Friday, May 23, 2008

An Onion For Your Thoughts

I saw the onion goggles hanging on a display in the produce section of the grocery store. They promised maximum clarity and protection and would keep you from crying when you chop onions. But I saw them as potentially perfect bicycling glasses.
And I was right! When I arrived at work the next morning, my eyes weren’t teary and bloodshot. I was thrilled!

But a colleague asked, “Well, now what are you going to do when you chop onions?”

“Cry,” I answered, “And pray.”

I have always rejected any attempts to protect myself from onion tears—chopping them under water, burning candles or matches, freezing the onions before cutting. I don’t want to avoid the tears because I use that time to tap in to the pain of the world.

I imagine all the people on the planet besides myself, who are crying right at that moment. And as I chop, I cry in solidarity with them. I open myself to take on a little of their spiritual pain and I lift them up. I lift them up. This means I don’t pray anything specifically, I simply see all those crying eyes surrounded by a healing light.

So the other night as I chopped onions to sauté with my Swiss chard, I prayed for the people killed and injured by the cyclone in Myanmar. I lifted up the people running their military junta who are refusing—refusing!—international relief efforts.

I cried and prayed for the families in China who are suddenly homeless; whose children have had limbs amputated, whose loved ones were crushed to death.

I wept in awe at the woman who after days of being trapped, told her husband, “We must stay alive. There is a reason that we are spared.” Such strength and wisdom in the midst of so much pain.

My tears were also about the kindness, the generosity of international medical teams who are there struggling to provide care—in a foreign country. And suddenly I stopped praying in general terms.

I imagined myself there unable to speak Chinese. It wasn’t the goggles that gave me maximum clarity, it was my tears. So I prayed for the aid workers, that their lack of language skills would be supplanted by their ability to speak the language of love and compassion.

I prayed that they would have new reserves of patience, wisdom and understanding. I prayed that their hands would be strong and sure and gentle.

Ats we ate, my husband and I talked about these world disasters. At the end of dinner, he turned to me and said, “I loved the chard, but it was a little heavy on the onions.”

Monday, May 12, 2008

The Closer

Today I was the Closer.

In baseball the Closer is called in to clean up the mess of a game or to keep any gains from being lost. In medicine, the Closer’s job is similar—smoothing over sticky situations or tying up loose ends and saying good-bye. This can happen before a patient is discharged home to get well or before they are discharged home to die.

In the latter case, the Closer is not necessarily the doctor. It turns out to be the person who has the closest relationship, the most credibility with the patient. And sometimes the Closer is me, the chaplain.

The doctor, the nurse and the social worker had all told the patient she was going home to die but she didn’t believe them. I ran into her family in the waiting room.

“You have to tell her there is no more treatment left,” her daughter said. “Tell her the cancer has spread everywhere.”

But I knew that is not what I needed to say to make the patient understand she was going home for the last time.

I had known this lovely woman for the six years she had been treated for angiosarcoma, a rare vascular tumor. I never saw her without her wig and make-up. The first couple years it was easy for us to talk about dying and death. But as it happens with many patients, the less hypothetical death gets, the harder it is to talk about.

I sat down next to her bed and took her hand. “I have an agenda,” I said. This is exactly what I was trained not to do. A chaplain should never come in with an agenda and the focus should be on the patient’s needs and not the chaplain’s.

She squeezed my hand and smiled. “You’ve always been honest with me,” she said.

I knew that I didn’t have to talk about the futility of treatment, the extent of her cancer or multiple organ failure. She looked right at me so I seized the moment. “I’ve come to say good-bye.”

She was shocked. “Good-bye?”

“Yes. Years ago you and I talked about this day coming and it’s here now. So I want to thank you for all our wonderful conversations.”

She blinked, still unbelieving. “But I wanted to die vibrant and kicking.” Ball one. This was going to be harder than I thought.

“I know. But people with cancer don’t usually die that way. If you want to go out vibrant and kicking it’s best to have a massive heart attack while doing the cha-cha.”

She smiled. Don’t think it’s easy to say stuff like this. But as the Closer you know what your job is and you have to do it. The only reason I could say it was that it true and not saying it would hurt her even more.

I continued my farewell. “I always looked forward to seeing you in the clinic for chemo. I loved talking with you and your husband. But I know it sucked for you.”

“No, no! It didn’t—it wasn’t bad for me! I looked forward to seeing you too!” In spite of all the pain meds on board, she was still the gracious hostess. “I loved talking about books, and wigs and jewelry and praying with you. Thank you so much for being there for me.” That sounded like a good-bye. Strike one.

For every chemo she received, I had laid my hands on the chemo bag and prayed over it. My prayer was usually something like, “May this chemo help her body remember how to heal itself.” Her body had healed itself for six years, which is pretty good for angiosarcoma.

She adjusted her wig and said, “I just don’t want to give up hope.” Ball two.

What does this mean, “to give up hope?” I hear this all the time, as if accepting reality is some moral failing. As if it’s not possible to both accept the reality while hoping for a miracle healing.

“What are you hoping for?” I asked.

Silence. For a long time. Strike two.

“Perhaps what you’re hoping for has changed,” I said. “Maybe it’s time to hope for a peaceful death, or comfort for your family or hope that you’ll be able to let go gracefully and gently.”

I waited a moment before saying, “I think it takes more courage to let go graciously—“ I opened my palms gently, “than to hold on tightly.” I clenched my fists until my knuckles were white.

She stared at my hands and tears rolled down her face. “All right. But I’d rather be doing the cha-cha.”

Strike three—and my turn to cry.

Saturday, May 10, 2008

Sisters Are The Best Medicine

I'm sure my I.Q. is lower because my sister was just here and I laughed my brains out for five days straight. Seriously. I looked like this photo 90% of the time. Well, okay, maybe I didn't look quite this good. (David Belisle took this as a possible cover photo for the paperback coming out this Fall.)

Lynie accompanied me to a breast cancer conference in Denver. We had a blast eating dinner in the hotel, shopping, drinking tea in bed and talking at night, drinking coffee in bed and talking in the morning.
I really cannot explain why I feel so refreshed and renewed. I've come back from other conferences tired and sick of cancer. So I can only guess that it was because Lynie was there.

I was really losing my mojo for work: sick of all the technological changes that were adding hours to our days and fed up with administrative duties that made me want to scream. When I received an e-mail telling me that I needed to come in for my annual TB test, I thought perhaps I should burn down the employee health building. I felt as if I just couldn't fit one more thing into my day. When was I supposed to see patients?

I missed my happy self. And yes, I suppose it was also because a month before I went off all my hot flash meds which are really anti-depressants. Like many cancer survivors, I was just sick of taking pills. Besides, I was, as my oncologist said, on "homeopathic" doses: 37.5 mg. of Effexor XR in the day and 25 mg. of Trazodone at night. Since the doses were so tiny I simply stopped taking them. I couldn't believe the sadness and rage I felt a few days a later.

I now know that I should have taken them every other day for a while. But because I was taking them for hot flashes, it never occurred to me that they might be affecting my moods. Because when you take an antidepressant for hot flashes, how does your body know? While I was on them, I would have told you that I perfectly fine---well, maybe not quite as sharp as I used to be. But who is?

But once I stopped taking them, I realized that the world is going to hell in a handbasket and I can't do a thing about it. And did I mention all the reckless morons on the Burke-Gilman trail who are trying to run me down on my bike? And horrible lighting in my hole of an office?

Funny I never noticed any of this before.

So it took a good month to get those drugs out of my system. And then I got a good whopping dose of Lynie and every since then I've been right as rain. I knew I was back to my old self when we were on the plane home and the guy in front of me had his armrest up, with all the volume buttons staring me in the face, taunting me, tempting me.

I poked Lynie. I silently pointed to the buttons. Her eyes widened. Then I pushed the volume button all the way to twelve, which is the highest it can go. We were laughing that kind of wheezy, silent laughter that made us weep and jerk like widows keening at a grave.

The guy never put his headphones on, but every time we looked at the armrest we fell apart laughing. The flight attendant came down the aisle and I expected her to say, "You girls go to your rooms right now!"

But she just said, "Seat belts?"

I would have answered, but a hot flash came on. Yes, the hot flashes are back, but so is my mind. They are not as bad as they were a year ago, so I'm just going to deal. And if things get really bad, I'll go visit my sister.