Monday, May 07, 2018

Outstanding Chaplaining, or At Least Quite a Bit of Chaplaining

Fifteen minutes before I arrived at work one day last month, I noticed that the on-call pager had gotten a page. After I punched in, Carolina, who was coming off call, told me there was a seriously ill patient at another campus for whom there was going to be a family meeting. A chaplain’s presence at the meeting was desired, so I headed over there and ended up spending nine and a half hours with the family, which I thought was outstanding chaplaining, but I know my boss would think the opposite, so I didn’t draw it to her attention, though of course I recorded everything accurately in my stats.

Probably 30 times I have said to a family in a similar situation that I am happy to stay if needed and they have said, “No, you can go. We’re fine.” If you average those with my long, long visit that day in April, it comes out to be a reasonable amount of time per visit.

It ended up being so long because the patient, in the course of the day, had about 30 visitors, and it took many hours before the family decided about going to comfort care. I’d gotten it in my mind that I was supposed to be there until they made a decision, and a key family member didn’t arrive until about 5 p.m., so the decision—which was to go to comfort care—was not made until after that.

At that point, it seemed reasonable that I would stay until the patient actually went on comfort care, which was a couple of hours later, and having stayed until that point, and knowing the patient was not going to live long after this transition, it seemed right to stay until the patient died, which did happen almost immediately, and having stayed until the patient died, I thought it would be only proper to support the family in their grief, to help explain the sequence of events after a death, and to offer condolences as people left, and that’s how it got to be nine and a half hours.

(The sequence of events after a death is that the patient’s body is placed in the morgue, where it can remain free of charge for at least several days while the family decides what they are going to do. Typically, they make arrangements with a funeral home, and then the funeral home arranges to fetch the patient’s body from the hospital.)

Much of those nine and a half hours, I was standing, because there were only three chairs in the room. At school, we are learning how our meditation practice and adherence to Buddhist precepts (ethical conduct) can be applied to chaplaincy, but that day, with my sesshin at school beginning two days later, I consciously did the reverse. As I stood there and stood there and stood there, I told myself, “Just this moment,” and recognized that I was strengthening qualities I would need for sesshin: endurance, patience, determination.

I learned a couple of interesting things that day, including where to see oxygen saturation on the bedside monitor. A nurse told me that a patient with low blood pressure might be given pressors (medication to boost blood pressure, such as epinephrine), and that usually such a patient is not given painkillers because they depress the blood pressure, working against the pressors. When an intubated patient in this situation is transitioned to comfort care, the nurse might then start giving painkillers, so that the patient doesn’t feel uncomfortable during the actual extubation and when back to breathing on his or her own; being short of breath is unpleasant. After the patient has been receiving painkillers for a while, such as fentanyl, then the extubation can occur, and after that, the pressors can be turned off, in which case such a patient will likely die within minutes.

There was a young doctor attending to the patient who had so many visitors. I liked how he took a very leisurely approach, coming every couple of hours to see what the family was thinking, answering questions, not rushing them in any way.

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