Monday, September 03, 2018

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.
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