Friday, August 18, 2006

Why Your ED Needs a Chaplain. All the Time. Really.

In a perfect world, all emergency departments would have 24/7, dedicated chaplaincy coverage.

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.
And, of course, it goes without saying that I'm also there for the situations when a staff chaplain would normally be called in: sitting with friends and relatives during a code, comforting people after a death or catastrophic diagnosis, helping patients and families deal with end-of-life issues. I haven't, thank God, had to do any of that too often, which is why it's a blessing that there's never any shortage of other work.


  1. Wow - I think it is wonderful how you define your role as chaplain. I think it is an excellent model.

    I haven't had the best experiences with chaplains (staff - inpatient). It always feels awkward. The other day a chaplain visited while my son was inpatient. He wanted to pray with us and I said it was fine but he then said to my son that he would pray that god would make him "all better". My son has dificulty hearing so I took the opportunity to rephrase it to "feel better". My son is fighting cancer for the third time and is not going to be made "all better". I have a problem in praying for a healing that won't happen and I really don't want my son to feel that god is failing him (he is 6).

    I think a chaplain should perhaps ask what the patient or family wants to be prayed about.

    Anyway - sorry about the rant...I just wanted you to know you have altered one person's views on chaplains.

  2. Susan,

    Thank you so much for posting, and I'm so sorry about your son's stuggle. This must be devastating for you and your family. God bless you for taking care of him; please remember to take care of yourself, too!

    And you don't need to apologize for ranting; if I'd been in your situation, I'd do the same thing!

    For whatever it's worth, I always try to remember to ask what people want me to pray for; sometimes the issues they're most anxious about have nothing to do with their medical condition. "Can you please pray for my daughter who just lost her job? Can you please pray for my friend going through a divorce?" I also ask about their faith tradition, so I can avoid Christian language with non-Christians. A few weeks ago I had a Wiccan patient who asked for prayer, and really appreciated it when I addressed Goddess as well as God.

    In situations where people aren't going to be "all better," I pray for an acceptance of God's will, acknowledging that this can be difficult. I pray for strength and comfort of body, spirit and mind for everyone concerned. I often pray for "the best possible outcome," which isn't always the outcome we want.

    I also spend a lot of time giving people permission to be angry. A wise friend once told me that "raging at God is a form of prayer," and hearing that can be tremendously liberating for patients who are furious at what's happening to them but who are also afraid that God won't love them anymore if they express that anger. "You go right ahead," I tell them. "God's big enough to take it."

    I try to explode all the "shoulds." When patients tell me (usually with quivering chins), "I know God won't give me more than I can handle," I always say, "Have you seen the bumper sticker that says, 'I know God won't give me more than I can handle, but I wish He didn't trust me so much?'"

    I think effective chaplaincy is about helping people be real, and helping them feel connected to God even at their rawest. It's hard enough being in a hospital bed without feeling as if God won't like you if you tell the truth about how it feels to be there.

    (Oh, and I've had bad chaplain experiences too. See my "Gormless Brigade" post from last week's Grand Rounds for an example.)


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