The Demise Of Time

Novelist Eric Kraft writes in Leaving Small’s Hotel that if events or periods of time do not have a marked end, even such mundane phenomena as a weekend, or even a day, then time has no rhythm and thus no meaning. I get a taste of what the lack of this rhythm is like from my experience with hospice residences and nursing homes. When I went to work on a recent Sunday, it struck me how that day felt like any weekday. I was expecting a different feel, a different mood to set apart the day. I thought it would at least feel quieter with less staff, somehow slower. Or that there would be say, a Sunday brunch option instead of the usual breakfast, or different kinds of activities than on a weekday, or maybe more informal dress on the part of staff. Nor did anyone seemed surprised that I was there on a typical day off, saying, “What are you doing here on a Sunday?” I actually felt let down. Not only had I given up part of my weekend, I had stepped out of time into a perpetual hell of monotony.

Then I thought about how much worse this must be for my alert patients, and how when I visit them and at times ask what’s new, they  frequently say every day is the same. It came home to me how a lot more than boredom is at stake here when a patient anxiously asked me for a pocket calendar. “I want to know what day it is. Can you bring me a calendar?” When I did, she was remarkably relieved. She took it like it was a gift of great moment and said: “I will mark off each day, and now know where I am and what’s going on.” Before getting the calendar she implied she felt disoriented and lost. She made me realize how strange the artificial environment of a facility is, including the deprivation of a sense of time passing, despite efforts to decorate for holidays and the like. Residents might as well be in a space vehicle between worlds.  (Which reminds me of a concern among some Jewish sages as to how to observe the start of the Sabbath if you were to find yourself on another planet. It cannot make sense to ask what time it is or what day it is except on a purely arbitrary basis such as the actual time it is in a given location such as your hometown.)

We tend to think that endings, however necessary, are undesirable. We may think we want our vacations to go on forever or have a festive occasion go on and on. But if they did, the experience of these periods would be subverted. An endless vacation would be a void rather than a vacation. A festive day that went on indefinitely would cease to be festive. We end up with nothing when we do not place boundaries on events and periods of time such as the seasons.  We remove the meaning that accrues from going forward in time. Perhaps we can restore a sense of a patient’s life unfolding in time by at least referring to how that is happening in our relationship with them. I can mention to a patient how long we have known each other.  I can refer to some of our earlier conversations and how they connect with the current one. I can acknowledge what I have learned from them and that I like to see them and look forward to seeing them again. Relationships with patients are not static; they are evolving. Let us at least refer to that.

Observing this temporal isolation of my patients makes me more conscious of how I should honor, as Eric Kraft urges, the end of such things even as seemingly trivial as one day. I rarely, for example, work on the computer past midnight (though the writing of this post on this particular day is taking me just past!)  I am looking ahead, dear readers, for your responses, in good time.

A Hippie’s Homily

Lucy, a patient not much older than myself, remarked to me last week, “I was at Woodstock, and tried every drug in the book…just like everyone else was doing.” Even on a cold day like that one, she was outside her home, seated by the back door, indulging now only in the drug of nicotine. She had unruly grey hair, except for a garish red clutching at the lower half of it. She had explained that she used to dye her hair red, but now found it was too tedious and tiring to sit long enough to have her hair dyed again, so she is just waiting for the rest of it to grow out. I gather you get the picture for why I then burst out, “So you are a hippie, right?” Lucy replied, “Oh yeah. Old hippies never die.”

She then turned her attention to her smoking habit after I mentioned further along in the conversation that I like to write. “I have a story for you to write about. And you don’t even have to attribute it to me.” I thanked her for that, as it can be a challenge to decide what to write about in Offbeatcompassion.  Oh boy! Fresh material dropping right into my lap! I settled in for the story, glad I had kept my pink button-down sweater on, not having anticipated the visit would be outdoors. She took one last puff on her current cigarette and began, “I’ve known Mr. Nicotine since I was ten. When I was ten, Mr. Nicotine was young, energetic, and cool. Handsome and cool. And a great talker. Everyone wanted to be with him, so we all joined in. But now, Mr. Nicotine is old and horrid and grumbles. He has a long grey beard and there’s food in it. He is very dirty, but now it’s too late for me to get away from him. So watch out you don’t get caught. That’s the story about Mr. Nicotine. He fooled me.”

I listened some more, and as the cold  penetrated past my sweater, I gave out some hints that I was about to put the brakes on the conversation. Her response as I left: “You’re givin’ up, huh?” I wish I had been quick enough on the draw to retort, “Certainly not. Chaplain visits never finish.”

No Pain Much Gain?

Just think: Suppose I had a condition called “congenital insensitivity to pain.”  This means I could slice my way through mosquito-infested swamps and not feel insect bites. This means I could go on a Polar Bear Plunge as easily as taking a dip in a heated pool and look heroic with nobody the wiser, and romp about in extreme heat without feeling like I was wrapped in cellophane. Best of all, I could impress my dentist by being unfazed by any procedure and brag about not needing Novocaine. “That? Oh that’s nothing. You should see me on the operating table.”  Or  I could consider a boxing career…

Actually this condition is no joke. Not experiencing the warning signs of pain makes serious injury quite certain. But even if in the future I was fitted with artificial sensors for hot and cold and pain so that I would react in time not to be injured, would I still feel deprived in some fashion? Would I be alone in my lack of pain, the way the android  Data on Star Trek: The Next Generation  feels like he is missing out on something by not having emotions, painful as well as pleasant? Setting aside an extreme case such as intractable pain, if I had the choice, would I opt to have this condition?

I am not sure because I do not know how it would shape my personality and assumptions. And if it happened at birth, I might have become insensitive not just to my own pain, but that of others. Poof! That would have derailed me from a chaplaincy career faster than saying “Clinical Pastoral Education.” If you could have congenital insensitivity to pain starting now, how do you think it would  influence your outlook?  What do you think it would be like?

Magical, Oh So Clinical

On the job, I feel like the person described in Supertramp’s 1979 hit called “Logical Song.”  The song describes a happy existence that is later in life replaced with an impersonal emotionless one. The difference on my job is that both halves of the excerpt quoted below are true simultaneously, every day. Part of me is the chaplain who with no agenda engages in dialogue with patients, reacting on the fly to whatever they wish to share. I am there sometimes facing the most intense emotions and sometimes I am there to savor life with them or just sit with whatever mundane moment is in progress. But then a separate part of me goes to my office to document the visits. Documenting involves a very strict set of rules and I have to write out a description of the visit in a detached tone. There are countless lists of things to put check marks by, and there are some words I must use no matter what the visit was like, for example, “A trusting relationship is being established.”

The first lines of the “Logical Song” symbolically correspond to the actual visits:

“When I was young, it seemed that life was so wonderful,
A miracle, oh it was beautiful, magical.
And all the birds in the trees, well they’d be singing so happily,
Joyfully, playfully watching me.”

Even in hospice, sometimes patients look back to “wonderful” and “beautiful” memories, and ponder the miracle of existence. They communicate this to me and I feel the poignancy of it and am in awe that they are letting me in on this ultra-personal dimension of their being.

The next lines correspond to the completely structured paperwork I must do:

“But then they sent me away to teach me how to be sensible,
Logical, responsible, practical.
And they showed me a world where I could be so dependable,
Clinical, intellectual, cynical.”

The song actually says “clinical!”  Yep, that is a part of who I am. When I forget to put in a certain detail or do not do it on time, my supervisor may say, “You are out of compliance.” Ouch! (She does like and appreciate me, though, it’s not that she doesn’t.)

On one level, this may seem to be too painful a conflict. I have seen budding chaplains who found they could not reconcile these disparate identities, and ended up leaving their jobs, or doing one part well and the other not well at all. On another level, I try to see the paperwork as two things: superficially, it can be a nice neutral break from the intense emotions and deep thoughts I must respond to: Good! I can do something mindless for a little while. Beyond that, I think of it as the tax I must pay for the privilege of being present with people who are giving of their most intimate selves, who are revealing to me their innermost beliefs as they risk getting nothing back in return.

Book Review of GRATITUDE by Dr. Oliver Sacks


Reading  Dr. Sacks’ farewell book with its mournful black cover was like going through a typical day on the job as a hospice chaplain. Just like my patients, this famous author, well-known for his medical narratives such as The Man Who Mistook His Wife For A Hat: And Other Clinical Tales lists his regrets, his triumphs, his hopes, and his efforts to make sense of the life that he had led. In a word, this book is about how he dealt with his approaching end. Many of us can relate to his regrets, which included wasting time, being shy, and not traveling more. He also hoped to love and work as long as possible; again, much as the average person might yearn for in this circumstance. He also mentioned his regret at not having learned a second language.

Finding out what he had to say about his own medical narrative may interest those who almost never hear about or think about what it means to review one’s life as death nears, but for me I initially found that very predictable. Nevertheless, because he expresses it so eloquently,  even as a jaded clinician, I became more and more captivated by his life review. More than that, reading this little book became a ritual means for me to say goodbye to this spectacular and compassionate doctor. For example he explains, “[As I get older] I begin to feel not a shrinking but an enlargement of mental life and perspective…One has seen triumphs and tragedies, booms and busts…One is more conscience of transience, and perhaps, of beauty….One can take a long view and have a vivid, lived sense of history not possible at an earlier age.”

The book was engrossing in so many other respects as well. Like his other works, he offers a distinctive view that makes it a privilege to saunter among his words. Who else would link the number assigned to each element in the periodic table with one’s age? He opens his essay entitled “Gratitude” by saying, “Mercury is element number 80….on Tuesday I will be 80 myself.”  He goes on to say that  when he was eleven years old that instead of referring to his age, he explained, “I could say ‘I am sodium.’”  (Sodium is the eleventh element). Such an association alone should be enough to entice the scientifically minded and the intellectually curious to get this book.

It is poignant to read that his defense mechanism for dealing with loss was to “turn to the nonhuman.” It saddened me to learn that when he was sent away to a boarding school, “numbers became my friends.”And that “the elements and the periodic table became my companions.”

The last chapter is entitled “Sabbath.” Here he mentions his Orthodox upbringing, and his growing indifference to the practice of Judaism and finally his rupture with it when his mother utterly rejected him when she found out he was gay. Much later in life, he was introduced to positive experiences of the Sabbath and found he could enjoy its peace not only on the seventh day of each week, but on the “seventh” day of his life as well.
The act itself of perusing the book is a sort of Sabbath. It causes the reader to reflect, to pause, and to savor existence. “I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.”

This article was first printed in pallimed.org on March 20, 2017 and is reprinted here with their kind permission. the link is:
http://www.pallimed.org/2017/03/book-review-gratitude-by-dr-oliver-sacks.html

Arc

We tend to think literature has an artificial structure that separates it from how real-life interactions go. But what happens during my visits as a hospice chaplain can have just as much of a “narrative thread” as any short story, with an arc that goes from building a connection with each other (the background), to pent-up emotion let free (the climax), to a peaceful aftermath (the resolution).

Why just yesterday I saw the patient Isabel (all names are aliases), relatively young in her mid-sixties, and her mother Gloria, fervently devout Christians originally from Cuba. Gloria and I began with greeting each other and some small talk, all tinged with a resigned air as we entered the bedroom and she gestured to her daughter lying in bed. Isabel dreamily opened her eyes, wanting the respite of prayer and song. Isabel encouraged me to keep going: “my eyes are closed, but I still am listening.” I had started with some traditional prayers, and some simple hymns. I felt the calmness in the bedroom, decorated with so many religious pictures they practically could count as wallpaper. The daughter was riding on the warm current of the comforting religious words and music. The mother was letting herself feel their message of peace. I paused, and Gloria let a memory rise out of her: “Even when Isabel was a child, she wanted to go to church. Every day she went to church. Both of us went. Every single day. When we were in [she names a place in the U.S.].” As she remarked on that, I pondered how her faith contrasted with  the Cuban government’s discouragement of religious expression. This much was, so to speak, Chapter One.

After a moment of quiet, I said I would offer some  “more modern” prayers, a shift to Chapter Two as it were. I recited a “prayer for caregivers” and “a prayer for the sick.”  It was then that Gloria’s emotions bloomed and she let her tears be released, the most intense moment of the visit. I said God was receiving her sacred tears. Perhaps for her these were tears of acceptance of Isabel’s fate, because during  my previous visit, anger was the emotion that took center stage. As I said goodbye to them, the mother asked me to bring copies of those modern prayers next time. Isabel acknowledged my departure with an opened eye, closing the third and last chapter of this human interest story.

Curiosity Seekers: Spiritual Science Fiction

curiosityfront

If you were offbeat enough to  find my first book “oddly entertaining,” then you might enjoy Curiosity Seekers  all the more.  It is a gentle science fiction work about a retro couple in the near future who gets into and out of various predicaments. Now that’s a lot more fun than hospice, isn’t it? One of the main characters is Gomer Ackerman, who repairs and beautifies material books which are becoming more and more scarce. The other main character is his wife Muriel, who designs one-of-a-kind greeting cards each intended for only one recipient. Their financial planner Virginia Boyden is more conventional, but things go awry after she gets dementia and becomes one of the first people cured of the disease. The catch is, as she gets better and better, an unexpected side effect comes up. In another story  Gomer becomes a widower and deals with his wife’s death by buying a robot that looks and acts like her, even in intimate matters. Ahem! He then suffers immense remorse and comes up with one ridiculous plan after another to atone.  You will also meet the Ackermans’ great niece Beatriz, who finds creatures on a different solar system that have to be very sparing with their words in order to survive.

Here is an excerpt for the readers of this blog, when Virginia describes part of her recovery: “When I had dementia, it’s like all the words in the English language had flown away from me into space, all the way to another solar system in another part of the Milky Way you could say. Then I called to them  to all please come back home, and they did, at first a few at a time, and then bunches of them at a time, each batch making a perfect landing in its own proper dear little spot in my brain, like birds finding the nests of their young days.”

You may wonder why a chaplain has written science fiction. One of my reviewers explains:

“Kaplan’s sci-fi will appeal to readers who like their spaceships and androids served with a side of spiritual contemplation.” — Mystery writer Mindy Quigley, author of The Burnt Island Burial Ground

You can see more about these interrelated stories on amazon:  http://amzn.to/2mjXpR0