The new chaplains and the ER

Emmanuel Ayedzi has seen emergency departments erupt into feverish action around him.

Ayedzi had previously worked in acute care as a spiritual care practitioner with Fraser Health. He had the experience to handle an ED, and thought he knew what he was getting into. 

“But I thought, ‘Wow. This is something else,’” he said. “It was a different category altogether,” 

Emergency rooms can be scary places. Patients with serious injuries and illnesses arrive for help. Pain and worry punctuate long waits. Ambulances and helicopters bring victims of car accidents, prison violence, and unforeseen calamities. 

And sometimes, people die. Another layer of fear permeates the department, invisible but tangible nonetheless. It settles in the hearts of patients, their family, and the staff looking after them. 

That’s why Ayedzi is there. 

Ayedzi is part of a pilot program putting trained spiritual care practitioners in emergency rooms in the Fraser Valley. Looking after spirits in a secular institution is a delicate dance—one that the intensity and pace of an emergency department transforms.

In the ER

Ayedzi had always felt pulled towards work in prisons and hospitals. Before joining Fraser Health as a spiritual care practitioner, he worked in nearby federal institutions.

“It was something that was calling me to the bedside,” he said. A pastor for over 20 years, he felt that the people most in need of help, whom he most wanted to assist, were not always in the congregations that gathered on Sunday mornings.

“So I made a little bit of a shift to see if I can bring my profession and my expertise into the hospitals instead,” he said. “And here I am. I don't necessarily practice religion here. But I bring the skills, the care, the love I have to people regardless of their background, their faith and their status.”

That shift led Ayedzi to train as a spiritual care practitioner.

Spiritual care practitioners—formerly known as chaplains and sometimes today called multi-faith chaplains—have worked elsewhere in Fraser Health, largely in palliative or long-term care, but have only recently started working in ERs, thanks to a new pilot program. 

The program puts spiritual health practitioners in emergency departments in Surrey, Langley, and Abbotsford. Its goal is to maintain the spirit of patients and their families as they handle emergencies—and to see the impact of spiritual care in an emergency environment.

Practitioners are trained and certified by the Canadian Association for Spiritual Care. Founded in 1966, the association trains professionals in psychospiritual therapy and holistic spiritual care. Spirit, the association defines, is a “universal dimension of human experience, a life energy, and a connection to the transcendent that promotes resilience in the face of challenges.” 

The physical practice of caring for someone’s spirit, though, doesn’t usually involve words like “transcendent.”

Ayedzi describes his work in a roiling ER as a series of questions.

“I’m asking the question in my mind, ‘Okay, why did this person come?’” Ayedzi said. He’s also wondering: who is their family? Will they be on the way? Will they be able to cope with this situation? 

And, after, he asks himself how his colleagues—the nurses and doctors who helped the patient—might be processing the experience. 

Spiritual care is work that, traditionally, happens slowly. The bedsides that Ayedzi worked at earlier in his career would often be in quiet rooms—not on wheels sitting in, or rocketing through, a hospital hallway. In the emergency department, spiritual care is decidedly different.

“It is very broad. It is very fast,” Ayedzi said. “And I have to be very intuitive on-the-go alongside the medical staff by way of making a difference.”

Ayedzi described his work as walking on a journey alongside a person who has lost someone or is ill themselves. He wants them to achieve their personal goals, maintain a sense of self worth, and “to articulate their sadness very well.”

“We are here to help individuals retain a sense of meaning and purpose, value and hope,” he said. “Because this is scary.”

Being present

Don Cowie, another spiritual care practitioner in Fraser Health’s pilot program, works in an ER in Surrey. He agrees that the relationships formed in emergency situations are different from those he might have seen otherwise in his work. 

In the ER, Cowie’s role is often to help people, especially family members of patients, handle the shock of a crisis and the confusion surrounding it. Like Ayedzi, he often focuses on helping people put names and faces to their feelings and help them connect to places they have found strength and courage in the past.

“A calm, compassionate presence can help people process what they're thinking, and maybe name some of the feelings they have,” Cowie said. “It’s been shown to really help people—it changes the way our brain works when we're naming our feelings and able to articulate about what we're going through.”

Spiritual care has also had practical, medical effects for patients examined. Studies have demonstrated impacts that range from shorter hospital stays to better pain management to a higher motivation to heal.

While emergency departments make for different, shorter relationships, the main goal of spiritual care is often the same as it is in other places in the hospital. 

“It's always about being present in the moment with people, but in an emergency it's even more so like that,” Cowie said. “And chances are I won't see that person ever again.”

Another part of the practitioner’s role, in any hospital setting, is asking someone what, if any, religious community they have been a part of in the past. The practitioner can help them get reconnected to that community for longer-term assistance in handling the fallout of the emergency that sent them to the ER in the first place.

The next class

Cowie stepped into his role in Surrey after he had taken on a teaching role training the next generation of spiritual care practitioners. Fraser Health needed someone experienced who could be in Surrey Memorial’s ER once a week. Cowie waded into the fray.

Cowie emphasized that the work he does—both teaching students and looking after patients and their families—isn’t new. Spiritual care practitioners follow in the footsteps of a long history of Christian chaplains who worked in armies, hospitals, and prisons. Emotional and spiritual care, practiced alongside physical care, has always been important, Cowie said. 

Whether or not it is important enough to be funded by the public, however, has been the subject of various debates over the last 30 years. In 2009, Fraser Health fired a dozen spiritual health directors to save money. Social workers covered the gaps they left and local churches fundraised to try to pay for the positions for three years. The pilot project in emergency rooms is part-time (one or two days a week in most cases) and is not the first return to official spiritual carers in Fraser Health. Other practitioners work in long-term and palliative care in the area.

Today, the definition of spiritual care is getting a little wider every year. While traditionally a field dominated by various Christian denominations, more and more students with different understandings of what spirituality might mean are joining classrooms like Cowie’s. 

“I think a lot of the people training come from a Christian background, but I have had very diverse students,” Cowie said. He’s taught Muslim, Buddhist, Jewish, and Sikh students, as well as trainees from a “broader, spiritual, non-identifying [background].”

Diversity in classrooms is translating into diversity in the wider practice of spiritual care. 

“We’re evolving in that way, and really, really seeking ways of embracing and broadening the field of spiritual care,” Cowie said.

Diverse religions

While the classrooms that Cowie teaches in are increasingly diverse and starting to include the increasingly wide variety of religions practiced by the Fraser Valley’s families, the pilot program that puts spiritual care providers in emergency rooms hasn’t gotten that far—yet. 

Cowie and Ayedzi both have backgrounds in Christian ministry. As far as they know, there isn’t a spiritual care practitioner with a different religious background in an ER in the region. (Outside of ERs, they noted, there is some more religious diversity in spiritual care providers in the valley. Indigenous elders have also been part of the spiritual care network in local hospitals.) In an email, a Fraser Health spokesperson said the health authority could not confirm the backgrounds of practitioners

Ayedzi said that the pilot project was just getting off the ground, and that Fraser Health was looking for experienced practitioners who could jump right in.

“I think those are the people who were there,” Ayedzi said. “It is just because we don't have people from other faiths yet in the pilot project. Yet.”

Different theologies

Spiritual care providers aren’t associated officially with any one particular religion. But often, people who want to become spiritual practitioners are interested in the role because of personal faith backgrounds. Some, like Ayedzi and Cowie, arrive in it after holding leadership roles in their churches. 

But that personal faith isn’t necessarily set aside in the pursuit of multi-faith spiritual care. For some, working outside of traditional models of faith and ministry is not an act of putting aside religious allegiance but of moving beyond traditional understandings of how that faith ought to be acted upon.

Cowie said learning to operate in a more secular program felt great. 

“I had kind of been evolving and in my own understanding of theology and spirituality,” he said. Cowie had a background in ministry but, in his words, was “out of it” for a while before training as a multi-faith spiritual practitioner. 

“It was really a great fit for me to move into this broader context of meeting people really just where they're at and not really bringing anything to them, but more being present to them, and helping them discover what it is for them that brings them strength and brings them meaning and purpose.”