Monday, January 22, 2007

Black Hole

Last night I worked five hours at the hospital instead of four. I spent the last hour -- a little more than that, actually -- with a very distraught patient with extremely complicated (and unpleasant) family issues. This was someone who'd been in our ED before, had had a bad experience, and claimed that everyone who worked there was awful, while being very abrasive to every member of the medical staff who walked into the room. Anyone who's worked in an ED knows the type.

I spent over an hour with this patient; the patient's nurse also sat by the bedside, listening, far longer than nurses usually do or can. Both of us kept trying to find ways to calm or soothe this person, who was genuinely in a bad situation, but was also, it seemed to me (and perhaps I'm being unfair), determined to remain hysterical. A few times I tried to leave, only to have the patient clutch my arm and beg, "Please don't go, please don't go, don't leave me, please don't go."

I think the only thing I accomplished was to get the patient, who was very dehydrated, to eat some ice chips, which I hope ultimately resulted in the urine sample the medical folks needed. ("No, I won't let you use a catheter. I hate catheters! No catheter!")

I'd started talking to the patient right before I ordinarily would have done my end-of-shift sweep of the waiting room; by the time I managed to disentangle myself, I was too exhausted to talk to another soul. So nobody in the waiting room last night was offered spiritual care, and as I left the ED, I saw new patients who'd come in; I hadn't gotten to talk to any of them, either.

Of course, I can never talk to everybody, and at the end of each shift, new patients are arriving as I'm leaving. But last night, I really felt as if I'd done an active disservice to other patients and families by spending so long with that one case. There are far better ways I could have spent an extra hour at the hospital.

I still feel bad for the patient, but I also wound up being angry at myself for not getting away sooner. I should have just said, "I have to go see other people now," which is what the nurse did (although she came back). Instead, I stayed there and listened to the patient go around in circles, endlessly repeating the same speeches.

Gah. This is what my therapist would call bad boundary management. I think I got pulled in because I genuinely wanted the patient to have something good to take away from this hospital experience. But that was as much the patient's responsibility as mine, and I was trying to do too much in an impossible situation.

Ah well. Live and learn, as my mother would say.


  1. Would you be you if you didn't give more than you could reasonably be expected to give?

    I have great faith in instinct. I suspect this needy person may have needed you more than anyone else.

  2. So maybe this is a learning experience for you? I think you probably filled that patient's very real, at least from their perspective, need. Frustrating as that must have been, Good Job!


  3. I really empathize.

    And thank you for posting this, and for sharing your chaplaincy work with all of us. Reading your blog makes me realize how much I miss the hospital. I'm going to do another unit of CPE one of these days -- maybe not until I finish my rabbinic program, because I have years of study ahead of me that I need to focus on, but someday I'm returning to this work...

  4. Sounds like this patient visit left you feeling knotted up inside, but I think every act of kindness helps another even if we or the person on the recieving end don't realize it at the time.


  5. It's amazing how hard it is to not be tangled up in those situations, isn't it? I've been there before--not with patients, but with 'friends'--and i always walk away feeling like i've done myself and them a disservice, despite my best intentions.

    Kudos to you for realizing that it's just as much her responsibility for making her visit better as it is yours. *hugs*



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