Crossing Rivers: Journal of An Integral Hospice Worker

By John Hughes

This book is a record of the experience of a spiritual caregiver at a hospice in Milwaukee, Wisconsin, in the form of a daily journal over the course of one year. The experiences and conversations contained herein are alternately harrowing, hilarious, heart-rending, and comforting. The reader encounters a great diversity of responses to life and death, bereavement, celebration and ugliness, as the companionable author describes his inner experience at the hospice. As more and more baby boomers face their own aging, and the decline and death of their parents, this book is a timely look at the state of the art of hospice in America. It also introduces the topic of Integral theory, spirituality, and practice, in a manner certain to fascinate newcomers to this evolutionary new concept.

• Language: English
• Publisher: BookBaby
• Release date: Jun 10, 2013
• ISBN: 9781483510712

John Hughes

John Hughes was born in Colwyn Bay, North Wales, Great Britain in 1970.He has worked as a milkman, landscape gardener, newspaper photographer,occasional proof reader and a fish terminal goods inspector. He currentlylives in Oslo, Norway. His other works are listed as follows: POETRYAphelion (1992),Recuillément (1993)Black Tin Deed Box (1996)PrestonZeitgeist (1994) Money & Make-Believe (1994)Room Twelve (1995)The Fiend that He Became (1995) Poetry from Beyond the Dashboard(1996) Touché (1997) The Night is Young (1997) 58th Parallel (1998)The Plant Collector (1998) O Livro das Letras Casa (1999) Replica (1999)Passports for the Journey to the Mad Dam (2000) Flowering Off the Chrome(2000) Rolling Over the Bones & the Running Through Poems (2002) WhenHope Can Kill & the Midnight Sun Poems (2005) Orpheus’ Loot (2007) Death Rattle (2009)Skin of Teeth (2010) Singeing of Beard (2012)FICTION Aphrodisiacs’ Spaghetti (2001) The Wondrous Adventures of Dip& Dab (2002) Deeper Tangled Grass (2005)The Bloody Shoots Burst Out of Uswith Love & Bullets at their Roots (2010)

Book preview

nature.

January 1, 2011

I was off today, from my job as a hospice chaplain, but, since the messages I have to listen to pile up at a rate of roughly 20 per day, I decided to avoid a Monday morning avalanche, and listen in the quiet of my home, via telephone, to reports of comings and goings, heightened and lowered levels of care (dictated by levels of patient health), and discharges, which often mean deaths.

There are several teams within my hospice firm, and I am on two of those teams, one of which involves driving over the countryside, the other involving an inpatient unit in a nursing home, where the patients are gathered like in a hospital wing. This morning, I heard among the phone reports that a patient of mine has died in that unit.

Damn.

I liked this one a lot. She was 90 years old, a talkative, confused, dainty woman with beady cute eyes and a tuft of white hair. We bonded as she described her life in Ohio, married to a Serbia-born gentleman who was a police chief for several decades. He had died 20 years ago and she had soldiered on in the company of her cats. She moved to Milwaukee to live in an assisted living home near her son, but only stayed there six weeks, fell down in her tiled bathroom, spent a week in the hospital, was declared fit for hospice because of rapidly advancing neurological issues, and spent five days with us. I bonded with her on the first two days, as she was tremendously sweet and showed me her lifetime of photographs. As her confusion progressed, she took to cursing like a sailor, and called me a shocking epithet on her second-from-final day of life, which is a coda I don’t think she’d be happy about in her right mind.

It’s my day off, and I didn’t need to do anything about this death, but I made a condolence call anyway to the son, J. He was thankful, tearful, grieving appropriately as we like to say in the hospice (just who came up with the notion of appropriate is unclear to me, and I consider the word to be highly suspicious).

The son draws hope from thoughts of heaven. He’s a realistic, salt-of-the-earth man in his sixties, and I will talk to him four more times in the future, as I look in on him every two weeks. I can tell he’ll be fine. Usually, when I hear someone say they are fine, I think of that as an acronym for Feelings I’m Not Expressing, but, in J.’s case, I think he’ll be able to live his life, move forward, without being completely stifled and immobilized by his grief.

I got off the phone. Time to go to my girlfriend’s house to cook her some shrimp etoufee.

Life is better than good. Is my day ruined by the death of this sweet patient? Not a chance. It’s New Year’s Day and I’m in love, and I intend to have a good time. In the nighttime though, when I go to bed, her ancient face will flash before my eyes, and I will hear her voice, for a moment, and there will be a brief wave of melancholy splashing through me. Then I’ll drift off, fine, grieving appropriately.

January 2

My understanding of chaplain work is fundamentally grounded in a principal idea (not original with me), which is that in the space between two souls, mine and the patient’s, in that intersubjective realm, God is encountered.

I don’t bend over backwards to define God, or to label the Mystery, because it’s all too huge and mysterious for my little mind. I am touched by the Taoist idea saying That which is called the Tao is not the true Tao, and Meister Eckhart, Christian mystic, said The God who can be spoken is not the real God. That which I call God is not the true God, the Ultimate Spirit of this universe, because I can’t know the fullest extent of infinity. It is important to remember this. But I savor the flavor of the Divine when I sit with a person who is dying, and when I hear them speak of their lives.

Patients express intangibly evocative things when we get into intimate conversation. I allow them to be themselves, to express who they really are and what they really feel and think, to the best of their awareness at the time, and they offer up jewels, time and again, which transform me. Often the revelations are down-to-earth, humorous, and uncanny. They point to the joy and mystery of being human.

Here are a few things I heard in 2010, which I continue to hold in my heart:

I engaged in hand to hand combat with the Nazis. I endured a living hell in Iwo Jima. I helped train the troops for combat readiness during the Korean conflict. I farmed for forty years. Now, I’m dying from bacon. That’s just the corniest thing I’ve ever heard.

I got high once. My mind became a cute little bundle. Then, I lost five dollars and ate four donuts. Everything isn’t for everybody.

(A woman sitting beside the body of her husband, who had died five minutes earlier. This was spoken through copious tears.) When this fool proposed to me, he knelt down on the sandy beach of Miami, asked me to marry him, and then fainted before I could say yes. Fifty five years passed, and I never really let him off the hook for that, but he was the sweetest little fella I’ve ever laid eyes upon.

(A man sitting outside the room where his wife will die within the hour.) Thirty-five years ago I asked her on our first date. I took her to a Chinese joint in Chicago, and we ordered the Happy Family Combination Plate. It tasted just a little funky, but we ate it anyway, then lingered to eat the fortune cookies and drink the tea. Well, let me tell you-- we both came down with horrific diarrhea right then and there, before we’d gotten home. I was stranded on the porcelain for a long long time, and at the same time, so was she, in the Ladies’ Room. We both started panicking that the other was getting impatient, because we didn’t know our predicaments were parallel. The waiter, looking at our empty table, thought we’d bolted without paying. We married two months later, and in all these years never ate Chinese food again.

I’m dying from cigarettes and whiskey, brother. My life wrote a check that my ass couldn’t cash.

(A woman who was half Cherokee Indian, half African American, who had been a lady boxer and opera singer, speaking three days before her death) I think I’m beginning to see that white light at the end of the tunnel, and peoples waiting for me up in there, but those peoples are weird and disappointing.

Me: How are they weird and disappointing?

Well, for one thing, there be too many coloreds up in there. And there is one man who is just staring at me with a focus.

Maybe he’s wondering when you’re going to join him.

He can wait. I ain’t dying for that Negro, no way.

I don’t come away with a concept about what I’ve experienced in these and hundreds of other encounters. I don’t have a definition or discursive essay to share, describing, expounding on the essences. I listen to the music here, and I respond as skillfully and resourcefully as I can.

You will discover, as you read this book, that all my responses are not ideal, to patients and their situations. I am as human as you—one hundred percent—and my professionalism is strongly colored by my background, by my limitations and weaknesses, and by my distractions. I do, however, have the strength of deeply enjoying the people I work with, to the point of loving most of them. I let their uniqueness touch mine. I let their music move me.

I consider this to be the purest description of my job.

January 3

The first work day of the new year arrived, and I spent much of it with Rob, a student social worker, showing him what a hospice chaplain does. I decided just to work at my usual tasks and ask him if he has any questions about a typical day in my life. So he got to watch me making roughly ten bereavement follow-up calls to people who have lost a loved one in the past eight weeks. With each death in the hospice unit or in my field team, I call that person’s bereaved family and/or friends with a condolence call in the first days afterwards, and then follow that with four phone calls spaced out over eight weeks, one every two weeks.

Rob overheard me having one conversation that lasted half an hour, as a niece of one patient vented about her family’s acid conflict over her uncle’s will. This woman had received the lion’s share of the inheritance, but there were significant amounts left to several people. She read to me a hate letter she received from her brother, who called the deceased gentleman worthless but who nonetheless felt aggrieved that the worthless one hadn’t left him much money—only $10,000. The letter was scathing and foul. This niece told me so many nuances of conflict, ugliness, and greed that I lost track of the story in the thicket of details. Yuck.

I wasn’t sure what she wanted of me, so decided that a caring, listening ear would be sufficient, as I surely didn’t have in my back pocket a peace treaty for the family war. I listened intently, and said wow frequently. Apparently this was what she needed, as, at the end of the visit, she said thank you so very much for hearing me out. Okay. I don’t know how she’s going to proceed in the face of so much animosity.

Other conversations were more conventional. There was a patient whom I was very fond of, whose family had come by on many nights and prayed that her imminent death would not arrive, and who framed her dying as succumbing to the devil. This poor sweetie, a woman roughly my age, was tormented by the idea that her death was a failure, and not a natural passage. It was framed as a failure of faith, an obvious indication that she was somehow deficient. My job as her chaplain, visiting with her each day, was to reframe that and to remind her ever-so-gently that everyone dies.

She finally died, after hanging on for several weeks beyond expectations. Her Dad, a quiet, simple man who had not been part of the fait- healing group, loved his daughter and suffered in solitude. He was hard to contact by phone, as he had no answering machine. My heart rose within me on this day when he picked up the receiver. He’d taken his daughter’s body to Illinois, so there could be visitation hours near the school where she taught. Then she’d been buried in Milwaukee.

It is a nightmare for a parent to bury their offspring, but here he was, shouldering his burden with quiet dignity and kindness towards me.

It’s hard some times but I’m getting by.

I knew you would. How are you getting by? What are your means of coping?

Just put one foot in front of the other, and remember the good times.

I reminded this kind gentleman that he himself would be the best at taking care of himself, because he knew what he truly needed, when, and how, like noone else knew. I warned him that many people are well-meaning, but they live within their own perspectives, can’t feel what he feels, don’t know his intimate history, and therefore are going to make mistaken suggestions. I invited him to be patient with those people, but to look within for his own wisdom in self-care.

I made the other calls, did the recordkeeping notes, and then took Rob to meet some patients in the inpatient unit.

As we walked to the first patient room, he asked me if there were some patients that I just found hard to be with. I replied that I find it much easier to be with patients who were conversational, as opposed to the nonresponsive ones. He asked what about denominations? Are there some that are tougher to be with than others?

No. People are people. I don’t care about denominations. Some conservative Protestant sects care very much about their unique claims on divine truth, and thus look upon me with suspicion as some sort of charlatan. It is my job in those cases to overcome that obstacle, to come across the divide with an olive branch. The key to doing this well is to look at the heart of the person, accept them for who they are, and truly take an interest in their story.

Sometimes this is harder than it sounds. The first family Rob and I visited were of a very conservative Protestant sect, and the dying patient was, in fact, a pastor of that sect. He was dying a painful death and the family had, for religious reasons, refused the use of painkillers of any type for him. They also had been stand-offish towards me. On this day, the patient was very near death (he died a few hours later), was staring into space vacantly, and his wife and daughter were seated on either side of him, looking stoic and unfriendly.

They were, in conversation with Rob and me, cold fish. They didn’t evince an ounce of Christian warmth. It was not my concern—their well-being was my concern. They clearly wanted me to leave, and I did, after summoning as much kindness as I could during our brief exchange.

So, yes, some denominations are tougher to be with than others. They kick you out and if you are thinking about your ego needs, you will be hurt. The encounter is not about my ego needs, but how I can best help. I was a little rankled by their rude dismissal of me, but able to shake it off.

Rob looked a little intimidated by the experience.

In the evening of this day, I was a leader of a bereavement support group, which consisted of two leaders and two attendees. It was my first time attending this group.

One gentleman complained that he had only had his mother around on earth with him for 59 years of his life, and he considered this unfair. I only had my mother around for six years of my life, so I sat and listened to him and talked to myself inwardly so as not to lose compassion. His point was, it stinks that his mother is gone. I can resonate with that. Yes. Fifty nine years, six years, after they’re finished, and the person is gone, what matters is what you do with the memories and the broken heart.

It took me a minute or two to get to that, and it wasn’t my very first gut reaction. The important thing was, when he said what he said, I was instantly able to say to myself, this will resonate with me. He had his mom for 53 years more than I did, and he’s griping. Acknowledge my feelings but hang in there with him.

I did so. It didn’t matter too much what I thought, because my colleague, co-leading the group, dominated the discussion with a lengthy monologue, and my interaction was limited because of that.

January 4

I got up in the morning and went to the meditation cushion. I have been taught a particular meditation which helps me get over myself and muster some authentic kindness for patients and co-workers.

In the meditation I envision Spirit (I tend to refer to God as Spirit, because for me the latter term is more universal-sounding and less tainted with the failings of religions. I am not offended if someone else uses God. I usually refer to God when speaking with patients.) up over my head, radiating warmth. I breathe that warmth down into my mind and heart and it floods my body all the way down to my toes. Spirit’s warmth circulates inside me like blood. I hold this vision for a good five minutes before the next step.

Then I envision a particular person. For instance, I might envision the prickly woman whose husband died yesterday, who rejected my presence. I get a good bead on her with my mind’s eye, observe her, hear her, feel her vibe. The, I acknowledge to myself that she has some sort of suffering within her that I don’t see, some shocks and blows from life I don’t know about, some reasons for being the sort of person I experience when I’m with her. So, she has suffering, and I consciously inhale and bring her suffering into myself.

Yes, it’s like that guy breathing in that black stuff in the film The Green Mile.

I sit on the cushion for a moment, holding that suffering inside of myself, letting it mix with God’s love which is in my bloodstream. Then I exhale, and instead of the dark cloud of suffering, what flows towards the person is divine healing.

Inhale a flood of divine love, let it flood my bloodstream. Picture a person who has irked me, acknowledge the seen or unseen suffering of their existence, and breathe this into my body. Mix that with the divine love, and then breathe divinely transformed healing into the person. If I do this a few days in a row, I stop calling her or him names under my breath.

Do this for a few people in one meditation session, and it’s radical what it can do for my outlook in a day. Today, I did so, and felt lovey dovey in my heart for a good several hours.

January 5

I drove forty miles for an appointment with a dying man, and his son met me in the driveway telling me that the appointment was canceled because the patient was asleep. This happened once already, a week ago, and we had rescheduled for today. I called yesterday to verify that the appointment was still on, and it was. So, I got back into the car feeling a little miffed.

It was not too bad, I wasn’t too angry, because I was listening to some Ray Charles on the car stereo, and enjoyed the drive. I took in a nice deep breath of fresh air, then drove another forty miles to my second visit.

This second visit went surprisingly well. I have been visiting T., a woman in her mid-eighties, for several months, and she has had something of a wall around her, not allowing me to get close to her. Today, the wall was down. She was talkative, as she described her upbringing and her college degree in mathematics. She laughed a lot at my attempts at silly antics. I left feeling encouraged about our relationship. It felt like I had a foothold for deeper relating with her in the future.

As I drove away, I grew introspective. Was the former wall between us really coming from her, or was it erected by me? It is easy to have feelings of distance evoked within myself by certain patients, because they trigger unease by reminding me of someone in my life, or they remind me of my own mortality. Then, I say that they are creating the distance. Does T. remind me of anyone? Who is she for me? Have I been subconsciously distancing myself from her? I mused on this while I drove, the Ray Charles music turned off for a while.

I don’t like her little room in the nursing home, because it looks sad to me, and it seems like she has nothing interesting to do in there. I don’t want this fate to befall me—that I might someday be confined to a boring room. So maybe I build an emotional wall, self-protective, between myself and this life experience T. is having.

Today, the wall was down maybe because I let it be down. When I walked into the nursing home, I noted that the Christmas decorations were still up in the lobby and Great Room, and they were remarkably beautiful and cozy-looking. A fire was burning in the fireplace, creating a hearth-like atmosphere that settled me. So I wasn’t as averse to the nursing home as usual. I felt charmed by the place. Then, lo and behold, the experience of distance between T. and I was mitigated.

Self-awareness is important in any helping profession.

January 6

This morning I was taken into the office of the Bereavement Care Specialist, with whom I’m friendly if not exactly friends, and was told that I’ve been failing to do some key recordkeeping.

I was not aware. What records haven’t I been keeping? He showed me, was stern, and I reverted to a defensive posture, and in anxiety gobbled some jelly beans he had on his desk.

I keep records for several hours a day as it is. I do more recordkeeping than actually visiting with patients. That should be enough, says I. I had never heard of the additional records I was supposed to be keeping. He said Yes you have, I showed this to you. Well, I don’t remember. One of us is wrong.

He’s the boss.

I’ll begin keeping said records. Henceforth, I predict that these new records will require an additional five hours of paperwork per week, which, of course, means five hours less of patient care. Also, I get to spend a couple hours catching up on the old, unkept records.

And do something about your handwriting, brother.

Crap.

January 7

This was a frustrating day because I spent more time catching up on the unkept records, and rewriting hand written notes which I’d rendered illegible with my handwriting, than I did in visiting people. Paper work, paper work, it’s a blizzard of paper work.

My lady friend Joyce preceded me in this job as hospice chaplain, and she left because in the end the paper work frustrated her too much. It’s governmental requirements, Medicare legalities, essentially, leading to all this paperwork, and it’s enough to make me go libertarian.

In the afternoon, I drove to a nearby town to meet a couple new to hospice. The husband is dying. They are my age, and when I spoke to the woman on the phone she sounded like she was being pulled in many directions by the requirements of life, and feeling frazzled.

When I entered the apartment I was taken aback by the sight of this woman, A., because she was the spitting image of the jazz singer Cassandra Wilson. I surveyed the interior of the house; a famous photo of several jazz greats assembled on a Harlem street in the 1950s caught my eye, and I liked the statuettes of nubile African women in traditional clothing which adorned the living room. But the house had an unsettled feeling, as A. buzzed about doing small tasks, her cousin did the same, and an unidentified white man appeared to be doing a plumbing task in the bathroom. I was left to fend for myself, so I went to the bedroom where the dying gentleman lay, looking absolutely miserable.

He was a dashing individual, even in extremis. A shaved head, a golden earring, and a distinguished white beard which he kept closely cropped all gave him a handsome air. He watched me enter, and I sat down quietly beside him before I even introduced myself. I folded my hands before me.

I’m John, the chaplain.

I just let those words sit there for a moment, and a peaceful feeling enveloped me. M. wasn’t smiling, and he scrutinized me tranquilly. He looked tired. There were two Bibles on the bedstand beside him.

You look tired, my brother.

I am. I need to sleep. Could you pray for me though?

I prayed for M., asking that M. would know the peace of God which passes all understanding in his heart, mind, soul and body, and that he would be filled with the knowledge of how vast was God’s love for him. I kept the prayer short and sweet, and looked into my brother’s eyes and saw serenity. I also saw the desire for sleep, so a little later I took my leave.

Out in the kitchen, A. sat down with me after concluding a few angst-ridden phone conversations. There was a meddling sister of M.’s who wanted to take over the medical and financial reins of the situation, and A. was fending her off. That sister might arrive at any moment for a confrontation.

A. told me about her life. Her first husband died after eight months of marriage, in a boating accident which also killed his brother. She then prayed for 25 years for God to bring a true love into her life. After 25 years, she bumped into an old high school friend, and they were married within the year. Now that man lay dying in the other room.

But I don’t admit that he’s dying. I believe that God can perform a miracle and bring M. all the way back.

Inside my head a flurry of ideas went off, in response to this. First, I thought to myself that she was in denial about her husband’s impending demise. Second, it was nice that she had a belief in God to rely upon. Third, if she was in denial, it was because she needed to be so at this time, and it was not my job to bring her out of denial into the hard truth. She’d get there soon enough. People need to go through their grief stages at their own pace, and it’s okay for them to be where they are, without being judged by me or hurried along when they weren’t ready.

I asked her if she was sad that M.’s life was in danger. She said no, her trust was in God and she would leave his and her destiny there.

I was impressed with her faith, but also saw the danger of such a perspective. She could easily be blindsided by reality when M. died. She could repress her feelings of grief and anger, out of a desire to be spiritual or faithful, and those repressed feelings could rule her life from their cranny beneath the floorboards of her life. What you don’t acknowledge can subvert you.

I saw this danger but knew that I could not wave a magic wand and lead her out of it. There might be unresolved feelings from her first husband’s death, if not grieved fully even after all these years.

Denial, faith, proceeding at the heart’s pace toward acknowledgment of a second loss—it was a complicated clinical situation.

I concentrated on using my chaplain skills, which include asking open-ended questions, and doing active listening. An open-ended question is something like so how do you feel now? versus a close-ended one, being such as are you from Milwaukee? Open-ended invites the person out into a clearing, while close-ended evokes yes or no or something similarly blunt.

Active listening involves a lot of responses which indicate clearly that you are hearing the person, with eye contact and body language to boot.

I was fully present for A., and offering her a caring ear. These are my tools, and they help me function when I see a person in an ambiguous place in their life.

I felt A.’s depth of strength and good humor as I sat with her. I saw tears being fought back. I could tell she was at wit’s end, and unable to express that to me. My colleague, the social worker Krista, had shown up during the visit, and had important questions for A. and M., regarding their preferences in the realm of resuscitation, and Power of Attorney responsibilities. As Krista inquired, I noted that A. wasn’t quite ready to answer.

So, a strong woman, and an enchanting man, dealing with a situation possibly over their head, leaning on a faith that was heartfelt and beautiful, but also fraught with assumptions. They’d only been married three years. My heart was heavy as I sat with A.

I am the same age as these two, and I also am in a new relationship which thrills me. I do not want that to come crashing down around me like it has for A. and M. The fragility of life and the emotional complexity which comes from that were both on full display before me.

When I left, A. didn’t seem sad to see me go, but was clearly itching to get back to her housework.

I’ll be back next week.

When I got back to the Inpatient Unit at the end of the day, I was informed that the mother-in-law of one of the hospice’s top national executives had just checked in. I wasn’t intimidated. I walked into the room, met four daughters and a friend of the patient, and spent 25 minutes with this mother-in-law, who was cute as a button, blind, and hard of hearing. I look forward to getting to know her next week.

January 8

I am on call for eight hours today. I have to get some bill paying done, a quick dash to the bank, a longer visit to the grocery store, and an outing with my daughter to the Humane Society. As I type these words, it is early morning and I am savoring some coffee. I’d like to work out if I could, but can’t see that happening. Maybe a little yoga. I’d like to read Teilhard De Chardin if I could—probably tomorrow morning.

January 9

I was asked to go out and observe a social worker as she did a consent signing, which occurs when the family of a dying person consents to allow their loved one into our care. The social worker is named Diane and is a down-to-earth, good hearted soul I’m just getting to know and appreciate. I appreciated very much that she would take me under her wing and show me the ropes of this procedure, which seems daunting. There are five forms to be filled out at a minimum, and each requires knowledge which I do not have.

On this wintry Sunday afternoon, we went out to a large home for the elderly, very swanky, and met the nieces of the patient, as well as the patient, who looked frail and listless. Diane, the two nieces, and I went to a meeting area just feet from the patient’s room. There, Diane and I got to know these women, one of whom was hilarious and irreverent, the other the straight woman of the duo, and we heard about their tough, smart aunt who was a business leader in the insurance industry for several decades.

The funny niece had a schtick about the disappointment of men and her love for the single life. I enjoyed myself immensely, bantered with her some, and watched Diane demystify the process of consent signing.

One of my growing edges in this ministry is to avoid the trap of thinking, I’m a chaplain, not a technician, so I shouldn’t have to do this sort of technical paperwork. The ideal is to be so proficient at the paperwork that the consent signing encounter itself is an act of outreach.

I see much anxiety on many people’s faces when they arrive on hospice. It is incumbent upon me to master these forms and nuances so I can help make the experience smooth as silk for the patient families.

The two women I met today were matter-of-fact about their aunt’s imminent demise, as she is in her late eighties and has lived a good life, but now wants out of this existence. Other people are not always so reconciled with the situation at hand.

I met a younger woman a while back who was bringing her mother onto hospice, and the expense was a huge problem for her. As an only child and single mother, she was sandwiched between the crushing demands of caring for a dying parent and a pair of teen offspring, with limited financial resources. Her own struggle for survival strongly colored her attitude towards our service.

I met another woman, this week, who was married to her shop-teaching husband for 60 years, and who was small and frail and daunted by the long hallway of the inpatient unit. She was just physically engulfed by her experience, and needed me to help her cope.

For both of these women, the burden of paperwork could be too much, if not presented as smoothly as possible.

We completed the signing today, and the former business leader in the insurance industry is with us now. A different team, and therefore different chaplain, will work with her.

The mother-in-law of the top executive nationwide of our hospice passed away today. I was called in to that and had a pleasant time with a group of intelligent, successful people, who sat around the table telling stories about their matriarch, and laughing. The patient had recently said she thought heaven might be chilly, so she hoped she’d be allowed to wear a sweatshirt up there. I suggested that she might be given a Snuggli.

January 10

I attended an early morning meeting in which our patient care coordinator announced to us that there is going to be a governmental survey of our practices, to make sure we are all in compliance with the rules and regulations. It will last a week, and we will all be under the microscope. I will be under the microscope. I wasn’t happy to hear it, but after the meeting I came to my senses and decided simply to reach out in love and kindness to the regulators who approach me. Also, I’ll comply with the rules and regulations.

We’ll see how that goes.

Then followed five hours of paperwork, accompanied by 45 minutes total of patient care. I kid you not. I slipped out of work a little early so I could get in my first workout of the year.

January 11

I was called by my supervisor to go to an emergency on another team. The chaplain of that team was out for the day, and the middle-aged son of a dying patient had been drunk and belligerent in a bar the night before, having to be removed by his mother. I was to respond to this family’s pain. I tried to connect with that son, and also that mother, but neither was receptive to my phone calls. I left messages and did not hear back from them. So I braved treacherous roads filled with snow, to journey to the hospital where the 92 year old patient lay.

The gentleman was asleep, looking very close to death, gaunt, mouth open, breathing unsteadily. The nurse confirmed for me that he probably only had hours to live, a day or two at most. I sat alone in the room with him, said prayers first out loud and then in silence, and then settled into a quiet meditation.

I studied meditation with a Zen master in the 1990s, and it has paid dividends for me in this profession. I translate meditative practice into listening. By this I mean, for meditation, I was taught to pay very close attention to how I sat on the cushion, to my body posture, to the way I held my hands, my head, and my spine, even to the way my tongue touched the top of my mouth as I sat. I was trained in the soft breathing technique, the relaxed facial expression and half-open eyes, of Zen meditation. It leads to a passionate yet deeply relaxed presence, full of openness.

I settled into a meditation like this for a few moments, and then the elder son of the patient arrived in the hospital room. This was not the one who had been drunk the night before; this was the retired police sergeant.

He told me much about his father, who was so old school that he once had broken his nose in a fall and had not sought medical help, but just said let it heal how it does. The patient had once sliced three of his fingers on a table saw and had had to be forced to go to the doctor for treatment. He was closer to the son who was not present, as they had shared passions for golf and bowling over the years. The police sergeant had not been particularly close to his Dad in any overt way, but now he was the one sitting beside the bed on a death vigil, while his brother caroused. I wasn’t sure if I was hearing an echo of the daughters in Shakespeare’s King Lear, or a variation on the story of the Prodigal Son, or what, but it felt like some sort of archetypal drama.

He reminisced. As he did, I settled into my body with relaxation, hands on my knees, torso bent slightly forward, spine erect, jaw tilted downward a little, eyes and face muscles soft, breathing rhythmically from my diaphragm muscles. I made sure to respond verbally to things he said with open-ended questions: how did that make you feel? I nodded my head gently on occasion to indicate receptivity and understanding.

He opened to my presence, and I believe that this Zen presence had a lot to do with that. He shared on a deeper level, how he had felt left out even though it was he who had moved 60 miles away. He was the political conservative, while his Dad and brother were liberal. Both his Dad and brother were wont to blame others for their difficulties in life, and he had never done so, and this made him feel alienated from them. He was just happy he had such a great wife as he did, who took away his loneliness. What I really needed to do, he told me four times, was look after the patient’s wife, his mother.

I told him I would do so. His body language and tone of voice became extremely relaxed.

I left after a while, knowing full well