The shofar's out of the cupboard and into my workplaces. So far:
My patient's eyes are open when a greet her - a rarity - perhaps due to the lunch-time visit. I greet her and mention the New Year. Her eyes close. I sound the shofar - the whole series - loudly. No reaction from her; her eyes remain closed. But the gentleman next to her turns to me and asks: "What the hell was that??!!"
I do a "service" for a nursing home with a younger population. Some sing along with "Avinu Malcheinu." Some "talk back" at me during the story (I love that!) We listen to Kol Nidre. And during the course of the service I sound the shofar. They are so appreciative. I get to go around the room afterward and everyone wants to shake my hand and wish me a "happy new year." And I shake all of their hands and wish them a "happy and blessed year" as well. It's a good thing that State isn't here to chastise me for not washing my hands in between every handshake. It may not meet universal precautions, but the moment and the touch far outweigh the benefit of trying to follow the letter of the law in this case.
I ask one of my facilities if they have any Jewish residents who would like to hear the shofar. "The only people we've ever seen in the building with a yarmulke are you and that examiner from the State. He hasn't been around lately." "Ok, thanks. I didn't think you had any Jewish residents, but I always like to ask." "What does it sound like? Will you blow it for us?" So I do.
I give the activity director of another facility a CD of High Holy Day music for her Jewish resident (not one of my patients.) "Thank you so much. I'll put it in her room. Her family will be so glad to hear you came by." So . . . out comes the shofar and with a few introductory remarks to the staff, family and patients present, I blow the shofar. The Jewish resident gives me a little smile. "Please let her family know that I also brought in the shofar so she could hear it."
My office thinks of it as good PR and outreach. I think of it as a mitzvah and my preparation for entering the Holy Days.
שנה טובה ומתוקה
May we all be blessed with a sweet and good New Year.
Wednesday, September 8, 2010
Tuesday, September 7, 2010
The unexpected . . . or what teenagers taught me about conversation
Some days hospice work bears a certain resemblance to working with teenagers. Anyone who has worked with (or had) teenagers knows that some of the best conversations you have are the ones that take place in the car. Whether it's the forced intimacy or the lack of eye contact, or just serendipity, a car ride can turn into an unexpected opportunity for sharing. Something special can take place in that moment. You can't plan for it or expect it or extend it. You can only experience it and give thanks for it.
Some days you have moments like that in hospice. Again, you can't plan it and you can't force it. And just because you had that special moment once with a patient or family, you can't expect it to happen again.
Much like moments in the car, some of these moments happen when I am not looking at my patient. This week I was sitting with a patient who does not talk a lot. He does like it, however, when the social worker or I sit quietly next to him and do our paperwork. He likes the company and the companionship.
The other day I sat next to him with a big afghan on my lap. The afghan belonged to another patient. It had been lost and then found in the laundry by a facility CNA. The yarn had broken in some places, been pulled out in others, and had open stitches that were unraveling. I had told the CNA that I would try to fix it. (Fortunately I usually carry knitting and had both a crochet hook and a yarn needle in my car.)
So I sat next to my patient and focused my attention on the yarn and the open stitches. I don't know whether it was my attention to the task, my awareness of some of his issues and concerns, or my thoughts focusing on Elul, but as I talked with him about what I was doing it turned into one of those unplanned, special moments.
I commented that it could be a challenging task to try to fix something that had been torn or broken. "Yes," he said. I sewed some more and said, "I know I can't make this perfect, but at least I can mend some of the holes and keep it from getting worse." He agreed. Although he's not much of a talker, I realized he was very focused on my words and actions. So I continued to mend the afghan and talk about repairing the things we could, letting go of the things we couldn't, and forgiving ourselves for not being perfect. He would listen, make a tiny comment or a sound of acknowledgment. This continued until there was no more yarn to reattach.
I know that I got a great deal out of this unexpected moment and conversation. I think that he did as well, for I have an invitation to visit again . . . and to bring my knitting.
Some days you have moments like that in hospice. Again, you can't plan it and you can't force it. And just because you had that special moment once with a patient or family, you can't expect it to happen again.
Much like moments in the car, some of these moments happen when I am not looking at my patient. This week I was sitting with a patient who does not talk a lot. He does like it, however, when the social worker or I sit quietly next to him and do our paperwork. He likes the company and the companionship.
The other day I sat next to him with a big afghan on my lap. The afghan belonged to another patient. It had been lost and then found in the laundry by a facility CNA. The yarn had broken in some places, been pulled out in others, and had open stitches that were unraveling. I had told the CNA that I would try to fix it. (Fortunately I usually carry knitting and had both a crochet hook and a yarn needle in my car.)
So I sat next to my patient and focused my attention on the yarn and the open stitches. I don't know whether it was my attention to the task, my awareness of some of his issues and concerns, or my thoughts focusing on Elul, but as I talked with him about what I was doing it turned into one of those unplanned, special moments.
I commented that it could be a challenging task to try to fix something that had been torn or broken. "Yes," he said. I sewed some more and said, "I know I can't make this perfect, but at least I can mend some of the holes and keep it from getting worse." He agreed. Although he's not much of a talker, I realized he was very focused on my words and actions. So I continued to mend the afghan and talk about repairing the things we could, letting go of the things we couldn't, and forgiving ourselves for not being perfect. He would listen, make a tiny comment or a sound of acknowledgment. This continued until there was no more yarn to reattach.
I know that I got a great deal out of this unexpected moment and conversation. I think that he did as well, for I have an invitation to visit again . . . and to bring my knitting.
Sunday, September 5, 2010
Sitting & knitting
We have a new patient. She's in her 90's. The family says she's "given up," she's "ready to go." The family is clearly not ready to let her go. They're willing to talk hospice, but they are hoping that the extra attention and services will tip her back on the side of living. I ask about volunteers. "She knits," they say. "Do you have someone who could come knit with her and maybe also pick up the stitches she drops?" "I knit," I say. "I'll see what I can do."
At my initial, and as it turns out, only, visit with the patient, she's curled up in the middle of her bed with the covers pulled up to the top of her head. She doesn't respond to my greeting or presence. So I sit down next to the bed, pull out my knitting, and knit. Eventually she says a word or two. As I sit there, a younger woman comes in. She's the daughter of another resident, a friend of my patient, a knitting companion. The younger woman and I talk about knitting. And then a voice comes from under the covers: "I think I'm dying."
Before I can even open my mouth to respond, possibly faster than the speed of light, the other woman says, "Oh no. You're not dying. You just need to eat more." My thoughts are unprintable. Eventually the other woman leaves. I continue to knit. And knit.
Finally I say, "So you think you're dying. What makes you think that?" She says, "I just don't feel well." She's silent and I knit some more.
Finally she says, "Am I dying?" I take a deep breath. "Everyone dies sooner or later . . . I think for you it will be sooner. You're not eating and you tell me that you just don't feel well." More silence. I've answered her question. I've told her what she needs to hear. She doesn't say anything else.
And a few days later she dies.
At my initial, and as it turns out, only, visit with the patient, she's curled up in the middle of her bed with the covers pulled up to the top of her head. She doesn't respond to my greeting or presence. So I sit down next to the bed, pull out my knitting, and knit. Eventually she says a word or two. As I sit there, a younger woman comes in. She's the daughter of another resident, a friend of my patient, a knitting companion. The younger woman and I talk about knitting. And then a voice comes from under the covers: "I think I'm dying."
Before I can even open my mouth to respond, possibly faster than the speed of light, the other woman says, "Oh no. You're not dying. You just need to eat more." My thoughts are unprintable. Eventually the other woman leaves. I continue to knit. And knit.
Finally I say, "So you think you're dying. What makes you think that?" She says, "I just don't feel well." She's silent and I knit some more.
Finally she says, "Am I dying?" I take a deep breath. "Everyone dies sooner or later . . . I think for you it will be sooner. You're not eating and you tell me that you just don't feel well." More silence. I've answered her question. I've told her what she needs to hear. She doesn't say anything else.
And a few days later she dies.
Friday, August 13, 2010
Indulging myself
I splurged last week. A small splurge, but on what appears to be a totally unnecessary purchase. I think of it, however, as an important indulgence. What kind of splurge inspired this posting? I bought a skinit for my work phone.
I could argue that I needed it to distinguish my phone from all the other phones on those rare occasions when we're all in the office, but that isn't the reason I bought it. (Although I think that was part of the reason I gave myself.) I could say it was because there was a special deal with free shipping, but if I hadn't bought one I would have not only not paid for shipping, but I would have also not paid to buy it. My real reason for buying it was that I could choose and upload my own picture.
In the past four months, we've had a number of family simchas. We've also had one very difficult, untimely loss. The picture on my skinit is a joyful, smiling photo from one of the simchas. I can't look at it without smiling. I look at it and remember how happy we all were. I look at it and I remember that the pain of our loss was also a part of the day. The photo reminds me that a month after one of the worst days in our lives, we celebrated one of the happiest.
When I see this photo as I'm working, I'm reminded that all of us have mixtures of love and loss, celebration and loneliness in our lives. It reminds me not to take my blessings for granted. It reminds me that joy may be followed by sorrow and then again, God willing, by joy. The photo helps me remember that I want to work to live, not live to work. It reminds me to turn off the phone when the day or the week is over.
The photograph is not a talisman. It won't protect me from the pain that comes with my work or the pain that comes with life. But I hope it will protect me from becoming callous or indifferent. I hope it will always make me smile. When I think about the joy the photo gives me, it is clear that this splurge was not an extravagance and not really an indulgence, but another important weapon in my battle against burnout.
I could argue that I needed it to distinguish my phone from all the other phones on those rare occasions when we're all in the office, but that isn't the reason I bought it. (Although I think that was part of the reason I gave myself.) I could say it was because there was a special deal with free shipping, but if I hadn't bought one I would have not only not paid for shipping, but I would have also not paid to buy it. My real reason for buying it was that I could choose and upload my own picture.
In the past four months, we've had a number of family simchas. We've also had one very difficult, untimely loss. The picture on my skinit is a joyful, smiling photo from one of the simchas. I can't look at it without smiling. I look at it and remember how happy we all were. I look at it and I remember that the pain of our loss was also a part of the day. The photo reminds me that a month after one of the worst days in our lives, we celebrated one of the happiest.
When I see this photo as I'm working, I'm reminded that all of us have mixtures of love and loss, celebration and loneliness in our lives. It reminds me not to take my blessings for granted. It reminds me that joy may be followed by sorrow and then again, God willing, by joy. The photo helps me remember that I want to work to live, not live to work. It reminds me to turn off the phone when the day or the week is over.
The photograph is not a talisman. It won't protect me from the pain that comes with my work or the pain that comes with life. But I hope it will protect me from becoming callous or indifferent. I hope it will always make me smile. When I think about the joy the photo gives me, it is clear that this splurge was not an extravagance and not really an indulgence, but another important weapon in my battle against burnout.
Wednesday, August 11, 2010
Elul
One of my favorite things to do at this time of year is take my shofar with me to work. From the beginning of Elul until Yom Kippur, I have it with me. I sound it for my Jewish patients. I let the nursing homes where I work know what it is, why I have it, and that I will visit any Jewish resident so that they can hear the sounds of the shofar. In a nursing home with a younger, more alert, special needs population, the activity department and I schedule a program so that the Jewish residents can prepare for the New Year.
In a job where almost everyday provides the unexpected, I never know what to expect once I take out the shofar. I do a lot of education with staff and residents at this time of year. I never sound the shofar without making sure that everyone around me knows what I'm doing -- especially when I'm on a dementia unit.
Sometimes there are moments of serendipity, of grace. I'm in a nursing home doing a spiritual assessment on a new patient. We're meeting in a corner of the activity / dining room. The activity director, spotting my kipah, comes over to tell me that they are making "cards for the Jewish New Year." I am able to respond not only by coming over to meet the residents and talk about the meaning of the New Year, but by saying, "I have a ram's horn in the trunk of my car. May I go get it so that your residents can hear the sound of the New Year?" And while I have it, a nurse mentions a bed-bound Jewish resident down the hall and I am welcomed into her room so that she can hear the sound of the shofar. "Her family will be so happy when we let them know that you were here."
I'm visiting one of my Jewish patients. We sit in her room and I talk to her about the season. There's no response today, no eye contact, no acknowledgment that I'm present. I take out the shofar and blow it. Her head jerks up, her eyes open, and, for a moment, she's there.
Another patient, another home - my patient is a 100 + year old Holocaust survivor. We visit in front of her room, by the nurses' station where she sits each day. I take out the shofar -- Tekiah -- and the woman sitting next to her in the hallway glares at me and loudly asks, "What are you trying to do - wake the dead?"
Another survivor. Not yet my patient, but when I talk on the phone about hospice with her out-of-state son, he asks that I take in the shofar so that she can hear it. It turns out she's in a different place in her dementia. The shofar scares her. When I greet her in Hebrew or Yiddish she gets agitated and motions me to be silent. She responds to me and converses only when I greet her in Polish. Unfortunately my Polish extends only to "good morning," "how are you," and "thank you," but that doesn't stop her from taking my hand and talking to me - as long as the shofar is not in sight.
Once again it's Elul. This morning I opened my living room cabinet and took out my shofar. I don't know what the next month will bring, but I do know that for my Jewish patients it will include the sounds of the shofar as, together, we prepare to either close the Book of Life or to greet the New Year.
In a job where almost everyday provides the unexpected, I never know what to expect once I take out the shofar. I do a lot of education with staff and residents at this time of year. I never sound the shofar without making sure that everyone around me knows what I'm doing -- especially when I'm on a dementia unit.
Sometimes there are moments of serendipity, of grace. I'm in a nursing home doing a spiritual assessment on a new patient. We're meeting in a corner of the activity / dining room. The activity director, spotting my kipah, comes over to tell me that they are making "cards for the Jewish New Year." I am able to respond not only by coming over to meet the residents and talk about the meaning of the New Year, but by saying, "I have a ram's horn in the trunk of my car. May I go get it so that your residents can hear the sound of the New Year?" And while I have it, a nurse mentions a bed-bound Jewish resident down the hall and I am welcomed into her room so that she can hear the sound of the shofar. "Her family will be so happy when we let them know that you were here."
I'm visiting one of my Jewish patients. We sit in her room and I talk to her about the season. There's no response today, no eye contact, no acknowledgment that I'm present. I take out the shofar and blow it. Her head jerks up, her eyes open, and, for a moment, she's there.
Another patient, another home - my patient is a 100 + year old Holocaust survivor. We visit in front of her room, by the nurses' station where she sits each day. I take out the shofar -- Tekiah -- and the woman sitting next to her in the hallway glares at me and loudly asks, "What are you trying to do - wake the dead?"
Another survivor. Not yet my patient, but when I talk on the phone about hospice with her out-of-state son, he asks that I take in the shofar so that she can hear it. It turns out she's in a different place in her dementia. The shofar scares her. When I greet her in Hebrew or Yiddish she gets agitated and motions me to be silent. She responds to me and converses only when I greet her in Polish. Unfortunately my Polish extends only to "good morning," "how are you," and "thank you," but that doesn't stop her from taking my hand and talking to me - as long as the shofar is not in sight.
Once again it's Elul. This morning I opened my living room cabinet and took out my shofar. I don't know what the next month will bring, but I do know that for my Jewish patients it will include the sounds of the shofar as, together, we prepare to either close the Book of Life or to greet the New Year.
Sunday, August 8, 2010
Again with the yarmulke . . .
This was my weekend to be on-call. There are a couple of differences in my on-call "look." Weekends on-call are the only time I wear jeans to work, although in the summer my weekend clothes are closer to my weekday work clothes. The big difference is that on Saturday on-call I don't wear a kipah. It's funny - as easy as it is to forget my kipah when it's on, I'm hyper-aware of its absence when I'm not wearing it. I almost feel as though I'm going to work naked; missing a vital part of my "uniform."
I walked into a facility yesterday to do some on-call visits. I said "hello" to a resident I often talk with on my way in and out. She looked at me and said, "You're not wearing your little . . ." and pointed to my head. "Right," I said, "my yarmulke. Well, I don't wear it when I'm working on the Sabbath." I didn't go into a lot of detail, simply explaining that Jews generally don't work on the Jewish Sabbath, so when I'm making on-call visits on the Sabbath I don't wear it.
I didn't want to get into an entire discussion on marat ayin (how things appear; not wanting to mislead a fellow Jew) and why I leave the kipah off. Although I consider myself an observant Jew, I am not a halachically observant Jew. In addition to working on some Shabbatot, there's the car I drive to the nursing home, the pen and paper I'm using to write up my visit notes, the BlackBerry that I use to check patient details, and the myriad of other non-Shabbasdik things involved in patient visits.
I leave the kipah off on Shabbat because I don't want to be a public Jew on that day. I don't want to advertise my religion. On a Shabbat on-call visit I just want to advertise the hospice presence. Of course, it's on my on-call days with no kipah, working in buildings where we have other chaplains during the week, and with staff who aren't familiar with me that I am most often mistaken for the hospice nurse. This weekend was no exception. "Yes, I think it's alright to skip a PPD on a hospice patient," I say, "but I'm not the nurse, I'm the chaplain. Let me call my nurse and get an answer to your question."
After a day on-call, disguised as "just another chaplain," it's a pleasure to put my kipah back on and enter the new work week as the Jewish chaplain.
I walked into a facility yesterday to do some on-call visits. I said "hello" to a resident I often talk with on my way in and out. She looked at me and said, "You're not wearing your little . . ." and pointed to my head. "Right," I said, "my yarmulke. Well, I don't wear it when I'm working on the Sabbath." I didn't go into a lot of detail, simply explaining that Jews generally don't work on the Jewish Sabbath, so when I'm making on-call visits on the Sabbath I don't wear it.
I didn't want to get into an entire discussion on marat ayin (how things appear; not wanting to mislead a fellow Jew) and why I leave the kipah off. Although I consider myself an observant Jew, I am not a halachically observant Jew. In addition to working on some Shabbatot, there's the car I drive to the nursing home, the pen and paper I'm using to write up my visit notes, the BlackBerry that I use to check patient details, and the myriad of other non-Shabbasdik things involved in patient visits.
I leave the kipah off on Shabbat because I don't want to be a public Jew on that day. I don't want to advertise my religion. On a Shabbat on-call visit I just want to advertise the hospice presence. Of course, it's on my on-call days with no kipah, working in buildings where we have other chaplains during the week, and with staff who aren't familiar with me that I am most often mistaken for the hospice nurse. This weekend was no exception. "Yes, I think it's alright to skip a PPD on a hospice patient," I say, "but I'm not the nurse, I'm the chaplain. Let me call my nurse and get an answer to your question."
After a day on-call, disguised as "just another chaplain," it's a pleasure to put my kipah back on and enter the new work week as the Jewish chaplain.
Thursday, August 5, 2010
"I assume you're a Christian."
I was visiting today with a patient and her daughter (really with the daughter, who's having a hard time facing the loss of her mom.) She was talking to me about her mother's faith; how long it's been since she "accepted the Lord." At that point she looked at me and said: "I assume you're a Christian." "No," I responded. A pause, and then I added, "But I understand the language."
It may seem like a funny response, but I do understand the language. And she's not the first person who has been concerned about my "relationship with Jesus" - I've had that discussion lately with several patients or family members. Today's woman took another look at me and said, "You're Jewish." "Yes." "I could tell from your headcovering." Last week's family member, after I initially missed her question about my salvation in our phone conversation, responded to my letting her know that I am a rabbi by letting me know that it was fine for me to visit her mother and to bless her because, "The Jews are God's chosen people."
Judaism is my spiritual "mother tongue." It is the lens through which I see the world. Most of my patients, however, are not Jewish. So I "translate" my religious language into theirs. I listen for the phrases in their conversations that tell me of their beliefs. I talk with them about this world and about the next (but instead I call it "the afterlife.") I affirm the lives of faith led by their loved ones. I reflect back to them the teachings that provide them comfort as they confront love and loss.
The religious differences may make me a better chaplain. I have to listen. I have to think about what they are saying and the meaning of the religious phrases they use. As I respond, I have to make sure that I have framed my response in the language they speak. I have to recognize my boundaries as well. I can't anoint a patient or absolve them of their sins. I have to reach out to their clergy, if they allow me to do so, or to clergy of their faith if they request it.
Often my kipah proclaims my faith so I don't get the questions I seem to have gotten lately. But whether patients and families know I'm Jewish or just know I'm the chaplain, my job is to let families know that I will listen to their spiritual needs, help them connect with a clergyperson if they wish, and accompany them on this journey.
It may seem like a funny response, but I do understand the language. And she's not the first person who has been concerned about my "relationship with Jesus" - I've had that discussion lately with several patients or family members. Today's woman took another look at me and said, "You're Jewish." "Yes." "I could tell from your headcovering." Last week's family member, after I initially missed her question about my salvation in our phone conversation, responded to my letting her know that I am a rabbi by letting me know that it was fine for me to visit her mother and to bless her because, "The Jews are God's chosen people."
Judaism is my spiritual "mother tongue." It is the lens through which I see the world. Most of my patients, however, are not Jewish. So I "translate" my religious language into theirs. I listen for the phrases in their conversations that tell me of their beliefs. I talk with them about this world and about the next (but instead I call it "the afterlife.") I affirm the lives of faith led by their loved ones. I reflect back to them the teachings that provide them comfort as they confront love and loss.
The religious differences may make me a better chaplain. I have to listen. I have to think about what they are saying and the meaning of the religious phrases they use. As I respond, I have to make sure that I have framed my response in the language they speak. I have to recognize my boundaries as well. I can't anoint a patient or absolve them of their sins. I have to reach out to their clergy, if they allow me to do so, or to clergy of their faith if they request it.
Often my kipah proclaims my faith so I don't get the questions I seem to have gotten lately. But whether patients and families know I'm Jewish or just know I'm the chaplain, my job is to let families know that I will listen to their spiritual needs, help them connect with a clergyperson if they wish, and accompany them on this journey.
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