Tuesday, October 31, 2006

Happy Halloween!

Dr. Hebert has posted a terrific edition of Grand Rounds, an homage to Poe's The Raven. ("Quoth the Intern, "Nevermore!") Nice graphic, too. I'm delighted to be included.

Gary and I love Day of the Dead artwork, so I've included some here. I'll bring candy to my classes today. Laundry permitting, I plan to wear mostly all black with orange socks, and my white-plastic-with-rhinestone-eyes skeleton earrings from Salem, MA, if I can find them. I think one of them is missing a limb, but that will only add to the effect.

I've been thinking today about my aunt, who died in June, and about my grandfather (my mother's father and my aunt's father-in-law), who died in 1987, and about his first wife (my mother's mother), who died in a terrible car accident in 1938. They're all together now, somewhere, and someday I'll be with them, too: with them and with a chain of other people whose names I don't even know, stretching back to the beginning.

When you think of death as a family reunion, it isn't nearly as scary. This is the advantage of being the baby of my generation. I'm going to have a lot of people, both known and unknown, waiting for me.

Monday, October 30, 2006

Life Lessons

There's an entire category of medical blogging known as the "things I learned from my patients" genre. You can find the great-grand-daddy of this literary form here, on a bulletin board that lists pages and pages of bizarre, self-destructive patient behavior, much of it involving drugs. These entries are very funny, but most of them are also decidedly unkind to the patients.

More recently, DisappearingJohn has been running a
Notes to Self series, which is a kinder, gentler version of this idea.

I have examples of my own -- so does anyone who's spent any time in an ED -- but I've been very cautious about posting them, because I don't want to sound as if I'm making fun of patients. I've decided to share two (from a much longer list) only because these were cases where the people involved genuinely thought they were doing the right thing; they were trying to be good citizens. So please understand that I mean no disrespect.

Animal Kingdom

Yes, we've read the books saying that if you're bitten by a snake, you should try to bring it to the hospital with you for identification, to be sure you'll be given the right antivenin. However, if you show up in the ED waiting room with a live rattlesnake, the staff will become extremely upset. (It's not easy to rattle ED staff, but a live rattlesnake will do it.) If you must bring the snake to the hospital, it should be dead. If it isn't dead when you arrive, it will be soon thereafter. If you like animals -- hey, many of us do, too -- and hate the idea of the snake being hurt (because after all, it was only defending itself), then please leave it in its natural habitat. We'll figure out some other way to identify the snake. We'll show you pictures or something.

Why God Invented Ambulances

If your buddy falls off the back of a moving vehicle at 70 mph, please, in the name of everything you hold holy, call 911. There's a time and a place for rugged self-reliance. This isn't it. Your buddy needs, at the very least, to be on a backboard and in a c-spine collar, those torturous devices that keep people's heads and necks immobilized. If you load him into the back of your car and drive him to the nearest hospital, you could cause him further injury. This is especially true if the nearest hospital doesn't happen to be a trauma center. If you bring your buddy here, the staff of this hospital will do their very best to help your friend, but they will also be making frantic phone calls to the ambulance company, requesting a Code-3 lights-and-sirens transport to the trauma center now.

Note: I've recently begun to realize that ambulances, although expensive, are probably the transportation of choice in many situations. I've driven myself to the doctor under conditions that made medical staff blanch and say, "You drove here?" In my case, we're talking only about pain so severe that I was weeping as I drove; granted, that's still not a smart idea, but these were situations where I was pretty sure that my condition wasn't going to get any worse (and, luckily, I was right).

A friend of mine recently had a small heart attack. He woke up with the classic elephant-standing-on-my-chest feeling and alerted his wife, who gave him an aspirin, piled him into the car, and headed for the nearest ED. He was talking to the ED doc within twenty-five minutes. "If we'd called an ambulance," he told me, "it would have taken longer."

"Maybe," I said, "but if anything had happened on the way, you'd have gotten medical attention. What would your wife have done if you'd had a bigger heart attack while she was driving?"

I've now decided that if I think anyone in my immediate vicinity is having a heart attack or a stroke, I'll call 911 rather than attempting transport myself. I'm sure there are other situations where ambulances are the way to go, and I welcome comments on the subject.

Update: I just found these guidelines from the American College of Emergency Physicians about when to call an ambulance.

Sunday, October 29, 2006

Life Imitates Art

I'm halfway through the Shelter copyedits and two-thirds of the way through the freshman-comp papers, and I've even done some prep for my fiction workshop on Tuesday. So I won't be spending tomorrow frantically trying to catch up on heaps of grading I didn't do over the weekend: this is A Good Thing, especially since I'm always tired after my Sunday-night hospital shift, which means that Monday is rarely my most productive day.

Today I'm not even attempting to get grading done. Sundays are reserved for church, swimming, and the volunteer shift -- oh, and blogging, of course! If I try to do more than that, I'll be too tired at the hospital, and that's very definitely Not A Good Thing, either for me or for the patients I'm visiting. If I ever get back on a Monday-Wednesday teaching schedule, I'll reclaim my Thursday evening volunteer shift (that is, if the person who inherited it from me is willing to switch). That worked much better all the way around.

In the meantime, I'm happy to report that I like Shelter, or at least the parts I've reread so far. It's not a perfect book by any means, but I'm not ashamed of it. I'd do some things differently if I were writing it now, but I'm not, and that's fine. The whole project's been surrounded by so much dread and loathing for so many years now that I'm deeply relieved to discover that there's a credible novel in there.

Gary pointed out yesterday that reviewers will inevitably try to trace a progression from Flying in Place to The Necessary Beggar to Shelter, when in fact Shelter came before TNB (and parts of it were written even before FliP). It's certainly a characteristic Palwick novel, containing all my usual obsessions: trauma, secrecy, family, grief, homelessness, social justice. (Now that description just makes you want to rush out and read it, huh?) A few months ago, I was talking about it to Jacob Weisman, my editor at Tachyon, and he laughed and said, "So does this book contain Rickety Contrivances of Doing Good?"

Yep. You betcha. Big time. John Clute will not be amused.

Oh well.

Or, actually, maybe John Clute will be amused, because one of the SFnal ideas in the book is that self-sacrificing compassion has been labeled "excessive altruism" and declared a mental illness, and is now treated with gene therapy. One of the main characters is desperately trying to avoid this treatment, and goes through all kinds of contortions trying to convince her parole officer that she's acting from self-interest, rather than inappropriate selflessness.

There's also some new, more unusual stuff in the book, like an AI based on Mister Rogers (who used to be considered too geeky for words, but is newly cool now that he's dead and an object of nostalgia).

What fascinates me is how the book reflects my present interests in ways I couldn't have predicted when I was writing it ten years ago. There's a big plot piece in which another character's struggling with how to practice ministry. This isn't Christian ministry per se; I wouldn't have called myself Christian yet when I wrote those chapters. Those parts of the book were, however, very heavily influenced by my reading of Matthew Fox, which is what got me started on the path that ultimately led me to church. But a lot of the book takes place in hospitals and other healthcare settings, and an important minor character shows up in one scene as -- you guessed it -- a hospital chaplain. When I wrote that stuff, I never dreamed that I'd ever be a chaplain myself.

Jacob, intrigued by this, said, "So do you think you got the chaplain stuff right? Would you write it the same way now?" For the most part, yes, I would. There are a few incorrect details that I'll revise on the copyedited manuscript, but I think I got the gist of the pastoral visit right.

So is this life imitating art, or what? The easiest explanation is that I was expressing interests I wasn't fully aware I had, and that writing about them primed me to become involved in them in real life. But the book also contains a very traumatic terrorist incident, and I wrote it before 9/11, even though everyone who reads it now will think it's a post-9/11 book.


Likewise, I wrote TNB in 2002, when the immigration debate hadn't yet heated up to anything like its current levels. That book now seems prophetic in ways I really wish it weren't.

I was chatting about all this to a colleague at work, and she laughed and said, "Well, isn't that what science fiction is supposed to do? You're clearly in the right field."

Actually, no; science fiction is always really about the present, not about predicting the future, but that's a more complicated argument than I was going to get into with her. So I said, "I guess so. But from now on, I'm only writing happy books."

As if! If it doesn't contain grim stretches of gloom and depression, along with those signature Rickety Contrivances, it's not Palwick.

Saturday, October 28, 2006

A Halloween Questionnaire

Since I'm itching to blog but don't have much time, here's a little questionnaire I'm hoping lots of people will answer. (Yes, this is a naked plea for comments.)

Favorite Halloween costume?

When I was ten or twelve, somewhere in there, my mother made me a bat costume with very convincing wings. But since I also had a hat with ears, and since my mother had drawn whiskers on my face, most people mistook me for a cat until I stretched out my arms. Then they thought I was a flying cat.

It was still a great costume, though.

And then there was the year, in my early twenties, when I dressed up as Samurai Editor, with a vaguely Japanese-looking bathrobe, a plastic sword, and a copy of Strunk & White stuck in my belt.

Some of my students would still agree with that one.

Favorite Halloween tradition?

When I was growing up, my mother had a Halloween party every year where she transformed my bedroom into a haunted house, complete with a sheet mummy on the bed. The best part of this was tactile: she put out bowls containing peeled grapes (eyeballs) and cold spaghetti (monster guts). Kids love stuff like that. She also read us ghost stories while holding a flashlight under her face, which made her spookier than the stories.

Most exotic place you've spent Halloween?

In 1988, I went to London for the World Fantasy Convention, always held in late October. On October 31, I took the train from London to Edinburgh. We pulled into Edinburgh at dusk, arriving through fields dotted with bonfires. (It was a lot like the Loreena McKennitt song All Souls Night.) Once I'd checked into my hotel, I took a "Haunted Edinburgh" tour, featuring extras dressed in white sheets who periodically made scary noises and rushed out at us. When one of these apparitions ran out to confront me, gibbering and waving its hands, I gibbered and waved my hands back, and the ghost started to laugh. At our next stop, a cemetery, I saw that ghost or another one (who can tell, with the sheets?) hiding behind a tombstone, and I waved. The ghost waved back.

It's very important to make friends with ghosts.

Friday, October 27, 2006

Big Book

Yesterday's mail brought the copyedited manuscript of my third novel, Shelter. This is the book I started writing in 1988, sold to Tor in 1994, finally turned in to Tor in 2001, and finally finished after getting revision instructions in 2003.

This is the book that taught me never to write a book under contract, because the pressure of having accepted money for an unfinished story gives me the mother of all writer's blocks.

This is the book that tried the patience of my husband, my editor, my agent, and everyone in the immediate vicinity who had to listen to me whining about it for more than a decade.

This is the book that was first listed as "forthcoming" in 2003, and that since then has seen several supposed publication dates come and go. This is the book Gary's taken to caling my "posthumous novel," because we'd both begun to believe that we wouldn't live to see it published.

So this past winter, when Locus once again listed it as forthcoming, with a pub date of June 2007, I was cautious about getting my hopes up. When the ad copy on the back of the mass-market paperback flats of The Necessary Beggar -- forthcoming in March! pre-order now! or if you don't want to wait, you can buy the hardcover! -- also listed the pub date for Shelter as June 2007, I was somewhat more optimistic, but still guardedly so. "I'll believe it when I see the copyedited manuscript," I told Gary.

Copyediting is the first step in the actual publication process. The manuscript is sent out for copyediting, and then sent to the author to have copyediting changes approved and queries addressed; the next step after that is bound galleys. A good copyedit is worth its weight in gold. Copyeditors not only fix usage or grammar glitches (of which, to give myself credit, I have very few), but put in typesetting marks and edit for consistency. Copyeditors will pick up problems that nobody else has noticed. Gary and I have been over this book a million times, and so has my editor, but the copyeditor caught some chronology problems and corrected some of the dates in the very complicated story.

Bless you, copyeditor!

So, anyway, I finally have the copyedited manuscript, and it says that the pub date is June 2007, so I'm finally starting to believe it. Yeee-hah! Next year will be quite the year: story collection coming out in February, the mass-market TNB coming out in March, Shelter coming out in hardcover in June. (Gosh. Maybe I'm really a writer?)

The downside is that I have to get the Shelter manuscript back to Tor by November 6, which for practical purposes means that I need to have it done by a week from today. And I know I'll have to make some additional minor revisions, in addition to approving changes.

The manuscript is 687 pages of very small type. Quoth Gary: "A brick of a book! A doorstop of a book! A book to kill cockroaches with!" I have my work cut out for me. I did the prologue and the first four chapters last night. That leaves twenty-eight chapters to go.

In the meantime, I also have a fresh batch of freshman-comp papers to grade by next Thursday. I use a somewhat unusual system where every student doesn't have to write every paper, which usually has the happy effect of spreading out my grading. Only nine students had to hand in the paper due yesterday, but eighteen of them chose to. I was really impressed -- my freshman-comp class rocks -- but I do have to admit that the timing could have been a little better. (And yes, I know that eighteen papers is nothing; I have a friend who teaches five comp classes a semester, and I can't imagine how the grading gets done. I have nothing to complain about!)

Oh, and I'm preaching a week from Sunday, which means the homily has to get written at some point.

So if I blog less often than usual over the next week, I hope you'll forgive me!

Thursday, October 26, 2006

Big Love

Last night, Gary and I watched the first two episodes of Big Love, the HBO series about a Utah man, Bill, who has three wives. Patrick Nielsen Hayden had recommended it, and I'm happy to report that so far, we like it much better than Veronica Mars. I'm always interested in stories about misunderstood or demonized populations, and so far, Big Love's doing a good job of showing that Bill's three families truly consider themselves one family -- and try to live that way, certainly not without strain -- and that polygamous cults living in isolated compounds can be very creepy indeed. Bill grew up in such a cult, and his parents and brothers are still there; the show establishes an effective contrast between his sunny, suburban, hectic life and the very unpleasant things happening back in The Compound.

Meanwhile, since they live outside Salt Lake City, Bill's family is under a certain amount of pressure to become active LDS members. These are invitations they have to resist, since the mainstream Mormon church outlawed polygamy in 1890, and the family's understandably anxious to stay under the radar.

Patrick, whose wife Teresa grew up Mormon, tells me that the show's quite accurate and believable, specifically in its depiction of The Compound. One of these days I'll get around to reading Jon Krakauer's Under the Banner of Heaven, which is about exactly this kind of fundamentalist, polygamous Mormon sect.

At an academic conference a few years ago, I met a historian who was giving a paper on Mormon cemeteries. She explained that when the Mormon church outlawed polygamy, the decision was extremely painful to many polygamous families: they'd set up those arrangements believing that they were following God's will, but then the church changed its mind and told them that they weren't lawful families anymore. The problem, of course, was that in many cases, they genuinely loved each other: they felt like real families whether they were recognized as such or not. Having to sever or hide such relationships -- having to pick only one wife and set of children from three, for instance -- was very traumatic for everyone involved.

This historian said that in many cases, the polygamous relationships can be detected in the arrangement of burial plots: families no longer allowed to acknowledge their loved ones in life did so in death.

Gary and I are looking forward to watching more of the show, although I do have to say that one of our initial reactions was, "Wow, that looks complicated. We're really glad to have only one spouse!"

Wednesday, October 25, 2006

Making Sure They Know

Several months ago, I responded to a code at the hospital and found a scene straight out of some medical drama. The patient was in asystole -- which means no electrical output from the heart -- but the code team labored mightily, with CPR and everything else they do, and it worked.

People don't come back from asystole very often. That code team knew their stuff.

And then it turned out that the patient was DNR.

DNR, for those of you who don't hang out in hospitals, means "Do Not Resuscitate." It meant that the patient had filled out a legal form requesting that heroic measures not be taken in the event of a code (no breathing or no heartbeat). DNR means, "If you find me dying, let me go."

The subject of advanced directives and living wills is more complicated than I'm qualified to address, although I can tell you that they're important. These documents tell medical caregivers your wishes in the event of any number of medical situations. If you're in a coma, do you want to be on a ventilator? Do you want fluids, tube feeding, antibiotics, blood transfusions? Who has your power of attorney if you can't make your own decisions? And so forth.

These documents vary from state to state, but all of us should file them. (Gary and I haven't, yet; we don't have a regular will, either. Do as I say, not as I do.)

But back to DNR. For obvious reasons, if medical personnel aren't absolutely sure that someone's DNR, they'll resuscitate. If someone's coding and the information isn't right there, the default is resuscitation. The patient I just described was being transferred from one part of the hospital to another, and his records hadn't quite caught up with him when the code started. Likewise, I once saw a nursing-home patient brought into the ER, after having been intubated by the ambulance crew in the field, because the nursing-home staff panicked: that patient had a DNR order on file, but in the oh-my-god-she's-not-breathing terror of the moment, anyone who knew that forgot it, and anyone who didn't know forgot to check.

This is very hard on families. It's one thing to have accepted that your loved one doesn't want heroic measures. It's another to see your loved one on a ventilator in the ICU, after heroic measures have mistakenly been taken, and to have to make the decision to turn off the machines.

An ER nurse I know says that this happens all the time. The DNR's on file, but the people who need to know that don't. Hello, heroic measures.

I was thinking about this the other day, and it occurred to me that there should be something you can wear on your body if you're DNR, something an ambulance crew will find right away. And, sure enough, Medic Alert will store your advanced-directive information and link it to your bracelet or necklace. (I'm not quite sure from this webpage if they'll actually put "DNR" on the jewelry itself.) In the meantime, I wonder if hospitals put color-coded wristbands on DNR patients, the way they do on patients who are likely to fall. I'm sure somebody does this. If not, it would be a good idea.

This sounds ghoulish, I know, but in the long run, it's kinder to everybody.

Tuesday, October 24, 2006

Grand Rounds, and CoH Call for Submissions

This week's Grand Rounds, the medical blog carnival, has been posted over at Health Care Law Blog. Thanks to Bob Coffield for including me! I'm looking forward to reading all the posts.

Last night I was talking to my friend Alex, and he said, "I still don't know what a blog carnival is." So for anyone who's puzzled about this, a carnival is a blog post providing links to many other blog posts on a specific topic. Grand Rounds is for medical posts, and Change of Shift is for nursing posts. There are many different carnivals; to learn more, click on the BlogCarnival box on my sidebar, which also links to recent carnivals.

And that brings me to my call for submissions. Here's the description of my own monthly carnival, Carnival of Hope:
There's a lot of bad news in the world right now, and all of us need reasons to keep going. Please share stories of good deeds done, good deeds received, enlightened corporate policies, satisfying volunteer work, unexpected compassion and empathy: the moments when love replaced fear, when an enemy became a friend, when the darkness lightened, even if just a little bit. Please note: I am looking primarily for posts describing firsthand personal experience. Also, I will not accept submissions that insult, attack, or demonize other people, or that claim to find hope in the victimization of other people. This is not a forum for "us versus them" rhetoric. Let's remind each other how much good there is in humanity, along with all the less pleasant things.
The next Carnival of Hope will be posted on Friday, November 10. Because November is when Americans celebrate Thanksgiving, I'm especially interested in posts about gratitude. The deadline for submissions is 5:00 PM Pacific Time on Thursday, November 9. You can either use the BlogCarnival submission form or e-mail me directly at SusanPal (at) aol (dot) com. Please include the permalink to the blog post, the blog URL, your name, and a brief description of the post.

November 9 is two weeks from this coming Thursday. That gives you a little over two weeks either to write a post for the carnival, or to browse your archives and find an old one. I've already gotten three submissions, and hope to get many more.

Please let me hear from you!

Monday, October 23, 2006

Recent Chaplain Sightings

Gary and I just finished watching the second season of Battlestar Galactica on DVD. Neither of us watched the original series, which from all indications was hilariously cheesy, but we adore the remake. From the miniseries through the first half of the second season, it didn't have a weak moment. There were a few wobbles in the second half of the second season, but the show's still smart, complicated, and thoughtful. It's that rarest of creatures, especially in visual media: character-driven SF. All of the actors are terrific. The writing's great. The show's visually stunning, and not just because it features the world's scariest robots. (I'm a big fan of scary robots, so BSG does it for me.) Gary ranks it second only to Buffy on his all-time great TV list; although I'm more attached to Buffy, I think BSG is more consistent.

/Begin digression./

One reason I find BSG so interesting is that it addresses faith issues. The treatment of religion feels a bit perfunctory and predictable -- monotheistic Cylons bad, polytheistic humans good -- but at least the show acknowledges that faith is important both to societies and to individuals. One of Buffy's great weaknesses was that, for all its crosses and dealings in the metaphysical, it never really explored belief. Any whiff of organized religion was an unerring indication of villainy; even after Buffy had been to heaven and back, she and the Scoobies never talked about what that experience meant. The Buffyverse contained an infinity of hells and demons, but only one heaven, apparently unpopulated. All the Good Guys were incarnate, and variously doomed. This cosmology reminds me more than a little of Lynda Edwards' heartbreaking article about the spiritual beliefs of homeless children in Miami. (And those kids seem to have been influenced by Buffy, since "the Chosen One" is part of their vocabulary.)

/End digression./

So the other night, Gary and I were watching the BSG episode where Chief Tyrol assaults Callie after she wakes him during a nightmare. Terrified at having hurt someone he loves, he asks for religious rather than psychiatric counseling. In comes a chaplain.

And what a chaplain! Okay, so this guy's methods are a tad unconventional -- he says flat out that prayer is useless and that the gods don't exist, and seems better suited to interrogation than pastoral care -- but he certainly gets the job done. In about thirty seconds, he cuts through Tyrol's post-traumatic fog, figures out the problem ("You're afraid you're a Cylon"), and tells the Chief how to fix it by letting other humans love him. And he's funny. "Of course you're not a Cylon, because I'm one, and I've never seen you at any of the meetings."

He leaves Tyrol gaping in shock. Gary and I were gaping in shock, too. "Dang," I said. "He's good." (Of course, if I ever talked to a patient like that, I'd lose my volunteer gig, but never mind.)

And then it turns out that he is a Cylon.


Meanwhile, back on planet Earth, I just found an organization called Corporate Chaplains of America. They operate on the premise that since many Americans don't attend church, but do spend a lot of time at work, workplace chaplains can be an important source of support and counsel in times of individual or family crisis.

Unfortunately, they only hire Christians. Although they emphasize that they're non-denominational and can minister to workers of any faith, or none, there's still an evangelistic undertone that makes me nervous. Nonetheless, it's a great idea. I can think of a number of times in my brief, unhappy New York corporate career when I really could have used a chaplain, and I wasn't even religious in those days.

Sunday, October 22, 2006

The Sordid Underbelly of Site Meter

Like many bloggers, I adore Site Meter. This is a free service that tells me how many hits I've gotten, where they're from, and how many pages the visitors read. It tells me how long visitors stay on the site. It tracks visits by entry pages, exit pages, and outclicks. Every week, Site Meter sends me e-mail with weekly traffic statistics: visits and page views broken down by day and by hour. The service gives me the ISP and IP address of each visitor and will even tell me the resolution of the visitor's computer monitor, although I'm not quite geeky enough to know what I'd ever do with that last bit of information.

Site Meter has given me renewed and sobering respect for issues around Internet privacy. I know more about some of my visitors than they might wish. If you're a frequent visitor to the site, even if you never post a comment, I have a picture of you in my head. There are people who come here every day, sometimes several times a day, whom I recognize by city and IP address.

If you're in this category: hi there, and thanks for visiting, and please post a comment sometime!

Let me say again that the version of Site Meter I use is a free service. If I upgraded to the paid version, I'd probably know what all of you had for breakfast.

One of Site Meter's most useful features is the ability to track visits by referral. If someone else has linked to my blog and you clicked on that link to get here, Site Meter will give me the referring URL. This is why I submit so regularly to Grand Rounds and Change of Shift; my Site Meter stats tell me that hits from those carnivals produce most of my traffic. Site Meter is also a much faster way to find links to my blog than the Technorati "blogs that link here" service, which sometimes lags days behind.

But here's the kicker: If you got here via an Internet search, Site Meter will tell me what search engine you were using and what you were searching for. If you type a phrase into Google and my blog comes up and you come here, Site Meter will give me the search phrase.

There's someone in Rochester, New York who's visited every day for months after doing a Google search on "palwick rickety." (Rickety Palwick is much more apt, of course, and would also work.) Lately I haven't seen Mr. or Ms. Rochester on my locations list, but a visitor from Los Angeles has been coming here, about as often, after doing the same search. This makes me wonder if someone recently moved from Rochester to L.A.

Meanwhile, I've gotten visits from people searching for information about critical-care nursing, about the Kathy Augustine case, about knitting. Some of the Google search phrases are truly poignant and hint at much larger stories. I've gotten hits on my "Heaven Can Wait" post from people searching on "Do suicides go to heaven?" I once got a hit on my HIPAA post from someone dong a Google search on "How do you know if someone can keep a secret?"

Site Meter is not keeping your secrets. Know this.

And some of those search phrases are pretty skanky.

After I posted my "Gormless Brigade" story, I had a run of hits from people who'd been searching for information on a particular kind of medical examination done with a particular kind of instrument. (Take Elvis. Add a P in front. Remove the S at the end and replace with a C. Got it? See how I'm trying to avoid further Google hits on this phrase? As for the instrument: take speculative, cut the "ative," and add "um.")

Okay, so it was probably predictable that I'd show up in some unsavory searches after that particular post, but what surprises me is how many people are deeply fascinated by this piece of medical equipment. A disproportionate number of them live in Scandinavian countries.

I couldn't make this up if I tried.

I have the very strong hunch that most of the people doing this particular search were men. (And there were even less appealing search phrases, which I'll spare you.) All I have to say, guys, is that nobody who's actually had one of these exams enjoys it, okay? Some of us tolerate them better than others, but it's nobody's favorite ten minutes in a doctor's office. As for that piece of medical equipment, if I never saw another one in my life, I'd be a happy woman.

And then, a few days ago, I discovered a new and truly slimy form of spamming.

If I think someone has linked to my site, naturally I like to go there and see what they said. I'm sure I'm not the only blogger who does this. Sometimes people have just been working their way through Blogger and hitting the "next blog" button, but one quickly develops a sense for referrals in that category. If there's more than one hit from the same site, or if there's a hit from an archived site, it's usually an actual link.

So yesterday I found a hit from an archived site, went there -- and found myself on one of those corn-with-a-p sites featuring really improbable anatomical structures.

Yea, verily, I say unto you: Ick.

Bodies don't squick me, and I don't object on principle to corn-with-a-p sites, as long as they depict adults who want to be there, and as long as they label themselves clearly and provide a "click here to swear that you're of legal age" gateway. I do object to being blindsided by this stuff, and I think slipping it into somebody's Site Meter is unbelievably sleazy.

The ironic thing is that, of course, there's a large demand for this kind of material, which is why there's so much of it out there. There must be easier ways for these people to get traffic than sliming my Site Meter.


Saturday, October 21, 2006

The Olfactory Tour

Before I started volunteering in the ER, a group of us got a tour. The woman who was showing us around said, "The hardest thing to deal with here is the smells. You've seen it on ER and you've heard it on ER, but you haven't smelled it on ER. You're going to learn to recognize the smell of a GI bleed."

She was right. I can now sniff out a GI bleed from twenty paces, not to mention other GI problems (from both ends) and leaking colostomy bags. And then there are the patients who haven't bathed for a very long time. And then there are the people with extremely high blood-alcohol levels; hardcore drinking produces its own unique aroma.

And then there's gangrene.

Gangrene's the worst. ER staff have ironcast stomachs and noses; normally, they don't even react to smells in the presence of the patient, although sometimes they'll gripe in private. (I once saw a nurse eating an onion-laden sandwich in the meds room; I commented that he shouldn't breathe on his patients after eating it, and he snorted and said, "The way some of them smell? Are you kidding?") But one evening I walked into the ER at the beginning of my shift and met a rolling wave of stench. An EMT coming towards me, and looking rather green around the gills, shook her head and said, "You picked the wrong night to be here."

We had a patient with very severe gangrene, who wound up being taken upstairs to have his foot amputated. In the meantime, the entire ER filled with the smell of rotting flesh. The ER doc treating that patient wore Vicks Vaporub under her nose. I'd only ever seen that in the autopsy scene in Silence of the Lambs. I asked if the patient wanted to see me, and one of the nurses said, "Yeah, maybe, but wait until we get him cleaned up a bit, okay?" By the time I went into the room, the stench had decreased a little, but I have to admit that I was relieved when the patient politely declined a visit.

I felt sorry for him; patients are often much more self-conscious about how they smell than about anything else. Female patients will blithely strip in front of me, even when I offer to give them privacy. "Oh, honey, I've had seven kids: I'm not shy!" (At church, many parishioners won't even take their socks off to have their feet washed on Maundy Thursday.) But people with even a little bit of body odor will apologize for it.

"Don't worry about it," I always tell them. "This is an ER. We smell worse all the time, believe me. It doesn't bother us." And most of the time, it really doesn't; or, if it does, we certainly don't hold it against the patient.

Context is everything. In church, I can't stand incense, which supposedly smells good, but invariably makes me sneeze. We don't have "smells and bells" services very often, usually only on Christmas and Easter. One of our priests is allergic to the incense; she not only sneezes, but loses her voice, so she has a hard time saying the Eucharistic prayer if the altar's just been doused with smoke. (I always refer to this as "fumigating the clergy.") Our liturgy committee recently discussed whether to have a "smells and bells" service for All Saints, when we're doing a baptism, and I said, "Can we have the bells without the smells, please?" Our allergic priest laughed and nodded. But in the ER, I'm pretty immune to smells, even downright nasty ones.

When Gary and I were in San Francisco over Labor Day Weekend, we took MUNI to Ocean Beach. Sitting directly behind us on the train was a guy who had a strong case of "I haven't bathed in weeks, and also, I drink a lot." Gary and I sat there for a while, and I thought, Hey, I can do this. No problem. I do it in the ER all the time.

And then I remembered that I was on vacation.

So we moved. I felt funny about it, because I don't like making homeless people feel any worse than they already do, but this fellow was asleep, so he didn't notice.

Once when I was a teenager, riding the New York subway, someone with a very similar demographic and aroma sat down next to me.

Then he fell asleep. Against my shoulder.

I didn't move. I didn't want to wake him up; I felt sorry for him. Other passengers were looking at me strangely and making faces at the smell, but that was their problem.

I guess I was in training for the ER even then, although I didn't know it.

Thursday, October 19, 2006

Licensed and Ticketed

Before I forget, Kim's posted the new Change of Shift. I'm honored to be included, and look forward to having time to read the other posts.

Yesterday's snail mail brought my official diocesan preaching license, good for three years and signed by none other than the Rt. Rev. Katharine Jefferts Schori, who I believe will only be here in Nevada for another two weeks or so. I took my preaching exam, a take-home essay test, in June, so I'm very happy to have the piece of paper saying I'm fully legal. My mother had a funny comment: "You mean you've been preaching all this time without a license?" But it's okay, because I had the equivalent of a learner's permit; I was supervised by a mentor who read all my homilies before I gave them. Now I can fly solo.

And, just to prove that we should never take our licenses for granted, or abuse them, I got my second-ever traffic ticket yesterday.

For speeding.

In a school zone.

Bad Susan!

There were no kids out at the time -- which is part of why I zoned out even with the little yellow flashing lights -- so the very nice cop who pulled me over just wrote me up for speeding without the school-zone part. I like cops, who have a difficult job for which they're often underappreciated. Anyone who teaches can relate. I always thank police officers, even or especially when they're ticketing me. (I once heard a cop explain that the two most dangerous parts of their job are domestic-violence calls and traffic tickets: they never know what the driver will do when they walk up to the car.) I was careful to thank this cop after he'd given me the ticket, so he wouldn't think I was trying to brown-nose my way out of the ticket. I think he thought so anyway. Oh well.

It will, of course, be paid immediately, just like the first one was; I deserved both of them, and life's too short to spend in traffic court. Guilty as charged, officer!

The irony is that I was speeding to try to get to a doctor's appointment on time, and then of course I was late because I got stopped. I told the story to the doctor's office staff, concluding, "This just proves that crime doesn't pay," and everyone laughed. Then they told me their speeding-ticket stories to make me feel better.

Gary cracked up when he found out about it. We routinely see people going, like, ninety on local roads (although rarely in school zones): I was doing twenty-five.

Hey, over the limit is over the limit.

Wednesday, October 18, 2006

Moms, Lambs, Kids, and Cats

Here's a really old homily; I preached it on Mother's Day, 2003 (May 11). Since then, I've preached two other times on Mother's Day, and all three times, I've talked about my cats. It's now something of a parish tradition.

We're nowhere near Mother's Day, of course. I'm posting this because yesterday, Marcia responded to my post from Monday and included a picture of sheep. In her comments section, you'll find remarks about sheep and goats. There's also been some recent discussion on Marcia's blog about requirements for parenthood, and I just learned that Kim's a cat person (as so many of the best people are). So all of that made me want to post this homily.

I have to admit that this is still one of my favorites. You can also find it in Sermons That Work XII: Preaching as Pastoral Caring. The Gospel is John 10:11-16.

* * *

At one of my preacher-in-training classes, we talked about difficult preaching occasions. Mother’s Day was near the top of the list. This is a secular Hallmark holiday which preachers nonetheless ignore at their peril. If we don’t talk about it, we offend Family Values. If we do talk about it, we may cause pain to anyone who wants to have children and hasn’t been able to, or who doesn’t want to have children and has been criticized for it. We may grieve parishioners who have lost a mother or a child, not to mention those who aren’t getting along with their mothers or their children. There are lots of ways for people to feel left out on Mother’s Day.

Just for the record, I get along very well with my mother. But my husband and I have chosen not to have children. We have cats. I’ve endured my share of insensitive remarks about this decision, so I bring my own baggage to Mother’s Day.

To go along with this over-sentimentalized landmine of a holiday, we have one of the most over-sentimentalized passages in the Gospels: Jesus as the Good Shepherd. Jesus seems to have been fond of sheep, which is fitting for someone known as the Lamb of God. Today’s reading goes nicely with that other Gospel story about the lost lamb, the lone wanderer Jesus goes out of his way to find and rescue. We know we’re the sheep in these stories, and that’s comforting. After all, the separation of the sheep from the goats is one of the Bible’s images of Judgment Day. As you probably remember, the goats do not get the better end of the bargain.

But we’re the sheep, and that means that Jesus is going to protect us. We don’t have to be afraid of wolves, or of getting lost. We don’t have to be afraid of the dark. Jesus is the good shepherd who cares for us, his fluffy, adorable lambs. It’s all very cozy.

The problem here is that being reduced to a pet, or even a valuable piece of livestock, doesn’t sit well with everyone. Being compared to sheep is not especially flattering. We usually call people “sheep” if we consider them passive herd animals who can’t think for themselves. My friend Clare, a cradle Episcopalian, is deeply offended by this analogy. She thinks the Bible got it backwards. Clare is indignantly, militantly pro-goat. Goats, Clare says, are much smarter than sheep. They’re hardier. They’re healthier. They have much more personality. Take that, sheep!

Looking for arguments in favor of sheep, I did some Internet research. I was delighted to find a website put together by real live sheep farmers, complete with a list of the ways in which sheep are different from goats. Surely these people would be loyal to their own flock. Surely I was about to read a passionate testimonial to the intelligence and motivation of sheep.

Well, no. One of the items on the “sheep versus goats” list reads, “Sheep are stupid; goats are smart. We like sheep, but we wouldn’t bet money on a lamb trying to find its way out of a maze.” Score one for Clare. I also learned that sheep tend to get very dirty in very unpleasant places, and that they suffer from a lot of really yucky diseases. Lambs, however, do recognize the voices of the people who feed them, and they’re undeniably adorable.

At this point in my sermon preparation, I was on the verge of writing a homily about how wonderful it is that Jesus loves us even when we’re dirty and stupid. And this is true: Jesus does love us even when we’re dirty. He loves us even when we’re too dense to understand his parables. He loves us even when we’re not adorable. Jesus does find us and bring us home when we’re lost, wandering in the dark and the cold, and Jesus did lay down his life to protect us.

In these ways, of course, the Good Shepherd is like a Good Mother. Good mothers –- biological or adoptive -- stay loving even when their children need baths, even when their children are sick, even when their children aren’t doing well in school. Good mothers have died to give their children better lives. Good mothers search for lost children. Good mothers struggle to guide children who are trapped in mazes, in the bewildering byways of addiction, of crime, of depression. Good mothers love their children even when their children aren’t adorable.

But there’s another level here, because Jesus extends this maternal concern to creatures who look nothing like him. It’s not as if he loves the sheep because they have his own eyes or his Aunt Bertha’s nose. He doesn’t give his life for his flock out of an overwhelming instinct to ensure that his own genes, or his own name, will survive in the world. Jesus isn’t related to the sheep, biologically or by adoption. They’re not even the same species he is. He loves them purely because they’re vulnerable and need protection; he cares for them because he has promised to do so. His love is a function of his radical, unconditional compassion, even for creatures who are radically different from him.

The Bible tells us that we’re made in God’s image and that we’re God’s children. Sometimes these promises make us very anxious about our place in the family. Do we look enough like God? Are we even the same species? Do we have God’s eyes, or his Aunt Bertha’s nose? What today’s Gospel lesson teaches us is that we don’t have to look like God. That seemingly insulting comparison to sheep turns out to be a wonderful gift. The differences between us and sheep become a blessing, a reminder that nothing –- not even the much greater differences between us and God –- can separate us from the love of Christ.

Early in my conversion, I struggled with the notion that God loved me. Even though I do get along beautifully with my mother, unconditional love wasn’t something I understood very well. I was unclear on the concept. And then one of our three cats disappeared. He was our youngest cat and our biggest, the one who’d knock screens out of windows because he refused to stay inside where it was safe. He was our juvenile delinquent. Every day he raced over the fence in our yard, and every day he came home for supper. Until, one day, he didn’t.

We put up signs all over the neighborhood. Every day for eight weeks, I went to the local animal shelters, looking for him. We never found him. I grieved for months, trying not to imagine him lost in the dark and the cold, unable to outrun the coyotes. I tried to ignore comments like, “Well, he was just a cat. It’s not like you lost a person.” I prayed a lot.

And then at some point it clicked, and I realized, “Oh. I get it. God loves me the way I love my cats.” I love my cats even though they look nothing like me, and even though most of the time, they’re not quite as smart as I am. I love them even when they miss the litterbox or scratch the furniture. I love them even when they’re not adorable. I love them because they’re vulnerable and need protection, and because I’ve promised to take care of them.

This realization didn’t come to me during a cozy, sentimental moment. It didn’t come when my cat was curled in my lap, purring. It came when I was struggling with loss and failure, when I was haunted by my inability to protect a creature I loved, a lost lamb I was unable to retrieve. It came because I could not bring myself to say, “He was just a cat.”

According to writer Kathleen Norris, “One of the most astonishing and precious things about motherhood is the brave way in which women consent to give birth to creatures who will one day die” (The Cloister Walk, p. 24). If this statement makes us remember Mary’s agony on Good Friday, it also reminds us that God the Immortal Father, no less than mortal Mary, was forced to witness Jesus’ death. Love is always an act of courage. It always makes us vulnerable, but never more so than when we consent to love creatures who will surely not outlive us, whose loss is therefore unavoidable. The immortal God’s love for mortal creatures -– for cats, for sheep, for people –- is an act of astonishing grace. God’s love willingly embraces the inevitable pain of mortal suffering.

But God’s love also promises that the pain will end, that there is a place beyond mortality, beyond suffering, beyond difference. “I have other sheep that do not belong to this fold,” Jesus tells us. “I must bring them also, and they will listen to my voice.” There are lots of ways for people to feel left out on Mother’s Day -– and on most other days -– but this is God’s Easter promise to all of us. However different we may feel, from God or from each other, whatever far field we’ve landed in and whatever strange flock we’re traveling with at the moment, God loves us as passionately as the most devoted mother loves her children. We all belong to Jesus, and someday we’ll all find ourselves gathered together in that final pasture: those of us who have lambs tagging along, and those of us who don’t, and those of us who’ve chosen to bring with us, instead, a beloved cat or a particularly charming goat.


Tuesday, October 17, 2006

Pounds of Grounds at Grand Rounds

The amazing Kim, who's worked several hundred twelve-hour shifts this week, has just posted a very impressive Grand Rounds.

This week's edition has a coffee theme, and no wonder. Kim must be hitting the caffeine pretty hard, to be getting all this done! (Especially since she'll also be hosting Change of Shift, the nursing blog carnival, on Thursday.)

I'm proud to be included, Kim. Thank you.

Monday, October 16, 2006

Social Justice. With Booze.

Yesterday at church, our preacher talked about the very uneasy-making Gospel: Jesus' instruction to the young man to sell everything he owned and give it to the poor. This hits comfortable Americans pretty hard, especially since -- as the preacher cheerfully acknowledged -- most of us aren't going to do it.

I started going to church partly because my husband and I had just bought our first house, and I didn't want to get complacent about living with one other adult and several housepets in a structure that could shelter entire third-world villages. (Our house is small, by Reno standards -- 1,700 square feet -- but even so.)

It worked. I'm not complacent. But I'm not about to sell the house, either, and I have a pretty crappy charitable-giving record. I'm much more generous with time and talent than I am with money. I'm banking on being forgiven instead of being damned, which may very well be a dangerous strategy.

Anyway, among other things, our preacher talked about the ONE campaign to end extreme poverty; this fits right in with the UN Millenium Development Goals, which the Episcopal Church strongly endorses. So I've now signed on to the ONE campaign, and -- as you may have noticed -- am displaying a nifty banner on the upper-right-hand corner of the blog.

"I was hungry, and you added a nice blog button." I'm betting that earns me goat-hood rather than sheep-hood. But at least I'm spreading the word, right?

In my defense -- are you listening, God? -- I help coordinate our parish's involvement in Family Promise, a program in which faith communities house and feed homeless families, parents and kids, for a week at a time every few months. We've been a host congregation for five or six years now; in 2007, we're going to switch to being a support congregation. Our final hosting week is coming up in November, and during announcements, I asked for volunteers. I got a lot of slots filled in during coffee hour. Most of the people who came forward were regulars, but one brand new person signed up, too, and I bet the homily had something to do with that.

On a lighter note, I have to say that church yesterday mega-reinforced some stereotypes about Episcopalians. Q: How many Episcopalians does it take to change a lightbulb? A: Two: one to call the electrician, and one to mix the pitcher of martinis.

And of course, wherever you find four Episcopalians, you'll find a fifth.

I walked into the parish hall at 9:00 yesterday to discover people drinking champagne in honor of the wedding anniversary of two parishioners. "Wow, we're drinking at nine in the morning," I told our senior warden.

She raised an eyebrow, checked her watch, and said, "No, it's a few minutes after nine, so it's okay."

And then there's the communion wine. One of the things I love about my parish is that we have homemade everything. Our altar was hand-carved by a former rector (whose grandson's wife is one of our current priests). The congregation made the stained-glass windows, getting together once a week for several hours, over a period of months, to learn the skills they needed. This happened about twenty years ago, long before I started going to church, but it's one of my favorite bits of our parish history. Our communion bread is homemade by people in the congregation: none of those tasteless fishfood wafers for us, nosirree.

And our communion wine, very strong stuff, is homemade by a parishioner who runs a home-brewing company.

So during announcements yesterday, we learned that the Sunday school kids had somehow been involved in bottling and labeling the communion wine for the following year (I'm unclear on the details), and would be bringing the bottles up to the altar as part of the offertory. Sure enough, the offertory included a procession of tykes lugging bottles of wine -- sometimes nearly as big as they were -- and leaving them in front of the altar, which began to resemble the site of a really wild party.

We start them young, in the Episcopal Church.

A few years ago, a friend of mine who was about to move away rented our parish hall for her going-away party. A work friend of hers asked anxiously, "But are we allowed to bring liquor, since it's a church?"

When she'd stopped laughing, my friend said, "We're Episcopalians. We don't let you in unless you bring liquor."

Sometimes I joke that I'm in the wrong place, since I don't drink. I should be Baptist. I do take a sip of communion wine each week; some parishioners, for various reasons, don't. Our clergy have always emphasized that taking the bread is sufficient for communion.

I love our commitment to social justice, though. And I love my parish community. Yesterday a friend came up to me and said, "I just learned you won an award! Why didn't you announce it at church? We love you, and a lot of us would have wanted to be there!"

I'd announced it on our listserv, but that was a while ago. I was startled by her vehemence, but also very moved. When I'm sick and tired of church politics (which is almost all the time), or feeling fuzzy in my faith (which is too much of the time), the people are what keep me going back.

Sunday, October 15, 2006

Nix to the Knitting Needles

Last week I got e-mail from my friend Inez, who’s an avid knitter. She reported that a friend of hers had gone to the ER and discovered, in the waiting room, a basket with knitting needles, yarn, and instructions for how to make squares for a blanket. The idea, presumably, was for waiting patients to produce squares that would then be assembled into a finished blanket and donated to some good cause.

Inez thought this was a nifty solution to waiting-room boredom, and since I volunteer in an ER, she wanted to let me know about it.

My very strong initial reaction, I’m afraid, was, “Knitting needles in an ER waiting room? Are you nuts?”

This reaction may say more about me than it does about the idea. If I were a kinder, gentler person, not to mention a better Christian, I’m sure the notion would have filled my head with lovely visions of waiting patients happily knitting blanket squares as insurance against the sudden, catastrophic failure of the ER blanket warmer.

But I’m not a kinder, gentler person; I’m myself, and my four hours a week volunteering in the ER and its immediate environs -- including the waiting room -- have given me a pretty good idea of what can happen there. So instead of seeing lovely piles of warm blanket squares, I had vivid, unwanted visions of small children running with knitting needles, tripping, falling, and putting their eyes out. I saw other small children accidentally putting their parents’ eyes out. I saw the parents of screaming small children (even those with eyes still intact) threatening to use the knitting needles to put the triage nurse’s eyes out if the family’s three-hour wait didn’t end in transfer to the actual ER within the next five seconds. I saw feuding family members attempting to strangle each other with yarn, babies choking on blanket squares, and intoxicated or demented patients using blanket squares as bandages, eyepatches, or diapers.

In short, I imagined a scene out of Dante’s Inferno. The tenth circle of hell: ER waiting room, with knitting needles.

Perhaps I have too lurid an imagination? But it’s worth mentioning that my husband, who spends as little time in hospitals as possible, raised his eyebrows when I told him about the knitting idea. “Hey, how about woodworking? You can hand out lots of nice sharp cutting implements.”

I routinely give crayons and paper to cranky children in the waiting room; crayons are blunt enough to minimize the chances of accidental blindness, although I usually check with the parents first to make sure that the kids won’t eat the crayons. I once hunted down a pillow for a patient who felt so miserable, and had been waiting so long, that he was lying on the floor (the staff usually discourages this, but the triage nurse that day took pity on him). But there are reasons most ER waiting rooms are barren wastelands bereft even of magazines.

For one thing, anything that isn’t nailed down tends to walk off. This is why the television’s not only bolted to the wall, but bolted so high up that you’ll dislocate your neck trying to watch it. I’ve periodically seen lovely collections of shiny toys in various hospital waiting rooms. The toys never last long.

Secondly, people in hospital waiting rooms sometimes become extremely upset at each other, themselves, or hospital staff, and no one wants them to have anything handy that could be used as a weapon. I once saw a triage nurse act as a bouncer, charging into a family dispute where two women were screaming at each other. I’ve heard a security guard talk about relieving a patient of a large, lethal switchblade. During my ER-for-volunteers tour, we were told that ER staff routinely get jumped by patients. I’ve never actually seen this; in the ER proper, anyone who might pose a threat gets put in restraints very quickly. (Restrained patients sometimes think that because I’m the chaplain, I’ll be a kind, gentle Christian and undo their restraints. Not on your life, buddy.) But that’s the ER proper: the waiting room’s another story.

And third, there’s the germ problem. Do you really want to finish off the blanket square that a previous knitter sneezed or coughed or bled on? Sometimes people donate stuffed toys to the ER, but when we give one to a patient, the toy goes home with that child. Teddy bears can’t be autoclaved, and the ER produces enough dirty laundry as it is.

Don't get me wrong: Hospital waiting rooms are no more inherently dangerous than airport lounges or subway stations or coffeeshops. Crazy stuff can go down anywhere, and if anything does happen in the hospital, a security guard -- or a burly triage nurse -- will be there within seconds. Obviously there’s at least one hospital in the country that considers knitting needles in the ER waiting room a fine idea. Maybe when I post this, I’ll be flooded with comments from hospital personnel telling me that their waiting rooms are full of people happily playing darts and practicing small-engine repair with power tools.

Even so, I strongly advise that if you want to knit, you should bring your own supplies from home. In fact, it’s not a bad idea -- especially if you have small children -- to keep an “ER bag” packed with books, toys, coloring materials, and simple craft supplies. Being empty-handed in a waiting room can make for a very long wait indeed, and watching that TV won’t do your neck any good.

Update on 10/18/06:

Knitting in other parts of the hospital, though, can be a very good thing. Check out this article about knitting as spiritual care.

Saturday, October 14, 2006

Reaching Out

You should be old enough to walk, I think -- I don't know much about babies -- but you aren't walking. Part of that's because your leg's hurt, which is why you're at the hospital. Someone at home hurt you, so you don't live at home anymore. The state got you out of there, and now you're being cared for by strangers.

The caregiver who brings you in clearly does care about you, and so does everybody else. The registration clerk cuddles you and coos; nurses want to hold you; the doctor tousles your hair, which makes you laugh. You don't seem to be in pain. The dressing on your leg needs to be changed, which is why you're here, but you're alert, looking around. Whenever you see a smiling face, especially a woman's, you reach out for that person.

One of your arms is hurt, too.

I smile at you as your caregiver holds you, so you stretch your arms towards me and whimper imperiously until the caregiver hands you to me. As I hold you -- carefully and awkwardly, because I don't have kids and never learned that balance-the-baby-on-the-hip thing that's supposed to come instinctively to women -- you start playing with my earrings, my ID badge, my necklace. You tug on my glasses, just like every other kid your age I've ever held, just like any kid who hasn't been hurt (badly hurt, deliberately hurt) by adults.

I wonder how you can trust big people, after what's happened to you. No one's ever hurt me the way you've been hurt, and even so, I'm not as trusting as you are. I don't know if I ever have been. When people hurt me even a little bit, I withdraw, shut down, build walls. My heart is calloused, and I protect it. I believe in and talk about and try to follow a God of love, but even so, I don't stretch out my arms to other people the way you do: not even to people I know. I reach out to give comfort -- that's why I'm at the hospital tonight, after all -- but much less often to receive it. I'm too afraid that I'll be left there, reaching; too afraid that I'll be ignored or, worse, slapped away.

I recently read a fascinating New York Times article about the biology of emotional healing. It turns out that our brains "mirror" those of the people we're with, which means that our emotional states -- and resulting physical states such as blood pressure -- tend to become synchronized. This helps explain why people with large, loving networks of family and friends live longer and recover more quickly from illness, and it's why visitors are so important to people in the hospital. "Sheldon Cohen, a psychologist at Carnegie-Mellon University who studies the effects of personal connections on health, emphasizes that a hospital patient’s family and friends help just by visiting, whether or not they quite know what to say." In contrast, "Social rejection activates the very zones of the brain that generate, among other things, the sting of physical pain."

Visits from loved ones are better than visits from strangers:
A case in point is a functional magnetic resonance imaging study of women awaiting an electric shock. When the women endured their apprehension alone, activity in neural regions that incite stress hormones and anxiety was heightened. As James A. Coan reported last year in an article in Psychophysiology, when a stranger held the subject’s hand as she waited, she found little relief. When her husband held her hand, she not only felt calm, but her brain circuitry quieted, revealing the biology of emotional rescue.
I think about all the lonely people I've visited in the ER: elderly patients careflighted in from hundreds of miles away, who have no family; homeless alcoholics; suicidal patients convinced that no one cares about them. I often suspect that some of these patients come to the ER, consciously or not, partly simply for the comfort of attention from other people, even if those people are overworked medical staff. Comfort from family is better than comfort from strangers, but comfort from strangers is better than being alone.

I always try to spend extra time with these patients. I can all too easily imagine being an old woman alone in an ER, desperate for human contact. I try to give lonely patients what I'd want if I were in their situation: someone to talk to, someone who cares about what's happening to them, even if that person's a stranger.

Sometimes, it's obvious how these patients have wound up alone. Just listening to them, you can see how they've made themselves unwelcome. You can imagine how their hurt, frustrated relatives and friends might tell the story. "We tried to be there for her, but she made it impossible. He's just too unpleasant. She forced us to walk away." Some patients only reach out to push other people away.

But some of these patients reach out for love, just like you do now, with your hurt arm and hurt leg. Some of them have that magical gift of being able to turn strangers into friends and advocates, even during a brief ER visit. They do this even though they aren't babies anymore, even though they aren't cute and innocent, even though protecting and comforting them isn't the appalled, instinctive first reaction of everyone who sees them.

We have to hold you down, to change the dressing. The PA asks me to help, because I'm there and you seem to like me. I hold you down, and you reach up to play with my ID badge. An EMT is holding you down, too, and he's made a little toy out of a gauze bandage. He tickles you with it when you turn towards him.

You're happy with the gauze toy and the ID badge. You hardly cry at all: only a little, at the end, even though what the PA's doing has to hurt. I don't want to think about how you've learned to stay quiet during pain. I don't want to think about how anyone could hurt a child who's so quiet, so alert, so loving.

After you've left, I talk to one of the nurses. We wonder what will happen to you. I'm trying to be optimistic; at least you're safe now. The nurse shakes his head, because he can't see any good outcomes. We can't want you to go back to your parents -- although I find myself praying for them, praying they'll recover from whatever made them do this to you, praying that somehow everything will work out -- but the alternatives are grim. "Foster care," the nurse says, his voice tight, and shakes his head again.

I think again about the hard cases I've seen here, the people who are alone, who've driven everyone away, who have nothing. Broken down addicts. Dying alcoholics. They were children once, too. They were probably as cute as you are. Maybe they reached out to strangers, before life hurt them too much and they stopped.

So this is my prayer for you, child: May you never stop reaching out. May you never forget how to transform strangers into friends. Although you probably won't remember all the love you received here tonight, may that love have seeped into your tissues, into your cells, into the nooks and crannies of your brain. May it be your blanket against the cold; may it cushion your heart from callouses.

May you never feel alone.

Thursday, October 12, 2006

Carnival of Hope: Volume 1, Number 2

Welcome to the second edition of Carnival of Hope! I’d like to thank everyone who sent in submissions. This month we have thirteen items, eleven blog posts and two news stories: very fitting for a carnival being posted on (or just before) Friday the 13th!

I did get fewer submissions than last month, though, so I have a request: if you’re a contributor, or a visitor who likes what you see here, please post a link to CoH on your own blog. That way, we’ll get the word out.

Also, please note the upcoming deadline in advance! The next Carnival of Hope will be Friday, November 10. Send your submissions to SusanPal (at) aol (dot) com by 5 PM Pacific Time on Thursday, November 9. Since November’s the month when Americans celebrate Thanksgiving, I’m especially interested in posts about gratitude, although if another theme develops from the submissions, I’ll use that instead.

This month, we have three themes. Several people sent in posts about film, so the first section is Hope at the Movies. There were also a number of posts about hope in the midst of great turmoil, pain or crisis, a section I’m calling Hope in the Maelstrom. And, finally, we have several posts about hope as an aspect of various religious or spiritual traditions, which I’m calling Hope as a Discipline.

This edition is dedicated to my husband Gary, who loves movies. So let’s head to the showing room!

Hope at the Movies

Have you ever seen a film that supposedly depicted someone like you, or was made for someone like you, that made you wince and say, “But I’m not like that?” Nehring delights in having found that rarest of rarities, a good Christian film, in this review of Hometown Legend. This post also treats us to some refreshing thoughts about what Christian art should and shouldn’t do: namely, teach by positive example, rather than by protest. Amen!

Films are so powerful because they can take us places we’d ordinarily never go and introduce us to people we’d otherwise never meet. Amanda of Imagine Bright Futures writes a lovely review of It’s a Magical World, a film in which Croatian children literally sing hope into existence.

Sometimes films show us places where we’d never want to go, making us empathize with situations no one should have to endure. Brandon Peele talks about the brilliant, wrenching film Hotel Rwanda as a blueprint for how to move past us/them divisions in his post The Evolutionary Role of Ethnocentrism.

When I saw Hotel Rwanda, I kept wishing it were fiction. But sometimes stories we’ve labeled fiction come eerily to life. Dr. Deborah Serani discusses how the science-fiction gimmick in a recent movie may become scientific reality, allowing trauma survivors to erase painful memories, in Eternal Sunshine of the Spotless Mind. This post raises all kinds of interesting questions. If you had access to this technology, would you use it? Are painful memories best erased, or can they be put to other uses?

Hope in the Maelstrom

At least sometimes, the difficult times we’ve endured give us tools we can pass on to people in the same situation; our own painful memories allow us to support and comfort others. In that spirit, MLR shares this very moving letter to mothers of autistic children. MLR had submitted this for the September Carnival of Hope, and to my great chagrin, I somehow forgot to put it in. (Maybe that new technique was tested on me without my consent?) MLR, thank you for letting me use it this time!

Sometimes our most painful experiences also show us what’s most important. PaedsRN of Mediblogopathy shares a harrowing but gorgeous story about how the hardest workdays can lead us to epiphanies, to moments of clarity when we realize that instead of just choosing a job, we’ve been Called to a vocation.

Too many days like that, though, would make any of us prime candidates for burnout. Nickie, preparing to follow her own calling in social work -- a field where the bad days can often outnumber the good ones -- ponders ways to avoid burnout in Socialwork struggles, or chances to hope. Nickie has a knack for finding hope, and I’m grateful to her for linking to this beautiful news article about music as medicine for schizophrenia patients. The severely mentally ill live in the center of the maelstrom all the time, and any source of hope for them is wonderful news indeed.

No one welcomes the maelstrom; but if we never get near it at all, we may begin to believe that reality is as orderly -- and as ordinary -- as our everyday lives. For a glimpse into how apparently unpleasant places can produce a wider and more mysterious view of the world, see my own Heaven and Earth, Horatio, a post about mystical stories in the ER.

Hope as a Discipline

The maelstrom, by definition, shatters our everyday lives. But sometimes the everyday disciplines we’ve developed beforehand are what help us heal. Everyone I know was deeply moved by the response of the Amish community to the recent schoolhouse shooting in Pennsylvania. If Dr. Serani describes a new-fangled, high-tech approach to recovering from trauma, the Amish approach is as old-fashioned and low-tech as a horsedrawn buggy. Read this Philadelphia Inquirer article about the Amish practice of forgiveness, and then ask yourself: Would I be able to forgive in a similar situation? I’m not at all sure I could. (Indeed, I struggle with forgiveness in far less dire circumstances.) No wonder so many of us prefer quick, high-tech fixes!

The ordinary, cyclical practices of our faith communities give us ways to reach out to others in non-painful times, too. Abu Sahajj Hakim of Wa Salaam: A Muslim American Journal describes the holy month of Ramadan as an invitation to peace, an opportunity for Muslims to build bridges to the surrounding community, in Ramadan: A Blessing for Everyone.

Sometimes we set out to practice a spiritual discipline, only to discover that things don’t go exactly as we planned. For proof that we can still learn from less-than-perfect outcomes, let’s go back to Brandon Peele (a fellow chocoholic!) who delivers a very entertaining report about his truncated Vision Quest. Among other things, he learned “why Charles Schulz drew flies circling Pig Pen.”

And, finally, it’s important to remember that not all kinds of hope are healthy. The discipline of hope calls us to recognize what kinds of hope are good for us, and what kinds may be hindering us, as Isabella Mori of Change Therapy explains in Understanding Hope.

This concludes our second edition. May all of you have a very lucky Friday the 13th and a very happy Halloween! And as we approach Thanksgiving, please keep the November Carnival of Hope in mind!

Less Godless Than Previously Supposed

Yesterday, a friend of mine sent me an AP report on this survey of college professors, which finds that the majority are religious believers of one sort or another -- or, at least, don't devoutly disbelieve in God.

Gosh. You mean I'm more mainstream than I thought?

A few years ago, I had a grad student who was doing some very cautious church-shopping, but also felt very self-conscious about it. She said that the attitude of most of her fellow students was that "smart people don't go to church."

My church is chock-filled with folks affiliated with UNR in one way or another. I've occasionally heard people in my department make statements critical of faith (usually specifically of Christianity), but they're a minority. We don't talk about it much, but my sense is that most of my colleagues, even if they're not religious themselves, are sympathetic to those of us who are.

I very rarely talk about my faith in the classroom, for obvious reasons -- it's a state school, for one thing, and most of the time the subject is simply irrelevant -- but last spring, we had some very loud protesters on campus who were yelling through bullhorns about how all gays would go to hell, waving placards about sin and eternal damnation, and so forth. It was horrible. I'm a free-speech fundamentalist, so I reluctantly conceded that they had a right to be there, but many people on campus were angry and on edge. Even if the content hadn't been so hate-filled, the heckling would have been unbearable just from the standpoint of noise pollution. While that stuff was going on, I did tell my students, "I'm a Christian, and I hope all of you understand that the people with the bullhorns don't speak for all of us." I also told at least one student, "If they're going to heaven, I'll take hell: the company will be better." The student giggled.

I think the obnoxious bullhorn-waving people were there because they thought that a university campus would be full of non-believers, ripe ground for saving souls. If so, I hope they read this survey and stay away from now on.

Do read the survey, if you're interested; there are all kinds of intriguing statistics about which fields, and which kinds of schools, have the highest and lowest number of religious professors. One has to take all of this with a grain of salt, of course, statistics often being statistically indistinguishable from spin. The bickering comments in response to the article are, in my experience, more typical of cyberspace than of academia. But then, I'm in an unusually civilized department.

Wednesday, October 11, 2006

Coming Attractions: Carnival of Hope at the Movies

Last night, I spent some time going through this month's Carnival of Hope submissions, deciding what to use, what order posts might go in, and so forth. I've created a draft of the carnival as a WordPerfect document, cutting and pasting URLs directly from the blogs; the BlogCarnival draft includes a lot of HTML I don't want or need, and getting rid of all of that stuff takes nearly as long as just doing it from scratch myself. Either way, it's a tedious process, if rewarding. I can't imagine putting together a huge carnival like Grand Rounds, or hosting three carnivals in the space of two weeks, as Kim's doing. (Other medical bloggers have begun to wonder aloud if she ever sleeps, or if she really has a job.) If anybody has any handy-dandy shortcuts, please let me know!

So far, I have eleven items -- twelve if I can get permission from one blogger to use a post I like but that he didn't submit -- and four of them are somehow about movies. Cool: a theme!

So if you've written a post about how a movie gave you renewed hope or compassion, and if you'd like to bump my carnival count up to Lucky Thirteen, please send your post to SusanPal (at) aol (dot) com by 5 PM tomorrow.

If you have a post that isn't about film but would otherwise be appropriate, of course send that along, too.


Tuesday, October 10, 2006

It's World Mental Health Day!

I just discovered that today is World Mental Health Day. This year's theme is building awareness about mental illness and reducing suicide.


Grand Rounds! Carnival of Hope!

This week's Grand Rounds is up, and, as always, offers a lively and eclectic mix of posts.

And don't forget that the deadline for Carnival of Hope is this coming Thursday -- that's two days from now! -- at 5 PM Pacific Time. Please send submissions to SusanPal (at) aol (dot) com, with a brief summary of the post.

Monday, October 09, 2006

When You Know the Patient

It's happened before; I've walked into a room or looked down at a gurney and seen someone I know. My ER patients have included the occasional parishioner, university colleague, or member of the hospital staff. I've been told that technically, according to HIPAA regulations, I'm not even supposed to let on that I recognize the patient in this situation, but these patients have usually recognized me, so that hasn't been a problem.

Last night's shift was, well, difficult. The ER was getting hammered when I walked in, and staff nearing the end of twelve-hour shifts reported that it had been that way all day. Everyone was tired. Tempers were short. I spent most of the evening trying to visit patients while staying out of everyone else's way.

To give you some idea of how busy it was, volunteer chaplains have to keep a tally of patients or family to whom we've offered services: not necessarily people with whom we've had deep conversations, but people to whom we've made ourselves available, even if they then said, "No thanks, you can go away now." The spiritual-care department, like every other part of the hospital, has to do basic bean-counting. I usually average about fifty beans in a four-hour shift. Last night, my count was seventy-four, and that's actually a little low, since I counted a few large family groups as one.

Fairly early in the evening, there was a code on another floor. A bunch of us headed up there: spiritual-care staff are required to respond to codes, and last night I was the only chaplain in the building. The code featured the usual cast of thousands. As happens in many codes, the patient came to quickly. From my vantageway in the hallway, I saw the patient's feet wiggling, and heard the doctor running the code say in a cheerfully booming voice, "Are we feeling better now?" Everyone laughed.

I told the nurse who was trying to contact family to call me in the ER if anyone wanted to talk to a chaplain, and then I left, after giving my full name to another nurse who told me that she had to document the role of every single person there. (For perspective on the hideous paperwork required of nurses, see this heartfelt rant from Kim.)

I'm sharing this part of the evening because it was a typical code: the patient didn't die -- at least in the codes I've seen, most patients don't -- and the initial tension of hearing "Code Blue" on the overhead dissipated pretty quickly.

I went back downstairs, talked to some other patients, and then went to the logbook to try to get a room number for someone who was being admitted and wanted a spiritual-care visit upstairs. The logbook contains labels with the name, diagnosis and destination of every patient admitted from the ER.

Looking for my patient's name, I saw another name. It looked familiar. I squinted at it. It looked very familiar. I scanned the diagnosis, which sounded very scary. I scanned the destination: OR.

My stomach dropped. "Oh my God," I told the nurse standing next to me. "I know this guy."

"Yeah, that'll happen."

"Can you tell me what's wrong with him?"

"Of course not. You know I can't, because of HIPAA."

I did some research and learned that my friend was out of the OR and in ICU. I went upstairs, wondering what HIPAA violation I was committing by going to the bedside of a friend who hadn't asked me to be there. My friend was out of it, on a vent, but his nurse told me that he'd opened his eyes and responded to simple questions, and that the surgery had gone well.

I still didn't know the story behind that scary-sounding diagnosis. I knew I couldn't ask the nurse, because of HIPAA. I asked the nurse to call me in the ER when the patient's wife showed up. I went back downstairs and did my scattered best to visit another few patients until the call came through; then I raced back upstairs.

It was good news. The scary-sounding diagnosis was actually much less scary than the terse notation in the logbook made it seem. My friend's going to be fine. I prayed with him and his wife -- I think maybe he squeezed my hand while we were praying, although that could have been an involuntary reflex -- asked if there was anything else I could do, and left when I learned that there wasn't.

Once again, some moments of panic (more moments, in this case) were replaced with relief. But do I need to explain that in this second situation, I had nothing resembling the professional objectivity I'd maintained so easily during the earlier code?

Back downstairs to the ER. More patient visits. And then, at the very end of my shift, I hear another code on the overhead.

Back upstairs. I'm on my way into the unit where the code is when I get waylaid by a hysterical visitor. "That's my relative's room number! What does Code Blue mean? What does Code Blue mean? What does Code Blue mean?"

As the previous case illustrates, a code can mean a lot of things. Sometimes codes turn out well; sometimes they don't. So I said, "I don't know. Let me go inside and see if I can get some information for you."

"I want to go in there. Let me in. Let me in."

"I have to ask if you're allowed back there," I said, and headed for the unit intercom.

"No, the visitor can't come back here during a code," the unit nurse told me. The relative, predictably, was furious. I was allowed in because I was staff. But as I headed into the unit, I was pushed backwards by a bed, surrounded by medical staff, being pushed out. The patient had been bagged and was being taken into emergency surgery.

A nurse stopped long enough to give the relative a terse and not very encouraging report. The relative then waylaid some ER staff who'd reported to the code and were heading back downstairs. "The nurse said X. What does that mean? Tell me what that means. I don't understand what that means!"

The ER doc said, gently, "I can't tell you. I don't know enough about this patient's situation. I'm sorry."

I can't imagine what it must be like to hear a code called on a loved one's room number, and then to see that person -- helpless and unconscious -- being wheeled down a hallway by grim-faced caregivers, and then to be told repeatedly that no one can tell you anything definite. This is the layperson's version of "when you know the patient." If you're hospital staff, at least you also know other people in the building. You have sources of support. But a visitor facing this situation must feel incredibly isolated.

This is what chaplains are for. The unit nurse asked if I'd wait with the relative for word, and of course I said yes. But the relative didn't want me there. The relative wanted a priest. The unit nurse said she'd call one. I said, "Would you like me to pray with you until the priest gets here?"

"No." Angrily. "I have my own prayers. I'm waiting for the priest."

So I left, reminding myself of that ever-useful CPE lesson. Chaplains are the only people in the hospital that patients or family can tell to go away, so if somebody dismisses you, tell yourself that you've just empowered that person.

I left, trying not to take the anger personally, reminding myself of the brief flare of anger I'd felt at the nurse who couldn't give me information about my friend because of HIPAA. The visitor was angry at me because I'd blocked access to the patient, because I didn't know enough or wouldn't say what I guessed, because I couldn't offer definite answers. Mainly, the visitor was angry at what was happening, and I was a convenient target. I know all that. But I was also frustrated and sad, because the only help I did have to offer had been rejected. I was trying to make the visitor feel less isolated. The visitor wasn't having any.

I hope the priest was helpful and comforting. I hope the patient pulled through. I wish I were more hopeful about that.

And I find myself wondering how I would have reacted if my friend had been in that patient's situation: in very serious shape indeed, with a very uncertain prognosis. Would I have been any less hysterical? And what if my friend were in that situation and I were a member of the medical staff, a nurse or doctor halfway through a twelve-hour shift, with other patients to care for? How would I wall off my feelings enough to keep doing my job?

It happens. How does anyone handle it?

Sunday, October 08, 2006

In Which We Honor Our Limits

The amazing Kim has put up yet another medical carnival, Pediatric Grand Rounds. There are some very moving posts here, and I've now added two new bloggers to my "heroes" sidebar: paramedic Drug-Induced Hallucinations, and neonatal nurse Ants Marching.

I have a friend who volunteers as a NICU chaplain. I couldn't do it. Just looking at photographs of those tiny babies makes me cry. I'm in awe of paramedics, too. As far as I can tell, their job is the medical equivalent of combat duty: long stretches of boredom punctuated by bursts of sheer terror. I couldn't handle that kind of stress.

Okay, so I'm pretty much in awe of all medical people, largely because I couldn't do any of their jobs. Various people who love me get cranky when I say things like this, and tell me, "Oh, nonsense! Of course you could, if you wanted to!"

No. I couldn't, really, for at least three reasons.

1. I'm a physical klutz. You do not want me trying to start an IV on someone, honest.

2. I don't have the necessary knack for math and science. There's a reason I majored in English, and it's not just because I love books.

3. I don't have the physical stamina required for twelve-hour hospital shifts, especially under high-pressure conditions. Sometimes I can barely handle my tiny four-hour volunteer shift.

When I tell people at the hospital that I could never do what they do, they often say something like, "You have a hard job, too." And sometimes my job is hard, but it's hard in a different way. If I make a mistake, no one will die. Even the hardest parts of my job don't seem as hard to me as the simplest parts of their jobs.

I take this as a sign that I'm in the right place.

When I was younger, I thought that I should be able to do anything; if I couldn't do it, I wasn't trying hard enough. I no longer believe that. It's okay not to be omni-competent. At this point, I think I have a pretty clear sense of where my gifts are, and also where they're not. It's important to recognize and honor limits.

I'm doing some of that this weekend. As I write this, our annual diocesan convention is winding to a close in in Fallon, Nevada, about ninety miles from Reno. I usually go to convention, but I'm not required to be there this year -- I'm not a delegate -- and I really needed some downtime at home. Also, one of my goals this semester is to reduce time spent in meetings, since I have a heavier committee load than usual. Convention's basically one long meeting.

Because all of our parish clergy are in Fallon, we aren't having the Eucharist this morning. Instead, we're having Morning Prayer. Morning Prayer's nice, but it doesn't feed me the way Communion does. This afternoon, I'll be doing my monthly Communion service at an assisted-living facility. This evening, I'm going to the hospital. If I went to church too, I wouldn't have time to swim. Swimming is my number one sanity saver. So instead of going to church, I'm going to go to the gym and pray while I do my laps.

Today's ministries are another reason I decided not to go to convention. If I'd had to drive ninety miles to get back to Reno to do the afternoon service, I'd have been completely wasted by the time I got to the hospital.

If I have a choice between meetings or ministry, ministry will win every time.