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The Art – and Importance – of Pastoral Care

Pastoral Care

A car crash, a terrible fall, a gunshot wound — whatever the cause of their hospitalization, a patient admitted through Penn Presbyterian Medical Center’s Trauma Center is dependent on the surgeons, nurses, radiologists, and many others who care for critically injured patients. But, unlike most trauma centers, there are also other staff members on PPMC’s front lines who play a uniquely significant role on the care team: trauma chaplains.

Trauma chaplaincy is Philadelphia native Barbara Trawick’s second career. After retiring from her administrative role at The Wharton School at the University of Pennsylvania, she was introduced to pastoral care through a church program that offered training for volunteers. Soon enough, she landed a part-time chaplaincy position in a long-term care unit at the Hospital of the University of Pennsylvania.

“I’ve always been about working with people, and I like exploring new ventures,” says Trawick, who has since become a part-time chaplain covering the overnight shift on Tuesdays at the Trauma Center at PPMC since it opened in 2015. “But trauma takes all of you. You never know what you’re going to be confronted with or what you’re going to witness. It’s always unexpected, and it’s very emotional.”

On the day I met Chaplain Ray Lewis, Jr., for example, four trauma cases had already been brought in – some violent, and some non-violent. But with a handful of new cases before lunchtime, Lewis, who has also been with the Trauma Center at PPMC since the beginning, said he knew early on that his plan for the day was going to go awry.

“Usually my days start with a meeting with the chaplain on duty during the previous overnight shift so I can get briefed on the new cases with their families,” he said. “From there, I set a plan of which patients and family members I need to visit, and which staff caring for those patients might also need support.”

Aside from the new cases that came in overnight, Lewis also checks in on trauma patients who have been at PPMC for a few days, or those who may not be doing well. Those conversations, he says, often center around coping with death, or adjusting to a “new normal” way of life. Sometimes a family may be dealing with just the latest in a string of family members lost to gun violence, and Lewis says these situations often require an added layer of counseling; in cases where the situation is sadly all too familiar for a family, Lewis needs to balance what’s happening in the moment with compounded grief that needs to be unpacked.

But, as Trawick noted, trauma is predicated on unpredictability, and when a new patient is on the way in, the trauma team – including the chaplain on duty – is notified and must drop everything and head directly to the Trauma Bay to meet the first responders delivering the patient.

On arrival at PPMC, trauma patients are often nonresponsive and may not have any identification. When that happens, the chaplain often takes the initial lead in a collaborative effort of putting together the puzzle pieces to not only identify the patient, but also their family. 

“All you can do is start gathering up the clues — where were they were picked up? What kind of injury do they have? Every piece of information can be a clue to who they are, where their family is, and how to reach them,” Trawick explained.

Lewis added that in recent years, social media has become a key player in identifying patients and their families; incidents of gun violence and other traumatic events, he says, have a way of being made public very quickly. 

Once a patient’s family is identified and confirmed, Pastoral Care is usually authorized by the attending physician to make the phone call and, with “sensitivity, love, and diplomacy,” Lewis says, inform the family that their loved one has been brought to the Trauma Center.

“There’s an art to pastoral care,” Lewis says, adding that sensitivity is crucial in ensuring the family arrives at the hospital safely. “I don’t usually identify myself as part of Pastoral Care in that first conversation because when people hear ‘pastor,’ they assume the worst, and we need them to be safe and as calm as possible getting here.” Sometimes, he says, the family is already aware of the situation and just didn’t know which hospital their loved one had been taken to, but often they have no idea something has happened. If the family is extremely emotional, he will advise that they try to get a ride to the hospital.

Chaplains are notified by security when the patient’s family arrives, and from there they become the primary link between the family and their loved one, coordinating with the care team to get updates as soon – and as often – as possible. Until families can be reunited with the patient, chaplains also stay with families in the waiting room, ensuring they don’t feel alone or forgotten.

“Being able to read people is so important,” Trawick explains. “You have to know how to push, and when to push. It’s not unheard of to have 30 or 40 family members show up, all wanting information. You have to be able to manage those relationships. As a liaison, we work to keep the family comforted and informed, and we’re taught how to present a non-anxious presence, but it can be challenging in such emotionally charged situations.”

The good cases are the ones where the family is able to be reunited with their loved one. At that point, chaplains can take a break to recharge and prepare themselves for the next case. But when a patient dies, the chaplain’s role as liaison continues, often by working with the family to coordinate care for the body, or connecting them with resources such as funeral directors or grief counselors to help them through the next stages.

“We’re also there to talk with them,” Trawick says. “Sometimes a family just needs to sit and take it all in. Sometimes they’re just like, ‘Wow, I just saw my mother, and now she’s dead.’ They need time, and they need to be with a compassionate person. Sometimes you don’t have to say a word.”

For both Lewis and Trawick, it can be challenging to shoulder the emotional turmoil of the day-to-day. 

“It definitely affects you,” Lewis said. “Most of the patients I see are males between 15 and 35 years old. They remind me a lot of my five brothers who are all in that age range. I cope with a lot of faith and self-care, which includes daily visits to the gym, and calls to Mom.”

Working the overnight shift is usually so busy that Trawick says she doesn’t have an opportunity to reflect until she’s home. That reflection — a ritual consisting of a shower, breakfast, prayer, and writing memorable moments and lessons learned in a journal — helps to put work aside and not bring it into her daily life. Though trauma chaplaincy is an unexpected chapter in Trawick’s life, its rewards have made it one of the richest.

“I am an integral part of the trauma team, and I love my team; we’re in sync,” she says. “I’m grateful for the opportunity to help people through such a difficult time, and hopefully we’re able to help them affect positive change in their lives.”

Lewis echoes this. Aside from the training that teaches pastoral care providers how to deal with these often difficult and always emotional cases, there’s another side of it that serves as a reminder of why he does what he does.

“There’s satisfaction in knowing you’re helping people recover, and their families,” he says. “Most people see the news stories, and that’s where it ends. But I see those people walk again, or open their eyes again. There are the days when you see the miracles.”

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