how practice supports me as a hospital chaplain

by Eden MyoShin Steinberg, Vice President of the Zaltho Foundation

Twice a week I am the nighttime on-call chaplain at a Boston hospital, available to come in for emergencies. One such night, I was sitting down to dinner with my family, when my pager went off. Its piercing sound filled the room, and I could feel a kick of adrenaline in my body. That jolt was accompanied by thoughts: “Oh no...” “Really? Now?” And, “I hope I can handle this.”

The text on my pager reads, “A patient just died in the ICU during a code blue.[1] The family is here. Please come in.” Without a grounding in Zen practice, I would be lost in such situations. I wouldn’t realize it, but I would be lost: swept away by thoughts, emotions, insecurities, hopes. Thanks to our practice, as the tension builds in my body, and as my thoughts and feelings start to shoot off in many directions at once, the voice of practice speaks calmly to me saying, “Breathe.”

I call the doctor back, confirming that I’m on the way. She can’t speak for long. The ICU is too busy. Mid-sentence she’s interrupted, apologizes, and hangs up.

I notice my heart rate increase. I notice fear. I also notice that it feels good to be needed and wanted. I’m not wearing appropriate clothing at the moment (too casual), so I charge up the stairs to my bedroom to change into more professional clothes and get my hospital ID badge. What to wear? I’m pushing clothes around in my closet, not finding what I’m looking for, getting flustered, worrying about taking too long. My mind is starting to race.

The voice of practice speaks to me again: “Slow down. Slow is fast. How you get dressed, how you handle your clothing right now is the same as how you will provide support to the family and staff. No rushing.”

I take a breath, slow my movements, change my clothes with attention, and leave the house. Getting into the car offers me another opportunity to steady myself, to ground myself in the present moment rather than rushing forward in my mind. In gassho, I say the driving gatha: “I am sitting in my car. I know where I’m going. When the car goes fast, I go fast.” I bow and start the car.

As I drive, I notice my thoughts accelerating again: “I wonder what’s happening at the ICU. They are waiting for me. Will I get there quickly enough? They are counting on me. Will I meet their expectations?” Practice again says, “Breathe. Pay attention to what you’re doing right in this moment. If you take care of this moment, the rest will take care of itself.

When I arrive at the ICU I’m directed to the patient’s room and see a large crowd of people gathered inside: four family members plus three medical staff. I take another breath, enter the room, and introduce myself. I see the lifeless body in the bed, still attached to the machinery of the ventilator. But at this moment, the dead person is not the focus. There’s a heated discussion going on. The people in the room barely register my arrival. I observe the scene, allowing it to inform me.

The focus of everyone’s attention is a man in his 60s or 70s, perhaps the patient’s spouse. One of the medical staff is saying to him, “Your blood sugar is too high, but you’re not our patient. We can’t treat you here. We recommend that you go to the Emergency Room. It’s on the other side of the campus. We can’t take you there, but we will call an ambulance for you to get you there safely.”

The man responds, “When you called me to tell me to come back to the hospital, I was eating dinner. I jumped in the car without taking my insulin. I don’t want to go to the ER. When I get home I’ll take my insulin.”

“We recommend you get medical attention.”

A middle-aged woman in the room says, “Dad, I’m worried about you.”

“I’m OK. Really.” The man looks over at the medical staff and calmly says, “Respectfully, I decline your advice. If you want me to sign something saying I release you from responsibility, I’ll do that. Really. I deal with this all the time. It’s not an emergency. I want to stay here with my wife.”

The members of the medical team agree to have him sign a waiver and then leave the room. I wonder if he’s making a good decision, but he seems calm and clear. I can understand not wanting to spend hours in the ER when your wife has just died.

Once the medical team clears out, I meet the family: two adult daughters, a teenage grandson, and the husband. We start to talk. I ask them what happened. They tell me that the patient, Deborah, had been in the hospital for several days. Today she had two cardiac arrests and died during the second one.

The husband tells me that he witnessed the first one, and how scary that was. “They told me I had to get out of the room while they worked on her, but I wouldn’t leave. They got her heart going again. Then she seemed like she was getting better and would be alright. Her fever went down. The doctor said that was a good sign. When I went home, I was feeling really hopeful.” He begins to cry.

I breathe and let him cry. There’s nothing that needs to be said by me. The daughters and grandson begin to cry as well. One of the daughters says to me through her tears, “She was the best mother.”

We start to talk about Deborah. They all tell me how loving, generous, and fair she was, how well she treated everyone. They told me she had had a very difficult childhood but went on to be a great mom “despite what happened to her.” The husband told me that they started dating when they were teenagers and had been married for 51 years. “Tomorrow I’m going to wake up without her!” He begins sobbing. I hold the space, saying little, allowing them to give voice to their grief in their own way and time.

As they continue to speak, there’s a lot of crying and then at times, as they tell stories about her, there is actually laughter. Then back to crying. Sometimes we’re all just silent.

As time passes, Deborah’s body is slowly changing color. When I arrived it looked pale white. Now it has turned pale yellow. At one point the family and the nurses work on taking off Deborah’s wedding ring, which was stuck, and take off her earrings.

The husband asks several times how he is supposed to handle getting the body to the funeral home for cremation. A simple process is explained to him (all he has to do is select a funeral home and they will pick up the body and take care of everything), but it’s hard for him to absorb this. He quickly forgets and asks again. I remember learning in my training that witnessing traumatic events impacts cognition. His mind is struggling to process simple instructions.

Zen practice supports me in just staying steady and present as the family goes through all this--not attempting to change or fix anything. Nothing can be fixed, and nothing needs to be fixed. The situation is what it is. There is shock. Sorrow. Feelings of love and appreciation for Deborah. Confusion. Disbelief. Tears.

At one point the nurse comes in, sees the family crying, and, due to her own discomfort, sort of pushes me forward saying, “Do you want the chaplain to say a prayer?”

I’m annoyed. I want to allow the family the space and time to decide for themselves what they need. The family looks at each other and then at me and says, “Sure.” But this seems like an attempt to please the nurse or to be polite. Now everyone is looking at me.

“Is prayer something that was meaningful to your mom?” I ask.

One of her daughters responds, “Mom was raised Catholic, but she stopped going to church.”

Then the husband says, “But she liked to pray.”

The daughter says, “Yes, she was very spiritual.”

“Did she like traditional Catholic prayers, or was her prayer practice more personal and spontaneous?” I ask.

“She prayed in a personal way,” her husband explains.

“OK, well, if you like, I could say a personalized prayer for her.”

“Yes, we’d like that,” says one of the daughters.

“OK,” I say. I notice within myself some fear rise up, some pressure to perform. There’s the thought, “Uh oh. Everyone’s looking at me. Am I really the chaplain? Am I qualified to do this?” I take a deep breath, step toward Deborah’s body, clasp my hands in front of my body, and lower my head. “God, I’m here with Deborah and her loving family. There’s so much warmth and love in this room, and a lot of sorrow.” I pause, feeling my way to the next words. “We release Deborah into your care.” The daughters and the grandson burst into tears. “Please bless her and keep her. May she find comfort and peace in your presence forever.  Amen.”

We’re all quiet for a few moments as some family members cry. One of the daughters turns to me and says thank you. I’m always surprised how powerful a few words of prayer can be for some people. There’s nothing complicated about the spontaneous prayers I’ve learned to say for Christian patients and their families, but these simple words can have quite an effect and help people to access their feelings.

The family tells me more stories about Deborah. There’s more crying and eventually more laughter. I marvel at all the different emotions that can surface at a time like this. I appreciate witnessing the flow. After about an hour, the family reaches a place where they feel ready to go home. We say goodbye, I go and check in with the staff, and then I go home.

Though I didn’t say or do all that much outwardly during this visit, it was intense for me. Just holding the space for this family and bearing witness to the intensity of their feelings had an impact on me. Also, spending an hour in the presence of a dead body, watching it change color, watching its jewelry be removed, was a powerful reminder of my own mortality--and that of everyone I love. Fortunately, I have a spiritual practice and a sangha that support me in being present with my own suffering and uneasiness so that it doesn’t have to overwhelm me or control me. Over time, through practice, I know that I can find peace with my unpeacefulness.

Without the support of a consistent meditation practice--one that I’m encouraged to bring off the cushion and into my whole life--I would not have been able to remain relatively quiet in this type of situation. I would have started filling the space with words--trying desperately to say the “right thing” that would somehow make everyone feel better. In the past, that was how my conditioning manifested in such situations.

Today I understand that I don’t need to go around attempting to rescue people in such situations (though this is a lot easier for me to practice with strangers than with those closest to me). I also have come to understand the truth of the words we say in the Invocation of Avalokiteshvara: “Just by listening, we already relieve a great deal of the pain and suffering in the other.” That’s fundamentally what I offered this family gathered around their loved one’s dead body--that and a quality, nurtured through practice, of being willing to not rush, to not attempt to force the situation in any particular direction, and to remain steady and open.

[1] A sustained effort to resuscitate an individual after cardiac or respiratory arrest.