Saturday, October 08, 2016

High Above the Malarial Swamp

Our schedule seems straightforward: attend the morning meeting and then see patients until class starts, or see patients all day if there is no class, but every single day seems to require invoking special procedures. For instance, whoever is on call doesn’t come in until time for class or 4:15 p.m., whichever comes first, so his or her floors must be covered until then. In another variation, if a person assigned to one campus is on call at the other, the next morning, he or she returns to his or her usual campus and takes the on-call pagers for part of the day, sharing the load with the person already on call at that campus.

At first, this seemed stressful: something weird is going to happen every day? But it’s actually kind of a good thing, because it gives us plenty of exposure to units other than our own. My wise friend Lisa C. said one thing she thinks about at work is what actions will make the most difference to her co-workers, so when it’s time to parcel out units to cover, I am often the first to raise my hand and just take whatever is at the top of the list. One day this past week I spent the entire morning with a very agitated young woman in the “psych zone” of the emergency department. Another day I had a long visit with a woman who has had stage four cancer for years and wanted to talk about her end of life wishes; she said none of her friends or family members want to talk about it.

When we’re on call, we carry four pagers: our own, the on-call pager, the Code Blue pager for the campus where we’re on call, and the Code Blue pager for a campus where only day surgery is done, so a Code Blue there would be rare and one at night or on a weekend rarer still.

I grossly oversimplified matters when I said that TWMC has two campuses. Actually, there are at least four, including the county hospital, plus various other facilities here and there. I haven’t had time to research it, but I was told that parts of the one where I’m assigned date back to the 1600s (could that be true?), built up the hill from the malarial swamp below. The building that houses our student office is the oldest building on campus. Jodie mentioned that it is not due for lead testing until 2017, so she brought in a home kit and tested the one drinking fountain in the long hallway outside our office. It passed the test, but ever since she mentioned that, I’ve been taking my water bottle home at night and filling it the next morning as I pass through the student union so that I drink at least one bottle of water each day that (probably) doesn’t have lead in it.

The bathroom is far cry from all the lovely corporate restrooms I frequented for 18 years. My new work bathroom is shabby and has two cramped stalls and no counter space for my toothbrush or sunblock other than the ledge of the sink itself.

One day this week, Anita accompanied me on joint visits to patients and gave me some really nice feedback, particularly on my ability to connect with patients. She suggested, “You might want to do joint visits with your peers.”

“Oh, yes, to see how they do it,” I agreed.

“No, so they can see how you do it,” she said. Very flattering.

My initial visits can be very quick, since there is very high turnover in my units and we are supposed to see 92 percent of patients within 24 hours of their being hospitalized. Anita advised prolonging my initial visits long enough to figure out if the patient needs to be seen again before our normal five-day follow-up. She also said weekends don’t count as part of the five days, which I was surprised but pleased to hear.
 
During one of our visits together, I was asked to pray, and did so. Anita said afterward that it’s fine for me to pray in the name of Jesus Christ if I’m comfortable doing that (which I am), but she doesn't think it’s good for me to let a patient assume that I’m Christian: it is deceptive or even dishonest. She suggested that I could say, “How wonderful that you have that connection with God. I connect this way ... ” I might want to do this if it’s clear that the patient is making an incorrect assumption about my religion.

Now, at VFMC last summer, when I asked what I should do if a patient asks about my own religion, Samantha said that I could answer by saying, “I’m part of a multifaith group of chaplains.” Since I am comfortable praying to God and so forth, Samantha said that if the patient pressed further, I could honestly say, “I’m an interfaith chaplain.” That is, she didn’t exactly say, “Why, tell them you’re Buddhist!”

So, how wonderful to find that at TWMC, the assumption is that I would say, “Why, I’m a Buddhist!” They are truly interfaith. On Friday, I announced it left and right, and felt even more joyful than I usually do. I felt liberated. As it happened, one patient was himself Buddhist and said he wonders if, per karma, his illness means he is being punished for something.

I said that Buddhism does include the concept of karma, but the Buddha also taught about sickness, old age and death—could this be natural sickness? He tried on the phrase: “Natural sickness.” I will follow up on that if I see him again.
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