By Lisa Hermann
The page from the Children’s Emergency Department said, “Lisa, we need you down here. There is a patient in cardiac arrest coming in.” As I entered the room I noticed a man in street clothes who seemed distraught. I cautiously assumed him to be the patient’s father, but approached slowly to offer support. I placed my hand gently on his shoulder, and he turned with tears in his eyes and swallowed me in his embrace. It took me by surprise, but I held him, and he held me. When I got a good look at him, I realized it was Joe (not his real name), one of the RNs in our Adult Emergency Department across the hall. The patient lying lifeless on the table was Joe’s infant son, whom he brought to the ED from home because he knew something wasn’t right. “I intervene, daily, on behalf of hundreds of others, but today I couldn’t save my own son.” That was all Joe could say. His son died that afternoon in the ED.
The chaplain’s role in the ED when a child dies, among other circumstances, is to transform a place that is sterile, frightening, and without feeling into a sacred and safe place for family and others gathered to receive unbearable news, share feelings, and begin grieving. Our role is to hold space and the others’ stories, honoring the family’s grief until they can begin holding it and carrying it for themselves. I believe there are four concrete ways to make this happen.
First, don’t just DO something, BE there. Practice a ministry of presence by meeting the family where they are. I introduce myself, then use silence as a tool. Just being there as a less anxious presence says so much when many people have no idea what to say or do next. Many times they are not sure what you can do for them, but do not want you to leave. Instead of inserting myself into their painful situation, I let the family invite me into their space and experience. Even if their pastor or spiritual leader is there, I stay. The pastor knows the family, but I know the clinical environment, and collaboratively we can better guide the family in these beginning stages.
Second, many feelings will be expressed — and suppressed. Grief is as unique to the individual as a fingerprint. In an emergency department you never know what is going come through those doors, so rather than attempt to prepare for it all, we work out of some basic understandings. That allows us to be present with the family of the deceased and to normalize their shock and disbelief, yet not discount their experience. We are able to say, “No, you are not abnormal, your child has just died, and your world has been ripped apart.” As chaplains we normalize the lamentation — lamentation as both sadness and a love song, honoring what was lost.
We acknowledge the search for meaning, the big question of “WHY!?” It is spoken by the bereaved as a question, but it is one that no one, including the chaplain, should attempt to answer. Many times the search for meaning that sounds like a question is actually a protest, a protest toward God and the natural order as they know it. This is not how life is supposed to be. No parent should ever have to bury a child. A family walked into the ED with a child, now they leave, arms empty. The family now reasons in terms not of milestones, but of never again, like Nicholas Wolterstorff in his book Lament for a Son. He writes, after his son’s death, that it is “the neverness that is so painful. Never again to be here with us — never to sit with us at the table. … All the rest of our lives we must live without him. Only our death can stop the pain of his death.”
The chaplain’s role is to normalize family members’ varied feelings, make room for them to ask why and to protest. The chaplain needs to hear and acknowledge the pain, the anger, and the uncertainty in that protest, but again not to diminish the family’s painful experience. I have found that having all the right questions — and none of the answers — helps me to sit with a bereaved family and normalize their feelings. As people talk, they begin to process and express their feelings. Through this processing they generally find answers to their own questions.
Third, work with nursing staff so that the parents hold their child, if they want to. Invite them to participate in some of the last things like washing and preparing the deceased for movement, and memory-making that some facilities do with hand molds and footprints. One emergency department I worked in had a rocking chair as standard equipment. On many occasions those rocking chairs and stretchers became a shared mourning bench for children, where families searched for and found words to voice their grief and honor life. The idea of a mourning bench, which comes from Nicholas Wolterstorff’s book, I find profound and sacred. I envision it as a place we sit together in our grief, no matter what that mourning bench looks like.
Fourth, use interdisciplinary resources. Most of the deaths that I responded to in our Children’s ED were both unexpected and lengthy, in terms of taking care of the family and visitors. I relied on the social worker, the RN, the physician, and the child life specialist to help this family navigate one of the most horrible events of their lives. No one was more important than the other. Often our roles of being present, offering reassurance, and allowing the family to be present with their child was a shared effort, and in the aftermath we could help one another.
On the wall at the seminary I attended in Louisville, KY, a bronze plaque bears the words of one of the former professors, Dr. George D. Carter: “It is not enough to say, ‘Ain’t it awful.’ We have to get close enough to get hurt.” Practicing a ministry of presence with a grieving family is to take a risk. The sterile becomes sacred when the chaplain goes where it hurts, risks the embrace, and reminds others that the Holy is already present and suffering. A chaplain’s job is to be with the family, journey alongside them, carrying their story, as they take those first few steps out into a new normal.
Rev. Lisa Hermann, BCC, is a chaplain at Providence Health in Columbia, SC.
