and loss and end of life moments?

Dale Nikkel (41:10)

In a leadership position now, I'm not at the bedside. I remember, you know, coming home from some very difficult situations, you know, tragedy and intense situations. And, you know, it's a great question I think we all need to be asking. 

I use the language of spiritual health now, and I think it's that harmony that exists in caring for ourselves that in nourishing those spiritual practices. And I named those earlier, whatever they might be for you. For me, it might be heading out into nature, picking up my guitar, leaning into relationships around me, religious expression. 

But I think each situation seems different to me, that what I did last time doesn't always work the next time. And I think the more practices I think that you have in your basket of wellbeing, I think you can draw on different things. And I think the strength also of the relationships around you, I think… 

A few decades back, I probably would have counted myself as a really intense introvert who just needed some quiet time. And I do like quiet time, but I think increasingly over the years, I've just learned the importance also of relationships and collegial support and family support. And, you know, there's a human family here. Every practitioner is kind of dealing with their day and, you know, holding a heavy load, as someone said, you know, but in supporting each other, I think probably that relational piece is probably the biggest piece for me right now and sharing and trying to connect and, you know… The COVID-19 experience probably that inspired that a little bit more. I noticed through those years, just the importance of human relationship, just the power of a quick text or a short conversation or a FaceTime and connection to those, you know, who are in my corner and who, who know me and I can let my guard down and just be whatever I am in that moment. 

So that's a long meandering way to suggest it's a basket of things in caring for oneself. 

But somewhere along the line someone said that wellbeing is kind of like heading north. You ever get there. You're following a direction. I think wellbeing I think is a bit of an aspiration, isn't it? Spiritual health is too, that you're on a path towards a greater sense of health, spiritual health or comprehensive wellbeing, whatever you want to language it as. But do you reach it? You know, yeah, maybe some of you have those moments where you feel like I've got this, but there's always a new twist, right? In life, you don't always have it. But if you're heading in that direction, I think there's a mindfulness that you want to get there and you're mindful that, you know, I need to be careful today with myself and give myself that sense of care or those around me as well.

Nate Houchens (44:11)

I think those moments of suffering and challenge are what create opportunities for meaning. And for so many, I suspect, spiritual health, as you allude, is different, right? It looks different for different people. There are no hard and fast indicators. There is no blood pressure target or hemoglobin A1c that we can sort of mark as an indicator of spiritual health. And yet I think for each person, there may be an idea of what that means for them. And perhaps spiritual distress for some is not knowing what that looks like and not knowing what spiritual health looks like for them.

Dale Nikkel (44:50)

That's interesting, isn’t it? What are the indicators of spiritual health, you know?

Nate Houchens (44:55)

This is what I suspect the analytical folks in the audience are wondering, right? Like how can I assess, you know, a person's spiritual health? How can I assess my own? What kinds of things can I look toward?

Dale Nikkel (45:08)

Well, that's a great question, right? Sometimes it’s easier. You talked about spiritual distress. That might be kind of easier. I think there's more in the literature about spiritual distress and that sense of lacking hope and kind of despair and some of these things that I am lacking, sense of meaning. And this gets complicated all of a sudden, doesn't it? Even as I'm naming these things.

But yeah, maybe it is those. I'm just kind of reflecting on the top of my mind here, but maybe it is those spiritual emotions, things like, you have a sense of peace? Do you have a sense of wonder? Do you have a sense of, perhaps, harmony within or compassion or empathy? I think as a clinician, I felt tired sometimes, I recall, in years past, where you feel like, how do you inspire that spiritual health? 

This is where it gets tricky, right? Because it seems that when we talk about spirituality, if you think back thousands of years, it's the poets and the musicians and some of the philosophers who have had a… or the artists that have had an easier time somehow talking about these things and how to, you know, express them. 

But it's difficult. Language does fall short, you know, when we're talking about the spiritual. There is a mysterious element to it, and it doesn't mean that we shouldn't push towards some of these, you know, these indicators of a sense of fullness, you know.

What does it mean for me to be spiritually healthy? And that's that diversity of our own, you know, could be our own upbringing, our own personality, all those physical aspects as well that contribute to our sense of spiritual health. 

And you're asking good questions. I'm going to be thinking about that on the drive home here today.

Nate Houchens (46:51)

These are the questions of a person who has zero training in spiritual health and sort of religious care.

Dale Nikkel (47:00)

It's interesting though that, I think how I would ask that to a patient is, it's a patient centered question really, isn't it? Like what does it mean for you to be spiritually healthy? And I think as much as you know we want kind of a list of the indicators of what that might be, we might get at some broader principles. But in the end if you ask someone you know what does it mean for you to be spiritually healthy? I think they would probably pause and say well let me think about that a little bit and it sure helps to have a, you know, a starry night in front of you or a campfire or some of these other life experiences that are bringing these things to the surface. I think, you know, we might know it more intuitively. I think spiritual care, as a profession, I think we're much more comfortable living in the mystery of spiritual health. And, you know, it's, yeah, it's maybe not as precise as we would prefer, but you know, spiritual health, what does it mean? Is it, you know, it's all these things that are so unique to us. Yeah, lots to think about.

Nate Houchens (48:06)

Lots to think about for sure. I want to be thoughtful of your time, Dr. Dale Nikkel. Thank you for spending your time today with us. Your wisdom and your guiding us in this mystery is very much appreciated. Thank you.

Dale Nikkel (48:20)

Yeah, thank you for your time. You've given me a lot to reflect on here and I do appreciate the opportunity and yeah, so supportive of this Sacred Moments Initiative. What a great mission you’ve got here. So thank you.

Nate Houchens (48:33)

Very kind of you. It's a team effort, yourself included. Dr. Nikkel, thanks so much.

Dale Nikkel (48:37)

Alright, take care.

Postlude

Nate Houchens (48:55)

We would love for you to be a part of this movement, and we would be honored to hear your story. If you have experienced a moment of grace, connection, or empathy that changed you, we invite you to submit it for consideration to be shared on Boundless Moments by sharing, you not only contribute to a collective celebration of human connection, you may also inspire others to recognize and cherish the sacred moments in their own lives. To discover more about sacred moments and to share your own story, please visit sacredmomentsinitiative.org.

This episode of boundless moments was produced, edited, and mixed by Nathan Houchens. Our program manager is Jessica Ameling, and our publishing and social media manager is Rachel Ehrlinger. Our podcast is made possible by the Sacred Moments Initiative, a humanistic project whose aim is to study, catalog, and share sacred moments. Learn more at sacredmomentsinitiative.org. Boundless Moments is also made possible by donations from listeners like you. Thank you so much for supporting our work in sharing sacred moment stories. If you enjoyed this episode, please subscribe to the show wherever you get your podcasts and drop us a rating or review to help others connect with us. I'm your host, Nathan Houchens. Thank you for joining and until next time, be well.