Sunday, December 03, 2017


Early in November, Ann Marie and I went to Open Studios, followed by dinner at Los Jaliscos. She was wearing her customary floating layers of orange and silver and red, and enormous pieces of jewelry, including a ring one third the size of a baseball featuring the image of an insect. All of this dazzled the artists. Periodically I explained that I myself had dressed in navy blue from head to toe so as to be an effective backdrop.

Another day, Ann, Tom, Ann’s friend Jill and I saw Daniel Handler’s play Imaginary Comforts at Berkeley Rep, preceded by lunch at Au Coquelet. Jill is a very cheery soul, and helped Ann with the driving from Sacramento. I love these afternoons at the theatre, a gift from Ann.

One Friday afternoon, I took a walk with Anita, my ex-CPE supervisor. I was planning to have dinner with Karen that night, but she hadn’t confirmed yet. Anita and I made our way to Balmy Alley and enjoyed the murals, and then we were both hungry, and I was still unable to reach Karen, so Anita and I decided to go ahead and eat, which we did at Heung Yuen, where F. and I used to go. I ate all of my substantial entrée, and a few bites of what Anita left of her entrée, plus half an order of pot stickers. Then I got a message from Karen saying she’d be at my door in a few minutes!

Karen and I went to Udupi Palace, a vegetarian Indian restaurant, where she observed mournfully that I had done with Anita exactly what she and I were supposed to do together: eat and go for a walk. I told her I’d have a little snack while she ate, but ended up ordering—and eating—a second full dinner, after which I felt extremely ill, followed by five straight days of diarrhea. During that time, the heat was broken in our apartment building, so I spent several days huddled in bed underneath all of my blankets, waiting for my intestines to settle down.

On Wednesday, I called my mother and she said you’re not supposed to let diarrhea go that long—that you can get dehydrated and end up in the emergency room. Who knew? She ordered me to go to Walgreens and get some Kaopectate or Immodium AD. I dragged myself over there and back; I had to sit down to rest on the way home. Back at home, I took both Kaopectate and Immodium AD to be on the safe side, which worked so well and so immediately that three days later I was wandering my neighborhood looking for prunes.

Late in November, I went to Michigan to visit my parents and sister for Thanksgiving. Right before I left, I submitted my application for school—a two-year low-residency program that will afford the exact 48 units I still need for board certification, if they let me in.

My visit home was nice. I spent a lot of time with my parents, and my sister came over twice, and I had lunch with Amy at Seva. Ginny was not feeling well on the day we would have gone to Café Zola. My parents made a wonderful Thanksgiving dinner: roasted chicken, dressing, two kinds of gravy, Waldorf salad, baked lima beans with olives, biscuits, Mama Stamberg’s Cranberry Relish (as well as cranberry sauce from a can, for those who don’t care for Mama Stamberg’s), and chocolate-chip cookies for dessert.

After I returned from Michigan, I felt super-crabby for several days—maybe too much MSNBC, which I only get to watch every six months, or maybe my brain got dried out on the plane. In class Wednesday night at County Hospital, we talked about trauma exposure and self-care and Clementine mentioned that since we deal with so much death and loss, creating something can be powerful: making art, gardening, writing, playing music, cooking.

She and I had a one-on-one and I told her about a patient I visited who had gotten a terrible diagnosis and had been wailing loudly off and on for weeks, per what I heard from another caregiver and certainly during much of our time together. After I left her room, I felt worried that I’ll get what she has. This has not really happened before, and Clementine said it was a flag—perhaps a signal that my self-care needs adjusting. She has stressed to us that self-care needs change over time. I don’t want to be the chaplain who is burned out or suffering from trauma exposure, but the latter, at least, cannot be avoided. As it was explained to us in the class at Sati Center, if you work around those who are traumatized, you will experience secondary trauma, just as surely as you will become warm if you stand near a fire.

On Friday at County Hospital, I visited a patient who was very cheerful, who said she was fine: “The universe takes care of me if I take care of my universe.”

As I was leaving the hospital at the end of the day, I came upon a man pushing a cart full of empty water bottles and singing to himself in an exceedingly merry fashion.

“You’re in a good mood. What’s your secret?”

He turned to me, and I saw how cheerful and relaxed his face looked. He explained, “I don’t want to be a grumpy old man. I want to be a happy old man. I realized that the difference between my very worst day and my very best day was my attitude. Also, I don’t believe in problems. I believe in inconveniences, which might be small or large. God solves problems.”

Still thinking about effective self-care, I decided to actually cook something other than cereal for the first time since June, 2016, and immediately felt more optimistic. Yesterday I made lentil-potato-tomato stew, while listening to music, and it was really nice. I have not had enough opportunities to listen to music lately, which is something that brings me joy. (Two favorite new songs: Radiohead
’s “The Tourist (new to me, anyway) and Janelle Monae’s Tightrope” (her solo version). The former is so beautiful and the latter is so infectious. What a lovely voice she has. I was surprised to hear some ukulele at the very end, which she mentions, saying the name of the instrument in such a sweet way.)
Speaking of optimism, Nancy Gibbs used this wonderful phrase in an essay in Time magazine (soon to be partly owned by the Koch brothers) about the state of our nation: “The expansive, oxygenated opportunity of optimism.” Outstanding use of Os.

Fire Circle

Early in November, nearly all of my clinical pastoral education cohort got together at the house in Berkeley where one of us lives. We brought food and ate and talked and, toward the end of the evening, sitting in the dark backyard around a fire, did a circle where each person got a chance to check in.

Another day, I got together with my CPE peer Nellie for lunch at Xolo in downtown Oakland followed by a trip to a store called Sagrada Sacred Arts, tea at Crepevine, and a visit to a bookstore. A couple of days later, I had lunch at Green Chile Kitchen with Mason, one of my two peers in my first unit of CPE in the summer of 2016. That was delightful.

My next day at work, I set out to have explicitly spiritual discussions. Early in each conversation, I said, “I want to know how I can support your spiritual well-being.” My first shift or two, I felt overwhelmed by the number of patients on my three units, but since these are all units where patients stay for a long time, and since Carolina and one of the CPE students also visit people in these units, and since a “spiritual” conversation takes a much shorter time than my normal kind of conversation, I’m now wondering if I’m going to run out of patients to see.

I’m finally starting to memorize some of the questions we use for taking a basic spiritual history, and I’ve gotten in the habit of checking the charts for an entire unit before picking out patients to see, in part to see if Carolina visited the person very recently. I also notice where the person lives: is he far from home? And marital status: is she married, single, widowed, divorced? This is just a snapshot, with much more to be learned, but someone who lives in San Francisco and is married is in a different situation from someone who is widowed and has come to the hospital from far away.

At County Hospital a couple days later, I continued to tinker with my approach. Mentioning the wish to support the patient’s spiritual well-being first thing seems to constrain the conversation a bit too much, so I started by asking how the patient was coping with his or her hospitalization, and then brought up spiritual well-being soon after that.

A couple of patients just ignored that question completely. One was screaming at the top of his lungs that someone had stolen his boots and that he wanted to leave the hospital immediately. After yelling for five minutes, he apologized quietly when the boots were discovered in the closet in his room. Another patient seemed taciturn and angry at first, upset because I wouldn’t go across the street to get him a soda; later he asked me for money. But then he started telling me all about his life and his relatives and was smiling when I left. A great thing about this work is that the gratification, or lack thereof, comes immediately.

At the hospital that day, I attended a session on dealing with difficult patients, part of a series that emphasizes the emotions of health care professionals. There were four presenters, including Clementine, who supervises us chaplains. Another was a trauma surgeon, who said his own inclination is never, ever to give up. However, he said he often has a frank talk with a patient where he claims he says, “I can do this, this and this, or I can withdraw support, and then you’re going to die.” I was wincing a bit at that. I learned in my first unit of CPE that we never “withdraw care” or “withdraw support.” We transition to a different type of care. And I hope he does not announce so baldly that the patient will die. Or am I wrong to hope that?

I pictured how I might conduct such a conversation: “I can do this, that and the other procedure. The recovery will be long and difficult, and I can’t guarantee how much function you’ll get back. This is for you to weigh out. These procedures will be hard on your body, there will be pain afterward, and the recovery period may be months. At that point, you may be able to do most of the things you enjoy, or you may not. However, it is your choice whether or not to have these treatments. It is perfectly reasonable to decide not to have them, in which case we would focus on making sure you are comfortable and free of pain. Your remaining life span would then be measured, probably, in weeks to months.”

While I was embedded with the palliative care team at the Truly Wonderful Medical Center, I noticed that they always referred to life expectancy in such terms: weeks to months, days to weeks, minutes to hours.

Yes, I think I don’t like the idea of anyone saying to someone, “Your other choice is that we can withdraw care, and then you’re going to die.” I hope he doesn’t literally say that.

Anyway, one reason I mention the presentation is that there was a second doctor there who said that it can be wrenching to care for patients in very difficult situations, including because there can be disagreements among care team members. However, he said, not caring is not a good alternative, because caring is what makes this work satisfying.

A Rock in the Stream

Late in October I took a walk in Golden Gate Park and had Thai food with a hospice nurse I met during clinical pastoral education.

I worked on a Sunday and had a one-on-one meeting with my boss, during which she offered zero words of affirmation and many, many criticisms—such as of nearly every line of one of my chart notes. I kept waiting for that moment when my stomach would clench and I would feel afraid, but it never happened. Not because she didn’t say anything critical—she said lots of critical things, but since I was actively waiting for them, they didn’t have any particular effect. As a grand finale, she directly announced that she can feel annoyed by me at times, and then quickly apologized, as if to suggest she’d gone too far (or, perhaps, to underscore that she had said something that could cause offense, in case I had missed it). But I am fresh from 15 months of CPE and constant discussion of feelings, so that did not upset me, either.

Also, I can see the truth in some of what she said. I do like to know what’s considered right and what’s considered wrong so I can do what’s right. When she pointed that out, I said, “Yes, that’s true. I’m an Enneagram One.” She said, “I don’t know … I’m also an Enneagram One, so I think it’s something more than that.” This I recognized as her trying to shake my confidence or make me think there’s some deep, dark, unfixable thing about me. I also recognized it as likely correct and not a cause for self-flagellation: I have my stuff that I’ll be addressing forever, which I came by honestly. So does she, and so does everyone else.

Besides saying some things that were true, she also said some helpful things. She is a good educator. I actually left our meeting feeling inspired (but also a little bit glad that we’re only going to meet every other month; I’m also glad for all the kindness and affirmation we receive at County Hospital). My boss said she doesn’t want to tell me, “This is right and this is wrong.” She wants me to figure out how to think about things to come to my own conclusion. (I believe my parents had the same plan 50 years ago, and it didn’t work then, either.) It will be good for me to try to do that.

She also really does not want chaplains sitting around chatting with patients about whatever is happening in their lives or even about what they are feeling. She said we are the only people who provide actual spiritual care—that not even the hospital priests or Eucharistic ministers do that, truly. She said there are lots of people who can provide emotional support, but that a genuine spiritual care provider is like a “rock in the stream.”

This has been my issue all along: I do shy away from pestering people about religion and spirituality, because I enjoy sitting around chatting with all sorts of people, because it seems rather personal and private to discuss with a stranger right off the bat, and also because there’s part of me that still thinks a chaplain is a religious zealot and therefore someone to avoid. Even though I am one! Ugh. My boss said not to tell patients, “We offer spiritual care and emotional support,” because emotional support is something I should be embodying all the time and not something optional for someone to request. So there is much to learn and practice. I’m going to be a much better chaplain for my time in this job.

On my very next visit, I skipped the part about emotional support and said I was there to provide spiritual care, period, and was surprised at the depth of the discussion that immediately ensued.

Wavelet of Joy

I went to County Hospital on a Friday afternoon quite some weeks ago now to work a shift that included a fairly long visit with a patient which I wrote up afterward for one of the two verbatims we have to do during the course of our training as volunteer chaplains. It was the first day I really felt I belonged there, and I also felt one of those little wavelets of joy that I count on to let me know I’m still on the right track.

Online, I saw a story about a police officer who was severely injured while in the line of duty, and in the background of the accompanying photos, I saw County Hospital, where he was being treated. I also saw an even more horrendous story about a three-year-old brutally attacked by his own father, a tech executive, and realized that that child was probably right then also at County Hospital or at the Truly Wonderful Medical Center. Maybe one of the new batch of CPE students was this child’s chaplain.

I was excited to return to the Very Fantastic Medical Center for my second shift. The pager was quiet during the day, so I went to one of the three units Carolina and I share and saw three patients. Two of the visits were long and very satisfying. The third was short; the patient was resting and said she had all the resources she needed to practice her religion. Later I was sitting in a charting room with big glass windows, and she walked by and waved and smiled. As at County Hospital, I had my first sense of really belonging there, and sent my boss a gushing email telling her that I love my job and thanking her again for hiring me.

One of the long visits was with a patient who was initially sort of belligerent. When I said we offer spiritual care and emotional support, she said, “Are you saying you think I have emotional problems?” She was waving around a pair of glasses missing one earpiece which periodically flew out of her hand. I must have answered that question correctly, because two minutes later, she said, “You look like Meryl Streep. Actually, you’re better-looking than she is. Her face is too narrow.” That’s officially my new favorite patient. Obviously one with some sort of visual impairment, but very charming. Toward the end of our time together, she asked if a chaplain could visit every day. I said I work only once a week, but would she like a chaplain to visit the next day? “No!” she answered. A relative at her bedside interpreted: “You’re her chaplain. I could see it in her eyes after you started talking to each other.” That made me wish I could be there every day.

Per my boss, I’m going to find out if religion or spirituality is important to patients, and if so, whether they have the resources they need, but I’m also reminding myself that it is the relationship that heals, and that it is attuned conversation and emotional presence that build that kind of relationship. This means I need to be in touch with my own emotions. Accordingly, this is now an explicit part of my sitting practice, sort of combining meditation and therapy.

I start with ten minutes of metta practice, and then, per Sayadaw U Tejaniya, I notice if I can feel my body. If I can, I’m present. I inquire if the most noticeable sense experiences are pleasant, unpleasant or neither. I inquire if I like or dislike these experiences, or neither. It’s interesting to notice how the latter two move in tandem and how they don’t. In fact, that’s extremely important to notice, because we assume that we will dislike things that are unpleasant, but it’s not actually required. Having an experience that is definitely unpleasant but realizing that one isn’t unhappy about it is liberating.

Anyway, I next inquire if I’m having any particular emotion, and if so, what I would call it, where I feel it, and how it is behaving. Is it thick, wispy, contracting, expanding, stationary, traveling elsewhere in the body? That is my practice lately, these questions over and over and over, and I’m noticing that it’s getting easier to feel my emotions when I’m with patients, which I think helps the connection on a subliminal level, but also affords clues as to what the patient might be experiencing, at least as a starting point.

I never got an email thanking me for applying for my dream job and letting me know I’m not qualified for it, but I finally heard that an offer was being made to another candidate, one who is new to the hospital. I would have been thrilled to get that job, but it would have made the next couple of years way too busy. Meanwhile, I’m settling in more and more at my current hospitals, and can now picture myself staying indefinitely.

Two years ago, I told myself that if my employer laid me off, I was going be a hospital chaplain, and now that’s what I am.

Enjoying Wildlife in the City

I believe this is a rat, but you can hardly tell, huh?

 (Click photo to enlarge.)