By Nicholas Perkins
I believe that ministering to families in an emergency department is a holy movement. Interdisciplinary care team members offer compassion based on communication and collaboration. The information that chaplains share with nurses and physicians can focus on the number of family members present, how they are related to the patient, and their location as they wait for information. I understand how the tone of my voice, body posture, and whether I sit or stand can affect a grieving family.
Serving individuals in the aftermath of tragedy requires that I respect the effects of shock in the same way I would put a warm blanket around a cold person. I cannot underestimate the effect of small gestures to a family in the emergency room, such as hot tea for a worried parent or coloring books for a tired child. A simple act can foster emotional availability and accessibility.
The initial interaction with a family sets in motion a theology of care that respects the physical, emotional, and spiritual boundaries of others. Due to the ever-changing rhythm in emergency departments, a chaplain needs specific skills such as a non-anxious presence, suspending judgment, and refraining from generalizations.
I can unintentionally influence encounters based on how the case may intersect with my history. When I ministered to the family of an abused child, I was aware of how my own adverse childhood experiences affected the situation when the patient shared that his father mistreated him. As challenging as it is, ministering to families in an emergency department invites me to be aware of how my history can affect specific encounters.
One model for ministry in this arena is based on Jesus and the two disciples on the road to Emmaus. Jesus, in the narrative, neither walks ahead of the disciples nor behind them. The pastoral care in that act bears fruit when I simply journey with a distraught person. I could communicate that I am leading if I walk in front, but walking behind could convey that I am pushing. Therefore, I walk beside the person or family to express that I am journeying with them.
I try to create an environment of engagement for families despite the myriad circumstances that bring them to an emergency department. I meet them when they enter, and I inform nurses and physicians of their arrival, since they usually want medical information about their loved ones. I understand how emergency departments can be chaotic, where information is delivered quickly and in medical jargon, and stress among families is amplified due to the intense pace that limits control and predictability. The rapport that I hope to build with a family begins when I take the time to explain in a general way why I may have to leave and that I will return soon.
Families appreciate it when I share this because it offers them something stable in an unstable time. There is a unique rhythm to serving families in emergency departments, in large part because chaplains may be the only ones who have the time to be with them during critical moments. It is important to distinguish between care that respects boundaries and that which crosses them during emotionally charged crises in these settings.
I remember the afternoon that a member of a Muslim family died in the emergency department. The patient’s brother shared the details of Islamic burial customs and rituals. One aspect of the ritual involved not touching the deceased upon the removal of the endotracheal tube and IV lines, while another concerned the ablution of the body by a family member. The room in which the patient died was messy due to the resuscitation efforts.
I understood that purity was important to this ritual, despite our different cultures and religions. Although the brother and I had a difficulty communicating, his gestures indicated that he would perform the washing when he returned with his mother. He let me know through the gentle motion of his hands that we could understand one another, even in the distress of the moment and our mutual challenges with communication. When he left, the staff and I swept the floor, removed the trash, wiped counters, adjusted the lighting, secured the curtain, and reverently placed a white sheet over the deceased. We did everything we could to respect the family and their faith rituals.
The brother was very appreciative when I escorted him and his mother into the room. Our efforts let him know that we valued him and recognized his dignity. We upheld the rituals of another religion and modeled how actions instead of words can augment the holy movement that involves ministering to families in emergency departments.
Nicholas Perkins, BCC, is a chaplain at Franciscan Health in Dyer, IN.
