March 2005
A 46-year-old resident in the 12-month Clinical Pastoral Education (CPE) program at Atlanta Medical Center (AMC), near downtown, I was training to become a healthcare chaplain. We provided spiritual care at the hospital, read assigned readings, wrote papers, attended group meetings with other residents and our teachers, and met with individual teachers. We wrote up accounts (“verbatims”) of chaplain encounters and shared those with residents and teachers, in order to receive feedback. Like medical residents, we learned as we worked.
I heard loud rapping on the chaplain office door, opened it, and met several people, who said they had been told their family member was at AMC in the Intensive Care Unit (ICU) and was brain dead and they better get there quick. They were breathing hard, looking at me eagerly, anticipating I could be helpful. I recognized the patient’s name. They said they thought a chaplain had called them, and I said I doubted it was one of us. He was in the ICU section where I was the assigned chaplain, so if any AMC chaplain had called them, it would have been me.
I recalled that he was a federal inmate and looked up his information on the computer. I told them he had been there two weeks. Two of them fell to the floor in exasperation and anger. One exclaimed, “How could he be here that long and no one told us?”
I led them to a conference room outside the ICU and said I’d find out what I could. The doctor predicted he would be brain dead by the next day. He had just enough blood flow to his brain that he couldn’t yet be declared dead. Earlier that morning I had watched as the neurosurgeon tested the patient for responsiveness. He checked his pupils with a flashlight, pressed a sharp pointed instrument against the bottoms of his feet, among other tests. Nothing. He lay in the bed, handcuffed to the rail, motionless, eyes closed, breathing steadily, thanks to a machine.
I told the prison guard with the patient about the family’s arrival, and he said the prison never tells family that an inmate is hospitalized, for security reasons. I said apparently someone at the prison broke the rules and called the family. He shrugged his shoulders. I wondered if a prison chaplain had felt sympathy for the family and tipped them off. That would be a risky decision that could cost someone their job.
I explained to the family that, as far as the prison was concerned, the patient was treated the same as if he were still locked up, which meant he could have no visitors apart from the tightly controlled visitation process at the prison. They couldn’t walk up to the prison and request a visit, and, from the prison’s point of view, this situation was no different. He was a short walk away through double doors and down a hall, but the prison walls still kept them away. The patient’s mother, tears running down her cheeks, said, “Do you mean I can’t see my son before he dies?” I said I’d talk to the charge nurse, Julie L., and see what we could do.
She called the warden and explained what was happening. Given that the inmate’s family was at the hospital and knew he was there and given that he was on the verge of being declared brain dead and not an escape or trouble-making risk, they faxed over their list of approved visitors for this inmate and allowed only those on that list to visit—and only for that day. I escorted the ones on the list back and forth to the patient’s room, two at a time.
The family continued to be angry and I suggested they direct their anger at the prison, not the hospital, since we followed their rules. They threatened to call a detective they knew, TV news reporters, and a friend who knew Atlanta mayor Shirley Franklin. “Tell her I need her,” the patient’s mother said. “I know he done wrong, but this shouldn’t happen.” They were outraged, ready to expose an injustice.
I expressed empathy with their situation and said as taxpayers they had every right to hold the prison system accountable if they thought the policy was wrong. I said perhaps the prison could make an exception and inform family when an inmate is in this one’s condition.
After I said that, I wondered if I was pandering to them. It wasn’t exactly a spiritual thing to say (“taxpayers”?). It sounded more like lawyerly advice. But it may have helped establish rapport between me and the family. For chaplains, rapport is foundational to trust, which can lead to meaningful conversation, which is fertile ground for spiritual care.
In fact, I didn’t say much of anything “spiritual.” I didn’t offer prayer or Scripture reading. They had one overwhelming need: being present with someone they loved who was about to die. Injecting something “spiritual” seemed like something I needed to do to prove my ministerial worth—not something they actually needed. (In CPE, we learned to consider, when relating to someone, “Whose need is being met?”) Facilitating their visits was pastoral enough. They were able to be beside someone they loved, say their own prayers if they desired, and say a final good-bye. Making a deep human connection—and what is deeper than anticipating the death of someone next to you and reflecting on their life?—is spiritually healing.
I was glad this happened while Julie was involved. In a prior incident, she had questioned my judgment. Now, she witnessed my competence: keeping the family calm, arranging orderly visits, and saving the nurses hassle. She and I interacted as colleagues.
In CPE, many residents, including me, were working on our “pastoral authority.” We asked ourselves such questions as:
***Will anyone find me helpful? Early in my residency, I would enter a room and introduce myself with almost an apology: “Hi, I’m Jerry. I’m the chaplain, but I’m here just to support you and listen.” My teacher put an end to that. He reminded me that I belonged there as part of the health care team, along with doctors and nurses.
***What if they assume I’m a stereotypical Baptist preacher and decline my visits without finding out otherwise? Once a gay man was in the ICU and during my initial visit, his partner arrived and, sounding perturbed, said he, as the patient’s appointed health care representative, had indicated he wanted no chaplain visits. Who knows what pain or rejection or ridicule they had faced from church people or ministers? This protective partner intended to prevent anything like that.
I of course agreed but also felt disappointed. I had no opportunity to explain that I wasn’t THAT kind of minister. My church welcomes gay folks and hosts gay marriages. Maybe that would have made no difference anyway, though. Explaining myself would have been more for my benefit, my self-congratulation. (“Whose need is being met?”) I was, like it or not, embedded in the world of “Christian ministry” and represented something they apparently needed to avoid. Their comfort and sense of safety may have demanded my absence, regardless of my openness and progressive theology.
***What if they WANT a typical Baptist preacher and are disappointed that I’m not?
Some staff complained about the family’s anger and threat to call a TV station, but I said I understood their emotions, and that they had calmed down appropriately once things were explained. In the end, the family and hospital staff expressed their appreciation to me.
Someone brought the patient’s 9-year-old daughter to the ICU hall, but, even though she was on the prison’s list of allowable visitors, I had to walk her back to the waiting room. The hospital’s policy didn’t allow ICU visitors under 12. I felt a twinge of regret as I thought of my own daughter, who was 6.
The patient’s grandmother arrived and asked if she could see him. She was not on the list, so I told her she couldn’t. Seeing disappointment in her face, I almost risked letting her in. The guard let me handle the gatekeeping and hadn’t been checking IDs, so he probably wouldn’t have noticed, but I didn’t try. If I had, I would have risked the forgiveness-not-permission tactic, but, instead, I followed the rules.
The patient’s 14-year-old daughter visited, and she commented that it was stupid that the unresponsive patient was still chained to the bed. Later, the guard pushed the chain under the sheet so it was less visible.
An AMC security guard met with the family, read the list of approved visitors, and said everyone else should leave the property since there was a large crowd (by then around 30 people) and since it was an “inmate situation.” Some family again expressed anger, but one, who had been a calm liaison between family and hospital, helpfully said that if they didn’t cooperate, no one would be able to visit. They grumblingly agreed and left. I finished taking the allowed visitors to the patient’s room.
The next day, a different guard stationed with the inmate told me he had heard a doctor say the patient was “gone,” and the guard had asked if the patient was dead, and the doctor had said, “Not quite.” Apparently, “not quite” only meant the machine maintained the patient’s breathing although he was in fact brain dead. That nuance didn’t register with the guard so when I later asked where we were, the guard said he had to hear from the doctor that the patient was dead, not just brain dead. Only then could someone come from the prison, fingerprint the patient, and declare him no longer an inmate. The nurse told the guard there was no difference between brain dead and dead, but he said he had to hear definitive word from the doctor.
The nurse paged the doctor, who told the guard the patient was actually dead. Until then, we were in this strange realm in which a dead man was still an inmate shackled to a bed.
I later told my teacher, Franklin D., who was also the director of the CPE program, about this incident, and he said he was glad I didn’t let the grandmother visit. If my deception had been discovered, he might have had to clean up a mess—because of me, a mere chaplain-in-training.
Should I have risked my job and, possibly, the status of the program in the hospital, to be compassionate to the grandmother?
Should I have gambled that a visit by the 9-year-old daughter would have been unnoticed, or overlooked?
I was operating amongst three systems: the prison, the hospital, and CPE, each with their own interests and institutional ways of operating. The prison prioritized security; the hospital wanted to keep things calm and keep the prison’s business; CPE needed a hospital to train in. We navigate our lives among such systems that shape and prod and pull us. We are able to make individual decisions, but institutional, systemic forces are restrictive, powerful, and enticing. They shape us in significant and sometimes unacknowledged ways.
I had two primary interests: become a better chaplain and complete the program. Without CPE certification I would have been unable to get a chaplain job. So I didn’t risk my standing there. It’s possible there would have been no bad consequence for me if I had taken those risks; perhaps hospital administration would have appreciated my empathy for the family. But I didn’t feel confident to challenge these systems.
There is, however, a reason to think I would have been safe.
Julie herself had once skirted the rules out of compassion. Another unresponsive gay man in a coma in the ICU had a long-time partner, but as gay marriage had yet to be legalized and the couple had no written documentation of the partner’s medical decision-making authority, the patient’s parents—conservative Catholics ardently opposed to homosexuality—were legally the closest next of kin (Georgia has a chart outlining this hierarchy) and thus by default had medical power of attorney. They barred the patient’s partner from visiting him. Julie—in violation of hospital policy—allowed the partner to visit early in the morning before the patient’s parents arrived for official visiting hours.
Julie’s standing in the hospital was much more secure than mine. ICU charge nurse is a key position, and she was excellent. I’m sure she could have defended her decision and kept her job. (She may have even cleared it with hospital executives, I suppose.) So there is a way to navigate those systems with finesse. I was a chaplain resident with little clout, needing to complete the training, so I have an excuse in my pocket, but a part of me wishes I had had the savvy and insight to risk breaking those rules with guile, courage, and love.
APRICITY 