CPE - Wk. 5

In my comments on Week 3 of CPE, I wrote:

It occurs to me that my maternal grandfather died from an inoperable brain tumor and my paternal grandmother died from stroke. There is a gentle undercurrent of tending to the spiritual needs of family as I serve this population of patients and their families.

How much more so when the patients sometimes bear a close resemblance to these or other family members. Depending on the relationship I had or have with the person the patient resembles, this can be a complicating factor in serving that patient's spiritual needs.

I see a resemblance to my ex-wife, with all the baggage of that relationship, and I have to take that recognition into conscious awareness and then put it in my pocket to deal with later with my peers. In group with them, I can unpack what that recognition meant to how I responded to the patient and what it meant to me. But in the moment I cannot allow such awareness to get in the way of what I am there to do. And later, together with my peers and my supervisor, I realize things about myself and that relationship that I hadn't even thought of in a really long time. Everything that ever happened to me is resting quietly in a brain shadow waiting for the light to move its way. Nothing that ever happened is gone except through brain injury or death.

I see a resemblance between one of my patients and my grandmother. I feel good about caring for her. But I have to work to keep her family story separate from my own. Parts of it match my family story too closely for comfort. Other points of difference prompt me to judge the response of her family negatively. I have to take the recognition, accept it for what it is, but set it aside when I am with this patient. My judgment goes into the file, it must not enter this encounter.

And sometimes the patient doesn't call to my mind anyone in particular, but something else makes the encounter difficult. Maybe I know what the doctors are saying but the patient hasn't been informed yet. Maybe I know that the patient who came in with one diagnosis now is going to have to face a worse one as well. As chaplain, I am not the person to pass on medical information to the patient or family. I work with them with what they know and believe and feel. Medicine is left in the hands of the medical staff. But when I know something the patient doesn't yet, the encounter can produce great tension within me.

I sit in group with my fellow Intern Chaplains. One recognizes a very painful experience from her family in the patient encounter described by another. The room fills with pain, tears, and caring attempts at expressing empathy. To do what we do, we are open to each other at sometimes raw and painful edges. We are Black and white, Christian, Jewish, and Unitarian Universalist, middle-aged and young-adult, men and women, gay and not-gay. But we are each other's brothers and sisters.

I sit with a family whose loved one entered the hospital expecting a diagnosis and treatment plan that would allow an eventual return to something like normal life. What they got was altogether different. Terminal degeneration. Quick progression. The family have great faith. But also very great pain. They are supported by an army of prayer warriors, as their tradition does in extremis, but realize that the miracle they ask for might best be made real with death to end the suffering. I sit with them, tears welling in my own eyes as they fall from the eyes of the present family. I pray with them, giving voice to their fears and hopes, my hand being gripped with great difficulty by the patient.

I move on to the family of a patient whose impending death is more immediate...

Central Reform Congregation
Waterman at Kingshighway, St. Louis MO

And then I leave that week behind in worship in the Kabbalat Shabbat service of Central Reform Congregation.

It was a special service. It began with a string quartet, musicians of the Gesher Music Festival of Emerging Artists - Sage Cole and Tessa Gotman (violins), Lilian Belknap (viola), and Sara Sitzer (cello) - playing the Adagio from Felix Mendelssohn's final composition, his String Quartet No. 6 in F-minor, Op. 80, written while devastated over the sudden death of his sister Fanny from a brain hemorrhage, after his own related collapse and brain injury that led to his own death. Fanny and Felix both could have been my patients on the neurology and neurosurgery floors. I could have been their chaplain... The Adagio is gentle but full of pain.

The service then progressed as usual, but with the string quartet joining the guitars and drums. So beautifully! Improvising. Rabbi Susan's teaching was based on the Torah portion where Miryam and Aaron die, Moses strikes the rock in anger at the people and will, as a result, not be allowed into the Promised Land. She dealt with the weirdness of the red heifer passage, the joining of life and death, curse and blessing, and other extreme opposites in the reality of life on earth.

Immediately after her teaching, the string quartet played Osvaldo Golijov's Tenebrae. In the composer's own words:

I wrote Tenebrae as a consequence of witnessing two contrasting realities in a short period of time in September 2000. I was in Israel at the start of the new wave of violence that is still continuing today, and a week later I took my son to the new planetarium in New York, where we could see the Earth as a beautiful blue dot in space. I wanted to write a piece that could be listened to from different perspectives. That is, if one chooses to listen to it "from afar", the music would probably offer a "beautiful" surface but, from a metaphorically closer distance, one could hear that, beneath that surface, the music is full of pain.

Pain and beauty, life and death, prayer for peace... The themes of my week played out in worship. Rabbi Susan declared the performance of Tenebrae "great Torah!" It was also powerful, powerful music. Music that touched, that grasped the soul.

The service progressed to a wedding blessing. Rabbi Susan always leads up to the blessing with a beautiful, emotion-filled, personalized teaching for the bride and groom standing before her and the congregation wrapped together in a single tallit, evoking the chuppah under which they will stand in a few short days. The teaching celebrates the couple's growth, achievements, and individual qualities and is filled with Rabbi Susan's personal memories of the couple - or the member of the couple whom she has known for many years, seeing them grow up.

The service then moved on to the Mourner's Kaddish, members standing to speak the name of parents, siblings, children, partners and others dear to them, remembering them in the first year after their death and on their yahrzeit, the anniversary of their death. Some deaths are within the past week, some a half-century or more ago. All the dead are remembered. May their memory be a blessing!

This juxtapositions of life and death, promise and memories, brought tears to my eyes. Again. And again we ended in blessing of the gathered congregation, the wine, the bread...