St. Luke and a Tale of Two Nurses

Today the litugical churches celebrate the feast of St. Luke, who, according to tradition, wrote the third canonical gospel, and who was believed to be a physician by trade. Therefore, it seemed appropriate to attempt a little bit of writing that reflects on my recent medical emergency and experiences of health care, and what the church might take from that experience to improve its pastoral practice. So, please bear with inept non-dominant hand typing and a bit of brain fog.

Luke’s gospel emphasizes physical healing and wellbeing, and seems (to me at least) to give women a more prominent role than the others. The line between spiritual and physical aspects of the person are somewhere between blurry and non existent, and it is at least partly for this reason Luke is sometimes called “the beloved physician.” Technical knowledge of the body, and the recognition that physical health is linked with the wellbeing of mind and spirit, seems to be (to me) at the heart of good medical care–and pastoral practice as well.

I broke my right wrist at about 9:30 p.m.on 3 October. I was diagnosed at an urgent care facility that night, and went for follow up (but not definitive) treatment at the ECMC emergency room the following day. This is the same hospital where I was taken when I broke my knee in January 2013, and was positively impressed with the quality of care I received there–both clinically and from the standpoint of feeling like I was a valued human being.

While I was in the emergency room on the 4th, we scheduled the surgery to repair my broken wrist. (I even got the same ortho trauma surgeon who fixed my knee. He must think I’m stalking him.) Monday the 6th of October was the day we selected–sooner was better than later, because of extreme pain, and the possibilty of bones starting to come togethether incorrectly. So, with the help of family, I duly appeared at the ECMC outpatient surgical clinic.

Time seems to go very slowly when you’re in pain. My operation took about 90 minutes, and I was wheeled into recovery around 3:30 p.m. I felt as though I came out of the anaesthetic not with pain, but because of pain. I tried to get a nurse to help, and was told that I would feel better if (a) I elevated my arm, and (b) I would stop crying and breathe deeply from the oxygen coming through the nasal canula. There were twwo problems with that. I had nothing with or on which to elevate my arm. I did ask for, and eventually got) a stack of blankets to rest my arm on.

But the second instruction was more problematic. My eyes were watering and my nose was running because of the pain, and the canula kept clogging. I told the nurse this several times, and it took a few requests before I convinced her that at least some tissues so I could blow my nose might be helpful.

I was getting the impression that the nurse assigned to my case viewed me as an inconvenience, and things began to turn around when another nurse took over my care. (I don’t think it was a shift change, as the first nurse was still there.) It seemed that my needs were being addressed more promptly, and that more effort was given to getting the pain under control. I left the hospital around 6: 30 that evening to go home and start my journey to recovery. My follow up appointment had been set for the 22nd.

When I had the hardware removed from my knee, a quality assurance nurse phoned a few days later to follow up and see how I was doing, and ask a few questions about my experience as a patient at ECMC. So, I was not terribly surprised when I got a similar call a few days ago. What did surprise me was how seriously my concerns were taken about not receiving the same level of excellent care I had for my prior surgeries at this hospital.

More surprising was that an hour later, the phone rang a second time; this was the surgical nursing manager, who really wanted to hear more about my experience. I was clear thatI was not looking to get anyone written up or fired, but that I was surprised not to get the same level of personal concern that marked my previous procedures at ECMC. The nursing manager assured me that Nurse #1 was not only a skilled and experienced professional, but normally a strong and vocal patient advocate. I agreed that something must have been “off”. We went over the logs–I was getting a lot of pharmaceutical support, but it still wasn’t controlling the pain.

Nurse #2 did nothing clinically differently–continued medication and monitoring. So what was so different? With the second nurse, I felt I was being heard, understood, cared for. I asked for a blanket, I got a blanket. She brought ice chips, lip salve, juice. She explained what was being done to manage my pain, and what might be tried next.

I don’t know what was going on with my first nurse. The nursing manager said that the pain I experienced was anticipated even before I left the operating room, and medication for it had started before I was sent to recovery. And it was a lot of medication. And it wasn’t working.

I may have been the fourth or fifth patient she had that day with severe and unmanageable pain. She may have been dealing with a difficult situation in her personal life. She may have been doing everything clnically right. But something was getting in the way of really providing care to a hurt, helpless, scared person attached to tubes and wires.

I’m ordinarily sensitive to tone of voice, facial expression, posture–and much more so when my intellectual faculties are suppressed. (And hearing the composition of the drug cocktail I had received, that was definitely the case.)Something nonverbal was really coming through that was telling me I was more trouble than she wanted.

And I am sure she did not intend to give that impression. I’ve known a lot of nurses, and I’ve never met one who would consciously want to leave a patient feeling s/he had received anything other than excellent technical care and personal concern. But I can see how various circumstances might combine to make it happen anyway.

I’m thankful–and impressed–that ECMC has a system in place for a third party such as a nursing manager to ask a patient about their experience, and to convey any concerns or areas for improvement to the staff who may need to hear that information. That third party wants the best outcome for everyone concerned, and in this situation, the outcome is the same: a hospital experience that treats the whole person well and gets the healing process in motion. (Full disclosure: my prior experiences at ECMC were so good I wrote thank you letters to the surgical staff. I’m not a difficult-to-please patient.)

St. Luke would approve of ECMC’s approach to whole-person care.

What could the churches learn from this? That’s always a worthwhile question, by the way.

It would be no bad thing to do reasonably regular ministry reviews. This would probably need a person from outside a congregation to come in and get a “view from the pew”, properly anonymize findings, and let a minister know how his/her ministry looks and feels to those on the receiving end. A conversation with the bishop or other local area official might help identify areas of excellence and things that need improvement. It might also help identify opportunities for collaborative working so ministers could play to their strengths better.

In the midst of all the turmoil at General Theological Seminary, the Episcopal Church at least should be looking at longer term questions about what seminary should provide–and getting the balance of theory and practice right, alongside with more attention to identifying situations on their way to going wrong and how to get things back on track.

It may also mean that lay people will have to look at a different model–instead of being proprietary about “our minister”, accepting an “on call” system by which a crisis can be dealt with by any duly authorized minister. (I needed a functional and caring nurse, and that was not necessarily ‘my’ nurse.)

Probably most pastoral mis-steps happen not because a minister is lazy or uncaring, but because s/he “unselfishly” takes one more call, one more meeting, one more visit than was wise–and the person on the receiving end of this ministry is not well served.

But who could tell their pastor “my needs aren’t met?” What governing body could conduct an unbiased review of a pastor they hired, and not create an adversarial situation between the pastor, congregants, and baord? We need that third party who wants good outcomes for everyone concerned.

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