Just Sabbath the Second

Late in December, at palliative care rounds at County Hospital, I asked if a member of the palliative care team is ever the one to, for instance, tell a patient of her diagnosis. Attending physician Amy said that the palliative care team should coordinate with the primary team in regard to giving the patient bad news, so that all are in the loop and as a courtesy. It’s also important, she said, for medical residents to learn this skill. (Doctors not on the palliative care team.)

We visited a patient who had been confused the day before, with the goal of determining if he wanted to stay in the hospital for treatment of his serious medical condition (longer life) or go home with hospice (better quality of life but maybe not as long). This visit was a good example of why it can be helpful to make a team visit to a patient.

The attending described the choices in a way that seemed clear to me, but the patient, who had been direct in expressing that he didn’t want to linger in the hospital, said he didn’t understand what she was getting at. After she tried a second and third time to explain the options, the social worker said to the patient, “You want us to be direct with you, right?”

“Right!” said the patient.

“If you stay in the hospital, you will live longer. If you go home, you will die sooner.” The patient finally understood (and said he would prefer to stay in the hospital, in that case).

I had a nice Christmas in Sacramento with Tom’s family, including a fabulous Christmas Eve feast at Paul and Eva’s. Christmas itself was quiet. Tom watched TV, Ann rested, and I read academic articles about palliative care, specifically the management of pain, as one does. In the afternoon, we went to Robin’s house and sat around chatting and snacking. I ate way, way too much cheese, and next thing I knew, I was sick, and on the last day of the year, had to take my first day off work due to illness in 15 months.

It was kind of a nice day: I lay in bed and started Lee Childs’ first Jack Reacher novel, Killing Floor. Things had seemed difficult since adding the two additional work shifts per week. It felt like I never had an unscheduled minute. If one has to feel lousy and be coughing up green stuff just to be able to lie in bed and read a novel, something is wrong. Whoever had been making my schedule had been doing it in an inconsiderate manner. That person, of course, was me.

I had three days off every single week at that point—why wasn’t even one of them relaxing? I decided to establish a real weekly day off: the Sabbath (which does not have to be the same day every week). Suitable Sabbath activities: reading for pleasure, seeing a friend or talking to same on the phone, sleeping, posting to this very blog, cooking (like an actual colorful, fragrant pot of soup, not just the chopping of vegetables and rinsing of greens I do every week), getting a massage.