Wednesday, October 18, 2017


Yesterday was my very first day as an actual paid staff chaplain. It went pretty well. I spent the first couple of hours at the office where Rebecca, our administrative person is, doing the last of orientation. I thanked her for a couple of things she said when I was doing CPE that were helpful to me. One was when I announced to my supervisor, “I’ve thought of another good reason I can’t be a chaplain: I’m an introvert.”

Rebecca, working away at her desk nearby, said, “Every chaplain I know is an introvert.” Objection overruled!

Rebecca also mentioned one day how much exercise chaplains get walking around the hospital all the time—that it’s a healthier job than some.

Rebecca said she wanted to thank me in return for teaching her how to center herself—I had not realized I had done such a thing—and also for being an inspiration in regard to mindful eating. She said she periodically attends mindfulness training classes at work where they talk about mindful eating. She said it never really sank in until she saw me having lunch one day and thought, “Mindful eating: There’s someone doing it.” She said that ever since then, she has been paying much more attention when she eats.

I took the shuttle over to my own campus and spent the day fielding pages to the on-call pager and dispatching requests. I saw only three patients, including one who was going on comfort care, meaning that death was imminent.

The air was smokier than it has been all week, and even in our windowless chaplains’ office in the basement, I could smell it. After an hour of sitting at the computer mid-day, my chest hurt, my eyes were burning, and I had a headache. At the end of the day, I spent another hour in that room. It no longer smelled like smoke, but I still got a headache. I hope it’s not going to be a chronic problem, something to do with the ventilation. I gather that even if you can’t smell smoke, such as from the North Bay and Santa Cruz wildfires, there can be yucky stuff in the air, so maybe it was that.

I punched out at 5 p.m. and went on standby, but lingered in the office until near 7 p.m. to see if any pages would appear. Nursing shift change is at 3 p.m., and my colleagues say most requests for an immediate visit from a chaplain turn up by 5 or 6 p.m. The likelihood of being paged after that is less. I spent that time typing up notes, figuring out how to print, and devising a method for tracking my daily stats—the number of minutes we spent doing this, that and the other. Late in the day, I realized I had forgotten to check one source of chaplain referrals and was relieved to see that there was only one request, and it could be handled the next day.

I walked home and made dinner, marveling that I was still on the clock, yet in my own kitchen with my own cat. I didn’t get paged during the night.

Today I had some stuff to do in regard to health insurance: check my latest notices from Covered CA, pay my monthly premium, and follow up on getting both forms of insurance that I had earlier in the year to authorize the mammogram I had in January, which in itself has been an absorbing little project. I am so grateful to have health insurance, but applying for it and dealing with it have been ongoingly stressful—so many weird little details. Fortunately, the people at Covered CA are excellent at what they do and very helpful.

I got a notice from them several weeks ago saying there was a discrepancy between what I’d reported as my income and what the computer said. I called and we agreed that I would upload some documents pertaining to my CPE stipend. I did that—with difficulty—and two weeks later got the exact same notice again. I called back, and this time the person said there is nothing in their system that tells them that documents have been uploaded. You have to call and say, “I uploaded some documents!”

So I told her, “I uploaded some documents!” and she went and checked them right then and said everything was fine—except that now that I had no verifiable income, I qualified for Medi-Cal instead of Covered CA, which is fine with me. A couple of days later, I got a call from a Medi-Cal worker and told her about my new job. She somewhat sternly told me that if my income from my new job is what I predict it is, I do not qualify for Medi-Cal (which is also fine with me, since it wasn’t something I was seeking in the first place).

Today I yet again got that notice from Covered CA saying there is a discrepancy in regard to my income. The other day, I tried doing my annual renewal online, but could not convince the system that I was never in foster care. So I called today and explained the whole thing to another helpful person. Whoever hired the people who answer the phone at Covered CA truly did a fantastic job. This person updated my income per what I think it will be, said not to worry about the foster care thing, and said he had gone ahead and renewed my insurance; I just need to choose a plan.

I’ve been feeling sorry for myself because my insurance has such a massive deductible that I don’t dare use it unless I really, really need to. I decided today to go look at the other options. Maybe that low-premiums / high-deductible plan is for some young whippersnapper that I no longer am. There are certainly some other choices, but I wasn’t sure how to proceed because I’m not sure what the various plans cover, exactly. This caused me to remember the big stack of documents Kaiser has mailed me over the past several weeks that I have not looked at. Possibly if I were to peruse those documents, I could make a better choice about next year’s plan. Mainly, I just hope I don’t inadvertently do something that causes my insurance to vanish.

Though if that did happen, County Hospital serves people with no insurance at all, and their doctors are one and the same as the doctors at the Truly Wonderful Medical Center, so the care would actually be superb; you just might have to sit in a clinic waiting room for six hours before getting it. I used to do that when I was in my 20s and didn't have insurance. However, it would be disingenuous of me now to rely on that safety net meant for others. I can pay for health insurance, and I am happy to have the opportunity to participate in a pool of insured people.

Oh! I always thought “whippersnapper” just meant a young person. It actually means “A person regarded as insignificant and pretentious” or “An unimportant but offensively presumptuous person, especially a young one.” But why? Oh, because of this: 1665-75; probably blend of earlier whipster and snippersnapper, similar in sense. All right, that clears that up.

Monday, October 16, 2017

Burning-Hot Coins and Slippery Rocks

I have finished reading The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, Anne Fadiman’s superbly written, riveting account of Lia Lee’s medical travails, and, for comic relief, have started Zen Confidential: Confessions of a Wayward Monk, by Shozan Jack Haubner.

He writes: “You deal with your shit in Zen by sitting with it. By breathing right into it. You don’t try to ignore it with pleasant thoughts or lofty ideas, and you don’t try to bury it with solutions. You deal with it, you work with it, one breath at a time. You hold it right there, in your hara, or breathing center. You don’t try to breathe it out; you don’t try to breathe it in. You keep it suspended in your diaphragm like a burning-hot coin. Your problems won’t change; only you can change. That’s the point.”

That reminded me of what Ezra Bayda wrote about trying to figure out what work to do—that he finally concluded that he just needed to sit with his anxiety about it, and after he did that for long enough, an idea came to him.

One skein of recent worry runs like this: What if I go to school for two years and then can’t get a job in San Francisco? Will I be able to find any job whatsoever at age 58? Today I was going to call my friend who worked for many years as a recruiter to ask her this, but then I remembered about the sizzling coin, and dropped the reminder to myself in the recycling bag instead. While my friend might actually have some ideas about this, in the end, the question can’t be answered in advance and answering it isn’t the point. Learning from my experience is the point, however haltingly, and however often I seemingly have to learn the exact same thing once again.

This doesn’t mean that I should go to school and work as a chaplain, of course, which points to another chronic worry: How do you know what to do? I really appreciated that CPE kept me from having to think about this for 15 months, but now CPE is gone and I’m back to having to feel my way across the river on my own, one slippery rock at a time.

One thing to consider: What is my motivation? In these periods of unease, fear and the desire for security and certainty loom large. Even though this fits nicely with my generally anxious temperament, I don’t want to spend the rest of my life lurching from one seemingly safe haven to the next. Ultimately, there is no such thing, and I also will feel disappointed in myself if I do that.

(However, I’m also not saying I’m going to mail my keys to my landlord and go live on the sidewalk with Hammett, trusting that all my needs will be met.)

The path toward chaplaincy does afford continual personal growth. Wanting to grow and learn seems like a pretty good motivation.

I had dinner with Sam last night at Eric’s and learned that perhaps the thrill of working for the complaint department could wane over time.

Closing for today with this little prayer from the Peace Pilgrim, which I say aloud almost daily, and which sometimes seems like enough and sometimes doesn’t seem like enough:

Live in the present,
Do all the things that need to be done.
Do all the good you can each day.
The future will unfold.

Sunday, October 15, 2017

No Teasing

Yesterday morning brought clear blue skies and a complete lack of smoke in the air—a welcome surprise. Charlie and I went for a walk through our neighborhood.

I found this written note in my pile of little pieces of paper and I’m going to keep it until I remember what it means:
“Louise = bad with medical. Katrina = good with medical. Doesn’t like to be teased.”
What on earth does that mean? I don’t recognize either of the names.

This morning also featured blue skies and clear air, just as welcome as they were yesterday, but I am in a state of unease about my path forward. I really do not want to go to school, for one thing. In 1998, the question I asked myself, which led to 18 lucrative but not particularly fulfilling years in a cubicle, was, “How can I weasel my way into a tech job without getting any more education?”

During the past year of doing CPE, I assumed I would go to school starting next year, because I believed that chaplaincy was the answer to the question, “How can I support myself doing something that seems worthwhile?” and school is required for board certification.

But now I’m remembering that, before that, my question was, “What kind of job can I do that takes place in a hospital?” I ruled out being a physician, nurse, OT (occupational therapist), PT (physical therapist), ST (speech therapist), or administrative assistant. That left just one choice: chaplain! I moved toward this several times and then backed away when I remembered how much religion would be involved. I still feel uneasy about the religious aspects.

Today I got a call from Sam and was reminded of another job that takes place in a hospital: complaint department! It appears that, each year when the CPE program finishes, a few graduates go to work there, where they are welcomed for their unique skillset.

Several times it has crossed my mind that I might like to work part-time doing tech support. I like sitting in front of a computer. I like assisting a variety of people with whatever is bothering them. Today it strikes me that working in the complaint department of a hospital might be just the thing: I could sit in front of a computer, use my chaplain skills, talk to different people every day, and not have to go to school. I would also not have to continue to deplete my savings at a nauseating rate, which I’ve only been doing for a month but already don’t like.

I told Sam about my troubles with my boss at my new paying job and at first he said it sounds like she is really suffering and that he thought I should confront her and tell her how her words make me feel. This struck terror into my heart. But after I told him a  couple of things she said, word for word, he said, “Hmm, do you think there could be any truth to that?” and, “Oh, just ignore her. Let that roll off your back.”

Friday, October 13, 2017

The Dorky Duckbill

On Wednesday, I walked over to County Hospital through the smoky air and spent the afternoon seeing patients. My new boss, over at VFMC, shared with us during orientation several things she’s not a fan of. One is chaplains stopping by to see patients “just to see how you’re doing.” It sounds like she wants her chaplains to confirm whether the religion listed for the patient is correct, find out if that religion is helping the patient—I’ve never heard anyone say it isn’t—and inquire if there is any religion-related support the patient needs, such as a Bible, which often is requested. She has an actual flowsheet for pastoral care conversations.

OK, then. I tried this out and it certainly does make conversations shorter, and resulted in even more walking, as I went to fetch Bible after Bible. Before you can be certified as a chaplain, you have to log 2000 post-CPE clinical hours. Possibly by the time I’ve done 2000 hours, I’ll have settled into approaches that are satisfying to me and also meet the job requirements.

On Thursday I stayed inside all day due to air quality issues. When I looked out my window in the morning, there was a layer of haze between me and the rooftops several blocks away. When I opened a window to see how things smelled, ash started blowing in immediately, and it smelled very smoky.

Today I stayed in most of the day, too, wondering if I was being overly wimpy. In the late afternoon, I went out to do a couple of errands. I ran into one of my fellow County Hospital volunteers. I was outside for only 30 minutes, and came home with a headache and irritated throat, and smoke-stinking clothes that had to be put into the laundry basket right away.

I have ordered a budget HEPA filter and some N95 masks, but who knows how long those will take to arrive? We are fitted yearly at work for an N95 mask. There are two general kinds. Thanks to that, I knew exactly what to order.

Tuesday, October 10, 2017


On Saturday, one of my CPE peers came over. I’ll call her Nellie. We had a really nice day together. She visited with Hammett, and we walked over to Scarlet Sage and on to Papalote for burritos for lunch. We went to Dog-Eared Books and came back to my place for tea. In the evening, Tom and I went to Eric’s, Chinese food at Church and 27th St., for dinner. We had pot stickers, eggplant and cod. Everything was incredibly delicious, really fresh and lovely.

Nearly a year after breaking up with F. (that is, him breaking up with me), I’m finally starting to get some helpful insight into the matter. Basically, I want him to behave in a different way so that I don’t have to have certain feelings, primarily that of longing. I haven’t been able to fathom why he doesn’t feel the same way. Doesn’t he miss the remarkable togetherness we had? (Quite some time ago, at this point.) No, he does not, because he refuses to feel longing; he prefers to feel angry. How he feels is based on how he sees things; how I feel is based on how I see things. There is no way for me to affect how he sees things. There wasn’t when we were together, and there certainly isn’t now. There is nothing I can do about that.

I realized that I have this little mound of grief, with notes of regret, guilt and occasionally anger, that I may have to carry forever. Once I accepted that, it was a short hop to tonglen: being willing to shoulder all of the bad feelings left from this relationship, and to wish for F. to be entirely free of them—there’s no sense in both of us feeling bad. A couple of days after I began to practice tonglen—“May I take upon myself all of the sorrow from this breakup; may F. be happy and at peace”—I noticed a new sense of separation between us which for the first time felt good instead of bad. It felt clean and peaceful.

I usually forget about tonglen practice until I’m desperate, but it is quite powerful. It is a way of turning toward difficulties rather than trying to make them go away, and it affords a bolstering and inspiring sense of doing something noble.

However, about the time the sense of separation arose, I began to consider how much of this pile of suffering might be self-inflicted and therefore optional. Maybe some of it is unavoidable, and this I will willingly carry with me, but probably a lot of it is due to how and where I deploy my attention. As the Buddha taught, grasping causes suffering. Theoretically, I could have figured this out two days after the breakup, but it always goes the way it goes.

Yesterday I went for the fourth and final day of orientation for my new position as staff chaplain at VFMC, along with my wonderful co-worker, Carolina, who I like more every time I see her. That will happen very rarely, since we are going to work on different days. The night before, I kept smelling smoke, and when I woke up in the morning, I learned that there are a lot of wildfires burning north of here. My apartment, where all the windows were closed, was smoky, and the hallway outside my apartment much more so. Outside the air was hazy. Even deep in the bowels of the hospital, in the basement, it smelled like smoke.

A few times yesterday, my new boss spoke to me in a rather withering manner, which caused a knot of fear in my gut. She spoke to Carolina in nearly the same tone, and I know it’s not personal. The person I feel for most is Rebecca, the administrative person, who I know is regularly criticized and scolded. It may be partly the difference between a hospital that is basically corporate and one that is a teaching hospital affiliated with a university. There’s quite a different feel.

However, I must admit that my boss’s bordering-on-rude observations were not entirely off the mark. I am detail oriented and risk averse. I am an Enneagram One, and I like to do stuff right, and in order to do that, I have to know what’s right. Unfortunately, the kind of question I am most urgently moved to ask is exactly the kind of question that can annoy my boss, so I guess this is an opportunity to figure out how to draw upon my own authority.

I also see the parallels with F.: I want my boss to act in a different way so I don’t have to have a knot in my gut. But that is outside my control, and it’s not reasonable to expect only good things to come my way. After having been affirmed constantly at TWMC (a teaching hospital affiliated with a university), being treated as if I’m a loser is hard, but I am grateful for the memory of that extravagant kindness, and also for currently being treated extremely well by Clementine at the County Hospital (also a teaching hospital affiliated with a university).

What they call “self-supervision” in CPE is called for here: how can I be a chaplain to myself? I can figure out creative solutions, such as taking the unpleasantness itself as my object of attention.

As for the job at TWMC, I haven’t heard anything. The online listing has now disappeared, so the application period appears to be over.

Friday, October 06, 2017

Patient Visit Protocol

Still no email about being screened out. It would be absolutely incredible if I got that job, but it will be fine if I don’t. I am starting to feel excited about the new job I already have—it was great to create an Outlook signature that says “Staff Chaplain” in it—and I also love being at County Hospital.

Today was my third day of orientation (of four) for my job at Very Fantastic Medical Center. They gave me the same user ID as when I did a unit of CPE there in 2016, so there were my electronic health record lists from more than a year ago, and lo and behold, one of my favorite patients of all time is in the hospital right this minute, as seen in my “Patients I Have Seen” list. She is even in one of the units I will be assigned to. I once read a chart note for her that said something like, “Patient’s room observed to be full of smoke. When nurse entered, patient threw a pipe behind her bed. Nurse was unable to retrieve pipe.” You particularly have to wonder about the sequence of events summarized by that third sentence.

At my new job, I have a partner, another per diem chaplain hired at the same time. Working on different days, we are going to share a SNF (skilled nursing facility) and an acute rehab unit. I will call my co-worker Carolina. She also did a year of CPE at the Truly Wonderful Medical Center, a few years before I did. At our first day of orientation, we had a presentation on what to do in an active shooter situation and got to see that alarming video yet again. Hospitals have a high rate of workplace violence compared to other industries.

The person doing this presentation had brought a bag full of fake guns to show us. One new employee knew all about this: “That’s a 957 with a 3S modification,” or whatever. I know this would sound completely normal in many parts of the country, but in 35 years in San Francisco, I have never once heard anyone speak with such authority about guns, and it was kind of unnerving.

I was very impressed when Carolina raised her hand, turned to face this fellow, and said, “I’m wondering why you know so much about guns.” He didn’t answer, but the presenter quickly said, “People have military backgrounds, and may know a lot about firearms. In an active shooter situation, I’d want to be near you,” meaning the gun expert.

That makes one of us. The next day, the gun expert didn’t come back to class.

Today we covered the sequence of events in regard to visiting patients. After another staff chaplain explained what to look for in the person’s chart before visiting, he said, “Then you go visit. You probably know what to do there.”

“We tell the patient our problems,” I offered.

“And cry,” added Carolina.

“Right!” beamed the staff chaplain.

Thursday, October 05, 2017

You Are Not Going to Believe This

It has been four days since I applied for the job I would most like to have in all the world, and I have not yet gotten an email saying my qualifications are not a match for their requirements!

We shall see. For the record, I feel that something astonishingly good is about to happen.

In the meantime, a clinical shift at County Hospital yesterday, and class in the evening. I’m trying to take as few notes as possible these days because such notes need to be typed up and filed, and probably 96 percent of them are never revisited. I probably have 200 pages of typewritten notes from CPE, and plan from now on to write down only what seems particularly valuable, such as the following, from a presentation on suicide.

Suicidal ideation can quickly become homicidal ideation, especially in the case of psychosis, so be careful when with such patients. We also learned that we should not tell a suicidal person that she won’t go to hell if she takes her own life. I didn’t understand this at first: are we supposed to tell her she will go to hell? Clementine explained that a person’s belief that her act of suicide will lead to eternity in hell might be the only thing keeping her from doing it: her lifeline. Removing this is unwise.

As it happened, during that very discussion, we had a patient actively dying elsewhere in the hospital. Several of us spent a bit of time sitting with her, including myself during a class break. I found another chaplain there busily stroking the person’s forehead and exhorting her to “Go toward the light” and “Let go and let God.” This chaplain explained that the woman had deliberately overdosed that very morning in her home, leaving a note saying she was not to be resuscitated. The chaplain said death was likely imminent.

I had a number of problems with this. First, a person who is not responsive, even one who is deep in a coma, may very well be able to hear and understand everything you’re saying. Even someone who has set out to commit suicide might be upset to have people standing by her bed chatting about her impending death, so I believe it is best not to discuss a person’s death, diagnosis or prognosis where she can hear you unless she is able to participate in the conversation.

It is also my understanding that as death approaches, many people turn inward and may no longer want to be pulled back toward what they will soon leave. For instance, while someone may formerly have enjoyed reminiscing about past times, he may no longer be interested in this. It is well documented that people often wait until they are alone to die, suggesting that maybe this is something that is between the dying person and her creator, or the universe, that others don’t have much of a role in, so I wasn’t sure about the vigorous forehead stroking, nor the specific instructions. How did we know this person believed in “the light” or in God?

My colleague stepped out and I pulled my chair close to the side of the bed and just sat there. I did not touch the patient nor say a single word. It seems to me that she was much less agitated once the other chaplain left, but I may be misremembering how she was when I walked in the room, or maybe that was going to happen anyway. I did feel sad. The space between this person’s breaths was very long. Death was not far off. What had brought her to this point? Who did she love during her decades of life? Who loved her?

I wondered if economics had played a part, or ill health. I wondered if her wishes not to have resuscitation attempted had been respected or not, and how those decisions are made. I do believe suicide is a reasonable choice in many situations and that we do properly have agency in this regard. Given that, should a hastily scrawled note carry less weight than fulfilling the legal requirements of the End of Life Options Act?

I returned to class troubled and shared my questions. Clementine said, “Those are good ethical questions.” I also shared my judgments about the interventions of the other chaplain, acknowledging that every chaplain is different, and that for all I know, as soon as my colleague left the room, the patient thought, “Where is that lovely hand that was just upon my brow?” This led to an interesting discussion. While one classmate was sharing his responses, I found myself increasingly near tears, which I attributed to that person’s emotional presence, and which reminded me that I would like to have that kind of emotional presence myself. I do believe that empathy is a skill that can broaden and deepen, and I felt inspired by my classmate’s effect on me. I guess this was the first time I had knowingly encountered suicide in the hospital, and it was difficult.

Monday, October 02, 2017

Dream Job

Last Friday I saw patients for the first time at County Hospital. New volunteers are supposed to shadow an established chaplain for at least four visits, and then be shadowed for at least two visits before seeing patients on their own, but Clementine said she didn’t think I needed to shadow anyone. I did three visits with her observing and then she said I can go ahead and see patients on my own. One visit was complicated, with an upset patient and an even more upset family member. Everywhere we went, Clementine announced proudly to other staff members that I just completed a year of CPE at the Truly Wonderful Medical Center.

I was glad to find that the gel at County Hospital seems fine in regard to smell, consistency and lack of adverse skin reaction. At TWMC, there is a dispenser outside every single patient room and often inside, too, but at County Hospital, there is a dispenser only about every four rooms, which dispenses a set amount that is way more than I would normally use.

On Saturday, Lisa and I took a walk in Tilden Park, our first in quite some time.

Late last week, Anita, my joyful ex-CPE supervisor, texted me about a job that has opened up at TWMC. It is precisely my dream job—one I was hoping would turn up two and a half years from now, after I finish school. I decided it would not make sense to apply now—that it’s someone else’s job. I told myself I will trust that what I need will turn up when I need it.

Then I spent most of Sunday with another CPE supervisor. We took BART to Point Richmond to go to Dharmata and hear the teachings of Tibetan Buddhist teacher Anam Thubten, who has quite a presence. After that, we had a beautiful brunch on the sunny back patio of Brezo. I told him—let’s call him Graham—my reasoning about the job, including that my boss at the Very Fantastic Medical Center will kill me if I quit my new job right after it starts. He said, “Hmm. I’m sure she’d understand that your dream job came along.” I told him that my school requires volunteering, and there is no way I can fit in school, my dream job, and volunteering. He said, “Hmm. Do they require volunteering per se, or just that you are practicing your clinical skills somewhere?” That very question has been lurking in the back of my mind for some time. Maybe it doesn’t have to be actual volunteering.

So, after our lovely day together, I came home and applied for the job. As Graham pointed out, if I don’t get it, my situation continues to be perfectly fine, and if the job becomes available later, I will already be known as someone who is interested in it. That makes total sense, but when I reported to the Very Fantastic Medical Center for my first day of orientation today and was greeted by a surly person at the front desk instead a smiling, friendly one, I felt a stab of longing for TWMC.