At the end of the week, I went to palliative care rounds at County Hospital. (If it’s starting to seem that this blog is about just one thing, there’s a good reason for that. My life is about just one thing at the moment.) The first two times I attended, so did the head of the spiritual care department, Robert, who is the main palliative care chaplain, but on this day, he told the team he was going to go answer his email and that I would spend my day with them.
The attending physician—there are five total—is someone I really like, whom I met during CPE, when I got to spend a quarter of the year with the palliative care team at that hospital. I think of him fairly often, because I told him back then that I had started to say to myself that if I got laid off from my corporate job, I was going to be a hospital chaplain, “and they kept their end of the bargain.”
“And you’re keeping yours,” he replied, which had never occurred to me! Now every time I tell that story, I end by saying, “And I’m keeping mine,” and I think of this lovely man.
During rounds, it was mentioned that a certain family had been receptive to the idea that life support for a gravely ill patient might not be God’s plan. Very often, people say, “We want him kept on life support. It’s not for us to determine God’s plan.” You could just as easily say, “We don’t want life support. It’s not for us to determine God’s plan,” but about 99 percent of the time, life support is considered to be God’s plan (because people don’t want their loved one to die).
Also, “We don’t want life support” has kind of an unappealing ring to it. In the monthly palliative care class I’m taking, the first speaker talked about how when a doctor asks a family, “Do you want us to do everything?”, of course the family answers in the affirmative. The speaker joked that no one ever says, “No … for my mom, half will be enough. My mom’s a quitter.”
But the word “everything” means something different to the doctor and to the family. To the family, it means everything that will be helpful. To the doctor, it means everything: ventilator, tube feeling, chest compressions, another futile round of chemotherapy with horrible side effects. So it was nice to hear that at least one family was open to the idea that all the interventions might actually be interfering with God’s plan.
At school in New Mexico several months ago, one presenter talked about how a single person who is calm can change the dynamic of a whole group. I was thinking about that at rounds and trying to be that person, because at least a couple of people were speaking extremely rapidly. As always, the table was covered with food: doughnuts, hard candy, grapes. The attending mentioned the difference between an interdisciplinary team and a transdisciplinary team. In the former, roles don’t overlap. In the latter, they do.
Someone mentioned how a non-palliative care clinician had said in a family meeting, “The longer he lives, the more pain he’ll have.” Everyone at rounds cringed. Apparently the better thing to say is, “We are interested in starting to focus more on comfort.”
I found what this attending had to say about patients quite interesting. Somehow it seemed more oriented toward the emotional and personal and involved fewer numbers. At the end of the meeting, he briskly listed several patients and said he’d like to see them all before lunch, if possible, and we set off as a group. As we wended our way from unit to unit, we were twice stopped by nurses who wanted to express their concerns about a (non-palliative care) patient.
We visited four patients, two in one of the four ICUs, and two elsewhere. The ICUs at County Hospital are in a new building and are airy and pleasant, much nicer than at my paying job. One of the people we visited was an elderly man who was in a positively merry mood despite his grim situation. Two of his siblings were in the room, and they were also very smiley. I decided it was time for me to make some sort of contribution, so after the doctor and nurse had spoken with the patient—doing a “symptom check-in”—I asked if I could ask a question. I said to the patient, “You seem to be in very good spirits. What helps you maintain your good mood?” The patient said it’s because he is grateful for the care he is receiving, and because he trusts his team to help him.
After we left, the nurse said, “That was a good question. I’m going to try to remember that.”