Wednesday, September 30, 2015

Lamb of God, you take away the sin of the world…have mercy on us.

A.Hanson, Minnesota, 2013
I am finding myself singing the Agnus Dei this morning, "Lamb of God, you take away the sin of the world, have mercy on us…"

This morning at approximately 12:21am Eastern time, the state of Georgia executed Kelly Gissendaner.  

Lord have mercy on us all.

My first experience with hearing about the death penalty in my life was when the state of Montana executed a man in 1995.  I remember being horrified with the sensibilities of a child that someone could be put to death by the government for killing someone else.  It just did not make sense to me then, and it still does not make sense to me.

A friend of mine was murdered in 2007 by a random stranger in a suburb of Minneapolis. I was devastated and outraged.  But I did not want her killer put to death, because that was not going to bring Katherine back and it would not honor her memory. The death penalty has tremendous costs, and they are not just financial.

I think about the people who are charged with carrying out executions. The wardens and guards and nurses and techs. The medical professionals who put an IV into the condemned person's body. Who are using the training that was obtained with the intent of preserving life and using it to end another person's life. I think about the person charged with pressing the button on the other side of a wall that will transmit the lethal drugs into the veins of the one being executed. The executor does not see the executed, because if they saw what they were doing, one would hope that they would not be able to do it. I wonder how those people feel at night when they go home from work and caress their spouse and hold their children. If their hands carry the blood of another. I wonder how this weighs on their hearts.

I wonder how the legal team feels and how the judge feels and how the supreme court felt when they denied Kelly Gissendaner's final emergency appeal. How they must feel when upholding the law of the land which is so senseless and horrifying.

I wonder how the family members of the victims feel as they watch an execution. Do they feel relief?  Or do they feel lingering hurt? Are they happy to put this chapter behind them?

I wonder how the family of the condemned person feels.  Do they feel relief as well? Are they weighed down by shame? Do they bury the memory of their once-loved one?

I would not say that I am "pro-life" because that is so politically charged.  I am PRO-HUMANITY. I am in favor of anything that reminds us of how we are all interconnected. I am in favor of preserving life. This extends to abolishing the death penalty, but also addressing the systemic racism and injustices inherent in our legal and penal systems.

Why do we kill people who kill people to show people that killing people is wrong? 

I also remember when I signed my first petition against the death penalty (an Amnesty International petition) at a church event as a high school senior.  And the many that I have signed since. Some days I feel hopeless.  Today is one of those days.  I am inspired by the ministry of Sister Helen Prejean, a Roman Catholic sister who has dedicated her life's work to speaking out against the death penalty.

I understand anger and the desire for revenge. I understand deep grief and hurt. I understand wanting vengeance for death.  But in the end, if death wins, we all lose. And that is why I am singing the Agnus Dei so fervently this morning.

Lamb of God, you take away the sin of the world…have mercy on us.  Mercy on us.  Mercy on us.

Monday, September 28, 2015

Stories from Chaplaincy: Warm and Dead

Late in the afternoon on a winter day a "trauma code" came overhead and through my pager. This case is the singularly most horrifying case that I experienced during my year of residency.  It still haunts me.

A patient was brought in on a search and rescue stretcher.  The EMS team tracked tons of snow into the trauma room. There was so much snow and ice brought in on this patient that the social worker and myself ran to the blanket warmer, grabbing stacks of blankets to place over the floor to prevent the team from slipping. The doors of the trauma room were closed.  Maintenance was notified to crank up the heat to over 85 degrees.  The team who was performing CPR was sweating profusely. I wrapped warm blankets around tearful firefighters and EMTs who were shivering even in the heat of the ED.

They needed to talk.  The patient was found in the water in the mountains. Clothes were frozen. Shoes were frozen. They didn't know who this person was or where they came from or how long they were in the water.

The Emergency Tech came out of the room in tears.  She couldn't start an IV.  She couldn't draw blood. The patient's veins were ice. She laid her head on the counter. A nurse came out of the room.  He said, "the patient isn't dead until they are warm and dead.  The patient isn't warm yet, so they aren't dead."

Warm and Dead.

And so for the next hour or so, rounds of CPR continued on the patient with ice in their veins. It is heart breaking to watch such fervent life-saving efforts. It is heart breaking to watch people who have dedicated their life's work to saving lives to be trying to save an impossible life.

Once a warmer body temperature was reached, resuscitation stopped.

I still don't know how the patient's family knew to come to our hospital. I know I didn't call them, and that was usually my job. I looked for a wallet, but there was none. I think the state patrol somehow notified them.  And also notified a victim's advocate who came to the ED covered in freshly fallen snow.  Such pure snowflakes amid such unrelenting horror.

From the family we learned that the patient disappeared after a call made several days earlier.

But after that, we don't know. Only that the patient was submerged for a few days and somehow their family ended up weeping into my arms.

When I thought of this patient, I could only think of white skin, the color of ice, frozen solid. And of ice in veins. And I would weep for the senseless and horror and aloneness of this death. And I would pray that this person knew some kind of comfort in their last moments out in the elements. And that when they were declared warm and dead, they might know how many techs and EMS workers and nurses and chaplains wept for them in a fluorescent ED.

Theology of Pastoral Care…an ever-evolving project

A.Hanson, Denver, 2015
At the start of my year of residency, I was quite timid in my pastoral caregiving.  I did not want to be too Lutheran or too Christian or not Christian enough or step on anyone’s toes or assert authority that I did not have.  I struggled a lot with the question, “what does a chaplain do that is different from a social worker or a particularly compassionate nurse?”

While still evolving, my pastoral theology centers around the conviction that pastoral care is an essential part of reuniting the whole person who is experiencing un-wellness with the social environment of which they are a part. Our discipline as chaplains is not concerned with treatment or therapeutic support, but rather, to meet another person where they are, using all of our humanity to meet their humanity. We have tasks that are therapeutic and we have tasks that are supportive of wellness, but our primary role is not wholly that. Perhaps more than anyone else in the hospital, chaplains are a link to the outside world and to a world of health and wholeness and a reminder of the hope that a person will rejoin that world outside the hospital. In the case of a patient’s death, we serve that function for family members.

Another core aspect of my pastoral theology is incarnational. I believe that God is in all people.  This might be seen as foolish, because it means that I tend to see people in the most affirming way but I think I will go on celebrating it because I would rather be foolish and see people as good than be suspicious and always be looking for evidence to the contrary. With this aspect of my pastoral theology, I do not think that I “bring God” to my patients, but rather, because God is in both of us, our time together is a fuller realization of the Kingdom of God. I view the hospital as a sort of communion table. We all bring ourselves to the table, we are broken and Christ is broken for us. The Lutheran understanding of the sacraments is that the most ordinary of things (such as water, wine, and bread) can carry the presence of God.  So the most ordinary of things in the hospital, one person sitting with another, already carries the presence of God.  Pastoral visits are sacramental and sacred.

One of the parts of my theology that has been challenged is my conviction that “God is always present.”  Because there are many, many times where I feel like this is not true. I have not found an answer for this question, and why my greatest discovery in my work as a chaplain has been the depth of mystery that exists in this work. Why bad things happen. Why patients with the same condition have vastly different outcomes. Why children die. Why parents die. Why sheer luck saves someone when all the knowledge in the world cannot. Why prayer seems to work. Why prayer does not seem to work. Why it is possible to feel the presence of God so clearly at times, and yet, at other times, God is so far away. I have no answers. When I started this residency I was searching for answers. I knew that explanations of faith healings and miracles and fervent prayers did not hold for me, but I was searching for the elusive answer that would somehow tie it all together.  And the answer has been revealed, and it is, “trust the mystery.” Patients frequently ask me what happens after death, and express their existential anxieties about what will happen to them, and the most truthful answer I have is “I have no idea.”  And I am settling into being okay with the mystery. My progressive Lutheran theology does not have the answers, neither does Christianity, nor does science. The only answer is, “I am willing to be with you in your suffering as you ask those questions.” Where I have landed in this particularly difficult part of my pastoral theology is to come back to Christ as seen on the cross, and God being willing to descend to hell and death, and I come away knowing, “There is no place that God is unwilling to go.” 

A final conviction that shapes my pastoral theology is that of, “I see your suffering and I am not repulsed by it.”  I do not take a medical model approach to suffering (diagnose and cure) or flee from suffering as the world is wont to do, but rather, an accompaniment model. I stand alongside my patients in their suffering and bear witness to it and provide a hand to hold and an ear to listen and a mirror to reflect.

Friday, September 25, 2015

Sabbath Coffee Tour: Keen Eye Coffee (38th Street and 28th Ave, Minneapolis)

Credit D.Gayman to Keen Eye Facebook
In my ongoing quest for coffee, I explored Keen Eye Coffee in the Standish-Ericcson neighborhood of south Minneapolis. This small neighborhood shop brews coffees from local roaster B&W Specialty coffee which has a roastery off Hennepin Ave in Minneapolis.

It was a cloudy and drizzly day, so I decided to have a little extra caffeine. I ordered a depth charge (shot of espresso dropped into brewed coffee).  I had the Columbian dark roast with a shot of house espresso. The Columbian was rich and deep, with no acidic aftertaste. The barista provided fresh cream in a server directly out of the fridge (no room temperature nastiness here!).

The space was welcoming and great for working. A bar along one window, with scattered armchairs and tables.  Free wifi is available, along with outlets. I spent about 90 minutes working on my mandala coloring book, enjoying my coffee and the quiet of the space. There was music playing, but it pleasant and added to the ambiance. Baristas (I think one might have been the owner) were friendly and welcoming to all customers.

There is food available as well, although I did not have any on this visit. There seem to be a variety of baked goods (with a note online about gluten free available) as well as soup and other lunch foods.

I walked to this coffee shop from my home, but there is street parking available. This coffee shop is located near the bustling brewpub Northbound Smokehouse, and the Hiawatha rail line, so happy hour and dinner time parking might be a challenge.

Keen Eye Coffee was a welcoming and cozy neighborhood coffee shop. I can't wait to go back and try their soups!

Thursday, September 24, 2015

Stories in chaplaincy: Miscarriage

Miscarriage. It drops into conversation like a bomb and silences everyone. It is a source of silent shame and deep pain. It is the death of hope and potential. It is a "personal problem" and a "woman's problem." It is tremendously common and yet deliberately hidden.

I was called into one of the small Emergency Department rooms early in the morning. My patient was lying in bed, covered in warm blankets. She was pale and tired. She had been there all night. She asked if I would hold her hand. She was alone.

We sat in silence for what seemed like hours. She said, "I didn't even really want it, you know. I was still trying to decide what to do with it."  I waited in silence.  "But its even more confusing, now that it's gone. I feel like I should be happy or sad. But I don't know what to feel."

I continued to hold her hand. I said, "What are you feeling?"

"Like I am missing part of me."

I decide to take a risk, saying, "Do you want to say goodbye?"

She started to cry and nodded. I stepped out of the room. A small specimen jar at the nurse's station contained the products of conception. I wrapped the jar in a towel. I cradled it gently in my arms as I walked back into the room and handed it to her.

She cradled the bundle and wept over it. She whispered for a few moments and then handed it back to me. Still holding the bundle gently, I left the room and returned it to the RN. I returned to the patient who was sleeping now. I stroked her hair off her forehead gently and turned to leave the room.

I said very little words in this interaction, but I made deliberate choices as pastoral interventions. I carried her fetal remains as an infant, wrapped in a towel, and handed them to her as such. I recognized the need for a small memorial service of sorts. This moment of ritual and of saying goodbye was just a few moments in the timeline of her hospital stay, but I hope that it made a difference. I hope that she had the time to say what she needed to say to her potential child and that moment, while filled with pain, was filled with humanity.  A fetal demise is not just a biological process, it is a death and requires ritual and attention.

Stories from the ICU: Minimally Acceptable Quality of Life

One of the situations where I often found myself called into in the ICU was when families were attempting to make difficult decisions about the future for their loved ones who were under our care. These were nearly always dire decisions. Patients were on life support, which works for awhile, but the longer someone has a ventilator or trach, the greater the likelihood of infection or hospital acquired illnesses. Sepsis was a constant and deadly threat. Nurses would balance the patient's body processes for them, with dialysis and mineral replacement and dietitians would balance artificial nutrition and fluids. Sometimes there is a possibility of recovery, often there is not.

One of the questions that is asked by critical care physicians or palliative care physicians is, "What is your loved one's minimally acceptable quality of life?"

It is not really enough to talk about "being alive."  Because "life" can mean barely hanging onto a grasp of this world. It can mean being in a coma, tethered to a ventilator and catheter and central lines, with machines and nursing staff taking care of your body's every function. This is enough for some families. Just the possibility of knowing that their loved one is still present with them.

But quality of life is different than being alive. We talk about being able to communicate and recognize our loved ones and care for ourselves and engage in meaningful activity. I spend a lot of time thinking about what meaningful quality of life would be for me. I would want to be able to communicate (whether or not that involves speaking or another tool for communication) and recognize my spouse and my family. I would want to be able to engage in the meaningful activities that I enjoy such as reading and writing.

For some people, minimally acceptable quality of life includes such things as maintaining hearing and sight, the ability to walk, and being able to complete all their own activities of daily living. These things are not at the top of my list, because I know people who are able to thrive even with these limitations.

But minimally acceptable quality of life varies for everyone. And it is the role of the chaplain in these conversations to be able to help families name this. We would gather our ICU families into a conference room, with social workers and nursing staff and chaplains and physicians present. The doctors would present the medical situation, and other team members would share insights. The family could ask questions, and then attempt to make the decisions that no one ever hopes to make.

Sometime last year (details deliberately obscured) I found myself in one of these family conferences. The patient had suffered a catastrophic brain injury as a result of an extreme sport. The neurologist was mostly confident that the patient would survive, but with significant impairments that would require ongoing medical support and would never live independently.

The family decided to proceed with transitioning to comfort care. To extubate, and remove all medications and interventions except morphine for pain relief. This decision was not made lightly, because this patient had another family member who had experienced a traumatic brain injury and had made it known that they would not wish to be kept alive in that situation.

This was a point of friction with doctors, who often had to persuade families to transition to comfort care after stopping non-beneficial medical interventions. The family's idea of minimally acceptable quality of life was different than that of the medical team. But in the end, it is the patient's decision (or in the absence of decision-making capabilities, the proxy decision maker). And as the chaplain, I accompanied this family through the worst days of their life, made a little bit easier because the patient had made their wishes known about their minimally acceptable quality of life.

It is my prayer that everyone who reads this post would think through what "life" means to them, and share that with family members and close friends. Don't make your family guess. Give them the gift of sharing your wishes.

Monday, September 14, 2015

Sabbath Coffee Tour: Spyhouse Coffee Roasters (Nicollet, Minneapolis)

For today's coffee adventure I set out for Spyhouse Coffee in the Whittier neighborhood of Minneapolis. This coffee shop had come recommended by several friends in Denver and it did not disappoint.

Spyhouse has three cafes (Broadway, Hennepin, and Nicollet) in Minneapolis. Beans are roasted at the Broadway cafe. I selected this location because it is relatively near my home. In terms of parking, Nicollet has one hour parking on the east side.  There is longer-term street parking west of Nicollet on side streets. The coffee shop itself is decorated in sleek mid-century modern design with plenty of tables and seats at the bar. There is free wifi and abundant outlets.  The espresso bar is expansive and you can easily watch your coffee being made. The downside to this coffee shop is its blaring music. It is too loud for conversation and WAY too loud for working. I tend to dislike loud music, although that may not bother some other people.

I had a mug of the Ignacio Gutierrez of El Salvadoran origin. It is said to have notes of "blackberry, allspice, and chardonnay."  I put a bit of cream and a small amount of raw sugar in it. This coffee had a rich depth to it and I could note a bit of spice.

The coffee was delicious and the space was welcoming, but the blaring music was too much for me.  I will give this coffee shop another visit to see if today was a fluke, but its just too loud for comfort.

Stories from the ICU: I see your suffering and I am not repulsed by it

As I unwind from my CPE residency, I have decided to share some of the amazing stories from my time as an ICU chaplain.  These are my best attempts to capture some of the fleeting and complex moments of those sacred hours.

This story comes from a night shift and from a call to the Cardiac ICU. I arrived at work to utter chaos. A patient had come into the Emergency Department in cardiac arrest. He coded twice in the ED, and much of the day chaplain and social worker's work that afternoon had been to find his family. There was one daughter who was camping in the mountains and unreachable by phone. Upon my arrival, the patient's son and daughter in law had been located and were at the hospital, although not in the patient's room.  The patient coded again and the physician begged me to locate the family. The patient was dying in spite of our best resuscitation efforts and chest compressions and intubation were non-beneficial. We tried never to have a patient die with a tube in their throat, it was distressing and traumatic for the family and uncomfortable for the patient. I tore off running to the family waiting area. Then the cafeteria. Then the chapel. And the parking lot. The family was ultimately located in their car outside the ED by an emergency nurse. We jogged to the CICU to what had to have been a horrible scene. Sometime in the course of the code blue, the patient had started bleeding and blood surrounded him on the bed, on the sheets and pillow and the floor. To someone accustomed to such things, it simply means putting on PPE, including plastic booties, a gown and gloves. So I did so. But to a family who belonged to that patient in the bed, it was devastating. The family was unable to bring themselves to enter the room.

The physician spoke with them in the hall and indicated that the patient was dying. The physician requested to extubate the patient and stop all heroic measures, as they were non-beneficial. The family gave consent. I stood with them outside the room as the patient's RN and respiratory therapist removed the tube. I warned them of the disturbing sound of suction. I stood with them in their suffering.

The patient began agonal breathing almost immediately. He was alone in the room and I went to his bedside. The family was frozen in the doorway.

Holding the patient's hand, I turned to them, saying, "He is dying. I will stay here with him and hold his hand so he is not alone. You do not have to come in if you do not want to, I know this is not how you want to see your father.  But I will stay here."

After a few minutes, the patient's son came to the bedside. He still was not touching his father. I said, "The breathing pattern that you hear is common for someone who is dying. He is not in pain, it is reflexive. Eventually there will be longer and longer pauses between breaths and then there will be a point where he will not take another breath."

The patient's son said, "Is it okay if I touch him?"

I responded, "Absolutely."  We each held one of the patient's hands, looking at his face, watching his chest rise ever so slightly. Until he was not breathing anymore.

Chaplaincy is standing in suffering. It is seeing suffering and not being repulsed by it. It is seeing the love and connection between father and son. It is about marking sacred moments. It is about bearing witness to love. For the opportunity to stand in a blood-spattered room and hold an elderly man's hand as he passed from this world to the next. To bear witness to suffering and not walk away. This is chaplaincy.

Friday, September 11, 2015

Sabbath Coffee Tour (Minneapolis): Blue Ox Coffee (Chicago and 38th Street)

I recently moved to Minneapolis and decided to continue my Sabbath Coffee tour here.  The first stop in the Twin Cities is Blue Ox Coffee Company.  This is within a short walking distance of my home, so it seemed a natural place to start. Parking is available in limited quantities along Chicago, but traffic is always a nightmare and the corner appears to be a major interchange for several bus routes. So in other words, be patient with parking.

The coffee shop is large and well-lit.  There are plenty of tables and outlets along the walls. There is free wifi, and board games for entertainment. There is a full espresso bar, as well as about a half-dozen roasts of coffee that can be brewed in a Chemex or a pour-over.  This coffee shop gets their beans from Madcap Coffee, a roastery in Grand Rapids, MI.  There are pastries and other foods available (and gluten free pastries available on the weekend!).

I had the Ethiopian Reko roast, which was a savory and bright (almost citrus) flavor, with a little bit of milk and raw sugar. It was delicious.

Because this is my neighborhood coffee shop, I will definitely be making my way back to this coffee shop again!