Monday, June 19, 2017

Diving Down and Popping Up

In late May, I had a young palliative care patient with a very serious diagnosis whose mother had come from across the country to be with him. The mother seemed very composed, even upbeat, but announced over and over that the patient had been misdiagnosed, that he did not have such-and-such illness, that the only reason he seemed ill was the medication he was receiving. Meanwhile, the patient himself, in his 20s, was obviously in rapid decline.

One day I asked the patient if I could speak to him alone for ten seconds. A few days prior, I had asked him when the three of us were together if he was on the same page as his mother and he had replied, “Not really.” When we were alone, I asked if he had someone to talk to about all his feelings and thoughts, and he assured me that he did, after which I wrapped up our conversation, so as not to keep his mother waiting.

Delia said later that this was a missed opportunity—that he had given me an opening. She said I should not have specified how long our time alone was going to be, and rather than asking him a yes/no question, I could have asked, “What is it like not to be on the same page as your mother?” or “How are you doing with that?” In any event, Delia thinks that particular yes/no question is never a good one: what if the person doesn’t have anyone to talk to? One might better ask, “What is helping you cope with this situation?”

When I asked her for feedback on the whole rotation, she said, “You’re a good chaplain. You’re a good listener. You’re very kind. You’re well trained. I’m confident in sending you to care for patients. You’re good to go as a chaplain. I’ve watched you be able to make relationships with all different types of people—that’s a strength.”

She said my opportunity is to “dive down” when patients want to talk about their feelings rather than to “pop up.” She said this is either my personal long-term work—it indeed is, which I told her—or else it’s graduate-level post-CPE development. She said that going for feelings is where the gold is, and that it makes our work more satisfying. She said what’s great about this work is the constant opportunities for personal growth.

After the rotation was over, I went to Michigan for a week to visit my parents, which was idyllic. We sat on their back deck and enjoyed the greenery and birds and squirrels, and we watched TV. (Alas, Rachel Maddow was out sick, so I did not get my semi-annual fix.) I had lunch with Amy at Seva and with Ginny at CafĂ© Zola and at Haab’s with my uncle and his wife. My father and I went on a field trip to his ancestral home, west of Ann Arbor, currently a pile of rubble. I was the expedition photographer. The new owner of the property was there and said it was fine for us to walk around the lot; he said he is going to turn the house back into the charming farmhouse it once was. We leaned in a window and I took a photo of a patch of wooden floor where I last saw my grandmother, 50 years ago, give or take. Sixty-five years ago, my grandmother sold half her lot to a young couple, who proved to be next door working in their immaculate yard. They are now in their 80s. We visited with them for a while.

My sister came over three times, including the night before I left, when she mentioned that she had enjoyed Big Little Lies. We watched the first episode, and then she went home, and my parents and I stayed up until 2 a.m. watching all seven episodes. My shuttle came just after 6 a.m. the next morning, but both of my parents got up to say goodbye. (Proving that they must be my real parents, which doesn’t necessarily mean biological parents, though they are also that. Sometimes when Dad does something particularly nice, my mother says, “Aww. He must be your real father.”)

I had asked Delia if it would be all right if I continued to visit my patient even though I was no longer on palliative care, and she said that would be fine, so after I was back, I went to see him. His mother, as always, did 99 percent of the talking, and 100 percent of what she had to say was that the hospital was overmedicating her son, and that she didn’t believe he had what he had been diagnosed with, etc. He interrupted quietly to say, “I do believe I have [such-and-such].” It was increasingly distressing to me that this lovely person was evidently going to reach the very end of his life without being able to have one direct conversation with his mother about it.

Despite my strong misgivings about his mother’s view of things, I was always very friendly to her, and she said one day that she thought of me as a friend. The patient celebrated his birthday early in June and I went to his room to sing “Happy Birthday” to him. After I left, it occurred to me that he might get a kick out of knowing that my birthday was the very next day, so I went back to tell them that.

One day I was talking to his mother outside his room and Delia came along with my peer who is doing the palliative care rotation in this final unit, the same thing I did in the third unit. Delia said to the mother, “I hear he’s not doing well,” and she got agitated and angry: “That is not true! He’s getting better.” Delia told me later that she hadn’t realized that was the patient’s mother.
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