Monday, June 19, 2017

Heady

Today I had the day off, per making sure to use every last minute of comp time before the year is over. I’ve been back to meditating in the style of Sayadaw U Tejaniya lately—not seeking to stick like glue to the breath or to bore into my experience with great determination, but applying just enough attention to be aware that I’m sitting there, to notice pleasant and unpleasant sense experiences, to notice my attitude toward sense experiences, to study the interplay of thoughts and other experiences.

I still felt kind of upset with Anita, though several more readings of her evaluation had made it look a bit less bad. It was clear that my disgruntled thoughts were harming precisely one person, me. I start every period of sitting with 10 minutes of metta practice. If the whole sitting is 10 minutes, it’s all metta. Today, even after that, when I felt myself starting to get wound up, I did metta for myself and noticed that, all of a sudden, Anita didn’t seem like the ogre she has been in my mind for the past few days. The badness isn’t in her; it’s in my own mind. SUT’s way of meditating is really great for keeping an eye on the mind, as it were, which gets up to terrible mischief with dizzying speed.

During breakfast, I got a call from my therapist at the Truly Wonderful Medical Center, wondering if I was going to schedule another session. I get to see her for free, but only for a certain number of sessions, so she was going to try to refer to me an outside therapist I could see weekly at a bargain rate. (Fifteen dollars a session is what some of my peers pay.) I told her I hadn’t gotten in touch after our last session because I don’t have time to see a therapist outside work even if it’s free. Even if the therapist paid me to visit her, that time would come right out of sleep time, so I can’t do it.

I said that, though I know I could see her two more times, I agree with her thought that seeing her every six or eight weeks isn’t enough to really build a connection. However, I said, she is largely responsible for pushing or nudging me out of the relationship with F., and for that I am grateful.

In the spirit of being honest, I continued, I wanted to tell her that at our last session, when she said, “That sounds kind of heady”
—meaning that I was thinking rather than feelingI felt rather criticized. (She let me get away with that. Anita would have said, “Criticized? Does that mean you felt angry, sad, scared or happy?”) I reminded her that in earlier sessions, she had asked, “Do you want to pause here and get in touch with emotions?” I had agreed to do that every time, and was astonished at how strongly and quickly feelings arose: like magic. I said that, along with feeling criticized, I also felt a little wounded when she said I sounded “heady.” I told her that I was thinking, “I’m sure that’s true! I’m not good at this! I need help!”

She thanked me for the feedback and said she could see me as many as three more times, if I would be willing to do that. She said she would like to discuss what I’d just told her. I readily agreed, and we made an appointment. The email from Chantal felt like a piece of grace, and so did the call from my therapist, as well as a lifeline. I am grateful for the help that shows up unbidden.

I walked off to see my shirt lady contemplating that when I can’t tolerate what’s happening in my body, the mind takes over. It feels so much better when my heart is open, which can’t be forced, but these things are helpful:

—Noticing where my attention is. (Am I aware of being aware of something, or am I lost in thought?)

—Resting my attention on my body just in this moment.

—Observing the content of my thoughts and remembering that they are just thoughts.

—Doing metta for myself. Even one mental repetition of “May I be happy and relaxed” is five seconds when I can’t be deciding horrible things about other people.

So here we are, and I now have decided to share my feelings with Anita about what she wrote, and ask for her help, as with my therapist. By the way, what was it that Anita said that was so gravely offensive? She said that it is not easy for me to be openly vulnerable and that I tend to be judgmental (supported with annoying, inaccurate and totally unfair anecdotes). This is, of course, what Delia meant when she said my opportunity is to learn how to “dive down” rather than to “pop up” and also what my therapist meant when she observed that I sounded “heady.”

I do easily lead with my head, and I’m basically terrified of being fully present in my body and emotions while in the company of others, but the message coming from all around me is clear: these capacities need to be nurtured and brought forth.

Giant Peeve Fest

Friday night I was on call at the other campus and, before rounding, read through Anita’s evaluation of me for the third unit of our four-unit clinical pastoral education program. I felt extremely angry at her after I read it. Her words of praise seemed faint or were my very own words, quoted from my self-evaluation, whereas the criticisms were lovingly detailed, it seemed to me.

I was so furious I decided to tell her that I no longer trusted her and would only discuss this vile document with another supervisor present. I decided never to tell her anything important or personal again. I wrote down all of my counter-arguments and all of the points I planned to nitpick over in classic Bugwalk style. Quite a number of hours were spent in this mode, with tremendous suffering resulting: my own. It even briefly crossed my mind to quit the whole program, which even in the midst of my giant peeve fest I was able to recognize as an overreaction.

I went to bed at 9:30 and, defiant, remained there until 9:30 Saturday morning. A couple of housekeepers poked their heads in, and I said, a little too loudly, “I’m still sleeping.” When I finally got up, I was still in a state of anguish and decided that I had better meditate for 45 minutes instead of the token 10 minutes I usually do when on call. That was the first time I’d ever meditated for 45 minutes while on call, and probably the last.

I went to the cafeteria for breakfast—two pieces of pepperoni pizza and green tea—and then to the student office, where one of the housekeepers was vacuuming. I said, “Good morning,” but I didn’t make eye contact; there was some residue from my earlier irritation with her and her colleague. Thank goodness, before she left the room I came to my senses, at least in that regard, and greeted her again, more warmly. I also apologized for keeping her and her colleague waiting. (They do not have to clean at any particular time, but I wanted to show extra respect.) She turned out to be this very adorable person, with a charming smile and even a charming name. (When I saw the other housekeeper later, I also apologized to her and received another winning smile.) Those might have been my nicest interactions of the whole day, since my bad attitude otherwise lasted all day.

I reread the offending evaluation several more times to see if it would start to look less bad, but it didn’t, really. At the end of the day, I walked all the way home, which took about an hour. I stopped at Whole Foods for three delicious slices of cheese pizza (making it a five-pieces-of-pizza day), which I ate while walking through the burning hot afternoon.

I called Sam after I got home and he said he hadn’t read his evaluation yet, but speculated that maybe they make a point of being kind of harsh after the third unit. That actually makes sense. My first evaluation, written by Jodie, was balanced and gentle. The second, written by Anita herself, was extremely glowing, which is why I was all the more surprised Friday night. There are two sets of “outcomes” we’re supposed to meet in the course of the year, one for each six months. It is possible that—OK, maybe this is paranoid—they purposely give you a great review after unit two, to put a burst of wind in your sails, and then let you have it after unit three, since unit four is your last chance to meet all of the remaining outcomes.

On Sunday, Tom and I went to Berkeley to meet Ann for lunch at Au Coquelet and the stage production of Monsoon Wedding at Berkeley Rep. Alas, Ann got stuck in terrible traffic and decided to head back to Sacramento. I’m sorry she didn’t make it. The show was just fabulous; she would have loved it. When we got to our seats, there was a card on one armrest thanking Ann for her support of Berkeley Rep and inviting her to have refreshments in the “VIP Lounge” at intermission, so Tom and I went up there. Now that I’m probably permanently in economy mode, I really appreciate, even more than before, getting to go to Berkeley Rep, and getting to visit the VIP Lounge, both due to Ann’s generosity.

Over the course of the day, I heard myself speaking to Tom in an uncharacteristically low-key and relaxed way: where did that come from? Tom is so extremely easygoing that I easily go right to the other extreme around him: tense and controlling. I recognized that gentle, quiet voice as belonging to one of the palliative care social workers, who had a huge effect on me. I include her in my metta meditation every single day just so I don’t forget her.

I felt tearful—exactly why, I’m not sure—at the end of the play, so full of color and song and giant emotions. I picked a fake Diwali marigold off the floor and brought it home as a memento.

I have written here about my 40-year friend, Chantal, opposite from me in every way. We haven’t spoken to each other in months for reasons outside the scope of this post. I let her birthday go by, and she did the same when mine came. But I could not let the anniversary of her mother’s death pass, so I sent an email on that day saying I was thinking of both of them. After a couple of days, I realized she hadn’t answered. Yikes! I felt kind of mournful about it. When I saw her note in the inbox Sunday night, I was pretty sure it was going to say, “You and I just don’t have enough in common. Goodbye forever!”

But it said this:

Bugwalk,
Thank you so much for your sweet note. One of the things that gets to me is thinking how few people remember, but you did. It means so much.
Thank you again.
Love,
Chantal


I wrote back:

Dear Chantal,

Oh, thank you! I thought maybe this note was going to say “Get lost!” I’m relieved and touched that it didn’t say that. Thank you. I hope we’ll get things straightened out one of these days. I always trust your good heart.

Love,
Bugwalk


She replied:

Dearest Bugwalk,
As I do yours. More things unite us rather than separate us.
Love,
Chantal

The Indefatigable Advocate

My cohort numbers 14 students, and we have had for several months three additional students who are at the hospital part-time. Now we have been joined by four summer students who are with us full-time. We love all of them, because they all take on-call shifts. They also are all great people, of course. The summer folks are mostly or all people in divinity school, which requires one unit of clinical pastoral education, which they typically do in the summer. There is a Lutheran, a Methodist, a Catholic, and a Unitarian Universalist. (Like, real religions.)

Fortunately, I was using the computer in the student office last Tuesday when I heard one of the summer students confirming a name someone was saying to him on the phone: my patient! He had just died, and Patient Relations was calling for help, as the patient’s mother was very upset. That was not surprising, after all these weeks of denial. I rushed to his room and found him in his bed, his mother and a couple of other relatives at his side. When I walked in, his mother said, “Thank you for coming. He loved you.” Despite what Patient Relations had said, she was perfectly, completely calm.

After 30 minutes, I left. They were coming to take his body in 15 minutes, and I wanted his family to have the last minutes alone with him. His mother walked out with me, heading to a restroom. She said to me, “Everyone thought I was in denial, but I wasn’t. He asked me to serve as his advocate, and that’s what I did.” She said that just a couple of days earlier, he had said to her, “Keep fighting, Mom.” I now recalled that one day she had given me a significant clue that she knew the truth all along: “If there is even a one percent chance, I have to believe in that one percent.”

I was touched and humbled by her final words to me. This woman, facing a parent’s worst nightmare, was willing to let the entire staff—including me—think she was nuts in order to do what she felt she had promised her son. And he, for his part, generously let her do her thing in her own way.

There is a palliative care meeting every week at another campus of the Truly Wonderful Medical Center. I am planning to attend as often as possible in this final unit, and went for the first time last week. There were 20 or so people there, half of them known to me. At the beginning, someone read a poem, and then we each introduced ourselves, and then the patients who had died in the past week were discussed by those in the room who had cared for them, often with tears. My patient wasn’t mentioned, so when they asked if there were others we should remember, I shared about him, and about what his mother said that last day. Two of the palliative care doctors added their thoughts. One said that the patient, despite being so young, never acted as if he felt entitled to live longer. She said he didn’t seem to think “Why me?” but rather “There is no reason this should not be happening to me.”

I now think that, in fact, he had a perfect death, only about 70 years too soon. He spent his final weeks listening to the voice of his mother, who never appeared tired or discouraged or in any way defeated. This remarkable woman saw her child safely every inch of the way to the finish line. He died peacefully, unworried.

A few days ago, Delia presented a didactic to us on moral distress, which she said there is a lot of in palliative care: the patient doesn’t want further treatment, but her family really, really wants that, for instance. She asked if we had examples and I mentioned my patient and my earlier worry that he was not getting to talk about his death. Delia said to our whole group, “I didn’t do such a good job with his mother. Bugwalk, you did a good job with her. Tell us how you did that.”

I said that I was aware of my judgments and opinions, but that I always remembered that, at root, she was a mother about to lose her child, and so I treated her with great warmth, and I also made sure to check in with her son periodically to see what he needed. I shared what she told me after he died, and what a good lesson it was that I don’t know what I don’t know.

After the didactic, Delia and I hugged each other and I said, “Thank you for your kind words,” and she said, “Thank you for your kind work.”

Looking North


This is the view to the north from the north edge of the property my father lived on as a child. He says it is much the same now as it was then.

(Click photo to enlarge.)

Diving Down and Popping Up

In late May, I had a young palliative care patient with a very serious diagnosis whose mother had come from across the country to be with him. The mother seemed very composed, even upbeat, but announced over and over that the patient had been misdiagnosed, that he did not have such-and-such illness, that the only reason he seemed ill was the medication he was receiving. Meanwhile, the patient himself, in his 20s, was obviously in rapid decline.

One day I asked the patient if I could speak to him alone for ten seconds. A few days prior, I had asked him when the three of us were together if he was on the same page as his mother and he had replied, “Not really.” When we were alone, I asked if he had someone to talk to about all his feelings and thoughts, and he assured me that he did, after which I wrapped up our conversation, so as not to keep his mother waiting.

Delia said later that this was a missed opportunity—that he had given me an opening. She said I should not have specified how long our time alone was going to be, and rather than asking him a yes/no question, I could have asked, “What is it like not to be on the same page as your mother?” or “How are you doing with that?” In any event, Delia thinks that particular yes/no question is never a good one: what if the person doesn’t have anyone to talk to? One might better ask, “What is helping you cope with this situation?”

When I asked her for feedback on the whole rotation, she said, “You’re a good chaplain. You’re a good listener. You’re very kind. You’re well trained. I’m confident in sending you to care for patients. You’re good to go as a chaplain. I’ve watched you be able to make relationships with all different types of people—that’s a strength.”

She said my opportunity is to “dive down” when patients want to talk about their feelings rather than to “pop up.” She said this is either my personal long-term work—it indeed is, which I told her—or else it’s graduate-level post-CPE development. She said that going for feelings is where the gold is, and that it makes our work more satisfying. She said what’s great about this work is the constant opportunities for personal growth.

After the rotation was over, I went to Michigan for a week to visit my parents, which was idyllic. We sat on their back deck and enjoyed the greenery and birds and squirrels, and we watched TV. (Alas, Rachel Maddow was out sick, so I did not get my semi-annual fix.) I had lunch with Amy at Seva and with Ginny at Café Zola and at Haab’s with my uncle and his wife. My father and I went on a field trip to his ancestral home, west of Ann Arbor, currently a pile of rubble. I was the expedition photographer. The new owner of the property was there and said it was fine for us to walk around the lot; he said he is going to turn the house back into the charming farmhouse it once was. We leaned in a window and I took a photo of a patch of wooden floor where I last saw my grandmother, 50 years ago, give or take. Sixty-five years ago, my grandmother sold half her lot to a young couple, who proved to be next door working in their immaculate yard. They are now in their 80s. We visited with them for a while.


My sister came over three times, including the night before I left, when she mentioned that she had enjoyed Big Little Lies. We watched the first episode, and then she went home, and my parents and I stayed up until 2 a.m. watching all seven episodes. My shuttle came just after 6 a.m. the next morning, but both of my parents got up to say goodbye. (Proving that they must be my real parents, which doesn’t necessarily mean biological parents, though they are also that. Sometimes when Dad does something particularly nice, my mother says, “Aww. He must be your real father.”)

I had asked Delia if it would be all right if I continued to visit my patient even though I was no longer on palliative care, and she said that would be fine, so after I was back, I went to see him. His mother, as always, did 99 percent of the talking, and 100 percent of what she had to say was that the hospital was overmedicating her son, and that she didn’t believe he had what he had been diagnosed with, etc. He interrupted quietly to say, “I do believe I have [such-and-such].” It was increasingly distressing to me that this lovely person was evidently going to reach the very end of his life without being able to have one direct conversation with his mother about it.

Despite my strong misgivings about his mother’s view of things, I was always very friendly to her, and she said one day that she thought of me as a friend. The patient celebrated his birthday early in June and I went to his room to sing “Happy Birthday” to him. After I left, it occurred to me that he might get a kick out of knowing that my birthday was the very next day, so I went back to tell them that.

One day I was talking to his mother outside his room and Delia came along with my peer who is doing the palliative care rotation in this final unit, the same thing I did in the third unit. Delia said to the mother, “I hear he’s not doing well,” and she got agitated and angry: “That is not true! He’s getting better.” Delia told me later that she hadn’t realized that was the patient’s mother.

Mano a Mano

Late in May, one of my fellow students at the other campus said, “I’m going to the symphony tonight.”

“Who’s playing?” asked one of his colleagues.

The first student answered, drily and after a pause, “The San Francisco Symphony orchestra.”

A nearby supervisor piped up: “Who are they playing against?”

Tuesday, June 06, 2017

My Official Parents

A couple of months ago, I asked my mother if she and Dad can adopt me, so I can have health insurance after CPE ends. Then I remembered that they’re already my official parents, and it doesn’t make any difference when it comes to health insurance. But maybe it would be nice to have a ritual, like when people renew their wedding vows, in which I can affirm that if I were choosing my parents right now, I’d still choose them.

Saturday, May 20, 2017

Euthanasia

Today while on call I went to see a patient who, in her ICU bed, reached for my hand immediately. She looked very uncomfortable and, upon being asked, said she has no friends or family visiting her. Her nurse chimed in: “Her husband visits.”

“Oh, your husband is here. That must be a comfort.” Normally I would not have said the second sentence, but the patient was having a lot of difficulty speaking, so I was trying to save her some trouble. She had the energy to roll her eyes, though, which she now did.

“It is not a comfort to have your husband here?”

She shook her head no. We continued to visit, and I offered prayers, and then she suddenly asked, “What about euthanasia?”

“You’re interested in the End of Life Options Act?”

“Is it legal?”

“Yes, it is. Would you like me to tell your doctors that you’d like to discuss it?” She nodded yes.

Later in the visit, after saying how much pain she is in, she asked if God would be angry at her if she took her own life. Normally I would ask for her own views, but again, due to the laboriousness of her speech, I decided just to offer my opinion. I said that I think God loves her, and does not want her to suffer, and could never be angry at her. “What do you think?” I added.

“I think God doesn’t want me to suffer,” she said. “It would be good if you could pray.”

I already had prayed, so this suggested that maybe the patient was having some confusion. When I left, I asked her nurse who I should let know about her request. She said I should tell the transplant team, and they could tell the patient’s medical team. So I paged the on-call transplant person and he called right back and I told him that the patient is interested in discussing the End of Life Options Act, and he thanked me heartily.

Later I ran into one of the palliative care doctors, also on call this weekend, and he said that it wasn’t necessarily wrong that I had done that (which pretty much told me it was wrong that I had done that), but that his approach is to find out more: why is the patient interested in this? Maybe she has a problem that can be solved. Maybe it is a matter of managing symptoms. He gently said there is the possibility that the transplant team will overreact, and then of course I felt terrible that in seeking to help this person, I may have cost her an organ. Though the doctor went on to say that it’s kind of moot, because if the person is so ill that she is never going to leave the hospital, she can’t exercise that right, anyway, because the hospital doesn’t allow it to be done on the premises. He also said that when we tell others, it’s important to provide context. The patient told me she is in pain, but I didn’t mention that to the transplant team guy.

I hope they don’t just cross the patient’s name off their list after a 20-second conversation. I hope there is plenty of discussion with the patient and time for the truth to emerge and best choices to be made.

Thursday, May 18, 2017

Ripping the Night Out of the Arms of the Sun

The next visit today was to a woman with breast cancer. This was just me and the palliative care doctor. He talked to her about her pain, and then she looked at my badge and asked, “And what can you do for me?” I told her what chaplains do and she requested a prayer. I prayed for her (and for the doctor, while I was at it), and when I was done, tears were streaming down her face, and she said, “Prayer is the only thing that really helps. Prayer is what helps.”

Next it was off to a palliative care department meeting, where there were about 25 people, of whom I was pleased to note I could name 18 or 19. Then another member of my small group and I took a shuttle to the other campus to spend the afternoon presenting our final self-evaluations. We did this in a small room with a huge window that looks west. First, Anita treated us to lunch from the taqueria truck outside. The dietician said I could have a slip once a week, so I requested a fish and chips burrito, which besides fish contained French fries, avocado, and chipotle sauce and was all I had hoped it would be. (I’m paying for it now, but it was worth it.)

The group I was in in the first half of the program had a steady trickle of conflicts, some involving me, some not. Not very fun, but we learned a lot and felt quite close to each other in the end. My new group has had no conflicts whatsoever. It is an excellent group, with young people and old people, white people and people of color. Sam is in my group, and an older woman, and a very young man (if he were 30 years older or I were 30 years younger, and if he weren’t moving across the country to study something very brainy in the fall, I would ask him out on a date the day after the program ends—he is a completely splendid person), and the new guy. The latter is extremely warm and kind, and also extremely intense. He listens in such an avid way that it can be off-putting.

When we do our self-evaluations, we also write about our relationship with each peer and affirm one of his or her strengths and offer at least one critique. In my critique of the new guy, I said that the way he listens sometimes makes me feel shy about sharing. In his “critique” of me, he offered one glowing compliment after the other, and right then, any lingering reservations about him finally evaporated—I can’t resist him any more—and our group is now officially one big lovefest. I will miss these people so much—the on-call schedule covering the rest of the year has now been published—but they will always, always be with me.

I listened this evening to Chris Cornell’s solo albums Carry On and Euphoria Morning. And now I know that he committed suicide. He must have been in horrendous pain, all alone in his last moments.