Saturday, October 08, 2016

Newly But Enthusiastically Burmese

On call last Sunday evening, I was busy with one patient visit after the other until 10 p.m., and after that enjoyed a solid eight hours of sleep. Some of my peers complain they can’t rest in the sleeping room due to noise in the hallway, but with a fan turned on and aimed straight at me—the same way I sleep at home—I have slept very comfortably there so far. Actually, I think I sleep better there than I do at home.

That evening, I was paged to the emergency department and told that a patient had died and that his family would be arriving soon. When I got there, I was shown into a small conference room and soon the family was brought to me. I wasn’t told explicitly that I should impart the news, but it seemed obvious that that was my assignment.

Once we were all seated together, one family member asked, “How is Dad?” Uh oh: she thought he was still alive.

I asked, “What have you been told?”

“They said he has stabilized.”

While I was thinking of how to word what I would say next, another family member asked, “Do you have something to tell us?”

I replied, as gently as possible, “Yes. I need to tell you that your father has died.” They cried a bit and we talked some, and then they went to the room to be with their loved one. The next day, a fellow student reminded me that we are forbidden to share any medical information whatsoever, and our supervisors confirmed that, though no one yelled at me. So that was probably the one and only time I will announce a death (though doesn’t that seem like the kind of thing a chaplain would do?). In the future, I will make clear to whoever summons me that someone else needs to break the news.

The time I was on call prior to last Sunday, I went around to the various ICUs in the evening to see if a chaplain was needed, as we are instructed to do. Every person I spoke with said, “No, I don’t think so.” Last week, however, at two units in a row, the person at the front desk said, “Yes! Can you see [this patient and this patient and this patient]?” When it got close to 10 p.m., I ceased advertising my availability and headed for the sleeping room. Therefore, I didn’t go to the final few ICUs—we have five of them, and twenty operating rooms—but everyone knows they can page us.

Last Monday, I presented my first verbatim. My self-awareness was applauded, which felt good. I asked what I should do in the future if an unhelpful impulse arises, such as to try to fix the patient’s feelings, which occurred in this visit and which I acted on. Jodie said she does not think of such impulses as unhelpful. For one thing, they may be useful in learning about myself. They may also provide emotional energy to draw upon, or provide a clue to something in my relationship with the patient it would be good to understand better.

If a patient is willing to discuss his or her feelings—if he or she takes a “deep dive”—I should ask if I can sit down, to make it clear that I have time to listen and am happy to do so. Also, asking, “May I get a chair?” builds in a pause that may deepen the conversation.

We are regularly reminded to question our assumptions. If a patient says he is, for instance, estranged from his children, I should not conclude that he is estranged from his children. Rather, I could ask, “What happened that makes you feel that way?” The patient’s perception of the situation may or may not be accurate.

It is also fine to share our own feelings: “This course of action sounds sad, but so does that one. This is a big deal.” If we go slightly astray, we can claim our own reaction: “I find myself wanting to give you hope, but what you’ve said is very sad. Forgive me for trying to push hope on you.”

Jodie said that if we say something really stupid (“Have a good day!”, to the mother of a young child with cancer), we can own it: “I’m sorry, that was a ridiculous thing to say. I know that just making it through the day would be wonderful.”

My group of five students has two supervisors, Jodie and Anita, who has just been authorized to supervise students. Anita suggested in our verbatim session that I pay attention to what happens when I get triggered, such as experiencing what seems like a disproportionate amount of emotion. Knowing my own symptoms can help me recognize
over-identification when it happens again, which it will over and over.

Later, one of my peers recounted a visit he’d made that day. When the patient said he didn’t want to talk to a Catholic priest, which my peer is, he deflected by telling the patient, “I come from Burma.” (He later came clean.) Amid much laughter, we decided that from now on, when we get into sticky situations, we’re going to say, “I come from Burma,” though I don’t know if we’ll be able to produce our peer’s extremely winning smile.
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