Proceed with Care

Holy moly, what a day! And it’s not even 3 p.m. yet.

I did not succeed in getting to bed on time last night, but it was only two hours later than planned rather than four. I was, as is customary these days, awakened this morning by a phone call from a guy who fixes or installs things, but he was just calling to say he planned to come in the afternoon, as they had “a lot of metal to make” for the air conditioner.

Accordingly, I was already awake and dressed when the drywall guy came, the one recommended just yesterday by our prospective painter. (“Our” referring to me and my sister.)

This young man was one of those people who is interested in everything and who can fix or build everything. On top of that, he delivered a pithy and inspiring sermon about losing his mother—how he prayed that she would live, but when she didn’t, he did not lose his faith in God. He accepted that not everything that happens is going to be good. Terrible things happen, too. It is not the work of Satan if something bad happens, and it also doesn’t mean the cosmic vending machine is broken. You can put your quarter in and push the button for the thing you want, but you may or may not get it. All things, good and bad, happen in God’s world / in the universe / under the sun. That’s what I believe, and so does my drywall guy, so that should pretty much settle that.

He also spoke about doing what you can to help others—not just sending them good wishes, but physically doing what needs to be done. In the realm of very practical assistance, he pointed out a wasps’ nest right outside the front door that no one else had spotted, even though it’s right there. It had four vertical tubes. I asked John what a person is supposed to do about that and he said to scrape it off the wall before it gets warm, so I used a trowel of my father’s from a bucket full of his gardening tools that has been sitting on the dining room floor just like that for years now to remove the wasps’ nest. The material was surprisingly hard. Yellow larvae ended up on the ground. John said to sweep them under the nearest bush, and he came out with a blower to do a final tidying up of the area outside the front door. He also shop-vacced out the fireplace!

In the late morning, I met with my Zen teacher, Joshin. We talk via Zoom every couple of months or so. I told him I was still wrestling with my decision. He asked what my understanding is in a dharma context. I said I understand that things are going—not the way they are supposed to: They are going the way they are going, without a doubt. I said I know trying to think my way to the answer is not helpful, especially as the goal I’m trying to think my way to doesn’t even exist (permanent happiness for an imaginary person).

Joshin spoke about something he is wrestling with which also entails trying to figure out what will happen in the future to a person of great importance to him, and finding himself worrying about things going wrong. The worry can lead to panic, and then the panicked feeling adversely affects what is happening right now.

He reminds himself to pause and recognize what condition of mind has arisen. He practices compassion for self. He sees that what he is trying to do is an expression of caring for his loved one, but is it actually helpful?

In regard to my decision, he offered a question for reflection: “What’s leading me?” On a splendid clear day like today, it is easy to answer that: The beauty and the peace of this place. My nervous system feels great here.

While we may rightly use our wisdom to anticipate the likely outcome of a decision, Joshin said, our task is to “attend to what’s happening now with a high degree of care.” He said that the Buddha’s last words were, “Proceed with care.”

He asked if I am familiar with a certain practice. I said, “Given that I’m going to have to ask you what that word means, I would say not.” He told me a bit more about it, and I remembered that he had mentioned this in an earlier conversation. I told him I had gotten the book he recommended; I can picture it on my shelf in San Francisco sitting there quietly waiting for something to happen. The practice is lojong. Joshin explained to me how to proceed. We’ll get back to that.

(From Wikipedia: Lojong is a contemplative practice in the Tibetan Buddhist tradition which makes use of various lists of aphorisms or slogans which are used for contemplative practice. The practice involves refining and purifying one's motivations and attitudes.)

The word itself appears to mean “mind training.”

A couple of hours later, I met with a friend of a friend who is the manager of spiritual care in two hospitals in a large hospital system in southeastern Michigan. We spoke for half an hour over Zoom. He said hospital chaplain jobs are not that easy to come by, as people understandably do not give them up. He said my best bets in my immediate area are the University of Michigan and, um, another hospital.

The latter is where my father went to the emergency room four years ago yesterday and where he then spent three weeks as an inpatient. My mother later on had a terrible experience there. Or she would have if she’d been awake. She managed to sleep for about 27 straight hours in that same emergency room. I had a terrible experience there, awake for nearly all those same hours, sitting overnight on a straight-backed chair next to my mother.

Just before she went on hospice, my mother was in the emergency room three times in a row, twice at the University of Michigan and once at the other hospital. Things were considerably better at the University of Michigan. Her stays there were much shorter, they did much more testing, and I didn’t have to throw a giant tantrum to get her discharged. The tantrum I threw at the other place, which caused the entire emergency department suddenly to fall silent and all the other patients in the vicinity to be quickly wheeled away from the person having the loud psychotic break was one of the finest acts of my entire life, and dazzlingly effective at achieving the desired results.

While my father was on hospice for almost exactly six months—hospice care is offered to those whose life expectancy is judged to be six months or less, though the average length of hospice care is much shorter—my mother somehow managed to be on hospice for two years. We aren’t Medicare fraudsters, and wouldn’t have done anything shady to prolong this excellent care, which was in danger of being lost only twice.

At some point, residing in memory care, my mother got a new hospice nurse (she had four of them, all told; my father had two) who immediately sniffed that she didn’t see why my mother was even on hospice. While recertification occurs at pre-established intervals, it is also the case that any time a hospice nurse judges that his or her patient no longer qualifies for this care, he or she is supposed to start discharge procedures immediately.

However, this nurse couldn’t possibly have done a thorough review in the very short period before she offered this opinion, and she also went around sharing this view with the caregivers who worked in memory care. When I heard about this, I was enraged, and called the hospice and requested a different nurse, who soon turned up and was with my mother through the end of her life.

The other time my mother almost stopped being a hospice patient, her nurse had reasonably made that determination and said that the final step would be a video call with the doctor. I never met this doctor in person; by all accounts, he is wonderful. I could also see, from his photos, that he is a handsome fellow, so I concluded that it would be good if I also attended this meeting.

Well, in the meeting, my mother suddenly and completely decompensated. She suddenly became unable to speak and began babbling unintelligibly. (For good measure, an hour or so after this meeting, she also fell; she was not injured.) The doctor said, hmm, maybe we’d better pause this process, and she ended up being recertified.

After my talk with the spiritual care hiring manager today, I concluded that if I see a .4 job in the Metro Detroit area, I’d better go ahead and apply for it. Having a freeway commute is not ideal, but working in a hospital is the best thing there is.

I also remembered where this whole thing began, in about 2011, which was that I was a hospice volunteer. I can be a hospice volunteer again! I can live a simple life and volunteer at a hospice or retirement community one afternoon a week, and volunteer teaching children to read another afternoon each week, for balance. Maybe the latter in Detroit.