Thoughts While On-Call

I was in the chapel office when I heard this incessant beeping coming from the top desk drawer….the source of which I discovered was the back-up pager that our per diem chaplains wear when we CPE students are otherwise occupied in class or group time.

The pager is designed to continuously beep if a rapid response call has come though from the front desk and no buttons have been pushed to indicate that it has been received and read. I flipped through the contents of the tiny LED screen and noted the endless stream of multi-digit numbers listing the code status and the room locations of the calls received:

999-231

999-188

333-113

333-222

Stroke Alert 4ED

etc. etc. etc.

The pager had 25 calls stored in its memory, all of which also came through on the primary pager while this one sat idle in the desk drawer for the better part of a week.

Fifteen were rapid response (999) or emergency (333) calls, many of which likely resulted in a death or life changing experience for the patients and families involved.

Nearly every rapid response call I’ve been summoned to results in the same scene: 20+ people crowded into a tiny hospital room and flowing out into the hallway, as one doctor straddles the patient’s bed doing chest compressions. Nurses and techs fly in and out carrying syringes and pushing electronic equipment while I, the chaplain, hover around the edges looking for tell tale signs of family members in the melee.  Rarely does this scene end well.

As I flipped through the list on the pager and deleted each call I couldn’t help but think of the stories behind each number. Some room numbers were familiar and I remembered the patients whom I saw in these rooms early last week. Often we don’t know what happens to a patient when their name disappears from the census list we print out each day. Some are discharged, some are moved to other units…and some end up as a string of numbers in the on-call pager.

Names and faces passed through my memory as I deleted each number, and a sadness fell over me as I contemplated the fragility and the futility of this act.

In a single second a life is deleted…a memory of a death erased to make room for those that are yet to come.

I know the memories of these individuals live on their family members and all those whose lives were touched by their existence…..and the brief memories that I have of these patients will live on in me. But in the chaplain’s on-call pager they exist for only a shift’s length of time. For a harrowing few minutes they are the source of activity, anxiety, and stress….and a few hours later they are deleted from existence, never to be seen again.

It’s a good thing people are not like pagers.

I cleared the pager of all it’s calls and placed it back in the desk drawer.

The one on my hip that has been going off all day remains silent for now.

I pluck it from its holster and scroll through the menu:

Erase all messages?

Yes. Please.

Messages erased. 

A (Tired) Chaplain's Lament...

I feel heavy.

I feel heavy under the weight of walking into hospital rooms and listening to stories of pain, loss, frustration, hopelessness, and despair.

I feel heavy under the weight of grief and anguish as it comes gushing out of family members who are anticipating the death of a loved one, or who have just watched their loved one die.

I feel heavy under the weight of standing at bedsides and staring down at hollowed eyes and gaunt faces and feeling the anguish of every… labored ….breath.

I feel heavy under the weight of shattered dreams, wounded hearts and broken promises that tear through the lives of those suffering with addictions. Over and over and over again.

I feel heavy as the last person peels away from the body, away from the room, and leaves me alone at the bedside praying for safe passage of a soul. Nurses return to their stations, doctors return to their charts, family members stagger down hallways and return to their homes, to get on with the horrific business of picking up the scattered pieces of their lives.

I feel heavy because as chaplains we are called to sit in this pain and anguish with those who are suffering through it. We are not there to ease their pain. We are not there to fix it.

We are not there to be “purveyors of hope” as professors in pastoral care classes gone by told us we as clergy are blessed to be.

We are weight bearers.

We lift up heavy-sashed windows and prop open triple-steel doors that people have shut tight to hold back their emotions, and we try not to get blown over as the pain comes rushing out.

We tremble under the strain of holding the weight of sobbing sons and daughters, parents and spouses as they fall into our arms and ask over and over again, “Why?”… “Why?” …“Why?”

We don’t have the answers.

We’re not expected to.

But still we stand on the front lines, inserting ourselves as a presence in the most painful moments of people’s lives. And we show up for this battle bearing no arms, except for the two that God gave us.

I feel heavy.

In the last 8 weeks I have learned how to stand in the pit with others, but I still have yet to learn how to climb back out.

Perhaps because as I stand in the pit I feel the weight of my own pain as well…

pushing me down, causing my knees to buckle, as I hold tight the windows and doors that are holding back the emotions I don’t want to leak out.

This chaplain needs a chaplain to be present in that pain.

I have only the two arms that God gave me.

And I can’t hold the world up, and myself, at the same time.

I feel heavy.

And I need someone to catch me, before the weight sends me crashing down. 

 

CPE - Week Three

When they tell you in seminary that CPE will be the most rewarding, and the hardest thing that you will ever do, they're not exaggerating.
This has been a very difficult week, both in CPE and outside of CPE.
And when the two are added together one tends to magnify the challenges of the other.

On Monday I walked in the door of the hospital at 8:30 am and was promptly told that there was a death in one of my units that morning and I needed to head down and wait for the family to arrive. This is a unit that rarely experiences a death, and the staff were visibly shaken up. Over the next four hours I sat with the grieving family, consoled each member as they arrived and were told the tragic news, accompanied them to the morgue, held a sobbing spouse as he reluctantly released his grip on his wife's lifeless body, accompanied the distraught mother to the emergency room as she took care of a medical issue of her own, and checked in with each member of the frazzled staff to make sure they were holding up ok.  Then I spent the rest of the day trying to deal with the aftereffects of having absorbed such a large amount of grief over such a long period of time.

On Tuesday I used my experience from the day before in the verbatim that I presented to my supervisors and peers. That was a huge mistake. The emotions were still raw, and at that time I needed to be lifted up, not taken down. And take me down they did. My peers who had not yet had an experience like this critiqued my pastoral care skills and made relentless suggestions for improvement. Despite my supervisors jumping to my defense and saying, "actually what you said there was appropriate" and "the staff said that you did an excellent job as did the family" all I heard were the criticisms of my peers. In our covenant group that followed I finally broke down in tears, admitting that throughout their barrage I wanted to shout, "You weren't there!" Afterward I felt ashamed for having shown so much emotion in the face of criticism. In my mind this was a sign of weakness....I had broken down under the pressure, and I feared that the others would think they needed to treat me with kid gloves from then on.

On Wednesday I went through the day feeling pummeled. More so by myself than my peers. It was a busy day. I did morning worship, carried the on-call pager, had individual supervision (more critiquing, self and otherwise), and led two spirituality groups, including one where a patient dealing with addictions admitted that he had tried to kill himself the day before. When I got home that night I was emotionally and physically exhausted. In one week's time I had dealt with four deaths and consoled three grieving families.
And then I received a phone call from a beloved couple in my church informing me that their son had passed away that morning.  The pastor had just left on a 2 week vacation and the couple had assumed that I was in charge and that I would do the funeral.  I felt awful having to explain to them that another local pastor had been left in charge and that I would have her contact them. Had I failed yet again? Should I have offered to step in and do the funeral? Should I have offered to drive over that night and sit with them? How could I? I had nothing left to give.

On Thursday I juggled patient visits, group time, and supervisor didactics while making phone calls to the grieving family in my church, the church secretary, and the pastor who would be doing the funeral. I came home that night and fell asleep in the chair at 8 pm.

On Friday I did a 20 hour overnight shift in which I spent the early evening shuttling between the bedsides of two hospice patients who were in the process of dying. Graciously, neither one of them was near death, and the rest of the night passed uneventfully.

Today I lead Worship and presided over Communion in the pastors absence.Thankfully, I did not have to preach and found the worship experience to be renewing and refreshing.

Interspersed between all of these CPE and church demands were other personal issues and conflicts that cropped up and offered additional stresses to my very limited reserves. Taken all together I feel like I'm getting a crash course in what it means to be a parish minister. I'm quickly finding out what it is like to juggle pastoral and personal demands, and the need to practice self-care.
I'm quickly learning that I am not Wonder Woman, and it is not possible to be "Super Pastor" - even in my own mind - and to still keep one's health and sanity.
Take note all, I am retiring my cape.
If you see me trying to put it back on at any point, do me a favor and slap me upside my head.
I will be sure to thank you for it.

CPE - Week Two

Week number two at the hospital had me carrying the on-call pager for the first time and doing my first on-call overnight shift.   What I've found most amazing about my CPE experience is that I never know what it is - or who it is - that I'm going to encounter at any given moment.
Every time the pager goes off, every time I knock on a patient's door, I never know what is going to happen next.
In the course of this week I met three woman who came to the hospital for three very different reasons. I had the privilege to step into the lives of these women only briefly, but their stories have stayed with me.*

*****

This week I met Evelyn, a woman in her late 60's who who came in for same-day surgery. She was sitting alone waiting for her husband to arrive when I approached her. She welcomed the visit. Evelyn told me the operation she was about to have was routine and she'd had the same operation several times before, but she was still nervous. We talked for about 15 minutes about her family, her hobbies and her work in the church. I offered a prayer and she accepted.
Then she asked me what denomination I belonged to. When I told her I was a member of the United Church of Christ her face took on a look of concern and worry....."Oh, I used to be a Congregationalist years ago, but then they started ordaining women when the Bible explicitly says that women should not speak from the pulpit....and THEN they went and started welcoming the gays - God does not want that, God says that being gay is wrong.....so I left that church. Now I'm a Baptist."

Her words stung.
In response, I acknowledged the distress she must have felt in leaving her church and left it at that.
I was conscious of the fact that the purpose of my visit to Evelyn was to be a calming presence in her moment of stress, and she thanked me for being just that. She was unaware that in expressing her views she had dismissed my calling, my understanding of God, and my right to be true to who I am. In her eyes I was a nice female chaplain who was doing the work of God.  But I can't help but wonder how she would have reacted to my comforting presence had I told her that I preparing to be ordained, that I had spoken in the pulpit many times, and I am a lesbian as well.
I will never know. She will never know.
And that is how it has to be.

*****

This week I met Alice - an elderly woman who had taken a fall.
Alice told me that she used to work as a cleaning woman at a local hotel that no longer exists, and that she has 5 wonderful sons but she wishes God had given her a daughter.
Alice shared these details of her life with me and then proceeded to repeat them again, and again, and again. In the course of our half hour visit she turned to me 6 times and said, "Did I tell you that I have 5 sons?"  Alice suffers from dementia. She lives in a world that exists in 5 minute increments. Every 5 minutes everything become new again...and in this constant newness she found joy rather than despair.  Each time, after telling me about her sons, she'd look over at me with a huge smile on her face and say, "How nice of you to visit, and who are you?" - "I'm the chaplain," I'd say, "I'm here to see how you're doing....do you mind if I sit and chat with you for a bit?" - "Oh yes, please do!" she'd say with a smile, "How nice, I love to have visitors!"
We repeated this introduction four or five times, and each time Alice seemed equally thrilled by the prospect of our visit.
When I returned to the chaplains office to chart my visit I saw in the patient notes that another chaplain had visited Alice the day before. He wrote, "Length of visit: 10 minutes. Patient suffers from dementia. She is incapable of carrying on a meaningful conversation." End of notes.
Ouch.

When I spoke to Alice she was happy and animated and smiled and laughed often. She also expressed sadness and frustration with her pain, and lamented the fact that she could no longer do all the things that she loved to do.
Alice lives in a world that renews itself every 5 minutes, but it is a rich and full world.
Our conversation did not go very deep, we simply did not have the time to go there, but it was a meaningful visit. Alice loves to have visitors...and she experienced the joy of greeting a new visitor 5 times in the course of our conversation. She also repeatedly experienced the emotional release that comes when we're able to express our frustrations and pain to someone who is willing to listen.
In her mind she experienced both ranges of emotions only once, but I have to believe that she found meaning in them.
And if the visit was meaningful to Alice, that's all that matters.

*****

And finally, this week I met Rita, or rather, I met Rita's daughter...and her sons....and their spouses...and her grandchildren.
Rita was in her late 80's. On Wednesday afternoon she sat in a chair in her hospital room dressed and ready to go home. She had spent the morning with a big smile on her face, telling her family, the staff, and the chaplain who came to visit her how happy she was to finally be going home.
She came in with a simple infection but given her age the doctors wanted to monitor her for a few days. Now she had been given the ok to go home.
At ten minutes to five, just after her daughter arrived to pick her up, Rita began to motion that she was having trouble breathing. A Rapid Response was called and within seconds doctors and nurses descended upon the room and placed Rita back in her bed.
That's when my pager went off.

When I arrived all I could see was a swarm of medical personal surrounding the bed, with one doctor making a valiant effort to perform CPR on Rita's small, frail body.
Then I noticed her daughter and her granddaughter crying in the hallway.
"Mom, this is not what Nanna wanted!" the granddaughter shouted through her tears.
"I know," her mother cried out in response, "But we have to at least try!"

It had all happened so suddenly. No one was prepared for this.
Over the next 10 minutes I sat with Rita's daughter Susan, as she made the difficult decision to have them stop the resuscitation efforts and let her mother go.
Then I spent the next hour and half with Susan, and her ever arriving family, as she had to say those horrific words over and over again - "Mom is gone."
In the end I felt like I had done very little but be present with this family in their grief. I handed out tissues and scooped up used ones, and I rubbed their backs and gave them a shoulder to cry on.

I had no words to ease their grief. They shared their own comforting words - "She's in a better place." - "She is finally home." But I had nothing to add to the conversation other than, "I am so sorry for your loss" and "No one is every ready for the passing of a loved one."
This was my first serious Rapid Response pager call, and the first situation where I encountered a grieving family. At times I felt completely inadequate and unsure of what to do or say. At times I felt as if I was just getting in the way. But in the midst of their grief the family does not see it this way.
In the end Susan and her family expressed gratitude for having the calming presence of a chaplain in the room. I felt as if I had done so little, but for them it was just enough.

*****

In the midst of all three of these encounters I tried to be mindful that it is not about me.
This is a ministry of presence.
While my supervisors and my peers may want a blow by blow account of what was said and done so my performance can be critiqued and suggestions may be offered on what I could have done it better, this is of no concern to the patients and families that I encounter.
I may not always say or do the right thing, but I'm quickly learning that just being there, and offering a listening ear, is all that matters.

*names and details have been changed to protect patient anonymity

CPE - Week One

I think I'm going to like being a chaplain.
I really do.
Granted, with just one week of CPE under my belt I've barely dipped my toe in the water, but where I once thought the experience would leave me feeling extremely anxious and stressed I instead find myself feeling enthusiastic and hopeful about going through this program.

The floor assignments I received have me doing a little bit of everything, and for that I'm grateful. My primary units are Medical/Surgical (which includes a 4 bed hospice unit) and in-patient Psych. I also have the Childbirth Center, and I'll be running an evening spirituality group at the out-patient Addictions/Mental Health unit across the street from the hospital. I'll also be running a weekly group in the in-patient Psych unit. When I'm "on call" I could be called anywhere in the hospital including Critical Care and the Emergency Room.
And I will be on call a lot.
Each student has to carry the emergency on call pager once a week during the day shift, in addition to that we have to do one 15-hour on call overnight shift every week and three 24-hour on-call weekend shifts during the 10-week program. There's also a back-up on call pager that has to be carried by someone every day, so I could conceivable be "on-call" for 55 hours during any given week.
They say the "Summer Intensive" CPE program is 40 hours per week.
That's not quite accurate.
At this hospital it's more like 50-70 hours.
Ouch.

There are seven students in our CPE group. Two women and five men. One Catholic, one Jew, two Lutherans, one Episcopalian, one Presbyterian, and me, the lone member of the UCC. Our immediate supervisor is a Quaker and the program supervisor is an ordained Disciples of Christ minister. As a group we have very interesting conversations at lunch. ;)

We spent the first few days getting to know each other, getting to know the hospital and the staff, spending time in the classroom, and doing role plays.
On Wednesday we shadowed the per diem chaplains, on Thursday we went out and did a few visits on our own, and on Friday we had 5 hours to do patients visits in our assigned units. I've found that getting into the rooms, introducing myself as a chaplain, and asking patients if they'd like a visit has been easier than I thought. A few years ago I volunteered at a health/rehab facility and it was my job to go around and ask patients if they'd like me to take them down to the recreation room for the regular Friday afternoon entertainment. I also had the chance to visit with patients afterward, many of whom where elderly and were long-term residents of the facility. Having that experience has eased my nerves of "cold calling" on patients in CPE...it's what to say AFTER I get in the room that has me stumped at the moment.

We're supposed to keep in mind that these are not social visits, but pastoral visits, so we have to do our best to steer the conversation away from the normal niceties and explore any underlying feelings or spiritual issues that crop up. That's a lot to do in a 5-15 minute visit with someone you've never met before.
I expect I will be grappling with this social-pastoral dichotomy throughout the 10 weeks that I'm there.

My first week of CPE ended with my first opportunity to sit with a fellow human being in the last hours of his life. At 9 am Friday morning a call came in from the hospice unit to let us know a patient was dying and a chaplain was needed. This is my assigned unit so I was sent. Thankfully the program supervisor went down with me and got me started. The patient, Bob*, was in the last stages of lung cancer. He had no family, and had only one friend who was on her way. My job was to sit with him until she arrived and then be a presence for her, and for the staff, who were visibly shaken.
I was quickly reminded that these caring compassionate people never "get used to" dealing with death.
The staff expected that Bob's passing would be quick but he ended up hanging on for most of the day. Jay (a fellow CPE student) and I tag-teamed through out the day, relieving each other as needed and spending time talking to Sister Jane, Bob's friend. It turns out that Bob was a Franciscan "novice" and was a few months short of taking his final vows in the Order. Graciously, just the day before, his Order made the decision to fast-track him and that night Bob chose his Franciscan name, Brother Jacob. Bob had a hard life. He suffered from mental illness, struggled with addictions, and was often homeless, until he found God, and Sister Jane.
It was an honor to spend those precious hours talking to this wonderful woman as we sat with Bob in the last hours of his life.
I was not there when Bob passed. Jay and I were called away for classroom instruction, and Jay took the call when we were notified that Bob was passing.
Bob was already gone by the time Jay arrived, and Sister Jane, spent from the experience, left soon afterward, grateful that her beloved friend's pain was finally over.
Rest in peace, Brother Jacob.



When I was first brought down to the hospice unit on Friday morning it was chaotic. Nurses and doctors were milling about with two crisis cases unfolding in adjoining rooms. At one point we had 4 chaplains tending to patients, family, and staff in this one small space. And in the midst of it all I was amazingly calm. It was my first day going solo, it was my first call, and I was told that Bob's death had the potential to be difficult and "messy." But I felt privileged to be there. I felt like I had a purpose and the staff wanted and expected me as the chaplain to be there. God was present, the Spirit was present. All I had to do was be present as well.

I expect to face much more difficult, and chaotic situations in the coming weeks.
The thought of it makes me anxious, which is to be expected, but I no longer feel afraid. And I never expected that I would say that, just one week in.
I think I'm going to like being a chaplain.
I really do.

*Names and details have been changed to protect patient anonymity