"Not Very Smart"

It turns out that her daughter is a nurse on another floor, and that daughter is the one who requested that I visit the patient.

She was 80 years old, but I would have guessed her to be 75. She was sitting in the chair, supported by pillows, with an oxygen cannula helping her to breathe. I pulled over another chair and settled in for a chat.

I have to say that I straightaway I liked her. A lot.

I began, as often I do, by asking what had brought her to the hospital. She replied that it was her breathing.

And then she got to the point. "I'm a twin, you know." I hadn't known. Her fraternal twin sister had been "the smart one." "I'm not very smart," she told me. "But my sister was smart." The sister had died at 39. My patient had now lived twice as long. We talked about the special bond of twins (my own mother was a twin); my patient will always miss her sister. She thinks of her every day.

She rambled on. She'd been in the hospital for pretty many days, not exactly certain. And she didn't know when she'd be going home. The diabetes was the problem, she said. She had it and didn't know anything about it. "I don't WANT to know about it. I'm not smart enough to understand it." I was taken aback. This was the second reference to not being smart. She lives alone, and people were worried about that in connection with the inadequately managed diabetes. I inquired about perhaps attending a patient information class on the subject, but, no, she didn't want to do that. Her daughter, the nurse, understood the diabetes and would take care of it. Her daughter was very smart, she said, "not like me."

Our conversation wandered around and soon the beeper shrieked and I needed to leave. We said a prayer together, and I said I would ask Sister to stop and see her on Monday, and off I went.

All the way down the hall(s) she stayed in my mind. I conjectured that her parents had been the ones who had given her this terrible message, the self image of stupidity. We tend to believe what our parents tell us about ourselves. I wondered what they would think, how they would feel, if they knew that 75 years or so after receiving that message, after marrying, keeping a household running, raising a family, helping at least one child through college, after all of that, she still believed what they had said.

Six Years

I spent a lot of last night in the Emergency Room.

As a hospital chaplain.

There were many Level II traumas, sometimes two at a time, and the staff was hopping.

Around 3:45 as I was dragging myself towards the elevator, hoping to get a few hours of sleep, it dawned on me: It was the Friday of Memorial Day Weekend. And I was in the Emergency Room. Again.

Six years ago, on the Friday of Memorial Day Weekend, I was in the Emergency Room, too. This time as a worried wife of a man experiencing a heart attack.

So I turned away from the elevator and went back to the triage area. I told them of my realization. And I thanked them for saving my husband's life.

A blog friend is celebrating her wedding anniversary today. That made me think that Joe and I are also celebrating an anniversary. We've had a wonderful married life of 47 years. But these last six have been something special. We had a reminder that nothing lasts for ever, not even us. And we spend more time together, go out separately less, and thoroughly enjoy the quiet times with each other.

I know that this weekend we are remembering those we lost, and that is as it should be. But it's also okay to remember one we didn't lose. And be thankful to those who made that true.

A Quiet Shift

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.

"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.