Saturday, February 25, 2012

Flying By My Clinically Trained Pants

“How’d you know what to say?” he asked. The medical students shadowing me asked this question. Most people regardless of their background or discipline ask that question. The other common phrase is, “I don’t know how you can do what you do. I couldn’t”.

“The journey of a thousand miles begins beneath one's feet”, is from the quote by Chinese philosopher Laozi. Great surgeons don’t start their career in an operating room. The science of medicine is learned and the art of medicine is a trained gift. 

Chaplains don’t start their work by sitting by the bedside of a patient who is asking, “What do you say Chaplain, to a person who isn’t sure what they believe and they are going to die?” They might start with a less ill patient and still let the patient lead the way.

When I first began hospital visitations.. in my clinical beginning.. my mentor would have me visit one patient and return to his office to discuss the case. We would talk for an hour about what the patient said, what I said, and how I might have participated in that conversation differently. Many years later I participated in clinical training. C.P.E. Clinical Pastoral Education is what that stands for. There are training centers all over the United States and several others through out the world. Each unit earned in this program consists of 400 supervised clinical hours. That time estimate doesn’t account for all of the reading, writing and other requirements for the program.

Students in C.P.E. begin much like I did with my mentor. Students visit a patient and then write a paper aptly named a verbatim. Indeed NOT recorded, but to the students best recollection the conversation verbatim. What did the student see in the room? What was absent? What was said between the student, patient, staff or any other person in the patient’s room? What was not said? What is the theological reflection [from the students religious tradition] of the patient’s situation? Often it is the recollection of the conversation, what the student HEARD not necessarily what was said that also reflects the state of mind of the student. When presented to colleagues, always in a clinical and confidential setting [HIPPA guarded] the student’s colleagues feed back, as well as their supervisor, places in the verbatim where the conversation was too directive, missed an important patient cue or possibly well done.

To apply to become a board certified Chaplain, the applicant needs to have completed four of these academic units. The requirements for application to C.P.E. are long as well.

I will share a secret. More of what I have learned is what not to say rather than what to say. More of what I have learned is not to give answers but to ask the right questions. MOST of what I have learned has been gifted to me with the trust from the patients and those who love them.

This was a week that left me brimming with gratitude and guarded with humility. I saw my work reflected through those medical students’ wide eyes. This week was one of the remarkable weeks that a Chaplain savors for months on end. It ended as one of the weeks when I will fall asleep with tears in my eyes knowing in fact I have made someone’s living better and someone’s dying easier. I am so fortunate to be given the work I do.

Not so much flying by the seat of my pants but focused and intent on each patient's need. Yes I am clinically trained and have many years of experience but what I hope more than anything is that each gift of trust from a patient can be regifted to others. I am deeply grateful to every one.
Top of Form
Bottom of Form

Sunday, February 19, 2012

Acronym and Shortened Language

We need a translator!

Regardless of employment, education or experience there are acronyms everywhere around us. The trick is to learn each unique language.

P.C.= Personal Computer
3D= Three Dimensional
WWW= world wide web [wild wild west???]
BLOG= a meshing of the term web log

I.R.S.= Internal Revenue Service [I thought this time of year I’d toss this one in]

Ph.D.= Doctor of philosophy
J.D.= Juris doctor

This is also true in the medical field as well. Think about a simple medical check up in your physician’s office.

MD= Medical doctor
RN= Registered nurse
LPN= Licensed practical nurse
APN= Advance practice nurse

You may be given medical orders to have tests:

CBC= Complete Blood Count
LDL= Low Density Lipoprotein
HDL= High Density Lipoprotein
PSA= Prostate-specific Antigen
PAP= The Papanicolaou test

And then……… there are those tests that can be ordered which may bring halt to what seems average.

MRI= Magnetic Resonance Imaging
CAT [SCAN]= Computerized axial tomography
PET [SCAN]= Positron emission tomography

Of course then come the therapies such as:

TOMO: Tomotherapy is a type of intensity-modulated radiation therapy (IMRT]
CYBER-KNIFE: no knife involved at all!
GAMMA-KNIFE: no knife here either!
CHEMO: shorten for chemotherapy

Some of the sites I have used as a reference are:

Words have great power and carry the experiences or the lack of them. Each of these terms carry with them no less.

No matter who you are my advice is when it doubt don’t assume, check it out. The caveat is to be sure you do your research using well recognized sites. The internet is an amazing tool but also can increase confusion without a discerning filter.

Regardless, ASK ASK ASK your medical professionals for explanation and sites they might recommend. I suggest you ask specifically what the test ordered is, why it is ordered, and what might be any risks. This may begin the dialog with your medical professionals so that you have the sense you are all on one team.

Oh, BTW I remembered I have to make the annual call for myself.

Friday, February 10, 2012

New Patient Discussion:
From my patient’s experiences

Many patients who become admitted to the oncology floors where I round remark to me that they have “never been sick” before this. If they had been in a hospital before they may have had a repairable cause such as appendicitis, a broken bone or even a cardiac issue. Now they have within a matter of days gone from having been ignorant of a cancer growing within them to being here in the hospital. Many are frightened, using words that are akin to a battle cry, and ignorant of what will come in the year ahead.

My first visit is a time for my patient and their supporters to meet me. In my first blog post I brought up the hurdles that need to be faced for me to even know if my presence might be a part of their coping while here. I find it rare when I can’t find a common ground to at least be able to share why I may become a part of their support team as well if they want to page me. If I am welcomed I ask a lot of questions to listen for what may be of help to the patient, their family and friends.

The following is a short list of ideas that I have found helpful from my patients perspectives and their experience:
  • Bring an inexpensive notebook with you and a roll of tape. Most of the medical professionals who you will meet will hand you a business card. As you tape them into your notebook leave room to make notes. You may get a telephone number not listed on a card. You may want to remember an associate’s name who didn’t hand you a card. This is an easy way to keep a concise reference of your medical team.
  • If you are the type of person who feels less anxious with having the most data, have a notebook with pockets or loose-leaf binder. If you keep copies of test results [not a necessary thing but if this is your personality] you will be able to have them in chronological order.
  • ASK EVERY QUESTION and if you think of one when the medical team isn’t in your room write it down. Stress, no less feeling ill, may cause you to forget in the time the team is with you. Leave room again for a written answer if you think you may forget. 
  • Pain and nausea are like a freight train. They take more to stop them once they are zooming down the track than if the brakes were applied early on. Patients have told me they actually use less medications if they start earlier with these symptoms. Not every patient has them but those who did said early interventions helped them.
  • If you are a family member remember your loved one will worry about YOU as they lay in the hospital bed. You actually will care for them by taking care of yourself. Don’t drive after dark if you aren’t comfortable. Sleep the night at home if you can. Eat healthy foods in smaller quantities if your own appetite has disappeared. 
  • Say yes to friends who offer to help. The satisfaction that you may have experienced in the past of helping one of your own friends will be the same for them. If you allow them to shop, cook, run errands etc then you can save your own limited energy for yourself and your family member in the hospital.
  • Consider a phone chain to help relieve the story and fact telling every moment you are not sitting my your loved ones bedside. People care but the retelling can be exhausting. A phone chain can be helpful Another resource many of my patients use is a site:  It’s a confidential and fairly easy website to set up where you can post any or all information you want your friends and colleagues to know. They may also leave you messages. Many of my patients have exclaimed that even if they don’t post they can read the messages that were left for them.
  • Set visitation time boundaries. Being in the hospital is not a time for everyone to visit. You are a captive audience and too many times there are too many visits that are too long as well. Be honest and tell people that you already have had too many today but then tell them when they could visit. Set a time limit. If you are feeling up to 20 minutes vs. 10 then you have the option rather than the visitor staying for 60 when you were falling back to sleep after 10. 
  • Always ask for what you need from the medical staff. Don’t assume anything. Ask for what you want too!! You’d be surprised how accommodating the staff can be if it doesn’t conflict with your treatments. In another hospital it was an underground fact that patients could get a milkshake if they only knew to ask. I admit I told many a patients about that. 
  • Forget the statistics!! The doctors are treating you with therapies they believe will make a difference. Statistics are good for the doctors to choose a treatment but I suggest you believe you are in the cure % unless they tell you otherwise. It's not a perspective of being an ostrich but one of grounded hope.
There are times when there are no clear answers, questions cannot be formulated, and there are no words. Those are also times to ask for me to sit beside you. Tell me, your Chaplain, what you are thinking, questioning, fearing and also celebrating. I am here to be an experienced listening presence as well as a practical resource.

Saturday, February 4, 2012

The Art and Science of Medicine. Ya Gotta Have Heart!

It was the beginning of the academic year in 2011 here in New Jersey. The first year medical students sat with enthusiasm and anticipation listening to the lecturer.  Each student came to learn medicine and eventually choose a specialty practice. Each student had passed a rigorous battery of tests and interviews to become accepted to medical school.  Their extensive academic journey began.

One of the opportunities I enjoy most is to offer lectures and short workshops for medical students and physicians. While the medical school and all of the clinical work fills them with tremendous knowledge about the science of medicine not every one is afforded the opportunity to learn the art of medicine. I am heartened to know this tide is turning.

Before what we now call modern medicine was practiced doctors, healers, etc. used what they had at hand to help the symptoms of illness or pain.  Before antibiotics were commonplace infection often was the cause of death rather than the injury or illness itself. So many works of art portray the doctor sitting by the patient’s bedside. The doctor was summoned to CARE for the patient. The community healer came with their limited poultices, balms and tinctures. In the end they sat at the bedside and attended the person’s death. Before they left the home they comforted the family the best they could.  When the medicine could not heal, the healer became the medicine caring for the patient and family.

I’d like to define the terms of science and art from my perspective.

The science of medicine is FACT based. Much like mathematics the science is either proven or unproven. It is reproducible fact. Clinical trials as an example prove that a new chemotherapy, for instance, has efficacy or not before it becomes an acceptable practice for use. I see doctors learn the science of medicine much like mathematical formulas. If X is true than Y+Z= R.

The art of medicine looks at the same formula. If X is true than Y+Z= R.  However, what happens when X is true and Y+Z= R. but no R can be found? The questions then begin. Why no R? Is there a new formula possible that we didn’t know before? What other factors other than X, Y, & Z did we not consider? What else is involved or missing? What’s their instinct pushing them towards considering? Their training informs “the gut” while searching.

The art of medicine is also the acknowledgement of humanity and the complex emotions of living, limitation and illness.  It also is the journeying in life with a person as they move closer to their end and eventual death.

I once heard someone say the two greatest fears of a patient are intractable pain and abandonment by their doctor if there isn’t any cure.  Pain is controllable now with a myriad of medications, combinations and delivery systems.

For a patient to trust that regardless of outcome, the physician truly cares and will journey with them until there no longer is life to me is the epitome of the healing art of medicine. The physician’s presence alone may become the healing that brought them to the practice of medicine.

The new classes of doctors who are graduating are being asked to never forget listen to their patient’s life narrative as they apply the science of medicine. Someday these doctors will be at my bedside and I am grateful the old/new art is flourishing.