Wednesday, December 30, 2009
My first assignment: check out the aircraft with one of the team. She explained the emergency exits, the plug for my helmet's microphone, the "off" switch for the aircraft's power and how to take the transponder with me ("in case of a hard landing"). I learned about where the fire extinguisher was. I learned how to use the seat belts, which basically wrap over the shoulders and across the lap like a straightjacket. I learned my role: "When you are seated, your job can be to look out for other aircraft. Using the clock-method, you might say, 'Plane at 3 o'clock' or 'Tower wire at 9 o'clock,' okay?" Oh, um, okay!
Methodically, she checked out the safety of the aircraft in between instructions and safety education. Clearly, this woman was comfortable with multi-tasking.
Next, back to the common area of the base. It is a comfortable but not fancy space with couches, a 32" TV and WII device, a cold draft flowing under the front door, and good lighting. The decor includes various greeting cards, notes about safety and a window-enclosed American flag given by a unit of the armed services in memory of the 2004 flight crew that perished in an accident. We hung out in this common area as the two medical team (my chatty buddy nurse and a very focused, serious-looking paramedic) and pilot inventoried their gear and shared light conversation. Serious-lady was also taking down the base's Christmas tree.
Fairly early, we got a call. In the base office, there are no overhead announcements or fancy buzzers or ringing bells or flashing lights. It was a telephone call, just as benign as any other call. Chatty buddy got the basic info, called out in a gentle voice that we were going to such-and-such county hospital and off we went.
I followed chatty buddy closely. Her easy going nature allowed me to ask her naive questions without an ounce of shame. As we approached the aircraft, she paused and looked at the pilot. My chatty buddy waited for him to change from the "fist" gesture to a "thumbs up" sign - just like she taught me in the check in. Hey, they really use this stuff!
We lifted off within minutes of getting the call. I was still smashing my helmet into my head (wow there's a lot of foam in this thing) and finding the buckle when I heard chatty buddy communicate to our hospital that we were outbound to pick up a patient. When she then radio'd ahead the other hospital, we found out that he was a big person. Very big. Like 375 pounds big. "We can hold the weight, no problem" the pilot replied to us all.
We flew about 8 minutes. I was alternating between "looking out for other aircraft" and adjusting the amazing wrap-around seatbelt when the pilot announced "2 minutes" until landing. The serious-lady took over the radio communications and got further details about the patient.
We landed without even any kind of bump. Heck, I've landed harder on my office chair when returning from a chaplain visit. Once we were on the ground, I fumbled with my helmet and seatbelt and walked quickly (kind of ducking, like they do in the movies) toward the waiting ambulance. They drove us around the parking lot to the emergency center entrance of the other hospital.
We traveled in a pack and I felt so honored to be in this company. These two strong, athletic, female paramedic/nurses, me, two gigantic EMS men with bright green jackets and a stretcher. We arrived en-force in the unit where we picked up the patient. (Well, they all shifted him from his bed-like-medical-device to the skinny board used in the aircraft.) We all herded out, placed him in the ambulance and rode through the parking lot. He WAS a big guy, so I really appreciated why they used an ambulance to move him and not even think of wheeling him down the parking lot between the cars.
A second set of EMS folks arrived to assist in loading the big guy into the aircraft. As four EMS guys and the two paramedic/nurses moved him into position, they all realized that the only way he would fit is if one of us did not go back. Serious-lady looked right at me and said, "Sorry, you'll have to stay here." Then she radio'd back to let our hospital know that one "of us" stayed at this other hospital. I really felt fine about that.
I grabbed my helmet and walked behind the security guard. He was directing traffic in the parking lot next to the heli-pad. Security guy was very talkative and his pride at serving in this once-in-a-while capacity ("I retired from the military so I know how to direct aircraft") was contagious. I, too, felt like I was part of something bigger. It so was not about me but our group effort in working with Big Guy to get him to our hospital.
I was starting to get the idea about care, about how we are part of something bigger...
I want you to think about how all this makes you more significant, not less. A body isn't just a single part blown up into something huge. It's all the different-but-similar parts arranged and functioning together. If Foot said, "I'm not elegant like Hand, embellished with rings; I guess I don't belong to this body," would that make it so? If Ear said, "I'm not beautiful like Eye, limpid and expressive; I don't deserve a place on the head," would you want to remove it from the body? If the body was all eye, how could it hear? If all ear, how could it smell? As it is, we see that God has carefully placed each part of the body right where he wanted it.
1 Corinthians 12:18-20 (The Message)
Thursday, December 24, 2009
Tuesday, December 22, 2009
Sunday, December 20, 2009
Tuesday, December 15, 2009
Thursday, December 10, 2009
This week we went to one of the other hospitals and watched the movie Wit. This profound movie epitomizes grief and suffering in one's own experience of illness. Starring Emma Thompson (magnificently acted), the story revolves around a professor of English literature. This professor's knowledge of poetry and her tough teaching style are both challenged as she endures various chemo treatments for her stage IV cancer.
During the film, the viewer learns of the professor's feelings as she looks directly into the camera and describes in poetic and often ironic style what she is experiencing. In one poignant moment, she realizes that she can only get her head around what she is doing by describing it. She says, "my only defense is the acquisition of vocabulary." In many ways, her words are not enough to heal her. In the end, we hear her voice quoting from one of her own literature research subjects, John Donne, "Death, be not proud".
Moving and troubling, the film for me portrayed a deep loneliness that accompanied her suffering throughout. I connected with my own loneliness, and the fear of my own mortality. Who will be there with me as I vomit my last guts out? Who will put hand lotion on my dry, lifeless hands? Who will crawl into bed with me and read me a children's story? Of course, I yearn for this to be my intimate love. Of course, I yearn for my family to be at my side. Of course, I yearn for my wit to remain with me to the end, so that I can at last describe it.
Theologically, I believe that God will be with me through my own death and dying process. I do believe that in those suffering places, I have seen, do see and will see God face to face.
So if you see the film, bring a box of tissues. And a gaggle of chaplains to debrief all the feelings that arise.
Instead he went out and began to talk freely, spreading the news. As a result, Jesus could no longer enter a town openly but stayed outside in lonely places. Yet the people still came to him from everywhere. Mark 1:45
What color are the feelings you have at this moment, the ones beyond words?
Wednesday, December 9, 2009
The therapist offered that in some cases, finding a church may be a helpful place for newly-clean addicts who seek out new friends and new patterns. After some sharing by other patients, I heard one say how at first, his new church really helped him. Then he got really involved and really active. He led trips, helped the homeless, taught Sunday school, held bible study, and really over committed himself.
I am sure that I took a deep breath when he said, "I got so busy saving others that I forgot about saving myself."
How am I like this patient? Well, I better learn to know when to say when. I pray for God's guidance, for my family's patience and for my colleagues' perseverance to help me not forget about self-care.
Tuesday, December 8, 2009
As I thought about the last five months, I realized that I am finding a deep faith in how God moves me and enlivens me in my care giving. I variously serve as a witness, companion, investigator, awkward hospital staff person, translator, interpreter, loving listener, reframer of perspectives and affirmer of God’s love.
It suddenly hit me today, Saturday, as I watched the World Famous Lipizzaner Stallions. The presentation of these amazing athletes by their equally well-educated riders captured my imagination as I realized how the role of the Dressage rider/trainer resonated so well for me and my pastoral functioning.
The idea of dressage is a way of training the horse to emphasize a horse's natural athletic ability and willingness to perform, so that its potential as a riding horse can be maximized. A fully trained horse will smoothly respond to a skilled rider's minimal aids - all the while the rider remains relaxed and appearing effortless. In chaplaincy, I find that my role is to smoothly respond as a rider, with minimal aid, remaining relaxed and making it look effortless – so that the patient/family can sense their own potential as a human being in which God delights.
The Lipizzaner horses, in particular, are bred for their athletic ability and are allowed to roam free until they are four years old. During this time, the trainers observe the horses in the natural environment and learn their natural rhythm. Only after this waiting time do the trainers begin to work with the horses for re-enacting their athletic ballet moves in the show ring. In chaplaincy, there is a bit of a "waiting time" associated with caregiving, in which I observe the situation and am better able to invite the care seeker to re-enact their own theology or to realize God’s ever-presence and how it can bear on the situation. This “background” perspective informs my pastoral functioning.
Historically, it was Xenophon (427-355 BCE) who is well known as one of the earliest European master trainers. His treatises, written in Greek, advocated the use of sympathetic training of the horse and many of his methods and ideas are still widely praised. Also in Christianity, there is a long tradition of pastoral care methods and these are mirrored in my pastoral image formation. With God's help, I hope to bring this long tradition to bear on the moment of care.
The Dressage Rider/Trainers train the horses to fully use their artistic ballet gifts, such as changing lead on every step at a canter, take years to master by the horse as well as the rider who needs to learn the appropriate cues. As a chaplain, my role is also to recognize the inner life of the care seeker and connect with my own, so that together our histories can find something new in our time together.
Further, the rider/trainer's goal is to have the show be about the horse, not the rider. The riders themselves have learned their own skills for riding and cuing the horse over years of education, usually a lifetime. The less obvious the moves are, the more effective the “show” is and the horse’s true essence comes out. This is much like chaplaincy. The less “showy” I find that I am, the more of God can show up and the more the patient/family is central to the intervention.
Even though there are standardized methods, each combination of horse and rider is unique. With horses, it is not uncommon that one horse trained to perform at a high level may be completely spooked by a venue that is loud or unfamiliar. The trainer’s role is to deal with the venue that comes up and work with the horse’s personality in that moment to bring out the horse’s gifts and graces in that particular instance. As it is with each pastoral intervention, where every relationship of chaplain and family is unique and changes based on the patient’s diagnosis/prognosis or sense of the future. As a chaplain, I am learning to adjust my interventions, my use of “training methods” to each situation.
Riding horses requires balance, harmony and relationship. This subtle type of sport requires some translation of ideas to the horse and interpretation from the horse’s response back to the rider. The rider must always listen to what the horse is “saying” in silence – through body language (horse’s ears are perked or lay back, how the horse moves away from or into the leg pressure or even how the horse may cling to the bit or avert from the movement of the reins). The chaplain, too, must listen to what the care seeker is "saying" in silence - through body language, facial expressions and reactions to others in the room. My role as chaplain is to then translate what's going on and interpret how the care seeker is responding to have any sense of how we can be together in the care intervention and become aware of God's ever-presence.
Sometimes, training a horse involves reframing a“scary” situation, such as “threading the needle” movement. In this movement, horses face one another as the riders guide them and weave between their neighbor horse/riders. Normally, horses avert or shy way from trotting or cantering directly towards another horse. Only after coaxing by the rider and developed trust in the relationship does the horse allow this “threading the needle” move. This kind of relationship takes loving listening, companionship, and true affirmation from both the rider to the horse and from the horse to the rider.
In chaplain work, I find that some patient/families, while gifted in other situations, are completely "spooked" by being at the hospital - a venue about which they are unfamiliar. When appropriate, I might reframe a ‘scary” situation for the patient/family into one of “normalcy”. This usually takes time, trust, and relationship. My pastoral functioning is one of relationship as is dressage riding.
In Dressage, as in Chaplaincy, both the horse and the rider (care seeker and chaplain) become more of themselves through this relationship – they know their own strengths and weaknesses individually. As a unit, something new happens.
Grace and beauty
For the LORD will rebuild Zion and appear in his glory. He will respond to the prayer of the destitute; e will not despise their plea. Let this be written for a future generation, that a people not yet created may praise the LORD - Psalm 102:16-18 (New International Version)
Monday, December 7, 2009
One of our medical resident colleagues recently shared an article about how "Death" is being defined - and redefined - as the medical profession begins to understand that "...there is no "moment" of death." In medicine, the "moral" lines move. "Dead" means irreversibly stopped, and stoppages are increasingly reversible.
Is it when the heart stops? How can that be when the plan is to restart the heart in a new body?
Is it when the brain stops? Then we can take organs from people on a ventilator. "Failure to take body parts looks like lethal negligence."
I can tell you that this was one of the most vibrant discussions we as a team have had in our 5 or so months of chaplaincy. The medical team was spot on with all their scientific wit. The behavioral psych team got into our own fears of death. The chaplains were spiritual and religious.
Then, Dr. Kildare told us about Mike and all bets were off. Oh, you've never heard of Mike, the headless chicken? Well, talk about redefining life and death. You see, Mike was supposed to be dinner, one summer evening in 1945. The only problem was that he lived for another 18 months after his head was cut off. He grew to be 8 pounds of robust chicken and for this feat was eventually valued at over $10,000.
Who needs a head, when you can be a chicken?
Which brings us back, of course, to chaplaincy. Where is God in all of this? Well, there's a good question. I hope you keep asking.
This day I call heaven and earth as witnesses against you that I have set before you life and death, blessings and curses. Now choose life, so that you and your children may live and that you may love the LORD your God, listen to his voice, and hold fast to him. Deuteronomy 30:18-20
How are you redefining life and death in this moment?
What memorial service, we asked?
- Every year at this time, a Christmas tree is placed in the lobby of the hospital.
- Every year, ornaments are placed on the tree by family members of patients who have died and have given their bodies to science.
- Every year for at least the last 15 years, family members show up and place their ornaments on the tree, commemorating their loved one ("for Johnny, my 18 year old son, who was killed by a drunk driver," or "for Suzanne, my fiance, who died in a terrible car wreck," or "for Pamela, my cousin, who had a brain aneurysm and died suddenly.")
- Every year, the organization that works with organ donation families holds this memorial service and some dozen or so families show up to remember their loved one.
- Every year, the medical team (nurses, case managers, physicians, staff) assists in this memorial service as they, too, remember these families and their loved ones.
I recognized "my" nurses from one of my floors. That's the floor with the most number of brain injuries or deaths and those nurses see many of these families. That's when the nurse manager suddenly called out, Chaplain, can you pray to open our ceremony?
And two minutes later, I began...O, most gracious and loving God...
In those moments, I realized that if I had more than two minutes to think about this, I might have been a little more freaked out. In some strange way, it was a bit like an initial visit or a middle-of-the-night call to pray with a family in the midst of some crisis. I asked in a sort of round about way what would be appropriate to pray for/about. The MC gave me just a few short words. That's all I needed and out came the prayer for courage and strength and gratitude...
I felt that the prayer was not about me, it was about God's presence in that moment for those people and for all the cloud of witnesses in whose memory we hung the ornaments. Okay, it was a bit bumble-y and so what. Just as soon as my inner critic began to work, I shoved her back in the box. Hey, I showed up. So did God.
Coincidentally, just a few days later, my colleague Erin presented this reading. (She had not been at this spontaneous entry-way memorial service and was simply commenting on how often we Chaplains are asked to pray.)
The following comes from Eugene Peterson's Living the Message.
"One of the indignities to which pastors are routinely subjected is to be approached, as a group of people are gathering for a meeting or a meal with the request, "Reverend, get things started for us with a little prayer, will ya?" It would be wonderful if we would counter by bellowing William McNamara's fantasized response: "I will not! There are no little prayers! Prayer enters the lion's den, brings us before the holy where it is uncertain whether we will come back alive or sane, for 'it is a fearful thing to fall into the hands of a living God.'"
Don't be flip with the sacred. Banter and silliness give no honor to God. Don't reduce holy mysteries to slogans. In trying to be relevant, you're only being cute and inviting sacrilege. Matthew 7:7
How do you show up for prayer in this moment?