Ministry to Angry Patients and Families

Psychotherapist John R. Rifkin, Ph.D., views anger in a revolutionary way; he says that it can be used as the natural energy created to heal one’s emotional injuries. In his book The Healing Power of Anger, he explains how to identify (righteous/dysfunctional) uses of anger so that one can unbend it and become empowered and self-nurturing.

There is a particular passage on page eleven of Russell H. Davis’s writing on Discordant Identification in a Stress Incident that reads, all of us prisoners of identification, inmates of hounded imagination, in bondage to our own aggression as surely as... the social, economic, racial factors that are responsible for people’s behavior.

Is it the social, economic, racial factors that are responsible for people’s behavior or what Elaine Penderhughes may refer to as a differential of power?

C-Chaplain M-Mother F-Family Member(s)

C: “Hi, can I get you to a more comfortable place then here in this cold hallway?

M: No, I ‘m better if I stand here, I need the air.” (She is crying and I can tell she does not know what to do. She is surrounded by maybe seven persons, all talking and standing in the door. Both doors of the entrance are open and cold air is blowing in. She finally succumbs and allows me to show her to the consult room. Once seated with the father of J I begin to talk with them.)

C1: “My name is Richard and I am going to be taking care of you until the doctors can come in and see you. (I hear sounds of mumbling over on the side) I know you are afraid, and as soon as the doctors are free they will come and speak with you. (More mumbling, even louder) I am going to get some Kleenex; can I also get you or Mr. H. some water? “

M1: (Crying) “Yes, thank you...”

F2: “Can she go in the back?” (Loudly and boldly)

C2: “I am quite sure...”

F3: “The lady said she (the patient) was talking and was alright. She was hollering and screaming and we want her (the patient) to know we are here...”

C3: “I can not tell you if that is the case or not, but I will return to the bay and find out if the...”

F4: (Now talking to another family member) “F*** him! He don’t know what the F*** he’s talking about.”

C4: (To the mother of the patient) “I will be back in a moment with your water.”
I go to the area where there is water and return a few moments later. Those were the few moments that I needed to compose myself, before I returned to the room. I had immediately grown angry and frustrated, but I am able to pull myself together, and act as though she was not being insulting or talking directly to me. It is here that I decide to continue with the care that is expected of the ED chaplain and to do my best to ignore any further insults.

As I return to the consult room with the water the same woman who had made the comments and spoke rudely asked:

F5: “Can you show me where the cafeteria is? I’m hungry.”

C5: “Sure come with me, and you want to take note of which way you are going so you can come back to this area without any problems.”

Define Power and Powerlessness

Analysis of Pastoral Care
To identify dysfunctional/righteous uses of anger
Identify feelings of discomfort
Identify aggressive and belligerent behavior
Familial stressors and impact
Emotional stress and its role

The following verbatim only confirms the
· Discomfort you may experience when trying to give care to patients and families.
· It may be hard to care for family members who are aggressive and belligerent
· You may be capable of looking beyond any frustrations and derogatory comments made by family of patients and give good pastoral care.
· It is a stressful time for families brought on by events such as traumatic deaths, traumatic/serious injuries, and life threatening situations
· Providing to the patient a sacred and spiritual place to deposit their anguish and pain
· People who respond to emergencies encounter highly stressful events almost every day. Sometimes an event is so traumatic or overwhelming that emergency responders may experience significant stress reactions. As a result of these types of encounters there are emotional, behavioral, cognitive and physiological reactions that might occur.
· In stressful incidents I thought my best work with these type patients and families is when I immediately give the best care possible to the patient and the family. In this event I had to deal with my emotion of anger and disdain for the family that I knew was hostile toward me.
In the midst of abuse from this family I was able to deal with my immediate feelings and keep moving as if nothing happened or was abnormal about the moment. In a case where the family dishonored me I felt as though I had to make a decision as to the attitude I would have in helping this family.
To give good care this must involve spiritual and emotional senses and quick decisions have to be made. At a time where this could have went either way I felt an obligation to my own training and professional identity of putting this family first. Also in their crisis I had to quickly understand their anger and although there was no death, their grief.
Psychological and Family Implications
This family and the patient were both loud and angry. Psychologically they were feeling emotions of intense pain and mental trauma. They were uncontrollable to a certain extent and I could never tell what their next reaction may have been. They were unpredictable and unable to express what it was that they needed in the moment. I felt as though the care they needed was someone who would understand not just the pain but their psychological and emotional state as well.

Self Evaluation
Claiming God and Reclaiming Dignity by Edward Wimberly was the book I used to launch my theological discussion with self about ministering to angry families. This book along with a couple of experiences in the ED, during this rotation allowed me to look at incidents, care of families and how it affects me personally, professionaly and theologically.
Edward Wimberly in his book uses Earnest Gaines’s book A Lesson Before Dying The Power Of Transforming And Connecting With Humanity And God. This for me may have been an afterthought or difficult but through the gift of providing to the patient a sacred and spiritual place to deposit their anguish and pain I have tried to awaken within myself a new door for ministry to patients. The book was a difficult read but after many attempts it took on a new life and I was able to move through it understanding the importance of the patient who does not look like the major dominate culture in American society. They may lack the empowerment and understanding of life to fully benefit from the pastoral aspect of the time we spend together. Yet they are human enough for me to look deeper into the pastoral/patient/family relationship and find the power that allows transformation in the family, patient and me. He mentions moving beyond the one-time conversation model into the “growing in perfection,” which is the life-long process of faithful service to God by the caregiver and extension of grace to patients.
Along with the aspects of grace and sanctification Wimberley moved me into the three areas known as prefiguring, configuring and transfiguring. It is based upon the patient’s prior knowledge to the encounter, the process of change or redemption in the midst of the action. The visit(s) can take the form of the sanctification process such as Ernest Gaines’ character Jefferson seeing the dying Jesus on the cross or take the form of me, the chaplain becoming the sounding board for abuse directed at me which would be my worst case scenario. With the patients here there is not as much as a glimpse of the dying Jesus, but does the visit have the power to open the ministry door to transformation of patient and chaplain. With each visit and encounter I am beginning to see more and more the affect that sickness and incapacity have on us all. We begin to share in the patient’s story the family’s story and our own stories that bring healing. We begin the process of creating a covenant with the patient that we will be conduits of good and/or righteousness.
What ever role the patient or family places me in I am able to conform to the moment hoping for the least of a good “pastoral visit.” It is in the visit that I find power not only for the patient but for me to reclaim and systematically through self care process and connect to my own internalized thoughts and self held conversations.
The book Understanding Race, Ethnicity and Power: the Key to Efficacy in Clinical Practice, by Elaine Penderhughes (chapter 6 Understanding Power) gives me more insight to the differential of power between patients, families and staff. There are differences in ethnicity, race and power and she tries to unfold the difference and give the value of circumstances that may impact me in negative ways. Patients see themselves one way, staff another and families another also. We have tried to cover cross-cultural work but there are situations that are intra-cultural issues.
It was hard for me to tell if I was being helpful in a pastoral sense or was I identified with the power structure of the hospital.
My assumption: I was viewed by this family as the black man for black families and they wanted to cut to the chase by having someone that they perceived as having real power and authority to serve them. Remember they wanted someone who knew what was going on or what they were talking about. My stature as chaplain was different from theirs and I now see that not only race was an issue but my occupation, dress, appearance, etc. Wimberley’s words of prefiguring along with their own experiences in hospital and my desire to transfigure something or someone all made for (Penderhughes’) differentials of power.
My response to go with the flow and mellow the atmosphere with plenty of self control spoke more of my prefiguring and old responses versus any clinical responses. Or were my old Christian graceful mannerisms in need of bolstering by the liberation/existentialism theology that says abuse from abusers no matter what color, denomination, class or sexual orientation should not be tolerated. What should be important to me is my own power, needs, responses and management in the moment including the care and condition of the family.
Ministering to angry families is a special ministry. The problem is to determine if the anger is directed toward me as the chaplain or elsewhere. The first point I had to learn was that people must be empowered, especially when a situation as rendered them helpless.
Anger is Power.
As I think about the differences in patients and families I find that there are distinctive variations in their dispositions from one patient and family to the next. The one commonality is that each family and patient is there in hospital to be served by staff of the hospital. How they are served is determined by the policy of each hospital and staff member. The level of care and involvement of staff, families, patients and generally speaking the staff of the hospital comes from a dedicated, caring and courageous group. Once care and treatment have begun there is movement toward what is best for the patient. Families and patients are offered levels of care based on their need. Some patients and families require/desire more care than others. This didactic is about the treatment of the patient and family and the chaplain’s pastoral role and how it might be established in the face of anger and disrespect given by the patient and or family.
If the chaplain is treated poorly they will feel humiliated and disrespected. Respect and recognition of the chaplain’s role is important to especially the chaplain. The chaplain establishes this role based upon their own instinctive desire to serve families and patients. What is desired by the chaplain is to be needed, respected and recognized. The refusal of pastoral care by the patient and family can be dealt with according to each occasion that arises. There is a mutual understanding that refusal of pastoral care comes with the territory. However to be disrespected and ignored raises other emotions and feelings within.
I have to ask myself how I deal with this rush of emotion that overwhelms me when families in particular find ways to disrespect me as spiritual care giver in a traumatic situation?
Who was I dealing with and how do they interpret my role?
· I am a chaplain in the system and my ways, my looks and behavior speak volumes.
· Chaplain role is defined and interpreted by the patient and family as employee of the hospital.
· Chaplain wears the employee identification badge and is dressed according to standards of the department.
· Patients and families are outside of the culture of the hospital and they are not a part of the system.
· They have come to a hospital to be served by a system that prides itself in serving anyone regardless of nationality, creed, sex, etc.
· When the family arrives at hospital they (the patient and/or family) may be alone, frightened and skeptical of the care that they may receive spiritually or medically.
· This may be the cause for the anger they may express toward chaplain, staff or others.
How does race and culture play a role?
· As an African American male, some of the issues are when people of color abuse and disrespect people of color who are trying to serve them
· Based upon race, class, culture you may feel threatened by the family of the patients who came into the ED as Trauma Alpha
· You may have feelings of humiliation and anger, cause of their behavior; especially from same race, class or culture
· Who does the family identify with, the patient, the support staff, the medical team, or security?
My Own Cultural identification:
I have feelings that relate me to the patient’s family no matter who they are if I am right, sometimes feeling powerless as an African American male in America. Does staff or others of a different culture, class or race including visitors dismiss them as ignorant or do they sympathize or feel empathy for them because their loved one is in the trauma bay.
Dr. Davis also speaks of divergent identification where the minority group may feel alien to the culture of the hospital and feel powerless or invisible. I agree with the writing that it is possible for a traumatized chaplain to provide adequate care to a traumatized family whose point of view is radically different from mine and so different that it challenges my
Is my identification tied so closely that inside I cheer their boldness to scream and holler at the system that never seems to be attuned to the powerless? It is both primordial and powerful that I chose to support and care for people who are abusive and yet give adequate pastoral care that gives my calling purpose and identification. I am able to offer pastoral care and that I have done so even in the face of an angry patient or family. I am able especially when the anger is directed toward me.