Saturday, August 18, 2018

End of Life Options

Earlier this year, a new person moved into my apartment building who demonstrated some behavior that I have judgments about: she told an outright lie in order to gain occupancy, which I think I mentioned here. I gave her a little lecture in my mind, and then quite a few more. I came to think of her as a bad person. She proved to be a major door slammer, and every time I heard her door slam—about eight times a day—my lack of charity grew. Months passed without my laying eyes on her, though her front door is close to mine. When the day finally came that I encountered her, I walked past her as if we were two strangers in the corridor of a downtown office building. It didn’t feel good, and I resolved that the next time I saw her, I would make eye contact and say hello.

More recently, I was entering the front door of our building, my bicycle panniers loaded with groceries. My neighbor came up behind me and said, in a very sweet voice, “I can hold the door for you.” She held the door, and I barely looked over my shoulder—I didn’t even see her face—and mumbled, “Thank you.”

Moments later, I felt heartsick. I had taken one fact about a person—she told a lie—and used it to make her into a non-person who could be treated accordingly. Thanks to studying the precepts for school, I was unable to stand the results of my own actions for more than 15 minutes, and went to knock on her door. She didn’t answer, so I sent her the email below. I reflected that while she took an action I deplore, I don’t know why she did that, and I still don’t know much else about her. It was a powerful reminder to be aware of what information I am taking in and what conclusions I am drawing, which may be entirely wrong, and also a reminder not to tell and retell myself judgmental stories about someone else. 

Dear [Neighbor],

Thank you for helping me with the door today.

I have not been friendly to you the time or two we have encountered each other—in fact, I have been rude, and I’m sorry. Please forgive me. You may rely on my being a better neighbor henceforth.

(I knocked on your door a couple of times today, as I would rather have spoken in person, but found you not home.)

As long as I’m writing, I would be appreciative if it would be possible for you to close your door a bit more gently when you go in and out. :-) Please let me know if there’s anything I’m doing that’s bugging you.

Best,
Bugwalk


I got a really nice note back from her, in which she said she would try to do better with the door. For a few days, it actually did seem a little quieter, but soon she was back to her normal ways. It bothered me less, though, because I had at least said something.

At work, I made a second visit to a patient who is very sad and discouraged, not sure if he wants to be here. I’m trying to develop ways of allowing lots of silence without it seeming really odd. One question that has perplexed me: where do I rest my gaze during these moments? Staring into the patient’s eyes is obviously not good, and looking just past his or head seems nearly as bad. I can imagine the patient asking in the first case, “Why are you staring at me?” and in the latter, “What on earth are you looking at?”

With this patient, I chose a spot on the floor fairly close to the edge of his bed and pretended it was a TV that we were watching together. I took five leisurely breaths; out of the corner of my eye, I could see the patient look at me once or twice, probably wondering what was going on. After five breaths, I looked at him and half-smiled, letting him know I was still with him, and then I looked back at my spot and took five more breaths. During this time, I was conscious of my own discomfort and strong wish to break the silence by, if necessary, veering off into a social conversation. However, I made it to the end of the second five breaths without saying anything, and then the patient suddenly said something about a big decision he is trying to make, the first I’d heard of it.

This patient has the means of taking his own life available at home, which he mentioned several times during our first visit. Every time he said it, he looked at me with a fearful, semi-daring expression that I couldn’t quite interpret. Does he think suicide is terrible? Did he assume I think suicide is terrible? Did he think he was saying something extremely shocking? Was he afraid I would yell at him? 


He mentioned it again in our second visit. I mentally weighed my dislike of giving a lecture—really, imparting any information whatsoever that hasn’t been asked for—with the possible helpfulness of what I might say about this, and decided to offer my views, which are based in tenets of palliative care. I said, “I think that can be a reasonable choice in some situations. I think we want to make sure first that symptoms such as pain, anxiety or depression are being well addressed. It’s also important for people to know that they will be supported and cared for as time passes.” This seemed to make the patient relax a bit; he let out sort of a sigh. Many times, when a patient wishes to exercise his rights under the End of Life Options Act, it is because he has symptoms that are not being properly managed, or he fears that his needs will overwhelm others and he will end up being abandoned or not cared for. Most particularly, depression is correlated with patients wanting to end their own lives.

Saturday, August 04, 2018

Just Too Hard

At County Hospital, I started one day by holding a baby whose nurse said he was withdrawing from drugs, quite a handsome little fellow. After baby holding, I reported to the chaplain office, where Clementine asked if I would like to back up the palliative care chaplain while she was away for a month, which of course I said I would be happy to do. She immediately dispatched me to see one palliative care patient and to attend the family meeting of another. Until that day, I had been asked to see only one or two palliative care patients the whole time I’ve been volunteering there. I offered guided meditation for pain to the first patient; she said afterward that it had been helpful and relaxing.

The family meeting was 90 minutes long and involved the patient herself, three family members in the room, two on speakerphone, me, and two doctors. As at the Truly Wonderful Medical Center, I was very impressed with the leisureliness with which the doctors conducted this meeting, allowing time for everyone to say everything he or she wanted to say, no matter at what length and no matter how far off topic. The doctors were generously affirming of positive sentiments: “That is beautiful! Wonderful!”

I had been told before the meeting that the patient didn’t really want any more treatment, but that the family was insisting on it. The doctors let the relatives express all of their hopes for the patient’s recovery, and then one doctor very gently, in an almost offhand manner, said that doctors take an oath not to cause harm, and have to consider how patients experience the treatment that is offered. “We want to do what is right, and what is best. Sometimes what that is is not clear. And it can change over time.”

One family member said he had initially felt strongly that the patient should proceed with treatment, but now had decided he would support whatever the patient wanted to do. However, another family member was exceedingly forceful in expressing that the patient must continue with treatment. This person leapt up to kiss the patient’s face over and over and was so emphatic that the patient, who could barely speak, eventually said—she was the last person invited to speak—that she wanted to continue with treatment.

The doctors expressed that sometimes a patient will continue treatment because that is what his or her family wants, but maybe the time comes “when it’s just too hard.” This particular patient often refuses medication or other treatments when none of her family members is around, but the insistent relative said this will not be a problem because, since there are several family members in the vicinity, there is no reason someone can’t be at the hospital every minute of every day. At this, another relative pointed out that many of the family members are elderly or have health problems of their own; the doctors validated that trying to be on the scene constantly would be very difficult.

But no matter. It was decided that the patient would continue with debilitating interventions, by her own wish, and the doctors seemed perfectly at peace with that. At the end, I asked the family if they would like a prayer, and they said they would. I murmured to the doctors, “I’ll offer a prayer after you leave.” I figured that, after 90 minutes in the room, the doctors probably had 20 new text messages apiece and little interest in hearing a prayer. Clementine said later that that was the right call. Half an hour after the meeting ended, I was near that patient’s room again and, needless to say, no family members were present. It just is not realistic for most families to staff a hospital room 24 hours a day, potentially for weeks or even months.

The final thing I did that day was to lead the weekly half-hour meditation, which happens in the chapel. Two patients and two staff members attended. One of my favorite things about volunteering at this hospital is never knowing what the day will bring.

While with a patient at my paying job, I had a brainstorm and asked, “In all this, what is the emotional terrain like?” We have a series of questions we’re supposed to get answered, perhaps chief of which is to determine if the person—uh, let me look at that piece of paper—ah! We’re supposed to find out if the person considers herself spiritual or religious. This is very awkward to ask when you’ve known someone for just two minutes.

When I asked the patient about emotional terrain, he readily told me about feeling sad and discouraged after surgery, wondering if he should even go on. Then I asked about his “human landscape” and he told me about his family and friends, and then, without my having said a word about it, he told me about his spiritual beliefs. I didn’t bother to write these questions down on the multi-page cheat sheet I carry around. I have probably made 400 pages of typed notes since starting to learn about chaplaincy, but all that matters is what I’m able to remember in the moment, which is very little, but hopefully will grow over time.

We’re also supposed to put as many exact quotes as possible in chart notes. Some of my peers have one long quote after the next in their chart notes; I often find I can’t recall a single sentence, though my boss said, in that case, quoting a word or two is fine. I would like to have much better recall, so I have a new goal of remembering just one sentence spoken by each patient, word for word.

Friday, August 03, 2018

Or Maybe The Disgruntled Disinterred

I am in the process of renewing my passport, so I can get a REAL ID (like next year when the lines at DMV are less than six hours long), and went to Walgreens to have a photo taken. I could not believe how terrible I looked in this picture. If I could find four other people of similar appearance, we could start a band called The Peevish Cadavers.

Recently I sat with a patient in the emergency department at County Hospital, consciously leaving plenty of silence. She told me that earlier that day, she had felt short of breath, so she had come to the hospital. We fell into a rhythm of silence, another detail or two emerging, then more silence. Suddenly she said, “They found a mass on my lung. I may have cancer.” I’m not sure she would shared that if there had not been plenty of space in the room.

I have noticed that in some visits, I can fall into helping to fill every moment with words, even if that means having a social conversation (“Did you hear The Peevish Cadavers are playing at Cow Palace soon?”). I am sure this is due to some discomfort of my own that I can’t tolerate, maybe even just the discomfort associated with silence. Wishing to change my own state, I talk, and maybe the person does not end up telling me about the mass in her lung or the recent loss of a loved one.

Very often, a patient will describe her situation to me and then say, “But I’m grateful! I’m getting good care, and others have it much worse than I do.” I increasingly find this poignant. While I appreciate and even applaud the impulse to practice gratitude even at the grimmest of moments, and while it is likely factually true that others have more serious prognoses, I think the patient is saying, “I don’t deserve your care and love, and I am ashamed to be seen asking for these things.”

I appreciated this in Reb Anderson’s book Being Upright: Zen Meditation and the Bodhisattva Precepts: “We must be careful not to use the immense suffering of others as an excuse to avoid awareness of our own pain. In fact, if we refuse to listen to our own suffering, we will not really be able to listen to the pain of others.” I would like to find skillful ways of introducing this perspective when I hear a patient say that others are the ones truly deserving of tenderness.

I called Emily in hospice late in June and ended up feeling kind of distressed after she described various difficulties she is having. She said that she is woken up each day at 6 a.m. so her diaper can be checked; getting up so early makes the days very long. A few hours later, she is bathed, which she said causes a good deal of physical discomfort. She is down to zero limbs that are free of pain, but when she expresses this to the aides who are bathing her, they say they have to do it that way or risk injury to themselves. Emily said she doesn’t want anyone else to suffer, either, so she tries not to complain too forcefully. I wonder if a sponge bath every other day would be sufficient, since she is not exactly working up a big sweat on a regular basis.

She said that when she was out on the back deck—a lovely place, as I recall—another patient asked if it would be all right if she smoked. Emily didn’t want to say no; she said she understands what it’s like to crave a cigarette. The smoking patient was joined by a smoking staff member, with the result that Emily found herself craving a cigarette, too. I have mixed feelings about that one. She is proud of having quit smoking a few months ago (because she couldn’t smoke in the hospital), but at this point, it probably doesn’t really matter that much if she smokes.

Finally, she said that workers at the hospice, when they see her crying, tell her, “Don’t cry!” I asked if they seem to mean well, or if they are just being unkind. She said it seems like the latter. This made me angry. Why is it bad to cry when you feel sad? Emily said, “Maybe they have difficulty with their own feelings.” That would be my exact analysis. She begged me not to mention any of this to the staff. She doesn’t want to be perceived as a troublemaker.

I felt bad for her after we hung up, and also chagrined that I had inadvertently told her a lie when I said that hospice was a nice place. It is not proving to be very hospitable from her perspective.

Wednesday, August 01, 2018

Warmer

The day Clementine at the County Hospital told me about the eight upsetting things that had happened, I came home and told all of them to my mother on the phone, who said afterward, half joking, “I needed to know all of that.” Of course, she didn’t need to know any of it, and it’s not fair of me to dump that kind of stuff on her. I remembered one of my CPE supervisors saying she doesn’t tell her husband what happens at work: “He isn’t trained to deal with trauma.” Neither is my mother, so the next time I talked to her, I apologized and said I won’t tell her disturbing stuff from work anymore. She said, “Well, you can’t keep it bottled up! It’s OK to tell me.”

That was very kind of her, but caused me to start thinking about the bottling-up thing. Is it bad to keep stuff “bottled up”? My boss at work told me that listening to someone spew out a story they have told many times before does not necessarily constitute quality spiritual care. The person may just become even more anxious in the retelling. She said that she has noticed that when she obsessively retells a story of her own, she can feel increased anxiety. Even my therapist, for goodness’ sake, lately said that revisiting an upsetting story isn’t necessarily therapeutic. I’m perfectly capable of insisting on telling a story whether she thinks it’s therapeutic or not, but what if she is right? What genuinely is helpful in this regard, for me and for my patients?

I decided that spewing forth a story is the verbal equivalent of being lost in thought and that I wouldn’t do it anymore: I wouldn’t tell my mother and I wouldn’t tell anyone else. And within a couple of days, I felt exhausted and sick of the whole chaplain thing. It even crossed my mind that maybe I would actually rather sit in front of a computer at a bank, a very rare occurrence these days. Clearly I was no longer on the right track. I thought of that childhood game where the other participants tell you if you are getting warmer or colder. I was getting colder.

I decided that I need an appropriate confidante, but who? I decided it should be another chaplain, maybe one of my colleagues. I was paged that night to the emergency department at one of our campuses to say a prayer for a patient who, not yet 60, had died very unexpectedly, alone in his office. The next morning, doing turnover, I mentioned this to two colleagues, though there was nothing either of them needed to do about it. They both were kindly supportive. One reminded me to practice self-care as I integrated this experience. That was really nice of them. We encounter death so often, it in some ways comes to seem like no big deal, but it actually is. Maybe the colleague who said I should remember to take care of myself would be a good confidante, or, at the least, I should remember to tell my team what I’ve lately encountered and ask how things are going for them, so we can support each other. After my exchange with my colleagues, my enthusiasm for chaplaincy magically returned.

Wednesday, July 25, 2018

I Get by With a Little Help from My Friends

Maybe a month ago, a nurse at work instructed me not to chart at her unit’s nursing station. I was immediately indignant. My very first CPE supervisor told me to chart at the nursing station. This is part of integrating myself into the units I serve, which is potentially all of them. She also said, as a rule, not to ask a patient’s nurse for permission to visit the patient, but to remember that I am also a member of the care team.

Later that day, I mentioned this to my boss, who also seemed immediately indignant. Her initial response was to tell me to go ahead and chart at the nursing station, but later she said to discuss the matter with the nursing supervisor, so I wasn’t sure how to proceed, but, being myself, was inclining toward announcing, “I’m a care team member and I’ll chart where any other care team member charts.”

The unit where this happened is not one I’m assigned to, so I sent my colleague who is the unit chaplain a note asking what her experience has been and if she had any insights that would be helpful.

Perhaps it was that same night that I got a page after hours asking for a priest. I called the church that is supposed to handle after-hours requests and got what they call in the corporate world a significant amount of pushback. It was possible that the need would end up being the following morning, so I called the priest who is one of our staff chaplains, and left him a message saying he might be needed first thing next morning at a particular campus.

It did end up working out that way, so I left our staff chaplain a message about an hour before our normal start time (actually 90 minutes before, because I temporarily forgot what our normal start time is) asking him to report directly to the ICU in question, if possible. I then texted him apologizing for having phoned him both after and before hours. He texted back saying he would go straight to the ICU to meet the patient’s need, and also that I should tell our boss about what had happened. But what had happened?

I asked what he was talking about: the other priest not having wanted to come to the hospital at night? My having called him outside of normal working hours? Both? He hastily backed off, saying I should do whatever I thought was appropriate, which left me, as with the nurse not wanting me to chart at the nursing station, confused about what to do next.

I went ahead and sent a note to our boss, copying our priest, outlining the entire sequence of events, and ended by saying that my purpose in sending this email was to let our boss know that there is some difficulty getting the priest from that particular church to come after hours. I also said I would welcome some direction as to when it’s OK to call our own priest.

The next time I was in the office, I saw that there had been no response whatsoever from 1) my boss; 2) our staff priest; or 3) my colleague in regard to where to chart on her unit. Now I was starting to fume. This was a Sunday morning. Soon the office phone rang: our staff priest. When he asked how I was, I grumbled that I had done what he had asked me to do—tell our boss something or other—and then neither of them had responded!

He said that he and our boss had continued the email exchange without me, which was fine, since my goal was not necessarily to send and receive email but to have the information I need in order to do my job. As to that, our priest explained that outside priests often have a lot on their plates, and that we should be understanding of that, and that if necessary, it’s OK to call him, our own priest, and it is certainly fine to call him with information he might need first thing the following morning. That was basically what I needed to know. (Although now that I’m writing this, I realize I still don’t understand why he wanted me to say anything at all to our boss.)

As long as I was on the phone with him, I asked what he does if he is discouraged from charting in a certain area. He said, “I might be understood as a coward,” but said he just saves his charting up and does it in his own office. That was helpful in that it made me feel there was no dishonor in not going to war with my colleagues.

Later that day, I also discovered that my fellow chaplain actually had sent a response to my question. It wasn’t in my inbox in the messaging system; it appeared as a comment on my original note. Fortunately, I enjoy reviewing messages I have sent so I can appreciate my own sparkling prose for a second or third time; that’s the only reason I saw her response, which was that if the nurse asks her politely to go chart somewhere else, she doesn’t mind doing that, but if the nurse is rude, I should discuss it with the nursing manager. She has told me in the past that those exact nurses are among the unfriendliest she has encountered.

At this point, I felt fine about not insisting on charting at the nursing station, and relieved that I wasn’t obligated to get into a fight about it. My colleagues, who both had initially annoyed me, ended up saving me.

Thursday, July 12, 2018

Inspect Ladder Before Use


The aluminum ladder whose leg suddenly gave way, resulting in grievous injuries for an esteemed relative. (The thinking now is that a wooden or fiberglass ladder might be safer in that it might make a creaking noise or something before failing.)

(Click photo to enlarge.)

Monday, July 09, 2018

Schwing Schwing Schwing Schwing

(Or is it just shwing?) This refers to Wayne’s World 2, featuring Aerosmith, one of the movies I watched with my mother while visiting Ypsilanti early in June. We also saw Miss Sloane (we both liked it a lot), The Florida Project, Into the Wild (for the second time), Wonder Woman, Nightcrawler, Boyhood, Get Out, Assault on Wall Street, and probably several other movies I’m forgetting. I got caught up on my MSNBC and Rachel Maddow, and enjoyed spending time with my parents and the cat that hangs around their place a lot, Jack. I had lunch with Ginny at Café Zola and with Amy at Seva. My sister came over three times, and I had lunch with my uncle and his wife at Haab’s, in downtown Ypsilanti. As for Wayne’s World 2, that was my mother’s idea. She normally dislikes comedies, but thought it would be good to have some familiarity with a work that is so well-known. I enjoyed it. I appreciated the main characters’ enthusiasm and joie de vivre.

The evening I returned home, I went to the first of six Feldenkrais classes I’m taking through Kaiser. The next day I got my annual performance review at work, which was glowing. My boss’s accompanying remarks were less so. For instance, the written review said my chart notes are great, and provide helpful information to other team members. In person, she said, “Actually, what I don’t like about your chart notes is … ” I thought that was a perfect way of handling it, in that my official review is something I can feel fantastic about, and I also got concrete information about areas where I can improve. (She also said that Jonas, before he left, said I have an “incredible” ability to connect with patients.)

When I went to County Hospital for the first time after being in Michigan, Clementine—looking a bit dazed—told me about no fewer than eight traumatic and/or disturbing incidents that had occurred at or affected the hospital in the prior couple of weeks, including two “gnarly” murders. One of the many ramifications of these things is that security is tighter, which means homeless people are less welcome to sit around in the cafeteria all day, and not at all welcome to sleep in the elevators overnight, as some of them normally do, so besides all the various kinds of misery, there has even been a loss of housing for a small group of people.

It was a fine day of learning for me. One of my fellow chaplains there is extraordinarily insightful. During our brief daily team meeting, we were talking about patients who ask us questions about ourselves. This person said, “I think that a patient who does this is trying to erase herself, so I need to leave a big space in which she can reappear.” That dazzled all of us.

My own learnings of the day:

1) I spent most of the morning, after holding babies, in the more acute psych unit, where I saw just two patients. One of them has problems with demons, and during our rather long talk, she said, “Oh! A demon just came out of me and went into you.” I paused and said, “I didn’t feel any demon come into me. It didn’t come into me. Maybe it dissipated into the air.” The patient said, “No, it came back into me,” and her face twisted in pain.

I happened to mention this to Clementine later, and was glad of that, because it caused me to remember that we’re not supposed to validate delusions. (Nor are we supposed to say, “What?! Are you crazy? There’s no such thing as demons!”) She said it was good that I had denied that the demon had come into me, but when I suggested that maybe it had gone into the air, I was validating the patient’s delusion. She advised me not to engage one way or the other about demons or other delusions, but to listen for the feelings. How does a person full of vengeful demons feel? Probably scared.

(Though Clementine said that once medication makes the demons go away, some patients can actually feel lonely for them, because demons aren’t always in a bad mood.)

2) This same patient asked about my religion and I said I am Buddhist. With non-psych patients, this is almost never a big deal. (I can recall only two patients who made it clear they didn’t like it; one went to work right away trying to convince me to accept Jesus as my savior.) This psych patient reacted favorably at first, but when I ran into her later, she spitefully accused me of stealing a Bible from her, and then said, with near-palpable malevolence, “Just because you’re Buddhist doesn’t mean you have to persecute me!”

From this I concluded it might be wise to be less forthcoming with psych patients.

3) I brought the other psych patient a copy of Our Daily Bread, which has two staples in the binding, and stopped by the front desk to see if they would like to remove the staples, which they did want to do to prevent the recipient or some other patient from removing the staples, straightening them, and using them as weapons. No one at County Hospital had told me to do this; we learned this during CPE. I mentioned this at our chaplain team meeting, and it appeared to be new information for some, so that was a reinforcement of learning for me and maybe something new for others.

4) Finally, in the ED I visited a patient who was handcuffed to her bed, with a police officer stationed outside. That morning, she had been a free woman, and now she was going to jail, and she was upset. I asked what had happened, and at some point, after I’d heard a few details, the police officer interrupted to say he didn’t think we should be discussing it. The patient got indignant and asked why not, but the police officer was quite right; I was chagrined that I hadn’t figured that out myself. I said, “You’re right, we shouldn’t be talking about this.” To the patient I said, “My thinking was that maybe it would make you feel better to say what happened.”

“It did make me feel better!”, said the patient. “I should be able to talk about whatever I want to talk about.”

“Fine,” said the police officer. “You can talk about whatever you want to talk about, but she shouldn’t ask you about it.”

When I left, I thanked the police officer and will not do that ever again. Then I felt kind of paranoid, worried that I’d get in trouble over it, but figured I wouldn’t. (I didn’t.) There’s just too much constantly going on there for everyone to follow up on every detail.

In the evening, Tom, Ann Marie and I went to see the first half of Angels in America at Berkeley Rep, thanks to Ann. Tom took me out beforehand for Thai food, for my birthday. The play was superb. The person playing the part of the angel, the nurse, and one or two other roles was the niece of my friend Carlos who died of a brain tumor in 2013. She is also a playwright, and, as we saw, a splendid actor. I couldn’t take my eyes off her, in part because I was trying to figure out if I could see any resemblance to Carlos, and at moments, I thought I could fleetingly see his face in hers. Lisa Ramirez is her name. I remember Carlos talking about going to see her performances and about how proud he was of her.

Saturday, July 07, 2018

Lockdown

While I was at County Hospital one day late in May, I got a text from Clementine saying that the ED was on lockdown and could I go check it out? I texted back, “Do you want me to enter the ED?” I wasn’t sure if she wanted me to go in and conduct a hostage negotiation or what. Presumably she didn’t intend for me to get my head blown off, so I wasn’t sure exactly what she wanted me to do. I didn’t hear back from her, and when I got near the ED, nothing appeared to be amiss.

I went in and saw sheriffs taking a barricade away from one of the entrances, and a staff member said the lockdown was all clear. Later I mentioned it to one of my fellow volunteers, and she said, “Yeah, that happens all the time.”

I told Clementine about having attended the training on psychological first aid, and she invited me to join the hospital’s disaster response team, or MCI (Multiple Casualty Incident) team, which I agreed to do.

Up on one of the units, a nurse told me that one of her patients seemed silent and withdrawn, and she asked if I would visit him. The patient was sitting up on the edge of his bed, and he did indeed seem to be downcast. I asked if I could sit down and then I just sat there quietly for some time. After a while, I said, “You seem kind of sad.” He nodded his head just slightly. I added, “It looks like you’re feeling kind of discouraged,” and he nodded at that, too. Then he started talking—about his disappointment that the Warriors had lost their game the previous night. Sounding stunned, he said, “I didn’t think that was going to happen.”

However, as the very leisurely visit unfolded, he shared about some physical symptoms he was having that he hadn’t told his nurse about. He said that, where he’s from, if you say you need help with anything, people lose respect for you. While I was there, he pushed his nurse call button and told her about his symptoms. It wasn’t necessary for me to tell him to do that. It was necessary for him to hear himself say aloud that he was in pain and that it’s hard for him to let people know he is having difficulties.

After that, I thought, OK, I think I’ve got it! There is nothing I can fix. The idea is to sit there, with patience and stillness, until whatever the wound is comes into view. I went off to see other patients thinking that I would do the exact same thing, and then of course found that what had worked in one visit had little utility in any other. Nonetheless, I like the idea of being quiet and patient, waiting for things to emerge on their own: whatever is bothering the patient, and also her resources and wholeness.

One evening, just after I turned off the light to go to sleep: beep beep beep! My work pager going off. I called the pager operator, who put me through to a nurse who said that a patient’s mother wanted to speak to a chaplain on the phone. My enthusiasm was whole-hearted, since the alternative was getting up, getting dressed again, and taking a cab back to work. “I would love to talk to her on the phone!”

Thursday, July 05, 2018

Chaplain Tries to Poison Fledgling Priest

A week or so after Mason’s graduation from divinity school, I returned to Berkeley to have breakfast with him before he moved back to New Mexico to serve his own church as a priest. I had checked online to see how far it is from his hometown to Santa Fe and it appeared to be more than four hours by car: too far for a day trip. I told myself that, realistically, this would probably be the last time I would see him, and to let go, let go, let go. I have a quote somewhere about how what we humans need practice in is letting go, because we’re already experts at holding on.

We met at the Sunny Side Café, near UC Berkeley, and after we ate took a walk on campus. I gave him a card congratulating him for receiving his M.Div. and a couple of small gifts, including a polished piece of malachite. (I learned later that malachite is poisonous and that you shouldn’t carry it around in your pocket. He told me he plans to keep it as a reminder that Chaplain Bugwalk tried to poison him.) I asked how long it would take him to drive to Santa Fe and was pleased when he said the trip is just two and a half hours. There is a Monday in August when I can be in Santa Fe but not at school, and it turns out that Monday will be Mason’s day off, so we have plans to meet. Mason suggested that we go to all the museums where, as a Native person, he gets in for free.

Back in the city that day, I attended a training on psychological first aid, such as one might have to render after an earthquake or other mass casualty event. One thing you can do to help someone feel calmer is to ask her to name five things she sees around her, five things she hears, and five sensations she feels in her body, then four of each of those things (not the same ones as before), and then three, two, and one. When the trainer had us do this, it was pretty hard to hear that many different sounds, but overall, this did seem to have a relaxing effect.

Her number-one recommendation for helping lesson people’s anxiety was to ask them to breathe into their diaphragms for a count of four, and then to exhale for a count of four, and to repeat this for a while. Another very useful thing the trainer shared was to say to a survivor, “Hi, I’m Bugwalk. I’m here to help. What’s your name?” and extend my hand. If the person says her name and extends her hand to shake mine, I have just learned several things: the person’s name, that she isn’t hard of hearing, that she speaks at least some English, that she is willing to engage with me both verbally and non-verbally, that she doesn’t have an injury that prevents her from moving her arm and perhaps that she is not in overwhelming physical pain.

The trainer said not to say, “Everything will be OK,” because it might not be, and to use a survivor’s name often, because people are very alert to the sound of their own names, so this might help keep the person we are talking to from getting lost in anxiety.

Most of the people in the room were nurses and social workers, most working in one hospital or another. Next to me was a fellow chaplain volunteer from County Hospital. She told me she is from Mackinac Island, a charming place in Northern Michigan and not one I had realized you can be from; I thought it shut down in the winter. At least last time I was there, about 45 years ago, there were no cars. You could get around by foot, horse-drawn carriage and bicycle, and also eat fudge. (It appears this is still correct. Wikipedia says motorized vehicles, except for emergencies, have been prohibited there since 1898. You can get there only by boat or plane; if it’s winter, you can also go over an ice bridge on a snowmobile.)

Back at home after the training, I gave Emily a call and asked the person who transferred the call to make sure she put the phone to her good ear.

“Do you have the phone up to your left ear?” I asked her.

“Correct.”

“That’s funny that you didn’t say ‘right.’”

“Correct.” She really is rather charming.

She said things were going better: She was visited by two of her friends, and another called her on the phone, and she likes the head nurse, and she had a good conversation with a volunteer, who had a helpful suggestion. When Emily feels upset, she likes to go for a walk. She told me that the volunteer said that, when she feels this urge, maybe she can imagine she is walking, and move her feet in bed. Surprisingly, this worked.

I found among my meditation-related clippings this account of something said by Suzuki Roshi during a sesshin; I misquoted it in an earlier post: “Suzuki Roshi began his talk by saying slowly, ‘The problems you are now experiencing’—we were sure he was going to say go away—‘will continue for the rest of your life.’ The way he said it, we all laughed.” I don’t have the name of the person who wrote this, and will be glad to add it if it comes my way.

Wednesday, July 04, 2018

Am I Dying?

One day we had a five-hour staff retreat at work starting with Mediterranean food for lunch. In the course of the afternoon, my boss mentioned that when Jonas left, among other things, we lost the person who trains others how to use the electronic charting system. I’m pretty good with that system and my former computer job often involved training other people, so at the end of the day, I offered my services and she said that before Jonas left, he told her I’m good with the computer, so she would take me up on that.

She also said she would like me to apply for a part-time job when one becomes available (this would be a step up from my current per diem position), that I have a lot to offer, that I’m a good team member, and that I’m doing a great job. I was flabbergasted. I told her that her words meant a lot to me, and that I’m happy at this hospital, both very true. I had been worried that she was secretly fuming about how much time I take off work, between school and vacations, so that was another reason I was relieved and delighted to find out she is glad to have me around: she’s not trying to figure out how to trade me for a per diem who doesn’t take so much time off.

In mid-May, I went to see Mason, my peer from my first unit of Clinical Pastoral Education, receive his M.Div. degree in Berkeley. It was an inspiring ceremony, and Mason got one of three special awards. Quite a number of his family members came from New Mexico to see him graduate.

When I got home, I called Emily in hospice, and this time I did much better when she asked me a tough question: “Bugwalk, am I dying?”

I said, “Well, a person goes to hospice when a doctor believes she has six months to live or less.”

“Which doctor?!”

“I imagine it was one of the doctors you saw at the hospital.”

“Oh. Yeah. I didn’t get along with that guy. I don’t think he liked me.”

I thought of saying I hope a doctor wouldn’t send a patient to hospice because he didn’t care for her personality, but in case she wasn’t already thinking that—though she probably was—I decided not to introduce that idea.

Then an interesting thing happened, which was that she changed the subject. A bit later, she returned to it, saying she felt frightened, and asking what she should do. And then she changed the subject again. That was a powerful learning experience: I don’t have to be afraid of telling people the truth, because a natural defense mechanism such as denial or avoidance will come to the fore when needed. These get a bad rap but are perfectly reasonable means of self-protection.

One Saturday, Sam and I met in the Castro for Thai food, and the following day Ann, Jill, Tom and I had lunch at Au Coquelet and went to Berkeley Rep to see Heidi Schreck’s play What the Constitution Means to Me. I enjoyed it. Each member of the audience was given a copy of The Constitution of the United States of America. I probably will never read it, but I feel like a better person now that I own a copy.

The next time I called Emily, I found that she was still distraught about finding herself in hospice. I managed to convey to her that, when she declined to take medication, her doctors likely interpreted that she didn’t want treatment and accordingly sent her to hospice. She said, “Oh. Well. I still don’t want to take medication.”

“Then you might be in the best place!” I shrieked. It can be kind of a maddening experience to talk to her on the phone because I have to bellow into the receiver, and she still misses thirty percent of what I say.

“What do you mean by that?”

“How do you think things would go if you were back at home?”

“That’s a good question.” I can’t remember what she said after that, but I was relieved that she is sure she doesn’t want to take medication, because that does mean she probably is in the right place. I was also kind of surprised by that. I sort of expected her to say, “What?! In that case, of course I want medication!”

When Sam and I had lunch the prior Saturday, we were dangerously near where Emily is. In fact, we walked over to look at it, because Sam had never been there. It’s quite a lovely place, on a very pleasant block. But having learned by calling Emily that I shouldn’t have done so, I knew better than to initiate in-person visits. That would not be sustainable on my end, and I would disappoint her. Having said that, I have asked the staff there to let me know when she is within a couple of hours of dying, as best they can tell. If I can, I will go over there and hold her hand.