The many roles of an emergency department chaplain

“ACTIVE SHOOTER, multiple casualties” scrolled across my large screen TV. I dropped everything, grabbed my credentials, and headed toward the hospital. My phone rang as I approached the entrance. The emergency department coordinator blurted, “Dr. Tom, can you come NOW? We need you.” I answered, “I’m already on my way. Be there shortly.”

Hospital chaplains have a calling to provide spiritual care to patients and their families—as well as staff. A few chaplains are embedded in the flow of patient services in the typical hospital and become part of the medical team, recognizing they support the primary medical services.

The staff love to address me as “Dr. Tom.” It is both professional and friendly. “Rev. Dr. Tom” is official. “Chaplain Tom” is better for patient contact, as the title reverend immediately brings to mind a specific religious affiliation, whereas I prefer to be ecumenical and serve all patients regardless of their religious affiliation, if any. Theologically all are God’s children. My objective is to strengthen the patients’ and their family members’ connection with their God and instill confidence in the medical care they are receiving. The outcomes are in God’s hands.

At traumatic times, my assignment is to escort family members to the family room. I also assist with non-medical patient care from time to time, even make beds, especially when staff is stressed.

EMTs transferred an unconscious woman onto a trauma bed on Christmas Day a few years ago. Fluids and waste fell on the floor. The associate medical director exclaimed, “On this day when we celebrate the Lord’s birth would it be too much to ask for a pair of booties to protect my new shoes?” After a quick trip to supply I handed a pair to an aide who slipped them on the doctor’s feet. I started to leave the room, but the charge nurse called out, “We need two more, Dr. Tom.” The medical staff didn’t skip a beat delivering timely treatment.

Having a close working relationship with the medical staff gives chaplains an additional avenue of insight into patient care. Doctors often ask me to accompany them when they disclose a diagnosis to a patient. Nurses greet me with, “The patient in room X needs you.” And they do not hesitate to call when there is a traumatic situation regardless of the hour.

Patient confidentiality is vital with the obvious exception of danger to self or others. I saw a patient take a pill from a bottle and return the bottle to her purse and reported it to the attending nurse immediately. Building this level of confidence with the nursing staff opens feedback that is valuable in spiritual counseling with their patients.

Non-essential staff were furloughed when COVID-19 hit, but I was quickly recalled to serve the entire hospital. Half of the ED beds were devoted to COVID patients. I was stopped in the hall by one of the physicians who said, “We need to upgrade you to a Level 3 mask at least, you are too valuable.” When N95 masks became available I was given several. Being called and told to get in line when the COVID vaccines became available for medical staff was an honor.

Burnout has exhausted many of the nurses. It is taxing when all the COVID patients are intubated, on multiple IV meds and unconscious. Frequent monitoring is required. The unit director of the largest COVID ICU asked me to pray for her nurses. I prayed over the unit public address system so the nurses did not have to leave the patients’ bedside. My heart twitches every time a passing nurse says, “Thanks for the prayers.”

Occasionally, there are special events. I love being a costume judge when the nursing staff dress up for Halloween and Christmas. It was indeed a special event when I was asked to officiate at a wedding for a female patient whose scheduled wedding had to be canceled due to a necessary surgery. The bride wanted to be married anyway. The surgeon approved having the ceremony in the hospital chapel the day before the surgery. The attending nurse made all the arrangements. It was a full family ceremony with recorded music, scaled down to avoid being too stressful.

Recently, I was about to enter a patient’s room just as the medical director of the unit arrived. I started to step aside, but he said, “You first, Dr. Tom. They need you more.”

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