Friday, December 30, 2016

Hard at “Work”

At the morning meeting, the staff chaplain who had been so kind the night before said I always seem to end up in some extreme situation when I’m on call at that campus, and he said, “You’re doing good work here.” He said that in front of the director of the spiritual care department, which I hope made up for my encounter with the latter an hour or so later, when he found me sitting serenely in the cafeteria after breakfasting on three pieces of quiche that were utterly delicious but very tiny, like hockey pucks. Pleasantly full of butter, eggs and bacon, and long after I had presumably gotten on the shuttle, I was reading The New Yorker and drinking green tea when his unmistakable voice came from behind me: “Chaplain.” I felt a bit embarrassed, though he didn’t seem upset.

I departed with alacrity and arrived back at my usual campus wondering if I’m just too lazy to be a chaplain (or anything else). Sitting in my corporate cube and feeling dissatisfied with what seemed like meaningless work, I more than once concluded that the best way I could contribute to a non-profit would be to refrain from “working” there.

I went to take the on-call pagers from the person who had been holding them until I arrived, and he asked if I wanted to have lunch with him. I was quite full, but did go sit down with him and did actually listen to him in my best chaplain manner, and, after all, it’s the holidays. We have been trained that providing care to one staff member translates to better care for ten patients; maybe caring for one chaplain translates to better care for ten staff members. My peer mentioned that he had seen one of the patients on my floor, discerned her problem, and recommended such-and-such course of action, certainly something that sounded wise and that I might tell myself in that situation. (That having a horrible medical problem means we must learn to live in a world that is new to us, and that being vulnerable gives us the best chance of connecting with others.)

I made my way to that unit, where they had pizza! I really ought not to have but I did, while sitting in a wonderful massage chair someone had lately given the department as a gift. Then I went to see the patient my peer had mentioned (he thought she could use more support), but our visit was cut short by the arrival of a care team member she needed to talk to, so I went to see another patient that two different nurses had asked me to visit that day. They said she was crying and crying. On my previous visit, she had complained nonstop, and I had been shocked to discover that she is only five years older than I am. I had genuinely thought she was 25 years my senior, and resolved never to complain again.

During our second visit, I sat down and just listened to her, and tuned in to my own heart center, and didn’t concern myself with whether all aspects of her tale were true or not. If they are not literally true, they are metaphorically or symbolically true, and have just as much impact, as far as I’m concerned. I felt quite relaxed and rather sleepy after all that quiche and pizza. I let my eyes close a time or two, and told the patient, “If I’m asleep when dinner comes, wake me up.”

I spent an hour and 25 minutes with her, by which time it was clear to me that her deepest desire is to feel loved, and that she does actually have faith in God. Voila! I marvel at my fellows who can march into someone’s room, immediately figure out what the problem is and dispense a solution, but I can’t do that and am also strongly philosophically opposed to it, even as I am sure that that approach brings wonderful benefits to many.

Fortunately, there are many ways to be a chaplain, including my ultra-time-consuming method. Toward the end of this visit, the patient showed me her childhood rosary, which she said she rarely shows anyone, and I was able to offer a prayer that I think was spot-on: for the patient to feel God’s love, and for God to show the patient how she can offer love and care to herself. The patient asked me to come back the next day, and was sad when I said I would be off for the next four days. Before the visit was over, she almost but not quite smiled.

All Gone

On Christmas Eve, Tom picked me up after work and we drove (in a car lent to us by a colleague of his) to Sacramento to spend the evening with Ann (Tom’s mother), Steve, Julie, Julie’s mother (Diane), and Ann’s two dogs. Tom and I slept over at Ann’s, and we all went to Paul and Eva’s the next day for stockings, refreshments, and to admire the Christmas tree. Present were the aforementioned, plus Paul, Eva, Dan, Sarah, Chris, Kristin, Chris and Kristin’s baby (Rowan), and Kristin’s mother and father, Jim and Denise. Late in the afternoon, we went to have Christmas dinner at the home of Steve and Julie’s next-door neighbor, Robin. Her two best friends were there, plus Ann, Steve, Julie, Diane, Tom and me.

I was able to go to Howie’s Tuesday night this week because I was scheduled to be on call on Wednesday afternoon. I knew Howie wouldn’t be there; he’s always away between Christmas and New Year’s. Attendance was generally light. Some people were probably away on their own holiday travels, and there are a lot of people who don’t come if Howie isn’t there, but my walking friend was there, with a couple who are longtime friends of his. He introduced the man as a chaplain, and at first I thought he was kidding, but the friend really is a jail/prison chaplain. He said he’s not sure what he offers, but he knows for sure what he receives. He said he learns something every day, and is frequently touched by those he encounters.

I told him that when I finish my two years of education, I will be 57—is that too late for a career change? He said, “If that’s the path you’re on, it will work out.” A chaplain intervention, just at the exact moment needed.

On Wednesday evening, I was on call at the other campus and feeling rather gloomy about F. We have been breaking up for nearly an entire year. As Todd Rundgren sings, “Grains of sand one by one—before you know it, all gone.” F. lately sent me such a rude text message that it may have represented our final ten grains of sand, all that was left of what once seemed like a whole beach. In any event, there has been no communication since then on the part of either party.

I mentioned to one of the staff chaplains that my romantic relationship had ended. This was the same person who complimented my gift for public prayer, so I like him very much. He put his hand over his heart and looked sad for me. I also ran my question by him about whether I’m too old to be embarking on professional chaplaincy. He said he started at approximately the same age, after a career as a social worker. He said many of the working chaplains he knows tend to have more life experience.

Soon I got a call from a nurse on behalf of a patient whose dog had died. She called back and said the patient had been given Ativan, so all was well at the moment, “but we can just call you whenever, right?” I know that some hospital personnel think there are three shifts of chaplains, in which case it would be perfectly appropriate to call at any hour for any reason. But this is not the case. I told her that when we’re on call, we work for 24 hours straight: we work during the day and we hope to rest as much as possible during the night. “Oh, I understand!” she said. I will say that I would not have said this had my supervisor been within earshot, though my peers supported my approach when I told them about it the next morning. I told the nurse that, having said that, if the patient was really freaking out during the night, or panicking, they should definitely call me, and I added that I sympathize with how painful it is to lose a pet.

I did my rounding, visited a patient I always visit when I’m at that campus, went to sleep, and was awakened at 5:30 a.m. by a call about a baby whose death seemed imminent. I was in the room when the doctor arrived and told the parents that the baby was telling us goodbye. He suggested that most of the medical equipment be removed so that the parents could hold their baby in their arms and change its diaper if they wanted, and when they were ready, the final piece of life support would be turned off. The doctor said that continuing to pump oxygen into the baby is damaging its lungs, but the parents shook their heads and said they wanted treatment to continue. This baby has been in the ICU for more than six months, and I learned later that the parents feel they are on the opposite team from the care providers, which must be really terrible—not to be able to trust your very ill child’s doctors and nurses, and to feel they are giving up too soon or even failing to value the life of your child.


A couple of Saturday nights ago, a relatively young man died in the emergency room. His family visited not all together, but sequentially. First his brother came and was extremely upset for half an hour, and then his father came and wailed loudly for about the same length of time, and finally another brother came and talked to me nonstop for 90 minutes or so on a wide range of topics, including some horrendous family incidents. I was exhausted after that.

I had kind of a strange visit with a patient a couple of day before Christmas, and did something I felt bad about later. I was on call and trying to juggle multiple tasks, and tried to fit in a visit with this patient, even though I could hear she was on the phone. “How long are you here?”, she asked, and something about her tone raised my hackles a bit. I wasn't sure how to answer, because I was scheduled to be there all night, but would just as soon not make appointments for 2 a.m. I told her I had to go provide a blessing for someone who had died and would try her back afterward. In retrospect, I see that I was slightly stressed by own attempt to fit too many things into the same set of minutes, and that I felt a little threatened by her question, which is to say that I was subtly rebuking her by mentioning the fact of death. She looked taken aback, and I felt ashamed of myself. Before I left the room, she asked what religion I am, and by the time I returned, she was ready to try to convert me to hers, and gave it a good solid effort.

I said, “My beliefs are different, but I’m glad you have a robust faith you can rely on.” Five minutes later she tried again, and I gave the same response. A few minutes later, not at all abashed, she again explained why her religion is particularly amazing. She had quite a determined manner; maybe that’s what pushed my buttons in our first brief conversation. This patient complained several days later to a peer of mine that she had been visited by no fewer than three Buddhist chaplains, and she declined to have one of us who identifies as Catholic and Buddhist pray for her, because she doesn’t understand how someone could be both.

The night of my first visit with her, I was called to provide a blessing for a second person who had died. At this man’s beside was his daughter, accompanied by a friend.

I asked, “Can you tell me a bit about your father?”

“My father? He was funny. He was a deacon in the church.”

“Is your mother living?”

“This is my mother.” Namely the person lying dead on the bed in front of me. Very big oops. From now on, I will consult the chart of the deceased party beforehand for key details such as gender.
As that evening passed, I noticed that I had once again fallen into being “nice” and ignoring the emotion that was actually present for me, which was sorrow. I’ve been rereading Charles W. Taylor’s The Skilled Pastor, in which he says it is the relationship that heals, and it is the skillful, attuned conducting of a conversation that builds a relationship. I’ve been against having any particular agenda from the beginning of clinical pastoral education and when I have proceeded in accord with some sort of plan, such as using the assessment model we have been taught, it has frequently felt strained and artificial.

With The Skilled Pastor in mind, lately I have again let go of any agenda, which initially led to several conversations that were extremely long and pretty much purely social in nature. One patient said happily, “Rarely do I get the chance to tell someone my whole life story! Let’s see, I was born ... ” And I could not figure out how to get out of that room; a tremendous inertia set in and I sat there for an hour. She seemed happy when we parted, but that obviously is not a fruitful way to proceed, and once again, I found myself wondering if I have any aptitude at all for what I’m actually supposed to be doing, or any interest in doing it, and then I began to worry about my financial future—if I’m not going to be this, what am I going to be?—which took me that much farther from my own true emotional experience.

I made an effort to get in touch with my own emotions, and an interesting thing happened in the next couple of visits: I was conscious of my own feelings, and of the physical sensations in the area of my chest, and both of the people I was speaking with cried.

One of our perks is several free sessions with a counselor, so I have gone twice to see a young lady therapist at student health services, and spent most of both sessions talking about F. In our second session, she said, “Let’s pause for a moment and think about how best to use this time. I wonder if you’d like to try getting in touch with any emotions that are present.”

Normally I would disavow having any—at least, that’s what I do when my own mental health professional tries this—but I know that a lot of what they try to teach you in CPE is awareness of your own emotions, and since I want to get all I can out of this experience, I said “Sure” and was amazed to find myself completely in tears. It was a relief to cry in the presence of a calm, kind person. I guess it was my own willingness to feel my feelings and something about A.’s presence that made that happen. So if there is a manner in which I can be present that allows patients to cry, I think that’s a good thing. Maybe being in touch with my own feelings while speaking with others is a crafty way of turning social visits into something more healing, and one I can feel entirely good about, unlike asking questions per some assessment model.

Saturday, December 17, 2016

Pretty Much Everything

Last week as I entered a room, I overheard the patient saying to someone on his cell phone, “I have to talk to the chaplain.”

I said to him, “You don't have to talk to the chaplain.”

“I get to talk to the chaplain,” he amended, and then, “I have assented to speaking with the chaplain.” It turned out he himself was a pastor and knew all about hospital chaplains and CPE students.

I went back to see the patient who had wanted the bravery infusion, which turned out to come via horses. In our first conversation, it was established that we are both atheists. As for what happens after death, she thinks nothing does, and I said I think the same, “but who knows?”

“Who knows?” she repeated, incredulous. “I know. I know: nothing happens!”

When I saw her this past week, after her surgery, nearly her first words were a semi-mocking, “But who knows?”

“Oh, dear,” I said. “I’m sorry I gave you something to stew over for these few days.”

“Few days?” she grumbled. “Probably forever!”

In defense of my position—which I made clear I was not trying to convert her to—I said that no one who has ever died has been able to report on his or her post-life experience, and I described hearing Jack Kornfield say something like, “When I was younger, I didn’t believe in this, that and the other. Now that I’m older, I believe in pretty much everything.”

“Now, there’s a person with no convictions,” said my patient.

We went on to discuss agnostics, whom this patient finds “wishy-washy.” She said she was afraid I might be one of them. I said I am not, and that I hadn’t meant to worry her.

She said, “Agnostics in general worry me.”

At the end of our conversation, she asked if I also work at the rehab where she’ll be going and if I ever stay friends with patients I’ve visited. This is an issue I worked through in my first unit of clinical pastoral education, when I did want to visit one of my patients after she went from the hospital to assisted living. I had visited her about 15 times and had come to be very fond of her. Samantha and I discussed this and she pointed out that, for one thing, the patient had not asked that I visit her. In addition, this might keep her from developing a good support system in her new home. Finally, would I really be able to follow through with regular visits? What if I met another patient I wanted to be friends with, and another and another? Samantha said that if it was meant to be, it would be—I would run into the patient on the street and we’d strike up a conversation.

After I told my patient last week that our relationship could not continue after she left the hospital, she cried. I was touched by that, though it is also true that people are often emotionally labile after surgery.

There were two holiday parties at work last week. At the first one, I ate eighteen small croissants, give or take; the secret is to repeatedly go get three more. The next day was our division party, with about 50 attendees, held in a building that is precariously perched on a very steep hillside and held up with long steel beams. The stairs up to the room at the tippy top where the party was held are on the outer edge of the building and overlook a very significant drop to the ground. It reminded me strongly of one flavor of bad dream I have, of going up stairs that become more and more treacherous. I learned later that one of my peers refused to take this route and insisted on an inside passage, which she said was circuitous.

The party was nice. An abundance of Mexican food was served, and each guest was given a small evergreen tree in a silver or red metal pot. Each department shared heartwarming stories of patient encounters. On our way back, in an elevator, a woman I didn’t know and who hadn’t been at the party admired our little trees, so I gave her mine, since I lack a yard and also have a brown thumb. She asked my name and said, “I’ll call it the Bugwalk Tree.”

I’m glad that was the last party for now, because while my stomach always has additional capacity, my garments no longer did.

Sunday, December 11, 2016

Horses, Of Course

I went back to see my dying patient this past Friday. He is being given morphine, but not enough to make him completely free of pain, which might also finish him off on the spot. On Tuesday, I spoke to a relative of his who was planning to visit on Friday from another state. Everyone thought that would be too late, but lo and behold, the patient was still alive that afternoon. The relative had hoped to converse with the patient, but for that it was indeed far too late. I never heard the patient speak a single word myself.

When I first saw the relative on Friday afternoon, he said he wanted the patient to get all appropriate treatment, but then the doctor came and explained gently but directly that the patient was passing away and that he was in pain, and they agreed that the focus would be on symptom relief and comfort. It’s the first time I’ve been present for such a discussion and was impressed at how the doctor, a Muslim woman in a headscarf, handled it.

I spent some time listening to what was on the relative’s mind and felt I was able to be of some real service there. He also arrived at his mother’s deathbed too late to talk to her, which he mentioned a couple of times. I could see that it was painful for him to have this happen again and that he was shocked at his relative’s appearance, which had become downright beautiful to me after the first half-hour of sitting at the bedside
a source of pleasure I would never have anticipated. I asked the relative to tell me a bit about the patient and learned what work he had done and what country he was born in.

On Friday I had lunch with one of my peers, which was enjoyable, and I saw another patient I’ve seen several times lately, a tough-talking atheist who is near 80 but looks quite a bit younger. She was headed to surgery and said that when she had spoken with her doctor that morning, she had gotten the impression that her chance of surviving the surgery was only 50 percent, which frightened her. She asked if she could end up in a wheelchair and her doctor said he didn’t expect that, but “anything is possible.”

She told me she needed a “bravery infusion.” I launched into a guided meditation, but she said, “No, no, no. I already have a script for lowering stress. I don’t need another script.” Oops. I should have asked if she wanted to do a meditation. So then I said, “You are in an ocean of bravery—clear, sparkling, refreshing bravery all around you.” But that was not helpful, either, and again, I should have asked what she had in mind. For all I know, her worst fear is of death by drowning. Oops again.

It turned out that what she had in mind was horses. The thought of horses around her makes her feel brave—imagining the sound of their hooves clip-clopping along beside her. So we discussed that, and she at first looked calmer and then suddenly burst into tears and said, “I’m scared! I don’t want to die! I have so much more I want to do.” I held her hand, and it ended up feeling like a very meaningful visit, as well as a good learning experience for me. I told her I would look for her after her surgery, and was able to find her later in post-op, which fortunately is also my area. She was still asleep, but I bent over and said to her, “Hello, [patient’s name]. This is Bugwalk. I’m here, and I’m pleased to report that you are one hundred percent alive! I will see you on Monday.”

Tom has had a cold this week and asked for my help making a trip to the grocery store today. Shortly before we were going to leave, he called and said he’d run into problems reserving a City CarShare car. He came down to my place, and sure enough, this now requires the use of Facebook. We are not on Facebook and have no plans to be on Facebook. Annoying. I sent them a polite note asking them to cancel our account and to return my refundable deposit of $300. Hoping that goes smoothly but won’t be surprised if it doesn’t. Fortunately, neither of us has been using the service much lately. I liked to drive one of their cars to visit Carol Joy, but can’t really justify the expense now. Fortunately, there is a bus I can take.

I have taken a 60 percent pay cut—well, actually, I got a 40 percent pay raise, combining my severance pay with the stipend I get from TWMC. But I have been saving every penny of the former, which will stop at the end of January, and then it will be a 60 percent pay cut, which at first seemed dismal and very not fun. But now I’m enjoying the challenge of living on my new income, and am even saving a token amount, just $100 each month, to adhere to the principle of living within my means.

It mainly has meant not taking cabs and not buying books, both of which are easy enough not to do. I’m taking Muni a lot more. I’ll be taking the bus to see Carol Joy from now on. It means really considering if I need something, and buying way less packaged stuff at Rainbow, where my typical weekly expenditure has gone from $175 to $75. They offer discounts in some departments if you spend a certain amount, so I’m planning ahead in order to take advantage of those. On the other hand, visiting my parents, going on meditation retreats and having bodywork twice a month are essential, so I am budgeting for those and doing without other things.

I now see that I can live on much less money than I would have thought—medical and housing crises aside—and I am now planning to do whatever I need to do to work as a chaplain or in some related area. For instance, I could see myself being a part-time chaplain and a part-time bereavement counselor. We shall see. I have a very strong sense of being carried along, of floating atop a powerful current.

One-Woman NODA

When I got back to work after visiting Michigan, I was kind of slow to get back into seeing patients. I cheated, sort of, by spending hours with an elderly man who was expected to die soon, sort of a one-chaplain no-one-dies-alone effort. I sat by the patient’s bedside for hours over the course of a few days, speaking and singing softly to him in Spanish. I told him, “I’m here; you are not alone” and “Everything is all right.” He seemed to get more agitated when I said that God loves him, though he is listed as Catholic, so I stopped saying that. When he writhed around and yelled, at first weakly and later producing no sound at all, I sympathized: “This is difficult.”

Eventually, I had to get back to my assigned duties—the dying patient isn’t even on one of my units; I must have first encountered him while on call—and found myself in distress with a patient who has had several surgeries. I felt boiling hot and weak and my stomach felt weird. I felt like I needed to sit down even though I was already siting down, and I thought, “I can't do this” and further that I probably can’t be a chaplain at all if I can’t listen to disturbing medical stories. Right?

Au contraire! It turns out that others in my group have the exact same response; one even said she doesn
’t like to hear about or see medical stuff.

The person who is on call in the evening runs the morning meeting the next day, at which we go over who is on call at which campus, who is leading the noon mindfulness session and which priest is on duty, etc. Afterward, this person sends an email to everyone with all of that information, and sometimes takes the opportunity to prepend his or her own message, as I did the morning after the election. (Speaking of that, faithless electors! Or maybe Twitter will cancel Trump’s account per its anti-bullying policies.) The on-call chaplain was evidently in an exuberant mood one morning last week. Her email started, “We’re ALIVE!”

Poop Dollops

While I was charting patient visits one afternoon a few weeks ago, a nurse came into the computer room and announced that there were “dollops of poop on the hall floor.”

“Poop dollops?” another nurse asked politely.

After I finished my charting, I saw a series of emails saying that the following week would be chart review, and since some of us would be out, our peers would need to do our work in addition to their own. One of the people who was going to be out asked if she could try to finish hers before going away, and the supervisors said that would be fine, but that others who would be away shouldn’t feel obligated to do the same.

However, now that I knew my colleagues would have an extra load because of my absence, and with just a couple of hours left to go in the day, I decided to try to complete mine, too, and was able to see all but two of my patients. One had not been in the hospital for 24 hours yet, so I didn’t need to see him, and the other reduced my score to 98 percent, which was all right.

To accomplish this, I had to briefly interrupt two visits patients were having with their physical therapists, and even a doctor visit, which I normally would never do. One of the PTs was a bit abrupt, which I could fully understand. Luckily, I saw her at the end of the day and apologized, and she was very nice about it; she also apologized. I explained that we have this crunch regarding metrics once a month and described how I rush from room to room on those days, thinking, “I hope you don’t have anything on your mind because I don’t have time to hear about it.” I told her it feels terrible; fortunately, it’s only once a month. Afterward I wondered if I’d sounded callous, but I think she and the other couple of PTs in the room understood.

I’m thinking more and more lately about chaplaincy as my explicit spiritual practice. It’s not in line with my meditation practice or in the spirit of my practice—it is my practice, moment by moment. I remember many times being on a meditation retreat, sitting with physical pain that was sometimes excruciating. Over time, I learned some techniques for being with pain (the most helpful comes from Somatic Experiencing), but mainly I learned how to relax, and eventually made the joyful discovery that my mind could be perfectly happy even when my body was exactly the reverse. These days being on retreat is easy. What’s sometimes very difficult is listening to people describe their medical experiences, which is, understandably, a favorite topic of those in the hospital.

The day after Thanksgiving (because I was on call on the holiday itself), I went to Michigan to see my parents and sister. We had our festive meal on Sunday: roasted chicken (perfectly tender but with a crispy skin), Mama Stamberg’s cranberry relish (which does have a kick), two kinds of homemade biscuits, two kinds of gravy, stuffing, sparkling water, no dessert. It was very nice of my family to have Thanksgiving on the wrong day. I also had lunch with Ginny at Café Zola (salmon burger!) and with Amy at Seva. It was wonderful to see everyone.
I watched a lot of cable news, mostly MSNBC, some CNN, and even some Fox News. I was interested to see what the latter was saying about current events, and was both pleasantly and unpleasantly surprised.

Monday, November 21, 2016

Gossiping Neighbor Causes Virulent Goodwill

I visited a patient who has dinner every single night (when she’s not in the hospital) with a group of women neighbors who have all lost their husbands. Each night, one of them cooks dinner and has the others over and does all the cleaning up, so that the others don’t have to do anything whatsoever. They enjoy each other’s company, and the next night, it’s someone else’s turn.

She said that when she lived in the house before the one she lives in now, her neighbors didn’t like each other, so she went around and said, fibbing, to each neighbor, “That person said something good about you,” and soon everyone liked each other. I was dazzled by her kind intentions and her community-building skills. I told her, “I don’t know if you feel better, but I certainly do.”

I also visited a patient who has demons in various parts of her body, which appears to be a very disagreeable experience. This was at the psychiatric institute. When I’m on call on a Sunday, which seems to be quite often, I typically get paged to go see a list of four or five psychiatric patients. I picture one patient saying, “I want to see the chaplain,” and every other patient within earshot saying, “Me, too! I want to see the chaplain, too!”

I’ve sometimes had a bad attitude about this phenomenon, which does not occur with medical patients, because they are one to a room in most cases. I feel grumpy about what could have been one visit turning into four visits (meaning that a proper lunch break is that much more elusive), and I have found myself thinking, “What’s the point? It’s not like I’m going to be able to do anything for them.” But then I realized it’s not like I can do anything for anyone else, either! (Picture a smiley face here.) Probably all I offer most patients is nothing more than a friendly presence and the willingness to listen, and I can offer the exact same to psychiatric patients.

Nonetheless, on call yesterday, when I got a request to go see four psychiatric patients, I felt resistant at first—again?!—but what could I do? I tromped over there and found that the first person didn’t want to get out of bed. One down! The second person was the one with demons, and we had quite a long and interesting talk. At the end, I offered to pray for the spirit of Jesus to be with her, but she asked what denomination I am, and when I told her I’m Buddhist, she said we’d better skip that, because messing around with Buddhism in the past has caused her to have hallucinations. She encouraged me to think about accepting Jesus Christ as my savior. I thanked her for the advice, saying, “You never know what will happen.”

Then a thought suddenly came to her: “How old are you?” I told her I’m 54, and her face lit up, and she said, “I knew it! I had a feeling you were younger than me. That means you’re my little sister and I’m your big sister and I have to take care of you!”

The next patient proved to be very endearing, and the last of the four was facing her first holidays after the death of a beloved parent. She said she felt better just being able to talk about her parent and her feelings. Instead of it being some sort of chore to make these visits, I left feeling rather joyful.

Two A.M. Code Blue

A week ago Saturday I was woken up during the night for the first time while on call at the hospital; there was a Code Blue at 2 a.m. These can take up to two hours to be resolved, but this one took only about 30 minutes, so that was lucky for me and presumably for the patient. That was maybe my eighth or ninth on-call shift. I remember telling a fellow student after my second on-call shift that I hadn’t been woken up during either night. “Get out!”, he shrieked, reflecting that this was unheard of. I apparently am the luckiest person in the entire universe to go so long without being paged in the wee hours. On call a couple of days ago, I received a Code Blue page at about 3:30 a.m., but when I arrived at the ICU, it had been canceled. I was back in the sleeping room 14 minutes after the pager had first gone off.

One of my peers has a patient who has a horrible wound that has refused to heal. He has explained her situation as one of being held together with Saran Wrap. There are instructions in her room saying not to try to turn her on her side, for fear the wound will rip open even farther. He also warned us lately that she is starting to decompose and that the smell is not good. This made me a little reluctant to visit, but I found that the smell was not at all overpowering; plus, the nurses continually have peppermint oil on a piece of gauze in the room, which makes a big difference, though now the smell of peppermint anywhere can bring to mind a rotting human being. In general, I’m noticing other wisps of scent here and there outside the hospital that strongly recall unpleasant scents inside the hospital.

This patient has been in the hospital for months and in the ICU for weeks, and apparently her family has refused to let her be transitioned to comfort care. My peer said it’s one of the worst situations of human suffering he’s ever seen. When I first began visiting her, letting her go seemed like the only decent thing to do, but then she began to communicate by writing on a piece of paper, making steady eye contact and smiling, and then I felt the opposite way, that it should be out of the question to stop curative treatment. How can you do that to someone who is obviously fully alive? Not to mention that the patient had not expressed the wish to die.

I have been somewhat dismayed to learn that, ultimately, this is at the care team’s discretion. You can fill out an advance directive saying you want every last thing done forever, but if your doctors determine that you are never ever going to recover, they can decide not to make further interventions and transition you to comfort care. However, I think that many doctors want to follow the wishes of patients and their families, and also don’t want to fail, which is how they may see death, and we all know that they do very often provide treatment they know will be futile.

I have visited this patient several times. A week or so ago, smiling, she wrote to me, “Glad you came.” She wanted to hear “Jesus story.” What I’m able to share about that is pretty limited, but she was able to communicate what reading from the Bible she would like to hear, so I read that aloud. Later in the visit, she wrote, “I dying never never go home again.” I asked, “Is that what you believe is happening?” She nodded. As gently as I could, I said something like, “I believe you are right about that.” Then I asked, “Are you at peace with that?” She moved her hands as if to say, “Sort of.” “Is your husband at peace with that?” She shook her head no. I asked if she felt worried, and she again shook her head no.

Somewhere along in here, I learned that her family did not want her to know of her poor prognosis! That seems like a pretty big decision to make for another human being, especially one who still has some means of communicating with others.

The day she wrote that note about never going home again, I carefully charted everything she had expressed, along with the particular Bible passage she had wanted to hear; I wrote the latter on a piece of paper that I left in her room, for good measure. In the few days after that, her family finally agreed to a do-not-resuscitate order. She has been declining very rapidly since then, judging by her appearance. I went three or four days in a row to see her and found her asleep every time. Nearly every one of my peers has visited this patient, she has been in the hospital so long. I have treasured those moments when I can strongly feel our human connection, and I think we will all feel a pang after she is gone.


On the Friday after the election, I had dinner with a friend who said she was feeling afraid and that she’s considering going back to using her maiden name, which sounds like a name that would belong to a European American. Her married name belongs to her husband, who is dead and whom she is still actively mourning. To think of her feeling forced to abandon his name made me feel very sad. This is someone who was born in this country and has lived all her life here. She talked about feeling anguished for one of her university students, a Latina who left class in tears. After dinner, we were going to go to La Boheme for tea, but I decided to invite her to my place instead. I’m not really set up for entertaining and rarely have anyone over, but it seemed like a good moment to make a gesture of drawing closer.

In the ensuing days, I found myself feeling anxious, partly due to Trump’s giving the Breitbart guy a fancy job and partly due to reading about Paul Ryan being on track to get rid of Medicare. On one of those worried days, I made my next mammogram appointment. Will it be so easy next year? I also had to do my annual benefits enrollment, since I will continue on my ex-company’s payroll until the end of January, and felt a pang when I saw my former salary. My situation is more precarious now. I am lucky to live in California, where we have a robust state health insurance exchange.

I also felt briefly enraged at Kellyanne Conway for saying it’s up to Obama and Hillary Clinton to get people to stop protesting against Trump. Obama and Clinton aren’t the ones who have gone around for months spewing hateful rhetoric. It’s up to Trump to signal that no one need be afraid of him, and not only is he not doing that, so far he’s making it clear that people are very right to be worried. We now have young people committing suicide out of fear that they or their family members will be deported.

I can’t wrap my head around women voting for a person who brags about grabbing women by the genitals. I have no doubt that he did that, that every woman who has accused Trump of assault is telling the simple truth, and that there are probably dozens more such women. I can’t understand Latin Americans voting for someone who has characterized their people as rapists. 

At the same time, I feel sad for those who truly believe Trump is going to bring their coal or steel jobs back—who for some reason think that a billionaire who, as far as anyone can tell, has never lifted a finger to assist anyone outside his own family, is going to make everything all right for them again. Even if he were willing to expend effort to do this, it can’t be done. It’s beyond Trump’s power to make it 1955 again, where everyone in the neighborhood and at work is white and where a blue-collar job is sufficient to support of a family of four, where men are in charge and women stay home and cook and keep their mouths shut.

The Trance of Thought

To follow up on my last post, my peer said she would indeed like to talk. We did that and easily worked everything out. I have also been thinking about what I wrote, in rather harsh (to myself) terms, about often feeling angry with or judgmental of others. Clinical pastoral education affords much opportunity to examine personal and interpersonal dynamics, and one thing that is coming nicely into focus is the automaticity of my negative first response to many things. It’s not unusual for me to dislike people in the first three seconds of knowing them (though this actually does seem to have shifted quite a bit; maybe this is more a historical observation), and many sensory inputs initially strike me as unfavorable. I think this tendency is probably hard-wired and I have probably spent way too much energy trying to change it.

However, there is a huge opportunity in all the seconds that come after the first three seconds. It’s in those seconds that I reiterate and re-reiterate to myself my first opinion and think of the things I’ll say / write / post in sharing that opinion, but also in those ensuing seconds that I have the opportunity to notice the initial, automatic thought as just a thought and not spin endless yarns about the matter to myself and perhaps others. Buddhist teacher Yvonne Ginsberg, subbing for Howie one night, said “The ‘awakening’ that the Buddha referred to is the awakening from the trance of thought.”

Over and over I see it these days: Ah, there’s my knee-jerk reaction. And there’s the story I’d like to indulge about it, but I’m not going to. Accordingly, I am feeling noticeably more tranquil.

My group at work lately presented our final self-evaluations for unit one, which seems to have gone extremely fast and is now over. We spent five and a half hours in a small conference room together going over our finals, one after the other, and it was rather grueling. What one peer shared aroused resentment in me, which quickly expanded to flow over the whole group, reawakening my sense of estrangement from the others.

By the following day, I was having my first and only real meltdown of this unit of CPE, though I didn’t get as far as deciding to quit. Come to think of it, it was very similar to what has often happened for me toward the end of a meditation retreat. Fortunately, Jodie had some time in her schedule, and I spent 20 minutes with her sharing all my gripes, which she gently pointed out weren’t necessarily objectively true: “Ah, is that how you see that?”

I spoke about a peer who is extremely energetic, presenting to groups of staff and initiating new forms of care. I told Jodie that I don’t so much feel competitive with this peer as defeated by her. I’m sure that if there is one chaplain job in all of San Francisco next fall, she’ll get it. But Jodie pointed out how this peer’s hospital units are fundamentally different from mine, and said, “She has a lot to learn,” which did make me feel better. I was also grumbling about the particular assessment model we’re supposed to follow, and of this, Jodie flatly said, “I don’t do that.”

After talking to her, I could clearly see my choice between persisting with negative views and taking constructive action, as well as the different results likely to be obtained, and I decided to do the latter. I don’t want to feel apart from my colleagues. I need them, and they need me. Jodie and Anita took us out for a nice lunch that day, which I thoroughly enjoyed, and in the afternoon, all 14 of us students and two of our supervisors had a party to celebrate the end of the unit.

Friday, November 11, 2016

Not Like the Others

The next morning (which was the morning after the election), I went to talk to the staff chaplain who had said there is nothing we can fix, and he reiterated that. He said he sees things the way I do. I said that, ironically, right after thinking about how I don’t believe in herding patients along, I had been extremely directive with the mother of the very sick baby. I described the visit and the chaplain said that he might have done precisely the same thing—if he’s only going to see someone once or twice, and there is an obvious way to relieve suffering, he will do what he thinks is best. I felt affirmed all around.

On Thursday, we had group, and right at the end, I shared that I had been feeling separate from the others because of my different idea of what chaplaincy is. I added that I had talked to one of the staff chaplains at the other campus and that he had said he sees it the way I do, which of course was a not-so-subtle way of saying, “I’m right and the rest of you are wrong (and also stupid).”

Now I must digress to say, briefly, that a few days ago I had an unpleasant interaction with a peer I had formerly felt close to, in which I felt she was needling me relentlessly. (She seemed to be practicing a type of passive-aggressive humor that I myself practice at times. It is charming in myself and perfectly intolerable in others.) I have felt angry at her ever since. We had been riding Muni together after work pretty often, but the last couple of days, I have been avoiding her. On one of those days, I said I needed to go to the bathroom and she said she’d be happy to wait—unless I’d rather be alone. “Yes, I might do some reading on the train,” I mumbled, and she walked off alone.

Thursday evening I was mulling over these two adverse interpersonal events, with my peer and with my entire group. I felt worried that one of my supervisors would scold the staff chaplain for inserting himself into the supervisory process and then he’d be mad at me for my big mouth, and even if that doesn’t happen, the whole session was being videotaped, and the director of Spiritual Care Services will potentially see it.

Furthermore, what is wrong with me? I believe that we co-create our reality because our views and beliefs color everything we perceive. In effect, we never see anything other than the inside of our own heads, and it is not uncommon for me to see people who seem to merit my judgment, my scorn, my disdain, my contempt, my anger. It is also very easy for me to decide to withdraw from a person or a relationship, in the micro or macro sense. I am likely to be the person sitting apart from a group reading a book. I am the person who decides to give up on a 40-year friendship because my friend says she is “colorblind.”

I brooded about this all evening. I called my peer and left a message saying I’d like to talk to her next week about the dynamics between us the past few days, though if she isn’t interested in doing this, then we won’t.

Why, why, why am I like this? I asked myself. I can’t afford to see my own therapist and she might or might not be helpful with this kind of inquiry, anyway, but I can go see TWMC’s therapists for free. I made a note to do this, and then I realized that I was being exceedingly harsh with myself, beating myself for hours. Would it actually be helpful to know why I have these tendencies, if that is a question that can even be answered? Maybe so, maybe not.

I then changed the focus of my ruminations:

Why do I judge others and decide they are wrong and bad? Because it protects me in some way.

What is the result of this behavior? Disconnection from others.

What will it take to change this behavior? I will have to be aware of when it is happening, remember that I don’t like the results, and I will have to tolerate whatever emotional experience it is that I’m trying to flee from. I think if I pay close enough attention, it will become obvious what it is that happens and why.

It is my tendency to identify all the ways I’m different from others, and to think difference equals wrongness, but these are just habits, and I can become more aware of them. I hope my peer will want to talk next week, and as for my group, I plan to have the conscious intention to look for ways we are alike and for what’s good about them, which is so many things. I also will try to remind myself that there are probably a million effective ways to be a chaplain, and that if they’re doing something that really isn’t helpful, they’ll learn that sooner or later.

One of my peers bumped into a CPE student from last year who said that the first unit is easy and that it gets way harder in the second unit. “What happens in unit two?” we asked our supervisors with trepidation. They told us that’s when we dive into interpersonal dynamics and self-awareness, which sounds like fun to me, and it also sounds like, in my case, it might be coming just in the nick of time.

World’s Worst Chaplain

My subgroup of CPE students consists of five people, plus our two supervisors, Jodie and Anita (not their real names, of course). Often, in discussing verbatims, I have been dismayed by what seems an inappropriate, too-ambitious or even arrogant agenda for a patient visit. For instance, deciding that a patient needs to reconcile with a certain relative, even though the patient hasn’t said a single word about wanting to do this. In the case of this particular verbatim, Jodie gently pointed out that a patient whose time is short may or may not want to allocate his energy in this way.

Earlier this week, I was riding the shuttle over to the other campus for my on-call shift and musing about how a peer of mine often proceeds in a way I would not dream of—also, come to think of it, that one, that one, and that one! It suddenly dawned on me that I’m the only person in my group who rarely thinks a patient needs to do this or that. I have certainly felt judgmental about this, since of course I think the way I do it is the right way, and on this day, I felt like the odd woman out: one of these things is not like the others. Also, if the job is to go around trying to get patients to do this or that, maybe it’s not the job for me.

I then recalled a staff chaplain sharing with me what another staff chaplain had told her: “There is nothing we can fix, nothing whatsoever. All we can do is accompany patients.” When I got to the other campus, I shared my misgivings with one of my young fellow students and he said he is having the exact same thoughts. He mused about how we are being trained in a certain assessment model: to figure out where a patient fits in this view of things, and to apply the corresponding ameliorative measures. However, my peer said, people don’t come to the hospital because they have a spiritual problem. They come because they have a medical problem that they want the doctors and nurses to address. He also said he tends to lead with his head, and so he’s wondering if this is the right line of work for him.

I think this is a fine young man (and exceedingly bright), and though I was having the same feelings, I didn’t want to be the partial cause of his giving up on something he might find very rewarding, so I said that I also lead with my head, and sometimes I miss getting to use my brains more, as I got to do in my previous job, but I also am drawn strongly to this work, and I trust my capacity to do it, and I also trust his capacity to do it, if that’s his choice. “I trust your heart,” I told him.

That evening, as it happens, I met with a young mother with a gravely ill baby who feared that his illness was the punishment for a bad thing she had done. After all my mental huffing and puffing about not imposing our views on patients, I found myself strongly advocating for an adjustment to her view of God.

This is what I said, quoting from the verbatim I wrote about this visit; what’s in parentheses is what I was thinking:

“I’d like to think that God would say that every single person on this earth has done things they regret—I certainly have. That we all have done many things we regret—I have. We have all done things that have harmed ourselves and harmed others, and I’d like to think that God loves us and forgives us, if He was ever upset with us at all.” (I feel very uneasy sharing my own thoughts about God—who I don't even believe in—with this woman. I don’t want to push my ideas on her, but the alternative seems to be letting her persist in the idea that God, who is supposed to love her, has made her baby gravely ill, so I think this is the greater good at this moment.)

Later I said:

“Maybe it is true that God punishes us for things we have done and I know you are wondering why your baby is ill. But I’d like to think that God loves us completely, more than we can understand, and that he would not harm a baby to punish us. Your baby being ill may be part of a giant mystery that we can’t understand.” (Not my exact words, but something like that. The patient’s mother looks calmer.)

I go on to say:

“I can’t imagine what you're going through. You know, I think God already loves and forgives you. I think the person who needs to forgive you is you. I see your love and care for your baby, and I think you also need your own love and care.”

Patient: “You really think maybe I need to forgive myself?”

Me: “That’s really what I think. I’m sure you’ve asked God for forgiveness many times.”

“I have!”

“Maybe it’s time for you to give yourself your own forgiveness.”

The patient’s mother said she felt better, and she did look visibly relieved, and she was no longer crying. As I was leaving, it occurred to me that I had once done the same thing she did. I said, “You know, I once [did such-and-such] myself.”

“You did?” Her face lights up.

“Yes, I did,” I say with a smile, and we part beaming at each other.

I hope she thought later, “If a chaplain did the same thing, maybe it’s not that bad” and not “That must have been the world’s worst chaplain! Maybe I’d better talk to a priest.”

Further and Further Behind

It was comforting to me that Hillary got slightly more of the popular vote, but the thing that had the most profound effect on me the day after the election was a piece in the New York Times by Michael Lerner entitled “Stop Shaming Trump Supporters,” which I think explained very clearly what happened here, and included this, to me, comforting line: “The racism, sexism and xenophobia used by Mr. Trump to advance his candidacy does not reveal an inherent malice in the majority of Americans.” I sent it on to a group of friends, to my colleagues at work, and to a group of dharma buddies.

Later I saw something online about people in Silicon Valley likening Trump to Hitler and mulling over whether California should secede from the United States, and my reaction was one of rage—at the techies, who I picture saying, “I’m Google employee #3! I paid $10 million for my house! If things don’t go just the way I want, I’m leaving and I’m taking my state with me.” It seems to me that such people have nothing—absolutely nothing—to complain about. Had they been able to see the person collecting their trash and the person scrubbing their kitchen floor and had they actually cared about the lives of these people, this might not have happened.

Trump’s election is an invitation for us to consider them. I’m not saying he will do the slightest thing to improve their lives; I’m sure he won’t. Plus he’ll probably get us into a nuclear war in his first six months in office. But I think the reason he won is that a lot of people are despairing and angry, and rightly so. As I studied the weary face of the person making my burrito that day, I suddenly felt perfectly fine about my new president. I imagine he’ll actually end up being impeached—how could he not?—and we’ll end up with Mike Pence, which is OK with me, given the alternative.

I may be wrong about all of this. Maybe it’s simply that we do still have enough bigoted, selfish white people in America for this to have happened.

Several people said they also liked Lerner’s essay; one of my colleagues sent it on to a bunch of people. However, one of my dharma buddies wrote that she disagreed entirely. She felt that the message could be boiled down to one of shaming people who speak up about racism. Her note was clear and respectful and calm. I replied in the same spirit, and will think over all that she wrote.

This is one part of Lerner’s essay that particularly got to me: “The upper 20 percent of income earners, many of them quite liberal and rightly committed to the defense of minorities and immigrants, also believe in the economic meritocracy and their own right to have so much more than those who are less fortunate. So while they may be progressive on issues of discrimination against the obvious victims of racism and sexism, they are blind to their own class privilege and to the hidden injuries of class that are internalized by much of the country as self-blame.” I confess that one thing I thought after Trump was elected was, “Well, I’ve saved up a lot of money. I’ll be all right.”

I got a response from another close friend (not Chantal, my 40-year friend) who started her longish note by saying, “I voted for Donald J. Trump.” She went on to say that she used to make such-and-such hourly wage, and now she makes less, while things cost more. She said, “I am falling further and further behind.” She pointed out the condescension in my email (I said at the top that Lerner’s essay was comforting to me because I had been thinking that the country was half full of “stupid, hateful people”) and she finished by saying that she doesn’t dare tell her colleagues how she voted.

“I sit at work and listen to people talk to each other about how stupid I must be. They are so smug talking about how people voted against their interests when they are in the exact same economic boat as I am. Talk about voting against your interests—Hillary never gave a s**t about my co-workers. She would have been elected to do Wall Street's bidding.”

I felt sad after I read this note. And there you have it. I was condescending, and I was assuming way too much about the views of others. (How could anyone possibly not think what I think!?)

Favorite Pumpkin

Needing the closet space back, I’ve finally been going through a stack of Carlos’s papers and saving the things that made me smile, like a poem dated Halloween, 1992. He couldn’t decide whether to call it “Pumpkin Song” or “Favorite Pumpkin,” and the first stanza is:

I’m my favorite pumpkin
Pumpkin pumpkin
I’m my favorite pumpkin
Look at me (orange me)

The very last thing I put my hands on, this morning, was a love note from the woman he was involved with off and on for 25 years and never really got over. She was out of commission when he was dying, but he did get to see her a time or two in his final months. That relationship was the source of some anguish in ours, as you might imagine, but it seemed fitting that this beautifully calligraphed card—she did all the calligraphy on the Women’s Building in San Francisco—closed my document review project. I decided to save it.

I had a great weekend a week ago. I took a walk with my walking friend, during which we went into the SPCA to look at kittens. I also met F. for a burrito, and we had a very lovely time together. I was going to say that he unaccountably has become very pleasant again lately, but I think I can actually account for it. He does not grasp the concept of “I statements” and can only express angry feelings via accusations. I know what’s underneath, but it’s still unpleasant to be addressed in an overtly blaming manner. He also routinely brings up offenses that occurred long ago, including two things in particular that he brings up over and over and over. In vain have I suggested that we focus our efforts on the present, and to no avail have I apologized for the one of those two things that I believe I was indeed at fault for. But lately it dawned on me in a new way how genuinely painful both of those things must have been for him. Finally, I felt that on an emotional level, and I expressed that to him, and ever since then, things have been much better. Go figure.

Last Sunday, Tom and F. and I went to Berkeley to have lunch at Au Coquelet and then to Berkeley Rep (thank you, Ann!) to see It Can’t Happen Here, based on the Sinclair Lewis novel. It has striking parallels with our situation, at the time, of having a demagogue running for president. Back then, we were positive Hillary was going to win and that we had nothing to worry about. Ah, how foolish and innocent we were five days ago.

On election night, I was on call at the other campus. I saw several patients, but skipped the normal rounding and went periodically to the office to see how the election was coming. I watched with shock as Trump neared and then secured victory. I read what Paul Krugman wrote in the New York Times about America perhaps being a failed state. I dreamed of someone attacking me with a pair of scissors.

In the morning, however, hearing Hillary say “I still believe in America” in her concession speech made me cry. I still believe in America, too. Or, at any rate, I was made in America and I’m staying in America, as Jessica Alba’s character says in the last episode of Dark Angel. Running the morning meeting that day, I started by acknowledging that not everyone in the room necessarily had the same views as mine. There were only two students there besides me, both very young, one African American and one European American, and our views actually were the same, but I don’t like to assume. I said, “If one of you voted for Trump, I’m still honored to have you as my colleague.”

I said that on the morning of election day, my mother and I had agreed on the phone that not only did we want Hillary to win, we wanted her to stomp Trump. I really wanted him to get his comeuppance. I was looking forward to never hearing his bloviating voice again. (I didn’t go into quite so much detail in the morning meeting.)

The results of the election, I said, were therefore shocking and disturbing, though I was glad to see that the popular vote was split pretty much 50-50. I said that at bedtime the night before, I noticed that things were exactly the same as on any other night: I put my warm socks on, I pulled the covers up. Trump’s election had not changed any of that in the slightest, and I reflected that I’m just as free to live from my values in Trump’s America as I was in Obama’s America. (Though I might be out of luck one of these days when it comes to health insurance.)

I ended by recounting what Steve Armstrong said at the end of a retreat I went on at Spirit Rock. He talked about being caught up in a terrible disaster, perhaps a catastrophic flood. With the waters rising around us, who would we want to see walking in our direction? He said we can be sure that the flood, in one form or another, is coming, and we can be the person we would want to see coming toward us.

After the morning meeting, whoever runs it send out an email to all the students, staff and faculty saying who is on call at each campus and other helpful information for the day. At the top of my note, I wrote this: “Remembering this morning that I can proceed from my highest values no matter who is president and that I can (try to) be the person I would want to see walking toward me on the worst day of my life: calm, kind, present.”

Sarah, the manager of Spiritual Care Services, did a reply-all that started this way: “Thank you, Bugwalk, and beautifully put. Your words inspire me to share that this morning I too recommit myself to acting from and being grounded in my highest values, including humility and resilience, and embodying powerful love and inclusion in all the ways I possibly can.”

The SCS director’s subsequent reply-all included this: “I too am proud to be associated with such centered, clear-minded, and big-hearted people as yourselves.”

Saturday, November 05, 2016

Spartan Gravitas

I was on call again at the other campus this past week and need to amend what I said about there being 11 sources of light in the sleeping room even after the main light is turned off. Actually, there are 16 of them, four of which blink. I brought along a sleep mask I discovered in a drawer at home which proved to be too uncomfortable to sleep in, but the lights didn’t keep me up the way they did the first time around. I dreamed I was sleeping on a city sidewalk when an enormous metal thing the size of a house fell out of the heavens and landed next to me, missing my head by inches, and I dreamed I was all alone on a city street in a torrential downpour.

But, backing up, I arrived at noon for a couple of didactic sessions followed by a department meeting, at which we learned that, for the first time in however long, TWMC is probably going to offer an extended unit of clinical pastoral education (CPE) starting in January; final confirmation still pending. This means a part-time schedule (16 hours a week, I believe). We students were extra-excited to hear this because it means some of our on-call shifts would disappear.

My group also learned that Jodie would be the supervisor for these new students, and Anita would then be the sole supervisor for our group. Anita is a brand-new supervisor and it did cross my mind that it might be good to have a more experienced supervisor, but if Anita is qualified to supervise, then she’s qualified to supervise, and I do like her.

At 4:15 p.m., I took my pager, the two on-call pagers and the on-call phone, had dinner in the cafeteria (a salmon burger and two orders of about the best French fries I’ve ever had), and then it was non-stop work until about 10 p.m. I visited a lot of people, including a young boy who may have cancer, another intubated in the ICU, a deranged woman in adult acute care, and twins born prematurely. One is doing fine; the other is struggling.

I arrived at one of the five intensive care nurseries just after a nurse had called a baby’s family to advise them to rush to the hospital if they wanted to say goodbye to him. He was a darling boy, several months’ old, who looked perfectly healthy asleep in his little crib. He was wearing a tiny shirt with a colorful decoration on it. The sight of that small cheerful garment made me cry, as I reflected that it was the last thing he would ever wear. I dried my eyes and blew my nose and re-gelled my hands, and then I stroked the baby’s head—he opened his eyes once or twice—and put one of my fingers in his tiny hand for him to hold, and I spoke softly to him, telling him that everything was all right, that he was safe and loved, that there was nothing to fear.

When his family arrived, I introduced myself and continued on my rounds. I visited patients, all children except for the deranged woman, until about 10 p.m. and then did charting until about 11. I noticed that one of my youngest colleagues has a gift for wonderful chart notes. I plan to study them for my own edification. I’m sorry to say that another of my young colleagues recorded in a chart note that a mother was still thinking about whether to “pull the plug” on her baby.

I got a solid eight hours of sleep or so and was awakened at 7 a.m. by a Code White, the same as a Code Blue but where the subject is a baby or child. The patient’s mother turned out not to want company, so I came back to the sleeping room and did ten minutes of metta meditation for the baby whose head I had stroked. I amended the phrases I normally use; I used these:

May you be happy and contented.
May you be safe and protected.
May your transition be peaceful and joyful.
May you die with ease of well-being.

As the on-call person, I was in charge of running the morning meeting, which begins with an interfaith reflection. I described my evening briefly and spoke about how it’s dawning on me more and more how essential it is for chaplains to be able to grieve, along with helping others to mourn their losses. I talked about the profound effect Stephen Jenkinson’s book Die Wise has had on me, how, as he says, most people who get a terrible diagnosis want More Time, but this is the More Time right now, it seems to me, and I talked about remembering to invite grief to have a seat at the table.

I led the group in metta meditation using the phrases above, and concluded by reading Sapphire’s poem “California Dreamin’,” which is heartbreakingly sad; I choked up while reading it. One of my peers asked to see Sapphire’s book and one of the staff chaplains came up and said a lot of nice things to me, about how beautifully I’d held the space. I told him he had made my day, and he said, “You made mine.”

Several of my peers came to ask about their young patients and thanked me for seeing them the night before. I felt such a lovely bond with them as we spoke. These are remarkable people. I feel so lucky that they are my co-workers. Two of them are going to North Dakota next week to join the Standing Rock protest against the Dakota Access Pipeline.

I had been thinking that working
as a chaplain with children, seeing so many children die, would be way too hard, but now I understand how people do this. The children are so precious and so cute and so vulnerable that the hearts of those who care for them break, and that, paradoxically, is what makes it possible. The danger is if your heart doesn’t break. I could really feel, during that on-call shift, a powerful mix of combined energies—sorrow, awe, tenderness—and how they were washing through me, back and forth, like waves coming in and going out. So, letting your heart break and also having someone to tell.

The staff chaplain who said all the nice things took the trouble to send this note to my supervisor:

I told Sarah [the manager of the Spiritual Care Department] that I wanted you to know what a fine reflection Bugwalk offered this morning. Upon learning of the death of a little boy she tended to last evening, Bugwalk offered him, and us, a metta meditation that was perfectly somber and light. She created quite the sacred space with spartan gravitas. 

I met this child and his mother once, perhaps two months ago. But Bugwalk’s earnest presence tapped my own grief immediately. She has a gift for public prayer.

Monday, October 31, 2016

A Bloody Tube or Two

A week or so ago, I spoke with my (Evangelical Christian, Republican, conservative) friend Chantal, whose unwanted-by-her divorce has recently become final after a separation of several years. A week before that, we discussed this sad milestone, and I shared something that Howie said when I was facing something difficult years ago: “You have the tools you need to deal with this.”

I found Howie’s words comforting, but Chantal said in our more recent conversation that she didn’t like my saying that. She felt it was “the chaplain” talking, when she just wanted her friend Bugwalk. I asked what Bugwalk would have said, and she said that Bugwalk would have said, “I’m so sorry.” Ironically, I did not say that because Chantal herself has advised in the past that if the problem is really painful, it can sound artificial; I mentioned this. I also apologized for responding in a way that she didn’t like, and she said that was all she needed to say about it; she just wanted to feel heard.

She then said it was good that we had had this discussion, because from now on, she can just say, “There’s the chaplain! I don’t want to talk to the chaplain!” After we hung up, I realized that I did not feel good about this at all. It is certainly the case that there are ways I would behave outside a patient room that I would not behave in a patient room, so in that sense, personal and professional identities are separate, and I can also understand someone not wanting to talk to “the chaplain” or “the therapist” or the “mediator.”

However, there is bound to be a lot of overlap, partly because I think what I am learning is wonderful and beneficial. It’s not something I try to forget when 4:30 p.m. rolls around. It’s also very new and I feel tenderly protective of this endeavor and of the fledgling chaplain that I am—I don’t really want to hear anyone say, “There’s the chaplain! Yuck.” After all, I don’t say to Chantal, “I don’t want to talk to the Evangelical Christian. I just want to talk to Chantal.” To me, they are inextricably linked. Also, what I said to her did not come from chaplaincy; I mentioned that to her in a note soon after our conversation.

A couple of days ago, I sent her this note:

Normally I would save this until we talk, but since it sounds like that will be a while [due to our respective schedules], I wanted to say it was a bit painful for me when you said you were glad we’d had our talk because now you’d be able to say “Uh oh, there’s the chaplain!” This endeavor is extremely meaningful and precious to me and I feel protective of “the chaplain,” but also that she is me! I may talk in a new way because of things I am learning, but I’m still me, and probably can no more not be the chaplain than you could not be the Evangelical Christian—that is you! What I’m sure IS happening is that I’m sounding different at moments, and I’m sure that is alarming when you’ve known someone forever. I welcome your saying “I didn’t like when you said that; it would have worked better for me if you had said this,” but I don’t want “the chaplain” to be seen as something bad. I know you understand, and we can definitely talk more about all of this when we actually talk!

We chaplains are in charge of planning the celebrations for a long list of holidays; we each have to help with two in the course of the year. I signed up for one Muslim and one Jewish holiday. On Thursday, my peers did celebrations for Diwali in the cafeterias at both campuses. At mine, they decorated a long table with marigold blossoms and tea lights, one fellow made and brought to work a big batch of the traditional dessert item, and a boom box played the appropriate music. It was quite beautiful.

I sat at a table nearby with one of my peers, our supervisor, one of our two admins, and one of the staff chaplains, who was in tears over a patient who had recently died after prolonged suffering. I sent her a note later: “Just wanted to let you know I’m thinking of you as you make the journey of grief—yet again. I admire your bravery in choosing work that means having to do this so often.”

As for myself, I don’t plan to spend the year fretting about this—next September is about 25 years away in clinical pastoral education years—but I’m open to discovering that I don’t actually want to be a hospital chaplain. I am enjoying this work and learning more each day. It makes me happy to visit patients, but I’m also visiting the easiest patients in the whole hospital (except for when I’m on call, when it is exactly the opposite). If I had to spend all day every day in a cancer or transplant ward, it might be a different story.

I am appreciating how my units fit together. In the surgical waiting room on the main floor of the hospital are people who are going to have surgery themselves that day and/or their loved ones. The person having surgery next goes to pre-op (also my unit) and then to post-op (mine, too) and then, if it was a knee or hip replacement or spine or sometimes brain surgery, to my floor. Recently I spoke with a man in pre-op who turned out to be a close friend of my walking friend; they have known each other for decades. This man was having a hip replacement and told the anesthesiologist that he preferred to stay awake for it! He assured the doctor that
the noises” (including bone being sawed through) would not bother him. He ended up on my floor and confirmed, smiling, that he did stay awake throughout (with a spinal block) and that it was not scary but “interesting.”

I visited a woman who’d had an aneurysm and had two bloody tubes sticking right out of the top of her head, and blood spattered on her pillow. I could have looked at her all night without discomfort, yet her saying several times how she’d woken up with a terrible pain in her head totally got to me; weird. A yucky feeling arose in my midsection, which I recognized very, very well from meditating, so I did the same thing I do when I’m meditating and a yucky physical sensation arises: just be aware of it and of my reaction, and tolerate it one second at a time.

I am of course by now experiencing aversion toward various of my peers. This is always my challenge, and it always leads to self-condemnation: I’m a bad person. I discussed this with my peer, Tony, who seems very wise to me, and he said I could sit down and talk about my gripes directly, though he thinks this often conceals a hope that after we say what we don’t like, the other person will stop doing it. He said he would recommend instead spending time with the person and asking for a story from his or her life. Tony said to keep listening to that person’s stories until I find something I love. I thought that was brilliant. Without Howie’s, without the soup kitchen and probably soon without F., it is essential to find friends at work, most particularly among my peers, the 13 people on earth who are most nearly having the same experience I am.

Saturday, October 22, 2016

Heart Work

One of the units I’m assigned to is pre-op, but I’d never had a conversation with anyone there until Thursday. Usually I just walk through the unit and smile and say hello to patients waiting to have surgery and their family members. On this day, a patient immediately engaged me and talked for 45 minutes about her long and really terrible medical history, which has involved two organ transplants so far. For one of them, she went to another country where they give you an organ from whichever criminal they have most recently executed. According to this patient, they test these organs for some things but not others, and she ended up with an organ that wasn’t very good.

During our talk, I began to feel a little green around the gills. I mindfully noted, “Very unpleasant, very unpleasant,” and noticed the feeling of my feet on the floor. I felt completely drained after our visit. One of the staff chaplains told me later that we don’t have to listen to a tale of this kind. We are welcome to interrupt and bring the focus back to something more immediate. At the place where I did CPE in the summer, we were instructed to study patients’ charts before seeing them, but here we don’t have to do that, and so I have no idea what is wrong with most of my patients unless they happen to mention it. Reading charts more than once made me very queasy, but it depended on the day, and I knew it was something I would get used to in time. It may well be that I end up realizing that I can be of more help if I do know in some detail what a person is dealing with. There is a difference between a joint replacement in an otherwise healthy person and stage four cancer.

On that same day, I got a phone message from F. saying that he wanted our relationship to be over. We have taken turns saying this to each other, or announcing a break, for many months, but I’m thinking maybe this was the real end. It is sad. I have seen the very dear facets of his personality, and I have many wonderful memories of us. Likely no one will ever be that in love with me again. But over the past year, I have too often seen parts of his personality that I find intolerable, and I have not been able to think of any way to get the nicer, more reasonable fellow back. That person seems to be gone for good, and I would rather spend my very limited social time with people who are cheerful, rational and tuned in.

So that was a hard day, and also a day when I rode my bicycle to work, which I have done only a few times. I like getting fresh air and saving money, but I felt wiped out by the end of the day. Maybe cycling to work is just too much exercise right now. I made a stupid mistake before I left work, as well. I’m also assigned to post-op, where people wake up from anesthesia, so I thought I’d swing by and see if the double transplant woman had survived her procedure. In post-op they said she’d gone back to her room on the transplant unit, so I went there and found her looking as if she’d spent the day at a spa. She was wide awake, looked great, and started complaining immediately. Fortunately, her doctor came along within ten minutes, so I could say, “Nice to see you after your procedure!” and leave.

The transplant unit is kind of a bummer. A pall hangs over it. I literally have the easiest units in the hospital—mainly joint and spine surgeries, though some of those are being done on cancer patients—and now I’m wondering if I only like this so much because I don’t have to hang around the transplant unit, or a neurological ICU, or an oncology unit. Also, the thrill of having the identity of chaplain is wearing off. I’m going to continually have to drop that and refocus on just being awake. If I don’t want to be “the chaplain” and if I get depressed visiting gloomy units, is this really a good career path for me?

Also on that day, I saw a patient whose baby (now several years old and perfectly fine) was born very premature and was in the ICU for more than a hundred days, an experience which permanently changed the patient’s perspective about what is important in life. When I went into his room, I asked how his day was going, and he politely asked in return how I was doing. I said “OK” and he picked up on that right away and inquired further! I decided to be honest and said, “I had a visit with a patient earlier that affected me; it’s kind of stayed with me.” That was all I had to say and the conversation went on. It felt good not to insist on being The One Who Is Fine (Let’s Talk About Your Problems), and when I recounted this exchange to the aforementioned staff chaplain later, she approved of my having been honest and not having insisted on remaining somehow above the patient.

We periodically get emails from the manager of the spiritual care department, Sarah, second in command to Paul. They always make me smile. We got one this week that began, “Dear hardworking and heart-working chaplains!”

Going Home

Last Monday I had my first on-call shift at the children’s hospital, which is huge and beautiful and new and very, very quiet. The hallways are almost deserted. As at my usual campus, we have a list of units to “round” on when on call, so I made my way to each of them, and, in the emergency department, spent time with a young Asian couple whose baby was having seizure after seizure. I visited another young girl about to be released from the emergency department and we played hide and seek. Her youngish mother, holding a small baby son, said she needed “prayers and love.” She said she never gets more than four hours of sleep. Accordingly, I prayed for her, which was mystifying for the young lady patient. The mother explained that, though she herself had grown up Catholic, prayer was something her daughter had never seen before.

The conventional wisdom is that it’s way better to be on call at this other campus because, for one thing, the sleeping room is supposedly much nicer, but that was not my experience. The bed was quite uncomfortable, and I counted 11 different sources of light remaining after the main light was turned off, including three things directly overhead that blink all night. I finally wrapped my head in a towel to make it dark, but it was not a comfortable night. The next day I ran the morning meeting at that campus—it was nice to see my colleagues who work there—and then took the shuttle back to my usual campus.

My patient visits are becoming longer, and I’m starting to have friendly relationships with the nurses on my units, one of whom showed me a picture on her phone of her one-year-old. I also met one of the two Catholic priests who regularly come to our campus to visit patients. He asked where I went to seminary and I said I’m a Buddhist. He said, “Ah, so you pray to the Lord Buddha?” Now wary of letting anyone persist in a misunderstanding, I said, “No, not really,” and he said, “You follow Buddhist philosophy,” which I could agree with.

On Tuesday I had a very long visit with a woman who looked rather stupefied; she had had a stroke. She said repeatedly that she wanted to “go home,” so I said I needed to ask if she was feeling suicidal. She said not at all; she wanted to go home. To heaven? No, she wants an apartment of her own! She lost her former place, where she’d been for years, because when it was time to sign the annual lease, she was in the hospital. That doesn’t seem like something that should cause you to lose your housing, but the patient talked to someone in a government office who confirmed that it often happens just that way.

During this conversation, a great feeling of tenderness and love for this patient welled up in me, and then gratitude that my job is literally to go around offering love to people. This is liberally extended in return. I pass a workman who says, “Good morning, chaplain!” with a big smile, and the driver of the TWMC shuttle says, “It’s a pleasure to have you aboard, chaplain.” As Paul, the head of the spiritual care department warned, we are giant blank screens that people project all kinds of things onto, both positive and negative. Some people see chaplains as agents of God, deserving of great respect. Others associate chaplains with terrible experiences they have had with organized religion.

Tuesday evening, Lisa C. and I had a wonderful feast at Esperpento: garlic shrimp, sautéed mushrooms, roasted potatoes with aioli, sautéed cabbage, a potato and egg omelet.

On Wednesday, I visited a patient whose name in the chart had been replaced by a row of asterisks. I was thinking that this must be a mental patient, as their names are routinely concealed. The patient had a woman visitor who said she was the patient’s sister and who glared at me throughout the short visit. The patient herself seemed kind of out of it, but pleasant enough. I delivered my standard remarks and then left. The visitor didn’t hurt my feelings. I was thinking, “You don’t want me to agitate your mentally ill sister—I get it.”

I went to chart the visit and had to “break the glass”—explain why I needed to see the chart and enter my password. Then I could see the patient’s actual name, at which point a giant wave of energy passed through my body: this was a very famous person I saw many times on TV in the 1990s. I thought back to her appearance and realized that, yep, that was her

The name of a mentally ill patient is actually listed as <restricted>, I realized later. When the name has been replaced by stars, or asterisks, it’s usually because the person is a star (famous), or a forensic patient (someone who is in the hands of the law; there will be guards posted outside the door), or someone who doesn’t want to be found, such as someone who is being stalked or is the victim of domestic violence.