Winter is a hard time for many. This is especially true in rural areas where weather often has a more immediate relevance. People live along roads that may be made impassible by snow, treacherous by ice, or deadly by rising water. Trees fall on houses and highways. Power lines snap before the power of ice-caked tree limbs. Those in very remote areas are often the last to see their electricity restored.
Of course, it’s hard for other reasons. Winter is a time of depression and financial hardship. In part because of the prolonged darkness and confinement indoors. Also because holidays (and our expectations of them) make inadequacy and remorse rise to the surface. People often attempt to push them down again with alcohol, drugs, or suicidal behavior.
The changes of winter are stark reminders that in the emergency departments of America, physicians, nurses, and others find themselves the last — and often only — resource for dealing with the social and psychiatric struggles of patients. Trained to manage the physical ailments of the human body, these other needs brought to us can leave us feeling our own kind of inadequacy.
Rural America, in particular, suffers from too much opioid abuse and too much poverty. Lack of work, loss of culture and connection, and dissolution of the family. All of these plague rural Americans. Mental health issues are thus epidemic, but there are a precious few mental health and social workers. I won’t even use the word ‘psychiatrist’ since they’re practically mythical in small town USA. In addition, there’s too little money to adequately and universally intervene in the personal struggles of our patients who need medications and therapy to deal with their assorted mental health issues.
What’s an ED to do? We face overwhelming need coupled with federal mandates to take care of everyone, and we are iced over (winter pun intended) with insufficient funds or staff to do it all.
Since I’m writing a lot about rural healthcare, here’s a thought: Rural America tends to be more religious than urban and suburban America. And as a Southerner, I can attest that “you can’t swing a cat” in small towns or rural areas without hitting a church of some flavor.
There are big deal Baptist churches and tiny community churches with 10 families per Sunday. There are socially “woke” Methodist churches. There are animated Pentecostal churches and sedate Lutheran churches. There are devout Churches of Christ and Catholic churches where Mass is celebrated surrounded by mountain grandeur. I could go on. Suffice it to say, all around rural hospitals there are congregations, priests, and pastors who want to serve those in need.
The church my family and I used to attend had a wonderful food bank that was open several days each week. One church in our area has a program to help young mothers find work and another provides clothes to children in foster care. There is a faith-based addictions program in our town that has helped many people who are struggling with substance abuse. And those are just in the area where I live now.
I’m confident that in small towns across America, there are churches with many services to offer those in need — even if it’s only the service of a listening ear and perhaps a new group of supportive people to help in times of crisis.
Many of the mental health issues I have encountered in my career seem to ultimately stem from personal pain and loneliness. While I’m not denigrating the importance of those who work in mental health professions, I would say that often enough, connection and love are therapies of inestimable value.
I suggest that directors of emergency departments, hospital social workers, and others in small, rural settings try to purposefully reach out to the faith-based communities around them. The contact information of willing outreach ministries and clergy should be in the EMR to be included with instructions as needed. Appointment times and lack of insurance may preclude a visit to the psychiatrist, and insufficient staff may limit access to the community mental health clinic. But those are not factors in community houses of worship.
And although I am saddened by the lack of chaplains in hospitals these days, I think a return to a chaplain rotation would be a great asset, especially in times of tragedy. It isn’t as if we can call typically a counselor or psychiatrist and have them come to the bedside. But odds are that there are pastors, priests, and laypersons who would. Having been a deacon myself, I know that there are untold numbers of men and women willing to serve.
We live in a cynical time, and the medical profession is sometimes unnecessarily skeptical of religion. But in a world of great hurt, perhaps a connection to the loving, serving believers of the world might make our work in the ED a little easier. Something is better than nothing to a patient with a broken heart or broken life.
And that’s true winter, spring, summer, or fall.
Edwin Leap, MD, is an emergency physician. He practices full-time in a rural community hospital in South Carolina. He has spent many years practicing in rural and critical access facilities, including work as a locums provider for Weatherby Healthcare. He is a writer and blogger. He and his wife have four children. See more at www.edwinleap.com.