April 16, 2015 by Michael

Decisions, Decisions, Decisions

The year we got married we made a lot of decisions. We purchased a fixer-upper. We had to get a car. We built a garage and searched for a lawn mower at the hardware store my father sent me to over in the Back of the Yards.

We also completed a budget together, elected an executor of our estate, little estate that we had as twenty-three year olds, and chose agents to make healthcare decisions for us if and when we couldn’t make those decisions for ourselves.

I selected my brother Mark, both because I trust my brother and because I didn’t want my wife to be in that situation. Mark will answer his phone and talk through the implications with a medical team, with my wife, with a cool demeanor. Mark will make sure I’m cared for.

I wanted to plan ahead and put that responsibility on my brother’s shoulders. That advance directive is still in place. Mark decides for me if I can’t decide for myself. He communicates for me if I can’t communicate for myself.

At a recent family dinner I reminded everyone of this. We were actually celebrating my mother’s birthday last fall, and I took the moment to nudge my loved ones to plan in advance. I told them that I didn’t want to live in a prolonged state if I had been oxygen-deprived for longer than 10 minutes. I gave specific instructions, in the presence of my family, to my brother and to the others. Mark’s the agent but they all heard about my decision. Again and again, I will remind them that there are wishes I have regarding my medical care. I will refine those as I go and certainly the longer I’m in healthcare as a chaplain.

Today is national healthcare decisions day. I went to a program about it here at the hospital. Randi Belisomo spoke about her organization, Life Matters Media, and talked about the simple and important process of choosing an agent. Of course, as a chaplain, I walk through the steps of this simple process with people. I witness their completion of the healthcare power of attorney form. And sometimes I get to tell people how vital it is to do this simple thing.

If you don’t choose a person to speak for you, the law has answered your lack of choice. The law puts surrogates in place when you have not chosen. Someone always speaks for those who don’t speak for themselves. So, today, if you haven’t chosen a person to stand in your place, to communicate for you what your medical care should look like, and how aggressive those interventions should or shouldn’t be, consider it. If you need to update your form, the form generally opens with something like, “This Power of Attorney Revokes All Previous Powers.” You can change it at any time.

Consider your feelings and thoughts on these matters, taking the opportunity to involve your family in your thinking, in your care, and in your planning. Communicate your wishes to your loved ones and to your agent, and realize that this is a good way to communicate what you want so that that doesn’t have to be decided for you. Document it on your state’s version of the healthcare power of attorney, and these don’t have to be notarized or done by an attorney, as long as you have a witness who isn’t named as the agent. You’ll want to consult your state’s version because every state is different, but they should be similar from one to another.

If you’re in Chicago today, Life Matters Media is working with the Chicago Public Library at two locations this afternoon to explain these advance directives and to help people fill these documents out. For more information, look here at Life Matters Media.

For the Illinois form, you can visit my hospital’s page and print off a copy.

March 2, 2015 by Michael

Public Process Note

I spend time with people who are dying, actively dying, and I spend time with the people who love them. It does and doesn’t get easier to listen to the rises of hope and the slips into sadness as some son imagines the soon-coming death of his mother or to the patient who looks ahead and thinks about not existing anymore.

I know how to stand and sit with a nurse whose patient just died or expired or passed away. I know how to acknowledge the connection between myself and a doctor I met only around the grim and delightful experience of a patient who died late that night a few months back, the recognition between us like a secret we keep to ourselves.

The medical intensive care unit, the on-call experience, the jacket that identifies me in the hospital all lend themselves to wearing the experience of somebody’s grief. Of course, I have my own because I learn something of these good people, I am known in little bits, and I know them in little bits. And then, I carry and hold the grief of others. And it does and doesn’t get easier.

This post isn’t about the skills necessary to carry the grief of others, and it’s not about the ways in which I support people up to the edge and just before the dark unknown that is death. Of course, for the Christian, the reality is that death is a step or slip or movement. Like the shift of one’s body in a gracious dance, death is supposed to be a movement into another life, another part of life. In the words of a young woman who said something I’ll never forget: Whether we live or die, we win. That is a Christian view of death.

The lived experience is murkier. Living with the stories and words and prayers of another as she approaches that existential doorstep into eternity is grounding.

When I woke up this morning, I heard myself say of one of my patients, “He’s not going to die over the weekend” and, shaking my head at the unbidden thought, “He’s not dying today”. Of course, when I arrived for our morning report where we discuss the issues of the previous day, where we talk about who needs to be followed or continually given care, that patient was on the lips of my colleague. She dropped her head and her tone and said she had sad news. It was brutal for that to be saved until the last relay.

I had been right up until that moment. He had not died. In my mind, he was still with us. In truth, his spirit or his intention was waiting on the perimeter of my unconscious, even before I woke, telling me in his own way–or in God’s own way–that he was, in fact, gone.

I was glad, made glad really, that my chaplain colleague was with him when he died. Knowing of his faith and seeing the notes that had been charted, she sat with him and played gospel music for him. She sang to him, held his hand. She was there when he breathed his last breath.

This morning became for me another moment to grieve, another patient I had cared for, another person I had gotten to know. He was another person whose story, in such a compressed time, I learned to appreciate.

I spent the day doing the same things I always do in the hospital. And if you weren’t a colleague of mine or a nurse from my unit, you wouldn’t know that this gentleman was now added to my mental picture of deceased patients. I would remember that he had been in that room. I would associate the number with the first meeting and then the second until I captured what my last prayers for him had been. Had I prayed a prayer of benediction? I generally tried to.

He joined a different cloud of witnesses and not just the one the scriptures speak of. His face became associated with his room so that when I walked by, I said another goodbye, and it was like that on the unit. He was still a teacher to me, a teacher in how to acknowledge what was happening in me, a teacher of remarking on a man’s grace-filled transformation, and how to continually respect the boundary that we give all that we have when we’re there and that when we’re not there, somebody else is.

He became an occasion for me to remember the other patients who I thought of in similar ways, even if there was one or two profound ways that distinguished him forever in my memory. He will be one of the people I look for when I slip through the split in the veil myself one day. I will anticipate him as a host quite like he was when he welcomed me at the hospital, and I believe he’ll be smiling widely and probably calling me by a title and a last name.

November 25, 2014 by Michael

“I’m Still Scared”

The first day or so into my residency I heard my supervisor utter from the corner a response that I scribbled into my calendar. I swipe quotes from people like free gifts, and his words were a little gift to me–a gift I’ve looked at and played with ever since.

We were gathered as interns and residents and going through the initial orientation to life in CPE at Northwestern Memorial. We were just starting our adjustment into life as chaplains at the area’s premier academic medical center. Some of us had never been in a hospital setting for CPE. A few of us had been in 3 or 4 hospitals before to serve as chaplains.

I don’t remember who said they were scared. I couldn’t quote them if I did for the confidences we keep. But I’ll out my supervisor since I won’t name him. The person had said in a sigh that they were afraid, and he said to the comment, “I’m still scared.” We had already heard a bit about how long he’d been in ministry, and his reaction in those three words, together, were a life raft.

It was an immediate frame of vulnerability and risk and strength, his words. I’ve thought about the many reasons to fear in this ministry.

The ministry of serving others in a congregation brings fears. I know that as a pastor who has served in churches for close to 15 years. The same is true for the role of a chaplain in a medical setting. We should fear. We should name our fears. They are real and they are credible. We could really muck things up.

And, of course, fear isn’t the only feeling in the room. There are other emotions. And all of them, like voices in a chorus, will be heard. Tenors and sopranos and every other important voice needs to be respected as it sings.

I’ve heard the fear with each beep of the pager. I like to tell my colleagues that the 3 to 4AM hour is my golden hour when I’m on-call. I’ve always been paged at that hour for, at least, one trauma. But with each page, with each shift, the fear gets smaller.

I can see how it works now. I know a lot about what will happen. Of course, there is the long spectrum of surprises that comes with any interaction. I don’t know how it will go with that next person who’s in crisis. That’s the beauty of it for me. The beauty of seeing what will be said, seeing how I’ll listen better, seeing how God will move between us.

But the fear part, the part of me that didn’t know what to expect is schooled by these first 4-5 on-call shifts now. I know what it looks like for a response team to descend upon a quiet floor when a patient is “crashing.” I know the frenetic, nervous space filled by firefighters and police officers and nurses while respiratory therapists are working to help a gunshot victim breathe. Those fears are decreasing.

Yes, I’m still afraid. This feels especially true this morning, after the night we’ve witnessed in Missouri. But I’m less afraid. And that feels like a part of the goal for life and for CPE. To be less fearful. To have those fears respected and known but less in control.

I’ll go to the next patient visit with less anxiety. I’ll feel more like myself as I sit with someone whose loved one just slipped away after the ventilator has been removed, after their breath has left their bodies for that final time.

And though, like my supervisor, I’ll still be afraid, I’ll be stronger, and I’ll be more in my skin as a less anxious presence. At least those are my hopes as I finish this on-call shift, as I walk out of the hospital and face the rest.

November 17, 2014 by Michael

Nudge Toward Self-Scrutiny

I’m reading Pamela Cooper-White’s book, Shared Wisdom: The Use of Self in Pastoral Care and Counseling. It’s essentially a book about countertransference and it’s good use in the pastoral ministries of care, counseling, and psychotherapy. I grabbed the title as one-to-read at the beginning of my residency and mostly because my previous clinical supervisor in Urban CPE suggested that I continue to explore the notion and practice of “use of self” in my work.

I hadn’t read Cooper-White’s work before I heard that direction from my supervisor. When we started our residency, we were given the option to choose one book to read and review in place of one verbatim. So, I’m reading Shared Wisdom in order to relay what findings I’m seeing and how they relate to chaplaincy in particular and to pastoral ministry in general.

I’m not going to review the book here. I’m 90% through it, but I want to finish it before commenting deeply on its high significance, even for ministers without any real introduction to pastoral care literature, psychodynamic theory, or the variety of approaches to pastoral counseling. The book is a great introduction to all those in my view, though it doesn’t intend to be exhaustive in that introduction.

I want to pull one quote that I think will grab at the book theme and intention. It’s context-less, which I’m generally against, but it does stand on its own and communicates a few things about the total work (It’s from pgs. 173-174):

Not only is none of us immune to the occurrence of unanticipated enactment moments in deep therapeutic work, but I would venture that none of us is immune to at least occasional seductive desires to be the omnipotent healer. While this probably does not constitute an entrenched, predatory charaterological pattern in most practitioners, the very dynamics that often draw individuals to pursue caregiving professions virtually guarantee an intensification of unconscious impulses along a healer-healed axis. Grandiosity may not only appear in the guise of being the special healer of our patients. It may also appear in the form of overestimating our capacity to contain and analyze all the possible meanings that can arise when enactments do occur. As Arnold Goldberg has stated, many enactments may not in and of themselves constitute anything overtly unethical in the moral sense. However, we must acknowledge our limitations in being able adequately to process these enactments and to contain the energies they generate.

Cooper-White is doing a few things here worth capturing:

She reminds us that enactments happen.
She pushes us to question our self-understandings as leaders, particularly of the omnipotent sort.
She says what most don’t know: certain kinds of people go into ministry and we generally have certain impulses.
She uses the word grandiosity which in itself is a nudge (or a wall) worth lingering with.
She writes about limitations and the notion is deeply theological, anthropological, and ethical.

November 5, 2014 by Michael

Why Pastors Should Take CPE (2 of 2)

There are several reasons to take CPE units. I started reflecting on some reasons in the previous post, addressing preliminary but powerful gains in the early process of CPE, in the application components, and in the readying work which comes with the structure of the program itself. Here I want to comment on a few of the guts of the program to answer why CPE as an education is vital:

Thinking takes time. It takes time to consider people and things and influences and connections. The education needs that time, requires that time of you, but it does so in a pervasive way. You don’t feel like you’re doing CPE work one minute and cutting it off the next. So the work pervades your other life areas–in a good way. You slow down, giving the education permission to alter the other parts of your life. The time you’re learning extends, and, hopefully, you are able to apply your lessons to the rest of your life.

Your sphere of ministry grows. I don’t know that ministers look for more responsibility, but my sense of things is that chaplaincy brings an entire zone of ministry that we were, before the experience, outside of. You begin to see yourself as a minister to a larger congregation, if that language helps. You see yourself and your ministry as a chaplain and, therefore, as bigger than the parochial zone of the congregation.

Praying for people changes you. You become more empathic when you pray for others. Pastors are used to this, but we aren’t used to really thinking through those prayers, thinking through those people, and CPE pushes you to consider your approach, your words, and how you pray. In CPE we think about the people and the prayers. We’re thinking about whether to pray or not to when it comes to a particular person. It reshapes what prayer is and isn’t, what it can be. You consider the God to whom you direct your words and the people in the room listening.

You’re pressed to write. You don’t write for publication in CPE, but you write weekly, at least, once a week in process notes. You write verbatims where you recount a portion of a conversation and includes non-verbals, impressions, thoughts, interior questions and impulses when you can. You’re writing but you’re doing a big kind of writing, writing where you mine an event for the sociological implications, the psychological considerations, the theological connections and so forth. You write and it touches how you start seeing. So you interact with these views, these sections, until they become how you are in the world. It’s just starting to happen to me where this shaping is taking place.

Peer groups empower you. One of my friends in the previous group said something to me that I’ll never forget. In fact, everyone in my previous group has said at least one thing I’ll never forget. How many times can a pastor say that truthfully, that someone said something you won’t forget? It doesn’t happen because we live in a world where we talk so much that we don’t hear ourselves much less take the time to truly hear another. We probably never feel truly heard, particularly because most pastors are afraid of therapy and unfamiliar with spiritual direction. Being listened to might scare us! The peer group opens you up to the possibility of holiness encountered through the care-filled presence of others. And it makes you think you’re capable of doing the same.

Recognizing your junk becomes easier. This can be frightening and very informative. You begin CPE by thinking about your origins. You’re asked about that stuff sometimes, particularly when you act out and people who’re just meeting you ask you questions about why you do what you. This recognition enables you to see conflicts with people in a new view. It calms you because you’re more aware of you and more aware of when something is “all you” or not you at all. The beautiful thing is in your ability not only to see your stuff for what it is but also to get the tools to address your growing edges, to ask yourself “Is this working for me?” and to change however slowly you need to.

You start the practice of being gentle with yourself. This started for me with spiritual direction, but CPE echoes this lesson. In CPE we’re focusing on the clinical method and reflecting on our ministry to others. But as part of that focus, we learn how to give ourselves a break, how to care for ourselves in concrete and specific ways, even when those ways are not dramatic and when they are, simply, going home and sleeping after 4 deaths on your unit. Of course, the learning extends to other places. Because we learn how to be gentle with ourselves, we teach out of that. We live out of that. We tell other people the same and it sounds right because it comes from a place of close integrity rather than a distant pulpit.

You see death differently. Most ministers are acquainted with death. Christian ministers proclaim a Savior who is acquainted with our sorrows, whose skin is dressed in our grief, and who, sadly, dies as part of an unfolding picture of grace. In CPE, you start seeing the small and grand openings of death. You have to start saying how normal death actually is. You make some sense of it theologically and press yourself to make faith sense of the event that’s been happening forever. You see death as a respite for the woman who has been in and out of the hospital for years because she was praying for it to come. You embrace the death of the old man who sang aloud and always laughed and who saw death as a passage to the door of heaven. Death becomes broader than what we mourn. As uncertain as it is, it is different.

Life has a lift to it. You hear words differently. You realize that two cardiac events for the same person almost always means a soon-coming death. But you walk away from the hospital and you want to live in response to what you saw. You want to hug your mother tighter or you slow down to listen to your son even though you have no idea what he’s talking about. You linger with your spouse or call your friend to hear their voice mail message all the way through. You live and laugh at things you see on the street. You look like you’re foolish. You are a little.

What would you add?

November 2, 2014 by Michael

Why Pastors Should Take CPE (1 of 2)

I’ve been writing this post in my head for more than a year. That doesn’t mean it’s good as much as it’s something I’ve been mulling over for a while. I’m taking a series of units of clinical pastoral education (CPE) at a Chicago hospital. I took a unit last year at a different site, Little Brothers, Friends of the Elderly. And my thoughts are coming out of those experiences as well as loving theft of smarter people who’ve said things about the same.

Here are some random thoughts about the early reasons to take a unit in CPE. My next post will comment on the content and group work in ways that keep the right confidences:

The requirements are minimal. You do need a theological background, so you have to be friends with graduate theological education. But if you’re in the work of that or if it’s behind or under you, the steps to enrolling in CPE are doable. Getting in tends to be an extremely hospitable process, one where you are lovingly and graciously asked significant questions that will in themselves be an education.

The requirements aren’t minimal. In a sense, just by going through the application process, you know that people around the table, in your peer group, have taken the decision to attend very seriously. It takes recommendations and essays and answers to fairly deep questions to get an interview for a site. But you know that everyone has answered, or been pushed to answer, the same strong questions. Once you start serving in your site and doing group work, you’ve joined a group of people who are generally good at making and staying with commitments.

CPE is a continuing education. Most people are familiar with CPE as part of a seminary education, but because I was working at a church during seminary, I didn’t take a unit in CPE. I didn’t have the time. The beauty of CPE is that you can take it at any point. And pastors need structured continuing education in theological reflection, in pastoral arts, and in group dynamics. The education provides for those.

Choosing gets easier. You have to choose your site, where you want to “do your unit,” where you want to learn. Part of that choice is in your experience of the interview with the potential group leader/clinical supervisor. This person will become either a very poor influence in your life over the months you’re learning or someone you “esteem among rubies.” In my case, my clinical supervisor was a critical reason I kept going forward to get more units. Her way and expertise with teaching us and me were outstanding. You should pray to have a supervisor like Sister Barbara at Urban CPE.

Praying gets harder. If you’re lucky, you’ll sit in a group with people as different from you as a new morning. That alone might shock you into transformation, growth, and learning. All of you being ministers, all of you won’t come from the same ministerial background. Welcome that for what it’ll do to how you approach God. You should find yourself using a broader range of words for God, expanding beyond your well-crafted experience of God, and, thereby, deepening in the way you’ve created that range and that craft. But praying may take longer. You’ll integrate yourself in prayer, listen to feelings and how they make their own prayers, and you’ll be heard differently as you pray for others in the intimate homes of people unfamiliar with your way of doing ministry. You may become a bit more humble.

We need feedback. As a pastor, I spend time telling people what I think, and I spend time helping people reflect on what they think. I needed an education that would come alongside me post-seminary which would enable me to regularly reflect on my practice of ministry and, as importantly, give me feedback. My experience of the pastoral care part of leadership is that you don’t get feedback normally. Building a vehicle for it was important. Once you go through a group or two, you expect feedback, learn how to hear people, and learn what it feels like to be heard.

Supervision is a gift. Clinical supervision is a weekly meeting with your supervisor, a pastoral educator who has had–by the time they sit with you–years of post-seminary training in listening, group work, paper writing, grief, chaplaincy, and teaching. She’s been to therapy in order to sit with you. He’s been through what you’ve been through at least half a dozen times. So, when you close the door of your meeting room and talk about what you’re learning as you serve in your clinical area, you’re receiving something precious.

The education is somewhat tailored. You develop your goals for CPE. There are common outcomes because the education is accredited through the ACPE. There are standards to meet, but you determine how and whether you meet them. The grading is first very interior because the focus, from application to post-unit evaluation, is on you and what you need. My interview at Northwestern was an inviting time of discernment last summer. The first question they asked me was, “What do you need from us today?” Blew me away.

Pastors doing process notes change. Ministers do a lot and we could even do more than we think. In other words, we could do what we do and not think. Process notes are an essential part of CPE where you write weekly reflections to 5-6 questions. You write out of your experience at your site, thinking through what you’re doing, interrogating your experience. Over time, you read your notes, see your growth, and you change. You add the language of the noted question to yourself and begin to monitor whether an interaction is illuminating. If your supervisor comments on your notes, it’s increases the amount of wisdom you’re gaining.

We start asking better questions. On my current process notes template, our supervisor has this question, “Where did you meet God this week?” Can you imagine answering that weekly for yourself? Before you lead a meeting or close the study door or leave for your Sabbath or give a benediction or counsel someone, knowing that that question is waiting for you is framing and powerful and internally shaping. When we asked good questions, it turns us into good questioners.

October 21, 2014 by Michael

Cognitive Routes Toward Empathy

I learned about mirror neurons before I knew what they were. We didn’t discuss these little brain pieces in my psychology courses at U of I. At least, I don’t remember discussing them.

There was a long string of hormones and hemispheres and lobes and Wiernke this and Braca that. I recall little pictures of synapses and the corresponding discussions about firing them and the little joke I kept making from then on about how several people I knew did not have all their synapses firing when they should.

It may have been that mirror neurons were noted in Dr. Boch’s course. I’m sure if I emailed Dr. Zabradoff about it, she could pull up a syllabus or an outline or, back then, a slide from her overhead projector which would clearly explicate the difference between that neuron and some other notoriously-to-me-obscure cellular detail.

I was not a specialist in those subjects under cognitive psychology. I preferred the clinical emphases which gave me some tools to talk to people with varying levels of brain strength. I was the student looking to hear from people on a crisis line in the middle of the night whose synapses were firing too much, mental pictures blending together into a collage they’d try to explain three hours before I was to wake up and go to class.

Even then I knew there was such a thing as a mirror neuron. I talked about it most recently to my wife as the thing my boy sensed when he was a little baby, when one of us was anxious, which would make him anxious. When I started my residency in clinical pastoral education, I learned that my son’s mirror neurons were firing.

A mirror neuron is that tiny brain particle that enables us—in our heads and in the rest of us—to mirror the experience of another. It is part of an internal neural mechanism that provides “a cognitive route” for our brains to evaluate social systems and for our emotions to catch up and act accordingly.

Another way of saying it is that mirror neurons make empathy possible. They are the little tools in our heads that make us able to see a social situation and create an appropriate emotional, verbal, and social response. And we often gauge response by mirroring what we see in another person. So we see a person who’s anxious and we interpret the situation as anxiety-provoking. We judge for the best response. We either become a non-anxious or, better, a less-anxious presence, or we get swept into (i.e., we jump into) the anxiety itself.

Have you ever noticed that you yawn when someone else does, that you feel happy after being around a person who lifts your spirit a bit? Those are mirror neurons at work.

I wonder what it would be like for people to take that little piece of information and run with it. If we could agree in the world for a moment or in a congregation for a weekend to show forth some kind of joy in front of another, some type of resilience for another, in order that that person might mirror us. It feels like it’s worth doing.

What if we agreed to show our deepest wounds, to wear them across our faces, in order to reflect the real, already present vulnerability at the core our selves? We could do it with our mental illnesses, with a quieted grief processes, with our dashed hopes and our fledgling beliefs.

It feels like we might make the world a slightly deeper place, a place where we could be less ashamed of smiling or crying or sobbing because we wouldn’t be the only ones doing so.

September 3, 2014 by Michael

A Prayer For All Our School Starts

O God, you know “our ends from our beginnings” as my elders used to say. You know our downsittings and our uprisings. Our futures belong to you. Our futures are with you.

Look ahead into this year and bless us with all the growth that would make you look good and make us look more like who we really are.

You know that this year will have shifts for us, changes to our schedules, and that we’ll need you, it seems, more than before. We submit to you and how you’ll work through the long pulling that will come.

Call us and speak to us and journey with us. Live in and through us so that we might bring light into darkness.

Give us grace that we might be full of love. May our days begin and end with you and be punctuated by love and grace.

Where we will learn to write this year, give us ready pens and appointed words. May the strokes coming from our fingers spell words that cause ourselves and others to flourish.

Where we will learn to count this year, make us ready to notice things, to add things to our lives what you bring and to patiently suffer through any subtraction for the loss it will be.

When we learn to work with others, make us prepared and mature enough to reconcile, to be humble, to practice silence even if it’s only holding that last word or that convincing, if sharp, retort.

When we listen, slow us down and open us to be so generous that what things people say and write and live become gifts which we cherish and steward and protect.

And finally, may you grant us these particulars:

That Bryce may have a fun year, one full of learning leaps like last time, loving his teachers and developing friendships with his classmates and collecting all those good words we say about him as a brilliant, beautiful, beloved boy.

May you grant Dawn the repeated remarkable brilliance of all her previous courses, giving her the steady help she needs as she prepares and sits for her comprehensive exam.

May you go with me daily into the learning rooms of the seminaries, into the peer work and ministry in the hospital, and into the regular course of growth that is my church ministry.

May we labor for you and with you and may we be marked with memorable moments we’ll never forget. Will you change us for the better, sweetening me, preserving the best natures of my wife and son, and turning us continually toward you as a family.

For us all, give us an abiding sense of your presence, reminders of your unfailing nature, comments and signposts along each path that you are active, boldly bringing about healing for people, growth in us, and justice for the world.

Amen.