Wednesday, July 25, 2018

I Get by With a Little Help from My Friends

Maybe a month ago, a nurse at work instructed me not to chart at her unit’s nursing station. I was immediately indignant. My very first CPE supervisor told me to chart at the nursing station. This is part of integrating myself into the units I serve, which is potentially all of them. She also said, as a rule, not to ask a patient’s nurse for permission to visit the patient, but to remember that I am also a member of the care team.

Later that day, I mentioned this to my boss, who also seemed immediately indignant. Her initial response was to tell me to go ahead and chart at the nursing station, but later she said to discuss the matter with the nursing supervisor, so I wasn’t sure how to proceed, but, being myself, was inclining toward announcing, “I’m a care team member and I’ll chart where any other care team member charts.”

The unit where this happened is not one I’m assigned to, so I sent my colleague who is the unit chaplain a note asking what her experience has been and if she had any insights that would be helpful.

Perhaps it was that same night that I got a page after hours asking for a priest. I called the church that is supposed to handle after-hours requests and got what they call in the corporate world a significant amount of pushback. It was possible that the need would end up being the following morning, so I called the priest who is one of our staff chaplains, and left him a message saying he might be needed first thing next morning at a particular campus.

It did end up working out that way, so I left our staff chaplain a message about an hour before our normal start time (actually 90 minutes before, because I temporarily forgot what our normal start time is) asking him to report directly to the ICU in question, if possible. I then texted him apologizing for having phoned him both after and before hours. He texted back saying he would go straight to the ICU to meet the patient’s need, and also that I should tell our boss about what had happened. But what had happened?

I asked what he was talking about: the other priest not having wanted to come to the hospital at night? My having called him outside of normal working hours? Both? He hastily backed off, saying I should do whatever I thought was appropriate, which left me, as with the nurse not wanting me to chart at the nursing station, confused about what to do next.

I went ahead and sent a note to our boss, copying our priest, outlining the entire sequence of events, and ended by saying that my purpose in sending this email was to let our boss know that there is some difficulty getting the priest from that particular church to come after hours. I also said I would welcome some direction as to when it’s OK to call our own priest.

The next time I was in the office, I saw that there had been no response whatsoever from 1) my boss; 2) our staff priest; or 3) my colleague in regard to where to chart on her unit. Now I was starting to fume. This was a Sunday morning. Soon the office phone rang: our staff priest. When he asked how I was, I grumbled that I had done what he had asked me to do—tell our boss something or other—and then neither of them had responded!

He said that he and our boss had continued the email exchange without me, which was fine, since my goal was not necessarily to send and receive email but to have the information I need in order to do my job. As to that, our priest explained that outside priests often have a lot on their plates, and that we should be understanding of that, and that if necessary, it’s OK to call him, our own priest, and it is certainly fine to call him with information he might need first thing the following morning. That was basically what I needed to know. (Although now that I’m writing this, I realize I still don’t understand why he wanted me to say anything at all to our boss.)

As long as I was on the phone with him, I asked what he does if he is discouraged from charting in a certain area. He said, “I might be understood as a coward,” but said he just saves his charting up and does it in his own office. That was helpful in that it made me feel there was no dishonor in not going to war with my colleagues.

Later that day, I also discovered that my fellow chaplain actually had sent a response to my question. It wasn’t in my inbox in the messaging system; it appeared as a comment on my original note. Fortunately, I enjoy reviewing messages I have sent so I can appreciate my own sparkling prose for a second or third time; that’s the only reason I saw her response, which was that if the nurse asks her politely to go chart somewhere else, she doesn’t mind doing that, but if the nurse is rude, I should discuss it with the nursing manager. She has told me in the past that those exact nurses are among the unfriendliest she has encountered.

At this point, I felt fine about not insisting on charting at the nursing station, and relieved that I wasn’t obligated to get into a fight about it. My colleagues, who both had initially annoyed me, ended up saving me.

Thursday, July 12, 2018

Inspect Ladder Before Use

The aluminum ladder whose leg suddenly gave way, resulting in grievous injuries for an esteemed relative. (The thinking now is that a wooden or fiberglass ladder might be safer in that it might make a creaking noise or something before failing.)

(Click photo to enlarge.)

Monday, July 09, 2018

Schwing Schwing Schwing Schwing

(Or is it just shwing?) This refers to Wayne’s World 2, featuring Aerosmith, one of the movies I watched with my mother while visiting Ypsilanti early in June. We also saw Miss Sloane (we both liked it a lot), The Florida Project, Into the Wild (for the second time), Wonder Woman, Nightcrawler, Boyhood, Get Out, Assault on Wall Street, and probably several other movies I’m forgetting. I got caught up on my MSNBC and Rachel Maddow, and enjoyed spending time with my parents and the cat that hangs around their place a lot, Jack. I had lunch with Ginny at Café Zola and with Amy at Seva. My sister came over three times, and I had lunch with my uncle and his wife at Haab’s, in downtown Ypsilanti. As for Wayne’s World 2, that was my mother’s idea. She normally dislikes comedies, but thought it would be good to have some familiarity with a work that is so well-known. I enjoyed it. I appreciated the main characters’ enthusiasm and joie de vivre.

The evening I returned home, I went to the first of six Feldenkrais classes I’m taking through Kaiser. The next day I got my annual performance review at work, which was glowing. My boss’s accompanying remarks were less so. For instance, the written review said my chart notes are great, and provide helpful information to other team members. In person, she said, “Actually, what I don’t like about your chart notes is … ” I thought that was a perfect way of handling it, in that my official review is something I can feel fantastic about, and I also got concrete information about areas where I can improve. (She also said that Jonas, before he left, said I have an “incredible” ability to connect with patients.)

When I went to County Hospital for the first time after being in Michigan, Clementine—looking a bit dazed—told me about no fewer than eight traumatic and/or disturbing incidents that had occurred at or affected the hospital in the prior couple of weeks, including two “gnarly” murders. One of the many ramifications of these things is that security is tighter, which means homeless people are less welcome to sit around in the cafeteria all day, and not at all welcome to sleep in the elevators overnight, as some of them normally do, so besides all the various kinds of misery, there has even been a loss of housing for a small group of people.

It was a fine day of learning for me. One of my fellow chaplains there is extraordinarily insightful. During our brief daily team meeting, we were talking about patients who ask us questions about ourselves. This person said, “I think that a patient who does this is trying to erase herself, so I need to leave a big space in which she can reappear.” That dazzled all of us.

My own learnings of the day:

1) I spent most of the morning, after holding babies, in the more acute psych unit, where I saw just two patients. One of them has problems with demons, and during our rather long talk, she said, “Oh! A demon just came out of me and went into you.” I paused and said, “I didn’t feel any demon come into me. It didn’t come into me. Maybe it dissipated into the air.” The patient said, “No, it came back into me,” and her face twisted in pain.

I happened to mention this to Clementine later, and was glad of that, because it caused me to remember that we’re not supposed to validate delusions. (Nor are we supposed to say, “What?! Are you crazy? There’s no such thing as demons!”) She said it was good that I had denied that the demon had come into me, but when I suggested that maybe it had gone into the air, I was validating the patient’s delusion. She advised me not to engage one way or the other about demons or other delusions, but to listen for the feelings. How does a person full of vengeful demons feel? Probably scared.

(Though Clementine said that once medication makes the demons go away, some patients can actually feel lonely for them, because demons aren’t always in a bad mood.)

2) This same patient asked about my religion and I said I am Buddhist. With non-psych patients, this is almost never a big deal. (I can recall only two patients who made it clear they didn’t like it; one went to work right away trying to convince me to accept Jesus as my savior.) This psych patient reacted favorably at first, but when I ran into her later, she spitefully accused me of stealing a Bible from her, and then said, with near-palpable malevolence, “Just because you’re Buddhist doesn’t mean you have to persecute me!”

From this I concluded it might be wise to be less forthcoming with psych patients.

3) I brought the other psych patient a copy of Our Daily Bread, which has two staples in the binding, and stopped by the front desk to see if they would like to remove the staples, which they did want to do to prevent the recipient or some other patient from removing the staples, straightening them, and using them as weapons. No one at County Hospital had told me to do this; we learned this during CPE. I mentioned this at our chaplain team meeting, and it appeared to be new information for some, so that was a reinforcement of learning for me and maybe something new for others.

4) Finally, in the ED I visited a patient who was handcuffed to her bed, with a police officer stationed outside. That morning, she had been a free woman, and now she was going to jail, and she was upset. I asked what had happened, and at some point, after I’d heard a few details, the police officer interrupted to say he didn’t think we should be discussing it. The patient got indignant and asked why not, but the police officer was quite right; I was chagrined that I hadn’t figured that out myself. I said, “You’re right, we shouldn’t be talking about this.” To the patient I said, “My thinking was that maybe it would make you feel better to say what happened.”

“It did make me feel better!”, said the patient. “I should be able to talk about whatever I want to talk about.”

“Fine,” said the police officer. “You can talk about whatever you want to talk about, but she shouldn’t ask you about it.”

When I left, I thanked the police officer and will not do that ever again. Then I felt kind of paranoid, worried that I’d get in trouble over it, but figured I wouldn’t. (I didn’t.) There’s just too much constantly going on there for everyone to follow up on every detail.

In the evening, Tom, Ann Marie and I went to see the first half of Angels in America at Berkeley Rep, thanks to Ann. Tom took me out beforehand for Thai food, for my birthday. The play was superb. The person playing the part of the angel, the nurse, and one or two other roles was the niece of my friend Carlos who died of a brain tumor in 2013. She is also a playwright, and, as we saw, a splendid actor. I couldn’t take my eyes off her, in part because I was trying to figure out if I could see any resemblance to Carlos, and at moments, I thought I could fleetingly see his face in hers. Lisa Ramirez is her name. I remember Carlos talking about going to see her performances and about how proud he was of her.

Saturday, July 07, 2018


While I was at County Hospital one day late in May, I got a text from Clementine saying that the ED was on lockdown and could I go check it out? I texted back, “Do you want me to enter the ED?” I wasn’t sure if she wanted me to go in and conduct a hostage negotiation or what. Presumably she didn’t intend for me to get my head blown off, so I wasn’t sure exactly what she wanted me to do. I didn’t hear back from her, and when I got near the ED, nothing appeared to be amiss.

I went in and saw sheriffs taking a barricade away from one of the entrances, and a staff member said the lockdown was all clear. Later I mentioned it to one of my fellow volunteers, and she said, “Yeah, that happens all the time.”

I told Clementine about having attended the training on psychological first aid, and she invited me to join the hospital’s disaster response team, or MCI (Multiple Casualty Incident) team, which I agreed to do.

Up on one of the units, a nurse told me that one of her patients seemed silent and withdrawn, and she asked if I would visit him. The patient was sitting up on the edge of his bed, and he did indeed seem to be downcast. I asked if I could sit down and then I just sat there quietly for some time. After a while, I said, “You seem kind of sad.” He nodded his head just slightly. I added, “It looks like you’re feeling kind of discouraged,” and he nodded at that, too. Then he started talking—about his disappointment that the Warriors had lost their game the previous night. Sounding stunned, he said, “I didn’t think that was going to happen.”

However, as the very leisurely visit unfolded, he shared about some physical symptoms he was having that he hadn’t told his nurse about. He said that, where he’s from, if you say you need help with anything, people lose respect for you. While I was there, he pushed his nurse call button and told her about his symptoms. It wasn’t necessary for me to tell him to do that. It was necessary for him to hear himself say aloud that he was in pain and that it’s hard for him to let people know he is having difficulties.

After that, I thought, OK, I think I’ve got it! There is nothing I can fix. The idea is to sit there, with patience and stillness, until whatever the wound is comes into view. I went off to see other patients thinking that I would do the exact same thing, and then of course found that what had worked in one visit had little utility in any other. Nonetheless, I like the idea of being quiet and patient, waiting for things to emerge on their own: whatever is bothering the patient, and also her resources and wholeness.

One evening, just after I turned off the light to go to sleep: beep beep beep! My work pager going off. I called the pager operator, who put me through to a nurse who said that a patient’s mother wanted to speak to a chaplain on the phone. My enthusiasm was whole-hearted, since the alternative was getting up, getting dressed again, and taking a cab back to work. “I would love to talk to her on the phone!”

Thursday, July 05, 2018

Chaplain Tries to Poison Fledgling Priest

A week or so after Mason’s graduation from divinity school, I returned to Berkeley to have breakfast with him before he moved back to New Mexico to serve his own church as a priest. I had checked online to see how far it is from his hometown to Santa Fe and it appeared to be more than four hours by car: too far for a day trip. I told myself that, realistically, this would probably be the last time I would see him, and to let go, let go, let go. I have a quote somewhere about how what we humans need practice in is letting go, because we’re already experts at holding on.

We met at the Sunny Side Café, near UC Berkeley, and after we ate took a walk on campus. I gave him a card congratulating him for receiving his M.Div. and a couple of small gifts, including a polished piece of malachite. (I learned later that malachite is poisonous and that you shouldn’t carry it around in your pocket. He told me he plans to keep it as a reminder that Chaplain Bugwalk tried to poison him.) I asked how long it would take him to drive to Santa Fe and was pleased when he said the trip is just two and a half hours. There is a Monday in August when I can be in Santa Fe but not at school, and it turns out that Monday will be Mason’s day off, so we have plans to meet. Mason suggested that we go to all the museums where, as a Native person, he gets in for free.

Back in the city that day, I attended a training on psychological first aid, such as one might have to render after an earthquake or other mass casualty event. One thing you can do to help someone feel calmer is to ask her to name five things she sees around her, five things she hears, and five sensations she feels in her body, then four of each of those things (not the same ones as before), and then three, two, and one. When the trainer had us do this, it was pretty hard to hear that many different sounds, but overall, this did seem to have a relaxing effect.

Her number-one recommendation for helping lesson people’s anxiety was to ask them to breathe into their diaphragms for a count of four, and then to exhale for a count of four, and to repeat this for a while. Another very useful thing the trainer shared was to say to a survivor, “Hi, I’m Bugwalk. I’m here to help. What’s your name?” and extend my hand. If the person says her name and extends her hand to shake mine, I have just learned several things: the person’s name, that she isn’t hard of hearing, that she speaks at least some English, that she is willing to engage with me both verbally and non-verbally, that she doesn’t have an injury that prevents her from moving her arm and perhaps that she is not in overwhelming physical pain.

The trainer said not to say, “Everything will be OK,” because it might not be, and to use a survivor’s name often, because people are very alert to the sound of their own names, so this might help keep the person we are talking to from getting lost in anxiety.

Most of the people in the room were nurses and social workers, most working in one hospital or another. Next to me was a fellow chaplain volunteer from County Hospital. She told me she is from Mackinac Island, a charming place in Northern Michigan and not one I had realized you can be from; I thought it shut down in the winter. At least last time I was there, about 45 years ago, there were no cars. You could get around by foot, horse-drawn carriage and bicycle, and also eat fudge. (It appears this is still correct. Wikipedia says motorized vehicles, except for emergencies, have been prohibited there since 1898. You can get there only by boat or plane; if it’s winter, you can also go over an ice bridge on a snowmobile.)

Back at home after the training, I gave Emily a call and asked the person who transferred the call to make sure she put the phone to her good ear.

“Do you have the phone up to your left ear?” I asked her.


“That’s funny that you didn’t say ‘right.’”

“Correct.” She really is rather charming.

She said things were going better: She was visited by two of her friends, and another called her on the phone, and she likes the head nurse, and she had a good conversation with a volunteer, who had a helpful suggestion. When Emily feels upset, she likes to go for a walk. She told me that the volunteer said that, when she feels this urge, maybe she can imagine she is walking, and move her feet in bed. Surprisingly, this worked.

I found among my meditation-related clippings this account of something said by Suzuki Roshi during a sesshin; I misquoted it in an earlier post: “Suzuki Roshi began his talk by saying slowly, ‘The problems you are now experiencing’—we were sure he was going to say go away—‘will continue for the rest of your life.’ The way he said it, we all laughed.” I don’t have the name of the person who wrote this, and will be glad to add it if it comes my way.

Wednesday, July 04, 2018

Am I Dying?

One day we had a five-hour staff retreat at work starting with Mediterranean food for lunch. In the course of the afternoon, my boss mentioned that when Jonas left, among other things, we lost the person who trains others how to use the electronic charting system. I’m pretty good with that system and my former computer job often involved training other people, so at the end of the day, I offered my services and she said that before Jonas left, he told her I’m good with the computer, so she would take me up on that.

She also said she would like me to apply for a part-time job when one becomes available (this would be a step up from my current per diem position), that I have a lot to offer, that I’m a good team member, and that I’m doing a great job. I was flabbergasted. I told her that her words meant a lot to me, and that I’m happy at this hospital, both very true. I had been worried that she was secretly fuming about how much time I take off work, between school and vacations, so that was another reason I was relieved and delighted to find out she is glad to have me around: she’s not trying to figure out how to trade me for a per diem who doesn’t take so much time off.

In mid-May, I went to see Mason, my peer from my first unit of Clinical Pastoral Education, receive his M.Div. degree in Berkeley. It was an inspiring ceremony, and Mason got one of three special awards. Quite a number of his family members came from New Mexico to see him graduate.

When I got home, I called Emily in hospice, and this time I did much better when she asked me a tough question: “Bugwalk, am I dying?”

I said, “Well, a person goes to hospice when a doctor believes she has six months to live or less.”

“Which doctor?!”

“I imagine it was one of the doctors you saw at the hospital.”

“Oh. Yeah. I didn’t get along with that guy. I don’t think he liked me.”

I thought of saying I hope a doctor wouldn’t send a patient to hospice because he didn’t care for her personality, but in case she wasn’t already thinking that—though she probably was—I decided not to introduce that idea.

Then an interesting thing happened, which was that she changed the subject. A bit later, she returned to it, saying she felt frightened, and asking what she should do. And then she changed the subject again. That was a powerful learning experience: I don’t have to be afraid of telling people the truth, because a natural defense mechanism such as denial or avoidance will come to the fore when needed. These get a bad rap but are perfectly reasonable means of self-protection.

One Saturday, Sam and I met in the Castro for Thai food, and the following day Ann, Jill, Tom and I had lunch at Au Coquelet and went to Berkeley Rep to see Heidi Schreck’s play What the Constitution Means to Me. I enjoyed it. Each member of the audience was given a copy of The Constitution of the United States of America. I probably will never read it, but I feel like a better person now that I own a copy.

The next time I called Emily, I found that she was still distraught about finding herself in hospice. I managed to convey to her that, when she declined to take medication, her doctors likely interpreted that she didn’t want treatment and accordingly sent her to hospice. She said, “Oh. Well. I still don’t want to take medication.”

“Then you might be in the best place!” I shrieked. It can be kind of a maddening experience to talk to her on the phone because I have to bellow into the receiver, and she still misses thirty percent of what I say.

“What do you mean by that?”

“How do you think things would go if you were back at home?”

“That’s a good question.” I can’t remember what she said after that, but I was relieved that she is sure she doesn’t want to take medication, because that does mean she probably is in the right place. I was also kind of surprised by that. I sort of expected her to say, “What?! In that case, of course I want medication!”

When Sam and I had lunch the prior Saturday, we were dangerously near where Emily is. In fact, we walked over to look at it, because Sam had never been there. It’s quite a lovely place, on a very pleasant block. But having learned by calling Emily that I shouldn’t have done so, I knew better than to initiate in-person visits. That would not be sustainable on my end, and I would disappoint her. Having said that, I have asked the staff there to let me know when she is within a couple of hours of dying, as best they can tell. If I can, I will go over there and hold her hand.