Friday, October 1, 2010

Palliative Care Inpatient Rounds at KGH June 27 2008

Today I accompanied Dr. Schroder to visit 3 patients in the morning.  All of these were near the final stages of life.  The first was alone, and seemed to be in quiet prayer when we arrived.  The doctor thought he was asleep, but he opened his eyes without trouble once he sensed our presence.  A feeling of peace was in the room.  The doctor talked with him for a few minutes to find out how he was doing.  As most rooms in the hospital have more than one patient I felt somewhat torn upon passing others by, as though my cursory glance or nod of greeting were insufficient for these poor suffering souls.
Our second patient was asleep, but his wife was present.  She seemed to have faced the reality of her spouse’s impending death with calm and reserve.  When asked whether the family had any church affiliations, or whether they would wish a referral to spiritual care, she responded ‘no’.  In my heart I said a prayer for the patient.
Our third patient revealed a human touch.  There was a slight smell in the room, which I associated with the commode which had not yet been emptied by staff.  The patient’s wife asked if someone could come by and clip his toenails, as she was not able to.  I sensed at once the frailty and dignity of this family.  The wife stated with some nostalgia how just a short time ago, her husband had been such a strong and vibrant man.  She noted how his multitude of problems had come all at once, as though unbidden.
During lunch the Palliative Care team had a seminar on how to care for vulnerable patients who wished to travel.  A nurse expressed dismay at those who acted in a manner she thought irresponsible for those with a terminal illness.   A patient of hers, upon seeing a magazine fall open to a page on the silk road, had flown overseas and climbed Asian mountains to her heart’s content, bringing home silk from which she made a purse for the nurse.  She died shortly thereafter.  Someone remarked about how dying wishes often included extravagant travel plans.  It seems that some of those with families overseas made long and arduous treks to say farewell, while others struggled to perform pilgrimage rites.
In the afternoon I accompanied a nurse, Cathy, to see a new referral to Palliative Care.  Although it was felt that the patient was not immediately at death’s door, her attending physician thought that she lacked the supports she needed to make decisions about impending end-of-life care.   Cathy, on the other hand, thought the patient had sufficient assistance from the family to help her through.  One point which troubled me somewhat during this encounter was the patient’s denial of any religious affiliation.  She did not appear to be far from the Lord’s peace, however, a point of grace which reminds me of Rahner’s exposition on implicit versus explicit faith.  Perhaps for many, God is, after all, a private affair.
I returned home to my wife, exhausted physically and drained emotionally.  Paradoxically I am full of hope and wonder at our child, who is to be born in the Fall.  To see the stages of life so juxtaposed makes one sit up a little, in contemplation of God’s ongoing work in the world and in His children.

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