These folks are awesome

When I work shifts in a hospital, I get called to the emergency department from time to time, and I am always amazed at the work done by the emergency department unit secretaries. The job seems to be an unholy combination of middle school teacher and air traffic controller. These folks, along with the emergency department charge nurse, keep track of who is in what room, despite the fact that there is no one spot where one can see all the rooms. (There's a computer system though.) Paper is flung at them from every direction--from EMTs and paramedics bringing patients in, from nurses and doctors. Phones ring constantly. Various law enforcement agencies appear, either to deliver or pick up patients. And the unit secretaries are expected to know what is going on all over the department. Amazingly enough, they do. When the hapless chaplain shows up, the unit secretaries are always there to set me right.

I remember a night when I was called to attend a cardiac alert. The patient was being "worked up," meaning that tests were being run and results returned. The emergency physicians had reviewed results and determined that the patient needed to be taken to the "cath lab" for an angiogram and maybe an angioplasty. The unit secretary had just received and relayed the message that the cath lab was ready to treat the patient. The only thing missing appeared to be a cardiologist, which would seem rather important. I learned that night that in this particular emergency department a cardiologist is called a "card." Thus, I was between the unit secretary and the room, and the unit secretary called over to ask me, "Do we have a card yet?" I peered into the room. "There's a new guy in there," I called back. "What's he look like?" asked the secretary. "Tall, slim, dark hair worn a bit long, expensively dressed, vaguely continental, with a hint of arrogance," I called back. "Ah. That would be the card. Your clue is the hint of arrogance," said the unit secretary. That does seem to be true, and I do think it is somewhat justified, having seen coronary arteries. Anyone who can navigate and repair those little tiny things deserves to be a bit arrogant in my book.

Arrogant or otherwise, this hospital has some very fine cards. For my part my fave is the one who brought home-made tiramisu to the cardiac unit's Christmas buffet one year. You've got to love a cardiologist who enjoys something less healthy than celery. Some of them are so intense about their vocation as cardiologists that their bedside manner suffers. A family member once wondered, vaguely, if his loved one's heart attack made him more vulnerable. Unfortunately he wondered this in the presence of a particularly intense card, who spent the next ten minutes lecturing the family member about what HE would recommend and how strict he would be about diet and exercise. I was really afraid the family member would pass out before the end of the lecture. Compared to the ascetic lifestyle the cardiologist was espousing, I think I'd rather have the heart attack.

The unit secretaries know everything, though. I don't know how they do it, but they just keep going. They ought to get a raise.

Some weeks are just like that...

...or, never EVER say, even to yourself, "What ELSE can happen?"

You can tell that a shift will be intense when it begins with a call from a manager informing you of a loss the entire team needs to know about and asking you to come in and make calls and offer supportive presence. After some hours of telling the story, you begin to feel numb--you realize that you, yourself, have not had any time to react on an emotional level. That's the role, and that's normal. You know you'll have to make a space at some point. When the shift continues with a series of difficult deaths you begin to sense the dwindling of your own resources. That, too, is normal. It goes with the role of "on-call" or PRN chaplain. No one calls the chaplain because things are going SO WELL after all. By the end of a shift you can be completely drained.

I had a weekend shift like this last weekend. I had a memorial service to do the Monday immediately following, and this was for a WWII veteran. The military portion of the service took place at graveside. I had been meant to deliver a closing prayer prior to the military portion but things got turned round and I ended up at the end. Military tributes are, to me, heartbreakingly beautiful. It is hard not to tear up at "Taps." In my area, there is a group of veterans that provide tribute over and above what the armed services provide. For this deceased veteran, the U. S. Army provided three young officers for the flag folding and presentation and "Taps." The veterans provided an invocation at graveside and a 21-gun salute. The honors began as the hearse rolled to a stop, with the slow salute delivered to the casket of the deceased. It was all I could do to remain composed. The flag ceremony has such powerful emotion, contained in the precision of the ritual, the two young officers remaining impassive in face as they fold and smooth the flag. The bugler who played "Taps" was exquisite. A windy day, and the haunting last note echoed across the cemetery. The 21-gun salute by veterans not much younger than the beloved soul we were burying. The final slow salute, and retreat by the military. And now *I* am supposed to say something? I got through it somehow, and then watched as the adult grandchildren of the deceased searched through the grass for the spent shell casings from the 21-gun salute, to hold them as final mementos.

The next day, a funeral for me to attend as mourner. Got there late, the directions were confusing, the homily baffling, the family and friends mourning profoundly. As I walked through the parking lot to my car, I was thinking about this deceased, grieving the loss, worrying about the family, wondering what was in the mind of the homilist, and I tripped in a pothole and, as it happens, broke a bone in my foot.

What ELSE can happen?

Well, when I went to have the foot X-rayed, my blood pressure was running quite high. I wasn't too worried--I was stressed out and having a fair bit of pain, so it made sense.

The next day I trundled my foot off to work for another incredibly intense shift, one where a particularly beloved patient died. At the end of the shift I asked someone to take my blood pressure--quite high again. I saw my primary care provider the following day and now am making dietary changes and monitoring, but may well end up on blood pressure medicine. Alas. Genetics has caught up to me. I have just eaten a nice bowl of steamed chopped broccoli for lunch and, while I feel virtuous as all get out, I still want a nice big generic diet cola. Nope.

What ELSE can happen??

Last night's shift? Five deaths. Four new patients. The Grim Reaper must have gotten a special deal on "Incredibly Aggressive Cancers That Kill In Weeks" because we have been seeing a bunch of these, and the impact on both patients and families is overwhelming. Family members are just trying to come to terms with a loved one's diagnosis, and the next call is: Come quickly if you want to see him, he is dying...

And I always kind of rue the timing when an ambulance bringing a new patient has to park to the side because there's a mortuary van at the ambulance door.

I'm on call until Monday morning. I don't think I want to KNOW what ELSE can happen!