Sunday, August 14, 2016

Fortunate Cookie Season

Words seen on a storefront.

Last Sunday, Mason arrived in the morning to take over as on-call chaplain. He has been a strong proponent of my going on to TWMC—he has said I’m gifted and that this is obviously my career, that I’m a good listener and have a comforting presence. Last week, he summarized the turn of events: “You were accepted for clinical pastoral education at one of the best hospitals in the country, but you’re not going to do it because you’re afraid you’ll be tired.”

“Yeah, it does sound kind of stupid when you put it that way,” I agreed.

He and Andrew have been two of the best parts of this summer. One day when Andrew and I were teasing Mason about always being late and saying he should make more of an effort to be on time, Mason said serenely, “That’s not the French way.” (He is not French and has never been to France.) He is always utterly himself, and is such a dear person. In a grand finale of tardiness (unless he does even better this coming week), he arrived 90 minutes late one recent day.

Remember that hearty laugh I hoped for? I caused it myself one day when we were doing role playing. Beforehand, we were discussing earth-based religions. Mason, an Episcopalian, rolled his eyes and Samantha asked what he thinks of when he thinks of earth-based religions. He said he thinks of a woman—and here he finished his thought by using his hand to indicate long, flowing underarm hair. He concluded, “I picture a woman with a unibrow sitting in a forest next to a tree.” One long eyebrow over both eyes.

In our role play, I was playing the wife of the patient, Andrew was the patient, lying on a sickbed made of three chairs in a row, and Mason was the chaplain. (In real life, this patient fell from a height and was impaled on a spike. After poring over his chart, I’ve decided to try to avoid having this experience.) In the role play, Mason asked about our religion and I said, “We’re Earth Forest Wiccans.”

Mason refrained from rolling his eyes and politely asked, “Tell me more about that.”

I said, “Well, each month on the full moon, we go out into the forest, and we do a thing with our eyebrows?” I used my fingers to indicate my own imaginary unibrow, which caused all four of us to laugh hysterically and ended the role play; the patient sprang up from his sickbed clutching his stomach.

I herewith take back what I said about Stephen Jenkinson being a jerk. He is a person of decided opinions, but they appear to have been hard-earned. His prose is rambling and at times a bit vexing, but my patience with his book—Die Wise: A Manifesto for Sanity and Soul—has been very amply rewarded, and I am now recommending it to everyone. It makes an excellent companion to Atul Gawande’s superb Being Mortal. Read Being Mortal first and move on to Die Wise.

I got a nice note back from TWMC about my withdrawal from their yearlong CPE program, and in the days after that, of course began to regret my decision. In class one day, I asked Samantha, Mason and Andrew, “Should I call [person at TWMC] and say I’ve changed my mind?” At that, Samantha put her head down on the table in front of her. When she recovered, she said, “Never answer your own question,” and, “It’s your job to ask the question. It’s their job to answer it.”

Accordingly, that night I sent this note:
I am now wondering if I have made a giant mistake and if it’s truly my body saying “I can’t do this” or if that’s my mind, coming from a place of fear.

I assume my spot is gone by now, but if not, or if another opening should arise before September 6, would one of you be willing to discuss this decision with me? I won’t blame you if the answer is “No!” :-)


The next day, I got a note saying they had indeed given my spot to someone else. For a couple of days, I felt bad about it, but then I spoke with my chaplaincy mentor, Naima, who reminded me that she had said months ago that it might be wisest to do the academics before doing CPE and also that I should keep an eye on my tendency to leap forward, getting ahead of what I have actually discerned is true for me.

She said to be sure to leave this summer unit with a good idea of what my strengths and weaknesses are, as judged by others, and that I might now profitably do some therapy about what came up in CPE that was difficult for me, take some courses at the Chaplaincy Institute in Berkeley, and / or go on a retreat. She said that being in the hospital stimulates the reactive mind while meditating stimulates the responsive mind. She said she thinks the particular CPE program and supervisor are just a small part of the process and that by no means has the world come to an end because I won’t be at TWMC this year.

Finally, she assured me that nothing has gone wrong and that she is not worried about my path. She said I’ve figured out what to do until now in my life, and that I’ll figure this out, too. “This is all part of becoming a chaplain: this is exactly what becoming a chaplain is.” Plus, I’ll always have the happy memory of Samantha putting her head on the table when I asked if, having withdrawn, I should unwithdraw.

I got this uplifting note from my friend and bodyworker Jack: “Sounds like you have clarity regarding this choice. It was a wonderful honor to be invited into that program and it’s a wonderful honor to listen to the whole of your life and build your choices from there. The chaplaincy does feel like such a lovely culmination of all that you are and I’m sure you will find your way forward with it.” I think so, too, and I now feel sanguine about the whole thing. I obviously don’t have a sound decision-making process, or maybe it would be more charitable to say that my natural decision-making process entails one reactive lurch after the other, and somehow I eventually end up somewhere else; that’s how I’ve made every decision I’ve ever made. In sum, the reason I wasn’t sure about TWMC was that I wasn’t sure!

Meanwhile, somewhere along in here I took Hammett to Mission Pet Hospital for a periodic check of his thyroid and was disappointed to learn that he has lost more than a pound since he was last weighed, in March. He now weighs as little as he did right when he was diagnosed with hyperthyroidism. I had noticed he was a bit more frenzied, and that the bones of his spine seemed slightly more prominent.

I was hoping it was a matter of needing to increase his medication, but Dr. Press said the next day on the phone that his thyroid looks fine, and thus does not explain the weight loss, which Dr. Press said is worrying. He said it might not be anything bad—it might be a urinary tract infection or something with his gastrointestinal tract—or it might be something bad. Other than being a little more energetic, Hammett seems just as cheerful as ever, which I hope means it’s not something terrible. However, he’s been through quite a bit medically for a cat just ten years old. If it’s his time, then it’s his time.

Yesterday my walking friend and I had lunch at Ananda Fuara, and in the evening, Lesley and I had dinner at Tacolicious, one of the many new places on Valencia St. The tacos I had were utterly delicious—one carnitas, one chorizo and potato, one cod. One of them had a long hair in it. Our server replaced it but did not apologize or offer to adjust our bill.

Sunday, August 07, 2016

Very Bad Chaplain

Yesterday I was on call and intended to goof off all day—I think I was worried that I’d have a profound experience with a patient that would make me feel I’d made a stupid decision regarding TWMC. But at about noon, I’d run out of non-work activities, and also had to acknowledge that my numbers for the week looked pretty pathetic, particularly after not having seen a single patient all day Wednesday. Number of minutes spent seeing patients; number of minutes spent looking at charts prior to visits, charting after visits, and traveling to or from or otherwise preparing for visits; number of patients seen; number of initial visits, etc.

So at noon I went to one of my three floors and visited all the good candidates for visits, including an old man I had seen before and liked right away. After our visit, while I was still on that floor, he received bad news and asked to see me again. He’d learned that he has a tumor and said he would like a prayer. I asked what we should pray for and he said he hopes that if he has to have surgery, “I come out a winner.” Here he choked up. I felt very touched by our encounter, and indeed felt that maybe I’d made a big mistake; maybe I should email TWMC first thing Monday and take back my resignation. Or maybe they will say, “We respect your decision, but would you like to come in and discuss it in person?”

At three p.m., numbers much improved, I was going to go to another of my floors, but was paged to attend to a dying patient. Her family wanted a priest to come and perform last rites and also a chaplain to come. I summoned a priest—they only come if the patient is Catholic and if a specific sacrament is needed—and he performed the rite and offered absolutely wonderful prayers as the other five of us stood with him around the body of the dying woman. He told the dying woman, who was unconscious, that she could release all fear or trepidation, and to lead us into the Lord’s Prayer, he said something like, “At a time like this, we can call upon God as we call upon a loving parent: Our father … ”

After the priest left, the woman’s two daughters said they did not want to see their mother die and that they wanted to leave, with their husbands. I said that was fine, and that I would stay with their mother. Then it occurred to me that maybe they didn’t really want to go, but were scared of being with a dying person. I’m surprised people would want their loved one to potentially die alone, but I can understand being afraid of witnessing the moment of death. I added that if they would like to stay, I would stay with them and keep them company, and all four of them ended up staying. The young, tattooed nurse felt bad about not being able to hang out there with them and said to them, in reference to me, “You’re not alone—thank goodness.”

We sat there together for more than two hours, and eventually everyone relaxed and one of the daughters told me about her mother, the flowers she grew and the dresses she sewed and the meals she cooked. After the mother’s heart stopped but before the breathing machine was turned off, her children left the room. I told them I would stay until she had passed. In her final moments and just after, I put my hand on her forehead and told her all was well, and that she was very loved. After she was gone, I said, “Rest in peace,” and at the doorway, I bowed to her.

We have a template we use for chart notes, where we fill in various pieces of requested information. I deleted most of the template, and entered the names of the patient’s daughters and their husbands. I referred to the patient by name instead of as “pt” and I typed in what her daughter had told me about her, so that my note could be a small memorial.

At this point, I was even more sure I’d made a terrible mistake regarding TWMC.

I went to the apartment where we on-call chaplains stay, where I have never gotten a page later than 5 p.m., and at 7:40 p.m., just as I was thanking the pizza delivery guy, a page came in: a patient was actively dying at another campus and his wife wanted a priest. I spoke with the wife on the phone and found it difficult to explain, in my limited Spanish, that since her husband wasn’t Catholic and therefore not in need of any sacrament, we couldn’t ask a priest to come. She was Catholic and just wanted to talk to a priest. For that, we have on-call chaplains, but this particular on-call chaplain was about to scarf down an entire pizza and was thus disinclined to serve. The woman was under the impression that I myself am a priest: “Are you a father?” (Hmmph.)

I told her I would call her back and called the nurse to ask if there was a staff member around who could translate for us. The nurse said there wasn’t, but that the woman’s son should be able to do that. I said it was fine to give him my cell phone number, but never heard from him. I rationalized that if they really needed me, they would have called, but I definitely felt guilty. I should have just gotten in a cab and gone over there. (I found out the next day that the patient died about 20 minutes after his wife and I spoke. She sounded remarkably composed, another reason I didn’t rush to her side.)

Don’t worry, I didn’t go unpunished for this. At 9:35, just after I’d gotten in bed, yet another page came in, again from a different campus. A family had gotten the news that their loved one was going to die and wanted a chaplain to come. It didn’t sound as if the patient was actively dying, so I called Samantha to see if we still go in that case: yes. So I got in a cab and headed over there, at this point past compassion fatigue and into active hostility. In the woman’s room, all hard feelings forgotten, I offered a prayer, which was pronounced “beautiful” by one of the 10 family members present.

My cab driver on the way back was born in 1944 and didn’t go in for pot smoking and all that in the 1960s; he was a boxer. Later he traveled with bands as a roadie: Santana, Journey, Natalie Cole. I told him my very first concert was The Spinners, with Natalie Cole, at the Bowen Field House at Eastern Michigan University in Ypsilanti in 1976, when I was 14. “That was me!” he said.

Yes, my decision regarding TWMC was correct. I will take the long way to whatever the destination turns out to be.

Unburdened

I was sure remorse about my decision would set in, since I change my mind about everything all the time, but after I sent my note, I did indeed feel relieved. I like a simple, quiet, orderly life with no dirty dishes in the sink and plenty of sleep. Samantha, in the way of the clinical pastoral education supervisor, periodically asked what my theology, or dharmology, had to say about this decision or whatever else we were discussing. I don’t feel obligated to obey the words of the Buddha, in part because Howie regularly reminds us not to be Buddhists, or even “meditators,” but just to be awake.

On the other hand, I have never through experience concluded that anything the Buddha said was wrong, and I have been thinking lately about his view that we ourselves are as deserving of kindness as anyone else is, and also what he said about living a life unburdened with tasks.

Here’s the beginning of the Metta Sutta (“sutta” means “teaching” in Pali):

This is what should be done
                By one who is skilled in goodness,
And who knows the path of peace:
                Let them be able and upright,
Straightforward and gentle in speech,
                Humble and not conceited,
Contented and easily satisfied,
                Unburdened with duties and frugal in their ways.

I kept thinking I could find a way to be at ease while doing CPE and to have a sense of well-being, but the truth is that I felt worse with every passing day. It’s possible that during a year of CPE, I would have figured it out, but more likely that I would have felt increasingly stressed and miserable and that I might even have become physically ill. It’s hard to relate to others from a place of well-being if one doesn’t have any. Friday evening I celebrated having made my decision and communicated it with a pesto pizza with pepperoni and sausage from Marcello’s. It was delicious and I slept quite well afterward.

Finally

By Thursday of this past week, I was deep into pondering my own values. The most important ones seemed to be financial security, health insurance security, and liking to be well-rested and not stressed out. On the other hand, there are all those years I wished I were doing something more meaningful, and how great it feels to have a sense of purpose, or mission—to do something I’m actually passionate about. That is also very important.

My skills have slowly been improving. I’ve gotten more practiced at assessing spiritual resources, including what support the patient has from family members or friends, which makes it easier to tell who needs what and how often to visit which patients. In one chart, I saw this in a note from the ethics committee: “Patient is Jewish and being followed by Pastoral Services.” I’m the only chaplain who has seen this patient, so that was me! Doctors, nurses and other care providers do read our notes.
 
Thursday night, my downstairs neighbor had people over, some rather loud. You know what I’m proudest of in this whole summer? That not one single time did I call Tom, my best friend and downstairs neighbor, to ask him to be a little quieter. He is fond of videos of cars going around and around a track, or planes flying around and around in a circle (judging from the sound), and in the past I’ve now and then given him a call, but this entire summer, I have said to myself what Howie once told us he says to himself: “I will take what the dharma gives me.” I did the same that night and eventually I did go to sleep, and woke up feeling unbelievably lousy, and clear (for the moment, anyway) that while I might indeed like to work as a hospital chaplain, I need to be on the ten-year plan, not the three-year plan. This is going to have to be a marathon, not a sprint. My body is making it clear that it has no intention of doing a year at TWMC.

When I arrived at work on Friday, just two people were in the office: Rebecca and Victoria, the other CPE supervisor. Samantha supervises us summer interns, who are finishing one unit of CPE. Victoria supervises the residents, about to finish their fourth units, and I think she has considerably more experience than Samantha, certainly more life experience. I asked if I could speak with her for five minutes and told her that I feel like I’m dying—she looked concerned—and that I don’t think I can do the year at TWMC.

She asked how she could be of most help. I said, “I guess I want someone to say it’s OK to do this the slow way and that I’m not blowing a fantastic opportunity by not doing the TWMC program.” She thought for a moment and said, “You are blowing a fantastic opportunity, but this might not be the right program for you.” She did one unit of CPE in a trauma center, which caused her to realize she did not want to do a yearlong residency in a trauma center, so she went elsewhere. She said that the TWMC program is excellent—they are among the top eight hospitals in the country—but relentless. She said that TWMC treats extremely ill people, people who come from all over the country, and that stress permeates such hospitals from the bottom to the top. She said a year of CPE there would be an “endurance contest.”

I think I would actually enjoy working with people with trauma, but if I am not physically thriving where the on-call arrangement is so relatively generous, I am not going to survive something much more intense. Victoria told me about a woman she knows who decided to take a leisurely path to certification, doing just one unit of CPE yearly until she had completed her four units. This woman wanted to feel well and be in good health at the end of her training. Victoria said she saw this woman as a role model, and reminded me that there are many different paths we can follow to our goal. I’m not even sure I absolutely have to work as a hospital chaplain. Just being kind to people in general might be good enough. Volunteering might be good enough.

So that was helpful, and so was Rebecca, who overhead me saying I am planning to try to return to my former company. She told me she had worked there herself and learned valuable things, as well as in a subsequent job she had as a marketer at American Express. She talked about how financial security is a good thing and how our long-range plan can have a variety of chapters in it. After talking to Victoria and Rebecca, I felt that it would be perfectly fine not to proceed to TWMC and also perfectly fine to seek a job at my former company. (Cross your fingers for me.) Now all I had to do was tell TWMC. That evening, I sent them this note:

Dear [three people at TWMC]—

I will always be grateful and extremely honored to have been accepted into [TWMC]’s yearlong CPE program.

My experience of doing one unit of CPE at [VFMC], which will conclude two weeks from today, has affirmed my interest in chaplaincy and I feel more deeply than ever what a profound honor and sacred trust it is to be at the service of those who are aging, ill or dying, and their friends and families. However, I am getting an unmistakable message from my body that my path will have to be one that is slower and perhaps more meandering.

I am sure it is a significant inconvenience for you to have a student withdraw after so many HR procedures have already been completed—I am extremely sorry that clarity didn’t arrive sooner and ask for your forgiveness.

It has been lovely to interact with all of you in person and/or via email, and I hope the year will be wonderful for you and for your lucky students.

With relief, some embarrassment, much gratitude and many good wishes,
Bugwalk

Pre-Mortem Gala

Last Monday, which I had off because I’d been on call on Saturday, Carol Joy and I saw Captain Fantastic, with Viggo Mortensen, and Absolutely Fabulous: The Movie, followed by dinner on Valencia St. She told me about a friend who decided she would like to hear all the nice things people might say about her after she’s dead while she’s still alive and, after a year of planning and preparation, threw herself a very well-attended pre-mortem featuring displays based on her life, such as pictures of all her boyfriends and husbands over the decades. She lay in a pine casket (yep!) and got to hear all of her friends’ loving tributes.

Tuesday afternoon in class we discussed our call to chaplaincy, and Andrew said some things I found helpful. He talked about making the mistake of trying to decide on what his call was rather than letting his bones tell him. Of one possible career path, he said, “My body didn’t want to do it.” Of a thing he did decide to do, he said, “I couldn’t not do it.”

That day we also did an exercise where we non-verbally acted out dynamics we had observed among the three of us. It was brief and rather shockingly revealing. It showed how Andrew and I can sometimes ally against Mason, supposedly the person who has difficulty with emotions; probably it’s Andrew and I who are impaired there. It also showed how Andrew and Mason, the two men, can ally against me, and how I then immediately withdraw.

In my weekly meeting with Samantha the next day, I asked what the point had been and she said that the dynamics among the group of students are also likely to arise in our work in the hospital, and I think she is quite correct about that. For instance, I leave a bit more physical space around myself in interdisciplinary rounds than others do. I assume that the others are the experts and also that they know each other fairly well. I am new to the group and new to hospital chaplaincy, so I also assume that I am not wanted and express that by where I place my body. Standing closer to the others might communicate more confidence in myself and more trust that others are open to my contributions.

In the same meeting, Samantha, per a discussion she had with Jacqueline, withdrew her deadline for telling TWMC I won’t be there (which had been Monday). She amended that to say it would be good not to start if I don’t plan to finish, and if I start and then must stop, it would be good to give as much notice as possible and to finish the unit in progress; the year consists of four units. She pointed out that I’m getting a lot of advice from others and may feel pressure not to disappoint others. She asked what my own values are, and what my own theology (dharmology) says. She said that we might not be able to have everything we value at the same time when going through a transition.

I was utterly fried that afternoon and saw no patients. I sat in a semi-comfortable chair in a lobby in one of the hospital buildings until it was finally within 45 minutes of the end of the day. Back in the office, I said to Samantha and our office manager Rebecca, “I thought of a good reason I can’t be a chaplain: I’m an introvert. One hour per day of being with people is enough for me.” Rebecca always defers to Samantha, but on this occasion, she said, “Bugwalk, I’ve never known a chaplain who wasn’t an introvert.” Samantha said that if I conclude I don’t want to be a chaplain because I only want to see people one hour a day, she can respect that, and she can also respect it if I say, “I don’t love seeing people eight hours a day, but I find it meaningful.” Samantha herself is one of the people I’ve felt subtly pressured by. I think she has wanted me to go on to TWMC, but on the other hand, she has never said, “You’re the most promising student chaplain I’ve ever met!”

Sunday, July 31, 2016

The Chipper Chaplain

On Friday, I finally got to see my mental health professional, Deborah, and I read her my long list of reasons not to do CPE at TWMC and she said it sounded like I have made my decision, but then I told her what I like about this work, including that it’s an honor to be with people at the most difficult moments of their lives, that I’m good at it, that I like meeting new people every day, and that it feels great to do something that is undoubtedly worthwhile.

She said it’s OK to be happy: If I’m happy having a simple, quiet, low-stress life at my former company—assuming I can get a job there—that is entirely fine. More than one friend has said it sounds like I’ll be OK financially whatever I do and that I should take money out of the equation, but Deborah said financial well-being is subjective. She knows people with $10 million who don’t feel safe unless they have a paycheck regularly coming in.

She said maybe there are other ways I can get my needs to be a chaplain met and that I need to guard my health and well-being. She said that, as a cancer survivor, I have to be careful about stress. She said she thought of that several times while I was listing the arguments against going on.

“Does stress cause cancer?” I asked.

“It can’t help,” she said, which sounded rather right to me. Later, however, I did a little online research and learned that there actually is no evidence that stress directly causes cancer.

I have been having a lot of difficulty falling asleep this past week. The person who was coming off call Saturday morning said trouble sleeping can be a symptom of compassion fatigue, which you can indeed have after just eight weeks of CPE. He suggested remembering to do the things that bring me joy, such as hobbies I might have been forgetting about lately. He said people confuse compassion fatigue with burnout, but they’re not the same thing. Compassion fatigue comes from dealing with all the feelings that arise in caring for dying or ill people—our cup is just overfull with feelings. Burnout is more when we hate the whole system, hate our boss, etc.

I asked if there’s such a thing as being a hospital chaplain without being stressed out and he said that in itself, it doesn’t have to be a stressful job. He said he’s gotten to the point where his job per se doesn’t stress him out, but he said it’s not a simple, mindless job, and it will always be challenging. When you add in running a household, raising kids, and all the other things we do, there is the potential for stress.

I attended a death yesterday, spending time with the family and offering a prayer, and visited another patient who was actively dying. I had to take cabs to two other campuses of the medical center. One of my cab drivers said, “You seem like a very chipper chaplain.” After I said I was trying to decide whether to continue in this field or not, another cab driver said, “At your age, you need a job with less stress.”

My three most joyful moments in contemplating what to do next month have been when I decided not to do CPE. That seems telling. But when I think about going ahead, I sometimes feel a sense of a huge, thrilling, unknown expanse—a mystery and an adventure. How wonderful to have the chance to go on an adventure! At other such moments, I feel profoundly touched and almost teary contemplating the opportunity to fulfill what seems like a sacred trust.

Per Jack, I acquired Stephen Jenkinson’s book Die Wise. Skimming through it, I concluded that he’s kind of a jerk—could it be that everyone who works in spiritual care is a jerk, at least sometimes? I can be a jerk, certainly. Maybe everyone everywhere is a jerk sometimes, but you never get to see this working in finance because people don’t bring their whole selves there. Anyway, I did like very much what Jenkinson wrote to his sons in his acknowledgements section: “May your days become your own true days, proof of how it all could be.” I believe my own true days more likely take place in a hospital than in a corporate cubicle. But I also don’t want to be stressed out all the time, and I don’t want to be strapped for cash.

One of my favorite patients, M.I., was discharged last week before I even had a chance to say goodbye, and my other favorite patient left the hospital against medical advice. I had really been enjoying reading her chart. One day she was found with a pipe and contraband pills. The chart said the writer, a nurse, had been “unable to retrieve the pipe.” A couple of days after that, the nurses noticed her room was filled with smoke and later found rolling papers and a lighter.

I wrote their names on little pieces of paper and put them on the shelf that in effect is my altar, where I keep objects that I find beautiful and meaningful. I will keep them in sight for a while, and later put them in some sort of vessel, along with the others likely to come, so I can look at their names from time to time and remember their faces.

Tilden Park

A week ago Saturday, on a beautiful, idyllic afternoon, I took BART to Berkeley to go for a walk in Tilden Park with Lisa M., who reminded me to “discover, not decide.” She said that what I need to do will become obvious in time, and if that’s after starting clinical pastoral education at TWMC and means I end up dropping out, then so be it. She reminded me that I don’t have to decide now what I’m going to do in a year, or even in six weeks. I’m not quite convinced in regard to the latter.

One day in class a week or so ago, I talked about my decision and afterward, Samantha told me that if I don’t plan to be at TWMC in September, I need to let them know by August first, which greatly increased my stress. I got a chance to discuss it last Monday with Jacqueline, Samantha’s boss. She said that Samantha does not have experience hiring chaplains and she does, and that even for a per diem or part-time hospital chaplain position she would not interview someone who had not completed their academic education.

Further, she said, she would not be interested in someone who had done a year of CPE and subsequently completed her education, because she figures that person’s clinical skills and assessment models are out of date. In addition, whereas Buddhist chaplains were once a novelty, we no longer are. (Jacqueline herself is Buddhist.)

I was delighted to hear this, since it came from a knowledgeable party and suggested it would not be a good idea to start at TWMC this fall. For the umpteenth time, I decided that once the summer unit of CPE ended, I would start looking for a job at my old company. I could maybe work there until retirement, and I’d be able to volunteer at the soup kitchen and go to Howie’s sangha every Tuesday night. Which doesn’t sound so bad.

But then I remembered how I used to sit in my cubicle thinking, “I totally don’t care about this work. This is my life passing by.” And then I got to wondering why TWMC even accepted me for a year of CPE if they know it means I’m going to be painting myself into a corner professionally. I hadn’t wanted to discuss my reservations with them because I didn’t want them to think I was going to flake on them, but at this point, I felt I had no choice, so I sent a detailed email sharing what Jacqueline had said, without using her name.

The very next morning, there was a reply from Paul, the director of spiritual care services at TWMC and a person with a national reputation in this field (and yet another Buddhist), saying that it would indeed be challenging, though not impossible, to get a position as a staff chaplain at a hospital before one’s academic study is done, but that he does not agree that doing school after CPE means
one’s clinical skills would be out of date. He said I would “definitely disprove that assertion” if I were able to regularly work per diem shifts during my academic years and that such hours would count toward becoming certified.

Berta, one of the CPE supervisors there, added that she is looking forward to meeting me in September and said that the academic training only takes one and a half to three years full-time and she can’t imagine that clinical skills three years old at most would be out of date. She said she’s still using skills she learned in CPE in 2002.
 
Samantha said in our weekly meeting that she was glad I decided to tell TWMC about my concerns and ask for their feedback. I said I felt I had no other choice: they must have let me into their yearlong program for some good reason, and they’re the only ones who know what that reason is, so I had to ask them. Samantha said I could have just sent them a note saying I was dropping out of the program, so she applauded that I took the risk of asking them.

Sunday, July 24, 2016

Heavily Meditated

That’s what I saw on someone’s t-shirt recently.

On Friday (my day off after being on call—which recuperative period will not be offered at TWMC, the medical center known here as the Truly Wonderful Medical Center, where I might or might not start a year of clinical pastoral education in September) I: meditated, went to the office to drop off the on-call stuff, took the bus home from work, had breakfast, gave Hammett his morning medication, finally did all my online courses for TWMC (this took quite a while), made an appointment for drug testing for TWMC, called Lisa M. re our date the next day, brought the recycling bin in, looked at a book online that my fellow student Andrew recommends, called Modern Times to order three books (including one required for TWMC—a paperback that costs $40!), tried on some stuff that arrived from Lands’ End, had lunch, wrote down what I spent in the past week, updated some personal documents, walked over to see Jack for bodywork, walked back home, did my exercises, had dinner, talked to David and Lisa on the phone, and gave Hammett his evening medication.

F. arrived at 9 p.m. after the open mic at the soup kitchen, which I normally attend, but this was the one possible time that David, Lisa and I could talk, and it was a very nice chat. It wasn’t long enough, but it was lovely to hear their dear, familiar voices. I came away with the impression that Lisa is leaning toward thinking it would be good to continue with the chaplaincy adventure, while David thinks it would be more prudent to collect a solid salary for a few years more; I may have that wrong. I know everyone thinks it’s perfectly fine whatever I decide to do, and I often hold both opinions myself in the course of a single day.

I also had a good talk about the whole thing with Jack. Unfortunately, this meant I didn’t really notice that bodywork was occurring, but his thoughts were helpful. He noted that I have been developing the capacity to be present and to be open with others for many years. We discussed my finances in detail and he said he and his partner, at 65, have been giving this a lot of thought themselves, and to him, it sounded like I don’t have anything to worry about financially if I decide to go on with CPE. He also thinks I would not have too much difficulty going back to my old company in a couple of years, if the “bottom drops out” of whatever I’m doing. He also said that if I decide not to do the year of CPE right now, I could probably do it some other year.
Finally, he gave me some tips on Alexander Technique for chaplains, since both charting and standing with patients have proven to encourage less than great ergonomics.
 
I’d been thinking that I would have to do a year of CPE (which is going to be very hard!), and then have to buy a car (that I don’t want!) and do education (that I’m not interested in!) and then work for a time as a hospice chaplain, which I’m scared of. I’ll say hello to and chat with almost anyone on the street or on a bus, but the idea of driving around to strangers’ houses is daunting. I’m not scared of the patients, but of random relatives or friends who might turn up, like their grandson who just got out of juvenile hall. I think I’m also scared of poop and vomit.

My current CPE supervisor Samantha agreed this past week that a hospital is a more controlled environment and said it is her understanding that “hospice chaplaincy is an adventurous job.” However, she pointed out that one of the part-time chaplains at our hospital has done only one unit of CPE (plus all the education). Therefore, she is “reasonably confident” that after doing five units of CPE, I could get a contract position (part-time, without benefits) at a hospital. My first thought was, “Great! I don’t have to have a car or be a hospice chaplain.” My second thought was, “I don’t want a part-time job without benefits at a hospital (or anywhere else).”

By the way, why am I doing online courses and spending $40 (!) on a paperback and schlepping over for drug testing when I’m not even sure I’m going to be at TWMC in September? Because if I do end up doing it, not having done those things will be a problem. Failing to complete basic requirements would be kind of a stupid way to make this decision.

Saturday, July 23, 2016

Move Your Foot

Last Tuesday I felt totally exhausted, and, just between you and me, that was after working in the afternoon only. I spent pretty much the whole morning at a dental appointment, Samantha being out of town. I did tell her before the summer began that I had to see my dentist on this date. I didn’t know it was going to take so long, and since I’d have to make up the hours, I don’t think I’ll be saying anything more about it. We have to do a certain number of clinical and class hours during a unit of clinical pastoral education, but apparently there are 10 hours’ leeway built in, so my conscience isn’t entirely besmirched.

Starting last week, I was back to doing all my exercises—and also back to not getting enough sleep! If my life consists of eight balls that must be juggled, one of them falls on the floor every single day, and life at TWMC will be worse (in case I didn’t already mention that). I’m now reflecting that there are suffering people everywhere, including in large corporations. I can practice my most heartfelt values anywhere, including at a large corporation. This often feels just too tiring. I want my underworked, overcompensated life back—is that so wrong?

I also was reflecting that I spoke too soon when I said it feels great to do something I’m good at. I’m good at being open and friendly, but as for actual spiritual assessments and interventions, I have no idea if I’m good at that. It may be that I’m actually not good at that, because I’m a major codependent, which is what makes me so friendly. Samantha shadowed me on a visit to a patient this week, and when we were choosing whom to see, she asked, “Why do you want to see this person?” I was opening my mouth to say, “Because she’s in a terrible situation and she said she really liked talking to me,” when I realized that was totally the wrong answer. We’re specifically there to provide spiritual care, and if someone isn’t interested or there is no apparent possibility of being able to offer that, we’re not supposed to make further visits to that person. Samantha’s feedback after our visit to the patient we chose was extremely helpful. She does know what she’s doing.

I’m still thinking about my decision pretty much nonstop, but not feeling a lot of angst about it. I’ve had a number of conversations with trusted friends and advisors, and have several more scheduled, and things are going to happen the way they’re going to happen. On September 6, I will either be at TWMC or I will not.

On Thursday, Samantha herself had to go to the emergency room—she is all right—so we had some class time with her boss, who advised asking ourselves, “Is this work breaking my heart or breaking my heart open?” I’m not sure about this. It definitely has its heart-opening moments, but I also notice myself feeling extremely testy about noises that didn’t used to bother me. Jacqueline said that people who claim to be completely selfless as caregivers scare her. They tend to see themselves as above patients, and can be prone to over-functioning and / or abusing their power.

Jacqueline wasn’t available for our whole class time, so Andrew, Mason and I ended up having a couple of hours of unsupervised IPR, which I think stands for Interpersonal Relating. Mason was expressing anxiety about whether he’s on the right path or not and Andrew said a lot of brilliant things to him that I was scribbling down for my own sake. This wasn’t strictly pastoral on Andrew’s part; it was more what you’d hear in a sermon, but I thought it was dazzling. One thing he said was, “God didn’t say to dive off the branch—he said to move your foot.”

I was also on call on Thursday and, as on Sunday, had pizza for dinner. My worst CPE-related fear is ending up having to live in a cardboard box on the sidewalk because I left the corporate world too soon. My second-worst fear is that I’ll take to comforting myself with pizza every night and be the chaplain who is extremely nice and, at 300 pounds, extremely cushiony.

Hard Stick

From a patient’s chart that noted, “Patient is a hard stick.” (It’s hard to get a needle into the patient.)

Last Saturday, figuring that if people can tell I’m a chaplain just by looking at me, it was past time for a haircut, I had this service performed at the Pretty Pretty Collective on 22nd St. and ended up with a do that was even more fabulous than I’d had in mind. I rode to work the next day (Sunday—I was on call) on the bus sitting near an alcohol-soaked fellow who said he was related to Clint Eastwood, and also that he owns the popular tourist destination Pier 23, which cast (additional) doubt on his original assertion. When Mason saw me (he had been on call the day before), he said, “Wow, you look like a movie star! Why are you looking so glamorous?”

In the hospital, a child of about four said something to me that I didn’t catch.

“What did you say?”

“Nice hairstyle!”

My mother scoffed at that later on the phone, but the child appeared to be a member of a culture that places a high value on courtesy and cordial relationships, so maybe the very first things such a child learns to say are “Please,” “Thank you,” “After you,” and “Nice hairstyle!”

I was supposed to lead an interfaith service at one of the medical center’s four campuses that morning, but just as I arrived by cab, I was paged to return to my usual campus for an emergency. There I was taken to a small room off the emergency department to meet with a woman who had traveled to San Francisco that weekend with her husband to celebrate their wedding anniversary. Sunday morning, the husband complained of chest pains, they called 911 and he was taken to our ER by ambulance. The wife followed in her own car and when she arrived, he was already dead. (She said he had been fit and trim, and someone who ate healthy food.)

One of my colleagues later said that this happens not infrequently, since San Francisco is a popular tourist destination. That it was their anniversary made it especially awful. One of their two children was able to come to the hospital before the man’s body was taken to the morgue. Hearing this young man’s last words to his already dead father was tremendously poignant; it made me cry.

Even as I feel more and more strongly impelled toward the adventure of a year of
clinical pastoral education at TWMC and what may lie beyond, and the more I dislike the picture of myself running back to my corporate job for purely selfish reasons, the more I wonder if a year of CPE is physically beyond me. Samantha has said many helpful things in the past six weeks, including one I have thought of often. On the very first day, in regard to our being asked to share about our lives and our feelings, she said that we are not obligated to divulge every detail just because someone has asked. “Share what you can share from a place of wellness,” she said. I think that is a good guideline for all of life. What work can I do from a place of wellness? What volunteering? What relationships?

I had Monday off due to being on call the day before and, for the first time since CPE began, swept the kitchen floor, vacuumed the carpeting, and cleaned the bathroom. It felt good to have things finally be clean again, but I noticed how stressed out I felt. Also, until that day, it had been a week or more since I’d done all the various physical therapy exercises and stretches I need to do in order to feel quite well. In the final weeks of this summer unit of CPE, I am going to try to see if I can do my exercises and do my work and get enough sleep and keep my house clean from a place of ease and wellness. If it’s simply not possible, that is something to be aware of. (Perfectionism and rigidity are also things to be aware of.) At TWMC, unlike where I am now, you don’t get the day off after being on call. If you’re on call Friday into Saturday, tough rocks—your weekend is one day. If you’re on call Sunday into Monday, also tough rocks—your weekend ends at 2 p.m. Sunday. If you’re on call Saturday into Sunday, then you do get a comp day, which you can use on Monday if you want.

Monday evening, Tom and I had burritos at La Corneta. I ran my decision past him and he seemed to be nodding every time I described another reason it would be extremely excellent for me to (try to) return to my corporate job, but it turned out that his advice regarding chaplaincy was “Stick with it.” He said he puts a high value on being able to help others, which he does in his own job as a teacher of special ed students, including many autistic students. The administrative assistant from my fantastic corporate job concurred. We exchanged emails this week, and she wrote, very kindly, “Continue the path—it will smooth out and be worth it. Your gift to others is your presence.”