In my role as a "casual" employee, I work as a chaplain in the local hospital only two or three times each month. But each shift is twenty-four hours long. I usually get a few hours of sleep during the night.
No two shifts are alike. Sometimes I can hardly catch my breath between answering the telephone, responding to the beeper, attending the Codes. Sometimes there is a more even pace, and I have time to do purposeful rounding, visiting the nursing stations in search of referrals.
While I relish the busy times, the dramatic times, I also like the opposite. It is something about the difference between hopping from a major trauma to attend a death and then respond to a Code vs. having the time to sit for an extended time with a patient, not having to think about what other work needs to be done.
A recent shift was one of the quieter ones. I picked up the referrals from the chaplain I was relieving and noted with interest that there were two requests for Advance Directives. As I was walking to the on-call room to deposit my tote bag, I was stopped by a member of the Palliative Care Team -- she was glad she had seen me because she had a patient who wanted an Advance Directive. And no sooner had I reached the on-call room than the phone rang -- yet another request! It seemed odd that all at once so many people would be wanting to put their ducks in a row.
I printed out four copies and headed to the patient nearest the office. There was a large family gathered and the nurse had indicated to me that they were
most impatient and that they were difficult and demanding. The patient himself was very, very sick, barely responsive. I felt a fleeting concern that there might be some railroading going on, and decided to spend some time getting to know the family a little bit. Before long, my little twinge was gone away. Because the patient was so very sick, I asked one of the men in the room to give me the information that I would need for the Durable Power of Attorney. I filled out the form and then went to find a second witness; then we roused the patient and I asked him to confirm the wishes that were expressed on the form. It was clear that he understood and that the information was correct. He made a mark on the page, it was witnessed, and I had the document put in his chart. I told the family I thought the patient was fortunate to have such a large family who loved him.
I had a call to visit another patient and when I got to the room for another of the Advance Directive patients, I learned that he had been discharged. The third patient was sleeping, so I handed that request off to my replacement. The fourth was a young woman with a trach who was also very, very sick. She could barely respond to my questions, but she was determined to arrange for her daughter to be "the decider" in the event she got sicker and could no longer make her own decisions.
I had a call from a nurse whose patient unexpectedly had to go have a cardiac catheterization and was upset and crying. I was glad that I had no other pressing demands because I was able to sit with her until Transportation came to move her to the cath lab. She was unclear about exactly what the procedure involved -- it had all come about so suddenly. Knowing it wasn't my place to attempt to explain a medical procedure, I spoke briefly from my own experience, telling her that my husband had undergone a STAT catheterization six years ago and that he had reported it was not uncomfortable and, in fact, had been interesting. The patient just needed someone to be with her, someone to let her talk. She had been packing her suitcase to take to a southern state to attend her granddaughter's college graduation -- the first one in the family -- when the chest pain began and radiated down her left arm. She was smart enough to know she needed to come to the hospital rather than to North Carolina. We talked about disappointments, and about taking good care of ourselves. Because my shift was so long, I was able to catch up with her post procedure and I was glad of that.
A nurse from the ER phoned for me to come down and gave me a room number. The lady in the bed was an Alzheimer's patient, and her husband was in the room with her. He was crying. He had just received a call on his cell phone that their grandson, a man in his late twenties, had hung himself. This was the second grandchild they had lost. The man -- who became my patient -- was overwhelmed with sadness. The care of his wife was his responsibility, mainly, and as I well knew, was demanding. They had been in the ER for six hours at this point and she was scheduled to be admitted to the Observation Unit; he said he would have to stay there with her. Otherwise, she would become too agitated. He was overwhelmed. I spent a good half-hour with him, just listening, and supporting him. I was worried about how he was going to get any rest (he told me he was diabetic and had to be careful about eating right). Then came word that the wife did not need to go for observation; she was stable enough to be cared for at home, and with great relief, they left.
I spent some time with a family who had decided to remove life support from their father; they were just waiting for their brother to arrive before this would be activated. Their very elderly and frail mother was at home, unable to endure the being present. They talked about their dad, what a vibrant man he had been, how he would detest being kept alive in his present condition but they had permitted it when they still had some reasonable hope that he would get better. We prayed together and I went on my way after telling them that if they wanted me to return after brother's arrival, to just call.
It was a quiet shift. No really major traumas. No Codes. No drama. Just simple pastoral care, listening, supporting, validating, praying. It was good.
