Two Thoughts

Reflection Number One

It's been about a year or more, I think, since I reconnected on Facebook with someone who was in my second grade class, and in many other classes as our group progressed through from kindergarten through 12th grade. I'm going to call her "Joan" (though that isn't her name) and I re-"met" her when a zealot began a page in opposition to the tearing down of our ancient elementary school. She sent me a friend request, I accepted, and that pretty much was that. We occasionally "like" each other's posts, but never progressed to the point of "Why don't we go to lunch?"

When I look back on my elementary school years, I was happy through fifth grade. My sixth grade teacher didn't make much effort to discipline the class and a nasty classmate, Barbara, picked on me mercilessly. I was a complete outcast. The teacher allowed the students to arrange the desks in banks; there were two banks of six for the girls and Barbara didn't want me or one other girl anywhere near her group. So we were apart and alone. I was the youngest person in our grade of fewer-than-ninety students, youngest physically, emotionally, chronologically, and developmentally. That year was a horror for me and the three years of junior high weren't much better. I was lonely, insecure, and picked on until we reached high school where there were many, many more kids and I found a niche.

A few weeks ago when I came to work at the hospital, as is my custom, I went through the alphabetical listing to see if anyone I knew -- either personally or as a patient previously -- was admitted. There was Joan's name. I hadn't seen her in 53 years. I had no specific memories of Joan's having been mean to me, but I was still a little uncertain as I approached her room. Immediately she said, "THERE you are! Come give me a hug! I knew you worked here but I didn't know how to have you come visit!"

We spent more than half an hour together. She was sick with an infection, but not uncomfortable, and glad of a visitor. We rehashed old times, shared snippets of our lives since graduation, remembered horrible teachers, caught up on what we knew of classmates. We had a good visit.

I left Joan and got to thinking. I found I had good memories after all, including Joan and her sidekick "Linda," and several other kids who had never been hurtful to me. They had been quiet, perhaps intimidated by Barbara the Bully, or perhaps just preoccupied with their own difficult adolescent lives. Of course Joan thanked me for coming to visit her. But she had no idea what she had done for me in return -- caused me to re-evaluate 50+ years of painful memories only to find there were good ones intertwined here and there.

Reflection Number Two

I love the work I do at the hospital. It is a real privilege to be part of people's lives when they are in the midst of crisis. A lot of my work is supporting families of trauma patients; they really need someone who can just listen to their pain and their fears, and the rest of the trauma team surely has no time to do that.

My friend Karla is my personal prayer champion. She tells me frequently that she prays for my work in the hospital, and I know she isn't just saying so. One night I left the on-call room to go to a particularly sad situation. As I waited for the elevator just outside the room, I noticed a pretty quilt hanging on the wall with appliqués related to this particular hospital. For some unknown reason, when I looked at that quilt that night, I remembered that Karla had been praying for me and that I wasn't going to the situation alone.

Almost every situation begins with my catching that particular elevator. And I've made a permanent mental link between that quilt and Karla. I go off to see the patient knowing that I'm not going alone. God goes with me, and so do Karla's prayers.

Last Rites

When my friend Sharon visited me a few months ago, we talked about pastoral care at the time of death. I told Sharon about an occasion when I'd called the priest to come for the Sacrament of the Sick and I had stayed and participated with the family; I had found it meaningful and Sharon reminded me that we Lutherans had a ready supply of rituals -- had I forgotten?

So I started carrying my old green Occasional Services book to work with me. I marked PC at time of death, Emergency Baptism, Laying on Hands. 

Today was the first time I used the book.

I was called to a room where a man is to be removed from life support — the family is in agreement that this is the right thing to do. The man and his siblings are Roman Catholic; the rest of the family is Presbyterian or unchurched. I phoned the priest on call to see if he would come over to perform the Sacrament of the Sick, but got his machine; I suspect he had already gone over to serve Mass as they have a 5 o’clock at that church. I left him a voice mail saying if he received the message and could come over by 5:30, we’d all be grateful.

I walked back to the room and shared all of that with the family. They thanked me for trying. Then I offered to read the Lutheran/Protestant version of commendation of the dying if they would want me to do that and if not, that was certainly okay. The Presbyterian wife wasn’t sure what to do; she didn’t want to do the wrong thing and offend the Catholics in the family. She asked the patient's sister to weigh in; this lovely lady listened to my offer and said, “God is God. We all believe in the same God. But this isn’t my decision to make. It’s hers.” So with the approval of the Roman Catholic side of the family and the wishes of the rest of them, I read a truncated version of the service while they all held hands and joined in the Lord’s Prayer. It was a lovely moment and I was so glad that Sharon had reminded me of these rituals and that I had been able to help this very nice family.

An hour or so later, Father called back. "I guess it is too late for your patient," he said. It was. The man had passed as soon as life support was removed. I was a little bit nervous as I told Father how I had handled it. I was afraid he would get territorial or something. But instead he said, "Thank you so much for doing that."

God IS God. We all believe in the same God.

Thank you, Doctor

I was called by a nurse from the ER. There was a cardiac arrest going on; would I come down and be with the family in the waiting room. I was there within two minutes.

The family in the waiting room was a woman in her mid-thirties, rapidly thumbing the keypad on her phone, texting. I told her who I was and asked her to tell me what was going on. She was the daughter of the patient in the cubicle, and she began to tell me a story of pain and suffering.

The patient and his wife were homeless. For the past month they have been living on the streets, occasionally spending a night with friends. The daughter had been fortunate enough to be able to live with her aunt in a small apartment, and her parents had been able to keep some of their possessions in the apartment's storage unit. The daughter also had a 9-year-old son. Autistic. The aunt had recently passed away, so she had to move out of the apartment. She had, with considerable effort, located a shelter in another town where she, her son, and her parents were scheduled to move tomorrow. "And now this."

I went back to the cubicle to check on the patient's progress. The patient's wife was slumped on a chair just outside the debacle. She looked tired. Not just "lack of sleep" tired but a deep down tired-out-by-life kind of tired. The patient had lived hard -- lots of tobacco and alcohol -- and was now possibly paying the price. He had a history of heart problems in the past. Chest compressions had been going on for about twenty minutes, pausing every now and again for administration of drugs, in an effort to gain a pulse.

I went back to the waiting area to find a man with a hoodie slumped in a chair near the daughter, and beside him an attractive, well-kept woman fingering a rosary. Turns out they were the patient's somewhat estranged son and his girlfriend. The sister and brother did not speak to each other; nor did they make eye contact.

I spent about an hour and a half with this family, back and forth between the cubicle and the waiting room, listening, reporting, supporting. The patient was critically ill; the first goal was to achieve a sustainable pulse so he could be taken to the Cath Lab for further diagnostic. This appeared unlikely, and ultimately he was transferred to the Cardiac Surgery Unit.

But the tension, the stress among the family never seemed to abate. Turns out that the son/brother -- and his 12-year-old daughter of whom he had partial custody -- had recently moved in with the girlfriend and the homeless parents were jealous and resentful that he did not invite them to move in as well.

When the patient was finally ready for transfer and the doctor came out to speak with the wife, it was the same cardiac surgeon who had saved my husband's life nearly seven years ago. I knew the patient was in very good hands. The wife thanked the resident. She thanked the cardiologist.

And as the two of us walked back down the hall to the waiting room, she stopped in her tracks, turned to me and said, "Thank you, Doctor -- that just sounds so inadequate."

Thy Will

There were already tears in his eyes, spilling down onto his cheek as I entered the room. "Thank you so much for coming," he said. He introduced himself, his wife, and his sister. Then he introduced the lady in the bed, his mom. Collectively, they had decided to institute a morphine drip -- the doctors had said that there was nothing more that could be done for Betty; her breathing was compromised due to fluid in her lungs. 

Instantly, I sort-of fell in love with this family. This was to be a brief connection, but a deep one. A man who is brave enough to let the tears come unashamedly is a man I want to be around. 

He told me that they had talked together, with the nurse, with the doctor, with Betty even, and the morphine drip was what they needed to do. I knew they were right. What was so interesting to me was Betty's active participation in the conversation, despite the struggle with each breath. It was hard to watch her, to hear the sounds of her failing lungs.

We gathered around the bed, joined hands, and spoke with God. We expressed thanks for the love of family, for the compassionate care of the medical team; we spoke of the assurance of a life with God after this one and we asked for the courage to entrust Betty to God's tender mercy. We ended with The Lord's Prayer.

Incredibly, as soon as the prayer began, Betty's breathing calmed. It wasn't as noisy. She was hearing the prayer. And when we began The Lord's Prayer, her lips moved and each word was whispered. 

Throughout my shift, I was drawn to return twice more to this special family. To put my arm around the sorrowing daughter, to hold the hand of the man who let his tears flow, to pray -- one more time for Betty -- "Thy will be done."

Angry, Distrusting, and Entitled

I don't know what to call it, this attitude that frightens, frustrates, and angers me all at the same time. It's a kind of incoherent combination of anger, distrust,  and entitlement and I haven't had a lot of experience with it. I'm very much aware that I am a privileged white person. I learned a lot about that when I worked at the Quaker school. I know that I am at some level racist even though I think I am not; I learned that at the Quaker school, too.  I have friends and colleagues who are black and sometimes I am aware that my whiteness is a factor in our relationships whereas -- as far as I can determine -- their blackness is not. I don't have very much experience with this un-nameable attitude that frightens and frustrates me at the same time.

The encounter was at work, near the end of a long shift, when I was called to a Pediatric Level 2 Trauma. Aria was not much more than a year old and she had been dropped by her uncle. On her head. Mom, Susan, could not have weighed more than 85 pounds and looked like she was about 15 years old. She was, in fact, nearly 18. Susan was quiet in the trauma bay, and terrified. Silent tears ran down her cheeks. Aria was lethargic but somewhat responsive. She had no visible injuries but had vomited. For safety's sake, she had been placed in a cervical collar. The trauma team -- about 8-10 individuals representing 8-10 different areas -- gathered around Aria, but were kind enough to pause from time to time to provide encouragement to Susan, who I was keeping close to, supporting, hugging, mopping tears.

Then someone came back and said that Susan's mother and brother were in the waiting area and would I come out and explain things to them. I left Susan and went out. I'd never seen the waiting area so crowded, but before I could ask for the woman I was seeking, she -- and the brother who appeared to be about fourteen or fifteen -- presented themselves to me and began a verbal tirade. I tried to explain that I was the chaplain and I wanted to fill them in on what was going on in the back because I knew they would be concerned. "Bullshit," was the response. "That's just bullshit." This was the opening of the tirade that would go on and on and on, interrupting me every time I tried to speak, insisting on going back to the trauma bay, needing to know what was going on, but not wanting me to tell them. I tried. I really did. But in time I tired of the abuse, the interruption, the insult. The brother/uncle (who I began to think of as "the perp") was worse than the grandmother. I felt like I was a in a scene from "The Wire" (of which I'd watched only one episode). "Fuck" this, "Fuck" that, and demands/insistence on being "with my niece" went on and on until I turned my back, mindful that there was a security guard just around the corner; I could summon him if I needed to. I faced the grandmother and stopped talking. Finally her vitriol stopped. "If you don't want me here, I'll go back to your daughter," I told her. "But you and your son will not be allowed to go to the trauma bay."

She quieted. I explained that Aria was getting a complete work-up, and the next step was a CAT Scan. A CAT Scan that was a routine part of the trauma work-up. She started again, angry, entitled, insistent, and clearly not trusting me for a minute. I told her, "I need to get back to Susan now," and left. The crowded waiting room had gone quiet in horror at the scene.

For the better part of an hour and a half, I went back and forth from the trauma area to the waiting room, doing my best to show these family members respect by keeping them informed in what had to be a terrifying situation. Sometimes Susan went out with me, sometimes not. The grandmother had phoned Aria's father, something Susan had pretty much decided to wait on, and shoved the phone at her daughter; another young/angry/entitled black man was on the other end.

As it turned out, things were not good. Aria had been dropped with such force that there was bleeding into her brain. She was going to have to be transported to the children's hospital in center city. There was a point where the possibility was air-lifting her and this led to uncertainty whether Susan could accompany her in the chopper due to weight restrictions. (My hunch was that once the chopper team had a glimpse of tiny Susan, this would not be a problem.) But the decision was made to use an ambulance. Susan -- but no one else -- would accompany her daughter.

It was a hard visit, a terrible end to a long shift. And I've continued to think about it, to the point of even wishing I was in a CPE group that I could process it with. I am aware of my white privilege, I was aware that I was the person keeping this family from being where they wanted -- and believed they were entitled -- to be. I believed that their distrust of me was not personal but because of my whiteness, my position of unwanted authority. I knew they were frightened and that the son/uncle was likely feeling very responsible/guilty, though that was not something he could admit.

At a couple of points I could actually see the effort the grandmother was making -- she was trying to come out of her culture and into mine so that we could communicate. It shouldn't have been that way, but it was. She wasn't entirely successful, but she tried. I admired her for that. At one point, she received word by phone that her younger son had dislocated his shoulder and was on his way to this same emergency room. It was nearly eleven o'clock and she had to be at work at six o'clock the next morning. "You have an awful lot on your plate right now," I told her and opened my arms to offer a hug. She hesitated for just a second and then let me hold her for a very short time. Another adult would stay with the younger boy so that she could -- somehow -- find a ride all the way downtown to meet her daughter and granddaughter. I was grateful for her moment of shared vulnerability.

The son/uncle never cracked. He remained angry/entitled/distrustful the entire time, never letting up with his horrible recital and demands. I could try to imagine/identify the feelings he was having, but the barrier was too thick and was likely deeply embedded in familial dysfunction and racial issues. I could do nothing for -- or about -- him.

All of this was at the end of a sixteen-hour shift.