The Last Shift

by Susan Palwick

In mid-May 2012, after over seven years of volunteering at the hospital, I worked my last shift as a lay chaplain in the ER. My faith-based hospital, bleeding out financially, had been sold to a secular for-profit healthcare company. Ten days earlier, I’d learned that one of their first changes had been to cut the Spiritual Care Department. Because there would no longer be staff chaplains to supervise volunteers, the volunteer-chaplain program had been cut, too.

Volunteers were assured that there would be roles for us elsewhere in the hospital, although—along with paid staff—we would have to reapply for our positions. My supervisor urged me to volunteer with hospice, where I could probably still work in a spiritual-care capacity. If I wanted to keep working in the ER, I could volunteer as a patient advocate. In that role, I’d still be able to visit and talk to patients; I just couldn’t call myself a chaplain or use the word God. A doctor told me, “Look, just do what you always do, but call it something else.”

Preach the Gospel without ceasing. Use words when necessary.

Plenty of my work in the ER doesn’t look explicitly spiritual. Over those seven-plus years, I’ve brought patients and visitors countless warm blankets and cups of water, had countless chats about pets and cooking and hobbies, tracked down reading material ranging from travel magazines to advanced-directive paperwork. If my name badge hadn’t read “volunteer chaplain,” if I hadn’t also offered to pray with patients, would it have made a difference?


My last shift included—along with the usual flurry of pleasant but superficial encounters—two significant visits. The first was with someone whose spouse had just attempted suicide. I introduced myself as the chaplain, but we didn’t talk about God. We talked about pain, about depression, about the effect of this event on the rest of the family. If I’d walked into the room as a patient advocate, the conversation would probably have been the same.

The second visit was with a patient who’d been brought in screaming, threatening bodily harm to nurses and EMTs. “I’ll kill you! I’m going to kill you! No, that’s not a threat: it’s a promise!” Three security guards had wrestled the patient into four-point restraints, but the patient still greeted anyone who walked into the room with howling, graphic descriptions of imminent homicide.

“You really don’t want to go in there,” one nurse told me.

“Why not try?” asked another with a shrug.

Since the patient was restrained and couldn’t hurt me, I sided with the second. I walked into the room as the patient squinted at me. “Hi. My name’s Susan. I’m the chaplain.”

The patient stared and then began to weep, reaching out a hand as far as the restraints allowed. “Chaplain! Will you pray with me?”

We prayed. The patient poured out largely incoherent, but unmistakably heartfelt, confessions of faith. When a nurse came in to take vital signs, the patient glared and said, “I’m with my chaplain now! She trumps you!”

“Actually,” I said gently, “since we’re in a hospital, the nurse trumps me.”

A few minutes later, when I left the room to visit other patients, my new friend started raging again, but for a little while, that part of the hallway had been blessedly quiet. I doubt I would have achieved the same effect if I’d walked in and said, “Hi. My name’s Susan. I’m the patient advocate.”

Preach the Gospel without ceasing; use words when necessary. Sometimes they’re necessary. Many patients respond viscerally to the title “chaplain,” to that small reminder that God is still with them. Removing that source of comfort is a huge loss for everyone.

I haven’t yet decided what I’ll do next. While I love the work of hospice, I also love the diversity of the ER, where most patients aren’t dying. I suspect that, after a few months off to relax and recharge, I’ll try to go back as a patient advocate, just to see if I can make the role work for me.

God will still be present. Many conversations will be the same as they would have been when my badge said “volunteer chaplain.” But others won’t, and I will no longer be able to offer what some patients most desperately need.


This article won the 2012 Honorable Mention for Personal Experience/First-Person Account from the Associated Church Press.

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