Wednesday, September 27, 2017

A Bit of Quiet Thinking Time

I have formed a buddy relationship with one of my CPE peers, and after I was back from the East Bay on Monday, we met for dinner at Eric’s, a Chinese restaurant at 27th and Church. I think we are going to try to talk on the phone at the same time every week. My life is starting to overflow with wonderful people who are doing things they really care about.

I’ve been having as many days as possible where I don’t set an alarm when I go to sleep and am starting to feel more like myself again. Quite often I am sleeping ten and a half or eleven hours. 

I have gone back to therapy as a pre-emptive measure. I know this work is going to bring a lot of stuff up that will require examination, and I also want another set of eyes looking out for secondary trauma that I might not notice. I’m seeing not the therapist I started seeing in my 20s, but the one I was seeing when I was with Carlos. She has a strong somatic focus, and our first session (yesterday) was wonderfully helpful. She put in clear context some behavior that has mystified me, and also drew a very obvious connection between that behavior and the ending of  my relationship with F. In sum, I practiced insufficient boundaries with him, and so now I’m deploying overly firm boundaries where they aren’t needed (as in not wanting to answer the simplest of questions about what I’m up to). I would never have thought of that.

She also talked about how we can feel safe, or in danger, or in such fear for our lives that we completely freeze or collapse. She sees my firm boundaries as a response to feeling endangered—which is not as good as feeling safe, but better than feeling an existential threat.

Possibly the most powerful technique in my chaplain toolkit is counting mentally to three after the other person stops speaking, to see if they have more to say. Almost always, he or she does start talking again during that time. I tried this on my mother this morning and, after three seconds, she said, as if talking to herself, “Yeah—it’s good to have this time to just think.” Funny.

I went to my dentist for a cleaning this afternoon, and then to County Hospital for our weekly training session. I haven’t started to see patients yet; I will start soon. It turned out that Clementine was out sick—I hadn’t checked my email—so I walked back home again and had time to catch up on my blog. All caught up!


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If Good Looks Was a Minute, You Know that You Could Be an Hour

Friday of last week, Carol Joy came to town from Novato and we had lunch at Indochine Vegan Cuisine. I had tofu with eggplant and basil that was delicious, but somewhat overpriced for the amount. After that, we played cards all afternoon.

In the evening, I started looking at the documentation requirements for board certification and at the details of my new health insurance and got overwhelmed. I worked myself into quite a fit of negativity, but was able to notice that and remind myself to take some small constructive actions—getting a glass of water counts—and to practice metta for myself. At night, I used my new white noise machine for the first time and I think it did contribute to a good night’s sleep. No matter how much sleep I get since CPE ended, I feel exhausted. I think there is some kind of emotional weariness that will take a while to abate.

On Saturday, I went to Rainbow and ran into a friend from my meditation group who said a really perfect thing after Carlos died, in 2013. (Something like, “I am staggered by the immensity of your loss.”) On Saturday, he said another perfect thing. He mentioned a friend who is a hospice social worker, or some such, and when I asked how she likes that work, he said, “She flourished! She reminds me of you. Her spirituality reminds me of yours.”

I knew it was going to be hard once CPE was over and I didn’t have a team of people pushing and pulling me along every day. I rarely experienced doubt about the path I was on during the past 15 months—I didn’t have the time or energy to. I think that may be a problem in the next couple of years, but I will try to take it one day at a time. I do know what I need to do today. And I could not possibly have been any more affirmed during CPE, what with getting to do the palliative care rotation and getting one of the special awards and all the million nice things people, including my supervisors, said throughout the year. Getting a paying job immediately also seems like a good sign.

On Sunday, for reasons I won’t bore you with, I got to see the show about the Temptations again, this time with Carol Joy, preceded by lunch at Au Coquelet, and I liked it even more the second time. It is absolutely fabulous. (When I was five years old, my favorite song was a Temptations song. We lived 45 minutes from Motown.) Our seats were excellent a week earlier, about the eighth or ninth row from the front. The second time I saw it, I sat in the second row, even closer to the action. Carol Joy loved it, too.

At the end, there was a lengthy standing ovation. I was nearly in tears of gratitude for this music being brought so vividly to life and for the mesmerizing dancing, and I could see looks of stunned wonder on the faces of some of the cast members at the outpouring of love they were receiving; some of them looked like they were nearly in tears as well.

On Monday, I went to have a TB test read for my new job and then I took BART over to the East Bay to meet my friend Ann Marie. We had a very tasty lunch at Cancun Sabor, and then we strolled onto the UC Berkeley campus—as we were arriving, 50 police officers passed us, walking in formation—and sat by a little creek and talked for a long time. A family of five raccoons walked by, down near the water. When our butts started to hurt, we walked on and found a wooden bench to sit on.

From there, we could see maybe 10 police officers standing around across the street, and periodically a helicopter hovered overhead. A TV truck arrived and raised an antenna high in the air. Then the police officers got into a van and an armored vehicle and drove toward the center of campus. I felt kind of sad for the students. Many of them are so young. It’s a shame that their campus is a place of such chaos, and at times violence.

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Three Darling Photos of Hammett

That’s my leg that he’s on.

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Free at Last

Our very last day of CPE, we turned in our badges and keys and got to leave early. In the evening, one of our peers had us all over to his place to relax and eat. The next day, a Saturday, I was planning to do this, that and the other—making good use of every single second, as I have been doing for 15 months—and then realized I didn’t particularly have to do anything that day. I could do it Monday! Or Tuesday! Or Wednesday! Instead it became a napping and reading day. Ahhhh!

On Sunday, Ann and Tom and I saw Ain’t Too Proud: The Life and Times of the Temptations, at Berkeley Rep, which I loved. The show begins with a mockup of the front of the Fox Theatre in Detroit, which is where Chris Cornell played his very last show.

The following week, I was on jury duty but didn’t have to report on Monday, Tuesday or Wednesday. On Monday, I went downtown so my periodontist could remove the dressing over the surgery and review his handiwork. I was a little afraid to see what was under the dressing, but when I looked at it later at home, I felt pleased by the meaty, bulky redness of this gum graft. Things definitely appear to be shored up.

I did a pretty good job of getting nine hours of sleep nearly every night that I was in CPE, and of stretching each morning for 30 minutes and meditating for 45 minutes. Toward the end, there were more and more days when I did a token 10 minutes of sitting or even had to skip stretching altogether, but on the whole, this all went pretty well. I figured that once CPE was over, I would most certainly do all of these things every day, but it has been just the opposite. It turns out that maybe the hardest thing about CPE is when there’s no more CPE. That absolutely inflexible commitment was a reliable backbone for my entire program of activities. Now that it’s gone, I feel somewhat adrift, but maybe the most disrupting factor is that now I do different stuff at different times every day. My routine has vanished.

I also thought I would dispatch the bulk of my ignored-for-a-year to-do list right away, but in fact, tasks that must be done are only proliferating: stuff for County Hospital, stuff for the Very Fantastic Medical Center, stuff for applying to school, stuff for my eventual application for board certification as a chaplain, including obtaining endorsement from my faith group.

On Wednesday, I went to County Hospital for IS (individual supervision) with our leader, Clementine, and she said she had been thinking about how I might make good use of this period of training. She said it could potentially be an “easeful” time, or maybe I could move in the direction of my interests and learn some new things. Learning some new things had never crossed my mind, but she made it sound rather appealing.

The rest of my group is brand-new to chaplaincy, and so they will not be assigned to an ICU or to the ED, but Clementine said I can potentially work in those areas, or maybe I would like to work with the palliative care team, or with the prison-psych patients. All of those sound enticing. She also said maybe I can help with teaching duties. I felt inspired after our meeting, and touched by her generosity.

On Thursday, I had to go to the Hall of Justice at 8:45 a.m., where I found myself in a room with about 200 other people for jury selection for a five-week trial. Like half the people in the room, I filled out a form requesting to be excused due to hardship and sat through several rounds of hearing other people’s names called. I wrote on my form that my only income is from a part-time per diem job that will start in a couple of weeks and that I am the sole member of my household.

I had worked myself into somewhat of a frenzy—I just got a new job! I cannot be on a five-week jury!—when finally my name was called. Free at last! But also feeling slightly guilty, since I could have told my new boss that I need to work every Sunday for the next five weeks, and I could have done my volunteering at County Hospital on Fridays, since the judge said the trial would happen Mondays through Thursdays only. And I could have been a little bit late for Wednesday night training at County Hospital every week. It would have been five crappy weeks, but not the end of the world.

I walked to the soup kitchen to volunteer for the first time in a year or so, and found it not very enjoyable. I’ve become slightly allergic to being asked, by nearly every person I encounter, “Where have you been? Really? Where was your internship? What are you going to do next? Are you moving to New Mexico???” Partly it’s just the irritation of being asked the same things over and over, but there’s some deeper and not so constructive psychological thing there, too: I like to share news, not have it extracted. I notice a similar dynamic with money. I like to offer it freely, and hate to be asked for it.

I also felt abashed by all the pairs of eyes trained on me. Maybe I’ve become more used to dealing with people one on one. I found it a little difficult to have 50 people, mostly men, staring at me at every moment.

And, of course, I missed F. terribly. That is where we met. I could so clearly picture him sitting in his customary seat, with his art materials (and three or four admiring women) surrounding him. I kept glancing at that spot as if looking at it often enough would magically cause him to appear, but it didn’t work, and looking every two minutes at the front gate also didn’t. But I know I’ll get used to being there again and will eventually stop hoping he’ll appear.

I dreamed that we made a plan to meet up weekly. In the dream, I thought, “This is great! I’ll get to see F. every week.” Then I thought, “But what if something goes wrong? What if he gets angry at me? Maybe it would even be dangerous for me to spend time with him. Maybe I’d better tell him I’ve changed my mind.” In the dream, I felt frightened about what would happen when I told F. that I didn’t want to see him every week after all. It was remarkably similar to a thought process that could occur in waking life. When I woke up, I was relieved that it had been a dream and that we parted nearly a year ago. But I still feel sad about it.


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I Am a Chaplain

In mid-September, just a few days before CPE ended, volunteer training at County Hospital began with a weekend intensive (six hours on Saturday, four on Sunday). We are eight people, plus our leader. We got along well right away and our leader is wonderful, but I felt a bit overwhelmed when we received our assignments and wondered if I should have started this next spring instead. I wished it weren’t overlapping with CPE. Our assignments included words that will be drearily familiar to any CPE student: reflections, verbatims, IS, goals. On the one hand, I have just done all of this for five straight units of CPE and don’t want to do any of it any more. On the other, I can do all of this with both hands tied behind my back at this point.

In the final week, I went to see my periodontist, since my dental insurance will soon be gone. I could have signed up for this via Covered California, but it was prohibitively priced. My periodontist said it appeared I would be in need of gum surgery in the next year or so. However, since I won’t have dental insurance in a year and I did have it right that minute, he suggested going ahead ASAP, so we did. 

He said he was going to augment my gums with a strip of tissue taken from the roof of my mouth, or from an amenable dead person (or, if not amenable, not in a position to refuse). Having material carved out of the roof of one’s mouth is painful, so I said I’d like tissue from a dead person. I was picturing that this was going to be sewn onto my gums, and wondered if he’d make an effort to match the colors. I couldn’t figure out how it was going to bond with my own gums, but was excited that I would never be alone again! From now on, it would be me and her, or him, or them, and I’d be able to see her/him/them every time I opened my mouth.

But on the day of the procedure, my periodontist explained that he was actually going to peel the gums away from a contiguous expanse of teeth and mash in the tissue from the dead person, stretch my gums over it, and sew it all together. So no color matching required. I actually felt a little nervous before this, but it went very smoothly and was surprisingly quick, maybe half an hour or so once the area was numb. The post-surgical instructions called for taking the rest of the day off, but this was not an option.

I went to work and in the afternoon got a call from someone in HR at the Very Fantastic Medical Center who extended an offer of employment as a per diem staff chaplain! This will be one 24-hour shift a week, which is perfect, except for continuing to be away from Hammett one night every week. I wanted to work two days a week, and this is kind of an efficient way to do that. It was a boost to get an actual paid job as a chaplain before CPE even ended. It made me feel like a real chaplain.

I immediately had to start doing various onboarding tasks (online training, authorizing a background check) plus all the medical stuff for my new job (vaccinations, two TB tests, flu shot, physical exam), which I was still in the process of doing for County Hospital. I began to feel somewhat overwhelmed, with so many appointments and so many details to attend to.

The second-to-last day of CPE was the most tiring of the entire year. I spent the whole day training the person who is taking over my main unit, and couldn’t believe how exhausted I was afterward. I took a final look at my Patients I Have Seen list: 787 people. And my Deceased Patients list: 30. The latter is by no means every patient I encountered who died, but those who meant something to me or who I remember very clearly. I also did not see all of those patients after death, but I saw a lot of dead people, maybe 20 in the course of the year.


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Newfound Respect for Respiratory Therapists

Late in August, I walked over to County Hospital (not its real name) for my interview with the director of the chaplaincy program there, which is all volunteers, except for her. I liked her right away. She described the chaplain training program as “CPE Light.” Along with the chaplains, there are volunteer eucharistic ministers and two Catholic priests assigned there, both of whom I know. I was in CPE with one last summer at the Very Fantastic Medical Center and the other was one of my peers in the yearlong clinical pastoral education program just completed.

That week, the director of spiritual care at Very Fantastic Medical Center contacted me and invited me to apply for two per diem positions, and told me to let her know when I could interview. I am planning to go to school part-time for two years starting in March, and also to volunteer as a chaplain at the County Hospital, so I can keep my skills current and also just because I have long wanted to hang around there. The final thing I was hoping to find was two paid days of chaplain work each week, so I was happy to be asked to apply for the per diem positions.

Sam had a job interview around that time that he said didn’t go very well—when they asked for examples of this or that, he couldn’t dredge them up on the spot. Learning from that, I made myself a cheat sheet of examples of various things: use of ritual, mediating conflict between others, offering meditation for physical pain, being with a patient who thought God was punishing him, and so forth. I thought the interview went quite well. The director said toward the end of our hour-long talk that she appreciated that I was ready to go with stories.

I made a goodbye flyer to give to my units at work, and smaller cards to hand out to people. Both had a photo of me on them (taken by a nurse on one of my units), and mainly expressed my thanks for the privilege of getting to work alongside such splendid people this past year.

The new crop of CPE students joined us in the final two weeks, and things became very chaotic and hectic and exciting: 14 of us plus 14 or 15 of them plus four extended-unit (part-time) students.

At morning meeting with one week to go, one of my peers shared about going to a meeting of respiratory therapists the evening before, at which he learned that a respiratory therapist goes to every Code Blue and that when it comes time for a patient to be transitioned to comfort care, it is the respiratory therapist who turns off, or turns down, the breathing support offered via ventilator!

Our mouths were, figuratively speaking, hanging open—we’d never thought about this before. It may be the respiratory therapist who is literally keeping someone alive, possibly a patient the respiratory therapist has come to know well and care about. Therefore, a respiratory therapist can opt out of being the one to turn off the ventilator, but my peer said he suspects this option is probably not exercised often. If you don’t want to do this, you might be in the wrong job. We were somewhat chagrined to be learning all of this so late in our program.

I learned another thing in those final days, a thing I’d been meaning to learn for months, which is who the people in the bright red scrubs are. They are vendors! I found this out by approaching one who was using a copy machine near the operating rooms. I asked why so many vendors are to be seen around the ORs, and he said it is because they are present when the equipment their company makes is used in a surgery, so that they can answer questions for the surgeons, or assist if there are problems, and can report useful information back to their bosses about how things actually go in the field.

Photo of Hammett Where it Looks Like a Cat Leg Is Growing out of His Head

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I visited a patient in mid-August who was being transitioned to comfort care. He was lying quietly in bed, eyes open just a little. I spoke to him out loud, offering good wishes. He looked terrible, which I discovered later was because he had died 20 minutes before I arrived. (Not all dead people look terrible. It varies tremendously. Some look serene and lovely.)

One of my colleagues mentioned that it was his habit to take a look at the list of patients near the nursing station for his unit each morning to see which ones were being discharged that day, and then not to visit any of those patients unless he absolutely ran out of every other kind of patient. This is a very good idea I wish I’d encountered about 12 months earlier. As he accurately said, all such patients say, “I’m happy! I’m going home today!” None of them says, “I’m going home today! I feel horrible. Can you sit down and talk to me?”

Sometimes a patient’s name is replaced in the electronic health record system with a row of asterisks. This might be because the patient is a celebrity (I encountered one this year), or a forensic patient, with armed guards outside his room (so far these have all been men). Or the patient might be a victim of partner violence who doesn’t want the hospital operator to tell callers she is in the hospital. I have also discovered that it can indicate someone who was formerly in the psychiatric institute. The names of all patients currently at the psychiatric institute are so obscured, but even after the patient has left there and is on some other unit for an unrelated reason, his or her name may be concealed. I’ll bet that’s because they make that change when someone becomes a psychiatric patient and then forget to unmake it. The asterisks are also used when an employee of the hospital becomes a patient.

At the very end of the month, the person who had been on call the night before was fried, so I took the pagers and got slammed—page after page after page, including a request for a chaplain to facilitate a viewing, which can take an hour or two, and, for the first time in my experience, a Code Blue at the campus where they do day surgeries. Naturally that happened on a day when we were down to four people. Fortunately, Jodie took over and determined that the crisis had passed and that no one needed to take a cab over there.

On top of all of that, there was a request for a chaplain to attend a family meeting. By then, it was 2 p.m. and I had turned the pagers over to a peer, so I volunteered to go. Just as I approached the conference room, the door swung open and two physicians said, “Perfect timing,” as they walked past me and vanished. (“That was not very good interpersonal team communication,” Jodie said later.)

I went into the conference room and discovered I was the only care team member present, with 19 family members and friends of a patient who had gotten several pieces of bad news. I recalled watching another supervisor lead a debriefing and drew upon what she had done. I asked people to share their thoughts and feelings, and I observed that there was a lot of sorrow in the room. After a few people spoke and it fell silent, I asked about the hopes they had had for the patient, and people said a few things about that. One woman said she felt guilty for leaving the patient too soon one recent day. Another comforted her, saying it would have come out the same whether she stayed or left. A young family member wasn’t so sure: “How can we know?”

Then a family member politely said they would like to be by themselves, and that they had their pastor with them. I said I would be happy to go, and asked them to point out their pastor. I thanked him for being there, and said one thing that made me happy was that they were all there together.

After that, I went to see one of my current favorite patients, a homeless man, and to say goodbye to my other favorite, finally off to rehab after two serious injuries and several weeks in the hospital. Days earlier, I had given the latter a piece of polished rose quartz “with the hope that all of you will always be seen and cared for.” That day, a nurse asked, “Did you give my patient a stone?” I admitted it, and he said, “Very cool!”

I also saw a man who had gotten in a life-changing accident; he was described by his nurse as being despondent. I didn’t find him to be despondent at all. He seemed quite angry, but also was admirably philosophical, saying that the accident had put things in perspective for him, and that it could have been worse, and that he was now thinking about how he actually wants to spend his time. People are remarkable.

Late in the month, I had my second-to-last on-call shift, starting on a Saturday afternoon. One thing that happened during that shift, besides my getting 10 hours of sleep—I’m pretty much convinced now that the same people who can’t or don’t get enough sleep when they’re not on call tend to not get enough sleep when they are on call, and that those who get enough sleep when they’re not on call can usually find a way to do the same while on call—was that I was sitting in front of a computer charting when there was a flash and all the computers froze, the phones went dead, and my badge suddenly no longer worked.

A nurse came onto the unit and reported that she had just been on an elevator that had gone into freefall, though it didn’t fall very far. Another nurse said he had had the same experience in the past, but, far worse, that a few years ago, a doctor was standing in the doorway of an elevator chatting when the elevator suddenly lurched and crushed him to death. One of my peers said it’s a good thing we didn’t find that out earlier in the year. I agreed: “We would all have thighs like tree trunks by now,” from taking the stairs. The lesson I took from that is to be either in the elevator or not in the elevator, but not to linger at the threshold.

Duke Energy Center

This is in Charlotte, NC, where I went while working for my ex-employer.

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After graduation, five weeks of the program remained, which we spent seeing patients and training our replacements.

During those weeks, I applied for health insurance through Covered California, which was harder than I thought it would be. Fortunately, there are actual human beings who are willing to stay on the phone with you for the entire process, which in my case was more than an hour. There were some ins and outs I would never have figured out on my own that had a big effect on how much my monthly premiums will be: $1.35 versus $600. (It turned out that the correct thing to do was to say that I didn’t have health insurance and that my health insurance would be ending on such-and-such date in September, only one of which was true.)

I estimated that I will have “medium” use of doctors and other health services, and “low” use of prescriptions, but I asked my helper what would happen if I was diagnosed with a horrible kind of cancer or got in a car accident two weeks after selecting my health plan. She said I would be SOL: that you get the care your plan provides and no more. When the next open enrollment period comes along, you can choose a different plan, and if you’re still alive at that point, then you can have your cancer treated.

Accordingly, I hit the back button a few times to estimate that I will have “high” use of doctors, and found that I could still choose the exact same plan at the exact same cost, so I went back yet again to see what would happen if I have “very high” use of services, and again nothing changed, so I am Kaiser’s newest member, and a very happy one. (At least, I was very happy until I realized that I have to spend $6300 before they start covering much of anything. Now I’m mildly happy.)

Once this was finally done, I realized that needing to apply for my own health insurance had been a minor source of worry ever since I learned I was losing my job, which was in January of 2016. Being done with this application and knowing that I would have health insurance after my internship ended was a huge relief.

Somewhere along in here, I decided to pursue interventional radiology for Hammett—radiation treatment for his hyperthyroidism, which is 95 percent effective. This happens at UC Davis and would have cost about $2500, but I figured it would rather quickly pay for itself in labwork and visits to the vet that wouldn’t need to happen, and medication that wouldn’t need to be purchased. Plus, instead of paying his cat sitter $30 a day, I could ask one of my neighbors to feed him when I’m away, since there wouldn’t be the need to administer medication, if all went well.

In the end, I decided not to do this, because an elevated thyroid can mask kidney problems, and therefore can actually be a treatment option when the cat develops kidney issues. If radiation has been used to set the cat’s thyroid permanently at a certain level, that option disappears.

One of our assignments in the final weeks of the program was to update the information sheets we were given for our hospital units last September, or write new ones as needed. This forced me to read the sheet for my main unit, which caused me to discover that there is a daily interdisciplinary rounds meeting! At a time when I could attend! So I went to it for the very first and very last time in mid-August.

I confessed this to Jodie, who said, “You hadn’t read it?” I told her it was extremely long (like possibly more than four pages—I’m the Donald Trump of chaplains) and she said that’s because the person who originally wrote it was a CPE student from a few years ago who was a Ph.D. who didn’t like to visit patients very much but loved to do research. She told me to feel free to edit as I saw fit, so it is now less than two pages of extremely interesting information.

Last year, I was oriented by two different chaplains. I can’t remember anything about one of them or what she showed me except that she didn’t seem very friendly, which I found surprising. As for the other, I seem to recall that we spent less than half an hour together, but that struck me as more than enough, due to his frequent bursts of foul-smelling flatulence. Maybe he had chosen his breakfast and lunch unwisely on that particular day, but I remember thinking that if this was the norm for him, his unit was probably pretty happy that his year with them was finally ending.

Hurt Toe

I thought the statues outside the new County Hospital were kind of stupid looking the first time I saw them, but this little guy has grown on me.

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Graduation Day

On August 10, my 13 peers and I graduated from the yearlong clinical pastoral education program at the Truly Wonderful Medical Center. The day started with Anita treating the five of us in her group to breakfast at Park Chow. We asked our server to take a photo of us and she pointed out that the three people on one side of the table were all wearing white shirts and the three on the other side were all wearing light blue shirts.

Back at work, I shined my shoes and checked my email and hung out in the student office until it was time to do an exit interview with members of the professional advisory group, an opportunity to give feedback about the program anonymously; none of our supervisors were present.

After that, I went outside to wait for my guests. I had not asked most people to RSVP, thinking it would be nice to be surprised, with the exception of Charlie, whom I pestered relentlessly about it. I really, really wanted him there, because he played a large part in my journey toward CPE. When Carlos was dying, he picked me up every single night at the hospital at the end of visiting hours so I could stay as late as possible and not have to then wait for the bus in that not-very-good neighborhood. The night Carlos died, he got out of bed at 1 in the morning to come and drive me home.

Consequently, I decided to do the two days of volunteer work my ex-employer paid us for at his soup kitchen. I fell in love with it the very first day and became a regular. Wanting to bring everything I could to the soup kitchen’s guests, I did the yearlong chaplaincy program at the Sati Center for Buddhist Studies. There I became totally inspired and vowed that if my employer laid me off, I was going to become a hospital chaplain.

They kept their part of the bargain, and I am keeping mine.

So it was crucial that Charlie be at my graduation, and he was, elegantly attired in a black sweatshirt—not the shredded, stained one of indeterminate color that he normally favors, though it would have been perfectly fine if he’d worn that one.

Along with him, seven other friends came, including two who had very good reasons—serious illness and very recent bereavement—not to. I felt extremely loved and supported. Ann came all the way from Sacramento with her friend Jill, and Tom came. He took the ferry over to Larkspur to help Ann and Jill with the final leg of the trip into the city, which is really going above and beyond. I have the best friends.

Sarah, the manager of the spiritual care department, spoke at the beginning of the ceremony, explaining what we went through this past year, and what we achieved. She estimates that we, collectively, had 68,840 interactions with patients, their family members and staff.

One of our supervisors had made a wonderful slide show covering the whole year: students having fun at a petting zoo, students cracking up while rowing a boat, students wearing enormous joke sunglasses, a student collapsed from exhaustion on the floor of the office. It was really fun to see all of these photos, and to see how much joy there was along with the immense amount of physical and emotional work. This slide show was right up to the minute, too: there we were at Park Chow that very morning, three of us in white and three in pale blue.

Then there were musical presentations by fellow students, and one of our supervisors recited a poem, and then each supervisor handed out certificates to her own students. I received mine from Anita, who said she wanted to recognize my wit and humor, my professionalism, and my fairness, even when there is a cost to myself.

Then the director of the spiritual care department came to the front to recognize some of our supervisors. This year, three special awards for students were inaugurated and presented by our director, and I got one of them, the Award for Integration: “recognizing and affirming your persistence and creativity in nurturing and developing both your head and your heart as effective and reliable instruments of spiritual caregiving and thereby distinguishing yourself in fulfillment of the ACPE Outcomes.”

After our very esteemed leader gave out these special awards, he had to leave. As he made his way up the stairs, we stood in his honor. Then we graduates were offered a Ritual of Handwashing. I was in tears as Sarah dried my hands, emotions overflowing. There was a non-denominational prayer at the end, and then we had a giant feast.

It was an absolutely perfect day.

I did it. I did it.

High Rise

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Perfect Conditions

One day in August, Anita and I did our final joint visits together. I chose a man I had seen twice before and we had a fairly short visit, ten minutes or less. Afterward Anita said she liked how I inquired into his experience without directly asking, “How do you feel about that?” She liked that I asked to sit down and that I incorporated his own words into my prayer for him at the end of the visit, and she also liked that I announced in advance that we would be leaving—often patients wait until you say you are leaving to announce what’s really on their minds, so giving advance notice might invite those things into the conversation while there’s still a little time to talk about them.

One of the verbatims I presented earlier in the final unit was about a visit that was nearly an hour long. Right after I said I was leaving, the patient mentioned hospice. Ugh. So then it appeared that I had abandoned someone who was ready to talk about something very important. I received the suggestion to say, “I’ll need to go in five or ten minutes,” so I now do that often, including in the visit Anita observed.

The one thing she thought I could have done better was to ask the patient to turn off the TV, or turn the volume off. I have mixed feelings about that. One day not long ago, I saw a patient one of my peers has led in meditation several times. I asked him what she normally does when she guides him in meditation. He said, “She makes me turn off the TV, and then she pulls down the shades, and she closes the door and pulls the curtain.” Wow! I did all of that, and he turned off the TV, and it was indeed very serene, so I will remember that, but I also think that we need practices that work in less-than-ideal as well as completely crappy circumstances. I don’t mind if someone has the TV on while we talk. If the person gets completely absorbed in what’s on TV, I can ask if I should come back another time. However, having the TV volume off—which many patients do of their own accord—is nice and might change the flavor of the conversation, so I will keep that in mind, too.


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In the Brain, Pain Is Pain

Early in August, my group presented our final self-evaluations. Since I had a lot of money left on my meal card, I treated us all to lunch from Publico, a wonderful taqueria on Gene Friend Way. They have a remarkable fish and chips burrito, and I also really like their vegetarian burrito, with chipotle crema added. Their French fries are superb.

That week at the palliative care team meeting, someone shared about a patient’s intractable pain. She listed all the medications that had been tried, along with acupuncture. She asked for help from the group, and I briefly described a few ways of using meditation to address pain. The woman jokingly asked if I was available to see the patient that day.

One of the things I mentioned was to do a body scan, guiding the patient in moving her attention from her feet to the top of her head, to help her inhabit all of her body, not just the part that hurts. I also suggested asking the person to focus on the very worst part of the pain and then to move her attention gradually away from the epicenter, until she arrives at a part of her body that doesn’t hurt at all. My final suggestion was drawn from Somatic Experiencing: to ask the patient to focus on the pain, and then on a part of her body that is completely free of pain, and then, on her own schedule, to shift her attention back and forth between these areas. Like the first two methods, this reminds the person that there are parts of her body that don’t hurt, and also keeps the nervous system from getting stuck in pain-resistance mode. Pain is unpleasant without a doubt, but resistance to it can make it much worse.

An interesting thing I learned around that time is that the brain does not have different pathways for physical, psychological, emotional or spiritual pain: pain is pain. Therefore, addressing any of these kinds of pain can lessen the overall intensity of the pain.

Early in August I saw a young patient several times that a number of chaplains saw; all of us liked her. Earlier in the year, we had a didactic where we learned that a wounded person always also has a healer built in. I could really see that in what this patient had to say on one day. I told her that I could hear her clarity about her immense difficulties and I could also hear her wisdom.

I noticed in her chart that other chaplains had tried various techniques with her: breathing in this or that way, thinking of things to be grateful for. In my longest visit with her, I focused on taking in what she was saying, and a very interesting, subtle thing happened. She would say, “I have such-and-such lousy experience every day during physical therapy.” I would imagine what that would be like as I looked back at her, and then I would see a little shift in her eyes, which to me looked like what is true being seen and accepted. That is, I would think, “This is what is happening for this person,” and then it was almost like she was seeing and accepting the same truth: “Yes, this is what is happening.” This happened three or four times in the course of our hour-long visit. I also pointed this out to her as a way of affirming indirectly that she had the capacity to be with what was happening. In that visit, I noticed that she was moving organically through an emotional landscape, with anxiety, sorrow, joy and hope appearing at different moments. When I left, she said she felt better.

In our final couple of visits, I decided that I wasn’t doing enough stuff relative to what other chaplains were doing, and I found myself throwing a laundry list of techniques at her: think of it this way, use this mantra, let’s do a guided meditation. The result was that, for the entire duration of both visits, she was stuck in anxiety, and the connection between us seemed to go flat. It was much better when I just listened and did my best to imagine what things were like for her.