Monday, January 26, 2009

The Work, or the Job

There is the Work, and there is the Job. The Work is what I do at the bedside, one on one with the patient or the family, or both. The Work is what I love the most, and what stimulates, inspires, and nourishes me.

Then there is the Job. The Job is the Monday through Friday going through the day getting it done part. I love this part too, although lately it's been a bit tough. My Job, primarily, is to provide medical care to patients in an inpatient hospice house. These patients are all what's considered acute level of care, meaning that they have uncontrolled symptoms in the context of a terminal and life-limiting illness. About 50% of them leave the hospice house and either return home or go to a nursing home. The other 50% of them die there. I make rounds, examine them, get histories, write orders, and answer questions from the patients and families. Sometimes there are conflicts that need to be resolved among the family members and I help with that. Sometimes they need help figuring out what the goals of treatment should be. Of course there is loads of paperwork associated with all of this, and similar loads of government regulations that must be met.

Sometimes I go out and see hospice patients in their homes, which is a completely different experience. The focus at home is usually not on symptom management, although that is part of it, but on disease progression. You also see how people manage their illness, and being chronically ill, and having disabilities. In many ways, it's very inspiring.

The last two weeks, I've been really immersed in The Job. It's been busy, and we've been short staffed. The Work is all part of it, interwoven in all I do, but harder to think about and tease out when I'm moving from one task to the next. Have the patients been seen? Do the nurses have the orders they need to give the care? Has the documentation been completed? What about the other paperwork? and the checkout note for the on-call? Oh, this family member wanted a call back, and this one needs FMLA paperwork completed.

This is not meant to be a complaint, just the reality of what's been going on. I think this is the way Real Life works: sometimes you just have to live life, and other times you get to think about it. I like to write about what I'm thinking, and I have several upcoming posts in my head. Right now I have to be happy with where I am in the process and know that it is a process.


  1. Not too long ago, I left a job because I loved the work, hated the job. The constraints, lack of support, unreasonable expectations, blah, blah, blah. This may not be what you mean, but sometimes hating the job is more important to pay attention to than loving the work. The work exists everywhere. Hating the job can lead to no longer being able to love the work. Some jobs can also be loved. You deserve a job you can love where you can do work that you love. Just one woman's opinion.

  2. Loving your work does make the job easier. When you are doing work that is meaningful to you, it is like flowing along with a river. The trick is to be mindful of the stream ... too fast and I loose my perspective ... too slow and I loose my direction. Taking care of ourselves when the job responsibilities/stress begins to overwhelm the life work we are called to is essential (you are so right in your earlier post about this).

  3. Risaden, I so agree with you that you have to at least like the job. I had a job once that was so onerous, I would be in the bathroom vomiting within 30 minutes of arrival in the mornings. This was not hospice or end of life care, but the case manager/discharge planner job. I had to do a fair amount of utilization review to insurance companies, trying to explain why we had not stopped aggressive care on a patient in the ICU who was costing them money. Needless to say, I didn't stay long.