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.