Monday, March 12, 2007
My job as a volunteer ED chaplain is to be, more or less, unfailingly kind and compassionate. I'm not supposed to allow myself to be cranky; I'm definitely not supposed to be tempted to slap poorly behaved family members upside the head, which is emphatically not What Jesus Would Do. (Some of my church friends, the ones who spend a lot of time studying non-violent communication, would banish me to the Outer Darkness for even using that language, but I'm trying to be honest here.)
I take the compassion-and-tolerance job seriously, and most of the time, I do a fairly good job of practicing it. But, because I'm human, certain kinds of behaviors push my buttons.
Near the top of the list are parents who frighten or guilt-trip their sick children. You know: the mom who tells her feverish, miserable kid all the horrible things that will happen if the doctors can't fix this -- brain damage! seizures! -- or talks about it on her cellphone within the kid's hearing, which boils down to the same thing. Or the parents who bring their little girl to the ED on Christmas because she has a really bad ear infection, and then go on at great length, in front of her, about how she always does this to them, and sure enough, she's done it again: she's ruined their day.
Two notes before I continue: 1) Most parents in the ED behave beautifully: they comfort and reassure their children even though they're worried sick themselves, and remain calm and sympathetic in the face of nonstop howling and bouts of projectile vomit. In short, they behave like adults. 2) I'm not for a second claiming that I'd be a model parent myself; I don't think I'd be a very good parent at all -- I have neither the stamina nor the patience -- which is one reason I've chosen not to have kids. It's the hardest job in the world, and people who do it well have my unstinting admiration.
Most of the time, I control myself around inappropriate parents. Instead of lecturing the parents, I sympathize with the kid and offer any reassurance I can. "I had ear infections when I was your age, and I know how much they hurt. But the doctors will give you medicine to make you better." And then I offer crayons or a stuffed animal or both, anything to distract the kid from nausea and needles. Most of the time, I manage to remember that I'm not seeing the whole context, and that the adult caregivers may be under pressures I can't imagine.
But I was having a bad night last night anyway: I'd had neither enough sleep nor a chance to exercise before my shift, and the ED was pretty quiet, which can be paradoxically stressful because it gives you more time to think about how you feel yourself, instead of concentrating on patients.
Enter Family Unit: sick, alarmingly lethargic Child, Adult1, and Adult2. Adult1 is in tears, arguing with another relative on a cellphone. Adult2 is issuing dire predictions about how Child's Willful Refusal to be healthy will result in organ failure in two days. (Yes, really.) Child is lying in bed, motionless and wide-eyed.
Chaplain is not happy. Chaplain snaps at Adult2, "Did the doctor tell you that? About the organ failure?"
Chaplain: "Then please don't talk about this where Child can hear it."
Adult2: "But Child needs to know the consequences of Willful Refusal to be healthy!"
At that point, fuming, I gave up on Adult2 and talked to the kid. "I know you don't feel well, but you know what? I think you're going to be just fine. The doctors are going to make you feel better. They're really good at that. Would you like crayons, or a stuffed animal?"
The kid shyly asked the adults if it would be okay to ask for a stuffed animal; the adults, returning to some semblance of rational behavior, said yes, of course. I experienced unexpected delay in delivering the stuffed animal, because the first one I found was claimed by a nurse who said it was so cute that she just had to have it herself (and then another nurse started fighting her for it: I told you we were having a slow night!), but the critter I did give the kid appeared to be a hit. From then on, the adults were model grown-ups, and the kid did so well after treatment in the ED that the whole family got to go home, instead of facing a hospital admission (which had been the initial game plan). The adults thanked me repeatedly for my help, not that I did that much. So that was a happy ending.
Except that I was still fuming. I vented to two nurses, who listened sympathetically. Then I realized that they had work to do and I shouldn't be taking their time, so I went upstairs to find a staff chaplain.
What I wanted to hear was, "Yeah, we all feel that way around clueless parents, and this is how to deal with it." And I got that, eventually. But first I got a long, gentle lecture about inappropriate boundaries, about how it's not my job to fix years of family dysfunction, about the intellectual arrogance of thinking I can tell people how to behave around their children.
I wasn't trying to fix years of family dysfunction. I know I can't do that. I was trying -- badly, no doubt -- to remind the adult that the child had ears. I was trying to make that moment a bit easier for everybody.
At one point I told the staff chaplain, "Okay, look, I think part of where I was coming from is that when I was a kid, other adults sometimes called my adult caretakers on less-than-optimal behavior, and it helped all of us."
The staff chaplain said, "In my experience, that's unusual." What he wound up telling me is that I should have just concentrated on interacting with the kid in the first place, rather than saying anything to the adults (which I already knew).
But thinking over the incident this morning, I wonder. I have a long history of small interventions with adults who are being inappropriate with kids in public (in post-office lines, on New York public transit). For a long time, my strategy with adults berating children in public has been to walk up and say something pleasant and off-topic (compliment the kid on his sweater, ask if the adult has the time). This serves several purposes: 1) It distracts the adult from the immediate frustration with the kid, and may defuse that frustration; 2) It reminds the adult that other adults have ears and eyes and are watching this behavior; and 3) It may show the child, however subtly, that other people watching this behavior don't think it's okay.
I think number three is the most important. If a kid is treated badly in public and nobody does anything, what message does that send to the child? That this is normal and acceptable behavior, or that nobody cares? I know that many people might say that other people's family dynamics are none of our business, but my approach has always been that if something's happening where I can see it, out in the open, it is my business. Maybe small distractions don't ultimately work; maybe all they do is to drive the behavior behind closed doors, where it will become worse. Maybe the kid will never catch the subtle message delivered by a stranger. Maybe I really am just an arrogant person with bad boundaries.
But maybe, just maybe, that child will grow into an adult who'll one day remember what happened so long ago, and will think, "Someone saw that, and didn't think it was okay."
In the meantime, I still need to be better at controlling my temper with clueless parents in the ED. I won't be back there for three weeks, until after our Maui trip. The vacation's obviously coming none too soon!