10 June 2006

the first week review

As many of you know, I am in CPE this summer. This means I am working in an institutional setting doing ministry under supervision and with reflection/learning. I am at a nonprofit multispecialty academic medical hospital with specialization in transplants, cardiac issues, and complicated medical issues. It is not a trauma center, and the demographic served is widely varied, but predominantly people with some resources. Although routine medical issues are treated, the majority of the patients come to this hospital after receiving care at other facilities because they require highly specialized care. The hospital has 1,500 full-time salaried physicians two major locations with more than 100 medical specialties and subspecialties. In 2005, 2.7 million patients came for treatment from every state and 100 countries. My facility operates at 98% of capacity on any given day and covers several city blocks.

My group is super-fantastic and my supervisor is also really wonderful. The tone is friendly, caring and without hostility, so I won't have a summer that becomes a CPE horror story. I have 3 units: adolescent psychiatry, pediatrics (general), and internal medicine; and one night on-call each week, where I'm in the hospital over night and respond to codes, crisis intervention pages, and deaths for the entire facility. My first on-call night was Thursday, and I had a training chaplain with me. We were pretty slow and he was tired, so I told him to go up to his on-call room and I would call him if I needed his assistance. It picked up briskly after that, and I was busy all night long, but I never felt out of my depth.

It was my favorite part of the experience so far, I guess because I felt like I made a difference. Day to day I make rounds and visit with patients, but the night is intense and my role seemed very clear (to me). I started off with praying with a family waiting for a surgical outcome, followed by a crisis intervention, went to a code (working primarily with the family; patient X was stabilized), went to a code where there was no family and the patient was transferred to ICU, went to another crisis intervention, responded to a second code for patient X (helped the family, who were continuing to arrive; patient was stabilized and taken to radiology for tests), while I was getting hotel information for the family that had driven in, patient X coded again in the CT scan room. The medical personnel could not get a normal rhythm and the patient died. I stayed with the family afterwards. Then, I reponded to another page in ICU, followed by a visit to a family after a death. I returned to the ICU to be with the mother of patient Y, who was undergoing a procedure.

In the middle of that (in the same ICU), I was with a family as a patient who had been taken off life support died. I had prayed with them and was reading from the psalms when the patient died and the nurse turned off the monitors. I remained for a short time, but they were not surprised and had time to prepare. After they had cried a little, they mostly relied on one another for comfort and didn't need me anymore. So, I returned to the mother of patient Y. As the patient's condition deteriorated, I went into the procedure room where the doctors made room for me so that I could give the patient a benediction. The mother wanted to know whether her child seemed tired, whether it was time, so I went because the medical work being done would have completely overwhelmed her. I reassured her about the decision to stop compressions, which had gone on for 1 hour, and held her while she cried and grieved and demanded to know why her child was dead. I sat with her and the patient afterwards and helped her contact the family and their pastor in another state and break the news to those who arrived afterwards.

I made pre-op rounds early in the morning and responded to another crisis intervention before handing off the on-call pager at 8am. It was a busy night, but I wasn't overwhelmed or afraid or confused. I did what was needed and I was able to help in the darkest moments of someone's life. I couldn't bring their children, mothers, fathers, sisters, brothers, wives, or husbands back. I couldn't make everything okay again. I couldn't work miracles. But I could be there to support these families, to hold their hands while we prayed, to give them comfort in their pain and loss, to hold them while they cried in joy or sorrow, to hear about the lives their loved ones had lived, to listen to the regrets for things unsaid or for angry words that could not be taken back, and to ease tensions between family members.

I was there. And that made all the difference, even though it did nothing to change the outcome.

And it has made all the difference in me.