Thursday, June 06, 2019

A Co-Worker with a Demon

Every morning that week, I made myself a beautiful, enormous salad and took it down to the lobby to eat, where it was slightly quieter and lots cooler. It was 95 degrees in my kitchen (yes, I know I mentioned that before) and the food in my cupboard was no longer being stored at the suggested cool temperature. It was all now toasty warm. There were also hoses rigged up to drain water from the dehumidifiers into both my kitchen and my bathroom sink.

While I was eating my salad in the lobby one day, a neighbor from one of the unaffected units came along and listened to the whole story, and then she went up to her apartment and brought back a gift of fish: low-mercury tuna from Vital Choice, and a can of Redtresca (Vital Choice’s name for salmon bellies, which my neighbor said are very tender and particularly high in omega 3s). (She also brought shrimp and mussels, but I don’t partake.)

I suddenly realized that I felt incredibly loved and cared for, which I would not have expected, and I also recognized my immense privilege: something bad happens, and immediately tons of people come to fix it. I know everyone can’t count on that. It also could have been way worse. It could have been sewage instead of fresh water. It could have happened at a time when someone wasn’t here to shut the water to the building off within just a few minutes. And my parents kindly listened to blow-by-blow reporting on the matter via phone, and my neighbor gave me fish.

Going to work one day afforded a much-appreciated break from the heat and noise. One of my co-workers mentioned that our new staff chaplain has a demon. “Oh, dear,” I said, and then realized he was saying “DMin,” also a very impressive thing to have.

Halfway through the week of drying, the water damage people came to open up the walls in my living room, hallway, bathroom and kitchen to dry the insides. Mine was the only apartment where this needed to happen.

I had put Hammett in the walk-in closet, along with his food and litter box, both on sheets of plastic. He seemed happy enough, so I was going to go out to the library. I put a note on the closet door saying DO NOT OPEN, and I put a chair in front of the door. I told the two demo guys that the closet door must not be opened, because my cat was in there and my top priority was that my cat not get out of the closet. Within a few minutes, while I was standing right there, one of them moved the chair aside, and when I said, “Pop quiz: what’s my top priority in this apartment?”, they both looked completely blank, so I changed my mind about going out, and sat in the kitchen while they did the work in the other rooms.

They started in each room by making a cave out of plastic in which to work. While I wrote thank-you cards for the contributions people had made for my street retreat (did I mention I plan to go on a street retreat?), amid the banging and crashing and sounds of debris falling, I could hear them yelling to each other:

“Beautiful!”

“Beautiful!”

And periodically:

“Watch out!”

“I got it!”

Later the boss arrived to see how his workers were doing, and I soon heard him yelling “Beautiful!” as well. In the end, three holes were made in my living room walls, along with a huge expanse of wall and ceiling removed in my front hallway, and a long hole in the bathroom. In the kitchen, fully half of the ceiling was removed. (I was pleased to see that the newly exposed wood appeared sturdy and was even quite nice looking.)

The building manager told me that every single month, for 14 years now, along with his rent check, Tom sends a hand-written card to the building owner: “I hope you are doing well,” or “It’s a sunny day here in the Mission,” or “I went on a fun bike ride to such-and-such place.” I had no idea he did this, and couldn’t believe it. He might literally be the only person on earth who does such a thing. (My own rent is sent from my bank via automatic billpay, and I never give it a thought unless it goes up and I have to adjust the amount. I suspect my bank does not include a hand-written card with each payment.)
 

I have received a lot of contributions for my street retreat, most with nice notes: checks in the mail, cash, an electronic contribution from my friend who wants me to be able to function to some extent in the modern world. One person sent a small, fat brown envelope which had inside, all stuck together with blue tape, a little vial of incense around which was wrapped a letter reflecting on her own street retreat experience, a five-dollar bill, and a small piece of paper on which was written, “The way in is unwinding.” The whole thing brought me joy. I laughed the whole time I was peeling it apart.

My routines were all messed up during this mold-prevention operation, yet another opportunity for reflection. If I can skip stretching for several days in a row, do I need to do it at all? Answer: yes. If I can skip writing down my dreams for several days in a row, do I need to do it at all? Answer: maybe not. My dreams seem to be less interesting than they used to be, and I was only doing it in order to improve my ability to have lucid dreams, but since I started writing down my dreams again, about three months ago, I’ve had literally two lucid seconds that I’m aware of, so I decided to quit writing them down.

Professionals to the Rescue

The building manager tried to get a plumber to come that very night. That was impossible, but one came first thing the next morning and fixed whatever was wrong. Tom, going by the second-hand instructions he received, had removed the wrong cap, and it also turned out that the valve that had recently been installed was defective. (I will mention that I got five hours of sleep on that drippy, nasty, foul-smelling night. I was up until 1:30 a.m. trying to soak up as much water as possible.)

Next to arrive was a cheery young electrician, who removed my three affected light fixtures and temporarily installed bare bulbs dangling from wires.

Close on his heels were the water damage people, three men. I had aimed a fan at the wettest part of my carpet and let it run overnight, but that was laughably inadequate. They came in and used instruments to determine where the water was. By this time, it had made its way into my living room and yellow streaks had appeared on the ceiling and walls nearest the bathroom, and an expanse of plaster was getting ready to fall. I asked if I needed to move my bookshelves and they said: yep. This is a very tiny place, so finding a place to put every single book, CD and every other thing that was on those shelves was a challenge.

Hammett sat calmly in his spot in the walk-in closet through most of this. Then the drying guys got out knives and starting taking up the carpet to see where it was wet underneath, and then they installed industrial-strength fans and dehumidifiers in my place, Tom’s, the building manager’s, and the hallways outside my place and Tom’s. In my place there were six fans altogether and three dehumidifiers. The head drying guy, who was very pleasant and friendly, said the windows had to be closed while these things were running, so as not to introduce humidity when we were trying to get rid of humidity. The dehumidifiers—one each in the living room, bathroom, and kitchen—put out more than a hundred degrees of heat.

In sum, it was extremely hot (95 degrees, where it is usually 71), extremely loud, and rather arid in my place, for an entire week. It was also dark, because I quickly realized that opening the shades meant light came in and made it even hotter. The drying guy said I could turn the stuff in the living room off while I slept, but I wanted this phase to be over as soon as possible, so I left everything running all night, and wore earplugs. Hammett evidently hadn’t gotten the news that cats’ hearing is more sensitive than ours. He was perfectly serene at almost every moment and seemed to positively enjoy being a temporary fan owner. (I learned later that cats can seal up their ears to keep out damaging sound, though not instantly; if you fire a gun near a cat, you might damage its hearing.) I think he liked the heat and the vibrations. He was even seen tenderly licking a fan one day.

The daughter of the building’s owner came and spent the day with us—her insurance person came—and she was incredibly nice about the whole thing. She was calm and cheerful, and said, “Stuff happens.”

Everyone who came in took tons of pictures. The bathroom light fixture was a particular crowd pleaser.




(Click photos to enlarge.)

The Sound of Water

In May, I sent my boss this email:

Hello!

I just had quite a long visit on my unit (transplant) with a patient a nurse referred me to. The patient’s affect was relentlessly flat, and he did not seem to have nurturing relationships in his life, or activities that bring him joy. I know “depression” is a clinical  term beyond my purview, so I just said in my note that he seemed downcast and I noted what I said above. I said to a nurse that I thought maybe he could use a psych evaluation, and the nurse said, “I’ll text his doctor and tell him the chaplain thinks he needs a psych evaluation.”

Nice to be taken so seriously!


My boss wrote back, “Good work, including the word ‘downcast’!”

Tom and I drove a Zipcar to Sacramento to visit Ann on Mother’s Day and to see her new place (and for me to meet her newish dog). We had a lovely lunch in the community’s elegant dining room, and Ann made a stunningly generous contribution to my street retreat.

May 15, 2019, is a day that will long live in (my) memory. The first part of it was routine. I rode my bike to work and kibitzed with my colleagues and saw patients. In the afternoon, we had a meeting at another campus, so I rode my bike over there and discovered that a cage had been installed around the bike racks in the parking garage. I tried my badge and it didn’t seem to unlock the cage door, but the parking attendant told me to pull the door open, and sure enough, it opened.

Our interim director gave us a presentation on patients with mental illness. A couple of us did a role play, trying out what we’d just learned. Then we had a team meeting, and, just when the day would normally have ended, I got a page about an emergency back at my normal campus. I considered whether to ride my bike back over there and then cycle home, or whether to take a cab there and back, and then ride my bike home from where it was currently parked. I don’t mind cycling in the rain (I’m not saying I love it), but strong winds were also forecast, so I decided to take a cab.

I saw the patient and her family (and discovered that we don’t have after-hours priest coverage at the new hospital), and then I called a cab to go back to where my bike was. It took 56 minutes to get a cab—and then it turned out that my badge really, truly didn’t open that cage. I called security and, fortunately, there were a few parking people hanging around that campus. One of them came and opened the bike cage and I rolled home. I got home three and a half hours later than usual.

I did my normal evening stuff. At some point, it dawned on me that I’d been hearing running water for quite some time. I remembered the words of a friend of mine who also once upon a time listened to running water in her apartment building for quite some time and learned from that experience never to ignore this sound. I called Tom, in the apartment above mine, to inquire, and he said that he had flushed his toilet 45 minutes earlier and it had never stopped running. He had just had a new valve installed a few weeks earlier. These are old-fashioned toilets with no tank (but plenty of water pressure, as I was minutes from discovering). He said he would let the building manager know in the morning.

However, the noise was not insignificant, so I said I would text her. She wrote back instantly to tell me to tell Tom to take “the cap” off and try shutting the valve for a minute and re-opening it. I passed this on to Tom and I heard him in his bathroom, and then I heard a grunt of dismay followed by the sound, perhaps, of a wrench falling on the tile floor. “Something has gone wrong,” I thought, and one second later, water began pouring down my bathroom window, and then coming right through the ceiling.

I called the building manager back and at first she said, “Go up there and see if you can help him,” but I said, “Oh, my God. Oh, my God. Oh, my God. There is water pouring down into my bathroom, and hallway, and kitchen,” and she said to go turn the water for the whole building off, and gave us instructions. Her husband helped us.

Tom’s place was engulfed in water, mainly the floor, and my place had water gushing down from the ceiling, and raining through three light fixtures, in the bathroom, by the front door, and in the kitchen. The glass covering for the light fixture in the bathroom, which was pretty large, filled entirely with urine-covered water. (Fortunately, this actually was clean water raining down, not sewage, but the building is ancient, and was getting a thorough interior rinse.) I put a bucket under the light fixture in my front hallway, and it filled completely with pitch-black water.

It was a wet, yucky night, with one towel after the other getting soaked. There was a terrible smell. The water went from my place down into that of the building manager below me, soaking her light fixtures and ceiling and walls, and thenceforth into the basement. (Which we figured might be good: the place is porous. Better than having water sit in one place indefinitely.) The hallway outside Tom’s place got really drenched, and there was water raining down outside my front door, too.

I called my father, and though it was well into the wee hours in Michigan, he kindly listened to my initial report, and several reports after that.

Tuesday, May 21, 2019

It’s Been Seventeen Minutes Since Breakfast—Isn’t It Time for a Snack?

Yep! Work on my thesis for school has begun. Thanks to my faulty memory, I can recall writing only one research paper prior to this one. I probably remember that paper because it was traumatic for everyone involved, including my parents. I nearly dropped out of college over it, or maybe I did drop out of college over it. Who can remember? It was on the causes of homosexuality, a topic of interest to me at the time.

This one is about spiritual care as an essential aspect of palliative care, a topic of interest to me now. You don’t have to read it
—if you read this blog, you are reading it. It’s not a research paper per se, but an ethnography, largely based on my experiences at County Hospital and at my paying job. However, there will also be academic sections drawn from pertinent papers and books.

Fortunately, I happened to encounter one of the students from the cohort prior to mine on the plane when I went to school in March, and she mentioned that she had used Word’s template for an APA style paper for her thesis (File—New from Template—APA Style Paper). This has already made my life a lot easier, and is going to save me a zillion hours.

I am allocating one day a week to work on this. The first day, I found myself immediately stuck trying to write the abstract, but then I found something online that said to write the abstract last, not first. I decided to just start writing up the notes I have taken, a task about which I feel confident, and by the end of the day, I had 13 pages out of 60 (excluding reference list and appendices) written. By chance, I had a telephone meeting with my mentor that day, our second in a year. She applauded my going ahead with what seemed obvious to do, and she advised me not to let myself feel stuck for too long—I can get help from her, or my mentor group, or the wonderful woman who is in charge of helping my entire cohort with our papers.

On my second day of working on my paper, I decided to make at least one citation and corresponding entry in the references list, and I compiled information on citing books, articles, websites, and personal communications. Some of these people who write about this stuff online are quite droll.

I did succeed in making one citation and matching reference, and then I got back to doing the fun part. At the end of the day, I had 30 pages written, which meant it was going extremely well or that I was doing something extremely wrong.

Eating the Schedule

I’ve been thinking it would be nice to have a polished piece of turquoise to carry around in my pocket to remind me of Santa Fe and school; I’d like to buy it there, but so far I haven’t come upon such a thing. Someone suggested a certain store, but someone else said to first visit the Native Americans who sit at the edge of the Plaza to sell various wares. I had a bit of extra time on my way back to the airport—this was the Tuesday after Easter—so I walked over there. A vendor told me that the Santo Domingos sell loose stones, but that they weren’t there because they were still dancing for Easter.

My shuttle driver was one I’d had before, and he is one of my favorites because he doesn’t tailgate. I told him about how all of his colleagues tailgate and about how he is the rare exception. I said none of them seem to have heard the thing about allowing one car length per 10 miles of speed. He said no one does that—that if you leave enough space for a car to squeeze in between you and the vehicle ahead of you, you can be sure someone will do it. (I guess that’s bad.) He said leaving a courteous amount of space causes you to be seen as weak.

He told me that ABQ is second-windiest major airport in the whole country to fly into or out of, because of the wind over the mountains and the Rio Grande; he said Denver is the windiest. As we drove along I-25, we could see clouds to the left and right, almost as if we were on a plane, because of the altitude.

During sesshin, one of our teachers talked about how oryoki helps us to treat everything with care: the cup, the doorknob, the book. I found myself doing this once I returned home, and noticed how pleasing it is compared with rushing around doing things carelessly.

Back at work, I found myself consciously asking myself, “What else is here?” and noticing more about people: their posture, their facial expressions, what they were doing with their hands.

It had gotten to be a bad habit of mine to sit in front of the computer in the morning for an unduly long time before going off to see patients, which has often made me feel guilty. After returning home, I decided to “eat the schedule,” as they say in Zen: to do what absolutely needed to be done on the computer, and then get going to my units. (To eat the schedule is to follow it precisely. I don’t have a precise schedule to follow at work, but if I did, nowhere on it would it say to goldbrick for 90 minutes in the morning.) So far I have found that, instead of being exhausted, applying energy seems to generate more energy. It feels good to know I’m doing what I’m supposed to be doing, and to be able to report at the end of the day that I saw 17 patients instead of seven.

Another thing I changed was to start sorting my patient list by length of hospitalization rather than room number, which leads to much more walking around the unit, which I think is good. I start with the people who have been there longest.

One morning, Hammett inspected his breakfast briefly and walked away lowing mournfully to himself. I think he was thinking, “I can’t believe that person gave me cat food to eat.”

At County Hospital in palliative care rounds, the current fellow (physician) talked about hoping family members could “entertain some preparedness around the end,” which I thought was a nice way of putting it. We discussed an Asian family where all the children except the oldest were at peace with not pursuing aggressive treatment for their parent; someone in our meeting said there may be a cultural expectation that the oldest son in an Asian family will make sure all treatment options are tried. It was also mentioned that if a patient is on chronic opioids for pain management, that may cause him or her not to be considered for an organ transplant, though this may be an arbitrary criterion, and maybe not fair.

Tuesday, May 14, 2019

Gassho-Less Gomashio

In mid-April I went back to school for the sesshin (silent meditation retreat) we are required to do each year. This one was seven days. On the plane, I was sitting in the last row, which might be safer, but any sense of security was somewhat eroded by being able to hear every word the flight attendants said to each other, which turned out to be about how much they hate turbulence! One said, “It lasted for thirty minutes. I was in the galley praying.”

Arriving in Albuquerque, I thought of something a teacher said in a dharma talk last year: “We want the entire web of causes and conditions from beginningless time to be different so our elbow won’t itch.” I want everything from beginningless time to be different so the air won’t be bumpy, but the truth is, the air is bumpy, and tensing up doesn’t make it less so. This time, I thought, “So it is. If these actually are my last few minutes of life, how do I want to spend them? Can I relax in this situation of turbulence?” I decided to spend them listing the things I am grateful for, the things I love. (I also reminded myself, “I will not infect others with fear.”)

The next day, sitting on my cushion in the zendo, I wondered why I have to think it’s my final five minutes of life in order to devote myself wholeheartedly to gratitude practice, or to metta, or to accepting what is. What’s stopping me from doing that even if I have years to live?

Also, I realized that I probably haven’t been taking refuge in dharma literally enough. I think of dharma as the truth—how things actually are; what a lovely idea!—but I then don’t recognize the pain in my shoulder or turbulence while flying as instances of how things actually are and instead categorize them as aberrances or interruptions of some sort.

Last year, I sat on a folding chair with no cushion, which got to be painful after a day or two, so I spent some time in the intervening year trying to find the right cushion for sesshin. The custom sewing person at a meditation supplies place agreed to make me a cushion, which turned out to be perfect. That part of my anatomy was free from pain.

Despite not getting anywhere near enough sleep during sesshin, I made a point of getting up early enough to stretch for 20 minutes or so before the first sit (which began at 6 a.m.), and so there were only two or three sits where I had significant physical pain, and I noticed that I could tune into the vibrating or pulsing nature of the pain immediately, which has sometimes in the past taken days to notice. When I can feel that something is pulsing, it means that it’s “Worse, worse, worse” but also and equally “Better, better, better.”

In the morning on the second to the last full day of sesshin, after many, many neutral to unpleasant moments of sitting, there was suddenly a light, buoyant feeling in my body, which once again reminded me that the suffering is not in the sensations but in the effort to ward them off. Once the mind has softened enough to accommodate whatever is happening, the suffering is gone. Naturally, as soon as I had this experience, I expected to have it at every sit for the remainder of the sesshin, and of course did not. Nonetheless, it was such a powerfully expansive experience that it completely made up for everything else.

As always, accepting what is was a challenge. As I traveled to school in a shuttle, the driver pointed out a controlled burn ahead, deliberately set to decrease the possibility of wildfire. This burn plunged us into about 18 hours of thick smoke, much worse than anything I’ve encountered in San Francisco the past couple of years, which sends me running for an N-95 mask and firing up my HEPA air filter. I was glad when the smoke cleared the following day, and chagrined when I returned the house where I was staying to find it full of smoke: incense lit by fellow students. Thankfully, one of our teachers said he would ask them to refrain, but by then, others in the house had warmed to the idea of burning incense, and I had to ask two other people to stop. One of them was a 15-year-old who was there with his mother. One evening, someone did laundry late at night and the washer malfunctioned, making a terrible noise and setting off a repeating beeping signal. I got up to ask the launderer (the 15-year-old’s mother) please to do laundry before sleeping hours.

When I met with one of the teachers for a practice discussion, I said that I was feeling miserable: tired, cold, and like a bad person for so frequently finding myself incapable of not telling another person not to do something. I confess that part of me seriously thought my teacher was going to say, “You are a bad person! Stop telling people what to do!” Instead, he kindly observed that I was also treating myself with unkindness, and gently advised trying on grandmotherly mind. In regard to feeling miserable, he reminded me about Frank Ostaseski’s advice to ask ourselves, “What else is here?”

That was really helpful. I had started the sesshin using the sensations in my feet as my anchor. That was right for that time. But later, it began to feel too constricted, and it seemed to exclude noticing emotions—to be a form of aversion—so then it was right to open up to the rest of my body, and to emotions. And then at some point, that was too much stimulation, and it was right to ask myself what else was here and to let my attention rest on more neutral areas in my body. It was a good reminder about upaya—that what is best changes from moment to moment. (That word means
“skillful means.”)
 
As for my misbehaving fellow yogis, I wrote the 15-year-old a note saying I hoped I hadn’t made him feel bad. After he read the first two words, he threw his arms around me and gave me a long, long hug. His mother was entirely kind and apologetic about the laundry noise. The other incense burner gave me a card at the end of sesshin apologizing for not always being careful about the rules and saying she hopes to do better. Instead of people hating me because I asked them not to do this or that, I was showered with love. It was a humbling, powerful experience of sangha.

For logistical reasons, we had our oryoki meals in the dining room instead of in the zendo. We sat in groups of five or six at tables, which went surprisingly smoothly, and afforded a nice family feeling. Last year, I particularly hated oryoki, I think due to the constant feeling I was doing something wrong (and partly because of the fear I would choke on a piece of spinach). This year, with more familiarity and with the family seating, I found the meals quite enjoyable.

The person sitting across from me got about ninety-nine percent of it wrong, often seeming petulant, and often failing to bow to me when she was “supposed” to (never mind holding her hands in gassho while I was applying gomashio to my food; in vain did our table leader, a resident at the center, try to get her to do that). One day, our leader was trying to help her tie up her bowls for the umpteenth time, and I saw that the end of her cloth was pointing toward herself rather than away, which meant her bow would fail. I reached to gently tug the tip of her napkin into workable position, and she whisper-snarled at me, “He’s my teacher!” After the end of sesshin, someone else who had sat at that table said she had felt challenged by this person’s attitude. I was pleased to be able to say, honestly, that she really didn’t bother me. I could see she was doing the best she could on all fronts, and obviously her behavior was not about me. While she might conceivably have appreciated my trying to help her get her bow right, it was also true that my help was unsolicited, so I didn’t take it to heart.

This same person was sitting next to me in the zendo and was a perfect neighbor. She rarely moved a muscle, she was utterly silent, and she did not emanate any kind of displeasing smell (e.g., laundry detergent). When I thanked her at the end, she just gave me a strange look and didn’t respond. At the closing council, when I asked for forgiveness from anyone I had harmed, I noticed she was smiling a little smile and got the feeling she was thinking, “I’m glad you apologized for all the terrible things you did to me!” Who knows what she was actually thinking? People are funny, aren’t they? Thinking of her, I smile. In the end, the sesshin was about people: the ones I liked, the one or two I didn’t, the ones who annoyed me, the ones I annoyed, and the qualities of forgiveness and generosity that ultimately enfolded us all.

Reunion

I was paged to visit a patient who had been placed on comfort care the night before. Her nurse said various interventions were being turned off. I found the patient lying in bed with no visitors present. The room was pleasant and sunny, with a colorful vase of flowers. I assumed the patient would be unable to speak and thought I would just sit quietly with her for a bit; maybe her family would turn up. But when I spoke quietly to her, she opened her eyes and looked right at me.

She said that she was Christian and would like a prayer for a peaceful passing and to see her husband again in heaven. I was surprised, impressed and moved; I felt I might cry after I left the room. People almost always want prayers for healing, including when they are right at death’s door. I don’t think I’ve ever heard anyone ask for prayers for a peaceful death, or any other kind of death. I did pray for that explicitly, and that she and her husband will be happy together in heaven for eternity, and I gave thanks for her life. Afterward she murmured, “That was nice.”

Crane Tree

The day after the hospital move, Tom and I went to see Metamorphoses at Berkeley Rep, preceded by lunch at Au Coquelet. It was really wonderful—inventive, beautiful, hilarious at moments, touching—and also rather moistening if you were sitting in the first or second row, as we were. Afterward, we chatted with a woman with a visual impairment who said that her seeing eye dog got freaked out when she was splashed with water and went to sit with two ladies in the row behind her owner.

On Ash Wednesday, always a hectic day for chaplains, I met the interim director at my paying job and also our new full-time staff chaplain. I asked the new chaplain, Felicia, if she would like to have lunch, and four of us chaplains ended up lunching together. Felicia is cheerful and energetic and has been a great addition to our group. (Although it gave me a pang to see a new full-time chaplain start while I languish as a per diem. My former boss asked me to apply for a full-time or .8 job, but I felt that, with school still underway, I could not.)

I got a book: Dream Work: Techniques for Discovering the Creative Power in Dreams, by Jeremy Taylor, who has written several books about dreams. I gather he advocates using every form of dream interpretation—considering dreams from a variety of perspectives, even including the Freudian one, to see what might be discovered.

I actually figured something out about a recent dream, in which I was in the backseat of a car being driven by my grandfather. Someone honked aggressively at us, but, knowing my grandfather to be quick to anger, I was sure he would defend us. Instead, he got out of the car and strolled off, not even locking all the doors. I always sort of know I’m dreaming, so I wasn’t afraid, but I was mystified that he had left me vulnerable to attack. I realized that this is about the part of myself that is quick to get angry and to mount a vigorous defense: maybe not always needed.

In mid-March, I went to Santa Fe for a week or so at school. SuperShuttle drove off without me, so I had to take a cab to the airport. Two of my fellow students were on the same flight, and one of them switched her seat to join me. She gave me a lot of helpful tips about the thesis we are writing in this second year. She had rented a car, so the other student and I decided to drive with her instead of taking the shuttles we’d reserved. How much it cost me to get to school that day, besides the airfare and $30 to check a suitcase: $21.06 for SuperShuttle, $43.65 for a cab, $20 cab tip (purposely large to restore my own good mood), and the $40 I chipped in for the rental car.

But it was worth it. (SuperShuttle did give me a refund later.) We had a fun drive together, stopping at Annapurna’s in Albuquerque for lunch. While we were at school, we had a chance to discuss our project proposals with the person who is in charge of helping us with our theses. We were not officially going to get feedback until a month later, but during our meeting, she told me to go ahead and start writing, meaning my proposal was approved.

Toward the end of the week, my cohort did final preparation for jukai, an inspiring ceremony in which we received the precepts. The day beforehand, our teachers led a session on the meaning of jukai. My cohort had begun a scholarship fund in honor of Roshi’s recently departed teacher, Bernie Glassman, and had raised nearly $10,000. We designated someone to present this to her. While we were at school, someone had the idea of us each folding a paper crane and writing a note to Roshi on it; someone went and found a beautiful branch to attach the cranes to. Someone else said we should learn a song to sing to Roshi, and so on and so forth. So on this day beforehand, Roshi came into the room to hear us singing the song, and she saw the crane tree, which was indeed a gorgeous thing, and then we told her about the scholarship. She was bowled over.

When I began this program, jukai had zero meaning for me, but by the time I did all the work to get ready for it, it had immense meaning. It was a really wonderful day. We meditated for an hour or so that morning in another temple on the property, and then the “Band of Joy” came to escort us to the zendo, where our family and friends and the cohort of chaplains after ours were in the audience.

I didn’t want to make anyone feel that they had to schlep to Santa Fe, so I invited only one friend who lives right there, but wasn’t sure if she would make it, per health issues. I told her it was fine if she didn’t come, or if she came and stayed for five minutes and then left. The ceremony was about 75 minutes long, and I was touched when I saw afterward that she was there, and had sat through the whole thing. We went up front in groups of three or four, and I feel that in those moments when Roshi was speaking to me, she truly became my teacher. It was a great week at school. It was fantastic to see my fellow students. I also had a good work assignment: grounds (i.e., making compost heaps), under the direction of a particularly delightful resident.

The Story of No Pizza

The first Saturday in March was the day of the long-awaited move of patients to the brand-new hospital at my paying job, a long-planned and staggeringly complex operation. I rode my bike to work for the first time in quite a while, despite the pouring rain. The new hospital has a lovely, secure bike room with lots of racks in it, plus a large number of racks outside the room for visitors.

The hospital provided free pastries and coffee for staff in the morning, and box lunches, but what I was really looking forward to was the pizza that was to be delivered at 5 p.m. While I was waiting for that, I went to every floor to look around. I noticed that, looking west, the view is of four churches. I went to the ICU and saw some of my newly arrived patients, including one who had just suffered such a horrendous family tragedy that she didn’t even know about it, because her husband had decided it was best not to tell her. (I believe she died without ever learning what had happened.) I offered the husband condolences. His first words were, “God is with me.”

The patient move seemed to go smoothly except for one patient who refused to leave his room at the old hospital. Last I heard that day, they had succeeded in getting him down to the emergency department, so I’m sure success was achieved in the end. I had seen chart notes warning that this or that patient was likely to die during transport, but none did.

There was only one glaring problem that day, to my knowledge. At 5 p.m., I rushed to the cafeteria along with lots of other staff members, only to see the same old pile of box lunches: no pizza. Someone said they had seen a huge amount of pizza being delivered, and we could all smell it, but they had stationed some guy in the cafeteria to explain to us that the pizza was only for “certain areas.” I was really kind of irate. It seemed wrong that they would tell us that staff would be getting pizza and then not provide it. It occurred to me that maybe the ICU was one of those certain areas, but I went back up there and it wasn’t. My mother sympathized. “It’s different than if they had said that at 5 p.m. there would be a salad bar.”

It was irritating to picture management on TV saying how great the move went—which it did, and they did go on TV to say so—while screwing people who worked hard to help make it happen. It was also kind of mystifying. How could this outfit successfully move more than a hundred patients, some of them at death’s door, across town without the slightest mishap and yet be incapable of causing pizza cooked by some outside entity to appear in the cafeteria?

Fuming, I set off for the parking garage. Before I could open a door on the ground floor where I needed to use my badge, someone on the other side opened it: the CEO of the hospital, Dr. Wrigley Bodacious (not his real name). I started toward the bike room, passing employees who were asking, “Where’s the pizza? Where’s the pizza?” Then I thought, “Wait a minute!” and I turned around to go have a word with Wrigley, who I’d never seen in person before. I walked back up to the lobby, where a security guard said that he had just stepped into an elevator, successfully eluding me.

At home, I gave Tom a call. He normally takes absolutely everything in stride, but even he was shaken: “That’s not right. People don’t forget a thing like that.” I came upon yet another flyer announcing the pizza delivery, which also had on it the number of the Command Center, so I called them. The guy there said he heard something had gone wrong with the delivery, but that they had pizza in such-and-such room if I wanted to come and get some.

The next day, I saw six or seven self-congratulatory emails from the move team, and replied to one of them expressing my disappointment about the pizza, and that’s the end of the story of the no pizza, as they did not reply. I hoped they would make this right in due time, but reckoned I would not be surprised if they didn’t, and to date, they have not.

Tuesday, May 07, 2019

The Funny One

I have been thinking lately about turning toward what is uncomfortable, the discomfort being sensations in my own body. (Where else could it be?) One place I am encountering an edge is in non-professional listening. There are people I find it incredibly difficult to listen to, and I think the same thing happens for some physicians, who listen to a patient in a leisurely, highly attentive manner for an hour, and then visibly tune out when I’m telling them something and get past the three-second mark (even if I’m answering a question they asked me).

I see that physicians work incredibly long hours and then often have families to tend to, so I know they need to make effective use of every half-second. I suppose it is a testament to their training and character that they can listen so beautifully to patients, and not a failing that they can’t do it with every person who happens to say something to them in the course of a day. As for myself, I aspire to listen to everyone in the same way, which means aspiring to bear the discomfort of fully attending to something I think is boring or irritating—but not always succeeding.

Clementine periodically trains a new crop of chaplain volunteers, and there are three new folks who go to County Hospital the same day I do who are quite young; at least one of them is just 20 years old. I heard one of them telling another about a visit to a room with two patients in it: “They’re both talkers. Like, talker talkers.”

At my paying job, I encountered a nurse in the ICU who had just switched to the day shift. He is a formidable mimic and was really making me laugh. Using a German accent, he said something about “German dancing—just using the arms,” and demonstrated, punching his fists into the air. I said, “You’re very funny,” and he said, “Some nurses are smart—I’m the funny one.”

At the very end of the day, I heard a physician saying to a patient right behind me in the ICU, “A chaplain is a good person to talk about that kind of thing with.” Then I noticed the physician had put a consult order in for a chaplain to see this patient, so I went to see her (as opposed to leaving because it was the end of the day). I knew from her chart that she had was having a recurrence of cancer. It turned out that she wanted me to facilitate a family discussion. I was excited to have the chance to run my own family meeting after seeing so many of them at County Hospital, and discovered that it was way more challenging than I expected: I found myself sharing words of wisdom in a way I rarely do speaking one-on-one with a patient. I think I was feeling pressure to drive toward a certain outcome, and so I didn’t just let things unfold naturally. I think it was basically fine, and I think the family was appreciative, but it highlighted that I’m really a very new palliative care clinician.

Late in February, I was paged to return to the hospital to offer a prayer for a patient in the ICU. I was fried when I got home and pondered the idea that I could end up having to return to the hospital twice the same night, which so far has never happened (and didn’t happen that night). I didn’t get anywhere near enough sleep and, the next morning, felt like my head was packed in cotton. I considered not going to County Hospital, but soldiered on.

I made it through the day. I didn’t attend any family meetings. I went with the team to see two or three patients, and I saw one non-palliative care patient and her son. The patient was reaching end of life and her son was quite upset. The patient herself, who had a dazzling smile, seemed almost jovial. I sat with a dead patient and her longtime partner for quite a while. (She said his final words to her were,
“You look so pretty.”)
 
My monthly palliative care class was about prognostication. We learned that fewer than two percent of patients and their families base their decisions solely on what their doctors say. Lived experience is given much more weight. (However, doctors are generally pretty accurate when it comes to predicting how much time a patient has left.) (Partly because they never say, “Thirteen minutes.” They say “Days to weeks” or “Weeks to months.)

The goal is to give people enough information that they have a sense of control, without overwhelming them, which makes it difficult for them to process what they are hearing and retain executive function. Therefore, communication may unfold over multiple conversations, in which clinicians try to discover where the patient or family member is in their understanding and to join with the person in her hopes and fears, and to make recommendations that are in line with the patient’s goals. It’s important to try to flow with what arises and to remain allied with the patient or family member; arousing resistance in the other person makes everything harder. It is important to remain attentive to the other person’s emotions and agenda.

Hoping along with another person is something we can always do, even if what they hope for is unlikely to happen. “I hope so much that that will happen. And I’m worried that we’re in a different place.” One might say both of these things in the same conversation, or split up into two conversations.

We had a guest instructor that day who said her two words are “wish” and “worry.” She said it can be good just to say, “I wish for that outcome” or “I wish things were different,” and then stop talking. Or, “I’m worried,” and stop talking, and see what the other person says.

Medical tidbits: A person can be sedated enough that she doesn’t realize her airway is obstructed enough to end her life. Medication that relieves nausea also lowers blood pressure, which may not be desired.

That day’s speaker, a physician, shared this quote, from Douglas V. Steere, a Quaker ecumenist (born in Michigan, near the tip of the thumb): “To ‘listen’ another's soul into a condition of disclosure and discovery may be almost the greatest service that any human being ever performs for another.”

The speaker offered a note to his fellow physicians re nurses: “Be nice to nurses. They keep your patients alive.”

During my internship, I had a patient who had survived with metastatic cancer for an extraordinarily long time. She is now gone, so what a lovely surprise to see a photograph of her in the speaker’s slide show, wearing lipstick and a big smile. The quote from her: “Everything takes longer than you think it should, thought it would, except your life.”