Challenging day - with a hospice patient who is not yet officially hospice
Tuesday, April 02, 2013
I have a favorite client. We are not supposed to have them, I know. But who can help having one? He was in multiple wars, has multiple wounds and is generally in reasonably good spirits about how poorly he gets around. Now he has other issues, which for patient confidentiality, I won't discuss.
The VA hospital made him wait months for tests and doctors visits with his primary physician (let alone specialists), for new pain medications and to get his diagnosis. HE is the reason I signed up to volunteer for their hospice (in addition to my for pay job), because I know at some point he will have to leave his home to be in their 24 hour facility. I want to be sure that someone (me) will be available to treat him with love and respect once he is in that facility.
I love hospice work best of all, anyway. It suits my personality. I am a mediator and a comforter. I have no qualms about dealing with even the "worst" tasks; I suction mucus; I change Depends and wound dressings. I give bed baths to men and women, even ones who have gone two months without a bath because they are so frightened. I am willing to meet clients in whatever condition they are in, at whatever age they behave like they are, and I treat their delusions as real if necessary. If they say they see or hear spirits or animae, I do not contradict them. (In fact, if they want me to, I help them "remove" the critters, as I did with a man who was possessed by octopuses. He experienced great relief. There is, in my opinion, no reason to tell a man within days of dying that he is imagining things if he is absolutely convinced he is not.) Most of the time I find great satisfaction and joy in doing these things.
Then there are days like today, when for some reason, I feel ineffectual.
Patients often get caught up in day to day living. When they come to hard moments at the end, they might wish for a chaplain, but sometimes they ask me for spiritual guidance - because I am the one they know, who has been coming day after day. I am Jewish and I think their families would probably have a cow. They needen't worry. I realize that usually the person is seeking reassurance rather than a discourse on MY personal beliefs.
Family members also seek guidance. Sometimes they directly ask. Sometimes, like today, they are indirect and there is a lot of tension. Sometimes husbands and wives or parents and children try to get me to choose sides.
The prayers families think they say for their patients often contain wants for themselves. (We want the patient to recover because we cannot imagine being ourselves without them.) Prayers with this in their core cannot be said in the presence of the patient. They are better shouted in an empty field or by the ocean, or somewhere else far from the patient. The hurt the petitioner feels is likely to disintegrate into anger, guilt and betrayal, maybe directed at God, medical personnel, others in the family and even at the patient for prior faults or for dying now.
If one is praying for another, pray FOR that other. Pray that the other receive comfort and peace, however they may come. That is all. Be still. Hold hands. Do that with the patient.
I know all this. I know it. I have counselled it and lived it and done it with dozens of others.
Today there was so much tension in the house. No one broke down. The threat of it just hung in the air. Did I fix it? I did not. Why? I do not know. I have a dozen and more times before. Because he is my favorite? Because I felt torn between him and her? Aaiiii...
I clocked out but I didn't want to go home. I went to the drugstore to get my hepatitis vaccinations for the hospice volunteering gig. I waited in line a looooonnnnggg time, only to be told they didn't have them in stock. So I drove to another drugstore. They wouldn't do them, either. So I tried to go to the Goodwill to donate clothes. They were closed. (It's Monday in rural Oregon.) So I tried to buy bread at a nice bakery. It was closed. Then I drove around for ten minutes because I still didn't want to go home. I finally decided I was being stupid and should go home, but I had some jerk tailgaiting me on a really windy road above a steep embankment above a river. My heart started to pound. Finally, I found a place to turn. The tailgater sped past me. I turned around, went home and rummaged around until I found my husband's stash of salty snacks.
Then I went to my second job of the day, feeling like a pufferfish.
My husband, who is a licensed clinical social worker, and I have both noticed how many nurses and social workers are very large. We know they all know better. But we also know exactly how it happens.