Angels in Carolina

Encountering angels on the pediatric floor of a hospital in North Carolina. A story about the importance of taking cultural beliefs into account when determining the cause of other people’s behavior.

I was completing my postdoctoral fellowship at the University of North Carolina Medical School, assigned to the pediatric consultation liaison service. One day I got a call from one of the physicians asking me to see one of his patients, a ten year old girl. The purpose for the consult?

“She’s an angel,” he said.

It took me a minute. “A what?”

“An angel, apparently.”

Yep, I’d heard right the first time. “And you’re calling me because. . . ?” I really wasn’t sure what I might do to evaluate and treat an angel. They really hadn’t covered that in grad school.

“She’s having crippling stomach pain but I can’t touch her to examine her,” he replied.

“And that’s because she’s an angel?” I wanted to add, What is she flying away from you? But reigned it as it was the physician was asking for help, something it had taken me about six months to train the medical staff to do. When I’d arrived they hadn’t thought psych services could really benefit their patients. We’d entered the next phase where they called, but usually only when I could make their job easier by getting the patient to do something they needed done. This case was no different.

“Look, I need to examine the patient and. . . ”

“Her name is. . . ?”

“What?”

“What’s her name?” I repeated. It made me a little crazy when they just referred to the children they treated as the patient. Another goal of mine had been to humanize the medical staff so they saw the families they treated as real people. I clearly had some work to do on there.

“Elizabeth,” he replied. “I need to be able to examine her and her parents won’t let me touch her.”

I waited. I may have gotten them to start calling the service more, but I was still training them on how to phrase a consult question in a way that gave me the information I needed to be able to address the problem. I waited in vain.

“Why won’t they let you touch her?” I finally prompted.

“Because it seems that when a child is an angel if you touch them they can’t travel from place to place or something,” he replied impatiently. He was getting impatient? Who was he kidding? He wanted me to evaluate an angel!

“Did you think to call for the clergy? The department of theology perhaps.” I didn’t do the whole physician prima donna thing. If they wanted me to help them do their job, they needed to treat me with respect.

He didn’t address my remark. “The parents said that she was an angel which was the cause of her pain but that it seemed to have grown so severe they wanted to see if there was also something medical going on well. But then they said I couldn’t touch her to examine her so I really don’t have any ability to do anything. I need you to convince them to let me examine her.”

“Did you ask them what you needed to do so you could examine her?”

“I reiterated the necessity of my being able to examine her.” I could hear his voice getting tight. In other words, no. I sighed and agreed to go up and talk to the family.

When I introduced myself to parents, I could see they were distressed. Their limited responses and rigid postures told me they were frustrated and upset by the interactions they’d had before with the rest of the staff. I suspected their physician was top of their black list.

I got a brief history of the problem. She’d had growing stomach pain over the previous week and that morning it had been especially bad. When she’d doubled over screaming, they’d realized they needed to get her to the hospital.

“Her doctor told me he hasn’t been able to examine her. Can you tell me why?” I asked.

The parents looked at each other. I could see whatever they’d told the staff to this point hadn’t been taken seriously.

“She’s an angel,” the father said with a lift of his chin. He stopped there, clearly waiting to see if I’d dismiss his claim, make fun of them or otherwise minimize and negate the importance of his statement.

“Can you tell me more about that?” I replied.

The father still looked wary, but the mother seemed to defrost a little. “In our religion, There are those children,special children that are born as angels. They have the power to travel between our world and heaven. They can intercede on our behalf with the greater angels on high who then intercede with God. Since children are pure and innocent, when God decides to send an angel to earth they take the form of children.”

She stopped there.

“Is there any explanation you can think which may be related to her being an angel that might explain the pain?”

Both parents looked at me differently, as if they understood that I’d listen and not brush off their beliefs.

“Whenever God’s followers are provided with the miracle of having an angel born to them, there’s a price to pay, a sacrifice of sorts. It seems that pain is that price. It makes it so the angel keeps their focus on Godliness. But not at this level. God wouldn’t want his servant to suffer like this,” the mother said, tears in her eyes.

“Okay,” I said. “How does all this affect the doctor’s ability to examine her?”

Apparently, accepting this explanation caused the father to final thaw towards me. He picked up the explanation.

“If someone touches her who is unclean, it prevents her from being able to travel to the heavenly realm.”

“Is there something her doctor can do to make it possible for him to be able to touch her? He can’t examine or help her otherwise.”

This was apparently the question no one had thought to ask. It turned out there was a simple washing ritual that wasn’t religious in terms of accepting or saying anything involving a particular belief system. The ritual wasn’t even that far off from the way the physician would normally wash before examining a patient. The doctor had no issue with it and washed as they instructed, then went in to examine Elizabeth.

Although she was clearly in pain even after taking the oral pain meds and sedatives that had been prescribed, the physician could find nothing wrong with her. None of the labs or tests showed anything abnormal. Yet she was still moaning in pain even in her sleep. The case was transferred to psych.

I met with the family to get a more detailed history of the problem. I wasn’t completely convinced Elizabeth’s problem wasn’t medical. Sometimes there were things that occurred that were unusual or resulted in symptoms that were not indicative of the real problem. There were more tests scheduled for the next day.

Yet there were also psychological disorders that resembled physical illnesses but had no known medical causes. The more I spoke with the parents the more I believed this was one of those cases. While the parents seemed grateful that I was asking about their religion and beliefs, it seemed like there was something going unsaid. In the meantime, Elizabeth’s pain seemed to be resolving.

They parents were planning to stay there their daughter overnight. Though it was after 8:00 pm, I knew if the tests in the morning didn’t show anything, and the pain didn’t worsen, they’d release Elizabeth. The family lived in a small isolated town in the mountains and I thought the parents were unlikely to seek additional help once they returned home unless the pain returned to the level it had reached this time. And I feared if we didn’t get to the bottom of the problem it very well might. They were also not likely to agree to come in to see me or follow through with the recommendations to pursue therapy with someone closer to where they lived as they believed they knew the sole cause.

I still hadn’t seen Elizabeth as she’d been sedated before. I went up to speak with her before I left. Her parents left us alone I started off as I usually did just asking about the things that she liked, what her favorite topics in school were, if she had any hobbies. When I asked about her friends however, she looked troubled and seemed not to want to talk about them.

As I tried to get her to talk about them, she suddenly looked stricken, then began to cry. I worried that if stress was to possibly to blame for her stomach condition the pain would return but it didn’t seem to do so.

Over the course of the next half hour I learned that a week before, her church youth bible group was on its way to a conference in a town in South Carolina. Twenty children had been chosen to go. She had been one of them but at the last minute hadn’t been able to attend as she was getting over the flu and her mother decided to keep her home.

It was raining the night the group left and the mountain roads became treacherous. At some point the driver must have lost control of the bus and it crashed through the railing and over a cliff. There had been no survivors. At this point, Elizabeth began to sob and said she felt like she was supposed to have been on the trip and why did someone else die instead? I learned that the accident had happened the night before her stomach pains had started.

Once Elizabeth started to calm down a bit she begged me not to tell her parents that she had mentioned it or had cried about it. When I asked why, she said that they and the other parents had said that there was a reason for everything that God did and crying showed a lack of confidence in his decisions. She and her friends had been expected to celebrate the lives of their classmates instead of mourning them.

I told her that I needed to broach the subject with her parents since I believed that the accident may have been contributing to her pain. I shared with her what I would tell them and she understood although was still anxious over their response.

I prefaced the discussion by saying that whatever I was about to say shouldn’t suggest I didn’t believe what they had said about their daughter being an angel or to imply I was trying to dismiss their beliefs. We spoke about the accident and I discussed that their daughter needed to be able to grieve for her friends. I said that I believed that grieving was a natural response for us when facing the loss of those we cared about and that it showed our attachment to others.

I added that from my own perspective, I believed that God wanted us to connect with and care about each other and that I didn’t thing that grieving for those we lost said we didn’t have confidence in God or that we were somehow calling his decisions into question. I also shared that Elizabeth was experiencing survivor guilt, something that was natural under the circumstances but which also needed to be processed so as not to create long term problems.

We talked at length and they began to see that it might not have been beneficial for their daughter to have been forbidden to mourn for her friends. They understood that she might have experienced guilt over surviving when she felt that she should have been the one on the bus despite their certainty that God’s decisions about who to take when, were just and right. They did state that they didn’t believe that any of this meant that their daughter wasn’t an angel and I again assured them that I wasn’t suggested that it did.

Elizabeth suffered a relapse of the flu and remained in the hospital for two more days during which time I was able to work with her and her family. Her parents clearly loved her and wanted her to be okay and once they understood the connection between her emotions and her physical state they were willing to discuss the accident and were very supportive of their daughters reactions. They continued to believe that she was an angel and I was able to make the rest of the staff on the unit understand the importance of respecting their beliefs.

Elizabeth’s stomach pain had almost completely resolved by the time she left the hospital. I received a thank you letter and later a Christmas card from her parents, and was relieved to hear that there had been no further episodes of stomach pain since her release.

That was not the last time we saw angels on the unit however. Three days later I received a call from the same doctor.

“We’ve got another angel up here,” he said. “From the same community as the first one. This time it’s blinding migraines and nausea preventing her from eating. Again the exam showed no medical cause for any of it. I’ve sent a bunch of tests off to the lab but figured I’d give you a call as I anticipate they’ll come back negative.”

I smiled. If he had examined her that meant he’d remembered to wash correctly, and I imagine he’d asked at least a little about the families beliefs and practices. I met with the family and found similar issues as those I’d identified in Elizabeth’s family. Before all was said and done we’d see a total four angels appear on the unit from that community, all with physical problems involving serious pain starting the day after the accident that had taken their friends lives.

I worked with the staff on understanding the importance of recognizing the beliefs and culture their patient’s came from no matter how much it may have differed from theirs, underscoring how it is the times we are fearful that we rely on our culture for reassurance the most. I pointed out that being in the hospital was a time we were likely to feel anxious and upset.

The other thing that I thought about during these cases was the amazing way that our mind and body interact. While it’s not unusual to have physical symptoms when extremely stressed out, I like to think that in these cases the symptoms served to get the children the specific type of help they needed. I also thought it was interesting that the symptoms all involved unexplained pain, something that in their community was a recognized symptom of something viewed as not just acceptable but miraculous.

I came away from the experience with a great deal of respect for the girls and their families. And although I came from a different faith, and had a different view of angels, before each of the children was discharged I asked them to keep me in mind. After all, I reasoned, it couldn’t hurt. I would take all the help I could get.

Natalie C. Frank has a Ph.D. in clinical psychology. Her area of specialization is pediatrics and behavioral medicine.

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