8.45 I arrived at work today having negotiated the problems of the buses through town. Thankfully, I have 15 minutes to review patients and check emails before handover.
9.00 Ward handover is our key meeting, where our multi-disciplinary team meet to discuss the needs of our patients today. We have 17/18 beds occupied. A patient died during the night. We are all reassured to hear that her husband was with her and that everything was very gentle. Her husband had received a lot of support from Chaplaincy and an on-call chaplain was called in the night to say last prayers. Another patient admitted yesterday afternoon is suffering from existential distress. Please could I pop my head around the door and see if she would value support from Chaplaincy?
9.30 Back to our office to plan the rest of the day. There is a knock at the door. One of our nurses has been talking to a patient who has formerly said they didn’t need chaplaincy support but is in a state of deep spiritual stress. She is saying things like, “I must be a really bad person for this to happen to me.” I agree to see the patient later on.
10.00 Arrive at the training suite in the Churchill to teach an On-Care Certificate Course. My subject as always is spiritual care at the end of life.
11.10 Our patient, Karen, is in her 50s. I gently introduce myself. She says very quietly, “I’m not religious you know, you won’t get me into your church.” I respond by saying it’s not my job and anyway, if I tried, I’d get the sack. She laughs and shares with me her deep sense of spiritual pain. She is too young to die. She wants to see her grandchildren as yet not born. She feels that it is deeply unfair. We explore her feeling that “she must be a bad person” to have a disease like this. She makes some observations about the “Christian view of God” which are very negative. She asks me what kind of God I believe in. I respond, “a loving God who feels the pain of our situation as much as we do.” She ponders that for a while and we talk about what gives her joy. As she talks she lifts. She says to me, “actually I have had a good life I am just cross that it is ending.” She is quiet for a long time. I don’t interrupt that quietness. She is processing things deep within herself. After about five minutes she asks me to come back tomorrow.
11.45 Return to my office. Write up notes from attendance on Karen. Advise Nurse that I have now seen Karen.
11.55 As I’m making a cup of tea in the sitting room, a relative, Sarah, arrives. She tells me that her brother is to be discharged to a nursing home and she is conflicted. She knows it’s the best thing for him. She and his wife have struggled to care for him at home and are exhausted but she is feeling terribly guilty. I make her a cup of tea and we sit down. She has children to look after. Both she and her husband have full time jobs and she needs to return to work. I listen and reassure her that whilst it is tough, her decision is perfectly valid. She has multiple responsibilities and needs to find a balance that works for her.
12.15 Back to office. Write up notes.
12.20 My pager sounds its urgent alarm. The on-call chaplain tells me there is a patient in Renal who has just received the news that dialysis is no longer effective or viable because of the deterioration in her health. She is now moving into the end of life phase and is deeply distressed and she may well come to Sobell. I attend immediately for the consultation. She is clearly in a state of shock and very frightened. She thanks me for coming and asks me to pray for her which I do. She is a regular church goer. I offer to ring her Vicar and tell him what is going on. She is grateful.
14.00 Back to office. Write up notes. Telephone Vicar and update her on the situation. She has said she will visit later today.
14.05 The Speciality Doctor knocks on my door. She has visited our patient, Nick, who has recognised that he needs to plan a funeral. Nick has previously told me in no uncertain terms that he is an atheist and doesn’t need a chaplain. I attend, in a little fear and trepidation. As I enter the room I say to him, “Nick, I know we got off to a bad start. Let us start again letting the past be the past. My only agenda today is to help you make your funeral arrangements in whatever way is right for you.” He says, “I think I was very rude to you a few weeks ago, sorry.” I reply, ‘It may be my age but I am having difficulty remembering anyway.” We both have a smile and a laugh. I help him think through what he might like to happen at his funeral and give him a list of local undertakers. We then start to talk of other things. He is passionate about science so we talked about the big bang and quantum physics. He shakes my hand and asks if I would come again.
15.00 Lunch! I am starving. Pop into the restaurant for a quick fish and chips.
15.20 I’ve received an email from a consultant asking if I can arrange an emergency marriage for a patient who has only days to live and wants to be married before he dies. I visit the patient and discuss all of the possibilities and legal requirements.
16.00 They have decided to have a civil wedding so I put in train the paperwork that needs to happen and contact the Superintendent Registrar. Time is of the essence as for him to make a legal marriage he must have capacity which will be tested by the Registrar. The time of the marriage is agreed to be 10.00am tomorrow. The doctors write a letter to say how ill he is and how urgent the situation is. Members of our staff start planning for decorating the Chapel and sitting room. I remove all religious artefacts from sight in the Chapel to agree with the law regarding Civil Weddings. Unbeknown to bride and groom our Chef is going to bake a cake for them.
16.15 A nurse taps on my door. Our patient, Florence, has died and her family would like me to come and say last prayers. I enter the room where 8 people are gathered. Florence has a deep faith but has told me not many of her family share it. I give permission for anyone who doesn’t want to take part to leave, but they choose to stay. Before I start, I ask them to think of times when Florence was full of life, when she was fit and well and they enjoyed each other’s company. We say last prayers and the family share memories about Florence. We talk about what happens next.
16.45 I am writing up my notes and notice from my office window that an empty ambulance has arrived. This means that our patient, Ron, is going to be discharged and go to a Nursing Home close to his family home. He came here thinking he was coming to die but now his symptoms are under control - he is going out to live. I go to say farewell to him. He is very grateful for the support he has had from everyone. He says, “I’m still an atheist mind,” so I reply, “I didn’t think it would be otherwise.” He says, “May your God go with you, you have been a great help.” That was a tear jerker for me as I walked to the bus stop to brave the traffic on the journey home.
Please note that names have been changed for anonymity.