Sunday, October 16, 2005

Back! Red of face but happy...

Individual supervision is oh so helpful. I got to see that I had *asked* for negative feedback on my verbatim, though not altogether consciously... had basically asked the group to enact my negative internal voice... and then taken the negative feedback as the *only* feedback I received. This chaplaincy stuff is so fascinating, so compelling to me--and, in my life, I am used to loving something only to lose it, so I set myself up to do exactly that. My supervisor says that a number of positive things were said, and to be honest I cannot remember a one of them! Such is the power of the negative internal voice. I have to say I was pretty mortified when we sorted the situation through. Supervisor, however, is unfazed. Apparently this is part of the plan.

So I am back to loving CPE. And enjoying my placement again. After a horrifically busy couple of weeks, things on the unit slowed down the latter part of this week. It would be great for the staff, who have been working their fingers to the bone, to have a week to catch their breath and regroup a little before the next busy time hits. Even I was tired and I am only there part-time.

Each family is different, hell, each PERSON is different. I have been thinking about how even the symbolic understanding of death is individual, to say nothing of relationship to the patient, level of concurrent stress, grieving style, etc., etc. It is amazing that families pull together as well as they do to support each other and the patients through an experience that is truly different for every person involved.

It is sometimes heartbreakingly sad for me to see patients with terminal diagnoses that relate to a lifetime of addiction. I have now seen end-stage liver disease, and it can be awful. It would have taken my parents eventually had other things not claimed them first. Some of the patients are aware of the link between their addiction and their current situation, but others come in so late in the process that most awareness is gone--and families have to cope, sometimes with horrific deaths despite every effort to keep patients comfortable. I think sometimes a patient's final illness and death can be a mirror to the family of a shared addictive process, but the denial can also be extreme. That's how it was in our family, anyway. My mother drank along with her seizure medication, which made her seizure disorder impossible to control. I, as a child, could not confront her about her drinking, although I tried unsuccessfully. She lied to all her doctors, and my father, who drank with her in the evenings, could not comprehend how seriously ill she was in any case. My father's alcoholism worsened sharply after my mother's death, though it was an MI that took him. I remember, at the funeral home, being offered the chance to see him one last time before the casket was closed. I stood, looking at the ravaged body, shaking my head. ANGRY. Angry at all the waste. As a chaplain, I can sometimes see the forces in a patient's life that make the addictive process attractive, maybe even insuperable. With my own parents I think I still don't have enough distance to see a "bigger picture." Which is one reason why one cannot be a chaplain to one's own family!

End-stage liver disease is the pits. Avoid if you can. End-stage COPD is not great either. Actually, few things are. Probably the easiest for the patient is to have a huge, sudden heart attack or stroke, and have a loving, heroic family that is willing to forego heroic treatment and just let the hospice staff keep the patient comfortable and let the dying process proceed. I say "heroic" because making that choice when the massive illness hits with no warning is terribly difficult. Making the choice to decline life support goes against the natural tendency of loved ones to grasp at hope, any hope, that the situation can be reversed.

That's all for now. Do your advanced directives, and avoid end-stage liver disease. And keep praying for me if you have any to spare! So much to learn...


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