Saturday, March 31, 2007

A Mile in Their Shoes

Last October, I read an article about Empathy Day at UNR's Orvis School of Nursing. In this required experience, nursing students are paired with a partner. Each spends half the day with an assigned disability -- an arm in a sling, say -- to learn what it feels like to navigate everyday experiences with a physical impairment.

The same principle is at work in childbirth classes where fathers are required to wear the Empathy Belly pregnancy simulator, learning firsthand what it feels like to have thirty-five pounds pressing on your bladder, along with a new center of gravity. Likewise, various exercises have been developed to help sighted people understand what it feels like to be blind.

These experiences, of course, are both temporary and low-risk, suggesting limits to the empathy they confer. One can argue that any chosen experience can't truly replicate what it feels like to be in a position where there's no saying no, no opting out. In my Women and Literature class, I'm teaching Barbara Ehrenreich's Nickel and Dimed, about her experiences working a series of low-wage jobs to see if it's possible to live on them. Even though Ehrenreich acknowledges that she isn't, in fact, one of the working poor, and that her account therefore can't come close to describing what it's like to live that way 24/7, my students have been uniformly critical of the fact that Ehrenreich is, in their words, "half-assing it."

The same criticism applies to people who, for instance, spend a night in a cardboard box to try to understand what it feels like to be homeless. That's not homelessness, one might argue, as much as it's a peculiarly low-tech kind of camping. Even the brave souls who go on one-week street retreats to experience homelessness know that they can go back home when the week is over. And while I applaud computerized efforts to help people understand schizophrenia, real schizophrenics can't rid themselves of voices and visions by exiting a computer program.

Still, camping out on the streets for a week entails genuine risk that running a computer program doesn't. Orvis' "Empathy Day," likewise, specifies that the experience has to continue for a set amount of time. But I've started to wonder if the efforts to increase empathy for the ill, disabled and stigmatized would be better served by methods which, while safely temporary, give the subject no control over the condition: simulations that recreate, not simply physical sensations, but the lived experience of powerlessness.

For instance, injections of PCPA, which depletes serotonin in the brain, might induce the despair and helplessness of clinical depression; while I'm unable to find the reference, I remember reading about how people who received these injections indeed quickly felt depressed. If nurses or medical students could be given these injections to understand what depression feels like, would they choose to receive them? Could nursing and medical schools ethically provide them? What about a shot to induce temporary schizophrenia? What are the limits -- practical and ethical -- of stimulating empathy?

Or consider the experience of chronic pain. If healthcare providers could be given a shot to put them into intractable functional pain for an hour or a day or a week, to help them empathize with chronic-pain patients, would they willingly go there? Could we, in good conscience, ask them to?

I wonder if the experiences for which healthcare providers most need to develop empathy are precisely the ones for which any realistic simulation would raise the most daunting ethical dilemmas. It makes sense that the divides that most need to be crossed are the ones that are most difficult to cross. Still, both patients and providers can only benefit from any efforts, however limited, to cross them.

Friday, March 30, 2007

Indulgences and Summer Plans

It's been a long week, and while a lot of good stuff has happened, I'm very tired and feeling a bit down, probably simply because of fatigue.

So, resorting to one of my favorite anti-depressant techniques -- spending lots of money at once! -- I've gone about acquiring various treats. From most to least indulgent, they are:

* Corrective Barracuda swim goggles. Gary and I were so pleased with the optical snorkeling masks we used in Maui that I went ahead and ordered some optical swim goggles for myself. On the face of it, this is very silly: I don't really need to see anything in the pool, y'know? Furthermore, I could have gotten them for much less than I did. I've been wearing inexpensive, non-correcting goggles, which have worked fine, and I could have gotten inexpensive corrective ones, too, but nooooo: I went for Barracuda goggles, the high-end brand. To be fair, these really are more comfortable than other goggles, but they're also pricy. Gary's comment: "You'd better not lose them!"

* I usually take a course at the Pacific School of Religion in Berkeley every summer, but none of this summer's offerings thrilled me. Oh, there were things that would have been very useful in all kinds of ways, but nothing that actively excited me. I enjoyed last summer's art course so much that I really wanted to take another one, but there weren't any (or none that appealed to me). So instead of going to Berkeley for a week, I'm staying home and taking a six-week course entitled "Explorations in Clay" at the Nevada Museum of Art. It will meet every Monday evening for three hours, starting June 11. A friend at the med school took this same class from the same instructor and really enjoyed it, although she said the class was crowded and it was hard to get time on the wheel. Still, I'll be messing around with clay for six weeks, and that will provide a very nice balance to my usual intellectual/verbal work. (The museum offers a children's class called "Clay Turds for Toddlers." Gotta love it! It's entirely possible that my own efforts will look a lot like clay turds too, but I'm determined to have fun.)

The prospect of going to Maui kept me going through the first part of the semester; the prospect of taking the clay class will keep me going through the second.

And actually, the week in Berkeley is usually so expensive that not going will more than pay for both the clay class -- which is discounted because I'm a museum member -- and the goggles. And I may be going to Berkeley for a weekend in August for a Tolkien conference, if I can get a paper proposal together by the deadline.

* I just got plane tickets for me and Gary to go to WisCon. This will be the first time he's come with me, and I'm really excited about it, and the plane tickets aren't actually an indulgence at all: it's not like we can walk there!

We already have quite a few plans for this summer. The weekend of May 18-19, we'll be in the Bay Area for me to do some readings at SF bookstores. The following weekend, we'll be at Wiscon. We'll be back in the Bay Area for a wedding at the end of June, and then of course there's the clay class, and somewhere in there I also have to plan next year's classes and oh, yeah, get back to work on the fourth novel. And I'm trying to talk my sister into visiting, and I'm sure my parents will want me to go out to Philly at some point to see them.

Busy, busy! And now to bed!

Thursday, March 29, 2007

Letting Go

The week after spring break is usually my worst week of the academic year. Everyone seems to come back from break feeling more tired than they were before they left. All of us, professors and students, are spacy. Tempers are often short. No matter how well I've been taking care of myself, this is the week when I feel most fragile and vulnerable, and it's been the time when I've most often been blindsided by classroom crises: some I couldn't have prevented, some I should have seen coming but didn't, and some I caused myself.

So I've been jittery this week, feeling as if I'm walking on eggshells. I have two very good classes this semester, but I've still been wary of dropping shoes. And I've certainly been playing the Absent-Minded Professor to the hilt, being disorganized and forgetting stuff. (My students, bless them, have joined me in laughing at myself.) It doesn't help that I've found myself in renewed mourning for a church friendship that went disastrously south about this time last year; it also doesn't help that -- maybe partly because the Maui trip kept me out of church the past two Sundays -- I've been feeling more than usually disconnected from That Which Is Bigger Than I Am, although that tends to happen this time of year anyway.

One of my classes today was indeed unusually emotional, but for once, it was in a good and healing way, not a hurtful one. The students who were involved have given me permission to write about it here, although I've promised not to use names.

In my fiction workshop, we discussed a story about a woman who's just died and can't move on to the next plane, even though she has no unfinished business that she knows of. A helpful angel explains to her that the living sometimes prevent the dead from completing their journey by not letting go, and sure enough, when the woman observes her close-knit and very loving family -- her husband, a married daughter, two grandsons -- she realizes that her daughter in particular is having a very hard time with her death: not eating, not sleeping. The dead woman starts trying to communicate with her loved ones, and discovers that only the children can see and hear her. One of them is just a baby, without language, but at last she manages to get a message to her daughter by having a conversation with the older grandson, who's about two, on his toy cellphone. He tells his mother that Grandma says everything's fine; the protagonist sees the relief on her daughter's face, and can finally move on.

It's a beautiful story, deftly and unsentimentally told by a skilled writer, and everyone in class loved it. One woman was especially moved, and cried when she talked about the story, because a friend of hers died of breast cancer two weeks ago. The story's protagonist has died of cancer, and at one point reflects on what a relief it is to be dead, how she feels "like herself" again, free of the pain and what that pain does to her family. The recently bereaved student found that passage especially powerful.

When it was the author's turn to talk, he told us that the story had been very difficult for him to write -- partly because he was using some new narrative techniques -- but that it was very important to him, because it was a true story. It had happened.

His aunt died just before the beginning of the semester. In the car on the way to the airport after the funeral, her two-year-old grandson started playing with his cell phone. Usually he just pretended to talk to his mother or father, but this time, everyone in the car heard him talking to his grandmother. "Hi, Gramma. How are you? That's good. I love you too. Bye." Then he told them, "Gramma says she's okay and everything's fine."

The recently bereaved student started crying again when she heard that. The rest of the class was silent. I felt like I was in the hospital, listening to one of those everyday anecdotes of the supernatural that float around the ED.

The author explained that he'd written the story to try to explain what had happened: to make sense of the conversation on the toy cell phone and to come to terms with his need to let go of his aunt, whom he misses desperately even though he's glad she's out of pain.

After class, the author and the bereaved student hugged. I hugged both of them. And the author told us another anecdote: his aunt and uncle had a clock they'd bought on a very early trip (maybe their honeymoon?). The clock stopped the instant his aunt died, and stayed stopped. But at one point, the clock started ticking again, and the two-year-old looked up and said matter-of-factly, "Gramma's here."

The class was so marvelous, at least for me, because it made visible a chain of messages. The toddler gets a message on his toy phone. My student writes a story to try to understand the message. And through the story, the message is communicated to someone else who's grieving and needs to hear it.

After that class, I taught my second class, and then dashed to my office for fifteen minutes to check e-mail, and then dashed to a meeting, and then dashed to a poetry reading by visiting writer Martha Serpas. My colleague Ann Keniston, herself an accomplished poet, had told me that Serpas was training to be a hospital chaplain, and that we might enjoy talking to each other.

Serpas read primarily from her latest book, The Dirty Side of the Storm, which is largely about loss. Her work's gorgeous and scripturally inflected in very interesting and resonant ways. But what affected me most was when she said, in response to some question about the loss in her work, "One has to let go of what one most wants to hold onto to join with the divine."

That was, of course, an eerily apt summary of what had happened in the first class. And it was also, I realized with a jolt, a message for me: a reminder of the importance of letting go of this friendship I've been grieving (which I've been trying to let go of for more than a year now, but which keeps haunting me anyhow).

After the reading, I spoke very briefly to Serpas, who must have thought I was a babbling idiot, because I was trying to say so much at once: about my hospital work, about my ED sonnets, about today's class experience. This is typical of the week after break, when I almost always sound like a babbling idiot, except for the occasions when language fails me completely. I guess I have to let go of that too, huh?

Anyway, does anyone else find the coincidences here just a little too thick to be completely coincidental? Or am I just crazy?

Wednesday, March 28, 2007

Lovely Shelter review from Don D'Ammassa

The first two Shelter reviews are already out, although the book won't be published until June.

This is the book that took me fifteen years to write and includes everything but the kitchen sink. It has complicated characters and an even more complicated plot -- plus a happy ending -- so I've been nervous about how reviewers would respond. To my immense gratification, Don D'Ammassa is my ideal reader, interpreting the book exactly the way I've hoped people would:
Most science fiction novels that hope to tackle serious issues -- bioethics, global warming, cloning, cultural clashes, or whatever -- deal at least primarily with one topic and use other issues, if at all, simply as part of the background or to provide a subplot. Susan Palwick's latest is much more ambitious than that, addressing a wide variety of topics at the same time. My previous experience with the author's work, particularly the marvelous and touching Flying in Place, tipped me off in advance that I was going to be introduced to a cast of vividly conceived characters, and I wasn't disappointed. If anything there was too many of them, and I wanted to know more about each of their lives. The characters include a sort of artificial intelligence -- a dead man translated into electronic life, a homeless man whose memories have been erased because he tried to help a child, a woman who disappeared for five years, and another who finds herself sucked into this woman's orbit. There's also a sentient house, a much more benevolent one than in Dean R. Koontz's Demon Seed. And part of the story evolves because the house offers shelter to a homeless man, which it should not have been able to do.

This is, I suppose, a mild dystopia, but it's more about the terrible things we sometimes do to ourselves and others rather than what is imposed on us by a cold and distant government. And it has an upbeat ending, although not because the rebels assassinate an evil dictator and bring about democratic reforms but because the characters discover some of the flaws in their own personalities, the reasons why they have been less than kind to one another, and move past that to a different kind of relationship. Proof, if we needed it, that a novel can be an intense, gripping experience even if it isn't filled with derring do, scientific marvels, and a cast of larger than life characters. This one's likely to be an award contender next year, although the low key cover seems aimed at a non-genre audience.
Publisher's Weekly, alas, was far less kind, calling the novel "sprawling" and "inflated," the characters "stereotypical," and concluding that the book will appeal most to younger readers.

Gary's been predicting that this book will polarize reviewers the same way "GI Jesus" does. And he's right; the polarization's happening already!

For whatever it's worth, my assessment is that the book went over the PW reviewer's head, although I've also been aware for a long time that this is likely to be the case for a fair number of readers (especially those who attempt to read it as a conventional SF thriller, which it most definitely isn't). I don't think "younger readers" will have the foggiest idea what to make of it; the PW reviewer didn't, either.

Thank you, Don D'Ammassa! Now I know that it's possible for people to read the book as I hoped it would be read, and that means the world to me.

Tuesday, March 27, 2007

The ED Sonnets: Room 9

He’s handcuffed to a gurney, with two guards
outside: corrections officers. I ask
if I can talk to him. They gesture towards
the bed and shrug. “Proceed at your own risk.”
But they’re more bored than wary: it’s a dare
to spook the female chaplain (CYA
pertains as well, no doubt). I feel their stares
inside the room. Their charge sends me away,
politely. Inmates almost always do:
the lack of privacy, I think. Outside,
the med staff gossips. “What’s he in for? What’s
his sentence? Is he faking?” But a few
are somber. “Look, it’s stomach cancer. Hide
the smirks, okay? He’ll die. No faking that.”

Grand Rounds

This week's edition is up, and I'm proud to be included.

Happy reading!

Monday, March 26, 2007

More Maui Pictures Than You Can Stand

This is my favorite picture I took in Maui. I took it in the Valley of Iao; a Google search informs me that this plant is known as the "Swiss Cheese Plant" (Monstera deliciosa), although it must have a more dignified name. The design shows up on lots of Hawaiian shirts. Pretty cool looking, yes?

I'll show the other pictures as small thumbnails, which you can click to enlarge.

Da Beach, Da Beach!

Here's the pretty little beach across the street from where we were staying. Off to the right, you can see the cloud-covered West Maui mountain; most days, the two mountains (this one and Haleakela) were either cloud-covered from the get-go or became that way by midday.

The beach was very clean, with gentle waves and a soft, sandy bottom. And I found the water deliciously warm, although it was often a bit too chilly for Gary. (Water temperature is the only thing I'm braver about than he is!) We're hoping to go back sometime in August, when the water will be really warm. The whales won't be there then, but the sea turtles will be.

Here's the beach looking in the other direction, with Realio Trulio Palm Trees in the distance. We took these pictures early in the morning: the beach was usually a little more crowded than this, although we tried to swim early to minimize sun exposure. We worked aggressively not to tan, smearing SPF 50 all over ourselves at every opportunity.

And here's my honey, smiling in the sunshine. He took a bunch of photos of me, but all of them turned out dismally -- making me look either profoundly pregnant or unsettlingly gorked-out -- so I'm not posting any of those.

I used to be more photogenic when I was young. Ah, well.

The Valley of Iao

As I've mentioned before, Gary and I call the Valley of Iao the Valley of Meow, and here you see why. The day we went, the valley was quite rainy, and only two or three kitties had come out to pose for photos. The first time we were there, last year, the place was swarming with cats. They're cared for by volunteers and by the Humane Society, but most of them are pretty feral: they'll pose for pictures, but petting's out of the question.

This little cat looks a bit like Belphoebe, whose death Gary and I were mourning the first time we visited the valley. We'd had to have her euthanized a year to the day before that first visit, and we hadn't expected to see cats, so coming across the colony felt like stumbling into cat heaven. It was a healing synchronicity.

Phoebe was white with brown spots, rather than orange ones. Still, seeing this cat made me remember her.

"Cats!" I hear you grumbling. "They went to Hawaii and took pictures of cats?" (Hey, at least we didn't get any shots of the feral mother with two kittens who lurked around our resort!) But it's true that the Valley of Iao is most famous not for its many cats, but for its singular needle, a botanical spire towering above the valley. Gary took this shot; I took others, but they don't show the scale as well. To the left, you can see the shingled roof of a lookout area at the top of the trail we'd just climbed.

Elsewhere in the world of botany, I was intrigued by this tree trunk with a new plant growing out of it.

I tried to take other botanical pictures, especially of fascinating, twisted tree roots that looked like something straight out of Tolkien's Old Forest, but I didn't have much luck with those shots.

Great Blooming Hibiscus, Batman!

I was more successful with plain old flowers. This one was on the sidewalk bordering our resort, but there are flowers almost everywhere you look on Maui. Last year we saw a delicate purple and aqua flower, called a jade plant I believe, that was one of the prettiest things I've ever seen. We were told that they can't be brought to the mainland because they harbor pests that could be dangerous to mainland crops. We wanted to find some to photograph this year, but didn't see any.

So we had to settle for ordinary colors like yellow and orange. This group of flowers was in the Valley of Iao, I believe. I think they're some kind of lily, although I'm hopeless at recognizing plants.

Oh, Lee had asked about leis: no, we didn't get any. It always makes me sad to think that the flowers hanging around people's necks will die; I prefer looking at them in their natural environment.

This was a very pretty plant we saw in upcountry Maui, where we'd gone to a winery. Gary and our friends Katharine, Jim and Maggi sampled the wine; I tried out samples of various lotions, and wound up buying a wonderful lavender body butter. It will be great for keeping my skin moisturized in our brutally dry Nevada air, and will be a lasting and soothing reminder of Maui.

These vines, growing on a trellis, were also at the winery. The pink looks good enough to eat, doesn't it? There was a tree with vivid purple blossoms we saw several places, and now I wish we'd gotten a photo of it, but we were always in the car when we saw it, on our way to somewhere else. The purple didn't look real: it was so rich and deep that I kept thinking it must be a special effect.

Rainforest Waterfalls, with Warning Sign

Gary took this shot on our way up -- or maybe down -- the rainforest trail where we walked through the magical bamboo grove. We didn't try to get photos of that, because the light was too dim. This was in the state park containing the Seven Sacred Pools of Hana, although I believe that at this point, we were above those pools. All of the pools had copious signage warning people about the dangers of jumping into them ("Submerged Rocks May Cause Injury or Death"), although that's not something we'd have been tempted to do anyway.

Gary did get a shot of the warning sign at the foot of Wailea Falls, the two-hundred-foot waterfall we hiked two miles each way to see. It was very impressive, but at that point I'd seen enough other waterfalls that it wasn't the high point of the hike. The high point was the bamboo groves, which will have to remain in memory only.

And there you have it. Isn't blogging wonderful? You can scroll very quickly through people's vacation slideshows, or skip them entirely, instead of being subjected to them in real time!

The ED Sonnets: Room 7

“We’re here on holiday.” The husband’s wan.
They’re Swedish, twenty-five-ish, tall and fair;
he sits beside the bed and strokes her hair.
“We’d just learned I was pregnant: now it’s gone,
the baby.” She seems calmer than her mate,
although that may be shock. “It’s very sad:
so strange to lose this child we barely had.”
Her voice is dreamy, slurred: they’ve medicat-
ed her for pain, no doubt. “We’ll try again,”
her husband says. She reaches up to kiss
his hand. I tell them, “Recognize your grief
and honor it: make room for mourning when
you feel the need. Some people will dismiss
this loss. It’s real, despite their disbelief.”

Refusing to Abandon

On the plane back from Maui, I finished reading Rita Charon's engaging and provocative book Narrative Medicine. I underlined many passages; some got stars next to them, too. Here's one of the starred statements: "Achieving safety and refusing to abandon -- not normalizing a high LDL, . . . not landing a BMI between 18 and 24 -- are the goals of clinical care" (150).

Reading that sentence, I remembered times when I've felt abandoned by doctors. In the mid-nineties, I began having twinges of lower right quadrant abdominal pain that led to round after round of exams and procedures: pelvic exam, ultrasound, GI series, exploratory laparoscopy. None of the tests showed anything. In one sense, of course, this was good news, except that the nagging pain continued. Each new specialist I saw was positive that his or her branch of medicine would offer me an answer; each initially approached my case with empathy and enthusiasm, and each time, I wound up feeling completely cut off when that specialty's procedures found no answer. There was a palpable withdrawal of interest, not only in my case, but in me as a human being.

I finally figured out on my own that the pain might be related to depression, which can cause GI symptoms; when I started meds in 1994, the pain subsided, although it never went away completely. I still have it. A few years ago, it became worse again. Because I still have my appendix, I went to my doctor to make sure that this was just the same old pain, and not appendicitis. I had a CT scan that showed "suspected thickening of the bowel wall," and then I went to my gastroenterologist and had another complete GI series, which again showed nothing (the "suspected thickening," it turned out, was just peristalsis). My GI doc offered me another exploratory laparoscopy, which I declined. I went back on antidepressants. The pain subsided again.

My current doctors haven't abandoned me, although they're puzzled about the pain. Whenever I see my gastroenterologist, he palpates that part of my abdomen to see if I'll still wince: I always do. And he always says, "Huh, you always have that hot spot, don't you? It's just one of medicine's mysteries." Because he's willing to accept my report of my own symptoms, even though he can't find a reason for it, I feel safe with him.

It's very important to note here that even at its worst, my pain has been fairly low-level. I've never taken pain meds for it: my goal has always been to learn the cause of the symptom, not to cover it up. That probably has a lot to do with why my current doctors have remained attentive and compassionate; they know I'm not using mystery pain to seek drugs.

A few months ago in the ED, I met a patient whose history was quite similar to mine, except that her pain was much, much more severe. Like me, she'd had tests -- over several years -- to rule out Crohn's, appendicitis, pelvic adhesions, and various other conditions. Weeping, she told me how much she hates being sick, hates not being able to give her children her full attention, hates not knowing what's causing the pain.

She'd come to the ED hoping that the doctors there could finally determine the cause of the pain, which was more severe that day. (One of the ironies of this kind of medical mystery is that one almost welcomes a worsening of symptoms, because if the pain's stronger, maybe something will finally show up on a scan.) "I've been here since this morning. I'm in agony. But the tests came back negative again, and when I asked for more pain meds, the doctor told me, 'I'm not giving you anything else. There's nothing wrong with you.'"

Listening to her, my heart sank. I remembered how it felt to be dismissed from all those doctors' offices more than a decade ago, how it felt to suspect that they thought I was a hypochondriac, and to wonder if they were right. This woman had the added burden of having been labeled a drug seeker. And indeed, when I told her nurse that the patient, sobbing from pain, had once again requested meds, the nurse rolled her eyes and said, "Yes, of course she did."

Drug-seeking is a real dilemma for doctors in EDs, and there are patients I label almost immediately, too. If I identify myself as the chaplain and you still keep begging me for Demerol, we have a problem. Drug seekers often report back pain or abdominal pain, so it makes sense that such a report without a clinically evident cause will raise a red flag for medical staff (although drug withdrawal produces symptoms of genuine physical pain, so drug seekers aren't necessarily lying about their discomfort levels).

Maybe that patient really was a drug seeker; maybe I was suckered by an Oscar-worthy performance. But I don't think so. I don't think anyone can act that well. I believed her, both because of her obvious frustration with being unable to care for her family, and because my own history has taught me that doctors can't always find the source of pain. The medical staff didn't have time to sit next to her bed and listen to her entire story; that's my job. But I wondered if they'd have been kinder to her if they'd heard what I did. It grieved me that this patient had been spoken to harshly by staff, that she had wound up feeling both unsafe and abandoned. According to Charon's definition, the handling of this case didn't meet the goals of clinical care.

Charon's a family-practice physician, and maybe such goals aren't appropriate in an ED, where long-term patient-doctor relationships are more the exception than the rule. Still, I wonder if there's some way for medical staff to honor their own principles and priorities without shaming patients, even those they believe are seeking drugs. "I know this is very frustrating for you, but I can't give you narcotics without concrete medical justification, and since all your test results come back negative, I don't have that here."

Would patients feel less abandoned if ED doctors in this situation said, "Here's the number of a pain clinic?" or even, "Here's the number of Narcotics Anonymous?" Would they feel less abandoned if doctors said (as various doctors have often said to me), "Medicine's an imperfect science, and sometimes we can't find the answers?" Is there some way to acknowledge suspected addiction without abandoning the patient?

If 12-Step programs are correct that addiction is an effort to fill the "hole in the soul," feeling unsafe and abandoned can only contribute to addictive behavior. And if patients aren't, in fact, seeking drugs, feeling unsafe and abandoned only adds emotional pain to their physical symptoms.

Thursday, March 22, 2007

It's not easy being green . . .

. . . Unless you’re a sea turtle. And no, I didn't take this picture; I got it off the web. I'll tell you about the turtles in a bit. But first:

Blogging News

The latest Change of Shift is up, posted as a series of limericks in honor of St. Patrick's Day, and I'm proud to be included!

I’ve also been tagged for a fun blog meme, but I won’t be able to participate until I get back home and have more time. Thanks for tagging me, Universal Health!

Today’s Erratum

In my last post, I said that the mandatory boating distance from whales is 100 feet; that should have been yards! Obviously, my vacation is eating my brain.

More News of Mice

The latest FoM review, by Victoria Strauss, is up at the SF Site. It's another very enthusiastic notice, although Straus joins Lalumiere in considering "GI Jesus" the weakest story in the collection. (I feel like I'm watching a tennis match, trying to keep a tally on this one!)

The Second Whale Watch

Here in Maui, yesterday’s expedition wasn’t quite as exciting as Tuesday’s, because we didn’t have hundreds of Spinner Dolphins surrounding the boat. The trip did start out with a spectacular whale breach, followed by pectoral fin slapping; after that, though, things quieted down. There were lots and lots of whales, including mamas, babies, and something called a “competition pod,” or “compod,” where two or more males head-butt each other (or maybe they only lunge at each other) over a female. But most of that was happening under the water, and while the naturalists claimed that they could see what was happening because of their polarized sunglasses, the rest of us with polarized sunglasses couldn’t see a thing. Either the naturalists were making it up, or they have x-ray vision.

We still had a good time, but it was a more placid good time than we’d had on the previous trip.

The Snorkeling Expedition

Gary and I have discovered that we love snorkeling. The boat’s first stop, at Molokini, allowed us to watch gorgeous little fish darting in and out of coral groves, and often swimming almost close enough to touch. Our optical masks worked very well: we could both see fine, even though we’re usually blind as the proverbial bats without our glasses. I heard lots of whalesong under the water, although Gary didn’t hear it. (There were a mama and baby whale quite close to us, and other people saw them breach, but we were watching fish when that happened.) It was really stunningly beautiful, and I can see how snorkeling could easily be a profoundly spiritual experience: just you, the water, the wildlife, and the gentle sounds of whalesong and your own breathing.

Unfortunately, my spiritual experience this morning was marred by three factors:

1. Gary and I were using proper snorkeling form: a dead-man’s float with gentle scissor kicks when we wanted to move somewhere. We were parallel to the plane of the water’s surface. This was how the instructor had told us to position ourselves. Unfortunately, most of the other people on our trip were hanging vertically down into the water, with their fins pumping as if they were on exercycles, popping up to chatter to each other and then plunking their masks back into the water to peer down past their feet. This meant that our own view of fish and coral was often blocked by a sea of pumping legs. I know that any true spiritual experience includes love for one’s fellow humans, but I was having some trouble with that this morning.

2. We had the first iffy weather of the entire trip: it was very cloudy and much cooler than it has been, and the water was very choppy. This meant that Gary and I both got chilly, even wearing wetsuit tops.

3. Probably as a result of #2, I wound up feeling very nauseous on my way back to the boat. Once I crawled aboard, I was okay, but it was touch and go there for a bit.

Me and My Turtle

On to Turtle Town! We saw more Spinner Dolphins on the way, and also had some more whale action. I’d told myself that it would be okay if I didn’t see any turtles, but I really wanted to see one . . . and sure enough, I did! I saw one large turtle, swimming placidly here and there, and I followed him (her?) at the required ten-foot distance. It really was ten feet this time, and not ten yards, because green sea turtles are no longer considered endangered, although they're still on the "guarded" list.

Later I learned that other people had seen a baby turtle: lucky them! I just saw the one. Sometimes I had to back up because I was too close to it. My turtle -- I became very proprietary towards the turtle very quickly -- was graceful and streamlined and soothingly green, and I was very happy; although, once again, my spiritual discipline of lovingkindness towards all living creatures stopped rather short of the idiot who swam about three feet from my turtle and flapped his fins in the creature’s face while trying to get a good shot with an underwater camera. My turtle appeared much less perturbed by this than I was, although it did make a dignified exit for its coral cave shortly thereafter. Honestly, dude: how would you feel if someone did that to you?

I thought about looking for other turtles, but I’d started feeling bad again, almost as green as my turtle was . . . and then rapidly more green, until I had to yank my snorkel out of my mouth to lose my breakfast and yummy boat snacks into the ocean. Delightful.

After that fun experience, I had to swim back to the boat, which wouldn’t have been a problem if I hadn’t been feeling violently ill. I managed to get there, though, and was keeping my remaining cookies down until everybody else got back into the boat . . . at which point I made a mad dash for the railing and hurled over the side of the boat five or six times in quick succession, while the other passengers stared at me. (“And now, ladies and gentlemen, our next eco-tourism adventure: Wild Vomit!”) The captain was very nice; she brought me a glass of cold water and told me, “You’ll feel better when we get going again, hon,” and then told the others, “We’re going to head back now, for the benefit of those of you who aren’t feeling so well.” It turned out that at least one other passenger was also sick, although I didn’t realize it then. When I apologized for fouling the water, the captain said cheerfully, “Oh, no problem! It’s fish food! The fish love you now! They want you to come back!” As Gary observed later, far better I should be sick into the ocean than into the boat.

Gary, alas, saw no turtles at all. He still loves snorkeling, though.

We made it back to the dock without incident, although it took a good ninety minutes for solid ground to stop rolling whenever I stood up. It’s the worst experience of sea legs I’ve ever had.

After a light lunch, a nap and a shower, I felt infinitely better, and Gary and I went for a nice walk on which I found fun inexpensive earrings and a new suitcase. The zipper on my old one had died. The new one is bright red, with yellow flowers and white turtles on it. It’s a little garish, but I definitely won’t have trouble spotting it at baggage claim.

So that was our exciting day. The whalesong and my turtle made everything worth it: I’d happily be that sick three times over, for those two experiences.

Tomorrow’s agenda: a quiet day of beach-lolling, probably a long walk for me and Gary, and then a fabulous dinner at an obscenely fancy restaurant, Nick's Fishmarket in Wailea. We went there for our farewell-to-Maui dinner last year, and it may be becoming a tradition.

Tuesday, March 20, 2007

Grand Rounds! Bamboo! Dolphins!

In Which We Announce This Week's Edition of Grand Rounds

This week's Grand Rounds is up, hosted by Dr. Samuel Blackman. I'm truly honored that he not only included the post I sent him, but said lovely things about my blog and then included a second post I hadn't even submitted. Thank you very much, Dr. Blackman!

In Which We Correct An Earlier Error

My post on Sunday said that we'd be returning next Sunday, but in fact, it will be next Saturday. I love Maui so much that I extended our stay by a day. Talk about Freudian slips!

In Which We Hike Through the Rain Forest

Yesterday, Gary and I hiked four miles through the rain forest, two miles up to a 200-foot waterfall and two miles down again. He's a much better hiker than I am, and this was a tricky trail: muddy and often fairly steep, with very uneven footing (lots of rocks and roots). We also had to forge a stream, across slippery rocks, in two places, although we fairly quickly hit on the idea of just wading through instead.

I did much better than I've done on hikes before, probably because I've been working out so regularly at home. I did manage to jam an ankle (which is fine and didn't even bruise) and bash my forehead on a low tree branch (again, no consequences), but I never fell. For me, this is a big deal.

The most beautiful part of that hike wasn't even the waterfall: it was walking through the bamboo forest. The park had put down wooden boardwalks, so the footing was easy there, and the bamboo was incredibly beautiful, rising yards above us with sunlight filtering dimly through it. It felt like being in a cathedral. When the wind blew, the bamboo stalks clacked against each other, making an eerie chattering. I felt like I was on another planet.

After the hike, my clumsiness continued: we went to another park where I swam briefly under two waterfalls, but also managed to fall and scrape my leg (again, nothing serious). Later, at dinner, I was pouring some olive oil onto my bread plate when the whole top came off; I righted the bottle before the oil overflowed onto the table, but everybody was teasing me for yet another mishap. Luckily, I managed not to spill olive oil all over our friend's new silk Hawaiian shirt!

In Which We Enjoy a Fabulous Whalewatch

Today we went on a Pacific Whale Foundation whalewatch out of LaHaina (we'll be doing another tomorrow). We saw lots of humpback activity: two juveniles playing, some bottlenose dolphins playing with the whales, and a pod consisting of a cow, a calf, and two whales. We saw lots of tails from diving whales, although there were no breaches as spectacular as the one we saw last year, when a cow breached and then her calf breached six times in quick succession. ("Look, ma! I can do it too!")

One young whale swam so close to us, maybe 75 feet, that we were being held captive, because the boat can't run its engines when a whale's that close. (Research vessels can get closer, but everybody else has to stay 100 feet away.) But the most magical thing happened when we were heading back, already late, to the wharf: we were suddenly in the middle of a group of five or six hundred Hawaiian Spinner Dolphins. The naturalists on the boats were going nuts, because they rarely see groups of more than twenty of these animals. Gary and our friends and I were right against the rail in the bow of the boat, and we could at least twenty dolphins directly under us, racing the boat and each other, periodically leaping into the air. You could tell they were out there just having fun! One dolphin, a few yards ahead of us, turned on its back and slapped the water with its tail.

I think dolphins are probably the most graceful animals alive, and seeing so many of them was an incredible thrill. I wonder what we'll see on tomorrow's whalewatch? Even if we see no animals at all, even if we only get a beautiful boat ride, we'll have considered our whalewatch money well spent.

And on Thursday, we get to snorkle! Gary and I really psyched about this; we both have horrible eyes, but it turns out that the snorkle place has optometric masks. I'm sure they can't correct for our astigmatism, but at least we'll be able to see more clearly than we would have otherwise.

And if I actually get to swim with sea turtles, I'll be ecstatic.

Sunday, March 18, 2007

Technical Difficulties

Well, we got to Maui fine, and we got some great photos today, and I even got them downloaded from the camera to my laptop, but I can't seem to upload them to Blogger. So I'll just have to post them when I get back!

They're pretty, though. Lots of flowers. Also beach. Also cats (in the Valley of Iao, which Gary and I have taken to calling the Valley of Meow because there are so many feral cats there, cared for by volunteers and the Humane Society). Also a nice one of Gary on the beach blanket. He took some of me, but all of them make me look like the Michelin Man -- worse than a dressing-room mirror, I swear! -- so I won't be posting those.

Tomorrow: the Road to Hana and hiking in the state park where the Seven Sacred Pools are.

Tuesday: whale watch.

Wednesday: another whale watch.

Thursday: snorkeling! Our tour stops at two places -- Molokini and Turtletown -- so I'm hoping to get to swim with sea turtles.

Friday and Saturday are so far open but will no doubt include beach excursions, as this morning did. Sunday, we come home.

Have fun, everybody. Be good (but not too rickety!).

Friday, March 16, 2007


At least, that's the idea . . . except that Gary and I are now worried about whether we'll actually get there tomorrow, because when we went to the Aloha site to print out our boarding passes, we learned that our itinerary had been changed: instead of going through Santa Ana to Maui, we were on a direct flight to Honolulu, and then to Maui. I called the airline to confirm this and to ask about seat assignments, and learned that not only were we on the new flight, but the new flight had now been delayed by two hours (which will at least let us sleep later tomorrow morning). I called the friends we'll be traveling with to update them, and one of them called me back to say that the Aloha people had informed her that yes, the plane really was delayed, and furthermore, it was also now going to stop in Orange County before continuing to Honolulu.

Gary and I can't wait to see what will have changed when we get to the airport tomorrow morning. I'm thinking they're going to issue us bicycles and wetsuits, and tell us to ride to a beach in LA and then swim.

In the meantime, my father's been in and out of the ER this evening, which ratcheted up my stress level a bit. And my mother may be having surgery in the next few weeks. And I'm feeling slightly guilty about going on vacation instead of going to Philadelphia to see my parents -- although both parents would say that was nonsense, since they want me to have a nice vacation. (I asked my mother if she wanted me to fly out for the surgery, and she said, "What? Of course not! Don't be ridiculous!")

So it's been a weird day. Between bouts of medical stuff and airline perplexity, I bought new shorts and a new bathing suit (I'm bringing four: should that be enough?) and packed as much as I can tonight, since I'll have to pack up the CPAP tomorrow morning. The cat-sitters have been given keys and gotten the litterbox tour. The cats have climbed in and out of open suitcases and perched on top of closed ones.

I don't know if I'll be blogging from Maui, since both time and internet access may be in short supply (the resort where we're staying doesn't have wireless, so I'll need to look for coffee shops). We are bringing the digital camera, but Gary doesn't want to take pictures and I'm not a very good photographer, so we'll see if anything comes of that. So if you post a comment here and it doesn't show up for a week, please know that that's because I haven't been online to approve it, not because I've rejected you!

I'll be back in a week, if not sooner. If, that is, we actually leave tomorrow.

Aloha, everybody. And please pray that Gary and I, and our friends, indeed reach Maui within the next twenty-four hours.

Thursday, March 15, 2007

Undercover Prayer

A few weeks ago, I prayed with a patient in one of our ED critical-care rooms. It wasn't a particularly sad or high-pressure situation, except to the extent that any ED visit is; the patient was in pretty good spirits, and seemed optimistic about the medical outcome.

What was memorable about that visit was the nurse's reaction.

We'd chatted before; she'd told me how happy she was that our ED has chaplains, and we'd laughingly compared notes on our faith traditions. (She's Baptist. I'm Episcopalian. There are plenty of jokes and stereotypes about both.) She's one of those rare souls who has the ability always to seem cheerful, no matter how crazy things are in the department.

But when I looked up from praying with this patient, I realized that she'd been standing with her head bowed, praying with us. Later, she took me aside and told me again -- even more emphatically than she had the first time -- how much it means to her that our ED has chaplains.

"You have no idea how heartening it is to hear someone praying openly with a patient. I've worked in a lot of places, and in some hospitals, it's almost forbidden to pray."

And then she told me a story about one of her patients in another state:

"He was Roman Catholic, and he was dying. He wanted last rites. I told the unit supervisor that we should call a priest, but the supervisor was an atheist and got mad at me and said there was no place for that in our hospital. Can you imagine? When the patient was dying, and this was his last wish?

"There was a community chaplain visiting another patient; he was a Jehovah's Witness. I guess he hadn't told the supervisor who he was. Anyway, I talked to him, and the two of us snuck past the supervisor, and we prayed with the patient. Neither of us knew anything about Roman Catholic last rites, but we did the best we could, and I think the patient knew that."

I've heard other stories about situations where chaplains weren't available when a patient was dying, when nurses and family members had to give the patient -- and each other and themselves -- pastoral comfort and support. But I'd never heard of a unit supervisor, regardless of his or her religious beliefs (or lack thereof), banning prayer from the floor.

I didn't think to ask the nurse who told me this story if she complained to the supervisor's supervisor. I can imagine that she wouldn't have wanted to do that for fear of reprisal; still, I hope that supervisor has somehow learned that good medicine encompasses more than pure science.

The ED Sonnets: Room 6.2

The door’s closed, which could mean that an exam
is underway, or that the patient wants
to sleep. I knock and hear a faint response:
“Come in,” not “go away.” Inside, the man
upon the bed is skeletal, and when
I say that I’m the chaplain, he begins
to weep. “I visit everybody in
the ER; don’t be scared!” He smiles, extends
his hand. “I’m not. I’m dying -- HIV --
and just a little while ago I prayed
for God to show me that he loves me, for
a sign. And then you came. You’re proof that he
still listens. I don’t have to be afraid;
I know I’m not an outcast anymore.”

Wednesday, March 14, 2007

"A Potent Brew of Mystery and Heartache"

That's how A.M. Dellamonica of SCI FI Weekly describes The Fate of Mice. It's generally a very positive review, although Dellamonica seems a bit unnerved by the "chilly, haunting and at times deeply disturbing" tone of most of the stories.

Maybe as a result, this review is in the thumbs-up camp on "G.I. Jesus:" "Her closing piece, 'GI Jesus,' is both uplifting and uproariously funny, and it offers a few delightful surprises." Which just goes to show you that tastes differ! And speaking of taste, Dellamonica appends a note to the end of the review advising readers that "these stories are like fine chocolate or good olives -- delicious, intense experiences -- but ones that are probably best savored at generous intervals."

Wow. To the best of my knowledge, my writing has never been compared to chocolate or olives before.

At my bookstore reading on Saturday, I warned the audience that the book is generally quite dark. A friend from church scoffed and said, "Susan, you don't have a dark bone in your body!"

I told him that he doesn't know me very well.

Tuesday, March 13, 2007

Grand Rounds!

This week's Grand Rounds is up, hosted by Hungarian medical student Bertalan Meskó. This is an admirably clear and well-organized edition; the Monty Python theme never gets in the way of understanding what the posts are about. Great job, Bertalan, and thanks for including me!

In other medical news, I've been talking to some folks at the medical school who are looking for ways to include more medical-humanities material -- including narrative medicine -- in their curriculum. It's early days yet, but I really hope something comes of this and that I'll get to be involved.

Yesterday, a friend at the medical school sent me a link to the website of the Taos Writing Retreat for Medical Professionals. Wow: would that ever be a fantastic place to work on ED sonnets! Unfortunately, the retreat is very definitely priced for medical professionals, and there's no way I can afford it. Maybe someday, though. Or maybe someday I could teach there.

For the moment, I'm just psyched that such a thing exists. Medbloggers, take note!

Monday, March 12, 2007

Chaplain Stress

My job as a volunteer ED chaplain is to be, more or less, unfailingly kind and compassionate. I'm not supposed to allow myself to be cranky; I'm definitely not supposed to be tempted to slap poorly behaved family members upside the head, which is emphatically not What Jesus Would Do. (Some of my church friends, the ones who spend a lot of time studying non-violent communication, would banish me to the Outer Darkness for even using that language, but I'm trying to be honest here.)

I take the compassion-and-tolerance job seriously, and most of the time, I do a fairly good job of practicing it. But, because I'm human, certain kinds of behaviors push my buttons.

Near the top of the list are parents who frighten or guilt-trip their sick children. You know: the mom who tells her feverish, miserable kid all the horrible things that will happen if the doctors can't fix this -- brain damage! seizures! -- or talks about it on her cellphone within the kid's hearing, which boils down to the same thing. Or the parents who bring their little girl to the ED on Christmas because she has a really bad ear infection, and then go on at great length, in front of her, about how she always does this to them, and sure enough, she's done it again: she's ruined their day.

Two notes before I continue: 1) Most parents in the ED behave beautifully: they comfort and reassure their children even though they're worried sick themselves, and remain calm and sympathetic in the face of nonstop howling and bouts of projectile vomit. In short, they behave like adults. 2) I'm not for a second claiming that I'd be a model parent myself; I don't think I'd be a very good parent at all -- I have neither the stamina nor the patience -- which is one reason I've chosen not to have kids. It's the hardest job in the world, and people who do it well have my unstinting admiration.

Most of the time, I control myself around inappropriate parents. Instead of lecturing the parents, I sympathize with the kid and offer any reassurance I can. "I had ear infections when I was your age, and I know how much they hurt. But the doctors will give you medicine to make you better." And then I offer crayons or a stuffed animal or both, anything to distract the kid from nausea and needles. Most of the time, I manage to remember that I'm not seeing the whole context, and that the adult caregivers may be under pressures I can't imagine.

But I was having a bad night last night anyway: I'd had neither enough sleep nor a chance to exercise before my shift, and the ED was pretty quiet, which can be paradoxically stressful because it gives you more time to think about how you feel yourself, instead of concentrating on patients.

Enter Family Unit: sick, alarmingly lethargic Child, Adult1, and Adult2. Adult1 is in tears, arguing with another relative on a cellphone. Adult2 is issuing dire predictions about how Child's Willful Refusal to be healthy will result in organ failure in two days. (Yes, really.) Child is lying in bed, motionless and wide-eyed.

Chaplain is not happy. Chaplain snaps at Adult2, "Did the doctor tell you that? About the organ failure?"

Adult2: "No."

Chaplain: "Then please don't talk about this where Child can hear it."

Adult2: "But Child needs to know the consequences of Willful Refusal to be healthy!"

At that point, fuming, I gave up on Adult2 and talked to the kid. "I know you don't feel well, but you know what? I think you're going to be just fine. The doctors are going to make you feel better. They're really good at that. Would you like crayons, or a stuffed animal?"

The kid shyly asked the adults if it would be okay to ask for a stuffed animal; the adults, returning to some semblance of rational behavior, said yes, of course. I experienced unexpected delay in delivering the stuffed animal, because the first one I found was claimed by a nurse who said it was so cute that she just had to have it herself (and then another nurse started fighting her for it: I told you we were having a slow night!), but the critter I did give the kid appeared to be a hit. From then on, the adults were model grown-ups, and the kid did so well after treatment in the ED that the whole family got to go home, instead of facing a hospital admission (which had been the initial game plan). The adults thanked me repeatedly for my help, not that I did that much. So that was a happy ending.

Except that I was still fuming. I vented to two nurses, who listened sympathetically. Then I realized that they had work to do and I shouldn't be taking their time, so I went upstairs to find a staff chaplain.

What I wanted to hear was, "Yeah, we all feel that way around clueless parents, and this is how to deal with it." And I got that, eventually. But first I got a long, gentle lecture about inappropriate boundaries, about how it's not my job to fix years of family dysfunction, about the intellectual arrogance of thinking I can tell people how to behave around their children.

I wasn't trying to fix years of family dysfunction. I know I can't do that. I was trying -- badly, no doubt -- to remind the adult that the child had ears. I was trying to make that moment a bit easier for everybody.

At one point I told the staff chaplain, "Okay, look, I think part of where I was coming from is that when I was a kid, other adults sometimes called my adult caretakers on less-than-optimal behavior, and it helped all of us."

The staff chaplain said, "In my experience, that's unusual." What he wound up telling me is that I should have just concentrated on interacting with the kid in the first place, rather than saying anything to the adults (which I already knew).

But thinking over the incident this morning, I wonder. I have a long history of small interventions with adults who are being inappropriate with kids in public (in post-office lines, on New York public transit). For a long time, my strategy with adults berating children in public has been to walk up and say something pleasant and off-topic (compliment the kid on his sweater, ask if the adult has the time). This serves several purposes: 1) It distracts the adult from the immediate frustration with the kid, and may defuse that frustration; 2) It reminds the adult that other adults have ears and eyes and are watching this behavior; and 3) It may show the child, however subtly, that other people watching this behavior don't think it's okay.

I think number three is the most important. If a kid is treated badly in public and nobody does anything, what message does that send to the child? That this is normal and acceptable behavior, or that nobody cares? I know that many people might say that other people's family dynamics are none of our business, but my approach has always been that if something's happening where I can see it, out in the open, it is my business. Maybe small distractions don't ultimately work; maybe all they do is to drive the behavior behind closed doors, where it will become worse. Maybe the kid will never catch the subtle message delivered by a stranger. Maybe I really am just an arrogant person with bad boundaries.

But maybe, just maybe, that child will grow into an adult who'll one day remember what happened so long ago, and will think, "Someone saw that, and didn't think it was okay."

In the meantime, I still need to be better at controlling my temper with clueless parents in the ED. I won't be back there for three weeks, until after our Maui trip. The vacation's obviously coming none too soon!

Sunday, March 11, 2007

Dreaming a Prayer

Last night I had an unusual, and unusually vivid, dream. It was a good dream, at least mostly -- not at all like the extended technicolor nightmare I had when I accidentally took two nortriptylene before bed instead of one -- so I don't think it's meds-related. It was also startlingly like a certain kind of fantasy novel, the ones where characters from a bleak, ugly reality find themselves transported to someplace happier and prettier, with better weather. Think Oz or Narnia.

So in this dream, I and someone else (I don't know who) were living in a dark, decaying urban landscape full of garbage and sewers and totalitarian police. And somehow, I think by crawling through the loathsome sewers, we reached, instead, a warm, sunny world, very bucolic. In the dream, I sat on the dirt floor of a cottage (two small rooms, whitewashed, with a thatched roof) as fresh air poured through the window and birds sang outside, while a very kind man -- a healer of some sort, or maybe a priest, clad in a simple white robe -- patiently explained to me how things worked in this reality.

I wound up back in the decaying reality at some point, and my companion and I were separated (or maybe my companion hadn't been with me in the sunlit world). I was fleeing through alleyways, trying to find the portal back to that peaceful cottage, when I woke up.

I lay blinking in the dark, thinking about the dream: and then I realized that the healer in the dream had been someone I actually know, one of my sickest and most troubled hospital patients, who's a frequent flyer at our ER. The dream-healer was my sleeping vision of, or hope for, what that man would be like if he were well and whole. And then I started thinking about other damaged people I know, and putting them in that world, too: consciously populating it with my ideal versions of people who desperately need any healing they can find (think Thomas Covenant, without violence).

Can a dream be a prayer? The Bible talks about God speaking to us through dreams; do we ever speak to God that way?

Whether the dream itself was a prayer or not, my conscious process of populating the cottage and its environs after I woke up certainly was.

I've been praying on and off for that patient ever since. I hope I don't see him at the hospital tonight.

Saturday, March 10, 2007

Turning Aside

Here's tomorrow's homily, which I'm posting tonight because tomorrow's going to be a "perfect storm," one of the rare Sundays when I'm preaching two services and doing an assisted-living service in the afternoon and going to the hospital in the evening. And I'll also be losing an hour of sleep because of the early switchover to daylight savings. I hope I can stay on my feet!

Today's bookstore reading was fun, with a fairly good turnout: fifteen or twenty people, which isn't bad for a beautiful Saturday afternoon! There were even a few people I didn't know, although most were friends.

Oh, while I'm on the subject of literary events, Tiel's hosting the poetry carnival Ringing of the Bards, and I'm proud to be included. Great job, Tiel!

After the bookstore gig, I came home and wrote the homily; I'd originally thought I'd be able to do that yesterday, but yesterday turned out to be a perfect storm of meetings, one of which was longer than expected.

Tomorrow's Scripture readings are Exodus 3:1-15 and Luke 13:1-9.

* * *

Today’s readings from Exodus and Luke are both, in different ways, about taking unbeaten paths, about turning aside from the ordinary to listen to, and trust, the unexpected. Both of these passages remind us that God is always inviting us to do a new thing. Those who maintain the status quo, conducting business as usual, risk never perceiving the Kingdom of God.

In Exodus, Moses leads his flock “beyond the wilderness” -- surely a foreshadowing of the greater journey he is about to undertake -- and sees something very strange: a bush that is burning, but is not consumed. “Then Moses said, ‘I must turn aside and look at this great sight, and see why the bush is not burned up.’ When the LORD saw that he had turned aside to see, God called to him out of the bush, ‘Moses, Moses!’”

These lines suggest that other shepherds have passed by and haven’t turned aside. Maybe they were so preoccupied with their sheep that they didn’t even notice the burning bush. More likely, they saw it, but were so frightened by the fire, and the resulting threat to their flock, that they simply fled, never even noticing that this bush wasn’t burning down to ash.

Having heeded God’s call by turning aside to explore the unusual, Moses finds himself entrusted with a far larger and more terrifying call, the charge to lead God’s people out of Egypt. Like nearly every prophet in the Bible, he at first considers himself unworthy of the task. “Who am I that I should go to Pharoah, and bring the Isrealites out of Egypt?” But because God has chosen him, and has promised to be with him, he does the work he has been given.

Moses’ story makes clear that being chosen by God entails as much struggle as salvation, as much hardship as honor. The flight from Egypt will not be an easy one, and Moses will not even live to finish the journey. And Moses’ story, and the later stories of the New Testament, also make clear that being chosen by God means putting aside business as usual. Shepherds leave their flocks to herd stubborn Israelites through forty years in the desert; fishermen leave their nets to fish for people; tax collectors leave their counting tables to work for an itinerant healer who values the two coins in a poor widow’s purse more than bushels of gold.

Some of Jesus’ audience in Luke have forgotten what it means to be God’s chosen people. Some of them, like some people now, think that being God’s chosen means being comfortable, being safe and protected. Some of them think that as God’s chosen, they can sit in judgment on those who have suffered more than they have, because such suffering must be a sign of God’s displeasure. Some of Jesus’ listeners believe that if they have been allowed to keep practicing business as usual, that means that they are eminently worthy and blameless.

Jesus sharply rebukes these notions. He tells his audience that they are no better than those who have suffered, and that if they do not repent of their own sins -- instead of counting other people’s -- they too will ultimately perish. Being one of God’s chosen doesn’t mean that you’re innocent or blameless: it means that you’ve been given a second chance, and also given the task of offering second chances to other people.

Jesus illustrates this lesson with the parable of the fig tree. The fig tree has borne no fruit for three years. Its owner, evidently adhering to the business-as-usual ethic of “three strikes and you’re out,” wants to cut it down. But the gardener -- whom we are surely meant to read as Jesus himself -- says, “Sir, let it alone for one more year, until I dig around it and put manure on it. If it bears fruit next year, well and good; but if not, you can cut it down.”

The fig tree may believe that it’s doing just fine: that because it’s still standing, nothing more is expected of it. If so, it has a real shock coming. It needs to start bearing fruit, or it will be cut down next year. The fig tree hasn’t been doing its job, but the gardener is willing to give it extra love and attention, to give it another chance.

We never hear the owner’s response. Does he say, “Sorry, but that’s not how we do business around here, and this tree has to go”? Or does he turn aside from his usual practice to embrace the gardener’s recommendation of clemency, to have faith that unexpected fruit may still be forthcoming from this unpromising tree?

Last week, my husband and I went to an Irish-music concert at UNR. One of the performers was a singer-songwriter named Tommy Sands who’s also a well-known peace activist in Northern Ireland. He told us a story about performing in another state -- Texas, maybe -- where he was approached by Jill Berryman of the Sierra Arts Foundation, who invited him to Reno to work with juvenile prisoners. Because Sands had helped heal conflicts in Northern Ireland, she thought he might be able to help gang members in Northern Nevada, too.

Sands listened to the call. He turned aside from whatever else he had been planning to do and came to Reno, where he worked with seventeen and eighteen-year-olds at Wittenberg Hall. He taught them to write songs about their lives, and he convinced the juvenile-court judge to accept these songs as testimony at their placement hearings, which would determine whether the young prisoners would be released, sent to treatment centers, or remanded to prison as adults.

Sands didn’t say what happened at the hearings. As in the story of the fig tree, we don’t know the outcome. But we do know that Sands nurtured the young prisoners and taught them to bear new fruit, to produce music instead of violence. And we know that he convinced the judge to turn aside from business-as-usual to accept this new form of testimony.

There is one story about Sands to which we do know the ending. According to an article I read about Sands, in 1990, “Sands started an event called ‘The Music of Healing.’ Musicians from both factions in Northern Ireland -- Catholic and Protestant -- met to play music together.” These sessions ultimately grew into the Citizen’s Assembly, which “looked for new ways of solving conflict and new ways of decision making.” The Citizen's Assembly, in turn, helped bring about the Good Friday Peace Accords, “which remain a source of hope for lasting peace in Ireland despite continuing problems.”

The media were initially “euphoric when the talks leading to the Peace Accords were being set up.” But once the talks were underway, “the media found themselves in the age old quandary -- peace does not make good ink. They began looking for cracks in the talks, interviewing factious extremists and trying to find drama in conflict. It was the kind of reporting that gradually breeds mistrust and polarizes the public.

“Sands knew that what the press needed was a ‘storm.’ So he decided to create one for them.” He wrote a song and taught it to forty children, twenty Protestant and twenty Catholic. “They marched, singing, to the building where the talks were being held.” Sands had written a simple song about peace. When the politicians inside the building heard the children singing outside, they “poured out into the street and joined in the singing. And the press had their storm.”

The politicians turned aside from business as usual to sing a new song. The reporters turned aside from business as usual to report on a new thing. While I’m sure that Tommy Sands would never compare himself to Moses or to Jesus, he is a living reminder of their lessons. Every day of our lives, but especially during Lent, God calls us to repentance and renewal: to turn aside from our old ways, to bear unexpected fruit, and to encourage those around us to do the same.


Friday, March 09, 2007

Carnival of Hope: Volume 1, Number 7

Welcome to Carnival of Hope! I'd like to thank everyone who sent in submissions, even if I didn't use them.

Before we begin this month's carnival, let's get "coming attractions" out of the way. The April CoH will be posted on Friday, April 13; submissions are due to me by 5 PM PDT on Thursday, April 12. Because of the auspicious date, the theme of the April carnival will be "how bad luck became good." If you have a story about some event in your life that initially seemed like bad luck but was then somehow transformed into a blessing, please send it to me! You can submit directly to me at SusanPal(at)aol(dot)com; please include "Carnival of Hope" in the subject line of your e-mail, and send me the permalink for the post with a two or three-line description of what it's about. You can also use the submission form at BlogCarnival.

Last night, my husband and I attended a wonderful concert of Irish music and dance. One of the performers was Tommy Sands, a renowned singer-songwriter who's also a peace activist in Northern Ireland and elsewhere. Some years back, Sands was invited to Reno to work with gang members in juvenile detention. He helped the kids write songs about their lives, and convinced the juvenile-court judge to accept these songs as court testimony. I haven't been able to find information about what impact this had on sentencing, but as Hugh Blumenfeld notes in his inspiring article Tommy Sands and the Music of Healing, "my guess is that it's hard to throw the book at a boy who can sing the story of his life."

In line with that theme, many of this month's posts are about how caring adults can teach, protect, and influence children. Ideally, of course, the most important adults in a child's life are her parents, and we have several posts about fine parenting.

Karen Shanley tells us how she helped her daughter Cait gain new perspective on her fear of fire in The Steering Wheel. Dr. Hal tells another heartening parenting story in To Be a Good Friend, about his hearing-impaired grandson; instead of teaching the boy to be afraid of the world because of his disability, his parents have taught him to define himself by his gifts and strengths.

Good parents help their children learn about, and accept, loss and sadness. In her very moving eulogy for her aunt, Christina tells us about taking her son to the funeral, an experience she didn't have as a child. "My son listened, and learned that death is a part of life. Not something to fear. Not something to ignore and hide from. He learned a little bit, today, about what it means to love."

Even the best parents sometimes learn the importance of safety precautions the hard way. Mama Mia offers a harrowing lesson in the need to child-proof windows, followed by a wonderful happy ending. Read her husband's post about their son's fall, and then read her own reflections on the accident. MM, I'm so glad everyone's okay!

If children are lucky, they learn important life lessons not just from their parents, but also from caring teachers. Rebecca Newburn tells us how she's taught her students to Take a Vacation from Complaining, a technique older people can also use. And Barbra Sundquist shares an essay from a friend whose very first dance class, when he was seven or eight, has helped him connect with joy for the rest of his life. Read his story in Tied to Joy With A Simple Piece of String.

Many other adults also help children. Megan Bayliss, a social worker in Australia who works with abused kids, sent her submission with this note: "I work in such a dark field that I make a daily point of seeking hope and courage in our unsung heros who just do what they do without any request for thanks." Her post shares some ways for businesses and indivduals to help raise money for Child Protection. Another public-service announcement, about an issue that affects far too many people of all ages, comes to us from Marcella Chester, who tells us about Blog Against Sexual Violence Day, 5 April 2007.

Children who've received help, and who've been taught the importance of help, become adults who help other people. Elliot shares a story of listening to someone who needed an ear in Recent patches of bright light. And here's Mama Mia again, telling us how good communication helped transform someone's viewpoint, and smooth over a difficult relationship, in Apology.

Both as children and as adults, all of us yearn for experiences of unconditional love. That kind of love is all too rare, whatever age we are, but for people of faith, God's love often becomes the inspiration that allows them to reach out to their fellow humans. Lee Long shares one such story in My Cup Runneth Over.

I began this month's edition with a story of how Tommy Sands uses music to try to transform lives. I'll leave you with Tiel Ansari's lovely (and musical) poem Gold Flakes, about the moments when darkness and coldness are transformed into light, life, and love.

See you in April!

Thursday, March 08, 2007

Reno News and Review! And Carnivals!

So here's the photo (credit: David Robert) from my Reno News and Review Fifteen Minutes article. (Fifteen minutes of fame, anyone?) It's not the best photo in the world, but it definitely could have been a whole lot worse, so overall, I'm pleased. The article's pleasant, too.

Meanwhile, the ever-energetic Kim has posted Change of Shift over at Emergiblog. Thanks for including me, Kim, and for plugging Carnival of Hope.

Speaking of which, please remember that the deadline's today at 5 PM PST (although since Gary and I will be at a concert this evening, I'll actually accept submissions until 10 PM). I have an exceptionally busy few days coming up, so the carnival will probably be posted sometime tomorrow rather than tonight. Please be patient!

Wednesday, March 07, 2007

The ED Sonnets: Hall Bed 6, Room 6.1

I finally have two more sonnets! These are modified Petrarchan, with the first eight lines rhyming abcd abcd rather than the standard abbacddc. These sonnets are the poetic form of the visit I described in my earlier post Voices.

I struggled a lot, with Gary's help, over the twelfth line of the second sonnet. Does the word "excruciating" convey the sense that the voices have gotten even louder since the patient's family left? That line originally read, "The din's/grown deafening: 'Die!' He came here instead," but Gary pointed out, correctly, that "die" shouldn't fall on an unstressed beat. I kept trying to find ways to keep "Grown" as the first word of that line, but no following word I came up with (raucous, grievous, howling) seemed strong enough.

I couldn't cover the entire visit in these twenty-eight lines. I thought of adding a third to describe the patient's artwork, but I wanted to stick to my scheme of one poem per patient location, and Gary thinks these two get the idea across.

All feedback will be welcome!


Hall Bed 6

He’s been asleep, but as I pass, he stirs:
squints up at me, and when I introduce
myself -- “I visit everyone, in case
they need to talk” -- he nods. “I need to talk
about how no one understands. It’s worse
when doctors don’t; they should. There’s some excuse
for other people. No one knows!” His face
begins to crumple. Techs and nurses walk
obliviously past. “What would you tell
us if you could?” He shivers. “What it’s like
to hear the voices.” “I don’t understand
that either, but I really want to. Will
you tell me?” “Sure.” He almost smiles -- for psych
evals, that’s huge -- and reaches for my hand.


Room 6.1

But first, I ask his nurse if we can move
him to a newly empty room. “I hate
this hallway; everybody stares!” The nurse
agrees. He tells me how for twenty years
three ceaseless voices have harangued him, have
not once been silenced, can’t be medicat-
ed into stillness, only grow perverse-
ly louder when he sleeps, won’t disappear
until he’s gone himself. “They want me dead.”
He has a job. He had a family,
but they walked out two weeks ago. The din’s
excruciating: “Die!” He’s here instead.
I praise his strength; he nods distractedly.
I’d surely, in his place, have given in.


Before I forget, the deadline for this month's Carnival of Hope is tomorrow, Thursday, at 5 PM PST. I'm more or less begging for submissions; I've gotten a lot of bland, impersonal personal-development posts this month, rather than the personal narratives I specifically ask for in the guidelines. So if you have a personal story about hope, gratitude, or good deeds, please send it to SusanPal (at) aol (dot) com, with the permalink of the post and a 2-3 line description.

Here's my own hopeful (or semi-hopeful) anecdote of the week:

Back in January, One of My Favorite Nurses at the hospital (hereafter abbreviated as OOMFN), decided to quit smoking. I learned about this because I'd seen OOMFN, clearly in a rush, buying a meal for an ED patient at the hospital coffeeshop; as I was buying my own chocolate-chip cookie, I said something like, "Wow, now there's an energetic person," and the cashier said, "Yeah, and giving up smoking didn't help."

So when I went back to the ED after my cookie break, I found OOMFN and said, "Hey! I hear you've quit smoking! Good for you! That's a really big deal! Congratulations!" OOMFN seemed startled, but thanked me. Since then, I've asked several times how the non-smoking campaign's going, and been told that it's going well, although "it's hard." (Giving up nicotine is supposedly more difficult than giving up heroin; I wouldn't know, since I've never indulged in either. But I can't even give up coffee, so it's a good thing I haven't used anything more dangerous!)

Last week, during my standard end-of-shift sweep of the waiting room, I met a young woman who said, "I'm pregnant, and I want to stop smoking. Do you have any information about that?"

I immediately thought of OOMFN. Could I get the two of them together to talk? But no: there might be HIPAA issues, and anyway, OOMFN (like all the medical staff that night) was running around like the proverbial headless chicken. And I didn't know how OOMFN had managed to stop; if the patch had been involved, that would be no help to the woman in the waiting room, who couldn't use the patch because that could hurt her baby, too.

Did we have how-to-quit-smoking info in the ED? I was constantly hearing doctors telling patients to stop smoking, so we had to have some printed material, right? But when I scanned the racks of wall pamphlets -- on heart disease, diabetes, stroke, alcoholism -- I didn't see anything about smoking.

I asked a tech, who suggested that I ask a doctor. I asked a doctor, who scratched his head, said, "I dunno. Tell her to go cold turkey?" and then suggested that I talk to the case manager. "I thnk maybe the hospital has a smoking cessation program." I talked to the case manager, who found a handout for me on the benefits of stopping smoking, with some do-it-yourself advice, but wasn't sure about the cessation program.

"Telemetry has standing orders to tell all their patients to quit smoking. They may have info we don't. Let me call up there." So she called telemetry, and sure enough, they had some pamphlets, and I went upstairs to get them. It turns out that there's a Nevada state hotline for people who want to stop smoking, paid for by Big Tobacco money. I gave one to the woman in the waiting room and gave the rest to the case manager, who said I should give them to the charge nurse, who said they should go in one of the wall racks. So I photocopied a bunch, but there were no empty wall racks, so they went into an obscure folder instead. At least the ED has them now.

During this long, involved process, I kept thinking, "It would have been so much simpler if I just could have gotten OOMFN together with that patient." I still wonder if I should have tried, if only to give the young woman a role model, although I think all of us know people who've stopped smoking.

My mother smoked a lot during her pregnancy with me; I managed to emerge without major birth defects, but I wasn't going to tell the young woman that story, because I was 150% in favor of her quitting. (My sister and I nagged my mother into quitting when I was about nine.) I see so many people in the ED who are addicted to all kinds of things, and so many of them really seem to want to quit, and so often, they face obstacles, especially the lack of rehab programs for patients without insurance. AA and NA are great, because they're free, but some folks -- especially the ones who've relapsed after some time in 12-step programs -- need closer supervision, at least for a while. OOMFN is already one of the more empathetic nurses at the hospital, but I hope that the experience of quitting smoking has created new and deeper empathy for addicted patients.

It's ironic, though, that in a part of the hospital where patients are constantly told to stop smoking, finding information about local resources took a good twenty minutes of my time. Maybe the logic there is that info on how to stop smoking is readily available on the Internet and other places, but it still can't hurt to be able to give patients printed information. And it can't hurt to remember that giving up smoking is really difficult: even for healthcare providers who know the risks of smoking all too well, even for parents motivated to stop by love for their children. We need to praise people who've given up nicotine as much as we praise people who've given up heroin or meth.

I think, and hope, that OOMFN has appreciated my interest and encouragement. I'm pretty sure the young mother appreciated my getting that information for her. Knowing that they're both trying to quit makes me very happy, and I hope their efforts succeed.