Medicine for Erma
By Virginia Giglio, CPE Intern | March 19, 2018

It was Ash Wednesday at the Catholic hospital in which I am a Chaplain Intern. All the Chaplains were wearing black ashes on their heads, and one of them even offered to place them on my head. Though I was raised Catholic, I felt disinclined to receive the mark of holy ashes this year, and refused the offer. I did not know why at the time, but the reason for this became clear to me after an experience with the family of a patient I will call Erma.

My routine initial visit with 70 year old Erma was in the ICU where she had been admitted for severe COPD symptoms. Erma, who is from Oklahoma, is a Native American ceremonial leader of the Cheyenne tribe as well as a Pentecostal Christian. Extremely sleepy during the visit, and with her family at her bedside, Erma had more family in the waiting room waiting to take turns at visiting her. The family told me that Erma’s husband/significant other was taken to his local ER with a COPD flare-up of his own as well as seizures; he was now home, but not resting comfortably. The family of these two elders had a lot on their plate.

My intervention with Erma was informed by my years as an ethnomusicologist among the Native American people and having produced two academic books with recordings of Cheyenne music. Taking cues from what I had learned through the years, I encouraged family involvement and recognized the importance of family comfort. I sang Cheyenne traditional hymns to the patient in the Cheyenne language as a spiritual and relaxation methodology. I also saw this activity as supportive emotionally and psychologically because the hospital, an entity apart from the comforting nest of a Cheyenne home, is a foreign environment.

The patient’s awareness of my presence ebbed and flowed as I visited with her. Erma was soothed by the sound of hymns I sang in the Cheyenne language and went to sleep soundly while listening. After my visit, I informed the family of Pastoral Services availability and how to reach a Chaplain if desired.

A few hours later I received a call from the volunteer in the ICU Waiting Room telling me that there was a family in crisis who was asking for me by name. Could I come immediately?

I hurried down to find Erma’s family members weeping and discussing a matter in a confused state. The family members, all female at this point, were having a hard time figuring out how to follow Erma’s instructions to them. Erma had communicated clearly to them that it was time for each of her female line (daughters and granddaughters by name) to "let me go home." She also had other instructions that were logistically problematic.

I sat down in the waiting room with the family gathered around and asked them to tell me about it. After pointed questions about their readiness for the potential death of their loved one, I ascertained that they were having a hard time accepting the gravity of the moment in the light of her other request.

“She wants her Medicine. She told us to go to her room at home and get her purse and get her Medicine and bring it to her and let her go.”

For a moment I was confused by their distress over being asked for her medicine in a hospital setting. Then I realized that Erma and her family were referring to her Medicine Bag necklace that she had the privilege to wear as a Cheyenne ceremonial practitioner. Her Medicine was not a capsule or in a bottle; her Medicine was a small buckskin bag of blessed charcoal acquired after she had undergone yearly Sun Dance ceremonies. For more years than her family had been alive, she had fasted and prayed for four days in the hot Oklahoma sun each June. The purpose of her suffering was to renew the energy of the cosmos, and more specifically to bring health, healing, and mental balance to all the people of the world.

As she lay there with death imminent, Erma wanted the Medicine without which she would not be able to depart the world. She wanted to join her deceased sister whom she heard calling to her. “Bring my medicine and let me go,” Erma had instructed her daughters and granddaughters.

“Imogene, as the oldest daughter, how do you feel about this?” I asked.
Imogene explained that the Medicine was in a purse in a town 1.5 hours driving time away from the hospital – one way. There was one vehicle. Someone had to stay with Erma. Someone had to go get the Medicine. 

But no one was inclined to leave Erma at this crucial time.

The stress in the daughter’s voice was palpable.

“How are you feeling right now? What’s going on?” I asked.

“I can’t wait for Auntie Della and Auntie Margie to get here. They are driving up (from a town one hour away.) But I don’t know when they are coming.”

“Oh dear,” I said. “You have a lot on your plate, don’t you.”

“Well, I am the oldest, and everyone is looking to me for answers.” When Imogene said this, I recalled that decision-making among Native Americans in general and Cheyennes in particular is best received by the social group when the decision is made by a consensus, not by one person. There is danger in standing alone, being seen as “bossy”, or potentially making the wrong decision and being blamed for it.

As Chaplain, my job became clear: I needed to assist the family members to come to a verbal consensus regarding taking care of their responsibilities. I began to think quickly while drawing on my knowledge of Cheyenne customs.

“Imogene, is it possible that one of the family could leave, go to fetch the Medicine, and then not be able to find it in her purse or in her home?”

“Yes,” said Imogene. “We didn’t think of that.”

Nods around the family circle. Disaster avoided!

“So, can the Medicine be replaced? Would Cheyenne tradition allow another Ceremonial person to bring some Medicine? Could Auntie Della or Auntie Margie bring her some Medicine? Do they have the materials to make a Medicine Bag for her, and do they have the knowledge? Would it be all right with everyone here to ask them about it?”

Nods all around the family circle.

“I’ll text them right now and find out,” said Imogene, and I marveled at modern electronics being used to solve an ancient dilemma.

“Yes! They said they would make her a Medicine Bag and bring it right away!”

I asked, “Is everyone happy with that? That everyone stay here with Erma and wait for a new Medicine Bag to arrive with Auntie Della and Auntie Margie?”

Nods all around the family circle.

That is how, in the familiar terms of EPIC Pastoral Care flow sheet, the family conference was facilitated, active listening provided, problem solving encouraged, emotional support provided, and the grieving process facilitated.

The patient Erma was allowed to fulfill Cheyenne ceremonial requirements.

The family came to a joint consensus on how this could be done.

They were now free to deal with anticipatory grieving for their loved one, and they were now ready.

I assured the family of my continued prayers and availability until the time of my departure from the hospital that day. I received hugs and there were tears and words of gratitude. The family even walked over to the ICU volunteer who was worried about them and assured him that the Chaplain had done a good job for them. I was touched.

As I walked back to the Pastoral Services office, I passed a nurse with ashes on her forehead. Then it dawned on me.
Paint on the forehead is a Cheyenne mourning custom. Had I appeared at this family conference with ashes on my head, it would have been a terrible sign to the family that their loved one was going to die.

It turned out that Erma survived her ICU visit and eventually returned home.

Dr. Virginia Giglio is an intern in CPE at Mercy Hospital Springfield, Missouri. Her clinical site is Mercy Hospital Oklahoma City. She can be reached at
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