Verbatims from CPE

Here are the verbatims that I presented during my CP. Each student prepares written verbatims to present to the peer group for feedback. A verbatim scripts and evaluates a specific visit. In this account, you describe the nature and extent of the encounter, your assessment of the issues, problems, and the situation. You give a brief, evaluative commentary on what you did and how you believe you were able to help.
The verbatim is supposed to illuminate the relationship of the chaplain with the patient and incorporate theological and psychological reflection upon the particular situation. The supervisor and peers provides feedback on the verbatims. The verbatim requires the student to recall what happened in a ministerial encounter and to assess it from a theological, psychological, and sociological perspective. In the verbatim seminar, the input of several persons provides additional perspectives and insight into what happened as seen through the eyes of several peers and supervisor.
In CPE, verbatim dialogs are typically analyzed in a variety of ways from a variety of perspectives with a common theme: learning. The student writes what she has learned from a psychological, theological, and sociological perspective. She discusses ministry, learning, and patient needs.

Mary
Pseudonym for pt. Mary M Pt’s age and gender: 88 F
Ethnic origin: Euro-American Pseudonym for son Dan
Pseudonym for daughter Carla (not present but talked about)
Length of encounter: 30 minutes Religion/culture: Lutheran


I. Observations, Self-awareness, Care Plan
The Patient: Mary is in her bed, hands over her chest, in a still and waiting posture. The TV is off. She has—what I assume is—a tracheotomy tube coming out of her throat, capped off. She does not use this apparatus for breathing. There is a large amount of dark material surrounding the area. I am unsure what this material is—is it some sealing material, is it clotted blood? She appears thin, perhaps frail. I don’t notice her son, pseudonym Dan, sitting quietly until I have spoken to Mary.
The Chaplain: I am required to gown and glove for this visit and it’s my first time doing so. I feel physically awkward as I can’t figure out the gown easily and it’s hard to fit the sleeves over my suit jacket—they are bunching up. I choose the wrong size gloves. I’m grateful for Elizabeth’s verbatim so I know about the thumbholes. I say a little prayer—God, please bless my time with this person, one of your favorite people. Amen. I feel curious about what stories I will hear. Spiritual Care Plan: My plan is to ask open-ended questions, actively listen, affirm, and engage in mutual reflection on whatever comes to the surface in our conversation.
II. Verbatim
C1: Hello, Ms. M. My name is Nancy and I’m one of the chaplains here.
P1: Hello.
C2: I’m here to see how you are doing and if I can be helpful. Sometimes being in the hospital is lonely. Then I see the son. I can see that isn’t the case for you. Hello.
S2: Hello. I’m Dan. We exchange smiles. I look back at Mary.
C3: Is he a good son?
P3: Yes, a very good son.
C4: You must be glad that he can be with you.
P4: Yes
C5: How are you doing today?
P5: Speaking slowly as well as can be expected.
C6:Are you waiting for a procedure?
P6: Yes, I’m scheduled for surgery today at 3.00. We all three look at the clock. It is now 3.33. C7: The team must be running a little behind. I think all surgery should be scheduled at 7.00 so we don’t have time to be anxious and the team can start before I’m completely awake. Some smiles and silence. Does waiting increase your nervousness?
P7: Yes it does.
C8: What are you having done today?
P8: They are going to operate and clear my carotid artery and do some other things…[a few slightly mumbled words that I miss]. I move to the chair close by her bed as Mary is speaking softly and deliberately. Also, I don’t want her to have to turn her head in case that hurts her neck.
C9: Are you feeling nervous about the surgery? [My colleagues recommended a more open ended question here, so Mary can name her own emotions.]
P9: Yes
C10: Do you know if there is something that would help your nervousness?
Blank look from Mary
C11: Sometimes people find that more information helps ease their feelings. Some people want to talk about their fears. Some want to pray together. Some folks want me to tell distracting stories.
P11: I’d like a prayer.
C12: Ok. A moment of silence. Holy and gracious God, we are here with your beloved child, Mary. Be with her as she goes into surgery. May she fully know your healing presence. Please release her from any fears. Guide the surgeon, the doctors and nurses, and all the people who care for her. Let all of us, who care for her, do what is best for her and her healing. We also ask for support and comfort for her family and friends, for those who love her that they may continue care for her as they care for themselves. We pray this in the name of the Father, the Son, and the Holy Spirit. Amen. We remained silent for a bit. It was wonderful to pray for you as a beloved child of God.
P12: A child of 88 years. We share smiles.
C13: Yes, and still beloved by God. Silence. Where will you go when you are discharged from the hospital?
P13: I live at Viva Assisted Living.
We share evaluations of assisted living and I report my mom’s experience. It is a positive experience for Mary. We talk about the restrictions that come with aging. After another spot of silence.
P14: My husband has Alzheimer’s.
C14: That must be difficult. How is he handling your hospitalization?
P15: He’s at …[I can’t remember the name of the care facility]. The daughter-in-law arrives. She’s just taken Mary’s husband to his care center. Mary introduces her as her daughter-in-law but without a name. I ask if there are other children. There is a daughter, Carla. The daughter-in-law joins in the conversation. The family reports about how the husband is doing with Mary’s hospitalization, which is generally positive.
C16: Alzheimer’s can be such a long good-bye. I’m sorry for your loss. [My colleagues recommend a less direct statement, again allowing Mary to name/describe her own experience.]
P16: Thank you. It is a loss.
C17: I’m learning that part of having a mature faith is working with both loss and limitations. She nods. Do you have advice for me on how to deal with the limitations? The losses?
P17: I adjust. I accept them as best I can and then I adjust my expectations. I try to depend on God.
C18: How does that work for you?
P18: Most of the times, it is okay. God helps me endure.
C19: It sounds like you and God talk a lot and you often feel God’s presence. Mary nods with a small smile.
C20: The surgery prep team arrives and I step out with the adult children. Before I go, I touch Mary’s foot and say, God bless you. I can see you tomorrow if you would like.
P20: Yes, please come.

The son and daughter in law stand with me in the hall. They tell their mother they love her and will be with her after surgery. She says I love you too. Mary is taken down the hall. The son turns to me and asks me to come back tomorrow and talk with his mom. I say I will.
S21: I want you to talk to my mom about my sister Carla. She wants to sue my parents because she’s unhappy about what they’ve done for her.
C21: My jaw drops. I didn’t know we could sue our parents. I’m thinking—wow, I never thought of that!
S22: Well, it upsets my mother and maybe she would talk to you about her.
D22: She worries so much. It’s ruining her health. She worries so much. I told her the surgery would also remover her worrywart so she won’t be able to worry anymore. She laughs.
C22: Are you the older perfect brother? [My colleagues thought this was confronting rather than reflective. I was wondering if the brother was tattling on the younger sister.]
S23: Yes, I try to be a good son. Big smile of recognition.
C23: Well if you are the good kid, the good older brother, as a younger sister, I might decide to be the bad kid because you had the good role all sewed up.
D23: It’s more than that. The son-in-law came to visit mom here and said, ‘Carla wouldn’t hate you so much if you would do this for her, and this for her, and this.’
C24: Carla’s husband came here and said this? I’m sure my shock is showing.
D 24: Yes, just last night.
C25: I shake my head in disapproval. Well, I will visit you mother tomorrow afternoon. I’m sorry the relationship with Carla is so difficult. She must feel horribly empty and never able to get enough. They nod yes and then leave to accompany Mary and go to surgery waiting room.

III. Dynamics/Identifications
The conversation with Mary was calm, quiet, and felt connected. I felt strong undercurrents in her short answers and look forward to asking more questions, to learning more of her story. Whatever her status as a ‘worried’ is, she seemed solid and content or self-accepting when we talked. Perhaps she was under the influence of pre-surgery drugs. The request from her son and daughter-in-law to discuss the sister Carla’s behavior with Mary and the description of her actions really shocked me. Did that request come from the son’s perception that Mary and I connected and/or the need to enlist someone to come to his mother’s aid, the chaplain cloak, or something else entirely. It seemed out of context.

IV. Self Evaluation
Our simple conversation felt like a concentrated life review. I think I provided Mary with a sense of affirmation. I sensed a peace in Mary and I tried to reflect that back to her and to acknowledge her fears. I also tried to acknowledge that peace and anxiety could coexist and often do in acute circumstances. Writing up this verbatim has allowed me to consider that the calmness might be drug induced which I hadn’t considered before.
With the son’s request at the end of the visit, I found myself wanting to come to Mary’s defense. I’m outraged on Mary’s behalf and I want to put up signs that Carla and her spouse couldn’t come to visit and perhaps they are the ones who need a good talking to! These are signs that I’m at risk to turning into the Defender against Bullies, a modus operandi that I now avoid when I can see it coming. After taking a moment to turn off that mo, I see that I have such scant information no evaluation about Carla or son Dan is possible. So I leave that one with God. This reflection wasn’t possible during the short face-time with the son and daughter in law.

V. Ethical/Social Justice Issues
Access to health care for those with Alzheimer’s and other illness that requires significant full time and skilled care is an economic and justice issue for us starting with my generation. As Boomers are living longer we need more assisted-living residences, memory care facilities, etc. and all at affordable access.

VI. Spiritual/philosophical/theological reflection
There’s an old song, Lonesome Valley with the lyrics—You’ve gotta walk that lonesome valley, You’ve gotta walk it by yourself, Nobody else can walk it for you, You’ve gotta walk it by yourself which I think describes the experience of maturing. This connects and contrasts with the experience of the presence of the Holy that prevents us from being alone or abandoned illustrated in the Rogers and Hammerstein lyrics—Walk on walk on with hope in your heart, And you'll never walk alone, You'll never walk alone. Both are true and this parabolic understanding of the human condition and our relationship with God is a core concept in my theology. This encounter also fed my belief that presence—being together—is somehow the point and can make a difference in people’s lives even though I don’t understand how. This is a possible miracle.
VII. Requests:
I was gobsmacked by the son Dan’s revelation and request at the end of this encounter. How else might I have responded?
How much of our own responses should we hide or filter? The shock of the son-in-law’s reported statements must have shown along with my disapproval. I didn’t say, ‘Oh my God, that’s horrible’ but I’m sure that was on my face.

1 comment:

  1. Thanks for writing this up...many are the puzzles of our lives...

    ReplyDelete