(Click photo to enlarge.)
Wednesday, September 27, 2017
Threshold
I visited a patient in mid-August who was being transitioned to comfort care. He was lying quietly in bed, eyes open just a little. I spoke to him out loud, offering good wishes. He looked terrible, which I discovered later was because he had died 20 minutes before I arrived. (Not all dead people look terrible. It varies tremendously. Some look serene and lovely.)
One of my colleagues mentioned that it was his habit to take a look at the list of patients near the nursing station for his unit each morning to see which ones were being discharged that day, and then not to visit any of those patients unless he absolutely ran out of every other kind of patient. This is a very good idea I wish I’d encountered about 12 months earlier. As he accurately said, all such patients say, “I’m happy! I’m going home today!” None of them says, “I’m going home today! I feel horrible. Can you sit down and talk to me?”
Sometimes a patient’s name is replaced in the electronic health record system with a row of asterisks. This might be because the patient is a celebrity (I encountered one this year), or a forensic patient, with armed guards outside his room (so far these have all been men). Or the patient might be a victim of partner violence who doesn’t want the hospital operator to tell callers she is in the hospital. I have also discovered that it can indicate someone who was formerly in the psychiatric institute. The names of all patients currently at the psychiatric institute are so obscured, but even after the patient has left there and is on some other unit for an unrelated reason, his or her name may be concealed. I’ll bet that’s because they make that change when someone becomes a psychiatric patient and then forget to unmake it. The asterisks are also used when an employee of the hospital becomes a patient.
At the very end of the month, the person who had been on call the night before was fried, so I took the pagers and got slammed—page after page after page, including a request for a chaplain to facilitate a viewing, which can take an hour or two, and, for the first time in my experience, a Code Blue at the campus where they do day surgeries. Naturally that happened on a day when we were down to four people. Fortunately, Jodie took over and determined that the crisis had passed and that no one needed to take a cab over there.
On top of all of that, there was a request for a chaplain to attend a family meeting. By then, it was 2 p.m. and I had turned the pagers over to a peer, so I volunteered to go. Just as I approached the conference room, the door swung open and two physicians said, “Perfect timing,” as they walked past me and vanished. (“That was not very good interpersonal team communication,” Jodie said later.)
I went into the conference room and discovered I was the only care team member present, with 19 family members and friends of a patient who had gotten several pieces of bad news. I recalled watching another supervisor lead a debriefing and drew upon what she had done. I asked people to share their thoughts and feelings, and I observed that there was a lot of sorrow in the room. After a few people spoke and it fell silent, I asked about the hopes they had had for the patient, and people said a few things about that. One woman said she felt guilty for leaving the patient too soon one recent day. Another comforted her, saying it would have come out the same whether she stayed or left. A young family member wasn’t so sure: “How can we know?”
Then a family member politely said they would like to be by themselves, and that they had their pastor with them. I said I would be happy to go, and asked them to point out their pastor. I thanked him for being there, and said one thing that made me happy was that they were all there together.
After that, I went to see one of my current favorite patients, a homeless man, and to say goodbye to my other favorite, finally off to rehab after two serious injuries and several weeks in the hospital. Days earlier, I had given the latter a piece of polished rose quartz “with the hope that all of you will always be seen and cared for.” That day, a nurse asked, “Did you give my patient a stone?” I admitted it, and he said, “Very cool!”
I also saw a man who had gotten in a life-changing accident; he was described by his nurse as being despondent. I didn’t find him to be despondent at all. He seemed quite angry, but also was admirably philosophical, saying that the accident had put things in perspective for him, and that it could have been worse, and that he was now thinking about how he actually wants to spend his time. People are remarkable.
Late in the month, I had my second-to-last on-call shift, starting on a Saturday afternoon. One thing that happened during that shift, besides my getting 10 hours of sleep—I’m pretty much convinced now that the same people who can’t or don’t get enough sleep when they’re not on call tend to not get enough sleep when they are on call, and that those who get enough sleep when they’re not on call can usually find a way to do the same while on call—was that I was sitting in front of a computer charting when there was a flash and all the computers froze, the phones went dead, and my badge suddenly no longer worked.
A nurse came onto the unit and reported that she had just been on an elevator that had gone into freefall, though it didn’t fall very far. Another nurse said he had had the same experience in the past, but, far worse, that a few years ago, a doctor was standing in the doorway of an elevator chatting when the elevator suddenly lurched and crushed him to death. One of my peers said it’s a good thing we didn’t find that out earlier in the year. I agreed: “We would all have thighs like tree trunks by now,” from taking the stairs. The lesson I took from that is to be either in the elevator or not in the elevator, but not to linger at the threshold.
One of my colleagues mentioned that it was his habit to take a look at the list of patients near the nursing station for his unit each morning to see which ones were being discharged that day, and then not to visit any of those patients unless he absolutely ran out of every other kind of patient. This is a very good idea I wish I’d encountered about 12 months earlier. As he accurately said, all such patients say, “I’m happy! I’m going home today!” None of them says, “I’m going home today! I feel horrible. Can you sit down and talk to me?”
Sometimes a patient’s name is replaced in the electronic health record system with a row of asterisks. This might be because the patient is a celebrity (I encountered one this year), or a forensic patient, with armed guards outside his room (so far these have all been men). Or the patient might be a victim of partner violence who doesn’t want the hospital operator to tell callers she is in the hospital. I have also discovered that it can indicate someone who was formerly in the psychiatric institute. The names of all patients currently at the psychiatric institute are so obscured, but even after the patient has left there and is on some other unit for an unrelated reason, his or her name may be concealed. I’ll bet that’s because they make that change when someone becomes a psychiatric patient and then forget to unmake it. The asterisks are also used when an employee of the hospital becomes a patient.
At the very end of the month, the person who had been on call the night before was fried, so I took the pagers and got slammed—page after page after page, including a request for a chaplain to facilitate a viewing, which can take an hour or two, and, for the first time in my experience, a Code Blue at the campus where they do day surgeries. Naturally that happened on a day when we were down to four people. Fortunately, Jodie took over and determined that the crisis had passed and that no one needed to take a cab over there.
On top of all of that, there was a request for a chaplain to attend a family meeting. By then, it was 2 p.m. and I had turned the pagers over to a peer, so I volunteered to go. Just as I approached the conference room, the door swung open and two physicians said, “Perfect timing,” as they walked past me and vanished. (“That was not very good interpersonal team communication,” Jodie said later.)
I went into the conference room and discovered I was the only care team member present, with 19 family members and friends of a patient who had gotten several pieces of bad news. I recalled watching another supervisor lead a debriefing and drew upon what she had done. I asked people to share their thoughts and feelings, and I observed that there was a lot of sorrow in the room. After a few people spoke and it fell silent, I asked about the hopes they had had for the patient, and people said a few things about that. One woman said she felt guilty for leaving the patient too soon one recent day. Another comforted her, saying it would have come out the same whether she stayed or left. A young family member wasn’t so sure: “How can we know?”
Then a family member politely said they would like to be by themselves, and that they had their pastor with them. I said I would be happy to go, and asked them to point out their pastor. I thanked him for being there, and said one thing that made me happy was that they were all there together.
After that, I went to see one of my current favorite patients, a homeless man, and to say goodbye to my other favorite, finally off to rehab after two serious injuries and several weeks in the hospital. Days earlier, I had given the latter a piece of polished rose quartz “with the hope that all of you will always be seen and cared for.” That day, a nurse asked, “Did you give my patient a stone?” I admitted it, and he said, “Very cool!”
I also saw a man who had gotten in a life-changing accident; he was described by his nurse as being despondent. I didn’t find him to be despondent at all. He seemed quite angry, but also was admirably philosophical, saying that the accident had put things in perspective for him, and that it could have been worse, and that he was now thinking about how he actually wants to spend his time. People are remarkable.
Late in the month, I had my second-to-last on-call shift, starting on a Saturday afternoon. One thing that happened during that shift, besides my getting 10 hours of sleep—I’m pretty much convinced now that the same people who can’t or don’t get enough sleep when they’re not on call tend to not get enough sleep when they are on call, and that those who get enough sleep when they’re not on call can usually find a way to do the same while on call—was that I was sitting in front of a computer charting when there was a flash and all the computers froze, the phones went dead, and my badge suddenly no longer worked.
A nurse came onto the unit and reported that she had just been on an elevator that had gone into freefall, though it didn’t fall very far. Another nurse said he had had the same experience in the past, but, far worse, that a few years ago, a doctor was standing in the doorway of an elevator chatting when the elevator suddenly lurched and crushed him to death. One of my peers said it’s a good thing we didn’t find that out earlier in the year. I agreed: “We would all have thighs like tree trunks by now,” from taking the stairs. The lesson I took from that is to be either in the elevator or not in the elevator, but not to linger at the threshold.
Duke Energy Center
This is in Charlotte, NC, where I went while working for my ex-employer.
(Click photo to enlarge.)
SBD
After graduation, five weeks of the program remained, which we spent seeing patients and training our replacements.
During those weeks, I applied for health insurance through Covered California, which was harder than I thought it would be. Fortunately, there are actual human beings who are willing to stay on the phone with you for the entire process, which in my case was more than an hour. There were some ins and outs I would never have figured out on my own that had a big effect on how much my monthly premiums will be: $1.35 versus $600. (It turned out that the correct thing to do was to say that I didn’t have health insurance and that my health insurance would be ending on such-and-such date in September, only one of which was true.)
I estimated that I will have “medium” use of doctors and other health services, and “low” use of prescriptions, but I asked my helper what would happen if I was diagnosed with a horrible kind of cancer or got in a car accident two weeks after selecting my health plan. She said I would be SOL: that you get the care your plan provides and no more. When the next open enrollment period comes along, you can choose a different plan, and if you’re still alive at that point, then you can have your cancer treated.
Accordingly, I hit the back button a few times to estimate that I will have “high” use of doctors, and found that I could still choose the exact same plan at the exact same cost, so I went back yet again to see what would happen if I have “very high” use of services, and again nothing changed, so I am Kaiser’s newest member, and a very happy one. (At least, I was very happy until I realized that I have to spend $6300 before they start covering much of anything. Now I’m mildly happy.)
Once this was finally done, I realized that needing to apply for my own health insurance had been a minor source of worry ever since I learned I was losing my job, which was in January of 2016. Being done with this application and knowing that I would have health insurance after my internship ended was a huge relief.
Somewhere along in here, I decided to pursue interventional radiology for Hammett—radiation treatment for his hyperthyroidism, which is 95 percent effective. This happens at UC Davis and would have cost about $2500, but I figured it would rather quickly pay for itself in labwork and visits to the vet that wouldn’t need to happen, and medication that wouldn’t need to be purchased. Plus, instead of paying his cat sitter $30 a day, I could ask one of my neighbors to feed him when I’m away, since there wouldn’t be the need to administer medication, if all went well.
In the end, I decided not to do this, because an elevated thyroid can mask kidney problems, and therefore can actually be a treatment option when the cat develops kidney issues. If radiation has been used to set the cat’s thyroid permanently at a certain level, that option disappears.
One of our assignments in the final weeks of the program was to update the information sheets we were given for our hospital units last September, or write new ones as needed. This forced me to read the sheet for my main unit, which caused me to discover that there is a daily interdisciplinary rounds meeting! At a time when I could attend! So I went to it for the very first and very last time in mid-August.
I confessed this to Jodie, who said, “You hadn’t read it?” I told her it was extremely long (like possibly more than four pages—I’m the Donald Trump of chaplains) and she said that’s because the person who originally wrote it was a CPE student from a few years ago who was a Ph.D. who didn’t like to visit patients very much but loved to do research. She told me to feel free to edit as I saw fit, so it is now less than two pages of extremely interesting information.
Last year, I was oriented by two different chaplains. I can’t remember anything about one of them or what she showed me except that she didn’t seem very friendly, which I found surprising. As for the other, I seem to recall that we spent less than half an hour together, but that struck me as more than enough, due to his frequent bursts of foul-smelling flatulence. Maybe he had chosen his breakfast and lunch unwisely on that particular day, but I remember thinking that if this was the norm for him, his unit was probably pretty happy that his year with them was finally ending.
During those weeks, I applied for health insurance through Covered California, which was harder than I thought it would be. Fortunately, there are actual human beings who are willing to stay on the phone with you for the entire process, which in my case was more than an hour. There were some ins and outs I would never have figured out on my own that had a big effect on how much my monthly premiums will be: $1.35 versus $600. (It turned out that the correct thing to do was to say that I didn’t have health insurance and that my health insurance would be ending on such-and-such date in September, only one of which was true.)
I estimated that I will have “medium” use of doctors and other health services, and “low” use of prescriptions, but I asked my helper what would happen if I was diagnosed with a horrible kind of cancer or got in a car accident two weeks after selecting my health plan. She said I would be SOL: that you get the care your plan provides and no more. When the next open enrollment period comes along, you can choose a different plan, and if you’re still alive at that point, then you can have your cancer treated.
Accordingly, I hit the back button a few times to estimate that I will have “high” use of doctors, and found that I could still choose the exact same plan at the exact same cost, so I went back yet again to see what would happen if I have “very high” use of services, and again nothing changed, so I am Kaiser’s newest member, and a very happy one. (At least, I was very happy until I realized that I have to spend $6300 before they start covering much of anything. Now I’m mildly happy.)
Once this was finally done, I realized that needing to apply for my own health insurance had been a minor source of worry ever since I learned I was losing my job, which was in January of 2016. Being done with this application and knowing that I would have health insurance after my internship ended was a huge relief.
Somewhere along in here, I decided to pursue interventional radiology for Hammett—radiation treatment for his hyperthyroidism, which is 95 percent effective. This happens at UC Davis and would have cost about $2500, but I figured it would rather quickly pay for itself in labwork and visits to the vet that wouldn’t need to happen, and medication that wouldn’t need to be purchased. Plus, instead of paying his cat sitter $30 a day, I could ask one of my neighbors to feed him when I’m away, since there wouldn’t be the need to administer medication, if all went well.
In the end, I decided not to do this, because an elevated thyroid can mask kidney problems, and therefore can actually be a treatment option when the cat develops kidney issues. If radiation has been used to set the cat’s thyroid permanently at a certain level, that option disappears.
One of our assignments in the final weeks of the program was to update the information sheets we were given for our hospital units last September, or write new ones as needed. This forced me to read the sheet for my main unit, which caused me to discover that there is a daily interdisciplinary rounds meeting! At a time when I could attend! So I went to it for the very first and very last time in mid-August.
I confessed this to Jodie, who said, “You hadn’t read it?” I told her it was extremely long (like possibly more than four pages—I’m the Donald Trump of chaplains) and she said that’s because the person who originally wrote it was a CPE student from a few years ago who was a Ph.D. who didn’t like to visit patients very much but loved to do research. She told me to feel free to edit as I saw fit, so it is now less than two pages of extremely interesting information.
Last year, I was oriented by two different chaplains. I can’t remember anything about one of them or what she showed me except that she didn’t seem very friendly, which I found surprising. As for the other, I seem to recall that we spent less than half an hour together, but that struck me as more than enough, due to his frequent bursts of foul-smelling flatulence. Maybe he had chosen his breakfast and lunch unwisely on that particular day, but I remember thinking that if this was the norm for him, his unit was probably pretty happy that his year with them was finally ending.
Hurt Toe
I thought the statues outside the new County Hospital were kind of stupid looking the first time I saw them, but this little guy has grown on me.
(Click photo to enlarge.)
Graduation Day
On August 10, my 13 peers and I graduated from the yearlong clinical pastoral education program at the Truly Wonderful Medical Center. The day started with Anita treating the five of us in her group to breakfast at Park Chow. We asked our server to take a photo of us and she pointed out that the three people on one side of the table were all wearing white shirts and the three on the other side were all wearing light blue shirts.
Back at work, I shined my shoes and checked my email and hung out in the student office until it was time to do an exit interview with members of the professional advisory group, an opportunity to give feedback about the program anonymously; none of our supervisors were present.
After that, I went outside to wait for my guests. I had not asked most people to RSVP, thinking it would be nice to be surprised, with the exception of Charlie, whom I pestered relentlessly about it. I really, really wanted him there, because he played a large part in my journey toward CPE. When Carlos was dying, he picked me up every single night at the hospital at the end of visiting hours so I could stay as late as possible and not have to then wait for the bus in that not-very-good neighborhood. The night Carlos died, he got out of bed at 1 in the morning to come and drive me home.
Consequently, I decided to do the two days of volunteer work my ex-employer paid us for at his soup kitchen. I fell in love with it the very first day and became a regular. Wanting to bring everything I could to the soup kitchen’s guests, I did the yearlong chaplaincy program at the Sati Center for Buddhist Studies. There I became totally inspired and vowed that if my employer laid me off, I was going to become a hospital chaplain.
They kept their part of the bargain, and I am keeping mine.
So it was crucial that Charlie be at my graduation, and he was, elegantly attired in a black sweatshirt—not the shredded, stained one of indeterminate color that he normally favors, though it would have been perfectly fine if he’d worn that one.
Along with him, seven other friends came, including two who had very good reasons—serious illness and very recent bereavement—not to. I felt extremely loved and supported. Ann came all the way from Sacramento with her friend Jill, and Tom came. He took the ferry over to Larkspur to help Ann and Jill with the final leg of the trip into the city, which is really going above and beyond. I have the best friends.
Sarah, the manager of the spiritual care department, spoke at the beginning of the ceremony, explaining what we went through this past year, and what we achieved. She estimates that we, collectively, had 68,840 interactions with patients, their family members and staff.
One of our supervisors had made a wonderful slide show covering the whole year: students having fun at a petting zoo, students cracking up while rowing a boat, students wearing enormous joke sunglasses, a student collapsed from exhaustion on the floor of the office. It was really fun to see all of these photos, and to see how much joy there was along with the immense amount of physical and emotional work. This slide show was right up to the minute, too: there we were at Park Chow that very morning, three of us in white and three in pale blue.
Then there were musical presentations by fellow students, and one of our supervisors recited a poem, and then each supervisor handed out certificates to her own students. I received mine from Anita, who said she wanted to recognize my wit and humor, my professionalism, and my fairness, even when there is a cost to myself.
Then the director of the spiritual care department came to the front to recognize some of our supervisors. This year, three special awards for students were inaugurated and presented by our director, and I got one of them, the Award for Integration: “recognizing and affirming your persistence and creativity in nurturing and developing both your head and your heart as effective and reliable instruments of spiritual caregiving and thereby distinguishing yourself in fulfillment of the ACPE Outcomes.”
After our very esteemed leader gave out these special awards, he had to leave. As he made his way up the stairs, we stood in his honor. Then we graduates were offered a Ritual of Handwashing. I was in tears as Sarah dried my hands, emotions overflowing. There was a non-denominational prayer at the end, and then we had a giant feast.
It was an absolutely perfect day.
I did it. I did it.
Back at work, I shined my shoes and checked my email and hung out in the student office until it was time to do an exit interview with members of the professional advisory group, an opportunity to give feedback about the program anonymously; none of our supervisors were present.
After that, I went outside to wait for my guests. I had not asked most people to RSVP, thinking it would be nice to be surprised, with the exception of Charlie, whom I pestered relentlessly about it. I really, really wanted him there, because he played a large part in my journey toward CPE. When Carlos was dying, he picked me up every single night at the hospital at the end of visiting hours so I could stay as late as possible and not have to then wait for the bus in that not-very-good neighborhood. The night Carlos died, he got out of bed at 1 in the morning to come and drive me home.
Consequently, I decided to do the two days of volunteer work my ex-employer paid us for at his soup kitchen. I fell in love with it the very first day and became a regular. Wanting to bring everything I could to the soup kitchen’s guests, I did the yearlong chaplaincy program at the Sati Center for Buddhist Studies. There I became totally inspired and vowed that if my employer laid me off, I was going to become a hospital chaplain.
They kept their part of the bargain, and I am keeping mine.
So it was crucial that Charlie be at my graduation, and he was, elegantly attired in a black sweatshirt—not the shredded, stained one of indeterminate color that he normally favors, though it would have been perfectly fine if he’d worn that one.
Along with him, seven other friends came, including two who had very good reasons—serious illness and very recent bereavement—not to. I felt extremely loved and supported. Ann came all the way from Sacramento with her friend Jill, and Tom came. He took the ferry over to Larkspur to help Ann and Jill with the final leg of the trip into the city, which is really going above and beyond. I have the best friends.
Sarah, the manager of the spiritual care department, spoke at the beginning of the ceremony, explaining what we went through this past year, and what we achieved. She estimates that we, collectively, had 68,840 interactions with patients, their family members and staff.
One of our supervisors had made a wonderful slide show covering the whole year: students having fun at a petting zoo, students cracking up while rowing a boat, students wearing enormous joke sunglasses, a student collapsed from exhaustion on the floor of the office. It was really fun to see all of these photos, and to see how much joy there was along with the immense amount of physical and emotional work. This slide show was right up to the minute, too: there we were at Park Chow that very morning, three of us in white and three in pale blue.
Then there were musical presentations by fellow students, and one of our supervisors recited a poem, and then each supervisor handed out certificates to her own students. I received mine from Anita, who said she wanted to recognize my wit and humor, my professionalism, and my fairness, even when there is a cost to myself.
Then the director of the spiritual care department came to the front to recognize some of our supervisors. This year, three special awards for students were inaugurated and presented by our director, and I got one of them, the Award for Integration: “recognizing and affirming your persistence and creativity in nurturing and developing both your head and your heart as effective and reliable instruments of spiritual caregiving and thereby distinguishing yourself in fulfillment of the ACPE Outcomes.”
After our very esteemed leader gave out these special awards, he had to leave. As he made his way up the stairs, we stood in his honor. Then we graduates were offered a Ritual of Handwashing. I was in tears as Sarah dried my hands, emotions overflowing. There was a non-denominational prayer at the end, and then we had a giant feast.
It was an absolutely perfect day.
I did it. I did it.
Perfect Conditions
One day in August, Anita and I did our final joint visits together. I chose a man I had seen twice before and we had a fairly short visit, ten minutes or less. Afterward Anita said she liked how I inquired into his experience without directly asking, “How do you feel about that?” She liked that I asked to sit down and that I incorporated his own words into my prayer for him at the end of the visit, and she also liked that I announced in advance that we would be leaving—often patients wait until you say you are leaving to announce what’s really on their minds, so giving advance notice might invite those things into the conversation while there’s still a little time to talk about them.
One of the verbatims I presented earlier in the final unit was about a visit that was nearly an hour long. Right after I said I was leaving, the patient mentioned hospice. Ugh. So then it appeared that I had abandoned someone who was ready to talk about something very important. I received the suggestion to say, “I’ll need to go in five or ten minutes,” so I now do that often, including in the visit Anita observed.
The one thing she thought I could have done better was to ask the patient to turn off the TV, or turn the volume off. I have mixed feelings about that. One day not long ago, I saw a patient one of my peers has led in meditation several times. I asked him what she normally does when she guides him in meditation. He said, “She makes me turn off the TV, and then she pulls down the shades, and she closes the door and pulls the curtain.” Wow! I did all of that, and he turned off the TV, and it was indeed very serene, so I will remember that, but I also think that we need practices that work in less-than-ideal as well as completely crappy circumstances. I don’t mind if someone has the TV on while we talk. If the person gets completely absorbed in what’s on TV, I can ask if I should come back another time. However, having the TV volume off—which many patients do of their own accord—is nice and might change the flavor of the conversation, so I will keep that in mind, too.
One of the verbatims I presented earlier in the final unit was about a visit that was nearly an hour long. Right after I said I was leaving, the patient mentioned hospice. Ugh. So then it appeared that I had abandoned someone who was ready to talk about something very important. I received the suggestion to say, “I’ll need to go in five or ten minutes,” so I now do that often, including in the visit Anita observed.
The one thing she thought I could have done better was to ask the patient to turn off the TV, or turn the volume off. I have mixed feelings about that. One day not long ago, I saw a patient one of my peers has led in meditation several times. I asked him what she normally does when she guides him in meditation. He said, “She makes me turn off the TV, and then she pulls down the shades, and she closes the door and pulls the curtain.” Wow! I did all of that, and he turned off the TV, and it was indeed very serene, so I will remember that, but I also think that we need practices that work in less-than-ideal as well as completely crappy circumstances. I don’t mind if someone has the TV on while we talk. If the person gets completely absorbed in what’s on TV, I can ask if I should come back another time. However, having the TV volume off—which many patients do of their own accord—is nice and might change the flavor of the conversation, so I will keep that in mind, too.
In the Brain, Pain Is Pain
Early in August, my group presented our final self-evaluations. Since I had a lot of money left on my meal card, I treated us all to lunch from Publico, a wonderful taqueria on Gene Friend Way. They have a remarkable fish and chips burrito, and I also really like their vegetarian burrito, with chipotle crema added. Their French fries are superb.
That week at the palliative care team meeting, someone shared about a patient’s intractable pain. She listed all the medications that had been tried, along with acupuncture. She asked for help from the group, and I briefly described a few ways of using meditation to address pain. The woman jokingly asked if I was available to see the patient that day.
One of the things I mentioned was to do a body scan, guiding the patient in moving her attention from her feet to the top of her head, to help her inhabit all of her body, not just the part that hurts. I also suggested asking the person to focus on the very worst part of the pain and then to move her attention gradually away from the epicenter, until she arrives at a part of her body that doesn’t hurt at all. My final suggestion was drawn from Somatic Experiencing: to ask the patient to focus on the pain, and then on a part of her body that is completely free of pain, and then, on her own schedule, to shift her attention back and forth between these areas. Like the first two methods, this reminds the person that there are parts of her body that don’t hurt, and also keeps the nervous system from getting stuck in pain-resistance mode. Pain is unpleasant without a doubt, but resistance to it can make it much worse.
An interesting thing I learned around that time is that the brain does not have different pathways for physical, psychological, emotional or spiritual pain: pain is pain. Therefore, addressing any of these kinds of pain can lessen the overall intensity of the pain.
Early in August I saw a young patient several times that a number of chaplains saw; all of us liked her. Earlier in the year, we had a didactic where we learned that a wounded person always also has a healer built in. I could really see that in what this patient had to say on one day. I told her that I could hear her clarity about her immense difficulties and I could also hear her wisdom.
I noticed in her chart that other chaplains had tried various techniques with her: breathing in this or that way, thinking of things to be grateful for. In my longest visit with her, I focused on taking in what she was saying, and a very interesting, subtle thing happened. She would say, “I have such-and-such lousy experience every day during physical therapy.” I would imagine what that would be like as I looked back at her, and then I would see a little shift in her eyes, which to me looked like what is true being seen and accepted. That is, I would think, “This is what is happening for this person,” and then it was almost like she was seeing and accepting the same truth: “Yes, this is what is happening.” This happened three or four times in the course of our hour-long visit. I also pointed this out to her as a way of affirming indirectly that she had the capacity to be with what was happening. In that visit, I noticed that she was moving organically through an emotional landscape, with anxiety, sorrow, joy and hope appearing at different moments. When I left, she said she felt better.
In our final couple of visits, I decided that I wasn’t doing enough stuff relative to what other chaplains were doing, and I found myself throwing a laundry list of techniques at her: think of it this way, use this mantra, let’s do a guided meditation. The result was that, for the entire duration of both visits, she was stuck in anxiety, and the connection between us seemed to go flat. It was much better when I just listened and did my best to imagine what things were like for her.
That week at the palliative care team meeting, someone shared about a patient’s intractable pain. She listed all the medications that had been tried, along with acupuncture. She asked for help from the group, and I briefly described a few ways of using meditation to address pain. The woman jokingly asked if I was available to see the patient that day.
One of the things I mentioned was to do a body scan, guiding the patient in moving her attention from her feet to the top of her head, to help her inhabit all of her body, not just the part that hurts. I also suggested asking the person to focus on the very worst part of the pain and then to move her attention gradually away from the epicenter, until she arrives at a part of her body that doesn’t hurt at all. My final suggestion was drawn from Somatic Experiencing: to ask the patient to focus on the pain, and then on a part of her body that is completely free of pain, and then, on her own schedule, to shift her attention back and forth between these areas. Like the first two methods, this reminds the person that there are parts of her body that don’t hurt, and also keeps the nervous system from getting stuck in pain-resistance mode. Pain is unpleasant without a doubt, but resistance to it can make it much worse.
An interesting thing I learned around that time is that the brain does not have different pathways for physical, psychological, emotional or spiritual pain: pain is pain. Therefore, addressing any of these kinds of pain can lessen the overall intensity of the pain.
Early in August I saw a young patient several times that a number of chaplains saw; all of us liked her. Earlier in the year, we had a didactic where we learned that a wounded person always also has a healer built in. I could really see that in what this patient had to say on one day. I told her that I could hear her clarity about her immense difficulties and I could also hear her wisdom.
I noticed in her chart that other chaplains had tried various techniques with her: breathing in this or that way, thinking of things to be grateful for. In my longest visit with her, I focused on taking in what she was saying, and a very interesting, subtle thing happened. She would say, “I have such-and-such lousy experience every day during physical therapy.” I would imagine what that would be like as I looked back at her, and then I would see a little shift in her eyes, which to me looked like what is true being seen and accepted. That is, I would think, “This is what is happening for this person,” and then it was almost like she was seeing and accepting the same truth: “Yes, this is what is happening.” This happened three or four times in the course of our hour-long visit. I also pointed this out to her as a way of affirming indirectly that she had the capacity to be with what was happening. In that visit, I noticed that she was moving organically through an emotional landscape, with anxiety, sorrow, joy and hope appearing at different moments. When I left, she said she felt better.
In our final couple of visits, I decided that I wasn’t doing enough stuff relative to what other chaplains were doing, and I found myself throwing a laundry list of techniques at her: think of it this way, use this mantra, let’s do a guided meditation. The result was that, for the entire duration of both visits, she was stuck in anxiety, and the connection between us seemed to go flat. It was much better when I just listened and did my best to imagine what things were like for her.
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