Chaplain's Corner

Have you ever gone to visit someone in the hospital and had to wear a gown and gloves, possibly even a mask, just to visit? This past year there was a lot of that at Bethesda Hospital.

One reason is that the person may be in isolation is because he/she is so immune compromised that the hospital is trying to protect them from catching anything from anyone who might come in to visit. This may often be the case with someone who is going through chemotherapy or when someone has an autoimmune disorder that compromises their ability to fight off the many germs that are all around us everyday.

Another reason, and this was the case at the hospital this last summer and fall, is that there is an outbreak of some antibiotic resistant germ in the hospital. When this is the case we gown and glove so that we don’t transfer the germs (spread through contact) from one patient to another.

Because this was something that has impacted us so much at Bethesda in the last year, I thought maybe it might be useful to reflect on the spiritual impact of this necessity. Whether we are aware or not, just about everything that impacts us physically also has a corresponding spiritual impact. So how would being a patient in a hospital room, in a situation where everyone who came into your room had to put on a gown and gloves, impact us spiritually?

Let’s not forget that spirituality is about far more than a person’s religious practice. Patricia Frain, a colleague of mine at the Health Sciences Hospital in Winnipeg, defines spirituality in this way: “Our longing to live meaningful and purposeful lives; our sense of relatedness and connection, our desire to live with trust and hope in an uncertain universe, and our desire to experience a sense of belonging to something greater than ourselves – Ultimate Mystery, God, the Divine, Oneness, the Unlimited, Nature, Life.” (Pat Frain – Health Science Hospital).

Reflecting on this definition, the area of spirituality that would be most impacted by spending time in isolation would be that second aspect, “our sense of relatedness and connection.”  That feeling of being untouchable created by being in isolation has a profound impact. I have seen some visitors come to the hospital, see that the person is in isolation and just turn and go home. The patient misses out on the relationship and connection to these visitors because the visitor is uncomfortable with the infection control procedures that require the wearing of a gown and glove.

But, those visitors who do come in, they are present, but differently present for they are behind this protective layer of a gown, gloves and possibly a mask. What do you think this “get up” communicates to the person in the bed? One of the first things it communicates to some is that there is something abnormally wrong with me. Another thing it may communicate is that there is something to be feared in this situation. The medical staff may have said something about a “superbug” or maybe they have said something about antibiotic resistant bacteria. To some, this could be quite frightening.

Certainly one of the first things we can to do lessen the spiritual impact of being in isolation in a hospital is to communicate in clear, easy to understand language exactly why the isolation is required and what it means to the patient’s well being. Like almost every other human interaction; good, clear, communication that is provided in a manner, both words and tone, that the listener will understand goes along way to easing anxiety.

Another spiritual issue that being in isolation may create is the absence or the diminishing of psychological/spiritual supports at a time when they are especially helpful. Most of us deal with short periods of isolation quite well, but things are different if you are sick and in the hospital. The hospitalization itself is stressful. A patient may not be aware of the stress, but the stress is there. Hospitalization increases personal vulnerability and increases in vulnerability create stress for most individuals. If the psychological/spiritual supports that can mitigate this sense of vulnerability are not fully available the person in isolation may experience the subtle and negative impact of stress.

This past fall I was involved with a patient who was dying and his family. Infection control measures had been in place for quite a while so the family had to gown and glove when they came into the room. A few days before his death they asked for a meeting with the doctor. The concern they voiced: Could we dispense with the gowns and gloves, Dad’s dying and we want to be with him in a normal way. The Gowns and gloves were not only having a spiritual impact on the dying man, but also on the family. The restrictions were lifted and the last couple of days were spent without the gowns and gloves. It made a big difference to this family.

Another important support, the support of touch is often lost in these situations. Even people who normally have a relationship where touch is common often touch much less when a person is in isolation. This is not necessary, the gown and the gloves which are discarded on the way out are a barrier to protect from the transmission of the germs, but the fact that the precaution is in place often makes people hesitant to hold a hand or to hug and this absence of touch has a subtle but real impact on the patient.

I observed another impact of isolation required by infection control on our Rehab Unit. The Rehab Unit is a place where we prepare people to go home. Meals are not normally served in their rooms, patients dress in their own clothing, providing assistance is discouraged as each person is being encouraged to do as much for themselves as they physically can. Late this past summer almost the entire Unit was placed on isolation because of infection control measures.

Patients who were getting better, moving about, socializing with other patients at meals and during activities, moving about freely were not allowed out of their rooms. It was a very discouraging week on Rehab. We were not able to hold our weekly chapel service and folks who hadn’t been able to worship with their own congregation possibly for several months, lost their only worship opportunity.

Granted, the physical consequences of isolation are not readily apparent. The patient’s spirit may be a bit low, the patient may sleep more out of boredom, the patient, may become a bit depressed; but spiritually, the impact is substantial. Infection control procedures are essential. Hospital based infections like VRE, MRSA and CDIFF can have deadly consequences if they spread to critically sick people.

So what can you and I do to mitigate the negative spiritual impact of hospital isolation? Visit often even if you don’t like the gowns and the gloves. Don’t make a fuss over the gowns and gloves when you are with the patient, keep the spirit of the visit positive and uplifting. Ask the patient, “Do you think this isolation is having any kind of negative effect on you?”  It is always better to talk about these kinds of things even though many people chose to stay away from such conversations. My rule of thumb: If you are thinking about it, chances are so has the patient, so it will do everybody good to talk about the matter.

Finally, when you have a friend or loved one in the hospital and they are in isolation for some reason, support them, support them, and support them. Support them with your presence, with cards, and with small gifts (cookies are almost always good). Don’t get fixated on the gowns and gloves. Keep touching!  What ever germs you may pick up are left in the garbage can with the gown and gloves when you leave. Don’t let fears further isolate your friend or loved one who may require isolation due to infection control procedures.