Difficult Seasons

In Part 1, I described in general what an ICU is like and and a number of the conditions you are likely to encounter when you make a visit.

In this post, I want to describe some of the preparation I use to help me be effective when I enter the ICU.  Hopefully, the information I presented in Part 1 helps you understand that an ICU is not a place you just walk into lightly.  It’s a very serious place because the patients there have serious medical conditions, they and their family members are anxious, and the medical staff has important work to do.  My presence in the ICU will hopefully be calming, encouraging, and non-intrusive.

Preparation is further important because I really have no idea what I’ll encounter when I walk into the patients room.  I have minimal information, usually just the patient’s name and room number.  I don’t know their condition, what they’ve been going through, or what family members may be present.  Sometimes I have visited them before, and so I may know something of their story.  But basically I go into every visit pretty much blind as to what I’ll find and what the needs are.  Surprisingly, that’s enough.

My goal is to go into each room neutral so that I can match — and not contrast with — the mood of the patient and family members.  That requires that I be able to put aside whatever else I’ve been thinking about, worrying about, enjoying, or whatever has happened earlier in the day.  I want to be able to give the patient and family my complete focus while I’m with them.

Sister Alice Potts, who was the first chaplain at M. D. Anderson, was a mentor to all of the staff chaplains that followed, and also to a lot of us who do lay chaplaincy.  She’s the one that impressed on us the importance of being neutral going into a room.  Her message to us was that if the patient is angry, then we should reflect their anger.  If the patient is frustrated, then we should reflect their frustration. If the patient is rejoicing, then we should reflect their joy. If they are speaking slowly and quietly, then we should speak slowly and quietly.  You get the idea.  “Join the patient where they are,” was her constant admonition.

My training and my mentors have also impressed on me the importance of being present for the patient.  Being present has many facets, but important to me is that I go into their room with no set agenda except to meet their needs as they express them at that moment.  That means going into the room with all my senses heightened.  I need to sense whether this is a good time for a visit, whether a conversation is appropriate, make a split second assessment of what’s already going on in the room, and many other things.  Being present can mean just leaving a card and slipping out quietly.  Or it can mean spending significant time engaging the patient and/or family.  Being there, though,is the most important thing I do, whether I say or word or not.

It’s also important to me that I enter the room as God’s representative, with the purpose of ministering to the patient and family.  I’m still me, with my skills, knowledge, and intuition — and with all my baggage too.  The visit is to be about the patient and family, and not about me.  I’m there to listen to them, not to tell them my stories.

My preparation is simple.  Since I generally make these visits on Monday afternoons, I’ll spend some time Monday morning reminding myself why I’m making them.  At some point during the morning or while driving to the medical center, I’ll pray for my effectiveness.  After arriving at the hospital, I’ll review my list of folks that I’m to visit, and if they are folks I’ve visited before, try to jump start my memory about their story.  I generally try to make my ICU visits first, before making visits to patients in regular rooms, to be sure I can spend whatever time is needed with them.  But sometimes I’m led to visit elsewhere first.  And occasionally, I find that I need to take a few minutes in a quiet place to re-center, to get ready to engage another patient.

That gets us to the point of entering the unit.  In Part 3, I’ll describe how I conduct the visit and some of the common tools I use.

Originally published in my personal blog.

As a lay chaplain, I’ve gotten to make a lot of ICU visits. At MD Anderson where I provide pastoral care for Lifeline Chaplaincy, a whole floor is devoted to ICU, with some of the units focused on treating patients needing intensive care because of surgical causes, and other units focused on other medical crises.

You always know that ICU is a serious place. People are there because their lives depend on receiving specialized, life stabilizing, intensive medical care. There are all kinds of machines in the rooms, lines and tubes running everywhere, monitors with flashing lights, and sometimes breathing support devices and even more. Sometimes the patient is in isolation because of infection, and gowns, masks, and gloves have to be worn by everyone entering the room. And of course, hand sanitization is standard before and after leaving the room.

Sometimes the ICU room is almost erily calm, while other times it is a hive of activity with medical staff performing procedures or doing assessments. Sometimes a family member is present (many spend the night in the room with their spouse/relative who is the patient at MDA), sometimes a family member is in the waiting room and the patient is alone in ICU, and sometimes there’s no family member at all.

The patient may be feeling pretty good, be anxious to talk, and be on the upswing. Or the patient may be comatose and/or on life support, unable to communicate. Or the patient may be at any of the variations in between these two conditions. Their prognosis may be optimistic, some variation of guarded, or nearing death.

The family providing support is generally exhausted, stressed, anxious, but coping. Some days are better for the family than others, depending on the course of what’s happened and what’s expected to happen.

When I first started making visits, I have to admit, heading into the ICU was intimidating. Part of it was because I knew the person I was to visit was seriously ill. Part of it was because it was entering an alien space. And part of it was recognizing that the patient and perhaps family I was to visit were in the midst of a crisis, and that although I’d had good training, knowing how to best respond to their needs was still a mystery.

As with most endeavors, experience is a great teacher. I’m much more comfortable and confident these days as I step off the elevator onto the seventh floor. I know that I’m just there as a person to be used by God to minister to others, and that He always steps up to make that enough. And I know how important it is to patients and family to have someone just walk in the door and say, “I came by just to check on you today.”

(More to come)

Originally published in my personal blog

Light at the End of a Tunnel

Hope begins in the dark, the stubborn hope that if you just show up and try to do the right thing, the dawn will come. Anne Lamott

When a loss event occurs, whether it’s death, illness, a broken relationship, a lost job, or whatever, we naturally head into a darker place.

It’s just like entering a tunnel.  At first, we still have some light, because we’re just getting started.  But as we move further into the grief and chaos that accompanies loss, life becomes darker.  It’s harder to see where to go, what to do, because we don’t have enough light.

Hope that an end to the darkness will eventially come is a critical element to coping during difficult seasons.  For those experiencing the season, holding onto hope is a daily challenge.

With hope, a person can show up and try to do the right things.  Without hope, paralysis sets in.

To those of us who sojourn with those experiencing difficult seasons, whether as friends, or relatives, or caregivers or chaplains, helping them maintain this hope is one of the most helpful things we can do.  Having others who have experienced similar seasons listen and then offer an encouraging word of hope is healing.

If you’re in the midst of a difficult season, seek out those who can bolster your hope.  And once you’re out of that season, seek out those to whom you can provide hope.

During this week’s lay chaplaincy visits at M.D. Anderson, I visited two couples who were in very different places.  In both cases, the husband was the patient, and the wife the care giver.  In both cases, hospitalization had been going on for a while.

In one case, the patient had been through a lot of difficult stuff.  He was improving, but was still suffering from some delirium, and really wasn’t able to get up and around.  I met his wife in the hallway, and as she gave me a positive-sounding update, her eyes said that she was worried and exhausted.

In the other case, the patient had also been through a lot, including a stem cell transplant, but was feeling good.  He was up and about, wearing his own clothes, and playing card games with his wife.  Her eyes were dancing, exuding hope that they were nearing the light at the end of the tunnel.  She also gave a positive-sounding update about her husband’s condition.

The first wife was telling me what she wanted to believe.  The second was telling me what she believed.

Their eyes told me the story behind the words, and the eyes also told me how to best respond to them to best support them where they were that day.