Saturday, July 31, 2010

End of Life Issues

I just found this article linked on Facebook by a friend of mine. It was in response to an article I had read earlier article that I got from Episcopal Chaplain at the Bedside.  Go read all 3. I'll wait.

This is really the most profound thing I have taken away from a summer of CPE. This issue of life, and quality of life is something that came up in my Loss and Grief pastoral care class, but it's at the heart of illness, and how we live, and most importantly, how we die.

After watching patients go through awful things, I went home and did an advance directive. I"m filing it with my doctor and putting a copy in my safe and on my fridge, should the EMTs ever come to my house. I implore you, go do the same. And think about, and talk about, what life and death mean to you with your friends and family.

Friday, July 23, 2010

Back to the Grind

My daddy (my mother calls her dad, daddy too) is back at the nursing home. He was discharged from the hospital today. The doctor said he remembered my name this morning! That is progress and makes me happy. I bet he will be less confused when back home too. He was worried about his roommate, Merv, who is blind.

I went back to work yesterday and it was good. It was hard to go to one of my units, because Monday, a long-time patient of mine died there. But I did it. I have a whole new bunch of patients there that I am coming to know and love.

Today we had a full day of patient visits and I got to see 9. We also had a workshop on gang violence. Whew.

Tomorrow I rest and practice my...

Sermon! That I am preaching at my home church on Sunday! I am excited and nervous. It means a lot to me to be asked to preach there, my home, my support, where my church family is. I did opening words as a worship associate last summer and knew that I was in the right place.

It is good to be home, I miss my daddy, and am grateful for all your prayers and good thoughts. I have felt lifted up by them and they have helped me to get through this week.


Wednesday, July 21, 2010

Home again

In a whirlwind of travel, intensive CPE, and family illness, I have been to PA and back to NY in 24 hours, while spending just as much, and possibly more  time in a hospital room then I would have in NY.

My father is medically stable. They are continuing to do tests. He had an EKG today, and will have a follow up CT scan tomorrow. He is terribly confused and has no recognition of anyone but me (and he doesn't remember my name), or even his distant past and childhood, which worries me.

I hated to leave, I hated to stay. I feel torn in two between my two homes. I was horribly homesick for both places in transit, both ways. I can't wait to go back, I dread going back.

The full-time chaplain, an Episcopalian priest, came and met with my dad and I, and I am much reassured. She promised me she would see him every day while he's there, and understood dementia and confusion and was patient and loving with him. He even oriented enough to ask her a Bible joke! (What 3 nuns are mentioned in the Bible?)

It was so hard to say goodbye to my dad. I told him how much I love him, and that he is a great dad. He got all teared up, which I have never seen him do. I didn't quite know what to make of it, but it was very moving.

He became agitated this afternoon and required a lot of redirection and supervision as he refused to wear his oxygen and kept trying to leave to "go home." They assigned him a 1:1 aide today but now he's sleeping and they just have the bed alarm on. Hopefully the Seroquel will keep him out for the night.

I now know what all that free floating anxiety I was feeling on Tuesday (yesterday?!) was about. My family has a history of being slightly psychic with each other (weird, and unbelievable and magical I know). But there you have it.

I wonder what tomorrow will bring? I know one thing is a run in the morning, a chance to see patients, and juggling phone calls with the hospital in PA. Being in the sandwich generation is no picnic (pun intended).

Walking in those shoes

I got a all at the end of the workday yesterday that my dad was having some sort of mini-stroke at his nursing home. I had them call the ambulance, and then called the hospital to give them my contact info, and set up some local people to come to the hospital and be with him.

He did indeed have a TIA  and is still pretty confused, and getting a bit agitated. For those that know his history, he already has brain damage from an aneurism, and has age-brain-damage-related dementia, and lives in a nursing home.

I talked to his doctor this morning who was encouraging, but I didn't see the improvement I was led to believe I would from talking to the doctor. Things are better, incrementally, than last night, but certainly not back to baseline.

As a chaplaincy intern, I did request a chaplain visit, something I've never done before. A volunteer chaplain came to visit and I learned a whole lot about what not to do ever again (if I ever did any of these things):

1. Do ask if you can stay and visit - don't just come in, get the name wrong, and then attempt to flee
2. Do ask about religious preference, don't tell me about yours, unless I ask
3. Do ask if the patient would like another visit
4. Do ask if the patient/family would like to pray (I fail to do this all the time, but sure would have been comforted by the offer this morning, even as a non-Christian).
5. Don't be intimidated by patients who are confused. They still like visitors and like to talk, even if they don't make sense to you.
6. Oh, and introduce yourself FIRST thing - don't make me guess who you are and what you want.

All that said, I'm glad she came, and hope she sends the full time chaplain up, as she promised. I'd really like someone to be able to sit with my dad, even for 10 minutes, after I can't be here.

The doctor said that if things stay stable, it would be fair for me to head home and monitor events from there. As I said, I'm not entirely encouraged by 'progress' from last night, but the next 5 hours should show a lot - 24 hours is supposed to show how things are going. I'm still waiting on results from his carotid artery ultrasound, and he'll have another CT scan tomorrow.

Thanks for all the prayers and good wishes on facebook. They mean everything. I miss my family like crazy, and owe a huge thank you to my daughter Emma, who packed my overnight bag and put everything I needed in it. She really is a mini-clone of me sometimes :). Love you girl.

Thursday, July 15, 2010

All About Me

I had an interesting (yet exhausting) day.

We had group consultation and self care, which is where all the interns get together and work in a specific process to work through difficult cases, interactions, role play, or just get to share something. I got angry at something someone said. I noted that I had a strong reaction and shared it (not a join, a difference, says the process), and let the rest of the interaction play out. I had to leave the room at the end. I was in tears, and couldn't bring myself to move to the next part of the group.

I spent some time in the chapel crying, and then called my husband, and questioned my whole calling, then I went to lunch, had an interesting phone call (more on that later), and then met with my supervisor after I visited my floors.

He said, quite astutely , "Do you feel like you're doing CPE?" 

Um, yep, I feel it.

He said, "Good, because you are really doing it."

I am discovering so many gender complications coming up this summer, working in a group of 5 men and 2 women. Finding a way to be angry and not feel guilty (or like a bitch) is hard as a woman (and for me specifically). I didn't have good role models for anger. However, my supervisor affirmed that I handled it appropriately, but allowed my own discomfort to "boomerang" and called it - I spent my afternoon feeling depressed and exhausted. My, he's a smart human being!

I did indeed spend my afternoon feeling depressed and exhausted, and he encouraged me to leave a little early and to do something nice for myself - to avoid even further boomerang activity feeling guilty and down about letting myself be depressed and exhausted all afternoon. Really, he is a smart guy.

I did handle my anger appropriately. We are encouraged to get out of our "person" system - or in lay terms, to not get caught up in our own emotions only when in an interaction - and to be in an "observer system" where we can have some transparency between what we're thinking and what we're feeling, and can both observe, note, and interact with awareness about how our own past experience is informing the current interaction. Fascinating, exhausting, and vital for ministry.

I'm pretty good at it, actually, but that doesn't make it easy all the time. As a matter of fact, it has a way of making me question my own authenticity, when I am feeling one way and noting it, and yet able to stay in a pastoral role (which is authentic, but it just feels weird afterwards).

In any event I realized that when I do the loving-kindness part of my meditation each day, I have never once started out with L-K for myself (?)! I find it difficult to do it even now that I'm aware of it. I have a decent self-image, yet I have a hard time even figuring out how I feel about this. I find it quite bizarre actually. And uncomfortable to send my own self L-K. But I have to. I see that.

So lots of good growth and such, but yeah, I'm exhausted.

My phone call that I mentioned earlier was good .It was unexpected - someone checking in with me to close a loop that made them uncomfortable. There was an attempt by that person to triangulate, which I was able to deflect, and it was all really positive. And I realize that it's all about me.

That person I got angry at? Not what they said, or how they said it. It was my past experience that created an authentic reaction to it. My ability to honor someone reaching out to me and also deflect some negative behaviors is about me too.

I'm growing, becoming, and well....seeking. Yes, I'm doing CPE.

Sunday, July 11, 2010

Life experience

A large part of CPE is understanding and being open to how our personal life experience informs our interactions with patients. My supervisor asks us to think about Who Am I? Who is the Patient? Who are we together?

When I walk into a room, I bring not just my role, but my life with me, whether I share it or not. The patient's interaction with me is based on their experience with religion, spirituality, authority, illness, prayer, etc. And those two people create a whole new experience that will inform future interactions.

This is true outside of CPE too, of course. My interactions with people in my life which have included abuse, violence, alcoholism, love, support, etc. all play into my day to day life. CPE has pointed this out to me in a variety of ways. I have had stories from other chaplains move me to tears because they touched my own story in some way. I have met with patients and family, and have felt protective and even angry on their behalf - or at  them due to my own past.

An awareness of how our experiences moves inside of us at all times is vital. It doesn't have to define us any longer, but it certainly informs us. Recently, I had a family member that I spent about an hour with, and they drove me crazy. They were misinformed about a number of things that I am familiar with, they were sexist, uncouth, and immature. For some time, I warred inside myself with my desire to find some way to gracefully exit the room, but knew that the people in the room needed me. At one point, I was feeling pretty useless, but still holding the energy, holding as much love and peace as I could, and the person turned to me (they weren't sure they wanted me there initially), and said with great warmth, "It really does help to have you here."

Well, that's why I am doing this work. Because despite my own history and reactions to people, my intention is to be pastoral and loving - it felt like a real win to have been able to acknowledge my feelings in the moment, face head on my desire to leave, and to stick it out with intention and love, and to have it validated! How powerful.

In non-CPE life, I am having a lot of these same reactions to a variety of people, and I'm trying to hold that same intention. i keep reminding myself, that just as I don't get paid to put up with stuff in real life, I don't get paid for my internship either ;) (that's a joke!) Intentionality in life is a daily practice - it's easier sometimes in the specific atmosphere of chaplaincy work, but it's good training for the rest of life.

Saturday, July 10, 2010

Sleepless in Strong

Wow, what a night. I find that on-call shifts are so intense when they are busy. I had 10 pages between 4:30pm and 8:30 a.m., only to sleep between 6 and 8a.m. By the time I left, I was totally drained. I had 4 traumas, including two violent incidents, one which was quite disturbing. I had a tragic fetal death - my first infant death, which I have been dreading. The baby was so tiny - 2 lbs - and perfectly formed. It broke my heart and I was grateful that the mother was sedated - at least there was a short delay in her grief. She woke up briefly and asked, "Where?" and I filled with sorrow for her.

The NICU and trauma staff are amazing. I have found such wonderful relationships with the medical staff. The social work staff is a bit more ambiguous at times. Especially in the emergency department, I often feel unwelcome, or at the very least, drastically misunderstood. We are often seen as walking with death, something I don't feel at all. Often my role is to simply hold the energy in a space - to provide presence and silent affirmation of the important work and emotions at play there.

I also had 3 deaths, at which I sat with families, prayed, and even cried with them. I had a family member agonizing over treatment of their sick spouse.

"What should I do?" was the question of the night, straight from raw grief. "What comes next?" "This sucks." "How do I go on?"

I don't have good answers for these questions. I know that grief is overwhelming, that it can only be dealt with a day, an hour, a minute at a time. Sometimes it threatens to drown you.

On-call shifts leave me feeling vulnerable and raw myself. No sleep plus giving every ounce of my spirit to room after room - 20 patients and families in 24 hours - leaves me filled with gratitude for my own health, my family, and my inner resources. It also leaves me depleted and too tired to figure out how to do more than weep sometimes. I am generally good at leaving it at the hospital, but I agonized a bit this morning before finally falling asleep at home, safe in my own bed.

Even before the night, we had a long morning of reflection and mid-unit evaluations. It got a bit heated at the end, which was difficult for me to witness. But I continue to feel blessed at having a great group of interns to work with. It is easy to be authentic with them.

I'm useless today - worked online for a bit, ate some cereal, and am going to veg out with some 24 episodes. Self care after all, comes in many forms!

Thursday, July 8, 2010


I haven't been posting much. Burning the candle at both ends, but I'm still here. I think of all the things I'd like to write, but my brain is on overload with CPE didactics, and all my patients that I see, plus my part-time job in the evenings, plus parenting. (Which is So Much Fun, because Jude is learning to READ! So exciting!)

Anyway, I've passed the halfway mark of CPE. It seems like I've been there forever, and also like no time at all has passed and I can't believe it will be over before I know it. In some ways, I wish I could continue on and do a full year residency now, but I'm also very much looking forward to my congregational internship.

I just can't say enough about how thoughtful and intentional the CPE program is at URMC Strong Hospital. I'm learning so much, being challenged by my supervisors and peers, and growing in many ways. I now have some patients I've been following for over a month and those connections are deep.

I am finding my passion again, after the exhaustion of the first year of seminary - my excitement and joy at serving. It's just that it's also taking up all my energy. I will be ready for a vacation before traveling to Chicago again in September!

The kids are surviving remarkably well, and actually have a better routine now then when I was in school. I hope to keep the momentum up in the fall!

Anyway, I'm brain dead, but maybe I can focus again over the weekend!