Lessons My Older Self Taught Me

Today I took my time machine back about fifteen years and 60 days ago so I could make my younger me a better chaplain right away. Why let her waste her time, and not benefit her clients at the same high (ahem!) level that I am employing right now? And I tacked on the extra days so we could luxuriate in some better weather; if one has a time machine, one should use it to best advantage. A transcript of our conversation follows:

Karen the Elder: “Karen, I’m here to do us a favor: I’m going to make your life easier, which means making my life easier. I figured by the benefit of my experience accumulated all these years, I’d clue you in.”

Karen the Younger: “That’s mighty nice of you. I’m all for diminishing the amount and degree of tough times ahead, as I’ve already had my share before now. And it’s good to see I will still look relatively pretty in my sixties. I’m burning with curiosity to hear what you’ve learned. You know me, curiosity is what drives me on in this job. And are you still highly curious?”

Karen the Elder: “Are you kidding? I even wrote a gentle science fiction book called Curiosity Seekers. I was gonna say, ‘check it out’ but it won’t be written until 2017.”

Karen the Younger: “What a tease! Now I’ll have to wait all those years.”

Karen the Elder: “And not only that. You will be getting a book published four years before that about hospice called Encountering the–”

Karen the Younger: “No way!”

Karen The Elder: “Well, that’s another story so to speak. I can’t stay long, because being in another time is a strain on the body. So I must go to my suggestions for how to be a better chaplain with the bonus of less stress at the same time:

First off don’t worry so much about drawing information out of a patient, as if you had a fishing line and had to reel in a heavy fish with all your might. You know about spirituality. You know about the mystics talking about receiving. And of course you know about mostly listening and being silent. So put those all together: You quietly sit with the patient, let the conversation meander in a natural way after you make a couple of open-ended remarks, and see what the patient releases for you to receive. As one of my mentors long ago said, “Each patient you see is the face of pastoral care.” So everything you are receiving is a gift arising of their comfort with you and their needs to share it and how special that is that you are there to receive it.

And so I think of receiving what the patient says as a spiritual act. In some cases the patient will sense it too and not only feel that you are honoring what they choose to say, but feel a summoning of God’s presence. I know there are requirements for the medical record, but I think whatever information arises out of the client’s need to impart it will ultimately result in what is truly spiritual care. It will be more to the point for what a chaplain should say in the clinical note as opposed to a social worker.

Karen, of course you already know about chaplains listening and being silent as much as possible. But the trick is not to feel anxious about it when both the client and you are silent, as if there was some contest as to who will break the silence first. Rather, be lost in thought as the patient may be, sojourn with their quiet and just listen for something that might burst through the surface for either of you. If not, close the visit by saying it was nice to spend a few quiet moments together.

Another thing: I used to think when a patient or family member expresses strong emotions I should be calm and soothing. That only goes so far. It’s better to broaden the tent of whatever emotion they are expressing to extend over you. If they are angry, join in being angry at whatever they are angry at; if joyful, then join in the celebration. Guilt though is another matter. You do not of course want to heighten this form of what I call ‘anger at the self.’ Acknowledge it as something they feel, but suggest in the future this may ease as they get a different perspective with the passage of time.”

Karen the Younger: “And what about—”

Karen the Elder: “I wish I could spend more time, but I am getting fatigued and must return to my present. But let me just add one more thing; Don’t be so intent on what you want to give a client. Find out what they want to give to you. They might want to reveal their pain, their sorrow, their regrets, their love, their beliefs, their hopes. Don’t forget what I said: maybe it will make the book Encountering The Edge a better book. Bye now! Oh, and you’ll be starting a blog called OffbeatCompassion… Bye!”

Karen the Younger: (teardrops fall)

The Temperature Of Water

My curiosity can get me into trouble, so I was very careful not to ask about a pattern I have noticed regarding some of my African American patients. I was afraid that if I asked one of their family members about it, they might think I was being prejudiced. Same thing about asking about it online. I might give the wrong impression to readers. But finally I found the right context and right person to ask. And now that I have gotten your curiosity up, I will reveal the pattern: it struck me how important it is for many of my African American patients to get water that is iced or at least very very cold and fresh. They also emphasize that the remaining water in their cup will absolutely not do. White patients in general have not made much of a point about this.

A patient’s wife who I will call Catherine explained it to me thus: “When our ancestors were slaves, working in the fields, they had to drink lukewarm water that they had taken with them. It was hot out in the fields, so their water was not refreshing and tasted stale.” Catherine thought some more about this and talked about later times: “And this memory passed down through the generations. In the old days, Whites had iceboxes and refrigerators, but Blacks did not, and besides the money being too much for us to have those things, Whites thought luxuries did not matter to us. So we went on having lukewarm unappetizing water for some time more. I think that’s why you hear this from your patients about drinking nice cool water.”

If you are an African American, I would like to know what you think of Catherine’s theory. And besides taking requests for fresh ice cold water very seriously, I would like to know if there are other matters I should be sensitive to when I serve as a chaplain to African Americans. Of course generalizations for any race or ethnic group are hard to come by, but if there is some particular example in your own experience we can all continue learning together.

 

You can also discuss this with me through Twitter:  https://twitter.com/chaplainkkaplan

Less Is More, Chaplain Style

Got your timer out? One of my hospice visits last week clocked under five minutes. Jonathan, from a culture vastly divergent from mine, let me know when the visit was over. It wasn’t that he had had more than enough of me; it was because our task was done. He wanted prayer, and as usual, I first ask patients what they want to pray about before I begin. He said “about my family.” He went from a seated position in his bed to a lying down one as he prepared to listen. I thought about the fact that he was only in his fifties, with his children keeping to themselves in a back room during the visit, and his wife out on some chore or at work. I took out a very handy booklet with modern freshly created prayers, Jewish-based but as about universal as you can get. I turned to the prayer called “For Family and Friends.”(From Gates of Healing, CCAR Press). Part of it says, “Let them feel free to bring me their own joys and sorrows that I may continue to participate in their lives even as they share mine.” I recited it to him slowly, so he could savor the words and also so he could leisurely convert the foreign language of English to Amharic. He then sat up and softly said, “that prayer went straight to my heart.”

Getting ready to lie down again, he remained quiet and confirmed when I asked, “Is that enough for today?” I consumed more time putting on all my winter wraps and making sure I had everything in my bag than making the visit itself. I called to his daughter to let her know I was leaving, and she sweetly thanked me and opened the door as I stepped back out into the clunking and clanking of the ongoing construction outdoors.

 


For writing shorter than that visit, see me at https://twitter.com/chaplainkkaplan

Careful! Metaphor Ahead

Sure, the metaphor hounds are well-meaning when they try to soften the blow of a calamitous diagnosis. The two top contending  metaphors for facing disease are (1) doing battle with it, and (2) going on a journey. Yes, I get it, war imagery can be energizing and drive the patient and family to do diligent research and pursue any treatments that bear a reasonable promise. And yes, a journey might comfort some who think of joining others who are on the same trajectory, especially if the endpoint involves arriving home to a congenial God. But for some people, these particular images are as off putting as the bromides they have to endure from family, friends and medical professionals.

Think about the military imagery for a moment. Our bodies do have natural defenses, with our antibodies doing their best as the good little soldiers they are. Medicine acts as reinforcements to join the fight. But we ourselves do not have to employ our mental faculties in a certain fashion to add money to the war chest. The effort itself to do so can be draining, as we feign cheerfulness and optimism. And what if the war effort results in a long drawn out inconclusive struggle with the disease, like so many wars in our world like the conflict with Afghanistan? Or even worse, what if “our side” starts to lose or even face final defeat? Then the patient will feel they lost the battle, and God forbid think they did not try hard enough or that they failed their loved ones. You get the idea how this might be a risky metaphor. And even apart from that, wars are a negative phenomenon to dwell upon anyways.

Given the inherent negativity of war and the image of division within our bodies, it is tempting to think of a journey as oh such a sweet and nonviolent alternative. But journey to what? Even if the journey is to God, or if not so dramatic, a journey to physical or mental limitations, what if you do not want to undertake such a journey just yet?  (Excuse me, Sir, I’d like to get off at the next station and I want my money back.) In the image of a mandatory journey, there is no sense of control, and this can be scary.  I think too, it obscures the idea of our whole lives as being a journey, which we do play a part in shaping. We  have some control, making choices that shape the subsequent stages of the journey, creating as many pleasant or at least educational stopovers as possible. In contrast, the disease journey image may make the patient feel the disease is boss and that they have no say in what will happen.

For those readers who do relate to these images, that is terrific. My concern is when people foist these metaphors upon those who might feel distressed by them, or when the  timing is wrong. So what to do? Whether you are the one who is sick or you know someone who is, the picture is complex. Let us take the latter. I think when a health professional is searching for metaphors it should be more towards the end of the process of offering help rather than at the beginning. One has to know a lot about the person in question to ascertain what might fit, and that takes time. One has to know the sick one’s attitudes toward disease, how they’ve coped in the past, what in life has given them meaning, and what they most care about. If the patient takes a scientific approach and is agnostic at best, the journey metaphor might strike them as pure hocus-pocus. A pacifist might not appreciate the war metaphor, and so on.

Just like a bromide, the proffered metaphor can be the lazy and anxious way to attempt a quick salve (or salvation). Real help takes an investment in time (oh, that!) and attentive eliciting of concerns and attitudes and beliefs. Real help is making way for the sick person to create or co-create with you their own metaphors if any. If you are currently chronically sick, do you have your own image for making sense of it? Do you have your favorite “pet peeve” images?

Since I want to leave the reader with at least one example of another sort of metaphor aside from battles and journeys, I will offer my own. I am not now chronically sick much less facing the end, but I can imagine what might work for me: I find nature, when it is peaceful, a great source of solace, and I subscribe to the notion of God as a Presence. So I think for me, as a part of nature myself, that my metaphor of  choice will stem from that. Perhaps I will feel more and more blended into it and more at one with it and with the Presence that dwells there and dwells within me as well.

Custom-Made Angels

An African-American patient’s daughter gestured to the angel topping a diminutive Christmas tree in the hospital room and said, “I hope you aren’t offended, but could we have a black angel?” While I as her chaplain hastened to assure her I was not offended, I first drew a blank on what she meant. Her mother was virtually on her way out of this existence, so my first thought, which I fortunately did not say out loud, is that she wanted black to represent grief or death. Then I understood: first I thought about my own stereotype about the color black, and then I realized the actual decoration was as white as you can get. She wanted an angel that was the same race as she.

I was so taken with this, because I have never thought about angels having race or gender. I never thought about their whiteness representing Caucasians. In the Jewish tradition, the idea of an angel is perhaps even more abstract than not having race or gender because we don’t think of them as a class of celestial beings. Rather, we think of them as humans who wittingly or unwittingly have a mission to deliver spiritual messages to others.  Such messengers impart an insight or prediction or warning of spiritual import to the person intended to receive that message. Many of you may be familiar with the story in Genesis where three mysterious strangers tell Sarah and Abraham that they will have a child despite Sarah being waaaay past menopause. And perhaps you have met someone who had a transformative effect upon you that has changed your view of things ever since or who has influenced you to make a life-altering decision.

A scholarly friend of mine named David Schwartz pointed out, however, that if angels can superficially assume race and other attributes similar to the person the message is intended for, the one getting the message might be more receptive to receiving it and letting it “penetrate the heart and spirit”.  I could see where an angel of color would comfort an African-American family and give them a celestial being or messenger they could identify with. (Just a curious note, another friend of mine informed me that until very recently, “angels were always portrayed as male, because the Bible consistently uses masculine names, male pronouns and male attributes.” Okay, one Black female angel for that daughter coming up!)

When the Black angel arrived at the tree I wondered what message it conveyed to that family.  Perhaps it was, “God is not a stranger, but the One who speaks your language, discerns your needs and accompanies you at every step of the way. Especially when your loved one is embarking on a path no longer intertwined with your own.”

The Camel Who Avoided A Broken Back

“Previous straws are more crucial than the last one. Take one away and the last loses its power.” (From an old Tweeted proverb of mine based on the much more ancient original proverb about that unfortunate mammal.) I recently realized from my own experience that sources of stress can be like those straws. They pile up in layers one at a time, each obscuring the previous ones yet taking a deeper and deeper cumulative toll. We sort of “get used to” each straw and try to ignore it or shrug it off best we can, especially while dealing with the latest incoming one. We lose track of our tally of how many straws have accumulated and to what extent each exacts its price, and this suppression of our awareness is what threatens our well being.

Let us ask ourselves, How many straws are we bearing now? Perhaps the first one is a family estrangement from 20 years ala Jacob and Esau. The second one might be credit card debt that never is completely cleared from month to month. Others vying for recent provenance might be watching Death stalk a family member, ready to snatch him from behind, or having to discontinue a work or personal relationship that has more and more dysfunction and less and less benefit. And then to top it off, bronchitis might come around to make a call on one of us.

As the straws gather up like the increasing numbers of leaves now stealthily taking over the ground, we habituate to the point that we forget about the first covering of leaves, never mind the ground itself.

No one can advise us which straw to tackle first, but it does not have to be in order of their arrival. Simply becoming more self-aware of the whole conglomeration of ‘em will help us in analyzing which one we should topple off first, making us like the lucky camel.

Film Review: The Curious Case of Benjamin Button

Although this provocative and fascinating film is “old news” having come out in 2008, I heartily recommend it for its timeless themes. This fantasy captivates me because it challenges assumptions about youth and old age so much that I was tempted to title this post, “The Elixir of Old Age”. The movie is about an individual born in his eighties, found abandoned on the porch of a nursing home who then gets younger instead of older as time passes. At first this sounds marvelous: why not get over all the bad stuff like arthritis and forgetfulness and baggy eyes in the beginning and have things get better and better, not only physically, but spiritually? There we would be, with the wisdom of our mature brains reflecting how we could make better use of those years of being in top shape and be attuned to appreciating them more once we reach them. Sure enough, as Benjamin becomes younger, he luxuriates in being able to do more things. He abandons the wheelchair. He then abandons one crutch, then the other. He enjoys getting a job on a ship because it is fun to be doing things “and even getting paid for it.” But life gets very complicated as he forms various bonds, including romantic ones…..But in case you have not seen the film, I won’t say much more about that part of the story save that what happens is not hackneyed but also most insightful.

But picture how getting younger would actually work out.  If we were to grow younger, and the ones we love grow older, we would have less and less in common with them. We would have less and less to share with them and we would literally be growing further and further apart. Just think of how it would accelerate or mutate the changing roles in our relationships, especially across the generations. Say my 13-year-old niece gets married in thirty years, would I want to be around her age at the time? When they have their 10th anniversary, how would I relate to them as a much younger person? The feelings of loss we all experience arise at least in part from the loss of connection we have with others, and being out of temporal sync would be another spur to such loss.

This film made me think about how glad I am to be growing old along with my husband, other family, and friends. We are increasing and deepening rather than decreasing our connections in so many ways. We have a growing stock of shared experiences, challenges, and insights. We have a shared understanding of what it is like to be older, and therefore can empathize with the limitations that others face. As he “younged,” Benjamin Button found himself even cutting off relationships he was doing well in, because he feared the consequences of eventually having to be taken care of as well as being cared about. The darkest side of becoming younger became painfully clear to him as he wandered about as a teenager for many years with virtually no connection with others at all.  This is as close to a living death that one can get. Although some of our loved ones including ourselves may have to be cared for, I see in a vast majority of cases, the people involved continue relating to each other on whatever level that may be. Unlike Benjamin, I rarely witness the caregiver nor care receiver completely cutting themselves off from each other except of course due to certain diseases or other extreme matters.

Whatever our circumstances, I rejoice in the ever deepening connections I have with people I have known, as well as the increased quantity of connections with new people I meet. Our stories get longer and filled with recurrent themes as we journey in step. Benjamin ends up as a baby…with no memories… at last closing his eyes, uninitiated.