Saturday, January 28, 2017

THE Hospital Chaplain

Doing joint visits with a peer proved to be so illuminating that many of us have gone on to do others voluntarily; we don’t need to provide written feedback on these. Tony and I did this yesterday and it was hugely educational. That same day, I’d had a brainstorm about my opening question. When I began this year of clinical pastoral education, I would ask patients, “How are things going?” The answer to that is often, “Fine,” or “OK.”

Then I started asking, “How are you doing today?”, which is slightly more personal and sometimes leads to a longer answer. Yesterday I started asking people, “Can you tell me a bit about your experience in the hospital so far?” Bingo! Every single time I asked this, I got a very long, detailed answer.

I keep falling into wanting to fix patients: to rid them of their uncomfortable feelings or somehow resolve their difficult situations. This urge is stubbornly persistent, even though it is contrary to my caregiving philosophy and even though I know perfectly well that it is not helpful (and also impossible). I do believe that it is the relationship that heals, and that it is attuned conversation that helps create a relationship that feels trustworthy, so I’m excited about my new opening question.

Tony pointed out that most people mention their biggest concern within ten seconds of starting to speak, and said I did a good job of remembering these statements and returning to explore them later on. He advised that, instead of saying, “I’m the chaplain for this unit and I visit everyone who is here to let you know that we offer spiritual care and emotional support while you’re here in the hospital,” I might announce grandly, as he does, “I’m the hospital chaplain.” He thinks that makes the patient feel special: the hospital chaplain has come to see me! He doesn’t say the whole thing about spiritual care and emotional support. He says, “We are here to offer care and comfort. That could be prayer or meditation or just talking.” More concise, and also offers some possibilities to choose from.

I explained that Samantha told me to say I visit everyone on the unit after I saw a woman who seemed disturbed by my visit. Samantha suspected that I had scared her: “A chaplain is here? Am I dying?” Explaining that I visit everyone prevents this misunderstanding, but Tony said I can always add that if the patient seems perturbed. Tony said that if it seems necessary, he adds, “I’m the unit chaplain and visit all the patients on this unit. Most will go home happy and healthy, and hopefully you will, too.” That latter is a nice touch.

He advised that if a patient appears to be having a lot of emotions or looks like she is about to cry, I could say, as he does, “Wait, hold on just a second. I want to let that sink in for a moment. You just said [whatever]—that makes me feel really sad [or angry].”

He said that he tells people, “One of the benefits of having a chaplain come is that we hold space for you to tell someone things you might not feel comfortable telling others. With me, social niceties are off the table.”

He told me that he makes a point of offering his hand to every family member who is in the room, starting with the patient’s mother, if she is there, and he said that before he leaves the room, he stands near the door for one long, uncomfortable extra moment to inspect everyone and take in dynamics. He said it took a while for him to feel comfortable doing this. Since being aware of interpersonal dynamics is the one outcome I still have to meet before advancing to Level II CPE, I am going to give this a try.

While I was observing Tony in action, he visited a patient who, upon learning that a chaplain had entered his room, said in an emphatic way, “I’m fine.” When that happens to me, which it does often, I say, “OK. Well, if you ever want to talk to anyone, we’re here 24 hours a day. Just let your nurse know. It was nice to meet you.”

Tony, however, did not take that for an answer. He said, “Strong agnostic/atheist?” When the patient confirmed this, Tony said, “Me, too.” At this, the patient looked slightly surprised. Tony went on, “I’m not here to preach or teach—just here to hold space for you to talk about what matters to you.” It is considerably more likely that that patient will feel like talking to a chaplain than one who hears what I usually say, so I’m definitely going to steal that approach.

Tony invited all of us students to his place after work last night. Two of us were on call, as always, one at each campus. Besides Tony himself, that left 11 potential guests. Six of us showed up at his place, where we ate burritos and met his wife and darling two-year-old little girl. After dinner, we played a game that involves drawing pictures and describing in words the pictures drawn by others; that was fun. I have known these people since early September and we are already, with pleasure, socializing outside work. I worked for 18 years at a large corporation and knew many great people, but did not make one single friend there that I saw outside work, other than for weekday lunches. This corporation sent me my last paycheck on Friday: a year and two weeks of my full salary as severance pay. I will always be grateful. I happened to bump into this corporation’s CEO not long ago and took the opportunity to thank him in person.

Last night was also an open mic at the soup kitchen. It was at such an event that I first laid eyes on F. He no longer hangs around the soup kitchen much, but it had occurred to me to go to the open mic just in case he was there. When I got home from Tony’s, I called my walking friend, who runs the soup kitchen, to see if F. had been there. My friend said that he had indeed been there, and had performed in top ranting and raving form, and had “seemed to be in a good space.” For some reason, that was terribly painful. Even though I officially want him to be happy, knowing that he actually is cheerfully going about his business gave me a tremendous pang.

It was a hard night, but I did not call him. It helped (a lot) that I know he would not answer my call nor call me back. He has closed the door and I am sure he will not open it again. This is just as well. It was the closest thing to an abusive relationship I have ever been in. I don’t want to be the person whose partner loses his temper with her all the time, nor the person whose partner hits her so hard and so often that he drives her brain stem several centimeters into her spinal cord. This is much farther down the continuum than the harsh words I received, but it is the same continuum.

Fearless Cleanliness Captain

This past Thursday I did joint visits with a peer, observing him as he interacted with patients and writing down what I thought he did well and any suggestions I had for improvement—and in CPE, you can never get away with saying you don’t have any of the latter—and then he did the same for me. This peer is a Catholic priest, and therefore has formidable resources in the area of prayer. I could see how much that was appreciated by a Catholic family.

We also had a class that day on group dynamics, and one on conflict mediation, which involved interactive exercises that made us laugh. We heard about active listening and various styles of dealing with conflict. I’d gotten to practice the latter earlier in the day, when I went to speak with Patricia, who led the session on the enneagram last week that so inflamed me. Anita, my supervisor, was present as well. We sat down in a dimly lit small office and Anita said she was there to be our mediator. I said, “I thought you were here to be my attorney.”

I’d written out what I wanted to say and thought it over for a week, and, using “I statements,” I told Patricia about what I’d experienced. Regarding the “I statements,” there is definitely some grey area. “I feel that you are a jerk” is certainly out of bounds. “I feel angry” is always within bounds. “I felt shamed, humiliated and intruded upon” is iffy—it expresses that you shamed, humiliated and intruded upon me. I.e., that you are a jerk. On the other hand, those are specific experiences and maybe there is no better way to say it. Anyway, that was among the things I said, and Patricia’s response could not have been more wonderful.

She was completely open and undefended, and responded straight from the heart: perfect. She expressed great sorrow at having had this impact on me. She did say she thought the mood between us on that day had been “playful,” and I can easily see why she thought that. I acknowledged that my words and affect had not matched, and that I had used humor to mask my feelings. As for her not hearing my “No,” she literally did not hear it. She said she would never, ever push past a “No” and that she did not hear me say that. I was relieved to learn that.

I confessed my lie and apologized to her and she generously said it was a necessary form of self-care in that moment. The whole conversation took no more than 20 minutes, and Anita looked delighted at all this clear, heartfelt communication and mutual taking of responsibility. Patricia and I parted with a hug, after she told me how much she respects me and that I can always count on her support.


We tidied up the student office recently and were rewarded immediately with pizza and later with one of the spiritual care manager’s cheery emails, in which she said, “And thank you, Jodie, for serving as our fearless cleanliness captain!”


I don’t know if you’ve ever given any thought to what might happen if you get a heart transplant and then the new heart stops and you are the subject of a Code Blue and compressions are performed on this new-to-you heart, but I had occasion to ponder this this week and learned that they use a portable ultrasound machine at the bedside to confirm that the heart hasn’t been damaged.

Well, Well, Well

I recently received two books I’d ordered and realized, when I saw them together, that there is a glaring similarity in their titles: Remembering Well and Dying Well.

The former is by Sarah York. The subtitle is Rituals for Celebrating Life & Mourning Death. I have this idea that I might like to be a part-time chaplain and a part-time bereavement counselor, maybe just because I know someone who does both these things and who is overflowing with good cheer. Being a bereavement counselor sounds nice because, presumably, most clients are not themselves ill, probably not going to die anytime soon, and what ails them will in most cases eventually pass and they will feel better. One of my peers was in a bookstore looking for a book about memorial services or something, and someone sidled up to her and recommended this one, which is out of print, but Amazon seems to have plenty of them.

The latter is by Ira Byock, M.D. The subtitle is Peace and Possibilities at the End of Life. There is a copy in the student office at work, and another of my peers said she thinks it’s very good.


We have inaugurated a 15-minute midday mindfulness session in the meditation room at the hospital on Mondays and Thursdays. I led the first one, which attracted 1.5 participants—a patient awaiting surgery, plus a staff member who came in toward the end, but seemed to appreciate her short time there. She thanked me when she left.

One of my goals for this unit of clinical pastoral education was to offer care to staff members, so I have gone to three of my five areas to let them know that I am available to speak with people one-on-one and also to lead meditation sessions, if desired. Two of the areas, which are on the same floor and often share personnel, said they would like weekly meditation, so that began this past Friday. It will always be led by me, unless I’m not available. I will now go to my final two areas and say I am available to care for staff, and tell them about the mindfulness sessions in the meditation room.

There are nine ACPE (Association for Clinical Pastoral Education) “outcomes” that must be met before one can advance to Level II CPE, hopefully after the second unit, halfway through the year. By the end of the first unit, I had met all but one of them, so I am trying to take care of that in the next month—the second unit ends February 24! This year is flying by. The outcome I still have to meet is to “Recognize relational dynamics within group contexts.” (I did actually complete this in my first unit of CPE last summer, but that probably doesn’t count at the Truly Wonderful Medical Center.) To this end, I will write about family and/or staff dynamics in my “weekly reflections,” which I discuss with Anita, and for the remainder of this unit, I will make sure my verbatims—transcribed conversations with patients—feature group dynamics.

We also have a mid-year consultation to arrange and prepare for. This is required before we can go on to Level II but isn’t something we have to pass or get a certain score on; we just have to do it. This is a discussion with a group consisting of my own supervisor, me, a member of my sangha, one of my peers, and a member of the Professional Advisory Group. Two weeks before our meeting, I have to provide a short autobiographical statement, my most recent self-evaluation, my supervisor’s most recent evaluation of me, a write-up on my goals either for the unit just finishing or the next unit (preferably the latter), and a document explaining what I want consultation on.

Finally, our self-evaluations for the second unit are due a little before February 24, and tax season is rolling around, so there is a lot to do.


I went to see the surgeon who took over when my breast cancer surgeon retired, and she said everything looks good to her, and now that it has been five years, there is very little chance of a recurrence. She also said she takes pretty much every kind of insurance, including Medicaid and Medi-Cal, and even if I don’t have insurance next year, we’ll work something out. That’s what my eye doctor lately said, too. Reassuring. For many years, I let fears about money and health insurance paralyze me, but I am not scared anymore.

After I saw my doctor, I stopped by the place where I did my first unit of CPE to see if anyone was around. One of the yearlong residents was there—the one who thanked me for being the only person who was nice to him when he started—and the administrative assistant and a woman who works in finance. It was good to see all of them, and I had a lovely chat with the resident. We agreed that one of the great things about being a chaplain, or training to be a chaplain, is that it forces you to practice excellent self-care and also to prioritize your spiritual practice. I now consider the time I spend sitting in meditation at home to be a part of my job, just as important as reporting to work and seeing patients.

You Can Do Good Work While You’re Doing Your Own Work

A week ago Saturday, I had breakfast and a nice long chat at Santaneca de la Mission with one of my peers, Marian. We have clashed slightly several times, but have easily discussed each instance and worked through it. Alas, this week at work, I got mad at her yet again and, while part of me dreads having to announce that I feel angry with her, I am increasingly convinced of the value of this kind of effort.

We were lately assigned a reading called “Functional Subgrouping and the Systems-Centered Approach to Group Therapy,” by Susan P. Gantt, from a book called The Wiley-Blackwell Handbook of Group Psychotherapy, edited by Jeffrey L. Kleinberg. It has proven to be utterly riveting, because it describes many of the things we have been encouraged to do in our interpersonal relations group, and why. I encouraged my peers to read it and one of them reported that he was enraged before he got to the end of the first page: “If these are the rules, why didn’t they give them to us sooner!?”

I consider being easily angered (just like F.) to be one of my two most destructive personality traits, and can report that pretending not to be angry and/or refusing to express it has not resulted in the magical eradication of this tendency. And now that I’m being very explicitly encouraged to know when I’m angry and to say it, I’m starting to feel pretty sure that it is precisely the inability to express anger directly that leads to it bubbling up left and right. When I don’t trust that I can say, “When you did that, I felt angry”—when I don’t trust that I can speak up for myself in an appropriate manner—I feel I am at the mercy of whatever may happen to arise: a chronic victim, who broods over grievances and easily notices additional ones, but doesn’t do anything constructive about them (just like F.). I think being overly self-effacing is the flip side of being overly quick to take offense.

One of our supervisors pointed out that clinical pastoral education is the very rare situation in which we are invited, encouraged and supported to tell seemingly antisocial truths, and that we should take advantage of it. The learnings this affords will be invaluable in our work as chaplains—I am fooling myself if I think that I’m only ever going to get angry with peers and never with any patient in the hospital—and in our personal lives.

I met a patient this week who was horrendously injured by her ex-husband. She is in chronic excruciating pain about which nothing can be done. For reasons pertaining to her children, she declined to prosecute her abuser. I noticed during our conversation that she had a definite and seemingly quite unnecessary apologetic air. I’m thinking that the first time this person disrespected her, she did not say, “That makes me angry. I will not be treated that way, and I will not spend any further time with you.”

F. never laid a hand on me in anger, but I had to notice, with some discomfort, some ways my behavior parallels this patient’s—not being sure I deserve to be treated well, not being comfortable expressing anger, sometimes (though not always) backing down when others are angry, prioritizing what others want over what I want. I knew that F. was not a good person to date before I got involved with him. I knew he was angry. I knew he had substance issues. I was very attracted to him and know I am far from the first person to be unduly influenced by a pleasing face, but I also let his extreme enthusiasm override my own misgivings. Why was I not able to say, “This is not a good idea. I will not do this”?

I think that learning to say, “I am angry about this” is going to be excellent for me personally, whatever work I end up doing, and so I am now almost looking forward to telling Marian next week that I’m annoyed about yet another thing.

The other thing that has caused me severe difficulties in relationships is basically being unable to tolerate intimacy, which manifests as changing my mind all the time about whether I want to be in a given relationship. Often I push people away just when they are expecting a friendly response. I imagine they think of me as being moody, and I am sure it is baffling and hurtful. I’ve known this about myself for a long time and have never really found an effective way to counteract it. When I’ve announced to people up front that I do this, it gets even worse.

Anita lately asked gently, in one of our weekly conversations, “Do you think you push people away before they have a chance to push you away?” I’ve been pondering that. I know that I experience intimacy and connection as a demand of some sort, against which I must vigorously defend. For instance, by barely greeting someone with whom I had a nice breakfast not three days earlier.

But maybe that eventually does come down to fearing not that there’s something wrong with the other person—he or she wants too much!—but that there is something wrong with me. I will not be surprised to discover that at the core of this. Or I may not have the sense that the other person wants too much but that this, that or the other is wrong with her. But what has changed? The other person is just as she always was. It is my mind that changes.

Now, what to do about it? Well! The aforementioned reading talks about “driving” and “restraining” forces. At the end of each interpersonal group, we list what was driving and restraining during the group. For instance, it was driving that such-and-such person shared so honestly about what was going on with her, and the kindness with which this was received was driving. It was restraining that just as we were starting to talk about emotions, another person told a long anecdote about what he had for breakfast. One surprising thing it said in this article was that it is more effective to weaken restraining forces than to try to strengthen driving forces. It said that if group leaders attempt the latter, it is like Sisyphus and the rock; they have to do it over and over. But if restraining forces are identified and weakened, growth bursts forth on its own. Isn’t that interesting?

In all this, have I concluded I’m just too psychologically damaged to be a chaplain? Certainly! But then I remembered Samantha, my supervisor in my very first unit of CPE, saying, “We can do good work while we’re doing our own work.” Everyone has his or her psychological crud. I am profoundly grateful for the chance to examine mine closely with people who are doing the same, under expert guidance.


Seen on the side of a building in the Tenderloin. It is two figures, one atop the other. Note the faces on the pants of the upper figure and on his bag.

(Click photo to enlarge.)

Saturday, January 21, 2017

Enneagram One

Last week at work, we had a presentation on the enneagram, which to me is on a par with astrology, which is to say I think it’s nonsense.

(Pausing here to say that they teach you a staggering amount of stuff in clinical pastoral education. Besides caregiving skills themselves, and all the policies and procedures for the department and the hospital, and the computer system and charting protocol, you learn about: caring for this, that and the other special population (one session apiece on psych patients, African Americans, Asian Americans, Latin Americans, Jehovah’s Witnesses, Jews, Catholics, etc.), family systems, palliative care (several sessions on this), various spiritual assessment models, interpersonal relations (Karpman Triangle, etc.), your own psychological baggage (Johari Window, etc.), the legacy of your family (including making a genogram), grief, emotions, group dynamics, conflict mediation, how to conduct an interfaith service, transference/countertransference and projection, boundaries, self-care, how to avoid burnout, child development … )

This second unit focuses a lot on self-awareness, family issues, and interpersonal dynamics. The presentation on the enneagram was the second one we’ve had and it was an extremely difficult experience for me. It was presented by one of the staff chaplains, with whom I have (or used to have) a good relationship. We have been told that it’s not for anyone else to tell you what your enneagram number is, but staff members routinely offer opinions about this. In fact, Thursday afternoon, Patricia twice told an anecdote about discussing with the spiritual care director what someone or other’s enneagram number is. “Do you think he’s a three?” “Nah, he doesn’t dress nicely enough.” One of my peers, sounding a little freaked out, asked, “Really? You guys sit around talking about people like that?”

I received what seemed to me an undue amount of attention, perhaps because I do have a relationship with Patricia, or because I happened to be sitting near the front. She had asked us to take a couple of online tests to help determine what our number is. At this point, I’ve taken four or five tests, and have also discussed what I might be with Patricia, and, irritatingly, have ended up with several different possibilities. Am I a one? A nine? It was very nice of my own supervisor, Anita, to suggest this, but this is not what I am. An eight? A five? Annoying.

We did a group exercise that to me was completely incomprehensible, and so I stood apart, with one other student. Patricia noticed this and asked, “Bugwalk, what is going on for you now?”

I said, “This doesn’t make any sense to me.”

“What emotion would you say you’re having?”

“Anger.” If nothing else, CPE teaches you to know how you feel and to announce it posthaste.

“Class, does Bugwalk look angry to you?”

Most everyone in the group looked like they didn’t think so, but a member of my own subgroup said, “Definitely.” On the one hand, I appreciate that he knows me well enough to know this, but something about the way he said it made me suspect he was enjoying my discomfort.

Patricia had said that no one can tell us what number we are and that we get to say what we believe is true for us, but several times in the course of this session, she said to me, with a definite triumphant air, things like, “Aha! The very fact that you asked that question” means such-and-such. It sounded like she was very sure indeed about who I am and also what’s wrong with me.

At some point, she took one of my classmates through a series of questions to help this person pick out her number. After that, she asked me, “Would you be willing to do that same kind of work now in this room?” I thought for one second and said, “No,” but she went ahead anyway, and in the course of that, I lied to her.

Not to excuse this, but to explain it, I was pretty much desperate at that point not to be whatever she thinks I am. She looked confused, which wasn’t satisfying even in the moment, and later that evening, when I pictured how her face looked after I lied to her, I felt sad and ashamed. She got wound up and she ignored my “No”, but she didn’t mean any harm.

Nonetheless, I am reserved, and I felt shamed, humiliated and very intruded upon. By the end of the day, I felt completely alienated from everyone in the room and it even crossed my mind to quit the program, though I recognized that as a major overreaction. It’s amazing that it’s taken me until halfway through the second unit to have that impulse.

The next day I had figured out what in my past accounted for my getting so upset, but I still felt estranged from my colleagues and refused to sit down at the morning meeting. I had a wet raincoat with me and I stood behind Sam with it hanging from my hand. “Do you want me to make a place for you to hang up your coat?” he offered.

“No,” I said.

He got up to do it, anyway, and I said more firmly, “N, O, no,” and we conducted the whole meeting with me standing up. That is, I acted like a 13-year-old. Fortunately, acting like a 13-year-old is totally allowed in CPE, as long as you eventually demonstrate that you understand your behavior, that you can be honest and open about it, and that you are able to experiment with making different choices.

I went to debrief with Anita, who had not been at the enneagram session. She listened very kindly and understood what I said and even teared up a bit on my behalf. She also gently pointed out that my words had perhaps conflicted with my affect. I said I was angry and I said I didn’t want to work with Patricia right then, but I had a pleasant expression on my face, and at moments I used humor to deflect from the intensity of what I was feeling. So that is one lesson for me: If I want people to understand that I’m angry, a smile does not help communicate that.

Later on, Sam paged me to see if I was OK and was horrified to hear how upset I had been—he had not realized that at all. At lunch, he said he had thought the whole thing was in good fun. I do plan to tell Patricia what I experienced. I asked Anita if she would sit in on that discussion, and she said she would.

Never Give Your Right Name

This past Wednesday night on call I had a steady stream of visits all evening, including:

—A handsome man who reminded me very much of F. He talked about how his fiancée is “the world” to him, and I remembered wistfully how F. used to feel that way. This fellow, like F., has been homeless off and on. When I was charting afterward, I saw a prominent warning attached to this patient’s record: some months ago, he let a pit bull loose in the emergency room and, when admonished, pulled out a knife. This, as far as I know, is not like F., who does not possess a weapon and who avoids conflict, precisely because he knows his temper is quick. I think both F. and this patient have a profound sense of distrust and therefore feel afraid and therefore feel angry. The patient’s advisory concluded by saying that the police should be called at the first hint of misbehavior.

—A Muslim patient who wished to see a chaplain of his faith. We don’t have one, so I was sent to assess and, as appropriate, call people on our list of Bay Area religious resources. The personal protective equipment information posted on this door was extensive and contradictory, and the type of mask that fits me best did not seem to be present. While I was studying these instructions, the patient yelled from inside the room, “Whoever you’re looking for, he’s not here!” He came to the door and asked loudly, “Who are you?”

“I’m the chaplain.”

“Are you a Muslim chaplain?”

“No, but—“


“No, but I can potentially call one for you.”

“No, thanks.”

“Are you sure?”

“Yes.” That concluded that visit.

—Two patients at the psychiatric institute. I gave one a rosary and he gave me a little hug.

—The patient on my own unit who got angry at me several days ago for saying that maybe his relationship is over. He has been telling everyone—the nurses, other chaplains—that he wants to see any chaplain but me, which inspired a round of high-fives among my envious colleagues, who asked what I had said to produce this excellent result. He wanted a chaplain that evening and I was the only one present, so I stopped by and called from the door, “Are you still angry at me?” The patient said calmly, “I’m not angry. I just don’t think we’re a good fit.” I thanked him for his directness and honesty and agreed to send another chaplain the next day.
—A patient in the psych area of the emergency department who was feeling very distressed about his loss of vision due to glaucoma.

—Also in the emergency department, the family members of a gravely ill man. The relatives were young African American men and I was pretty sure they didn’t want me trying to probe into their emotions, so I just sat quietly, per The Caregiver’s Tao Te Ching, by William and Nancy Martin: “Sitting quietly with another person, we watch him find renewal within himself.” After about an hour of near-silence, one of the young men said to me, “These must be the hardest jobs in the world.” 

“Why do you say that?” 

“Because there are so many people you can’t help.” 

At some point, it looked to me as if he wanted to go into the patient’s room but felt shy about it, so I said to him, “You can go in if you want—I’ll go with you,” and we went in. Later he asked what the specialty of one of the doctors was. I said he was a neurologist—he did a lot of tests involving the patient’s eyes that I found difficult to watch—and the relative observed that you must have to go to school for a long, long time in order to be a neurologist.

While I was in the emergency department for the aforementioned visit, I could hear a grown man screaming frantically, “Where’s my dad? Where’s my dad?” I approached to see what was going on and saw the man lying on a gurney with mesh covering his whole head and heard him say angrily, “Why is my mother mad at me? Because I broke her shit? She broke my shit!”

Earlier, I had struck up a conversation with the wife of a patient in the hallway, who invited herself to join me for dinner and chatted throughout in a somewhat unintelligible manner. She mentioned that her husband was having surgery the next day, and I knew I had a patient to visit who wanted a pre-surgery blessing, so I asked her name, but it wasn’t the name of the person I was supposed to see.

When I arrived at the room of the patient, I was quite surprised to see my dinner companion, who said with satisfaction, “Never give your right name.” Her husband is paralyzed and described to me the accident that caused his paralysis, after which he had an out of body experience that he described in great detail. It was quite a beautiful story; he got to see and speak with his dead mother. This patient seemed calm and relaxed and was very easy to understand. He fell asleep during my prayer for him. I was sort of puzzling about what his relationship must be like, with someone who seems very agitated and whose way of speaking is quite difficult to understand, but they have been together for 35 years.


(Click photo to enlarge.)

Monday, January 16, 2017

The Other Kind of Dog

Friday night on call, I offered prayers for a particularly ghastly looking man dying in the ICU. He had severe facial injuries and his eyes were open, blank and white, held partly shut with medical tape. I thanked God for the immense gift of this man’s life, all the remarkable people he met and the remarkable things he did. I have no doubt that both of these are true. His nurse stood on the opposite side of the bed with her head bowed during the prayer.

The evening was entirely full of patient visits and making my rounds, and the next day was also very full, but in between were nine and a half hours of sleep, for which I was very grateful. On Saturday I got a request to go visit four patients at the psychiatric institute. As I was walking toward the front door of the psych unit, someone who works there was coming down the hall toward me and asked, “Spiritual care? I could tell by the way you walk.”

When we drew abreast of each other, he said, “The SPCA is here, doing a therapy animal event.”

“Oh, great,” I said. I was envisioning a cage full of gamboling kittens.

“They brought a dog. Or, no, a rabbit—the other kind of dog.”

One of the psych patients, a young man, told me that he’s been feeling like killing himself, and also like killing other people. I was glad we were sitting in the little office right near the front desk, where all the workers are, and that I’d thought to block the door open with a chair, though the chaplain who normally visits that unit pointed out later that a lot of people feel like killing someone. The question, as with suicidal ideation, is whether the person has actually formulated a plan. This fellow told me he’s been homeless for 21 years.

I said, “You don’t look old enough to have been doing anything for 21 years.”

He said, “I’m 21 years old.”

When it came time to meet with the second patient, also a young man, the little office was in use, so we were shown to an empty room far at the back of the unit, and when the worker left, he closed the door. This person, who is Chinese, told me how Chinese students are being killed for their skins. I led him in a guided meditation, and then he told me a bit about his recent history. According to him, he’s in the psych unit because he hit his guardian, who is a woman. I started to feel distinctly uneasy. Evidently, so did the patient, because he suddenly said, “Us sitting here talking—there’s something behind it, right?” I was relieved when I was out of that room and plan not to get in that situation again.

The third psych patient’s girlfriend had come to visit him, so we didn’t speak for long. The fourth was an older woman with a particularly charming smile due to a tooth missing right in front. She told me she had changed religions, and now members of her former congregation are sending her “presents” that turn out to have bombs in them. She asked me to pray for her safety, which I did, and then she added her own prayer, in which she described how God can “take the shape of a butterfly.”

I now am happy to get a request to visit the psych unit. I hear such interesting things there, and each patient has his or her own unique world. Entering into each of those worlds has a sort of dreamlike feel to it.

As for F.: still gone. At first I was saying to myself, “May I align myself peacefully with things as they are.” I think this is a good wish, but I eventually saw that it was also about hoping not to feel too much pain. The latter can be accomplished by thinking about all the bad things about him, but has the drawback of not being the whole truth. He has horrible qualities but also excellent ones and we had many wonderful times together, so I amended my wish: May I be open to this experience of loss, just in this very second. There is a raw, bereft, stunned quality to some moments.

Yesterday was hard. Tom, Ann and I went to see 946: The Amazing Story of Adolphus Tips at Berkeley Rep, a Kneehigh production. We had lunch at Au Coquelet first. Lunch was delicious and it was great to see Ann and Tom and the play was splendid, even with our sightlines somewhat impeded by the railing in front of our loge seats. But this is precisely what F. and I did on what turned out to be our last day together. We had a marvelous time. I had not the slightest idea that I’d never see him again, which is likely what is going to happen. We will almost certainly not be friends.

I think what makes him feel strong and safe is getting angry and staying that way. He has decided that I have this and that horrible quality—I wouldn’t say I don’t, but I also have splendid qualities, which I don’t think feature any longer in his ruminations. He has decided that he is a wholly innocent party who has been cruelly victimized. This is not accurate—I am not a victimizer—but there is nothing more powerful than an idea oft-rethought. I can see that likely nothing good could ever happen between us again, but it’s still hard to lose him.

Not Amused

Several days ago, a nurse interrupted my visit with a patient to gently point out that I had totally overlooked a sign on the outside of the patient’s room explaining what PPE—personal protective equipment—was required. There was a droplet hazard. I was supposed to be wearing a mask and eye protection. I put on the PPE immediately asked the nurse, “Should I freak out?” She said no, just to be sure to wash my hands with soap and water after leaving the room rather than using gel. Afterward, I asked her, “Uh, what does he have?” Fortunately, merely the flu.

Last week, we did our mid-unit self-evaluations, which involved displaying genograms we’d created—this was a fair amount of work—and presenting a two-page analysis of family dynamics, along with sharing what we’d written about our peers and our supervisors. In the middle and at the end of every unit, we have to describe our relationship with each peer, and offer at least one sentence of affirmation and one sentence of critique for suggested growth. Each person gets 45 minutes for his or her whole presentation, and there are five of us, so it is quite a long afternoon, but helps us to know each other better, while doing all of the preparatory work helps us to know ourselves better. I brought in a few family photographs, which people seemed to enjoy, including of the band my Great Uncle Ivan was in. I said that, like me, he was a trumpet player and had goofy hair. My colleagues easily picked him out.

We have brought onboard three new interns who will be doing a part-time unit of clinical pastoral education for the next several months. They are going to take some of our on-call shifts, so we are especially pleased to have them.

I have a patient who is chronically distraught over the end of his marriage, which occurred two years ago. I told him about my own recently ended romantic relationship and how I have been noticing the interplay of thoughts, emotions and physical sensations. Jodie said approvingly, “Good use of self.” She is no longer my supervisor, but her office is right next to the student office, and she is nice about hearing brief reports or commiserating with difficulties.

At the end of the visit, after the patient said maybe his wife will come back and maybe they’ll go to counseling, I said, “Or maybe she’s done with the relationship.” He got really angry and said loudly, “I don’t believe we’re ever done with a relationship. How can she be done with 17 f*cking years of her life?” I told him I wasn’t comfortable being spoken to that way and that I was going to leave. “I’m sorry,” he called after me.

“Don’t worry about it,” I said. “In about three seconds, I’ll have forgiven you, and I will see you again. We have a relationship.”

Jodie’s brow creased over the “Maybe she’s done with the relationship.” She said he
s not ready to hear that, even though it’s been two years. Or, as I think of it, I got too far out ahead of him. I think I also got invested in his relating to his difficulty some other way than how he was relating to it. I probably wanted him not to be devastated over his loss because I don’t want to be devastated over mine. For what it’s worth, another chaplain who has seen this patient several times didn’t think there was anything wrong with what I said. He said he has told the patient the same thing more than once.

Jodie also thought I should not have told the patient not to worry about what he’d said, and should have let his apology stand, in hopes that he might make some connection between his behavior and how it affects others. She said that saying “Don’t worry” sort of negated his apology. Instead, I could have said, “I hear your apology and thank you for that. We will meet again; we have a relationship.”

I visited a patient who treated (that might not be the right word) a lump in her breast with natural medicine. Now her cancer has metastasized to her spine. I led her in a guided meditation that put her soundly to sleep, a welcome result. One might say that she should have gone to a doctor immediately and done whatever he or she said to do, but other patients refuse chemotherapy and go on to live with stage four cancer literally for decades, so you never know.

I arrived at work this past Friday afternoon to start my on-call shift to find Sam, without whom I would not be in this program, and another colleague in the student office. The latter reported that she had just been with a patient who is having a hard time; she asked me to visit this person if I had time. Like an improvising musician picking up on a bandmate’s riff, Sam suddenly and quite loudly sang-shrieked, “Having a hard time!” I thought that was extremely funny and said, when I was done laughing, “That was very entertaining for your peers.”

“For one of them,” corrected our colleague.

River of Sludge

I got to spend the day after New Year’s Day with Carol Joy. We had brunch at Santaneca and then spent the afternoon playing cards at my place and getting caught up.

That week at work, I saw yet another exceedingly well-known person in a hospital room—Jodie says I seem to have a knack for this—and I also went into a room to offer a blessing to a dying woman to see that one of her children is an acquaintance of mine. I ran into one of the biggest benefactors of my entire life, right after my own parents, in one of our waiting rooms; his wife was having surgery. This person, with tremendous kindness and goodwill, trained me how to do the work that I did for nearly a decade. Another new patient on one of my units turned out to be the wheelchair-bound fellow who often asks me for money near 16th St. and Valencia.

A patient I spent quite a bit of time with a couple of weeks ago expressed a lot of appreciation for the care she was receiving, including spiritual care. She thanked me repeatedly for my “reflective” listening, and seemed to really like a guided meditation I led her in. I Duckducked her later—used DuckDuckGo, the search engine that doesn’t track its users or their searches, to do some cyber-snooping. When the NSA asks them, “What’s Bugwalk been looking up?”, they can honestly say, “We have no idea.” I have nothing to hide, but I don’t like knowing that if I get curious about how to make a bomb using only ingredients from my own underwear drawer or the best way to skin a cat, Google (and Facebook) will cheerfully tell the NSA all about it. As for my patient, it turned out she’s kind of famous because she has lived with an advanced stage of a serious disease for many, many years and has worked to improve understanding about living with this disease and about what palliative care can offer.

Another patient that week said he felt despair about some news he’d gotten, which he said felt like a river of sludge coursing through his chest.

One of my co-workers recently got a new laptop and treated me to a cup of tea in the cafeteria in exchange for my trying to figure out why Pandora wouldn’t work. I did fix that, and do several other simple pieces of configuration, for which she was extravagantly grateful. It reminded me of how much I enjoyed the tech support aspects of my former job. Tech support and chaplaincy require some of the same skills.

The co-worker with the new laptop mentioned that she once accidentally walked in on the autopsy of a young girl. She said the top of the decedent’s head had been removed, leaving a neat circle, and that her face had been peeled down so that her features weren’t visible. I’m not sure if that would be better or worse. The one time I saw someone with his face peeled down, I did not enjoy the experience; this was during the yearlong chaplaincy class at the Sati Center, when they took us to an anatomy lab to visit the cadavers.

I arrived at TWMC the rainy morning of January 10, 2017, to find clerical and administrative members of the Teamsters picketing in front of the hospital. Something about this touched me profoundly and I arrived in the student office crying. (A good cry seems to be necessary every now and then in this line of work.) Nearly sobbing, I told one of my peers how upsetting it is to see people standing in the rain in effect saying, “I work 40 hours a week and would like to be able to pay my rent,” while smirking billionaires in Washington, DC, hand each other even more riches.

On my way to see patients that day, I met an extremely nice fellow in the stairwell. He said that he once did clinical pastoral education himself, but his religion wouldn’t ordain gay people, and he didn’t want to live a dual life, so he went into fundraising instead. He asked, “Are you the head of the program?” and when I said I wasn’t, he asked, “Are you a CPE supervisor?” CPE supervisor is one thing I hope never to be; no, I am just another program member, I told him. I was thinking that maybe it was my professional appearance and air of authority that made him think I had some elevated role, but it’s probably just that I look old. Nearly every single time I get on Muni, someone leaps up and asks if I want to sit down. I’m only 54! I wouldn’t call that young, but it’s also not the same as being 90. I guess all this courtesy is because my hair is quite grey now. I felt a little better when I lately saw a woman who to my eye was no more than 40 and who had long, flowing, dark hair offered a seat on the bus.

Cafe Noeteca

(Click photo to enlarge.)