Unrise (Rather Than Sunrise): September 9, 2020

Here are two photos I took on that day. One is of a lobby in one of the hospitals where I work. It looks like it's night, but it was about 2 p.m. 

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Drumming Class

One day while I was sitting on a unit not my own, a nurse approached and asked, “Are you a chaplain?” She explained that one of her patients was reporting shortness of breath in response to her heart medication, but the RN wondered if the patient was actually having panic attacks associated with the anniversary of the suicide of her daughter. I agreed to visit the patient. Before I finished my charting, a physician came and asked the same thing, and told me the same story about the same patient. She added, “Shortness of breath is not a symptom normally associated with this medication.”
 
I went to see the patient, who was friendly and welcoming. Just as our visit began, her bedside RN gave her a new medication and warned, “This is the last resort.” The patient told me about the difficulty she’d been having with her prior medication and explained that if she had the same problem with this medication, she would have to have surgery.

After we’d been talking for 10 minutes or so, I said, “I understand something terrible happened at this time of year two years ago. I don’t know if you feel like talking about it.” The patient then told me the story of her daughter’s life, becoming tearful several times. Sometimes, as she looked into space, I imagined she was seeing the tiny face of a precious girl decades earlier.

Near the end of our 80-minute visit, I asked who she could talk about her child with and learned that she did not have a confidante. At the conclusion of our time together, during which I mainly just listened (and during which the patient did not experience any shortness of breath—maybe she was able to avoid surgery?), I expressed my sorrow at the loss of her beautiful child, and mused, “I imagine the anniversary has some impact. I don’t know what it would be, but I would think there would be some.”

The patient thought for a moment and said, “Yes, that’s probably right. Maybe I’d better go back to therapy or find a group.”

I reported a bit of this to the patient’s bedside RN, who seemed pleased, and I also felt pleased.

At the end of September, 2020 (a year ago!), I had my first COVID test, not administered in regard to Job One, but as part of onboarding for Job Two. It was pretty unpleasant; a stiff little plastic brush was stuck quite a ways up my nose. The result was negative.

Tom began leading his students in stretching each day via Zoom, which he reported was a popular offering. One day, after the end of stretching class, a loud, very repetitious noise commenced. When I called to ask, “Now what’s happening?”, Tom brightly replied, “Drumming class!” That evening, I called back to say that I had been impressed with his students’ mastery of drumming.

“I’d say they have tested out of drumming and don’t have to practice any more!”

My first day at Job Two arrived. You have to complete a screening each day before going in any building, answering the now-familiar series of questions, but your temperature is never taken, unlike at Job One. The day was chaotic, with calls, pages and electronic requests for spiritual care flowing in. When the next chaplain arrived, I had to turn over about six things I hadn’t been able to get to.

On October 8, 2020 (almost a year ago!), Duckworth and Marvin turned seven months old and I was finally able to find ten minutes to complete their microchip registration online.
 
Several months before the pandemic began, three friends and I had begun to co-facilitate a Buddhist meditation group in the Tenderloin under the auspices of the San Francisco Night Ministry. When the group had to stop meeting per social distancing, we began using that same time of week to check in via Zoom, and at this point, we have become fast friends. Late in October, one of us who lives in both Northern and Southern California came to town and we decided to meet, spread far apart, in the room where our meditation group had been meeting.

When the cab driver dropped me off in front of the building, he said, “Be careful.” Seconds later, a man came up to within about three inches from me and said, “How you doing?”

Seeing my three friends was wonderful and did not prove to be a superspreader event.

Around that time, I met with a committee for board certification as a chaplain (via Zoom), and did not pass. You send in a big pile of stuff, including 31 essays. The idea is that you will demonstrate your competency in each of the 31 areas in writing and/or via your conversation with the committee. I was asked to do more work on six of the competencies, and make a subsequent appearance.

At an orientation session prior to our committee meetings, someone at the national organization told us that if we didn’t pass after our first appearance, we should not take it as a “No” but as a “Not yet,” and she added that people routinely say the additional work they had to do was worth it, so when I got the news, I was perfectly gracious, and I resolved to have a good attitude about the whole thing, although sorrow soon set in: Ugh—I was so looking forward to this process being over.

Have you ever had someone important die and, for moment after waking up in the morning, you don’t remember it, and then you remember it? It’s as if the person has died all over again. This happened with my board certification. The following day I woke up and thought, more or less, “Another beautiful day! Isn’t it wonderful to be alive!” And then: “Oh! I didn’t pass my thing!”

One thing that made me feel better was the utter shock of everyone I told this to, and another was that three of my friends / colleagues also didn’t pass, including one whose MDiv is from a very fancy school and who started his own religious community after graduation. Apparently there was a huge crop of candidates, so there may have been inexperienced committee members, or even people serving for the very first time. Maybe committee members new to this process didn’t want to be the ones to let a psychopath slip through. Also, this was over Zoom, whereas these interviews formerly were always in person, and maybe that made it harder for the committee to get a good sense of the candidate.

In due time, I received my written report from my committee and found some disturbing things in it; for instance, the committee said they weren’t sure about the care I offered a Hmong patient, as written about for such-and-such competency. I looked at my essays and saw that I did not write anything a Hmong patient for that competency, but I did for a different competency—so which one did I not pass? There were three things like that, so I sent a note to the coordinator, and she got in touch with my committee. One of my committee members wrote back, “Well, whichever competency it was, we think such-and-such.” That seemed rather cavalier to me.

I convened a group of three of the four of us who didn’t pass, and invited several chaplains in the pipeline right behind us, so we could share what about our experience we thought might be helpful to each other. I typed up notes from this session and sent them to the CPE educators I am personally acquainted with; they were warmly received.

I started to not feel good about the whole thing, partly based on my own experience, but considerably more so in regard to two of my friends who were explicitly given a hard time for not being Christian. Finally, and somewhat on impulse, as is my custom, I sent a note to the organization saying I was feeling unenthusiastic about continuing with this process—could I maybe speak with someone who could restore my trust in this organization? I ended up having a very helpful conversation with someone who agreed that my committee had been rather flippant. As for understanding which competencies I actually needed to address, she said, “Maybe these are the competencies the universe wants you to work on.” I decided to assume that was the case.

The Great Outdoors (COVID Version)

Ah, beautiful!

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COVID Overview

I can’t remember what I’ve said about this so far, but to recap how COVID affected life at the hospital:

One of the first things that happened was that employees were instructed to use one particular entrance, and visitors to use another. (This made my own process of getting into the building about ten minutes longer.) We began to have to answer a series of questions when arriving, and to have our temperature taken every time we entered the building.

Visitors were restricted. This has ebbed and flowed over the months. At many times, the restrictions have been so stringent that the building has seemed quite empty. This has been a considerable hardship for patients, and is often mentioned by them.

Employees from the beginning have been required to follow social distancing guidelines: staying six feet away from others as possible; frequent hand hygiene; wearing of a mask when not eating; eating preferably done in the cafeteria, where tables have been placed far apart and many chairs removed. There are signs everywhere with instructions about social distancing and PPE usage. Plexiglas appeared here and then there. At times, people were seen carrying buckets around the hospital, wiping down high-touch surfaces.

Chaplains are considered essential employees and have reported to the hospital the whole time, whereas our manager, administrative person and one or two others began working from home in March (of 2020, this is) and have rarely or never been seen since.

At first it seemed there would be no effect on my income, and in fact, there seemed to be a double financial upside in that I was not traveling nor taking days off work in order to travel. However, after a while, the pandemic began to cause budget problems for the hospital, partly because elective and non-urgent procedures were put on hold to leave room for a surge of COVID patients, which to date has not happened in San Francisco, at least not in the hospital where I have been working for the past few years. Many workers have been forced to take time off (this might entail using PTO; I’m not sure, since this does not apply to me, since I am a per diem and do not have PTO), and retirement and early retirement have been encouraged. As mentioned here, I began to have fewer shifts than before, which is what led to my seeking and (fortunately) getting Job Two.

As for our actual work, from the beginning, we have placed new emphasis on staff support. Chaplains do not go in the rooms of COVID patients. If we are called to care for such a patient, it is done by telephone or video. I think this largely to preserve PPE and perhaps to put as few staff members as possible at risk. Because visitors are so restricted, chaplains have been more important than ever when it comes to emotional support of patients. There is sometimes a balancing act, as we try to stay six feet from patients and keep visits as brief as possible, while maybe being the only person there, besides the bedside RN, when a patient’s final hours are approaching. We want to keep ourselves and others safe, but not leave someone who is dying alone, or leave a frightened single visitor alone.

The supply of PPE has been uneven. At times, employees were asked to put their used N95 masks into special bins so they could be cleaned and reused. This didn’t seem to go on for long, and is not happening currently. However, rather than being fitted this year and last for N95 masks that come in at least two different sizes, we are now being fitted for one-size-fits-most models that I suppose are cheaper. In my case, I think the fit was better with the sized masks.

The first time I reported to work after San Francisco’s shelter in place order (which was a week or so later than my colleagues did, because that was also Hammett’s final week), I made sure my father and sister had my important financial information. However, I didn’t feel frightened of going to work, and I have never felt scared at work, though once or twice, at one job or another, I have walked by a whole series of rooms containing COVID patients and kind of thought, “Holy moly.” I do find I don’t want to stand around right outside such a room for long.

The hardest part has turned out to be when one of my very own colleagues has been sloppy about social distancing, which occurs exclusively at Job One, and the second hardest part was early on when people in my neighborhood weren’t wearing masks and/or allowing six feet when I thought they should be.

Cats

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I Really Like You

Early October brought yet another bad night with cats, this one involving the mini-blinds and an unbearable racket as I was trying to fall asleep. I kept losing my patience and tossing Duckworth and Marvin into the bathroom, followed by a loud, satisfying (to me) slam of the door. When I had to pee in the middle of the night, I let them out, and soon heard a loudish crash: a pretty blue ceramic pot given to me by my sister, falling onto the hardwood floor. Fortunately (for the cats), I could detect only one small sign of damage, and that might have been there before. Into the bathroom went the cats once again.

Before my alarm went off, I leapt out of bed to do something I’d decided would have to be done: I moved nearly all my books to the two bookshelves in the living room and moved a bunch of small items and pieces of paper to the bookshelf in the walk-in closet, which is off limits to the cats. I don’t necessarily want anyone who comes in here seeing all my books, or touching them (cooties!), let alone asking to borrow them, but I was sick of having papers knocked to the floor and then used as toys, and I could see that Marvin was very close to hopping up onto a shelf where there were a lot of little things I really didn’t want disturbed.

In my saner moments, I reminded myself: Whatever it is, it can be repaired, replaced, repainted, restored to its former condition of cleanliness, or, if all else fails, remembered.

While on call I received a request to visit a patient who had just been diagnosed with the same kind of cancer his mother and grandmother had had. The patient’s grandmother, with metastatic cancer, declined chemotherapy and lived on for many years, eventually dying of something else. The patient’s mother’s cancer was also advanced and she had survived it. My patient, alas, was just in his early 30s and said his diagnosis was completely unexpected. He knew he was experiencing some pain; that it was cancer never crossed his mind. The COVID pandemic delayed medical visits and tests.

I had two long visits with this (not spiritual or religious) patient where we talked about nothing in particular. He was determined to “fight,” and he was concerned about the effect of his diagnosis on his family. Our second visit was taken up almost entirely with discussing the feeding tube that was scheduled to be placed that same day. We did not discuss anything particularly deep or personal, but the patient seemed to appreciate having company.
 
The very next day, the patient ended up in the ICU, and when I went to see him, he was intubated and unresponsive. I learned that his team did not expect him to leave the ICU alive. The next time I went to see him, he stared out the door at me with no expression. I wasn’t sure if he even remembered me, or if he wanted me to visit or would prefer I didn’t. He was unable to speak, and also unable to shake his head “no,” but he could slightly nod his head “yes.” He could also make the “thumbs up” gesture, and used this to indicate that he would like to communicate via writing. I asked his nurse about this, and she said he had tried, but not been able to.
 
I gave the patient a pen and paper and he labored repeatedly to express himself, making a mark or two, after which his hand fell weakly away. At times he pointed at himself and then at me. Clearly he was writing “I,” which he did over and over, but I couldn’t make out anything else. A speech therapist came in and figured out that the next word was “really.” After the speech therapist was gone, I finally figured out what the patient was trying to say. I asked him, “Are you trying to say you really like me?” The patient nodded, and I nearly wept: This patient, with whom I had discussed nothing in particular, felt connected to me and was willing to expend a huge amount of his little remaining energy to express this. Even though what we discussed had seemed mundane, it had indeed mattered that I—that the chaplain—was there.

In the end, his family decided to say their goodbyes and leave, after which he would be transitioned to comfort care. If they had discussed this with me, I would have affirmed their decision. I would have said that the patient could feel their love from any distance, and I would have meant it. I would have said whatever decision they made was the right decision, and I would have meant it. But inside myself, I felt a bit shocked, and sorry that he would likely die alone, even if he didn’t know it. On his final day, I sat with him three different times, for as long as I could.

Bottles

 
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Loogie-Free Zone

One day in mid-September, Tom and I walked around the block to talk to one of our neighbors about a couple of practices of his that had been causing us some dismay. This is the fellow who for years stepped out his back door several times a day, took a hit off his bong—filling my place with secondhand smoke, if my windows were open—then coughed his head off. The grand finale was when he coughed up a giant loogie and spat it onto the ground. I was grumbling about this to Tom and was surprised when he said he really hated the spitting, too. I thought he was going to say, “What guy who smokes weed and spits?”

I said I was thinking of going to talk to him about it and asked Tom if he would come with me. I was surprised again when he said, “Sure.” We picked a day, but when that day rolled around, it was too hot. We picked another day, but it proved to be too smoky. Then our neighbor seemed to be out of town, and so forth.

Finally, there came a day when, alas, our neighbor was certainly home and it wasn’t too hot or too smoky to spend 15 minutes outside. I had been rehearsing a speech, and felt quite nervous as I meditated beforehand. It occurred to me that I more than usually did not know what was about to happen, which was slightly thrilling. Tom and I strolled around the block, arriving disappointingly soon, and I rang the bell that I thought must be this fellow’s. Someone buzzed us in instantly, and we went into the lobby. A woman came out of a nearby door and I said, “Maybe we rang the wrong bell.”

She said, “Who are you looking for?”

I said, “The smoking guy.” She looked puzzled.

I said, “The guy who smokes weed out back.”

She said, “Oh! He lives here, but he’s not here right now.”

She said she was his partner, so I said maybe we could tell her what was on our minds and she could pass it on. I delivered my spiel, during which she smiled and nodded understandingly, and then she said, “I’ll try to pass that on with the grace with which you delivered it.” How nice! I thanked her for her kindness, and off we went, lighter in heart and step.

This was back in September, and I can report that the nice woman’s partner has not smoked outside their back door even once since then; sometimes I hear him coughing from far away. After a couple of weeks, I sent them a heartfelt thank-you note.

At my wits’ end one lousy day with kittens—some days the misbehavior seemed relentless—I emailed a few people to say how much I hate living with these cats. Hammett’s cat sitter immediately replied to say that maybe I would have to return the cats and adopt an old cat. A relative who has cats said she was sorry this was happening and could I send them back? This had occurred to me many times, but having it seconded by others felt heartbreaking. I should know by now how futile it is to imagine a future scenario, imagine how I will feel about it, and then try to make a decision based on that. This never seems to have much to do with reality. That is, the thought of handing the cats over and bidding them goodbye is horrendously sad, but that doesn’t mean it’s not the right thing to do.

I went and took a look at adoptable cats at the SPCA just to see if a one-year-old cat perfect for me happened to be right there, and saw two sad things. One was a cat whose owner was looking for a new home for him when I was shopping for Duckworth and Marvin. That cat was still listed there. He bites. Also when I was looking for D&M, I saw the cutest kitten and almost indicated my interest in him. In fact, I think I had visited the website to go ahead and do that only to find that his picture was no longer there. Someone else had adopted him. Well, now they wished to unadopt him. There was a photo of him, two months older, in the Rehoming section. That’s where photos of Duckworth and Marvin would be if I decided to give them up. (Which I have since definitely decided not to do.)

I had more discussion with Hammett’s cat sitter and she said a very wise thing:

I understand. We all get frustrated and then feel bad afterward. My partner and I ask ourselves: What is it that they are trying to teach us? What can we learn? Maybe what we need to learn is patience with our own frustration.

So, onward and upward with cats. When I went to put away their toys before bedtime that day, I saw that I had forgotten to put them out! That can’t have helped.

Duckworth

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The Dust Age

I had mostly been using Duckworth’s one white whisker to tell him and Marvin (formerly Howie) apart, though there are several other differences, including their general shapes and their profiles. Marvin’s nose doesn’t curve but goes pretty much straight down, giving him a rather exotic look. However, you have to be looking at him from the side to see this. Duckworth has a round little belly. Also, Duckworth’s fur is silky soft and Marvin’s is a little scrubbier, like Hammett’s was. I was thinking one day that if Duckworth were to lose that one white whisker, I could always go back to telling them apart by looking for the distinctive markings on top of Marvin’s head, as if someone had dipped three fingers in peanut butter, or gold leaf, and stroked his head. I took a look at him to confirm this—and saw that those markings were entirely gone, and then one day Duckworth lost that white whisker. He has never grown it back, and even now I still sometimes find it difficult to be sure which cat I'm talking to.

Sometime in August, the cats’ diarrhea finally cleared up, which was great because I was getting really tired of scraping diarrhea off everything in the bathroom.

My parents’ departed charming and beloved cat dribbled poop everywhere he went in his old age. I remember going to visit, which I hope to do again someday, and seeing all the chairs and couches covered with towels.

“Do these towels cover the poop?” I asked.

“No, they cover the upholstery.”

“What covers the poop?”

“Nothing.”

“What?!? How do you sit on poop?”

“Let me demonstrate,” said my father. He extracted a folded white cotton handkerchief from his pocket and said, “Pretend that’s poop.” He tossed the handkerchief onto the seat of the nearest chair and sat down on it.

Aha! So that’s how it’s done.

The cats have been pretty hard on a lot of my possessions. Shredded items include my bicycle seat, sheets, the brand-new shower curtain, the hardwood floor, the paint on the bathroom windowsill, the binding of at least one book, and various shoelaces. I’m trying to learn to love the feeling of grit affixed to the bottom of my feet, because I don’t have time to do anything about it.

However, so far they do not make any particular effort to get out the front door when it opens, which I was quite worried about, since there are two of them, and they also do not seem interested in shredding the upholstered chair. They use the horizontal and vertical scratching surfaces provided.

I see that they teach each other—I was going to say “for good or ill,” but I think it might be only for ill. Marvin has so far not taught Duckworth to cover up his poop, but he has taught him how to let his tongue dangle, flapping, out of his mouth, ready in case there is a suckling opportunity, whether of one’s brother or oneself. It’s kind of gross looking. Because Duckworth does not involve himself with covering up poop, he is perfectly pristine at all times. He smells like cotton candy. Picking him up is like hoisting two loaves’ worth of bread dough; he evidently lacks bones, and he radiates relaxation, often yawning while held. Marvin, whose manner is often worried and tense, does the right thing in regard to his own poop and sometimes in regard to Duckworth’s, as well, and consequently is sometimes filthy; he is undoubtedly the cat who tracked all the diarrhea throughout the place.

Hammett has not been forgotten. I show Duckworth and Marvin a photo of him periodically: “Now, if you want to see what an actual good cat looks like, here’s a photo of one.”

I am using the spray bottle to deter just a few things: hopping onto the kitchen counter or ironing board, and participation in my daily exercises. Regarding the latter, they can get excited and take an exploratory nip of a finger now and then, or try to seize fabric—i.e., my pants—that is moving in a rhythmic manner. For some things, I have adopted the view that their “bad” behavior is a request for affection, even though I’m sure it is usually not. The cat is probably not thinking, “I wish Mom would pick me up,” but rather, “Who even is that chick? I just want to shred these shoelaces.”

One evening as I lay in bed, I felt someone adjusting my coiffure. When I reached back to investigate, I stuck my finger right into the open mouth of a cat and felt its little snip-snap teeth encircling my finger.