Sunday, April 02, 2017

Chair Assignment

I began the palliative care rotation last Monday. I hadn’t gotten any instructions—Delia, the palliative care chaplain, was away the prior week—so I went to morning meeting as usual and then, per Jodie’s instructions, just went to the palliative care office, where I found Delia sitting with a doctor and a social worker for morning rounds. The doctor did most of the talking. It took her an hour to discuss 11 or 12 patients. I was surprised we could spend so long on so few patients, but I appreciated getting a good understanding of each person’s situation.

Delia explained to me that, at this hospital, palliative care is a consult service and only gets involved when the patient’s attending doctor or primary care team requests it. The doctor who was in our rounds meeting is the attending doctor for palliative care services itself. The palliative care patients are divided into two groups, and each group has a fellow—an M.D. who is training to be a palliative care physician, who rotates between the two groups. There are four palliative care fellows total, and each one comes with a clump of medical students.

After rounds, the four of us agreed to meet in a certain ICU at 11 a.m. I arrived 10 minutes early and then everyone else didn’t get there until quarter after, so that was a lot of standing around, but then, chaplains do a good deal of standing around.

We went to a patient’s room but he had visitors, so several care team members discussed his case and then Delia and I went back to the office, where she said she wants this rotation to be more leisurely than what I normally do, with time for reading and reflection. She said that on some days, she will tell me to go home early. She said I’m welcome to go through her files anytime I want and to make copies of anything that interests me, and I’m welcome to rummage through her books and borrow anything I like. On the other hand, she also told me not to sit in her chair nor to sit in one of the four comfortable chairs for the rounds meeting unless the whole group is four people or fewer.

I said, “Oh, chaplains don’t sit in those chairs.” 

She said, “No, you don’t sit in those chairs.” Got it! She also said not to leave so much as a toothbrush in the office overnight, which she shares with two palliative care social workers, but I can leave my backpack there during the day if I want.

At this point, it was noon. I told her I was going to participate in a peer’s mid-year consultation from 12:30 to 2. She said to rejoin her at 3, which should give me time to have lunch, research the spiritual beliefs of a certain obscure ethnic group, go visit a patient of that group, and, time permitting, a second patient.

We get 30 minutes for lunch and two 15-minute breaks, but we can configure this as desired, so I don’t usually take breaks and instead have an hour-long lunch. I couldn’t figure out how I was going to have my lunch and do all that other stuff in the allotted time. Delia said she eats at her desk and sometimes doesn’t eat, which alarmed me a little, partly because one of her specialties is self-care and avoiding burnout. but mainly because I have no intention of ever skipping lunch.

I went to my colleague’s consultation and then back to the student office where something lucky happened: the two people who were in there happened to know all about the topic I was supposed to research. In 90 seconds, they explained the key points of this group’s spiritual beliefs, saving me 20 minutes on the computer. I ate and went to see the patient, who was unresponsive, anyway, and then to see the other patient, who was not interested in speaking with a chaplain, and then charted both visits.

When Delia later asked me what I’d learned, I was able to report that I’d learned this, that and the other and seen both patients. She reviewed one of my chart notes and gave me feedback. She said she wants palliative care notes to be listed as such; my notes are listed as spiritual care. I could easily be changed in the system to be a part of the palliative care group, but I’m not in fact a palliative care chaplain, and also, when I’m on call, I would need my notes to display as spiritual care notes. Therefore, Delia said just to tell her what I do and she’ll do the charting. I felt a slight pang that I might not have any chart notes to show for these next two months, but I don’t really care that much. Also, she might get sick of this chore and think of some way for me to do it.
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