Spiritual Care

How I Heard

Phyllis, above left: Our Spiritual Care protocol is to give me the earliest heads up when something out of the ordinary is happening -- even when it is only a possibility, but especially if it is something BIG. So when my house phone rang at 2:14 am and the caller ID showed it was Orlando Health, I immediately thought, Oh, God, this is not good! Regina Nevels was our chaplain on duty on the campus, and she told me there was a possibility of 20 gunshot-wound victims coming from the Pulse nightclub only three blocks away. That proximity to our campus meant the patients would arrive before additional chaplains could get there. Once again, I thought to myself, This is not good!

After getting her update, I texted every chaplain on our team at 2:25 am. I indicated “Mass Casualty Incident,” “Gunshot Wound - 20 victims,” “Report to ORMC IMMEDIATELY.” Two chaplains texted back immediately, “getting dressed, on my way, about 30 minutes ETA.” I then began to call chaplains’ cell phones and home phones. My call scared the wife of one chaplain so much that she told me I had the wrong number. I knew it was the right number and that at this time of the morning I probably scared her, so I immediately called back. Our chaplain answered, “Yes, chaplain, what is wrong?” I informed him of the mass casualty incident (MCI) and the number of patients. He said he would dress and be on his way into Orlando Regional Medical Center (ORMC).

Synopsis

June 12, 2016, happened to be a Sunday and many of us were expected to be in our church pulpits or at least on the platform for morning service. It also fell during Ramadan, so my Muslim chaplain had been fasting. Regardless, our feelings were that we had to be at ORMC Level One Trauma Center and do what we do every day: identify the patients, obtain next-of-kin contact information and notify them their loved one was here.

Preparation

After notifying our chaplains, I continued to communicate with the chaplain on campus. Regina was our per diem chaplain and only had been with ORMC for six months. Her only trauma experience was from her orientation time and those six months.  She had completed her first unit of Clinical Pastoral Education at another hospital system, but it did not have a Level One Trauma Center. Trauma is very, very different in the type and number of patients ministered to, and the role, duties and responsibilities of the chaplain in collaboration with the clinical interdisciplinary team. Six months of experience, wow!  Thank God, in March when we had our community-wide MCI drill, I had approved for her to come in and participate. Never before at ORMC had a manager approved any per diem chaplains participating in MCI drills, but my thought was they serve on the weekends and at night when there is a huge possibility of them being on duty, by themselves, when a MCI could occur.  My fears proved to be correct. She was the ONLY chaplain on the campus when this incident began. The budget and the hours for her to be at the drill proved invaluable. She followed department protocols extremely closely, which enabled our rapid response. Through our training and team work, we were able to identify patients in a more timely manner, rotate chaplains so they could  preach in their churches or our Muslim chaplain could pray during Ramadan and limit to only three the number of chaplains working more than an eight-hour shift.

Response

While I drove to the hospital, I continued to speak to my chaplain on duty. My concern was not what I was feeling, but what my chaplain was feeling. As a manager -- shepherd of the chaplains -- it is my responsibility to care and support them. I didn’t want her to feel abandoned or that she was in this all ALONE. We, her colleagues, were coming to support and assist her as quickly as possible. Reinforcements were on the way. Before long, two chaplains had arrived and others were nearing campus.

At this point, my focus moved to the arriving chaplains. I knew there was concern that a shooter could be on our campus and wanted to avoid anyone having to walk in alone. We do not wear uniforms, but dress in professional business attire and wear our ORMC team-member identification badge. I tried to reach one chaplain who was on his way, but he did not answer his cell phone. I called the other chaplain still en route and she could see him walking down the sidewalk toward the hospital entrance. I told her of my concerns and asked her to pick him up in her car and park on the 3^rd floor of the garage so we could all walk in together. Which is what we did. As we walked into the employee entrance, we encountered a SWAT team walking out of the cafeteria with rifles drawn. I am so glad I focused on “my” chaplain team members first and provided the best possible support and care for them and their safety. This is the heart of the manager, “the shepherd,” to care for his sheep.

With six of us now on the campus and patients continuing to fill the ED/Trauma Center, our focus all went to our patients. All trauma patients are given a doe name, City, Month, Doe (Albany, June, Doe). It is the chaplain’s role and responsibility to identify the patient, obtain date of birth and emergency or next-of-kin name and contact information. Many of the patients from the nightclub did not have a driver’s license or other identification on their person. It is essential that we have a picture identification to ensure this is the patient. Our chaplain team had identified 24 of the 44 victims by 7:00 am and family/friends had been identified for 19 of these patients. This is what we do as chaplains in the trauma center on a normal daily basis, just not to this magnitude and intensity. Our chaplain team did an amazing job!  We were prepared, followed protocols and procedures, and will never look at MCI drills and each other the same.

Since my feelings are from the manager “shepherd” point of view, I wanted to share the perspective of the chaplain on duty. She had taken the role of trauma chaplain at ORMC only six months earlier.  In her own words, this is how she felt and what happened as she processed the night’s events.

Chaplain Regina Nevels, above right, was on duty June 11, 2016, for the overnight trauma shift that typically goes from 11:30 pm to 8:00 am.

On June 11, I was on the midnight shift. I kind of rested all day, but felt this uneasiness the entire day. I spent the first part of the morning with my grandchildren, then went over to my daughter’s house so she could do my hair. I got home about 6:30 pm and ate something, ironed my suit for the night and laid out all my accessories. I finally got in bed around 7:00 pm after covering my window with a navy blue sheet to darken the room.  I set my alarm for 10:00 pm.

I must have dozed off after a while, but it was not a deep sleep, because I still felt like I was awake. When my alarm went off I remember jumping up and having that uneasy feeling strong in my stomach. I thought it was from being startled awake by the alarm clock. I began to get ready for my overnight shift. I remember praying on the way to work, Lord, I don’t know what’s going on, if this is anxiety, your word says be anxious for nothing, so please take it away. Lord, I’m not sure what this is but I need your help, you know what’s going on.

As I headed to the Trauma Bay, I walked as fast as I could because I know how important it is to get there before EMS leaves. We have to make sure that we gather as much information from them as possible in case the patient is non-verbal. I got on the elevator and pushed the button for the first floor. I was looking through my bag to gather pen and my log sheet so that as soon as I walked in I would be ready.

I walked in the Trauma Bay and there were about 20 nurses, physicians, techs and others surrounding two patients in trauma bays 2 and 3. The room holds 6 trauma bays. I stood there for a moment when I heard over the speaker that police were bringing in another victim  by car and two more were on the way. I thought, What is going on? I am going to need to call Phyllis because the two patients I was just with are going to die tonight and I am going to need help.

Panic started to rise in me. Again, I thought, I have to call Phyllis. I grabbed my Ascom and with shaking hands tried to look for her number and could not find it. Then I pulled out my personal cell phone and tried to remember where her number was, but I could not think straight. I knew I had her numbers as I called her so many times from my phone, but I could not find it and time was wasting. I recalled the yellow sign in the office with her number and her daughter’s number, and took off running down the hall to find it.  I tried a few times to put the code in to get in the door but I kept messing up. Finally, I got in and dialed her number as I was running back out of the door. I told her about the two patients up on other floors and the patients in the trauma bay. She said, “OK I will get dressed and come in.”

As I got back to the trauma bay, there was another patient being brought in the room. Then I heard something that I never imagined I would hear. There are 20 more on the way and then more after that. I thought, Oh my God, what is happening. They said there is a shooting at a nightclub. I immediately dialed Phyllis back and said there is a shooting at a nightclub, 20 more are on the way and that there will be more coming. She said she would call for back up and be there as quickly as possible.

Immediately I began to get to the eight patients who were now in the room. I knew that I had to identify them before they died, were intubated or moved, or taken to surgery. In my six months as a chaplain at ORMC, I had never witnessed anything like what I saw that night. I have had to go through bloody pockets to retrieve information, but not like that. I had to change my gloves several times because they would be filled with blood as I looked through blood-soaked pockets for identification. I talked to a patient who had been shot four or five times, including once in the neck. He was yelling “Help!” as blood squirted out of his neck. In the midst of his pain, I had to ask his name, date of birth and who I could call.

As I worked my way through the room, I thought…..This is not happening, this is crazy Lord. Lord, you have me here for this, this is crazy. I remember going through the pockets of a patient and finding his completely blood-soaked wallet, and having to wipe the blood off with my gloves and then changing the gloves again and again just to obtain his information. I thought, This can’t be happening. Who would do this?

I looked over and saw a man on a stretcher still tubed and his body was still jumping. For a moment, I stood there and thought, Why is he pushed off to the side, why is the tube still in his mouth? Is he OK, is he going to surgery? Then I asked and they said he is dead as they  pushed another dead body on a stretcher next to his and  several more patients were brought into the room. I could feel evil.  I felt the fear. Then I said, Lord, please send Michael, Gabriel the Warring Angels to stop this, this has to stop, Lord, please help. As another victim came into the room, I went to her bedside to gather her information.

Finally, I looked up and either Chaplain Steve or Chaplain John arrived first, I can’t recall which one. I wanted to fall into their arms and cry, but I knew I had to keep it together. I wanted and needed to be held at that moment, but I had to be strong. I pushed those emotions to the side and updated him on what I had done, then I heard Code Silver (Active Shooter) in Triage area. Chaplain Steve said to take cover. I saw a group of people running out of the ED area toward the service hallway, so I ran with them.

We ran down the hall, which was the same hall our office is on and they ran to the left. There was a guy holding the door, beckoning everyone to follow him. It seemed like I stopped and froze to think about where I wanted to go. I remember thinking I don’t want to get trapped anywhere. I can run in my office, but I would be alone, or I can make it to the front door and run out of there, but I knew if I did, I may have kept running. I knew I had my phone, but my keys were in my purse in the office. But I had my phone and could call my husband.

The guy was beckoning me to follow them, so I ran into the basement and we locked ourselves in another office. When we got down there away from the doors, I could still hear people running. I was so afraid I didn’t know if we would hear screaming and gun shots, and what if the shooter followed them or found us. I called my husband first and told him to pray. I called Phyllis back and told her that they called a Code Silver and that I was safe in the basement. She said, “Oh my God, I am on the way.” We heard someone coming down the hall and we ran further back into the office and got down near the floor. There were about 10 of us. Then someone opened the door and everyone jumped. It was one of the employees. He said he thought it’s cleared, but would let us know. Then another guy looked out of the peep hole on the door and said he saw police and went to open the door. I told him not to open the door because we don’t know if it’s the police or not. He said, “You are right.” So we waited what seemed like another 20 minutes before we found out it was clear.

We stayed together and went back upstairs. As we got back inside the door of the ED area, they called the Code Silver again. There was a tech standing at the door telling us to come in the CT scanner room, and we hid under the tables in there. At this point, I’m like, Lord, you have to do something. I called my pastor friend in Detroit and told him briefly what was going on and to please pray. I put him on speaker phone as he began to pray. I felt a sense of peace and calm, and knew that we/I was going to be OK. Then they cleared it again. As we left the room, they called the Code Silver again and a physician, an ED Guest Rep and I ran and locked ourselves in the break room. The physician and the guest rep  hid under the table, but I just stood up. I didn’t have that fear now, but I knew to be wise and stay away from the door.  They cleared it again. The three of us had to use the restroom and none of us wanted to go alone. So we decided to stick together and go in one of the staff bathrooms together.

By then, I was emotionally, physically and spiritually exhausted. I didn’t feel like I had anything left in me. Yet victims were still coming in. Some were still dying. As I headed back to the Trauma Bay, I noticed three stretchers in the hall with the cover pulled over each of them. I had this sick feeling in my stomach. But what caught my eye were these shoes that must have once looked very pretty. They were purple with about a 4-inch heel. And they were stained with blood. I thought about the young girl who was wearing these shoes and I wanted to pull the cover back and see her face. I stood there for a moment and thought how I would respond if I pulled the cover back and her eyes were open or she was shot in the face. For some reason I really wanted to see her face. Maybe to identify her, I’m not sure. I stood there for a few seconds as I thought through this situation and decided not to pull back the cover. Instead, I walked back toward the Trauma Bay.

Shortly after I got back in the Trauma Bay, Phyllis and four other chaplains were able to get in. Phyllis looked at me, pulled me to the side and let the others take over. I wanted to fall into her arms and just cry, but again, I told myself, You are OK, be strong, you have help now, it will be OK.  She asked had I eaten. I wondered who would want anything to eat at a time like this. I didn’t feel as if I would ever eat again.  She asked if I had water and to go get some water. I did not want to go anywhere in that hospital alone. She kept me off to the side for a while and assured me I had followed protocol and that I did everything as we were trained to do. I felt like I didn’t do everything I could have. I ran and left the patients during the Code Silver.  I wasn’t able to accurately keep up with all the patients. I couldn’t get to some patients because I could not keep up with the pace. For all that, I felt like I didn’t do a good job.

Instead, I felt completely numb inside and to everything around me. I just wanted to go home. I didn’t want to talk. I had seen and heard too much that night.

Finally, Phyllis asked if I had charted anything that night. I told her about the two patients dying that I had been with prior to the shooting, so she told me to go to the office and chart and drink some water. I thought, I don’t want to go by myself, I am afraid. But I didn’t want to seem like a wimp. I did not want to look like I couldn’t handle the situation and lose my job. I had so many emotions I remember saying to myself, OK, Gina, keep it together, you see this all the time, this is how your shifts are. You always have a bunch of patients, this is no different. You get people dying from gun shots on your shift. I remember telling myself, You are OK. So I left the Trauma Bay and headed toward the office. The halls were empty and I was afraid, so I ran to the office — not real fast but fast enough to get out of the empty halls quickly.

I got into the office and looked in the mirror and I wanted to rip my chest open. So much pain. This was a horrible nightmare. So many deaths. Why? Who would do something like this? I looked on the internet for any news and nothing was there. Finally, Phyllis came in the room and I pushed those thoughts to the side. She said, OK, we have to chart, you start charting. I signed onto the computer and set up log sheets, but I could not find any words to type. Phyllis had to literally pull her chair up beside me and tell me word for word what to type. I had nothing in me.  I was numb and no words came to my mind. One of the chaplains came in and said the name of the nightclub and that 20 more victims were on the way. I Googled the name and saw that it was an LGBT club and wondered why this was happening. What is this about?

I had to go back to the ED and see more patients.  I am sure at this point I was just a machine. Doing my job. I had no compassion, no emotions, nothing to give. I remember looking for Chaplain Steve. I found him with a patient and he was crying. I did say to him, “Thank God you are alive.” He said, “Yes, God was with me, I’m never going out again.” I said, “He kept you.” That was the extent of my pastoral ministry that night.

The hurting thing for me about that night was not providing pastoral care. I could not say to one of them that it was going to be OK. I could not comfort one person, because there were so many coming in right after another. Maybe I could have slowed down. If I had it to do all over, I don’t know what I would have done differently.

One thing I learned about myself is that through the grace of God I was able to keep it together at a time when it was expected. I used to have fear of working in a hospital and seeing blood and horrible wounds, but that night I saw what I saw and kept moving in the midst. I surprised myself.

I know those I spoke to were relieved to know we would be contacting family for them. I know that gave them some comfort.  After finding out this was an LGBT club, I thought, Why? Lord, you love all of us. I began to ask God questions. Lord, why did you let some live and others die? I couldn’t understand this. Did some of them not accept you? Why? I asked a friend and she reminded me that God has mercy on whom he would have mercy. I thought, Wow! I stopped asking God the why after that. I know that He loves the LGBT community just as he loves me. God is still a good God. One thing I learned about myself is that I am strong.

What We Changed

• We will bring our newly hired chaplains as well as our weekend/night pool chaplains in for the annual March community mass casualty drill.
• We added not just a scribe to maintain and communicate the “master” list of patients, but a second scribe in case the first scribe is not available.
• We will obtain patient lists from other Orlando Health hospital sites as well as other local hospitals.
• More communication was added, not only with the incident command center, but with business office manager/representative and care coordination as well.

Conclusion

A bedside chaplain’s and a manager’s feelings and concerns are very different, but each has a ministry role and cares for the “flock” they are “called” to serve. This is an example of servant leadership, and the role of leading by serving and demonstrating how to care for those under your leadership.  As chaplains, we minister to different “patients” — there is the patient in the bed, the family, the clinical team and those we manage/lead.

Key Takeaways

• Call in additional chaplain support as needed in a mass casualty event, per our department protocols.
• If a manager is out of town, ensure that the mass casualty plan/contact/role/protocol plan is in place throughout the absence.
• It is vital to include our newest hires in our emergency preparedness exercises, including the March community mass casualty drill
• We must have a scribe and a secondary scribe to maintain the “master” list of patients in a more timely manner.