Sunday, August 04, 2019

Jack


                                                      2/13/2004 – 8/1/2019

My parents
’ beloved cat has died. 

In Jack’s final year or so, he spent most of his time inside, where he loved to sit for hours on one lap or another. Prior to that, my father says, he had two behaviors that were especially endearing: He would try to accompany Mom and Dad on their daily walks, either trotting along behind them or trotting a few paces ahead and periodically looking back to be sure the whole party was still together. (They could prevent him from following them by putting food out on the back deck; he would rejoin them for the end of the walk.)

Jack also liked to keep Dad company when he was working in the yard, either sitting nearby and watching Dad’s activities, or climbing up on downed tree limbs and using them as horizontal scratching posts.

Dad reports that Jack had a wide range of distinctive vocalizations, and that he and Mom were sure he often was trying to tell them something, but they were never able to learn more than a word or two of cat language.

Dad says that Jack was the most remarkably companionable cat he has ever known. “He was my buddy.”

Monday, July 15, 2019

Walking Like a Walking Person

Late in June at County Hospital, there were only two palliative care patients for me to see, so Clementine sent me to the ICU, where there were at least three horrible situations: a PVA (pedestrian versus automobile) accident that had resulted in brain death; a young parent accidentally caught in gang crossfire, also brain dead; the savage beating of a young woman.

I went into one room to find a doctor comforting the sister of one of the brain-dead patients. The doctor had taken the sister tenderly in her arms and was crooning into her ear. It was a tour de force of compassion, particularly given that the doctor probably has to do this five times a week. The sister was weeping, and then said, resolutely, “I’m going to let you do what you need to do,” by which she meant withdraw life support.

It’s impossible to know, but I wonder how it would have gone if the doctor had stood six feet away with her arms folded, saying, “There’s nothing more we can do.” Maybe then the sister would have yelled the words heard very often around the ICU: “Well, you’re not going to pull the plug! You’re not going to give up on her!”

One morning at the end of my 24-hour on-call shift at my paying job, I spoke to the person taking over. Fred asked, “How are you?” I said, “Oh, fine,” and then I added, “except for my right knee, which is killing me.” I’m not sure why I said that, and I expected Fred to say, “Sorry to hear that,” and that would be the end of the conversation. Instead, he said, “What’s the history of this problem? Where does it hurt?”

He told me that he had once been in an accident that had given him knowledge of such matters, and he hypothesized that my kneecap was being mashed against the joint. He said that when he had a similar problem, an acupuncturist treated the twin indentations under the kneecap known as the “calf’s nose.” This was helpful, but Fred figured there was no reason he needed to pay an expert to do this, so he went and bought his own acupuncture needles, boiled them in water, and stuck them in the indentations under his knee, with good results.

I was going to call my PCP the very next day for a referral to physical therapy, but when I thought about what Fred had said, it explained my symptoms exactly. Accordingly, I began doing quad stretches many times a day, and there was immediate improvement. A couple of days later, I went to have a massage, and my massage person worked on my right quads and suggested putting arnica gel on my knee, along with Tiger Balm and CBD oil, either spaced out or all at once. He said arnica is good for sore muscles, and the other two are good for inflammation, but via different compounds, so it’s worth it to use both. (Actually, all three are good for inflammation.)

Thus I found myself on the phone to the nearest marijuana dispensary, placing my very first order. I looked at their website before I called and couldn’t believe how many products they have. I explained that I wanted CBD oil without THC and the helpful employee pointed out various options and said she’d put my order in a bag for pickup. I’d thought I would have to provide my full name and address, or even show ID, but I only had to give my first name.

The next time I discussed my knee with Fred, he had more suggestions, including that I should go see the chiropractor in my PCP’s office, who Fred thinks is wonderful. I said, “Is he going to mess up my spine?” I had never in my entire life seen a chiropractor, but this one really is wonderful. Friendly and enthusiastic, he explained what was going on, released various frozen spots, and gave me some additional exercises to do at home. He said it was not in fact a case of my kneecap being mashed against the joint, but rather patella tracking disorder, due to a ligament that he said is slightly “lax.” He explained why stretching my quads helped. He said my focus does not need to be on growing cartilage but rather on lessening inflammation. My knee is not entirely better—maybe this is now a chronic situation of occasional achiness and stiffness—but it’s much improved and I can walk pretty much like a person who can walk.

Little Miracle Baby

One day late in June, I did a refresher for the two students I’d most recently trained at work in the use of the electronic charting system. I thought it might make more sense after they’d been using the system for awhile, and I could tell that some pieces of information were making sense to them for the first time. In the afternoon, the staff chaplains had our monthly meeting, and in the evening, Tom and I watched half of the Democratic Presidential candidates debate online. (That is, we watched the whole thing; half of the 24 candidates were debating.)

My right knee at that point had been hurting for about a week, which can happen if I slack off on my exercises, or perhaps for no discernible reason at all. I’ve been in physical therapy for this at least three times over the years. My father reminded me that the original injury likely was one I received at age 23 or 24, when I worked for PG&E, in the general construction department, when I fell off a telephone pole and got a lot of big slivers and also gave my knee a good thump. The co-worker supervising my pole-climbing practice said, after I fell, “Get back up the pole, Bugwalk!” Today I would say, “No, I won’t!”, but back then, I followed instructions, and fell maybe four times in a row. There was a worker’s comp claim, and it was determined that PG&E was at fault, and in fact permanently responsible for my knee, though I suspect if I called them up and asked them to pay for physical therapy, it would be an uphill battle.

Usually my knee feels better as soon as I get back to my stretching and strengthening exercises, and this time was no exception. In fact, my knee felt so much better that one day at work, I walked up the stairs from the second floor to my unit, on the tenth floor, with no ill effects. Accordingly, after lunch, I did the same thing again, and by the time I got to the tenth floor, I was in excruciating pain, which refused to budge, no matter how faithfully I did my exercises. The night Tom and I watched the debates, I could hardly walk. One thing that made it noticeably worse was sitting down; every time I stood up again, there was a sharp uptick in pain.

Once in a while, I get extremely dizzy, which I attribute to stress. Toward the end of Clinical Pastoral Education, I had three or four days in a row of dizziness, and the night Tom and I watched the debate, I suddenly got extremely dizzy just before bedtime. During the night, I sat up for some reason or other, and noticed that I still felt awfully dizzy.

At 2:10 a.m., my work pager went off: a dying baby was in need of baptism. I was genuinely afraid I was going to fall while making my way to work and end up in the ED myself, but somehow I got there, painfully folding my knees to get into a cab and painfully extracting myself again at the hospital. It was the worst possible night for the pager to go off: both sitting and standing were problematic.

The baby in question was one day old and had already coded (stopped breathing) at least once. The doctor had explained to his parents that he would not live. I performed the baptism and then I prayed for the baby, saying, in part, something like, “Of course we pray for a miracle, but if we can’t have the miracle we want, we give thanks for this miracle: that this baby is alive and breathing right this minute.”

Later I was kind of slapping my forehead over that: so often clinicians have to temper a family’s hope for a miracle—why on earth did I introduce the idea myself? Also, it was kind of stupid to give thanks for the breath of a baby when that baby was only breathing due to being on a ventilator, and would die once the ventilator was disconnected. However, the parents seemed comforted.

I spoke with the doctor while we waited for other family members to arrive to hold the baby for the first and last time. The doctor said that during his residency, 80 babies a year died. He studied how to help families with bereavement and learned that it’s important for family members to see the efforts to revive a patient who has coded. He talked about how, even if they know a baby will die, they give the baby a couple of days on life support, to give the parents a chance to start to come to terms with saying goodbye.

I asked him what he does to care for his own emotional well-being and he said that he doesn’t need to do this frequently, but now and then, it’s essential for him to go unburden himself to one of his two or three best friends.

Three days later was my next work day. I was sure the electronic health record (EHR) would say that the baby had died at the age of one or two days, but the baby was still alive. I went to visit, and found the baby doing well, with thrilled family members at his bedside. When I told a nurse this story, she cooed at the baby, “You little miracle baby!”

Update: this baby, who was “cold and blue” upon arrival at NICU went home “in good condition” a couple of days ago.

Cornbread Cake

In mid-June, I went to visit my parents and sister and Amy and Ginny in Michigan. I didn’t get to see my uncle because he was at his cottage up north. It was a lovely visit, doing all the things I enjoy doing there: hanging around with my parents, getting caught up with my sister, watching MSNBC (Rachel!), going to Seva with Amy and Café Zola with Ginny.

It was also nice to be with Jack the cat, upon whom my father dotes, worrying over his appetite, shopping for new kinds of food, cooking things Jack might like. I joked to a friend about my father saying, “I have bought these 95 kinds of food for Jack and have tasted them all. I think this one is the best.” That’s an exaggeration, but not by much. I told my friend that my father is an excellent cat father and that he’s like that with people, too. He goes well out of his way to care for those he has identified as being in his flock: Mom, his own children, other relatives, Jack the cat, and another person I have finally concluded is my half-brother, since we in effect share a parent.

During my visit, my father hosted a birthday celebration for me: pizza delivery and cake suitable for the person who avoids sweets. He has approached this problem different ways over the years. This year, he made a cornbread cake, omitting the cup of sugar the recipe calls for. It had buttermilk in it, and was moist and pleasing. As for frosting, he was thinking he would put cream cheese on it, and was wondering what might be added to the cream cheese. I suggested fruit-only preserves. He used strawberry and the result was wonderful—light and delicately sweet.

When my mother said later in the day that she could go for another piece of cake, my father said there should be plenty in the fridge, as he had had to test his recipe by making it more than once, of course.

Back at home and at work, I greeted a patient on a gurney in the hallway who turned out to have likely C. diff. From now on, I will wait until the patient is situated in his or her room and any instructions about precautions have been posted.

I was asked to visit a dying patient whose mother wanted someone to read the Bible to her. When I got to the unit minutes later, her nurse said, sounding shocked, that the patient had just died. When I went into the room, I saw the patient lying on her bed with her eyes wide open, and I got a tingling sensation all over my body. (A similar thing happened once before with someone who had just died: goosebumps on my shins.) I spoke directly to the patient, since the strong energy in the room made it seem she was still there in some sense.

I also visited a patient who has lived in his car since parting from his spouse two years ago. A nurse in the ED wrote in his chart note that patient was “inappropriately focused on needing to move his car.” Worrying about your car being towed is far from inappropriate if your car is also your home, contains all your possessions and is the thing that prevents you from having to sleep on the sidewalk or in a shelter. I swallowed the urge to send the nurse a message to that effect.

Finally, I visited a patient who had left the hospital a month prior with a newly transplanted organ and high hopes. Bad labwork had put him back in the hospital.

I went for a sleep study late in June, after having noticed that my sleep requirement seemed to have gone way up. Long ago, I was diagnosed with mild sleep apnea after a sleep study, and thought maybe it had worsened, accounting for what seemed like undue weariness—needing as many as 13 hours of sleep some nights, with nine hours a night, which I had considered a minimum, now insufficient.

The technician festooned me with wires and said that if I woke up at least 15 times per hour in my first two hours of observed sleep, I would then be set up with a CPAP machine to try out for the rest of the night. He had me try a few different ways of attaching a CPAP to my face, and said that 75 percent of people being studied end up qualifying to try the CPAP. If a CPAP was indeed needed, then I was looking forward to having one and enjoying more restful sleep, but I was hoping I wouldn’t need one—not to have the diagnosis, hassle or expense.

I caught myself waking suddenly from sleep at least three times soon after retiring, so I was sure the technician would be coming along with the CPAP, but he never did. As for improved sleep, that has already occurred, thanks to my new PCP, who, when she ordered the sleep study, also reminded me about proper sleep hygiene: no screens starting two hours before bedtime, taking magnesium in the evening, not lying awake in bed for more than 15 minutes.

I have been faithfully following these instructions, including that I take 500 mg of magnesium glycinate 90 minutes before bedtime. Maybe five or six times, I did get up and read in my dimly lit room until I felt really drowsy, which more than once took hours, and I felt lousy the next day, but now, as a rule, I fall asleep fairly easily and quickly, and sleep much more soundly than before. Nine hours, alas, really isn’t enough, but if I sleep nine hours on work nights and maybe 11 or 12 hours one night a week, and 10 or 10.5 hours the rest of the week, it seems to balance out.

Sufficient Unto the Day Is the Evil Thereof

It ended up taking a week to dry out my apartment. I was left with (and still have at this moment) the various holes in my various walls and removed kitchen ceiling as previously described.

Like, here's my little hallway.



Here’s Hammett with the final dehumidifier.


And Hammett tenderly licking one of the fans.


Early in June, I got an email newsletter from one of the leaders of the street retreat I’ll be going on. He was reflecting on another retreat just concluded, and about how much help the retreatants had gotten from actual homeless people:

Street generosity comes in many forms. A woman in her 70s and who has been sleeping on park benches for decades, like a Bodhisattva walking through the hell realms with joy, quietly lured rats away from our sleeping area with scraps of food she had saved in her handbag.

Rats near the sleeping area?!?

Close on the heels of that alarming transmission, my mentor group met, including a person who had been on that retreat. She joined a few minutes late because she had spent the whole day in the ER dealing with a painful symptom that arose on retreat and lingered afterward. The retreat “did me in,” she confessed.

She also said that she spent too much time preparing, since you don’t need much: the clothes you’re wearing, a plastic bag in case it rains, one dollar. She said she wondered afterward why she had thought there was so much to do beforehand. She also said there was no overlap between what she worried about beforehand and what actually ended up being difficult (i.e., what she should have been worrying about). Encouragingly, she said everyone’s mala was different, so there is no need to fret about making the right kind.

Early in June, I went to the annual palliative care retreat in Marin, a fantastic day of seeing colleagues, meeting new people, eating, making art, singing.

By drawing myself a picture as I walked around my floor of the hospital at my paying job, I finally solved the mystery of why I have to turn 11 corners to go all the way around something that is basically a square.

Several weeks ago there was a half-time job for a palliative care chaplain at the Truly Wonderful Medical Center, where I did my Clinical Pastoral Education. That obviously was my job. I applied for it, and over the next couple of weeks, mulled over the pros and cons of taking that job versus staying where I am. Then I realized I had not been invited for an interview! This was a lesson in acceptance and humility. (I heard soon after that that a CPE peer of mine whose demographics are very different from mine had been invited for an interview. I’m pleased to say that, after about ten seconds, I was able to sincerely wish that he will get the job and that it will be a big success all around.) It was also simplifying: I guess I don’t have to try to decide whether to leave the Very Fantastic Medical Center or not.

And whether or not I have the title of “palliative care chaplain,” I am one. When I walked into the room of one patient, he said, “I was going to call for you! I would like to discuss what happens next, like my burial and so forth, and also what the spiritual meaning of this is.”

I said, “Would you like to discuss those things right now, with your family present, or another time?”

He said, “Right now. Please sit down.”

Once upon a time, I might have been flustered by that. I might not have known what to say or how to approach such a conversation. I might even—worst of all—have tried to install hope in the patient: “Maybe you’re not going to die!”

Another reason that conversation was great, from my point of view, was that the patient’s sister, who is very devout, mentioned a part of the Bible I actually recognized. “Matthew, chapter six,” I said, and we nodded and smiled at each other. That was extremely satisfying. That’s literally the only chapter of the Bible I would be able to recognize. It’s the one that, in the King James version, ends with my favorite line in the entire Bible: “Sufficient unto the day is the evil thereof.” I must have heard that in church when I was a small child and never forgotten it, because I have always known it. It means not to worry about yesterday or tomorrow. The Lord’s Prayer can also be found in that chapter, and the thing about the lilies of the field.

Thursday, June 06, 2019

A Co-Worker with a Demon

Every morning that week, I made myself a beautiful, enormous salad and took it down to the lobby to eat, where it was slightly quieter and lots cooler. It was 95 degrees in my kitchen (yes, I know I mentioned that before) and the food in my cupboard was no longer being stored at the suggested cool temperature. It was all now toasty warm. There were also hoses rigged up to drain water from the dehumidifiers into both my kitchen and my bathroom sink.

While I was eating my salad in the lobby one day, a neighbor from one of the unaffected units came along and listened to the whole story, and then she went up to her apartment and brought back a gift of fish: low-mercury tuna from Vital Choice, and a can of Redtresca (Vital Choice’s name for salmon bellies, which my neighbor said are very tender and particularly high in omega 3s). (She also brought shrimp and mussels, but I don’t partake.)

I suddenly realized that I felt incredibly loved and cared for, which I would not have expected, and I also recognized my immense privilege: something bad happens, and immediately tons of people come to fix it. I know everyone can’t count on that. It also could have been way worse. It could have been sewage instead of fresh water. It could have happened at a time when someone wasn’t here to shut the water to the building off within just a few minutes. And my parents kindly listened to blow-by-blow reporting on the matter via phone, and my neighbor gave me fish.

Going to work one day afforded a much-appreciated break from the heat and noise. One of my co-workers mentioned that our new staff chaplain has a demon. “Oh, dear,” I said, and then realized he was saying “DMin,” also a very impressive thing to have.

Halfway through the week of drying, the water damage people came to open up the walls in my living room, hallway, bathroom and kitchen to dry the insides. Mine was the only apartment where this needed to happen.

I had put Hammett in the walk-in closet, along with his food and litter box, both on sheets of plastic. He seemed happy enough, so I was going to go out to the library. I put a note on the closet door saying DO NOT OPEN, and I put a chair in front of the door. I told the two demo guys that the closet door must not be opened, because my cat was in there and my top priority was that my cat not get out of the closet. Within a few minutes, while I was standing right there, one of them moved the chair aside, and when I said, “Pop quiz: what’s my top priority in this apartment?”, they both looked completely blank, so I changed my mind about going out, and sat in the kitchen while they did the work in the other rooms.

They started in each room by making a cave out of plastic in which to work. While I wrote thank-you cards for the contributions people had made for my street retreat (did I mention I plan to go on a street retreat?), amid the banging and crashing and sounds of debris falling, I could hear them yelling to each other:

“Beautiful!”

“Beautiful!”

And periodically:

“Watch out!”

“I got it!”

Later the boss arrived to see how his workers were doing, and I soon heard him yelling “Beautiful!” as well. In the end, three holes were made in my living room walls, along with a huge expanse of wall and ceiling removed in my front hallway, and a long hole in the bathroom. In the kitchen, fully half of the ceiling was removed. (I was pleased to see that the newly exposed wood appeared sturdy and was even quite nice looking.)

The building manager told me that every single month, for 14 years now, along with his rent check, Tom sends a hand-written card to the building owner: “I hope you are doing well,” or “It’s a sunny day here in the Mission,” or “I went on a fun bike ride to such-and-such place.” I had no idea he did this, and couldn’t believe it. He might literally be the only person on earth who does such a thing. (My own rent is sent from my bank via automatic billpay, and I never give it a thought unless it goes up and I have to adjust the amount. I suspect my bank does not include a hand-written card with each payment.)
 

I have received a lot of contributions for my street retreat, most with nice notes: checks in the mail, cash, an electronic contribution from my friend who wants me to be able to function to some extent in the modern world. One person sent a small, fat brown envelope which had inside, all stuck together with blue tape, a little vial of incense around which was wrapped a letter reflecting on her own street retreat experience, a five-dollar bill, and a small piece of paper on which was written, “The way in is unwinding.” The whole thing brought me joy. I laughed the whole time I was peeling it apart.

My routines were all messed up during this mold-prevention operation, yet another opportunity for reflection. If I can skip stretching for several days in a row, do I need to do it at all? Answer: yes. If I can skip writing down my dreams for several days in a row, do I need to do it at all? Answer: maybe not. My dreams seem to be less interesting than they used to be, and I was only doing it in order to improve my ability to have lucid dreams, but since I started writing down my dreams again, about three months ago, I’ve had literally two lucid seconds that I’m aware of, so I decided to quit writing them down.

Professionals to the Rescue

The building manager tried to get a plumber to come that very night. That was impossible, but one came first thing the next morning and fixed whatever was wrong. Tom, going by the second-hand instructions he received, had removed the wrong cap, and it also turned out that the valve that had recently been installed was defective. (I will mention that I got five hours of sleep on that drippy, nasty, foul-smelling night. I was up until 1:30 a.m. trying to soak up as much water as possible.)

Next to arrive was a cheery young electrician, who removed my three affected light fixtures and temporarily installed bare bulbs dangling from wires.

Close on his heels were the water damage people, three men. I had aimed a fan at the wettest part of my carpet and let it run overnight, but that was laughably inadequate. They came in and used instruments to determine where the water was. By this time, it had made its way into my living room and yellow streaks had appeared on the ceiling and walls nearest the bathroom, and an expanse of plaster was getting ready to fall. I asked if I needed to move my bookshelves and they said: yep. This is a very tiny place, so finding a place to put every single book, CD and every other thing that was on those shelves was a challenge.

Hammett sat calmly in his spot in the walk-in closet through most of this. Then the drying guys got out knives and starting taking up the carpet to see where it was wet underneath, and then they installed industrial-strength fans and dehumidifiers in my place, Tom’s, the building manager’s, and the hallways outside my place and Tom’s. In my place there were six fans altogether and three dehumidifiers. The head drying guy, who was very pleasant and friendly, said the windows had to be closed while these things were running, so as not to introduce humidity when we were trying to get rid of humidity. The dehumidifiers—one each in the living room, bathroom, and kitchen—put out more than a hundred degrees of heat.

In sum, it was extremely hot (95 degrees, where it is usually 71), extremely loud, and rather arid in my place, for an entire week. It was also dark, because I quickly realized that opening the shades meant light came in and made it even hotter. The drying guy said I could turn the stuff in the living room off while I slept, but I wanted this phase to be over as soon as possible, so I left everything running all night, and wore earplugs. Hammett evidently hadn’t gotten the news that cats’ hearing is more sensitive than ours. He was perfectly serene at almost every moment and seemed to positively enjoy being a temporary fan owner. (I learned later that cats can seal up their ears to keep out damaging sound, though not instantly; if you fire a gun near a cat, you might damage its hearing.) I think he liked the heat and the vibrations. He was even seen tenderly licking a fan one day.

The daughter of the building’s owner came and spent the day with us—her insurance person came—and she was incredibly nice about the whole thing. She was calm and cheerful, and said, “Stuff happens.”

Everyone who came in took tons of pictures. The bathroom light fixture was a particular crowd pleaser.




(Click photos to enlarge.)

The Sound of Water

In May, I sent my boss this email:

Hello!

I just had quite a long visit on my unit (transplant) with a patient a nurse referred me to. The patient’s affect was relentlessly flat, and he did not seem to have nurturing relationships in his life, or activities that bring him joy. I know “depression” is a clinical  term beyond my purview, so I just said in my note that he seemed downcast and I noted what I said above. I said to a nurse that I thought maybe he could use a psych evaluation, and the nurse said, “I’ll text his doctor and tell him the chaplain thinks he needs a psych evaluation.”

Nice to be taken so seriously!


My boss wrote back, “Good work, including the word ‘downcast’!”

Tom and I drove a Zipcar to Sacramento to visit Ann on Mother’s Day and to see her new place (and for me to meet her newish dog). We had a lovely lunch in the community’s elegant dining room, and Ann made a stunningly generous contribution to my street retreat.

May 15, 2019, is a day that will long live in (my) memory. The first part of it was routine. I rode my bike to work and kibitzed with my colleagues and saw patients. In the afternoon, we had a meeting at another campus, so I rode my bike over there and discovered that a cage had been installed around the bike racks in the parking garage. I tried my badge and it didn’t seem to unlock the cage door, but the parking attendant told me to pull the door open, and sure enough, it opened.

Our interim director gave us a presentation on patients with mental illness. A couple of us did a role play, trying out what we’d just learned. Then we had a team meeting, and, just when the day would normally have ended, I got a page about an emergency back at my normal campus. I considered whether to ride my bike back over there and then cycle home, or whether to take a cab there and back, and then ride my bike home from where it was currently parked. I don’t mind cycling in the rain (I’m not saying I love it), but strong winds were also forecast, so I decided to take a cab.

I saw the patient and her family (and discovered that we don’t have after-hours priest coverage at the new hospital), and then I called a cab to go back to where my bike was. It took 56 minutes to get a cab—and then it turned out that my badge really, truly didn’t open that cage. I called security and, fortunately, there were a few parking people hanging around that campus. One of them came and opened the bike cage and I rolled home. I got home three and a half hours later than usual.

I did my normal evening stuff. At some point, it dawned on me that I’d been hearing running water for quite some time. I remembered the words of a friend of mine who also once upon a time listened to running water in her apartment building for quite some time and learned from that experience never to ignore this sound. I called Tom, in the apartment above mine, to inquire, and he said that he had flushed his toilet 45 minutes earlier and it had never stopped running. He had just had a new valve installed a few weeks earlier. These are old-fashioned toilets with no tank (but plenty of water pressure, as I was minutes from discovering). He said he would let the building manager know in the morning.

However, the noise was not insignificant, so I said I would text her. She wrote back instantly to tell me to tell Tom to take “the cap” off and try shutting the valve for a minute and re-opening it. I passed this on to Tom and I heard him in his bathroom, and then I heard a grunt of dismay followed by the sound, perhaps, of a wrench falling on the tile floor. “Something has gone wrong,” I thought, and one second later, water began pouring down my bathroom window, and then coming right through the ceiling.

I called the building manager back and at first she said, “Go up there and see if you can help him,” but I said, “Oh, my God. Oh, my God. Oh, my God. There is water pouring down into my bathroom, and hallway, and kitchen,” and she said to go turn the water for the whole building off, and gave us instructions. Her husband helped us.

Tom’s place was engulfed in water, mainly the floor, and my place had water gushing down from the ceiling, and raining through three light fixtures, in the bathroom, by the front door, and in the kitchen. The glass covering for the light fixture in the bathroom, which was pretty large, filled entirely with urine-colored water. (Fortunately, this actually was clean water raining down, not sewage, but the building is ancient, and was getting a thorough interior rinse.) I put a bucket under the light fixture in my front hallway, and it filled completely with pitch-black water.

It was a wet, yucky night, with one towel after the other getting soaked. There was a terrible smell. The water went from my place down into that of the building manager below me, soaking her light fixtures and ceiling and walls, and thenceforth into the basement. (Which we figured might be good: the place is porous. Better than having water sit in one place indefinitely.) The hallway outside Tom’s place got really drenched, and there was water raining down outside my front door, too.

I called my father, and though it was well into the wee hours in Michigan, he kindly listened to my initial report, and several reports after that.

Tuesday, May 21, 2019

It’s Been Seventeen Minutes Since Breakfast—Isn’t It Time for a Snack?

Yep! Work on my thesis for school has begun. Thanks to my faulty memory, I can recall writing only one research paper prior to this one. I probably remember that paper because it was traumatic for everyone involved, including my parents. I nearly dropped out of college over it, or maybe I did drop out of college over it. Who can remember? It was on the causes of homosexuality, a topic of interest to me at the time.

This one is about spiritual care as an essential aspect of palliative care, a topic of interest to me now. You don’t have to read it
—if you read this blog, you are reading it. It’s not a research paper per se, but an ethnography, largely based on my experiences at County Hospital and at my paying job. However, there will also be academic sections drawn from pertinent papers and books.

Fortunately, I happened to encounter one of the students from the cohort prior to mine on the plane when I went to school in March, and she mentioned that she had used Word’s template for an APA style paper for her thesis (File—New from Template—APA Style Paper). This has already made my life a lot easier, and is going to save me a zillion hours.

I am allocating one day a week to work on this. The first day, I found myself immediately stuck trying to write the abstract, but then I found something online that said to write the abstract last, not first. I decided to just start writing up the notes I have taken, a task about which I feel confident, and by the end of the day, I had 13 pages out of 60 (excluding reference list and appendices) written. By chance, I had a telephone meeting with my mentor that day, our second in a year. She applauded my going ahead with what seemed obvious to do, and she advised me not to let myself feel stuck for too long—I can get help from her, or my mentor group, or the wonderful woman who is in charge of helping my entire cohort with our papers.

On my second day of working on my paper, I decided to make at least one citation and corresponding entry in the references list, and I compiled information on citing books, articles, websites, and personal communications. Some of these people who write about this stuff online are quite droll.

I did succeed in making one citation and matching reference, and then I got back to doing the fun part. At the end of the day, I had 30 pages written, which meant it was going extremely well or that I was doing something extremely wrong.

Eating the Schedule

I’ve been thinking it would be nice to have a polished piece of turquoise to carry around in my pocket to remind me of Santa Fe and school; I’d like to buy it there, but so far I haven’t come upon such a thing. Someone suggested a certain store, but someone else said to first visit the Native Americans who sit at the edge of the Plaza to sell various wares. I had a bit of extra time on my way back to the airport—this was the Tuesday after Easter—so I walked over there. A vendor told me that the Santo Domingos sell loose stones, but that they weren’t there because they were still dancing for Easter.

My shuttle driver was one I’d had before, and he is one of my favorites because he doesn’t tailgate. I told him about how all of his colleagues tailgate and about how he is the rare exception. I said none of them seem to have heard the thing about allowing one car length per 10 miles of speed. He said no one does that—that if you leave enough space for a car to squeeze in between you and the vehicle ahead of you, you can be sure someone will do it. (I guess that’s bad.) He said leaving a courteous amount of space causes you to be seen as weak.

He told me that ABQ is second-windiest major airport in the whole country to fly into or out of, because of the wind over the mountains and the Rio Grande; he said Denver is the windiest. As we drove along I-25, we could see clouds to the left and right, almost as if we were on a plane, because of the altitude.

During sesshin, one of our teachers talked about how oryoki helps us to treat everything with care: the cup, the doorknob, the book. I found myself doing this once I returned home, and noticed how pleasing it is compared with rushing around doing things carelessly.

Back at work, I found myself consciously asking myself, “What else is here?” and noticing more about people: their posture, their facial expressions, what they were doing with their hands.

It had gotten to be a bad habit of mine to sit in front of the computer in the morning for an unduly long time before going off to see patients, which has often made me feel guilty. After returning home, I decided to “eat the schedule,” as they say in Zen: to do what absolutely needed to be done on the computer, and then get going to my units. (To eat the schedule is to follow it precisely. I don’t have a precise schedule to follow at work, but if I did, nowhere on it would it say to goldbrick for 90 minutes in the morning.) So far I have found that, instead of being exhausted, applying energy seems to generate more energy. It feels good to know I’m doing what I’m supposed to be doing, and to be able to report at the end of the day that I saw 17 patients instead of seven.

Another thing I changed was to start sorting my patient list by length of hospitalization rather than room number, which leads to much more walking around the unit, which I think is good. I start with the people who have been there longest.

One morning, Hammett inspected his breakfast briefly and walked away lowing mournfully to himself. I think he was thinking, “I can’t believe that person gave me cat food to eat.”

At County Hospital in palliative care rounds, the current fellow (physician) talked about hoping family members could “entertain some preparedness around the end,” which I thought was a nice way of putting it. We discussed an Asian family where all the children except the oldest were at peace with not pursuing aggressive treatment for their parent; someone in our meeting said there may be a cultural expectation that the oldest son in an Asian family will make sure all treatment options are tried. It was also mentioned that if a patient is on chronic opioids for pain management, that may cause him or her not to be considered for an organ transplant, though this may be an arbitrary criterion, and maybe not fair.