Friday, December 30, 2016

Hard at “Work”

At the morning meeting, the staff chaplain who had been so kind the night before said I always seem to end up in some extreme situation when I’m on call at that campus, and he said, “You’re doing good work here.” He said that in front of the director of the spiritual care department, which I hope made up for my encounter with the latter an hour or so later, when he found me sitting serenely in the cafeteria after breakfasting on three pieces of quiche that were utterly delicious but very tiny, like hockey pucks. Pleasantly full of butter, eggs and bacon, and long after I had presumably gotten on the shuttle, I was reading The New Yorker and drinking green tea when his unmistakable voice came from behind me: “Chaplain.” I felt a bit embarrassed, though he didn’t seem upset.

I departed with alacrity and arrived back at my usual campus wondering if I’m just too lazy to be a chaplain (or anything else). Sitting in my corporate cube and feeling dissatisfied with what seemed like meaningless work, I more than once concluded that the best way I could contribute to a non-profit would be to refrain from “working” there.

I went to take the on-call pagers from the person who had been holding them until I arrived, and he asked if I wanted to have lunch with him. I was quite full, but did go sit down with him and did actually listen to him in my best chaplain manner, and, after all, it’s the holidays. We have been trained that providing care to one staff member translates to better care for ten patients; maybe caring for one chaplain translates to better care for ten staff members. My peer mentioned that he had seen one of the patients on my floor, discerned her problem, and recommended such-and-such course of action, certainly something that sounded wise and that I might tell myself in that situation. (That having a horrible medical problem means we must learn to live in a world that is new to us, and that being vulnerable gives us the best chance of connecting with others.)

I made my way to that unit, where they had pizza! I really ought not to have but I did, while sitting in a wonderful massage chair someone had lately given the department as a gift. Then I went to see the patient my peer had mentioned (he thought she could use more support), but our visit was cut short by the arrival of a care team member she needed to talk to, so I went to see another patient that two different nurses had asked me to visit that day. They said she was crying and crying. On my previous visit, she had complained nonstop, and I had been shocked to discover that she is only five years older than I am. I had genuinely thought she was 25 years my senior, and resolved never to complain again.

During our second visit, I sat down and just listened to her, and tuned in to my own heart center, and didn’t concern myself with whether all aspects of her tale were true or not. If they are not literally true, they are metaphorically or symbolically true, and have just as much impact, as far as I’m concerned. I felt quite relaxed and rather sleepy after all that quiche and pizza. I let my eyes close a time or two, and told the patient, “If I’m asleep when dinner comes, wake me up.”

I spent an hour and 25 minutes with her, by which time it was clear to me that her deepest desire is to feel loved, and that she does actually have faith in God. Voila! I marvel at my fellows who can march into someone’s room, immediately figure out what the problem is and dispense a solution, but I can’t do that and am also strongly philosophically opposed to it, even as I am sure that that approach brings wonderful benefits to many.

Fortunately, there are many ways to be a chaplain, including my ultra-time-consuming method. Toward the end of this visit, the patient showed me her childhood rosary, which she said she rarely shows anyone, and I was able to offer a prayer that I think was spot-on: for the patient to feel God’s love, and for God to show the patient how she can offer love and care to herself. The patient asked me to come back the next day, and was sad when I said I would be off for the next four days. Before the visit was over, she almost but not quite smiled.

All Gone

On Christmas Eve, Tom picked me up after work and we drove (in a car lent to us by a colleague of his) to Sacramento to spend the evening with Ann (Tom’s mother), Steve, Julie, Julie’s mother (Diane), and Ann’s two dogs. Tom and I slept over at Ann’s, and we all went to Paul and Eva’s the next day for stockings, refreshments, and to admire the Christmas tree. Present were the aforementioned, plus Paul, Eva, Dan, Sarah, Chris, Kristin, Chris and Kristin’s baby (Rowan), and Kristin’s mother and father, Jim and Denise. Late in the afternoon, we went to have Christmas dinner at the home of Steve and Julie’s next-door neighbor, Robin. Her two best friends were there, plus Ann, Steve, Julie, Diane, Tom and me.

I was able to go to Howie’s Tuesday night this week because I was scheduled to be on call on Wednesday afternoon. I knew Howie wouldn’t be there; he’s always away between Christmas and New Year’s. Attendance was generally light. Some people were probably away on their own holiday travels, and there are a lot of people who don’t come if Howie isn’t there, but my walking friend was there, with a couple who are longtime friends of his. He introduced the man as a chaplain, and at first I thought he was kidding, but the friend really is a jail/prison chaplain. He said he’s not sure what he offers, but he knows for sure what he receives. He said he learns something every day, and is frequently touched by those he encounters.

I told him that when I finish my two years of education, I will be 57—is that too late for a career change? He said, “If that’s the path you’re on, it will work out.” A chaplain intervention, just at the exact moment needed.

On Wednesday evening, I was on call at the other campus and feeling rather gloomy about F. We have been breaking up for nearly an entire year. As Todd Rundgren sings, “Grains of sand one by one—before you know it, all gone.” F. lately sent me such a rude text message that it may have represented our final ten grains of sand, all that was left of what once seemed like a whole beach. In any event, there has been no communication since then on the part of either party.

I mentioned to one of the staff chaplains that my romantic relationship had ended. This was the same person who complimented my gift for public prayer, so I like him very much. He put his hand over his heart and looked sad for me. I also ran my question by him about whether I’m too old to be embarking on professional chaplaincy. He said he started at approximately the same age, after a career as a social worker. He said many of the working chaplains he knows tend to have more life experience.

Soon I got a call from a nurse on behalf of a patient whose dog had died. She called back and said the patient had been given Ativan, so all was well at the moment, “but we can just call you whenever, right?” I know that some hospital personnel think there are three shifts of chaplains, in which case it would be perfectly appropriate to call at any hour for any reason. But this is not the case. I told her that when we’re on call, we work for 24 hours straight: we work during the day and we hope to rest as much as possible during the night. “Oh, I understand!” she said. I will say that I would not have said this had my supervisor been within earshot, though my peers supported my approach when I told them about it the next morning. I told the nurse that, having said that, if the patient was really freaking out during the night, or panicking, they should definitely call me, and I added that I sympathize with how painful it is to lose a pet.

I did my rounding, visited a patient I always visit when I’m at that campus, went to sleep, and was awakened at 5:30 a.m. by a call about a baby whose death seemed imminent. I was in the room when the doctor arrived and told the parents that the baby was telling us goodbye. He suggested that most of the medical equipment be removed so that the parents could hold their baby in their arms and change its diaper if they wanted, and when they were ready, the final piece of life support would be turned off. The doctor said that continuing to pump oxygen into the baby is damaging its lungs, but the parents shook their heads and said they wanted treatment to continue. This baby has been in the ICU for more than six months, and I learned later that the parents feel they are on the opposite team from the care providers, which must be really terrible—not to be able to trust your very ill child’s doctors and nurses, and to feel they are giving up too soon or even failing to value the life of your child.


A couple of Saturday nights ago, a relatively young man died in the emergency room. His family visited not all together, but sequentially. First his brother came and was extremely upset for half an hour, and then his father came and wailed loudly for about the same length of time, and finally another brother came and talked to me nonstop for 90 minutes or so on a wide range of topics, including some horrendous family incidents. I was exhausted after that.

I had kind of a strange visit with a patient a couple of day before Christmas, and did something I felt bad about later. I was on call and trying to juggle multiple tasks, and tried to fit in a visit with this patient, even though I could hear she was on the phone. “How long are you here?”, she asked, and something about her tone raised my hackles a bit. I wasn't sure how to answer, because I was scheduled to be there all night, but would just as soon not make appointments for 2 a.m. I told her I had to go provide a blessing for someone who had died and would try her back afterward. In retrospect, I see that I was slightly stressed by own attempt to fit too many things into the same set of minutes, and that I felt a little threatened by her question, which is to say that I was subtly rebuking her by mentioning the fact of death. She looked taken aback, and I felt ashamed of myself. Before I left the room, she asked what religion I am, and by the time I returned, she was ready to try to convert me to hers, and gave it a good solid effort.

I said, “My beliefs are different, but I’m glad you have a robust faith you can rely on.” Five minutes later she tried again, and I gave the same response. A few minutes later, not at all abashed, she again explained why her religion is particularly amazing. She had quite a determined manner; maybe that’s what pushed my buttons in our first brief conversation. This patient complained several days later to a peer of mine that she had been visited by no fewer than three Buddhist chaplains, and she declined to have one of us who identifies as Catholic and Buddhist pray for her, because she doesn’t understand how someone could be both.

The night of my first visit with her, I was called to provide a blessing for a second person who had died. At this man’s beside was his daughter, accompanied by a friend.

I asked, “Can you tell me a bit about your father?”

“My father? He was funny. He was a deacon in the church.”

“Is your mother living?”

“This is my mother.” Namely the person lying dead on the bed in front of me. Very big oops. From now on, I will consult the chart of the deceased party beforehand for key details such as gender.
As that evening passed, I noticed that I had once again fallen into being “nice” and ignoring the emotion that was actually present for me, which was sorrow. I’ve been rereading Charles W. Taylor’s The Skilled Pastor, in which he says it is the relationship that heals, and it is the skillful, attuned conducting of a conversation that builds a relationship. I’ve been against having any particular agenda from the beginning of clinical pastoral education and when I have proceeded in accord with some sort of plan, such as using the assessment model we have been taught, it has frequently felt strained and artificial.

With The Skilled Pastor in mind, lately I have again let go of any agenda, which initially led to several conversations that were extremely long and pretty much purely social in nature. One patient said happily, “Rarely do I get the chance to tell someone my whole life story! Let’s see, I was born ... ” And I could not figure out how to get out of that room; a tremendous inertia set in and I sat there for an hour. She seemed happy when we parted, but that obviously is not a fruitful way to proceed, and once again, I found myself wondering if I have any aptitude at all for what I’m actually supposed to be doing, or any interest in doing it, and then I began to worry about my financial future—if I’m not going to be this, what am I going to be?—which took me that much farther from my own true emotional experience.

I made an effort to get in touch with my own emotions, and an interesting thing happened in the next couple of visits: I was conscious of my own feelings, and of the physical sensations in the area of my chest, and both of the people I was speaking with cried.

One of our perks is several free sessions with a counselor, so I have gone twice to see a young lady therapist at student health services, and spent most of both sessions talking about F. In our second session, she said, “Let’s pause for a moment and think about how best to use this time. I wonder if you’d like to try getting in touch with any emotions that are present.”

Normally I would disavow having any—at least, that’s what I do when my own mental health professional tries this—but I know that a lot of what they try to teach you in CPE is awareness of your own emotions, and since I want to get all I can out of this experience, I said “Sure” and was amazed to find myself completely in tears. It was a relief to cry in the presence of a calm, kind person. I guess it was my own willingness to feel my feelings and something about A.’s presence that made that happen. So if there is a manner in which I can be present that allows patients to cry, I think that’s a good thing. Maybe being in touch with my own feelings while speaking with others is a crafty way of turning social visits into something more healing, and one I can feel entirely good about, unlike asking questions per some assessment model.

Saturday, December 17, 2016

Pretty Much Everything

Last week as I entered a room, I overheard the patient saying to someone on his cell phone, “I have to talk to the chaplain.”

I said to him, “You don't have to talk to the chaplain.”

“I get to talk to the chaplain,” he amended, and then, “I have assented to speaking with the chaplain.” It turned out he himself was a pastor and knew all about hospital chaplains and CPE students.

I went back to see the patient who had wanted the bravery infusion, which turned out to come via horses. In our first conversation, it was established that we are both atheists. As for what happens after death, she thinks nothing does, and I said I think the same, “but who knows?”

“Who knows?” she repeated, incredulous. “I know. I know: nothing happens!”

When I saw her this past week, after her surgery, nearly her first words were a semi-mocking, “But who knows?”

“Oh, dear,” I said. “I’m sorry I gave you something to stew over for these few days.”

“Few days?” she grumbled. “Probably forever!”

In defense of my position—which I made clear I was not trying to convert her to—I said that no one who has ever died has been able to report on his or her post-life experience, and I described hearing Jack Kornfield say something like, “When I was younger, I didn’t believe in this, that and the other. Now that I’m older, I believe in pretty much everything.”

“Now, there’s a person with no convictions,” said my patient.

We went on to discuss agnostics, whom this patient finds “wishy-washy.” She said she was afraid I might be one of them. I said I am not, and that I hadn’t meant to worry her.

She said, “Agnostics in general worry me.”

At the end of our conversation, she asked if I also work at the rehab where she’ll be going and if I ever stay friends with patients I’ve visited. This is an issue I worked through in my first unit of clinical pastoral education, when I did want to visit one of my patients after she went from the hospital to assisted living. I had visited her about 15 times and had come to be very fond of her. Samantha and I discussed this and she pointed out that, for one thing, the patient had not asked that I visit her. In addition, this might keep her from developing a good support system in her new home. Finally, would I really be able to follow through with regular visits? What if I met another patient I wanted to be friends with, and another and another? Samantha said that if it was meant to be, it would be—I would run into the patient on the street and we’d strike up a conversation.

After I told my patient last week that our relationship could not continue after she left the hospital, she cried. I was touched by that, though it is also true that people are often emotionally labile after surgery.

There were two holiday parties at work last week. At the first one, I ate eighteen small croissants, give or take; the secret is to repeatedly go get three more. The next day was our division party, with about 50 attendees, held in a building that is precariously perched on a very steep hillside and held up with long steel beams. The stairs up to the room at the tippy top where the party was held are on the outer edge of the building and overlook a very significant drop to the ground. It reminded me strongly of one flavor of bad dream I have, of going up stairs that become more and more treacherous. I learned later that one of my peers refused to take this route and insisted on an inside passage, which she said was circuitous.

The party was nice. An abundance of Mexican food was served, and each guest was given a small evergreen tree in a silver or red metal pot. Each department shared heartwarming stories of patient encounters. On our way back, in an elevator, a woman I didn’t know and who hadn’t been at the party admired our little trees, so I gave her mine, since I lack a yard and also have a brown thumb. She asked my name and said, “I’ll call it the Bugwalk Tree.”

I’m glad that was the last party for now, because while my stomach always has additional capacity, my garments no longer did.

Sunday, December 11, 2016

Horses, Of Course

I went back to see my dying patient this past Friday. He is being given morphine, but not enough to make him completely free of pain, which might also finish him off on the spot. On Tuesday, I spoke to a relative of his who was planning to visit on Friday from another state. Everyone thought that would be too late, but lo and behold, the patient was still alive that afternoon. The relative had hoped to converse with the patient, but for that it was indeed far too late. I never heard the patient speak a single word myself.

When I first saw the relative on Friday afternoon, he said he wanted the patient to get all appropriate treatment, but then the doctor came and explained gently but directly that the patient was passing away and that he was in pain, and they agreed that the focus would be on symptom relief and comfort. It’s the first time I’ve been present for such a discussion and was impressed at how the doctor, a Muslim woman in a headscarf, handled it.

I spent some time listening to what was on the relative’s mind and felt I was able to be of some real service there. He also arrived at his mother’s deathbed too late to talk to her, which he mentioned a couple of times. I could see that it was painful for him to have this happen again and that he was shocked at his relative’s appearance, which had become downright beautiful to me after the first half-hour of sitting at the bedside
a source of pleasure I would never have anticipated. I asked the relative to tell me a bit about the patient and learned what work he had done and what country he was born in.

On Friday I had lunch with one of my peers, which was enjoyable, and I saw another patient I’ve seen several times lately, a tough-talking atheist who is near 80 but looks quite a bit younger. She was headed to surgery and said that when she had spoken with her doctor that morning, she had gotten the impression that her chance of surviving the surgery was only 50 percent, which frightened her. She asked if she could end up in a wheelchair and her doctor said he didn’t expect that, but “anything is possible.”

She told me she needed a “bravery infusion.” I launched into a guided meditation, but she said, “No, no, no. I already have a script for lowering stress. I don’t need another script.” Oops. I should have asked if she wanted to do a meditation. So then I said, “You are in an ocean of bravery—clear, sparkling, refreshing bravery all around you.” But that was not helpful, either, and again, I should have asked what she had in mind. For all I know, her worst fear is of death by drowning. Oops again.

It turned out that what she had in mind was horses. The thought of horses around her makes her feel brave—imagining the sound of their hooves clip-clopping along beside her. So we discussed that, and she at first looked calmer and then suddenly burst into tears and said, “I’m scared! I don’t want to die! I have so much more I want to do.” I held her hand, and it ended up feeling like a very meaningful visit, as well as a good learning experience for me. I told her I would look for her after her surgery, and was able to find her later in post-op, which fortunately is also my area. She was still asleep, but I bent over and said to her, “Hello, [patient’s name]. This is Bugwalk. I’m here, and I’m pleased to report that you are one hundred percent alive! I will see you on Monday.”

Tom has had a cold this week and asked for my help making a trip to the grocery store today. Shortly before we were going to leave, he called and said he’d run into problems reserving a City CarShare car. He came down to my place, and sure enough, this now requires the use of Facebook. We are not on Facebook and have no plans to be on Facebook. Annoying. I sent them a polite note asking them to cancel our account and to return my refundable deposit of $300. Hoping that goes smoothly but won’t be surprised if it doesn’t. Fortunately, neither of us has been using the service much lately. I liked to drive one of their cars to visit Carol Joy, but can’t really justify the expense now. Fortunately, there is a bus I can take.

I have taken a 60 percent pay cut—well, actually, I got a 40 percent pay raise, combining my severance pay with the stipend I get from TWMC. But I have been saving every penny of the former, which will stop at the end of January, and then it will be a 60 percent pay cut, which at first seemed dismal and very not fun. But now I’m enjoying the challenge of living on my new income, and am even saving a token amount, just $100 each month, to adhere to the principle of living within my means.

It mainly has meant not taking cabs and not buying books, both of which are easy enough not to do. I’m taking Muni a lot more. I’ll be taking the bus to see Carol Joy from now on. It means really considering if I need something, and buying way less packaged stuff at Rainbow, where my typical weekly expenditure has gone from $175 to $75. They offer discounts in some departments if you spend a certain amount, so I’m planning ahead in order to take advantage of those. On the other hand, visiting my parents, going on meditation retreats and having bodywork twice a month are essential, so I am budgeting for those and doing without other things.

I now see that I can live on much less money than I would have thought—medical and housing crises aside—and I am now planning to do whatever I need to do to work as a chaplain or in some related area. For instance, I could see myself being a part-time chaplain and a part-time bereavement counselor. We shall see. I have a very strong sense of being carried along, of floating atop a powerful current.

One-Woman NODA

When I got back to work after visiting Michigan, I was kind of slow to get back into seeing patients. I cheated, sort of, by spending hours with an elderly man who was expected to die soon, sort of a one-chaplain no-one-dies-alone effort. I sat by the patient’s bedside for hours over the course of a few days, speaking and singing softly to him in Spanish. I told him, “I’m here; you are not alone” and “Everything is all right.” He seemed to get more agitated when I said that God loves him, though he is listed as Catholic, so I stopped saying that. When he writhed around and yelled, at first weakly and later producing no sound at all, I sympathized: “This is difficult.”

Eventually, I had to get back to my assigned duties—the dying patient isn’t even on one of my units; I must have first encountered him while on call—and found myself in distress with a patient who has had several surgeries. I felt boiling hot and weak and my stomach felt weird. I felt like I needed to sit down even though I was already siting down, and I thought, “I can't do this” and further that I probably can’t be a chaplain at all if I can’t listen to disturbing medical stories. Right?

Au contraire! It turns out that others in my group have the exact same response; one even said she doesn
’t like to hear about or see medical stuff.

The person who is on call in the evening runs the morning meeting the next day, at which we go over who is on call at which campus, who is leading the noon mindfulness session and which priest is on duty, etc. Afterward, this person sends an email to everyone with all of that information, and sometimes takes the opportunity to prepend his or her own message, as I did the morning after the election. (Speaking of that, faithless electors! Or maybe Twitter will cancel Trump’s account per its anti-bullying policies.) The on-call chaplain was evidently in an exuberant mood one morning last week. Her email started, “We’re ALIVE!”

Poop Dollops

While I was charting patient visits one afternoon a few weeks ago, a nurse came into the computer room and announced that there were “dollops of poop on the hall floor.”

“Poop dollops?” another nurse asked politely.

After I finished my charting, I saw a series of emails saying that the following week would be chart review, and since some of us would be out, our peers would need to do our work in addition to their own. One of the people who was going to be out asked if she could try to finish hers before going away, and the supervisors said that would be fine, but that others who would be away shouldn’t feel obligated to do the same.

However, now that I knew my colleagues would have an extra load because of my absence, and with just a couple of hours left to go in the day, I decided to try to complete mine, too, and was able to see all but two of my patients. One had not been in the hospital for 24 hours yet, so I didn’t need to see him, and the other reduced my score to 98 percent, which was all right.

To accomplish this, I had to briefly interrupt two visits patients were having with their physical therapists, and even a doctor visit, which I normally would never do. One of the PTs was a bit abrupt, which I could fully understand. Luckily, I saw her at the end of the day and apologized, and she was very nice about it; she also apologized. I explained that we have this crunch regarding metrics once a month and described how I rush from room to room on those days, thinking, “I hope you don’t have anything on your mind because I don’t have time to hear about it.” I told her it feels terrible; fortunately, it’s only once a month. Afterward I wondered if I’d sounded callous, but I think she and the other couple of PTs in the room understood.

I’m thinking more and more lately about chaplaincy as my explicit spiritual practice. It’s not in line with my meditation practice or in the spirit of my practice—it is my practice, moment by moment. I remember many times being on a meditation retreat, sitting with physical pain that was sometimes excruciating. Over time, I learned some techniques for being with pain (the most helpful comes from Somatic Experiencing), but mainly I learned how to relax, and eventually made the joyful discovery that my mind could be perfectly happy even when my body was exactly the reverse. These days being on retreat is easy. What’s sometimes very difficult is listening to people describe their medical experiences, which is, understandably, a favorite topic of those in the hospital.

The day after Thanksgiving (because I was on call on the holiday itself), I went to Michigan to see my parents and sister. We had our festive meal on Sunday: roasted chicken (perfectly tender but with a crispy skin), Mama Stamberg’s cranberry relish (which does have a kick), two kinds of homemade biscuits, two kinds of gravy, stuffing, sparkling water, no dessert. It was very nice of my family to have Thanksgiving on the wrong day. I also had lunch with Ginny at Café Zola (salmon burger!) and with Amy at Seva. It was wonderful to see everyone.
I watched a lot of cable news, mostly MSNBC, some CNN, and even some Fox News. I was interested to see what the latter was saying about current events, and was both pleasantly and unpleasantly surprised.