By Kevin Stephenson
I participate daily in multi-disciplinary team meetings on my assigned floors as a chaplain. The goal within our health system is to provide a holistic approach to patient care that will sustain the healing process after medical discharge.
An RN case manager makes sure the patient is on track with the medical treatment plan and is responsible for the overall patient care and medical interventions. The licensed clinical social worker is responsible for discharge planning and the psychosocial issues that surround the patient’s medical recovery. The physical therapist is responsible for mobility issues.
Recently, the team asked me to intervene for a married mother of five school-aged children. She home-schooled all her children, including one who was disabled. The patient’s husband was away on active military duty. The normal length of stay for her type of surgery is four to seven days, but she had already been in for 15 days. The nursing staff reported that the patient continually called out for pain medications. The physical therapist reported that the patient refused to comply with rehabilitation work due to complaints of pain and nausea — which the therapist questioned. The patient was also receiving wound care for the surgery. Her primary nurse complained of the patient repeatedly calling for nursing attention. The nurse also complained that the patient repeatedly urinated in her bed and refused to use the bedside commode.
“She’s using every excuse not to go home,” the case manager told me. “The nursing staff considers her a one-and-done patient,” meaning that a nurse will generally care for the patient one time and then request removal. It appeared pastoral care services were needed for both the patient and the staff members caring for the patient.
I entered the patient’s room and asked her how she was coping with her illness. “I think about my kids and my husband,” she said. “I need to get better for them. I am all they have. But it is very hard doing this all by myself sometimes.”
“What do you mean by ‘all by myself’?” I asked.
“Well, my husband is an active-duty military man, and he is currently out of the country. So much of the time, I am all by myself with my five children, and it is very hard. He can be called out of state or country at any moment. No one seems to understand that. It is very hard being a military wife and mother.” She began to cry.
“Have you shared this concern with anyone?”
“No. I am a military wife, and I should be able to cope with everything. It is what is expected. But I cannot cope with it all,” she said, still weeping.
“It sounds like you have been struggling with this for a while,” I said. “What does your husband think about all of this?”
“He is dedicated military officer, and he thinks I should just handle things when he is on duty. But I get really depressed and feel like I cannot go on like this. I think that is why I am so sick. I cannot manage my children like I need to, and I feel all alone without my husband.”
“So, you feel if you had better support at home from others,” I said cautiously, “you would heal faster and able to manage your family?”
“Yes. I cannot go home like this. I will just get worse.”
I asked if I could tell the case manager about her situation. She agreed and asked if I could pray with her.
“Yes, I can,” I said. “Do you have people praying for you back home?”
“No, not really. No one really knows what is going on with me. I don’t want people to get the wrong idea about me in the military.”
“I understand your need for privacy,” I said. “It takes a lot of courage to share what you just did and strength to endure what you have gone through. Let us pray.”
When I left her room, I immediately went to the case manager’s office to debrief. We realized that wives of active-duty military personnel had unique needs, and our hospital was seeing more of these cases. Based upon my report, the team decided to arrange for outpatient home-based nursing psychiatric care for the patient. This nurse could privately address the psychiatric, emotional, and physical needs of the patient and her family. Our case manager presented the discharge plan to the patient. The patient approved the plan and was discharged within days.
Kevin Stephenson, LPC-S, is a staff chaplain at Ascension/Saint John Health System in Tulsa, OK.
