A Star Wars Last Supper

Via Neatorama

Okay, so I don't have a lot of content today. But I finished CPE in Jacksonville on Friday, pastored on Saturday, Sunday, and this morning, and am now back in Orlando for the first time in ten weeks. My wife and I have a date. Some things are more important than blogging. Just not many.

The Universality of Pastoral Care

In the spring of 1998, I was deeply grounded in my atheist non-belief, but on one dark day in that time, my thoughts were not on belief in the divine or a lack thereof.

I had had my first romantic relationship, and it had come to an end. I was thoroughly in love with this girl, and she had ended our passionate love affair. I was beyond devastated, and wandered the streets of Delaware, Ohio in a numb, agonized haze.

At one point, I found myself at the office door of the University chaplain. I was not a Christian at all, but there I was. He looked at me and said "John, what's wrong?" I told him, and collapsed on his shoulder weeping. This man didn't try to convert me. He just listened to me and mourned my loss with me.

I wasn't a Christian, but I needed a pastor, and somehow, I knew it. Some embedded knowledge had seen through the pain and guided me to the chaplain. Looking back (now that I am in CPE), I don't know how I knew that this man would listen for me and care for me. But I did, and went.

At some point in our lives, we will all need a pastor. The cannot shield ourselves, outwardly or inwardly, from all of the slings and arrows that will come our way. In our broken world, pastors aren't just useful -- they're critical.

Hospital Ethics: Limited Resources

Here's an ethical dilemma presented to my CPE group:

Mrs. CZ is a 71 year old woman who has a recently diagnosed lung cancer for which she has refused surgery and radiation therapy. She developed pneumonia distal to the tumor and was admitted to the community hospital in her rural county. She has shown no signs of improvement for 7 days and has continued to refuse treatment for lung cancer. She is now comatose and requires mechanical ventilation. The victim of an automobile accident is brought to the hospital with a crushed chest, apparent pneumothorax, and broken bones in the extremities. The patient requires a respirator immediately. Of the six patients on the six respirators in the unit, Mrs. CZ has the poorest prognosis. She seems unable to be weaned and thus would probably die if ventilatory support were discontinued. Should she be removed in favor of the accident victim?

How would you answer?

I Observed an Autopsy Today

It was a unique experience.

The Fuzziness of Death

Last week, I was summoned to a patient room in ICU shortly before a patient was expected to die. She was a woman in her 70s, and when I arrived, several family members had gathered to be with her. I was there in the last few minutes of her life, and with her family well afterwards.

It was the first time that I had watched someone die.

Death is a strange thing. What was unexpected is that life is not an on/off switch. There was no precise moment of her death. It's not like in the movies where the heart just stops and there is a loud, continuous buzzing from the heart monitor. Even the heart does not just simply stop; residual electrical activity continues until it fades away almost imperceptibly.

Her death was more vague, more fuzzy and obscure. There was a time in which she was alive, and a time in which she was dead, and a softly-defined boundary in between. The systems of her body simply shut down, one by one. She did not die at one point in time, but rather faded from life.

It was something that I had not at all expected.

About a minute later, a fixed boundary was demanded from me. Another relative came into the room. It the midst of the confusion and chaos of the crowded room, it was uncertain what was happening. She looked at me and said, "What's going on?" The nurse said nothing. I had to make a split-second decision that (1) yes, the patient was indeed dead in every clinical sense and (2) to inform the woman of her grandmother's death.

For a while, the timing of death was vague and uncertain. Life did not turn itself off in the patient; it faded away like a receding tide. But then it was official, stated, and formal. The boundary between life and death had ceased to be fuzzy, and was not sharp.

CPE Practical Jokes

One of the most nerve-wracking parts of being a CPE student/chaplain is that you never know what you're going to get when you walk into a patient room. It can be a person filled with the joy of Christ, or someone who throws a bedpan at the chaplain.

So here's my idea for a hidden camera show: get actors to pose as hospital patients, rig the room with hidden cameras, and wait for the chaplain interns to show up. Make the patients as eccentric as possible, or create bizarre situations/problems for the chaplain interns.

What do you think?

CPE Interviews and the Kobayashi Maru Test

Previously, Andrew Thompson and Theresa Coleman asked that I write about my experiences in CPE (Clinical Pastoral Education). The hospital setting is a very confusing place for a non-medical professional, but overall, it's been a good experience.

This shall be my first post on the subject, addressing the application and interviewing process.

I interviewed with three CPE facilities for this summer, which we shall call A, B, and C. CPE interviews are different than those for application to jobs, schools, or even ministry (e.g. certification at DCOM). They are basically impromptu psychoanalysis sessions.

This took me by surprise at facility A. The interview went something like the first twenty seconds of this video:



I was quite taken aback by this interview. I had never experienced anything remotely like it in any setting. I've been through hardball interviews before. This was something far beyond hardball. Every answer that I provided to every question was not only wrong, but stupendously wrong. I could do nothing right.

I left interview A angry at the interviewer, convinced that he was just a jerk. Then it occurred to me: surely such a person could never have been ordained with that kind of personality, let alone be put in a ministry position which is wholly social. The interview was a Kobayashi Maru simulation: a no-win scenario designed to test how I deal with hopelessly losing situations. After all, in a hospital setting, I will be a caregiver to people who are in no-win scenarios themselves. It would be helpful to experience the frustration of such situations myself so that I can better help people going through them on a much larger and serious scale. When I expressed this to my DCOM chair, he confirmed that such interview techniques are normal in CPE, and related an even more appalling story from his own seminary days.

I went to facility B for an interview. It was radically different from interview A. They wanted to probe inside of my psyche and did so. The purpose of CPE interviews appears to be to get to know the student at a very intimate level. The thing is, they did this without being the slightest way abusive. In fact, the B set of interviewers got to know the inner John a whole lot more than the A interviewers, and it was because they did call me a liar, etc. It was a hard interview, but it was not a no-win scenario. There was no immediate and severe antagonism and animosity, like there was in interview A. We did a difficult role-play in which I interacted with a nurse supervisor and a suicidal patient. It was challenging, and they critiqued my mistakes but praised me for what I did well. I felt very comfortable with the B people and thought that there was so much that they could teach me about relating to people emotively.

Then I went to interview at CPE facility C. If A and B represent a scale of interviewer behavior, then C was somewhere in between A and B, but leaning strongly toward A.

I had decided that my biggest mistake in interview A was caring about the outcome of the interview. That is, I really wanted to get into CPE facility A, and the interviewers knew it, and so felt free to play mindgames with me, toying with me like a cat does a mouse. I had already been accepted into a CPE program, so I really did care about "winning" -- that is, getting into facility C as well so that I had as many options as possible (the UMC candidacy process develops a strong belt-and-suspenders mentality). And the only way to care about getting into C was not to care about getting into C. You follow?

Interviews A and C started out as basically verbatim duplicates -- and I really mean almost word for word. They read my biographical statements and noted that I had moved very frequently as a child and wanted to know how that had traumatized me. I mentioned that I was sort of rootless, having no true hometown, but saw more benefits from my mobility than disadvantages. Both sets of interviewers asked leading questions, strongly urging me to express that I was deeply emotionally scarred from moving so frequently and that my parents had been emotionally abusive. I don't have perfect parents, but neither hypothesis is really plausible. Interviewers A noticeably sagged in disappointment when this was my answer. Both questioned whether I was being honest with them.

So as I said, I had decided beforehand that if interview C starting turning out like interview A, I would respond very differently. It was turning into a Kobayashi Maru, and I had a solution to the test: I wouldn't play. You see, a no-win scenario is also a no-lose scenario; if I can't win, then I can't do anything to induce losing either.

I expressed my amusement at how interview C was progressing almost identically to interview A, and how much I really wanted to give them the childhood trauma of moving that they so deeply craved but alas, there was no trauma in that part of my life to give them. I have experienced emotional trauma, just not there. I hammed it up, bombastically imitating interviewer A's visible disappointment that I was not abused as a child. One of the interviewers covered his mouth to hide his giggling. But per my strategy, I pointed out that he was giggling and had tipped his hand.

There were a number of Kobayashi Maru elements in interview C, particularly from one man. For example, he asked questions about my inner self. When I began to answer them, he refused to allow me to answer them. Next, he berated me for not answering his questions.

My overall strategy was to directly and explicitly point out when and where they had been unfair or ridiculous -- and with full amusement, not an ounce of anger. So I explained what the Kobayashi Maru was in Star Trek, what it means proverbially, and how parts of their interview followed this pattern.

They were taken aback by my approach.

Now it is possible that I completely misread the situation and that there was no Kobayashi Maru test here, despite what my DCOM chair described as normal. But if that is true, and interviewers C considered their behavior to be normal, moral, and professional, then the last thing that I would ever want is to work under them. In this case, I completely blew interview C, and have lost nothing.

So my performance was either spectacularly good, or disastrous. Either way, I have lost nothing.

Now this Kobayashi Maru approach to CPE interviews: I can see some merit in it. But as much as one can learn something about people by how they respond to exasperating no-win scenarios, I think that interviewers B learned so much more about me because they took a completely different approach. Theirs was the superior interviewing approach, and certainly my first choice at the present.

I was actually accepted at facilities A, B, and C. I chose B, even though it is three hours away from home, because I did not wish to expose the inner John to sadists. My experiences thus far in the weekly individual and group therapy sessions have only justified my decision.