In mid-February, I got to see a psych patient at County Hospital for the first time. I think Clementine forgot I’d not yet been oriented to that unit. It was a little bit frightening. I went to the psych unit at the Truly Wonderful Medical Center maybe 25 times in the course of my year there, and actually was scared there a time or two, as well, but usually it was pretty relaxed and often quite wonderful. At County Hospital, I was escorted through two locked doors and introduced to a patient who was rocking back and forth with great intensity. We were shown to a seating area ten feet from the front desk and sat facing each other in extra-heavy chairs, just like they have at TWMC’s psych unit: too heavy to pick up and throw.
When the patient rocked forward, his face came very near mine. I was struck by how clear his eyes were, and how white the whites of his eyes were. He was extremely hard to understand, but I got it when he asked, “This is just between us, right?” I think he wanted to confess to stabbing a relative in the face with a knife, if I’d understood his earlier remarks correctly, certainly a dispiriting incident for all involved, but not one a mandated reporter would have to do anything about at this point. However, it is my understanding that I can’t promise confidentiality. I said, “Well, I’m a member of your care team. I’m not a priest.” Often people equate chaplains with priests and talking to a chaplain with going to confession, but they are not the same thing.
Just then it occurred to me that I was basically blocking this patient’s way out of the small area we were in, wedged between a dining table and a half-wall, and I wondered if that was causing him any anxiety, which would be undesirable, and half a second later, he leapt up, squeezed past me, and walked off, waving his hand dismissively behind him.
I distinctly recall being told in Clinical Pastoral Education that our conversations with patients are not confidential—that we are members of the care team and that we chart just as doctors and nurses do. However, I was lately reading a book about chaplaincy that stressed that conversations with chaplains are confidential, except as limited by law. I know that chaplains do often receive “confessions.” I once heard a chaplain say that someone had told her on his deathbed that he had killed someone.
I imagine that the vast majority of “confessions” I might hear are not things I would be obligated to do anything about, and I would like people to be able to unburden themselves, but I would not want to give false assurances to a patient who then tells me about child, partner or elder abuse that I would legally be required to report.
In a Terry Gross interview on the radio, someone mentioned that he is acquainted with a Klan member who calls NPR The U.S. Jews and Girls Report.