Sunday, March 26, 2017

Floppy

A couple of weekends ago, I had lunch at Au Coquelet with Ann and Tom and then we went to Berkeley Rep to see Hand of God, which we all loved. Raucous and mesmerizing. It was a brilliantly sunny afternoon and I had some time to pass before going to the monthly potluck at Thomas House, so before heading home, Tom and I sat outside a café in Berkeley, reading and having refreshments. The potluck was nice, as always.

A few days later, I was on call at the other campus and visited a baby who has been in the hospital her entire life and whose parents come to the hospital to see her very rarely. She had a mask over her whole face, so it was hard to see her features, but I was instantly charmed by the loose, almost floppy way she moved her arms and legs. I put my hand near her and at first, every time her hand bumped into mine, she moved her hand away, but after a while, she allowed her hand to rest on mine, which made me cry.

We had a didactic earlier that day on narrative spiritual assessment, which appealed to me right away. In this assessment model, you just talk to the patient and try to get a sense of the four Cs: crisis, connection, “care gate,” and care plan. We learned that there are five types of crises:

—Disruption. The person’s normal life pattern is disrupted / stopped / slowed down. Hospitalization itself is a disruption.
—Discomfort. Acute and/or chronic pain.
—Disfigurement. Loss or anticipated loss of body image.
—Disability. Diminished capabilities or potential loss of independence.
—Death concerns for oneself or a loved one.

Connection has to do with support system and spiritual or other resources. Is person connected, unconnected (never had spiritual resources), or disconnected (used to have resources but doesn’t now)? If the latter, what happened?

The “care gate” is our potential opportunity to assist, which may become obvious once we learn more about what the crisis is and what types of resources the person has or lacks. The care plan might include prayer or meditation, presence, scripture or sacred writings, counseling, listening, or sacraments, rites or rituals.

I subsequently read an excellent article by James Michael Lewis called “Pastoral Assessment in Hospital Ministry: A Conversational Approach.” He says a good assessment model provides practical information, doesn’t interfere with conversation, and can be used when there will be only a single visit with the patient. My favorite two sentences: “A plan … is not always a document projecting future actions. It is simply what the chaplain intentionally chooses to do.”

My new interpersonal relations group has met twice so far. At our first meeting, we shared our fears in regard to being in this group with each other, and so were off to a roaring start. After our second meeting, Anita, our supervisor, sent us a note that started, “You all brought it!”

Somewhere along in there, I went to a noontime presentation on the “second victim”—how caregivers can be affected by adverse patient outcomes. The presenter came from a hospital in Missouri. At the end of her talk, she mentioned two harrowing incidents from our own hospital, both of which I had responded to as a chaplain.

At the end, I discovered that Delia was there. I mentioned to her that I had responded to both incidents and she said vaguely, “Yes, we can really be affected by our work.” I was expecting more of a “Wow, really?” and went away counseling myself that Delia is not my mother or my therapist, and that I should avoid burdening her with undue requests for attention.

We are all now doing our mid-year consultations, to which we invite a peer, one of our supervisors, a member of our professional advisory group, and a mentor of our own, which could be a member of our sangha or congregation. Flatteringly, I was invited to be the peer participant for two of my fellow students and have attended one so far. It was a wonderful experience, mainly because I heard great things from the professional advisory group member and the person’s own mentor, both of whom were Buddhist.

One said we can ask ourselves, “What risk do I need to take to cease the doing [as opposed to being]? What is the place of rest in this situation?” She went on to say that the role of the chaplain is subversive: to remain present and not to be swept away—not to be tied to doing. “Do I really need to do something? How can I be of this situation?”

The week after we saw Hand of God, Tom and Ann and I returned to Berkeley for another tasty lunch at Au Coquelet and to see Roe, about Roe v. Wade, which was also excellent.
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