Interview on Seekers of Meaning: Jewish Sacred Aging Podcast

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I had the recent fortune of being interviewed by Rabbi Dr. Richard Address for his Jewish Sacred Aging Podcast, Seekers of Meaning. I am proud of having been offered this opportunity to share a little of what is in my mind about Chaplaincy, spirituality, and my personal experiences within the profession both in general and during COVID-19.

Reflecting on Yom Kippur during COVID-19

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As we are in the middle of the period between the Jewish new year, Rosh Hashanah, and the Day of Atonement, Yom Kippur, I find that it is a unique time of reflecting on the rights and wrongs we have done, not just in our “normal” lives but in how we have and continue to react to the COVID-19 pandemic. It is a time of reevaluation, taking stock, finding a place of gratitude for where we have been and where we are while also looking to figure out where we want to be.

On Yom Kippur, the liturgy includes a communal confession, with a series of lines in which we say, “On the sin which we sinned before you regarding…” Following in this same vein, Dr. Erica Brown offers a COVID-19 viddui (confessional prayer), which I found compelling and comforting. Let me just share a few of the lines and suggest reading the whole litany here.

For the sin of living at work instead of working from home.

For the sin of impatience with myself.

For the sin of impatience with those I love.

For the sin of impatience with those I do not love.

For the sin of judging those who are less fastidious than me about COVID as careless and those who are more fastidious as fanatics.

For the sin of not letting others be vulnerable.

For the sin of letting go of the structures that keep me whole.

For the sin of not being kind to myself.

For the sin of not being kind to others.

For the sin of having too rigid a schedule.

For the sin of having no schedule.

For the sin of calling this is the new normal when it’s really the new abnormal.

For the sin of thinking this will never end.

Put Your Mask On First – Self Care modeling

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Actions speak louder than words. During this time of continuous stress and trauma, it is not enough for us to speak about the importance of self-care. We need to show the importance of self-care. Granted, this is easier said than done. Yet I believe those in positions of leadership need to be the first to say, take a break and don’t feel guilty about it. Take a break and breathe so that you can be more present at work. This morning, I came across a post, Memo to Managers: The Importance of Putting Our Masks on First which presented the importance of exemplifying the importance of self-care through the metaphor of putting on one’s oxygen mask first during and emergency on an airplane. As an aside, I have always wondered about the ethics behind deciding on putting one’s mask on before assisting someone else, but I leave that to the philosophers among you.

The post’s author Micol Zimmerman Burkeman, suggests that we refocus our energies to get better at caring for ourselves as an outgrowth of how well we tend to care for our communities.

In my time both serving as a Jewish educator and in my role as a coach and consultant, there are two incontrovertible facts I have learned about Jewish professionals. 

1. We care deeply for our communities

2. We do a lousy job of caring deeply about ourselves.

In order to overcome this, she suggests:

There is, however, an absolute truth about employee self-care in the workplace: when a manager prioritizes self-care, both for their team and for themselves, employees are more likely to participate in it and prioritize it. This will in turn result in a more productive, more invested and more motivated team. 

If a leader can show the importance of caring for oneself as a way of caring for others, people follow right behind and will feel permitted to do the same. Of the suggestions offered in this piece, I just want to highlight one as a focus for those in positions of leadership or for those seen as examplars:

This is an extremely trying time for everyone. No one has escaped the impact of the pandemic, whether the effect has been large or small. Staff need compassion now more than ever. They need to be reminded that their organization cares about them and not just their work. Leading with compassion and empathy could not be more important. When leaders at Disney are asked about the secret behind their exceptional customer service, their answer is simple: “One thing we know at Disney is that the extent to which you genuinely care for your people is the extent to which they will care for your customers – and each other.” Sometimes the most simple truths are the most profound. The more you care for your employees, the more they will care for their community. Schedule time for regular check-ins. Ask staff how they are doing before asking about their work, and actively listen. Follow up on anything they’ve shared. Model compassion and empathy and your team will follow, and they will thrive. 

As we continue through this marathon of chaotic times, may each of us find a place to be compassionate to ourselves and by extension to all whom we serve and work with.

Personal Reflection on Sound

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As my phone chimed this morning with an email received, I noticed my reaction. Since the pandemic, I have noticed that there are many times when I hear the chime of an email, I jump and I feel a quickening of my heart, thinking the email is something bad. Of course, it was just a regular email exchange. Yet, I find myself often reacting like this since the daily bombardment of illness and death emails I was receiving during the earlier days of the COVID – 19 pandemic.

As we continue to either slowly emerge from the COVID-19 pandemic quarantine or find ourselves in the midst of it, it is important to focus on how we react to things that are “normal.” By knowing what is now triggering negative reactions, such as how my email chime raises my anxiety slightly, and knowing why, we might be able to over time learn to recognize that the fears are of the past and not of the present. We know these reactions are not easy to overcome, yet we can at least be more mindful and conscious of them.

Praying for healing during a Pandemic

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Faith based traditions have prayers for the ill that focus on praying for healing. This term, healing, is fraught with assumptions. While there is a value to hope in the face of illness and death, there is also the inevitability that we will not recover from all illness and that death will occur eventually. As such, how do we use the word healing in regards to the chronic illness or death. For spiritual care providers, this question arises on a daily basis. In the Jewish prayer for healing, the Mi Sheberach, there is a request for both physical and spiritual healing. In reflecting on this prayer, often the answer is we are praying for the potential hope of some healing, whether physical or spiritual, regardless of the ultimate outcome. In a recent article in Tablet Magazine, A Prayer for Pandemic Times, Allison Lerman-Gluck presents a perspective on this prayer from her own living experience dealing with chronic illness.

Now, during the global pandemic, the world around me is suffering from illness with no full recovery in sight, and many people are expressing feelings of helplessness. These are big feelings, and the question at the core of them is profound: How can you hope to recover when the illness facing you has no cure?

Living with chronic illness, I have some experience with taking ownership over these big feelings and learning what it means to heal, even when the wound remains open.

The comparison of chronic illness to a virus with no immediate cure is powerful. Within both, the need for “healing” may very well be more spiritual and psychosocial than physical, at least from the standpoint of not having cure. How does one grasp with the permanence of limitations and refocus the words of healing prayers?

Through reclamation of the word “healing,” I’ve been able to take back the Misheberach. I learned from my chronically ill community about the “spoon theory,” which provides a device for explaining our minute-to-minute physical and mental statuses and abilities. This taught me that healing is a daily journey with mountainous valleys and peaks, and that my goal is not total physical wellness. My goals are acceptance, with a healthy dose of motivation to take the best care of my body and mind.

I also want to reframe the idea that a return to able-bodiedness is a necessary finish line for the journey of healing. We all deserve the type of care that people emit when saying healing prayers. I hope that shining that light of loving attention on chronically ill people leads to further action on the part of able-bodied, well people. If you’re saying the same prayer for someone, week after week, how long will you keep saying it? How long will you remember them? And what can you do as a tangible act of support for them after you say the prayer? Being well-thought about is a form of healing from societal ableism.

Healing is a journey like all journeys, with peaks and valleys. In reflecting on this idea, I am mindful of my own chronic ailment, gout, that comes and goes. Most of the time it is an academic ailment that exists but is not experienced. Yet, when gout hits, it reminds me very clearly of its existence as a part of my life. While not the same as more regularly invasive chronic illnesses, it is always lurking, waiting. As such, I hope for continued sense of “healing.”

In regard to the current pandemic, while COVID-19 is an acute illness:

But on a societal level, the pandemic is a chronic condition: There is no known cure. There is no vaccine. There are no tried and true treatments. There is a big difference between having an acute illness that affects just you, and possibly your family, and having an illness that will affect the whole world, at different times, potentially over years and years. This is an illness that has shut down our economy, shone light on deep structural racism and economic inequity, and kept many of us inside, scared, lonely, with our lives shaken to their core. Physical healing will come for many who get sick during this time. But this is a pandemic that has no end in sight. Our societal healing has barely just begun, as we start to mourn the lives lost, even as more lives are lost still. Looking toward the future does not bring relief. There will be more illness, more loss, more death, global instability, loss of income, loss of health care, iniquity and oppression on a wide scale.

It can feel pointless to pray for healing when there is currently no definitive end in sight to the illness and suffering all around us. But it is not pointless.

And what are we praying for:

Healing comes in many forms. Here are some of mine: For me, healing means accepting my limitations but also knowing my strengths, and celebrating both, because they contribute to the holiness of my body and spirit. Healing means finding solidarity with others who live with chronic illness and disability, through the silliness of sharing memes or through the quietness of telling someone “I see you” when they’re bed-bound in a darkened room, and they cannot see themselves. Healing means surrounding myself with people who are able to meet me exactly where I am each day and cutting out the people who say things like “you’re too young to be this sick” or “but you don’t look sick.” Healing means taking in every good moment as a blessing, and holding on to those blessings for all the bad moments still to come. Sometimes, healing means sitting with a hard moment and really seeing it, really experiencing it, not trying to distract myself from it. And healing means action, working for change when structural inequity is revealed, because all oppressions are connected, and our liberation is bound together.

We find ourselves praying for the small healings of the moment. We pray for people to recover, for people to find spiritual strength, healing of the soul of society, etc. The healing we are looking for is a return to the lives we lived, recognizing it might not be the same but hoping some things can return to a semblance of “normalcy.”

To conclude, the author shares her version of the Misheberach adjusted for this moment

Misheberach translates to “the one who blessed.” May the one who blessed our ancestors bless and heal those who are sick, suffering, and dying. May the one who blessed our ancestors give me strength to continue on, day by day, one foot in front of the next, with my intention set on doing everything within my power to contribute to the process of global healing. May that healing come in whatever forms are most needed. May we all be blessed. And let us say: Amen.

As we continue to adjust to the changes during the next phase of our confronting COVID-19, let these words be a guide, a refocus on taking things as they come and hoping each step we take leads to our healing.

How to Support Mental Health in COVID First Responders

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I want to bring people’s attention to an interview conducted with Director Deborah Marin, Professor of Psychiatry and also Director of the Center for Spirituality and Health, of the Mount Sinai Health System. This interview describes her observations about the mental health of those in her system as observed during the COVID-19 pandemic.

Some observations based on the interview:

It felt not the way we like to practice medicine. We’re very high-tech but we’re very high-touch, too. We like to hold people’s hands and check on people, and chaplains love to speak to patients. Yet so much was done by telehealth.

As we know, COVID-19 has forced everyone to try new approaches in care. We are fortunate to have the capabilities for telehealth, yet as observed, there is an inherent challenge in not being able to be as personally connected.

We know that a large percentage of folks are experiencing grief, sadness, loss, and anxiety. Anxiety not just about getting sick but about getting loved ones sick. People are also feeling depressed and showing signs of PTSD. 

I can say I have felt all these emotions throughout these months. Being witness to illness and death on a constant basis, not within a hospital, but within a senior care facility, raised these emotions in an acute way. The challenge throughout was not feeling I had a haven. Usually, facing death and dying is something that can remain in the health care environment of one’s profession. One way to recognize burnout is when it encroaches on one’s personal life. During the pandemic, these two aspects, the personal and the professional, blended together.

People were also redeployed. In our cardiovascular institute, for example, people typically come in, get stents and get bypasses, recover, and go home. Our first COVID unit was our cardiac care unit, where it became medical intensive care units with such sick people. That’s jarring for health care workers. Their roles changed. They were no longer doing things they were used to doing.

We have been stretched to adapt and be flexible with how we work and how we interact. To have a forced role change that doesn’t feel temporary can be traumatic unto itself. People go from being experts to being novices in an instant. It is important to rely on the basics of one’s profession and recognize one’s limitations.

The other challenging aspect is that health care workers have so many other issues going on. Work-life balance has been disrupted, schools have been closed. People wonder, “Am I available enough for my kid? How am I going to get my job done?” 

A common challenge is finding balance in work and life. How much more so when everything is out of sync and where the normal support systems cannot be tapped into.

An important issue right now is to let people know things they can do to help themselves and others and find meaning. There can be growth after these events, when people realize that they’re problem-solvers or they did something they never thought they could do. Thoughts like: “I didn’t know I had it in me.” There’s a lot of meaning-making happening.

Yet, with all the challenges and traumas, most have preserved so far. We have learned to adapt and found growth in the midst of the pain. While we are not out of the woods yet with this pandemic, there is much to absorb and learn on a day to day basis.

Engaging and accepting the Paradox

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These past three months have raised complex and often contradictory feelings in our hearts. Whenever we find ourselves in crisis or in grief, we find a multiplicity of emotions washing over us at the same time. For example, at the time of death, I will often hear family members speak about feeling relief in the person no longer suffering while also shedding tears at the same time. In a piece posted on eJewishphilanthropy, I am Doing, I am Still, we are presented with similar paradoxical feelings about the quarantine through the eyes of a high school Junior.

The best way to describe my quarantine is “a paradox prayer,” a phrase I’m borrowing from a friend, Chloe Zelkha, who leads Avodat Lev (service of the heart), a virtual space of prayer, poetry, and groundedness. Inspired by Rabbi Simcha Bunim, one of the founders of Hasidism, Chloe recently asked, “If you were carrying two slips of paper in your pocket, two opposite truths that tell the story of a big both/and coming up for you in this moment, what might they say?”

The responses were varied and moving. They reflect how many of us are feeling.

“To be alive at this time is terrifying // to be alive at this time is inspiring.”

“This too shall pass // this will have lasting impacts.”

“We are safe // we are vulnerable.”

“It is okay to be happy // it is okay to be sad.”

“I am strong // I need help.”

“It is time for vigilance // it is time for ease.”

“It is too much to hold // my heart has infinite capacity.”

I am struck by how much these thoughts are underlying the lived experience for so many of us at the moment. I believe that in reflecting on the above question posed, to carry around opposite truths as both/and, we can learn to better engage with our hearts and further care for ourselves.

Time

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I want to share a piece I read that focuses in on our perspective of time, Mental Health Musings… by Carly Namdar. The piece focuses on different perceptions of time she experiences in our current climate.

The first point is how we have been forced to reconfigure how we mark milestones and time.

Some say we’ve been robbed of the milestones we thought we were going to have, while others have altered their expectations and pivoted creatively to turn celebrations into smaller, more meaningful experiences. I’ve read so many posts about making the moments at home count, savoring the time we have now and considering what is within our circles of control, while others are preaching that productivity is not the yardstick by which we should be measuring our progress.

I have found myself reflecting on this with regard to funerals and grieving. With the changes in how we remember the recently deceased, how we bury someone and the lost opportunities for fulfilling time-honored rituals in the usual manners, what are the moments like. Can we create quality over quantity? In funerals I have officiated it, my message is quality. With smaller groups, the service is more intimate and I believe allows for a deeper connection to the memory of the deceased. Families have opportunity to reflect and share, laugh and cry in a less formal way than if it is a large gathering. The value is in the reframing of the time spent.

Beyond the marking of milestones, we are left asking how we are using time. What changes to our life schedule have we been able to make, perhaps forced to make and is it working? What are the difficulties we experience in the day to day with all the changes?

A little further down, the author describes how her watch stops as a metaphor for her perspective on time.

My watch just stops, out of the blue, all the time. I take it off my wrist, leave it untouched and sure enough, it starts working again if I just leave it alone. I’ve heard about theories of excess electricity and magnetism in the body that can actually slow a watch down or make it stop altogether. Sometimes I wonder if G-d is sending me a sign to scale things back, wind myself down and focus on the present, or forget about the time that’s ticking away … sometimes we may just need to tune in more to our own messages with compassion and acceptance, so that we can give of ourselves to others, and take a mindful step away from our technology.

This picture of the watch stopping and restarting is a powerful one in helping us think through how we use time in general. Can we pause and restart? And when we restart, will we remember how we felt about time during these critical moments?

Trust

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All strong relationships need to be built on trust. Can I trust someone to listen to me, care about me and not take advantage of me? Can I trust someone with my vulnerabilities? How do we build trust beyond individuals, trusting communities, institutions, information? Will they accept MY story even when it isn’t “truth?” These questions have been weighing heavily on me.

In searching for how to build trust, here is a one list, based on an article from Psychology Today, 7 Ways to Build Trust in a Relationship:

  1. Say what you mean, and mean what you say. …
  2. Be vulnerable — gradually. …
  3. Remember the role of respect. …
  4. Give the benefit of the doubt. …
  5. Express your feelings functionally, especially when it’s tough. …
  6. Take a risk together. …
  7. Be willing to give as well as receive.

Do we listen? Are we vulnerable and uncomfortable? Are we willing to work to build trust? I have no answers, just many questions.

We’re Not Ready for This Kind of Grief

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I am working on a presentation that ties in the topic of general grief and mourning with grieving during a pandemic. In researching the specific pieces on complicated grief resulting from a pandemic, I came across this article from the Atlantic magazine, “We’re Not Ready for This Kind of Grief: The coronavirus pandemic will leave lasting emotional scars (warning – Atlantic only allows up to 5 free reads a month).” This article was written in April, in the midst of the peak period of COVID-19 in the US.

To begin with, for those of us on the medical front lines, we can well imagine that the grief we are experiencing is similar to wartime grief. As the author offers:

According to my mother, there are two unique forms of grief that everyone touched by war understands. There’s the grief associated with the loss of human life—through bombings and brutal combat, and through the disease that runs rampant when health care and all other social services are halted. Then there’s the grief associated with the loss of a life as we once knew it: loss of country, loss of employment, loss of identity as a “prewar person,” and the subsequent need to start over. The two run along together like two dark snakes intertwined.

We are experiencing little that was like it was before. We are pained, traumatized, exposed to death and exposed to other losses simultaneously. We are overwhelmed by the pain this creates, even when we don’t recognize we are in pain.

All of this damage is occurring while people are still dying from other causes, too—and when grieving people are being discouraged from even going outside, much less seeking solace from their loved ones. Making matters worse, the current crisis has put enormous stress on the healing professions that, in normal times, help families deal with loss and bereavement. Our society is ill-prepared for the kind of grief the coronavirus is visiting upon so many people during so short a span.

Death and loss is occurring all around us. It effects everyone and harms those trained to be the healers and ones who help others. We are all in this together and continue to be. While the grief surrounding a pandemic are not fully comparable, some of the following points from previous mass casualty grief studies can offer perspective and what to look out for.

Research on grief after large-scale casualties is scant, but the literature suggests that suffering personal losses can be particularly harmful when experienced in times of broader social stress. A 2015 study found that children who lost a loved one during a mass-trauma event such as a natural disaster, a terrorist attack, or a war are likely to suffer long-term psychological trouble. Studies of service members and veterans who served during 9/11 found a high prevalence of what is sometimes called complicated grief—a type of bereavement that is unusually severe and long-lasting. These service members and veterans showed worse symptoms of post-traumatic stress disorder and had a higher number of lifetime suicide attempts.

A study of survivors of the Rwandan genocide found that what the researcher called “unprocessed mourning”—in part the result of the halting of traditional mourning rituals during the war—contributed to lingering mental-health woes. Two years after the 2004 Indian Ocean tsunami, chronic grief was found in almost half the survivors, and was strongly associated with losing a spouse or being female. And a systematic review of Ebola survivors found high levels of psychological distress, including prolonged grief, which was compounded by the stigma placed both on survivors and their families as they attempted to return to work.

As is clear, there is an increased likelihood of complicated grief because of the increased stressors or because of “unprocessed mourning.” I wonder if the moving of mourning rituals to Zoom changes some of this sense of unprocessed mourning.

For those in healthcare, pandemics can be a particular challenge. Normally, we all have tools and methods for coping with death and know when we have reached our emotional limits. But these are not normal times and for many, there is no time for a break (or at least we don’t perceive we have time for a break. Furthermore,

Before the coronavirus, the ethos of humanism—of listening closely to patients’ concerns and fears and tending to their needs—had never been stronger in the medical profession. The pandemic returns doctors to a time when compartmentalizing a patient’s suffering—and one’s own—is an emotional survival tool. “We’re asked to be as dispassionate as the disease itself,” Daniel Lakoff, an emergency-room doctor in New York City, recently told me. “We don’t touch the patient in many cases, we use telemedicine, we give oxygen, and we watch and wait. And we often feel powerless.”

How we render care for others has changed for all medical disciplines. In chaplaincy, so much work has become remote or at the very least, with PPE, we have created increased perceived distance between us and the people we care for. We are all in pain and grieving.

Finally,

Claire bidwell smith, a counselor in Charleston, South Carolina, who has written three books on grief, told me that these recent weeks have been the busiest of her decade-long career. (She offers her services online.) She raises the possibility that grief may play out differently during this pandemic from how most people typically experience it. Usually grief feels very personal, Smith says, because the rest of the world proceeds normally while the bereaved feels numb and alone. That dynamic may change because much of the world has now ground to a halt. Grief may be delayed, she said, but a shared catharsis may lie ahead. “I think there will be a massive collective mourning when we’ve emerged from this, for us as a culture,” Smith said. “While what’s happening is heartbreaking, and we haven’t been able to ritualize or memorialize. We will come back to this.”

We have only begun to grieve, if that. We are feeling the pain of all the losses but have we processed them yet. Do we recognize the long and hard road ahead of us? This article offers us a chance to reflect and contemplate were we are currently and understand the challenges that still lay ahead.

For some other resources I found in researching online, see:

Grief During the COVID-19 Pandemic: Considerations for
Palliative Care Providers

Coping with Grief and Loss – Mourning the Changes since COVID-19

Therapeutic Response to Trauma and Loss
in the COVID-19 Pandemic

Grief Following Patient Deaths During COVID-19
Tips for Healthcare Workers in Managing Grief

Ambiguous Loss:
Grief in the Time of COVID-19