I've been busy, really...

So much to think about, so few brain cells with which to do so, alas. CPE so very absorbing. Right now just praying for the peaceful death, SOON, of a patient who has suffered greatly. The patient is now, I am told, actively dying, and being kept pain free, but the wish of everyone who has cared for her is that she can be quickly released now from a body which has endured immense assaults from her illness. I sang to her Monday night, the night she was admitted into hospice care, as she was being medicated for pain. As I sang and the medicine began to work, I watched her jaw relax, and her forehead un-furrow, and eventually her eyebrows wiggle in a relaxed face, as if she were thinking of something enjoyable. Gradually her grip on my hand also relaxed as the medication took firm hold. I tried stopping singing and she began furrowing, moving her head. I started again and again she stilled. Eventually she drifted into deep, painless sleep, and I said good-night and left. Wednesday I went into her room; she was unresponsive and beginning the descent into dying, but very comfortable. I spoke to her and her eyebrows wiggled a response, as if she remembered the sound of my voice. I sang some more, and left her to her rest. I hope within the next hours she will rest eternally.

Thinking of a simply lovely family doing their best to help their husband/father die. They wondered why he was 'holding on;' they guessed he was afraid of the unknown. His dying process seemed slow, very measured. I asked what he was like as a person--did he love adventure, new sensations? Would he have longed for a chance to parachute, just to see what it would be like? All immediately responded that he would not, never, it was not his nature to rush into such things. Perhaps it was not his nature to rush into dying either. I wish we could tell you, I said to him, what exactly it would be like--and I wish I could tell you for sure that wonderful things would happen. Though he was unresponsive, I was talking to him and family. I have to be honest with you, I said. What's true is that we really don't know, because no one has gone absolutely all the way and then reported back. So I can imagine, I said, that a sensible man would take one step at a time. Who knows if he heard; at least, I hope, his family could relax a bit about his process, let go of the idea that they could say the right thing to induce him to 'let go.'

One patient is sharing chocolate. Her husband and sister bring it for her, and she is a generous lady, so chocolate is to be had.

The nursing and CNA staff are grieving deeply themselves, because a beloved colleague died suddenly a couple weeks ago. It was a shock to all who knew her, and working on a hospice unit does not make one's own personal shock and grief any less hard. They are stretched thin, thin, thin. I think I'll bring them some more chocolate tomorrow. Or something. One wishes one could bring something a lot stronger than chocolate, but such things are not allowed to enter the hospital. These staff are amazing. I watched them care for a very helpless and ill patient the other day, and it was sacramental, the gentleness and respect for someone who by virtue of old age, dementia, and terminal illness could be thought of as 'one of the least of these.' Not by the nurses and CNAs who proffered clean dressings and gown, plenty of pillows to support weary limbs, soft lighting for rest, medication for pain, brushing of hair for dignity, respectful touch, and gentle, loving, reassuring words.

29 years ago today my father died at 58, killed by his first and only massive heart attack.

And, a last word, buy the advent devotional book! Proceeds will help with hurricane relief. I wrote one entry, but you'll have to buy the book to find out which one.

Back! Red of face but happy...

Individual supervision is oh so helpful. I got to see that I had *asked* for negative feedback on my verbatim, though not altogether consciously... had basically asked the group to enact my negative internal voice... and then taken the negative feedback as the *only* feedback I received. This chaplaincy stuff is so fascinating, so compelling to me--and, in my life, I am used to loving something only to lose it, so I set myself up to do exactly that. My supervisor says that a number of positive things were said, and to be honest I cannot remember a one of them! Such is the power of the negative internal voice. I have to say I was pretty mortified when we sorted the situation through. Supervisor, however, is unfazed. Apparently this is part of the plan.

So I am back to loving CPE. And enjoying my placement again. After a horrifically busy couple of weeks, things on the unit slowed down the latter part of this week. It would be great for the staff, who have been working their fingers to the bone, to have a week to catch their breath and regroup a little before the next busy time hits. Even I was tired and I am only there part-time.

Each family is different, hell, each PERSON is different. I have been thinking about how even the symbolic understanding of death is individual, to say nothing of relationship to the patient, level of concurrent stress, grieving style, etc., etc. It is amazing that families pull together as well as they do to support each other and the patients through an experience that is truly different for every person involved.

It is sometimes heartbreakingly sad for me to see patients with terminal diagnoses that relate to a lifetime of addiction. I have now seen end-stage liver disease, and it can be awful. It would have taken my parents eventually had other things not claimed them first. Some of the patients are aware of the link between their addiction and their current situation, but others come in so late in the process that most awareness is gone--and families have to cope, sometimes with horrific deaths despite every effort to keep patients comfortable. I think sometimes a patient's final illness and death can be a mirror to the family of a shared addictive process, but the denial can also be extreme. That's how it was in our family, anyway. My mother drank along with her seizure medication, which made her seizure disorder impossible to control. I, as a child, could not confront her about her drinking, although I tried unsuccessfully. She lied to all her doctors, and my father, who drank with her in the evenings, could not comprehend how seriously ill she was in any case. My father's alcoholism worsened sharply after my mother's death, though it was an MI that took him. I remember, at the funeral home, being offered the chance to see him one last time before the casket was closed. I stood, looking at the ravaged body, shaking my head. ANGRY. Angry at all the waste. As a chaplain, I can sometimes see the forces in a patient's life that make the addictive process attractive, maybe even insuperable. With my own parents I think I still don't have enough distance to see a "bigger picture." Which is one reason why one cannot be a chaplain to one's own family!

End-stage liver disease is the pits. Avoid if you can. End-stage COPD is not great either. Actually, few things are. Probably the easiest for the patient is to have a huge, sudden heart attack or stroke, and have a loving, heroic family that is willing to forego heroic treatment and just let the hospice staff keep the patient comfortable and let the dying process proceed. I say "heroic" because making that choice when the massive illness hits with no warning is terribly difficult. Making the choice to decline life support goes against the natural tendency of loved ones to grasp at hope, any hope, that the situation can be reversed.

That's all for now. Do your advanced directives, and avoid end-stage liver disease. And keep praying for me if you have any to spare! So much to learn...

Feeling a little better... for now

Thanks to those who sent good wishes and hugs. I needed 'em.

Actually did not get shadowed by supervisor--had a concrete question to ask him, and he took the interview for the new patient on Wednesday. Which worked well because the patient and he formed a good, supportive connection. The right thing happened!

I just have to keep putting one foot in front of the other and learning. Talked to a relative in great pain last night--a loved one is dying, and this relative holds some religious beliefs that are very clear-cut as far as what humans need to do/think/say in order to achieve salvation. Trouble is, the dying, greatly-loved one has not done/thought/said the right things, and now the relative is suffering terribly because of the thought that the loved one will not only die, but experience eternal separation from God. I can only imagine what pain the relative is feeling--and, of course, loved one's spiritual choices are absolutely out of relative's control. This is not my theology in any sense, and I knew better than to try to talk relative out of relative's beliefs; all I could do is sit with relative in the pain of experiencing a possibility so frightening and so very out of control. Relative is grieving some other losses as well, making the situation even harder. I prayed with relative that God will be as a beacon of guidance and wisdom and love to all. That, at least, I could pray with sincerity and without causing relative to shut down. I hope loved one will have some time to identify loved one's own spiritual needs as opposed to those of the relatives, and I hope relatives will be able to find a way to respect loved one and trust that God will care for all. For last night, it seemed my job was to listen, acknowledge the pain, and support this relative's plans for self-care.

At the other end of the spectrum was the patient who, asked if there was a religious preference, flatly asserted that religion "didn't do any good." Asked what does do good, the patient immediately answered "Animals!" Thus I notified the social worker, and now if the pet therapy volunteers are in the building this patient gets a visit. There is nothing on earth I can say or do that comes anywhere close to a Golden Retriever, not for this patient. And perhaps for many--Golden Retrievers may be born chaplains.