Sunday, April 09, 2017

This Can’t Be Good for My Very-Close Veins

(Varicose.)

Last Sunday, I was on call at my own campus. There had been emails going around about a particularly difficult patient (one I never saw) who finally had to be told that she would get one chaplain visit per day and no more, to be administered in the late morning. That didn’t stop her from calling one of my peers at 1:30 in the morning, though she had received a visit earlier that day. That peer hadn’t carefully read the emails about this patient, and got dressed and went to see her. Fortunately, she had been discharged by last Sunday, so I was surprised (and displeased) to get a call from her saying that she was wondering where the daily chaplain phone call she had been promised was! I said that we don’t offer services to people who are no longer in the hospital (indeed we don’t, as was confirmed later; we can barely see all of those who are in the hospital), but she was adamant and we ended up being on the phone for 20 minutes, during which I had to keep saying silently to myself, “This person is suffering, this person is suffering.” (Weirdly, during this conversation, the patient asked, “What are you—about 54 years old?” That is exactly how old I am.)

I got a pretty good night’s sleep that night and arose at 6 a.m. to offer prayers for a patient coming in for surgery, per previous arrangement. The patient said she has strong faith in God and so wasn’t worried on her own account, but she wanted to make sure that Someone would be guiding the hands of her surgeon. She was wearing fuzzy jammies and her bedroom slippers.

I suppose I went to the teaching session that morning and to rounds and to visit a patient or two with the team or with Delia; I can’t remember. My notes indicate that there was nothing to do in the afternoon and that I felt extremely exhausted. I have peers who now and then go to the library and spend a whole morning or afternoon reading. I have never done this, until Monday. I read for awhile and then fell asleep in one of the many comfortable chairs in the library, waking myself up with gentle snoring. Paradoxically, what is making me so tired is having less to do. I used to see lots and lots of patients and spend virtually no time talking about them (except of course for discussing with my peers those patients of particular interest to us: very colorful, ill-behaved, or in particularly sad or harrowing circumstances).

Now it’s almost exactly the opposite. Rounds take an hour each morning, and then the team decides who to see, and then new information comes in via one channel or another, and all of the care team members have to hear the new information and give their opinions. Having to coordinate with one or more family members also attenuates the schedule. We might end up seeing two or three patients in a whole day, and currently, that will usually be the team seeing the patient and me observing, or Delia seeing the patient and me observing, though she has also sent me off to see patients on my own, which most often means talking to the patient’s family.

Also, I used to quite often sit down in a patient’s room. To encourage care providers not to stand over patients, which does not exactly communicate that the provider has plenty of time to speak with the patient and is interested in what she is saying, there is a sturdy folding chair behind the door of nearly every patient room in the hospital. (If it’s not there, it has migrated into another room.) But now I’m standing around for 30 or 45 minutes at a time, like a police officer doing crowd control, because if there is one team member who is going to get to sit down, it’s not going to be me. Tiring.

Being one to leap to conclusions, I was thinking by the end of Monday that maybe I would not enjoy being a palliative care chaplain, though I recognize I have barely begun this period of training. The next morning, I felt very unenthusiastic about the whole thing. When Delia asked how I like palliative care so far, I didn’t say that I hate it. Instead I tactfully observed that the ratio of time spent talking about patients as opposed to talking to them is nearly the opposite of what I was doing before. She said this isn’t unique to palliative care—that doctors discuss their patients all the time, and that usually chaplains do work with a team, though it depends. She mentioned a certain hospital where the chaplains just get a list of people to see and don’t discuss cases with a team, which she characterized as “lonely.”

She asked that day, “Are you tech-y?” and enlisted my aid sending videos to someone, which she was having trouble doing from her phone. Being able to help was satisfying. Every now and then it occurs to me that I actually kind of like sitting in front of a computer all day, as I did in my former job.
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