Thy Will

There were already tears in his eyes, spilling down onto his cheek as I entered the room. "Thank you so much for coming," he said. He introduced himself, his wife, and his sister. Then he introduced the lady in the bed, his mom. Collectively, they had decided to institute a morphine drip -- the doctors had said that there was nothing more that could be done for Betty; her breathing was compromised due to fluid in her lungs. 

Instantly, I sort-of fell in love with this family. This was to be a brief connection, but a deep one. A man who is brave enough to let the tears come unashamedly is a man I want to be around. 

He told me that they had talked together, with the nurse, with the doctor, with Betty even, and the morphine drip was what they needed to do. I knew they were right. What was so interesting to me was Betty's active participation in the conversation, despite the struggle with each breath. It was hard to watch her, to hear the sounds of her failing lungs.

We gathered around the bed, joined hands, and spoke with God. We expressed thanks for the love of family, for the compassionate care of the medical team; we spoke of the assurance of a life with God after this one and we asked for the courage to entrust Betty to God's tender mercy. We ended with The Lord's Prayer.

Incredibly, as soon as the prayer began, Betty's breathing calmed. It wasn't as noisy. She was hearing the prayer. And when we began The Lord's Prayer, her lips moved and each word was whispered. 

Throughout my shift, I was drawn to return twice more to this special family. To put my arm around the sorrowing daughter, to hold the hand of the man who let his tears flow, to pray -- one more time for Betty -- "Thy will be done."

Angry, Distrusting, and Entitled

I don't know what to call it, this attitude that frightens, frustrates, and angers me all at the same time. It's a kind of incoherent combination of anger, distrust,  and entitlement and I haven't had a lot of experience with it. I'm very much aware that I am a privileged white person. I learned a lot about that when I worked at the Quaker school. I know that I am at some level racist even though I think I am not; I learned that at the Quaker school, too.  I have friends and colleagues who are black and sometimes I am aware that my whiteness is a factor in our relationships whereas -- as far as I can determine -- their blackness is not. I don't have very much experience with this un-nameable attitude that frightens and frustrates me at the same time.

The encounter was at work, near the end of a long shift, when I was called to a Pediatric Level 2 Trauma. Aria was not much more than a year old and she had been dropped by her uncle. On her head. Mom, Susan, could not have weighed more than 85 pounds and looked like she was about 15 years old. She was, in fact, nearly 18. Susan was quiet in the trauma bay, and terrified. Silent tears ran down her cheeks. Aria was lethargic but somewhat responsive. She had no visible injuries but had vomited. For safety's sake, she had been placed in a cervical collar. The trauma team -- about 8-10 individuals representing 8-10 different areas -- gathered around Aria, but were kind enough to pause from time to time to provide encouragement to Susan, who I was keeping close to, supporting, hugging, mopping tears.

Then someone came back and said that Susan's mother and brother were in the waiting area and would I come out and explain things to them. I left Susan and went out. I'd never seen the waiting area so crowded, but before I could ask for the woman I was seeking, she -- and the brother who appeared to be about fourteen or fifteen -- presented themselves to me and began a verbal tirade. I tried to explain that I was the chaplain and I wanted to fill them in on what was going on in the back because I knew they would be concerned. "Bullshit," was the response. "That's just bullshit." This was the opening of the tirade that would go on and on and on, interrupting me every time I tried to speak, insisting on going back to the trauma bay, needing to know what was going on, but not wanting me to tell them. I tried. I really did. But in time I tired of the abuse, the interruption, the insult. The brother/uncle (who I began to think of as "the perp") was worse than the grandmother. I felt like I was a in a scene from "The Wire" (of which I'd watched only one episode). "Fuck" this, "Fuck" that, and demands/insistence on being "with my niece" went on and on until I turned my back, mindful that there was a security guard just around the corner; I could summon him if I needed to. I faced the grandmother and stopped talking. Finally her vitriol stopped. "If you don't want me here, I'll go back to your daughter," I told her. "But you and your son will not be allowed to go to the trauma bay."

She quieted. I explained that Aria was getting a complete work-up, and the next step was a CAT Scan. A CAT Scan that was a routine part of the trauma work-up. She started again, angry, entitled, insistent, and clearly not trusting me for a minute. I told her, "I need to get back to Susan now," and left. The crowded waiting room had gone quiet in horror at the scene.

For the better part of an hour and a half, I went back and forth from the trauma area to the waiting room, doing my best to show these family members respect by keeping them informed in what had to be a terrifying situation. Sometimes Susan went out with me, sometimes not. The grandmother had phoned Aria's father, something Susan had pretty much decided to wait on, and shoved the phone at her daughter; another young/angry/entitled black man was on the other end.

As it turned out, things were not good. Aria had been dropped with such force that there was bleeding into her brain. She was going to have to be transported to the children's hospital in center city. There was a point where the possibility was air-lifting her and this led to uncertainty whether Susan could accompany her in the chopper due to weight restrictions. (My hunch was that once the chopper team had a glimpse of tiny Susan, this would not be a problem.) But the decision was made to use an ambulance. Susan -- but no one else -- would accompany her daughter.

It was a hard visit, a terrible end to a long shift. And I've continued to think about it, to the point of even wishing I was in a CPE group that I could process it with. I am aware of my white privilege, I was aware that I was the person keeping this family from being where they wanted -- and believed they were entitled -- to be. I believed that their distrust of me was not personal but because of my whiteness, my position of unwanted authority. I knew they were frightened and that the son/uncle was likely feeling very responsible/guilty, though that was not something he could admit.

At a couple of points I could actually see the effort the grandmother was making -- she was trying to come out of her culture and into mine so that we could communicate. It shouldn't have been that way, but it was. She wasn't entirely successful, but she tried. I admired her for that. At one point, she received word by phone that her younger son had dislocated his shoulder and was on his way to this same emergency room. It was nearly eleven o'clock and she had to be at work at six o'clock the next morning. "You have an awful lot on your plate right now," I told her and opened my arms to offer a hug. She hesitated for just a second and then let me hold her for a very short time. Another adult would stay with the younger boy so that she could -- somehow -- find a ride all the way downtown to meet her daughter and granddaughter. I was grateful for her moment of shared vulnerability.

The son/uncle never cracked. He remained angry/entitled/distrustful the entire time, never letting up with his horrible recital and demands. I could try to imagine/identify the feelings he was having, but the barrier was too thick and was likely deeply embedded in familial dysfunction and racial issues. I could do nothing for -- or about -- him.

All of this was at the end of a sixteen-hour shift.

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.