CPE - Wks. 9 and 10

Week Nine started off as something innocuous enough but ended with me with no energy to write about it. So now I have two weeks to cover and perhaps even less up for the writing.

Wk. 9
Monday. In class our supervisor presented the sacred text: Jacob at the Jabbok wrestling with the strange man. I didn't tell him that he was stealing from my sermon material for CRC. The didactic for that day was on hospice chaplaincy and was presented by BJC's hospice chaplain Eunice Hiott. She presented a picture of great need paired with resource cutbacks so stark that many of her hospice patients get a visit from her only once for the initial assessment, with any further support provided by volunteers. I had been thinking of hospice care as something rather attractive: serving the needs of a dying patient over the duration of a final illness. But no. For most it seems hospice chaplaincy is little more than a bureaucratic form to fill out - figure out what is most needed and then be unable to provide it. Eunice is currently doing the job once was done by four chaplains. None of the warm, supportive chaplaincy I'd imagined in hospice. At least not for most patients. Let the air out of that balloon.

Wednesday. I visited a patient, retired, whose primary complaint other than the uncertainties of her health was that she was neglected by her adult child. She explored her situation through narrative. And as I listened to her story, what emerged was not neglect but a story of her child not believing the religious doctrines that are important to the patient. The longer I listened to her admit, when I pressed her, to the wonderful qualities of her child while persisting in her characterization of herself as being abused by her child, the tenser I became. To the point that I sat nearly fifteen minutes in strong physical pain from a major cramp in the middle of my back, trying to hide it in my face and responses, because my job is not to tell her where she is wrong but to elicit from her what is important to her and what her resources are for dealing with it. But this was like listening to my grandmother. I felt guilty for just a moment, thinking of this patient as a pain in my backside. Literally.

Thursday. The class topic today was Family Systems.

Friday. While covering for my mentor who was out with gout, I had the full experience of a Code 7 (cardiac arrest) being called on a patient just as I happened by. The room filled with doctors and nurses. The patient's family member who had been in the room was asked to move to the hall so the doctors could maneuver. When she heard that the patient had no pulse, she let out a shriek that went to the bone. I stayed with her to provide what support I could. Prayed with her. But mostly I didn't leave her. The medical team wanted her to go to the waiting room, but she would not, could not budge. When she gained the tiniest bit of composure, she set to calling family members. As they arrived, the patient was rushed to ICU, and CPR continued for more than 2 hours. I never realized how brutal CPR is. Athletic strength was exerted by person after person in the team. Med students were called in from other units to keep up the exhausting effort.

I accompanied the doctor when he updated the family at the halfway point. He was explaining facts and likelihoods. The family wouldn't hear it. They refused the explanation. And the doctor, deaf to the emotional reality in front of him, kept trying to EXPLAIN. I tried to give him nonverbal signals that it was not helpful and that he might consider leaving. But he missed my cues too. Since I had no working relationship with this doctor, I could not simply tell him it might be better for him to leave. Finally, the family shouted him out the door. It was a wrenching two and a half hours. The pain of the family was raw and exposed and refused to be quiet. The patient lived.

That was the morning. In the afternoon, I had the death of another patient...

My back was still very sore from Wednesday's encounter that reminded me of the worst aspects of my grandmother. But I wasn't feeling the effects yet from the encounters of this Friday. Yet for reasons I didn't quite understand, I stayed for a couple of hours after my shift ended talking with the evening chaplains. I didn't talk about the encounters so much. But I wasn't ready to go home to an empty apartment. I finally left when I saw there was not much time left before Shabbat services at Central Reform Congregation. I hurried out the door and got there on time. I was so ready to greet the Sabbath.

Central Reform Congregation
Waterman at Kingshighway, St. Louis MO

I let the music and the words of the prayers wash over me. During the silent prayers of the Amidah, I had a few emotions of my own that flowed into the silence. Memories of patients and families and the connection I made with them for a brief time. It all flowed into the silence as others were silently reciting the fixed texts or their own words. Mine was a more an amorphous glob. A slowly flowing glob reaching into the void.

Afterward, Leslie Caplan and her friend Pamela, a member named Sarah, and I stood talking in the parking lot for quite awhile. Sarah was curious about what I would be preaching on next week. I retained the secret. Leslie, who earlier this summer had dubbed me a "Hebetarian," told me this evening that she thought maybe I was more Hebe than 'Tarian.

Saturday/Sunday. I drove to Mt. Vernon on Saturday morning to spend the weekend there. I e-mailed out some inquiries regarding where the processes were in others' preparations for the fall. Did some writing and reading. Spent time with Walter and our dogs.

On Sunday morning, I was slow starting and walked into Mt. Vernon UU Fellowship, my home congregation, about seven minutes late. No mercy. I opened the door to find that the chairs were all facing the entrance. As it turned out, the reason was that Debbie Czarnopys-White, who was leading the service, wanted to take advantage of a banner on display over the back doorway. Her service was on spirituality, as distinct from religion, and she brought in an array of spiritual perspectives, represented in the symbols on the banner.

In the coffee hour, I spent time with Donna Beaumont and Gail DeVilbiss, new board members of the fellowship, answering some of their questions about the congregation's history and the early years of board decisions and offering my opinion of a few issues that probably will need the current board's attention. Then conversation on other matters with Linda Rowe and with Deb Czarnopyz-White. After going out to lunch with Walter mid-afternoon, I searched through my computer for various files related to the organization of the fellowship and sent them to Donna, did laundry, and packed for my return to St. Louis. I had thought I would leave for St. Louis after an early supper, so as to avoid driving in the dark, but I just wasn't ready. I ended up watching Mystery on PBS with Walter before leaving, getting into my apartment after 11:00PM.

Week 10
Monday. My mentor was still out. I spent more time on his floors but mine. A family of a patient in ICU, people I'd been providing spiritual care for a couple of weeks, informed me that they had made a decision and would do a terminal wean in a few days, allowing their loved one to come off the ventilator and die a natural death. They put on a brave face, but conversation reveals the chinks in the armor.

In the evening, I discover that a task I had thought was finished was, in fact, not. I fret a little and then decide to do the task after work the next day.

Tuesday. After a day with moderate encounters, I stayed on my own time in the office to complete the task I had discover needed done the day before. I worked on it until complete at around 9PM. Headed home to find a notice from the building manager telling me my rent was late and a penalty was incurred. I had prepaid the entire term of this summer lease, so I knew it was wrong. I called the office expecting to get voicemail but got a live body. No brain, though, it seems. Because when I told him I had prepaid the entire term of the lease at the time of signing, he asked me what I meant. "Prepaid?" As if I had coined the word. I found myself angry at him for being so stupid but reigned it in.

Wednesday. Because the apartment office doesn't open before I clock in at the hospital, I make the call mid morning to see what was up with the late-rent notice. Turns out that having an end date on a lease is insufficient. They require that I give them a 30-day notice in writing informing them when I will be vacating the apartment. They knew explicitly at the time I signed this short-term lease that on August 15 I would vacate the apartment, that there was no possibility that I would extend. I am paid through the end of the lease, which falls on August 15. A couple of weeks ago a message from the manager informed me that I was coming up on the end of my lease and that I should contact the office if I wished to extend. And now, even though I am paid up, the absence of a written-30-day notice means I'm late even though I'm early and that I owe rent for time after I will vacate the apartment. I was angry. And I told the manager so. I distinguished between her and the policy, saying I was not angry at her but that I was very angry. I asked what they would do if I did not pay. She said they would begin the eviction process. I said, "So if I leave at the end of my lease, I will be evicted after I'm gone?" I was getting angrier. I ended the conversation and, realizing my emotional state, walked back to the office rather than going to the floor to see patients. I just wasn't there for them then. And as I walked I got angrier and angrier. I was livid. It was not simply in my mind but in my body.

Back in the office I tell my colleagues what has me riled. Bob tells me to take deep breaths. "Calm down. You're on blood pressure medicine," he says. I call Walter. Eventually I calm down but still feel the emotion in my chest. I walk to north campus and back to try to get back into a place where I can do what I am there to do.

I go out to the floor to begin seeing patients and am greeted by the family that told me on Monday that they were about ready to take their loved one off the machines. The number of family present has grown. I sit with them, meeting the new arrivals. This is the kind of family that just enfolds everyone in their presence. At the time of their need, I have been taken into their warm embrace. It is their way of responding to my bein their with them and for them over these past weeks. They tell me that their loved one will be taken off the machines at 1PM. I promise to be there with them.

I return to be with them and spend several hours with them before and after. I find I am quite emotional along with the family. Their loved one's body is tenacious, not easily letting go as the inevitable happens after removal of the machines. At 4PM, the family is still waiting. I explain my evening schedule to the patient's daughter and mother and return to the office to accept the triage pager and begin the next eight hours as on-call chaplain.

A slow triage shift. Only three deaths, including the one I'd been waiting for with the family through the day. There was a non-emergency referral that was a short encounter, but draining. A patient was hostile to a chaplain's presence. And the only reason I was there in the first place was that the mother of the patient was concerned about the patient's eternal salvation. Say what? How is her worry about something outside the room what this is all about? She wasn't even present. And me? I'm a Universalist. If there were a heaven, everybody would go there. I let the patient know that a chaplain was available if he wanted one and that we are not here to push any agenda or anyone's agenda, excused myself and left.

After midnight, I returned to the apartment and found a dun tucked behind the doorknob. I growled. Drank half a beer without the least enjoyment. And fell asleep on the couch.

Thursday. Slow start. Breakfast. Coffee. Ablutions. Practicing my sermon for Friday evening at CRC. I took my trousers to the cleaners. Stopped by the apartment manager's office. Went through the crap. I was angry at the manager too this time because I saw her attitude. She wasn't just doing her job. She refused to even consider any reasonable accommodation, such as not charging the late fee because I was paid up through the end of the lease. It boiled down to paying up the full un-owed amount now or the account would be sent to collections. I wrote a check. Feeling the rage in my body in ways I never had before. I was really worried that I was going to end up a patient in the hospital myself.

Went to the St. Louis Art Museum. Stood looking at my Florentine Nobleman for several minutes, alternately unseeing, elsewhere, and dealing with aesthetic minutiae. I walked to the center of the large room of portraits, saw them all staring impassively at me. Had enough of them. And walked into the next room. There I sat on a leather sofa and gazed into Bircher's Twilight in the Wilderness.

Twilight in the Wilderness (1865) by Alfred T. Bircher

A magical-realist effect was in play. As I looked at the painting, it felt alive, beckoning in more than an aesthetic way. It was as if I could have walked into the painting and off into its sunset. I knew the boundary of the imagination and the "real," but it felt as if this were a portal. I sat there contemplating its allure for a long time. Zoning out. Not my thoughts wandering. Real zoning.For a few moments, I was Nowhere. I was in the Void. Then I would return to the painting, the portal before me. Eventually I realized that the same museum guard had passed by more than a dozen times. Was he watching me? Is this level of absorption with a work so rare in the art museum that it appears suspect? I moved on.

Similarly engaged with a work I had always despised:

January, December, November (1989) by Gerhard Richter

Something about the bottom portion of the left canvas of January drew me in:

Detail, left panel of January

Here too I zoned into the Void. It was wonderful and exhausting. Eventually I got up, went to my car, drove to the Central West End, and ate lunch from the buffet at Rasoi, an Indian restaurant. Returned to the apartment, took off my clothes and fell asleep for two and a half hours. On the bed for a change.

Got up. Putzed around a bit. About 7:30PM I started making supper: Italian sausage and a melange of potatoes, sweet peppers, and okra. I enjoyed it thoroughly with a Boulevard Pale Ale.

Friday. The end of the week is beginning. Who knows what the day brings. But looming large in my mind, looming really large, is the arrival of Shabbat at the end of this day of service...