Prophetic Kindness: Perspectives from a Safety-Net Emergency Department
Jenna Frush, MD, and Samuel Lowe, PhD, Boston Medical Center
Boston Medical Center has served as the social safety-net hospital for the city of Boston since its inception in 1864. It simultaneously functions as the busiest trauma center in the northeast and a focal point for resources for patients who have been relegated to the margins of society for a myriad of reasons, including chronic illness, substance use disorder, economic struggles, and mental health challenges. Perhaps this is most evident in the bustling, often overcrowded, emergency department (ED) where many patients spend hours, and even days, in hallway beds leaving little opportunity for peace, privacy, or rest. And while the ED has historically served as the vanguard of the hospital, the mounting political, economic, and social upheaval has further marginalized society’s most vulnerable populations who often seek respite there. Further, interactions in the ED may be construed as terse, one-off, and impersonal, as ED practitioners continue to field the brunt of various misaligned healthcare policies and priorities. BMC, then, is an institution comprised of people who are suffering precisely because they have been oppressed, orphaned, and widowed at the hands of a society whose interests lie more in monetary profit and efficiency than in human flourishing.
Where might the gospel inform our care of these patients? In conversation with Chaplain Sam Lowe, BMC’s Director of Chaplaincy Services, we will look to Isaiah 1:10-17 in hopes of naming a prophetic response to the current state of healthcare, particularly in the emergency department. We will begin our conversation with a brief history of BMC, formerly known as Boston City Hospital, paying particular attention to its roots as a charitable institution in an urban setting. I, then, as an ED physician, will offer a perspective of the healthcare challenges unique to the emergency department, drawing upon interactions with patients to highlight the ways in which we may better serve their physical, emotional, and spiritual needs. We will discuss the implementation of specific practices, including a “moment of silence” led by the code leader in our trauma bays, and highlight how this is taught to our resident physicians. Lastly, we will explain and explore the ways in which seemingly small acts of kindness within a broken system – presence, hope, and sharing in lament – may be considered prophetic.
While we offer our approach at BMC as one example of a prophetic response to the current state of healthcare, we also want to explore how this may be established at other organizations. The first step is to create an infrastructure which requires the input and engagement of a diverse team. Clinical and support staff must be willing to acknowledge the importance of prophetic acts of kindness in the ED setting and willing to learn and/or engage in such behaviors. A team of providers and caregivers who are compassionate for and proficient in meeting needs of underserved populations must be established, including but not limited to chaplains, social workers, nurses, physicians, and other stakeholders. Importantly, this effort will require the support of administrative and clinical leaders to provide financial and other resources to address challenges and barriers that may arise.
Following our presentation, we look forward to reflecting with the audience in communal storytelling as a means of collective hope for the redemption of healthcare.
Where might the gospel inform our care of these patients? In conversation with Chaplain Sam Lowe, BMC’s Director of Chaplaincy Services, we will look to Isaiah 1:10-17 in hopes of naming a prophetic response to the current state of healthcare, particularly in the emergency department. We will begin our conversation with a brief history of BMC, formerly known as Boston City Hospital, paying particular attention to its roots as a charitable institution in an urban setting. I, then, as an ED physician, will offer a perspective of the healthcare challenges unique to the emergency department, drawing upon interactions with patients to highlight the ways in which we may better serve their physical, emotional, and spiritual needs. We will discuss the implementation of specific practices, including a “moment of silence” led by the code leader in our trauma bays, and highlight how this is taught to our resident physicians. Lastly, we will explain and explore the ways in which seemingly small acts of kindness within a broken system – presence, hope, and sharing in lament – may be considered prophetic.
While we offer our approach at BMC as one example of a prophetic response to the current state of healthcare, we also want to explore how this may be established at other organizations. The first step is to create an infrastructure which requires the input and engagement of a diverse team. Clinical and support staff must be willing to acknowledge the importance of prophetic acts of kindness in the ED setting and willing to learn and/or engage in such behaviors. A team of providers and caregivers who are compassionate for and proficient in meeting needs of underserved populations must be established, including but not limited to chaplains, social workers, nurses, physicians, and other stakeholders. Importantly, this effort will require the support of administrative and clinical leaders to provide financial and other resources to address challenges and barriers that may arise.
Following our presentation, we look forward to reflecting with the audience in communal storytelling as a means of collective hope for the redemption of healthcare.