By Linda Arnold
I used to work at a hospital in an exceptionally diverse area, a diversity that was mirrored in the patient population, the nursing and support staff, and the medical staff. It included significant numbers of Hispanics, Africans, African-Americans and Orthodox Jews.
One of the leaders of the local Orthodox Jewish community, a rabbi who was a frequent visitor to the hospital to see his own congregants, had a massive stroke and was brought to the ER. He was put on a ventilator, but his condition was grave. According to one stream of the Orthodox Jewish tradition, once life support is initiated, it cannot be withdrawn. The critical care doctor (a woman who had been raised as an Orthodox Jew) and I (a Catholic chaplain with good knowledge of that tradition) met with the patient’s wife and other family members. It was understood that nothing would be withdrawn, but neither would anything be added.
The crucifix in the room could not be removed because it was glued to the wall, but I arranged for it to be covered. We offered a conference room to the family where they could eat the hospital’s kosher food or their own. I commented to one of the nurses that modesty was an extremely important value, and without being asked, the nurse made certain that the patient was appropriately covered under his gown. After about 48 hours, I requested and the hospital arranged for the house officer to sign the death certificate so that, should the patient die during the night, his body could be removed immediately. On the whiteboard in the patient’s room, in the space for “What do you want to be called?” a nurse had written “RABBI.”
The patient died early in the morning on the fourth day. His funeral was held in the community at noon. He was on his way to the airport shortly thereafter and was buried in Jerusalem by sundown the next day.
When I went to give my condolences to the rabbi’s wife, she shared that writing “RABBI” on the whiteboard summed up the respectful way we had treated him and his family. Indeed, everyone involved had done their utmost to respect the family’s traditions and needs.
At the same time that the important rabbi was dying on the unit, another patient was also dying — an elderly gentleman who had come here from China many years before, never learned to speak English or to drive while he worked in a Chinese restaurant, brought his entire family to the United States, and raised his children here. His daughter, the family spokesperson, was a research scientist. The patient was not an important person in the community, but he was important and beloved to his family, and their tradition of filial piety demanded that they do everything possible for as long as possible.
The critical care staff, the palliative care team, and I met several times with the family. They came along slowly, but when I suggested we would welcome a visit from the Buddhist monks at the wife’s temple, something special seemed to happen.
The monks came and chanted, with the door to the ICU bay closed to avoid disturbing other patients. The patient was moved from the bed to a gurney so as not to disturb his body until eight hours after death, to honor the family’s Buddhist belief about not causing pain. After he died, in the presence of monks and family, no tubes were removed, nor was the regular postmortem care done. After two hours in the room, the patient’s body was covered with a yellow and red ceremonial cloth and processed, with monks, chimes, family, friends, and hospital security, to the viewing room in the morgue (at the opposite end of the hospital). They stayed there to complete the required eight hours. At 9 that night, the critical care unit sent a nurse to the morgue to remove the tubes and catheters and prepare the body. The family was tremendously grateful that their traditions and needs had been honored.
Spiritual care had prepared the way with extensive education on cultural and religious diversity, and in creating an atmosphere where diversity was not just tolerated or respected but valued and celebrated. The very different traditions and socio-economic situations of the two families mattered not at all to the way in which they were respected and cared for.
Linda Arnold, BCC, retired as director of spiritual care at Holy Cross Hospital in Silver Spring, MD.