Her mother hung anxiously at the edge of the room, watching our team prepare for intubation. Elana’s brown hair laid strewn across her pillow as we positioned her motionless body. The chaos of her continuous electroencephalogram contrasted with her stillness and shallow respirations. At only 5 years old, Elana’s seizures were refractory to first, second, and third-line agents and now our escalating therapies had resulted in respiratory depression. I did my checklists, prepared with the team, and intubated. I breathed a sigh of relief as I left the room to answer my cellphone.

Two emergency calls and a few admissions later, I circled back to Elana’s room, expecting a long night ahead. Her bedside nurse whispered to me, “The mother wants to know if we can perform an exorcism.” I looked at her sceptically. “Exorcism? In the intensive care unit?” The nurse nodded and assured me that the request was serious. As a senior pediatric intensive care unit (ICU) resident, my understanding of and experience of exorcisms was admittedly limited and images from movies immediately came to mind. Levitations and loud yelling seemed undesirable given how busy the unit was.

Elana’s mother sat quietly at the bedside, the midazolam and propofol infusions churning away behind her. The exorcism question lingered in my head as I glanced at the monitors; finally, burst suppression. What should I say? I needed to update the family on recent investigations and our suggested treatment plan, which did not include religious ceremonies. I dialed the phone interpreter and stepped towards the bedside.

Elana’s mother spoke first. She thanked me and firmly asked me to save her daughter’s life. She feared that a spirit may have caused the illness and that a cleric was needed urgently. She held my gaze as she emphasised that she wanted medicine and faith to be used for treatment. I provided my medical updates and agreed that we would try to do both. As I left the room, I realised that I was not entirely certain what I had just agreed to and that I should probably update the consultant.

The pediatric intensivist was outside a nearby patient room. I sat down and steadied myself, “The family of the 5-year-old with refractory status epilepticus would like us to perform an exorcism.” I was met with a puzzled expression. “I mean, there’s a cleric that could perform the ceremony.” She agreed that the request was unusual, and it was unlikely that our unit had hosted an exorcism previously. Given the importance of patient and family-centred care, she agreed we should try to facilitate it. “We need to discuss this with the charge nurse. It should be within our unit policy for religious accommodations.” I looked down at my notes, surprised that the intensivist was open to the idea.

My surprise continued when the charge nurse seemed unphased by the family’s request. “We perform other religious and cultural ceremonies—baptisms, prayers, and smudging—how is this different? Do you know if they need candles or open flames? That may be the only difficulty.”

I returned to Elana’s room. All her family wished for was a cleric to perform the exorcism, time at the bedside for some spoken words, and a route for the demon to exit. Elana’s mother reassured me that they would not physically touch her, change any of her medical support, or administer any substances. Overall, the process sounded straightforward, unobtrusive, and peaceful. The charge nurse suggested that the demon could leave through the room’s air vents. We removed Elana’s restraints, which were standard practice in our unit for all intubated patients.

While we waited for the cleric to arrive, the bedside nurse pulled me aside. “I can’t be here for this. I’m Catholic and I’m afraid her demon will possess me.” I realised then that I should not assume that only the patient’s family held this belief system or one like it. Our unit has healthcare providers from around the world, and part of the exceptional care that we provide stems from the diversity of lived experiences and perspectives. As it was early evening in an already busy unit, I hadn’t thoroughly considered the impact that this ceremony could have on other staff. Ideally, our multidisciplinary team would have met ahead of time to discuss logistics, but this would be challenging to arrange on a weekend and the family was eager to proceed. The ever-resourceful charge nurse worked out a personnel swap and all members of the team were on board to proceed.

Shortly thereafter the cleric arrived and greeted the family. I turned off the in-room alarms and looked back at Elana, who still laid motionless. Her mother nodded to me, and I stepped out and closed the door. The healthcare team watched respectfully through a window, poised nearby to help if necessary. We eagerly watched her heart rate tracing as the cleric moved to the foot of the bed, softly chanting. Elana’s family swayed side to side with clasped hands as they stared at her. The exorcism was over in under an hour.

Working with the family and our health care team to facilitate this ceremony was an opportunity for growth and allowed me to reflect on my own beliefs and unfamiliarity with the diversity of religion. I learned that exorcism is an ancient practice, existing across centuries within the practices of many religions including Buddhism, Judaism, Catholicism, Taoism, Hinduism, and the Islamic faith. It is meant to expel demons, jins, or malevolent spiritual entities from the possessed person. Variations of exorcisms have been performed historically to treat seizures. As health care providers, our patient care is shaped by our values and beliefs, religious and non-religious alike. Growing up in small town North America, my beliefs have been shaped by primarily Western and Christian centric media and teachings. I now better understand that my hesitation to facilitate this common religious practice for some stemmed from my limited experience. The fact that Hollywood tropes came immediately to my mind is a testament to the power of media.

While our team asked some logistical questions, facilitating this ceremony, like many others supported in the pediatric ICU, was key in maintaining a therapeutic alliance with the family and providing supportive care. Religion can play a crucial role in a family’s journey through critical illness. In embracing openness and humility, we offered the family support that held great meaning for them. Might we have said no? Certainly, we could have, but allowing the space for a question opened us up to being able to provide truly holistic patient care.

Days later Elana stabilised and was transferred to the ward. Weeks later we received an update from Elana’s neurologist: Elana was back at school.