Wednesday, April 25, 2018

Resurrection

At County Hospital, I saw in the ED a patient who had gone on an alcoholic bender and was full of remorse. I myself am a recovering alcoholic and could easily have encouraged him to try AA again, blah blah, (or Refuge Recovery or some other group). But, channeling some things I’d learned at school, I reminded myself that this man was whole, not broken, and turned aside the impulse to offer solutions. I focused on sensing my body, which allowed me to feel along with this patient his disappointment in himself and his frustration. He mentioned that he had hated being forced to go to church as a child. Quite a bit later in the conversation, he said that he had disliked going to AA meetings. I noticed the parallel and, in a few words, pointed it out. He said, surprised, “Yeah! You’re right.” That was satisfying.

I want to be a chaplain to whom patients say, “Yeah, that is how I feel!” and not, “That’s good advice.”

It was Good Friday, and I had to smile when a patient being discharged from the ED, a small older Asian woman hauling a cart, said as she passed me, “Thank you! I’ve been resurrected.”

At the end of March, I had lunch at the Truly Wonderful Medical Center with Jodie, my supervisor for my first unit of CPE there. I wanted to ask her advice about how to meet the Association of Professional Chaplains’ continuing education requirements, if it was OK that I told the nurse I was disgruntled with my co-worker, and what she thinks about processing irritated feelings with co-workers. Should I not do that and talk to a friend or my therapist instead?

It was a gorgeous day and lunch was delightful, a big salad apiece. Jodie did have some thoughts about continuing education, and as for telling the nurse I was disgruntled, she said, “You’re a human being. It’s another thing if you go on and on about it,” which I didn’t. Regarding processing with my co-worker, she said, “You have to! You don’t want bad feelings festering.” I asked, “What if I’m furious at her every single day?” and Jodie said, “In that case, you would need to self-supervise, to decide what to bring up and what to let go of.”

I got an email from my boss asking me to establish a goal for this year, preferably one that is measurable. I suggested that maybe I could have one or two conversations a month with other care team members, whom we also serve as chaplains. She wrote back, “How about if you do two staff support events for each of your units by the end of the year?” I have three units and there is nothing I would less rather do, particularly now that I know all that school is going to require, but there didn’t seem to be much point in arguing or pointing out how much this is going to cut into my limited time with patients. I wrote back, “OK.”

Early in April, not so long after our joint visits, I learned that Jonas is leaving for a job closer to his home. I was happy for him, but very sorry to see him go. He is a really lovely person, and there is no other plausible mentor in sight. Chaplains at work include a couple currently in Clinical Pastoral Education, a couple who did their CPE last year (including me), and a couple who did their CPE the year before that, and that’s it, except for one person who did her CPE several years ago, but hasn’t worked as chaplain until now. I hope our boss will hire an experienced chaplain who can guide the rest of us.

My boss has been instructed by management that chaplains who are not yet board certified must progress toward this on a specified timeline—four years from hire date for per diems, such as myself—with deliverables for each year. This year I must write an autobiography. Fortunately, this task recurs over and over on the path toward professional chaplaincy, so I have any number of them to use as a starting point.

Tuesday, April 24, 2018

Flap

During the week at school in New Mexico, we did an exercise of applying the Four Noble Truths to an actual problem. (I loved hearing that Bernie Glassman, Roshi’s teacher, calls these The Four Opinions.) One of the members of my group shared how he tries to dig more deeply into issues: “I’m upset about this.” Why is that a problem? “Well, because of this.” Why is that a problem?

I soon got a chance to apply this when I noticed that a fellow student was making what seemed like quite a loud racket typing on her laptop. I grumbled to one of our teachers, who (correctly) said that I should talk to her (rather than about her), and that I might need to just “fold it in” (which was a nicer way of putting it than “get over it”). I asked myself why the noise was a problem: because she was the only one who was making noise. Why was that a problem? Because she was getting to do something no one else was getting to do.

Aha! It was a sibling issue: my sibling was getting more cookies than I was, which of course is intolerable. I recalled my father saying when I was a small child, “Life isn’t fair.” Indeed it is not. I then asked myself if I have ever been the one to get more cookies. Indeed I have been. And with that, the sense of separation disappeared: I am just like her. Sometimes she gets more cookies, sometimes I do. I did not need to speak with my peer, and the sound ceased to bother me.

There has been some rearranging of staff at my paid job lately, so I am now sharing the office with a part-time staff chaplain instead of one of the CPE students. While I was away at school, without consulting me, my new office-mate rearranged the furniture such that when I sit at the desk I usually use, my left elbow bumps the wall. I felt angry, not so much about the actual changes, which I’ll get used to, but that she didn’t check with me.

When I arrived on one of my units and a nurse greeted me and asked how I was, I said, “Disgruntled,” and told him about the new office arrangement. He asked, very mildly, “Have you talked to her?” I hadn’t planned to. I was going to try just to get over it, but I’m glad he said that because it caused me to realize, with chagrin, that I was talking about my co-worker rather than to her.

Jonas, my colleague and mentor (at the time), made his weekly trip to our campus and he and I and my furniture-moving co-worker had lunch. He and I were scheduled to do joint visits afterward, so when he ended up on a lengthy phone call with our boss, I decided this was probably my best opportunity to speak with my colleague. I told her I had felt dismayed at finding the furniture moved and that it would have felt good if she had checked with me first, since we share the office. She said she didn’t even think of that—when she saw an opportunity to “make things better,” she sprang into action. (She said that one reason it didn’t even occur to her to take my opinion into account was that I “work on Sundays.”) I tried to convey that “better” is subjective, and my colleague did apologize for not talking to me first, but a slight heat also crept into the conversation. Just then, Jonas got off the phone and my colleague said that we were discussing a difficulty, and Jonas said, in a jocular tone, “What? Who got offended about what?”

I said, “I don’t think I used the word ‘offended,’ but I was sharing that I felt dismayed about the change in the office.” Then we dropped the subject and a fourth person joined us and we discussed our palliative care patients and I felt worried that Jonas thought I was a big jerk, not to mention my colleague. I also felt worried that I’m going to end up losing this job because I can’t get along with my co-workers.

I thought about how this would have been handled in the corporate world and concluded that I would never have had this kind of problem, because there are basically just two kinds of people there: managers and everyone else. Everyone else doesn’t move the furniture, and if a manager causes the furniture to be moved, generally no one else complains. However, in CPE there is a huge emphasis on intra- and interpersonal dynamics and communication, so working as a chaplain seems to be kind of a gray area. It’s not quite the standard workplace.

Once the fourth person was gone, I said to Jonas, “Just wanted to see if you had any feelings about my sharing my dismay about the furniture move.” Jonas said, “Oh! No! I think it’s good that you shared your feelings. Some people aren’t bothered by that thing, and some are.” I was glad I checked.

He and I went off to do joint visits, which went very well. I watched him conduct one patient visit, and he watched two of mine. He offered several words of appreciation, about my interactions with patients and about my charting, and said at the end of the afternoon that he had enjoyed spending that time with me. When we were charting, he said, “You’re much more careful about the details than I am.” I joked, “Well, on the other hand, you probably don’t get upset when someone moves your desk.” He thought that was funny, and I felt I had restored my reputation as a not-completely-awful human being, in case that had been in jeopardy.

However, when I got back to the office, I found that my colleague had decided that a drawer in the desk I most often use would be a good place for her to put her random papers, even though it’s a shared drawer, not assigned to anyone. We each have a designated spot where we can put papers. I pointed hers out and asked, hating my self-righteous tone even as the words left my lips, “Do you want to put your papers there?” Ugh.

In the course of my time with Jonas, I finally learned what a “flap” is. I often see this in regard to patients with decubitus ulcers (bedsores), and had pictured a thick steak of flesh hanging from a patient’s body or draped over it like a small blanket. However, it turns out it’s a skin graft that is placed over the wound.

Monday, April 23, 2018

The Difficulties You Are Experiencing Will Always Be with You

The day after I arrived at school, I discovered a row of hooks located just next to the shower, and also that the person occupying the Monk’s Room was a female fellow student. The hairy legs had been some sort of elevation-induced hallucination. All of the people staying in this building were women. The week, of course, turned out to be mostly wonderful, and flew by. Our curriculum largely centered around the Buddhist precepts and systems theory.

I appreciated that they not only said that our contemplative practice is crucial to our work as chaplains but backed it up by including at least two hour-long periods of meditation in each day’s schedule, which involves 40 minutes of sitting and 20 minutes of other stuff: various ceremonies and rituals (“service”) and/or mindful walking (kinhin).

However, sitting in the zendo, where incense is in liberal use, proved to be the hardest part of the week. (Sam tells me that the San Francisco Zen Center and the Berkeley Zen Center long ago eliminated the use of incense, which the Internet tells me causes lung cancer and is just as bad for you as secondhand cigarette smoke is. However, I also hear that Roshi is “high church,” so I don’t think the incense will be going away.) In the zendo, as on my first night there, I sat with my head aching and heart pounding and my body urgently insisting that I get it to breathable air. I spent pretty much every period of meditation the entire week saying to myself over and over, “Just this moment, just this moment.” Which is not a bad thing to practice; my mind was not wandering. Periodically, I told myself, “The difficulties you are experiencing will always be with you,” just in case I started to think there might arise a moment of ease or even pleasure. This paraphrases something I once heard a teacher say on a retreat at Spirit Rock (where they also do not use incense). The teacher at Spirit Rock was quoting a Zen teacher.

During our very first period of zazen, one of our three teachers (two men; one woman; the latter is the founder of this Zen center and a powerful force in Buddhism and beyond) escorted us new students to another temple for meditation instructions. Another of my recurring bad dreams has to do with claustrophobic tiny doorways that get smaller as I’m attempting to pass through. The doorways for this temple don’t actively shrink, but they are extremely low, and all but the very shortest people have to crouch down to enter. Again, there was an exceedingly claustrophobic feeling. A third bad dream come to life in less than 24 hours. Come to think of it, I probably have also had a bad dream about trying not to be observed by strangers when my undergarments are not in place, so make that four.

I had already resolved to survive the week one way or another, but what made me feel much better was when our first class session convened and I saw Roshi in person for the first time. Something about her presence made me feel that all was well. During the course of the week, groups of four or five of us were called during meditation for dokusan, teacher interview. During my interview, Roshi mentioned how important it is to study the precepts so that we can trust our own good hearts as we do our work.

The campus turned out to consist of much more than one one-story building. There are 10 or 15 buildings, all different inside (all the same color outside) and full of wonderful objects and furniture, Tibetan, Japanese and American Southwest.

During the week, I got a clump of emails indicating that there was a problem with my endorsement from Spirit Rock, a crucial part of board certification. It had been a somewhat laborious process to apply for this. The Association of Professional Chaplains said the letter of endorsement from Spirit Rock was in hand; the problem was that they don’t recognize Spirit Rock as a faith group. My contact at Spirit Rock suggested via email that perhaps I’d like to do the work to get Spirit Rock recognized, which I would not like to do at all. Between paid work, volunteer work, even more volunteer work, and the immense pile of deliverables for school, I am not at a loss for things to do.

At the end of the two-year chaplaincy program at the Zen center, it is possible to apply for ordination as a Zen priest. This is at Roshi’s discretion and depends on whether she feels she has a good relationship with the applicant, who is expected to become a member of the center and attend at least one sesshin (five- or seven-day intensive meditation practice period) per year. I have zero desire to be a Zen priest—mainly, I don’t want the requisite clothing—but it seems to me that if there is the possibility of being ordained, perhaps it would also be possible to receive a letter of endorsement, which seems like a lesser thing. I asked the center’s expert on APC requirements about this and she said to ask her again in August. (I also checked with the APC after I got home to see if an endorsement from school would be acceptable, and they said it would be.)

I am hoping that, about two years from now, I will be able to receive school’s endorsement, which I suppose will also entail becoming a member and going there annually for a sesshin. If that doesn’t work out, I guess I will have to do the work to help get Spirit Rock recognized by the APC. Another option would be to go through the entire program of the Chaplaincy Institute in Berkeley, which affords ordination as an interfaith minister (and costs a lot).

I was pleased that I’d be taking a non-stop flight from Albuquerque back to San Francisco: big plane! But no—it was that same 48-seat midget plane. I have to go back to school three more times this year as of this writing, plus three times next year, plus once in early 2020, and potentially once annually for the rest of my life, so I guess I will learn to enjoy riding in that wind-tossed little plane, since it turns out there is no nonstop flight from Oakland at the time of day I need to travel.

Saturday, April 14, 2018

Executive Time

Late in March I went to school for the first time, a Zen center in New Mexico. Skip the rest of this paragraph if you don’t like to read about other people pooping. I flew to Los Angeles, went to the airport restroom, carefully wiped off the toilet seat (which already appeared impressively clean), put down a seat cover or two, and, magazine in hand, was enjoying a little executive time when the door of the long narrow stall slowly and inexorably swung open. No one had opened it. The latch had just come loose. Through the now-open door, I could see the face of a woman reflected in the long mirror over the sinks; she in turn could see me sitting on the toilet. I rushed to do a cursory cleanup and re-secure the door, which seconds later threatened to open again.

Then I walked for a long, long time and, just as I was wondering if I was even still in the airport, finally arrived at a tiny, desolate-seeming gate area. Boarding was announced and we walked down the gangplank, or whatever you call it. I performed my usual pre-flight rituals. Usually when I get to the plane, all I can see is the dark interior, but it dawned on me that I was looking at the sky. “This is the plane? Where is it?” I asked myself. I had to lower my gaze to see it: oh, down there. Once inside, I found that the ceiling was about two inches above my head, and I am only five feet six inches tall. It was intensely claustrophobic. I immediately regretted that I’d already booked the flight for my next trip to school, and resolved to take only nonstop flights from Oakland after that, which I assume would be in a larger plane. This one had just 12 rows of four seats.

As we approached Albuquerque, there was very strong turbulence, adding to my resolve never to set foot in a plane that small again. At the airport (“sunport”), I boarded a shuttle to go to Santa Fe. The mountains between the two cities were gorgeous. It was 32 degrees and snowing very lightly. We passed through downtown Santa Fe, where all the buildings are the same adobe color. When we arrived at school. All I could see was one small building. “This is the Zen center? Where is it?” I asked myself.

I went into the building to check in and a fellow student escorted me to my dorm room. I have a small set of recurring bad dreams, one being about treacherous staircases that become less and less navigable as I ascend. Sometimes this is a spiral staircase, and it turned out that my room was at the top of just such a staircase. I honestly don’t think I would have been able to get my heavy suitcase up it, but my peer, a good 10 or 15 years older than I—and I no spring chicken—gamely hauled it up, where I saw my two roommates (who both turned out to be wonderful) and one remaining bed. I hadn’t indicated on my questionnaire that I have any mobility issues because I didn’t want them to think I’m old.

Downstairs was a seating area with a fireplace, several other rooms for students, and a shared bathroom. I couldn’t see any hooks in the shower and wondered where one would hang her towel and après-shower attire. Right next to the shower was a room labeled Monk’s Room, and sure enough, I could see the hairy legs of some fellow sitting on the edge of his bed.

That night I lay in bed with my heart pounding and my head aching—school is at an elevation of about 7000 feet—as I labored to breathe and fumed about the lack of hooks in the shower and the presence of a man right outside the shower. I worked myself into a good snit (via what is called papañca in Theravadan Buddhism: proliferation of mind) and lay awake for at least three hours, increasingly irate. I resolved to leave first thing in the morning and never return. Then I mentally calculated if there is any feasible way I can otherwise come up with 48 units toward an M.Div. equivalency and was forced to conclude there is not.

By morning, I had decided to persevere for the remainder of the week, at least. The schedule was generously designed: an hour of zazen in the morning and in the evening. An hour of samu, or work, in the morning. My job was mainly cleaning bathrooms, a task I have successfully avoided at Spirit Rock for more than 20 years (and do not do often at home, either), but it wasn
t so bad. An hour for rest in the morning and another in the afternoon. Two hours of class in the morning and two in the afternoon. Sometimes we had another 75 minutes of class after dinner and sometimes we had the evening off. The food was wonderful. My cohort is 23 people: 19 women and four men. Precisely four people of color, all women, all Asian. All splendid people.

Friday, April 13, 2018

I Need Everything

On the day I was supposed to shadow the other chaplain in the ED at County Hospital, I arrived at 8:45 a.m. instead of 12:30 p.m., but it turned out the other chaplain was out. At first Clementine said I should just go to another unit, and she also took me to the ICU to introduce me to some of the nurses there, but when I asked if I could just go to the ED on my own, she said that would be all right.

I wandered around trying to get the lay of the land, checking in with the social workers and at the three different “pods,” as Clementine had instructed, and visiting with a patient or two. Maybe six different patients had police officers or sheriffs outside their rooms. One was wailing and looked quite miserable (the patient, not the police officer). I asked if I could visit and the officer said, “Sure, but keep your distance. He likes to swing his fists.” I went into the little room and the patient immediately beckoned me nearer, nearer. I stayed just out of reach and asked how he was doing. He said he was hungry and that his handcuffed wrist hurt and that he needed “everything—I need everything.” I conducted some of the conversation in Spanish. After a while, I asked if he would like a Bible and he said he would, an English version (though clearly his first language was Spanish).

When I stepped out of the room, a doctor immediately approached and said, “I noticed you were visiting with that patient. What did he say?” I said that he had said he was hungry and that his wrist hurt and that he wanted to go home. She said, “You’re the first person who’s been able to talk to him without him getting upset.” That was gratifying.

I fetched him a Bible in English, and also a Nuestro Pan Diario (in English, Our Daily Bread), a little publication that has an entry for each day with accompanying Bible verses. When I returned, he was eating a bag of nuts and the handcuff attaching him to the bed railing had been moved to his other wrist! So there you go: chaplaincy does actually do some good. He opened the Bible to a random page and began reading in halting English, which was rather touching. The police officer said kindly, “That’s very good.”

Later I encountered a man on a gurney in the hallway whose face was dripping with blood. One eye was swollen shut and one side of his head looked kind of mashed in. He told me his name and I told him mine and observed, “You have had a mishap.” This wasn’t the same as seeing someone with half their head blown off or their intestines trailing along the floor, but I was pleased to note that it was effortless to focus on the person rather than his injuries, and that the sight of the blood was not itself preoccupying or perturbing.

Thursday, April 12, 2018

Floss Mishigas

A patient at my paying job grumbled one day that he had been refused dental floss. I keep a container of floss at work, and decided to give him the whole thing. On my way off the unit to get it, I asked another care team member if it’s true that patients aren’t allowed to have dental floss. It is true: a determined person could potentially harm herself with it. The patient’s nurse confirmed that and suggested it would be better if I brought one of those little plastic single-use floss things (which one sees lying on the sidewalk everywhere one goes, which is revolting), but I only have actual floss, so I just brought two short pieces, definitely not long enough to fashion a noose from.

I had told the patient I was going to bring him dental floss, so I did, but as I performed this act of mercy, paranoia blossomed and grew acute. I could hear my boss asking, “What? You gave a helpless patient eight inches of deadly dental floss?” The image was so vivid that I returned to the patient’s room to ask for the second piece of floss back. He gave me the used one, too, and made it clear he thought the whole thing was ridiculous. I buried both pieces of floss in the trash container in a staff restroom.

A bit later, I came upon a family member trying to find his wife and escorted him to that unit. Along the way, I introduced myself as the chaplain on duty and he asked jovially, “Do I call you ‘Father’ or ‘Sister’?”

I said, “‘Father!’ I feel it has a more authoritative ring in our patriarchal society.”

When we parted, he shook my hand and said politely, “Nice to meet you, Father.”


Pursuant to the arrival of my new slightly larger refrigerator and noticeably smaller stove, Tom came over and pulled the refrigerator away from the wall so I could clean behind it. The building manager estimates my old refrigerator was purchased at least 40 years ago. It’s amazing that it lasted so long. The area behind and under it was definitely in need of attention. Since it was so filthy back there, Tom also pulled the stove out, and what was behind there was even worse, including an area that seemed to be coated with hardened oil.

Then I remembered F.’s habit of balancing a pan lid on the back edge of the stove while he was cooking us one of his (wonderful) breakfasts: eggs, potatoes, tortillas. I am sure that’s what caused all that oil to end up on the floor behind the stove, which means that at least had not been there for 40 years.

As swap day arrived, there was less and less food in the refrigerator and certainly no produce. The day the new appliances were due, I had a meal that might be called Walnut-Anchored Greasy Sesame Millet Mound. 

Monday, April 09, 2018

GSW

As mentioned, I was starting to feel a little bit frustrated with Clementine over at County Hospital because any number of enticing possibilities had been mentioned in my first six months there without a single one of them coming to fruition. She had said that I might like to work with the palliative care team, or with forensic patients (prisoners), or on the psych unit, or in the ED. Those all sounded great except for the forensic patients. I’m not scared of them; I’m susceptible to getting crushes on them. In any event, none of those things had happened.

More recently, she asked if I’d like to be trained to hold babies in the NICU (neonatal intensive care unit). My school requires volunteer work, so I told them I was volunteering at County Hospital as a chaplain, but they said that would not do—a person who wishes to be a hospital chaplain should find some volunteer work other than as a hospital chaplain. I loved the idea of holding babies in the NICU, because: babies! And I also thought it would be both an intensification of chaplaincy work—because what is worse than a baby dying?—and also a nice balance for it, in the case of babies that get well and go home with their families.

Clementine said to email County Hospital’s volunteer coordinator and ask about training, copying her. I also sent school a note making the case outlined above. I was pretty sure they were going to reiterate that I should not do my volunteer work in a hospital, period, but they wrote back and said this sounded like an excellent idea. However, after I sent my note to the volunteer coordinator, Clementine replied to both of us and asked that this be put on hold until she could speak with staff members in the NICU.

At this point, I started to feel distinctly disgruntled: Why can’t I hold babies in the NICU, since presumably any old person off the street can apply to do this? When I arrived for my volunteer service one Friday afternoon, I asked Clementine if there is an existing mechanism for people to be trained to hold babies in the NICU, and said I was worried that if I didn’t get going with that, I’d end up having to pick some other volunteer work for school, and then I wouldn’t have time to hold babies in the NICU, and I really want to hold babies in the NICU!

She said there is a mechanism, but that the NICU has had bad experiences with chaplain baby holders in the past, and she would actually like several of us chaplains to be trained to do this, so she was worried that if I went ahead on my own and got turned down, it would wreck things for the other chaplains. She said that she would move talking to the NICU higher on her to-do list. At just that moment, we were nearing the office of the exact person she needed to speak with, and she marched over and knocked on the door. The person wasn’t there, but my frustration dissolved completely at that moment. Clementine is a totally remarkable person, and she is doing the work of about five people.

Not only that, but that same day, she took me to three units where she would like me to serve and introduced me to other care team members. We spent about 90 minutes together, which itself was a big treat. In the NICU, she showed me the labor and delivery area, and postpartum. She said that the mother of a dead baby is often put in a room in labor and delivery rather than postpartum, so she doesn’t have to hear other people’s babies crying.

Then we visited the ED, which is vast. She pointed out what color gown means the person is a psych patient, and what color means the person is a fall risk. She said it’s fine to say hello to any patient in the ED, and that you can basically round in there continually for a whole shift, since things change so often.

She said it might take six months for people to warm up to me in the ED. The staff tend to be less religious—she said some lose their faith because of what they see there—and accordingly tend to have more negative projections onto chaplains; e.g., the chaplain is a Christian zealot who seeks to proselytize. I hope this does not prove to be hubris, but it seems to me that nothing I see could cause me to lose my faith, because my faith is in the laws of nature themselves: this causes that.

She said some chaplains always wear gloves when they are in the ED, which is optional except that if there is blood, I should wear gloves. And I should refrain from ever saying to another care team member, “Hope the rest of your shift is quiet,” because that is a jinx.

She said that the hospital has a joke about what kind of high school students go into what kind of work in the hospital. She gave several examples, but the only one I can remember is that it’s the students who smoked and cut class who end up working in the ED. In my era, we called these people, of which I was one, “burnouts.”

Clementine said that, after a murder, the family often wants to see the deceased patient, and that the only person who can grant permission for this is the medical examiner, not the detective or anyone else. And she said that frequently the M.E. gives white families permission to do this and refuses permission to black or brown families. She said that sometimes when people grieve, it is loud and physical. People may scream and pound the wall, and when those people are large black men, they tend to get a negative response. She said not to ally myself with the M.E.; for instance, not to sit next to him in family meetings.

She reminded me that County Hospital has the city’s only Level 1 Trauma Center. Gruesome car accidents, murders, gunshot wounds (the abbreviation used in charts is “GSW”), children who are thrown down the stairs—or worse—by their own parents end up there. Our mayor died there not long ago. Quite frequently a car pulls up outside carrying a gunshot victim, a rolling crime scene quickly encircled in yellow tape. Clementine warned me, “There are things you can’t un-see.”

(If you have chest pains or are short of breath or break your leg, you would do well to come to the ED at the hospital where I do my paying job. This could mean the difference between waiting for ten minutes and waiting for six hours.)

Clementine said that working in the ED has some things in common with disaster chaplaincy, that it demands one’s very best self-care, and that I should debrief with her or the head of spiritual care after a shift in the ED as necessary. She said the staff there deal with a tremendous amount of trauma, and some do better self-care than others. She pointed out that besides the emotional highs and lows, there is an intense body process of adrenaline spiking and draining away; plus, it can just be heavy physical work.

She instructed me to shadow another chaplain in the ED on my next shift, and after that, she said I could be an ED chaplain! I was thrilled—this is probably the most intense hospital chaplain work in the whole city—and also a tiny bit nervous. I am at ease with ill and dying people, with bereaved people, and now with dead people. But I do not like gore, so it appeared that this would be a growth experience. (However, there is one significant perk: Visits in the ED don’t get charted.) Maybe if I can get the hang of this, when I’m old(er), I can travel the world as a disaster chaplain.

Thursday, April 05, 2018

Frenchly

After a couple of months of mindful non-dieting, I was forced to admit to myself at the beginning of March that my work clothes were slowly but steadily becoming more snug. (My non-work clothes are such that I could weigh 300 pounds before perceiving any discomfort.) I concluded that, after all, it just works best for me to diet most of the time and binge some of the time, and that potato chips simply cannot have any place in my life, however modest. I set about constructing a restrictive eating plan, but as the minutes passed—this whole episode lasted about two hours—I felt more and more gloomy and finally realized the mistake in my thinking.

It cannot be that there is no way to eat potato chips and not gain weight. It might be that your entire diet has to consist of just ten potato chips per day, but there must be a means of balancing intake and caloric expenditure eating whatever you want—don’t the French do this? Decades ago, my mother and I embarked on just such a diet, calculating how much chocolate we could eat if that was the only thing we were going to eat. It didn’t work very well at all, but that’s because we ate our day’s allotment of chocolate by 10 a.m. and then ate a whole bunch of other stuff. The principle was perfectly sound (if you overlook the health effects of eating nothing but chocolate).

I decided to continue with my mindful eating and with not having any forbidden foods other than sweets. I could probably get to the point where it would be possible to eat just one cookie, but what’s the point? With relief, I wrote all the yummy stuff down on my grocery list again, and turned to focusing my attention on hunger and not-hunger, trying to notice the point during a meal when the feeling of hunger can no longer be detected. I could hear the mild complaining from my head when the point of not-hunger was reached: But I was planning to have such-and-such! I could tell right away that this was going to be fruitful as far as the fit of my work clothes, which proved to be correct.

Tuesday, April 03, 2018

Lunch with a Mentor

One Sunday at work (still in late February) I talked with a fellow who suffered a terrible injury while trying to help a neighbor, a person who, according to the patient, never acknowledged this injury or apologized or went to visit the patient in the hospital. This led to the loss of the patient’s job, followed by the loss of his house. I felt like weeping after I left him.

I am always aware that I am hearing just one viewpoint. Maybe right before this patient did his neighbor a good turn, he burned down his neighbor’s barn: maybe there are aspects of the story that weren’t mentioned that explain everything. However, I do believe that every story is true on a psychological level, and it is very possible that what a patient or family member shares is the literal truth on every level. It is certainly true that people in this country lose their savings, jobs and homes after becoming ill or being injured while others enjoy first-rate medical care and the best of everything every day of their lives, and it is this that made me feel like weeping, from rage as much as from sorrow.

It has dawned on me that there is much to be learned from the chart notes of other chaplains, from which I am stealing shamelessly. At least, there is much to be learned about felicitous phrases to put in a chart note, and from those, I get an idea about what other chaplains are focusing on. I’m glad there are plenty of other chaplains in my group, even if I rarely see any of them.

Along around then, I had lunch with Jonas, for whom I’d stored up several questions, including how he responds when a patient asks if the conversation is confidential; I was thinking of the psych patient mentioned earlier. Jonas said that when a patient asks, “Is this between us?”, he doesn’t start by saying he’s a mandated reporter. He says something like, “I hear that you’re concerned about me telling someone else what you share with me. Let me give you the rundown.” He then tells the person he has to report it to an agency if a patient tells him about child, elder or partner abuse. He might say, “I will also share with the rest of your care team what would help them to help you heal. I don’t have to share specifics.”

In regard to asking if the patient has support from others, which Delia at the Truly Wonderful Medical Center said not to do, lest it make a patient with no friends or family feel bad, Jonas said he starts by asking a broad question about support: “What is getting you through this?” People might mention other people right away. If not, he might follow up with, “Are there people who are helping?”

He said he does ask people why they’re in the hospital. He probably already knows this from their chart, but this is a way of finding out what the patient understands: “What landed you here?”

In answer to another question of mine, he said that if the parent of a child patient says right away, “We’re fine,” that’s that. The parent has the right to make this decision and the chaplain should leave the room. However, we might want to tell the social worker about this response, and we should definitely chart it.

If the spouse or partner of an adult patient immediately says, “She’s fine,” we can say “OK” and leave (or give a brief introduction to spiritual care services and leave), but Jonas said we should go back later to talk to the patient when she is alone. Jonas said he can be very direct in such conversations and mention that sometimes a partner may want to keep something hidden. We can also ask the patient how she thinks being a caregiver is affecting her partner.

If Jonas knows something important about a patient, such as that he has just gotten a serious cancer diagnosis or is recently bereaved, he might say later in the conversation, “There is something I was hoping we might talk about, but it’s something that might be difficult for you to discuss.” If the patient says, “My mother died, but I’m fine,” then Jonas said we should drop it: we gave the patient an out and he took it.

Jonas said he does sometimes say “I’m sorry” to a patient, usually adding what specifically he is sorry about. He might typically do this when a patient is very emotional. He might say, “I’m sorry that this is so difficult for you.” Clementine at County Hospital also said she sometimes says she is sorry, though it can be risky. Sometimes the patient will say angrily, “What are you sorry about? You didn’t cause [whatever horrible thing has happened].” Clementine said that when she does say it, she makes sure it’s not the last thing she says, because then people feel obligated to say, “It’s OK,” when it is not OK. So she might say, “I’m so sorry this has happened. I can see how sad you are.”

Monday, April 02, 2018

All Stories Are True

At County Hospital late in February, I had a long chat with a fellow who was “right as rain” until late November, and then suddenly stricken with a mysterious and rare illness. I think he appreciated having the opportunity to tell his story to someone who had plenty of time to listen to it. I have read and I believe it is true that when we have a traumatic experience, we need to tell the story X number of times.

I also had a conversation with a woman who seemed at first perfectly well, but by the end of our talk, I was starting to think she was not at all oriented to reality. I shared some of what she said with a couple of my fellow chaplains, one of whom responded with the James A. Owen quote, “All stories are true. But some of them never happened.” I believe that. If it is not literally true that this woman’s cousin is paying agents of darkness to bedevil her in such-and-such ways, it is true in some other way, perhaps in that she feels alone and endangered.

She was having physical symptoms, so I encouraged her to go to the ED and offered to walk there with her, but she said, “No, no, I’m fine,” and hurried off. I could see in her eyes that she had just realized she was dangerously near a parole officer.

I left the hospital late—there was a crisis with a premature baby toward the end of the day—and scurried over to a Market St. karaoke lounge to go to a friend’s birthday party. There were several people there whom I knew. My friend was joyful and bursting with life in a red dress, and I also got to meet her two darling sisters for the first time. I briefly considered getting up and singing a Metallica song. I think that would have been a crowd pleaser: 55-year-old me with my rapidly whitening hair and conservative chaplain clothes, but after a while, I realized that the songs somehow all sounded the same, I guess because the arrangements and accompaniment were generic. The place was hellishly loud, making conversation impossible, and there was a two-drink minimum, so before I had to order a drink, I gestured to my friend that I needed to go.

I was getting hungry, so I went to Whole Foods, a place I normally hate, but which now seemed an oasis of quiet and calm. I got two pieces of pizza to eat while walking home, a rare time-saving exception to my mindful eating practice. Just as I finished the first piece, I encountered a homeless woman sitting on the sidewalk. It had been unusually cold and windy, and as much as I was looking forward to that second piece of pizza, which was the more desirable one, I could hardly have two while this woman had none, so I said, “Would you like a piece of pizza?”

She said, “I’d love a piece of pizza! I don’t want to suffer any more. Please don’t talk to me.” I handed her the pizza and said, “Would you like a napkin?” She reached up her hand and I handed her all the napkins. As I walked away, she asked, “Are you homeless?” “No,” I answered, and for some reason, I felt like weeping.

That night I slept for 11 hours, and dreamed that I was playing the trumpet beautifully, with mastery and ease. I also dreamed that Sam was tending to a patient in the hospital with great warmth and tenderness, and that the patient was very pleased.

A couple of days later, I went to Sam’s goodbye party at the Zen temple where he had been living. He has gotten a job in hospice, the second person of our CPE cohort to gain employment as a chaplain.