Supporting the Front Line: A Conversation with a Trauma Hospital Chaplain
By Interview by Megan Fowler

If COVID-19 patients overwhelm a hospital’s capacity and there are more patients who need ventilators than there are ventilators, who will be saved? For the Rev. Charles Dey, this question is not hypothetical. As head of the ethics committee at SSM Health St. Louis University (SLU) Hospital, Dey works with the triage team to define and implement policies in these worst-case scenarios. As the manager of pastoral care, Dey must then communicate those policies to chaplains so that they can support families — most of whom cannot come visit their hospitalized loved one — and hospital staff on the front line of the crisis.

As a Level 1 trauma hospital, SLU Hospital normally treats patients with more severe conditions, and the coronavirus has stressed the system even more. While SLU Hospital has 25-30 COVID patients at any given time, the hospital has not been overwhelmed.

Dey is a PCA teaching elder who attends Grace and Peace Fellowship in St. Louis, and also a chaplain with the 131st Bomb Wing of the Missouri Air National Guard. He talked with byFaith’s Megan Fowler about the fatigue of the front line and the unique challenges and opportunities of hospital chaplaincy. This interview has been edited for clarity.

What is the situation on the ground at SLU Hospital? 

We’re in a downtown, densely populated area, and we are St. Louis’ safety-net hospital. If no one else will take the patient, we’re the hospital that will, given that we’re part of a Catholic health care organization and the mission that we have. For a while we had 25 to 30 COVID-positive patients on a given day — now it’s down to less than 10. We also have all the other acuity that we carry on a given day being a trauma hospital and the specialty care that we provide here. 

Acuity means more severe? 

Yes. We keep the higher-acuity plate spinning while taking on the COVID-positive patients, too.

What is your interaction like with COVID patients? How do you participate in their care?

I’m one step removed as a manager running operations for the department. My role has been making sure the chaplains are equipped to do the work they do on their units. When all of this started, a lot of my responsibility was communicating the changes taking place. It was incredibly rapid the number of changes, just like in any other health care setting across the nation, with PPE (personal protective equipment), and learning to safeguard ourselves and patients from COVID. 

Our virtual ministry has recreated pastoral care. We got hold of iPads and immediately started creating ways to connect patients with their families because there are no visitors allowed. That has been a huge part of our ministry.

The thing that was the most drastic change was recreating the pastoral-care platform in about a week’s time. Our department was asked to develop visitor guidelines in collaboration with nursing that would safeguard families, patients, and staff alike. We have to safeguard our chaplains, some of whom were at risk, so we had to not visit COVID patients. We still are not visiting COVID patients or PUI’s (people under investigation). That was something we implemented to safeguard our chaplains, but also for conservation of PPE. We were anticipating a surge in patients, so the last thing we wanted was chaplains using precious PPE when we could meet those needs in other, creative ways.

How did the platform change?

A lot turned in to phone ministry initially. We immediately set up a staff support hotline because we wanted to continue creating avenues for the chaplains to support the staff. When you get off shift and need to debrief that shift and process it on your drive home, you can call the hotline and get a chaplain to process with. It didn’t get quite the traffic we thought because people are still in crisis mode, and you do less processing when you’re in crisis. And people are still moving at a pretty good clip. 

Our virtual ministry has recreated pastoral care. We got hold of iPads and immediately started creating ways to connect patients with their families because there are no visitors allowed. That has been a huge part of our ministry. Where needed, we were even helping other providers connect with families so the families can get the information they need. And a lot of it is helping families lay eyes on their loved one. A lot of it is taking place in the ICU where patients are not responsive. But people are able to see the patient and then get some greater grasp of what is going on and how they’re doing.

One example is a gentleman who had been in prison, and he was here with a severe brain injury. The family was concerned that this had taken place because of some sort of violence in the prison. So the family wanted to see this patient’s head to know if anything traumatic had taken place. Nursing has really been involved with the chaplains on this project, and one of the beautiful moments was watching this nurse who was having a really stressful day, and she patiently took the iPad and showed each angle of the man’s head so the family could see there was in fact no trauma that had caused the injuries, that it was just part of the disease process for the disease that he had. Just to know that for them, it staved off a lifetime of wondering. 

A lot of the purpose of the virtual ministry we have now is helping families understand the reality of the condition — COVID or not. We help people get a better perception of what’s going on. Helping families make the transition to comfort care and that continuing to intervene might harm a person rather than curing the person. That’s a reality in our hospital every day. For chaplains, the glory and the overwhelm of it all is, we’re going to connect folks with their loved ones however we can. If there’s clinical information to be communicated, we’ll do it with HIPPA-compliant ways.

Has this virtual model of pastoral care changed your view of the chaplaincy?

There are parts of pastoral care that I hold so very dear and for good reason. It’s how God knit us together and how He made us that we need touch and personal connection and that our body language and tone communicate as much as the words we say. But as good as it is, I had idolized it in some way. In those moments, I was believing God couldn’t work under these conditions. It took me saying that out loud, and then laughing out loud, realizing what I was saying and how foolish it was, for me to come to terms with that. 

I had the evidence right there in front of me, seeing the chaplains over and again connecting families with their loved ones. Despite not being able to come in, the families have been expressing gratitude to have some connection with the person they love. Despite it not being ideal circumstances for pastoral care, God meets us in these vulnerable moments and in crisis. The care is still taking place. It’s still kind of a zoo coordinating all the requests that we get for people to connect. But it’s happening. 

You are regularly surrounded by death and suffering. Do death and suffering seem worse when they surround you, but at arm’s distance, and you cannot engage with people in person? 

Yes. For chaplains, we can walk into a room in the midst of that, and we know how to navigate that. It’s a whole different level of complexity navigating it over a screen.

How has your spiritual support to the staff changed?

It has changed in a couple of ways. We have the hotline set up. And where we can’t visit patients, our pivot is supporting the staff in those units designated COVID units. We’ve converted one of the lounges into a staff-support place so chaplains are working there to be available. Our work is going to be ongoing as far as people processing the continued stress, the collective exhaustion felt by everyone. We expect that to go on for months, if not years. 

Charles Dey

It’s all relational ministry. Our chaplains know the nurses, the housekeepers, care partners, so it’s checking in, giving them space to talk. Walking the halls, staff are just quicker to stop what they’re doing when the see the chaplain walk by, and strike up a conversation. The staff have been needing that moment to talk and process. 

There’s been a lot of publicity about the ethical quandary of whom do we care for first if we don’t have enough resources for everyone. Has your hospital had that conversation?

Yes, that’s a conversation going on nationally. Not even New York has had to formally transition into a crisis standards model of care. I lead our ethics committee, and as a result one of my responsibilities has been implementing the crisis standards model at SLU Hospital. I work with other senior leadership in the hospital, and we make up the triage team. SSM has its prescribed standards of care, which have been agreed upon not just at the hospital and regionally, but in partnership with neighboring hospitals. Any time crisis standards must be implemented, it must be on the regional level for added public legitimacy and equity throughout the region.   

When we quickly had to revamp pastoral care to stay connected with families and patients, we were also having the larger discussions about how crisis standards could be implemented in case of scarcity of resources — people, supplies, space. We have the protocol for crisis standards, but how do you operationalize that? 

Given my role with the ethics committee, that has taken a lot of my time. We haven’t had the surge we anticipated, so we haven’t had a scarce supply of ventilators. But we have a responsibility to do the work to make sure we are prepared. We were sprinting to build out that process. If we’re going to shift to crisis standards of care, there’s a fair amount of advance work that goes into assessing all your patients in this way. Should that happen, our triage team will support hospital leadership to make the decision about who gets resources and who doesn’t. Ultimately that will fall to our hospital leadership. Our triage team presents them with the information to make that decision. 

What does that responsibility feel like?

We don’t have a lot of hospital chaplains in the PCA, but it is a growing number, and they give so much of themselves to this work — especially now. I’m convinced there is a particular cost to hospital chaplains over time who minister at the bedside and care for those grieving death day in and day out.

For anyone involved in those decisions, the potential for moral distress that one feels is pretty weighty and significant. There was a 24- to 48-hour period where I was absorbing the responsibilities of this and shed a lot of tears trying to recognize if there was the surge in cases that we were predicting, we may well be in a place where we would not be able to offer a ventilator to someone who needs it or would have to make a decision around even taking resources from someone who wouldn’t benefit from them in order to give them to someone who would benefit from them. That’s all done well and ethically sound and appropriate and uncommon to our society, but not to our world. 

Even if it’s ethically sound, it’s still hard, and haunting, right?

Yes. Early on, I had a lot of conversations with the staff chaplains about all that I was working through to bring them along in the process of my own moral distress, or potential for it, so that they would be prepared should they support staff who were experiencing the same thing. 

Where do you find comfort in the midst of all the challenges?

I count it a great mercy that our own pandemic efforts have happened during spring. Spring has been God’s gift and comfort. In the early weeks of the pandemic I recall the feeling of a perpetual winter. I had been listening to “Pilgrim’s Progress” to and from work in the car. One morning Christian stumbles upon the house “Beautiful” built by the Lord of the hill. This house was built to lodge pilgrims and give relief and security. Spring, and the beauty it holds, has been just that — a constant reminder of God’s trustworthiness and provision of relief through these past months. 

How has your church supported you as you work so close to the front line?

Many hospital chaplains are fortunate to be able to lead God’s people during the week while also benefiting from the word and sacraments of worship each Sunday in a local congregation. Though some weekends are occupied with ministry at the hospital or with the Air Force, I am able to worship with my family at Grace and Peace Fellowship the majority of the time. Christ’s grace and leading have been manifest in our pastor’s preaching and have reoriented me to the Gospel when still spinning from all the change, fear, and contention found in the hospital that week. Our prayer group has faithfully listened, shared in our tears and laughter, and held my wife and me in prayer. Friends have walked alongside me in phone and Zoom conversations as I’ve processed the day’s events, and together we’ve tried to uncover the Holy Spirit’s work in us and, more commonly, in spite of us. 

What do you want PCA members to understand about your work and the work of chaplains during the pandemic?

Chaplains are having a very different experience of this pandemic than others. We don’t have a lot of hospital chaplains in the PCA, but it is a growing number, and they give so much of themselves to this work — especially now. I’m convinced there is a particular cost to hospital chaplains over time who minister at the bedside and care for those grieving death day in and day out. I can’t quantify it or even fully articulate it, but for those who have seen far more death than most, I’m grateful for the brief notice this unique ministry will receive and the understanding that these chaplains have. They are working tirelessly to bring the Gospel to bear in extraordinary times. I can testify to the way chaplains are bathed in prayer by those who know this ministry well and the need for it. My hope would be that PCA members have a bit more of a window into this Gospel work and may remember us in prayer just a bit more for it. We feel it and we need it — especially now.

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