Tuesday, July 27, 2010

Dual Realities

I am feeling comfortable with my patient visits. On call on Friday, Saturday and Monday, with no morning classes, there was a lot of time for orders and a lot of time for other visits.

I like the role of chaplain. I enjoy the patients. I enjoy learning about their medical challenges, what keeps them going, what brings them down. I am developing my own style. I listen closely to people, initially echoing back what they are saying. Sometimes I paraphrase and check out if I have done it correctly. I move the conversation and thoughts along. I celebrate the small steps that they are making. I honor their pain and troubles. I point out dualities in their stories.

One woman told me yesterday, “I have always been the rock for my family, I have always supported them through their crisis, and now I can’t do that anymore. A little while later, she said, “I’m just thinking about all of the gifts that God has given me that I haven’t used, and I realize that I’m just so selfish.” I reminded her to the two thoughts and asked her how she reconciled them. She said that she didn’t know. I think I probably responded, “Isn’t that the way with most situations, everything is itself and its opposite. “I have no doubt that you have always been the rock of your family helping them through crisis, and that you have gifts that were given to you by God and that you have not taken full advantage of. Can you think of ways that you might want to take advantage of some of those gifts now?

People have been responding favorably. They seem to enjoy the probing questions. It’s so amazing to me that they would talk so earnestly with a stranger.

A man on Saturday was taking himself to task about this worry. He quoted scripture that said that he shouldn’t worry. I sympathized with him that he had a lot on his plate in terms of his medical condition, and noted that his situtation was made even more difficult because his worry was seen as a crisis of faith. We talked about how in God’s world we don’t have to be perfect and how scripture points us to a more Christlike existence that asks us to always be striving toward a goal to be forgiving and trusting in God, but not one that demands that we always achieve that goal. It’s the striving that’s important, we agree.

Many of the lessons explored in the patient’s rooms are ones that I need to take to heart. I don’t know if that because it’s a collaborative process, or whether, like that woman who was the rock, that I, too, am selfish at my core. “Aren’t we all,” I probably replied when she made the remark. In my understanding of the world, we are selfish and we are generous all in the same moment. It is the yin and yan of life, of human existence.

I think that’s one of the reasons I like this hospital work. It’s all pretty real here. People are stripped of their possessions, their clothes, their familiar surroundings. They, and we who walk with them, maneuver in the realm of the spirit, in the region of the heart, in the midst of high tech reality. It is the ultimate duality: it is complex and simple this healing of body and heart. The lessons and the healing are personal and universal.

I am learning about all that I don’t know. I am seeing that I know what I need to know. I am becoming differentiated from my emotions. I am learning about choice. I am seeing that we have to deal with what we have to deal with and that sometimes that dealing is surrendering to the situation, sometimes it’s diving in.

I am learning how different people are and how alike we are at the same time.

These are things that I share with the patients I visit. We fill each other’s days and for that, we are both grateful.

Friday, July 23, 2010

Legacy of the Heart

I was disappointed that D. had been discharged from the hospital. I wanted to give her “Legacy of the Heart,” a book by Wayne Muller about the spiritual advantages of a painful childhood. If anyone could use the soothing voice which tells us that we can use painful childhood experiences to grow more fully into ourselves, it was this 18-year-old. With no money, abandoned by her mother as a young teenager, she was proud that she was the first of seven children to graduate from high school.

Joyfully, and a bit defiantly, she told me that she graduated at the top of her class. She had been accepted in a university and was on her way to the first of five degrees that she wanted. The only thing that stood in her way was a strange pain in her abdomen. Perhaps it was a problematic gall bladder, the medical staff didn’t know.

She also knew that she had closed her heart and that it prevented her from getting close to people and would hold her back.

“How can I trust having been through the experiences I have lived through?” she asked.

We laid my Reverie Harp, a small lap harp that produces a beautiful sound no matter how you touch it, on her chest. I asked her to strum the instrument, feel the vibrations in her body and just listen playfully to see if it spoke to her.

She was silent and thoughtful, her fingers brushing the strings gentle. After a few minutes, she stopped, smiled and opened her eyes.

“Well,” I said, “Did you hear anything?”

“It said, “Listen to your heart, your heart is trustworthy,” she replied.

“Wow!” I said.

We talked about intention and affirmation and how it can be helpful to find a four or five word positive phrase and repeat it over and over. She liked the idea.

“I’m going to write this down,” she said. “So I don’t forget it.”

We worked on another affirmation, which she wrote down as well.

I am glad that when I promised her that I would see her again, I said that it was contingent on her being in the hospital. I am glad that I was true to my word.

She had trusted me with her story, her emotions, and had opened her heart to me. She had also given me her wisdom that when we don’t know what to do or how we are going to do it that we can listen to your heart and know that it is trustworthy.

In our moments together, she found her own way to use her painful childhood. She named her own legacy of the heart, and with it I am sure she will be empowered to accomplish all that she desires.

Saturday, July 17, 2010

Discerning my tears

My mother tells me that I cried for the first two years of my life. She says that all I wanted was to be held, and being a infant in the mid 1950s, when baby rearing protocol insisted on a feeding, changing and putting a baby down in the crib, I cried most of the time. At the age of two, I simply stopped.

I cry a lot still.

I cry in joy, I cry in sorrow. Sometimes I grieve.

Generally my crying is not a prolonged affair, a tear here and there, a quiet sob, which racks my body with four or five involuntary utterances. I cry in sympathy with others, holding and responding to emotion that is not even mine.

Sometimes I clearly understand what I am crying about, sometimes I do not. And I feel an underlying expectation that I know what I am crying about. In our group sessions, when someone starts to cry, the question is often asked, “what are those tears about?”

When I answer, “I don’t know,” I feel that I am admitting that I don’t fundamentally know what is going on. I feel inadequate in the explanation. I judge myself for not knowing what I am feeling. I imagine others around me silently clucking their tongues and saying, “Geez, she doesn’t even know what she is crying about. How am I supposed to react if I don’t know what is wrong?”

I am coming to realize that maybe nothing’s wrong. Maybe my crying is a coping mechanism, just like coughing clears our throat or our eyes tearing washes away impurities.

I generally shed tears in my individual supervision and yesterday my supervisor commented that there is so much pain that I carry around. I tried to explain that I thought pain and joy happen simultaneously. I related observing a dying patient receiving a phone call from his brother. The patient cried tears of joy, and that joy was tinged with great sorrow. He was so overjoyed to hear from his brother, he was so sad as he anticipated his impending death.

By my observation, he feels this because his days are limited. I feel this duality of joy and sorrow because I am alive and sensitive to my surroundings. In some ways I am coming to realize that I live in a world of emotion, and I surmise that others do as well. But this is not something that is a problem. This is something that is a gift.

Our universe and everything in it, including plants and non-verbal animals, respond to emotion. Not surprisingly, there are some noetic scientists who put forth the concept that the fabric of the universe is a hologram that responds to intention and emotion.

I understand that in our world of stoic and intentional distance holding up emotion as positive runs contrary to the internalization of dispassionate living as facing a sober reality. But I believe that if we were actually to understand that our emotions are buffeting us around, whether we acknowledge them or not, we would find that we have more choice in our reactions.

In chaplaincy, we are urged to connect heart to mind and compassion with assessment. We are being asked to participate in the peeling away of defenses, to become in touch with our emotions and our past hurts so that we can know ourselves better and by extension be better ministers.

I have found in this process that I have a great capacity to feel. And for that I am grateful.

Tuesday, July 13, 2010

A second chance

My day began and ended with families where the second chance for living was coming to an end.

In the first visit, a woman in her late 50s asked to fill out a Living Will and a Healthcare Surrogate form. She was realistically preparing for open heart surgery, said that she had almost died three times in the last year, and was thankful for decades of remission from Hotckins Lymphoma. At the time, she said, the chemo-therapies had not been so gentle and all of the medicines from that time, which she recognized gave her 30 years of living, were the cause of her current medical crisis, and could kill her this week. She said she was desensitized to the drama of it, and simply wanted to make sure that if she was put on a respirator due to her impending surgery, that it not go on for more than three months.

“I will not be a Terry Schiavo,” she said simply.

She had an amazing sense of balance, and was not angry or seemingly sad at the prospect of her death.

“I learned that each day is a gift,” she said.

The visit at the end of the day was not so cheery. Here gathered a grieving family, as their husband, father and uncle, lay dying of liver failure. He had been a transplant success story for some 15 years and, up until last week, was on the list to receive a new liver. But had he had taken a turn for the worst, and his liver and his kidneys were failing. He was on comfort measures only, and according to the palliative care technician would probably die within 24 hours.

The room was darkened and his wife and his sisters were weeping. Undoubtedly, their grief would carry them to gratitude at some point down the road. They would remember the joy of the 15 extra years that a transplanted liver had made possible. But today, it was about loss and sorrow and saying goodbye.

There is no real comparison between the first and the last visit of the day. Grief and reconciliation are not constant. There is no right way or wrong way to let go of life and loved ones. There is no sure way to maneuver through our painful experiences.

It is this lesson that seems most poignant to me at this stage of CPE: how important it is to meet people where they are with compassion and a curiosity to learn more about the what’s really happening for them. It’s not about fixing the situation; it’s not about providing comfort; it’s about walking together through hard and at the same time ordinary human situations.

Wayne Muller, in “The Spiritual Advantages of a Painful Childhood,” explained that we all want to consider ourselves extraordinary – we want to see our problems, our struggles, as being amazingly more complex and difficult that anyone else’s. He comments that we make ourselves significant by our magnitude of our troubles. Really, though, “none of us is more special than anyone else. Each of us was given a particular combination of wounds, gifts, talents and imperfections that merely give texture to the quality of our experience.”

It’s comforting to understand that our lives are ordinary and that we are uniquely ordinary together. Each day we get to face our particular challenges. Each day, we have a second chance at living. While not as dramatic as the two families that I visited with yesterday, we have a second, third and fourth chance to experience the wonder of human life from our very unique perspective.

Saturday, July 10, 2010

Ambassador of God

There's is a awful lot of praying that happens in the Pastoral Care Department and in the work of the chaplains. Our morning and afternoon report begin with a prayer. Most pastoral visits either begin or end with a prayer.

I like prayer, and see it as praying to that small wise essence in ourselves. Another Unitarian Universalist chaplain colleagues describes praying for another as connecting his wise essence in himself, to the wise essence in the other. He prays across to the other person, as opposed to up to an outside entity.

Many of the prayers offered during our routine reports are "He" focused, complete with "You" pronoun that is responsible for all. A common prayer might be: "We thank You, God, for the gifts that You provide for us. Help us to ever grow closer to You and to do Your will in our work today."

It's a cool prayer and I have do a bit of translating to find connection in it. God for me is not a being, it is an ever present life force. God, for me, is the fabric of the universe. And as beings in the universe, that life-force is in all of us, and it plays out in our lives all of the time.

I hear the voice of God within me and that voice guides me always. But it is not a person and "He" does not exercise "His" will. I connect to that life-affirming energy and depending on my connection, it meets me where I am.

It is mystical, it is ancient, it is intimately connected to everything. We function in its presence, and we create its presence by our attention.

I'm happy for this exploration and I'm content with the time that I have to explore this spiritual connection in my life. In our initial orientation, we were told that we were the ambassadors of God. And that being that ambassador, it wasn't a question of our relationship to God, we were to meet people in their relationship to God.

Interesting though, in order to meet people where they are, you have to know where you stand.

Thursday, July 08, 2010

Redemption and forgiveness

I asked a patient the other day about his concept of redemption and forgiveness.

“I don’t go to church much,” he replied to me.

“I’m not asking about church,” I said. “I want to know whether you think that there is redemption and forgiveness in the world. Because what happens next in your life depends on whether you think you can be redeemed and forgiven.”

We had seen each other in the elevator, and I had been asking someone else how they were doing, or how the patient they were calling on was going. Some of the most effective chaplaincy work is done relating to people in the corridors and the elevators.

“Are you a chaplain?” he asked. “Can you come and visit with me?”

I wrote down his room number on my client tracking sheet, and his name, just in case, he had said. It was good thinking for him to give me his name because he was unsure whether he had the room right, and that way I could look him up.

He told me that he had taken a bus to Tampa from Connecticut and that he had no money and no place to go. “I really need to talk with someone,” he said.

“I guess so!” I responded, smiled and told him I would see him later.

When I met back up with him, he told me, after I asked a couple of times, (“So you got on a bus in Connecticut and came to Tampa, how was in that you ended up in the hospital?”) that he had been doing cocaine for the past 30 years. He had no family, no place to go, and was looking to finally changed up his life. That’s why he came to Tampa, in one sense to thrust himself into a place which was new and where he knew no one, and where it would be very difficult to get high.

We talked about how huge his situation was: no place to go, no money, no family, no friends. He told me he was embarrassed, shamed. I talked his intention to begin anew; and that what he needed to hold tight to was his desire to not get high. There was this one thought, albeit a huge challenge, that he needed to stay focused on. The rest, I said, would fall into place. And this, holding onto the thought that after 30 years of bad choices he could begin to make new ones, healthy ones, was dependent on his belief in forgiveness and redemption. The forgiveness and redemption of himself.

Wayne Muller, in Legacy of the Heart, writes that forgiveness can set us free and that our fears and our rage, our reaction to our childhoods and our current situations, need to be nurtured and invited, and never pushed away. We have to embrace all of the pieces of ourselves, and in the embrace—of the bad thoughts, the awful experiences, the deep hurt, the betrayal, the abandonment away—a space will open up and a reconciliation can occur. The ancient Greek language, he writes, has two words for time: chronos, meaning chronological time, the measurement of minutes and hours and years and kairos, a sense of time that describes the deeper readiness of things to be born. Kairos is a time when an opening appears and an opportunity for a healing, a redemption and a forgiveness can occur.

Crisis, whether they are medical or whether they are impromptu urging to get on a bus and begin life anew, open a space for kairos and an opportunity for us to recognize and honor the painful pieces of ourselves, to hold ourselves and others in compassion and empathy. And I believe that in exploring our connection to the spiritual values of salvation, redemption, forgiveness, we may get a glimpse of the underlying values that we will hold ourselves and others accountable to and for. This kind of reflection opens up a space that cleanses and becomes expansive so that joy, wholeness and health can come in.

“I saw a lot of chaplains today, in the halls, around the hospital, and I just felt that I wanted to talk to you,” my patient told me.

“You have a lot, an overwhelming reality, in front of you,” I told him. “But you only have to think about one thing,” I made a small circle with my forefinger and my thumb and pointed to it, “which is totally within your control,” I said. “And that is that you are making the change in your life that you desire, a change that you set into motion when you got on a bus in Connecticut.”

In one sense, it’s the choice that we each have, each moment, to be the change that we desire in the world. So often we look to your circumstances, to all of the people who have hurt us, to all of the situations that we have had to face in what is often a terribly unfair world.

And we need to remember one thing: that we are worthy, that no matter the choices that we have made, we have the opportunity to begin anew and achieve the peace and love that we so clearly deserve and desire.

This is what I told my patient from the elevator. This is hopefully why the patient chose me: to affirm and support his new beginning and to offer him unconditional redemption and forgiveness.

May it be so.

Monday, July 05, 2010

Hunkering down

With nearly one half of my time in my Pastoral Care Education (CPE), I feel compelled to become more serious about using my time well. I am looking to hunker down, I write in my journal. I look up the word to be sure.

Figuratively speaking hunkering down means to apply oneself seriously to a task; which is what I feel I want to do with my learning. However, hunkering also means to crouch down low and take shelter in a defensive position, which is actually what I would like to avoid. In fact, it is important to give up one’s defensiveness and to move from a critical mind to one that is curious. But giving up critical mind is very difficult and abandoning one’s shelter in a defensive position seems like a scary proposition.

In the end, what is required is not to become more serious, but rather to develop more faith.

According to Wayne Muller, in “Legacy of the Heart,” faith is a way of being. It is a spiritual practice, a way of discovering what is reliable and true, a way of expanding trust in our inner wisdom. It is a place inside where we are in compassionate relationship with what is strong and whole within ourselves, where we listen to the still, small voices of our heart and soul.

It’s hard to have faith in still small voices. I think our culture encourages us to have faith in strength, to exude confidence, and to never admit when we don’t know what to do or what to say. CPE teaches that expressing the inability to offer any relief in the face of the pain and the questions, is actually something that is helpful to say. It’s kind of ironic that when you don’t have anything to offer, you can offer that you don’t have anything to offer.

It’s kind of the like the idea of hunkering down and being serious about letting go and being open.

Or put another way, I seriously have to lighten up.