• Jacqueline M. Pressey

Entry #26 Walking into the DEEP PLACES: Realities of Trauma Stewardship

Updated: Nov 17

Chaplains respond regularly to daily codes and consults as part of our pastoral/spiritual care responsibilities. We have been training and preparing our best to be able to serve others through the mist of medical crisis and/or trauma. But the reality is one never knows what one will face once we enter that patient’s room. Trauma is a part of life, but one’s emotional mindset determines how severe or intense that trauma is mentally perceived. One’s spirituality and/or spiritual care needs can vary based on one’s inner belief’s, life experience’s either from good or bad, can contribute to the facets of one’s beliefs and connectedness to each other and this world. “Spirituality is that aspect of humanity which refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness, to God, to self, to others, to nature, and to the significant or sacred,” (Carey, L., & Hodgson, T., 2018).

In the role of a chaplain/trauma steward, you have been entrusted with the power to impact and produce change in the lives of yourself and others. As a trauma steward, you provide a safe space for honoring others hardship and suffering without assuming responsibility for taking their pain as your own.

Moral injury is a trauma related syndrome caused by the

physical, psychological, social and spiritual impact of

grievous moral transgressions, or violations, of an individual's

deeply-held moral beliefs and/or ethical standards due to:

(i) an individual perpetrating, failing to prevent, bearing witness

to, or learning about inhumane acts which result in the pain,

suffering or death of others, and which fundamentally challenges

the moral integrity of an individual, organization or community,

and/or (ii) the subsequent experience and feelings of utter betrayal

of what is right caused by trusted individuals who hold legitimate

authority, (Carey, L., & Hodgson, T., 2018).

The results of unresolved trauma/moral injury:

The violation of deeply-held moral beliefs and ethical standards

—irrespective of the actual context of trauma—can lead to considerable

moral dissonance, which if unresolved, leads to the development of

core and secondary symptoms that often occur concurrently. The core

symptoms commonly identifiable are: (a) shame, (b) guilt, (c) a loss

of trust in self, others, and/or transcendental/ultimate beings, and (d)

spiritual/existential conflict including an ontological loss of meaning

in life. These core symptomatic features, influence the development

of secondary indicators such as (a) depression, (b) anxiety, (c) anger,

(d) re-experiencing the moral conflict, (e) social problems (e.g., social

alienation) and (f) relationship issues (e.g., collegial, spousal, family),

and ultimately (g) self-harm (i.e., self-sabotage, substance abuse,

suicidal ideation and death), (Carey, L., & Hodgson, T., 2018).

To be used to participate in the stewardship of trauma, remember as chaplain’s, the privilege and trust that a patient/person may be giving you when they are vulnerable and transparent as they are seeking comfort through pastoral care.


Reflection/Lesson Learned:

As I write this extremely painful memory/experience from earlier into my 1st years of chaplaincy clinicals training, were I had to accept and comfort teenage parents through their decisions made in the care of their 8-month-old daughter. Even when my heart and emotions didn’t necessarily agree with them, yet I still had to serve them through their medical crisis by providing them pastoral/spiritual care with objectivity, comfort, and support. I received an early evening consult from the pediatric ICU. I read that an 8-month-old African American female infant was awaiting a lifesaving liver transplant. The nurses station requested a chaplain for the teen parents of the infant. I entered their room after speaking with the ICU unit nurse. The nurse informed me that their infant was awaiting a liver transplant. But her labs had become critical, and it could possibly take her off the transplant list. I took a moment, and took breath, and prayed, Lord, this is going to be tough, please guide me in comforting them. Good evening, I’m Chaplain Pressey, the nurses station asked me to visit you. I see your names are mom and dad, what’s your daughter’s name? As both the parents were sitting on the sofa while their daughter was in the ICU crib, hook up to numerous machines and IV’s her little body had tubes everywhere. She was just laying there, not asleep. She looked at me and I stood there, beside her crib, looking at her and I started singing her prayer to her, called, “I am a Promise,” by Veggie Tales (2005). This is one of my children’s prayer songs that I commonly used as a prayer. The words are:

I am a promise I am a possibility I am a promise With a capital P I am a great big bundle of potentiality, oh yeah

And I am learning to hear God's voice And I am trying to make the right choices I'm a promise to be anything He wants me to be

I am a promise I am a possibility I am a promise With a capital P I am a great big bundle of potentiality

And I am learning to hear God's voice And I am trying (I'm trying) To make the right choices I'm a promise to be anything God wants me to be

I can go anywhere that he wants me to go I can be anything that He wants me to be I can climb the high mountains I can cross the White Sea I am a great big promise you see

Oh yeah

I am a promise I am a possibility I am a promise With a capital P I am a great big bundle of potentiality

And I am learning (I'm learning) To hear God's voice And I am trying (I really am)

To make the right choices I'm a promise to be anything he wants I'm a promise to be anything he wants I'm a promise to be anything God wants me to be Oh Yeah

As I started singing it to her, she smiled at me and pulled herself up to stand holding her hand onto the rail of her crib. She tried to jump a bit even though she looked so very sick. Her mom started to cry and said she hasn’t smiled in days, thank you. I stopped singing it, but her mom asked me if I would sing it, again, as she picked her up out of the crib and held her as I sung it. We began to talk about many things, how young they were, she was 17 and the dad was 18 years old. That they didn’t know what they were going to do if she doesn’t get a liver transplant. And that they hadn’t eaten dinner, yet. Well, 1st before we started to seriously talk, I was able to order them something to eat. I sat down in the chair in front of the sofa where they were sitting, as she was holding her daughter with all the tubes stretched from the bed. Her mom said, that they were waiting to hear the lab results to see if she was going to get a liver transplant. Now, I had already been told by the nurse that it wasn’t looking good, which is why they requested a chaplain. I listened as she cried, and talked as she was holding and hugging her daughter. At this moment within the trauma, I changed from being a chaplain to operating as a mother to a young daughter, son and granddaughter. Although, the dad didn’t say very much. Most of my interaction was with the mother and daughter. Until it was time for me to leave.

I told the mother that I would have the song made into a framed picture for them. She thanked me, and I told her that I would check on them throughout the night. But I got a 2nd code page around 2am to return back to them. When I got there this time, they were sobbing while her daughter was laying in the crib. When I came pass the nurses station to enter the room, the nurse shook her head, no. Sadly, that meant that the baby was too sick to get a liver transplant, and they had informed the parents. Now I’m vested emotionally in this family, yet I had to hold it together to be a comfort, although, it felt like my own children. I had to listen to them make plans about this awful reality. I stayed for hours with them as the hospital was making arrangements to transfer the daughter to a hospice hospital for her final care until she passed. I learned that the hospital that could take her was 200 miles away. The mother said that they wouldn’t be able to get there much to see her. My heart was breaking as they discussed not being able to travel to the hospital. I stayed with them for another few hours while the daughter slept. And the pain of the reality that they were living in that moment. I left about 4am and I told them that I would send the picture of the song to the new hospital as soon as I could. I said goodbye, again for the final time.

By that morning, their daughter had been transferred to the new hospital.

Yes, when I got back to the chaplain on-call overnight quarters, I just sat on the bed and cried for a moment. Before I left that morning, I got all the information that I needed to get in touch with the other hospital to check on them, so I thought. I stayed in contact with the hospital for three weeks, calling every few days to see how they were doing and had they gotten the gift that I had sent. What I sadly learned, that the parents had only been to the hospital one time when the daughter was transferred to the hospital. I contacted the chaplain’s office at the new hospital. I spoke to a chaplain there that said they would stay in touch with me. And she did, for three weeks until the baby passed. The chaplain promised me that they would make sure that she didn’t die alone. Her parents never returned after that 1st onetime visit when she was transferred.

Many chaplains live through moments like this one that I described all the time. And we have to go home and recover from the emotional pull and work through the complexities of the spiritual care provided, and our own personal grieving for the people we served and will serve, while we heal. It is part of what encompasses the chaplain service/calling. To be completely honest. I’ve had many times where I couldn’t shake off a complex patient visit. I have curled up, cried, prayed and dreamed about a many of moments that I wouldn’t have been able to handle without God. In moments like these, I’m so very grateful that I had my daughter and pastoral covering to vent to and to be prayed for. But these patient encounters never stopped me from returning to my next pastoral journey that I was assigned by God. Sometime it is through our own personal sufferings and weaknesses that we learn how to depend on God for guidance and direction, know matter what your faith tradition is. In the end what we all do is about how we can show love to others through their rough patches in life.

From my faith tradition, a Bible scripture:

By this shall all men know that ye are my disciples, if ye have

love one to another. (John 13:35, KJV)

Remember this, each one reach one or should I say, each one, love many!

Here’s a sneak preview, “March 2022 Edition: Blog Closing, Rap Up!” Until next time.

For the sake of the Chaplain’s healing, CALL!

Dr. Jacqueline M. Pressey, Chaplain


"Every job is a self-portrait of the person who does it. Autograph your work by becoming Extraordinary through pursuing Excellence!"


Reference

Carey, L., & Hodgson, T., (2018). Chaplaincy, Spiritual Care and Moral Injury:

Considerations Regarding Screening and Treatment. Retrieved February 9, 2022,

from https://doi.org/10.3389/fpsyt.2018.00619

Van Demoot-Lipsky, L., & Burk, C. (2009). Trauma Stewardship: An Everyday

Guide to Caring for Self While Caring for Others. Retrieved May 11, 2021 from

https://www.amazon.com/Trauma-Stewardship-Everyday-Caring-

Others/dp/157675944X/ref=sr_1_1? crid=3Q15NC8M7U95V&dchild=1&keywords=trauma+stewardship&qid=1623416948&sp refix=TRauma%2Caps%2C158&sr=8-1

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