Chaplain's Guide: Patient Passing
TW/CW: Death and Dying
Trigger Warning and Content Warning: Death
This post talks about patient death in the context of the hospital. There are no descriptions of death other than references to the patient or the patient’s body.
I am thankful to offer this Substack post, co-authored with my friend and fellow chaplain, Eleanor. Good friends are hard to come by, and I am grateful for our shared learning experience, which gave me the tools needed for spiritual care and the surprising delight of a new friend. It is a gift to be able to share experiences with someone who shared in this work. Eleanor is a hospital chaplain in Walla Walla, WA. While there are a million things we still have to learn about chaplaincy, just you wait.
I, AJ, am nearing my work anniversary as a hospital chaplain at a critical access hospital in Montana. For those of you who may be like the person I was a year ago, I had no idea what a “critical access hospital” meant! Let’s start there.
A small hospital is generally defined as having fewer than 50 patient beds. Ours has about 20 if we stretch. Critical Access means that we offer emergency services, but for significant injuries or conditions, we call in a helicopter or ambulance to transport folks to hospitals with higher levels of care. Sort of off the topic, but I used to think that going on a helicopter meant that a patient was in “worse shape” than going by ambulance, which, to a degree, is true. Eleanor shares a story of a time when she was with a family member of a patient who was scared when they learned her loved one had to be life-flighted. Eleanor explained that this is actually a positive because it means: 1) the patient was stable and stable enough to fly. 2) the patient was going to a facility with the resources the patient needed. The scary part is when patients cannot be flown, either because they are not stable enough or, as in AJ’s location, winter storms sometimes mean helicopters cannot fly
I, AJ, am on call a lot with this work and am finally living my 80’s and 90’s dream of carrying a pager. I named mine Peter Pager, Pete for short. As a chaplain in this community, I am called in whenever we have a medical emergency (often called code trauma or code blue). I always appreciate it when my pager does not go off.
I am not planning to talk about the medical side of a code/ patient emergency, nor am I qualified to. I am the wrong type of doctor for that. My first few experiences with these cases were intense. There are a lot of moving pieces, yet everyone has a job. My job is to be with the family.
The number one question I get asked when I am with the family after a patient dies is often a grief-filled question, “What do we do now?” Sometimes, they ask for practical next steps. Other times, it is a question of how to grieve. For the second, I recommend J.S. Park’s new book, As Long as You Need: Permission to Grieve.
While I certainly hope you never experience loss in this way, here are a few things that take place in the event of a patient passing.
If your hospital has a Spiritual Care Department, a chaplain will be called to support you. Some hospitals don’t have chaplains; other staff members, such as social workers, will be called to provide comfort.
If the code is in progress, you may be invited to be present. As I said, they are intense. However, seeing doctors try to do everything possible can bring families a sense of closure. Eleanor shared with me this helpful article on the subject.
Some hospitals have a “grieving space” dedicated for family members to gather while decisions regarding care are made. Various terms are used here in different hospitals and settings. In Eleanor’s context, they use “transitioning care goals” to discuss medical interventions that treat illness or injury to modalities that prioritize patient comfort. In AJ’s setting, we use “updating goals of care” similarly. We also have “family meetings to discuss goals of care,” in which we seek to “provide care in alignment with what the person’s body is doing.”
Depending on the nature/reason of hospitalization, a few different things take place. Not all hospital settings do this, but in AJ’s context, if the patient has been on site for less than 24 hours, we call a coroner, who takes down personal/family information. Sometimes, a person may require an autopsy, and, for us, that decision is made by the corner. For AJ’s context, we contact a local funeral home to assist with transportation.
If they are a hospice patient and were admitted for a hospice respite and pass from natural causes, the coroner does not need to come out.
Again, not all hospital systems do this. Sometimes, it can be jarring to see a local sheriff coroner come in for a patient's death.
Medical staff will help prepare the body for viewing. You are welcome to stay for as long as you’d like during the viewing. Something important that Eleanor notes here is that when the funeral home arrives, the process can be upsetting for families. Some faith traditions require a body never to be left alone, but generally, we invite families to step outside the room while they transfer from the hospital bed to the funeral home’s care. The funeral home will have the family’s contact information and can facilitate viewings at their facility.
For both of our hospital settings, we are required to call the organ donor hotline whenever a person passes. It’s part of the process, even if the patient does not wish to donate.
Chaplains and the Spiritual Care team will offer bedside vigils at the time of passing. I, AJ, have performed bedside vigils for patients/families who didn’t want or could not afford a funeral.
From AJ: One that comes to mind is eating pumpkin pie with family members in a patient’s room because it was the patient’s favorite. We took a bite, shared a memory, and honored this person with the food they loved.
One thing I appreciate about Eleanor and her approach to chaplain y is that she has a wealth of resources, especially for bedside vigils. Here some of her list of options for in-hospital vigils:
Read a sacred text or poem in alignment with the patient’s faith tradition
Scripture such as Psalm 23
Mary Oliver’s “When Death Comes”
Excerpts from the Tibetan Book of the Dead
Anoint the patient’s forehead with oil
Say (or SING!) a blessing over the patient in alignment with the faith tradition.
For non-religious patients, Eleanor offers, “May you be at peace, may you know harmony, and may you be free from suffering, from now until forever from now)
Offer prayers of comfort and strength if the family desires
Stay with the family as long as they need or desire. Create and allow space for stories, silence, and connection.
Some hospitals have morgues, and others, like mine, do not. We have a few funeral homes in the local area that families have the option to call to make burial plans. The funeral home will come out and transport the remains to the funeral home. They are available 24/7.
We will do our best never to rush the process. Some faith traditions require family members to arrive at the hospital to say goodbye. Others just need time and space to sit and be with their beloved.
There is no right way to grieve. Every aspect of grief is normal.
It is my (AJ) hope this post helps “normalize” and demystify what happens in the hospital setting when a patient passes. Our culture often does not like to talk about death, as these conversations can bring about upsetting feelings. Feeling uncertain, scared, or unsure is normal.
Id like to conclude with this quote Eleanor, “I just can’t help but wonder if some of the mystery were stripped away, maybe the fear would dissipate.”
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