Saturday, March 31, 2018

Code Emma

Toward the end of February, I saw a patient at work who seemed very bright and well educated. His manner was affable, he was open and forthcoming, he smiled frequently. And his life was nearly empty of people. In a mild, almost offhand manner, he shared how he had been very generous with this person only to be abandoned in return, and how another person had not so much as telephoned him while he was in the hospital.

It was somewhat chilling, because he was so much like me: not someone who seemed terrible, not at all. He seemed to have many fine qualities, yet his attitudes (per my own analysis after 45 minutes of conversation) had made it so that he had ended up alone, or at least feeling alone.

Being with so many people who are dying has certainly made me think about my own death—where? with who present? with a tube down my throat?—and also about how best to care for my health while I still have it. But maybe the most important gift is getting to think about how to live between now and death. I still have a chance to learn to be more tolerant, to notice what I have received rather than what I haven’t, to nurture my relationships as best I can. I have today, anyway.

This makes me think of another patient I saw recently, one who was very generous. During our visit, she called to the nurse outside the room, “Can you please bring me a cup and some ice? I want to share my raspberry drink with the chaplain.” Later she said, “This hamburger is really good. You should have half of it.” I remarked on her readiness to share, and she said, “I was raised that way.” I imagine that she spends very little time thinking about who hasn’t come to see her, and I’ll bet she has plenty of visitors, including whoever had brought a vase crammed with beautiful white roses.

While I was charting at work one day, an announcement came over the P.A. system of a “Code Emma.” I immediately consulted the back of my badge, where there is a cheat sheet that explains what various codes mean. The person sitting to my left did exactly the same. We did not see this code on our badges. Someone behind us explained, “It means AMA—that someone is leaving against medical advice.” The patient who was trying to escape, in her wheelchair, was my favorite patient, the one whose chart contains a note by a nurse saying that the patient’s room was filled with smoke and when the nurse entered, the patient threw a pipe behind her bed. “Nurse was unable to retrieve pipe,” the note concluded.

To this day, this patient smokes in her room all the time, to the ire of the care staff, and does other things her doctors would prefer she didn’t. I could easily imagine her wheeling herself away from the hospital with all her might, joint dangling from her lips, but there was soon an announcement saying, “Code Emma all clear.”

Toward the end of the day, I had a text message exchange with another chaplain in which I feared I might have caused offense, so I sent a note saying that if strained feelings ever arise, I am happy to process. My colleague texted back, “Can I call you right now?” He wasn’t upset, but wanted to share some things that pertain to his work as a member of the chaplain team. We ended up being on the phone for quite some time and had a really nice talk. I was glad I had made the offer.

After all that patting myself on the back about my insight about F.—that we weren’t even in the same relationship—I texted him around that time, my first attempt to contact him since running into him on the street last June. This is what I wrote, in a series of three texts:

You may have heard this already, but if not, I wanted to let you know that [S.] died at Laguna Honda a month or a month and a half ago.

I am sorry. You were a wonderful friend to her.

I hope you are doing well. I think of you every day, I miss you every day, and I send you love and good wishes every day.

He didn’t reply. Not in an angry way, not in a friendly way, not at all. (Why would I think he would possibly reply in a friendly way? Yet I did.) In the most bereft moments after I texted him, checking my phone and seeing nothing, I gave myself the meditation instructions Howie often offers: “Just this moment.” One moment at a time, the period of wishing F. would text back—even angrily; just something—passed.

At work, I found myself using the same instruction often, along with, “Relax.” It made things seem very easy, very doable. Certainly I can do whatever needs doing in just this moment: taking a step, noticing what I see, pressing a key on the computer keyboard. In this year since losing F., I have employed many helpful practices and had many clarifying insights, and probably every bit of that was necessary at the time, but maybe the ultimate lesson is that, while many perspectives are useful, liberation doesn’t come via thought, but from turning toward what is—the sorrowful feeling, the knot in the gut—in just this moment, over and over. How wonderful that this is so easy to do. How unfortunate that it is so eminently easy to forget to do.

Friday, March 30, 2018

Jews and Girls

In mid-February, I got to see a psych patient at County Hospital for the first time. I think Clementine forgot I’d not yet been oriented to that unit. It was a little bit frightening. I went to the psych unit at the Truly Wonderful Medical Center maybe 25 times in the course of my year there, and actually was scared there a time or two, as well, but usually it was pretty relaxed and often quite wonderful. At County Hospital, I was escorted through two locked doors and introduced to a patient who was rocking back and forth with great intensity. We were shown to a seating area ten feet from the front desk and sat facing each other in extra-heavy chairs, just like they have at TWMC’s psych unit: too heavy to pick up and throw.

When the patient rocked forward, his face came very near mine. I was struck by how clear his eyes were, and how white the whites of his eyes were. He was extremely hard to understand, but I got it when he asked, “This is just between us, right?” I think he wanted to confess to stabbing a relative in the face with a knife, if I’d understood his earlier remarks correctly, certainly a dispiriting incident for all involved, but not one a mandated reporter would have to do anything about at this point. However, it is my understanding that I can’t promise confidentiality. I said, “Well, I’m a member of your care team. I’m not a priest.” Often people equate chaplains with priests and talking to a chaplain with going to confession, but they are not the same thing.

Just then it occurred to me that I was basically blocking this patient’s way out of the small area we were in, wedged between a dining table and a half-wall, and I wondered if that was causing him any anxiety, which would be undesirable, and half a second later, he leapt up, squeezed past me, and walked off, waving his hand dismissively behind him.

I distinctly recall being told in Clinical Pastoral Education that our conversations with patients are not confidential—that we are members of the care team and that we chart just as doctors and nurses do. However, I was lately reading a book about chaplaincy that stressed that conversations with chaplains are confidential, except as limited by law. I know that chaplains do often receive “confessions.” I once heard a chaplain say that someone had told her on his deathbed that he had killed someone.

I imagine that the vast majority of “confessions” I might hear are not things I would be obligated to do anything about, and I would like people to be able to unburden themselves, but I would not want to give false assurances to a patient who then tells me about child, partner or elder abuse that I would legally be required to report.


In a Terry Gross interview on the radio, someone mentioned that he is acquainted with a Klan member who calls NPR The U.S. Jews and Girls Report.

Thursday, March 29, 2018


Mid-February brought another bout of really missing F. and having to talk myself out of calling him to say, “Let’s fix this! Let’s go to counseling!” I was thinking for the hundredth time that what made the ending so hard was how sudden it was. I reflected that, for that matter, the beginning was also quite sudden. And that the sudden beginning was according to his plan, and so was the abrupt ending! In fact—it finally dawned on me—the whole thing went according to his template for how a romance should begin and proceed, and later according to his script for what a proper revolutionary does when he realizes he is being victimized by a callous perpetrator.

In some ways, I did not exist in that relationship at all! I was merely the other party that is required for him to act out his patterns yet again (while, of course, I acted out mine). So: a breakthrough. Why on earth would I want to take up a role like that again? Seeing that didn’t make me angry at him and nor did it make me sadder than I already was, but it was rather poignant to contemplate us humans being beetling around our familiar tracks over and over.

At work, for the first time I encountered a patient in obvious conflict with his significant other. We had a couple of presentations on mediating conflicts during CPE, but I was unable to dredge up any useful details in the moment. Also, it wasn’t like there was one particular conflict, but just an alarming intensity of bickering and anger right in the hospital room, so I went with my intuition. I said, “Forgive me for asking a really nosy question—you can ask me to leave the room if you want—but how was your relationship three weeks ago?” That was before the patient’s serious diagnosis, and the answer was that it was the same as I was now seeing. That is, the ill will wasn’t due to the stress of the new diagnosis.

So I spoke with both parties together, and then asked if I could speak with each alone. I must say my sympathies were distinctly with the patient, but I listened as openly as I could and confirmed that each has someone to talk to other than his or her partner, which seemed important. A few days later, I saw in the chart note of another chaplain that the patient and the patient’s spouse felt these conversations had been helpful.

Valentine’s Day would have been F.’s and my third anniversary, though reaching this milestone would have been more likely if we’d made it to our second anniversary, which we didn’t. I thought about him, of course, but didn’t have to battle the desire to contact him, which I attribute to the aforementioned insight that we weren’t even in the same relationship. That evening, I kind of felt like texting “You alive?” but this idea was easily discarded. It was possible I might catch him in a friendly mood but much more likely that I would catch him in an angry mood. There’s no way to know, and once I remembered that, I also remembered that it would be far kinder just to let him be.

At County Hospital that week, I saw Clementine for the first time in ages. I was really happy to see her, but she hardly seemed to notice me. I felt a bit hurt, and I also got to thinking about how at various moments she had suggested that I might want to work with the palliative care team, or with prisoners, or with psych patients, or in the emergency room. I had told her I wanted to do all of that, but never heard anything more about any of it, and I started to brood about it a little.

School requires us to volunteer, and that’s why I’m volunteering at County Hospital, besides the fact that I have wanted to be there for years. However, it turns out that we’re supposed to volunteer outside our major area of interest, so, for instance, the person who wants to be a hospital chaplain is asked to volunteer not at a hospital. However, I can’t exactly leave there now. I like the place and I like the people and I appreciate that there are people. At my paying job, I’m almost always the only chaplain around. So I will be staying, but will also need to find an additional volunteer position. 

Clementine had mentioned that if I want to work with the palliative care team, it would be good if I could put in a whole day, but increasing my hours is out of the question at this point. After I brooded for a while about why none of those enticing possibilities had come to fruition, I told myself that it is only fair that the volunteers who can put in a lot of time should get the plum assignments, and that I would carry on cheerfully with whatever they ask me to do. And then I got an email from Clementine saying she would like to talk to me about my clinical assignments, which made me feel a lot better, though since I couldn’t increase my hours, there might not end up being any change.

Tuesday, March 27, 2018

Alms for the Poor

I decided not to ask my parents for money for the street retreat in New York—each participant must come up with five hundred dollars—because that basically means asking my father for money, and he is already incredibly generous with us children. But I did want there to be a bead on my mala for him and my mother, so I telephoned and asked my father for a dollar. He said yes and passed the phone to my mother, who—per a sudden burst of inspiration—I asked for a hundred dollars. She said, “Hold on,” and there was silence for a few moments. When she came back on the line, she said, “You just asked your father for a dollar?”


“And you asked me for a hundred dollars?”

I agreed this was so. In the mail, I received a check from my father for fifty dollars, with “Alms for the poor” written on the memo line. In the same envelope was a single dollar bill with a post-it note attached to it reading, in my father’s writing, “From your mom.”

(However, let the record reflect that my mother said that if I was stuck when it was closer to retreat time, she would send me the other 99 dollars.)

Early in February, I was looking online for the obituary of my friend Mark, and could not find it, but discovered immediately that he was a registered sex offender. It was hard to know what to make of that. The photo of him was absolutely current and listed his current (well, former) address, though maybe once you get on that list, you have to keep your photo up to date. I know that some people end up listed for ridiculous reasons, such as childhood games of “doctor,” and that once you’re on it, it’s impossible to get off it, but I assume that most people are included for a good reason.

He was the stay-at-home parent for his three daughters. Maybe one of them ended up recollecting something that didn’t seem right to her. Maybe he was an out-and-out child molester. The category he was listed in is for offenses less severe than rape. I can’t ask him and I certainly can’t ask his bereaved wife, so this will probably remain a mystery forever. At first, it didn’t seem to have much effect on my feelings about him, since it was so completely out of context, but now I must admit it has cast a shadow.

Also early in February, I went back for the first time since graduating to the Truly Wonderful Medical Center to have lunch with my palliative care mentor, Delia. I also went to visit the current crop of Clinical Pastoral Education students and to see the faculty members who were around.

A few days later, I went to the San Francisco Zen Center and meditated in the zendo and then heard a dharma talk. Sam met me after the talk and we had lunch together there and then walked downtown.

It feels now as if there are just two kinds of days: if I work, it’s a Monday, and if I don’t, it’s Saturday! Each week there are two or three Mondays and all the other days are Saturdays.

One weekend at work I visited a woman whose baby was threatening to be born way too soon. I led her in a guided meditation that felt very awkward for some reason. I was sure she was thinking that it was terrible and that I had no idea what I was doing, but afterward, she said it had been very relaxing, and when her nurse came in, she said I had nearly put her to sleep. (Which was good. Slumber is not normally a goal of mindfulness meditation, but I consider it a success when a patient falls asleep, because it’s tiring on every level to be in the hospital.)

I also saw a fellow who a year ago was at the Truly Wonderful Medical Center, where he was visited by a wonderful woman chaplain—almost certainly one of my peers—who explained to him that she would be unable to meet for coffee or dinner after he was discharged from the hospital. He was still disgruntled about it, and blamed the hospital rather than the chaplain. He said that happy patients are more likely to make financial contributions to the hospital, and isn’t this desired by the hospital? If so, they would do well not to treat people “like they’re not even human beings.”

I was going to email my cohort and describe this, of course without using the patient’s name. Likely one of my peers would have said, “I remember that guy!” But I decided not to, because it wasn’t necessary—there was no good reason to do it—and because even though the patient wouldn’t knowingly be harmed, he would have indirectly been harmed by unwittingly becoming an object of humor or scorn, however mild and however fleeting. I feel increasingly protective of the patients I see.

I also want to be the very best chaplain I can be. I really love this job and would be devastated if I inadvertently did something that made me lose it. It brings out the best in me, just as going to my meditation group does. Going to work almost feels like going on a one-day meditation retreat. The day beforehand, I have a ritual of washing my glasses and shining my shoes, which are Ecco men’s shoes. They are very comfortable for walking to the hospital and up and down the stairs all day long, and they are very sober looking. When I put them on, I feel like I am the chaplain.

I now recollect, though, that there is also a sad memory associated with these shoes. Once I began CPE at the Truly Wonderful Medical Center, I realized I needed shoes that were more comfortable and planned a trip to a place downtown that specializes in such. It’s not far from where F. lives (or did live), and so I went to visit him, and then I went to the shoe store. With my free time so exceedingly limited, I was glad to be able to do these two important things on one afternoon. F. was irate. It went beyond his feeling that I should have spent every bit of my time with him and no time buying shoes. It was partly that, but he literally felt that I had viciously insulted him by having an errand to do after our visit, and he brought it up over and over and over in the months afterward.