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.)
Thursday, August 30, 2018
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!
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.
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.
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.
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.
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.
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.
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.
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