Wednesday, May 23, 2007

Mortality Fatigue

My hospital shift this week was, even more than most are, full of reminders of mortality: two patients who'd come to us from home hospice care; a patient who'll soon be in hospice care; a patient grieving the recent death of a beloved spouse; a patient, initially cheerful, who began weeping with worry over a son in Iraq; and a code (although that patient was alive when I left the hospital).

In August, I'm going to be the guest speaker at a three-hour med-school seminar on end-of-life issues. I'll be talking to the students about grief and leading them in some writing exercises about the subject. This shift was definitely material for that, but right now, I'm merely numb, unable to extract teaching moments. I'm glad that I have a few months before the seminar.

I keep reminding myself that there was balance in the shift, too: lots of cute little kids who loved the stuffed animals I gave them. I'd gone to the dollar store and stocked up on teddy bears and bunnies and handpuppets, and put each in a individual plastic bag so it would stay clean in the ED. I gave lots of those away, and the nurses gave some away, too.

Also, many patients requested prayer, and were exceptionally grateful for my presence. So in that sense, it was a good shift.

But I've been beating myself up over an unfortunate interaction I should have avoided. Near the end of the shift -- actually, a few minutes after I should already have left -- the family member of one of the dying patients asked to talk to me. This family had asked to see the chaplain when they arrived, and had repeatedly thanked me for my prayers whenever one of them saw me in the room or in the hall. So when the relative motioned me into a relatively quiet hallway, I was happy to oblige.

"Is anyone in your church pro-life? I'm very involved in that, and we're always looking for new people."

I shouldn't have let myself get pulled into a discussion, but I was tired, and I felt closer to this family than I have to many others. I should have said -- what should I have said? "It's not appropriate for me to discuss politics here"? "I'd love to talk, but I'm past due to go home"? I honestly don't know.

Instead, I tried to explain as respectfully as possible that a) I don't know where most people in my parish stand on the issue and b) while I'm profoundly ambivalent about the issue myself, I'm simply not comfortable denying legal access to safe, low-cost abortions.

Predictably, this unleashed a barrage of statistics from the relative, who wanted me to know just how many babies have been killed since abortion was legalized. I tried to explain that my focus tends to be on what we aren't doing, what we need to do, for kids who've already been born: homeless kids, hungry kids, uninsured kids. I talked about what a struggle it is for even my affluent friends to find affordable daycare.

This developed into an intense, moderately heated discussion, as medical staff walking past gave us mystified looks. It stayed respectful, though: we agreed that it's an incredibly complicated issue, and reassured each other that God loves all of us. Both of us tried to understand the other's point of view. At the very end, I told the relative, "Good luck. You're facing something very hard right now," and only then did it occur to me that at least some of the urgency about saving the unborn came from the relative's powerlessness to save the beloved patient.

Duh. Brilliant, Susan.

And how would I have responded differently if I'd realized that sooner? Probably I would have said, "It's awfully hard not to be able to save people, isn't it?" That was the subtext of the conversation anyway, but if I'd recognized it earlier, I might have been able to get the relative to talk about the more imminent loss, the immediate loss, and about the theological issues it raises for this very devout family.

Is this a teaching moment after all? The presentation of deferred grief in the relative of a dying patient?

Instead, I feel like I fell flat on my face and did a really bad job for someone in pain, although at least I learned from it. (Gotta love that 20/20 hindsight.) I'll be far more sensitive to this sort of dynamic in the future. That doesn't make me feel better about this interaction, though. I just have to trust that another chaplain, somewhere down the line, will be better at getting to the core issue.


  1. Anonymous12:32 PM

    Wow, and I thought I was hard on myself! Cut yourself some slack, Susan. You were technically done for the day, you were tired, and you got into a conversation on a subject filled with sinkholes. I mean this in a good way: you can't help everyone, all the time. You did good work for many people during that shift, and just because you didn't "get" what the minefield of that last conversation was about, you beat yourself up? Nuh-uh, I don't think so!


  2. Anonymous5:47 PM

    Susan, you are a very, deliberately caring teacher who worries that any of your comments do no harm. I know that's the same kind of chaplain you are. Is there some way you can learn to treat yourself as you actually treat others.

    I'm pretty bad about beating up on myself, but nothing compared to you. Jeff is right, cut yourself some slack. In other words, show Susan the same mercy Susan shows others.


  3. Oh, Susan-

    You were real and present with her, and you were tired and overstressed/overstimulated. I think you were just fine! She needed to dispel frustration, anxiety, anger and disbelief - she was anticipatory grieving. You were right there and allowed her to do the work she needed to do. It didn't have to be perfect. You loved by being present and allowing communication that was open and respectful to occur. The content probably didn't matter very much. You could have argued about cheese - swiss or cheddar - it would have served the same purpose for her.


    Hope you found some comfort, too!

  4. Thanks, Jeff and Sharon. The issue is really that I shouldn't have gotten embroiled in the conversation in the first place; in retrospect, I couldn't have realized what the subtext was much before I actually did.

    The situation pushes my buttons because, as a volunteer chaplain, I'm particularly open to charges of "unprofessionalism," and I'd hate anyone to think less of volunteer chaplains because of how I handled that situation.

    In my defense, the relative was the person who raised the incendiary topic, and who went to some trouble to seek me out to do so. At least I honestly engaged with the issue, which may have been more respectful than brushing it off may have been. But I need to figure out a way to redirect the political into the personal if this happens again.

  5. And thanks to N=1, too (with whom I've discussed this over e-mail)!

  6. You know, I appreciate as much as anybody the value of the verbatim (for the unfamiliar, the specific case study tool used in training chaplains). But the experience is consistent for all of them: there's always something to critique.

    So, when you look back you wonder how you might have done this better. First, I concur with others: "better" may well have been an unreasonable expectation of yourself. You were on your way out, both physically and emotionally, and you got ambushed. Oh, the intent wasn't evil; and it probably was an effort to find some good in a hopeless situation ("at least I found access to some new allies); but it was an ambush nonetheless. Could you have handled it better? Perhaps; and I'll get to that. Could you have done a lot worse? Absolutely. You were respectful, treating this grieving person like a real person and not an enemy or a stereotype. You were pretty calm yourself. You reached a reasonable position on which to part, and maintained some sense of an appropriate relationship. There's a lot in that to appreciate.

    How might you have done it better? I don't know: let me think. Here, far away in my hospital office, my first thought of a response is, "You know, I've been focused things here, and I just can't think right now of anyone that might connect. I do know folks in my church have access to the National Organization of Episcopalians for Life, and I'm sure others know that, too. Now, how do you think the rest of the family is doing?" Which can then lead to, "And how about you?"

    Or perhaps that's too wordy (one of my faults). How about, "Oh! Gosh. Well, no, not right now. Sorry that I can't help you right now. So, how is your family doing?"

    Those are some thoughts; but they are not to suggest that you were a poor chaplain in that circumstance.

  7. Thanks, Marshall! I always appreciate your thoughtful comments, and this one is especially helpful. I agree with you (although I hadn't quite been able to articulate it) that the "ambush" was the relative's attempt to salvage something from a bad situation; that's one reason I felt an obligation to respond seriously. But you suggest useful phrases for graceful disengagement, and I'll keep them in mind for the future!

  8. You know, you just may have given a distraught family member a useful outlet for his/her frustration, rather than having all that frustration channeled back at the patient. Sometimes people need to blow off steam, and, when they are distraught, they just might do it in very inappropriate ways.

    Maybe -- just maybe -- you actually gave that family member enough of an outlet for that frustration that he or she will be able to take a deep breath and deal with their loved one's situation in a more rational manner because you reacted the way you did.

    We are all human. Please don't take all of the responsibility for this unfortunate situation on yourself.

  9. You sound like a good heart-ed person. It is very hard to understand people in this world,even difficult to understand is the life cycle. what is the points of all the things we do in life.


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