(Click photo to enlarge.)
Sunday, July 30, 2017
Tingling Hands
This past Wednesday, I got up at 4 a.m., as usual, to meditate, see to Hammett’s needs, stretch, and have breakfast. I took the city bus to the palliative care team meeting and got a ride afterward to campus from my hospice friend who usually goes to that meeting. Back at work, I realized I didn’t have my hat. I walked to the administrative building to get the key to Jodie’s office; I had stopped to see her upon returning to campus and thought I might have left my hat there. I walked back to the building where her office is to see if my hat was in her office. It wasn’t. I walked back to the administrative building to return the key and got on the shuttle to go to the other campus.
I went to the weekly farmers’ market and to Publico to get a fish taco, with the sun blazing down on my bare face, before going into the hospital. Inside the hospital, I went to the cafeteria to eat my fish taco. I spied a couple of my peers sitting outside on the patio and went out to offer them blessings for their hands; it was Blessing of the Hands week. I went up to the student office and hung out until a didactic on the “use of self” started. After that, three peers each spent 20 minutes apiece offering wisdom: on a specific aspect of the Kabbalah, on the Jizo ceremony for dead children, and on the “Rule of Life.”
I waited for the shuttle after work for about 45 minutes, in a long, long line, and after I got on, found we were stuck in an impenetrable traffic jam. It ended up taking an hour and a half to get home; I could have walked there in an hour. Then it was time to see to more of Hammett’s needs, water my neighbor’s plants, check my email, make my to-do list for work for the next day and fall into bed, where I fell asleep right away, but then woke up 30 minutes later and lay awake for hours. This happened several nights in a row. I finally fell asleep, but after I got up to go to the bathroom, I again lay awake for a long time. And that is the story of one day in CPE.
The palliative care team meeting that day was very interesting. We ran out of dead patients to talk about, and discussed informational interviews with potential hospice patients: Giving information versus pushing hospice services. It’s hard to get people interested in hospice when two or three other services (e.g., surgery or oncology) are saying, “We can do such-and-such for you.” It’s even worse when providers say, “You can either do nothing or have treatment.” Given that choice, who would not choose treatment? Sometimes people speak of “withdrawing care,” which is a terrible phrase. We never withdraw care as such; we transition from curative care to hospice care or comfort care.
In telling people about hospice services, we might do better to say, “Let’s optimize the possibility you are going to get stronger. These are the services hospice can provide.” Also, hospice is not a one-way street; you can do a trial period. People are eligible for hospice when their life expectancy is judged to be six months or less, but most people go to hospice so late that they die a week or two after going “on service,” and so of course people associate hospice with immediate death. It’s not supposed to be what you do for a few days before you die. It’s supposed to afford up to six months of being able to do what is most meaningful and enjoyable to you at the end of your life, as possible, without having to spend time on treatment that is no longer helping, takes up however much time, costs however much money, and potentially causes suffering and makes it impossible for you to speak with your loved ones.
It was mentioned that, at our medical center, attending physicians feel uncomfortable with fellows having conversations about end of life choices without oversight. The only current requirement is that a person with metastatic cancer be asked if he or she has a durable power of attorney, which is a pretty low bar. I also learned that “case finding” is not appreciated—other doctors don’t enjoy hearing that their patients have turned up on a list of possible palliative care patients.
As mentioned, it was Blessing of the Hands week this past week. We were invited to write and submit a verse to be used for the blessing, and the verse that was chosen was lovely. (I did not submit one.) It was also very easy to memorize, so I did that, and then I went around my unit offering this brief ritual of good wishes to care team members. I would invite each person to rest his or her hands on mine, and I would speak the words of blessing, and finish by saying, “Thank you for your important work.” People seemed to really like this. We each signed up for areas in the hospital outside our actual patient units, like radiation oncology or administrative areas. In addition, I offered blessings to random people who crossed my path: a cashier in the cafeteria (who said this made her day), a couple of construction workers, several housekeepers, two young volunteers, and four of my peers. Near the operating rooms, someone at the front desk announced it over the P.A. system, and 14 people lined up to have their hands blessed. One person said afterward that it made her hands tingle; she was smiling.
I went to the weekly farmers’ market and to Publico to get a fish taco, with the sun blazing down on my bare face, before going into the hospital. Inside the hospital, I went to the cafeteria to eat my fish taco. I spied a couple of my peers sitting outside on the patio and went out to offer them blessings for their hands; it was Blessing of the Hands week. I went up to the student office and hung out until a didactic on the “use of self” started. After that, three peers each spent 20 minutes apiece offering wisdom: on a specific aspect of the Kabbalah, on the Jizo ceremony for dead children, and on the “Rule of Life.”
I waited for the shuttle after work for about 45 minutes, in a long, long line, and after I got on, found we were stuck in an impenetrable traffic jam. It ended up taking an hour and a half to get home; I could have walked there in an hour. Then it was time to see to more of Hammett’s needs, water my neighbor’s plants, check my email, make my to-do list for work for the next day and fall into bed, where I fell asleep right away, but then woke up 30 minutes later and lay awake for hours. This happened several nights in a row. I finally fell asleep, but after I got up to go to the bathroom, I again lay awake for a long time. And that is the story of one day in CPE.
The palliative care team meeting that day was very interesting. We ran out of dead patients to talk about, and discussed informational interviews with potential hospice patients: Giving information versus pushing hospice services. It’s hard to get people interested in hospice when two or three other services (e.g., surgery or oncology) are saying, “We can do such-and-such for you.” It’s even worse when providers say, “You can either do nothing or have treatment.” Given that choice, who would not choose treatment? Sometimes people speak of “withdrawing care,” which is a terrible phrase. We never withdraw care as such; we transition from curative care to hospice care or comfort care.
In telling people about hospice services, we might do better to say, “Let’s optimize the possibility you are going to get stronger. These are the services hospice can provide.” Also, hospice is not a one-way street; you can do a trial period. People are eligible for hospice when their life expectancy is judged to be six months or less, but most people go to hospice so late that they die a week or two after going “on service,” and so of course people associate hospice with immediate death. It’s not supposed to be what you do for a few days before you die. It’s supposed to afford up to six months of being able to do what is most meaningful and enjoyable to you at the end of your life, as possible, without having to spend time on treatment that is no longer helping, takes up however much time, costs however much money, and potentially causes suffering and makes it impossible for you to speak with your loved ones.
It was mentioned that, at our medical center, attending physicians feel uncomfortable with fellows having conversations about end of life choices without oversight. The only current requirement is that a person with metastatic cancer be asked if he or she has a durable power of attorney, which is a pretty low bar. I also learned that “case finding” is not appreciated—other doctors don’t enjoy hearing that their patients have turned up on a list of possible palliative care patients.
As mentioned, it was Blessing of the Hands week this past week. We were invited to write and submit a verse to be used for the blessing, and the verse that was chosen was lovely. (I did not submit one.) It was also very easy to memorize, so I did that, and then I went around my unit offering this brief ritual of good wishes to care team members. I would invite each person to rest his or her hands on mine, and I would speak the words of blessing, and finish by saying, “Thank you for your important work.” People seemed to really like this. We each signed up for areas in the hospital outside our actual patient units, like radiation oncology or administrative areas. In addition, I offered blessings to random people who crossed my path: a cashier in the cafeteria (who said this made her day), a couple of construction workers, several housekeepers, two young volunteers, and four of my peers. Near the operating rooms, someone at the front desk announced it over the P.A. system, and 14 people lined up to have their hands blessed. One person said afterward that it made her hands tingle; she was smiling.
Lake
This is the view from my cousin’s deck. That is a child’s play oven you see in the foreground.
(Click photo to enlarge.)
(Click photo to enlarge.)
One Thing I Will Never, Ever Do
Things are moving very fast now. Anita and I have had our very last one-on-one meeting, because this coming week we will do joint visits for the last time, and the week after that, we will present our final self-evaluations, and on Thursday of that week, we will graduate! After that, there will be five weeks devoted to seeing patients, so we can practice being full-time chaplains for an extended period.
I’ve changed my procedures when rounding at the other campus. For most of this year, I have gone around to the five infant care nurseries and just said hello to the nurses. A few on-calls ago, a male nurse said to me, “Thank you! Visit some babies!” So I did that, and it was so nice that now I say, “I’m just saying hello and admiring babies,” and then I go into several rooms to peer at our littlest patients, most quietly sleeping, and wonder what they are dreaming inside their little baby heads.
Last week I presented my final verbatim of the year. Anita said she thinks I would be a good CPE supervisor. I told her I am never, ever, ever going to be a CPE supervisor: they work way too hard. But I did appreciate hearing that she thinks I could be a good teacher and leader. Another supervisor that I did joint visits with offered to write me a letter of recommendation, and it turned up just one day later, full of glowing compliments. Anita is also going to write me a letter, and when I bumped into yet another supervisor this past week, she said, “I’ll write you a letter of recommendation if you want.” So I am feeling very recommended, which is a nice feeling.
I’ve changed my procedures when rounding at the other campus. For most of this year, I have gone around to the five infant care nurseries and just said hello to the nurses. A few on-calls ago, a male nurse said to me, “Thank you! Visit some babies!” So I did that, and it was so nice that now I say, “I’m just saying hello and admiring babies,” and then I go into several rooms to peer at our littlest patients, most quietly sleeping, and wonder what they are dreaming inside their little baby heads.
Last week I presented my final verbatim of the year. Anita said she thinks I would be a good CPE supervisor. I told her I am never, ever, ever going to be a CPE supervisor: they work way too hard. But I did appreciate hearing that she thinks I could be a good teacher and leader. Another supervisor that I did joint visits with offered to write me a letter of recommendation, and it turned up just one day later, full of glowing compliments. Anita is also going to write me a letter, and when I bumped into yet another supervisor this past week, she said, “I’ll write you a letter of recommendation if you want.” So I am feeling very recommended, which is a nice feeling.
Mayday!
I’ve been going most weeks to the palliative care team meeting across town. People from several hospitals attend this meeting. The first time I went, someone told a long, long story about a patient. I wondered why this person was going on at such length, and then I realized that the whole point of this meeting is to share stories about patients. We start by introducing ourselves and we hear a poem, and then we tell stories about patients, and at the end, we each share something we feel grateful for. Emotions are welcome, which is not at all true in many areas of medicine, so this meeting is special. The leader, a palliative care doctor, said a couple of weeks ago, “If you’ve come to this meeting once, you’re welcome for life.” I plan to keep going after CPE is over.
Mid-July, I flew to Seattle for a long weekend to visit my cousin and her husband and their two children and my cousin’s mother-in-law and their dog and four cats. They live in a house north of downtown that overlooks a shimmering spring-fed lake. I had met Sarah, who is now four, on a past visit, and got to meet Thomas, two, for the first time. One day my cousin was in the back yard with her daughter. Thomas asked his father, “What are those girls doing down there?”
The weather was gorgeous: sunny, clear, warm. On Saturday, my cousin gave me a ride to Kenmore, where David and Lisa now own a home, and we took a beautiful 10-mile bike ride along the Sammamish River to Redmond, where we had lunch at Ooba Tooba’s, a taqueria, before riding back. It was a perfect day, and the whole trip was lovely and relaxing. I was really conscious of enjoying every moment of it.
My cousin’s mother-in-law is an astute genealogy researcher and has been looking into my cousin’s, and therefore my, family. I learned some interesting new things. On Monday, she took me back to the University of Washington LINK light rail station, where she had picked me up on Friday, and I took the $3.25 trip back to the airport.
At the San Francisco airport, I stepped out of the terminal to tell the fellow I’d like to take SuperShuttle home and was astonished when he said it might take up to an hour; usually the wait is about ten minutes. I spotted a man seated on a bench who had been in the shuttle I took to the airport on Friday. He was in the same boat (so to speak) and had just learned that there are 70 SuperShuttle vans sitting idle on a lot somewhere because so many drivers have gone to work for Uber. Furthermore, all the Ubers on the road are clogging traffic, exacerbating the problem. How anyone could have thought having one passenger in each Uber would be good for traffic is beyond me.
Having seven people in a SuperShuttle van is good for traffic. Having 50 people in a bus is good for traffic. (Unless it’s a Google employee bus full of people driving the rents beyond comprehension, of course.)
“I heard there are 45,000 Ubers in San Francisco,” I said. Then I remembered I had actually heard it from him, during the shuttle ride three days earlier. Fortunately, a SuperShuttle van turned up in about ten minutes.
Wednesday of the following week, we had a work retreat in Golden Gate Park. We did tai chi and partner exercises and had lunch al fresco, and in the afternoon we were free to do whatever we wanted. I went boating on Stow Lake (a man-made lake three feet deep, but it looks like a lake, and is surrounded by greenery, and there are ducks and turtles) with Sam and two other guys. It was extremely fun, including Sam shrieking, “Mayday! Mayday!” when we went into the branches at the side of the lake. When we returned, we partnered up again and shared our aspirations for the rest of CPE and beyond with our partner, and offered each other blessings—CPE students do this kind of thing all the time. My partner offered me such a lovely, heartfelt blessing that we overflowed with good feeling and joined the pair next to us for a group hug. “Aw, that was so good! Group hug!”
Mid-July, I flew to Seattle for a long weekend to visit my cousin and her husband and their two children and my cousin’s mother-in-law and their dog and four cats. They live in a house north of downtown that overlooks a shimmering spring-fed lake. I had met Sarah, who is now four, on a past visit, and got to meet Thomas, two, for the first time. One day my cousin was in the back yard with her daughter. Thomas asked his father, “What are those girls doing down there?”
The weather was gorgeous: sunny, clear, warm. On Saturday, my cousin gave me a ride to Kenmore, where David and Lisa now own a home, and we took a beautiful 10-mile bike ride along the Sammamish River to Redmond, where we had lunch at Ooba Tooba’s, a taqueria, before riding back. It was a perfect day, and the whole trip was lovely and relaxing. I was really conscious of enjoying every moment of it.
My cousin’s mother-in-law is an astute genealogy researcher and has been looking into my cousin’s, and therefore my, family. I learned some interesting new things. On Monday, she took me back to the University of Washington LINK light rail station, where she had picked me up on Friday, and I took the $3.25 trip back to the airport.
At the San Francisco airport, I stepped out of the terminal to tell the fellow I’d like to take SuperShuttle home and was astonished when he said it might take up to an hour; usually the wait is about ten minutes. I spotted a man seated on a bench who had been in the shuttle I took to the airport on Friday. He was in the same boat (so to speak) and had just learned that there are 70 SuperShuttle vans sitting idle on a lot somewhere because so many drivers have gone to work for Uber. Furthermore, all the Ubers on the road are clogging traffic, exacerbating the problem. How anyone could have thought having one passenger in each Uber would be good for traffic is beyond me.
Having seven people in a SuperShuttle van is good for traffic. Having 50 people in a bus is good for traffic. (Unless it’s a Google employee bus full of people driving the rents beyond comprehension, of course.)
“I heard there are 45,000 Ubers in San Francisco,” I said. Then I remembered I had actually heard it from him, during the shuttle ride three days earlier. Fortunately, a SuperShuttle van turned up in about ten minutes.
Wednesday of the following week, we had a work retreat in Golden Gate Park. We did tai chi and partner exercises and had lunch al fresco, and in the afternoon we were free to do whatever we wanted. I went boating on Stow Lake (a man-made lake three feet deep, but it looks like a lake, and is surrounded by greenery, and there are ducks and turtles) with Sam and two other guys. It was extremely fun, including Sam shrieking, “Mayday! Mayday!” when we went into the branches at the side of the lake. When we returned, we partnered up again and shared our aspirations for the rest of CPE and beyond with our partner, and offered each other blessings—CPE students do this kind of thing all the time. My partner offered me such a lovely, heartfelt blessing that we overflowed with good feeling and joined the pair next to us for a group hug. “Aw, that was so good! Group hug!”
Smaller and Smaller
So I did share my feelings with Anita about what she wrote in my evaluation at the end of the third unit (of four) of the clinical pastoral education program I will be graduating from a week from Thursday. I told her it’s hard for me to have feelings with others observing, and I asked for her help. (I also told her that Delia and my at-work therapist had said the exact same thing she did.) She was warm and understanding. I think she was also chagrined that I had felt so upset. She said she never intends for anyone to feel that she is using their words against them—she wants to give direct, specific feedback, but tries to make it so there aren’t any surprises. She also said she thinks I’m a “phenomenal” chaplain.
Toward the end of June, Howie led a half-day of meditation at the Mindfulness Care Center, which was lovely. I also had lunch with someone who was pretty much my best friend back in the mid-1980s. Our three part-time CPE students had their graduation ceremony.
I had my first chaplain job interview, at a hospice that is just getting started. The interview went very well, but I felt rather lukewarm about the job, which sounds like it will be an hour here and an hour there initially. Afterward, I decided to go to the downtown Container Store, and as I walked there, I found myself thinking about F. a lot, wishing I would see him. Several blocks from his apartment, it occurred to me that if he were returning to his home on a northbound Mission St. bus, he would probably get off at the stop at 7th and Mission. I turned my head to look at that bus stop, and there he was, across the street, walking in the direction of his place.
I scurried ahead to the corner and crossed the street so that I was waiting for him when he arrived at Market St. We had a brief exchange, at the end of which he said, “I should go.” I said, “OK,” and he walked off. For half a block, we walked in the same direction, on opposite sides of Market St., and then he turned north, and I stopped and watched him until I couldn’t see him anymore. I think it was good that we met, because I got to see with my own eyes that he has psychologically gone away from me. The time I saw him before that, before we broke up, everything was just as it had always been, and so it was hard to wrap my mind around the fact that we were no more. It was really helpful to get to act out physically what had happened emotionally: we were together, then going the same way but no longer together, and then he got smaller and smaller and smaller, and then he disappeared.
The last day of June, I stayed at the other campus all day, where I had been on call the night before, because they were short-staffed. In the evening, I treated Sam to dinner at Chez Maman West, near Hayes Valley, and then we saw Hamilton at the Orpheum. Sam knows pretty much everyone in the entire hospital, and of course was present when a nurse happened to manage to buy a number of tickets for $100 apiece, of which she sold him two. That was months ago, followed by my low-key but persistent campaign to be his date for the show. At some point, he asked me to make a particularly unfavorable on-call trade with him. I decided to do it, since he has done me favors during this year. I was not thinking about Hamilton one way or the other, but right after I said I would make the trade with him, he invited me to join him. I had read the book it was based on, Ron Chernow’s splendid biography, and I was dying to see the show, and I did see the show! It was all I had hoped for—really wonderful.
A few days later, Ann and Tom and I had lunch at Au Coquelet and went to Berkeley Rep to see An Octoroon.
Toward the end of June, Howie led a half-day of meditation at the Mindfulness Care Center, which was lovely. I also had lunch with someone who was pretty much my best friend back in the mid-1980s. Our three part-time CPE students had their graduation ceremony.
I had my first chaplain job interview, at a hospice that is just getting started. The interview went very well, but I felt rather lukewarm about the job, which sounds like it will be an hour here and an hour there initially. Afterward, I decided to go to the downtown Container Store, and as I walked there, I found myself thinking about F. a lot, wishing I would see him. Several blocks from his apartment, it occurred to me that if he were returning to his home on a northbound Mission St. bus, he would probably get off at the stop at 7th and Mission. I turned my head to look at that bus stop, and there he was, across the street, walking in the direction of his place.
I scurried ahead to the corner and crossed the street so that I was waiting for him when he arrived at Market St. We had a brief exchange, at the end of which he said, “I should go.” I said, “OK,” and he walked off. For half a block, we walked in the same direction, on opposite sides of Market St., and then he turned north, and I stopped and watched him until I couldn’t see him anymore. I think it was good that we met, because I got to see with my own eyes that he has psychologically gone away from me. The time I saw him before that, before we broke up, everything was just as it had always been, and so it was hard to wrap my mind around the fact that we were no more. It was really helpful to get to act out physically what had happened emotionally: we were together, then going the same way but no longer together, and then he got smaller and smaller and smaller, and then he disappeared.
The last day of June, I stayed at the other campus all day, where I had been on call the night before, because they were short-staffed. In the evening, I treated Sam to dinner at Chez Maman West, near Hayes Valley, and then we saw Hamilton at the Orpheum. Sam knows pretty much everyone in the entire hospital, and of course was present when a nurse happened to manage to buy a number of tickets for $100 apiece, of which she sold him two. That was months ago, followed by my low-key but persistent campaign to be his date for the show. At some point, he asked me to make a particularly unfavorable on-call trade with him. I decided to do it, since he has done me favors during this year. I was not thinking about Hamilton one way or the other, but right after I said I would make the trade with him, he invited me to join him. I had read the book it was based on, Ron Chernow’s splendid biography, and I was dying to see the show, and I did see the show! It was all I had hoped for—really wonderful.
A few days later, Ann and Tom and I had lunch at Au Coquelet and went to Berkeley Rep to see An Octoroon.
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