Monday, November 19, 2018

One Hundred Percent Forbidden

It is absolutely, strictly forbidden for Hammett to sit on my turntable. I would like to think that he has a slightly guilty expression here, but I’m not sure.


(Click photo to enlarge.)

Meeting the Stranger

For my third field trip for school, I signed up to volunteer with Sidewalk Talk, which was started by two therapists in 2014 “to help heal that which divides us through the fine art of skilled listening.” I watched training videos on their website (available free to volunteers; $29 for others) and thought they were superb.

In one of them, co-founder Traci Ruble talks about asking ourselves, “Who is this person in this moment?” and letting the other person be different every day. This reminded me of the Zen idea of meeting the stranger (instead of thinking, “Oh, yeah, I know this person”). She said that “listening for data leaves us lonely” and instead to listen for the other person’s essence.

She strongly advises against fixing and helping, and points out that seeking to help is an exercise of privilege: “I know better than you.” It is about the need of the listener rather than the talker. Instead, she recommends reflective listening: “Connection is the solution. Solutions aren’t the solution.” (She tossed in a helpful tidbit for couples: “I don’t want you to soothe your partner and I don’t want you to solve for your partner. I want you to hear your partner.”)

The videos also covered self-care and safety for volunteers, boundaries, and how to talk to someone who may be feeling suicidal. One of the videos is an extended role play between Traci and the director of San Francisco Suicide Prevention. The latter said it’s fine to ask directly if a person is thinking of harming herself, and to try to ask in such a way and at such a moment in the conversation that the person may feel comfortable answering honestly.

One important goal is to assure the person that it’s all right to talk about feeling suicidal: “Wow—you must really be in a lot of pain. I’m glad you are talking about this,” or, “I’m really glad that you’re talking about this. It’s so hard to talk about.” From there, goals are to find out if the person has a plan for how she will take her own life, if she has the means to carry out her plan, and if she has ever attempted suicide before; the latter is the best predictor that someone will attempt suicide again. Reflective listening is good here, too: “You’re feeling super-isolated right now … .”

If the person has a lethal weapon, like a gun, and says they’re planning to use it that evening, the volunteer can say something like, “The fact that you’re telling me this tells me that part of you doesn’t want to do this.”

If the person says, “I’m going to do this and there’s nothing you can do about it,” it’s time to intervene more forcefully, such as by calling 911. The suicide prevention director also said to call 911 if the person is having an acute psychotic episode. (“There are bugs crawling all over me.” “I have to do this because it’s the only way to save the world.”) The volunteer likewise should call 911 if the person is under 18, because young people’s emotions can be very volatile. The volunteer can also call the suicide prevention hotline right in the moment, while speaking with the suicidal person.

Regarding boundaries, Traci pointed out that when we merge with another person, we are so close that we can’t clearly see him or her. “If I crawl into other person’s skin and am experiencing everything she is experiencing, I’m no longer receiving her.” Doing this erases the space in which two people might connect.

Traci said that she is not a micro-manager and has very few rules, but two things she feels strongly about are that a volunteer should not use her phone while sitting in the listener chair, and she should not chat with other volunteers, as both of these send the message that the volunteer is not available for conversation.

By the time I finished watching the videos, I was really excited about going out to try my hand (my ears) at this. It seemed like something that would have great synchronicity with chaplaincy, and that would be very good listening practice, since I wouldn’t have the agenda of finding anything out about the person’s spiritual or religious beliefs or needs, as I am tasked with doing at work.

Monday, November 12, 2018

Rakusu Relief

Did I mention that every stitch of this had to be sewn by hand? The fabric for the plaquet with the pine twig stitch (in green) on it came from a piece of clothing given by Roshi to our cohort for this purpose.




(Click photos to enlarge.)

Expedition to Seattle

In mid-October I went to Howie’s for the first time in quite a while. I didn’t go more than once or twice during my yearlong internship—I did almost nothing that year except sleep and be at the hospital—and once the internship ended and I got the job I now have, my work schedule interfered. The group at Howie’s was smaller than it used to be, and the chairs were arranged differently, but there were familiar faces along with the new faces, and Howie himself was just as ever.

My friend Charlie goes to Howie’s, and it had been our custom to walk together along Mission St. afterward, but that was two years ago. Now it is his custom to get a ride home with a woman who is part of the group. At first, I felt a little bit stricken over this, and considered asking Charlie if he’d walk with me one week out of three, but in the end I resolved to be generous about this and to encourage his getting a ride home every week, and that’s what I have done.

I picked my rakusu back up in the latter half of the month and had a lovely, meditative day of stitching away. It has been a real learning experience. As of yesterday, it is done!

Also in October I made my annual trip to see my cousin and her family, and David and Lisa, in Seattle. My cousin went to the University of Michigan and is a huge fan of the Wolverines; she put on her UM socks while watching “the game.” (Michigan versus Michigan State?) When pumpkin-carving day rolled around, she put on her orange pumpkin shirt, with socks to match, and both of her young children were also wearing orange shirts for the occasion (plus one of them was wearing oversized safety goggles, just in case).

I was planning to be an observer, but my cousin gently said, “Pumpkin carving isn’t really a spectator sport,” so I carved a pumpkin and it was fun. As for David and Lisa, the three of us went to the Chihuly Garden and Glass museum, which is pretty spectacular, and then to Bamboo Garden for lunch. They joined us at my cousin’s for dinner that evening. It was wonderful to see everyone up there.

My 90-minute flight going there was delayed two hours and the return flight was delayed three hours, but I really enjoyed the splendid view of Mt. Rainier on the way back, as well as of downtown San Francisco.


 David at the Chihuly museum.


(Click photo to enlarge.)

Sunday, November 11, 2018

Reunited with my Republican Friend

Early in October I received the unwelcome news that my boss at my paying job has decided to leave her position. Our relationship has, surprisingly, grown to be excellent, so I am sorry she is leaving because I will miss her, but I’m also sorry because she has been very supportive of me as a chaplain and of course I don’t know what the new boss will think of me. (I seem to recall from my corporate career that I tend not to have very good luck with a boss who replaces my former boss. I think both times I was laid off, I had a fairly new boss.)

I had lunch with one of my CPE peers at the Pork Store on 16th St. on a weekday morning and found the restaurant pleasantly empty. I had a delicious breakfast for $10. I had to run around that day doing stuff for my annual flu shot and TB test, which needed to be done at County Hospital with documentation provided to my paying job, or vice versa, plus there were some extra steps at County Hospital in order to get my badge renewed.

On the bus from downtown to County Hospital, I was sitting in a seat reserved for people who are elderly or disabled, which I offered to a woman with a baby in a stroller. She declined the offer, but there was a little chorus of stunned responses around me. Someone said, “That was nice,” as if it were the most astounding thing he’d ever witnessed. Are things as bad as that in civic life? Aren’t you supposed to offer your seat to someone pushing a stroller?

One Saturday at work I felt unusually weary, and by that evening it was clear that I had a cold, which proved to be a drippy one that existed mainly in my head—in my cranium, not my imagination. I had had the aforementioned flu shot about six days earlier, and remembered that a relative of mine was extremely unwell for a month after having a flu shot several years ago, but I concluded that the culprit was having stopped drinking green tea three days beforehand. I thought that maybe it would improve my sleep to take in no caffeine whatsoever, and replaced it with green rooibos, which is also loaded with antioxidants, so I didn’t expect to suffer any ill effects, but the internet says that green tea interferes with six different phases of the creation of a cold virus. I started drinking green tea again immediately, but the cold lasted for about ten days.

I had to go to work slightly sick the following Saturday, because I thought I’d be better by then, and by the time I realized I wasn’t, it was too late to ask my boss to find someone to take a 24-hour weekend shift. I felt guilty going to the hospital, even though I knew I was well past the contagious phase, and was surprised (and sort of relieved, though also shocked) to hear other workers freely coughing. What mainly made me feel terrible that day was the three Benadryl I’d taken in the preceding 24 hours. I felt dizzy, disoriented and generally lousy. (The internet says Benadryl is not good for you, and that you should take it only if you are having a major allergic reaction.) Fortunately, the Benadryl wore off by the afternoon, and I was able to see a patient or two, and even without having a coughing fit.

I saw a patient on the oncology ward, and then I talked a bit with a nurse who said he was near the beginning of a shift that was probably going to be especially difficult, with many mentally ill cancer patients. I asked how he copes with an extra-difficult shift and he said, “Spiritual care would actually help. It’s great to talk to someone who looks you right in the eye—like you’re doing.” I was pleased by that, and he was pleased when I told him that we are there to care for staff as well as patients and family members. I told him that on our stats-tracking spreadsheets, there is a column for staff.

It made me remember a day at school when Fleet Maull led us in an exercise that involved staring into the eyes of one peer or another for what at first seemed like a long, long time. After lunch that day, my little subgroup met, and our mentor, who is wonderful, suggested that we start by “looking around the circle and taking a moment to see each person.” Then she said, sounding surprised, “Wow! You guys are good at this,” and we explained about our class. Ever since then, I’ve found it easier and more natural to look people right in the eye. I think in the past I felt it might be intrusive in some way, or that I wasn’t worthy of non-verbally asking for that kind of connection, but now it feels quite nice. Of course, if the other person doesn’t want eye contact, then he or she can easily break it.

Mid-October, I talked to my Republican friend on the phone for the first time since Trump was elected. We spoke for a full two hours, one hour for me and one for her. I was keeping in mind some things we learned in another class at school, from a guy who is a mediator. He had a lot of great things to say, but what I was particularly remembering was that he said not to “argue about facts.” He suggested that we have coffee monthly with someone whose views are very different from ours: “Have an improbable dialogue.” He said to stay in relationship and to avoid the temptation to shy away from those who challenge us. My conversation with my friend was very satisfying, though I noticed that when I said something in my chaplaincy was going well, as I did a couple of times, this was met with a cool silence, and I remembered that one of the several things that led to our taking a break from each other—for two years—was her getting the feeling that I was talking to her as a chaplain would, rather than just being myself.

Saturday, November 10, 2018

School

At sunset, for just a few moments, the nearby mountain face turns this remarkable color.



(Click photos to enlarge.)

Rakusu Rage

In mid-September, I attended Schwarz Rounds at County Hospital. The topic was treating young adults with drug problems. We also received a handout on treating various kinds of “hateful” patients. All four panelists talked about the same young patient who was seriously ill and whose mood and wishes changed constantly. In the end, two of the panelists said, all they could do was be with her, often in silence, which one of the panelists said was really challenging, but “paid off,” in that she picked up nuances over time that helped her understand how best to care for the patient.

A few days later, my CPE cohort met, as we do every two months, this time at the home of one of our members in Berkeley who has most often been our host. It was nice to sit in her beautiful back yard and eat and talk. Toward the end of our time together, we did an official check-in, with time for each person to say what she or he had been up to.

Lately I was talking with another chaplain of about my vintage—new—who is starting to move into leading trainings and writing things for publication. I felt a pang of anxiety: should I be training people and writing chapters for books? Am I falling behind? But of course I’m not even board certified yet, and I also thought about some of the extremely busy chaplains and CPE supervisors I know. Some of them clearly do not get enough sleep. I do get enough sleep, and generally, I feel quite well. So I decided to continue on my well-rested track and not teach anyone anything or write anything other than this blog. If I have to choose between being an exhausted, stressed-out person who tells other people how to feel great and being a highly refreshed person who never tells anyone anything, I choose the latter.

I shadowed a new chaplain at County Hospital, and per the way things are done in the palliative care class I attend one day a month, I asked her what she thought had gone well, and then I added what I thought she had done well. Our teachers in the class say it has been proven that this is the best way to learn. They call it “appreciative inquiry,” and point out that what we focus on increases.

The next night, I was paged while on call and had to return to work. A Catholic patient had died and the family really wanted pastoral care. When I got there, I found that they had also called their own priest, and that he had already arrived. The nurse was very apologetic, but it was all right. I just turned around and came back home.

One Sunday Tom and I went to Sacramento on the train to celebrate his birthday with Ann, his mother. She treated us to lunch at Bento Box, Tom’s choice, and then we went to her place so he could open his birthday present. On the train home, we sat with a young father and his two very delightful young sons. He and Tom are both teachers, so they had plenty to talk about, and it also turned out that they live just around the corner from us.

In Emeryville, after we got off the train and were waiting for the bus to take us back across the Bay Bridge, I saw someone who looked remarkably like Tom’s niece, because that’s who it was. The three of us went to Old Mediterranean for dinner.

On an utterly gorgeous day a few days later, I went up to Novato in a Zipcar to see Carol-Joy. We had brunch at Toast, played cards, went to see Life Itself, and returned to Toast for dinner: spinach salad and blue cheese fries, both very yummy.

Toward the end of the month, Charlie and I had tea at the Atlas Café.

I was then still working on my rakusu for Jukai next March, which must be sewn by hand. We had been instructed to take refuge with each stitch: “I take refuge in the Buddha, I take refuge in the dharma, I take refuge in the sangha.” I was working on it one day during the Brett Kavanaugh hearings, and found myself unable to turn off NPR. I got angrier and angrier, not so much at Kavanaugh—though I totally think he did exactly what Dr. Ford says he did, and therefore I also think he’s a liar and has no business being on the formerly Supreme Court—but at my rakusu.

I had meant to work on it for just an hour or two, but I ended up spending the whole day, getting more and more stressed out, and it was a thoroughly crappy day. I saw my tendency to blame others for my misery. (“These instructions are terrible!”) However, as angry as I got, I did not snatch up the scissors and cut my sewing project to shreds. I did do that once when I was five or six years old, when my mother was helping me to sew a skirt, and to this day it is a painful memory. After this horrible rakusu day, I set it down for several weeks, to let the bad vibes dissipate.

Thursday, November 08, 2018

Graduation from Hospice

In the second week of September, I went on the second of my four self-assigned field trips for school, this one to a Baptist church around the block from where I live. The pastor and congregation were warmly welcoming, spirit was flowing abundantly, and a young woman guest preacher gave an absolutely splendid sermon without once consulting any notes. It must have lasted an hour or longer; the whole service lasted two and a half hours. For that reason, they will not be seeing me again, but it was a wonderful experience and I had a very interesting conversation with the pastor afterward about caring for Baptist patients.

He said the main thing to remember is that “they just want love. It’s about the relationship, not religion.” During the three hours I was at this church, I did not hear the Lord’s Prayer recited, so I conclude a Baptist patient would not be waiting for that. The pastor said that salvation does not come because one is baptized or because one does this or that meritorious action—it’s because Christ died for us. (Nonetheless, as the young woman said in her sermon, we are made in God’s image and are supposed to set an example of Christian conduct, including treating others with love.) “Grace” and “mercy” were words I heard over and over. The pastor also said that Romans 8:28 is a touchstone: “And we know that all things work together for good to them that love God, to them who are called according to his purpose.”

I asked what he might say to a patient who wonders why God has visited a terrible illness upon her. He said that he would say, “It’s not always the Lord doing something to us. Sometimes our own choices have played a part. Bottom line: God is still in control.” He said it’s important for people to remember that “this is a temporary situation,” meaning life on earth, and also that “we live in a flawed world.”

I asked about the situation where a person is in the ICU and it seems clear that what is being prolonged is suffering rather than life, but the person’s family and friends are hoping for a miracle. He said that he might say to the patient’s loved ones, “We can be kind of selfish. You see her suffering. Why would you want her to be in this state? We can try to prolong life, but it’s not in our power. Remember how a caterpillar becomes a butterfly. Let us let her go to life everlasting.”

This pastor currently works in IT, but is thinking of becoming a full-time professional chaplain. This is something I know a thing or two about, so I told him about Clinical Pastoral Education and that I’d be happy to answer any questions about the path to chaplaincy that arise for him.

I gave Emily in hospice a call and found out that she had “graduated” and gone off to a senior community. Fortunately, she had approved my being added to the list of people with access to her medical and other information, so I was able to find out which one. It’s the same one where the only other person I’ve ever known to graduate from hospice also ended up; they were in the same hospice, so maybe there is some kind of connection between that hospice and that senior community.

It occurred to me that Emily would have lost her whole cadre of volunteers, and that this might have been quite a blow, but I still don’t know if this is the case, because every time I called the new place over the course of a few weeks, she was eating or playing bingo or what have you, which seemed like a good sign. When I finally reached her, we were back to her not being able to hear me and saying over and over, “Are you there? Are you there?” while I yelled as loudly as I could into the phone.

Meanwhile, I was still mentally flailing about trying to think how to build community, and then I read something that changed my plans yet again. Most days I read a page from The Caregiver’s Tao Te Ching: Compassionate Caring for Your Loved Ones and Yourself, by William and Nancy Martin, and often find it helpful. These sentences brought me back to earth: “There is nothing to figure out.” Also, “Each day we assume less about what should happen.”

I remembered that the only moment in which I can act is this one, and also that it may be true that going to such-and-such meeting regularly would be helpful in having a sense of community, or it may not. It might not be any truer than that getting back together with F. (which has not been offered) would bring great joy. Some things are fairly easy to see as false, but in fact, I really have no idea what should or shouldn’t happen, given my extremely limited vantage point—how little I can see of the entire web of causes and conditions.

I decided to relax, to tolerate the nagging sense of lack and uncertainty, and, if there should happen to be a choice in a given moment to move toward community, to do that, if I remember. I reflected that, once upon a time, I thought, “If I could be a chaplain, I’d be so happy!” Well, now I am one, and now I think, “If I had more of a sense of being part of a team of chaplains, I’d be so happy!” That is: wants are endless. It’s so easy to locate satisfaction in the never-arriving future.

I went off to work for the second time at the new hospital. The first time I was there, it was Saturday and I was alone. This time it was Wednesday, so I joined the chaplain who has been at this hospital for a long time (that is, at the old hospital next door, whose patients are now all at the new hospital). The office is basically his office, and I wasn’t sure how much he enjoys sharing it, but he was extremely friendly. He showed me some things in the electronic health record that were very useful and then we walked around the hospital and he introduced me to a number of people. At one point, he told someone that he’s the “head of the department,” so I played along and said, “Yes, I have to run and get him a doughnut every ten minutes.” I didn’t plan any of this or expect it, and ended up feeling very welcomed and accepted, and therefore enthusiastic about the day ahead. It also turns out that there is a bathroom in the old building, where our office is. It’s right across the hallway from our office, and we have a key to it. Not only do we have a bathroom, since the building is almost empty, it’s a semi-private one.

I later sent an exuberant note to my co-worker thanking him for the warm welcome, and copied our boss. I got a really lovely reply from my co-worker saying he appreciated my ministry and presence, and then both of us got a very nice note from our boss saying we are both wonderful team members and that our collaboration skills are appreciated.

Wednesday, October 31, 2018

Halloween Self-Portraits




I took these during a recent power outage.

(Click photos to enlarge.)

My Boss's Excellent Plan

My cohort at school has a number of things to do before jukai—Zen ceremony for receiving the precepts—next March. Besides the two lineage charts that I finished while I was at school in August and sewing our rakusus, we have to write about each of ten precepts, each of the Three Refuges, each of the Four Commitments, and each of the three Zen Peacemaker Tenets. We decided to do the writing as a group, taking three days for each item: one to read about whatever it is, one day for contemplation, and one for writing. It’s nice to know we’re all focused on the same thing, in all our various locations.

The final task is to make a piece of art or writing representing our own lineage, which doesn’t have to be literal. That is, mine won’t be a PowerPoint with Howie appearing right above me and Howie’s main teacher, whoever that is, appearing right above him. Rather, this is something that honors all of the people who guided or inspired us on our spiritual path. Mine will probably start with the first dharma book I ever read, which was Who Dies? An Investigation of Conscious Living and Conscious Dying, by Stephen Levine.

Early in September, I went to the first session of a class on palliative care at the Truly Wonderful Medical Center that will meet once a month for about a year. Our teachers are an interdisciplinary team of four women: a chaplain, a physician, a nurse and a social worker. One of my peers from Clinical Pastoral Education is in the class, along with two of my co-workers. The day was utterly superb, including a wonderful talk by a pioneering palliative care physician. Even lunch was wonderful. I figured it would be a sandwich and small bag of potato chips apiece, but it was a lavish spread of chicken, lasagna, brown rice and vegetables, along with two kinds of salad and three dressing choices, with cookies for dessert. I still don’t eat sugar, but I stuffed myself with salad and lasagna.

While reviewing charts at work one day, I read earlier chaplain notes saying that a certain patient had sneered and been rude and answered questions in a “sarcastic” manner. While thus engaged, I could hear a patient shrieking loudly from his room that he needed help, help! The fact that no one rose to assist him immediately suggested that he might have been shrieking off and on for hours. Then I realized that the shrieking and sneering, sarcastic patients were one and the same: now I was definitely going to visit this person.

I entered the room to find the patient staring at me with a forbidding, even angry expression. He looked as if he didn’t intend to say a word, or if he did, it was going to be a discouraging word. I said cheerfully, “I know you don’t enjoy chatting with chaplains, but I just thought I’d stop by and see how you’re doing.” At this, his expression changed completely. He smiled and looked me in the eye and said, “Actually, I do enjoy chatting with chaplains, but I’m [outrageous religion guaranteed to offend any chaplain]!” At this, I raised and extended my hands, palms up, as if to say, “Go figure! Fine with me,” and then he told me that he expects to die soon and that he’s at peace with that. It was quite a powerful visit. I was impressed by his equanimity, and also suspect that this kind of acceptance can come and go, so I asked who will be with him on this journey and was glad he has company.

This was on an oncology ward that I normally rarely visit. I now go to various campuses and various units per what my boss thinks needs covering, and can end up almost anywhere. That day I ran into a meditation friend of mine who is an oncology nurse. It was the first time I’ve ever seen her in the hospital. Three observations about the oncology ward: care team members are much more often in patients’ rooms than they are on other units. Ditto family members and friends. And that people facing the end of life are more likely to get right to the point. When I approached one woman’s bed, she immediately stuck out her hand to take mine.

The first day of the palliative care class awakened a desire in me to be part of a palliative care interdisciplinary team, as our teachers are, or like my oncology nurse friend and her co-workers, and it kind of threw into relief how much that seemed to be lacking at my paying job.

A few days later, I was thinking about this and got more and more aggrieved as I mentally detailed how poorly we’re being treated by our boss, how much we’re being excluded, how little we’re being valued, etc. That’s why the palliative care class is so great: it’s a chance to spend a whole day with a like-minded bunch of people. It’s also why serving at County Hospital is so wonderful. There almost always are two or more chaplains there—sometimes six or seven—and our supervisor is usually there. In between visiting patients, we hang out with each other and it’s fun.

As I told myself my victim story over and over, I felt worse and worse. Finally, I remembered who is responsible for my feeling like part of the team: me. I had vowed never to attend a team meeting now that we per diems weren’t being paid to join in, in order to show my boss how terrible her new plan was. However, if it’s important for me to feel like I’m part of a team, and if I’m entirely responsible for that, what actions could I take? There are many. I could schedule lunches with my co-workers. I could periodically send an email to the group. And I could go to the meetings, even if I’m not paid for doing it, and even if it causes my boss to think her plan is perfectly fine.

Wednesday, October 10, 2018

Reddish



(Click photo to enlarge.)

SOB

Late in August, I went to see Emily in hospice for the first time. It was great to see her. (Oh, right, I had vowed not to make an in-person visit, but I finally broke down.) She looked well, I thought, with her eyes very clear. She told me about a day when she realized she didn’t know where her call button was. Worried that she might need assistance and not be able to summon it, she tried yelling for help. When this did not produce results, she began to sing “Swing Low, Sweet Chariot” at the top of her lungs, and to yell, “Jesus, take me!” This caused a staff member to arrive very soon and to scold Emily: “You’re scaring the other residents.” (Emily grumbled to me, “She didn’t even ask what was bothering me.”)

I went from the hospice to have tea with my school peers who live in the Bay Area. We meet at a place near the Haight called The Center, which has astronomically expensive tea and very agreeable ambience.

The next day, I was in the ED at County Hospital when a “900” was called over the PA, a severe trauma, in this case, a stabbing. I stood outside the young man’s room in the resuscitation unit and thought about how shocking it must be to be suddenly punctured by a knife or a bullet.

I also visited three people in the psych ward. I enjoyed these visits during CPE, and I enjoy them at County Hospital. (I never get to visit the psych ward at my paid job.) For one thing, these are always referrals, so I can directly ask the person why he or she wanted to see a chaplain; in the course of normal rounding, that question would not make sense, since the patient probably didn’t want to see a chaplain. I asked a couple of these patients their thoughts on how they might reconnect to their sense of the sacred, leading right away to interesting discussions. One person wanted to be issued a Bible upon leaving the hospital so he could hit Mormons over the head with it.

In another unit, a patient said that she was feeling short of breath. Any number of times I have given the nearest nurse a message from a patient only to be told that the patient’s nurse is such-and-such person, which I interpret to mean, “Not my job. Why are you bothering me?” So on this occasion, I tried to telephone the patient’s nurse and when I found the number out of service, I finally mentioned the patient’s SOB to someone else at the nursing station who leapt up and said, “Don’t wait on that kind of thing! Tell anyone!” Later I apologized to her, and she said, “Yeah—ABC: airway, breathing, circulation. That kind of thing anyone can help with.” Now I just need to figure out how to tell when someone is having ABC problems.

Here’s an interesting thing I learned that day, from a homeless patient: that it is better to sleep during the day and be up during the night, because it’s warmer during the day, and people can keep an eye on you and your stuff, but you have to be careful not to sleep through mealtime at the soup kitchen, since food is mostly not available at night. (Later on, I  learned that you should also try not to sit down in the closely guarded territory of a  drug dealer. This was told to me by a patient who was severely beaten, ending up with at least one broken limb, when he made this mistake.)

The next day, I went to work for the first time at our brand new hospital. I was away on moving day and couldn’t even figure out how to get to the chaplain office, which is one of the few things remaining in the old hospital next door. I had to call my boss to have her explain how to get in there; even the security guards thought the whole place was sealed off. I’m pretty sure I was the only soul in the entire building, and it was creepy. I decided never to be in there at night. When I went back to the new hospital, the first thing I did was ask the security guard how I would explain to emergency personnel exactly where I am. I could just picture a security guard or police officer saying, “Oh, no, there couldn’t be anyone in there,” while I’m being murdered.

It also appeared that there was no bathroom available in the old building, nor a time clock. In the new building, the cafeteria is closed on weekends, so I ended up eating at a kiddie table in the lobby, because if I’d punched out for lunch in the new building and walked back to the chaplain office to eat, that would have used up a lot of my 30-minute lunch period.

We per diems had been told in the past that if we attend work meetings on days we don’t work, we’ll be paid for them. That day, we got an email saying we’re still welcome to attend work meetings on our days off, but we won’t be paid for them, which made me feel rather less welcome. I started to feel somewhat ill used, but remembered an exercise we did at school, where we told a partner about a time when we were victimized. (As it happens, I told a story about something my boss said during orientation a year ago.) When my partner told his story about being mistreated by a professor in his graduate program, I felt indignant on his behalf, and a feeling of connectedness arose between us. When I told my story, I could feel, similarly, that my partner was a little bit outraged on my behalf.

Then we were instructed by our teacher—Fleet Maull, who co-founded the first prison hospice program—to retell the same story, but taking responsibility for everything that had happened. It was interesting to see that, even though I had considered the fault to be entirely my boss’s, it was easy to retell the story explaining how it was my fault that things happened as they did. What was even more striking was how the connection between myself and my partner changed, deepening noticeably and taking on a sweet feeling, very different from the feeling of being connected by anger.

Thursday, September 27, 2018

NYC





You might be startled to see, as proven by the bottom photo, that the entire island of Manhattan has tilted since you were last there, likewise the Statue of Liberty.

(Click photos to enlarge.)

Seeking Attractive Gentleman with Rent-Controlled Manhattan Apartment

I returned from school on a Thursday in August; the following Thursday I flew to New York City, visiting for the first time since I was three. Of that trip, I remember only walking on a city street in search of Fred Braun’s shop, which my mother wanted to visit, and I thought I could recall seeing the Statue of Liberty. My father says we did take the ferry to Staten Island, so that must be a real memory, one of my earliest.

It was extremely thrilling when Manhattan came into view from the plane window. The plane landed at LaGuardia, where I was fetched by my esteemed relative Lucy and her fiancé, Ricky, whom I was meeting for the first time, and who I feel is an excellent addition to our family. I really liked him.

Ricky and Lucy dropped me off at Leo House, a Catholic guesthouse in Chelsea where anyone can stay. I was really happy with this place. It cost just $170 a night—it would have been less if I hadn’t chosen a room with its own bathroom—and was clean, old-fashioned and charming. Some of the Yelp reviews said the front desk people were rude, so I made a point of being extra nice to all of them, and they were all very friendly in return.

That evening, which was warm and balmy, I walked to Greenwich Village (I’m in Greenwich Village!) and had dinner at a diner. The next morning, I had breakfast at Chelsea Square Restaurant, half a block from Leo House, and took the subway (I’m on the subway!) to 51st and Park Avenue to have lunch with my old friend Frank. We went to a French café for salads. After lunch, I walked to Central Park. (I’m in … you get the idea). En route, I passed by Fox News. I sat for a while in the park—it was a very hot and rather humid afternoon—and then took the subway to Chinatown and the Bowery. In the evening, Lucy and I walked through Times Square and had dinner at a Thai restaurant near Leo House.

I hadn’t thought I would visit the 9/11 memorial, but when I realized how quick and easy it would be to get to, I decided to go. The next morning, I took the subway there and Lucy and I met in the Oculus. I was staggered by the memorial, which I realized I had never even seen a picture of before. I thought it perfectly balanced extreme somberness with life and energy. Lucy was very kind about pausing often during the day while I took photographs. After the memorial, we walked past the New York Stock Exchange and saw the place where George Washington took the oath of office and also the Charging Bull, or at least the people standing around it.

Then we took the ferry to Staten Island, which does afford an excellent view of the Statue of Liberty. We thought we would have lunch on Staten Island and were both surprised when we disembarked and found—nothing, basically. There were some handsome old buildings now used for municipal purposes, but not the bustling commercial strip with ten restaurants to choose from we assumed we would find. (We learned later that the neighborhood near the ferry landing is considered to be a bad one.) We went a few blocks down the street and visited a grocery store, and then walked back to the ferry.

Back in Manhattan, we found Ricky parked in their car right outside the ferry terminal. He graciously drove us around for the next several hours, though Harlem and all over the Bronx, preceded by lunch in Brooklyn and a spin through DUMBO. Coming back from the Bronx, we drove along Fifth Avenue and passed the Museum of Modern Art and the Plaza Hotel (where Eloise lives!). We passed the handsome dwellings of the one percent. One of them had an orchid in his or her window. (We also passed Trump Tower; I took a photo. My mother said later that I shouldn’t have done that: “Every time someone takes a picture of it, he gets an email saying he’s great.”) And thus I saw all five boroughs in three days!

When Ricky and Lucy dropped me off that evening, Ricky said he had enjoyed the afternoon and that whatever I wanted to do on future visits, he would be happy to participate. He added, “School starts in a week and a half, so if your next visit was before that, that would be convenient for me.” (He is in graduate school, pursuant to being a high school teacher in the Bronx.) I felt sad when they drove away, and hope to see them again yearly. I really appreciate their spending so much time with me and making sure I saw so many things, and I really loved New York City. What a splendid place.

Thursday, September 13, 2018

Adobe


A couple of times at school, I have stayed in this building, in the little room on the second floor, which sleeps three.

(Click photo to enlarge.)

The Most Dangerous of All

Our ten days at school in mid-August were packed with interesting presentations and enriching activities. I stayed in a room with three of my fellow students. My bed was right next to the windows, which we left open every night. It was lovely to snuggle under the puffy comforter and feel the breeze on my face and hear the coyotes howling in the morning.

Next March, my cohort will receive the Zen precepts in the ceremony known as jukai. To prepare for this, we have to do several things by the end of this December: create a chart representing the traditional lineage of male ancestors, starting with the Buddha and ending with our own teacher (who will write my name at the very bottom before she returns this document to me during the ceremony); create a chart representing notable female ancestors; make an artwork or produce a piece of writing about those who have influenced our own spiritual paths; hand sew a rakusu (a small biblike traditional Japanese garment); and write a gloss about each of the precepts, along with the Three Refuges and the three Zen Peacemaker Tenets.

We were advised to try to complete the patriarchs’ and matriarchs’ charts while we were at school in August. You are allowed some artistic license with the latter, but the former has to be just so, and involves drawing a long winding “bloodline.” (Traditionally, people had to draw this line in one stroke, but we were allowed to lift our red markers from the long scroll of rice paper as needed.) I stayed up until 1:30 a.m. one night and got both of them done. We also began sewing our rakusus, and here I must pause to appreciate our sewing instructor, someone who went through this two-year chaplaincy training several years ago. There are 23 people in my cohort, plus at least three people who will be joining us for jukai, which means one person is trying to assist people at 26 different stages of doing this sewing project, any number of whom are freaking out at any given moment, yet she never seemed at all flustered.

Working on our lineage charts and rakusus gave rise to joy, tears, quiet and not so quiet satisfaction, frustration, gratitude and many kind offerings of emotional support, encouragement, sympathy, and instruction from those farther along. It was a beautiful time of teamwork, group effort, and deepening relationships. Really, it was fun. Now that I’m working on my rakusu at home by myself, I am very grateful that my mother taught me how to sew. There are people doing this who have literally never threaded a needle before. There are people who don’t own an iron or ironing board.

For basting thread, I am using red thread that was in the very first sewing kit my mother ever bought me, when I was maybe eight years old. I am using scissors she gave me, and my sewing stuff now resides in a handsome round wicker basket that she made. Most of all, I am using the knowledge she imparted to me. We have an excellent online guide, yet inevitably, some things are assumed. For instance, I don’t think it explicitly says how to make a knot in a piece of thread. (We can email our sewing instructor if we get stuck, and she will also do a video phone call with us.)

During my week at school, my childhood home in Ann Arbor was sold, and the father of my very oldest friend died. One of our teachers is a famous Zen gardener who writes for Tricycle and other publications. (There will be a story about her time at school with us in the next issue.) In her corn kernel necklace, she afforded a fine example of a person evidently being exactly and delightfully herself. (“If this sounds woo-woo, deal with it.”) I can fall into thinking that being a chaplain requires a certain piety, or even at times a funereal manner, but am pretty sure that what is almost always most needed and welcome is authenticity, practiced in an ethical manner.

This teacher led us in building up a compost heap, preceded by a ritual in which we called upon the powers of the four directions. Those who wanted to could make a clay sculpture representing something they wished to let go of; these were placed on the compost heap before the final layer or two of stuff was added. While we were working on the compost heap, our teacher divided us into three groups for singing. The first group sang something like, “Rot, rot, rot, rot!” The second group sang a somewhat more complicated but still applicable phrase. To the third group, she said, “You’re the most dangerous of all!” Members of this group were instructed to shriek “Get down!” as the spirit moved them. We loved her.

My parents are avid gardeners who always had a compost heap in the yard of the home that was just sold. Getting to participate in making a compost heap helped with grieving the loss of that enchanted, quiet place, with its beautiful fruit trees, grapevine, flowers and vegetables.

Tuesday, September 11, 2018

Santa Fe Motel Parking Lot


(Click photo to enlarge.)

Hairdon’t

At the end of July, I had breakfast with one of my former Clinical Pastoral Education peers, who raved over my new very short hairdo. Others have also complimented it, but it hasn’t been a hit across the board. One young hospital patient called me a “dyke-looking bitch with goofy glasses.”

I’m starting to think that, in some ways, holding babies, which I do most weeks in the NICU at County Hospital, is harder than being a chaplain. I twice held a baby who was withdrawing from drugs. He has since left the hospital, and I found myself thinking about him, picturing him crying while his mother shoots up. The thought of this baby being unhappy caused me some moments of real anguish.

Early in August, I headed to school in Santa Fe two days early so I could spend some time with Mason, one of my two peers in my first unit of CPE. Landing in Albuquerque, I experienced the worst turbulence of my life, as evidenced by the fact that never before have I clutched the arm of the stranger sitting next to me and burst into tears. The plane was bucking and corkscrewing and lurching up and down. A flight attendant making an announcement over the PA broke off in the middle of a sentence and rushed down the aisle, holding onto both sides of the overhead luggage bins.

I was one hundred percent positive I was within a minute or two of the end of my life, and accordingly had a word with my deceased grandmother, whom I expected to see in person imminently. I asked if it is safe to die and she again assured me that it is (as she does just before I board any plane). I put my cell phone in my jacket pocket, so my family might have a chance of identifying my body, and considered how I would like to spend my final 30 seconds. It was immediately obvious that human connection is most important, so I said to the fellow next to me, who was clutching the seat in front of him, “If we crash, can I hold your hand?”

He said, “Yes.” Then, in what sounded like an afterthought, “Hope we don’t.” We did not, and that evening, Mason and his brother and I had dinner at a pizza place recommended by one of the Sandia shuttle drivers.

The next day—a blisteringly hot one—I had breakfast in the grand dining room at La Fonda and then Mason and his brother and I saw the oldest house in the country (from the 1600s), and the oldest chapel, which is next door. We saw a church that was the first Gothic structure built west of the Mississippi, and we went to the Institute of American Indian Arts Museum of Contemporary Native Arts and to the state capitol, which is full of art. We drove out to Ten Thousand Waves, a Japanese spa and restaurant, just to have a look at it.

We had lunch at Souper!Salad! and that evening I had dinner at Tomasita’s with four of my fellow chaplaincy students and two of our teachers.

Monday, September 03, 2018

Fog Plus Wildfire Smoke


Note the little stripe of more or less blue sky at the horizon.

(Click photo to enlarge.)

Letting Go of Technique

My boss recently hired two additional per diem chaplains, bringing the total to four. We learned that we would also have four CPE students starting in September (though it turned out that one of them later thought better of this, so we actually have three). She did a reorganization such that several people will work only during the day and never be on call. The CPE students will handle most of the on-call duties during the work week, and the plan was that we four per diems would duke it out for the remaining evening and weekend on-call hours; we would not have the possibility of working weekday shifts.

It took a while for this to sink in, but I finally realized that I would be going from working once or twice a week to potentially working as little as twice a month. I also am no longer assigned to certain units, where I have come to know staff members and long-term patients, but will go to different units on different days. Further, since all of our team meetings are on weekdays, I realized I would probably never see the rest of my group again. Three simultaneous losses: of money, of connection with my team, and of connection with my units. Also, if I was only going to work night shifts, while I’m all in favor of being paid for sleeping, that wouldn’t be much time with patients.

If my boss hadn’t made it clear that she thinks I’m doing a good job and would like me to apply for a job with more hours per week once I’m done with school, I would have been really upset about all of this, sure that she was trying to get rid of me. But since she has made her favorable opinion clear, I decided to continue to do my best, with a good attitude. Things seem to change often in this line of work, so I figured this would not be the situation for very long, and if I really didn’t have enough patient care hours, I could always add a second day at County Hospital.

And then about two minutes later, my boss offered me a steady day of work each week, and then we lost the fourth CPE student, so I will work a second day of the week now and then, plus some nights. So there definitely was no reason to be concerned, and I even came around to thinking it will be fine to go from hospital to hospital. It will be an opportunity to meet a lot of staff members currently unknown to me and to become familiar with a lot of different units.

One thing that happens very regularly is having a great conversation with a patient and thinking, “Now I’ve got it!” Whatever seemed to “work” with that patient, I then try in the next visit—and invariably find that it doesn’t have the same effect at all.

When I speak with patients, I frequently leave plenty of silence, which often results in their saying things not directly elicited by me, sometimes very important things. With a patient one recent day at the county hospital, I was mentally counting to five after he finished speaking, then ten, then fifteen. I realized a quality of stubbornness had arisen in me, even a mild aggression: I am going to sit here without speaking until this person says something! And then it occurred to me for the first time that maybe the reason a patient speaks during a period of unusual silence—a period far longer than would occur in a social conversation—is not that he feels invited or free to do so by the lovely, calm silence, but because he feels anxious!

With mild chagrin, I realized that deliberately leaving a certain amount of silence, while often effective, is a technique. When I say it is effective, I mean that it results in the patient doing something I think he should do, but how do I know that’s really what would be beneficial? Employing this procedure is also about reducing my own anxiety, because, having decided in advance what to do, I don’t have to experience confusion or unease.

Now that I have realized this, I intend to hold my toolkit of techniques much more loosely and to remember the council guideline (we often do council at school) of speaking spontaneously. A healing conversation cannot be forced, but arises from the relationship co-created by myself and the patient, which in turn depends on my willingness to risk authenticity and vulnerability (practiced in an ethical manner). I will try to practice the kind of patience that allows for intuition to arise, and that gives a feeling of aliveness and spaciousness, rather than steely determination. Can I trust my innate wisdom and good heart? Can I trust that the whole universe is permeated with benevolence and regularly offers delightful surprises, including intuitions that arise at just at the right moment?

One Friday evening, Tom, Ann Marie and I saw the second half of Angels in America at Berkeley Rep. Carlos’s niece was again playing the role of the angel. I had to beg Tom not to leave during the first intermission, and really beg him not to leave during the second. I didn’t want to find myself walking alone at 16th and Mission after midnight.

Thursday, August 30, 2018

Complaining, Too

In mid-July, I went to a continuing education event called “Cultivating Resilience and Compassion” at UCSF Medical Center, hosted by the Department of Spiritual Care Services. I saw a zillion people I know: fellow CPE students from my own cohort and the ones before and after, my former CPE supervisor and other supervisors, people from County Hospital, and people from my paying job, including my boss.

The first half of the day was led by chaplain Rev. Denah Joseph, the second by Rev. Maureen Jenci Shelton. Denah reminded us of the signs of burnout: exhaustion, numbing / depersonalizing others, impaired sense of engagement, meaning and accomplishment. Resilience is built from self-compassion, pro-social emotions (such as gratitude and optimism), and reflective practice and emotional processing: What did I learn from my experience? What were my intentions? Denah said of her work, “I get more than I give. There’s a generative quality to compassion.” (Someone in the audience raised his hand and said, “I knew this job was dangerous when I took it.”) Someone, maybe Denah, described a cartoon where someone is saying, “I know life is suffering, but isn’t it also complaining?”

Denah stressed the importance of community: of finding one’s people and sharing with them. She said that 75 percent of chaplains are introverts, so this can be a challenge. Introverts tend to process internally, and need to make an effort to talk with others. She said the very most important factor in resilience is positive, supportive and nurturing relationships: stay connected.

There was a lot of merriment during the day. The head of the spiritual care department said that if anyone had a crisis, they could page UCSF’s on-call chaplain, “who will rush to your side and ask, ‘Why did you page me?! You’re surrounded by chaplains.’”

In line for the bathroom, I realized that this event could just as aptly have been called The Comfortable Shoes Fashion Show.

A few days later, I went back to school for just three days, for a calligraphy class taught by the famous Zen circle guy. I actually did not enjoy it that much; I mainly chose it because it fit well into my schedule. It did of course actually apply to chaplaincy, since everything does. Here are a couple of paragraphs from the paper I wrote about the class afterward:

Practicing calligraphy, I can make whatever preparations seem appropriate—set up ink, brush and paper; have an example to look at—but I can’t do anything to affect the actual stroke of the pen or brush until it begins, and even then, it’s largely out of my control. My intention is only a small factor even though “I’m” the one who’s doing it. The stroke will end up being as it is due to how much I have practiced before, the state of my nervous system at that moment, how well rested I am, if I am happy or sad, how warm or cold the room is, who I’m sitting near, what happened earlier that day, and many other things that may seem completely unrelated.

How far does what affects my work, whether art work or chaplain work or cooking or writing, extend? Given that everything is inextricably connected, it is probably literally true that if someone in Japan is having sencha instead of genmaicha with her breakfast, my brush stroke will be different. Can I bring this expansive view to my time with a patient, humbly remembering that there is a tremendous amount I do not and cannot know about her?


I had thought that of course I didn’t need to take a raincoat to New Mexico in July, but it turns out that of course you do have to have your raincoat at that time of year. It did rain; it rains or snows in Santa Fe every month except for May or June.

I sat in the front seat of the shuttle going from the sunport in Albuquerque to Santa Fe, and the driver told me that about the weather. He said that when the humidity drops to a certain level, they close the roads that go up into the mountains in order to prevent fires, and indeed they hadn’t had any yet. He pointed out a bright green expanse in the Sangre de Cristo mountains ahead of us as we traveled north and said that this was an area of aspens, which he said grow after there has been a fire; the fire may have been long in the past. He said the darker green elsewhere was ponderosa pines. He said that when the mountain appears to be brown, people think they’re seeing dirt, but it’s actually trees with bare branches.

One day, I saw a large black beetle inside the building where I was staying, near a door. The next day, there were two of them. And when I came out of the zendo one time and put on my Timberland boots, I felt that there was something in one toe, which proved to be another large black beetle. My roommate, who was fantastic, said, “Hmm, what message are the beetles trying to give you?”

I thought about it and concluded that beetles are quiet little creatures who never undergo a turbulent plane ride to go to another state: they were trying to tell me not to travel. I know this is the correct message because it arose from my own psyche. Another person might see the same beetle and conclude that he should spend more time in nature, or that she should paint her Volkswagen shiny black, and those would be the correct messages for those people.

On the plane ride home, the flight attendant advised us as to where to find the sick bags, something I haven’t heard a flight attendant mention in decades, or maybe ever. The young woman next to me said, “The what?” Honestly, I would rather just be at home with Hammett. Also, I fundamentally don’t like the weather in New Mexico. It’s always either too hot, too cold, too windy or too suddenly wet. (Speaking of complaining.)

Wednesday, August 29, 2018

Zero Drop

One day at work, I made the mistake of asking a patient a question the answer to which was a detailed description of his near-Whipple surgery. As happens now and then, I began to feel sort of queasy and urgently distressed. (This actually was the first time this has happened since I got this job; it happened two or three times during Clinical Pastoral Education.) I thought I might have to say, “Oh! I just remembered I have to wash my hair,” and leave the room. But instead—I was pleased with how this worked out—I consciously made room for the intense sensations in my own body, and gently directed his story away from the mechanics of his surgery by calling attention to other aspects of his experience, such as his emotions, and, thankfully, he forgot to finish explaining what his surgeon had done.

The shoes I wear for work are Ecco men’s shoes which I have found very comfortable for more than a year, but a few months ago, as I was tromping up and down the stairs at the hospital, I suddenly began to have pain in two of my toes, including a big toe. I consulted my father, who has made quite a study of foot comfort and health—once again, I must remark that my parents, between them, know everything—and he said I might want to try Lems shoes. This stands for Live Easy and Minimal; their shoes are zero drop and have roomy toe boxes. My father, my mother, and at least one of my siblings wear the Lems Primal 2 and love them, so I got a pair. (They run small, so I got one European shoe size larger than the largest European size I have ever worn, and that was perfect.)

They are incredibly comfortable and my toe pain is 98 percent gone. I can feel everything through the soles, which seems like it might cause discomfort, and it still might, but so far, there are no ill effects, and while I’m wearing them, my feet and my whole self feel fantastic. When I was leaving Rainbow recently, a fellow with long blond hair came along and said, “Nice rack!” (He meant my bike rack.) He looked like the type of person that San Francisco used to be crammed with, who now have vanished. It was so striking to see such a person that I thrust out my hand and introduced myself. I wondered who he was, where he lives, what he does. Maybe he just looks like a hippie-anarchist but is actually a venture capitalist or the CEO of a tech company.

I said to him, “I see that you, like myself, are wearing zero-drop shoes!” I added that it seems like I’m in a better mood when I wear my Lems. He agreed enthusiastically. He said, “Yes, I feel grounded, but also whooo!” and here he grinned and gestured toward his head, indicating how it might joyfully float off into space due to the good vibes coming from his feet.

On a beautiful sunny day, I went in a Zipcar to Novato to see Carol-Joy. We had breakfast at Toast; I had huevos rancheros. Then we went to see Ocean’s Eight. We saw the trailer for the new Tom Cruise Mission Impossible film—I’m totally seeing that—and also a trailer for a movie about an army chaplain! I will have to see that, as well. After the movie, we went to her house to play cards, and then back to Toast for dinner. I had a spinach salad and bleu cheese fries. Both were delicious.

Because I’m studying in a Zen context for the next couple of years and having to attend a sesshin yearly, I’ve decided to practice zazen instead of a more Theravadan manner of meditating. As far as I can tell, this mainly means having less focus on an object, and sitting with my eyes open. (Since drafting this post, I’ve decided it means having quite upright posture (which I usually have, anyway), not moving, and being aware that I am sitting. Maybe one big difference is making a point of not moving.) At first, I really didn’t like sitting with my eyes open. I’ve tried it before, and it seemed not special enough: Here I am, sitting on a chair, seeing what’s in front of me. How is this different from any other moment of the day?

I have gradually realized that its very ordinariness is what makes it so powerful. This is more or less what I do the rest of the day, so there is the opportunity while sitting to observe my wish that something more profound or more thrilling or more unusual would happen, and to remind myself that just this is my life.

And then the rest of day, I can practice doing what I did while meditating, which is to be aware that I am present in a body, seeing stuff and hearing stuff—to spend fewer moments lost in thought, which is directly applicable to my work as a chaplain, but also has slowly but surely increased a sense of dazzled wonder: Wow! I see this! I hear this! I am awake! This is my life!

Tuesday, August 28, 2018

Tenderloin Mosque

One Friday afternoon, I went to do one of my four self-selected field trips for school, at a mosque in the Tenderloin. The building that houses it is old and shabby. I took the elevator up to the third floor and there, lo and behold, was a mosque taking up nearly an entire floor.

I met with the imam in their library before the sermon and prayers to ask for his advice on caring for Muslim patients. The imam set out a chair for me opposite his folding chair, a good six feet away, and told me that, with San Francisco real estate so expensive, there are few mosques in the city. Most choose locations in the suburbs. This mosque is, on the one hand, in the heart of the city and quite convenient to downtown and the Civic Center, but also in a pretty lousy neighborhood, which is what makes it possible for it to be there. The imam said it is the largest mosque in San Francisco and that there are three or four other smaller mosques in the city.

He said the mosque is open for prayers five times a day, seven days a week. He said it’s perfectly possible to pray on one’s own, but it’s nice for people to do this in community. He said they rely on donations to keep going, but don’t have members per se: “Whoever comes, comes.” He estimated that 300-400 people visit, with maybe 50 of those being women; children also attend. Members of the community volunteer to help with essential tasks.

He said it is not necessary for an actual imam to lead the daily prayers. Someone (a male someone) with proper familiarity with the Koran can do it. Besides the daily prayers and the Friday sermon and prayers, other activities are support for the 30 days of fasting at Ramadan. The mosque offers food at the end of each day, as it can be hard for a student or working person to fast and attend school or work all day and then prepare food. They also celebrate the ten days in August when people traditionally make a pilgrimage to Mecca.

The imam said that when he is not at the mosque, he visits people who are in the hospital, and he visits schools to teach about Islam, and offers spiritual direction to students who are Muslim.

Around 1 p.m., people started arriving for the sermon and prayers. The imam selected a scarf from a rack in the library for me to borrow, showed me how to put it on, and smiled at the effect. I made my way to the women’s area, in a rear corner of the large main room. The carpeting is raspberry colored, with green stripes. The walls and ceiling are painted dull yellow and orange. There are colorful tiles and panels here and there, and pillars throughout the room with rugs or tapestries fastened around them at the bottom—decorative elements and also soft places for people to lean against.

I watched the room slowly fill with people, most of whom sat down on the floor; a few sat on folding chairs. Eventually, there may have been 300 men and 30 women. When I realized that was the ratio, I felt slightly nervous, as I have read and do believe that places where there are way more men than women tend to be unsafe for the latter. However, I felt I was unlikely to be victimized at a worship service. It took me longer to realize that there were also 330 people of color in the room and precisely one European American, which did not cause me any anxiety at all. (Though I’m not sure that the people in the room all necessarily self-identify as people of color, per my brief research on this topic, so it may not be correct for me to identify them as such.)

The sermon was given, in quite a bombastic manner, by someone other than the imam, a man standing in an ornate area across the room from the women’s area. He delivered his remarks in Arabic and then English. I was annoyed to hear him say something snide about women he knows “who have 200 pairs of shoes.”

Most of the women didn’t make eye contact with me, but a couple, particularly older women, smiled and nodded. It seemed to be acceptable to play religious music on your own phone in the mosque before the service began, and to use your phone for silent activities during the service. Once the service began, everyone stood up and got into rows along the green lines in the carpet, which I then realized were spaced just far enough apart to allow for kneeling during prayers. At some moments, there was chanting, but only by the men; women remained silent throughout.

Afterward, I retrieved my shoes and returned my borrowed scarf to the library, where I said goodbye to the imam. I made my way out of the building in a crowd that seemed to be only men. Most ignored me, but one or two were very polite, motioning for me to go ahead of them. One younger fellow seemed to glare at me, maybe wondering why a woman with an uncovered head was present.

I learned from the imam several pieces of information that will be helpful in caring for Muslim patients in the hospital. I know that learning about a group takes us only so far, as no group is homogenous. The imam also mentioned this, and shared some thoughts. The first was that it’s important not to intrude on the privacy of a male or female Muslim patient—not to look at the patient’s body if it is uncovered or in an immodest position, such as with legs spread. He said that Muslims do not eat pork, which must be taken into account in meal preparation. He said that a Muslim patient might want a Koran, and might want a visit from an imam, and that the best thing I can do as a chaplain is to be responsive to such requests. There probably are not readings I can offer myself, which might well be in Arabic. He said it’s better just to offer patients a Koran.

He said that some male Muslim patients would avoid shaking hands with or otherwise touching a woman, but not all; it depends on the person. (However, he said it’s best not to shake hands in the hospital, anyway, to avoid the transfer of germs.)

He said that Muslims would typically pray to “God” or “Allah,” that either is fine, and that one might begin, “Oh, God,” and continue, “We ask you to heal this person and make things easy for him.” My prayer for healing for the patient can end with “Amen.” When I offer prayers for a Muslim patient, I should have my hands in front of me, fairly close to each other, fairly close to my body, palms up.

When a Muslim patient is approaching death, his or her family must prepare to wash his or her body after death. The family contacts a mosque or funeral home, and then typically the deceased patient is taken from the hospital to the mosque or funeral home for washing, and then prayers are offered at the mosque or the burial site.

Wednesday, August 22, 2018

Go Ahead On, Brother

When I turned on the radio one morning, someone was reading what sounded like a list of accusations against Trump. “Whoa! Congress must have decided overnight to impeach him,” I thought. “Yes, he did that, and that!” And then I realized it was the Fourth of July and that NPR people were reading aloud the Declaration of Independence. Then I wept a little for what has happened to my country, never anywhere near perfect, but now appreciably worse.

However, as one outrageous act has followed the other, I have found myself calmer and calmer, often remembering Martin Luther King’s words, shared with us by Obama: “The arc of the moral universe is long, but it bends toward justice.” This giant mess may not be set right during my lifetime, but I believe people do want to live in a friendly and just world, and that eventually society will reflect those values. Or maybe I’m wrong about that. Maybe people do not want to live in a friendly and just world. If that is the case, then that is the case. All I can do is conduct myself as I see fit.

Having said that, I did feel a little pissed off when I heard that Trump was getting ready to meet with Putin in private. Trump works for us. We pay his salary. He has no business conducting our affairs in secret.

At County Hospital, when a youthful-looking doctor entered a patient’s room, one of the patient’s relatives yelled, “This guy’s the doctor? He looks like he’s 15. Go ahead on, brother! I’m proud of you.”

I again got to hold the baby who was withdrawing from whatever drugs his mother was or is (hopefully was) taking. He was upset because his diaper needed changing, and began to wail loudly and move his arms. There was something oddly touching about the sight of his arms, which seemed rather beefy relative to his tiny size, but so little relative to the whole world.

Saturday, August 18, 2018

End of Life Options

Earlier this year, a new person moved into my apartment building who demonstrated some behavior that I have judgments about: she told an outright lie in order to gain occupancy, which I think I mentioned here. I gave her a little lecture in my mind, and then quite a few more. I came to think of her as a bad person. She proved to be a major door slammer, and every time I heard her door slam—about eight times a day—my lack of charity grew. Months passed without my laying eyes on her, though her front door is close to mine. When the day finally came that I encountered her, I walked past her as if we were two strangers in the corridor of a downtown office building. It didn’t feel good, and I resolved that the next time I saw her, I would make eye contact and say hello.

More recently, I was entering the front door of our building, my bicycle panniers loaded with groceries. My neighbor came up behind me and said, in a very sweet voice, “I can hold the door for you.” She held the door, and I barely looked over my shoulder—I didn’t even see her face—and mumbled, “Thank you.”

Moments later, I felt heartsick. I had taken one fact about a person—she told a lie—and used it to make her into a non-person who could be treated accordingly. Thanks to studying the precepts for school, I was unable to stand the results of my own actions for more than 15 minutes, and went to knock on her door. She didn’t answer, so I sent her the email below. I reflected that while she took an action I deplore, I don’t know why she did that, and I still don’t know much else about her. It was a powerful reminder to be aware of what information I am taking in and what conclusions I am drawing, which may be entirely wrong, and also a reminder not to tell and retell myself judgmental stories about someone else. 

Dear [Neighbor],

Thank you for helping me with the door today.

I have not been friendly to you the time or two we have encountered each other—in fact, I have been rude, and I’m sorry. Please forgive me. You may rely on my being a better neighbor henceforth.

(I knocked on your door a couple of times today, as I would rather have spoken in person, but found you not home.)

As long as I’m writing, I would be appreciative if it would be possible for you to close your door a bit more gently when you go in and out. :-) Please let me know if there’s anything I’m doing that’s bugging you.

Best,
Bugwalk


I got a really nice note back from her, in which she said she would try to do better with the door. For a few days, it actually did seem a little quieter, but soon she was back to her normal ways. It bothered me less, though, because I had at least said something.

At work, I made a second visit to a patient who is very sad and discouraged, not sure if he wants to be here. I’m trying to develop ways of allowing lots of silence without it seeming really odd. One question that has perplexed me: where do I rest my gaze during these moments? Staring into the patient’s eyes is obviously not good, and looking just past his or head seems nearly as bad. I can imagine the patient asking in the first case, “Why are you staring at me?” and in the latter, “What on earth are you looking at?”

With this patient, I chose a spot on the floor fairly close to the edge of his bed and pretended it was a TV that we were watching together. I took five leisurely breaths; out of the corner of my eye, I could see the patient look at me once or twice, probably wondering what was going on. After five breaths, I looked at him and half-smiled, letting him know I was still with him, and then I looked back at my spot and took five more breaths. During this time, I was conscious of my own discomfort and strong wish to break the silence by, if necessary, veering off into a social conversation. However, I made it to the end of the second five breaths without saying anything, and then the patient suddenly said something about a big decision he is trying to make, the first I’d heard of it.

This patient has the means of taking his own life available at home, which he mentioned several times during our first visit. Every time he said it, he looked at me with a fearful, semi-daring expression that I couldn’t quite interpret. Does he think suicide is terrible? Did he assume I think suicide is terrible? Did he think he was saying something extremely shocking? Was he afraid I would yell at him? 


He mentioned it again in our second visit. I mentally weighed my dislike of giving a lecture—really, imparting any information whatsoever that hasn’t been asked for—with the possible helpfulness of what I might say about this, and decided to offer my views, which are based in tenets of palliative care. I said, “I think that can be a reasonable choice in some situations. I think we want to make sure first that symptoms such as pain, anxiety or depression are being well addressed. It’s also important for people to know that they will be supported and cared for as time passes.” This seemed to make the patient relax a bit; he let out sort of a sigh. Many times, when a patient wishes to exercise his rights under the End of Life Options Act, it is because he has symptoms that are not being properly managed, or he fears that his needs will overwhelm others and he will end up being abandoned or not cared for. Most particularly, depression is correlated with patients wanting to end their own lives.

Saturday, August 04, 2018

Just Too Hard

At County Hospital, I started one day by holding a baby whose nurse said he was withdrawing from drugs, quite a handsome little fellow. After baby holding, I reported to the chaplain office, where Clementine asked if I would like to back up the palliative care chaplain while she was away for a month, which of course I said I would be happy to do. She immediately dispatched me to see one palliative care patient and to attend the family meeting of another. Until that day, I had been asked to see only one or two palliative care patients the whole time I’ve been volunteering there. I offered guided meditation for pain to the first patient; she said afterward that it had been helpful and relaxing.

The family meeting was 90 minutes long and involved the patient herself, three family members in the room, two on speakerphone, me, and two doctors. As at the Truly Wonderful Medical Center, I was very impressed with the leisureliness with which the doctors conducted this meeting, allowing time for everyone to say everything he or she wanted to say, no matter at what length and no matter how far off topic. The doctors were generously affirming of positive sentiments: “That is beautiful! Wonderful!”

I had been told before the meeting that the patient didn’t really want any more treatment, but that the family was insisting on it. The doctors let the relatives express all of their hopes for the patient’s recovery, and then one doctor very gently, in an almost offhand manner, said that doctors take an oath not to cause harm, and have to consider how patients experience the treatment that is offered. “We want to do what is right, and what is best. Sometimes what that is is not clear. And it can change over time.”

One family member said he had initially felt strongly that the patient should proceed with treatment, but now had decided he would support whatever the patient wanted to do. However, another family member was exceedingly forceful in expressing that the patient must continue with treatment. This person leapt up to kiss the patient’s face over and over and was so emphatic that the patient, who could barely speak, eventually said—she was the last person invited to speak—that she wanted to continue with treatment.

The doctors expressed that sometimes a patient will continue treatment because that is what his or her family wants, but maybe the time comes “when it’s just too hard.” This particular patient often refuses medication or other treatments when none of her family members is around, but the insistent relative said this will not be a problem because, since there are several family members in the vicinity, there is no reason someone can’t be at the hospital every minute of every day. At this, another relative pointed out that many of the family members are elderly or have health problems of their own; the doctors validated that trying to be on the scene constantly would be very difficult.

But no matter. It was decided that the patient would continue with debilitating interventions, by her own wish, and the doctors seemed perfectly at peace with that. At the end, I asked the family if they would like a prayer, and they said they would. I murmured to the doctors, “I’ll offer a prayer after you leave.” I figured that, after 90 minutes in the room, the doctors probably had 20 new text messages apiece and little interest in hearing a prayer. Clementine said later that that was the right call. Half an hour after the meeting ended, I was near that patient’s room again and, needless to say, no family members were present. It just is not realistic for most families to staff a hospital room 24 hours a day, potentially for weeks or even months.

The final thing I did that day was to lead the weekly half-hour meditation, which happens in the chapel. Two patients and two staff members attended. One of my favorite things about volunteering at this hospital is never knowing what the day will bring.

While with a patient at my paying job, I had a brainstorm and asked, “In all this, what is the emotional terrain like?” We have a series of questions we’re supposed to get answered, perhaps chief of which is to determine if the person—uh, let me look at that piece of paper—ah! We’re supposed to find out if the person considers herself spiritual or religious. This is very awkward to ask when you’ve known someone for just two minutes.

When I asked the patient about emotional terrain, he readily told me about feeling sad and discouraged after surgery, wondering if he should even go on. Then I asked about his “human landscape” and he told me about his family and friends, and then, without my having said a word about it, he told me about his spiritual beliefs. I didn’t bother to write these questions down on the multi-page cheat sheet I carry around. I have probably made 400 pages of typed notes since starting to learn about chaplaincy, but all that matters is what I’m able to remember in the moment, which is very little, but hopefully will grow over time.

We’re also supposed to put as many exact quotes as possible in chart notes. Some of my peers have one long quote after the next in their chart notes; I often find I can’t recall a single sentence, though my boss said, in that case, quoting a word or two is fine. I would like to have much better recall, so I have a new goal of remembering just one sentence spoken by each patient, word for word.