Sunday, February 04, 2018

Wow! A Cow!

After starting my paying job as a hospital chaplain, I got into the habit of saving my two 15-minute breaks for the end of the day, and spending that last half hour reading before I walked home, a nice buffer between major parts of the day. A few weeks ago, I got paged during that time and ended up working until nearly midnight, and more recently, I got paged precisely at 4:30, right when this break was going to start, and had to go to another campus for a death, so I have decided this is not the best way to schedule breaks.

There have also been ergonomic issues at work, because no two workstations are alike, and nearly all of them are wrong in one way or another: the monitor is too low and/or the keyboard is too high and/or the chair is too low. One day, I tried using the standing workstations. (By the way, these are called WOWs: workstations on wheels. According to a nurse in employee health, they used to be called COWs: computers on wheels, until a patient heard someone say, "Can you get this cow out of here?" and took offense. There may be some truth to that. I have definitely heard people refer to WOWs as COWs.)

I visited 17 patients that day, which is probably a personal record, and of those, 15 were initial visits, which are prioritized by my boss. Most visits were short, but a couple were quite long, including the last of the day, with a patient about my own age who has months to live. It was an emotional conversation, which I did not want to cut short. I tried to channel what I'd learned from the palliative care team during CPE, and also remembered things I'd read in Ira Byock's wonderful books. Once it was over, I still had charting to do and metrics to record (how many minutes were spent doing this or that), so I ended up logging out 40 minutes late, which might partially account for why I felt so utterly exhausted. My neck was also painfully tight.

Next shift, I went back to using the seated workstations, and paid attention to having my hands at waist level when typing. For the first time, I went into our (very nice) meditation room at work twice during the day and meditated for 15 minutes, after which I felt quite tranquil. That's a much better way to spend my breaks; going outside for a walk would also be good.

This past Tuesday I again meditated twice for 15 minutes. It was a lovely day. I got to be outside many times, walking between my units, which are located in different buildings. I had been traveling between them via a shared basement, but another care team member told me she always takes the opportunity to go outside, which had not occurred to me and which is much more pleasant. There's a huge deck with a spectacular view of downtown and the Mission. I can see County Hospital from there and vice versa.

While reviewing the chart for a patient I have seen many times, in a part of the electronic record where there would normally be only text, I unexpectedly bumped into a photo of her decubitus ulcer, also known as a pressure sore or bedsore. A bedsore doesn't sound like such a terrible thing, but these ulcers can eventually become actual holes with exposed bone, tendon or muscle. This one has refused to heal, has necessitated multiple surgeries (debridement: the removal of infected, damaged or dead tissue), and is located in a place one most particularly would not want to have a bloody hole in one's body. The image of it was horrendous. I let out an involuntary "Ooh!" My estimation of nurses, already extremely high, shot up another notch.

As I walked home after work, for the very first time something happened that I'd been expecting since CPE began in June of 2016: I saw one of my patients on the street. This fellow was talking to himself and passed within a few inches of me, his face nearly as familiar to me as my own, even though I visited him just once for maybe 20 minutes at County Hospital. I was wearing my big hat and he didn't notice me.

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