Pager Calls

This is my view at midnight:

I am on call this freezing cold snowy weekend for the local ER, which I haven’t done since a month ago.

Naturally this snowy night would be my turn.

I came in grudgingly because my body is so worn out, but also honestly-gratefully because I am slowly paying down those Cancer bills. This is such a relief to me, so I try not to complain and just go work hard like everyone else has to do.

I finish at 330am, and I am tired and cold, and know I will not get much rest with the kids in only a few hours.

I go home slowly on the slick roads, and creep quietly into the house.

There is peace here, where my husband lays and my children sleep.

It is home, and I am glad for any moment here.

I say my prayers again when I crawl into bed, as I ponder job possibilities for me and Nathan.  There are two offers I have, but I am reluctant to change my life.  Nathan has a “bite” on a possible Broadway production in New York, which would be amazing, but so many producers have said that before so we never know for sure. But these are my work-prayers as I crawl into bed.

Mostly what matters are these babies, and how we would do anything to care for them well, and so often wonder what that means.

Right now it means me sleeping while I can before the pager goes off again, especially since I will be way nicer with a little sleep.

Except first I shovel the driveway and sidewalk to the van, and salt the path, so it will be safe and ready for those children if we do still have church in the morning.

Maybe that’s my act of faith, even if it’s 4am.

Good night, town.

Showdown with Six

Six announced at breakfast this morning that she is getting adopted, and that we can call her “Sophia”.

That is not her name, of course.

She is also not getting adopted, not yet.  Her next court hearing is in April, and the DA may very well recommend termination, but it could be a good year or more before that actually happens – if it does.  Her family could find an alternate plan before then, instead of adoption.  We really just don’t know what will happen with her.

She is aware, however, that her mother is not improving, and in some ways getting worse.

Mama, my other mom is still stealing stuff.

I know, sweetie.

And she still takes those pills.

I know, sweetie.

And she isn’t very much of a grown up.

This I know.  When Six got a leap pad system for Christmas, the mom wore out the battery before Six ever got to play with it.  When they have their weekly one hour supervised visit, the mom colors the coloring books before giving them to Six.  When she got to go out to lunch with Six during an appointment about Six getting cochlear implants, she asked if they could have ice cream for lunch.

Most recently, mom got kicked out of grandpa’s house, where she had been living since getting fired from the hotel job that also gave her a place to stay.  Now homeless with only three weeks until court, it isn’t looking very good.  And Six knows it.

But Six also knows that Five and Toddler are getting adopted, and they are getting a lot of attention for it.  It’s been brewing, but finally came to a head today.  We had a showdown, while Six was refusing to use her words to express herself directly.

It all started with lunch, simple enough.  Well, she had been fussy and mean to Five and Toddler all day.  But the showdown started with lunch.

The kids picked what to eat, and I did my best to make that as close as I could with what we had.  No one complained, even when I was a mean mom and made them eat vegetables with it.  Even when I said they also need a fruit, and could pick an apple or applesauce, no one griped.  Six herself quickly chose an apple she herself picked out, and skipped back to the table happily enough.  Nothing seemed amiss.

Until she took a tiny little fairy bite out of just the skin, and loudly announced she was “done” because she “tried a bite”.

No, I said, you chose the apple, so you need to go ahead and eat it.

Now, mind you, we do not have finish-your-plate rules at our house.  We know food issues, and are not going to force any of them to eat.  If they don’t eat their vegetables, fruit in this case, and proteins, though, they do not get dessert.  We rarely have dessert, so that is a treat they usually don’t want to miss.

But still, I was not going to get in a battle over an apple.

Excepting then she looked me right in the eyes, picked up her apple, reached over, and dropped it on the floor.  On purpose.  Daring me to do something about it.

I did not engage.

She then proceeded to eat her main dish, ignoring the vegetables and her apple on the floor.

That’s when 13, who often forgets she isn’t the mom anymore, reminded her she needed to finish her vegetables and not just the main dish.

Six replied by looking me in the eyes again, picking up her vegetables one by one, and flicking them to the floor.

I still did not engage, and was consciously ignoring negative behavior when Five smelled a battle brewing and suddenly shouted out, “I can’t believe you are throwing food on the floor!  That is so gross!  You better tell mom you are sorry!”

That got Toddler riled up, who chimed in with, “Yeah, you pick those up!  You eat those dirty foods on the floor!”

That’s when Six began to scream.

She began to scream like I have never seen her scream.  She began to scream like a Toddler scream, like the entire ocean of emotions inside her was going to come out.  She began to scream like she suddenly felt the weight of grief of her mother’s choices, the loss of her home and family, the confusion at why two of the kids could be adopted already and not her yet, and the irritation at not being an only child anymore.  All of it welled up in her in some kind of emotional tsunami, and came out of her in some kind of feral wail like I have never heard before from any creature ever.

This was naturally followed by an all out temper tantrum on the floor, kicking and screaming right there under the table, carrots and broccoli flying in the air while the apple rolled somewhere under the couch.

I asked her to go to her room while she cried, because crying is always okay.  Screaming is not always okay, but sometimes necessary, and so better to do it in the safe privacy of her room.  I stayed calm, and reached for her hands, and initially she responded to me.  We got part way through the kitchen toward her room, and she just turned on me as the wave of emotions turned into rage.  Her hearing aids and my cochlear implants went flying as her socked feet slipped from under her mid-leap toward me, and she fell in a pile on the floor.  I got her picked up again and walked her to her room, where she lay crying for some time.

By the time she was quiet again, the baby and toddler were down for naps and Five and 13 were in his room watching a movie.  I was working on their adoption videos, and waiting for Six to settle.  When she was quiet, I went to open her door.  I thought she might be asleep, that perhaps she was tired for some reason and that was why she had such a fussy day, but she was awake.  I told her she could stay there and rest if she wanted, but if she was hungry she could go pick up her vegetables and finish her apple (which had been found on the coloring books, quiet un-touched by the dirty floor).

That’s all I said, and beyond that, I was still not in an apple battle.

Except then when I went to check on the baby, I came back and she was sitting smiling at the table.  I asked what she was smiling about, and she said, “I finished my apple!  So can I have dessert?”  I looked, and she had not eaten any of her lunch at all, even discounting the vegetables that had to be thrown away, and her apple core was no where to be seen.  I investigated further, and found her apple in the trash.  She had lied about it!

When I let her know she did not have to finish her food, but would not get dessert because she had not eaten, she began to cry all over again.

This is our Six, who holds things in for so long that nothing comes out until it all boils over at once.

She had so many things she was sad about, and so many things she was angry about, and so many things hurting her.  None of it was about lunch, or the apple, or tossed vegetables.  It is about her mom, who is very nearly younger than Six developmentally.  It is about her mom, who won’t stop abusing substances long enough to win Six back.  It is about her mom, who won’t get a job because she doesn’t want to stop stealing.  It is about her grandpa, whom Six wants to love but is afraid of because of the yelling and domestic violence and now has kicked out her homeless mom (but will let her back any day now because he enables her like that).  It is about her, this girl who wants to be adopted but doesn’t know yet if she will be, this girl who grieves for the loss of a family that doesn’t seem to want her.

It was so, so sad.

She did, in the end, eat an apple.

She did, in the end, win some dessert after supper, the last of the wheat free cupcakes from my birthday.

She did, in the end, use her words to express all these things.

And it was, in the end, powerful for all the kids.  She shared her thoughts and feelings about foster care and adoption and her birth family.  This even opened up 13, who is aware termination is happening but insists on not being adopted, who has no choices left in town but us and so is stuck here but doesn’t exactly want to attach, much less engage.  She even used the adoption workbook from the state to pick out faces about her feelings toward her mom:  sad, mad, hurt, ashamed, embarrassed, and frustrated.  Good for her.

It was a break through for all of us, I think, but a really hard day.

We cannot NOT celebrate the adoption of Five and Toddler, just because the other kids are still foster kids.

We can be careful to give them extra support and attention so they don’t feel left out, even finding ways they can participate in the process – like starting to make their own videos, which they all loved.

But we are not the ones who make the decisions, or decide who stays and who goes, or who can fix everything into a lovely little package, wrapped up in a shiny ribbon like a thirty minute sitcom.

Life is harder than that.

Life has been so hard for them.

I made sure, when it was bed time, to spend extra cuddle time with Six.  We tickled and snuggled and wriggled around laughing until I knew she was okay again, until she knew she was okay again.  It’s a lot to process for such little ones, and hard to do so when we don’t actually have any answers for anything.
The only answer I have to give is to keep loving and to keep trying.That’s all I got.

 

#WhatChaplainsDo – CPE 1 Verbatim 1

Emily Christensen
CPE I – Verbatim 1

PERSON: Female
CLINICAL DIAGNOSIS: “Brain Dead” – per nurse
PRESENTING PROBLEM: Mom requested chaplain visits to pray and sing with patient

ADDITIONAL INFORMATION:

Chart – patient had a heart attack, surgery scheduled for morning

Nurse – mom was requesting trach, since doctor told her patient would die if extubated –
Surgery scheduled was to place trach

NOTE: Chaplain referral paper specifically asked for “prayers and singing to the patient because mom believes she can still hear you, even if she is not awake.”

PLANS: Upon receiving this referral, I knew the patient seemed as medically stable as possible in this moment since was on life support and mom had no plans to remove it. That meant prioritizing, and I had to go minister to a family with a dying patient first. It was my first experience of that in this chaplaincy setting, having to decide between two tough cases what to do first since I could not be both places. Once I was able to get to the patient’s room, my plan was just to practice being a presence as we had discussed in class. I planned to offer a prayer since that had been requested by mom, and knew it needed to be out loud with the patient so she could hear since that had also been requested. I did not know if I would hold her hand or how to approach her physically in that moment, and wondered what my plan was for that. I could also tell from the note that this was some kind of dissonance in what was happening, between what the doctors could see and what the mother was facing, so I made a plan to try and get more information but without it did not yet have much of a plan for what to do with that information.

SITUATIONS AND FIRST IMPRESSIONS: I first went to the nurse’s station to let them know I was here, and to ask more information. That’s when the nurse gave me the additional information (above). She said mother had just stepped out to go home and change clothes, so was not here at the moment, but I could still visit the patient and then she would call me back later in the evening when mom returned. The air in the room was very, very loud. This immediately made me anxious, as I was worried I would not be able to hear or understand. The patient was a young girl, but very large, filling the bed entirely, except for below her waist, where the shape changed but I could not figure out why. I thought it might be because of those compression sleeves they put on people after surgery sometimes, or because she was on one of those extra large air mattress things that sometimes change how much air is in them. The patient’s head was rolled to one side, facing the door where I was standing. Her hair was pulled up in a ponytail on top of her head. Her eyelids were open, but her eyes were rolled back in her head. She had an iv in one arm, with a sign saying not to do anything in the other arm, not even to take blood pressure over there. She was intubated, and had a lot of tubes in her face and around her head, connected to machines on both side of her. I wondered how to help her, when she could not communicate or respond, and was also trying to brace myself in case she did respond in some way, so that I would not startle. My personal feelings were two things, one that surprised me and one that didn’t – I knew that at some point in this chaplaincy, I would see an intubated person for the first time since my mom was killed, and this was the moment, much sooner than I had expected, but it was also easier than I expected and I was relieved that trigger was over with and not so hard as I had thought it would be – but what I did not expect was the shape being wrong, and that being a trigger, and trying to figure it out and not being able in my head to figure out why the shapes were wrong. My only agenda was to pray with her and sing to her as requested, and I wondered what kind of prayer or song was okay since mom (who had requested it) was not there and the patient could not respond with guidance for what might be comforting to her. I had to pray for help for how to pray and what to sing, and was anxious for doing both out loud.

VERBATIM:
(C = Chaplain, P = Patient, Mom = Mom)

C1: My name is Emily, and I am a chaplain. Your mother said you might like a visit.
P1: No visible response.
C2: I waited a bit, and did decide to go ahead and reach for her hand, and was careful not to hold the hand the sign said not to touch. My I hold your hand for a bit? When I picked up her hand and put my other hand over it, her eyes moved and her body shuddered. It did startle me, and I did not know if it was coincidence or if she was responding to the connection. I was also not sure if mom wanted to be there when I prayed, but because the nurse said she had just left to go home, I knew it would be awhile. So I decided to go ahead and say a prayer. I prayed for comfort and peace, for her and her mother, and for the doctors to know what needed to be done and for mom to understand what is best for the patient. When I finished praying, her eyes were in a different place toward me, but I do not think they were focused on me. I was quiet for awhile, just holding her hand, but after some time remembered I was supposed to sing. The more I prayed to think of what to sing, the more I couldn’t think of anything, and so decided it must be about music and not about lyrics. So I just started humming. At one point, a nurse came in, but saw me with her and excused herself, saying she could come back later. I hummed for a long time, she began to have tears fall down her cheeks. I wiped these with a tissue from a box in the room, and patted her head as well. I sat with her again in silence for some while, before the pager went off and I promised to return later in the evening. By this time, her eyes had rolled back in her head again, and there was no visible response that I could notice. I did ask the nurse, on my way out, to page me when mother returned.

When I was paged later, I returned to the room for the second visit:

C3: Hello, I am Emily, and I am a chaplain. I came by earlier to pray and sing with your daughter.
Mom3: Good, I am glad you came. The nurse told me you came. I am glad the nurses can do something right around here.
C4: Mom sounded irritable, and was huffing and puffing around the room, moving stuff and putting it back where it was, and moving it again. I noticed the patient’s eyes were still rolled back in her head, and now her eyelids were half-closed over them. I am glad they paged me to come. What can I do for you this evening?
Mom4: Go ahead and do whatever you need to do, that’s fine. Mom sounded receptive to me, but was wanting me to direct our interaction, and I had no idea what to do! I needed a starting place to get mom to open up or to build some rapport with her to find out what she and her daughter needed from me since she had requested me to come.
C5: I did pray with your daughter, and held her hand.
Mom5: Oh, good. She likes that, I think. When I hold her hand, her body shudders. What do you think that means? Does it hurt her? Or does she like it? I can’t stop touching her. I keep messing with her blanket, and trying to wash her hair with this dry shampoo and clean her up, and I know she wouldn’t like me fussing over her, but I don’t know what to do. Mom now was clearly just needing to vent and talk, so I tried to focus on just being present and receiving what she was sharing. It was the burritos, you know. She is here because of those burritos. I told her not to eat them, but she kept hiding them from me. She has had diabetes; she always has, and lots of us Indians do, you know. Her leg was amputated awhile back, and she has been on dialysis. I tried to take her to lunch before dialysis, but she said she wasn’t hungry, and she is always hungry, so I knew she had been eating burritos again. But we always stop for snacks on the way to dialysis, so we had her in the wheelchair at the grocery store to get her snacks, and we were trying to get her back in the car, and she just collapsed. Her phone broke. I don’t know why her phone broke, but I keep playing with these pieces in case I can fix them, but this screen is shattered. You know what those doctors said? They said her brain doesn’t have anything in there – they hooked her head up to all those patches and cords and tried to show me, and they said she isn’t coming out of this. They said she’s already gone. Can you imagine telling a mother their daughter is gone? She’s still in there, I tell you, and I’m not leaving here without her. Mother was quiet again, then, for a while, but busy in her body, bustling about the room trying to fix things and arrange things and take control of whatever she could – including a doctor consultation room nearby, that a nurse had to keep asking her to leave. I focused on staying very still in contrast to her, but mirroring her body language anytime she did slow down and come to me, and then she would start talking again. They said she had another heart attack, and that if they take out those tubes she will die, just like that. Can you imagine telling a mother that about her child? They said her brain went too long without enough oxygen. They can’t say that. I told them they can’t say that. So they are doing surgery in the morning to put that thing in her throat so she can breathe. I called my boss to tell him I quit my job because now I will need to take care of her full time for a while, until she is back on her feet – well, the one foot she has. Mom finds this funny, and start to laugh. And then freezes mid-motion, and starts to cry. I keep rambling to you, but I don’t want to talk to her. I don’t want to talk to her because I am not going to tell her goodbye, do you understand? We can stand here all night, but I am not going to tell her goodbye. We are just going to have a long night together, some surgery in the morning, and then everything will be fine. Mom is quiet then, and very still for a long while. She suddenly stands up, looks at me, throws her hands into mine, and says: Well, go ahead and pray then, if that’s what you are here to do. Pray for me and my daughter, and those stupid doctors that don’t know anything and the nurses who can’t do their jobs. Only God can help them, and God help us all.
C6: I prayed, then, a prayer of peace and comfort, wisdom for the doctors, help for the nurses to know how to care for mom and daughter, and for mom to see clearly the love she and her daughter share and to gain strength from it. Before we finished praying, someone came in the room, but stood still and silent. When we finished, we looked up to see a nurse who needed to do some care. Before I could say anything, the mom thanked me and told me to come back in the morning before surgery, turned her back, and went back to trying to fix the broken phone she didn’t know how to work.

THEOLOGICAL REFLECTIONS: My theological experience was exploring ways to be present, but also to let her know I was present – since that was what had been requested. The humming idea really helped, because for some reason I felt not to worry about songs, just music. While I was there, and after I left following the chat with mom, I wondered about when the soul leaves the body, or some religions and cultures that talk about the spirit staying nearby to witness what happens to the body or their family response. I also thought of Psalm 4:8: I will lay down in peace, and sleep.

SOCIOLOGICAL REFLECTION: The crisis affected my relationship with the patient and family in a temporal way, in that they kept paging me to return for another visit. It affected my relationship with other staff, in that mom was very critical of the nurses and tried putting me as a go-between. This required me to keep my boundaries while still advocating for patient and mom as well as staff, and negotiating some redirection and reframing to help mom better express what she was feeling to more effectively meet her needs. The justice issue appeared very real with mom, who felt a great injustice was being done to her daughter (and to her) by the doctors saying her daughter was going to die.

PSYCHOLOGICAL REFLECTION: The only feelings or fears I noticed during the meeting was about whether she was going to wake up again or not during any of my visits, because the doctors were so certain she was gone now, and the mother was so sure she wasn’t. I had to keep reminding myself that I wasn’t there to answer that or figure that out, but to be present for the nurses working with a difficult mother and be present for a mother in horrific circumstances and a daughter who was past actively dying. The mother had a great deal of apparent guilt, whether real or false, about her role in the mother dying (the doctors later said mom took her off dialysis early the last time she went, and that this may have contributed indirectly to the first heart attack, and I later learned mom was worried about being reported for medical neglect). Learning this last piece of the story reminded me of our discussion the first week about the chaplains who worked with the sex offender last week.  Would I have treated this mom differently from the beginning if I had first found out that she had contributed to her daughter being in this state? As for the mother, I found it interesting she was so focused on fixing a phone she didn’t know how to work, and this seemed very symbolic of the family dynamics and her wanting to “fix” her daughter that she had not understood or supported.

INCLUSIVE REFLECTIONS: The patient was so young, that it somehow felt more sad that she was dying, which made me think about why that is and why I would feel that. It reminded me of my chaplaincy interview when one of the chaplains asked me if I thought everyone with cancer would die, and I replied with, “I hope not”, because I was still facing it and not ready to die, and this patient was seven years younger than me. Also, I have worked a lot with Native Americans and diabetes, and so it was frustrating that this still happening and so many are still dying so young. It felt overwhelming and I felt helpless in that way, because so many of us have done so much work to try and stop it from happening. In that moment, it didn’t matter how many lives are better, just that we lost this one.

ANALYSIS OF PASTORAL CARE: My risk-taking was definitely humming, which is really scary as a deaf person. I struggled to know what the patient’s needs were in that moment, and how to let her know I was there. I also struggled with staying in my role as chaplain and not intervening like a therapist with the mother, who was being very difficult for the staff that evening. I learned that we can be very present for those who cannot respond at all, even when we do not even know if they were still alive or not. I very much felt her spirit present, but was not all together sure by the third visit that her spirit was still in her body.

PASTORAL OPPORTUNITY: I did go visit the patient again the next morning, as mother requested. She was prepared for surgery and waiting her turn. Her mother had indeed called to quit her job, and was verbalizing the idea that her daughter would be better after surgery and go home that day. That visit was more of a presence visit than the listening to a rant visit like the evening before, as the mother was petting her daughter, and cleaning her hands and face, and being very still and quiet with her in a way I had not seen. Her behaviors and interactions and facial expression looked like she was saying farewell to her daughter, but that was not what she was verbalizing, so she was still experiencing some incongruence as she tried to process what was happening with her daughter.  I noticed the patient no longer made any eye contact, and her eyes were back in her head and there was no visible response anymore like there had been the night before.  The doctor told me later that the patient had had another heart attack in the night, and that they were only keeping her warm, that her brain was dissolving from all that had happened and she would not recover or wake up again.

SPECIFIC ASSITANCE YOU NEED: I was interested in other faith tradition ideas about when a spirit leaves a body (not that we always know these things, but what are the ideas different faiths present about it?), or whether it was appropriate to have held her hand or not, which seemed appropriate at the time.

#WhatChaplainsDo – #CPE 1 Reflection 1

Emily Christensen
CPE I
Reflection #1

1. What has been my internal dialogue (with God, other…)?

I feel like the past five years were so intense in experiences of death and grief that my internal dialogue had been very focused on enduring. I felt as if I was cold, sitting in the unending rain, waiting for the storm to pass. I knew I was okay, or that I would be okay, but my breath was knocked out of me over and over until the only thing I could do was wait for it to finish. Sometimes it was worse, like I was laying low under a train that was going over me, and all I could hear was the loud clackety racket and the cold wet from all that rain. I had no control over it, and could do nothing to make it go away.

The train faded into the distance last year, and the sun began to warm me. I waded through mud to get out into the light, but could not do more than that. The years had been hard, and terrible, and I needed time to recover. I rested and waited, letting the mud dry so I could kick it off. I soaked in the sun until I felt warm again. I sang low, soft songs until I could breathe again. I looked at flowers, and played in rivers, and dug through the earth for vegetables until I was myself again.

Except that I was not myself. I was something more, something that had become, someone who had grown through those long, dark nights. I thought of my tomato plants, and how they have to be pruned back so much to be strong and healthy, and not everything can grow at once. I thought of my corn, growing tall in the storms, and how weathering so much is what made it so sweet. I thought of my river, and how tears are always “a river that takes you somewhere” (Clarissa Pinkola Estes). This is where I found me, after waiting and pondering, after sitting still and listening, after resting, after being still a very long time, until my spirit was coaxed back to me and my body was ready to breathe again.

This is where I am now: set free, able to move, choosing to sing and to dance. I am so excited to be ministering, to be learning, to be participating in life again – even when participating in life means participating in dying. My dialogue has shifted, now, to gratitude and to embracing and to lifting my arms with the wind and breathing with songs of my faith and the laughter of my family. I have been underground this long time, digging my roots deep, but Spring is coming and there is green poking through the snow.

For ye shall go out with joy,
and be led forth with peace:
the mountains and the hills shall break forth before you into singing,
and all the trees of the field shall clap their hands.
~ Isaiah 55:12

2. What experience/ministry events have created the most emotional response within me or have impacted me the most?

My first call on my first overnight shift came before my peer was finished giving me the tour. She quickly found a nearby phone, and even found a paper and pencil for me to take notes with so that I could be ready with any information. But we were far from the classroom was where my backpack lay waiting, and I did not have the cords for my cochlear implants with me. I completely went into panic, with great anxiety and almost a tearful fear. She stayed calm, and walked me back to the chaplain’s office. During the walk, I felt badly that someone was waiting on us to respond because I had not brought everything I needed with me. The walk also gave me time to calm down, and to think, and I realized that this could easily happen again. If one of my goals was to learn to use the phone, then why not now, while I had someone to help me? I wouldn’t always have someone to help me, so whether I felt ready or not, it was time to try. I did call back the number, and I had to ask the nurse three times what the room number was. The nurse was very patient, and the other chaplain was kind to write it down for me when she could hear it and I still couldn’t get it right. It was frustrating that I could not get it right, but it was not so hard or scary as I thought. If she had not been there, I knew at least the floor, and could have checked with the nurses in person to clarify since it is easier for me to understand in person.

3. What questions does this event raise for me about?
a. My ministry?

This example was a more practical piece, but it was one that has made me anxious in the past. Getting cochlear implants has given me so much more access to the world, but is a kind of “passing” because I still cannot actually hear. I get digital information sent to my brain that my brain has learned to code and interpret as sound, but it is not the same. It made me wonder what other things I have avoided because I cannot fully function as I hope, as well as dig deeper to find the courage to face some of those fears so I can improve my function – which would only give me even greater access to the world around me, instead of hiding or missing opportunities just because I am afraid that I will not understand or speak correctly.

b. My theology?
In several of the didactics and reflections, different people have shared about being called to this work or trusting the process. If I really believe that I am called to this work, then I must also act on my faith that Heavenly Father will provide what I need to actually do it. There is a Mormon saying that our Prophet, President Thomas S Monson once said (General Conference, April 1996), that “when we are on the Lord’s errand, we are entitled to the Lord’s help. Remember that whom the Lord calls, he also qualifies”. This means to me that if He has asked me to do this, then He will also help me to really do it. When I think about this, I also think about stories like Moses, who was afraid to speak, or disciples that were only fishermen but asked to become ministers to so many.

4. What new things have I become aware about myself lately?

Using the phone was not as scary as it felt, or maybe it was but not anymore. I still need practice, and may still have some limitations that just are there, but I am able to try.

I also have learned that my intuition, along with spirit-prompting, is better than I knew it would be, at being able to discern what someone needs or not (like to talk or just to listen), but much like the phone experience it is way less scary because there are other chaplains here. I have relied a great deal on the good counsel of the residents, and their suggestions have been very useful. I have become aware that ministry is much smoother when I listen to residents about how to listen to patients! It really made a difference as I got started this week with my first overnight.

5. What goals have I thought about or worked on this week? What is my plan as I go into next week?

I worked on using the phone. It is going to take a lot more practice. Realizing that if I can even get some of the information – a name or a floor, even if not the other details, then I can get those details later in person once I get to the floor. I can also still use my phone and the cords if it just isn’t working because someone is soft or speaks too quickly.

I was also prompted to consider my pastoral identity, which I feel is very raw and fresh and vague, so that is something I am just now beginning to consider as I begin my reading and my first chaplain experiences. This is what is unfolding next, though, and I know because I can feel it stirring within me the way words wait on a page before I can type them.

6. In what ways do I experience my pastoral identity taking shape/broadened?

I realized that I can do it, whereas before I had no idea what it would be like or what it would feel like. I also learned that I enjoy it very much, which is a big relief since I was so excited to try. The first piece of my pastoral identity taking shape, though, I think has to do with my goal about integrating clinical skills: some things have helped me a great deal already, such as knowing how to enter a room, how to consult with nurses or other staff, being comfortable in the hospital setting and waiting room environment, and getting charting done quickly. These things are very small things in our role as chaplains, but it is the beginning of the framework of my pastoral identity taking shape, as I learn to function as a chaplain so that I can discover and develop who I am as a chaplain.

7. In what ways are my faith/and or my theology being challenged and/or experienced as a resource?

My other experience of my theology being challenged was when a patient was dying, which I will write about in my verbatim, and the doctors informed the mother that the patient was “already gone” but mom was insisting patient was still “in there”.  It made me think about things like when does passing actually take place, how technology in the medical field affects this (like we talked about in class with quality of care v. quantity of care), and when the soul leaves the body. It made me also think of Jewish tradition, which says the spirit stays with the body for three days, or until it is buried. I wondered if they were both right, that she was “already gone”, and yet still present in some way, waiting for her mother to let her go.

8. What ways have I utilized my group/supervisor for my learning?

The other chaplain was very kind to stay after class before my first shift and show me around, and patient as I wrestled with the map, and strict with making me find my way back instead of her showing me. This helped so much!

The reflections and didactics and verbatims in our class time has helped me so much to understand our role, to understand the differing needs of patients, and how to improve upon our care for them.

They have also been super useful for practical things, like to always come to class with something prepared whether assigned or not, codes for the doors, a sticker on our badge for the codes, tips for the sleeping room, etc.

9. How are my relationships going with my peers and supervisor?

I have felt very welcome since the beginning, and am so very grateful for these connections and the support. It feels very positive, even when we get very intense with digging to deeper truths or improving upon our work.

10. What would I like to focus on in supervision today?

I needed to focus on this as a beginning, as the discovery of my pastoral identity, and how I have already made so much progress. I was so lost at first, overwhelmed with all the pieces and not having any idea what I would be doing, but the pieces are falling into place and that helps me feel more confident in understanding what I am trying to learn and practice.

#WhatChaplainsDo – #CPE Learning Goals

Chaplaincy training is known as “CPE”, which stands for “Clinical Pastoral Education”.  There are four units required to become certified, and each unit is 400 hours.  These hours have to include overnight shifts, Sunday shifts with chapel services, group supervision, class didactics, book and journal reviews, verbatims, and reflection essays.  At the beginning of each unit, each chaplain intern has to set formal “Learning Goals” as an official contract between myself and my CPE program.  These goals become the measurement of my progress and my completion of the program.

It is required to have to professional goals and two personal goals.  Each goal has the goal statement, and then the minimum performance level (how will myself and my supervisor know I am meeting my goals), terminable observable behaviors (what it looks like as I meet my goals or what I will do to complete the goal), and self-defeating behaviors that could keep me from meeting my goals.

So, with risk of being uber vulnerable after already been raked across the coals by my fellow chaplain interns, here are the CPE goals I set for myself for this semester…

Emily Christensen
January 2015
CPE Unit 1

GOALS FOR CPE UNIT ONE

I. PROFESSIONAL LEARNING OBJECTIVES:

1. Goal Statement (What do I hope to accomplish?): I will foster the further development and integration of the spiritual gifts and clinical skills necessary to provide pastoral care to people in the hospital setting.

A. Minimum Performance Level:
1. I will read Hospital Ministry: The Role of the Chaplain Today by Lawrence E. Holst, and two recent journal articles.
2. I will learn the protocol for both chapel services, as described in the orientation manual.
3. I will learn the medical terms listed in the orientation manual.

B. Terminal Observable Behavior:
1. In my verbatims, I will also identify and reflect upon spiritual gifts utilized in the ministry encounter.
2. I will actively seek feedback from my peers and supervisor as I participate in the learning process.
3. I will present to the class what I have learned about ministry specific to the hospital setting.

C. Self-defeating Behavior:
1. compartmentalizing spiritual and clinical skills
2. minimizing contributions

2. Goal Statement (What do I hope to accomplish?): I will deepen my ability to listen and facilitate ministry, without the need to problem solve (redefine “resolution of the problem”).

A. Minimum Performance Level:
1. I will read something (?) about listening or presence?
2. I will shift my role to being comfortable as primarily a presence rather than a problem solver, though with some understanding of overlap.
3. I will present my presence experiences through verbatims.

B. Terminal Observable Behavior:
1. Verbatims reflect improvement in listening skills and availability of presence.
2. I will become more comfortable with accompanying the person in their experience, rather than directing it.

C. Self-defeating Behavior:
1. inexperience
2. lack of confidence

II. PERSONAL LEARNING OBJECTIVES:

1. Goal Statement (What do I hope to accomplish?): I will maintain quality participation in the CPE program while balancing other work with quality time with my family and good self-care.

A. Minimum Performance Level:
1. I will not work a Sunday shift and an ER shift the same weekend.
2. I will protect Family Home Evening and date night.
3. I will take my children to school four days a week, and tuck them in five nights a week.

B. Terminal Observable Behavior:
1. I will maintain my personal quiet time.
2. I will hear my children singing.
3. We will go playdates without laptops.

C. Self-defeating Behavior:
1. wasting no-kids time without being productive or resting
2. trying to work and parent at the same time

2. Goal Statement (What do I hope to accomplish?): I will learn to use the phone.

A. Minimum Performance Level:
1. I will return pager calls, either with my cord or on a hospital phone.
2. I will make three attempts at using the hospital phone in non-emergent situations.

B. Terminal Observable Behavior:
1. The contact will confirm successful communication.
2. I will share my experience of my attempts, and how I measured success (or failure).

C. Self-defeating Behavior:
1. fear
2. inexperience
3. overwhelmed by external expectations

Sing for Your Supper

Tuesdays are hard work for me, thanks to combining one of my latest work nights with the bath night that cannot be avoided since I am gone Wednesdays overnight.

Once in a while, Tuesday nights get extra exciting because Nathan is away at symphony rehearsals.

I have no complaints, though, even if it is sometimes hard, because I am so grateful that Nathan is so good with the kids and so much help while I am gone one night a week for this short season.  It was impossible, we thought, and now we are halfway through it!  The hardest part is still yet to come: when the Hillcrest and VA programs overlap by about six weeks, right at the time we expect the new baby to arrive.  Those will be a hard six weeks, and I am already praying for our future selves, and that baby.

I have managed to get all of my papers, projects, and presentations finished, though!  It feels so good to be through that part of it.  I am too old for this!  I have been in school since I was five years old!  I am finished!  It’s such a funny mess I am in, and of course I really do love every minute, but the early mornings I had to get up to get homework finished before long days?  That was intense, and hard, and I am glad that piece is done.  I am sleeping all night, sleeping late as I can now, and it feels good to be on a more relaxed schedule again.  I still have classes to watch, and quizzes to take, but I finished mid-terms and only have finals left (about six weeks from now, right in the middle of the screaming baby in heroin withdrawal and the Sunday and Wednesday overnight shifts).

The best thing, though, about having finished all my projects is that while my schedule is still a little intense with the extra chaplaincy training going on, there are two significant changes that make a world of difference:  first, sleep, which I already mentioned but mention again because I love it so much, and secondly, my time at home is actually time at home.  Since January, every spare moment – even if it wasn’t really a spare moment – was spent writing, researching, and typing.  Now when I am home, I can be a wife and a mom again.  I can play with the children, and clean our house (thank goodness), and actually cook once in a while.  Nathan has some mad skills for helping out, which I knew from when I had cancer, but I am really glad to be freed up to just be me again.  That is nice, and makes the intense schedule seem not so bad compared to how hard that was.

This means that I worked on cleaning our bedroom this morning, the kitchen on my lunch hour, and the food storage room and bathrooms after work before the kids got home.  Once the kids got home, I played the mean-mom card, and told them that if they wanted supper then they would hurry up with their chores.  Their chores are simple, because two are six and two are two, but chores are really important.  They have all been here long enough to know what is expected, and are all old enough to practice responsibility.  I do not even have to tell them anymore what to do specifically, because they know!  I was really proud of them as they burst into motion: putting blocks in the block basket, legos in the lego basket, train pieces in the train box, dirty clothes in the hamper, dolls on Toddler’s bed, Five’s cars in his room, books back on the shelves, and everything with glitter in the girls’ room.  They finished in about ten minutes, and I praised them and bragged on them for their hard work.  This saves me hours of cleaning, when they pick up after themselves, and now the house is ready so that any spare moments tomorrow can be for a quick dusting, and vacuuming (while we can still see the floor), and then maybe while they are sleeping I can sweep and mop.  It feels good to be caught up again, and the house not quite so destroyed.

I also rewarded them with wheat free, pudding filled, powdered-sugar-ed cupcakes after dinner!  They really did work hard, and I was proud of them for helping, for cleaning up their own messes, and for working together to accomplish a goal.  We talked about each of those things, and how it benefited all of us, and how the house feels so much better when we can find things and have room to play.  That’s when Five informed me that I was the only one who hadn’t put away my books, which are stacked a mile high on my desk for school.  I told him I have to use them everyday, and that as soon as my class is finished this spring, and he told me that was okay as long as I don’t forget.

Some of them I can put away at the end of next week, actually, as next week will be my finals for my Jewish Studies courses.  The calendar is different, of course, for my Jewish school, so my finals will be next week, and then in March I will begin my next two courses with them: Tanakh (Old Testament) and Jewish Pastoral Care.  I am super excited for these two classes, and especially the Jewish one for chaplaincy, I just had my first Jewish death last weekend.  I knew some things: don’t leave the body alone, let the husband close her eyes, cover the mirrors, point her feet to the door, and read Psalm 21 and Psalm 91.  I tried my best, and the family seemed to be responsive, but I would like to know better how to serve them more and do it well.

I have learned that I am allowed to post my reflections and verbatims from chaplaincy, so I will start doing that.  To catch up, it might seem like a lot at once, so my apologies for the blog-spam, but then it will space out more after that.  All the information is non-identifiable, so you don’t actually know who the patient was, of course, and all of them are by permission.  Verbatims are done in counseling supervision as well, so I was familiar with it and excited to be challenged, refine my skills, and grow internally and spiritually through the process.  It will be fun to share, so my friends know more about what I am doing as a chaplain since it is kind of new to us.

There is so much new to us:  Five and Toddler are here to stay, something we have never ever felt before.  It’s amazing the settling already, and the shift in our bond, and the unfolding of our futures being tied together.  I don’t have words for how it changes things, but it does in ways I did not understand.  The baby and Six are probably being terminated, too.  Six may have family step up at the last minute, so I don’t know that she will be up for adoption.  The baby, though, was talked about in a meeting with the supervisor of caseworkers this week, and they told us to be prepared to adopt the baby if we wanted to keep her.  They don’t think she is going home.

Then there is 13, who is all together another story.  She has been through so much, and has such attachment issues, but really just doesn’t want to be here.  She is not acting out right now – we are working hard with her to support her and help with maintenance behaviors, so there is no trouble or drama, but she doesn’t want to stay, and she doesn’t want to be adopted.  I think they will probably move her to a group home, then, when rights are terminated soon, and it breaks my heart because we would totally be a family for her, and she has such potential, but is not what she chooses.  I have had to struggle with it this week a great deal, even with some tears, because it is not my choice and it is her life and I think my ego is bruised that I couldn’t help her get better fast enough to attach well enough before the DA started termination.  Sometimes I blame the cancer, because she got bounced around two times more after leaving here last summer, and that just makes me angry, but there is nothing I could have done about it, and nothing I can do about it now.  I just care for her a great deal, and don’t want her lost, but maybe it is my turn to trust her – she has endured a great deal, and maybe what she needs is still out there, and maybe she will find who she is able to attach to, and maybe she will be just fine because she really is so amazing.  Or maybe I just try to talk myself into understanding those things only because it stings so much that she will have to leave.

As far as we know, the new baby is still alive.  We know it is a girl, and we got confirmation again this week that we will be the initial placement for the baby.  We also found out that since we are adopting Toddler, we count as kinship for the new baby!  That means that even if other family comes forward, we still have precedence for keeping the baby because we are kinship just as they are, but also have a sibling.  I don’t know if that is a good thing, and so it is okay for me to be excited about it, or if that means nothing really because anything could happen at court and we don’t even know.

This is hard work, getting our family in chunks and pieces and all at once but never knowing what the actual moment means while you are living it.

Except that I know it is real when Six laughs while I braid her hair.

And I know it is real when the baby laughs while I tickle her feet as I take her socks off at night.

And I know it is real when even 13 giggles over cupcakes, giving me a thumbs up when no one is looking.

And I know it is real when Toddler leans over in the middle of dinner, just to put her head on my shoulder.

And I know it is real when Five smiles at me and calls me Mommy and tells me he is really glad he gets to be adopted.

And I know that if you are really, really getting adopted, then that means you need a little white suit for the Temple!  So look at this, what made me cry tonight!  It’s a miracle!  So amazing!  And it made me cry like a girl!

My First Chapel

Today was my first chapel at the hospital!

It’s been so long since I planned worship services. That was one of my minors in undergrad, and I did a full internship for that back in the day. I am grateful now, for that experience.

Because it is an ecumenical environment, we have to be careful and sensitive to a variety of beliefs that may come to the chapel service.

We must also be prepared for a congregation in crisis, whether that is the patients themselves, staff, or loved ones of patients.

We also must prepare a sermon. It must have a theme, so that we can stick to the topic only if the people who come prefer that (such as “comfort” or “hope”), without using a heavy text. We also must have an Old Testament scripture ready in case only or some Jews or Muslims come, as well as an overlapping New Testament text ready in case only Christians of some variety attend the service.

I chose Genesis 15, with the overlapping text of Hebrews 10, because these were assignments for a class anyway, but also felt applicable to this environment. I spoke about being tired, of the weary sort, and promises of strength and capacity to endure. I was nervous because it’s hard to speak without knowing your audience, but we have to speak so much at church and professionally that I just flowed with it.

We have to choose a response meditation, because so many of the liturgical churches use those, and it has to be ecumenical even in its words for God, who I call Heavenly Father.

I chose a litany of intercession (119) from one of the common books of prayer (the congregation together says aloud the “Hear us, O God” part:

Almighty God, who loves and forgets none, we bring before you our concerns for all your children.
For all whom we love;
Hear us, O God.
For all who have blessed us with kindness, led us with patience, and restored us by their empathy and help;
Hear us, O God.
For all who suffer, the sick in body or mind; for all who are troubled by the suffering of others;
Hear us, O God.
For all who are perplexed by the deeper questions of life, and overshadowed with doubt, that light may arise in their darkness;
Hear us, O God.
For the infirm and the aged, and for all who are passing through the valley of death, that they may find strength in you, and light at evening time;
Hear us, O God.
For all forgotten by us, but dear to you;
For all your children throughout the earth;
Hear us, O God.

I thought the “hear us, O God” part felt Mormon enough, even if we don’t often do responsorial readings.

I closed by playing Amazing Grace on my cello, and this was a miracle. I brought it to practice, and loved the sound of it in the chapel space. What an experience! I only got to sight read it quickly just before the service, and I am so new at it anyway, that it was very simple and really bad, but I did it! I was so brave! It was so terrifying, and I felt bad to shrill against the ears of suffering people, but the last note was good so maybe they felt love and comfort in that!

I hope it was okay. I prayed before the service, for the Spirit to speak to their spirits, and prayed after in gratitude. That’s all I know to do.

And now it is snowing, so I could be stuck here for days.

Except this day, this day, is the holy sabbath, and I have patients to visit, and might even skip lunch to finish my work so that tonight I can practice cello in the chapel. That would be amazing, and plenty of fodder for imagination and motivation to keep trying to learn how.

And maybe today, or more often, the cello sings my prayers, and today my prayers are of peace and stillness and gratitude on this day of rest, for my babies have been safely delivered to me and my body restored to health and the year of my entrance into mortality celebrated – and my birthday also marks six year now, since I first read the Book of Mormon overnight and started taking missionary discussions to learn more.

And that changed everything.

This year of rejoicing? This week of celebration? It is only the beginning!

(null)