What I Learned Being an ER Trauma Chaplain

Leadership in the church is a weighty task. Unfortunately, the news is dotted with stories of leaders who have found themselves crushed under that weight and need to step away from their role. Just this week, I spoke with two leaders who have asked for insight and prayer to regain health in a role where they find themselves driven by the next service, the next plant, the next leadership initiative.

Because we believe in healthy leaders, we are happy to partner with Steve Cuss, lead pastor of Discovery Christian Church, in his book, Managing Leadership Anxiety: Yours and Theirs (Thomas Nelson). His excellent work offers valuable principles to help leaders understand the anxiety and the weight of leading. His insights will help leaders take back control of their lives and lead again at the next level.

—Greg Ligon
Leadership Network

Leaders are action-oriented, forward-thinking, git-’er-done type people. That’s a good thing, right?

Not always.

My first ministry role was trauma chaplain. I needed a job for a year while my wife finished college, and the local hospital was hiring chaplain residents. Chaplain residents serve like medical residents—a short, intensive, underpaid role that provides valuable experience. Except I had never seen a dead body before; I had no prior experience of grief. I was 24 years old.

“Will you show me what to do?” I naively asked in the interview.

“Um, no.”

I had been married eight days when I started. My first shift lasted 28 hours and they left me alone in the only Level One ER in the city. What could possibly go wrong?

I brought with me lots of initiative and action-oriented leadership but no self-awareness. I didn’t realize, for example, that after being paged to the emergency room to meet an incoming ambulance, I was praying the same quiet prayer. The same prayer, every time.

Please God, don’t let it be my wife. Please don’t let it be anyone I know.


In the early weeks I couldn’t keep up with the onslaught of death and trauma that I experienced, and my internal processing was working overtime. Trauma can invade anyone’s happy life unannounced. My quiet prayer was an attempt to build a fortress against the very real fear that my wife would be strapped to the gurney with an EMT straddling her, shouting commands while my wife had that deep look of terror in her eyes that most trauma patients have.

My prayer was a human prayer, and there was nothing wrong with praying it. But it is a prayer of distance. Please God, keep suffering far, far away from my fearful heart. When the patient did burst through the double doors, head strapped down, eyes startled, and was neither my wife nor anyone I knew, I prayed a second prayer.

Thank you, God, that it is not my wife or anyone I know.

That prayer, equally human, equally honest, sounds very much like the prayer of the Pharisee in Luke 18:11: “‘Thank you, God, that I am not like that person.’”

That is a prayer of distance and disconnection. You cannot be present to people when you are creating a protective distance from them. I was physically there, but spiritually and emotionally absent. Internal anxiety creates distance between you and the person you are serving because you spend too much energy attending to your anxiety or worse yet, you are in its grip but unaware of the squeeze.

Leaders act. Leaders take charge, leaders do something. I am wired that way and never knew those traits can get in the way of what is really going on. They can be an anxious response.


Chaplaincy taught me valuable lessons that have served me in every leadership role since. I learned how to overcome my propensity to take action and instead pause, take note and allow myself to move through the processes of anxiety, fear and action.

The lesson first began with a doctor on the code team, the crew with the cart that rushes into a patient’s room when the patient’s heart stops. If you’ve seen a television medical drama, that’s a pretty accurate rendition of what happens, except for the lack of chaplain. In every medical drama I’ve watched, there is never a chaplain. I watch the shows and yell at the screen, “Where is the chaplain?”

But I digress. I’m not bitter. OK, I’m working on it.

In real life, while the team is in the room with the yelling and the paddles and the action-oriented leadership, the chaplain is sitting just outside the room with the loved ones—door open, hearing everything, saying nothing because you just must wait. They call it nonanxious presence. That’s the goal: nonanxious presence. Do you know how much work it takes to look like you are a nonanxious presence when inside you want to act, say something, do something? But all those responses are just to manage your anxiety, not to serve the people in front of you.


One day after a harrowing code encounter, I was chatting with the code team doctor. He said, “The secret to serving on the code team is anytime a patient’s heart stops, first take your own pulse.”

For any leader prone to act in response to the internal and external pressure you feel to do something, that doctor’s advice is gold. When it’s all flying around, and the stakes are high and you’re about to act, first, take your own pulse. It reminds me of how every time you fly, you are instructed, “In the unlikely event that we lose cabin pressure, first put the oxygen mask on your own face before helping someone else.”

At the risk of generalizing, I think flight attendants are smarter than most leaders I know, because they know that you cannot help someone when you’re unconscious. Or dead. And I think we all know more than a few dead leaders walking.

Sometimes a leader is the last person to know they are not OK, that they are acting out of anxiety, rather than out of what the situation requires. I believe that happens because internal anxiety competes for the space inside us in which God resides. So when we are anxious, we struggle to be aware of God’s presence and God’s work.

Over that chaplain resident year, I learned a valuable lesson. It is one of those lessons I must relearn; a lesson I often have to fight to learn. It is the lesson of God’s presence.

When I am anxious, it feels as if it is all on my shoulders. I must do. I must act. It’s all on me. When I first take my own pulse, I remember that it is in fact on God’s shoulders. It is not all on me. God is carrying it. God is walking with me into the anxious situation where I don’t know what to do, or where I wonder what people are thinking, or where I don’t know if I have one more day in me or where I have had an anger fantasy ahead of time to preempt the tense meeting with that person. God is with me. God is carrying it.

But that isn’t the lesson. That is the easy part. The lesson is to realize that not only is God with me, but God is ahead of me. God is already in the space into which I am entering. God is already in the meeting, in the place I am just now entering. God with me, God ahead of me. If I pause, I can remember that God is already at work in the space into which I am going. Easy to write; tough to remember, especially when I am anxious.

Twenty-three years later, in many leadership roles, the same is true today. When someone’s heart stops beating, first take your own pulse.