Monday, November 19, 2018

One Hundred Percent Forbidden

It is absolutely, strictly forbidden for Hammett to sit on my turntable. I would like to think that he has a slightly guilty expression here, but I’m not sure.


(Click photo to enlarge.)

Meeting the Stranger

For my third field trip for school, I signed up to volunteer with Sidewalk Talk, which was started by two therapists in 2014 “to help heal that which divides us through the fine art of skilled listening.” I watched training videos on their website (available free to volunteers; $29 for others) and thought they were superb.

In one of them, co-founder Traci Ruble talks about asking ourselves, “Who is this person in this moment?” and letting the other person be different every day. This reminded me of the Zen idea of meeting the stranger (instead of thinking, “Oh, yeah, I know this person”). She said that “listening for data leaves us lonely” and instead to listen for the other person’s essence.

She strongly advises against fixing and helping, and points out that seeking to help is an exercise of privilege: “I know better than you.” It is about the need of the listener rather than the talker. Instead, she recommends reflective listening: “Connection is the solution. Solutions aren’t the solution.” (She tossed in a helpful tidbit for couples: “I don’t want you to soothe your partner and I don’t want you to solve for your partner. I want you to hear your partner.”)

The videos also covered self-care and safety for volunteers, boundaries, and how to talk to someone who may be feeling suicidal. One of the videos is an extended role play between Traci and the director of San Francisco Suicide Prevention. The latter said it’s fine to ask directly if a person is thinking of harming herself, and to try to ask in such a way and at such a moment in the conversation that the person may feel comfortable answering honestly.

One important goal is to assure the person that it’s all right to talk about feeling suicidal: “Wow—you must really be in a lot of pain. I’m glad you are talking about this,” or, “I’m really glad that you’re talking about this. It’s so hard to talk about.” From there, goals are to find out if the person has a plan for how she will take her own life, if she has the means to carry out her plan, and if she has ever attempted suicide before; the latter is the best predictor that someone will attempt suicide again. Reflective listening is good here, too: “You’re feeling super-isolated right now … .”

If the person has a lethal weapon, like a gun, and says they’re planning to use it that evening, the volunteer can say something like, “The fact that you’re telling me this tells me that part of you doesn’t want to do this.”

If the person says, “I’m going to do this and there’s nothing you can do about it,” it’s time to intervene more forcefully, such as by calling 911. The suicide prevention director also said to call 911 if the person is having an acute psychotic episode. (“There are bugs crawling all over me.” “I have to do this because it’s the only way to save the world.”) The volunteer likewise should call 911 if the person is under 18, because young people’s emotions can be very volatile. The volunteer can also call the suicide prevention hotline right in the moment, while speaking with the suicidal person.

Regarding boundaries, Traci pointed out that when we merge with another person, we are so close that we can’t clearly see him or her. “If I crawl into other person’s skin and am experiencing everything she is experiencing, I’m no longer receiving her.” Doing this erases the space in which two people might connect.

Traci said that she is not a micro-manager and has very few rules, but two things she feels strongly about are that a volunteer should not use her phone while sitting in the listener chair, and she should not chat with other volunteers, as both of these send the message that the volunteer is not available for conversation.

By the time I finished watching the videos, I was really excited about going out to try my hand (my ears) at this. It seemed like something that would have great synchronicity with chaplaincy, and that would be very good listening practice, since I wouldn’t have the agenda of finding anything out about the person’s spiritual or religious beliefs or needs, as I am tasked with doing at work.

Monday, November 12, 2018

Rakusu Relief

Did I mention that every stitch of this had to be sewn by hand? The fabric for the plaquet with the pine twig stitch (in green) on it came from a piece of clothing given by Roshi to our cohort for this purpose.




(Click photos to enlarge.)

Expedition to Seattle

In mid-October I went to Howie’s for the first time in quite a while. I didn’t go more than once or twice during my yearlong internship—I did almost nothing that year except sleep and be at the hospital—and once the internship ended and I got the job I now have, my work schedule interfered. The group at Howie’s was smaller than it used to be, and the chairs were arranged differently, but there were familiar faces along with the new faces, and Howie himself was just as ever.

My friend Charlie goes to Howie’s, and it had been our custom to walk together along Mission St. afterward, but that was two years ago. Now it is his custom to get a ride home with a woman who is part of the group. At first, I felt a little bit stricken over this, and considered asking Charlie if he’d walk with me one week out of three, but in the end I resolved to be generous about this and to encourage his getting a ride home every week, and that’s what I have done.

I picked my rakusu back up in the latter half of the month and had a lovely, meditative day of stitching away. It has been a real learning experience. As of yesterday, it is done!

Also in October I made my annual trip to see my cousin and her family, and David and Lisa, in Seattle. My cousin went to the University of Michigan and is a huge fan of the Wolverines; she put on her UM socks while watching “the game.” (Michigan versus Michigan State?) When pumpkin-carving day rolled around, she put on her orange pumpkin shirt, with socks to match, and both of her young children were also wearing orange shirts for the occasion (plus one of them was wearing oversized safety goggles, just in case).

I was planning to be an observer, but my cousin gently said, “Pumpkin carving isn’t really a spectator sport,” so I carved a pumpkin and it was fun. As for David and Lisa, the three of us went to the Chihuly Garden and Glass museum, which is pretty spectacular, and then to Bamboo Garden for lunch. They joined us at my cousin’s for dinner that evening. It was wonderful to see everyone up there.

My 90-minute flight going there was delayed two hours and the return flight was delayed three hours, but I really enjoyed the splendid view of Mt. Rainier on the way back, as well as of downtown San Francisco.


 David at the Chihuly museum.


(Click photo to enlarge.)

Sunday, November 11, 2018

Reunited with my Republican Friend

Early in October I received the unwelcome news that my boss at my paying job has decided to leave her position. Our relationship has, surprisingly, grown to be excellent, so I am sorry she is leaving because I will miss her, but I’m also sorry because she has been very supportive of me as a chaplain and of course I don’t know what the new boss will think of me. (I seem to recall from my corporate career that I tend not to have very good luck with a boss who replaces my former boss. I think both times I was laid off, I had a fairly new boss.)

I had lunch with one of my CPE peers at the Pork Store on 16th St. on a weekday morning and found the restaurant pleasantly empty. I had a delicious breakfast for $10. I had to run around that day doing stuff for my annual flu shot and TB test, which needed to be done at County Hospital with documentation provided to my paying job, or vice versa, plus there were some extra steps at County Hospital in order to get my badge renewed.

On the bus from downtown to County Hospital, I was sitting in a seat reserved for people who are elderly or disabled, which I offered to a woman with a baby in a stroller. She declined the offer, but there was a little chorus of stunned responses around me. Someone said, “That was nice,” as if it were the most astounding thing he’d ever witnessed. Are things as bad as that in civic life? Aren’t you supposed to offer your seat to someone pushing a stroller?

One Saturday at work I felt unusually weary, and by that evening it was clear that I had a cold, which proved to be a drippy one that existed mainly in my head—in my cranium, not my imagination. I had had the aforementioned flu shot about six days earlier, and remembered that a relative of mine was extremely unwell for a month after having a flu shot several years ago, but I concluded that the culprit was having stopped drinking green tea three days beforehand. I thought that maybe it would improve my sleep to take in no caffeine whatsoever, and replaced it with green rooibos, which is also loaded with antioxidants, so I didn’t expect to suffer any ill effects, but the internet says that green tea interferes with six different phases of the creation of a cold virus. I started drinking green tea again immediately, but the cold lasted for about ten days.

I had to go to work slightly sick the following Saturday, because I thought I’d be better by then, and by the time I realized I wasn’t, it was too late to ask my boss to find someone to take a 24-hour weekend shift. I felt guilty going to the hospital, even though I knew I was well past the contagious phase, and was surprised (and sort of relieved, though also shocked) to hear other workers freely coughing. What mainly made me feel terrible that day was the three Benadryl I’d taken in the preceding 24 hours. I felt dizzy, disoriented and generally lousy. (The internet says Benadryl is not good for you, and that you should take it only if you are having a major allergic reaction.) Fortunately, the Benadryl wore off by the afternoon, and I was able to see a patient or two, and even without having a coughing fit.

I saw a patient on the oncology ward, and then I talked a bit with a nurse who said he was near the beginning of a shift that was probably going to be especially difficult, with many mentally ill cancer patients. I asked how he copes with an extra-difficult shift and he said, “Spiritual care would actually help. It’s great to talk to someone who looks you right in the eye—like you’re doing.” I was pleased by that, and he was pleased when I told him that we are there to care for staff as well as patients and family members. I told him that on our stats-tracking spreadsheets, there is a column for staff.

It made me remember a day at school when Fleet Maull led us in an exercise that involved staring into the eyes of one peer or another for what at first seemed like a long, long time. After lunch that day, my little subgroup met, and our mentor, who is wonderful, suggested that we start by “looking around the circle and taking a moment to see each person.” Then she said, sounding surprised, “Wow! You guys are good at this,” and we explained about our class. Ever since then, I’ve found it easier and more natural to look people right in the eye. I think in the past I felt it might be intrusive in some way, or that I wasn’t worthy of non-verbally asking for that kind of connection, but now it feels quite nice. Of course, if the other person doesn’t want eye contact, then he or she can easily break it.

Mid-October, I talked to my Republican friend on the phone for the first time since Trump was elected. We spoke for a full two hours, one hour for me and one for her. I was keeping in mind some things we learned in another class at school, from a guy who is a mediator. He had a lot of great things to say, but what I was particularly remembering was that he said not to “argue about facts.” He suggested that we have coffee monthly with someone whose views are very different from ours: “Have an improbable dialogue.” He said to stay in relationship and to avoid the temptation to shy away from those who challenge us. My conversation with my friend was very satisfying, though I noticed that when I said something in my chaplaincy was going well, as I did a couple of times, this was met with a cool silence, and I remembered that one of the several things that led to our taking a break from each other—for two years—was her getting the feeling that I was talking to her as a chaplain would, rather than just being myself.

Saturday, November 10, 2018

School

At sunset, for just a few moments, the nearby mountain face turns this remarkable color.



(Click photos to enlarge.)

Rakusu Rage

In mid-September, I attended Schwarz Rounds at County Hospital. The topic was treating young adults with drug problems. We also received a handout on treating various kinds of “hateful” patients. All four panelists talked about the same young patient who was seriously ill and whose mood and wishes changed constantly. In the end, two of the panelists said, all they could do was be with her, often in silence, which one of the panelists said was really challenging, but “paid off,” in that she picked up nuances over time that helped her understand how best to care for the patient.

A few days later, my CPE cohort met, as we do every two months, this time at the home of one of our members in Berkeley who has most often been our host. It was nice to sit in her beautiful back yard and eat and talk. Toward the end of our time together, we did an official check-in, with time for each person to say what she or he had been up to.

Lately I was talking with another chaplain of about my vintage—new—who is starting to move into leading trainings and writing things for publication. I felt a pang of anxiety: should I be training people and writing chapters for books? Am I falling behind? But of course I’m not even board certified yet, and I also thought about some of the extremely busy chaplains and CPE supervisors I know. Some of them clearly do not get enough sleep. I do get enough sleep, and generally, I feel quite well. So I decided to continue on my well-rested track and not teach anyone anything or write anything other than this blog. If I have to choose between being an exhausted, stressed-out person who tells other people how to feel great and being a highly refreshed person who never tells anyone anything, I choose the latter.

I shadowed a new chaplain at County Hospital, and per the way things are done in the palliative care class I attend one day a month, I asked her what she thought had gone well, and then I added what I thought she had done well. Our teachers in the class say it has been proven that this is the best way to learn. They call it “appreciative inquiry,” and point out that what we focus on increases.

The next night, I was paged while on call and had to return to work. A Catholic patient had died and the family really wanted pastoral care. When I got there, I found that they had also called their own priest, and that he had already arrived. The nurse was very apologetic, but it was all right. I just turned around and came back home.

One Sunday Tom and I went to Sacramento on the train to celebrate his birthday with Ann, his mother. She treated us to lunch at Bento Box, Tom’s choice, and then we went to her place so he could open his birthday present. On the train home, we sat with a young father and his two very delightful young sons. He and Tom are both teachers, so they had plenty to talk about, and it also turned out that they live just around the corner from us.

In Emeryville, after we got off the train and were waiting for the bus to take us back across the Bay Bridge, I saw someone who looked remarkably like Tom’s niece, because that’s who it was. The three of us went to Old Mediterranean for dinner.

On an utterly gorgeous day a few days later, I went up to Novato in a Zipcar to see Carol-Joy. We had brunch at Toast, played cards, went to see Life Itself, and returned to Toast for dinner: spinach salad and blue cheese fries, both very yummy.

Toward the end of the month, Charlie and I had tea at the Atlas Café.

I was then still working on my rakusu for Jukai next March, which must be sewn by hand. We had been instructed to take refuge with each stitch: “I take refuge in the Buddha, I take refuge in the dharma, I take refuge in the sangha.” I was working on it one day during the Brett Kavanaugh hearings, and found myself unable to turn off NPR. I got angrier and angrier, not so much at Kavanaugh—though I totally think he did exactly what Dr. Ford says he did, and therefore I also think he’s a liar and has no business being on the formerly Supreme Court—but at my rakusu.

I had meant to work on it for just an hour or two, but I ended up spending the whole day, getting more and more stressed out, and it was a thoroughly crappy day. I saw my tendency to blame others for my misery. (“These instructions are terrible!”) However, as angry as I got, I did not snatch up the scissors and cut my sewing project to shreds. I did do that once when I was five or six years old, when my mother was helping me to sew a skirt, and to this day it is a painful memory. After this horrible rakusu day, I set it down for several weeks, to let the bad vibes dissipate.

Thursday, November 08, 2018

Graduation from Hospice

In the second week of September, I went on the second of my four self-assigned field trips for school, this one to a Baptist church around the block from where I live. The pastor and congregation were warmly welcoming, spirit was flowing abundantly, and a young woman guest preacher gave an absolutely splendid sermon without once consulting any notes. It must have lasted an hour or longer; the whole service lasted two and a half hours. For that reason, they will not be seeing me again, but it was a wonderful experience and I had a very interesting conversation with the pastor afterward about caring for Baptist patients.

He said the main thing to remember is that “they just want love. It’s about the relationship, not religion.” During the three hours I was at this church, I did not hear the Lord’s Prayer recited, so I conclude a Baptist patient would not be waiting for that. The pastor said that salvation does not come because one is baptized or because one does this or that meritorious action—it’s because Christ died for us. (Nonetheless, as the young woman said in her sermon, we are made in God’s image and are supposed to set an example of Christian conduct, including treating others with love.) “Grace” and “mercy” were words I heard over and over. The pastor also said that Romans 8:28 is a touchstone: “And we know that all things work together for good to them that love God, to them who are called according to his purpose.”

I asked what he might say to a patient who wonders why God has visited a terrible illness upon her. He said that he would say, “It’s not always the Lord doing something to us. Sometimes our own choices have played a part. Bottom line: God is still in control.” He said it’s important for people to remember that “this is a temporary situation,” meaning life on earth, and also that “we live in a flawed world.”

I asked about the situation where a person is in the ICU and it seems clear that what is being prolonged is suffering rather than life, but the person’s family and friends are hoping for a miracle. He said that he might say to the patient’s loved ones, “We can be kind of selfish. You see her suffering. Why would you want her to be in this state? We can try to prolong life, but it’s not in our power. Remember how a caterpillar becomes a butterfly. Let us let her go to life everlasting.”

This pastor currently works in IT, but is thinking of becoming a full-time professional chaplain. This is something I know a thing or two about, so I told him about Clinical Pastoral Education and that I’d be happy to answer any questions about the path to chaplaincy that arise for him.

I gave Emily in hospice a call and found out that she had “graduated” and gone off to a senior community. Fortunately, she had approved my being added to the list of people with access to her medical and other information, so I was able to find out which one. It’s the same one where the only other person I’ve ever known to graduate from hospice also ended up; they were in the same hospice, so maybe there is some kind of connection between that hospice and that senior community.

It occurred to me that Emily would have lost her whole cadre of volunteers, and that this might have been quite a blow, but I still don’t know if this is the case, because every time I called the new place over the course of a few weeks, she was eating or playing bingo or what have you, which seemed like a good sign. When I finally reached her, we were back to her not being able to hear me and saying over and over, “Are you there? Are you there?” while I yelled as loudly as I could into the phone.

Meanwhile, I was still mentally flailing about trying to think how to build community, and then I read something that changed my plans yet again. Most days I read a page from The Caregiver’s Tao Te Ching: Compassionate Caring for Your Loved Ones and Yourself, by William and Nancy Martin, and often find it helpful. These sentences brought me back to earth: “There is nothing to figure out.” Also, “Each day we assume less about what should happen.”

I remembered that the only moment in which I can act is this one, and also that it may be true that going to such-and-such meeting regularly would be helpful in having a sense of community, or it may not. It might not be any truer than that getting back together with F. (which has not been offered) would bring great joy. Some things are fairly easy to see as false, but in fact, I really have no idea what should or shouldn’t happen, given my extremely limited vantage point—how little I can see of the entire web of causes and conditions.

I decided to relax, to tolerate the nagging sense of lack and uncertainty, and, if there should happen to be a choice in a given moment to move toward community, to do that, if I remember. I reflected that, once upon a time, I thought, “If I could be a chaplain, I’d be so happy!” Well, now I am one, and now I think, “If I had more of a sense of being part of a team of chaplains, I’d be so happy!” That is: wants are endless. It’s so easy to locate satisfaction in the never-arriving future.

I went off to work for the second time at the new hospital. The first time I was there, it was Saturday and I was alone. This time it was Wednesday, so I joined the chaplain who has been at this hospital for a long time (that is, at the old hospital next door, whose patients are now all at the new hospital). The office is basically his office, and I wasn’t sure how much he enjoys sharing it, but he was extremely friendly. He showed me some things in the electronic health record that were very useful and then we walked around the hospital and he introduced me to a number of people. At one point, he told someone that he’s the “head of the department,” so I played along and said, “Yes, I have to run and get him a doughnut every ten minutes.” I didn’t plan any of this or expect it, and ended up feeling very welcomed and accepted, and therefore enthusiastic about the day ahead. It also turns out that there is a bathroom in the old building, where our office is. It’s right across the hallway from our office, and we have a key to it. Not only do we have a bathroom, since the building is almost empty, it’s a semi-private one.

I later sent an exuberant note to my co-worker thanking him for the warm welcome, and copied our boss. I got a really lovely reply from my co-worker saying he appreciated my ministry and presence, and then both of us got a very nice note from our boss saying we are both wonderful team members and that our collaboration skills are appreciated.

Wednesday, October 31, 2018

Halloween Self-Portraits




I took these during a recent power outage.

(Click photos to enlarge.)

My Boss's Excellent Plan

My cohort at school has a number of things to do before jukai—Zen ceremony for receiving the precepts—next March. Besides the two lineage charts that I finished while I was at school in August and sewing our rakusus, we have to write about each of ten precepts, each of the Three Refuges, each of the Four Commitments, and each of the three Zen Peacemaker Tenets. We decided to do the writing as a group, taking three days for each item: one to read about whatever it is, one day for contemplation, and one for writing. It’s nice to know we’re all focused on the same thing, in all our various locations.

The final task is to make a piece of art or writing representing our own lineage, which doesn’t have to be literal. That is, mine won’t be a PowerPoint with Howie appearing right above me and Howie’s main teacher, whoever that is, appearing right above him. Rather, this is something that honors all of the people who guided or inspired us on our spiritual path. Mine will probably start with the first dharma book I ever read, which was Who Dies? An Investigation of Conscious Living and Conscious Dying, by Stephen Levine.

Early in September, I went to the first session of a class on palliative care at the Truly Wonderful Medical Center that will meet once a month for about a year. Our teachers are an interdisciplinary team of four women: a chaplain, a physician, a nurse and a social worker. One of my peers from Clinical Pastoral Education is in the class, along with two of my co-workers. The day was utterly superb, including a wonderful talk by a pioneering palliative care physician. Even lunch was wonderful. I figured it would be a sandwich and small bag of potato chips apiece, but it was a lavish spread of chicken, lasagna, brown rice and vegetables, along with two kinds of salad and three dressing choices, with cookies for dessert. I still don’t eat sugar, but I stuffed myself with salad and lasagna.

While reviewing charts at work one day, I read earlier chaplain notes saying that a certain patient had sneered and been rude and answered questions in a “sarcastic” manner. While thus engaged, I could hear a patient shrieking loudly from his room that he needed help, help! The fact that no one rose to assist him immediately suggested that he might have been shrieking off and on for hours. Then I realized that the shrieking and sneering, sarcastic patients were one and the same: now I was definitely going to visit this person.

I entered the room to find the patient staring at me with a forbidding, even angry expression. He looked as if he didn’t intend to say a word, or if he did, it was going to be a discouraging word. I said cheerfully, “I know you don’t enjoy chatting with chaplains, but I just thought I’d stop by and see how you’re doing.” At this, his expression changed completely. He smiled and looked me in the eye and said, “Actually, I do enjoy chatting with chaplains, but I’m [outrageous religion guaranteed to offend any chaplain]!” At this, I raised and extended my hands, palms up, as if to say, “Go figure! Fine with me,” and then he told me that he expects to die soon and that he’s at peace with that. It was quite a powerful visit. I was impressed by his equanimity, and also suspect that this kind of acceptance can come and go, so I asked who will be with him on this journey and was glad he has company.

This was on an oncology ward that I normally rarely visit. I now go to various campuses and various units per what my boss thinks needs covering, and can end up almost anywhere. That day I ran into a meditation friend of mine who is an oncology nurse. It was the first time I’ve ever seen her in the hospital. Three observations about the oncology ward: care team members are much more often in patients’ rooms than they are on other units. Ditto family members and friends. And that people facing the end of life are more likely to get right to the point. When I approached one woman’s bed, she immediately stuck out her hand to take mine.

The first day of the palliative care class awakened a desire in me to be part of a palliative care interdisciplinary team, as our teachers are, or like my oncology nurse friend and her co-workers, and it kind of threw into relief how much that seemed to be lacking at my paying job.

A few days later, I was thinking about this and got more and more aggrieved as I mentally detailed how poorly we’re being treated by our boss, how much we’re being excluded, how little we’re being valued, etc. That’s why the palliative care class is so great: it’s a chance to spend a whole day with a like-minded bunch of people. It’s also why serving at County Hospital is so wonderful. There almost always are two or more chaplains there—sometimes six or seven—and our supervisor is usually there. In between visiting patients, we hang out with each other and it’s fun.

As I told myself my victim story over and over, I felt worse and worse. Finally, I remembered who is responsible for my feeling like part of the team: me. I had vowed never to attend a team meeting now that we per diems weren’t being paid to join in, in order to show my boss how terrible her new plan was. However, if it’s important for me to feel like I’m part of a team, and if I’m entirely responsible for that, what actions could I take? There are many. I could schedule lunches with my co-workers. I could periodically send an email to the group. And I could go to the meetings, even if I’m not paid for doing it, and even if it causes my boss to think her plan is perfectly fine.