E100: The Spiritual Domain of Friendships

Kirtly: Some people come into your life for a reason, and some for a season, and some for a lifetime. Welcome back to our "7 Domains of Women's Health" series on friendship. As always, our last session on any topic is the spiritual domain. And today, we're talking about the spiritual domain of friendship.

I'm Dr. Kirtly Jones, a reproductive endocrinologist, and we've talked about how we evolved for connection, for friendship. If you didn't catch the first session of the friendship series on the physical domain, you might go back and listen, as it explains the powerful physical effects of a friend, and it lays down the foundation of our connections as humans, as friends.

And with me is my co-host, Dr. Katie Ward. She has a doctorate in nursing practice and in anthropology. So she thinks deeply about friendship, and she has a specialty in women's health.

I want to start with friends who are with us to help us through important spiritual and emotional transitions, those friends who are with us at a birth or at a death or at another powerful spiritual transition.

I've recently experienced the loss of a beloved, and I had friends, spiritual friends, who guided me on this path. And they're friends who have different religions than I do, and they see the world through a different lens than I do, but their presence and their words and their beings were enormously comforting.

Katie: And Kirtly, I want to express my condolences publicly on our podcast. I've lost parents and friends, and as we talked about earlier in this series, my dog recently, but not a beloved partner. And I'm not sure I know what that feels like or how to be a spiritual friend in that setting, but I'm really sorry for your loss.

Kirtly: We'll walk that walk together.

Katie: Yeah. But when we did talk about my losing my dog, I mentioned that I use phrases like "she's over the Rainbow Bridge." In fact, when I had to share that information with another person in her life who loves her, that was the only word I could . . . I couldn't type in that Sophie had died. I just had to use "over the Rainbow Bridge." Not because I think I'm going to see her again over some bridge or in an afterlife even, but I didn't have any other way to talk about it.

And I think one of the really wonderful things about dogs is they have this ability to be completely present in the moment, and they're not worrying about their afterlife.

Kirtly: Well, we don't think they are, but we don't know, Katie.

Katie: I guess we don't. I guess that's true. But one of the things I know about my dog is she was very present in the moment. And I think about it this time of year because we just changed the clocks and that was her least favorite time of year. She had this particular internal rhythm, and if her rhythm didn't match mine, even by an hour, she was confused and upset and didn't know where her food was.

So there's something profound about just being in the moment with me and noticing everything and living without anxiety about what comes after. I think that's a piece of what a spiritual friend does, that they are with you in the moment. And maybe just by being there or being in ritual . . . Humans have rituals around birth and death and other significant events because I think it helps us know how to be present in the moment. And so I hope that I know at least that much about how to be there for you.

Kirtly: I think you do, Katie. And in these 7 Domains of Friendship, we've talked about our young friends and the powerful bonds made in adolescence. And we've talked about how friends improve our health and help us live longer and more rewarding lives. Today, we're going to talk about friends who are with us at the end of our lives or the lives of a beloved.

And with us in this virtual Scope studio to help us think about these friends who hold our spiritual hands through difficult times is Chaplain Susie Nelson. Chaplain Susie is a board-certified clinical chaplain for the past 9 years and has 20 years of previous pastoral experience. She works in the hospice arena, working with patients as they prepare to die, and also with their loved ones both through the process of dying and after death when they grieve and mourn their loss. In her practice, she meets with people and families at the end of life, and these people come from all different traditions.

Welcome to the "7 Domains of Women's Health," Chaplain Susie.

Susie: Thank you for having me.

Kirtly: Can you tell us a little bit about your practice and how you became a hospice pastor?

Susie: About 25 years ago, two years apart from one another, both of my parents passed while they were on hospice care. And that was my first experience with hospice. I wasn't that aware of everything that they offered prior to that time. All I can say is both times, both experiences, those people were absolute angels for us. Not only for my mother and my father, but for myself.

And at the time, I was in the sandwich generation. I was still raising children and had a junior-higher and a couple of high-schoolers, and I was working part-time, and it just was a crazy time of life. And so they helped me so much to honor my parents across the threshold. And I just prayed at that time, Lord, someday I want to be on the other side of this equation. So that's a short story for the long journey.

Kirtly: That's lovely. And can you talk a little bit about the role of friends in the hospice setting, the friends of the family or of the person at the end of their life? We always think about the person who is dying surrounded by their family. But often, what about friends? I mean, I want to be there for some of my friends. I don't want to get kicked out of the room by their family.

Susie: I had to stop and think about it. I've helped well over 300 people cross that divine threshold, and I've seen lots of scenarios, as you can imagine. There is no patient or family that is ever going to be repeated exactly. Every situation is unique.

So I've seen situations where sometimes families can be quite dysfunctional. I think every family is dysfunctional on its own level.

Katie: Isn't there a quote about that somewhere?

Kirtly: There is a famous quote.

Susie: There's no such thing as a non-dysfunctional family. But sometimes families can be very distraught through the circumstances. They can be at odds with one another, not able to agree on care and final arrangements and all of these things. And I've seen a best friend of the patient or a friend of the family be able to come in and be a calming presence and just remind everybody what's happening and what's important. They've been able to be a neutral party in the thing, but almost an advocate for their best friend who's dying, and it's a very precious thing.

Kirtly: I like that term. Families often recapitulate their same old battles, even in something that is so new to them, a person that they're battling for or battling against. But they recapitulate old sorrows and angers. And sometimes having someone come in who's only been a friend and hasn't been part of these things, sometimes that can be the most soothing person, aside from the hospice chaplain, of course.

Katie: When I was losing my parents, it wasn't simultaneous. They were very much involved in their church. But I had a lot of conflict with the pastor in their church. And I found the hospice chaplain to be a great neutral territory for me, somebody I could talk to without just the emotional overlay that the pastor that they were connected to brought into the room.

So I just want to say thank you for being the hospice chaplain and being that neutral and safe space, because that meant a lot to me when I was in those situations.

Susie: I'm glad you had that experience. I count it sacred space and I never take it lightly.

One thing I did want to say, too, is that sometimes a beautiful thing that I see happen is within families, sometimes there are best friends. I have counseled and comforted many bereaved daughters who will say, "My mother was my best friend. Not only did I lose my mom, but I lost my best friend." Or a son and father relationship like that. "I don't know what I'm going to do this year when it's hunting season. I've never gone hunting without my dad." And so it's beautiful to see friendships within families as well. So you can have one end of the spectrum all the way to the other.

Kirtly: Yeah. Well, some family members come with a long history of friendship with the person that the family may not know. And so I think of certainly during the HIV epidemic, when someone who was gay was dying and their friend, their powerful romantic friend, or just a friend within their community comes in, and the family doesn't always know. Or they come from different religions, and the family has a tradition that they feel very strongly tied to, and the friend doesn't do that. How is that negotiated, or what's the experience in your practice?

Susie: Well, I am technically an interfaith chaplain. So when I enter a circumstance, I never come in with my own beliefs, but I come in to learn what the patient's beliefs are and how I can best support them.

Sometimes I have to just remind people, and some people with different beliefs will disagree with me here, but it's my firm conviction that we don't . . . This is not a dress rehearsal. We don't get a redo. And we need to remember that this is their journey into eternity. How best can we support them? And that oftentimes will be a deal breaker. They'll say, "Okay, well . . ."

In our demographic here, we have many, many Mormon families who have loved ones who have left the faith, and it's caused a rift. And so I oftentimes will just ask my patient, "What's your relationship with God? How are you with Him? Are you at peace? How can I best support you?" And I usually get a lot if they know that I'm not there to convert them to something. So that's helpful.

And if that patient has a particular pastor or rabbi or shaman or whatever that they want brought in, I can be a link to help make that happen as well so that they have their prayers and their beliefs comforted and confirmed.

But you're talking about friendships in general, and on a spiritual nature, I have found, even in my own life, that I am closer to many of my friends who believe the way I do than I am with family members who disagree with me.

Katie: Yeah.

Kirtly: Yeah. And it might be when you say maybe to them, "Who do you want in the room today?" . . . Because people who are dying, often they're very uncomfortable, or they're not quite sure what's going on. But if you say, "Who would you like to hold your hand today? This doesn't have to be your last day, but who would you like in the room today to spend time with you?" everybody wants to be there, but what you want is someone who can be calm in the room, who can be a friend and a love. I think those things become really important.

Susie: I so agree with you, Kirtly. Those last hours/days are so precious. And I'm always on a journey to find out what that person feels they will want and to provide for that. I've seen everything from a rip-roaring band and Rolling Stones session and people around the bed, to candlelight and incense and heart music or quiet and maybe just that one person, or no one. I've seen people wait until the room is cleared before they go.

Katie: I had to find some comfort in the idea that maybe I needed to leave the room for my mother to go.

Susie: That's very often the case, Katie.

Katie: Yeah. But I sometimes think of friends as my chosen family. I don't have a lot of family, and there are rifts, and so friends are family for me. These are the people I really choose to make a family out of.

Susie: Yes, you make a very good point. Our family is given to us, but our friends are chosen. There's a couple of proverbs that I love. One says, "There is a friend who sticks closer than a brother." Another says, "A friend loves at all times, but a brother is born for adversity." And the kind of meaning that I take away from that is a friend, a true friend, as much as they are able, always shows up.

You think of someone who is so close to you, who knows intimate thoughts that maybe you haven't shared with anyone else or experiences that you haven't shared with anyone else. On the other hand, a brother or a family member, we would hope, would feel enough responsibility, even if they don't like you, to show up and help you through something.

Kirtly: Yeah. Well, I'm going to take a little tack here, a little turn, a little tangent. I'd like to talk about the idea of spiritual friends, because sometimes the people who come at the last hours who are friends are people who have had unique spiritual relationships. They're comfortable walking into a . . . And I'd say the room in which someone is dying is a spiritually intense place. Even if you're not a spiritual person, it's not an easy place to be. And the friend that shows up for that, shows up for you in this transition, often had been a spiritual friend.

I think in the spiritual literature, these friends are those with whom one can share deep conversations about life and our beliefs and our connection to a greater purpose.

I mean, these friends may not be your best friend or someone you share a lifetime of experiences with or someone you call to go out for coffee, but these are people in whom you've had a trusting relationship with the confidence that you can openly share and discuss your spiritual questions and a journey.

They may share a common religious tradition, or they may not, but they're willing and helpful to listen to you and engage in deep conversations about meaning and values and beliefs.

I don't know, Katie or Susie, do you have experience with friendships like that?

Katie: I'll speak up a little bit. We've been, for obvious reasons, talking about one end of the lifespan, but I have a lot of experience with people who work at the other end of the lifespan around birth. What I've learned from my midwife colleagues is the value of telling that story and kind of saying it over and over again.

I mean, I'm not always thinking about that necessarily in a cosmic sense, but I think bearing witness to the sequence of events and being with people as they move through the narrative, that does really connect the now with another moment forward or backwards.

So I was thinking about that a lot, about how I've learned to be . . . Because I've spent more time sort of with people who have just given birth, and the importance for them of telling their birth story and moving through the sequence of that.

And so I was kind of thinking about that sort of listening and witnessing. It does feel sacred to me. And I've been thinking about that as a way to be with people as they lose someone, is about asking about the story and being there to listen to what happened and then what came next. I think that that connects in a bigger way.

Kirtly: Yeah, I've been telling my story, and it helps me to say it over and over. And so even people who aren't deeply in faith, if they're good enough friends, they're willing to listen to me tell the story over and over.

Katie: And I think it's important. I think that bearing witness is a sacred kind of responsibility.

Susie: I agree completely. And there are some people who can do that just better than others. It's important for us to find our people, the people that we know will listen. If it's an end-of-life experience, it gets to the place where a lot of times people will be like, "I don't know what to do with your pain, and I can't be with it." But to find people who are able to listen to what occurred and how it affected you and what it meant to you and to, like you said, Katie, bear witness, just listen, be present with it. Don't judge it, don't correct it, don't . . . Just, yeah, bear witness to it, that we can tell it again.

Kirtly: And that's the kind of spiritual friend . . . You can't tell that to everyone. Sometimes there are people who've been good friends, and they're not the people who are going to be that for you.

My experience is I have friends who are important to me, but they may not be the ones with whom I try to explore my own spiritual identity or tell a profound spiritual story. And for me, as I have no religious foundation, I don't have a minister or a priest to tell me how to think or what words to use. I may use a conversation with these friends, and they are few with whom I can trust, who are active listeners.

As you said, they are willing to be there and listen nonjudgmentally, who can help me find words or just listen to my thoughts. And they can share their own if they want. Maybe not. And hopefully I'm a trusted and nonjudgmental listener if they share their own spiritual journey or what they've been through in difficult times.

These people often offer deep emotional bonds and help me through difficult times and enrich my spiritual life. In the Intellectual Domain of Friends, we talked about friends who help us think a little harder, more carefully. And a spiritual friend might help you think a little softer, to take a softer gaze at one's inner self, shining a soft light on a path to understanding oneself and the world and our place in it. So I think of my spiritual friends as people who think and help me think softly.

Katie: I like that.

Susie: I like that too. And often, just a gentle reflection of what you heard back allows them to know that they were heard. And that is such a gift. Our presence is a present.

Kirtly: Yeah, it is.

Katie: I've been thinking about what you're calling spiritual friends. And yeah, it's this thinking softly. This might be harder thinking. I don't know. But people who help me think about and recognize generational patterns. I've spent time thinking about how my parents' lives and those circumstances shaped me. And now I'm in a position where I'm watching my son parent his children, and that line of connection from ancestors to descendants and understanding my place in that line, it feels meaningful, and it requires understanding.

And I don't know that I frame it in terms of faith or a deity. I definitely recognize that I'm in the middle. I'm part of something that extends beyond my own life. It's just in the middle of a flow between what came before and what came after.

I think we pass those things on through our stories and our patterns of behavior, but the stories that we tell and how important those are. And I think that that's a thing that kind of crafts tradition and ritual that makes these significant events meaningful.

And so having a group of people that sort of have that same ritual around it is always a source of comfort. So that was what I was thinking about, about spiritual friends, the ones that carry the story.

Susie: I was thinking a little bit about your beautiful concept of helping you think softly. Is that how you said it, Kirtly?

Kirtly: Mm-hmm.

Susie: I thought that is so often the case, and yet I can remember times in my life that I was looking at hard decisions or looking at something that could be just really, "I need to make the right choice, or it's going to have ramifications one way or another."

I have appreciated having spiritual friends in my life who could ask me the hard questions. It's like, "Susie, think clearly. If you make this decision and this happens, or this decision and this happens, will you be okay with that?"

And I have appreciated the people who I have grown to trust enough that I could say, "Tell me what you really think. Am I missing something? Am I looking through my blind spot?"

And boy, that can be really helpful at the end of life as well, because people don't want to leave loose ends. They want to make sure that they've said everything they need to say and make sure that people hear everything that they need to hear. Do you know what I mean?

Kirtly: Yeah, I do. And listen thoughtfully.

Well, maybe many people don't seek or need a spiritual friend, and maybe the concept of a spiritual friend is brand new to people who are listening. I didn't use that term. When I was researching for this particular podcast, I started hunting for spiritual and friend, and then "spiritual friend" popped up in the Buddhist literature and in the Christian literature. I went, "Wow, there are spiritual friends, and I think I've got some."

But anyway, for people who don't need this, their spiritual life isn't a big part of their personal growth, or they have a deep relationship with their religious tradition and the leaders of their faith provide a sounding board or a roadmap for that religion.

But many people raised in one religious tradition undergo a crisis of faith, a time when they question the tenets of their faith. And at that time, a spiritual friend or the religious leader may help them through a difficult spiritual time. They would offer a sounding board and help someone find their way in their original faith or with a new one.

So if you're looking for a spiritual friend, how do you find one? And I guess I didn't know I had them, but when I read about the definition of them, I know I have a couple. So how do you find them?

Maybe you already have one and you just didn't use that phrase, or you haven't come to conversations with a good friend that lead you down a path of discussing meaning and personal growth and faith. And maybe a friend who's experiencing a similar transition in their own growth could be the one to explore spiritual ideas.

Maybe this kind of friend, this kind of discussion, comes just by happenstance. Someone opens themselves up to a conversation, and if you're lucky, you walk in, and then something opens up with this friend or becomes a friend, and you have someone who can walk this walk with you.

If it doesn't happen by happenstance, you might find that finding a community to help you think about your spiritual path may have to be intentional. You may have to go looking, and you might find a community with which to explore your spiritual life, or you might join a faith group, and there might be workshops or retreats with people who are also looking to have conversations about their spiritual path.

And there are many of these groups in the Christian religion, and that's one I know best, because I'm raised in this culture. The very first book groups . . . we've had a 7 Domains of Book Groups. The very first book groups were women's Bible studies groups in the 1800s.

Other religions may have places or retreats especially for talking and thinking about one's spiritual road. The Buddhist path has a long tradition of religious friends, and the Buddha had special writings about the power of religious friends.

So, Chaplain Susie, do you know any of these groups, and maybe support groups suffering from loss might be a place to develop discussions about spirituality?

Susie: Oh, yes. I know that in my own experience, I have found spiritual friends within women's Bible studies coming to common ground. I think church communities are a good avenue to explore. And just having conversations with people that you're already friends with, maybe just saying, "What do you believe about spiritual things?" And have a conversation with someone. You might have more in common than you realize, or you may bring up some points that would cause you to dig deeper into, "What do I really believe?"

Kirtly: I think that's a wonderful way of putting it, too. Just say it and see what happens.

Susie: Yes. What is your spiritual belief? What's your relationship with a higher power or God? Or like with me, what do you believe about the Trinity and Jesus Christ and the cross? Then you find people that believe like you do, and there's something of a knitting of the hearts together that just happens on a spiritual nature. I can't describe it any other way.

Kirtly: Well, I was sitting on my back deck with some friends that go back over 50 years, and I was just talking about man's search for meaning and how, for me, there is some . . . I just happened to talk about the majesty of the creation, and my friend just said, "Well, I'm an atheist." And I said, "Okay, but do you think that the creation is majestic and amazing?" And he said, "Oh, of course."

He's a scientist and geologist, and I'm a biologist. But we were different in terms of what we were willing to put into this majesty that we love, and we're a little different about . . .

He was happy to talk about it, and we've never in 52 years ever talked about it before. It was a great discussion because it helped me think about my own path. And he was willing, after 52 years of mostly talking about hikes and trips, to give me a little.

Susie: That's great. And I have had some people that I've had those types of discussions with, because I am so firmly grounded in my own convictions and beliefs, but I love this person and want to spend time with them. You come to the end of it and you say, "Well, I'm never going to believe the way you're believing, and you're never going to believe the way I'm believing, so let's just agree to disagree and still be friends."

Kirtly: Yeah. Right.

Katie: That's what I was going to add too, because I think you . . . I mean, I've said this before on the podcast, but I have never felt as spiritual as I might at a concert where there are 20,000 people all singing the same song in unison, or with six friends at a book group, or sitting around a campfire just enjoying each other's company.

So I think it doesn't always have to be the ultimate conversation about creation versus evolution, even though I don't think that that's a fair way to put things. But I think there are so many ways to be spiritual and finding connection and . . .

Susie: We all carry a spirit around with us, whether we like it or not. We are threefold beings: spirit, mind, and body. We can't avoid it.

Kirtly: Well, what we feel when there is something . . . A very famous choir conductor called Robert Shaw said, "The divine is heard in the human voice." There is something when you're singing with people, when a bunch of people are singing, that really makes my chest expand. I mean, it's this physical feeling.

Katie, sorry, in these many podcasts you've heard me talk about what happens in my chest when I'm happy or when I'm feeling spiritual.

Katie: There's a lot going on there.

Kirtly: What's going on in my chest? No, it's not a heart attack, and it's not indigestion. It's just really a good feeling.

This rounds up our 7 Domains of Friendship, and we thank you all for listening. If you haven't been with us for all of the 7 Domains of Friendship, you can find them at womens7.com, or wherever you get your podcasts under the title "7 Domains of Women's Health."

You can listen with a friend, someone who can hold your hand for part of your journey through life. They'll make you more healthy and more resilient and more happy, and you will do the same for them.

And I'll finish, almost finish, with a little haiku for the 7 Domains of Friendship.

Help me find my way.

Shine your light on my questions.

My path glows brightly.

So before we sign off, I want to say thank you to Chaplain Susie and, of course, to Katie, as we've been friends together for a little while. This is Episode 100 of our "7 Domains of Women's Health" long-form podcast, and it's number 50 for Katie and me as co-hosts. We tend to celebrate occasions with round numbers, and this is a time to celebrate you, our listeners, and all of the people who've been with us as interviewees and friends.

Without you, and, of course, our production team at Scope at the University of Utah, and our producer, Chloé, we wouldn't have a lovely round number without you. So I'm thinking about this lovely round number with many thanks to you all, and I'm grateful.

Katie: Since it's number 50, I want to say thank you for adding me into the podcast here. This has been one of the unexpected joys in my career. It was not something I saw coming. I'm thrilled to be invited and to get to be a part of this, and I can't believe we've done 50 of them. But just in case this doesn't break the microphone, I've got a . . . It didn't make too much noise.

Kirtly: Well, maybe Chloé can add the noise. Chloé, you need to find that noisemaker and add it.

Well, thank you. Thank you, Susie, for joining us. And for you, it's number one. That's always a very important number. For me, it's 100. For Katie, with a big little noisemaker, it's 50. So thank you all for listening.