Monday, December 31, 2007

. . . And Beginnings


Today I happened to run into the staff chaplain I wrote about in my previous post. She indeed spent many hours ministering to the family of the comatose patient, and thanked me for telling her about them instead of simply leaving at the end of my shift.

And she had some good news: when the patient died, the family readily agreed to donate the patient's organs. That patient's untimely end has now made new beginnings possible for other people.

Organ donation has been on my mind, because my friend Katharine DeBoer's brother received a new kidney on December 5th. David had gone into kidney failure from diabetes complications, and he'd been on dialysis for eighteen months. His new kidney was donated by a coworker he met only four months before the surgery, who's now lobbying for paid leave time for state employees who donate organs. Their local TV station did a three-part story, fittingly called The Gift of Life, on David and the donor, Janet. Be sure to scroll down to Part 1 so you can watch the story in order.

The evening after the surgery, I went to Katharine's house for our weekly Knitnight. (She wasn't able to fly to Vermont for the surgery, because she was still teaching, but she's there now.) As soon as she opened the door, I asked how the operation had gone. "The new kidney's working," she said, with tears in her eyes. "He's producing urine."

Watching the news documentary, I wondered if I'd be brave enough to donate a kidney to a stranger if I were a match. I'm not at all sure that I would, but I'm immensely grateful that there are people in the world who are.

To learn more about organ donation, you can visit the U.S. Government page about the issue, or go to Donate Life America.

Saturday, December 29, 2007

Endings and Beginnings


My hospital shift this week was difficult and emotionally draining, filled with grief: a patient who lost a beloved parent a few months ago, a patient being admitted to the hospital but frantic with worry over a spouse with advanced Alzheimer's, a patient who'd lain down to take a nap and become unresponsive, and whose CT showed disastrous bleeding in the brain.

The first patient was in the ER because of ETOH issues, and was too out of it to have a coherent conversation. I pride myself on being sympathetic even to the most difficult of our alcoholic patients, but at this particular bedside, I got worn down quickly. The patient's professions of love for me alternated with keening howls over the deceased parent, and none of my calming techniques did any good. Because what the patient needed most was probably sleep, I retreated. Over the course of the shift, I watched other staff struggling to keep their tempers with this patient. The grief was real, though, and I wished I could have found some way to offer comfort.

The second patient agonized -- "Who's going to provide the care if I'm here?" -- but then read me the riot act for breaking confidentiality when I talked to our case manager about the situation. "You shouldn't have done that, hon. I don't want social services involved! I hope you'll take this as a lesson!" Flustered, I apologized and went back to the case manager, who said cheerfully, "I forget things very easily. Don't worry about it." Then I went back to the patient, who lectured me for a few more minutes -- very kindly -- but then showed me a series of dog-eared family photographs. "Here we are hiking before the Alzheimer's really set in. I love this picture. This is how I want us to be remembered."

It was a sticky ethical situation. The patient was right that I should have asked permission before talking to the caseworker, but I also suspect that this patient wound up in the hospital at least in part from the stress of caretaking, and that the entire family probably desperately needs services (respite care, if nothing else). The patient was very invested in believing that no one else could care for the spouse, and clearly felt threatened by any offers of help that might prove otherwise; and was so distressed about the hospitalization, I'm guessing, at least in part because it would prove that other people could care for the spouse. A relative in the room told me wearily, "We've been down this road a lot of times," so I have a feeling the same scenario has played out before.

I loved looking at the family photos, but left -- with a promise to come back -- when I overheard something outside about an unresponsive patient being brought in. The charge nurse told me, "They're trying to intubate. I asked the family to go outside, because that's hard to watch. They're probably in the waiting room. Will you go talk to them?"

"If you'll come with me," I said. "Under the circumstances, they're going to panic if the first person they see is a chaplain."

She came with me, and we found the family and led them to the chapel, which is quieter and more private than the waiting room. They were, understandably, very distraught. I prayed with them. Then the case manager, the charge nurse and the doctor came in, and the doctor explained the CT results. "I've never seen someone recover from something like this," he said gently, and we all watched the family dissolve into tears and disbelief.

"This can't be happening," the spouse said, over and over. "This can't be happening." The patient was intubated now, and the family had been invited back to the bedside. We made a slow, mournful procession; the spouse walked slowly, using a cane, but didn't want a wheelchair. "This can't be happening!"

At the bedside, I watched the family cry, kiss the comatose patient, say, "I love you." The spouse was on a cellphone, trying to reach other relatives, and occasionally looked at me pleadingly, struggling for words to explain the medical situation. Narration of test results alternated with self-blame. "If only I'd -- "

"No," one or another of us would say. "There's nothing you could have done. Nothing could have prevented this. It just happened."

"We were going to the doctor today. If we'd gone to the doctor -- "

"It isn't your fault," I said, and shot a help me glance at the nurse who was checking the monitor.

"It's not your fault," the nurse agreed, to my immense relief. "Nobody could have predicted this or stopped it. Not you, not your doctor, not even us if you'd gotten here sooner. It just happened. Things like this happen."

"But why?" None of us could answer. We didn't know.

In the middle of this, a Code Blue came over the intercomm. It was upstairs, in ICU. Normally, I'd have gone, but I knew there was at least one staff chaplain on duty, and I didn't feel like I could leave this family. My shift was almost over, though, and I was exhausted: I had to go home.

I excused myself to go talk to the case manager. Could we get a staff chaplain down in the ER? "I called up there," the case manager said, "but nobody answered."

"They're probably on the code," I said. "I'll go up and see what's happening, because if a staff chaplain isn't there, they may need somebody."

I excused myself, telling the spouse that I was going to look for another chaplain. On my way out of the ER, I glanced back at the room that had held the Alzheimer's spouse. The room was empty: I'd lost the chance to keep the promise I'd made to go back, unless I wanted to go see the patient upstairs. And I was exhausted, and it was almost the end of my shift, and given what had happened, I thought the patient would only feel more betrayed if I wrote a note asking another chaplain to visit.

In CCU, I found a long-faced staff chaplain -- the only one still on duty, it turned out -- standing with a cluster of other staff outside the room, where the curtain had been drawn. The doctor had just called the code. A griefstricken relative was still next to the bed, imploring the patient not to die, even though the patient already had.

The staff chaplain looked as exhausted as I felt. "I hate to dump this on you," I said, but proceeded to dump it anyway, explaining the situation with the intubated patient. "I feel like someone should be with the family, but my shift's almost over. What should I do?"

"Go home," the staff chaplain said promptly. "You've put in your shift. You've done good work." (Ha, I thought.) "Thanks for letting me know about this; tell them I'll be there when I'm done here."

I went back down to the ER and delivered the staff chaplain's message, and the spouse thanked me. And then I went home, exceedingly glad that this was the last shift of my year. Because of travel plans, I won't be there next week or the week after.

As I left the hospital, I tried to remember shifts that had left me feeling as if I'd accomplished something. This was one of the shifts that only made me think, So, like, why exactly am I doing this? Am I helping anybody here? Am I having fun yet? I felt entirely inadequate: "like butter that has been scraped over too much bread," to quote Bilbo Baggins.

But I'll go back, because after three years, I've had enough positive visits to outweigh one awful shift. I'll go back and start a new year, and this week's patients will start their new years, learning how to live in a world rendered alien by loss. It's trite to say that every ending is also a beginning, especially when that beginning is so unwanted. But my hope for all of these patients is that they'll discover good things in that world along with the terrible ones: that in all that darkness, they'll also find friendship, and hope, and love.

Thursday, December 27, 2007

Happy Birthday, Liz!


Today's my sister's birthday. Here she is wearing the shawl I made her, along with the matching shirt and earrings I sent. The shawl's larger than the others I've made -- twenty-five inches wide rather than twenty, and correspondingly longer -- and it took a lot of time, so I was very relieved when she told me how much she likes it!

In this shot, you can see the length. I was afraid that she'd think the colors are too garish, but she says she likes them. And when I apologized for the errors in the shawl, she said, "Pshaw!"

Harley helped me make this shawl by sitting on top of it and kneading it while I was knitting. The yarn was soft to begin with, and is now softer due to an infusion of cat hair. But there are six cats in my sister's household, so I figured she wouldn't mind.

Happy birthday, big sister! I hope you have a wonderful day!

Wednesday, December 26, 2007

Excellent Xmas


Christmas was quite wonderful this year, after several years when it was emotionally difficult.

My homily went very well, thank goodness. I hadn't been conscious of being unduly nervous about it; nonetheless, I woke up at 5:00 a.m. yesterday after a night of intense anxiety dreams. But many people, including our bishop-elect, told me that they enjoyed the homily very much, and its metaphors wound up being knit throughout the rest of the service. Our deacon prefaced the Prayers of the People by asking us to pray for those who are disconnected from the fabric of society; Bishop-elect Dan, before beginning the Eucharistic Prayer, talked about how the eucharist is one way the infinite God takes intimate form. When it was time for the blessing, he discarded the traditional Christmas blessing and instead offered an extemporaneous (and quite rhetorically dazzling) wish that all of us discover how tightly we are knit to God, each other and our own depths. This man knows how to take an image and run with it!

I think a few people thought the homily was merely cute; nevertheless, I didn't embarrass myself or my parish, which was what I'd been worried about.

I also got a great deal of really wonderful Christmas loot from Gary, including a gorgeous set of interchangeable circular knitting needles from Knitpicks. The needle tips are multicolored, laminated birch, inspired by multicolored wooden cooking spoons. They look beautiful and feel fabulous, very smooth. They also join very smoothly to the cable, which has almost no memory and thus stays nice and straight right out of the case: no dipping in hot water to try to get the coils out! I love working with these needles, and since I now have every tip size from 4-11, I'm sure this set will serve me for many years. The only drawback, noted in other reviews I've seen, is that the length and size aren't printed directly on the cables and needles. This isn't an insurmountable problem, but it is annoying.

Gary also got me the DVD of that 1980 cult classic, Flash Gordon. This is the unbelievably campy one with the Queen soundtrack, newly rereleased and subtitled, "Saviour of the Universe edition." I have especially fond memories of this movie because I wrote a paper about it for my "Bible and Literature" class in college, and the professor gave me an A+. Rewatching it last night, I caught scriptural echoes I hadn't been aware of the first time; turns out I also could have used it in the paper I wrote about Milton's Paradise Regained in grad school, although that professor was somewhat less enchanted than the first one with pop culture. (His comment on that paper was, "This is a great sermon, but only a so-so essay." At the time, I was devastated. Now I realize that he was talking about formal, generic issues; he would doubtless be amused by the fact that these days, I write more homilies than pieces of academic literary criticism.)

I was equally delighted to get more lavendar products from Ali'i Kula Lavendar in Maui: a new container of their wonderful body butter creme, since I was almost out, as well as some bath soap and liquid hand soap. This is truly yummy stuff. There's a lavendar store in Reno, quite close to our house, but while I love their dried lavendar and their hand balm, their bath products aren't as nice as Ali'i Kula's. And anyway, I love anything that reminds me of Maui!

Beginning with my last birthday, when he gave me a stethoscope, Gary seems to have started a tradition of giving me a medical gift every holiday. This Christmas, it was the Merck/Merial Manual for Pet Health, so that if I'm fretting about a kitty symptom, I can look it up. This edition was designed for pet owners rather than veterinarians, which means it's in everyday language.

I've been using Gary's wall calendar to track the progress of knitting projects, so he got me my own, a beautiful Nevada Wilderness Calendar. I can't seem to find an image online, but trust me, the photographs are stunning! Also: Leo Kottke's "best of" album, since I love his music, and a new pair of flannel PJs, since some of my old ones are literally threadbare.

Thanks, Gary! And I hope everyone reading this had a wonderful holiday!

Tuesday, December 25, 2007

Christmas Grand Rounds


Grand Rounds always falls on Tuesday, even if the day's a major holiday, and this week's edition is up (including a post from yours truly).

Happy reading!

Seamless Garments


Here's the knitting homily. Gary, my dyed-in-the-wool atheist -- who nonetheless always appreciates a good metaphor -- likes this a lot, so I hope I won't embarrass myself in front of our bishop-elect!

This painting of the knitting Madonna is the one I refer to in the fifth paragraph of the homily.

I wish you all a very Merry Christmas, and the happiest of New Years!

*

Good morning, and Merry Christmas!

Whenever we have one of our contemporary services, I’m struck by a phrase from the Shema: “the infinite and the intimate are one.” No season in the Christian calendar emphasizes that lesson more than Christmas. This morning, we’ve gathered to celebrate a birth, the arrival of God among us as a vulnerable human infant. God is infinite, but few things are as intimate as a newborn baby, nestled with his exhausted, exultant mother in a stable.

Christmas is the Feast of the Incarnation, and incarnation literally means “embodied in flesh.” At Christmas, God’s love takes human form among us. We, too, are incarnations of God’s love, called to make our own love visible in the world. Creativity is one of the ways we do that. Every painting, symphony, blueprint and poem incarnates -- gives a body to -- what we think and feel. Created in the image of a creator, we too create. Christ is the Word made flesh, but we too, more modestly, give flesh to our ideas.

It’s fashionable to decry the commercialism of Christmas, but I suspect that all that gift-giving is really a kind of incarnation. Every gift under the tree is an embodiment of love. The gifts that mean the most, though, are often homemade: the plate of cookies baked from scratch, the quilt sewed by a great-aunt, the crooked angel paperweight made by a child. These intimate gifts reflect the infinite depth of our feelings for one another.

Many of you know that several months ago, I taught myself to knit. So far, I’ve produced a series of prayer shawls and a balaclava, a ski mask, for my husband. My projects display more devotion than skill, but the recipients of my gifts don’t seem to mind my mistakes: instead, they’re touched by the time I’ve put in. And during my many hours of knitting this autumn, I’ve thought about Mary. I kept picturing her, during her pregnancy, knitting baby blankets and booties for Jesus, even though my research into the history of knitting tells me that the craft didn’t take its current form until the Middle Ages.

The idea of Mary knitting appealed to someone back then, too: the earliest image of knitting we have, probably from around 1400, is this painting of the Madonna knitting, on four double-pointed needles, Christ’s seamless garment, the one for which the soldiers cast lots after the crucifixion. At Christmas, the image reminds us -- somberly -- that birth foreshadows death, but it is also a reminder of continuity, because knitters still use this technique. I’m using it to make another balaclava, this one for myself.

Knitting is a very intimate activity, but if the infinite and the intimate are truly one, we shouldn’t be surprised to see God described as a knitter. The Bible contains several such images. At least two of them deal directly with birth. “You have clothed me with skin and flesh, and knit me together with bones and sinews,” says Job, and Psalm 139 proclaims, “you formed my inmost being. You knit me together in my mother’s womb.” While the word “knit,” in these contexts, probably means something more like “weave,” author and knitting guru Susan Gordon Lydon is definitely talking about the contemporary form of the craft in her own theological musings. In her book Knitting Heaven and Earth, she writes:
I knit and I wonder. Is God a knitter, a craftsperson, a seamstress? Did (s)he create the vast oceans with a sweep of the hand or patiently construct them one drop at a time? The most miraculous things in the world are those we take totally for granted: water and skin. Who could dream of constructing a seamless, elastic, self-repairing fabric of any fiber available on earth? Who could synthesize the proper combination of hydrogen and oxygen to produce a substance that boils and freezes, moves violently of its own accord, cuts through rock and gently soaks tiny plants, or bursts dams and levels whole villages and towns. I contemplate the miracles of water and skin as yarn passes through my fingers, on its way to creating a garment of softness and warmth (203-204).
Mary, too, must have contemplated the miracles of water and skin, as she lay exhausted and exultant in the stable, running her fingers over the delicate skin of the baby who had so recently emerged from the waters of her womb.

Before and after their birth, children grow cell by cell, a drop at a time. Christmas reminds us that mighty things grow from tiny ones: kingdoms from mustard seeds, floods from raindrops, saviors from embryos. Over the course of the coming year, we will follow Jesus step by step through his ministry, watching him grow from a squalling infant into a healer and prophet, into the Messiah. And we will be called to grow with him. We will watch Jesus acquire followers: with them, we will doubt, wonder, question, witness miracles and betrayal and death, and stand in awe and terror at the ultimate miracle of the resurrection. After the ascension, we will watch Jesus’ followers become the church.

The church, too, grows from small beginnings. The Collect for All Saint’s Day begins, “Almighty God, you have knit together your elect in one communion and fellowship in the mystical body of your Son Christ our Lord.” Christ the infinite is composed of the intimate, the bodies and deeds of his elect. That means us. We are Christ’s hands and feet and heart now in the world. God the knitter joins us together, one stitch at a time.

Christmas is fundamentally about connection, about earth joined to heaven in the person of Jesus. Faith is fundamentally about connection, about how we express our love for God, our neighbors, and ourselves. Few activities embody -- incarnate -- connection as literally and vividly as knitting, which forms seamless fabric from interlocking loops of yarn.

Knitting holds a surprising number of lessons for the church. First, it teaches us that there is no one right way to proceed. Nearly any pattern can be made a number of ways, using a variety of techniques. I taught myself to knit using chopsticks as needles and ribbon as yarn. After a month or so, I discovered that I’d been making half my stitches backwards, knitting onto the back of the stitch instead of the front. My projects had come out fine anyway.

Knitting also teaches us patience and perspective. Projects grow a stitch at a time; the larger pattern becomes visible only after many hours of work. Trusting that the pattern will emerge requires faith in the pattern’s author, and persistence in making each successive stitch even when we can’t yet see how it will fit in.

And, finally, knitting has taught me what kind of mistakes matter the most. This balaclava contains an embarrassing number of twisted stitches and odd yarnovers. It’s a beginner’s project. It’s going to hold together, though, because all of the connections are there, even if they aren’t all lovely. The truly terrible mistake in knitting is the dropped stitch, the stitch completely disconnected from its neighbors. A dropped stitch can unravel an entire project, no matter how splendid the work around it may appear. In knitting, every stitch counts.

And so it is in the church. In our baptismal covenant, we promise to “seek and serve Christ in all persons,” not simply the lovely ones. The God who came among us as a humble infant in a stable dwells among us still, in “the least of these.” This Christmas, let us strive to make Christ’s love visible to all our neighbors, to knit everyone around us into the warm, seamless garment of the Kingdom of God.

Amen.

Monday, December 24, 2007

Hurrah for Pennie Hembree!


This morning's paper had one of the best Christmas stories ever, about a woman who used to be a homeless addict. A year ago, she was dying on the streets. Today, thanks in large part to the intervention of police officer Patrick O'Bryan and social worker Joan Swickard, she's clean and sober, living in her own apartment, and volunteering in the community to help people who are where she used to be.

Even more important than the material help O'Bryan and Swickard offered was the fact that they cared enough to offer it. Hembree realized that if "Swickard and O'Bryan cared that much about her life, she should, too. She also wanted to let them know their efforts weren't in vain."

Swickard expands on this:
Swickard said many homeless like Hembree think they are not worth saving. Many also do not have support systems, or people who are constantly monitoring them and helping them navigate the social services system.

"It's difficult for these people because they don't think they're worth it," she said. "But they have to know that we don't give up on them. We think they are worth it."
I really, really hope that the ER staff I know who are suffering from burnout and compassion fatigue will read this story. I'm tempted to print it out, highlight the parts about not giving up on people, and tape it to the med-room door.

Hmmmmm . . . I may just do that.

(Katharine was over last week, and we were talking about a mutual acquaintance who's a social worker. I said, "If I were starting over, I might become a social worker," to which Katharine rolled her eyes and said, "Susan, you are a social worker." But really, I'm not, because I don't know enough to navigate the system fully. Idealism does not a social worker make. And I suspect that if I were in that job, I'd burn out in five seconds, simply overwhelmed.)

Hurrah for Pennie Hembree! Hurrah for Patrick O'Bryan! Hurrah for Joan Swickard! And hurrah for Manor Care, the nursing home where Pennie stayed and recovered until she got her own place. Several members of my church do a service there every two weeks; I wonder if they know her?

Sunday, December 23, 2007

Xmas Prep


Gary and I have both gotten our wrapping done, and I wrote a draft of my homily. Gary likes it and thinks it's done, but I want to do some polishing tomorrow, when I've gotten a bit of distance from the piece.

Knitting progress: I now have six inches of my balaclava and twenty-four inches of my shawl. I've bought yarn for another three projects (all for other people), with two more planned. Should keep me busy!

Blogging news: TTLB has downgraded me from "large mammal" to "adorable little rodent." I think I prefer the latter! (I'm a rickety little rodent.) Also, Sarah wrote a lovely post about me and my work. Thank you, Sarah!

Saturday, December 22, 2007

A Christmas Story


Many years ago now -- it must have been in 1985 or 1986, although I don't remember the exact year -- my grandfather Jerome spent Christmas in the hospital. He was in his late eighties or early nineties then, and he'd fallen and broken his hip. He needed surgery to repair the break.

After the surgery, he developed a fever and became disoriented. Lying in his hospital bed in traction, he didn't know who we were when we visited. His only clear memories were of his childhood and early adulthood. Jerome and his twin brother George had been born in Flagstaff, Arizona in 1896, but when he was well, he rarely talked about those days. His first wife, my mother's mother Della, had been killed in a car accident in 1938, an accident that also put Jerome in the hospital for six months. When he was well, he never talked about the accident, and rarely about anything that had happened before it.

But in his feverish state, those days seemed to be all he remembered. My mother and I lived a block from the hospital, and every day I'd go visit Jerome and listen to his stories. He told me about raising a pet coyote pup in the backyard when he was a boy, and about how his mother wouldn't let the children go downtown on Saturday nights, because of all the saloon gunfights. He told me how much he loved horses. Once he'd saved a stable of horse from a barn fire, running back into the burning building, again and again, to lead each of them to safety. Saving all those horses was the proudest moment of his life, he told me. He loved horses; they were so much better than cars. When he said that, I wondered if he was thinking about the accident that killed Della.

He talked about the accident, too, a little bit: about how angry he'd been in the hospital because no one would tell him how Della was, how he fainted in the hospital rooftop garden when his brother finally broke the news that she was dead. He wept, remembering it, his rage at the loss newly raw.

I loved listening to Jerome's stories, even the painful ones, but of course we also all wanted him to come back to us, to return to the present. My aunt Barbara, known as Bobbie to the family, was a nurse. She decorated his traction apparatus for Christmas, to give him something bright to focus on. One of the decorations was the bear ornament in the picture at the top of this post.

In time, the fever subsided, and Jerome came to himself again. He told us that in his dementia, the little bear had spoken to him, telling him who he was and what had happened to him. He had never shown any signs of mysticism before, and he told us about the talking bear very matter-of-factly. I wrote a heavily fictionalized version of the incident in a fantasy story called "A Masquerade of Voices," printed in David Hartwell and Kathryn Cramer's anthology Spirits of Christmas, and of course I gave a copy of the story to Bobbie. Bobbie kept the bear to hang on her family's Christmas tree, and she sent me this picture of it in honor of the story.

I think what called Jerome back to his family was love: that was the voice he heard. Love became tangible in Bobbie's little bear, but also in the family photo album my mother made him for Christmas, and -- in less tactile form -- in my visiting every day to hear his stories.

There's a sad postscript to this story, though. Like Bobbie, I wanted to do something to brighten Jerome's hospital room. One day while I was Christmas shopping, I passed a health food store and went inside to buy a snack. The owner was making huge, beautiful crepe-paper flowers in vibrant pinks and blues. I asked her how much they cost, and explained that I wanted to bring some to my grandfather in the hospital. She gave them to me. She wouldn't take any money.

I kept meaning to go back and thank her, but a few weeks later, the store burned down. The newspaper said that the owner had been killed in the fire. I've always felt terrible that I didn't thank her when I had the chance, and terrible that no one ran inside to save her, the way Jerome saved his beloved horses.

Jerome died in June of 1987, and Bobbie died in June of 2006. I miss both of them, and I hope they knew how much I loved them.

This Christmas, give something bright and beautiful to the people you love, especially if they're sick. And don't wait to thank the people to whom you're grateful: let them know now how much they mean to you.

Winter Solstice


Today's the Winter Solstice! From here on in, the days will get longer until midsummer. Hurray! We're over the hump of winter light deprivation!

And may anyone who celebrates this as a holy day have a blessed celebration.

On a sad note, my friend Joel killed himself on the winter solstice twenty years ago. The memorial service included a poem he'd written about yearning for spring.

I'm thinking about him and his family today.

Eh?


So I was cruising along as a modest flippery fish in the TTLB ecosystem. Yesterday I noticed that I'd gone back up to crawly amphibian, which was nice but a little puzzling, since I hadn't had a huge jump either in visits or links.

And today they've got me listed as a large mammal, which is way up there.

This makes no sense, and I'm sure I'll get bumped back down the food chain soon. But hey, I'll take it!

Friday, December 21, 2007

Assorted


Mom had her colonoscopy this morning -- and an endoscopy at the same time -- and the doctor says that everything looks more or less okay, allowing for age and preexisting diverticulosis. He doesn't see anything dire, anyhow, although he did take some biopsies. So this is a huge relief, even though it also means that we don't have an answer about her lack of appetite.

Meanwhile, I told folks at the hospital about the lovely card, and -- although it really is a lovely card -- they're a bit perturbed. No one there would have given out my last name or home address, and we can't figure out how the family got it (especially since my last name was misspelled). So I'm going to write back to the family and ask. Everyone at the hospital said, "Let us know when you find out, please, because if there's a security leak here, we need to know about it."

Knitting-wise, I'm about fourteen inches into a very pretty shawl for myself, and about five inches into a balaclava for myself; that one isn't turning out as well as Gary's did, but it's for me and doesn't need to be perfect, so I'm going ahead with it anyway.

Tasks for today and this weekend:

Write recommendation letters for students.

Start writing my annual performance summary.

Write my Christmas homily.

Work on Faith&Health columns.

Answer ten zillion e-mails.

Wrap Gary's Christmas gifts.

Clean my study, at least to the extent of being able to see the surface of my desk again.

We'll see how much of this actually gets done! But right now, I need to swim.

Wednesday, December 19, 2007

Wow


I just got a lovely and very unexpected Christmas card, from a family I'd spent time with after their husband and father died in the ER.

Our ID badges don't include our last names, so the family had to do some research to get mine (not to mention my address!). Taped into the card was a "card of thanks" from the paper; it specifically mentioned me among the many people who helped them that day.

I'm very moved by this, and also humbled.

I don't keep many Christmas cards, but I'm going to keep this one.

Tuesday, December 18, 2007

Balaclava Field Test


It's chilly and rainy here today. Gary went hiking anyway -- he's hiked in worse weather than we had today -- and when he got home, he reported that he'd worn the balaclava. He says it's warm and comfortable, and that he likes how flexible and adjustable it is.

Yay! It may not be a beautiful garment, but it's a practical one.

How to Make Susan Happy


I just received two Christmas gifts from my sister and brother-in-law.

One's smoked salmon. The other's delicious dark Belgian chocolate.

I am a happy, happy woman. May everyone's holidays be this delectable!

And on that note, off to the gym!

Monday, December 17, 2007

Grand Rounds in Haiku


This week's edition is up, with each post cleverly described with a haiku. I'm very pleased to be included.

Happy reading! Hard to believe that next week's Grand Rounds will fall on Christmas Day!

More Knitgeekery


Although I don't like Lion Brand yarn, they have a fabulous website, including e-cards featuring knitting and crocheting images. This painting is by Vincent Van Gogh.

They also have a section of parody cards: the Mona Lisa knitting, that kind of thing. But I prefer the classics!

One of their images is an ad for a WWI popular song called, "I Wonder Who's Knitting for Me?" I sent that to Gary, to go along with the WWI balaclava. They also have the oldest known portrayal of knitting, at least in the West: the Madonna knitting Christ's seamless garment on four DPNs. I'm going to use that in my Christmas homily. What fun!

In other news, I just booked a flight to go back to Philly for a week in January. These days, I like to visit my parents whenever I can. Best of all, the fare was only $288! And I'm flying through Phoenix -- which, with any luck, means I won't get stuck in blizzards -- with plenty of time to make connections. Nothing's a guarantee of a smooth trip this time of year, but I've done as much as I can.

And I can knit on the flights. Yay!

Sunday, December 16, 2007

Behold the Balaclava!


Here are Darling Hubby and the Balaclava of Doom. This shot gives a nice view of the ribbing, your basic K2P2 version, which is fun to knit and has a good solid feel to it.

I know, it's a pretty dorky looking piece of headgear, but it's going to be warm when Gary's hiking on cold, windy days up on the mountain, and that's the main point. As he says, "The deer won't make fun of me."

And anyway, it may be a dorky piece of headgear, but it's a lovingly handknitted dorky piece of headgear. A lovingly handknitted, dorky piece of headgear with poignant historical significance, since I used the pattern the Red Cross distributed during WWI to civilians knitting for men at the front. And lovingly handknitted historical significance has to count for something, right? Gary has been very complimentary about his balaclava, praising my ambition in tackling something this tricky while I'm still a beginner. I praise his noble disregard of fashion in wearing it, even if only in the company of deer!

And here we have a front shot. I kept trying to get Gary to smile, but he refused. (Maybe he'll smile for the deer?) I think he looks a bit Jedi-esque in this shot. "I am not the hiker you are looking for. Move along. Move along, I tell you, because if you don't stop pointing at my dorky piece of headgear and giggling, I'll have to demonstrate my skill with the light saber."

Here's another side view that shows the main portion of the head covering, the part knit in garter stitch. The balaclava was actually pretty easy to knit, once I figured out how to juggle the doublepointed needles. I like DPN work because it's very portable: small projects are ideal for carting to meetings, coffeehouses, on planes, and so forth.

And here's a shot of the top, on this headform thing Gary cleverly rigged up from various household objects. The top looks really dorky because of those two little raised bits resembling ears. (It's a cat! It's a bat! It's a . . . dorky balaclava!) That happened when I started joining the top to the sides, and I'm not sure how I could have prevented it. I suspect it will go away when the balaclava's been worn for a while.

Now I'm making a smaller one for myself, in lovely crimson wool.

And after that, I'll attempt socks!

A Walk on the Beach


The patient was in our ER for a medical clearance before being admitted to a psych hospital. As I've discussed here before, this process can take a very long time (I gather that's true in other parts of the country, too). The patient and a family member were in one of our less comfortable rooms, the one with dentist's chairs instead of beds. The patient wasn't suicidal, but was sufficiently depressed and anxious to have decided that hospitalization was a good idea.

Being there of your own free will doesn't make the interminable wait more pleasant, though, especially when you can't even lie down. Among other things, psych patients always have all of their personal effects taken away. This doesn't make complete sense to me: while some items, such as nail files, could be used for self-harm, others couldn't. But I guess the rationale is, "better safe than sorry," even when a patient has said, "No, I'm not suicidal."

In this case, the confiscated items included two types of medication. One was an anti-anxiety med.

The ER was a zoo that day. Two other hospitals in town were on closed divert, so we were getting a steady stream of ambulances. This meant that waiting times were even longer than usual.

I'd prayed with the patient, who believed in God but wasn't conventionally religious. I kept stopping back to see how things were going. For a while, the patient and the family member were fine; if anything, the family member seemed more on edge than the patient did. But then I looked into the room and saw the patient's face contorted, as if tears might start pouring at any moment.

"Are you okay? You look really upset."

"I'm just -- I'm really anxious. I think I'm starting to have a panic attack. I really need my anxiety meds. Can you see if there's any way I can get them?"

I checked at the nursing station and was told, "No way!" (The thinking here, I believe, is that the psych hospital is in charge of psych meds, and that the ER staff isn't about to give the patient anything that could be used to OD.) I went back to the room to report this. The family member, very understandably, glared at me and said, "This is ridiculous! They can't do something that's going to help? They want a patient to go into a fullblown attack?"

I tried to find the patient's nurse, who was doing a procedure on another patient. I went back to the nursing station and was told to look for the doctor. I found the doctor, who listened very attentively -- especially considering how busy the department was -- and then said, "Have them put the chart up. I'll check in as soon as I can and see what we need to do."

But more ambulances were coming in, and I had no idea how soon anything was going to happen. So I took a deep breath, went back into the room, and said, "The doctor's going to come in, but in the meantime, let's try to get you calmed down. You've told me how much you love the ocean, and I do too. I want you to close your eyes and imagine that you're walking on the beach."

I've been on the receiving end of plenty of guided meditations, but I'd never guided one myself. I included lots of instructions about slow breathing ("breathe in . . . now out . . . now in . . . now out") interspersed with sensory description. "You can smell the salt air and hear the seagulls, and as you look out at the incoming waves, you know that you're part of God's good creation and that God loves you. You feel the cool water on your feet and the sand between your toes. In the distance, dogs are running into the surf, chasing sticks their owners have thrown for them, and when they've retrieved the sticks, they race back onto the beach and leap for joy. The sunlight is warm on your shoulders."

I'd closed the door to the room, and because the patient had also complained of an oncoming headache, I'd turned the lights off. The hubbub of the department had faded. The only sounds were my voice and the soft rhythm of breathing: the patient's, the relative's, mine. The patient's face had relaxed, and when I described the dogs, I saw a smile.

At the end of the meditation, I said, "How do you feel now?"

The patient, eyes still closed, smiled again and said, "I feel like God's with me."

Score one for guided meditation.

I'll definitely be using this technique again, and I recommend it to anyone who needs a way to calm someone who feels panicky. I'm sure meds are more reliable, but this was a very effective stopgap measure.

When I left the room, the patient was napping, and my shift was over. I wish I knew what happened after that -- unfinished stories are one of the occupational hazards of ER ministry -- but I hope, and trust, that the patient's doing well now.

Friday, December 14, 2007

Buffy-Pup is Growing Up!


Buffy's new mom sent me a set of photos a week or so ago: she's still an adorable puppy, but she's definitely getting much, much bigger!

I wonder if she's going to be one of those dogs who always think they're lapdogs. I imagine that Nancy and Gene will train her better than that, though. Some friends of ours have a beagle (a large beagle) whose idea of bliss is jumping into your lap and thwapping your face with his tail. He's a sweet dog, but the tail's a bit much.

And here's another. What a good puppy!

I still hope she's going to be a therapy dog someday. If I'm ever in the hospital, I definitely want a visit from a Golden Retriever, or some other large dog with floppy ears.

A visit from a cat would be even better, but so many people are allergic that I don't think they're allowed in hospitals. I've never heard of a hospital therapy cat; have you?

Knitting News


The balaclava is finished! I hope to get some photos to post tomorrow or Sunday; we're getting ready for company right now, so Gary's not available to pose.

Also, I've been experimenting with different seating. The ideal knitting chair has excellent back support, but no arms. Knitting on our various couches was making my back unhappy, and dealing with chair arms was making my back unhappy in another way. I solved this by resurrecting an old chair from college: a small folding rocking chair, wooden with a caned seat and back, without arms.

Perfect! It was just what the doctor ordered.

Except that it's twenty-five years old, and the caning on the seat has started to give way. I can still sit in it, but that probably won't last long! So now I have to figure out if it makes more sense to have it recaned -- I'm not even sure where I'd have that done -- or to try to find a new one.

Nertz!

Tuesday, December 11, 2007

Thanks, Library Journal!


Library Journal has included Shelter on its Best of 2007 list. You have to scroll down to get to the SF/F section, but since there are only five books listed, I'm very pleased.

The Necessary Beggar was on the same list for 2005. Have I mentioned lately how much I love librarians?

Monday, December 10, 2007

Dive into Grand Rounds!


This week's edition is up, with a diving theme that makes me homesick for Maui! I'm very happy to be included in this edition.

So head on over and dive on into the best of the medical blogosphere!

Sunday, December 09, 2007

Sensitivity


I was recently informed by an ER patient that I need to take sensitivity training.

The patient was educated, articulate, dignified, and clearly suffering from a mental illness. The mental illness wasn't the presenting complaint, though; a small physical injury was. When I stopped by, as part of my routine rounds, and identified myself as the chaplain, the patient requested prayer, but didn't give me the chance to offer it. Instead, I became the audience for a long, winding, alternately convincing and bizarre narrative about family history, the injustices this person had suffered at the hands of police and paramedics, and the events leading to the ER visit.

The patient wasn't white. This is important.

I sat and listened; that was clearly my job in this situation. When the medical staff entered the room, I left. When I went back in, the patient was ranting to a nurse about how the doctor had been racist. The doctor had called the patient by first name; the patient found this disrespectful.

Trying to help, I said, "That's how we do it here; he'd call any patient by first name. I'm sure he didn't mean to offend you." But the patient was on a roll. The doctor was racist; police were racist; paramedics were racist; the nurses were racist.

The nurse gave me an imploring look and said, "I'll go find the doctor." I followed her out of the room and asked if she wanted me to talk to the doctor too; she said, "No, that's okay. He just has to go back in there and make nice."

I went back into the room. The patient was talking to someone on a cellphone. I left, and wound up in the middle of a cluster of nurses who were muttering about the patient.

"You know, that makes me angry, being called racist."

"It's a symptom of mental illness," I said. "Has to be. Something's wrong there."

Everyone agreed, but the staff was still angry about the accusations. This was all complicated by the fact that the patient had been discharged, but showed no signs of leaving. The doctor had evidently suggested a security escort, which wasn't going to make the patient feel better about anything.

I went back into the room. The patient, off the phone now, had spread a bewildering collection of personal items out on the countertop and was arranging them haphazardly into small piles. Things kept falling onto the floor. "I need to get all of this organized so I can go get my money." I offered to help pick up the things on the floor, but the patient said, "Oh, no, my lawyer's going to fly in and lift all the fingerprints from that. We can't touch it."

"How about if we wear gloves?" I asked, but the patient -- while moving things back and forth on the counter -- said that we had to leave everything where it was. The nurse came back and started explaining discharge instructions.

"You're standing up! You're talking down to me!" the patient said. "You're racist!"

I'd been standing the whole time. "I've been standing; I'm sorry if that bothered you -- "

Whereupon the patient whirled to face me and said, very calmly, "What you need is, what do you call it? Sensitivity training. That's it. You don't know what it's like to be black."

"That's true," I said, "I don't," whereupon the patient treated me to a long lecture about racism.

The nurse left. The patient calmed down. Through the open door, I could see three security guards (two of them white), and my heart sank. But the patient had evidently forgotten about lawyers and fingerprints, and gave me permission to pick up the things on the floor. "Oh, it's fine if you do that. I don't have a problem with you. Have you seen my driver's license? I think the ambulance people stole it."

I was trying to lift a very large plastic bag of personal belongings. Was this well-dressed, well-groomed person homeless? "I can't pick this up," I said.

"Neither can I. I can't lift anything."

So a helpful, smiling security guard stepped in to give us a hand. Perfect! Exit patient, with a helpful, smiling security escort. An audible sigh of relief went up from the nursing station, and the nurses started teasing me. "Hey, Susan, so you need sensitivity training, huh? Yeah, of course you do, because you're so insensitive."

"Well, I've had that training through church, but I guess it didn't take."

"Yeah, you must've flunked."

"Hey!" a tech called. "I found the driver's license! It was on the floor!"

"I'll take it out there," I said.

"No," said the tech, "I'll do it," and did. But a few minutes later he came back, fuming. "So I hand over the driver's license, and then I say, 'You can't smoke in here because it's a hospital,' and what response do I get? 'You're racist!' So I say, 'It has nothing to do with race! You couldn't smoke in here if you were purple or yellow or green!'"

"It's a symptom of mental illness," I said again, weakly.

"Yeah, I know, but it still makes me angry. One of the admitting clerks came up to me when I was out there and said, 'You know, I've been called everything, but being called racist really made me angry!' And I said, 'I know! Me too!'"

Later, I talked to a nurse, who observed ruefully, "When people say things like that, nobody's as nice to them, and then of course they think it's because of racial issues."

"It's a self-fulfilling prophecy," I said.

"Yes, exactly."

Meanwhile, I was frustrated by our complete inability to address the psychiatric issues. This patient lives out of the area and hadn't come in because of psych issues, which made them off-limits. And it would only have made things worse to tell the patient, "No, we aren't racist; you're mentally ill."

I'm sure the patient's encountered genuine racism in the past, and now sees it everywhere. Something -- personal history, the psych issues, a combination -- has left that patient oversensitized to the possibility of prejudice. The medical staff, meanwhile, were reacting far more defensively than they usually do to insults, insisting to me and to each other that they aren't racist. The patient's obsession had sparked some collective psychodrama, some group wrestling with anger and guilt, in the nurses and techs.

And I was in the middle, having very little luck communicating with either side. The patient's accusations didn't worry me, because I really did see them as symptoms; but precisely because I viewed them that way, I had trouble empathizing with the reactions of the medical providers, who were taking this symptom far more personally than they take most others.

Which means, I guess, that I really do need sensitivity training.

Brief Update


I've been meaning to post more, but it hasn't been happening. The last day of classes is tomorrow, but various kinds of committee work -- several involving heavy reading -- continue until the 19th. There's also, of course, grading, and tomorrow's the deadline for applications to my spring fiction workshop, which means that I have a pile of manuscripts to read and weigh. My semester will end late this year!

So what did I do yesterday? Christmas shopping! Most was online; some was at a local art gallery that's nowhere near any malls. (My holiday resolutions include not going near shopping malls until mid-January at the earliest.) The good news is that I'm now done, although I may still pick up a few impulse items for Gary. The bad news is that none of the academic stuff got done yesterday, despite my best intentions. Aaaaargh!

Friday, December 07, 2007

A Worthy Campaign


Lee, who has a pretty good feel for my politics, sent me an e-mail about one of the latest action alerts from the Episcopal Public Policy Network. They're supporting a bipartisan bill called The Second Chance Act to develop reentry programs for prisoners.

I've listened to inmates in the ER talk about how scary and hard it is to get out of prison and have nowhere to go, no one to offer help, no new skills to use to get a job. I have many friends who do prison ministry, and who are very disheartened by the cuts in education programs inside prisons. No wonder so many people go back to their old ways when they're released! This bill could help a lot of them.

EPPN has provided a handy online letter, which you can edit and personalize; EPPN will send it to your elected representatives, urging them to back the bill.

My liberal friends often lament the fact that the Christian Left isn't as politically outspoken as the Christian Right (although I imagine this bill will appeal to at least some people in both camps). This is a good way for the Lefties among us to make ourselves heard. The EPPN website has a lot of information about other causes, too.

Social justice is one of the pillars of authentic faith, Christian or otherwise. Oddly enough, it's also good politics. Who knew?

Wednesday, December 05, 2007

Today's Knitting Discovery


The lowly safety pin makes an excellent stitch marker: you can slide it on and off the needle or open it to insert it between stitches, and when you're not using it as a stitch marker, you can use it for other things. And you can acquire many of these at a time very inexpensively.

Before I discovered the magic of safety pins, I'd been using supermarket twist ties, which work fine too. So why do people spend money on fancy stitch markers?

Katharine said, "Because somebody decided to sell them." Unless I'm missing something (always possible!), this is a fine example of the triumph of marketing over common sense.

Gary's balaclava is coming along: I've finished the ribbed neck portion and, with Katharine's advice on how best to redistribute stitches among needles, have started knitting the back and sides. It may even, fingers crossed, be done for Christmas, although Gary's been following my progress, so it won't be a surprise!

Tuesday, December 04, 2007

Grand Rounds, and Mom


This week's edition of Grand Rounds is up, and I'm delighted to be included. Happy reading!

And in family medical news, my mother's in "hurry up and wait" mode. The gastroenterologist said that her weight loss and lack of appetite could be caused by many things, and she's scheduled for a colonoscopy on December 21. I'm glad this doctor doesn't seem to think the situation's as urgent as her primary-care doctor did, but I'm not thrilled that she has to wait so long to get answers. I asked her if there's any plan for maintaining her weight in the meantime, and she said there isn't.

So we're in a holding pattern, or trying to be.

Sunday, December 02, 2007

Thanks for the tag, Laurie!


Laurie Edwards very kindly tagged me for the "Seven Random Things" meme; since I already participated in this meme back when it was "Eight Random Things," I'll refer you to that post.

Tag, anyone who's reading this. If you haven't already participated in this meme, you're it!

They Won't Be Better Off


One of our local hospitals recently had a tragedy: a man walked up to the ER triage desk, handed the nurse a signed note that said, "I want to be an organ donor," pulled out a gun, and shot himself in the head. He died.

Apparently the victim did not, thank God, threaten anyone else: nor were there children in the area to be traumatized by watching the shooting. But I can't imagine what the triage nurse must be going through. Clearly there wasn't time for anyone to stop the man who died: he was determined. He had a plan and carried it out. Everything happened very quickly. But people who were there -- especially the nurse -- must keep seeing the incident over and over, replaying like a film behind their eyes. They must be haunted by it.

I wonder if they'll ever not be haunted by it, even though they didn't know the suicide victim. And those who did know him, his family and friends, will surely struggle for years, if not decades, with his death.

My paternal grandfather killed himself before I was born. The family doesn't talk about it much, but the impact on all of us -- even those who never knew him -- is still profound. There have been other suicides in and around our circle. A good friend of my father's jumped out a high window when I was a little girl; Dad's second wife was a widow whose first husband shot himself. I barely knew my father's friend and didn't know my stepmother's first husband at all, but their deaths still chill me.

Others hit closer to home. In 1987, a brilliant and charming young coworker at one of my temp jobs in New York orchestrated an elaborate final journey that culminated in his shooting himself in the head at the base of Mount Denali in Alaska. In 1988, one of my college roommates -- an even more brilliant medical student -- jumped out of her apartment window. I still think about Joel and Sumi at least once a week; during my own dark times, I think about them every day.

Although I suffer from depression, I've never been actively suicidal, partly because I'm keenly aware of how many people would suffer, would grieve and rage, if I killed myself. When I find myself flirting with the idea, I draw up a list of those people, stopping at twenty-five or thirty, but knowing there are really many more. I'm quite certain that neither Joel nor Sumi would have put me on any such list; nonetheless, the sorrow of their deaths has never left me. I think about them, and I think about their families, and I think about the people -- construction workers, in Sumi's case -- put into the horrible position of finding their bodies, of having those images burned into their brains.

The week after I heard about the hospital suicide, I visited a suicidal patient during my own hospital shift. The patient told me, "I wanted to kill myself so I'd stop hurting my family."

Usually I deal well with suicidal patients; I'm compassionate to them, and I'm pretty good at getting them to open up. But with this patient, I did all the wrong things. Those words pressed a nerve, one that was rawer than I knew, and I found myself lecturing. "Killing yourself would hurt your family much more than anything else you've done! If you want to stop hurting them, please stay alive and find ways to make amends!"

The patient withdrew, no doubt put off by the heat of my words. The terrible ill-logic of depression -- "they'd be better off without me" -- is a symptom of illness, not a rational thought process. Arguing with someone in that state doesn't help. It's like arguing with the wind. I knew that.

I knew that. This patient needs medication and psychotherapy, not a hectoring chaplain. I handled the visit badly, and realized afterwards that the words came out with such force because, for years now, I've wished I could have said them to my grandfather, to my father's friend and my stepmother's first husband, to Joel and Sumi.

The holidays are hard on people; Joel killed himself during this time of year. And so, even though it may do no good, this is my message to anyone struggling with such profound despair that death seems preferable, such great pain that it seems as if everyone in the vicinity will be better off if you're no longer alive:

The people who love you won't be better off. The people who hate you won't be better off. Casual acquaintances, co-workers, and the strangers who have to deal with your remains will not be better off.

Please don't kill yourself. Please call someone and ask for help instead, even if you think nothing can ease the pain. Give hope a chance. Read this page from the Mayo Clinic. Call a friend. Call 911.

Please choose life.

Saturday, December 01, 2007

Mythies Rule!


Last night, I was the guest at a meeting of Crickhollow, the Reno chapter of the Mythopoeic Society. They were discussing my novel The Necessary Beggar and thought it would be fun to have the author on hand.

Each meeting starts with a potlock dinner, with foods based on the book they've read. So the carrot above (which I got to take home with me) represented the carrot taken away from Macsofo in the refugee camp. Someone brought a roast chicken, because the family in the book is put off by the belief of some Christians that the damned "roast like chickens;" since the family's culture has Middle Eastern elements, someone else brought pita bread stuffed with lamb and herbs.

The hostess made Gandiffrian Chicken Stew, described on this card (which I also got to take home with me). Someone brought a Blue Moon pizza, since Zamatryna and Jerry eat there. Another treat was venison salami, donated by a hunting family who'd finally gotten a deer after many years of trying. They'd written a card thanking the deer for its bounty, in accordance with the family's beliefs, and the entire buffet table was decorated in a Thanksgiving theme.

And -- I couldn't believe this, but I was delighted! -- someone had actually made jello with chicken and broccoli, the unappetizing casserole given to the family in the camp after Darroti dies. Unfortunately, this dish suffered a mishap in the car on the way to the meeting, so we didn't get to see it, but I made the cook promise that if she made it again, she'd send me a photo. I asked her if she'd actually have been willing to eat the concoction, and she admitted that she'd made up a card for it that read, "For Display Purposes Only."

Anyway, it was a fabulous meal, and the discussion was great, too: lots of thoughtful comments and smart questions. Nobody in the room thought Jerry was a dumb jock -- I never intended him to be, but many readers have taken him that way -- although one person had developed an abiding, unshakable dislike of Stan because of his religious beliefs, even though he changes at the end of the book. But hey, that's like life, right?

It's such a pleasure to talk about one's work with engaged readers!