Friday, July 05, 2013

Summer of 1983 CPE

You cannot become a Master of Divinity without undergoing the semi-dreaded Clinical Pastoral Education, and so that is how I spent the summer of 1983: as a chaplain intern at UMass Medical Center in Worcester. There were four of us interns. The other woman and the two men were Roman Catholics: Bob and Tom preparing for the priesthood and Elaine already a nun. Tom, our well-groomed Supervisor, was the Protestant hospital chaplain.
We interns bonded as intense experiences tend to cause: ten weeks of counseling training and education, also supervision and also applying theology to the misery we were there to serve. We had workshops on death and bereavement; suicide assessment and prevention; theology of counseling; alcoholism diagnosis and treatment, and mental illness. The schizophrenia classes took place at Worcester State asylum, that huge pile of bricks across the road,
UMass Medical Center itself was of newer brick than the asylum was; not so much a pile but a complex; the typical modern arrangements of suites and atria and bridges to the other building. That first morning, in a friendly-sized conference room with couches, Tom’s introduction was also complex, vastly organized, and with plenty of schedules, forms, syllabi, and explanations. The program was balanced with observation, practicum, workshops, papers to be written, and supervisory groups.
UMMC was a tertiary care facility, Tom said, the kind of place where you went from bad to worse, the place where they medi-vaced you in from the secondary or primary care place when you had the most mysterious diagnosis and ultra-serious pathologies. It was the teaching hospital of UMass Medical School and also of us chaplains, probably the most expendable members of any medical team.
But that was part of what was so great about it—the team approach where doctors, nurses, specialists, medical interns, and chaplains gathered on a patient’s behalf to give one another updates and ideas. It was at UMMC I first learned about medical teams; about confidentiality requirements; about patient’s families; about the charts.
In the beginning I expressed misgivings about the charts and also with these written exercises called verbatims. You have a session with a patient where they confide in you and then you’re supposed to write it in the chart for all the other medical people to read it and also write up whole conversations “verbatim” so they could be analyzed in your group supervision.
“When they sign in here they are agreeing to all this charting and information-sharing,” Tom says.  OK, I now realize, the supervisor cannot sit in on every session, so they rely on the verbatim. Without charts, medical personnel couldn’t know the patient’s history, vital signs, how they slept through the night. I was just very new to clinical treatment and that is why you cannot become a Master of Divinity without this chaplain internship.
One of the first tours we got was the cadaver lab, where the med students learned anatomy by carving up those who left their bodies to science. Coming across one of those glassed-in bridges to the other buildings we abruptly encountered a freestanding preserved human foot and ankle—in need of a pedicure I might add. I apologize to science. I don’t mind donating organs, but no one is going to study my dead remains, not even archaeologists!  I’m going to enjoy my life, then choose clean(ish) cremation (Ps 90:12).
Which brings us to the series of classes on death education. A black-haired Doris or Darleen talked about Kubler-Ross and read a poem by Robert Lowell: “no blood upon the ground, no teeth about the place.” She showed us videos of terminally ill patients talking to their counselors. (I decided not to let my final days be filmed.)
Then Doris-Darleen asked, “Would you want to know?”
“I already…know,” I answered.
“You know you’re going to DIE,” she said. “Oh.”
“Hang on to that arrogance, Pat,” supervisor Tom said wryly.
Due to my own hang-ups entirely—hopefully I’m mellower 30 years later—I disliked supervisor Tom. In addition to good grooming, he had the most perfected latest theories of psychology; faith seemed to count for less. I considered him shallow, and narrow, a sad example of a semi-bright intelligence that had reached its full potential. This happens when you supervise people; their hang-ups get taken out on you.
So who doesn’t have annoying ways. Part of our study was the phenomenon of “countertransference.” Tom did a good job with us.
The main learning from those sunny weeks spent indoors came from the patients, the ones who gave their trust to us interns with death stalking down every corridor.
The patients have been in my heart all these years. Mrs. Berkowski was losing her leg to diabetes and sobbing, “My retirement! My retirement!” It seemed as if people of retirement age had a special vulnerability. As did teenagers. A young man in ICU—what was “Danny” doing here? He looked fine—until I noticed with a somersaulting heart that his left arm was missing. He had grabbed an uncle’s new motorcycle and wiped out. The tertiary hospital had lots of tragedies.
Danny became the textbook example for me of the grieving process Doris-Darlene had outlined for us. One day I would see him and he would tell me, “I had an accident and my fingers were cut off.” Soon it was, “I lost my hand in an accident,” until finally he worked his way up to the reality. Our role, in addition to serving as the person it was “safe to get angry at, safe to kick out of the room” was to “find” them and be in it with them. Not in the sense of easing pain but of bringing God’s presence into the pain, to represent the immanence of the divine. As Tom said, “Don’t forget that you are a minister of the Gospel.”
Let us not be shy about bringing God into the picture. Tom’s most important lesson, though: we work with the patient’s faith. One woman cried as she clutched my hand: “I feel it, I feel it, the grace pouring through you!”  Too many to name: patients dying of things you never dreamed could happen, such as Eric, whose body was just rotting from the fingertips inward as he lay on a gurney, unable to speak but naked to anyone who passed by. Amy, old before her time, had a tube that needed to be suctioned all the time and took communion through her husband’s receiving it.
Yes, we brought communion to those who wanted it, The Roman Catholic chaplain would bless the elements, and we interns would take them out to any patient who requested it.  I had explained to one patient that the Episcopal Church was a “sister communion” to her Roman Catholic faith (they had a lot of Catholics in that area). When I walked in carrying the little kit, she exclaimed, “Here comes Sister Communion!”
We also gained experience in designing and leading worship services, including preaching homilies Friday noon. This is where I was first given the Psalms, which have been a long time love. A homily on Psalm 116 seemed to appear in my brain regarding “precious to the Lord is the death of his saints.”  Later on, the Psalms, along with the clinical counseling, would develop into a whole ministry that was just starting by the time of CPE.
CPE meant a glorious summer spent indoors (my husband had to go on our annual camping trip without me). It brought intense emotion, anxiety, even anger, as the five of us, interns and Tom reviewed verbatims, confronted each other with perceptions in role playing exercises. I learned that my “fight or flight” reflex gets me to react, rather than respond. I told one of the priest-interns, “You always have that smile, even when you’ve just seen a dead body come into the ER. It’s creepy.” The nun Elaine had to work—really work—on crafting a decent homily.
And that is how you get to be a Master of Divinity. This was my day all day every day that summer. I would drive home from handing a half-piece of juicy fruit gum to a 12-year-old anorexic boy; from giving a backrub to a cerebral palsy victim who couldn’t speak; from watching a cathether being JAMMED into the urethra of a naked heart bypass patient; from praying the 23rd Psalm with a large family gathering around a deathbed; from discussing his many reincarnations with a former Lithuanian prince (“I would stomp around the castle saying, ‘Heads will roll! But nothing ever happened.”) who in this lifetime struggled with multiple sclerosis; from offering clumsy comfort to parents of a brain-dead teenage girl who had ridden her bike into a bus (It was the braces on her teeth that got to me). Tom said, Don’t bring them home with you, but I would. I’d sit there in my living room empty of my own large family for the summer. I’d have two drinks and (over)cook my fish. Then I would dream about them that night. And of course as I said remember them vividly still.
One day towards the end of the program, Tom handed me a note to call the daughter of a patient of mine who had unexpectedly died in surgery. I started asking Tom, What do I do, what do I say… then, “Oh never mind, Tom. I know what to say.” Thanks to this internship and his supervision, I did.
I framed the CPE certificate to display with other awards and diplomas. A few years later I would hit the floor of a hospital to work as a chaplain and counselor to detoxing drug addicts. I had CPE training, and that turned out to be enough.

Written June 25, 2013.


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