"Call My Girlfriend!"

He'd been brought in as a trauma, but was remarkably lively and talkative. The accident occurred when he drove into a tree, but there was no evidence that he'd been texting. He'd been on his way to pick up his girlfriend to go downtown for a symphony concert. The paramedic told me that the girlfriend had been phoned from the scene and told the concert wasn't going to happen. She was not coming to the hospital.

After someone close to the gurney stepped aside, I went close and asked him, "Is there someone I should call for you? Your son or daughter perhaps?" "No," he told me, emphatically. "Call my girlfriend." I reminded him that the paramedic had phoned his girlfriend already. Impatient with my apparent denseness, he said, "No, my other girlfriend!"  He had some trouble remembering her name (he'd hit his head on the steering wheel) but eventually came up with it as well as her phone number. All of the trauma team seemed amused, as was I.

I called the other girlfriend and discreetly didn't mention the first one. I told her that Mr. T would call her once he was settled in a room, and she was fine with that. She was unable to come to the hospital.

So I went back to Mr. T and reported what I'd done. He asked me to lean in a little closer. "You have pretty eyes!" he told me. "And I like your hair!" The trauma team perked up and I told Mr. T, "You have two girlfriends already! You don't need a third!"

He was 95.

Two Situations Involving Rules

Situation One: I was walking down the corridor after lunch when I heard someone crying loudly. I picked up my pace, as did the woman who was walking ahead of me. We came upon a middle-aged lady, up against the wall, heaving with sobs, "I want to die! I want to die! I can't be brave any more!" The other woman -- a laboratory worker -- and I managed to get the lady to leave the hallway and step into the chapel. We spent an hour with her as she cycled between regaining her composure and resuming her lament. We pieced together that she had just left visiting her daughter, who had been a patient for a couple of weeks, and who had just received a new diagnosis. Conversation with the daughter's nurse revealed that the lady was not good at managing her diabetes, had skipped several days of visiting the daughter, and had exhibited a change in mental status. After a long time, we were able to persuade the lady to go to the Emergency Room where someone could check her blood sugar in the hope of getting her stabilized. I reported her words, "I want to die!" to the triage nurse. Confident that the lady was in good hands and having received a call to attend a patient, the lab woman and I left her there and went on to our work.

Fifteen minutes later I received a call from the lab worker. She had accidentally left something down in the ER and when she went to pick it up, she learned that the lady had left. When questioned about "I want to die!" she had responded that she had no plan to kill herself that day. Though her blood sugar was likely out of line, though she clearly needed some sort of care beyond what we had been able to provide, since she was not a danger to herself or to others, the ER nurse had no way to keep her and administer treatment. This was a case where rules got in the way of care and there was nothing that could be done about it.

Situation Two: The patient had suffered a cardiac arrest and the team was working hard to bring him back. My job was to support his partner-not-wife-of-sixteen-years. When the patient had Coded, the partner had phoned his daughter, who was on her way to the hospital. Soon, the patient appeared to be stable and the resident came out to speak to the partner-not-wife. "Is his daughter coming in?" she began. "I am so sorry, but because you are not family, I cannot give you any information about his condition." She looked sorry, and the partner understood and did not argue, but looked very, very upset.

Since the patient had just come to the hospital that day, he was not yet assigned to a particular service, and the resident sat down and placed a call to an attending. I heard her explain the patient's situation in detail and then she said, "Okay. I'll call him." The partner was anxious, looking at her watch, wanting to go into the patient's room but not yet permitted, wanting information that she was not legally entitled to. When I saw the resident pick up the phone to place the next call, I moved the partner a few feet so that she would be closer to the telephone. "Now, just eavesdrop," I told her.

"Answer Your Damn Phone!"

When the beeper shrieked that there was a Code 30 -- a cardiac arrest -- I hurried to the indicated location. The patient was an elderly woman and there was no family visiting at the time. My role at the time of a Code is to support the family. A staff physician phoned the family to notify them of the change in the patient's condition, and urged them to come to the hospital. Meanwhile, the Code 30 team continued to work with the patient.

When the family arrived -- a wheelchair-bound husband, two grown daughters with husbands, and one grandchild -- I escorted them to the family lounge just outside the unit. There were some other people there; sensing what was going on, these kind folks quickly moved their positions so that the Code family could all be together.

Immediately the daughters began using their cell phones, calling or texting everyone they could think of. One of them said, "I can't post to Facebook from my phone. Who can I call to get them to post?" They wanted everyone to know that Granny had taken a turn for the worse. When the resident came out to speak with them the first time, one of them even asked him to wait until she was finished her phone conversation. After hearing what he had to say, the texting and phoning resumed: Granny was very sick, indeed. There was another sister in a far-away state who needed frequent updates; then there were all of the other grandchildren, some of whom were at college or in other states. A lot of energy was put into what to do about one teenage grandson who was alone at home; they didn't want him to be alone when he heard about Granny's turn for the worse -- he had completely freaked out when the cat had died. My gentle suggestion to wait until Granny's condition was resolved before notifying this vulnerable lad fell on deaf ears. The dispatched a cousin to go over to tell him in person.

A bit later the nurse came out and suggested that the family might be more comfortable in an empty patient room, away from the crowd in the lounge. I knew this to be a euphemism for "bad news is coming," and went to help bring in additional chairs, get cups of water and tissue boxes. Once settled in the room, the efforts to communicate resumed. Messages that had been left previously had been picked up and the return calls were coming in. One of the phones didn't ring; instead, a grouchy, loud male voice would proclaim, "Answer Your Damn Phone!"

The chief resident came into the room and said, "I'm so sorry." He went on to explain how hard and long the team had worked to try to bring Granny back. At this point she had been gone for nearly an hour. The husband-turned-widower sat shocked in his wheelchair, but his daughters' main concern once again was to get the word out, to make sure everyone knew immediately. I watched all of this for a few minutes and then went over to the wheelchair. "How long have you and your wife been married?" I asked him. "Fifty-eight years" came the reply. A lifetime. He and I spoke quietly together while the daughters and granddaughter continued with the work they had deemed most important. Again I heard "Facebook" mentioned and "Answer Your Damn Phone!"

I was repulsed by their behavior. I thought back to a time when mobile telephones were not allowed to be used in the hospital and wished that were still the case. As much as I understand that Denial has its clear purpose in grief work, there was something wrong with this picture. They reminded me of the people who come to graduations and weddings, and miss the experience because they are so busy making a video to watch later on. None of his family was caring at all about the bereaved man in the wheelchair who had lost his life-long partner. I was glad that I could be there for him since they weren't.

Not soon enough, the batteries ran out; the phoning and texting came to an end. They put away their damn phones.

And then, the daughters began to cry.

What It Is Like

It is wonderful. Being a hospital chaplain, that is.

My work began in the middle of December when I was asked to find five dates when I could work from 2 until 10 p.m., shadowing an experienced chaplain, and learning the particularities of the hospital. Finding 40 hours in the last two weeks of December was a challenge, but we managed. The men that I worked with were patient and kind (well, what would you expect?) and taught me well. 

I wasn't concerned about the work that I would be doing; I'd done that before and felt competent. My biggest worry, as it happened, was one that would take care of itself: Finding my way around the humongous, state-of-the-art emergency trauma center! There appeared to be no logic whatsoever as to how it was laid out. I was just going to have to go there and do it and look for patterns and clues.

My mentors believed me to be ready, and very recently I worked my first solo shift from 3 p.m. on one day until 3 p.m. the next day. There is an on-call room and it is anticipated that eight hours of the shift will be sleep hours, though it is not anticipated that those eight hours would be consecutive!

The hospital chaplain has a variety of visit types and there is plenty of time spent doing documentation and reporting. On this first shift I did all of these different things:

• Responded to one Level I and three Level II traumas. This must be done with all due speed and my role is to work with whoever I can to identify next-of-kin for the trauma patient, and then to contact that individual and ask him to come to the hospital. Sometimes the family member has come in with the patient; other times the family is contacted by the nursing home sending the patient; and sometimes I need to prowl through the patient's cell phone looking for "Mom" and make that call.
• Supported a family member immediately after a patient's (not unanticipated) demise.
• Assisted a patient who wanted to make a Living Will and select a Health Care Power of Attorney.
• Arranged for a priest to provide Sacrament of the Sick to a patient nearing the end of his life.
• Supported a patient (and her husband) who had come to the hospital with what she thought was a very minor problem only to discover she had a far-advanced major diagnosis.
• Visited numerous patients in their rooms upon referral from the nurses and the previous chaplain.

Another night I might be asked to perform a Baptism for an unstable newborn, to sit with a dying patient who has no family, to be with a woman who had just become a widow due to her husband's sudden cardiac arrest. The beeper is with me constantly, as is the telephone, and the chaplain's number is intentionally an easy one to remember.

I found one wonderful nurse in the ER who eased me along with a difficult family identification. I discovered that the staff in the triage section are good-natured and amazingly helpful with all kinds of questions. I learned that breakfast and lunch are the best meals in the cafeteria and that the dryness of the institution requires lots of chapstick and cups of water

When I was working on the final trauma of my shift, very tired from too few, too short segments of sleep, all at once I realized that I wasn't actually thinking about where I was going. My feet had learned the layout of the ER, while my brain really had not!

I love it. I absolutely love it.