Month: April 2019

NEXT OF KIN?

The patient in ICU is apparently not married. A woman by the name of Martha is at bedside and said she is his girlfriend, of two years. As a Chaplain my next step is to let the staff know about “Rose” the sister. I’m so blessed to work with some awesome Doctor’s and Nurse’s. As a Chaplain you are part of the medical team. So, do not be afraid to communicate.

After talking to the Doctor of record for the patient, he asked me to contact the sister, and see if she would come in. He is concerned about some of the results that have come back and would like to talk to the family.

NOTE: Number one rule: A Chaplain cannot diagnose; we cannot say what happened. We cannot say test results are a concern. Calling a family member can be difficult if you do not feel comfortable have the RN call. Always follow your hospital policies.

I was able to talk with Rose who said she lived about 2 hours away. She would be there as soon as she could. I noted that I spoke with the sister and when we might expect her in the chart. I told the RN and informed the Doctor and he told me he would call me when she got there. With other patients to see you move on.

One of the most important things is legitimate next of kin. I can’t emphasize this enough. The bible tells us a man will marry and become one. Legally (medically) that little piece of paper means, one can speak for the other, unless one or sometimes both are deemed to be non-decisional. You might often see this in married couple where one has Alzheimer’s. One other way is that if the spouse chooses a different POA and completes a power of attorney form (POA) naming someone other than a spouse. Or, a surrogate can be completed at the hospital by the Doctor. If there is no legal spouse then the next of kin goes to Mother and/or Father followed by the siblings, oldest first moving down the line. EVERYONE should fill out these forms. You can print them on line. They are truly one of the most important things you can do for your loved ones. (Perhaps later I will talk more about these forms) This is a must, for a hospital Chaplain this is something we deal a great deal with daily. I digress.

As a Chaplain, you must listen to the Spirit. More times then I can count, I have gotten a heads up, gut feeling, that something is not going to work out well. The Lord will always put you were you need to be. Is this one of those cases?

Family

Serving as a Hospital Chaplain is often challenging. Family, friends, in-laws, out laws, cousin’s, can often prevent the treatment the patient wants. Which can move the Chaplains role into a referee, an investigator, and sometimes sadly, the bearer of bad news. So, for any of those interested in this career you must have two skills sets, the ability to listen and the ability to listen to what is not being said. Let’s do a little case study.

NOTE: these case studies are fictional these are for example only and the things a Chaplain may deal with as a Hospital Chaplain.

Case study: The Chaplain has been called to the ICU and given a quick report by the RN. The patient, a 40-year-old male was brought by ambulance with respiratory issues. The patient is not married. The girlfriend came home, and the ambulance was there. Patient was in respiratory distress. The ER Doctor consulted the critical care Doctors. Patient was emergently intubated and place in the intensive care unit (ICU). The girl friend is at bedside.

NOTE: when using Pt that is medically used and means patient.

The investigator: In the RN report, I heard three things that should catch a Chaplains attention. Pt is young, Pt has a girlfriend at bedside. Pt is currently unable to make decisions for himself. Pt is intubated and on medications to keep him sedated.

Some Chaplains may go right in and talk with the girlfriend. I personally like to review the chart if possible. Reading the ER notes can tell you what was found by the paramedics and what happened in the ER. Having listened to the RN I begin to look for why this Pt came in in respiratory distress and is now intubated. Are there family? Has Pt been here before?

The ER notes tell me Pt girlfriend had returned home from shopping and the ambulance was there. She stated that, Pt has been sick for several weeks with a cold. They were treating it with over the counter drugs. She knows of no medical issues or any medications he takes. Paramedics noted that a friend had called, and he was at the home when they arrived. So, who and where is the friend that had called the ambulance? The ER notes also mention that preliminary lab testing show drugs and alcohol are in Pt system. There are no family members listed, only the girlfriend and no previous visits to this hospital are noted.

So, now it’s time to listen to the girlfriend’s story. I will write my encounter just as I would when I am putting them into the chart notes.

Writer was consulted for spiritual care: Pt was brought to ER from home found to be in respiratory distress and intubated now in ICU writer explained to women at bedside I was the Chaplain. She is small tearful, who said her name was Martha. She told writer she is Pt girlfriend of 2 years. Writer asked what had happened. She did not know. She had been out shopping and when she came home there was an ambulance in the driveway. She began to cry. Writer asked if Pt had been ill? Pt had a cold and was taking over the counter medications for several weeks. Writer asked if Pt had any other family members or friends coming? She replied that he has a mother who lives out of state and several sisters and brothers. She did not know much about his father. Writer asked if she had contacted his family to let them know he was here. She has one of his sister’s numbers but has never talked with any of the other family. Writer asked if she would contact the sister. She became very quiet and said she does not get along with his family. Writer asked if we could contact her. She nodded yes and gave writer the phone number and name. Writer asked if she and Pt belonged to any church in the area and she replied no. Writer asked if she would like me to say a prayer and she tearfully said yes. Writer said a prayer and gave much support. Writer also asked if she knew if anyone was at the house with him. She shook her head no and said he was alone when she left. Below is the name and number of the sister.

Rose 234-2222 Pt sister.