Sunday, August 14, 2016

Fortunate Cookie Season

Words seen on a storefront.

Last Sunday, Mason arrived in the morning to take over as on-call chaplain. He has been a strong proponent of my going on to TWMC—he has said I’m gifted and that this is obviously my career, that I’m a good listener and have a comforting presence. Last week, he summarized the turn of events: “You were accepted for clinical pastoral education at one of the best hospitals in the country, but you’re not going to do it because you’re afraid you’ll be tired.”

“Yeah, it does sound kind of stupid when you put it that way,” I agreed.

He and Andrew have been two of the best parts of this summer. One day when Andrew and I were teasing Mason about always being late and saying he should make more of an effort to be on time, Mason said serenely, “That’s not the French way.” (He is not French and has never been to France.) He is always utterly himself, and is such a dear person. In a grand finale of tardiness (unless he does even better this coming week), he arrived 90 minutes late one recent day.

Remember that hearty laugh I hoped for? I caused it myself one day when we were doing role playing. Beforehand, we were discussing earth-based religions. Mason, an Episcopalian, rolled his eyes and Samantha asked what he thinks of when he thinks of earth-based religions. He said he thinks of a woman—and here he finished his thought by using his hand to indicate long, flowing underarm hair. He concluded, “I picture a woman with a unibrow sitting in a forest next to a tree.” One long eyebrow over both eyes.

In our role play, I was playing the wife of the patient, Andrew was the patient, lying on a sickbed made of three chairs in a row, and Mason was the chaplain. (In real life, this patient fell from a height and was impaled on a spike. After poring over his chart, I’ve decided to try to avoid having this experience.) In the role play, Mason asked about our religion and I said, “We’re Earth Forest Wiccans.”

Mason refrained from rolling his eyes and politely asked, “Tell me more about that.”

I said, “Well, each month on the full moon, we go out into the forest, and we do a thing with our eyebrows?” I used my fingers to indicate my own imaginary unibrow, which caused all four of us to laugh hysterically and ended the role play; the patient sprang up from his sickbed clutching his stomach.

I herewith take back what I said about Stephen Jenkinson being a jerk. He is a person of decided opinions, but they appear to have been hard-earned. His prose is rambling and at times a bit vexing, but my patience with his book—Die Wise: A Manifesto for Sanity and Soul—has been very amply rewarded, and I am now recommending it to everyone. It makes an excellent companion to Atul Gawande’s superb Being Mortal. Read Being Mortal first and move on to Die Wise.

I got a nice note back from TWMC about my withdrawal from their yearlong CPE program, and in the days after that, of course began to regret my decision. In class one day, I asked Samantha, Mason and Andrew, “Should I call [person at TWMC] and say I’ve changed my mind?” At that, Samantha put her head down on the table in front of her. When she recovered, she said, “Never answer your own question,” and, “It’s your job to ask the question. It’s their job to answer it.”

Accordingly, that night I sent this note:
I am now wondering if I have made a giant mistake and if it’s truly my body saying “I can’t do this” or if that’s my mind, coming from a place of fear.

I assume my spot is gone by now, but if not, or if another opening should arise before September 6, would one of you be willing to discuss this decision with me? I won’t blame you if the answer is “No!” :-)

The next day, I got a note saying they had indeed given my spot to someone else. For a couple of days, I felt bad about it, but then I spoke with my chaplaincy mentor, Naima, who reminded me that she had said months ago that it might be wisest to do the academics before doing CPE and also that I should keep an eye on my tendency to leap forward, getting ahead of what I have actually discerned is true for me.

She said to be sure to leave this summer unit with a good idea of what my strengths and weaknesses are, as judged by others, and that I might now profitably do some therapy about what came up in CPE that was difficult for me, take some courses at the Chaplaincy Institute in Berkeley, and / or go on a retreat. She said that being in the hospital stimulates the reactive mind while meditating stimulates the responsive mind. She said she thinks the particular CPE program and supervisor are just a small part of the process and that by no means has the world come to an end because I won’t be at TWMC this year.

Finally, she assured me that nothing has gone wrong and that she is not worried about my path. She said I’ve figured out what to do until now in my life, and that I’ll figure this out, too. “This is all part of becoming a chaplain: this is exactly what becoming a chaplain is.” Plus, I’ll always have the happy memory of Samantha putting her head on the table when I asked if, having withdrawn, I should unwithdraw.

I got this uplifting note from my friend and bodyworker Jack: “Sounds like you have clarity regarding this choice. It was a wonderful honor to be invited into that program and it’s a wonderful honor to listen to the whole of your life and build your choices from there. The chaplaincy does feel like such a lovely culmination of all that you are and I’m sure you will find your way forward with it.” I think so, too, and I now feel sanguine about the whole thing. I obviously don’t have a sound decision-making process, or maybe it would be more charitable to say that my natural decision-making process entails one reactive lurch after the other, and somehow I eventually end up somewhere else; that’s how I’ve made every decision I’ve ever made. In sum, the reason I wasn’t sure about TWMC was that I wasn’t sure!

Meanwhile, somewhere along in here I took Hammett to Mission Pet Hospital for a periodic check of his thyroid and was disappointed to learn that he has lost more than a pound since he was last weighed, in March. He now weighs as little as he did right when he was diagnosed with hyperthyroidism. I had noticed he was a bit more frenzied, and that the bones of his spine seemed slightly more prominent.

I was hoping it was a matter of needing to increase his medication, but Dr. Press said the next day on the phone that his thyroid looks fine, and thus does not explain the weight loss, which Dr. Press said is worrying. He said it might not be anything bad—it might be a urinary tract infection or something with his gastrointestinal tract—or it might be something bad. Other than being a little more energetic, Hammett seems just as cheerful as ever, which I hope means it’s not something terrible. However, he’s been through quite a bit medically for a cat just ten years old. If it’s his time, then it’s his time.

Yesterday my walking friend and I had lunch at Ananda Fuara, and in the evening, Lesley and I had dinner at Tacolicious, one of the many new places on Valencia St. The tacos I had were utterly delicious—one carnitas, one chorizo and potato, one cod. One of them had a long hair in it. Our server replaced it but did not apologize or offer to adjust our bill.

Sunday, August 07, 2016

Very Bad Chaplain

Yesterday I was on call and intended to goof off all day—I think I was worried that I’d have a profound experience with a patient that would make me feel I’d made a stupid decision regarding TWMC. But at about noon, I’d run out of non-work activities, and also had to acknowledge that my numbers for the week looked pretty pathetic, particularly after not having seen a single patient all day Wednesday. Number of minutes spent seeing patients; number of minutes spent looking at charts prior to visits, charting after visits, and traveling to or from or otherwise preparing for visits; number of patients seen; number of initial visits, etc.

So at noon I went to one of my three floors and visited all the good candidates for visits, including an old man I had seen before and liked right away. After our visit, while I was still on that floor, he received bad news and asked to see me again. He’d learned that he has a tumor and said he would like a prayer. I asked what we should pray for and he said he hopes that if he has to have surgery, “I come out a winner.” Here he choked up. I felt very touched by our encounter, and indeed felt that maybe I’d made a big mistake; maybe I should email TWMC first thing Monday and take back my resignation. Or maybe they will say, “We respect your decision, but would you like to come in and discuss it in person?”

At three p.m., numbers much improved, I was going to go to another of my floors, but was paged to attend to a dying patient. Her family wanted a priest to come and perform last rites and also a chaplain to come. I summoned a priest—they only come if the patient is Catholic and if a specific sacrament is needed—and he performed the rite and offered absolutely wonderful prayers as the other five of us stood with him around the body of the dying woman. He told the dying woman, who was unconscious, that she could release all fear or trepidation, and to lead us into the Lord’s Prayer, he said something like, “At a time like this, we can call upon God as we call upon a loving parent: Our father … ”

After the priest left, the woman’s two daughters said they did not want to see their mother die and that they wanted to leave, with their husbands. I said that was fine, and that I would stay with their mother. Then it occurred to me that maybe they didn’t really want to go, but were scared of being with a dying person. I’m surprised people would want their loved one to potentially die alone, but I can understand being afraid of witnessing the moment of death. I added that if they would like to stay, I would stay with them and keep them company, and all four of them ended up staying. The young, tattooed nurse felt bad about not being able to hang out there with them and said to them, in reference to me, “You’re not alone—thank goodness.”

We sat there together for more than two hours, and eventually everyone relaxed and one of the daughters told me about her mother, the flowers she grew and the dresses she sewed and the meals she cooked. After the mother’s heart stopped but before the breathing machine was turned off, her children left the room. I told them I would stay until she had passed. In her final moments and just after, I put my hand on her forehead and told her all was well, and that she was very loved. After she was gone, I said, “Rest in peace,” and at the doorway, I bowed to her.

We have a template we use for chart notes, where we fill in various pieces of requested information. I deleted most of the template, and entered the names of the patient’s daughters and their husbands. I referred to the patient by name instead of as “pt” and I typed in what her daughter had told me about her, so that my note could be a small memorial.

At this point, I was even more sure I’d made a terrible mistake regarding TWMC.

I went to the apartment where we on-call chaplains stay, where I have never gotten a page later than 5 p.m., and at 7:40 p.m., just as I was thanking the pizza delivery guy, a page came in: a patient was actively dying at another campus and his wife wanted a priest. I spoke with the wife on the phone and found it difficult to explain, in my limited Spanish, that since her husband wasn’t Catholic and therefore not in need of any sacrament, we couldn’t ask a priest to come. She was Catholic and just wanted to talk to a priest. For that, we have on-call chaplains, but this particular on-call chaplain was about to scarf down an entire pizza and was thus disinclined to serve. The woman was under the impression that I myself am a priest: “Are you a father?” (Hmmph.)

I told her I would call her back and called the nurse to ask if there was a staff member around who could translate for us. The nurse said there wasn’t, but that the woman’s son should be able to do that. I said it was fine to give him my cell phone number, but never heard from him. I rationalized that if they really needed me, they would have called, but I definitely felt guilty. I should have just gotten in a cab and gone over there. (I found out the next day that the patient died about 20 minutes after his wife and I spoke. She sounded remarkably composed, another reason I didn’t rush to her side.)

Don’t worry, I didn’t go unpunished for this. At 9:35, just after I’d gotten in bed, yet another page came in, again from a different campus. A family had gotten the news that their loved one was going to die and wanted a chaplain to come. It didn’t sound as if the patient was actively dying, so I called Samantha to see if we still go in that case: yes. So I got in a cab and headed over there, at this point past compassion fatigue and into active hostility. In the woman’s room, all hard feelings forgotten, I offered a prayer, which was pronounced “beautiful” by one of the 10 family members present.

My cab driver on the way back was born in 1944 and didn’t go in for pot smoking and all that in the 1960s; he was a boxer. Later he traveled with bands as a roadie: Santana, Journey, Natalie Cole. I told him my very first concert was The Spinners, with Natalie Cole, at the Bowen Field House at Eastern Michigan University in Ypsilanti in 1976, when I was 14. “That was me!” he said.

Yes, my decision regarding TWMC was correct. I will take the long way to whatever the destination turns out to be.


I was sure remorse about my decision would set in, since I change my mind about everything all the time, but after I sent my note, I did indeed feel relieved. I like a simple, quiet, orderly life with no dirty dishes in the sink and plenty of sleep. Samantha, in the way of the clinical pastoral education supervisor, periodically asked what my theology, or dharmology, had to say about this decision or whatever else we were discussing. I don’t feel obligated to obey the words of the Buddha, in part because Howie regularly reminds us not to be Buddhists, or even “meditators,” but just to be awake.

On the other hand, I have never through experience concluded that anything the Buddha said was wrong, and I have been thinking lately about his view that we ourselves are as deserving of kindness as anyone else is, and also what he said about living a life unburdened with tasks.

Here’s the beginning of the Metta Sutta (“sutta” means “teaching” in Pali):

This is what should be done
                By one who is skilled in goodness,
And who knows the path of peace:
                Let them be able and upright,
Straightforward and gentle in speech,
                Humble and not conceited,
Contented and easily satisfied,
                Unburdened with duties and frugal in their ways.

I kept thinking I could find a way to be at ease while doing CPE and to have a sense of well-being, but the truth is that I felt worse with every passing day. It’s possible that during a year of CPE, I would have figured it out, but more likely that I would have felt increasingly stressed and miserable and that I might even have become physically ill. It’s hard to relate to others from a place of well-being if one doesn’t have any. Friday evening I celebrated having made my decision and communicated it with a pesto pizza with pepperoni and sausage from Marcello’s. It was delicious and I slept quite well afterward.


By Thursday of this past week, I was deep into pondering my own values. The most important ones seemed to be financial security, health insurance security, and liking to be well-rested and not stressed out. On the other hand, there are all those years I wished I were doing something more meaningful, and how great it feels to have a sense of purpose, or mission—to do something I’m actually passionate about. That is also very important.

My skills have slowly been improving. I’ve gotten more practiced at assessing spiritual resources, including what support the patient has from family members or friends, which makes it easier to tell who needs what and how often to visit which patients. In one chart, I saw this in a note from the ethics committee: “Patient is Jewish and being followed by Pastoral Services.” I’m the only chaplain who has seen this patient, so that was me! Doctors, nurses and other care providers do read our notes.
Thursday night, my downstairs neighbor had people over, some rather loud. You know what I’m proudest of in this whole summer? That not one single time did I call Tom, my best friend and downstairs neighbor, to ask him to be a little quieter. He is fond of videos of cars going around and around a track, or planes flying around and around in a circle (judging from the sound), and in the past I’ve now and then given him a call, but this entire summer, I have said to myself what Howie once told us he says to himself: “I will take what the dharma gives me.” I did the same that night and eventually I did go to sleep, and woke up feeling unbelievably lousy, and clear (for the moment, anyway) that while I might indeed like to work as a hospital chaplain, I need to be on the ten-year plan, not the three-year plan. This is going to have to be a marathon, not a sprint. My body is making it clear that it has no intention of doing a year at TWMC.

When I arrived at work on Friday, just two people were in the office: Rebecca and Victoria, the other CPE supervisor. Samantha supervises us summer interns, who are finishing one unit of CPE. Victoria supervises the residents, about to finish their fourth units, and I think she has considerably more experience than Samantha, certainly more life experience. I asked if I could speak with her for five minutes and told her that I feel like I’m dying—she looked concerned—and that I don’t think I can do the year at TWMC.

She asked how she could be of most help. I said, “I guess I want someone to say it’s OK to do this the slow way and that I’m not blowing a fantastic opportunity by not doing the TWMC program.” She thought for a moment and said, “You are blowing a fantastic opportunity, but this might not be the right program for you.” She did one unit of CPE in a trauma center, which caused her to realize she did not want to do a yearlong residency in a trauma center, so she went elsewhere. She said that the TWMC program is excellent—they are among the top eight hospitals in the country—but relentless. She said that TWMC treats extremely ill people, people who come from all over the country, and that stress permeates such hospitals from the bottom to the top. She said a year of CPE there would be an “endurance contest.”

I think I would actually enjoy working with people with trauma, but if I am not physically thriving where the on-call arrangement is so relatively generous, I am not going to survive something much more intense. Victoria told me about a woman she knows who decided to take a leisurely path to certification, doing just one unit of CPE yearly until she had completed her four units. This woman wanted to feel well and be in good health at the end of her training. Victoria said she saw this woman as a role model, and reminded me that there are many different paths we can follow to our goal. I’m not even sure I absolutely have to work as a hospital chaplain. Just being kind to people in general might be good enough. Volunteering might be good enough.

So that was helpful, and so was Rebecca, who overhead me saying I am planning to try to return to my former company. She told me she had worked there herself and learned valuable things, as well as in a subsequent job she had as a marketer at American Express. She talked about how financial security is a good thing and how our long-range plan can have a variety of chapters in it. After talking to Victoria and Rebecca, I felt that it would be perfectly fine not to proceed to TWMC and also perfectly fine to seek a job at my former company. (Cross your fingers for me.) Now all I had to do was tell TWMC. That evening, I sent them this note:

Dear [three people at TWMC]—

I will always be grateful and extremely honored to have been accepted into [TWMC]’s yearlong CPE program.

My experience of doing one unit of CPE at [VFMC], which will conclude two weeks from today, has affirmed my interest in chaplaincy and I feel more deeply than ever what a profound honor and sacred trust it is to be at the service of those who are aging, ill or dying, and their friends and families. However, I am getting an unmistakable message from my body that my path will have to be one that is slower and perhaps more meandering.

I am sure it is a significant inconvenience for you to have a student withdraw after so many HR procedures have already been completed—I am extremely sorry that clarity didn’t arrive sooner and ask for your forgiveness.

It has been lovely to interact with all of you in person and/or via email, and I hope the year will be wonderful for you and for your lucky students.

With relief, some embarrassment, much gratitude and many good wishes,

Pre-Mortem Gala

Last Monday, which I had off because I’d been on call on Saturday, Carol Joy and I saw Captain Fantastic, with Viggo Mortensen, and Absolutely Fabulous: The Movie, followed by dinner on Valencia St. She told me about a friend who decided she would like to hear all the nice things people might say about her after she’s dead while she’s still alive and, after a year of planning and preparation, threw herself a very well-attended pre-mortem featuring displays based on her life, such as pictures of all her boyfriends and husbands over the decades. She lay in a pine casket (yep!) and got to hear all of her friends’ loving tributes.

Tuesday afternoon in class we discussed our call to chaplaincy, and Andrew said some things I found helpful. He talked about making the mistake of trying to decide on what his call was rather than letting his bones tell him. Of one possible career path, he said, “My body didn’t want to do it.” Of a thing he did decide to do, he said, “I couldn’t not do it.”

That day we also did an exercise where we non-verbally acted out dynamics we had observed among the three of us. It was brief and rather shockingly revealing. It showed how Andrew and I can sometimes ally against Mason, supposedly the person who has difficulty with emotions; probably it’s Andrew and I who are impaired there. It also showed how Andrew and Mason, the two men, can ally against me, and how I then immediately withdraw.

In my weekly meeting with Samantha the next day, I asked what the point had been and she said that the dynamics among the group of students are also likely to arise in our work in the hospital, and I think she is quite correct about that. For instance, I leave a bit more physical space around myself in interdisciplinary rounds than others do. I assume that the others are the experts and also that they know each other fairly well. I am new to the group and new to hospital chaplaincy, so I also assume that I am not wanted and express that by where I place my body. Standing closer to the others might communicate more confidence in myself and more trust that others are open to my contributions.

In the same meeting, Samantha, per a discussion she had with Jacqueline, withdrew her deadline for telling TWMC I won’t be there (which had been Monday). She amended that to say it would be good not to start if I don’t plan to finish, and if I start and then must stop, it would be good to give as much notice as possible and to finish the unit in progress; the year consists of four units. She pointed out that I’m getting a lot of advice from others and may feel pressure not to disappoint others. She asked what my own values are, and what my own theology (dharmology) says. She said that we might not be able to have everything we value at the same time when going through a transition.

I was utterly fried that afternoon and saw no patients. I sat in a semi-comfortable chair in a lobby in one of the hospital buildings until it was finally within 45 minutes of the end of the day. Back in the office, I said to Samantha and our office manager Rebecca, “I thought of a good reason I can’t be a chaplain: I’m an introvert. One hour per day of being with people is enough for me.” Rebecca always defers to Samantha, but on this occasion, she said, “Bugwalk, I’ve never known a chaplain who wasn’t an introvert.” Samantha said that if I conclude I don’t want to be a chaplain because I only want to see people one hour a day, she can respect that, and she can also respect it if I say, “I don’t love seeing people eight hours a day, but I find it meaningful.” Samantha herself is one of the people I’ve felt subtly pressured by. I think she has wanted me to go on to TWMC, but on the other hand, she has never said, “You’re the most promising student chaplain I’ve ever met!”