ER 1.21 “House of Cards”

As Stacy mentions, Grey’s Anatomy surpassed ER last month to become TV’s longest running hospital drama. Here are some articles about this milestone (with lots of spoilers for later seasons of ER, if you’re only watching season one now).
”’Grey’s Anatomy’ Makes History” from The Hollywood Reporter
”7 Reasons Why ‘Grey’s Anatomy’ Has Outlasted ‘ER’” from USA Today
”’Grey’s Anatomy’ Cast Reacts to Surpassing ‘ER’…” from ET Online
”’Grey’s Anatomy’ Becomes Longest Running Hospital Drama on TV” from People
”’Grey’s Anatomy’ vs. ‘ER’: By the Numbers” from E! Online

The chaplains talk about the death of Dr. Greene’s OB patient in the previous episode as a “sentinel event.” You can read about the definition of a sentinel event and what policies and procedures the Joint Commission recommends here.

Offering staff support is one important part of a hospital chaplain’s role, and offering staff debriefings following a difficult situation or patient death can be helpful. This article gives some guidance on how to approach such debriefings.

The chaplains believe that Dr. Greene seems to be suffering from compassion fatigue and secondary trauma following the death of his patient. You can learn more about burnout, compassion fatigue, and secondary trauma in this presentation from Dr. Trudy Gilbert-Eliot.

Janie says, somewhat jokingly, that as adults we need to take more time-outs. That is especially important in hospitals, particularly following a death. Nurse Jonathan Bartels is credited with promoting “The Pause,” a simple moment of silence following a patient death for everyone who worked with that patient at bedside. (He notes in this article that the idea came from a chaplain getting everyone to pause for a prayer following another death.)

ER 1.19 "Love's Labor Lost"

In looking at Dr. Benton's behavior when he is working too long without sleep, Carrie cites the acronym HALT. This article expands on the dangers of being Hungry, Angry, Lonely, or Tired.

When ER introduces a little girl who has been severely punished for exploring her body, Carrie also mentions her work with LeAnn Gardner on SAFE Seminars. This stands for Sexual Awareness and Family Empowerment. This kind of holistic sex education can help parents understand what is "normal" at different stages of childhood development and, especially in American churches, help undo some of the damage caused by the Puritan heritage. This list of books for both parents and kids for learning about body safety is another great resource. 

Stacy tells us she did some research on the actress who played Tatiana, the little girl with AIDS whom nurse Carol Hathaway wanted to adopt. The actress's name is Milana Vayntrub and she's still working today, most notably in AT&T commercials as Lily and in a recurring role on NBC's This Is Us as playwright Sloane Sandburg. She and her family came to the US as refugees from the Soviet Union when she was very young, and in 2016 she started a charity to help refugees called Can't Do Nothing. 

The ER episode "Love's Labor Lost" is one that lots of people remember from when it first aired. Stacy says she has read a lot of articles about it online. Here are a few of them. 
"Haunting First Season Show Leaves a Lasting Impact" from the LA Times
"A Riveting ER Gives Dr. Greene One Bad Day That Just Keeps Getting Worse" from The AV Club
"ER: An Oral History of the Powerful, Groundbreaking 'Love's Labor Lost'" from TV Guide
"19 Reasons 'Love's Labor Lost' Is the Most Breathtaking Episode of ER Ever" from Bustle
"ER Insiders' View: Rick Ladomade" (featuring a funny story behind the scenes of this very dramatic episode) from Variety

Sadly, almost 25 years after this episode aired, maternal mortality rates in the US have only increased. Mothers like the one we met on ER die in the hours to weeks following birth in this country at a rate higher than any other in the developed world. The numbers are highest among women of color, regardless of wealth and education. Even women like Beyoncé and Serena Williams have had close calls. Carrie has gathered a few resources where you can learn more about this alarming trend and what can be done about it.
NPR Special Series "Lost Mothers: Maternal Mortality in the U.S." 
"Maternal Deaths Are Rising in America" from USA Today
The Safe Motherhood Quilt Project

See Ep 9 Show Notes page for more.

Carrie says that Mark and Jennifer Greene's disintegrating marriage is displaying all of Gottman's Four Horsemen. For those not familiar with Gottman's research, these are four ways of communicating (or not communicating) which often presage the end of a relationship: criticism, contempt, defensiveness, and stonewalling. You can read more at the link above. 

We talk a lot in this episode about Tatiana, a little girl with AIDS whom nurse Carol Hathaway wants to adopt. Carrie wishes that she had pediatric Hospice care available to her. You can read about pediatric Hospice and Palliative Care in this article from the American Academy of Pediatrics.

In regards to several of the patients and families we see in these episodes, Stacy and Carrie mention complicated grief, also known as complex bereavement disorder. You can read more about it from the Mayo Clinic at the link above. 

In "The Birthday Party," we see the tragedy of a young boy finding his father's gun and accidentally shooting his brother. Sadly, this is something that we as chaplains have seen in our hospitals in real life, and it's a very preventable occurrence. Please read the articles below for more on keeping kids safe from guns in the home.
"Guns Within Reach" from Parents magazine
"Child Access Prevention" from Giffords Law Center to Prevent Gun Violence
"Are You Talking to Parents About Keeping Guns Away from Children?" from Psychology Benefits Society

When Doug Ross shames the mother whose son is malnourished, Carrie makes reference to "toxic charity." This concept is from the book of the same name, Toxic Charity: How Churches and Charities Hurt Those They Help (And How to Reverse It) by urban activist Robert Lupton. 

Near the end of this episode, Stacy and Carrie share the great impact that a short reframing of one of Jesus's parables had on their lives. It appears that Jeanne Stevenson-Moessner's "The Self-Differentiated Samaritan" is not available anywhere for free online, but her essay is part of the book Images of Pastoral Care and is well worth the price of the book alone (though there's some other good stuff in there as well). 

See Ep 8 Show Notes page for more.

ER 1. 15 "Feb. 5, '95"

In "Long Day's Journey," we see a somewhat unusual case of domestic violence in which the victim is a parent and the perpetrator is her teenage daughter. You can find resources and help for many different kinds of domestic abuse at The National Domestic Violence Hotline website.

Sara Jane does not know who Bobcat Goldthwait is! We hear his distinctive voice as Carol Hathaway's patient who stays under a sheet for the whole episode. Stacy realizes that most people under 40 probably aren't familiar with him, so here's a video of one of his classic stand-up routines on David Letterman's show. 

Grace, the cancer patient featured in one of these episodes, is staying at a hospice facility but comes into the ER when her condition worsens. There are many options for end of life care explored on the American Cancer Society website.

Stacy mentions an article referencing George Clooney's idea to put a basketball hoop on the set. It was this article (see #7) or one like it.

When a kid comes into the ER pointing a gun at people in "Feb. 5, '95" the chaplains remark that it seems strange that everyone would freeze and there wouldn't be a plan in place for how to handle such a situation. Maybe it wasn't the case in 1995, but today, hospital employees have to watch training videos like this one annually. 

Nurse Hathaway is very protective of the new crash carts she gets for the ER in the second episode. If you don't know what a crash cart might contain or why it's important, this video features two nurses demonstrating what it is and how it works. 

See Ep 7 Show Notes page for more info.

ER 1. 13 "Luck of the Draw"

The chaplains discuss claiming their pastoral authority and other learning opportunities in CPE. If their conversation doesn't scare you off, you can find out more about Clinical Pastoral Education through ACPE here.

Stacy mentions a sketch by Amy Schumer where a group of women make progressively absurd apologies. I couldn't find the video clip online, but this article does a good job explaining the skit and why it hit home for so many women.

As Dr. Benton's family faces continuing challenges in caring for his mother who has dementia, and Dr. Ross treats a young boy with a brain injury whose father is overwhelmed by his needs, the chaplains talk about the importance of community resources and support groups. You can find information on Respite Care here (especially for senior citizens) and support for families dealing with Traumatic Brain Injury here. 

In this episode and others, the chaplains mention Family Systems Theory. You can learn more at the link.

See Ep 6 Show Notes page for more. 

ER 1.11 "The Gift"

The chaplains talk about the power of music with patients on the show and patients they've met in hospitals. You can learn more at the American Music Therapy Association website.

Sara Jane mentions Myers-Briggs types, which many chaplains have learned about in their CPE training. The Myers-Briggs Type Indicator can give interesting insights into personality.

Since "Blizzard" features a Catholic nun praying over a patient who has died, the chaplains discuss the comfort of repetitive prayers such as the prayers often used in Catholic tradition. Stacy says she also sometimes uses the Book of Common Prayer. 

Sara Jane tells the beautiful story of one of her patients, a man with dementia, teaching her to dance the fox trot. Like music, dance can have great therapeutic value for hospital patients. You can learn more at the American Dance Therapy Association website. 

The chaplains debate the language of organ harvesting vs. organ procurement. Whatever word we use for it, organ donation does save lives. In ER, the doctors will often mention the UNOS list. Stacy mentions different experiences with local Organ Procurement Organizations. You can find the list of all OPOs in the U.S. here. And if you haven't done so already, you can sign up to become an organ donor here. Just be sure to talk to your family about your wishes! As we saw in this episode of ER, next of kin usually have to sign off before organ procurement can begin, even for a patient who is a registered donor. 

Carrie says that trauma can often cause us to move backward in our stages of faith. James W. Fowler's book Stages of Faith is a classic, and is often required reading in seminary as well as in psychology classes. This helpful chart illustrates the different stages. 

ER 1.9 "ER Confidential"

In discussing patients Jamie, who was raped, and Mr. Randall, whose wife and son died in a car crash which he survived, Carrie mentions the importance of Trauma Informed Care. This is "an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma." That definition comes from The Trauma Informed Care Project, and the link will take you to lots of resources and information from them.

If you or someone you know is a survivor of sexual assault in need of help, Carrie recommends starting with RAINN, the Rape, Abuse, and Incest National Network. They have a 24/7 hotline, both on the phone and online chat format. Their website has many great resources and they can put you in touch with local help as well.

Both doctors and patients in these episodes of ER are shown contemplating and even attempting suicide. This is a difficult subject for many people. Some of the chaplains who host this show have been there ourselves and would not be here now if we hadn't sought help. If you or someone you know is having thoughts of suicide, there are many resources available. A good place to start is Suicide Prevention Lifeline. 

As Carrie and Janie discuss in this episode, rates of suicide are incredibly high among transgender men and women. Trans Lifeline is staffed by transgender people who can understand better than anyone the struggles of those who call in need of help. If you or someone you know could benefit from their services, please reach out. We don't want anyone else's story to end the way Ms. Carleson's does in this ER episode.

Stacy mentions learning, after meeting multiple parents whose new babies had indeterminate sex characteristics, that being born intersex is as common as being born with red hair (about 1 in 200 babies). This article gives insight from doctors and parents, as well as adults who were born with intersex conditions. Intersex: When a baby isn't quite boy or girl

The chaplains acknowledge in this conversation that religious folk have often excluded our LGBTQ friends and family members rather than being a place of safety and love for them. There are religious communities, thank God, where this is not the case. There is a list of organizations from many different religions that have partnered with GLAAD on their website, which could lead you to a local place of worship or online faith community where LGBTQ believers are welcome.

See Ep 4 Show Notes page for more.

ER 1.7 "Another Perfect Day"

The chaplains discuss "patient satisfaction scores" in this episode and wonder whether they existed in 1994 when ER began. They didn't, at least not nationally. The standardized national measure of patient satisfaction, for the past ten years or so, is the HCAHPS Survey.

Carrie mentions Epic, which is the electronic healthcare records software that many hospitals in the US now use. You can read more about Epic here.

Stacy says that she was worried about the psychiatrist, Dr. Div Cvetic, featured in these episodes because he showed signs of compassion fatigue pointing towards burnout. If you're wondering about what to look for, or think you may be at risk for burnout yourself, here is a free burnout self-assessment tool that could be helpful. At the end of the test, you'll also find a link for the more rigorous Maslach Burnout Inventory (which must be purchased).

There is a good conversation in this episode about how to quantify the value of what chaplains do. It's very difficult to give numbers and hard data that hospital administrations are often looking for that show the value of spiritual care. HealthCare Chaplaincy Network has this list of suggested spiritual care quality indicators and ways to measure them. For a less technical and more narrative approach to the question, see Stacy's blog post, The Case for Chaplaincy. If you're a chaplain, let us know how your hospital or healthcare organization measures what you do!

ER 1.5 "Into That Good Night"

The chaplains mention transference at work in some of the relationships between doctor and patient, as well as among the doctors. Some simple definitions of transference and countertransference such as those on Wikipedia may be helpful.

Over-identification with a patient can be problematic, as the chaplains discuss in Dr. Carter's care for a hit-and-run victim. This excellent blog post by a doctor explains the issue of over-identification very well.

Carrie mentions the stigma of a patient being labeled "noncompliant" and how easily that could have happened to Doug Ross's young asthma patient and her mother. This NYT editorial written by a doctor explores the complicated nature of noncompliance. 

The chaplains talk a lot in this episode about how dead bodies are treated in hospitals, the care that chaplains often take with bodies, and the Christian belief in incarnation. You can read Stacy's thoughts on these subjects in her blog post, M is for Morgue.

Stacy references this article about the diversity of "ER" both behind and in front of the cameras.

See Ep 3 Show Notes page for more. 

ER 1.2 "Day One" 

ER 1.3 "Going Home"

Advance Directives information and forms for every state, such as the one Stacy mentioned in this episode, can be found here. 

What is a Child Life Specialist? (We haven't seen one yet on "ER.")

Find out more about Godly Play as a therapeutic resource for children.

What is the GCS score the "ER" doctors are always talking about and the chaplains mentioned?

Sara Jane referred to her work on Nearing Death Awareness. Here is a recent article on NDA.

See Ep 2 Show Notes page for more. 

ER 1.1 "24 Hours" on Hulu

What is CPE?

What is HIPAA? 

In our very first episode, we're talking about the pilot episode of ER, "24 Hours." We'll meet the characters, introduce ourselves as your hosts, discuss how chaplains can care for hospital staff under stress, and talk about some big ways things have changed since 1994 (including George Clooney's haircut).