continued again it in the complete and total engraved answering machine you must be bad.
Hmmm, well never mind on the voice recognition plan for blogging. I'll check back in later when I am done lamenting the lack of engraved answering machines in my life.
I must be bad.
Monday, March 31, 2014
Sunday, March 30, 2014
The Mayor of the Hospice Unit
Most people think of dying at home when they think of hospice. Then again, most people don't want to think of hospice at all.
Although I work for hospice, I work mostly in a hospital. On the hospice inpatient unit our job is to find solutions to complex pain and symptom issues unmanageable at home. Well, that is the medical side of it. As chaplain, my job is to be with people and their loved ones in a way that reminds them of what they value and hold dear. Yes, I have the better job. No, I'm not one bit biased; I just hate suction tubes, suppositories, and the math involved in pharmacology.
It is not uncommon for us to have patients for only a day before they die. It is not uncommon for us to have a complete turnover in our unit within a week. Hospital staff think, "Well, duh. That's our life every day."
The difference is that hospitals have the goal of prolonging life. Our goal is to relieve suffering, provide compassionate connection, and prepare for death. The difference in our goals changes the style of care. An example of the difference: when I worked on regular units in hospitals and patients died, there were often many staff in the room because some sort of emergency code had been called. Everyone is talking, rarely is anyone talking to the patient. Family is asked to step outside. People have side conversations about their shift, the president, a sale at Kohl's; nervous conversations based in the fear of failure.
Vigorous attempts are made to save a life, an anonymous life. When the patient dies, comforting of the staff takes place in private because an environment in which success equals life has difficulty balancing the reality of grief and loss. (Don't get me wrong- if I should choke while we are eating tapas, get me to the hospital quickly. I'm just saying the perspective is not warm and fuzzy.)
In hospice when a patient dies we move slowly and deliberately. Prayers are said if appropriate, soothing words if not. There are no alarms or bells, few tubes or machines. If family is present, they are surrounding the patient and only a couple of staff are in the room at the same time. We all know the dying person's name.
Unless we are singing or praying, we the staff are very quiet. Afterwards we may give each other hugs, or thank one another for the care we gave that patient. In the best cases, we have come to know the family, so we better understand what this particular loss means to them. We talk about the patient again after death to assess the bereavement risk for the family, and if we were there, to share our opinions on whether it was a "good death" (when the patient dies in a way that was in line with their hopes). This latter part is important to us because we want every patient to die well, but know that this is not something we can truly control. The assurance that the best end occurred is a great comfort to hospice workers.
Which brings me to the Mayor. The Mayor was a member of the Greatest Generation. He was on our unit for a couple of weeks getting symptom management. He sat up and received visitors like a priest receives confessors. He smiled when staff came in. He read books and magazines. He was sound of mind, strong of character, and a gentleman in every way.
We planned to send him home with his medications stabilized to be with his family for his final weeks or months. I went home from my shift on a Friday after saying good night to the Mayor. It's a habit you get into with certain patients. When they are fully aware of their surroundings you give them the respect that you would give them if you were a guest in their home. Before you leave "their place" you say goodbye. At least I do.
When I would check out with the Mayor, he'd look over his reading glasses, put out his hand for a shake, and bid me a happy evening. He also always thanked me for coming to see him, even though he had visitors every day. What a guy.
I came back Monday morning and went to say hello but the Mayor had gone home. It was a great way to start the week. The Mayor had become well enough to go home and live in the comfort of familiar surroundings. Or so I thought for about thirty minutes. And so did several of my co-workers. We were all smiles.
In team report we covered the deaths of the weekend. The Mayor had not gone to his home in Richmond but to his eternal home. We were shocked and distraught. How could this happen?
Now you are probably thinking, "You work in hospice every single day and you get distraught when a patient dies? One patient?" Well, yeah. It's called a breakdown in compartmentalization and here is how it works.
We can all agree - working in hospice is not easy. There have been 12 patient death weeks at our unit. And I mean work week not 7 day week. There are a limited number of ways to deal with that and remain engaged and open to the next 250 patients, much less 250 more families. In general, we do it through routine.
Our patients mostly die according to a couple of patterns. We learn the patterns and we say goodbye to them incrementally according to the pattern. We can handle it as long as it stays within the emotional safety of the rhythm we know which is usually one of gradual decline in communication and interest in the outside world. Just as a baby becomes increasingly interested in the world beyond what she can reach as she grows, the dying person becomes less engaged the closer she comes to death.
Until they don't. Like the Mayor.
On the last day of the Mayor's life he ate three small snacks, read a magazine, hosted family and guests in his room, and took a nap. As he was getting ready for bed he began to feel ill. He was sitting on the side of his bed waiting for the nurse to assist him to the bathroom. She entered and he shared that he didn't feel well. They talked. She checked on his vitals and she realized that the Mayor would not be following the pattern. She told him. He talked to her. She held his hand and laid him on his bed. She talked quietly to him and he to her until he died. It all lasted ten minutes.
The Mayor didn't die as we or he had hoped or planned. He was in a hospital not home. He was without his family. He had not finished his plans.
But he died with someone caring for him. Someone holding his hand. Someone who knew his name. Someone who mourned him when he was gone. Staff all hugged each other quite a bit that day we found out how the Mayor had died. Then we went into other people's rooms and remembered to give a little extra eye contact, hold their hands, and say goodbye when we left for the day. The dying may never end with hospice but neither does the learning.
Although I work for hospice, I work mostly in a hospital. On the hospice inpatient unit our job is to find solutions to complex pain and symptom issues unmanageable at home. Well, that is the medical side of it. As chaplain, my job is to be with people and their loved ones in a way that reminds them of what they value and hold dear. Yes, I have the better job. No, I'm not one bit biased; I just hate suction tubes, suppositories, and the math involved in pharmacology.
It is not uncommon for us to have patients for only a day before they die. It is not uncommon for us to have a complete turnover in our unit within a week. Hospital staff think, "Well, duh. That's our life every day."
The difference is that hospitals have the goal of prolonging life. Our goal is to relieve suffering, provide compassionate connection, and prepare for death. The difference in our goals changes the style of care. An example of the difference: when I worked on regular units in hospitals and patients died, there were often many staff in the room because some sort of emergency code had been called. Everyone is talking, rarely is anyone talking to the patient. Family is asked to step outside. People have side conversations about their shift, the president, a sale at Kohl's; nervous conversations based in the fear of failure.
Vigorous attempts are made to save a life, an anonymous life. When the patient dies, comforting of the staff takes place in private because an environment in which success equals life has difficulty balancing the reality of grief and loss. (Don't get me wrong- if I should choke while we are eating tapas, get me to the hospital quickly. I'm just saying the perspective is not warm and fuzzy.)
In hospice when a patient dies we move slowly and deliberately. Prayers are said if appropriate, soothing words if not. There are no alarms or bells, few tubes or machines. If family is present, they are surrounding the patient and only a couple of staff are in the room at the same time. We all know the dying person's name.
Unless we are singing or praying, we the staff are very quiet. Afterwards we may give each other hugs, or thank one another for the care we gave that patient. In the best cases, we have come to know the family, so we better understand what this particular loss means to them. We talk about the patient again after death to assess the bereavement risk for the family, and if we were there, to share our opinions on whether it was a "good death" (when the patient dies in a way that was in line with their hopes). This latter part is important to us because we want every patient to die well, but know that this is not something we can truly control. The assurance that the best end occurred is a great comfort to hospice workers.
Which brings me to the Mayor. The Mayor was a member of the Greatest Generation. He was on our unit for a couple of weeks getting symptom management. He sat up and received visitors like a priest receives confessors. He smiled when staff came in. He read books and magazines. He was sound of mind, strong of character, and a gentleman in every way.
We planned to send him home with his medications stabilized to be with his family for his final weeks or months. I went home from my shift on a Friday after saying good night to the Mayor. It's a habit you get into with certain patients. When they are fully aware of their surroundings you give them the respect that you would give them if you were a guest in their home. Before you leave "their place" you say goodbye. At least I do.
When I would check out with the Mayor, he'd look over his reading glasses, put out his hand for a shake, and bid me a happy evening. He also always thanked me for coming to see him, even though he had visitors every day. What a guy.
I came back Monday morning and went to say hello but the Mayor had gone home. It was a great way to start the week. The Mayor had become well enough to go home and live in the comfort of familiar surroundings. Or so I thought for about thirty minutes. And so did several of my co-workers. We were all smiles.
In team report we covered the deaths of the weekend. The Mayor had not gone to his home in Richmond but to his eternal home. We were shocked and distraught. How could this happen?
Now you are probably thinking, "You work in hospice every single day and you get distraught when a patient dies? One patient?" Well, yeah. It's called a breakdown in compartmentalization and here is how it works.
We can all agree - working in hospice is not easy. There have been 12 patient death weeks at our unit. And I mean work week not 7 day week. There are a limited number of ways to deal with that and remain engaged and open to the next 250 patients, much less 250 more families. In general, we do it through routine.
Our patients mostly die according to a couple of patterns. We learn the patterns and we say goodbye to them incrementally according to the pattern. We can handle it as long as it stays within the emotional safety of the rhythm we know which is usually one of gradual decline in communication and interest in the outside world. Just as a baby becomes increasingly interested in the world beyond what she can reach as she grows, the dying person becomes less engaged the closer she comes to death.
Until they don't. Like the Mayor.
On the last day of the Mayor's life he ate three small snacks, read a magazine, hosted family and guests in his room, and took a nap. As he was getting ready for bed he began to feel ill. He was sitting on the side of his bed waiting for the nurse to assist him to the bathroom. She entered and he shared that he didn't feel well. They talked. She checked on his vitals and she realized that the Mayor would not be following the pattern. She told him. He talked to her. She held his hand and laid him on his bed. She talked quietly to him and he to her until he died. It all lasted ten minutes.
The Mayor didn't die as we or he had hoped or planned. He was in a hospital not home. He was without his family. He had not finished his plans.
But he died with someone caring for him. Someone holding his hand. Someone who knew his name. Someone who mourned him when he was gone. Staff all hugged each other quite a bit that day we found out how the Mayor had died. Then we went into other people's rooms and remembered to give a little extra eye contact, hold their hands, and say goodbye when we left for the day. The dying may never end with hospice but neither does the learning.
Newcomer Introduction
Wanna know what I've been to since conception? First - you need a better hobby. Second - well, ok.
Life History or at least the good parts.
1970's - Idyllic childhhood in Richmond,
Virginia filled with urban living, roller skating, dancing,reading and marching
to the beat of a tune heard only in my noggin.
1980's - Discover boys, DIY fashion design,
poetry, Prince, and an interest in theology. Go to college. Fail to fit in.
Revel in that.
1990's - Throw away youth on formal education
including seminary. Learn that hate is a word reserved for: endless committee
meetings, traditional worship styles, cookie cutter weddings and funerals. Determine
that organized religion can easily disintegrate into a 4 letter word. Tap into
an unknown gift of calm and comfort in the face of death. Go into hospice work
because death is not the worst thing that can happen to a person.
2000's - Have babies! Love babies! Have babies
suck the life out of me. Brainwashed by unknown forces (aliens? ghosts?
zombies?) to go back into parish ministries within "organized"
religion for over 6 years. Transform the concepts of death rituals and worship
experience for a small set of religious liberals who reward me greatly. Blog,
rebuild some crucial closets and bathrooms of the Gulf Coast after Hurricane
Katrina, learn a ridiculous amount about death, dying, grief, funerals,
cemeteries, and death related legislation. Leave parish ministry in search of
sanity, time with the "babies", and a family business.
2010's - A roller coaster. High points include
teaching hundreds of students on a variety of topics, writing, protesting
uterus obsessed legislation, mentoring the "babies" in State Fair
arts and crafts competitions, learning to play full body tambourine in New
Orleans. Low points include family tragedies and marital dissolution. You can't
have everything, right?
These days - Revel in the opportunity to provide my
offspring with an idyllic childhood in Richmond. Rejoice in urban living,
roller skating, dancing, reading and marching to the beat of a tune heard only
in my noggin.
Saturday, March 29, 2014
Luddite Lament
"And now I'm back... from outer space... you just walked in to see me here with that same look upon my face..."
I have been locked out of the Jots world for MONTHS. Madness, chaos, misplaced passwords, rabid procrastination, technology continuing to advance while I wonder where I put the instructions for my stereo.
Oh, yeah, and now that I am back I see all the stuff I was trying to fix on this thing when I locked myself out. Ugh. No wonder it took me so long to get back. Luddite life - you never really put it behind you.
Well, this loooong silence no doubt separated the wheat from the chaff as far as my dear twelve fans are concerned. I have so much to update the remaining three of you on! There have been publications. There have been radio shows. There have been T-shirts designed! There are zines in the works. There was the world's zaniest birthday cake. Most importantly, I neither broke any part of my body nor had any catastrophe.
The only bad news is that I work six jobs in order to keep my children in shoes that fit. They are very tall and I daily wonder how that happened. The balance is that one of those jobs is paying for health insurance. I can't afford a co-pay yet but... baby steps.
So, if all goes well (toes and neck hair crossed) this is the first of several entries bringing us back together and caught up. Please feel free to say hi in the comments. I've missed you three.
I have been locked out of the Jots world for MONTHS. Madness, chaos, misplaced passwords, rabid procrastination, technology continuing to advance while I wonder where I put the instructions for my stereo.
Oh, yeah, and now that I am back I see all the stuff I was trying to fix on this thing when I locked myself out. Ugh. No wonder it took me so long to get back. Luddite life - you never really put it behind you.
Well, this loooong silence no doubt separated the wheat from the chaff as far as my dear twelve fans are concerned. I have so much to update the remaining three of you on! There have been publications. There have been radio shows. There have been T-shirts designed! There are zines in the works. There was the world's zaniest birthday cake. Most importantly, I neither broke any part of my body nor had any catastrophe.
The only bad news is that I work six jobs in order to keep my children in shoes that fit. They are very tall and I daily wonder how that happened. The balance is that one of those jobs is paying for health insurance. I can't afford a co-pay yet but... baby steps.
So, if all goes well (toes and neck hair crossed) this is the first of several entries bringing us back together and caught up. Please feel free to say hi in the comments. I've missed you three.
Monday, September 02, 2013
Rosh Hashanah - the "boring" one
"But I don't wanna change."
This is going to be a tricky Jewish New Year around my house. I talked with the children again about Rosh Hashanah, the forgettable Jewish holiday in the worldview of the under 12 set. My offspring value neither apples with honey nor lengthy Hebrew recitations, so Rosh Hashanah is not-too-affectionately known as, "the boring one."
I'd like to chalk it up to their affinity for latkes, nightly candle lighting, building tree shelters, and matzoh ball soup; none of which are associated with this holiday. But the truth is that I have happy children. Change and regret have not become part of their daily lives. They feel no need to ritualize loss and hope. They're happy little Zen masters most hours of every day except when it's time to clean their bodies or their rooms. Or, G-d forbid, they accidentally touch each other. (That's their orthodox streak coming out.)
I love Rosh Hashanah. For years I spent the weeks coming into the holiday with a little book called Preparing Your Heart for the High Holy Days. I'd meditate and pray and read stuff and be an all around bore about it. Good times.
As I aged and suffered more losses, the metaphor of the books of life and death and who will be inscribed in which became more and more meaningful. The literal image is a nightmare, but coming to an understanding that we all have a limited amount of seasons has been transformative. I enjoy the meditative mood of the holiday, and the days of awe are aptly named for me. But try telling that little soliloquy to 8 and 11 year olds.
So there we were in the chapel where I give all of my spiritual guidance (the car) and I shared with the Buddha babies my incredibly brilliant, thoughtful, and laudable idea to celebrate this year with the kid-appropriate ritual adapted from Tashlikh. Smartly, I didn't put it that way.
"So what we will do is tramp down to the Mighty Mighty James River and write what we want to change about ourselves on biodegradable paper and then we will cast them into the river and watch them float away!"
My son gave his diplomatic nod which means, "I am still young enough to refrain from derisive snorting. Revel in these days, madre."
My daughter declared decisively, "But I don't wanna change."
How is it that the parenting coup of raising happy people from scratch becomes a mega-fail in celebrating my most favorite-ist holiday? Crap. Being a responsible, spiritual adult on my own is hard. Raising up little spiritual chicklets in my personal direction is a bear. Zen masters aren't necessarily good little devout Jews. That's fine with me. Well-adjusted Unitarian Universalist kids.
With that goal in mind I took the puddins to the Unitarian Universalist Community Church of Glen Allen yesterday. They had a great program planned and the sermonizer was rumored to be tolerable. You know what that means. Yeah, I was preaching. I led the children's worship talking about Tashlikh and how Rosh Hashanah is happening during the start of the new school year. Thanks to the tepid reaction of my own offspring on the subject, I mixed it up a little for child-relevance sake. I invited the children, of whom my daughter was one, to think of changes in their school life they wish for this year. One wanted to be better in math, another in English. One was positively, absolutely NOT going to be bullied. (Amen to that!) My daughter had her hand up for awhile.
"Yes, madame. What will you be changing this year?"
I'm stumped. Her grades are good. She's a happy puppy and she already has made it clear that change is not on her mind. Then my daydreaming began. Oh, please please please let her vow to become a morning person. Or an overwhelming desire to wash all the dishes from now on. Pleeeeeease.
"I'm going to quit choir this year!" She announced with triumph.
"What? This..." Not mornings. Not dishes. Yes change. Poop. "(Stammer). You... (sputter)," finally I had to drop the Rev. and just be Mama right up in there in front of everyone. "Choir? Really? Darn it. And this is how you tell me? In front of dozens of witnesses. You..." I was thinking how lovely her little voice was practicing "Man in the Mirror" last year. Then I remembered she didn't actually sing half the songs at the concert, just looked nauseous and well-behaved in the front row. Sigh.
"Well played, little bird. Well played. Way to embrace change." I high fived her.
The little church pumpkins then commenced telling scraps of paper their secrets for transformation and metamorphosis and throwing them in a "river" (wheelchair ramp) by the pulpit. I whispered "Fear" into mine as I had told the children I would, and tossed it high. My daughter gleefully threw the choir away. While the others tossed bad grades and bullies down the ramp with flourish, some huzzahs, and even a bit of dancing with celebratory fist pumping, one little curly haired cherub came up to me. I bent down to her and she cupped her hand around my ear, whispering, "I'm not going to be afraid any more either. Just like you." If that isn't an engraved invitation into the days of awe...
So this is how we will be doing Rosh Hashanah this year. I'll be praying in services and my secret prayer spots for two days, then we'll all tramp down to the riverside. I will prayerfully put my hopes for the New Year on a piece of thin paper and ceremoniously toss it in the river. My little imps are welcome to make boats, swans, airplanes, arrows, rockets, or whatever else they desire to celebrate the New Year in whatever way they want. They can include secrets, hopes, pet peeves, or name the projectiles George, as long as they send them soaring. Whatever they choose, I doubt it will be boring. Shanah Tovah, y'all!
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