Lucy was gorked out—asleep or unconscious—when I was moved into our shared room. Lucy is old and small, Italian and Catholic. Today is our sixth day together, although we have virtually never spoken. I’ve made a few overtures to Lucy and her family but there has been little response so I have let it slide. Lucy is in the bed by the door; I’m by the window. We are about eight feet apart; I cannot help but hear the conversations on her side of the curtain. I am a witness, not a participant. And what I am hearing is making me bloody pissed off.
Lucy is dying and the hospital staff is botching the job of helping her do it.
As far as I can tell, Lucy’s main problem is her heart is going. This is her fourth successive hospitalization in recent times. Her blood pressure, which should be around 120/70, has dropped as low as 80/36. I did not know a person could live with a blood pressure that low. This morning she was put on the bedside commode; consequently, she went into respiratory crisis with an oxygen level of 84. It should be around 95.
It took me about two days to understand that Lucy is dying. The medical staff and her family are irrational and inconsistent about accepting it. Her church has utterly failed to acknowledge it. Lucy and her family are devout Catholics. Because this is St. Joseph’s Hospital, and Lucy is a Catholic, she is on the short list for chaplain services. That means that every morning someone comes and gives her communion. Because I am not Catholic, I am not on the short list for pastoral care. In a week, I have had one visit from a Catholic person who said she served “protestant Christians, too.” There is no protestant chaplain in this hospital, and the shame lies on the protestant church.
Lucy’s chaplain care consists solely of two minutes for communion. No one has sat with her to talk or to pray. Lucy is going to God. Don’t you think it would be nice if somebody talked to her about that? Where the hell is her home-church priest? Lucy is no Christmas-and-Easter Christian; she’s a good Catholic. Why hasn’t her own priest gotten his butt in here to finish his service to her? And why hasn’t the hospital priest done it?
The message should be one of comfort and strength: It’s okay, Lucy. God is with you, and will be with you every moment when things are hard. You have been faithful to God; God will continue with you. It’s okay to let go and let God carry you where he will, when he will.”
Instead, this morning the jackass nurse du jour was instructing Lucy in what she needed to do to build her physical strength. I’d had enough of the crap and said quietly and firmly from my side of the curtain, “She’s in Hospice care.”
The nurse replied, “But even in Hospice you can work to keep a positive attitude.” Maybe, or maybe not, but the nurse was not working on attitude: she was working on strength training, and lying about it. She wants Lucy to get out of bed and start doing deep knee bends (which might not be a bad idea because it would immediately put her out of her misery). This nurse’s goal is recovery, which isn’t going to happen. Therefore, it is unreasonable and inappropriate to lay that expectation on Lucy. In my mom’s last two years, she’d say, sadly and with effort, “I suppose I should try . . .” and I would reply, “It’s okay, Mom. You’ve worked hard all your life. It’s okay to rest now. You don’t have to do anything you don’t feel like doing.”
Because of the shortage on this floor, this morning’s nurse has been borrowed from another floor. She’s never before laid eyes or hands on Lucy, and this is one of the problems: nursing is not consistently passing the message. Some nurses are kind and don’t hassle Lucy, others set too-high standards for Lucy to reach, and then she crashes and the nurses go into crisis mode. When Hospice care is in place, then the in-hospital nurses should be Hospice nurses, not the random brand-X nurse.
The two regular crisis precipitants for Lucy are eating and evacuating. All she really feels like eating are mashed potatoes and gravy, and ice cream. The unit kitchen stocks ice cream so she can get that pretty easily and frequently, but the hospital kitchen—babe, if you want to observe dysfunction in action, come visit St. Joe’s Dietary Dept. So Lucy is repeatedly getting trays loaded with food she doesn’t want and can’t eat, and she’s going into crisis trying to digest what is sent. I got the card telling me to call Dietary every morning for my day’s requests. Lucy is way past the point of being able to do that. Her family apparently has never been told about it. Only one nurse has tried to do it for her on one day; you have to call every day.
Lucy cannot get to the bathroom so she variously uses a bedside commode, a bedpan, or evacuates in her bed. A couple days ago one of her daughter’s was here when the nurse was wiping Lucy’s bottom after using the commode. Lucy is to go home to this daughter’s house. The daughter, in a tightly controlled gasp, wonders aloud why her mother can’t clean herself. Daughter has not got a clue as to the level of care her mother will need at home. She isn’t seeing it, and the nursing staff isn’t showing it to her.
The nursing staff is inconsistent in their expectations, and is not doing a good job in communicating reality to the family. The nursing staff is unable to focus on comfort, as opposed to treatment. The family doesn’t get it. Lucy got a bladder infection, the doctor started treating it, and the discharge planning continued. The other daughter said in outrage, “How can they discharge you with a bladder infection?” Babe, it’s called dying. They don’t cure you so you can go home to die.
Yesterday (or the day before, one is never entirely sure about the passage of time in a hospital) the doctor came in and gave orders to remove the IV, the catheter, and so forth. As each thing that bound Lucy to life was removed, there was a visceral sense of relief. Since the first day I moved in, Lucy has been telling people that she’s dying, or that she won’t be around much longer. She knew. She was ready. The doctors, the church and the family were dragging way behind the patient.
We have done such an effective job of separating church and state that Medicare will not pay for in-hospital chaplains. They should. The facts are that something like one-third of Medicare costs are incurred during the patient’s last thirty to ninety days of life. One-third! We are looking to doctors to save us and ultimately they cannot. Jesus saves. It is no longer about the body, which cannot possibly survive; it is about the spirit.
Lucy’s daughter tells me that she has not been receiving appropriate spiritual care because there aren’t enough pastors. There aren’t enough pastors because the churches don’t have enough money to pay them. If patients had the support of spiritual care then they would make different decisions than when they have to continually fight against the aggressiveness of doctors prescribing medical treatment.
Either let the government pay for spiritual care in hospitals, or make weekly spiritual classes mandatory for physicians. If you are refering the patient out to God, then have a specialist in place to handle the transition.