Saturday, September 30, 2006

Beastly Blessings

Here's one of the pictures Inez took of me with Ricky; she's posted about my visit to Iowa on her own blog. I'm still hoping she'll send me a photo of the mutilated toothbrush, too.

This seems like a suitable image to introduce my homily for the Feast of St. Francis. This is definitely one of my more lightweight efforts, but hey: fluffy fits the occasion, and with all that barking going on outside, it wouldn't be fair to ask the congregation to focus on a heavy topic.

The Gospel's Matthew 11:25-30, although I don't talk about it much.

* * *

Today we celebrate the Feast of St. Francis of Assisi, the thirteenth-century friar, groomed for prosperity by his wealthy merchant father, who instead embraced poverty. Like many other parishes, we have adopted the tradition of blessing the animals on the Feast of St. Francis, which is why you’ll find our courtyard milling with creatures of all kinds. Dogs and cats are always the most numerous visitors, but over the years, our clergy have blessed pet birds, fish, snakes, lizards, turtles, and many other species.

The Blessing of the Animals is a celebration of the amazing variety of God’s creation, and it reminds us that we’re part of a web of life far larger than our merely human households and communities. We perform this blessing on the Feast of St. Francis, the patron saint of ecologists, because he considered non-human animals his family. Francis gave one of his most famous sermons after seeing a flock of birds in a tree. According to the friar who recorded the incident, Francis ran towards the birds, “humbly begged them to listen to the word of God,” and delivered this sermon:
My brothers, birds, you should praise your Creator very much and always love him; he gave you feathers to clothe you, wings so that you can fly, and whatever else was necessary for you. God made you noble among his creatures, and he gave you a home in the purity of the air; though you neither sow nor reap, he nevertheless protects and governs you without any solicitude on your part.
Francis’ biographer goes on to record that this event was a turning point for Francis. “He began to blame himself for negligence in not having preached to the birds before . . . from that day on, he solicitously admonished the birds, all animals and reptiles, and even creatures that have no feeling, to praise and love their Creator.”

And so, because this is the day when we try to follow the blessed Saint Francis, here is my own message -- although it’s really more of a letter than a sermon -- to the furred, feathered and finned flock of creatures in our courtyard.

To our Brother Dogs and Sister Cats, to our Cousin Birds and Turtles and Fish, and to all the beloved beasts who grace our hearts and homes: Grace to you and peace from God our Father and the Lord Jesus Christ. The humans who love you have brought you here today to bless you, to remind ourselves of your place in God’s creation. Some of you consider this a joyous adventure full of wonderful new sounds and smells. Some of you would clearly rather be home, although at least you aren’t at the vet’s office. Some of you, when our priests stretch out their hands to bless you, delight in being patted, while others would really be happier if the hands were offering yummy treats.

We’ve brought you here today to bless you, but also to tell you that we’ve gotten a lot of things wrong over the years. Humans are very new animals, and the more we learn, the more we realize that you’ve always known much more, and done much more, than we ever gave you credit for. Saint Francis loved birds, but he was wrong when he told them that they neither sowed nor reaped. Since Francis’ time, we humans have learned how much birds and other wild animals help the work of pollination, spreading seeds so that plants and flowers can grow. We’ve learned to admire the industry of honeybees who gather pollen, and of birds and other creatures who forage ceaselessly for food, or for material to build their nests. Last year, many of us were enthralled by a movie about penguins marching hundreds of miles to lay and hatch their eggs in howlingly inhospitable conditions.

Some of you have worked for humans as long as humans have existed. Horses, oxen, and sheepherding dogs have made much of our own work possible. Animals of all kinds have fed us, clothed us, and carried us and our belongings where we needed to go. Even now, when so much of our work is done by machines, some tasks are still best accomplished by four-footed workers. Dogs use their keen noses to rescue us after bombings and avalanches, and can detect the presence of everything from explosives to cancer. They assist and guide those of us who cannot see or hear. My friend Nickie, who is both blind and suffering from a very painful condition in one foot, reports that her guide dog is so sensitive to her needs that if she is hurting and tired and asks him to take her to the stairs, he’ll lead her to an elevator instead.

We humans are starting to understand how important you other animals are to our health and comfort. We’ve learned that pets make us less lonely, and may even help us live longer. We’ve begun to use therapy animals in hospitals and nursing homes, because humans who won’t respond to another person will often open up to the affection offered by a dog or a cat. We’ve learned that when we need to put some of our fellow humans in giant cages called prisons, because they’ve done bad things, having you there keeps them calmer and happier. Cats in prisons don't judge the people who pet them, and many prisoners now help train guide dogs. This work gives both prisoners and puppies someone to love, and allows both to be useful.

You teach all of us about unconditional love. Sometimes I wonder if you aren’t actually little pieces of God wrapped in fur -- or feathers or fins or scales -- who come down to Earth, as Jesus did, to show us what’s important. In today’s Gospel reading, Jesus says, “I thank you, Father, Lord of heaven and earth, because you have hidden these things from the wise and intelligent and have revealed them to infants.” In one of our human languages, the word “infant” literally means “non-speaking.” Like human infants, most of you can’t produce words that we understand, but that doesn’t mean that you don’t communicate. Like our own young, you teach us to love, and you teach us to accept love, and you’re very good at making your needs known. We know when you’re hungry and when you’re tired; we learn to recognize when you’re ill. We just wish that we were better at understanding you, so we could make you happier. And, like very young humans, you know many things that supposedly wiser people have forgotten and need to learn again: how to live in the moment, how to enjoy simple things, how to play.

Eight centuries ago, St. Francis urged all of you to praise and love God, but I suspect that here, too, you could give us lessons. Anyone who has watched a dog frolicking in the snow has witnessed pure joy and praise. Last spring, my husband and I went to Hawaii, where we saw humpback whales: mothers and calves who, based on their ecstatic leaps out of the water, were surely delighting in God’s creation. I once read a story about a woman who came downstairs one Christmas morning to discover that her cat had left a dead mouse among the camels and wise men in the creche. The cat, she told her friends, must have brought the finest gift it could imagine to the Baby Jesus. A few years ago, my husband and I came downstairs on Christmas Eve to find that one of our own cats had left a baby bird lying neatly at the foot of the stairs. Our cat was deeply hurt by our distressed response to this Christmas gift, but I’m sure that God looked into the heart of the giver, and understood.

So when we bless you, please understand that we’re really thanking you for everything you’ve done to bless us. Please be patient with us as we continue to learn more about you, about ourselves, and about the astonishing world God has given all of us. And please continue to teach us how to praise our Creator very much, and always love him.

Emergency Baptism for Everybody

On August 3, I wrote this post complaining about the fact that I hardly ever see chaplains on TV medical shows like ER or Scrubs. (I also complained about other medical-show cliches, like the Fallacy of the Uncrowded Code Room.) Yesterday, my friend Claire added a new comment to that post, part of which I'll quote here:
I almost never watch broadcast TV, much less an ER that isn't a rerun, but I did last night (9/28 already) and I'm sure you'll be gratified to know there WAS a chaplain in the episode! A mother called for the chaplain to join the OR team for emergency surgery on a teeny distressed preemie baby from the NICU (we won't say whose!) because the father had wanted to have the baby baptized and the outcome looked so iffy. My predictible plot-meter suggests there had previously been conflict between the parents over whether or not to baptize, but I missed the beginning so can't say for sure.

Anyway, the chaplain appeared in the OR scenes, all scrubbed, gowned and masked just like everybody else except he was praying over a big black book with with a big cross on the cover conspicuously displayed in the shot. He MAY have had some kind of purple vestment on over the scrubs, can't remember for sure.
I asked Claire, "Was the big black book scrubbed, too?" I've never been in an OR, but I'm pretty sure that a non-sterile Bible wouldn't be allowed in there, and I'm positive that non-sterile vestments wouldn't be. (If I'm wrong about any of this, I'm sure someone will correct me!)

While I'm glad that ER finally got around to including a chaplain, it sounds as if this episode perpetuated three more fallacies, two small and one large:

1. At least where I volunteer, chaplains don't lug Bibles around. In the Spiritual Care Department, there's a big box with bound copies of the Psalms and the New Testament, like those Gideon Bibles you find in hotel rooms. Sometimes I'll ask if an ER patient would like one of these, and if the patient says yes, I'll run upstairs and get one. But I don't carry them as a matter of course. I carry a clipboard case with pens, my cell phone, prayer cards, packs of tissues -- my #1 most-in-demand item -- and pretty plastic rosaries made by other volunteers (also often greatly in demand: an indigent patient once asked shyly for four of them to give to her family as Christmas presents).

2. Vestments are liturgical garments worn during church services. Nobody wears them around the hospital. Chaplains who are ordained will often (not always) wear a clerical shirt and collar, but vestments are different: heavy, hot, jaw-droppingly expensive, and strictly ceremonial. Those puppies cost the world to clean, and you definitely don't want to get hospital goop on them.

3. Okay, here's the biggie: you don't need a chaplain to baptize someone. Here are the emergency-baptism instructions from page 313 of the Book of Common Prayer:
In case of emergency, any baptized person may administer Baptism according to the following form.

Using the given name of the one to be baptized (if known), pour water on him or her, saying:

I baptize you in the Name of the Father, and of the Son, and of the Holy Spirit.
That's it. Water and an invocation of the Trinity: that's all it takes. In a real emergency, if clean water isn't available, you can use saliva, although I trust that would never be necessary in a hospital.

If you don't know if the person's been baptized, say, "If you are not already baptized, Name, I baptize you in the Name of the Father, and of the Son, and of the Holy Spirit." If someone who's been given an emergency baptism recovers, the baptism should be recognized at a public celebration of the sacrament in the patient's faith community, with appropriate clergy presiding. In that case, the full baptismal rite will be performed, except that the water won't be administered again. But all baptized people can perform emergency baptisms: relatives, friends, nurses, doctors, security guards, volunteers, other patients.

I've never had to do this. I was only asked to perform a baptism once, and that was a joking request by a young man who was in the ER for something like a sprained ankle, and certainly wasn't in dire peril. I told him that if he was serious about wanting to be baptized, he should find a faith community and have it done there. Baptism recognizes someone as part of the Body of Christ, which means that ideally, there will be as many other members of the body in attendance as possible.

But I could and would do an emergency baptism if I had to, and so could all kinds of other people. While some patients (or their parents) might prefer clergy to perform the rite, it isn't always possible to find an ordained minister on short notice. If I were performing an emergency baptism for someone who was distressed that I wasn't clergy, I'd probably say something like, "I have a hunch that God cares much less about those little white collars than people do. Jesus wasn't clergy, either, but He loved everybody, no matter who they were or what they wore. Baptism is an assurance of God's love and forgiveness."

Actually, I strongly suspect that God also cares much less about baptism than people do, but an emergency baptism is an act of pastoral comfort and reassurance, and I'd never act dismissive of it to someone who requested one.

So now you know: if you've been baptized, you, too, can perform an emergency baptism! I hope that most hospital personnel, especially NICU nurses, are already aware of this. But if you weren't before, now you are.

(Note: if you haven't been baptized and there's no one around who has been, I suspect that the love and compassion you'd display by performing the rite would outweigh any theoretical risk to your soul or the soul of the patient. This is assuming, of course, that performing the rite wouldn't offend your own beliefs. Distraught patients and their loved ones probably aren't going to ask you to whip out a baptismal certificate. But I'm on truly heretical ground here, so you never heard me say this.)

So now can we get that non-sterile Bible out of the OR, please?

Friday, September 29, 2006

Heaven and Earth, Horatio

I've always been an empiricist, skeptical about mysticism, miracles, and anything that can't be verified, quantified, and reproduced under laboratory conditions. It's not that I don't want to believe in such things, but until I'm given convincing evidence to the contrary, I'll almost always assume that any given "divine intervention" is really the product of individual imagination and wishful thinking. This doesn't lessen its power one iota for the person who experiences it, but it does mean that most so-called "miracles" don't shake my faith in a universe governed by the laws of physics. Sure, I write fantasy, but that's fiction.

My religious conversion was a very long and winding process, but part of it involved a good six months of impossible things happening to me every day, encounters and coincidences so wildly improbable and grace-filled that the laws of physics couldn't even begin to explain them. Most of these events were small -- for instance, I'd dream about a very specific object that would then arrive on my doorstep, a gift from a friend I hadn't told about the dream -- but when several of them happen to you every day, over a period of months, you begin to have a healthy respect for the fact that there's something at work in the universe other than the laws of physics.

During this surreal interlude, I came to believe that these small daily miracles were God's way of breaking through my intellectual defenses. It worked. I'd been given empirical proof of grace and divine love, evidence I couldn't possibly ignore. Once the lesson had gotten through my thick skull, things gradually went back to normal. On the whole, this was a relief. The surreal interlude had been a bit too much like living in The Twilight Zone; it was wonderful, but also scary, exhausting, and isolating, because I couldn't talk to most people about what was happening to me. They'd either look at me like I was crazy or try to rationalize and dismiss my experiences, so I quickly learned to stay quiet.

Having gone through the surreal interlude, I now believe in miracles. But I'm still fairly allergic to conventionally pious religious language about prayer, angels, and divine providence. Although I can quote the famous definition of faith as "the evidence of things not seen," my preferred route to faith is still evidence.

This is one reason I like volunteering in an ER. Emergency-medicine people are the ultimate empiricists: they trust numbers and believe in results. There's very little time or space in an ER for sentimental pieties. Time and time again, I've seen empirical proof that prayer comforts patients and makes them feel better, but because I'm liable to be shoved aside at any moment by the medical team, there's no room in my prayers for fluff or cliches. (A few medical caregivers will wait for me to finish a prayer, but most won't; nor do I believe they should. In an ER, physical medicine takes precedence.) I have to get to the meat of the matter, to pray for the patient's deepest needs and desires, and to do so in the most authentic language I can muster. Prayer in the ER isn't about Sunday-school platitudes. It's about reminding patients that a real, loving God is present to and with them even when -- especially when -- they're ill, in pain, terrified, angry, bleeding, smelly, and otherwise in no shape to attend a church service.

The stories patients share with me tend, likewise, to be about their bedrock beliefs and experiences.

And many of these stories are about mysticism, miracles, and divine interventions.

I've heard more ghost stories and near-death narratives than I can count. There's the guy who died and saw his dead aunt waiting to welcome him. Okay, so that could just be wishful thinking. But what about the woman who almost perished in a fire and described to her rescuers exactly what they'd been doing while she was unconscious without a heartbeat? What about the patient, driving a long distance to meet her best friend, who felt her friend's soul pass over and through her like a gust of wind, and arrived at her destination to learn that indeed, her friend had unexpectedly died? What about the person who died, came back, and now can't walk through a hospital without feeling the pains and illnesses of the patients? Who'll call a friend and say, "Is your foot better?" without having been told that the foot was injured? Who sees recently departed spirits and points them in the right direction, and who once woke from an exhausting dream of doing this for hundreds of lost, bewildered souls, only to turn on the television and discover that the Twin Towers had just collapsed?

The people who tell me these stories don't sound crazy. They're perfectly matter-of-fact about this stuff. They have everyday lives, jobs and families. Sometimes they'll say, "Well, I know a lot of people wouldn't believe this, but you're the chaplain, so I can talk to you about it."

Multiple patients have told me about difficult times in their lives when they were approached by strangers who said, "I have a message for you from God." This might sound nuts, except that these strangers proceeded to describe the patients' life situations in detail, and then assure them of happy endings. And the happy endings happened. And we aren't talking about finding the perfect dress on sale: we're talking about medically impossible cures from cancer.

And then there are the times when patients have had messages for me. Like the time when a gorked-out patient no one thought was even coherent opened her eyes, looked up at me, and said, "You're in pain, but it will be all right." And I was in pain, but nobody else had picked up on it, because I was keeping up a brave front. All right, so that could just be an uncannily sensitive patient. But then there was the time when a patient told me a long, beautiful story about a childhood mystical experience that ended in fear and darkness, until God's voice said, "Don't be afraid of the darkness; there's love there, too." And a few days later, something happened that sent me into one of the darkest times I've known, and it lasted for months, and one of the things that got me through it was repeating that mantra: "Don't be afraid of the darkness; there's love there, too."

Was that a message from God, or just coincidence?

There's no way to prove either theory. But I'll tell you this much: after spending several years talking to ER patients, I now believe in all kinds of things I once would have dismissed as impossible. My work in the small, cramped rooms of the emergency department has shown me a universe that is infinitely large, wild, and full of wonders.

Thursday, September 28, 2006

Questions, and a Reminder, and a Link

I've had Vera VAIO since last December. Yesterday, I plugged her in to recharge her battery after the flight, but it would only recharge to 84%. It stayed at 84% all day. I was very annoyed; I thought the $200 battery had died on me and that I was going to have to buy another, less than a year after buying the computer.

But today, the battery charge is back up to 100%. Weird! Does anyone have an explanation for this?

Also: I'm trying to track down one of the latest cover versions of The Kinks' song "Better Things." I've recently heard it on the radio as a bright, bouncy pop tune sung by a female vocalist, and I'd like to find that version so I can buy or download it. Does anyone know the name of the singer or the band?

Also, how does one insert an audio file into a blog so that readers can click and listen? One of the hosts of Grand Rounds did this, providing a soundtrack for the edition, and I'd love to include the latest version of "Better Things" in Carnival of Hope.

Speaking of which, remember to get your submissions to me by 5:00 PM Pacific Time on Thursday, October 12!

And, finally, the mass-market paperback edition of The Necessary Beggar is up on Amazon for pre-order! All the same words as the hardcover, at a fraction of the price! Although you will have to wait until March to read it.

Wednesday, September 27, 2006

Our Personal Lepers

This week's Grand Rounds included this post arguing for better and more compassionate treatment of sex offenders. Last winter, I gave a homily connected to this topic, so I thought I'd post it.

I preached this homily on February 12, 2006. The readings are 2 Kings 5:1-14 and Mark 1:40-45.

* * *

On January 26, 2006, just a few weeks ago, a group of twelve world leaders -- including Jimmy Carter, Desmond Tutu, and the Dalai Lama -- issued “a Global Appeal to End Stigma and Discrimination Against People Affected by Leprosy.” Leprosy is one of the world’s oldest and most dreaded diseases. The first known written mention of it is dated 600 BC. Untreated, it causes terrible deformity, and for most of its long history, there has been no remedy. Because everyone knows that leprosy is highly contagious -- and because for centuries people believed that lepers were being punished by God for their sins -- lepers have typically been shunned by their communities. They have been outcasts.

In 1981, the World Health Organization discovered a cure for leprosy: a combination of three drugs that, if given early enough, also prevent deformity. The treatment makes the illness completely noncontagious, although it turns out that leprosy is not highly infectious. What “everyone knows” is wrong. Since 1995, the World Health Organization has provided free treatment to all leprosy patients, resulting in dramatically reduced disease rates. In 1985, there were 5.2 million leprosy patients worldwide. At the end of 2004, there were 286,000.

With all this progress, why did twelve world leaders need to issue a global appeal? Well, because community attitudes about leprosy have not kept up with medical knowledge. In too many places, people continue to believe the same things about leprosy they’ve always believed. A news article about the appeal describes the problem: “social attitudes continue to destroy lives, forcing even cured persons into lifelong isolation. The result is a vicious cycle; people who contract leprosy hide the disease until disfigurement appears. Disfigurement reinforces social stigma.” All leprosy patients have to do is take some medicine, but the medicine can’t work if no one knows it’s there, or if the people who need it are afraid to come forward to ask for it.

This morning’s Scripture readings are about the healing of two lepers, about the miracle of a cure from the illness long before the advent of the World Health Organization. These cures, like the cure offered today, seem deceptively simple. All Naaman has to do is wash seven times in the river Jordan. All the leper in Mark has to do is ask Jesus for healing and accept the touch of Jesus’ hand. But when we look at these stories against a background of social stigma and isolation, the cure from leprosy starts to seem less miraculous than the fact that these two lepers were willing to come forward, willing to name their illness and ask for help.

Naaman, the mighty warrior, had community support in seeking help. His wife’s servant told him about Elisha, the prophet who could cure him. His lord gave him a letter of introduction to the king of Israel. When this powerful patient actually became annoyed at the simplicity of the treatment, his servants scolded him and told him to take his medicine. Naaman had a lot of help from people who loved him despite his disease, who did not stigmatize and isolate him.

We know much less about the leper in Mark. He comes to Jesus alone, already isolated. He says, poignantly,“If you choose, you can make me clean.” The leper believes that Jesus can cure him. But he also knows that Jesus might not offer the cure. Jesus may not think the leper is worth it. Jesus may not choose to spend precious healing resources on this wretched outcast.

Jesus, of course, does the right thing, and sends the cured patient off to the Temple to be declared clean by the priest there, to be received back into the community.

This morning’s readings are third in a series of healing miracles from Mark. We’ve heard healing stories for the past two weeks, and we’ll hear another next week. All of these miracles occur in the context of community. Last week, Sherry talked about how we become co-workers with God when we pray for healing. But we also become co-workers with God when we work to end stigma, when we refuse to make anyone an outcast. If we choose, we can offer the healing of acceptance, of a loving community that points people towards the resources they need and urges them to take their medicine. But to do that, we have to believe that they’re worth helping.

There aren’t many literal lepers in the United States, but there are certainly people who struggle with stigma. The poor, especially the homeless poor. Prison inmates, especially sex offenders. Alcoholics and drug addicts. Last October, Congress heard testimony from the American Bar Association about stigma against addicts. Republican congressman Jim Ramstad said, “One of the hardest steps for any addict or alcoholic to take is to ask for help.” Drug offenders, even if their crimes were non-violent, are often barred from receiving student loans, food stamps, or subsidized housing. In 2004, 178,000 young people were denied education benefits because of drug convictions, even though education is one of the key elements of overcoming addiction. After all, everyone knows that addicts, especially if they’ve been in prison, can’t be trusted and aren’t worth helping.

When my husband read this homily, he said that comparing criminals to lepers doesn’t make sense. Lepers have an illness they haven’t chosen. Criminals end up in prison because they’ve made bad choices. What’s happened to them is their own fault. And this is true. But if they want to make better choices and we choose not to help them, where does the fault lie then?

If someone came to St. Stephen’s and said, “I’m a convicted drug offender, but I’m trying to do better and I want to be part of your community,” what would we choose to do? What would Jesus do? If your personal answer is that of course you’d welcome this person, because you know that addicts can and do recover, then dig deeper. Who wouldn't you welcome? Who are the people you’d fight tooth and nail to keep out of this place? Who are the people you just know can’t be trusted and don’t deserve the healing gift of community? When you’ve answered that question, you’ve found your own personal lepers -- and believe me, we all have them. But once we’ve learned where stigma lives in our own hearts, we can begin to seek our own healing from it.

Stigma hurts us as much as it hurts those we cast out. It is a refusal of our baptismal vow to seek and serve Christ in all persons. By separating us from other people, stigma also separates us from God, in whose image even the least of us is made. Christians are called to follow Jesus, who was “moved by pity” when he saw the leper, who reached out his hand to touch the untouchable, restoring a despised outcast to health and community. Stigma prevents us from doing those things.

I don’t have any easy cure for this condition, but I do have suggestions, a three-part plan for healing. The first step is to pray for compassion. When have I been cast out and rejected? How did that feel? Do I want other people to suffer that way? The second step is to seek humility. What do I really know about the people I’m casting out? What does “everyone know” about them? Are those “facts” actually true, and am I willing to do the research to find out? And the third step is to claim courage: the willingness to advocate for the despised, to share with others what I’ve learned.

A few weeks ago, I was talking to someone who does prison ministry with sex offenders on the East Coast. My friend complained about the stigma and isolation these men face when they’re released. I said, “But everybody knows that sex offenders can’t really be reformed. You can’t blame people for being scared of them.”

My friend responded by sending me a link to an article on the Unitarian Universalist national website. The article noted that “there is a generally held perception that sex offenders are untreatable.” As a result, several Unitarian congregations have voted to completely exclude people with sex-offense records. The author continues: “The problem is that [the assumption] isn’t true. The review of the literature . . . shows that with treatment, the majority of sex offenders will not recommit a sexual offense.” The article also notes, in bold print, that “involvement with a faith community may actually lessen the chance that a person will commit another sex offense.” Community support reduces isolation and increases accountability.

I really didn’t want to know any of that. Sex offenders are my own personal lepers; I’d much rather simply assume that they’re hopeless and banish them. The article has forced me to struggle with how I’d respond if a sex offender came to St. Stephen’s and said, “I’m trying to do better, and I want to be part of your community.” What would I choose to do?

I don’t know. And -- even though it’s cowardly of me -- I hope I’ll never have to find out. But I have a sneaking suspicion that I do know what Jesus would do.

Tuesday, September 26, 2006

No Place Like Home

Before I forget, this week's Grand Rounds is up, and I'm once again proud to be included.

I'm back home in Reno now, with Gary and the cats and my very own messy study. I had a fabulous time in Iowa, and Inez and I are already planning a return trip, but it's still nice to be done with traveling for a while. Inez should be sending me some pictures of Ricky and the mutilated toothbrush, so I'll post those when I have them.

In the meantime, here's the post I wrote on Sunday.

* * *

I’m composing this blog entry on WordPerfect, thousands of feet in the air, somewhere between Salt Lake City and Omaha.

This morning, I was very proud of getting everything I needed into three small carry-on bags. I left my shampoo and toothpaste at home, since buying supplies in Iowa made more sense than checking luggage simply for the sake of toiletries. And so, after getting up at the obscene hour of 4:30 a.m., I piled my little bags into the car and drove to the airport, wondering what security would be like.

The lines were much longer than usual, especially given how early it was. Before we even got to the screeners, someone asked all of us if we had any lotions or gels. I said no, wondering if I was cheating by not reporting my two little containers of Lip Medex. But I did confess to having a CPAP, and was duly sent to the line for people who needed extra attention, like the couple in front of me who’d both had hip replacements.

When I put my CPAP bag on the conveyer belt, I called to the screener, “There’s a CPAP in here, so it will need to be hand-checked.”

The screener glared at me and snapped, “Thank you. I’ll take care of that when I see it on the screen.” Was it my imagination, or was he thinking, If this stupid woman hadn’t said anything, I could have just ignored it?

But since I had said something, of course I was taken aside by a screener. My Lip Medex sailed through the machine without incident, which makes me wonder what would have happened if I’d tried to sneak some hand lotion through. Lizard skin is one of the hazards of living in Reno, and my hands are especially dry because I wash them so often. The dehydrating effect of airplanes never helps.

When my CPAP’s been screened in the past, it’s been taken out, examined, and given chemical tests involving strips of paper and special readers. This morning, the screener opened my suitcase, blinked at the machine without even touching it, yawned, closed the suitcase again, and told me I could go. The entire process took about five seconds. If the CPAP had been stuffed with dynamite, he wouldn’t have known.

Now, maybe this is just because I’m so pure and innocent looking, especially when I’m not actually wearing the CPAP. (My friend Inez, when she saw the masked crusader picture on my blog, commented gleefully, “Darth Palwick!”) But the process didn’t increase my confidence in national security. Gary tells me that someone’s coined the term “security theater” to describe nonsensical security precautions that exist purely for show, to make travelers feel safer by subjecting them to baroque inconveniences. This wasn’t even security theater. This was security snoozefest. These guys weren’t even pretending to be worried.

And that, on the whole, does make me feel safer. But now I really wish I’d brought my hand lotion.

So I got to my gate nice and early, especially since my flight had been delayed half an hour. There were signs all over the place advertising AT&T wireless access for only $3.95, so I happily bought a cup of coffee and then turned on my laptop, thinking I’d raise my cybercool index by writing a blog entry in the airport. What fun!

AT&T accepted my credit card and told me I was connected. But no webpage except the AT&T ad would come up. I kept getting messages that pop-ups had been blocked, and I repeatedly turned off pop-up blocking, and the same thing kept happening. I was in AT&T hell.

And then the gate attendants made a cheery announcement that the flight delay had been canceled. “We were originally scheduled to leave half an hour late, but gosh, the plane’s here, and the crew’s here, and all of you are here, so we’re leaving now! Get out your boarding passes, folks, and dump those beverages, because you can’t bring any liquids aboard!”

A plane leaving early? Has anyone ever heard of this? I’d taken two sips of my coffee, and I had to throw it out. Added to the AT&T rip-off, that means I wasted about six dollars at the airport this morning. As airport spending goes, that’s a pittance, but it’s still annoying.

But the first flight went very smoothly, with the added bonus of a flight attendant with a flair for stand-up comedy. (“We appreciate your business, and we want your feedback. We think we’re doing a good job, but we may just be in denial.”) When she wasn’t making funny announcements or handing out water, she sat right next to me, and we had a nice chat. Before she was a flight attendant, she worked in a funeral home; she says that was great training for her current job, because it taught her how to stay calm around very upset people. We also talked about our pets: instant bonding! And I got some grading done.

So far, the second flight’s been fine too. I’m happily working on Vera VAIO, my adorable ultralight laptop -- named after Jayne’s gun in Firefly -- and listening to my favorite music on Windows Media Player, using noise-reducing headphones to quiet the din of the plane engine. (Don’t spend your money on $300 Bose headphones. I have Sennheisers, which are less than half the price, and they work fine.) Things could be a lot worse, even if my hands are dryer than Death Valley in August.

* * *

Leaving Omaha this afternoon, I didn't mention my CPAP to the screeners, and it sailed right through without any extra inspection. And, of course, water and small amounts of lotion are allowed again as of today, although I didn't discover this in time to bring any with me.

Maybe somebody's finally figured out that Security Theater is more trouble than it's worth?

Monday, September 25, 2006

The Screaming Room

Inez lent me a book by Catherine Whitmire called Plain Living: A Quaker Path to Simplicity. There's a section called "Unexpected Songs for Times of" with sections for Fear, Suffering, Despair, Death, Grief, and Hope. After this morning's news, I opened to the section about grief, and found this 1977 quotation from Carol R. Murphy:
The Hassidic Jews have a custom of going out into an open field at night to cry out all their questions and doubts to God, to go down to their basic level of faith. Possibly Jesus was doing this at Gethsemane. Today we may well take the advice of the mother of a dying child who suggested that every hospital should have not only a chapel but a screaming-room. Perhaps this should be the anteroom to the chapel, as in our hearts we have to go through the earthquake and the whirlwind before we are able to hear the still, small voice.
Much of my work at the hospital involves giving people permission to be angry. I think we definitely need a screaming-room.

On a much lighter note, my visit to Inez' class this morning was delightful, and I'm really looking forward to my reading and talk this afternoon. After the class, we had a fine lunch at the campus cafeteria -- which serves much better food than Inez and I are used to from institutional food services, although evidently the students complain -- and then came back to Inez' house so she could take a nap and then walk Ricky.

One of the cats had knocked down my bottle of antidepressants and scattered them on the living room floor. Luckily, I retrieved them all, although I've now put them in a small jar with a top that fastens much more securely.

But the cat had also knocked down my toothbrush, and Ricky must have had his way with it, because it's gnawed and bent: toothbrush by Dali!

So a new toothbrush will definitely be one of my Iowa souvenirs!


Via Electrolite, I just learned that John M. Ford has died. I didn't know him well, but we had some pleasant conversations at conventions. He was a charming man and a brilliant writer.

I also learned this morning that a long-time friend has died, a woman I knew only through the Internet and a few phone conversations. She'd been going through grueling cancer treatments for years; evidently her death was peaceful, but while it can't exactly be called unexpected, it's a huge shock. She'd been hanging in there for so long that part of me thought she'd be around forever.

My prayers go out to their family and friends.

The universe is smaller today, and only love can make it larger again.

Sunday, September 24, 2006

Planet Corn. With Cows.

I had a safe and pleasant trip to Iowa, where there's a great deal of corn. Storm Lake is a two-and-a-half-hour drive from the Omaha airport: we drove through a lot of very green scenery featuring vast quantities of corn. It wasn't as flat as I expected, and the sky and clouds were delightful, but wow: corn! Also, cows.

Storm Lake itself contains a lovely lake, as you'd expect, complete with two lighthouses. The larger of these is in the middle of a cornfield. We walked a little around the Buena Vista campus (pronounced Bewna Vista). From what Inez tells me, it sounds like a very good small school. Among other things, they give out the biggest "Best Teacher" award of any college in the country: a $38,000 cash prize and a semester off from teaching.

Inez also informs me that the local strip club in town is called "The Storm Lake Performing Arts Center." Gotta love it!

I've had a great time catching up with Inez and playing with her dog, Rickie, who's the world's best beagle. On one of the planes, I composed a long post about security measures and other things, but I can't get wireless at Inez's house, and my laptop doesn't seem to want to read her memory stick, so I can't post it tonight (I'm on her computer now). I may post it tomorrow; we'll see.

Right now, I'm in that jet-lagged state where I don't quite know what planet I'm on. Planet Corn. Yeah, that's it. With cows. And one very energetic beagle.

Saturday, September 23, 2006

Heaven Can Wait

The hospital where I volunteer doesn't have a psychiatric ward. Psych patients are held in our ER for medical clearance before being transferred to one of the local mental hospitals; this usually involves an evaluation by a psychiatric social worker, contracted by an outside agency, who comes in to talk to the patient.

The process means that psych patients often spend even more time waiting -- on gurneys, watched by a security guard -- than medical patients do. One poor soul spent a full day in our ER, waiting for a bed to become available at the mental hospital. Our security guards are very kind and compassionate to these folks; security guards may provide more pastoral care than chaplains do. A nun I know says that her best pastoral-care training was the ten years she spent as a bartender in New York before taking her vows, and security guards, like bartenders, spend a lot of time listening to unhappy people.

The psych population includes suicidal patients, and these cases always get referred to me. I think some of the medical staff aren't quite sure what chaplains do, and plenty of pastoral-care needs aren't obvious to them anyway: patients tell me about things -- family crises, recent bereavements -- that they won't mention to doctors or nurses. But if someone's dying, or if someone has come in wanting to die, I'll always get a heads up.

I have to be careful with these patients. I have plenty of personal experience with the issue, but I'm not a psychologist, and my old volunteer coordinator warned me that it can be dangerous to encourage patients to open up before they've seen the social worker, the person who most needs to hear what's going on with them. Many of these patients don't want to talk, anyway, and some who do are dealing with such overwhelming tragedy that if I were in their place, I'd probably want to die too. "All three of my children were killed in a car crash, and then my wife left me, and then I lost my job." In cases like that, I'm always intensely grateful for the professionals, and for the existence of hospitals that can keep people safe. I pray with such patients and tell them I'll be praying for them; I tell them that I'm glad they're alive, and that I want them to stay alive. I always hope that telling me their story has somehow made the grief a little more tolerable, but I'm rarely under any illusion that it actually has.

Over time, though, I have developed three strategies that are often helpful. I offer them here, in case anyone else can use them.

1. I always ask suicidal patients how they got to the hospital. Most of them either called 911 or called a doctor or therapist who called 911. In those cases, I'll say something like, "That means you got yourself here, and you should be incredibly proud of yourself for doing that. You did what you needed to do to get yourself somewhere safe, and you did that under really difficult conditions. When you're so depressed that you don't want to live anymore, calling 911 is as hard as walking to the hospital on a broken leg would be." If the patient's someone especially likely to feel stigmatized (homeless, an addict or an alcoholic), I'll add, "And you did what you needed to do to survive even though it meant coming to a place where you're scared people will look down on you. That takes a tremendous amount of courage."

Suicidal patients, by definition, are usually filled with despair and self-loathing; they consider themselves helpless, hopeless, and contemptible, and assume that everyone else sees them that way too. They often see being at the hospital as further proof of their incompetence. Turning that around -- telling them that getting to the hospital is an act of heroic strength -- often means the world to them. I can see it in their faces: they respond with wonder and gratitude. "I never thought of it that way. Thank you."

2. Sometimes suicidal patients ask me if I believe that suicides go to hell. Others have told me, "I know God loves me and won't condemn me, and I hurt so much, so why can't I go to heaven now?" I've heard quite a bit of anecdotal evidence that belief in a loving, nonjudgmental God can actually increase the risk of suicide. And many patients who've lost loved ones, especially children, want to rejoin them.

I don't believe that suicides go to hell; my personal theology is that we all wind up in the presence of God, and that our feelings towards and relationship with God will determine whether being there feels heavenly or hellish. So when this issue comes up, I say, "I believe that God loves all of us and welcomes all of us when we die, but I don't believe in leaving early. Heaven isn't going anywhere. If you die a natural death in another thirty years, surrounded by friends and family, you'll go to the same wonderful place you'd go to if you died now. But if you go there now, you'll never know what wonderful things might have happened here that you'll never get to experience, or what good work you might have done here that God needs you to do."

This is the theological version of that time-honored strategy, "Just stay alive for one more day. You can always kill yourself tomorrow." With luck and grace, some tomorrow will be better. As the hotlines say, suicide is a permanent solution to a temporary problem. This approach, like the first, helps patients turn the situation around, helps them see it a different way. They almost always nod. "I never thought of it that way. Thank you."

3. I always emphasize to suicidal patients -- and more generally to other psych patients -- that depression and other mental illnesses are real, physical maladies, not signs of personal weakness or wrongthink, and that they're treatable. "You're feeling so down right now partly because your brain isn't working right: you literally can't see any hope. That's not your fault. It's biochemistry, and you need to take medicine to fix it, just like you'd need to take insulin if you were diabetic. If you can just wait for the meds to start working, things really will look better."

With one patient, I used the "walking to the hospital on a broken leg" analogy and then said, "You're looking at your life with a broken brain right now, but the good news is that it can be fixed." A passing nurse gave me a very startled, disapproving look, but the patient reacted with delight. "A broken brain! No one's ever explained it to me that way. That's so helpful. Thank you!"

Another patient had gone off anti-depressants at the insistence of her AA group, which condemned all mood-altering drugs. I've heard this before, and it infuriates me. Nobody takes Prozac to get high, and most antidepressants aren't addictive. They just don't work that way. Most of the doctors I've talked to believe that addictions begin as self-medication for underlying mental illness: if that's true, telling people not to take their psych meds greatly increases the risk that they'll go back to alcohol or street drugs. I asked that patient, "If you were diabetic, would your AA group tell you that you couldn't take insulin?"

She nodded. "Yeah, you're right. That's kind of crazy, isn't it?"

As with all patients, the time I spend listening to suicidal patients probably means more than the time I spend talking to them. But I'm glad to have found some things to say that seem to be helpful, and I hope others can use them. As they say in twelve-step programs, "Take what you liked, and leave the rest."

Friday, September 22, 2006

Scattered Updates

Thanks to everyone who commented on my previous post with prayers for my father. He's back home; I just talked to him. It turns out that he stayed in the ER overnight and was released this morning, with new meds, by a doctor who wants the family to keep an eye on him this weekend and wants to see him back on Monday. Between the uncomfortable gurney and the noise, Dad spent a very sleepless night in the ER, but did have a fine time talking to a nurse who's a fellow sailor.

His main annoyance at the hospital stay was that he'd gone to the VA to have a driving test so he can be approved for an electric scooter. The test was canceled when the doctor saw his EKG and sent him to the ER instead. So after being discharged from the ER, Dad went and doggedly sat outside the driving-test office for an hour or so until someone showed up, and managed -- with the help of a very nice patient who let Dad have his appointment -- to get himself into a slot today.

Dad's 84 and taking a bewildering array of medications; his eyesight's none too good, and he'd gotten no sleep. Predictably, he didn't do well on the driving test, but he did talk the examiner into letting him take it again a week from Monday, when he'll be better rested and will have new glasses.

Have I mentioned that my father's a force of nature? If I'd spent a sleepless night in an ER, I'd go straight home and go to bed, not camp out at another hospital office to reschedule a test! (What do you want to bet he gets that scooter?) I hope I have half his energy when I'm his age!

Meanwhile, I was very moved by this story about music as a treatment for schizophrenia. (Thanks to Nickie for the link!) It's a lovely article anyway, but it was especially welcome after my previous post about the frustrations of trying to communicate with delusional patients at the hospital.

And in writing news, the cover flats for the mass-market paperback edition of The Necessary Beggar arrived a few days ago:

It's always a thrill to have one more piece of evidence that a book's inching towards publication! This one will be on sale March 6, 2007.

As for me, I found the lab this morning and got through my two meetings later on. I also swam, which made me feel much better. But I've still gotten almost no grading done, so I'd better get to it!

Thursday, September 21, 2006

Two, Four, Six, Eight: Time to Hyperventilate!

On Sunday, I'm flying to Iowa to do a class visit, reading and talk at Buena Vista University, where my friend and former student Inez teaches. So I'm trying to get ready for the trip, plus I have two meetings at school tomorrow, plus I just got a new set of freshman-comp papers, plus I'm buried under a ton of other paperwork and committee work and general clerical insanity, plus I'm behind in every other part of my life, plus I didn't have time to exercise today.

So I told myself I'd grade until nine and then watch some Veronica Mars with Gary to relax. Patrick Nielsen Hayden describes VM as "Buffy Methadone." So far, we don't like it as much as he does, but it's diverting, and we're interested enough to keep watching.

I dutifully sat at my desk and shuffled papers -- didn't grade any, but at least got them organized -- and then remembered that I also have to go for routine bloodwork tomorrow morning, and I'm not sure where the lab is. That led to a Google search for the lab, with very unhelpful results, which had me feeling even more frustrated.

I sat there trying to figure out why I was so phenomenally scattered, even for me, and then remembered: "Oh, yeah, Dad's in the hospital."

I got an e-mail from my sister right before my 4:00 class today; Dad had been having some erratic heart rhythms he thinks were caused by a new medication, but when he went off the meds, the cardiac stuff kept happening. Today he went to the VA for a routine check-up, and they were concerned enough to send him to the ER, where somebody decided he should be sent up to the ICU for overnight monitoring -- not because he's in dire peril, but because the ICU is the only place they can do that kind of monitoring. (Huh? The Philly VA doesn't have a telemetry unit?)

Anyway, my father had called my sister's house and told my mother all this. (My parents have been divorced for decades; Mom lives with my sister, and Dad has an apartment.) Mom passed it on to my sister Liz when Liz got home from work; Liz e-mailed me to say that she'd called the hospital but they'd never heard of Dad, so she had no idea where he was.

I called the hospital. The main operator, sure enough, had no record of him, which was puzzling until I figured out that he was probably still in the ER and hadn't been admitted yet. I called the ER; yes, he was there, and I got to talk to him. He sounded fine and said his heart had slowed down from 120 to 70, which sounds pretty good to me. He didn't know if they were still planning on sending him to the ICU.

After I talked to him, I called Liz back and explained the situation to her; then I raced to class, taught my class, discovered after class that I'd locked my keys in my office, luckily found a janitor to open the door for me (since it was after hours), and came home.

And proceeded to get no work done. But I think I'm going to forgive myself for having jangled nerves tonight, and just give up and watch an episode of VM.

What do we do in times of stress? We blog, of course. And then we watch DVDs.

Change of Shift, with Nurse Chapel!

There's a terrific edition of Change of Shift, the nursing blog carnival, up over at kt living. Thanks for including me!

My personal favorite from this edition, for reasons that I trust will be obvious: Confessions of a Closet Trekkie.

Yes! More evidence to prove to my students that Star Trek is inspiring stuff! Hooray!

And to round out your medical reading for the day, check out this article on Slate about the legal and ethical intricacies of blood-alcohol testing in the ER. Thanks to Eagle-Eyed Gary for pointing me to the article (and for many other things, of course!).

And now I must bid my beloved blogosphere adieu and go do class prep. I woke up with a headache, which doesn't bode well for the rest of the day.

Maybe I'll take some Tylenol before I start the class prep. Yes, I think that would be a good idea.

Wednesday, September 20, 2006

Illusionists vs. Trekkies

A few days ago, Gary and I went to see The Illusionist. It's a gorgeous movie, and we really enjoyed it until the last ten minutes, when it turned into one of those "now we're going to explain how nothing you saw was what you thought you were seeing" movies. This kind of narrative has become very popular lately: The Sixth Sense did the same thing, and the Harry Potter books make a similar move. Rowling's novels tend to feature thirty-page denouements in which one character explains what was really happening during the preceding 600 pages; what was really happening is invariably very different from what the reader has been led to believe.

This kind of ending annoys me. It makes me feel that my faith as a viewer or reader has been betrayed; it leaves me feeling tricked, rather than entertained. This is why I discourage "surprise ending" stories in the writing workshops I teach. I tell my students that their job as writers is to create trust in the story they're telling, not to showcase their own cleverness by breaking that trust.

When we got home from seeing The Illusionist, I had e-mail from a friend who'd been taken in by one of the latest cases of Munchausen by Internet, and who was very distraught about it. Someone had told a long, elaborate story about personal tragedy, and my friend -- and others -- had believed it and been affected by it, only to discover at the end that it was all a lie, that the people and tragedies they'd been mourning had never existed at all. My friend's comment was, "The lesson here is that no one's what they seem to be."

I answered by saying that most people are what they seem to be, and that fraudulent narratives do their greatest damage by destroying our trust in everything, by creating the nagging fear that maybe nothing we see or hear is really what it claims to be. This isn't just an Internet phenomenon: a few years ago, my parish was thrown into turmoil when we learned that a trusted leader had been behaving unethically, and lying to close friends and church officials about that behavior, for months -- or maybe years. The people who'd been closest to him repeatedly said things like, "Now I wonder if I ever really knew him at all."

This kind of deception destroys our faith in everything. It makes us feel as if we can't trust the ground we're standing on. It makes us wonder if anything is what it seems to be.

Now, granted, films and novels are fictions, "untrue" stories. We all know that. But I don't think the proper job of fiction is to encourage us to doubt reality. I think the job of fiction is to give us new ways to understand and engage with the real. Some of the most culturally persistent fictions give us hope that reality can be different, that we can work to change the world around us, or at least that we can have a positive effect on that reality. These fictions, no matter how seemingly outlandish, create trust and faith rather than demolishing them.

Enter science fiction and fantasy. I talk here about some of the reasons academics are uncomfortable with these genres, and especially with the world-changing aspects of them. I've written here about my own life-altering history with Star Trek. The Lord of the Rings has had a similar effect on people. This article by Chris Mooney includes a poignant anecdote about Tolkien's effect on the real:
In 1972, when Greenpeace leader David McTaggart sailed into a French nuclear testing area -- thereby triggering the launch of the organization -- he wrote in his journal: "I have been reading The Lord of the Rings. I could not avoid thinking about the parallels between our own little fellowship and the long journey of the Hobbits into the volcano-haunted land of Mordor...."
In my freshman-comp course this semester, I'll be showing GalaxyQuest, one of my favorite stories about belief in story. The Thermians in the movie mistake fiction for reality, and proceed to make the fiction reality by patterning themselves after it.

As an introduction to GalaxyQuest, yesterday I gave my students this article by Ronald Moore, the writer for Battlestar Galactica, about how Star Trek changed his life. Then I showed the first half of Trekkies, the documentary about Trek fandom. (This turned out to be a good move, since many of my students are completely unfamiliar with Star Trek. Wow, I feel old!) The film profiles some very hardcore fans, including Barbara Adams, the Star Trek juror.

My students responded with hilarity and astonishment. Many of them thought the fans in the film were just too weird for words. "These people have a problem. They think the show's real!"

One student disagreed: "They know it's not real. They're doing this for fun."

It seems clear to me that most of the fans, including Barbara Adams, do know that the show's not real; at the same time, though, they want the values of the Star Trek universe to be real, and they're going about the project of making those values real by living them out in the world. Their fandom goes beyond mere fun, as valuable as that can be; they're making a statement of faith. They believe in the values upheld by the story. They also believe in the real world. They believe that they can change the real world for the better by acting in accordance with the story. For some of them, that includes wearing very colorful costumes in courtrooms and at the supermarket.

There are obvious parallels to more conventional faith communities.

The Trekkie approach will earn you a lot more mockery than existential doubt and dread will. But if I have to choose between an Illusionist and a Trekkie, I'll take the Trekkie any day.

Tuesday, September 19, 2006

Kids Know What Makes Them Barf

Herewith, a good nurse/bad nurse story from the dark ages.

In 1968, when I was seven, I had two operations in the same year. The first one, to remove my tonsils and adenoids, was done at Big Fancy Hospital in New York City, where my father and stepmother lived. I was scared, especially of shots, but a kind, smiling nurse with an alluring butterfly barrette distracted me so successfully that I didn't even realize when the needle went in. Good nurse! I had an intravenous anesthetic, so I didn't have to breathe smelly gas, and after the operation, I got to eat lots of ice cream because of my sore throat. It was about as good an experience as surgery can be.

So when I learned that I needed a second operation, this time to correct a wandering eye, I was very unhappy, but not as scared as I had been the first time. This surgery would be performed at Small Local Hospital in New Jersey, a block from my mother's house. We knew ahead of time that the anesthetic would be ether, really smelly gas: my mother helped me "train" by sniffing her nail-polish remover. I got used to that, so I thought I could handle the ether. And my doctor warned me that I'd have patches over both eyes after the operation, because he didn't want me to be scared when I woke up and couldn't see anything.

But ether is much, much smellier than nail polish remover. I fought against the mask, but the OR staff were bigger than I was, and they pressed the mask down on my face so I had to keep breathing the gas. I felt like I was suffocating.

Then I woke up. Not only couldn't I see, but I couldn't bend my arms. The doctor had warned me about the eye patches, but nobody had told me that I'd have stiff towels wrapped around both arms, to keep me from scratching my eyes. I thought I'd fallen off the operating table and broken both my arms.

I begged and begged to get the eye patches off, so I'd be able to see, and finally someone agreed. But the towels stayed. I could only reach things that were at arm's length; I had to move like Frankenstein's monster.

My roommate was a fourteen year old girl who'd just had her fourteenth ear surgery. She had to sleep sitting up, with towels wrapped around her head. I thought she was very brave.

In the middle of the night, I had to go to the bathroom. I managed to get my call button at arm's length, and pressed it. No answer. I pressed it again. No answer. I must have pressed it five more times: nobody came. By now I really had to go to the bathroom, but I couldn't lower my own bedrails, especially with those towels on my arms. My turbaned roommate rang her call button, because we thought maybe mine was broken. No luck. So finally she got out of bed and helped me get to the bathroom.

Using the bathroom isn't very easy when your arms aren't working right. I suspect my roommate had to help me quite a bit, although I don't remember.

The next morning, my breakfast tray arrived. It was oatmeal. I like oatmeal now, but I hated it then, and it invariably made me sick to my stomach. So I pressed my call button. This time a very harried nurse showed up. "If I eat oatmeal, I'll throw up," I told her.

"Just eat your breakfast."

"But I'll throw up! I always throw up when I eat oatmeal."

"Just eat it!" she said, and went away.

I ate it. (The towels must have been off by then, or I wouldn't have been able to feed myself.) I threw up. I pressed my call button. Nurse Oatmeal came back. "Now what have you done? Look at this mess! I'm going to have to change your sheets!"

I was only seven, but I knew injustice when I saw it. "But I told you oatmeal makes me throw up! You said I had to eat it anyway!"

Bad nurse.

My parents were furious when they learned what had happened. I don't know if anyone filed a complaint. Looking back at it now, I suspect the place was drastically understaffed -- which would explain the lack of response to middle-of-the-night call buttons -- and that Nurse Oatmeal's anger at me was really anger at herself for not listening to me. At least, that's what I hope it was. Otherwise, it's really hard to explain this story.

As an adult who volunteers in an ER, I can tell you that everybody bends over backwards to be nice to kids. Adult staff feel for children (unless the kids are atrociously behaved, which only happens occasionally); they have little contests to see who can make the baby smile; they do everything humanly possible to make pediatric procedures easier. ER staff know that children hate having their arms immobilized for easier IV access. I've seen nurses give a child's teddy bear a matching arm splint and IV so the kid will have company (and this is in a department where there's very little time to do anything extra). When a child's howling, being held down for a blood draw or a shot, everyone's miserable.

These are ER staff. They aren't working on a peds ward. They didn't go into medicine specifically to work with children, but they still do everything they can to follow the Butterfly Barrette model.

Nurse Oatmeal, presumably, had chosen to work on a peds ward. Or maybe she hadn't? Maybe she'd just been assigned there? Maybe she'd been called in because of a staffing shortage, and that's why she was so mean? Or maybe she was a young nurse who thought she'd like peds and then found out she didn't? (She seemed old to me, but I was only seven.)

I still don't get it, even almost forty years later.

But I do know this: Kids know what makes them barf. Nurses, please listen to them!

Grand Rounds on the Tundra!

This week's Grand Rounds is up over at Tundra Medicine Dreams. Great medical reading! Gorgeous photos of Alaska! What more could you ask?

Monday, September 18, 2006

Writing Therapy

This morning I had a pleasant e-mail conversation with Rob Gierka, who wrote to thank me for my Pet Chaplain post. He's working on a book of pet-chaplain stories and would like to include mine, which of course made me very happy.

He also asked if I might want to become a pet chaplain myself. I said I'd love to, except that I don't have time and don't think I could handle the work emotionally; I can maintain compassionate detachment much more easily with people than with animals. (There's also the issue of my having dropped out of CPE, which I believe Rob requires of his chaplains.) Just writing the post about Phoebe had me in tears, and I can't read pet-loss sites without dissolving. I've comforted plenty of hospital patients who've lost pets, but I don't think I could hold it together in the presence of suffering or dying pets themselves.

Writing the post about Phoebe was certainly helpful, though, and that raises the issue of writing therapy. A lot of research has shown that writing about trauma, even for just fifteen minutes a day, helps people recover more quickly, as long as they're writing to "make meaning" of the experience and not just retraumatizing themselves. Two weeks ago, I gave my freshman-comp students this CNN article about the healing effects of writing, as a way of answering that perpetual freshman-comp question, "What good is this stuff, anyway?" I've also recently talked to several hospital patients -- one who lost a child several years ago, and another who's an abuse survivor -- about writing therapy. One of the patients said, "Hey, you know, my doctor talked to me about that, too!" The other patient hadn't heard of it, but was very intrigued and receptive.

Writing's a way of externalizing trauma, of getting it out of your head into a safe container. Writing gives you control: you were powerless when the trauma happened, but when you write, you're the one choosing what will be said, and how. Fifteen minutes a day isn't a huge time investment, and pen and paper are inexpensive, available even to low-income patients. Of course, in some cases literacy might be an issue, but I haven't encountered that yet. If I did, I might recommend some form of art therapy: fifteen minutes a day of drawing, maybe.

Last summer, PSR offered a course for people who want to use writing in healing ministries. I thought about taking it, but decided that it would be too much of a busman's holiday, and that I needed to take something that would be more purely fun. The course I took instead -- which I wrote about here, here (although a little less directly), and here -- wound up being perfect for me. From now on, I plan to take at least one art class every summer, to nourish the non-verbal parts of my brain.

But at some point, I might want to do more formal work with writing therapy. Maybe I could do writing therapy with pet owners, if I ever find myself with more free time. I've been telling people that I'll volunteer at the ER as long as I can walk, and that when I can't walk anymore, I'll volunteer at the Crisis Call Center. But the writing-therapy angle would be another option.

I guess I won't have a boring retirement!

Sunday, September 17, 2006

A Keeper

This week's hospital shift went much better than last week's. This is probably mostly because I didn't do the nursing-home service this afternoon, so I had time to swim, which -- in addition to being good exercise -- is an important centering and prayer discipline for me.

Gary's suggested that on my nursing-home Sundays, maybe I should skip church in the morning so I'll have time to exercise. I think that's throwing out the baby with the bathwater, but I might go to the early service to give myself time to get to the pool (that is, if I'm not preaching and required to be at both services). On the other hand, having to be anywhere at eight in the morning means I'll be shot by five in the afternoon, so that's probably not the best idea either.

Hmmmm. I'm going to have to work on this. At least the nursing-home service is only once a month!

Anyway, whether it was because of my swim or a different mix of patients or who knows what else, today's shift was very satisfying. I saw a patient from last week, someone I'd helped with a social-service issue; I don't often get to hear how things have gone for people, so it was nice to have a follow-up visit (although of course both the patient and I would have been happier if a second ER trip hadn't been necessary). A lot of folks requested prayer tonight. I got to spend time with an adorable baby who glommed onto me and merrily yanked on my necklace, my earrings, my glasses, and my ID badge, and then snuggled sleepily into my shoulder. I had pleasant interactions with staff, including one nurse who came up with a mock-scientific, straight-faced explanation for why I simply had to have a Milky Way bar after I'd already eaten a bag of almonds. "Almonds are very healthy, and the chocolate will help you metabolize them better."

I worked a little longer than I usually do, and when I went to take myself off the board, sure enough, I'd been erased already! But this time I gave the charge nurse a hard time about it. "Yeah, I go to take myself off the board and I'm already gone, and that just makes me feel so loved and wanted, you know?"

She was laughing. "I took you off. I take the doctors off, too. Don't take it personally." (Ah, yes, the ER mantra! "Don't take it personally!")

So it was one of the shifts when I felt like I belonged there, which means that it's one of the shifts I'll hang onto when things aren't going so well. This one was a keeper.

Keepers are important. They're what keep me going back.

Saturday, September 16, 2006

The Masked Crusader!

Blog readers! Do you suffer from constant fatigue? Do you doze off during the day? Do significant others and housepets refuse to sleep in the same room with you, because you snore loudly enough to shake walls and rattle windows? Do people who've heard you snore report a characteristic pattern of increasingly loud snoring, ending in a choking gasp?

If you answered "yes" to these questions, then you, too, could be suffering from a sleep disorder!

The best-known sleep disorder is apnea, a potentially life-threatening condition in which patients stop breathing during their sleep. The brain alerts the body to wake up and breathe; the body dutifully obeys, interrupting sleep. As a result, the patient will be exhausted in the morning, but won't remember ever having woken up. In addition to creating sleep deprivation, a serious condition all by itself, apnea greatly increases the risk of heart attack and stroke.

Gary and I learned about apnea when his mom was diagnosed and started using CPAP (Continuous Positive Airway Pressure), a machine that blows pressurized air through a mask into your nose so your airway will remain open and you'll keep breathing. Because we were educated about sleep disorders, we had a good hunch about what was going on several years later, when I began suffering from severe daytime fatigue, combined with increasingly dramatic snoring at night.

Based on my symptoms and Gary's description of my snoring, my doctor was convinced I had apnea. When I went for my sleep test, it turned out that I didn't have apnea; I have a similar but less serious condition called Upper Airway Resistance Syndrome (UARS). My airway narrows when I sleep, but doesn't close completely. My sleep is still interrupted by "wake up!" messages from my brain -- an average of sixteen times an hour, according to the sleep test -- but I don't stop breathing. This is a Good Thing.

The treatment is the same, though. Yes, that's a picture of me in my CPAP mask at the beginning of this post. My sister took the photo two years ago during a summer roadtrip, during which she memorably described the CPAP headgear as looking "like a cross between a vacuum cleaner and a jock strap." Pretty glamorous, huh?

But I feel so much better on CPAP that I've now become an absolute evangelist for sleep testing. I recently exhorted a friend to have it done; it turns out that she has severe apnea, and in the month or so that she's been on CPAP, her blood pressure has gone down to its healthiest level in years.

Visiting my father a year or so ago, I became convinced by his snoring, and his daytime fatigue, that he had apnea and should be tested. He talked to his doctor at the VA, but because he couldn't describe his own symptoms very well (we can't hear ourselves snore!), they didn't give him the test. So this summer, I wrote a letter to his doctors describing his snoring.

It worked. They gave him the sleep test. He called me a week ago to report that he indeed has apnea; we were both very excited by this news, because starting on CPAP could make him feel so much better. Because the VA moves slowly, he has to wait a while for the equipment, but he's feeling hopeful about the outcome.

Yesterday, he called me with the official results of his sleep test. According to the VA, 5-15 sleep interruptions per hour indicate a mild disorder; 16-30 indicate a moderate disorder, and anything over 30 is severe. My father had an average of fifty interruptions an hour. And he's already had heart trouble and one mild stroke.

I can't tell you how happy I am that I said something!

So if you have these symptoms, or if someone you love has these symptoms, please, please, please look into sleep testing!

Q: If I think I have a sleep disorder, what should I do?

A: Consult your doctor. The first step will probably be bloodwork to rule out other possible causes of fatigue, like thyroid problems. If everything else checks out, you'll be sent for a consultation with a pulmonologist. Bring a significant other with you! If you don't have a significant other, set up a recorder next to your bed so you'll have a tape of your own snoring. As my father's case illustrates, it's very important for the doctor to hear the testimony of someone who's actually heard you snore.

Q: What's the sleep test like?

A: Oh, it's very entertaining. You show up a few hours before bedtime at a lab with a bunch of bedrooms. Techs spend forty-five minutes or so hooking you up to so many wires, monitors, belts and microphones that you look like someone getting ready to go up in the space shuttle. (Really, I wish I had a picture of myself wired for the sleep test.) And then they tell you to go to sleep.

All the wires and monitors are pretty lightweight, and the labs invest in good beds, but many people still have trouble sleeping. Part of the problem is that sleep labs, by definition, are filled with people who snore really loudly. Before my test, I was told that if I showed signs of apnea, I'd be woken up halfway through the night to be fitted with CPAP. At that point, I desperately wanted CPAP, so I lay awake, listening to the building vibrate from other people's snoring. Periodically somebody's snoring would stop, which meant that person had been woken up and fitted with CPAP. I finally dozed off . . . and was woken up and fitted with CPAP, to my great joy!

And then I woke up and discovered that I wasn't wearing CPAP. I'd never been wearing CPAP. I wanted CPAP so badly that I'd dreamed about getting it. I went home literally weeping with exhaustion and frustration. Luckily, it turned out that all the wires and monitors had picked up proof that I had UARS, so I got my CPAP anyway.

Q: But isn't CPAP, well, uncomfortable?

A: It can be. The biggest challenge is finding the right headgear, but there are lots of different kinds -- ranging from simple nasal cannula, like oxygen tubing only thicker, to full-face masks -- so you'll have a wide range of choices. If the first thing you try doesn't work, don't give up! Your medical provider will work with you on this.

I have a very small head, and wound up having to wear a pediatric mask. It took me about a month to figure that out and to find headgear that worked for me. During that month, I was frustrated and miserable. Since then, I've been very happy.

Q: But isn't having to deal with the machine a pain in the neck?

A: No, not really. It's quite small, and very quiet and easy to clean, and there are even battery-powered models for camping. Plane travel's a bit of a hassle, because the machine has to be carry-on. (Do not put your CPAP in checked luggage, because it will get thrown around and will break. I'm speaking from experience.) Also, CPAP machines often have to go through special tests at airports to make sure they aren't bombs. But the folks who work at security see hundreds of these machines a day, so they're friendly and sympathetic. They don't really think CPAP machines might be bombs, but their bosses do. The screeners are just doing their jobs. And you may have a chance to encourage your sleepy security screener, whose wife complains about his snoring, to go get his very own sleep test. You could be saving a life!

Q: Yeah, yeah, yeah. But, come on . . . you know! Doesn't it, doesn't it interfere with -- oh, you know! Doesn't your husband hate it that you're wearing this thing that looks like a cross between a vacuum cleaner and a jock strap? And doesn't that, um, ah, have a negative effect on your marriage?

A: Oh! So that's what you really wanted to know!

No, CPAP does not interfere with recreational intimacy. I wear CPAP when I'm asleep. My husband and I engage in recreational intimacy when we're awake. Sleep deprivation has a far more negative effect on recreational intimacy than CPAP does.

Gary loves my CPAP, because I don't snore any more.

Or as the sign in my pulmonologist's office puts it:

"Laugh, and the world laughs with you.
Snore, and you sleep alone."

So, all you snorers, what are you waiting for? Go get that sleep test!

Friday, September 15, 2006

Random Acts of Love

On September 8, a Portland ER nurse named Susan Kuhnhausen returned home from work to discover an intruder with a hammer in her house. She proceeded to strangle him with her bare hands. I learned about this from GruntDoc. Moral of the story: Don't mess with emergency nurses!

But it turns out there's more. The intruder had been hired by Kuhnhausen's ex-husband to kill her. GruntDoc reports on the story here, and includes a link to an Oregonian article that includes Susan Kuhnhausen's new voicemail message:

"I'm not able to answer all the calls that I've received. I'm being comforted by your concern and your support. I want you to know that our lives are all at risk for random acts, but more likely random acts of love will come your way than random acts of violence.

"I would encourage you all to follow guidelines for home security and personal safety and security. I love my neighborhood. This is my home. I feel safe here. Thank you all so much."

We're all at risk for random acts of love: how wonderful is that?

And how true!

Thursday, September 14, 2006

Carnival of Hope: Volume 1, Number 1

Welcome to the first Carnival of Hope! I'd like to thank everyone who sent me posts, whether or not I used them. Reading through all the submissions was a very heartening experience for me, and I hope you'll have the same reaction to the final edition!

I'm still getting the hang of formatting, and putting the carnival together was much harder than I expected, so this first go may be rather rough. Please bear with me as I learn. If anyone out there with lots of carnival experience -- that would be you, Kim! -- has advice for me, please share it. In the meantime, I'm delighted to have found this photograph of a flower pushing through a concrete sidewalk; I plan to use it as the Carnival of Hope logo from now on. It reminds me that seemingly small things can possess enormous power.

Nickie from Nickie's Nook knows something about pushing through barriers. She reminds us of the power of persistence (and prayer) in her very moving post about learning to work with a guide dog, Never Forsaken. Facing yet another physical challenge, this one involving chronic pain, she discovers the healing effects of Just A Few Words.

The supportive presence of friends can indeed make the difference between a lousy day and a great one, as Karma explains in Get By With A Little Help From My Friends Part II from JewBuQuest: From Abuse to Happiness. Your Faithful Blog-Carnival Editor reveals the dark roots of her Disgusting Cheerfulness, and advocates small steps that can have big effects on chronic depression, in Making a List. Checking it Twice. And Keagirl, the blogging urologist of UroStream, likewise attests to the great power of simple steps -- this time surgical ones -- in Happy day.

Elsewhere in the hospital, ER nurse Kim of Emergiblog offers us a sobering look at the importance of hope to family members in Where There Is Life, There Is Hope. The end of hope, Kim says, is the beginning of shock and grief: a terrible moment, although it's one we will all experience at one time or another.

Certainly most of us cling to hope as long as possible, especially when it comes to the illnesses of those we love. None of us would choose to suffer, or to watch those we love suffering. And yet the compassion created by shared pain can overcome seemingly insurmountable distances and "bring the world closer," as Amanda of Imagine Bright Futures tells us in her beautiful post Empathy.

If you're looking for a lighter way to make the world seem like "a smaller, friendlier place," Suite 101's Jennifer Miner recommends that you join her in Geocaching with My Portable GPS. But if you're geocaching and encounter a sign that says, "Not a Through Road," have faith and don't turn back! That's what Will Shetterly of It's All One Thing learned from Today's Inspirational Message.

Yet another way of bringing farflung people and places closer is the goal of the National Geographic All Roads Film Project, "showcasing breakthrough film and still photography from indigenous and under represented minority cultures around the globe." Thanks to Lee of Chrysalis Dreams for sending me that link! And closer to home, Lee describes the comfort and wonder of ordinary, everyday routines in her lovely post Comics and Ritual.

How do we cope when our everyday peace is shattered, when our sense of safety is broken? Each of us can decide to respond with vengeance -- or with love. I have to admit that I've avoided most of the 9/11 anniversary tributes, because they're too painful. But I can only find hope when I read about a mother whose message to her firefighter son, killed at the World Trade Center, is, "We know you're telling us to smile more." Tracy Coenen of FRAUDfiles Fraud Blog shares this story in A tribute to John Patrick Tierney. "This was my contribution to the 2,996 Tribute, in which one blogger honored each of the the 2,996 victims of 9/11."

Post-9/11, Violeta's proposal at Questallia to make each day Forgiveness Day couldn't be more timely.

And yet forgiveness can be very hard-won. Sometimes it seems impossible. And sometimes our ability to forgive depends on whether we consider ourselves insiders or outsiders. Ali Eteraz, a progressive Muslim living in Europe, tells us, "That is the solution to fighting hate: make people feel like they are insiders." Be forewarned: his essay on this subject is challenging, and the comments on his post are even more so. I almost didn't include this piece, because so much of it seems to participate in the very us/them, politically polarized rhetoric I want Carnival of Hope to avoid. I'm still nervous about whether I'm doing the right thing by putting it in (and I expect that some of my readers will have strong opinions on the subject!). But reading it made me feel like that flower pushing through the sidewalk; when I kept going, I arrived at a very thought-provoking story about eleven-year-old Ali, an outsider, being defended against school bullies by two other kids who said, "We aren't all like that." I wish the defense hadn't been as brutal as the assault, but I certainly can't argue with Ali's conclusion: "The fundamental human need is one of recognition." If you haven't been scared away by this introduction, then, read The Fanatics, Not Foreign Policy posted at Unwilling Self-Negation.

Returning to gentler territory, we find Elias, an Australian teacher who grew up in the war-torn Middle East, reflecting on whether his childhood experiences have made him Grateful for Every Day? And elsewhere on Elias' blog, Ramblings of an Australian Teacher, we join him in rejoicing in the power of education, which holds out one of humanity's brightest hopes for the future, in Teaching is a Privilege.

And that concludes our first edition. The second one will be posted on Friday, October 13, surely a good day for a Carnival of Hope! Please send your posts directly to SusanPal(at)aol(dot)com, or submit by clicking on the BlogCarnival button on my sidebar. The deadline is 5:00 Pacific Time, Thursday, October 12.

Thank you for reading, and may all your hidden flowers tunnel their way towards the light!

Bits o' Good News!

So I'm feeling Disgustingly Cheerful again this morning, although it may not last long. (Among other things, I've now embarked on the Excellent Adventure known as perimenopause, which may make my moods even flakier than usual.) Here are some reasons why:

* On Tuesday I handed back my first set of freshman comp papers. I'd expected to give them back today. I told the students, "I've been teaching for almost fifteen years, and this is the first time I've ever gotten papers graded more quickly than I expected to, and that's because they were so much fun to read." Go, frosh!

* Yesterday, the copy-edited manuscript of The Fate of Mice arrived, further proof that it's really going to be a book! Woo-hoo! Oh, by the way, if you're a Famous Writer reading this -- or more famous than I am, anyway, which doesn't take much -- and you'd be willing to give a blurb on the book, could you please contact me privately? We have a couple of blurbs, but we're looking for more. I hate asking people to do this, but it's a necessary part of the process.

* Last night I discovered that I'd gotten a bunch of Carnival of Hope submissions (deadline: 5:00 PM today!) that I hadn't known about. BlogCarnival was supposed to e-mail them to me, but they hadn't come through, even though the site has my correct e-mail address. So I e-mailed the support team to describe the problem, but I figured nothing would happen, because I've had lousy luck with the support teams at websites. I e-mailed TTLB three times to see why I wasn't showing up on their site, and they never got back to me; the same thing has happened a few other places. But this morning, I had several e-mails from BlogCarnival, and they fixed the problem, and the person who did that, Denise, also wrote a really nice note about my carnival. Hey, how's that for prompt, efficient, friendly service? BlogCarnival gets an A+!

So tomorrow, the first Carnival of Hope should be posted, although I expect to be up very late tonight trying to get it organized and written. A new blogging challenge: this is what I live for.

Everybody needs a hobby!