Your Delivery Has Arrived

There's this strange phenomenon around the hospital. It's a robotic delivery box for medictations, mail and, well, whatever else needs to be delivered around the hospital. It's name (their names) are Tuggle, Tugster, Rx2D2 (say that three times fast!)... etc.




About the size of a small freezer, Tuggle makes its own way on its own around the hospital by wireless routers positioned on the hospital ceilings. It has a large camera-eye on the front that informs itself if it's about to run into something (a wall, a nurse, a chaplain...).



Seriously, we'll be milling about in the ICU hallway, comiserating about an impending death with a wailing family member and ... oops - here comes Tuggle. Look out. Part comic relief, part hospital work horse, part bane of the unit secretary's existence.



When Tuggle arrives at it's destination, it cries out in a semi-robotic, non-gendered voice, "Your delivery has arrived." Tuggle patiently waits. If the appointed recipient does not respond promptly, Tuggle repeats it's statement. "Your delivery has arrived." I was with one unit secretary when Tuggle arrived and annouced it's presence. The secretary was on the phone with someone and said, "Oh, hold on a minute, my husband is here..." as she went to get her delivery and then send Tuggle on its way. In another unit, I saw the classic stacks of folders for mail delivery; there were three levels, "In" "Out" and "Tug."

Just down the hall from our office, where the Behavioral Health Unit is locked, Tuggle waits and repeats any number of times before that unit secretary, at the end of the long hall behind those locked doors actually hears Tuggle. "Your delivery has arrived." "Your delivery has arrived."



But while they were on their way to buy the oil, the bridegroom arrived. The virgins who were ready went in with him to the wedding banquet. And the door was shut. - Matthew 25:10

How many times has God stated this to me and I did not hear? How many times has my delivery arrived, and God patiently waits; waiting for me to unlock the key and receive with gratitude what God delivers.

What has arrived in your delivery today?

Talk to the Hand

I did my daily sweep through the NICU this morning. This visit always begins with an obligatory 2-minute handwashing (timed!) before entry.

I wash my hands in innocence, o Lord, that I may go in procession round your altar, Singing aloud a song of thanksgiving and recounting all your wonderful deeds. - Ps. 26:6-7

Baby after baby, small (700g) and large (2900g), healthy and not-so, sleeping and awake. At this time of the morning, only a few parents are visiting. Each little babe receives a little prayer from me and a peek under the hood. Each baby space is kept dark to assist their little brains in forming and maturing. It's kept light in the space only if there is a need to help their liver functioning, in which case a blue-ish disco light is on.

So many wonderful little babes!

I wonder what they are thinking? I wonder what their parents feel, seeing them here? I wonder what their future holds? I pray for God's presence and comfort and healing.

Today, I met the mother of precious little twins. They've been here a month as of today. "Baby Girl 1" and "Baby Girl 2" is about all the identification they get. I talked to the mother, asked how she felt about going home with them soon, and knelt beside her to say a prayer for their little family.

Life was good, mom was glad to see me, and I was on my way. "Before I leave, may I peek under her blanket?" I asked Mom. "Of course!" she replied.

There's the little girl, trying to sleep. Her head is turned away from me, but her perfectly formed hand is poking out towards me. From under her swaddling blankets, she's saying to me with her hand, "STOP RIGHT THERE... talk to the hand."

Well, she put me back in my place. It ain't about me here.

Into your hands, O God, we place your children. Support them in their successes and in their failures, in their joys and in their sorrows. As they grow in age, may they grow in grace and in knowledge of You.

In Whose Hands are you, right now?

Wishes

This week in journal club we discussed several articles about Medical Ethics Dilemmas.

47 year old woman in the Emergency Center from a motor vehicle accident. Her only hope is blood transfusion, but she is a Jehovah's Witness and so refuses the transfusion. Does the doctor give her the transfusion against her will or honor her religious believes and allow her to die?

An elderly woman transported to the Emergency Center with severe respiratory distress. She has severe, end-stage lung disease and has clearly expressed to her family, friends and physicians that she does not want her life artificially prolonged. However, her loving husband and family cannot bear the thought of her death, and beg that "everything be done" to preserve her life. Her medical condition is precarious and only the placement of an "endotracheal" (breathing) tube and attachment to a respirator will allow her to survive. What should the doctor do?

While these are thought-provoking and conversation-generating ethical dilemmas, the real meaning comes in how this impact my life - your life - our lives. What are my wishes, I ask myself?

If I am in a trauma situation and I am unable to speak for myself, who do I want to speak on my behalf? Do I want to be resuscitated? Would I want to be on a breathing machine? What about tube feeding, if I am incapacitated for such a time that I need nourishment - would I want that?

I see this in the hospital time and time again - families anguishing about what their loved one would want them to do. So, have I talked to my family about my wishes?

Have you?

Verbatim Redux

...do not worry about how you are to speak or what you are to say; for what you are to say will be given to you at that time. Matt 10:19

As a team, we chaplains have been learning about "getting in the hole" with folks. That means getting into the dark and deep places where the patient/family member is hanging out and connecting with them there. Deep companioning, witnessing and sharing can happen. And sometimes healing can happen.

It's the opposite of responding with "oh, that happened to me one time... let me tell you about it..." It's a scary place to be vulnerable with another and connect in fear, loneliness, alienation, confession, or hopelessness.

So last week, I presented a verbatim about an encounter that I had with a man who was very worried about the future and regretful about the past. [Verbatim: an account of an exchange between me and a patient or family member. Includes "she said, then I said, then she said, then I said" as well as an analysis of what I was feeling and my theological take on it.]

At the time, I sensed that I connected with him. However, one of the gifts of "verbatim" is that I can stand back and look at the exchange and realize with my own two eyes and with no small amount of humility that I perhaps missed him. I am fascinated by my blindspots.

It took some nudging and coaching from my supervisor and my colleagues for me to realize that no, I did not get into the hole with this guy. I merely reflected back to him that yep, he was in that hole. How's it look from down there?

The redux came this Monday. I had a chance to take a timed-release capsule lesson from that verbatim and ruminate on it over the weekend. Funny thing was, that I could not remember what the "solution" was for that guy. As I talked it out with my colleagues and my supervisor, I got to experience it all over again.

As my supervisor modeled one way to "get in the hole," I realized how much I need to stay awake and alert even as I am present to the patient's story. I'm really blessed to be with a team of colleagues that will be with me on this strange and sometimes repetitive journey of learning.

Over and over, I hear the words of Matthew, "do not worry about how you are to speak or what you are to say..." and, well, show up one more time to the next patient to see if I can get into their hole with them.

How did you show up today?

Who Ya Gonna Call?

As a mother comforts her child, so I will comfort you; you shall be comforted in Jerusalem. - Isaiah 66:13

Code Trauma: 45 yom - gunshot wound to the ... When I arrive in the trauma bay, the man is talking and explaining to the police what happened. Yes, he is in pain. Yes, he can feel it when the doctor pushes *there.* No, he doesn't have any allergies. Okay, he says, you can take an x-ray. I approach him... Is there someone I can call for you?

Trauma Alert: 38 yom - fell. They wheel him into major care. The EMS explain how he was climbing a roof, slipped and fell. Oh, when he slid off, he landed on the fence. I can see from the size of his hands that he's done construction most of his life. He lies still as they shift him from the transport gurney to the hospital bed. Registration asks his name, address, did it happen at work, and other questions. I approach him... Is there someone I can call for you?

Multi-Car Accident: husband and wife both in trauma bays. Both talking. X-ray for him. Wound care for her. On their way home from a church event and "that lady" turned right in front of us! ... Is there someone I can call for you?

Burley macho guys. Gang folks. Construction workers. Church couples.

Who can I call for you? MY MOTHER! I WANT MY MOMMY!

It is kind of a surprise, but really not. It happens over and over. I feel warm inside when they ask me to call their mother. Of course, I say... what is her name? I am honored to speak on their behalf to the one who is first on their lips for comfort.

Can you say a prayer for me, too? is usually the second thing they ask. Of course, I say...

Who is your comforter right now?

Be Changed

Listen, I will tell you a mystery! We will not all die but we will all be changed,... 1 Cor 15:51

Q: Will you pray with me?

A: What do you pray for?

Its one of my responses to the request for prayer.
- For healing of my pancreas

- For my children that they may have the strength to help me through this

- For patients in this hospital who are sick (not for me)

- For the family of the man next door - - they are taking this really hard

- For my doctors that they will find out what is going on with me

- For courage to make the right decision

- For God's glory

- For my grandson on his first day of kindergarten

- For my pastor that he will have strength to hold our church together

- That I will see my sister again before I die

- That I can breathe again without effort

- That God will take me home

I continue to be changed by the responses. I may not "die," in the way that Paul means in his first letter to the people of Corinth. I *will* continue to "die to my old way of being" - to die to my old self that held presumptions about what people hold in their heart. I will continue to be changed.

Prayer changes things. And, it continues to be a mystery, and a marvel, and a wonder.

How are you changed, right now?

First Things First

Where is the contemplative mind being taught?


In today's CAC (Center for Action and Contemplation) email, Fr. Richard Rohr invites the reader to consider where the contemplative mind is being taught. He offers, "The contemplative mind is really just the mind that emerges when you pray instead of think first. Praying opens the field and moves beyond fear and judgment and agenda and analysis, and just lets the moment be what it is—as it is."



What struck me is his follow-up comment, "...We really have to be taught that mind. We now are pretty sure that it was systematically taught—mostly in the monasteries—as late as the 13th and even into the 14th century...."

So in the ancient churches, the monks were taught that before engaging the brain, first engage the spirit. I find this very inspiring.

Upon reflection, I notice how my visits which I precede with a short, silent prayer almost always are the ones at which I can be fully present, and leave with a sense of Wholeness and Shalom. I hunger for a teaching that offers to pray first, and a mind that can get out of the way for a Spirit of prayer to enter my heart at all times. I hunger for the Holy Spirit to come and re-form me.

What is your first thing, first?

Plentiful Harvest

Then he said to his disciples, "The harvest is plentiful, but the laborers are few." Matt 9:37

It was early in the evening when I was paged to the Emergency Center. As I stood around waiting for the medical team to stabilize the patient, a woman from a nearby EC room stepped out and asked for a cup of water. Of course, m'am, one moment please. When I delivered the water (with a lid on it!), the patient in the bed looked at me with such sad eyes. She was ill, clearly, and simply sought some reassurance. I took a moment to be with her and her friend.

As I walked out of that room, the patient rep asked if I could meet a different family who was now struggling with a new diagnosis. They were in the small conference room. I sat with them as the doctor explained next steps. We prayed together and one by one, the family members visited the patient.

Walking back to the original page, I met the patient and the family members and provided pastoral support. As I left that situation (by now it was late night), one of the nurses asked if I could just step into one of the other rooms to be with a young adult who was all alone and very tearful....

As I reflected on the evening, I found that whether I was paged or not, the harvest of spiritual needs was indeed plentiful, and with only me in the EC at that time of night, the laborers were few. Where were my colleagues? Shall I wake them? ... (grin)

I'm curious about how your harvest is plentiful right now?

The Life You Save May Be Your Own

“Our hearts are restless until they rest in You”: St. Augustine, favored author of Thomas Merton

Listening to Speaking of Faith's Krista Tippett the other day, she interviewed Paul Elie in a segment entitled "Faith Fired by Literature." He discusses his new book, The Life You Save May Be Your Own: An American Pilgrimage, a literary pilgrimage through the lives of Dorothy Day, Thomas Merton, Flannery O'Connor, Walker Percy.

His thesis is that through literary works, each of these authors found their own authenticity to grow and be themselves, while making a difference in the world. Through each author's own struggle to become them-SELF, they found an integrity that saved their SELVES and thus fueled their writing and work in the world.

For example, Thomas Merton's restlessness provided a tension in his life as a monk and writer. It fueled his on-going questioning about how he was to serve God and grounded him with a sense of determination that drove his contemplative life, his inner journey. He, having gotten to the monastery of Gethsemane in Kentucky, which he thinks is really the perfect place on God's earth for him, he then proceeds to imagine other places that would be more perfect, and he does this scarcely leaving the monastery for the next 20 years.

Paul Elie writes, "He imagines monasteries in the Andes or on an Indian reservation, or hermitages in France or in the hills of Italy, or in the Far West or in Alaska, again and again thinking, 'If I could only find this place that was ordered to my peace and solitude and experience of God, everything would be right.' And this is what, in his case, one of his mentors identified as Augustinian restlessness. "We are restless until we rest in you." And this feeling of restlessness was the core of Merton's spirituality."

Ms. Tippett later asks Mr. Elie to tell the story of the title of this book and what that phrase means to him. Mr. Elie explains that it comes from a story of Flannery O'Connor's.

"The story was originally called "The World Is Almost Rotten." But O'Connor's friend, Sally Fitzgerald said, 'Call it "The Life You Save May Be Your Own"' because at the end of the story the protagonist drives down the side of the road off into the distance, passing one of the signs that were on the side of the road in the '50s, telling people to wear their seat belts because the life you save may be your own. This, to me, is the pattern of pilgrimage distilled into an expression: "The life you save may be your own."

So the process of pilgrimage is how we take others' stories and, while remaining faithful to them, make them our own.

As a resident in a CPE program, I couldn't help but relate this to what I am experiencing here. It is through my experience of others' stories and, while remaining faithful to them, hear my own story. I then learn how to connect my story and by my SELF with patients to become whole in my pastoral functioning. Through these dances with death and birth and trauma that I am forming my own sense of SELF that is now fueling my theology and work at the hospital.

Yes, I provide pastoral support to patients who experience spiritual crises.
Yes, I provide pastoral presence to family members in trauma situations.
Yes, I pray with folks for God's presence to be known, felt, and ingested.

And, it affects my own life. Each day, through each visit, in every interaction, I'm saving my own life.

How are you saving your own life through your inner or outer journey, right now?

Authority

For I also am a man under authority, with soldiers under me, ...
When Jesus heard him, he was amazed...

I've been "working on" my understanding of pastoral authority.

How do I understand my - or any - pastoral authority? How does my theology inform my understanding of it? What does my experience say to my cognitive knowledge of it? How and when is my self-doubt triggered and how can this be a teacher for me? These interrelated questions pull deep within me for reflection and ponder. I believe these questions, and their answers, hold some keys for me in becoming more authentic in my pastoral care.

I find myself using pastoral authority:
- to contact the chaplain at a prison to arrange for the grandson of a dying patient to speak to the woman who raised him for the last time.
- at the bedside of a newly-dead patient to commend her spirit into God's Love as she passed from death into Life.
- to say nothing to the wailing mother whose young adult son died on the operating table, while all the folks around her gave cliche responses to the unnameable horror that happened.
- when the doctor waited for me to be present while he delivered delicate treatment news to the family of a trauma patient.
- to sit with the child and play word games as his mother tearfully said her last goodbyes to her father.
- to invite a patient to think about how or where God is in all of "this" (arm waving)

Pastoral authority is so ambiguous. At this stage in my awareness, sometimes I am sensitive to it, other times it is only afterward that I notice how I used it (or did not).

Even Jesus was amazed (read: astounded, dumfounded, stunned, flabbergasted) by authority. Okay, I have a lot to learn. Thanks be to God!

What shape does your vocational authority take right now?

I'm Not Here To Make Friends

September 25, 2009

Today, I listened to the Sept 11, 2009 podcast of This American Life entitled "Frenemies." In it, Ira Glass brought together stories about friends. Or wait, enemies? How about both? Tales of estranged sisters, BFFs breaking up and making up and breaking up, and how reality stars walk the fine line between making friends and making a name for themselves.

• The sister who the author is stuck with, but from whom she becomes estranged after her marriage to man from another religion.
• The bridegroom who was requested to toast the marriage of his best friend to his ex-fiance.
• The two women who met through a now-ex boyfriend of both.

Act Two included a story from deep inside the natural habitat of frenemies: reality TV. Rich Juzwiak, a full-time blogger spends a lot of time watching and dissecting reality TV shows. And last year, he noticed that one sentence seems to repeat an awful lot in the frenemy friendships that happen on reality TV. Once, he geeked out on common phrases that he hears on these programs. By far the most common phrase that reality show contestants like to share is "I"m not here to make friends!" It's so popular, in fact, that he spliced and recorded four minutes from dozens of reality TV shows into one youtube video. It's not a pretty sight.

As I completed the reading for this week's didactic on Pastoral Care, I read from Henri Nouwen's article on the Wounded Healer. He writes, "A minister is not a doctor whose primary task is to take away pain. Rather, he deepens pain to a level where it can be shared...and in sharing it can understand it as a basic human condition." (read: I'm not here to make friends)

"Perhaps the main task of the minister is to prevent people from suffering for the wrong reasons..." He proposes that through common wounds, the care giver can liberate people from the supposition that there should be no fear or loneliness, no confusion or doubt. "...these sufferings can only be dealt with creatively when they are understood as wounds integral to our human condition. Therefore, ministry is a very confronting service. " (read: I'm not here to make friends)

"...[ministry] does not allow people to live with illusions of immortality and wholeness. It keeps reminding others that they are mortal and broken, but also that with the recognition of this condition, liberation starts." (read: I'm not here to make friends)

"These wounds and pains are openings and occasions for a new vision. Mutual confession becomes a mutual deepening of hope, and sharing weakness becomes a reminder to one and all of the coming strength."

As a Chaplain, I find this difficult. I so want to be a people pleaser. I so want to tell people that it will be okay. I so want to fix what's broken, take away the pain, offer immortality and wholeness. Then I remember: I'm not here to make friends. What a paradox.

How does your woundedness draw you closer to others and bring healing, right now?

Earth Awe

September 27, 2009
The earth has brought forth its increase; may you, our own God, give us your blessing. May you give us your blessing and may all the ends of the earth stand in awe of you. Ps. 67:6-7

If you know anything about me, you know that I love to be in nature. Today, I got to be in nature with my family and new friends. What a way to restore and renew myself!

The psalm reminded me of the wonder of all creation. Being in nature feels like a prayer and a gift - it goes both ways. It's a mutual relationship that I have with The More of life. As I ask for Creator's blessing, I also notice how the tall trees stand in awe of that More.

After climbing the firetower for a view of the Smokey Mountains, we descended into the valley along a ridgeline just outside of Hot Springs, NC. We jumped a few springs, busted through some cobwebs, spoke loudly to a fantastic spider, pushed back several thorn-covered vines, ducked under low-hanging rhododendron, and saw two (or was it three?) silver-blue beetles making babies.

We laughed, we pondered, we questioned, we observed, we appreciated and we breathed deeply.

We stood in awe of You.

How is the earth bringing forth its increase in your world, right now?

The Nose Knows

September 24, 2009
Pray then in this way: Our Father in heaven, hallowed be your name. Your kingdom come, your will be done on earth, as it is in heaven. And forgive us our debts as we also have forgiven our debtors. And do not bring us ot the time of trial but rescue us from the evil one. - Matt 6:9-15

Okay, this is a bit of a stretch, but I think this prayer is about how to live as a human, with senses, on the earth. I hope that I learn each day how to live into God's will in this moment, on earth, since heaven is so outside of my realm.

One of the aspects of being human with five senses to remind me of my humanness, is the sense of smell. When I eat, my smell muscle informs my taste buds what's coming up and they get ready. When I hike in the woods, I love to stick my nose into the bark of a tree and smell the scent of butterscotch or of eucalyptis or pine. My smeller reminds me of my humanity.

This day, during my on-call rotation, I had a bouquet of scents to color my work time. The scent of septecemia surrounding the patient in isolation. The scent of starvation hovering around the patient who was too sick to eat and whose family declined the feeding tube. The scent of charcoal that the OD patient swallowed to absorb the drugs he had consumed. The scent of race car fuel from the jeans and boots of the young man who, in the words of his Pastor, "won the final victory and who can breath the sweet fresh air of heaven."

I pray, then, in this way... that through scents that stir my soul I may be reminded of my own humanity and may I be reminded of Love on earth, as it is in heaven.

What is earthly scents fill your airspace in this moment?

Grieving

September 23, 2009
Grant us, O God, not to be anxious about earthly things, but to love things heavenly; and even now, while we are placed among things that are passing away, to hold fast to those that shall endure... Collect for Proper 20

This day we met in Greenville to attend a conference about grieving. "Don't we know enough about grieving?" we laughed to ourselves as we piled in the car for the short commute to the conference center. (Have you ever done that - attended a conference about something that is so familiar that you think it must be a joke?)

I learned with humor and gratitude how anxiety about earthly things can appear.

The speaker directed his comments to the more than 100 folks who were funeral directors. For this audience, their role in connecting grieving families to the ritual letting go of a loved ones means that grief work is simply part of the job. It was helpful to hear how grieving family dynamics show up at the funeral home.

• The wailing sister who can't believe her brother died, even though she never spoke to him in the last four years.
• The demanding grandson who thinks he knows what dress Grandma would want to wear, even though he never once visited her while she was in the nursing home.
• The siblings who don't talk to each other because their father was abusive to one and left his estate to the other.

I got the picture that when patients die in the hospital, I'm only experiencing one tiny piece of the family dynamic that might play out more fully later on. I really gained appreciation for the funeral homes who provide important negotiating work in the midst of death.

I placed my hope on Love that endures through our human frailty and holds us together despite earthly anxiety.

What is passing away for you, in this moment, and what are you holding fast to?