Malade Screening: Serving Our Lords the Sick with Utmost Care

 

This time of year preparations for our 2016 Lourdes pilgrimage pick up significantly, as do the questions to the medical team and the hospitallers about the selection of Malades and their companions. With that in mind, here is an overview of how it all works, given from my perspective as pilgrimage Hospitaller.

 

Malade applications, due by mid-December, are entered into a database that includes contact information, medical history and a physician recommendation. The entire process is overseen by our medical director, Dr. Harry Johnson, KM. Our chief nurse, Joan Cincotta, DM, and our assistant chief nurse, Marguerite Baxter, DM, call and make initial contact with the applicants. Joan and Marguerite review medical history and medications, ask additional information if necessary, and confirm the current health situation of each applicant. They then update the database so that the volunteer physicians and nurses have the most complete information on the health and well-being of the applicants for the selection process.

 

Beginning in January the medical team conducts two Malade screening events, one at Mercy Medical Center in Baltimore for applicants from Pennsylvania, Maryland, Delaware, Northern Virginia, and Washington, D.C., and the other at St. Cecilia’s in Houston for applicants from Houston, Dallas, and Louisiana. About half of all Malade applicants are seen at these two events. The remaining ones are interviewed individually by physicians in the regions where they reside or by a physician who specializes in their particular diagnosis. Harry Johnson heads up both the Baltimore and Houston screenings and organizes physicians conducting individual interviews.

 

On Sunday, January 31^st, physicians and nurses from around the country gather at Mercy Medical Center and begin the selection process. The first and most important question is whether or not it is safe for a Malade applicant to fly to Lourdes, stay for a week, and fly back. The second consideration is whether this might be the last opportunity for a particular Malade to make the pilgrimage as his or her condition progresses. We also give attention to regional participation; if there is only one prospective Malade from a region we try to give that applicant particular consideration. In addition, we try to accommodate wounded military veterans.

 

We’re often asked if there are any situations or conditions that would disqualify a Malade applicant. Over the years we’ve found that Malades with dementia or Alzheimer’s have a difficult time with the pilgrimage. Applicants who might be scheduled for surgery, especially involving the head or lungs, also tend to be at too much risk to travel. Likewise, we are not able to accommodate Malade applicants who are quadriplegic or who require a specialized lift.

 

Our physicians and nurses carefully evaluate every application, classifying each potential Malade into one of four categories: accepted, wait listed, deferred, or not appropriate. Most applicants fall in the first three categories. Those that fall into the fourth typically have a diagnosis that would make the pilgrimage unsafe for them.

 

Most years a few Malades withdraw from the pilgrimage, usually for health reasons, in which case we draw from the wait list. During the selection process we assign a number on the wait list and when a spot opens we call the first Malade applicant on the list and share the good news. In the rare instances that a wait listed Malade applicant cannot join us we move to the next name on the list. Occasionally we exhaust the list, and then start calling those on the deferred list with the invitation to join us. Drawing from these lists as necessary, our goal is to take 48 Malades on pilgrimage each year. Most withdrawals occur in April, often because an accepted Malade will hold out as long as possible before making the decision to withdraw.

 

Every year there are requests to take additional family members, sometimes because the entire family, including siblings, is involved in caring for a child Malade. When this happens, the family or the region where the Malade resides covers the expenses of the additional companions. We have a policy that strongly favors having two companions for a child Malade, usually the parents, the idea being that if one of them becomes ill the other will be able to provide consistent care to the child Malade.

 

The screening process also takes in the health of the Malade companions. Over the years some companions have been nearly as ill as the Malade applicant. In some cases it may be necessary, as space allows, to take both as Malades. When this occurs, we may require two additional companions. 

As pilgrimage Hospitaller, it is my responsibility to inform each prospective Malade of the application results -- accepted, wait listed, deferred, or not appropriate. Calls to those accepted are easy and edifying. Letting folks know they’ve been wait listed or deferred is much more difficult. Tears, frustration, and even anger, sometimes are part of the response. This too is grace-filled as our beloved Malade applicants are in most cases facing great challenges in their lives, and having the opportunity to serve them in some way is an honor and a privilege.