The caregiver and the scapegoat

Today, turned out to be a banner day for medical workers accused of criminal wrongdoing. Not only did Libya -- finally! -- release a doctor and five nurses who had spent 8 1/2 years in prison under threat of execution (on the flimsiest of evidence), but also a grand jury in Louisiana cleared the last of those accused of "mercy killing" during Hurricane Katrina:

NEW ORLEANS, Louisiana (AP) -- A grand jury Tuesday declined to indict Dr. Anna Pou, the surgeon accused of killing four seriously ill patients in the aftermath of Hurricane Katrina.

Pou and two nurses were arrested last summer after Attorney General Charles Foti's investigation concluded they gave four patients a "lethal cocktail" at Memorial Medical Center amid the chaotic conditions that followed the August 2005 storm.

What these two cases -- across the world from one another -- had in common is the element of scapegoating. In both Katrina, and the infecting of hundreds of Libyan children with HIV, there was a tragedy the result of which innocent people died. In both cases, there was an angry public. And, in both cases, the politicians in power were looking for somebody to blame.

It had always struck me as terribly unfair that the Dr. Pou, along with two nurses, were accused of criminal wrongdoing. It's not that I'm defending their actions (I really don't even know the details). But, at a time when dozens of police officers and others were abandoning their posts, these three caregivers chose to follow the call of their profession and stay. They stayed with their patients in a hospital where the electricity was out, where the first floor was under 10 feet of water and where the temperatures topped 100 degrees. Did they make some questionable decisions under those incredibly difficult circumstances? Maybe. But to haul them before a court of law when all they were trying to do was save lives? Absurd! I'm so glad it's over.

_______________

The next Katrina?

Episcopal Chaplain points out that the Dr. Pou case is anything but irrelevant to the work of hospital chaplains and ethcisits: the very kind of challenging ethical dilemmas that Dr. Pou faced in a sudden crisis (ie, not enough working medical equipment and care to go around) may be just around the corner for all of us. All takes is a (widely expected) flu pandemic or a major terrorist event (please, God, let it not come to be).

What will we do? Are we ready for these ethical decisions? Will we (again!) scapegoat the people brave enough to stay at their posts?

Libya frees nurses and doctor in HIV case

From the New York Times:

clipped from www.nytimes.com Libya Frees Nurses and Doctor in H.I.V. Case SOFIA, Bulgaria (AP) -- Five Bulgarian nurses and a Palestinian doctor who had been imprisoned for 8 1/2 years in Libya arrived to a hero's welcome Tuesday after being released from life sentences for allegedly contaminating children with the AIDS virus. Shortly after their arrival, Foreign Minister Ivailo Kalfin announced that President Georgi Parvanov had signed a decree to pardon the medics, who arrived on a plane with French first lady Cecilia Sarkozy and the EU's commissioner for foreign affairs, Benita Ferrero-Waldner.

Holy books banned by the Feds?

It sounds like there's some exaggeration in this article. But, nonetheless, as a person of faith I am concerned -- I can't imagine any legitimate reason for the federal prison authorities to be limiting the Holy books of any faith tradition.

clipped from The Jewish Week (07/20/2007) Fearing Muslim ‘radicalization’ in prisons, feds limit number of religious books. Jewish Inmates Say Torah Now Banned Fearful that some religious books — particularly those of Muslims — might promote “violence and radicalization,” the federal Bureau of Prisons has removed all but 150 books per religion from its prison chapels. As a result, Jewish inmates who have long had access to hundreds of Jewish books, complain that now even the Torah is denied to them.

_______________________________
UPDATE (7/25):

Apparently, as I predicted, there was some exageration in the article. Or at least that's what it seems from this letter the New York Board of Rabbis wrote to the editor of Jewish Week:

July, 24, 2007

The Jewish Week

1501 Broadway, Suite 505

New York, NY 10036

Attn: Gary Rosenblatt, Editor

Stewart Ain, Staff Writer

Dear Editor:

With regard to your recent article entitled “Jewish Inmates Say Torah Now Banned,” (07/20/07). The New York Board of Rabbis understands that the removal of Jewish books is part of a comprehensive review process of all religious materials of all faith constituencies, according to the Chief Chaplaincy Administrator of the Federal Bureau of Prisons. Upon completion of this process, all such materials will be returned to the prison library. Furthermore, no limitation will be placed on the number of books available to inmates. The following two communications were received from Rev. Susan Van Baalen:

Dear Rabbi Potasnik, This is a follow up to our recent conversation regarding procedural and operational changes for chapel libraries Bureau-wide. Approximately one year ago we began a process of reviewing all library holdings with a view to discarding all materials that were discriminatory, or had the potential to incite violence or foster radicalization of inmates. In order to ensure that all libraries had some materials available, during the lengthy review process, we asked Subject Matter Experts (in the Jewish case, two Orthodox and one Conservative rabbi) to provide us with an initial list of up to 150 books, and 150 audio and video selections that were unquestionably suitable for prison libraries. After the publication of the initial list, we announce that additional items would be added to the lists after the SMEs had the opportunity to review additional materials. At no time was there a decision to limit the holdings to 150 per faith group.

* * * * * * * * * * * * * * * * * * *

We have informed all stakeholders and the media of the process, but it seems they prefer to print their own interpretation of the process. Both stakeholders and chaplains have been informed that the list of library holdings will be updated in October. Chaplains and stakeholders were asked to submit titles, authors, publishers and ISBN numbers of books and other materials they wished to have reviewed. To date we have received very few. As the materials are submitted to us, they are forwarded to the subject matter experts for review and likely inclusion in the October update, or a future update, if not received in sufficient time to review for October. Books will not be removed from the shelves; instead, additional books will be added to the original 150.

It is not true that the Torah is denied them – although Sefar Torahs are not items we can afford to purchase and protect in the prisons. In the few institutions where Sefar Torahs are accessible, there is still access. Sidurs and Tenach are available in every prison.

The Torah and Tenach are not considered library holdings. These are worship materials and stored and used as such. They do not circulate as library books.

With regard to the mistakes in the Jewish Week article – it is fraught with error. The number of Jews is approximately one-half the number cited by Aleph.

The library renewal project has not been delayed. There are benchmarks that have been met, and future benchmarks that will be met. This includes continued review of materials and continued updating of lists. Most importantly, to be sure you understand, I repeat what I have told all of our stockholders and those inmates who have inquired: This is an on-going process. The lists will be updated at least annually, adding books to the initial collection of approximately 150. Prayer and worship aids are not considered library materials – and no action has been taken with respect to worship aids. Thank you for your cooperation.

Please note that the NYBR is the endorsing and reviewing body of all Jewish chaplains in our City and State Correctional facilities. We also maintain communications with Federal officials and will monitor this latest development. Each Jewish inmate is entitled to access all religious materials in every institution, and we at the NYBR are determined to protect that right.

The NYBR is the largest interdenominational rabbinic body in the world representing all denominations within the Jewish community

Rabbi Joseph Potasnik

Executive Vice President

New York Board of Rabbis

Rabbi Stephen Roberts

Associate Executive Vice President &

Director of Jack Weiler Chaplaincy Program

New York Board of Rabbis

Rabbi Arthur Morgenstern

NYBR Liaison to Correctional Facilities

A Modern Orthodox rabbi takes on interfaith prayer

An interesting post (with comments) from a Modern Orthodox rabbi with an ill congregant who has some born-again Christian friends who want to pray for her:

Personally, I am not terribly bothered by their request. If we follow the Rama's ruling that Christianity is not classified as avodah zarah for non-Jews, why not permit them to do what they want?

Other WACvillians have a different take; they view these “friends” as preying rather than praying, attempting to convert her.

The full post.

Secular Turks may vote for religious parties

From the New York Times:

clipped from http://www.nytimes.com/2007/07/19/world/europe/19cnd-turkey.html?hp Election in Turkey May Be a Watershed ISTANBUL, July 17 — For 84 years, modern Turkey has been defined by a holy trinity — the army, the republic and its founder, Mustafa Kemal Ataturk. Each was linked inextricably to the others and all were beyond reproach. But a deep transformation is under way in this nation of 73 million and elections this Sunday may prove a watershed: liberal Turks, once the principal political supporters of the nation’s ruling secular elite, are turning their backs on it and pledging their votes to religious politicians as well as a broad new array of independents. #*#

Libya lifts Bulgarian nurse death sentences

From a New York Times article:

Libya on Tuesday commuted the death sentences of five Bulgarian nurses and a Palestinian doctor convicted of having intentionally infected hundreds of Libyan children with H.I.V., the virus that causes AIDS.

Libya changed the medical workers’ sentences to life in prison after the families of the infected children each received $1 million. The decision could pave the way for a deal in which the Libyan government transfers the medical workers to Bulgaria, where it is probable they would be released.

I had written about this last week. While I am very pleased that Libya has finally lifted the death sentence here that does not in any way justify the torture -- both literally and figuratively -- to which these healthcare workers have been subjected. Nor does it justify the pain this ongoing injustice has imposed upon their loved ones.

Free the Benghazi Six!

Rabbi-chaplain to file civil rights lawsuit against US military

It would deeply sadden me if the below accusations are really true. The political blog Truthout reports:

A former Army chaplain who has been listed as a deserter by the Department of Defense intends to file a civil rights lawsuit against the United States military for refusing to discipline three Evangelical Christian Army chaplains at Fort Stewart, Georgia. The three allegedly subjected Rabbi Jeffrey Goldman to vulgar displays of anti-Semitism in 2001 and 2002.
. . . . .

According to documents obtained by Truthout, an investigation by the Army Inspector General into Goldman's claims of anti-Semitism shows that in May 2001, Captain Robert Nay, a Christian chaplain at the Fort Stewart Army base, hung Nazi uniforms and swastikas on the wall of the officers' club at Hunter Army Airfield in Savannah, Georgia, during a May 23, 2001 interfaith prayer breakfast Goldman was ordered to attend.

Do we mean what we say?

It seems to me that this is the central issue in the debate over the Pope's recent proclamation allowing the wider use of the traditional “Latin Mass ”. This traditional mass contains statements that are painful to many Jews. The text of the Good Friday liturgy, in particular, singles out Jews for conversion, attributes to them a particular “blindness,” and asks God to lift the “veil from their hearts” so that they might know Jesus Christ.

If Catholics are really speaking of a genuine belief in the "blindness" of my people when they go to a mass saying these words then I have to say I do find it painful, especially as that would be reminiscent of the centuries of oppression that Jews have faced from Catholics and other Christians.

But do Catholics really mean what the words literally say? Few are the people (or priests!) in the world today who understand Latin (and the mass would be said in Latin).

In my own spiritual practice, I have long held that the meaning of the (Hebrew) prayers I say is not in any way limited to the literal meaning of the words. One of the reasons I like praying in a language that is not my native tongue is that it makes it easier for me to lift my spirit from being chained to the thoughts behind the words and instead let they prayers go straight into my gut and into my soul. This is one of the reasons I am not a Reconstructionist (which in its classical form holds that we "must only say what we really mean" and therefore made extensive changes to the traditional Jewish liturgy).

Nonetheless I am troubled by the Pope's action. Why make this change now? What is he trying to tell the world about Catholicism and its relationship to other faiths? The Center for Christian-Jewish Understanding recently wrote a letter to Catholic Church leaders, stating in part:

Many Jews and Christians understand the wider use of the 1962 rite containing the preconciliar Good Friday prayer text to be a reversion to the unfortunate Adversus Judeus tradition that the Church has so forthrightly and consistently rejected since the Second Vatican Council. The theology of this prayer appears inconsistent with the Church’s binding commitments undertaken in Nostra Aetate (1965) to deplore anti-Semitism and eschew negative depictions of Jews and to “foster and recommend mutual understanding and respect,” and Guidelines (1974) that states: “Lest the witness of Catholics to Jesus Christ should give offense to Jews, [they must maintain] the strictest respect for religious liberty…” The rich legacy of Pope John Paul II concerning Catholic-Jewish relations consistently taught that the Church’s “attitude to the Jewish religion should be one of the greatest respect, since the Catholic faith is rooted in the eternal truths contained in the Hebrew Scriptures and in the irrevocable covenant made with Abraham” [Sydney, Australia, Nov. 26, 1986].

_______________

By the way, here are some interesting blog posts on this subject by Jewish writers who are _not_ so bothered by the pope's decision:

• Rabbi Jill Jacobs
• Rabbi Jill Jacobs, again
• Rabbi without a cause
  

Literary Resources

Some resources for literary CPE:

• Alan Abrams' study questions on Kafka's Metamorphosis
• Alan Abrams' study questions on Tolstoy's The Death of Ivan Ilyich
• Literature, Arts & Medicine Database (http://litmed.med.nyu.edu)
• Abayye blog entries on the power of story
• Other resources that I -- and other educators and CPE supervisors -- have found particularly helpful
• Anton Chekhov's Gusev
• Edwin Friedman's Friedman's Fables
• Becket's Waiting for Godot
  

#*#

Soon to be in stores

I just got in the mail, today, a copy of the upcoming Celebrating the Jewish Year: Fall Holidays -- Rosh Hashanah, Yom Kippur, Sukkot. I have an essay in there (pg. 168) on the Never-ending Joy of the holiday of Sukkot!

Amazon expects to start shipping the book at the end of August. Its author is Rabbi Paul Steinberg, an amazing ex-classmate of mine who works at a Jewish day school in Dallas.

Free the Benghazi Six

We Jews know all too well how prone people are to blame "foreigners" when something tragic and unexplainable happens. This historical legacy of being scapegoated should make us even more sensitive when we see the same thing happening to others. And there are few such cases in the world today more troubling than that of the six healthcare workers, mostly Bulgarian nurses, who have been condemned to death by Libya. Just, yesterday, the Libyan Supreme Court upheld the death penalty imposed on the six.

The case arose because of the infecting of over 400 Libyan children with AIDS at a hospital in 1998, a tragic and inexplicable event. An event that may have even had to do with some degree of negligence. But a conspiracy of intentional murder (of which the six were convicted)? Murder worthy of the death penalty? And only the foreign workers being responsible, not a single Libyan? The accusations are laughable on its face.

But there is nothing laughable about innocent people being killed by a government in order to placate an angry populace. Nothing laughable at all.

You can sign a petition for the six here.

The ultimate healing?

I heard a presentation, today, where somebody quoted from a 1998 article where a leading expert on spirituality in healthcare described death as the "ultimate healing".

"There is some sort of built-in conflict between most of our medical measures and spiritual ideas," Penn Folklore and Folklife Professor John Hufford, PhD, told his audience in Medical Alumni Hall. "Just think about the irony: In religion, death is the ultimate healing. That clashes with the whole purpose of medicine."

It was a bit of one of those "sour milk" moments for me -- a moment where I saw a Christian assuming (incorrectly!) that a tenet specific to their own religion was universal to all faiths. While there is a diverse variety of beliefs in Judaism about death and the afterlife, it would be hard to say that Judaism understands death as a healing (or a "victory" as some Christians say). [I wasn't, however, offended or excluded by the presenter today, who was clearly working hard to make me feel included and welcome.]

My prayer is that the experts in spirituality in healthcare can grow to better understand what is their own values and assumptions and what are other people's values.

Redemption the Jewish way -- it's not easy

Jews don't tend to talk about theology too much. But, as an interfaith educator of student chaplains I talk to Christians a lot. And they do like to talk about theology. Today, one of them asked me what redemption would mean to me.

As usually happens when I get asked this kind of question, I was a bit stunned at first. But then I reached back into my knowledge of the tradition and pulled a piece of wisdom out of our liturgy -- when we welcome a new Jewish boy into our covenant with God (a bris ) we wish that he may grow up to be entered into three things:

• תורה/Torah -- The study of Torah.
  
• חופה/Huppah -- Marriage (literally the marriage canopy)
• מעשים טובים/Maasim Tovim -- Literally, "good deeds"
  

Of course I wasn't talking about national or eternal redemption (if I was, I might have talked about the coming of the Messiah ). Rather, we were discussing what redemption might look at for the person who has got "lost". For the person who has seriously sinned, or gotten badly involved in drugs or criminal activity. For the person who has (physically) hurt others or his or herself. How might that person be "saved" to use a word Christians like? (We were talking about an actual patient like this. One who had been sexually abused as a child and later fell into prostitution and drug use.)

I said that my hope for such a person is that they could fulfill the promises of the bris: That they could grow to find their way to Torah. That they could find a relationship with another that could be honest and loving and lasting. And that they could find a way to help others and be a positive influence on the world through their good deeds. That would be redemption to me.

My Christian colleague's response shocked me: "That sounds impossibly hard," he said.

And this speaks to a dramatic difference between Christianity and Judaism. For most Christians, redemption is something that only comes as a gift from God. They might even say that there is nothing you can do to earn redemption; it can only come from God (being saved by grace).

What I love about these kind of conversations is that they affirm for me my identity as a Jew. I can intellectually understand this sort of Christian theology. But in my gut it means nothing! In my gut I'm all Jew.

Blessed are You, Lord our God who made me a member of the covenant of Israel!

_________________

FYI, here are some quotes from the old Encyclopedia Judaica's article on redemption:

The sages [of the Talmud] know nothing of a miraculous redemption of the soul by external means. There is no failing in man, whether collectively or as an individual, which requires special divine intervention and which cannot be remedied, with the guidance of the Torah, by man himself.

Joseph B. Soloveichik, the modern Orthodox thinker, describes redemption in terms of faith and performance of mitzvot, but also includes the idea that the human capability of renewal and self-transformation manifests itself especially in times of human distress. Being redeemed is a mode of existence, not an attribute. "Even a hermit can live a redeemed life" (i.e., as a mode of existence, redemption is an individual thing and not dependent upon society. "The Lonely Man of Faith" in: Tradition, vol. 7, no. 2, Summer 1965). Furthermore redemption is a function of man's control over himself. "A redeemed life is ipso facto a disciplined life" (ibid.). As opposed to dignity which is man's triumph over nature and the feeling of success, redemption is when man is "overpowered by the creator of nature," and it is discovered in the "depth of crisis and failure" (ibid., 23–24).

This is your brain on cigarettes

There was a fascinating interview, today, on NPR's Fresh Air with the director of the National Institute on Drug Abuse (NIDA). In the interview, Dr. Nora Volkow had many interesting and provocative things to say about the science of addition, but the one thing that really stood out to me is what she replied when she was asked what the worst gateway drug. Was it marijuana? Alcohol? No. She said it was nicotine.

It's not that cigarettes make you high. It's that they stimulate the same dopamine receptors that cocaine and crystal meth do. They get you trained to want to get your dopamine thing on.

I'm glad to say that the hospital I work at has recently decided to become to a smoke-free campus!

Ideology kills -- politics and healthcare

The Bush administration's former surgeon general testified on Capitol Hill, today:

"Anything that doesn't fit into the political appointees' ideological, theological or political agenda is ignored, marginalized or simply buried, . . . The problem with this approach is that in public health, as in a democracy, there is nothing worse than ignoring science, or marginalizing the voice of science for reasons driven by changing political winds. The job of surgeon general is to be the doctor of the nation, not the doctor of a political party."

Dr. Richard Carmona, who served as the surgeon genera from 2002 until 2006, was testifying before a House of Representatives committee. Carmona said that he was muzzled from speaking from a scientific point of view on such life-and-death issues as AIDS prevention and stem cell research.

Cutting the beef -- hands-on eco-kosher

The woman on the right is my friend Devora Kimelman-Block. She's surrounded by beef as part of her effort to get kosher meat that is organic and locally and humanely raised. This is not the kind of meat you can find even in a kosher butchery.

That's something that would stop most people. But Devora is the kind of amazing person who just doesn't let anything stop her. So she went out and found the sources and people to get what she needed.

The picture is from a front-page story ("Eco-Kosher Movement Aims To Heed Tradition, Conscience") in Saturday's Washington post. It quotes Devora:

"I'm very interested in my children having a relationship with where their food comes from," said Kimelman-Block, 36, who has two daughters and a son, ages 2 to 7. "I just think it's an important part of what I'm teaching them that we go out to this farm and we know the farmer and we help plant the potatoes and help pick the strawberries."

Go Devora!

Where are the Jews? Where are the men?

From a quick review of the ACPE web site:

• There are currently no rabbis who are candidates to be CPE supervisors (these are the people who train other chaplains, etc.).
• There are four rabbis who have made associate (which is one small step shy of being fully certified).
• But none of these four is male!
• There are five fully certified rabbi supervisors, two of whom are male and three of whom are female.

Now, granted, these numbers don't tell the whole story (there's also the CPSP and potential supervisors like myself who are earlier in their training and might make candidate in the next year or so). But, nonetheless, they are very troubling. There just aren't enough Jewish CPE supervisors to give rabbinical students and other Jews a good chance of being able to find a Jewish supervisor to train with. And how are we ever going to get enough if we don't have any Jewish candidates?

Finally, I think it's important for there to be male role models for Jewish chaplains. To the best of my knowledge, there is not a single male rabbi from the Conservative Movement (my denomination) who is a CPE supervisor.

These numbers just make me more determined to follow the path I'm on!!

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

I climbed up my favorite hill on my bicycle after work today for the first time in a long time. When I started to approach the top -- some 800 feet above the valley below -- I felt an excitement start to course through my body. I was going to be going very fast, very soon. The air I was pushing through would become a roar as I lowered myself into the lowest crouch possible. Nothing would exist for me, but myself and the descent as I concentrated every bit of mental energy on safely guiding my bike down the curving road.

But when I actually got there I found myself lusting for even more speed than gravity could provide and I started pedaling furiously to try and go even faster. I topped out at 69 kilometers per hour (43mph), seven mph shy of my dream of hitting 50, but still -- believe me -- quite fast to be going on two narrow wheels!

I consider myself a pretty risk averse person overall, but something happens to me when I get on a bicycle. I become fearless. . . . Maybe that's what happens to people here in Pennsylvania who ride motorcycles. Maybe they're responsible people most of the time, but when they get on their motorbikes they don't care about their own safety anymore.

I just don't know any other way to explain the fact that so many motorcycle riders here don't wear helmets. It was not very long ago that I stood in a room at the hospital when a neurosurgeon told two teenage children that the father they had seen perfectly healthy only hours ago was almost surely going to die from his injuries. It was a bad accident. This guy was really hurt. But they stopped his bleeding. As I overheard one of the docs say later, "it would have been a great save if it wasn't for the head."

We see this all the time in our trauma center: Motorcycle riders who, if they had only been wearing a helmet, would have one day been able to leave the hospital and resume their normal lives, again. Instead, their families are left with the heartbreaking decision of whether to shut off life support because their loved one's brain is gone.

And it's so unnecessary. Pennsylvania had a helmet law. But it was repealed in 2003. And despite the tragic results of that repeal some motorcycle advocacy groups are still fighting restoration of a helmet law.

The groups make the kind of ludicrous argument that people are more careful when they ride without a helmet and so are less likely to get in an accident. Well, I wonder how that would have helped the guy who came into our trauma center this morning. He, like so many other motorcycle riders who get in accidents, was riding as safely as could be. He was stopped at a light when a truck and a car had their own mishap that sent the car flying into the rider. He was just in the wrong place at the wrong time. He said he never even saw it coming. All he remembered was getting hit.

And there's only one reason he remembered it -- he was wearing a helmet! He's hurt. He'll be hurting for a while. But he'll be perfectly fine once he heals. Thanks to his helmet. That's what helped him. No amount of "greater awareness" if he hadn't had it on would have helped. He might be a vegetable, right now.

I think there really needs to be a grass roots movement to get this helmet law back. Surfing the web, I couldn't find any sign of a group fighting for its restoration, although State Rep. Dan Frankel, D-Allegheny has introduced legislation.

If you live here in Pennsylvania, I urge you to write your representative and ask them to support restoration of the helmet law.

__________________

By the way, the Jewish tradition has no place for the kind of "who cares if I get myself killed, it's my right to decide" attitude behind the fight against helmet laws. Judaism sees our bodies as merely being on loan from God and we are commanded to take care of this gift. Making sure to preserve our own lives is very important in the tradition.

And, yes, I do wear a bicycle helmet!

Marriage and Judaism

Elliot Dorff, one of my favorite rabbinical school professors -- and just a general mensch -- is featured in the latest broadcast of NPR's Speaking of Faith.

Rabbi Dorff speaks beautifully in this show about the role of marriage in Judaism, and about how Jewish traditions -- especially Shabbat -- help support the institution of marriage.

It's worth a listen!!!

________________

By the way, I think it says something wonderful about Judaism that Rabbi Dorff should start out talking about sex and marriage and eventually end up taking about Shabbat. That's what reading the Talmud is like -- all discussions eventually lead to Shabbat. It's the great obsession of Rabbinic Judaism. . . . And something that distinguishes Judaism from the other Abrahamic faiths. Can you imagine Christian scholars starting out talking about sex and marriage and end up talking about the Christian sabbath command to rest from work once a week? No way! They might talk about the role of prayer or of faith in Jesus, but not the sabbath. It's not that Christians don't have a sabbath in their faith -- they do (you can see the remnants of this in the places still left in the United States where the law keeps stores closed on Sunday). But Christianity is not obsessed with the Sabbath. Rabbinic Judaism -- and me! -- are.

. . .cycling in the rain, I'm cycling . . .

People who know me well know that I don't bicycle ride just for exercise. I ride to go to the supermarket and the park. . . . And I ride because God is out there.

Out where, you say? Well, there are three classic places to find God in the Jewish tradition -- in out texts (Torah!), in our relationships with others (ministering to hospital patients for sure!) and in nature (God's creation). And while God certainly created the sunny day we normally hope for when we get on a bicycle, sometimes it's easier for me to find God's hand in nature when I can feel that hand actively touching me. . . . When I can feel the wet of the rain touching me, the wind pushing me and the sound of thunder in my ears.

קוֹל יְהוָה, עַל-הַמָּיִם
The voice of HaShem (the Lord) is upon the waters! we sing as we parade the Torah around the sanctuary on Shabbat
אֵל-הַכָּבוֹד הִרְעִים;
The Glory of God thunders.
יְהוָה, עַל-מַיִם רַבִּים.
HaShem is upon the myriad of waters.
--Psalm 29

This afternoon I awoke around 2:30pm (I was recovering from being on-call in the hospital for the 24 hours of July 4th). I would have tried to get out on the road right away, but I had broken a spoke Tuesday night. Luckily I had a spare and -- as part of my ongoing program of trying to learn to do more of my own bike maintenance -- I already had the experience under my belt of once replacing a spoke before. This was the occasion for me to assemble my new truing stand (I had purchased it at the end of April, along with a repair stand ($175.48 for both, including tax and shipping from Nashbar). You really don't need a stand for basic truing, but I have to say it made the task much easier.

Anyway, so I had this feeling of success when I finally got the bike put back together. But it was kind of dark outside and there was rain and some thunder. I looked at the weather report and saw the rest of the afternoon and evening was expected to be more of the same. It took me a few minutes to talk myself into it, but soon I was heading out the door into the rain. I'm so glad I did!

It made me think of the best time I ever had riding in the rain. It was last August and part of an awesome week-long bike tour I did on my own from here in Reading to the Jersey shore and back (around 300 miles total). That day I had badly underestimated how much time it would take me to get me to my final destination for the day (about five miles northwest of downtown New Brunswick, NJ). Around dusk, I hadn't even made it to New Brunswick when powerful gusts of wind and the sight of lightening in the distance ushered in the storm. And this wasn't just any storm. It was probably the worst thunderstorms to hit New Jersey that entire summer; trees and power lines got knocked down throughout the state.

When I finally made it into New Brunswick, it was dark and I found myself in a maze of roads under construction by the Rutgers campus. I was lost and didn't have a good map. All I knew was I needed somehow to follow the right bank of the Raritan river. All I had was my compass and a rough sense of where the river was. There was no one around as the rain started to fall hard and I started to get scared.

Eventually I made my way into downtown New Brunswick and found the road I needed (rt. 527). At first it was a fairly decent city street, but it soon turned into the kind of high speed multi-lane highway (with a minimal shoulder) that it would have been dangerous to ride on during the daytime. And here it was dark amid a pouring thunderstorm! Trucks were passing by splashing up waves of warm water onto me. I could hardly see in front of me.

And then it happened. The fear disappeared. I was bone tired and exhausted, but my legs kept turning without me having to consciously will them on. I realized that I was singing.

I have been a rover
I have walked alone
Hiked a hundred highways
Never found a home
Still in all I'm happy
The reason is, you see
Once in a while along the way
Love's been good to me

It was from this amazing Johnny Cash album -- American V -- that was constantly on my iPod and in my heart and mind that summer. Songs that spoke to me with their voice of a man who knows he is close to death, but has grown to have nothing but acceptance in his heart (acceptance that brings him profound joy even as he stands right before the doorway to the end). . . Songs that were a deep spiritual inspiration to a man who was spending his time working amid so much death and suffering in a hospital. Songs of a man who was prepared to die at that moment and face whatever might lay before. Songs of spiritual joy.

At that moment, in that rain storm, I was prepared to die and face whatever might lay before me. I don't know any state in the world a person can experience that is more spiritually powerful than that . . . that has more God in it than that. And it wasn't prayer that got me there. It wasn't Talmud study or meditation. It was the bicycle . . . and the rain, the beautiful rain.

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I haven't been riding as much this summer as last, but I feel I am at a point where I can make a reasonable commitment to myself to ride regularly for the next two months or so. My goal is to ride 150 kilometers a week (93 miles). For those who are serious bicycle riders this probably seems like an absurdly modest goal. But for a man of my (rather large) size and slow average speed, it will take some effort to maintain.

I am on good pace to make it this week, however. I have gotten out every evening. Including today's ride, I have gone 98.6 kilometers so far. I have tomorrow off from work, so, God willing, I will probably have no trouble getting in a 60 kilometer ride. I will probably go on one of my standard rides. Here's a map of it!

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The Johnny Cash song I quoted above (Love's been good to me), I have since learned was written by Rod McKuen and first sung by Frank Sinatra! (I've never heard the Sinatra version.)

Getting out of the way (and the illness narratives)

One of the first things we try and teach our new chaplains is not to say, "I understand exactly what you are saying, let me tell you when the same thing happened to me . . ." and then going on to tell the patient their own story.

Students really have trouble understanding this -- "don't we want to establish common ground with our patients," they ask? "Doesn't this establish rapport?"

The problem is that we're jumping to conclusions when we do this. We're assuming we understand what the patient is going through before we even have the slightest conception of his or her experience. We're taking the focus off the patient and putting it on us. We're telling our story by preventing the patients from telling theirs.

My supervisor shared with me an excellent short article by a San Francisco doctor that explains this problem wonderfully by talking about the "Illness Narratives". The Illness Narratives (Restitution, Chaos and Quest) were described by sociologist Arthur W. Frank (see his The Wounded Storyteller: Body, Illness, and Ethics; for a brief, but excellent, description of these three narratives, see the short article, above).

The author of the article takes a great quote from Frank's book that well describes much of my understanding of how pastoral care can heal:

"Serious illness is a loss of the destination and map that had previously guided the ill person's life: ill people have to learn to think differently. They learn by hearing themselves tell their stories, absorbing others' reactions and experiencing their stories being shared".

This is what we try and train our student chaplains to do instead of sharing their own stories with patients -- inquire into the patient's experience. Get out of the way and let them to tell their story. Don't try and fix their problem. Instead, try and understand their experience. . . and open the door for the suffering person to take the next step: the step to the learning and self-transformation that has the potential to make them into a person who has regained control over their life, even if they have tragically lost any control over what their body is doing.

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By the way: Speaking of people who miss the patient's story by telling their own (in a ill-conceived effort to establish rapport), the Archives of Internal Medicine recently published a study saying many doctors are doing just that. The New York Times headlined its story about the study: Study Says Chatty Doctors Forget Patients

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Blogging as working with perfectionism

I was joking with a colleague the other day about our shared problems with perfectionism. He said, "how can you be a perfectionist, you have a blog?"

He made me realize that one of the (many) reasons I have been keeping a blog is because it is a way of challenging my perfectionist streak. I put all kinds of things up on this blog that feel incomplete (and/or not fully proofread) to me. Things that my perfectionism might have prevented me from ever getting out if my only outlet were regular publications.

Long live blogging!

The best defense is offense -- meeting certification committees

This past Friday an educational group for CPE supervisors-in-training I attend focused on the ins and outs of appearing before committees.

Committee appearances are one of the most anxiety-provoking things about training to be a CPE supervisor. It's kind of like the bar exam for law students; it's a huge thing you have to get through in order to truly enter the profession you've been training for so long and hard. But the big difference is that committee appearances -- as opposed to an exam paper -- are very personal. And the experience of going through them (and, especially failing them) is very personal as well.

Me and my supervisor both did presentations that sought to understand the dynamics of committee appearances through the psycho-dynamic lens of Ekstein and Wallerstein's The Teaching and Learning of Psychotherapy. Ekstein and Wallerstein introduced something called the clinical rhombus for understanding the dynamics in the relationships a person training as a psychotherapist faces. I wrote about that in my entry on The magic of parallel process (and the clinical rhombus).

One thing I learned in all this is that you cannot be passive with a committee and expect to do well. The worst thing that can happen is that you end up feeling attacked and the committee feels like you feel you're being attacked. This is a form of getting defensive. You need to be assertive with the committee and one way to do that is to try and set the agenda yourself at the beginning. This is counter-intuitive for many people (isn't the committee the ones in charge? they're the ones in a position of authority here, are they not?). But it is a way of showing the committee members that you've "grown up" enough in your role that you're ready to move on to being one of their peers. It also shows that you can set the agenda elsewhere, especially with your students.

My presentation was based on this handout that talks about the clinical rhombus.

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My supervisor started his lecture by setting forth a framework of four interrelated characteristics of good helping professionals (like CPE supervisors!) and where those might go wrong in the context of a committee appearance:

Assurance in a role of Authority (breakdown: you might feel like an impostor)	Articulate in understanding of the field (breakdown: you lack a grasp of your theory about the field)
withholds Judgment of others (breakdown: you lose objectivity and compassion for students and peers)	conveys accurate Empathy (breakdown: you over-identify with students or patients and thus can't tell the difference between what's really going on with them and what's happening with you another breakdown: becoming disconnected from others)

For an aspiring CPE supervisor seeking to demonstrate competency to a committee it's the two on the first row that are likely to be especially problematic. Almost anyone feels like an impostor at the beginning of a new career/role. Like a pack of dogs smelling fear, a committee is likely to smell any lack of confidence a person has about their role. The rookie response is to try and hide that anxiety, but that is highly unlikely to work. What's left, then, is to try and talk about it. Admit to it and try and show how you're working with coping with that anxiety.

This is where theory can help you. The committee will appreciate it if you can talk about your anxiety (and how you're coping with it) through the lens of your theory. If you can do this, you will also be demonstrating your ability to be "articulate in your understanding of the field" at the same time.

This is also where the best defense is offense. Of course, you should not take this too literally (that is, don't attack the committee). But taking the first step by admitting to your anxiety and starting to talk about it is a potentially successful course.

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My supervisor went on to talk about this in the Ekstein and Wallerstein framework. They talk about

• Learning problems, and
• Problems about learning

Learning problems can be thought of as a goal. So, the goal here is to get certified.

Problems about learning are about your (psychological) resistances to achieving your goal/learning.

Now, this is where things get pretty counter-intuitive. Why would anyone resist getting certified (that is, resist succeeding before a committee)? Why would you want to fail?

Well, here you need to think about change. Everybody resists change. It's just a natural part of who we are as human beings. Change is threatening.

To put this in terms of a theory, Kurt Lewin described this kind of resistance to change in terms of a force field analysis.

And what might be some reasons behind why a person might resist certification?

• Fear of loss of relationship with peers (other students)
• Fear of "growing up" as represented by no longer being a student (which can relate to fears of death/aging and/or "not being good enough" . . . which can relate to issues leftover from childhood ("daddy never thought I was good enough, so maybe I'm not"))
• Fear of the loss of mentor relationships
  
• Fear of responsibility.

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The things I listed in the last paragraph might all be termed as problems about learning. They might also be termed as neurosis or developmental issues. They all, certainly, are very personal.

Everything is very personal about this committee appearance process and that can be really maddening and draining for the student. In addition to what is fair and good about all this, there is something that is fundamentally unfair about it as well -- especially the random nature of the selection of the committee members you appear before. They may have their own personal issues and you may trigger them. (God, forbid, you should, for example, look like the overbearing mother of one of the members!)

If you run into this kind of countertransference during an appearance, you may just be screwed (and get a nice lesson in how unfair life can be). But you can try and do something about it. Again the best defense is offense. You can confront the committee member by spelling out what you're experiencing. This is a pretty intimidating thing to do, but it might work!
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One final thing that might be worth saying is that anxiety can be your friend. That is, it can help you keep aware and on your toes. And you really need that in a committee appearance!