Tuesday, January 01, 2019

Too Calm

After I got back from school late in November, I was home for one day and then went to Michigan for Thanksgiving, which was pleasant, as always, including lunch with Ginny at Café Zola and lunch with Amy at Seva. My parents and I reclined in front of the TV and watched Rachel Maddow. They made a wonderful Thanksgiving dinner; my sister came over to help eat it.

The flight back home was nearly unceasingly turbulent; the flight attendants had to spend a good deal of the trip sitting down. I did not enjoy it. I poked the arm of the woman next to me, who was watching a movie. She took off her headphones and looked at me kindly. I said, “I’m scared,” and she said, “Oh, I know. I don’t like turbulence, either. Hopefully it will smooth out.”

I found out that my boss at my paying job had decided that two people would share palliative care, a second-year Clinical Pastoral Education resident I’ll call Merlin, and me. Merlin and I were assigned to cover three ICUs together and to attend the weekly palliative care rounds meeting. He was also assigned to cover the transplant unit and I was assigned to the oncology unit. One of the ICUs is the medical-surgical ICU, where almost every after-hours call for chaplain care originates. All of these units are at a different campus from where I’ve been going.

In the laundromat one day, I saw a fellow I have seen around my neighborhood literally for decades, often running in Dolores Park. I decided the time had come: “My name’s Bugwalk.” He told me his name and we started chatting. Later a woman who lives in the building next to mine came by and tapped on the window. “Oh, there’s Molly,” said Doug; we both know her. After Doug was gone, a Latin woman came in. I wanted to introduce myself to her, as part of building the kinds of connections that social media is destroying, but at first feared she would think it was weird. Finally, I decided to be brave and told her my name and she immediately told me hers, and we talked in a friendly manner until I left. We spoke mostly in Spanish; I told her my Spanish is terrible and that I need to practice.

She asked what church I go to, so I told her I’m Buddhist, and asked if she is Catholic. She said she is, and that she goes to Mission Dolores. I told her that one of the priests there is a friend of mine, and she said she knows and likes him. So: two new friends in one trip to the laundromat, and it turned out that both of them and I have a mutual friend.

At County Hospital palliative care rounds one day at the end of November were the attending physician, a social worker, a nurse, two chaplains, and another nurse who is interested in learning more about palliative care. A couple of people had brought their breakfast along to eat at the meeting. One person was having an egg sandwich with cheese and bacon on white bread, which was the healthiest item of food in sight. Another person brought cookies, cheese puffs, and homemade macaroni and cheese to share. In the center of the table was a bag of candy. There appears to be a lot of comfort eating.

The meeting was led by an attending I was meeting for the first time. He asked how I came to be there, but seemed to tune out before I finished telling him. He was very generous in explaining the details of how certain illnesses typically progress, even drawing us diagrams of the heart and of an individual cell to explain how “membrane potential” works. I listened closely and took a lot of notes—free medical school, an hour at a time!—and after awhile, I noticed that he was making eye contact with me and directing some of his remarks to me. I suppose most teachers appreciate an interested student.

Emotions appear to be welcome at this meeting. The nurse wept when she shared about a patient who died just a week after his diagnosis and hospitalization, and about the shock and sorrow the patient’s grandson was experiencing.

After rounds, Robert, the main palliative care chaplain, and I went to see a patient in the ICU, where many palliative care patients are to be found. The patient appeared to be unresponsive, but when Robert gently asked her if she was feeling uncomfortable, she said, in a small voice that she was, and when Robert asked if she could say what type of discomfort she was having, she said, “I want to be out of this body.” Afterward, we spoke with Clementine, who supervises the volunteer chaplains, and she observed that there is such a thing as being too calm; she has seen chaplains wrongly assume that a patient won’t be able to communicate and not try to do any sort of assessment.

Though Robert is a chaplain, he asked the patient a question about her physical pain. In the monthly palliative care class I’m taking, we were told that every palliative care clinician, including spiritual care clinicians, should be able to perform a basic assessment in eight domains: Structure and processes of care (including how patient understands her prognosis); physical aspects of care; psychological and psychiatric aspects of care; social aspects of care; spiritual aspects of care, religious and existential aspects of care; cultural aspects; care of the imminently dying patient; and ethical and legal aspects of care.

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