4 keys and an office

I've never seen myself as a person on whose shoulders anyone should put a lot of responsibility. My view of my responsibility when someone asks me for advice is to say, "sure, I've screwed up my life, let me help you do the same for yours."

The photo to the left is of the keys I have as part of my work (the flat gray tab is electronic). Now, I've had keys to where I work before, usually to the store when I worked retail or to my office and classrooms when I taught, but those were never more than a single key (two in the case of office and classrooms). With this new work I have doubled, if not quadrupled, my burden of responsibillity.

It's funny, as I feel no pressure about having responsibility for something as nebulous as the souls of seventy or eighty residents and staff; but give me something physical of keys and a place with the solidity of an office and my anxiety rises exponentially.

I use the keys each week as they are to the units I visit. I visit my office perhaps twice a month, usually to use the computer when on-campus. All my materials are in the trunk of my car, ready to hand, and I spend all of my workdays at the units, generally having a leisurely walk between buildings (it helps me to keep my life and thoughts slow). My wife's advice is to get over myself, to recognize that I've grown up and can be trusted with such things, and accept it. It's ego, I know, my self-image of myself as someone ready to split when the going got hard. But as my mentor once pointed out to me, "when was the last time you ran from a situation?", and the answer was sometime in the late 80s. Despite my cutoffs and armless tees and sandals, I am a deeply responsible square now. One of the girls I minister to even convinced me I would be a really good dad.

As if to add insult to injury.

my communal fantasy

Last week I performed a funerary service for an infant and made contact with a small group of mostly young, mostly organic farmers. Since then I've been indulging in a fantasy imagining myself in a commune with them or people like them whose warmth keeps me happy. I'm fully aware that as a farmer I am a total flop, but I'm a good pair of hands and shoulders, and in my fantasy I am the public face of a group of introverts, doing the shopping and appearing at zoning meetings and such, and being the spiritual advisor and confidante of the group, providing direction and counseling when I am not digging up potatoes. Sometimes I have the sense that the future of religious folk lies in becoming small intentional communities who covenant together--such ideas come naturally when one reads Irresistible Revolution and Occupy Religion--and it's in those moments I feel warm and hopeful.

pastoral clinical week 11

(I'm late getting this written partly because it's not due to be turned in for another week and partly because I've been writing it in my head for a couple weeks. it's actually a reflection of a pre-christmas situation.)

CPE REFLECTION 11

I’m not certain how upset I ought to be over this situation, as it may be me simply over-thinking it by placing myself in the resident’s place. But I’m fairly certain I wouldn’t have let the situation remain if I were still working in group homes.

Earlier this week I stopped in to visit a resident who’s been on a rollercoaster of health lately; sometimes in good shape, sometimes otherwise. When he first joined my floor he was starting the slow descent into dementia which has sped up in the ensuing months, to the point at which he sometimes seems uncomprehending of his surroundings. When I dropped in on him it was roughly 6:30 in the evening. His door was closed completely, which is unusual, and at first I thought he might be in bed already. But I knocked gently anyway and walked in. He was sitting in his wheelchair, indulging in his habit of ripping pieces of paper into smaller and smaller pieces of paper.

Nothing seemed out of the ordinary. We were having our usual conversation about how he was feeling and how he was doing when I noticed his sweatpants were down around his hips. I said, “Were you trying to change your pants?” He started to absently pull at them like he was pulling them up but I asked him to wait a moment I couldn’t see whether his undergarments were on. I looked behind him and realized he was sitting in a very messy undergarment that he’d obviously recently shat in.

I told him, “Wait a minute while I get someone.” I stepped out into the hall and caught a staff I knew and told him, “This guy's Depends are messed and I think he might have been trying to change his pants.” He said okay, and followed me back into the resident’s room. When we got there he gave him the medication that he’d been preparing, then asked if he was all right. The resident said he was. The staff couldn’t have helped noticing his pants were around his thighs and the undergarment was soiled but turned around and shrugged at me and then left the room. I stayed with my resident a few more minutes until I simply couldn’t take the smell any longer and left.

This disturbs me because I’m not at all certain I handled the situation right. My first inclination was to help him change (but I don’t do that work anymore) so my second inclination was to find someone who would help him change. However, that person seemed to take my resident’s word that he was all right sitting in messy undergarments.

On reflection that night, it struck me that the door might have been closed so that no one would enter and he could have some privacy to sit in his room. But I can’t imagine anyone opting to want to sit in a shit-filled undergarment, privately or not. The staff I approached is someone I’ve worked with on the floor for my whole length of time there and I trust his judgment. I didn't get the sense he was simply walking away from a situation but was acting on how he understood the resident to prefer. But I also can’t imagine allowing someone to decide for himself to remain in such a situation, particularly someone with the recent history of health issues of this resident. Should I have confronted the staff afterward and asked if we were making the best decision? Should I have alerted someone else?

I’m conflicted about the situation. My immediate reaction was to change the resident’s undergarments, and frankly I’m glad I waved that option away because I’m not qualified to do that anymore. I’m glad too of my second reaction, which was to recognize my role as being part of a team and report the situation to someone who could correct the situation. This is a role I've been working at. But I’m uncomfortable with the way the situation ended. Is it, I wonder, all right to let a resident opt to sit in shat-in adult undergarments, however privately, for an unspecified amount of time? Should that be within his rights? And can someone like this resident, whose thinking has been muddled at the best of times but is nearing the end of his life and is clearly showing increasing dementia, be permitted to make that decision?

clinical pastoral experience week 5

CPE REFLECTION WEEK 5

What’s concerned me most this week is the newest development—that one of my residents is convinced that I tried to kill him while visiting him in the hospital. I’m not worried about legal or ethical repercussions from the accusation—that I didn’t do anything resembling what he remembers, pulling off his nose tube, is pretty clear to me and to others—but I am worried about how this will affect our relationship once he’s been discharged from the hospital and returns to the facility.

It’s possible he won’t remember the incident at all, that it’s a memory caused by his pain medication and just as ephemeral. It’s possible that he’ll return and his first words to me will be, “Isn’t that funny, that I thought you tried to kill me?” But it’s possible too that he’ll become more convinced of the reality of that memory and it will adversely affect the relationship we have and that’s the biggest concern I have. How do I move both him and me beyond that, especially if he remains convinced of it?

The Nurse Manager for my floor has pointed out to me that this experience is good in a sense, as it gives me an idea of what it feels like to the aides and nurses when the residents call them bitches and niggers or accuse them of ignoring them or trying to kill them, and she’s right. From the perspective of ministering to the staff this is an invaluable situation. If anything good could be said to come out of the situation this would be it. I thought I’d had nearly every experience in my group home years but this one is new and I don’t like the feeling much.

Otherwise this has been a good week. I think that as a group our CPE cohort is coming together better, seeing one another as individuals with needs and concerns and less as other people who simply do much the same things as we do, only not as well or in a different way. The conflicts that strained our initial coming together--one person's perceived distance because of his new illness, a threeway misunderstanding—have been addressed and I don’t see any new ones on the horizon.

My relationships with my residents are becoming more solid. Another, older resident has also been hospitalized this week and my visits to him have proved beneficial I think to him and me. After conversation with my floor social worker I’ve determined a way of connecting with two residents in vegetative states that involves simply sitting quietly with them, much the same way as I’d already been sitting with another. I’ve begun to have positive interactions with still a third who’s so self-isolating that I almost never see her, but who I’m certain to approach whenever I see her out. She remains distant but encouraging: she hasn’t yelled or called me a fucker which I take as positive signs. I’ve sat with her only as long as she seems to want, which is usually about four or five minutes, and I think something she likes is that I don’t have any demands of her: one of her first comments to me was, “What do you want?”

I’m concerned about the development of another resident's abscess. Or not his abscess itself but its effect on the staff and to a lesser extent on him. That he’s going to die from it is a given and that it’s probably going to happen sooner than later is something everyone, including the resident, has known, but while he seems to be resigned to it, I think staff members are realizing that the time has come for the actual process to play out. The floor nurse manager very nearly cried when she told me he has bone showing and the consequences of that. I’m watching this development closely and picking my way carefully.

effing the ineffable

I think I was happiest the nights I was making bread. I don't mean happiest in the sense that that time of my life was the happiest I'd ever been, but I think that the hours I spent baking bread while working overnights at the Van Kirk group home were the most fulfilling hours I've ever spent.

this is like trying to describe the undrescribeable. (it was nearly 30 years ago, after all.) I took to mixing, rolling, and pounding dough as if I'd been born to it. I loved coming up with new versions of different breads--sweet breads, herb breads, doughy breads--and it was one of the few consistencies of my life then that I could do it each night and enjoy doing it. as I remember it came about as an accident--I was the only one interested in making the bread the administration insisted we bake on the overnights--and got to be quite good at it. years later, working at b&n, I spent a part of a year just baking bread, making it the skill I could count on when all other things had collapsed.

I think it is in doing things like this that we become closer to what we think of as god, particularly if the bread is for people who depend on us. it's like my once-buddy snake said about the beneficence of meat: that people he did not know bought the ham whose slaughter he'd cleaned up after to put in their mouths, not knowing that it came from him or anything about him, and that somehow that was a holy thing.