Thursday, November 30, 2006

Change of Shift. Pats on Back.


The latest Change of Shift is up over at Fat Doctor. Thanks for including me!

In writing news, I'm almost done with the Fate of Mice galleys (and a good thing, too, since they're due tomorrow). I also have to respond to a long marketing survey by tomorrow. This is stuff I thought I'd get done over Thanksgiving, but didn't.

I've canceled my classes today to give myself more time; I always build a little slack into the course schedule in case I'm felled by the flu -- which I haven't been this year, hurray! -- so we can still get everything done. And I don't think my students are heartbroken.

My mood's been unaccountably low since Sunday; maybe that's just a delayed reaction to last week's stress, but whatever it is, it's both unpleasant and annoying. After four days of feeling like I've been hit by a truck, I need to remind myself that I've also gotten some very nice compliments this week. So, at the risk of sounding like I'm bragging, I'm going to list them.

* Karen Joy Fowler wrote a lovely blurb for The Fate of Mice; this will join similarly lovely blurbs from Pat Murphy, Jo Walton, and Sheila Williams.

* My friend Inez passed along some kind words from her brother-in-law, who taught my story "Gestella" in one of his classes and said it generated quite a bit of student discussion. (Given the polarized response that story has gotten from some readers, I can just imagine!)

* I received unexpected e-mail from the rector of a local church, who not only enjoyed The Necessary Beggar, but used it as a sermon illustration last Sunday.

Also, rereading The Fate of Mice has been a good experience. It's always nice to look back at one's own work and decide that it doesn't suck.

And on that note, back to the galleys!

Wednesday, November 29, 2006

Tip for Aspiring Writers #249


Do not ask your Local Author to read your unpublished manuscript.

Yesterday when I got to work, I found a small padded mailing envelope in my mailbox. It contained a floppy disk and a note from someone who'd seen a story about me in the newspaper and wanted me to read her novel. "I realize you are very busy, but if you could find the time, I would forever be in your debt."

This kind of thing happens to me quite often, although I'm hardly a household word and have never gotten within a hundred miles of a bestseller list. I've had people bring me manuscripts in shoeboxes. I get e-mail from folks who want to know if I'll critique their 1,200-page fantasy trilogies. I sometimes meet people at parties who want to know if they can send me their stories, or their children's stories, or their next-door-neighbor's second cousin's stories.

My answer is always the same: Sorry, but no. I only read the work of current students.

I wrote a note to yesterday's Aspiring Writer explaining this, and advising that if she wants a critique of her work, she should either take a writing class or join a local writer's group.

Why do I only read the work of current students? There are two reasons: a) I'm being paid for it and b) It's very literally all I have time for. I'm sorry if this sounds harsh, but it's the honest truth. Come on; does anyone walk up to a surgeon at a party and say, "Hi, I know you're busy and all, but I was just wondering if you could whomp out my appendix, for the heck of it, for free?"

Reading and critiquing manuscripts is a lot of work. It's not something anyone can do well in five minutes. Reading the work of my current students takes nearly all of my reading time and energy, and sometimes it's difficult for me to get to everything they give me. (One of my current students gave me a story manuscript -- an unassigned piece he'd written on his own -- weeks and weeks ago, and I haven't read it yet, although I really do want to. I swore I'd get to it by Thanksgiving, and then I got derailed by my father's crisis. This weekend, I promise!) I have very little time for pleasure reading. I'm woefully behind in my field. I got books for my birthday in September that I really want to read, but haven't yet, because I simply haven't had time. I just agreed to review a new book on Tolkien, because I really want to read it and know that I'll only make the time if I have a deadline and an obligation. I don't have time to read the published work of award-winning authors I consider friends.

So no, I'm not even going to try to make time to read the unpublished work of strangers.

I suspect that often, the psychology of aspiring writers (and some of them will even come out and say this) is "But my work's brilliant! If I can just get the right person to look at it -- someone who's published, someone with connections -- then I'll finally get my lucky break, and the literary world will benefit from my genius."

That may be true. Really, I hope it is true. But if it's true, the happy discovery will have to be made by someone else.

So where does Aspiring Writer find that "someone else"?

In writing classes, or critique groups run by local writing organizations.

See, here's the thing. What you want is a group of people who are committed to your work and will spend time on it. You'll get that in a class because the professor's paid to teach it, and because responding to other students' work is a course obligation for your peers. You'll get it in a critique group because the other Aspiring Writers are as hungry as you are: they'll respond to your work because they want you to respond to theirs. It's an implicit contract.

And responding to other people's work is essential. It's much easier to see the flaws in other writers' stories than in your own, because you have more distance. But once you've gotten practice at analyzing other people's work and helping them figure out ways to fix it, you'll be able to transfer those skills to your own writing.

The key factor here is duration. The average class lasts several months; good critique groups can stay together for years. You want to find people who'll get to know your work over that length of time, who'll be able to tell when you're getting better (or worse) because they've seen your earlier writing and have a basis for comparison. Writing's a process; no one learns it overnight. You need readers who'll be with you for the long haul.

I tell my students to be very wary of weekend writing conferences, the ones that bring in Big-Name Writers to share gems of wisdom, and sometimes even to read manuscripts. These events can be a lot of fun, and you may even learn useful things, but the psychology of the attendees often seems to be, "If I can just get into the same room with Big-Name Writer, either some of BNW's genius will rub off on me, or BNW will recognize my inherent genius, and my struggles will be over."

It doesn't work that way. You're far better off working with Obscure Writer for several months in a class than spending a few hours with BNW at a weekend conference.

I also tell my students to be very wary of how-to-write books, especially of the "How to Write a Novel in Ten Easy Steps!" genre. If novels could be written in ten easy steps, everyone would be writing them.

Writing is an art, not a science. It's hard work. It's a discipline. There aren't any shortcuts. Anyone who promises you a shortcut is lying, peddling snake oil. There are a lot of snake-oil salesmen out there. Be very wary of them.

Addendum:

Gary has reminded me to warn you about one common species of snake-oil salesperson, the so-called "agent" who charges a reading fee to evaluate manuscripts.

Legitimate agents don't charge reading fees. Legitimate agents take a percentage -- usually fifteen to twenty percent -- of actual sales: they don't make money unless you publish. And, guess what: legitimate agents usually have more work than they can handle, which means that you generally won't find them handing out business cards at weekend writing conferences. I'm not saying it couldn't happen, but I am saying to be careful.

Do your homework, please. At the very least, google the person's name. Ask who this agent's other authors are, and find out if they've actually published books with reputable presses.

True story: I once got ecstatic e-mail from a former student announcing that she'd gotten an agent. When I googled the person's name, the first thing that popped up was a page of warnings and horror stories from a website for aspiring writers, talking about how this individual charged reading fees and then never delivered on promises.

Reading fees are almost always suspect, unless they're associated with literary contests . . . but some of those are suspect, too. Do your homework.

Tuesday, November 28, 2006

Grand Rounds! Cute Cats!


This week's Grand Rounds is up!

And since my brain is mush and I have nothing intelligent to say -- although this may change after I've had my morning coffee and stared at the lightbox for a few more minutes -- I'm going to fall back on that tried-and-true filler technique of bloggers everywhere, the Adorable Pet Photo:


The fluffy beast in back -- who actually does have two eyes, although you can't quite tell that in this snapshot -- is Harlequin, Harley for short. (My mother gave me a coffee mug that says "Harley Mama;" this has nothing to do with motorcycles.) The short-haired youngster in front is Figaro. Gary and I like this photo because it accurately represents their personalities: Harley's staid and dignified, whereas Figgy's a wide-eyed bundle of mayhem.

Like all cats, they're pleasingly eccentric. One of Harley's nicknames is "Rescue Kitty," because if Figaro's locked in a closet or in the garage, Harley will find one of us, paw our leg and mew, lead us to wherever the other cat is, and scratch at the door so we'll open it. ("What is it, Lassie? Is Timmy stuck under the tractor again?") He also routinely attempts to rescue me from the bathtub.

Figaro's oddest quirk is that he likes his toys to be extremely clean, and to that end will drop them into water whenever possible. We keep toilet seats down so the plumbing won't become clogged with toy mice. This disappoints him, but he puts his toys in his water bowl instead. One morning about six months ago, Gary came downstairs, peered in the water bowl to check for the usual toy mice, and yelped. "Hey! That's a real mouse!"

Figaro had evidently gone hunting in the garage, caught an actual rodent, and then carried it into the kitchen and put it where all the other toys go: the water bowl.

We're planning to get a new kitten sometime soon. If we do, there will definitely be more cute cat pictures here than any of you can stand.

Consider yourselves forewarned.

Monday, November 27, 2006

Peds Night


Anyone who's spent time in an ED knows that cases come in waves. There will be five head lacs at the same time, or three strokes, or four migraines. One corner of the ED will be populated entirely with young women who've attempted suicide, or elderly patients who've broken their hips, or teenagers who've had bicycling accidents.

Last night was peds night. We usually get a let of kids with coughs or runny noses whose anxious parents have brought them in to be checked out, but this was different. I counted at least four very sick and unhappy kids, ranging in age from infancy to early school age. At least one was admitted. One had a viral illness unusual in a child that young (I overheard one of the docs saying, "I can't believe I tested a toddler for that and it came back positive"). One child, who already had complicated health issues, came in after a frightening episode of what will be another chronic condition. The least sick of these kids -- and the one I know went home -- had to undergo a painful procedure.

I wasn't in great form last night anyhow, because I was extremely tired despite a long afternoon nap. (I think my father's saga was catching up with me.) On nights like that, I always tell myself that a half-baked chaplain is better than none, and I know some patients were glad I was there.

But dealing with sick kids is a special challenge for several reasons. I don't have kids myself, so I'm less adept with these cases than I would be at talking to patients facing conditions with which I've had first-hand experience (cancer, stroke, depression). And the suffering of children is a pastoral and theological nightmare, automatically raising thorny questions about how a loving God can allow that kind of pain.

There's no way to blame kids for their own suffering, as we're often so eager to do with adults. ("If you'd only taken your meds/stopped drinking/worn a seatbelt, this wouldn't be happening!") It's very hard to label children "guilty," and most of us -- thank God -- would recoil from even trying. Parents feel especially helpless when their children are either too young or too ill to talk, as was the case with most of the peds patients last night. When the parents identify strongly as Christian and ask me for prayer, I'll often insert a phrase about how the God we worship weeps with them, because he endured the agony of watching his own child suffer. Parents seem to find this reminder comforting, although in more academic settings, it raises thorny theodicy issues of its own.

Last night, only one of the four families -- the one whose child had been admitted -- requested prayer. I didn't think to insert the phrase, and I'm not sure what difference it would have made. They were all exhausted; at that point, the kid was doing better than the adults were.

Of the other three families, one politely sent me away. The other two didn't ask for prayer. They needed to talk about how hard it was to feel so helpless. I said, "This is probably harder on you than on your child," and they agreed.

Everyone on the staff was exquisitely kind to these families, of course. Sick children bring out the best in adults. Nurses go out of their way to provide extra care; harried doctors slow down for a minute to admire the baby, or talk about their own kids.

And these cases move other patients and their families, too. The child with the chronic health problems was in a bed next to an adult patient and spouse. When I visited this second family, the spouse was crying. "I heard what those people next door are going through, and I can't imagine it. That sure puts things in perspective, doesn't it?"

Yes, it does. (Oh, and by the way, do the HIPAA police really think those flimsy cotton curtains between beds do anything to protect patient privacy?)

As much as I hate seeing children in pain, I find myself wishing that every ED patient received this kind of compassion. Anglican activist Louie Crew tells the story of asking Ernest Gordon, who was a prisoner at the River Kwai in World War II, how he survived being tortured:
"I practiced the discipline of remaking the face of each torturer into the face his mother had seen cuddling him in her arms," he said. "It is very difficult to be swallowed in bitterness when you can do that, and it is the bitterness that would have killed me, even had I lived."
When I'm talking to a very difficult patient, someone I'm tempted to blame for her or his own suffering -- "If you'd only taken your meds/stopped drinking/worn a seatbelt, this wouldn't be happening!" -- I sometimes remember to practice that same discipline, to try to see the patient as a beloved, suffering child. I'd like to think that this is how God sees all of us, even or especially when we're at our worst, and I have a hunch that the discipline benefits me even more than it benefits the patients.

Sunday, November 26, 2006

Dad Update


Dad's still in MICU, probably until tomorrow. He's doing well, but they want to make sure that he's absolutely stable before they transfer him to a less monitor-intensive part of the hospital.

My contact with him has been sporadic. The day before yesterday, I talked to him and he said that his nurse hadn't even had to move the bed to get the phone to reach. Yesterday I called and got a nurse who told me that it wasn't possible to get the phone to reach "because we're having emergencies here." (That can't be good. I hope they have a chaplain.) I wished her luck, and told her to tell my father that I'd called and that I love him.

This morning I called and couldn't get anyone to pick up the phone at all; I must have let it ring forty times. I'll try again in a little while. I hope they aren't having more emergencies (and most definitely that any emergencies don't involve Dad, although that doesn't sound too likely at this point).

Meanwhile, my sister's been visiting every day. Yesterday, she and my nephew met the nice doctor I talked to on the phone the other night, the doctor who was so kind and patient with my HIPAA meltdown. They were extremely impressed with him. They said he was thorough, very good at directing all of his questions at Dad while still including them, and very good at asking Dad questions to make sure he understood what he'd just been told.

The doctor said to my sister, "I think I spoke to you on the phone," and she explained that no, that had been another daughter from Reno. I can just imagine his relief at learning that he didn't have to be in the same room with the crazy anti-HIPAA lady!

A little later:

I've now talked to Dad, and he sounds good, much more alert and like himself than he has since this whole thing started. He's bored, though, because he can't see well enough to watch television or read. Supposedly there's a radio setting on his TV, but it's broken. He wanted to know what was happening in the news, so I read him some AP headlines and portions of articles.

My father dislikes cats; my sister and I both love them, and my sister has six. A friend of my father's sent my sister a poinsettia for the holidays, which was lovely, except that poinsettias are poisonous to cats. (My sister says they've had poinsettias in the house before with no problem, but when I was on the phone with her yesterday, I heard her saying, "No, no, shoo, scat, get away from there!")

My father hadn't known this bit of feline trivia, and even though he doesn't like cats -- and couldn't resist a crack about "well, that's one way to get rid of them" -- his lawyer brain immediately kicked into gear. "How can they not tell people that?"

"Dad, the florist didn't know your friend was buying the plant for a cat-intensive household."

"But there should be a warning label on the plants, the way there is on cans. A lot of people have cats. I can imagine a lawsuit over this."

Yup, he's definitely feeling better!

Note:

A Google search informs me that poinsettias are actually only mildly toxic to cats, although some plants have been treated with pesticides that could be much more toxic. Most of the time, eating a poinsettia will only make the cat barf, as eating any other houseplant would. On the other hand, none of us need to clean up extra kitty messes, do we? So it's still a good idea to keep the plants away from pets.

Saturday, November 25, 2006

Happy Birthday, Gary!


Today is my beloved husband's birthday. (No, we won't be eating this cake, which isn't even a kind of cake we enjoy; it's a picture I found on the Internet. He's very anxious for me to inform you that he's only 55, not 60. Pretty cool that it features his name, though!) Tonight we'll be having a festive dinner out with a group of friends, two of whom also had birthdays this week, and most of whom are alumni of our Firefly Fridays, when we had people over to watch Joss Whedon's brilliant series. The highlight of those gatherings was singing the Firefly theme song; we all had lyric sheets, and we got better as the Fridays progressed. The fact that one of our friends is a world-class operatic soprano didn't hurt, although she did rather tend to outshine the rest of us.

Gary just opened his birthday gifts, one of which is Season One of Battlestar Galactica. Do we sense another Friday DVD series coming on? We may have to wait to do BSG, though; many people want to do a Buffy series, and the screen ratio doesn't work on our screen, so we may be doing Fridays at someone else's house for a while. I already have most of the musical episode of Buffy memorized -- which would be more impressive if I could actually sing -- so I'm greatly looking forward to Buffy karaoke with friends.

Anyway, when I initially asked Gary what he wanted for his birthday, he asked me to have his brown leather jacket relined. The lining had gotten so torn up that he'd cut it out completely, but then he had trouble getting his arms in the sleeves. He said that was all he wanted for his birthday, but I insisted on getting him a few things to open, too.

Yesterday I tackled the jacket relining project. I looked up "leather" in the phone book and called every business listed to see if they relined jackets. Only one did. They quoted me a flat price of $165. (Gary said, "That's why I said it was the only thing I wanted for my birthday!") Since I had no choice -- and since $165 is considerably less expensive than a new jacket -- I drove to the store to give them the jacket.

I should mention here that my fashion sense runs to "grungy casual" at best -- for me, dressing up is wearing shoes other than Keen sandals -- and yesterday, I was grungier than usual, because we'd hiked for two hours in the morning and I hadn't changed. I was wearing khaki jeans, running shoes, a white cotton turtleneck, and a venerable fleece jacket liberally adorned with cat hair.

Wrong outfit, although I don't think I own anything that would constitute the right outfit in this place. It's one of those leather-and-fur emporia featuring $2,700 ostritch-leather jackets, cunning little chinchilla scarves for a mere $500, and bargain-basement cashmere-lined leather gloves for $85. (I was tempted by those, I must admit, but $85 is far too much to pay for a pair of gloves, especially since I lose gloves about as often as I lose socks.) I expected to run into Cruella DeVil every time I turned a corner.

The proprietor was a distinguished looking gentleman with a thick European accent -- Italian, I think, although it's entirely possible that he's really from New Jersey and faking it for the job, the way the Grand Venice Canal gondeliers do in Vegas -- who was wearing an exquisitely tailored suit, approximately one quart of cologne, and gold-and-diamond jewelry. When he saw me coming, his nostrils flared; he was clearly resisting the urge to take a step backwards. (Hey, I can relate: anyone who's ever spent time in an ED has had the same experience with well-marinated patients.) When I put the jacket down on the counter, his eyebrows rose.

"I'd like to have my husband's jacket relined," I told him.

He used the tip of one finger to arrange the jacket so he could look at the inside. Then he coughed and made a strangling noise. "We make the pattern from the existing lining, you understand? There is no lining here."

I called Gary. No, he hadn't kept the lining. Meanwhile, the shopkeeper was looking down at the jacket -- well worn, its cloth cuffs pilled and liberally adorned with cat hair -- and snorting in amazement. "He cut out the lining," he said, in a tone that made it perfectly clear that this is the wrong way to remove a lining.

"I guess so. Can you reline it?"

He sighed and cast his eyes heavenward. "Maybe, maybe, I don't know. We will try. It will take longer, you understand? We will have to make the pattern from scratch. It will cost you more, because labor here costs $75 an hour. We will charge you $200."

Well, I didn't have much choice, so I put down a $100 deposit and watched the shopkeeper, his nose wrinkling, put the jacket on a hanger. I giggled all the way home, and when I got back to the house, I told Gary, "You have to come with me when I pick up the jacket, just for cultural anthropology. I think the extra $35 was really a biohazard-handling charge."

Gary shook his head. "You know that they'll farm this relining project out to somebody from the Philippines who'll do it in thirty seconds and make fifteen cents, right?"

When we go back, we're seriously considering wearing our very worst clothing and carrying brown-bagged bottles of Strawberry Ripple, just to watch the shopkeeper freak out completely. But that would be mean, wouldn't it?

Friday, November 24, 2006

The Happy Ending I Couldn't Imagine


When I was growing up, family members always told me that I "wore my heart on my sleeve," and cautioned me to stop doing that so I wouldn't get hurt. But I was never really able to stop doing it, even when I did get hurt. I've always expressed my emotions, sometimes in ways that make people uncomfortable. I'd make a lousy poker player! On the few occasions when I did manage to remove my heart from my sleeve, what replaced it was a concrete barrier about ten feet thick. Luckily, I figured out pretty quickly that this is no way to live. If I shielded myself from pain, I also lost my ability to feel joy.

Two years ago, I took a summer course at the Graduate Theological Union in Berkeley about writing life narratives. The teacher was a chaplain at a woman's prison, and she led us through a week-long process of identifying important personal symbols and images and then writing a fairy tale, using those elements, that would be a metaphorical representation of our own lives.

The symbol I came up with was the heart on the sleeve, and I wrote a story about a little girl named Cora (short for "corazon," Spanish for heart) who's born with her heart outside her chest, and who suffers greatly because of it. The teacher loved the story, and wanted me to finish it. My old therapist loved the story, and wanted me to finish it.

They wanted a happy ending. It wasn't coming.

I finally did finish the story, but it doesn't exactly have a conventional happy ending. This is the story -- called "Sorrel's Heart" -- that I wrote last April when I was gorked out on muscle relaxants after throwing my back out. It will be included in The Fate of Mice. It's very, very dark. My GTU instructor and my old therapist wouldn't be pleased.

Throughout this process, I thought the heart-outside-the-body thing was strictly a metaphor, physically impossible. The story's fantasy.

Except, as it turns out, it isn't fantasy. I learned from Doctor Anonymous this morning that there's a real medical condition, called ectopia cordis, in which babies are born with their hearts outside their bodies. This birth defect is extremely rare, and the children usually don't live more than 48 hours. Dr. A reports on the progress of Naseem Hasni, born on Halloween, who's currently undergoing corrective surgery for this condition, and he includes a video clip about a young man named Christopher Wall, born in 1975, who when the clip was filmed held the record for being the longest-lived ectopia cordis patient. (He was twenty-one then. I need to do research to find out if he's still alive.)

The clip's about eight minutes long. Don't watch it if you're extremely squeamish, and if you do watch it, make sure you have tissues handy. "Inspiring" doesn't even start to describe this story.

One of the things the story emphasizes is that because Chris has been shown so much love and compassion in his life, that's what he gives back to the world.

The happy ending was alive and well the whole time I was struggling with my story, and I didn't even know it.

Thursday, November 23, 2006

Thanksgiving

Thanks to everyone who left comments on my post yesterday about my father, or who sent e-mail. Your prayers and good wishes helped me through a tough day.

I never did get back to sleep yesterday. I swam for half an hour, had two meetings at school, dashed back home to find a phone message from my sister that Dad had been admitted to the MICU (Medical Intensive Care Unit), called and spoke to her very briefly, and then dashed back out again to meet a friend for the new James Bond movie. (We didn't like it; too many senseless, physically impossible action sequences that added nothing to the story.)

When we got home from the movie, I finally had time to call the hospital to get more information. I called the MICU, where a nice nurse told me that Dad's vital signs were stable and that he was cracking jokes. (That's my Dad!) But no, he didn't have access to a phone, so she was going to transfer me to his doctor.

I spoke to the doctor, who told me that Dad was "doing fine" but that no, he couldn't be more specific about the admission diagnosis, because of patient privacy rules. I'm entirely too familiar with HIPAA, but I was really tired at that point, and I'm afraid I fell entirely into daughter-brain and lost it for a minute. "I'm his daughter! What do I have to do, send you a blood sample?"

"Your father can give you information, if he wants to, when you talk to him," the doctor said patiently.

"But I can't talk to him. He doesn't have a phone!"

"Call the nursing station again."

"I just talked to them!" But of course, HIPAA isn't the doctor's fault. I apologized for snapping at him, and he said it wasn't a problem and that he understood, and I wished him Happy Thanksgiving, and he returned the sentiment.

And then I called the nursing station again. "No, I'm sorry, your father doesn't have a phone. You have to talk to his doctor."

"I just spoke to the doctor! He can't tell me anything because of HIPAA! This is so frustrating!" I'm sure my voice was a jet-engine whine.

"Okay, okay," the nurse said. "Okay, honey. Let me put you on hold. I'll see what I can do."

Well, they pushed Dad's bed closer to the door of his room so that a hall phone would stretch to reach him, which meant that -- mirabile dictu -- the next voice I heard was his.

And he sounded good, or at least better than he had that morning. He was glad to be in the hospital. He was in MICU for physical problems, but he's also been very lonely, so he was thrilled that the nurses were laughing at all his jokes. He told me proudly how every time he told a new joke, the nurse who'd heard it would pull all the others into the room so they could hear it, too.

"Trust me," I said, "they don't get many patients cracking jokes in MICU."

My father's also made a major decision about his own care; I can't talk specifically about that here (HIPAA, HIPAA!), but it's a big deal in terms of his personal history and our family history. It's something he's probably needed for a long time, but hasn't done before. He's skeptical about whether it will work, but at least he's trying it. I was really proud of him, and I told him that.

Over dinner, Gary and I talked about how in an odd way, it was actually comforting that he was in MICU: it meant that I hadn't been over-reacting in making all those phone calls to get him to the hospital, and that my sister and I wouldn't have to worry about his condition, because highly trained professionals were worrying about it for us.

Later in the evening, I got e-mail from my sister, who's also very relieved that he's in the hospital, and who specifically thanked me for making all the phone calls. That meant a lot to me.

So when I woke up today -- after much better sleep than I'd had the previous night! -- the main thing I was thankful for was that my father's in the intensive care unit. Pretty bizarre, right? Context is everything.

I'm grateful to my brother-in-law for driving him to the hospital. I'm grateful to the ER staff; Dad said he hardly had to wait at all, and I'd like to think that my conversation with the triage nurse had something to do with that, although I'll never know. I'm grateful to whomever decided to admit him. I'm grateful to the MICU nurses who've been laughing at his jokes and moving his bed so he can talk to me on the phone. I'm grateful to the other medical professionals who've been spending time with him. I'm grateful that at the age of 84, my father's willing to try something new. I'm grateful to Gary, and to friends at work, and to friends on the blog, who've listened to me venting about all this.

(And on the HIPAA front, I e-mailed my sister a letter for Dad to sign, giving the hospital staff permission to discuss his medical condition with us. When my mother was being treated for lung cancer, her doctor was willing to talk to me without written permission, but I can understand why doctors are more cautious these days.)

Thank you, everyone. May you have a blessed, joyous, and healthy Thanksgiving.

Wednesday, November 22, 2006

Split Screen

My father's having one of his periodic medical crises. He's in Philadelphia, where my mother and sister are. My mother lives with my sister; my father has his own apartment.

Last night, talking to my sister on the phone after she'd had an alarming visit with Dad, I found myself bouncing back and forth between daughter-brain and chaplain-brain. I was upset and worried, but part of me was also very detached, and I found myself thinking, "Okay, how would I respond to this if my sister were a family member at the hospital?" I even pictured the two of us sitting in the dismal little room where I wait with relatives during codes. And I slipped into bizarre medical-speak. When my sister said that Dad had been able to get out of bed to open the door for her, and that he knew where things were, I said, "So he's oriented to his environment?"

Good grief. Where did that come from?

I'm sure that retreating into chaplain-brain was a defense mechanism, but it was a very odd sensation, like standing in front of one of those mirrors that shows you multiple images of yourself.

This morning, I called my father, ascertained that he was willing to go to the hospital -- he hadn't wanted to last night -- called the VA to see if they could arrange to pick him up (they couldn't) and then called my sister's house to ask if my brother-in-law could pick him up (he could). My sister was at work, although my mother called her to tell her what was going on. Dad wanted to avoid the expense of an ambulance, and I'm glad we were able to do that.

By some miracle, I also managed to speak directly to my father's primary-care physician. She recognized his name immediately, and when I shared some relevant parts of his history, she said, "I didn't know that. The ER needs to know that. Make sure that the person who brings him in tells them that."

So, just to be safe, I called the ER and talked to the triage nurse. I again found myself using clinical language: "You'll probably need to rehydrate him." (I'm sure triage nurses just love calls like this from family members!)

Again, I had the split-brain thing going on. I've had a lot of practice working the phones: I've done it for my father on multiple occasions, for my mother during some of her illnesses, for students in crisis, and sometimes even for ER patients. It makes me feel good to navigate bureaucratic mazes to get help for people, which means that I probably sounded weirdly cheerful and uninvolved both to the primary-care doc and to the triage nurse.

Or maybe I didn't; maybe I sounded just like any other fretful family member. Who knows? In any case, my chaplain-brain knows that I can't really chaplain myself, but it's trying to do that anyway. I've been telling myself the same stuff I tell family members. I woke up at 3:30 AM -- ouch! -- initially because a cat had jumped on me, but then I couldn't get back to sleep. I lay in the dark for a while, telling myself, "You have to take very good care of yourself right now. You're under stress. You need sleep. Go back to sleep."

It didn't work. So I got up, put on my chaplain/advocate hat, and started making phone calls. I'm feeling much better now that Dad's being seen; maybe I'll even manage to get a nap in later.

Tuesday, November 21, 2006

Curse you, Blogger Beta!


Yesterday, my Site Meter stopped working: when I clicked on the icon, I got their homepage, but couldn't access my blog statistics.

I tried many things that didn't work. Lee suggested that I upgrade my template in the new Beta version of Blogger, because her Site Meter had worked after she did that.

I upgraded and reinstalled. It's still not working. (Plus all of my old third-party buttons went away.) And now there's a new problem: wonky fonts in posts with cut-and-paste quotations. I can't find any HTML code in those posts that indicates a font change, because if I could, I'd remove it.

I sent e-mail to Blogger Beta, but of course they didn't answer.

Somebody please help!

Later:

Site Meter has now mysteriously started to work again. Thanks be to God!

I still can't figure out the font problem, though. Aaaargh!

On the positive side, I've now added my labels to my sidebar, for handy-dandy topic-specific blog navigation.

Later still:

Well, I fixed the spacing problem, more or less. Now I have to figure out how to get a bit more space after the post titles. Any suggestions?

The Lightbox of Doom

Our friend Rob brought over the lightbox yesterday. And what a lightbox! This thing's huge, the size of a chair. Gary looked at it and said, "That could be used to light a landing strip for 747s."

I'm sitting in front of it now, but I'm noticing some eyestrain. I have it on the highest of its three settings, so maybe I'll turn it down a notch. Or two.

Okay, I just turned it down a notch. I think that's a little better.

Dazzled, we are. Will this make us less green, grumpy and wrinkled? Stay tuned, you should!

And in other medical news, Dr. Anonymous has posted the latest Grand Rounds. There's recently been discussion of how to make GR smaller and more manageable, with every commenter I've read heavily in favor of more selectivity on the part of hosts. In that spirit, Dr. Anonymous has divided this week's edition into "The Best of the Best" and "The Best of the Rest," with a link dump at the end so nothing really gets left out. I'm honored to be one of his Editor's Picks! Thank you, Dr. A!

Monday, November 20, 2006

On Hold (A Very Long Story in Five Parts)

1. In Which We Provide Some Background and History

I began attending church on March 21, 1999. I was baptized on June 11, 2000. A few weeks after my baptism, I was flipping through the Book of Common Prayer and stumbled on the ordination liturgy for deacons, which reads in part:
God now calls you to a special ministry of servanthood directly under your bishop. In the name of Jesus Christ, you are to serve all people, particularly the poor, the weak, the sick, and the lonely. [. . . ] At all times, your life and teaching are to show Christ's people that in serving the helpless they are serving Christ himself (543).
I found this profoundly moving. I began to wonder if I might have a calling as a deacon. Since I'd only been in the church for five minutes, I didn't do anything about it, but I prayed aboout it a lot. Like, every day for a year. It didn't go away.

Deacons are an ancient order in the church, but as far as I know, only the Roman Catholic and Episcopal churches ordain them. Many other churches have lay deacons. During Sunday worship, deacons read the Gospel, lead the prayers of the people, set the table for Communion, and dismiss the congregation at the end of the service, sending the people out into the world to do God's work. Most of the deacon's work, though, is outside the church; deacons serve as a bridge between the church and the world. One of their jobs is to "interpret to the Church the needs, concerns, and hopes of the world," especially of underserved or stigmatized populations, and to motivate others in the church to do something about those needs. Deacons typically show up in places like hospitals, prisons, and homeless shelters. They're the social-justice arm of the church. Deacons don't perform sacramental functions like baptism, Eucharist, or marriage; those are reserved for priests.

Priests have to spend six months as "transitional deacons" before being ordained to the priesthood. Combined with the fact that many parishes don't have deacons, this has led to a common misperception that deacons are mini-priests, pre-priests, wannabe-priests, or subordinate to priests. None of this is true. The diaconate is a "full and equal order" in the church, and deacons answer directly to the bishop. For more background on the diaconate and diaconal ministry, browse the School for Deacons website, especially their online discernment kit. If you don't feel like reading that much, here's my four-word description of the difference between deacons and priests: "Priests bless. Deacons nag."

2. In Which We Are Called to the Diaconate

I belong to a Total Ministry parish. Total Ministry emphasizes baptism as the foundation of ministry and honors the ministries of all the baptized. TM developed in dioceses with small, rural parishes that couldn't afford to pay clergy; one of its cornerstones has been the identification, from within the congregation, of parishioners with specific gifts. TM parishes "raise up" their own clergy, lay leaders who are then trained locally instead of going to seminary. Until very recently, the national church recognized two types of clergy: seminary trained clergy, who could be called to any parish and were paid for their work, and "Canon 9" or TM clergy, who were trained and ordained for service only in their home parishes, and who couldn't be paid. Of the five clergy in my parish -- three priests and two deacons -- only two are seminary-trained. The others were identified by a congregational calling process and took diocesan classes (nine classes in Scripture, church history, ethics, and preaching, plus a "craft class" in issues specific to the diaconate or the priesthood) to get the training they needed. They aren't paid for their service to the church; all of them either have full-time jobs elsewhere or are retired.

In the spring of 2003, my parish had a calling process to identify new clergy. Parishioners were asked to consider prayerfully who might have the gifts required for the diaconate or the priesthood, and to put those names in a box that would be opened by the Bishop.

On July 3, 2003, I got a phone call from the Bishop saying that my parish had called me to the diaconate. Needless to say, I was elated.

3. In Which All Hell Breaks Loose

I didn't think the ordination process would be very difficult; I'd already taken most of the courses I needed, since I was in the process of getting my lay-preaching license, and I had a lot of support from people in my congregation, including my parish clergy.

Boy, was I ever wrong.

Things started going haywire almost immediately. My interview to be admitted to postulancy -- the first step in a process leading to candidacy and then to actual ordination -- was a fiasco. I'd spent weeks writing answers to essay questions about my spiritual biography and gifts. I offered to mail copies of this material to the members of the Commission on Ministry (the hard-working and beleaguered diocesan committee that oversees ordination and licensing) and was assured that this wasn't necessary, that the Bishop's office would do it instead. But when I arrived for the interview, no one on the COM had read my fifteen pages of material, because they'd only gotten it that morning. I passed the interview anyway, but I was annoyed.

Not a big deal: don't sweat the small stuff. I'd been admitted to postulancy, which was what mattered. But within weeks of that annoying interview, two things happened: 1. A parishioner came to me with information about clergy sexual misconduct in our parish (this did not, thank God, involve a minor), and 2. My mother was diagnosed with lung cancer.

Let me say up front that both of these situations ultimately ended well. The offending clergyperson is now gone, and my mother is healthy and cancer-free. But getting there took months, and I can't adequately express the toll those months took on me. The parish situation was enormously complicated, even more so than these things usually are. It wasn't hard for me to decide to help the parishioner who had come to me report the situation -- because of my position in the church, I considered myself a mandated reporter -- but the misconduct investigation dragged on far longer than anyone expected it to (or than published church documents about misconduct proceedings appeared to promise that it would), and in the meantime, those of us who'd reported got very little information or support. Other people closer to the situation suffered far more than I did. But through most of this, I was also afraid that my mother was dying.

The upshot of that particular mess was that my trust in church-as-bureacracy was seriously damaged. After it was all over, I tried to talk to various officials about what I thought could have been handled better. We all know what prophets don't get in their own countries. My efforts seem to have had no effect, although I hope I'm wrong about that.

In the meantime, I started my 400 hours of Clinical Pastoral Education (CPE), crashed and burned within a month because I was still too stressed out from the other stuff, and retreated into volunteering instead. (CPE is often an ordination requirement, and I was strongly urged to complete it, but I just couldn't. Now you know why I'm so emotional about the volunteer chaplaincy debate.) I went through one COM interview for candidacy and flunked because I was so stressed out from CPE, not to mention the previous events. I passed the second interview, but my trust in church bureaucracy deteriorated further. Somewhere in there, I lost a cherished friendship with a church mentor (not in my parish), over very painful personal issues. Those issues were seemingly unrelated to any of the rest of this, but that situation created yet more trust issues for me. At one point I told my spiritual director, a Roman Catholic nun -- and someone I had, thank God, been able to talk to about everything -- that the overwhelming message of my ordination process seemed to be, "Trust no one but God."

In the meantime, the national church had abolished canonical distinctions between Total-Ministry clergy and seminary-trained clergy. Locally trained clergy can now, like those who've been to seminary, be called to any parish and be paid for what they do. In theory, this did away with a two-tier system in which many clergy with seminary degrees looked down on their locally trained colleagues. (Needless to say, those attitudes have remained impervious to legislation.) In practice, it threw our hard-working, beleaguered COM into a panic. They were now ordaining clergy for the whole church; didn't that mean they needed more stringent requirements? The old nine-courses-plus-a-craft-practicum system went smash. Among other things, the COM decided that all local candidates for ordination would have to take the General Ordination Exam, a four-day, 9-to-5-with-an-hour-for-lunch written test on every conceivable aspect of church history, tradition, and practice. The GOE is the church version of the bar exam or medical boards. Most of the people who take it have had three years of seminary. Local candidates were assured that the test would be purely diagnostic, that instead of deciding whether or not someone could be ordained, it would be used to determine what kind of continuing education that person needed to pursue after ordination. (I told friends, "Oh, terrific. I'll be in remedial church-history classes for the rest of my life.")

To add some comic relief to all this, I'd also discovered that I'm a bumbling idiot when it comes to liturgy. I'd tried acolyting to learn some of the table-setting tasks usually performed by deacons at the altar. I hated it. I was really bad at it. I could never remember what went where or what all the stupid little napkins were called; I did things in the wrong order; I made things more difficult for the clergy and other acolytes. This sounds minor, and really, it is, but it was starting to make me dread going to church, so I finally told everybody that I just wasn't going to acolyte anymore, thank you very much. I told the Bishop that acolyting made me feel like Inspector Clouseau trying to impersonate Martha Stewart. She very kindly reassured me that a deacon's role is to proclaim the Gospel and send the congregation out into the world to live it, and that any other functions "are gravy -- or white sauce."

4. In Which We Are Impaled on the Horns of a Dilemma

Throughout this three-year nightmare, I knew intellectually that church-as-bureaucracy is composed of imperfect humans, and functions no better or worse than any other bureaucracy. I'd never expected either perfection or sainthood from the system. But my own experiences with the insitutional church -- and the many other experiences I heard about from other people, including strangers who wandered up to me at diocesan convention and shared their horror stories of being in process -- started to make me wonder if I really wanted to be ordained. It didn't help that I'd watched ordained friends being badly treated by the bureaucracy, too.

Ordination requires, among other things, taking a vow "to obey your bishop and other ministers who may have authority over you." This is, in effect, a vow to obey an imperfect human bureaucracy, and it's a blank check: a vow to obey anyone who may wind up in a position of authority in the future. It made me very nervous. I began to realize that if I wanted to take that kind of vow, I'd be in the Army. My spiritual director (who's had to take her own vows, of course) advised me rather vehemently that the church couldn't ask me to vow obedience to anyone but God. I talked to clergy who said, "Oh, the obedience clause is never invoked," but then I read about situations where it had been invoked. I talked to clergy who said, "Oh, people don't really mean that; we keep our fingers crossed behind our backs when we say it." But part of my problem with church-as-bureaucracy was that I'd heard the institution say a number of things it then decided it didn't mean; that was what had created my trust crisis in the first place.

Call me naive or idealistic, but I didn't want to take a vow I didn't believe. I didn't want to begin my ordained ministry with a piece of calculated cynicism.

I started thinking very seriously about not being ordained. The more I thought about it, the more sense it made. I wouldn't have to add yet more tasks to an already-overcrowded schedule; I wouldn't have to take the blasted GOE (yes, I could do it, but if I wanted to, I'd have gone to seminary); I wouldn't have to learn what all the stupid little napkins are called and the proper order in which to snuff candles; I wouldn't have to take a very problematic vow of obedience. But I could still keep living a diaconal life, doing the things that had made my congregation call me to ordination in the first place. I could still preach (I have a lay license), still bring services to nursing homes (I have a lay-eucharistic-visitor license), still do my beloved hospital work. (I wouldn't have started volunteering at the hospital if I hadn't been in process, and I'm forever grateful to have discovered work that means so much to me.) The only thing that not being ordained would prevent me from doing is reading the Gospel to the congregation on Sunday morning, and was that worth all the agony? Some ordained deacons assured me that ordination opens doors, but others warned me that it closes just as many, that in many cases, the collar interferes with diaconal ministry. Collars scare people.

So I talked to friends and a few trusted advisors, weighing the points for and against ordination. It was hard to keep emotional turmoil out of these conversations. Because I've been so vague here, the fact that this three-year string of events reduced me to a crispy critter may seem puzzling. The people I talked to more openly weren't puzzled at all.

One parish friend, when I told her that I was 95% convinced that I shouldn't be ordained, listened to my history and reasons, and then shook her head and said, "Why is it only 95%? Good grief, Susan, why would you want to be ordained at this point?"

Another parish friend, when I burst into tears one Sunday morning, took me aside and said gently, "You're suffering from post-traumatic stress disorder. You know that, don't you?"

A priest in another part of the diocese, when I gave her a brief (but more specific than I've been here) rundown of my problems with the church, blanched and said, "I'm amazed you're still standing in the church."

The whole mess affected my health. Before my postulancy interview, I was required to go through a thorough psychological examination. I passed it with flying colors, despite my depression history; the psychologist wrote a glowing report and said specifically that I showed no evidence of depression.

When the events I've outlined here drove me back into therapy and back onto meds, I was diagnosed with "major depression." You don't have to be Freud to figure out that there's a cause-and-effect relationship.

For about a year now, it's seemed like an obvious decision. I shouldn't be ordained. Gary agrees; my therapist agrees; my friends and family agree; even people who say "But you'd be such a great deacon!" come around to agreeing after they hear the whole history. My parish clergy have been scrupulously careful to avoid anything that might seem to be telling me what to do, and have assured me that they'll support me whatever decision I make -- but they clearly understand my misgivings.

So it's easy, right? This one's a no-brainer.

Except that I can't seem to bring myself to withdraw from ordination. I've told any number of people that I'm withdrawing, and I've outlined my withdrawal letter. I just can't seem to write it. Part of this is because I actually feel more called to diaconal ministry than ever. My faith in God hasn't been shaken by any of this, and my sense of calling has only intensified. I'm simply very, very wary of trying to live out that calling within this particular imperfect human bureaucracy.

One factor is undoubtedly pride: if I withdraw, some people will see me as a failure, someone who just couldn't hack it, no matter what I say to the contrary. Another factor is simply that I've been following this path for so long -- six years, in one way or another -- that leaving it is very hard.

Intellectually, I'm 150% convinced that I should withdraw from ordination. Emotionally, I can't let go. I'm a Myer-Briggs J: I like having things settled. My paralysis is making me nuts.

5. In Which We Cry a Lot

One sign that I can't let go is that thinking about this keeps making me cry. Typing out the passages from the Prayer Book at the beginning of this post made me cry. Attending the ordinations of friends makes me cry. Seeing our deacons in liturgical regalia makes me cry.

Two weeks ago, I decided that I just had to bite the bullet and write the @*&@)# letter. After church, I marched up to the head of our vestry -- who's also very conveniently on the COM -- and said, "I want to withdraw from ordination. Can you tell me how to do that? I write a letter to the COM, right?"

As I've said, our clergy have scrupulously avoided telling me what to do. But our senior warden looked at me and said point blank, "Susan, don't withdraw. Just -- be on hold. There are people who've been in process as long as any of us have been alive. Everyone on the COM knows that you're doing diaconal work. No one's going to hassle you about this."

My eyes welled up, but I managed not to cry.

Later that day, I did my monthly service at an assisted-living facility. After the service, a new person wandered into the room, and one of the regulars introduced her to me. "This is Susan, our deacon."

"I'm not a deacon," I told her. (I'm diaconal, deaconish, deacon-like.) "I'm a layperson."

She patted my arm. "I've just elevated you to deacon."

My eyes welled up; again, I managed not to cry. I went home and wrote e-mail to two of our parish clergy, describing these two conversations. I didn't know how to interpret the second one. Was it a sign that I should continue with ordination, or was it -- which really makes more sense -- a sign that I'm indeed already functioning as a deacon even without the blasted dog collar? In the e-mail, I included the riff about being a J and wanting to have things settled.

The next morning, one of our priests wrote back. "You are settled. You are Susan, who is multi-gifted, multi-talented, a multi-blessing. You are in transition, as every human being is."

This time, I cried.

I haven't posted about the ordination mess on the blog before -- although some of you already know about it -- because I wanted to wait until I'd made a final decision before saying anything. But it doesn't look like I'll be deciding anything final anytime soon, and it's too big a part of my life to keep censoring entirely.

So there you have it. I'm on hold. I know what I think I should do, but I can't make myself do it, and I don't know if that reluctance is self-centered or God-centered.

All prayers will be appreciated.

Sunday, November 19, 2006

"How Are You?"

One of my personality krenks is that when people ask this question, I tend to tell them. It's taken me years to learn that most of the time, they don't want to know. Most of the time, the question's a polite, perfunctory way of acknowledging someone's presence, rather than a request for a life story. Most of the time, the appropriate response is, "Fine, thanks," even if you're in crisis-clinic mode and expecting the end of the world as we know it in the next five minutes.

My current therapist would call this a boundary issue. (My previous therapist used to do a very funny riff on the real meaning of "fine," which is an acronym for "F***ed up, Insecure, Neurotic and Emotional.") One reason I have trouble in this area is that when I ask how someone is, I usually really want to know the answer, so I have trouble remembering that other people don't.

I've gotten a little better at saying, "Fine, thanks," especially when I really am fine. But when I'm not fine, I still tend to go into TMI mode.

Last week in the photocopier room at work, a colleague asked how I was. I told him -- and immediately thought, Oh, you idiot, he didn't really want to hear all that!

But to my surprise and gratitude, he responded with immediate sympathy and concern: told me that he has trouble at this time of year too, shared his own experience with a light box, wished me luck, confided that he hasn't ordered his spring books yet, either.

On Friday, we had a group of friends over to watch Joss Whedon's Serenity. Some of them asked how I was. I told them, not without some misgivings that they might flee the house as a result. That didn't happen; instead, we got into a lively conversation about various antidepressants. (What was that I was saying about depression being a household word?) One of our friends said, "My mom has a lightbox she never uses. We'll give it to you. Can you cancel the order on yours?"

There was some interruption -- someone else arriving at the house, maybe -- and I never got a chance to follow up on that question. After everybody left, I remembered it, and figured I'd just stick with the lightbox I'd ordered; our friends could give the unused one to someone else.

But last night, the phone rang. "Hey, Susan, can you cancel your order? Do you want that lightbox? I can pick it up tomorrow and drop it by the house on Monday." So we've now canceled the Amazon order, and I'll be getting a hand-me-down lightbox (which evidently cost $800 new) on Monday.

If I hadn't told the truth when my friends asked me how I was, this wouldn't have happened.

I have great friends and colleagues, but I have to say that these two experiences aren't helping me with my boundary issue.

Saturday, November 18, 2006

Cool Stuff

MedGadget, the "internet journal of emerging medical technologies," is having a medical science-fiction writing contest. I think this is a nifty idea. I won't be entering, because a) I have no time and b) I have no use for the digital electronic stethoscope they'll be sending to the winner. I'll be interested to read the winning entry, though!

One reason I have no time to think about this contest is that the deadline is December 1, which is also my deadline for returning the Fate of Mice galleys that arrived in the mail on Thursday. Gosh! It's really going to be a book!

And, speaking of the intersection between writing and medicine, yesterday a colleague at work told me that some folks at UNR are designing a minor in Medical Humanities. He thought I might be interested. I told him I'd love to be involved somehow -- I've been kicking around vague ideas for a course in medicine and literature -- so he's sent my name to the people who are working on the project. We'll see if anything comes of all this. Academic politics being what they are, I don't want to get my hopes up too much, but such a program might give me an exciting way to combine several of my current interests.

Friday, November 17, 2006

Walking the Dog

After I posted yesterday about my depression flare-up, my dear friend Claire sent me this New York Times op-ed piece by Andrew Solomon:
"Despite medical advances in the last 20 years that have greatly improved our ability to help those who suffer from depression, we lack an effective system for administering care. Only a very small percentage of depressives who seek help receive appropriate treatment for their condition. Research often stalls short of being translated into useful medicine. Depressives continue to be stigmatized, which makes their lives even more difficult and lonely. Finally, many sufferers are left to spiral, unsupported, into despair because their insurance companies refuse to pay for treatment.

"These problems are similar to those cancer patients once faced, and the best way to address them might be similar as well. We need a network of depression centers, much like the cancer centers established in the 1970s."
I'm all for a network of depression centers; I think that's a great idea, although I'm not sure I agree with Solomon that depression continues to be stigmatized. If anything, I think it's become a household word, right up there with certain male performance problems that also used to be discussed -- if at all -- in hushed whispers behind closed doors. Depression as malady-du-jour, though, may have the effect of trivializing the illness, always a risk in a pharma-crazy society anyway. Depressed? Pop a pill! Nothing to it!

Cancer's in no immmediate danger of being dismissed this way. I don't mean for a second to deny the devastation of the disease; I've lost friends to it, and my mother's survived both breast cancer and lung cancer. But because there's no quick fix for cancer, or even the perception of one, there aren't cheery little pop-a-pill-and-you'll-feel-better ad campaigns.

Instead, cancer's produced a rhetoric of heroism. Cancer patients are invariably described as "brave," even when they don't want to be. When my mother was being treated for breast cancer, this drove her nuts. "I'm not brave! I'm doing what I have to do. It's not like I have any choice!" Even so, cancer survivors like Lance Armstrong achieve iconic status. Military metaphors abound: cancer treatment's always "a battle," and patients either "win the battle" or "succumb after a long, brave battle."

And then there are all those blasted ribbons. Is anybody else heartily sick of perky colored lapel ribbons for every cause under the sun? Has anybody else completely given up trying to keep all the colors straight? Gary and I went grocery shopping recently, and I picked up a box of coffee filters adorned with a pink breast-cancer ribbon. Coffee filters fight breast cancer? What the hay? This brand filters carcinogens out of your coffee?

The first ribbons I remember seeing were yellow ones, probably during the Iran hostage crisis; according to Wikipedia, the yellow ribbon has a long history -- dating back to 1917 -- in military and political conflicts. Given that history, I don't think the connection to cancer ribbons (even though ribbons now signal all kinds of other things, too) is an accident. Cancer patients are, in a sense, prisoners of war, held hostage by an enemy force. It's easy to see cancer this way because it's an invasive illness, often with clearly visible battle lines drawn on x-rays and CT scans. Cancer cells are "other," hostile mutations bent on overrunning the body's defenses.

As I've said here before -- in a discussion with Will Shetterly that I can't locate at the moment -- I have trouble with battle metaphors for illness. I prefer the metaphor of the journey, with illness as a foreign country which, for all its perils and pains, may also be a place to learn new skills and meet new friends. Sometimes we get to return from that journey and come back home, at least for a while; sometimes the foreign country is the end of our travels. But since everyone's travels in this world will end one day anyway, I don't think it's helpful to imply that people who've gone on to their final destination have lost a battle, or are losers in any other sense. I've heard too many people who were ill vow to "keep fighting" even when they were exhausted and clearly needed rest instead. I suspect that in at least some cases, military imagery encourages patients to push past their limits, instead of honoring their own needs.

Battle metaphors, though, are undeniably sexy. They thrill us; they get our adrenaline going. And that means that, in some twisted way, cancer's sexy, or has been made sexy for the sake of raising money and awareness.

Depression's not sexy. It's common as dirt and every bit as dull. Depression's boring, both for the patient and for everyone else in the vicinity. For one thing, there aren't visible battle lines. Depression isn't an invasion by foreign or mutated cells. If anybody's come up with a sexy metaphor for neurotransmitter imbalances, I haven't heard it yet. There are, of course, famous literary metaphors: Styron's Darkness Visible, Churchill's "black dog." I'm quite fond of the latter; I've tried to domesticate my dog, to train it to heel. When my depression starts howling, I tell myself, "Okay, time to walk the dog," with "walk" as a shorthand for self-care. That's not very sexy, though: nobody's going to start wearing chartreuse pooper-scoopers on their lapels. The very dailiness of depression, and of other long-term chronic illnesses, mitigates against dramatic metaphors.

My "dull as dirt" simile above suggests another metaphor, an agricultural one: depression as the field in which our pain germinates and bears the fruit of compassion. This metaphor is both daily and seasonal, and works well to describe the condition. But it's not very sexy, either.

We don't have depression heroes. We don't have depression icons. There actually is a green ribbon for childhood depression (of course there is), but I had to do a Google search to learn about it. What we have instead is a pop-a-pill mentality that reduces depression -- and male performance problems, and lots of other things -- to the status of a headache.

I'm not sure there are any simple solutions to this situation. As I've said, I don't like battle metaphors, and the metaphors I do like aren't likely to raise anyone's adrenaline levels. But I do have a request: if you know someone who needs to walk the dog every day, offer to come along for companionship and support, even or especially if it's raining out. You may learn things about the neighborhood you never knew, and when you get back, you'll be newly and deeply grateful for that cosy armchair and the roof over your head.

Thursday, November 16, 2006

Change of Shift, and Other Medical Adventures

The latest Change of Shift, the nursing blog carnival, is up over at Life in the NHS.

And in other medical news, I'm horribly behind in every aspect of my life (except, of course, blogging, although even there I haven't responded to some recent comments), and yesterday I had a pretty disheartening conversation with my therapist, who's making noises about either upping my antidepressants or adding another med. At this point, I'm well past procrastination and into the realm of psychomotor retardation, that fun depression symptom where everything takes three times longer than it should because you feel as if each limb is weighted with several dozen pounds of lead. Also, thinking is harder than usual. Since I more or less think for a living, that's particularly annoying and inconvenient. This is rarely a good time of year -- it's grading-crunch time for academics -- but this year, it's much worse than usual.

The problem with depression, though, is that you can't see it on an X-ray or in a blood test. Rationally, I know that this is a realio-trulio chronic medical condition, and that -- as with any chronic medical condition -- I can expect flare-ups. But there's still part of me that suspects that the real problem is that I'm lazy and inefficient. If I were only more ________, I wouldn't be having these problems. Mental-health Mad Libs! Such fun! Fill in the blank with the adjective of your choice!

However, I don't want to up my meds dosage (I've already had a little tachycardia on the current dose, and I'm not eager for more of that), and I'm also loathe to add another drug. So I promised my therapist I'd try a bunch of other things, and see a psychiatrist for a meds evaluation if the other things don't work.

Number one on the list of other things is light therapy. Fall's usually my favorite season, but this year I've noticed myself hating the shorter days, which suggests SAD. So last night, Gary ordered a light box from Amazon. If anybody out there has experience with these gizmos, please let me know.

I was extremely grateful that my therapist didn't tell me to stop blogging. She said, "No, I think that's good for you. You enjoy it. It's a form of self-care." Gary agrees.

And now I really must go try to get some grading done. I was doing pretty well last night, but then the phone started ringing with calls from people I hadn't heard from in a while. Conversation with friends: self-care, or procrastination?

Wednesday, November 15, 2006

Chaplaincy Debate: the Miniseries!

Yes, there's more. The folks over at PlainViews have posted another set of responses to the volunteer-chaplain controversy. Here's part of one reaction from Louise M. Hutchinson, a chaplain in Fall River MA:
I am aware of an organization that provides hospital/nursing home visitation by lay men and women who refer to themselves as "chaplains." At first, I was shocked, but got over it because they really just do not understand that there is a "difference." I tried to explain, but got nowhere. The organization has been ministering for YEARS. I am grateful that these men and women who take their "gift of visitation" seriously for Jesus' sake.
We're shocked, shocked, to learn that people who've been ministering to patients for years actually think of themselves as chaplains!

Okay, I guess that was snarky. I obviously can't be a good chaplain. If I'd completed 5,000 hours of CPE, I wouldn't be snarky anymore: snarkectomy is a requirement for certification. Also, I must not be too bright, because I clearly just do not understand the huge difference, to the patient, between a board-certified chaplain who visits the bedside to talk, comfort, and pray and a volunteer chaplain who visits the bedside to talk, comfort, and pray.

Ms. Hutchinson: Hey, I get it, really. There are things staff chaplains can do, especially in terms of teamwork with other professionals at the hospital, that volunteers simply can't. In complicated situations -- ethical dilemmas, culture clashes, tangled family conflicts -- that teamwork may be crucial. But in less complicated situations, the conversation and comfort and prayer offered by a caring, well-trained volunteer are just as meaningful to the patient as they'd be if they were offered by a staff chaplain. And that frees up the staff chaplain to deal with the complicated stuff.

I've had very meaningful visits with ED patients who weren't being admitted to the hospital. Because we don't have a staff chaplain dedicated to the ED, and because the pastoral needs of these patients weren't necessarily obvious to medical staff, these patients wouldn't have gotten any pastoral care if I hadn't been there. So yes, I take my "gift of visitation" seriously -- and in all seriousness, thank you for at least acknowledging that. Many of your professional colleagues don't.

While I take my ministry seriously for Jesus' sake, though, that doesn't mean that I can't talk to people who don't believe in Jesus. I've been trained better than that. Here's another response, this one slightly longer, from the Rev. Mary Holmen, Chaplain at Selkirk Mental Health Center:
It was suggested that chaplains are “an extension of the church”. While I belong to a church and am endorsed for ministry (ordained) by that church, in my professional role I am the Interfaith Chaplain. There is even some discussion about whether "chaplain” is the best title for one engaged in interfaith spiritual care, since it is rooted so firmly in Christian history. I minister to people of all faith traditions and none, for the experience of illness affects the spiritual health of all people. I operate from a theological conviction that the Creator wills and intends for us to become whole persons –- physically, mentally, spiritually, and emotionally. The resources of one’s own and other traditions can assist in that journey to wholeness. Some patients and families will indeed want -– and they get -– the ministry of the church, through prayer, sacred readings, sacraments and other rites, and connection with their tradition and its representatives. There are a lot of people, though, who do not belong to any organized faith group and do not intend to form this kind of connection. I seek to bring the conviction and hope that healing and wholeness are possible, rather than “the church” in an official sense.

On the other hand, (trained) volunteer pastoral visitors can and should be an extension of their own church to their own members. That kind of support and connection is extremely important in the journey of recovery and navigating the changes that may be happening in the person’s and family’s life.
Rev. Holmen's comments underscore another annoying theme in this debate, the belief -- evidently widespread among professional chaplains -- that only professionals can provide interfaith ministry, or ministry to those with no faith at all. Volunteer chaplains, in this school of thought, can only be trusted to visit those of their own faith traditions. This is the flip side of the belief that volunteers can't be trusted not to proselytize, evangelize, and generally Bible-thump their way through the hospital.

Rev. Holman: I've been trained not to proselytize or evangelize, which aren't activities I'd engage in anyway. I wouldn't proselytize if you paid me. I only started going to church -- to the consternation and alarm of most of my family and friends -- when I was thirty-eight. I've had lots of practice in interfaith and nonfaith dialog; in fact, I'm far more comfortable talking to Wiccan patients, Jewish patients, or atheist patients than I am talking to some extremely conservative Christian patients. Like you, I "minister to people of all faith traditions and none." Like you, "I operate from a theological conviction that the Creator wills and intends for us to become whole persons –- physically, mentally, spiritually, and emotionally." Like you, I "seek to bring the conviction and hope that healing and wholeness are possible, rather than 'the church' in an official sense."

The staff chaplains at my hospital hold volunteers to these standards. They expect us to function as effectively as professionals, although within a far more limited sphere. Because they expect this, and because they've trained us well, it works. We do a good job.

Which doesn't mean that at least one of us doesn't also need a snarkectomy.

Tuesday, November 14, 2006

Screamers

I've posted about how some people find the most challenging aspect of the ED to be the smells. Hospital odors can indeed be intense, but there are sounds I find far worse.

Screamers come in several varieties: howling children who won't calm down, psych patients responding to some reality no one else can perceive -- or so enraged or terrified that all they can do is wail -- elderly patients suffering from dementia. In all of these cases, the patient is in a place no one else can reach. Screamers are walled off from both communication and comfort, isolated in their agony even when they're surrounded by family and staff trying to help them. These cases are heartbreaking.

And they're loud. If there's a screamer in the ED, you'll know it the minute you walk in the door. The sound carries through the entire department, piercing and inescapable. No one blames screamers for screaming -- everyone understands that they can't help it -- but the noise puts both staff and patients on edge. Screamers are the ED version of car alarms.

These patients become the center of concerted efforts by anyone in the vicinity: nurses, techs, volunteers, security guards. Driven both by compassion and by a frantic desire for the noise to stop, everybody tries to get them to quiet down.

But with a real screamer, by definition, very little will work. Screamer kids will only scream harder at the sight of a teddy bear, crayons, or anyone at all wearing scrubs. They want home. This isn't it. I once saw a screamer adult brought in on a backboard and in a cervical collar; because those contraptions are so uncomfortable, we thought he might stop screaming if he was unstrapped. It didn't work. He bolted out of bed and kept screaming, running laps around the department, until security tackled him and put him in four-point restraints.

For me, the hardest patients are the elderly, like the old woman alone in the critical-care room -- her children having fled -- who cried "Help me" over and over. I asked her what was wrong. Two nurses across two shifts asked her what was wrong. She couldn't or wouldn't answer us. "Help me. Help me. Help me!" I watched the first nurse struggle with anger at the patient's absent family, who may after all have felt as helpless as we did. I watched the second nurse put up walls, emotional barriers to shut out the noise and what it meant.

I started avoiding the room. It was too hard to hear her crying "Help me," to want to help, and not to know how.

When screamers finally stop screaming, muscles and jaws unclench around the department. Everyone can breathe again. The screaming toddler has finally fallen asleep. The screaming psych patient has finally succumbed to injections of Haldol and Ativan. I once had a few moments of success with an elderly dementia patient whose husband had brought her to the hospital and immediately left. Strapped to her bed, she kept keening, "Mama, Mama, Mama," sobbing for someone who wasn't there. I sang her a lullaby. She turned to me with a wondering expression, and for a little while, she didn't scream.

But sometimes no one on the staff can do anything, because they're staff.

One evening a screamer arrived halfway through my shift. The patient, accompanied by a frantic relative, was taking Methadone to kick a heroin habit, but the Methadone dose had been decreased too quickly. The patient was in withdrawal, writhing in agony -- and screaming. A staff member begged me to do something to help. "Junkies feel so horrible about themselves, and I'm scared this kid's going to go out and use again." But whenever I went into the room, the patient turned sharply away from me, and the relative gave me a helpless shrug. Because I was the chaplain, the patient expected to be shamed or lectured.

The second bed in that room held a burly fellow with prison tats, including swastikas. He'd been brought in by a woman, wife or girlfriend, who looked as if she'd had a hard life of her own.

The nurse assigned to the room was non-white, and understandably nervous about the patient with the tattoos. The noise from the other bed was close to unbearable. It wasn't a good room. I found myself avoiding it, and the nurse probably wanted to do the same thing.

And then I went by the room on my way to somewhere else, and heard -- nothing. Silence, sweet peace. I ducked inside to find out what had happened, and found the woman who'd brought in the tattooed patient leaning over the now-quiet screamer. She was giving the screamer a backrub. The patient had finally relaxed, and so had the exhausted relative.

"Thank you," I said, and the woman smiled at me.

"I'm a masseuse. Massage really does help people calm down."

I wondered if we should recruit a volunteer massage therapist for the ED, but I'm not sure the patient would have let that person close, either. The woman giving the backrub was a peer, an equal: someone else dealing with real or perceived staff judgments, someone with whom the patient didn't need to be ashamed.

I don't know if the patient knew any of that consciously, but I do know that I saw Christ in that room. Christ is a hardened woman leaning over a bed, giving a backrub to someone who's finally stopped screaming.

Grand Rounds and the Holy Grail


This week's Grand Rounds features a Monty Python theme, complete with sound clips. The posts I've read so far are excellent. Thanks for including me, Topher!

I hope to post something more substantial tomorrow, or maybe tonight. Busy days in through here.

Monday, November 13, 2006

Fun With Labels

Blogger kept nagging me to update to their Beta version, so I finally did. So far, the only new feature I've used is the labels you'll see at the end of each post.

If you click on a specific label, you'll be taken to a page containing all the posts that also have that label. So, for instance, if you want to read all my homilies, click on the preaching label at the end of the most recent one, and you'll get all of them (along with a few preaching-related posts that aren't actual homilies).

This is a useful sorting system, and should make it easier for readers to find material that interests them.

Sunday, November 12, 2006

The ED as Heaven

Sometimes hospital patients ask me what I believe about the afterlife: who goes where, how the destination's determined, what it's like. I always tell them that I don't know, and that we can't know until we get there (although, like everyone else, I've heard stories.)

I do have theories, though.

If you've been reading this blog for a while, you may have figured out that my theology's often a tad unconventional, or at least takes forms of which many more conservative Christians wouldn't approve. I once reassured a distressed patient, worried about the ultimate destination of a reprobate relative, that God loves everybody. I'm pretty sure this opinion wouldn't be considered heretical in most quarters (even conservative ones), but this particular patient frowned, scowled, glared up at me from the gurney, and snapped, "You're too liberal."

Well, maybe. But I don't and can't believe in a God who shuts people out, which means that I have a really hard time with the concept of hell as maximum-security-prison. Hell as a state of misery in which we trap ourselves and which we carry with us, Milton's "this is hell, nor am I out of it"? Absolutely: been there, done that. Hell as a shame-born compulsion to flee whomever loves us, whether God or other people? Yep; we've all seen that, right? But hell as the eternal, inescapable, x-strikes-and-you're-out corner to which God sends us forever because we've been bad? Doesn't work for me.

So my idea (undoubtedly heretical) is that we all wind up in the same place, and that how we respond to our neighbors determines whether it's heaven or hell for us. This is similar to the anecdote, probably apocryphal, about the Chinese vision of hell as a sumptuous banquet at which the guests are starving, because they've been given six-foot chopsticks and can't feed themselves: heaven's the exact same set-up, except that the guests are feeding each other with the chopsticks, instead of trying to feed themselves.

Last night, it occurred to me that I imagine whatever-comes-next as working more than a little like a good emergency department. Everyone's taken in, regardless of creed, color, attire, or ability to pay; everyone's treated with respect and compassion; everyone's healed and made whole. One of the things I really like about this idea is the vision of the souls in the most pain being first in line for treatment -- every ED has a triage system -- rather than being sent to a corner to writhe in eternal torment.

Of course, as in any ED, there may be patients who walk out AMA, or who become indignant at the idea of those people being treated first -- didn't somebody famous say "the first shall be last?" -- or who refuse to comply with treatment. And for them, maybe this place is hell.

What about staffing, you ask? Well, maybe those who've been made healed and whole joyously volunteer to help heal others in turn. I'm imagining this as a place where the healers love their work and never get tired. (I'm also imagining actual ED staff rolling their eyes at this vision and muttering, "Heaven forbid!")

Okay, so I'm weird. I'd much rather spend four hours volunteering in the ED than trying to make small talk at a cocktail party. (Cocktail parties: instant hell.) But this metaphor makes me happy.

I probably won't be sharing it with patients, though. "Oh, my vision of the afterlife? Actually, it's kinda like where you are now, only with even better pain meds." I don't think most of them would get it, and who can blame them?

Saturday, November 11, 2006

Our Anniversary


Today's the anniversary of the day Gary and I met, and also our wedding anniversary. We've now known each other for seventeen years and been married for eleven.

Gary's always liked 11/11 because it's easy to remember. The year we got married, 11/11 was on a Saturday, and he liked the idea of having that as the wedding anniversary too, because then there would only be one date to remember. And since this is our eleventh wedding anniversary, there are just elevens all over the place!

(Actually, it's a little more complicated than that: we were legally married at City Hall on a weekday in late July, because Gary had always wanted to be able to say, "Sorry I'm late to work, but I just got married." On 11/11, we had our own ceremony and a big party at a restaurant with friends and family, but that's the date we consider the "real" anniversary, even though it isn't the legal one.)

Above is my favorite picture of us, taken by a church friend on his porch a year or two ago.

Tonight we're going out for a very fancy meal at our favorite restaurant in Reno, which also happens to be one of the most expensive. Otherwise, though, I'm going to be spending most of the day grading. It's that time of the semester!

Friday, November 10, 2006

Today's Rickety Contrivance

Overheard snippet of conversation at the health club:

"So at lunch today I was chatting with the couple next to me, and when they left, they paid my bill! I couldn't believe it! That was so nice! I can't wait to do the same thing for someone else!"

Last Tuesday we had some extra time in my fiction workshop, so I gave the students an exercise. I put a list of six abstract nouns up on the board (things like honor and poverty), and told them to write a scene, using only concrete nouns, that would illustrate the concept they'd chosen without ever naming it explicitly.

I listed three positive nouns and three negative ones. All but one student chose to write about one of the negatives.

On Thursday, we did the same exercise again, but I gave them only positive nouns. They found this more difficult, and we talked about why: because nice things are less dramatic and therefore less story-worthy, because the students were afraid of sounding corny, and -- most interesting to me -- because writing happy stories makes them feel childish, since happy stories were what they wrote when they were kids.

When I was in graduate school, I wrote an essay called "Poisoning Peter Pan: the Inner Child in the Academy," about my own experiences with academic contempt for anything "childish" -- i.e., emotional or enthusiastic or un-ironic -- by way of earlier observations on the subject by Alice Miller and Jane Tompkins. I never tried to publish the essay for a number of reasons, including the improbably-optimistic hope that maybe this kind of thing only happened at Yale. (My advisor's tart warning that I should only publish the piece posthumously was also a factor.) After listening to my students last week, I wonder if the topic's more relevant than I thought. Hmmmm. I do have tenure now. Maybe I should dig it out and look at it again. Or maybe I could post it here. Hmmmm . . . .

Anyway, during the conversation last Thursday, I told my students that lots of nice things happen in the world that we'd never buy if they were fiction. The rickety contrivance I overheard in the health club is a perfect example; if anyone wrote that in a story, the readers would all be saying, "C'mon, doesn't work, why would the couple buy this woman lunch? What's their motivation? Are they really white-slavers or something? Are they crazy? Are they going to stalk her and kill her? Are you going to try to sell the movie rights to Quentin Tarantino?"

(Yes, I remember when Pay It Forward came out, although I didn't see the film. I also remember that many critics made merciless fun of it.)

But now the woman who was unexpectedly treated to lunch wants to do the same thing for somebody else, and maybe that person will be similarly inspired. This could start a trend of kamikaze kindness: walk into a restaurant at lunchtime, strike up a conversation with a stranger, pay the stranger's bill, and walk away.

Bwah hah hah!

I'm not sure I'd have the nerve to do this myself, although I'm not sure why I wouldn't. Is anybody out there braver than I am?

Thursday, November 09, 2006

Carnival of Hope: Volume 1, Number 3

Welcome to the November Carnival of Hope! In honor of Thanksgiving, this month's theme is gratitude.

Many of our contributors this month have written about how hope and gratitude can result from a shift in perspective. In a moving post about his -- and others' -- response to September 11, 2001, Daniel Brenton writes about Gratitude: An American Path and invites us to join him in a "conspiracy of gratitude." This conspiracy begins with focusing on what we have, rather than on what we want. John Olsen uses a similar contrast of attitudes to find the bright side of a painful and poignant family situation in Perspective. John, I'm sure these children are very grateful for what you and your wife have done for them!

It's easy to find gratitude in a story of family generosity; many of us would be hard-pressed, however, to change our perspective if we were suffering from a painful injury. In What Defines You? Hueina Su tells us how the enforced meditation of physical therapy led her to a choice not to define herself by her chronic pain. And on a lighter note, Joe Donnachie chooses to exult in conditions others would find miserable in The Joy Of Rain. As someone who lives in the driest state of the country, I can really relate to this one; when it rains in Nevada, the locals rejoice!

Sometimes changes in perspective are relatively easy, a matter of making a conscious choice to see something differently. But often the process is more difficult: sometimes the only way out is through, and sometimes we can only find our way through the darkness by facing it head on, even though it terrifies us. John Hill shares a story of a childhood friend who did just that in How Facing An Old Fear Changed Her Life. And DisappearingJohn rejoices in closeknit family, renewed health, financial stability, and career fulfillment -- the triumphant end of a very long road -- in the joyous post What a Great Place! What a great post!

Long journeys begin with small steps. New Orleans residents have begun to rebuild after the devastation of Katrina, and Tracy Coenen shares visual evidence of this healing by showing us More pictures of post-hurricane New Orleans. Good things are happening farther north, too. In A Step in the Right Direction!, my friend Lee celebrates the election of a Muslim Congressman, Keith Ellison of Minnesota. I agree with her that this is a welcome step towards increasing American political diversity.

Since it's the eve of Veteran's Day, it seems only fitting to express gratitude to those who serve their country, and who so often pay a very high price for doing so. My own post Making Peace With God tells the story of two men who found healing from the trauma of war by following paths of peace. I hope this story will inspire others to use them as role models. And on that note, Erek Ostrowski offers a very useful distinction between Heroes and Role Models. Whereas the so-called heroes of literature or action-adventure films often make us feel inadequate, Erek says, "Real heroes are people who help us see our own strengths."

May all of you find strength, hope, and peace during the upcoming holidays!