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Imagine being in a foreign country surrounded by a people and a culture that are completely different from your own. You don't speak the language. Suddenly you experience great loss and are left to deal with the aftermath alone.

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I deal with women in this situation on a regular basis. As an RN and a grief counselor, I care for patients who have experienced the loss of a baby through miscarriage, ectopic pregnancy, stillbirth or newborn death. As a nurse, I am concerned with how families deal with their loss and their grief. As a Christian, I want to communicate the love of God in their grief. Christ promises never to leave us or to forsake us, but not all my patients have that assurance and peace.


I work in a women's health unit in a moderate-size community hospital. The surrounding neighborhood has one of the highest Arabic populations outside of the Middle East. Most of my Arabic patients are women, modestly dressed from head to toe. Their hair and necks are draped in a hijab, the scarf that veils the head as a symbol of modesty and submission in the Muslim religion. Although I have occasionally cared for Christian Arabs, most of this Middle Eastern population is Muslim. Sarah was one of these patients.


As I entered Sarah's room, I found her quietly crying, alone in her bed. She was curled up in a fetal position, holding her abdomen. Her head was covered with her veil. Only her tear-stained brown eyes were visible. She was approximately fourteen weeks pregnant and had been admitted for a threatened/inevitable miscarriage. I knew by the apparent pain and cramping, it was just a matter of time. I sat down next to her and softly touched her arm. I needed to assess her physically and gain a basic understanding of her ability to communicate. The previous shift had told me, "She doesn't speak English."


I know a few words in Arabic but I would need help if she didn't speak English. I pointed to her abdomen and with a questioning tone said in Arabic the word for pain. Her eyes darted directly to mine at the sound of her familiar language. Through the initial struggle of beginning our nurse-patient relationship, I discovered that she spoke some English-definitely more English than I spoke Arabic. Later she expressed how touched she was at my desire to communicate with her in Arabic. She said, "It made me feel like you cared about me, like you wanted to be my friend."


I did what I could do to make her physically comfortable. Then I considered another need, being a witness of the love of Christ without making her feel uncomfortable or defensive.


Jesus tells us, "You are the light of the world" and to "Let your light shine before others" (Mt 5:14, 16). I silently prayed for wisdom and guidance; then I left Sarah alone while I cared for other patients, hoping the pain would subside.


I was suddenly called back to her room. I found her in the bathroom. Her eyes were filled with panic. She was on the toilet, shaking and crying. She was holding her breath and moaning. I knew she was beginning to bear down. I hated the thought of letting the fetus plop into the toilet. I grabbed two gloves and reached under her to grab this little bundle.


With the fetus still attached to Sarah, I cradled it in my hand and helped Sarah back to bed. I gently placed the fetus on clean white linens. I wanted this mom to see her little one treated in a respectful way. The baby had ten fingers and ten toes. Everything looked appropriate to the size and the shape of a thirteen-to fourteen-week fetus.


Sarah cried silently and held her child in her hands. I quietly asked her, "Would you like me to say a Du a?" This is a word in Arabic for a prayer for blessing and comfort.


Typically, nurses would ask about a desire for baptism or blessings, but these terms are solely associated with Christian beliefs and would be shunned by a Muslim patient. I knew in my heart that this baby's soul was already in the presence of God, but how I dealt with the loss for Sarah would have an impact on her personal journey with grief and how she would be influenced by my faith.


Sarah cried harder and said, "Yes."


I knew I could pray, asking God to meet the needs of Sarah's heart and strengthen her during this time without creating spiritual barriers. I prayed out loud for her as she held my hand and together we both held the baby, "Lord God, I come before you in time of need. You know the needs of Sarah's heart. Please be with her, strengthen her and speak with her, comfort her. Draw close to her and help her to see how much you love her. God, grant her peace."


We embraced and cried together. I held her in my arms for what seemed like a long time.


The door sprang open. The doctor on call came into the room. By this time, Sarah had delivered the placenta. I left while the physician examined Sarah and spoke with her about her loss. I took the fetus and laid it on a small pillow, made for us by volunteers. I gathered a tiny pair of booties, a baby identification band and a memory quilt for Sarah. She would be leaving the hospital with empty arms, a difficult hurdle for most people. Tokens of remembrance could comfort her in the coming days.


The doctor quickly came and went. The difficult question of why this happened had already surfaced. Many physicians handle it by telling patients that they can donate the fetus to a nearby university hospital for genetic testing. Often couples agree because they assume they can learn what went wrong and be able to prevent tragedy next time. However, in most situations, the reasons for the miscarriages are unknown, and no definitive answers will be found.


When I lost our first child, I wrestled with this. I finally concluded that God didn't promise all the answers. He did promise that I wouldn't have to walk alone. My job was to walk by faith. For many couples, genetic testing and investigation is good and useful. But I felt Sarah needed to know that once the tests were completed, the fetus would be cremated, and no burial options would be available. Cremation is a violation of the Muslim faith for any fetus that has reached a point of human recognition.


The doctor had given Sarah the forms for donation, and she had readily signed. I knew in my heart that she would be tormented if she learned that her baby had been cremated. I couldn't keep silent. I privately approached the doctor who had witnessed the consent signing and expressed my concern. The doctor shrugged her shoulders and told me not to make a fuss.


I felt accountable to Sarah. I wanted her to come to a personal relationship with God, knowing Christ as her Savior. If I didn't respect her thoughts and beliefs, I would have no hope of reaching her heart. I asked Sarah if she understood what would happen to the remains after the testing.


She simply said, "No." She hadn't thought that far ahead.


I asked what her faith taught in regard to this situation. She said she was unsure. She decided to talk with the Imam, the spiritual leader in the mosque. I knew what his answer would be, so I held the release papers knowing that once the process was put in motion I would be unable to stop it. A potential delay was better than a violation of religious beliefs that could result in a lifetime of grief for my patient. I felt the doctor would be angry at my so-called interference, but I had to act.


It is important for parents to enter the grief cycle gently. The grief for the loss of a child begins with the initial loss but continues with a heartache for what could have been. The latter aspect can be overwhelming. For many, this is a tumultuous storm that spins out of control. Grief is not a single event but a process that must be dealt with individually, considering spiritual and cultural components of the families involved.


After Sarah talked with her Imam, she and her husband decided to bury their child. We helped make arrangements in the time period required by her religion. Ceremonial washing was performed at the hospital, and her child was buried the next morning.


Sarah came from a background different from my own, yet we shared much. I still cry when I think of Sarah and the bond we created while praying and holding the child of her hopes and dreams. Although I haven't had direct contact with her since that time, I have spoken to people in our community who mention the "kind nurse" who helped keep the baby from being cremated.


Many weeks after Sarah was discharged, I received a note from her. She wrote, "I can't stop thinking about you and how you spoke with me. Something very different-I cry and smile both together. Thank you. Love, Sarah"


I pray that God's love will shine on Sarah and draw her close to him. The morning of the burial, I was able to share Scripture passages with Sarah. The Koran is the Scriptures of the Muslim faith, but they respect Jesus as a prophet and will usually be open to the Bible, especially Old Testament passages. I spoke to Sarah about David and his child who died. David was unable to bring the child back to life but believed he would one day go to be with the child. Explaining that I knew I would see her child again because I had accepted the love of God, I told her that she could have that comfort too.


I've learned that the small amount of effort it takes to understand the people in your community and learn their culture can have eternal rewards. I still don't speak fluent Arabic and often use gestures to communicate with my patients, but I know God can use these humble attempts to speak, when hearts are tender and ready to hear.