Background Data:

Patient information: Ministry Context:

Diagnosis: Cancer, Palliative Peer Group Presentation: Seminar
Age & Sex: 95/Female Resident’s Name: Arnold Torres
Marital Status: NA Unit of Training: Fall 2018 Unit II
Faith Tradition: Catholic Center Location: VB.B, SICU
Race: White Verbatim Submitted: 1/10/2019
Ethnicity: Hispanic Referral By: Page
Physician: Ortiz Type of Visit: Visit
Admission Date: 12/20/2018 Date of Visit: 12/24/2018
Sexual Orientation: Her. Language Visit: English

1. Background Introductions
An emotional theme that came up during this visit was one of disappointment and
sadness. I felt this coming through the visit and the patient expressed herself in such a way
that I was able to empathize with her rather quickly. I felt her disappointment and sadness
during the visit and left me feeling both with and for her.

2. Body of the Visit:

This patient is new in SICU. I knew very little about her, but knew that she was Catholic,
enjoyed hymns and scripture, and seems lonely. She was admitted to palliative care under
“decline in clinical status”, which a very vague term indicating that the person’s health is failing
for no specific reason other than general decline and age. The case manager had recently
mentioned to me that this patient might benefit from daily visits. I planned on going in to
introduce myself and develop some rapport with her, see about her needs and wants, and then
plan from there what next steps would be.

Legend: C-Chaplain P-Patient

Micro Skills Conversation and what happen in the visit. (knock on the Result
Used door)
C1: Hello, Mrs. Sanchez?

P1: Yes?

C2: Hi, I’m Arnold. I’m a Chaplain (sitting down at

1
bedside)

P2: Yes. Come in. (seems a bit anxious)

C3: How are you today?

P3: Good. I’m tired though.

C4: Really?

P4: Yes. I’m 95.

C5: Really?

P5: Yes. I turned 95 this past weekend.

C6: Wow! Well happy birthday! How was it?

P6: Well, I thought it would be a big thrill…but it

wasn’t.

C7: Well you don’t look 95.

P7: Everybody says that. But there’s nothing really

new to say. Nothing new at all.

C8: Oh. I’m sorry to hear that.

(silence)

C9: How long have you been here?

P9: A couple of days. It feels like always.

C10: Do you like it?

P10: I’m not wild about it.

C11: I see…it’s not where you’d like to be.

2
P11: Home is where the heart is.

C12: And you’re heart’s not here.

P12: No.

C13: Where were you before?

P13: At my own place. But I had to give it up.

C14: Oh?

P14: My daughter said it was too much for me and that

I couldn’t live there on my own anymore. So I had to go
to nursing home. She didn’t know it was so dumpy
(smiles).

C15: (laughs) I see.

P15: I miss her.

C16: Does she see you?

P16: Yes, but she’s busy. She has two sons in their late
20’s. They’re doing well. They have very good jobs.

C17: I see.

P17: (pauses) I’d like to live with her.

C18: I see. You’re pretty disappointed that you can’t.

P18: Yes. I’ve had a lot of disappointments in my life.

(pauses)

P19: I’m cold (brings up blankets)

C19: It’s pretty cold outside.

3
P20: Is it?

C20: Yep. Some people like the cold though…

P21: They’re athletic

C21: Really?

P22: Yes. Athletic people like the cold.

C22: Yes I guess they do. I’m not athletic though.

P23: (smiles) I like Florida.

C24: Really?

P24: It’s the easy life.

C25: Ah! Did you ever live there?

P25: No. I was never able to.

C26: Hm.

(silence)

C27: You seem to have had a lot of disappointments in

life.

P27: (sighs) I just wish things could have been better. I

wish I could be out of here. I’d like to live with my
daughter. (pauses) I’m sorry, but I’m getting tired.

C28: I see. Well I’d like to stop by and see you

again. Would that be OK?

P28: Yes. (makes direct eye contact)

C29: I bet you have some wonderful stories.

4
P30: Well I don’t think…it’s not that interesting…

C30: I don’t think you could live 95 years and not have
some wonderful stories. I think that some of the most
interesting stories are the ones that don’t seem interesting
to you. To you they’re mundane but to other people
they’re amazing.

P31: (smiles)

C31: Before I go would you like your TV on?

P32: No, I can’t watch tv. I used to like to read, but

now I can’t see well. I had cataracts and I could only
have one removed. They had to take me in an ambulance
and it was horrible. I went this way and the other way…

C32: The ride was pretty scary for you.

P32: It was. I couldn’t go and get my other eye

done. But now they’re different.

C33: And that has to be hard for you too.

P33: Yes. I used to read Dickens. My favorite was

David Copperfield.

C34: Really?

P34: Yes.

C35: I haven’t read much Dickens, but I did just read a

book by Jack London, “The Sea Wolf”.

P35: London…he wrote about Alaska. I remember that

the Europeans liked Jack London more and Americans
tended to like Dickens.

C36: Would you like me to get you some books on tape

for you? I like to listen to books on tape when I’m
driving.

5
P36: No thanks.

C37: How about a radio?

P37: No. I could ask my daughter, but I couldn’t get

one

C38: I could ask to get one here.

P38: No. It would just be another disappointment.

(pause)

P39: I’m tired. I’d really like to close my eyes and rest.

C39: Ok. Before I go, would you like me to pray with

you?

P40: (makes eye contact again) Yes.

C40: And you’re Catholic, right?

P41: (looks surprised) Yes.

C41: Don’t worry. Nurse told me. I didn’t just figure it

out. Would you like to pray the Lord’s Prayer?

P42: Yes I would.

(we pray the Lord’s prayer together. She has points where
she loses track and I try to match her pace).

C42: God bless you. I was very glad to meet you. I’ll
stop by and see you again.

P43: I’d like that…I’d like that.

C43: Have a good day!

6
IV. CONCLUSION

1. The patient, family members, etc. (assessment of the Spiritual/Emotional implications)

The patient was more open with me than I expected at first. I also did not expect her to be so
alert and oriented. Most of my patients have at least some degree of dementia, and she was quite
sharp and insightful. Her comments on Dickens and literature took me quite off guard. Themes
of sadness, loneliness, lost dreams and hopelessness came through early on in our
conversation. Through most of the conversation she did not make direct eye contact, choosing to
either look down or through the corner of her eye. I sensed some sensitivity and afterward noted
that I did not use touch as much as I tend to do. She gave me a lot of feedback during the
conversation through her body language, as well as through some very direct answers at times –
her “Yes” had some passion behind it.

Another theme that came through me to her was one of significance. I recognized that a
challenge that many of the elderly have is one of looking back on their life as one of significance
and fruitfulness or one of failure and disappointment. I wanted to reflect her value in a
meaningful way, recognizing that her age was milestone that needed to be recognized and one
which could be reframed in a way that made it no longer a “disappointment” but a source of
satisfaction and meaning. As this is a theme I visit often in my own life as well
(meaningfulness) I felt a strong connection with her and at the end I felt that she was a pretty
remarkable person who was struggling with a lot of depression.

After the visit I checked her chart at the nurse’s station and found that many commented on her
depression, that she refused care at times, and was not eating at times. I reviewed the chaplain’s
notes as well and he did not note any depression, instead focusing on her religious traditions and
interactions around that. I also followed up with our social worker after the visit and she felt that
the patient might have had some mental illness in her past that was never treated. She also stated
that of the patient’s four children only one is involved and the rest are estranged. She had sought
treatment from a psychiatrist in the past but frequently changed doctors.

2. You as a Chaplain
I thought the visit went well and it ended up being the best one I had this week. There were a
few times where I think we both felt a bit uneasy and I tried to wait for her to break the silence
rather than interject on my own. I also noted a few times when we both went off track (talk
about the weather) but I used these moments to try to join with her as well. I felt her depression
and sadness and wanted to reflect an acceptance of herself as she was. I felt sad for her but also
felt that the visit had brightened her day a little which made me satisfied and happy. She
expressed a desire to continue the relationship which affirmed what I felt as well. I also felt that

7
my uptime during the visit was helpful in that I felt less distracted and a little more refreshed
than I usually do that time of day.

3. Theological Reflection
I did not ask her much about her faith or religious background. I had a general knowledge of
them but as the visit went on I did not see them as a primary focus. I expect as time goes on this
may become more a part of our conversation, and perhaps a means to come to some
reconciliation with herself and God. I wondered if her disappointment was leveled at herself,
fate or God. I feel that she may have some anger directed toward God for her lot in life, and she
probably directs this inward.

3. Plan of Care
I plan on visiting this patient again, after Christmas. I would like to look in to getting her some
books on tape, but before I do so I would like to further develop our relationship. I would like to
further investigate her own faith and beliefs and while I don’t expect to make grand changes in her
life I do hope to effect some positive influences which could make her feel more accepted and
worthy of care. Of course, even if just that happens, that could be considered a grand change for
Mrs. Sanchez.

6. Learning Goals

Pastoral Formation:
Learning Objective As I deal with the patient’s I see that I could have ask for help.
Thinking that I can do it myself. This is a learning process for to ask for help. I believe
she needed help and wanted to be with her daughter.

Pastoral Competence:
Learning Objective As we learn and talk about the dead and dying. I want to explore the
end of liffe for patients like Mrs. Sanches who at 95 is actively dying. The patient

Pastoral Reflection:
Learning Objective As I stood there and asisted Mrs. Sanches, and journey with her I
realize that I was acting pastoral authority.

7. Level I or Level II Learning Outcome(s) Addressed in the Verbatim #311.1 311.9 and
Level II #312.1 312.9

8. Interface with Curriculum Content (current or past)

Ministry in the (SICU) didactic and verbatim, my learning contract was a great part to help me
with this case.