The Journal of Emergency Medicine, Vol. 48, No. 6, pp. 751–753, 2015 Copyright Ó 2015 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter
http://dx.doi.org/10.1016/j.jemermed.2014.12.054
Humanities and Medicine SEEING EYE TO EYE: BECOMING THE CHAPLAIN IN THE EMERGENCY DEPARTMENT OF A LEVEL I TRAUMA CENTER Christina Bodemann, MDIV Pastoral Care Department, Lutheran Medical Center, Brooklyn, New York Reprint Address: Christina Bodemann, MDIV, Chaplain Resident, Pastoral Care Department, Lutheran Medical Center, 150 55th St., Brooklyn, NY 11220
‘‘Trauma Team Level I to the Emergency Department.’’ The trauma team–doctors, students, surgeons, nurses, mobile x-ray–all rush to the trauma bay. The patient is 3 minutes out. The doctors are joking, putting gloves on. Registration is waiting; a nurse’s aide has the plastic bags ready to collect the belongings. The medical students look at each other nervously. The ambulance arrives. They wheel in an elderly lady, unresponsive. She has a scratch on her forehead, and is strapped tightly to the gurney; ‘‘94 year old female, fall, found on the bottom of the staircase at home,’’ the Emergency Medical Technician reports. The medical staff is now busy in the trauma bay: an i.v. for blood work, put her on a monitor. ‘‘Hello, can you hear me?’’ the doctor yells at the woman. ‘‘What is your name?’’ A few minutes later, an elderly man arrives. He scuffles, has a hard time keeping his balance. ‘‘Where is she?’’ he asks. ‘‘She is in the trauma bay, behind that curtain; the doctors are taking care of her now. How are you related?’’ ‘‘She is my wife,’’ he says. ‘‘We have been married for 64 years.’’ ‘‘Let me get you a chair,’’ the chaplain says. Trauma responses, rounds in the critical care area, visits for patients who have been waiting for a bed in the hospital for 20 hours and more, support at medical codes, being present for patients, their families and staff: all part of the job description for the chaplain in the Emergency Department (ED).
It all began with an idea the director of the ED had in conversation with the director of Pastoral Care: ‘‘We need a chaplain in the ED. Someone who has time to listen, who can calm down, deescalate, someone who can deal with angry and noncompliant patients. We need to improve patient satisfaction.’’ A position for a chaplain resident was created, a second-year residency in Clinical Pastoral Education with a specialization in chaplaincy for the ED. The resident would be responsible for integrating this new position into the already-existing multidisciplinary team of doctors, nurses, aides, technicians, the social worker, and the patient navigator that usually receives new patients when they arrive in the ED. It soon became clear that ED chaplains have a unique role on the ED team, part of the staff and yet, separate from it. This separation, not being in the chain of command, allows the chaplain to be eye to eye with everyone: nurses, doctors, aides, patients, families. The chaplain can meet everyone where they are, and bring a unique perspective: Hector Hector came in as a trauma. Pedestrian struck by a car. His face is bruised and his head is still fixed in a cervical collar; he is uncomfortable and cannot rest in that position. Anyway, how are you supposed to rest in this
RECEIVED: 2 July 2014; FINAL SUBMISSION RECEIVED: 6 October 2014; ACCEPTED: 21 December 2014 751
752
environment? It’s so noisy! They need to do some more testing before they can take the brace off. That’s what they said 2 hours ago. He does not want to be too demanding, he knows they are busy here. But does he really have to wait this long? And he is in pain. The medication they gave him is not working. They say they cannot give him more. But does he have to be in pain like this? The chaplain stays with him. Mary Anxiously, Mary and her partner come into the ED. Something is wrong with Mary’s stomach. She has been in pain for a week now, and she has no appetite. She is worried, and does not know what is causing her pain. She is afraid of the unknown, especially because they keep doing all of these tests and she hasn’t gotten any results back yet; she is not even sure what she should hope for anymore. Hopefully, it won’t be anything serious, but they should find something, so that she knows what it is, and she can do something about it in the future. Prevent it from happening again. The chaplain names what she feels: Anxiety and uncertainty, while all she wants is to go home. Carla Carla, the charge nurse, is upset. The doctor who is supposed to take the patient does not want to do it. How is she supposed to do her work? And then one ambulance after the other is coming in. Like there were no other hospitals in the area. Triage is overwhelmed, so many patients that have not even been seen. She is stressed out and worried. Her husband is sick. He has been for years now. When she comes home, she is his nurse as well. She is keeping it together but sighs when the chaplain asks her how she is doing it. Somehow. But sometimes it gets to be too much. Christian A code 33, respiratory distress, is called for the woman in the first room on the critical side. They need to intubate. Her family is in the waiting room, the nurse tells the chaplain they are really upset. While they are trying to intubate, her heart stops. Her family is waiting through the cardiopulmonary resuscitation (CPR); her husband is unable to speak. Will her pulse come back? From time to time the chaplain checks on the progress of the code. Still doing CPR. Now Christian starts telling the chaplain about his wife. They met 42 years ago at the beach in Coney Island. She had asked him to help her put up her sunshade. ‘‘I don’t know what I would do without her. She is my everything.’’ The chaplain stays with him.
C. Bodemann
Through the uncertainty. The doctors come in. It doesn’t look good. They got a pulse back, but it’s not stable. If she makes it, she will have to be in the Intensive Care Unit for a few days. ‘‘When her heart stops again,’’ the doctor asks, ‘‘do you want us to continue the CPR? Her heart is weak, and I am afraid we are only hurting her at this point.’’ Christian is not able to make a decision. All he wants is for her to come back. He doesn’t want to hear the doctor’s words: ‘‘I’m very sorry.’’ The chaplain stays with him, asks him if he wants to see his wife. Yes, he does. They walk together. He wants the chaplain to bless her, wants to touch her one last time. Arthur Hey chaplain . Arthur’s words are slurred. Hey chaplain, I know you. She walks over to Arthur who comes to the ED almost every day. Everybody knows him. He gets drunk, and then he comes here to sleep. To get some food. And a sweater. It has gotten cold outside. Today he wants to talk about his girlfriend. He really cares about her. He doesn’t finish his sentence and dozes off. Nice to see you, chaplain. Rose The patient navigator does not know what to do anymore. Rose has been yelling at her for 10 minutes straight at the top of her lungs. Rose is upset, because her sister is not getting the care she needs. She has been here for 6 hours, and now they are telling her she needs a psychological examination, but she has refused treatment. Rose threatens to sue the place; the navigator has difficulty keeping her voice down. ‘‘Chaplain, can you help me?’’ The navigator leaves, the chaplain sits down with Rose. Slowly, Rose calms down. Starts telling her story. Nobody has listened before. The doctor says that seeing her is not high on the priority list. People don’t get care when they are yelling at everybody. The chaplain asks the doctor to see Rose’s sister. The chaplain says there seems to have been some confusion, a breakdown of communication and she thinks the doctor could clear things up. The doctor refuses at first, does not even make eye contact with the chaplain. A few minutes later, however, she is surprised to see him talking with a much calmer Rose. Becoming a chaplain in the Emergency Department has been a slow process. Whereas some staff members are very open to the presence of a chaplain, others are skeptical: ‘‘We did not need a chaplain here before, why would we call one now?’’ Becoming part of the multidisciplinary ED team takes continual presence of the chaplain: persistent introducing, re-introducing, educating, and reassuring. Yes, please call the chaplain. Don’t hesitate. The chaplain provides emotional and
Seeing Eye to Eye
spiritual support. You can call her when you need help. When somebody is in distress, not only when somebody dies or wants to pray. A colleague in the United Kingdom has described the work of a chaplain in the ED very accurately as ‘‘purposeful loitering.’’ Bystanding; withstanding; often at a distance, and not in the way; observing; getting used to the functioning of the ED, being seen as a presence and at work. Until people have slowly gotten used to the chaplain’s presence. Until they have started reaching out: The chaplain has become vital to the aide who asks her if she can get a cup of water for the patient in B12, to the patient navigator who tells her about the impatient pa-
753
tient she should visit, to the nurse who gives the chaplain a report on the patients in her care as soon as her shift starts, to the doctor who approaches the chaplain when she gets the impression that there is more to a person’s story than she has time to explore. In a place that is as hierarchical as the ED, with its doctors, nurses, aides, patients, and families, there is no place for the chaplain, and every place for the chaplain; the listener, the one person who can be a presence, a witness, a guide. On everyone’s level—with a unique point of view. And as for the husband of the Level I trauma patient? The chaplain pulls up a chair. And she sits down with him.
http://dx.doi.org/10.1016/j.jemermed.2014.12.054
Humanities and Medicine SEEING EYE TO EYE: BECOMING THE CHAPLAIN IN THE EMERGENCY DEPARTMENT OF A LEVEL I TRAUMA CENTER Christina Bodemann, MDIV Pastoral Care Department, Lutheran Medical Center, Brooklyn, New York Reprint Address: Christina Bodemann, MDIV, Chaplain Resident, Pastoral Care Department, Lutheran Medical Center, 150 55th St., Brooklyn, NY 11220
‘‘Trauma Team Level I to the Emergency Department.’’ The trauma team–doctors, students, surgeons, nurses, mobile x-ray–all rush to the trauma bay. The patient is 3 minutes out. The doctors are joking, putting gloves on. Registration is waiting; a nurse’s aide has the plastic bags ready to collect the belongings. The medical students look at each other nervously. The ambulance arrives. They wheel in an elderly lady, unresponsive. She has a scratch on her forehead, and is strapped tightly to the gurney; ‘‘94 year old female, fall, found on the bottom of the staircase at home,’’ the Emergency Medical Technician reports. The medical staff is now busy in the trauma bay: an i.v. for blood work, put her on a monitor. ‘‘Hello, can you hear me?’’ the doctor yells at the woman. ‘‘What is your name?’’ A few minutes later, an elderly man arrives. He scuffles, has a hard time keeping his balance. ‘‘Where is she?’’ he asks. ‘‘She is in the trauma bay, behind that curtain; the doctors are taking care of her now. How are you related?’’ ‘‘She is my wife,’’ he says. ‘‘We have been married for 64 years.’’ ‘‘Let me get you a chair,’’ the chaplain says. Trauma responses, rounds in the critical care area, visits for patients who have been waiting for a bed in the hospital for 20 hours and more, support at medical codes, being present for patients, their families and staff: all part of the job description for the chaplain in the Emergency Department (ED).
It all began with an idea the director of the ED had in conversation with the director of Pastoral Care: ‘‘We need a chaplain in the ED. Someone who has time to listen, who can calm down, deescalate, someone who can deal with angry and noncompliant patients. We need to improve patient satisfaction.’’ A position for a chaplain resident was created, a second-year residency in Clinical Pastoral Education with a specialization in chaplaincy for the ED. The resident would be responsible for integrating this new position into the already-existing multidisciplinary team of doctors, nurses, aides, technicians, the social worker, and the patient navigator that usually receives new patients when they arrive in the ED. It soon became clear that ED chaplains have a unique role on the ED team, part of the staff and yet, separate from it. This separation, not being in the chain of command, allows the chaplain to be eye to eye with everyone: nurses, doctors, aides, patients, families. The chaplain can meet everyone where they are, and bring a unique perspective: Hector Hector came in as a trauma. Pedestrian struck by a car. His face is bruised and his head is still fixed in a cervical collar; he is uncomfortable and cannot rest in that position. Anyway, how are you supposed to rest in this
RECEIVED: 2 July 2014; FINAL SUBMISSION RECEIVED: 6 October 2014; ACCEPTED: 21 December 2014 751
752
environment? It’s so noisy! They need to do some more testing before they can take the brace off. That’s what they said 2 hours ago. He does not want to be too demanding, he knows they are busy here. But does he really have to wait this long? And he is in pain. The medication they gave him is not working. They say they cannot give him more. But does he have to be in pain like this? The chaplain stays with him. Mary Anxiously, Mary and her partner come into the ED. Something is wrong with Mary’s stomach. She has been in pain for a week now, and she has no appetite. She is worried, and does not know what is causing her pain. She is afraid of the unknown, especially because they keep doing all of these tests and she hasn’t gotten any results back yet; she is not even sure what she should hope for anymore. Hopefully, it won’t be anything serious, but they should find something, so that she knows what it is, and she can do something about it in the future. Prevent it from happening again. The chaplain names what she feels: Anxiety and uncertainty, while all she wants is to go home. Carla Carla, the charge nurse, is upset. The doctor who is supposed to take the patient does not want to do it. How is she supposed to do her work? And then one ambulance after the other is coming in. Like there were no other hospitals in the area. Triage is overwhelmed, so many patients that have not even been seen. She is stressed out and worried. Her husband is sick. He has been for years now. When she comes home, she is his nurse as well. She is keeping it together but sighs when the chaplain asks her how she is doing it. Somehow. But sometimes it gets to be too much. Christian A code 33, respiratory distress, is called for the woman in the first room on the critical side. They need to intubate. Her family is in the waiting room, the nurse tells the chaplain they are really upset. While they are trying to intubate, her heart stops. Her family is waiting through the cardiopulmonary resuscitation (CPR); her husband is unable to speak. Will her pulse come back? From time to time the chaplain checks on the progress of the code. Still doing CPR. Now Christian starts telling the chaplain about his wife. They met 42 years ago at the beach in Coney Island. She had asked him to help her put up her sunshade. ‘‘I don’t know what I would do without her. She is my everything.’’ The chaplain stays with him.
C. Bodemann
Through the uncertainty. The doctors come in. It doesn’t look good. They got a pulse back, but it’s not stable. If she makes it, she will have to be in the Intensive Care Unit for a few days. ‘‘When her heart stops again,’’ the doctor asks, ‘‘do you want us to continue the CPR? Her heart is weak, and I am afraid we are only hurting her at this point.’’ Christian is not able to make a decision. All he wants is for her to come back. He doesn’t want to hear the doctor’s words: ‘‘I’m very sorry.’’ The chaplain stays with him, asks him if he wants to see his wife. Yes, he does. They walk together. He wants the chaplain to bless her, wants to touch her one last time. Arthur Hey chaplain . Arthur’s words are slurred. Hey chaplain, I know you. She walks over to Arthur who comes to the ED almost every day. Everybody knows him. He gets drunk, and then he comes here to sleep. To get some food. And a sweater. It has gotten cold outside. Today he wants to talk about his girlfriend. He really cares about her. He doesn’t finish his sentence and dozes off. Nice to see you, chaplain. Rose The patient navigator does not know what to do anymore. Rose has been yelling at her for 10 minutes straight at the top of her lungs. Rose is upset, because her sister is not getting the care she needs. She has been here for 6 hours, and now they are telling her she needs a psychological examination, but she has refused treatment. Rose threatens to sue the place; the navigator has difficulty keeping her voice down. ‘‘Chaplain, can you help me?’’ The navigator leaves, the chaplain sits down with Rose. Slowly, Rose calms down. Starts telling her story. Nobody has listened before. The doctor says that seeing her is not high on the priority list. People don’t get care when they are yelling at everybody. The chaplain asks the doctor to see Rose’s sister. The chaplain says there seems to have been some confusion, a breakdown of communication and she thinks the doctor could clear things up. The doctor refuses at first, does not even make eye contact with the chaplain. A few minutes later, however, she is surprised to see him talking with a much calmer Rose. Becoming a chaplain in the Emergency Department has been a slow process. Whereas some staff members are very open to the presence of a chaplain, others are skeptical: ‘‘We did not need a chaplain here before, why would we call one now?’’ Becoming part of the multidisciplinary ED team takes continual presence of the chaplain: persistent introducing, re-introducing, educating, and reassuring. Yes, please call the chaplain. Don’t hesitate. The chaplain provides emotional and
Seeing Eye to Eye
spiritual support. You can call her when you need help. When somebody is in distress, not only when somebody dies or wants to pray. A colleague in the United Kingdom has described the work of a chaplain in the ED very accurately as ‘‘purposeful loitering.’’ Bystanding; withstanding; often at a distance, and not in the way; observing; getting used to the functioning of the ED, being seen as a presence and at work. Until people have slowly gotten used to the chaplain’s presence. Until they have started reaching out: The chaplain has become vital to the aide who asks her if she can get a cup of water for the patient in B12, to the patient navigator who tells her about the impatient pa-
753
tient she should visit, to the nurse who gives the chaplain a report on the patients in her care as soon as her shift starts, to the doctor who approaches the chaplain when she gets the impression that there is more to a person’s story than she has time to explore. In a place that is as hierarchical as the ED, with its doctors, nurses, aides, patients, and families, there is no place for the chaplain, and every place for the chaplain; the listener, the one person who can be a presence, a witness, a guide. On everyone’s level—with a unique point of view. And as for the husband of the Level I trauma patient? The chaplain pulls up a chair. And she sits down with him.
