Friday, August 04, 2006

God in the ER

For almost two years now, since October 2004, I've spent four hours a week -- unless I'm ill or out of town -- as a volunteer chaplain in the emergency department of one of our local hospitals. This hospital isn't a trauma center, so the work isn't as dramatic as it sounds: we don't get gunshots, stabbings, or really bad car accidents. But the place is still plenty busy, with a huge range of patients and problems.

I started out being more than a little scared of the ER. Now I absolutely love it. I'm an ER junkie, although my infatuation would probably fade pretty quickly if I had to pull the twelve-hour shifts that are standard for medical staff. When I can't work my modest four hours, though, I get positively cranky. This is exactly the same way I feel when I miss my almost-daily exercise or can't get to weekly communion: irritability combined with physical restlessness. Withdrawal symptoms. (I had a great time in Berkeley last week, but I was still jonesing for the ER.)

A few months back, I realized that the ER has become sacred space for me, because it's where I most reliably encounter God. Sometimes it feels more like church than church does, even or especially when it's really busy. This seemed a little odd even to me, so I sat down to figure out why.

First of all, the ER (at its best, although no human institution functions at its best all the time) epitomizes a culture of compassion. As I've said here before, genuine vulnerability is one of our deepest taboos. But ER patients are all, to varying degrees, profoundly vulnerable, and instead of being mocked, they receive supremely skilled and conscientious care. The staff do whatever they can to relieve pain, both physical and otherwise. Nurses have sought me out to say, "Will you please go talk to this very anxious patient?" or "We have a patient who's dying and is here all alone: do you have the time to sit with her?" Anyone who's spent time in an ER knows that some patients -- especially the elderly and bereaved -- come to the hospital because they're lonely and need human care and attention, even if they aren't fully conscious of those motivations themselves. But loneliness and grief can take a heavy physical toll, and these patients receive the same care as anyone else. This kind of focused attention and respect renders frail, broken human flesh holy, and functions as powerful medicine in its own right.

And so all that suffering isn't, as you might think, depressing. Too many of us respond to suffering either with overwhelmed denial ("If I pretend it's not happening, I won't have to figure out what to do about it") or with despair ("There's nothing I can do about this, and everything's hopeless"). ER staff see suffering firsthand, but they neither deny it nor allow themselves to despair about it. They get to work doing whatever they can, however small or partial that effort may be -- and sometimes, of course, it's life-savingly large -- to solve the problems in front of them. They do what they can, where they are, with what they have. What might the world look like if all of us did that everywhere, every day?

I'm also continually astonished by how the ER brings out the best in patients. Some, of course, are in too much physical pain or too chemically impaired or under too much emotional stress even to be polite. (Hey, I'm not always nice when I'm sick, either.) But most patients manage to be deeply gracious even when they're in agony. They thank me for visiting them. They thank me for being a volunteer. They tell me how grateful they are to the doctors and nurses. When I pray with them, they weep, squeeze my hand, promise that they'll pray for me. They tell me amazing stories: stories that move me to tears and laughter, that show up in my dreams, that fill me with awe. After an hour or two in the hospital, any pains or worries of my own have vanished. I've heard life stories that made me wonder how the patient managed to get up in the morning, let alone remain cheerful in the face of a medical crisis. The word "humbling" doesn't begin to cover this.

And patients help each other. They form community. I've seen patients and their friends and relatives offer each other hugs, Tylenol, pillows, tissues, shoulders to cry on, cabfare home. Children to whom I've brought crayons and paper (we have coloring packets put together by other volunteers, and they're a great distraction for kids) often draw pictures for the doctors and nurses. More than once, when I've introduced myself as the volunteer chaplain, a patient has said, "I'm okay, thanks, but the person in the next bed really needs you."

Everyone in the ER, patients and staff, dwells in liminal space: in the space between life and death, health and illness, the known past and the unknown, frightening future. This is what Celtic spiritual traditions call "thin space." It's where the human and the divine come most closely into contact. And the range of humanity in the ER is amazing: we see the very old, the very young, the poor and the rich, every possible ethnic group, the homeless, the addicted, prisoners (always accompanied by corrections officers), people who are grieving and people who are joyous, the helpers and the helped. The Body of Christ has many members, and the ER is as concrete an example of the Body of Christ as I can imagine.

And so after a while, everyone in the ER looks like Christ to me: patients in pain, staff working to relieve pain, worried relatives and friends. The ER shines with Christ, overflows with Christ, incarnates Christ. And at the end of every shift, Christ sends me back out into the world, to feed others as I have been fed.

Thanks be to God. Alleluia, alleluia!


  1. bill pounds12:33 PM

    Thank you for your narrative on your experience in the ED. Your volunteering brings a freshness to ministry in this context. Volunteers are critical in hospital ministry for the insight and energy they demonstrate in providing care. I am the retired director of pastoral care at Swedish Medical Center in Englewood CO and an acpe supervisor
    who valued greatly the volunteers at our center. We were the primary medical center for the Columbine victums and our volunteers were incredibly helpful. Pax, Bill Pounds

  2. Thanks, Bill!

    Columbine . . . words fail. I'm not sure how I'd function in a situation like that; I hope I never have to find out.

    Just out of curiosity, how many of your volunteers were clergy, versus laypeople? As a layperson, I've discovered that many people (including medical staff) assume that all chaplains are clergy. Volunteer chaplains sometimes have to spend as much time explaining what they aren't as what they are!

  3. Anonymous4:27 PM

    I work in a catholic hospital as a night shift house doctor. This reminds me of an incident last night. The ER called up to us in the ICU with a heads-up on an incoming 56-year-old being coded en route to the ER. Walking back to my office in the eerie, empty atrium overlook, with my foot steps echoing, I paused. I hoped God was in the ER.

  4. Hi, Anon. Thank you for posting! I hope that patient made it.

    I think ICU would be a very hard place to work. In the ER, we see a lot of people who aren't in very bad shape at all, who are going to be able to walk out and go home again. In the ICU, everybody's in very bad shape by definition.

    Bless you for doing that work!

  5. Tina in Ohio10:22 PM

    Thank you for your words. They were refreshing to my spirit and a joy to my soul. I am just finished only my second day as a registration clerk working in the er department. I am deeply in love with Jesus and have found that He has called me by name to be in the midst of exactly what you have said, many walks of life in many stages. The er I work in is a Trauma 1 facility so we do see the super severe cases. I have met glorious saints and some pretty practiced sinners (aren't we really all those). I have heard Jesus' name said with sweetness, while hearing other words not so sweet, yet you have reminded me of an essential thing that I have known for a long time. In a very real and special way, Christ is very near the suffering, and especially near those who are dying. Your words reminded me of the joy of knowing that when I am talking with patients and trying to help them as much as I can, I am really showing Christ love.

    Thank you for the encouragement


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