Seven treatments for people in crisis.
I was standing at the edge of the crowd at a public event, not a hospital event. The woman walked up to me as if she knew me.
“Hi, Jon,” she said. “My name is Eleanor. When I saw you earlier, I tried to place you. Eventually, in the course of conversation around our table, someone said the word, ‘chaplain’ and I placed you. We talked the night my husband was in the ED.”
I recognized her. We talked about that night. We talked about her husband. We had a nice conversation. As we finished she said, “Thank you. Your words and presence were so helpful.”
That’s our goal in pastoral care. After everything has settled, we want to know that we were helpful. Which has me thinking these days. As chaplains interacting with people in crisis situations, “How can we offer treatment that will promote healing and recovery?” That’s what the rest of the team is doing. Everyone involved in patient care works hard to not introduce more damage than was caused by the illness or the accident. And then, everyone works to lay a foundation for getting better, for finding the best possible health going forward.
One day I understood this tension when a person with a stroke came in. There is a drug that can help a person recover from a stroke. It must be given within a short period of time in situations that meet certain criteria. But the way it works to break up clots can also cause rapid, uncontrollable bleeding in some patients. In the hallway outside the patient’s room, the physician talked twice with the family, to make sure everyone understood that, in this case, the likelihood of great recovery was greater than the possibility of death.
As I think about risks and rewards in medicine and procedures, I wonder how we can do our best to offer care during those times that will increase the likelihood of spiritual, emotional, and even physical health.
We want to be able hear a day, or a week, or six months, or a decade later, “When I was in that moment, you said something, and it helped.”
Is it possible to say the wrong thing, to be damaging? I think it is. As chaplains, most of us are cautious about “Everything will be okay.” While it may be true theologically, giving hope of physical survival to a wife whose husband is close to death can be devastating. We shy away from, “don’t worry.” We avoid “Don’t cry” and “God has a plan.” We’re especially cautious of “All thing work together for good for those who love God.”
But I’d like to suggest some things that we can offer to patients and the ones who care about them.
Seven treatments to offer people in crisis.
1. An intentionally peaceful presence
The rooms in our Emergency Department have two doors. On one side is the door to the rest of the world. The patient comes and goes through this door, in with the EMTs, out to tests, in to wait, out to treatment. In a crisis, a family member or friend often comes through that door, too.
The other door leads to the core. Everyone else comes through that door. Nurses, respiratory, the trauma doctor, phlebotomy, x-ray, physicians of various specialties. Everyone moving to and from the patient, a dozen or more people.
And then a chaplain. We stand at the door on the core side. We look around the room for the loved one. If there is one, that’s our focus, sometimes more than the patient.
We work our way through the crowd, or we go around to the other door. But we are always looking at that face. Scared, confused, relieved at not being responsible anymore.
“Hi. I’m Jon. I’m a chaplain.”
In those first moments, they will be asked for information. What happened? Has this happened before? What are they taking? Every new person will ask the same questions.
They will be asked for decisions.
So the first thing I try to offer is a small circle of calm.
I use a variety of tools. I start with questions. “Can I get you a chair? May I get you some water? Is there anyone else coming? May I call someone? This is scary, isn’t it?”
There is not one question or statement. I don’t know the back story. But I want to help get the rush of adrenaline, anger, panic, fear slowed enough so that the person in the room becomes a collaborator in the care for the patient. And doesn’t become a patient.
It’s hard work to bring this calm. There may be two other rooms we are involved with. We may have just attended a death. We may have been moving all night or day. But at this moment, this person needs calm.
2. An interested third-party perspective. We care about the patient, family, and providers. But we aren’t any of them. Our training and our calling is to help people understand from a different perspective, one that includes decisions other than simply medical, that includes times other than the present, that includes values other than the body.
This perspective allows us to hear what the doctor is saying more clearly than the frantic son heard. We can explain to him what the doctor really said, particularly after the son stopped listening when he heard the word “aneurysm”.
One evening a man came in with a preliminary diagnosis of stroke. There were tests. There were doctors. One family member heard one doctor say this. Another family member heard another doctor say that. And the family members ended up in that kind of looping discussion that increases panic.
I heard both doctors. They were talking about different parts of the stroke process. By giving some perspective, one daughter calmed down and was able to participate in the conversation.
When a family understands that death is not likely in the next two hours, they can make better decisions. They can breathe.
3. Compassionate honesty. We are constantly asked questions about outcomes: “Is he going to die?” Sometimes we are asked when we know the outcome, “Is she dead?” Sometimes we are faced with deep grief: “How can I go on?”
The people in hospitals have a hard time answering that question. On one hand, most people don’t like giving bad news. On the other hand, most people don’t like to lie.
For me, compassionate honesty means answering as much of the question as clearly as possible, with as little speculation, as little medical opinion, and as much room for God as I can provide.
This includes honest uncertainty. Sometimes there isn’t an answer. And we are better saying, “I don’t know” than “it will be okay.”
4. Vocabulary for the experience. Most people are novices in trauma. Their experience of the Emergency Department is video fiction, where the procedures and outcomes are adapted to fit a story. And then they are afraid that the TV story will be theirs.
At those moments, we can offer new stories, vocabulary for this experience. In our best moments, we can give people images for thinking about God, about faith, about fear, about hope, and even about treatments.
One mom was terrified by the idea of her son getting a breathing tube, a ventilator. In her mind, a ventilator meant that her son must be dying. Her husband was comfortable with the idea, but that didn’t help mom. So I explained that sometimes a tube is like training wheels for breathing. It helps the body regain equilibrium. It gives the body a chance to put energy into other activities. For her, and for her son, this image helped her see that this was less about life-saving and more about life-sustaining.
While in the ED, families often aren’t hungry. I ask if they are diabetic. I say, “eating is like being on the plane when you hear, ‘Put your own mask on first.’”
When families are in the time following a death, wondering how to go on, I often say, “You know how when there is a wind blowing and you have to lean into it to stand up? You’ve been leaning into the wind. It will take some time to regain your balance.”
5. A next step
“What do I do now?” I hear it often. Everyone in the ED does.
We respond by giving people 100 things to do. Lists of explanations they don’t understand, with words like infarct, and neuro and God and trust.
As chaplains, we can’t take responsibility for explaining all the medical language. And, we probably aren’t helpful when we join in criticism of how confusing doctors can be.
But we can understand something of how the mind and heart work and offer some helpful next steps.
- We can pray with them, offering the model of conversation with God.
- We can pray for them, asking for wisdom.
- We can give them tangible things to do that will get them moving. Like telling them to sanitize their hands.
- We can offer them water (at least).
- We can connect them with the next conversation partner.
- We can help them get to where they need to be in the hospital.
- We can tell them what to expect.
- We can tell them the next person who will come in to see them.
- We can tell them what they won’t have to do next.
6. Curated resources. When a family member first hears a diagnosis, they may start searching the Web to find out what it means. They will find the best and the worst. As they discover information, their panic may grow. Because the information may be misinformation. It’s not interpreted in the context of their loved one. The medical staff, when available, will be far more helpful because of knowing both the patient and the diagnosis process and the hospital.
A chaplain has the same opportunity with the spiritual and emotional diagnosis. We can listen to the situation and help identify specific, relevant resources for this person in this situation. Questions can range from “Can my car stay where it is?” to “Do I call his estranged son? to “Where do I sleep tonight?” to “I don’t know how to pray.”
At those moments, we have several resources to offer.
- We have words of hope, refined by a hundred similar conversations.
- We can find people with answers (like security, case management, nurses).
- We can find Bibles and CareNotes.
- Sometimes curation of resources means letting the next shift know what is happening in this person’s life.
Said simply, we are putting in their hands the resources that will help them when they begin to breath again in the middle of the night.
7. Connection to community. Coming to the hospital is an isolating thing. That’s why I ask anyone I can questions about connections. After the EMTs walk out of an emergency department bay, we ask them about any family for the patient. Even though most people have phones in their hands, I still ask if there is anyone I can call. I often ask people if they are part of a congregation (or faith community or church). I ask people where they come from. I want to get people connected to whatever helpful community they have.
There is a caution, however. Sometimes people are in communities that caused their pain. The patient may be a victim of abuse or violence or neglect. Chaplains often work with other staff to keep patients out of the public hospital directory.
Even in those situations, our opportunity is still to help people find the helpful parts of their community. Because patients with support from family and friends are more likely to recover more quickly.