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CaseConference #12 (Scroll down to read responses)

A 16-year-old delivered a baby by caesarian section. The baby had cardiac anomalies which were discovered earlier in the pregnancy.

A large number of persons were present with her and the father of the baby at the hospital. The family identified themselves culturally as Gypsies.

After delivery, the baby was transported to the Nursery Intensive Care Unit. While numerous family members remained in the hallway outside the LD operating suite, several others went to the NICU demanding to see the baby.

Staff in both units attempted to explain the need for family to wait in the designated waiting areas, to lower their voices, and that medical information about the baby's condition could only be provided to the parents. Family members, including the patient's mother, became even more vocally upset in the units and connecting hallway. The nursing supervisor paged the chaplain to respond.

What is your role as chaplain in this situation?

Is crowd control part of your job?

Does the fact that the family "members" identify themselves as Gypsies affect how you deal with them?

What is your responsibility to the patient and his parents?

What is your responsibility to the staff who requested that you intervene?

CaseConference #12 Responses

My obligation to staff is to help them deal with patients and families. I believe staff has called me because the family is less likely to see me as aligned with NICU/LD. The staff hopes I can bring peace to the group.

My obligation to Pt and family is to provide spiritual care within the context of their culture-as nearly as possible--and to help negotiate between them and hospital "authorities/rules."

Sometimes crowd control IS a chaplain's business; sometimes not. In this case, I believe I am obligated to try.

The fact that the group self-identifies as "Gypsy" raises some possibilities in my mind, based on "generalities" I have read about Gypsies, and based on the behavior (as reported to me) of these Gypsies:

1) Gypsies stick together, in loose family groupings, trying to be autonomous from the Dominant Culture
2) Often there is mutual distrust between Gypsies (counter-culture) and the Dominant Culture
3) Dominant Culture acquiesces to "appeals to logic;" and thinks Gypsies don't "act right"
4) Gypsies have been frequently persecuted
5) Gypsies have a reputation-deservedly or otherwise-of lying and stealing (which, of course, raises the question of what "careers" that fit within their culture are available to them... Which came first--?)

All of these things suggest that the people outside NICU and LD are probably behaving in a culturally correct manner. They are worried about mom and baby, and wonder what is going on that they cannot see. They may wonder whether staff is treating mom and baby properly, if staff really cares about a gypsy mom and baby. They truly do not understand somebody's "rule" that the family cannot be with young woman and baby. Their culture says they should be together. Being together may be more important than specialized medical care. They are probably fighting the "rational logic" of the Dominant Culture with their own tactics, that are based on the truth inherent in this statement: "When (a minority) gets loud, white people get nervous."

My first tactic would be to do my own assessment of noise-level and "disruption."

Next, I would want to locate the cultural "leader" and talk to that person. What are the issues? What is at stake? What needs to happen?

Finally, I would offer to serve as the go-between or negotiator between hospital and Gypsy cultures: How can each "side" flex in order to reach a mutually agreeable solution?

Chaplain Kate Zon
Carondelet Health's Saint Joseph Medical Center
Kansas City, MO.

Please check the archives below for comments made about the last CaseConference.

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