Tuesday, April 03, 2018

Lunch with a Mentor

One Sunday at work (still in late February) I talked with a fellow who suffered a terrible injury while trying to help a neighbor, a person who, according to the patient, never acknowledged this injury or apologized or went to visit the patient in the hospital. This led to the loss of the patient’s job, followed by the loss of his house. I felt like weeping after I left him.

I am always aware that I am hearing just one viewpoint. Maybe right before this patient did his neighbor a good turn, he burned down his neighbor’s barn: maybe there are aspects of the story that weren’t mentioned that explain everything. However, I do believe that every story is true on a psychological level, and it is very possible that what a patient or family member shares is the literal truth on every level. It is certainly true that people in this country lose their savings, jobs and homes after becoming ill or being injured while others enjoy first-rate medical care and the best of everything every day of their lives, and it is this that made me feel like weeping, from rage as much as from sorrow.

It has dawned on me that there is much to be learned from the chart notes of other chaplains, from which I am stealing shamelessly. At least, there is much to be learned about felicitous phrases to put in a chart note, and from those, I get an idea about what other chaplains are focusing on. I’m glad there are plenty of other chaplains in my group, even if I rarely see any of them.

Along around then, I had lunch with Jonas, for whom I’d stored up several questions, including how he responds when a patient asks if the conversation is confidential; I was thinking of the psych patient mentioned earlier. Jonas said that when a patient asks, “Is this between us?”, he doesn’t start by saying he’s a mandated reporter. He says something like, “I hear that you’re concerned about me telling someone else what you share with me. Let me give you the rundown.” He then tells the person he has to report it to an agency if a patient tells him about child, elder or partner abuse. He might say, “I will also share with the rest of your care team what would help them to help you heal. I don’t have to share specifics.”

In regard to asking if the patient has support from others, which Delia at the Truly Wonderful Medical Center said not to do, lest it make a patient with no friends or family feel bad, Jonas said he starts by asking a broad question about support: “What is getting you through this?” People might mention other people right away. If not, he might follow up with, “Are there people who are helping?”

He said he does ask people why they’re in the hospital. He probably already knows this from their chart, but this is a way of finding out what the patient understands: “What landed you here?”

In answer to another question of mine, he said that if the parent of a child patient says right away, “We’re fine,” that’s that. The parent has the right to make this decision and the chaplain should leave the room. However, we might want to tell the social worker about this response, and we should definitely chart it.

If the spouse or partner of an adult patient immediately says, “She’s fine,” we can say “OK” and leave (or give a brief introduction to spiritual care services and leave), but Jonas said we should go back later to talk to the patient when she is alone. Jonas said he can be very direct in such conversations and mention that sometimes a partner may want to keep something hidden. We can also ask the patient how she thinks being a caregiver is affecting her partner.

If Jonas knows something important about a patient, such as that he has just gotten a serious cancer diagnosis or is recently bereaved, he might say later in the conversation, “There is something I was hoping we might talk about, but it’s something that might be difficult for you to discuss.” If the patient says, “My mother died, but I’m fine,” then Jonas said we should drop it: we gave the patient an out and he took it.

Jonas said he does sometimes say “I’m sorry” to a patient, usually adding what specifically he is sorry about. He might typically do this when a patient is very emotional. He might say, “I’m sorry that this is so difficult for you.” Clementine at County Hospital also said she sometimes says she is sorry, though it can be risky. Sometimes the patient will say angrily, “What are you sorry about? You didn’t cause [whatever horrible thing has happened].” Clementine said that when she does say it, she makes sure it’s not the last thing she says, because then people feel obligated to say, “It’s OK,” when it is not OK. So she might say, “I’m so sorry this has happened. I can see how sad you are.”
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