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A prayer for the person at the edge of life and death.

I’ve written about everyone else at a CODE BLUE–an event, usually in a hospital where a person’s heart has stopped and a team of people gathers to restart it. I wrote about how to talk with God about all the people who are gathering. When I wrote it, I didn’t talk about how to talk with God about the person.

It’s time.

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God, at this moment, there are people who are trying to restart a stopped heart. God, in this space at the edge of life and death, I do not know what to ask you for.

I know too much and not enough.

I know the research about CPR. I know that the longer this process goes, and the older the body, the lower the chances that the person will walk out of this hospital. The higher the chances that the lack of oxygen to the brain will cause irreversible brain damage. The more that the bones in the chest are breaking.

For this family, this person is 1 in a million. For you this person fully matters. But even as we are talking, the chances are slipping away. From 1 in 3 to 1 in 5 to 1 in 10 to 1 in 100. To zero.

I know the conversations we have about quality of life, about playing God, about doing everything possible, about one last chance to know you. I know that for people who say they love you and believe the Bible, the fear of making you mad by making wrong choices is a real fear. I know that fear isn’t consistent with your character.

I believe that our times are in your hands. I believe that our days are limited, that it is appointed to humans to die, in these bodies at least. I believe that we don’t know when that day and time will be.

I know the stories of people who, in a variety of situations, with insurmountable odds, endured and thrived. I know Ellen’s story who wondered why she was brought back when she had said that she didn’t want to be resuscitated and who died a couple days after our conversation.

I believe that what looks like dead isn’t. And yet I know when we don’t hear a heartbeat and don’t see a heart moving with ultrasound and don’t see any reflexes when we shine lights in pupils, that the person is dead.

I believe that dead people can come back to life. I believe that there was a young man who was really dead that you raised and a girl who was really dead that you raised and a young man that Elisha raised and a woman that made clothes and a handful of other people. I know that there were many people when you were living, Jesus, that you didn’t bring back to life. And I know that except for the people who are alive now, everyone who has ever lived has died, even if they came back briefly. Except, of course, for you, Jesus, the firstborn of us.

All of those thoughts are swirling through my mind, God, as we stand here, now.

But I confess that I don’t know what to ask you about this person in this room with a heart that is stopped.

I don’t want to be disappointed, to have this family devastated by your apparent inaction.

I don’t want to be unfaithful, to believe that if only we had prayed harder you might have brought them back, as if this death is someone on our hands.

And I acknowledge that, for all we know, they are already absent from this body in front of us, being prodded and pushed. And I acknowledge that, for all I know, this person will start talking in 15 hours. Or 15 minutes. Or right now.

I confess that I don’t know what will happen. But in this moment, I know you are here. And with this person. And so God, even as we ask many things for everyone else in this room, I ask that this person in this moment at the edge of life and death will know your love and your peace.

Amen

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I’ve written about books that review decision-making at end of life.

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Prayers of a hospital chaplain on the way to a Code Blue.

The warning sound on the overhead paging system is heart-grabbing, starting at a low pitch, then quickly sliding higher. And then the words: “CODE BLUE Core Tower. 6th floor. CODE BLUE. Core Tower. 6th floor.” A few seconds later, pagers buzz with the room number. 

All over the hospital, adrenaline starts to flow. People from all disciplines of healthcare start moving toward the 6th floor, where someone’s heart has stopped. There are no directions from the patient saying, “Do not Resuscitate”. It’s time to get it started. 

Part of the interdisciplinary team that is moving toward the room is the chaplain. It’s our job to call the family if no one has. It’s our job to be with the family if they are present. It will be our job to care for the family if the heart isn’t restarted. 

It’s probably our job to pray, too.

I think that you are thinking that I will be the spiritual one. I think you are thinking that I must be asking God to start the heart. I think you are thinking that I must be humming an old hymn: “May the peace of God my Father rule my life in everything, that I may be calm to comfort sick and sorrowing.”

I realized recently that what I’m actually saying as I shuffle down the hall, up the elevator, down the hall is this:

God, get me there. 
Don’t let me mess up in conversations.
Let me know what to do.
Don’t die don’t die don’t die
She’s going to die, isn’t she.

These are my real words. They are honest words. They are almost all about me. 

And so, I began thinking through what to talk with God about as I’m walking quickly to the room where a heart isn’t beating. 

Here’s what I could say:

God, grant the doctor running the code a wisdom that goes beyond training. Allow her to forget the room she came from and the patient that she was going to. Help her be able to be here. Give clarity of communication to the team. Help her remember what worked the last time, on a patient with these numbers, when that last time was eighteen months and twenty codes ago.

God, grant the tech who has his hands on the chest strength of both arms and stomach. Help him keep in mind the song that provides the best rhythm. Help him to not think about how this patient reminds him of his grandfather until this process is done. Help him to find the exact pressure that will help most and damage least. And help him sleep tonight without dreams of what happened today.

God, grant the pharmacist the favor of having everything needed currently stocked in the cart. Give her the ears to hear the muffled orders the first time, with right measures. Give her the wisdom to know when the numbers may be wrong.

God, care for the nurses, at the bed, in the room, in the hall, at the computer. Grant them the patience and precision and collaboration needed in the middle of the chaos. Help their eyes and fingers to find the right supplies. Help their compassion for this person they’ve cared for the past week give them perseverance and not paralysis. Help their experience stabilize the whole room. Keep their inexperience from overwhelming their training.

God, give the respiratory therapists the very breath of life. As they are bagging this patient, help them forget the other patients in the hospital, forget the rest of the chaos in the room. May they stay steady.

God, grant us words for the family in the other room, in this room, at home unaware. The one in the room who is suddenly overwhelmed by twenty people crowding the room and the bed, help that surge of panic to not overwhelm them. The one in the hall, watching the pumping arms, hearing the conversation of necessary experimentation, let them not dwell on the thoughts that we don’t know at all what to do. The one we haven’t yet reached, help them hear all of our words.

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By now, you see that I haven’t said anything about the person in the bed. The center of the attention. The one who may most need God’s help. Right? That’s my most uncertain conversation with God as I’m going down the hall. So it will wait for another post.

I’m offering this post and the next one not as recipes for what to say to God but as a glimpse of the needs of a variety of people in the middle of a literal life and death moment.

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I hate shots. But I’m on the list.

I hate shots. I can’t watch other people get them. I turn my head all the time in the hospital when a needle shows up anywhere close to an arm. And choosing to receive flu shots has been a challenge, though I’ve done it. 

So when I cried about scheduling a shot the other day, you might think that I was going back to my childhood fears. 

I wasn’t. 

I had just spent some time in our hallways where the physical, emotional, and spiritual effects of COVID-19 are being experienced by people infected, by their families, and by my co-workers. I’d sat with a spouse for a long time who was trying to figure out personal responsibility for this impersonal virus. While I was talking with that spouse, my colleague and friend attended the death of a person I’d responded to earlier in the day. I’d walked by the room where my first COVID-19 death was, where I had watched a nurse using her own phone to Facetime with the family before we’d started to figure out how to do it with hospital tablets. 

And now I walked into the office with my friend and we each had an email with a link that would allow us to receive the Pfizer COVID-19 vaccine. 

I was a bit overwhelmed. 

Nancy and I had talked earlier about what I would do if it were offered, whether or not I should accept. If she had questions, I wanted to take that into account. She didn’t hesitate. “Yes,” she said. 

And so, when I got the email, I scheduled the shot. And teared up. 

I let Nancy know. She said “Thank you.” I texted our kids. They celebrated. And I understood that every time I walk into work, aware of the risks and the realities, they walk in, too.

Unlike them, I am always aware of those whose work is more hands-on. The respiratory therapists, the patient care techs, the nurses. They put on the hair coverings and the masks and the goggles and the gloves and the gowns, and walk in the rooms. They provide the actual touch, the unmediated voice, the eye contact. 

I forget, in the comparisons, that we as chaplains are not in THOSE rooms, but we are in the space, too. And the families of all of us are there. So I’m getting the vaccination. 

I almost didn’t say anything in public about being on the list.

Among the people I know, and love, are people for whom this action is political. For whom it is spiritual weakness. Fortunately, a friend reminded me that my action, and words, may be helpful to someone else. 

I understand that on Wednesday, after the shot, I may be in the tiny tiny percentage of bad side effects. Chaplains think about those things because we spend time with the 1% of bad outcomes and the 100% death rate among humans. But I’m not so much afraid of the virus or the shot as I am acutely aware of the implications of both in lives and given the choice, I’m getting the shot. 

I’m grateful for the privilege for protection. And the opportunity to go to work. And the blessing to be part of the lives, and yes, the deaths, of people. 

Peace. 

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Words matter.

I am a words guy. And I’m getting worse.

My friends come to me for words sometimes. They are looking for the right word for a moment, for a situation. Sometimes, I confess, I inflict my struggle against imprecision on others.

I care about words because words evoke meanings in us. They trigger memories, they shape how we think about situations.

I’ve remained mostly silent about four words, but it’s time to talk.

Social. Virtual. Alone. Nuance.

We’ve been talking about social distancing, which conveys something about a gap in relationship. It feels akin to emotional distancing. But we could have been talking about physical distance, the space between bodies. We know how to work with physical distance, we work with that all the time through text and phone and FaceTime and letter-writing. We have worked with long-distance relationships for generations. But as soon as we made it social, we created a different feeling. And we got defensive.

We’ve been talking about virtual activities, a word that was related to simulation and hypothetical and games. Virtual reality is made-up, or it was for a long time. We put virtual backgrounds in our Zoom calls to hide the real background. But we could have been talking about on-line activities or mediated activities. We talk about virtual meetings and forget that these are real meetings in which real humans make actual decisions about life-changing situations happening through a variety of communication tools. We talk about virtual memorial services and forget that we are real people remembering the real death of a real person.

We’ve been talking about people dying alone. Which, before the current pandemic, happened often at the hospital and elsewhere. But we could have been talking about people dying without their family in the room. And at the same time being treasured by the people who were caring for them. I’ve watched as people have died, hand being held by a nurse. Who then, of course, walked out of the room in tears. That person wasn’t alone.

We’ve not talked about nuance. We could have talked about where masks are helpful and where they don’t matter. We could have talked about what gatherings are worst and why, and what gatherings are safest, and why. We could have been more clear. We could have been more thoughtful. We would have been more helpful.

Peace.

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Grief and Holidays in 2020

We’re exhausted, many of us. We can’t quite figure out why. We can’t think as clearly as usual, we don’t have the motivation we used to. Our relationships are struggling, we’re more cranky.

We think that there may be something wrong with us. But there isn’t. It’s grief. Grief is our response to loss. Our responses can be physical, emotional, mental, spiritual, or a mix of all of those. And we’ve had a lot of loss this year. (See “Excess Grief“)

The next months are full of family gatherings, holidays, and the expectations and routines that go with those. We wanted to give you some things to tell yourself as you approach the end of this year, to help you through what may be difficult.

Acknowledge that the last year has been hard.
When we look at our lives and our losses, we often think, “But their life is harder” or “I should be able to handle this” or “I have to be strong for my family.” This year, however, there have been many kinds of loss and they all add up. Lost jobs, lost vacations, lost classrooms, lost routine, and lost loved ones. All that loss adds up. So, looking in the mirror, looking at each other, and saying “This IS hard” gives us the freedom to start addressing the pain and the grief.

Give yourself and others permission to hurt.
We know that we do hurt because of the loss. But some of us don’t like to admit that we are hurting. Covering it doesn’t help it. Acknowledging that your family can be sad because you lost a grandparent is important.

Acknowledge that everyone is feeling the loss differently.
For some people, this was a close friend. For others, this was someone they hardly knew. Rather than expecting everyone to be experiencing grief the same way, identify how you feel and know that someone else may feel differently. And be courageous enough to talk about how hard it is to talk about things.

Embrace adjustments in the traditions.
Gatherings will be challenging enough this year. Families and friends will be considering whether it’s safe to gather, whether it’s safe to talk about all that’s happened in the world this year. For you, however, everything is personal. Someone is missing. So, make sure you intentionally talk about the traditions linked to that person.

You may want to consider whether a particular role or task the person did can be passed on to someone else or should be retired. If dad always lit the first candle, then talk about passing that role to the firstborn. If mom always fixed a fruitcake but no one else liked fruitcake, it’s okay to retire that tradition. Every family has traditions, and some can be retired. (And you may want to start a new tradition!)

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I wrote this for families grieving this year, to be shared by Parkview Health, where I’m a chaplain.

For more on an Advent journal that can help with asking helpful questions around the table, visit 2020Advent.com

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Excess grief

Dear friends.

Some of you know that I see people who die, sometimes before, sometimes after. It’s what chaplains do at our place. In that process, I see diagnoses, I see cause of death. Sometimes it’s related to COVID-19. Sometimes it isn’t.

This isn’t about that debate.

I keep talking to friends who are sad. They wonder whether there is always this sadness, or if this year is different somehow. It is different somehow. In many ways.

This isn’t about all of those ways.

This is about excess death.

In the United States, from January 26 through October 3, 299,000 more people died than would have been expected to die based on the number of deaths during the previous five years. Said differently, people die all the time from all causes. This year, about 300,000 more people than usual have died. (CDC report).

Of course, when you read the report in order to debate with me, you’ll see that there are qualifiers about reporting lag (so the number is on the low side) and some averaging by week. I would love for you to read the report that carefully.

But regardless of the cause, these people died. Moms and grandpas. Aunts and nephews. Best friends and mentors. Babies we never had a chance to meet and 91-year-olds. Human beings who have no known next of kin. Regardless of cause, for eight months, about 1234 more per day died (on average) than the 7778 people (on average) than usually die.

No wonder so many of us are sad and angry and frustrated and numb. No wonder we are reacting more than responding, that we want to punch walls and people, that we are denying and rationalizing. No wonder we don’t know what to say to each other.

Because our culture isn’t great at talking about death. And we’ve got many more lost people to not talk about .

Tomorrow is All Saints’ Day, a day in the life of the church where we can remember those who are gone and their connection to God and to those who are here. Charlotte Donlon writes about how the words and texts of that day can provide support these days.

In a few hours, I’ll be leading a funeral for a family. There will be many other families facing those moments today, more than on average. And this weekend, and last week.

I have no political agenda in this, just a chaplain agenda.

The grief is piling up. This is hard.

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Here’s where I got the Death statistics for 2018:

This leads to “A conversation about pain and grief” with a coworker and friend of mine.

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Helpful books for hard times.

I led a funeral today for a guy I’ve known for several years. He and his wife attended the church where I worked at the time, and I was able to be with her just before he died last week. The funeral was at that church, so I got to see several of my friend/colleagues. It felt like getting the band together again to be helpful.

As I stood in Linda’s office putting together my folder for the service, I discovered I’d forgotten the graveside service part at home. I said, “Does Lee have his copy of my book here?”

It felt odd, I confess. But I wrote Giving a Life Meaning: How to Lead Funerals, Memorial Services, and Celebrations of Life to have a practical tool to help people know what to do in leading a service. I’ve used it myself three times in the last few months. I knew that Lee’s copy might be in his office because he used it to help him with his first funeral this week. Kim found it. I photocopied what I needed for the graveside.

This book is one of five in a series of resources for faith, sickness, grief and doubt. They are incredibly practical books that are helpful for the hard times that no one wants and that come anyway.

My friends and current colleagues published No Matter How Small: Understanding Miscarriage and Stillbirth this year. It’s another book in that series. Kristin and Patrick Riecke have their own experience with miscarriage and have years of experience helping other people. They understand the silence and the insensitivity that often accompany infant loss. In the stories in this book, that pain finds a voice.

For Patrick and Kristen and me, these books are ways to give words and ideas to people who are caring for and about others.

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Before you do things that might bring you to the Emergency Room

Dear person I care about who is going into the weekend (even if we have never met)-

I sometimes tell people what to do or not do. That usually doesn’t work. Because no mom likes to meet a chaplain in the waiting room, or get a call from a chaplain, I sometimes turn my badge around until we can talk for a minute.

That’s my part.

But I’d like to ask a favor before you do risky things that might end with a traumatic trip to the Emergency Room. 

  1. Know what kind of scars or other identifying marks your loved ones might have. Including eye color.
  2. Carry ID for yourself and your kids.
  3. Wear seatbelts.
  4. Be careful.
  5. Keep a list of allergies and medications.
  6. Let someone know where you are going.
  7. Assume that there is a one in a million chance that it might be you, and that sometimes that one time comes.
  8. Don’t worry about always wearing clean underwear (It may not stay that way).
  9. If your blood alcohol level is .28, don’t drive in a way that you end up in the ER saying foolish things.
  10. Know that your phone may not come with you. Or your purse.
  11. A leather jacket and a helmet can allow me to talk to you afterward.
  12. Remember that these days, only one person can come in, so decide ahead of time who that person is so we don’t have to watch fights between various family members. Or “family members”. 
  13. If you don’t want people related to you making health care decisions for you, make sure you appoint a health care representative. In writing, While alert and oriented. 

Stay out of the ER. That’s what you can focus on to help your mom (or loved one (but especially moms)).

The nurses and the techs and environmental services team and the respiratory therapists and the registration team and the phlebotomists and the child life specialists and the EMS teams and the CT team and the docs of all sorts and the security team and the rest of us are all cheering for you.

I know that because of my conversations with people from every one of those teams when someone you love doesn’t make it. So if you can help us, we can help you better.

Thanks on behalf of the people who might be visiting with you or your loved one in the Emergency Department.

Cordially,

Chaplain Jon.

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What one person caring for people in hospitals looks for.

I haven’t written much about the pandemic. I’ve been too busy living in the middle of it, going to work as a hospital chaplain. We continued to work, though with constant adjustments in ways we provided care to patients, their families and friends, and our coworkers. 

Now that I’m starting to recover my equilibrium, I want to mention the things that I pay attention to. 

I am fundamentally interested in the person in front of me. Sick or injured, worried or grieving, exhausted or frustrated or angry or numb. As much as I can debate the numbers and the trends and the patterns, all of those are not the person in front of me. 

I’m more interested in hospitalizations than cases. When cases increase, it can be due to more cases or more identified cases. While those are useful numbers for many people, I’m affected by increases in hospitalizations. Those numbers aren’t due to testing, they are due to being sick. 

I’m interested in what are called excess deaths. Every day, on average, in the US, 7700 people die. If we are seeing people die from a virus rather than other causes, that’s one thing. If we are seeing people die from the usual causes and then an additional group from the virus, that’s another thing. When I did some digging a month ago, in this country we had about 700 excess deaths a day. Which means that every day, 700 more families than usual are dealing with the loss of a loved one. 

I’m curious about non-medical reasons for questioning guidelines, and how people who question guidelines about masks and other precautions are or are not people who question other guidelines. Because I care about the person in front of me, I wonder. And, because I care about the person in front of me, I wear a mask. It doesn’t hurt me. It may help you.

I’m curious about the amount of passion about positions. I’ve often noticed that when tension suddenly goes up in a meeting, the reason for the emotional response is often not related to the topic, but to something deeper, more emotional. 

I’m sensitive to the kinds of loss and accumulating grief that we have. There have been many losses: lives, jobs, insurance, security. The response to loss is grief. Recently, I talked with a person who spent their wedding anniversary in the hospital, facing complications from cancer treatment, learning of the death of a loved one, in the pandemic. And the person said, “I should be more encouraging.” I reviewed the reasons that the person was okay processing their grief. 

I’m also aware that I have watched people who have a positive test for COVID-19 take their last breaths. And people with other illnesses or injuries take their last breaths. And all without families in the room. And none of them alone, but with nurses and patient care techs in the room, eyes filling with tears. And so I know that the illness is real, that the implications are widespread, and all death is painful. 

I’m aware of the impact of word choices: Social distance rather than physical distance. Freedom of action rather than responsibility for each other. Back to normal in contrast to new normal in contrast to making wise choices. Flattening the curve as opposed to stopping the spread. 

I’m not taking sides, arguing positions, or debating. Instead, I’m letting you know what I look for. Because, after all, you are in front of me, too.

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I couldn’t be there when they died.

These days, and all days, people die and family isn’t present. It’s particularly hard when rules keep people away. But sometimes it’s distance, sometimes it’s relationship, sometimes it’s timing.

From my observations as a chaplain and as a human, I’d like to suggest some of the reasons we feel so emotionally hurt when we know we might not be present.

This is not an exhaustive list (though it feels exhausting). Often we simply want to be present. But I’ve seen these and so I want to offer them to you to think about.

  • We are afraid of failing them when they didn’t fail us. 
  • We are afraid of missing last words.
  • We are afraid of not being able to say last words.
  • We are afraid of not measuring up.
  • We are afraid that someone will think we haven’t cared.
  • We are afraid.
  • We are afraid that what we have said in the past won’t count somehow.
  • We are afraid that they will feel alone at the very end and that we ought to be there. 
  • We are afraid that they won’t have someone to speak for them at the most vulnerable time. 
  • We are afraid that we will miss something. 
  • We are afraid that we didn’t tell them that we loved them enough, or at all. 
  • We are afraid that the people who are around us with judge our love.
  • We are afraid that our presence might have brought about a miracle and if we aren’t there, it won’t happen.
  • We are afraid.
  • We are afraid that unless we see them all the way through that we are somehow deficient. 
  • We are afraid of not being with the one person that held us together, that held our family together, that gave us a reason for living, that remembers everything that matters to us, that sustained us when we couldn’t sustain ourselves. 

Because of the depth of those fears, not being with someone at their point of death is hard. And the truth? Being there at their point of death is hard, too. 

So what’s my advice? 

Think about why it is so hard. Give voice to the reason. And do what is possible to address the thing you are afraid of.

  • If you needed to say something, say it now.
  • If you are afraid of what people will think, tell them to shut up.
  • If you are afraid of them being all alone, find out who from the care facility will be there. And let them know how grateful you are and ask if you can talk one last time to your loved one. Even if they can’t respond.
  • And think about what they wanted in their most vulnerable moments. Some of us want people around. Some of us don’t. It’s interesting to me the times that a person dies after everyone has come and gone. As if they don’t want their last moment to be their loved one’s last memory. 

It’s hard. All of dying is hard. 

But sometimes, if we can think through what causes our fear and address those things, we can stop being so hard on ourselves.