A Still Small Voice (2023)

[bunniefuu]

Hap, do you

want some calming music?

Do you prefer it quiet?

You prefer the quiet?

Okay.

You want the pen?

No?

You wanna show me something?

This is in the way?

Okay.

Do you want me to move this?

It's fine here?

Okay, can I hold your hand

for a minute?

What?

Can I hold your hand?

There we go.

Hap, I'm sorry it's so difficult

to communicate right now.

And I hope

your body's intelligence

can bring you back.

And I have no understanding

of what your body is

going through right now.

I'm doing my best, okay?

All right,

so let's take a moment

to get ourselves centered

and ready, bringing your

energy across the boundary

into this time and space.

You're welcome

to close your eyes

or let your eyes

fall in front of you.

And I would just invite you

to check in with yourself

at the center of your being.

What are you feeling?

What is your experience?

Could be anger, grief,

distraction.

And when you're ready, you can

slowly lift your eyes

and begin to make eye

contact around the room

and just let the group

know when you're here.

Here.

I'm here.

I'm here.

I'm here.

Okay, so the

table is open if anybody

wants to share their experience.

Would you guys

mind if I went first?

All right.

So I just had the call

at noon for the family,

the patient I've been following

for probably

four or five visits now.

Patient took a turn

for the worse yesterday

and now is actively dying.

So, yeah, that's what I'm

coming to the group with today.

So, Michele, take

a moment to really connect

because you're holding a lot.

You're holding a lot

and I want you to be able to

bring in the experience

that you're having right now.

So as you close your

eyes, as you look down,

what are you feeling

inside of yourself?

I think kind of two

things are coming to me.

One is sadness and the

other is just feeling

a little bit of helplessness

at being in a system

that, pardon my language,

but creates kind of a really

shitty experience for people

at the end of life.

He's just in this nondescript

room on a medicine floor,

spending the last few hours

of his life.

Yeah, and I'm wondering

about if helplessness is,

when you start to elaborate,

I get a sense for your anger.

Yeah, there's anger underneath.

Okay, let's see

if you can get a subgroup.

You can just say anybody else.

Anybody else?

That was a lot.

So the subgroup

is really around the anger,

the frustration.

It doesn't have to be

about patient experiences,

could be about anything.

I can join you

in your frustration and anger

because of my experience

of not being able

to see my mother

in a hospital when she was dying

because of COVID restrictions.

I was very angry,

I was very frustrated.

I can join you.

Yeah.

And what's your

experience right now, Fumiko?

Let me go, let me go

see my mom, so that's...

- Okay.

- Let me hold her hand.

Good, good.

Anybody else?

Fumiko, I hear, um...

loss of agency.

The feeling of hitting

a wall and trying to like

just get to the person

you love or...

to the place

that your heart wants to be.

I... I can join in...

in feeling, um...

stunted or blocked

by something out of my control.

Yeah, I just wanted

to reflect that back.

I don't know that

I fully grasped it, but...

I think that's

what I said, thank you.

Yeah.

Thank you.

There's an old adage,

"Don't just stand there,

do something."

And we flip that.

We say,

"Don't just do something,

stand there," or "be there."

Because there's connection

and healing in that.

Thank you for

calling Pacific Interpreters.

This is Katherine. I'll be

your Polish interpreter today.

This call may be monitored

for training and quality.

Are you calling from the

main hospital or from FPA?

From the main hospital.

May I have

your employee number please?

829-8613.

- Okay?

- Okay, hi.

Hi, so my name is Margaret,

I'm a chaplain

here at Mount Sinai.

I offer spiritual care

and emotional support

to our patients.

Oh, okay.

Okay, if I wake up tomorrow.

Yeah, yeah.

How are you feeling right now?

- On 19?

- 18.

18. Sunita B.

Same step down.

So the first name

I didn't catch.

- Sunita.

- No, for eight. Eight.

So eight is Nagafna.

How is the 24 now?

Not ready

yet, that's why I'm asking...

- Okay, okay.

I'll go later, that's okay.

And I'm Margaret.

Oh, hi Margaret.

Hi, oh, now I get it.

I thought I saw someone

on the job.

- Yeah.

- Okay.

Hi, can I come in?

Can I close the door?

What are you

making of your diagnosis?

How are you relating to it?

I have a distance from it.

- Yeah?

- It's like, okay, it's this,

but I don't know what that

means, on a living level.

What do you mean?

So they have this diagnosis of

adenocarcinoma.

Which is a fancy

way to say lung cancer?

A particular kind

of lung cancer.

- Okay.

- Okay.

What does that mean?

I know my life is gonna change,

but I don't know how and

what, you know, in what ways?

So I really have...

sort of waiting to see,

and yeah,

my intention is to live,

but I also want a certain

quality in my life, so...

I really do have

to wait and see.

I have to be in this moment

and go to the next moment,

the next moment, and I'm

very clear from my past

that it will be revealed to me.

It is revealed.

And then I'll know, do

this, don't do that.

Do that, don't do this,

you know.

The mechanics of it

will be taken care of.

But that's mechanical.

Yeah.

What I'm looking for is...

and there's a question

of blame here and guilt

'cause I did smoke.

I was gonna

ask you about that one.

Twenty-five years, so

on one level it's like

this is the consequence

of your behavior.

My mother smoked

for much longer than I.

She didn't get lung cancer.

My brother smoked for longer.

He didn't get lung cancer.

And you quit for...

And I quit for 30 years

and I get lung cancer.

That's what's so...

Yeah.

So... I am

looking at this whole

question of unfairness.

I wanted to ask you,

and you might wanna take

time to think about this one,

but a question that's been

percolating for me to ask you

is what are you most proud of

in your life?

Because you've lived

such a thoughtful life.

I've been true to myself.

- Your integrity.

- My integrity, yeah.

Been true to myself.

Wherever it led I went.

Crazy as it was,

you know.

Okay, no this is not the

way, let's go this way.

And so maybe this comes back

to the question before,

that decision making, right,

because that's where our

integrity might be questioned

or, you know, shaped further.

Yeah.

How do you know when

you're acting with integrity?

What are you listening to

inside of yourself?

Oh, inside of myself

I know for sure.

There's a kind of knowing

in my solar plexus.

When I'm like, not sure,

it's like:

so that gives me that clue.

And the other thing I do,

'cause I have,

I discovered as an adult,

I have ADHD.

'Cause I, there's a list

of things and I said,

Oh, I have all of those.

And so I've learned with

meditation and stuff,

slow it down, pay attention.

Those are things I focus on.

So when you feel settled.

- Yeah.

- And steady.

- Then I can make a decision.

- Yeah.

Or the decision comes,

it's just like, this is it.

I heard you say before, like,

there's like a small voice.

- Yeah, definitely.

- That told you to get out

of that relationship.

Like a small quiet voice.

The still small voice

does come to me.

Still small voice, yeah.

So we're going to be

looking out for that now.

- Now, right.

- Right?

That's what I'm looking for,

and I'll know when I hear it.

Right.

So no being told to go

faster, quicker than you...

That's really, I'm usually

pushed along by everybody.

This is really interesting

for me to see myself go,

"You're not letting them

push you around."

You're sticking up for yourself?

Yeah, yeah.

So that's kind of exciting.

I think so.

So going slow.

- Yeah, going slow.

- To hear yourself.

Yeah, yes.

- And maintain the integrity.

- Yes.

- Thank you.

- Your own pace.

I go at my own pace in order

to hear my own small voice.

Yeah.

Yeah.

Yeah I have patients to call,

but I'm not in the mood yet.

I think I'm like

running on empty.

It's maybe like one o'clock,

I don't know.

From your role as my

supervisor and, you know,

the time that has gone by,

where would you like to see

me next in terms of growth?

What talents have come

through or certain skill sets

either that you would want

to be improved on or like,

just like, where would you

put me next

if you had like any say

or choice in that

from what you've seen of me?

I'm thinking about your

emotional boundaries.

A lot gets through and

that can really drain you,

deplete you, and I think um...

whatever you can do

to try to close

those boundaries

a little bit more

so a little bit less

gets through.

So it's not an all or nothing,

it's not open or closed.

It's how open, how closed

are those boundaries.

So you can manage your empathy.

I feel it within me

that I wanna

go deeper or further

or go in this direction and,

ah... should I,

or should I not

at this point?

And what are the risks

and what are the rewards?

What's the potential fallout?

Because it seems like what's

lurking in the background

is what is the price

that you will pay

in terms of exhaustion?

There's a lot of effort

that goes into holding back,

and there's a lot of effort

that goes into saying it

and then dealing with what

comes after it's said.

So it's not... I say that to

acknowledge the challenge,

the difficulty

of either direction.

And that's gonna live

on beyond the residency,

I think, and that's

not a failure

of yours or the residency.

I think it's just one of those

larger issues that we all,

if we're lucky,

we identify them

at some point and we say,

Oh, okay, this is one

of those long-term things

that I'm just gonna have

to continue to grapple with

and develop over the long haul.

Would it be possible

for me to ask you to

keep an eye

on that learning goal,

and kind of

be more forward with me

where you see me doing that well

or like where I could

have been tighter.

I hear that.

And the feedback could be harsh.

Don't be, like,

soft on me there, okay?

Okay, yeah, yeah,

well, yeah, I mean,

I don't know that I...

It's hard for me to get harsh,

so I don't think you have

to worry about harsh.

I think what I'm hearing

you say is

Step it up on the feedback

in this specific area.

- Yeah.

- Give me more.

I'm so terrible at this.

Run in circles.

- I love it.

- Or I'm the best!

There you go.

How many of these do we have?

That's pinball.

Watch that second bounce.

How's the morning been going?

Anything from the weekend,

anything of note

for the week ahead?

Mati, you want to start us off?

I mean, Thursday night...

You had a big case in the PICU

and I read there was...

That was huge, yeah.

So an 11-month-old

came in for surgery

and unexpectedly died

in the operating room.

Yeah,

the parents were 17 years old.

Oh my gosh.

It was heavy.

So yeah,

that was part of my weekend.

Yeah.

Thank you for going

and being there

and just so you know,

there was so many emails that

night and the next morning.

I appreciated getting

to read your chart note

and having all the

information at my fingertips.

So thank you so much.

- Hey, all right.

- All right.

- Okay.

- Okay, all right.

I'd like to look at the

calendar and see if we can get

more frequent consultations

scheduled.

We're, you know, we're

meeting pretty infrequently

and I'd like to meet more,

if possible.

That would be great.

Okay. Cool.

So why don't we take a moment

and get ourselves centered then.

Okay, sounds good.

Yeah, just take

a couple breaths.

Feet on the floor.

And gathering up your energy

and bringing it to this context.

So are you here?

I'm here.

- Great.

- Yeah.

- Me too.

- Good, good.

Okay.

One of my primary

goals for all of this work

is to... just really,

sit a little more easily

in the...

in the role of authority.

Okay.

Yeah.

You know, I don't know,

I'm just gonna associate

here for a moment,

but what comes to mind

is my first supervisor...

I was telling somebody

the other day...

who I, you know, I still love

to this day and respect greatly.

Some of the approaches

were really threatening.

You know, it was like I

saw him walk out angrily.

Hmm.

- I s...

- So that kind of provocative...

- Okay.

- Yeah, yeah, I saw,

I don't know if it was him

or one of the other educators,

but ripping up a verbatim

at some point.

Just kind of tossing it back

to the student, This is crap.

Whoa, whoa.

You know, that kind of thing.

And then with my

first presentation,

I was very nervous and guarded

and my supervisor said,

"You're really

guarded right now.

I don't know if I should

tear down your guard

or let you take it down."

And in that moment I was like,

Oh, well, I don't want

him to tear it down,

I'll do it myself. So I said,

"I'll just do it myself."

And I, you know,

proceeded and tried to,

you know, be more vulnerable.

But looking back on that,

I mean that,

that was, it was

a threatening intervention.

Certain actions

were modeled for me

and that's sort of

the range of options,

you know,

yelling and walking out.

Yelling and walking out.

And that being, like,

what is the point of that?

The point is, I think,

to be one up

rather than one down.

That's not how I wanna be

in this role.

Yeah, I had a student

once who said...

This was pretty cool.

She said,

she wanted to see me

like the black belt

and she knew she could throw

punches and it wouldn't hurt.

I thought it was

a really great image of...

Yeah.

You know, like a child in

a karate class, you know,

and the sensei like really,

you know, firm and comfortable.

Muscles in their belly,

you can kick...

Yeah, relaxed and know that

it's aiding the development

of the student, to do this

sparring and whatnot.

Exactly right.

So really I do hear

the next step, David,

is to be able to do the work

to be in your authority, right?

Yeah. Yeah.

Fully. You can have

your full experience

and you're not gonna be

destroyed by the student.

Right.

And you're not gonna be a bully

that you have to

destroy her either.

Yep, that's it.

It's really, yeah, staying

away from those extremes,

trying to be

more measured, in the middle,

which to me is more courage.

It's like the courage to

stay with the discomfort,

the anxiety, and work

through it,

you know, in a present

kind of way.

That's what I really want.

And you not feel threatened.

But to be able to hold

that structure for them.

Right, right.

Yeah.

"The eternal

providence has appointed me

to watch over the life and

health of thy creatures.

May the love for my art

actuate me at all times.

May I never see

in the patient anything

but a fellow creature in pain.

Grant me the strength,

time, and opportunity

always to correct

what I have acquired,

always to extend its domain.

Oh God, thou has appointed

me to watch over

the life and death

of thy creatures.

Here am I ready for my vocation

and now I turn

unto my calling."

Even though the

person who wrote this prayer

is a physician,

he's identifying, like,

I'm called to this work.

Acknowledging, like,

he can't do this alone.

For me, I'm the same way.

And I've had conversations.

I don't know if you and

I have had it, David,

but I've had it

with other persons.

Like, I can't do this

work if I don't pray.

Like, for me, I think,

just for me in my practice,

it's impossible.

How is that for you?

Like if this is something

that you wanna flesh out.

I have no idea

where my prayers are going.

My inheritance and

life experience is like...

if...

There's... there's like

a sense of malnourishment

or like lacking of, like,

an immanent god.

Like, I'm, yeah...

My grandfather had a wife

and three kids

m*rder*d by the Nazis.

My grandmother was in

Auschwitz for a year,

and just like a starving woman,

like in the cold,

walking among the dead,

and survived

the gas chambers twice.

And yes, the question is,

where...

where the hell are you?

And, like, how much of

a beating should we be taking?

And how obligated am I to you

if I don't feel you,

I don't see you

and like, you've...

you weren't protective.

That trauma is so profound

and so deep

that it almost like

exists for me on that, like,

transcendent level of

just, like, I do not get,

like, what do you make of this?

I don't... I don't...

It's heavy.

But that's like

my child self saying that.

So there's still like a...

How can I conceptualize

this differently or like

what does it mean to

have like a more adult

relationship with the divine?

I'm like grasping

for like a different,

a different kind of knowing.

Thank you for sharing that.

When you make space like this,

it doesn't surprise me when

significant things emerge.

So who knew with this oath

and prayer of Maimonides

that we would wind our way

through your family history

and where you wanna be

and who you wanna be

in the midst of all of that.

I didn't say much because

mostly 'cause I'm really fatigued.

I was up 'till two this morning.

It just it hit me in this hour.

I have been thinking, I wonder

what would it be like to,

I don't know, go to the park,

end early?

I feel like we're all exhausted.

I do have that impulse as well.

You're welcome to go

do whatever you'd like.

Go home.

I'm gonna go get a snack

and take a nap or something.

I'm exhausted.

You could look at religion as,

like, a psychological crutch

because it's way easier

than confronting reality.

But then at the same time,

I can't throw all of this out

because there's too much here

that is nourishing.

Iced tea,

KIND bars, essential oil.

Okay, essential oil.

- Essential oil?

- Yeah.

Whatever, tea, I don't

know, what's that one?

That's an iced tea.

- Okay.

- So let's start with that.

I don't think I've met you yet.

- No, Jermaine.

- Margaret.

Nice to meet you, Miss Margaret.

Nice to meet you.

I'm running low on ice, but

you have ice on this unit

so you could get more

if you want, yeah?

Okay.

Do you take sugar?

I'll try it plain, I'll try

to do it bland. Let's see.

Okay, you know. You know.

Okay, so essential oil.

How you feeling?

What do you need?

Oh man. I feel sluggish...

You need, sluggish, so

do you want some citrus?

Okay.

Ooh.

This is just what I need, yes.

- Yeah?

- Yes.

Yeah, to help to

clear out my airway.

- Good.

- Like, be able to breathe.

- Breathe. It's important.

- That smells good.

Yeah, that one gives you a kick.

Like it.

And then you

can put it over here.

Yeah, you want iced tea?

Yes, please.

You could keep sniffing.

Yeah. This is actually good.

This is like literally

what I need right now.

How much time do you guys take

to check in with your

own body when you're here?

Oh man, never.

- Okay, there we go.

- Okay.

- There we go.

- Right.

- You want sugar?

- Yes.

Okay.

Last one.

- Okay. There we go.

- All right.

Hello.

Hi, Elana?

Hi.

Hi, it's Chaplain Margaret

calling. Is now a good time?

Yeah, I remember.

I have your number saved.

Yeah. I am so sorry

for your loss.

I am so sorry.

Thank you.

I know he passed away like

30 minutes after I left.

Yeah.

And he also seemed very,

very calm and not in pain.

Yeah.

Not that that lifts

anything, but...

Yeah, at least

he wasn't hurting though.

Yeah.

Yeah.

Oy, I am so sorry.

Thank you,

I appreciate you calling.

Of course, and how

is Alla doing?

I was just on the phone with her

when you called.

She is devastated.

Yesterday was the funeral

and, ah...

she's like, just really,

really worried about me

'cause like I got really,

really, really, really,

excuse my language,

f*cked up yesterday

and she's just scared that

I'm gonna like spiral.

Do you share

the same concerns as her?

I don't really

care about myself right now.

What do you care about?

I don't know.

Mmm...

Okay.

Is this your first

experience with a major loss?

- Yes.

- Okay.

So... I just wanna

give you permission

for being in the unknown

and having no expectations

for how you should feel

or what you should be

going through, or

whatever is, is okay and enough.

Thank you.

Okay?

What do you believe,

like, happens after death?

I'm not too familiar with,

like...

Uh, Judaism.

Yeah. Um...

Well, I could speak

from my own perspective

and then I could speak somewhat

from like a Jewish

theological perspective,

but I'm gonna differentiate

those two, okay?

Okay, I'd like to

hear yours first. Definitely.

I don't always choose to

share private information

or personal information

with my patients or family,

but in this moment it feels,

um...

it feels appropriate.

Thank you.

I lost my father pretty suddenly

and I would also say tragically.

- I'm so sorry.

- In 2016.

So I have my own

experience and relationship

with profound grief

when it's unexpected

and quite complex.

Yeah.

I will say that it has

turned my life upside down

in ways that, while I

was going through it,

it felt like hell,

but now that I am somewhat

on the other side of it,

I realize was a gift.

Um...

I... I have come to

kind of like a place

of comfort in feeling,

and this is more of an intuition

or I guess a personal belief.

I can't

back it up with any data,

but it's a personal

belief and perspective,

um, given my line of work,

that when a soul is

finished with its work

and its...

its reason for being

alive in its body,

in its current body,

is complete,

death is okay.

What you said earlier

about the reincarnation,

like if the soul's work

isn't done,

then they come back

in another body or form.

Ben was so scared of that.

Hm.

Like he just,

he told me that um...

he was scared that like

he would just keep coming back

and living the same life.

Yeah, I mean,

death is scary,

because it's unknown

territory, right?

Yeah.

If anybody tells you they

know an answer of where we go

or what happens, I would

say don't believe them.

- We don't know.

- No one knows.

We have ideas, intuitions,

maybe like traditions,

but what I can say is

that when I was with him

before he went to the ICU,

he was at peace, he was calm

and he was well-supported.

And um...

I guess...

just let the tears come.

It's love. Right?

Yeah.

It's love and things

will change and shift

and just allow, allow, allow

whatever comes.

There's no right way to grieve.

There's no specific way

to grieve.

It will come, it will go,

and there are ways to honor

him while you're here.

Yeah.

Good morning.

Okay.

Um, I'm just gonna lift

that I still have a headache

and I'm gonna go slow,

and as usual,

there's always a lot of content.

So I'm gonna pace myself, okay?

"So I knew

that the primary medical team

had been experiencing

great difficulty

with the patient's family

and their communication style.

This was evident to all

given that the patient's wife

was often hysterically crying

very loudly on the unit,

both at bedside

and in the hallways.

She would move around

her husband's bed,

placing aloe vera leaves

all over his skin."

I wrote patshing.

It's kind of like a Yiddish

way of saying hitting,

but that's what it felt...

that's what it seemed like.

She like hitting her husband

like that to make him wake up,

which was kind of disturbing.

So transference,

countertransference.

"The patient's wife

reminded me of myself.

It reminded me of my

three-year-long acute grief

after my father's death

and my inability

to live without my heart

feeling like

it was falling out of my chest.

I would often come home

from classes

and all I could do

was get in the bath,

the closest feeling

to being held in warm

and compassionate hands

when far from home

and community of origin.

The wife's hysteria

reminded me of my mother

when she first left the

ultra-Orthodox community

and did not have access

to certain cultural

and educational resources

and literacies,

and often found herself

struggling to protect

her voice against

institutional systems

that were

more powerful than her.

She would use her

hysteria to move mountains

when all else failed.

Lack of desire to live

any longer due to acute

spiritual and

emotional distress."

That's my dad.

That's something that was

triggered here as well.

So the whole thing

felt very frightening.

Very disturbing.

Complicated. So what do

you need from this verbatim?

This is one of these cases

where I wanna be able to like

make like a protection

around myself.

Like these are cases

that like I hand off

because it's too close to

home, it's too triggering,

and this person is

weighing on me because like

I actually believe her

when she says,

I will go and k*ll myself.

And I cannot just like put

up a boundary and be like,

Well, my working hours

are from Monday to Friday

and I'm on PTO on this day,

and so therefore, like, no.

- This is one of those...

- Why not?

Life and death, no.

It's against my personal

moral code of ethics.

If somebody's in a life

and death situation

where they might take their

life, I will answer the phone.

So how do you...

You chose to answer the phone,

but you can't know

what's gonna be conveyed to you

- when you answer the phone.

- No.

So why did you answer

your phone on your day off?

Because I won't know what's

gonna be conveyed to me

if I answer the phone and that

person might hurt themselves.

You're very insistent right now

on not setting

certain boundaries

and I think that merits

serious consideration

on your part

because it's connected to

the other serious concern

that you've been raising,

which is your depletion.

And I don't think

you can have both.

It felt like there was nobody.

The social worker was like,

Discharge, discharge,

discharge, I don't care.

Like, the wife is not suicidal.

It doesn't matter

that she had a plan.

It doesn't matter that

she said all those things.

We're not even

gonna chart it as that.

But that doesn't address

the boundary-setting issue.

It does for me, it does.

Because it would harm me to know

that somebody took

their life because nobody else

was available

to pick up the phone

and I was technically on PTO.

Right, but that assumes

that you're the only person,

and you're not.

So I'm looking for structural

ways for you to set boundaries

so that you can preserve

yourself and not hit the point

of fatigue and depletion

that you've been expressing

over the last several weeks.

So that's where I'm coming from.

I also wanna challenge

what might be some sort

of unconscious

mental model of yours

that sort of presents itself as,

I'm the only one

who can fix this problem.

And I don't think

that's the case.

So that's a part that I

want you to reflect on...

and we can take it up more in

individual supervision on Thursday.

Can I ask you a question?

Mm-hmm.

I'm curious if you, from

your perspective, feel like

this residency has been

successful both for me

and for my placement

in the cohort.

Successful, hm.

Well, that's

an interesting question.

I was kind of... it's a

surprising question to me.

I don't know if I would

evaluate it in those terms,

success or not successful.

I'm wondering if we have

mutually agreed upon goals.

- Yeah, me too.

- For you, okay.

Yeah, I am

wondering about that too.

Yeah, and I can tell you

what my goal is

and then we can see

if it's similar to your goal.

The fact that the issues

have surfaced,

I think are a mark of success.

Now we have a couple of months.

What can we do?

What I want you to do,

what I wanna do with you

is I want you to explore

rather than explain, because

I know you can explain,

I know you have hypotheses,

I know you have a mental

model and I think sometimes

those get in your way

of exploring

the experience right now

and learning something new.

Okay, I can join you

in the assessment

that I'm quite good at

explaining and need more

experience and spaciousness

for exploring.

That pivot feels very accurate.

Keeping my thoughts and

my statements open-ended,

question mark at the end.

I need more information. Yes.

Okay, curiosity, good.

It's a join

and a difference here.

You know, Tuesday was a

really meaningful day for me

in many ways and very

frustrating because I did feel

your care for me or space

for, like, maybe holding

my intensity, like, was waning.

It did feel like

there was a fissure

or like a breaking of trust.

- Mm-hmm.

So my communication...

sounds like really

closed your boundaries

and caused you

to start questioning.

I'm not sure exactly what

our relationship, my...

- I would say your empathy.

- Hearing.

Okay.

It felt like the rules went

up, the empathy went down.

That's what I experienced.

Mm-hmm.

And sometimes that happens

when there's

stress in the system.

Yeah, for sure.

That is true.

Yeah, but receiving

that was very difficult

because it felt like I

didn't feel cared about

and I didn't feel invested in,

and I feel like I'm

being blamed or shamed

for ringing the bell when I say,

this feels too much for my body.

Or the ride is going too fast,

it needs to

slow down a little bit.

Or something's not right.

And it could be that

there's learning goals here

that relate to like, you

know, the core issue.

It could very well be,

and I'm receptive to that.

But it felt like the care,

the empathy, and the curiosity

was replaced with rules

and, Sit down

and eat your broccoli.

And make sure

that you clean it up

and put it in the dishwasher

and chart it.

Mm-hmm.

You know what I mean?

I do, I do, I do know

what you mean.

I'm not laughing at you.

I'm laughing in recognition

of what you're describing.

It really resonates.

Yes. So you're reminding me

of my stepdaughter's feedback

and, ah, that's just

an acknowledgement.

Sometimes I do get rigid and

it comes across as uncaring,

different from the

relationship that we've built,

so I'm saying that to

validate what you're saying.

I hear you and it

resonates with me and...

I got tense

and I'm sorry that it

had that impact on you.

First floor.

Are there specific words

that you say during a baptism?

Yeah.

Do you know them by heart?

Do we have like

a card or something?

We have a book.

- We have a book?

- Yeah.

Okay, it's an emergency

so I'm gonna grab the holy

water while that gets located.

Is it there?

Well, yeah, but

I mean it's 15 pages long.

Well, I'm just

gonna take a bit of it

and I'll improvise.

Yeah, I mean you'll figure out

what to skip

and what to include.

I do the same thing.

Okay.

- Yeah.

- Awesome.

- 127.

- Oh my,

I was just about to

like, my heart dropped.

If you can't tell, I'm nervous.

Can you tell?

I get really nervous

every time I do a baptism.

Very nerve-racking.

Okay.

Let's go.

Adding this to the fanny pack.

And this.

See ya in a bit, thank you,

thank you.

- Oh, okay, good luck.

- Thanks.

Okay, the chaplain

is here at the front desk.

Where should I meet her?

Where should she meet you?

It was, uh, twins

and one passed away.

Okay, so one made it

and one's passed.

Do we have baby names?

Yeah, one is Isabella

and one is Aurora, I believe.

The one that's with us now

that passed, what's her name?

So the one that passed

Aurora, I believe.

Can we confirm that?

Yeah, I can confirm.

- And mom's name is Layla Sue?

- Yeah.

- I think it's Leila.

- Leila?

That's the way

she pronounces it.

That's very helpful, thank you.

Mom, do you wanna hold Aurora?

Is it okay?

Okay.

Okay.

Okay, so I'm gonna baptize her.

Okay?

Let's just take a couple deep

breaths together and center.

Beautiful, okay.

Okay, we got this.

We got this.

It's okay if I begin?

- Of course.

- Okay.

"The sacrament of baptism

is an outward and visible sign

of the grace of God

and as much as

the promise of the Gospel

is not only to us,

but to our children.

Baptism with water

and the Holy Spirit is the mark.

Baptism is a sacrament

through which we are united

to Jesus Christ and given part

in Christ's ministry

of reconciliation.

Baptism is a visible sign

of an invisible event

as though thou art alive."

In the name of

the Father, the Son,

and the Holy Spirit.

I bless you, Amen.

And Dad, I would like you to

do the same if you can. Okay?

In the name of

the Father, the Son,

and the Holy Spirit.

- Amen.

- Amen.

Beautiful.

Okay.

She had life in your body.

Right?

Yeah.

- She had life.

- Yes, very lively.

And she had purpose

in your body.

And we don't have access

to what that was about.

But we did our part

and you did your part.

You delivered her.

And she's beautiful.

Yes.

She's beautiful.

- Thank you.

- You got it.

Is there anything else

I can do for both of you?

You don't have a Bible, do you?

I do, I do, do you want...

Jeremiah 29.

You wanna, yeah,

go for it, go for it.

"'For I know the plans

I have for you, '"

declares the Lord,

'Plans to prosper you

and not to harm you.

Plans to give you

hope and a future.'"

Mm.

Yeah. You know, I think

that's, you know, for all of us.

We have hope in the future

and I know she does in a more...

celestial plane, let's say,

and you know,

we're excited about her sister

and her big brother and everyone

in the family, feels blessed.

At the same time, we feel

extremely heartbroken

that she couldn't make

it out with her sister.

Yeah.

Lord, our God, Eternal One,

please bless this family.

Bless this family

to know and to hold

the complexity of life

in their bodies

as they have known

for these last several months.

To be able to grieve,

to be able to celebrate,

simultaneously,

is one of the hardest

tasks you have given us

and we take it on.

We ask you, God, to bless

Aurora.

Bless her life, bless her heart,

bless her to know

she always has a sister,

always has a companion that

she shared the womb with.

Bless her to know that her

parents are only stronger

and more fortified

by this experience

and that Aurora will

remain an eternal teacher

and have a place

in our home to reside

whenever her spirit

wants to visit.

We thank you, Eternal

One, for the complexity

of this experience and

the ways that Aurora

has taught us and will

continue to teach us

how to be great parents,

community members, mother.

We thank you and we will

grieve and we will celebrate

simultaneously, at once,

as we are obligated.

We thank you God, amen.

- Amen.

- Amen.

Amen.

Okay.

- Mom, you good?

- Yeah, thank you.

- Yeah, thank you.

- Okay.

- All right.

- Okay.

- Okay.

- Technical stuff, all right.

All right, now are ya here?

I'm here, yeah,

yeah, I do feel here.

All right, good, okay.

So David, what method would

you like to use today?

You wanna use "My

problem is I" or another?

Hmm.

Exploring.

I think I wanna use,

ah, a different one.

That one's always tough,

although I see the merit.

- And it can be, yeah.

- Yeah.

Well, let's, before we

begin then, how are you?

Let me say hello.

Yeah, thank you.

Well, that's where I wanted

to begin anyway, is uh...

is that I've got a mishmash

of things that I think

we can probably...

they're probably related, but

we can probably tease them out.

Okay.

My, whatever you call

it, my filter is down,

my bandwidth is stretched.

I don't have the room

inwardly to metabolize

the harder stuff that

comes at me right now.

Okay.

I'm telling myself right now,

I don't wanna

do supervision anymore.

And I don't think that's

exactly the truth.

Okay, but right at the moment,

you don't wanna do supervision.

I don't wanna do it.

Okay, anymore.

You don't know the future.

- Yep.

- At the moment,

you don't wanna do supervision.

- Yeah, I don't wanna do it.

I dread it.

If I can cancel it, I cancel it.

I would've

canceled it yesterday,

but we haven't met

in several weeks

and then it's like,

there's only five...

after this week

there are only four more weeks

and it's like,

you gotta supervise.

You have to.

You have to do this.

It's... first of all,

it's your job.

It's... they need it.

Like, you can't stop doing this.

But I wanna stop.

Okay.

All right, so let's pay

attention to, you know,

this piece of you that

wants to stop and you know

what's going inside you,

David, right now

that you wanna stop?

Like, what about the supervision

do you wanna be done with?

Well, it hurts.

It hurts, okay.

And I wanna stop hurting.

Wanna stop hurting, of course.

That's the motivation

is it hurts and,

man, my shame triggers

are so triggered right now,

but I don't have the um...

I don't have the fortitude

at the moment

to really, um...

provide the supervision

I wanna provide.

That's why I'm, you know,

I'm thinking,

Okay, you need a break.

Well, what I'm really

hearing, David,

when you say it hurts,

right, and you know,

this work does hurt if

we don't have the fortitude,

which we don't always have.

Yeah.

Yeah.

And you don't wanna hurt,

of course.

No.

Who wants to do

something that hurts?

Yeah.

It's hard to know.

I can see what I need to do.

Okay.

And I can't find

the strength to do it.

Okay.

I see it, I know what

needs to happen, but I just,

I don't have

the gas in the tank.

It's like...

Okay, so I think that

this is so important, right?

You see it, you know it,

here, what needs to be done

and you don't have

the gas in the tank.

Okay.

My guess is that you are

absolutely a voice

for the group.

No one in this group has the

gas in the tank right now.

Lord, our God, Eternal One,

we come before you today,

to celebrate the devotion

and the love between

a daughter and her mother.

We do not want to miss

this opportunity to love

because we are

stuck in the past.

Lord our God,

we ask that you guide us

in this very challenging

and dark moment,

and let us remember...

that when we think we're

at the end of the rope,

there's always something

that appears

that keeps us

desiring life, desiring you,

and desiring to serve, amen.

Amen.

- We can't redo the past...

- Yes I know

We can't redo the

past, but you know what?

I'm more afraid that you're

gonna miss the present

because you wanna

replay the past.

We cannot save our parents.

We cannot save our parents,

okay?

These things happen.

It's natural.

And we're also in COVID, so

you're, everyone's foggy.

Nobody's thinking straight.

Everyone's in a stress response.

I don't want you to be

shouldering this guilt

because it's not

your responsibility

to fully shoulder that.

Whatever people are

saying about negligence,

you don't let that in.

You love your mother

and you continue to love her

while she's here now.

But I tell you this as

somebody who lost somebody

with no warning at all, none.

You do not know

what's gonna happen.

You do not know

and I could tell you that

now from the other side,

being somebody stubborn who

thinks she knows everything

what's gonna happen

all the time.

So let me be that stranger

that tells you it's dark,

but you have no idea

what's gonna happen.

Okay?

You will have time

to decide how to make meaning

of the past, but I don't

want you to lose the present.

Your mom is still here.

You're not dumb.

You're not negligent.

You just can't

control everything

and this is shocking

and COVID is very,

very stressful.

I have a little bit of

a cold, but don't worry,

it's nothing serious.

For today,

Karen is on call? Yes.

And, um, Jason, Sophia,

and Fumiko are off today...

and I'm...

I don't see Mati on this call,

so my last email...

I'm gonna check in with her

on whether she's

in or not today,

but I'll confirm that for now

I will list Johnny for her,

Mati's units,

and if that changes,

I'll let you know, Johnny.

I also have Johnny

listed for the SICU/TICU.

Good morning, Mati.

Wanted to follow up.

Thought you'd be here,

that you'd...

- Hey, Mati.

- Hi, both of you.

- Hi

- How are you?

I guess I've just

been feeling like resistant

because, like, my body

doesn't feel okay.

When I woke up,

I was just like, I can't.

I can't imagine doing this

five days a week in a row.

I don't have a marathon

in me right now.

And maybe, maybe others do...

personally, I don't.

- No, I don't.

- Like, legit.

Like, pal care

took a lot out of me

and my body was breaking

down during pal care

and I was like,

You can't get sick right now.

Yeah.

I feel kind of angry

that my body's being

asked to produce

at a certain level

or standard that I am...

- That's true.

- ...not willing to do.

And I can't do it.

I don't wanna do it.

So you really escalated

this situation unnecessarily

by asking about HR.

You always have a privilege

to go to HR.

I took the privilege

today as well.

I talked to labor relations

and you are not

being mistreated.

That is a gross exaggeration

of the situation.

You have two options.

When you say you're gonna

be here from 12 to eight,

you come in from 12 to eight

or you notify me and Amy

in advance.

I took grand rounds,

but I was on the phone,

I was listening. I was

present, my name was on there.

I made sure that it was present

and then I came here as soon

as I could after I finished

doing some of the work at

home which I had to do.

Are you hearing what I'm saying?

The two options.

You brought

this to labor relations

and now I have to figure out

what to do with that, yeah.

No, you're hearing

the wrong thing.

I've said I need to know

in advance.

What does advance look like?

Before twelve o'clock.

Your shift is 12 to eight,

you notify me at 1:08 that

you're gonna be in at two...

I went to labor relations

to make sure

that you're not being

mistreated and you are not.

That's how you made

sure I'm not being mistreated?

That is a gross exaggeration.

By taking it to labor relations.

Unnecessarily escalating

the situation.

That's how you made

sure I'm not being mistreated.

Listen, I said...

I don't feel

safe with you in a room.

- Fine, good.

- I've said what I'm gonna say.

I'm gonna send you

an email to put it in writing

and that's that.

This truly is

a bittersweet week.

You know, bitter in the sense

that I always feel some grief

about saying goodbye to the

residents as they're leaving

and really sweet because

it's such a celebratory time

because you've accomplished

and achieved something

so hard. So hard.

As we all know, it really

takes a lot to be open-hearted

and to keep going back

again and again in this work

and to build those

muscles and that capacity

and wanna thank each

of you for your tears,

for your laughter.

Jessica, that you've

been able to join us

as a staff chaplain.

Michele, that you'll

be able to join us soon.

Fumiko, that you're leaving now,

but we hope to welcome you back.

Mati, who had to leave early

but really gave so much

of herself through the

course of this year.

I think I'm trying

to hold my own integrity with,

you know, not feeling closure

in certain goodbyes

and not pretending either.

But also leaving an

opening for until soon.

I recall you saying,

I cannot believe

I cannot believe

what my body can endure

and I just needed

to share that with somebody.

To let them know.

And what I felt in that moment,

through the tears, was awe.

It was this quiet strength.

I checked in for one thing,

I got four other things

happened since I've been here.

You got pancreatic cancer,

COVID, then liver failure,

aneurysm, bacteria

in the stomach?

Did I get that somewhat right?

Yeah.

Girl, your body...

it's been through a lot.

Yeah.

God, you are a waymaker.

You are such an awesome God

that makes ways out of no ways

and we thank you for that, Lord.

God, I also thank you

for the power of yes.

I thank you for allowing

me to wake up every day,

allowing us to do

what you call us to do,

knowing that yesterday,

there's nothing

that we can do about it,

but learn for today.

God, we thank you

for your great expectations

over our lives.

We thank you for giving us

a window into the complexity

and intelligence

of the human body.

We know that better than many

because we have

been through so much.

Lord our God, we ask

that you make it clear

what is the teaching you

wish for us to receive

in our suffering.

What is the teaching?

How might we receive it

and give it as a blessing

to others,

holding and standing our

ground with full integrity,

as a way of service to you,

as a way of service to spirit,

and a way to keep our temple

alive, breathing and well.

Once again, you came

on time, Margaret.

- Thank you.

- I was having a hard time

today, this morning,

to be honest with you.

And I was like, God, why?

Like, what's good?

Like, what's really good?

That's how I talk to him.

What's really good?

Like, what's going on?

Because I know you say you,

you won't overbear us,

but did you really mean that I

could go through all of this?

He does amazing things,

that's why I can't be angry.

Because if I think about

all the things

that I've been through,

I lived through

every single one,

so it's not my time.

You know,

it's not your time, girl.

Now be quiet, get some rest

'cause you gonna have work to do

when you get outta here.

And that's how I look at it

and I found my joy.