The Funny One

I have been thinking lately about turning toward what is uncomfortable, the discomfort being sensations in my own body. (Where else could it be?) One place I am encountering an edge is in non-professional listening. There are people I find it incredibly difficult to listen to, and I think the same thing happens for some physicians, who listen to a patient in a leisurely, highly attentive manner for an hour, and then visibly tune out when I’m telling them something and get past the three-second mark (even if I’m answering a question they asked me).

I see that physicians work incredibly long hours and then often have families to tend to, so I know they need to make effective use of every half-second. I suppose it is a testament to their training and character that they can listen so beautifully to patients, and not a failing that they can’t do it with every person who happens to say something to them in the course of a day. As for myself, I aspire to listen to everyone in the same way, which means aspiring to bear the discomfort of fully attending to something I think is boring or irritating—but not always succeeding.

Clementine periodically trains a new crop of chaplain volunteers, and there are three new folks who go to County Hospital the same day I do who are quite young; at least one of them is just 20 years old. I heard one of them telling another about a visit to a room with two patients in it: “They’re both talkers. Like, talker talkers.”

At my paying job, I encountered a nurse in the ICU who had just switched to the day shift. He is a formidable mimic and was really making me laugh. Using a German accent, he said something about “German dancing—just using the arms,” and demonstrated, punching his fists into the air. I said, “You’re very funny,” and he said, “Some nurses are smart—I’m the funny one.”

At the very end of the day, I heard a physician saying to a patient right behind me in the ICU, “A chaplain is a good person to talk about that kind of thing with.” Then I noticed the physician had put a consult order in for a chaplain to see this patient, so I went to see her (as opposed to leaving because it was the end of the day). I knew from her chart that she had was having a recurrence of cancer. It turned out that she wanted me to facilitate a family discussion. I was excited to have the chance to run my own family meeting after seeing so many of them at County Hospital, and discovered that it was way more challenging than I expected: I found myself sharing words of wisdom in a way I rarely do speaking one-on-one with a patient. I think I was feeling pressure to drive toward a certain outcome, and so I didn’t just let things unfold naturally. I think it was basically fine, and I think the family was appreciative, but it highlighted that I’m really a very new palliative care clinician.

Late in February, I was paged to return to the hospital to offer a prayer for a patient in the ICU. I was fried when I got home and pondered the idea that I could end up having to return to the hospital twice the same night, which so far has never happened (and didn’t happen that night). I didn’t get anywhere near enough sleep and, the next morning, felt like my head was packed in cotton. I considered not going to County Hospital, but soldiered on.

I made it through the day. I didn’t attend any family meetings. I went with the team to see two or three patients, and I saw one non-palliative care patient and her son. The patient was reaching end of life and her son was quite upset. The patient herself, who had a dazzling smile, seemed almost jovial. I sat with a dead patient and her longtime partner for quite a while. (She said his final words to her were, “You look so pretty.”)
 
My monthly palliative care class was about prognostication. We learned that fewer than two percent of patients and their families base their decisions solely on what their doctors say. Lived experience is given much more weight. (However, doctors are generally pretty accurate when it comes to predicting how much time a patient has left.) (Partly because they never say, “Thirteen minutes.” They say “Days to weeks” or “Weeks to months.)

The goal is to give people enough information that they have a sense of control, without overwhelming them, which makes it difficult for them to process what they are hearing and retain executive function. Therefore, communication may unfold over multiple conversations, in which clinicians try to discover where the patient or family member is in their understanding and to join with the person in her hopes and fears, and to make recommendations that are in line with the patient’s goals. It’s important to try to flow with what arises and to remain allied with the patient or family member; arousing resistance in the other person makes everything harder. It is important to remain attentive to the other person’s emotions and agenda.

Hoping along with another person is something we can always do, even if what they hope for is unlikely to happen. “I hope so much that that will happen. And I’m worried that we’re in a different place.” One might say both of these things in the same conversation, or split up into two conversations.

We had a guest instructor that day who said her two words are “wish” and “worry.” She said it can be good just to say, “I wish for that outcome” or “I wish things were different,” and then stop talking. Or, “I’m worried,” and stop talking, and see what the other person says.

Medical tidbits: A person can be sedated enough that she doesn’t realize her airway is obstructed enough to end her life. Medication that relieves nausea also lowers blood pressure, which may not be desired.

That day’s speaker, a physician, shared this quote, from Douglas V. Steere, a Quaker ecumenist (born in Michigan, near the tip of the thumb): “To ‘listen’ another's soul into a condition of disclosure and discovery may be almost the greatest service that any human being ever performs for another.”

The speaker offered a note to his fellow physicians re nurses: “Be nice to nurses. They keep your patients alive.”

During my internship, I had a patient who had survived with metastatic cancer for an extraordinarily long time. She is now gone, so what a lovely surprise to see a photograph of her in the speaker’s slide show, wearing lipstick and a big smile. The quote from her: “Everything takes longer than you think it should, thought it would, except your life.”