Wednesday, January 31, 2007

Meds for Life


I spent all morning at my mental-health group: first I had an appointment with the psychiatrist to discuss meds, and then my regular weekly appointment with my therapist. My primary-care doc, whom I adore, has been prescribing and monitoring my meds, but when I was having trouble on just the nortriptylene, my therapist got me in to see this shrink, who's evidently excellent (and whom I like very much).

In the meantime, my primary had put me on an additional, very small, dose of Effexor. That combo's been working pretty well, and the shrink says that she sees no need to change it. After taking my history, though, she did tell me that I'll probably need to be on antidepressants for the rest of my life. People who've had three episodes of major depression -- and I've probably had more than that, although I didn't recognize all of them when they were happening -- have a 90% change of recurrence, and the episodes become more severe and happen closer together as the patient gets older.

The psychiatrist who put me on Prozac back in 1994 had told me the same thing; when I went off Prozac in 1998 and stayed off for eight years, I thought I'd proven him wrong. Regular readers of the blog know that I hated going back on meds, and also hated having to start a second med when the nortriptylene wasn't working by itself. I'd really been hoping that the latest bout of depression was just a result of the situational crud that started three years ago, and that I could get off meds in a year or two, so I wasn't happy about today's pronouncement. When I told the doctor that I'd been off the Prozac for eight years, she said gently, "Sure, but then you had to go back on. Maybe you can get off again for a while. You probably won't be able to stay off, though." And then she gave me the speech -- which I know by heart, because I've given it both to myself and to other people -- about how I have to tell myself that I have a chronic medical condition, like diabetes or high blood pressure.

Intellectually, I know all that. But I'm still bummed.

So, anyway, I'm going to switch my meds management from my primary to this shrink, because if things go south again, I want to be an established patient of someone who has more experience. (My primary's very good, and the shrink was impressed by the nortriptylene-Effexor combo, which wasn't one she'd have thought of; still, in this case I think a specialist is better.) I'm seeing her again in a month, and she said that if I feel worse again before then, I should call her and she'll get me in right away. If I were doing worse, she'd either raise my Effexor dose or put me on Cymbalta. I'd probably opt for the Cymbalta; the doctor confirmed that Effexor is one of the drugs that tends to numb creativity. I'm really, really hoping that none of that will be necessary!

After seeing the shrink, I kvetched to my therapist, who was very sympathetic and said, "Look, you can try to go off. It's not a big deal. You might just need to go back on, that's all. You're very aware of your emotional states. You know when you need to be on meds. You'll take care of yourself."

So there you have it. And now I'm going to go swimming, today's version of walking the dog.

Tuesday, January 30, 2007

Time to Consume Grand Rounds!


This week's Grand Rounds is up, with a theme of consumerism in health care.

Happy reading!

Monday, January 29, 2007

New Sticker


Last night at the hospital was nuts: deceptively few people in the waiting room, but nonstop ambulances, lots of really sick patients, several catastrophic diagnoses (advanced lung cancer, brain tumor), and screamers of every shape and size. Most of the hall beds were full, and in a couple of them, folks were tied down with the hospital's most heavy-duty restraints. I saw one person restrained in a very odd position -- one hand tied to the bedrails by the waist, the other stretched up over the head -- and when I asked the security guard what that was for, he said cheerfully, "Oh, that way they can't reach up and bite us."

Usually my four-hour shift includes a snack break, a couple of bathroom breaks, a visit to the chapel, and so forth. Last night, I never even got to the water fountain. My census was actually a little lower than usual, because I had a few long visits, but I was working the whole time. As I was leaving, I saw another security guard who looked at me, sighed, and said, "And it's not even a full moon!"

In the middle of all this, a mom came in with a sick kid. The kid recognized me from a previous visit, months ago: good memory! I hadn't met the mom before; last time, the kid had come in with a grandparent. It was one of those rooms where I didn't expect to be spending much time -- parents with sick kids are usually in the "Oh, we're fine" category -- but it turned out that there'd been a recent, very devastating loss in the family. The mom was reeling, and needed to talk and pray and cry.

After we'd talked for a while, she asked if I'd sit with the kid while she went out to make a phone call. I was happy to do that, and we had a nice conversation. ("I like your doctor shirt. Do you like blue? We saw some doctor shirts with clouds on them at a store. I could buy you one. What size do you wear?") Somebody had given the kid a sheet of stickers -- valuable currency, with pediatric patients -- and before I left, the child gave me one and said, "You did a good job talking to my mommy."

How cool is that?

So I now have a new sticker on the back of my volunteer badge. When I got home, I proudly showed it to Gary, who looked bemused. But that's okay. During one of those slow or difficult shifts when I wonder why I'm at the hospital, my sticker will remind me.

Sunday, January 28, 2007

Hometown Boy Makes Bad


Three years ago, I preached on today's readings, Jeremiah 1:4-10 and Luke 4:21-32. This is the famous rejection at Nazareth, and it's a pretty thorny passage. Three years ago, it was particularly and painfully apt for me, because I was embroiled in our parish misconduct mess, wondering if I was going to be driven out of my congregation for speaking truth to power. That didn't happen, for which I'm deeply grateful.

Most people in our parish didn't know about the misconduct investigation yet when I gave this homily; but, of course, the erring priest did, and also knew who'd reported (I wasn't the main reporter, but I'd counseled the main reporter, and also sent a supporting letter). At the end of the service, he came up to me, looking exasperated, and said, "That was a good homily, Susan."

I give him a lot of credit for graciousness under pressure; nonetheless, it was a very surreal morning.

* * *

This morning’s homily has been a real struggle for me. Every time I read this Gospel passage, I find myself sympathizing not with Jesus, but with the townspeople of Nazareth. Jesus is being obnoxious. Of course they’re angry at him. He tells them that prophets are always rejected, but they haven’t rejected him yet when he says that. They reject him only after he’s already rejected them. In popular psychology, this is what’s known as a self-fulfilling prophecy. And what’s worse, Jesus speaks in maddening non sequiturs; my personal response to most of what he says is a baffled what?

I had no luck whatsoever parsing this passage until I tried to imagine it from the point of view of one of Jesus’ friends, until I tried to fill in the gaps in the conversation. I invite all of you, now, to do the same thing.

Jesus is back in town! He’s been off wandering somewhere – doing amazing things, if the reports can be trusted – but now he’s back home. He’s going to the synagogue on the Sabbath, like a good Jewish boy, and you’re going there too. You grew up with Jesus. The two of you played together while the adults stood in small clumps, muttering about boring things like taxes and Roman occupation. It’s sure been great to see him again. He has some strange new friends, true, but that doesn’t matter. He’s still Jesus, still a Nazareth boy.

In the synagogue, you watch proudly while Jesus stands up to read from Isaiah. The passage brings tears to your eyes. “The Spirit of the Lord is upon me, because he has anointed me to bring good news to the poor. He has sent me to proclaim release to the captives and recovery of sight to the blind, to let the oppressed go free, to proclaim the year of the Lord’s favor.” Now that you’re an adult, you know what the grown-ups were muttering about. You’ve watched your father, who’s sitting next to you, struggling to pay his taxes, and if the Romans are better than the Greeks who preceded them – at least they’ve allowed the Jews to keep their own religion – you still hate being ruled by foreigners, by people who don’t belong here.

“Today this scripture has been fulfilled in your hearing,” Jesus says, and a happy sigh goes up from the crowd. Jesus has come to free the oppressed Jews. Some of the people around you are skeptical. “Isn’t this Joseph’s son?” says your next-door neighbor. “We’ve known him since he was in diapers. Where does he get off, acting like he’s the Messiah?” But most of the worshippers praise Jesus’ gracious speech, his promise of deliverance.

But then everything goes wrong. Jesus says, “Doubtless you will quote to me this proverb, ‘Doctor, cure yourself!’” You blink. What? He hasn’t told you to cure anything; he’s told you that you will be cured! Hasn’t he? Is Jesus implying that you need to release captives and free the oppressed? That can’t be right! You are the oppressed! The Romans are the bad guys here!

You’re working so hard to figure this out that you miss what Jesus says next, until you hear your father saying in exasperation, “Of course we want you to do for us what you did in Capurnaum! Everyone says you’re a holy man and a healer, Jesus, and we’re your friends and family! Who deserves your help more than we do?”

“No prophet is accepted in the prophet’s hometown,” Jesus answers cryptically.

Your neighbor mutters, “If you want us to accept you, stop insulting us! Speak plain Aramaic!”

So he does, which just makes things worse. He reminds all of you that even though there were thousands of hungry widows in Israel during the prophet Elijah’s time, Elijah was sent only to one of them – a foreigner. He reminds all of you that even though there were thousands of lepers in Israel during Elisha’s time, Elisha was sent only to one of them – a foreigner.

By now, your father’s shaking with anger. “Is this why you came back?” he demands. “To tell us that you won’t help us? To tell us that you’re going to help foreigners? What does that mean, Jesus – that you’re going to help the Romans?”

“Well,” says your neighbor, “if he only wants to help foreigners, I guess he doesn’t belong with his old friends anymore, does he?”

And then the entire crowd’s on its feet, pushing and shoving. You’re carried along in the rush. You feel sick. You’re mad at Jesus yourself, but you can’t believe the rage he’s just unleashed. It occurs to you bleakly that the town’s lashing out at Jesus because they can’t lash out at their real enemies; their real enemies are too dangerous. Jesus is a scapegoat. But this thing’s too big for you to stop, and before you know it, the crowd’s dispersed, and you’re trying to put together what happened.

They – you – tried to throw Jesus off a cliff. But Jesus got away, somehow. He parted the mob the way Moses parted the Red Sea, and went on his way. You shiver, remembering that. You know your scripture, and you remember the Lord saying to Jeremiah, “You shall go to all to whom I send you, and you shall speak whatever I command you. Do not be afraid of them, for I am with you to deliver you.” Jesus really must have been sent by God, if God kept him safe that way. Does that mean that you are an oppressor?

And suddenly you remember the beggar you passed on the side of the road the other day. You didn’t give him anything; you told yourself you couldn’t afford it, because of the Roman taxes. Your stomach twists uneasily. A small, mocking voice in your head says, “That wasn’t good news for the poor, was it?” But that was the Romans’ fault, you tell yourself. They’re the bad guys, not me! Not us! We’re not the oppressors: they are.

Is this what really happened, two thousand years ago in Nazareth? There’s no way for us to know. But this is a version of the story that makes political and emotional sense to me. Us vs. Them. That line ran through pretty much everything in first-century Judea, and it runs through pretty much everything in twenty-first century America. And it means that prophets are no more popular now than they were in Jesus’ time. Just look at what happened to Martin Luther King, Jr. In common usage, the word prophet tends to mean “someone who foretells the future,” but Biblical prophets are people who speak out against current injustice, and who do so in explicitly God-given language.

“I have put my words in your mouth,” God tells Jeremiah. God’s words are dangerous. What sounds like good news to the poor, the oppressed and the imprisoned may sound very different to rich people, oppressors, or prison guards. And no matter what side you’re on, prophecy is always about change – and change is always frightening, even to the people who benefit from it. Prophets want to turn the world upside-down. They’re trouble-makers. The only people who like them are the poorest and the most oppressed, who have no privilege of their own to be threatened, and have nothing at all to lose from change.

My sister, who’s Quaker, once told me that nearly all of us are both oppressed and oppressing. Nearly all of us have both been wronged and done wrong. That, I think, is what Jesus is telling the people of Nazareth. He’s telling them that they’re part of the problem. He’s telling them to cure their own faults, instead of only blaming others. And he’s telling them that he’s not their private property. He’s been sent to everyone, family and foreigners alike. He’s been sent to the entire world, not just to one neighborhood. God’s justice is for all people, even for people who look like enemies.

And what of Jesus’ childhood friend? I picture him sitting on his bed that evening, trying to rewrite the horrible day. Couldn’t Jesus have found some way to be less offensive? Couldn’t he have called his neighbors to repentance more gently, more lovingly? He can’t keep talking to people that way, miraculous healings or not. He’s going to get himself killed.

And a few years later, when Jesus does get himself killed, the childhood friend hears the news and thinks sadly, “You didn’t get away that time, Jesus. No parting of the mob there.”

But there are other stories in the air, incredible stories, tales about how Jesus did get away: stories from people who saw him dead, undoubtedly dead, and then saw him vibrantly alive. Jesus avoided neither the mob at Nazareth nor his death on the cross; somehow, impossibly, he walked safely through both of them. And the childhood friend shivers, and finds that he believes. And he still pays his taxes, and he still struggles to be kind to people poorer than he.

We follow in his footsteps. Believing in Jesus, we still find ourselves complicit in injustice, and we still get angry when we’re asked to confront the fact that we, and not just they, are the source of some wrong. We struggle and repent; we do our best to mend what we have broken. We work towards the Kingdom of God, where there is neither Jew nor Roman, neither slave nor free, neither us nor them: where all will be accepted, and all will be at home.

Amen.

Saturday, January 27, 2007

Saturday


Aw, heck, so I got snoped with the Julie Andrews thing. I feel kind of silly. On the other hand, it's one of those stories one wants to believe. I almost wish I didn't know it was an urban legend (and I wish she hadn't lost her voice!).

Last night we had eight friends over to watch the three-hour Battlestar Galactica miniseries. Unfortunately, I think a number of them were distracted by Balthazar, who had absolutely no fear of a roomful of strangers. He merrily climbed all over all of us, with occasional forays into the munchies: a couple of us spent time juggling containers of food so he wouldn't get into them, and he had a deliriously happy few minutes batting a piece of popcorn around the floor. At one particularly tense moment in the miniseries, I heard a yelp from one of our friends; I thought she was reacting to what was happening on screen, but no, Bali was climbing up her leg. (The big cats, meanwhile, had fled upstairs, and were probably thinking, "Oh, good, he's picking on the humans for a change!")

I hope our friends will be willing to come back. They probably traded exasperated comments about the cat once they'd left. Maybe we should lock him in another room next time.

Today I got up, got a bunch of work done (yay!), went for a walk (yay!), came home and tried to get more work done and couldn't (boo!), and then gave up and watched two episodes of Supernatural with Gary. We've now watched the first four episodes, and have decided not to watch any more; all four episodes had gaping plot-logic holes, and we don't find the two main characters that interesting.

Nertz. Oh well. There are enough good shows out there; we don't need to watch mediocre ones.

So, as you can see, I'm leading a monumentally eventful life. On the other hand, sometimes boring is soothing.

Friday, January 26, 2007

Book News! And Julie Andrews!


The Fate of Mice, which has been available for preorder from Amazon for lo, these many months, is now actually in stock. Yes! The book is sitting in Amazon's warehouses, itching to be released into the world and enjoyed by discerning readers! Amazon will send it to you! You can hold it in your hot little hands and breathlessly peruse its scintillating pages! Makes a great gift idea! Order yours now! Don't delay!

I haven't gotten my copies yet, but expect them to arrive within the week. There's nothing quite like the thrill of seeing a finished book.

Meanwhile, Shelter is now listed on Amazon and available for preorder, with a pub date of June 12. Tor's sending out four-color advance reading copies -- my editor tells me they only do that for about six out of thirty books -- and I expect to get my copies of those any minute, too. Oh, and Tor's also going to do an online Reading Group Discussion Guide for the book. My editor called and asked if I wanted to write the questions myself, or if they should have a freelancer do it; I opted to let the freelancer do it, as long as I had final approval. Patrick laughed and said, "Yeah, I figured you didn't need another syllabus to write."

I've been really busy at work this week and haven't had time to respond to comments or e-mails, so if you've posted or sent me something and I haven't gotten back to you, please accept my apologies!

Speaking of e-mail, my mother sent me the wonderful item below. Some of you have probably seen it too, but if not, I hope you enjoy it.

* * *

Actress/vocalist,Julie Andrews, to commemorate her 71st birthday on October 1, made a special appearance at Manhattan's Radio City Music Hall for the benefit of the AARP. One of the musical numbers she performed was "My Favorite Things" from the legendary movie "The Sound Of Music."

Here are the lyrics she used:

Maalox and nose drops and needles for knitting,
Walkers and handrails and new dental fittings,
Bundles of magazines tied up in string,
These are a few of my favorite things.

Cadillacs and cataracts and hearing aids and glasses,
Polident and Fixodent and false teeth in glasses,
Pacemakers, golf carts and porches with swings,
When we remember our favorite things.

When the pipes leak,
When the bones creak,
When the knees go bad,
I simply remember my favorite things,
And then I don't feel so bad.

Hot tea and crumpets and corn pads for bunions,
No spicy hot food or food cooked with onions,
Bathrobes and heating pads and hot meals they bring,
These are a few of my favorite things.

Back pains, confused brains, and no fear of sinnin',
Thin bones and fractures and hair that is thinnin',
And we won't mention our short shrunken frames,
When we remember our favorite things.

When the joints ache,
When the hips break,
When the eyes grow dim,
Then I remember the great life I've had,
And then I don't feel so bad.

Ms Andrews received a standing ovation from the crowd that lasted over four minutes.

Thursday, January 25, 2007

Change of Shift, and New Cat Antics


The new Change of Shift is up over at Emergiblog. Thanks for including me, Kim!

Meanwhile, Balthazar's new favorite toy is the computer. He loves to chase the cursor on the screen, and the other night he sat and watched a movie with Gary, looking very interested at all the colorful moving things. We don't dare get him one of those "kitty TV" DVDs of mice and birds and such, or he'd shred our monitors!

Tomorrow night we're resuming our Friday-evening DVD showings, this time for Battlestar Galactica, so Bali will get to meet some of our friends. He's a very sociable kitten, so I don't expect him to be freaked out by new people.

I haven't managed to get any new pictures of him lately, but when I do, I'll post them.

Wednesday, January 24, 2007

Good Reasons Not to Go Into Healthcare


Anybody who reads this blog regularly has figured out that I'm something of a medical groupie: I hang out in an ER four hours a week, read a bunch of medical blogs, and often write on medical topics. I'm known as the "medical person" in my immediate family, because I'm the one who likes researching other people's diagnoses and who's comfortable advocating for loved ones with healthcare providers. When I go to my own doctors, I tend to have a pretty good idea of what's going on -- on several occasions, I've made my own correct diagnosis before showing up in the office -- and my medical caregivers treat me like someone who knows what she's talking about.

Gary often teases me about going to medical school; when we watch TV medical shows, I frequently figure out what's wrong with the patients before the TV docs do (although, given the unreality of most TV shows, that probably has more to do with the fact that I'm a writer than with my interest in medicine). So the question naturally arises: "Say, Susan, why didn't you become a doctor or nurse?"

I had this conversation recently with someone in the ER waiting room, a trauma nurse visiting from another state who was waiting for word on a friend. She was impressed that chaplains at my hospital are trained to visit waiting rooms; I told her that I'm in awe of ER nurses, and that I could never do the work. She smiled, shook her head, and said, "Sure you could. All you need is love."

Well, no. You need some other things, too. For instance:

* A good head for math and science. There's a reason I was an English major, okay? I forced myself through AP Calculus in high school, with many tears and headaches, and then abandoned math completely. My science education pretty much ended in tenth grade, when we had a biology teacher who claimed that because bats were the only true flying mammals, they were the only mammals with feathers, at which point the class shook itself out of its stupor and started trying to convince the teacher that no, bats didn't have feathers. Really. No feathers. (We did convince her, but it took a good ten minutes.) I might have been okay at science if I'd had better teachers, but I doubt I ever would have been great at it.

* Physical coordination and fine motor skills. I'm not someone you want trying to start an IV on you, ever. Honest. Trust me on this one.

* A high tolerance for stress. Doctors and nurses are in a field where their mistakes can literally kill people. I couldn't handle that. If I make a mistake on a syllabus, my students will read the wrong chapter. That, I can live with.

* Lots of physical stamina. Twelve-hour shifts? Thirty-six hours on call? No way. Sleep deprivation and I do not get along.

The closest I've ever come to going to med school was attending SUNY's Summer Intensive Latin Program, fondly known as Latin Camp, after my first year of graduate school. (Passing a reading test in Latin or Greek was a requirement of my program, and I'd had no previous exposure to either.) Latin Camp covered two and a half years of college-level Latin in two and a half months. We walked in knowing nothing. Ten weeks later, the final exam was seven hours long and included sight translation from The Aeneid.

On the first day of Latin Camp, we were warned that a) this was probably the most difficult thing we'd ever do and b) the program routinely destroyed marriages and other intimate relationships. We were invited to bring our significant others to class (eight hours a day, five days a week) so they'd see what we were going through. I was living with Gary for the first time that summer; a few weeks into the course, he said plaintively, "I don't understand why you aren't willing to get a B in this course to spend more time with me."

I said, "You don't get it. It's not a choice between getting an A or getting a B. It's a choice between passing or flunking." (I passed, but there were many days when I didn't think I would.)

Latin Camp meant all Latin, all the time. We were in class eight hours a day, and then came home and studied and did homework until we went to sleep. We had the home numbers of all of the instructors, who were -- quite literally -- on 24-hour call. I once called one of the teachers at 2:30 in the morning for help translating Cicero. Two weeks in, Gary offered to program the teachers' numbers into our speed dial (replacing less important things like 911), and I said, "Oh, that's wonderful! Not having to hit all those numbers will save me so much time every night!" He just looked at me. He told me later that this was the point at which, had I been in a cult instead of an academic program, he would have had me kidnapped and deprogrammed.

And then there were the flashcards. I carried a filebox of flashcards with me everywhere. I studied them over meals, on the subway, and as I walked from the subway to class. If they'd been laminated, I'd have studied them in the shower. One morning as I was trudging along the sidewalk with my head bent over my flashcards, I heard a cheerful, "Hi, Susan!" and looked up to see a friend who worked in publishing. "It's so nice to see you! What are you up to this summer?"

"Studying Latin," I said, and burst into tears.

Because, you see, I wasn't very good at Latin. It was hard for me. I was slow. To keep up, to get all the homework done each night (because missing a night's homework was the equivalent of missing a week's work), I stopped sleeping for a while, or at least only slept a few hours a night. I believe it was during this hazy period that my publishing friend greeted me.

Not sleeping turned me into a weeping zombie. I got really bad at Latin. I started flunking our daily quizzes. Finally one of the teachers took me aside and said gently, "Susan, you're doing so badly because you aren't sleeping. We never told you not to sleep. Go home tonight and get some sleep." I went home that night and slept for eighteen hours.

I've often told people that Latin Camp was kind of like medical school, except that instead of dissecting cadavers, we were working on a dead language. But when I made a mistake in Latin Camp -- and I made a lot of them! -- the worst thing that happened was a mangled translation of Cicero or a failed quiz. My mistakes weren't going to kill anybody. They badly damaged my pride, but that's not fatal.

You don't want me trying to start an IV on you even when I'm fully awake. You really don't want me trying to start an IV on you when I'm sleep-deprived. So I'm going to pass on twelve-hour shifts and thirty-six hours on call. I'm perfectly happy being an English professor and volunteer chaplain who hangs out in the ER four hours a week. I like being someone who gets to sit down a lot.

I may be a groupie, but I'm not a wannabe. I know my limits.

Six-Month Blogaversary!


Six months ago today, I created Rickety Contrivances. I've had a lot of fun with the blog since then, and have met a lot of interesting people through their own blogs, or through their comments.

Thanks to everybody who reads this blog! Eat some chocolate today -- or whatever your decadence-of-choice is -- and think of me.

Tuesday, January 23, 2007

Grand Rounds!


This week's Grand Rounds is up, and I'm delighted to be included.

Happy reading!

Monday, January 22, 2007

Black Hole


Last night I worked five hours at the hospital instead of four. I spent the last hour -- a little more than that, actually -- with a very distraught patient with extremely complicated (and unpleasant) family issues. This was someone who'd been in our ED before, had had a bad experience, and claimed that everyone who worked there was awful, while being very abrasive to every member of the medical staff who walked into the room. Anyone who's worked in an ED knows the type.

I spent over an hour with this patient; the patient's nurse also sat by the bedside, listening, far longer than nurses usually do or can. Both of us kept trying to find ways to calm or soothe this person, who was genuinely in a bad situation, but was also, it seemed to me (and perhaps I'm being unfair), determined to remain hysterical. A few times I tried to leave, only to have the patient clutch my arm and beg, "Please don't go, please don't go, don't leave me, please don't go."

I think the only thing I accomplished was to get the patient, who was very dehydrated, to eat some ice chips, which I hope ultimately resulted in the urine sample the medical folks needed. ("No, I won't let you use a catheter. I hate catheters! No catheter!")

I'd started talking to the patient right before I ordinarily would have done my end-of-shift sweep of the waiting room; by the time I managed to disentangle myself, I was too exhausted to talk to another soul. So nobody in the waiting room last night was offered spiritual care, and as I left the ED, I saw new patients who'd come in; I hadn't gotten to talk to any of them, either.

Of course, I can never talk to everybody, and at the end of each shift, new patients are arriving as I'm leaving. But last night, I really felt as if I'd done an active disservice to other patients and families by spending so long with that one case. There are far better ways I could have spent an extra hour at the hospital.

I still feel bad for the patient, but I also wound up being angry at myself for not getting away sooner. I should have just said, "I have to go see other people now," which is what the nurse did (although she came back). Instead, I stayed there and listened to the patient go around in circles, endlessly repeating the same speeches.

Gah. This is what my therapist would call bad boundary management. I think I got pulled in because I genuinely wanted the patient to have something good to take away from this hospital experience. But that was as much the patient's responsibility as mine, and I was trying to do too much in an impossible situation.

Ah well. Live and learn, as my mother would say.

Saturday, January 20, 2007

Fun With Phones


UNR just got a new phone system: not just new physical telephones, but entirely different phone numbers. The English Department, for instance, used to have one main number, with extensions for individual faculty. Now we all have individual numbers.

Multiply that by a fairly large campus, and you can imagine how much work it was. (Although in the English Department, at any rate, we were perfectly happy with our existing phones, and would have preferred to avoid the changeover.) Today the IT people sent out an e-mail thanking everyone for their cooperation during the switch. Most campus mail is pretty dry, but somebody had a lot of fun with this one:
Perspective is everything. In a remarkably short time, NEC completely replaced the phones in the equivalent of a small city. And, ours would not be considered a normal city. We had over 100 different types of phones. Moreover, ours is a creative environment where over the past 25 years, many individuals had developed some wiring wonders with the help of Radio Shack and a credit card. In some instances, numerous devices shared a single line. Sometimes, those devices shared the line or had even replaced a connection to a long forgotten alarm. Just finding some phones in a relatively small office was, on occasion, an Easter Egg hunt, where we found the jack in the wall behind a desk and reeled in the phone, which was buried under mounds of journals, papers, old sandwiches, and a variety of other items too numerous to mention.
Wow. You mean there are professors with messier offices than mine? I specialize in dustbunnies and lots of paper, but no old sandwiches!

The phone memo reminded me of one of my favorite passages from E.B. White's Stuart Little. This is one of the paragraphs I give my writing students to demonstrate beautiful prose rhythm:
“Following a broken telephone line north, I have come upon some wonderful places," continued the repairman. "Swamps where cedars grow and turtles wait on logs but not for anything in particular; fields bordered by crooked fences broken by years of standing still; orchards so old they have forgotten where the farmhouse is. In the north I have eaten my lunch in pastures rank with ferns and junipers, all under fair skies with a wind blowing. My business has taken me into spruce woods on winter nights when the snow lay deep and soft, a perfect place for a carnival of rabbits. I have sat at peace on the freight platforms of railroad junctions in the north, in the warm hours and with the warm smells. I know fresh lakes in the north, undisturbed except by fish and hawk and, of course, by the Telephone Company, which has to follow its nose."
In other work news, today I got syllabi and class handouts photocopied for one of my two classes. I'm still working on the other one, the Women & Lit class, but after struggling with some dead space in the class schedule, I realized that there was room to add another book. We'll now be reading Mary Karr's The Liar's Club, in addition to the other six. They're all great books, so it should be a fun semester!

I had a very productive and pleasant day today. I woke up at 7:00, went to the gym at 8:30 and did forty minutes on the elliptical, and then came home and ate lunch before Gary and I went to see Children of Men, which we liked and recommend; we had a few plot problems with it, but it's very stylish and well-crafted and doesn't look like every other movie out there, which is incredibly refreshing. When we got home from the movie, I dashed to work and did photocopying; lo and behold, sitting on a shelf in the photocopy room I found my clip-on sunglasses, which had been missing for weeks! Then I came back home and worked on the Women & Lit syllabus.

I even ironed the Magic Shirt for tomorrow, but that brings us to today's sad news: the Magic Shirt has begun to fray along one seam. Gary was unable to get me another for Christmas, because the company doesn't make that pattern any more. I'm bummed. I hope I'll be able to find a new Magic Shirt before this one becomes unwearable!

Because I'm farther along on teaching prep than I expected to be tonight, Gary and I will be able to watch some ER on DVD. A colleague at work has been giving me a hard time (only half joking, I think) about watching DVDs to relax, instead of reading: evidently I'm being insufficiently intellectual. But hey, it's all narrative, right?

Friday, January 19, 2007

Starred Review in Publishers Weekly!



The reproduction quality isn't great, but the content's certainly nice! A starred review, by the way, means that they particularly liked it. Not all that many books get starred reviews; it's cause for celebration. My agent in New York called to read this to me over the phone, and then faxed it to me.

You can order the book directly from Tachyon, from Amazon, or from your local bookseller.

Reno readers: I'll be doing a reading from the book on Saturday, March 10, at 3:00 PM, at Sundance Books.

The ED Sonnets: Cookie Break


After that last set, I thought something a little lighter would be in order! In actual practice, I usually don't take a food break until I've done at least one sweep of the entire department. The sonnet cycle will be unrealistic in that I'm only writing about one patient per bed, whereas in many cases I talk to several, after earlier patients go home or are admitted.

The hospital canteen -- a small coffeeshop type place, since the cafeteria's often closed when I'm there -- has the world's best chocolate-chip cookies.

*

I need a snack. I head to the canteen,
but glance at beds along the way. Room 2
is empty -- he must be in ICU --
and in 1.2, the baby’s gone, bed clean.
I guess the spinal tap was negative;
that calls for treats. My four-buck coupon buys
one fresh-baked cookie, water (smallish size),
and a banana. Here’s a relative,
one of the 4.3 clan; we smile and nod.
I sit and munch, and think how every shift
the patients give me far more than they get.
Those tales in 5 were bulletins from God:
surprising, ghost-assuaging grace, the gift
of postcards from a place I don’t know yet.

Thursday, January 18, 2007

Several Cat-Related Updates


Figaro, as you can see, thinks it's great fun to try to fit himself into Balthazar's bed. Why are cats so fond of spaces much too small for them? The other day, Harley crawled headfirst into a small wastebasket -- he's a pretty big cat -- and wound up with his rump and tail sticking out. Sort of like someone at a party wearing a lampshade, upside down.

Bali's still running around like a complete maniac, but in the meantime, he's really started sneezing a lot. I'm now terrified that the other cats will get sick. I'm going to call the vet tomorrow morning.

Yes, I'm the original worried cat mom. Can you imagine if I had human children? I'd be a wreck!

And in very happy writing news, today I found an excellent review of The Fate of Mice. It's here; you have to scroll down past the Marillier review to get to mine.

And no, I don't know why this site is called the Agony Column. I've corresponded a bit with the editor, Rick Kleffel, and he's very nice, but I haven't gotten around to asking him that question yet. Rick, if you wrote this review, thank you!

The Publisher's Weekly review will be out on Monday. I'm on the proverbial tenterhooks, as you can probably imagine.

"Life Finds a Way"


For those of you who haven't seen this story, a chimp at a Louisiana animal sanctuary has just had a baby, even though all of the male chimpanzees there have had vasectomies.

This happens to people, too; I know someone whose husband had had a vasectomy years before who discovered that she was pregnant. You can imagine the relationship strain there! When the guy went in for testing, it turned out that his body had healed itself from the results of the surgery -- sometimes the tubes mend themselves, and sometimes a third one grows -- and he had a full sperm count. (Their little girl's about four now, and the three of them are very happy.) I'm betting something similar happened to one of the male chimps.

I understand that the sanctuary wants to keep their population stable, but since wild chimps are endangered, another baby chimp in the world is a very happy thing. The story's especially satisfying since the chimps in this sanctuary are retired lab animals. Here are some quotations from a spokeswoman for the sanctuary (the mom is Teresa, and the baby's Tracy):
"This really shows that no matter what precautions you take, life finds a way," Ms Brent said. [. . . ]

"Tracy is one of the few chimpanzees born into an environment where she will be able to learn natural behaviours such as foraging, climbing trees and nesting from a group of wild-born chimpanzees . . . . This is a rare opportunity for Teresa to teach Tracy the skills she learned from her own mother in Africa so long ago."
Welcome to the world, baby Tracy!

Wednesday, January 17, 2007

The ED Sonnets: Room 5


I finally got some more sonnets written last night (when, par for the course, I should have been doing other work instead!). Lee, thanks for the nudge. Gary, thanks for the editing!

*

Bed 5.1

Room five’s for criticals, and has four beds.
The only room that’s scarier is 2,
though many patients here go home instead
of being brought upstairs, to ICU.
This corner’s where I first saw someone dead.
We’d prayed; her voice had vanished, but I knew
from her expression what she would have said
could she have spoken: “Help me. Help me! Do
you understand?” A dying cat once stared
at me like that. I held her hands and prayed;
she struggled less. But later when I went
to check on her, the patient wasn’t there:
a cold corpse lay, eyes open and afraid,
fixed face a mute mask of abandonment.

*

Bed 5.2

The patient smiles. “Do you believe in ghosts?”
I nod, try not to grimace; in this room
my ghosts do somersaults, and spreading gloom’s
not what I’m paid -- unpaid! -- for. (It’s almost
a year since that old lady died, and still
Bed One unnerves me. That’s why I’m relieved
no patient’s there right now.) “Then you’ll believe
this story. When my dearest friend fell ill,
I drove to see her, but before I’d hit
the halfway point, I felt her singing soul
blow through me like a mist, and knew she’d passed.
But oh, that tune was joyous! Hearing it,
I knew that she was happy, well, and whole.
I hum it now for healing, and hold fast.”

*

Bed 5.3

His skin’s fine parchment, yellowed, leathery.
The woman at the bedside weeps. “I’m not
his daughter, no. If he has family,
I’ve never seen them! Listen, there’s a lot
I’d tell them if I could! I’m just an aide:
I empty bedpans at the nursing home.
But this old guy -- he’s failing. I’m afraid
he’s dying, and I love him like my own.
That doesn’t happen often: maybe twice
in fifteen years I’ve felt this way about
a resident. I know the best advice
is not to get involved. Don’t care. Stay out
of other people’s lives -- but how could I
stand knowing he’d come here, alone, to die?”

*

Bed 5.4

“I’ve had ten heart attacks, three surgeries,
more Cath Lab visits than I care to count.
Tonight they want me in telemetry.
I shudder when I think of the amount
of rent I’ve paid here! But, you know, each day’s
a gift. That near-death thing? Been there, done that.
Three times -- although I never saw that blaze
of light they talk about, just darkness. What
a darkness! Soft as velvet, warm as skin,
pure peace. The strongest drugs they have can’t touch
that feeling. Maybe it’s like being in
the womb; I wouldn’t know. But there’s not much
that scares me now. Death doesn’t, anyway.
I wish they’d hurry with my dinner tray!”

Tuesday, January 16, 2007

Grand Rounds! Balthazar Update! Fun Meme!


This week's Grand Rounds is up, in creative poetic format! Thanks for including me, Kerri.

And for all of you who've been jonesing for Balthazar updates, here's a new photo. He's been difficult to photograph lately, because he doesn't hold still long enough!

Yesterday we let him out of the study to meet the big cats. Now I'm wondering if we did that too soon, since he's started sneezing again; I hope the big guys don't get sick! But so far, the introductions have gone well. He keeps trying to intimidate Harley and Figaro, but they're very patient and haven't sent him flying with one swat of a paw (which they could easily do). Bali's been chasing Figaro all over the house; when Figgy was a kitten, he did the same thing to Harley. Must be a rite of passage.

Here are Bali and Harley sniffing each other (and not trading cold germs, let us pray). That big white thing to the right is the Lightbox of Doom. The futon couch to the left normally has a quilt on it, but Gary washed the quilt yesterday, to try to get some of the cat hair off. Harley's a very placid cat, much less athletic than Figaro, so there hasn't been much chasing going on there. Yesterday afternoon, Harley snoozed on my study couch while Bali napped in his nest on my rocking chair.

And in the fun world of blogging, Nickie tagged me for a meme: writing six-word stories. Mine aren't brilliant, but I tried. The last one actually happened on a disastrous family boating vacation when I was a kid; the boat was storm-tossed rather than becalmed, but I couldn't fit that into six words.

Couple quarrels. He chokes. Heimlich reconcilation.

Treed cat. Two worried strangers. Romance.

Becalmed sailboat. Worrisome screeching. Stowaway katydid!

I hereby tag Lee, DisappearingJohn, jsd, Maggie, TC, and Bohemian Road Nurse.

Have fun, kids. Don't do anything I wouldn't do. Here's another photo of Balthazar to inspire you! He has a piece of lint stuck to his chin in this one. Because of his long fur, he's like a little lambswool duster, collecting dust and grit wherever he goes. Sometimes he looks kinda like Pigpen from Peanuts. But of course we love him anyway!

Monday, January 15, 2007

Why New-Age Self-Help Formulas Make Me Crazy


Happy MLK Day! This seems as good an opportunity as any to indulge in a rant that's been building for a while now.

Every month, when I go through my Carnival of Hope submissions, I find a lot of posts from human-potential, seven-surefire-steps-to-success, self-help type blogs. You know: those perky sites that suggest that all your problems are a function of wrongthink, and that if you just adjusted your attitude, your life would suddenly become wonderful? The ones that claim that yes, you can do anything you want -- overcome all obstacles! become rich and famous! never be unhappy again! -- if you just approach your problems the right way?

I use very few of these posts, because I don't believe them.

Let me preface this by saying that if this stuff works for you, more power to you. Certainly attitude's important, and certainly maintaining a positive outlook is a key component of physical and mental health. But I have three very big objections to this approach: a) it's profoundly individualistic, denying the human need for interdependence with other people, b) it ignores real, material, physical circumstances (poverty, hunger, illness, war), and c) it leads inexorably to blame-the-victim thinking, which means that at bottom, it's more cruel than compassionate.

Are you a starving, HIV-positive victim of genocidal conflict in Darfur? Feeling down? Hey, it's just wrongthink! Adjust your attitude, look on the bright side, and everything will be fine!

See how quickly this stuff breaks down when you remove it from the bubble of American affluence?

Before I became Episcopalian, I briefly attended a Unity church. (Not to be confused with a Unitarian church; they're completely different!) It was a very welcoming, non-threatening place for someone who hadn't gone to church before: there was no creed, no scripture, nothing dark or scary. Everything was love, peace, joy, and bliss. The people were very friendly and outgoing, and I was genuinely fond of many of them.

But it quickly became too fluffy for me. Even when I was still going there, I took to calling it "woo-woo New Age ecumenical Christian light," which drove the minister nuts. I got tired of hearing "Chicken Soup for the Soul" read from the pulpit, rather than any scripture written more than five minutes ago. And I started getting very itchy when, at the end of each service, we all held hands and sang "Let there be peace on earth, and let it begin with me," while swaying back and forth.

At Unity, "let it begin with me" meant adjusting your attitude. What passed for theology there was a metaphysical approach that maintained that if individuals changed their consciousnesses, the world would change in response, without any physical effort. So we often sat and meditated about peace, but the church had no social-outreach projects: although some individuals were certainly involved in volunteer work of various sorts, there was no organized effort to improve material conditions for people suffering from a lack of peace (or water or food or clothing or money or healthcare).

I tried to talk to the minister about this. I remember suggesting that if someone's dropping a bomb on your head, changing your attitude isn't going to change the situation. She was unconvinced.

Unity's approach also made it profoundly unhelpful to people who were in pain. If you were in pain, you had a bad attitude, and that made your pain your fault. When I expressed grief that someone in the congregation had died of cancer, I was told briskly, "You shouldn't be sad; he's better off now." When I tried to talk to a friend there about a difficult conflict with someone to whom I'd been close for many years, I was told gently, "People can only upset you if you let them."

After nine months of this, I fled to the Episcopal Church: where matter matters; where service to the poor, the ill and the lonely is an obligation conferred by baptism; and where people hug you, listen and sympathize when you're having problems. (Can you imagine my trying to be a hospital chaplain with a Unity outlook? "Nonsense, that cancer shouldn't upset you: just adjust your attitude!") Incarnational Christian theology acknowledges that people need each other, that they can and should help each other, and that the world is a broken place that often hurts us, even as we try to mend it. Incarnational Christian theology acknowledges that social problems are real, pressing, and very often seem intractable. Incarnational Christian theology acknowledges that there aren't any easy answers, that there aren't seven surefire steps to success.

(On the subject of "steps" and self-help, let me say here that my family and I have been greatly helped by various 12-Step programs. The 12-Step, model, though, explicitly states that we can't do everything by ourselves, and that the most effective model of self-help is helping others.)

Today we celebrate the legacy of Martin Luther King, Jr. He recognized injustice and took concrete steps to address it. He spoke, took to the streets, joined with other people. He had a dream, but instead of simply sitting at home and meditating about it, he used it as his inspiration to do hard, meaningful, material work. His dream, and his willingness to be visible in the service of that dream, ultimately killed him, because changing your attitude about an assassin's bullet won't make you any less dead.

The world is better now because of Martin Luther King, Jr., but there's still more to be done. He wouldn't want us only to sit home and meditate about peace. He'd want us to get out there and help make it happen.

Sunday, January 14, 2007

God's Favorite Magic Trick


Three years ago, I preached on today's Gospel reading, the Wedding Feast at Cana, as a guest preacher at another parish. Since the reading's come around again today, I'm posting the homily. I'm fond of this one.

* * *

Everybody loves a wedding, which may be why, among the many miracles of Jesus, the Wedding at Cana is a perennial favorite. People are so fond of this story, I suspect, because it’s such a happy miracle. Nobody’s sick or dying. There are no lepers in sight. As befits Jesus’ very first miracle, he isn’t doing anything that might frighten bystanders, like raising the dead or controlling the weather. Most of Jesus’ later miracles will involve some element of pain or fear or anxiety -- griefstricken relatives, people with major medical problems, disciples screaming in terror as their friend comes walking along on top of the water -- but there’s nothing at Cana to scare anybody. This is a beginner’s miracle, a miracle with training wheels. The happy wedding guests would be even happier if they had more wine, so let’s make some, shall we?

In fact, the most flustered person in the entire tableau is Jesus himself, who seems to be suffering more than a little performance anxiety. The Gospel of John makes him sound imperious and majestic, as if he’s totally in command: “Woman, my hour has not yet come!” But it’s difficult for me to hear this story without imagining a very different and decidedly more human tone to his voice. It’s hard not to picture Jesus as the reluctant son being pushed to perform by a proud, nagging Jewish mother.

“Yeshua? Yeshua! These people have no wine! Do something!”

“But Mooo-ooom! It’s not time yet! I’m not ready! I’ll mess up in front of everybody!”

“Oh, nonsense, you will not! Go on: you can do it, I know you can! You’ll be just fine. Servants! Hey, you there, servants! Do whatever my son tells you to do, all right?”

Now, it’s true that Jesus was already in his thirties when this happened, so maybe he didn’t whine quite this much -- but mothers never lose their capacity to embarrass us. A proud, nagging mother can make the most majestic adult feel as if he’s ten years old, trying to avoid playing the piano in front of guests. And Mary’s nagging is embarrassing for another reason: she’s reminding Jesus, none too gently, that whether he feels ready isn’t the point. The people around him are the point. Jesus’ hour to perform a miracle has come, whether he’s written it in his daytimer or not, because this is the hour when the guests have run out of wine. Their need is more important than Jesus’ timetable or his feelings of inadequacy.

Jesus shouldn’t have been nervous, of course; Mary’s faith in him was fully justified, and he handled his command performance beautifully. The happy guests got wonderful new wine, and Jesus’ career as a miracle worker was off to a splendid start. His later miracles, even when they involve pain and fear and anxiety, will follow this same basic pattern of creating abundance from scarcity. Changing water into wine is just a warm-up for his later work of changing despair into hope, illness into health, and death into life.

This is God’s favorite magic trick, this business of transforming emptiness into plenty. It’s the first story the Bible tells us. “In the beginning, when God created the heavens and the earth, the earth was a formless void and darkness covered the face of the deep . . . . Then God said, ‘Let there be light,’ and there was light.” And God created everything else in turn: day and night, sea and sky, plants and animals and people. Jesus’ miracle at Cana, while it was momentous both for him and for the other people there, was only one tiny instant in God’s career of transformation. And if God the Father and God the Son are in the magic business, God the Holy Spirit is, too. The first Pentecost, when the Spirit descended upon the disciples, transformed bewilderment into understanding, because suddenly everyone could understand the speech of everyone else. It transformed doubt into faith, because the skeptical bystanders were converted. And it transformed a motley, jostling crowd into a joyous church.

God’s favorite magic trick shows up everywhere in the Bible. It shows up everywhere in our own lives, too. Whenever winter gives way to spring, we see God the Father working His familiar wonder, which somehow never grows old. Whenever the Spirit moves us to new compassion, new creativity, new cheerfulness, we feel the emptiness within us transformed into abundance. And whenever we reach out to someone in need, or receive human help from an unexpected quarter, we witness the transforming power of Christ, who changes lack to love.

As disciples of Christ, we are called to perform magic tricks of our own. In the words of St. Teresa of Avila, “Christ has no body now on earth but yours, no hands but yours, no feet but yours. Yours are the eyes through which Christ’s compassion looks out on the world. Yours are the feet with which He is to go about doing good, and yours are the hands with which he is to bless us now.” True, most of us can’t literally change water into wine, but we can feed the hungry, comfort the lonely, and plant gardens in empty lots. A kind word spoken to a harried parent at the Post Office can ease the discomfort of everyone in line. A simple “thank you” can make a co-worker who’s felt invisible suddenly feel appreciated. A few dollars sent to an international aid agency can buy rice for an entire family for a month.

And if these examples sound too easy, well, they’re only easy when we’re paying attention. The Wedding at Cana teaches us that we miss opportunities for miracles whenever we’re too focused on our own schedules and our own feelings of inadequacy. We need to do what we can, where we are, with what we have -- even if we feel unready or unworthy, and even if our actions seem very small.

If we can do this when we’re happy, we’ll be better at doing it when we’re facing pain and fear and anxiety. A friend of mine with long, beautiful hair was recently diagnosed with cancer. Because she knew that she was going to lose her hair to chemotherapy anyway, she cut it off and sent it to a charity called Locks of Love, which makes wigs for ill children. Another friend of mine, when her sister died very suddenly of an asthma attack, told the doctors to donate her sister’s organs to other patients in need. These aren't training-wheel miracles. These are miracles performed by people facing searing loss, who ask how they can transform their own suffering into blessing for others. “This is my body, given for you.” This is Eucharist.

All of our lives will lead us eventually into such dark places, into pain and loss, as surely as Jesus’ own life did. It will be easier for us to change that suffering into blessing if we’ve been practicing all along, if we’ve started with the easy stuff: the training-wheel miracles performed in the joyous, sunny bustle of a wedding, where our only job is to make people who are already happy even happier. The Wedding at Cana reminds us that everyone has to begin somewhere, and that no miracle is too small. And it reminds us that our stage fright doesn’t matter.

“But I’m not ready!” we say, in our panic. “I haven’t practiced enough! I’ll mess up in front of everybody! Can’t somebody else do it?”

We come up with every excuse we can think of, but our loving, nagging family won’t let us get away with that. God our Father, and Christ our Brother, and the Spirit our Sister beam at us from the wings, urging us on. “Oh, nonsense, of course you can do it! You learned from us, didn’t you? You’ll be just fine: we know you will. Go on, now. Just go on. Go on out there, and make us proud.”

Saturday, January 13, 2007

Creature Comforts


An ED nurse recently told me a story about a homeless woman, living in her car, who wanted to be able to keep her cat with her in the emergency department. The nurse said no, because so many people are allergic to cats. (She might have been willing to try to bend the rules a little had the woman brought in a dog.) I don't know what happened to the cat, but -- based on my experience with ED patients -- I suspect the woman may have been more worried about her pet than about herself during her hospital visit.

Pets are family, and they figure very largely in my conversations with patients. When I ask people worn down by chronic illness and worry to tell me about their sources of strength and comfort (the quintessential chaplain question), dogs and cats and other beloved creatures are often on the list. This is especially true, as you might expect, of the solitary and elderly, for whom worry over pet care is a major source of stress during hospitalization. Quite often, someone about to be admitted will ask for help contacting a neighbor or friend to feed the cats or walk the dog. On one occasion, we had a patient who was so frantic about her dog that we called Animal Control to see if they could send an officer to check on the animal's safety; luckily, the patient got to go home rather than having to be admitted, so the call turned out to be unnecessary.

When I see people wearing animal-themed clothing or jewelry, I always compliment them and ask if they have pets. This usually leads into lively conversations bout the patients' dogs, cats, birds, fish, or horses, and often gives me a chance to share my own pet stories. Talking about animals comforts pet owners at least as much as prayer does; I think for most people, it is a form of prayer, since companion animals incarnate the unconditional love we usually associate with God. (I often tell patients that dogs and cats are little pieces of God wrapped in fur coats.) The pure affection shown by animals is why pet therapy is so effective, but it turns out that pets are good therapy even when they aren't physically present.

Wild animals can function the same way. I wrote one of my ED sonnets about a homeless man who delighted in feeding the birds every day. Another patient, so suicidally depressed that he was brought to the hospital curled in a fetal position, uncurled and became animated as he talked about watching the feeding behavior of wild birds at a lake he'd once visited. He demonstrated their diving patterns for me by using his hands and imitating the noises they made.

He hadn't responded when I asked about family, friends, music, or hobbies -- topics that will often get suicidal patients talking -- but when, as a last resort, I asked if there were any places that made him happy, he started talking about the lake and the birds. His desire to see those birds again became a reason for him to stay alive.

I recently had a haunting visit with a married couple: one spouse was in organ failure and might not be leaving the hospital, and the other was clearly trying to contain grief and exhaustion after years of chronic illness. They wanted me to pray with them, and when I asked if they had special prayer requests, other than the obvious medical ones, they looked at each other, and then the wife asked shyly, "Do you think pets are important?"

"Of course pets are important!"

Six months before, they'd found a baby finch under a tree, and brought it home and raised it as a pet. They told me how affectionate it was, how it would perch on their shoulders, how it loved taking teacup baths. They were heartbroken when it flew away, and they were worried about whether it could survive on its own.

"Lots of people around here have finch feeders," I told them. "My husband and I have one."

That made them happy. They told me what the bird looked like, and I told them I'd look for it at our feeder. We prayed about the illness, the family, the hospitalization, the bird. Since then, I've seen lots of finches matching their description at our feeder. However slim the chances that one of these birds is actually theirs, it comforts me to think that it might be.

In graduate school, I studied Old English for two semesters. One of the poems we read included a poignant metaphor for mortality: the bird who flies into one end of the lighted feast hall, out of the cold dark winter night, but then flies back out the other. Whenever I see the finches now, I think about that patient -- confined to a bed and keenly aware of mortality -- and I think about the beloved bird who carried the patient's love out into the world, to fly freely.

The patient was unhappy that the bird had flown off, rightly concerned about a tame animal's survival. I know I'm over-romanticizing by imagining the bird as the patient's soul, released into greater life; but I still smile, even more than I used to, whenever I see the finches outside our window.

Friday, January 12, 2007

Carnival of Hope: Volume 1, Number 5


Welcome to Carnival of Hope! The next edition will be posted on Friday, February 9; submissions are due to me by Thursday 2/8, 5:00 PM PST. No immediate themes come to mind, so this one's open. Valentine's Day tends to make me gag, and I couldn't think of a clever theme revolving around groundhogs, so just send your most hopeful posts.

Since we've just begun a new year, the theme of this month's edition is new beginnings. But just as the beginning of one year can't occur without the end of another, so our human beginnings are sometimes inextricably entwined with endings. Several of our posts this month serve as powerful illustrations of that idea. The first few, although ultimately hopeful, are a little tough to read, but fear not: just as winter lightens into spring, so the posts this month will become lighter, too.

We start off with Marcia Kilpatrick's Open Letter to a Family I've Never Met, thanking the family of an organ donor whose heart has given her cousin a new chance at life.

If you've ever wondered if you should sign that organ-donor card, this post should convince you. A few years ago, a friend of mine died at the age of twenty-five, and her younger sister -- her only remaining family -- decided to donate her organs. A friend of ours said, "I hope whoever gets her heart realizes what a treasure it is." Marcia's post made me remember my friend, and I hope that somehow the donor's family will get to read this. And Marcia, I wish your cousin a long, happy life with his new heart.

Daniel Brenton, likewise, shows us how a new beginning can come from tragedy in I am Grateful I am Still Alive.

What happened to Daniel -- being the unwitting agent of a stranger's death -- is one of my worst fears, and I was moved by his account of going through that and coming out the other side. (Daniel, this is why I didn't start driving until I was thirty-six.) This is a harrowing story, but well worth reading.

Recovery from grief, finding hope in new beginnings, is also the theme of Tim Abbott's haunting and poetic "Skating Away (on the Thin Ice of the New Day)", which follows the lines of a family tree -- with both growing and missing branches -- in the figures traced by ice skates. Losing a child is one of the worst griefs there is, but Tim shows us that the joy and buoyancy of living children can, in time, help ease that pain. May Emily and Elias skate far and fast!

Even when a literal death isn't involved, new beginnings often require that we have the courage to walk away from our old lives before those lives kill us -- either literally or figuratively. Laura Young shares the story of her brother's courageous decision to leave police work in Laying Down the Badge. Not only did he recognize the toll that his work was taking on him, but he used his experience to make conditions better at his new job.

When we think of new beginnings, most of us don't consider major life changes. New Year's Resolutions are often more our speed, even if we cheerfully acknowledge that we'll abandon them after three weeks.

Charles H. Green argues convincingly, though, that such resolutions are invitations to self-hatred, and that listing the things for which we're grateful is A Better New Year's Resolution that will ultimately produce the same results.

Gratitude takes practice, however, and sometimes we have to start small. Barbra Sundquist shares an example from her friend Linda in Joy Is Not the Same as Happiness. "Being grateful for toilet paper is an art that I developed when I could not find anything else to be grateful for!" May all of us, like Linda, find people who will hold our dreams in the palms of their hands.

Toilet paper also shows up, accompanied by shower caps, in Andrea Dickson's Bourgeoisie Guilt: Can I Conquer My Vanity for the Sake of My Sanity? Andrea ponders how frugality is often at odds with pride, but also realizes that excessive generosity can begin to warp our perceptions of friendship.

Sometimes we form our deepest friendships with people who have helped us, even when they don't initially speak our language. There's also a lot to be said for traveling without four-star amenities, bringing with you only as much as you can carry, so that you'll truly be open to new experiences and cultures. Jake Danger tells us how his friend Ryoko learned to love backpacking, and leave the tour bus behind, in Lessons From a Turkish Grandmother.

And sometimes people help us by teaching us their language, especially when we're trying to begin a new life in a new country. Steve Rudolf sent his post with this note: "WorkDish is a user-submitted job info site. Here's a great post from a 'reading tutor' about the benefits of such work." The person who wrote the post says, "If you want to feel pretty damn good about the world, spend one afternoon a week helping people learn to read. It's inspiring." I couldn't agree more!

And on that note, see you in February!

Thursday, January 11, 2007

Change of Shift, et cetera


The latest Change of Shift, the nursing blog carnival, is up over at Emergiblog. I missed the submission deadline for this, as well as Grand Rounds, this week, which means that my daily-visit average will be taking a real hit. Drat! Kim always does a fantastic job with carnivals, though, and I'm looking forward to reading this edition.

After my slow start yesterday, I had a very productive day. I got fifteen files read at the office, although I had to cancel a therapy appointment to do it. I decided that staying put and getting work done was more helpful to my mental health than the appointment would have been.

Then I came home and put together a draft of Carnival of Hope, since I plan to be at the hospital tonight. (The weather's foul again, though, so I may not be. For the last two-plus years, I've missed weekly shifts only for travel or illness, but after the experiences of the last few weeks, I may add inclement weather to that list.) It's a potent -- but small -- edition. There's still time to submit your own post: the deadline isn't until 5:00 PM PST, and since I probably won't be home tonight, I'm willing to extend that to 10:00.

The kitten is still extremely energetic. Thanks to folks who posted cat-medication tips yesterday!

And on that note, time to get ready for work. I only have ten files to go! Woo-hoo!

Wednesday, January 10, 2007

Not Much


Thanks to folks who left comments yesterday.

Balthazar appears to be almost fully recovered (although he can't meet the other kitties until he's off the antibiotics). He's bouncing around like a maniac and attacking everything he sees; right now, he's wrapped around my ankle. Ah, yes. We've entered the "don't walk around the house barefoot" season of cat ownership.

He's also gotten difficult to medicate; it was easy to give him his bubblegum flavored antibiotic (!) when he was weak and limp, but now he squirms and fights. Gary and I had trouble doing it together yesterday, and the cat weighs less than two pounds!

The medicine tastes like bubblegum because vets use pediatric formulas. Banana is another popular flavor for kitty medicine, although cats hate bananas. Somebody needs to come up with a fish or chicken-flavored formula.

I, unlike the cat, am feeling quite lethargic. I meant to be at work by now (yep, we can see how successful that was). I'm so busy at the moment because I'm on the department committee that reads everyone's annual-evaluation materials and decides on merit/raise levels (we don't decide the monetary amount of each "step" -- that's done by the university -- but we decide how many steps everyone gets). Anyway, this involves working through 45 thick files, since people submit everything they've published for the year, plus course syllabi and other teaching materials. The materials were due this past Monday; next Tuesday, after the MLK holiday, we'll begin having all-day meetings to discuss them, which means that we need to get them read this week. So far, I've done ten a day. Twenty down, twenty-five to go.

This is very solid, rewarding service -- our department rocks, and it's fun to see what everyone's up to -- but it's incredibly time-consuming, and I still have course prep to do. (I'd be farther along if the Shelter galleys hadn't arrived when they did.) This is my last year on this committee for a while, though, so next year, I'll get my winter break back.

Everything will get done. It always does, although I'm never quite sure how it has.

Among other things, I haven't had a chance to stay caught up on friends' blogs, so if you've posted about something dramatic and I haven't commented, please forgive me.

Time to medicate Balthazar. Wish me luck!

Tuesday, January 09, 2007

Grand Rounds. Carnival of Hope. Various Updates


This week's Grand Rounds is up! Because of the cat crisis this weekend, I missed the submission deadline; this is the first time I haven't been in Grand Rounds since I started submitting. Oh well. There's always next week!

And speaking of blog carnivals, please remember that the deadline for this month's Carnival of Hope, with a January theme of "new beginnings," is this coming Thursday, January 11, at 5:00 PM PST.

Cat update: We just took Balthazar for his post-hospital checkup, and he's fine. His temperature was normal, and the vet said he looked good. Yesterday I'd noticed some clumsiness and head tremors; today he seems fine, but she said I should keep an eye out for that, since various things can cause neurological deficits in kittens.

I haven't had a chance to get back to the ED sonnets, although I want to. Work is very busy right now, and will be for the next two weeks at least; I may actually get a bit of a break when classes start on the 22nd.

And on that note, off to the office!

Monday, January 08, 2007

Balthazar's Home!


We just got home fifteen minutes ago. His temp was down to 102.6 this morning, which is just a hair above normal. Yay!

The first thing he did when he got home was to eat as if he'd never seen food before. Now he's curled up on the back of my neck, purring (I'm hunched over my keyboard). I guess his trauma hasn't made him hate people! The folks at Animal Emergency commented on what a sweet cat he is: as much as they poked and prodded him, he'd curl up in their hands and purr.

Tomorrow morning he'll go to the regular vet for what was supposed to be a first set of immunizations, but will now be a post-hospital checkup, since he can't get shots until he's off the antibiotics.

Thanks to everybody for the e-mails, comments and prayers. They helped!

Fire, Water, and Hope


Here's yesterday's homily, which is a pretty dry -- ironically, given the watery subject! -- teaching sermon. It's not one of my favorites, but my congregation responded kindly.

Speaking of dry, my new meds were giving me an awful case of cottonmouth, and at the second service, I had to excuse myself after the fourth paragraph to grab the glass of water our priest always keeps near the altar. Awkward, but forgiven.

Kitty update: As of 8:00 last night, his temp was still a bit above 104, although the vet said his appetite and attitude were excellent. I have to pick him up by 8:00 this morning, since Animal Emergency isn't open during normal business hours. If his fever's broken during the night, I can take him home. If it hasn't, I'll drive him to our regular vet -- only half a mile away, hurrah! -- so he can be rehospitalized there.

Oh, yes, the Gospel: Luke 3:15-17, 21-22.

*

Two weeks ago was Christmas Eve. Yesterday, January 6, was the traditional date of the Feast of Epiphany, when the three wise men from the East arrived to bring gifts to the infant Jesus. And today, the first Sunday after Epiphany, we celebrate Jesus’ baptism in the Jordan.

This chronology might make you think that Jesus was baptized as an infant of two weeks old, that the wise men’s gifts included a long white baptismal gown. But, in fact, the Gospels tell us that Jesus wasn’t baptized until he was about thirty. The church calendar -- this year especially -- wastes no time jumping from his joyous birth to the beginning of his adult ministry.

Jesus’ baptism raises a number of questions. If he was baptized as an adult, why do many Christian churches, including the Episcopal Church, baptize both adults and infants, as we’ll be doing at St. Stephen’s today? If Jesus was the perfect, sinless Son of God, why did he participate in a baptism for the repentance of sins, especially at the hands of a man who had just said, “I am not worthy to untie the thong of his sandals”? What’s all this bewildering business about fire and doves and the Holy Spirit? And since both John and Jesus were Jewish -- not a tradition that we tend to associate with baptism today -- how does our current practice of baptism connect to what happened on the banks of the Jordan in the first century?

Let’s take the last question first. Jews, both in the first century and now, would call Jesus’ baptism a mikvah, a ritual cleansing and rededication to God. Among a variety of other uses, the mikvah is still required today for converts to conservative or orthodox Judaism. Some of you may remember that my friend Ellen adopted a little boy from Russia a few years ago. Ellen was born Jewish, but in a few weeks, she’ll take her son Paul to the mikvah -- also the name of the specially constructed bath where the ritual occurs -- to be immersed in the water and received fully into the Jewish community.

Jesus was born Jewish. But John the Baptist was performing “a baptism of repentance for the forgiveness of sins,” asking those he baptized to renew their commitment to God. It’s a measure of how deeply John moved his followers that they thought he might be the Messiah. When they asked him what they should do to demonstrate their repentance, in a passage just before this morning’s Gospel reading, he gave them a set of instructions for right living. “Whoever has two coats must share with anyone who has none; and whoever has food must do likewise.” This sounds a lot like things Jesus would say later. Many people see Jesus’ baptism as a way for him both to emphasize his own humanity -- the fact that he was the Son of Man, not just the Son of God -- and to endorse John’s message. And as for why Jesus chose to be baptized by a man who wasn’t worthy to untie the thongs on his sandals: well, that’s hardly surprising behavior from a savior who would later insist on washing his followers’ feet.

If some scholars have been puzzled about why Jesus chose to submit to John’s baptism, Jesus’ father seems to have approved. The Gospel tells us that after Jesus’ baptism, “the Holy Spirit descended upon him in bodily form like a dove. And a voice came from heaven, “You are my Son, the Beloved; with you I am well pleased.” Humans -- John the Baptist, Sherry Dunn, Rick Sorensen -- baptize with water, but only God can send the Holy Spirit, as He did at the first Pentecost, when tongues of flame descended upon the disciples. For both Jews and Christians, ritual purification with water symbolizes rebirth and inclusion, a way to say,”You are part of our community now, and we love you, and we believe that God loves you.” But only God himself can send the inner assurance, the bone-deep faith that we are God’s children, God’s beloved.

Christians who baptize infants do so to include children in the Christian community, the household of God, even before those children can consciously choose that household for themselves. All Christians baptize adults who have recently chosen our household. In the Episcopal church, and others that practice infant baptism, the sacrament of confirmation gives older children, and adults, a chance to fully and consciously rededicate themselves to God. But several times a year, whenever a baptism is performed, Episcopalians also renew their baptismal vows, reminding themselves of the promises they have made to God and to their fellow humans.

One of the meanings of the Hebrew word mikvah is hope. Baptism is a sacrament of hope not just for the baptized person, but for the gifts the baptized person will give the world. For John the Baptist, for Jesus, and for us today, baptism promises God’s forgiveness, but it also requires us to make promises of our own. “Whoever has two coats must share with anyone who has none; and whoever has food must do likewise.” We hear John’s commandment echoed in Jesus’ later one: “Love one another as I have loved you.” And we hear Jesus’ commandment echoed in our baptismal promises, the covenant we will say together in a few minutes.

All of us will be asked: “Will you proclaim by word and by example the Good News of God in Christ? Will you seek and serve Christ in all persons, loving your neighbor as yourself? Will you strive for justice and peace among all people, and respect the dignity of every human being?” To each of these three questions, we give the same answer. “I will, with God’s help.”

When we make or renew our baptismal vows, we promise to bring the hope of Christ to everyone. The hope of Christ, Christ’s mikvah, doesn’t simply take the form of water sprinkled on our foreheads; and these days, it rarely takes the form of doves or supernatural voices, neither of which we’re very likely to witness at St. Stephen’s this morning. It takes the form of the human work we do with our human hands to improve the world we live in, both for humans and for the rest of God’s creation: the earth, the waters, the atmosphere, and all living things. God helps us with that work by sending the Holy Spirit: by setting us on fire to do works of justice and compassion, to comfort the lonely and heal the sick and broken.

Baptism is the beginning of a lifetime of work in God’s service. That service may require us to wash our friends’ feet, as Jesus did. It may require us to speak truth to power, as Jesus did, and as John the Baptist also did. John told powerful Herod things he didn’t want to hear; the editors of the Episcopal lectionary tactfully left out of today’s Gospel the passage in which Herod has John arrested and thrown in jail. Service to God requires us to share not just in Jesus’ life and in his resurrection, but in his death, in his pain at the worst that God’s beloved children can do to one another. Today we celebrate Jesus’ baptism. In a few months, on Good Friday, we’ll mourn his death. Christians believe in eternal life, but baptism is no guarantee of earthly safety.

This makes baptism sound rather scary; and as joyous as it is, it should scare us a little. These are big promises we’re making: promises to keep our eyes open when it might be simpler to look away, to speak when it might be simpler to stay silent, to stretch out our hands when it might be simpler to turn our backs.

And so today we will pray for God’s help in keeping our promises. We will pray to receive the Holy Spirit, to be set on fire to bring the hope of Christ to the world. And we will pray to hear what human words and sanctified water cannot themselves confer: the still, small voice of God telling us, “You are my child, my beloved, and with you I am well pleased.”

Amen.