Sunday, October 02, 2016

A Visitor from Kentucky

I am thrilled to find the time to post something: pretty much a miracle, considering that this weekend I had to complete: the first verbatim of this first unit of clinical pastoral education (a word-for-word account of a visit with a patient, as best the aspiring chaplain can remember it, plus analysis and description of this and that), the design of a 20-minute interfaith service I will lead on Tuesday, and my statement of service, which is meant to explain why I want to do this work and what I believe my spiritual foundation for it is. The latter also required completing a creative project, which I finished an hour ago.

I cut out a favorite photograph of myself and stuck it to a white piece of nice paper, which in turn was joined to a piece of cardboard, for sturdiness. I put gold star stickers here and there, and drew little stars with a purple marker. I added various pieces of chaplain-related encouragement I have gotten from friends, the words winding among the stars. It looked so nice when it was done that I laminated it.

This same weekend, I had to do laundry, go to Rainbow, go see the shirt lady, and do various other chores. I also managed to have dinner with Karen V. on Friday night at Santaneca. My landline died several days ago, so I also had to call AT&T, which was a horrible experience, and I also got an email saying my email password had been stolen and to change it. After I did that, the email on my iMac no longer worked and I had to call Apple. Just as Apple answered the phone, I spilled an entire glass of water onto my desk. Ugh. Nonetheless, I got it all done, with one precious hour to spare.

CPE is going surprisingly well, one day at a time. Having done the summer unit makes a vast difference. I’m not having to figure out from the ground up what must fit into my schedule and what has to go. We are asked to do a tremendous amount, but we are treated very kindly and generously. We get comp time for any minute we spend beyond the normal work day (which is only seven and a half hours) and $16 worth of free meals in the cafeteria each time we are on call.

On my fourth day, I was meeting with my supervisor when her phone rang and I heard her say, “I’ll go right now.” Someone on campus had suffered a ghastly self-inflicted injury and chaplain support was needed. I trotted along behind Jodie hoping the body was not in situ and was glad to find it wasn’t. I could never be a paramedic. Jodie supported the witnesses by encouraging them just to pace up and down and to breathe, two simple and effective ways to metabolize shock, or emotions in general.

In the first week or so, I found myself feeling impatient with more than one peer. Five of us are at the other main campus and nine at the one where I am assigned, and it is challenging to be crammed with so many people in one tiny student room, with everyone’s anxiety levels spiking up and down all day However, I believe that my happiness this year depends greatly on my relationships with my peers. I must ask myself how I can help them to feel safe, relaxed and cared for. This past week, we met as a whole group and each took 15 minutes to tell our life story, focusing on an important transition, a time we felt understood by someone else, and the first time we realized we were different from or the same as others. Many of the stories were tremendously touching. I felt an expansive sense of love for these people. They are so dear. I especially appreciate being in a group with several people in their 20s.

My initial impression of the student room was that it was smelly, dingy and depressing, but now that I have spent more time there, I see that it actually has high ceilings and tall windows that open, and that there is a view of part of the Golden Gate Bridge. From a classroom on a higher floor in that same building, I could see the Marin hills and a sailboat moving slowly toward the ocean. It made me think of all the lovely relaxing moments I’m going to have a year from now. In fact, from many places inside the hospital or on campus, there are splendid views of Marin and downtown San Francisco. It is actually a very beautiful place.

There has been lots and lots of orientation and various kinds of training, including on how to put on and take off various pieces of personal protective equipment. Somewhere along in there, I did manage to see a patient or two, but the first day I really saw patients was during “chart review” week. At the place where I was over the summer, we had to track every single minute we spent doing anything, which was stressful and burdensome. Where I am now, you’re kind of on your honor most of the time, and periodically they have a week where you try to make initial visits to 100 percent of your patients who have been in the hospital for 24 hours or less, and to make five-day follow-up visits. For this first chart review, they said we didn’t have to worry about the follow-up visits.

Furthermore, you can do one unit at a time. Once you’ve managed to see every new patient for a given unit, you can call or email your supervisor and say, “Check the system right now!” before a new patient arrives. I am very lucky in that three of my five units are exempt from chart review: the waiting room (of course), and pre-op and post-op; the turnover in the latter two areas is just too high.

That leaves me with two units, one with eight beds and one with maybe 30; I haven’t really studied it yet. Last Monday, for mysterious reasons, the smaller unit was entirely empty. This seems to happen a lot, that units close and re-open suddenly. Jodie said, “Zero patients! That means you automatically get 100 percent.” Seeing all of zero patients counts as success. That left just my one big unit, where 16 patients were new. Nearly all the rest had never been seen by a chaplain, unless they’d been there so long that someone from the previous year of CPE had seen them, but I didn’t have to worry about that at the moment.

I rushed over there and visited all 16 in the course of two hours, and had one visit substantial enough to write a verbatim about. Yay! I was shocked when I noticed two days later that nearly every single patient in that unit was brand-new, meaning that they all needed initial visits, which if I had time to do, I would do, but I don’t. The pressure is only really on when it’s chart review time, so that is lucky. I also don’t have time to read much of anything. Every day I throw another inch of reading material onto the stack, and maybe in retirement I will read it all.

One day I was taken by a peer on a tour of the psych unit, where we examined a rosary to make sure it could easily be broken, and thus not used to strangle anyone. When it did break, the psych unit worker said, “OK, these are kosher.”

“So to speak,” I added.

During that tour, I needed to use the restroom and my peer took me to the nearest one. Outside the door was a staff member with a patient, who was older and shorter than I am, and reaching to touch anyone who came near him. I turned to go through the bathroom door and felt hands on my shoulders: the patient. I said to him, “I’m going to be in here by myself,” and I went into the bathroom and put both of my hands on the door to close it. The patient pushed on the door a bit; I pushed a bit harder from my side. I repeated, “I’m going to be in here by myself,” and I pushed harder. So did he. I managed to get the door closed and then I noticed that, under the nearly closed door of the single stall was a pair of red hospital socks.

“Is there someone in here?” I asked, feeling nervous.

No one answered, and no feet were to be seen when I bent over and looked under the stall enclosure, but the paranoid thought crossed my mind that whoever had removed the socks was crouching on the toilet seat, and I decided not to open the door to the stall, and to find another bathroom. Except that the grabby patient was still standing right outside the door to the bathroom, along with my peer and the staff member, so I was trapped between either two mental patients—we’re never supposed to go into any such patient’s room—or between a real one and an imaginary one.

Finally the party outside the door moved along. My peer said later that the staff member had mishandled the situation, that he should have realized that I was in effect trapped in the bathroom and moved the patient away immediately. He said he was angry about it and that he was going to mention it to a supervisor there.

One day I read that of 10 patients who are the subject of a Code Blue—the patient’s heart or breathing has stopped and resuscitation is attempted—only two will recover enough to leave the hospital. I recall Samantha saying last summer that many doctors have specified that they do not wish to receive CPR in any circumstances, because the recipient is never be the same afterward.

We begin each day with a morning meeting where whoever was on call the night before goes over who is where that day and leads an interfaith reflection: sharing wisdom, reading a poem, leading a brief guided meditation. This is a lovely way to start the work day, and reminds me why I want to be a chaplain.

I intended to ride my bike to work, but so far I’m still taking Muni. One nice thing about that is being able to call my mother while I’m doing the walking portions of the trip, and another nice thing is being able to read a novel or magazine while en route.

One day we had a didactic, as they call them in CPE, on end of life options, including the Aid in Dying law, led by the director of spiritual care, Paul. Paul mentioned that you can’t put in an advance directive anything like, “If I get sick, I want you to shoot my brother-in-law in the head.”

My first on-call, a week or so ago, ended up going extremely well, meaning that I got a full night’s sleep. With a portable fan on and aimed at me, the unpleasant smell in the sleeping room (different from the student office) was undetectable. In the evening, I visited a dead person whose appearance would have terrified me before CPE and which now didn’t faze me in the slightest. I asked her relatives to share memories and we had a lovely 30-minute visit. There was a page at 9 p.m., but that visit only lasted five minutes. The next time I was summoned was for a Code Blue, which occurred precisely as ten minutes of meditation ended the next morning: perfect.

I had just the breakfast I’d envisioned and a wonderful salad for lunch in the cafeteria that day, paid for by TWMC, and I felt fine, since I’d gotten plenty of sleep. I know I won’t always be that lucky. Some of my co-workers have looked wretched after their on-call shift, and reported being up nearly all night and feeling terrible.

One evening at home, I pulled my bedcovers back and sat down on the edge of the bed. From the corner of my eye, I could see Hammett respectfully examining something on the other pillow: an enormous (relative to anything you want to see on your bed) sparkling green grasshopper. Normally I’m perfectly fine with putting a clear plastic container over a spider or bug, sliding a piece of cardboard under it, and dropping it out the window, while hoping for its safe landing, but this creature was so large and so unexpected, I thought this might be more a job for Tom, who came right down and actually walked the grasshopper downstairs and out into our building’s small backyard.

He said he didn’t think there was another on the premises and that he suspected it had arrived with some packaged item. My new work shoes, still in their Amazon wrapper! Yes, there were some folds where a grasshopper could have been concealed. I guess this grasshopper liked dark, hidden places, since when he left the package, he made for a spot under my blanket. Can you imagine if I’d woken up with him on my face in the middle of the night? I looked to see where the package had come from: Kentucky. A handsome Kentucky grasshopper, now very far from home.
Post a Comment