Incarnations in the ER

How a shifting spiritual perspective helped revive me

Friends…I wrote this a few years ago. (Has it been that long???) I am excited to share it with you now!

NB: This article references multiple New Testament stories from the gospel accounts, and it may not be for everyone. That said, it seems like a good thing to share with the Crash Cart Campfire this Easter! It comes from the heart. Whether you’re feeling extra crispy from healthcare burnout or just working your way through life in this messy world, I hope this article will be a blessing for you.

Wishing you all grace and peace today.

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INCARNATIONS IN THE ER

Burnout

Don’t make me go back to the ER.

That’s what I had been thinking since early August when I started a two-month break from my job as an ER doctor. Don’t make me go back. For over a decade I had loved my work in the ER, but after experiencing the pandemic and severe career burnout, it just wasn’t the same. The work had become so overwhelming, so traumatizing, so draining, that I knew I needed a break. And when I say I needed a break, I really mean it. It was either take a break now or walk away from medicine once and for all.

As I worked through my burnout and trauma and sought new direction and clarity during my time off, I got to a better place mentally, emotionally, physically and spiritually. I knew that at least in the short term, when this sabbatical ended, I would need to go back. And so there loomed in front of me the specter of my first shift back in the ER. Would I still have what it takes? Could I still react fast enough in life-threatening situations? Would I break down if I got overwhelmed on shift? Did I have any empathy left for my patients? I was afraid of the answers.

Sound Counsel

To help overcome my trepidation, my counselor encouraged me to visualize walking into the ER at the start of a shift, to look around, and to notice the people and the environment as I started a day at work. Now think of the good things you see, she advised, the good things you feel. And as I pictured my colleagues, our nurses, the patients, the familiar feel of picking up my hospital phone for the shift, logging in and checking the board for unseen patients, asking my colleagues how I could help them out, my stress and fear lessened. I remember distinctly smiling at the thought that sitting down at our workstation next to a colleague on a crazy busy shift had always felt like Luke Skywalker and Han Solo taking their seats on the Millennium Falcon as a battle was just underway. In this visualization exercise I remembered that despite all the trauma, most of what I saw at work was good. My fears lessened.

The Question I Needed to Answer

Then my therapist, knowing of my Christian faith, asked me to visualize something else. As you’re thinking about your workday, she asked, where is Jesus in the ER? Where do you see Him? Where do you picture Him? Where is He as you walk in to start your day? Where is He as you go about your work? Where is He as you resuscitate a patient?

I had to admit I hadn’t thought like that before. As a practicing Christian and an ER doctor, I had been asking for God’s help and guidance at work and for my patients for almost 15 years now. I had always thought of Jesus as the Great Healer. I believed that ultimately God decides all questions of life and death and that I am only doing my best with the skills He gave me. But I don’t think I had visualized Him as an actual Presence in the ER before. I hesitate to confess I may have at times had a bit of a messianic complex walking into to work, ready to save the day.

During the visualization exercise, I first imagined Jesus, my Good Shepherd, walking into the ER alongside me. Gently leading me. Walking with me from room to room. And that’s where I needed Him to be for sure. Whereas before I had felt like a wolf among sheep in the ER, ready to devour disease, prepared to pounce on any pathology, lately I had felt more like the vulnerable and frightened sheep, easy prey for the wolves of volume surges, multi-system traumas, untimely deaths, and diagnostic dilemmas. But if the Good Shepherd was leading me, I could know Jesus would be with me even in the valley of the shadow of death that the ER so often is. If the Lord is my Shepherd, I shall want for nothing. That visualization exercise and focusing on God’s protection, provision, and guidance boosted my courage to come back the ER in desperate dependence on God to meet my needs and the needs of my patients.

Work has been scary at times since I’ve been back. It’s the ER. Bad things happen. But I have continued to take comfort in the thought of Jesus as my Shepherd in the ER. I often recite Psalm 23 as a prayer in my head or aloud in my car before each shift. But now my awareness of Jesus in the ER extends well beyond the pastoral and has become far more incarnational. I have come to realize that I get little glimpses of Jesus all the time in the people around me on shift.

Incarnations

For instance, when my colleagues see that I have plenty of patients on my plate and offer to pick up the next couple of patients, I hear Jesus saying, “come to me, all who labor and are heavy laden, and I will give you rest.” (Matt 11:28) In observing a small kindness from a nurse to a patient, I see Jesus tending to the needs of Galileans. In the faces of family members who have just lost loved ones, I see the fully human Jesus weeping at Lazarus’ death. In my disenfranchised homeless patients existing on the fringes of society, I see the homeless Jesus unwelcome in his hometown. When a patient offers kind words and gratitude to me, I intentionally pause and absorb those words as an avatar for God’s pleasure and an ever-so-minor version of the final words all His servants long to hear “well done good and faithful servant.” (Matt 25:28) I accept hugs from any co-worker or patient, even a psychiatric patient, who offers one, knowing that I am broken and empty and need all the love I can get at any time. Surrounded by humans made in the image of God, even the most unexpected patients or colleagues provide glimpses of God’s goodness, kindness, mercy, and compassion.

Amongst all these little moments, I’ve had three recent encounters that stand out as particularly divine. The first involved a charming woman in her forties with seventeen living children who came into the ER pregnant. Seventeen living children. Pregnant with number 18. She said she had lost a pregnancy early on as a mother, but all the other pregnancies were pretty smooth. Today, though, at the fifteen-week mark, she was cramping a lot and bleeding a little. She just needed to check things out. Her husband, the father of this ever-expanding brood, held her hand in a chair at the bedside.

The Lost Sheep

After my assessment, I unfortunately had to inform her that the ultrasound showed us that her baby had died in the womb. Awful news. Never easy, I thought as I approached her room with the news, but at least she has seventeen others. How cold and calculating of me! To my surprise the mother wept bitterly at the news. I have rarely seen tears like the ones I saw from her that day. She was devastated by the loss of this little one, whom she already cherished so dearly. This mother’s love moved me deeply, and I immediately thought of the parable of the lost sheep. In this parable, Jesus tells His disciples that a good shepherd will leave his ninety-nine other sheep to find the one which is lost. He will search high and low to find us. Our value to God is not diluted by numbers or the presence of others. Just as with a mother, there is not a fixed amount of love to ration out carefully. Each one of us matters so much. I saw in her tears God’s expansive and extravagant love for us.

The Valley of the Shadow of Death

A couple of months ago, I had to deliver some other bad news to a different patient — a woman in her sixties. A mass in her lungs that had been identified, but not treated a year ago during an ER visit, had now grown significantly. The patient had never been able to follow up with specialists after she had been told about the tumor last year due to the limitations of her disability, fixed income, and rising rent prices. The one clinic visit she had been able to attend 11 months ago had cost her so much up front that she had gone without paying her electric bill and had eaten very little for a month just to cover the fee. Unfortunately, the daily struggle of paying the bills had to take priority over addressing a growing tumor that was not causing her symptoms.

As I told her about her tumor’s growth, she interrupted me, “Now don’t use those big medical words with me, son. I ain’t got no PhD, and I don’t know what an oncotomogist is. Keep it plain. You got to speak ghet-toe to me.” Isn’t that how Jesus spoke, plain and simple, everyday language, for everyone to understand?

I cut out the medical jargon and told her plain and simple I was worried about her cancer growing and spreading. She became irate. “You see that’s the problem. I couldn’t pay to do nothin’ about this. This system is putting dollars and cents over human lives. Dollars and cents, over human lives.” And I saw in her anger the righteous Jesus overturning the tables in the temple, the Jesus of justice crying out for the least of these. All I could do was say I was sorry, that I agreed our healthcare system could be awful, and that I would do what I could to help her get to the next step. Then the patient changed her tone, softer, yet more defiant and empowered. “But you know it’s ok. It’s gonna be just fine. Because my Lord and Saviour Jesus Christ will protect me.” “That’s right,” I said.

I noticed that on her right bicep she had a large tattoo of two praying hands and the words “The LORD Is My Shepherd.” I suspected this patient did not really trust me, as I was merely another doctor in this broken system of dollars and cents. I doubted that she would really engage with me personally, so it was a bit of a risk when I told her I believed the words of her tattoo. “The Lord IS our shepherd.” I started reciting the Psalm. “He makes me lie down in green pastures, he leads me beside still waters…” As I continued, she chimed in, hesitantly at first, but with growing confidence as we invoked the old verse line for line in harmony, crescendoing triumphantly in unison. “Yea though I walk through the valley of the shadow of death I will fear no evil, for you are with me.” (Ps 23:1-4) I pray that she continues to feel sustained by these very words that have been sustaining me, that she is aware of the presence of her good shepherd as he walks the scary path ahead.

The Ultimate Answer — A Tattoo?

A couple of nights ago I saw Jesus very unexpectedly. A man in his thirties was brought into the ER overnight by police and paramedics. He was high on drugs, probably PCP, and had been rummaging through people’s yards when police were called. He had resisted arrest, leading to a prolonged physical scuffle during which the patient sustained many scrapes and bruises. Fortunately, the police were able to apprehend the man without significant harm to themselves or the criminal, but the patient’s mental status was too altered for jail. He needed assessment in the ER and observation for a time before jail intake.

I followed the stretcher into his ER room. Several officers, paramedics, nurses, and security officers worked to safely transition the patient onto the hospital bed and handcuff the patient to the bed rails. All the while the patient, much calmer now that he knew he was arrested and couldn’t resist anymore, was muttering nonsense. “When did you stop working at the hospital, Sylvia? Why did you leave us?”, he asked sincerely of one of the officers (not named Sylvia.) He looked wide-eyed at the ceiling and cried out “I’ll give you all the happiness, I’ll give you everything I have in this world!” The handcuffs held him back as he attempted to raise his arms in rapture.

Clearly under the influence of drugs, he was cooperative enough to let me examine him. I found on this large, muscular man no significant signs of serious chronic illness and no evidence of major injuries, only scrapes and bruises all over from the scuffle. His heart and lungs sounded fine, but I lastly needed to lift his shirt and examine the torso to make sure I wasn’t missing any major injuries.

As I did so, I saw a remarkable tattoo on his upper chest. In fact, he had many tattoos, but this one, though fainter, decidedly older and more sloppily drawn, stood out from all the rest. It consisted of a downward semicircle of text in an elaborate font that stretched from one collarbone to the other. I lifted his shirt higher to get a clearer view, and I at first had to focus to make out the letters. I read them aloud as I made them out. “JESUS… KNOWS….MY….PAIN… It says JESUS KNOWS MY PAIN.” It may have just been me, but it seemed like everything got quiet in that room as I read the words aloud and paused afterwards. Everyone in the room resisted the temptation to make a glib comment or crack a joke about these lofty religious words coming from this criminal high on drugs. “Yes, He does,” I thought to myself.

Suffering Sovereign

I have been reading a lot about Jesus’ suffering on this earth and on the cross lately. I’m coming to understand better the significance that, according to Christian teaching, our Sovereign allowed Himself to suffer on our behalf. We humans may not always know God’s reasons for allowing suffering in this world, or for allowing this or that terrible thing to happen. However, we do know that Jesus lowered Himself to walk through this broken world we inhabit and experience in His Crucifixion more pain than we can ever know. Subsequently, we can know that our God has compassion for us, a transformative and foundational conviction.

As I’ve thought lately about how our theologies sometimes leave us without the explanations we so crave, I’ve been reminded, too, of the limitations of medicine. In the ER, we may not always have the answers to a patient’s problem or pain or the ability to solve their problems — in fact, we often don’t. But we can always acknowledge our patients’ pains and their plight and offer them our compassion and empathy.

Wounded Healer

Jesus Knows My Pain. The four words of his tattoo were the most important words that could’ve been brought to me in the ER that night. I often wonder if those words are the most important that can ever be uttered in this broken world. Those four words have been the answer to help me in my suffering lately. I may not always get the relief that I pray for from my current struggles in this world, but my Savior was a man of constant sorrows who experienced those struggles, too. As I have battled PTSD, loss, burnout and exhaustion and feelings of professional failure, I have come to find Jesus’s incarnation and suffering on this earth as my greatest source of strength and hope. His suffering was greater than any I will ever know. And in this, the suffering Sovereign, the Wounded Healer, offers me something greater even than empathy. Through His Resurrection and Ascension over His suffering, He has elevated me in my troubles and allows me to share in His victory and new life.

It was my faith’s answer to the riddle of human suffering, tattooed across this criminal’s chest.

Seeing Jesus Again

Even as the man continued to mutter what sounded like nonsense (“Who burned down the hospital? Why did he do it?”) I could now see Jesus in this 30-year-old criminal in so many ways. He was beaten up, arrested, alone, homeless, forsaken, full of longing that could not be satisfied on this earth, misunderstood, and speaking sincere words that no one could yet make sense of. I do not know what trauma in this patient’s life, what series of bad decisions or medical conditions or societal ills, led him to this life of substance abuse and crime. But no matter how he got here, I know that Jesus knows this man’s pain. And Jesus knows MY pain. And my morally-injured colleagues’ pain. And he knows our burned-out nurses’ pain, and our grieving patients’ families’ pain.

Back in the ER

Jesus knows my pain. Jesus is here in this ER — certainly as our Shepherd and reflected in the people around us. But He is here in the ER as a sufferer as well. When we take care of one of the least of these in Jesus’ name, the Gospels tell us, we take care of Jesus. And because of that, I can be back here in the ER, too.

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Thank you so much for reading. I’d love to hear from you either in a comment, an email, a text or a phone call. Tell me, Crash Cart Campfire friends,

• How has a fresh spiritual perspective impacted you in the workplace?

• Where do you see evidence of The Divine in your day-to-day life, if at all?

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  *This article originally appeared in FOCUS Magazine.