“In my Father’s house are many mansions”… some very tiny, but mansions still.

PROVIDING MEANING IN DEATH By: David J. Fair, D.Min., B.C.E.T.S.

The bonding of an unborn child and it’s parents was made so clear to me when I answered a page late one Saturday afternoon at the Medical Center. The operator told me I was wanted in the ER and when the ward clerk answered she said a young woman had experienced a miscarriage and the couple wanted to see the Chaplain. A thousand things ran through my mind, not the least of which was the premature birth of my youngest granddaughter Courtney just a year ago. So frail in the neonatal unit. Now healthy. The words of a current country and western song ran through my brain, “ What do you say at a moment like this”. I had handled miscarriages and still births before. I was able to offer comfort and prayer and this would be hard I told myself but chaplaincy was never expected to be easy. I was briefed at the nurses station, knocked on the door of the treatment room, and was admitted by a couple in their twenties, both overcome by grief. There in a small plastic biohazard bag on the gurney with the mother was a tiny fetus the size of my fingernail. I put my arms around the mother who was crying and told the couple I was sorry for their loss. I now understood why the ER staff had been so uneasy and tentative with both my page and my briefing. Normally an expectant mom is taken to the OB Unit of the hospital. If there is a miscarriage or stillbirth and the fetus weighs 500 grams then a set of laws and policies kick in. They concern health codes, and the handling of the remains. Yet here we were in the ER with a fetus the size of a baby grasshopper with no legal standing. Yet an
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ethical and moral one. The biohazard bag it was placed in seemed an indictment of how the ER staff felt. No legal standing. Not a hospital problem. I could tell the couple was confused and looking for direction. On questioning, it was discovered the couple had a two year old and seven month old son and didn’t know mom was pregnant until she began to miscarry. It was clear the parents saw this loss as if the baby had been full term and stillborn or one of their sons had been killed. The couple indicated they didn’t go to church but wanted to do something appropriate. “ Chaplain, would you say a prayer ?, “ the father asked. I prayed with my arms around them. Afterwards I asked if they were thinking about some type of service for their child. The response was over whelming. It was like a dam burst. They cried and were at the same time joyful. The acknowledgment that the tiny fetus was their child by someone else ratified their grief, and the healing began. They wanted a service and had considered a name. They had picked out a beautiful first and middle girls name. “ How did you select a girl, “ I asked. They told me because they already had two sons they though this one would be a girl. The father said the grand parents had the boys for a week and they wanted to wait on a funeral until they returned. I went to speak to the ER doctor and a nurse. The doctor said the fetus could be released to them, after all it was theirs, and the mom would be ready for release after a few tests. The next question was what to do with the fetus until the service. Several options ran through my mind as the couple made it clear they were out of work and had no money. I was greatly disturbed Katlin Marie was in a plastic biohazard bag. I recalled a few years before, on a SIDS death, we used a Precious Memories box to try to create meaning for the family. However when I arrived at OB
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I was told they no longer used the boxes. The charge nurse gave me a baby blanket and a baby memory book. Returning to ER Katlin Marie was put into her new blanket. The plastic bag was quickly discarded. I asked the parents if they wanted me to make arrangements for the baby to be kept until the service or did they want to take her home, leaving the room so they could discuss the decision. Katlin was going home. If the parents had not wanted to make other arrangements I would have imposed on a friend who owned a local funeral home. The parents planned to make a small casket from items belonging to their two sons. They agreed to call me when they were ready for the service. I made sure one last time the hospital had no objection to the tiny fetus leaving the hospital and going home. It reminded me of pioneer days and even in some cultures today where the body of the deceased is taken to the family home prior to burial. After a final prayer and making sure the couple had the hospitals booklet on miscarriage we said our good byes. While checking out at the nurses station staff made various comments about the parents decision, but I reminded them, it is about the parents and their needs, not the institutions. Monday I was faced with the burial dilemma. The family said they hoped they could bury baby Katlin Marie at a local cemetery on the plot of the fraternal great grandmother. The concern was, the lack of funds and cemetery association approval for the unorthodox request. As time progressed I had to recognize my predigest to the way I was handling the matter. I gave mental assent to the fact the fetus was life at conception yet I was approaching others as if this was some odd request to bury a tiny fetus as if it were a child. If others were going to respect the dignity of the death I had to come to grips with the fact we were burying a baby no matter what the size. If I truly believed what I said, then size didn’t
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matter and the approach needed to be we are burying a baby not just a “ fetus”. The cemetery had no problem with burying the baby on the great grandmothers plot, but when a family member objected we were back to square one. Some family members apparently struggling with the burial of a fetus weren’t comfortable with placing the baby on an existing plot. Thus adding to an existing family rift the request was rejected. My friend at the funeral home told me he had received a letter, a couple had donated money to the cemetery to create a Baby Land, if couples couldn’t pay for a plot, they would. The cemetery director balked when asked if Katlin Marie could be buried in Baby Land. The donor family surely wouldn’t approve of something like that, after all, this was different it wasn’t really a baby. After pleading with the director he agreed to talk to the grounds supervisor and try to locate a spot somewhere, anywhere a small box could be buried under a few inches of earth. This has been a battle. A battle to make the world recognize Katlin Marie is a baby, no matter how small. To get them to understand if the family believes life begins at conception, then size doesn’t matter. The law addresses health and public safety concerns. In that venue maybe size does matter. At some point remains can become a health problem. In Texas at 500 grams the law applies. If health care workers can’t respect a families potential belief life begins at conception, then a biohazard bag will always do the trick. The bigger the fetus the bigger bag we need, plain and simple. If we remember to always treat remains with dignity, we will never offend no matter what the belief. Out of darkness of the ordeal comes a teaching moment. A moment to meet with the hospital to discuss issues of dignity for all life and for all death. A moment for the cemetery association , to discuss burial and closure for families. Creamains are often buried, in small boxes, why not a baby fetus.

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Lastly a teaching moment for chaplains. A time to look at when life begins. And when life begins then ends why should ritual be determined by the law and not the spirit. We will know the battle has been won, when there are a supply of baby blankets stacked next to the biomedical bags in ER, and when the size of the headstone in Baby Land is not determined by the size of the child buried there. Within a week of the miscarriage my phone rang. It was the Dad. The children are home, can we bury Katlin now, was his question. I arrived at the cemetery early. The grounds keeper had dug a small hole under a huge oak tree. I applauded their choice. The family arrived, mom and dad and the two brothers. In Dad’s hands a small box decorated with scraps of clothing from the boys. Attached to it a handmade cross and a poem Mom had written. Another car arrived. A couple from my church I had shared the story with. They wanted the family to know someone cared. Then another car, an aunt of the mother. She too didn’t want the family to be alone in their time of grief. The service as brief, emphasis on King David’s statement to his servants on the death of his son. “ I shall go to him. But he shall not return to me”. The reading of mom’s poem. Prayer. Tears including mine. Then taking from Jewish tradition the family was encouraged to each put a scoop of dirt in the grave after the box as gently placed . Each person taking the shovel, a little earth, even the young brothers. I finished the job. Then a blessing. The family chose to stay awhile at Katlin Marie’s grave. The rest of us quietly slipped away. I pass the cemetery daily on my way to work. The tall tree an ever present reminder of Katlin Marie, and a young family who asked. “ Chaplain would you say a prayer”

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Blessings and sacred moments are God’s gifts. Blessings come in all shapes and sizes. Some come in tiny packages. In summation here are the important points when evaluating an institutions ability and readiness to meet the needs of parents in miscarriage situations: • Develop a clear policy on briefing of chaplain when being called into a case involving miscarriage, where all facts are articulated in the first contact. • Make sure clear policies and procedures are in place for handling miscarried fetus of less than 500 grams (Texas law applied). • Policy directing staff to treat fetus regardless of weight as full term in relation to the dignity of the body and grief issues with the family. • Establish a protocol for involving the OB unit, Chaplains, and ER staff in responding to miscarriage cases not transferred to OB. • Debrief each case involving miscarried fetus in the ER, with the goal of updating policies and procedures and normalizing the thoughts , feelings, and emotions of staff. Chaplain’s role in miscarriage case in ER : • • • • • Respond immediately to the ER Obtain briefing from charge nurse Make initial contact with family Determine if parents are relating to the miscarriage as a fetus or baby If family views miscarriage as not being a child, help family move toward closure at ER • If family views the miscarriage as loss of a child, proceed as you would with final arrangements for stillborn death. { families will differ on the issue of baptism, service, and burial of stillborn. Family wishes prevail with guidance from Chaplain when requested.) It may be necessary to baptize the baby if the family’s faith tradition suggests. It should be noted each state has a gram weight that determines how a fetus is dealt with. In Texas if under 500 grams , the family is free to choose the disposition of the remains with out hospital involvement. If the weight is

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over 500 grams Texas law provides options in dealing with remains and hospital is involved. Usually cremation is the choice for the fetus. In Texas a body can also be buried without embalming if done within 24 hours of death. Regardless of what law applies families are free to choose the type of ritual they desire or none at all. One role of the Chaplain is to help facilitate matters arising from the miscarriage and to attend to the family members as he or she would in the event of any in hospital death.

Dave Fair, holds a Doctor Of Ministry degree from Lake Charles Bible College. He is a certified Master Chaplain, Pastoral Bereavement Specialist, Pastoral Counselor, and is Board Certified as an Expert in Traumatic Stress, Diplomat. Chaplain Fair, is Director Of Chaplain Services for The Brownwood (TX) Police Department, Medevac EMS, and has served 15 years as a Chaplain at Brownwood Regional Medical Center

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