Elizabeth

I met them many years ago when I was part of a clinical pastoral education group and serving as a chaplain at a large inner city teaching hospital. It was my first day on the oncology floor and the last thing I wanted to do was to walk into the room that housed a 16-year-old girl, newly admitted. I'd expected the oncology floor to hold a much older population. But walk in, I did, and thus began a relationship that would be intense over the next eight months. Elizabeth had broken her arm in a car accident, and in the local emergency room in upstate Pennsylvania the x-rays had shown a bone tumor close to her shoulder. The tumor was malignant and would need to be removed. But first Elizabeth would need to undergo many rounds of in-hospital chemotherapy in an attempt to shrink the tumor before the surgery. In all likelihood, Elizabeth would lose her arm to cancer in an effort to preserve her life.

By way of an odd coincidence, I was connected to this patient and her family. They came from a "town that nobody ever heard of" that was about three hours away from Philadelphia. The same town where my father-in-law lived. Elizabeth's parents, Jean and her husband, were his veterinarians. They knew my father-in-law and they knew his Brittany spaniel and his spiteful cat even better.

It turned out that Jean, then, became my patient rather than Elizabeth. Every few weeks when Elizabeth would be admitted for her chemo, I'd pick Jean up and we'd go to the cafeteria where she could share her fears, her worries, without Elizabeth's having to hear them. During this time usually the social worker would visit Elizabeth so that she, too, could share. Jean and I became close.

On the day of the operation, I was with Jean and her husband when the surgeon came out to report to them. I stayed long enough to hear him say, "We were able to save her arm," and then I went back up to the oncology floor, happy to be the bearer of good news in a setting where there was precious little of that.

This wasn't the whole story, however.  When I found the chemo nurse on the onc floor and told her that Elizabeth's tumor was gone and her arm was saved, she wasn't elated.  Instead, she said to me, "Well, that may well be.  But that arm will be totally useless; it will just hang by her side and atrophy."  How quickly my joy turned to confusion.  I didn't really know how to feel.  I'd been praying for preservation of the arm; I guess I thought it went without saying/praying that the preserved arm would be functional. 

My clinical pastoral education experience came to a close that very week.  I never had the opportunity to visit Elizabeth or Jean on the floor again.

Six months later, at Christmas, I received a card from Jean.  "If you're ever in the neighborhood," she said.  But no mention of Elizabeth's useless, atrophied arm.  I guessed the family was thankful she was alive, thankful she had the arm.  The prospects at the get-go hadn't been all that optimistic.

The following summer my husband and I were invited to a surprise party for his father.  We needed a place to change into our party finery following a long car ride, and it couldn't be Pop's place.  I emailed Jean.  We followed her directions out to a beautiful property with an amazing view.  It was good to see her, to see her husband, and to introduce these important people to Joe.  Elizabeth had finished her first year of college and wasn't living at home.  But she had come by that day and was inside making lunch.  I felt shaky and nervous and my stomach was tied up in knots.  I didn't know if I could bear to see this beautiful girl with her useless limb.

And then the door opened.  And she came out.  Carrying a plate with a sandwich in one hand.  And a glass of milk in the other.  It was all I could do not to cry right then and there, with the joy of a year before now an honest-to-God reality.

Over the years the Christmas cards have continued with quick check-ins. Elizabeth graduated college.  She started a photography business.  Elizabeth married.  Life was good.

And then, years later,  I received a most welcome message:  Two weeks ago, Elizabeth gave birth to a little boy.  And this time I didn't need to hold back the tears.  Tears of pure joy.

Stillborn but Still Born

The early part of the morning had been quiet; then the beeper went off and it was the kind of call that a chaplain dreads.

A young couple had come into hospital the previous afternoon to deliver their third child. Upon hooking the mom up to the monitor, it was found that the baby had died due to a nuchal cord. The mom had to labor, and about fourteen hours later she delivered Lindsey, a little girl with a cleft lip and some other problems.

The family was new to the area, in the middle of a job change, no family in the area, no church affiliation yet, no local friends. They talked about their 4-year-old daughter at home who was expecting a little sister, and needed to figure out how they were going to tell her what had happened. They had a 2-year-old son as well. Dad's parents were gone and Mom's mother very ill; their situation couldn't be much sadder.

They wanted to have Lindsey baptized, and so we talked about blessing vs. baptism. Baptism of a stillborn is theologically unsound, but I have done it anyway if it was important to the parents. This couple agreed to a blessing which was done with the same holy water and language as used in a baptism, only saying "bless" in place of baptize.

I liked them so much. After the blessing, I left them alone with their baby.

I returned a couple of hours later to deliver the certificate of blessing I'd prepared. The nurse told me that mom was having trouble giving the baby up but it was time for her to do that. When I went into the room, the dad was holding Lindsey and the mom was looking through the box that held the foot prints, the photos, the little cap and other things that the hospital had gathered for her. Off to one side was a metal table with wheels; this would be used to take the stillborn baby down to the morgue. Of course the mom was having trouble!

Dad asked if I wanted to hold the baby and when I had her it seemed as though it might be easier for the family if I took the baby from the room in my arms instead of the nurse taking her away on the metal table. We prayed together and they kissed her goodbye. It was so sad, and yet handing the baby to the chaplain (instead of putting her on the wheeled table) was somehow metaphorical for giving her back to God, and they were able to do that.

I was scolded by the nurse for risking infection by taking the baby in ungloved hands, but I didn't care. It was the right thing to do.

Miss Myers

I see myself as a dinosaur: I hardly know anyone else who knows and can use Gregg shorthand. I learned mine in high school and have used it for more than fifty years, in one way or another. My teacher stressed the importance of our shorthand being perfectly legible; one never knew when another stenographer might have to interpret our notes and transcribe.

When my children were little, I used to buy their Christmas presents and wrap them immediately to prevent snooping.  So that I didn't forget what was inside each package, I'd write the contents in shorthand on the package tag.  It drove the kids crazy; they'd try to get my sister (another shorthander) to tell them what it said.

I use my shorthand at work, of course, and at meetings I attend for church.  I write my gift list in shorthand so that if my family finds it, their surprises won't be spoiled.

Here's my best shorthand story:  I was spending a night as the on-call chaplain at our local hospital.  The beeper was being very well-behaved and it seemed I was in for a quiet evening.  I stopped by the family lounge, where people wait for news of someone in surgery.  A small gathering there looked anxious, so I approached them.  It seemed that their person had been in surgery far longer than they had anticipated; they had had no word, and were very worried.  I offered to check into it.  I went to the OR suite and checked in at the main desk; someone there was able to give me a progress report about the patient, giving me a great many details which I wrote down on the little notepad I carried.  I was glad to be able to take good news to the waiting family.

Since it was still pretty quiet, after doing the visits I'd been requested to handle, I sat down with the patient census to see if there were any recognizable names.  There were a couple of patients who came in and out fairly regularly, and I liked to check on them.  And, of course, I would want to visit people from my church or neighborhood.  Up popped a name I recognized immediately, a name I'd not thought of for thirty-five years:  My high school shorthand teacher.

I went up to her room and she looked up expectantly.  She was alone.  "Miss Myers?" I began.  "I don't know if you remember me."  She looked me over and she did.  She'd been my homeroom teacher as well as shorthand, so I'd been with her for three full years. I hadn't been the easiest student.  We settled in for a visit; she wanted to know about my life and I wanted to know about hers.  She had been retired for some time; her brothers and sisters were all gone.  She lived in a retirement community and this was the first time for her to be hospitalized. It was all overwhelming. The next day would bring surgery for her breast cancer.  She was terrified.  She was thinking through what her life had meant.

I spent a long time with her, listening, reassuring, praying, listening some more.  As I got up to leave she stopped me asking, "Do you ever use your shorthand?"  "Of course I do!" I assured her, pulling the pad from my jacket pocket.  "In fact, I used it just before I came up to see you!"  Since there was no information that would identify the surgery patient, I showed her the notes I'd made at the OR desk and her sweet anxious face lit up.  "Oh!" she exclaimed.  "I can read every word!"

"I Thought It Would be Charles"

Better minds than mine have analyzed the Trayvon Martin tragedy and better writers than I have expounded on it. It would seem there would be little to add.

But I write nonetheless because I know Trayvon's case is not unique. There have been many Trayvons.

During my seminary years, I spent ten weeks one summer doing Clinical Pastoral Education at an inner city hospital setting. I had regular floors and departments that were my "parishes," and every sixth night and sixth weekend day, the entire hospital was mine to cover. Throughout that time, I never had a single night where I was not awakened from my on-call room to come to the Trauma Unit because of a shooting. Larcenia, a young black girl who had been sitting on her front steps in search of some cooler air than in her row house, was the exception; she was the victim of a senseless drive-by shooting and she never walked again, never had feeling of any kind from her mid-section down. Larcenia was 14.

But, as I said, she was the exception. Because more often than not, it was a young black male who had been shot. Sometimes it was an act of vengeance; sometimes there was gunfire from multiple players. And sometimes it was random, thoughtless shooting. Perhaps for sport.

One night the victim was a young black man named John. He was seventeen years old. He lived, thank God, but not without compromises in his quality of life. My job was to talk with him, to get his identification information, and to ask him who I should call at home. John was a sweet guy. He had no idea who had shot him or why. He believed it had been a white guy in a car. And he asked me to phone his grandmother. When I reached the lady, I told her as gently as I could that I was the hospital chaplain, that John had been admitted, and he was alive and talking to me, and wondered if there was someone who could bring her to the emergency room. I'll never forget what she said to me: "Did you say it was John that was shot? I always thought it would be Charles who would get shot."

It was unfathomable to me that this woman, and probably many, many other African-American mothers and grandmothers actually lived with the expectation that their sons and grandsons would be shot. I couldn't wrap my mind around it -- and I've later learned that this is due to white privilege.

That summer was more than twenty years ago. How little progress, if any at all, we have made.

"Well, You Did It"

I was the on-call chaplain that night.  This meant that I was the only person from Pastoral Care in the hospital.  I carried the beeper and had a quiet little room where I could sleep if things weren't busy.  My shift began at 5 p.m. and would end at 7 a.m.

The beeper went off around eight o'clock.  It was the head nurse from the ER.  A woman had been brought into the hospital after a successful suicide attempt.  Her family had been contacted and would be coming in to see her. Would I please go to the viewing room and wait for the family. 

The woman was in her sixties, not unattractive, and dressed in casual clothing.  There were no marks on her; she had taken pills.  I felt uneasy as I waited with her, and this was unusual.  The viewing room felt exceptionally cold.

When her adult children arrived, they were angry.  They did not seem at all sad.  "Well, you did it," said one of them.  And the rest of them echoed that sentiment.  They berated their mother for what she had done.  They were very, very angry.  But they showed no signs of wanting to leave.  It was confusing.  My task was simply to Be With Them; if I could do more, that was good.  But I was at a loss as to how I could work with this family.  Their anger was so bitter and pervasive.

Then came a knock on the door.  It was a cousin, who was a pastor in the Swedenborgian tradition, a Christian faith very, very different from my own Lutheran one.

"Well, she did it," they told him.  They remained stiff and angry as he looked first at the mother and then at them. 

The cousin waited a bit.  Then he said, "You know, we are only accountable for those things that we do when we are not being forced and when we are not in pain."  Another pause.  "And she spoke with me many times about the pain that she was in."

And then they began to grieve, and the room felt warmer.     

Cranberry Girls

It was a terrible shift, really. One of the worst I've ever had.

There were two Codes on the same patient; he didn't respond to the second one.

There were five traumas, one of which was a man about whom the paramedic said, "Be very careful with his shoes. They cost a thousand dollars." For those of us in the trauma bay not yet directly working with the patient, our attention was instantly diverted to the floor.

Ugh.

There were a couple cardiac arrests. Neither patient responded. There was a death of a very sick man whose surviving sister's main response was that she did not have the money to pay for his funeral. A visit to a patient whose husband and daughter hated each other and didn't try to hide it.

And the worst was at the very end of the shift. Another cardiac arrest, this one for a man in his twenties. And someone had mistakenly brought the patient's siblings back to his cubicle without the doctor's having met with them first, to let them know he had died.

It was a blur of horror, the ultimate awful, awful shift.

Except.

As a hospital chaplain, one doesn't receive very many happy calls. But on this dreadful day there was one. And it was truly wonderful.

It was a nurse from one of the intensive care units. It seemed that her patient's daughter's wedding had been scheduled for that day. And the patient was still in an ICU and unable to go to the church, much less the reception. And so the dear bride unselfishly knew what to do. The nurse wanted me to tell her that it was okay to have a wedding in the waiting area outside the ICU; they would bring the patient from her room for the ceremony. I said that of course it was all right, but was she sure that was the right place? I suggested an alternate venue: the hospital chapel, a beautiful setting on the ground floor. Would the patient be able to be brought there for a 20-minute ceremony? Yes, she would. I told the nurse to let the nursing supervisor know what was going on and made a note to wander downstairs around two o'clock.

Shortly after one o'clock, there was a bit of a commotion in the lobby. Men in tuxedos, little girls in fairy princess flower girl dresses, a half dozen bridesmaids wearing cranberry dresses, and the bride, resplendent in her sparkling gem-studded dress, all shaking off snowflakes and providing their own flurry of activity had arrived and were heading up to visit the mother of the bride. They paused here and there for photos. And I was called away for another situation.

With a few minutes to spare, the latest awfulness was resolved, and I made my way to the chapel. The nursing supervisor was there, helping the bride and groom make the room their own. Photos were made of the couple at the altar with the snow falling in the window behind. "How can I help?" was my immediate question. The supervisor sent me up to the ICU to escort the wedding party to the ground floor. It took two elevators to hold all of us. Everyone was settled in place and soon the guest of honor arrived in her wheelchair with an oxygen pack and a nurse or two. And then it was time. Somehow the little organ began playing "Here Comes the Bride," and the four little flower girls and the ring bearer escorted the bride and her older brother into the chapel. I closed the door and became the self-appointed guard so that no one would disturb this magical moment.

So, the worst shift ever ultimately came to an end, as they all do. It will be a shift that will stay with me for a while. I'll forget the deaths, the impoverished sister, the traumas (but maybe not the shoes), the cardiac arrests and the codes. What I'll remember is the bride -- beautiful inside as well as out -- and those lovely young girls, tall and proud in their cranberry gowns, doing the right thing.

The Good Neighbor

It happened again on Saturday night. A too-young man experienced cardiac arrest, leaving behind a too-young widow and children: 10, 8, and 5. There's a slide show of images that plays through my mind: the tremendous efforts of the emergency room team, the stoicism of the patient's German mother, the sincerity of the in-charge physician, and the despair of the wife. The slide show tends to stick, however, when it comes to the response of Sandy, the next-door neighbor.

My experience is that humans are programmed against willingly taking responsibility for their failings. The preschooler who says he did not get into the chocolate cake, despite the icing evidence around his lips. The motorist who says, "It was yellow, officer. It wasn't red." "It wasn't my fault; don't blame me." We just do not want things to be our fault. It's how we're made.

And yet, I've seen it time and time again in our emergency room. A sudden death and the family member will say, "She wasn't feeling right all afternoon. I should have brought her here sooner." "I should never have let him go upstairs." "I should have checked on him earlier." This uncharacteristic claim of responsibility on the part of the bereaved, I think, is some mixed-up attempt of the psyche to buy back time, to get a do-over, to change history. A form of bargaining, a way to postpone accepting the unwelcome reality.

When we walked into the conference room, the two neighbors were anxiously waiting for good news. But it wasn't to be. The nurse told them, gently but clearly, that the patient had died. One of the women had done CPR at the scene. Her immediate response to the unhappy news was, "I should have done more! I should have continued the chest compressions! I should have . . . ." Taking the responsibility for this death upon herself. The wise nurse very, very quickly put a stop to it. "There is nothing you could have done that would have changed the outcome."

Sandy struggled to accept this. Then her thoughts turned to the practical. She telephoned her husband who was with the children, children who matched her own in ages. A plan was devised that he would take all of the kids inside and put on a movie. And after the movie, the kids would all have a sleep-over. Just like they often did. They'd have one more night of their normal lives, and their mother would somehow find a way to tell them in the morning. Sandy was organized, caring, decisive. She had tried to save the man's life and now she was protecting his children. Could anyone have a better neighbor?

I left the two women in the conference room to return to the wife and mother, to tell them of the plan for the children. The wife was doing the typical cycling from excruciating sorrow to attention to detail. She'd phoned her own mother. Her mother-in-law had called the patient's brother who was on his way to the hospital, coming from about an hour away. The pastor would be arriving in a few minutes. It would be okay for the neighbors to go home; she had enough support.

When I returned to the conference room, the other neighbor was holding Sandy in her arms. The families were so close, the loss so devastating. The organized, efficient Sandy had vanished. "I should have started the CPR sooner! I didn't do the chest compressions right! I could have done more!"

"No," I told her in a voice stronger than I knew I had at that moment. "You did nothing wrong. You did everything right. The outcome wouldn't have changed. Sandy, you gave him a chance."

I wonder if she'll ever believe me.

Yesterday

Yesterday morning my friend of forty-plus years broke her blog silence with a lovely post about how she met her husband. It would have been their sixty-fifth wedding anniversary. She wrote about their courtship, his hopes for the future, and recaptured the feelings of a college girl, meeting a man and knowing her life was about to change. Near the end of her post, she wrote, "I don't intend to make this a story of our marriage, which was cut short by his death in a car accident when he was only thirty-eight. He was teaching at [the university] by that time and working on his doctoral dissertation We had three girls and a boy on the way when that happened. It was a terrible loss, of course. I had never thought that one could survive such a thing, but we did. He had given me that strength."

On and off throughout the day, I thought about my friend's post. At the time we met, she was a single mom with four pre-pubescent and pre-pre-pubescent kids. I was young, not-long-married, and full of my own hopes. I seldom thought of what her life had been before we met.

Her post stayed with me throughout the day. I thought of this young woman, alone with all of this responsibility. I wondered how she had been able to get out of bed each morning. "He had given me that strength."

In the afternoon, I went to work at the hospital. When my colleague gave me report of his day, after mentioning a need for an advance directive and a couple of minor traumas, he said, "We had a real tragedy here today. A young man, 32-years-old, collapsed at the gym with cardiac arrest. He leaves three young children."

My stomach tightened. Not because it reminded me of my old friend, but because somehow, instinctively, I knew who the man, the children, the wife were. My colleague didn't say any names, but I knew. I kept it to myself, I remained professional, and only after John had left and I was alone in the on-call room did I have the courage to unfold the hand-off sheet. The name there was the one I expected.

There's a young woman at our church who is involved and active among the younger set. She's stylish and attractive; no, she is just downright cute. She's so adorable that she was able to show up at worship without trying to cover the ingrowing hair that follows chemotherapy. For this woman has spent the past months recovering from breast cancer. At her age. Her children (5, 3, and 1 respectively) are beautiful and fashionably dressed. Her husband was equally handsome in his own way, and obviously adored her. A family for a magazine cover.

Two questions bombarded my brain. How had I known it was him? There must be thousands of 32-year-old men with three children. And how will she be able to get out of bed in the morning? I pray that He has given her that strength.

I went about my work. Fortunately, it was a stress-free shift. I spent an hour with a woman concerned about her sick mother's future. I discussed an advance directive with another woman. I delivered a Bible to a very nice man and prayed for his healing. A moment of panic when a pediatric trauma was called turned to gratitude that the trampolinist wasn't seriously hurt. And then it was time to go home to my husband, who I held a bit more tightly than usual.

Mr. P.

I knew who he was the minute he said his name, even though the catch in his voice made him a wee bit hard to understand. I was sitting in the office writing my notes from the last trauma when the telephone rang. And, as I mentioned, when he said who he was and that he had to talk to somebody, his image flashed up before me.

Anyone who ever went to a viewing at the Protestant funeral home in our town knows who he is. A man of average height and average build. He wore a black suit, of course, and was immaculate. You might not even notice him if it weren't for his face. It was distinctive. His features were chiseled, his nose large and angular and, of course, there was no smile. There was something a bit intimidating about him; you just knew he wouldn't be one to engage in small talk or -- God forbid -- banter. I kind of imagined that he had a wife who was a little bit afraid of him and three or four children who toed the line impeccably. Not that I thought him to be mean, no, not that. He just looked like someone who knew exactly how things should be done and, by cracky, they were going to be done that way.

But the voice that I'd never heard before, belied the image. He sounded fragile. Frightened. Vulnerable.

He was seated on the side of the bed and when I asked if I could sit down, he apologized for not being able to pull the chair over for me. As his eyes brimmed over with his tears, I took his hand and gently asked, "What's going on?"

His opening words undid everything I'd ever presumed about him. "I have a little doggy," he began. "And I love her."

We spent about forty-five minutes together, an unusually long time for a visit. He told me his life's story. He'd grown up upstate and learned his trade there. Upon completing mortuary school, he learned of a job down here and met with the owner of the funeral home. On first meeting they both knew it would work. He worked at that funeral home for sixty years. There was no cowering wife, no nervous children. Not much at all in the way of family -- a difficult hypochondriac of a sister and her son, Joel.

He was a sweet, gentle, and lovely man. Appearances, as they say, can be deceiving.

He'd come to the hospital unexpectedly, as so many do. And he hadn't planned on staying. But there he was, and his dog, Ember, was very much on his mind. On the day of admission, the nephew had gone over to his home, let the dog out, and fed her. He'd gone back again the next morning to tend her again. Then in the afternoon, the nephew and the sister had come to the hospital to see him. The visit hadn't gone well. The sister apparently had gotten out of a sick bed to come, and Joel hadn't been happy about having to transport her. They had words. The family had left in a bit of a huff.

And now my patient was worried that the nephew wouldn't continue to care for Ember.

My non-medically trained quick assessment suggested to me that this was no short stay. Mr. P. was shaky and frail and he admitted to being unsteady on his feet, although he had been able to open the door to let Ember out back to transact her business. I foresaw another day or so in hospital and then a stay in rehab. Mr. P. is 88.

I held his hand. I passed him tissues. And I listened. In due time, having gotten it all out, he focused on his main issue: his doggy's wellbeing. He seemed at a loss. We talked about what he might do and decided he would give Joel a phone call and say that he wasn't feeling good about how their visit had gone and just wondered if he and Joel were okay. If Joel was unable to continue caring for Ember, Mr. P. would ask him to take her to the kennel and pay him for doing so. We had a plan.

I had hoped to pop in again the next day before leaving, just to see how it all worked out. In my mind was the back-up plan of contacting my own dog boarder, a young mom from my church, who would make Ember feel right at home. But a trauma, and then another got in the way, and this turned into another one of those stories where I'll never know the ending. That's one of the unsettling parts of my work.

Love and Compassion

I just finished reading Paul Kalanithi's masterpiece, When Breath Becomes Air. The writing is exquisite.

A neurosurgical residency graduate who is struck by advanced cancer in his mid-thirties, he writes about his life, his studies, his work, his family and how all of these aspects tie together.

I have to take the book back to the library, but need to keep this one passage:

"As a resident, my highest ideal was not saving lives -- everyone dies eventually -- but guiding a patient or family to an understanding of death or illness. When a patient comes in with a fatal head bleed, that first conversation with a neurosurgeon may forever color how the family remembers the death, from a peaceful letting go ('Maybe it was his time') to an open sore of regret ('Those doctors didn't listen! They didn't even try to save him!') When there's no place for the scalpel, words are the surgeon's only tool.

For amid that unique suffering invoked by severe brain damage, the suffering often felt more by families than by patients, it is not merely the physicians who do not see the full significance. The families who gather around their beloved -- their beloved whose sheared heads contained battered brains -- do not usually recognize the full significance, either. They see the past, the accumulation of memories, the freshly felt love,* all represented by the body before them. I see the possible futures, the breathing machines connected through a surgical opening in the neck, the pasty liquid dripping in through a hole in the belly, the possible long, painful, and only partial recovery -- or sometimes more likely, no return at all of the person they remember. In these moments I acted not, as I most often did, as death's enemy, but as its ambassador. I had to help those families understand that the person they knew -- the full, vital independent human -- now lived only in the past and that I needed their input to understand what sort of future he or she would want: an easy death or to be strung between bags of fluids going in, others coming out, to persist despite being unable to struggle."

*I would add "their hopes for the future."

A little more than five months ago, I was part of what is a hospital chaplain's worst fear: A Pediatric Level One Trauma. A child the same age as my granddaughter had suffered a febrile seizure while taking a bath. By the time her father found her, her face was under the water and her brain had been deprived of oxygen for several minutes.

"Andrea" was put on a ventilator and the parents were told that she needed to be in a pediatric intensive care unit, so she was choppered to the children's hospital to undergo what my supervisor told me was a last hope procedure: her body temperature was deliberately lowered in the hope of reversing some of the damage to the brain.

This patient has stayed with me like few others. There is a Facebook page where 8-year-old Andrea's parents post daily updates and photographs. They report progress. Daily, they say that she is "working hard." God forgive me, I am skeptical. I so admire their hope, their determination. But sometimes we see what we need to see and these parents need to believe that the girl who went upstairs for a bath will be back with them. I see a vacant look in her eyes, but I so want to be wrong, for them to be right. One of my colleagues said, "It would have been better to have let her go." The words sound heartless; I waiver between condemning her and agreeing.

The community in which the family lives has been astonishing in their support. Fund-raisers of every possible kind have been and will be held. Dozens of meals have been prepared and shared, the neighborhood men have come together to build the first-floor home addition that is now needed. I've never been prouder to be part of this town.

Years ago I spent a weekend at a Quaker retreat center attending a program on medical ethics. One doctor spoke at length about a phenomenon that strikes the children of the Amish community not terribly far away. These children progress normally for a few years and then, without warning, begin to regress until they are once again infants, but in growing bodies. They are kept with their families, brought to all gatherings, groomed, dressed, and cared for. The doctor said, "These children are not the objects of our love and compassion. They are the source."

The Smell of Evil

Sunday's Gospel was the story of when Jesus went to visit his friend Mary and she massaged his feet with expensive, fragrant ointment. The pastor did a fine job with his sermon, getting us all to think about distinctive, beautiful aromas. He talked of what Mary had done as "the smell of love and kindness." It was a good sermon, and I smiled to myself as I remembered my experience of Friday night.

I could smell something the minute I set foot in the trauma bay. It was a terrible smell -- kind of a strange combination of the dirtiest feet in the world and, erm, poop. I expected the patient to be filthy dirty. Sometimes we'll get a homeless patient who hasn't had a bath or a change of clothes in a long time, and he'll smell pretty ripe. And that is pretty much what I expected.

But when I got up close to him, he wasn't dirty at all. He was neatly shaven and his face was clean. The clothes piled at the foot of the gurney were relatively clean. But the smell was overpowering. It was my  job to ask who I should contact to come to the hospital. He was soft-spoken and he was a bit drifty. He nearly fell asleep while giving me his girlfriend's telephone number. He seemed pleasant enough and I found myself wondering why this young man had been assaulted.

After I contacted his friend, I went out front to update the triage desk with the patient's name. The triage nurse said, "Oh, the assault patient. How's he doing?" I said that he had gone off to CAT Scan but was moving all of his body parts appropriately. Then I added, "He's kind of stinky." Everyone in the trauma bay had been aware of it. The triage nurse said, "Oh, that's the heroin. Heroin addicts have that very distinctive smell about them."

I had no idea.

The smell of love and kindness. And the smell of evil and heroin.

A Visit with Bessie

When I got to her room, there were three visitors surrounding Bessie's bed. There were cards taped to the wall, a couple of flowering plants, and a balloon or two. One of the visitors was by her side, spooning bits of vanilla ice cream into her mouth. The little blue referral card indicated that Bessie was the mom of the hospital's compliance officer.  "Oh, I didn't know you had company," I said, and promised to return later. The visitors wouldn't hear of it. "She can really use a chaplain visit today. She's been kind of down. We'll go get a cup of coffee." I protested, but they prevailed. I settled into the visitor chair.

I don't know all of this lady's details, but we had the best visit. We started with what had brought her to the hospital and, clearly, she had been through a lot. She had had to give up many things that she enjoyed due to her failing body (if I remember correctly, she was 86), but her mind was totally intact. My patient spoke of having been responsible for the Thursday night dinners at the place where she used to live, and her eyes filled with tears as she described the pleasure of planning the menu, preparing much of the food, and shopping at the dollar store for seasonable paper plates, napkins, and table decorations. This had been a big loss amidst her many losses.

Bessie shared that she and her husband had recently moved to a retirement center and they had had a major cleaning out of 39 years' worth of accumulated "stuff" before moving. And when she got settled in her new digs, it turned out that outside the apartment's front door, in the hallway, there is a little shelf and the residents like to decorate their little shelves -- some seasonally and some just whatever. And this poor lady had nothing to decorate her shelf!

She had a bazillion stitches in her scalp and discolorations bruises in many locations, and her motor coordination (or lack thereof) was such that she had eaten her apple pie with her hands because she couldn't manage the fork. What was foremost in her mind was her undecorated shelf at home. Just what would the neighbors think.

I really, really liked Bessie, and we set a goal of her getting well enough to be discharged so she could go to the dollar store and replenish her knickknacks. And when I took her hand for prayer, she apologized that it was sticky, but she just had to have that apple pie!

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.

Christmas Night

I worked the 3p-11p shift on Christmas night. The person I picked up from had been on for sixteen hours and he said it had been quiet. He wished me the same.

I spent a great deal of time with three families. For two of them, Christmas will never be the same.

Patricia had fallen at home. Her health hadn't been good for a while, and after a busy Christmas day, late in the afternoon she went upstairs to take a nap before dinner. She didn't make it to the bed and when the family heard the crash, it was probably already too late. 911 came and worked on her, brought her in the ambulance and the ER staff continued to try to bring her back. I sat with the daughter who had followed the ambulance to the hospital. Before long, the resident came in, bringing sad news. When Patricia's husband and other daughter arrived, they were, of course, shocked to learn of her passing. Her husband told me that they had been married for more than sixty years. "How can I go back into that house?" he kept asking. How, indeed?

Edward's enormous family was gathered in the conference room when I joined them, and more and more continued to come until they were spilling out into the hall. The patient had had a longstanding relationship with alcohol, and his consumption on Christmas night had apparently been considerable. Edward was a great-grandfather and his mother was still alive, though not among the four generations present. When the resident came to tell Anita that Edward was gone, she collapsed on the floor. "I tried so hard, I tried so hard," was her refrain. She seemed to think that if she had tried harder, she could have cured Edward's alcoholism.

Arthur had been driving home from a Christmas dinner, his wife at his side and his two adult children in the back of the car. Another motorist ran a red light, and Arthur's entire family came to the hospital as Trauma patients. Arthur was not injured, and he moved from cubicle to cubicle as his family members were assessed and treated. They will all recover from their physical injuries.

My shift came to an end. I handed the beeper over to my replacement. I wished her a quiet night.

Go Gentle

"Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light."

Thus says the poet about facing death.

It was about four o'clock in the morning when the telephone rang, and a nurse from the emergency room asked if I could come down to the cubicle where a woman was going to pass away very soon. 

She was 89 years old and was lying on her back, her face turned toward the right where the young male nurse who had phoned was standing with his hand on her shoulder. On her left, another nurse was softly stroking her hair. At the foot of the gurney were two or three others, one of whom had grown up in my church and had become a nurse as a second career (but not before getting what appeared to be a bazillion tattoos). The cubicle was quiet; the beeping function of the cardiac monitor had been silenced.

She had been a hospice patient for two years and was reaching the end of her journey. Her nearby family was away at the seashore, and another daughter, the one most concerned about her, lives three or four states away; there was no way any of them could get to the hospital in time. "Don't worry," the young male nurse had told them. "We'll take very good care of her. We'll treat her like family."

"This is my first patient death," the young man told me. "It's a good first death to have," responded a colleague. There were perhaps a half a dozen of us, standing quietly around the patient, listening to her gentle, slowing breathing. 

We joined hands -- with the one nurse still stroking her hair and the other with his hand on her shoulder -- and I offered a prayer. I thanked God for her life and for all that she had meant to her family. I thanked God for the care she had received this night and for the adoptive family surrounding her. I spoke of our assurance that God had created her and would receive her into his arms at the end. I prayed for comfort and for mercy.

When I finished, the patient was still and the tattooed nurse from my church listened for a heartbeat; there was none.The "first death" nurse said, "You know, I haven't sorted out what I believe about life and death and an afterlife. But she took her last breath in the middle of your prayer. That has to mean something." 

They thanked me for coming down; I thanked them for calling me. It had been a privilege to be among them, this adoptive family. The patient went gentle into that good night; there was no need to rage against the dying of the light.

Changed. Forever.

Most of us have those moments, the one where our lives are forever changed. If we don't have them ourselves, we know someone who has.

When it is us, we cope, we slowly adjust, we reimagine and reinvent our lives. When it is our friend, we support, we bring food, we futilely try to "make it better."

One of the dimensions of my job as a hospital chaplain is being exposed to these moments for others, people I never knew before. And with this exposure comes absorption of some of their pain.

My most recent shift was fraught with such experiences.

Early in the evening I was with six men who had gathered to remove life support from their brother/uncle. Four of them had flown to my city from Texas, and all of them bore a strong resemblance to Javier Bardem's character in "No Country For Old Men." All of our mothers told us that "appearances can be deceiving" and "don't judge a book by its cover," but I was unprepared for the incongruity of how gentle, loving, and tender these brothers/nephews were, eagerly holding hands all around while we prayed for God's mercy.

A lovely, too-old-to-still-be-driving octogenarian mistook the accelerator for the brake pedal, causing a five-vehicle accident and most likely her husband's death.

A pedestrian hit by a car as he crossed the street to the train station on his way home suffered a massive skull fracture and intracranial hemorrhage; his wife and son live so far away that he had already been taken to surgery by the time they arrived. "But I had just spoken to him!" she said over and over, trying to take back time. It will be days before the heavily-sedated patient will be allowed to attempt to wake up; and only then will he will be able to be assessed for brain function, for mental capacity. And during that time the family will spend hours driving to spend hours at the bedside, waiting without any idea of the outcome. "This will be a long process," the resident said and I noticed she didn't use the word "recovery."

All of these lives changed in a moment.

And perhaps the saddest story is the one about the man of -- oh, how do we phrase this? -- limited intellect who called 911 for his bedridden mom who had stopped breathing. The two of them lived alone together in an unhealthy environment. What will become of poor "Ben," now that she is gone?

Changed in a moment.

Forever.