Tuesday, September 25, 2012

The Chaplain and the Cop

It’s probably no surprise to say that when an officer and a chaplain are working side by side it’s most likely not a happy event.

In my personal experience I have worked beside an amazing man who is the one who always showed up when something catastrophic transpired involving an officer or a child. He is the go-to debriefer. We have remarked that it’s not a good thing that we have to work together yet we are so very grateful we do.

That detective who became a colleague retired this past year. I’m so very happy for him. Now he is busier than ever but choosing his energy-spending vs. tragic loss and deeper issues choosing for him.

Over the years we have worked side by side I came to understand that much like so many experiences it takes “one” to know one. Some examples might be a breast cancer patient who tells their story to another; a leukemia patient who encourages a newly diagnosed one. There is also a bond between police offers that only an insider can truly sit beside another among tragedy and trauma.

My colleague and friend has given me many gifts of understanding over our tenure. Today I was hopefully able to pay that forward.

Today I was asked to see a retired police detective. He has cancer but that isn’t what’s on his mind. He is having serious issues with PTS reliving so many of the tragic losses he came upon before he retired. He also spoke of seeing every person no matter how “bad” as a person. He also told me about his own mentor when he was a newbie.

One of the radiation machines was being recalibrated this day. That unfortunately backed up the patient appointments.

Fortunately, an RN called me to meet this teary retired cop who after an hour gave me one of the highest compliments a chaplain could receive from a person in “blue”.

We shook hands firmly as he said, “I am so glad I talked with you today. Talking with you today was like talking to another cop.”

I am grateful to my colleague who I shall not name here to protect his identity however, to every officer whose heart sees the humanity in those who need a hand up and struggles with the consequences of extreme violence I am grateful.

Today I was blessed with the extreme and violent stories of a cop needing to tell. That may not make sense to you reading…… but it does to me.

Friday, June 29, 2012

It's A Dead Issue: Honoring Life

Went into that good-night
Passed away
End of the race
Bought the big one
Bit the dust
Gone home
Bumped off
Checked out
Crossed over
Got their wings

These are only a few of the words and phrases used to talk about death without using the word dead.

No, this isn’t starting to seem like an uplifting blog. I hope indeed it doesn’t seem morbid!

Working in a hospital the terms we often use for conditions are specifically descriptive and clinical. The hospital staff use the term expired as in “The patient expired.” Much like with the phrases above there is truth. Somehow those phrases haven’t ever sat right with me.

Many of these terms make me think someone is trying to lighten the grief or make death all right when maybe that isn’t possible. Is it all right to lose your 90 year old beloved grandparent solely because of their age? Is it all right to lose a loved one from a chronic illness because their suffering is over? For me these words try to soften what truly cannot be softened.


Death is stark, not light nor funny and ultimately one experience we will all share. My perspective is we cannot make death all right because the person is of long age, ill nor any other reason. Death takes a relationship and alters it forever. The person may seem present in many ways yet you are not able to even share a cup of tea.

I like to frame death like the following example:

He was an amazing man and will be missed in a way no one else can understand *and* yet I am grateful he is no longer suffering.

There is another side of death that many are not willing to mention. That is the relief you might experience because of the relationship you had was not one that brought goodness.

Someone said to me a few weeks ago that in her faith tradition a person is inspired and then when they die they expire. I’m still trying to reconcile the word expire used in a different context.

Theology and beliefs also come for consideration as well. But, I believe your physical body must die before what you believe about the afterlife can begin.

My feelings about this subject are my own and I do not expect anyone else to agree. I do think that to say a person has died marks with a word the stark transition that has occurred. In that I also think it gives us a beginning to honor a life.

Saturday, June 2, 2012

The Safe Side of the Bed

New Chaplain Students

Last week’s blog was about how my patients in treatment and active follow up do not have a summer vacation.

Our hospital’s summer period offers training for chaplains, faith leaders, and lay people as well as future MD’s, RN’s etc. Many faith traditions require the C.P.E. [clinical pastoral education] program we offer. This past week was the beginning for our summer program. People come to this program for many reasons and often leave transformed differently than they initially expected. They are in for anything BUT a summer vacation!

Ten people come together for 10 weeks in this intensive immersion program. There are no restrictions of age or faith tradition to participate. The goal is to learn how to be present with those in crisis, illness, suffering and celebration as well as reflect on their own reactions and feelings. They respond to all who come through the doors as a fellow human; that’s the only assumption allowed!

As a mentor, not supervisor, I think I have the best of all positions during this time. I get to know each of the students and watch their interactions as the program begins and progresses. Many a thesis paper has been written on group dynamics. I love to watch the dynamic unfold every summer. Who is a leader? Is this person leading from a place of strength or fear? Who is quiet? Are they quiet because they absorb every detail and nuance or is he or she paralyzed with fear entering this program? There are too many emotions and dynamics to begin to reflect here, that’s for sure!

The CPE students are oriented by the permanent staff as well as the chaplain residents who are leaving after their own 10 month program. This process takes just three days. On the night of that third day the first summer student in the rotation takes the house pager and is alone overnight. In the morning we all gather to hear the report of every pager call after 5:00pm the previous day. We do this so each of the daytime assigned Chaplains can follow up.

At the end of the report this past Friday morning the group burst into clapping. Were they relieved for the first who had a relatively common call night? Were they clapping from nervousness thinking about how their own first night might unfold? Ahhhhh, that is for the student and supervisor to talk about.

I am always fascinated and aware of how amazing the people are who come to spend their summer vacation in our academic program. Often as clinical staff we are aware of our position being one of the “safe side” of the bed. That means we are not a patient vulnerable to the medical processes.

It was a very long time ago when I visited my first patient. I will never forget the care and wisdom my mentor Rev. Konrad Kaltenbach offered me. I attempt to pay back his gift every summer.

May each of our summer students have the courage to discover their weaknesses and acknowledge the strengths yet undiscovered. For the CPE students, as they begin, they surely do not feel there is a safe side of the bed!

Sunday, May 27, 2012

It’s that time of year again. As I write it is the official start of summer. It’s been a rainy week and that is predicted to continue however the thunderstorms are indeed the hallmark of summer. Summer for so many here in the northeast is a time of joyful awakening. It’s been cold or dreary, then cloudy and wet, and then summer brings a time of renewal. Many cancer patients watch this from afar. Their time away is no summer vacation.

I met Mark many years ago in the bone marrow transplant unit. A nasty form of leukemia had flattened this vibrant and powerful man. He lay in a darkened room as his wife paced the hallway. She shared much about their lives and also about their adult children. She had done her own statistical research about survival rates and was terrified. I thought to myself as he navigated his treatments that he always seemed FLAT in his bed. After his treatment and discharge I saw him a few months later walking in the hallway of the hospital. He had grown his hair back into a ponytail and also had grown a beard. He remarked how he was only visiting a friend who was having a heart procedure. I reflected and thought of the flat affect I had remembered and now he was once again vibrant man before me.

Although I did my training in all areas of medicine, working in oncology for over 10 years I have come to my own non-scientific hypotheses, conclusions, or antidotal findings. One finding is that there is a rhythm that patients and families develop while coping over a long treatment period. Unlike a trauma or limited illness, the intensity during those times cannot be sustained.

A part of my new patient discussion can be a discussion about coping skills. Let me use the examples I use in my discussion:

If you have a injury, the flu, or time limiting event often people cope in this progression.

“Ugh oh.. I think I am coming down with the flu”, or “I fell and sprained my ankle”, or like scenario.

Regardless of the event, most often the progression of disability is a slow or sudden decline and then a linear progression to what I call the best recovery potential. An example in the case of an orthopedic injury the person may never be as strong as before that injury.

My experience with people in treatment for cancer is that their journey to wellness isn’t EVER linear. Symptoms from treatments, removal from their daily routine for months at a time, etc. all can cause a jagged up-down-up-down-up-down roller coaster of emotion even within a day. The coping skills that we normally develop cause emotional exhaustion. What I often see then is that the person become FLAT in the bed. Hopefully this doesn’t last over a long period of time as a new rhythm develops.

Several years ago I was watching the news when a story came on the TV about a school project for elementary students during the summer. They were to color a gingerbread man style cut out, put him into an envelope and send him on a summer vacation. If he were to visit the beach he could be photographed with a sand pail and write about how the sunscreen stung his eyes. He may have been sent to his grandmother’s house where he got to stay up late and eat ice cream for dinner. At the end of the summer he returned home with a journal of his travels. Stanley was flat yet his adventures allowed him to take on the vibrancy of a human child.

When I look at my patients who have come to the end of their normal push to cope and now lay flat in their bed I think of that flat character. My patients are indeed going on a journey and it is no summer vacation. They may be flat for now however I wait for the day when we all may celebrate they are once again going home.

Authors note: Patients name is not his real name

Wednesday, May 16, 2012

Distractions vs. Focus

Taking time to notice Cora’s light:

  It’s been several weeks since I blogged. I have missed the discipline of writing and have been told by my readers they have missed reading as well. Thank you to “you”! for saying so!

This can be such a frenetic time of year for many people. Weddings, Baptisms, graduations, moving, vacations etc. are on the rise as the summer months come more near.

Last weekend I participated in a multi-family yard sale for the first time. It was so awakening as to how many things I had kept over my years that had grown idle in my life. I sold a beloved table that even my son said he would miss but I am no longer hosting the overflowing family gatherings. I sold many children’s items as well. It was heartwarming to see items that had served many of us going on to continue in another home. The man who bought the table paced anxiously attempting to reach his wife. “I still am in the dog house for buying something before asking her. I can’t do it again.” He said.  He later took that chance and emptied his wallet 12.00 short of my FIRM price. That table was to be placed in his sunroom and serve making space for his family dinners. It made all of us smile as he loaded it into his truck.

I have been thinning out my belongings using a series of criteria:

1.     Have I used it in the 10 years I have been in my current space ?
2.     If I still like what it is, why is it in a storage container not being used?
3.     If I were to move to a smaller place, what would I be willing to leave behind.
4.     How many bread pans do I need if I am gluten free now? [laughing]

As I spoke to others about my yard sale adventure the reactions were all envy to have thinned out belongings or those who were overwhelmed by the idea of beginning a daunting task.

My own mother is moving. As she began to sort and pack I began to look at my own space and really LOOK using my sorting criteria above.

Indeed, everyone believes they are healthy until a doctor gives them news to the contrary and their innocence of health is forever lost. Weeks ago I made a comment to a friend that working in a trauma center and also seeing many oncology patients every day I am mindful that my life could be altered or taken in an instant. I said I wanted to lighten my life-load and not burden my family if accident or disease were to strike. That said I would also enjoy the minimalism vs. clutter.

Little did I know that my seemingly innocent comment almost became true.

Two weeks ago on a drizzling early evening I was driving to nearby town to go to a “big-box’ store for a particular item. It was after a long day at work and I was tired and thinking about all the TO-DO’s on my list for the yard sale, the wedding I am performing, the baptism and and and and.. etc. As I drove slowly up a hill and turned around the curve my thinking immediately changed. Coming at me was a jack-knifed tractor-trailer who had locked up his brakes as he was careening down the hill towards me. As many have said, these situations are remembered in slow motion. I was on a small country road without a shoulder, lucky there were neither telephone poles nor mailboxes as I first steered around the tractor part. Relief was for only seconds as I then saw the trailer swinging into my lane. Indeed, I stopped unscathed. The truck then hit a pole and spun around as if he were coming UP the hill not down. The truck driver was not hurt either. It took me a few days to shake off how unscathed I was and how close to being airlifted to a trauma center I had come.

In those days afterwards, and even now I have a renewed sense of the goodness and blessings in my life. As I lighten my load of “stuff” I am finding I have more awareness of the items that trigger memories, and usefulness of things I do keep.

I also have a renewed awareness to take time to notice the small stuff because in retrospect it may not be small after all.

Sunday, April 22, 2012

Innocence, Love, Tragic Losses, and Sweetness Found: Part 2 of 2

There it was, on Adam’s blog… he was going to be a DAD!

Much like others who are newly pregnant they struggled with how soon to tell. Immediately when you find out? 60 days? 90 days? Well, they finally spilled the beans, plural beans!! TWINS !!!!!

The joy multiplied for those of us who were bystanders. Adam and his wife have many many friends, families and have lived numerous places so their levels of people knowing them was broad.

Adam, the blogger, skirted the information highway with at times maybe more than his beloved wife would have wanted. Yet those of us who were experienced in such things, pregnancies and babies, were given a wonderful window into their new adventure. 

With twins they MD wanted to see them a bit more often than with only one baby growing. So as those days and weeks moved forward Adam used his internet expertise for help. If he had to buy two of everything, WHICH TWO? Cribs, car seats, high chairs etc. The list of course was enormous. The more recent parents chimed in on his blogs as to which products they liked and why. Those of us who were many years past infants marveled at all the new and helpful things that had come onto the market. I have to say the video-baby-cam would be my personal favorite.

Adam blogged about videos he saw, diaper options, and had made up cute “public” names for each of their boys. Yes, they did decide to know their genders.

October 25th is a day that those who love and care for Adam and his wife will never forget. It is the day they lost both their boys. A quote from his blog. “Even as I type this post, it still feels unreal.”

I sobbed for them unable to fathom what this may be like; to this day what it *is* like.

What I found so amazing is that all those years of blogging had enabled Adam to still allow a window in their life as he was able. Not so often in the early weeks but often enough to hear some bits and pieces. Enough to know they had been surrounded by blood-family and church-family for as long as they might need.

Understanding from my own clinical training would be that Adam and his wife processed their losses differently and on different timelines. Adam respected his wife’s need for online privacy while continuing to write about his own thoughts and feelings.

I gasped when doing some of the research for this article and found that the horrible night I had first encountered Adam in our office, he had stood with a family and lovingly blessed their baby. How could he have ever projected someone would be offering that in return?

One of the most profound responses that many who have lost a child have to recon with is to the question, “Oh, how many children do you have???” Not everyone who asks that out of general interest is prepared to hear of the loss of a child, or multiples.

Well, the wonderful news first is that indeed Adam and his wife grew closer during their healing not farther apart. Unfortunately that can be the terrible fallout when a child [or children] has died.

In January 2011 I posted here on my blog a poem I wrote with Adam and his wife in mind.

Now less than 2 years later they have another son who is so amazingly cute he makes me giggle.

When asked the question as to how many children they have he replies, [from his blog] “I am a father of 3, 1 living.”  

Adam still blogs and uploads photos as always. I am grateful to know Adam even if only afar these days and enjoying every photo he shares of their precious 3rd son. 

From my vantage point Adam, who now is an ordained minister, was forever transformed in those days and the days since. His blogging such personal thoughts has given those around him the ability to get close to him rather than him seeming untouchable and perfect. Sometimes the suffering of others is understood better from having experienced our own.

Like some people I meet I say, "They have been to hell and back" and thats why they so appreciate the now. Indeed. 

Saturday, April 14, 2012

Innocence, Love, Tragic Losses, and Sweetness Found: Part 1 of 2

The true story of a young man and his family told from my perspective. I may quote from his BLOG for accuracy at times.

[Note the details are as I remember them and have been researched to the best of my ability. I am publishing this with his permission for my use]

Summertime is one of the periods of time during the year that I look forward to working as a Chaplain in an academic setting. We have a training program that is required for graduation of many theological institutions and religious groups. The name of the training is Clinical Pastoral Education; insiders refer to the program as CPE. The first day of the academic summer is always filled with anxiety of the unknown for the 10-12 new students who will be there fulltime for 10 weeks. The staff Chaplains do our best to relieve that tension as we begin see who may be seemingly more self reliant, more timid, more assured etc. Each of them are assigned an academic supervisor as well as having the opportunity to seek us out the staff as mentors.

Where I work we have a house-pager that is in the hands of an in-house Chaplain 24-7 for needs and emergencies. From 5:30PM to 8:30AM there is only one Chaplain to respond to pages. That Chaplain is responsible for all calls within the 600 bed inpatients if at capacity as well as the Bristol Myers Squibb Children’s Hospital 100 beds. They are also responsible for coverage in the emergency room and trauma center. Often it is a matter of triaging the calls as they come in. Being called to the bedside of someone at the end of his or her life would take priority over someone who wanted information. A trauma in the trauma center with family in the waiting area would take priority over a person who needed a listening ear. ALL of those are important but for one Chaplain alone, it is a matter of prioritizing each call and need. Every call will be responded to. We keep a call-log where the Chaplain records every page, the time, the person’s name why the Chaplain was called, and if need be for the daytime staff a recommendation for follow-up.

When I was doing my clinical training I remember thinking to myself that if I got two contiguous hours of sleep in that 15 hour period of time I was all right!

With that background let me begin a few days before June 7th, 2007.

The new summer C.P.E. students had come with great enthusiasm and trepidation. This was as I had said appropriate for a new experience. Many hadn’t ever been in a hospital no less visited people who are vulnerable and seeking council or a listening ear.

One of the students I remember standing out in those first few days was Adam. Adam stood out I recall as being one of the group “geeks”. I remember him talking about how he blogged. I wasn’t sure what I thought at the time about online publishing for anyone to read personal thoughts. How funny to me now that here I am doing just the same.

I refer to his blog of his first overnight on-call to begin his story.

            If I had to pick a phrase to describe my first 24hr on-call experience, it would probably be trial by fire. When I walked into the Pastoral Care Office today, one of the staff chaplains was reading through the log-book. When I walked in, she stopped, looked up at me and said, “Are you okay? Do you need a hug?”

That she is me.

That was a horrific night for many who came to our hospital Level One Trauma Center and multi-facility hospital. Even now when I read his blog post I feel my stomach tense knowing what that night might have been like for Adam and those he visited.

I once again refer to his blog :

One of those [calls] was for a young couple who were going to have to deliver a 22 week still-birth. I met with the couple both before and after the delivery and gave a blessing over the baby’s body once it was delivered.

Remember last week I spoke of paradox? Whenever I experienced a night like he described I would drive home grateful that although I didn’t sleep all night these calls were not for my family. I was grateful I was able to stand with those suffering with the gratitude that once I had a chance to eat and sleep and my life would move forward. I was not the one whose life was turned upside down.

Summer after summer we have 10-12 students come for training and then they leave to go the next phase of their life. Because there are so many students who pass through this program during the summer and extended fall-winter-spring sessions it is rare to stay in contact with many.

Because I always read Adam’s blog I had the sense that I was staying in touch with him. I knew about his wife, his adorable dog etc. It is an interesting phenomenon to communicate and yet not really be communicating.

At one point Adam had asked to speak with me about some concerns he had regarding decisions he was making in his ministry path; he wanted to know my opinions, and my theological reasons for decisions I had made. I used a new technology to me, SKYPE. Adam was in California at the time so we used video conferencing.

As the years moved forward I read in his blog about the struggles he had and was so amazed to watch his tenacity of standing for what he believed at the same time respectfully listening to others council. From my perspective as a mentor these were important signs that he would one day become a well-rounded, grounded and respected faith leader. His life seemed to me to be one that was common for most young faith-leaders to-be. His life was filled with study, reflection, hope as well as great joy. He had his amazing wife beside him as well as great friends and family.

It was at during the last week of June 2010, if my math is correct, that Adam and his wife began a journey that would forever change their lives. They became pregnant. For me even at this distance I found myself joy filled for them. Their ministry paths were becoming clear and now their family was going to add a baby. There it was, on Adam’s blog… he was going to be a DAD!

[part 2 next week]

Wednesday, April 4, 2012


First let me begin with the definition of the word paradox.

1. A seemingly contradictory statement that may nonetheless be true: the paradox that standing is more tiring than walking.

I began thinking about this more clearly, and then with more confusion just this morning. Therefore I created my own paradox.

The calendar marks a date and tells us it is SPRING. Spring to me means warmth, flowers, and even bugs. Yet it seems all I have felt is rain, cold, and I can still wait a long time for those bugs!

I had heard that today was supposed to be warm. Indeed it is warm but for me it is a paradox that it is also a dreary day.

As my thoughts began to wander this morning they came to rest gently while I thought of a patient whom I had come to know fairly well over his admissions. His life had been one of extremes. He had experienced horrible things in his life; so much so that many of us could not even imagine. In his later adult life, he had transformed those experiences to a career. He was working to expose facts so others would not suffer the same but now modern atrocities. The paradox for me was that now meeting him as he was in treatment for cancer, he had such a cheerful spirit. There was no bitterness, no anger etc., and no fear. “I have a tenacious disease” he said. This is a man who made peace with paradox in his life. He chose to embrace living even in suffering, and find peace while he lay ill. Indeed, a paradox from my perspective. How could he have endured suffering like his and now at the other end of his life, be so peaceful?

My understanding from him [note he was a Buddhist] is that it is his beliefs that carry him. Faith and what we believe can at times seem like a paradox.

  1. I/We pray yet it can often feel like a one way conversation.
  2. I/We suffer and try to find a spiritual understanding, yet that seems a paradox as well.

What I am attempting to say is that life, like Spring, can be a paradox. Think of the athlete who has cancer vs. a person who didn’t care for their health living to 100. I think we as people attempt to make sense, to make clear what doesn’t rather than stepping back to view a paradox.

In a life that reminds us that not much is for sure, and that the next paradox is right around the corner, life also gives us an opportunity to be more peaceful in the uncertainty.

My question to you is, what grounds you during uncertain times? On the cusp of Christian holidays of Maundy Thursday, Good Friday and Easter, and the Jewish holiday of Passover is it your faith is you belong to one of those traditions? Is your paradox of suffering hope?

Next week I will write about a very personal story. I have been given specific permission to use the story in its entirety. It is about youth, true love, unimaginable deaths and well.. I hope you read next week.

Friday, March 30, 2012

Grief by Surprise: Tears of a Chaplain

This morning I went to a seminar presented by members of a support group from our metro community. I was looking forward to a morning of learning and meeting other professionals. Once there I relaxed in a nice chair with my mug of coffee. I ate my breakfast brought from home as others ate the free breakfast. It was nice, relaxed, and planned. Although we all had name-tags there were very few people I knew personally in the room.

As the presenter began speaking I hadn’t had any way to know my mood would dramatically change. She lit a candle and told it's meaning in the room. Then she said she also needed to mention that the candle was to remember two friends who had died this last week. One died suddenly and the other from an illness. Their photos popped up on the screen as she named them.

There she was.. my patient.. the presenters friend.. This was a photo of her with her smiling face and head full of hair. There it was, her photo, as this presenter told about how her friend had championed for this cause before her illness.

Her friend. My patient

She was my patient who trusted me to tell me so much. It was her family who trusted me with their fears and wonderful stories. She was my patient, whom I married to the love of her life in her hospital room only a month ago. She was my patient who died last weekend; the patient I last saw with a smile on her face. There her photo was before me.

As the presenter mentioned her name I flashed all that I said above in milliseconds. I audibly inhaled a gasp and whispered aloud, “She was my patient!” as I welled up with tears. I fought the urge to leave. The presenter was tearful as well saying she “hoped to not do that” but did. We made eye contact and decided without saying to talk after the seminar.

In my profession many people move though my professional life. Every single person matters to me when I am in his or her presence. No, I am not thinking about another patient, a meeting, lunch or anything else BUT YOU. When I leave the room I may say a silent prayer and then move on to the next person and their family. It is a way of life for those of us in helping professions.

Almost a year ago there was a patient at the end of her life who asked for me. I sat beside her and we spoke. I choose not to share those precious moments specifically here. After leaving her room I made it as far as the nearest nurses station before becoming tearful. This is extremely unusual for the nurses to see so the ones close surrounded me with hugs and tissues. One of the MD’s came over and asked me why I was so sad. When I told him he too welled up with tears. One of the nurses broke the sadness by remarking, “OH NO! Both the Chaplain and the Doctor are crying!!!” Indeed it must have been quite a site for us two to be sitting with red noses.

I confess. I care about every patient I see. I give each of you my best. In addition there are emotional connections made that are left unsaid. I remember an elderly woman who reminded me of my grandmother. I am sure I made an extra visit or two to her room before leaving at night on my own time. How about the couple that had met as teenagers and never been apart? Now he lay dying as a 50 year old. Why did I lay awake at night thinking of them? I do know why. There is an obvious connection in our human experiences or the story is compelling. Of course I kept this all to myself. However, Those two stories were from almost 10 years ago, meaning I remember them as impacting me.

The presenter and I embraced after the meeting and cried. She had lost a dear friend and I cried for the loss in this world of a magnificent woman.

I would not be able to give each of you my best if I was this affected by every loss. That said I am grateful to shed tears. My tears always remind me how important our connections are and how much you deserve from me. My tears keep me humbled.

Dedicated this day for a woman who will be missed by many and remembered by this Chaplain.

Sunday, March 25, 2012

I wonder.. about Jack

Stories for a child.

I was with an 8 year recently.  He watched television, played on his electronic handheld device and played chess on a tablet device as I observed his face. Much like I remember as a child, while reading, he looked like he was 100% engrossed in his activity.

What did I do when I was his age? Roller skating, are you old enough to remember the skate key? Jacks when the ball was the key to a good bounce. Marbles when you could win or lose your cats eye or possibly your shooter. At times I would catch a desert blue tail lizard and then let it go so it wouldn’t die. When I was bored I would take a volume of the encyclopedia and leaf through it looking for pictures and read the captions.

Back to the present, I was asked for a hug before bed. I asked him if he’d like me to tuck him in. He thought that was just fine so I followed him. He asked if I could also sing to him, a nightly duty of the tucker-in-er. I would have had I been able to think of a song! So instead I asked him if I could tell him a bedtime story. “Yes, yes, YES!” he said.

We began, little did he know it was to be a combine effort.

ME: Once there was a little boy whose name was ______ ?

HIM: ummmmm Jack!

ME: Once there was a little boy whose name was Jack. He lived in a neighborhood with lots of houses. His house was different from all the others. The first thing was the color. His house was _____ ?

HIM: RED, no… PURPLE, no…  VIOLET, no.. PURPLE!!

ME: Once there was a little boy whose name was Jack. He lived in a neighborhood with lots of houses. His house was different from all the others. The first thing was the color. His house was purple.

And there we went to Jack’s world. It turned out he had skylights where he saw the moon and stars in the shapes of a cow and a bull. There was an owl who hooted Jacks name and made him giggle. Jack had a good nights sleep and when he awoke the sun was out. Jack thought it was a beautiful day so he and his family were going to ______________.

Time for sleep now.

“Why did you stop with the story?”, he asked. “What about the rest of the story?” I replied that we could add to the story whenever we were together.

One of my all time favorite movies is about a princess who is betrothed to marry a prince she does not love. The movie begins with a grandfather telling his grandson this story before bed.  

I wonder what adventures Jack in our story will encounter. I’m hopeful we will have several more years to build this story.

I also wonder if children in 2012 have time to wonder…..

Friday, March 2, 2012

Lions and Tigers and Bears… OH MY!!!!!!

 The courage it takes to be a cancer patient and family.


“I don’t like this forest”, said Dorothy

“I think it will get darker before it gets lighter”, said the Scarecrow

Clinicians gather to seek each others opinions as to how to best support our patients. Often I receive consult requests from physicians. When I reply we talk about the patient, their clinical status but more than that, their personal situation. My next step is to meet the patient, their family and friends. Other times I meet people as I round in the treatment areas and inpatient floors.

Different diseases and their treatments often have a range of physical responses. The staff may ask a patient of they are experiencing symptoms such as pain, nausea, feeling tired, tenderness in a part of their body etc. or what is called “brain fog”. There may be transportation issues or the inability to perform necessary daily tasks. Our departments of social work and our navigators have an amazing range of knowledge and are a tremendous resource as well.

Patients may share with me that they don’t like the side effects however the staff are balancing them with medications or other suggestions. No one likes this forest. And it may get darker before it gets lighter as the scarecrow remarked. My support piece is to gather the parts of your experience that you may not be able to tell anyone else. Other times I have the profound joy of celebrating good news with you.

This week I was in conversation with numerous clinicians and other medical professionals discussing how we could make our patients feel better as they navigated their treatments. We also discussed what might make the experience easier.

Working in Radiation Oncology these last months has given me an additional view of what courage looks like. Courage looks like a patient whose spouse abandoned them and they come for treatment alone. Courage looks like overcoming panic. Courage looks like walking through the doors every day for 6 weeks. Courage looks like putting make-up on and a smile, and comforting the other patients as you wait for your own radiation. Courage is celebrating your last treatment with the staff. Courage is as varied as every person walking into our treatment center. I truly respect every one of you and am grateful you let me get to know you.

This week I was particularly moved by the courage it takes for not only the patients but their families and friends. Each of them “have to stay stay strong”, “can’t let him see me cry”, “what are ya gonna do?” every day.

I therefore ask YOU who are reading this. How could we as clinicians make this experience easier for you? One person said her reply was always help with kindness. I believe we do. What in a practical way would make your experience easier or better? No suggestion is too minor! One patient’s wife was concerned about parking so I consulted with our valet parking company to see if they could add additional staff on the days when Rad/Onc is the busiest. That is only one example.

I ask you to think and share. Is it the rooms’ paint color? Music? Privacy? Simple things or large requests I ask you to be open and creative. Please let me know. We cannot change the fact of cancer but possibly we may be able to make the road back out of the forest a less stressful and easier journey.

Saturday, February 25, 2012

Flying By My Clinically Trained Pants

“How’d you know what to say?” he asked. The medical students shadowing me asked this question. Most people regardless of their background or discipline ask that question. The other common phrase is, “I don’t know how you can do what you do. I couldn’t”.

“The journey of a thousand miles begins beneath one's feet”, is from the quote by Chinese philosopher Laozi. Great surgeons don’t start their career in an operating room. The science of medicine is learned and the art of medicine is a trained gift. 

Chaplains don’t start their work by sitting by the bedside of a patient who is asking, “What do you say Chaplain, to a person who isn’t sure what they believe and they are going to die?” They might start with a less ill patient and still let the patient lead the way.

When I first began hospital visitations.. in my clinical beginning.. my mentor would have me visit one patient and return to his office to discuss the case. We would talk for an hour about what the patient said, what I said, and how I might have participated in that conversation differently. Many years later I participated in clinical training. C.P.E. Clinical Pastoral Education is what that stands for. There are training centers all over the United States and several others through out the world. Each unit earned in this program consists of 400 supervised clinical hours. That time estimate doesn’t account for all of the reading, writing and other requirements for the program.

Students in C.P.E. begin much like I did with my mentor. Students visit a patient and then write a paper aptly named a verbatim. Indeed NOT recorded, but to the students best recollection the conversation verbatim. What did the student see in the room? What was absent? What was said between the student, patient, staff or any other person in the patient’s room? What was not said? What is the theological reflection [from the students religious tradition] of the patient’s situation? Often it is the recollection of the conversation, what the student HEARD not necessarily what was said that also reflects the state of mind of the student. When presented to colleagues, always in a clinical and confidential setting [HIPPA guarded] the student’s colleagues feed back, as well as their supervisor, places in the verbatim where the conversation was too directive, missed an important patient cue or possibly well done.

To apply to become a board certified Chaplain, the applicant needs to have completed four of these academic units. The requirements for application to C.P.E. are long as well.

I will share a secret. More of what I have learned is what not to say rather than what to say. More of what I have learned is not to give answers but to ask the right questions. MOST of what I have learned has been gifted to me with the trust from the patients and those who love them.

This was a week that left me brimming with gratitude and guarded with humility. I saw my work reflected through those medical students’ wide eyes. This week was one of the remarkable weeks that a Chaplain savors for months on end. It ended as one of the weeks when I will fall asleep with tears in my eyes knowing in fact I have made someone’s living better and someone’s dying easier. I am so fortunate to be given the work I do.

Not so much flying by the seat of my pants but focused and intent on each patient's need. Yes I am clinically trained and have many years of experience but what I hope more than anything is that each gift of trust from a patient can be regifted to others. I am deeply grateful to every one.
Top of Form
Bottom of Form

Sunday, February 19, 2012

Acronym and Shortened Language

We need a translator!

Regardless of employment, education or experience there are acronyms everywhere around us. The trick is to learn each unique language.

P.C.= Personal Computer
3D= Three Dimensional
WWW= world wide web [wild wild west???]
BLOG= a meshing of the term web log

I.R.S.= Internal Revenue Service [I thought this time of year I’d toss this one in]

Ph.D.= Doctor of philosophy
J.D.= Juris doctor

This is also true in the medical field as well. Think about a simple medical check up in your physician’s office.

MD= Medical doctor
RN= Registered nurse
LPN= Licensed practical nurse
APN= Advance practice nurse

You may be given medical orders to have tests:

CBC= Complete Blood Count
LDL= Low Density Lipoprotein
HDL= High Density Lipoprotein
PSA= Prostate-specific Antigen
PAP= The Papanicolaou test

And then……… there are those tests that can be ordered which may bring halt to what seems average.

MRI= Magnetic Resonance Imaging
CAT [SCAN]= Computerized axial tomography
PET [SCAN]= Positron emission tomography

Of course then come the therapies such as:

TOMO: Tomotherapy is a type of intensity-modulated radiation therapy (IMRT]
CYBER-KNIFE: no knife involved at all!
GAMMA-KNIFE: no knife here either!
CHEMO: shorten for chemotherapy

Some of the sites I have used as a reference are:

Words have great power and carry the experiences or the lack of them. Each of these terms carry with them no less.

No matter who you are my advice is when it doubt don’t assume, check it out. The caveat is to be sure you do your research using well recognized sites. The internet is an amazing tool but also can increase confusion without a discerning filter.

Regardless, ASK ASK ASK your medical professionals for explanation and sites they might recommend. I suggest you ask specifically what the test ordered is, why it is ordered, and what might be any risks. This may begin the dialog with your medical professionals so that you have the sense you are all on one team.

Oh, BTW I remembered I have to make the annual call for myself.

Friday, February 10, 2012

New Patient Discussion:
From my patient’s experiences

Many patients who become admitted to the oncology floors where I round remark to me that they have “never been sick” before this. If they had been in a hospital before they may have had a repairable cause such as appendicitis, a broken bone or even a cardiac issue. Now they have within a matter of days gone from having been ignorant of a cancer growing within them to being here in the hospital. Many are frightened, using words that are akin to a battle cry, and ignorant of what will come in the year ahead.

My first visit is a time for my patient and their supporters to meet me. In my first blog post I brought up the hurdles that need to be faced for me to even know if my presence might be a part of their coping while here. I find it rare when I can’t find a common ground to at least be able to share why I may become a part of their support team as well if they want to page me. If I am welcomed I ask a lot of questions to listen for what may be of help to the patient, their family and friends.

The following is a short list of ideas that I have found helpful from my patients perspectives and their experience:
  • Bring an inexpensive notebook with you and a roll of tape. Most of the medical professionals who you will meet will hand you a business card. As you tape them into your notebook leave room to make notes. You may get a telephone number not listed on a card. You may want to remember an associate’s name who didn’t hand you a card. This is an easy way to keep a concise reference of your medical team.
  • If you are the type of person who feels less anxious with having the most data, have a notebook with pockets or loose-leaf binder. If you keep copies of test results [not a necessary thing but if this is your personality] you will be able to have them in chronological order.
  • ASK EVERY QUESTION and if you think of one when the medical team isn’t in your room write it down. Stress, no less feeling ill, may cause you to forget in the time the team is with you. Leave room again for a written answer if you think you may forget. 
  • Pain and nausea are like a freight train. They take more to stop them once they are zooming down the track than if the brakes were applied early on. Patients have told me they actually use less medications if they start earlier with these symptoms. Not every patient has them but those who did said early interventions helped them.
  • If you are a family member remember your loved one will worry about YOU as they lay in the hospital bed. You actually will care for them by taking care of yourself. Don’t drive after dark if you aren’t comfortable. Sleep the night at home if you can. Eat healthy foods in smaller quantities if your own appetite has disappeared. 
  • Say yes to friends who offer to help. The satisfaction that you may have experienced in the past of helping one of your own friends will be the same for them. If you allow them to shop, cook, run errands etc then you can save your own limited energy for yourself and your family member in the hospital.
  • Consider a phone chain to help relieve the story and fact telling every moment you are not sitting my your loved ones bedside. People care but the retelling can be exhausting. A phone chain can be helpful Another resource many of my patients use is a site: www.caringbridge.org  It’s a confidential and fairly easy website to set up where you can post any or all information you want your friends and colleagues to know. They may also leave you messages. Many of my patients have exclaimed that even if they don’t post they can read the messages that were left for them.
  • Set visitation time boundaries. Being in the hospital is not a time for everyone to visit. You are a captive audience and too many times there are too many visits that are too long as well. Be honest and tell people that you already have had too many today but then tell them when they could visit. Set a time limit. If you are feeling up to 20 minutes vs. 10 then you have the option rather than the visitor staying for 60 when you were falling back to sleep after 10. 
  • Always ask for what you need from the medical staff. Don’t assume anything. Ask for what you want too!! You’d be surprised how accommodating the staff can be if it doesn’t conflict with your treatments. In another hospital it was an underground fact that patients could get a milkshake if they only knew to ask. I admit I told many a patients about that. 
  • Forget the statistics!! The doctors are treating you with therapies they believe will make a difference. Statistics are good for the doctors to choose a treatment but I suggest you believe you are in the cure % unless they tell you otherwise. It's not a perspective of being an ostrich but one of grounded hope.
There are times when there are no clear answers, questions cannot be formulated, and there are no words. Those are also times to ask for me to sit beside you. Tell me, your Chaplain, what you are thinking, questioning, fearing and also celebrating. I am here to be an experienced listening presence as well as a practical resource.

Saturday, February 4, 2012

The Art and Science of Medicine. Ya Gotta Have Heart!

It was the beginning of the academic year in 2011 here in New Jersey. The first year medical students sat with enthusiasm and anticipation listening to the lecturer.  Each student came to learn medicine and eventually choose a specialty practice. Each student had passed a rigorous battery of tests and interviews to become accepted to medical school.  Their extensive academic journey began.

One of the opportunities I enjoy most is to offer lectures and short workshops for medical students and physicians. While the medical school and all of the clinical work fills them with tremendous knowledge about the science of medicine not every one is afforded the opportunity to learn the art of medicine. I am heartened to know this tide is turning.

Before what we now call modern medicine was practiced doctors, healers, etc. used what they had at hand to help the symptoms of illness or pain.  Before antibiotics were commonplace infection often was the cause of death rather than the injury or illness itself. So many works of art portray the doctor sitting by the patient’s bedside. The doctor was summoned to CARE for the patient. The community healer came with their limited poultices, balms and tinctures. In the end they sat at the bedside and attended the person’s death. Before they left the home they comforted the family the best they could.  When the medicine could not heal, the healer became the medicine caring for the patient and family.

I’d like to define the terms of science and art from my perspective.

The science of medicine is FACT based. Much like mathematics the science is either proven or unproven. It is reproducible fact. Clinical trials as an example prove that a new chemotherapy, for instance, has efficacy or not before it becomes an acceptable practice for use. I see doctors learn the science of medicine much like mathematical formulas. If X is true than Y+Z= R.

The art of medicine looks at the same formula. If X is true than Y+Z= R.  However, what happens when X is true and Y+Z= R. but no R can be found? The questions then begin. Why no R? Is there a new formula possible that we didn’t know before? What other factors other than X, Y, & Z did we not consider? What else is involved or missing? What’s their instinct pushing them towards considering? Their training informs “the gut” while searching.

The art of medicine is also the acknowledgement of humanity and the complex emotions of living, limitation and illness.  It also is the journeying in life with a person as they move closer to their end and eventual death.

I once heard someone say the two greatest fears of a patient are intractable pain and abandonment by their doctor if there isn’t any cure.  Pain is controllable now with a myriad of medications, combinations and delivery systems.

For a patient to trust that regardless of outcome, the physician truly cares and will journey with them until there no longer is life to me is the epitome of the healing art of medicine. The physician’s presence alone may become the healing that brought them to the practice of medicine.

The new classes of doctors who are graduating are being asked to never forget listen to their patient’s life narrative as they apply the science of medicine. Someday these doctors will be at my bedside and I am grateful the old/new art is flourishing.