Teachings

       How are you? Pity soaks the moment like wet bread.                                          Do I spit it out, or must I gum this unguent down?                                                  —Christian Wiman, from “Darkcharms”

I learned in my first week as a hospital chaplain never to ask, “How are you?” or any variation of the question. Before my chaplaincy program, I went to law school and served as a criminal prosecutor in North Carolina; I never felt compelled to utter this small-talk inquiry to any party during that time. But instead of the harsh overhead lighting inside a dilapidated courthouse, I now find myself underneath the sterile bulbs of a university hospital in Virginia for the next three months. Clinical Pastoral Education (CPE), a standardized chaplaincy program housed in most large hospitals in the United States, is a popular summer option for students in seminaries. I gave up the moral distress of putting kids in jail for nonviolent crimes to study literature in a divinity school, a move I hope will serve as an adequate bridge from law to secondary education and advocacy for the poetry world that lent me the courage to head down this road. “To make injustice the only / measure of our attention is to praise the Devil,” Jack Gilbert writes in the providentially named poem “A Brief for the Defense.”

Back in the hospital, my fellow interns and I watched the film Wit, along with most other summer chaplaincy programs in the country, to understand why we shouldn’t ask how someone is doing. The movie depicts an angry John Donne scholar (played by Emma Thompson) during her various stages of cancer:

         I've been asked, "How are you feeling?" while throwing up into a plastic basin.

             I have been asked as I was emerging from a four-hour operation with a tube in                every orifice: "How are you feeling today?"

             I'm waiting for the moment when I'm asked this question and I'm dead.

             I'm a little sorry I'll miss that.

I asked the question all summer. What else was I supposed to say when I cold-knocked and walked into a room of a vulnerable person I’d never spoken to nor seen in my life?

Wiman goes on to write, “prevarications, extenuations, tomorrow’s tease of being: / we are what we are only in our last bastions.” This notion of “our last bastions” troubles me. The most common definition of his last word: “an institution, a place, or a person strongly defending or upholding particular principles, attitudes, or activities.” When a grown man who is half-naked in a hospital bed cries because he can’t move his bowels, is this all that he is if he dies tomorrow?

I visited this man almost every day for two months last summer. In the mornings, we had didactics (such as “Caring for the Buddhist Patient”) or verbatims (in which we workshopped, word for word, how a patient visit had unfolded), so I visited this guy after lunch each day. He was about my father’s age—mid-50s—and he was cleaning brush behind some of his property near the West Virginia–Virginia line when he was shot with an AK-47. It was an accident—some kid was dry-firing it a few houses down, messed up, and shot my patient in the back of his right shoulder. The shell bounced around and traveled down his bowels. I prayed for shit with him all summer.

I’ll call him Joe. On our second visit, Joe had me weeping. After telling me more details about how someone shot him with an assault rifle, how his hospitalization hurt the business at his auto shop, and how the traveling back and forth from home exhausts his wife, I said to him, “You don’t seem like you’re angry at all.” Joe told me he’s not. “The first thing I did was to forgive that boy.” Behind wet eyes, I told Joe that it’s rare to encounter someone who actually does what Jesus told us to do. And I rethought Wiman’s line about last bastions.

•

My first overnight stint, one that spans morning to morning, came four weeks into my summer program at the hospital. During the normal workday hours, no fewer than four chaplain interns, five chaplain residents, two staff chaplains, and two chaplain supervisors roam the main building’s eight floors, which hold 601 beds. I cover only the pediatric and orthopedic units in my afternoons. But once the on-call shift hits, from five in the evening until eight the next morning, I cover the entire hospital. I love this, I told my supervisor, because I like holding down the fort. He told me this feeling might be telling of something else. This standardized chaplaincy program, after all, was designed for participants to learn more about themselves than anything else all summer.

An in-between feeling, like the time on Cadillac Mountain I saw the sun blaring its new brightness, hit me each time I emerged from the on-call suite (a basement room with a twin bed) at the end of my overnight shifts. I write in-between in a similar sense to Seamus Heaney’s notion: between the present and something greater to which I’m not privy. After living for 24 hours inside the building, I open the door from the basement to the three-story wall of windows in the lobby that try to serve as a gate to a beaming sun—the motions and resultant visuals make me feel as though a day never passed. It seems this way because the civilization inside never stops, never rests. The citizens might change shifts, but it’s noticeable only if I try—there are so many of them, and they are so busy. Days separate, it seems, not because of a new sun’s rising but because a rest period has begun and ended.

When does a new day come into being after one of my overnight shifts? Not until I step outside. “As the doors glide shut behind me, / the world flares back into being— / I exist again, recover myself,” writes Anya Silver in “Leaving the Hospital.” As her poem’s speaker emerges from the building, she comments on a fellow patient who doesn’t fare well at night: “the nighttime cries of a man withered / child-size by cancer, and the bells / of emptied IVs tolling through hallways.”

The nurses inevitably page the on-call chaplain when they hear “the nighttime cries of a man withered” because they usually have more pressing medical concerns that need their attention. I find early on in my summer that hymns work better than other forms of language or media to console these souls. Forget small talk, television, and off-the-cuff prayers—these folks know their hymns. After a few weeks of confidence-boosting patient encounters, I realize poetry might also be helpful in these instances of distress. The patients don’t know the poems I carry in my pocket the way they know their hymns, but they quiet nonetheless. I chalk up these powers to poetry’s economy of words. When you know you don’t have much longer in this life, why not make every word you speak and hear pack as much meaning as possible? “Poetry is an orphan of silence,” Charles Simic said.

•

“Ceremoniously, gravely, and weakly, / Dozens of pale hands are waving / Back, from inside their flames,” James Dickey writes in “The Hospital Window.” Like the speaker, I take images of hospital residents with me after sleepless nights. They remain vivid, and the images still live and move after I leave the hospital on my bike as people drive and walk to work in the morning. I helped a man—if helping means being the last person to pray with him—die during the weeks in July when the Virginia heat blurred my vision outside. He told me he was ready. I didn’t take him seriously, and I tried to convince him that it wasn’t time. “That the dying may float without fear / In the bold blue gaze of my father,” Dickey writes. Drained and on my ride home, I think about when I asked him when last he saw his children. “Before I went blind over a decade ago,” he laughed.

•

Those mornings I traveled north on I91,
passing below the basalt cliff of East Rock
where the elms discussed their genealogies.
I was a chaplain at Hartford Hospital,
took the Myers-Briggs with Sister Margaret,
learned I was an I drawn to Es.
In small group I said, “I do not like it—
the way so many young black men die here
unrecognized, their gurneys stripped,
their belongings catalogued and unclaimed.”
—Spencer Reece, from “ICU.”

I read Reece’s poem a few months before I left the divinity school to head to Charlottesville for the summer. I knew what genealogies and the Myers-Briggs were, but I did not know what they meant in a chaplaincy environment until about a month into my program. All three concepts turn out to be processes for me to learn to work better, gentler, more chaplain-like among my fellow chaplains.

If this poem has a volta, or turn, it lands for me in the three middle lines about black men dying without respect or recognition. I didn’t see this coming after the poem began with lines about relationship measures. Like the University of Virginia hospital, Reece’s Hartford Hospital is public and categorized as a Level I Trauma Center. Neither place can turn anyone anyway. Today that means undocumented folks or those without health insurance. At UVA, that means a lot of white patients in low socioeconomic situations with little to no health literacy. These seem to be the majority of people with whom I pray. Are there a lot of them, or are they the ones who want to talk to God? I learn the answer to both questions is “yes.”

The only people who die here “unrecognized, their gurneys stripped, / their belongings catalogued and unclaimed” are poor white people experiencing homelessness at the time of their hospitalization. The last person I speak with in this situation tells me he’s an archaeologist. I can feel a smug expression form on my face when he says this. Because my youngest brother is two years into an archaeology PhD program at another Virginia school, I think I can chaplain the hell out of the guy using this shared experience.

We talked about his former prominence in his field in Virginia, briefly, before he brought up his sporadic homelessness. He alluded to failing mental health and a fall from “the man I was.” He told me that he wishes it were all over. I knew he meant death, but I pushed him to say it. He did and started crying and turned his face into the pillow. “I have no one.” I discover an estranged sister still lives. I would give up my life for my two brothers, so I don’t understand how siblings reach this point. I read Reece’s line again: “It is correct to love even at the wrong time.” And I find it difficult to imagine a wrong time to love when a hospital bed confines one of the parties—but his line assumes a wrong time exists.

I do understand, however, that the archaeologist who cries before me has no Orpheus, no one to bring him out of hell, no one to say, “I knew I would find you, I knew I would lose you.” Even my love at this right time cannot overcome his spiritual being’s having a dissolute human experience, to borrow the philosopher theologian Pierre Teilhard de Chardin’s words. I prayed, saying aloud to him, “I hope he finds you, I hope he keeps you.”

•

I asked for a day off to workshop a few poems at a writers conference in town. My supervisor, a chaplain and an ordained American Baptist minister, gladly gave me the time. He had told me a few weeks earlier that he is a Poetry magazine subscriber, and our relationship got kicked up a notch. At the conference, a friend and I are talking about writing, family, insecurities, and she mentions Stephen Dunn. I hadn’t heard of him. My appreciation for poetry came relatively late in my life—not until I began to study it in divinity school while surrounded by people who write it.

A few weeks later, my friend sends me a copy of Dunn’s poem “A Coldness.” The speaker says about his sick brother, “From then on he was delusional, / the cancer making him / stupid, insistently so, and lost. / I wanted him to die. / And I wished his wife / would say A shame / instead of God's will. Or if God / had such a will, Shame on Him.”

I’ve found the lines about cursing God, “Shame on Him,” to be true. My supervisor had told us—me and my fellow chaplain interns—that we might find it appropriate to tell a patient that it’s all right to be angry at God. It takes me a while to say this to someone because a lot of my patients believe that to question God is to curse her very nature. They believe it’s God’s will for them to suffer. Some refuse pain-alleviating medication because they believe God wills them to suffer like Christ. “Sometimes, God sucks,” I eventually tell one woman around midnight before she goes into surgery the next morning for a cancer.

•

I turned over Gregory Orr’s lines from an untitled poem in his collection How Beautiful the Beloved: “No meaning but what we find here. / No purpose but what we make.” Near the end of my summer, I received this text while I’m asleep in the on-call room, in my clothes and under a single sheet: “Patient in 3112 has expired. Family bedside, can you stop by?” I first noticed the son, his polo logoed with old-money Charlottesville. I had come to expect a different sect of society inhabiting a hospital room when I enter. Only now did I realize state-funded hospital beds (as opposed to those in private medical institutions) serve as a great equalizer. If doctors and nurses treat patients differently according to assumed abilities to pay, I haven’t seen it.

The son’s wife had gorgeous, shoulder-length gray hair. Why was I preoccupied with it? Did I look for beauty, something good, in that room full of death? Wallace Stevens’s line “Death is the mother of beauty” is too easy in room 3112. I wanted to ask the woman to come back after I visited the maternity ward on my rounds—does life also give birth to beauty, Stevens?

These thoughts occur before my eyes snapped to the dead woman's mouth—open, her lips curled around her teeth. My eyes didn’t leave her mouth until I left the room. The son talked to me about her work for her neighborhood (beautifying, organizing, celebrating), her swimming every day. She taught all her grandchildren how to swim. “No other world / But this one: / … No purpose but what we make.” I wanted to ask about what else she did, but I stopped myself because I realized that maybe these acts are enough. Lay theologian and attorney William Stringfellow:

In the Gospel, vocation means being a human being, now, and being neither more, nor less than a human being now. ... And, thus, each and every decision, whether it seems great or small, whether obviously or subtly a moral problem, becomes and is a vocational event, secreting, as it were, the very issue of existence.

•

During the first two months of my chaplaincy, I didn’t hear poems other than the ones I read as prayers in morning department meetings, and I didn’t hear the word poetry mentioned in any mouth other than my own. I volunteered, from the first week of the program and with excitement, to attend weekly meetings of the ethics consult service and weekly lectures curated for and by summer interns in the Center for Biomedical Ethics and Humanities. These lectures usually involve matters such as end-of-life legal battles, the craziness of anti-vaccination folks, and caring for incarcerated patients. They ended up being my favorite hours of the week all summer.

In my final weeks as a chaplain, Dr. Daniel Becker, director of the Center for Biomedical Ethics and Humanities at UVA, planned to lecture. I learned that Becker has an MFA from Warren Wilson and is also founding editor in chief of a literary magazine called Hospital Drive. He reads a few of his favorite poems and some of his own work. Why am I only now discovering this guy in my own hospital?

The first poem Becker read is “A Step Away from Them,” from Frank O’Hara’s Lunch Poems, because, he says, we’re at lunch too. I start writing:

It’s my lunch hour, so I go
hear a doctor read O’Hara’s Lunch Poems
…
What an old-fashioned thing to do,
but he’s straddling carbon,
which is not oldfangled like delivering lunch on wheels,
like the sandwich carted to the old man two nights ago.
He said it was the first thing he had eaten in three days.
He said it was dry. He said he wanted to end it all,
but it was hard to do in a hospital.
He died last night, and my mind isn’t
on lunch or poems or Lunch Poems.

The man who died the night before is the same man I asked, “When is the last time you saw your kids?” while forgetting to change this language for a blind person. He thought it was funny, and he also thought it was funny when he told me that it’s hard to kill yourself in a hospital. I laughed too.

Whenever I hear one of O’Hara’s lunch poems, I’ll think of this man and how he showed me that one could will his life to an end. He seemed fine—sick enough to be in a hospital but otherwise fine—when I visited him the previous evening. Members of his medical team collectively said that they hadn’t expected him to die at this time either. Yesterday, during his lunch hour, I walked in to his room, and before I said anything else—even my name—I yelled, “Damn, they gave you a cheeseburger?” The man chuckled, said it was a ham sandwich, and called it terribly dry. He then laughed about being blind but coughed in a fit afterward. He laughed about trying to commit suicide; he called me Father and grabbed my hand. Today, he’s dead. “But is the / earth as full as life was full, of them?,” asks O’Hara’s speaker.

•

Among the many people I’ll remember from that summer—my patient shot with an AK-47, the boy who tried to commit suicide but failed, my supervisor who listened to my laments—emerges Claudia Emerson. I met her on August 8 at the writers conference before my last week at the hospital. She read on the last night, and I didn’t recognize her until her introduction. She had recently undergone chemotherapy.

Emerson, who grew up in Chatham, Virginia, about 45 miles from my childhood home, reads eight sonnets inspired by the meaning of metastasis, a Greek word that means “displacement,” from meta, “next,” and stasis, “placement.” I wrote down a few notes, but one of her earlier poems that she read—“Frame, An Epistle”—is the one that sent me into a vulnerable and embarrassing (for me) public moment. Emerson’s reading—when she got to the penultimate line about noticing for the first time the way the speaker’s loved one has cut and planed a piece of cherry—was the first time I’ve teared up at a poetry reading. “But this morning, / as I put on my overcoat, then straightened / my hair, I saw outside my face its frame,” Emerson writes, “you made for me, admiring for the first / time the way the cherry you cut and planed / yourself had darkened, just as you said it would.” I was not sure what to do except blink to stop the tears and pretend it hadn’t happened.

Four months later, almost to the day, I was on a train from New Haven to Philadelphia, where I was to catch a flight to Memphis to interview someone for an article I was writing. Twenty minutes into my train ride, I learned that Emerson had died. I found the photo that I took of her on that day at the Boar’s Head in Charlottesville. I had captioned it on Instagram:

“There is no reason why the teaching of poetry shouldn't be as serious as the teaching of medicine.”
 —Pulitzer Prize-winner and former poet laureate of Virginia Claudia        Emerson after being treated for cancer in a teaching hospital (at           #VQR2014)

The fact that she said this after treatment in a teaching hospital and that I worked at a teaching hospital was not lost on me. I then found my notes as the train passed Norwalk, and the memory of my tears after her reading of “Frame, An Epistle” comes to me. The speaker singles out a mirror to keep because it doesn’t evoke a missed loved one. It’s the one furnishing that has been invisible to her all these years. “No one / pauses long before it,” but the speaker eventually, because of a careful characteristic of the frame, stands attentively before it. The tragedy is that she notices the detail too late.

I asked one of my patients, weeks before Emerson’s reading, what he did in the hospital to pass the time. I think he had grave issues in his legs from diabetes, and he told me he watched his television all day. I commented that I’d never seen his television turned on, and he explained how he projects images from his mind onto the black screen. Before I had a chance to think “This guy has lost it,” he told me that he replays events from his life that he’s proud of and situations when he has disappointed himself. “If I get out of here, I’m going to make it up to the people I might have hurt,” he said.

I asked to hear about one of the latter situations, and he told a story about refusing to shake a boy’s hand in church when they were teenagers (the patient is in his 60s now). The other boy “wasn’t all there mentally,” he told me, and everyone in the neighborhood thought that he was weird. The patient joined the crowd, ignoring the boy too. “He’s alive, and I think he still lives around me,” the man said. “I’m going to find him and shake his hand.” I hope he’s not too late.