Tuesday, January 01, 2019

Sunnily Positive

The next day, Merlin and I went to palliative care rounds together, my first time attending. These rounds happen weekly in a comfortable conference room where everyone can sit down, and  since there is no one in the room but ourselves, the speaker doesn’t have to lower her voice and it’s easy to hear every word. Merlin kindly made sure I got added to the group text list and he and I were also added to a master list of palliative care patients in the electronic charting system. Each week, one of us will copy the new patients from that list to the lists of palliative care patients our own department maintains, one for each campus.

It isn’t only Merlin and I who see palliative care patients, and, conversely, all the patients he and I see won’t be palliative care patients, since we have the ICUs, oncology and transplant to cover between us. Every chaplain is asked to see whatever palliative care patients are on his or her units. If we hear of someone during rounds who particularly needs attention, we let the chaplain for that unit know.

At palliative care rounds, I met a doctor whose name I have been hearing since my first unit of CPE. I was surprised to see how young and relaxed she looks. I’m not sure what to call her. I’ve noticed that my boss at my paying job would call the doctor named Anne Smith “Dr. Smith.” At County Hospital, the head of the spiritual care department would call the same doctor “Dr. Anne,” which is kind of charming. For myself, if she has introduced herself to me as “Anne Smith,” I’m inclined to call her “Anne,” but I don’t want to overstep. Maybe it’s knowledge common to everyone but me that even if a doctor introduces herself with both her names, you’re not supposed to call her by her given name.

After palliative care rounds, I went to the rest of ICU rounds and felt tired afterward. Merlin and I met and discussed the ICU patients. The idea is that I will do initial visits on my three work days and Merlin will do them on the three days when he is there and I’m not. On the days I do initial visits, he will do follow-ups and vice versa. I was surprised when he asked if we should divide up the initial visits: why would we do that? The Enneagram One was a little vexed: the arrangement couldn’t be clearer; why muddy it up? But then I realized that I might actually not get through all the initial visits, and if he wanted to help, why not? It was kind of him to offer.

I spent the rest of the day doing these initial visits and basically did get to all of them; here and there a person was asleep with no family in the room, or there were care team members in the room doing something. I did not get to set foot in the oncology unit, but I did run into my friend who is a nurse in that unit.

I put some energy into finding a place to sit down to chart. They are in short supply in the ICUs. I often chart standing up, but I also often sit down while visiting with a patient, which rarely happens in the ICU. The rooms are small and may not have a chair, or if there is a chair, there may well be a family member already sitting in it. Formerly, I used to sit around at the beginning of the day answering my email and so forth, but now I have to get to rounds, so a good amount of sitting has been eliminated from my day.

At the end of the day, I decided to go ahead and chart in the cardiac ICU nursing station, sitting on a chair. It had occurred to me that every single bedside nurse in the ICU has his or her own computer, plus a chair, so there shouldn’t be too much competition for what now struck me as the most desirable spot in the whole hospital: an actual place to sit down in front of a computer! No one objected to my charting there. A few female nurses gathered nearby and were joking with each other; they made me laugh, and then one of them addressed me directly. It was nice to feel included.

At the end of the day, it was dark and starting to rain and I could see the cab I’d requested parked three-quarters of a block away. I was exhausted and irritable and wondering why I had even agreed to add two day shifts weekly to my one on-call shift, though it was this that afforded the opportunity to serve as a palliative care chaplain and help cover some of our most challenging units.

Being irritable is a sign that I’m stressed out, as I imagine is true of most people. When I get extremely stressed out, I get dizzy. Toward the end of CPE, there were several days when I was awfully dizzy and even fell once or twice, after which I consulted a doctor. I felt a little bit of this dizziness my first two days on my new units, which was good, because it made it clear that I had been right not to apply for the full-time job. Just in case, I also used one of my breaks on the second day to talk to my friend Martine on the phone, and she agreed that not applying for the job was the right decision, and she was sunnily positive that everything will work out fine, which I also usually believe. I guess the concern is that the new boss will fire me because I’m a per diem, but Martine pointed out that if my current boss loves me, probably the new boss will, too.

I met Charlie at Pancho Villa for a burrito after work and then we went to Howie’s. A sangha member who has cerebral palsy gave the talk, about disability and what we take for granted.

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