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.

Friday, August 03, 2018

Or Maybe The Disgruntled Disinterred

I am in the process of renewing my passport, so I can get a REAL ID (like next year when the lines at DMV are less than six hours long), and went to Walgreens to have a photo taken. I could not believe how terrible I looked in this picture. If I could find four other people of similar appearance, we could start a band called The Peevish Cadavers.

Recently I sat with a patient in the emergency department at County Hospital, consciously leaving plenty of silence. She told me that earlier that day, she had felt short of breath, so she had come to the hospital. We fell into a rhythm of silence, another detail or two emerging, then more silence. Suddenly she said, “They found a mass on my lung. I may have cancer.” I’m not sure she would shared that if there had not been plenty of space in the room.

I have noticed that in some visits, I can fall into helping to fill every moment with words, even if that means having a social conversation (“Did you hear The Peevish Cadavers are playing at Cow Palace soon?”). I am sure this is due to some discomfort of my own that I can’t tolerate, maybe even just the discomfort associated with silence. Wishing to change my own state, I talk, and maybe the person does not end up telling me about the mass in her lung or the recent loss of a loved one.

Very often, a patient will describe her situation to me and then say, “But I’m grateful! I’m getting good care, and others have it much worse than I do.” I increasingly find this poignant. While I appreciate and even applaud the impulse to practice gratitude even at the grimmest of moments, and while it is likely factually true that others have more serious prognoses, I think the patient is saying, “I don’t deserve your care and love, and I am ashamed to be seen asking for these things.”

I appreciated this in Reb Anderson’s book Being Upright: Zen Meditation and the Bodhisattva Precepts: “We must be careful not to use the immense suffering of others as an excuse to avoid awareness of our own pain. In fact, if we refuse to listen to our own suffering, we will not really be able to listen to the pain of others.” I would like to find skillful ways of introducing this perspective when I hear a patient say that others are the ones truly deserving of tenderness.

I called Emily in hospice late in June and ended up feeling kind of distressed after she described various difficulties she is having. She said that she is woken up each day at 6 a.m. so her diaper can be checked; getting up so early makes the days very long. A few hours later, she is bathed, which she said causes a good deal of physical discomfort. She is down to zero limbs that are free of pain, but when she expresses this to the aides who are bathing her, they say they have to do it that way or risk injury to themselves. Emily said she doesn’t want anyone else to suffer, either, so she tries not to complain too forcefully. I wonder if a sponge bath every other day would be sufficient, since she is not exactly working up a big sweat on a regular basis.

She said that when she was out on the back deck—a lovely place, as I recall—another patient asked if it would be all right if she smoked. Emily didn’t want to say no; she said she understands what it’s like to crave a cigarette. The smoking patient was joined by a smoking staff member, with the result that Emily found herself craving a cigarette, too. I have mixed feelings about that one. She is proud of having quit smoking a few months ago (because she couldn’t smoke in the hospital), but at this point, it probably doesn’t really matter that much if she smokes.

Finally, she said that workers at the hospice, when they see her crying, tell her, “Don’t cry!” I asked if they seem to mean well, or if they are just being unkind. She said it seems like the latter. This made me angry. Why is it bad to cry when you feel sad? Emily said, “Maybe they have difficulty with their own feelings.” That would be my exact analysis. She begged me not to mention any of this to the staff. She doesn’t want to be perceived as a troublemaker.

I felt bad for her after we hung up, and also chagrined that I had inadvertently told her a lie when I said that hospice was a nice place. It is not proving to be very hospitable from her perspective.

Wednesday, August 01, 2018

Warmer

The day Clementine at the County Hospital told me about the eight upsetting things that had happened, I came home and told all of them to my mother on the phone, who said afterward, half joking, “I needed to know all of that.” Of course, she didn’t need to know any of it, and it’s not fair of me to dump that kind of stuff on her. I remembered one of my CPE supervisors saying she doesn’t tell her husband what happens at work: “He isn’t trained to deal with trauma.” Neither is my mother, so the next time I talked to her, I apologized and said I won’t tell her disturbing stuff from work anymore. She said, “Well, you can’t keep it bottled up! It’s OK to tell me.”

That was very kind of her, but caused me to start thinking about the bottling-up thing. Is it bad to keep stuff “bottled up”? My boss at work told me that listening to someone spew out a story they have told many times before does not necessarily constitute quality spiritual care. The person may just become even more anxious in the retelling. She said that she has noticed that when she obsessively retells a story of her own, she can feel increased anxiety. Even my therapist, for goodness’ sake, lately said that revisiting an upsetting story isn’t necessarily therapeutic. I’m perfectly capable of insisting on telling a story whether she thinks it’s therapeutic or not, but what if she is right? What genuinely is helpful in this regard, for me and for my patients?

I decided that spewing forth a story is the verbal equivalent of being lost in thought and that I wouldn’t do it anymore: I wouldn’t tell my mother and I wouldn’t tell anyone else. And within a couple of days, I felt exhausted and sick of the whole chaplain thing. It even crossed my mind that maybe I would actually rather sit in front of a computer at a bank, a very rare occurrence these days. Clearly I was no longer on the right track. I thought of that childhood game where the other participants tell you if you are getting warmer or colder. I was getting colder.

I decided that I need an appropriate confidante, but who? I decided it should be another chaplain, maybe one of my colleagues. I was paged that night to the emergency department at one of our campuses to say a prayer for a patient who, not yet 60, had died very unexpectedly, alone in his office. The next morning, doing turnover, I mentioned this to two colleagues, though there was nothing either of them needed to do about it. They both were kindly supportive. One reminded me to practice self-care as I integrated this experience. That was really nice of them. We encounter death so often, it in some ways comes to seem like no big deal, but it actually is. Maybe the colleague who said I should remember to take care of myself would be a good confidante, or, at the least, I should remember to tell my team what I’ve lately encountered and ask how things are going for them, so we can support each other. After my exchange with my colleagues, my enthusiasm for chaplaincy magically returned.

Wednesday, July 25, 2018

I Get by With a Little Help from My Friends

Maybe a month ago, a nurse at work instructed me not to chart at her unit’s nursing station. I was immediately indignant. My very first CPE supervisor told me to chart at the nursing station. This is part of integrating myself into the units I serve, which is potentially all of them. She also said, as a rule, not to ask a patient’s nurse for permission to visit the patient, but to remember that I am also a member of the care team.

Later that day, I mentioned this to my boss, who also seemed immediately indignant. Her initial response was to tell me to go ahead and chart at the nursing station, but later she said to discuss the matter with the nursing supervisor, so I wasn’t sure how to proceed, but, being myself, was inclining toward announcing, “I’m a care team member and I’ll chart where any other care team member charts.”

The unit where this happened is not one I’m assigned to, so I sent my colleague who is the unit chaplain a note asking what her experience has been and if she had any insights that would be helpful.

Perhaps it was that same night that I got a page after hours asking for a priest. I called the church that is supposed to handle after-hours requests and got what they call in the corporate world a significant amount of pushback. It was possible that the need would end up being the following morning, so I called the priest who is one of our staff chaplains, and left him a message saying he might be needed first thing next morning at a particular campus.

It did end up working out that way, so I left our staff chaplain a message about an hour before our normal start time (actually 90 minutes before, because I temporarily forgot what our normal start time is) asking him to report directly to the ICU in question, if possible. I then texted him apologizing for having phoned him both after and before hours. He texted back saying he would go straight to the ICU to meet the patient’s need, and also that I should tell our boss about what had happened. But what had happened?

I asked what he was talking about: the other priest not having wanted to come to the hospital at night? My having called him outside of normal working hours? Both? He hastily backed off, saying I should do whatever I thought was appropriate, which left me, as with the nurse not wanting me to chart at the nursing station, confused about what to do next.

I went ahead and sent a note to our boss, copying our priest, outlining the entire sequence of events, and ended by saying that my purpose in sending this email was to let our boss know that there is some difficulty getting the priest from that particular church to come after hours. I also said I would welcome some direction as to when it’s OK to call our own priest.

The next time I was in the office, I saw that there had been no response whatsoever from 1) my boss; 2) our staff priest; or 3) my colleague in regard to where to chart on her unit. Now I was starting to fume. This was a Sunday morning. Soon the office phone rang: our staff priest. When he asked how I was, I grumbled that I had done what he had asked me to do—tell our boss something or other—and then neither of them had responded!

He said that he and our boss had continued the email exchange without me, which was fine, since my goal was not necessarily to send and receive email but to have the information I need in order to do my job. As to that, our priest explained that outside priests often have a lot on their plates, and that we should be understanding of that, and that if necessary, it’s OK to call him, our own priest, and it is certainly fine to call him with information he might need first thing the following morning. That was basically what I needed to know. (Although now that I’m writing this, I realize I still don’t understand why he wanted me to say anything at all to our boss.)

As long as I was on the phone with him, I asked what he does if he is discouraged from charting in a certain area. He said, “I might be understood as a coward,” but said he just saves his charting up and does it in his own office. That was helpful in that it made me feel there was no dishonor in not going to war with my colleagues.

Later that day, I also discovered that my fellow chaplain actually had sent a response to my question. It wasn’t in my inbox in the messaging system; it appeared as a comment on my original note. Fortunately, I enjoy reviewing messages I have sent so I can appreciate my own sparkling prose for a second or third time; that’s the only reason I saw her response, which was that if the nurse asks her politely to go chart somewhere else, she doesn’t mind doing that, but if the nurse is rude, I should discuss it with the nursing manager. She has told me in the past that those exact nurses are among the unfriendliest she has encountered.

At this point, I felt fine about not insisting on charting at the nursing station, and relieved that I wasn’t obligated to get into a fight about it. My colleagues, who both had initially annoyed me, ended up saving me.

Thursday, July 12, 2018

Inspect Ladder Before Use


The aluminum ladder whose leg suddenly gave way, resulting in grievous injuries for an esteemed relative. (The thinking now is that a wooden or fiberglass ladder might be safer in that it might make a creaking noise or something before failing.)

(Click photo to enlarge.)

Monday, July 09, 2018

Schwing Schwing Schwing Schwing

(Or is it just shwing?) This refers to Wayne’s World 2, featuring Aerosmith, one of the movies I watched with my mother while visiting Ypsilanti early in June. We also saw Miss Sloane (we both liked it a lot), The Florida Project, Into the Wild (for the second time), Wonder Woman, Nightcrawler, Boyhood, Get Out, Assault on Wall Street, and probably several other movies I’m forgetting. I got caught up on my MSNBC and Rachel Maddow, and enjoyed spending time with my parents and the cat that hangs around their place a lot, Jack. I had lunch with Ginny at Café Zola and with Amy at Seva. My sister came over three times, and I had lunch with my uncle and his wife at Haab’s, in downtown Ypsilanti. As for Wayne’s World 2, that was my mother’s idea. She normally dislikes comedies, but thought it would be good to have some familiarity with a work that is so well-known. I enjoyed it. I appreciated the main characters’ enthusiasm and joie de vivre.

The evening I returned home, I went to the first of six Feldenkrais classes I’m taking through Kaiser. The next day I got my annual performance review at work, which was glowing. My boss’s accompanying remarks were less so. For instance, the written review said my chart notes are great, and provide helpful information to other team members. In person, she said, “Actually, what I don’t like about your chart notes is … ” I thought that was a perfect way of handling it, in that my official review is something I can feel fantastic about, and I also got concrete information about areas where I can improve. (She also said that Jonas, before he left, said I have an “incredible” ability to connect with patients.)

When I went to County Hospital for the first time after being in Michigan, Clementine—looking a bit dazed—told me about no fewer than eight traumatic and/or disturbing incidents that had occurred at or affected the hospital in the prior couple of weeks, including two “gnarly” murders. One of the many ramifications of these things is that security is tighter, which means homeless people are less welcome to sit around in the cafeteria all day, and not at all welcome to sleep in the elevators overnight, as some of them normally do, so besides all the various kinds of misery, there has even been a loss of housing for a small group of people.

It was a fine day of learning for me. One of my fellow chaplains there is extraordinarily insightful. During our brief daily team meeting, we were talking about patients who ask us questions about ourselves. This person said, “I think that a patient who does this is trying to erase herself, so I need to leave a big space in which she can reappear.” That dazzled all of us.

My own learnings of the day:

1) I spent most of the morning, after holding babies, in the more acute psych unit, where I saw just two patients. One of them has problems with demons, and during our rather long talk, she said, “Oh! A demon just came out of me and went into you.” I paused and said, “I didn’t feel any demon come into me. It didn’t come into me. Maybe it dissipated into the air.” The patient said, “No, it came back into me,” and her face twisted in pain.

I happened to mention this to Clementine later, and was glad of that, because it caused me to remember that we’re not supposed to validate delusions. (Nor are we supposed to say, “What?! Are you crazy? There’s no such thing as demons!”) She said it was good that I had denied that the demon had come into me, but when I suggested that maybe it had gone into the air, I was validating the patient’s delusion. She advised me not to engage one way or the other about demons or other delusions, but to listen for the feelings. How does a person full of vengeful demons feel? Probably scared.

(Though Clementine said that once medication makes the demons go away, some patients can actually feel lonely for them, because demons aren’t always in a bad mood.)

2) This same patient asked about my religion and I said I am Buddhist. With non-psych patients, this is almost never a big deal. (I can recall only two patients who made it clear they didn’t like it; one went to work right away trying to convince me to accept Jesus as my savior.) This psych patient reacted favorably at first, but when I ran into her later, she spitefully accused me of stealing a Bible from her, and then said, with near-palpable malevolence, “Just because you’re Buddhist doesn’t mean you have to persecute me!”

From this I concluded it might be wise to be less forthcoming with psych patients.

3) I brought the other psych patient a copy of Our Daily Bread, which has two staples in the binding, and stopped by the front desk to see if they would like to remove the staples, which they did want to do to prevent the recipient or some other patient from removing the staples, straightening them, and using them as weapons. No one at County Hospital had told me to do this; we learned this during CPE. I mentioned this at our chaplain team meeting, and it appeared to be new information for some, so that was a reinforcement of learning for me and maybe something new for others.

4) Finally, in the ED I visited a patient who was handcuffed to her bed, with a police officer stationed outside. That morning, she had been a free woman, and now she was going to jail, and she was upset. I asked what had happened, and at some point, after I’d heard a few details, the police officer interrupted to say he didn’t think we should be discussing it. The patient got indignant and asked why not, but the police officer was quite right; I was chagrined that I hadn’t figured that out myself. I said, “You’re right, we shouldn’t be talking about this.” To the patient I said, “My thinking was that maybe it would make you feel better to say what happened.”

“It did make me feel better!”, said the patient. “I should be able to talk about whatever I want to talk about.”

“Fine,” said the police officer. “You can talk about whatever you want to talk about, but she shouldn’t ask you about it.”

When I left, I thanked the police officer and will not do that ever again. Then I felt kind of paranoid, worried that I’d get in trouble over it, but figured I wouldn’t. (I didn’t.) There’s just too much constantly going on there for everyone to follow up on every detail.

In the evening, Tom, Ann Marie and I went to see the first half of Angels in America at Berkeley Rep, thanks to Ann. Tom took me out beforehand for Thai food, for my birthday. The play was superb. The person playing the part of the angel, the nurse, and one or two other roles was the niece of my friend Carlos who died of a brain tumor in 2013. She is also a playwright, and, as we saw, a splendid actor. I couldn’t take my eyes off her, in part because I was trying to figure out if I could see any resemblance to Carlos, and at moments, I thought I could fleetingly see his face in hers. Lisa Ramirez is her name. I remember Carlos talking about going to see her performances and about how proud he was of her.

Saturday, July 07, 2018

Lockdown

While I was at County Hospital one day late in May, I got a text from Clementine saying that the ED was on lockdown and could I go check it out? I texted back, “Do you want me to enter the ED?” I wasn’t sure if she wanted me to go in and conduct a hostage negotiation or what. Presumably she didn’t intend for me to get my head blown off, so I wasn’t sure exactly what she wanted me to do. I didn’t hear back from her, and when I got near the ED, nothing appeared to be amiss.

I went in and saw sheriffs taking a barricade away from one of the entrances, and a staff member said the lockdown was all clear. Later I mentioned it to one of my fellow volunteers, and she said, “Yeah, that happens all the time.”

I told Clementine about having attended the training on psychological first aid, and she invited me to join the hospital’s disaster response team, or MCI (Multiple Casualty Incident) team, which I agreed to do.

Up on one of the units, a nurse told me that one of her patients seemed silent and withdrawn, and she asked if I would visit him. The patient was sitting up on the edge of his bed, and he did indeed seem to be downcast. I asked if I could sit down and then I just sat there quietly for some time. After a while, I said, “You seem kind of sad.” He nodded his head just slightly. I added, “It looks like you’re feeling kind of discouraged,” and he nodded at that, too. Then he started talking—about his disappointment that the Warriors had lost their game the previous night. Sounding stunned, he said, “I didn’t think that was going to happen.”

However, as the very leisurely visit unfolded, he shared about some physical symptoms he was having that he hadn’t told his nurse about. He said that, where he’s from, if you say you need help with anything, people lose respect for you. While I was there, he pushed his nurse call button and told her about his symptoms. It wasn’t necessary for me to tell him to do that. It was necessary for him to hear himself say aloud that he was in pain and that it’s hard for him to let people know he is having difficulties.

After that, I thought, OK, I think I’ve got it! There is nothing I can fix. The idea is to sit there, with patience and stillness, until whatever the wound is comes into view. I went off to see other patients thinking that I would do the exact same thing, and then of course found that what had worked in one visit had little utility in any other. Nonetheless, I like the idea of being quiet and patient, waiting for things to emerge on their own: whatever is bothering the patient, and also her resources and wholeness.

One evening, just after I turned off the light to go to sleep: beep beep beep! My work pager going off. I called the pager operator, who put me through to a nurse who said that a patient’s mother wanted to speak to a chaplain on the phone. My enthusiasm was whole-hearted, since the alternative was getting up, getting dressed again, and taking a cab back to work. “I would love to talk to her on the phone!”

Thursday, July 05, 2018

Chaplain Tries to Poison Fledgling Priest

A week or so after Mason’s graduation from divinity school, I returned to Berkeley to have breakfast with him before he moved back to New Mexico to serve his own church as a priest. I had checked online to see how far it is from his hometown to Santa Fe and it appeared to be more than four hours by car: too far for a day trip. I told myself that, realistically, this would probably be the last time I would see him, and to let go, let go, let go. I have a quote somewhere about how what we humans need practice in is letting go, because we’re already experts at holding on.

We met at the Sunny Side Café, near UC Berkeley, and after we ate took a walk on campus. I gave him a card congratulating him for receiving his M.Div. and a couple of small gifts, including a polished piece of malachite. (I learned later that malachite is poisonous and that you shouldn’t carry it around in your pocket. He told me he plans to keep it as a reminder that Chaplain Bugwalk tried to poison him.) I asked how long it would take him to drive to Santa Fe and was pleased when he said the trip is just two and a half hours. There is a Monday in August when I can be in Santa Fe but not at school, and it turns out that Monday will be Mason’s day off, so we have plans to meet. Mason suggested that we go to all the museums where, as a Native person, he gets in for free.

Back in the city that day, I attended a training on psychological first aid, such as one might have to render after an earthquake or other mass casualty event. One thing you can do to help someone feel calmer is to ask her to name five things she sees around her, five things she hears, and five sensations she feels in her body, then four of each of those things (not the same ones as before), and then three, two, and one. When the trainer had us do this, it was pretty hard to hear that many different sounds, but overall, this did seem to have a relaxing effect.

Her number-one recommendation for helping lesson people’s anxiety was to ask them to breathe into their diaphragms for a count of four, and then to exhale for a count of four, and to repeat this for a while. Another very useful thing the trainer shared was to say to a survivor, “Hi, I’m Bugwalk. I’m here to help. What’s your name?” and extend my hand. If the person says her name and extends her hand to shake mine, I have just learned several things: the person’s name, that she isn’t hard of hearing, that she speaks at least some English, that she is willing to engage with me both verbally and non-verbally, that she doesn’t have an injury that prevents her from moving her arm and perhaps that she is not in overwhelming physical pain.

The trainer said not to say, “Everything will be OK,” because it might not be, and to use a survivor’s name often, because people are very alert to the sound of their own names, so this might help keep the person we are talking to from getting lost in anxiety.

Most of the people in the room were nurses and social workers, most working in one hospital or another. Next to me was a fellow chaplain volunteer from County Hospital. She told me she is from Mackinac Island, a charming place in Northern Michigan and not one I had realized you can be from; I thought it shut down in the winter. At least last time I was there, about 45 years ago, there were no cars. You could get around by foot, horse-drawn carriage and bicycle, and also eat fudge. (It appears this is still correct. Wikipedia says motorized vehicles, except for emergencies, have been prohibited there since 1898. You can get there only by boat or plane; if it’s winter, you can also go over an ice bridge on a snowmobile.)

Back at home after the training, I gave Emily a call and asked the person who transferred the call to make sure she put the phone to her good ear.

“Do you have the phone up to your left ear?” I asked her.

“Correct.”

“That’s funny that you didn’t say ‘right.’”

“Correct.” She really is rather charming.

She said things were going better: She was visited by two of her friends, and another called her on the phone, and she likes the head nurse, and she had a good conversation with a volunteer, who had a helpful suggestion. When Emily feels upset, she likes to go for a walk. She told me that the volunteer said that, when she feels this urge, maybe she can imagine she is walking, and move her feet in bed. Surprisingly, this worked.

I found among my meditation-related clippings this account of something said by Suzuki Roshi during a sesshin; I misquoted it in an earlier post: “Suzuki Roshi began his talk by saying slowly, ‘The problems you are now experiencing’—we were sure he was going to say go away—‘will continue for the rest of your life.’ The way he said it, we all laughed.” I don’t have the name of the person who wrote this, and will be glad to add it if it comes my way.

Wednesday, July 04, 2018

Am I Dying?

One day we had a five-hour staff retreat at work starting with Mediterranean food for lunch. In the course of the afternoon, my boss mentioned that when Jonas left, among other things, we lost the person who trains others how to use the electronic charting system. I’m pretty good with that system and my former computer job often involved training other people, so at the end of the day, I offered my services and she said that before Jonas left, he told her I’m good with the computer, so she would take me up on that.

She also said she would like me to apply for a part-time job when one becomes available (this would be a step up from my current per diem position), that I have a lot to offer, that I’m a good team member, and that I’m doing a great job. I was flabbergasted. I told her that her words meant a lot to me, and that I’m happy at this hospital, both very true. I had been worried that she was secretly fuming about how much time I take off work, between school and vacations, so that was another reason I was relieved and delighted to find out she is glad to have me around: she’s not trying to figure out how to trade me for a per diem who doesn’t take so much time off.

In mid-May, I went to see Mason, my peer from my first unit of Clinical Pastoral Education, receive his M.Div. degree in Berkeley. It was an inspiring ceremony, and Mason got one of three special awards. Quite a number of his family members came from New Mexico to see him graduate.

When I got home, I called Emily in hospice, and this time I did much better when she asked me a tough question: “Bugwalk, am I dying?”

I said, “Well, a person goes to hospice when a doctor believes she has six months to live or less.”

“Which doctor?!”

“I imagine it was one of the doctors you saw at the hospital.”

“Oh. Yeah. I didn’t get along with that guy. I don’t think he liked me.”

I thought of saying I hope a doctor wouldn’t send a patient to hospice because he didn’t care for her personality, but in case she wasn’t already thinking that—though she probably was—I decided not to introduce that idea.

Then an interesting thing happened, which was that she changed the subject. A bit later, she returned to it, saying she felt frightened, and asking what she should do. And then she changed the subject again. That was a powerful learning experience: I don’t have to be afraid of telling people the truth, because a natural defense mechanism such as denial or avoidance will come to the fore when needed. These get a bad rap but are perfectly reasonable means of self-protection.

One Saturday, Sam and I met in the Castro for Thai food, and the following day Ann, Jill, Tom and I had lunch at Au Coquelet and went to Berkeley Rep to see Heidi Schreck’s play What the Constitution Means to Me. I enjoyed it. Each member of the audience was given a copy of The Constitution of the United States of America. I probably will never read it, but I feel like a better person now that I own a copy.

The next time I called Emily, I found that she was still distraught about finding herself in hospice. I managed to convey to her that, when she declined to take medication, her doctors likely interpreted that she didn’t want treatment and accordingly sent her to hospice. She said, “Oh. Well. I still don’t want to take medication.”

“Then you might be in the best place!” I shrieked. It can be kind of a maddening experience to talk to her on the phone because I have to bellow into the receiver, and she still misses thirty percent of what I say.

“What do you mean by that?”

“How do you think things would go if you were back at home?”

“That’s a good question.” I can’t remember what she said after that, but I was relieved that she is sure she doesn’t want to take medication, because that does mean she probably is in the right place. I was also kind of surprised by that. I sort of expected her to say, “What?! In that case, of course I want medication!”

When Sam and I had lunch the prior Saturday, we were dangerously near where Emily is. In fact, we walked over to look at it, because Sam had never been there. It’s quite a lovely place, on a very pleasant block. But having learned by calling Emily that I shouldn’t have done so, I knew better than to initiate in-person visits. That would not be sustainable on my end, and I would disappoint her. Having said that, I have asked the staff there to let me know when she is within a couple of hours of dying, as best they can tell. If I can, I will go over there and hold her hand.

Saturday, June 30, 2018

Husband Needed ASAP

Despite what I had said to Emily earlier, I actually was tempted to go over to the hospice to visit her after work or on the weekend, recognized that as the impulse to overfunction, and remembered the conversation I had with my very first Clinical Pastoral Education supervisor in a similar situation. She asked if the patient had asked me to stay in touch with her. Well, no, she had not. My supervisor asked how it might play out if I did go visit the patient in her new facility, and I could immediately see that it would likely end in disappointment for the patient. I might visit every weekend for a couple of months, but sooner or later, I would have other things to do. I saw that it was not feasible or appropriate to try to prolong the relationship with even this one patient, let alone every patient I particularly like, which is a lot of them.

This impulse to overfunction is also about the mistaken notion that the patient really needs me. The patient might really like me and might even miss me, but there are (one hopes) many people who will care for her in her new home, and my hanging on could stall the development of important new relationships.

After I got home from work, I felt disoriented, as if a bomblet had gone off in my psyche. I had a wave of thoughts: “Maybe I should get married. Maybe I should move in with a roommate. I’m going to start eating sugar again. Chocolate-chip cookies!” Translation: Being closely connected to people, always a good thing, might prevent my ending up alone and terrified when it’s time to go to hospice. And: life is short, so eat cookies.

I quickly dispatched with the latter: not good self-care. And then with the former. Being connected with people is good, but what was happening here was that Emily’s fear had triggered mine, and I was going to have to deal with that, and also remember that end of life happens a million different ways and that I’ll just have to see how it is when I get there. I think I read in When Professionals Weep a clinician’s observation that most people who know they are going to die are able to make some sort of peace with it before it happens. I found myself thinking, and sincerely meaning it, “Gosh, wouldn’t it be lucky if I got cancer while I still have mental clarity and enough money?”

The next day, I no longer felt upset. (Joan Halifax in Standing at the Edge writes that “open awareness meditation seems to reduce our tendency to get [mentally] stuck, thus enhancing greater emotional pliancy.”) However, in the course of the morning, forgetting everything I had reminded myself about the perils of overfunctioning, I telephoned the hospice and spoke with Emily. I also spoke with someone who works there and said I thought Emily would love to be visited by a volunteer. When I spoke with Emily, she sounded fairly calm, though she had gotten the upsetting news that she can’t go visit her friends any more. She said that I had been there at the worst time—when they came to take her from the hospital—and she thanked me. When I asked if she still felt scared, she said, “Yes.” I told her I had asked for a volunteer to visit her and she said that would be good.

So that conversation was OK. She was of course glad to hear from me and I was relieved to hear that she seemed calmer, but now it was unclear what should happen next. Should I call her every day? Every couple of days? Weekly? I concluded that it had been a mistake to call, and that I should have known better. There was a very natural stopping point for our relationship—when the ambulance door closed—and I should have honored and respected that.

Friday, June 29, 2018

Moving Day

When I worked a couple of days later, I went back to see the patient who was on her way to hospice. I will call her Emily. We had quite a long visit, during which I asked if she’d like to do a writing project. She liked that idea, so I asked her questions about her life, including what the most wonderful parts have been, and wrote down her answers. At the end of the visit, I said that we could continue another day, but a nurse who had just come in said, “She won’t be here. She’s leaving at 3 p.m.” This was news to both me and Emily.

I asked, “Where is she going?” or maybe Emily asked, “Where am I going?” and the nurse named the hospice where I used to volunteer, but didn’t say the word “hospice.” That is, pretending the place is called Number One Hospice, the nurse said, “She’s going to Number One.” I told Emily that I’ve spent a lot of time there, and that it’s very nice. Of course, her anxiety level shot up, because one of the main things bothering her was realizing that she was no longer in charge of her life. I told Emily that, if I could, I’d come back before 3 p.m.

I returned about 2:30 and found Emily weeping and terrified. Another care team member came in and said soothingly to her, “You’re going to go to this really nice place for a little while,” and all but winked at me. I was outraged. After this person left, Emily said, “I’m never going home again, right?” I said, “That’s right. Probably. All kinds of miraculous things happen in this world and sometimes people go to hospice and then feel much better and go home, but if you’re thinking that you will not go home again, I think that is probably correct.”

Later she asked, “Hospice means end of life, right?” I confirmed that, but in a wordy, probably kind of confusing way. I couldn’t quite bring myself to be direct because it seems like a terrible thing to learn that you will die in the foreseeable future. That is, it was likely my stuff, and indeed, by this point, I’d abandoned my usual practice of mostly listening and was somewhat urgently trying to reassure Emily: It’s a lovely place, there will be nice people there, everything will be OK. She said over and over, “This is exactly what I was afraid would happen. This was my worst fear, and now it’s happening.”

I did also acknowledge and validate her sorrow and terror, and I did say, “This will take some getting used to,” which I stole from the trailer of the new palliative care documentary End Game, which I hadn’t yet seen. (I have now; it’s good.) Those were the better things I did, I think. I also held her hand, and I was there. I asked a few times, “How are things right this moment?” and every time I asked that, there was no answer, but I got the feeling she was realizing that things were actually OK in any given moment.

She asked, “Will I see you after I leave the hospital?” and I had to say no, that the relationship must end when the patient leaves the hospital.

When the transport guys—two nice young men—came in the room with the gurney, I felt a wave of terror. At this point, I was pretty much psychologically merged with Emily and had crested the peak of empathy and toppled over to the other side, into empathic distress, as Joan Halifax describes in her new book, Standing at the Edge: Finding Freedom Where Fear and Courage Meet. She hammers home the distinction between empathy and compassion, which at first seemed like a picky sort of point, but might end up being one of the most important things I learned from her book.

I rode the elevator down to the first floor with Emily and the two transport workers, and watched her be loaded into an ambulance, and after the door closed, I wept briefly. I told one of my co-workers about it and he offered some wise words. I appreciated his kind intention, but what the offering of wise words basically conveys is, “I can’t stand feeling what has arisen in me as I hear your words and I need it go away right now.” I didn’t blame him. It’s extremely hard to say nothing when someone tells you what he or she is upset about. I couldn’t do it with Emily in our final half hour together in the hospital. It is something I hope to get much better at.