"Pastoral Care" - one size don't fit all, but showing up goes a long way

Sioux Falls has two large medical centers, and people are flown in for care from all over South Dakota and surrounding states.

Frequently, Episcopal Clergy in Sioux Falls assist with pastoral visits to church members from the Reservations. The Mission clergy are hours away and have heavy pastoral responsibilities as it is, so it is a humbling honor to share even a bit of their work for the Lord.

It is a learning experience. The models of medical and spiritual care we use as White people don't apply as well with the Lakota/Dakota folks. A few examples:

1. Decision making. Our White cultural model has the medical staff turn to one key person (spouse, usually) to make a decision - preferably by quick reference to a previously checked box on a form. There is some family consultation, and maybe the clergy person is asked a moral or other question, but our culture and law look for a designated person to "make the call" ASAP. For the Tribal culture, decisions are communal and there is an elaborate network of relatives who should have input, even if that takes some time and phone tag. Grandmothers, "Aunties" and other relatives, established by marriage connections and Tribal ceremony as well as by blood, are essential to this decision making.
2. Clergy role. White culture places a higher value on the priest as counselor. Choosing the "right words," emotional presence and attentiveness to each individual are priorities. Tribal culture places a higher value on the power of ceremony - the priest as sacramentalist. Willingness to show up, the Church's words of prayer and God's presence via the sacraments are valued.
3. Family/community. White culture is more compliant with hospital concepts like "immediate family only." We tend to shuttle individuals or couples in and out of the room, with maybe a small group gathered for prayer at key moments. Tribal culture sees "family" more broadly, and keeps larger groups present - sometimes to the discomfort of hospital staff. I recently shared Holy Communion with a group of 25 Reservation Mission people at a patient's bedside (the staff were really wonderful in accommodating this). The patient's adopted brother was a Lay Reader at their Mission, so I had an altar team right there in the room. The circle of extended family spontaneously offered a hymn in Lakota and several people offered up prayers - it was a church service larger and more elaborate than my parish's usual Sunday 8 a.m. gathering!

Of course there are the signs of our common humanity:

1. Loved ones travel many miles and hours to be with the sick and dying. Be it carloads of relatives from the Reservation or a career woman flying in from the coast, they come.
2. The words that mean the most. "I love you." "I will miss you." "Thank you for..." These and other words from the heart are not bound by culture - they are native to descendants of Crazy Horse and Leif Ericson alike.
3. The presence of children brings comfort.
4. Hand holding, hair stroking and other touching. Intuitively, this takes over for our limited words.
5. Tears.
6. Sharing memories that stir up laughter and gratitude.