To celebrate finals week, my last post consisted of a real dialogue between a chaplain and her patient. I gave all of my readers a test to see if they could identify problems with how the chaplain did her job. I am reproducing the dialogue here for everyone’s convenience followed by my evaluation of the answers that over a dozen people gave. Smart but tough crowd! To see their original comments, please see my previous post. Here is the dialogue:
Chaplain: interaction #1 (The patient seemed alert and was sitting up in bed reading a book. The chaplain knocked on the door.)
Patient: interaction #1 Yes, come in.
C2 Mrs. Jones, I’m So and So, the chaplain-on-call. I understand that you wanted to visit with a chaplain.
P2 (She smiled.) I like the way you said that…”to visit with a chaplain.” Our minister said that there would be chaplains available to talk to if I wanted to. (She winced some. I sensed that she might be in some pain. I waited a moment and then responded).
C3 Indeed, I am here to visit with you, Mrs. Jones. Am I picking up that you are in some pain right now?
P3 (Smiling but still wincing some.) You observed accurately, Chaplain. I am having some pain. Not a lot but some. By the way, it’s Mary. (A slight pause). I hate being in the hospital. The nurses are very sweet, and I have a very competent oncologist. But being here is such a waste of time.
C4 Mary, you sound like a busy person. It’s no fun just to lie here, especially in some pain, when you could be doing…what?
P4 I’m a manager of a large real estate company…Oh (she winces again).
C5 Mary, are you sure you feel like visiting now? I could come back another time, say, in the morning.
P5 Chaplain, you don’t need to stay. I know there’re probably some here worse off than me.
C6 Mary, if you want me to stay, I will. You’re important, and you did have the nurse page me.
P6 (Smiles slightly). Thanks, Chaplain. I would like to talk…I really don’t want to talk about it…But (winces slightly…pauses.)…I know I need to…My family physician came by while my daughter was here earlier… [She then tells her concerns in the rest of this transcript]
My steller class picked up on three issues. The first was about the patient’s physical pain. Nancy makes the pun that the chaplain “wasted time” by discussing pain. Not only once, but three times she refers to it. Cathy acknowledges that the chaplain can ask about pain, but that she should then ask the patient what the patient herself wanted to discuss. Cathy by the way also picked up on the patient’s hesitation to ask for help, manifested by her saying to the chaplain that she probably has other patients to visit who are “worse off.” This hesitation was made worse by the chaplain’s ambiguous signals about her availability.
Vicki correctly explains that to be fair, pain must be addressed. The whole hospice team is supposed to address the issue of pain during a visit, and to report it to the nurse right away if necessary and if the patient gives permission to do so. But then, anyone visiting is free to address other issues. Peg says the chaplain shows discomfort through all this talk about pain and wants to run away from it. Now that’s an astute answer. Perhaps the chaplain was focusing on physical pain to avoid dealing with emotional and spiritual pain! DJ speaks to that as well.
Another issue was how the chaplain responded to Mary’s assertion that being in the hospital was a “waste of time.” Many of you said the chaplain should not have tried to guess what the patient meant by that. Let the patient do the explaining. You get an “A” for that extremely important point. As Gydle said, maybe the patient wanted to talk about nearing the end of her life and could think of far better ways to spend her time. Sande thinks the chaplain’s guess as to what wasting time meant was a lot more about the chaplain’s own issues than the patient’s. Right you are! Jessica said never to assume what the patient needs. Instead, ask an open-ended question. Jane got that right too. As for Elizabeth, she is being very very generous to us chaplains.
The biggest issue in my opinion is the mixed signals the chaplain gave about wanting to be there. Strangely enough, she is basically asking the patient if she is sure she wants the chaplain there. This wrong signal definitely came across because the patient takes it as a hint that the chaplain rather be elsewhere. I give Leah kudos for the following perceptive answer: “Maybe the chaplain was looking for assurance that Mary wanted her there.” Talk about having it backwards! Chaplains should be reassuring patients, not the reverse. Thus the chaplain was showing her own discomfort, which almost got in the way of a successful visit when she gave the chaplain a way to get off the hook basically by saying to her: “Chaplain, you must have more pressing cases than I to take care of.” The good news is that despite all of these problems, the patient went on at length about what she needed to say. (I did not show this part of the dialogue.) One lesson here is when we badly need to vent, we will take any listener, no matter how flawed, as long as some compassion is present (and maybe not even much of that quality).
My thanks to all for participating. We’ll have to do it again sometime. :-)