Tuesday, June 19, 2007

The joys of supervision

Here we are, well into the fourth week of our summer chaplain intern program (my first time as a CPE co-supervisor!) and I am _exhausted_. But, wow, there I was, kind of fading in the late afternoon today, when I noticed a conversation one of our students was having. And all of my sleepiness was all of a sudden replaced by an intense joy. . . . I was positively kvelling!!! The way the student was talking demonstrated so clearly to me that he's really been listening to what we've been teaching and modeling for him; and that he's been working really hard to try and understand and integrate that learning.

It was definitely an "aha moment", and it made me feel great . . . . but I'm still exhausted. :)

Sunday, June 17, 2007

I'm a Wiki, you're a Wiki . . . .

. . . . wouldn't you like to edit Wikipedia, too?

Tonight I did! Yes, as hard as it might be to get your head around, the pages on that amazing free Internet encyclopedia can be edited by anybody . . . even a chaplain. :)

My latest contribution (my second effort at editing a Wikipedia page) was to add a site I just found to the "external links" part of Wikipedia's page on Humanistic Medicine.

The site I added -- the Literature, Arts & Medicine Database -- is really pretty amazing. I came across it while trolling the Web for info about a Chekhov story we are using to spark discussion in our chaplain summer interns' reading seminar. The database is full of texts and comments on literature, film and art meant exactly to be used for this purpose -- that is, to help folks (mostly medical students) use literature and art to help sensitize themselves to the full reality of the patient experience (and not just think of patients as bunch of diagnoses and numbers).

The entries are listed by categories. For example, if you want to teach a session on Death and Dying, you can just go to that category in the database and find dozens of suggestions to use of relevant films and short stories -- including comments on exactly how you can use each!

I'll be interested to see if my addition stays up on the Wikipedia page. From what I understand, there is a small army of serious Wikipedia edtitors who kind of police the site, making sure changes fit the standards of the encyclopedia (I, myself, wonder if the site I added might be better suited to the Narrative Medicine page) . . . We'll see if my entry makes the grade! :)

Friday, June 15, 2007

Where the (theological) rubber meets the road

One thing that chaplain students coming to our hospital sometimes find hard to understand is that we send a chaplain to every trauma (gunshot wounds, serious car accidents, etc.) that comes into our hospital. 'What's spiritual about that?' they sometimes ask. Today, at a bi-weekly all-day seminar, one of my fellow chaplaincy supervisors-in-training said something that helped remind me of the reasons why -- he quoted a trauma doctor at a nearby hospital:

People come into the trauma bay as a consequence of the failures of society.
It's so true. The summer student we've assigned to follow up with our trauma patients keeps coming to me telling me about how many of his patients have a history of attempted suicide. How many of them are jobless or poor. How many of them have drug and alcohol problems. How many of them have been in trouble with the law. How many of them are in abusive or otherwise unhealthy relationships.

In short, while anyone can potentially be a trauma patient, a disproportionate number of them are from the most troubled sectors of society. They are so often from among the forgotten, the unloved and the hopeless. And, what group of people are more appropriate for a chaplain to see? What group is more likely to spark questions in the chaplain student that may lead him or her to new insights and new understandings of what God calls them to do? And what group can benefit more from having contact with someone (the chaplain!) who can model for them the possibility of being an object of God's love and what the implications of accepting God's love can be?

I, personally, have learned so much over the last couple of years by being involved in trauma cases. It's helped soften my heart. And it's helped make tougher the parts of me that need to be tough in order to care for people around pain and crisis. Trauma cases remind us of "The Big Questions" -- what is life? what is the meaning of life? why do the good suffer? what is death? etc. And addressing the Big Questions is exactly what spiritual caregiving is all about. That's true, even if the world 'God' is never mentioned once in a conversation.


I learned many other things at our seminar, today, but one thing that comes to mind is what one of the faculty said about how she works to help students to learn to give each other feedback. This is something that my first Clinical Pastoral Education supervisor worked very hard to help us with. It's something that's very hard to do well. Feedback can often be hurtful to the person you are offering it to. And when they are hurt they cannot really hear it from you. They may feel attacked and get defensive. Effective feedback has to be offered in a way that minimizes the chance of the receiver getting defensive.

This supervisor trains her students to offer feedback by requiring them all to do it. For example, after a student has presented a verbatim (a word-by-word record of a conversation with a patient) to their peer group, each one of the peers is required to offer one piece of positive feedback and one of negative feedback to the presenter.

I'm not sure I like this system (too rigid, I think), but I recognize it has the strength of a sort of leveling of the playing field between talkative and quiet students. It assures that even the quietest person's voice is heard.


I hope you had as productive a day as I did.

Shabbat Shalom!!


Thursday, June 14, 2007

Automotive, Again

Tomorrow morning, God willing, I will end my two-week fast from a car-using existence. I need to drive as part of my education -- every two weeks I go to an all-day meeting in Philadelphia of other aspiring chaplaincy educators (supervisors-in-training). Our meetings take a form that would be fairly familiar to anyone doing a unit of Clinical Pastoral Education (CPE) -- we have a peer group meeting, a lecture and seminars where we get a chance to present our work with students to our peers and supervisors for their feedback, as well as a chance to review relevant books we are reading.

I wasn't able to make the last meeting, so I am looking forward to seeing my peers, again, after a month or so.

Tomorrow will also mark the end of week 3 of the 11 week summer program I have been co-supervising. It has been another great -- and exhausting! -- week. I continue to be awed by the efforts of our students and by their commitment to the learning process.

Some of the highlights of the week for me include the session we devoted to a discussion of Tolstoy's The Death of Ivan Ilyich. [See my discussion of use of literature in chaplaincy and medical education here. Also, see the study questions I created for the students.] We also had a moving session using the "Verbatim as Theological Event" method for theological reflection. I hope to write soon again to explain the Verbatim as Theological Event method and to reflect further on the relationship between Christian theological reflection and the Jewish process of Midrash.


This Shabbat we will be reading Parshat Korah, which contains the story of the great rebellion against Moses -- the great leader of the Israelite people who nonetheless struggled to express himself in words -- led by Korah, a man of fine speech.

As me and my students go about the halls of the hospital and visit patients and families in the coming week, I hope we will remember the leadership of Moses, and remember that we do not have to be like Korah (that is, a person who speaks well) to minister to people. Finely crafted words are not what makes us a comfort; rather, it's what lies in our hearts and the truthfulness of the compassion we can offer.

May it be the will of the Blessed Holy One that we will be able to find compassion in our hearts and be able to offer that to our patients -- and each other.

Tuesday, June 12, 2007

Week 3 -- I never promised you a rose garden

We are now well into the third week of the summer Clinical Pastoral Education (CPE) program I am co-supervising (my first time as a supervisor-in-training!).

Once you get two or three weeks into a summer program, the students' initial excitement usually starts to get displaced by feelings of exhaustion (and sometimes doubts about whether they will be able to survive complete the program).

Our students are no exception to this. These four folks have been working so hard. Not only have they seen a lot of patients, but they've experienced many of the toughest calls you can find within a hospital's walls, including ministering to people amid sudden and tragic deaths.

It's incredibly rewarding work they're doing, but also profoundly exhausting and overwhelming. As one of them said, today, "I don't want to feel anything more."

Anyone who has ever been a chaplain knows this kind of feeling. Chaplaincy, for all of its rewards of being able to be close to people amid their most intimate thoughts and moments, is no rose garden. The key to survival is to be able to have the courage and strength to do what this student did, today: put your pastoral "macho" aside and admit to someone -- someone who is capable of truly hearing it -- that you've given all you can give for now.


Like my students, I am profoundly exhausted here in the third week. But, somehow, I also remain tremendously excited (and even, as you can see, have the energy to blog about my experience!). I love the kind of learning we do in CPE and it's such an incredible privilege to be a part of these students' intense experience and to hear of their struggles, hopes and dreams. I am awed at their heart and the genuineness of their efforts.

I am so grateful to הקדוש ברוך הוא for taking me to this place.


By the way, if you're interested in reading about some summer CPE students' experiences, "Episcopal Chaplain at the Bedside" has collected some links to some student chaplain bloggers here.

Hospitals and (Paris) Hiltons

In the wake of our classroom discussion of the 88th Psalm, one of our student chaplains commented to me about the juxtaposition of the psalmist's sense of the the intensity of his suffering and of the closeness of God to him. The student said the psalm reminded him of how immediate God's presence can feel to a person who suddenly finds his or herself in the hospital.

Reading the psalm through the eyes of a patient, we find illness compared to the experience of being in prison (verse 9). One thing that hospital patients and prisoners surely share is predilection for suddenly embracing religion. The latest "jailhouse convert" is socialite Paris Hilton. Writes the Associated Press:

"I'm not the same person I was," she said [to Barbara Walters]. "I know now that I can make a difference, that I have the power to do that. I have been thinking that I want to do different things when I am out of here. I have become much more spiritual. God has given me this new chance."

It would be easy to ridicule Hilton's sudden references to God in her public statements. And, certainly, many jailhouse converts have gone back to their previous ways soon after their release. But we should not let these disappointments make us cynical. When a patient (or prisoner) speaks to us of their faith, we owe them our trust and attention. If we believe in a God who loves God's creations and wants them to make תשובה/teshuvah (repentance, return) to God, then -- especially if we are chaplains -- we must model for the person the possibility that their faith will indeed be accepted and embraced.

May you it be the will of the Blessed Holy One that you will be a light unto others and show them the love and acceptance that will help them find their way to Torah and faith.

Car-free (for one more day, at least)

As I wrote recently, as part of my effort to be kind to both the Earth and myself, it's now been over a week since I've used my car (and have been doing my shopping, etc., by bicycle).

But then the rear wheel of one of my (two) bicycles seized up. I realized the hub needed to be rebuilt. I didn't have the right tools to get the job done so the wheel needed to be brought to the bike shop. And, ironically, that seemed to mean that I would need to get in the car.

But, three bungee cords later, I managed to get the wheel onto my other bike and went to the bike shop and back this afternoon.

One more car-free day!

Sunday, June 10, 2007

Psalm 88 -- going to the bottom in order to get back up

I've written here before about the possiblity of using great literature to help people (whether they be chaplains or doctors) develop a greater sensitivity to just what it is that hospital patients experience and need. This summer I'm actually putting this into effect myself by leading some literary study sessions with our summer chaplain interns.

Most of our readings will be from 20th and 19th century literature -- like Tolstoy's The Death of Ivan Ilyich. But last week we started with a much older work of literature -- the book of Psalms.

I got the idea that Psalm 88 might be a particularly appropriate psalm to focus on from Paul Steinke, a very interesting trainer of chaplains who works at Bellevue in New York. Rev. Steinke encourages his chaplain students to read psalms to their patients. But, as one of his former students explained to me, he does not encourage them to read any psalm. In fact, he even discourages them from using the most favorite psalm of chaplains everywhere -- Psalm 23 -- at all.

Steinke's reasoning, as I understand it, is that Psalm 23 is too comforting. Comforting words -- as important as they might be -- are relatively easy to find. What is hard to find -- and what it is that the chaplain might be the only one willing to offer -- is someone who will be willing to join the ill person in their most lonely place, the place where their suffering and despair is the greatest. And joining them there -- being willing to try and break their lonliness there -- may be the most healing thing we can do.

Psalm 88 goes to such a dark and despairing place in the most dramatic of ways. In its mere 19 lines, it expresses a wealth of emotions the suffering person might feel, including that God has abandoned them (verse 6):

I am like the dead who have been released [from life]
בַּמֵּתִים, חָפְשִׁי
like the slain lying in the grave
כְּמוֹ חֲלָלִים, שֹׁכְבֵי קֶבֶר
whom You [God] remember no more;
אֲשֶׁר לֹא זְכַרְתָּם עוֹד
And from Your hand they are cut off.
וְהֵמָּה, מִיָּדְךָ נִגְזָרוּ

The psalm also wonderfully expresses the terrible loneliness of an illness, and even the shame that the victim of the illness can feel at his or her condition (verse 9):

You [God] have estranged my friends from me
הִרְחַקְתָּ מְיֻדָּעַי, מִמֶּנִּי
You have made me an abomination to them;
שַׁתַּנִי תוֹעֵבוֹת לָמוֹ
I am imprisoned, and cannot get out
כָּלֻא, וְלֹא אֵצֵא

The line that says you have made me an abomination -- a toeavah -- to them is particularly powerful to me.

What I also love about this psalm is the lines that reflect what I think is one of the central themes of the entire book and that represent the book's favorite way of asking God for mercy. The Psalms' author believes that our purpose is to praise God -- in song and prayer. And, further, the author believes ferverently that God appreciates these songs. In asking for mercy -- and for more life -- the author seeks to remind God that only the living can offer such song (verses 11-14):

Will the dead rise to give thanks to You, Selah?
אִם-רְפָאִים, יָקוּמוּ יוֹדוּךָ סֶּלָה
Will Your lovingkindness be recounted from the grave?
הַיְסֻפַּר בַּקֶּבֶר חַסְדֶּךָ
Your faithfulness amid destruction?
אֱמוּנָתְךָ, בָּאֲבַדּוֹן
Will Your wonders become known in the darkness?
הֲיִוָּדַע בַּחֹשֶׁךְ פִּלְאֶךָ
And Your righteousness in the land of oblivion?
וְצִדְקָתְךָ, בְּאֶרֶץ נְשִׁיָּה
But I, to you HaShem cry out,
וַאֲנִי, אֵלֶיךָ יְהוָה שִׁוַּעְתִּי
and in the morning
my prayer to you will be the first thing.
תְּפִלָּתִי תְקַדְּמֶךָּ

In those final words I have put in bold, one of our students saw a fundamental hopefulness in this psalm, in that the author -- for all his feelings of despair -- has not give up on God and continues to pray to God.

I am not sure I see that in the psalm myself, but I was very encouraged to see how intensely the student was engaging the text of the psalm to find things within it that supported his own theology. It was clear that our discussion of the psalm struck the students deeply, and individual students several times during the week referred to something from our discussion while they were describing their work with patients. This connection by students of the literary study with their reflection on clinical work is, of course, precisely the goal of bringing literary study into a Clinical Pastoral Education program. So, I was extremely pleased to see this.

I hope we have similar results with our next reading!

By the way, my notes are a couple of years old now, but what they indicate is the following (lamenting) psalms are the ones Rev. Steinke was encouraging his students to use (the ones in parenthesis are ones considered not quite as useful as the others):

(30), 38, (41), 88, 90, 130

And here, by the way, is psalm 88


A cyclist's dreams (and a chaplain's reality)

I was sitting in my office, just starting to write in the below about the difference between the Dutch and American approaches to bicycle safety, when the trauma pager went off. I rushed down to our ER to find it was a teenager being rushed in. You guessed it -- hit by an SUV while riding his bicycle (without a helmet!).

Happily, it looks like the bike rider escaped with no life-threatening injuries. But it was just yet another reminder that all the reality of life comes the chaplain's way when you're working in a large hospital, especially one with a trauma center. But, now, on with (the more happy business of) my speculations about bike riding . . . .

One of my longest held dreams is to live a car-free life. For the years I lived in New York City (the public transportation capital of America) and my year in Jerusalem this was something I actually achieved. Since leaving New York, it's been more of a challenge, but I still try. Last week, for example, I didn't start my car even once. I was able to do all my shopping and run all my errands by bicycling.

In a place like Reading, PA -- as in most of the United States -- using a bicycle to actually move stuff (instead of just for pure recreation) is a pretty counter-cultural thing to do. Not so, of course, in Amsterdam. I recently came across a very amusing page full of photographs of how the Dutch use bicycling in the normal course of their everyday lives.

The photographer was especially amused by the sight of people in business wear riding (see his photo to the right of a Amsterdam businessmen on a cycle). This is something I have done even in the car capitol of the world -- Los Angeles. When I was a chaplain for the summer at UCLA's hospital I used to go back and forth between the Westwood and UCLA locations in my white oxford shirt with my tie flapping behind me in the wind.

There are, of course, some here in the States who do advocate a more bicycle-centered lifestyle. They tend to be located in more counter-cultural locations like Northern California or the Pacific Northwest. I found the link to the Amsterdam page on the site for a new Portland Bike shop called Clever Cycles (for some laughs, check out the link they have to some Dutch pro-bike riding public service videos ). Here is a shot of what their shop looks like:

Note the wheelbarrow-like things in the right of the photograph (and also hanging from the ceiling in the upper left). Those are a Dutch-built cycles with a wooden cargo box in the front that is -- believe it or not -- actually designed primarily to put children in (check out the British version of the company's web site if you don't believe me).

The box is touted as a safer alternative to the way some Dutch move their children around town:

Clever Cycles also sells a particularly American solution to the problem of carrying cargo on a bicycle -- the Xtracycle. I first saw one of those on the streets of Boston. It looked so crazy, I thought it was a homemade one-time conversion job, but it turns out it's a kit you can buy from some folks in Northern California to convert just about any bike. Note the skateboard-like looking thing on the top of the cargo area.

Apparently, the Dutch aren't the only ones who can carry kids and cargo on a bike:

Note that, unlike the Dutch kids above, these American kids (and mom) are wearing helmets. Apparently, if you were to dare to wear a helmet in Amsterdam, you would be the subject of no end of ridicule. Unfortunately, there is more than American silliness behind our penchant for putting plastic on our heads when we hit the roads with pedal power: it is much more dangerous to ride here than in Europe. This is not because our roads are inherently less safe (the opposite is true as our roads tend to be much wider, leaving more room for bicycles). It's for cultural reasons -- we just don't respect the bicyclists' right to be on the road and our drivers -- in general -- aren't paying attention for them. All the helmets in the world aren't going to help much if automobile drivers continue to think of bikes as just a 'toy' that belongs in a park.

There are so many reasons why I love the idea of using the bicycle as a tool. Being kind to the Earth (=environmentalism) is definitely one of them. But it's also the beautiful simplicity of the thing. Why spend part of your day exercising (=people's obsession with 'going to the gym') and a separate part of your day driving to go shopping when you can do both at the same time? Overall, it saves time and takes less effort.

Unfortunately, the way we live in this country makes it hard to have a bicycle-centered lifestyle. We tend to live far from our places of shopping (and work). And, as I mentioned above, our roads tend to be treacherous. As regards safety, it was interesting for me to read what one Dutch-born commenter to the person who took the photographs in Amsterdam had to say about the photographer's amazement at the Dutch not wearing helmets:

The Dutch do take bike safety seriously. They've just taken a different
approach. When growing up in Holland, in first grade, we all went through a
full week of safe bicycle riding classes. At the end of the week, police
officers put together a course where each child was presented with traffic
situations for approximately 30 minutes while police officers observed.
Depending on how you did, you received your "safe bicycle" certificate.
Over the next few years, you received refresher courses. Additionally, when
you work on obtaining your drivers license, there is a strong emphasis on
driving around bicyclists.

Here I am constantly amazed how parents teach kids to ride their bicycles.
Kids are taught to ride on the wrong side of the road (am fairly certain
that's illegal) and kids ride on bicycles without lights in the dark
constantly. Signaling is never taught it seems like. (actually, almost the
same can be said for drivers).
Anyway, back to my dreams. I think I my dream is to have three bicycles:
  • The Commuter: a rugged hybrid-style bike that can handle potholes and that has open-top basket-style saddlebags permanently attached so I can stop at the grocery store on the way home from work.
  • The Roadster: a road and/or touring bike that is for going on hours-long excursions on days off.
  • The Truck: something (an Xtracycle?) that can handle serious trips to the supermarket, etc. . . . . . I had such a bike when I was a kid with a paper route. It had big metal baskets on both the front and the back. My Father (of Blessed Memory) even made a contraption so I could tow one of those folding shopping carts behind me. It worked pretty good (and held a lot of Sunday newspapers!), except for that one time I was racing my friends down this one hill with it behind me. When I got to the turn at the bottom of the hill, the cart flipped over and sent me and my papers flying. . . . No broken bones, though. :)

Friday, June 08, 2007

Getting this party started (II)

I just wanted to take a few minutes before Shabbat comes in to acknowledge what a great week I had and how thankful I am for it. It was the second week of our summer interns' program, and it was the first week where I formally functioned as the supervisor for two of the students by meeting with them in the first of our weekly one-hour individual sessions.

It has been an important dream of mine to become a CPE supervisor. I do not know if it will be the will of the Blessed Holy One that I should ever complete the long path to becoming fully certified as a supervisor, but this week I took an important first step on the journey towards that goal. I was very happy with how this "first step" went, as I was very happy with many of the things that myself, my supervisor and the summer students did during this past week. I remain extremely excited about this summer and am looking forward to great experiences and great learning -- both for myself and the students. May the Lord accompany on us on our journeys. May it be the Lord's will that we -- and our patients -- will be blessed by our journeys and struggles. And may peace follow us -- and all people -- wherever we go.

A stranger in a strange land

I was reflecting today on what really bothered me in the experience I described in my recent "Sour Mile" post: I think what I really wanted this chaplain in an overwhelming Christian hospital to do was to acknowledge that it would certainly indeed be a problem to have a Jewish chaplain (that is, me) in his program.

I concede that what I am saying is counterintuitive. You would think that a minority person would want to hear exactly what this guy was working hard to tell me -- which is that it would not be a problem, and that any needs I had could be accommodated.

But the problem is that I know that there is no way any such assurance could be true. Any person who has ever experienced being a minority knows that his or her minority status is a constant issue that must constantly be struggled with. The really scary thing is when somebody refuses to acknowledge the presence of that struggle. It means even harder work for you as the minority person in terms of educating the people around you -- before you can even start the difficult process of struggling with the differences, you have to first convince them that the need to struggle even exists.

For us Jews who live and work among others, it is essential never to forget that, no matter how welcome we might feel where we are, we still always indeed remain strangers. Our greatest leader -- Moses -- made a reminder of his strangerhood (living amid other people) in the most dramatic way -- he gave one of his sons a name that constituted such a reminder:

וַתֵּלֶד בֵּן, וַיִּקְרָא אֶת-שְׁמוֹ גֵּרְשֹׁם: כִּי אָמַר--גֵּר הָיִיתִי, בְּאֶרֶץ נָכְרִיָּה.
And she [Moses' wife Tziporah] gave birth to a son. And he [Moses] named him Gershom: as he [Moses] said, "at stranger I was in a strange/foreign land. [Exodus 2:22]
Again, like I said in my Sour Milk post, I appreciate the good and honest intentions of the chaplain I was talking to. But, I wanted to identify why his assurances did not fully satisfy me.

Shabbat Shalom!