Saturday, January 08, 2011


Today's hospital shift was both slower and busier than last week's. My census was lower (70-ish rather than 119), but I had more to do. Several nurses asked me to visit with specific patients, and more patients asked for prayer.

One of these was a bewildered, disoriented individual who gazed up at me from the bed, squinting, as I gave my hi-I'm-the-chaplain spiel, but who then asked for a prayer. I'm always happy to pray with patients, so I went into my preparing-for-prayer spiel: 1) "What's your name?" 2) "Obviously we're praying for your medical condition, but is there anything else, or anything more specific?" 3) "What's your faith tradition?"

I ask this last question so I won't, say, offend someone who's Jewish or Hindu or Muslim by using Christian language. But today the patient squinted up at me and said, "I'm Satanist."

I've met several other Satanists in the ER. None of them have been in the least alarming; indeed, they were clean-cut, earnest individuals who very politely explained to me that while Christians believe in love, Satanists believe in vengeance. (My standard response to this is, "Well then, a lot of people I know who call themselves Christians are really Satanists without knowing it," a line that makes both Christians and Satanists laugh.) But this was the first time a Satanist has ever asked me for a prayer, and I wasn't sure what to do. We aren't supposed to pray anything that contradicts our own beliefs, so I wasn't going to start chanting to Beelzebub. After a moment of thought, I offered my standard prayer, stripped of references to God or Christ; I opened with "Dear Ruler of the Universe" instead. The patient squirmed a little at one of my standard lines -- "Help this patient know that in every darkness, you are the light" -- but I've had Christian patients who became much more upset when I used some translation of the Lord's Prayer they didn't like.

The prayer mostly seemed to go fine. Afterwards, I helped the patient use a phone to contact a family member, which was probably the more important of the two tasks.

My standard intellectual response to Satanism is that it mainly reveals a lack of imagination; to me, although I'm admittedly not too well-versed in the subject, it's simply an inversion of Christianity. And if you don't want to be Christian, there are plenty of other paths out there: Jewish, Buddhist, Muslim, and so forth. Why embrace a pale, anemic inversion of Christianity when there are so many richer, more authentic traditions?

The Satanists I've met in the ER, however, have been much more relaxed and polite than the Wiccans I've encountered there. This is odd, because Wicca's a peaceful, neighborly faith -- "An ye harm none, do as ye will," and the Rule of Three, and all that -- and the Wiccans I know outside the hospital are lovely people. In the ER, though, every Wiccan patient seems to assume that as a Christian chaplain, I want to burn her at the stake (I haven't had any male Wiccan patients yet), until I display enough familiarity with the tradition to allay those fears. Then the patients are usually delighted that I know that the winter solstice is a High Holy Day, or whatever. But Satanists don't seem to have that initial terror that I'll be mean to them. Maybe it's because they really do know, and believe, that my faith is about love, even if they don't subscribe to this quaint notion themselves?

Of all the religious, non-religious and irreligious folks I've met at the hospital, the ones I have the most trouble talking to are that specific segment of right-wing Christians who seem to believe in the Devil more firmly than they believe in God: who are grimly on guard against "The Enemy" -- an entity they believe can show up at any time in any form -- and who ascribe any ill that befalls them to demonic interference. The folks like this I've met seem to view life as a war. They don't seem to have nearly as much faith in the efficacy of love or kindness or prayer as they do in the efficacy of evil. My own Christian tradition doesn't believe in literal supernatural demons, and I never know how to respond to this kind of rhetoric. I usually just smile, nod, and keep my mouth shut.

I'll take a Satanist over one of those any day.

One reason demon-professing Christians make me so uncomfortable is because there often seems to be such a thin line between them and my least favorite group of patients. Everybody in the ER has a least favorite group of patients. Sometimes it's homeless people, or addicts, or even kids, because it's sheer misery to start an IV on a howling toddler. My own least favorite group is paranoid shizophrenics.

This isn't because I don't like and feel for these patients as people, but because their belief systems make them so miserable and are so impervious to any reality check anyone can offer. I've seen three of these folks in the past few months. In each case, the patient arrived at the ER seeking help, with a frightening story of stalking and persecution. In each case, the patient was intelligent and articulate. In at least two of these cases, the story initially seemed plausible (and in at least one, the paranoia had probably been triggered or intensified by a history of real, grim domestic violence). But in all three cases, the inevitable "they" showed up.

Them. You know them. They tap phones; they hack into computers; they have landlords and the police and yea, verily, even ER personnel on their payrolls; they can walk through locked hospital doors and tamper with records. They're everywhere. The patient can't say who they are or why they're doing this, but knows for sure that they want to deprive the patient of home, livelihood, friends, freedom, life: "They're trying to kill me, but in the meantime the goal's to get me locked up in a mental hospital where no one will believe me, and I know this sounds crazy, I really do, but I'm not crazy, I swear to God I'm not, please tell me you don't think I'm crazy, and you can't tell anybody what I just told you because then they'll lock me up."

See how easily We morph into Them? See how automatically any effort to help the patient gets turned into another instance of persecution?

This kind of terror is absolutely heart-breaking. It's real fear, but it's impervious to logic, comfort or reason. It's profoundly isolating, both because non-paranoid folks tend to avoid anyone who talks this way and because the patients themselves often, with the noblest of motives, break ties with the people they love. "I've cut off any contact with my family, because I have to protect my kids from Them. If They have a list of the people I care about, They'll hurt those people to get at me."

When I'm talking to a suicidal patient, I can say, "You aren't seeing things straight, because there's a biochemical imbalance in your brain. When that's treated, life will seem brighter." Suicidal patients get that. They understand it, and it makes sense to them, and at least sometimes, it comforts them. But if you tell a paranoid patient, "There are no They; They are a symptom; you're safe here," you become one of Them yourself. All efforts to tell the patient that this is a safe place make the patient feel less safe, less understood.

So instead I just say, "I know how scared you are. How can I make you feel better?" But so far, neither the patients nor I have found any successful strategies.

(And in the back of my mind, I have to admit, I'm often thinking something like, "Okay, what if there is some conspiracy against this patient?" The scenario's such a film cliche: nobody believes the person talking about vampires or ghosts or UFOs or microscopic cameras in the teabags, but guess what? Cue ominous film music. They're really there.)

As frustrating as this situation is, it's also infuriating. C'mon, Patient: this is an ER, and I know you're smart. When patients show up talking about spy satellites in the light fixtures, we call in a psych consult. You have to know that. Why else did you come here? What did you think we'd be able to do for you?

As often as not, these patients -- and the folks I've seen in this category are harmless, not violent to themselves or others, and we can't put people in the hospital against their will just because they're completely terrified of something that doesn't exist -- wind up walking out AMA, having added the ER staff to the growing list of Them. This condition seems viral to me, with every previously untouched environment becoming contaminated on contact. The patient walks into a new place full of potential friends and allies, but by the time the patient leaves, all of those folks are Them, all over again.

These patients make me feel hopeless and helpless, which is why they're my least favorite group. And demon-professing Christians talking about how Satan lives in their car radio often seem dangerously close to sliding into that other category. At least, though, the demon-professing Christians usually feel better when they leave, since they're happy to accept treatment for whatever medical condition brought them in.

Really, though: if I've had to deal with patients in the other two categories, a calm, polite Satanist can be a positive relief.


  1. That was a really interesting glimpse into your volunteer life. Thanks for sharing and casting light on so many subjects.

  2. oh, God bless you.

    you know, i'm not schizophrenic, but i have been sometimes psychotic. and twice while i was psychotic, i really WAS being hunted down, once with dogs, so sometimes when i think the "they" might be coming to get me that unfortunate intersection of reality is not a helpful thing.

    "i'm willing to accept the idea" i said to a pastor once, "that this might be a paranoid delusion, but since in real life i HAVE been hunted by dogs i'm having trouble sorting this one out. can you help me with that?"

    imagine being the pastor on the other end of the line who's telling me not to get carried away by my delusion and to calm down as i say "barbara, i'm going to want to maintain phone contact with you, but i can see the searchlights and i can hear the dogs and in a few minutes i'm going to have to put the phone in my pocket so i can put my hands where the officers can see them. can you stay on the line?"

    and then of course she can hear the dogs, too, so my version of the story has a little weight.

    but it's those ER chaplains who have to be draaaaged out of bed at ungodly hours to talk with me on snowy nights when nothing but prayer seems to make sense and otherwise i'm just one more whack-a-loon they can't medicate enough and nobody looks hopeful when the chaplain comes into my room, but it's the chaplain who gets me fit enough to be able to deal with whatever comes next.

    as for your polite satanist, one thing i know about satanists is that they respect strength and they like fear and chaos amuses them.

    by asking for a prayer from a christian chaplain, he was likely to have one of those three needs met, regardless of your reaction. you met him with strength and compassion and also assisted him with general life tasks. so congratulations on having yourself screwed together right.

    and bless you for knowing the proper place of your work.

    and thank you from all of us out here, the hurt and the psychotic.

  3. Well, you know, there are Satanists and there are Satanists, as it were. There are certainly anti-Christians; but there are also the Anton Szandor LaVey folks, who are more interested in self-indulgence than they are in personalized power.

    I really haven't had much contact with Satanists. On the other hand, I tend to have good relationships with pagans. They certainly seem to be hesitantat first, until I smile and say, "Really? What tradition?"


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