Recently a child died unexpectedly while admitted to the hospital. Because it is rare to have anything unforeseen happen at our hospital, the staff experience these moments as difficult to reconcile. I hear “what if” questions from the most brilliant and competent of care providers. I also find myself asking how I could have met the spiritual and emotional needs of the family and staff better. Those questions are perfectly reasonable. We have a hospital culture that invites us to always grow and become more than we are. So, these questions come from a place of recognizing that we can always do something better. But will the growth from that process necessarily change the outcome of such situations?
It might but that does not need to be our only focus. Our job, regardless of the specifics of our functions, is to enter into particular moments in time where we engage all the dynamics and variables of that moment bringing who we are and what we can offer. That sounds like a lot but it is exactly what we do every day. Working in a hospital, regardless of the position, is very much about being engaged so that we see the patterns and needs as they emerge. We utilize our senses, training, and one another to produce the best outcomes for our patients and families. Yet, we don’t always get the result we want.
Shortly after this child died, I was talking with one of the staff as she asked the questions of what could have been done differently. Yet, I sensed in her a darker sense of guilt and doubt that I’ve watched haunt nurses and doctors to the point of leaving the profession. As we spoke, I asked her, “What would it have really taken to create a different outcome for that child?” She looked at me puzzled so I answered the question for her. I said, “I believe you did your absolute best in that small moment in time that you were with the patient. That moment was preceded by many many moments where other decisions would have had to have been made in order for your moment to be different. It’s like walking in on an elaborate pattern of dominos falling. You only get to see a small section but the dominos have been hitting one after another for a long time. You did exactly what you could in that moment.”
What I told her is true. When I look at the medical realities of the patient, I see a series of events that cascaded toward that one moment where she died. Our staff entered into a critical moment for that child and provided world class medical care that honored her and her family. We worked hard as individuals of various disciplines and as a team. Yet, we were not able to save the child. Why? Did someone do something wrong? Not in that moment. Sure, there are little things that we can improve upon. For example, I wish I had arrived faster to support the family. But I didn’t because there are many needs and as a chaplain, I triage needs just like the clinical staff.
I’m not saying that medical mistakes never happen because we all know that they do. Nevertheless, that was not the case in this moment nor has it been the case in any moments I’ve witnessed. Yet, I continue to encounter staff that internalize the traumatic nature of such a loss and become haunted by its memory.
We enter moments. We can’t be responsible for all the other moments that lead to that one. We must have grace for ourselves and recognize our limits. This grace is certainly akin to God’s grace. We are always in the presence of moments with God and all creation where we are limited in our influence because there is so much more that has happened and will continue once we’re gone. We are truly part of an elaborate, always unfolding, pattern of dominos that drop and create the next moment and the next moment and the next moment. May we always enter the moment.
