I haven’t written on this much, but felt that I’m in a good place to share my thoughts now that it’s been 2 years.

My dad had a stroke about 5am the day after Christmas in 2008.  When it happened, I fell back on a lot of the things I learned in CPE (Clinical Pastoral Education).  CPE is something almost all ministers of most every denomination are required to take during their training.  It wasn’t a bunch of classes; instead, it is primarily experience driven.   I think this quote about CPE from Wikipedia sums it up nicely:
“Learning in CPE is largely focused on the students’ development of the self. The students are introduced into encounter with persons in crisis. Out of an intense involvement with persons in need, and the feedback from peers and supervisors, students develop new awareness of themselves as persons and of the needs of those to whom they minister.”

So why is it they take this approach?  Because everyone experiences crisis differently.  The reality is that there really is no way to teach what you or others will actually feel or experience when another person dies, is informed of a terminal illness, is involved in an accident that will permanently affect you or a loved one, etc.  Yes, there is some minimal educational ground work that can be done to set expectations and understanding basic processes of how people deal with acute stress. (i.e. the 12 stages of grief)  But after that, it is a process of experiencing and participating – then taking time to reflect, connect what you learned, and process what happened based on your own beliefs and faith.  If one does this over time and with enough people, (hopefully) you learn enough about yourself, your faith, and how to be present to others so that one can actually be of service to others in those moments.  That’s what CPE (hopefully) does.

Unfortunately, this also means it’s limited by the individual student’s ability to cope with and process the experiences they have.  People must be in a healthy place themselves before they start.  Much of the screening (6+ months of screening to get into a 4 month program) is to judge some of that.  But the reality is that even when ‘ready’ you walk into CPE, it will expose all of your own unresolved emotional, family, political, relationship, faith and other issues.  This is ok so long as you are willing to properly deal with those emotional hits and not take them out or project them on others.  Your job is to listen to the person in crisis’ beliefs/needs/feelings/confusion and guide them to understanding of what it is they are experiencing and what their own lives are telling them.  It’s not about telling them what they should do/feel.  Some programs go so far as to even require their students simply reflect what the person is saying/feeling and do not allow them to even ask questions. (try THAT as a listening exercise with someone at some point).

So to that end, here are some things I learned (or re-learned) and probably are good to keep in mind if you or a loved one gets seriously or fatally injured.  This is mostly true for the first few hours of the event:

1. You will (all) be in a surreal state – You and everyone involved (save the hospital staff) will experience everything in a surreal state of adrenaline, grogginess (if at a weird time of day), and emotions that can be anything from fear/terror, anger, shock, disbelief, or even ambivalence. Your internal state will be in such a state that you’ve likely never felt it before both physically and mentally. But what will you feel exactly?  There are no rules and no two people will be the same – in fact, in different crises, the same person will likely experience it differently each time.  THIS IS ALL NORMAL.  Outside of obvious self-/other-/ or property destructive behavior – simply let everyone react as they are doing and tell yourself that’s ok.

In these moments, folks will react in the way their psyche and bodies need or dictate.  It will likely be strange and you’ll see sides of folks you likely never have – but again that’s ok and to be expected.  The only key is that you don’t try to force yourself or others into a particular response.  Don’t tell yourself or others that their crying needs to stop, or others must do a particular thing or act a certain way, etc.  As long as the behavior isn’t causing harm or getting in the way of decisions that need to be made in those moments – it is probably better to let it run its course.  It is the time to respect and let those things happen for everyone there.  If one person starts monopolizing interaction, or breaking into behavior that is utterly disruptive or combative, then you *might* calmly ask them what they need next (ex: asking if they’d like to go somewhere quiet, or just sit down, or hold the loved ones hand, etc).

Severe grief, destructive behavior, or completely disruptive/domineering behavior that is trying to force others into courses of action/disparaging/etc should not be allowed if it’s severely impacting others. The best answer for that behavior is to gently remove them from the immediate vicinity and have them speak their mind to good listener.  Most of the time this behavior comes from trying to take control of a situation that hurts that they cannot be in control of.

Here’s some common things people might experience/fall into.  But expect people to vacillate between several of them:

• Shock – babbling nonsensical things, fixation on details that aren’t important.  Some will just sit and cry, or waver between crying, disbelief, and back to crying.
• Emotional shutdown – the person just shuts down and may sit with a blank stare or walk out of the room, sometimes right in the middle when something huge is happening.
• Attempting to take control of the situation or become screaming angry – some people will react by trying to take control of what’s going on.  They’ll ask all sorts of questions of the staff/doctors or even get combative.  However, as long as they aren’t getting in the way of the doctor’s work – then this is ok.  The doctors are usually good about telling someone they need to shut up or leave if its interfering with their work.

2. Time no longer exists – You’re likely in the states mentioned above – and the normal way we experience time will be gone. Minutes might pass like hours, or if there is a lot of activity, you might experience 2 hours in the blink of an eye.  When you’re all said and done, you’ll be completely outside your normal perception of time.  Many people walk outside and realize half a day has passed.  Or that it’s now morning, or night.  This is why it’s ok to let people do much of what they do – because they don’t realize they’re in these strange states for as long/short as they are.  Again, all perfectly normal.
In that situation, if it’s clear that the situation will go on over hours, it’s time to be attentive to yourselves/each other.  Give each other permission as the situation allows to go rest in shifts, to eat, to get a shower, etc.  Nobody will want to leave at first, but it is absolutely essential. You can’t be there for the other person and process things in a healthy way yourself if you’re constantly in alert mode.  Severely exhausted people make worse decisions and are less emotionally capable of dealing with crises.  Offer to take turns sitting watch for each other. Sometimes the best thing to do is give others permission by example, “Bob, I really need to eat.  Please could you stay here and watch until X o’clock and I’ll do so for you after.”

3.You’ll shut out what most other people are saying – especially your family/siblings/close ones –  Even if you are really trying to listen to others, in the heights of crisis – you simply are in an altered state and will unlikely be able to process meaning/intent from words properly.  This is a good way to see where people are – because in these moments, all shields are down and people are responding with the raw guts of what they are feeling – not with their rationality intact.  Don’t get upset if someone screams at you, or breaks down in response to a simple question.

4.  You won’t know what to do – both during, and right after, you might feel like you want to run away.  You’ll feel like no matter what, you have to stay even though you can’t do anything.  You’ll feel helpless.  You’ll want everything back to normal.  You’ll just want the person back the way things were. You’ll be scared of what’s supposed to happen next.  You’ll be angry at doctors, the person in crisis, a sibling.  These are all normal things to happen; so don’t take them personally (or try to take them out on each other if you’re the one experiencing them).  Do, however, take note of them for later processing.  These feelings will all have to get sorted out in good time.  That is exactly what 1/2 of grieving loss is.  Don’t expect to be able to deal with it all right then; but don’t bury it all either.  Healing is the process of going through all those issues that came up – and it takes far longer to talk them out than it does to have them come up.

5. You are in trauma yourself! – When a loved one has an accident, or is rushed to the hospital, or is going through emergency surgery/etc, recognize that you will be kind of in a state of ongoing trauma yourself too.  Just like hard exercise creates tiny tears in your muscles, you are experiencing the ripping of your emotions and mental reality as the event is happening.  Sometimes it feels like waves of strange new reality or change just flowing over you, or perhaps the crumbling of things you held as true and dear.  This will go on until the situation stabilizes enough (person is stabilized physically, surgery is over, etc) that the outcome is known (they’ll live/die/etc).
While it’s going on, you’ll likely be left with tons of questions: what does this mean?  what will happen now?  what if they don’t get better?  what can I do? etc.  Sometimes it might be regrets.  These thoughts/questions very likely will unseat you – because they’re likely challenging the things you’ve known/loved a long time (my father’s always been there since the day I was born, what will life be like without him?).  Recognize this is normal and don’t try too much to bottle them up, or go crazy trying to answer them or acting out.  Just know these things WILL all get sorted out in time, and that there is no problem that cannot be overcome or dealt with given enough time and the help of others.  However, in the moment, you are experiencing trauma yourself – so be gentle with yourself and don’t try to force things.

6.  Fatigue will set in.  You’re in a massively heightened state of internal stress/activity that will feel like running a marathon; and you’ll get very tired without knowing why.  Be sure to be attentive to yourself and your own needs as time allows or you are setting yourself up for a physical collapse/emotional breakdown in which you’ll be no good to others or yourself.

7. These all apply to the person experiencing the trauma as well!  Don’t forget to realize/address these same things with the person undergoing the event.  They’re in a brand new situation in their life and perhaps experiencing their own mortality.  Maybe for the first time in their lives.  They might even know this is their last moments of life.  Talk to the person as if they are a real person – not some kind of little kid.  You might have to speak loudly and clearly, but address them as you would anyone else.

Probably the best lesson I’ve learned out of this was:
Dealing with loved ones and family is messy.  It isn’t efficient or the ‘best’ way to deal with things.  It is also essentially the lesson of what love is.

More in another post about steps we can take before the inevitable crises of life happen.