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"Coming to Know" in the ER

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Today a 29-year-old woman came into the Emergency Room.

When I am not moving loads of laundry from the washer to the dryer, playing taxi driver to my seventh-, fourth-, and first-grade children, or making another meal, I work as a part-time chaplain at a nearby hospital. In the hospital setting, pastoral care is diagnostic. We are trained to understand a patient's spiritual needs with a definite, clinical assessment.

This shift I met "Sarah" from Rwanda. Her parents were killed when she was 13. She lived in a refugee camp after that. She married while living in the refugee camp. Her husband was good to her for the first year of their marriage and then he started drinking. She has spent the last 12 years of her marriage being beat up, strangled, and kicked.

Her first baby died when she went into labor at seven months pregnant. She said, "He came out and cried for a bit, but no one came to help and so he died." Her second baby died when he was one. She said the other women in the camp poisoned him because they are envious of other women's firstborn males. (Who knows: maybe this is how the mind of a traumatized 18-year-old mother deals with a baby starving to death or dying from malaria. But maybe he was poisoned out of envy. I don't know.)

She has been in the States for four years and finally decided to leave her husband and is living in the local shelter for battered women. Sarah is now 14 weeks pregnant. She often goes without food to feed her three living children. She came to the ER complaining of pain. I couldn't help but wonder if she came in because she is deeply depressed.

Finally, after much talking and sharing we both began to weep. As tears ran down her face she kept saying, "I don't know why I was born. There is no life for me or my children. I don't know why I am alive..." I spoke of hope. We spoke of God's anguish over her suffering, but her eyes were dull.

There are some cases that stick with me, and Sarah is still with me.

I was reflecting on Sarah while reading the February 2009 volume of The Journal of Pastoral Care. In an article by Joseph H. Clarke entitled "Pastoral Diagnosis: Assessing the Psychotheological Themes of Freedom and Meaning," the author offers an examination of emotional freedom and the search for meaning and how practitioners of the pastoral arts come to an understanding of the nature of suffering.

I mentioned that in the hospital - in Clinical Pastoral Education - we are trained to diagnosis spiritual needs of a patient. I appreciate the insight Clarke has on the tension this causes within the notion of pastoral care. He explains, "Pastoral diagnosis is an often misunderstood concept sitting uneasily amidst an array of skills utilized by the pastoral practitioner. At first glance the words pastoral and diagnosis appear contradictory in nature. Pastoral often denotes a gentle, non-agenda drive appraisal, where-as diagnosis often denotes a more definite, clinical assessment. The term itself illustrates an ambivalence residing within the character of pastoral care and counseling. Is it a supple, more subjective process or is it a stringent, more objective discipline? My own understanding, and the thesis of this article, is that pastoral diagnosis must be both supple and stringent, but never ambivalent."

I was keenly aware as I spent the evening with Sarah that I was not just there to hear her story, although the ministry of Presence is real and powerful. I was also there to offer her pathways to freedom and meaning. To diagnosis literally means "to come to know." Clearly Sarah was expressing the psychological themes of depression and anxiety. She was also expressing the theological themes of despair, hopelessness, and alienation. As a pastoral diagnostician how do I understand these pychotheological themes in Sarah and offer her new ways to explore and eliminate that which keeps her from freedom and meaning?

My time with Sarah was too short. That is often the nature of Trauma Center/Emergency Room ministry. I spoke what I could into Sarah before she was sent back to the shelter; however, the themes and issues Sarah raised inside me will linger for a long time.

Posted by Caryn Rivadeneira on March 3, 2009 6:48 PM

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