Saturday, June 7, 2008

So How Is CPE Going?

As I began this first week of involvement with the CPE program our Regional Trauma Center , I entered the program with excitement for the learning and the meeting of new people. I also was anxious about what participation in group would be like given some of the “war stories” others had shared with me. I was concerned about remembering the details and protocols. I was worried about my sufficiency to meet the needs of those with whom I would come in contact.
I have been pleased to get to know my fellow team members, and supervisor, as well as the residents, staff and chaplain associates. There is diversity of backgrounds, personalities and faith traditions which has allowed me to have greater insight into my team and their experiences as they relate them. I have valued hearing the paths my team mates have taken to get to this place and time. Hearing these stories aids me in knowing their approaches more fully. The sharing has at times been very personal, both in terms of life experience but also in terms of vocation and discernment. It is a comfort to me to know there is much in common. I sense that our relating these things in community has facilitated the ability to bounce ideas off of one another about practice- I do not feel unable to seek feedback or ask questions. Several others have echoed their appreciation of this openness as well. In my first vocation, I was trained to speak for others. Advocacy was not in the first person. Statements were rarely about myself. While advocacy is a skill, I have had to re-orient my speaking to using first person statements. This is something that requires re-tooling my process away from past usage. I am working with this, so perhaps by the end of CPE, my supervisor will not have to ask about my pronoun choice. While I know there will be times when I am greatly challenged, my perception of the ethos of the group does not jive with the “war stories” I was told. There is a pastoral quality about our conversations in group that I feel is affirming and supportive. I am relieved.
Learning all of the forms, processes, protocols, 8 floors, etc. is coming along. I am not a detail person and tend to over-prepare to compensate. I am aware that this is my style of dealing with anxiety, and is also part of my first vocation where I was expected to have the answer and make quick decisions and judgments. I have been weaning myself away from all of the forms and examples I was carrying “just in case” and for a couple of days had the word “ASK” written on my binder in order to remind myself to not make assumptions or just jump right in. Also it served as a reminder that I can ask rather than worry about large quantities of information. I have also noticed that different people have different styles of handling certain paperwork and other things. I am exploring which of these is best for me.
Something as simple as what I carry with me was a trial and error process. At this point, I have put together what allows me to carry things without them flying everywhere, have what I need to streamline my reporting after responding to a patient need, without carrying extra or unnecessary things. I prefer to not have to run back and forth to the CPE office and to write details while they are still fresh. I know this will not always be possible. By keeping the basics to accomplish this as much as possible, it allows me to put the administrative aside, and enter a room “present” to the person I am seeing. I also find that by stopping at the station where the chart is located, I not only can see what may be going on for the patient, but I can center myself before entering. These are ways I have reduced my concern about paper and protocol so I can focus on caring for people.
Finally, I was worried about my sufficiency to offer people what is needed. Part of this worry is that I tend to be a “do-er” rather than someone can “be.” I tend to try to fix things and to seek answers. The story about the fantasy verbatim with Eeyore’s tail hit home for me. How I saw this play out this week was my concern over having the right things to say or carry with me. Knowing that I struggled with this dynamic I asked for help before visiting on my own. I am grateful that I could engage in role play and my supervisor was willing to do a visit for me to observe. This allowed me to pick up some useful pointers but it also reassured me that my fear of the unknown and lack of confidence was exaggerated. Even though I knew this, I needed some reassurance. I also have found listening to others experiences as well as de-briefing my own offers insight and support. I can pick up useful tips from others. From my past vocation I had learned that there was not a limit to the variety of family dynamics and issues. I was reminded of this during the week and while my approach to situations is from a different perspective, my prior life experience can be informative so long as I do not choose to focus on “been there, done that” in place of listening.
My prior training in listening was to very different purposes. I am aware that I need to redirect the purposes of asking and listening. “Why do I want to ask this question?” I am going to read more about reflective listening with a goal of developing this skill more fully and setting aside my prior framework of asking and listening. I am telling myself that “what facts do I need to know” should not be running through my mind, nor should “ I know what I want to tell you.” These concepts, while useful in my past, as opposed to “ what do you need” and “ what are you sharing?” During this week, one of the team was expressing frustration that his visits were short because no one wanted to talk about faith and he had no purpose. Hearing this allowed me to see “doing” aspects in another- this mirrored for me what I might need to keep in mind. In the light chatting that the patients sometimes offer, I am looking for ways to explore why their statements are important to them- how can they be affirmed, what are concerns, how are they perceiving and experiencing events in their lives. Several of the patients I have visited are eager for a person who will just sit and listen. Being in the hospital one can be surrounded by lots of people and yet be very alone and isolated. There is a great buzz of activity, but it is right outside the door and no one has time to just talk.
I have been amazed at the great insight and faith of some of the patients I have visited. I have also been saddened when I cannot offer more to someone in need. But I am cognizant of the fact that no one visit by anyone can suddenly make everything better given the issues faced by people in the hospital. Just being here shifts the landscape, and takes away frameworks the patient has in his or her life on multiple levels.
I know that I have only observed one trauma alert and the thing that is still in my mind is having to be the person handling the trauma call. Part of this concern is in the unknown of the process. I noticed that the one trauma alert, which was fairly mild in terms of bodily injury did not have the drama I might think of from watching “ER” or “House.” As a lawyer, I was always amazed at how people perceived what it meant to go to Court based upon war stories and TV. I have now been confronted with how that has been a part of my thinking regarding healthcare. While there will be times of great trauma, there will also be many other times where the tone is lessened. But for the patient who is experiencing the event, and the family or loved ones, they too may be bringing not only the physical aspects of injury, and the suddenness of it all, but all of their preconceived notions of what Emergency Department means- these will play on the responding family’s mind until they get here and beyond. Being attuned to my own preconception I hope will help me walk with them in their anxieties and offer what I can to aid them, knowing there will be no magic solution.
“So how does your faith help you in these times?” Probably I should ask myself this question as much I might ask it of others. I hope that I remember this as much as anything else so that I do not artificially place too much on myself and so that I can remain in both worlds.


Ivy said...

Thanks for sharing. It gives me a glimpse of what next summer will bring. Peace.

Althea N. Agape said...

that's a good summary. My biggest surprise has been just how drained I am after a few visits. I am an introvert, so that could be part of it. I have to turn in my first verbatim tomorrow and I am not good at remembering and relating the actual conversation. Details like that are NOT my forte. Well, there will be plenty of room for improvement between verbatims 1 and 10....

I hope the rest of your time goes as well as this week seems to have.

david said...

That's sound so much like my CPE experience. We learn a lot about ourselves, our faithfulness and our dependency on God to get through the tough times so that we can minister to those around us.

I know it is tiring, but sounds like your experience is very worthwhile. Peace!