The Diving Bell and the Butterfly

In CPE, we watched the stunning movie "The Diving Bell and the Butterfly" about a young French socialite (Jean-Dominique Bauby) who has a stroke and is almost entirely paralyzed inside his body.  He is unable to move at all, except for blinking his left eye.  It's a humbling story to watch, as he struggles with feeling trapped, with realizing he's now incapable of atoning for past wrongs, and with simple things like a buzzing TV that he can't turn off.  Eventually, his speech therapist devises a laborious communication technique whereby she lists all the letters of the alphabet until he blinks to choose one.  Letter by letter, he is able to write the book "The Diving Bell and the Butterfly" to tell his true story, the one on which this movie is based.  We're required to write a short theological reflection for class, and here's mine:

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 Why, for what reason, does God love me? Perhaps every human wonders this as they change, growing in some faculties and losing in others.  It’s easy to assume that God and other people love us for the strongest or best faculty we possess at the moment – maybe helpfulness or generous service, a strong work-ethic, a quick intellect, or a kindly spirit.  Yet all these can be stripped away.  I’ve seen it happen with my grandmother these past few years, as her once lively body and good-natured mind become dull with pain and bitterness.  And I saw it in the “Diving Bell and the Butterfly,” in Jean-Dominique’s frustrations and shifting emotions.  Underneath all these changeable capacities, there must be something deeply true to each human that God recognizes and loves even when we can’t pinpoint it.

The fact is that I didn’t much like the character of Jean-Dominique Bauby even when he did have all of his faculties.  I thought he was arrogant and inconsiderate, too enamored with his own playboy ethos as well as cruel to the mother of his children, Celine.  I don’t understand why he was surrounded by so many female ‘beauties’ throughout the movie; it was unrealistic to portray him as having some magnetic pull to attract these women so desperate to spend time with him.  Yet in any case, people did love him and there was something of God’s grace in that.  Even though he had been absent a lot, the children still kissed and loved him. Even though he could only blink, the speech therapist and book translator loved him in their own ways too.  Hence the movie testifies to the grace of being loved even when it isn’t deserved and can’t be earned.

As paradoxical as it seems, I believe that this most passive faculty – this fact of being loved by God and, by extension, loved by others - is what makes us who we are.  For whereas I have a hard time letting Jean-Dominique off the hook for being such a cad to Celine, I know that grace is true when I consider other, more forgiving cases.  For example, I know a family with a baby who died a few weeks after birth.  The family grieved and how they wondered at the unfairness of God in starting his little life just to end it: What was the point? The baby never did anything at all, couldn’t even manage to pump the blood through his veins.  But at some point in arranging the funeral, someone suggested to the mom that the baby did have something, and the one most important thing: the capacity to engender love.  For every short minute of that little blue and dying boy’s life, he was engendering love in the heart of God and all the family gathered around.

In ministry, I find it helpful to remember that any given person’s essence – whatever makes them who they are, as a distinct human loved by God - is located on a level deeper than faculties.  For if God loves both the dying baby (who couldn’t do anything for himself) and the jerk husband/father like Jean-Dominique (who did too much for himself), then God must be engaging souls on a level that I can’t comprehend.  It’s one of those things, yet again, that the intellect, the emotions, the will and all other perceptive faculties, etc.  just can’t touch.  And in a sense, I find that freeing - for I don’t have to know why God loves a given patient; I just have to trust that God does, and then aim my pastoral love towards that deep, quiet and imperceptible place in the soul where God sees the fullness of who they are.  For God knows each person better than they know themselves, and certainly much better than I ever could.

On the Metro

Last night on the metro, I was disturbed by a conversation I couldn't help overhearing.  Four gals, dressed preppy as could be, were talking loudly about yet another friend's wedding which was to take place this morning. Hair pulled back, earrings, purses. They looked nice enough, but they were anything but nice talking about their friend, the bride-to-be.

"Can you believe her?!"
"I know, it's like she's lost her f***ing mind, getting married."
"Yeah - just 27 and she's f***ing getting MARRIED."
"You couldn't force me to get married with a gun to my head." 
"Someone should have just shot her."
"What kind of a b*** does she think she is, marrying some idiot straight-lace.  He's probably a virgin or something."
"Ha! I hope she f***s around on him."
"Yeah, with them keeping separate apartments and all till now.  It's like you want to say, "Lay off the f***ing statement."
"God, I mean, what are they thinking? Probably they think they're going to be monogamous or something!"
"Haha, right - not!  I'll believe it when I see it.  Not in this modern era!"
"Ding, dong, here comes the divorce."
"I mean, what's the point anyways - what does she think she's getting tomorrow? An entrance into old people life, that's what.  Seriously, what the f*** is the big deal with people?  What do they think they're getting that I'm missing?  WHAT am I missing!? Nuh-thing. God, thank God, I'm free to f*** whoever I want."
"She's an f***ing b****."

They were gleeful practicing their backstabbing comments for the next morning: bridesmaids prepping for the big day in their friend's life, begrudging their friend her marriage and all her hopes for it.  Now granted, I don't know what was really going on.  Maybe they were peeved about something the friend had done.  Or maybe they were jealous.  Or perhaps it was a show, as they tried to prove to the Cardinals fans sitting nearby on the Metro just how crass they could be.

But I found myself feeling so angry and so tired. It wasn't that I was offended or even all that surprised; in many ways it was just an ordinary conversation overheard on the metro not so different from most conversations on public transport in terms of gritty vulgarity.  Rather, it was that I couldn't stop thinking about a couple that came into the hospital around 4:00 that afternoon. We were paged for a cardiac arrest - male in the ED trauma; wife in the ER waiting room.

My preceptor chaplain and I arrived at the trauma bay just as the doctors and nurses were putting down their equipment and turning away from the man's dead body. The husband had been brought in for cardiac arrest, but the doctors couldn't bring him back. My preceptor and I glanced at each other, wishing we hadn't checked on the husband, wishing we didn't know.  The wife was waiting for us in the ED's quiet room.  She was an elderly woman and was desperate for her husband of thirty-something years to be alright.  She was sitting there in the quiet room nervous and straight on the edge of the seat as she told us about her husband, and all the years they'd been married so far.  It seemed forever before the doctor came.

When the doctor told her, she literally crumpled into herself, looking very, very old.  I hadn't realized that so much of her had been nervous energy.  All her size seemed to constrict, deflating and caving suddenly from the inside.  When we took her back into the trauma bay, she cried loudly and leaned over him for a long time.  Then, when we finally walked back out through the trauma room, even the nurses glanced away as she moved past.  She was shaking with grief and it was hard to watch.  Maybe this struck me more than some of the other deaths because it was just her and no other family, this solitary wife with so much anxious love and then devastated grief for her husband.

So I sat there on the Metro, listening to these hipster Metro-riders making snide comments about the wedding, and I felt angry.  At first I thought I was angry because of these loud, crass talkers on the metro, until I dismissed that for they were petty. Then I thought I was angry on account of the the couple in the Emergency Department, that their tragedy was more of a shock than I realized - and yet for all the cases we get there, this cardiac case was relatively tame and well-within the extremities of my experiences thus far in the hospital.  And so I realized I was angry on behalf of the bride and her husband-to-be.

I'll never meet them and know nothing about them - but I hope this couple that got married today has a beautiful marriage.  I hope they treat each other well and that they have a long time to learn how to do that.  I hope that they have the good wishes of their family and friends today, and the blessing of God for every day after this.  And I hope it's a long, long time before either of them ends up in the ER, dying and grieving and thinking back on a life lived together.

Ah, CPE - what an experience.

Two-way Vision

I've found that, in order to have a really good conversation with a patient at the hospital, I rely a great deal on having double vision - the capacity to see the world from not only my eyes but also from the patient's.  When I can't put myself in the patient's place, the conversation falters in awkward ways.

Conversations tend to go well when I'm talking to patients who are women or around my age, because I experience the conversation like a good Skype conversation where both people can be attentive to the camera feeds.  After all, when Skyping with someone, the main screen view is my perspective looking towards the other person and their surroundings as they look from my gaze.  Yet there's also that smaller box down in the right-hand corner where I see the world as my conversation partner sees it, with me and my background as the object of sight. The angle of light is different for the two different cameras, and I can see the difference and the similarity with those two camera views running.  That whole screenshot is how I imagine the best conversations happen inside the chaplain.  My primary perspective is, naturally, my own, and yet I can also take into account my conversation partner's perspective.  Really good pastoral care when I can be that present to both sides of the conversation.

But this Skype metaphor first came to me because I have been trying to figure out what is going wrong when conversations go badly.  I find it very difficult to talk with men, especially old men in their forties and fifties and sixties. It feels very flat... I'm just looking at this other human organism sitting in the same room, and well, there they are.  It's kind of like looking at an image of someone on a movie screen, where you'd only hypothetically wonder what that movie character would think if they could see you sitting there in the cinema.  In terms of connectivity, it feels more like a static image, and not a Skype conversation with a return gaze.  But this is super problematic -because these patients actually are real and, even if I have no intuitive sense of their perspective, they actually are looking at me and apprehending me as a presence there in the room; so it makes me nervous to know I'm not invisible to them.  So it's a perfect storm for crippling self-consciousness.  It's like Skype does a one way freeze:  I just see a blurred and frozen image of this person with no feedback perspective at all, and yet I know intellectually that the patient is watching me and can see me flounder perfectly clearly.  This has made for some really awkward conversations, especially since several of the older male patients I had today had trach tubes and really were just sitting there looking and me and not capable of saying anything or giving me anything to work with.  I wish I could have seen the world a little from where they sit, because patients in that situation are so lonely and themselves desperately wish for connectivity to be re-established.

I've got to find someway to keep Skype from freezing!

Book Review: The Family Crucible

Already, I've realized that hospital chaplaincy involves just as much work with patients' families as the patients themselves.  It's amazing the things people will say about each other in the pressure-cooker of a crisis - worried things, sweet things, spiteful things, and bitter things.  But it's saddened me to see the frequency with which anger and blame tinge these most serious bedside conversations.

So I've been reading a fantastic book about family systems from the hospital's Pastoral Care library: "The Family Crucible" by Augustus Napier, Ph.D, and Carl Whitaker, M.D. It's both an introduction to family systems theory and a case study of a particular family's extended pychotherapy sessions.  As I've studied at YDS, the basic premise of family systems theory is that the family constitutes its own operational unit, with parts that pull and push on each other.  This isn't necessarily a bad thing - after all, this pull and push is the relational force that ideally helps members mature and grow.  But it also means that, when family dynamics become entrenched or grow cold, the interlocking and systematic nature of family makes for a difficult  pathological knot to untie.  Problems are never one person's issue - everyone in the family system plays a role.

In "The Family Crucible," Napier and Whitaker do an awesome job of presenting family systems theory in an understandable way.  I'm not sure how this will help, but I'm hoping to get quicker at parsing what's going on when people at the hospital argue over their relative competencies to have power of attorney for their dying family members.

Trauma Drama

As it turns out, the hospital is not so calm as I initially thought when I first visited.  As a Trauma 1 center, the Emergency Department receives a lot of extremely difficult cases, which arrive either by helicopter or by ambulance.  I have immense respect for the trauma chaplain there who manages to be both collected and caring in the most hectic situations.

This afternoon, the trauma chaplain was showing us the ropes of the Emergency Department when we got news of a particularly bad auto accident case.  I did not like being there.  The mere description of what had happened made me feel woozy, and by the time the helicopter landed and the patient was wheeled into the trauma bay, my vision was going black and I thought I was going to pass out.  I didn't, but it definitely gave me pause.  I had been impatient with all our orientation, wishing to get out on the floors doing chaplaincy, but not anymore.

Now I am glad they are giving us as much orientation as they are.  The trauma chaplains have big role to play in talking with the paramedics to find out any information about possible family contacts, standing ready in the bay to talk with the patient if they are capable of talking, going to visit any family in the waiting room once they arrive, etc.  Down there in the ED, there's actually quite a lot to do and I was trying my best - through the haze of wooziness - to pay attention to all the logistics involved in finding, notifying, and orienting relatives.

When I'm on call, I'll almost certainly be paged for trauma events since the hospital gets so many, so I need to know what to do and not pass out.

Quote!

"People don't care how much you know, until they know how much you care."
- John C. Maxwell

Into the Fire

Ah, could there be anything better than good metaphor from a great friend?

Today at lunch, my previous campus minister Cathy M. shared the best image for chaplaincy: Hospital chaplaincy is like being a firefighter... everyone else is running away from the building, but you run in. Someone's in there, and they're glad that you're coming.

Indeed, patients often do feel like they've been abandoned in a burning house.  In a myriad of ways, those around them may have unintentionally run away from the flames of hurt and confusion.  Someone is realizing they'll never walk again, that they're not going to see their children grow up, that they're dying - but the friend doesn't visit, not wanting to intrude or ask awkward questions.  The sibling is there in the hospital room yet keeps busy, distracted on a laptop researching medical options and opinions. Thus friends and families sometimes flee from the discomfort of tough, emotional conversations by taking refuge in distance and logistics.

The chaplain doesn't know what's inside that burning house any better than anyone else, but this is precisely the time when he or she can serve by going in rather than out, towards rather than away.

Proverbs 2: Ministries of Presence

"For the Lord gives wisdom; from his mouth come knowledge and understanding. He holds success in store for the upright; he is a shield to those whose walk is blameless, for he guards the course of the just and protects the way of his faithful ones" (Proverbs 2: 6-8)

Earlier this week, I was commenting to Troy, one of the campus ministers at Wash. U that I find the notion of "ministry of presence" beautiful but frustratingly vague.  Everybody talks about chaplaincy as a "ministry of presence" as if that paves the way to everything bright and beautiful in pastoral care.  I understand the basic idea, that as chaplains our primary role is simply to be with people; for there's no 'right' thing to do or say, but only that truth which flows from being truly attentive to a person and everything they share in conversation.  More often than not, it means listening rather than talking.  But, I contended, it still seems that "ministry of presence" still leaves an awful lot of room for awkwardness.  I mean, seriously, what do you do if you're sitting with someone in what you think is supportive silence, but they don't get what you're there for?  Eh, explain to them, "Oh, I'm being a minister of presence to you!"? (Cringe. Pastoral care FAIL)

Troy laughed, but then pointed out usefully that there are always multiple presences.  Just as a campus minister is present in very different ways when interacting with students at coffee hour or in deep one-on-one conversations, so too a chaplain's presence is an adaptable thing.  Where I went wrong with the 'ministry of presence' idea was in imagining it as some kitchy posture of generic receptivity.  (I have seen this happen with freshman YDS students taking "Pastoral Care" for the first time, as they go overboard trying to practice their 'being nice' skills on everyone else at the Div School, asking with that too-kind smile if you are really okay.)  But a true ministry of presence is not at all generic.  Its attention is specific, and its response is specific.  Of course! This resonates with what I know of ministry from working in church and school settings.

Indeed, God is present to us in specific ways, as Proverbs 2 reminded me tonight.  Sometimes God is the challenge of wisdom, sometimes the voice of understanding, and other times the shield and guard that protects us.  I don't yet know exactly how that translates into hospital chaplaincy, though I do know it has worked that way in my ministerial experiences so far... God has usually helped me know what to do.  At St. Martin de Porres middle school this past year, I certainly sometimes challenged, sometimes comforted, sometimes defended, and sometimes just listened.  Yet the hospital will be much, much harder - so I'm praying for the ability to be present in the appropriate way at the appropriate time.

A Preview

Since the Metrolink system and bridge are under construction here in St. Louis, I went this afternoon to scout out the easiest way to get to the hospital by public transit and bike so I'm on time on Monday.  And since I was going all the way there, I stopped into the hospital to see what it is like:

 (Photo credit: Matthew Lehner)

The hospital complex is mid-sized - the towers above plus several other buildings behind.  Inside, it was easily navigated and - to my surprise - comfortable.  In my mind, at least, hospitals are freezing cold and stressful places where people rush around making beeping noises.  But on first glance, the hospital seemed calm and friendly.  As I wandered around, several staff members asked kindly if they could help me with anything or help point me in the right direction.  And although the hospital floors themselves are pretty standard, I was delighted to find a lovely little Gothic-style chapel on the third floor:

Chapel (Photo credit: HFWH)

I am glad and content that I will be learning pastoral care here.  This spring, when everybody was deciding where to go for their CPE programs, I worried that I was making a mistake to bypass the larger medical center sites.  As a WUSTL undergrad, of course, all we heard about was the enormity and prestige of Wash U/Barnes-Jewish.  And now as a grad student, there is Yale-New Haven hospital downtown as the obvious big swanky hospital.  Those are great Trauma 1 centers, but there is something freeing about learning in a hospital where I have no institutional affiliation - a place where I've never had to explain why I switched out of the biomedical sciences into a religious studies major, where I've never tried to justify being a divinity student against the more obvious utility of the medical students down the hill.  So CPE here will be it's own blank slate.  I'm just a normal person walking into a normal hospital that cares for people who are sick. This place seems fitting to me, like when you try on a pair of shoes and they just feel right.

Speaking of which (best for last), I got new shoes!  I needed some close-toed flats that would be comfortable to wear around the hospital, and so Lauren and I went to the mall.  Pretty cute for $27!

Hospital Chaplaincy Footwear (Photo credit: Me!)

Proverbs 1: Fear of the Hospital, Fear of the Lord

"The fear of the LORD is the beginning of knowledge; fools despise wisdom and instruction" (Proverbs 1)

CPE starts on Monday, and I definitely have fear though I doubt this is the true awe for God that a minister ought to have in apprehension of walking into hospital ministry.  Right now, I'm most afraid of being awkward, and of seeming too young.  And I'm afraid of being a bad chaplain and making people feel worse rather than better.

In a way, there is a strange kind of freedom in accepting that it'll go very rough without any guarantee of it getting better.  Most of my life, I've gone into new challenges with a rigid determination to push through to success in whatever I was about to tackle, confident that if only I worked or studied hard enough then I would do well.  I even got through a horrendous semester of calculus in college that way, going to office hours every week and working problems deep into the night until I got my A.  The equation: Effort + (Studying x Hours Not Slept) = Success.  But chaplaincy isn't a meritocracy, and it simply doesn't work that way... there's no way to be type-A enough to force someone to reflect and share deeply with you in the midst of their grief or confusion - for, obviously, to force it would be cruddy ministry anyways.

So I'm just waiting for my program to start, and there's nothing I can study or do to prepare for the hype and pressure of the emergency room.  I'm just trying to make sure I'm as stable as possible - eating well, sleeping regularly, reading my Bible, emotionally capable of taking things in stride.  Right now, it feels very mundane and kind of boring, not glorious at all, but all I can do is hope this is the foundation and beginning of knowledge.  What knowledge? I'm not entirely sure, since there's nothing one is supposed to accomplish or do, no problem to fix.  Even on my good days, I'm inevitably going to be sitting there feeling awkward when I don't know what to say to a grieving parent, or can't understand what an intubated patient is wanting to say to me.

That's where God is really going to have to come through for us.  There is only so much from book knowledge and work ethic that one can rally usefully in a hospital room conversation.  I need God to help me be real, to perceive what people are really trying to say, and to truly learn when I bungle it up.