Saturday, March 17, 2018

A Day Away

I attended a daylong mindfulness retreat on Friday at my favorite mindfulness center.  I am always renewed when I go there.  The peaceful and rejuvenating atmosphere, the inspiring workshops, the wholesome meals, the lovely concerts, the restorative yoga and meditation classes, the beautiful woods hiding the stone labyrinth, even the little gift shop with unique books and items—everything leads me to contemplation and reflection.   I have attended two Zentangle weekends, a mindful knitting retreat, and now this day of immersion in mindfulness and meditation, which I attended with my good friend, Mommy Goose.

I think the day was just what I needed.  I’ve had a meditation practice for about 8 years now, starting with the Mindfulness-Based Stress Reduction (MBSR) meditations I learned during my first and most severe back issues in 2010 (when I couldn’t sit—or function for long periods of time--for almost 2 years because of chronic pain from spinal issues and a tailbone dysfunction.)  I still find the MBSR approach to chronic pain one of the most potent tools I have when my back and tailbone issues flare.  From there, I studied Buddhism and found that it really resonated with me—the focus on presence and compassion, the approach to suffering and the alleviation of suffering.  I integrated a regular breathing practice and later a metta or lovingkindness practice.

But with the recent challenges of CPE, when I probably need meditation the most, my practice has been slipping.  I have not volunteered for so many hours in a week since the children were born; it’s essentially an unpaid part-time job.  Nor have I been engaged in coursework (with papers and readings etc) like CPE since I finished my classes for my Ph.D. almost 20 years ago.  And I can see the obvious effect on our home life—laundry goes undone, as does the grocery shopping.  We’re eating more take-out.  And I’m struggling with issues of guilt—I’ve been late to take kids to activities, I’ve been gone on snow days, I had to rely on friends to pick up a child who missed the bus, which I know are issues that working parents regularly deal with, but it is new to us.  While Mama and the kids are handling it all in stride and aren’t disappointed or critical, I am struggling at times.

As for the workshop, which I think both Mommy Goose and I really needed, I sat, watching my monkey mind, observing my breath, and could feel the anxiety pass away.  I did a body scan and felt tight muscles relax.  I practiced an alternate nasal breathing technique and felt my mind clear.  I did a mindful eating exercise and paid attention to a meal for the first time in weeks.   I was familiar with all of these exercises but hadn’t practiced in awhile, despite it being one of my learning goals.  I had been sitting daily at hospice, breathing in the pain and grief of the patients, breathing out love and peace (the practice of tonglen), but I needed something different.

My favorite part was a mindful listening exercise with a focus on empathy.   First, we sat with a partner and alternately shared a story while the other person listened deeply—no interruptions or advice, not even therapeutic nods or “uh huhs.”  At the end we simply said, “I will remember this for you.”  To be heard is such a deep gift.  Then we stood, with one person’s eyes closed while the other looked into her face (we were all women) and gently touched her arm or shoulder while the teacher read, slowly, something like this:  "This person, like me, has been happy and sad.  This person, like me, has had hope and despair.  (It went on like this for a bit) May this person, like me, be happy, healthy, safe, and free from suffering."  To be seen by another and to see another, to acknowledge our shared humanity reminded me of why I was drawn to hospice work in the first place and why the first UU principle (about worth and dignity, a la the UU Golden Rule) is my guiding light.

CPE Reflections

I don't even know where to start to tell you about CPE, here about one-third of the way through the unit.  Here are some of my reflections:

On being a part-time (unpaid) working mom:

  • On my first day, I was an hour late getting home because of traffic and Sis was late to horses.
  • On my second day, Sis missed the bus and thankfully a friend could pick her up.
  • On my third day, it was a school snow day but not that terrible so I went to work and the kids stayed home.
  • One time, a kiddo misunderstood that I'd be home extra late and was upset and scared.
  • Many times, I have just not had the ingredients or wherewithal to cook; we're eating a lot of take-out and odd dinners.
  • Same with laundry not getting done regularly and kids wearing not-quite-clean uniforms to activities (so now they are doing their own laundry!)
  • and we are weeks behind on regular medical check ups (and will be weeks more.)
  • I have to hibernate away from everyone so I can write, attend online classes, and read.
  • Even when it's not actual work, I'm distracted and feel like I'm out of time and missing something.

On my CPE professional, personal, and spiritual goals (which we had to write up in the beginning):

  • I will seek out my place in spiritual care as a humanist Unitarian Universalist chaplain, because I sometimes feel a lack of worth and authority as a chaplain—“impostor syndrome” perhaps—which hampers my ministry.  I think this is the result of at least two issues: 1).  I am at the beginning of my journey in pastoral education and still very much learning in all areas, and 2).  I am not a Christian but currently often only see Christian chaplains as work at hospice—while they are good role models in so many ways, we have theological approaches.  Many of Connecticut Hospice’s volunteers are Roman Catholic deacons, brothers, and priests and so the focus is often on communion, mass, and the Sacrament of the Sick, for our Catholic patients (I’d say 75% of our patients are Catholic).  I believe I have something to offer all of our patients, but I struggle sometimes with overcoming my doubts;
  • I will become more familiar with the stories of the Bible so as to communicate more effectively and authentically with my Christian patients (I was raised in a decidedly non-Christian, atheist family and I continue to make great and conscious efforts to overcome the lacuna in my Biblical literacy) and to understand the spiritual metaphors of the stories to inspire my own spirit;
  • I will continue to expand my multicultural/multi-faith competency so I can connect more authentically with people of different faiths;
  • I will work on my communication skills, particularly my initial visits with family and patients in order to overcome awkwardness and promote greater connection.  I do a lot of “cold” visits and know that the first few minutes, my first few sentences, are crucial to establishing connection;
  • I will improve my use of open-ended questions to facilitate discussion;
  • I will learn NDoc, the platform used at Connecticut Hospice for tracking patients; 
  • I will learn the processes for IDT for Connecticut Hospice homecare patients;
  • I will continue to master the reporting practices for Spiritual Care visits.
  • will reignite my meditation practice;
  • I will continue to study spiritual resources of prophetic men and women from many faith traditions for my own spiritual growth;
  • I will investigate and adapt traditional religious language—notions of grace, faith, blessings, God, etc.—as relates to my liberal progressive beliefs and use this language to facilitate interfaith dialogue.  (For example, I have learned to think of my metta—lovingkindness—meditations as prayer and to describe them as such to others; similarly, I do not use the term “God” to express my understanding of the universe but recognize that my beliefs in love, the spirit of life, and community are encompassed by the word God for many people.)

On patients and visitors I remember:

  • the young man with the brain tumor whose extended family and friends circled around him daily to provide comfort and support.  The hardest part?  Seeing his toddler running around the lobby and talking to his parents about watching their beloved son slowly die.
  • the African-American Baha'i gentleman who believed in a loving God but wasn't sure religion had made the world a better place, seeing how so many Christians and others preached such hatred, especially now and who said that we couldn't have talked like we did when he was younger because the white supremacists would have killed him for being alone with a white woman.
  • the happy Finnish woman with the beautiful crocheted blanket her mother made 90 years ago, who liked to talk of her home and the summer place by the sea and had seen her parents visiting her.
  • the very angry woman who blamed hospice because her husband was deteriorating and she didn't have much time left with him and who then got another woman in the room upset that her brother was dying, too.  That woman, the sister, did find some comfort that day in my singing to her brother.  
  • the woman who wanted came at me in the hallway sobbing, begging me to pray aloud for her mother in accordance with her own conservative Protestant Christian views--so that I convince her sister and her dying mother that they were wrong to be Catholics!
  • the family that demonstrated so much equanimity in the face of the medical malpractice that had led to their mother's dying in hospice.
  • the woman who didn't understand what her dying father was waiting for (because he would have hated being like that and they had all said goodbye but would stay with him until the end--was he waiting for his birthday? the Patriots to win the Superbowl again?) until she opened the window and he breathed the fresh air and died.
  • the woman who was an artist who painted lovely portraits and landscapes and hated that people would patronize her because she couldn't talk above a whisper because of her cancer, who felt comfort in knowing that her siblings had been through the same thing before her.
  • the woman whose friends held happy gatherings everyday, raucous and joyful--and teased me that as volunteer chaplain I must be too pure for them.
  • the woman who was telling funny stories when I showed up--and someone asked if I had "the weed?", leading to a conversation about spiritual care, family and friends, and recreational drug use.
  • the woman who kept crying out in pain for help and for a daughter who was not there with whom I sat until the third dose of something finally relieved her.  
  • the Catholic patient who died right on his arrival at hospice whose family was still arriving--and how devastated and guilt-ridden they felt that he hadn't received the sacrament of the sick, whom I led in prayers at the bedside because I was the only Spiritual Care volunteer there.
  • the woman, who was a "fan" of Mary and Catholic television but belonged to no particular faith community (though she had been Lutheran, Presbyterian, and "Epistopalian") who begged for reassuring verses on heaven and all the prayers, blessings, and rituals of any religion in her panic about her mother's active dying.
  • the Ukrainian Jewish siblings who were transferring their 90+ year old dying father back home so their mother, who couldn't travel, could be with him at the end, and who were sad that he had received such indifferent care at the nursing home when there was such loving care at hospice (what was America coming to?)
  • the woman deep in the grip of dementia who would become so anxious and agitated when I came to her bedside that I quit visiting so she wouldn't become upset.
  • the young gay man with HIV/AIDS who was not quarantined or discriminated against the way he would have been thirty years ago--and all the loving friends and family who surrounded him and how we talked about Pride parades and Macy's.
  • the older gay man whose partner was always there, who loved dogs; it was heartbreaking to hear how he had said goodbye to his own dogs before entering hospice.
  • the woman who was a writer/illustrator and had left such a creative legacy for all of her children.
  • the woman whose bedside table was decorated with photos of many years of annual family reunions (all over North America) and all the happy memories her children shared with me about her.
  • the older Catholic gentleman who came to Mass every week but didn't talk much to anyone when we'd visit his bedside; he had a kind face.
  • the former UN employee who wandered the halls during PT and would talk to me about books he loved to read and asked what the nautical flags on our pole meant (they are non-sensical.)
  • the former hospice volunteer who had many employees at hospice visit and invited me to sit down when I said I was a UU.
  • the visiting family member with the beautiful voice who sang along with the pianist and me to a version of "Water is Wide" with words referencing the mass shooting; we all hugged at the end.
  • the patient and his wife who regularly sailed out of the harbor seen through our window who told us that the island with the green buoy was Mermaid Island.
  • the gentleman who was actively dying and whom I was praying for with a volunteer when the grumpy nurse snapped at us for trying to wake him up (which was not what was happening; same grumpy nurse has snapped at me for visiting a woman with dementia, thinking it encouraged her hallucinations.  I avoid whatever room she's assigned to now.)
  • the daughter who came into the Commons room while I was playing Greensleves who thought it was a sign from her mom who had just died minutes before because it was her favorite song.

Other Observations about clinical hours at hospice:

  • As a volunteer, it took awhile for me to be recognized as a member of the team by the full-time employees; they are very used to me now and know to come find me.
  • There is too much paperwork and no one seems to understand the whole charting system, which is both done by hand and by computer but we're not sure how they integrate the two.
  • I am more nervous visiting a patient who has visitors than one who has not; I feel like I'm interrupting their visit.
  • I never wake a patient.  Like sleeping dogs and babies.
  • Patients who are still awake and alert often suffer from loneliness and welcome company and my visits.
  • The view is most comforting to the visiting family; I'm not sure how well our elderly patients lying in the (very fancy and expensive beds) can see the Sound.
  • The staff, volunteers, and families were intrigued to watch the Bald Eagle eat his lunch on the ice floe this winter.  There apparently have been a few meaningful bird sightings, like the hawk that watched a memorial service for an employee and flew away when it was over; other hawks have sat outside windows until a patient's death and then flown off.
  • Everyone loves the therapy dogs--staff need them as much as patients, I think!
  • Psalm 23, the Lord's Prayer, and/or "Amazing Grace" seem to transcend any particular faith and are comforting to so many.
  • I like our terrible old out of tune piano in the Common Room.  I try to play Greensleeves there but can't avoid the worst notes.  Still, I like to play.  I also like to sing at Mass or the Interfaith service, even though Christian hymns aren't my favorite (especially because they don't use the UU changed lyrics!)  Two that stick with me are "How Great Thou Art" and "In the Garden."  
  • I've made a few small afghans for hospice and have been touched to recognize them on the beds of patients.  Gotta buy more yarn!
  • I don't wear scarves to work because they dangle and could cause infection to spread.  I also always wear short sleeves because it is so warm in the building (due to all the windows and the need to keep patients warm); I usually have a very light sweater, which I take off if I have to gown up for infection protections, which is doubly warm.
  • Nurses order a lot of take-out for and any snack brought disappears super quickly.  Even faster than with teachers.
  • I really like the people in the art therapy department--mainly music and art people, which really isn't a surprise.  In fact, when they hold events, it's a lot like a museum education program with different crafts!  And the musical ones are so gifted.

CPE Observations:
  • Thank goodness for this blog and my reflective writing habit of the last ten years.  Everything I write for CPE is similarly reflective, not like academic writing at all.
  • So far, the verbatims and class sessions have been less daunting than I expected from the memories of friends who have done them elsewhere before.   I just shared my first case study verbatim this week and have only received a few "giftings" (critical/analytical comments.)  But oh, one of them was very touching and encouraging.  Still, I've been anxious waiting for their responses.  And I have to present to the group this week in our class, which is doubly nerve-wracking.
  • And while the online modules were very informative, the final test was ridiculous--it didn't really evaluate what was learned but focused on minute details (what hospital did the author of that one article work at?) and word-for-word definitions and comprehensive lists (I think the module instructors must have a chip on their shoulder in the heavily evidence-based medical field in which many of them work and are trying to make it more scientific.)  Blah.
  • The book we have to read, by Anton Boisen, reminds me of Spring Awakening, with the struggle of repressed sexual desires causing an emotional/spiritual crisis for the author.  I've about 1/3 of the way done with it.  Boisen is often seen as the founder of the discipline of hospital/healthcare chaplaincy.
  • Other things I'm consulting:  Karen Armstong's books Great Transformation: The Beginning of Our Religious Traditions, The Bible: A Biography, The Case for God, The History of God; Scotty McLennan's Christ for Unitarian Universalists; John Buehrens's Understanding the Bible: An Introduction for Skeptics, Seekers, and Religious Liberals; Neville Kirkwood's Pastoral Care in Hospitals; Interfaith Ministry Handbook; The Work of the Chaplain; What do I Say? Talking with Patients About Spirituality; Arthur Becker's The Compassionate Visitor; Professional Spiritual and Pastoral Care: A Practical Clergy and Chaplain's Handbook.  And, yes, The New Oxford Annotated Bible.

My Case Study Presented to Class:

KNOWN FACTS: It was late afternoon; our Roman Catholic priest had just left; I had stayed to complete some paperwork in advance of the big storm brewing to hit the next day.  One of the social workers arrived in a rush; a patient had just died while being transferred to hospice and the family was shocked and distraught, asking for a priest.  I called the priest on his cellphone, but he said he wasn’t able to come back because he was already out of town.  So I told the social worker I would go.   I knew nothing about the family—not even which members were present, only that their loved one was dead and they were Catholic.  I grabbed a Bible as I headed upstairs.
PREPARATION:  I had never addressed a newly-bereaved family by myself, especially one that wanted a priest but was getting a chaplain-in-training!  In the elevator ride up to the second floor (which I took instead of the stairs so I could pause to think), I took a few deep centering breaths and decided on the 23rd Psalm and the Lord’s Prayer, with or without singing “Amazing Grace;” I would adapt according to the family’s needs and wishes.
OBSERVATIONS: When I arrived at the bedside, curtains drawn, no one but the deceased patient was there.  He was a Caucasian male in his 80s, clearly dead but still warm to the touch; his mouth was open but he looked relatively peaceful.  I realized I had been in the room with another patient when he was brought in not too long ago.  I hadn’t noticed any turmoil upon his arrival and had made a mental note then to find his paperwork because I hadn’t known he was coming.
I stood beside his bed and read the 23rd Psalm, said the Lord’s Prayer, and said metta, a Buddhist meditation of compassion (In this case, I used “may you be free from suffering and the causes of suffering” and “may your friends and family be comforted.”)
I left the bedside and went in search of the family, who I found in one of our private niches.  There was a Caucasian woman seated on the couch crying, just staring at her blank phone.  A man of similar age stood at the window talking to someone on his phone.
F(1)= woman
C 1(standing at the entrance to the private niche, I wait a moment before entering.  The man sees me and turns his back, still talking on the phone; the woman doesn’t look up so I knock gently on the wall.  She looks up so I approach her on the couch.)  I’m Jamie from Spiritual Care.  I am so sorry for your loss.   I know it was more sudden than you expected.  (She nods and begins to cry.  I sit down next to her and turn towards her, waiting some.)  I understand you wanted the priest, but he is unable to come.
F(1)1:  He’s not here?
C2:  No, I’m sorry. He had already left and is unable to come back.
F(1)2:  He won’t come back? 
C3:  No, I’m sorry.  I visited your father (I look for her to confirm my guess because I wasn’t sure she was his daughter) just now and said some prayers.  Would you like us to pray together at the bedside?
F(1)3:  Yes, yes.  Thank you.  But my brother is on the phone.
C4:  There’s no rush.  I can sit here with you until he’s ready.  And then we’ll go.
F(1) 4:  (renewed crying) I can’t believe the priest isn’t here.  Oh, we shouldn’t have moved him.  They said he would make it through the weekend so we moved him to be here and I didn’t expect to arrive and he’d be gone already.  Oh, we shouldn’t have moved him.  What if the transfer rushed things? And he didn’t even have last rites.  (crying; she has a tissue and so I sit beside her, quiet and still for a bit.)
C5: I was in the room with another patient when he arrived and there didn’t seem to be any problems.  Sometimes this just happens.  I understand it was a shock.
F(1)5:  I can’t believe the priest isn’t here.
C6:  How about this:  after we pray, I will go back to my office and see if I can find another priest locally?
F(1)6:  When will the regular priest be back?
C7: Not until tomorrow morning.
F(1)7: And my father will be gone by then . . . (crying; her brother finished his conversation and comes over to the couch.  I stand up to address him.)
C8:  I’m Jamie from Spiritual Care.  I’m so sorry for your loss.  I know the timing was unexpected. I’ve been talking to your sister.  The priest is not here and so I offered to lead some prayers. 
F(2)8: That would be nice.  Thank you.
F(1)8: (standing and putting away her tissues)
C9: We’ll go in together. Is that alright?  (Both nod and follow me out of the niche.  We walk to the room and I open the curtains.  I stand on one side of the bed and they gather on the other.  I place my hand on their father’s head and begin to read the 23rd Psalm.  She begins to cry and touch her father’s face.  I pause after the Psalm.) We commend his spirit back to its home.  May he be free from suffering.  May he be at peace.  We pray for comfort and strength for his loved ones who, while they trust that his spirit is home, will miss him here with them.  Is there anything you would like to say to your father?
F(1)9: (kneels at her father’s side, stroking his face,  crying.)  I love you, Dad.  I love you.  I love you. (buries her head on his shoulder and cries; her brother wipes away tears.)
C10: (I wait until there’s a natural break in her crying.) And so we pray as we have been taught.  “Our Father . . . “ (Catholic version.)
F(2)10: Amen. (he touches his sister’s shoulder, who stands up.)  Thank you.  That was very . . . important.  Thank you so much.
C11:  You are welcome to stay here as long as you need to.  I will go make the calls to see if I can find another priest to come speak to you.
F(1)11:  Thank you, thank you.  (They leave the bedside and the curtained area and walk away, down the stairs, I’m not sure where to.)
Wrap-Up:  I went to make calls but couldn’t find a priest.  When I returned to the room, the patient was gone and the brother and sister had left. 

It’s really hard to say, actually.  The woman was crying a lot, shocked and distraught.  But I couldn’t infer with any certainty if this was because they were very close or because she had unsaid things/regret.  I do not know how strong her faith was (and I did not ask questions such as “where is God in this for you?”), only that they wanted a priest.  I don’t even know if they were all Catholic (we have many mixed-faith families.) 

I had many emotions as I headed upstairs.  I was frustrated with the priest for not coming back and nervous about not being able to fill his shoes.  But I also didn’t know how to tell them that even if the priest came he can’t do the last rites.  It was too late.  I’m not sure if this is common knowledge among lay Catholics.
I knew this moment would come, that I would need to provide some kind of bedside commemoration of a deceased patient.  I had closely observed how our chaplains (this priest, the previous priest, and the minister) had handled this situation; I had recently read the Gospels and considered appropriate passages.  But I was still nervous, especially under these circumstances.
In retrospect, I wish I had asked the woman to tell me about her father while we were waiting for her brother to get off the phone, so I could have added that to my prayers, but she was crying, and I didn’t want to interrupt that.   I’ve had discussions with both the minister at my church and one of our lay ministers who is a hospice social worker about how touch, talk, the offering of a tissue even, etc., interrupts and even terminates at times the flow of emotion or sends a signal subtly that the present emotion is uncomfortable or unwanted for the listener.  Similarly, I didn’t ask questions about her faith, etc., or really many questions at all.  The grief was just so fresh and her tears so strong. 

Transference:  The woman was clearly focused on, and even incredulous that, the priest was not there; she focused much of her energy on the priest in the beginning.  I was waiting to see if she would become angry at me about the priest, but she re-oriented herself once her brother was off the phone.  I think part of her focus on the priest was also her own regret or guilt at transferring her father to our facility, which she thought might have rushed his death; this regret was then compounded when she couldn’t see the priest or provide for her father’s last rites. 
Counter-Transference:  I was nervous.  I wanted to offer comfort to the family, to help honor the patient’s death, to give them a quiet space before the chaos of funerals, etc. began.  But I felt inadequate because I was not the priest, which means both the woman and I were thinking of the absent priest in the beginning.  I have concerns about confidence in my hospice ministry and a lack of pastoral authority, so this touched on some of my weaknesses, exploration of which is one of my learning goals. 
Our priest and I had actually started the day at the bedside of a Catholic patient who died.  He listened to the family a bit, but no prayer, no blessings; still, his very presence in his role as priest comforts people.  I have also been with my on-site supervisor, a non-denominational Christian minister, at bedsides.  He often prays with families using a passage (Psalm 91, I believe) about the secret place God has prepared and encourages them to talk.  I used the latter as my guide.  I have spoken to my on-site supervisor about this, as well as a few UU ministers I know, including the one at my church, and am feeling better about how it played out.

I had actually been reading up on canon law about the Sacrament of the Sick (our shorthand is SOS) because our priest, who is new to his assignment with us, has missed a few SOS when he has been on call; patients have died without receiving this very important Catholic sacrament. Oddly, I think I am more bothered by this than the priest; to me, it seems like a lapse in his duty, but to him it is the will of God.   I had read that the sacrament is never given to decedents or by anyone but a priest.  So when he said he wouldn’t come, I knew a). no one would give SOS to the deceased patient and b). even if it the sacrament could be delivered, none of the other deacons or brothers or Eucharistic ministers connected with us could administer it (they weren’t present either, but I had their phone numbers, too.)   I don’t know why I didn’t tell the woman that the priest couldn’t administer the sacrament anyway; perhaps because I wasn’t sure exceptions aren’t made—I have seen rules about the sacraments bent before.  It also seemed harsh to say it was just too late for her father.
I also wondered why the facility from which the patient had transferred had not offered SOS if he were so close to dying.  Patients do not need to be in extremis to receive the sacrament.
Perhaps it also seemed harsh to me that the patient would go unshriven, carrying the weight of his sins, just because of the timing of his death.  As a Unitarian Universalist, I don’t view concepts of sin or salvation or the power of the priest the same way as Catholics, but I was seeing it from the woman’s point of view.  I have come to understand how very important and central the priest and SOS are to Catholic families, even if they are “lapsed.”  In fact, when the patient in question was arriving, the priest was administering SOS to another patient in the same room—one who had left Catholicism after youth and was a very devoted Congregationalist—but as that patient said, if you’re raised with Catholicism, it stays in your very core.  We also had another patient’s daughter this week who begged for the SOS even though neither she nor her mother had ever been Catholic—the daughter said she worshipped Mary and watched EWTN; the daughter was looking for any prayers, any rituals, panicking.  And our very ecumenical priest did give the SOS to her mom. 
Hopefully that gives you a sense of what I've been doing for six weeks or so.