Tag Archives: icu

September 24, 2009 · 18:32

The Sacrament of the Smile….Making it Real

In Andrew Greeley’s Bishop Blackie Ryan mystery “The Archbishop in Andalusia” the character Bishop Blackie makes a comment after celebrating Mass in the cathedral at Seville. He said “Every sacramental encounter is an evangelical occasion. A smile warm and happy is sufficient. If people return to the pews with a smile, it’s been a good day for them. If the priest smiles after the exchanges of grace, it may be the only good experience of the week.” (The Archbishop in Andalusia p.77)

I’m the kind of person that if I’m angry or not doing well my face can show it even if I don’t want it to. It’s sometimes hard to hide emotions even though I try, but I have gotten pretty good at hiding them by putting on a poker face and smiling, even if it hurts to do so. This works most of the time, but sometimes with people who know me pretty well it catch me. They ask me if I’m doing okay and they are pretty good at taking care of me in those moments, which unfortunately are a lot more common after Iraq than before it but occasionally happen.

However on the whole I remain a pretty upbeat person. I think my most common greeting with people that I work with or see relatively often is “Hey, what’s up, what’s new, what’s happening in the world?” Most of the time I’m a pretty laid back kind of person. I think that this is due a blend of genetics from a recessive gene in my family as well as having grown up on the West Coast and spending a lot of my adult life somewhere in the former Confederate States of America. The genetic factor has to be a recessive gene as a lot of folks in my family can get spun up and pretty serious pretty fast.

Since being upbeat unless I am downcast is the baseline for me, even with my PTSD I find a lot of humor in life and still manage to have fun. I love the folks that I work with in my ICUs and being in those places with those colleagues does me an incredible amount of good.

One thing that I have noticed is that it is important for me to smile; in fact I generally like smiling except when I don’t. I admit that there are some times and some people that I am like the scene in the movie Patton where Patton is forced to make conversation with a Soviet General after the war. In those kinds of times the smile is definitely faked and thankfully most people don’t realize it.

However what I find is that many people respond positively to a genuine and caring smile and greeting. Let’s face it times are not the best, all the economic problems and political conflict coupled with ongoing wars and wondering what is going to happen stress a lot of people out. A lot of this is the news media’s fault as they heap one negative story after another on their viewers, particularly those who are addicted to 24 hour non-stop cable news and talk radio. As a result it is amazing to see the number of people out in town who don’t smile. Since I work in a pretty good sized teaching medical center I see people going through a lot of health and life crisis, but even here I don’t quite see the level of disgruntledness that I see out in town. Frankly I’d like to see a lot more gruntled than disgruntled people.

In the past year that I have been here I have endeavored to be as positive and cheerful as possible and with some exceptions I have managed pretty well. In fact I have made it my crusade to honestly try to greet everyone that I contact with a kind word or smile and often a God bless you or simply “blessings on your head.” What I love to see is someone who has been obviously beaten down; do a double take when they realize that someone; that being me, is taking the time to say something nice to them. I love the sheepish smiles, the surprised thank you and God bless you responses that I get in return.

No place is this more important than church or chapel service when I or for that matter any Priest or minister serves God’s people. Grumpy pastors, who are too bothered to care, perform their duties in a perfunctory manner or worse are rude and disrespectful to the people that God entrusts to their care do damage. It’s like Archbishop Blackie said, the encounters that we have are occasions to share the grace and love of God, to be with them, care for them and are in a very real sense both evangelical and sacramental occasions. When I was in Jacksonville Florida as a Navy Chaplain I would occasionally serve at the altar of our cathedral church. People would almost always comment on how joyful I looked while celebrating Eucharist and serving communion. How can I not be when I am entrusted with such a great gift for God’s people?

Judy and my college room-mate Kendra is in town this week. We had kind of a three’s company situation. I had my men’s bedroom which was a total college guy mess and Judy and Kendra shared the other bedroom. At the time Kendra was an Atheist being bombarded by many of our well meaning but hyper aggressive Christian friends. We had a blast. Kendra is like super duper deaf, lost all of her hearing at the age of four after she had learned to speak and read. She’s incredibly intelligent and as a 15 year old scored in the upper one percentile of the SAT where I not to be too flashy scored somewhere around the upper thirty-fifth percentile due to my abysmal math score. It was due to Kendra that I learned sign language. All of Judy’s friends were deaf at Cal State Northridge and I needed it, but Kendra and her sense of humor helped make me do it. When I first met her Judy had to run out and when Judy came back to her dorm room, this was before the three’s company” set up she found Kendra and I reading the “Official Sick Joke Book” and since I couldn’t sign just yet pointing to the jokes and laughing. Anyway, Kendra eventually came to faith and joined the Episcopal Church in Pasadena just a few years back. In her spiritual biography she mentions us not trying to convert her, even going to church with us without feeling pressure. She knew that we cared for her and our continued friendship was a part of how she came to faith. I thought that was so cool. My sign language is in the crapper now but I am going to do my best to have fun. I picked up a copy of “Mommy Dearest” so we could watch it and relive great memories of chasing each other around the apartment with wire coat hangers saying “no more wire hangers.” Trust me you have to see the movie to get this one.

Of course I try to ensure that I don’t appear to be a total idiot when I do this, with some mindless smile or joke that is inappropriate to the occasion. Let’s look at a unlikely scenario: With me in the room the Doctor says to the patient “Sir, I have good and bad news.” The patient says “What’s the good news?” The doctor replies “the good news is pretty soon you will feel no pain.” The patient says “Doctor that’s wonderful news, you know I’ve been in so much pain for so long. So what’s the bad news?” The doctor replies “Son you’re going to die.” Then I as the chaplain with a mindless big grin on my face chime in, “Let’s focus on the positive now…have you seen The Bucket list? Gotta love Jack Nicholson and Morgan Freeman huh? They are such good actors. Hey, I have an idea, you want to pray?” As the nurses and doctors struggle to pull the man’s hands from around my throat I gasp out “so do you want me to come back later?” That of course is extremely unlikely in my case; in fact I usually am the glass half-full kind of guy when it comes to dealing with sick people since I am neither a physician nor God.

I have a sense of gallows humor but am very careful how and when to use it and thankfully I am able to not smile like an idiot when bad news gets delivered. It’s a gift. Let’s face it there is that stuff about those Chinese kids Yin and Yang, everything has to be in balance.

All this being said there are times where the foot is in the other shoe. These are the times that the person who is afflicted with a life threatening condition or knows that they are dying is the one who smiles and comforts others, even throwing in a joke or poking fun at someone in the room. Having experienced this even very recently I have to say that these kinds of folks do more for me than I think that I can ever do for them. Often there is a time of interaction where the person allows me into their world, to share a story, a laugh and a blessing. For a Priest it doesn’t get any better than that. These are holy times where God shows up and tonight I have the honor of spending time with such a man and his family. I am reminded at these times how precious the time is and just how in the midst of pain, suffering and even death, that the God who says “I will never leave you or forsake you” is truly with us as we walk through the “valley of the shadow of death.”

I’ll be smiling tonight in every ward that I visit and hopefully with every staff member, patient and family member that I encounter, knowing that in their lives, that smile might be the only good thing that happens to them all day, or maybe even all week.

Make sure that you smile and give a kind word to someone soon.

Peace,

Padre Steve+

2 Comments

Filed under healthcare, Pastoral Care, philosophy

Tagged as andrew Greeley, bishop blackie ryan, cable news, california state university northridge, church, Episcopal church, George Patton, god, god's love, god's people, grumpy pastors, holy eucharist, humor, icu, jack nicholson, mommy dearest, morgan freeman, no more wire hangers, pastors, patton motion picture, PTSD, room mates, SAT test, smiles, talk radio, the archbishop goes to andalusia, the bucket list, the official sick joke book, valley of the shadow of death, yin and yang

August 24, 2009 · 20:50

Going to War: A Reflection so Far, Memories, PTSD and hopes and fears Past and Present

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As I have been writing of my experience in Iraq it is amazing to me the amount of emotions that I have experienced. It is strange to feel like I am back there as I write. I know that this is necessary but at times it is unnerving especially as I talk to friends who are going through much the same experience that I had coming home and sometimes worse. I have been in e-mail contact with a friend from a NATO ally who has done a couple of tours in Afghanistan. I can really feel for him as he is in a smaller military with a lot few resources that the Americans to deal with PTSD and other maladies from this war which seems to drag on without end. Another friend on the West Coast has been dealing with the ravages of both PTSD and TBI and another Army Chaplain friend who has 2 Bronze Stars to his credit deals with PTSD as well as a very rare and eventually fatal lung and brachia condition. Friends from my medical center are being deployed, I’ve been told that I am too valuable and needed where I am to deploy. I do understand that at the same time deep in my heart I want to be with my friends from my ICU as they go to war.

The emotions took a big turn as I actually started writing about being in Iraq, beginning with the C-17 ride in to Baghdad. In some sense the mirrored what I was going through two years ago. It kind of came to a head the other night when I wrote about the rocket that went over my head at Camp Victory while waiting for my ride to head to the Camp Liberty heliport. Then there was the flight to Fallujah and I can remember that flight. I have never really liked flying in general and ancient helicopters in particular. Thinking that many of the CH-46s that I flew in while in Iraq had been in service in the Vietnam era was none too comforting. They were almost as old as me. Marine Helicopters are notorious for hydraulic fluid leaks. The old joke goes” “How do you know when a Marine helicopter is low on hydraulic fluid?” “When it stops leaking” is not entirely in jest. I guess you can say that most of my career flying rotary wing aircraft in the Army and Navy has been just this side of terrifying. I manage to survive every time but it takes forever to come back down from the anxiety of the preparation for and actual flights themselves it is no wonder that I still have problems sleeping and going on alert any time I hear a helicopter overhead.

Faith at times is an ongoing struggle. While I believe I question God more, especially when I see little kids suffering or read about young men and women killed in action or maimed by combat. I find that I am less compassionate toward those who have not deployed who make suicide gestures and screw with their friends and families and then blow off help. It angers me that their narcissism takes time and resources away from people who have been in the shit who need help and have to wait to get help. I also find that religious people who have trite answers for everything really annoy me, especially those that are constantly talking about “spiritual warfare” when they have no clue about war, suffering and death. They are what Luther called the “theologians of glory” and they have no real answers, just platitudes that work fine until a real crisis comes. Despite this I believe somehow in the God who is willing to be with me in the middle of the Valley of the Shadow of Death and at the foot of the Cross.

One of the things that tears at me now is the deep division in the United States as the obviously enlightened zealots of the extreme right and left push their agendas so hard that it seems impossible to find and amicable solution. I wonder if we have entered “Weimar America.” I guess I can understand how the moderates of the conservatives and socialists in Germany were ground to dust beneath the anvil of the Communists and hammer of the National Socialists in the later years of the Weimar Republic. I really understand the military men who found both alternatives distasteful and tried in vain to seek the middle ground and maybe restore some sanity to the country. That article is yet to be written. I think I will call it “Weimar America?” What really gets me is that both the right and left have dropped all pretense of civility and are now engaging in physical altercations at political meetings or “town hall” meetings and some have even be brandishing automatic weapons near venues where the President is speaking. I have seen the results of this type of no-quarter politics in the Balkans and in Iraq. I wonder what the hell all these demigods on both sides are thinking and if they in their devotion to their alleged “principles” would attempt “to destroy the country in order to save it.” I have become ashamed of the leadership of both political parties as well as the special interest groups that drive the agendas of both extremes, especially as in the case of some who use the Christian faith to justify their actions. When I see these people in action my anxiety level often returns to what it was in Iraq and on my return. I can honestly say that the people on the extremes make me fear for my country. I feel that they are pushing us to the abyss and that I can’t do a damned thing to stop it. I’ve matured enough to know it is not simply the fault of one side or the other; as both are at fault and it seems that the most extreme on both sides have actually been wanting this to happen, at least from my viewpoint as a passionate moderate.

I have come to realize that my true countrymen are those that I have served with to defend this country and protect others abroad, especially as the insanity continues to spread. Though I struggle and have to deal with emotions as if they were brand new every day just as I think that I am getting better I know that I have to keep going. I owe it to my brothers and sisters from the current war and wars such as Vietnam. Sometimes I wonder if all of us PTSD afflicted vets are the only sane people in the country. We are a brotherhood. “We we happy few, we band of brothers.”

brothers

I’m glad that I have friends, especially vets from Iraq, Afghanistan, the Gulf and Vietnam. Limey and Barney with the Hue City Vets, Ray and Charlie the Vietnam Veteran of America brothers who man the beer stand on the concourse behind home plate, and so many others like my trusty assistant Nelson Lebron who helped keep me safe and sane in Iraq.

In the middle of all of this I grieve for my Vietnam Vet and retired Navy Chief dad who wastes away in a nursing home with end stage Alzheimer’s which according to his doctor should have killed him months ago.

I’d better stop while I’m ahead. I need to catch myself, maybe have a beer and focus on some baseball for a while before I get ready for work. I have duty tomorrow and I expect that I will be busy the next couple of days. I hope when I get off Wednesday afternoon that I will be able to see the Tides play. I can use the view of the diamond at Harbor Park that helps calm my soul about now. Maybe between no and then I can get in with my buddy Elmer the Shrink.

pub2

Pray for me a sinner,

Peace, Steve+

7 Comments

Filed under alzheimer's disease, Baseball, iraq,afghanistan, Military, Political Commentary, PTSD, Tour in Iraq, vietnam

Tagged as afghanistan, automatic weapons, baseball diamond, c-17, camp liberty, camp victory, ch-46, fallujah, foot of the cross, harbor park, icu, iraq, Martin Luther, nato, nelson lebron, norfolk tides, PTSD, radical groups, spiritual warfare, struggles with god and faith, theologians of glory, united states, valley of the shadow of death, vietnam, vietnam veterans, we happy few we band of brothers, weimar germany, weimar republic

July 10, 2009 · 16:54

Brothers to the End…the Bond between those Who Serve Together in Unpopular Wars

This story shall the good man teach his son;
And Crispin Crispian shall ne’er go by,
From this day to the ending of the world,
But we in it shall be remembered-
We few, we happy few, we band of brothers;
For he to-day that sheds his blood with me
Shall be my brother; be he ne’er so vile,
This day shall gentle his condition;
And gentlemen in England now-a-bed
Shall think themselves accurs’d they were not here,
And hold their manhoods cheap whiles any speaks
That fought with us upon Saint Crispin’s day.

From the Speech of King Henry V at Agincourt in Shakespeare’s “Henry V” 1599

We have a new Greatest Generation whose accomplishments will likely go unheralded by history and unlike the “Greatest Generation” of World War Two not receive the full honors and accolades due them. The brothers, and for that matter sisters as well who have served in the current War on Terror, Iraq and Afghanistan campaigns have now been serving in a war that is now twice as long as the American involvement in World War Two. Many, like me have been in this since the beginning and many have made multiple deployments to the combat zones. And many of us, if not most of us would go again; I know that I would because part of me is still in Iraq; for me this war is still un-won and un-finished.

With MTT near Syria Advisers out on the Badlands of Al Anbar

With no disrespect to the Greatest Generation of World War Two, all of the current Soldiers, Sailors, Marines, Airmen and Coast Guardsmen are volunteers, as are the members of the Reserves and National Guard. Likewise this generation has for the most part fought the war alone as the vast bulk of the country has lived in peace untouched by any inconvenience to daily life such as gas and food rationing, requirements to work in war industries and the draft as were citizens in World War Two. In the Second World War there was a sharing of the burden which in large part has not occurred in this war. While many have pitched in to help and volunteered to help veterans and their families the vast majority of people in this country are untouched by the war, not that there is anything wrong with that. This is simply a comparison of the situation that those who served in World War Two and the present conflicts faced. So I have to say that our “Greatest Generation” is only a small part of the generation, as the line in Henry V “we few, we happy few who fought together….”

Dynamic Duo Brothers

These Soldiers, Sailors, Marines and Airmen from the United States as well as our Allies who serve alongside of us are my brothers and sisters. I am friends with military personnel from the UK, Canada and Germany who have served in the various combat zones or at sea and met quite a few others from France, the Netherlands and Australia. Of course my Iraqi friends who I served with while with our advisers in Al Anbar province who are not only trying to bring peace and stability back to their country but have to worry about their families being targeted by terrorists.

There are a number of things that unite us in this relatively small brotherhood. However, I think that this brotherhood could also be extended to our brothers who fought in Vietnam, French, Vietnamese, Australian, South Korean and American, the French who served in Algeria and the Americans and others that served in Korea. All of these wars were unpopular, had little support on the home front and often left returning veterans found themselves isolated and their sacrifices either ignored or disrespected. For those Americans who serve in the current wars I can say that at least to this point the public has been much more supportive than they were to our Vietnam brothers, many of who were even disrespected by World War Two vets who had fought in “a real war.” I cannot count the Gulf War in this list as it was hugely successful and the returning vets were hailed as conquering heroes with ticker tape parades.

advisers convoy prep Getting Ready for A Mission

Our shared brotherhood includes our scars, physical, psychological, neurological and spiritual. Those who served on the ground in Iraq and Afghanistan as well as those who served in Vietnam, French Indo-China and Algeria have the common shared experience of fighting people who don’t necessarily like foreigners no matter how noble our intentions and who have a long history of outlasting people that they believe to be invaders or occupiers. We have had to fight wars with no front lines, no major units arrayed against us, but rather asymmetrical threats propagated by creatively devious foes who use low tech easily available technology and a willingness to sacrifice themselves and others to force attempt to kill us. Thus we have cleverly designed and often quite powerful IEDs or Improvised Explosive Devices which can obliterate a HUMMV.

374 Prayer Before a Mission

These threats create a situation where there is no front line and thus where every excursion outside of a FOB (Forward Operating Base) or COP (Coalition Outpost) is automatically a trip into a potential danger zone. Enemies can infiltrate bases posing as local nationals in either military uniform or as workers, rockets and mortars can be lobbed onto even the largest and most secure bases at any time and any vehicle driving by you on the road could be loaded with explosives and just waiting to blow you up while insurgents with automatic weapons and Anti-Tank Rocket Propelled Grenades (RPGs) have taken down helicopters. When you have taken fire on the road, in the air and had rockets whiz by you this becomes a reality that you never forget.

helos at night A Familiar Sight to Me, Flying at Night AP Photo/David Guttenfelder

As a result we do not only have men and women with physical wounds, but wounds that have damaged the psyche or the soul. PTSD is very common either from a direct encounter or the continual wear and tear of being in a danger zone wondering if you were to get hit that day every day of a tour. I have lost count now of people that I know who have mild to severe symptoms of PTSD. Traumatic Brain injury is another condition men and women attacked by IEDs, mortars and rockets experience. Likewise there are the injuries that shatter the soul. These are the images of ruined buildings, burned out vehicles, wounded bodies, injured children, refugees and wars desolation that can leave a person’s faith in God, or ideals that he or she believes in weakened or even destroyed. There are many idealistic and patriotic military personnel who because of what they have seen question God, their National Leadership and even themselves. I cannot get the image of a refugee camp on the Iraqi Syrian border full of Palestinian refugees who have nowhere to go; they had been invited to Iraq under Sadaam and have been sitting on the border trying to get home for years now. The Palestinian authority wants nothing to do with them.

237 Iraqi Kids in War Torn Village on the Euphrates

These men and women are my brothers and sisters. I have seen quite a few of my ICU staff deployed this year with more getting ready to go. These are my friends and I do get concerned for them and pray earnestly for their safe return. I wish that I could go with them because I know them and have already walked with them through the dark valley of the shadow of death in our ICU. We already have a bond that will not be broken.

It is now two years since I was in the process of leaving for Iraq and a year since my PTSD crash. However, I still would do it again in a heartbeat. There is something about doing the job that you were both trained to do and called to do that makes it so. Likewise the bonds of friendship and brotherhood with those who you serve are greater than almost any known in the human experience. Shared danger, suffering and trauma bind soldiers together, even soldiers of different countries and sometimes with enemies. I remember the conversation that I had with an Iraqi Merchant Marine Captain on a ship that we had apprehended for smuggling oil violating the United Nations sanctions. The man was a bit older than me, in his early 60s. He had been educated in Britain and traveled to the US in the 1960s and 1970s. He had the same concerns as any husband and father for his family and had lost his livelihood after Sadaam invaded Kuwait in 1990. He was a gentleman who provided for his crew and went out of his way to cooperate with us. In our last meeting he said to me: “Someday I hope that like the Americans, British and the German soldiers at the end of the Second World War can meet after the war is over, share a meal and a drink in a bar and be friends.” That is my hope as well.

In the final episode of the series Band of Brothers there is a scene where one of the American soldiers, Joseph Liebgott who came from a German Jewish family interprets the words of a German General to his men in the prisoner compound. The words sum up what the Americans had felt about themselves and likewise the bond that all soldiers who serve together in war have in common, if you have seen the episode you know how powerful it is, I ended up crying when I heard it the first time and cannot help but do so now that I have been to the badlands of Al Anbar Province.

“Men, it’s been a long war, it’s been a tough war. You’ve fought bravely, proudly for your country. You’re a special group. You’ve found in one another a bond that exists only in combat, among brothers. You’ve shared foxholes, held each other in dire moments. You’ve seen death and suffered together. I’m proud to have served with each and every one of you. You all deserve long and happy lives in peace.”

A Chance Meeting with our EOD Mobile Uniit 2 Brothers

May God bless all of especially my brothers who served in with me in Iraq or have served or are serving in Afghanistan; as well as my brothers who fought in Vietnam, Indochina and Algeria. We may never get a victory parade, but we have each other.

Peace, Steve+

5 Comments

Filed under History, iraq,afghanistan, Military, PTSD, vietnam

Tagged as afghanistan, al anbar province, al qaida, algeria, asymmetrical threats, band of brothers, fob, french indochina, gulf war, henry v, hummv, icu, ied, improvised explosive devise, iraq, kuwait, PTSD, rpg, sadaam hussein, the greatest generation, traumatic brain injury, united nations sanctions, veterans, victory parades, vietnam war, war on terror, we happy few we band of brothers, world war two

July 8, 2009 · 20:45

Sometimes You Wanna go Where Everybody Knows Your Name

The hit long running comedy Cheers set in Boston Bar is something that I have grown to appreciate more and more throughout the years. It comes from the community of disparate people who find refuge in that bar each with their own lives and stories which all intersect at Cheers. The lyrics to the theme song from the show sum up where I sometimes find myself in life, especially coming back from Iraq.

Making your way in the world today takes everything you’ve got.
Taking a break from all your worries sure would help a lot.

Wouldn’t you like to get away?

Sometimes you want to go

Where everybody knows your name,
and they’re always glad you came.
You wanna be where you can see,
our troubles are all the same
You wanna be where everybody knows
Your name.

You wanna go where people know,
people are all the same,
You wanna go where everybody knows
your name.

The last verse to the song “Where Everybody knows Your Name” never aired on the show and continue….

Be glad there’s one place in the world
Where everybody knows your name,
And they’re always glad you came;
You want to go where people know,
People are all the same;
You want to go where everybody knows your name.

The need for community is something that I didn’t think that I really needed for most of my life. It took a huge amount of time isolated in the military as well as coming back from Iraq with a nice case of PTSD to realize that I could not exist without some kind of local connection. This is something that when I returned from Iraq I knew that I did not have. For a good amount of time this didn’t matter because I was always on the road or deployed. It is easy to cover up the need for local relationships and community when you aren’t around.

For me this isolation really began when we moved to the Hampton Roads area back in 2003. I was assigned to a command where I was on the road a lot. However I sought to make build relationships with the local mission of my church in our area as well as other local clergy. After a clash with the local idiot masquerading as a priest I was forbidden by the bishop to have any contact with any of his priests or parishes. I guess since that bishop didn’t get my tithe that I didn’t matter. A couple of years later both the bishop and the idiot priest had left our church for happier hunting grounds. So when I came back from Iraq in 2008 I was isolated. I had transferred in October 2006 from a Marine Command where I felt absolutely comfortable to a different command where I was new and about everyone else was going about 95 different directions. The command chaplain who I had come on board under in the larger command had transferred during my deployment, while the one officer that I had developed a relationship with at my new command was deployed a couple of months after me. When I returned from Iraq even my office had been packed up and I had no-where to work from for over a month. My belongings, including many military mementos and awards were crammed into a trailer and it took almost a year to find the majority of them. A couple of items were not recovered. So on the military side I was pretty isolated and feeling pretty down. As I said I had no church ties from my denomination anywhere near me and had not, due to my own pathology and hectic travel and deployment schedule did not establish a relationship with another church until this year. Other friends had transferred over the years and I had one other chaplain in the area that I can call a friend. We have known each other since 1999 and our wives are best friends. Apart from that I was about as isolated and alone as I could get. It was then with my PTSD kicking my ass that I knew after all these years that I needed to be in community and in relationships with people locally. It was no longer good enough to simply check in with guys that I had known for years but who lived far away.

It took a while to get from knowing that I needed something until I was able to get established in a number of places and begin to build my local ties. The first two places were Harbor Park where I see the Norfolk Tides play and the local Gordon Biersch Brewery Restaurant. Harbor Park was something that I went to before Iraq as I love baseball. I was no stranger there, I’ve been around long enough to get to know staff, vendors and ushers and have met the General Manager Dave Rosenfield on a good number of occasions as he walks the concourse among the Harbor Park faithful. However something happened when I came back from Iraq. In most places I could not handle crowds, even going to church at the fairly large Catholic Church where I occasionally attend with Judy who is a member there. It is large and rather busy and since I only know a few people there I get a bit anxious, even though I love the Pastor, Deacons and the few people that I know. However every time I would step onto the concourse at Harbor Park and the lush green field came into view I could feel stress and anxiety leaving my body. Somehow almost magically I am at peace when at a ball game. I felt the same thing even in crowded Major League Parks at San Diego and San Francisco when I made trips to the west coast. When the season ended last year it was terribly difficult as the PTSD and Anxiety, nightmares and chronic pain were still raging. When this season came around and with Harbor Park now on my way home from work I knew that I needed to get a season ticket. I cleared with Judy and for the first time in my life I had a season ticket. Since the season began in April the Park has become more of a place of refuge and place of fellowship with some great people. Seeing Elliott the Usher, Ray and John the Vietnam Vets at the Beer Stand behind the plate, Kenny the Pretzel Guy, Skip the Usher in the section above me, Mandy up in the Tides Store my next seat over neighbor Barry, Barry’s daughter Julie, Tina and her husband, the Judge and others has given me a sense of community that is like a comfortable pub.

The same has been true at the Gordon Biersch Brewery Restaurant has become another place where I feel at home. I think this began with Kira, the choir child from Judy’s Church as well as guys like Mike, John and girls like Kai Ly who been incedible. We began by being frequenters of the dining room but have over the past several months moved to the bar as it is a bit more laid back and we get to know more people. Now the noise can occasionally be a bit much, but the kids who work there are really great to be around. I was just recently inducted into the Stein Club. Both Harbor Park and Biersch were important because even though the people that I met were those in the intersection they were places and people that began to get me back in touch with community.

Another really key part of building community for me is my work at Portsmouth Naval Medical Center. Somehow I am at home in the surreal environment of the ICU and PICU and the great folks who work on those floors. On call I am beginning to feel the same way about our NICU. The relationships formed in these areas as well as with my fellow chaplains have become especially important. My boss and some of our other chaplains have really helped me through some really rough times since I got here as I have dealt with the PTSD and other issues from Iraq. As I have made the adjustment to being back in the hospital setting I realized just how much I enjoyed the challenge of Critical Care chaplaincy, the care for patients, families and especially the staff and residents. I am at home here.

The final piece fell into place a few months ago, that was beginning to worship at St James Episcopal Church in Portsmouth. I had met the Rector (Pastor) of the Parish, Fr John at the hospital as he visited two of his parishioners who were patients in my ICU. We not only met but we became friends and he invited me to St James. Now Fr John is from Nigeria and the parish is predominantly African American, West Indies or Nigerian. The church reminds me a lot of East Side Presbyterian Church in Stockton CA which I attended with Judy. The liturgy while Episcopal is punctuated with familiar hymns and Old Negro Spirituals. The Church itself was founded in the 1890s as a place for African American Episcopalians to worship, Jim Crow being quite strong in those days. When I first went there I wondered about the wisdom of it but I knew that I needed a place to worship outside my little guestroom altar. I didn’t know what to expect, but the folks at St James love worship, music and have enfolded me, a Priest from a different communion into their community and for the first time since I came in the Navy, and certainly since I came back from Iraq I feel a sense of connection with a local parish. One thing that I believe is quite significant is that prior to the Civil War my familyowned slaves in what was then the western part of Virginia. I even met a man from Liberia who has my last name. His family went from the United States, to Canada, back to the UK and then on to Liberia before his family came back to the United States. His brother even serves in the US Navy. I’m sure at one point Cecil Dundas’s ancestors once were owned by some part of my family in Virginia. But we are both of the Dundas family and I think that is pretty cool. Small world.

I don’t necessarily think that I am alone in the search for community. I think for a lot of people they would want to find such a community in church, but from what I am seeing across the denominational spectrum and the move to large churches or mega-churches I am seeing more lonely people who attend church regularly but never feel a sense of family or community. Some of the things I hear from these lonely and disconnected Christians remind me of the lyrics to Abba’s hit Super Trouper:

Facing twenty thousand of your friends
How can anyone be so lonely
Part of a success that never ends
Still I’m thinking about you only

Part of this I think is that many churches have places more value on “Church growth” and programs than they have on people. There has been a shift, especially in larger churches to proliferate programs which take up a lot of time, but don’t foster relationships. Often the senior pastor is unreachable and untouchable in large churches. Someone may get contact with a staff pastor, but often this is even driven down to minimally trained small group or home group leaders. The churches themselves are so large it takes a long time for a new person to get to know anyone. Now large church can do a lot of good, but I do think what they lack is intimacy. Some home groups have this but others are train wrecks full of pretty bad juju. So I wonder if this is a part of the isolation and disconnection of people. Just a thought….

It has take me about five years to get connected in this area. The cool thing now is that there are a number of places where I can go where just about everybody knows my name. Slowly but surely I’m getting better as I get more connected. I now have the beginnings of a community which is rich and diverse, military and civilian and have the blessing of friendship with so many people that that make up the communities of which I have become part. The Deity has a wry sense of humor to take this introverted rugged individualist to put me into community with such a great bunch of people. She had to about throw me under the bus to do it, but I am glad that she did.

Peace, Steve+

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Filed under philosophy, PTSD, Religion

Tagged as Baseball, black episcopalians, bosnia operation, cheers, civil war, community, gordon biersch, hampton roads, harbor park, icu, iraq, norfolk tides, picu, PTSD, slavery, st james episcpal church, where everybody knows your name

June 7, 2009 · 22:48

Everybody has a Pitch Count…Good Managers Know When You’ve Reached It

Everybody has a pitch count, be they a baseball pitcher or a military, police or critical care health provider. At some point one can push themselves so hard that they can injure themselves or if not that start making mental mistakes that cost games for a pitcher or lives to people in military, public safety or critical care medicine. In baseball managers have to make sure that their pitchers don’t wear themselves down. It is very easy for a pitcher, especially a hard thrower to wear out early from overuse causing injury. At times hard throwers, or for that matter any pitcher can over pitch. They can try to do too much. At first this may not be noticeable, maybe they lose a little bit off of their fastball or their curve ball may not be as sharp. The pitcher may shake it off and tell his coaches and trainers that nothing is wrong. They do this for a couple of reasons. First, they are competitors; they want to do the job that they have to do. Second, they don’t want to admit that something is wrong with them be it a possible physical injury or maybe even a mental issue which is keeping them from getting good control of their pitches. Of course the physical wear and tear on pitcher is brutal. The physical punishment of throwing a baseball 80-100 mph on the arm, especially the elbow and shoulder is brutal. The amount of torque applied to these joints is severe. If a pitcher is using incorrect technique or has thrown too many pitches the effects can be devastating to his career.

While I am not a pitcher, when I played I was a utility infielder and catcher, I do think that everyone has something to learn about life and work from managers, pitchers and knowing when a pitcher is suffering from overuse injuries or has lost his physical or mental edge. The manager has to know when the pitcher has reached his pitch count and when it is time to pull him even if the pitcher wants to stay in the game. The same is true with anyone who serves in military, police or intensive medical professions such as EMS, Emergency Rooms and Intensive Care units. This became apparent to me over the past year and a quarter since I returned from Iraq. I am now 49 years old. I stay in pretty good shape and physically can still outperform many younger people in such things as push-ups, sit-ups and running. I pretty much know my physical limitations especially coming back from Iraq with some physical and emotional scars. I work in ICUs and if my life as a chaplain was limited to simply doing that work on the floor I could do it forever. I thrive in the environment and actually am more at ease on an ICU or in an ER than I am on general patient floors or doing administrative tasks. However, those are also part of my life. So I have to achieve a balance. I am usually pretty good at knowing when it is time to tell my manager, in this case our director of pastoral care that I am not doing well. Yet, sometimes even when I know I’m not doing well I won’t stop. I will push myself to the point of physical and emotional collapse. I hit this point last week following a month of family illness, end of life planning for my dad, a medical emergency with Judy and several very demanding weeks at work where I put in a huge amount of hours because the job had to get done. I hate to leave something undone or have to leave something for someone else to do. I don’t like to be taken out of a game. My first Navy tour after 17 ½ years in the Army I was my Division Chaplain’s relief pitcher. I ended up taking several battalions because their chaplains either got in trouble or were pulled for another assignment. Likewise I was given the task of working with young guys who had run into some kind of trouble to see if they could be salvaged.

A good manager has to recognize when his pitcher is having problems before he gets in trouble. Until the advent of relief pitchers that were primarily relief pitchers and not washed up former starters, they generally pitched deep into a game. As such many racked up huge numbers of wins, strike outs and complete games. In fact most of the top ten are guys that pitched when it was almost unheard of to bring in a reliever. Thus there are men like Cy Young who won 511 games, Walter Johnson with 473 wins and Grover Cleveland Alexander and Christy Matthewson who won 373 each. Young played 22 years and had a record of 511 wins and 316 losses. He pitched 7356 innings. He played in 906 games, started 815 games and had 749 complete games. No wonder the award for best pitcher is named after him. Cardinals Hall of Fame pitcher Bob Gibson started 482 games and completed 255 of them. In 1969 he won 20 games, 13 of which were shut outs. Gibson once reportedly said: “I used to get tired in the seventh inning too. And the manager would come to the mound and ask me if I wanted to come out. Then I would look over at the bullpen and see who was warming up. Then I would say, ‘No, I’m going to stay in.”

As baseball moved forward teams began to have more depth on their pitching staffs. Rotations were developed where pitchers pitched every 4^th game, and frequently in our era every 5^th game. Additionally since the 1970s the specialist relief pitcher has become a key part of the game. While there were relievers prior to that, the relief pitcher as a specialist did not really get off the ground until Rollie Fingers of the Oakland A’s won salary arbitration against A’s owner Charlie Finely. At that point pitchers who could come into a game on no notice in certain situations became more and more a trend. Now it is standard for a team to have long, middle and short relief specialist as well as “Closers.”

In a sense while some people may not like it, it is not a bad thing for the game. One only has to look at how many pitchers had abbreviated careers o of overuse injuries including Sandy Koufax and Dizzy Dean who are both in the Hall of Fame. If you look you can find others. This was especially true before the advent of “Tommy John surgery” when pitchers with a torn rotator cuff faced the end of their careers. As such teams became much more aware of how many pitches a starting pitcher and even relievers should throw in a game. The pitch count was developed. For a healthy starting pitcher in the middle of a season this is usually around 100 pitches. Relief pitcher counts will vary. While pitch counts are not necessarily the Gospel, there is a point in every pitcher’s career where he hits his own pitch count limit, be it in a game or a career. As Whitey Ford said: “Sooner or later the arm goes bad. It has to…Sooner or later you have to start pitching in pain.”

So you may be asking what does something arcane like the mechanics, kinetics and injuries have to do with life. As you know the Deity Herself speaks to me through baseball. This has application to those in high stress jobs where they are called on to put their lives on the line for others or deal with danger, death or tragedy in an environment where just one mistake can be fatal or where a word, gesture or throw away comment can harm someone else. The managers, supervisors or commanders of people who do such work have to be cognizant of the effects of this on their people.

I am luck, the Deity Herself has surrounded me with a number of people who can look at me and tell me to sit down even when I want to continue to keep pushing. Last Friday was one of those days. It was the culminating point of a nearly a month of personal and professional stress, lack of sleep and the lingering effects of my PTSD and chronic pain which flare up when I have exceeded my personal pitch count. My boss was away last week. However we remained in communication. I was scheduled for weekend duty, which for me I remain in house because I am not able for the most part to meet the response time for a emergency call. When my boss came back he must have checked in with several folks who k now me to see how they thought I was doing. Friday afternoon after I got home I got a call from the acting department head who told me to stay at home that my boss was going to pull my duty for me. I really needed this. However, I told him that I still could come in if needed and was told to stay home and take care of myself.

With a manager like that I will be able to keep playing my game longer. I may have occasional rough outings but I will do fine. The lesson is that everybody has their own personal “pitch count” even if they do not throw a baseball. Like my favorite theologian Harry Callahan says: “A man’s got to know his limitations.”

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Filed under Baseball, ER's and Trauma, healthcare, Loose thoughts and musings, philosophy, PTSD

Tagged as baseabll, bob gibson, charley finley, christy matthewson, cy young, dizzy dean, ER, grover cleveland alexander, harry callahan, icu, pitch counts, relief pitchers, rollie fingers, sandy koufax, starting pitchers, Tommy John Surgery, whitey ford

May 20, 2009 · 19:41

Whirling, transient nodes of thought careening through a cosmic vapor of invention…

mental floss

“My mind is aglow with whirling, transient nodes of thought careening through a cosmic vapor of invention…” Headley Lamar (Harvey Korman) Blazing Saddle’s

Blurred Days, Preparing for Death and Medium Rare Diseases : The past 10 days have been a blur. So much has happened that I have a hard time coming to grips with it all. First was going out to California to assist my mom and brother in dealing with things concerning my dad’s worsening condition. It was good to have a couple of visits with him where he was with me at least for a few minutes. I will treasure those figuring that they may well be the last that I have with him on this green earth. Yet it was hard. I had to kind of package away my stuff for a while and hoping to process when I got back. It seems that the Deity Herself has decided that she needed to build more character in this character than this character thought that he needed. When I got back we were faced with the first real health crisis in our lives. Judy contracted Epiglotitis somehow and we spent the majority of the past three days in hospital ER’s or having her admitted to hospital. Nothing is ever normal for us. Maybe it’s because neither of us are normal. In fact Judy is Abbess of the Abby Normal (see the link on my blog roll). So Epiglotitis is very unusual, 10-40 cases in a million. Most are kids and it is almost unheard of in this country. The Third Year ENT Resident said that he had never seen it before. The attending almost missed it until the ER Attending saw the soft tissue X-Ray. As I said in my last post after I had made the diagnosis which was confirmed by the physicians: “It’s a kid’s disease except when it happens to adults.” It is what probably killed George Washington. Thankfully even early Monday morning though the ER Attending did not see it he did the right thing in a heavy dose of IV antibiotics and steroids. This probably arrested the development of the condition. When it worsened we got Judy into the ER pretty fast and again the right thing was done. She seems to be doing well now that she has been discharged home and for this I am most grateful that she is not dead or even the Grateful Dead. However two long nights in ER with little rest following the trip to California have left me worn out. I do hope that the Deity Herself does not think it necessary to build any more character in this miscreant Priest. Thankfully my Department Head took my duty today and put me on two days of leave to put myself back together. Sleep has been fitful and my anxiety levels have been rather high. Thankfully no PTSD meltdowns this time at least not yet.

The Holy Unction of the Baseball: If you remember my post Baseball in Between Life and Death in the ICU I mentioned a dear woman and her husband who were both big baseball fans. She was in the ICU and seeming to be getting better and I promised her a baseball. She crashed hard. The next day when I brought the ball in she was heavily sedated and intubated. She was trying to die on us. If you recall I placed the baseball in her hand and she gripped it tight. Her husband and sister said that she did not let it go for about 7 or 8 hours. I prayed for her as I did this. I went to California and she was still pretty bad off. By the time that I came back I heard that she was doing a lot better. I saw her yesterday and had a wonderful visit with her and her husband. There is a possibility that they may be actually able to do something to help her heart function. She remembers having the ball in her hand and wondering how it got there even when she was heavily sedated. Could it be possible that the Deity Herself could have made The Holy Unction of the Baseball a new sub-Sacrament of the Sacrament of Healing?

Don’t Screw Up the Prayer: I did the invocation and benediction at the groundbreaking ceremony for Preventive Medicine unit at Norfolk. I’ve done hundreds of prayers at military and civil functions. They are not hard to do. What you don’t want to be is too memorable because if this is the case you have probably done something to be remembered and not in a good way. I have seen this done a number of times. Often the Chaplain has no clue that he stepped all over it. This can happen by going too long, forgetting the words or trying to be too uppity, sectarian, funny or unique. Since most of the time the people at these functions have to be there the chaplain cannot presume that they are the show and can do whatever they want. In the Navy this is really important. I write these prayers out and have done so for many years now. Not only do I write them out I read them several times before I ever get in front of a live audience. Doing this keeps me from doing something stupid, which on occasion even I can do. I even have a basic format that I put the prayer into: The introduction; specific event/unit/situation that I am asking God to bless, and the closing sentence. I try to keep it to 30-45 seconds, never more than a minute. It is not good when they look at their watches when you are praying or yawn. In the public forum you have a place to be a witness, but it is always a delicate balance. The people at the event are not there to see the chaplain. The chaplain is like the ceremonial first pitch or meeting between the managers of the two baseball teams and the umpires to discuss the ground rules. Chaplains are not the main event unless it is an actual worship service. Even memorial services and ceremonies where the chaplain plays a huge role, the chaplain is not the reason everyone is there. It is no place to try to be Paul Harvey and tell “the rest of the story.” Thus this ministry in the public arena can be one that either provides the chaplain entrance into the community with opportunities to provide great ministry, even evangelical ministry. Or ensures that they remain an outsider to the community, nipping at the fringe and hoping someone will hear them. When we were done I had an officer compliment me on my prayer. He said it wasn’t too long, wasn’t too short and honored what they were doing. I love it when a plan comes together.

A Tale of Two Burgers: Yesterday I did something that I have not done in years. I had two hamburgers in a single day. Both were fast food burgers and usually I maybe eat A HAMBURGER every 45-60 days. Yesterday as you know from reading this was rather hectic. One the way home I stopped by Sonic to get a Super Sonic Double Cheeseburger with Mayo, Mustard and Ketchup. For fast food this is a hell of a burger. It is tasty and big. Sure it’s not the best hamburger in the world but it will work in a pinch. Early this morning after leaving Judy at the hospital I stopped by a 24 hour McDonald’s. I was hungry and tired. Unfortunately they have an exceptionally limited after midnight menu. Two Types of Quarter Pounder, The Big and Tasty Burger, a Southern Chicken Sandwich, Chicken McNuggets and Chicken Strips. Not much to choose from. I should have gone with the McNuggets or regular Quarter Pounder but taken in by the name I asked for the Big and Tasty. This was very possibly the very worst hamburger that I have ever had. The meat was bland and greasy and topped by a mound of mayonaise that drowned out any other taste. I could feel my arteries closing as the first bite went down. I can only say “Never Again.”

Moving to the Front of the International League: My Norfolk Tides are now 26-12 not only atop their division but now has the best record in the International League. This is a exciting young ball club. We have not had anything like this in years at Norfolk. I just hope that the Orioles don’t rape the Tides to fill their roster. I know that the minors exist to support the big team but right now this is a special team and fun season. I pray that the Deity will ensure the Orioles success so that we can continue like this the rest of the season.

Getting the call reversed: It looks like our insurance company has decided to agree with us and the body shop and denial the fraudulent claim against Judy. Sometimes arguing with the umpire nicely gets the call reversed.

As always thank you for your kind words, encouragement, concern and prayers over the past 10 days. They are appreciated and I know that they are effectual.

Peace, Steve+

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Filed under alzheimer's disease, Baseball, ER's and Trauma, healthcare, Loose thoughts and musings, Military, PTSD

Tagged as abby normal, alzheimer's disease, baltimore Orioles, Baseball, big and tasty burger, blazing saddles, ceremonial prayers, chicken mcnuggets, end of life, ENT, epiglotitis, ER, first pitch, george washington, grateful dead, harvey korman, headley lamar, hospitals, icu, international league, mcdonald's, memorial services, norfolk tides, paul harvey, quarter Pounder, sacrament of healing, sonic, super sonic double cheeseburger, the rest of the story, Unction

May 18, 2009 · 16:17

Monday Monday…a visit to the ER and the DMV

Well what can I say? If you remember Garfield the Cat and how he hates Monday’s you can probably understand this post. Maybe you have lived this yourself. Maybe not, but there is always tomorrow.

I really expected to have a nice day recovering and resting from my very draining trip to California to help out with my dad. It started that way but didn’t end that way. When I got home I found out that my license plates had been stolen off of my car. Thus I knew that today I would need to go to the DMV to report them stolen and get them replaced. I figured that this couldn’t be too bad, I called my boss yesterday afternoon and he graciously gave me the time to do so. Of course I could not gotten through the front gate without them, but still it is good to have an understanding boss.

Late in the evening I started to get my things together for work. After having watched the movie Fletch with Judy I was tired and expecting to go to bed. Judy had told me earlier in the evening that she had a sore throat and had taken some throat stuff to make it feel better. The throat stuff usually takes care of the problem. This time it didn’t. She started complaining of sharp pain of like 9 on the scale of 10 in her throat and that she was having a hard time swallowing. This to me was odd. Judy has a super high threshold for pain, that fact that she has been married to me for nearly 26 years testifies to this. Once in Germany she had a cavity filled with no anesthetic when the Army dentist who had the shrine to Dr Mengele in his office refused to give a topical before sticking her with a needle. She let a broken ankle go for a year before having something done about it. Sorry I don’t like to suffer like that. But she has a super high threshold for pain. So at 0002 in this morning (for those not German or military both of Mickey’s hands are pointing straight up to the 12) yes Monday dark and early, we set out for Sentara Bayside ER. I was not a happy camper. I picked up one of my Andrew Greeley Bishop Blackie Ryan mystery novels and took Judy through the rain to the ER.

Now to me a real ER is where guts are hanging out, people a being coded in multiple rooms. In a real ER there are gunshot wounds, stab wounds, burns, strokes, heart attacks, people mangled in car or industrial accidents. Likewise there are always Police with knuckleheads who have been arrested, drug overdoses, suicide attempts and real live psychotic people who think that they are Jesus. Death, crisis, mayhem that dear readers is my kind of ER. Eating a cheeseburger with a trauma surgeon while looking at the track of a bullet in an open chest after some gang banger got whacked and we could save him. That is an ER to me. I did my residency at Parkland Memorial Hospital in Dallas as the Trauma Department Chaplain and worked as an ER Department Chaplain in a Trauma Center in West Virginia. I’m used to full waiting rooms, upset people and various forms of craziness. I now work in a teaching hospital and have the adult and pediatric ICUs. To put it mildly this was not what I experienced this morning. We got there and there was no one in the waiting area, which unlike places I have worked before was nicely decorated and relatively comfortable. They even had Lifetime set as the channel on the cable TV. Judy went through triage quickly and was taken back. After a while I was called back. Judy was getting an IV placed and a full panel of labs and a CT Scan of her obviously swollen neck were ordered. This was a bit scary for her, and a little unsettling for me as first she is my wife and I don’t want to lose her, but also because I know that if untreated whatever was going on could threaten her airway. This is never a good thing.

The nursing staff and the ER physician were very nice. I have no complaints. For a while it looked like that Judy might be admitted until she responded to the three different IV meds and drips that she was on. Now whatever was going on was potentially serious but seemed to have been nipped in the bud. I did try to comfort Judy by telling her that it couldn’t be that bad because she wasn’t intubated, didn’t have a Foley catheter or NG tube, but she didn’t find that terribly comforting. I young man how had cut his arm pretty bad after giving a dumpster an elbow was across the way and had a pretty cool cut, but still pretty mild by what I am used to. Compared to the places that I have worked it was far too sedate. It was really kind of boring. I guess that is okay, I didn’t want Judy to be the one who got sporty and provide the entertainment for the evening.

We got out of the ER about 0330 and hit 24 hour Walgreens to pick up her medicine. She even got good stuff for pain, Vicodin. All I ever get is Motrin, no let me take that back, my Nurse Practitioner here put me on Ultram for my chronic pain in my shoulders. But this isn’t like Vicodin. The people in the pharmacy were all friendly, giving us a cheery “Good morning” every time that we turned around. We finally got home well after 0400. Checking in with the boss I got permission to come in late.

This afternoon I still had to go to DMV to get the license plates. I didn’t get much sleep and what I had was not very good. Groggy and grouchy like a bear waking up from hibernation I put myself together. I did not want to go to the DMV, but it had to be done. Now the DMV sends chills up my spine. I grew up in California, so my first experience of the DMV was in that fair state. The DMV in California is like the major league of the DMV. I’m sure that I stood in line behind Jimmy Hoffa one day well after he went missing never to be seen again. He’s probably still in line. The last time I went to the DMV here it was a long wait. Today I expected the worst. It started out where I thought that would be the case when the rent-a-cop at the door sent me outside and told me that I couldn’t have my Norfolk Tides travel mug filled with Dunkin Donuts French Vanilla coffee, Splenda and Coffee Mate Nonfat French Vanilla creamer in the building. I thought, “well isn’t this just great….I’m tired as hell and have to wait in DMV for what could be forever without more coffee.” I was even less happy than when I got there. Thankfully the rest of the DMV time was not too bad. The lady at the desk was friendly and had lived in California and even knew something about Mudville. I left with my temporary tags and stopped by the Advance Auto Parts store on Princess Anne Blvd in Virgina Beach to pick up a new license plate frame and mounting devices. Now Advanced usually gives military members a 10% discount on the purchase. Showing my ID card I expected this. However the young man refused to give it to me because “I had not specifically asked him for it.” I thought this was kind of shitty as all the other guys there have went out of their way to honor this. I decided to say the hell with arguing with him and just write a nasty comment on my blog with tags for Advance Auto Parts on Princess Anne Blvd in Virginia Beach. Following this I got Judy some soft food to eat and went in to check in with the boss, drag all the stuff I would need for the week into work and to go through my hundred or so e-mails so I wouldn’t have to do that tomorrow.

In a few minutes I head over to the Church of Baseball, Harbor Park Parish for a double header between the Tides and the Louisville Bats. Tonight, though tired I need this.

Thank you all for your prayers, encouragement and kindness this past week.

Peace, Steve+

Post Script: The double header against Louisville was great. The Tides swept the twin bill winning 6-2 in the first game and 2-0 in the night cap. Justin Christian homered and Matt Wieters a triple with Chris Tillman picking up his 5th win with no losses. David Pauley getting the win, his third and Jim Miller his 10th save striking out the side to close the game. The Tides are now 25 and 12 and up by 2.5 games over the Bulls in the IL South. I really needed tonight, the weather was a tad bit cold but it was good to be back with my Church of Baseball Friends. Barry my partner down in section 102 B had his daughter down and it was fun to be with both of them. My section usher Elliott was back as was Chip up in section 202. Had my usual King Twist pretzel from Kenny up on the concourse.

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Tagged as advance auto parts princess anne blvd virginia beach, andrew Greeley, army dentist, bishop blackie ryan, california DMV, church of baseball, coffee mate french vanilla creamer, dr mengele, dunkin donuts french vanilla coffee, ER, fletch, garfield comic, germany, harbor park, icu, jimmy hoffa, license plates, lines, louisville bats, military discount, monday's, motrin, norfolk tides, pain threshold, parkland hospital, rent-a-cops, sentara bayside, Splenda, trauma centers, ultram, vicodin, virginia DMV, walgreens

May 7, 2009 · 15:38

Baseball in Between Life and Death in the ICU

CALBaseball_142

I have had a number of patients in my ICUs who are or in the case of some who have passed away avid baseball fans. Likewise there are a number of physicians and nurses who are avid fans of the game, or sometimes certain teams. Like me the are members of the Church of Baseball. Some even attend my parish, Harbor Park. It is funny how in the intersection of life and death that baseball finds a place more than any other sport. Baseball has a quality and nuance that is different from most other sports, save perhaps golf. Baseball is not bound by the constraints of time. It has an eternal quality that somehow transcends life and death. Two of my favorite attending physicians are big fans and one coaches on the side.

There is a scene in The Babe Ruth Story where a critically ill child asks the Babe to hit a home run for him. The Babe then went out and hit two. Later in the movie when the Babe is dying of cancer he is given a Miraculous Medal. The film was rushed to completion before Ruth died and the scene at Yankee Stadium was filmed shortly before a game and Ruth came from his death bed to be there.

In Field of Dreams the spirits of the 1919 White Sox who were forced out of baseball in the “Blacksox” scandal. The Pride of the Yankees deals with the life of Lou Gehrig, baseball’s original “Iron Man” and his battle with ALS. His speech at Yankee Stadium when he retired from the game is classic. It is a reflection on life well lived and thanksgiving for what he experienced.

LouGehrigDay

Lou Gehrig at Lou Gehrig Day July 4th 1939

“Fans, for the past two weeks you have been reading about a bad break I got. Yet today, I consider myself the luckiest man on the face of the earth. I have been in ballparks for seventeen years and I have never received anything but kindness and encouragement from you fans. Look at these grand men. Which of you wouldn’t consider it the highlight of his career just to associate with them for even one day? Sure I’m lucky. Who wouldn’t have considered it an honor to have known Jacob Ruppert? Also, the builder of baseball’s greatest empire, Ed Barrows? To have spent six years with that wonderful little fellow, Miller Huggins? Then to have spent the next nine years with that outstanding leader, that smart student of psychology, the best manager in baseball today, Joe McCarthy? Sure, I’m lucky. When the New York Giants, a team you would give your right arm to beat and vice versa, sends you a gift, that’s something. When everybody down to the groundskeeper and those boys in white coats remember you with trophies, that’s something. When you have a father and mother work all their lives so that you can have an education and build your body, it’s a blessing. When you have a wife who has been a tower of strength and shown more courage than you dreamed existed, that’s the finest I know. I consider myself the luckiest man on the face of the Earth. And I might have been given a bad break, but I’ve got an awful lot to live for.” – July 4, 1939 at Yankee Stadium on Lou Gehrig Appreciation Day

These are intersections of life and death. In the ICUs I have a surprising amount of dealings with baseball. I have a lady who is very sick. She is a delightful woman with a wonderful husband. She looked like she was on the uptick a couple of days ago we had a great talk, and wonderful time. We found that we shared a common passion…you guessed it, baseball. We agreed that the Biblical writers describing heaven being unaware of the Deity’s love of baseball had erred in their description of heaven. We agreed that heaven had to have not streets of gold, but the lushest turf and most immaculate infield, with foul lines that went into infinity. She and her husband watched the Nationals and Astros play deep into the night. Yesterday she took a turn for the worse. As we visited we visited I prayed and anointed her at her request. And I asked her if she would like a baseball. Her eyes lit up and she nodded “yes.” So I promised that I would get one from the stadium last night. Well, the Devil got in the mix and the Tides got rained out, so I went home. I found a ball that I got when throwing out the first pitch at a Kinston Indians game a few years back. I inscribed it to her and took it to her room. She was pretty heavily sedated, but her sister was with her. I let her know that I had the baseball for her. She opened her eyes and I put the ball in her hand. Her hand gripped it tight and I blessed her.

I do pray that she will get better.

Peace, Steve+

grainger stadium Granger Stadium Kinston NC

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Filed under Baseball, healthcare, Religion

Tagged as babe ruth, Baseball, carolina league, harbor park, heaven, icu, kinston indians, lou gehrig, norfolk tides, pride of the yankees, rain outs, the babe ruth story, yankees

April 28, 2009 · 22:42

Don’t Mess With the Pig- The Swine Flu is no Joking Matter

I am not an alarmist by any means. I am a realist and a historian. If we know anything from human history there have been great plagues as well as epidemics and pandemics of various types. Our world is rich in life and beauty but it is also full of really really nasty diseases that on occasion get loose and act really really bad. Influenza, which normally kills about 30-40,000 people annually in the United States is one of those ugly nasty diseases. Even mild cases can make you want to die and this is the easy stuff. I’m not smart enough to make a prediction that the Swine Flu will be the next big pandemic, but it has potential and that potential needs to be addressed to ensure the safety of everyone, even lawyers.

The Avian and Swine variations of the flu are like normal flu on steroids. They kill if they are not contained quickly. The last scare we had with the Swine flu was back in the 1970s. I remember getting the vaccine for it. Hopefully those anti-bodies as well as all the ones from every other flu bug that I have been vaccinated for or exposed to will keep me safe with good preventive measures. That bug was contained and it did not become an epidemic. Because it didn’t the pharmaceutical companies that produced the vaccine were beaten down. A small minority of people had side effects from the vaccine. The pharmaceutical companies, for all their faults, got hosed on this. They had their asses sued off and were not protected. Maybe we should pray, like Henry IV that if this Flu becomes a pandemic that it kills all the lawyers first. People, especially we Americans then developed the attitude that this is not a threat. This attitude could cost us big if we are slow to react.

The fact is there will be another epidemic or pandemic. The really big one was the Great Influenza or the “Spanish Flu of 1918-1919. This was nasty a virulent strain of Influenza A subtype H1N1, the same subtype as the current Swine Flu. It killed people by the millions worldwide, most of whom were the young and able bodied. Thousands of US Soldiers in France and Stateside Camps got sick and died with the first outbreak in the US coming at Ft Riley Kansas. Back then there was no mechanical ventilation nor antibiotics. So if you were blue from lack of oxygen you were put in the “you’re going to die line.” Back then the mortality was about 2.5-5% with anywhere from current estimates 50-100 million deaths world wide. In the United States it is estimated that 28% of the population was effected with between 500,000 and 675,000 fatalities. More than half the fatalities were in 20-40 age group.These were the “Flu virgins.” Regular Flu kills the elderly and young children, this Flu was different, it ate up the young and otherwise healthy people with no immunity.

With supportive care in the United States and other first world countries that will be significantly lower but still catastrophic. Estimates range to 2 million dead in the United States alone. Because we are a much more fluid society in the event of a real pandemic the government will have to take draconian measures. These will have to ensure that public safety limiting movement, deciding who gets vaccines first and who gets treated the most acutely with the coresponding reality that in a pandemic there will be people for whom the best you can do is palliative care. This will offend sensitivities of religious people, good hearted “secular” humanitarians as well as various political factions. Civil Libertarians will be outraged. Media goons and talk show hosts will rant against the government. Conspiracy theorists will come out in droves. Unfortunately if this outbreak becomes a epidemic or even a pandemic drastic actions may be required until the emergency passes. Marital Law may be an option. I’m not a big fan but if this gets really ugly it may have to happen.

I am an ICU chaplain. Really bad Pneumonia’s are a pain in the ass to treat for Intensivists and quite often exacerbate or cause cause problems in other organ systems. This flu and the Avian flu produce pneumonia’s in spades both viral and bacterial. In the Spanish Influenza it was the bacterial pneumonia’s that killed the most people. Through in ARDS, pulmonary edema and hemorrhages in the lungs. If you have ever been in an intensive care unit and seen a young person on a vent battling a pneumonia and barely hanging on to life then grab your seat. Lot’s of young people will die. Likewise there will not be enough ICU beds and ventilators to go around should this reach the pandemic stage. Resources will be short and physicians and government officials will have only bad and worse choices. Those in the front lines of the battle, young physicians, nurses and technicians will be among the casualties.

I am not privy to any plans of the Department of Homeland Security, Department of Defense or CDC. However, I am graduate of the USMC Command and Staff College. I am sure that both departments have been preparing for such case since the Avian flu started showing up in the 1990s, as well as the threat of terrorists using biological weapons post 9-11. Unfortunately there are some who would see what these agencies are doing to plan for a worst case scenario as some diabolical plot, a conspiracy theory to make the government more powerful. If fact there are some of the Keepers Of Odd Knowledge that are alleging a government plot to engineer such a virus. I have seen this from both left and right wing bloggers and I’m sure that their message will get out and cause people to act stupidly and jeopardize public health. In other words, they will damn everyone else, and do what I want even if it means that they spread a virus that will kill those around them. Sorry this is selfish, irresponsible and just plain idiotic. Prudence is the watchword.

On my way to the ball park I heard a radio talk show host talking about the “Napolitano Flu.” He was taking a shot at the Secretary of Homeland Security. Unfortunately for the millions of listeners this man and others like him will not take the threat seriously. I’m not going to say that there will be a pandemic with this outbreak. However, a pandemic is bound to happen and when, not if, it happens the blood of these people’s listeners will be on their hands. Ignorance and idiocy in encouraging stupidity is not a virtue even if you have valid criticisms of the way the government is handling the situation.

Anyway, those are my thoughts on this. I hope it goes away. I don’t want any of this to happen. Anyone with half a brain doesn’t want it to happen. However it will someday and maybe even with this strain. God I hope not.

Peace, Steve+

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Filed under healthcare, History, Military, Political Commentary

Tagged as 1918-1919 Spanish influenza, avian flu, department of defense, department of homeland security, icu, napolitano flu, swine flu, type a h1ni influenza

April 17, 2009 · 20:08

Long Goodbyes- Letting go when a parent has Alzheimer’s disease

jeff-dad-and-me-at-ca-capitol1 Better Times: Jeff, Dad and Me in front of California State Capitol around 1972-1973

We all hit times of transition in our lives. Sometimes these involves moves, job changes and relationship changes. However the hardest seem to be the passage of generations, especially when we see our parents passing away or in their final months. Alzheimer’s disease makes that process different, it’s not like a heart attack or stroke although strokes can have a similar effect, cancer or renal failure. Alzheimer’s takes the person that you knew away long before they die. It is the longest of goodbyes.

My dad has been diagnosed with Alzheimer’s for some time now. He has been going down bit by bit for the past several years. It started slow, in fact we didn’t initially notice it. He started not remembering things and having minor fender bender accidents which we found out about later. As he continued to go down his mental status, nervous behavior and lack of awareness increased. As this happened my mother tried to take care of him herself, she tried hard, but was unable to cope with him. Eventually she began to wear down. When he fell down and broke his arm in several places last year it was the beginning of the end for him, an end that is likely fast approaching. Since he broke his arm his mental status and physical condition have deteriorated significantly. Additionally his disease process has affected my mom, who has not taken care of herself the way that she should.

I saw him in the spring of 2007 just before I went to Iraq, and last year after my return from Iraq I made three visits to the California from my home in Virginia. I anticipate a trip out in the relatively near future. Neither my dad or my mom are the parents now that I grew up with, the disease has taken a toll on both of them. Of course we all think about the patient, but the closest caregiver is often worn down to nothing by the process. This has been a process of a long goodbye for all of us.

Diseases such as Alzheimer’s are hard to deal with. They are slow moving and because they are rob the person of who they are, difficult to watch. Those closest to them seldom realize what is happening until things start really getting weird. Such was the case with my mom. my dad was having auto accidents and other problems before his diagnosis. Before this dad was active, involved with community groups and an avid golfer. He loved all kinds of sports and to travel.

His deterioration has been most remarkable to me. This is perhaps due to my distance away from where my folks live. I don’t see him everyday. Thus when I go back my benchmark for how I see him is different than that of my mom and brother. I can see the major changes in every visit because of the distance. Likewise I can see the deterioration in my mother’s condition with each visit. I can see the toll that my dad’s disease has taken on her. She is not the same as she was even a few years ago.

Even though I am not in the same town, I am reminded of my parents on an almost daily basis. In my work in the ICU of a major Naval Medical center I get to spend time with a lot of people who are a lot like my folks. My parents are retired Navy, my dad retired as a Chief Petty Officer back in 1974. I am a quintessential “Navy Brat.” I grew up in it, I lived and guess that I still live for the adventure of military life. I find that there are a couple of major sub-groups of military brats. Those who loved it and somehow continue that type of lifestyle, and those who don’t and as soon as dad retires never look back. They never move again if they can help it. My brother is like that, he has remained and been very successful as a teacher, and now school principal in the town that we retired in. He has a wonderful family and it turns out that we are a lot more alike than we are different. I see a lot of this where I work. It seems that a good number of the patients and families that I get to know in our ICU are my parents generation. Their kids are often “Navy Brats” like me. We have a shared experience of life that you do not find in many other places. It is like we are family.

While I spend time with these folks, many going through end of life situations, I often see my parents. Every old retired Chief, or retired Chief’s wife reminds me of my folks. They remind me of the good times and the bad. They remind me that I am awaiting my time to be be at my parents bedsides, not as the Priest, but as the son. With every one of these visits I am back home. During clinical pastoral education training you are taught to recognize what is your stuff and what belongs to the patient and the family. I’m pretty good at doing this, but even recognizing this fact, the feelings can run pretty strong. Like the Romulan that I am I am not a big fan of emotion.

This is a long goodbye. Alzheimer’s ensures that you do not wake up and find that your parents died suddenly and unexpectedly. They die a little more every day. With each visit I have returned to my home and duty station wondering when I will hear that either mom or dad has passed away.

This week was hard. I got a call from the nursing supervisor of the place where my dad is being cared for. His condition has gotten worse, his weight is dropping rapidly, 10 pounds in the past month despite increases in diet and nutrition. The call came at a unusual time, when I saw the number I thought that it was the call that said he had passed away. The lady who called is an old high school classmate who not only is concerned about my dad but also my mom and she let me know that dad has lost 4 pounds in the last week. His doctor is surprised that he is still alive. He is down to 116 pounds, and even when I saw him at 130 last year he looked really bad.

We made the decision yesterday to make my dad a hospice patient. He will remain where he is, but will now will receive hospice care. The decision was another watershed. My brother and I both have known and made our peace with the fact that my dad is in his final months or maybe even days. The end is coming, and is sooner than it once was. It has been harder for my mom, I don’t know if she will recover, she had somehow hoped beyond hope that he would somehow regain himself.

The goodbyes to my dad have been said, but they are not finished. When that will be is still uncertain. Until that day things will remain in this no-man’s land between life and death. I know that there are millions of others going through similar situations and to them I say “you are not alone.”

Peace, Steve+

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Filed under alzheimer's disease, Loose thoughts and musings, Military

Tagged as alzheimer's disease, end of life, hospice care, icu, navy brat

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Don’t Mess With the Pig- The Swine Flu is no Joking Matter

Long Goodbyes- Letting go when a parent has Alzheimer’s disease

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