Thursday, August 31, 2006

Judge Not. Unless It's Your Job.

I’ve been promising for a while to write a post about race, class and gender in the Emergency Department. This piece is really more about first impressions in the ED and how they can sometimes be affected by those variables. Some of the things I wanted to say here were taken right out of my mouth by Kim in this post, so by all means go read it!

Disclaimer: I’m a volunteer chaplain with no medical training who spends four hours a week in an ED. What follows is based on my observations over the last two years, but I welcome other interpretations from all the people out there who know much more about emergency medicine than I do or ever will. This piece contains my first impressions about first impressions in the ED. If I’m wrong about something, please correct me!

* * *

We all know that our first impressions are often wrong, but we’ve also all been taught that first impressions count. And that’s rarely more true than in an Emergency Department. The ED is an extremely high-pressure environment, and the people who work there have to make expert medical judgments very quickly. That’s their job. They’ve received years of training to do this, and most of them are supremely good at it. But because they’re human, and also because they have so much to do and so little time for introspection, sometimes other judgments creep in, unexamined, along with the medical ones: judgments about lifestyle, manners, behavior. (Some of these judgments may have bearing on medical issues, but some won’t.)

Meanwhile, the patients are also making judgments, because that’s also their job. Every ED patient is in some sense an imperilled organism, and the most urgent task for any imperilled organism is to evaluate its immediate environment, to answer the question, “Am I safe here?” If a caregiver is for any reason curt or rude or insensitive, or even appears to be curt or rude or insensitive, the organism’s answer to that question will be, “No, I’m not safe here,” and the organism will be frightened and unhappy. ED patients are, to varying degrees, profoundly dependent on their caregivers. If the person controlling your oxygen supply appears to dislike you, you will be a very unhappy organism.

So. A patient comes to the ED. A team of medical caregivers -- doctor, nurse, scribe -- arrives to talk to the patient. These conversations are usually fairly brief, but during this interaction, each side is furiously compiling information, recording behavior, and, yes, making judgments: because that’s each side’s job.

All of this happens quickly. It’s largely nonverbal and also largely unconscious. But once those first impressions have been made, they can be hard to shake, especially since the ED isn’t a place where people are likely to have long, involved conversations or interactions. And that’s why it’s profoundly important for both sides, to whatever extent possible, to be aware of the first impressions they may create.

Advice for Patients

The single most important factor in how the ED staff perceive you is your manners. If you are rude to your caregivers, you can still expect conscientious medical care, but you cannot expect warmth or empathy. If, on the other hand, you are polite and appreciative, you have just earned very important brownie points, credit that will make up for many other factors.

Politeness trumps everything. If you come in with meth mouth or swastika tattoos or a t-shirt bearing a hateful political slogan -- and I’ve seen all of those things in the ED, many times -- you can still win friends by being courteous to your caregivers. If you are in any of these categories, in fact, it’s especially important that you be courteous to your caregivers, because these are some of the first impressions that your caregivers, being human, will tend to judge.

Some (not all) ED staff can be less than sympathetic to alcoholics and drug addicts, homeless patients, and patients flagrantly noncompliant with diabetic or cardiac self-care. But I’ve never seen a case where a courteous patient couldn’t overcome such biases. If you’re afraid that your caregivers will judge you for your membership in some large group or category, the best way to make them see you as an individual instead is to be nice to them. Say please and thank you. Don’t interrupt the doctor. Answer questions as succinctly, precisely and accurately as you can. Don’t rail about the universe, the economic system, the medical system, or the so-and-so’s who did this to you. (At least, don’t rail at the medical team. You can rail at me, because I’m the chaplain, and listening to you rail is my job.)

Please do remember that visual signals count. If you have swastika tattoos, you’d be well-advised to cover them up to avoid offending the staff.

If you assume that the medical team is judging you, and if as a result you become hostile and defensive, you’ve probably just reinforced whatever negative stereotypes the medical staff may hold, and then they’ll become hostile in response. Congratulations: you’ve just created a self-fulfilling prophecy.

If your relative is in the code room and the doctor asks you what happened and you start to tell a long winding story about how you found your loved one slumped over at the kitchen table and then you called 911 but the goddamn ambulance didn’t get there for twenty minutes, and if the doctor then interrupts you to ask about your relative’s medical history and medications, answer the question. The doctor needs this information to save your relative’s life. The doctor is not interrupting you because he’s an arrogant so-and-so who thinks he’s so hot because he went to medical school and who’s determined to disrespect you because you have less education than he does. The doctor is interrupting you because he’s trying to save your relative’s life. The doctor doesn’t have time to listen to the long, winding story about the kitchen table and the ambulance.

Tell me the long, winding story about the kitchen table and the ambulance. I’m the chaplain. Listening to long, winding stories is my job.

In general, if the staff seems curt or rude or insensitive, especially after you’ve tried to be polite, remember that their behavior probably has nothing to do with your ethnic origin, ability to pay, addictions, or housing status. If you’re being nice to them and they don’t seem nice back, it’s probably because they’re so busy that they can’t be nice to anybody. If you’ve had to wait, it’s because of the triage system, which is truly non-discriminatory. That person who got seen before you wasn’t treated first because he was white or had insurance. He was treated first because he’s having a heart attack and you have the flu. When you’re having a heart attack and he has the flu, the positions will be reversed.

And yes, it’s hard to be polite and understanding when you’re frightened and in pain. We all know that. But we’ve also all seen patients manage it.

Advice for Staff

Remember that virtually the moment you enter the room, the imperilled organism in the bed will know how you feel. If you're sympathetic to the patient, the patient will know that. If you feel contempt for the patient, the patient will know that, too. If you really don’t give a hoot about this person but you’re doing your best to be polite and professional, the patient will realize that you’re faking it, but will appreciate the effort.

In most cases, these assessments will be very accurate. In some cases, they’ll be skewed by other factors. Patients bring their social histories with them. You see the whole ED; they only see what’s happening in their own rooms. If it’s one of those really busy nights when you don’t have time to be nice to anyone, the patient may assume that you’re being brusque because the patient is an addict, homeless, or of a different ethnicity than yours. People who’ve been shamed for some aspect of their identity may perceive such behavior even where it isn’t present or intended.

One of my jobs as chaplain is to assure such patients that the staff is being brusque with everybody, including me, and that it has nothing to do with skin color or income. (This is, of course, assuming that the patient is being polite.)

Please remember that alcoholics, addicts, psychiatric patients, low-income and homeless patients, and noncompliant diabetics and cardiac patients are usually not, in fact, stupid. They know how you feel about them. They may know much more about their medical conditions than you give them credit for. I’ve heard homeless bipolar suicidal alcoholics deliver extremely concise and elegant analyses of the interactions between these conditions. Please respect patient self-knowledge and expertise. And please remember that in many cases, such patients are judging themselves far more harshly than anyone else ever could.

If you’re caring for a patient with a swastika tattoo, please remember a) that the patient may have gotten the tattoo fifteen years ago, and that it may no longer represent her or his belief system and b) that prisoners often need to display gang insignia as a matter of survival, and that those insignia may not ever have represented their actual values. (Don’t like prisoners? If they’re out, they’ve done their time. If they’re in the ED with corrections escorts, they’re doing their time.) I’ve seen patients with swastika tattoos behave badly towards non-white staff, but I’ve also seen patients with swastika tattoos who wanted to show everybody pictures of their kids and who went out of their way to help other patients. People are complicated. Try to give them the benefit of the doubt. If they’re nice to you, be nice back. If they’re not nice, call security.

If you’re a white staff member, please be especially courteous to and respectful of non-white patients. If you’re a male staff member, please be especially courteous to and respectful of female patients. If you’re a wealthy, well-educated staff member, please be especially courteous to and respectful of Medicaid high-school dropouts with meth mouth. Some patients come in assuming that they’re going to be kicked when they’re down; try to be aware of who such patients might be, so you can be especially careful to avoid anything that might feel like kicking.

And yes, I know, you already have far too many other things to do, and you may really feel like kicking some of these patients (especially if they aren’t being polite). But that isn’t going to improve anyone’s mood or manners, and ultimately, moods and manners affect medical compliance.

It’s worth mentioning here that one of the most admirable bedside manners I’ve ever seen belonged to an individual who was at least eight feet tall. Quite frankly, I’d have crossed the street to avoid this person if I’d first seen him in public after dark. He looked like a hitman or ex-boxer, someone out of a Quentin Tarantino movie. The fact that he had to stoop to avoid major weather systems didn’t help.

But I’ve never seen anyone who was kinder, gentler, or more empathetic towards patients. And I suspect there’s a direct connection; I have a hunch that he figured out pretty early on that he scared people simply by coming into a room, and that he had to compensate to make them feel safe. Sadly, he’s moved on to another hospital. I miss him.

All of us, patients and staff, have the capacity to scare people just by coming into a room. (I can terrify patients just by identifying myself as the chaplain.) If we figure out some of the ways we do that and how to compensate for it, we’ll all be much happier.

Preaching Challenge

A few weeks ago, the liturgy committee at church divvied up preaching dates for the fall, and I asked to preach on October 1, when we'll be celebrating the Feast of St. Francis. This is when we do the Blessing of the Animals; people bring their pets, and the priests bless them between the two services. During the later service, some of the kids babysit the critters in the playground instead of going to Sunday School.

There are always lots of dogs, of course. We've also had snakes, turtles, mice, hamsters, birds, goldfish, and cats. I'd never bring my own cats, because being in their carrying cases around all those barking dogs would terrify them; they'd think they were being cursed, not blessed. But I often bring pictures of them, so they can be blessed in absentia. My own theological position is that pets bless us, rather than the other way around, but it's only fitting that we return the favor sometimes.

It's all wonderful fun, very joyous and affirming. I love watching people with their companion animals, because the relationship brings out the best in everybody. The prayers we say include special mention of children, but I think adults are even more transformed in the presence of their beloved critters than kids are. Their eyes shine. They walk around grinning. Very dignified grown-ups cradle their toy terriers in their arms and indulge in baby-talk. Children act that unselfconscious all the time, but it doesn't come easily to most adults (especially since we're Episcopalians, "God's frozen people").

I've always wanted to preach on the Feast of St. Francis, so I was delighted to be given the slot. I have a book called Animal Rites by Andrew Linzey, the English Anglican priest who wrote the first Blessing of the Animals, and we'll probably use one of his "Eucharistic prayers for all creatures."

And then last night I looked at the readings for October 1. The Gospel is Mark 9:38-50, one of the notoriously Hard Sayings of Jesus:
John said to Jesus, "Teacher, we saw someone casting out demons in your name, and we tried to stop him, because he was not following us." But Jesus said, "Do not stop him; for no one who does a deed of power in my name will be able soon afterward to speak evil of me. Whoever is not against us is for us. For truly I tell you, whoever gives you a cup of water to drink because you bear the name of Christ will by no means lose the reward.

"If any of you put a stumbling block before one of these little ones who believe in me, it would be better for you if a great millstone were hung around your neck and you were thrown into the sea. If your hand causes you to stumble, cut it off; it is better for you to enter life maimed than to have two hands and to go to hell, to the unquenchable fire. And if your foot causes you to stumble, cut it off; it is better for you to enter life lame than to have two feet and to be thrown into hell., And if your eye causes you to stumble, tear it out; it is better for you to enter the kingdom of God with one eye than to have two eyes and to be thrown into hell, where their worm never dies, and the fire is never quenched.

"For everyone will be salted with fire. Salt is good; but if salt has lost its saltiness, how can you season it? Have salt in yourselves, and be at peace with one another."
Oh, ick.

The first paragraph is just fine, but that second one is pretty hideous. Yes, yes, I know, he's using exaggeration for rhetorical emphasis: I get it. But first of all, who in the world has neither stumbled nor caused anyone else to do so? Where's the forgiveness here?

And do we really need images of vivisection on the Feast of St. Francis? How does one connect this to cute furry critters? By talking about guide dogs for those who've torn out their eyes so they won't make anyone stumble?

Yea, verily, once again I say unto you: Oh, ick.

Some preachers, when confronted with a passage like this, simply ignore it and talk about one of the other readings, but my preaching class emphasized that this is usually a bad idea, especially when the hard stuff is in the Gospel. We use an assigned lectionary; we haven't been given the luxury of ignoring the hard stuff. And the people in the pews are going to be wrestling with the reading, so the person at the pulpit should really join them.

But in this case, I'm wondering if I have any wiggle room. I've e-mailed one of our priests to see if I can use the readings for the Feast of St. Francis instead. I don't think I'll be able to, since it's not a major feast day -- there are only a few where you can substitute those readings for the Sunday ones -- but it can't hurt to ask.

And if I get stuck with the vivisection Gospel, I'll make it work somehow. I enjoy challenges, and I've preached on Hard Sayings before. But this one really is a humdinger.

Update: Our priest got back to me and said we can use the Francis readings. Thank you, Sherry! (If only all difficulties resolved so easily!)

Wednesday, August 30, 2006

Jonesing for the ER

Classes started yesterday and I'm already behind, even though I stayed up late last night grading. How did this happen?

I suspect my happy days of blogging every single morning are at an end. (Yeah, I know: I can see you blogging veterans rolling your eyes. Everyone told me this would happen.)

Part of the pressure is that Gary and I going away this weekend -- the last getaway before 24/7 grading starts in earnest -- and I need to get things done so I'll be able to leave. The getaway weekend also means that I won't get to the ER this week, since I've switched shifts to Sunday.

I'm happy to be getting away, but I miss the hospital when I'm on vacation.

Last March, we spent spring break with friends in Maui; it was glorious, and we're going again this year. On the evening when I would have been in the ER, we were at a very fancy restaurant, sitting on a terrace overlooking the Pacific, having an exquisite meal. We all loved it. But I found myself calculating the time difference, figuring out where I would have been in my hospital shift, wondering what was happening.

I also get homesick when I'm sick and can't go to the hospital. ("Oh no! I'm too sick to go to the ER!")

Last April, I threw my back out; I was on campus, moving from one class to another, and suddenly could barely move at all. I could neither stand up straight nor bend over. I hobbled to my grad seminar, where one student gave me Advil and another, after the three-hour-plus class, carried my books to my car for me. The next day I went to see my doctor, who put me on muscle relaxants and ordered me to rest my back for at least three days.

"Oh," I said, lying contorted in agony on her examining table. "So I guess that means I can't do my ER shift tonight?"

She gave me an amazed look. "No! Absolutely not!"

I'm a strange little creature. But then, you all knew that.

Tuesday, August 29, 2006

Major Drugs. No Needles.

The new edition of Grand Rounds is up over at Protect the Airway, which has become one of my favorite blogs. There’s a kind of Grand Rounds tradition to see who can come up with the cleverest presentation, and this edition takes the form of an ED tour. I'm honored to be included, especially since I submitted my post after the deadline!

But one thing got left out: the blanket warmer.

I’ve decided that warm blankets are the best thing about the emergency department. We’re talking major drugs: these things are at least as effective as morphine. Patients who’ve just been given a warm blanket will moan in ecstasy and close their eyes. Pain and worry lines fade, replaced by blissful smiles.

The worst thing about having a fever in the ED is that you aren’t allowed to have a warm blanket. If your temp’s up, I can only give you a sheet.

I once saw an agitated, suicidal homeless patient magically become calm, happy and grateful, just because I’d given him a warm blanket. Another homeless patient who was being discharged ran after me with tears in his eyes to say “thank you,” when I’d done nothing but give him a warm blanket hours earlier. As a chaplain, I’ve learned that the two things most guaranteed to make patients weep with gratitude are heartfelt, personalized prayers and, you guessed it, warm blankets.

I often tell patients, “I want one of these blanket warmers for my house. I think Sharper Image should sell them. They’d make a million dollars.” The patients always laugh and agree.

My birthday’s next week. If you want to get me something really special, you now know what that would be.

Of course, I don’t want you to go to any trouble, really. But if you just happen to have a spare blanket warmer lying around, I’ll happily take it off your hands.

Monday, August 28, 2006

Making a List. Checking it Twice.

When I came up with my Carnival of Hope idea, I e-mailed some fellow bloggers about it, and I noticed that several of them posted small bits o' optimism yesterday. Is this just coincidence, or is my Evil Plot to Achieve World Domination through Disgusting Cheerfulness already bearing fruit?

Bwah hah hah!

About the Disgusting Cheerfulness thing: most people who know me know that I'm a long-term chronic depressive, recently back on meds after a number of years off them. I accepted a long time ago that this is a medical condition I need to manage, just as I'd need to manage diabetes or hypertension, and I've developed some very workable strategies for doing that. I've always been very high functioning; I've never been overtly suicidal or needed hospitalization, and I have every intention of keeping it that way.

But I do want to emphasize that Disgusting Cheerfulness isn't my normal state. At all. Even remotely. And it never has been. I'm told that most kids and adolescents think they're immortal and invincible; this always makes me wonder what planet they're from, or what planet I'm from, because I never felt that way when I was a kid. Ever. I was always convinced that I was about to die, or that my parents were about to die, or that if any of us left on a trip, something horrible would happen and we'd never see each other again. Throughout most of junior high and high school, I believed that by the time I was twenty-five, I'd either have killed myself or have been locked up in a psychiatric hospital.

Okay, so maybe teenager Susan was just a little melodramatic. (You think?) But I cried myself to sleep every night for years, and various teachers and friends and relatives made concerned noises at me about depression even before anybody knew much about it. This was the nineteen-seventies. Nobody had even heard of Prozac yet.

If I'd grown up in the eighties or nineties, I'd have been put on meds when I was two. Overall, I'm glad I wasn't. I still prefer to be off meds, but part of managing a chronic medical condition is knowing when you have to supplement your self-care strategies with better living through chemistry.

So, anyway, looking on the bright side isn't something I insist on doing because I'm a naturally Disgustingly Cheerful person who's naive about all the darkness in the world. It's something I insist on doing because not doing it is very literally dangerous to my health, and maybe to my life. There's been suicide in and around my family, and when I was in my twenties, two friends killed themselves. I have all kinds of fun risk factors for suicide, and I don't want to go there. I don't even want to get close.

So I'm stubborn about self-care. Here's what I do:

* Take meds. Go to therapy.
* Exercise at least every other day, and preferably every day.
* Volunteer: service is a known antidepressant.
* Stay active at church: spirituality is another known antidepressant.
* Stay in touch with friends. This is a challenge; my default is isolation.
* Keep a blessings journal.

This last one is a notebook in which I jot down a very quick list of good stuff that's happened that day. My cats are usually on the list; on really bad days, when I can't think of anything else, air and water are on the list. (There are very few days like that, luckily!) Sometimes the list's long and sometimes it's short, but I've made an entry for every day -- although sometimes I fall behind and have to catch up -- for almost nine years. This is a very useful discipline, because it trains me to look for things to write down. And when you have several notebooks of blessings sitting around, it's harder to believe that everything sucks.

Also, when I even get close to thinking about suicide -- if I find myself even thinking of thinking about it -- I make a list in my head of twenty-five people who'd be upset if I killed myself, or even tried to. I know the list is probably actually much longer than that: I'm certain I wouldn't have been on any such list drawn up by my two friends who committed suicide, and I think about both of them all the time. But making a list of twenty-five people who'd be really pissed off by my untimely demise, or even just a little disgruntled, always restores my perspective. Depression's a form of disconnection, and this is a way of connecting myself again.

My doctor and therapist both like this strategy a lot. I was talking to my doctor about it once and said, "And even if I couldn't think of anybody else to put on the list, you know, somebody has to find you. How horrible is that?" She looked at me and said gently, "It's pretty bad."

So that's why I'm starting a Carnival of Hope: as a larger way of looking for blessings, and of encouraging other people to do the same thing. (Kim has plugged it on Emergiblog; thanks, Kim!) Is it corny? Yeah, maybe, but so what? Maybe we'd all be in better shape if we weren't afraid to be corny sometimes.

Oh, and speaking of corny carnivals, I have an embarrassing admission to make. My Pet Chaplain post is in this week's Carnival of the Cats. If cute pictures of furry animals make you squirm, do not go there!

Sunday, August 27, 2006

Hard to Swallow

Here's today's homily. The Gospel is John 6:56-69.

* * *

When I was a little girl, maybe seven or eight, my father and stepmother had a fancy dinner party for some of my father’s legal clients. One of the hors d’oeuvres was caviar. I’d never had caviar before, but my father believed very firmly that children should be encouraged to try a variety of unusual food, so he gave me some.

I loved it. I kept going back for more. My father, watching me inhale this very pricy stuff like so much peanut-butter-and-jelly, gently encouraged me to leave some for the guests, but I didn’t take the hint. And so at last, very reluctantly, he used the one tactic he knew would curb my appetite. “Susan,” he said, “did you know that caviar is fish eggs?”

He got exactly the reaction he’d expected: “Ewwwww!” I refused to touch caviar for another seven or eight years.

Many years after that, I took a summer course in liturgy at the Graduate Theological Union in Berkeley. Most of the people in the class were working on specific projects. A priest in his sixties wrote a retirement liturgy for clergy. I wrote a liturgy to bless the Family Promise ministry at St. Stephen’s. And one of our classmates, a Catholic laywoman, was determined to produce a version of the Eucharistic prayer that omitted every mention of body and blood.

“It’s disgusting,” she told us vehemently. “How can you even think about that and not get sick to your stomach? It’s cannibalism! No wonder more people don’t come to church, if they have to listen to that!” Although my classmate was using bigger words than I’d used when I was a little girl, her reaction to communion was the same as mine to caviar: “Ewww!”

As today’s Gospel makes clear, my GTU classmate’s objection is hardly a new one. Eating human flesh and drinking human blood were shocking breaches of Jewish dietary law; they must have sounded every bit as barbaric to Jesus’ first-century audience as they did to my twenty-first-century classmate. Jesus lost a lot of followers over this teaching. He was doing a new thing that flew in the face of old laws, and that also evoked a very negative gut reaction. The many people who walked away from him had law, tradition, and instinct on their side.

The few people who stayed had only their lived experience.

They don’t sound any happier about the flesh and blood part than anyone else. When Jesus asks the twelve, “Do you also wish to go away?” Simon Peter doesn’t say, “Oh, don’t be silly, Jesus! Why would we want to leave? We can’t wait to eat flesh and drink blood!”

Instead, he asks plaintively, “Lord, to whom can we go? You have the words of eternal life. We have come to believe and know that you are the Holy One of God.”

This short answer suggests a longer one. “We’d leave if we could, Jesus, because this teaching of yours is really hard to swallow. But we’ve been living with you, following you, watching you heal lepers and walk on water and feed thousands of people with a few baskets of crumbs. We can’t deny what we’ve seen. We can’t deny the evidence of our senses or the testimony of our lives. We know you’re the Holy One. And if following you means eating flesh and drinking blood, that’s what we have to do, because there’s nowhere else for us to go. We can’t say ‘no’ to this awful diet of yours without losing everything else you’ve given us.”

This pattern has played itself out many times in the centuries since. It’s an old, familiar story: someone in the church does a new thing that flies in the face of law and tradition, something that makes many observers sick to their stomachs. In response to this new thing, many people walk away, horrified at breaches of law and propriety. But a few others stay -- even if some of them are a little queasy themselves -- because their lived experience tells them that this place, right here, is where they have found healing, miracles, and sustenance: where they have found the words of eternal life. For them, there is nowhere else to go.

This pattern is playing itself out even as we speak in the global Anglican Communion. The American church has done several radically new things, including consecrating an openly gay bishop and choosing a woman to lead our national church. These actions are genuinely offensive to many Anglicans, people of deep faith who simply cannot accept such flagrant disregard for Scripture and church tradition. And if a fair amount of physical nausea seems to be involved, well, that’s part of the pattern too, isn’t it?

It’s certainly true that the ministries of Gene Robinson and Katharine Jefferts Schori represent a huge break with tradition, and with traditional interpretations of Scripture. And it’s also true that the American Episcopal Church is vastly outnumbered by the other churches in the global communion. But this morning’s Gospel proves that tradition, Scripture and numerical superiority are not, by themselves, self-evident proof of godliness. Jesus himself flew in the face of tradition and Scripture, and more disciples walked away from him than stayed.

This is dangerous territory. I don’t want to suggest for a moment that denial of tradition, disregard for Scripture, and numerical inferiority are self-evident proofs of godliness, either. I do think that all of us living in this complicated moment need to honor our lived experience. Where have we found healing, miracles, and sustenance? Where have we found the words of eternal life? Wherever that place is, there is nowhere else for us to go. If we have found ourselves healed by female clergy and fed by gay clergy, we need to keep making our home with them. If we find such ministries horrifying rather than sustaining, we may need to make our homes elsewhere. The bickering over who is being disloyal to whom is beside the point. All of us need to be loyal to the evidence of our senses and the testimony of our lives, trusting that we are all still God’s beloved children. “In my father’s house are many mansions,” Jesus tells us. One suspects that there are many kitchens there, as well. All of us need to go where we are fed.

And we need to remember that tastes and palates change, and that something that once seemed disgusting can come to be a delicacy. I happily eat caviar again, even though it’s fish eggs. I don’t know if my GTU classmate has learned to stomach the symbolism of communion; but if she hasn’t, I pray that she has found some other sustenance on her path to God, food that is more palatable for her. Many of the people who rejected Jesus’ awful diet during his lifetime came to the communion table after his death, at Pentecost and afterwards.

We follow a god who fed thousands from a basket of crumbs, who commanded the parents of a girl he had raised from the dead to give her something to eat, who returned from the grave himself to break bread with his disciples and roast fish on a beach for breakfast. If we know anything about Jesus, it is that he does not want anyone to go hungry.

We won’t be sharing communion at St. Stephen’s this morning, because this is a Morning Prayer service. That’s ironic, isn’t it? But if we find ourselves hungry for communion, maybe God is inviting us into sympathy with the hungers of those around us, the hungers of the world.

Let us, then, feed ourselves and each other. And let us have faith that even if our search for satisfying food seems to be leading us away from each other, all paths will lead at last to God’s heavenly banquet: to the feast where we will sit side by side, and where there will be enough dishes to please everyone, and where no one will go hungry.


Saturday, August 26, 2006

Carnival of Hope

Okay, I'm starting my very own blog carnival. Click on the link to read the description. This will be monthly, at least to start. If I get lots of submissions, I may move it to every two weeks.

I wish I expected lots of submissions.

I started this because I'm so incredibly sick of fear, loathing, political paranoia, bitterness and despair in the blogosphere. I know the current administration's a disaster; I know our civil liberties are being sold down the river; I know I can't trust a blessed thing I see or read in the mainstream media.

I've been knowing all that. It's not news. And I'm becoming increasingly convinced that all of us need to start making a concerted effort to look for positive reasons to get out of bed in the morning. Because if we can't do that, the Bad Guys really will have won.

So send me your happy, uplifting blog posts, all right? (Deadline: Thursday, September 14, 5:00 PM Pacific Time.)

Share some optimism. I dare you.


Anyone who writes has heard the question, "Where do you get your ideas?" My writing students often worry about where their ideas will come from. I tell them that writers are people who pay attention. When we pay careful attention to the world, there's no shortage of stories.

Here's a perfect example of this process, from page 7 of John McPhee's Coming Into the Country:
The Kitlik, narrow, and clear as the Salmon, rushes in white to the larger river, and at the confluence is a pool that could be measured in fathoms. Two, anyway. With that depth, the water is apple green, and no less transparent. Salmon and grayling, distinct and dark, move into, out of, around the pool. Many grayling rest at the bottom. There is a pair of intimate salmon, the male circling her, circling, an endless attention of rings. Leaning over, watching, we nearly fall in. The gravel is loose at the river's edge. In it is a large and recently gouged excavation, a fresh pit, close by the water. It was apparently made in a thrashing hurry. I imagine that a bear was watching the fish and got stirred up by the thought of grabbing one, but the water was too deep. Excited, lunging, the bear fell into the pool, and it flailed back at the soft gravel, gouging the pit while trying to get enough of a purchase to haul itself out. Who can say? Whatever the story may be, the pit is the sign that is trying to tell it.
I ask my writing students to pay attention so they'll see the signs that are trying to tell stories: snippets of overheard conversation, bizarre news headlines, unlikely found objects.

Gary often goes hiking on our local mountain, which is also a favorite spot for shooters. On our dining room wall is a round piece of metal full of holes. It looks like avant-garde art, but it's actually a hubcap someone used as a target. Gary found it and brought it home. We've occasionally talked about making a sculpture garden in our backyard from the discarded, bullet-riddled stuff up there: news kiosks, cars, washing machines.

Once, near the top of the mountain, Gary found an upright bass kicked and smashed in and shot to splinters. The entire instrument was too big to carry easily, but the head had been snapped off -- tuning keys twisted, bent, and pocked by bullets -- so he brought that home. I used it as a visual aid in a Maundy Thursday homily, and I've also shown it to my students as a writing prompt, because there has to be a story there.

What story is this sign trying to tell?

Once, four days before Thanksgiving, we found a nineteen-pound Butterball turkey, still in its plastic wrapping, shot full of bullet holes in the middle of a fairly inaccessible trail. (That one upset me because of the waste of food, until I realized that the coyotes would get it.)

What story is this sign trying to tell?

We're surrounded by stories: the ones we can see, the ones we can't, the ones we'll never know but want to know. Trying to imagine those stories is a way of loving the real world where the stories live.

Fiction isn't escapism. It's engagement.

Friday, August 25, 2006

Your Title Here

I can't for the life of me think of a good title for this post, which will be a motley collection of odds and ends. If anybody has any great ideas after reading it, lemme know. I'd offer you a cool prize, but I can't think what that would be, either. So you can suggest a cool title and a cool prize. A year's supply of cat fur, maybe?


My last Thursday shift went well last night; the minute I walked into the ER, a staff member snagged me to ask me to talk to a patient, and that always makes me happy. It's nice to be seen as a resource. That patient wound up doing well, too (no credit to me), which is always a plus. Gary's cookies were popular. I called our local crisis hotline to get some social-service referrals for a frantic family, who thanked me profusely; the ER no longer has social workers, and this is exactly the kind of help that patients often need and that medical staff don't have time to give. (My old volunteer coordinator, who's left to go to grad school, used to tease me about being a social worker at heart.) I got to watch a doctor hop on top of a bed to reduce a dislocated joint, which is the kind of dramatic move I thought only happened on ER. (The other staff were very impressed, but also clearly alarmed that the doctor might fall.) I alerted a nurse to a possible problem with some equipment, and instead of giving me the Go-Away Glare, the nurse said, "Thank you for calling that to my attention." That same nurse, when I mentioned how patient the staff has been with me this past year, squinted at me and said, "What are you talking about? You're the one who's been patient." Since this is someone with whom I had a really royal tussle over ice chips at one point, that felt good. A very sweet patient told me several times, "I love you," and that patient wasn't even drunk (I routinely hear professions of undying devotion from ETOH patients, but not usually from sober ones).


There was also some tough stuff, though, as always. One patient dealing with a very difficult loss asked me for prayer, but also asked for non-Christian language. Because so many people have had such toxic experiences with Christianity, I'm very sympathetic to such requests. But my own theology of loss and suffering is deeply and very specifically Christian, so when I can't use that language, I'm working with a drastically reduced toolbox. It feels like trying to perform brain surgery with a paperclip and a piece of dental floss. I did the best I could, and I'm sure the patient appreciated it, but it was definitely one of the moments when I regretted dropping out of CPE, which would have given me better ecumenical/interfaith/broadly-spiritual resources.

It was also one of the moments when I was grateful not to be the most important entity in the equation. As a fellow volunteer's fond of saying, "God was in the room before we got there, and God will be in the room after we leave."

Dogs and Cats

Talking to a patient with a beloved dog, I mentioned one of my pet (ha!) theories, that pets are small pieces of God wrapped in fur coats -- or feathers or fins, depending on your zoological preferences -- who come into our lives to teach us about unconditional love. The patient's nurse said, "Oh, that's definitely true of dogs. I'm not so sure about cats." I protested that of course it was true of cats, but both the patient and the nurse seemed unconvinced.

Okay, faithful readers: where do you fall on this issue? Especally if you have both dogs and cats?


I went to bed feeling less exhausted than I often do after a shift, but I woke up at 5:00 a.m. (ugh!) with a madly itching right forearm, which has since developed into a rash. A quick web search informed me that most such rashes have no obvious origin and disappear as mysteriously as they came, so I'm not going to panic just yet about having picked up something awful at the hospital. (I've been sick less often since I started volunteering there, maybe because I've become maniacal about handwashing.) It sure is annoying, though!


When I toured my favorite websites this morning, I learned from Locus that Stephen Martiniere, who did the cover art for my novel The Necessary Beggar, has won a Chesley Award for best hardcover jacket art. He didn't win for my book, of course, but it still feels like reflected glory. Congratulations, Stephen!


Tonight Gary and I are having some friends over to watch Joss Whedon's brilliant Western-in-space series Firefly on the new 42" plasma set, which Gary refers to as the "Omega 13." (If you've seen GalaxyQuest, you'll catch the reference.) We're going to start with the pilot, show two episodes each on successive Friday evenings, and wind it all up with Serenity, the feature film made from the series. It should be good fun!

Any fellow browncoats out there?

And finally . . .

Toto, I'm Not In Kansas Anymore

I've set site meter not to record my own visits to the blog, and I've also set my location as Reno. But it is recording my visits -- I can tell by timing and outclicks -- and for some reason, it thinks I'm in Kansas, 1,212 miles away. Does anyone have an explanation for this, or advice on how to fix it?

Thursday, August 24, 2006

Changes of Shift

The new edition of Change of Shift is up over at Emergiblog, and makes great reading, as always. Thanks for including me, Kim!

I'm also changing shifts myself. For the past year, I've been working Thursday evenings at the hospital. Because of my teaching schedule, I'm going to have to switch to Sundays. This will be my last Thursday.

I'm sad. I like the folks who work on Thursday, and I've even managed to worm my way into several of their long-term memories (given everything else the medical staff have to keep track of, I'm an extremely small blip on most of their radars). A couple of my favorite nurses work alternate Sundays, though, so there will be some familiar faces.

I've asked Chef Gary to bake cookies as a "thank you" to the Thursday ER staff for putting up with me for the past year. ("What's that mosquito on my radar screen, and why does it keep pestering me about ice chips?") Food is always welcome in an ER, and Gary makes one mean ginger snap.

I'm sure I'll become attached to the Sunday staff, too. But the change means that some Sundays are going to be very busy: there will be weeks when I'm preaching two services starting at 8:00 a.m., and then doing a service at an assisted-living facility in the afternoon, and then going to the hospital in the evening. Luckily, all of that doesn't happen on the same day very often! And since I won't be teaching on Mondays this year, I'll have a rest-and-prep day, and won't have to go straight from ministry-marathon into the classroom.

At some point I need to shift gears and start working on fiction again, especially since I have the very untidy first draft of a fourth novel sitting in a box in my study. Blogging is the literary equivalent of crack cocaine: you write something, you see it "in print" right away, you get feedback quickly. None of that's true of conventional publishing. On the other hand, holding a published book in your hands is a feeling blogging can't duplicate. I need to wean myself from instant-gratification mode and get back to my craft.

And the beginning of the school year signals a shift of seasons. When the cold weather comes, I worry about my friend A, not to mention all the other people living on the streets. This AP story about rising attacks on the homeless isn't much comfort.

I've been meaning to send A a care package -- and procrastinating, as always -- since I have his mailing address. I've collected some books for him, and I may send food, and I know he'd like a letter. (I haven't decided whether to send money or not. I have to figure out how to handle that.) None of this will make him any safer, but I don't know anybody who doesn't like getting packages.

Wednesday, August 23, 2006

PITA for Christ

If "pain in the ass" were a Myer-Briggs Personality Type, it would be mine. (My actual Myer-Briggs type, for those of you who care about this kind of thing, is INFJ.)

One of the things I love about my volunteer-chaplain gig is that the ER transforms some of my more, ah, colorful personality traits -- the ones that often seem to be shortcomings or handicaps in other areas of my life, like cocktail parties or university committee meetings -- into valuable assets.

For instance:

1. I'm really stubborn and maddeningly persistent. My parents love to tell the story of the toy baby carriage I had when I was a toddler. I quickly learned how to push it in a straight line, but it took a while for me to master turning. Until I did, I'd push the carriage until I encountered a piece of furniture. Then I'd try to push the carriage through the piece of furniture. Then I'd back up, let out an ear-splitting howl, and charge full force into the piece of furniture. (My parents have never, fortunately, collected fragile antiques.)

In the rest of my life, this kind of doggedness often annoys people who want me to let go of some issue. In the ER, it helps me help patients in a hectic environment. If I need to find out if Patient X is allowed to have ice chips, I will by God get the information. If I can't find Patient X's nurse, I'll ask the charge nurse, the doctor, or anyone I see at the nursing station who might have access to the chart.

2. Even people who love me dearly have been known to describe me as "abrasive." This is a decided advantage in the ER, where pressure-cooker conditions often render staff a little abrasive, too. When I took my ER-for-volunteers tour, our guide warned us never to take anything personally. I've been snapped at, growled at, and on occasion outright yelled at for asking stupid questions, but if I'm on a Mission from God to find out if Patient X can have ice chips, it won't faze me much. (The people doing the snapping, growling and yelling are of course on their own Missions from God. We're all there to help the patients, which makes temper flare-ups much easier to accept.)

I'm told that many ER volunteers quit because they get intimidated. Not me. On more than a few occasions, I've been the recipient of what I call the Go-Away Glare. A nurse will spot me coming from fifty paces, scowl at me, and cross his or her arms. No words accompany this; none are needed. You can practically see the thought balloon forming above the nurse's head. "You are a clueless volunteer who keeps getting underfoot, and I am a highly skilled, overworked and underpaid professional who's been on my feet for the last eleven-and-a-half-hours and has helped save the lives of three coding patients and can't even remember the last time I could squeeze in a bathroom break, and I am so exhausted that I can barely see straight, and if you ask me an annoying question about ice chips, I will hurt you."

Sorry, friend. See this baby carriage? Patient X wants ice chips. I'm on a Mission from God, and you're not going to stop me by making faces. Don't take it personally.

3. I really, really suck at small talk. I cannot for the life of me make polite social chit-chat about the weather or sports scores or Top 40 radio hits. I'm much better at talking about pain, suffering, poverty, and world hunger.

This doesn't go over well at parties. (Most of my life, people have told me that I'm "too serious," "not fun," and "don't have a sense of humor.") In the ER, it's a huge blessing. The patients don't need someone who can make small talk. They need someone who'll cut through the small talk. It's amazing how often, when I introduce myself, patients will say, "Oh, I'm fine, thanks!" They'll say this if they have broken bones, if they're on oxygen and a heart monitor, if an NG tube is pulling blood from their stomach or if a Foley catheter is draining blood from their bladder. (By the way, not being squeamish is another very helpful personality trait for ER volunteers.) "It's nice of you to come by, but I'm fine, thanks!"

"Really?" I ask them. "You're fine even though you're in the ER, hooked up to all these interesting contraptions?"

That almost always makes patients laugh, and very often they'll then give me a less socially acceptable -- but more honest -- answer. Some patients stick with "fine, fine," because they're feeling so much better than they were when they got to the ER, but I've also had patients and their relatives go from "fine, fine" to sobbing in my arms in less than five minutes.

ER patients need people who are willing and able to listen to them talk about their pain, suffering, dread, and desperate oh-my-God-I-asked-an-hour-ago craving for ice chips. ER patients like the fact that I'm serious, not to mention stubborn and persistent.

And oddly enough, many of them seem to think I have a good sense of humor. Who knew?

Tuesday, August 22, 2006

Milestones and Comments

Dr. Charles has done a terrific job on the 100th edition of Grand Rounds. I'm honored to be included!

And I had some kind of coming-of-age myself yesterday, when I received my first really nasty blog comment: someone who identifies as Catholic responding to my Gormless Medical Brigade post to say, among other things, that any doctor who believes that a woman has an STD is entitled to look down on her.

Let me just say that none of my Catholic friends would share that viewpoint.

And let us pray most devoutly that this visitor, who came here via last week's Grand Rounds, isn't a medical caregiver.

This is why I moderate comments, even though I might get more if I didn't. As far as I'm concerned, the blog is the cyber-equivalent of my living room, and I'm not going to leave the door open for anyone to walk in and trash the furniture.

I thought for a while about how to moderate that comment. I could have rejected it, of course, except that I also believe in the First Amendment, and the post does raise some important issues. (So far, the only comments I've rejected are outright spam.) I thought for a while about incorporating it into an actual post to address those issues, but that would be giving it too much weight. So I finally decided to accept it and respond to it with a comment of my own. I doubt that the visitor -- who chose to remain anonymous -- will be back to read my response, although I'd love to be wrong about that. But I'm still getting hits from last week's Grand Rounds, and this way, anyone who cares enough to read the comments will be able to read that one and see what I said.

Gary and my friend Lee think I did a good job responding. My basic point was that shame is bad medicine (not to mention bad religion). With STDs, there's also a public-health issue. Patients who feel humiliated won't return for treatment, which is bad news for their partners. This is why San Francisco has a free health clinic for sex workers, so those women and men can receive nonjudgmental, caring medical treatment in an environment where they feel safe.

I'm sure my Catholic commenter would be scandalized by the very idea, but I strongly suspect that Jesus thoroughly approves.


The Catholic commenter came back and posted a very thoughtful and respectful response, to which I've now responded. I'm delighted that my assumptions about this person have been proven wrong, and that we seem to be having an actual conversation. How refreshing, especially in cyberspace!

Monday, August 21, 2006

Pet Chaplain

Two years ago today, our cat Pyewacket died. He was fifteen years old and ill, and we had to take him to an after-hours emergency vet clinic. Luckily for all of us, Pye’s regular vet was working there that night. She was very kind and gentle both with us and with him, and assured us that euthanasia was the right decision. His death was peaceful.

The anniversary of his death seems like a fitting time to explain why Pet Chaplain is in the Heroes section of my sidebar.

Less than a year after Pye died, we lost our other fifteen-year-old cat, Belphoebe. She’d been sick too, so sick that we’d asked our vet (a different one) if she’d come to the house to give Phoebe The Shot. She said she would. But we thought we still had a little bit of time.

Gary was going to a concert that night, and I had a shift at the hospital. I thought about staying home with Phoebe, but she’d been sleeping all day, on a blanket in a corner of my study, and didn’t seem to be in any pain. Maybe I was hoping that she’d keep sleeping and simply wouldn’t wake up, that she’d spare us the decision. In any case, I decided to go to the hospital.

It was a quiet night. My only memorable visit came when I knocked on the door of a room, went in, and introduced myself as the volunteer chaplain. The patient looked up at me, started to cry, and said, “I’m dying of AIDS. Fifteen minutes ago I was praying to God to send me a sign that he still loved me, and then you walked in. You’re a sign from God.”

If you’re only going to have one memorable visit, that’s the one to have. During slow times at the hospital, when nobody wants to talk to me and I don’t feel as if I’m doing any good for anyone -- and sometimes a stretch like that will last for weeks -- this is the memory I come back to, the one that keeps me going. Sometimes, it’s not about what you do. Sometimes you don’t have to do anything but show up. Sometimes the mere fact that you’re there gives someone new hope or new meaning.

This is the classic “why I am a chaplain” moment.

But the minute I walked back into the house after that shift, I heard Phoebe, upstairs, moaning.

She’d dragged herself out of my study and was huddled under Gary’s desk. She was wheezing, trembling. When I touched her, she screamed.

Gary was still at the concert, which probably wouldn’t be over for at least another half an hour. He didn’t have a cell phone. I had no way to reach him. He’d gotten a ride from friends -- he doesn’t drive -- but they were performing in the concert, so I couldn’t call them, either.

I paced, talked to Phoebe, sent panicky e-mail to a couple of friends, and called the after-hours clinic (where our old vet, alas, was no longer working) to alert them that we’d be coming in. I didn’t want to go down there without Gary. The person who answered the phone, sounding as bored as if we were discussing paper clips, said, “Are you just bringing her in for euthanasia, or do you want an exam? The emergency exam is $85.”

“I want to be sure I’m doing the right thing,” I said. I must have already been crying by then.

Gary didn’t come home. I paced. Phoebe moaned. I was afraid to touch her again, because I didn't want to cause her more pain. I thought about the patient at the hospital. Do cats pray? Had Phoebe been praying for her people to be there, all those hours when she was alone? Had she been praying for a sign that we still loved her, that God still loved her? The only thing that kept my self-reproach from becoming full-fledged hysteria was that Gary would have gone to the concert even if I hadn’t gone to the hospital. I still wouldn’t have been able to reach him. I’d just have had to wait that much longer.

Gary didn’t come home. Finally it occurred to me that he might have gone to our friends’ house for an after-concert drink. I called, and he was there, and I said, “He has to come home now. Our cat’s dying.”

Our friends, bless them, offered to drive us to the emergency clinic, but I said that I didn’t know how long we’d be. It was already late at night, and they had work the next morning. I said I was okay to drive.

So they brought Gary home, and Gary put Phoebe in the carrying case, and we drove the fifteen miles to the clinic. (Our regular vet is a block away.) When we got there, the clerk asked again if we wanted the $85 exam, and I said again, “I want to be sure I’m doing the right thing.”

We waited with Phoebe in a room. The vet came in, took one look at her, said scornfully, “Yes, it’s time,” and left again. Both he and the techs were glaring at us, at me, or at least that was how I felt; maybe it was just my own guilt. She was indeed very clearly in horrible shape, and I think they thought we’d let her suffer too long already. That may be why what happened next happened so quickly.

When Pye died, our vet told us we could stay with him as long as we wanted, both before and after the final shot. She took him to another room to examine him, sedated him, and carried him gently back to us on a soft crocheted afghan. He was lying on the afghan, with our hands on him, when she gave him The Shot.

Nothing like that happened this time. My memory, which is probably inaccurate, is that almost as soon as the vet left -- this stranger we’d never seen before -- he came back again with The Shot. They must have taken Phoebe out of the room at some point, because I know he told us that she was in organ failure, that her lungs were filling with fluid, and I think they must have shaved her leg and put in an IV catheter for The Shot. But what I remember is the vet coming in and giving Phoebe The Shot on that cold metal table. As weak as she was, she fought. She stood up and struggled and tried to get away, and then she fell over into my hands.

It wasn’t peaceful.

I wasn’t peaceful. I was howling, sobbing. I was a crazy woman. The vet had left. I think a tech touched my shoulder and mumbled, “I’m sorry,” but then he fled. I could see people peering in the window of the room at me. Gary was huddled in a corner, a million miles away.

I’ve now seen enough death at the hospital to know that family members frequently fly off in different directions, especially if the death’s unexpected or difficult. Relatives don’t usually fall into each other’s arms the way they do in movies: they bounce off each other and off the walls, like pinballs. Gary and I were reacting perfectly normally. But I didn’t know that then.

In retrospect, I should have let our friends come with us.

At some point, I was lucid enough for just long enough to think, “I really need a chaplain. A few hours ago, I was the chaplain. But I can’t do it for myself, and they don’t have a chaplain here. Nobody here even wants to get near me.”

We left. I drove the fifteen miles home; the discipline of driving steadied me, although I’m sure any objective observer would have said I shouldn’t have been driving at all.

The next morning, I did a Google search and found Pet Chaplain: a multicultural, multifaith pastoral-care service, “caring for people who care for pets.” I was both amazed and grateful. I hit the “contact” button and sent off a tearful e-mail about Phoebe: about how guilty I felt because I’d been at the hospital, caring for strangers, when my cat was in so much pain. I talked about the AIDS patient. I couldn’t regret that visit (how could I ever regret that visit?), but had Phoebe been praying while I was gone? How good had I been at showing her that I still loved her, that God still loved her?

Rob Gierka wrote back right away. He said all the right things. He told me that my work at the hospital was important, and that clearly I’d been meant to be there. He told me that I’d loved my cat and given her a good life, and that I’d done the right thing for her at the end, even though it was so hard. He assured me that God loved both me and Phoebe. And he told me just enough of his own history to make me understand just how much he could empathize.

And that’s why Pet Chaplain is one of my heroes.

I could never do what Rob does. I can usually stay calm and focused around suffering people, but I can’t maintain any kind of detachment around suffering or dying animals. This has to be incredibly hard for the people who work at veterinary clinics. That’s probably why everyone seemed so cold the night Phoebe died. Maybe they really were judging me, or maybe I just thought so because I felt so guilty. But maybe they wouldn’t get near me because they were trying to hold it together themselves.

I still feel awful about what happened that night. Now I wish we’d had our vet come to the house that afternoon. But then I surely would have been in no shape to go to the hospital, and the AIDS patient needed me. I don’t think there’s any way to solve this dilemma. I don’t think the AIDS patient was more important than Phoebe because he was human and she was a cat; they were both important. She was part of my family, and he was part of my ministry, and I couldn’t be there for both of them. This is a very stark story about human limitation.

I still feel guilty. I believe very firmly that our pets will meet us in heaven, because it won’t be heaven if they aren’t there. But in the only dream I had about Phoebe after she died, she’d come back from the dead and was stalking me, growling and glaring: Zombie Kitty. That may sound funny, but it was an awful dream, one of the ones where you scream yourself awake and then can’t shake the feeling for -- well, to be honest, I still haven’t shaken the feeling. It wasn’t a peaceful dream, and I’m still not at peace with what happened.

But I’m more grateful than I can say that someone was willing to listen.

Thank you, Rob Gierka.

Sunday, August 20, 2006

Geek Love

Before I had a blog myself, I didn't understand how people could spend so much time on them.

Now I get it.

I spent entirely too long last night fiddling around with Site Meter before finally getting it installed on the blog. This thing is amazing. Not only does it track hits, helpfully leaving mine out so I won't inflate my own count, but it tracks them by country, continent, and time zone. I had a visit from Romania this morning! In many cases, it will tell me what city the visitor is from; in all cases, it will tell me how far away the visitor is from Reno, in miles. It will often tell me how the visitor found my site: through a search, and if so for what, or through a referral from another site. (Grand Rounds has been very, very good to me. Note to self: submit to Grand Rounds regularly!)

This stuff is completely addictive. It's the last thing I need to be doing with a mere week until school starts, when one of my syllabi isn't even done yet, especially since I'm also preaching and leading Morning Prayer next week. (Procrastination, thy name is Susan. This was true even before I had a blog.) Also, I owe entirely too many people e-mail.

Meanwhile, I'm wrestling with TTLB. I'm registered, but when I search for my blog, nothing comes up, and when I try to re-register the blog, it tells me I'm already in the system. But I can't get my place in the ecosystem to come up on my site! I have to know whether I'm a crunchy crustacean or a lowly insect. (Yes, as you suspected, I'm a Christian who believes in evolution.) I've e-mailed TTLB, but gotten no answer. Does anyone out there have any advice?

And this morning on Making Light, I found a button for the completely beguiling How Much is Your Blog Worth?, which reports that Rickety Contrivances of Doing Good is worth $8,468.10. Well, heck, I'm impressed! I've so far womanfully resisted installing this on my actual site, on the grounds that it would really be too hypocritical after snide comments I've made about consumerism.

So my blog is eating my life, even though I know I shouldn't let it. Is there a 12-Step Group for bloggers?

My name is Susan, and I have a blog.

Saturday, August 19, 2006

Get me out of here!

I have a few unusual personality quirks. One is that I actively dislike Lake Tahoe.

I mean, really dislike it. "Fear and loathing" might not be too strong a phrase.

Yes, the lake is pretty, but in general, the place is overcrowded, overpriced, and overrated. People claim to go up to the lake to relax, but as far as I'm concerned, it's about as relaxing as the Upper West Side of Manhattan, which it actively resembles. Take the Upper West Side, twist it into a circle, plunk a large body of water in the middle and add a lot of trees, and you've got Tahoe. Except that on the Upper West Side, you can take the subway to avoid insane traffic.

Tahoe has really insane traffic. Especially on a Saturday. Especially on one of the last Saturdays before the beginning of the school year. And the roads are narrow, two lanes, often without an appreciable shoulder, which means that there's very little margin for error when you have a large truck climbing up your rear bumper, three cyclists ahead of you taking up too much of the lane for you to pass safely, and a huge oncoming truck towing a boat -- and swerving into your lane -- in the other lane. This kind of thing is why I didn't learn to drive until I was 36 and absolutely had to. (Reno has lousy public transit.)

As lakes go, I'll take Pyramid Lake any day, partly because wonderful things have happened to me there and partly because I'm a high-desert person. I like to see a lot of sky; I like to be able to see the horizon. Tahoe makes me claustrophobic. There are too many trees.

I'm also severely meeting-challenged. I just don't do well in long meetings, no matter how nice the other people are or how interesting the subject. I can sit still for a very long time when I'm writing; I can't sit still for very long at all in meetings. I'd infinitely rather do something than sit around discussing long-term strategic planning (which is why running around like a crazy person in an emergency room, handing out blankets and crayons, is fun for me).

So you can probably guess that this wasn't one of my better days. It didn't help that I got lost getting to our hosts' cabin, although I'd left early enough that I was still the first person there. In the morning, we sat around under the pine trees in the backyard and talked, and I got to watch bluejays, and we weren't visited by any bears -- our hosts have a photo of a mama bear and cub meandering through their front yard, which is definitely something you want to see in a picture and not in person -- and I got to catch up with some colleagues I hadn't seen for a while, and it was really very pleasant.

Then we had lunch, which was also very pleasant. Then everyone decided to walk down to the lake while continuing discussion of long-range planning, and I went to my car to get my hiking shoes.

And I locked my keys in my car.

The last time I did that was in Eureka, Nevada. That time it took three hours for AAA to show up to get me back into the car. The wait was pretty nerve-wracking, because I was parked next to a store window displaying a t-shirt with an anagram for WRANGLERS: Western Ranchers Against No-Good Liberal Environmentalist Radical Shitheads. My car boasts the bumper stickers "Christian, Not Closed-Minded" and "Feminism is the radical notion that women are people," not to mention the planet-Earth decal I've put there instead of an American flag. My bumper stickers may have been part of why the Eureka police helpfully offered to smash in a window so I could retrieve the keys ("No thank you, officers, I'll wait for AAA"), and why small children periodically trooped by on the sidewalk, pointing at me and my car and giggling. ("Liberal Locks Herself Out of Car!" It was probably on the front page of the town newspaper the next morning.)

The only person who took pity on me in Eureka was an immensely tall, shaggy man wearing a leather vest and an interesting assortment of tattoos, who emerged from a dilapidated shack behind me and said, "Honey, I'm a four-time convicted felon, and I'm sure I can help you break into that car." As it turned out, my Ford Escort defeated him. He called a locksmith friend, who didn't have the right equipment for the Escort. But he offered me water and the use of his bathroom and phone if I needed them. If I ever preach on the parable of the Good Samaritan, he'll be my illustration.

So anyhow, back in Tahoe, things weren't nearly that grim. AAA got there in an hour, and in the meantime I sat on our hosts' porch and started reading John McPhee's Coming Into the Country, which made me wish that I were in Alaska instead of at Lake Tahoe.

Just after I'd locked myself into the car, though, as I watched all my colleagues head off on their hike (I wanted to get home at a reasonable time, and had to stay with the car until AAA got there), I felt decidedly desolate for a few minutes. Remember that Ray Bradbury story "All Summer in a Day," about the girl on Venus who gets locked into a closet on the one sunny day in the entire year? I spent a lot of my childhood feeling like that kid, and for a few minutes today, I felt that way again, even though I was the person who'd locked myself out.

Then I found the McPhee book, settled down to read, and got over it. Hurrah for being an adult!

And now I'm back home, after another harrowing drive. Gary and I are going to go for a walk in our gorgeously clear, open -- even with all the new developments -- sage-scented Nevada neighborhood. We may see some rabbits, and we might even see rattlesnakes, but we definitely won't see any bears.

It's good to be home!

And before anybody says anything: Yes, I know, I need to get one of those little magnetic key compartments that goes on the underside of the car.


We just got back from our walk. The wildlife count was an unusually large number of rabbits (at least ten), too many birds to count, one lizard, and one extremely small snake. I don't think it was a rattler.

And no bears!

Miles to Go Before I Sleep

The writing faculty of my department is having an all-day retreat today.

Fifty-six miles away, at Lake Tahoe.

Starting at 9 a.m.

I'm one of these people who always requests a teaching schedule with classes starting no earlier than noon, thank you; it's not that I don't wake up early, just that I function best when I have introspection time before having to form logical sentences in public.

Well, I'll introspect in the car, I guess.

In the meantime, part of yesterday's post sparked this post about race and class, with some lively back and forth in the comments section, over at Will Shetterly's blog.

Also, in an e-mail exchange with Kim a few days ago, I talked about giving crayons to kids in the ED and described myself as "St. Susan of Crayola." She loved the phrase and thought I should use it in a post sometime. I forgot yesterday, so I'm using it now.

And now I have to go drink lots of coffee and get ready to hit the road.

Friday, August 18, 2006

Why Your ED Needs a Chaplain. All the Time. Really.

In a perfect world, all emergency departments would have 24/7, dedicated chaplaincy coverage.

Yes, I know: in a perfect world, all emergency departments would also have unlimited budgets, 24/7 dedicated social workers, their own kitchens, and massage therapists for both patients and staff. Humor me; I'm a science-fiction writer, and utopian visions come with the territory.

My impression (correct me if I'm wrong) is that most EDs either use hospital staff chaplains, who cover the entire building and are summoned to the ED only in crisis situations, or community clergy who come in when someone in their own flock is in dire need. This means that these chaplains see only a very few ED patients: those who've self-identified, or been identified by staff, as needing spiritual care.

I volunteer four hours a week as an ED chaplain. During each shift, I try to see every patient in the ED, the Fast Track area, and the ED waiting room. I don't normally go up to one of the floors unless there's a code (spiritual-care staff in my hospital are expected to respond to codes). Most of the patients I see aren't in obvious, dire need of spiritual care -- although some are, of course -- and plenty of them politely dismiss me. But for many reasons, my presence is still very helpful.

  • I have time to listen to anything the patient wants to say; that's my job. Medical staff generally don't have time to listen to anything other than medical symptoms, but having an attentive listener can significantly ease patient stress, which often reduces the severity -- real or perceived -- of symptoms. This is true even for non-religious patients: careful listening is ecumenical medicine.

    A disproportionate number of the ED patients I see have been recently bereaved. Grief is hard, stressful work, and it will almost always exacerbate existing medical conditions. Patients probably won't mention this to the medical staff, because it isn't a medical condition. But they'll tell me, and I'll listen, and maybe they'll feel a little better, or at least -- for a few minutes -- less alone.

    Several times, patients staggering under the burden of very old, secret traumas have warned me, "You really don't want to hear this."

    My answer is always, "Yes, I do. That's what I'm here for."

    Most such stories are heart-breaking, but the patients always feel better after they've told them.
  • Because I'm not medical staff, patients often feel safe venting to me about the medical staff, which at least sometimes keeps the doctors and nurses from having to get those earfuls themselves. I spend a lot of time explaining the triage system to people who are furious at long waits, and when patients feel as if medical staff have been short with them, I assure them not to take it personally. "It's really busy here tonight, and they're treating everybody that way, just because they have so much to do."

    On several occasions, non-white patients have taken me aside and said, "Can I ask you a question? Are the people who work here racist? Because they haven't been very nice to me." (This has always happened on evenings when the ED was really busy and when the staff was mostly white. I'm white myself, but again, I'm the person who's there to listen; and for obvious reasons, non-white patients would be hesitant to discuss this issue with medical staff.) I always tell them that no, the staff aren't racist, that they're treating everybody that way -- including me! -- and that some apparent rudeness may in fact be frustration at not being able to help everyone more quickly. The patients have always gratefully accepted this explanation. They don't want to think badly of the staff, but they need reassurance that they're receiving the same level of care as everyone else.
  • Patients who aren't otherwise unhappy may simply be bored after hours of waiting for test results or a bed upstairs, and I give them something to think about other than their own discomfort. I sometimes describe myself as "the walking distraction." (I also tell patients, "I'm the person who won't be sticking any needles into you this evening.") There's a lot to be said for relieving monotony.
  • Sometimes I'm able to tell the medical staff things they need to know. "Doctor, are you aware that elderly patient X lives alone and is terrified of being discharged because she can't manage the stairs in her apartment building?" "Nurse, are you aware that patient Y is having trouble breathing/is sobbing in pain/desperately needs a commode?" Sometimes I'm just repeating things the staff already knows, but reminders can be useful, and I try not to be too annoying.
  • Patients are very impressed that the emergency department has chaplains, and they're grateful for the service. They think better of the hospital because we're there, which makes us great PR. And as I discuss in this post, a visit from a volunteer chaplain may sometimes be more meaningful to patients than one from a staff chaplain (although 24/7 volunteer coverage would, I agree, be a huge challenge).
  • A visit from a chaplain may be especially important to patients who feel marginalized -- such as addicts, the homeless and prisoners -- and who need to be assured that they're still beloved children of God.
  • Because I consider the ED my turf, I'm generally happy to help out in any way I can. I give kids crayons. I give water, crackers or blankets to patients who are allowed to have them; these are instances when I have to pester staff, to make sure that Patient Z isn't NPO or febrile, but my bringing the patient a glass of water will save ten seconds of someone else's time. I restock the blanket warmer. I deliver patient messages to friends in the waiting room, help relatives find their loved ones in the ED, direct people to bathrooms, phones, and the cafeteria, hunt down pillows, hold babies whose moms are strapped to backboards. Maybe none of this sounds spiritual to you, but I believe that everything's at least potentially spiritual. I think it was Mother Teresa who said that to a thirsty person, water is prayer.
And, of course, it goes without saying that I'm also there for the situations when a staff chaplain would normally be called in: sitting with friends and relatives during a code, comforting people after a death or catastrophic diagnosis, helping patients and families deal with end-of-life issues. I haven't, thank God, had to do any of that too often, which is why it's a blessing that there's never any shortage of other work.

Thursday, August 17, 2006

It's Also About Me

The other day I had some time to kill before an appointment, so I stopped at a small outdoor mall and started browsing. This was a fairly chi-chi set of shops, and at the end of the row, there was a clothing store called "It's All About Me!"

Bemused, I went in. As I'd suspected from the name, the shop turned out to be one of those places where a cotton tank top with artful rips in it costs $90. Who buys this stuff? I discovered that a former student works there, and we had a pleasant chat, so I was glad I'd entered the store. Still, High-End Narcissism Boutiques always fill with me an odd mixture of exhaustion and despair, maybe because it really is so difficult for me to imagine who'd spend that kind of money on clothing that isn't going to last very long and isn't terribly unusual or attractive to begin with. I'm a writer, and I believe very strongly that the best fiction is an act of imaginative empathy, but I find it almost impossible to empathize with High-End Narcissism Boutique shoppers. The project leaves me feeling as if I'm contemplating a species of alien. There are many people who are far more apparently challenging -- televangelists, torturers, terrorists -- for whom I can at least begin to imagine worldviews and motivations. But when I try to enter the heads of people paying $90 for a ripped t-shirt, I draw a blank, even though my vast assortment of earrings and Keen sandals would, I'm sure, seem equally baffling to many of my fellow humans. My failure of imagination is my failure, not the failure of the t-shirt shoppers, and it bothers me.

A few days after I'd gone into "It's All About Me!", I heard a radio ad for a high-end health-club/spa in Reno called The Sanctuary. I've been unable to find a website for this place, but the ad had running water in the background (think Feng Shui waterfalls) and a soothing, flutey female voice listing all the spa amenities. The radio spot ended with the triumphant tag line, "The Sanctuary: where it's all about you!"

Okay, so it's not exactly news that consumer culture depends on fostering self-involvement. And I can easily imagine people for whom The Sanctuary would provide much-needed balance: harried soccer moms, stressed-out healthcare providers, frenzied chief executives. People who spend most of their time caring for others often desperately need self-care, and probably need a space away from the rest of their world where they can get it. These folks, I can sympathize with. Of course, that may be because last summer, I switched from our community swimming pool, with its maddeningly limited lap-lane hours, to a high-end private health club that has its own Feng Shui waterfall, not to mention hot and cold running amenities. I'm well aware that this makes me an alien to the many people who could never afford the place, even with the various incentives and discounts it offers.

Still, the message "It's All About Me!" (or "You!") makes me squirm. The flipside of that attitude is the rugged self-reliance for which Nevadans are particularly famed, a kind of individualism which to me, in its extreme forms, begins to look like pathology. I don't think it's any accident that Nevada consistently has one of the country's highest suicide rates: and no, it's not the tourists killing themselves. It's state residents. Take rugged individualism, throw in a dash of rural isolation, add alcohol and firearms, and you get one lethal stew. Too many people consider it shameful to ask for help, or don't know how. Too many people don't recognize how interdependent and interconnected all of us are, and how reliant on things we don't and can't do for ourselves. Do we make our own air and water? Do we pave our own roads or make our own cars? How many of us build our own houses, or even grow our own food?

One reason I love the church is because, at its best, it acknowledges interconnection and interdependence. That's exactly what the metaphor of the Body of Christ means: the people in a church, like any family, form one body with many cells and organs, and what happens to one affects the whole.

And like any family, church families go through ups and downs, communication problems, situations where one person's behavior hurts somebody else. Really, this is just small-group dynamics. It happens everywhere; it's no surprise. But over the past few years, several church friends with whom I've tried to discuss such situations have said crossly, "It's not about you!"

Oh, so now I'm not part of the Body of Christ? Or you aren't? Either one of us can do whatever we want, with no thought whatsoever to how our behavior affects other people? If I believed that, I really would think it was all about me. (And on at least one occasion, I've been dismayed to learn that someone had been upset with me for months and hadn't said anything. I can't fix the problem if I don't know about it.)

I once heard a tired hospital staffer, who's since moved on to another job, grumble about a grandmother who was very upset about a very sick child, "She needs to shut up and deal. This isn't about her."

Say what?

The truth is that, especially in a small and tightly-knit group, everything's about everybody.

It's not all about me, but neither is it not about me.

It's also about me.

Wednesday, August 16, 2006


In January, I learned that my novel The Necessary Beggar had won an Alex Award from the American Library Association. Ten of these are awarded every year to adult books with exceptional appeal to teen readers.

In June, I went to the ALA Conference in New Orleans, where there was a panel to discuss this year's awards. Five of us were there: me, Jeannette Walls, A. Lee Martinez, Gregory Gallaway, and Neil Gaiman. The panel was a lot of fun, and meeting this year's Alex-Award committee members was both a privilege and a pleasure.

Librarians rock. I'm now convinced that librarians are the Secret Rulers of the Universe. (I knew this when I was a dreamy bookworm of a kid, but I'd forgotten it as an adult.) Also, they know how to laugh at themselves. The official ALA gift shop was selling Librarian Action Figures, which raise a finger to their lips and say "Shhhhh!" when you press a button. When the Alex panel was about to start, a lot of people in the audience were still chatting, and other people started saying, "Shhhhhh!" I said, "We must be in a room of librarians," and everyone laughed.

So, anyway, today's mail brought my actual, physical Alex Award, the bronze medal you saw at the beginning of this post. It comes with a nice little wooden stand. It's a lovely object, and it will look great in my office at work.

I know I've been posting a lot of ego items the last few days, but really, this stuff doesn't happen to writers very often -- or not to most writers, anyway -- and we need to enjoy it when it does.

And to answer the inevitable question about New Orleans: the convention was in the French Quarter, the least damaged part of the city. The ALA was the first major meeting to come there since Katrina, and shopkeepers were falling all over us in gratitude. Everybody had a Katrina story. And no, I didn't venture outside the Quarter to look at hideous storm damage. Until just a few months ago, my father lived in Ocean Springs, Mississippi -- just east of Biloxi and right on the water -- and when I visited him after Christmas, I saw enough storm damage to last me a lifetime. When I was at the ALA, just looking at the books about Katrina in my hotel's gift shop made me start to cry; I didn't need more sensory input.

And yes, we were in that Convention Center. You never would have known from looking at the place that anything unpleasant had happened there.

Here's my favorite Katrina story, from my father's friend Darlene, who was an art teacher at a Biloxi high school. (I believe she's retired now.) The Friday before the storm hit, she'd been in her classroom getting it ready for the school year. She always decorated her room with her students' art, to give them pride in their work. (As I recall, this school served mostly lower-income students.) That Friday, she left a to-do list on the corner of her desk.

Then the storm came. She couldn't get into her school for three weeks, and in the meantime, the National Guard were billeted there. Darlene was afraid the place would be a mess. But when she got back into her classroom, it was spotless. The to-do list she'd left on her desk the Friday before the storm was still there, apparently untouched. And the National Guardsmen had written notes on the blackboard to Darlene's students, telling them how beautiful their artwork was.

Very few Gulf-Coast residents I've met have anything good to say about FEMA, but I haven't heard a negative word about the National Guard.

Tuesday, August 15, 2006

News of Mice

Today Jacob Weisman, my editor from Tachyon, called to talk about the table of contents for my story collection The Fate of Mice, which is coming out in February. (You'll find a link to its Amazon page in the sidebar. You can pre-order, if you want to. I'm just sayin'.) Of the eighteen stories I submitted, the collection will definitely contain ten, including three brand-new, never-before-published stories that I wrote between April and July. One of those, which I wrote in virtually one sitting when I was completely zonked out on muscle relaxants after throwing my back out -- kids, don't try this at home -- is probably the darkest thing I've ever produced. And if you've read my story "Gestella," you know that's saying something!

Jacob and I are negotiating over another two or three stories, pieces I'm fonder of than he is. Several older stories are being consigned to merciful oblivion.

I'm excited about finally having a story collection, especially with such a cool cover. Is that cover fabulous, or what? This is the first time I've gotten memorable cover art on the first try. Jacob tells me that books with cats on the cover tend to sell well, although this kitty doesn't look particularly cuddly (especially in the context of the title). He also reports that this is the first time Tachyon's had a feline cover; may it do well for all of us!

Yesterday's mail brought my contributor's copies of Jonathan Strahan's Science Fiction: The Very Best of 2005, which includes my story "The Fate of Mice." As I mentioned in an earlier post, that same story's reprinted in Rich Horton's Science Fiction: The Best of the Year, 2006 Edition.

Okay, I think I've done enough self-promotion for one day. I'd better go lie down now.

Another Medical Miscellany

This week's Grand Rounds is up over at Hospital Impact. Tony did a great job with this edition, and we get to look at an adorable picture of his infant son!

Last night, Gary found this surgical resident's diary on Slate. It's from 1997, but still makes fascinating reading.

In the land of fictional medical narratives, we've now finished watching the fifth season of ER on DVD. Next up, the second season of Carnivale, which we're both hoping will make more sense than the first one. It's a visually gorgeous show with colorful and intriguing characters, but it's also utterly inscrutable.

Sunday, August 13, 2006

The Gormless Brigade: A Medical Horror Story

When I decided to become a volunteer hospital chaplain, I got a lot of negative reactions from family and friends. “Oh, no! You aren’t going to turn into one of those people who marches into a hospital room and starts thumping a Bible, are you?” “You aren’t going to turn into one of those people who shows up with a simpering smile, leaves a prayer card on the bedside, and vanishes again, are you?” “You aren’t going to turn into one of those people who says I have to accept Jesus for my illness to be cured, are you?”

No, no, and no. My training emphasized that the first principle of pastoral care is meeting people where they are, instead of telling them where they “should” be. Proselytizing is forbidden (and isn’t something I’d be inclined to do anyway). Our goal is to learn enough about the patient’s belief system to try to help that person marshal emotional and spiritual resources. This means that a lot of the time, I don’t even talk about God. I’ve had pastoral conversations about people’s grandchildren, about their pets, about Buffy the Vampire Slayer. I try to learn what people love -- whether that’s cooking or genealogy or Little League -- because the things we love are the things we live for, and that means they’re the things that heal us.

But listening to all those horror stories about hospital chaplains, I remembered one of my own.

Caveat Lector

I’ve dithered for a few days about whether to post this, because you can’t get the full effect of the gormless-chaplain story unless I first tell a gormless-gynecologist story and a gormless-ER-doc story. (Lest you think it’s all bad news, there’s a saintly ER nurse in there, too.) To tell those stories, I need to go into some fairly graphic and personal details that might embarrass people. They don’t embarrass me, but I don’t want to make anyone else uncomfortable.

I’m offering this as a cautionary tale to medical and pastoral caregivers about what not to do, although I hope most folks would know better anyway. But if you’re embarrassed by graphic medical stories, especially about the female reproductive system, please don’t read this. Also, this is quite long. I considered breaking it up, but my husband thinks it should all be one post.

The Gormless Gynecologist

Long, long ago, in a galaxy far, far away (popularly known as New Jersey), I had an abnormal Pap smear. This meant that during a routine pelvic exam, my gynecologist found pre-cancerous cells on my cervix. To determine the next step in medical treatment, I needed a colposcopy, a specialized examination and biopsy of the cervix.

Colposcopies are office procedures. Gary and I were living together, but not yet married. His best friend had just died of cancer, and so -- even though my gynecologist’s nurse assured me rather impatiently that the abnormal Pap was really nothing to worry about -- we were both anxious. Gary volunteered to come with me to the colposcopy, to hold my hand during the procedure. (This meant the world to me. Any guys reading this: if you really want to score brownie points with your significant other, offer to go along during medical procedures!) The day before the procedure, he’d popped a tendon playing tennis, but -- in typical male fashion? -- he stayed quiet about how much pain he was in.

So we’re in my gynecologist’s office. I’m up on the table, in stirrups. Gary's standing beside me, holding my hand. My gynecologist, who’s young and female and subscribes to the “tell the patient exactly what you’re doing at each moment” school of medicine -- which I normally appreciate -- is giving me a perky, chatty tour of the procedure. “Okay, Susan, now I’m inserting the speculum! Okay, now I’m staining your cervix with vinegar! The vinegar makes the abnormal cells turn white under this special light we’re using! Oh, look! There are so many abnormal cells that your cervix looks like a glazed donut!”

Those were her exact words. I felt like I’d been punched in the stomach, but at least I was lying down. Gary was standing up. His calf was massively swollen from his athletic injury. His best friend had just died of cancer. The room was also rather warm. The upshot of all this was that he turned gray and began sweating copiously. “You don’t look too good,” the doctor told him.

She and her nurse promptly abandoned me to make sure Gary wasn’t having a heart attack. (He wasn’t.) They left me dangling in those stirrups, worrying about him, for a good twenty minutes. Because of all the confusion, when they did come back, they forgot to give me discharge instructions.

Discharge instructions include symptoms of post-biopsy infection: “If you develop nausea or a fever, call your doctor.” I hadn’t gotten the instructions. So two weeks later, when I developed fever, nausea, vomiting and diarrhea, I assumed I just had the flu. But after several days, the nausea turned into periodic waves of wrenching abdominal pain: pain that, when it hit every few minutes, left me gasping for breath and curled into a little knot of agony. You know that 1-10 pain scale, with 10 being “the worst pain you’ve ever felt”? This was a 10.

Enter Saint Nurse

Gary and I went to the nearest ER, which happened to be a Catholic hospital. I was wearing jammies, slippers and a bathrobe, walking doubled over because of the pain, puking into a plastic bowl I was clutching to my chest. When we walked into the ER entrance, the person behind the registration desk took one look at me and said, “You go right back there and lie down, honey.”

By some fluke, the place was almost empty. I got prompt attention from a kind, funny, personable ER nurse. Between waves of pain -- now somewhat reduced by pain meds -- she asked me about my graduate work, chatted about my doctoral dissertation, and generally treated me like an intelligent, competent human. And when my bloodwork came back with a white-cell count of 29,000 (normal is between 5,000 and 9,000), she became very grave and quiet, and told me quickly and gently -- as someone else quickly and gently started an IV for antibiotics -- that I had a very serious infection and would have to stay in the hospital.

Enter Gormless ER Doc

I’d told Saint Nurse about the colposcopy, and the ER doc wanted to do a pelvic exam. This doctor had already lost points for telling Gary to go sit in the waiting room. My impression at the time was that he kicked Gary out because we weren’t married; he asked Gary to leave when he heard the word “boyfriend.” Maybe he would have asked a husband to leave, too. I don’t know. I wasn’t yet a churchgoer -- that wouldn’t happen for another few years -- and I was very conscious of being in a Catholic hospital. That definitely colored my perceptions of what followed. (I volunteer in a Catholic hospital now, and I love the place, but I’m also very sympathetic to patients who are nervous about being in a faith-based institution.)

Maybe the ER doc was having a lousy day, even though the ER was temporarily quiet. Maybe he was just very bedside-manner-challenged. Maybe what happened next had nothing to do with the fact that a) he knew I wasn’t married and b) I was about to be admitted to the hospital with a diagnosis of Pelvic Inflammatory Disease. PID is most often caused by untreated STDs; it sometimes results in infertility, which will become important later in this story. My interpretation of events may have been swayed by the fact that the doctor was clearly from India and that his English wasn’t terrific; this made me wonder if he had more conservative beliefs about sexual mores than an American doctor might. (Someday I’ll post about the role of gender, race and social class in the emergency department. They definitely affect patient-staff interactions, but they aren’t often discussed.)

Whatever his reasons, this doctor gave me the roughest, most painful, most callous pelvic exam I’ve ever had. I clung to Saint Nurse’s hand, trying to be a good patient, trying not to whimper. When the exam was over, he took out the speculum, held it up so I could see the bloody pus on it, and glared at me as if I was something he wanted to scrape off the bottom of his shoe. “This is bad discharge,” he said, his voice dripping scorn. Saint Nurse squeezed my hand.

“I’m due for my period,” I said. “Could that be some of the blood?” (As it turned out, I had indeed just gotten my period.)

“Yeah,” Saint Nurse chimed in eagerly. “Could it?”

He curled his lip. “This is really bad discharge.”

I felt like the Whore of Babylon. Why was he talking to me that way? I was already sick as a dog and about to be hospitalized; was he trying to make me feel even worse? Later, when Saint Nurse was taking me up to my hospital room, I told her, “You have a much better bedside manner than he does.” She giggled. She didn’t seem to think he was a horrible doctor, so maybe he really was just having a bad day. He shouldn’t have taken it out on me, though.

Enter Gormless Chaplain

Upstairs in my hospital room, where I went through severe separation anxiety because Saint Nurse had gone back downstairs to the ER, I lay in bed, wondering when I’d see another doctor. My eyes were tearing from the pain of the IV: they had me on doxycycline, which is great stuff (it brought my white count back down to 9,000 in two days) but also burns the veins going in. I didn’t expect to see another doctor that night, but I was sure I’d see one in the morning.

The next day, my sister and mother visited, and Gary came and played Scrabble with me to distract me from the pain of the IV -- I got a new dose of doxycycline every twelve hours, and quickly learned to dread it -- but no doctor came.

The next morning, my aunt and uncle and several friends visited. Still no doctor. In the afternoon, my sister came by again, and she was still there when a short, excessively cheerful man appeared in the doorway and said, “Hi, Susie! I’ve come to see how you’re feeling!”

I stared at him. “My name’s Susan.” Blood relatives and extremely close friends who’ve known me for longer than twenty years get to call me Sooz. Nobody calls me Susie. “Are you my doctor?”

He chortled maniacally and bounded a few feet into the room. “Well, hi there, Susie! So how are you today?”

My sister looked alarmed. I shrank back against my pillows and tried to stay calm. “I prefer ‘Susan,’ thank you. I’ve been waiting to see a doctor. Are you my doctor?”

He beamed at me and hopped closer to the bed. “So, Susie, you seem to be in a good mood!”

At that point, I lost it. ”My name’s Susan. Who are you?”

“I’m the chaplain!” he said, chuckling. (My sister told me later, “You should have seen the look of relief on your face when you found out he wasn’t the doctor.”) He asked me if I’d like him to pray with me. I thanked him but explained that no, I wasn’t religious. It turned out that he was a Catholic priest. Somehow we started making small talk -- I didn't know that I could tell the chaplain to go away, and I wasn’t going to kick a priest out of my room in a Catholic hospital -- and discovered that we were both writing doctoral dissertations. He asked what mine was about, and I told him that I was writing about runaway mothers as figures of social reform in nineteenth-century British and American women’s writing.

He beamed at me. “Oh, how wonderful! Motherhood is women’s highest calling!”

I think my jaw dropped. The dunderheaded sexism of the comment would have been bad enough, but I was in the hospital with a diagnosis of a condition that could have left me infertile.

Now, I was positive that I didn’t have classic STD-related PID (and indeed, the STD tests came back negative). I was positive that the infection was somehow related to the colposcopy, although there was no way to prove it. And I’ve never wanted kids, so the fertility issue was far less important to me than it would have been to most women.

But he had no way of knowing any of that. If fertility had been an issue for me, his comment would have been devastating (even aside from its dunderheaded sexism), especially after I’d felt so judged by the ER doctor. “Whore of Babylon, your licentiousness has barred you from Woman’s Highest Calling!” For many reasons, I wasn’t about to buy into that message, but many other women might have.

I don’t know if the chaplain had access to my chart or not, and I don’t know if he’d have had any clue of what “PID” meant if he’d read it. When I became a chaplain myself and worked on medical floors, before I discovered that I preferred the ER, we were required to chart on patients (“Prayed w/pt” was the standard note). When I could find the chart -- which wasn’t often -- I usually tried to make some sense of the History & Physical section so I could suss out any potential landmines before I met the patient.

Nobody’s perfect. I believe that this chaplain was a genuinely sweet, if gormless, man who was truly trying to cheer me up. Even at the time, I wasn’t as upset with him as I was with either my gynecologist or the ER doc, and now I have quite a bit of sympathy for him. I know I’ve put my foot in it with patients sometimes too, and we worship a God of forgiveness.

But the lessons remain. Medical caregivers: please try to think about how your words would sound to you if you were the patient. Pastoral caregivers: please remember to introduce yourselves and your function right away, and try to avoid bringing up potentially sensitive subjects unless the patient does so first. And if you have any access to information about the medical condition being treated, educate yourselves!


After I’d gotten out of the hospital and had recovered completely from the infection, I had laser surgery to remove the abnormal cells from my cervix. (I had a bunch of other tests, too, to make sure nothing else was wrong, but that’s another set of posts.) I’m delighted to report that since then, I’ve been fine, and all of my Pap smears have been normal.