Thursday, June 28, 2018

A Surprise One-Way Trip to Hospice

One day at work, a nurse called me (that is, paged the on-call chaplain) on behalf of a patient whose death was expected soon and who was all alone. Her family had requested that she be dressed, when dying, in her own clothes, but they hadn’t brought the clothes, and they also didn’t bring themselves, even on her last day.

I told the nurse, “I’m going to sit with her for a while, but I’m going to read my magazine while I sit with her—I’ll be back.” I went and got my New Yorker and sat next to the patient for an hour or so, periodically reassuring her that she was not alone and that she was loved. She was in a coma, and even if she hadn’t been, she didn’t speak English, but I hoped the sound of a human voice might be reassuring. She had one eye frozen open.

I stayed until I had to go to another campus to respond to a call there. While I was at the other campus, I was paged on behalf of a patient just a few doors down from the dying patient. It wasn’t an emergency, but since there was no chaplain scheduled to be at my own hospital the next day, I decided to go back there and see this patient, plus another for whom there was a non-urgent request, plus I would check in on the dying patient.

I found the dying patient evidently not breathing and having turned a yellowish color, and went to tell a nurse, who called a doctor, who came and pronounced her dead. I’ve never before been the first person to discover that a patient is dead. While I was waiting for the doctor and saying a few words to the patient, I had the odd experience of feeling strong goosebumps on both of my shins.

I went then to see one of the other patients, one whose nurse had told me she was going to hospice and was very upset about it. Accordingly, I brought along a CareNote on this subject. (From their website, slightly edited: “These compact booklets offer strength, help and healing for those who are hurting. CareNotes provide a wealth of emotional, recovery, health, grief and eldercare support and information. These wellness-oriented booklets address real-life emotional, psychological and spiritual needs.”) I don’t think I’ve ever given anyone a CareNote before, but we have a vast selection of them, I restock the meditation room with them regularly, and my co-worker hands them out all the time, so I thought I would follow suit. They use the word “God,” but aren’t associated with any particular religion.

Good thing I didn’t hand the patient this helpful item first thing because she did not know she might be going to hospice, and was very upset when the word was mentioned. From now on, when someone tells me a patient is going to hospice, I’ll ask if the patient is aware of that fact. She and I ended up having a long conversation, during which I stressed that she is in charge of making choices on her own behalf, and when we parted, she asked me to come back, so I guess recovery from that fairly serious misstep was achieved. I cravenly didn’t allude to it in my chart note, but I did come clean with her nurse, who didn’t seem perturbed.

I added, “She doesn’t know she’s going to hospice.”

The nurse said, “Well, she’s refusing care,” which I guess means the patient is therefore going to hospice.

That wasn’t my only misstep of the day. The other was that, when I first encountered the dying patient, I was kind of shocked by how young she looked, and asked her nurse—in front of her—how old she was. Later, outside the room, I apologized to the nurse and told him I do know that such a patient very well may be able to hear and understand what is said around her. (Though this patient, as mentioned, fortunately didn’t speak English.) He said, “No problem.” I’m not sure why I said that in front of her. Maybe, for some reason, I suddenly had a particular need to be seen as a kindly person who is bothered by an untimely death (which of course I am and was).

At County Hospital, I visited a patient who was missing quite a selection of body parts. After we’d talked for a while, I asked what had happened, and he said that years ago he had sepsis (a damaging immune reaction to an infection) and was given pressors (medication to elevate blood pressure, which may be given during sepsis if intravenous fluid replacement is not enough to maintain blood pressure), and this was the result.

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