The Walls Are White

Right after I arrived at the County Hospital one day, before I could report to the NICU—it had been many weeks since I’d been there, for one reason or another—we got an urgent request for a chaplain to go to the ICU. I don’t normally cover that unit, but I did receive orientation for the ICU once, and since I was the only chaplain in sight, I decided to go.

I found a rather complex family situation, with some people meeting others for the first time, and some family members expressing mistrust and even suspicion toward the doctors and nurses. One thing they all agreed on was that they wanted a priest, so I texted our priest, and waited with the family until he arrived.

The family complained that they had been requesting a priest for a week. This may well be so, but we also noticed that the patient was not listed as Catholic in the electronic health record; if he had been, our priest might have stopped by as a matter of course. It often happens that a patient’s religion, and other demographic info, is not available because he or she is unable to provide it upon arrival at the hospital, or the situation is so urgent that no one takes the time to ask questions that don’t seem pertinent.

I ended up hanging around for an hour. By then, several members of the palliative care team had arrived for a family meeting. One of them said, “I don’t know if they want a chaplain to participate, but if they do, can you attend?” I said I could, and then I just kept hanging around, and when everyone went to the meeting room, I went with them and no one told me to leave.

As is often the case, family members had different opinions about how the patient should be cared for, and at least some people were angry and upset. As always, it was wonderful to see the palliative care team in action, and how, even though they are seeing these same dynamics for the 500th time, they are kind and patient and explain the diagnosis and prognosis carefully. They treat everyone’s feelings thoughtfully, and make space for everything.

Before the meeting ended, one upset family member rushed out. “Should I go after her?”, I asked, and enough people nodded that I did, but I couldn’t find her.

After that, I went back to the office, where I and another volunteer—one of my Clinical Pastoral Education peers—were asked to attend mass in the hospital chapel to support our priest, who is yet another CPE peer of ours. It was nice to see his smiling face as he led the service. There were maybe 10 attendees.

In the afternoon, the head of the spiritual care department asked if I would attend a family meeting in his place, so I got to go to two family meetings with the palliative care team that day. Again, people were upset and there were differences of opinion. Again, one person rushed out of the room. This time, one of the palliative care team members directly asked me, “Do you want to go with her?” This time I found her, and I took her to the rooftop garden, where we talked for 45 minutes, giving her a chance to vent and to express her concerns and to tell me a bit about the patient.

While I was waiting for that second family meeting to start, one care team member in the ICU told another that they had a “mert.” “What’s a mert?” I asked. The person explained that an ICU nurse, acting as a member of the Medical Emergency Response Team, goes around to other units to see if any patient is decompensating. If so, the ICU “merts” the patient, and the patient is transferred to the ICU.

In the afternoon, I went to round in the ED, where there are several resuscitation rooms, called “resus” rooms for short. I normally am kind of shy about going into them, because I don’t want to interrupt the doctors and nurses, but I know of a volunteer chaplain who freely visits those rooms, so I went ahead and went into three of them. In the first, I offered prayers for a patient who had three family members at his bedside. The family members looked noticeably more relaxed after the prayer. When people believe in prayer, it can really mean a lot to them to be prayed for in the hospital.

In the second room, I spoke briefly in Spanish with a patient who, fortunately, was feeling mejor. (If she had been feeling worse, likely she would have spoken at much greater length, using words I didn’t understand, and would have spoken more rapidly, compounding my comprehension difficulties.) She was very kind, smiling at my efforts to speak with her in her tongue.

I have mixed feelings about speaking Spanish with patients when I basically can’t speak Spanish. I can limp along, but am far from fluent past a certain basic point. On the one hand, it seems like the most obvious and effective way to improve my Spanish, the patients always appreciate it, and I can always engage at least a telephone interpreter if needed. On the other hand, it seems kind of unfair to expect someone who is already under duress to do something that is for my benefit (though eventually it will hopefully benefit other patients).

The third patient I saw in resus was really angry, and on the verge of getting dressed and leaving before getting his test results. I asked, “How are you helping yourself cope with this?” He said, “The walls are white.” That is precisely what I do when I am under most strain: name to myself what I see around me. I applauded his effective use of mindfulness and asked where he had learned it. One of the things he was angry about was that he was hungry, so I chased down his doctor, which took a while, to confirm that it would be OK for him to eat. (A chaplain is never, ever to give a patient anything that he or she can ingest, even if it’s a cup of water on the tray table right in front of the patient, half an inch farther than he or she can reach.)

Once the doctor said the patient could eat, I went and used my volunteer meal card in the cafeteria to buy a selection of what was still available: whole-grain chips and energy bars. I put some in the chaplain office and took some to the patient. He was still angry, but seemed somewhat touched by the effort I’d gone to. When I left the hospital that day, I saw him out front on the sidewalk. I’m sure he must have noticed me, but he didn’t say anything, which was fine, since we were past the natural ending point of our relationship.