Sunday, July 31, 2016

The Chipper Chaplain

On Friday, I finally got to see my mental health professional, Deborah, and I read her my long list of reasons not to do CPE at TWMC and she said it sounded like I have made my decision, but then I told her what I like about this work, including that it’s an honor to be with people at the most difficult moments of their lives, that I’m good at it, that I like meeting new people every day, and that it feels great to do something that is undoubtedly worthwhile.

She said it’s OK to be happy: If I’m happy having a simple, quiet, low-stress life at my former company—assuming I can get a job there—that is entirely fine. More than one friend has said it sounds like I’ll be OK financially whatever I do and that I should take money out of the equation, but Deborah said financial well-being is subjective. She knows people with $10 million who don’t feel safe unless they have a paycheck regularly coming in.

She said maybe there are other ways I can get my needs to be a chaplain met and that I need to guard my health and well-being. She said that, as a cancer survivor, I have to be careful about stress. She said she thought of that several times while I was listing the arguments against going on.

“Does stress cause cancer?” I asked.

“It can’t help,” she said, which sounded rather right to me. Later, however, I did a little online research and learned that there actually is no evidence that stress directly causes cancer.

I have been having a lot of difficulty falling asleep this past week. The person who was coming off call Saturday morning said trouble sleeping can be a symptom of compassion fatigue, which you can indeed have after just eight weeks of CPE. He suggested remembering to do the things that bring me joy, such as hobbies I might have been forgetting about lately. He said people confuse compassion fatigue with burnout, but they’re not the same thing. Compassion fatigue comes from dealing with all the feelings that arise in caring for dying or ill people—our cup is just overfull with feelings. Burnout is more when we hate the whole system, hate our boss, etc.

I asked if there’s such a thing as being a hospital chaplain without being stressed out and he said that in itself, it doesn’t have to be a stressful job. He said he’s gotten to the point where his job per se doesn’t stress him out, but he said it’s not a simple, mindless job, and it will always be challenging. When you add in running a household, raising kids, and all the other things we do, there is the potential for stress.

I attended a death yesterday, spending time with the family and offering a prayer, and visited another patient who was actively dying. I had to take cabs to two other campuses of the medical center. One of my cab drivers said, “You seem like a very chipper chaplain.” After I said I was trying to decide whether to continue in this field or not, another cab driver said, “At your age, you need a job with less stress.”

My three most joyful moments in contemplating what to do next month have been when I decided not to do CPE. That seems telling. But when I think about going ahead, I sometimes feel a sense of a huge, thrilling, unknown expanse—a mystery and an adventure. How wonderful to have the chance to go on an adventure! At other such moments, I feel profoundly touched and almost teary contemplating the opportunity to fulfill what seems like a sacred trust.

Per Jack, I acquired Stephen Jenkinson’s book Die Wise. Skimming through it, I concluded that he’s kind of a jerk—could it be that everyone who works in spiritual care is a jerk, at least sometimes? I can be a jerk, certainly. Maybe everyone everywhere is a jerk sometimes, but you never get to see this working in finance because people don’t bring their whole selves there. Anyway, I did like very much what Jenkinson wrote to his sons in his acknowledgements section: “May your days become your own true days, proof of how it all could be.” I believe my own true days more likely take place in a hospital than in a corporate cubicle. But I also don’t want to be stressed out all the time, and I don’t want to be strapped for cash.

One of my favorite patients, M.I., was discharged last week before I even had a chance to say goodbye, and my other favorite patient left the hospital against medical advice. I had really been enjoying reading her chart. One day she was found with a pipe and contraband pills. The chart said the writer, a nurse, had been “unable to retrieve the pipe.” A couple of days after that, the nurses noticed her room was filled with smoke and later found rolling papers and a lighter.

I wrote their names on little pieces of paper and put them on the shelf that in effect is my altar, where I keep objects that I find beautiful and meaningful. I will keep them in sight for a while, and later put them in some sort of vessel, along with the others likely to come, so I can look at their names from time to time and remember their faces.

Tilden Park

A week ago Saturday, on a beautiful, idyllic afternoon, I took BART to Berkeley to go for a walk in Tilden Park with Lisa M., who reminded me to “discover, not decide.” She said that what I need to do will become obvious in time, and if that’s after starting clinical pastoral education at TWMC and means I end up dropping out, then so be it. She reminded me that I don’t have to decide now what I’m going to do in a year, or even in six weeks. I’m not quite convinced in regard to the latter.

One day in class a week or so ago, I talked about my decision and afterward, Samantha told me that if I don’t plan to be at TWMC in September, I need to let them know by August first, which greatly increased my stress. I got a chance to discuss it last Monday with Jacqueline, Samantha’s boss. She said that Samantha does not have experience hiring chaplains and she does, and that even for a per diem or part-time hospital chaplain position she would not interview someone who had not completed their academic education.

Further, she said, she would not be interested in someone who had done a year of CPE and subsequently completed her education, because she figures that person’s clinical skills and assessment models are out of date. In addition, whereas Buddhist chaplains were once a novelty, we no longer are. (Jacqueline herself is Buddhist.)

I was delighted to hear this, since it came from a knowledgeable party and suggested it would not be a good idea to start at TWMC this fall. For the umpteenth time, I decided that once the summer unit of CPE ended, I would start looking for a job at my old company. I could maybe work there until retirement, and I’d be able to volunteer at the soup kitchen and go to Howie’s sangha every Tuesday night. Which doesn’t sound so bad.

But then I remembered how I used to sit in my cubicle thinking, “I totally don’t care about this work. This is my life passing by.” And then I got to wondering why TWMC even accepted me for a year of CPE if they know it means I’m going to be painting myself into a corner professionally. I hadn’t wanted to discuss my reservations with them because I didn’t want them to think I was going to flake on them, but at this point, I felt I had no choice, so I sent a detailed email sharing what Jacqueline had said, without using her name.

The very next morning, there was a reply from Paul, the director of spiritual care services at TWMC and a person with a national reputation in this field (and yet another Buddhist), saying that it would indeed be challenging, though not impossible, to get a position as a staff chaplain at a hospital before one’s academic study is done, but that he does not agree that doing school after CPE means
one’s clinical skills would be out of date. He said I would “definitely disprove that assertion” if I were able to regularly work per diem shifts during my academic years and that such hours would count toward becoming certified.

Berta, one of the CPE supervisors there, added that she is looking forward to meeting me in September and said that the academic training only takes one and a half to three years full-time and she can’t imagine that clinical skills three years old at most would be out of date. She said she’s still using skills she learned in CPE in 2002.
Samantha said in our weekly meeting that she was glad I decided to tell TWMC about my concerns and ask for their feedback. I said I felt I had no other choice: they must have let me into their yearlong program for some good reason, and they’re the only ones who know what that reason is, so I had to ask them. Samantha said I could have just sent them a note saying I was dropping out of the program, so she applauded that I took the risk of asking them.

Sunday, July 24, 2016

Heavily Meditated

That’s what I saw on someone’s t-shirt recently.

On Friday (my day off after being on call—which recuperative period will not be offered at TWMC, the medical center known here as the Truly Wonderful Medical Center, where I might or might not start a year of clinical pastoral education in September) I: meditated, went to the office to drop off the on-call stuff, took the bus home from work, had breakfast, gave Hammett his morning medication, finally did all my online courses for TWMC (this took quite a while), made an appointment for drug testing for TWMC, called Lisa M. re our date the next day, brought the recycling bin in, looked at a book online that my fellow student Andrew recommends, called Modern Times to order three books (including one required for TWMC—a paperback that costs $40!), tried on some stuff that arrived from Lands’ End, had lunch, wrote down what I spent in the past week, updated some personal documents, walked over to see Jack for bodywork, walked back home, did my exercises, had dinner, talked to David and Lisa on the phone, and gave Hammett his evening medication.

F. arrived at 9 p.m. after the open mic at the soup kitchen, which I normally attend, but this was the one possible time that David, Lisa and I could talk, and it was a very nice chat. It wasn’t long enough, but it was lovely to hear their dear, familiar voices. I came away with the impression that Lisa is leaning toward thinking it would be good to continue with the chaplaincy adventure, while David thinks it would be more prudent to collect a solid salary for a few years more; I may have that wrong. I know everyone thinks it’s perfectly fine whatever I decide to do, and I often hold both opinions myself in the course of a single day.

I also had a good talk about the whole thing with Jack. Unfortunately, this meant I didn’t really notice that bodywork was occurring, but his thoughts were helpful. He noted that I have been developing the capacity to be present and to be open with others for many years. We discussed my finances in detail and he said he and his partner, at 65, have been giving this a lot of thought themselves, and to him, it sounded like I don’t have anything to worry about financially if I decide to go on with CPE. He also thinks I would not have too much difficulty going back to my old company in a couple of years, if the “bottom drops out” of whatever I’m doing. He also said that if I decide not to do the year of CPE right now, I could probably do it some other year.
Finally, he gave me some tips on Alexander Technique for chaplains, since both charting and standing with patients have proven to encourage less than great ergonomics.
I’d been thinking that I would have to do a year of CPE (which is going to be very hard!), and then have to buy a car (that I don’t want!) and do education (that I’m not interested in!) and then work for a time as a hospice chaplain, which I’m scared of. I’ll say hello to and chat with almost anyone on the street or on a bus, but the idea of driving around to strangers’ houses is daunting. I’m not scared of the patients, but of random relatives or friends who might turn up, like their grandson who just got out of juvenile hall. I think I’m also scared of poop and vomit.

My current CPE supervisor Samantha agreed this past week that a hospital is a more controlled environment and said it is her understanding that “hospice chaplaincy is an adventurous job.” However, she pointed out that one of the part-time chaplains at our hospital has done only one unit of CPE (plus all the education). Therefore, she is “reasonably confident” that after doing five units of CPE, I could get a contract position (part-time, without benefits) at a hospital. My first thought was, “Great! I don’t have to have a car or be a hospice chaplain.” My second thought was, “I don’t want a part-time job without benefits at a hospital (or anywhere else).”

By the way, why am I doing online courses and spending $40 (!) on a paperback and schlepping over for drug testing when I’m not even sure I’m going to be at TWMC in September? Because if I do end up doing it, not having done those things will be a problem. Failing to complete basic requirements would be kind of a stupid way to make this decision.

Saturday, July 23, 2016

Move Your Foot

Last Tuesday I felt totally exhausted, and, just between you and me, that was after working in the afternoon only. I spent pretty much the whole morning at a dental appointment, Samantha being out of town. I did tell her before the summer began that I had to see my dentist on this date. I didn’t know it was going to take so long, and since I’d have to make up the hours, I don’t think I’ll be saying anything more about it. We have to do a certain number of clinical and class hours during a unit of clinical pastoral education, but apparently there are 10 hours’ leeway built in, so my conscience isn’t entirely besmirched.

Starting last week, I was back to doing all my exercises—and also back to not getting enough sleep! If my life consists of eight balls that must be juggled, one of them falls on the floor every single day, and life at TWMC will be worse (in case I didn’t already mention that). I’m now reflecting that there are suffering people everywhere, including in large corporations. I can practice my most heartfelt values anywhere, including at a large corporation. This often feels just too tiring. I want my underworked, overcompensated life back—is that so wrong?

I also was reflecting that I spoke too soon when I said it feels great to do something I’m good at. I’m good at being open and friendly, but as for actual spiritual assessments and interventions, I have no idea if I’m good at that. It may be that I’m actually not good at that, because I’m a major codependent, which is what makes me so friendly. Samantha shadowed me on a visit to a patient this week, and when we were choosing whom to see, she asked, “Why do you want to see this person?” I was opening my mouth to say, “Because she’s in a terrible situation and she said she really liked talking to me,” when I realized that was totally the wrong answer. We’re specifically there to provide spiritual care, and if someone isn’t interested or there is no apparent possibility of being able to offer that, we’re not supposed to make further visits to that person. Samantha’s feedback after our visit to the patient we chose was extremely helpful. She does know what she’s doing.

I’m still thinking about my decision pretty much nonstop, but not feeling a lot of angst about it. I’ve had a number of conversations with trusted friends and advisors, and have several more scheduled, and things are going to happen the way they’re going to happen. On September 6, I will either be at TWMC or I will not.

On Thursday, Samantha herself had to go to the emergency room—she is all right—so we had some class time with her boss, who advised asking ourselves, “Is this work breaking my heart or breaking my heart open?” I’m not sure about this. It definitely has its heart-opening moments, but I also notice myself feeling extremely testy about noises that didn’t used to bother me. Jacqueline said that people who claim to be completely selfless as caregivers scare her. They tend to see themselves as above patients, and can be prone to over-functioning and / or abusing their power.

Jacqueline wasn’t available for our whole class time, so Andrew, Mason and I ended up having a couple of hours of unsupervised IPR, which I think stands for Interpersonal Relating. Mason was expressing anxiety about whether he’s on the right path or not and Andrew said a lot of brilliant things to him that I was scribbling down for my own sake. This wasn’t strictly pastoral on Andrew’s part; it was more what you’d hear in a sermon, but I thought it was dazzling. One thing he said was, “God didn’t say to dive off the branch—he said to move your foot.”

I was also on call on Thursday and, as on Sunday, had pizza for dinner. My worst CPE-related fear is ending up having to live in a cardboard box on the sidewalk because I left the corporate world too soon. My second-worst fear is that I’ll take to comforting myself with pizza every night and be the chaplain who is extremely nice and, at 300 pounds, extremely cushiony.

Hard Stick

From a patient’s chart that noted, “Patient is a hard stick.” (It’s hard to get a needle into the patient.)

Last Saturday, figuring that if people can tell I’m a chaplain just by looking at me, it was past time for a haircut, I had this service performed at the Pretty Pretty Collective on 22nd St. and ended up with a do that was even more fabulous than I’d had in mind. I rode to work the next day (Sunday—I was on call) on the bus sitting near an alcohol-soaked fellow who said he was related to Clint Eastwood, and also that he owns the popular tourist destination Pier 23, which cast (additional) doubt on his original assertion. When Mason saw me (he had been on call the day before), he said, “Wow, you look like a movie star! Why are you looking so glamorous?”

In the hospital, a child of about four said something to me that I didn’t catch.

“What did you say?”

“Nice hairstyle!”

My mother scoffed at that later on the phone, but the child appeared to be a member of a culture that places a high value on courtesy and cordial relationships, so maybe the very first things such a child learns to say are “Please,” “Thank you,” “After you,” and “Nice hairstyle!”

I was supposed to lead an interfaith service at one of the medical center’s four campuses that morning, but just as I arrived by cab, I was paged to return to my usual campus for an emergency. There I was taken to a small room off the emergency department to meet with a woman who had traveled to San Francisco that weekend with her husband to celebrate their wedding anniversary. Sunday morning, the husband complained of chest pains, they called 911 and he was taken to our ER by ambulance. The wife followed in her own car and when she arrived, he was already dead. (She said he had been fit and trim, and someone who ate healthy food.)

One of my colleagues later said that this happens not infrequently, since San Francisco is a popular tourist destination. That it was their anniversary made it especially awful. One of their two children was able to come to the hospital before the man’s body was taken to the morgue. Hearing this young man’s last words to his already dead father was tremendously poignant; it made me cry.

Even as I feel more and more strongly impelled toward the adventure of a year of
clinical pastoral education at TWMC and what may lie beyond, and the more I dislike the picture of myself running back to my corporate job for purely selfish reasons, the more I wonder if a year of CPE is physically beyond me. Samantha has said many helpful things in the past six weeks, including one I have thought of often. On the very first day, in regard to our being asked to share about our lives and our feelings, she said that we are not obligated to divulge every detail just because someone has asked. “Share what you can share from a place of wellness,” she said. I think that is a good guideline for all of life. What work can I do from a place of wellness? What volunteering? What relationships?

I had Monday off due to being on call the day before and, for the first time since CPE began, swept the kitchen floor, vacuumed the carpeting, and cleaned the bathroom. It felt good to have things finally be clean again, but I noticed how stressed out I felt. Also, until that day, it had been a week or more since I’d done all the various physical therapy exercises and stretches I need to do in order to feel quite well. In the final weeks of this summer unit of CPE, I am going to try to see if I can do my exercises and do my work and get enough sleep and keep my house clean from a place of ease and wellness. If it’s simply not possible, that is something to be aware of. (Perfectionism and rigidity are also things to be aware of.) At TWMC, unlike where I am now, you don’t get the day off after being on call. If you’re on call Friday into Saturday, tough rocks—your weekend is one day. If you’re on call Sunday into Monday, also tough rocks—your weekend ends at 2 p.m. Sunday. If you’re on call Saturday into Sunday, then you do get a comp day, which you can use on Monday if you want.

Monday evening, Tom and I had burritos at La Corneta. I ran my decision past him and he seemed to be nodding every time I described another reason it would be extremely excellent for me to (try to) return to my corporate job, but it turned out that his advice regarding chaplaincy was “Stick with it.” He said he puts a high value on being able to help others, which he does in his own job as a teacher of special ed students, including many autistic students. The administrative assistant from my fantastic corporate job concurred. We exchanged emails this week, and she wrote, very kindly, “Continue the path—it will smooth out and be worth it. Your gift to others is your presence.”

Monday, July 18, 2016

Tattooed Fingers

Last Thursday in class, we presented the mid-unit self-evaluations we’d written, which also included a paragraph or two about each of our peers and about Samantha. It was nice to be able to tell my peers what I like about them (and also to ask Mason to please come to work on time, which he never does, even when he’s on call) and to hear what they like about me. Andrew said he feels closer to me than to anyone else in our group of four (which includes Samantha). There was a lot of frank sharing that afternoon. As we were wrapping up, Mason said to me, “This is your future career. You have a gift.”

On Friday, I went to see a patient who has always been asleep when I’ve peeked in her room. I heard a nurse go in there, say something and come out, and figured the patient would certainly be awake, so I knocked and went in and she grumbled, “Look what happens right after I ask them to close my door.”

“You ask them to close your door and the whole world comes in,” I sympathized.

She was extremely skinny and covered with tattoos, including on each of her fingers. She said the doctors hadn’t thought she would make it through the previous night, but “Here I am.” I had read in her chart about a prior occasion of her leaving the hospital against medical advice and other things that made it sound as if she’s a difficult patient and as if the nurses and doctors don’t like her. I’d say the feeling is mutual. I suspected our talk would last 30 seconds, but felt I should try, and we ended up talking for 20 minutes. I thought she was quite charming. She said she was worried about her young son being without her. She said she had seen another “monk,” but didn’t want to talk to him. She said she liked talking to me and asked for my name and the phone number of the spiritual care department, which I gave her. When I said “Bye” at the end of our visit, she said, “Don’t ever say ‘Bye.’ Say ‘See you later’ or ‘Talk to you later.’”

Andrew wrote in his mid-term that he has been projecting onto the concept of chaplaincy, to his detriment, and I realized I have very much been doing the same: chaplaincy is done by boring Christians with frumpy hairdos and involves chatting about the Bible. As I slowly wake up in this new setting, I’m starting to ask myself what Buddhist contemplative or spiritual care looks like. I do have an entire book on this very subject, which I did read before starting clinical pastoral education and will consult again. And, yes, I see my negative attitudes about Christians, and those are changing, too. I imagine most of the people at the conference a couple of weeks ago were Christians, since most chaplains are, and they didn’t seem boring. They seemed inspired, warm and enthusiastic. Mason is a devout Episcopalian and brings tremendous resources of prayer to his caregiving. In this environment, I get to think about this more and can increasingly honor the beliefs of others, which obviously are just as precious and meaningful to them as mine are to me.

In addition, I am providing spiritual care to persons of all faiths and I am happy to pray to the Lord if that is what is comforting to a patient. I do that quite often. And I also need to inquire, as Samantha has been encouraging since the beginning of this program, into how my own theology, or dharmology, provides a foundation for providing spiritual care. It seems to me that the basic practices of Buddhism are to see things as they are and to be kind to ourselves and others. One of the most fundamental truths in Buddhism is that suffering does exist, both built-in and optional, and that this suffering has causes, and that we can end the optional suffering and improve our ability to cope with inevitable suffering (including illness, aging and death) by understanding the causes of suffering and abandoning them. That, I would say, provides a very ample foundation for providing spiritual care, even if I never mention any of this explicitly to any patient.

I got a letter from TWMC which made it clear that there will not be time during the day for writing assignments, but on the other hand, the day there is 30 minutes shorter, so that might balance out. It also said we get 15 days off during the unit, but they might not be the days off we want; that’s at their discretion.

Warbling Well-Doer

Now that I’ve eliminated (thanks to the conversations with Bill and Chantal) that plug of negativity—sort of an emotional constipation—I can feel that when I’m actually being a chaplain, it is often wonderful. It feels great to be doing something that seems totally worthwhile, and it also feels great to be doing something I am really, really good at, which is being a calm, open and friendly presence.

As my skills improve, I have a greater number of satisfying conversations with patients. I’m on my own throughout the day and am free to experiment and observe the results. I overheard a staff chaplain asking Samantha in the office, “Are you anxious?”, so I tried that a little later and the person I was talking to said, “Yes! Because of this, this and this.” Aha!

Last Tuesday, I had another particularly great visit. I introduced myself as a chaplain and the patient said, “You look like a chaplain. I felt the spirit when you walked in.” She asked if I could sing and I said that I can sing, but I don’t know many hymns (meaning that I don’t know a single line of any hymn). The patient thought for a moment and requested “God Bless America.” I don’t know the words past the first line or so, but I sang as far as I could and hummed thereafter, and the patient (plus the two physical therapists who were working with her) seemed pleased. “You have a lovely singing voice,” said the patient. (Another thing to be mindful of: do I like this work because it feeds my ego?)

This reminded me of back in 2009 when I was training to be a hospice volunteer. It was at the very organization where I work right now, and one day a staff chaplain came to address our class. She explained that she was the singing chaplain—that she went around and sang to patients. I was totally jealous: I want to be the singing chaplain! And now, nearly seven years later, I am.

On Wednesday, I felt kind of exhausted in the afternoon and went to meditate in the chapel. There I encountered the wife of one of my patients. Her husband has ALS and she has many caregiving duties. It was clear that she loves her husband, and also that her lot is stressful. She said she took a class in mindfulness-based stress reduction at our hospital that has really helped. Before I closed my eyes to meditate, I noticed a speck of something white on my pants. I wet my fingertip with spit (my own) to dab at the stain, which I suspected was toothpaste from when I brushed my teeth after lunch. (I want to be the singing chaplain, not the one with a frightening expanse of toothless gums.) I put my finger back in my mouth to get more spit and realized I was tasting barf, not toothpaste. I decided not to meditate after all, but to walk down the hill and ask Samantha if I was going to die. She didn’t think so but advised me not to ingest anything else that randomly comes my way in the hospital.

Later that day I had yet another excellent patient visit. This patient has declined to speak with me in the past and wouldn’t make eye contact, so even though she’s in my area, I decided just to leave her alone. Mason ended up seeing her and apparently she fell in love with him, because several days ago, I was paged to her room (that is, she requested a chaplain) and arrived just as a couple of doctors were going in. I asked them to tell her I was waiting. When they came out, they said apologetically, “We told her you were here, but she said she sees Mason.”

Last Wednesday, I was at the nurses’ station in her area when she happened to call for a chaplain again. I told her nurse that she prefers to talk to Mason, but said I’d see what I could do. The nurse asked for my name, and after I told her, an exuberant and funny nurse named Rick whom I often see in that unit exclaimed, “The lovely and talented Bugwalk!” I went into the patient’s room and said, “I know you don’t want to talk to me, but Chaplain Mason is out today. The nurses said you seem sad. Do you want to talk about what’s making you sad? Or I could just sit down and we could be silent together.” She indicated that the latter would be OK, and then right after I sat down, she told me everything that was on her mind.

I ended up being there for 40 minutes, during which she said, “I know you’re in the right place and doing God’s work because you people make me feel so calm.” And, “I feel calm right now—I never feel this way.” (Again feeding my ego.) She said she doesn’t want to talk to any of her friends about her problems because she doesn’t want to feel like “I have egg on my face.” That was sad. At the end of the visit, she said that while she'd still like visits from Mason, I am welcome to visit, too. She said, “What turned it around was when you said you’d just sit quietly in the room with me.”

This visit made me feel that I can increasingly trust my in-the-moment sense of what to say and do, and my intuition.

The patient said at the end of our visit that she was feeling so much better, she thought she would have her window shade opened and sit up in bed. I told Rick this and he said, “I’ll go open her shade right now!” He bounded into her room with exaggerated clown steps and yelled, “Let there be light!” I need to ask him how he maintains his extreme good cheer. He is delightful.

Saturday, July 16, 2016

Wondering / Flight Risk

The day after I talked to Carol Joy’s husband, Bill, I talked to my 40-year friend, Chantal (let us call her). She and I haven’t had our conversation about racism and colorblindness yet, what with one thing and another (new job and sciatica on her part, clinical pastoral education on my part), but we will, and we are both enthusiastic about having more hard conversations and understanding each other better and feeling closer. I told her all about CPE—we hadn’t talked since it started—and I said I know it’s lame to return to a corporate job and that you’re supposed to follow your heart. “It doesn’t sound like this is in your heart,” she said. “It doesn’t sound like this is giving you joy.”

After those two conversations, it felt entirely settled that I would finish the summer CPE program and then try to get another job with my former company. I had a variety of positions there and think the ones I enjoyed most were the ones where I was providing technical support and training, and getting to write documentation. Maybe I could have another job like that, there or somewhere else.

Monday morning I was thinking about the difference between responding, or making conscious choices, from a calm place and reacting from an anxious place. I am noticing pieces of my dharma practice kicking back in as the shock of starting CPE abates. Practicing metta for myself is very helpful. When I think, “May I be happy,” at least those are three seconds when I’m not worrying or fixating on something negative.

I saw in M.I.’s chart on Monday that she is a “wondering / flight risk” (the person meant to write “wandering”) and therefore has a sitter with her all the time. As written, it seems to describe my current situation perfectly. Another patient, I saw, has a “necrotic stump.” Fortunately, I don’t have that yet.

Naturally, as soon as I felt I had complete permission not to be a chaplain, I began to remember how much I kind of love it. I got a call to go see a man in the medical-surgical ICU, which is a very intense place. I didn’t read his chart first and was kind of shocked when I saw his dull eyes and hanging-open mouth. I spoke to him and at first he made sustained eye contact, but he never said anything and then he stopped looking at me, so I excused myself and called the person who had sent me there to find out who had wanted what for this patient. The social worker explained that his current state is his “baseline”—normal way of being—but that he does enjoy being visited and having people talk to him. She told me where he lives and said he likes baseball and the movies. OK! I went back in there and started chatting away: “I know you live at such-and-such place. I’m sorry you’re stuck in the hospital today. I hope you get to go back to such-and-such place soon. I’m sorry I don’t have anything intelligent to say about baseball, but my boyfriend is a Warriors fan,” etc., and during all this, the patient was looking at me directly, and then he became quite animated, making faces and waving his arms. He appeared to be trying to smile and to talk.

When I ran out of things to say, I told him it had been nice visiting with him and that I’d try to see him again, and as I turned away, he whispered, “Hi.” I turned back and he said it again: “Hi.”

“I hear you saying ‘hi.’ Thank you for saying ‘hi’ to me!”

He said it over and over, louder and louder, first whispering, then in full voice, and then pretty much yelling. When I walked out of his room, a couple of nurses were looking in our direction with quizzical expressions on their faces, as if to say, “What on earth is that?” It was immensely gratifying.

Sunday, July 10, 2016

An Entrenched, Possibly Terminal, Case of Self-Pity

I spent Thursday evening (after the conference at the church in Oakland) in tears, which has been rather common lately. I have been feeling very sorry for myself, mainly because my most important communities have vanished, meaning the soup kitchen volunteers and guests, and those at Howie’s. My mental health professional still exists, but our schedules this summer overlap on precisely one day, more than a month from now. There are any number of people I could talk to, but I don’t have time to talk to them, though this is partly for a good reason, which is that I am making a point of doing something with a friend one day each weekend, if I’m not on call Saturday or Sunday. Those pleasant days are what have been keeping me going.

Thursday evening, I felt resolved that I do not want to be a chaplain. What I’m doing right now is very hard. The program starting in the fall would be even harder and would last for an entire year. (At the conference, I was seated next to two people who are finishing up their year at this place, and they agreed it is brutal. If on-call eats half your weekend, so be it. You don’t get a day off after being on call, though there is one particular situation where you can get a comp day. They said you sometimes have to work 14 days in a row. They did also say they have learned a lot and that it has been a wonderful year. They are both young. I’m old.) After that year, if I hadn’t jumped off the bridge during it, I would have to do education that I have no interest in for its own sake, and after that, I might or might not be able to find a highly stressful full-time job as a hospice chaplain, or a part-time job that would not pay enough to live on. Samantha and I had our weekly meeting Friday afternoon and she agreed that chaplaincy is an unstable field. I don’t know if I’m constitutionally suited for unstable. Also, I’ve had enough health difficulties that the idea of periodically losing my job along with my health insurance is kind of frightening.

I also have very little interest in providing spiritual care per se. I am devoted to my own meditation practice and I like to hear about other people’s meditation practices and the insights that arise therefrom, and I also like to read about what the Buddha had to say and what modern commentators have to say about what the Buddha said, and that is where my interest in religion ends. What drew me to chaplaincy was wanting to hang around a hospital and be friendly to people, which one can do as a volunteer, as Samantha said on Friday. I told her about trying to decide whether to go back to my former company or not and that the best time to do that would be before mid-January. She said that in that case, I’d better make up my mind in the next month, because it’s not good to start a yearlong CPE program and then quit it (though my therapist has given me permission to do this). She said, “I see potential in you to do good chaplaincy work,” which I appreciated, but if it’s going to be immensely difficult and/or boring to get there, and result in not enough money or too much stress or both, and if it really is explicitly religious and/or spiritual, which I now understand it is, I think it’s not for me.

I have been able to adjust my schedule so that I can sit for 45 minutes most or all days, which is making a big difference, and I am getting enough sleep (namely nine hours) pretty much every night. Those are probably my two most crucial self-care activities, so that is good, but I’m really missing my sangha and the people at the soup kitchen.

Yesterday I went to see Carol Joy in Novato. We had brunch at Toast and then, because there was no movie we wanted to see, we went to her house and played three entire games of Sneaky Pete, 21 hands, followed by dinner at the Sonoma Latina Grill. It was a gorgeous afternoon, and I got to discuss my big decision with her husband, Bill, who has lately retired from a long career as an emergency room nurse. I asked him, “Should I be a hospital chaplain or go back to my former employer?” He immediately replied, “Go back to your former employer.” His view is that it’s a simple business decision: I can be a chaplain at any age but if I think I’m going to get a lucrative job at age 60 or 65, I’m not. He said lots of people want to be chaplains and are willing to do it for free, and added that it’s lousy to not have enough money at any age, but really lousy to be old and not have enough money. I will continue to ponder, or rather, try to ponder less and sit with the yucky feeling of uncertainty more. All this thinking definitely is not helping.

Saturday, July 09, 2016

Chapeau of Inner Critic

I figured out what in my own history accounts for at least part of my sorrow about M.I., thanks to the joke I made here about her family hating her because she’s the oldest sister—like me. Aha! I’m sad about her because I’m sad that I’m not closer to my own sisters. While clinical pastoral education isn’t therapy, as Samantha has mentioned a couple of times, we make these kinds of inquiries so we will understand why patients affect us as they do, and why we might be moved to over- or under-function, doing too much or too little. As Samantha has also said, “You are the textbook.” Like when it briefly crossed my mind that I’d better adopt M.I. and bring her to live at my place. That would be doing too much.

I was on call on Monday, which was July 4. I didn’t get any pages, and the spiritual care office didn’t receive any voice mails. This was my third on-call out of nine. I spent the night in the apartment near the hospital reserved for this purpose and got plenty of sleep and was able to meditate for 45 minutes in the morning before going to the office to turn the pager over to Mason, who was late. Then I rushed home, ate, showered, and rushed back to work. Normally we get the whole day off after being on call, but we have to attend class no matter what. That afternoon, Samantha mentioned that if a patient says anything about being stressed out, for instance, she tells them to talk to someone else. She is there for one thing and one thing only: to provide spiritual care.

I felt horribly rushed that day, and when I got back to my bicycle at the end of the day, I realized I’d lost a polished stone I’ve been carrying in my jacket pocket for years, and then I was furious: on top of everything else, CPE made me lose my little stone. I went back to the office to look for it, then back to the bike cage, then back to the office, and then I was even more angry because I was going to be really late getting home. Fortunately, I remembered what I had done with my jacket that I don’t usually do, and sure enough, there was my missing item.

This was the one night of the whole summer I was able to stay at Howie’s for the whole evening, because I had also been granted Wednesday off, for working the holiday and because I didn’t get to have all of Tuesday off. However, I felt extremely irritated by small noises there, in a way I haven’t felt for years, and then I was overcome by the desire for pizza, so I left early and bought three enormous pieces of pizza, and then made my way over to a dark, empty street so I could stuff pizza into my mouth unobserved, while holding the pizza box in my other hand.

On Wednesday, I had a very nice massage and felt great afterward.

On Thursday, my peers and I attended, along with other Bay Area CPE students, a mid-summer conference held at a church in Oakland. The morning was filled with one exercise after the other, like “What is your inner critic saying to you? Do you recognize this voice from anywhere? If you were to make a face that looks just like your inner critic, what face would it be? If your inner critic were wearing a little hat, what would it look like? Draw a picture of your inner critic’s hat.” That kind of thing.

In the afternoon, we did Theater of the Oppressed. There was a tremendous amount of interaction in the course of the day, and acting things out, and a lot of physical movement, and a bunch of having to touch and be touched by complete strangers. One of my peers was grumbling the next day about the total lack of asking for consent for the latter. None of this was stuff I enjoy, but I participated until I became utterly exhausted, about 2 p.m. or so, and then I was angry that CPE, which makes me tired every day, had tossed in this day that was as tiring as five normally tiring days put together. Some in the group looked pretty cheerful and as if they are practicing good self-care; some quite the reverse.

Sunday, July 03, 2016

The Boating Life

Wednesday night, after the employee had committed suicide earlier in the week, after I read about M.I.’s relatives who won’t help her, after I was asked to confront Mason, and after I found out I should be seeing eight times as many patients as I’d seen the week before, I cried and cried. When I thought of M.I., I cried even harder. On Thursday morning, I got up and cried some more, and then F. and I got in a fight, at 6:30 a.m.

Things were terrible between us last week. He stomped out of my place soon after arriving and went home, and on the phone on Sunday night, we actually broke up, though we patched things up an hour later. I mentioned to a colleague that we’re really having a hard time and she said that clinical pastoral education is famous for finishing off relationships.

On Thursday morning, he could hear the distress in my voice and asked, “What can I do?”

I said, “You can say, ‘Bugwalk, I’m sorry you’re feeling sad.’”

“I understand the science of transition—”

“No! You can say, ‘Bugwalk, I’m sorry you’re feeling sad.’”

“I understand the science of transition—”

Here I lost my temper and hung up on him. Why on earth did he ask what he could do if he wasn’t going to do it? When I called back ten minutes later, he said, sounding very wounded, “You hung up on me! Please don’t ever hang up on me again.” I said I wouldn’t, and that he for his part should please not ever stomp out of my apartment again. He agreed to that, and then he explained that he simply didn’t hear the instructions I had given him. It’s the first evidence I’ve encountered of hearing loss on his part, but I’m not surprised. He is 62 and has spent many hours with earphones on, probably with music or the radio turned up way too loud. So that explained that, and we soldiered on.

I assumed Thursday would be a really lousy day at work, but it actually was quite good. I thought of a way to change my workflow so that I can visit more patients, and saw an impressive (to me) number of them. I realized I was shying away from engaging interpreters because why should I bother to do that for a two-minute conversation? But if I’m going to see more patients, I have to include the ones that speak Arabic or Cantonese or Chinese, so I did call an interpreter that day for a two-minute visit to a Toisan-speaking patient. I went again to visit the team whose colleague committed suicide, and I used my own rudimentary Spanish when visiting another patient, which was satisfying.

On Friday, I visited a patient who had a plastic bulb of blood in his lap, that which was draining out of his surgical site. That totally did not bother me! Whereas reading “Patient was given instructions for how to use bulb to drain surgical site” actually has given me a twinge. Weird.

I visited M.I. and realized that responding to her empathetically, which is what we’re trying to learn to do, actually is not helpful. Perhaps this is true of patients with dementia in general. It made her cry, and then she went into the bathroom to wash her face “so they won’t see.” So sad. At the end of our visit, I was joking around with her instead—she said that I should give her my car so she can escape and that I can walk home myself; I said she’s too smart for me and that next time I visit her, I’d better bring my attorney—and when I left, she had a big smile on her face.

M.I. has been in the hospital for 25 days now, and is probably right when she says her bruise doesn’t warrant her continued presence there. Samantha said this may be something for the ethics team to review—sometimes the hospital really is detaining someone improperly. But I saw in M.I.’s chart that there already has been an ethics review, and it was concluded that she cannot take care of herself and that a conservator must be assigned, which is a time-consuming process. Meanwhile, she has been moved from a room with a nice view to one with no window at all, which is really bothering her. Samantha said that is too bad—that people with dementia benefit from natural light and being able to see out the window.

Yesterday my walking friend and I spent six hours together. We walked and walked, and we sat in the Civic Center, and we had lunch at Ananda Fuara, and we went to visit San Francisco’s second Navigation Center, which just opened. The Navigation Center finds permanent housing for homeless people. My friend, who runs the soup kitchen where I volunteer, said people love living there because there aren’t rules about when you have to arrive in the evening and leave in the morning, and you can bring all your stuff and your dog, and couples can live together. The city is acting quickly to open more Navigation Centers, six total.

We walked along a stretch under the freeway—where F. slept for three years himself—and saw several RVs parked at the curb—one with a large motorboat on a trailer. My friend knew the person who lives in the RV and inquired about the boat. The guy said it belongs to a friend of his, a woman who is currently “living out of it.” Someone is living in that boat.

I assumed F. and I would have another terrible weekend, but it has been wonderful. He arrived evidently determined to do everything he could to help us have a nice time together, and we did. For instance, he was wearing a shirt he knows I really like, and had neatly trimmed his mustache, and said that he was planning to skip going out to smoke his customary half a joint before bedtime. It was quite touching. I thought he was getting to the point where he was giving up on us, but I saw from all of his efforts how important our relationship still is to him. For my part, I will continue trying to practice acceptance and understanding, and I will appreciate and enjoy everything that can be appreciated or enjoyed.

Employee Suicide

So last Tuesday was kind of good, but on Wednesday I felt terrible again, grimly musing that I have not felt really great for one moment since starting clinical pastoral education, or so it seemed while I was in that dark mood. The first thing that happened at work was learning that a hospital employee had committed suicide and had been found by one of his colleagues, who went to his place with the police after he didn’t show up for work the day prior. Samantha’s boss, Jacqueline, sent a note instructing us chaplains to provide spiritual care to his colleagues. I sent Samantha a note asking where they were to be found, but since she almost never answers an email (and didn’t answer this one), I figured it out myself and went to see the group, who were very grateful. They kept thanking me for coming.

I went to see M.I., who ended up in the hospital after a fall which gave her a colossal bruise from her forehead to her chin, and then was discovered to be so demented that she can’t be sent home. That day I was poring over her chart and saw that her sister-in-law and her sister, who both live in another country, have declined to be responsible for her. There is another sister, but no one will provide her phone number, so M.I. is languishing in the hospital and says over and over that she wants to go home, she needs her clothes, she wants to go to church. I felt broken-hearted for her, so sad that her own family can’t or won’t do anything to assist. Of course, maybe she’s a terrible person and they rightly are turning their backs. Maybe she was the oldest sister! (Like me.) Or maybe they truly are not in a position to be able to help.

I told Samantha about this in our weekly meeting that afternoon, and, as they do in CPE, she asked what in my history might trigger such sorrow. She did not take at face value that my sorrow was about my patient. These are some notes I made a couple of weeks ago: I see this person is having this feeling, but I’m not having this feeling. Or, I am having this feeling, but it’s not about what this other person is experiencing. It arises from my own stuff. (However, even though it’s my stuff, I still need to address conflicts and share my feelings with others.)

This leads nicely to the next thing Samantha and I discussed on Wednesday afternoon. I have to back up to say that on Monday, Mason was on call, but did not arrive to take the pager from the previous person, which is supposed to happen at 8:15 a.m. He is late pretty much every single day—unbeknownst to Samantha, since she herself is often late, or may start the day with a meeting at another campus—and on that day, he didn’t arrive until 9 a.m. To his credit, he mentioned this himself in class on Tuesday afternoon. On Monday morning, I took the pager temporarily so that the person finishing his on-call shift could go home.

Before Samantha and I met Wednesday afternoon, I overheard her on the phone evidently talking to Jacqueline, saying that Mason has failed to follow protocol a number of times and that she was going to send Jacqueline an email she had drafted, to find out if it was too harshly worded. Or would it be better just to address in her weekly meeting with Mason? I heard her say, “OK, good idea—I’ll do that.”

In my meeting with her, Samantha said that on Monday when I took the pager—good thing I wasn’t waiting for thanks—it could be seen as an instance of over-functioning, and that Mason and I in effect had conspired or colluded to make it so that she wasn’t affected by Mason’s lateness. I said that I had taken the pager because making sure someone responds to it seems as if it’s the top priority, but that I could see how it could be seen as over-functioning, since I was doing something that was not my responsibility. (By the way, I guarantee that if I had not taken the pager and someone had called it and gone ignored, I would have been scolded for wrongly ordered priorities.)

Then Samantha asked how I would feel about letting Mason know how his tardiness is affecting me, including his being late the first two days of the program. I said that I, ahem, sort of feel it could be the role of a supervisor to address such matters, and she said that indeed a supervisor can do this sort of thing, but so can a peer. I didn’t really think she was trying to get me to do her dirty work. From firsthand experience, I know she is perfectly capable of delivering a clearly worded criticism or correction. I think it was that she was trying to stimulate a confrontation between peers, which is part of how people learn in CPE, but I had no intention of doing such a thing and have not done it. Mainly, that’s because I dread conflict (which is precisely why you’re supposed to do this kind of processing, to learn to be better at it), but also because Mason is sort of always doing something wrong and I believe is perfectly aware of it, and I just didn’t want to pile on.

Next, we went over my stats for the prior week: the number of minutes I spent seeing patients and charting, and the number of patients I visited. Samantha was gentle about this, but said that technically, I should be seeing eight times as many patients! I had seen 15 in a week (which is indeed pretty pathetic—am I just a born slacker and there is no doing anything about that?) and should have seen 120—which is never, ever going to happen. Even Samantha allowed that no one ever actually does this, but in theory, we have 30 hours a week to see patients, and should see four an hour.

Saturday, July 02, 2016

Copious Rectal Bleeding

The clinical pastoral education roller coaster remains in full swing. On Monday, I felt that I hated this work and would definitely not continue past the end of the summer. I am more oriented. I almost remember which way to turn after exiting the elevator or stairwell and almost know which patient rooms are mine without looking at my list. Also, I’m getting a sense for which of my three areas has the patients with the most repulsive ailments.

Early in the week, this seemed to be shaping up to be a career-ending, or career-aborting, problem. If I myself had copious rectal bleeding requiring half a roll of toilet paper to sop up, then I would just be dealing with that moment by moment, and if I visit a patient with the same, no problem. But reading the words “rectal bleeding” in a chart, along with the details about the half a roll of toilet paper, makes me feel overwarm and queasy. It’s definitely a possibility just not to read charts (though we are supposed to), but it is helpful to know if a patient has dementia or if he or she can’t speak.

I suppose I’ll get used to the chart thing sooner or later. I have been looking up terms and acronyms so I can understand better what I’m reading, 95 percent of which is not disturbing in the way described above. What I was hating early in the week was having, almost without exception, one short conversation after the other all day long. I realized that I was asking a yes / no question (about whether spiritual or religious support was needed) and added an open-ended inquiry about how the person was doing, or how their day was going. That added about seven seconds to each conversation (two for me to ask the question and five for them to answer it). Continuing to experiment, after one patient answered that question, I let a silence arise, and then said, “Tell me more,” and the person did actually tell me more, so I am learning, slowly.

Toward the end of Monday, I kind of cheated and went to see a woman who I know doesn’t need anything from me, but who is guaranteed to talk for 20 minutes, due to dementia. M.I. is quite a charming person, 70 or so and lovely to look at. It was such a pleasure just to sit down, which I rarely do during the day, and listen to her chat about this and that. That was the high point of the day.

Samantha returned to the office on Monday after her week away, and when I first heard her voice behind me, I felt a wave of terror. I was saying here that I couldn’t think of one instance of being spoken to rudely at my former job—I had completely forgotten the part about being bullied by a particular person for six long years. There are interpersonal challenges anywhere you are.

On Tuesday, I had some positive interactions with Samantha and two good—at this point just meaning long—patient visits, including one with a palliative care patient. Palliative care is not the same thing as hospice, but generally a palliative care patient is dying. This patient was talking away in a rather jaunty manner, but I could see the look of terror in her eyes, and several times it appeared that she was tearing up. By nature, I like to ask a lot of questions, but asking questions causes people to think instead of feel, so I replied very minimally, just saying “Mmmm” after each time she spoke, and very soon she was musing on what happens after we die.

We learned that day that Samantha is pregnant with twins. Normally I disapprove of attributing women’s unpleasant behavior to hormones (“It must be that time of the month!”), but perhaps she does actually have raging hormones, or worries about how she and her husband will support three children—their first child is just one year old—on two do-gooder salaries.

Periodically I get an email from my ex-employer inviting me to apply for this or that job. It’s nothing personal, just matching job titles, but it feels good to get these, anyway. It’s odd that you can be a chaplain by merely doing some volunteer training and you can also be a chaplain by putting in an immense amount of effort spanning years. Maybe being a volunteer chaplain in retirement would be enough for me. Also, I really miss being at the soup kitchen.