Wednesday, January 31, 2018

A Trip to Cuba Over the Beautiful Blue Sea

About a week and a half ago, after I was in bed for the night I got a call from my best friend when I was 13, Mark. I saw it was him, but didn't pick up, since I had to get up at 4 a.m. I meant to text him from work but discovered his info had vanished from my phone, so the following day, after retrieving his info, I texted to ask if everything was OK.

He is my friend who lost his father and both of his brothers—his only siblings—in the course of several months a few years ago. One brother was 55 and the other was 54. That Mark hadn't left a message made me wonder if something terrible had happened—if perhaps he had lost his wife.

But after texting him, I got a voice mail from his wife saying that it was Mark who had died, suddenly, of a heart attack. I called her and she told me they had had a party to celebrate their youngest daughter's graduation from college. Mark turned in at 1:30 a.m. or so. His wife saw their remaining guests off and fell asleep on the couch. When she joined Mark at 5 a.m., he was gone, at 55 years old. None of the brothers made it to 56.

The next day was kind of crappy. I'm sure the pall of Mark's death was hanging over me as I walked to County Hospital for my shift, where I felt tired and bemused. I had 11 visits with patients, a record number, which mainly meant that I had a lot of charting to do, which is done by hand there, and that the visits were short and perfunctory. Afterward I had pupusas with a fellow volunteer, but even that wasn't fun. I just wanted to come home and sit in my comfortable chair and drink tea and read The New Yorker.

My prior shift at County Hospital, I visited just three patients, and all three visits were long and satisfying. One challenge there is that most rooms don't have chairs for a guest to sit in, though some do. I hate standing over people who are lying in bed, and I also hate walking all over the unit looking for a chair which has to be returned later. I think I'm going to buy a sturdy little folding stool to carry around with me, which I understand another volunteer does.

The night after my 11-visit shift, I didn't set my alarm, and slept for a restorative eleven and a half hours. I dreamed of flying to Cuba in a small airplane over a beautiful blue sea. In Cuba, I hung out with some theater people who were singing songs, and part of the dream was also lucid, when I was trying to send a text message and realized I was dreaming.

I continued to feel kind of lousy for a day or two and realized I really needed to get to Howie's. Spiritual sustenance is going out, to the best of my ability, but not coming in. I almost never went to Howie's during CPE and looked forward to being a regular again once CPE was over, but now I nearly always am working on that night of the week. I discussed swapping work days with the other per diem, but that didn't work out, so for now, I will just have to attend a different meditation group.

During my one-on-one with my boss last week, I mentioned that a certain patient had lied to me, as I discovered when I looked at her chart some days later. My boss asked why I had looked at her chart, and I didn't really have a good answer for that. The true answer is simply that I was curious, which I didn't say. My boss advised me to do my best, and then let patients go.

When I was in CPE there in 2016 and throughout my yearlong internship, I always maintained an electronic list called Patients I Have Seen. Often I would review it in the morning, just to see who was still in the hospital and if anyone had died. If I needed or wanted to see one of those patients again, it was easy to find his or her record. I also made myself such a list when I got this job, but after talking with my boss, I deleted it, and will see how life is without it. If there's really a good reason to have it, I can always make another one.

I also had at home a nice-looking little pad of paper where I wrote the names of patients who were especially important to me, but I got rid of that, too. If a patient is meaningful enough that he or she spontaneously comes back to mind, fine. If not, having a means of remembering former patients is just more psychological baggage, more unnecessary weight. I'm now starting to think about getting rid of my journal. I might start by discarding one page or a whole year and see how it is.

My mother says she's started to get rid of things because she has reached the age she was saving them for and sees that she has no need of them. I'm not still going up, up, up, gathering more and more and more. I'm on the other side of the hill now. I'm coming down. Things are going away, most recently Mark.

This quote keeps coming back to me: "Apprentice yourself to the curve of your own disappearance." ~David Whyte

A Chewy Wad of Rhetoric

One of my CPE peers is now the full-time priest at County Hospital, so he and I had dinner one Friday night mid-January at a Chinese place and agreed to do this monthly. A week later, Karen and I had dinner at Udupi Palace (vegetarian Indian food) and the next day, my CPE peer Nellie and I went to the women's march in San Francisco, which had a relaxed, pleasant feel. On Sunday evening, my CPE cohort got together in Berkeley to eat and get caught up.

At work the following week, I had a one-on-one meeting with my boss which went better than expected and made me wish I hadn't spent so much time practicing responses to things she might say—none of which she did say—which I knew even at the time was a waste of time and energy.

I brought one patient visit for her scrutiny, and of course she told me everything I did wrong, but I reminded myself that she likes to teach, and that she is trying to educate me, and that I should learn as much from her as I can. Even though the words might have been very similar to our prior meeting, this time I didn't feel attacked.

I had recently told her all the dates I need to be away for school and for visiting my parents and for the Annual Christmas Blow-Out in Sacramento, and some tension arose. The speech I was rehearsing mentioned that, as a per diem, I don't have health insurance, I don't have dental or vision insurance, and I don't ever have such a thing as a paid day off. The only thing I have is some flexibility as to when I'm available for work or not, though I appreciate that a per diem who is quite unavailable will not be employed for long.

I do know, from long and bitter experience, that hurling a big wad of well-polished rhetoric at another person is never effective, but I even rehearsed saying, "I'm not so much asking for days off as letting you know when I am not available to work." However, none of that got said, fortunately. The subject barely arose. She said mildly that one particular month is a problem, and I said I wish I could change those dates, but both trips are for school; my hands are tied.

As before, she said plenty of things that were helpful—specific ideas about charting and conducting visits. And she gave me an actual compliment: "You initiate visits well."

There is a staff member not in our department who enthusiastically offers patients the chance to speak with a bona fide chaplain and turns over a list of names each weekend to the chaplain on call. I arrived at work Tuesday full of zeal to review charts for patients on all three of my units and conduct as many initial visits as possible—visits to people who have never seen a chaplain. However, there was such a long list of those weekend referrals that seeing them took up nearly the whole day.

My boss has lately been trying to get us to handle whatever comes in during our shift and not pass it on to the next chaplain, even if it's not at all urgent, and even if the request is specifically for some other chaplain. Therefore, I got to wondering why the person who worked Sunday didn't go see all those referrals and considered asking about that, but decided not to. I'm extremely lucky to have this position and I'm going to do whatever comes my way cheerfully. If someone else is doing something wrong, that will emerge sooner or later.

When I got this job, I agreed to work one 24-hour shift a week. Soon enough that became two shifts a week for the other per diem, Carolina, and three shifts per two weeks for me. At first I wondered why Carolina got more shifts than I did (other than that the boss seems to like her more than she does me), but then I decided that was a perfect amount of work, since these are all 24-hour shifts. It was more money, too, but it was kind of a wash, since if my income goes up, I will need to pay more for my Obamacare.

At our one-on-one meeting, my boss asked if I can identify another day of the week I could work, and next thing I knew, I also was signed up for two shifts a week, which is more than I want to work, though it also means that even if I pay full price for my health insurance, I am now—four months after finishing CPE and at least two years prior to getting board certification—fully self-supporting as a hospital chaplain. That is remarkable. I should say that I am temporarily fully self-supporting. I have a feeling that things change often in this line of work.

The Ritual of Taking Nourishment

I have a nice sturdy folding table that F. used to do art projects on when he was here. After he wasn't here anymore—18 months ago—I folded it up and put it behind my bicycle in the kitchen and continued to eat either with my plate perched on my lap or standing up while washing dishes or whatever.

I have had an eating disorder nearly all my life and, as an adult, have most often dealt with it by keeping strict control most of the time and overeating outrageously (i.e., bingeing) the rest of the time, as when dining out. A couple of years ago, I decided at least not to read while eating, and very recently, I decided not to listen to the radio, either. If I supposedly enjoy this activity so much that it seems like something I could never give up, odd that I can't bring myself to pay full attention to it. I also was inspired by my recent visit to Naima at her hospital, when she talked about how grasping and aversion lead to suffering.

If that is true, then eating an entire pizza, which I have done many, many times, is not an experience of freedom but one of bondage. It seems like an activity I would be bereft without, but maybe the reverse is true.

I also have been thinking about trauma stewardship. My job comes with built-in stress and trauma, and I can easily see occasional outrageous overeating becoming daily outrageous overeating. I don't have anything against fat people, which adjective I use in its descriptive function, not pejorative. It is not fun to be fat in this society. Those who are have my sympathy and understanding. I have been fat. But I don't want to be the sad 400-pound chaplain who eats a whole pizza after every shift.

My eye fell on that table, which I had thought of as F.'s table. "You know, this is actually my table," I said to myself, and I hauled it out from behind the bicycle and set it up in the kitchen. It's larger than I need for eating, so at first I was using the far side of it as a repository for random objects, but after a while, I decided that while it was nice to have a place to put stuff, a beautiful spot for eating was more important.

I also designed a ritual, which goes this way. I turn off the radio, which has been on while I prepare food. I put a place mat on the table, along with food and drink and a napkin. I light a candle. I announce out loud, "The Ritual of Taking Nourishment." I sit down and say this prayer before eating:

I offer thanks to all those whose hard work went into making this food appear in front of me. I offer thanks to Mother Nature, who made this elephant and everything else! May I eat this food with gratitude and appreciation. May it nourish and delight me. May all beings have fresh food and clean water. May all beings have secure shelter and excellent medical care. May all beings feel loved and cherished. May all beings be nourished and delighted.

Hammett is vigorously discouraged from sitting on the table while it's being used for eating, so he often makes a point of sitting on it right afterward, just to remind me that I'm not the boss of him.

Saturday, January 27, 2018

Perky Eyebrows

The day after the evening with the four emergency pages I sprang out of bed after just six hours' sleep (an extreme rarity) with a burning desire to work on this very blog, which is when I saw the acceptance letter from school. This launched a frenzy of activities: sending back my acceptance letter, reviewing all the info they'd sent, paying my tuition, learning many details pertaining to my first trip there, and, after a break for a trip to the dentist, choosing my electives for the rest of this year.

Besides the two core training periods that everyone must attend, I picked out a five-day sesshin (Zen-style silent meditation retreat)—everyone has to do one of these each of the two years—and two electives. One is a three-day workshop on death with two experts on same. The other is a street retreat, where you go out into an urban environment with a single dollar bill in your pocket, no change of clothes, no toothbrush, and a plastic trash bag in case it rains. The idea is to find out what it's like to be dependent on the kindness of others—some slight idea of what it's like to be homeless.

When I first read about these street retreats a few years ago, I was like, "I am never doing that," but when I was choosing my electives for school, I saw they offer two of these, one in San Francisco and one in New York City, and decided on the spot to do the one in New York. Oh, I skipped a step. My very first thought was that I don't wish to be raped and murdered on the streets of New York City, and therefore I would not do this, but then I learned that you're either with the whole group or with a subgroup at all times, and that the group includes a teacher, so I decided to sign up, though those very facts made me wonder how realistic it is. Does anyone really confuse a whole bunch of clean, well-fed and mostly white people with an actual homeless person? Anyway, it seemed that this would be an interesting experience, and I felt like weeping after I decided to do it, which seemed like a good sign.

I later talked to someone who has done this, and she said it is not about pretending to be homeless, but more just about finding out what it's like to have nothing to do but hang out all day, and it is also an exercise in asking for stuff: food, toothbrushes, and all the money we have to raise beforehand, which we will donate to social service agencies afterward. That is kind of brilliant: forcing people who may rarely have to ask anyone for anything to ask for a lot of stuff, as mendicant monks did in the time of the Buddha and still do. Probably at least one of those kinds of asking was going to be uncomfortable.

I called my mother to tell her all the good news of the day: On my walk home from the dentist, I acquired a King James version of the Bible, a nice hardcover for less than $20! I felt disappointed when I recently realized that the Gideon Bible I brought home during my first unit of CPE doesn't say in it, "Sufficient unto the day is the evil thereof," which is my favorite line. For that, you need King James.

I also got good news from my dentist, and of course there was the good news about going on a street retreat in New York City. My mother said, "No. No. I do not give my permission for this. Isn't there a place where your mother has to sign to give her approval? You're a minor, right?"

At the end of the conversation, I asked her to pass all my good news on to Dad. I listed them again, ending with the retreat. "Yes, good," said Mom. Then, "I'm frowning. I just realized my words are not matching my facial expression." Pause. "I'm trying to perk my eyebrows up."


I've been really lucky over the past few months in that at the end of the workday, I go home and have dinner and go to sleep and don't have to return to the hospital: my sleep is not interrupted by the pager going off. And I am being paid for all of these hours, half what I get per hour during the day. So when I got a page 15 minutes before quitting time requiring my presence at another campus, I couldn't be too unhappy about it, though I had gotten a crappy night's sleep the night before and I was hungry and looking forward to going home and eating and going to sleep.

I waited half an hour for a shuttle and went to the other campus, where I spent 90 minutes with an older woman who has dementia, unbeknownst to herself. According to herself, she was minding her own business at home and then was forced into an ambulance and conveyed to the hospital, where she said she had no intention of staying. But reading her chart note made it clear she is unlikely to go home ever again. When I left, she said she felt better. She said, "I felt low when you arrived." She cried at times during the visit. So did I.

While I was charting that visit, I got a page requesting Sacrament of the Sick for another patient at that same campus. The name rang a bell and I was able to confirm in his chart that he had received the sacrament a couple of days prior. Meanwhile, the P.A. system announced a Code Blue, and a short while later another. During CPE, we had to report to every Code Blue, but at my new job we don't do that, so there was nothing I needed to do—until I got a page saying that both codes had been for the same patient, and that a very distraught family member was present—could I come?

I said I was on my way, and then got another page for the same patient who had wanted the Sacrament of the Sick; now they just wanted the chaplain to come. I couldn't believe it: four emergency pages in a row after hours, though at least they were all at the same campus.

I went to see the distraught family member, who was in tears, begging her relative not to die. In between moments of weeping, she told me about the other terrible losses her family has sustained recently, including of quite a young person. At that point, the patient had been receiving chest compressions for 30 minutes, meaning that, one way or the other, she was not coming back.

In CPR, they do chest compressions for a while and then assess. I kept hearing a doctor say, "Stop compressions. No pulse. Resume compressions," and my heart sank. CPR is violent and horrible; it can break ribs, and your brain is missing out on a lot of oxygen. As I have mentioned before here, many doctors specify that if they ever need CPR, they would prefer not to receive it—just to die.

Finally the relative said, "Stop. Just stop." And the patient was gone. It was terrible. Other immediate family members had arrived, and the partner of one of the family members was also there. When I left, the family members were bent over the patient's bed sobbing, and the partner was outside the room. He quietly pulled me aside and asked, "All that emotion—is it normal?"

"Yes," I said firmly, fearing that he was going to go in and exhort his partner to get past it and move on with life.

Then he said, "When my mother died, I didn't cry like that." Pause. "But I guess everyone is different?" It was very moving. I looked him in the eye and said, "Everyone grieves in a different way." After a moment I added, "You didn't do it wrong."

During the 90 minutes I was with this family, I went to call a priest for emergency last rites. While I was doing that, another care team member sidled up to me and quietly reminded me about the other patient waiting for me to come. It turned out that they were planning to extubate this patient—for him to go on comfort care—but they were waiting for my presence until doing this!

Finally I was on my way to that last patient, who had three family members at his bedside. His nurse pulled me aside and said she expected the patient to die right after extubation, and that she didn't think the family members realized that was going to happen. I sat down in the patient's room and after a while, the respiratory therapist came in and removed the tube. I don't think I've ever seen this done. Normally, everyone is asked to leave the room, and all the family members did leave the room beforehand, two in a decisive rush, and the other after thinking about it for a moment.

I decided to stay to see just how terrible this is, but it's not that awful. The tube is longer than you'd expect, and there's a bit of slime or gunk on it, but that's the whole thing. The family members returned and now the patient wasn't getting oxygen or pressors—medicine that keeps the blood pressure up. However, he did not die immediately at all. Two hours and 20 minutes after I'd arrived, he was "chugging away," as the nurse said. Other family members had arrived. When one of them pointed out that "it might be hours," I said, "I confess I was starting to think about that," and all agreed that it would be fine for me to depart. When I finished my quick chart notes—I don't use the formal template in this kind of case, but just write freehand, per my own preference—it was 11:45 p.m.

A Variety of Stimulating Conversations

A week or so into January, I arrived at work and saw my boss was in her office. I greeted her and she returned the greeting coolly. I suspected she was thinking, "I hate you." But then I remembered that I also can be grumpy when someone greets me if it startles me or feels like an intrusion. "Maybe I startled her," I thought. "Maybe she's like me."

A bit later, I was walking by her office again and she called my name, and we had a perfectly pleasant little interaction. She smiled at me, sort of, and asked how school is going. I told her that school hasn't started yet; it starts in March. This was true, but another thing that was true was that I hadn't yet learned if I'd been accepted into the program, which was starting to be significant source of stress. I had applied seven weeks earlier, and had flights to book and days off work to request and cat sitters to engage, not to mention that I was hired for this job with the understanding that I'd be moving toward board certification by going to school.

That day, after talking to my boss, who mentioned she'd like to know ASAP what days I will need off, I texted three friends and asked them to pray for me. Yes, I did this. I'm laughing as I write this. I included a friend whose prayers have proven to be magically effective in the past. She texted back saying that of course she would pray for me. (Well, first she texted back asking, "Who is this?" We don't usually text.) And later that day, my acceptance email finally arrived! Whew! I was relieved and delighted.

I am going to be a board-certified chaplain! Someday.

I spent the day at one of my rehab units, where I saw eight patients. We track our minutes in two general categories: actual time with patients, and everything else: traveling to the unit, reviewing charts before seeing patients, and writing chart notes afterward. The latter can easily take twice as long as the former, but now that my procedures for reviewing charts beforehand are more streamlined—I've tinkered with this a lot
and now that I'm more practiced at doing it, the difference in time is starting to be less pronounced, and sometimes it comes out to be the same amount of time in both categories, or even more for seeing patients.

I saw my boss again later in the day and mentioned that I'd gotten a compliment from a patient: He said, "We like it when you visit us
it gives us a feeling of well-being." My boss said, "Got an MRN?" Medical record number. I sent it to her, along with the quote from the patient, and soon received an email that said, "Nice compliment," followed by a thorough critique of the visit; she had read my whole chart note. That would have infuriated me even the day before, but at this point I found myself chuckling rather than fuming: There she goes again.

I guess I'm getting used to her way of doing supervision, and having had a pleasant interaction in the morning and having had the thought that perhaps we are similar helped a lot. She does always give me something to think about. Her critique mainly boiled down, once again, to the difference between emotional support and spiritual care. But isn't raising someone's spirits part of spiritual care? I asked her this in an email and she said, "Yes, I am sure he enjoys the variety of stimulating conversations he has with you and others," but that this patient seemed to be receiving more visits than his actual spiritual needs would warrant. This was partly because his room was right across from the charting room, which has big windows, and once the patient had caught sight of me, I felt guilty if I didn
't visit; I confessed this to my boss.

One Hundred Percent Cacao

Early in January I had an appointment at Kaiser and then walked home, which took about a hour and cost about $30, since I passed Whole Foods, where they have pizza; Gus's, where they have a type of fake dairy that one might dip a potato chip in, as well as several kinds of 100 percent cacao; and Valencia Whole Food, where they have a kind of rice-based crunchy snack that I like. In the evening, Sam and I had dinner at Udupi Palace and then he came over to my place for tea and a nice chat.

At work one day, I learned that Carolina has been reassigned to another campus, to units that are almost certainly more interesting than the ones I now have sole possession of, and she will also get the chance to see two of the other chaplains regularly. I felt a series of pangs: The boss likes her more than she likes me. Carolina will become friends with colleagues I hardly ever see. She will gain valuable experience. I felt sad and worried. I reminded myself that what is happening is meant to be—Howie says you can tell what's meant to be by what is: if it's happening, it's meant to be. This doesn't mean that it was so ordained by a higher power but that the lawful working of a vast web of causes and conditions has produced this result, and could have produced no other.

I further reminded myself that I have the tools to deal with this—more wisdom from Howie—and that my best course of action is just to keep doing my job as well as I can. This work is its own reward, for the most part, but if there are additional rewards to be had, they will come from doing my best.

Later I realized that I was misreading the schedule and that there won't be as much fraternization of my fellow chaplains as I had thought at first, and a couple of weeks later, Carolina mentioned the difficulty she is having getting along with the main chaplain at her new campus, so you never know.

Usually the CPE students are in charge of leading an interfaith service that happens twice a month, but due to a student's illness, I was asked to do this early in January. I had fun planning it. It turns out that the activities director does way more work for this event than any chaplain does: She goes around three units finding out what patients want to come, she makes sure that their rehab activities won't conflict, and she physically transports those in wheelchairs to the service. Along the way, she also finds out which patients would like a one-on-one visit with the chaplain and which would like communion, and writes their names  down. She mentioned that the nurses also ask patients if they would like to go to this service, but only the Catholic ones. I was slightly chagrined to hear this, since it is explicitly an interfaith event, for people of any faith or none.

There ended up being two attendees, both in wheelchairs, plus the activities director, which was good, because she was a lovely presence and also made valuable contributions. I started by telling the two patients to let us know if they experienced pain or distress during the session, as we would want to attend to that immediately.

I read the June 7 prayer from Prayers for Healing: 365 Blessings, Poems, & Meditations from Around the World, edited by Maggie Oman, and led a guided meditation, a body scan. I said it was fine to skip any body parts that the person was unable to feel, but the activities director said it's good to imagine body parts you can't feel, because that is 25 percent of the work of rehab! Who knew? I will definitely remember that for the future.

After the body scan, I said, "Taking a few moments to bring to mind the illness or injury you are dealing with, or perhaps an emotional difficulty or something that is worrying you. Thinking about what your biggest concern is today." After allowing time to think about this, I said, "It's natural to want our difficulties to go away, to be over, to want to be able to do what we were able to do before. But taking a moment to imagine your difficulty as a friend that you care about, who needs your kindness, or your encouragement, or the wisdom that you have gathered in life. Taking some moments to offer words of encouragement or wisdom to your problem."

I did this myself, thinking about my colleague and her new assignment. I said to myself, "You feel sad."

"Yeah!" something inside myself answered.

"You feel worried."


Those "Yeah!"s were strangely comforting, so I said to the group, "You might notice emotions as you think about your difficulty. It is natural to feel sad, or scared, or angry. So, making space for those feelings and naming them."

After a couple of minutes
after I had pondered my own difficulty and received my own words of wisdom—I invited the others to feel their bodies in the room and to open their eyes, if they wanted to, and to share about their experience. The only person who wanted to share was the activities director, though the other two looked peaceful and thoughtful, as they also had during the meditation. In the Sati Center class, we were trained to keep our eyes open during such meditations so we can see what is going on with the person(s) we are leading.

The activities director said she didn't really connect with words to offer her difficulty, so instead she smiled at it. Great idea. I will also be stealing—that is, remembering that. The activities director added that she has her resources, and pulled out an envelope which she said was full of prayers and helpful things she has collected over the years. I asked, "Would you like to share one of your favorites?" and she read us a Native American prayer.

I asked the group to close their eyes and think of a word that expressed their aspiration for the rest of this one day, or a quality that is needed, or an image that provides encouragement, perhaps the face of someone whose support and love can always be counted on. I myself shared that I was picturing the face of my meditation teacher and imagining him reminding me, "You have the tools you need to deal with this."

I closed with the August 24 entry from Prayers for Healing.

Afterward, the activities director took one of the patients back to her unit, and I waited with the other, so she wouldn't be alone. I think this patient must have had a stroke. She very haltingly shared that she is normally "not this quiet." She said it was hard for her to speak right then, but, "Your words
they comforted me." I was pleased for her sake, and it was also gratifying to hear.

Greek Salad with Sun-Dried Tomatoes

Tom and I had a fantastic Christmas in Sacramento: Christmas Eve at Ann's with her and Steve and Julie, Christmas morning at Paul and Eva's with everyone, and Christmas dinner at Robin's. She is Steve and Julie's next-door neighbor and now a close friend.

A few days after Christmas, Carol-Joy came to town and we had brunch at Santaneca, went to Costco for cashews, saw The Shape of Water and I, Tonya, and had lunch at Fuzio. At Santaneca, I had one bean pupusa and one with queso and loroco, and at Fuzio I had a really tasty Greek salad with feta and olives and also sun-dried tomatoes and croutons.

The last Friday of the year found me at County Hospital by myself—no other volunteer was there, and even the staff were all gone by mid-afternoon, so I got to see my very first palliative care patient and also got to go to the abortion clinic for the first time. I visited an old, wrinkled, mustachioed and bearded woman (not at the abortion clinic), very hard of hearing and shocked at finding herself in the hospital, unable to function as she had just a few weeks earlier, and feeling lonely and uncared for. I spent a good amount of time with her. I asked if she'd like to hold hands and she immediately thrust her hand at me, through the railing at the side of her bed. By chance, I saw her again a couple of weeks later, just as two transport workers came to take her to a nursing home. I was glad to be able to see her off. She said she felt scared.

Anita, my CPE supervisor, and I took a walk in Golden Gate Park one day and had lunch at Lemonade, and on the very last day of the year, Charlie and I took a walk.

I spent the first day of the year at work, by choice, as I have the idea that what we do on the first day of the year sets the tone for the rest of it. That meant going to sleep at 7 or so on New Year's Eve, but I knew when it was 2018 from all the fireworks exploding outside.

At work, there were horrible life-changing injuries and amputations and people decades too young struck down out of the blue. In the afternoon, I was paged to another campus to visit the family of a patient who had died, but it took so long to get a cab (the mode of transportation my employer pays for) that when I got there, the family had departed with no plans to return. I visited the patient for a couple of minutes, anyway. I was pretty sure he was no longer in there—he looked really dead—and I prayed that he is in a place of love and tranquility, and for peace and solace for his family.

In the charting room, I heard a male nurse grumbling to his colleagues about a difficult patient. As if speaking to the patient, he said, "Lady, I'm on two packets of Metamucil."

My friend Lesley and I agreed to meet one afternoon at the Embarcadero Cinema. I arrived about three minutes before the hour and waited until 15 minutes after, with no sign of her. Finally I turned on my phone and texted her and heard an alert 15 feet away. I leaned forward, looked to my right and saw her feet. She was sitting on the same long bench I was sitting on, with a big vertical beam obscuring our view of each other. She said she had arrived even before I did, so we were sitting there on the same bench all that time.

She is an OT, so I asked her about how she deals with compassion fatigue or secondary trauma, but she said she finds her work, with psych patients, stimulating and doesn't really experience that. I described about half of one of my days and she said, "Oh, my. No, my work is nothing like that!"

We saw Lady Bird, which we both liked, and had lunch at Fuzio and walked to the Ferry Building to go to Sur la Table.

Monday, January 01, 2018

A Dastardly Deed

One day I found that a wild animal had arrogantly knocked my little fan on the floor so that it could occupy the whole of the small bedside table, and thereupon was lolling—at that very moment—in a manner so casual as to border on the insulting.

Hmm, now that I look at these pictures in my own blog, I see that there is some paint missing from my swing-arm lamp. I have had that lamp for decades and it still works perfectly, whereas others I have bought more recently have all been unsatisfactory in one way or another. I will never part with that lamp!

(Click photos to enlarge.)

Tips for a Slimmer Silhouette

At County Hospital, we got a presentation on palliative and hospice care, at which we were told that most advance directives are too vague: “If I don’t have meaningful quality of life, let me die a natural death.” Better to say, “If I can’t ride my bicycle … ” or “If I can’t remember my own name … ” or “If I can’t eat … ” Whatever specifically constitutes quality of life.

We learned that hospice care is not usually done in the hospital because Medicare reimbursement for hospice is only $200 a day, whereas the cost of occupying a room at County Hospital and being cared for by a nurse is $8000 a day, and this is on a medical-surgical ward, not even in the ICU, and this is before factoring in any other care: examination by a physician, labwork, medicine, use of equipment.

Comfort care—palliative care at the very end of life—is often provided in a hospital (e.g., for an intubated patient in the ICU), but it can also be at home if the person has housing and 24-hour care, which can be from friends.

In mid-December I had lunch with Jonas. He talked about how he knows when compassion fatigue is sneaking up on him and how he handles it. He said that certain terrible memories will stay with us forever, but that most will fade, and that part of the trick is figuring out how to nudge memories to move along. As we discussed this, tears came to his eyes, and I imagined that he was remembering a certain patient of his own, perhaps a child, as he does palliative care and also works with children.

I spent a Saturday with my CPE peer Nellie in Oakland, and one Sunday, Ann, Tom, Jill and I saw Watch on the Rhine at Berkeley Rep (it was excellent), after lunch at Au Coquelet. Another day I went to visit the hospital where my chaplaincy mentor, Naima, works. She showed me around and then we chatted in her office. She said that since she usually just has one short visit with each patient, she tries to quickly assess what is causing them to suffer, using her own Buddhist understanding of what causes suffering. Once she figures out what they are pushing away, she tries to encourage them to let it in a little, or if they are clinging to something, she tries to see if there is a way they can let go. I wish I could be a fly on the wall for two or three such conversations. It would be interesting to see how she goes about this, especially in one brief visit.

It also caught my attention that she uses her own understanding of what causes suffering rather than finding out what the patient thinks is causing her suffering and what the patient’s own spiritual practice or religion or way of understanding life has to offer.

The day after visiting Naima, I attended the holiday party at my paying job, thirteen people, including our boss. I was seated across from a colleague who mentioned that he is of a certain religion that has such-and-such dietary restrictions. I asked if his wife is also of that religion and he said she is.

Our boss, who was seated at the head of the table and not next to me or my colleague, evidently had been listening carefully and said to me with a somewhat terrifying deadpan expression, “I’m curious why you asked that.” I felt like a five-year-old being scolded. I also felt a frisson of fear, and the impulse to defend myself, which I managed to resist for about 30 seconds. I could have just let her statement stand, but I succumbed to the urge to explain and said that it’s interesting to me when partners follow different diets, although, in retrospect, I’m not actually sure that’s why asked that. I guess I don’t actually know why.

Our boss reiterated that she always finds it interesting when someone asks a question like that, making it pretty clear that she thinks it’s terrible when someone asks a question like that, and then she turned to her neighbor and said, “I really think [whisper whisper whisper],” and her neighbor said, “Oh, yes. Me, too. [Whisper whisper whisper.]”

At the end of the party, which was otherwise pleasant, we took a group photo. There are two people in the group who are quite large. The boss said to one of them, “Turn sideways! Turning sideways makes you look slimmer.”

The next day, I got to wondering if it is indeed terrible to ask someone about his or her partner’s religion, even if that is directly the topic at hand, and so I texted my colleague to apologize, but he said he had not been at all offended. He also said that he’d felt uncomfortable when our boss was asking me about it, which makes two of us.

Drive-By Shooting

During a shift at County Hospital in December, I was in an elevator with two sheriffs, each of whom was stabbing repeatedly at the “close door” button on his side of the elevator. One turned and explained, “Drive-by shooting: we have to secure the car.” Walking toward the chaplain office, I saw a car parked outside with both doors flung open, and a bleeding young man being carried toward the emergency department on a stretcher.

In the chaplain office, I mentioned this to two other volunteers. One has been around for a while and instructed the other to go to the emergency department. (Which he did not do. He told me later that there’s no point—that the only people who are going to be near the patient for the first several hours are doctors and nurses.) I described the sheriffs’ behavior in the elevator but, as I took a breath to continue my anecdote, the senior volunteer said to me, “Enough. Enough.”

This was annoying: Who is she to tell me when to talk or not to talk? Aren’t we supposed to be able to debrief with each other? Maybe she was trying to finish up her charting or maybe she’d heard enough upsetting stuff for one day, which I can understand, but maybe there’s a politer way to say so. I went away fuming.

At my paying job, I encountered a patient who had very impulsively committed a horrendous act of self-injury. He was open and easy to talk to. I spent half an hour with him, hearing about how he came to do this unbelievably awful thing, about his spiritual beliefs, and his plans to move forward with his life.

Afterward, I could not rid my mind of images of the act itself, as I imagined it—it was the very first thing I thought of when I woke up the next morning—and recognized this as secondary trauma, but I wasn’t sure what to do about it. I know it is important to talk to someone, but whom?

As I walked home in the evening after having seen this patient, I found myself seeking out pleasurable sense experiences, things that seemed to affirm life: the beautiful green expanse of Dolores Park, the smell of evening settling over the shrubs, a charmingly appointed apartment lobby with an ornate daybed, lights strung in trees. It makes more and more sense why the arts are so much a part of chaplaincy. Poetry and music and dance and literature bring beauty, joy, healing, sometimes laughter. Here’s something I hadn’t expected: because people frequently bring patients flowers, and because they often end up at the nursing station, hospitals are full of flowers!

When I got home, I called my ex-CPE supervisor, Anita, and told her about my patient. She was suitably horrified and recalled that I had said it helps me to write about things that bother me, so maybe I would want to do that. She also said that she finds it helpful to use the “empty chair” technique to express herself. She said maybe I could sit opposite an empty chair and say why this patient’s story frightened me.

I hadn’t realized that it had frightened me, but once I thought about it, I concluded that fear must be at the root of what we strongly react to. At first I didn’t think I was afraid that I would take that kind of impulsive action against myself, but that possibly I feared one day getting into the state of emotional misery that preceded it: what if my happiness goes away and I can’t figure out how to get it back?

But later I could see more clearly that this patient had felt abandoned and unloved, as I have at times, and he turned his bad feelings on himself, as I have at times, so I think the fear was not due to encountering something unrecognizable but just the opposite: seeing that this patient was on a continuum I have personal experience of, so could that happen to me? In the end, it was an example of projection: assigning “irrevocable self-violence” to this other person, and then being horrified by it, as if it had nothing to do with me.

During dinner the evening after meeting this patient, I lit red candles. The last time these candles were lit, F. was here, so it had been at least 18 months. They afforded a beautiful, festive touch.

In Search of Mentors

After the trillion details involved with signing up for Obamacare and becoming a Kaiser Permanente patient, my first visit over there (early in December) was extremely smooth. My new doctor seems like a smart young snippersnapper and was easy to communicate with. Afterward, I went to Publico for a burrito and French fries.

That evening, Tom and I had dinner at an Indian restaurant with David and Lisa, who were visiting from Seattle. It was excellent to be with them, as always.

I had been thinking about asking the senior chaplain at my paying job, Jonas, to have lunch with me. To gain board certification, you have to submit, among other things, two verbatims that each use a different assessment model. I thought it would be interesting to ask Jonas what assessment models he uses, and made a note to call him.

This note joined many other little pieces of paper on my desk, the most readily visible aspect of my to-do list, but just the tip of the iceberg. Progress on everything that didn’t get done over the past 15 months
—well, now 19 monthshas been astonishingly slow. One day, my eye fell on that particular note, and I saw that it was 9:20 a.m., when Jonas might still be sitting at his desk, so I decided to carpe diem and picked up the phone.

Jonas said, “Bugwalk? That’s weird—I was just writing you an email, and I was checking the calendar to see when you’d be in next.” I have very little interaction with Jonas, so that was weird. He was there when I did my unit of CPE last summer, and once or twice sat down with me and offered very helpful advice. On the phone last month, he said we could certainly have lunch and we set a date.

The reason he was writing me an email was that he’d been surprised, and not necessarily pleasantly so, to see that I’d written in a chart note that a patient who was dying and who had lost a child to suicide did not have any spiritual needs. This suggested to Jonas that I had not read the chart notes from the palliative care team before seeing the patient, which indeed I had not.

I have a filter that shows any chaplain notes pertaining to a patient, and I do look at those, and I read at least the most recent chaplain chart note. While we were on the phone, Jonas suggested that I make a second filter, for notes from the palliative care service.

I told Jonas that I welcome his feedback—I wish to learn all I can—and that I take responsibility for my actions and that I don’t wish to blame anyone else or badmouth anyone, but I have been under the sway of our boss’s efficient workflow. However, Jonas said that is just for brief, “drive-by” visits, which was useful information; I don’t think I’ve ever heard our boss say that.

Jonas added that he can tell from perusing my chart notes that I learned a lot during my year of CPE (the case at hand notwithstanding, I guess). I appreciated his saying that, and also how tactfully he shared his concern. After we hung up, a wave of beginner’s mind swept over me. What am I trying to do as a chaplain? Why? How? And from whom will I learn, given that I’m mostly wandering around the hospital without oversight? I need to figure out how I can be mentored. With that in mind, I sent Delia, the palliative care chaplain at the Truly Wonderful Medical Center, a text asking if we can have lunch, and I also made a date to meet with Naima, my overall chaplaincy mentor.

I have a few books on my shelf that will likely be helpful, and I am going to reflect on what people seek from their spiritual practice or religion. What do I seek from mine? How does my religion meet those needs? If I were in the hospital, what kind of help might I need from a chaplain to make best use of my religion? A reminder here that a chaplain is a person who provides spiritual care or guidance for someone who is away from her usual source of spiritual care because she is away at college, or in prison, or in the military, or in the hospital, or in a hospice, or even at her corporate job; there are chaplains who serve corporate employees. On the radio the other day, I heard about a spiritual care provider who travels with a circus.

God Damn

(Click photo to enlarge.)