Friday, February 6, 2009

Spiritual Care

For part of our Medical Student Leadership Group course, we were sent off in pairs to shadow the spiritual care team of our affiliate hospital – ministers, chaplains, priests, rabbis, etc. When our course director (one of my favorite med school characters!) gave a talk to my class introducing the Spiritual Care Team shadowing experience, I remember this warm and gushy feeling – an appreciation that the holistic care ideal that is cited amongst a list of priorities in my curriculum was actually real. Even before formally getting to see a patient for “medical care purposes” as a student, I’d have this opportunity to enter what is arguably MORE intimate sphere of existence for a human being. That’s a huge deal. I’ve never talked about my spirituality or general life philosophy with any doctor; I don’t think I’ve even had those kinds of dialogues with my family. I write publicly about my way of seeing the world (through my blog that has strangely come to be read and commented on by people I’ve never met) – at least the “private” thoughts associated with sufficient comfort and relevance to share, and the “spirituality” component of those thoughts is marginal. But, as I saw it, I’ve never shared with another human being the content of the conversations I imagined being privy to through this experience. It was huge.

Over the past few months, my classmates who have had their shadowing experiences already have vocalized sub-ideal experiences. I was able to write off many of their specific gripes as clearly non-applicable to me (“feeling awkward about praying” – big deal; suck it up and learn from the experience; or, “not getting to do anything” – listening to someone talk about their lives through the lens of their healthcare has yet to lose its novelty for me). But still, friends of mine cautioned me to stop hyping up the experience (as I hype up many experiences, and come to learn that expecting the “best thing ever in the whole world” is almost always going to result in sub-“best thing ever in the whole world” – even experiences that are very positive.
Expectations management is key.

At 4:30 today, my shadowing partner and I arrived at our designated spot to meet the chaplain with whom we’d be tagging along. Nobody was there. 5 minutes pass. 10 minutes. 15. Coping mechanisms kicked in: I wasn’t excited for this, I told myself. It wasn’t going to be that influential. It wasn’t a big deal. Whatever “take-home points” there were going to be – I already knew them. I could go home early. Yeah. That.

Down the hall shuffled a white-haired woman, a cross dangling upon her chest, clipboard in hand. “Was I supposed to have students today?” she asked, her face reddening. “I didn’t prepare anything!”

We assured her that we hadn’t been waiting long – that she didn’t need to do anything special, that we just wanted to soak up whatever we could from whatever she was going to do this particular afternoon. She told us, repeatedly, how embarrassed she felt – but before long, she began to appreciate that we were legitimately as open-minded and “expectation-less” as we said we were.

There had been two consults called in that day. The chaplain would visit them and ask if she could bring in us medical students to observe.

Then, it became real. This was really going to happen. With no conscious effort, I readjusted my expectations. I had specific goals I wanted to get out of this: 1) see ways in which people express their need to discuss their spiritual wellness; 2) see how a spiritual minister contributes, if at all, to a person’s awareness of those needs, if they’ve not yet surfaced; 3) ask questions, later, of this chaplain about these two priorities if I’ve not been able to observe these things myself. Modest, reasonable, specific. Perfect.

We went to see the first woman, a congestive heart failure patient, who graciously accepted us all into her room. As my colleague and I stepped into the room, I met by a forceful gush of odor. The odor of sickness. I paused, accepted its presence, and continued to enter – mindful of control over even the slightest crinkle of my nose. This was my life now. I stepped closer.

V. looked about 95 years old – though I’m absolutely useless at age-estimation. She looked frail, almost wasting away beneath the hospital sheets. Her lips were parsed, corners of her mouth crusty. Iron-deficiency anemia, I thought to myself. Her fingers were clubbed. I remembered being taught that you can detect lung problems, among other things, that way.

As V. spoke to us, it seemed difficult for her to get her words out. Her breathing was not labored but there was something very strained about it. I felt strained imagining what it would be like to not be able to communicate fluidly. She told us about her family, about her church – it was clear that her church was a key influence in her life, that she derived a sense of purpose from belonging to that particular group. I don’t relate to that myself. People in my life whom I know do experience that relationship haven’t elaborated on it for me; I’ve never asked. I made a mental note to explore this further with a non-stranger so that, when no longer in the role of a passive observer, I’d be able to be more effective.

Before we left, the chaplain asked V. if she wanted her to pray. The chaplain laid her hands over V’s clubbed, bent fingers. Her prayer contained both deliberately religious and non-religious, spiritual themes – energy, intention. I saw the corners of V’s closed eyes lift up, her cracked lips hopeful. She was peaceful.

My eyes watered. I felt guilty that I was so affected, knowing how many times I would be moved to moisture in this hospital.

I realized that I no longer noticed the smell in the room.

Our next patient was likely in her early 60s, recovering from a post-surgical infection. Her husband sat by her side. He looked more tired than she did, as he detailed the chronology of events leading to her infection. My classmate and I looked at one another knowingly – we both so desperately wanted to know what microbe had infected her, what drugs she’d been on, and then go rehearse their mechanisms of action and known toxicities – and were self-amused at our mutual appreciation for how inappropriate that would be. We stood silently.

The chaplain, intent to make specific teaching points, asked the woman whether there were any “lessons” she’d want budding physicians in training to know about. As the woman responded, the chaplain “summarized” the teaching point (totally unnecessary) – and I wondered whether this couple felt empowered to know that they were teaching us and serving as tremendous resources, which is how I justified the awkwardness the chaplain was imposing – that maybe it wasn’t awkward, maybe it was an effective device. I don’t think it would have been effective for me in the patient’s role – but I appreciated that everyone has different things that appeal to them. As the woman shared specific encounters, the chaplain pared it down to a single-word, rote adjective: “compassionate,” “caring.” The couple echoed the words, and agreed with the cursory paraphrase. I just wanted to hear them talk forever without being pared down to a list of adjectives that in no way add up to the sum of the original details. I appreciated the comparison to the lame, bare-bones notes I’d taken on yesterday’s lectures. Irony.

It was then time to pray. The chaplain took the patient’s hand, who took her husband’s hand. Instinctively, I reached down for his hand – hoping that I wasn’t violating any “rules” as a passive observer -- and my classmate’s on the other side. He completed the circle. I felt like I was a part of something bigger, a moment that would be with this person for a long time – she seemed like the kind of person for whom an experience being prayed for by the hospital chaplain in the “big city” would be a big deal. I didn’t relate to that, but appreciated it was a privilege to witness this woman's experience. As similar themes of energy and hope and balance were added to the circle through the chaplain’s words, I watched the woman’s face – her rosy cheeks lifted in a hopeful plea, the corners of her eyes similarly lifted with delight. Her lips were parted, and I saw her mouthing the same phrase over and over after each line of prayer.

Thank you.”

My eyes got watery again. But this time, I didn’t feel guilty.


Charles said...

Please don't think I'm so psycho and that I am stalking you, I just think your writing ability is phenominal and your topics are facinating. Not sure if you saw it or not but I commented on your TMI post yesterday. What an opportunity you have to influence soooo many people. I loved how you explained the emotions after the Chaplain's prayers with the patients. Hopeful. Peaceful. It is amazing that those kinds of feelings/emotions can be derived from a persons relationship with a higher power. I believe that. I have that. I experience that on a daily basis and I'm grateful for that. For me it is more than a feeling or an emotion of some sort, it's a state of mind or state of being as a result of a relationship with God through the person Jesus Christ. What kind of Chaplain did you visit with? Just curious because they are all very diffirent. Seems like a wonderful experience for you. Wow! Sounds like you are having the time of your life.

Melissa Marotta said...

Hi Charles,
Thank you for both of your VERY thoughtful comments... I hadn't seen the "TMI" one til you referenced it (I need to check the settings so that I get an email alert for this blog when someone comments, like do with "Spintastic" - I'm surprised that it's not automatically the same, since it's the same account).
Thank you for sharing your own experience of empowerment through your own spirituality - it really is amazing and inspiring to see that manifested in so many ways, extending into the way people live their lives.
This Chaplain was Protestant - and her practice was not to bring that up unless the patient asked. V. was a Christian missionary; the second patient was did not belong to an organized religion, but the discussion was very very very similar in scope with even greater success for her, as I saw it.
It means a lot to me that you read this blog - I never thought ANYONE would, let alone someone I've never met. It really does independently reinforce the "big picture," as you commented on the other post. I'm indeed aware of the challenges of the battlefront I am preparing to enter, but I'll do my best to remember the important perspectives, moments, and lessons that continue to fuel me on the road ahead.