Saturday, June 21, 2008

Godspeed Golden Girl

This morning I sent Lutheran Chick#1 and my Beloved off to Minnesota to Lutheran Summer Music Academy. For the next month she will be at Gustavus Adolphus for flute and voice. Wearing her LTSG Tshirt and a smile. May the days ahead be bright and full of adventure. So for LC#1 and all of the other bright eyed youth who are the church of today, a little Natasha Bedingfield...missing you but can't wait to hear how this chapter of your life will be written.

Monday, June 16, 2008

Where the Women are strong...

Despite my fears that Friday night would be the time of incessant business, it turned out to be Sunday. Sunday was the day that I had planned to bring consecrated communion elements to one of my patients, an elderly German lady who is a Lutheran. Our Synod assembly was preventing her pastor from visiting her, she said. Outliving the Garrison Keillor phrase, " the women are strong," her body is giving out, and hard decisions need to be made about a extended care facilty, not a return home after the fall into the glass curio cabinet. I had offered to bring her communion and share a period of worship with her. It turned out to be such a crazy day that by the time I got there, she had gone for an ultrasound. Her roommate, an even frailer lady was curious about my visit. I had asked her if she wanted to join in communion and she had refused until I was about to leave and return at a better time. Suddenly, her tiny voice cried out, "Wait, you're Lutheran aren't you? " "Yes, I am." "I'm Episcopalian! No one has been to see me from the church, may I join you after all?" I assured her that would be wonderful. I left a note for my original intended visit to have the nurse page me.
I was finishing up a trauma when the nurse called and cheerfully chirped, "The girls are ready for you!" Knowing I had not much time, but how important this connection to the outside world was, I tried to clear my mind as I headed up in the elevator.
When I arrived, each was sitting in a chair, with lipstick on. I explained what we would be doing and offerred a printed copy of the service to Dorothy, the Episcopalian lady. Rita, the Lutheran, knew the service by heart and still would be saying much of it in German.
So we began, and then Dorothy realized part way through the confession that she needed her bifocals. We stopped and after a thorough search could not find them. Rita chastised her for not having them out. I offered that I would speak the confession and Dorothy could follow in her heart. God would still know her thoughts.
We were just about ready to have communion and my phone went off. The family of my cardiac arrest patient had arrived. I responded that I would be there in 5 minutes.
I began to sing "Lamb of God" and they both joined. They each began to cry. After communion and prayer and a blessing, I spoke with each- not as long as I would like but long enough to hear how much the liturgy and sacrament had meant to them. A window on who they had been before the chronic-ness of now. Faded memory, failing bodies, families who are tired and stressed about what to do.
Today was a followup visit with Rita about her options, and as we met. A group of doctors and family came in to tell Dorothy that there are no more options, the cancer is inoperable, hospice is next, and one more diminishment to a once vital soul must be faced.
Then I was called for a death of a 101 year old woman who was surrounded by family, who lived to see great, great, great great grandchildren. Goldie lived on her own until two weeks ago. So for Rita, Dorothy, Goldie and all of the other women who once had a carefree mind of their own and a devilish look in their eyes..

Thursday, June 12, 2008

Strange Confluences of Events

OK, so it all started with being called to ICU. Mom of a patient in distress. Daughter's "outcomes are not expected to be good." The nurse says. I know what that means- not is good is final. Through screaming, crying, anger, reminiscing, unpacking of enough baggage to fill more than one Faulkner novel, I not only see why the despondency generally. The mom had reached her end of patience ( which may not have been much) and had yelled at the daughter with AIDS. Mean words, that ended with Mom saying she can't take it anymore - she is going to kill herself. Daughter leaves in a snit, it is 99 degrees outside, and after walking too far she collapses from heat stroke, and is in a coma. These were the last words between them.
Now here is the mother. Wanting the daughter to wake up- not likely. And as we cycle through it all, the mother speaks present tense- I can't go on. I'm going to kill myself, I could take pills. I know she might have pills, or she might not. I have been there an hour. It has been hard. She has gone on and and on - I have barely been able to say a word. Now she is clutching on to me and sobbing.
"Did you say you want to kill yourself, or you do not want to?"
What to do? I can't take her to mental health voluntarily. I can't leave her there. I could excuse myself to sort this but how long can I be gone? We are into the third of four stages. But what if I am wrong? What do I have to use?
"you said you want to be here when your daughter wakes up, because you are such a loving mother."
" How will doing this change your wish to be here?"
Silence- for the first time
"Do you want to be here to tell her you love here when she wakes up?"
"What does that tell you? Can you hold on for her?"
"I think I can"
"You said you want to be in a support group for families with AIDS - you want to be heard and to help"
"Do you remember the social worker is coming tomorrow."
"I can't be here until 2"
As we talked on we made plans for the next day, we prayed each sharing prayers. She prayed "Lord thank you for the woman who came to see me- I don't remember what her name tag said but I am glad she came"
We made a plan- a different plan for tomorrow, not the frustrated plan of today.
Lots of other things may come, but this crisis passed.
A mother of a dying daughter. A woman whose illness cancelled a long planned family trip. The list could go on. How is God present and speaking? In the presence of ordinary people who are willing to be sent. In the gathering of two or more in God’s name. In the times where for some reason a person in need found or was found by another who really didn’t need to be there then, but was. In the bright light of the person who has experienced a near death experience and finally feels it can be shared with someone who will not judge it, but believes in the light.
When I started this program, I was worried I would have nothing to say, that I might not know what to pray, or how to be present with someone. It is a learning experience, but I have abandoned the idea of props for a lot of things I do pastorally. Most of the time what I need shows up, or is already there, just waiting to be manifested. What is needed by the patient shows up. While I may not fully see this in the midst of the moment, I usually see it later when I step back. But other times I see it then and can be in awe.
Where I struggle is in “trauma.” But if I am honest, I can say that there is a reason it is called “trauma.” It is best to focus on my role and not the big picture. Don’t look at how tall the mountain is, just start taking steps. To know that situations are fluid. That I will have bad days, and so will others. To know that not everything can be resolved and that is how it is for reasons beyond me. That what I am feeling is often very internal, not external – so I can either bring it out and ask for help, or accept a low level of discomfort as normal- part of being human. Just like everyone else. Processing this has allowed me to begin to have a more realistic handle on the concept of competence.
I am getting to know the team of fellow interns, residents and staff better, and to experience different styles. I have come to appreciate even more the mutual concern that is prevalent, even when I don’t know it. The person who thought of calling to see if I was OK. The person who chastised someone who was to relieve me and who was late-“get down there and relieve her in the trauma bay!” The ability to process stressful circumstances when I needed fresh perspective. And the chance to laugh when we are all confused.
I am experimenting with new styles, and trying to embrace some of the concepts in The Skilled Helper. Oddly, it was when I was at my wit’s end that it kicked in- the reflective question that made some one pause.
In my first supervisory session I mentioned having a chance to continue to work on diversity awareness and language issues, particularly with the Latino/a population. Later that day, I did a visit where I was again faced with a closed door of a particular patient, and was ready to leave a note. The door opened and a woman emerged to tell the nurse the patient was feeling nauseated again. The sign on the door said “Spanish-speaking only.” I asked the woman if she was related- she is the daughter. We discussed how the request for pastoral care had not been able to be met- door closed. While today was not good because of a scoping procedure, I got an update on the patient and new concerns, found out that several family were taking shifts each day. Coordinated when the daughter is there and she is willing to translate. Confirmed there was no wish for a priest or communion, but a visit would be appreciated. I then spent time talking to the daughter about the balancing act she was doing, and in the last two years she has lost a brother and father. It was a good visit there at the door, and I think she valued my efforts to bridge the gap and the respecting of the family’s situation and needs.
I am ready to begin The Art of Listening. I hope to read other options that have been offered to me as resources. As I head into my first overnight on call, there is anxiety ( it is Friday the 13th and I am on alone), but I see that I am only alone if I make the choice not to reach out. And that even when I think I am at my wit’s end, there are things that are there if I can self-talk and then accept the anxiety as energy. And I am amazed at how what I need or want to see often presents itself. While this week had watershed moments, I am feeling supported.

Two years ago to the day my life was altered by a family suicide. This week, I paid it forward in one more strange confluence of events.

Monday, June 9, 2008

Healing Touch

This past Sunday's gospel lectionary reading in Matthew told the stories of Jairus' daughter and the woman who had been bleeding for 12 years who reached out at touched the fringe on Jesus' clothes. Here in the land of CPE, I have been thinking alot about touch and healing. In one room there is a man who is experiencing a failing liver and is inelegible for a transplant. Lots of other things are going wrong as the liver fails. I am sure he would love to stand in for the woman. Deeply spiritual, he and his wife believe in earnest that a healing by God could occur. I doubt it will, and some of this is denial, but yet I am sure that those who saw that unclean and probably pretty unseemly woman grovel to touch the fringe, thought it was equally incongruous. And I am certain that value judgements about her sin that brought on this affliction were even more rampant than the thoughts of today about someone who admits to living a wild life in the past. Then there is the woman with cerebral palsy. In the hospital because at her age and with her condition, she is pushing the extremes of life expectancy. Each time in the hospital is closer to assisted care, rather than the apartment on her own where Mom checks in to see how she is. She was praying simply for this crisis to end. And it passed. I came in as she had heard things were improving. And this woman for whom life is not only a challenge, but a compromise, is determined to get out, go home and keep praising God. She loves to sing, she shared her music. A little garbled for most, but to God I am sure it was just as ethereal as any heavenly choir. We shared a prayer, and before I began, I asked if we could hold hands. Her hands have some mobility, not a lot. She was so joyful that I would hold her hands to pray. I did not think twice about asking. But later a peer stated that her joy was the fact that I was not put off by her disability, that I embraced her as she was. Healing touch for the soul. There was the elderly woman with emphysema. Outgoing and engaged, trapped in a body that is letting her down. Sitting with her oxygen she is trapped, yet leaning into our chat. She is feeling good today, she put on her lipstick, a touch that gives her dignity. As we get ready to pray, I ask her if she wished to hold hands. I thought she would leap out of the chair with enthusiasm. Touch is a connection- touch draws her in. Touch for her was a tight sqeeze of my hands- I am still vital. Healing touch.
And today a terminally ill patient- what cancer has not taken, this weekend's stroke did. He cannot talk. He is stuck. Yet when I stopped in to say hello and offer a prayer, he grabbed my hand before I asked at his bedside. Touch cannot heal his body, but perhaps it touched him. God knows.
"If I can just touch the fringe."
I was asked how we know God is present or speaking.When I held the hand of an anxious spouse and prayed,"Lord you know what is on our hearts and minds, our struggles. Grant us peace" the hand relaxed with an audible sigh." When you prayed that I felt angels enter the room," she says. Healing touch. A touch I cannot offer on my own, but by the power of the Spirit, a healing of a soul, for now, just the same. I am overwhelmed.

Saturday, June 7, 2008

So How Is CPE Going?

As I began this first week of involvement with the CPE program our Regional Trauma Center , I entered the program with excitement for the learning and the meeting of new people. I also was anxious about what participation in group would be like given some of the “war stories” others had shared with me. I was concerned about remembering the details and protocols. I was worried about my sufficiency to meet the needs of those with whom I would come in contact.
I have been pleased to get to know my fellow team members, and supervisor, as well as the residents, staff and chaplain associates. There is diversity of backgrounds, personalities and faith traditions which has allowed me to have greater insight into my team and their experiences as they relate them. I have valued hearing the paths my team mates have taken to get to this place and time. Hearing these stories aids me in knowing their approaches more fully. The sharing has at times been very personal, both in terms of life experience but also in terms of vocation and discernment. It is a comfort to me to know there is much in common. I sense that our relating these things in community has facilitated the ability to bounce ideas off of one another about practice- I do not feel unable to seek feedback or ask questions. Several others have echoed their appreciation of this openness as well. In my first vocation, I was trained to speak for others. Advocacy was not in the first person. Statements were rarely about myself. While advocacy is a skill, I have had to re-orient my speaking to using first person statements. This is something that requires re-tooling my process away from past usage. I am working with this, so perhaps by the end of CPE, my supervisor will not have to ask about my pronoun choice. While I know there will be times when I am greatly challenged, my perception of the ethos of the group does not jive with the “war stories” I was told. There is a pastoral quality about our conversations in group that I feel is affirming and supportive. I am relieved.
Learning all of the forms, processes, protocols, 8 floors, etc. is coming along. I am not a detail person and tend to over-prepare to compensate. I am aware that this is my style of dealing with anxiety, and is also part of my first vocation where I was expected to have the answer and make quick decisions and judgments. I have been weaning myself away from all of the forms and examples I was carrying “just in case” and for a couple of days had the word “ASK” written on my binder in order to remind myself to not make assumptions or just jump right in. Also it served as a reminder that I can ask rather than worry about large quantities of information. I have also noticed that different people have different styles of handling certain paperwork and other things. I am exploring which of these is best for me.
Something as simple as what I carry with me was a trial and error process. At this point, I have put together what allows me to carry things without them flying everywhere, have what I need to streamline my reporting after responding to a patient need, without carrying extra or unnecessary things. I prefer to not have to run back and forth to the CPE office and to write details while they are still fresh. I know this will not always be possible. By keeping the basics to accomplish this as much as possible, it allows me to put the administrative aside, and enter a room “present” to the person I am seeing. I also find that by stopping at the station where the chart is located, I not only can see what may be going on for the patient, but I can center myself before entering. These are ways I have reduced my concern about paper and protocol so I can focus on caring for people.
Finally, I was worried about my sufficiency to offer people what is needed. Part of this worry is that I tend to be a “do-er” rather than someone can “be.” I tend to try to fix things and to seek answers. The story about the fantasy verbatim with Eeyore’s tail hit home for me. How I saw this play out this week was my concern over having the right things to say or carry with me. Knowing that I struggled with this dynamic I asked for help before visiting on my own. I am grateful that I could engage in role play and my supervisor was willing to do a visit for me to observe. This allowed me to pick up some useful pointers but it also reassured me that my fear of the unknown and lack of confidence was exaggerated. Even though I knew this, I needed some reassurance. I also have found listening to others experiences as well as de-briefing my own offers insight and support. I can pick up useful tips from others. From my past vocation I had learned that there was not a limit to the variety of family dynamics and issues. I was reminded of this during the week and while my approach to situations is from a different perspective, my prior life experience can be informative so long as I do not choose to focus on “been there, done that” in place of listening.
My prior training in listening was to very different purposes. I am aware that I need to redirect the purposes of asking and listening. “Why do I want to ask this question?” I am going to read more about reflective listening with a goal of developing this skill more fully and setting aside my prior framework of asking and listening. I am telling myself that “what facts do I need to know” should not be running through my mind, nor should “ I know what I want to tell you.” These concepts, while useful in my past, as opposed to “ what do you need” and “ what are you sharing?” During this week, one of the team was expressing frustration that his visits were short because no one wanted to talk about faith and he had no purpose. Hearing this allowed me to see “doing” aspects in another- this mirrored for me what I might need to keep in mind. In the light chatting that the patients sometimes offer, I am looking for ways to explore why their statements are important to them- how can they be affirmed, what are concerns, how are they perceiving and experiencing events in their lives. Several of the patients I have visited are eager for a person who will just sit and listen. Being in the hospital one can be surrounded by lots of people and yet be very alone and isolated. There is a great buzz of activity, but it is right outside the door and no one has time to just talk.
I have been amazed at the great insight and faith of some of the patients I have visited. I have also been saddened when I cannot offer more to someone in need. But I am cognizant of the fact that no one visit by anyone can suddenly make everything better given the issues faced by people in the hospital. Just being here shifts the landscape, and takes away frameworks the patient has in his or her life on multiple levels.
I know that I have only observed one trauma alert and the thing that is still in my mind is having to be the person handling the trauma call. Part of this concern is in the unknown of the process. I noticed that the one trauma alert, which was fairly mild in terms of bodily injury did not have the drama I might think of from watching “ER” or “House.” As a lawyer, I was always amazed at how people perceived what it meant to go to Court based upon war stories and TV. I have now been confronted with how that has been a part of my thinking regarding healthcare. While there will be times of great trauma, there will also be many other times where the tone is lessened. But for the patient who is experiencing the event, and the family or loved ones, they too may be bringing not only the physical aspects of injury, and the suddenness of it all, but all of their preconceived notions of what Emergency Department means- these will play on the responding family’s mind until they get here and beyond. Being attuned to my own preconception I hope will help me walk with them in their anxieties and offer what I can to aid them, knowing there will be no magic solution.
“So how does your faith help you in these times?” Probably I should ask myself this question as much I might ask it of others. I hope that I remember this as much as anything else so that I do not artificially place too much on myself and so that I can remain in both worlds.