By Anne Millington
My day at the hospital is mapped out, and I have patients to see, a meeting to attend. Suddenly, my pager goes off: “Code Blue Team. ED.” A patient is in cardiopulmonary arrest and requires immediate resuscitative efforts.
As the chaplain member of the Code Blue team, I immediately re-route myself to the Emergency Department, my day’s priorities now shifted to providing spiritual support to the patient and possibly family in crisis. While Code Blues can occur anywhere in the hospital, the majority I have responded to have been in the ED, where often little is known about the newly arrived patient. They are true crisis situations, and, in my experience, the patient usually does not survive. While the medical team strives to resuscitate the patient, I focus on supporting any gathered family and friends, responding to their varying spiritual needs during a difficult and often surreal time.
During ED Code Blues, meeting people where they are generally involves meeting people who are in shock, mentally reeling, attempting to gain some sort of footing. I recall a Code Blue involving a former Marine, accompanied by a good friend who was also a former Marine. When I introduced myself, the friend said, “Is he dead? Is he dead? I do not want another Marine to die alone.” When I responded, “I know the medical team is still working on him,” he jumped up and began pacing, pausing occasionally to take deep breaths, beads of sweat on his brow. Clearly, this was not the time for any kind of in-depth conversation or meaning-making efforts, and I assessed that any spiritual support must begin with checking the patient’s status. Unfortunately, the patient did not survive. After sitting for some time with his now-bereaved friend, I said, simply, “I’m so sorry for your loss.” As silence enveloped us, I remembered his desire to be there at the end for another Marine, and so I added, “You were here today for your friend. You’ve done him a good service. One Marine to another.”
I also try to help people in crisis stay focused on the present moment, not on the regrettable past or the terrifying future. Once I offered spiritual support to a woman whose husband had unexpectedly fallen down some stairs. Although the ED medical team had restored the husband’s pulse, and his vital signs were promising, his wife kept repeating, “Now he’s going to be brain dead … now he’s going to be brain dead … all the things we had planned, all the things we wanted to do together. And now he’s going to be brain dead.” Initially, I responded, “I can imagine how worried you must feel, how scared you must feel.” But at the same time I could see that she was torturing herself prematurely. After a bit of time, I gently said, “I know you are afraid your husband is brain dead, but no one has said that yet. There are still some unknowns and I know how scary this may be, and I know how much our human minds can jump to scary conclusions. For now, though, as far as we know, the worst has not happened, and maybe it won’t.” As it turned out, her husband did survive and proceeded to make a highly successful recovery, brain and all.
When patients do not survive, families and friends generally have strong feelings about whether or not to view their loved one’s body. Once a woman was found drowning and was brought in by her husband. She was pronounced dead very quickly, and her husband sobbed, “How could this have happened? How could this have happened?” As other family members arrived, new waves of grief washed over them all. After some time had passed, I quietly asked the husband, “Do you feel that you or any of your family here would like to view your wife?” His response was clear and resounding, “No. No. I don’t want anyone of us to remember her this way. She was a beautiful woman. Now … she doesn’t look like herself at all.” I scanned the family’s faces, noticing only looks of agreement, of relief. “That’s fine,” I said. “If any of you decide you would like to see her, just let me know.” I spent some time praying with the family and, as they departed, the patient’s husband asked if I would go and pray over her body, which I did.
Other families, however, require permission and even encouragement to leave the deceased’s bedside. One patient was the matriarch of a large family, and their grief was intense. Her son and family spokesperson told me, “I want each family member to have a chance to pay his or her personal respects.” But as some family members were coming from distant places, it took almost two hours to gather the full group of 25 or 30, and staff was beginning to get concerned. The son told me they were planning a big funeral, so I replied, “I think it’s important to know that this is only goodbye for now. They will have another chance to pay their respects at the service you are planning.” He nodded, and yet everyone just seemed to linger. So I approached him again, and said, “We are going to need to care for her body soon, so shall we say a final prayer and then you all can leave her with us for now?” Fortunately, he understood, and after a final prayer, the family was able to say goodbye-for-now and depart.
After a Code Blue, I look to focus immediately on the spiritual needs of the ED staff. They, too, have experienced the crisis, and yet they usually have to “keep calm and carry on” to meet the needs of other patients. I remember complimenting a nurse after a Code Blue about how she handled the patient’s family. She immediately teared up and said, “I just felt so bad for the patient. I heard he just lost his wife, and he had a tattoo that said ‘I love you forever.’ I bet he had had that done in honor of her when she was alive. I felt so sorry for him.” While this nurse had already moved on to the next patient, her feelings were still fresh and raw, and I was glad she was able to voice them.
To meet people in crisis where they are, I must be where I need to be, physically, emotionally, and certainly spiritually. To this end, I have sought to establish and maintain disciplines of prayer, spiritual direction, self-care, self-reflection, supervision, peer support and more. Jesus said, “The wind blows wherever it pleases. You hear its sound, but you cannot tell where it comes from or where it is going. So it is with everyone born of the Spirit.” (John 3:8) I seek both to hear and honor the wind of the Holy Spirit within the crisis, and I seek then to guide others into whatever relief, wisdom, and solace the Spirit may be offering. It is my prayer that the Holy Spirit, in partnership with my efforts and disciplines, will enable my service as a chaplain to be truly a ministry of presence — presence to the Spirit, presence to others, presence to myself.
Anne Millington is a chaplain at Beth Israel Deaconess Hospital in Milton, MA.
