Sunday, September 18, 2016

Whatever You Have to Do Today, You Can Do It

There are lots and lots of young people on the TWMC (Truly Wonderful Medical Center) campus, certainly the students, but even the people who work there look awfully young, going by the pictures posted on the walls of the units I’m assigned to. I noticed a lot of people marching right up the center of the sidewalk, which struck me as arrogant, but if that’s the culture, that’s the culture: I must adjust. I was also realizing that probably 98 percent of the brand-new medical students are scared; anyone who is not scared is probably overusing substances. I’ve developed a silent practice of looking at a student and thinking, “You can do this. Whatever you have to do today, you can do it.” I’m saying the same to myself.

The palliative care chaplain came to visit our class one day last week. She is a Theravadan Buddhist who has been meditating for 50 years, and she brought a force field of calm into the room with her. I could feel it unmistakably from several rows back.

Someone else in our group of 14 students has taken my usual role, which is to ask a million questions about every possible thing that might happen. It’s interesting to watch anxiety rise and fall for individuals and the whole group, and to notice my judgments of others’ anxieties, which is a strong indicator that I am intolerant of those feelings in myself. Am I really calm, or just clamping down on feelings?

I was taken by various outgoing interns to visit the areas I’m assigned to in the hospital. Two of them are low-acuity (people aren’t acutely ill) with high turnover, meaning long pastoral relationships probably won’t develop. A third is the pre-operative area, where people are busy being visited by nurses and the anesthesiologist, etc. The fourth is the post-operative area, where people are under anesthesia, and after they wake up, they go somewhere else, judging from my own experience. Finally, I have been assigned to a waiting room! Paranoid thoughts arose: Did they deliberately give me all the low-stress areas in case I flake again and these areas end up not being covered? Every single one of my peers has an ICU, or the emergency department, or a unit where babies may die. But I will take what has been given to me and do my best with it. I gather a lot of people didn’t get the assignments they wanted, and our teachers said they didn’t want to ignore that disappointment, but it is their experience that people end up feeling that whatever units they were assigned to were perfect for them.

I was worried before my summer unit of clinical pastoral education that I would react to the hand sanitizing gel. They had two kinds, and neither turned out to be a problem, though one smelled kind of nasty. TWMC has a different kind, and it immediately made my hands feel a bit irritated. But I mentioned that to my supervisor and she said there was a student two years ago who was sensitive to chemicals, and there is some other stuff such people can use.

I was kind of disappointed to learn that, because I was thinking this would end my CPE experience, and I was already kind of looking forward to quitting. “Oh, well! I really, really tried!” I would also then have to avoid TWMC permanently for my own medical care, lest they terminate me during a mammogram or pap smear.

TWMC has two campuses. One is new and beautiful and in a part of town with superb weather, not too far from where I live. The campus where I’ve been assigned is old and shabby and smelly: atmospheric. The weather there also is not very good. It tends to be overcast and chilly. The small student room in particular is revolting. It smells, it has little natural light, and the chairs are stained. Instead of having lockers with locks, we have unlocked filing cabinet drawers, one per student, in which to store our valuables. This room is a good hike from the actual hospital, separated by maybe four buildings, two of which are being torn down.

One day I found three boxes of doughnuts in the student room. New student (not me): “I’d better not.” Outgoing student: “What?? Not eating doughnuts is not a choice. You have to eat doughnuts!” Now I see why several people have said that everyone gains 20 pounds during their year of CPE. This is all quite different from VFMC (the Very Fantastic Medical Center), where I was during the summer. Our student room there was a large office we shared with staff chaplains and a handful of other employees. Two walls were entirely covered with a lovely, soothing hand-painted mural. Natural light streamed in several large windows. The hospital itself seemed clean and new and beautiful. We each had a locker with a lock. Adjoining the office was a gorgeous yoga studio with a bamboo floor. Not one single time did I lay eyes on a doughnut. (Because they are not a health-supporting food and we were in a hospital!) We would have treats if we had a celebration, but only then, and leftovers, even of sweets, would sit for days before they finally disappeared.

Here’s one good thing: At VMFC, if you’re there on weekends because you’re on call, you have to round on your normal units (visit the patients there). At TWMC, if it’s the weekend, your only task is to respond to pages. Of course, that very well might end up being a whole day (and night) of work. One person who showed me around said he didn’t find his duties there particularly stressful. He said the hardest part was when a young patient who wasn’t expected to die did.

Despite my low-acuity areas (waiting room!), I will have plenty of exposure to dying and death when I am on call. This gives me the opportunity to mention that at VFMC, the sleeping room was a whole apartment located in a building across the street from the hospital. At TWMC, the sleeping room is a cramped, foul-smelling room inside the hospital and just yards from the main entrance, so it is probably noisy. There are no windows in it. It’s just big enough for a fold-out bed. We can’t go in it until 9 p.m. on weeknights—two hours past my bedtime—and we get off at 4:30 p.m., so the student chaplain may have to find somewhere to twiddle his or her thumbs for four and a half hours.

At 54, I think I’m the oldest person in the group (also older than every supervisor, I believe). There is a woman who is 50 and a couple of people who appear to be about 45, and everyone else is 26, give or take. Good thing I didn’t put this off any longer.

Needless to say, I did not sleep well the night before starting CPE nor really any night since. However, whatever I was sick with I never noticed again after the first day, after starting to take Sudafed, per the precisely correct recommendation of my doctor’s assistant.

Friday we got off a little early, so I went to 24th St. and the Castro in search of shoes; my feet are killing me. Yesterday I got up at the crack of dawn and did my laundry, talked to my 40-year friend on the phone, took Hammett to the vet, ate, went to see F. at his place, went to the mall in further search of shoes—it was very hot and sunny; I felt dazed and bedraggled—went to a shoe store on Mission St., went to see my shirt lady, came home and ate and went to bed early. I’m going to try to make it so weekday and weekend bedtimes are about the same.

Today I went to Rainbow and did my cooking for the week, which for the next year will consist of slicing three cucumbers and boiling some eggs. I sorted through all my various pieces of paper and emails and electronic documents for TWMC and made a giant list of questions and things to do. I wrote an assignment that is due Tuesday, after new employee orientation tomorrow. I have a massive backlog of reading, which I will just have to fit in somehow. Like, it would be good to read the stuff about being on call before Friday, when I’m on call, but I don’t see when I’ll be able to do this. On-call starts at 4:15 p.m. and goes until 4:30 p.m., so on Saturday, I will be the only chaplain at that campus of the hospital, no doubt confused and exhausted, and certainly unshowered.

However, having done the summer unit makes an enormous difference. I would be going completely crazy if not for that. Much that I heard last week was already familiar to me, plus TWMC uses the exact same charting system as VFMC, but in an even simpler way, thank Sam. Also, speaking of Sam, it’s so great to have a built-in friend. I would not have even been able to do the assignment I was doing today if not for having done the summer unit and if not for Sam emailing me his so I could get an idea.

Please feel free to point out typos and obvious mistakes here—I suspect there will be a lot of both over the next year.

Wednesday, September 14, 2016

First Day

Wow. Even with basically no sleep and a probable brain tumor, this was like night and day compared to my first day of clinical pastoral education this past summer. It makes a big difference to be with people who are really, really nice. I’m sure they can be jerks (just like me) and are perfectly capable of being firm when necessary, but the whole vibe is kind and gentle and supportive and warm.

Sam said there is one supervisor he’s not crazy about—she keeps kind of yanking his chain—so I knew she would end up being my supervisor, but it turned out she isn’t. My supervisor is a very nice woman who has a small child. She told me just to go with the schedule for now and they’ll try to get me caught up next week.

There are 14 people in the whole group, six of whom are Buddhist, and another couple “Budd-ish.” At least one person reported having no religious affiliation at all. Everyone was extremely friendly. One young man turned to me and asked, solicitously, “How is for you to be here today?”

There was an abundance of breaks. We heard 45 minutes about this, then had a 15-minute break, then heard 45 minutes about that, and had another break. Mid-day, we were treated to quite a yummy catered lunch while we met with members of the Professional Advisory Group. One session was on the health, dental and vision coverage we have all been signed up for, which sounds like excellent coverage. We also did a session on charting. They use the exact same system that we used at VFMC, but in a simpler manner; they mostly just have us make selections from lists and actually discourage lengthy narrative. They pointed out that the patient gets to read whatever we write, so simpler might be better.

Besides finding out who my supervisor is, I found out which campus I’ll be at and which units I’m assigned to. One is orthopedic surgery, which I also had at VFMC, but someone pointed out this might be different. There will be some people who have joint replacements followed by smooth recoveries, but others who have had the same surgery fail six times in a row and have come to TWMC as a last resort. One of my colleagues was assigned to pediatric oncology. A chaplain who works there said not to worry that our assignments will have an adverse effect on getting jobs later. He said people do not care what particular unit you worked in and that we will get jobs because employers will know we went through a very rigorous CPE program.

I’m in a small group of five people: the woman who took my place when I dropped out (Budd-ish), a woman who is Christian and into yoga, a fellow from Burma who is a Catholic priest, and another man who is, like me, a Theravadan Buddhist.

One thing I learned from this summer was not to take tons of notes, because they just have to be typed up later, which takes time, and may be rarely if ever consulted. I took very few notes today.

At the end of the day, we all went out to a sunny spot in a nearby park and put on a temporary altar—a colorful blanket on the ground—an object we’d brought along to symbolize our feelings about the transition now underway. We each described our object, and while this kind of thing might not be naturally something I’d think of doing, I could really appreciate each person’s sincerity and openness. These are lovely people. We also had been asked to bring along a poem or prayer rolled up like a scroll and tied with a ribbon or piece of yarn. We put all of these in a basket and then each took one. I had to tie mine with string, but it was really a perfect poem, by Molly Fumia, and the person who ended up with it, who is one of our supervisors, was delighted by it.

Almighty Sam

For the past week plus a couple of days, I have felt very fatigued and have had a headache much of the time, which is extremely unusual for me. The last time I was at the soup kitchen, I had to sit down before my shift was over, which has never happened before. I have also felt dizzy at times, and faintly nauseous. I concluded this might be a flare-up of mono, per what I read online, and have spent a lot of time resting.

As energy permitted, I also started casting various irons into the fire. I have been researching the two-year chaplaincy program at Upaya Zen Center and the 12-module program at the Chaplaincy Institute in Berkeley. I also applied for a temporary position with my old employer. I noticed that I felt energized by the former and disheartened by the latter. On the other hand, I didn’t immediately hear back from the schools—I still haven’t heard from Upaya—whereas the day after I applied for the job, the hiring manager called me, and the day after that, we had an interview on the phone, and the job actually sounded very fun and interesting.

I emailed my wonderful contact in HR to ask what would happen if I accepted a temporary position but declined an extension to that position—would that end my severance pay? Going a bit further, what if I were to leave a temporary position at some random moment (i.e., to start the program at Upaya)? Surely that would end my severance pay. But it turned out the answer to both questions is no. You can decline the extension to a temporary position or leave it whenever you feel like it and still get the rest of your severance pay. Remarkable. (A small good thing to balance all the bad news about this company lately heard.)

I had told the hiring manager that I could start right away, and there didn’t seem to be any downside to that, particularly given that I could leave the job at any moment and go back to getting severance pay, or maybe it would prove to be a fantastic job that I would do for years.

On Sunday, I still felt lousy and had to miss the big annual potluck which is held at the soup kitchen itself rather than at Thomas House, where the core community lives. On Monday, I got a call from the Chaplaincy Institute and had a wonderful conversation with the admissions manager. I figured that either I would get a job with my old company and start doing the Chaplaincy Institute’s program, or I would take the next two years and do the Upaya program plus the Chaplaincy Institute’s classes, and then I would finish with a year of clinical pastoral education at VFMC, where I was this summer, and then I would look for a job.

Lately I have had the feeling that something excellent was going to happen. Maybe that was just the feeling of having a number of appealing options, which is indeed a good feeling, but it seemed stronger than that. Over the months, I’ve had a handful of what I think of as chaplain dreams, and I had one a couple of nights ago, where I was wearing a robe like a Zen Buddhist would wear, and I had a wrist mala on—a circle of beads that some Buddhists wear around their neck or wrist (which I would not be caught dead wearing in real life). In the dream, I also had a circle of beads around one finger, like a finger mala.

Yesterday morning I still felt crappy and was reflecting that I am more and more appreciating the frailty of the body, how it periodically says, “Time to rest!” I finally called my doctor and got a call back from her assistant, who is an excellent diagnostician, and who said she would not immediately conclude that this is a brain tumor. She also didn’t think it was a mono flare-up but more likely a virus of some sort, maybe an inner ear infection or fluid in the inner ear. She said to try taking some Sudafed and to call again if it’s not gone in another week.

I had asked Jacqueline to send me the link to the application for part-time work at VFMC and not heard back, so I figured that conversation was at an end, but on Monday of this week, she sent the link. I had been starting to think that being on call Saturdays actually would not be a bad thing; I was remembering that I liked being on call on weekends because then you get to handle all the pages yourself rather than dispatching them to appropriate co-workers. Also, nearly every page represents a person who actually wants to talk to a chaplain, whereas making normal rounds involves talking to rather few people who want this. Also, the hospital is quieter on weekends.

I turned on my computer yesterday morning to get Jacqueline’s phone number and called her to say I’d reconsidered about Saturdays. It was fortunate that I had the urge to call her, because I might not have turned my computer on until much later. Now that it was on, I noticed an email from Sam, my friend who began CPE at TWMC last week, reporting that someone had already dropped out of the program! He sent a second email saying he’d mentioned my name to two of the teachers.

Though my reasons for deciding not to do the program were sensible, I regretted that decision and felt a pang every time I saw a TWMC van go by, or when I thought of those who would have been my peers starting their huge adventure without me. I didn’t really expect hear from TWMC yesterday, but it was clarifying to note my reaction to the possibility: great excitement and enthusiasm.

Now and then I get a call which is someone responding to a page; whoever sent the page typed in the number wrong. I think these pages originate from somewhere in the TWMC health care system; I’ve been getting them for years. As it happens, I got one yesterday morning after seeing Sam's notes and had to smile—at least I got some sort of call from TWMC.

And then a bit later, there was another call, and this time the caller ID said “TWMC MED CTR.” Yeah! It was the spiritual care director calling to say that someone had dropped out and that a rumor had reached him that I was still interested in doing the program. “I’m there!”, I tried not to yell in his ear. It was a joyful conversation. I could tell he was smiling as he said, “I know you Theravadan Buddhists don’t pray to God.” Naima, my chaplaincy mentor, said something similar later on the phone: “Does this change your mind about whether there’s a God or not?” (She is a Zen Buddhist and Mystical Christian.) I don’t think this has made me believe in God, but it’s really made me believe in Sam. Thank—uh, Sam that I had a friend on the inside who could mention my name at the right moment. Thank Sam!

After I spoke with the spiritual care director, per his instructions I called the administrative assistant who had helped me with all my application and onboarding stuff earlier, who now yelled, “Miss Bugwalk! How are you? This is wonderful! This was meant to be!” I felt very, very thrilled and delighted.

I slept not last night, and finally gave up at 3 a.m. and got up to write this (plus the preceding entry, craftily backdated). However, I feel all right. Either the Sudafed helped, or I’m too tired to tell how I actually feel. If I don’t die on the first day, that will be a good omen. Or if I do, I’ll already be in a hospital, surrounded by chaplains! There are 14 student chaplains in my group, and six of us are Buddhists. (However, the spiritual care director is not a Buddhist. I said that in an earlier post. He isn’t. The one at VFMC is.)

I was remembering a day in that somewhat horrible month of August, when I was changing my mind twice a day about whether to go on to TWMC or not. One afternoon, when it was clear that I would be there, I felt a quiet but unmistakable wave of joy and almost awe: I am doing this. I am going to be a chaplain.

I am doing this! I am going to be a chaplain! I start the yearlong CPE program at TWMC today!

Friday, September 09, 2016

Bazooka Joe

So, let’s see here, I did take Hammett to his doctor in the middle of August and he was examined and had more bloodwork done and got body X-rays to make sure he didn’t have a bulging tumor in his midsection. The prior appointment and labwork had cost about $150, and had shown that Hammett’s thyroid level was a bit elevated, but not enough to have caused his weight loss, in his doctor’s view. The second appointment and tests—which all proved to look perfect—cost $650 more, for a grand total of $799, after which Hammett’s doctor concluded that elevated thyroid was, after all, the culprit, and advised increasing the amount of methimazole he gets daily.

Since Hammett did have a known condition and his symptoms and original labwork were perfectly consistent with that, I’m planning to say something about this and am in the process of wording my remarks. I think highly of this doctor and count on him absolutely, but, as I was reading somewhere about the training of medical professionals, when you hear hoofbeats, think horses, not zebras.

You may recall Jacqueline, Samantha’s boss, saying she would not consider someone for even a part-time per diem position as a hospital chaplain unless that person had finished all the education plus a year of CPE, and furthermore that the CPE would have to be after the education, not before. Therefore I was flattered and very surprised when, toward the end of my summer of clinical pastoral education at the Very Fantastic Medical Center, she offered me a part-time job, one eight-hour day plus one 24-hour on-call shift weekly.

She invited me to her office for an interview and told me how to change my resume to make it into more of a chaplaincy resume, and we had a discussion or two on the phone. She wanted someone to be on call every Saturday, and I suppose that, as a fledging chaplain, I should have leapt at the opportunity, but I really didn’t want to do that, and after saying so, I didn’t hear from her again, and concluded that might be that. I know that at least one person finishing up the yearlong program at the Truly Wonderful Medical Center (where I would have started earlier this week had I started there earlier this week) has applied for the same job, and will probably get it. That’s OK. I’m on the slow and leisurely track, and if I never get there at all, that’s all right.

Poor Samantha, who is pregnant with twins, was extremely ill our final week of CPE and only able to drag herself in on the very last day. I’ve never seen anyone at work who looked more miserable. She came to oversee our presentations of our final self-evaluations, in which we also had to write about our relationships with our peers and with Samantha. The latter opened a final can of worms or two which I suppose will go permanently unresolved.

After that, we rushed over to another campus of the medical center for our graduation ceremony, and Samantha went home. We three interns graduated that day, plus the four people who had done the yearlong program. In addition, a couple of the five people starting the yearlong program now underway attended our ceremony and one of them said that if he didn’t get a chance to speak to me again, he wanted to thank me for being the only person in the spiritual care department who was friendly to him when he started! I don’t know what to make of that. Shouldn’t spiritual care providers be extra-friendly, or at least no less friendly than the general population?

There was one day between CPE ending and my nine-day retreat at Spirit Rock Meditation Center beginning, and I spent that day making final changes to my self-evaluation and updating my resume per Jacqueline. On that day, I also noticed a painful lump in one breast, very similar to that which proved to be mastitis a year ago, except that there was no red streak. This was not good at all, because my breast cancer surgeon lately retired, and I was positive my new doctor would insist upon my coming in before prescribing antibiotics. I did some research and concluded that it might be a blocked duct, which I commenced treating with a heating pad and massage, including applying the flat end of my electric toothbrush, and over the next couple of days, it cleared up and no red streak ever appeared.

The retreat was wonderful, partly because I had an extremely difficult roommate and was forced to exert extra effort to return to my chosen object, which I did successfully over and over and over. My teachers were pleased. Phillip said, “I’ve known you for many years and this is a new level.” Sally encouraged me to apply for the Dedicated Practitioners Program and said I could use her as my sponsoring teacher. She said, “You’re one of the more sincere practitioners that I work with.”

I really did not have very much discursive thought during this retreat, but each day we did a period of metta practice, and I was using my father as my benefactor, which caused me to recall the afternoon he set out to teach me how to blow bubbles with bubble gum. I was maybe four years old, and I distinctly remember our being in the front yard of the first house I lived in in Ann Arbor, and my father giving me a couple of pieces of Bazooka Joe. It was touching to think of him, rather a young man himself—28, if I was four—perhaps having made a mental list of all the things his children would need to know, including how to blow bubbles, how to play tennis, and that exercise is good for you.

When we were children, he bought each of us a brightly colored duffel bag, perhaps thinking of the family trips we would take. I still have that red bag, plus another extremely durable duffel bag he bought me. In fact, I had that latter bag with me at the retreat. I use it regularly, and 40 or 45 years after my receiving it, it shows virtually no signs of wear. (It was from Lands’ End.)

One day, from my dorm window, I saw two young deer foraging for food near their mother, who was sitting on the ground nearby. Charmingly, one of the youngsters discovered a promising long blade of grass—sticking out of its sibling’s mouth—and did its best to get its share.

Since being back from retreat, I have been recuperating from my summer of CPE, and going to Howie’s to meditate on Tuesday nights, and volunteering at the soup kitchen.