The reason I rushed out to buy all those crunchy snacks as soon as I decided to make a new effort to eat mindfully is that potato chips and their ilk are very delicious things to eat—at least, I used to think so—and, in theory, if I'm eating in response to physical hunger and stopping when physical hunger is no longer present, I can eat very delicious things and not fear to have them in the house. There don't have to be "forbidden foods," not even sweets. I'm glad, though, that I don't have to experiment with eating sweets because eating crunchy snacks seems to have afforded the necessary insights, and not eating sweets, besides being a vote for good health, is a sacred vow of mine.
I forgot to say a couple of things about my new neighbor: It did occur to me after a couple of days that a chaplain is not supposed to be mean to people. If I encountered this young lady in a hospital bed, I wouldn't have any problem being on her side, a clue that this ill will was definitely optional.
Also, my ire was hurting precisely one person, and not just any person, but the one whose well-being is closest to my heart: myself. For several days, I frequently made the silent wish, "May I be free from enmity." The great thing about that is that just the act of wishing that brings immediate relief, since the three seconds it takes to think that is three seconds free of aversion and therefore of suffering.
This brings to mind the anecdote about Ajahn Chah strolling with his students and espying a huge boulder. "Is that boulder heavy?" he asked his students.
"Yes, teacher, it is!"
"Not if you don't try to pick it up," he corrected them.
How wonderful that being free of enmity is one hundred percent under one's own control, and is a surefire way of lessening suffering.
I also reminded myself to focus on the experience of aversion rather than its object, as mentioned yesterday. Noticing actual sense experiences rather than my thoughts about them. This is what Howie advised me to do when I first told him about F., three years ago now. After I described F., Howie said, "Run away as fast as you can. Attend to the experience of desire rather than the object of desire." This advice I did not take, but the latter has been extremely helpful lately in processing the remaining vestiges of the powerful attachment that doomed relationship gave birth to and reinforced over and over.
It has taken a long time to feel OK about F. being gone, but time—a few seconds plus a few more seconds plus a few more seconds, repeated over and over—has eventually begun to work its healing magic.
Monday, February 05, 2018
Sunday, February 04, 2018
Later, I Will Be Very, Very Perfect
For a long time, I've had a checklist that shows fundamental daily tasks: meditation, stretching, exercise, etc. I decided a week ago that I do not actually need this. There is some pleasure in putting check marks in the little boxes, but this checklist is more often the source of a mild sense of failure. "Tomorrow I'll do better," I think, which is an awful lot like "Tomorrow I'll stay on my diet." I saw that this checklist was mainly a visual representation of whether I'm good or bad (since if you go off your diet, you're bad) and I did away with it. The only thing I'm tracking now is meditation, without noting whether it was 45 minutes or ten, which I used to record. I'm now just putting a colorful star on the current day's page in my calendar book, though maybe even that isn't necessary.
Daily meditation itself is quite necessary, and the other tasks are pretty necessary, too, but if they happen most days, that's good enough. If something really does contribute to well-being, I will be motivated to do it with or without a checklist.
I have also lately had a major insight regarding crunchy snacks. When I decided about six weeks ago to make another effort to eat mindfully, and to try to exercise more choice about what and how much I eat, I stocked up on potato chips and cheese puffs and so forth. I had some meals that consisted entirely of one of these and right away discovered that, while I was eating in response to physical hunger and stopping more or less when I wasn't hungry anymore, I did not feel well after such a meal.
I had a lot of meals where I had whatever I would normally have, plus a bowl of potato chips or whatever. Soon I noticed the amount of potato chips getting larger and larger, and I noticed my waistline expanding a bit. I started to think, for the millionth time, that maybe I just can't have these things in the house. I felt the impulse to have the kind of binge known as Finishing All of This Because From Now On, I'm Never Going to Eat It Again, a close relation of the binge called I Might As Well Keep Eating, Because I Already Overate. In the former case, I either finish the particular item or give the rest to Tom, and in either case, I eat food I'm not physically hungry for, and the cycle of what amounts to dieting and bingeing continues.
In regard to the part about never eating whatever it is again, it has taken me so incredibly long to grasp that it does not matter what I intend to do later. The only thing that matters is what I do right now. I guess this has taken so long to learn because not eating potato chips later is extremely easy and feels great, whereas not eating potato chips right this minute has basically been impossible.
So, determined to break this cycle and determined not to continue to eat compulsively—determined to have the fantastic feeling I get when I choose—I reassured myself that it doesn't matter if I gain some weight during this learning experience, and I started having a small number of crunchy snacks with meals. For instance, I would have my normal breakfast in a bowl (millet or buckwheat, canned salmon, vegetables, fresh minced ginger, rosemary salt, hot pepper sesame oil, extra virgin olive oil, and a low-sodium bouillon cube; shiitake optional) and next to that, on a plate, five potato chips, five cheese puffs, and five of a kind of crunchy rice thing I like (Laiki Rice Crackers). Also fake sour cream for the potato chips, which I prefer to real sour cream.
After a few meals like that, no overeating having occurred, I made an astounding discovery: that there is no way eating crunchy snacks can afford satisfaction, for me, anyway. The first potato chip is obviously not satisfying: who eats just one potato chip? Nor is the second, nor the third, nor the fourth, nor any potato chip after that, until I'm completely stuffed. That is frequently the point at which I stop, of necessity, and that is also not at all satisfying, physically or psychologically. The worlds of true satisfaction and potato chips do not overlap! There is no actual need that potato chips meet! It's purely about sense desire, which puts me in mind of the thing I probably say to myself more often than any other single thing, a quote from Joseph Goldstein: Desires fulfilled breed more desires.
Fortunately, feeding actual physical hunger with actual real food is satisfying. For a few meals, I skipped putting the five of this and five of that on the plate: what's the point? However, I have a number of bags of potato chips, cheese puffs and rice crackers in the apartment now, so I will probably do the five of each thing fairly often until they're gone or until they start to inch toward their expiration dates, at which point I'll give them away.
Today I went to Rainbow and bought no crunchy snacks. Along with other groceries, I bought artisanal whole-wheat bread, goat milk ghee, large green olives stuffed with feta, kalamata spread, and artichoke parmesan spread. For lunch, I had toasted bread with ghee on it, or with ghee and one of the two spreads. I had two olives. It was such a delicious meal. The ghee is lovely—just pure fat, which is always a good thing, but with a goat cheese tang. Eating when I'm genuinely hungry and stopping when my body has had enough feels so great. I always knew this would be true, but I mostly could not do it. I feel like I've finally arrived in a whole new world.
(Not to say that I will never again eat a whole bag of potato chips. As the Zen saying goes: Whichever of the two occurs, be patient. But to eat mostly mindfully for six weeks is absolutely unprecedented.)
I also feel often lately that I am the luckiest person on earth. My diabolical plan worked! I am being paid to do something that has tremendous meaning to me, and which affords a huge amount of satisfaction. Something I would do for free, and do actually do for free, each week at County Hospital.
Daily meditation itself is quite necessary, and the other tasks are pretty necessary, too, but if they happen most days, that's good enough. If something really does contribute to well-being, I will be motivated to do it with or without a checklist.
I have also lately had a major insight regarding crunchy snacks. When I decided about six weeks ago to make another effort to eat mindfully, and to try to exercise more choice about what and how much I eat, I stocked up on potato chips and cheese puffs and so forth. I had some meals that consisted entirely of one of these and right away discovered that, while I was eating in response to physical hunger and stopping more or less when I wasn't hungry anymore, I did not feel well after such a meal.
I had a lot of meals where I had whatever I would normally have, plus a bowl of potato chips or whatever. Soon I noticed the amount of potato chips getting larger and larger, and I noticed my waistline expanding a bit. I started to think, for the millionth time, that maybe I just can't have these things in the house. I felt the impulse to have the kind of binge known as Finishing All of This Because From Now On, I'm Never Going to Eat It Again, a close relation of the binge called I Might As Well Keep Eating, Because I Already Overate. In the former case, I either finish the particular item or give the rest to Tom, and in either case, I eat food I'm not physically hungry for, and the cycle of what amounts to dieting and bingeing continues.
In regard to the part about never eating whatever it is again, it has taken me so incredibly long to grasp that it does not matter what I intend to do later. The only thing that matters is what I do right now. I guess this has taken so long to learn because not eating potato chips later is extremely easy and feels great, whereas not eating potato chips right this minute has basically been impossible.
So, determined to break this cycle and determined not to continue to eat compulsively—determined to have the fantastic feeling I get when I choose—I reassured myself that it doesn't matter if I gain some weight during this learning experience, and I started having a small number of crunchy snacks with meals. For instance, I would have my normal breakfast in a bowl (millet or buckwheat, canned salmon, vegetables, fresh minced ginger, rosemary salt, hot pepper sesame oil, extra virgin olive oil, and a low-sodium bouillon cube; shiitake optional) and next to that, on a plate, five potato chips, five cheese puffs, and five of a kind of crunchy rice thing I like (Laiki Rice Crackers). Also fake sour cream for the potato chips, which I prefer to real sour cream.
After a few meals like that, no overeating having occurred, I made an astounding discovery: that there is no way eating crunchy snacks can afford satisfaction, for me, anyway. The first potato chip is obviously not satisfying: who eats just one potato chip? Nor is the second, nor the third, nor the fourth, nor any potato chip after that, until I'm completely stuffed. That is frequently the point at which I stop, of necessity, and that is also not at all satisfying, physically or psychologically. The worlds of true satisfaction and potato chips do not overlap! There is no actual need that potato chips meet! It's purely about sense desire, which puts me in mind of the thing I probably say to myself more often than any other single thing, a quote from Joseph Goldstein: Desires fulfilled breed more desires.
Fortunately, feeding actual physical hunger with actual real food is satisfying. For a few meals, I skipped putting the five of this and five of that on the plate: what's the point? However, I have a number of bags of potato chips, cheese puffs and rice crackers in the apartment now, so I will probably do the five of each thing fairly often until they're gone or until they start to inch toward their expiration dates, at which point I'll give them away.
Today I went to Rainbow and bought no crunchy snacks. Along with other groceries, I bought artisanal whole-wheat bread, goat milk ghee, large green olives stuffed with feta, kalamata spread, and artichoke parmesan spread. For lunch, I had toasted bread with ghee on it, or with ghee and one of the two spreads. I had two olives. It was such a delicious meal. The ghee is lovely—just pure fat, which is always a good thing, but with a goat cheese tang. Eating when I'm genuinely hungry and stopping when my body has had enough feels so great. I always knew this would be true, but I mostly could not do it. I feel like I've finally arrived in a whole new world.
(Not to say that I will never again eat a whole bag of potato chips. As the Zen saying goes: Whichever of the two occurs, be patient. But to eat mostly mindfully for six weeks is absolutely unprecedented.)
I also feel often lately that I am the luckiest person on earth. My diabolical plan worked! I am being paid to do something that has tremendous meaning to me, and which affords a huge amount of satisfaction. Something I would do for free, and do actually do for free, each week at County Hospital.
A Little Story About Slamming
We got a new neighbor in our apartment building lately. It's a one-bedroom unit with beautiful hardwood floors, which the owner paid who knows how much to have redone before this young woman—a bitcoin consultant—the only kind of person who can afford to rent an apartment in this neighborhood now—moved in. Pets are prohibited in the building as of many years ago. When I moved in, cats were allowed, but at this point, only I and the building manager have one. (And Tom has a python, which the manager pretends not to notice.) The building manager sent an email the other day to everyone but the new tenant saying that after she moved in, she mentioned that she has a service animal! Specifically, an emotional support dog.
There is starting to be a backlash against everyone carrying some sort of animal everywhere, but at this moment, in San Francisco a landlord cannot legally forbid you to have an actual service animal, nor even an emotional support animal. Given that, I suppose it technically doesn't make any difference whether she mentioned it before she moved in or after, but it did not sit at all well with the building manager, nor with me. (I suspect others were startled and displeased, as well, but I haven't discussed it with anyone other than the building manager. Oh, also Tom, who said that maybe she has good qualities, as well, which was a very unsatisfactory response, perfectly characteristic of Tom in its generosity and kindness.)
I found myself feeling viciously judgmental, thinking of horrible things to say to this new neighbor. I planned to work "ethics-impaired" into it somewhere, during my lecture on how if she refrained from telling whopping lies of omission, she might have better relationships with other people and thus less anxiety; with less anxiety, she might not need to carry a little dog everywhere.
I tried to figure out why this pushed my buttons so much. Was it just the Enneagram One reacting to something that seemed clearly wrong? After a couple of days of stewing, I remembered how Carlos used to say, "If you knew someone's whole story, you would understand why they act the way they do." Maybe this is indeed a self-entitled rich millennial who does whatever it takes to get what she wants, but maybe she is genuinely a victim of some sort of trauma. I thought of a line from the Alcoholics Anonymous Big Book that might apply, something like, "This is a sick person. How can I be helpful to her?"
Matters were slightly complicated by the fact that this woman, who lives on my floor, slams her door every time she goes in or out. (If your hand is no longer in contact with the doorknob when the door actually closes, you have probably just annoyed someone somewhere.) I moved on to drafting the very direct note I planned to leave on her door, anonymously, of course.
And then I remembered one of the weekly emails I'd recently gotten announcing Howie's sitting group. They always have a quote at the top, many of which are gems. This one said, "If we cannot be happy in spite of our difficulties, what is the good of our spiritual practice?" ~Maha Ghosananda
OK, right, right, right. There are people starving to death, immigrants being hounded and terrorized, people in Cape Town about to run out of water. Today I read a dreadful thing online about a woman whose dog escaped from her house. Someone taped its feet together and threw it out the window of a car on the freeway, where it was immediately killed. Hearing an annoying sound is about the least problematic problem you can have, with the possible exception of someone I haven't even met telling a lie which does not directly affect me to someone other than myself.
I decided to work with this for a month, and if I still feel like asking her to close her door more quietly, then I will. By that time, it will be a much friendlier request than it would be right now. What was happening was that I would hear the door slam and a whole wave of angry thoughts would begin. Now I hear the door slam and notice it as a sound, and observe what happens in my body, which is a little frisson of fear. And then it's over. The whole thing takes two seconds if it doesn't become a story.
There is starting to be a backlash against everyone carrying some sort of animal everywhere, but at this moment, in San Francisco a landlord cannot legally forbid you to have an actual service animal, nor even an emotional support animal. Given that, I suppose it technically doesn't make any difference whether she mentioned it before she moved in or after, but it did not sit at all well with the building manager, nor with me. (I suspect others were startled and displeased, as well, but I haven't discussed it with anyone other than the building manager. Oh, also Tom, who said that maybe she has good qualities, as well, which was a very unsatisfactory response, perfectly characteristic of Tom in its generosity and kindness.)
I found myself feeling viciously judgmental, thinking of horrible things to say to this new neighbor. I planned to work "ethics-impaired" into it somewhere, during my lecture on how if she refrained from telling whopping lies of omission, she might have better relationships with other people and thus less anxiety; with less anxiety, she might not need to carry a little dog everywhere.
I tried to figure out why this pushed my buttons so much. Was it just the Enneagram One reacting to something that seemed clearly wrong? After a couple of days of stewing, I remembered how Carlos used to say, "If you knew someone's whole story, you would understand why they act the way they do." Maybe this is indeed a self-entitled rich millennial who does whatever it takes to get what she wants, but maybe she is genuinely a victim of some sort of trauma. I thought of a line from the Alcoholics Anonymous Big Book that might apply, something like, "This is a sick person. How can I be helpful to her?"
Matters were slightly complicated by the fact that this woman, who lives on my floor, slams her door every time she goes in or out. (If your hand is no longer in contact with the doorknob when the door actually closes, you have probably just annoyed someone somewhere.) I moved on to drafting the very direct note I planned to leave on her door, anonymously, of course.
And then I remembered one of the weekly emails I'd recently gotten announcing Howie's sitting group. They always have a quote at the top, many of which are gems. This one said, "If we cannot be happy in spite of our difficulties, what is the good of our spiritual practice?" ~Maha Ghosananda
OK, right, right, right. There are people starving to death, immigrants being hounded and terrorized, people in Cape Town about to run out of water. Today I read a dreadful thing online about a woman whose dog escaped from her house. Someone taped its feet together and threw it out the window of a car on the freeway, where it was immediately killed. Hearing an annoying sound is about the least problematic problem you can have, with the possible exception of someone I haven't even met telling a lie which does not directly affect me to someone other than myself.
I decided to work with this for a month, and if I still feel like asking her to close her door more quietly, then I will. By that time, it will be a much friendlier request than it would be right now. What was happening was that I would hear the door slam and a whole wave of angry thoughts would begin. Now I hear the door slam and notice it as a sound, and observe what happens in my body, which is a little frisson of fear. And then it's over. The whole thing takes two seconds if it doesn't become a story.
Salads at La Boheme
On Wednesday I had lunch at Cafe La Boheme with Jonas, my fellow staff chaplain. We each had a salad. He is our palliative care chaplain and it occurred to me that I hadn't told him about my palliative care rotation during CPE, so I did that, and while I was at it, I told him about the special award I got at graduation, for persistence and creativity in developing the head and heart as reliable instruments of spiritual caregiving.
"That's a nice way of saying it," he responded, and I felt a bit stung. It sounds kind of ludicrous in retrospect, but I was sure he meant, "That's a nice way of saying you're emotion-challenged." But I swallowed my sense of hurt and agreed, "That is a nice way of saying it." And then I resolved never to have lunch with him again: jerk.
But then I remembered a conversation two days earlier with my beloved CPE peer, Tony. Over breakfast, he told me about having an unpleasant interaction with a member of a group he has just joined and how he reminded himself that, after CPE training, he is equipped to deal with this, and he has resolved that he will not let conflicts fester, so he is making ready to talk to this person.
Accordingly, I called Jonas the next day and said I wasn't sure what he'd meant. He explained that he'd literally, sincerely meant that that was a nice way of expressing that idea. "I wasn't saying it sideways," he assured me. In turn, I told him that I'm touchy about this, because it's always been easier for me to lead with my head, and so I have to work harder to get my emotions involved. (Well, except for anger. That emotion always seems quite easy to access.) Our exchange was brief and satisfying.
On Friday at County Hospital, now on a roll, I spoke with my fellow volunteer who'd responded to the anecdote I was on the verge of telling a month ago by saying, "Enough. Enough." That really made me angry, and I still felt annoyed the next time I saw her, and the time after that, which was Friday, so I asked if we could speak after our team meeting. We went outside—it was a beautiful day—and I started by saying I wanted to talk to her because I want us to have a good relationship.
I reminded her of the exchange and said it had made me feel like I was being put down, and I said it had made me angry. She responded in a very open-hearted manner and said that she understood completely, and she apologized. I'd thought she was going to respond angrily, but it was quite the reverse. In fact, it almost seemed as if she was flagellating herself more than the situation would warrant. I'd thought of a couple of reasons she might not have wanted to hear my anecdote, but it turned out it was something else entirely.
I visited just three patients that day, one very briefly; one for about 15 minutes, limping along in English and Spanish; and one for quite some time. Whereas at my paying job there is an emphasis on initial visits and trying to find out about the spiritual needs of as many patients as possible, at County Hospital there are no such instructions, so I have the luxury to sit around with one person for an hour or more, which I really appreciate. I can do that at work, too, but there might be a conversation with my boss later about why I felt the visit had to be so long. The patient I spent such a long time with on Friday had recently had a body part amputated and said she was grieving for it: "It's like losing a loved one."
At the end of the day, my erstwhile nemesis told a few of us in the office that it would be her birthday this weekend. She told us what age she is turning, and we assured her—truthfully—that she looks younger. I walked out with her, and thanked her again for processing with me, and we parted with much good feeling.
"That's a nice way of saying it," he responded, and I felt a bit stung. It sounds kind of ludicrous in retrospect, but I was sure he meant, "That's a nice way of saying you're emotion-challenged." But I swallowed my sense of hurt and agreed, "That is a nice way of saying it." And then I resolved never to have lunch with him again: jerk.
But then I remembered a conversation two days earlier with my beloved CPE peer, Tony. Over breakfast, he told me about having an unpleasant interaction with a member of a group he has just joined and how he reminded himself that, after CPE training, he is equipped to deal with this, and he has resolved that he will not let conflicts fester, so he is making ready to talk to this person.
Accordingly, I called Jonas the next day and said I wasn't sure what he'd meant. He explained that he'd literally, sincerely meant that that was a nice way of expressing that idea. "I wasn't saying it sideways," he assured me. In turn, I told him that I'm touchy about this, because it's always been easier for me to lead with my head, and so I have to work harder to get my emotions involved. (Well, except for anger. That emotion always seems quite easy to access.) Our exchange was brief and satisfying.
On Friday at County Hospital, now on a roll, I spoke with my fellow volunteer who'd responded to the anecdote I was on the verge of telling a month ago by saying, "Enough. Enough." That really made me angry, and I still felt annoyed the next time I saw her, and the time after that, which was Friday, so I asked if we could speak after our team meeting. We went outside—it was a beautiful day—and I started by saying I wanted to talk to her because I want us to have a good relationship.
I reminded her of the exchange and said it had made me feel like I was being put down, and I said it had made me angry. She responded in a very open-hearted manner and said that she understood completely, and she apologized. I'd thought she was going to respond angrily, but it was quite the reverse. In fact, it almost seemed as if she was flagellating herself more than the situation would warrant. I'd thought of a couple of reasons she might not have wanted to hear my anecdote, but it turned out it was something else entirely.
I visited just three patients that day, one very briefly; one for about 15 minutes, limping along in English and Spanish; and one for quite some time. Whereas at my paying job there is an emphasis on initial visits and trying to find out about the spiritual needs of as many patients as possible, at County Hospital there are no such instructions, so I have the luxury to sit around with one person for an hour or more, which I really appreciate. I can do that at work, too, but there might be a conversation with my boss later about why I felt the visit had to be so long. The patient I spent such a long time with on Friday had recently had a body part amputated and said she was grieving for it: "It's like losing a loved one."
At the end of the day, my erstwhile nemesis told a few of us in the office that it would be her birthday this weekend. She told us what age she is turning, and we assured her—truthfully—that she looks younger. I walked out with her, and thanked her again for processing with me, and we parted with much good feeling.
Wow! A Cow!
After starting my paying job as a hospital chaplain, I got into the habit of saving my two 15-minute breaks for the end of the day, and spending that last half hour reading before I walked home, a nice buffer between major parts of the day. A few weeks ago, I got paged during that time and ended up working until nearly midnight, and more recently, I got paged precisely at 4:30, right when this break was going to start, and had to go to another campus for a death, so I have decided this is not the best way to schedule breaks.
There have also been ergonomic issues at work, because no two workstations are alike, and nearly all of them are wrong in one way or another: the monitor is too low and/or the keyboard is too high and/or the chair is too low. One day, I tried using the standing workstations. (By the way, these are called WOWs: workstations on wheels. According to a nurse in employee health, they used to be called COWs: computers on wheels, until a patient heard someone say, "Can you get this cow out of here?" and took offense. There may be some truth to that. I have definitely heard people refer to WOWs as COWs.)
I visited 17 patients that day, which is probably a personal record, and of those, 15 were initial visits, which are prioritized by my boss. Most visits were short, but a couple were quite long, including the last of the day, with a patient about my own age who has months to live. It was an emotional conversation, which I did not want to cut short. I tried to channel what I'd learned from the palliative care team during CPE, and also remembered things I'd read in Ira Byock's wonderful books. Once it was over, I still had charting to do and metrics to record (how many minutes were spent doing this or that), so I ended up logging out 40 minutes late, which might partially account for why I felt so utterly exhausted. My neck was also painfully tight.
Next shift, I went back to using the seated workstations, and paid attention to having my hands at waist level when typing. For the first time, I went into our (very nice) meditation room at work twice during the day and meditated for 15 minutes, after which I felt quite tranquil. That's a much better way to spend my breaks; going outside for a walk would also be good.
This past Tuesday I again meditated twice for 15 minutes. It was a lovely day. I got to be outside many times, walking between my units, which are located in different buildings. I had been traveling between them via a shared basement, but another care team member told me she always takes the opportunity to go outside, which had not occurred to me and which is much more pleasant. There's a huge deck with a spectacular view of downtown and the Mission. I can see County Hospital from there and vice versa.
While reviewing the chart for a patient I have seen many times, in a part of the electronic record where there would normally be only text, I unexpectedly bumped into a photo of her decubitus ulcer, also known as a pressure sore or bedsore. A bedsore doesn't sound like such a terrible thing, but these ulcers can eventually become actual holes with exposed bone, tendon or muscle. This one has refused to heal, has necessitated multiple surgeries (debridement: the removal of infected, damaged or dead tissue), and is located in a place one most particularly would not want to have a bloody hole in one's body. The image of it was horrendous. I let out an involuntary "Ooh!" My estimation of nurses, already extremely high, shot up another notch.
As I walked home after work, for the very first time something happened that I'd been expecting since CPE began in June of 2016: I saw one of my patients on the street. This fellow was talking to himself and passed within a few inches of me, his face nearly as familiar to me as my own, even though I visited him just once for maybe 20 minutes at County Hospital. I was wearing my big hat and he didn't notice me.
There have also been ergonomic issues at work, because no two workstations are alike, and nearly all of them are wrong in one way or another: the monitor is too low and/or the keyboard is too high and/or the chair is too low. One day, I tried using the standing workstations. (By the way, these are called WOWs: workstations on wheels. According to a nurse in employee health, they used to be called COWs: computers on wheels, until a patient heard someone say, "Can you get this cow out of here?" and took offense. There may be some truth to that. I have definitely heard people refer to WOWs as COWs.)
I visited 17 patients that day, which is probably a personal record, and of those, 15 were initial visits, which are prioritized by my boss. Most visits were short, but a couple were quite long, including the last of the day, with a patient about my own age who has months to live. It was an emotional conversation, which I did not want to cut short. I tried to channel what I'd learned from the palliative care team during CPE, and also remembered things I'd read in Ira Byock's wonderful books. Once it was over, I still had charting to do and metrics to record (how many minutes were spent doing this or that), so I ended up logging out 40 minutes late, which might partially account for why I felt so utterly exhausted. My neck was also painfully tight.
Next shift, I went back to using the seated workstations, and paid attention to having my hands at waist level when typing. For the first time, I went into our (very nice) meditation room at work twice during the day and meditated for 15 minutes, after which I felt quite tranquil. That's a much better way to spend my breaks; going outside for a walk would also be good.
This past Tuesday I again meditated twice for 15 minutes. It was a lovely day. I got to be outside many times, walking between my units, which are located in different buildings. I had been traveling between them via a shared basement, but another care team member told me she always takes the opportunity to go outside, which had not occurred to me and which is much more pleasant. There's a huge deck with a spectacular view of downtown and the Mission. I can see County Hospital from there and vice versa.
While reviewing the chart for a patient I have seen many times, in a part of the electronic record where there would normally be only text, I unexpectedly bumped into a photo of her decubitus ulcer, also known as a pressure sore or bedsore. A bedsore doesn't sound like such a terrible thing, but these ulcers can eventually become actual holes with exposed bone, tendon or muscle. This one has refused to heal, has necessitated multiple surgeries (debridement: the removal of infected, damaged or dead tissue), and is located in a place one most particularly would not want to have a bloody hole in one's body. The image of it was horrendous. I let out an involuntary "Ooh!" My estimation of nurses, already extremely high, shot up another notch.
As I walked home after work, for the very first time something happened that I'd been expecting since CPE began in June of 2016: I saw one of my patients on the street. This fellow was talking to himself and passed within a few inches of me, his face nearly as familiar to me as my own, even though I visited him just once for maybe 20 minutes at County Hospital. I was wearing my big hat and he didn't notice me.
A Handsome Check from JoJo the Cat
For our street retreat, we have to raise a minimum of $500 apiece, to be donated to worthy causes afterward. I started by drafting a humorous email I intended to send to everyone I could think of. This seemed like a painless, comfortable way to raise this money, and if there was a shortfall, I figured I would ask my parents for the rest.
But a couple of days later, I woke up knowing that would be a ridiculous way to proceed—the point is not to do what is painless and comfortable. As Bernie Glassman writes in Bearing Witness: A Zen Master's Lessons in Making Peace, "Asking—begging—is not the norm. But behaving according to your norm doesn't cause a shift anyplace." He took a bunch of Zen students on a street retreat in New York City for the first time in 1991, and required them to raise more than $3000! Each participant had to "sell" 18 small mala beads for $108 apiece, and a large one for $1,080. I'm sort of glad I don't have to do that, but also sort of sorry, because even raising $500 has already proven to be a remarkable experience.
I decided that I would not send a mass email but rather that I would ask people one at a time, on the phone or via email, per our customary mode of communication, and knew I had to call Lisa in Seattle before she read this. (Thank you for reading my blog, King!)
I also decided that I will panhandle outside for some of this money, and thought about how people doing this often say, "Spare change for something to eat?" or, "I'm trying to get $12 for a room." Maybe people say this because it sounds better than "I need the money for drugs," (if that does happen to be the real reason) or maybe people more often give when there seems to be some good reason for contributing, or perhaps the person asking feels weird not offering a justification. I thought about a fellow who hangs around in my neighborhood who usually doesn't say anything when I walk by, but who once in a while asks, "Can I have three dollars?" It's quite charming precisely because he doesn't say what he wants it for, and also because he asks for such a specific amount. I always say, "Sure!" Sometimes I add, "You can have five dollars!" Once I gave him twenty dollars. It will be interesting to be the person outdoors asking strangers for money.
Having made all these decisions, I telephoned Lisa and asked, "Will you please give me twenty dollars?"
"Sure!" she said.
I was positive the next thing she was going to say was, "Uh, what do you need twenty dollars for?" But she actually asked, "How is your day going?" and then I teared up because she didn't ask what I needed the money for. If no other gift comes from this retreat and the fundraising beforehand, that was more than enough. My unusual request was met with perfect open-heartedness and nothing was requested in return, not even information that would be very reasonable to ask for.
Of course then I explained the whole thing and Lisa in turn explained that my request had slightly alarmed her, since she knows I am starting a new career. Maybe it wasn't going so well? However, rather than ask, "What's wrong? Are you losing your apartment?", she asked about my day, which was a very gentle and tactful approach. So on top of receiving her unthinking generosity, I got to remember what a wonderful, kind friend she is.
Next I made the same request to David, Lisa's husband, who said, "Sure!" Then, "What do you need—oh, never mind, it doesn't matter what you need it for."
Then a call to Carol-Joy, who also said, "Sure!" and didn't ask what I wanted it for.
I ended up having really interesting conversations with all three of my friends, and Carol-Joy told me some stories I'd never heard in three decades of friendship—yet another gift of this process.
I called Sam, who immediately asked why I needed the money, but once I told him what it was for, he said he was good for it. After that, I emailed a relative with whom I've had bitter fights in the past over money. Given that, I decided four dollars would be the right amount for this request. My relative immediately emailed back, "Sure, I'll give you four dollars."
By the end of the day, I had raised more than a hundred dollars, which felt great until I realized I'd already asked most of my very closest friends: Where was the other nearly $400 to come from? Thus another learning was that I should have asked for more money. I felt OK asking for twenty dollars. I would not have felt at all OK asking for fifty dollars, so that is probably what I should have done.
When Lisa and David's check arrived, I was relieved to see that their cat, JoJo, had also decided to contribute.
But a couple of days later, I woke up knowing that would be a ridiculous way to proceed—the point is not to do what is painless and comfortable. As Bernie Glassman writes in Bearing Witness: A Zen Master's Lessons in Making Peace, "Asking—begging—is not the norm. But behaving according to your norm doesn't cause a shift anyplace." He took a bunch of Zen students on a street retreat in New York City for the first time in 1991, and required them to raise more than $3000! Each participant had to "sell" 18 small mala beads for $108 apiece, and a large one for $1,080. I'm sort of glad I don't have to do that, but also sort of sorry, because even raising $500 has already proven to be a remarkable experience.
I decided that I would not send a mass email but rather that I would ask people one at a time, on the phone or via email, per our customary mode of communication, and knew I had to call Lisa in Seattle before she read this. (Thank you for reading my blog, King!)
I also decided that I will panhandle outside for some of this money, and thought about how people doing this often say, "Spare change for something to eat?" or, "I'm trying to get $12 for a room." Maybe people say this because it sounds better than "I need the money for drugs," (if that does happen to be the real reason) or maybe people more often give when there seems to be some good reason for contributing, or perhaps the person asking feels weird not offering a justification. I thought about a fellow who hangs around in my neighborhood who usually doesn't say anything when I walk by, but who once in a while asks, "Can I have three dollars?" It's quite charming precisely because he doesn't say what he wants it for, and also because he asks for such a specific amount. I always say, "Sure!" Sometimes I add, "You can have five dollars!" Once I gave him twenty dollars. It will be interesting to be the person outdoors asking strangers for money.
Having made all these decisions, I telephoned Lisa and asked, "Will you please give me twenty dollars?"
"Sure!" she said.
I was positive the next thing she was going to say was, "Uh, what do you need twenty dollars for?" But she actually asked, "How is your day going?" and then I teared up because she didn't ask what I needed the money for. If no other gift comes from this retreat and the fundraising beforehand, that was more than enough. My unusual request was met with perfect open-heartedness and nothing was requested in return, not even information that would be very reasonable to ask for.
Of course then I explained the whole thing and Lisa in turn explained that my request had slightly alarmed her, since she knows I am starting a new career. Maybe it wasn't going so well? However, rather than ask, "What's wrong? Are you losing your apartment?", she asked about my day, which was a very gentle and tactful approach. So on top of receiving her unthinking generosity, I got to remember what a wonderful, kind friend she is.
Next I made the same request to David, Lisa's husband, who said, "Sure!" Then, "What do you need—oh, never mind, it doesn't matter what you need it for."
Then a call to Carol-Joy, who also said, "Sure!" and didn't ask what I wanted it for.
I ended up having really interesting conversations with all three of my friends, and Carol-Joy told me some stories I'd never heard in three decades of friendship—yet another gift of this process.
I called Sam, who immediately asked why I needed the money, but once I told him what it was for, he said he was good for it. After that, I emailed a relative with whom I've had bitter fights in the past over money. Given that, I decided four dollars would be the right amount for this request. My relative immediately emailed back, "Sure, I'll give you four dollars."
By the end of the day, I had raised more than a hundred dollars, which felt great until I realized I'd already asked most of my very closest friends: Where was the other nearly $400 to come from? Thus another learning was that I should have asked for more money. I felt OK asking for twenty dollars. I would not have felt at all OK asking for fifty dollars, so that is probably what I should have done.
When Lisa and David's check arrived, I was relieved to see that their cat, JoJo, had also decided to contribute.
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