Stories from the ICU: I see your suffering and I am not repulsed by it

As I unwind from my CPE residency, I have decided to share some of the amazing stories from my time as an ICU chaplain.  These are my best attempts to capture some of the fleeting and complex moments of those sacred hours.

This story comes from a night shift and from a call to the Cardiac ICU. I arrived at work to utter chaos. A patient had come into the Emergency Department in cardiac arrest. He coded twice in the ED, and much of the day chaplain and social worker's work that afternoon had been to find his family. There was one daughter who was camping in the mountains and unreachable by phone. Upon my arrival, the patient's son and daughter in law had been located and were at the hospital, although not in the patient's room.  The patient coded again and the physician begged me to locate the family. The patient was dying in spite of our best resuscitation efforts and chest compressions and intubation were non-beneficial. We tried never to have a patient die with a tube in their throat, it was distressing and traumatic for the family and uncomfortable for the patient. I tore off running to the family waiting area. Then the cafeteria. Then the chapel. And the parking lot. The family was ultimately located in their car outside the ED by an emergency nurse. We jogged to the CICU to what had to have been a horrible scene. Sometime in the course of the code blue, the patient had started bleeding and blood surrounded him on the bed, on the sheets and pillow and the floor. To someone accustomed to such things, it simply means putting on PPE, including plastic booties, a gown and gloves. So I did so. But to a family who belonged to that patient in the bed, it was devastating. The family was unable to bring themselves to enter the room.

The physician spoke with them in the hall and indicated that the patient was dying. The physician requested to extubate the patient and stop all heroic measures, as they were non-beneficial. The family gave consent. I stood with them outside the room as the patient's RN and respiratory therapist removed the tube. I warned them of the disturbing sound of suction. I stood with them in their suffering.

The patient began agonal breathing almost immediately. He was alone in the room and I went to his bedside. The family was frozen in the doorway.

Holding the patient's hand, I turned to them, saying, "He is dying. I will stay here with him and hold his hand so he is not alone. You do not have to come in if you do not want to, I know this is not how you want to see your father.  But I will stay here."

After a few minutes, the patient's son came to the bedside. He still was not touching his father. I said, "The breathing pattern that you hear is common for someone who is dying. He is not in pain, it is reflexive. Eventually there will be longer and longer pauses between breaths and then there will be a point where he will not take another breath."

The patient's son said, "Is it okay if I touch him?"

I responded, "Absolutely."  We each held one of the patient's hands, looking at his face, watching his chest rise ever so slightly. Until he was not breathing anymore.

Chaplaincy is standing in suffering. It is seeing suffering and not being repulsed by it. It is seeing the love and connection between father and son. It is about marking sacred moments. It is about bearing witness to love. For the opportunity to stand in a blood-spattered room and hold an elderly man's hand as he passed from this world to the next. To bear witness to suffering and not walk away. This is chaplaincy.