Sunday, September 18, 2016

Whatever You Have to Do Today, You Can Do It

There are lots and lots of young people on the TWMC (Truly Wonderful Medical Center) campus, certainly the students, but even the people who work there look awfully young, going by the pictures posted on the walls of the units I’m assigned to. I noticed a lot of people marching right up the center of the sidewalk, which struck me as arrogant, but if that’s the culture, that’s the culture: I must adjust. I was also realizing that probably 98 percent of the brand-new medical students are scared; anyone who is not scared is probably overusing substances. I’ve developed a silent practice of looking at a student and thinking, “You can do this. Whatever you have to do today, you can do it.” I’m saying the same to myself.

The palliative care chaplain came to visit our class one day last week. She is a Theravadan Buddhist who has been meditating for 50 years, and she brought a force field of calm into the room with her. I could feel it unmistakably from several rows back.

Someone else in our group of 14 students has taken my usual role, which is to ask a million questions about every possible thing that might happen. It’s interesting to watch anxiety rise and fall for individuals and the whole group, and to notice my judgments of others’ anxieties, which is a strong indicator that I am intolerant of those feelings in myself. Am I really calm, or just clamping down on feelings?

I was taken by various outgoing interns to visit the areas I’m assigned to in the hospital. Two of them are low-acuity (people aren’t acutely ill) with high turnover, meaning long pastoral relationships probably won’t develop. A third is the pre-operative area, where people are busy being visited by nurses and the anesthesiologist, etc. The fourth is the post-operative area, where people are under anesthesia, and after they wake up, they go somewhere else, judging from my own experience. Finally, I have been assigned to a waiting room! Paranoid thoughts arose: Did they deliberately give me all the low-stress areas in case I flake again and these areas end up not being covered? Every single one of my peers has an ICU, or the emergency department, or a unit where babies may die. But I will take what has been given to me and do my best with it. I gather a lot of people didn’t get the assignments they wanted, and our teachers said they didn’t want to ignore that disappointment, but it is their experience that people end up feeling that whatever units they were assigned to were perfect for them.

I was worried before my summer unit of clinical pastoral education that I would react to the hand sanitizing gel. They had two kinds, and neither turned out to be a problem, though one smelled kind of nasty. TWMC has a different kind, and it immediately made my hands feel a bit irritated. But I mentioned that to my supervisor and she said there was a student two years ago who was sensitive to chemicals, and there is some other stuff such people can use.

I was kind of disappointed to learn that, because I was thinking this would end my CPE experience, and I was already kind of looking forward to quitting. “Oh, well! I really, really tried!” I would also then have to avoid TWMC permanently for my own medical care, lest they terminate me during a mammogram or pap smear.

TWMC has two campuses. One is new and beautiful and in a part of town with superb weather, not too far from where I live. The campus where I’ve been assigned is old and shabby and smelly: atmospheric. The weather there also is not very good. It tends to be overcast and chilly. The small student room in particular is revolting. It smells, it has little natural light, and the chairs are stained. Instead of having lockers with locks, we have unlocked filing cabinet drawers, one per student, in which to store our valuables. This room is a good hike from the actual hospital, separated by maybe four buildings, two of which are being torn down.

One day I found three boxes of doughnuts in the student room. New student (not me): “I’d better not.” Outgoing student: “What?? Not eating doughnuts is not a choice. You have to eat doughnuts!” Now I see why several people have said that everyone gains 20 pounds during their year of CPE. This is all quite different from VFMC (the Very Fantastic Medical Center), where I was during the summer. Our student room there was a large office we shared with staff chaplains and a handful of other employees. Two walls were entirely covered with a lovely, soothing hand-painted mural. Natural light streamed in several large windows. The hospital itself seemed clean and new and beautiful. We each had a locker with a lock. Adjoining the office was a gorgeous yoga studio with a bamboo floor. Not one single time did I lay eyes on a doughnut. (Because they are not a health-supporting food and we were in a hospital!) We would have treats if we had a celebration, but only then, and leftovers, even of sweets, would sit for days before they finally disappeared.

Here’s one good thing: At VMFC, if you’re there on weekends because you’re on call, you have to round on your normal units (visit the patients there). At TWMC, if it’s the weekend, your only task is to respond to pages. Of course, that very well might end up being a whole day (and night) of work. One person who showed me around said he didn’t find his duties there particularly stressful. He said the hardest part was when a young patient who wasn’t expected to die did.

Despite my low-acuity areas (waiting room!), I will have plenty of exposure to dying and death when I am on call. This gives me the opportunity to mention that at VFMC, the sleeping room was a whole apartment located in a building across the street from the hospital. At TWMC, the sleeping room is a cramped, foul-smelling room inside the hospital and just yards from the main entrance, so it is probably noisy. There are no windows in it. It’s just big enough for a fold-out bed. We can’t go in it until 9 p.m. on weeknights—two hours past my bedtime—and we get off at 4:30 p.m., so the student chaplain may have to find somewhere to twiddle his or her thumbs for four and a half hours.

At 54, I think I’m the oldest person in the group (also older than every supervisor, I believe). There is a woman who is 50 and a couple of people who appear to be about 45, and everyone else is 26, give or take. Good thing I didn’t put this off any longer.

Needless to say, I did not sleep well the night before starting CPE nor really any night since. However, whatever I was sick with I never noticed again after the first day, after starting to take Sudafed, per the precisely correct recommendation of my doctor’s assistant.

Friday we got off a little early, so I went to 24th St. and the Castro in search of shoes; my feet are killing me. Yesterday I got up at the crack of dawn and did my laundry, talked to my 40-year friend on the phone, took Hammett to the vet, ate, went to see F. at his place, went to the mall in further search of shoes—it was very hot and sunny; I felt dazed and bedraggled—went to a shoe store on Mission St., went to see my shirt lady, came home and ate and went to bed early. I’m going to try to make it so weekday and weekend bedtimes are about the same.

Today I went to Rainbow and did my cooking for the week, which for the next year will consist of slicing three cucumbers and boiling some eggs. I sorted through all my various pieces of paper and emails and electronic documents for TWMC and made a giant list of questions and things to do. I wrote an assignment that is due Tuesday, after new employee orientation tomorrow. I have a massive backlog of reading, which I will just have to fit in somehow. Like, it would be good to read the stuff about being on call before Friday, when I’m on call, but I don’t see when I’ll be able to do this. On-call starts at 4:15 p.m. and goes until 4:30 p.m., so on Saturday, I will be the only chaplain at that campus of the hospital, no doubt confused and exhausted, and certainly unshowered.

However, having done the summer unit makes an enormous difference. I would be going completely crazy if not for that. Much that I heard last week was already familiar to me, plus TWMC uses the exact same charting system as VFMC, but in an even simpler way, thank Sam. Also, speaking of Sam, it’s so great to have a built-in friend. I would not have even been able to do the assignment I was doing today if not for having done the summer unit and if not for Sam emailing me his so I could get an idea.

Please feel free to point out typos and obvious mistakes here—I suspect there will be a lot of both over the next year.

Wednesday, September 14, 2016

First Day

Wow. Even with basically no sleep and a probable brain tumor, this was like night and day compared to my first day of clinical pastoral education this past summer. It makes a big difference to be with people who are really, really nice. I’m sure they can be jerks (just like me) and are perfectly capable of being firm when necessary, but the whole vibe is kind and gentle and supportive and warm.

Sam said there is one supervisor he’s not crazy about—she keeps kind of yanking his chain—so I knew she would end up being my supervisor, but it turned out she isn’t. My supervisor is a very nice woman who has a small child. She told me just to go with the schedule for now and they’ll try to get me caught up next week.

There are 14 people in the whole group, six of whom are Buddhist, and another couple “Budd-ish.” At least one person reported having no religious affiliation at all. Everyone was extremely friendly. One young man turned to me and asked, solicitously, “How is for you to be here today?”

There was an abundance of breaks. We heard 45 minutes about this, then had a 15-minute break, then heard 45 minutes about that, and had another break. Mid-day, we were treated to quite a yummy catered lunch while we met with members of the Professional Advisory Group. One session was on the health, dental and vision coverage we have all been signed up for, which sounds like excellent coverage. We also did a session on charting. They use the exact same system that we used at VFMC, but in a simpler manner; they mostly just have us make selections from lists and actually discourage lengthy narrative. They pointed out that the patient gets to read whatever we write, so simpler might be better.

Besides finding out who my supervisor is, I found out which campus I’ll be at and which units I’m assigned to. One is orthopedic surgery, which I also had at VFMC, but someone pointed out this might be different. There will be some people who have joint replacements followed by smooth recoveries, but others who have had the same surgery fail six times in a row and have come to TWMC as a last resort. One of my colleagues was assigned to pediatric oncology. A chaplain who works there said not to worry that our assignments will have an adverse effect on getting jobs later. He said people do not care what particular unit you worked in and that we will get jobs because employers will know we went through a very rigorous CPE program.


I’m in a small group of five people: the woman who took my place when I dropped out (Budd-ish), a woman who is Christian and into yoga, a fellow from Burma who is a Catholic priest, and another man who is, like me, a Theravadan Buddhist.

One thing I learned from this summer was not to take tons of notes, because they just have to be typed up later, which takes time, and may be rarely if ever consulted. I took very few notes today.

At the end of the day, we all went out to a sunny spot in a nearby park and put on a temporary altar—a colorful blanket on the ground—an object we’d brought along to symbolize our feelings about the transition now underway. We each described our object, and while this kind of thing might not be naturally something I’d think of doing, I could really appreciate each person’s sincerity and openness. These are lovely people. We also had been asked to bring along a poem or prayer rolled up like a scroll and tied with a ribbon or piece of yarn. We put all of these in a basket and then each took one. I had to tie mine with string, but it was really a perfect poem, by Molly Fumia, and the person who ended up with it, who is one of our supervisors, was delighted by it.

Almighty Sam

For the past week plus a couple of days, I have felt very fatigued and have had a headache much of the time, which is extremely unusual for me. The last time I was at the soup kitchen, I had to sit down before my shift was over, which has never happened before. I have also felt dizzy at times, and faintly nauseous. I concluded this might be a flare-up of mono, per what I read online, and have spent a lot of time resting.

As energy permitted, I also started casting various irons into the fire. I have been researching the two-year chaplaincy program at Upaya Zen Center and the 12-module program at the Chaplaincy Institute in Berkeley. I also applied for a temporary position with my old employer. I noticed that I felt energized by the former and disheartened by the latter. On the other hand, I didn’t immediately hear back from the schools—I still haven’t heard from Upaya—whereas the day after I applied for the job, the hiring manager called me, and the day after that, we had an interview on the phone, and the job actually sounded very fun and interesting.

I emailed my wonderful contact in HR to ask what would happen if I accepted a temporary position but declined an extension to that position—would that end my severance pay? Going a bit further, what if I were to leave a temporary position at some random moment (i.e., to start the program at Upaya)? Surely that would end my severance pay. But it turned out the answer to both questions is no. You can decline the extension to a temporary position or leave it whenever you feel like it and still get the rest of your severance pay. Remarkable. (A small good thing to balance all the bad news about this company lately heard.)

I had told the hiring manager that I could start right away, and there didn’t seem to be any downside to that, particularly given that I could leave the job at any moment and go back to getting severance pay, or maybe it would prove to be a fantastic job that I would do for years.

On Sunday, I still felt lousy and had to miss the big annual potluck which is held at the soup kitchen itself rather than at Thomas House, where the core community lives. On Monday, I got a call from the Chaplaincy Institute and had a wonderful conversation with the admissions manager. I figured that either I would get a job with my old company and start doing the Chaplaincy Institute’s program, or I would take the next two years and do the Upaya program plus the Chaplaincy Institute’s classes, and then I would finish with a year of clinical pastoral education at VFMC, where I was this summer, and then I would look for a job.

Lately I have had the feeling that something excellent was going to happen. Maybe that was just the feeling of having a number of appealing options, which is indeed a good feeling, but it seemed stronger than that. Over the months, I’ve had a handful of what I think of as chaplain dreams, and I had one a couple of nights ago, where I was wearing a robe like a Zen Buddhist would wear, and I had a wrist mala on—a circle of beads that some Buddhists wear around their neck or wrist (which I would not be caught dead wearing in real life). In the dream, I also had a circle of beads around one finger, like a finger mala.

Yesterday morning I still felt crappy and was reflecting that I am more and more appreciating the frailty of the body, how it periodically says, “Time to rest!” I finally called my doctor and got a call back from her assistant, who is an excellent diagnostician, and who said she would not immediately conclude that this is a brain tumor. She also didn’t think it was a mono flare-up but more likely a virus of some sort, maybe an inner ear infection or fluid in the inner ear. She said to try taking some Sudafed and to call again if it’s not gone in another week.

I had asked Jacqueline to send me the link to the application for part-time work at VFMC and not heard back, so I figured that conversation was at an end, but on Monday of this week, she sent the link. I had been starting to think that being on call Saturdays actually would not be a bad thing; I was remembering that I liked being on call on weekends because then you get to handle all the pages yourself rather than dispatching them to appropriate co-workers. Also, nearly every page represents a person who actually wants to talk to a chaplain, whereas making normal rounds involves talking to rather few people who want this. Also, the hospital is quieter on weekends.

I turned on my computer yesterday morning to get Jacqueline’s phone number and called her to say I’d reconsidered about Saturdays. It was fortunate that I had the urge to call her, because I might not have turned my computer on until much later. Now that it was on, I noticed an email from Sam, my friend who began CPE at TWMC last week, reporting that someone had already dropped out of the program! He sent a second email saying he’d mentioned my name to two of the teachers.

Though my reasons for deciding not to do the program were sensible, I regretted that decision and felt a pang every time I saw a TWMC van go by, or when I thought of those who would have been my peers starting their huge adventure without me. I didn’t really expect hear from TWMC yesterday, but it was clarifying to note my reaction to the possibility: great excitement and enthusiasm.

Now and then I get a call which is someone responding to a page; whoever sent the page typed in the number wrong. I think these pages originate from somewhere in the TWMC health care system; I’ve been getting them for years. As it happens, I got one yesterday morning after seeing Sam's notes and had to smile—at least I got some sort of call from TWMC.

And then a bit later, there was another call, and this time the caller ID said “TWMC MED CTR.” Yeah! It was the spiritual care director calling to say that someone had dropped out and that a rumor had reached him that I was still interested in doing the program. “I’m there!”, I tried not to yell in his ear. It was a joyful conversation. I could tell he was smiling as he said, “I know you Theravadan Buddhists don’t pray to God.” Naima, my chaplaincy mentor, said something similar later on the phone: “Does this change your mind about whether there’s a God or not?” (She is a Zen Buddhist and Mystical Christian.) I don’t think this has made me believe in God, but it’s really made me believe in Sam. Thank—uh, Sam that I had a friend on the inside who could mention my name at the right moment. Thank Sam!

After I spoke with the spiritual care director, per his instructions I called the administrative assistant who had helped me with all my application and onboarding stuff earlier, who now yelled, “Miss Bugwalk! How are you? This is wonderful! This was meant to be!” I felt very, very thrilled and delighted.

I slept not last night, and finally gave up at 3 a.m. and got up to write this (plus the preceding entry, craftily backdated). However, I feel all right. Either the Sudafed helped, or I’m too tired to tell how I actually feel. If I don’t die on the first day, that will be a good omen. Or if I do, I’ll already be in a hospital, surrounded by chaplains! There are 14 student chaplains in my group, and six of us are Buddhists. (However, the spiritual care director is not a Buddhist. I said that in an earlier post. He isn’t. The one at VFMC is.)

I was remembering a day in that somewhat horrible month of August, when I was changing my mind twice a day about whether to go on to TWMC or not. One afternoon, when it was clear that I would be there, I felt a quiet but unmistakable wave of joy and almost awe: I am doing this. I am going to be a chaplain.

I am doing this! I am going to be a chaplain! I start the yearlong CPE program at TWMC today!

Friday, September 09, 2016

Bazooka Joe

So, let’s see here, I did take Hammett to his doctor in the middle of August and he was examined and had more bloodwork done and got body X-rays to make sure he didn’t have a bulging tumor in his midsection. The prior appointment and labwork had cost about $150, and had shown that Hammett’s thyroid level was a bit elevated, but not enough to have caused his weight loss, in his doctor’s view. The second appointment and tests—which all proved to look perfect—cost $650 more, for a grand total of $799, after which Hammett’s doctor concluded that elevated thyroid was, after all, the culprit, and advised increasing the amount of methimazole he gets daily.

Since Hammett did have a known condition and his symptoms and original labwork were perfectly consistent with that, I’m planning to say something about this and am in the process of wording my remarks. I think highly of this doctor and count on him absolutely, but, as I was reading somewhere about the training of medical professionals, when you hear hoofbeats, think horses, not zebras.

You may recall Jacqueline, Samantha’s boss, saying she would not consider someone for even a part-time per diem position as a hospital chaplain unless that person had finished all the education plus a year of CPE, and furthermore that the CPE would have to be after the education, not before. Therefore I was flattered and very surprised when, toward the end of my summer of clinical pastoral education at the Very Fantastic Medical Center, she offered me a part-time job, one eight-hour day plus one 24-hour on-call shift weekly.

She invited me to her office for an interview and told me how to change my resume to make it into more of a chaplaincy resume, and we had a discussion or two on the phone. She wanted someone to be on call every Saturday, and I suppose that, as a fledging chaplain, I should have leapt at the opportunity, but I really didn’t want to do that, and after saying so, I didn’t hear from her again, and concluded that might be that. I know that at least one person finishing up the yearlong program at the Truly Wonderful Medical Center (where I would have started earlier this week had I started there earlier this week) has applied for the same job, and will probably get it. That’s OK. I’m on the slow and leisurely track, and if I never get there at all, that’s all right.

Poor Samantha, who is pregnant with twins, was extremely ill our final week of CPE and only able to drag herself in on the very last day. I’ve never seen anyone at work who looked more miserable. She came to oversee our presentations of our final self-evaluations, in which we also had to write about our relationships with our peers and with Samantha. The latter opened a final can of worms or two which I suppose will go permanently unresolved.

After that, we rushed over to another campus of the medical center for our graduation ceremony, and Samantha went home. We three interns graduated that day, plus the four people who had done the yearlong program. In addition, a couple of the five people starting the yearlong program now underway attended our ceremony and one of them said that if he didn’t get a chance to speak to me again, he wanted to thank me for being the only person in the spiritual care department who was friendly to him when he started! I don’t know what to make of that. Shouldn’t spiritual care providers be extra-friendly, or at least no less friendly than the general population?

There was one day between CPE ending and my nine-day retreat at Spirit Rock Meditation Center beginning, and I spent that day making final changes to my self-evaluation and updating my resume per Jacqueline. On that day, I also noticed a painful lump in one breast, very similar to that which proved to be mastitis a year ago, except that there was no red streak. This was not good at all, because my breast cancer surgeon lately retired, and I was positive my new doctor would insist upon my coming in before prescribing antibiotics. I did some research and concluded that it might be a blocked duct, which I commenced treating with a heating pad and massage, including applying the flat end of my electric toothbrush, and over the next couple of days, it cleared up and no red streak ever appeared.

The retreat was wonderful, partly because I had an extremely difficult roommate and was forced to exert extra effort to return to my chosen object, which I did successfully over and over and over. My teachers were pleased. Phillip said, “I’ve known you for many years and this is a new level.” Sally encouraged me to apply for the Dedicated Practitioners Program and said I could use her as my sponsoring teacher. She said, “You’re one of the more sincere practitioners that I work with.”

I really did not have very much discursive thought during this retreat, but each day we did a period of metta practice, and I was using my father as my benefactor, which caused me to recall the afternoon he set out to teach me how to blow bubbles with bubble gum. I was maybe four years old, and I distinctly remember our being in the front yard of the first house I lived in in Ann Arbor, and my father giving me a couple of pieces of Bazooka Joe. It was touching to think of him, rather a young man himself—28, if I was four—perhaps having made a mental list of all the things his children would need to know, including how to blow bubbles, how to play tennis, and that exercise is good for you.

When we were children, he bought each of us a brightly colored duffel bag, perhaps thinking of the family trips we would take. I still have that red bag, plus another extremely durable duffel bag he bought me. In fact, I had that latter bag with me at the retreat. I use it regularly, and 40 or 45 years after my receiving it, it shows virtually no signs of wear. (It was from Lands’ End.)

One day, from my dorm window, I saw two young deer foraging for food near their mother, who was sitting on the ground nearby. Charmingly, one of the youngsters discovered a promising long blade of grass—sticking out of its sibling’s mouth—and did its best to get its share.

Since being back from retreat, I have been recuperating from my summer of CPE, and going to Howie’s to meditate on Tuesday nights, and volunteering at the soup kitchen.

Sunday, August 14, 2016

Fortunate Cookie Season

Words seen on a storefront.

Last Sunday, Mason arrived in the morning to take over as on-call chaplain. He has been a strong proponent of my going on to TWMC—he has said I’m gifted and that this is obviously my career, that I’m a good listener and have a comforting presence. Last week, he summarized the turn of events: “You were accepted for clinical pastoral education at one of the best hospitals in the country, but you’re not going to do it because you’re afraid you’ll be tired.”

“Yeah, it does sound kind of stupid when you put it that way,” I agreed.

He and Andrew have been two of the best parts of this summer. One day when Andrew and I were teasing Mason about always being late and saying he should make more of an effort to be on time, Mason said serenely, “That’s not the French way.” (He is not French and has never been to France.) He is always utterly himself, and is such a dear person. In a grand finale of tardiness (unless he does even better this coming week), he arrived 90 minutes late one recent day.

Remember that hearty laugh I hoped for? I caused it myself one day when we were doing role playing. Beforehand, we were discussing earth-based religions. Mason, an Episcopalian, rolled his eyes and Samantha asked what he thinks of when he thinks of earth-based religions. He said he thinks of a woman—and here he finished his thought by using his hand to indicate long, flowing underarm hair. He concluded, “I picture a woman with a unibrow sitting in a forest next to a tree.” One long eyebrow over both eyes.

In our role play, I was playing the wife of the patient, Andrew was the patient, lying on a sickbed made of three chairs in a row, and Mason was the chaplain. (In real life, this patient fell from a height and was impaled on a spike. After poring over his chart, I’ve decided to try to avoid having this experience.) In the role play, Mason asked about our religion and I said, “We’re Earth Forest Wiccans.”

Mason refrained from rolling his eyes and politely asked, “Tell me more about that.”

I said, “Well, each month on the full moon, we go out into the forest, and we do a thing with our eyebrows?” I used my fingers to indicate my own imaginary unibrow, which caused all four of us to laugh hysterically and ended the role play; the patient sprang up from his sickbed clutching his stomach.

I herewith take back what I said about Stephen Jenkinson being a jerk. He is a person of decided opinions, but they appear to have been hard-earned. His prose is rambling and at times a bit vexing, but my patience with his book—Die Wise: A Manifesto for Sanity and Soul—has been very amply rewarded, and I am now recommending it to everyone. It makes an excellent companion to Atul Gawande’s superb Being Mortal. Read Being Mortal first and move on to Die Wise.

I got a nice note back from TWMC about my withdrawal from their yearlong CPE program, and in the days after that, of course began to regret my decision. In class one day, I asked Samantha, Mason and Andrew, “Should I call [person at TWMC] and say I’ve changed my mind?” At that, Samantha put her head down on the table in front of her. When she recovered, she said, “Never answer your own question,” and, “It’s your job to ask the question. It’s their job to answer it.”

Accordingly, that night I sent this note:
I am now wondering if I have made a giant mistake and if it’s truly my body saying “I can’t do this” or if that’s my mind, coming from a place of fear.

I assume my spot is gone by now, but if not, or if another opening should arise before September 6, would one of you be willing to discuss this decision with me? I won’t blame you if the answer is “No!” :-)


The next day, I got a note saying they had indeed given my spot to someone else. For a couple of days, I felt bad about it, but then I spoke with my chaplaincy mentor, Naima, who reminded me that she had said months ago that it might be wisest to do the academics before doing CPE and also that I should keep an eye on my tendency to leap forward, getting ahead of what I have actually discerned is true for me.

She said to be sure to leave this summer unit with a good idea of what my strengths and weaknesses are, as judged by others, and that I might now profitably do some therapy about what came up in CPE that was difficult for me, take some courses at the Chaplaincy Institute in Berkeley, and / or go on a retreat. She said that being in the hospital stimulates the reactive mind while meditating stimulates the responsive mind. She said she thinks the particular CPE program and supervisor are just a small part of the process and that by no means has the world come to an end because I won’t be at TWMC this year.

Finally, she assured me that nothing has gone wrong and that she is not worried about my path. She said I’ve figured out what to do until now in my life, and that I’ll figure this out, too. “This is all part of becoming a chaplain: this is exactly what becoming a chaplain is.” Plus, I’ll always have the happy memory of Samantha putting her head on the table when I asked if, having withdrawn, I should unwithdraw.

I got this uplifting note from my friend and bodyworker Jack: “Sounds like you have clarity regarding this choice. It was a wonderful honor to be invited into that program and it’s a wonderful honor to listen to the whole of your life and build your choices from there. The chaplaincy does feel like such a lovely culmination of all that you are and I’m sure you will find your way forward with it.” I think so, too, and I now feel sanguine about the whole thing. I obviously don’t have a sound decision-making process, or maybe it would be more charitable to say that my natural decision-making process entails one reactive lurch after the other, and somehow I eventually end up somewhere else; that’s how I’ve made every decision I’ve ever made. In sum, the reason I wasn’t sure about TWMC was that I wasn’t sure!

Meanwhile, somewhere along in here I took Hammett to Mission Pet Hospital for a periodic check of his thyroid and was disappointed to learn that he has lost more than a pound since he was last weighed, in March. He now weighs as little as he did right when he was diagnosed with hyperthyroidism. I had noticed he was a bit more frenzied, and that the bones of his spine seemed slightly more prominent.

I was hoping it was a matter of needing to increase his medication, but Dr. Press said the next day on the phone that his thyroid looks fine, and thus does not explain the weight loss, which Dr. Press said is worrying. He said it might not be anything bad—it might be a urinary tract infection or something with his gastrointestinal tract—or it might be something bad. Other than being a little more energetic, Hammett seems just as cheerful as ever, which I hope means it’s not something terrible. However, he’s been through quite a bit medically for a cat just ten years old. If it’s his time, then it’s his time.

Yesterday my walking friend and I had lunch at Ananda Fuara, and in the evening, Lesley and I had dinner at Tacolicious, one of the many new places on Valencia St. The tacos I had were utterly delicious—one carnitas, one chorizo and potato, one cod. One of them had a long hair in it. Our server replaced it but did not apologize or offer to adjust our bill.

Sunday, August 07, 2016

Very Bad Chaplain

Yesterday I was on call and intended to goof off all day—I think I was worried that I’d have a profound experience with a patient that would make me feel I’d made a stupid decision regarding TWMC. But at about noon, I’d run out of non-work activities, and also had to acknowledge that my numbers for the week looked pretty pathetic, particularly after not having seen a single patient all day Wednesday. Number of minutes spent seeing patients; number of minutes spent looking at charts prior to visits, charting after visits, and traveling to or from or otherwise preparing for visits; number of patients seen; number of initial visits, etc.

So at noon I went to one of my three floors and visited all the good candidates for visits, including an old man I had seen before and liked right away. After our visit, while I was still on that floor, he received bad news and asked to see me again. He’d learned that he has a tumor and said he would like a prayer. I asked what we should pray for and he said he hopes that if he has to have surgery, “I come out a winner.” Here he choked up. I felt very touched by our encounter, and indeed felt that maybe I’d made a big mistake; maybe I should email TWMC first thing Monday and take back my resignation. Or maybe they will say, “We respect your decision, but would you like to come in and discuss it in person?”

At three p.m., numbers much improved, I was going to go to another of my floors, but was paged to attend to a dying patient. Her family wanted a priest to come and perform last rites and also a chaplain to come. I summoned a priest—they only come if the patient is Catholic and if a specific sacrament is needed—and he performed the rite and offered absolutely wonderful prayers as the other five of us stood with him around the body of the dying woman. He told the dying woman, who was unconscious, that she could release all fear or trepidation, and to lead us into the Lord’s Prayer, he said something like, “At a time like this, we can call upon God as we call upon a loving parent: Our father … ”

After the priest left, the woman’s two daughters said they did not want to see their mother die and that they wanted to leave, with their husbands. I said that was fine, and that I would stay with their mother. Then it occurred to me that maybe they didn’t really want to go, but were scared of being with a dying person. I’m surprised people would want their loved one to potentially die alone, but I can understand being afraid of witnessing the moment of death. I added that if they would like to stay, I would stay with them and keep them company, and all four of them ended up staying. The young, tattooed nurse felt bad about not being able to hang out there with them and said to them, in reference to me, “You’re not alone—thank goodness.”

We sat there together for more than two hours, and eventually everyone relaxed and one of the daughters told me about her mother, the flowers she grew and the dresses she sewed and the meals she cooked. After the mother’s heart stopped but before the breathing machine was turned off, her children left the room. I told them I would stay until she had passed. In her final moments and just after, I put my hand on her forehead and told her all was well, and that she was very loved. After she was gone, I said, “Rest in peace,” and at the doorway, I bowed to her.

We have a template we use for chart notes, where we fill in various pieces of requested information. I deleted most of the template, and entered the names of the patient’s daughters and their husbands. I referred to the patient by name instead of as “pt” and I typed in what her daughter had told me about her, so that my note could be a small memorial.

At this point, I was even more sure I’d made a terrible mistake regarding TWMC.

I went to the apartment where we on-call chaplains stay, where I have never gotten a page later than 5 p.m., and at 7:40 p.m., just as I was thanking the pizza delivery guy, a page came in: a patient was actively dying at another campus and his wife wanted a priest. I spoke with the wife on the phone and found it difficult to explain, in my limited Spanish, that since her husband wasn’t Catholic and therefore not in need of any sacrament, we couldn’t ask a priest to come. She was Catholic and just wanted to talk to a priest. For that, we have on-call chaplains, but this particular on-call chaplain was about to scarf down an entire pizza and was thus disinclined to serve. The woman was under the impression that I myself am a priest: “Are you a father?” (Hmmph.)

I told her I would call her back and called the nurse to ask if there was a staff member around who could translate for us. The nurse said there wasn’t, but that the woman’s son should be able to do that. I said it was fine to give him my cell phone number, but never heard from him. I rationalized that if they really needed me, they would have called, but I definitely felt guilty. I should have just gotten in a cab and gone over there. (I found out the next day that the patient died about 20 minutes after his wife and I spoke. She sounded remarkably composed, another reason I didn’t rush to her side.)

Don’t worry, I didn’t go unpunished for this. At 9:35, just after I’d gotten in bed, yet another page came in, again from a different campus. A family had gotten the news that their loved one was going to die and wanted a chaplain to come. It didn’t sound as if the patient was actively dying, so I called Samantha to see if we still go in that case: yes. So I got in a cab and headed over there, at this point past compassion fatigue and into active hostility. In the woman’s room, all hard feelings forgotten, I offered a prayer, which was pronounced “beautiful” by one of the 10 family members present.

My cab driver on the way back was born in 1944 and didn’t go in for pot smoking and all that in the 1960s; he was a boxer. Later he traveled with bands as a roadie: Santana, Journey, Natalie Cole. I told him my very first concert was The Spinners, with Natalie Cole, at the Bowen Field House at Eastern Michigan University in Ypsilanti in 1976, when I was 14. “That was me!” he said.

Yes, my decision regarding TWMC was correct. I will take the long way to whatever the destination turns out to be.

Unburdened

I was sure remorse about my decision would set in, since I change my mind about everything all the time, but after I sent my note, I did indeed feel relieved. I like a simple, quiet, orderly life with no dirty dishes in the sink and plenty of sleep. Samantha, in the way of the clinical pastoral education supervisor, periodically asked what my theology, or dharmology, had to say about this decision or whatever else we were discussing. I don’t feel obligated to obey the words of the Buddha, in part because Howie regularly reminds us not to be Buddhists, or even “meditators,” but just to be awake.

On the other hand, I have never through experience concluded that anything the Buddha said was wrong, and I have been thinking lately about his view that we ourselves are as deserving of kindness as anyone else is, and also what he said about living a life unburdened with tasks.

Here’s the beginning of the Metta Sutta (“sutta” means “teaching” in Pali):

This is what should be done
                By one who is skilled in goodness,
And who knows the path of peace:
                Let them be able and upright,
Straightforward and gentle in speech,
                Humble and not conceited,
Contented and easily satisfied,
                Unburdened with duties and frugal in their ways.

I kept thinking I could find a way to be at ease while doing CPE and to have a sense of well-being, but the truth is that I felt worse with every passing day. It’s possible that during a year of CPE, I would have figured it out, but more likely that I would have felt increasingly stressed and miserable and that I might even have become physically ill. It’s hard to relate to others from a place of well-being if one doesn’t have any. Friday evening I celebrated having made my decision and communicated it with a pesto pizza with pepperoni and sausage from Marcello’s. It was delicious and I slept quite well afterward.

Finally

By Thursday of this past week, I was deep into pondering my own values. The most important ones seemed to be financial security, health insurance security, and liking to be well-rested and not stressed out. On the other hand, there are all those years I wished I were doing something more meaningful, and how great it feels to have a sense of purpose, or mission—to do something I’m actually passionate about. That is also very important.

My skills have slowly been improving. I’ve gotten more practiced at assessing spiritual resources, including what support the patient has from family members or friends, which makes it easier to tell who needs what and how often to visit which patients. In one chart, I saw this in a note from the ethics committee: “Patient is Jewish and being followed by Pastoral Services.” I’m the only chaplain who has seen this patient, so that was me! Doctors, nurses and other care providers do read our notes.
 
Thursday night, my downstairs neighbor had people over, some rather loud. You know what I’m proudest of in this whole summer? That not one single time did I call Tom, my best friend and downstairs neighbor, to ask him to be a little quieter. He is fond of videos of cars going around and around a track, or planes flying around and around in a circle (judging from the sound), and in the past I’ve now and then given him a call, but this entire summer, I have said to myself what Howie once told us he says to himself: “I will take what the dharma gives me.” I did the same that night and eventually I did go to sleep, and woke up feeling unbelievably lousy, and clear (for the moment, anyway) that while I might indeed like to work as a hospital chaplain, I need to be on the ten-year plan, not the three-year plan. This is going to have to be a marathon, not a sprint. My body is making it clear that it has no intention of doing a year at TWMC.

When I arrived at work on Friday, just two people were in the office: Rebecca and Victoria, the other CPE supervisor. Samantha supervises us summer interns, who are finishing one unit of CPE. Victoria supervises the residents, about to finish their fourth units, and I think she has considerably more experience than Samantha, certainly more life experience. I asked if I could speak with her for five minutes and told her that I feel like I’m dying—she looked concerned—and that I don’t think I can do the year at TWMC.

She asked how she could be of most help. I said, “I guess I want someone to say it’s OK to do this the slow way and that I’m not blowing a fantastic opportunity by not doing the TWMC program.” She thought for a moment and said, “You are blowing a fantastic opportunity, but this might not be the right program for you.” She did one unit of CPE in a trauma center, which caused her to realize she did not want to do a yearlong residency in a trauma center, so she went elsewhere. She said that the TWMC program is excellent—they are among the top eight hospitals in the country—but relentless. She said that TWMC treats extremely ill people, people who come from all over the country, and that stress permeates such hospitals from the bottom to the top. She said a year of CPE there would be an “endurance contest.”

I think I would actually enjoy working with people with trauma, but if I am not physically thriving where the on-call arrangement is so relatively generous, I am not going to survive something much more intense. Victoria told me about a woman she knows who decided to take a leisurely path to certification, doing just one unit of CPE yearly until she had completed her four units. This woman wanted to feel well and be in good health at the end of her training. Victoria said she saw this woman as a role model, and reminded me that there are many different paths we can follow to our goal. I’m not even sure I absolutely have to work as a hospital chaplain. Just being kind to people in general might be good enough. Volunteering might be good enough.

So that was helpful, and so was Rebecca, who overhead me saying I am planning to try to return to my former company. She told me she had worked there herself and learned valuable things, as well as in a subsequent job she had as a marketer at American Express. She talked about how financial security is a good thing and how our long-range plan can have a variety of chapters in it. After talking to Victoria and Rebecca, I felt that it would be perfectly fine not to proceed to TWMC and also perfectly fine to seek a job at my former company. (Cross your fingers for me.) Now all I had to do was tell TWMC. That evening, I sent them this note:

Dear [three people at TWMC]—

I will always be grateful and extremely honored to have been accepted into [TWMC]’s yearlong CPE program.

My experience of doing one unit of CPE at [VFMC], which will conclude two weeks from today, has affirmed my interest in chaplaincy and I feel more deeply than ever what a profound honor and sacred trust it is to be at the service of those who are aging, ill or dying, and their friends and families. However, I am getting an unmistakable message from my body that my path will have to be one that is slower and perhaps more meandering.

I am sure it is a significant inconvenience for you to have a student withdraw after so many HR procedures have already been completed—I am extremely sorry that clarity didn’t arrive sooner and ask for your forgiveness.

It has been lovely to interact with all of you in person and/or via email, and I hope the year will be wonderful for you and for your lucky students.

With relief, some embarrassment, much gratitude and many good wishes,
Bugwalk

Pre-Mortem Gala

Last Monday, which I had off because I’d been on call on Saturday, Carol Joy and I saw Captain Fantastic, with Viggo Mortensen, and Absolutely Fabulous: The Movie, followed by dinner on Valencia St. She told me about a friend who decided she would like to hear all the nice things people might say about her after she’s dead while she’s still alive and, after a year of planning and preparation, threw herself a very well-attended pre-mortem featuring displays based on her life, such as pictures of all her boyfriends and husbands over the decades. She lay in a pine casket (yep!) and got to hear all of her friends’ loving tributes.

Tuesday afternoon in class we discussed our call to chaplaincy, and Andrew said some things I found helpful. He talked about making the mistake of trying to decide on what his call was rather than letting his bones tell him. Of one possible career path, he said, “My body didn’t want to do it.” Of a thing he did decide to do, he said, “I couldn’t not do it.”

That day we also did an exercise where we non-verbally acted out dynamics we had observed among the three of us. It was brief and rather shockingly revealing. It showed how Andrew and I can sometimes ally against Mason, supposedly the person who has difficulty with emotions; probably it’s Andrew and I who are impaired there. It also showed how Andrew and Mason, the two men, can ally against me, and how I then immediately withdraw.

In my weekly meeting with Samantha the next day, I asked what the point had been and she said that the dynamics among the group of students are also likely to arise in our work in the hospital, and I think she is quite correct about that. For instance, I leave a bit more physical space around myself in interdisciplinary rounds than others do. I assume that the others are the experts and also that they know each other fairly well. I am new to the group and new to hospital chaplaincy, so I also assume that I am not wanted and express that by where I place my body. Standing closer to the others might communicate more confidence in myself and more trust that others are open to my contributions.

In the same meeting, Samantha, per a discussion she had with Jacqueline, withdrew her deadline for telling TWMC I won’t be there (which had been Monday). She amended that to say it would be good not to start if I don’t plan to finish, and if I start and then must stop, it would be good to give as much notice as possible and to finish the unit in progress; the year consists of four units. She pointed out that I’m getting a lot of advice from others and may feel pressure not to disappoint others. She asked what my own values are, and what my own theology (dharmology) says. She said that we might not be able to have everything we value at the same time when going through a transition.

I was utterly fried that afternoon and saw no patients. I sat in a semi-comfortable chair in a lobby in one of the hospital buildings until it was finally within 45 minutes of the end of the day. Back in the office, I said to Samantha and our office manager Rebecca, “I thought of a good reason I can’t be a chaplain: I’m an introvert. One hour per day of being with people is enough for me.” Rebecca always defers to Samantha, but on this occasion, she said, “Bugwalk, I’ve never known a chaplain who wasn’t an introvert.” Samantha said that if I conclude I don’t want to be a chaplain because I only want to see people one hour a day, she can respect that, and she can also respect it if I say, “I don’t love seeing people eight hours a day, but I find it meaningful.” Samantha herself is one of the people I’ve felt subtly pressured by. I think she has wanted me to go on to TWMC, but on the other hand, she has never said, “You’re the most promising student chaplain I’ve ever met!”

Sunday, July 31, 2016

The Chipper Chaplain

On Friday, I finally got to see my mental health professional, Deborah, and I read her my long list of reasons not to do CPE at TWMC and she said it sounded like I have made my decision, but then I told her what I like about this work, including that it’s an honor to be with people at the most difficult moments of their lives, that I’m good at it, that I like meeting new people every day, and that it feels great to do something that is undoubtedly worthwhile.

She said it’s OK to be happy: If I’m happy having a simple, quiet, low-stress life at my former company—assuming I can get a job there—that is entirely fine. More than one friend has said it sounds like I’ll be OK financially whatever I do and that I should take money out of the equation, but Deborah said financial well-being is subjective. She knows people with $10 million who don’t feel safe unless they have a paycheck regularly coming in.

She said maybe there are other ways I can get my needs to be a chaplain met and that I need to guard my health and well-being. She said that, as a cancer survivor, I have to be careful about stress. She said she thought of that several times while I was listing the arguments against going on.

“Does stress cause cancer?” I asked.

“It can’t help,” she said, which sounded rather right to me. Later, however, I did a little online research and learned that there actually is no evidence that stress directly causes cancer.

I have been having a lot of difficulty falling asleep this past week. The person who was coming off call Saturday morning said trouble sleeping can be a symptom of compassion fatigue, which you can indeed have after just eight weeks of CPE. He suggested remembering to do the things that bring me joy, such as hobbies I might have been forgetting about lately. He said people confuse compassion fatigue with burnout, but they’re not the same thing. Compassion fatigue comes from dealing with all the feelings that arise in caring for dying or ill people—our cup is just overfull with feelings. Burnout is more when we hate the whole system, hate our boss, etc.

I asked if there’s such a thing as being a hospital chaplain without being stressed out and he said that in itself, it doesn’t have to be a stressful job. He said he’s gotten to the point where his job per se doesn’t stress him out, but he said it’s not a simple, mindless job, and it will always be challenging. When you add in running a household, raising kids, and all the other things we do, there is the potential for stress.

I attended a death yesterday, spending time with the family and offering a prayer, and visited another patient who was actively dying. I had to take cabs to two other campuses of the medical center. One of my cab drivers said, “You seem like a very chipper chaplain.” After I said I was trying to decide whether to continue in this field or not, another cab driver said, “At your age, you need a job with less stress.”

My three most joyful moments in contemplating what to do next month have been when I decided not to do CPE. That seems telling. But when I think about going ahead, I sometimes feel a sense of a huge, thrilling, unknown expanse—a mystery and an adventure. How wonderful to have the chance to go on an adventure! At other such moments, I feel profoundly touched and almost teary contemplating the opportunity to fulfill what seems like a sacred trust.

Per Jack, I acquired Stephen Jenkinson’s book Die Wise. Skimming through it, I concluded that he’s kind of a jerk—could it be that everyone who works in spiritual care is a jerk, at least sometimes? I can be a jerk, certainly. Maybe everyone everywhere is a jerk sometimes, but you never get to see this working in finance because people don’t bring their whole selves there. Anyway, I did like very much what Jenkinson wrote to his sons in his acknowledgements section: “May your days become your own true days, proof of how it all could be.” I believe my own true days more likely take place in a hospital than in a corporate cubicle. But I also don’t want to be stressed out all the time, and I don’t want to be strapped for cash.

One of my favorite patients, M.I., was discharged last week before I even had a chance to say goodbye, and my other favorite patient left the hospital against medical advice. I had really been enjoying reading her chart. One day she was found with a pipe and contraband pills. The chart said the writer, a nurse, had been “unable to retrieve the pipe.” A couple of days after that, the nurses noticed her room was filled with smoke and later found rolling papers and a lighter.

I wrote their names on little pieces of paper and put them on the shelf that in effect is my altar, where I keep objects that I find beautiful and meaningful. I will keep them in sight for a while, and later put them in some sort of vessel, along with the others likely to come, so I can look at their names from time to time and remember their faces.