Wednesday, October 28, 2009

My turn

Today, as I walked through the back staircase of Mt. Sinai, traveling between floors, I thought, when I am a patient or a family member, I should remember that this is how the docs and other medical folks get around.

I think thoughts like this often. When it is my turn...I will...

These thoughts have no value to them-positive or negative. I do not feel morbid about them, just shickingly realistic. I feel like I am watching the sneak preview on a film, except I seeing the version where I know too much. My experience of this movie will be different because I alrady have seen the spoiler.

Rabbi Lawrence Hoffman wrote (in an article I recently read whose title I am forgetting) how illness, health, death, birth, weddings, funerals, life cycle events of all shapes, sizes and varieties are all places we visit in life's journey. He posits that the power of visiting the sick is it is a requisite destination along the way and, just as we (perhaps reluctantly) watch slides shows and look through photos on facebook of other people's trips, we also visit the sick, attend the funeral of our loved one's loved ones, dance at the wedding of your coworkers daughter and so on. We get a sneak peak of what these events will be like when it is our child's wedding, our parent's funeral, our health which has failed.

What strikes me is the certainty I feel that being here on the other side (as patient or family member) is inevitable. Am I clairvoyant? Am I having a vision of my future? Or is this just a natural aspect of this work? I hope this is normal because if there is some disturbance in the force and I am sensing something that will happen...well, that just freaks me out a little bit. Quite frankly, whatever my future my be, I don't want to know in advance.

Really, that would spoil all the fun.

Tuesday, October 27, 2009

Getting Away With It

I tend to live at a break-neck pace. I find I am at my happiest when I am scheduled (arguably...over-scheduled). My mom likes to say "You burn the candle at both ends." And if a candle had three or four ends, I would burn it from there too. But it suites me and I am happy with all the wonderful things I get to do. Somewhere along the way, I have absorbed an ethic that says one should always be occupied. Something akin to idle hands doing the devil's work. If I am not doing something, I think I must be doing something wrong.

At Mount Sinai, where I am a chaplain intern, I have a list of patients to visit. I make my way from room to room, floor to floor trying to visit. Some days, everyone is out of the room and I leave many business cards and notes saying, "sorry I missed you." Some days, I get to see one person and the conversation is so long that I do not get to even poke my head in on anyone else. Some days, I might see someone who affects me so profoundly that I simply need a break, need a time out before attempting to visit another patient. Then, I am most adrift, looking for paperwork to file, an errand to run, a coffee to drink.

Somewhere else along the way, I came to value achieving (arguable, over-achieving). I could drink in life, lap it up, but if I am not chugging it down, something feels amiss. At work, I am afraid someone will find out that I do not see everyone. I feel like I am somehow slacking off, shirking responsibility...If every moment I am not on-task, then I must be OFF-task.

But this is not the nature of chaplaincy. And truthfully, I can see how the nature of chaplaincy is forcing me to be...slower, more focused and maybe even more reasonable. At work, I have to learn quality not quantity. I have to find a way to make peace with less actually truly being more. Walking out in the middle of patient x's painful story
in order to go make sure I have time to visit and check off that I saw patient y, is not only obviously asinine, it would be damaging to abandon someone in a moment of vulnerability like that.

Slowly I am learning that slowing down is not failing, slowing down actually means the potential for deeper, more meaningful and (not even worth arguing) better.

And yes, I am submitting this to my supervisor who will now know for sure-most days I do not actually get it all done. And truly, that is a true success.

Tuesday, October 20, 2009

Atheism on the Subway

The Subway always gets me thinking.


I got the the platform this morning and realized I was sadly without reading material. Wasted opportunity to get some work done on the train...So when I saw a discarded AM New York on the ground at the 59th street station while I was waiting for my 4/5 Express downtown to 59th street, I picked it up. There was an article on Godless New York. An anonymous donor is running a $25,000 ad campaign-posters in the MTA Subway stations which read “1 Million New Yorkers are Good without God. Are You?” Apparently the goal is for atheists in New York to know they are not alone.


And of course, public outrage ensues. The article offers the opinions of many New Yorkers who are righteously indignant at this affront. How can we even suggest that there is no God? They wonder...


On to the train I step...


No, let me rephrase. The morning 4/5 express-ride is an exercise in gymnastics and personal space amongst other things. Those waiting to get on the train cram in. And it is as if the moment we are on the train, we forget the anxiety of being outside the train wondering if we will fit in to the cramped car (and I won't lie, Holocaust cattle cars are often floating in my head...) There are some structural problems with the cars. There are not many polls or things to hold on for those of us under 5'5” unless you are standing immediately next to a door.


This morning, I oozed onto the train with hundreds of fellow New Yorkers. Tens of New Yorkers stood behind me, pressing to also be amongst the chosen few who could cram on in to the train and move ahead on their journey towards work, home or whatever their particular and important destination. Standing at the corner of the entrance was a very large, very short woman. I called in to the train, can everyone in the middle step in so the people outside can get on? One woman, with ample room to move simply looked away. The large, short woman gave me a cold hard, angry stare. I looked at her and said, please?


I am too short to reach anything other than here and I simply cannot move.


Someone taller could have stepped around her and moved in to the train, others could have given her the death stare and socially urged her to step in further. Someone could have said, yeah, please, come on guys, let's make some room...


None of that happened.


And I started wondering, who cares if you, me, anyone believes in God if we are unwilling to risk or bare discomfort for the sake of our fellow man standing before us and asking politely?

Saturday, October 10, 2009

The Yom Kippur Sermon from Laramie Wyoming, 99% recycled material...

NOTE: What a difference a year makes...In rewriting and redelivering this sermon, I had that great JEwish moment of understanding why we come back to do things again...because we can never actually redo anything-just doing it the first time changes who we are...I am not the same rabbi I was a year ago, I am not the same person. Last year I thought it was so cool to deliver a sermon which felt like I was actually saying something to a packed room of 700-1000 people.

And this year, I cried during my own sermon as I looked in to each face of each of the 40 people sitting in the small Lutheran chapel in Laramie Wyoming while I told them, we are all going to die. God forgive my arrogance. Thank you for reminding me humility.

Words are more than just black ink on a page. Words have meaning and power and I find these words here, even a year later, still have a power over me...

Forgive the formatting, this is similar to what the text looks like when I deliver it and I do not have a version which is paginated in a more normative fashion.

Happy New Year, I hope we all were inscribed for a long, rich and beautiful life.


Yom Kippur Sermon, 5770, Laramie Wyoming:


We are all going to die.

Not just us,

but the people we care for as well.

And, not only will our deaths come,

but they will come on a time table not set by us,

not according to our schedule.

None of us want any of this to be true,

but it is.

We build our lives ignoring these facts.

With great arrogance and flippancy

we do things like plan for the future.

We make commitments we cannot necessarily keep when we say see you tomorrow.

We don't know.

But we insist on making this contract with God

We agree to the following terms:

Everyone in the world

-especially me and those I care for the most-

will die old.

We will die peacefully.

We will die in our sleep outliving the people we should outlive,

having accomplished all that which we wish to accomplish.

This seems to us like a fair death.

We sign on to this contract but this agreement is one-sided.

No one,

no thing

is signing on the other side of the page.

And when this contract is broken,

we get very, very upset.

When someone dies young,

suddenly, or painfully, we claim

"this is not fair! This is not right"

But no one other than us agreed to these terms.

Since there is no contract-

no rules have been broken

we alone feel this is “unfair”



Our Yom Kippur liturgy

is designed to remind us

of the end of our lives.

We recite the same psalms and

say the same penitential

and confessional prayers today

which are said at the deathbed.

We do much to feel like we are approaching death.

We abstain from eating and drinking.

We abstain from physical intimacy

Many do not adorn themselves in any manner,

do not bathe or brush their teeth.

We treat our bodies as if they do not exist.

By the end of the day today,

we will feel a bit closer to death.

Some will choose to not wear leather and

to wear only white.

Some wear white, cotton robes called kittels.

These are worn in traditional Judaism at Yom Kippur, one's wedding, and in one's burial.

We do all of this to practice for the day

when we do stand in judgment before God,

for the day that will inevitably come,

when we die.

We are forcing ourselves to ask,

how have I lived my days thus far?

Have I really lived at all?



We are about to read from parashat Nitzavim

found in Deuteronomy.

This text occurs at the end of Moses' life.

He is giving the Israelites their final charge

before entering Israel to conquer it.

The people are re-committing to the covenant with God,

not just for those who were there but for those not there as well, meaning for us too.

The portion has a simple message;

you will sin and make mistakes

(we are people, this is what we do)

but we can always return to God,

we can always tshuv, turn, change or repent

The portion closes with the following lines:

יט הַעִדֹתִי בָכֶם הַיּוֹם, אֶת-הַשָּׁמַיִם וְאֶת-הָאָרֶץ--הַחַיִּים וְהַמָּוֶת נָתַתִּי לְפָנֶיךָ, הַבְּרָכָה וְהַקְּלָלָה; וּבָחַרְתָּ, בַּחַיִּים--לְמַעַן תִּחְיֶה, אַתָּה וְזַרְעֶךָ.

I bring to bear witness of all of you this day, the heavens and the earth. The life and the death I give before each of you, the blessing and the curse. Each of you, choose life so that you may live, each of you and your descendents.



But how can we choose life?

Death is inevitable.

Opting out is not an option so

what on earth does this mean?



Recently, I seved as a chaplain in training at Memorial Sloan Kettering Cancer Center in NYC working with the pain and palliative care unit. I spent a large amount of time this summer with dying people and their families. One morning, I went to work and went straight to see Andy, a twenty-seven year young man and his huge extended family. Cancer brought him from good health to his last day in three short months. By the time I arrived, he had already died. I spoke with his mother who just looked at me and said, but he was so young?!? It is so unfair.



I could tell you many stories of the unfairness I encountered there, but I don't need to bring stories from New York. You know the unfairness of death right here in your own community. Lori Schneider, Deborah Wasser, and others who all died too young, too soon.

When my father's Dad passed away about three and a half years ago at the age of 85, he said he felt his father's death was sad, but fair. I wondered, what makes a death fair? His response was that death is fair if you have done all you want to do. “Death is never fair,” I replied “because there is always more we want to do-including just live another day.” My dad then revised his thought. “I think it was fair,” he explained, “because my father had said all he had needed to say.”



I think there is more fairness when that happens. The fairness is not about doing all you wanted to do because that is impossible but perhaps, death is more fair when someone dies knowing they have said all of their I’m sorries and their I love yous.



Have you said all of yours?



But I think fairness in death

is not only about having done enough

or said enough.

It is more than that...

One of the chaplains at Sloan Kettering, Jane,

said to me,

you know,

the greatest lesson I take from this place

is the constant reminder to live-

the reminder to live my life

the way I want to have lived it when I die.

Repeat this...

I think this is what today's Torah reading is about,

why we read this today on Yom Kippur

In our Torah text, God says,

This life and this death I give before each of you, the blessing and the curse. Each of you, choose life so that you will live, each of you and all your descendents.”

God is not setting before us a choice of bodily living or dying. That is not up to us.

The choice is in the kind of life we will live.

The text makes an analogy-

life is a blessing and death is a curse.

This cannot be referring to actual life and death

since we know of lives that do not feel like blessings,

deaths which are not curses.

But there exists this tension between life and death,

blessing and curse.

We cannot pretend death away.

By ignoring that there is an end to our existence,

we could put off until a rainy day the person we should be now.

But,

if all we did was constantly face the reality of the limits of life,

our deaths could consume us

and would rob us of the essence of living.



The choice here is in how we walk this balance.

In our text, we read the words,לְמַעַן תִּחְיֶה

so that you will live.

This could also be translated as,

for the sake of being or in order that you will be.

I feel the text is telling us-

being is living and

choosing it a blessing,

living means choosing a life as the person you can be;

as your best possible self.

Death means choosing anything else:



Complacency, laziness, and plain old stubborn refusal to change

causes a kind of death

and brings with it

the curse of living a life unfilled

seen most clearly in the death which feels so unfair.

I never got to be the person I wanted to be,

I never truly got to live.

In my conversation with my father,

he added the following:

He still feels sad that his dad is gone,

he still misses him.

We all do.

He told me,

There is more I would like to have done with him

but that is the lesson that I have had to learn and to live with.

I could have done more to be the son I truly wanted to be.

And I still can.”



We the living can bring fairness to death.

When we let death remind us to live,

to truly live,

to be and become the people we know we can

and want to be,

then,

THEN death is fair.



Two words show up over and over

in this morning’s Torah reading:

Shav and hayom.

Change and Today.

The repetition of shav,

turn, change

reminds us again and again,

we can always change.

Just because I WAS one way yesterday

does not mean that I have to be that same way

tomorrow.



And hayom,

today

Today,

meaning these words

were not not just said to the Israelite people then,

but they were said to us TODAY

as we prepare to enter the New Year.

Today is the day,

now is the time.

Tshuv hayom,

Change TODAY



At the end of the day,

we will stand before God and

seek out God's forgiveness

for our sins.

We will open the ark,

this plain pine box

reminiscent of a coffin.

It causes us to remember,

death is coming and

we do not know when,

where, how or even why.

Staring into that openness,

that abyss,

we are reminded of the unknown of what lies beyond.

That vastness asks us,

When you look back on your life,

how do you want to see it?

Who do you want to have been?

Who do you want to be that you are not yet being?

Shav, shav, shav

it repeats-turn turn turn-

change now, right now,

Today BE the person you want to be

before the gates close.



The life and the death I give before each of you today,

the blessing and the curse.

Each of you,

choose life so that you may live,

each of you and your descendents.

The Problem with Dying

This week another patient died. I am a chaplain intern at Mount Sinai Hospital in New York City. Patients are going to die. That is, for many, what they go there to do. And yet, I am startled. A man, an old man (93, I believe). Died. He did not suffer, he was healthy and more active than I am until two weeks ago. Then a stroke, I think, and this week, we terminally extubated him. I watched as the doctors did what they do. And then we ushered in the family so they could be with him while waiting for him to die.

I can't imagine sitting in a room with someone I love and waiting for them to die.

And I went home that night, just completely thrown. And, to make matters worse, I was thrown by the fact that this man's death threw me! I wrote my sermon on death and dying. I have now delivered it twice. I know we all die, I know it is normal and natural. I know it happens whenever it happens. And I know I have no control over that. I have made my mental peace with Death.

But my heart refuses the whole endeavor.

Somewhere in me, I cannot seem to defeat the inner five year old who folds her arms over her chest, stamps a black-pattened-leather, mary-jane clad foot on the floor and cries, "this is not fair! I do not deserve this."

And I know neither how to explain to her that yes, it is unfair and that she might as well just learn to live with it not do I know how to best Death and make it succumb to MY rules of life and living.

And I am angry because Death is a problem which cannot be solved, nor can I, at this point in my life, reframe it so that it is not a problem, but more of a challenge to navigate or-quite simply-just one of life's many truths.

Recently, in a my class Visions of Reform Judaism, I read an article by Rabbi Lawrence Hoffman (my hero). In it, he pointed out that one underlying metaphor within Judaism is "the journey." If life is a journey, then, like corss-country road trips, there are requisite stops along the way. When you drive America, you have to go to the Grand Canyon, Mount Rushmore, The White House, Lincoln Memorial etc. On our life road trip, we must stop by at "sickness" "health" "joy" "sadness" and so on. We must also stop by at "death."

And I both long for and dread the day when not only do I know this in my head, but I also know this in my heart. When the death of another does not so startle me. When I can get through a day at Mount Sinai and not consider the day which will one day come when I am in a hospital somewhere wrestling with the life and death, sickness and health of my self, my parents, my brother and his family, my friends, my neighbors, my congregants...the list goes on.

But when the day comes that I am inured to death and no longer traumatized by its surprise, I will sleep through the night, I will walk out and just go on with my day, I will not think about the loss to the world and to those who loved the person, and I...I will be just a little less human, a little less soft, a little less warm.

Thursday, October 8, 2009

Chaplaincy in the land of Social Justice

Recently, during a coffee break with Rabbi Brent Spodek from American Jewish World Service, we began chatting about the overlap of social justice and being a chaplain. Rabbi Spodek's essential question, as I recall, is how can being a chaplain be an act of social justice.

Here is my vision, I can see chaplaincy as an opportunity to do more than just social action (as in direct service work like going to a soup kitchen and serving a meal)but to create true social change.

But what is this thing, chaplaincy in the first place? I am a chaplain at Mount Sinai hospital in New York City. My job is to sit with people and bear witness to their experiences, especially bearing witness to people's suffering. Here is the hope, like any heavy load one carries, it is easier when two people are shouldering the burden than just one. The goal of sitting with someone is not to solve problems, but to make their portage less burdensome.

In social justice/social change world...well, I think being a chaplain opens up a space for some true social change. Beyond just helping those who are burdened (and PS, we are ALL burdened by something) to carry the load, there is something which acknowledges the humanity of another human being, which validates someone else's sense of self worth just by asking, are you ok?

My assumption and understanding, there are people in the world who are in pretty terrible life circumstances. People do not wake up in the morning and think, I want a really hard, miserable life full of suffering and travail. No, what happens is if you hear enough messages from your family, your community, the media, strangers on the street and other subtle sources of input that you, are worthless or even just worth LESS, eventually you will believe it.

At the soup kitchen, we teach the kids, imagine the homeless person on the street who is not only in a place to need help, is not only asking for help, but is spending the day being ignored by almost everyone who walks by while in the middle of doing one of the hardest things people ever have to do (which is admitting we cannot do it all alone and HAVE to ask others for assistance). Imagine how fundamentally invisible-ing that feels, how profoundly terrible it feels go through a day, let alone a life of being unseen by all other people in the world. (Imagine going through a day without anyone even saying hello to you...) Now what would happen for that person to just simply be acknowledged?

People out there say, well why don't those who are in need just pull themselves up by their boot straps and change, make their situation in life better? Well, what if you do not even know that you deserve better? What if you cannot even imagine better? What if you do not even know that your boots have straps to pull?

This is the power of being a chaplain in creating social change, as I can see it.

And it feels like an appropriate and powerful role for those who are the "haves" to play in the lives of those who are the "have nots."

Imagine if that tv show where the really sexy host from Home and Garden TV built a new house not for the most deserving but for the seemingly LEAST deserving. What if we assume that the hardest, meanest people are the ones who hurt and suffer the most? What if that show validated THEIR humanity, their suffering and misery? Can you imagine, in a certain supported social context, how an act that that (the giving of a home to someone who is constantly told by the world you deserve nothing and so we give you nothing!)would change that person's life and the lives of others around him or her? Assume for a moment, our symbol least deserving person, consumed with his/her own pain takes it out on those around him/her through various kinds of violence (emotional, spiritual, physical) what would happen to our crime rate our abuse rate or jobless-ness rates if people everywhere who formally felt like nobodies suddenly knew that really truly they are somebodies? Somebodies who deserve better.

Somebodies with boot straps to pull up...

Tuesday, October 6, 2009

Vulnerability-Getting to OK

I wonder, sometimes, if anyone is actually ok.

It seems to me that everyone is walking around carrying a whole heck of a lot of secret baggage. As far as I can tell, the rules of the grown up game are carry as much as you can stoically, and then pretend as hard as possible that you are not weighed down by it all.

Why is it so hard, so non-normative, to be less than totally ok. I think we all look at people who are "having a tough time" with pity and sympathy. But secretly, perhaps, we envy those who finally get to publicly declare, damn, I have had enough and just for this moment I cannot carry it all alone. I can't do this right now!!

As if doing this secret portering of our own mishugas were a laudable achievement.

And while we stand there and offering comfort to the fallen soldiers amongst us, those unable to carry the weight, we part-pity, part-envy them. Envy that they are strong enough to admit the difficulty, strong enough, brave enough to throw in the towel, even if it is just for a moment.

Recently, one of my Rabbi mentors said to me, being vulnerable is hard. We test the waters with people-let the guard down a little, see if it is ok, let a little more of the secret baggage (my language not hers) show, and little by little, we let people in as we see that they are safe. But the trouble is, the more vulnerable we are to another human being, the more frightening the relationship is because the more vulnerable we are to the pain that can happen when there is a mis-step (and the mis-steps in REAL relationships will come), when someone leaves, when someone dies.

There is no conclusion here, no wisdom I have to offer. Just these thoughts on the absurdity of it all. The pretense of "everything is fine," the posturing of having it "all together." This need to look perfect-it drives our economy (beauty industry, fad diets, clothing, products, fashionable coffees and various home goods which communicate an air of "I am ok, see, I have an especco machine). It is the reason we have tv-to watch other people fall apart and to live vicariously through them, to watch other people juggle and be in awe and wonder, and from them we learn-keep going, keep making it look good.

What would happen if as a world we said HELP!! This is too hard!! What would happen if we decided that really, panty hose are uncomfortable no matter how nice your legs look in them and so we just are not wearing them anymore. What would happen if we said, truly, the stuff which is weighing me down has so much power over me BECAUSE I pretend it is not there. What would happen?

Maybe just maybe we really would then be ok...

(PS, Mom, I TRULY am fine, I just am thinking about all of this after a tough day at the chaplaining at the hospital and hearing all about the things that people hold as secrets...When people ask, why me?? As if they are being singled out when truly, it is all of us. We all suffer, we all are burdened and we all...well, most everyone at least, feel like we are the only ones. When really, look to your left, look to your right. That person, they too are sloppily, precariously, and tee-totteringly carrying their own mangled, tangled set of stuff often refered to as "my life")