Washington Heights, New York City. August 26, 2011
365 Part Deux
Today was my graduation day at CPE. I AM FINISHED. My first unit of CPE is now OVER. Woohoo!
I began today like most days – hanging out in the PICU. I wanted to say goodbye to the few patients who seemed to live in the PICu with me. Most were alone as their parents were at work and I did what I usually do – I chatted with them, made some faces, and then said a short prayer. My goodbyes with some of the staff occurred during the week so this was just a few hours for patients. The sun was shinning bright, the medical rounds were already over, and there was a calmness through the whole place that gave me permission to walk around (and jokingly absolve a nurse by telling him to say half-a-dozen Hail Marys). But one thing I wanted to do was say goodbye to that child I met last Thursday.
I looked up her charts and saw that she was going to be discharged this morning. I entered her room and saw her mom and a friend talking to the little baby. The last time I saw the little one, she was waiting to be extubated. Today, she was resting comfortably. She was breathing easily, grabbing at hands like babies will do, and a pink blanket held her tight. She looked like every baby should. I chatted with the mom and she was less nervous than last week. She couldn’t wait to go home. She said thanks again for my being there on Thursday and for all I did for them. The visit was short but sweet and, with that, I found it to be a fitting ending to my first unit of CPE.
With that done, all the summer interns gathered in the chapel for our graduation ceremony. The staff of the department and the residents came to support us. We said words, we sung songs, we received our certificates, and then we finished with hugs and goodbyes. The certificates looked grand (except for the minor typo where they said we had completed Unit II rather than Unit I) and we then went, with our supervisor, out to lunch. It was bittersweet. We chatted and had a good time but I don’t think it has really sunk in that I won’t have to get up tomorrow and go to the hospital; that I won’t see my new friends tomorrow either. We really were a good and joyous group. I’m really gonna miss seeing some of them as often as I have. I’m gonna miss going onto the floors, writing verbatims, and all that. I’m honestly thinking I might do another unit of CPE before I graduate. I never would believe that before I started but I guess that’s how it works. I found out I’m actually good at this. Who would have thought.
On Wednesday, my colleagues and I had a “self care” day. Sure, we only have a week left in the program but, hey, we needed the day. We went and grabbed a drink (it was noon somewhere in the world), ate some Indian food, and then went and saw Crazy, Stupid Love. It was a great day and I took a couple of pictures. Enjoy!
I’d like to talk about babies for a minute.
During my round in the PICU, I tend to avoid crying babies. I’m not sure why but I do. If a baby is crying, I assume that the parents are with them and that it really isn’t a good time to stop by and say hello. Crying babies also tend to not respond to my funny faces, my “oohs ho ho ho,” my attempts at “where’s the baby” and all the other things I do to try and provide spiritual support to those who are ten months and younger. It’s a skill I’ve been developing and I have a good time with it. But crying babies, well, they’re crying. And usually they have good reasons to be crying. A baby in the hospital with ivs, tubes, and other such things – you’d cry too I bet. I know I’m not suppose to avoid them but I do.
But, for some reason today, I didn’t.
The social worker in the PICU referred me to a family who were Catholic and were open for a visit. They were busy yesterday so I planned to stop by this morning. I walked around and could hear their baby crying. I avoided it at first, saw a couple of other patients, but then decided to buck up and see the kid. I said hi to the nurse, suited up (the child was under isolation), and walked on over. The kid was squirming and crying. The kid had just had surgery the afternoon before and, from the chart at least, everyone said the kid was doing great. The docs had seen her fifteen minutes prior and were already trying to get her moved out of the PICU. The parents were so happy, they even felt comfortable enough to go home for a few hours. Things were looking up for this kid.
So I started my routine. I talked to the kid, made faces, told it I understood, and tried to get her to calm down. But it wasn’t working. I thought that maybe I was scaring her and I made the motions to walk away but that didn’t seem to be it. And the more she cried, the more I went into the typical “baby-crying-I-don’t-know-what-to-do-because-I-am-a-man” routine. But then she made a face I thought I recognized. She’s just struggling to poop, I told myself. The baby seemed to be calming down. But something was off. I asked the baby, “Are you alright? What are you doing? What’s wrong?” And then the crying stopped. So did the squirming. The alarms started going off and her heart rate dropped like a rock. I turned quickly to see that the nurse had stepped out. I looked back, and the baby was doing one final squirm and I saw it’s face starting to turn blue. I went “oh shit!” and ran from the room. I ran into the next room, told the nurses that something was wrong – that “there’s a baby that doesn’t look right.” My face said more than my words and two nurses quickly followed me into the room and got to work. The baby, in the words over the intercom, “coded” or “destated”. She stopped breathing. The nurses started to give her air and do chest compressions. More nurses came. Then doctors showed up. Soon, the entire staff was in the room working as a well oiled machine. They were doing their darnest with the kid. The communication was fluid. The movements precise. They knew what they were doing. But there was a panic in the air. The air was filled with suspense. And as they worked, I pulled back. I walked backwards until I ran into the far wall and the entire time, I did the only thing I could do – I prayed. I prayed hard. Over and over again, like a broken record, I prayed “Dear God, not her. Not her. Not her. Not again. You better save her God. You better fucking save her.”
It wasn’t long before the baby started to cry again. I saw her arms flail. She didn’t really like the air mask on her but she required it. She was back. She was breathing. And her heart rate returned to normal. She cried some more while the doctors kept working on her. The social worker came and chatted with me. So did the PCD. They told me she would be okay. And then, once the situation stabilized, the nurses started saying to me “Thank God you were here” and “This was divine intervention” and “You saved her life.” I took off my isolation gear, said if they needed me anymore, and when they said no, I stepped out. I needed to get out of there. I was freaked.
I went back to the office and called my wife. I talked to a couple of my colleagues and I told them what happened. I tried to calm down and get back to work. Several folks in the PICU reached out to me and asked if I was okay. My colleagues did a great job supporting me. My supervisor told me that I now have the best CPE story to share when I go back to school in the fall. But what was running through my mind was when I was going back to the floor, what was I going to see, what was I going to say, and “did I wait to long to get the nurses?” In the meantime, I attended a funeral, ate lunch, and had a class on group dynamics. It was near the end of the day before I finally had a chance to head back to the PICU. I checked the charts and read what happened. I gathered my things and went back up to the unit. I met the nurse of the room and we chatted. She was still traumatized by the event and so was I but I provided some pastoral counseling to her even though I was suffering from the same event she was. I don’t think I said all the right things to her but I think she was just happy to see me come back to the floor and to talk with her and say that it’s okay. I met the mom and she had been told what happened. She seemed rather calm and was grateful that I had been there. And I left feeling pretty good – still in shock but doing better.
But right before I met the nurse and the mom, I ran into the mother of a patient who’s child, who had been improving, had just taken a turn for the worse. She was frantic. She wasn’t ready to talk so I said I’d come back tomorrow. So when I walked back to the subway after work, and as I entered the stairs and into the artificially lit tunnels that led to the over-heated platforms, my heart sunk. Even though some good had happened today, it’s not over. In the next bed over, a family is heart broken and is suffering. Another child might die. As much as I am enjoying being a chaplain, I’m not really sure I could handle this every day. I joked at lunch that I have “won” CPE but I’m not so sure. I haven’t even properly processed what happened last Friday and then this happened. I’m not sure I could do this all the time (though I know this doesn’t happen all the time). This was a rather heavy baptism by fire.
Today was one of those days when three interesting things happened.
First off, I started the day arriving 5 minutes late to CPE. There is nothing new about this. I’ve noticed that the closer I get to the end of CPE, the slower the subways seem to run. Or, at least, that’s what I tell myself.
I arrived at my CPE site, gathered with the group, and started to go through the patient censuses (or censi?) and the medical charts. But then my phone rang. I didn’t recognize the number but it was 212 so I decided to throw caution into the wind and pick it up. It was a call from the bishop’s office! At first, I thought they were going to tell me that there was something wrong with my paperwork or maybe they had found my blog (eep). Instead, they told me that there had been a drop from the MNYS’s voting delegation to the Churchwide Assembly in two weeks. As I was the next person in line based on the vote totals from 2 years ago, they wanted to know if I could go. My heart leaped. I was excited. I really wanted to go. And then they told me the dates of the assembly…and I can’t go. NOOOOOOOOOOOOOOOOooooooooo…….. /fade to black
Actually, I will be having a lovely time on vacation with my wife, my parents, my brother, and my sister-in-law during the churchwide assembly. I will have plenty of pictures to share once I get back and I’m going to have a wonderful time. But, man, it would have been nice to go to churchwide. I really do enjoy synod assemblies (and I’m starting to learn I might be the only one but, come on, they are awesome). Hopefully I’ll head to the next Synod assembly when the next churchwide delegates are elected and I’ll get myself thrown in the pool then.
My next adventure of the day, I met with a mother with a newborn in critical condition. We prayed, we chatted, and then she asked me to do her a favor. Part of our script for CPE asks that we, as chaplains, ask the patient/family member/etc if there is anything else they need done. Sometimes, I’ve been asked to get the patient ice. Once, I was asked to go get two packs of skittles from the vending machine. But today, I was given a candle and asked to light it for the mother and her child. I found that really touching even though I don’t know any nearby church that allows candles to be brought in and lit. Even the local catholic parishes have switched to the electric flickering candles before their statues of Saints. I made sure to stop by a catholic church (which is her family’s tradition) and light a candle for her and her newborn (in front of a statue of St Jude no less) but I’ve got a candle that I would like to light somewhere and to fulfill their wish. Hopefully I’ll figure that out tomorrow.
Finally, the last interesting tidbit of the day was a compliment I received from my supervisor. He asked me if I thought about doing anymore CPE. He mentioned maybe I should look into doing my internship as a resident in a CPE program. He said I’ve got a great way with the patients and that it’s a gift. I began the program scared to death of being a chaplain…and here I am, being told I’m good at it. Huh. I was thinking about it, during my third year at seminary but…hmm. I don’t know. I really have started enjoying meeting with the patients and talking to them, walking with them, and letting them be where they are at. And I think I’m good at it. So huh. Maybe they tell all their CPE students that :p But it’s at least something to think about.
Today I presented my final verbatim for my current unit of CPE. I’d be lying if I wasn’t excited about the verbatims being over but I’d also be lying if I wasn’t a tad sad about it. Turns out, I actually LIKE doing verbatims.
My final verbatim was about a visit I had a few weeks ago with a family. The patient was a teenager who had suffered a gunshot wound. I picked this visit to write about because a) it was kind of weird and b) I wanted to receive feedback on how I minister to families. When I walked to the patient’s bedside, I entered a strange and hostile family dynamic that, in the words of my supervisor, “even the most experienced chaplain in the world wouldn’t have known how to deal with effectively.” The only true effective way was to divide and conqueror. Sadly, I was not reading my book about the post-Alexander the Great empire, so the military metaphors failed to enter my mind. I did a decent job with the patient, I failed with the parents, and – all in all – I learned a lot. You might be shocked to realize that when you actively dislike someone, your ability to provide pastoral care actually diminishes – especially if you don’t realize what your gut is telling you. I know, shocking stuff, but it’s actually harder to notice than you realize. Even subtle feelings can cause strange conversation dynamics. Even with my summer CPE unit almost over, I still have a lot to learn.
So, after spending an hour today reliving my visit with a family containing people I disliked and having myself grilled over some of my issues, I found myself being summoned via pager. I was called to visit a family I met with the day before. A rather youngish man was being disconnected from life support. The family was lovely – I grew close to them rather quickly – and I was able to provide some spiritual and emotional support. I watched Last Rites be performed (and also learned why I’m glad my tradition has only a few sacraments – there’s more to comfort care than just performing the ritual!) and learned a lot about a beloved family man. The family was withdrawing support with the expectation that he would die rather quickly. But… he didn’t. He lingered. I received a page to stop by after class, before the end of my work day. After my verbatim – where I got angry and attacked a father – I found myself, face to face, with a father who was about to die. I entered the room, stood with his family, and talked with them. And then, rather soon, the man’s state changed. His breath slowed down. His family said their last goodbyes and encouraged him to finally go. And then he took his last breath.
I have never seen someone take their last breath before.
I stood with the family while the doctors performed their final checks. I stood with the family as they cried and expressed how heart broken they were yet how relieved they were that he was finally gone. I held the family when they needed it. And then I gave them their space and hugged them goodbye.
It’s been several hours since I saw the patient die and every time I think I’ve come to terms with it and processed the experience, I realize that I haven’t. I really don’t know what to feel at the moment. I feel sad. I know I’m grieving. I know I witnessed something unsettling. I also know that I did some good and I know that I was able to do Christ’s work even though I never read a psalm, never said a prayer out loud, nor did I read any bit of the gospels. But I think what gets me is the fact that the family, even before I entered the room, wondered if the patient was hanging around because I wasn’t there. The family said, several times, that the patient was waiting for “this spiritual man” who “he knew would bring comfort” to be there before he left. The patient’s wife hugged me and said the same thing as I left. I have no idea what to make of that. Maybe it’s true; maybe it was a fluke of fate. I don’t know. I really don’t know. But it was a truly beautiful, moving, and heavy thing to be told. I’m not sure what it all means yet. I’m not sure if I really believe what the family told me. It’s just too…awesome; too powerful; too unlike how I see myself. I almost feel as if I was given a responsibility in that moment – a responsibility that I don’t understand nor do I truly even know what it is that I’m suppose to do. But I do know that something wild happened. And I know I did some good. But I’m still just blown away with being called to be there, at that moment. Just… blown away.
I have just begun my “first” night being on-call.
Actually, that’s not totally true. I’ve had one night so far but this is my first “real” on-call event. Because Weill-Cornell does not have a major emergency trauma center, our on nightly on-call schedule is a tad different than other hospitals. Rather than being on call for a night (and having to “sleep”/work at the hospital), we instead are on call for an entire week. I began tonight at 9pm and I will be on call through 9am tomorrow morning. I will also be covering the 8pm Friday to 9am Monday morning (while also working 9-5 on Sunday). The trick will be in actually falling asleep and not waking up every few moments believing that my beeper is “about to go off.” I think I’ll be fine though. My first night on-call, earlier in the month, I received a call at 3:30 in the morning (but I was able to pass it off to a catholic priest). But, with my luck, I just might have to go in every night this week. I hope not though.
My last few days at the hospital have been going well. I feel that I’ve plateaued in the amount of reflection I’m able to do about myself. I’ve learned a lot. I’ve discovered quite a bit of growing edges about myself. I think I’ve got a lot of work to do. But the energy I’ve been using to reflect on myself has been disipated. I’ve felt it move into other areas of my work, specifically my interactions with patients. I’m taking more risks, experimenting more, and seeing what works. During these last few weeks (less than 3 – can you believe it?), I think my main goal will be working on how I provide pastoral care to those where death is fast approaching. I tend to be ineffective at the “life-review” process that death can cause and I also tend to avoid asking the questions that really force a person to reflect on their death. What do they find meaningful? What are they hopeful for? What gives them meaning even in the face of death? They’re tough questions but good questions. And they are questions, when I’m confronted with death, that I tend to just avoid. I’ve got to work on that.
But besides that, I can feel CPE winding down. I have one final verbatim to do (on Friday) and then my final evaluation. It’ll be weird not getting up and going to the hospital. It will be weird not seeing my group every day, talking to them, having lunch with them, and learning with them. It will be weird not having to walk into rooms and talk to folks about their spiritual and emotional lives. But that doesn’t mean that my work as a chaplain is going to end. The more I’ve practiced it, the more I realize how often I will now being using it. And the opportunities for pastoral work are endless. I’m starting to understand while some supervisors in CPE tend to say that everyone, no matter their religion, profession, spirituality, or whatever, should take CPE. It’s actually a pretty amazing thing.
I can’t believe that I just completed my seventh week of CPE. The week was, probably, my hardest week “academically” but not emotionally. The kids in the PICU were in good spirits, with most there for post-op monitoring. No one yelled at me. No one paged me during the day I was on call. I did have to pray at the bedside of one woman who was actively dying and I did run into my first experience trying to minister to a family where the mother and father were not on speaking terms, but none of that really bothered me. I did have a cold through much of it so trying to talk to people without coughing was a bit of a challenge. Luckily Sudafed/Muscinex are a hell of a drug.
Academically, however, I had two verbatims, I had to plan an interfaith service, and I had to write a paper about an aspect of my operational theology. After reading my seven page paper out loud, I was then grilled on it. It was tough but not totally uncomfortable. I noticed that I spent most of my time responding to questions with my eyes looking down or away from the people I was speaking to. I felt a tad vulnerable so my response was to disengage from eye contact. I found that experience to be a little neat because, even though my body language was uncomfortable, I actually could tell exactly what I was doing. Every time I broke eye contact with a person, I knew I was doing that. I wasn’t able to stop myself from doing that but I could at least note what I was doing. I’m getting much better at parallel processing on the fly it seems.
Folks described my paper as a little heady, so I was grilled in an attempt to see how my operational theology was tied to my experience. I revealed some things to some folks, people understood me a tad better, and I made a few folks feel sad. To be quite honest, I’m a tad happy that none of what I wrote/or said is going to be forwarded to my candidacy committees. It was emotional but I learned a lot so, all in all, I had a good time.
One of the many things that stuck out at me was that people experienced my writing as something completely different how they experience myself in real-life interactions. Where they found my writing to be harsh, they all said that they experienced me as a very kind and tender person. Where my paper seemed a tad cold, they said that I’m the exact opposite of that. Ever since they mentioned that, I’ve been pondering what that means. If I am a kind and tender person (and I think that I am – too many people tell me that for me to discard it), how do I write in that way? Do I talk about rainbows and puppy dogs? Or is my inner spirituality tougher than that – reflecting the spiked leather jacket I use to wear? Is my outside persona a mask for what I really am? And is my operational theology at odds with my tender personality?
The idea behind the whole exercise was to see if what we profess matches with our thoughts, our actions, and our developing pastoral theology. There was no right and wrong answer (and there can’t be since every individual’s theology belongs to them). I’m not sure if my operational theology matches my pastoral presence but I’m hoping it gets there. My theology begins in a place of brokenness because that’s where faith found me. But it isn’t the only place where faith can be found. So one of my life-goals is to, somehow, create space for theologies that start from somewhere else. I’m not sure how to do that yet but, well, I’ll figure it out somehow.