
Working in the Emergency Room as I do, death and dying surround me constantly. I've learned there are many kinds of death, many more ways to die than the average person could think of, and I have probably experienced everyone of them. This line of work does not bear understanding by some, but I choose it as my life’s work.
The ER in which I work in serves as the regional trauma center, as the regional mental health crisis center and now as a premier neuroscience center. I would venture to say that I see more than my fair share of death and dying. The trauma center brings any kind of trauma that could befall a human being - auto accidents, falls, assaults, industrial accidents, domestic violence, and gang violence and more. I have come to know that the human body and the human spirit can sometimes survive just about anything. I have seen paramedics, doctors, and nurses struggle to make survival happen and when they fail, it always seems to come as a shock -"This one just couldn’t be saved." I speak with the family as gently as I can to ascertain their loved one's name, date of birth and insurance. These are questions that no family should be answering at a time like this. Their grief surrounds me as well, no matter how hard I try to distance myself. I have no answers for them, only questions.
The acute, strong emotional experiences of trauma feel like bursts of pain in the middle of the other “dying” that goes on in an ER. The outbursts of fresh grief make daily dying seem inconsequential.
My “everyday” work is filled with “chronic dying”, a dying that seems to go on forever as it, most times, does for years and years. Sometimes this dying ends with the suddenness of trauma, but that comes as a relief. The pain of this dying has already been experienced to the fullest, not only by the person, but their family and friends.
This kind of dying also comes in many forms, through mental illness, alcohol and drug addiction, poverty and homelessness. I see countless affected people come through the ER doors and those, like me, who have worked here for a long time see how these afflictions cause patients and their families untold misery. The slow wasting of mind and body is as difficult to watch as any trauma.
“My” hospital lies within the city limits. The effects of poverty make this ER different from the suburban hospitals, as the staff cares for each patient’s immediate needs, but are unable to help them when they cannot afford the medicine the doctor has just prescribed, or give them a home with heat, or food to eat. The staff cannot go home with the infant whose mother has no idea how to care for him, so he will be coming back to the ER again when his illness becomes life threatening.
The regional mental health crisis center brings to the ER any one suffering from mental illness, chronic or acute, including alcohol and drug addiction. Most of these patients return time and time again. Inevitably, a relationship evolves with them and their families. When they come into the ER I witness firsthand the effect of their suffering, through their inconsolable crying and rantings and suicide attempts to their inability to care for themselves and the resultant decline in their health.
I see their families suffering and their withdrawal of support through the years as they must also learn to survive the disease. The ER becomes the only place for the afflicted to go. Mental health illnesses and addictions know no boundaries. Color, class, and culture show no strength against this disease, and it often leads to poverty and homelessness when the person can no longer hold a job, care for themselves and have alienated all of their support systems.
Recently, Tony came into the ER seeking shelter, food and company. An intelligent and funny woman, Tony lives on the streets. She can be charming and endearing, demanding and abusive. I have known Tony for 35 years and when I have time to sit with her, I find her “in the know”, always up on current events and the Hollywood scene. That day she looked bad. Living on the streets for so long, she was weather worn, malnourished and her ever strong spirit seemed to be fading. Sometimes she will be the one bright spot in my day, with her wit and charm; other times she will be the bane of my existence as she pesters me and challenges me as I do my work.
When the winter comes, I wonder which one of “my” homeless will make it through the season. The bitterness of winter and the unrelenting heat of summer can be very hard on those living outside. My hearts aches for the “newly” homeless, those who have recently found themselves on the streets and have not yet developed the coping skills to manage that harsh life.
The daily turmoil of “acute” death and “chronic” death in my life sometimes leaves me confused. So many patients struggle to live, and so many seem hell-bent on their own destruction. I stand by and watch, but I cannot remain unaffected. These dyings take a toll on all those immersed in the everyday life of an ER. Everyone on staff can suffer from vicarious trauma and most are totally unaware of their own need for consolation.
My life in the ER, after my experience with ILEM, has changed dramatically. I see patients and my co-workers differently. I see them in all of their brokenness, and through the eyes of my brokenness. I see how truly beautiful they are as the face of Christ. Has my deepened spirituality made this easier? Yes! Believe me, I do not glide through every shift on winged feet, throwing flowers and sunshine in everyone’s path. But I do remind myself of my responsibility to care for all of God’s children, and that has changed what my eyes see and what my heart knows. I have also learned how to take care of myself as I go about my life’s work and ministry. I am also a child of God.
Would it come as a surprise to you to know that in my parish I serve as a leader of the Lazarus Ministry and the Bereavement Ministry? I did not choose to surround myself with ministries of consolation. God chose that for me a long time ago and I have just discovered his plan. What a relief!
As I walked out of the ER the other night, I saw Tony again, crossing our parking lot and singing at the top of her lungs, an old Marvin Gay song, “What’s Goin’ On?” and I am reminded again what my heart knows.

- by Susan Commini (CLEM 2008)