Christmas Night

I worked the 3p-11p shift on Christmas night. The person I picked up from had been on for sixteen hours and he said it had been quiet. He wished me the same.

I spent a great deal of time with three families. For two of them, Christmas will never be the same.

Patricia had fallen at home. Her health hadn't been good for a while, and after a busy Christmas day, late in the afternoon she went upstairs to take a nap before dinner. She didn't make it to the bed and when the family heard the crash, it was probably already too late. 911 came and worked on her, brought her in the ambulance and the ER staff continued to try to bring her back. I sat with the daughter who had followed the ambulance to the hospital. Before long, the resident came in, bringing sad news. When Patricia's husband and other daughter arrived, they were, of course, shocked to learn of her passing. Her husband told me that they had been married for more than sixty years. "How can I go back into that house?" he kept asking. How, indeed?

Edward's enormous family was gathered in the conference room when I joined them, and more and more continued to come until they were spilling out into the hall. The patient had had a longstanding relationship with alcohol, and his consumption on Christmas night had apparently been considerable. Edward was a great-grandfather and his mother was still alive, though not among the four generations present. When the resident came to tell Anita that Edward was gone, she collapsed on the floor. "I tried so hard, I tried so hard," was her refrain. She seemed to think that if she had tried harder, she could have cured Edward's alcoholism.

Arthur had been driving home from a Christmas dinner, his wife at his side and his two adult children in the back of the car. Another motorist ran a red light, and Arthur's entire family came to the hospital as Trauma patients. Arthur was not injured, and he moved from cubicle to cubicle as his family members were assessed and treated. They will all recover from their physical injuries.

My shift came to an end. I handed the beeper over to my replacement. I wished her a quiet night.

Go Gentle

"Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light."

Thus says the poet about facing death.

It was about four o'clock in the morning when the telephone rang, and a nurse from the emergency room asked if I could come down to the cubicle where a woman was going to pass away very soon. 

She was 89 years old and was lying on her back, her face turned toward the right where the young male nurse who had phoned was standing with his hand on her shoulder. On her left, another nurse was softly stroking her hair. At the foot of the gurney were two or three others, one of whom had grown up in my church and had become a nurse as a second career (but not before getting what appeared to be a bazillion tattoos). The cubicle was quiet; the beeping function of the cardiac monitor had been silenced.

She had been a hospice patient for two years and was reaching the end of her journey. Her nearby family was away at the seashore, and another daughter, the one most concerned about her, lives three or four states away; there was no way any of them could get to the hospital in time. "Don't worry," the young male nurse had told them. "We'll take very good care of her. We'll treat her like family."

"This is my first patient death," the young man told me. "It's a good first death to have," responded a colleague. There were perhaps a half a dozen of us, standing quietly around the patient, listening to her gentle, slowing breathing. 

We joined hands -- with the one nurse still stroking her hair and the other with his hand on her shoulder -- and I offered a prayer. I thanked God for her life and for all that she had meant to her family. I thanked God for the care she had received this night and for the adoptive family surrounding her. I spoke of our assurance that God had created her and would receive her into his arms at the end. I prayed for comfort and for mercy.

When I finished, the patient was still and the tattooed nurse from my church listened for a heartbeat; there was none.The "first death" nurse said, "You know, I haven't sorted out what I believe about life and death and an afterlife. But she took her last breath in the middle of your prayer. That has to mean something." 

They thanked me for coming down; I thanked them for calling me. It had been a privilege to be among them, this adoptive family. The patient went gentle into that good night; there was no need to rage against the dying of the light.

Changed. Forever.

Most of us have those moments, the one where our lives are forever changed. If we don't have them ourselves, we know someone who has.

When it is us, we cope, we slowly adjust, we reimagine and reinvent our lives. When it is our friend, we support, we bring food, we futilely try to "make it better."

One of the dimensions of my job as a hospital chaplain is being exposed to these moments for others, people I never knew before. And with this exposure comes absorption of some of their pain.

My most recent shift was fraught with such experiences.

Early in the evening I was with six men who had gathered to remove life support from their brother/uncle. Four of them had flown to my city from Texas, and all of them bore a strong resemblance to Javier Bardem's character in "No Country For Old Men." All of our mothers told us that "appearances can be deceiving" and "don't judge a book by its cover," but I was unprepared for the incongruity of how gentle, loving, and tender these brothers/nephews were, eagerly holding hands all around while we prayed for God's mercy.

A lovely, too-old-to-still-be-driving octogenarian mistook the accelerator for the brake pedal, causing a five-vehicle accident and most likely her husband's death.

A pedestrian hit by a car as he crossed the street to the train station on his way home suffered a massive skull fracture and intracranial hemorrhage; his wife and son live so far away that he had already been taken to surgery by the time they arrived. "But I had just spoken to him!" she said over and over, trying to take back time. It will be days before the heavily-sedated patient will be allowed to attempt to wake up; and only then will he will be able to be assessed for brain function, for mental capacity. And during that time the family will spend hours driving to spend hours at the bedside, waiting without any idea of the outcome. "This will be a long process," the resident said and I noticed she didn't use the word "recovery."

All of these lives changed in a moment.

And perhaps the saddest story is the one about the man of -- oh, how do we phrase this? -- limited intellect who called 911 for his bedridden mom who had stopped breathing. The two of them lived alone together in an unhealthy environment. What will become of poor "Ben," now that she is gone?

Changed in a moment.

Forever.

How Can I Let Her Go?

I was awakened by the beeper at about four o'clock in the morning. It was a Code.

When I got to the patient's room, there were family members huddled outside the door, clasping their hands and sobbing. The Code was going on, and before very long, a pulse returned.

The patient had only been admitted to the hospital twelve hours earlier. She had end stage renal disease and several other problems. She needed dialysis. Complications had ensued in the dialysis unit and she was sent to a critical care floor. The need for dialysis was complicating her other problems.

The family members were the patient's daughter, the patient's aunt, and the patient's niece. The daughter is an only child and there was no mention of a husband.

The resident spoke kindly but frankly to the daughter. The patient was very, very sick. She needed dialysis, but her blood pressure was probably too low and heart rate too slow for her to sustain the procedure. In all likelihood, the resident said, once dialysis was started, it would just be a matter of time until the patient Coded again.

The daughter's wedding day is November 1.

A terribly sad situation.

The patient was only in her mid-fifties, but she had been abusing her body with alcohol for a long time,

It was agreed that a slower form of dialysis would be attempted. Pressors were given, and the patient was prepared. I prayed with the family and left.

Oddly, I was able to fall back to sleep, but not for long. At 6:15 the beeper announced another Code and I grimaced when I saw the room number.

The fiancé has joined the family by now and was holding the patient's daughter as she sobbed, "She's my mom. How can I let her go?"

The nurse and the resident spoke at length with the daughter. In time she came to a place where she understood that her mother's body was simply giving out. Her lungs were filling with fluid, her need for dialysis was overwhelming, and the pressors would only help for so long. Her liver was cirrhotic as well; the patient was shutting down.

At the mention of the liver, the daughter became more focused. "What will you write is the cause of death?" she asked. "Will it be cirrhosis?" The resident said that it would be end stage renal disease, and the daughter was relieved. It was important that liver cirrhosis not be the cause of her mother's death.

Born Too Soon

While each hospital encounter is unique, there are situations that are similar.

But I've never experienced anything remotely like this one.

A nurse from Labor and Delivery phoned. She sounded upset. Her patient, we'll call her Ruthie, had delivered a 22-3/7-week baby boy about two hours earlier. The baby was alive, but would not be for long. And Ruthie would have nothing to do with him. She didn't want to see, much less hold him. She would not talk about burial or cremation arrangements. She would  not talk about her baby. She just wanted to go home. The man with her was of the same mind. The couple were in their thirties, and "weren't from around here." Neither, in fact, is a citizen of this country.

The nurse couldn't stand the thought of the baby's being all alone, dying, and going to the morgue. She was staying with the baby and loving him. She wanted to know what would happen to the baby and whether there was anything I could do.

Mindful of my boss's instructions not to hesitate to contact the nursing supervisor if I found myself in an untenable situation, I went to find her. The sadness of the situation was shocking to her, as well. She spoke with the sweet nurse and made began the process of contacting social work to assist with making the infant a ward of the county. As we talked, my role became clear to me.

I went up to the delivery floor and sought out the nurse. She told me that the doctor was with the baby, and together we went in. He was very, very tiny, and his breaths were not close together. He was under a warming lamp and wearing a little green knitted hat. The doctor had her hand on him. I asked them to join me in prayer and thanked God for creating this beautiful child, and asked God to receive him back into his loving arms. I made the sign of the cross on his forehead and blessed him. He would not live much longer.

The parents would have nothing to do with me. They did not want to be consoled and they did not want to plan and they did not want to talk. They wanted to be left alone.

Born too soon to a mom who wanted him so much that she got all mixed up when nature failed her, this baby will be with me for a long time.

It was a terribly sad situation. This brief little life was supported by a loving and gentle doctor, a caring nurse, and a chaplain called in desperation.

His parents didn't even give him a name. But as I stood there with my finger on his tiny forehead, I thought about my own firstborn and knew that he wouldn't mind sharing his name. I will think of him as Thomas.

"Not Very Smart"

It turns out that her daughter is a nurse on another floor, and that daughter is the one who requested that I visit the patient.

She was 80 years old, but I would have guessed her to be 75. She was sitting in the chair, supported by pillows, with an oxygen cannula helping her to breathe. I pulled over another chair and settled in for a chat.

I have to say that I straightaway I liked her. A lot.

I began, as often I do, by asking what had brought her to the hospital. She replied that it was her breathing.

And then she got to the point. "I'm a twin, you know." I hadn't known. Her fraternal twin sister had been "the smart one." "I'm not very smart," she told me. "But my sister was smart." The sister had died at 39. My patient had now lived twice as long. We talked about the special bond of twins (my own mother was a twin); my patient will always miss her sister. She thinks of her every day.

She rambled on. She'd been in the hospital for pretty many days, not exactly certain. And she didn't know when she'd be going home. The diabetes was the problem, she said. She had it and didn't know anything about it. "I don't WANT to know about it. I'm not smart enough to understand it." I was taken aback. This was the second reference to not being smart. She lives alone, and people were worried about that in connection with the inadequately managed diabetes. I inquired about perhaps attending a patient information class on the subject, but, no, she didn't want to do that. Her daughter, the nurse, understood the diabetes and would take care of it. Her daughter was very smart, she said, "not like me."

Our conversation wandered around and soon the beeper shrieked and I needed to leave. We said a prayer together, and I said I would ask Sister to stop and see her on Monday, and off I went.

All the way down the hall(s) she stayed in my mind. I conjectured that her parents had been the ones who had given her this terrible message, the self image of stupidity. We tend to believe what our parents tell us about ourselves. I wondered what they would think, how they would feel, if they knew that 75 years or so after receiving that message, after marrying, keeping a household running, raising a family, helping at least one child through college, after all of that, she still believed what they had said.

Six Years

I spent a lot of last night in the Emergency Room.

As a hospital chaplain.

There were many Level II traumas, sometimes two at a time, and the staff was hopping.

Around 3:45 as I was dragging myself towards the elevator, hoping to get a few hours of sleep, it dawned on me: It was the Friday of Memorial Day Weekend. And I was in the Emergency Room. Again.

Six years ago, on the Friday of Memorial Day Weekend, I was in the Emergency Room, too. This time as a worried wife of a man experiencing a heart attack.

So I turned away from the elevator and went back to the triage area. I told them of my realization. And I thanked them for saving my husband's life.

A blog friend is celebrating her wedding anniversary today. That made me think that Joe and I are also celebrating an anniversary. We've had a wonderful married life of 47 years. But these last six have been something special. We had a reminder that nothing lasts for ever, not even us. And we spend more time together, go out separately less, and thoroughly enjoy the quiet times with each other.

I know that this weekend we are remembering those we lost, and that is as it should be. But it's also okay to remember one we didn't lose. And be thankful to those who made that true.

A Quiet Shift

In my role as a "casual" employee, I work as a chaplain in the local hospital only two or three times each month. But each shift is twenty-four hours long. I usually get a few hours of sleep during the night.

No two shifts are alike. Sometimes I can hardly catch my breath between answering the telephone, responding to the beeper, attending the Codes. Sometimes there is a more even pace, and I have time to do purposeful rounding, visiting the nursing stations in search of referrals.

While I relish the busy times, the dramatic times, I also like the opposite. It is something about the difference between hopping from a major trauma to attend a death and then respond to a Code vs. having the time to sit for an extended time with a patient, not having to think about what other work needs to be done.

A recent shift was one of the quieter ones. I picked up the referrals from the chaplain I was relieving and noted with interest that there were two requests for Advance Directives. As I was walking to the on-call room to deposit my tote bag, I was stopped by a member of the Palliative Care Team -- she was glad she had seen me because she had a patient who wanted an Advance Directive. And no sooner had I reached the on-call room than the phone rang -- yet another request! It seemed odd that all at once so many people would be wanting to put their ducks in a row.

I printed out four copies and headed to the patient nearest the office. There was a large family gathered and the nurse had indicated to me that they were most impatient and that they were difficult and demanding. The patient himself was very, very sick, barely responsive. I felt a fleeting concern that there might be some railroading going on, and decided to spend some time getting to know the family a little bit. Before long, my little twinge was gone away. Because the patient was so very sick, I asked one of the men in the room to give me the information that I would need for the Durable Power of Attorney. I filled out the form and then went to find a second witness; then we roused the patient and I asked him to confirm the wishes that were expressed on the form. It was clear that he understood and that the information was correct. He made a mark on the page, it was witnessed, and I had the document put in his chart. I told the family I thought the patient was fortunate to have such a large family who loved him.

I had a call to visit another patient and when I got to the room for another of the Advance Directive patients, I learned that he had been discharged. The third patient was sleeping, so I handed that request off to my replacement. The fourth was a young woman with a trach who was also very, very sick. She could barely respond to my questions, but she was determined to arrange for her daughter to be "the decider" in the event she got sicker and could no longer make her own decisions.

I had a call from a nurse whose patient unexpectedly had to go have a cardiac catheterization and was upset and crying. I was glad that I had no other pressing demands because I was able to sit with her until Transportation came to move her to the cath lab. She was unclear about exactly what the procedure involved -- it had all come about so suddenly. Knowing it wasn't my place to attempt to explain a medical procedure, I spoke briefly from my own experience, telling her that my husband had undergone a STAT catheterization six years ago and that he had reported it was not uncomfortable and, in fact, had been interesting. The patient just needed someone to be with her, someone to let her talk. She had been packing her suitcase to take to a southern state to attend her granddaughter's college graduation -- the first one in the family -- when the chest pain began and radiated down her left arm. She was smart enough to know she needed to come to the hospital rather than to North Carolina. We talked about disappointments, and about taking good care of ourselves. Because my shift was so long, I was able to catch up with her post procedure and I was glad of that.

A nurse from the ER phoned for me to come down and gave me a room number. The lady in the bed was an Alzheimer's patient, and her husband was in the room with her. He was crying. He had just received a call on his cell phone that their grandson, a man in his late twenties, had hung himself. This was the second grandchild they had lost. The man -- who became my patient -- was overwhelmed with sadness. The care of his wife was his responsibility, mainly, and as I well knew, was demanding. They had been in the ER for six hours at this point and she was scheduled to be admitted to the Observation Unit; he said he would have to stay there with her. Otherwise, she would become too agitated. He was overwhelmed. I spent a good half-hour with him, just listening, and supporting him. I was worried about how he was going to get any rest (he told me he was diabetic and had to be careful about eating right). Then came word that the wife did not need to go for observation; she was stable enough to be cared for at home, and with great relief, they left.

I spent some time with a family who had decided to remove life support from their father; they were just waiting for their brother to arrive before this would be activated. Their very elderly and frail mother was at home, unable to endure the being present. They talked about their dad, what a vibrant man he had been, how he would detest being kept alive in his present condition but they had permitted it when they still had some reasonable hope that he would get better. We prayed together and I went on my way after telling them that if they wanted me to return after brother's arrival, to just call.

It was a quiet shift. No really major traumas. No Codes. No drama. Just simple pastoral care, listening, supporting, validating, praying. It was good.

"Call My Girlfriend!"

He'd been brought in as a trauma, but was remarkably lively and talkative. The accident occurred when he drove into a tree, but there was no evidence that he'd been texting. He'd been on his way to pick up his girlfriend to go downtown for a symphony concert. The paramedic told me that the girlfriend had been phoned from the scene and told the concert wasn't going to happen. She was not coming to the hospital.

After someone close to the gurney stepped aside, I went close and asked him, "Is there someone I should call for you? Your son or daughter perhaps?" "No," he told me, emphatically. "Call my girlfriend." I reminded him that the paramedic had phoned his girlfriend already. Impatient with my apparent denseness, he said, "No, my other girlfriend!"  He had some trouble remembering her name (he'd hit his head on the steering wheel) but eventually came up with it as well as her phone number. All of the trauma team seemed amused, as was I.

I called the other girlfriend and discreetly didn't mention the first one. I told her that Mr. T would call her once he was settled in a room, and she was fine with that. She was unable to come to the hospital.

So I went back to Mr. T and reported what I'd done. He asked me to lean in a little closer. "You have pretty eyes!" he told me. "And I like your hair!" The trauma team perked up and I told Mr. T, "You have two girlfriends already! You don't need a third!"

He was 95.

Two Situations Involving Rules

Situation One: I was walking down the corridor after lunch when I heard someone crying loudly. I picked up my pace, as did the woman who was walking ahead of me. We came upon a middle-aged lady, up against the wall, heaving with sobs, "I want to die! I want to die! I can't be brave any more!" The other woman -- a laboratory worker -- and I managed to get the lady to leave the hallway and step into the chapel. We spent an hour with her as she cycled between regaining her composure and resuming her lament. We pieced together that she had just left visiting her daughter, who had been a patient for a couple of weeks, and who had just received a new diagnosis. Conversation with the daughter's nurse revealed that the lady was not good at managing her diabetes, had skipped several days of visiting the daughter, and had exhibited a change in mental status. After a long time, we were able to persuade the lady to go to the Emergency Room where someone could check her blood sugar in the hope of getting her stabilized. I reported her words, "I want to die!" to the triage nurse. Confident that the lady was in good hands and having received a call to attend a patient, the lab woman and I left her there and went on to our work.

Fifteen minutes later I received a call from the lab worker. She had accidentally left something down in the ER and when she went to pick it up, she learned that the lady had left. When questioned about "I want to die!" she had responded that she had no plan to kill herself that day. Though her blood sugar was likely out of line, though she clearly needed some sort of care beyond what we had been able to provide, since she was not a danger to herself or to others, the ER nurse had no way to keep her and administer treatment. This was a case where rules got in the way of care and there was nothing that could be done about it.

Situation Two: The patient had suffered a cardiac arrest and the team was working hard to bring him back. My job was to support his partner-not-wife-of-sixteen-years. When the patient had Coded, the partner had phoned his daughter, who was on her way to the hospital. Soon, the patient appeared to be stable and the resident came out to speak to the partner-not-wife. "Is his daughter coming in?" she began. "I am so sorry, but because you are not family, I cannot give you any information about his condition." She looked sorry, and the partner understood and did not argue, but looked very, very upset.

Since the patient had just come to the hospital that day, he was not yet assigned to a particular service, and the resident sat down and placed a call to an attending. I heard her explain the patient's situation in detail and then she said, "Okay. I'll call him." The partner was anxious, looking at her watch, wanting to go into the patient's room but not yet permitted, wanting information that she was not legally entitled to. When I saw the resident pick up the phone to place the next call, I moved the partner a few feet so that she would be closer to the telephone. "Now, just eavesdrop," I told her.

"Answer Your Damn Phone!"

When the beeper shrieked that there was a Code 30 -- a cardiac arrest -- I hurried to the indicated location. The patient was an elderly woman and there was no family visiting at the time. My role at the time of a Code is to support the family. A staff physician phoned the family to notify them of the change in the patient's condition, and urged them to come to the hospital. Meanwhile, the Code 30 team continued to work with the patient.

When the family arrived -- a wheelchair-bound husband, two grown daughters with husbands, and one grandchild -- I escorted them to the family lounge just outside the unit. There were some other people there; sensing what was going on, these kind folks quickly moved their positions so that the Code family could all be together.

Immediately the daughters began using their cell phones, calling or texting everyone they could think of. One of them said, "I can't post to Facebook from my phone. Who can I call to get them to post?" They wanted everyone to know that Granny had taken a turn for the worse. When the resident came out to speak with them the first time, one of them even asked him to wait until she was finished her phone conversation. After hearing what he had to say, the texting and phoning resumed: Granny was very sick, indeed. There was another sister in a far-away state who needed frequent updates; then there were all of the other grandchildren, some of whom were at college or in other states. A lot of energy was put into what to do about one teenage grandson who was alone at home; they didn't want him to be alone when he heard about Granny's turn for the worse -- he had completely freaked out when the cat had died. My gentle suggestion to wait until Granny's condition was resolved before notifying this vulnerable lad fell on deaf ears. The dispatched a cousin to go over to tell him in person.

A bit later the nurse came out and suggested that the family might be more comfortable in an empty patient room, away from the crowd in the lounge. I knew this to be a euphemism for "bad news is coming," and went to help bring in additional chairs, get cups of water and tissue boxes. Once settled in the room, the efforts to communicate resumed. Messages that had been left previously had been picked up and the return calls were coming in. One of the phones didn't ring; instead, a grouchy, loud male voice would proclaim, "Answer Your Damn Phone!"

The chief resident came into the room and said, "I'm so sorry." He went on to explain how hard and long the team had worked to try to bring Granny back. At this point she had been gone for nearly an hour. The husband-turned-widower sat shocked in his wheelchair, but his daughters' main concern once again was to get the word out, to make sure everyone knew immediately. I watched all of this for a few minutes and then went over to the wheelchair. "How long have you and your wife been married?" I asked him. "Fifty-eight years" came the reply. A lifetime. He and I spoke quietly together while the daughters and granddaughter continued with the work they had deemed most important. Again I heard "Facebook" mentioned and "Answer Your Damn Phone!"

I was repulsed by their behavior. I thought back to a time when mobile telephones were not allowed to be used in the hospital and wished that were still the case. As much as I understand that Denial has its clear purpose in grief work, there was something wrong with this picture. They reminded me of the people who come to graduations and weddings, and miss the experience because they are so busy making a video to watch later on. None of his family was caring at all about the bereaved man in the wheelchair who had lost his life-long partner. I was glad that I could be there for him since they weren't.

Not soon enough, the batteries ran out; the phoning and texting came to an end. They put away their damn phones.

And then, the daughters began to cry.

What It Is Like

It is wonderful. Being a hospital chaplain, that is.

My work began in the middle of December when I was asked to find five dates when I could work from 2 until 10 p.m., shadowing an experienced chaplain, and learning the particularities of the hospital. Finding 40 hours in the last two weeks of December was a challenge, but we managed. The men that I worked with were patient and kind (well, what would you expect?) and taught me well. 

I wasn't concerned about the work that I would be doing; I'd done that before and felt competent. My biggest worry, as it happened, was one that would take care of itself: Finding my way around the humongous, state-of-the-art emergency trauma center! There appeared to be no logic whatsoever as to how it was laid out. I was just going to have to go there and do it and look for patterns and clues.

My mentors believed me to be ready, and very recently I worked my first solo shift from 3 p.m. on one day until 3 p.m. the next day. There is an on-call room and it is anticipated that eight hours of the shift will be sleep hours, though it is not anticipated that those eight hours would be consecutive!

The hospital chaplain has a variety of visit types and there is plenty of time spent doing documentation and reporting. On this first shift I did all of these different things:

• Responded to one Level I and three Level II traumas. This must be done with all due speed and my role is to work with whoever I can to identify next-of-kin for the trauma patient, and then to contact that individual and ask him to come to the hospital. Sometimes the family member has come in with the patient; other times the family is contacted by the nursing home sending the patient; and sometimes I need to prowl through the patient's cell phone looking for "Mom" and make that call.
• Supported a family member immediately after a patient's (not unanticipated) demise.
• Assisted a patient who wanted to make a Living Will and select a Health Care Power of Attorney.
• Arranged for a priest to provide Sacrament of the Sick to a patient nearing the end of his life.
• Supported a patient (and her husband) who had come to the hospital with what she thought was a very minor problem only to discover she had a far-advanced major diagnosis.
• Visited numerous patients in their rooms upon referral from the nurses and the previous chaplain.

Another night I might be asked to perform a Baptism for an unstable newborn, to sit with a dying patient who has no family, to be with a woman who had just become a widow due to her husband's sudden cardiac arrest. The beeper is with me constantly, as is the telephone, and the chaplain's number is intentionally an easy one to remember.

I found one wonderful nurse in the ER who eased me along with a difficult family identification. I discovered that the staff in the triage section are good-natured and amazingly helpful with all kinds of questions. I learned that breakfast and lunch are the best meals in the cafeteria and that the dryness of the institution requires lots of chapstick and cups of water

When I was working on the final trauma of my shift, very tired from too few, too short segments of sleep, all at once I realized that I wasn't actually thinking about where I was going. My feet had learned the layout of the ER, while my brain really had not!

I love it. I absolutely love it.

Peaceful Passings

I have written little about my new position as a hospital chaplain. Mostly, this is because I am still in awe that I am actually -- after all of these years -- doing the work I have so long wanted to do.

I work for twenty-four hours at a time, responding to the trauma and code beeper, doing purposeful rounding on all of the units, receiving referrals and requests, and following up with ongoing situations. It is expected hoped that I will sleep for seven or eight of those twenty-four hours, but that is seldom the case and the hours are not consecutive. I never know what a shift will bring.

A recent one brought death.

I had been asleep for about an hour when the beeper shrieked. A Level One Trauma was coming in, and it was yet another older person who had fallen, sustaining an injury to his head. And this one didn't even happen outside in the ice.

My role is to support the family; in this case, the wife who was in the waiting room with the next-door neighbor, the kind of guy anyone would wish to have for a next-door neighbor. I introduced myself and explained that since her husband had been brought in as a trauma, the protocol called for me to attend; she shouldn't read anything more than that into my presence. We became acquainted and when she told me that her husband had had a heart attack two years earlier and had been on a blood thinner ever since, I felt a sinking feeling in my stomach.

Soon the chief resident came out and confirmed what I'd feared. The gentleman had sustained a massive intra-cranial bleed, he was on a ventilator for assistance with breathing, and would not survive surgery if it were attempted. Betty would need to make some decisions and the situation was complicated. Her daughter was six or seven hours away, her son across the ocean, and her husband's son at least twenty-four hours away. Would they want to come to see him? Should he be admitted to the MICU for 24-48 hours so that people could travel in? Or would it be better to stay in the ER and remove the ventilator? Only a few hours earlier the man had been joking with the neighbor about the ice on their shared driveway.

Many phone calls were made and, regrettably, many messages were left on voice mails. Betty's pastor was out-of-town, and it became my task to help her try to think clearly, to take into consideration her husband's wishes, what she wanted, and what the children might prefer. Ultimately she decided that the right thing would be to submit to the inevitable and remove the life support.

It took about twenty minutes after that for the gentleman's heart to stop. It was a slow and gradual process, and those famous words came into my mind: "Do not go gentle into that good night." He did go gently; death came quietly and slipped him away. Together Betty and I asked for the courage to entrust him to God's merciful care. I'd been with Betty for just three hours; when we parted, I felt as though I'd known her -- and her husband -- for many years.

Some hours later, I was called to a patient's room. The occupant had died a few hours earlier and his daughter was at the bedside, waiting for the funeral home people to come for him. Their religion required this. I chose to sit with her for the better part of an hour. She told me that his death had also been gradual and gentle; nothing to fear. She told me, "It is an honor to sit here with his body." And I told her it had been my privilege to sit there with her.

It was a difficult shift, but a meaningful one. Two women, both in very intimate stages of life -- and death -- had allowed me to share their experience, to offer support, to remind them of God's love. I'll never see either of them again, but they will be with me always.