Sunday, December 16, 2007

A Walk on the Beach

The patient was in our ER for a medical clearance before being admitted to a psych hospital. As I've discussed here before, this process can take a very long time (I gather that's true in other parts of the country, too). The patient and a family member were in one of our less comfortable rooms, the one with dentist's chairs instead of beds. The patient wasn't suicidal, but was sufficiently depressed and anxious to have decided that hospitalization was a good idea.

Being there of your own free will doesn't make the interminable wait more pleasant, though, especially when you can't even lie down. Among other things, psych patients always have all of their personal effects taken away. This doesn't make complete sense to me: while some items, such as nail files, could be used for self-harm, others couldn't. But I guess the rationale is, "better safe than sorry," even when a patient has said, "No, I'm not suicidal."

In this case, the confiscated items included two types of medication. One was an anti-anxiety med.

The ER was a zoo that day. Two other hospitals in town were on closed divert, so we were getting a steady stream of ambulances. This meant that waiting times were even longer than usual.

I'd prayed with the patient, who believed in God but wasn't conventionally religious. I kept stopping back to see how things were going. For a while, the patient and the family member were fine; if anything, the family member seemed more on edge than the patient did. But then I looked into the room and saw the patient's face contorted, as if tears might start pouring at any moment.

"Are you okay? You look really upset."

"I'm just -- I'm really anxious. I think I'm starting to have a panic attack. I really need my anxiety meds. Can you see if there's any way I can get them?"

I checked at the nursing station and was told, "No way!" (The thinking here, I believe, is that the psych hospital is in charge of psych meds, and that the ER staff isn't about to give the patient anything that could be used to OD.) I went back to the room to report this. The family member, very understandably, glared at me and said, "This is ridiculous! They can't do something that's going to help? They want a patient to go into a fullblown attack?"

I tried to find the patient's nurse, who was doing a procedure on another patient. I went back to the nursing station and was told to look for the doctor. I found the doctor, who listened very attentively -- especially considering how busy the department was -- and then said, "Have them put the chart up. I'll check in as soon as I can and see what we need to do."

But more ambulances were coming in, and I had no idea how soon anything was going to happen. So I took a deep breath, went back into the room, and said, "The doctor's going to come in, but in the meantime, let's try to get you calmed down. You've told me how much you love the ocean, and I do too. I want you to close your eyes and imagine that you're walking on the beach."

I've been on the receiving end of plenty of guided meditations, but I'd never guided one myself. I included lots of instructions about slow breathing ("breathe in . . . now out . . . now in . . . now out") interspersed with sensory description. "You can smell the salt air and hear the seagulls, and as you look out at the incoming waves, you know that you're part of God's good creation and that God loves you. You feel the cool water on your feet and the sand between your toes. In the distance, dogs are running into the surf, chasing sticks their owners have thrown for them, and when they've retrieved the sticks, they race back onto the beach and leap for joy. The sunlight is warm on your shoulders."

I'd closed the door to the room, and because the patient had also complained of an oncoming headache, I'd turned the lights off. The hubbub of the department had faded. The only sounds were my voice and the soft rhythm of breathing: the patient's, the relative's, mine. The patient's face had relaxed, and when I described the dogs, I saw a smile.

At the end of the meditation, I said, "How do you feel now?"

The patient, eyes still closed, smiled again and said, "I feel like God's with me."

Score one for guided meditation.

I'll definitely be using this technique again, and I recommend it to anyone who needs a way to calm someone who feels panicky. I'm sure meds are more reliable, but this was a very effective stopgap measure.

When I left the room, the patient was napping, and my shift was over. I wish I knew what happened after that -- unfinished stories are one of the occupational hazards of ER ministry -- but I hope, and trust, that the patient's doing well now.


  1. That was the perfect thing to do! You really helped that patient.

    If I win the lottery, I'm starting medical clearance clinics for psych patients.

  2. Thanks, Mary! I hope you win the lottery!

    I wonder if anyone's tried to get a grant for this. It seems like there has to be some kind of solution!

  3. That was a wonderful thing to do for the patient. I've been shown how to do it for myself and it has always helped. Great job, Congratulations on its success. :)


  4. That story made me cry. I hope if I'm ever stuck in the hospital that I'll be visited by a chaplain like you.

  5. Anonymous8:52 PM

    Good job Susan! If you want to explore this, I highly recommend "Sadhana" by Anthony De Mello. (It's the text I use in my Prayer class; we use it mostly in the Meditation unit. What I like about this book is that de Mello is a big fan of just doing it. Everyone once in a while he'll offer some thoughts, but mostly he's encouraging his readers to just do the exercises.

  6. Great idea, Susan. It sounds like that was the perfect thing to do. It's a tool I haven't seen discussed enough in my classes, in my opinion.

    PS: It's Nickie, I just show up with my livejournal user name now...

  7. Thanks, everybody. And Nicky, I would have known who you were just from the "puppybraille" nickname!

  8. Anonymous2:11 PM

    That is inspirational. Thank you.


  9. Done well, Beloved; and well done!

  10. Congratulations for using your instincts and doing the exact right thing for the patient at the right time. You are a true patient advocate.

  11. Fantastic. I had a crisis helpline worker do this with me from the other end of the phone line, and it helped so much.

    To have someone who will listen when I am ill makes all the difference. Silence, or refusing to hear (as the nurses appeared to do) is the most damaging things anyone can do to me. It's unfortunate that some medical staff seem to believe ignoring the patient and their requests (on the grounds that they are "mentally unwell" and responding isn't helpling) is the right thing to do.

    Great post, thanks.


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