Yes, I know: in a perfect world, all emergency departments would also have unlimited budgets, 24/7 dedicated social workers, their own kitchens, and massage therapists for both patients and staff. Humor me; I'm a science-fiction writer, and utopian visions come with the territory.
My impression (correct me if I'm wrong) is that most EDs either use hospital staff chaplains, who cover the entire building and are summoned to the ED only in crisis situations, or community clergy who come in when someone in their own flock is in dire need. This means that these chaplains see only a very few ED patients: those who've self-identified, or been identified by staff, as needing spiritual care.
I volunteer four hours a week as an ED chaplain. During each shift, I try to see every patient in the ED, the Fast Track area, and the ED waiting room. I don't normally go up to one of the floors unless there's a code (spiritual-care staff in my hospital are expected to respond to codes). Most of the patients I see aren't in obvious, dire need of spiritual care -- although some are, of course -- and plenty of them politely dismiss me. But for many reasons, my presence is still very helpful.
- I have time to listen to anything the patient wants to say; that's my job. Medical staff generally don't have time to listen to anything other than medical symptoms, but having an attentive listener can significantly ease patient stress, which often reduces the severity -- real or perceived -- of symptoms. This is true even for non-religious patients: careful listening is ecumenical medicine.
A disproportionate number of the ED patients I see have been recently bereaved. Grief is hard, stressful work, and it will almost always exacerbate existing medical conditions. Patients probably won't mention this to the medical staff, because it isn't a medical condition. But they'll tell me, and I'll listen, and maybe they'll feel a little better, or at least -- for a few minutes -- less alone.
Several times, patients staggering under the burden of very old, secret traumas have warned me, "You really don't want to hear this."
My answer is always, "Yes, I do. That's what I'm here for."
Most such stories are heart-breaking, but the patients always feel better after they've told them.
- Because I'm not medical staff, patients often feel safe venting to me about the medical staff, which at least sometimes keeps the doctors and nurses from having to get those earfuls themselves. I spend a lot of time explaining the triage system to people who are furious at long waits, and when patients feel as if medical staff have been short with them, I assure them not to take it personally. "It's really busy here tonight, and they're treating everybody that way, just because they have so much to do."
On several occasions, non-white patients have taken me aside and said, "Can I ask you a question? Are the people who work here racist? Because they haven't been very nice to me." (This has always happened on evenings when the ED was really busy and when the staff was mostly white. I'm white myself, but again, I'm the person who's there to listen; and for obvious reasons, non-white patients would be hesitant to discuss this issue with medical staff.) I always tell them that no, the staff aren't racist, that they're treating everybody that way -- including me! -- and that some apparent rudeness may in fact be frustration at not being able to help everyone more quickly. The patients have always gratefully accepted this explanation. They don't want to think badly of the staff, but they need reassurance that they're receiving the same level of care as everyone else.
- Patients who aren't otherwise unhappy may simply be bored after hours of waiting for test results or a bed upstairs, and I give them something to think about other than their own discomfort. I sometimes describe myself as "the walking distraction." (I also tell patients, "I'm the person who won't be sticking any needles into you this evening.") There's a lot to be said for relieving monotony.
- Sometimes I'm able to tell the medical staff things they need to know. "Doctor, are you aware that elderly patient X lives alone and is terrified of being discharged because she can't manage the stairs in her apartment building?" "Nurse, are you aware that patient Y is having trouble breathing/is sobbing in pain/desperately needs a commode?" Sometimes I'm just repeating things the staff already knows, but reminders can be useful, and I try not to be too annoying.
- Patients are very impressed that the emergency department has chaplains, and they're grateful for the service. They think better of the hospital because we're there, which makes us great PR. And as I discuss in this post, a visit from a volunteer chaplain may sometimes be more meaningful to patients than one from a staff chaplain (although 24/7 volunteer coverage would, I agree, be a huge challenge).
- A visit from a chaplain may be especially important to patients who feel marginalized -- such as addicts, the homeless and prisoners -- and who need to be assured that they're still beloved children of God.
- Because I consider the ED my turf, I'm generally happy to help out in any way I can. I give kids crayons. I give water, crackers or blankets to patients who are allowed to have them; these are instances when I have to pester staff, to make sure that Patient Z isn't NPO or febrile, but my bringing the patient a glass of water will save ten seconds of someone else's time. I restock the blanket warmer. I deliver patient messages to friends in the waiting room, help relatives find their loved ones in the ED, direct people to bathrooms, phones, and the cafeteria, hunt down pillows, hold babies whose moms are strapped to backboards. Maybe none of this sounds spiritual to you, but I believe that everything's at least potentially spiritual. I think it was Mother Teresa who said that to a thirsty person, water is prayer.