Wednesday, December 26, 2018


A week or so into November, fires 150 miles away filled the air with smoke here in San Francisco. I walked to County Hospital wearing an N95 mask. This kind of mask, if properly fitted, will help keep particles out of the lungs, though the wearer might still smell the smoke, or whatever it is, and his or her glasses can still potentially steam up.

That was my very first day with the palliative care team. At rounds, we discussed a patient who had been in jail or prison, received compassionate release because his death was imminent, and had subsequently perked up. Now what?

Before rounds, Robert, the head of the spiritual care department and main palliative care chaplain, explained how he conducts himself in rounds. “I don’t say much. I hold the space for the others. I might chime in if there’s a patient I’ve been following.” He said that if there has been a recent tragedy, he might say at the end, “Can we take a moment of silence?” He asks the doctor’s permission to do this; he said that doing this at all depends on who the attending is and what time it is.

Besides the terrible fires, there had been a recent mass shooting, so Robert did ask if we could have a moment of silence at the end of the meeting. He said a few words to draw our attention to those affected by both events, and then there was a bit of quiet, which ended with Robert saying, “Thank you.” That day was the monthly palliative care team lunch, when people eat together in a conference room. It was a friendly, relaxed gathering.

On Saturday, the playground outside my living room window, normally filled with children, was completely deserted due to the smoke. However, there were three completely insane (adult) tennis players on the adjacent courts. Hammett and I spent the entire day sealed in our apartment with our HEPA filter air purifier running. Tom called from Sacramento in the evening and said it was even worse there. One benefit of staying inside all day was that I finished sewing my rakusu.

I let the air purifier run all night on its lowest setting, and the next morning, the air in the room did seem noticeably fresh. When I rode my bike to Rainbow to get groceries, I wore a mask. My eyes were burning as I pedaled, and when I got home, I saw there was black gunk in the corners of my eyes.

In mid-November, I went back to school for the fifth and final time this year. When I got on the plane to fly to Albuquerque, the flight attendant advised over the P.A. that passengers should not move to a different seat unless requested to do so: “So the plane stays balanced.”

It was probably for that reason that they didn’t mention it when we flew over the Grand Canyon. The only reason I knew I was seeing it was that I was seated next to a Navajo woman who pointed it out, along with lots of other topographical features, including the Shiprock (in Arizona), Navajo Mountain (mostly in Utah, but partly in Arizona), and Ute Mountain (in Colorado). It was wonderful to have such an excellent tour guide. I gave her half my lunch, and by the time we landed, we were good friends. She gave me a magazine for Mormons, of which she is one, and took me outside the airport so I could meet her husband, who had come to pick her up. When we parted, she said she was honored to have met a Buddhist person for the first time.

It was freezing cold at school, with snow on the ground. The temperatures were in the 40s during the day and in the 20s at night. It was colder in Michigan, where I went two days after getting back from school, but, on the other hand, I never had to walk outside in my bare feet in Michigan, which I had to do every day at school. I consoled myself with the thought that I will never, ever go to Santa Fe again in November, nor December, January, or February.

The class I was there for was taught by Roshi and the fellow who started, or helped start, the Zen Hospice Project in San Francisco.
There were at least two students in the class who have terminal diagnoses, and many others who have suffered significant losses. One day, during a meditation on turning toward what is difficult—such as death—an older student collapsed and had to be taken away by ambulance. Fortunately, he was soon feeling better and returned later that day. Roshi said people regularly faint there, due to the altitude.

Most everything that was said I had heard or read previously, and there were also a lot of tedious guided meditations—I generally don’t like guided meditations—and I did not sleep well any of the three nights we were there, but there were also some genuinely powerful moments, including a ritual we did on the last day. I also enjoyed the company of my fellow students, including five or six people from the chaplaincy program, and meeting a whole bunch of new people. I met someone who will be starting the chaplaincy program next spring, which was particularly great. I gave her my key piece of advice, and she said two other people had already told her the exact same thing: get the book reports and field trips done ASAP.

As always, the food was fantastic. I was on cleanup duty after two dinners, and those might have been the most fun moments, working alongside other students and some of the full-time residents to wash the dishes of 70 people. My daily work assignment was also in the kitchen, helping to prepare for lunch by chopping vegetables or crumbling feta, and that was also enjoyable. Otherwise, I was kind of counting the moments until it would be over, and was delighted when I was in the shuttle heading back to the airport. I noticed on my boarding pass that the span of time allotted for getting everyone onto the plane is ten minutes, which is plenty.

Friday, December 21, 2018

Pleasingly Exotic

I visited a patient in the ICU who is both a racial and gender minority and also seriously mentally ill. As I looked into her eyes, I found myself kind of staggered by how difficult her life has undoubtedly been. She mentioned that she doesn’t like to talk to most people because—here she waved her hands to indicate that they are here and there, not completely oriented and present.

About 15 minutes into our 20-minute conversation, I asked, “Do you think our conversation is going well?” I didn’t think I was fishing for a compliment. I thought I was genuinely curious, but I must have expected her to say,
“Oh, yes, you’re easy to talk to,” because I was surprised when she said, “No, not really.” She explained, “Because you’re not really you.”

Perhaps she had noticed a way that I did not seem authentic. Wishing to be more helpful, and also thinking I might learn something useful, I asked, “How do you think I could do better?”

She pondered for a couple of minutes, and finally said, “I’m not supposed to be helping you. You’re supposed to be helping me.” After a few more minutes of conversation, she said reprovingly, “There you go again.” What this meant, I had no idea.

When the afternoon was nearly done and limited time remained, I went to see a patient whose chart had said she was anxious. I found her in a good post-surgery mood, full of compliments for the hospital and all who had cared for her. She told me about some stressors she had been dealing with prior to surgery, and thanked me for visiting: “Just that little bit of talking was helpful!” 

I gathered that she had found being visited by a chaplain pleasingly exotic, because as I left the room, she said, “Wait till my friends hear about this!”

Thursday, December 20, 2018

Crisis Scheduled for April

At the November palliative care class, we got to practice delivering bad news to “patients” played by professional actors.

One of my co-workers, when we were discussing a certain patient, pointed out something I’d never thought about: that one of our campuses has a NICU but no adult ICU, and the three others all have an ICU but no NICU. What if both are needed at the same time? We decided that it would be best if this pregnant patient delayed having a crisis until our new hospital opens early next year; it will have both.

I noticed in a patient’s chart the diagnosis of “contrast dye induced nephropathy.” Before my case of mono was diagnosed a few years ago, I had a scan with contrast dye. Sorry to learn it can mess up your kidneys.

Very happy news arrived early in November: that I was working enough hours each week, on average, to qualify for health insurance from my paying job! I was thrilled. My Obamacare premium was $600 a month throughout 2018, and my deductible was nearly $5000, so on top of forking over $600 a month, I paid out of pocket for a lot of stuff (mainly physical therapy for my various aging body parts). I will pay no premiums at all for the insurance I will get from work, and my deductible for 2019 is $250!

Around then, I got a call from my boss, who said she was trying to think how she could give me more hours. She said, “You really do a nice job. I hear about the way you engage with patients.” She asked if, in addition to my weekly 24-hour on-call shift, I could do two additional day shifts each week. I had formerly said that I could not work more than two days per week while I’m in school, but I went ahead and said yes. I think it was in the back of my mind that we’ll be getting a new boss, and that it might be a good idea to be more visible during this transition. I asked my boss if she has any inkling what the future might look like. I thought she was going to say she had no idea, but she actually did say she thinks full-time chaplains will be preferred to part-time chaplains.

For that reason, it was probably good that I agreed to take on the extra shifts, but that night, I was in a minor panic. As I lay in bed, I found myself obsessively going over and over how I was going to fit everything in. I tried to attend to my body, but my attention kept snapping back to the future very determinedly.

I trust my boss’s kind words were sincere, but I did also find out the next day that our only chaplain who was working five days a week had taken a job in another county, so my boss was probably also in a minor panic of her own. What she specifically asked me to do was to take over palliative care, and to attend the weekly palliative care rounds.

When I started working in a hospital, I thought “rounds” meant walking from one patient’s room to the next, and some physicians do conduct rounds that way, but more typically people just stand or sit in one spot, not in a patient room, and talk about the patients. I attended rounds once or twice during my very first unit of Clinical Pastoral Education and found it so tedious that I avoided rounds thereafter.

At my job, we have to keep very detailed statistics. I literally account for every single minute, and record the number of patients I saw and the number of staff members I cared for and so on and so forth. We turn in these numbers on a monthly spreadsheet, but an odd thing is that we never, ever get any feedback on this spreadsheet. No one ever asks, “How did you see only one patient in the course of an entire week?” Per my aversion to rounds, that column has been blank month after month, but no one has ever remarked on it.

In regard to my new work schedule, I soon realized that I’m going to have to do what I did during Clinical Pastoral Education, which was to take things one day at a time, which proved to be wonderful—so simple. In the morning, I would petition the universe to help me through just that one day, and when the day was over, it was over. I didn’t think much at all about the future. I am now returning to that mode, of necessity, but also, something fantastic happened that is going to save me a million hours.

Next year for school I have to do a project and write a 50-page thesis. This is double spaced. If I were just to type, without regard for content, it would take me about two hours. Of course, it’s not quite that simple. We’re supposed to design a project that relates to the learning plan we wrote at the beginning of the program, and the paper is supposed to be a formal academic paper with proper citations and all that. The last time I wrote a research paper, I was about 20 years old and it was traumatic. I mentioned that to my mentor and she was very reassuring. She immediately sent me links for a couple of websites she relied upon when she was doing her own paper.

As for the project, I had been thinking about a couple of things, one being that I would join a group of conservative Trump-voting Republicans in doing some kind of ongoing service work. I would get to know them, read the authors they think highly of (like Ayn Rand), and later interview some of them about how they came by their beliefs. I really liked this idea, and so did my mentor. Another idea was to volunteer with undocumented immigrants and do something based on that. 

Right after I realized that while both of those might be great ideas, I had no time whatsoever to do either of them, I happened to talk to my mother, which I rarely do these days, because her phone is basically dead, and my parents no longer have a landline. My father’s phone is slightly better—I talk to him now way more than I talk to my mother—but it tends to go on the fritz after a while, and he has to step outside to get good reception, and in November, it’s no longer stepping-outside weather. (I don’t want to be a nag, but I did say to my father that it might be helpful for them to have phones that work in the event that one of them has to call 911 to indicate that the other has fallen down the stairs or had a heart attack.)

Anyway, I was talking to my mother and I said something about this project and she said, “Maybe it should be about something you’re already doing.” Brilliant! Since I am serving with the palliative care team at County Hospital, taking a palliative care class at the Truly Wonderful Medical Center, and had just been asked to be a palliative care chaplain at my paying job, I decided my project will be about palliative care. I’ll be able to say what it’s like to be a palliative care chaplain working with a team or one working alone, because I will be doing both.

Then I remembered that it has to pertain to my learning plan and sent my mentor an email asking what she thought. She wrote back, “This will work beautifully as a thesis topic.” What a relief. I can record what I’m experiencing and learning at both hospitals, read papers and books about palliative care chaplaincy, and interview other chaplains. Boom! This is as good as done.

The Walls Are White

Right after I arrived at the County Hospital one day, before I could report to the NICU—it had been many weeks since I’d been there, for one reason or another—we got an urgent request for a chaplain to go to the ICU. I don’t normally cover that unit, but I did receive orientation for the ICU once, and since I was the only chaplain in sight, I decided to go.

I found a rather complex family situation, with some people meeting others for the first time, and some family members expressing mistrust and even suspicion toward the doctors and nurses. One thing they all agreed on was that they wanted a priest, so I texted our priest, and waited with the family until he arrived.

The family complained that they had been requesting a priest for a week. This may well be so, but we also noticed that the patient was not listed as Catholic in the electronic health record; if he had been, our priest might have stopped by as a matter of course. It often happens that a patient’s religion, and other demographic info, is not available because he or she is unable to provide it upon arrival at the hospital, or the situation is so urgent that no one takes the time to ask questions that don’t seem pertinent.

I ended up hanging around for an hour. By then, several members of the palliative care team had arrived for a family meeting. One of them said, “I don’t know if they want a chaplain to participate, but if they do, can you attend?” I said I could, and then I just kept hanging around, and when everyone went to the meeting room, I went with them and no one told me to leave.

As is often the case, family members had different opinions about how the patient should be cared for, and at least some people were angry and upset. As always, it was wonderful to see the palliative care team in action, and how, even though they are seeing these same dynamics for the 500th time, they are kind and patient and explain the diagnosis and prognosis carefully. They treat everyone’s feelings thoughtfully, and make space for everything.

Before the meeting ended, one upset family member rushed out. “Should I go after her?”, I asked, and enough people nodded that I did, but I couldn’t find her.

After that, I went back to the office, where I and another volunteer—one of my Clinical Pastoral Education peers—were asked to attend mass in the hospital chapel to support our priest, who is yet another CPE peer of ours. It was nice to see his smiling face as he led the service. There were maybe 10 attendees.

In the afternoon, the head of the spiritual care department asked if I would attend a family meeting in his place, so I got to go to two family meetings with the palliative care team that day. Again, people were upset and there were differences of opinion. Again, one person rushed out of the room. This time, one of the palliative care team members directly asked me, “Do you want to go with her?” This time I found her, and I took her to the rooftop garden, where we talked for 45 minutes, giving her a chance to vent and to express her concerns and to tell me a bit about the patient.

While I was waiting for that second family meeting to start, one care team member in the ICU told another that they had a “mert.” “What’s a mert?” I asked. The person explained that an ICU nurse, acting as a member of the Medical Emergency Response Team, goes around to other units to see if any patient is decompensating. If so, the ICU “merts” the patient, and the patient is transferred to the ICU.

In the afternoon, I went to round in the ED, where there are several resuscitation rooms, called “resus” rooms for short. I normally am kind of shy about going into them, because I don’t want to interrupt the doctors and nurses, but I know of a volunteer chaplain who freely visits those rooms, so I went ahead and went into three of them. In the first, I offered prayers for a patient who had three family members at his bedside. The family members looked noticeably more relaxed after the prayer. When people believe in prayer, it can really mean a lot to them to be prayed for in the hospital.

In the second room, I spoke briefly in Spanish with a patient who, fortunately, was feeling mejor. (If she had been feeling worse, likely she would have spoken at much greater length, using words I didn’t understand, and would have spoken more rapidly, compounding my comprehension difficulties.) She was very kind, smiling at my efforts to speak with her in her tongue.

I have mixed feelings about speaking Spanish with patients when I basically can’t speak Spanish. I can limp along, but am far from fluent past a certain basic point. On the one hand, it seems like the most obvious and effective way to improve my Spanish, the patients always appreciate it, and I can always engage at least a telephone interpreter if needed. On the other hand, it seems kind of unfair to expect someone who is already under duress to do something that is for my benefit (though eventually it will hopefully benefit other patients).

The third patient I saw in resus was really angry, and on the verge of getting dressed and leaving before getting his test results. I asked, “How are you helping yourself cope with this?” He said, “The walls are white.” That is precisely what I do when I am under most strain: name to myself what I see around me. I applauded his effective use of mindfulness and asked where he had learned it. One of the things he was angry about was that he was hungry, so I chased down his doctor, which took a while, to confirm that it would be OK for him to eat. (A chaplain is never, ever to give a patient anything that he or she can ingest, even if it’s a cup of water on the tray table right in front of the patient, half an inch farther than he or she can reach.)

Once the doctor said the patient could eat, I went and used my volunteer meal card in the cafeteria to buy a selection of what was still available: whole-grain chips and energy bars. I put some in the chaplain office and took some to the patient. He was still angry, but seemed somewhat touched by the effort I’d gone to. When I left the hospital that day, I saw him out front on the sidewalk. I’m sure he must have noticed me, but he didn’t say anything, which was fine, since we were past the natural ending point of our relationship.

Just Sabbath

Late in October, I went out to volunteer with Sidewalk Talk in the Tenderloin (a block and a half from F.’s place, but I didn’t see him). We set up several pairs of chairs facing each other, attached large signs to a fence behind us, and sat down. There were five volunteers including myself. I was sitting at one end, and was a little surprised when the two volunteers next to me started chatting with each other: wasn’t that one of the very few things the co-founder had asked us not to do? I assumed this conversation would soon end and that quiet receptivity would take its place, but that was not to be. The other volunteers talked to each other for the whole two hours, and the only person who sat down to talk to any of us was a woman who the others said comes by every week.

The very chatty volunteer sitting next to me turned to me a time or two, obviously hoping to converse, but I (an Enneagram One) like to follow the rules, so I engaged only briefly. Maybe that was wrong of me; maybe I was missing a chance to be friendly and open with this person while waiting for some other, imaginary person who never turned up. I noticed my rigidity about following the rules, as well as my judgments about those who weren’t.

As for myself, I initially focused on just sitting there in a relaxed manner, but that resulted in no engagement with any passerby whatsoever, so I started making eye contact, and then saying “Hello” and sometimes waving hello. These behaviors did result in eye contact with several people, and in some saying “Hello” back. I felt that calling, “Hey! Come and sit down!” would not be quite in the spirit of the thing, but maybe if I volunteer with Sidewalk Talk again, I will try that.

One powerful experience related to Sidewalk Talk came after I watched the training videos but before I actually went out to volunteer. I was at the grocery store, going through the line of a person whose line I have gone through many times—she doesn’t seem to be particularly friendly, but she always gets my bag discounts right, so I like her. On this day, taking an extra moment to observe her, I noticed for the first time that she has a tattoo on one arm: BLACK SABBATH.

“Are you a metalhead or just Sabbath?” I asked. Her face lit up as she assured me, “Just Sabbath,” and then went on to discuss when the term “metalhead” came into use. I didn’t need to look soulfully into her eyes and ask nosy questions to try to get her to tell me how she was feeling. All I had to do was to notice one small thing about her and remark on it for an alive sense of connection to spring up.

The way I got hung up on how my fellow volunteers were doing it “wrong” can definitely occur in other contexts. Getting to see this dynamic play out so clearly in a condensed time frame may help me to remember that this is not a helpful way for me to act at work, at my volunteer job, or anywhere else.

The next day I worked, I got a request from a fellow chaplain to see a patient who was facing an unwanted pregnancy termination. My colleague said she didn’t “get far” with this patient; that the patient spent the entire long visit complaining angrily about one thing or another. My colleague concluded that this patient had no spiritual or religious beliefs, and no support system. I too found the patient initially in a suspicious mood, but when she learned I am a chaplain, she invited me to pull up a chair (which told me that the other chaplain had gotten farther than she thought). I sat down for what I thought would be an experience similar to my colleague’s. Remembering what I had learned in the Sidewalk Talk training, when I felt tempted to ask a question, I reminded myself that listening for data divides us, and to listen for essence.

The patient shared that she is, in fact, the adherent of a particular religion, that she has a couple of people she can absolutely rely on, and that she was very sad about losing her child—she cried several times as she spoke—but that she also had a deep understanding that things were unfolding as they must. She had made detailed plans for how she would honor this child who was never to be born. It was a powerful and emotional visit—I cried, too—and for that I can thank Sidewalk Talk. It’s great that what seemed like a failed excursion ended up having such beneficial results.