The Harrowing of Hell

Here's my homily for the Great Vigil this evening. I'd started doing something completely different, and discovered last night that it wasn't working, so this version got written in a rush this morning. To my immense relief, Gary loves it, although he's not even remotely religious.

The Great Vigil is absolutely gorgeous, the most beautiful and mysterious service of the year, as far as I'm concerned. If you've never been to one, I can't recommend it highly enough.

Part of my writer's block on this was the fact that a few years ago, I preached a homily at the Great Vigil that had much of the congregation in tears, and I was trying to hold myself to that standard -- and freezing up, of course. I'll probably post that older homily tomorrow, just for the sake of completeness.

The Gospel is Luke 24:1-10, not that it particularly matters in this case.

May all of you have a blessed Easter!

*

On this, the most beautiful and terrifying night of the church year, we have come together with all who witness Christ’s resurrection. Like the women at the tomb, we tremble at what we do not understand, but find ourselves comforted. Like the apostles who scattered after Jesus’ arrest, we flee from God in our moments of hopelessness, but find ourselves greeted by the risen Christ, who breaks bread with us and claims us as his own. Like the two messengers in their dazzling garments, we find ourselves charged with the task of proclaiming to the world that Christ is risen, even when those to whom we speak run from us.

For on this most blessed of nights, there is nowhere we can run and not encounter God. The tomb is empty, but Christ has risen from even deeper depths. The Easter Vigil is the church’s most ancient liturgy, and tonight we bow before the mystery of one of its most ancient doctrines: that when he died, Christ descended to hell and freed the souls imprisoned there.

The Harrowing of Hell was a favorite theme of medieval art and drama, and surely we can see why. In contrast to the scandal of the cross, where Jesus refused to save himself, the Harrowing of Hell gives us an energetic savior: Jesus as superhero in the greatest prison-break drama ever written. If Mel Gibson turned this story into a film, Jesus would surely be played by Daniel Craig or Vin Diesel. There would be thundering music and lots of special effects. Things would blow up, and Jesus, muscles bulging under his spandex superhero costume, would emerge in a blaze of light, triumphantly leading a train of former captives.

And what would Hell look like, in this movie? Some sort of industrial wasteland, most likely, the air blighted by smokestacks belching toxic fumes, the ground pocked by bubbling pools of green sewage. Think of Mordor in Peter Jackson’s film version of The Lord of the Rings. Think of Chernobyl. Think of the grimmer stretches of the New Jersey Turnpike. If you’ve read Dante’s Inferno, you know that the tradition of Hell as environmental supersite is very old, although not as old as the tradition of Christ’s descent into Hell. Dante, among other people, locates Hell elsewhere: somewhere we have to travel to reach, somewhere we fervently pray we will never see. None of us would willingly go there for a visit, much less to live, but luckily, we can avoid this place if we love God and follow Christ, as we are commanded to do.

But if discipleship means following Christ, aren’t we also called to follow him into Hell, to free the captives there? If so, how do we go about booking our tickets to this least appealing of tourist destinations?

The medieval world located Hell Elsewhere. But against Dante’s view, we can set Milton’s. In Paradise Lost, Satan escapes from the geographical confines of Hell, only to discover, in one of his most famous speeches, that he has not really escaped at all: “Why, this is hell, nor am I out of it.” The line quotes Marlowe’s Dr. Faustus; more indirectly, it echoes the Gospel. “The Kingdom of God is within you,” Jesus says. Surely Hell is within us as well.

All of us have spent time there. Hell is the place where we are loneliest, most hurt, most hopeless. Hell is the place from which we cannot even imagine being rescued, because we cannot imagine anyone wanting, or being able, to reach us. Hell is the place where our fear overwhelms our faith, where our pain overwhelms our praise, where the darkness overwhelms the light, seemingly forever. Jesus harrows this hell, too, today and every day, although he rarely resembles a superhero in spandex. Hell is where we feel farthest from God, but there is nowhere God cannot reach. Christ is everywhere.

Many of us have times of the year, often coinciding with painful anniversaries, that are particularly hellish. For many years, the weeks surrounding the spring equinox were a time like that for me. This was when I was most tired and least resilient, when pain struck out of nowhere: scathing hate mail from people I had considered close friends, the agonizing and guilt-inducing death of beloved pets, humiliating episodes at work where I found myself being publically upbraided for things I hadn’t known I was doing wrong. Friends and family pooh-poohed my increasing dread of the spring equinox, dismissing it as superstition or self-fulfilling prophecy. But nothing I did, or didn’t do, succeeded in breaking the pattern.

I started doing research. I learned that in many cultures and faith traditions, the spring equinox corresponds to a descent into the underworld. For Christians, this is the Harrowing of Hell. The fact that the pattern was so universal offered some comfort; I had company. And if I descended into hell every year, at least I always came back up.

Last year, my friend Katharine DeBoer -- whose beautiful voice has blessed our service here tonight -- invited my husband and me to go to Maui with her over spring break in late March. When I told Katharine that I was nervous about the trip because of my long-standing history of awful things happening that week, she assured me that bad luck can’t travel across water.

My research had uncovered Carl Jung’s fascination with the archetypal descent to the underworld, which he calls the night-sea journey. One of the stories that illustrates this archetype, prefiguring Christ’s harrowing of hell, is Jonah’s journey in the belly of the whale. In March, Maui is home to humpback whales who travel there to breed and bear their young.

We went on a whale watch. We had seen a few fins and a few blows
-- definite whale sightings, but not dramatic ones -- when suddenly a tail fifteen feet across came out of the water right in front of us, and then vanished again. Everyone gasped. Our guides explained that the tail appears that way when the whale is diving, descending to the depths.

Back on dry land, I looked for some way to remind myself of that awe-inspiring sight. In a bead store, I found two silver whale-tail charms, which I had made into the earrings I’m wearing tonight. After I had bought the charms, I discovered that on the back of each was etched a tiny cross: a reminder that there is no depth so deep that Christ cannot reach us there.

And that made me remember all the people who had comforted me during my spring crises: friends who told me they loved me when I felt most rejected, veterinarians who sent beautiful hand-written condolence notes, students who assured me of the value of my work. These people stretched out their hands to pull me back into the light. They were Christ for me.

In a fourth-century sermon that is still read in Eastern Orthodox churches every Easter, St. John Chrysostom describes Christ’s harrowing of Hell: “Hell grasped a corpse, and met God. Hell seized earth, and encountered heaven. Hell took what it saw, and was overcome by what it could not see.” I could not see, until I thought to look, that I had risen from hell not through my own power, but through God’s grace, through Christ’s redeeming love.

Christ is everywhere and in everyone, even people who are not wearing spandex. This Easter, let us remember the personal hells that Christ has harrowed, the darknesses from which he has freed us. Let us, following him, bring the light of Christ -- the Morning Star who knows no setting -- to those in other hells: to prisons and hospitals, to homeless shelters and halfway houses, to war zones and our own seemingly peaceful neighborhoods. Let us proclaim, in everything we do and say, the triumph of love and the joyousness of empty tombs.

Alleluia! Christ is risen!

How To Kill God

I preached this homily on Good Friday two years ago. The Gospel is John 18:1-19:42.

One fact in this homily is outdated. I'm delighted to report that, according to the 2007 Suicide in Nevada Fact Sheet, Nevada no longer has the nation's highest suicide rate. In 2004, the most recent year for which statistics are available from the CDC, Alaska was first. Nevada was second.

Go, us.

*

The Gospel we just heard, the Passion narrative, tells the all-too-familiar story of Jesus’ trial and execution. Christians spend much of Lent meditating on Jesus’ Way of the Cross, the sufferings leading to his death. Here at St. Stephen’s, we begin our Lenten Wednesday-night potlucks with the ancient tradition of walking the Stations of the Cross, offering prayers in front of each of the fourteen icons depicting Jesus’ journey to Golgotha. You can see those icons on the walls around the sanctuary. They were a familiar fixture in Episcopal and Catholic churches long before Mel Gibson translated the Stations of the Cross into glorious technicolor.

When we walk the Way of the Cross, we imagine ourselves in Jesus’ place. We imagine ourselves being condemned, carrying our crosses, falling under our burdens. But on Good Friday, we are called to do something else. On Good Friday, we are called to reflect on our roles, not as the tormented Christ, but as his killers: the people who wash their hands of responsibility, who deny their Lord, who cry out, “Crucify him!” Those who play that part make a journey, too. It is far easier than Jesus’ journey; it requires far less effort. This journey asks of us primarily that we do nothing in the face of injustice, that we look away from whomever we define as “the least of these.” For each Station of the Cross, there is a corresponding Station of Complacency. On this day when Christ died, all of us are called to acknowledge -- and own -- these stops on the journey, this instruction manual for how to kill God.

First Station: Jesus is Condemned. It’s not hard to condemn Christ. All we have to do is demonize anyone we don’t understand: conservative or liberal, rich or poor, bureaucrat or activist, hawk or dove, straight or gay. We assume the worst about this person’s motives. We stop seeing this person as an individual, as a unique child of God, and see instead one of them, those people, the ones who are determined to destroy us and everything we stand for.

Second Station: Jesus Carries His Cross. We force the condemned person to carry a burden we would never accept ourselves: the blame for our own fear and anger, or responsibility for her or his own suffering. For instance, we may insist that poor people stay poor because they just don’t want to work, even if low-wage jobs in our area will not cover local housing costs.

Third Station: Jesus Falls For the First Time. We wait for the person on whom we have laid this burden to crack under the pressure, and then use this event as further evidence of unworthiness. For instance, if a poor youngster in an inner-city ghetto -- or, alternatively, a rich youngster at a fancy boarding school -- begins selling drugs, we tell ourselves that all poor people are criminals, or that all rich people are corrupt, or, at least, that this particular individual is fatally flawed. We deny the possibility of change or redemption.

Fourth Station: Jesus Meets His Mother. We forget that when anyone suffers, that person’s family suffers too, and that even the worst among us have mothers who love us. We support some mothers and ignore others. For instance, in debates about capital punishment, we emphasize how much the mothers of murder victims suffer, but overlook the pain of mothers whose children are executed by the state -- or vice versa. In wartime, we grieve with the mothers of our own fallen soldiers, but not with the mothers of the enemy -- or vice versa.

Fifth Station: Simon Helps Jesus Carry His Cross. We delegate compassion and good works to other people: clergy, charities, the Peace Corps. We admire them from a distance while feeling mingled pity and contempt for their doomed idealism. We canonize them, give them awards, and write them checks, but do not on any account get our own hands dirty.

Sixth Station: Jesus Meets Veronica. This station grew out of a medieval French legend that an anonymous woman stepped forward and wiped Jesus’ bloody face with a cloth. Veronica completes the trinity of those who care for the outcast and rejected: mothers, idealistic do-gooders, and anonymous servants. Therefore, if mothers and Peace Corps volunteers are not available, we assure ourselves that other people will offer comfort, even if those others are mired in their own poverty, overwork, and stigma. Nursing home aides function well here. So do corrections officers, drug counselors, and social workers.

Seventh Station: Jesus Falls For the Second Time. We condemn as weak, lazy and ungrateful those who stumble even after they have received help. We tell ourselves that if those people can’t improve themselves with the help of their mothers, their social workers, and the Peace Corps, they’re clearly a lost cause. We deny the possibility of change or redemption.

Eighth Station: Jesus Meets the Women of Jerusalem. According to theologian Henri Nouwen, the weeping women Jesus met were professional mourners, paid to grieve loudly for him while ignoring the grim plight of Jerusalem and of their own children. Continuing this tradition today, we support the sentimental exploitation of personal and social tragedy by the news media. At the same time, we dismiss efforts to address the root causes of such tragedy, especially when those efforts threaten our own privilege. For instance, we cry at human-interest stories about literacy volunteers, but vote against school bonds that would raise our own taxes.

Ninth Station: Jesus Falls For the Third Time. We support “three strikes and you’re out” laws. We deny the possibility of change or redemption.

Tenth Station: Jesus is Stripped. We take away any last recourse of those who are already defeated. For instance, we limit the ability of people who are financially overwhelmed by medical expenses to declare bankruptcy. If the sufferers are wealthy and famous, we use the news media to hound and harass them, robbing them of privacy and dignity.

Eleventh Station: Jesus is Nailed to the Cross. This one sounds inescapably barbaric, but we don’t hammer the nails ourselves. We vote for people who will do it for us. We acquiesce to unjust and life-denying corporate, governmental and religious policies: reduction of health benefits, wars of opportunity, denial of civil rights. We rationalize. We tell ourselves that we’re just following orders, or that we’re just doing our jobs, or that saving people’s lives is somebody else’s job: their mothers’, or their social workers’, or the Peace Corps’ -- or God’s.

Twelfth Station: Jesus Dies on the Cross. We refuse to mourn for “those people.” We insist that trouble-makers get what they deserve. We rejoice at the deaths of enemy combatants and criminals executed by the state. We tell ourselves that if they die, fewer of us will have to die. We tell ourselves that if these deaths were not God’s will, God would have prevented them.

Thirteenth Station: Jesus is Taken From the Cross. We allow unjust and preventable deaths to remain invisible. We do not question or protest the casualty count, on either side, in wartime. We do not question why the violent deaths of affluent people are front-page news, while the violent deaths of the indigent go unmentioned. Those of us living in the state with the highest suicide rate in the country -- that would be Nevada -- do everything we can to forget this fact, instead of asking why such deaths happen and how they can be prevented.

Fourteenth Station: Jesus is Laid in the Grave. We favor “final solutions” that cannot be escaped or undone without a miracle, and that deny the possibility of change or redemption: for instance, capital punishment or permanent deportation. We tell ourselves that once “those people” are done away with, they’ll be gone for good, because God doesn’t grant miracles to the likes of them. Then we go home and get a good night’s sleep. The body has been laid in the tomb. The tomb has been sealed with a stone. It is finished. What else could possibly happen?

Are there any of us who have not walked the Way of Complacency? Naming these stations, I see myself in too many of them. Where I see myself, I am called to practice both repentance and compassion. Where I do not see myself, I must try to avoid the danger of demonizing other people, the sin of self-righteousness. The Stations of Complacency take many more forms than I have outlined here. No doubt I am most blind to the ones where I have lingered the longest. No doubt all of you can provide many other examples and definitions.

The lesson of Good Friday is that we are all guilty; we have all done something to help kill God. But the lesson is also that we are all forgiven. In one of his last utterances on earth, Jesus begged, “Forgive them, Father, for they know not what they do.”

And so Good Friday leaves us with a question. Once we do know what we do, once we have learned to recognize the Way of Complacency -- what will we do about it?

Broken, Blessed, Redeemed

Before I forget, this week's Change of Shift is up over at Emergiblog. Thanks for including me, Kim!

This is one of my oldest homilies -- I preached it on Maundy Thursday, 2002 -- but it's still one of my favorites. I arrived at this version of eucharistic theology after a friend of mine died of an asthma attack at the age of twenty-five; her younger sister, her only surviving relative, donated her organs to try to spare others the pain of loss. "This is my body," indeed.

I don't, unfortunately, have a photo of the St. Stephen's altar, but it's beautiful, even if you don't know the story behind it. Mary Graves Dunn left behind a one-year-old boy, who, in the course of time, grew up and got married: his wife is one of our parish priests. Whenever she celebrates the Eucharist, I think about the powerful family history embodied in, and at, the altar.

The Gospel is Luke 22:14-30.

* * *

“Then he took a loaf of bread, and when he had given thanks, he broke it and gave it to them, saying, ‘This is my body, which is given for you. Do this in remembrance of me.’” These words, the Institution of the Last Supper, are the source of the eucharistic prayer we hear every Sunday. The eucharist carefully follows that same four-fold pattern: the priest takes the bread, blesses it, breaks it, and gives it to the congregation.

Take, bless, break, give. The more you think about that pattern, the stranger it becomes. Why would you bless something, only to break it? Why would you give as a gift something that was broken? Most of us don’t want broken presents. If something’s broken, we throw it away. It becomes garbage. [lift Hefty trash bag, containing an object the congregation can’t see yet] And the more beautiful the gift was in the first place, the more distressed we are if it’s been broken by the time it reaches us.

Many years ago, a dear friend of mine, who lived thousands of miles away, sent me a beautiful glass vase as a birthday gift. I opened the box, saw the exquisite hand-blown glass, and was delighted -- only to realize, when I lifted my new treasure out of its packaging, that it had broken in transit. My friend had carefully chosen the gift for me; she’d blessed it and sent it into the world, where it broke. I mourned the fact that the vase wasn’t whole any more, and I regretfully threw it away. But how would I have felt if my friend had deliberately broken the vase before sending it to me? How would I have felt if she’d chosen the lovely object, blessed it, smashed it, and put it into a gift-wrapped box?

Well, I probably would have thought she was crazy, or else that she hated me. Sane people -- at least outside the church -- don’t bless things and then break them. People who love you don’t give you garbage as a gift. That simply isn’t done. It’s not the way of the world.

I remember the way of the world, very forcefully, whenever I go hiking on Peavine. If any of you have been up there, you know that -- along with lovely scenery and wildlife, and lots of fresh air – the mountain is home to garbage. [Heft Hefty bag.] A lot of garbage. A lot of large garbage: cars and trucks, refrigerators, washing machines, television sets. People haul that stuff up onto the mountain and dump it, and then they use it for target practice. Most of those former major appliances have so many holes in them that you can hardly tell what they used to be.

I’d gotten used to the cars and washing machines. And then one day my husband found this. [Lift ruined head of bass fiddle out of the Hefty bag] This is the head of a bass fiddle. Its body, kicked and caved in and shot to pieces, was lying several yards away from this smaller piece, which my husband brought home. We looked at it and scratched our heads. Maybe somebody got really frustrated with music lessons? Maybe somebody’s auditions didn’t go well? There’s a story here, that’s for sure, but we’ll never know what it is.

What we do know, what we can tell just by looking at this ruined object, is that whoever broke it didn’t bless it first. The pattern here isn’t take, bless, break, give. The pattern here is take, curse, break, throw away. That’s the way of the world, especially here in America, with its malls and consumer culture. The way of the world is so familiar to us that often we hardly see it anymore, hardly comment on it. It can take something as startling as an assassinated bass fiddle on Peavine -- or as shattering as the ruins left behind by a suicide bomber -- to make us wonder if there isn’t some other way, some better way.

Whoever built this instrument loved it. It was designed to be beautiful and to create beauty; it was designed to be part of a whole, part of a band or an orchestra. And then it fell into the clutches of someone who hated it, who cursed it and broke it and discarded it. Look at the splintered wood. Look at the holes gouged into the neck. That much damage didn’t happen by accident. It was deliberate. It was planned. And it took a lot of force. [drop bass fiddle back into Hefty bag -- thunk -- put bag on floor]

We’re here on the eve of the darkest day in the Christian calendar, the day when the most beautiful thing in the world will be broken, nailed to a piece of wood, and discarded on a hillside. That horror was already planned, already inevitable, when Jesus said that first eucharistic prayer, and he knew it. He was trying to tell his disciples, too, but I wonder how much they allowed themselves to hear. “This is my body, given for you.” Did any of them except Judas grasp how literal that phrase was about to become? Did they truly realize that the crisis was only hours away, or did they think that Jesus was just using metaphors again, speaking in parables?

Much later, after the wonder and terror of the resurrection, the disciples will understand what he was saying. Later, they’ll realize that he was already trying to comfort them. My body will be broken, but it will be a gift, too, the best gift you’ve ever gotten, the gift that brings new life: just wait and see. They can’t possibly understand that yet, on Maundy Thursday. And they won’t be able to understand it on Good Friday, when all they’ll know, all they’ll be able to see or smell or taste, is their grief.

We understand it now, don’t we? We listen to the words every Sunday: take, bless, break, give. Of course we know what they mean: we’ve had almost two thousand years to think about them. Well, I’m not so sure. If we really knew what they meant, I think there might be less garbage on Peavine. If we really knew what they meant, I think there’d be more people like Kate McDermott and Jon Rowley, who got married last summer, and who asked for such an unusual wedding gift that it got written up in The New Yorker.

Kate and Jon are gardeners. To celebrate their marriage, they asked their friends to send them garbage. People sent them coffee grounds, banana peels, dryer lint, pulp from juice bars, and a box of buffalo poo, among other things. Kate and Jon, who have both been married before, used these unlikely gifts as compost to help nourish a wedding rose bush. “We are recycled ourselves,” Kate says. “We’re taking all the life experience that most people discard and turning it into something bountiful and full of life.” (Molly O’Neill, “Bridal Registry: Will You Mulch Me?” The New Yorker, August 13, 2001, 26.)

Clearly, these are Easter people: they know about resurrection, about broken things producing new life. They know that redemption is, both simply and profoundly, God’s way of recycling, of saying that nothing has to be garbage, that nothing needs to go to waste, that not a sparrow falls but is counted. But how do you make sense of all that when it’s not even Good Friday yet? What do you do when you’re heading into the darkest time you’ve ever known, or already in the middle of it? What do you do when you feel broken yourself?

I’ve come to believe that the eucharistic prayer is not just a pattern, but a promise. I think it’s God’s way of reminding us that when we feel broken, we can be gifts. I think it’s God’s assurance that if we feel broken, we’ve already been blessed, instead of cursed. We can only feel broken when we have first been whole; we grieve most deeply the loss of what has given us the greatest joy. The hard part, our work as Christians, is to remember the prior blessing and to reach for the future gift. Our work as Christians is to find loving alternatives to the cursing, discarding, despairing way of the world. Our work as Christians is to be co-redeemers with God.

This sanctuary contains a poignant reminder of that work. On Christmas Eve, 1934, a young woman was killed in Berkeley, California when her bicycle brakes failed on a steep hill. Her father, Frederick Graves, was the vicar of St. Stephen’s. He must have felt broken beyond all reckoning; what parent wouldn’t? But if his grief included cursing and despair, we have no record of it. What we have instead is the altar he carved as a memorial, on which he inscribed the words, “Erected to the glory of God in gratitude for the joyous life of Mary Graves Dunn.” In his pain and brokenness, Frederick Graves remembered the blessing of his daughter’s life, and he turned his family’s grief into a gift. Our eucharistic table is itself a kind of eucharist.

“Do this in remembrance of me.” When you listen to the eucharistic prayer this evening, think about the gifts that you, too, have created out of grief and darkness. Only you know what they are. But whatever they are, they are a true remembrance of Christ the Redeemer, whose will it is that nothing go to waste.

Amen.

Today's Discussion Question

My post about using simulated disabilities to increase empathy has, to my considerable surprise, gotten quite a few comments from people saying that these are specious exercises, and that compassion's better than empathy.

Part of the argument seems to be that empathy exercises may lead people to believe that they understand something they really don't. Well, sure: but having your own episode of any given illness or injury could have the same effect. ("I know just what you're going through, because I broke my leg once too!") My take on the subject is that even with the best will and imagination in the world, we learn things through direct physical experience that we couldn't learn other ways. However, I seem to have been outvoted on this.

By the way, I'm defining empathy as understanding gained through shared experience, and compassion as a more generalized desire to ease suffering. If someone else is defining these terms differently, please let me know.

But even if we accept the premise that compassion is better than empathy -- and I'm not sure the two can be separated so neatly -- we're still left with the question of how to make people more compassionate; and, specifically, how to overcome barriers to compassion.

In my volunteer work in the ER, I've seen plenty of medical caregivers who are very compassionate towards patients with some problems (stroke, heart attack, broken legs) but decidedly compassion-challenged towards patients with other problems (substance abuse, psychiatric issues, life complications from poverty). These caregivers aren't bad people or unskilled providers, but their compassion was either limited to begin with or has become limited through exhaustion: compassion fatigue is a real and pressing issue. The limits of compassion often seem to fall along class lines, which brings us back to empathy. It's often easier to feel compassion for people who are like us, because we identify with them.

So how do we instill compassion for the person who isn't like us: for the stranger, the other, the outcast? More specifically, how do we do that in a nursing school, medical school, or clinical setting where people are very busy, may have no time or inclination to immerse themselves in the humanities ("No, really, you'll have much more compassion for transgendered people if you go watch Boys Don't Cry"), and are struggling to master difficult technical and physical skills?

Grand Rounds

This week's edition is up over at Urostream, hosted by urologist Keagirl. Thanks for including me!

How to End the Nursing Shortage

Within the past week, I've heard two nurses deliver impassioned tirades about why the field's so difficult (and understaffed). I know these nurses in different contexts: one at the hospital, one in the classroom. They're different ages and have different backgrounds, and between the two of them, they've done just about every kind of nursing. While two people isn't a statistically reliable sample, these factors suggest that their complaints are largely true across the board.

Both of them report that nurses get abused by everybody: by patients, other nurses, and doctors. The abuse ranges from the verbal (being called stupid or cursed at) to the physical (having excrement thrown at you). Add that to the sheer physical demands of the job, especially in trauma/ED, and you have a surefire recipe for burnout. One of the nurses said, "You go into this because you want to make a difference in people's lives, but most of the time, you don't -- or you don't feel like you do. You just get put down."

Both of these nurses are extremely kind, articulate, intelligent people, and I was shocked to hear how consistently they'd felt belittled. In my two and a half years volunteering in the ED, I've certainly seen bad patient behavior, but I've heard more patients praising their nurses, and I've never seen a doctor insult a nurse. One of the nurses delivered this tirade in front of the nursing station and next to a doctor, which suggests that she was comfortable with at least that set of colleagues. Still, the bitterness in her voice was unmistakable.

“So why do you do it?” I asked her. “Why stay in the field?” (The other nurse has left the field.)

To explain why she stays, she told me two stories. One was about helping to resuscitate a toddler: the child had been brought in blue after having drowned, and left the hospital pink and yelling, to everyone’s joy. “That’s the best feeling in the world.” A few days later, the mother brought the child back to the hospital to thank the medical team, and they all cried.

The second story was about helping the family of a dying patient: respecting their wishes and telling them they were doing the right thing; caring for several of them in the patient’s room when they became ill themselves, so they wouldn’t have to leave the patient’s side; allowing them to stay in the room as long as they needed to after the patient died. “I didn’t do anything special; I just did what I’d do for anyone, what I’d want myself in that situation.” But the family wrote a letter to the hospital praising the nurse’s care, saying how wonderful she’d been. “Whenever I have a bad day at work, I go home and reread that letter, and think, ‘Okay, this is why I do this.’”

I’ve always made a point of thanking the nurses who’ve cared for me, and when I hear a patient praise a particular nurse, I try to tell the nurse about it. To me, these actions are routine common courtesy; until last night, I didn’t realize just how important they are.

If you want to help end the nursing shortage, say “thank you” to a nurse. Better yet, write a letter your nurse can read after a tough day.

And whatever you do, don’t throw excrement.

Welcome to Holy Week

So it’s Palm Sunday. Does anyone else consider April 1 an unnervingly appropriate date for this? “Welcome to Jerusalem, Jesus! We love you! You’re our hero! Ooops -- just kidding! We have to kill you now, okay?”

My parish has a gorgeous set of Holy Week services: Maundy Thursday foot-washing and agape meal, a three-hour Good Friday service from noon to three, and a stunningly beautiful Great Vigil on Saturday night (at which I’ll be preaching this year). These services get fairly dismal attendance, but we diehards always wind up not caring, because the liturgies are so moving that it doesn’t matter how many other people are there.

After the intensity and intimacy of Holy Week, Easter Sunday morning’s always a shock, with hordes of strangers we never see -- or see only at Christmas -- crowding the sanctuary. I’ve come to actively dislike this service, which makes me feel as if my living room has been turned into Grand Central Station, and so I’ve decided that this year, I won’t go.

(Here’s a joke:

(Three churches are overrun with squirrels. The Baptists put out poison, but the squirrels avoid it and keep infesting the church. The Methodists put out traps, but the squirrels avoid them and keep infesting the church. But the Episcopalians have a brilliant idea: they baptize the squirrels, who then come back to church only on Christmas and Easter.

(Gary and I now call Easter Sunday “squirrel Sunday.”)

The Great Vigil is the first Easter service: that’s my Easter. On Sunday morning, I’ll go to the gym and then go to dinner at our friend Katharine’s house. She’s the friend we go to Maui with; although she doesn’t go to my church, she’ll be singing at the Vigil -- she’s a world-class soprano who often gets asked to perform at area churches -- so she’ll have shared Easter with me.

Meanwhile, Palm Sunday’s supposed to be a celebration of Jesus’ triumphal entry into Jerusalem. But, probably because it’s so hard to get people to come to Holy Week services, most churches, including ours, have fallen into the habit of moving straight from the Procession of Palms into the Passion. Otherwise, Sunday-only parishioners will have gone from the triumphal entry straight to Easter, with none of the dark stuff in the middle. And without the darkness, you can’t appreciate the light.

For a few years now, my parish has been emphasizing the celebratory nature of Palm Sunday and not doing the Passion, telling people that to get the full effect of Easter, they have to come to Holy Week services. This hasn’t worked very well, so I suspect that after this year, we’ll go back to the emotional-whiplash model (celebration! crucifixion!) that everybody else uses. That way, people who come both Sundays will at least have had the Passion narrative, although the Christmas-and-Easter squirrels will have gone straight from incarnation to resurrection, with none of that messy stuff in the middle. Quite the trick, that.

And if Holy Week gets scant attendance at church, the rest of the world is even less aware of it. For many people, of course, this week is Spring Break, which makes it easier to celebrate both Holy Week and Passover, but most people seem to view it purely as vacation. For several years, I regularly gave a paper at the Popular Culture Association Conference, but it’s always scheduled during Holy Week/Passover, because so many academics have the week off. This is more than a little awkward for observant Christians and Jews. I once met a Jewish academic at the conference who brought her entire family along so they could honor the holiday. Needless to say, that gets expensive.

When I started attending PCA, I hadn’t begun going to church yet. But once I had, the conflict between the two became increasingly painful, culminating with the year the conference was in Philadelphia, where my parents and sister live. I love my family, but they consider my conversion baffling (at best), which can create tension. I told them that I wanted to try to get local Holy Week services, but this led only to hilarity -- “She wants to go to church to get her feet washed! She can’t do that here! Ha ha!” -- and to inconvenience. Service times kept getting in the way of other things my family wanted to do, and they considered the Holy Week project so bizarre and ridiculous that I just didn’t go. I gave my conference paper, on science fiction as conversion narrative, on Good Friday . . . and at that point, the cognitive dissonance became so great that I decided that I wasn’t going to PCA anymore. I wanted to be able to spend Holy Week with my faith community.

Conflicts still pop up, though. Several years ago, one of our grad students, who was a Lutheran pastor, fumed to me that a going-away party for someone in the department had been scheduled for Good Friday. “Don’t they know that some people will be in church then?” Evidently the department administration at the time didn’t know that, and the event stayed where it was. This year, my department chair scheduled a faculty meeting for 1:00 on Good Friday; when I e-mailed her to explain that I wouldn’t be there because it was a religious holiday for me -- and maybe for other people too -- she very obligingly changed the date of the meeting to the following Friday (which is, of course, Friday the 13th). I hadn’t expected that -- I’d thought I’d have to give someone my proxy -- and I was extremely grateful.

Meanwhile, a friend from back East will be in town this week, and we’d arranged to have dinner with him on Wednesday and go to a concert with him on Thursday; even I’d forgotten that it was Holy Week! Last night, with a jolt, I remembered, and told Gary that I wouldn’t be able to go to the Thursday concert, because I had to go to church. He accepted that, but I don’t think he was happy.

For me, Holy Week is the culmination of the liturgical year, the point around which everything revolves. It’s the heart of my faith. But I’m living in a culture where Holy Week seems to be viewed as optional and unnecessary, a vestige of religious fanaticism which should, like the appendix, be excised if it creates difficulty. I can’t blame non-churchgoers for feeling this way: after all, many people who do go to church -- even non-squirrels who faithfully attend most Sundays -- seem to agree with them.

Do observant Jews go through this, too?

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.

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!

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?

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.

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!

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.

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.

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.