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Wednesday, January 14, 2009

Life in the fast lane


Yesterday was one for the books.

It began when I happened to walk into Ms. Conroy's "room" - not an office, exactly, but a "space" of her very own which is very different from my "space."

She had left her EMT squawk box on and, as I walked into the room, it started to crackle and hiss as it does just before an announcement is made.

An overdose. Transporting the patient to a local hospital.

I recognized the address immediately. It was the home of one of my parishioners. My heart sank.

I had been having some growing concern about this particular person. Nothing specific. Just a 'gut' feeling. I had been trying not to 'hover'. Just calling every once in a while. Just to 'check in'. Trying not to feel like a nag.

I found myself suddenly frozen in place. What to do? Strictly speaking, I wasn't supposed to have heard this information. But, and there was no mistake about this, I had. What to do? Now that I knew, no matter how I knew, what to do?

I called Ms. Conroy. We talked. I called a few colleagues. No answer. I emailed a trusted colleague I knew would be online. We strategized.

A plan emerged: I would go to the hospital and, while there, I would check the admission book. Oops! Why look! One of my parishioners admitted through ER. Guess I just better saunter my sassy self over there, right? Just to 'check in'.

I finished getting dressed - no lingering over that second cuppa joe this morning - and braced myself against the frigid weather for the drive over to the hospital.

That's when I met the first wrinkle in my dubious little pastoral plot.

HIPPA. Don't ask me what the acronym stands for. It doesn't really matter. The first letter must stand for "Hell." It's a heinous little federal regulation designed with the best of intentions. And, we all know where that leads (see first letter of the acronym).

It's supposed to protect the confidentiality of the patient. Right. This is not a bad thing. This is a good thing.

However, as my sainted grandmother always said "a little power in the wrong hands can do a great deal of damage." And so it is with HIPPA regulations.

You know, when someone is admitted after a car accident, or a cardiac episode, or a stroke, I flash my little hospital "pastoral care / chaplaincy" badge that has my picture and my name on it, and they clear the decks. I'm in there in a flash amidst the IV poles and cardiac monitors and the blood and the bandages.

Call the boys with the white coats and stern faces from the 6th floor psych unit and you can hear the lock down. The bars go up.

"No," said the lovely volunteer with ancient eyes at the ER Information desk, "I'm afraid we don't have a listing for that person."

"Hmmm . . ." said I. Maybe I got the wrong hospital. The ambulance might have been diverted due to an overcrowded ER. Happens all the time.

So, back I went to my car and drove to another community hospital.

"No," said the lovely volunteer at that ER Information desk, "No listing here."

She was very nice. I'm sure she was telling me the truth. I said, "Do you suppose they might have transferred to the community psychiatric hospital?"

"That may well be," she offered, clearly distressed at my distress.

"Wouldn't that be noted somewhere?" I asked.

"Well, yes . . .actually, it would." Then, she brightened, "How about I call over there and see what I can find out for you?"

I expressed my gratitude as she busily punched some numbers, got put on hold, made a face that expressed her distress at the 'musak' she was being forced to listen to, and then returned to me with disappointing news that my parishioner wasn't listed there.

She read the disappointment on my face and then, lowering her voice, she said, "You know, maybe if you go there, and they see your collar, maybe you'll have more luck." Then she 'mouthed' the (dreaded) word "HIPPA."

So, back into my car (thank goodness I have my hospital badges - I had already saved $6 in parking fees), and off to the psychiatric hospital for which I didn't have a badge, so I checked to make sure I had at least a few dollars in cash.

As I was tallying up the contents of my wallet, I also started to check into my calendar, and noted that my carefully laid out schedule for the day was now in complete shambles.

I sighed deeply. A for effort. F for time management. The report card of a pastor. The story of my life. Sometimes, I endure complete success and utter failure, and sometimes, in the exact same moment. Grrrr . . .

I called my Parish Assistant, made some phone calls, shot off some emails from my iPhone (whatever did we do before this technology?), and then drove to the psychiatric hospital.

Another brick wall. No one was giving me any information. Not whether my parishioner was there. Not if my parishioner wasn't there. Just the stone cold faces with icy smiles and pleasant voices of bureaucracy with a polished, cool, professional capitol "B".

I don't mean this to sound the way it's going to sound, but here it is, anyway: Since when was confidentiality an issue of concern for clergy?

Please don't hear that as arrogance or clericalism or expected, or assumed privilege. It's a cry from my pastor's heart. I mean, just because some well-publicized clergy have crossed boundaries, doesn't me we ALL do. That's a little like saying that just because you've had problems with an adolescent young man, or even a few teen-aged punks, that ALL adolescent young men are bad. Grrrrr . . . .

I got in the car and checked my email. I had blathered a bit of my frustration about the situation in an email on another subject to my Sr. Warden, without breaking confidentiality or giving any specifics, and he wrote back, "Please don't give up. Please keep trying to find our friend."

Of course. Of course. The irony was not lost on me that this person was feeling desperate because of a sense of crushing isolation and desperate loneliness and yet I was desperately throwing myself against not one, not two, but three brick walls, trying to connect. Trying to say, "You're not alone. I'm here. We're here. God's here."

Back in my car. And, just because God has a sense of humor, my phone rang. It was another parishioner. Her daughter was ill and couldn't make the NYC Ballet tonight. Might I be able to join her?

Hello? What?

This was so "out of the blue" it was purple! I almost couldn't get my head wrapped around what she was saying. What she was asking. I didn't know how to respond.

So, I laughed. She must have thought I was insane. And, in that moment, if being out of touch with reality is the definition of insanity, it would have been my picture, in the dictionary there, as Exhibit 'A', next to the word 'Crazy'.

I knew I had some diocesan pre-convention convocation something or other and I should go that evening, but you know, right in that moment, an evening at the NYBC with this woman sounded like manna from heaven. I accepted the invitation with absolute delight and gratitude.

I may have been flunking time management, but, to my everlasting gratitude, God doesn't wear a watch.

On the road again. Back I went to the first hospital where I was absolutely certain I would find my parishioner.

The ER staff was not happy to see me. "Let me ask you something," the ER attendant asked icily. "How do you know that your patient is here?"

"My parishioner? You mean to tell me that my parishioner IS here?"

He smirked, "I didn't mean that. I meant, what makes you think your . . . PARISHIONER is a PATIENT here?"

"Well," I fudged, sending up a quick request for forgiveness before I sinned, "A neighbor told me." Well, I assume it was a 'neighbor' who had made the announcement on the EMT squawk box.

"Ah, yes, Chatham," he said, "The posh little suburb where everyone knows everyone else's business."

I almost lost it, but I'm proud to say I didn't. I took a deep breath and then, got his attention, looked into his eyes and said, "Chatham is a community where many people care deeply about each other. Especially in my congregation."

He looked at me with obvious contempt, said nothing and returned to shuffling around his Very Important Paper Work.

It was then that I caught her eye - an lovely Black woman who was beckoning me over to her place behind a partition.

"Give me your cell phone number," she whispered, "I'll make a few phone calls and check on your parishioner. It may take me a while, depending on how quickly my calls are returned. I'll call you, if you don't mind coming back."

"No, no," I stammered, undone by her obvious kindness. A surprise encounter with human kindness always has a greater impact in the midst of cold, hard bureaucratic concrete.

I gave her my business card and circled my cell phone number. "Thank you," I said, aware that my eyes were filling with tears.

She gently took my arm. "If I were that person and you were my pastor, I would want someone to try as hard as you are trying to find me," she whispered.

I left the hospital and got into the office around 11. My poor Parish Administrator! Not only did he have to swing with the curves of my day, he also had to listen to me dump my crap all over the front office. Sainted man, is he.

Memo to self: Give this man a raise at the earliest possible moment.

An hour and a half later, the call came through. I just know she had pulled some strings in some pretty high places, but she got me in.

"Thank you, thank you, thank you," I said to her, then, catching my breath, added, "You know, I feel as if I've been living the Parable of the Lost Sheep. I've left the 99 in search of the 1 and it's been a pretty daunting process. I've got some things to clear off my desk, but I'm on my way."

"You know, Rev," the woman said, "I'd like to think that when Jesus went in search of that one lost lamb, there were some other shepherds in the field, helping him out."

"Ah," I said, "So THAT's how He did it!"

We both laughed and giggled and shared how good God is and how wonderful it is to be sisters and brothers in Christ. I suddenly felt 10 pounds lighter and ready to face whatever God had next in store for me.

Know why? 'Cuz I knew I wasn't alone. I could tell my parishioner that he wasn't alone, either and s/he'd know that I was telling the truth from my heart.

It's amazing how that all works, isn't it?

The ballet? It was COPPELIA, a delightful little piece of Balanchine fluff, something which debuted in Petersburg in 1884 which he adapted and debuted in 1974.

The woman who danced the part of Swanilda was from Salt Lake City, Utah. The man who danced the part of Frantz was born in Madrid, Spain.

I wondered if they ever thought, as little children, that they would one day be dancing with each other on the stage in New York City.

It IS a small world, after all.

Did I mention that the parishioner who invited me just turned 80? She plays tennis three times a week and got frostbite on one of her toes a few years ago playing paddle ball. She bounded up the two flights of stairs to the second tier (our seats were in the first row), like a veritable gazelle, and arrived poised and lovely.

I, on the other hand, was winded. And, I'm in the gym 3 times a week!

We missed the 10:15 train so caught the 10:49 and got home a little before midnight. Six o'clock came very early this morning.

Just another day in the life of a pastor in a sleepy if not fairly posh little suburban community.

Ain't nothing quite like it.

And you know, I wouldn't trade it for all the little ballerinas, cute as they were, on the stage of the NYBC in Lincoln Center, NYC.

Nope, not one.

20 comments:

Göran Koch-Swahne said...

Wonderful, just wonderful!

dj said...

i'm sitting here at my desk crying. what a beautiful story, mother. thank you, as always, for sharing your life with us.

David said...

'I wouldn't trade it for all the little ballerinas, cute as they were, on the stage of the NYBC in Lincoln Center, NYC'

and the wonderful thing is you didn't have to- ou had it all dear friend

God is God- God is always good

Amen

Muthah+ said...

So many people have scanners in this part of the county that there is no privacy. The evening I got the call that a parishioner had had a fire in their home, I was there before the firefighters were finished putting out the fire. It was important. The rest of the congregation was ready to help out--the shepherds of the 99--but it was important for the pastor to be there.

Hospital folks don't always get how important to the lost sheep for their pastor to be with them because they are working out of the health-care model. Bravo for the woman who understood the role of the pastor and helped you out.

I have a nurses in my congregation who serve at most of the hospitals where my folks go. It is great to be able to call upon them to find out stuff that Hippa keeps from me.

marnanel said...

God bless you. Your blog constantly renews hope in me for the world. Thank you.

Elizabeth Kaeton said...

Oh, wait. You guys think I do this for you? I do this to keep myself sane! Imagine what I'd be like without my blog. On second thought, never mind. It's not a pretty picture.

Just a crazy old woman, talking to herself out loud, letting others listen in.

You don't have to be crazy to do this work, but it sure as hell helps.

Allie said...

It may just be to keep yourself sane, but it inspires us non the less.

Erika Baker said...

I cried too, and I thought it was wonderful. And I LOVED the story of there having been helpers to find the lost sheep.

But I confess to feeling slightly uneasy. You happened to know that this parishioner would want to see you. I've known enough deluded priests who were convinced that someone needed them when in fact, they had no idea of the true mental state of that person at that moment in time.

It does worry me slightly that you were able to get round the system....

suzanne said...

Well, you're not a crazy old woman, because your younger than I and I don't think of myself as old..Crazy absolutely, Nuts Positively!

The story of your whole day reverts right back to your story yesterday of the tortoise and the hare. I believe it is all about pastoring. You can have the large mega churches with their neuvo religion. Give me a smallish to midsize church that struggles with finances, and leaky roofs but who has a community of love for one another and a ton of understanding, even for the old foggie who constantly stirs things up, because he/she has the only right idea, (you know who I mean. You've got one and so do we) Oye.
BUT you are the pastor who loves her flock of wayward souls right where they are. AND you're willing and caring enough to search until you find them. (I hope this person is okay).
This is exactly what the TEC needs, and I Thank God for you and others like you, who work your fingers to the bone for me and others like me.
"Well done Good and Faithful Servant."

Hutch said...

As someone who has worked in healthcare as a nurse and social worker for over twenty years, I understand HIPPA to be in place to protect us as patients when we are most vulnerable. I may not want my pastor or fellow parishioners knowing that I have overdosed, had a miscarriage, abortion or STD or anything else for that matter. If I want them to know, I can call them or have a family member call them or request that the hospital contact them. That a nurse would reveal confidentail information to anyone is appalling and one of the reasons we have HIPPA laws - if she worked for me, she would be fired for cause. The hospital would be fined if it were discovered and a complaint made and could lose federal funding. It's that serious. Learning confidential information through accident does not excuse violating boundaries or the law. I also question whose needs are being met - the patient, the pastor or the parish.

Elizabeth Kaeton said...

Erika and Hutch - as a former nurse, I share your concern. It shouldn't be easy to get information about a patient. I affirm most of HIPPA. However, it is not evenly applied, depending on the staff, some of whom can be real Nazi's and others of whom can be real angels and still keep the law. I think I give several examples of this in my post.

I have two questions:

1. Why are the standards different - or seem to be, at least, for medical patients vs. psychiatric patients?

As I said, I have NO trouble getting in to see a patient with a medical emergency. I ALWAYS have trouble with a psych admission.

2. Why did no one think to ask the patient? They didn't have to reveal that I was there. They simply had to ask, "Would you like to see your clergy person / priest / pastor?"

In fact, this is precisely what my "ER Angel" did. And my parishioner said, of course, yes. Then, she asked, "Would you like me to call your clergy person/priest/pastor?" "Yes," was the answer.

Done.

See? Really simple. Direct.

Maybe that's the problem. Too easy. Too direct.

I would turn your question on its side, Hutch, and ask whose needs are being met by not asking the patient directly - especially a psych admit - if they would like to see their clergy person?

Certainly not the patient's needs, which include spirituality, last time I did a Nursing Assessment and Care Plan.

Sorry if that sounds cranky. I was really treated rudely by that staff person. All he had to say was, "I'm very sorry, but fed. regs. prevent us from giving you that information."

I suspect there was a real bias against clergy going on there - esp. with regard to psych patients. OCICBW, but you know, I'm thinking that there is a "cultural attitude" in the Psych Dept. about that. It certainly isn't something I've encountered with other admissions.

Thanks, Suzanne, for the 'age lift.' Guess the sleep deprivation is making me feel older.

BTW, y'all, today's report is "stable" and "greatly improved." We are having dinner together next week.

IT said...

I admit I agreed at the concern with subverting HEPA but you are (as always) very sensible: just ask the patient! Should be automatic, all they have to say is "no".

Too often bureaucracy and common sense do not work together.


IT

Kirkepiscatoid said...

Elizabeth: To answer one question...psychiatric patient info is "double protected" by HiPPA b/c of the implications in employment, etc. When you sign a release at the doctor's office you have to check an extra box to release psychiatric stuff.

I have to deal with HiPPA every day, the good the bad and the ugly. But, as you pointed out, #2 is very easy to do...and totally above board. "Would you like to see..."

What drives me CRAZY are doctors office staff when I am trying to get more patient history on one of the biopsies I get. If the doctor is unavailable, it is handy to get the nurse to read me the chart notes. What flames my keaster with a foot-high flame is when some office person says, "We can't do that b/c of HiPPA."

Then I have to steel up and say, "Excuse me, but I am looking at this person's BIOPSY. I am a consulting physician on this case. YOUR office failed to provide me enough medical history. I have every right to reject this specimen b/c of lack of clinical information as per OUR procedure manual. Now, are you going to put the nurse on the phone with the chart, or do I have to talk to Dr. So-and-so in the doctor's lounge about how his/her office staff fails to give me what his/her patients need to obtain enough history for me to obtain the proper diagnosis?"


GRRRRRRR.

Pat Klemme said...

Thanks for your persistence and for your loving care of your parishoner.

I've been the one in the psych ward and the last person I wanted to see was a priest, but then I wasn't active in a church at that time, so there was no risk (hope) for it. It never crossed my mind.

I think psych facilities and treatment centers are much tighter about confidentiality because of the stigma of mental illness (right or wrong!) and the actual damage that information can do to someone's life if it becomes public. People can lose their jobs, their health insurance, their reputation, and future possible jobs. It should NOT be this way, but in real life, that's the way it is.

One more note here, we see our religion as helpful, supportive, and healing. Some churches are not so, and psych facilities will testify to abusive or wrong-headed "counselling" meted out by well-meaning, but deficient clergy. I'm not surprised you hit a brick wall. They have no idea whether you are part of the problem or not.

Having been the patient, I'd just as soon they continue to err on the side of caution.

But as the parishoner, Elizabeth+, you can come after me anytime.

Erika Baker said...

Elizabeth

I agree, it's astonishing that they don't simply ask the patient!
And the rudeness with which you were treated is inexcusable by any standards.

But why there should be different standards for medical and psych patients... well, I have no personal experience of being on a psych ward but my mother had a life long battle with mental health issues. The only predictable thing about them was that they were completely unpredictable and could change her pesonality within seconds.

Unlike the medical patient who is possibly just in physical discomfort and worrying about her condition, a mental health patient can suddenly become quite different from the person you chatted to over coffee after the Service last Sunday, even if it's "only" anxiety that makes them want to withdraw from any human contact because they feel deeply vulnerable and exposed.

It's only right that they should be given extra layers of protection, especially from people who think they know exactly what the patient might want.

Elizabeth Kaeton said...

Thanks, Erika and Pat for your personal stories and the helpful reasoning behind the "extra layer" of protection for psych patients.

That being said, this situation was an overdose. First time. The patient made the 911 call, never lost consciousness, and her/his life was never in serious danger.

This was an instance of situational depression with suicidal ideations and attempt. The prognosis is good.

I understand the situation is different when there is chronic mental illness. I understand that "the church" has been the cause for many situation which have lead to depression and suicidal ideations. I understand that the church has not always modeled compassion when it comes to the treatment of certain instances and situations of mental illness - temporary or chronic. I understand that we have sometimes deserved the suspicion and even contempt. God knows, I understand.

Really, all I'm saying is

(1) All mental illness is not chronic or completely debilitating. In the assessment of the patient, a spiritual assessment should be made and the question asked of him/her, "Would you like us to call your clergy person?"

(2) Not all clergy should be painted with the same tainted brush. We should be judged as individually as the patient.

I will tell you that I ran into the snarky ER attendant yesterday while at the hospital for a completely different reason. He struck up a conversation with me while we were waiting for the elevator. One of the things he said was, "Why didn't you tell me you had your doctorate in pastoral care and counseling?" I said, "Because you never asked."

He smirked again. I guess he's just always a wise guy.

Pat, if you needed a pastor, I would move heaven and earth to find you. Now that I know what I know about the Parable of the Lost Sheep, I wouldn't hesitate to ask some of the other sheep and the shepherds to help me out while I go look for you.

JCF said...

if she worked for me, she would be fired for cause

You sound like you would have made a very good Pharisee, Hutch. :-/

[Love your story, Elizabeth. I'm glad your parishioners is doing well---prayers still ascending]

Frair John said...

HIPPA causes more trouble than it is worth. A better law needs to be in place, as well as a willingness on the part of Health Care porfessionals to implement the law and not use it as an excuse to grind thier particular axes.

BTW- This stupid bit of legislative sputom was the reason why a friend of mine died alone, scared and in pain.

IT said...

Before we go after the Hippa, Perhaps you folks should re-read the comment that not all religious visits are welcome? (Some church people do more harm than good).
And consider the cases in LA of celebrities whose medical data was provided to the media.
if I'm ill, I don't want an outsider able to call up the hospital and find out my medical details. I also don't want people able to just barge in any time into my room.
On the other hand, I have also been in the situation of trying to find out what's going on with a loved one in the Emergency Room, so I'm aware that there needs to be a balance.
But these rules exist for a reason, and wilful breaking of them should be cause for dismissal. Indeed, in the case in the LA hospital, the employee who sold (yes sold) celebrity data will be charged with a crime. And she should be.
In the case of Elizabeth's story, the nurse made a sensible decision: rather than handing the info over to Elizabeth, she asked the patient. There's the mechanism that needs to be in place.

IT

Frair John said...

Medical personnel are not the ones to make that call, IT.

The law is poorly written and all to often makes medical bureaucrats the gate keepers of all information and places them in positions to make decisions for patients that are convenient for the hospital or staff that may run counter to the wishes of the patient.