Ps 121 Is My Friend

BEST patient comment EVER!!!!

2011-08-06T16:41:00.002-06:00

So one day I went to visit a patient in a care facility. I had been told that the patient had health problems that made him pretty confused at times, and also he tended to sleep a lot. I went into the room and his wife was visiting also and said it was fine to say hello to him. The patient was dozing. I walked up to his bed and said, "Hello, Mr. X." He opened his eyes, looked right at me, and said, "YOU'RE A SCOUNDREL!" His wife looked a little horrified, not knowing me. I was delighted. "I am," I said. "How did you figure that out so fast? You're really GOOD." He gave me a knowing, mischievous smile that had a bit of a swagger to it. And went back to sleep.

Tangled Web of Rambling

2011-06-25T16:32:00.002-06:00

I spend a lot of idle time in the blogosphere, because I enjoy good writing and because the actual lives of people have always fascinated me. I read a tweet from someone whose writing I enjoy and respect, that directed me into the drama of a mother in TN whose son died a bit over a year ago of a drug overdose. The mother is a well-known blogger and she has a lot of internet supporters, and a lot of support is what any parent needs at the death of a child. Somehow I can't let the drama go, probably because a lot of it is about addiction, and the impact of addiction on families, and that is a topic about which I have far more first-hand knowledge than I would wish. Drugs and alcohol contributed to the early death of both of my parents. I was raised in a house of addiction. And so I project into this situation, and I react with rage, frustration, bafflement, compassion, every emotion in the book.

A summary, hopefully fair: the young man in question was 19. His parents became aware of early drug use when he was, I believe, 14. Eventually he was sent to two residential rehabilitation programs that combined treatment with education so that he could continue high school work. He left rehab when, at 18, he attained legal majority, and returned home, where, within a matter of weeks, he was using once again. From this point he used harder and harder substances, developing an addiction to opiates. I believe I am correct in saying that in the last weeks of his life he was injecting opiates, selling as well as buying drugs, and also selling sex for drugs. He was 19 when he died, having been found in the home of two people who, his parents believe, sold him lethal doses of methadone, were prostituting him and other young men, and failed to call for help for several hours while he was in extremis in their home. At some point before being found in that home, their son was involved in a drug deal gone bad that left him beaten.

Their son was taken to hospital where, his parents believe, he was found to have anoxic brain injury from drug overdose as well as from beating injuries. He appeared to recover some limited functionality but eventually succumbed to complications from his brain injury.

The blogging mom and many others believe this young man was murdered, based on statutes that allow for those who illegally provide fatal doses of drugs to be charged with murder. They believe that the criminal justice system has failed them and their son by declining to perform an intensive criminal investigation into the circumstances of their son's death, to include the injuries he sustained in the drug deal gone bad, the provision of methadone allegedly at the hands of those in whose house he died, and the failure of those persons to render aid. Further, they believe the criminal justice system has failed to take action on credible evidence (statements their son made while in hospital) about a prostitution ring the couple was allegedly running from their home. The parents have filed a civil suit against those in whose home he died, as well as a methadone clinic from which the methadone allegedly was obtained. Currently, the mother is also attempting to draw attention to alleged improprieties in the medical examiner's office which performed her son's autopsy, an autopsy which, it is alleged, failed to find any evidence of the serious beating injuries the parents believe their son sustained along with a lethal drug overdose. One hardly knows what to think. Could it be true that every single person in the justice system that has encountered this family has been utterly incompetent and unprofessional at best, and complicit in large-scale criminal activities in the city and county? Could the family be the victims of a draconian plot? Perhaps, I suppose--I don't know the county involved and certainly its medical examiner function has been heavily criticized and problematic for years before the death of the young man in question. Perhaps this grieving mother will end up doing good if there is widespread incompetence and she is able to bring about a cultural change in law enforcement.

I don't know how much any of the mom's effort at finding justice will help the family, though, and that's the rub for me. (By the way, google "Justice for Henry" to read the mom's own accounting and opinions.) I find myself by turns fascinated, appalled, and irate over the family's view of their son and his addictive disease, and fascinated, appalled, and irate over the information that is out there and accessible that seemingly they never, ever had.

One aspect that, I have to admit, sticks in my craw a bit, is that the mom describes her son, over and over, as "fighting a brave struggle against drugs." That phrasing, or similar, appeared in his obit and factors into every aspect of her war for "justice" for her son, and I have to say that I am so utterly ordinary that, if it sticks in my craw, chances are it sticks in other craws as well. Although I acknowledge that I don't know everything about her son's life, what I do know from what she has posted leads me to a far different conclusion: that her son was not, in fact, fighting any kind of struggle against drugs at all. I see a young man who attended treatment programs only as long as he could legally be compelled to do so. I see someone who made no attempt to alter his life for sobriety once home and who, within weeks, was abusing drugs perhaps more severely than he had before leaving for treatment, and who, within months, was on a downward spiral where death was becoming more likely with each passing day. I see, from his mother's own account, a man who resisted even the suggestion of treatment for his addiction to the very end of his life. In short, I see an addict who manifested, in terms of behavior, absolutely no intention whatsoever to change his life, other than talking about hating his addiction. I see also a man who manipulated his family to obtain a place to sleep, food, and a cell phone, and I can imagine him using talk of how much he wanted to change to keep alive the hope that led a family member to keep providing him with those basic needs. I see a man whose untreated addictive disease was not only killing him but destroying the family who loved him and believed in him. And I see a family who continues to hold onto their image of their clearly gifted, charismatic, artistic son as "bravely struggling" in ways that do not allow them to get, on an emotional level, the ways in which he participated in his own illness and, eventually, in his own death.

The family seemed never to be aware of the types of danger that awaited their son once out of rehab. Mind-bendingly, they seemed never to know how lethal the opioids were that flowed freely in their community and all over the country. Nationwide publicity about, for instance, oxycontin notwithstanding, they seem to have had no idea that their son had easy access to substances that could and did kill him. They seem to look back with nostalgia to the 60's and to their own youthful years as times when young people could use drugs as more or less a rite of passage, safely, and emerge on the other side better and stronger from the experience. They seem, and their supporters seem, appallingly ignorant of the deaths that have occurred since long before the 60's from addiction to alcohol and drugs. Thus ignorant, they seem to feel that their adult son (this point I do wish to make and make strongly--he was not a minor child) was failed by a social network including a criminal justice system that allowed terrible drug pushers access to lethal drugs and young people in a new and unique manner.

The mother and her supporters seem also woefully ignorant about addiction itself, about how addicts behave and about the huge mortality and morbidity associated with alcohol and drug addiction. Would that the same programs which offered to rehabilitate their son, no doubt at staggering expense, have demanded that the parents enroll forthwith in Al-Anon or Narconon, that they might begin to understand what demon gripped their son and how eager that demon was to demolish him and everyone around him. Would that they have been given the agonizing knowledge that neither they nor any other human being or human system would be able to impact their son's life in such a way that he would stop using, no matter what they did. Would that those programs, while working with their son, also told his parents what so many families living with addiction know: that you cannot and must not trust any word that comes out of the mouth of a person who is using drugs--that the beloved person is in fact possessed by a force they cannot control, and that the force of addiction renders the beloved person utterly unreliable and untrustworthy. Would that they have had some preparation for the horrific but not, in the larger scope of the world of addiction, surprising outcome to their son's disease, given their son's refusal until the bitter end to treat his addiction.

If I could have offered one piece of knowledge to this family in the last weeks before their son's fatal overdose, it would have been this: Your son is dying. Your son is dying as surely as if he were in a hospital bed riddled with cancer. Whether it happens quickly or slowly, your son is on the path to death, and there is nothing you or anyone else can do. Take the rose-tinted glasses off, look clearly at what he is doing and who he is doing it with. He is not "bravely struggling." It is not "just a matter of waiting until he turns around." You can hope, but his situation is beyond bad. It doesn't matter what you do, or what anyone else does except him; you are helpless in the face of almost certain death. Be prepared.

That wouldn't have changed a thing, I know it wouldn't. But, if they could have heard that, perhaps from other parents, they could have had people to walk with them through the truth of those days, to help them understand the law enforcement view, the depth of the injury, the devastatingly poor prognosis. The awful phone call his mother got would still have been awful, but would have been part of a context rather than a lightning bolt out of left field. They would have been able to see the fullness of their son's life--the enormous and real promise, and the enormous and real destruction--rather than holding the promise and understanding the destruction as something temporary which would eventually pass. It has seemed to me that, as the mother grieves over the idea that her son is not seen completely but only as "an addict," she too fails to see him completely. She sees the innocent youth, duped by older evil people into things he would not have done otherwise, rather than, yes, the addict, the man of immense promise whose life had been handed to a demon, a demon with which he, at the end of the day, did not choose to engage. When people say these sorts of things to the mom, she hears us saying he "deserved to die" and "deserved to die a terrible death." That is not what I am saying, really--no one "deserves to die a terrible death," but people with addiction die terrible deaths every day in every city, and it really does not matter whether law enforcement is impeccable or not, whether drug overdoses are prosecuted or not, etc. It is human tragedy and evil at its most immediate and painful. And the roots of addiction are complex and multifactorial and some people die even if and after they choose treatment for themselves, because the disease is so godawful powerful.

I tell families of persons dying of consequences of addiction that, if I had a magic wand and the capability to eliminate one disease from the planet, I would choose addiction without a second's hesitation. I have no time for libertarian talk about how anyone should have the freedom to consume any substance they like, on grounds that the harm is done solely to the user. That viewpoint is self-centered and utterly naive. Families, friendships, communities, cultures, economies are ravaged by addiction, and it is at this point impossible to predict who might be able to use something "safely" and who might not.

There are no easy answers and no simple places to put blame. I wish this family some measure of peace, and I wish that none of their other family members ends up in the same evil situation. I wish I thought for one moment that the success of their lawsuit would vindicate either them or their dead son, or even that I thought for one moment that their suit could or would prevail. Their lives are utterly and unalterably changed by their loss and it is always thus. I wish them more fullness of knowledge and vision even though I know it may bring more pain. And I wish there WAS an easy answer to what they are going through.

Ah, the Royal Wedding

2011-04-19T21:08:00.002-06:00

It has been a rough couple of weeks. Owing to an act of colossal stupidity (mine, of course) I wrecked my car... this was awful in every way and I am slowly climbing out of the pit of that. My second (now only) car has been skillfully resurrected by a VW mechanic who (a) does not work for the VW dealer and (b) knows what he is doing. (Could this be a coincidence?) Hopefully the wolfhounds will fit, one at a time at least, in the back of the VW. The tiny dog will fit anywhere in the VW but will of course wish to drive it. I doubt she can manage the clutch, however.

Meanwhile, I find what innocent enjoyment I can in contemplation of the Royal Wedding. Now, most people around me find it irrelevant if not utterly boring, but although I am otherwise as unromantic as a cement block, I am vulnerable to the fantasy of Royal Weddings. After all, I did get up at oh-dark-hundred to watch Diana marry Charles, although it was plain as the nose on anyone's face that expecting a 19-year-old virgin and a 32-year-old well-traveled male to have much of anything at all in common was utter lunacy. Fat lot of good it did THEM, my getting up so early.

There is after all something archetypal about royal weddings, that's why they hold any fascination at all. One (or even I) project something shining and gold on a royal couple, and the wedding, itself an archetype, holds the weight of great hope and promise. And at least this time the couple are of similar age, met at university, have known one another for more than a month or two, and apparently are able to converse for more than a sentence or so. These factors lend one (or me, even) to hope for better times for them than for the unfortunate Charles and the late Diana, who seem to have been even more appallingly mismatched than I imagined in my wildest dreams.

I want them to be happy, William and Catherine, and I want their relationship to be genuine and not a sham, and I want their dreams of spending their lives together to be richly fulfilled. Marriage is at best a sacred calling, a true sacrament, in which ordinary daily experience is infused with the presence of the Divine. I wish that for this young couple, as I wish it for everyone I know who chooses a partner and takes that courage step into life together.

And I want to see the dress, and her hair, and whether she wears a tiara, and whether they get to stay on in their rented farmhouse, and whether he loses all his hair by 35, and whether they have babies, and on and on and on. Incurably nosy, that's what I am, especially about lives that mine has never, and will never, resemble. I always have been curious about royal families. I always have wondered what it would be like to grow up in a palace and to have "what you will be when you grow up" decided for you even before you were born. Life in a royal family seems such an odd combo of freedom (from worry about money, especially) and restriction (one cannot plausibly run off and join the circus, really, if one is royalty--Princess Stephanie of Monaco tried it, which says it all actually). I used to think, why would anyone NOT want to be a prince, or princess, or whatever, but now I think of the fellow I once heard of who worked for a Buick dealer and was very successful as a salesman because he believed, truly believed, that Buick was the best car in the world. He refused to check out the competition because he was afraid he might find out that Buick was really no better than Chevrolet, and then where would he be? As a royal one would simply have to believe one was relevant, because if not, how could one bear it? And, as the relevancy of royalty comes under increasing question, maintaining the belief would become tougher and tougher, and of course what about the poor soul born a Crown Prince who is, sadly, a person who yearns to be steamfitter, or a priest, or a phlebotomist, or anything at all really, other than a future King. Like most youthful fantasies, thoughts of royalty become tempered by experience of reality over the years.

I still, though, look forward to the wedding. I hope the dress is magnificent, and the day is sunny, and the horses shiny and perfectly groomed, and the vows said without a hitch (let us not forget that Diana, by mixing up two of her husband's names, took Prince Philip in marriage... ) and the balcony kiss enough to make the world swoon. It will be grand.

What on earth?????

2011-01-25T22:35:00.005-07:00

So there are days at the end of which only two options seem valid, the first being a stop at the local hock shop to see what's available in the way of a .38 snubbie and the other being the implementation of a rigorous quality testing program upon one's supply of Adult Beverages.

Today has been such a day.

Actually, all of the last week has fallen into the same unfortunate category. Sadly, at the end of each day, I have lacked the energy to visit the local hock shop(s) and my level of fatigue has gotten in the way of the attention to detail required for proper quality analysis.

This is not fun.

There are many things that have annoyed me lately, and about the only one I can discuss without fear of legal ramification is the proliferation of what are properly called Medical Marijuana Dispensaries but more accurately called "dope shops."

Mind you, I do think medical marijuana has its place. And I do think people who need it oughtta be able to get it without engaging in clandestine drive-by purchases in questionable parts of town or setting up elaborate systems of artificial lighting in the closets of their guest rooms. But really there are limits--limits on need, appropriateness, and good taste for mercy's sake--and my state has sadly left all of those limits so far in the dust they may as well have fallen off the edge of the earth.

How many dope shops does any stretch of city street really NEED to have anyway? I live a few blocks from one of the more dope-shop-intensive streets in town and I can tell you that however many there are right now? Is too many. Waaaayyyyy too many. Honestly I wouldn't mind them nearly so much if it weren't for the AWFUL!!! decor. If I were to pick a color that would subtly allow the customer looking for this business profile to identify same, I would not have picked the sort of sickly greenish-chartreuse that is practically ubiquitous. And, if I were bound by some apparently unpublished dope-shop code of ethics that required I use that color, I would use it in small bits. I would NOT PAINT THE WHOLE FRONT OF MY BUILDING IN A COLOR THAT LOOKS LIKE THE CONTENTS OF A BABY'S USED DIAPER. Honestly. Some shops use a combo of awful green, awful brown, and awful yellow that makes me think of patients with particularly bad end-stage liver disease. Perhaps that is called Foreshadowing, or perhaps the goal is to make the building so depressing to look at that all its neighbors will be compelled to become customers in order to reach some state of hazy equanimity. And let me tell you, the universal Red Cross symbol of Medical Help that appears on a lot of the shops looks particularly disgusting against a sickly yellow background.

And oh my God the NAMES!!! The names of the businesses!!! It is difficult to keep track as there is some, shall I say, turnover, but "A Cut Above?" I would have guessed a hair salon, but ooooh no, not unless there is more than one business under the roof. "Bonnie and Clydes Caring Cannabis?" Do you WANT to advertise a connection to crime? "Chronic Wellness???" From smoking marijuana? Listen, I talked to a doc about a year ago who said, with the fervor of a man who sees a pulmonology residency in his future, that in 30 years all the patrons of these businesses will have lung disease worse than those who use tobacco. Because if you are smoking the stuff, unless you're more sophisticated than many, you're rolling it up in ZigZags with NO FILTERS. And if you want to know how good that is for you, look at the inside of someone's water pipe sometime, and think of your lungs. Anyhow, back to the names. How about the Ganja Gourmet Medical Marijuana MMJ Restaurant Dispensary? You can view a menu online. Honest. Which is one of the fascinating things about the Medical Marijuana MMJ business (sorry, couldn't help it) -- you have a Full Range of Products from Which to Choose. Not just leaves and buds, oh no. And no need to bake your own Medical Marijuana MMJ brownies anymore either, you can buy 'em premade (be sure the kiddies don't pick up the wrong batch for birthdays at school, just saying). At the Ganja Gourmet one can buy Medical Marijuana MMJ-infused pizza!!! and beef pot pie (pun intended I am sure)!!!! and rice krispy treats!!!! and double-fudge cookie with hint of espresso (what's the point of THAT, I want to know???) and, yes, "Stoney Road" ice cream.

Back to names after the brief gustative diversion: A number of these sickly green businesses include words like "natural," "kind," and "healing" in their business names. I suppose these names are meant to contrast the businesses with purveyors of allopathic health care which is not really fair. I mean, if you are having a big fat heart attack and you are being resuscitated, your immediate concern (if you are perfusing well enough to have one, that is) is less about "kindness" than about the forcefulness of the compressions being applied to restart your ticker. Your concern about "kindess" comes the next day, when you are supposed to start waking up, broken ribs notwithstanding. Maybe sickly green isn't so disgusting then, I dunno. I am beginning to ramble here, but do go back up a paragraph or so and ponder what I said about "lung disease," and think about that in relationship to "kindness." Take your time.

There is purportedly a Medical Marijuana MMJ business (I canNOT help it, the redundancy is simply too much) named Releaf. Do they recycle, too, I wonder? And the Rocky Mountain Farmacy. Cute. By far my favorite though is the SweetLeaf Compassion and Wellness Center (italics mine). What the hell? "Good afternoon. I need to purchase some compassion. Also wellness. Do you have a price list?"

Which brings me in a somewhat befogged way back to the beginning of my post. I probably do need to purchase or otherwise obtain some compassion, if only for the poor souls that have to write ad copy like the following (for The Giving Tree MMJ Dispensary): "...An established licensed Denver medical marijuana dispensary providing premium compassionate caregiver services and products..." Anyone who has to spend their days writing that kind of purple prose to describe premium products otherwise known as "Afghooey," "Northern Lights," or "Green Crack Medical Marijuana," and probably writing said purple prose while sitting in a sickly-greenish room deserves at least a pound of compassion, SweetLeaf or otherwise. Or perhaps a double-fudge Medical Marijuana MMJ-infused cookie with hint of espresso. Balance in all things, indeed.

I don't know about you, dear reader, but I am feeling much better indeed after this little rant about the Medical Marijuana MMJ business. It may be that I can forego the rigors of quality assurance for another day and the .38 snubbie for two or even three. It is good to feel gratitude, even though the quality analysis of a tiny bottle of peppermint schnapps is, if done well, a task worth doing.

("Green Crack Medical Marijuana???????????????????????")

Stuff, maybe nonsense

2010-12-19T00:30:00.002-07:00

So I have been finding myself more easily angered lately; certainly grief resulting from the death of my friend J a week before Thanksgiving is a huge factor but perhaps there is more to it. I attended a couple of presentations lately where it seemed that large topics were oversimplified and where the speakers' own point of view was presented as fact. This is the sort of thing that can (and did) make me totally nuts. One is reminded that, when the only tool one has is a hammer, then everything tends to look a hell of a lot like a nail. It is so easy not to notice that one has only a hammer.

There is much to annoy in current health care discourse and sometimes it seems the job of chaplain brings me to notice those things acutely. At present there is an enormous focus on how patients need to change their lives so as to improve health, with an underlying sense of judgment applied to folks who are perceived as using "more than their share" of health care resources. Consider smokers. You cannot read an H and P (history and physical) about a patient who has smoked or is smoking without that fact being noted, no matter what the reason for the patient's visit to a health facility. Some health professionals are openly scornful of smokers feeling that they have brought some health issues upon themselves and should have known and done better. Which in an abstract sense is true--the dangers of smoking have certainly been widely published and an informed consumer certainly can find the information that suggests quitting would be a Good Thing. I don't know, though, if we understand what it is we ask folks to do when we keep harping on the topic. If I live in a family where everyone smokes, and I work with smokers, and my friends smoke, and indeed some of my social contacts come from "smoke breaks" at work, say, then is it really an individual thing that I can simply stop? Will I not have to do something about my environment if I am taking the dangers of smoke seriously? That's a lot harder than slapping a nicotine patch on and fighting cravings, which is hard enough on its own.

I begin to wonder why we don't get as righteous when we deal with people who have a lifetime of participating in sports, from jogging on up, and now are needing joint replacements, physical therapy, etc., related to wear and tear from athletic activity. Are such people not also taking "more than their share?" But hospitals, far from scorning the Boomers with blown knees, are building fancy new orthopedics units and buying fancy new robots for surgeries and competing like mad to get the business. Maybe joint replacements, being procedures, are reimbursed at a more reasonable rate compared to obstructive pulmonary disease, which can involve repeated hospital stays and is ultimately not curable. I don't know--but health care is not neutral in its views of its consumers. I have heard folks blame returns to hospital (that is, patient is discharged but only maintains in the home or nursing home for a day or so and comes right back) on patients' failure to adhere to discharge instructions. I suppose this accounts for some, but the ones I've seen happen with medically complex patients who are discharged because their insurer demands that they move to a lower level of care in a certain number of days. The guidelines for length of stay depend on the main problem for which the patient is being treated. Which is probably highly appropriate and cost-effective for patients whose condition is relatively straightforward, but for patients with underlying health issues may be kind of nuts. Thus we see patients discharged from the hospital on Day X after some procedure, when something may be brewing but it's too early to know, and a day or so after they get to a rehab facility or home, there's a full-blown infection somewhere and back to the hospital they go. That certainly cannot be blamed on patient failure. So better patient education is not going to be the big fix for this problem. The fact is, hospitals discharge patients earlier and sicker than once was the case, and not all patients have the support in the home to recover well, and care facilities are getting sicker patients without in many cases the staffing to care for these patients. No simple fix here, so when I hear a speaker talk about how repeat admissions must be fixed by patients being more responsible I am annoyed to put it mildly.

It seems to me that the huge push to reduce employee expenses in aid of controlling costs is nuts. First off, the more people get put out of work, the wider the gap becomes between rich and poor. Also, when people are not working, they are not able to consume the products and services being offered so "efficiently." Cutting numbers of workers has been disastrous in a number of areas--I'd say health care is one. Robots, scanners, protocols can only do so much. At some point none of these can substitute for a set of skilled human eyes that can assess a patient and understand when to use, and when not to use, the tools at hand. I'd also say that food production is an activity that should be more labor-intensive. Perhaps there would be less food-borne illness if more eyes and hands were on the job, and more care taken for quality. Perhaps food production could happen in more sustainable ways if the entities doing it were less concerned with "efficiency--" I don't know.

Last night I remember fragments of a dream--I was in a place where there was a fair bit of land and there were gates where I could let my dogs into fenced areas. Somehow a mother bear and two cubs got into the area where the dogs were and I was terrified. I wanted to get the dogs in and away from the bears, but one bear cub got into the house for awhile. Eventually the bears were on a neighboring golf course, and I called the authorities. The authorities could hear the bears but couldn't find them. Eventually they told me I was simply going to have to work on dealing with the bears, finding ways to keep the dogs safe knowing the bears were around. Not the news I wanted by a long shot. Puzzling.

Weird times, these are, in the inner as well as outer life. That's all for now--need sleep.

back again

2010-12-04T16:10:00.002-07:00

It has been tough to figure out how to blog given the responsibility to refrain from posting anything that might allow identification of a specific person or facility. Which I understand, because when your job involves Seeing Dead People it is important not to do anything that causes any more pain to the living people who surround said Dead People.

So I will be self-involved and blog about MEEEEEEEEEE!!!!!

It has been a rough month or two. Jobs that involve death and dying hold an inherent level of stress and loss, that is if one plans to be actually present to the work. There are lots of ways to avoid doing so, but I think people who are facing loss need human connection more than they need most anything else, so there you have it: an inherent level of stress and loss.

If there is one thing I am NOT, it is romantic. When I become more weary I become LESS romantic, less convinced that "things happen for a reason" or that "the right thing happens in the end." I become more likely to be pissy about what has gone wrong or firm about the existence of sin, yes SIN, and evil in the world and in the big systems that surround us.

We had a workshop on the environment at work. The worldview behind the presentation is that people are inherently good and need education about what needs to be done. Once educated, people will feel "empowered" to make the right decisions and do the simple things that will change culture and save the planet. The notion is that an industrialized model that relies on continued growth in production and consumption has put the planet and its people in danger (I actually agree with this and have been saying it in one form or another for some time). There is, however, a certain irony in listening to this message from a man wearing a Ralph Lauren shirt. A kinder soul than I suggested maybe he bought the shirt used from a thrift shop, but I think not. The presentation involved some video segments of folks in beautifully and expensively decorated offices. I was in a rage at the romanticism of it all by the end. Would that anything were so simple. Would that we could just make one change that wouldn't hurt ANYONE. Would that everything about indigenous societies was so praise-worthy and possible to implement that the world could simply turn the clock back.

I know I am not enlightened. I know I don't do my best every single time. I know I could do better at conservation and recycling and the like. I know in that vein I sin. I also would guess I am not alone. I also would guess that it is very hard to discern what the best choice is in most situations. Out here we don't have water to spare. Is it really better to stop using disposables and use water to wash dishes, cups, towels, the like? Is it better to compost? What IS the best choice? I am tired of romantically smug folks who are SURE they are doing right things and aren't able to see complexity. I am tired of people who are unwilling to confront the fact that evil exists. You work in systems, it is easy to see evil. It is harder to see our own. Am I willing to keep my thermostat set lower in winter? Am I willing to spend more time cooking? What really IS required?

I have a much lower anthropology than most people it seems. Maybe because I know myself better, know my own ability to let myself off the hook for things. The presentation was supposed to be enlightening and uplifting. It was not--it made me despair. "Education" sure has worked well for racism and sexism, hasn't it? It sure has worked well for efforts for peace, right?

Here's where a doctrine of sin CAN bring comfort: it allows me to say, I am no better than you, and you no better than I. We have a problem. And we already know we will resist fixing it, because that is how we are. How can we work together to find out what to do and sustain one another to do what we can, even if that involves sacrifices we already know we will resist making? How can we help ourselves be accountable? How can we broaden our view and face uncomfortable things?

Eh. Enough for today. I am mourning the loss of a good friend who died just over two weeks ago. I am sad for some tough deaths at work and for times of low census that have stressed teams to the max and for tough circumstances faced by friends. I am glad for big furry dogs and a tiny hot-water-bottle of a dog who make me laugh a thousand times in a day. I am glad for holiday lights and evergreen smells and the gorgeous music of the season and new friends at church. And I hope next week's presentation at work doesn't make me mad...

AmbulanceFAIL

2010-07-11T13:23:00.003-06:00

So I heard this one from a nurse who heard it from a member of the family involved: The family had needed a "non-emergent transport" to take a member for some specialized care. As the family member was basically comatose an ambulance transport was called for. The ambulance arrived and pulled up in the driveway. The two medics jumped down from the cab, went to the back, opened the doors, and found... no stretcher. OOPS. They use those big yellow ruggedized pram things and you wouldn't THINK you could overlook one, especially since at the end of the prior run they put it BACK IN THE AMBULANCE, but I suppose one could get busy and forget. Anyhow the ambulance had to return to base and get a stretcher. There is a certain slight swagger that goes with being an EMT or paramedic, but I imagine that was lacking the second time they arrived at the house.

There is a time for stupendous silliness in hospice work as I have mentioned before. Some days are beyond stressful for any number of reasons, and a good belly laugh is the best way to release some of that. I was sitting at a nurses' station calling a mortuary to arrange a pickup on one such day, late in the afternoon. The somewhat disinterested answering service operator was droning throught the necessary questions. As she asked, "Name of the pronouncing doc?" I heard a sound and looked up to behold exactly that doc, white coat and all, being rolled past the nursing station in a wheeled Geri-chair (a kind of recliner) by one of the nurses. The doc was reclined back, gazing straight ahead, legs extended and feet crossed at the ankle. I am sure that the answering service operator wondered why I snorted in such an undignified way before answering the question; it was all I could do not to laugh out loud. The nurse had been rolling the chair to put it away, and the doc had apparently popped into it; this nurse, who has a marvelous deadpan, simply kept on going.

More Mortuary Bad Fun

2010-05-31T21:20:00.004-06:00

I was relaxing with a friend of mine who is a funeral director, who was serving as a sounding board for my story of a difficult interpersonal interaction I'd had.

"I tell you," I said to him, "I felt like putting a gun to my head in there..."

"The ol' .38 looking pretty attractive, eh?" he asked, sympathetically.

"Even a .22," I answered. "Granted, not a good stopper, but still a good killer."*

"It'll do the job," he agreed. "Not much damage, either. You could still have a full viewing."

Janet Evanovich would have been proud.

* I learned the difference between "a good stopper" and "a good killer" from a firearms expert who was a co-worker many years ago. That's the kind of arcane bit of info that is fun to drop into conversation, especially with friends like this one, who can take it and run with it.

Better than Halloween

2010-03-28T06:16:00.000-06:00

On Halloween one can play at assuming an identity of choice. When hanging out with people who are delirious or confused, the element of choice can be lacking.Ob a recent night there were several confused patients on the unit. At some point the team members conpared notes. The charge nurse had been mistakeb for a priest. One of the nursing assistnts was mistaken for a physician.I, the chaplain, was thought to be qa physical therapist. And one patient, trying to reconcile the information that Mike was his nurse with an old belief that nurses are female, asked me if Mike was a bearded lady...

Major mortuary bad fun

2010-03-22T14:57:00.004-06:00

There were a couple of questions about my mention of marketing collateral on my last post. I wasn't exactly thinking about marketing collateral for mortuaries themselves, although I know some businesses market by presenting seminars on funeral planning, bereavement, and the like, and they offer brochures and other small items. I've seen nice pens and notepads, and coffee cups are within the realm of imagination. The products I've seen are well-designed and tasteful.

Where marketing gets interesting, though, is in marketing products sold through mortuaries to customers. I learned this when my Mom and later my Dad died. When Mom died, my older brother and I went to the funeral home with Dad to Make the Arrangements. We were assisted by a funeral director who was both very kind and very earnest. He took us to a couple of cemeteries so Dad could pick gravesites for himself and Mom to be buried together. (By the way, if you Make Arrangements for a burial, you'll encounter fees labeled "grave opening" and "grave closing." These fees are for digging a hole, and filling it in later.) After that, we visited what I remember as Giant Roomful O Caskets and we chimed in our support as Dad picked one he thought was right for Mom. (Believe me, you DO NOT want to think much about the plethora of options in caskets. Spring counts for the mattress on which the deceased will lie? Hello--the deceased is DEAD, right?)

Afterwards, we went to the director's office, where we were fortified by styrofoam cups of coffee as we faced the final tasks on the huge list of Arrangements to be Made. It turned out that we needed to select a burial vault, which is sort of a concrete box with a top that fits in the grave and contains the casket. The funeral director offered us three choices--basically a Good, Better, and Best of burial vaults. This would not have been really funny, I suppose, except for the fact that as a family we had often joked about the old Sears Catalogue, which offered a Good, Better, and Best option for about anything you might care to buy, from cloth diapers to tractors. We started feeling a bit giggly as we viewed the brochure the director produced. They looked a lot the same, the vaults, and to my non-technical eye it seemed the major difference (besides price) was the length of the guarantee. Each of these choices offered a guarantee to protect the remains of the Loved One from various, erm, degrading influences encountered in the Burial Situation, so to speak. This struck me as rather bizarre and also rather mercenary; after all, who would mark a date on the calendar fifty years hence to go dig up Aunt Ruby and make sure she looked as good as the day you buried her? Odd. I can't remember which vault Dad selected; it wasn't any of my business actually. But we did have quite a laugh when we got out of the place, about the Good, Better, and Best vaults.

Some years later my Dad died. The same brother and I repaired to the same funeral home to make the same Arrangements. We may even have met with the same director, though I can't recall. The year was 1976, the Bicentennial. Anyone alive then must surely recall the patriotically-themed products that flooded every market. We learned that the funeral business had gone with the flow when we entered the Giant Roomful O Caskets. Striped linings and star-studded pillows and linings with the Declaration of Independence printed so as to show above the deceased's head were available in abundance. There were metal caskets subtly and not-so-subtly tinted in shades of red, white, and blue. Coffin kitsch, who would have thought? My Dad loved laughing at kitsch, but would probably have haunted us forever had we buried him in it, so we picked a casket that closely matched Mom's, which we knew he would like. (We were slightly taken aback by the price tag, which showed evidence of significant inflation, but pressed boldly on.) We might, had Dad lived until 1977, been able to get a good discount on a bicentennial casket, but the fear of haunting is not one I take lightly.

When we went to the director's office to finish the Arrangements, we were presented with the same styrofoam cups of coffee. I wasn't startled when the director mentioned burial vaults, but I must say the marketing collateral for same had been greatly enhanced. Instead of glossy brochures, the director brought out three small scale models, cutaway, each model being 1/2 of a vault, for the Good, Better, and Best options. The models fit in a man's hand. Each included the lid, and if you lifted the lid, a tiny light bulb went on so you could view the interior. Each model had a Good Housekeeping Seal of Approval sticker affixed to the outside. (I don't know whether the Approval had been granted to the models or to the products they represented, come to think of it.) OMG!!!!! Dad would have died laughing if he had not already died of a heart attack. My brother and I could NOT, absolutely COULD NOT, look at each other. The director was terribly earnest as he showed us the models, which made the moment even funnier, not that it needed any help. I'm sure he thought our choked voices as we ordered "the same as Mom's" were evidence of our deep grief. I found myself wondering if I could abscond with one of the little vaults, so I could keep it on a shelf as a lifelong conversation starter.

Our favorite mortuary owners have said they might be able to score me a miniature vault. I may have to take them up on it. They also told me that (1) the REAL purpose of the vault is to keep the ground from settling, which helps with appearance and maintenance of a cemetery; (2) all of the vaults do about the same job; and (3) all of them eventually get water in them, so you should bury your Loved One with a snorkel and fins. No need to thank me; when I receive information that valuable, I feel some obligation to pass it along.

There are conventions and expos where manufacturers of caskets, vaults, and the like present their products to the mortuary-owning public. I almost wish, maybe I DO wish, that I could go to one of these, although I might die laughing.

Odd bits and pieces

2010-03-17T12:59:00.002-06:00

I have not written in some time, largely because things at work have been busy and I have been tired, and so a lot of bits and pieces of stories are stuck in the bits and pieces of my mind. I've lost a bunch of weight due to modifying my diet for blood pressure reasons, and I like that! My foot is just about totally better--I can walk my big dogs in regular shoes with just a little soreness and no pain, and I really like that!!!

We have had rough times at work with very, very sick patients accompanied by very, very stressed families. Some time ago we had a run of patients with liver failure, often involving alcohol consumption. We've also had some patients with cancers that kind of putter along for awhile and then flare up like wildfires overnight. Patients of both types can seem to be doing pretty well for some time and then crash, and families often are just so shocked they can't keep up. "She was fine two weeks ago," they will say, looking at us in disbelief as we begin the process of what is charted as "teaching re: dying process." Sometimes family members become angry and accusative because they cannot, really cannot believe their relative's position is going so very far south so very rapidly. They insist that the staff is overmedicating or underfeeding or any number of other things. They believe that there HAS to be a way to make their relative comfortable but still awake, alert, oriented, and able to relate. The bad stuff is just too bad and coming too fast for them to cope. Thank heavens for our wonderful physicians who are excellent at talking to families and explaining what is going on. Sometimes the families don't believe anyone except the doctor. Sometimes they don't believe the doctor either...

One thing that anyone doing hospice work learns fast is that old communication patterns, old relational patterns do not change just because someone in a family is dying. It's not like TV, where suddenly every member of a family is called to be their very best, and to behave in ways they have never behaved before, so that Complete Healing happens. Rather, people and families can be profoundly stressed by a terminal illness and impending death, and react in the ways that are most familiar to them. If a family has never "done" direct communication, that's in most cases not going to start now. If a family has been a welter of conflict since its inception, through multiple generations, that's in most cases going to continue. If a family has reacted to stress by manufacturing chaos, then an impending death is likely going to result in chaos. And, if a family system's preferred reaction is to create chaos, then that system will fairly predictably blow up when supporting institutions are least prepared to respond--that is, nights and weekends. Thus, the job of on-call chaplain for nights and weekends can be very interesting indeed.

To be sure, some families make some astounding changes when a member is dying. I have been tremendously moved--for instance, by a son long in conflict with his ill father who said, matter-of-factly, that they had decided they didn't have time anymore for quarreling and it was time to lay everything out on the table and get it over with. And so they did. And I've been similarly moved by other family members who have been inspired to take responsibility for their own participation in estrangements, seek to make amends, and offer words of love and appreciation. That's grace in motion, but to expect it of all families leads only to frustration and judgment. We only get a snapshot of dynamics, and we don't see the future. It is not true that everything has to be tied up with a bow before death--it's not true that that is "the last chance." What is, is. Even if it makes my hair stand on end.

So, our favorite mortuary driver showed up last Sunday when it was snowing outside. (The weather forecast, by the way, had mentioned "a chance of rain.") He was in his usual dark suit and long dark overcoat. He was smiling as he said, "It's snowing." I responded, "Yes, but it's not sticking to the roads yet." "Ah," he answered, "But it will be later on. And there will be NO traffic by then, and THE ROADS WILL BE MINE." He had a very sinister gleam in his eye, so I imagine some Very Quiet Passengers got the rides of their lives, or perhaps I should say the rides they never had in their lives.

We have a favorite mortuary too, now. The owners bring us donuts. LOTS of donuts. The owners are thin. This seems a little unfair. They are trying to build relationships in the community--hence the donuts--and I like them because they respect hospice work and are (we hear) very nice to families who select their mortuary. We cannot explicitly recommend or disparage any mortuary, especially one that feeds us donuts, but I do like these folks. Especially because one of them told me they could get me all manner of horrible marketing collateral for funeral products, which is another whole post in itself. I may take them up on the offer...

These folks are awesome

2010-02-09T23:02:00.002-07:00

When I work shifts in a hospital, I get called to the emergency department from time to time, and I am always amazed at the work done by the emergency department unit secretaries. The job seems to be an unholy combination of middle school teacher and air traffic controller. These folks, along with the emergency department charge nurse, keep track of who is in what room, despite the fact that there is no one spot where one can see all the rooms. (There's a computer system though.) Paper is flung at them from every direction--from EMTs and paramedics bringing patients in, from nurses and doctors. Phones ring constantly. Various law enforcement agencies appear, either to deliver or pick up patients. And the unit secretaries are expected to know what is going on all over the department. Amazingly enough, they do. When the hapless chaplain shows up, the unit secretaries are always there to set me right.

I remember a night when I was called to attend a cardiac alert. The patient was being "worked up," meaning that tests were being run and results returned. The emergency physicians had reviewed results and determined that the patient needed to be taken to the "cath lab" for an angiogram and maybe an angioplasty. The unit secretary had just received and relayed the message that the cath lab was ready to treat the patient. The only thing missing appeared to be a cardiologist, which would seem rather important. I learned that night that in this particular emergency department a cardiologist is called a "card." Thus, I was between the unit secretary and the room, and the unit secretary called over to ask me, "Do we have a card yet?" I peered into the room. "There's a new guy in there," I called back. "What's he look like?" asked the secretary. "Tall, slim, dark hair worn a bit long, expensively dressed, vaguely continental, with a hint of arrogance," I called back. "Ah. That would be the card. Your clue is the hint of arrogance," said the unit secretary. That does seem to be true, and I do think it is somewhat justified, having seen coronary arteries. Anyone who can navigate and repair those little tiny things deserves to be a bit arrogant in my book.

Arrogant or otherwise, this hospital has some very fine cards. For my part my fave is the one who brought home-made tiramisu to the cardiac unit's Christmas buffet one year. You've got to love a cardiologist who enjoys something less healthy than celery. Some of them are so intense about their vocation as cardiologists that their bedside manner suffers. A family member once wondered, vaguely, if his loved one's heart attack made him more vulnerable. Unfortunately he wondered this in the presence of a particularly intense card, who spent the next ten minutes lecturing the family member about what HE would recommend and how strict he would be about diet and exercise. I was really afraid the family member would pass out before the end of the lecture. Compared to the ascetic lifestyle the cardiologist was espousing, I think I'd rather have the heart attack.

The unit secretaries know everything, though. I don't know how they do it, but they just keep going. They ought to get a raise.

Some weeks are just like that...

2010-02-06T12:47:00.002-07:00

...or, never EVER say, even to yourself, "What ELSE can happen?"

You can tell that a shift will be intense when it begins with a call from a manager informing you of a loss the entire team needs to know about and asking you to come in and make calls and offer supportive presence. After some hours of telling the story, you begin to feel numb--you realize that you, yourself, have not had any time to react on an emotional level. That's the role, and that's normal. You know you'll have to make a space at some point. When the shift continues with a series of difficult deaths you begin to sense the dwindling of your own resources. That, too, is normal. It goes with the role of "on-call" or PRN chaplain. No one calls the chaplain because things are going SO WELL after all. By the end of a shift you can be completely drained.

I had a weekend shift like this last weekend. I had a memorial service to do the Monday immediately following, and this was for a WWII veteran. The military portion of the service took place at graveside. I had been meant to deliver a closing prayer prior to the military portion but things got turned round and I ended up at the end. Military tributes are, to me, heartbreakingly beautiful. It is hard not to tear up at "Taps." In my area, there is a group of veterans that provide tribute over and above what the armed services provide. For this deceased veteran, the U. S. Army provided three young officers for the flag folding and presentation and "Taps." The veterans provided an invocation at graveside and a 21-gun salute. The honors began as the hearse rolled to a stop, with the slow salute delivered to the casket of the deceased. It was all I could do to remain composed. The flag ceremony has such powerful emotion, contained in the precision of the ritual, the two young officers remaining impassive in face as they fold and smooth the flag. The bugler who played "Taps" was exquisite. A windy day, and the haunting last note echoed across the cemetery. The 21-gun salute by veterans not much younger than the beloved soul we were burying. The final slow salute, and retreat by the military. And now *I* am supposed to say something? I got through it somehow, and then watched as the adult grandchildren of the deceased searched through the grass for the spent shell casings from the 21-gun salute, to hold them as final mementos.

The next day, a funeral for me to attend as mourner. Got there late, the directions were confusing, the homily baffling, the family and friends mourning profoundly. As I walked through the parking lot to my car, I was thinking about this deceased, grieving the loss, worrying about the family, wondering what was in the mind of the homilist, and I tripped in a pothole and, as it happens, broke a bone in my foot.

What ELSE can happen?

Well, when I went to have the foot X-rayed, my blood pressure was running quite high. I wasn't too worried--I was stressed out and having a fair bit of pain, so it made sense.

The next day I trundled my foot off to work for another incredibly intense shift, one where a particularly beloved patient died. At the end of the shift I asked someone to take my blood pressure--quite high again. I saw my primary care provider the following day and now am making dietary changes and monitoring, but may well end up on blood pressure medicine. Alas. Genetics has caught up to me. I have just eaten a nice bowl of steamed chopped broccoli for lunch and, while I feel virtuous as all get out, I still want a nice big generic diet cola. Nope.

What ELSE can happen??

Last night's shift? Five deaths. Four new patients. The Grim Reaper must have gotten a special deal on "Incredibly Aggressive Cancers That Kill In Weeks" because we have been seeing a bunch of these, and the impact on both patients and families is overwhelming. Family members are just trying to come to terms with a loved one's diagnosis, and the next call is: Come quickly if you want to see him, he is dying...

And I always kind of rue the timing when an ambulance bringing a new patient has to park to the side because there's a mortuary van at the ambulance door.

I'm on call until Monday morning. I don't think I want to KNOW what ELSE can happen!

Whoa

2010-01-28T13:21:00.003-07:00

When I work shifts in the hospital, I respond to certain overhead pages--codes, of course, and then various "Alerts." A fairly common alert is a Cardiac Alert, which is sounded when a patient displays a suite of medical indicators that suggest the ticker is not ticking as it should. A Cardiac Alert generates a team of individuals who gather at the patient's bedside--portable X-ray, portable EKG, lab, nursing, a cardiologist, and a hapless chaplain, whose job is generally that of escorting the patient's family and friends to the appropriate waiting room. Cardiac alerts sometimes are called in the emergency department even before the patient arrives, which causes the assembled team to stand inside the ambulance entrance like some demented Welcome Wagon group. I feel at a loss there, with no machine or basket of tubes or white coat. I have to bite my tongue to keep from saying, "Welcome to XYZ Hospital. Would you like coffee, tea, or an angioplasty?"

One day a husband and wife were in the emergency department because the husband had been taken ill. They were in a room, a doctor had seen them, he was feeling a bit better, and they were watching TV and waiting patiently. Over the loudspeaker they heard the page: "Cardiac alert; emergency department; room 7. Cardiac alert; emergency department; room 7." The husband said, "Gosh, someone here must be REALLY sick." They took a moment to hope the person would pull through. Then the husband wondered, "Is this happening near us? What room are WE in?" The wife stepped out to look at their room number. "Uh... We're in room...7..." Seconds later the cardiac alert team burst into their room. I would imagine that if he wasn't having a heart attack before he had one then. Truly he had no idea; whatever the doctor had said to them, they didn't see this (us) coming.

He DID pull through, and what a story for the grandkids.

Sometimes marketing baffles me

2010-01-25T22:29:00.003-07:00

So there is an Exceptionally Distressing condition that impacts the male of our species, and within the last decade a number of products have become widely available to treat said condition. Apparently the condition is so Excessively Disturbing that the market for such products is great. I expect anyone who has ever had an email account has received spam offering these pharmaceutical products for sale. I am no exception, even though I am the wrong gender to find these products beneficial. (Indeed, I should say that if men affected by the condition relied upon female counterparts to purchase the products sales might well go down.) I noticed, around about the third week of November, a rather drastic increase in the number of emails in my spam folder, and upon looking further, I noticed that the drastic increase was solely accounted for by sales offers for products to treat the Extremely Devastating condition. I pondered this. I haven't changed gender or social activity level, so I began to wonder if the increase was related to the holiday season. Does the condition occur with greater frequency over the holidays, so that sellers are trying to strike while the iron is hot? (or not, as it happens...) Or, does the condition occur with less frequency, so that sellers have overstock they wish to unload? I cannot imagine. The trend has continued, past Christmas, past New Year's, past Epiphany. I'll see if it tapers off after Candlemas, but the approach of Valentine's Day may signal a continued barrage of spam. One determined spammer sends roughly three identical posts a day despite receiving no response whatsoever from my email address. This must be at least a mildly lucrative business given the level of email blitz which, while cheap, is not completely free. I wonder if the products being marketed by the spammers are even real. So often they are not. My favorite spammers send me offers for GENUINE Rolex replicas. Why have a FAKE fake Rolex if you can have a REAL fake Rolex?

I suspect I will never know why my spam folder has gotten so overloaded with products for the Eternally Depressing condition. I suppose it could be worse, but I really DON'T need to know how. Give me a good GENUINE Rolex replica any time!

Clusters of Bad Luck

2010-01-23T11:48:00.002-07:00

I know that it is easy to see "patterns" that are actually meaningless. That said, sometimes it appears as if, in our hospice program, certain diagnoses come in bunches. It will seem to me in some weeks that every other patient has pancreatic cancer, or end-stage coronary disease, or lung disease, or something. Perhaps there is some store where the Grim Reaper shops that offers half off on overstocked terminal conditions. A blue light special on anoxic brain injuries?

Sometimes it seems as if the kinds of complicating bad luck that families experience come in clusters as well. We may have several families in our program that have experienced multiple losses in the last couple years, or that have out of town loved ones trying like crazy to make it to see the patient in time, or that have other really sick loved ones to care for. We've had weeks where it seems that every other family has a family member who copes by using alcohol in ways that complicate the whole family's efforts. Not surprising given that we live in a culture where advertising would make us think that alcohol makes us better, stronger, and more attractive. Unfortunately using large amounts of a depressant to cope with depressing reality generally makes things worse rather than better.

On the other hand we have families that, under the terrible stress of a member's illness and death, show themselves to be wonderful and grace-filled in every way. I've been in rooms where 4 or 5 generations are present including little babies who are passed from lap to lap, and where those most in need are supported with respectful tenderness. One family member was concerned what staff members would make of the laughter that occasionally bubbled out from their doorway into the hall. "We enjoy each other's company," the family member told me. One could imagine the comfort brought to our patient, resting comfortably but not really talking, to hear his family enjoying him and enjoying each other as they always had. I think it's great.

I think it's especially great when there are families on the inpatient unit who have things in common, maybe little kids near the same age. They meet in the family dayroom where there's a TV and coffee and etc., and the kids may play together, and the families often care for one another in very tender and helpful ways. It can help us to help someone else, and thus I have seen women about to be widowed reach out to one another, exchanging phone numbers, talking in the hallways, encouraging each other. I have seen musician visitors to one family going to another patient room to play songs or sing with another family. I have seen families who love to cook bring enormous platters of food to the family area, reasoning that "everyone here is going through the same thing, and we all need to keep our strength up." HIPAA makes these shared efforts harder, but it is uplifting to notice that all the privacy regs in the world can't stop people who need to bond from bonding and caring.

Even deaths can come in clusters. We've had weekends where no one dies at all, and one memorable one where nine people died in 24 hours. Who knows why? Perhaps mere coincidence, perhaps atmospheric conditions. Perhaps heaven and earth have come very close in what the Celts call a "thin place," and more than one spirit has slipped through.

And now I need to prepare for work. This week brings a bunch of families who are trying like crazy to care for their loved ones at home, against great obstacles, and some of those loved ones may end up needing transfers for inpatient care. It also brings family members newly sensitized to questions about hospice, wondering if this choice is really "right" according to their religious beliefs. Hopefully there will be a baby or two to admire, maybe a dog to pat, a joke to share, and a way to make a difference for someone.

Wow! Technology!

2010-01-21T16:10:00.000-07:00

Hot diggety it is possible to blog via BlackBerry! I have finished my fourth and final unit of clinical pastoral education, aka CPE. To celebrate I upgraded my mobile phone and plan.

Don't know if this'll format right so I'll end here.

Euphemisms, Confluences of Catastrophe, and Observations

2010-01-17T22:36:00.004-07:00

Wouldn't YOU worry if a mortuary van pulled up to your ambulance entrance, and you noticed it bore special "handicap" license plates, with the universal little sign that is supposed to represent a wheelchair? I do. I mean, it's not like the passengers will care if they can't park right in front of the supermarket, is it? They're just going to wait in the van regardless.

It's not great, but it happens sometimes that, at a hospice, a couple of mortuary vans are at the ambulance entrance when a new patient comes in by ambulance. We hate for their first sight to be a mortuary cot with a Very Quiet Passenger on it, but it can't be helped. On the other hand, if a very anxious and stressed family is touring one of the wings, we ask any mortuary drivers picking up Passengers to wait until that family leaves before heading down the same hallway with the cot.

Usually, if the fire department is coming for a random safety investigation, they'll arrive as the charge nurse is trying to take report on a new patient while scanning orders while waiting for a doctor to call back, and while there are tons of people at the desk with questions about their loved ones, and the printer has just jammed.

I think every nurse in the WORLD knows what it means when a handoff report (for a patient coming into a unit) includes the sentence, "Oh... and he's been a little bit agitated this morning." BATTEN DOWN THE HATCHES, is what that means. There are all kinds of very good reasons why patients get agitated and unreasonable. And often, once someone has gotten agitated and unreasonable, it takes awhile to get back to calm and reasonable.

Sometimes the agitated and unreasonable person in a patient room is not the patient.

However, staff members are not allowed to medicate family members, friends, one another, or themselves. So you almost hope the agitated, unreasonable person in the room IS the patient.

If anyone came up with a way to deploy Ativan in a room spray, it would be worth a Nobel prize.

Telling a grieving little kid that his aunt is going to be SO HAPPY in heaven with Jesus is likely to put that kid off theology for a lifetime. Kids are smart that way.

Notes At the End of a Tough Day

2010-01-17T22:25:00.002-07:00

1. Drinking, as in alcoholic drinking, can kill you or your loved one at a shockingly young age. It's easy to think that one has years if not decades ahead to cope with the problem. Livers and kidneys can go pretty far south as it turns out before they let us know that all is Not Well.

2. If your loved one checked into rehab and came home early announcing he was sober and didn't need to finish? It probably isn't true.

3. People who are alcoholic do not want to be alcoholic. After awhile, a person addicted to alcohol is not drinking to feel good. He is drinking to stop feeling ghastly. And he doesn't believe there is any way, without alcohol, to stop feeling ghastly. And alcohol isn't working so well anymore...

4. If there is one disease that makes me wish in vain for a magic wand, it is addiction. Hell on earth for the patient and everyone who loves him.

More PSA

2010-01-10T21:02:00.002-07:00

Good to know, for your loved ones and maybe even yourself: There really is a difference between a person who makes decisions no one likes and a person who is incapable of making their own decisions. Unfortunately, well-meaning people can blur that difference by forgetting that there is no law that forbids a competent person to choose to live in an "unsafe" manner. It's is a good thing there is no such law, or else we would be arresting everyone who chooses to skydive or mountaineer, and if we got totally crazy we'd arrest everyone who chooses to drive a car.

So, if your loved one decides she wants to return home to independent living even though her heart might stop at any moment, say (or any number of other things), and that completely freaks you out, you do have some ethical choices. You could ask the loved one to reconsider; you could scrape up money and hire attendants; you could move in with the loved one or ask the loved one to move in with you assuming you can take care of her. But, if your loved one clearly understands the risk of sudden death (or whatever) and is willing to incur that risk because of her desire to live independently, and can be clear about that, chances are she is not incompetent. You can really disagree with her decision, you can wish she'd go to a nursing home or something, you can try to talk her into doing it your way, but you may not succeed.

You can intervene if your loved one is not capable of understanding her risk or is not able to decide whether that is an acceptable risk. If your loved one has dementia such that she cannot understand her condition and its consequences, you can intervene. If you are her designated decision-maker, you can override her wishes in aid of her safety. If she doesn't have a designated decision-maker there are ways of filling that gap. But if she's competent, all you can do is figure out how you wish to cope with the possible consequences of her decisions.

The systems in place for determing competence are not idiot-proof and some are not even fool-proof. I recently heard of a situation where an elder was found incompetent because the family felt her choices were unsafe, even though she was clear about her condition, wishes, and risks. She was seen by a mental health evaluator and thought the questions she was asked and the test she was asked to take were stupid and irrelevant, and said so. She was absolutely intransigent and crabby besides. The evaluators couldn't figure her out and decided she wasn't competent. Not so. The patient was perfectly competent to make decisions--she just made decisions other people didn't like.

We who work in hospice can fall into the trap of feeling that any sane person would like the care we can provide at end of life. Who on earth would want to be in pain, alone, and unsafe when there are options? Who wants to die in an emergency room or ICU with tubes in every orifice and machines for company? As it happens, plenty of people would make that choice--people for whom, say, agency and independence are much more important than comfort and safety. I met such a person once when I attended a hospice referral. EVERYONE involved--doctors, nurses, family, hospice admission staff--felt that receiving inpatient hospice care was in the patient's best interest. The patient, however, did not agree. And the patient was clearly competent to choose. This patient was a fighter, down to the bone. Remaining a fighter was how the patient found meaning and identity. The patient had a bad disease and knew it, but was not done fighting and might never be. I felt for the family because this patient would be hard to take care of, but we could not give the family the comfort of believing the patient incompetent. Hospice could have provided comfort and support and safely, but comfort and support and safety were not important to the patient as fighter. Our values did not match. I am guessing the patient probably did die in an ICU unit, or will, having stayed a fighter until the very end. And that has to be OK, problematic as it might be for those left behind.

DNR does not equal suicide

2010-01-05T11:39:00.003-07:00

I don't know why this is, but over the last several months I've encountered more families voicing some suspicion about hospice care than I did previously. Perhaps the elevated level of attention to health care (death panels, anyone???) has made people more comfortable asking questions than before; that would be good. Or, perhaps the elevated level of attention given to health care has made people more suspicious of the intentions of health care professionals (that might be good or not, depending on the situation).

A couple of people have asked me, as the chaplain, whether or not a DNR (do not resuscitate) order is tantamount to suicide. This is an interesting question, and it may be that in some communities there are recommendations against the DNR--I don't know. But in the cases where I've been asked, I've been familiar enough with the faith tradition to be able to assure the person that a DNR is not considered equivalent to suicide. I think there is a misconception about resuscitation, perhaps based on TV, where rescues are so often so totally and unconsequentially successful. To be sure, sometimes resuscitation does succeed, but if you or your loved one is older and frail, and there's a terminal diagnosis, especially one involving the heart, the chances are that if your heart stops, it won't be in the mood to start up again no matter what is done. Without the DNR, the default position of a first responder has to be to try to bring you back, and that will involve someone slamming her or his weight on your chest about 100 times a minute. If your heart SHOULD be horrified enough to start up again, and you SHOULD eventually wake up, consider that now you will have the terminal diagnosis you started out with plus multiple rib fractures. This will not feel good. You won't be able to breathe well enough to keep your lungs clear, assuming they were clear to start with, and you will have won the battle but lost the war, in a painful way. Having the DNR in place is not suicide in this situation. Rather, it is protecting yourself or your loved one from what is called "futile care" -- that is, care that won't help you. Although, as I say, it may be that some religious communities have a particular opinion about the DNR, I'm not aware of any that believe we are morally obligated to accept care that won't help us.

That said, there are some people who need assurance from their own community or denomination when it comes to the implications of treatment decisions. They can't and shouldn't rely on my word as a chaplain. That's when my job is to facilitate the conversation where it needs to happen, and stand with the patient or family member against pressure for a fast decision. It's easy for the medical system's value for speed to take over, but at the same time a patient or family member who is not sure about a decision is one who will carry that unsureness forward throughout the course of the decision, whatever that may be. Especially in a decision for comfort care or hospice, it's normal to have some lingering doubts, which can be very painful and stressful, but if a simple visit with a priest or pastor or leader can take some pressure off or offer some concrete guidance, it's well worth having that visit.

Someone once mentioned a desire to "have my DNR tattooed on my butt." If you have a similar intention, let me do my civic duty and warn you that the first responders will not roll you over to check your butt. Have the DNR, and the name of your MDPOA, tattooed on your chest, which is what they will pound on if they feel the need to resuscitate you.

Just a Simple Request

2010-01-04T21:28:00.003-07:00

When a patient gets transferred from one facility, let's call it Health Care Facility A, to another, let's call it Health Care Facility B, flow of information can be critical for proper follow-up for the patient's needs. Often whoever is caring for the patient at Facility A speaks directly with the receiving professional at Facility B, as the patient is being rolled out the door at Facility A. (This is by no means the only communication, because are procedures all along the way including a formal acceptance of the patient by Facility B.) But the last-minute report, usually exchanged between nurses, can be very useful. It can be especially useful if the nurse at facility A has cared for the patient for longer than ten minutes, although this is not always possible.

My simple request is this: if, at Facility A, the patient has loudly and frequently voiced a preference for receiving a dozen root canals with no pain reliever while lying on a bed of nails over being transferred to Facility B, could someone include that in the report? It would sure help me do my spiritual assessment... actually, it would help me preserve my hearing while attempting to do my spiritual assessment.

Evidence-Based Blog Changes

2010-01-04T21:23:00.002-07:00

So, I have finally selected a different template for the blog, if you can still call it one given the infrequency of my posting. I have finally believed the research that shows that light letters on dark are Very Hard To Read, even though I sort of liked them. Thank heavens for "canned" templates for those of us too lazy to love html.

It may now be that I have enough material so that I can blog thematically without having to worry about HIPAA and patient/family privacy concerns. The last thing any blogger wants is to inadvertently post something that makes a patient or family member feel that one is describing them in a particularly intimate time. As it happens, there are plenty of bigger themes that I like to blab about, and there is humor to be found in those as well, and pathos, and the like. So we'll see how it goes.

If this is heaven...

2009-09-23T13:00:00.002-06:00

The other night I was working a shift in the hospital. I was paged to a Code Blue. Most times when I'm paged to those the outcome is bad for the patient and family, so I was trying to get myself mentally in gear as I headed for the department that had paged me. I spotted the typical cluster of respondents--portable X-ray, lab, portable EKG, in a hallway, and joined them. The doctors and the nursing supervisor were in the room. The X-ray technician told me the patient was conscious and talking which is pretty rare. I peeked in and there were plenty of folks round the bed, starting medicines, checking monitors, and the like. The patient was on the bed, which was tilted so the head was downward, and was talking to a doctor. Usually by the time I arrive the patient has Gone to their Reward, is Resting, has Passed, is With the Lord, is In a Better Place, or has Crossed Over, effectively even if not officially. Lying head down? Talking to a doctor? If this is heaven, maybe I'm not so excited about trying to get there.

A rare good outcome; hoping things worked out for this patient.

These are the stories that linger

2009-05-31T09:56:00.002-06:00

Not long ago I saw a patient I'd met months past, an old man with dementia and other severe health issues. I'd seen him a few times before he got better and went to a nursing home, and I loved him. He had not had a very easy life, and I imagine he hadn't always been a very easy man. His family had some conflicts and struggles too. He'd been a stubborn man, and he didn't like asking for help, and he really just wanted to be in his own home, but he needed more care than family members could provide, so he had to live in a nursing home. He came back to the hospital not long ago, his dementia by now very advanced, and his other health problems as well. There had been some sort of accident at the nursing home, a bad one. He had fractures and bruises and cuts, and lots of stitches. I was horrified when I saw his poor battered self resting in a bed. The medical staff had determined they needed to get his pain under control before even doing a full assessment of his condition, so they were waiting for medicine he'd been given to take effect. He was moaning--I got his nurse, who checked him and got more medicine. I sat beside him, trying hard not to cry. So many bruises and bandages and cuts and stitches, no wonder he was hurting so. And his breathing sounded awful. I touched his hand, and he grabbed mine and held it tightly, his face turned slightly toward me. He would doze a bit, awaken coughing, and start wailing, or maybe it was keening, again. I told him we would get him feeling better, but he just kept on keening. On a hunch, I said to him, "We'll keep you safe here. We'll protect you." THAT had an effect--he stopped keening and seemed to settle, only to wake again. I tried the reassurance several times--he always settled to the words, "We'll protect you." He was so frightened. He didn't know where he was, or why, and he was in terrible pain, and I don't know about his accident, perhaps that frightened him as well. Even a healthy old man would have been upset, and this was not a healthy man. A family member came in to be with him. We decided he was chilled, and I went to get him a warm blanket, and told the nurse I thought he was afraid. I told her the words that had calmed him and she wrote them down to use later when she needed to give him more care. Back in the room, I helped tuck the warm blanket around him, very gently so as not to hurt him more. He wasn't afraid of me, it seemed; I could touch his head, his shoulder, his battered face. I murmured more assurance to him, told him we loved him, told him once more we'd protect him. Medicine was starting to work, and he was settling. It was time for me to get out of the way so his family could be with him without interruption. I checked on him a couple times before my shift ended. He had finally been able to rest, but his breathing was even worse. The family had been called back in. Early the following morning, he died.

I couldn't get him out of my mind for days. I will never know what all transpired to bring him back to the hospital. He'd had his accident some days earlier and been taken to an emergency room for care, and apparently he'd been taken back to the nursing home to recover, and then been brought back in. I just hated seeing him so hurt, so vulnerable, so terribly frightened. This is not what he wanted or what his family wanted for him. It isn't what I would want for anyone. It isn't the way we'd want anyone to die.

We don't take the best care of our vulnerable elderly in this country and culture. They're pushed to the side by the younger generations; they aren't making money anymore; they aren't the demographic that even churches want to attract. Those who care for them in nursing homes are not well compensated. And sometimes, our vulnerable elderly end up like this poor man, broken and bruised and terrified, because their medical needs are too great for care at home. Their friends are dead or dying, their political clout is zero, and in most cases only family members are left to care about what has happened to them. They have become anonymous.

So, today, I want to make this man a tiny bit less anonymous. Sure, he was an old man with dementia who could no longer even recognize his family members. When I first met him months ago, his capabilities were already greatly diminished. Nonetheless he was full in personhood to the end. He liked music (big bands, Sinatra). He liked a good meal. He liked company--he liked having his hand held, he liked to laugh. He was a lifelong Baptist who'd been a member of a huge urban church. He liked church music and hymns. He liked the Bible, and he loved to watch religious programming on TV. He liked a kind of religion that was upbeat and gave him hope. He liked the Lord's Prayer. He had a radiant smile and wispy hair that stuck out every which way no matter how often it was combed. He liked being outdoors, watching television, and birds.

Now he is gone, and his suffering has ended. May he rest in perpetual light.

More mortuary bad fun plus best Five Wishes ever

2009-03-06T15:08:00.002-07:00

So the mortuary drivers have learned that I am up for a good story--two younger men who work for one of the transport services told me the following one. They had been called to a home. The service for which they work always dispatches two drivers/vans to a home in case the removal is, ummmm, complex. So to speak. This was a very straightforward removal until the moment the two men were wheeling the cot and its Very Quiet Passenger down the driveway of the home, at which time a pizza delivery truck zipped up and parked. The pizza person jumped out, grabbed the pizza, turned around, and was confronted by two men in dark suits and a very unmistakable mortuary cot with a very unmistakable Dead Person thereupon. The men told me the pizza person's facial expression was absolutely priceless, and the act of stepping back while juggling the pizza and trying not to fall right down in the middle of the street took great coordination. The drivers called up to the house and found out someone alive had ordered the pizza and was prepared to pay for it, and took off about their business, but I imagine the pizza person needed a stiff drink at the end of the day at the very least.

One of the hospice patients in a care facility had completed the Five Wishes document to outline his end-of-life choices, a very good thing to do. This individual had always been fiercely independent, very bright, and very outspoken. Friends, family, and caregivers reported that his communication could be painfully blunt. Thus, a choice for having inspirational readings and beloved poems read at the bedside was eliminated with three large, FORCEFUL X's. Likewise he'd written the word "Bull***t" next to a section exhorting the family of the writer to see the writer's death as a personal growth opportunity, indicated that he didn't care at all how his family disposed of his remains and suggested the decisions be based on financial reality only, scribbled in the margin that his family could believe whatever they wanted about death, and indicated, for his thoughts about his death, "Not liking it much." This was the best such document I've ever seen, in terms of giving a glimpse of the person who wrote it. An out-of-town relative attended the death and I brought out the document for the family to think about a mortuary. This relative found such a sense of her loved one in the document that I made a special copy to send home. You don't have to be "nice and polite" to be real and worthy of love and remembrance. Through reading the wishes the relative got one last chance to "hear" the loved one, and was able to realize his essence had maintained throughout his illness, and found that comforting. As for me, I just loved that "Five Wishes." Especially the big forceful Xs crossing out everything that sounded schmaltzy or inauthentic to its author. I hope the God of humor did not greet the author with a squadron of chubby harp-playing angels sitting on a fluffy cloud.

Catching Up

2009-02-07T14:02:00.003-07:00

It's been a while, again--this'll be kind of a random post.

Sheer joy at the inauguration of President Obama!!!!!!!! That this country is ready to have, as its representation to the world, someone who is not white, is a huge source of hope for me. Things CAN change. And, as an old romantic and an old feminist, it did my heart good to see the closeness between him and Michelle Obama. Who is everything one could dream of in a First Lady: drop-dead gorgeous, brilliant, accomplished, honest, and, with her husband, very attentive to their children.

Completion of second unit of required 4 of clinical pastoral education (CPE). Now I'm in the third. I look to a time when this will be over; it's expensive, good learning to be sure, but wearying. I need the four units to make myself at all plausible as a chaplain.

Grief as well as joy and pride as seminary classmates proceed to ordination. It's so complicated; never have I been so sure that my choice was right, but that doesn't mean I have to like the consequences. At core I do experience a call to ordination, a sense that ordination is somehow a piece of who I am. I don't know if, or how, I will find it...

Have been hanging out once per week at the Episcopal Cathedral--there is an Evening Prayer service followed by Eucharist each weeknight, and since weekends aren't feasible, I've been going there, usually Tuesdays. It's a very small group and many aren't all that friendly, one senses they are there for a time of meditative worship and soul-feeding rather than community, and that's something I understand quite well. Now I know one fellow's name--big progress! The most friendly person I've encountered is the Dean and Rector, who is sort of both CEO and pastor of the cathedral parish, and a very outgoing fellow. No doubt a politician as well, one doesn't get to be Dean and Rector of a Cathedral parish without some skills in that department, but I like his warmth and humor. He's asked me to read a couple times at service, and that feels like "coming home," and brings both deep sadness and deep joy. The services are liturgical and beautiful and I do sense the possibility that this denomination, problem-ridden as they all are, could be home. The rub? I don't know that the Colorado Diocese currently implements the procedure for endorsing lay chaplains, which I would need if not ordained, and ordination? I can't imagine that as possible, and if I could imagine it as possible, I imagine it would require many more years of preparation...

Meanwhile I have friends pursuing ordination in UCC, which does ordain for chaplaincy, and is theologically open, and etc. And its ordination process is said to be more sane than others, although not everyone agrees. I don't know much about it at all.

So much to learn, so little time!!!!

Bad fun on the night crew

2009-01-13T20:20:00.005-07:00

So, I have a standing joke with one of the charge nurses who works night shift at the inpatient unit to which I am sometimes called. When I leave, and this nurse is charge, I always tell him I'm "off to Joe's (bar and grill, our imaginary local cheap bar)." I bring him greetings from the mythical Joe, and we talk about the price per pitcher of beer. He tells me how many pitchers I should drink for him. If we are with a patient who is up for it, we involve the patient in the joke. The other night, I had finished handling a death, and I told the charge nurse I was off to Joe's. A floor nurse, thinking I meant the nearby St. Joseph Hospital (called "Joe's" in the same way that the nearby St. Anthony Hospital is sometimes called "Holy Tony's By the Sea"), said he hadn't known I was on call for them. The charge and I corrected him. I said, "No, no, Joe's BAR AND GRILL." The charge nurse said, "We hang OUT together, at Joe's bar and grill." The floor nurse was flummoxed. Which, of course, made us more determined to be poker-faced. The charge nurse was actually getting off in an hour, so we talked about meeting up in an hour. I reminded the floor nurses I was still on call until morning and promised to stay relatively sober, and left them, laughing all the way to my car. It's hard to shock a crew of hospice nurses, especially a night crew, but hey, you have to have fun.

This particular night crew has lots of jokes. For some reason, a number of us have acquired imaginary names, with the last name "Suggs." I am "Reverend Suggs." Who knows why. I don't know that the managers quite know what to do with us, but that makes it even better. Since some of the more difficult deaths happen at nights or on weekends, when we have to lean on each other for support, shared jokes have a special importance... you really HAVE to laugh when a family wants an autopsy, and it's after hours, and there's no one there in the Pathology department of the nearest hospital to tell us what to do to arrange for the autopsy, and when we finally find the policy it doesn't say who pays to get the body to the hospital, and a family member says, "Well, we HAVE a van..." and all you can think of is the urban myth about the stolen station wagon with the deceased grandmother strapped to the luggage carrier.

(I should say that we got the body to the hospital without use of any private vehicle. The family negotiated a transport by the mortuary who was going to get their business for the final arrangements. One reason the family wanted the autopsy was because they suspected that hospice treatment, where we don't give IV fluids "just because we can," had resulted in death by starvation for their loved one. Our favorite mortuary driver arrived to transport the deceased to the hospital's morgue. He asked why the autopsy, and we explained we'd starved the patient to death, because we are just like that. He was nonplussed by the size of the body, the loved one having been a person of some stature. He complained, "I thought you starved this person to death, why's she so heavy?")

A public service announcement

2009-01-10T12:19:00.004-07:00

Get those advance directives going! I have had an update on the law in my state, and, given that the update comes from a physician board certified in hospice and palliative care who has practiced for a long time here, it's well worth repeating.

Here's the thing: in my state, if you become incapacitated and do not either designate a medical durable power of attorney or leave advance directives, things get very complicated. What your doctors are required to do is contact those closest to you and ask them to name a party to act on your behalf. A consensus is not required, the physician explained, but an election is.

Think carefully about this. Are your closest relatives close at all? Is ANY of them a person you'd like to have acting on your behalf? Would you feel guilty imposing that responsibility on them? Or, in a darker scenario, is the one most likely to be elected the one least likely to know what you'd want? Family dynamics are complicated, I'm just saying.

And if you have no directives, no MDPOA, and no one can be found to act for you? DOCTORS will. Often, the doctors caring for you in this situation will be doctors who don't know you at all, and won't have (and shouldn't be expected to have) any idea what your values are and what you would want done for you.

Get to work on those directives. Attach them to your fridge with a magnet. Better yet, tattoo them on your body. In more than one place.

Oh coroner! My coroner! Or, the job market is bad, but still...

2009-01-10T12:00:00.003-07:00

In the state and county where I work, the coroner's office must be notified of every death, and depending on a series of criteria, may be required to conduct a death investigation. Even for patients in hospice care, a death investigation may be required. One common reason for a death investigation is a fall or fracture in the days right before death, that precipitates the final decline. When hospice workers report the death (by paging a coroner's investigator; one is on call 7x24), the investigator may request certain information from the medical record, may come to the site to examine the body, interview the family, and review the records, and may elect to have the body transported to the coroner's facility for further investigation or autopsy. There was a death in a care facility one night, and the coroner's investigator requested transport of the body for investigation. Luckily, the family said their goodbyes and left the facility before the transport service arrived. I say luckily, because the transport service dispatched a driver who looked as if he'd been repairing a car when he got the call. He was a big burly young guy, dressed in work pants and jacket--I looked for his name in an oval patch on his jacket, but that detail was missing. He had a badly grown out crewcut, dirt under his fingernails, and bloodshot eyes. His cot squeaked badly as we walked to the room to retrieve the body. I told him he needed some WD-40, and he muttered something about a brake job. He then told me he hadn't been getting more than a few hours of sleep a night for weeks, because he'd been filling his brother's call shifts while his brother was on vacation, and that particular night (it was about 2 AM) he'd had only about an hour of sleep. "You're DRIVING?" I asked. "Yup," he said, "Hope I make it." I think if I were the deceased I'd sit right up in horror at that point, and plan to make my way to the coroner's on my own, but this deceased was apparently unconcerned and remained Very Quiet while loaded into the back of the van. I hope he made it, because you'd hate to be the family and hear that your loved one had been in an auto accident ON THE WAY TO THE MORGUE. Seriously, if I'd been a family member and this guy showed up to transport my loved one, I'd have declined permission, not that it might have done much good, since it was for the coroner's office. And, in any case the driver told me the back-up for his shift was HIS GRANDFATHER. Apparently the business is family-owned... Imagine making conversation on dates, saying you worked for your family's business DRIVING DEAD PEOPLE ON ONE HOUR OF SLEEP. This poor guy is doomed to remain single for a long, long time, I fear.

Don't even know what to name this one

2009-01-07T10:15:00.002-07:00

I got a call once, to go to the scene of a death in the home hospice program. The home hospice program brings hospice care to a patient wherever the patient happens to reside. In this case, the patient lived in one of those retirement complexes that offers graduated levels of care, all the way from independent apartments through assisted living to a skilled nursing facility. These can be wonderful since residents don't have to completely leave their friends and support relationships when they find themselves in need of more care.

So I agreed to meet the hospice nurse at the complex. When I got there, I found a gentleman in white shirt, tie, slacks, sport jacket, wearing an ID that identified him as a chaplain from the complex itself. I hadn't known the complex had a chaplain or had called a chaplain; we introduced ourselves and the chaplain explained he lived in the apartments, was a retired pastor, and was one of the chaplains available to all the residents at the complex.

There are a number of clear advantages and wonderful possibilities about the arrangement this complex has, having retired pastors available for the spiritual needs of their fellow residents. Unfortunately, none of those advantages was in evidence in the situation I describe. This particular chaplain, while well-intentioned, was very hard of hearing, did not know the deceased or the family, and had a skill set that relied almost exclusively on saying prayers and reading Christian scripture.

The family, consisting of a heartbroken spouse and a number of supporting relatives, arrived at the scene. They'd been visiting the deceased most of the day and really had not expected death to come that evening, so they were shocked and regretful at having left, in addition to heartbroken over the death. The chaplain and I began to talk with them; it soon became apparent that the family was in no shape to cope with the repeated questions owing to the chaplain's hearing problems. (The spouse would introduce an adult child to the two of us, and the chaplain would then ask something like, "And what is the relationship between you two? Is she your daughter?") The chaplain optimistically mentioned prayers and scripture; a lot was going on at the moment but it did not escape my notice that the family, without a single exception, ignored the suggestion.

I had to meet with the hospice nurse briefly and on my return I noticed the family seemed even more restive. It devolved that the chaplain had announced he would take the family to view their loved one, and the family wasn't sure they wanted to do this at all, and REALLY didn't want to do this until one last family member arrived. I assured them there was no hurry and no rules, they could do exactly what they wanted. The chaplain interjected that now we would say prayers and read scripture. I caught a desperate glance from one family member. It seemed to say, "DO something about this man, or I can't promise I'll stay polite." I interjected that it didn't seem that prayers and scripture sounded comforting, and perhaps the family would just like to remember their loved one while waiting for that last person to arrive. The desperate one jumped on that suggestion as if it was a winning Powerball ticket, but of course the chaplain then asked, "Do you have a church?" It devolved that the family really is not religious at all. Fine by me. Finally the last relative arrived and the spouse wanted to go see the deceased. I said, "I can walk you back to the room so you can have some family time." The chaplain, perhaps not having heard, said, "I'll go with you." We marched ourselves to the room and I said, "If you need anything at all, I'll be in the lobby where we were sitting," and firmly closed the door, leaving the family inside and the chaplain and me in the hallway. I wish I'd had a brain in my head; if I had, I'd have invited him to come with me and tell me about his ministry. I didn't have a brain in my head, so he stationed himself roughly three inches from the door of the room.

Shortly after, the hospice nurse asked me to come back with her while she explained some logistics to the family. We went back, and to my horror, the room door was open and the chaplain inside. When we entered, I caught another desperate glance from the same family member who'd silently begged for help earlier... We said what we'd come to say; the chaplain was standing there with a look of impending prayers and scripture. This time I decided not to mince words. I asked the family if they'd like a little time alone, AS A FAMILY, and the desperate one leaped on the suggestion as if he'd seen a second winning Powerball ticket, and we escorted the chaplain out. This time, at last, he got the hint and decided he'd return to his own apartment, as long as the hospice nurse and I agreed to stay as long as the family might need us. We thanked him for coming, and I for one WATCHED HIM LEAVE. The nurse and I went back, I to the lobby and the nurse back to the nurse's station to handle the required procedures. The family took some time and then, assured that there was nothing at all that they needed to do, took their departure.

Encounters like this one are why a lot of folks are suspicious as can be about chaplains. A lot of folks have met "religious types" who aren't sensitive, who have a religious agenda, who insist on inserting themselves into a family in ways that are not helpful. There's a lot of baggage that goes with the word "chaplain" and all of these things are part of that baggage. To be sure there are families whose religious values match those of that chaplain who might have found his presence reassuring. Unfortunately, the family we were there to see was not such a family, and the chaplain did not have the ability to shift tactics to a different way of support. I am guessing that he also had a bit of judgment, a bit of feeling that the family "should" have religious values more like his, and a bit of hope that he could steer them in what felt to him like an appropriate direction. That might have been his job as a pastor, but it's not the work of chaplaincy, which is to be present to the family as they are, to offer what they need if you happen to have it, or find the right person if you can't do what they need. And a ministry of presence sometimes means having the sensitivity to realize that you need to get the h--l out of there and leave the family alone.

POA, POA, my kingdom for a POA

2009-01-02T12:53:00.005-07:00

In health care settings we are always aware that we are encountering but a tiny slice of a patient's (and family's) life. We try our best to understand the person and family but sometimes the task is like trying to assess the overall health of a human body by looking at a single "slice" of a CT scan. You can see what's right in front of you but not what came before, except by inference. Sometimes things sort of make sense but other times something comes blasting into the situation as if from left field.

I am thinking of a patient who was admitted to hospice care. Six people were involved in the decision (the patient was in a coma and couldn't make decisions). Five of the six believed that hospice care was in their loved one's best interest. The sixth did not, wishing for continued aggressive treatment. Where I live, the law sets up a heirarchy of relatives in terms of their right to make decisions for an incapacitated patient. A spouse, for example, takes precedence over an adult child, who takes precedence over a parent, who takes precedence over an adult sibling, etc. This heirarchy, however, is trumped by a medical durable power of attorney (MDPOA). If an MDPOA exists, the person who holds the MDPOA is the authorized decision-maker for the incapacitated patient.

In most cases, even if one member of a family holds the MDPOA, that member consults with other family members and a consensus is reached. That's a good outcome, because the burden of making life-and-death decisions (like withdrawal of life support when a situation appears beyond recovery) is enormous upon whomever is tasked with the decisions. If the family is in agreement, the burden is shared, and the members of the family can support one another through the tough time.

Sometimes that doesn't work, and existing conflicts in the family come into play and get acted out around the end-of-life decisions. A family member who has historically felt disempowered may be vocal in opposing the care plan determined by the MDPOA, and that gets hairy, because the opposed family member often attempts to engage the caregiving staff against the MDPOA. The law is clear, however, that the right and responsibility to act for the patient rests with the MDPOA. So the opposed family member really cannot be allowed to determine the course of treatment, unless the MDPOA agrees. I have seen families where old sibling rivalries explode into fights over care of an incapacitated parent, and also seen families where old rivalries for a family member's affection produce agonizing conflict over who really was close enough to the person to understand their wishes, the law be damned. Often you can't figure out what the fight's actually about when it explodes. And when deep pre-existing conflict is at the bottom of the fight, you shouldn't put any money on the possibility of reconciliation any time soon.

In the family I'm thinking about, the patient was admitted to hospice, and five of six relatives agreed to make that choice. From the understanding of the hospice staff, no MDPOA existed, and among the five in agreement were several who are right at the top of the legal heirarchy. The one dissenting relative cannot overturn the choice, except--after several days of private and public stewing, the dissenting relative claimed to hold the patient's MDPOA. Yikes. That could change everything. If the relative were to produce a valid MDPOA, then it may be back to the drawing board, even though the incapacitated patient has apparently been pronounced incurable by a number of medical specialists.

It can be difficult to see where God is when the tempests are raging. The family member whose needs are most important would seem to be the incapacitated patient, who is unable to make or articulate decisions about care or quality of life. Of course, when families are in conflict, every person genuinely believes that she or he is representing the true desires of the incapacitated one, even if that belief is fueled by personal need. In the shock and anguish of a loved one's end of life, we all hear what we most want to hear, and so interventions from staff have to be both compassionate and very clear. Sometimes the chaplain's role as I've experienced it is to find a way to affirm all of the warring family members while letting go of any expectation of facilitating a resolution. Sometimes clarification (and re-clarification as needed) of facts is helpful, to give relatives in great pain the option of engaging a channel other than the emotional. Sometimes social workers are the best support, facilitating family meetings, arranging for physicians to answer medical questions, etc. But the desire for a miracle can captivate family and care staff as well. The family, or some members, may desire that God restore their loved one's health or that God would turn the hearts of those opposed to their point of view. The care staff may get caught by the desire that the family be united in peace, which in most cases would be as big a miracle as the healing of the patient. My own notion of chaplaincy is to model straightforward acceptance of the "as-isness" of the situation. I find myself saying things like, "You and your parent may never agree about this; you represent two genuinely different points of view," but also saying things like, "The story's not over; I know you feel completely at odds with (whomever) right now, but who knows what the future may hold." That, and trying to actually be in the room with the anger and tension and the cloud of unknown history, and hold each member tenderly. And remind other staff that the family's fight is not with us but with each other, and it's old.

This one was tough

2008-12-24T12:23:00.003-07:00

Jack (not his real name) was a lovely man in his eighties whom I met when his wife died in hospice care. I spent time with the family during her last illness and was the chaplain on duty when she died. Jack was deeply affected by her death. He adored her and had been her main caregiver for a long time, as she had some chronic health problems before her final illness. Jack would weep, openly, at her bedside, because he knew how much he'd miss her. He had adult children and grandkids too, and all of them adored him and vice versa. We all hoped he'd be OK given what a disruption as well as a loss the death of his wife would be. His wife had become the center of his life, and caring for her had occupied most of his time, and when that happens the adjustment is enormous--there are so many empty hours to fill. I was drawn to Jack immediately, because he was absolutely genuine and open-hearted. He was not afraid to show deep emotion for his wife and family, and at the same time he was very much a strong man. I just loved him, all of us who cared for his wife just loved him. He and I met up again at the quarterly memorial service the hospice provides for patients who have died in the past few months. Jack remembered me right away. He gripped my hand and wept, we hugged and talked. He was there with several family members, and it was clear that there was a lot of love in the family.

Just a couple months after his wife died, Jack came into the hospital for something that seemed pretty minor. Unfortunately, it seemed that every test he had revealed some new, ominous problem. He had operation after operation, had a heart attack during one operation, and finally had a stroke. He wanted treatment carried out until it was clear he could not get better, as his organs were failing one by one. At that point he came into the hospice inpatient unit. And there he was, the big strong stocky man with his leonine head, his big hands, his very proper VanDyke beard, dying. He remembered me and was too tired to talk. We wanted him to rest and sleep, finally free of all the tubes and monitors from the hospital. He'd put up a tremendous fight but was utterly worn out. The medical staff worked to control his pain, while family members gathered.

On Sunday afternoon I was at the nurse's station and a daughter-in-law ran toward us crying. "He just stopped breathing." I grabbed his nurse from report and we all ran to the room. As soon as I looked I knew he was for all purposes gone. The nurses waited until all reflexive breaths had stopped, and verified that his great heart had stopped beating. Then they left. The room was filled with sobbing. One thing about Jack--his sons-in-law and daughters-in-law loved him without reservation. He was their Dad too. (One son-in-law had told me the day before that Jack had been the one who taught him to be a man, just by example.) The family asked for a prayer which I led, my own voice breaking. Imagine losing both your parents in just a couple of months... I checked in on the family a couple of times in the next few hours. Busy with other emergencies, I didn't see them when they left, but I did have the chance to go see Jack one last time, as the mortuary van was driving up. I sat beside him and caressed those big hands, blew him a last kiss, and told him goodbye. He was simply a wonderful man--I'd learned that he was a combat veteran of WWII, wounded in action. He was also a quiet philanthropist. His family told me that until his last illness, when they'd had to pay some bills for him, they'd had no idea how many charities he'd supported without a word to them. He loved to give and receive hugs, and tell stories, and play cards with his friends, and he loved his family dearly. He was a rock to them, someone who was always simply there. It was tough to say goodbye.

Merry Christmas in heaven, Jack. I imagine you and your beloved wife as newlyweds again and wish you eternal joy.

Economy and Waste in Health Care

2008-12-18T13:41:00.002-07:00

Let me start by saying that I think there are many valid points of view about what causes health care costs to be so dramatically high and to rise so dramatically fast. Doctors see different things from patients, and both may see different things from accountants who see different things from insurors and lobbyists and etc. So I fully acknowledge that even the sum total of all I see or could see from my perspective is only one viewpoint and not the whole.

However, there are things that certainly make one wonder. A new patient came into the inpatient hospice unit recently. This patient has had some serious diagnoses for quite awhile and everything kind of came together in a perfect storm a couple months ago. The patient was in and out of the hospital, in and out of intensive care. A couple weeks ago the patient, who could in layman's terms be described as "held together by chewing gum and baling wire," was discharged from the hospital to a skilled nursing facility (SNF) for "rehab." This lasted about 24 hours, whereupon the patient was returned to the hospital in critical condition and went back to ICU. And back onto a ventilator.

Now, obviously, cost is minimized when patients get the appropriate level of care in the appropriate (that is to say, cost-effective) setting. And to be sure nothing is gained by keeping a patient in a hospital who doesn't need to be there, but really? Two ambulance transfers in 24 hours? With all the coordination and paperwork and orders and etc. that are required to transfer someone to another care facility? How much money did THAT save? The patient is now in hospice, the last acute crisis having pretty much shown everyone that the prognosis is simply awful, the patient is suffering terribly, and it's time to quit with the invasive curative stuff and look for comfort.

I really am annoyed by expense that is disguised as efforts toward efficiency. Such as, holding meetings every single day to browbeat department leaders about why they are not more cost-effective. If the meetings degenerate into repetitive exhortations to "do better," and, in the industries where I've worked that tends to be the case, then they become, themselves, a huge waste of money as well as a morale-destroyer. I suppose you could call that efficiency: wasting money and ruining morale in a single meeting. I'm sure Scott Adams has explored this theme in the Dilbert strip and books.

A death early this morning, and our wild and crazy mortuary driver appeared. I warned him the deceased was a good-sized fellow, not tall but sort of stocky. He sighed. "They're all big, today," he said. He'll be more chipper in a couple more days when we have some snow and ice for him to drive through.

Oh, and here is a GOOD rant: I was present at a death of a gentleman of middle age. His mother and sister were attending him. A brother had died recently, so this mother had lost two sons in, I think, less than a year. The earlier death had happened in some sort of care facility and unfortunately a new age romantic had attended the family. The romantic had told the mother that she should not have her hands on the body of her dying son because "It would hold him back spiritually" and "She needed to let him go." She had tears in her eyes as she said, "I didn't get to hold my son..." and wondered about THIS son. Who, as it happens, had curled his fingers around my hand when I touched it. I'd transferred his hand pronto into his Mom's hand, where he continued, although profoundly unresponsive, to curl his fingers round hers. "LOOK," I said to her. "There just is not one rule for all. Your SON will tell you what he needs, and you will know. If he gets agitated when you touch him, you will know he is asking you for a little space. But, see, he is curling his fingers around your hand. It looks to me as if he LIKES having you touch him. You're his MOTHER, you know him, you stay here and do what you know will help him." He died less than thirty minutes later. With his mother and sister holding him. The way they wanted, the way he wanted, the way they didn't get to do thanks to the romantic, the last time. Blech. Now, I suppose it is possible that the previous son was agitated and the caregiver wanted to diminish the stimulation around him, that can happen. But the way it was phrased, that's mean, and I call it every bit as much abuse of power as if the caregiver had told the mother her son would go to hell if she didn't get him to say the sinner's prayer.

When we have agitated patients and they need calm, I would ask the family to try giving the patient a little space and emphasize that as a way for them to help, which is what they are yearning to do, rather than lay some sort of trip about "holding back spiritually."

Enough grumbling, time to walk Big Fuzzy!

A pretty boring post

2008-12-17T14:07:00.002-07:00

It was soooooo cold over the weekend that my windshield washing fluid froze in its jug (and in its reservoir as well). I have purchased a jug of SERIOUS windshield washing fluid that purports to be good to minus 34 Fahrenheit. Having done so I can rest assured that the remainder of the cold season will be warmer than the weekend. Despite the windshield washing fluid fiasco, my car cooperated brilliantly, starting without fail on the first turn of the key. I big-puffy-heart my car.

This afternoon I have to assemble the bits of a holiday package for my Sole Blog Reader (well, perhaps one of two, but the one related to me). Said reader is unlikely to be reading, as I suspect he is suffering the pain of Inevitable Disappointment From The Hero. Yes: Our President-elect, though in many ways apparently of sane mind, has proposed the Superintendent of the Chicago Public Schools as his choice for Secretary of Education. This on the basis of "experience with what's really happening in the classroom." I can barely type these words; I flinch, imagining them as so many lashes in the flesh of my Sole Blog Reader. On the one hand he was warned, as I did, I believe, mention the tendency of heroes to disappoint, while rejoicing with abandon at the results of the Presidential Election. I do feel constrained as a proper chaplain to inject SOME hope into the situation by pointing out that, as the head of an even larger bureaucracy in DC, the proposed Secretary may be hindered from doing any further harm to the hearts of minds of those who actually participate in What Happens in the Classroom. Also, should the selection pass muster, the City of Chicago and its Schools will have another Superintendent, and provided the current Superintendent's name is not hard-coded into too many places in the City's new computer system, things might improve.

You think?

Oddments

2008-12-13T13:39:00.002-07:00

The husband of a hospice patient who died a few months ago is now in the hospital himself. A granddaughter stopped by to let us know and ask if I could visit him. I went over that evening and found this lovely gentleman on a vent in the ICU. I guess he has been found to have serious heart trouble and also cancer, and has undergone a couple of serious surgeries. He has a lot going against him medically, and the stress from the loss of his wife is a huge additional factor. He really adored her and, in her last days, he alternated between trying to be strong for her and the children and grandchildren and simply weeping at the loss. His granddaughter is afraid he'll "give up." I kind of hate that language as it implies that death is a failure, and who could blame this gentleman if he just wants to be with his wife? The family, though, at least some members, are still reeling from the earlier loss and don't want to imagine losing him as well, and who could blame them either? Given all that he has been through in terms of cancer and surgeries, I don't know what his quality will look like if he survives this hospitalization, so I hope that what is best for him is what happens, and that his family will find the support they need whatever comes about. This is the second time in the last couple of months that I've visited a widowed husband in the hospital. The first one did die, which seemed understandable, as he told me that two combat tours as a paratrooper had been indescribably difficult but only a drop in the bucket compared to the difficulty of losing his beloved wife. Both of these widowed husbands have been really wonderful men, good husbands and fathers, beloved in their families. And I have loved them, too. It's hard to see them suffer...

I am especially lucky to have a couple of friends whose mere existence makes the world a far better place. I don't see them often enough due to demands of their lives and mine, but I did run into one of them earlier this week. He's a program director for a local nonprofit that provides emergency assistance to individuals and families. It was pure, pure joy to see him and talk to him--he's one of those people whose main decision point, about anything, is "What is the RIGHT thing to do?" This focus, rather than a focus on expediency or a focus on money, can put him in opposition to organizational structures at times but he is absolutely steadfast. He told me that the needs for emergency assistance in the community he serves have at least tripled in the last few months with the downturn in the economy. Sobering. On the other hand, he is one of the funniest people in the entire world and he always leaves me laughing. He has at least a couple of books in him, and I hope with all my heart he writes them!

Speaking of books, one of my classmates at seminary has published her first. I recommend it without reservation; it's Salvation on the Small Screen, and its author is Nadia who blogs at The Sarcastic Lutheran. It's for those with a healthy skepticism, an interest in theological reflection, and a stiff sense of humor. I sat in the local coffee shop laughing out loud through it, and my brother and sole blog reader also enjoyed it.

And speaking once more of books, I think our craziest mortuary driver should write one as well. Oh, the stories. SUCH stories!!!

And the reason this post is so boring is that I worked all night Thursday and my body clock is completely out of whack. I could sleep for a week, though I don't need to!

A sweet moment...

2008-12-11T14:29:00.003-07:00

I was at a care facility and visiting an elderly lady who didn't seem to feel much like talking. She was sitting in a chair in her room. I noticed her hair was a bit tangled, and I asked her if it would be all right if I combed it. She said she'd actually like that. So I picked up her comb and started, very gently, working out the tangles in her pretty silver hair. I told her her hair was like spun silver. She was quiet for a moment, then talked about her grandmother's hair. I told her about my grandmother's hair, and about one of my aunts, whose hair turned white overnight, so the story went, when she was 24 years old. She started talking, a bit at a time, about her family, and eventually talked about the death of her father when he was very young, about how much she'd missed him and still did, about her most clear memories of him. She's well into her eighties, and that loss impacts her life to this day. I don't know if she'd have ever told me the story if I'd approached her as a "conventional chaplain," since I've been told she's a little suspicious and isn't always very talkative with strangers. How lovely to have time as two women, bound by a ritual as old as history, of gently caring for her hair and telling stories.

Back again with another note from my Advance Directives

2008-12-10T10:37:00.002-07:00

I would like to begin regular updates. If wishes were horses, of course, beggars would ride, but let's see if I can do at least a little bit better than I have.

From the ever-increasing stack of my advance directives: If I have dementia and I am not peaceful in my dementia but rather miserable, and if I fall and break some ribs, and give myself a pneumothorax (collapsed lung), PLEASE do not put a chest tube in to reinflate the lung so I can go to a SNF for rehab. Chest tubes hurt for one thing, and if my memory is shot I won't be able to remember why it is there, and it will freak me right out everytime I see it, and so I'll probably make repeated attempts to remove it, and I'll end up in restraints. And I won't like that, not one little bit.

So: a big NO to the chest tube, a bit YES to Oodles O Drugs, aka Comfort Care.

Bad Fun, or the pleasures of a remote door control

2008-09-16T23:09:00.002-06:00

In a building where sometimes I work there is a back entrance that is for ambulances, mortuary drivers, deliveries, etc. There's a doorbell thing back there so that the arriving driver can alert the desk, and there's a security camera system so that the desk staff can see who's there and then remotely open the double doors with a switch.

Late at night in a high-stress job, lots of things seem really entertaining. The other night a mortuary driver arrived, his first visit to this particular building. Typically the drivers back up to the ambulance entrance, finish a bunch of paperwork (you don't do anything in this life including leave it without generating paperwork), and then exit their vehicles, remove the "cot," and ring the bell. We can watch them from the desk. This new driver didn't know the drill, so he called the main number on his cell phone. We told him we'd let him in. He didn't get out of his van, though--he started on the paperwork. Oh, joy--we hit the switch, and the double doors swung majestically open. They're on a timer, so about the time he opened his door and got out of his van they swung equally majestically closed. He looked a bit nonplussed as he got the cot out, and we timed it perfectly, opening the door again just as the second set of wheels hit the ground. Now he thinks the building is psychic, because at night you really don't notice the security camera. I guess if you time it just perfectly, you can have the doors swinging closed as the unfortunate soul outside is grabbing frantically at them. We ARE a simple people, we are, and easily entertained in the middle of the night.

Recently I saw my favorite mortuary driver, the one who loves to drive in rain and snow. It was a beautiful day and so he was a little bored with the road conditions, but he did entertain us with some rather remarkable retrieval stories. And one crucial piece of information which should perhaps be stencilled in lime green on every piece of rental medical equipment. If your loved one is ailing at home, and you are setting up a room in the house for your loved one's care, think about this: If it is ALL BUT IMPOSSIBLE to get the hospital bed into that room, it is going to be ALL BUT IMPOSSIBLE to get the loved one OUT of that room. Especially if said loved one is, not to put too fine a point on it, At Rest, Deceased, In His Glory, Merely Sleeping, etc., etc. I am advised that locations which require negotiation of spiral staircases, and basement locations, and locations down long twisty halls, are popular but not logistically sensible. I know, I know, it seems weird, but just let Great-Uncle Cuthbert snooze in the middle of the living room in his rental bed and recliner. Great-Uncle Cuthbert will enjoy the 52-inch flat screen TV same as anyone; the presence of the TV will encourage friends and relatives to keep him company, and all KINDS of things will be made more simple.

No, don't thank me, passing along these little tidbits of advice is just one more service I offer on this poorly-updated blog.

A snippet from my "advance directives..."

2008-07-30T12:52:00.004-06:00

...which do not actually exist yet in written form, my bad. My state is a "Five Wishes" state, which means that I could, if I choose, use the very popular "Five Wishes" document to define what I do and don't want at the end of my life and most particularly identify the person to serve as my agent, medical durable power of attorney, whatever it is called where you live.

Now, I do have some problems with the Five Wishes--there are some twitchy items I could choose, like wanting everyone in my family to resolve any differences they may have if possible (talk about a good guilt trip to lay on the family as one trips out the door), and wanting all my loved ones to know that I see my death as a time of personal growth for them and me so that the end of my life will have meaning (hmmmmmmmmmm.... that is just too New Age for me and I think there are plenty of things that give life meaning that don't require me or anyone else to think about personal growth). The biggest thing about Five Wishes is that it is a wonderful vehicle to begin thinking about end-of-life issues, but it can't possibly, in itself, carry all the context-sensitive information that you'd want folks to act upon near the end of your life. Thus, you must choose your representative with care and have many conversations with that person, and/or write a lengthy addendum to the Five Wishes. If I choose the Addendum Option, I suspect mine will be about 30 pages long, ranging from the sublime, as:

If I have end-stage dementia and I hate my life and I fall and bust my hip, I truly do not want to do surgery and rehab for the busted hip. There are times and places for huge amounts of painkillers, frequent access to ice cream and mashed potatoes, and letting nature take its course. That's one of them.

To what may seem ridiculous:

If I am in your facility, and I am not able to speak, and you feel impelled to turn the TV to the "relaxing music" option, resist. Resist with all your might and main, because I WILL haunt you. Some "relaxing music" (stuff by Will Ackerman, very notably) is absolutely beautiful and I like it. But the rest? Elevator music. And that stuff sounds to me like fingernails on a chalk board. While the resulting increase in my pulse and blood pressure may be initially gratifying to you, it means I am going nonverbally nutso. And in this, as in so many areas of life, it is, truly, the little things that make a difference.

From time to time I'll put snippets of my Imagined Addendum into the blog with the hope that they will (a) inspire focused thought on your part about your own Advance Directives, and/or (b) make you laugh.

Sacred space in red flannel

2008-07-27T22:47:00.002-06:00

In the past several months I've gotten to visit some patients who are receiving hospice care at home with relatives as their principal caregivers. I have seen some caregiving that is so exquisite, so tender, that even remembering brings me to tears. There was one man who was wearing his favorite blue striped pajamas along with a pair of shoes that were meant for serious walking. He was hours from death and not really responding to voices. His family told me he'd wanted those shoes on earlier in the day. "We don't know why," they said. "But he wanted them, so we put them on him, and he seemed to like that." His room was quiet, softly lit, comfortable in temperature, and the most restful place you can imagine. Friends as well as family would come and sit silently with him for a while, and his old dog wandered in and out. The love in the room was palpable, and so was the peace. The family had wanted a prayer and a blessing for him before he died, and that's why I got to meet them. I think his blessing had come, time and again, in the love with which he was cared for.

Another patient was tucked up in flowered nighties, amid a riot of flowered sheets and pillowcases. Her bed was placed so that she could look out into the garden if she liked. The room was full of family pictures and treasures. The caregiver and the patient were delighted to have days to simply be together. "I know the sheets don't match," said the caregiver. "But she likes flowers, and I found everything I could that had flowers on it." The effect was simply joyful.

Recently I visited a home where the patient, who had had dementia for some years, was dying. (She died the next day.) Her family had cared for her at home all those years and now were preparing for her death. Her caregiver had dressed her in soft, old, comfortable flannel, and all the sheets and pillowcases that touched her were also flannel. The caregiver told me she wanted only soft things to touch the patient, so that nothing would rub or chafe at her skin or cause her distress. Red flannel, blue flannel, flowered flannel, all washed and soft and arranged very lovingly around her. The room, again, was softly lit and quiet. Family members took turns sitting beside their loved one, whispering to her, stroking her hair, holding her hand. She looked as comfortable as a person can look and as peaceful as a person can look, and even though she'd had dementia for a long time, it was clear that her family members adored her and were focused, in their care, on who she was, what she liked, what she needed.

Each of these families was concerned that they do caring "right." In each case, the patient looked so comfortable and so peaceful that a piece of me wished I could crawl in beside them and rest with them. Not every family can do this, but the families of these patients had found a way to make caring an act of love, acknowledgment, and even joy. The dying time, in each home, was a special time to "fuss over" the patients for the last days, to accommodate their whims or to respond to their special likes or simply to cherish and comfort a beloved body by surrounding it in softness. Homely things--a pair of shoes, a flowered pillowcase, a soft red flannel sheet--seemed imbued with sacredness because of the tenderness with which they were offered. There was absolutely nothing on earth that anyone could suggest to any of these families to improve their care. The patients were blessed in their surroundings, and I was renewed, and deeply humbled, at the sight of "family" at its very best.

The Power of the Bible (YIKES!)

2008-07-15T23:36:00.002-06:00

If you are familiar with folk remedies in the USA, you'll remember that folks with ganglion cysts were advised to "cure" them by smashing them with the family Bible. A ganglion cyst is a fluid-filled bulge in a joint capsule, usually in the hand or wrist. Smashing them, aside from the obvious possibility of collateral damage (too bad about all those little bones in your hand), CAN reduce the swelling, but it does nothing for the weak spot in the joint capsule that bulges. Well, maybe if the capsule leaks and then scar tissue forms, the fix is more permanent. I don't know. In any case this folk remedy seems to me to be taking the phrase "healing power of the Word" farther than I tend to want to do.

Nonetheless the Bible is cherished by many, and what translation you bring to visits does matter. Based on some stories in Oliver Sacks' incredible book The Man Who Mistook His Wife For A Hat, it has seemed right to me to use the King James version when reading to elderly patients, especially those with dementia. I found in my student placements that singing "old standard" hymns, or sounding them without words, could be very connecting to patients with dementia, perhaps because the familiar sounds connected these patients with a sense of peace and comfort. So it made sense to me that, for these patients and perhaps for most, hearing cherished texts in the translation most familiar to them would be particularly comforting. For most older Protestant patients, that means the King James version, complete with "thee" and "thou."

Once I was at the bedside of a patient quite near death. Family members mentioned that they had felt a pull to read Bible passages to their loved one who had been a faithful member of a LCMS (Lutheran Church, Missouri Synod) church for many years. They'd been reading from a Bible they found in the care facility, one of the more modern translations. I mentioned offhand my thought about the King James. When I was about to leave, a family member asked if I'd read from that version. So, I read psalm 23 and then psalm 121. At the end of 121, as I closed my book, the family members said "Amen." The patient exhaled--and then did not inhale again, having slipped away on the "Amen." It took me a moment to realize what had happened because it was so peaceful, and once I did realize, my instantaneous thought (luckily a silent one) was, "Oh crap, I've killed her." The family members, tearful and joyful all at the same time, said, "See? She just needed her King James Bible." Who knows.

Ah, blessed humility

2008-07-15T09:55:00.002-06:00

Once I met a patient and family who were just arriving at the facility. The patient was a bit older and wore glasses, as do I. The whole family was pretty stressed out--electing hospice care is not a milestone any family looks forward to or takes lightly--so I asked if there was anything they might like: coffee, tea, some ice water. The patient asked for coffee. I asked about cream and sugar but heard no answer. So I brought a cup of black coffee; the patient took a sip and bellowed, "How come you didn't put sugar in my coffee?" At this point I realized the patient had trouble hearing, and I was really embarrassed. No point in attempting to disguise the obvious, so I bellowed back, "I guess because I am DUMB. How many sugars would you like?" Patient answered, I went and got the sugar, and a spoon, and a napkin, and brought it back with an apology. Now, I wear my hair cut very short--my hair doesn't hold a curl well at all and, if left long, clings flat to my head in a most unappealing manner, so a very short cut is the most practical thing I can do. Our patient added the sugar to the coffee, took another sip, was far more satisfied, and looked up at me and said, "Well, I think you're a nice fella anyway."

There will be NO doves at my funeral

2008-06-04T22:58:00.002-06:00

So I have to do two memorial services next week and, as always, working on service planning makes me re-visit the many services I've attended and remember all the things I DO NOT WANT to have happen at mine. Whenever it happens. A non-exhaustive list which will, hopefully, be informative to those who have not considered the truly remarkable things relatives and friends WILL come up with to honor the deceased.

1. Doves. There is a company in my city that consists of a guy, a truck, a portable stereo, a microphone, a speaker on a tripod, and some number of white doves. For a fee, he will appear at your event (wedding, funeral, Arbor Day picnic, whatever) and perform a Ritual of the Doves. For funerals, there are several choices, with prices increasing with the number of white doves involved. The guy reads an explanation of the significance of the white dove (which I can't remember), reads a really maudlin prayer/blessing, releases the agreed-upon number of doves, and plays a song. "On the wings of a dove??" I can't remember that either despite having heard it a number of times. The last of these I saw, the survivors had chosen the "Holy Trinity" package. For this, the Dove Guy brings 4 white doves. One dove, representing the spirit of the deceased, is handed to the closest survivor to hold while the maudlin blessing and prayer (which does sort of go on) is read. The other three (for the Father, Son, and Holy Spirit, of course, and OF COURSE only male language is used, eh) are released first, and then the survivor releases the fourth "when he/she is ready to let go of the loved one." I think you can see how this could go terribly, terribly badly. In some families that fourth dove would be taken home and put in a cage in the front room and stuffed and kept there through the generations after its own demise. In others, the poor bird would be squashed flat as a pancake in seconds due to unconscious, unresolved feelings re: the spirit of the deceased. At the last Ritual of the Doves I attended, the day was really REALLY cold. The Father, Son, and Holy Spirit, released from their traveling carrier, blasted off like bats out of hell (or maybe bats out of International Falls, MN, in January) and could not be seen after the first .5 seconds. The fourth dove was released after a tasteful pause of another second, and it too vanished from sight in no time. Those poor doves wanted warmth and shelter and really all you could see was a flurry of wings. Not too impressive. Plus all the funeral attendees had to get up from the chapel and GO OUTSIDE IN THE COLD to watch the release. Now, I know lots of people who derive profound meaning and comfort from the Ritual of the Doves, but I don't, not so much, so no doves at my funeral.

2. Open mic. It has become popular to leave an interval in memorial services so that "anyone who would like to share a (brief) memory" can come forward and lay claim to the microphone. No, no, no. This is NOT a good idea. I mean, it might be fine if your crowd of mourners were all quiet, polite, tasteful people with strong inhibitions about speaking in front of others. You might hear some sweet memories about how much the deceased loved family or church or Rocky Road ice cream. BUT, and it is a big BUT, the crowd of mourners is not always of like mind on what constitutes proper disclosure, and sometimes there are folk there who either talk too much under stress or have agendas of their own. And oh my heavens, can things get hot then. I have heard way too many well-substantiated stories of how things that should NEVER HAVE BEEN SAID AT ALL were blabbed at the open mic. Like, lovers coming out of the woodwork, presenting themselves to the family members who are now horrified as well as bereaved. Or people purporting to speak for the deceased offering a little Final Honesty ("And, to his parents, I just wanted to say that he always resented you for the ways you treated his brother better..."), or people of strong belief that is nonetheless not shared by the deceased or family, nattering endlessly on about how they are just SURE that Aunt Edith really DID accept Jesus Christ as her personal Lord and Savior despite the fact that she went to synagogue every Saturday. Nope. No open mic at my funeral.

3. Star Trek. Yes, it is true, some folks do live and die by Star Trek. My former supervising pastor officiated at a Star Trek-themed funeral. The open casket featured the deceased in uniform, and a loop of apparently-relevant snippets from Star Trek episodes played endlessly through the gathering. The pastor was somewhat nonplussed that the loop was not stopped during his homily, but gosh. Sorry, but no Star Trek.

4. Nude pictures in the photo montage. If there should ever be someone in my life with whom I enjoy getting nude and taking pictures, I truly hope that person will not need to share said pictures with whomever turns up at the funeral. No matter HOW MUCH they want to remember me naked (and truly I cannot imagine ANYONE wanting to remember me naked--quite the opposite I should say). It adds an extra edge to a service when the officiant has to watch the relatives closely to be sure that no one is experiencing a Coronary Event from viewing the photo montage. No nakeds. None.

5. Video footage of me on my deathbed. Yup, have seen this one. Video footage of the deceased looking quite poorly discoursing on the Bible quotes to be read at the service. Please. If I want particular quotes and particular interpretations I'll write it down. No video. No video RECORDED, to say nothing of played at the funeral.

5. Tschotchkes of mine, wrapped in wrapping paper, handed out to the attendees. Look, whoever has to cope with all my crap, just hire a rolloff and dump all that stuff, OK? You don't want it, fine, but foisting it off on folks coming to the memorial is tacky, plain and simple. I think it must be a beloved custom somewhere in the country, because the one time I saw this practice, most folks took it in stride and thought it sweet, while I stood in the back thinking GOOD GOD, are these people CRAZY?

6. Altar calls. No, no, no thank you. My demise is my demise, not a chance to make a random and scruffy bunch of strangers feel guilty about their relationship, or lack thereof, with their Personal Lord and Savior. No. That's a cheap shot and it SCARES PEOPLE.

And that's enough for tonight. For our next lesson, we'll talk about the inadvisability of incorporating certain types of music into the service. For instance, the Schubert Ave Maria. Sung by amateurs. Oh, no, no. None of that. Also no puppets. God created the stereo system so that neither of these ploys need ever be mentioned again.

Too hot to handle

2008-04-28T21:56:00.004-06:00

There are very few nursing homes that will accept patients who have "behavior problems," which is a real shame, because there are lots of medical conditions that can disrupt people's behavior in ways that are beyond their control and that make them very tough to care for. I have seen some patients with medical problems that make them "disinhibited" sexually such that they can be offensive or even assaultive to caregiving staff. Once in field placement I was visiting at a care center and such a patient was escalating into agitation. I was able to keep him somewhat calm by wheeling him in his wheelchair round and round (and round) the facility but eventually I had to take him back to his room, where he thought it would be a grand idea if I joined him in bed. He grabbed me to implement his idea. I disengaged myself pretty easily and left him to (hopefully) calm down by being quiet in his room. I let staff know about his behavior, and they sighed wearily. The patient started shouting and cussing. The staff decided that it might be best not to respond, so as not to reinforce his behavior. (I was thinking more in terms of massive doses of antipsychotics but those were apparently not ordered for him, at least not that day!) "Just ignore him," the charge nurse told a young female CNA, who was cutting another patient's hair out in the hallway. I was charting in a corner behind the nurse's station. Aside from the screaming and cursing the environment was peaceful--that is, until the CNA let out a bloodcurdling shriek. The agitated patient had crawled out of his room and sneaked up behind her and stuck a hand up her shirt! "Didn't you see him coming?" one of the nurses asked. "YOU TOLD ME TO IGNORE HIM," shrieked the CNA. The patient, with a satisfied glimmer in his eye, was "escorted" back to his room by two security guards. The charge nurse brought the CNA back behind the nurse's station to have a break and file an incident report. The CNA seemed pretty shaken. Thinking to console her I said, "I know, it's a drag, but it's not your fault, after all he tried to haul me into his bed a while ago." "OH MY GOD," wailed the CNA, "HE TRIED TO HAUL THE CHAPLAIN INTO BED WITH HIM." The charge nurse said, tongue firmly in cheek, "He must have really wanted to get closer to God." I really had to laugh then. Wouldn't he have been in for a surprise? He was at least nominally Catholic, and in the Catholicism of my family upbringing, bedding a Protestant would have been a ticket to the hot place even if he HADN'T been married already. The care center staff were about fed up with the patient; I phoned his primary hospice nurse, who began ripping HER hair out by the fistful, and the last I heard, the poor fellow was on his way up to a more controlled unit with a behavior management focus, and the hospice provider's medical director was receiving an urgent request for some serious medication. I have to say, I was grateful for the time spent in an inner city church, where persons with behavioral issues are not at all uncommon. It really helps to have a context for separating the patient to some degree from the behavior, realizing that the offensive behavior is really NOT personally directed, and finding the humor in it all.

A particularly sweet moment

2008-04-28T01:29:00.003-06:00

I am a white Anglo-Saxon Protestant person and I have to say that sometimes we who fall into that cultural grouping are a bit reserved when it comes to physical affection. I am not talking about sex, but about daily affectionate touch and tenderness. Once in awhile I see a WASPish family break that stereotype, though. I am thinking of a patient I knew once, an old man who had a large, loving family. In his last couple of days he was slowly dying, mostly unresponsive, but being kept comfortable by family and care staff. His family members were unabashedly tender to him. I saw especially his grown sons caressing the dear balding head, leaning foreheads down to touch his, holding his arms, resting a loving hand on his thin chest. I saw wife, sons, daughters, gently holding his old, worn hands, shaping their own hands to his hands, arms, face, body, allowing their hands to store the memory of their loved one's physicality. I could imagine how our patient's gnarled, spotted hands must have held his sons and daughters, loved his wife, in the years past. I wondered if, even deep in his coma, he might have been soaking up the love of his family, feeling the tender caresses and wordless farewells, taking comfort from the touch of his own dear ones right through the very moment of his death. I wondered if, in the days of loss after his death, family members might have found themselves unconsciously curling their fingers into the shape that had held this dear man's hands, or stroked his head--or remembering the precise feel of his forehead against theirs, his cheek against theirs, his lips against theirs. Their time of farewell felt poignant and so sacred to me, because it was both "spiritual" and sensual, and because his body, even old and worn and sick, was so thoroughly, respectfully, and tenderly loved.

Have a thought for those left behind...

2008-04-22T22:04:00.002-06:00

...and, if you have loved ones in the teens and twenties, say, and you are dying on a weekend, you might want to think about holding off until mid-afternoon. My tongue is thoroughly in cheek as I write this, thinking of the young person who was called to the hospice because of the death of an elder--let's say a great-uncle. Close family, everyone was coming to be together. Sadly, the great-uncle died between 8 and 9 AM on a Sunday, and when his young relative arrived, it took no great insight at all to discover that Saturday had been a party night. The young person encountered a sign on the patient's door advising a checkin at the nurse's station and came and found me. I gently explained that great-uncle had died about an hour before. Even though the sign was on the door, I explained, it was OK to go in, because there were a number of relatives there enjoying some last time with the beloved great-uncle. The young person took a step toward the room, then reeled back in horror, so unsteady that I leapt to offer an arm. "Do you mean... he, it, I mean... is IN THERE STILL????" Yes, I said, the body is still present. "Oh, whoa, WOW, oh, wait, I don't think I can DO THAT." Eyes like dinner plates, mind slowly grasping the whole scene, slowed, one might guess, by lingering effects of the night before. Look, I said, there are no rules, you certainly don't have to go in, you can do what feels right to you. Would it help, I asked, if I knocked on the door and asked a family member to come and speak to you? "Oh, WOW, oh, yeah, OK, could you do that?" I did. I noticed the young person hung waaaaayyy back, not wanting even an accidental glimpse of... him, I mean it... Family members came out and I left them to work out the details. I imagine that young person was looking for "a hair of the dog" within moments of leaving the hospice!!!

So, elders, let your young relatives have at least a few hours of sleep before expecting them to come join you, er, it, er whatever. Oh, WOW.

Procession

2008-04-19T13:44:00.002-06:00

The patient had been much-loved. Family and friends were in the room with the body; I went down to ask some quick questions and get the form filled out that would permit us to release the body to the family's chosen mortuary. They let me know that they would remain with the body until the mortuary transport arrived. It was clearly hard for them to let go. Some tried to remain calm (as if we needed them to) and then wept in sadness for their loss. A strong Christian faith told them their loved one was now free of pain and with God, but there is nothing, nor should there be, that removes the pain of loss. I told them that, when the transport came, their loved one's body would be placed on the cot, and they could follow it to the exit, if they liked. They liked. When the mortuary attendant arrived, I took him aside and asked that he leave the face uncovered until the body was loaded, to which he agreed. We walked to the room, I introduced him, and stood back. When the family was ready, the CNA and I and the attendant wrapped the body in sheets and transferred it to the cot and tightened the straps around it. Then the attendant draped the cover over the body, leaving the face uncovered, as we'd agreed. We rejoined the family in the hall. They had given me permission to walk with them, so we set off, slowly, down the hall, turning the corner to the utility hall, slowly down that long, bright, barren hallway, on the gleaming tile floor, a ragged but heartfelt procession, down to the ambulance entrance. The attendant stopped as someone hit the switch for the double doors to swing open. I started to pray, aloud: "May the angels, dear M., receive you into paradise; may they bear your spirit upon their wings to the presence of God..." The doors opened, the family and friends gathered around me. We watched, in silence, while the attendant slid the cot onto the rails in the back of the transport vehicle and closed the door. The double doors swung closed. A family member touched my arm. "Thank you," she said. "I didn't know we would be allowed to do that."

Most families leave before we call the mortuary. Most times, a CNA then goes in to prepare the body for transport by removing peripheral IV lines and subcutaneous sites and foley catheters and placing a toe tag. Mostly we place bodies in body bags, though the majority of hospice facilities do not. And then we close the room door and leave a sign on it that directs any visitors to the nurse's station. When the transport attendant comes, we do paperwork, escort them to the room, and they load the body and take off. Sometimes that feels just right, but sometimes it seems as if the body, dead, becomes a piece of scut work, our interest no longer focused in that direction, just manual tasks left to do. Sometimes we can discount the impact on a CNA when we ask him to handle the body of someone for whom she has provided the most intimate of personal care and companionship, place that body in a bag, and zip up the bag over the face. It is a tough thing to do, and I think that once in awhile that's why the task is so easy to assign to CNAs. So, being an irreverent sort of chaplain at times where "scope of work" is concerned, I have made myself available to help if needed. Some of the best nurses do so as well. I notice that we all, CNAs, nurses, and I, "talk to" the person as we prepare the body. And we comb the hair, wash the face a last time, carefully arrange the hands. I think that last preparation can be a sacred moment, because even if you do believe that body and spirit are utterly separate and spirit is always better, the body has been loved and cherished, lived in, and in its unique pattern of strengths and weaknesses has played a huge part in who the deceased was and how he or she lived and died. And the body is the medium through which the family and friends have encountered the deceased, and the loss of its familiar presence, its appearance, texture, substance, is a huge piece of their grieving. So, to me, that body deserves tender care in the preparation for transport as much as in its living state. Providing that care honors the person who was and those who grieve--and also allows us to feel the loss and say a last goodbye. I think it has meant something to the CNAs that the chaplain will come and help, and sometimes it has meant something to the families waiting outside the room as well.

Suicide is painless--not so much

2008-04-15T20:55:00.002-06:00

Working shifts in the hospital, I have gotten called to the emergency department several times to see patients who have attempted suicide. These are draining situations for all who deal with them, for a lot of reasons--sometimes the staff members have lost relatives or friends to suicide or have histories of depression, as I do. The situations that give me the coldest chills are the truly lethal ones, where it is possible to piece together the story and realize how intent the patient was on death. Each story is different but every one involves careful planning, concealment, deception of family, all in the service of a drive to death. The patients arrive at the hospital only because some strange fluke resulted in discovery of their plan; but they don't always survive. Depending on the means they've chosen to kill themselves, or the amount of time elapsed before they are found, it may not be possible to save them. If they do live, it may be only a matter of time before they try again. I suppose that what makes these calls especially creepy is that the drive to live which often helps other patients survive extreme challenges of illness or injury is, in the lethally suicidal patient, locked in combat with a relentless drive to death, and it is truly--truly--unclear which drive will prevail. Very scary stuff. And the families--no idea the patient has had this in mind, it hits them straight out of left field. The first priority is survival of the patient but even when that happens the story is only beginning. I don't think things ever go back to "the way they were" after a lethal suicide attempt. Treatment for the patient might or might not help--not every person responds to medicines for depression--sometimes the suicide attempt itself leaves disability--the lack of parity for mental health treatment means that medicines and therapy may be out of reach--and the stresses, losses, pain that may have interacted with the patient's depression may be irreversible. It is very hard to find hope, to encourage families to have hope, when the obstacles are so formidable. It is hard for me to stand at a bedside with family members, watching the numbers on a monitor, hoping against hope for signs a patient is going to survive the physical consequences of a lethal attempt. I know in those moments that the family can't completely comprehend what lies ahead and that they will be desperate to find a fixable problem, to ensure the horror won't happen again. But what is true is that when the drive for death overwhelms the drive for life, there is no way to prevent a suicide. And that is a sobering reminder of finitude, of how utterly limited we are as human beings.

Prayers have been requested...

2008-04-02T16:54:00.002-06:00

A few long, blabberish posts ago I mentioned a young blogging couple who are doing their best to live out what they believe is God's will for them. Tonight it looks as if the young wife, who has end-stage cystic fibrosis, may get the double lung transplant that could offer her some more years to live and raise her baby daughter. Her husband has asked, on his blog, for prayers, for her and them of course, but also for the donor and the donor's family, who must now be in tremendous grief, and for those who are going to be in travel this night to get to either family.

Let's do it.

Great postcard

2008-03-31T21:01:00.004-06:00

Where I work there is one nurse who is a real outdoor-adventure lover. He's done all kinds of wilderness activities, ocean activities, you name it. Someone brought in a postcard for him that just cracked us all up. The photo on the postcard shows a forest scene with a pickup truck in the middle. In the bed of the pickup is a hospital bed with an IV hung on a stand near the head. There's a guy propped up on pillows in the hospital bed; a nurse, in starched white uniform dress and cap, stands beside him, fingers on his pulse and eyes on her watch. He's holding a rifle or shotgun across his knees. The caption is something like, "This could be the last season I get to go out hunting." Hospice IS a philosophy not a place, no?

Cool people

2008-03-31T20:46:00.002-06:00

One reason for loving my job is that I get to meet absolutely terrific people I wouldn't have met otherwise. I got to see a favorite recently--he is the widowed husband of a woman who died some time ago after a short illness. I was the hospice chaplain with her and the family when she died and I quite lost my heart to the family. Her husband is now in his eighties, and he's not in the best health himself, and he has some dementia. But he has one of the biggest hearts I've ever encountered, and he's utterly emotionally open and utterly delightful as well. When I was meeting with the family to plan his wife's memorial service, I remember sitting with him -- he was utterly shattered by this loss as they'd been married for a long time and very close, and had been a terrific match for one another. Husband was ex-military and had seen combat in two wars, and I remember he told me that losing his wife was a pain worse than anything he had experienced in his life, worse even than combat in wartime. While we were planning, and I was marvelling at the family and their grace in the face of ravaging grief, a group of tree trimmers was working at the house next door. Suddenly there came a crash that made the whole house shake, as a giant limb fell to the ground. Husband looked at me. "Well," he said. "That was your car." Best deadpan I have EVER seen. How could anyone fail to adore such a man? As it turned out he was in the hospital over the weekend with a touch of pneumonia. I got to go visit him and hold his hand and hear how profoundly the loss of his wife had affected him. And I got to tell him that I think he is an incredible man and that I wish there were more like him in the world. He went home today before I could visit again, but I am praying hard for him. He's lost 30-some pounds since his wife died, and I don't know if the pneumonia is a passing thing or the beginning of the end. I do know that his kids are crazy about him and have rearranged their own lives to keep him safe in his home for as long as humanly possible. I wish them time to keep sharing their love with one another, and I wish for the goodness and love that is embodied in that family to continue to spread out into the world. And I am thankful beyond words to have met them.

Idle ramblings

2008-03-27T22:09:00.003-06:00

So, one night I was working in the inpatient hospice and a patient was dying, and he'd only been there an hour or so and I didn't know a thing about him. (That's not all that uncommon; I think sometimes when patients come over from one of the nearby hospitals they get to our floor and it is so QUIET that they can finally hear themselves think, and mobilize themselves to get on with dying instead of wondering what that latest overhead page means.) I did learn that he was a real adventurer, piloted planes, I can't remember what all else. Eventually it was time to call the mortuary and my favorite wild driver showed up, and oh, yes, it was snowing to beat the band. I met him at the ambulance entrance and asked if he had his GPS up and operational. OH yes, he said, with a twinkle in his eye. Good, I said, because this one? I think he'd like a little ride. YOU GOT IT, said the driver, and it made me feel happy to think that our late patient was getting his last ride from someone he'd probably have really liked knowing.

One night I was working a shift in the hospital and got called to the emergency department to offer support to the mother of a toddler who had accidentally ingested something toxic in the home. Poor mother--she was there by herself because she has another child who has long-term health problems and had just had surgery and was requiring round-the-clock care at home, and so her husband was home taking care of that child, and mom had run out the door with no socks, shoes, coat, or hat to get to the hospital with the sick toddler, who had to be intubated and hooked up to IVs and monitors and so forth until the toxic stuff worked its way out of the system. Poor mother--best she could figure, the ingestion happened while she was in the middle of some procedure the other kid needs and this toddler just grabbed something--YIKES, little kids grab things so fast--and now the mom was feeling terrified, guilty, lonely, lost, terrified, sick, exhausted, terrified, you can just imagine. And more or less in shock because all this happened so fast and there was the toddler on a ventilator heavily sedated.

Kind nurses had found warm no-skid socks for mom's feet and gotten a chair right outside the trauma bay and water for her, and the staff chaplain just going off shift had been there for her. She worried me because she would alternately sob, desperately and convulsively, and stare ahead with no expression at all. As she began to talk a bit and told me her story, of the other kid who has had so many challenges, of her good and faithful husband who felt so torn but knew a parent needed to be with each child, of their lives, so focused on kids right now that they haven't even had a chance to build a friendship network since moving to this state to be near the best care for the other kid, of her terror that the toddler wouldn't pull through, I began to see how much she and her husband had fought for these children of theirs, how devastating this day's incident was, how truly she believed herself to be an awful mother. She began to shake, then told me she was moving into a panic attack, "I can't stand that I can't do ANYTHING." "I know," I said, "That has to be the worst for a mother--right now you can't go in there and take care of your little one and make it better." "I can't do ANYTHING," she wept, shaking. "Well," I said, "We can pray." I began to talk, very softly, about how we could ask God, the great physician and healer, to touch the toddler, take the toddler into God's hands, and work with the strength and resilience of the child's body, of how we could ask God to be present with just the strength that child needed in the moment, of how we could trust in a loving God to be completely present and completely concerned with the well being of the toddler, of how we could ask God to guide the hands and hearts and minds of the doctors who were involved, and of how we could ask God to enfold the mother as well in warmth and tender care, and grant her as well the necessary strength...I kept trying to use very concrete, even tactile images so that mom could "see" and "feel" with her body, hoping that would ground her to fight the panic. She kept reaching out of her panic to nod along with my soft voice and eventually drew a deep, shuddering breath and said, "Better now."

Shortly the doctor came out with an update. He said the toddler "should make it through this." I asked him to repeat what he'd said and checked to verify that she had heard those words. We got mom into the trauma bay to see the child for a few minutes, and I know that helped, probably helped both. The respiratory therapist especially was very kind, telling mom the good signs she was seeing. Eventually the toddler had to be transferred to a specialty children's hospital, because when a little kid needs to be in ICU, your best bet is to have critical care specialists who are trained to focus on kids. Mom talked to the dad a couple of times and asked me to talk to him once, because I was calmer. I stayed with mom until the transport team was ready to take both of them. We gave the little one a sign of the cross on the forehead and a last word of blessing before they took off. The little kid looked even littler on the pram, with all the monitors and the tube for the vent. The mother was still terrified but now calmer (we'd also gotten her a blanket and orange juice since she hadn't eaten), and ready for the next steps. You *know* you are tired when you can't wait to get to the new hospital because you know they have comfy chairs next to the kids' beds in ICU and maybe you can get some sleep at last.

Puts lots of things into perspective.

Evidence Based Medicine--when it fails

2008-03-12T12:12:00.002-06:00

Warning--some ranting
Disclaimer--this story has nothing to do with any facility I have ever worked for

OK, so, I have two friends--a woman about my age, we'll call her A, and her mother, who is, let's say, a bit older than we are, like about 90, and we'll call her B. B is roughly the size of a sparrow. They live in a city not far from me, about an hour's drive. B had a bad fall in January, owing to an unfortunate combination of ice and wind. A, being proactive, took B to the nearby hospital's emergency room to get checked out, make sure she hadn't broken anything, etc. B's O2 sats were low (oxygen level in her blood), and while it seemed she hadn't broken anything, tests revealed that she had a pulmonary embolism (blood clot in her lung). Things to note: She has a history of heart disease and is on a couple medicines for that, a beta blocker and something else, and also she had some really deep, painful bruises from her fall.

The hospital where she was seen has, like most hospitals I suspect, a protocol for treating pulmonary embolism. According to this protocol, she was admitted under the care of the hospitalist team, put on oxygen via nasal cannula (she only needed it for a day or so), and started on oral coumadin (a blood thinner, via pills, which takes a few days to build up to a level where it's working well) and intravenous heparin (another blood thinner, yes, the one that has recently been in the news for lack of quality control but that's yet another story) that was supposed to work while the coumadin built up. The plan was for these drugs to keep any more clots from forming and start dissolving the one that was in her lung, and for her to go home as soon as the coumadin had reached a good level in her blood. Blood thinners, we are told, are dosed by patient's body weight. There is no factor for age. Also, don't forget the fall and bruises.

I went to see her in a day or so. She was being switched from the IV heparin to a different drug that she could inject for several days at home, so she wouldn't have to stay in the hospital all week (she hates hospitals and was happy to give herself shots in aid of going home). Physical therapy wanted to get her up walking before agreeing to the release, but she was having pain and as I watched her gait it was abnormally tilted to one side. I didn't like this, and A had reported it to nurses, but the discharge planning process was moving along. Someone from pharmacy came to give her a mandatory "teaching" about her blood thinner. It was all verbal, and took about 15 minutes. Her eyes (and mine and her daughter's) glazed over after five minutes. As part of the training, the pharmacist described the symptoms of abnormal bleeding that occasionally occurs for patients on blood thinners. Huge bruises or growing bruises were two indicators.

The next morning we heard that she was not in fact going home, because her blood pressure kept dropping. Apparently there is a protocol for treating that, too, because she was put on IV fluids. Also, she was really sleepy. At some point of that day, it was decided that her existing heart meds (which had taken MONTHS to tune) must be responsible for her blood pressure drop, so these were discontinued. The blood thinners were continued. The fluids were continued. A reported that B had huge bruises blossoming from her fall. The following morning (24 hours after the blood pressure started dropping), it occurred to someone to take a look at her hemoglobin and hematocrit (blood tests that assess, indirectly, how many red cells you have and how good a job your blood is doing carrying oxygen to your body). The blood tests were not ordered "stat" (draw immediately), so sometime in mid-afternoon the lab tech showed up to draw the blood, and by late afternoon, the results were back. Both numbers were HALF what they should have been. This suggested bleeding somewhere in her body. Perhaps in her ABDOMEN, where she kept reporting pain.

It occurred to someone that perhaps a CT scan of her abdomen would be informative. The CT was ordered and showed internal bleeding in three locations. (Remember the DEEP BRUISES? Do you know what bruises are?? They are areas of bleeding from an injury, and you want the bleeding to, oh, I don't know, CLOT at some point. Blood thinners do not help this process. To put it mildly.) At this point the proverbial brown matter hit the proverbial fan. Blood products were ordered stat, blood thinners were discontinued, and emergency surgery scheduled. I was never able to find out exactly what was done in surgery that night but a part was the installation of a "basket" in one branch of the vena cava to prevent clots that might break off elsewhere from further damaging lungs and heart. She came back from surgery about the time her poor daughter, A, who had been staying with her about round the clock, developed a virulent GI bug. A had to go home. Her best friend and I agreed to split shifts and stay with B the following day.

Poor B had a rocky night. She kept reporting pain and increasing feeling of tightness in her abdomen, and for whatever reason the night staff decided she was having heartburn (that is, when they were not offering tylenol). She was vomiting the heartburn meds and the tylenol. Finally, in the early morning, two things happened: someone checked her blood pressure and it was high. She told that someone that she gets elevated BP readings when she is in PAIN. Also, another someone decided that really tylenol is NOT sufficient for relief of pain due to INTERNAL BLEEDING and put her on a morphine PCA (patient controlled analgesia, pain pump, whatever, which requires the patient to be alert, oriented, able to remember instructions, etc., in order to get pain relief. B is 90, had been very, very sick now for 4 days. She had no clue how to work the PCA.) I arrived just as B's nurse came in to bolus her with an IV dose of Lasix for her high blood pressure. She'd had one dose of morphine which had provided effective pain relief (this, by the way, does suggest the pain was organ pain from bleeding, not heartburn). But she was looking weary and painful. I asked if she had pain, she said yes, I reinstructed her on the PCA, and she gave herself another dose. I was hoping she could rest, although not optimistic because the Lasix, had she been hypervolemic as suspected, should have made her need the bathroom pretty quickly.

20 minutes after the Lasix, it was CNA rounds time, and her CNA came in and took her BP. It was 90/40 (for the record, that is not high. It is LOW. As if, say, a person were bleeding.) I asked the CNA to re-take the BP and expressed my concern about the Lasix bolus in light of the reading. The CNA did a manual BP, no change, and tried to tell me the Lasix was a grand vasodilator and 90/40 wasn't really all that bad. I asked the CNA to report the reading to the nurse. The CNA rolled his eyes at me. Meanwhile, I kept trying to settle B to rest. Her room was right outside the nurse's station because she was a fall risk (true; 90 and disoriented from LACK OF OXYGEN and pain will buy you that, I agree). It was really noisy. I kept closing the door. Every person who came into the room left it OPEN on departure. And there were lots of them. She did get a little sleep before lunch. Which, when it arrived, contained enough food for an army. What tiny appetite she had disappeared, overwhelmed by the sight of so much food.

Right after lunch, A's best friend arrived to change shifts. B's forehead started furrowing again and she agreed, when asked, that she was having pain. I instructed both her and her new "sitter" on how to use the PCA, and she gave herself another dose of pain medicine. Shortly thereafter the nurse came in and announced that the PCA pump would be discontinued because she was using so little medicine she didn't need it and henceforth she could just call the nurse when she needed medicine. In vain did we protest that, without someone sitting with her, she could not manage to use the pump and we doubted she'd be competent to call the nurse, and she did not need to be in pain. He rolled his eyes at us. Shortly thereafter the transport team came to take her for a repeat CT. They unplugged the PCA and wheeled her out in a wheelchair. She was back 20 minutes later. They put her back in bed and left the PCA, unplugged, by her bedside. I'd had about enough so went out to ask the nurse to plug in the PCA. (I didn't remember where it was plugged in, and all the plugs were color coded, who knew where it should go??) He rolled his eyes at me, and said, "It HAS a backup battery, you know" (how would I have known THAT?) but did come in and plug it back in.

A little while later, I had to leave for work. A's best friend stayed at the bedside. B got two more units of blood product (packed red cells). I called later to see if the results of the CT scan were back. They were. It was "unremarkable." What on earth did that mean, I asked A's friend? She had no clue. Did it mean, unremarkable for a patient actively bleeding? Unremarkable compared to normal? Unremarkable as in, no changes from the day before? We had no idea at all. At least B was feeling some better from the morphine, A's friend was there to watch her and make sure that nurses knew if she was having pain, etc.

The next day it was decided that the morphine was causing B's blood pressure to drop too low. She was given a different medicine. Thankfully, it worked. At some point, staff reported to A that B's bleeding did appear to have stopped. And apparently they decided that blood thinners were not a good choice for B.

B made it out of the hospital alive. Luckily her heart failure did not get worse in the days without her heart meds. She did contract A's gastrointestinal virus and was so sick that her (own) doc wanted her back in the hospital but she refused to go and got better on her own. Luckily, also, she has not shown any signs of adverse reactions to her four transfusions. Her pain has been slow to resolve but she is definitely feeling better.

In the eyes of the hospital, this was probably a success. She was given a standard treatment, she had some complications, and these were addressed. New protocols were started when needed. However, in my eyes her stay left a lot to be desired. For starters: the protocol for pulmonary embolism was apparently not designed for someone with trauma/injury, but this was not addressed. B was not seen by the same team on successive days (what with the hospitalists' rotation schedules, and nurse staffing, don't let me go there). There did not seem to be any one person who was responsible, not for the protocol checklist, but for taking care of this patient. When B's blood pressure dropped, logic would demand that someone say, what has changed for this patient? Oh, we started her on blood thinners, wonder if that's responsible? rather than deciding that the heart meds, on which she had maintained normal pressure for, say, MONTHS, must have been the culprit and discontinuing those. The "training" B received re: the blood thinners included watching for pain and increasing sizes of bruises. Although she had these, and they were reported by B's daughter A, apparently no one understood them as signs until they'd been going on for 24 hours. When someone did begin to ask questions, the bloodwork was ordered with normal priority. So the bleeding kept on for way longer than it needed to. The morning after surgery, B stated clearly that pain causes her to have elevated BP readings. No one re-took her blood pressure after the pain relief was started--they just gave Lasix, which turned out to be unnecessary if not contra-indicated. And, the choice of a PCA for an elder who is woozy is not appropriate. Scheduled pain meds, please, and followup with the patient.

But, hey, there are protocols. And they work wonderfully and, I am sure, in a cost-effective manner, for patients who are young, alert, have no pre-existing health conditions, and able to advocate for themselves.

Here's the scariest thing yet: I was telling this story to a friend whose mother had a number of medical crises before her eventual death. I mentioned the pulmonary embolism and the protocol, and she said to me, "Don't even bother with the rest. She got too much coumadin and had internal bleeding and almost didn't make it, right?" So--this protocol has a known problem. Her mother's experience was years ago. Has there been any change? Guess not. I suspect it works enough of the time to be cost effective.

I intend to modify my advance directives to note that if I am ever found responsive near B's hospital I should be left where I am. Don't take me there, leave me in the road or wherever. The outcome will be the same and it will cost a lot less money.

Here's the thing--we somehow must not see our vulnerables, our elders and the sick among us, as deserving of attentive care, if we simply subject them to treatments that appear to have been developed from working with younger, healthier patients, those who present with only the problem being treated and who can advocate for themselves. To me as a chaplain, this is an enormous problem on many levels, including perhaps at core the spiritual. Efficiency and cost control replaces care of persons, and it works well for those in the most powerful class/age group, the decision-making class/age group. Those on the margins are those most likely to have complications. Not OK, not in the justice tradition of Judaism or the tradition of Christianity, despite the fact that "Christian values" are supposed to be important in this country. Let's think about that once in awhile.

COR-0

2008-03-07T13:19:00.002-07:00

Occasionally I get to work shifts overnight in a nearby hospital. COR-0 is the overhead paging code in the hospital that indicates a patient is not breathing and has no heartbeat. The team that responds includes the chaplain. These calls, in my experience, have been heartbreakers. I've responded to a couple where the patient is someone younger than I am, who has not survived despite massive resuscitation efforts. (I have seen ER techs standing on chairs to get a better purchase for CPR, and when the patient comes in by ambulance the team is waiting with medications, defibrillator, etc., at the ready.) There is one benefit to working primarily in hospice, and that is that I am used to dead people and I know what dead people look like. Thus, at the last COR-0 I attended, as the ambulance crew brought the patient in, doing CPR as they raced into the trauma bay, the back of my mind said: I know what that is, that is a DEAD PERSON. And it did help, because it let me get the deep breath and the mental preparation so that when the doctor came out to the family, I knew what the outcome was. And because I was not surprised by the word, I could be more ready to attend to the family. One of the ER docs that night told me that it always takes him awhile to get back to an even keel after a sudden death, especially when the patient was by all accounts a wonderful person. "That's good," I said to him. I should have explained--this doc was immensely compassionate to the family, and I think the fact that he lets the deaths affect him allows that compassion to come through.

A weird thing happened though one night. The page to a COR-0 in a particular room in the emergency department, but as I arrived the staff was cancelling the page. "Just a mistake," they said. I wondered: how do you make a mistake determining if someone is breathing and has a heartbeat? "Oops, never mind, I had the stethoscope backwards?" or did the patient, previously unresponsive, sit up and ask for a Diet Coke? I dunno.

Chaplains also respond to "cardiac alerts." A cardiac alert in this particular hospital is the code that means there is reason to believe that a patient is having a heart attack. When the patient is already in the hospital, a team descends upon the patient's room; when the patient is being brought in, the team awaits in the emergency department. It is awkward being the chaplain at these. I always wonder, while waiting with the cluster of doctors, nurses, lab, portable X-ray, EKG, registration, etc., what on earth I am supposed to do. The unholy part of me, which is the major part of me, has been tempted to say, "Welcome to the hospital. Would you like coffee, tea, or an angioplasty??" Cardiac alerts get cancelled if the cardiologist turns up, looks at the EKG tracing, and determines the heart is OK. That's a good news/bad news thing for the patient. The good news is, not a heart attack. The bad news is, "We don't have a clue what's wrong with you at this moment."

If the patient is having a heart attack, the team rushes her/him for an angiogram to see if there is one or more blocked arteries. In the best case, these can be fixed then and there. My job is to get the family to the appropriate waiting room, help with any calls, offer support and even prayer if they want, and wait with them for the doctor if they want company. Some of the docs kind of ignore the chaplain, while others involve us more, like the one who said to me (I'd stepped out for the doctor's report and the cardiologist caught me on the way back in to the patient), "We're doing a HIGH RISK (meaningful glance) angioplasty for this patient." I did not leave the one relative present until the procedure was over and the patient had survived.

Whew.

Now, THIS was puzzling...

2008-02-11T22:17:00.000-07:00

I was on call overnight, and I was paged early in the morning. Some bad news had come in about a loved one of one of our patients, and the patient needed to be told. The nurse wanted a chaplain present to support the patient, so I went to the unit and we went to the patient's bedside. The nurse, who knew the patient a whole lot better than I did (gosh, I'd never SEEN him before) told him the news. I sat with him for a few minutes, telling him I was sorry he had had to receive such bad news. This particular patient is a quiet man of immense dignity. He had some reactions to the news, to which I simply listened and responded with what I call a "supportive mumble," to let him know I was listening but didn't want to take over the conversation. Pretty soon he said he'd like to be alone. The nurse wanted me to stay with him, but that's not what he wanted, so out we went. The nurse told him we'd be nearby and when he wanted us back he should use his call bell. For the next half hour I hung out in a corner of the unit, sitting on a borrowed chair, thinking about this lovely man who was already sick and now had bad news to cope with. I felt helpless; there wasn't a thing I could say or do to make anything better. I couldn't even keep him company, really, because what he needed was time alone. Eventually he rang his call bell. The nurse and I went back to his bedside. He asked the nurse for some coffee, and then turned to me and said, "Your presence was deeply felt and very comforting. You are good at your job." I was/am dumbfounded. Could he really sense me, over in a corner of the unit, trying to be out of the way, wondering if I should just leave and go back to the on-call room? Who knows. I was touched by his reaching out with a compliment. I asked if it would be OK with him if I kept him in my thoughts and heart. He had tears in his eyes as he agreed. So there he was, and there he still is. I hope he is doing OK.

The nature of spiritual care is.... ???

2008-01-17T11:34:00.000-07:00

So, in working as a weekend on-call person, I have found myself returning again and again to this question. The chief chaplain for the hospice organization for which I work is not Christian, has a medical background, and has 4 units of CPE. His notions of appropriate scope of practice differ strongly from mine. For one thing, he uses "energy work" such as Healing Touch and Reiki, as part of chaplaincy, and I'm not even completely sure how I feel about that. For another, he believes in "distance Reiki," and I completely do not, unless you consider it no more than another language for "prayer," and that's an equation that I suspect he would reject--he believes in distance work as an actual "healing" technique. And I think his understanding of healing, and of spiritual distress, is quite different from mine. Not to mention the fact that when we disagree he tends to say, "As we learned in CPE..." as a veiled power move, given that he has 4 units and I have 1.

On the other hand, among the chaplains employed by our "umbrella organization," I have found that some, Christians from different traditions, see spiritual matters explicitly through the lenses of their own denominational choices, and I don't agree with them either, and in fact I worry about the patients who encounter these folks. An example being the fellow who reported, in a group discussion, that patients often ask him what happens after death and/or what heaven is like. I asked him how he responded to these patients. His response was completely taken from a set of Bible citations, and his justification for the response was that "he knows" this is the truth. Not, he believes, or he chooses to believe, but he KNOWS.

So I have been grappling with the term "spiritual care," attempting to relate what "seems right" in patient situations to some sort of theological underpinning, looking for ways to understand why I think I am giving "spiritual care," what I think "spiritual distress" is, etc. And I have mentioned, in the large discussion group of chaplains, that we use the term as if we all understood it identically, and I don't believe that is the case. Some agree with me and want to talk about it and others become defensive. But it's a loaded question, the question of what we do, and at some point we will have to talk about it.

One difference I have with the Buddhist chaplain, and with a Unitarian Universalist chaplain who just resigned, is that I have experienced both of them feeling that "spiritual distress" is a bad thing that should be "treated" somehow, by energy work or by blessings or prayers for peace. For me, spiritual distress is both more complex in its nature and more ambiguous in its role in the lives of persons nearing death and their families. Perhaps it is true that the desired state for each person at death is peace, but I seem to encounter people who have needs along the way, needs for reconciliation, for community, for rage, for being heard, for doubt, for all sorts of things that don't immediately translate to peace. Even people who present as "fine" can encounter rough patches along the way to death, ways in which what they have believed or not believed suddenly ceases to be useful and leaves them unsupported. I tend to think that some amount of spiritual distress is pretty normal for persons who are facing a terminal diagnosis and that much can be gained by working through it in some way--finding an alternate way to think about illness and punishment, for instance, or telling a trusted person something that has been a deeply held secret, or expressing a regret, or re-examining some crucial life events from a different perspective. I've seen people do all these things, with and without the help of chaplains. I prefer the "working through" approach to the "energy work" approach, and I'll admit that is my bias. I also have a much "lower anthropology" than do many Buddhist, Unitarian, or metaphysical folks. I don't think the essence of human nature is perfect, alas, and nothing in my life experience suggests that it is.

I'll also admit my biases against "cheap grace" and against the facile use of Christian prayer and scripture when these are undertaken without first listening to the patient's own language and experience. For myself, Christianity is the faith tradition that is "in my bones," so to speak, but for many of the patients, Christianity, while it may have been a piece of their upbringing, is not meaningful in their current construction of spiritual understanding. There is an art, at which I need to get better, of asking questions that allow the patient's own imagery and language to emerge, and I think that is crucial. I also think it is crucial to be clearly aware that religion is not in any sense neutral and that religious teaching has done incalculable harm to incalculable numbers of people. Thus I have no feeling of automatic relief or optimism upon hearing that someone is a member of a church or denomination. That might be helpful for them, but might not be. It does not absolve the chaplain of the need to be aware of the potential for harm.

Anyhow, this is all getting too "heady." I'll close by saying that I pray with patients in less than 50% of chaplain contacts, which horrifies some, and my next post will discuss why I think helping the CNA prepare a body for the mortuary can be valid spiritual care.

If you've read this far, go look at Confessions of a CF Husband and offer the family some encouragement. I'm not in alignment with them politically and my spirituality is very different from theirs, but this young couple has a strong sense of call from God and are following that call despite tremendous personal hardship, and that is something to be respected.

Late night emergency call

2008-01-03T10:32:00.000-07:00

The call came late on a Sunday evening; I'm on call until Monday morning, so I assured the nurse I would indeed come in. A new patient was being admitted to the care facility where I work, as an emergency, impending death, and was accompanied by a family with high needs. I took report from the nurse who brought the patient in, who told me the patient had been in home hospice care and taken a terrible turn for the worse. The white middle-class family was completely undone, the nurse said, and it's not surprising given the suddenness of the change.

I found the family with the patient, all of them in hysterics (except the patient who was barely responsive and fighting for air). Listening for just a few minutes I realized that the death of this family member represented, for the family, a loss simply impossible to contemplate. YOU CAN'T DIE, they kept screaming at the patient. And I do mean screaming. The rooms are kind of soundproofed at the facility, but if the door was cracked you could hear them down the hall.

Four hours of struggle--the family fought every medical intervention on the part of nursing staff. At one point the patient's partner said to me, I knew you all would just drug her up so she can't even talk to us. And then, to the patient, WAKE UP, TALK TO ME!! In vain I tried to explain that the patient's disease was the reason for her inability to speak. We could have withdrawn all medication and with no oxygen getting to organs or brain, conversation was just not going to happen. There is, as a friend tells me often, a reason why they call it respiratory FAILURE.

The family did permit the nurses to give medicine for comfort, but every dose was a fight. The family believed the medicine was killing the patient, despite teaching from nursing staff and from me. And the family--partner and grown kids--remained resolutely hysterical, out of control, inconsolable. They could not leave the patient alone, but kept climbing on the bed, grabbing hands and arms, grabbing her head, her face, pulling at her, trying to get her to respond. The partner was the "gatekeeper" for the bunch but was so out of control that it was impossible to reason or even comfort. All interventions apparently felt like confrontations and escalated the wailing and screaming. In brief moments one or more of the adult children appeared to comprehend that the patient's death was inevitable, but they were not able to move out of hysteria and consider the patient's needs at all. Everytime I or the nurse entered the room we were met with openly hostile stares. We knew they were angry at the situation--the illness and death of their loved one--and we were easy to blame because we were there.

Who knows what earlier traumas had destroyed this family's coping skills. I don't know anything about them, though I wonder if the patient was perhaps the only grounded or pragmatic one, and without that voice, the family became like a solar system whose sun has mysteriously vanished, flung suddenly without gravity into the terror of deep space.

It was not a peaceful death. The patient's partner was lying atop the patient screaming, YOU PROMISED YOU'D GET WELL. The adult children surrounded the bed, sobbing, choking, wailing, DON'T DIE, YOU CAN'T LEAVE US!!! Not a comfortable way to leave this world.

The drama didn't stop with death; the family ripped all the medical devices off the patient before the coroner had released the body (luckily the coroner DID release, it would have been very messy indeed had the death been a coroner's case). After a couple of hours with their loved one, the family members were all cried out. Only then was I able to speak to the partner, to say how sorry I was for his loss, to say that I knew that all they wanted was for their loved one to get well, and how sorry I was that we could not offer them that solution.

I learned the next day that the patient had had cancer for three years and it had spread widely. But in that time there'd been no estate or funeral planning. The family just simply could not entertain this person's death as a possibility. It was not going to happen, not now, not ever. For whatever reason, the death seemed so horrible that it could not even be thought of. This was the unsurvivable loss, the event feared above anything. I have seen other families who have defined/experienced a particular loss as unsurvivable, and the consequences reach through generations. One family had experienced a divorce after a husband and father left. This impacted them so badly that fear of abandonment echoed on down, especially, among the women of the family, fears of abandonment by a man. It was almost encoded in the DNA: one does not survive abandonment. So I fear for the partner and children of our patient who died that Sunday evening. I hope somewhere they find a way to regroup and survive.

But what a failure I felt. There was simply nothing I could think of to bring peace or calm to that room. I wonder now what would have happened if I had simply been blunt, simply said, "Look, she is going to die, and she's going to die tonight. You have a decision to make: what do you want her last experience of you to be????" I don't know--that might have helped them focus. Or, it might have escalated them into physical confrontation with staff--they might have insisted on removing the patient to hospital for resuscitation, against the patient's wishes. I just don't know. Tomorrow I'll be visiting with my very-experienced chaplain boss, and I will ask him. At least, examining my feelings, I had a glimpse of what the family felt: helpless and angry. However, my one advantage was that if life has taught me anything it is that the unimaginable, the worst, can and does happen, so I was able to stay out of their panic and determination that their loved one not die. Staff said it helped THEM to have me on the floor throughout the struggle and willing to stay in the room with the screaming. So that's something, but wow.

What a night!!!

BAD driver--no, BAD CHAPLAIN.

2007-12-11T22:24:00.000-07:00

Another shift, another mortuary call. I went back to the ambulance entrance to let the attendant in with his cot. "It's slippery out here," he said (it was snowing/sleeting). "You need some ice-melt here--but, wait, maybe you get extra business this way??" (BRAT). I said, "Well, YOU could get some business too, you know." Delighted, he said, "Hey, you're right!!" We looked at each other. "Why don't you just take some business cards and scatter them around on the icy spots?" I suggested. "That's what I usually do."

Much too young

2007-12-11T22:01:00.000-07:00

End-stage liver disease again. This patient is young, seems no more than a kid really, about the age my mother was, when she died.

No family. No friends. No one. The patient came to hospital through the emergency department, went to ICU, got worse and worse, and doctors finally decided upon hospice. The patient was signed in by physicians.

It is easy, and I am told health professionals often do it, to be angry or scornful about patients whose drinking or drugging or smoking or overeating has produced huge problems. And sometimes our patients have caused enormous amounts of pain to others because of these behaviors. None of that negates their value as parts of creation, and none of that should impact the care they receive, but it does. Health professionals are human too, and many of *us* have been hurt by the behavior of people in our own lives with addictions.

I sat quietly at the patient's bedside, wondering what hurt was medicated by alcohol all those years, whether there had ever been hope in that young life. I prayed for the family and friends who were either dead or alienated by alcoholic behavior. I prayed for an end to pain, for peace. After my shift, I awoke in the night, thinking of that young poisoned body now struggling to die. "YOU take care of that one," I said to God. "No one else can."

The patient died the next morning, 14 hours after admission to hospice, never having regained consciousness.

Just a quick note

2007-11-27T09:48:00.000-07:00

Grand Rounds 4.10 is up at Prudence, MD. There are some wonderful, thought-provoking posts this week, and I'm flattered that my submission was included! Thanks!

Sweet Dreams

2007-11-26T13:26:00.000-07:00

Some moments stay with you.

He was old, and sick, and very, very tired. He was ready to die, had been so for days, and had been waiting, sometimes patiently and sometimes less so, for death to come. On this particular afternoon he was restless, not comfortable, and his eyes were roaming around the room. A nurse and I were with him. The nurse went to get pain medicine. His eyes roamed and roamed, not settling, and he was vocalizing, but I couldn't make out anything definite. "It's OK," I said, and touched his head very lightly so he would know where the sound of my voice was coming from. I noticed that his eyes drifted shut with the touch. The nurse gave him his medicine. He seemed chilled, so we tucked his blankets all around him, warm around his shoulders and up under his chin. His eyes roamed. I touched his head again and his eyes drifted closed. I left my hand in place and his eyes stayed closed. I stroked his hair, very lightly. "It's OK, buddy," I said. "It's fine to rest." Slowly he turned his head, resting against my hand. I stroked his head gently and watched as his breathing slowed, relaxing, as the medicine took hold and pain went away.

Family came. That was good for him, I think. Eventually they left, utterly exhausted. They wanted to know, right away, when he died--we knew it would be that night. For the rest of my shift I peeked in on him regularly, calling a nurse for any signs of discomfort. At the end of my shift I was ready to leave but decided to check on him one last time.

He was dead. I walked back into the hall and called his nurse, who had been in his room two minutes before. He'd been alive then. So I called the family as they'd wished, and was able to tell them he'd died two minutes before. They wanted to know right away, and he wanted to die. For once everyone got what they wanted.

Sweet dreams, buddy.

Gosh, I am a rotten blogger

2007-11-23T10:32:00.000-07:00

The last several weeks have been really challenging with some co-worker/political issues; I am feeling less like a person about to lose her job, which is reassuring, but have been doing a lot of thinking about what chaplaincy is for me, and about how my own personality and also my own training and particular religious bent defines chaplaincy. The two staff chaplains at my location (I am on-call) have very different spiritualities from me and approach the job with a very different mind-set, and that will continue to be challenging I think. More posts about this later; today I want to offer something a bit light.

I am a hospice chaplain, and at work I see individuals and families at very vulnerable, painful, dark moments. One way I keep from being overwhelmed is to find humor in certain situations, and surprisingly enough even in death humor is not in short supply.

The other night I was waiting for a mortuary to come and remove a body; the family of the deceased had elected to remain until that happened. We were all exhausted, and it was taking FOREVER. Finally, FINALLY the buzzer rang telling me to let in the attendant and the long skinny gurney (I have learned that these go by the benign euphemism "cot"). The attendant, a young, pleasant fellow, was embarrassed at having taken so long. The reason? His dispatcher had gotten things mixed up and sent him to a nearby hospital. Where he had pushed his "cot" earnestly from floor to floor, nurse's station to nurse's station, looking for the deceased. And where I can imagine weary charge nurses looking up and feeling a millisecond of fleeting horror--did I miss a death? How could I have missed a death??? before realizing it was the mortuary attendant who was confused. At 3 AM I can imagine our young attendant just wishing for a body, any body, so he could pick it up and go about his business. After touring the entire hospital and finding no bodies at all, let alone the one he'd been called out for, he called the dispatchers back and got it sorted.

Another day, another body--I let the mortuary attendant in, signed the relevant bits of paperwork, and escorted him to the room. While we were walking, we made idle conversation. He said he couldn't wait for snow. I thought he was being sarcastic, but no. I said I liked snow best if I didn't have to drive in it. Said he, "I drive at night, and when I'm driving the road is MINE, there's no one else out so it doesn't matter if I'm going straight ahead or sideways!!!" As I looked at him in horror, he said, "One time I was driving in a blizzard so bad the visibility was zero. I just used my GPS to tell me whether I was on the road or not. THAT was FUN!" Think about THAT if your loved one dies in a snowstorm. Your loved one's last ride might be a real adventure. And if you're driving in a snowstorm, and a nondescript van goes sliding past you sideways with a man grinning maniacally at the wheel? He might have a Very Quiet passenger or two in the back.

Back again

2007-10-15T11:30:00.000-06:00

Chaplaincy is stretching me in ways almost beyond words--and I love it. Obviously I cannot post about patients or families that I see so can only talk in generalities, but I have to say I love the dance of communication with a patient or a family, trying to find a language we can share that may allow me to hear a need or offer a support. All families are unique in what is meaningful to them even though there are common themes. I work in an inpatient setting with patients receiving hospice care and many of the patients are far enough along on their journeys that they are unconscious and not terribly responsive, so the families are often the focus of my visits.

I think everyone in any aspect of health care encounters patients and their families who are dealing with the terminal consequences of long-time abuse of alcohol and drugs, most typically via end stage liver disease. For me this situation is particularly sad and hard to cope with, because the dying persons may be my age or younger, and the families are losing a loved one at what "should" be the prime of life. Even more difficult for the relatives and friends, liver failure progresses so silently for such a long time that the terminal illness appears to be sudden and short, so that there is no time to adjust to the impending loss. And, if the alcohol or drug use is a family secret or even has been kept hidden from the family, there is even more chance of shock and horror when the disease becomes terminal. Some patients and families feel ashamed of the fact that the liver failure is caused by what seems to be a behavioral choice that could have easily been stopped. Every form of denial can come to play.

I hate end stage liver disease; the suffering for the terminal patient, if hospice or palliative care is not elected, can be enormous. The failing liver affects other organs in the body so that they shut down. There is tremendous pain. The brain may be affected, causing seizures and dementia. The skin is tremendously jaundiced and the patient's body may be swollen with fluid buildup, meaning that the family is beholding a greatly disfigured version of their loved one. Add that to the apparent suddenness of the disease onset and the speed with which it progresses, and you have reason for enormous suffering and grief for relatives as well. If the relatives and friends are able to accept the role of alcohol and drug use in the picture, then comes the self-recrimination for being either unaware of the patient's use or unable to stop it, and the rage at the patient for not stopping it, and so on and so on.

God can seem utterly absent from the picture. Individual and corporate sin loom large. Some terminal patients have begun their path of substance use by participating in the kind of party culture that is publicized in advertising--only, for whatever reason, these people have been unable to break free. Others have begun the path using alcohol or drugs to cope with stress or hopelessness that comes from poverty or personal loss or the effects of racism or other pernicious effects of the culture at large. Ours is not an easy culture for a person with a predilection for addiction to maintain sobriety. Sobriety is a daily slog, not a quick fix, and the level of change in a person's life required to maintain it may simply be overwhelming.

Against this amount of suffering, platitudes are hopeless and even insulting. A chaplain may come on the scene only in the last few days or hours of the patient's life. For me, the weight of sadness the family brings touches the weight of sadness in my heart for my mother, who was saved a death from end stage liver disease only because she died even earlier, of post-operative complications. So, in a very personal way, I am aware of the years of suffering for the patient and those who love the patient that have gone ahead of those few days or hours.

What to do? I think the family offers the clues. The terminal stage is not the time for a family's theology or denial or whatever to be confronted. If asked for prayer, I ask God's help for what the family is grieving, whether it be the suddenness of their loss, the suffering of the patient, the hopelessness of having tried to help and been unable, whatever. And I affirm the patient as God's beloved child, and each member of the family likewise. And sometimes, all I can do is lament, give voice from the psalms or my own prayer to the helplessness the family feels, the distance from God, the desperate yearning for God to make Godself known, the agony of the suffering. I read Ps 88 to one family and they were deeply touched--yes, that IS exactly how they felt, for themselves and on behalf of their loved one, and to think it was in the Bible, that God actually knew and cared.

I hate end stage liver disease. If any who are reading is at risk for this and can make any changes to lessen that risk, let me tell you: I think the effort is worth it.

I've been tagged!

2007-10-04T23:20:00.000-06:00

And I think it's a first! I've been tagged by Introspectreangel (waves at Angel). So here goes:

Fab Four meme...

4 jobs I have held
Dishwasher/food service worker
Lab assistant
Chemist
Lead software QA engineer

4 films I could watch over and over
9 to 5
Priscilla, Queen of the Desert
Almost any Pink Panther movie with Peter Sellers as Inspector Clouseau

4 TV shows I watch
Sorry, none here... Not a big TV watcher!

4 places I've lived
A suburb of Chicago
A college town in IL
A college town in IA
A suburb of Denver

4 favorite foods
Ice cream
Tiramisu
Mac 'n cheese
A nice medium rare prime rib

4 websites I visit daily
http://www.msnbc.msn.com
http://www.crimenews2000.com
http://julia.typepad.com/julia
http://revjph.blogspot.com

4 favorite colors (note: I'm thinking clothes here)
A very bright turquoise (I have a jacket this color)
Pink
Grey heather
Very dark brown

4 places I'd love to be
My warm bed
Someplace with bodies of water
Just about anywhere walking Toby Wolfhound
Oregon Coast

4 names I love but would NEVER name my children
Genevieve
Billy Bob
Medhbh
Mehitabel

I don't have any readers to tag, but if you come across this, it's fun!

It's been a bit busy around here...

2007-09-10T10:53:00.000-06:00

I didn't realize how long it had been since my last entry however. The hiring process to which I referred got even more confounded and I wasn't able to officially have a "first day of work" until 8/30. Such is the process today--I was required to provide a physical capability report from my physician and then the employers had to make a determination as to whether my permanent restriction on lifting could be accommodated. I was a wreck; I can catastrophize better than most and had pretty much decided that owing to my age and decrepitude I was unemployable. However I finally was able to begin orienting; last week was a full week orienting with all of the various positions in the organization. I had forgotten how exhausting it is to start something new and was glassy-eyed by the end. My chaplain style is somewhat different from those of the full-time and part-time regular chaplains (as theirs is from one another) and of course each of them has 4 units of CPE to my lousy one. However I think once settled in I will be OK. It was a pleasure to see familiar and beloved faces on the inpatient and home care teams!

The inpatient hospice staff will, I predict, find ways to use my time on weekends. The homecare, not so much; they don't find many situations that could in their experience benefit from a chaplain. They find that, when there are deaths, families would either prefer a spiritual caregiver they already know or privacy. And perhaps once per year a family requests that a chaplain attend the death, so that won't be a big use.

The full-time chaplain is a practitioner of a couple of alternative healing arts and is willing to offer those for the benefit of patients and staff. The part-time one also... I suppose I *could* say I do a bit of therapeutic touch, and might do so in a pinch, but in a way that seems to tread on the toes of nursing staff, and also of the staff who are professionals in massage and healing arts who are available to patients at least in the inpatient unit. I dunno. However, in making a visit shadowed by the part-time chaplain, whose time is dedicated to the inpatient unit, I was able to discern via observation what she discerned via scrutiny of energy fields, so hopefully I won't be utterly useless in comparison.

It is good to be back, good to see patients, good to have a badge that says I am actually a hospice chaplain, even if only part-time and on-call. The HR staff, who create the employee badges, have offered me an opportunity to let go of any spiritual pride attendant upon finishing my M.Div degree, as my badge has the M. on one line and the Div. on the next, like this:

Firstname Lastname M.
Div.

It is a testimony to how rigorous we all are at looking at employee badges that no one has commented on this.

Toby Wolfhound continues to grow. He is now tall enough to look out the windows with ease, and what he sees disturbs him greatly: there are PEOPLE out there. And they need to be barked at. Today is particularly awful, because there are tree trimmers hired by the power company who are out back cutting branches away from the lines. I have finally tucked him into his big pen so he doesn't see out the window, because the racket is giving me a headache. He is not altogether terrified; he is both terrified AND excited, and now he is barking at me from the pen--he wants to come out and watch some more. Oy. He's doing great at walking on lead, and increasing his confidence out and around the neighborhood; I am totally proud of him! Such a good puppy. I need to take more photos.

In the last couple of weeks, I have heard more information that validates my decision to leave my former denomination. Also, I preached at the church where I was until June, on the Sunday of Labor Day weekend. It is so painful. This church does SO much good, and provided a place of great theological freedom and safety. But there is "DNA" in the denomination that has been there from the beginning that prevents it from being a safe place for all, and even prevents it from acknowledging it is not safe for all. There are too many toxic secrets, and the denomination is really not ready to begin to address them. I keep thinking, it could be so much better. One good thing that came of the preaching assignment is that I came away feeling that I could in fact be effective in parish ministry; I don't anymore believe without qualification the pastor's assessment of me, because now I know more about his own personal philosophy and behavioral choices.

Had a wonderful meeting with a pastor in the Ecumenical Catholic Communion church where I've been going to worship. He is also a pastoral psychotherapist. I ended up basically blabbing about the events of the past year and venting. He agrees with my self-assessment: that I am not even really ready to join a congregation let alone a denomination. I worship at his church as a place of respite and he is fine with that. Working weekends gives me a perfect explanation for my former church members who want to know why I am not with them, and who know only bits and pieces of why. (Much of what I learned was learned in confidential settings and cannot be disclosed to members of the parish.)

The young man for whom so many have been so generous with prayers (thank you!!) is recovering. Some of the really awful physical consequences he could have had seem not to be happening, thank heavens, but other, more subtle effects will take months to sort out. His treatment continues, and those who love him are hoping that he will in fact have the chance at a life without severe restrictions.

And that's all for now!

Friday Five

2007-08-17T10:47:00.000-06:00

I stopped by Introspectreangel's blog and am swiping from her: the assignment is to respond to five words....

1) Vineyard--this one gets me to the parable of the laborers in the vineyard, with those hired at the last, to work only one hour, being paid a full day's wage just as those hired at the beginning of the day. My former pastor preached on this recently, and noted how easy it is for us who are white, educated, employed in the US to identify with those who worked all day and felt cheated, whereas for some in the world who would give anything for any work at all, any way at all to feed themselves and their own, a God whose generosity was like that of the vineyard's owner would be a source of overwhelming hope and joy. A point well taken indeed.
2) Root--I am filled with frustrations of late (employment stalled for awhile owing to a false positive on a fast drug screen; nothing can happen until the FULL drug screen comes back from the lab, which may be next week, and will HOPEFULLY resolve the false positive; also, this brings up my annoyance at my former denomination which never acknowledged my withdrawal from their ordination process, telling me how important I was NOT to them, also my sense that some in my hoped-for new job would rather someone else had been hired, too bad for them!) and I need to get back to some root sense of connection with God's presence. It is amazing how just sitting and reading morning prayer helps.
3) Rescue makes me think of Toby Wolfhound who is across the room from me practicing his loveseat utilization. He is learning many ways to position himself for comfort on the loveseat, truly a proper Irish Wolfhound if there ever was one. He was not a "rescue" but a rehome; nonetheless, some of the problems of rescue dogs (lack of socialization principally, and lack of human contact leading to fearfulness) are his. He is progressing well but of course slowly. Such a good puppy.
4) Perseverance is what I need a dose of to get through the annoying nature of the getting-employed process. And it will be what I need to establish myself, once actually on board assuming the drug test fiasco works. (Dr. Google has told me which of my PRESCRIPTION MEDICATIONS, hello, is likely responsible.) Perseverance and trust. I feel a little rubbed raw by the past year or so, ready to see the worst a bit prematurely, and I have a lot of stored-up annoyance and anger. Grumble.
5) Divided is how I feel inside when my membership in the Self-Doubt Club (thanks to Prof. Larry Graham for this image) moves into the foreground. I am torn between the perception that in the moment I am surrounded by incompetents and the deep suspicion that perhaps there is something wrong with ME.

I think I'll go snuggle my puppy for awhile....

With thanks for the prayers

2007-08-11T22:45:00.000-06:00

Wonderful news: the young man about whom I posted, who was in a coma, has emerged from the coma and is able to recognize and talk with relatives. He is off the mechanical ventilator. Long-term prognosis is still unclear, because of organ damage and internal injuries. But I thank you, as do others closer to him, for the prayers. His closer relatives hope that knowing that people all over the world have been pulling for him will help him cope.

Also good news: I have been offered the chaplaincy job I applied for some time ago, and I'm very excited. It is part-time, on-call work, but that is how one gets "a foot in the door" in that field in this part of the States. It is hospice work, which I love. I will have the chance to work with some folks I have worked with before, and it will be a challenge but also a wonderful opportunity.

And Toby Wolfhound, meanwhile, makes me laugh 100 times a day. I have told him that a puppy's job is to make things better, and he is applying himself to the task. As can be seen above, he has mastered the art of paper shredding/recycling, and Awful Mad Kitty is still in one piece although rather chewed. Toby may be able to get work in Records Management because of his talent for shredding, but it is early days yet. As he matures he may develop additional abilities. Like digging. He is very shy with others but very silly in the safety of his new home. Also, having been outdoors with minimal shelter his first five months, he has no desire to be left out AT ALL. And he likes, especially, being in where it's cool. I've been taking all 3 dogs walking at once, which has to be a sight, but helps Toby's confidence. If I didn't know that he feels that the World is a Terrifying Place, I would think he'd had a good time this morning. (I think he doesn't want to lose face by admitting that it is sometimes exciting and fun to go on walks.) I'm glad he is mine. It would take a team of teams of wild horses to get him away from me!

Various updates

2007-08-07T21:46:00.000-06:00

No news about the young man referenced in my last post. His injuries were very grave and the doctors and family were "waiting to see" how things went. My Hebrew Bible professor made note, in a poetry class, of the dramatic mood swings in some of the Psalms; they remind me of what it is like having a loved one in ICU. A number is better than expected: euphoria! Until the next set of numbers, with new problems.

Toby Wolfhound is quite possibly the sweetest puppy in the world. It took him about 12 hours or thereabouts to decide that I was someone important, perhaps his Mommy, and he has been wonderfully affectionate. He LOVES the terrors, who in turn are teaching him Very Bad Things. He is really scared of the big wide world; in the world he inhabited before, there were lots of dogs and a person or so, and to his amazement the situation appears reversed once we leave our yard. It seems he can scarcely imagine so many people; he is gobsmacked, he wonders why on earth there are so many of us. I sympathize. Toby loves to be snuggled; all 75 pounds of him. He likes to lie on his back with front paws tucked for a chest scratch/belly rub, and he likes it if I stretch out with him for a nap. His temperament is quite soft and shy although he does love to play with the Terrors, especially the Oldest and Bossiest Terror, and goes flying through the air to land with a big thump in front of her, or on top of a toy. I've gotten him a toy shaped like a cartoon cat--it's called Awful Mad Kitty--and he loves to pounce on it, shake it vigorously, and chew it. I may be creating a monster by saying, "Toby, GET that cat. GET THE CAT." He's just so funny, so intent, puppywise, in his play. That's one of the things about giant breeds that both makes one laugh and drives one over the edge: here is this big dog, bigger than many retrievers, and he is all puppy, all the time. He really, really isn't mature; he really, really DOESN'T know much. But he is surpassingly cute and huggable, and what could be better?

Horrific news

2007-08-05T13:21:00.000-06:00

This morning I learned that a young man, a relative of mine through marriage, is in hospital, in a coma, after what may have been a suicide attempt. His survival is questionable; if he does survive, he may have a lot of continuing severe problems from this situation. It is impossible to know what would be "best" for him. His extended family is devastated. His immediate family has already endured the deaths of two of his siblings; how does one go on? How much tragedy can one family, can one mother, absorb and still put one foot in front of the other?

The young man was, as a child, molested by a priest. For him, that experience was utterly destructive. Something in his spirit was, it seems, irretrievably broken, he could not recover, his life has not been good since. Perhaps he had underlying vulnerabilities; don't we all? but his story carries that chill of encountering radical evil, his life carries the agony of radical suffering. No amount of "everything is part of God's plan" theology can come close to touching the suffering of this man and of everyone who has loved him. The worst CAN happen, and in his case, whether he lives or dies, it has happened.

Pray, please, for the whole extended family of this man--cousins, aunts, uncles, siblings, mother. Pray that the hospital crew caring for their loved one may be competent and kind, pray that they may have the supports they need in the days to come, pray that somehow they may know peace.

Here's the PUPPY!!

2007-07-26T19:11:00.000-06:00

This is Toby Wolfhound, cute as he can be. He is every bit a pet; if you know wolfhounds you will guess that at the very least his ears are not his fortune, but look at his cute face.

He is doing well. We (all three dogs and I) mowed half the back yard. I'd been worried Toby would spook at the mower, but no. He was initially taken aback by the noise, but soon decided, puppy-wise, to use the mower as an excuse to run. He'd chase after it, and then turn and run away. If I stopped and called him to check on him, he'd run over with wagging tail, all happy. He likes the mower. Who'd have thought.

He's now met three neighbors, and this morning wanted a longer walk, and seems shy but game. I think he'll do a good job at what puppies do best: making things better.

Other news: I applied for a weekend/on call chaplain position--the HR person just called to say they hope to have a decision in another week. It has dragged on for some time and I don't feel all that confident. But while we were mowing I realized that if they really HATED me they wouldn't bother to keep me in the loop. Perhaps. Maybe that's not true, but don't tell me. I need to keep some hope.

A puppy!!!! Overwhelming joy!

2007-07-24T22:47:00.000-06:00

My beloved Wilson Wolfhound died in February at the tragically young age of 4.5 owing to heart failure, a problem in the breed. I was bereft; if one loves big dogs, there is nothing so comforting as a big dog to wrap one's arms around, to talk to, to love. I have missed my big darling desperately during this wilderness time. My two old terrier mixes, also beloved, have been doing their level best to pick up the slack, but anyone who knows terriers knows that, for them, picking up slack generally means redoubling their efforts to manage the entire household. I have laughed and laughed, and the Terrors and I have enjoyed wonderful long walks even though they are both 14 and each have several veterinary diagnoses.

A wonderful friend of mine in wolfhounds has been putting the word out that there was a home that needed a wolfhound, just in case a wolfhound came along that needed a home. Today, a five-month-old puppy came to join me and the Terrors. He has spent much of his life outdoors without a lot of human contact and affection. However, he is rapidly deciding that affection and patting feel very good, that a house with soft rugs on the floor feels good for sleeping, and that one's very own bowl of fresh cool water is a particularly good thing, especially when one has not had these things on a regular basis before. He tells my friends and me, by virtue of his face, that his name is Toby.

When I met him earlier today he was overwhelmed and exhausted. But by tonight he had met the Terrors and loved them, figured out how to lean on me and ask for patting, figured out how to look up with endearing puppy eyes and give kisses, discovered his puppy bark, etc. He is simply adorable.

We now will begin the adventures of socializing, training, vetting, and etc. But oh, it is so wonderful to have a big furry friend to hug.

Wilderness Fatigue

2007-07-21T22:50:00.000-06:00

So I went to the ECC (Evangelical Catholic Community) congregation where I've been hanging out the last few weeks, and my former seminary classmate the Sarcastic Lutheran gave a truly excellent homily linking themes from the book of Ruth and the story of Mary Magdalene. The Sarcastic Lutheran is an intimidating bit of creation indeed. I have yet to discover anything whatsoever that she cannot do. And on top of that she is one of the most authentic people I've encountered, very clear about who she is and is not and very open.

Anyhow as I sat in the pews I was struck with a wave of grief; I want that, I want to preach again, to share the elements of communion, to bring the message of a loving if sometimes profoundly annoying God (read the Psalms of Lament if you doubt that last) to a community. All of that I gave up. And why? In the sad times it is hard for me to remember that the theological differences that lie behind my decision are genuine and deep, and that the denomination I left is best served by my leaving, as am I. I find in myself a certain desire to be super-flexible-pastor, no theological position too challenging for me to embrace, no behavior too challenging for me to affirm as good. And yet that is not who I am. My former denomination, which brings a particular and profoundly needed message to a community desperate to hear it, moves in theological directions where I just, simply, cannot follow. Thus, the wilderness, thus the deep grief, the continued collision with the limits of who I am; and thus the oh-too-human desire to wish those limits away, rather than to engage them as part of God's calling to me. How prideful of me to think that I can, or should, have no limits to whom and how I serve. Is there any other human who is without limits? Hardly. Surely, I think, there must be people whose limits are more compatible with mine, to whom I can bring something needed.

Unfortunately, at present, the wilderness, while no doubt containing exciting and life-giving possibilities, also contains tangled vines, old branches that trip one up while walking, and bugs. Perhaps even snakes. And almost certainly porcupines.

Cleaning

2007-07-20T10:56:00.000-06:00

I have been spending a lot of time doing housework, which is a thing I actually enjoy when I have time to do it. After three years of graduate school, there's a lot of housework to do. I am feeling particularly ruthless, which is exactly the right frame of mind for housecleaning, as it leads me to toss things for which I really have no use at all. Am happily scrubbing baseboards, vacuuming cobwebs, etc., etc. It is a good anchor, that and reading prayer twice per day.

Have been visiting an ECC congregation the last couple of weeks, and enjoying the people and their sense of commitment. Hung out with the Sarcastic Lutheran before service last week and with ECC folks afterward for lively discussions about church, roles, theology, what ordination means, and the like. These discussions are timely as emerging churches and emerging denominations are considering how to understand the role of pastor/spiritual leader. ECC is ordaining women, and also having to decide what constitutes an ordination call and process, and emerging churches, it seems from what little I know, are thinking deeply about what it means to be a leader--not an "authority figure" from on high who tells people what to think and do and believe, as the role of pastor has been cast by some, but something else... the questions that arise from the desire for leaders to be more transparent and embedded in community are important questions.

ECC I think faces some theological challenges, because it posits itself as "Catholic" without being rigorous as to its sources of authority--it is now focused on formation as a denomination and on openness. I think the healthiest thing ECC can do in this stage of its development is to build a set of values that allows for open, even heated, discussion of difference. Theological knottiness is down the road sooner or later for them, because what it means to be "Catholic" is not simple or straightforward for those who join. For some, it means remaining identical to the positions of Rome except for certain ones that are troublesome; for some, it means remaining identical to the ritual and rubric of Rome but with greater openness as far as membership and ordination; etc., etc. Eventually this will need sorted out, because "Catholic" is so multivalent that there will be definitions that are mutually incompatible, that will have to be discussed. A climate that can handle discussion in a healthy way will be their best tool to take forward IMHO. And trying to find positive distinctives, rather than defining themselves solely over against Rome.

Back to cleaning now.

Simply stunned

2007-07-12T13:10:00.000-06:00

Gosh.

Our President held a news conference this morning to announce that current events in Iraq show that progress has been made.

Is ANYONE surprised he would say that? Shocked, appalled, disgusted, heartbroken, irate, sure, but surprised?

OF COURSE that is what he said. It is what he wants to believe and what his privilege and his resistance to reality and his careful choice of supporters tells him to believe.

Tell it to the people on the ground. Tell it to the families who have lost loved ones; not just American families but Iraqi families. Tell it to the women who have been raped. Etc.

Progress.

The "Religious Right" and the sex industry

2007-07-11T10:49:00.000-06:00

So, a couple weeks ago I went to a book signing event at a big independent bookstore. Mike Jones, the man who disclosed a sexual business relationship with former evangelical leader Ted Haggard, was there to talk about his book and sign copies. I didn't know what to expect, and in particular I didn't know who would attend. Would the audience be sympathetic to Haggard or to Jones, or would most be merely curious? Would the appearance turn into a slanging match? As it happened, I think most attendees were either curious or sympathetic to Jones. If Haggard supporters were present, they remained quiet during Jones' talk and the question and answer session.

Jones, a long-time bodybuilder, is a good-looking and very well-spoken man. He is unafraid to tackle any topic and in particular is unafraid to speak directly and explicitly about sexual matters. He read excerpts from the book, some about his escorting business, and one about the death of his mother, which occurred only weeks before his discovery of Haggard's identity. During the question and answer session, Jones received generally supportive comments for his choice to reveal Haggard's political duplicity (Haggard, as a powerful spokesperson for his variant of evangelical Christianity, opposed gay marriage and aligned himself with really vicious anti-gay language).

At the time that Jones disclosed his contacts with Haggard and since, I have had reservations about the choice, since the action also impacted Haggard's wife and five children--it seems they did not know about his double life, and found out about it in a particularly public way, and I didn't think that aspect of their experience had been addressed in the discourse about the whole mess. So I was pleased to hear that Jones himself says that in retrospect he might have done some things differently.

During the question and answer session, a number of speakers thanked Jones for his actions and some called him a hero for having exposed this hypocrisy. A few spoke about how significant it was to them that Jones had "taken on the church," and expressed their opinions that the church was the single most dangerous institution facing sexual minority persons. These remarks garnered applause, and I felt uncomfortable about this. It seemed that many of those present saw the sexual minority community and conservative religion as utterly separate and diametrically opposed. (They may also have seen the escorting business as representing the sexual minority community as a whole.) The more I thought about it, the more I thought these remarks, popular as they were, represent a potentially dangerous oversimplification.

I'm not particularly familiar with the sex industry, but in his talk Mike Jones stated that he had had sexual business relationships with many men employed in churches. He also stated that he suspected that some paid his fees with money taken from collection plates. I think it would be fair to say that he saw his work as providing respite from the hostility these men encountered in their work and daily lives, of providing a dose of tenderness and caring that allowed them to go back into the world and function. If it is accurate that there is a significant number of men in conservative religious institutions who desire male-male sex and seek it out from sex workers, then the conservative institutions and the sex industry are not in fact separate and opposed, but tightly joined in a complicated symbiotic relationship. It is pretty well known that some religious institutions raise a lot of money by disseminating really vicious anti-gay propaganda, generally focusing on the sex lives of sexual minority persons to the exclusion of any other considerations. In such propaganda, all sexual minority persons are identified with extreme images of pornography, prostitution, and the like (all of which exist among so-called "normal" heterosexuals as well). So these religious institutions benefit from gay escorts like Mike Jones in two ways: they use exaggerated images of such people in their propaganda, and gain supporters and money; and, individuals within the movements use sex workers in support of living double lives, maintaining their positions of power and reward while obtaining particular satisfactions "on the side." These postures on the part of individuals and institutions are certainly problematic. The sex industry, however, in providing services to men living such double lives, also allows the power structure to be maintained without challenge. It also depends for some of its income on the very existence of structures including religious ones that require secrecy and denial for sexual minority persons. In these ways, looking systemically, both the sex industry and hostile religious institutions are complicit in maintaining one another EVEN THOUGH their positions would seem opposite. Let me make it extremely clear that I believe this symbiotic connection is NOT limited to gay sex; I am writing about gay sex because that's what Jones and his book are about.

Mike Jones, in publicizing Haggard's duplicity, lost all of his escorting business. I don't know that there is any "going back" for him. He could be embraced by conservative religious movements IF he "repented" of his past and denied his sexual orientation. Neither party in the deadly embrace of symbiosis has room for Mike Jones as he exists today. And, sadly, the symbiosis will continue.

There are conflicting opinions about whether, or how, Mike Jones' actions impacted the larger political sphere. The long-term effects on Haggard and his family and his former congregation are yet to be seen. The effect on Jones has been exceptionally complex. Naming him as a hero and ignoring the larger systemic realities may feel good to some, but I do see some moral ambiguity in his actions and positions. I see moral ambiguity most places, so that does not make Mike Jones unique in any way. But, listening to him, I got the sense that Mike Jones is a complex man who might, actually, fare better in his own life in the long run by facing the ambiguity.

That's enough for now. More on the topic in another post.

Ch-ch-ch-changes

2007-07-10T11:51:00.000-06:00

So, Sunday was the first time in more years than I can think that I did not attend service at the church/denomination I am leaving. This was a far more emotionally-laden event than I had expected; I thought and thought about where to go, where to take this first step. I thought so long that I would have been too late for a couple of the options. Finally decided to visit a church in a town some miles away where I know the pastor as a sometime teacher at seminary; I have a huge respect for him.

I was sitting on the couch tight with anxiety, my neck and shoulders like rocks, abdominal cramping, trying to sense--what was I afraid of? The piece of me that says I am a failure, an overly-narrow and hyper-reactive person who is unable to be ordained in my prior denomination because of hard-heartedness, say, or inability to truly follow the way of Christ--that piece of me feels undeserving of sitting in any church and also being found out as the failure I am. The piece of me that is angry at my former denomination is afraid I will be judged for my long association with them, projection of some of my own inner wondering about how I shut down some sensitivities to remain in fellowship. And the piece of me that is just plain sad and lost was there as well.

I cried in the shower, wiped tears from my face while driving, felt tears in parts of the service, and also when I spoke to the pastor afterward. What do you know, he gave me a card and offered to be among those who walk with me through the grief. Imagine that. I do not know if this church or denomination will be an eventual home. I do know that I need places to sit and worship, just sit and worship in community, places where I can bring all the pieces and lay them before God.

So--a big milestone.

Things that make you go "hmmmmm," yes indeedy, and other stuff too.

2007-07-07T21:17:00.000-06:00

OK, so, the news are reporting that John Mark Karr was arrested in a case of domestic violence involving an argument between himself, his father, and his girlfriend.

Yup, the guy who was reportedly obsessed with the murder of JonBenet Ramsay, and sent all kinds of really, really, REALLY weird emails about his relationship with her and other little girls. He has a girlfriend.

I just want to shout across the internet to her, whoever she is, whatever she looks like, however she met him, and say, "Honey. You can do better."

---------------------------------------------------

Busy day of walking dogs mowing lawn running errands, and I was cruising over by the coffee shop and there was the Bloodmobile, so I got to give blood, first time in a long time. I am now a TWO GALLON DONOR. They gave me a fake tattoo and now all I have to do is figure out the best time to deploy it. Even better, they gave me a heart-shaped squishy thing, not the anatomically-right one, but very cute anyhow. And I am about to enjoy a bowl of low fat chocolate ice cream with no guilt whatsoever.

AND the dogs decided that, after a rainstorm and drop in temperature, they needed a second walk. Those two little 14-year-olds have walked two miles today. I am tired. They want to know what we're doing now.

Have been working on a post inspired by reading Mike Jones' book (he's the guy who revealed that evangelical leader Ted Haggard was living a double life, enjoying gay escorts while purporting to be a happily married father of five). There are those who would make Jones into a hero; I don't think it is that simple, and I'm not sure that the sort of "reduction" that is actually part of making someone a hero is in Jones' best interest over the long haul. Hopefully I'll get the post done soon. Though if those little old dogs keep demanding an escalating amount of walking, heaven knows. I am so thankful for them and the company they bring.

Friday Five

2007-07-06T23:27:00.000-06:00

Long time no see, easing back into the routine via RevGals' Friday Five:

Today, what are you:

1) Wearing--Denim shorts, black AIDS T-shirt, and my fuzzy slippers. Very trendy.

2) Reading--Hmmm, let's see: a couple "bathtub books," plus K. Pargament's The Psychology of Religion and Coping. Although the latter is in tiny spurts; my brain is still recuperating from the last quarter. I think there are a couple pastoral theology books lying around too.

3) Eating--Just finished a bowl of reduced-fat chocolate ice cream.

4) Doing--Sitting on the couch, contemplating the rubble-like piles of books I am sorting. Repeating, "This looks worse than before, but it will soon look better." Repetition conveys power, so it is said.

5) Pondering--Will I ever find work? How badly did I suck in this afternoon's interview? Is the thermostat in the van starting to go bad? Am I a complete failure as a human being? Is there any ice cream left in the freezer?? How can ANYONE believe that going to war in Iraq was a good idea from any perspective? How can ANYONE think that racism has been eliminated in the US of A? Or sexism, or heterosexism? How can I most easily lose XXX pounds? And on, and on. Bedtime now!!!!

A sad story

2007-04-17T23:17:00.000-06:00

Have been thinking about the young shooter at Virginia Tech and about those who came into contact with him. His behavior as described was overtly bizarre, his writings dark and violent, it seems clear that those around him found him abnormal and even disturbing. And yet all who wanted to help him, including a teacher who tutored him privately, were hindered because the young man was legally of age, not a minor child. No one could order him into treatment or even make a call to his family. Such a tragic story. For some reason this was a man filled with rage. I wish it were possible to intervene in such cases, but of course the risk of altering current law is that merely eccentric behavior, or unpopular but not dangerous speech/writing, could become grounds for intervention. At least that is the fear. And so at least in my state the grounds for involuntary confinement are very narrow. I don't know what I'd have done, confronted with a man like the shooter. I imagine him to have been far beyond the kind of help his teacher tried to offer by tutoring him--but, faced with an individual in such pain, it would be difficult to fail him in the class, even though he was unable to participate meaningfully, for fear of triggering some sort of violent or self-destructive behavior. Which, of course, is what ended up happening anyway. So sad for his family, roommate, teacher, along with the hundreds affected by his appalling choice of mass murder and suicide. I wish so much that he could have been linked to the bomb threats before he put his murderous plan into action. But that was not to be.

Virginia Tech mass killing

2007-04-16T22:48:00.000-06:00

Can't stop watching the coverage. Feeling raw, vulnerable. Why? I am a student now. A bit closer than Columbine (I was working then). We create distance as we can. How horrific this is, can't imagine the friends, the families.

One student here has relatives near Virginia Tech. One student in the class I taught tonight has a parent connected with the university. Other connections will emerge over time.

Nothing to do but watch the coverage. That, and pray for everyone affected.

I can talk about it now...

2007-04-15T17:33:00.000-06:00

I have been such a bad blogger (bad! bad!!) but there is a reason--huge discernment process about whether or not to proceed to ordination in my denomination. This has been a helluva year so far, but now I have made the decision NOT to go forward and have notified both my supervising pastor and the PTB in the denomination, so there is no reason to be silent about it anymore. I couldn't be open because of the (admittedly very remote) chance that someone would discover this before all was said and done, and I feared that would complicate matters. I have disagreements with my denomination over some things that are extremely important to me and found myself unable to compromise, and even though the denomination is entering a period of theological change and growth, it occurred to me that going forward on the hope that the denomination would move in directions that would make me more comfortable would be the ethical equivalent of choosing a life partner who "will be perfect as soon as he/she stops doing X..." In other words, not ethical or feasible at all.

Having made and communicated the decision, I feel tremendous and deep grief and also a sense of openness and possibility that has been missing for a long time in my life. I graduate with my M. Div. on June 1, and am looking for work now; I will also be looking for a denomination! One unanswered question is whether I am called to ordained ministry--it's unanswered sort of, in that I believe I am called to ordained ministry but not in the denomination where I thought I was called. That's one difference I have with them--I have a rather stricter notion of pastoral role, and theology of ministry, and their notion and theology is sort of indeterminate right now. Officially it takes one shape, but codes of conduct and so forth do not support what is verbally stated, and there is an undercurrent of resistance to the official position that means effectively that individual churches have different notions and individual pastors have individual notions, with sometimes very little theology behind them I think. There are wonderful people in that denomination and many find the openness both theologically and rulewise to be the most liberating thing about it, but I have found that I need more structure. And I need a place where I can ask some theology questions that interest me, that I think the place I've been is not ready to engage. Things like: how can we use religious sources of authority to reach sexual/relational ethics, without either oversimplifying to the point of absurdity or being so restrictive as to be irrelevant to much of current society? And, is it feasible to hope for an ethical framework that is valid for all persons, regardless of gender or orientation?

So that's that, and I will try to be a better blogger. Any thoughts on my questions, the one of you who reads this blog, let me know!!! It feels good to be back.

Also I am scooter riding again which cheers me immensely.

Beginning of LAST QUARTER OF SCHOOL

2007-03-26T10:58:00.000-06:00

Oh. My. God. Ten more weeks. I cannot believe it is so soon--when I started this adventure of seminary, the last quarter seemed so far away, and now it is upon me. Now, I've got to find work!!!! Have contacted a place where I did a training assignment, and I don't know if anything will come of that, b/c they have written the qualifications for their open position to require two units of CPE and I have only one. Feh. But in any case, they remembered me with happiness and that alone redeemed what had been a very bad day. I wish I were not so vulnerable as to need encouragement, but I suppose everyone does, at this point.

Got on the bicycle this morning and rode, just a few miles, just enough to get hot and sweaty and tired--first ride of the spring, and it felt good. The legs usually tone up pretty quickly, so before long I'll be able to ride gratifying distances. I hope. The little old dogs, despite being little, and old, and each having things wrong with them, can now walk a mile and then come home and play, so exercise is available.

In the midst of one learning goal: preaching three sermons in a row. Actually, past the middle. I have done two, one is left. I could get used to this. Once I've done the research and reading, I have this very weird way of going about sermon prep--sometimes it is absolutely clear to me that I have to write the thing out and memorize, other times it is clear to me that I cannot use that tool, have to have it more "in my mind." Not consistent, and what has been hard is to allow the inconsistency and not force a "method" of prep. Many of my congregation are from more Pentecostal backgrounds where the experience of Spirit working in life is familiar and also prized, and I suspect they would tell me to listen to the Spirit and her guidance as much as possible.

A very well-known speaker from my denomination came to seminary and gave a sermon at weekly worship. Reactions were very wide. Some felt the message was the most liberating thing they had ever heard, that it provided new life and hope to them on their own journeys. Others, including a professor I very much respect, felt the speaker had a very "off" personal vibe, something that, in the words of a younger student, "creeped them right out." The speaker acted like kind of a jerk to me, nothing new for this speaker, but the whole thing is great grist for my discernment mill.

I so miss my big fuzzy darling. Each time I have to tell someone he is gone, it is like an echo of that awful night again. Saturday I was up with friends who also have wolfhounds. They have a young male about a year old, a rescue, who is just settling into his new digs in wolfhound heaven up there in the foothills. He was fearful of all the guests until it was proven that we all had treats and that we could sit down and be at his height, at which point wild kisses and tail-wagging were forthcoming. Their older wolfhound, a female, instructed me to scratch her ears and rub her chest before I left. Content, she rested her big head in the crook of my elbow just as Wilson did when he died. I had to bury my face in her fur and take several deep breaths. Wolfhound fur absorbs lots of salt water and it was a very good thing indeed. I did get such a huge kick out of seeing their terrier mix and the male pup play--the terrier is WAY smarter and can corner on a dime, but she can't outrun the pup, so they were having a hugely good time up among the rocks and the trees, in the fog and rain. That pup will be solid muscle in another week--his new owners are trying to put weight on him, but I suspect it is a lost cause with all that running, which is actually really good for him and them. A tired puppy is a good puppy, in fact sometimes a tired puppy is THE ONLY good puppy.

Very sad times here

2007-03-10T09:40:00.000-07:00

My sweet Wilson Wolfhound was euthanized early in the morning of February 17. He had become suddenly and acutely ill; I suspected heart failure or pneumonia. The vets found a foreign body in his stomach, aspiration pneumonia, and possibly more problems with the stomach. They wanted to take him into surgery, and I had a very bad feeling--I just couldn't do it this time. He went so peacefully, in my arms. It all happened so fast that I was simply in shock, but I just had such a bad feeling, I couldn't choose otherwise for him.

A necropsy showed that his left-sided heart disease had progressed very rapidly since being diagnosed last June. He was, in fact, in left-sided congestive heart failure with pulmonary edema at time of death. The cardiologist who reviewed the pathology results noted that we might have pulled him through one more surgery, but that the heart disease itself was incurable and had progressed to a point where he had very little quality time left. He was only four and a half years old.

When he was diagnosed last summer, I had said to the cardiologist that perhaps he was wearing his heart out by loving; he was the sweetest, most affectionate, silliest dog imaginable and had friends all over. I have had to break the news of his passing to so many--to people in coffee shops, pet supply stores, and all over the neighborhood. He loved so many people and so many people loved him. He was, at a very difficult time, a significant connection for me to the goodness of life itself, and his loss has hit me hard. I was numb for the first couple of weeks or so, but that has worn off, and I think I could have WRITTEN the books about grieving that were assigned for my pastoral care class. Sometimes my arms literally ache with sadness, the realization that I will never hug him again. It is the price of love, this grieving, a part of life, a part of created reality.

After my darling was put down, I sat at the vets with a cup of coffee to gather myself for the lonely drive home. Suddenly I heard screaming at the entrance. The staff person at the desk had gone back to ICU, so I ran to the door to find a couple holding their limp dog and screaming for help. I quickly let them in; as quickly a vet ran forward and took the dog back to treatment to see if they could resuscitate it. I got the couple sitting down, brought kleenex and a wastebasket, and sat rubbing backs, listening, and prompting them to breathe as they screamed and sobbed. I knew what news they were going to get from the vet... their little old dog had, in fact, had a heart attack or stroke and was dead, died in their arms on the way. There was nothing they could have done, but oh how well I know the need to go through the "if-onlies." If I had gotten there sooner, etc. I hope it helped them that I was there.

Then I took my guy's leash and collars and went on home, to my little old dogs, whom I will be spoiling nonstop for the rest of their days. However many or few those are. Thank heavens for them; returning to a house with no dog at all would have been awful.

Graduation is in about twelve weeks, maybe less. Who knows what I'll do then? I was not selected for the residency I'd applied for, so job-hunting is going to be a major focus. I hope I can get hospice work, even part time, and cobble together enough to get on with. It's scary and sad as well, not having my big goofball to love and come home to. But all this will pass. I keep telling myself.

Haggard Redux

2007-02-05T09:59:00.000-07:00

So now Ted Haggard and his wife Gayle are moving to either Iowa or Missouri and are planning to study for Masters degrees in psychology so they can help others. They apparently are planning a largely on-line curriculum. I worry that they are studying to start some sort of ex-gay thing, and also someone who is as capable as Haggard of duplicity and living a double life ought, IMHO, to opt for a program with as much face-to-face time and supervision as possible to maximize his learning and minimize his denial. I think studying psychology in a decent program with high-quality involved faculty could be good for them both, but I suspect that's not what they are going for. Call me picky, but simply destroying one's life and completing a distance learning program would not be credentials of choice for a therapist. Just saying.

Yikes, I've been switched...

2007-01-28T20:03:00.000-07:00

To New Blogger. Nervous. But no smoke has come out of the keyboard yet. There are no odd smells, strange drops in room temperature, or other harbingers of disaster. So I am choosing to be optimistic.

Did lots of housework yesterday morning instead of studying. All 3 dogs were very helpful. After we'd finished the vacuuming, floor scrubbing, rug shaking, and light bulb changing, they were exhausted.

Today I took Wilson Wolfhound for a long walk in the snow and ice and cold, with people to meet and snowbanks to sniff. He is very happy indeed.

Church discernment continues. More conversation coming up this week. Hard, hard stuff. I find that I am just not as optimistic as many others are. Maybe because I've seen things go further south... Most seminary students in mainline denominations seem to yearn for a bit more of a "congregational" approach, seeing the very real advantage of freedom to be more responsive to the local demographics. However, the corresponding disadvantage is that, when you're on your own, you're on your own when it's going south as much as when it's rosy. I know there's no perfect situation. But I'd vote for some degree of shared understanding so that, when something goes south, you don't have to first fight about whether it's REALLY south before deciding what to do.

In theology lingo, my anthropology is much lower than many people's--that is to say, I don't think humanity is just getting better and better eventually to merge with perfection. I tend to think we are born in a condition of radical brokenness, and that if left to ourselves we aren't very good at being loving neighbors to anyone. Somehow we need the help of one another, the help of God, and a healthy dose of willingness to examine and learn from our own behavior to help us live in ways that are not totally dominated by brokenness. And, no, I don't think we all have to wander around feeling awful about ourselves. I think it's not a matter for personal guilt and shame, it's just life.

Will try to be more faithful in posting. I have good motivation: I have papers to work on, so won't I be tempted to blog instead? Of course I will!

Oy

2007-01-19T22:23:00.000-07:00

A tough week. Some sort of sinus crud, but I have, I believe, held it at bay by drinking fluids non-stop (to my classmates' amusement, I would show up with a big cup of coffee and a can of soda or bottle of water and sip away). Excellent classes; I think this will be the quarter I hate to finish, because I would love to have time to just keep studying.

Have learned in theology lecture that Karl Barth had a mistress whom he took everywhere. Not unlike Carl Jung and some of his followers, even up until now. What is it with these Swiss men and their wives and their mistresses??? Entitlement everywhere it seems.

In deep discernment struggle. Re-evaluating denominational affiliation. While a "congregational" polity, which allows for each local church in a denomination or fellowship to be quite different in character, can be immensely liberating, it can also allow for real problems at the local level--conflicts or patterns of behavior that are damaging to clergy, congregation, or both. I have seen some examples recently that have troubled me deeply. I have also seen some direct communications from the denomination that have expressed one message, while indirect communications express something quite different, in ways that make it tough to impossible to comprehend what the denomination actually stands for. Also, I find that as my own standpoints become more clear, I am in opposition in some key ways to some positions, at least at the local level.

So it is a tough time. There is so much that is so good about this church, but there are some areas of unclarity. How to weigh all of that and come out with an overall picture--my professors have suggested some questions to ask, but ultimate decisions are mine. Prayers appreciated.

It remains cold. Wilson Wolfhound adores the cold; for him, nothing is a better than a long walk with a lot of good smells AND new people to meet, in the cold. This, he says, is how it should always be!

Moments of grace

2007-01-13T12:26:00.000-07:00

So often we use the term "grace" to mean a state of pleasure or peace or abundance or any number of other desirable attributes. But sometimes "grace" means a clear view of what my Jungian analyst, years ago, used to call the "as-isness" of a particular situation. And such a view is always useful, even liberating, but not always pleasant. I had a moment of grace in a staff meeting a week or so ago at church. One of the senior staff said, "If you are a staff member at this church and you are actually DOING ministry you are not doing your job correctly." I saw, clearly and at a depth I have not previously reached, that this IS the pastoral model and staffing model at the church. And this model is "not me." The church operates on what my spiritual director describes as a "large-church" model where staff's role is solely the management and some of the training of volunteer staff who actually interact with the members of the congregation to provide direct service. So, I now know: I am not a large church pastor, not even a large church staff member. I need--and am trained--to provide direct service.

The public discourse regarding pastoral models has become quite polarized, and it is common to find, in books detailing one model, real "pathologization" of those who function in other models. Thus, in a required reading from my supervisor, the notion that pastors who choose to spend a lot of time in direct interaction do so out of the "desire to be liked," and those who are able essentially to become managers are more emotionally complete. One could wish the discourse could simply be framed in an understanding that different people have different gifts and all are useful in different contexts.

Unless, of course, one believes in one's heart, as some of these writers clearly do, that small churches are dying churches, and that the church as a whole needs to reconsider its mission in ways that lead naturally into growth, and thus to pastors whose gifts are motivational and managerial in nature. And many people do believe that.

Very, very cold here

2007-01-12T22:00:00.000-07:00

Getting a real Winter here this year; still lots of snow and now below-zero temperatures. No pseudo-winter, not this time!

Am taking church's training class by which pastoral caregivers are trained. Vast majority of pastoral care is provided by these volunteers. Found myself somewhat horrified at content; mainly based on a training handbook for crisis line volunteers from a secular organization. Some religious content added, but inconsistent theology, not surprising based on our theologically-diverse population. "How to offer prayer" took up about 30 minutes. I offered feedback on the feedback sheet stating that I was not comfortable with some of the theological assertions (God always answers prayer; God is in charge of everything; God has a plan--these can be immensely comforting to those who find such assertions seem to fit the pattern of their lives, but as the theology profs at school so aptly point out, every theological assertion has its downside). The instructor and director of ministries asked me about my feedback this afternoon and I tried to collect my thoughts and gave them and one other volunteer some ideas based on chaplaincy etc., and suggested some of the downsides to some of these assertions in certain situations. It was dicey because the instructor is very comfortable with "God always answers prayers" and the director of ministries has the "God has a plan" notion as a core of his own theology.

I hope I was able to make the points without seeming critical of THEM--I framed my comments as, each of us, when we speak of God and how God works, naturally speak of how we have experienced God in OUR lives, but of course the fact that God is greater than human comprehension means that our experiences are not the whole of God, and we have to be cautious about sending unintentional messages even with the kindest possible intent. Like, telling someone who has been praying for years that a beloved child could successfully get off drugs, that "God always answers prayers; you just have to ask for what you want." That may be true to us but may not be as helpful as staying with the anguished parent in the moment of anguish. Or, telling someone who has suffered a staggering loss that "God is in charge of everything that happens," which raises the question of why a loving God would have chosen to inflict the loss.

It is that pesky problem of evil that rises up at annoying times, and the temptation to offer a religious platitude -- especially if those are comforting in one's own life -- can be so strong. But so many people have been damaged by religious platitudes; even being told, in the wildness of grief for a loved one, that said loved one "is in a better place" can send the message that grief is selfish and wrong, rather than offer support. I do remember one couple in hospice during my CPE unit, who were reeling with the shock of a sudden diagnosis and only days left together. Perhaps the most connecting thing any of us did for them was validate their rage and devastation. I remember saying, with tears in my own eyes, "This sucks for you. It just does." We told them it was perfectly fine and even Biblical to be angry at God. I remember the surviving spouse, at the memorial service, catching me in a fierce hug, saying, "Thank you. Thank you." over and over, and I have to think it was because we all just stayed with them and gave them no talk about "God's plan" or "God's will." (I think they'd have chased us out of the room if we had tried that, anyhow.)

Anyhow I hope I was able to offer some constructive suggestions without giving personal offense.

Wait till we get to the topic of forgiveness. And my viewpoint that pushing people to forgive before injury has even been acknowledged is a power play, not a supportive gesture. They'll LOVE me then.

Back to school on Monday!!

2007-01-06T12:35:00.000-07:00

Hooray, hooray! I have two classes plus internship which should be a more manageable situation than the 4 classes plus internship last quarter.

Since last post we have had TWO more snowstorms. My bum shoulder finally awoke to the fact that it was sick of shoveling and has been tricky.

Much of my mental energy has been consumed with an issue at church that, being personnel-related, cannot be discussed outside. There are some problems that arise from nowhere despite the best efforts of all and sundry. There are other problems that are as big and combustible as the Hindenburg (dirigible) and that float slowly toward an organization, casting a huge shadow, and hewing to a path that is utterly predictable. If your organization has one of these, when it arrives and catches flame as it inevitably will, do not tell me either directly or indirectly how shocked and surprised you are, and how you can't imagine what to do next. I'm just saying. Because I will have to stand on my tongue in order to remain appropriate, and my tongue has boot prints on it already.

Got to go write some stuff for a church committee and also for the dog club. Cheers!

A lovely Christmas

2006-12-26T09:03:00.000-07:00

So, the Colorado blizzard is melting although the streets are rutted, icy, and bumpy. Christmas Eve services went well. I preached at the two morning ones; at the late morning one, our church's adopted homeless family, who have now attained housing and employment, came to meet us and receive their mountain of Christmas gifts. The four children, all of whom are adorable, were thrilled. Each got to open one gift, so we had two little girls proudly wearing their new bathrobes for the rest of the service. I don't know who was more excited--the children, or the congregation--we were like kids ourselves the weeks before Christmas, buying and wrapping gifts.

At the evening service, the pastor preached, and we had our traditional candle-lighting. Standing room only despite the weather! The singer who always sings for the candle-lighting wanted to make room for us to do something different; he loves the song and ceremony but didn't want his attachment to it to get in the way. He said, "We don't have to do this..." and we said, "Oh, yes, we do." Then he said, "Well, I don't have to the be the one who sings..." and we said, "Oh, yes, you do." And so it was.

There are three brothers who are served by, and serve in, the food pantry. They are late-middle-aged and all are disabled. One or two are able to work part-time only. They have developmental disabilities and some other disabilities as well. They are absolute bears for work--it may take them a little longer to learn a complex task, but once they've got it they are rock solid. One brother is the lead volunteer on one of the main "stations" in the food pantry. They are loving and beloved members of that little community. On Christmas Eve night, the pastor welcomed them as members of the church. I took some photos and will get prints for them. They were so excited!!! Each of them came up to each staff member before church to remind us that they were joining, and one said, "This is going to be the best Christmas EVER." Since I have been working in the food pantry in December, I now get hugs from all three brothers, and I look forward to it, and to them. I hope they like their pictures.

Sad news too. One member of the church's Board is worried about one of her brothers, who's been in frail health with diabetes and horrific complications (renal failure, one amputation already and another one may be in his future) who spent the week before Christmas in ICU with what looked like an Addison's disease crisis though his doctors aren't completely certain. This poor fellow is only 44, and has been through so much already, and his family members are worried sick. Another man's son died of leukemia just before Christmas, and a man who is perhaps one of the best-loved in the church had a colonoscopy Saturday--he has a type of familial colon cancer for which he's been treated twice, and he is now waiting for biopsy results on three more polyps. He's scared to death, and I am too. Praying like mad for good news. I think it may be especially bad for him because he *knows* what will be ahead for him if the cancer has returned.

The unwonted exercise of shoveling, scraping, and pushing that resulted from the blizzard left my bad shoulder flared up, so I've had an off-and-on migraine (comes from the neck being in spasm, not as severe as most migraines most people have so it's more annoying than incapacitating). Yesterday was quiet and peaceful. I listened to music, read, walked the dog, did laundry. A letter carrier broke the silence to deliver the absolute perfect Christmas gift, from my brother and sister-in-law: a Starbucks gift card!!!! I feel warm, comfortable, happy, and deeply loved. It does not get any better. I hope everyone else's Christmas was good as well.

a quick note

2006-12-15T09:08:00.000-07:00

The sewer line is replaced! The crew worked really efficiently; everything was done in 4 hours, then they had to wait for the city inspector. I had to leave to have my dental restoration installed but by the time I got home everything was filled in. Totally excellent.

The tire that had "no nail or anything in it?" The one the dealer's employee thought needed replacing? Two screws, in two different areas of the tire. Total bill: $20.00. I kept the screws and am tempted to drive down and show them to the dealer.

So far, so good!!!

If it isn't one thing it's another

2006-12-12T21:26:00.000-07:00

Never, ever ask "What else can happen??" unless you really want to know.

So, last night on my way home from my food pantry shift, I swerved to make room for emergency equipment and hit a curb and wrecked a tire on my van. Limped home. This morning the city came and inspected and found that, yes, my sewer tap is broken. And no, I do not qualify for DURA money to help with the repair. Too many assets. OK. Fair enough, because that money really *should* be for people who are hurting badly, and God only knows there are plenty of them.

AAA came and swapped the busted tire for the donut, and I dropped the busted tire at the tire place, and I took the bus to the shop to get the other car out. Here's a lovely tale: the reason the "Check Engine" light was on was because the battery was failing. (The "battery" light never came on, of course.) And there really is nothing they can do to check the electrics because there was no problem when they tested things out. So they replaced the battery under warranty. OK, now, this is the car with the power doorlocks that, on the passenger side, are possessed. And this is also the car that had the *last* battery replaced last March AFTER IT WENT TOTALLY FLAT AND COULD NOT BE RECHARGED. A pattern. Which do *you* think is more likely?? Two bad batteries in a row or an electrical problem? Also, I asked them to check the right rear tire which was low. And call me if action was needed. No call. When I picked it up, I paid and walked out front where the car was supposed to be. And looked into the shop, where I saw two guys putting air into the right rear tire. When questioned, the man who brought the car round told me that, yes, they'd checked it earlier and there wasn't a nail in it or anything so it has a slow leak so all that can be done (!!!) is replace the tire. And it's a *slow* leak so it probably won't be flat for two or three days (!!!!!!) They didn't think this warranted a call before I came to pick up the car. Soooooo, when I got the new tire put on the van this evening, I made an appointment at the tire place for the car on Thursday morning (unless either the tire has flattened or the intermittent electrical problem has caused the battery to fail again, oh joy). Then, once each vehicle has four functioning wheels, I will make an appointment to take the van in for its Check Engine light diagnostic. And I am praying that they will not find anything ghastly expensive wrong. I am also praying that the eedjits who had the van for three full weeks over the summer for repairs that should have taken less than one week did not mess anything up. I would put nothing past them. (It was a dealership, which *closed* abruptly shortly after I finally got the van back.)

I am really tired and my sense of humor about all this is getting a little loopy. When I was talking to the sewer contractor to whom I have been recommended, I scheduled an appointment for an estimate for tomorrow. The contractor had some folks who could have done it today, but I explained about the two broke cars and told him I expected the telephone to explode momentarily. It hasn't yet, but I am wary.

Food pantry ministry is wonderful fun and I am in awe of how this group of volunteers, so many of whom are themselves facing tremendous obstacles in life, have got a system going and have built familial relationships while working very hard to serve their clients. Actually, all the volunteers I've worked with so far are themselves clients, and they have been most gracious to me. They've been good teachers partly because they're so proud of their work (and with good reason). And, truly, there is something elementally satisfying about filling an order and handing someone a sack with the groceries they've chosen from the list, and thanking the person for coming, and wishing them a good week. I think I am definitely more cut out for the "trenches" of direct service than for the equally demanding but different "trenches" of management.

We did have a truly terrifying moment when one client collapsed with an acute asthma attack. The client had been having breathing problems triggered by weather change and I think coming in from the dry cold to the dry heat just tipped things from "problem" to "crisis;" the client fell down hard, and everyone started running to assist. Client didn't have an inhaler, hadn't been able to find it, but luckily I had mine, so I ran to the car and got it. Someone called 911. I swear, I thought we were going to lose this person on the spot--deeply flushed face and almost agonal respirations--but after about 15 hits of albuterol in about 10 minutes, by the time the paramedics arrived the client was sitting up with support and was able to speak a few words at a time. The client wanted to just walk home but the treating paramedic warned that the risk of death (yes, that's what he said) was still substantial without further treatment, and after a few minutes to think it over and some encouragement from friends who were there, the client agreed to transport to the nearest hospital. Paramedics would not allow the client to walk to the ambulance, even with assistance, for fear the airway would start to close again. So the poor client got rolled out on a stretcher, receiving oxygen, and never did get groceries (though the volunteers will help with that during the week if need be). Not the way anyone wants an evening to go. Client had not wanted an ambulance and one very zealous volunteer was shouting "Don't call 911" on the basis of supporting the client's wishes. I said, forcefully, that calling wasn't a choice. It's one thing if someone gets clear information from a medical professional who is capable of assessing the risk, and then chooses to decline treatment. That's awful enough to cope with, but declining even to be examined, while under care of our church in some way, is not something we can let happen. Especially not when a person can't think clearly because NO OXYGEN IS GETTING TO THE BRAIN. I hope the poor client had a short stay in the ER with some good breathing treatments and is resting safe at home now with medication.

Yikes.

No, I don't want to know what else can happen.

Back again!

2006-12-11T10:19:00.000-07:00

It has been awhile (again), as I realized that I had gotten really, really run down and needed REST. Plus the city is coming to do a dye test on my sewer line tomorrow which will, they anticipate, prove that I need to have the thing dug up and repaired at my expense, plus both cars have "Check engine" lights (one is now in the shop, the other will go in as soon as that one's back) so I have been hit with the economic equivalent of a major migraine. Why these things couldn't wait until I am done with school I have no idea, but it must have to do with God's occasionally unfortunate sense of humor. Weary, weary is how I feel, but happy anyhow.

Very little besides the absolutely necessary is getting done. But the dogs and I are enjoying each other's company. Christmas lights are up. I am working on two sermons, plus working at the food pantry two shifts each week, plus, plus.

Another sad story--another pastor of a big evangelical church has resigned as allegations surfaced of his same-sex connections. Poor man and his poor family, he has fought his homosexual inclinations since childhood and has a load of internalized shame. And he married without telling his wife; she knew nothing until last week. So much healing needed on all counts. AND, he still believes homosexuality is sinful, and would still teach that. So much suffering and all needless in my opinion. Prayers for that family and that church--they'll need 'em.

Service in Boulder last night--they are working on the order of service THEY want, and musicians from that community sang and played, very nicely. I will preach there in January and they seem happy about that. But I didn't get home until late, so I could sleep all day, but it's food pantry day today! Gotta get cracking soon here, so will sign off for now.

Back at last

2006-11-25T18:36:00.000-07:00

So much for blogging every day during November. At least I've gotten back into the blogging habit, which makes me very happy actually.

I ended up really sick; got through my professor's site visit OK (I think; can't really remember the sermon except people seemed to like it and find it thought-provoking as well as humorous, so it can't have been as awful as I fear it was). Dr. G., my professor, is a mensch, he really is, and he hung in there for the whole service and the meeting of my lay committee, had lunch with us, was full of insights and questions and respectful attention to the committee. I don't think this particular prof can DO "disengaged," and the committee was delighted by him. One committee member remembers the last faculty member who supervised a candidate from our church, and that faculty member just popped in and popped out and basically said, "Carry on." Dr. G. is a huge contrast, offering his contact information to the committee, telling them he is available for support and suggestions, affirming them, enjoying them, being very self-disclosing, offering his insights into the competing priorities I am juggling, etc. I thought it was a very productive meeting, and Dr. G. said he thought it was "terrific." He also enjoyed the humor at church. I wasn't sure how he would respond to the humor in my sermon because I like to play off stereotypes, we all do, and so I was playing with the stereotype of the Gay Male with perfect taste. I had the whole congregation laughing over my accomplishment of choosing, by myself, an outfit that complemented my Bible cover. Dr. G. had said, don't preach to him but to the congregation, so I resolutely didn't even look at him. One committee member asked what he thought of the humor and he responded immediately that he loved it, laughed his head off, and believes that if there is a playful spirit in a church that's a sign that something important is going right. So that was good. One more task left on the site visit, and that is a meeting between me, pastor, and Dr. G., and hopefully that will happen in the next couple weeks. The committee wants to work further with the learning goals, inspired I think by our discussion of how the denomination's agenda (have the student clergy acquire ability to do certain tasks, or proficiency in certain areas) differs from the school agenda (have the student define areas he/she wants to explore). So we'll talk further in December about that and about how that conflict has rather caught me in a squeeze. Especially since I am very interested in chaplaincy.

My final papers totally sucked, and I hope I can pass what I need to pass. I was still quite sick plus on a large dose of antibiotic plus 40 mg of pred per day, and I felt edgy and driven but absolutely unable to focus, as if ideas kept swirling around and just as I'd got a grip one one it would recede into the muck, so writing was (unusually for me) utter hell. I was just relieved to hand the things in, and I expect really poor grades, but it was all I could do.

Finally feeling a little better, breathing better, two more days of antibiotic. Of course, in the middle of everything, a huge chunk of filling AND tooth have fallen out. In the holiday week. I did get an emergency temporary put on, but that lasted less than twelve hours before IT fell out too. I will go in either Monday afternoon or Tuesday morning. Luckily not much pain, just a dull aching on that side of my face. This'll be a crown, which is fun with NO dental insurance. I will hold out for the least expensive fix; we can always get fancy some other time, I think. But I'm virtually certain it can't be filled again, because there's almost nothing left.

A bit behind on my brother's first Advent box-let. I have had to do the dog club newsletter. However, a plethora of little items awaits wrapping and shipping. I *did* find something perfect but it is out of my price range. The item rendered me speechless, featuring as it did a music box, some lovely resin sculpture, *and* a snow globe containing -- wait for it -- three Wise People, gifts, and a palm tree. What's not to love? It is all the fault of Sara at Going Jesus for getting me to notice, really NOTICE religious kitsch.

So tonight I need to get the labels printed, so tomorrow we can ship the newsletter (friends are helping with the mailing assembly, bless them!!!) and then on to whatever is next. HOORAY!

Aaaaaahhh, good drugs

2006-11-17T22:33:00.000-07:00

Lucky me, I am sicker, so off to the doctor I toddled today, and now have 5 days' worth of prednisone and 10 days' worth of amoxicillin and that should knock out this crud which decided to awaken my asthma. Whee!!!

Got the second paper done. Two down, two to go. I have the sermon more or less sort of in place. I'm not real happy with it, it's not one I really feel passionate about, but there you go. After another couple slugs of antibiotics it may seem better, and of course there's still 36 hours to go (35 but who's counting?) before I have to deliver it, and anything can happen. The Visual Arts people made the slides all wonderful as they always do. There's one image I absolutely adore--two kids in what appears to be a praise choir, and one is clapping away but the second is clearly over the whole thing, and the look on her face is priceless. Isn't it true that, even in the middle of the most inspiring singing, sometimes you just "don't feel it??" The point for that one is that part of what church is about is being with others, so on those days you aren't alone and can maybe get carried along on the confidence of others, and some other day you'll carry someone else along, and that's how it goes, because there are times when all you can see in front of you is a steep uphill climb. I want to talk about how what looks like an uphill climb is sometimes absolutely accurate, especially at this time of the year, when the messages from the culture get so loud, telling us that our value is based on looks/money/amount of Stuff we have. And then propose some alternate things to look at other than ads--those we love, the beauty of nature. I've got a stunning photo of a climber on a very exposed ridge with summit in view, and beauty all round, and to me that works for the notion that perseverance may not lead us on a flat, easy route, but one filled with all the joy and beauty and inspiration of God.

Smarmy, isn't it? Feh.

Paper for tomorrow is done...

2006-11-15T22:16:00.000-07:00

...though badly. Thank heaven I am taking class pass/fail, although I have a terrible and perhaps unreasonable fear that I will fail. At least the paper is the right number of pages. That has to count for *something.*

Going to slam some medicine and off to sleep. One down, 3 to go. Plus sermon.

Surprise...

2006-11-14T23:46:00.000-07:00

Final paper I thought was due next Tuesday???

Due this Thursday. At 1 PM.

Feh.

Good grief, I missed a day!

2006-11-13T22:08:00.000-07:00

But I have a good excuse: after the two services in the morning (with the hallucinating congregant at 9 AM who scared some of the volunteer liturgists half to death with bizarre behavior), and a nap in the afternoon to keep trying to ward off the cold, it was off to Boulder to set up for the worship service there. The man who had panicked about not knowing what to bring to set up the altar--the one I had promised to work with in Denver after the 11 AM service--had forgotten that discussion and decided to go to Boulder only, so I hauled everything up and was met by him, distressed that I was ten minutes later than I'd said. We still had 50 minutes before service, so it was no big deal. We set up, I ran the service with the volunteers, although not as carefully as I ought to have; they'd all been chosen by Church Plant Pastor, but apparently he'd not told the guy leading congregational prayer any guidelines, so we got a lengthy prayer with all masculine images of God, and such formal wording I doubt the college students even understood it; it's not what church means to them. Turns out it is a generational thing and an educational thing; Prayer Guy is a lovely man who was trained in a very conserving theological seminary many years ago, and his language reflects how he prays in private. Next time, I should remember: when someone says, "I have a prayer all written out!!" ask, tactfully, to see it. So, schlepped all the stuff back down, and off to sleep again. I have to take the stuff back to church tomorrow.

Oy, today was drafting a paper for Ritual and Worship and then meeting with the group to run the service demonstration we are doing tomorrow. It is as hard for me to negotiate with too MANY good ideas as with too few. I think we have something more-or-less workable even if theologically a little scattered; we are presenting an interfaith service, and those often *are* a bit theologically wide open.

So--time for more sleep!!!

The cold is winning...

2006-11-11T22:25:00.000-07:00

Thank heavens for tissues with lotion.

The memorial service went well. A lovely family. And the doves co-operated, and the cat was nowhere near when they were released. Luckily.

The news yesterday said that Britney had dumped K-Fed via text message. A class act to the very end, no?

I do not think I will *ever* get all the papers done, especially not with my head stuffed up. This is just what I needed, NOT.

However I had to go to the bookstore to get some books for the group presentation that happens Tuesday, the one that keeps growing willy-nilly to the point where I no longer have even a clue what we're doing, and THAT was nice. They have some grand gift items. Like the Marie Antoinette action figure with the button you press to make her head fly off. Now THAT's a visual that might actually hold the attention of middle schoolers.

Church is having its art auction this evening. I *should* be there, but my excuse now is that I am contagious. Plus having to study. And now I am going to bed.