Sunday, September 18, 2016

Whatever You Have to Do Today, You Can Do It

There are lots and lots of young people on the TWMC (Truly Wonderful Medical Center) campus, certainly the students, but even the people who work there look awfully young, going by the pictures posted on the walls of the units I’m assigned to. I noticed a lot of people marching right up the center of the sidewalk, which struck me as arrogant, but if that’s the culture, that’s the culture: I must adjust. I was also realizing that probably 98 percent of the brand-new medical students are scared; anyone who is not scared is probably overusing substances. I’ve developed a silent practice of looking at a student and thinking, “You can do this. Whatever you have to do today, you can do it.” I’m saying the same to myself.

The palliative care chaplain came to visit our class one day last week. She is a Theravadan Buddhist who has been meditating for 50 years, and she brought a force field of calm into the room with her. I could feel it unmistakably from several rows back.

Someone else in our group of 14 students has taken my usual role, which is to ask a million questions about every possible thing that might happen. It’s interesting to watch anxiety rise and fall for individuals and the whole group, and to notice my judgments of others’ anxieties, which is a strong indicator that I am intolerant of those feelings in myself. Am I really calm, or just clamping down on feelings?

I was taken by various outgoing interns to visit the areas I’m assigned to in the hospital. Two of them are low-acuity (people aren’t acutely ill) with high turnover, meaning long pastoral relationships probably won’t develop. A third is the pre-operative area, where people are busy being visited by nurses and the anesthesiologist, etc. The fourth is the post-operative area, where people are under anesthesia, and after they wake up, they go somewhere else, judging from my own experience. Finally, I have been assigned to a waiting room! Paranoid thoughts arose: Did they deliberately give me all the low-stress areas in case I flake again and these areas end up not being covered? Every single one of my peers has an ICU, or the emergency department, or a unit where babies may die. But I will take what has been given to me and do my best with it. I gather a lot of people didn’t get the assignments they wanted, and our teachers said they didn’t want to ignore that disappointment, but it is their experience that people end up feeling that whatever units they were assigned to were perfect for them.

I was worried before my summer unit of clinical pastoral education that I would react to the hand sanitizing gel. They had two kinds, and neither turned out to be a problem, though one smelled kind of nasty. TWMC has a different kind, and it immediately made my hands feel a bit irritated. But I mentioned that to my supervisor and she said there was a student two years ago who was sensitive to chemicals, and there is some other stuff such people can use.

I was kind of disappointed to learn that, because I was thinking this would end my CPE experience, and I was already kind of looking forward to quitting. “Oh, well! I really, really tried!” I would also then have to avoid TWMC permanently for my own medical care, lest they terminate me during a mammogram or pap smear.

TWMC has two campuses. One is new and beautiful and in a part of town with superb weather, not too far from where I live. The campus where I’ve been assigned is old and shabby and smelly: atmospheric. The weather there also is not very good. It tends to be overcast and chilly. The small student room in particular is revolting. It smells, it has little natural light, and the chairs are stained. Instead of having lockers with locks, we have unlocked filing cabinet drawers, one per student, in which to store our valuables. This room is a good hike from the actual hospital, separated by maybe four buildings, two of which are being torn down.

One day I found three boxes of doughnuts in the student room. New student (not me): “I’d better not.” Outgoing student: “What?? Not eating doughnuts is not a choice. You have to eat doughnuts!” Now I see why several people have said that everyone gains 20 pounds during their year of CPE. This is all quite different from VFMC (the Very Fantastic Medical Center), where I was during the summer. Our student room there was a large office we shared with staff chaplains and a handful of other employees. Two walls were entirely covered with a lovely, soothing hand-painted mural. Natural light streamed in several large windows. The hospital itself seemed clean and new and beautiful. We each had a locker with a lock. Adjoining the office was a gorgeous yoga studio with a bamboo floor. Not one single time did I lay eyes on a doughnut. (Because they are not a health-supporting food and we were in a hospital!) We would have treats if we had a celebration, but only then, and leftovers, even of sweets, would sit for days before they finally disappeared.

Here’s one good thing: At VMFC, if you’re there on weekends because you’re on call, you have to round on your normal units (visit the patients there). At TWMC, if it’s the weekend, your only task is to respond to pages. Of course, that very well might end up being a whole day (and night) of work. One person who showed me around said he didn’t find his duties there particularly stressful. He said the hardest part was when a young patient who wasn’t expected to die did.

Despite my low-acuity areas (waiting room!), I will have plenty of exposure to dying and death when I am on call. This gives me the opportunity to mention that at VFMC, the sleeping room was a whole apartment located in a building across the street from the hospital. At TWMC, the sleeping room is a cramped, foul-smelling room inside the hospital and just yards from the main entrance, so it is probably noisy. There are no windows in it. It’s just big enough for a fold-out bed. We can’t go in it until 9 p.m. on weeknights—two hours past my bedtime—and we get off at 4:30 p.m., so the student chaplain may have to find somewhere to twiddle his or her thumbs for four and a half hours.

At 54, I think I’m the oldest person in the group (also older than every supervisor, I believe). There is a woman who is 50 and a couple of people who appear to be about 45, and everyone else is 26, give or take. Good thing I didn’t put this off any longer.

Needless to say, I did not sleep well the night before starting CPE nor really any night since. However, whatever I was sick with I never noticed again after the first day, after starting to take Sudafed, per the precisely correct recommendation of my doctor’s assistant.

Friday we got off a little early, so I went to 24th St. and the Castro in search of shoes; my feet are killing me. Yesterday I got up at the crack of dawn and did my laundry, talked to my 40-year friend on the phone, took Hammett to the vet, ate, went to see F. at his place, went to the mall in further search of shoes—it was very hot and sunny; I felt dazed and bedraggled—went to a shoe store on Mission St., went to see my shirt lady, came home and ate and went to bed early. I’m going to try to make it so weekday and weekend bedtimes are about the same.

Today I went to Rainbow and did my cooking for the week, which for the next year will consist of slicing three cucumbers and boiling some eggs. I sorted through all my various pieces of paper and emails and electronic documents for TWMC and made a giant list of questions and things to do. I wrote an assignment that is due Tuesday, after new employee orientation tomorrow. I have a massive backlog of reading, which I will just have to fit in somehow. Like, it would be good to read the stuff about being on call before Friday, when I’m on call, but I don’t see when I’ll be able to do this. On-call starts at 4:15 p.m. and goes until 4:30 p.m., so on Saturday, I will be the only chaplain at that campus of the hospital, no doubt confused and exhausted, and certainly unshowered.

However, having done the summer unit makes an enormous difference. I would be going completely crazy if not for that. Much that I heard last week was already familiar to me, plus TWMC uses the exact same charting system as VFMC, but in an even simpler way, thank Sam. Also, speaking of Sam, it’s so great to have a built-in friend. I would not have even been able to do the assignment I was doing today if not for having done the summer unit and if not for Sam emailing me his so I could get an idea.

Please feel free to point out typos and obvious mistakes here—I suspect there will be a lot of both over the next year.
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