Thursday, October 05, 2017

You Are Not Going to Believe This

It has been four days since I applied for the job I would most like to have in all the world, and I have not yet gotten an email saying my qualifications are not a match for their requirements!

We shall see. For the record, I feel that something astonishingly good is about to happen.

In the meantime, a clinical shift at County Hospital yesterday, and class in the evening. I’m trying to take as few notes as possible these days because such notes need to be typed up and filed, and probably 96 percent of them are never revisited. I probably have 200 pages of typewritten notes from CPE, and plan from now on to write down only what seems particularly valuable, such as the following, from a presentation on suicide.

Suicidal ideation can quickly become homicidal ideation, especially in the case of psychosis, so be careful when with such patients. We also learned that we should not tell a suicidal person that she won’t go to hell if she takes her own life. I didn’t understand this at first: are we supposed to tell her she will go to hell? Clementine explained that a person’s belief that her act of suicide will lead to eternity in hell might be the only thing keeping her from doing it: her lifeline. Removing this is unwise.

As it happened, during that very discussion, we had a patient actively dying elsewhere in the hospital. Several of us spent a bit of time sitting with her, including myself during a class break. I found another chaplain there busily stroking the person’s forehead and exhorting her to “Go toward the light” and “Let go and let God.” This chaplain explained that the woman had deliberately overdosed that very morning in her home, leaving a note saying she was not to be resuscitated. The chaplain said death was likely imminent.

I had a number of problems with this. First, a person who is not responsive, even one who is deep in a coma, may very well be able to hear and understand everything you’re saying. Even someone who has set out to commit suicide might be upset to have people standing by her bed chatting about her impending death, so I believe it is best not to discuss a person’s death, diagnosis or prognosis where she can hear you unless she is able to participate in the conversation.

It is also my understanding that as death approaches, many people turn inward and may no longer want to be pulled back toward what they will soon leave. For instance, while someone may formerly have enjoyed reminiscing about past times, he may no longer be interested in this. It is well documented that people often wait until they are alone to die, suggesting that maybe this is something that is between the dying person and her creator, or the universe, that others don’t have much of a role in, so I wasn’t sure about the vigorous forehead stroking, nor the specific instructions. How did we know this person believed in “the light” or in God?

My colleague stepped out and I pulled my chair close to the side of the bed and just sat there. I did not touch the patient nor say a single word. It seems to me that she was much less agitated once the other chaplain left, but I may be misremembering how she was when I walked in the room, or maybe that was going to happen anyway. I did feel sad. The space between this person’s breaths was very long. Death was not far off. What had brought her to this point? Who did she love during her decades of life? Who loved her?

I wondered if economics had played a part, or ill health. I wondered if her wishes not to have resuscitation attempted had been respected or not, and how those decisions are made. I do believe suicide is a reasonable choice in many situations and that we do properly have agency in this regard. Given that, should a hastily scrawled note carry less weight than fulfilling the legal requirements of the End of Life Options Act?

I returned to class troubled and shared my questions. Clementine said, “Those are good ethical questions.” I also shared my judgments about the interventions of the other chaplain, acknowledging that every chaplain is different, and that for all I know, as soon as my colleague left the room, the patient thought, “Where is that lovely hand that was just upon my brow?” This led to an interesting discussion. While one classmate was sharing his responses, I found myself increasingly near tears, which I attributed to that person’s emotional presence, and which reminded me that I would like to have that kind of emotional presence myself. I do believe that empathy is a skill that can broaden and deepen, and I felt inspired by my classmate’s effect on me. I guess this was the first time I had knowingly encountered suicide in the hospital, and it was difficult.
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