Wednesday, October 18, 2017

Snippersnapper

Yesterday was my very first day as an actual paid staff chaplain. It went pretty well. I spent the first couple of hours at the office where Rebecca, our administrative person is, doing the last of orientation. I thanked her for a couple of things she said when I was doing CPE that were helpful to me. One was when I announced to my supervisor, “I’ve thought of another good reason I can’t be a chaplain: I’m an introvert.”

Rebecca, working away at her desk nearby, said, “Every chaplain I know is an introvert.” Objection overruled!

Rebecca also mentioned one day how much exercise chaplains get walking around the hospital all the time—that it’s a healthier job than some.

Rebecca said she wanted to thank me in return for teaching her how to center herself—I had not realized I had done such a thing—and also for being an inspiration in regard to mindful eating. She said she periodically attends mindfulness training classes at work where they talk about mindful eating. She said it never really sank in until she saw me having lunch one day and thought, “Mindful eating: There’s someone doing it.” She said that ever since then, she has been paying much more attention when she eats.

I took the shuttle over to my own campus and spent the day fielding pages to the on-call pager and dispatching requests. I saw only three patients, including one who was going on comfort care, meaning that death was imminent.

The air was smokier than it has been all week, and even in our windowless chaplains’ office in the basement, I could smell it. After an hour of sitting at the computer mid-day, my chest hurt, my eyes were burning, and I had a headache. At the end of the day, I spent another hour in that room. It no longer smelled like smoke, but I still got a headache. I hope it’s not going to be a chronic problem, something to do with the ventilation. I gather that even if you can’t smell smoke, such as from the North Bay and Santa Cruz wildfires, there can be yucky stuff in the air, so maybe it was that.

I punched out at 5 p.m. and went on standby, but lingered in the office until near 7 p.m. to see if any pages would appear. Nursing shift change is at 3 p.m., and my colleagues say most requests for an immediate visit from a chaplain turn up by 5 or 6 p.m. The likelihood of being paged after that is less. I spent that time typing up notes, figuring out how to print, and devising a method for tracking my daily stats—the number of minutes we spent doing this, that and the other. Late in the day, I realized I had forgotten to check one source of chaplain referrals and was relieved to see that there was only one request, and it could be handled the next day.

I walked home and made dinner, marveling that I was still on the clock, yet in my own kitchen with my own cat. I didn’t get paged during the night.

Today I had some stuff to do in regard to health insurance: check my latest notices from Covered CA, pay my monthly premium, and follow up on getting both forms of insurance that I had earlier in the year to authorize the mammogram I had in January, which in itself has been an absorbing little project. I am so grateful to have health insurance, but applying for it and dealing with it have been ongoingly stressful—so many weird little details. Fortunately, the people at Covered CA are excellent at what they do and very helpful.

I got a notice from them several weeks ago saying there was a discrepancy between what I’d reported as my income and what the computer said. I called and we agreed that I would upload some documents pertaining to my CPE stipend. I did that—with difficulty—and two weeks later got the exact same notice again. I called back, and this time the person said there is nothing in their system that tells them that documents have been uploaded. You have to call and say, “I uploaded some documents!”

So I told her, “I uploaded some documents!” and she went and checked them right then and said everything was fine—except that now that I had no verifiable income, I qualified for Medi-Cal instead of Covered CA, which is fine with me. A couple of days later, I got a call from a Medi-Cal worker and told her about my new job. She somewhat sternly told me that if my income from my new job is what I predict it is, I do not qualify for Medi-Cal (which is also fine with me, since it wasn’t something I was seeking in the first place).

Today I yet again got that notice from Covered CA saying there is a discrepancy in regard to my income. The other day, I tried doing my annual renewal online, but could not convince the system that I was never in foster care. So I called today and explained the whole thing to another helpful person. Whoever hired the people who answer the phone at Covered CA truly did a fantastic job. This person updated my income per what I think it will be, said not to worry about the foster care thing, and said he had gone ahead and renewed my insurance; I just need to choose a plan.

I’ve been feeling sorry for myself because my insurance has such a massive deductible that I don’t dare use it unless I really, really need to. I decided today to go look at the other options. Maybe that low-premiums / high-deductible plan is for some young whippersnapper that I no longer am. There are certainly some other choices, but I wasn’t sure how to proceed because I’m not sure what the various plans cover, exactly. This caused me to remember the big stack of documents Kaiser has mailed me over the past several weeks that I have not looked at. Possibly if I were to peruse those documents, I could make a better choice about next year’s plan. Mainly, I just hope I don’t inadvertently do something that causes my insurance to vanish.

Though if that did happen, County Hospital serves people with no insurance at all, and their doctors are one and the same as the doctors at the Truly Wonderful Medical Center, so the care would actually be superb; you just might have to sit in a clinic waiting room for six hours before getting it. I used to do that when I was in my 20s and didn't have insurance. However, it would be disingenuous of me now to rely on that safety net meant for others. I can pay for health insurance, and I am happy to have the opportunity to participate in a pool of insured people.

Oh! I always thought “whippersnapper” just meant a young person. It actually means “A person regarded as insignificant and pretentious” or “An unimportant but offensively presumptuous person, especially a young one.” But why? Oh, because of this: 1665-75; probably blend of earlier whipster and snippersnapper, similar in sense. All right, that clears that up.

Monday, October 16, 2017

Burning-Hot Coins and Slippery Rocks

I have finished reading The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, Anne Fadiman’s superbly written, riveting account of Lia Lee’s medical travails, and, for comic relief, have started Zen Confidential: Confessions of a Wayward Monk, by Shozan Jack Haubner.

He writes: “You deal with your shit in Zen by sitting with it. By breathing right into it. You don’t try to ignore it with pleasant thoughts or lofty ideas, and you don’t try to bury it with solutions. You deal with it, you work with it, one breath at a time. You hold it right there, in your hara, or breathing center. You don’t try to breathe it out; you don’t try to breathe it in. You keep it suspended in your diaphragm like a burning-hot coin. Your problems won’t change; only you can change. That’s the point.”

That reminded me of what Ezra Bayda wrote about trying to figure out what work to do—that he finally concluded that he just needed to sit with his anxiety about it, and after he did that for long enough, an idea came to him.

One skein of recent worry runs like this: What if I go to school for two years and then can’t get a job in San Francisco? Will I be able to find any job whatsoever at age 58? Today I was going to call my friend who worked for many years as a recruiter to ask her this, but then I remembered about the sizzling coin, and dropped the reminder to myself in the recycling bag instead. While my friend might actually have some ideas about this, in the end, the question can’t be answered in advance and answering it isn’t the point. Learning from my experience is the point, however haltingly, and however often I seemingly have to learn the exact same thing once again.

This doesn’t mean that I should go to school and work as a chaplain, of course, which points to another chronic worry: How do you know what to do? I really appreciated that CPE kept me from having to think about this for 15 months, but now CPE is gone and I’m back to having to feel my way across the river on my own, one slippery rock at a time.

One thing to consider: What is my motivation? In these periods of unease, fear and the desire for security and certainty loom large. Even though this fits nicely with my generally anxious temperament, I don’t want to spend the rest of my life lurching from one seemingly safe haven to the next. Ultimately, there is no such thing, and I also will feel disappointed in myself if I do that.

(However, I’m also not saying I’m going to mail my keys to my landlord and go live on the sidewalk with Hammett, trusting that all my needs will be met.)

The path toward chaplaincy does afford continual personal growth. Wanting to grow and learn seems like a pretty good motivation.

I had dinner with Sam last night at Eric’s and learned that perhaps the thrill of working for the complaint department could wane over time.

Closing for today with this little prayer from the Peace Pilgrim, which I say aloud almost daily, and which sometimes seems like enough and sometimes doesn’t seem like enough:


Live in the present,
Do all the things that need to be done.
Do all the good you can each day.
The future will unfold.

Sunday, October 15, 2017

No Teasing

Yesterday morning brought clear blue skies and a complete lack of smoke in the air—a welcome surprise. Charlie and I went for a walk through our neighborhood.

I found this written note in my pile of little pieces of paper and I’m going to keep it until I remember what it means:
“Louise = bad with medical. Katrina = good with medical. Doesn’t like to be teased.”
What on earth does that mean? I don’t recognize either of the names.

This morning also featured blue skies and clear air, just as welcome as they were yesterday, but I am in a state of unease about my path forward. I really do not want to go to school, for one thing. In 1998, the question I asked myself, which led to 18 lucrative but not particularly fulfilling years in a cubicle, was, “How can I weasel my way into a tech job without getting any more education?”

During the past year of doing CPE, I assumed I would go to school starting next year, because I believed that chaplaincy was the answer to the question, “How can I support myself doing something that seems worthwhile?” and school is required for board certification.

But now I’m remembering that, before that, my question was, “What kind of job can I do that takes place in a hospital?” I ruled out being a physician, nurse, OT (occupational therapist), PT (physical therapist), ST (speech therapist), or administrative assistant. That left just one choice: chaplain! I moved toward this several times and then backed away when I remembered how much religion would be involved. I still feel uneasy about the religious aspects.

Today I got a call from Sam and was reminded of another job that takes place in a hospital: complaint department! It appears that, each year when the CPE program finishes, a few graduates go to work there, where they are welcomed for their unique skillset.

Several times it has crossed my mind that I might like to work part-time doing tech support. I like sitting in front of a computer. I like assisting a variety of people with whatever is bothering them. Today it strikes me that working in the complaint department of a hospital might be just the thing: I could sit in front of a computer, use my chaplain skills, talk to different people every day, and not have to go to school. I would also not have to continue to deplete my savings at a nauseating rate, which I’ve only been doing for a month but already don’t like.

I told Sam about my troubles with Jacqueline and at first he said it sounds like she is really suffering and that he thought I should confront her and tell her how her words make me feel. This struck terror into my heart. But after I told him a  couple of things she said, word for word, he said, “Hmm, do you think there could be any truth to that?” and, “Oh, just ignore her. Let that roll off your back.”

Friday, October 13, 2017

The Dorky Duckbill

On Wednesday, I walked over to County Hospital through the smoky air and spent the afternoon seeing patients. Jacqueline, over at VFMC, shared with us during orientation several things she’s not a fan of. One is chaplains stopping by to see patients “just to see how you’re doing.” It sounds like she wants her chaplains to confirm whether the religion listed for the patient is correct, find out if that religion is helping the patient—I’ve never heard anyone say it isn’t—and inquire if there is any religion-related support the patient needs, such as a Bible, which often is requested. She has an actual flowsheet for pastoral care conversations.

OK, then. I tried this out and it certainly does make conversations shorter, and resulted in even more walking, as I went to fetch Bible after Bible. Before you can be certified as a chaplain, you have to log 2000 post-CPE clinical hours. Possibly by the time I’ve done 2000 hours, I’ll have settled into approaches that are satisfying to me and also meet the job requirements.

On Thursday I stayed inside all day due to air quality issues. When I looked out my window in the morning, there was a layer of haze between me and the rooftops several blocks away. When I opened a window to see how things smelled, ash started blowing in immediately, and it smelled very smoky.

Today I stayed in most of the day, too, wondering if I was being overly wimpy. In the late afternoon, I went out to do a couple of errands. I ran into one of my fellow County Hospital volunteers. I was outside for only 30 minutes, and came home with a headache and irritated throat, and smoke-stinking clothes that had to be put into the laundry basket right away.

I have ordered a budget HEPA filter and some N95 masks, but who knows how long those will take to arrive? We are fitted yearly at work for an N95 mask. There are two general kinds. Thanks to that, I knew exactly what to order.

Tuesday, October 10, 2017

Eggplant

On Saturday, one of my CPE peers came over. I’ll call her Nellie. We had a really nice day together. She visited with Hammett, and we walked over to Scarlet Sage and on to Papalote for burritos for lunch. We went to Dog-Eared Books and came back to my place for tea. In the evening, Tom and I went to Eric’s, Chinese food at Church and 27th St., for dinner. We had pot stickers, eggplant and cod. Everything was incredibly delicious, really fresh and lovely.

Nearly a year after breaking up with F. (that is, him breaking up with me), I’m finally starting to get some helpful insight into the matter. Basically, I want him to behave in a different way so that I don’t have to have certain feelings, primarily that of longing. I haven’t been able to fathom why he doesn’t feel the same way. Doesn’t he miss the remarkable togetherness we had? (Quite some time ago, at this point.) No, he does not, because he refuses to feel longing; he prefers to feel angry. How he feels is based on how he sees things; how I feel is based on how I see things. There is no way for me to affect how he sees things. There wasn’t when we were together, and there certainly isn’t now. There is nothing I can do about that.

I realized that I have this little mound of grief, with notes of regret, guilt and occasionally anger, that I may have to carry forever. Once I accepted that, it was a short hop to tonglen: being willing to shoulder all of the bad feelings left from this relationship, and to wish for F. to be entirely free of them—there’s no sense in both of us feeling bad. A couple of days after I began to practice tonglen—“May I take upon myself all of the sorrow from this breakup; may F. be happy and at peace”—I noticed a new sense of separation between us which for the first time felt good instead of bad. It felt clean and peaceful.

I usually forget about tonglen practice until I’m desperate, but it is quite powerful. It is a way of turning toward difficulties rather than trying to make them go away, and it affords a bolstering and inspiring sense of doing something noble.

However, about the time the sense of separation arose, I began to consider how much of this pile of suffering might be self-inflicted and therefore optional. Maybe some of it is unavoidable, and this I will willingly carry with me, but probably a lot of it is due to how and where I deploy my attention. As the Buddha taught, grasping causes suffering. Theoretically, I could have figured this out two days after the breakup, but it always goes the way it goes.

Yesterday I went for the fourth and final day of orientation for my new position as staff chaplain at VFMC, along with my wonderful co-worker, Carolina, who I like more every time I see her. That will happen very rarely, since we are going to work on different days. The night before, I kept smelling smoke, and when I woke up in the morning, I learned that there are a lot of wildfires burning north of here. My apartment, where all the windows were closed, was smoky, and the hallway outside my apartment much more so. Outside the air was hazy. Even deep in the bowels of the hospital, in the basement, it smelled like smoke.

A few times yesterday, my new boss, Jacqueline (not her real name), spoke to me in a rather withering manner, which caused a knot of fear in my gut, and which I well remember from last summer. She spoke to Carolina in nearly the same tone, and I know it’s not personal. The person I feel for most is Rebecca, the administrative person, who I know is regularly criticized and scolded. It may be partly the difference between a hospital that is basically corporate and one that is a teaching hospital affiliated with a university. There’s quite a different feel.

However, I must admit that Jacqueline’s bordering-on-rude observations were not entirely off the mark. I am detail oriented and risk averse. I am an Enneagram One, and I like to do stuff right, and in order to do that, I have to know what’s right. Unfortunately, the kind of question I am most urgently moved to ask is exactly the kind of question that can annoy Jacqueline, so I guess this is an opportunity to figure out how to draw upon my own authority.

I also see the parallels with F.: I want my boss to act in a different way so I don’t have to have a knot in my gut. But that is outside my control, and it’s not reasonable to expect only good things to come my way. After having been affirmed constantly at TWMC (a teaching hospital affiliated with a university), being treated as if I’m a loser is hard, but I am grateful for the memory of that extravagant kindness, and also for currently being treated extremely well by Clementine at the County Hospital (also a teaching hospital affiliated with a university).

What they call “self-supervision” in CPE is called for here: how can I be a chaplain to myself? I can figure out creative solutions, such as taking the unpleasantness itself as my object of attention.

As for the job at TWMC, I haven’t heard anything. The online listing has now disappeared, so the application period appears to be over.

Friday, October 06, 2017

Patient Visit Protocol

Still no email about being screened out. It would be absolutely incredible if I got that job, but it will be fine if I don’t. I am starting to feel excited about the new job I already have—it was great to create an Outlook signature that says “Staff Chaplain” in it—and I also love being at County Hospital.

Today was my third day of orientation (of four) for my job at Very Fantastic Medical Center. They gave me the same user ID as when I did a unit of CPE there in 2016, so there were my electronic health record lists from more than a year ago, and lo and behold, one of my favorite patients of all time is in the hospital right this minute, as seen in my “Patients I Have Seen” list. She is even in one of the units I will be assigned to. I once read a chart note for her that said something like, “Patient’s room observed to be full of smoke. When nurse entered, patient threw a pipe behind her bed. Nurse was unable to retrieve pipe.” You particularly have to wonder about the sequence of events summarized by that third sentence.

At my new job, I have a partner, another per diem chaplain hired at the same time. Working on different days, we are going to share a SNF (skilled nursing facility) and an acute rehab unit. I will call my co-worker Carolina. She also did a year of CPE at the Truly Wonderful Medical Center, a few years before I did. At our first day of orientation, we had a presentation on what to do in an active shooter situation and got to see that alarming video yet again. Hospitals have a high rate of workplace violence compared to other industries.

The person doing this presentation had brought a bag full of fake guns to show us. One new employee knew all about this: “That’s a 957 with a 3S modification,” or whatever. I know this would sound completely normal in many parts of the country, but in 35 years in San Francisco, I have never once heard anyone speak with such authority about guns, and it was kind of unnerving.

I was very impressed when Carolina raised her hand, turned to face this fellow, and said, “I’m wondering why you know so much about guns.” He didn’t answer, but the presenter quickly said, “People have military backgrounds, and may know a lot about firearms. In an active shooter situation, I’d want to be near you,” meaning the gun expert.

That makes one of us. The next day, the gun expert didn’t come back to class.

Today we covered the sequence of events in regard to visiting patients. After another staff chaplain explained what to look for in the person’s chart before visiting, he said, “Then you go visit. You probably know what to do there.”

“We tell the patient our problems,” I offered.

“And cry,” added Carolina.

“Right!” beamed the staff chaplain.

Thursday, October 05, 2017

You Are Not Going to Believe This

It has been four days since I applied for the job I would most like to have in all the world, and I have not yet gotten an email saying my qualifications are not a match for their requirements!

We shall see. For the record, I feel that something astonishingly good is about to happen.

In the meantime, a clinical shift at County Hospital yesterday, and class in the evening. I’m trying to take as few notes as possible these days because such notes need to be typed up and filed, and probably 96 percent of them are never revisited. I probably have 200 pages of typewritten notes from CPE, and plan from now on to write down only what seems particularly valuable, such as the following, from a presentation on suicide.

Suicidal ideation can quickly become homicidal ideation, especially in the case of psychosis, so be careful when with such patients. We also learned that we should not tell a suicidal person that she won’t go to hell if she takes her own life. I didn’t understand this at first: are we supposed to tell her she will go to hell? Clementine explained that a person’s belief that her act of suicide will lead to eternity in hell might be the only thing keeping her from doing it: her lifeline. Removing this is unwise.

As it happened, during that very discussion, we had a patient actively dying elsewhere in the hospital. Several of us spent a bit of time sitting with her, including myself during a class break. I found another chaplain there busily stroking the person’s forehead and exhorting her to “Go toward the light” and “Let go and let God.” This chaplain explained that the woman had deliberately overdosed that very morning in her home, leaving a note saying she was not to be resuscitated. The chaplain said death was likely imminent.

I had a number of problems with this. First, a person who is not responsive, even one who is deep in a coma, may very well be able to hear and understand everything you’re saying. Even someone who has set out to commit suicide might be upset to have people standing by her bed chatting about her impending death, so I believe it is best not to discuss a person’s death, diagnosis or prognosis where she can hear you unless she is able to participate in the conversation.

It is also my understanding that as death approaches, many people turn inward and may no longer want to be pulled back toward what they will soon leave. For instance, while someone may formerly have enjoyed reminiscing about past times, he may no longer be interested in this. It is well documented that people often wait until they are alone to die, suggesting that maybe this is something that is between the dying person and her creator, or the universe, that others don’t have much of a role in, so I wasn’t sure about the vigorous forehead stroking, nor the specific instructions. How did we know this person believed in “the light” or in God?

My colleague stepped out and I pulled my chair close to the side of the bed and just sat there. I did not touch the patient nor say a single word. It seems to me that she was much less agitated once the other chaplain left, but I may be misremembering how she was when I walked in the room, or maybe that was going to happen anyway. I did feel sad. The space between this person’s breaths was very long. Death was not far off. What had brought her to this point? Who did she love during her decades of life? Who loved her?

I wondered if economics had played a part, or ill health. I wondered if her wishes not to have resuscitation attempted had been respected or not, and how those decisions are made. I do believe suicide is a reasonable choice in many situations and that we do properly have agency in this regard. Given that, should a hastily scrawled note carry less weight than fulfilling the legal requirements of the End of Life Options Act?

I returned to class troubled and shared my questions. Clementine said, “Those are good ethical questions.” I also shared my judgments about the interventions of the other chaplain, acknowledging that every chaplain is different, and that for all I know, as soon as my colleague left the room, the patient thought, “Where is that lovely hand that was just upon my brow?” This led to an interesting discussion. While one classmate was sharing his responses, I found myself increasingly near tears, which I attributed to that person’s emotional presence, and which reminded me that I would like to have that kind of emotional presence myself. I do believe that empathy is a skill that can broaden and deepen, and I felt inspired by my classmate’s effect on me. I guess this was the first time I had knowingly encountered suicide in the hospital, and it was difficult.

Monday, October 02, 2017

Dream Job

Last Friday I saw patients for the first time at County Hospital. New volunteers are supposed to shadow an established chaplain for at least four visits, and then be shadowed for at least two visits before seeing patients on their own, but Clementine said she didn’t think I needed to shadow anyone. I did three visits with her observing and then she said I can go ahead and see patients on my own. One visit was complicated, with an upset patient and an even more upset family member. Everywhere we went, Clementine announced proudly to other staff members that I just completed a year of CPE at the Truly Wonderful Medical Center.

I was glad to find that the gel at County Hospital seems fine in regard to smell, consistency and lack of adverse skin reaction. At TWMC, there is a dispenser outside every single patient room and often inside, too, but at County Hospital, there is a dispenser only about every four rooms, which dispenses a set amount that is way more than I would normally use.

On Saturday, Lisa and I took a walk in Tilden Park, our first in quite some time.

Late last week, Anita, my joyful ex-CPE supervisor, texted me about a job that has opened up at TWMC. It is precisely my dream job—one I was hoping would turn up two and a half years from now, after I finish school. I decided it would not make sense to apply now—that it’s someone else’s job. I told myself I will trust that what I need will turn up when I need it.

Then I spent most of Sunday with another CPE supervisor. We took BART to Point Richmond to go to Dharmata and hear the teachings of Tibetan Buddhist teacher Anam Thubten, who has quite a presence. After that, we had a beautiful brunch on the sunny back patio of Brezo. I told him—let’s call him Graham—my reasoning about the job, including that my boss at the Very Fantastic Medical Center will kill me if I quit my new job right after it starts. He said, “Hmm. I’m sure she’d understand that your dream job came along.” I told him that my school requires volunteering, and there is no way I can fit in school, my dream job, and volunteering. He said, “Hmm. Do they require volunteering per se, or just that you are practicing your clinical skills somewhere?” That very question has been lurking in the back of my mind for some time. Maybe it doesn’t have to be actual volunteering.

So, after our lovely day together, I came home and applied for the job. As Graham pointed out, if I don’t get it, my situation continues to be perfectly fine, and if the job becomes available later, I will already be known as someone who is interested in it. That makes total sense, but when I reported to the Very Fantastic Medical Center for my first day of orientation today and was greeted by a surly person at the front desk instead a smiling, friendly one, I felt a stab of longing for TWMC.

Wednesday, September 27, 2017

A Bit of Quiet Thinking Time

I have formed a buddy relationship with one of my CPE peers, and after I was back from the East Bay on Monday, we met for dinner at Eric’s, a Chinese restaurant at 27th and Church. I think we are going to try to talk on the phone at the same time every week. My life is starting to overflow with wonderful people who are doing things they really care about.

I’ve been having as many days as possible where I don’t set an alarm when I go to sleep and am starting to feel more like myself again. Quite often I am sleeping ten and a half or eleven hours. 


I have gone back to therapy as a pre-emptive measure. I know this work is going to bring a lot of stuff up that will require examination, and I also want another set of eyes looking out for secondary trauma that I might not notice. I’m seeing not the therapist I started seeing in my 20s, but the one I was seeing when I was with Carlos. She has a strong somatic focus, and our first session (yesterday) was wonderfully helpful. She put in clear context some behavior that has mystified me, and also drew a very obvious connection between that behavior and the ending of  my relationship with F. In sum, I practiced insufficient boundaries with him, and so now I’m deploying overly firm boundaries where they aren’t needed (as in not wanting to answer the simplest of questions about what I’m up to). I would never have thought of that.

She also talked about how we can feel safe, or in danger, or in such fear for our lives that we completely freeze or collapse. She sees my firm boundaries as a response to feeling endangered—which is not as good as feeling safe, but better than feeling an existential threat.

Possibly the most powerful technique in my chaplain toolkit is counting mentally to three after the other person stops speaking, to see if they have more to say. Almost always, he or she does start talking again during that time. I tried this on my mother this morning and, after three seconds, she said, as if talking to herself, “Yeah—it’s good to have this time to just think.” Funny.

I went to my dentist for a cleaning this afternoon, and then to County Hospital for our weekly training session. I haven’t started to see patients yet; I will start soon. It turned out that Clementine was out sick—I hadn’t checked my email—so I walked back home again and had time to catch up on my blog. All caught up!

Self-Portrait


(Click photo to enlarge.)

If Good Looks Was a Minute, You Know that You Could Be an Hour

Friday of last week, Carol Joy came to town from Novato and we had lunch at Indochine Vegan Cuisine. I had tofu with eggplant and basil that was delicious, but somewhat overpriced for the amount. After that, we played cards all afternoon.

In the evening, I started looking at the documentation requirements for board certification and at the details of my new health insurance and got overwhelmed. I worked myself into quite a fit of negativity, but was able to notice that and remind myself to take some small constructive actions—getting a glass of water counts—and to practice metta for myself. At night, I used my new white noise machine for the first time and I think it did contribute to a good night’s sleep. No matter how much sleep I get since CPE ended, I feel exhausted. I think there is some kind of emotional weariness that will take a while to abate.

On Saturday, I went to Rainbow and ran into a friend from my meditation group who said a really perfect thing after Carlos died, in 2013. (Something like, “I am staggered by the immensity of your loss.”) On Saturday, he said another perfect thing. He mentioned a friend who is a hospice social worker, or some such, and when I asked how she likes that work, he said, “She flourished! She reminds me of you. Her spirituality reminds me of yours.”

I knew it was going to be hard once CPE was over and I didn’t have a team of people pushing and pulling me along every day. I rarely experienced doubt about the path I was on during the past 15 months—I didn’t have the time or energy to. I think that may be a problem in the next couple of years, but I will try to take it one day at a time. I do know what I need to do today. And I could not possibly have been any more affirmed during CPE, what with getting to do the palliative care rotation and getting one of the special awards and all the million nice things people, including my supervisors, said throughout the year. Getting a paying job immediately also seems like a good sign.

On Sunday, for reasons I won’t bore you with, I got to see the show about the Temptations again, this time with Carol Joy, preceded by lunch at Au Coquelet, and I liked it even more the second time. It is absolutely fabulous. (When I was five years old, my favorite song was a Temptations song. We lived 45 minutes from Motown.) Our seats were excellent a week earlier, about the eighth or ninth row from the front. The second time I saw it, I sat in the second row, even closer to the action. Carol Joy loved it, too.

At the end, there was a lengthy standing ovation. I was nearly in tears of gratitude for this music being brought so vividly to life and for the mesmerizing dancing, and I could see looks of stunned wonder on the faces of some of the cast members at the outpouring of love they were receiving; some of them looked like they were nearly in tears as well.

On Monday, I went to have a TB test read for my new job and then I took BART over to the East Bay to meet my friend Ann Marie. We had a very tasty lunch at Cancun Sabor, and then we strolled onto the UC Berkeley campus—as we were arriving, 50 police officers passed us, walking in formation—and sat by a little creek and talked for a long time. A family of five raccoons walked by, down near the water. When our butts started to hurt, we walked on and found a wooden bench to sit on.

From there, we could see maybe 10 police officers standing around across the street, and periodically a helicopter hovered overhead. A TV truck arrived and raised an antenna high in the air. Then the police officers got into a van and an armored vehicle and drove toward the center of campus. I felt kind of sad for the students. Many of them are so young. It’s a shame that their campus is a place of such chaos, and at times violence.




(Click photos to enlarge.)

Three Darling Photos of Hammett




That’s my leg that he’s on.

(Click photos to enlarge.)

Free at Last

Our very last day of CPE, we turned in our badges and keys and got to leave early. In the evening, one of our peers had us all over to his place to relax and eat. The next day, a Saturday, I was planning to do this, that and the other—making good use of every single second, as I have been doing for 15 months—and then realized I didn’t particularly have to do anything that day. I could do it Monday! Or Tuesday! Or Wednesday! Instead it became a napping and reading day. Ahhhh!

On Sunday, Ann and Tom and I saw Ain’t Too Proud: The Life and Times of the Temptations, at Berkeley Rep, which I loved. The show begins with a mockup of the front of the Fox Theatre in Detroit, which is where Chris Cornell played his very last show.

The following week, I was on jury duty but didn’t have to report on Monday, Tuesday or Wednesday. On Monday, I went downtown so my periodontist could remove the dressing over the surgery and review his handiwork. I was a little afraid to see what was under the dressing, but when I looked at it later at home, I felt pleased by the meaty, bulky redness of this gum graft. Things definitely appear to be shored up.

I did a pretty good job of getting nine hours of sleep nearly every night that I was in CPE, and of stretching each morning for 30 minutes and meditating for 45 minutes. Toward the end, there were more and more days when I did a token 10 minutes of sitting or even had to skip stretching altogether, but on the whole, this all went pretty well. I figured that once CPE was over, I would most certainly do all of these things every day, but it has been just the opposite. It turns out that maybe the hardest thing about CPE is when there’s no more CPE. That absolutely inflexible commitment was a reliable backbone for my entire program of activities. Now that it’s gone, I feel somewhat adrift, but maybe the most disrupting factor is that now I do different stuff at different times every day. My routine has vanished.

I also thought I would dispatch the bulk of my ignored-for-a-year to-do list right away, but in fact, tasks that must be done are only proliferating: stuff for County Hospital, stuff for the Very Fantastic Medical Center, stuff for applying to school, stuff for my eventual application for board certification as a chaplain, including obtaining endorsement from my faith group.

On Wednesday, I went to County Hospital for IS (individual supervision) with our leader, Clementine, and she said she had been thinking about how I might make good use of this period of training. She said it could potentially be an “easeful” time, or maybe I could move in the direction of my interests and learn some new things. Learning some new things had never crossed my mind, but she made it sound rather appealing.

The rest of my group is brand-new to chaplaincy, and so they will not be assigned to an ICU or to the ED, but Clementine said I can potentially work in those areas, or maybe I would like to work with the palliative care team, or with the prison-psych patients. All of those sound enticing. She also said maybe I can help with teaching duties. I felt inspired after our meeting, and touched by her generosity.

On Thursday, I had to go to the Hall of Justice at 8:45 a.m., where I found myself in a room with about 200 other people for jury selection for a five-week trial. Like half the people in the room, I filled out a form requesting to be excused due to hardship and sat through several rounds of hearing other people’s names called. I wrote on my form that my only income is from a part-time per diem job that will start in a couple of weeks and that I am the sole member of my household.

I had worked myself into somewhat of a frenzy—I just got a new job! I cannot be on a five-week jury!—when finally my name was called. Free at last! But also feeling slightly guilty, since I could have told my new boss that I need to work every Sunday for the next five weeks, and I could have done my volunteering at County Hospital on Fridays, since the judge said the trial would happen Mondays through Thursdays only. And I could have been a little bit late for Wednesday night training at County Hospital every week. It would have been five crappy weeks, but not the end of the world.

I walked to the soup kitchen to volunteer for the first time in a year or so, and found it not very enjoyable. I’ve become slightly allergic to being asked, by nearly every person I encounter, “Where have you been? Really? Where was your internship? What are you going to do next? Are you moving to New Mexico???” Partly it’s just the irritation of being asked the same things over and over, but there’s some deeper and not so constructive psychological thing there, too: I like to share news, not have it extracted. I notice a similar dynamic with money. I like to offer it freely, and hate to be asked for it.

I also felt abashed by all the pairs of eyes trained on me. Maybe I’ve become more used to dealing with people one on one. I found it a little difficult to have 50 people, mostly men, staring at me at every moment.

And, of course, I missed F. terribly. That is where we met. I could so clearly picture him sitting in his customary seat, with his art materials (and three or four admiring women) surrounding him. I kept glancing at that spot as if looking at it often enough would magically cause him to appear, but it didn’t work, and looking every two minutes at the front gate also didn’t. But I know I’ll get used to being there again and will eventually stop hoping he’ll appear.

I dreamed that we made a plan to meet up weekly. In the dream, I thought, “This is great! I’ll get to see F. every week.” Then I thought, “But what if something goes wrong? What if he gets angry at me? Maybe it would even be dangerous for me to spend time with him. Maybe I’d better tell him I’ve changed my mind.” In the dream, I felt frightened about what would happen when I told F. that I didn’t want to see him every week after all. It was remarkably similar to a thought process that could occur in waking life. When I woke up, I was relieved that it had been a dream and that we parted nearly a year ago. But I still feel sad about it.

Downtown



(Click photos to enlarge.)

I Am a Chaplain

In mid-September, just a few days before CPE ended, volunteer training at County Hospital began with a weekend intensive (six hours on Saturday, four on Sunday). We are eight people, plus our leader. We got along well right away and our leader is wonderful, but I felt a bit overwhelmed when we received our assignments and wondered if I should have started this next spring instead. I wished it weren’t overlapping with CPE. Our assignments included words that will be drearily familiar to any CPE student: reflections, verbatims, IS, goals. On the one hand, I have just done all of this for five straight units of CPE and don’t want to do any of it any more. On the other, I can do all of this with both hands tied behind my back at this point.

In the final week, I went to see my periodontist, since my dental insurance will soon be gone. I could have signed up for this via Covered California, but it was prohibitively priced. My periodontist said it appeared I would be in need of gum surgery in the next year or so. However, since I won’t have dental insurance in a year and I did have it right that minute, he suggested going ahead ASAP, so we did. 

He said he was going to augment my gums with a strip of tissue taken from the roof of my mouth, or from an amenable dead person (or, if not amenable, not in a position to refuse). Having material carved out of the roof of one’s mouth is painful, so I said I’d like tissue from a dead person. I was picturing that this was going to be sewn onto my gums, and wondered if he’d make an effort to match the colors. I couldn’t figure out how it was going to bond with my own gums, but was excited that I would never be alone again! From now on, it would be me and her, or him, or them, and I’d be able to see her/him/them every time I opened my mouth.

But on the day of the procedure, my periodontist explained that he was actually going to peel the gums away from a contiguous expanse of teeth and mash in the tissue from the dead person, stretch my gums over it, and sew it all together. So no color matching required. I actually felt a little nervous before this, but it went very smoothly and was surprisingly quick, maybe half an hour or so once the area was numb. The post-surgical instructions called for taking the rest of the day off, but this was not an option.

I went to work and in the afternoon got a call from someone in HR at the Very Fantastic Medical Center who extended an offer of employment as a per diem staff chaplain! This will be one 24-hour shift a week, which is perfect, except for continuing to be away from Hammett one night every week. I wanted to work two days a week, and this is kind of an efficient way to do that. It was a boost to get an actual paid job as a chaplain before CPE even ended. It made me feel like a real chaplain.

I immediately had to start doing various onboarding tasks (online training, authorizing a background check) plus all the medical stuff for my new job (vaccinations, two TB tests, flu shot, physical exam), which I was still in the process of doing for County Hospital. I began to feel somewhat overwhelmed, with so many appointments and so many details to attend to.

The second-to-last day of CPE was the most tiring of the entire year. I spent the whole day training the person who is taking over my main unit, and couldn’t believe how exhausted I was afterward. I took a final look at my Patients I Have Seen list: 787 people. And my Deceased Patients list: 30. The latter is by no means every patient I encountered who died, but those who meant something to me or who I remember very clearly. I also did not see all of those patients after death, but I saw a lot of dead people, maybe 20 in the course of the year.

Self-Portrait


(Click photo to enlarge.)

Newfound Respect for Respiratory Therapists

Late in August, I walked over to County Hospital (not its real name) for my interview with the director of the chaplaincy program there, which is all volunteers, except for her. I liked her right away. She described the chaplain training program as “CPE Light.” Along with the chaplains, there are volunteer eucharistic ministers and two Catholic priests assigned there, both of whom I know. I was in CPE with one last summer at the Very Fantastic Medical Center and the other was one of my peers in the yearlong clinical pastoral education program just completed.

That week, the director of spiritual care at Very Fantastic Medical Center contacted me and invited me to apply for two per diem positions, and told me to let her know when I could interview. I am planning to go to school part-time for two years starting in March, and also to volunteer as a chaplain at the County Hospital, so I can keep my skills current and also just because I have long wanted to hang around there. The final thing I was hoping to find was two paid days of chaplain work each week, so I was happy to be asked to apply for the per diem positions.

Sam had a job interview around that time that he said didn’t go very well—when they asked for examples of this or that, he couldn’t dredge them up on the spot. Learning from that, I made myself a cheat sheet of examples of various things: use of ritual, mediating conflict between others, offering meditation for physical pain, being with a patient who thought God was punishing him, and so forth. I thought the interview went quite well. The director said toward the end of our hour-long talk that she appreciated that I was ready to go with stories.

I made a goodbye flyer to give to my units at work, and smaller cards to hand out to people. Both had a photo of me on them (taken by a nurse on one of my units), and mainly expressed my thanks for the privilege of getting to work alongside such splendid people this past year.

The new crop of CPE students joined us in the final two weeks, and things became very chaotic and hectic and exciting: 14 of us plus 14 or 15 of them plus four extended-unit (part-time) students.

At morning meeting with one week to go, one of my peers shared about going to a meeting of respiratory therapists the evening before, at which he learned that a respiratory therapist goes to every Code Blue and that when it comes time for a patient to be transitioned to comfort care, it is the respiratory therapist who turns off, or turns down, the breathing support offered via ventilator!

Our mouths were, figuratively speaking, hanging open—we’d never thought about this before. It may be the respiratory therapist who is literally keeping someone alive, possibly a patient the respiratory therapist has come to know well and care about. Therefore, a respiratory therapist can opt out of being the one to turn off the ventilator, but my peer said he suspects this option is probably not exercised often. If you don’t want to do this, you might be in the wrong job. We were somewhat chagrined to be learning all of this so late in our program.

I learned another thing in those final days, a thing I’d been meaning to learn for months, which is who the people in the bright red scrubs are. They are vendors! I found this out by approaching one who was using a copy machine near the operating rooms. I asked why so many vendors are to be seen around the ORs, and he said it is because they are present when the equipment their company makes is used in a surgery, so that they can answer questions for the surgeons, or assist if there are problems, and can report useful information back to their bosses about how things actually go in the field.

Photo of Hammett Where it Looks Like a Cat Leg Is Growing out of His Head


(Click photo to enlarge.)

Threshold

I visited a patient in mid-August who was being transitioned to comfort care. He was lying quietly in bed, eyes open just a little. I spoke to him out loud, offering good wishes. He looked terrible, which I discovered later was because he had died 20 minutes before I arrived. (Not all dead people look terrible. It varies tremendously. Some look serene and lovely.)

One of my colleagues mentioned that it was his habit to take a look at the list of patients near the nursing station for his unit each morning to see which ones were being discharged that day, and then not to visit any of those patients unless he absolutely ran out of every other kind of patient. This is a very good idea I wish I’d encountered about 12 months earlier. As he accurately said, all such patients say, “I’m happy! I’m going home today!” None of them says, “I’m going home today! I feel horrible. Can you sit down and talk to me?”

Sometimes a patient’s name is replaced in the electronic health record system with a row of asterisks. This might be because the patient is a celebrity (I encountered one this year), or a forensic patient, with armed guards outside his room (so far these have all been men). Or the patient might be a victim of partner violence who doesn’t want the hospital operator to tell callers she is in the hospital. I have also discovered that it can indicate someone who was formerly in the psychiatric institute. The names of all patients currently at the psychiatric institute are so obscured, but even after the patient has left there and is on some other unit for an unrelated reason, his or her name may be concealed. I’ll bet that’s because they make that change when someone becomes a psychiatric patient and then forget to unmake it. The asterisks are also used when an employee of the hospital becomes a patient.

At the very end of the month, the person who had been on call the night before was fried, so I took the pagers and got slammed—page after page after page, including a request for a chaplain to facilitate a viewing, which can take an hour or two, and, for the first time in my experience, a Code Blue at the campus where they do day surgeries. Naturally that happened on a day when we were down to four people. Fortunately, Jodie took over and determined that the crisis had passed and that no one needed to take a cab over there.

On top of all of that, there was a request for a chaplain to attend a family meeting. By then, it was 2 p.m. and I had turned the pagers over to a peer, so I volunteered to go. Just as I approached the conference room, the door swung open and two physicians said, “Perfect timing,” as they walked past me and vanished. (“That was not very good interpersonal team communication,” Jodie said later.)

I went into the conference room and discovered I was the only care team member present, with 19 family members and friends of a patient who had gotten several pieces of bad news. I recalled watching another supervisor lead a debriefing and drew upon what she had done. I asked people to share their thoughts and feelings, and I observed that there was a lot of sorrow in the room. After a few people spoke and it fell silent, I asked about the hopes they had had for the patient, and people said a few things about that. One woman said she felt guilty for leaving the patient too soon one recent day. Another comforted her, saying it would have come out the same whether she stayed or left. A young family member wasn’t so sure: “How can we know?”

Then a family member politely said they would like to be by themselves, and that they had their pastor with them. I said I would be happy to go, and asked them to point out their pastor. I thanked him for being there, and said one thing that made me happy was that they were all there together.

After that, I went to see one of my current favorite patients, a homeless man, and to say goodbye to my other favorite, finally off to rehab after two serious injuries and several weeks in the hospital. Days earlier, I had given the latter a piece of polished rose quartz “with the hope that all of you will always be seen and cared for.” That day, a nurse asked, “Did you give my patient a stone?” I admitted it, and he said, “Very cool!”
 

I also saw a man who had gotten in a life-changing accident; he was described by his nurse as being despondent. I didn’t find him to be despondent at all. He seemed quite angry, but also was admirably philosophical, saying that the accident had put things in perspective for him, and that it could have been worse, and that he was now thinking about how he actually wants to spend his time. People are remarkable.

Late in the month, I had my second-to-last on-call shift, starting on a Saturday afternoon. One thing that happened during that shift, besides my getting 10 hours of sleep—I’m pretty much convinced now that the same people who can’t or don’t get enough sleep when they’re not on call tend to not get enough sleep when they are on call, and that those who get enough sleep when they’re not on call can usually find a way to do the same while on call—was that I was sitting in front of a computer charting when there was a flash and all the computers froze, the phones went dead, and my badge suddenly no longer worked.

A nurse came onto the unit and reported that she had just been on an elevator that had gone into freefall, though it didn’t fall very far. Another nurse said he had had the same experience in the past, but, far worse, that a few years ago, a doctor was standing in the doorway of an elevator chatting when the elevator suddenly lurched and crushed him to death. One of my peers said it’s a good thing we didn’t find that out earlier in the year. I agreed: “We would all have thighs like tree trunks by now,” from taking the stairs. The lesson I took from that is to be either in the elevator or not in the elevator, but not to linger at the threshold.

Duke Energy Center


This is in Charlotte, NC, where I went while working for my ex-employer.

(Click photo to enlarge.)

SBD

After graduation, five weeks of the program remained, which we spent seeing patients and training our replacements.

During those weeks, I applied for health insurance through Covered California, which was harder than I thought it would be. Fortunately, there are actual human beings who are willing to stay on the phone with you for the entire process, which in my case was more than an hour. There were some ins and outs I would never have figured out on my own that had a big effect on how much my monthly premiums will be: $1.35 versus $600. (It turned out that the correct thing to do was to say that I didn’t have health insurance and that my health insurance would be ending on such-and-such date in September, only one of which was true.)

I estimated that I will have “medium” use of doctors and other health services, and “low” use of prescriptions, but I asked my helper what would happen if I was diagnosed with a horrible kind of cancer or got in a car accident two weeks after selecting my health plan. She said I would be SOL: that you get the care your plan provides and no more. When the next open enrollment period comes along, you can choose a different plan, and if you’re still alive at that point, then you can have your cancer treated.

Accordingly, I hit the back button a few times to estimate that I will have “high” use of doctors, and found that I could still choose the exact same plan at the exact same cost, so I went back yet again to see what would happen if I have “very high” use of services, and again nothing changed, so I am Kaiser’s newest member, and a very happy one. (At least, I was very happy until I realized that I have to spend $6300 before they start covering much of anything. Now I’m mildly happy.)

Once this was finally done, I realized that needing to apply for my own health insurance had been a minor source of worry ever since I learned I was losing my job, which was in January of 2016. Being done with this application and knowing that I would have health insurance after my internship ended was a huge relief.

Somewhere along in here, I decided to pursue interventional radiology for Hammett—radiation treatment for his hyperthyroidism, which is 95 percent effective. This happens at UC Davis and would have cost about $2500, but I figured it would rather quickly pay for itself in labwork and visits to the vet that wouldn’t need to happen, and medication that wouldn’t need to be purchased. Plus, instead of paying his cat sitter $30 a day, I could ask one of my neighbors to feed him when I’m away, since there wouldn’t be the need to administer medication, if all went well.

In the end, I decided not to do this, because an elevated thyroid can mask kidney problems, and therefore can actually be a treatment option when the cat develops kidney issues. If radiation has been used to set the cat’s thyroid permanently at a certain level, that option disappears.

One of our assignments in the final weeks of the program was to update the information sheets we were given for our hospital units last September, or write new ones as needed. This forced me to read the sheet for my main unit, which caused me to discover that there is a daily interdisciplinary rounds meeting! At a time when I could attend! So I went to it for the very first and very last time in mid-August.

I confessed this to Jodie, who said, “You hadn’t read it?” I told her it was extremely long (like possibly more than four pages—I’m the Donald Trump of chaplains) and she said that’s because the person who originally wrote it was a CPE student from a few years ago who was a Ph.D. who didn’t like to visit patients very much but loved to do research. She told me to feel free to edit as I saw fit, so it is now less than two pages of extremely interesting information.

Last year, I was oriented by two different chaplains. I can’t remember anything about one of them or what she showed me except that she didn’t seem very friendly, which I found surprising. As for the other, I seem to recall that we spent less than half an hour together, but that struck me as more than enough, due to his frequent bursts of foul-smelling flatulence. Maybe he had chosen his breakfast and lunch unwisely on that particular day, but I remember thinking that if this was the norm for him, his unit was probably pretty happy that his year with them was finally ending.

Hurt Toe


I thought the statues outside the new County Hospital were kind of stupid looking the first time I saw them, but this little guy has grown on me.

(Click photo to enlarge.)

Graduation Day

On August 10, my 13 peers and I graduated from the yearlong clinical pastoral education program at the Truly Wonderful Medical Center. The day started with Anita treating the five of us in her group to breakfast at Park Chow. We asked our server to take a photo of us and she pointed out that the three people on one side of the table were all wearing white shirts and the three on the other side were all wearing light blue shirts.

Back at work, I shined my shoes and checked my email and hung out in the student office until it was time to do an exit interview with members of the professional advisory group, an opportunity to give feedback about the program anonymously; none of our supervisors were present.

After that, I went outside to wait for my guests. I had not asked most people to RSVP, thinking it would be nice to be surprised, with the exception of Charlie, whom I pestered relentlessly about it. I really, really wanted him there, because he played a large part in my journey toward CPE. When Carlos was dying, he picked me up every single night at the hospital at the end of visiting hours so I could stay as late as possible and not have to then wait for the bus in that not-very-good neighborhood. The night Carlos died, he got out of bed at 1 in the morning to come and drive me home.

Consequently, I decided to do the two days of volunteer work my ex-employer paid us for at his soup kitchen. I fell in love with it the very first day and became a regular. Wanting to bring everything I could to the soup kitchen’s guests, I did the yearlong chaplaincy program at the Sati Center for Buddhist Studies. There I became totally inspired and vowed that if my employer laid me off, I was going to become a hospital chaplain.

They kept their part of the bargain, and I am keeping mine.

So it was crucial that Charlie be at my graduation, and he was, elegantly attired in a black sweatshirt—not the shredded, stained one of indeterminate color that he normally favors, though it would have been perfectly fine if he’d worn that one.

Along with him, seven other friends came, including two who had very good reasons—serious illness and very recent bereavement—not to. I felt extremely loved and supported. Ann came all the way from Sacramento with her friend Jill, and Tom came. He took the ferry over to Larkspur to help Ann and Jill with the final leg of the trip into the city, which is really going above and beyond. I have the best friends.

Sarah, the manager of the spiritual care department, spoke at the beginning of the ceremony, explaining what we went through this past year, and what we achieved. She estimates that we, collectively, had 68,840 interactions with patients, their family members and staff.

One of our supervisors had made a wonderful slide show covering the whole year: students having fun at a petting zoo, students cracking up while rowing a boat, students wearing enormous joke sunglasses, a student collapsed from exhaustion on the floor of the office. It was really fun to see all of these photos, and to see how much joy there was along with the immense amount of physical and emotional work. This slide show was right up to the minute, too: there we were at Park Chow that very morning, three of us in white and three in pale blue.

Then there were musical presentations by fellow students, and one of our supervisors recited a poem, and then each supervisor handed out certificates to her own students. I received mine from Anita, who said she wanted to recognize my wit and humor, my professionalism, and my fairness, even when there is a cost to myself.

Then the director of the spiritual care department came to the front to recognize some of our supervisors. This year, three special awards for students were inaugurated and presented by our director, and I got one of them, the Award for Integration: “recognizing and affirming your persistence and creativity in nurturing and developing both your head and your heart as effective and reliable instruments of spiritual caregiving and thereby distinguishing yourself in fulfillment of the ACPE Outcomes.”

After our very esteemed leader gave out these special awards, he had to leave. As he made his way up the stairs, we stood in his honor. Then we graduates were offered a Ritual of Handwashing. I was in tears as Sarah dried my hands, emotions overflowing. There was a non-denominational prayer at the end, and then we had a giant feast.

It was an absolutely perfect day.

I did it. I did it.

High Rise



(Click photos to enlarge.)

Perfect Conditions

One day in August, Anita and I did our final joint visits together. I chose a man I had seen twice before and we had a fairly short visit, ten minutes or less. Afterward Anita said she liked how I inquired into his experience without directly asking, “How do you feel about that?” She liked that I asked to sit down and that I incorporated his own words into my prayer for him at the end of the visit, and she also liked that I announced in advance that we would be leaving—often patients wait until you say you are leaving to announce what’s really on their minds, so giving advance notice might invite those things into the conversation while there’s still a little time to talk about them.

One of the verbatims I presented earlier in the final unit was about a visit that was nearly an hour long. Right after I said I was leaving, the patient mentioned hospice. Ugh. So then it appeared that I had abandoned someone who was ready to talk about something very important. I received the suggestion to say, “I’ll need to go in five or ten minutes,” so I now do that often, including in the visit Anita observed.

The one thing she thought I could have done better was to ask the patient to turn off the TV, or turn the volume off. I have mixed feelings about that. One day not long ago, I saw a patient one of my peers has led in meditation several times. I asked him what she normally does when she guides him in meditation. He said, “She makes me turn off the TV, and then she pulls down the shades, and she closes the door and pulls the curtain.” Wow! I did all of that, and he turned off the TV, and it was indeed very serene, so I will remember that, but I also think that we need practices that work in less-than-ideal as well as completely crappy circumstances. I don’t mind if someone has the TV on while we talk. If the person gets completely absorbed in what’s on TV, I can ask if I should come back another time. However, having the TV volume off—which many patients do of their own accord—is nice and might change the flavor of the conversation, so I will keep that in mind, too.

Succulents


(Click photo to enlarge.)

In the Brain, Pain Is Pain

Early in August, my group presented our final self-evaluations. Since I had a lot of money left on my meal card, I treated us all to lunch from Publico, a wonderful taqueria on Gene Friend Way. They have a remarkable fish and chips burrito, and I also really like their vegetarian burrito, with chipotle crema added. Their French fries are superb.

That week at the palliative care team meeting, someone shared about a patient’s intractable pain. She listed all the medications that had been tried, along with acupuncture. She asked for help from the group, and I briefly described a few ways of using meditation to address pain. The woman jokingly asked if I was available to see the patient that day.

One of the things I mentioned was to do a body scan, guiding the patient in moving her attention from her feet to the top of her head, to help her inhabit all of her body, not just the part that hurts. I also suggested asking the person to focus on the very worst part of the pain and then to move her attention gradually away from the epicenter, until she arrives at a part of her body that doesn’t hurt at all. My final suggestion was drawn from Somatic Experiencing: to ask the patient to focus on the pain, and then on a part of her body that is completely free of pain, and then, on her own schedule, to shift her attention back and forth between these areas. Like the first two methods, this reminds the person that there are parts of her body that don’t hurt, and also keeps the nervous system from getting stuck in pain-resistance mode. Pain is unpleasant without a doubt, but resistance to it can make it much worse.

An interesting thing I learned around that time is that the brain does not have different pathways for physical, psychological, emotional or spiritual pain: pain is pain. Therefore, addressing any of these kinds of pain can lessen the overall intensity of the pain.

Early in August I saw a young patient several times that a number of chaplains saw; all of us liked her. Earlier in the year, we had a didactic where we learned that a wounded person always also has a healer built in. I could really see that in what this patient had to say on one day. I told her that I could hear her clarity about her immense difficulties and I could also hear her wisdom.

I noticed in her chart that other chaplains had tried various techniques with her: breathing in this or that way, thinking of things to be grateful for. In my longest visit with her, I focused on taking in what she was saying, and a very interesting, subtle thing happened. She would say, “I have such-and-such lousy experience every day during physical therapy.” I would imagine what that would be like as I looked back at her, and then I would see a little shift in her eyes, which to me looked like what is true being seen and accepted. That is, I would think, “This is what is happening for this person,” and then it was almost like she was seeing and accepting the same truth: “Yes, this is what is happening.” This happened three or four times in the course of our hour-long visit. I also pointed this out to her as a way of affirming indirectly that she had the capacity to be with what was happening. In that visit, I noticed that she was moving organically through an emotional landscape, with anxiety, sorrow, joy and hope appearing at different moments. When I left, she said she felt better.

In our final couple of visits, I decided that I wasn’t doing enough stuff relative to what other chaplains were doing, and I found myself throwing a laundry list of techniques at her: think of it this way, use this mantra, let’s do a guided meditation. The result was that, for the entire duration of both visits, she was stuck in anxiety, and the connection between us seemed to go flat. It was much better when I just listened and did my best to imagine what things were like for her.

Sunday, July 30, 2017

Hammett


(Click photo to enlarge.)

Tingling Hands

This past Wednesday, I got up at 4 a.m., as usual, to meditate, see to Hammett’s needs, stretch, and have breakfast. I took the city bus to the palliative care team meeting and got a ride afterward to campus from my hospice friend who usually goes to that meeting. Back at work, I realized I didn’t have my hat. I walked to the administrative building to get the key to Jodie’s office; I had stopped to see her upon returning to campus and thought I might have left my hat there. I walked back to the building where her office is to see if my hat was in her office. It wasn’t. I walked back to the administrative building to return the key and got on the shuttle to go to the other campus.

I went to the weekly farmers’ market
and to Publico to get a fish taco, with the sun blazing down on my bare face, before going into the hospital. Inside the hospital, I went to the cafeteria to eat my fish taco. I spied a couple of my peers sitting outside on the patio and went out to offer them blessings for their hands; it was Blessing of the Hands week. I went up to the student office and hung out until a didactic on the “use of self” started. After that, three peers each spent 20 minutes apiece offering wisdom: on a specific aspect of the Kabbalah, on the Jizo ceremony for dead children, and on the “Rule of Life.”

I waited for the shuttle after work for about 45 minutes, in a long, long line, and after I got on, found we were stuck in an impenetrable traffic jam. It ended up taking an hour and a half to get home; I could have walked there in an hour. Then it was time to see to more of Hammett’s needs, water my neighbor’s plants, check my email, make my to-do list for work for the next day and fall into bed, where I fell asleep right away, but then woke up 30 minutes later and lay awake for hours. This happened several nights in a row. I finally fell asleep, but after I got up to go to the bathroom, I again lay awake for a long time. And that is the story of one day in CPE.

The palliative care team meeting that day was very interesting. We ran out of dead patients to talk about, and discussed informational interviews with potential hospice patients: Giving information versus pushing hospice services. It’s hard to get people interested in hospice when two or three other services (e.g., surgery or oncology) are saying, “We can do such-and-such for you.” It’s even worse when providers say, “You can either do nothing or have treatment.” Given that choice, who would not choose treatment? Sometimes people speak of “withdrawing care,” which is a terrible phrase. We never withdraw care as such; we transition from curative care to hospice care or comfort care.

In telling people about hospice services, we might do better to say, “Let’s optimize the possibility you are going to get stronger. These are the services hospice can provide.” Also, hospice is not a one-way street; you can do a trial period. People are eligible for hospice when their life expectancy is judged to be six months or less, but most people go to hospice so late that they die a week or two after going “on service,” and so of course people associate hospice with immediate death. It’s not supposed to be what you do for a few days before you die. It’s supposed to afford up to six months of being able to do what is most meaningful and enjoyable to you at the end of your life, as possible, without having to spend time on treatment that is no longer helping, takes up however much time, costs however much money, and potentially causes suffering and makes it impossible for you to speak with your loved ones.

It was mentioned that, at our medical center, attending physicians feel uncomfortable with fellows having conversations about end of life choices without oversight. The only current requirement is that a person with metastatic cancer be asked if he or she has a durable power of attorney, which is a pretty low bar. I also learned that “case finding” is not appreciated—other doctors don’t enjoy hearing that their patients have turned up on a list of possible palliative care patients.

As mentioned, it was Blessing of the Hands week this past week. We were invited to write and submit a verse to be used for the blessing, and the verse that was chosen was lovely. (I did not submit one.) It was also very easy to memorize, so I did that, and then I went around my unit offering this brief ritual of good wishes to care team members. I would invite each person to rest his or her hands on mine, and I would speak the words of blessing, and finish by saying, “Thank you for your important work.” People seemed to really like this. We each signed up for areas in the hospital outside our actual patient units, like radiation oncology or administrative areas. In addition, I offered blessings to random people who crossed my path: a cashier in the cafeteria (who said this made her day), a couple of construction workers, several housekeepers, two young volunteers, and four of my peers. Near the operating rooms, someone at the front desk announced it over the P.A. system, and 14 people lined up to have their hands blessed. One person said afterward that it made her hands tingle; she was smiling.

Lake

This is the view from my cousin’s deck. That is a child’s play oven you see in the foreground.
 

(Click photo to enlarge.)

One Thing I Will Never, Ever Do

Things are moving very fast now. Anita and I have had our very last one-on-one meeting, because this coming week we will do joint visits for the last time, and the week after that, we will present our final self-evaluations, and on Thursday of that week, we will graduate! After that, there will be five weeks devoted to seeing patients, so we can practice being full-time chaplains for an extended period.

I’ve changed my procedures when rounding at the other campus. For most of this year, I have gone around to the five infant care nurseries and just said hello to the nurses. A few on-calls ago, a male nurse said to me, “Thank you! Visit some babies!” So I did that, and it was so nice that now I say, “I’m just saying hello and admiring babies,” and then I go into several rooms to peer at our littlest patients, most quietly sleeping, and wonder what they are dreaming inside their little baby heads.

Last week I presented my final verbatim of the year. Anita said she thinks I would be a good CPE supervisor. I told her I am never, ever, ever going to be a CPE supervisor: they work way too hard. But I did appreciate hearing that she thinks I could be a good teacher and leader. Another supervisor that I did joint visits with offered to write me a letter of recommendation, and it turned up just one day later, full of glowing compliments. Anita is also going to write me a letter, and when I bumped into yet another supervisor this past week, she said, “I’ll write you a letter of recommendation if you want.” So I am feeling very recommended, which is a nice feeling.

Washington Bike Ride


(Click photo to enlarge.)

Mayday!

I’ve been going most weeks to the palliative care team meeting across town. People from several hospitals attend this meeting. The first time I went, someone told a long, long story about a  patient. I wondered why this person was going on at such length, and then I realized that the whole point of this meeting is to share stories about patients. We start by introducing ourselves and we hear a poem, and then we tell stories about patients, and at the end, we each share something we feel grateful for. Emotions are welcome, which is not at all true in many areas of medicine, so this meeting is special. The leader, a palliative care doctor, said a couple of weeks ago, “If you’ve come to this meeting once, you’re welcome for life.” I plan to keep going after CPE is over.

Mid-July, I flew to Seattle for a long weekend to visit my cousin and her husband and their two children and my cousin’s mother-in-law and their dog and four cats. They live in a house north of downtown that overlooks a shimmering spring-fed lake. I had met Sarah, who is now four, on a past visit, and got to meet Thomas, two, for the first time. One day my cousin was in the back yard with her daughter. Thomas asked his father, “What are those girls doing down there?”

The weather was gorgeous: sunny, clear, warm. On Saturday, my cousin gave me a ride to Kenmore, where David and Lisa now own a home, and we took a beautiful 10-mile bike ride along the Sammamish River to Redmond, where we had lunch at Ooba Tooba’s, a taqueria, before riding back. It was a perfect day, and the whole trip was lovely and relaxing. I was really conscious of enjoying every moment of it.

My cousin’s mother-in-law is an astute genealogy researcher and has been looking into my cousin’s, and therefore my, family. I learned some interesting new things. On Monday, she took me back to the University of Washington LINK light rail station, where she had picked me up on Friday, and I took the $3.25 trip back to the airport.

At the San Francisco airport, I stepped out of the terminal to tell the fellow I’d like to take SuperShuttle home and was astonished when he said it might take up to an hour; usually the wait is about ten minutes. I spotted a man seated on a bench who had been in the shuttle I took to the airport on Friday. He was in the same boat (so to speak) and had just learned that there are 70 SuperShuttle vans sitting idle on a lot somewhere because so many drivers have gone to work for Uber. Furthermore, all the Ubers on the road are clogging traffic, exacerbating the problem. How anyone could have thought having one passenger in each Uber would be good for traffic is beyond me.

Having seven people in a SuperShuttle van is good for traffic. Having 50 people in a bus is good for traffic. (Unless it’s a Google employee bus full of people driving the rents beyond comprehension, of course.)

“I heard there are 45,000 Ubers in San Francisco,” I said. Then I remembered I had actually heard it from him, during the shuttle ride three days earlier. Fortunately, a SuperShuttle van turned up in about ten minutes.

Wednesday of the following week, we had a work retreat in Golden Gate Park. We did tai chi and partner exercises and had lunch al fresco, and in the afternoon we were free to do whatever we wanted. I went boating on Stow Lake (a man-made lake three feet deep, but it looks like a lake, and is surrounded by greenery, and there are ducks and turtles) with Sam and two other guys. It was extremely fun, including Sam shrieking, “Mayday! Mayday!” when we went into the branches at the side of the lake. When we returned, we partnered up again and shared our aspirations for the rest of CPE and beyond with our partner, and offered each other blessings—CPE students do this kind of thing all the time. My partner offered me such a lovely, heartfelt blessing that we overflowed with good feeling and joined the pair next to us for a group hug. “Aw, that was so good! Group hug!”

Sammamish River

David and Lisa during our excellent bike ride.


(Click photo to enlarge.)

Smaller and Smaller

So I did share my feelings with Anita about what she wrote in my evaluation at the end of the third unit (of four) of the clinical pastoral education program I will be graduating from a week from Thursday. I told her it’s hard for me to have feelings with others observing, and I asked for her help. (I also told her that Delia and my at-work therapist had said the exact same thing she did.) She was warm and understanding. I think she was also chagrined that I had felt so upset. She said she never intends for anyone to feel that she is using their words against them—she wants to give direct, specific feedback, but tries to make it so there aren’t any surprises. She also said she thinks I’m a “phenomenal” chaplain.

Toward the end of June, Howie led a half-day of meditation at the Mindfulness Care Center, which was lovely. I also had lunch with someone who was pretty much my best friend back in the mid-1980s. Our three part-time CPE students had their graduation ceremony.

I had my first chaplain job interview, at a hospice that is just getting started. The interview went very well, but I felt rather lukewarm about the job, which sounds like it will be an hour here and an hour there initially. Afterward, I decided to go to the downtown Container Store, and as I walked there, I found myself thinking about F. a lot, wishing I would see him. Several blocks from his apartment, it occurred to me that if he were returning to his home on a northbound Mission St. bus, he would probably get off at the stop at 7th and Mission. I turned my head to look at that bus stop, and there he was, across the street, walking in the direction of his place.

I scurried ahead to the corner and crossed the street so that I was waiting for him when he arrived at Market St. We had a brief exchange, at the end of which he said, “I should go.” I said, “OK,” and he walked off. For half a block, we walked in the same direction, on opposite sides of Market St., and then he turned north, and I stopped and watched him until I couldn’t see him anymore. I think it was good that we met, because I got to see with my own eyes that he has psychologically gone away from me. The time I saw him before that, before we broke up, everything was just as it had always been, and so it was hard to wrap my mind around the fact that we were no more. It was really helpful to get to act out physically what had happened emotionally: we were together, then going the same way but no longer together, and then he got smaller and smaller and smaller, and then he disappeared.

The last day of June, I stayed at the other campus all day, where I had been on call the night before, because they were short-staffed. In the evening, I treated Sam to dinner at Chez Maman West, near Hayes Valley, and then we saw Hamilton at the Orpheum. Sam knows pretty much everyone in the entire hospital, and of course was present when a nurse happened to manage to buy a number of tickets for $100 apiece, of which she sold him two. That was months ago, followed by my low-key but persistent campaign to be his date for the show. At some point, he asked me to make a particularly unfavorable on-call trade with him. I decided to do it, since he has done me favors during this year. I was not thinking about Hamilton one way or the other, but right after I said I would make the trade with him, he invited me to join him. I had read the book it was based on, Ron Chernow’s splendid biography, and I was dying to see the show, and I did see the show! It was all I had hoped for—really wonderful.

A few days later, Ann and Tom and I had lunch at Au Coquelet and went to Berkeley Rep to see An Octoroon.