Preparation

The new semester is upon us and I am in Florida – seemingly side-tracked by a family member’s illness.  Prior to leaving, I was in a state of panic.  Was my syllabus ready?  Are the guest speakers scheduled?  Is the course website functional?  Do I have something coherent to say on the first day of class?  These questions were roiling around because essentially, upon my return, I will be “on” working with our incoming students on Monday afternoon and walking into my first class Tuesday at 9 a.m.  So as I was leaving the voice inside my head was shouting, “There’s no time to prepare when I get back.  It has to be completed now!”  And in fact it did get done.  The website is working.  The syllabus is complete.  The guest speakers are coming. And while here, I’ve been working on projects that were goals for the summer and keeping up to date on email, etc.  But, unknowingly, what  I’ve really been doing is preparing in more meaningful ways for course I’m about to teach.  This course is the Social Work Practice in Health Care course.  I’ve written about it before.  The material we cover and the experiences students bring to class are compelling.  And I am enriched by teaching it every year.

Hospitals and clinics are bustling places. There are schedules, goals, tasks, and life that must be juggled and prioritized by those who work there.  Likewise for families who are caregivers – there is school, work, groceries, laundry, and on and on. What a contrast – for the sick person, there is only time.  Time to be distracted from pain or discomfort by television or pain killers, time to remember the past, time to wonder about choices made and roads not taken, time to share stories and fears.  It is time when the “normal” cares of the day are meaningless but the cares of a lifetime are front and center.  In a word, it is sacred space, a place to confront and make peace, to mourn past losses, and remember past joys.  For the outsider being with someone who is ill presents a chance to be quiet, to learn to listen, and perhaps to learn things you did not know before.

On Tuesday, my students will come to class wanting to know what to do.  How to make a proper assessment, how collaborate effectively with an interdisciplinary team, how to interview in order to obtain all relevant information, how to get someone to do what they are supposed to in order to maintain or better their health status.  All worthy goals.  But what they really must learn is to listen and to enter in to the sacred space that illness creates.   Paradoxically it is the slowing down and the listening that will give them the answers for most everything else that they need to know how to do and then they will be able to execute those things with dispatch and efficiency.

So my time here, which I didn’t think I had time for, has reminded me of precisely what I will need to give to my new students – slowness, patience, tolerance for strong emotions, humor, and the respect for the sacred space that they may be allowed to enter into with those they serve.

Advertisements

Some Thoughts Following the Passage of Amendment One

For you non-North Carolinians, North Carolina has just passed an amendment to the state constitution banning same-sex marriage, domestic partnerships, etc. The amendment has far-reaching consequences for many families, not only GLBT families. A friend wrote in a hopeful post this morning that the fight over this amendment will bring about full equality much more quickly than having never had the fight at all. Because, through the lead-up to the vote, people have had to have conversations with their friends and neighbors and confront questions that they thought didn’t apply to them. This statement prompted me think about my own process surrounding GLBT issues – how I came confront them as a young person, how I integrated my support for GLBT individuals with my faith, the importance of all of it for my work, and perhaps, most importantly, how I confront these questions as a parent.
Growing up where and when I did, there was little need and no encouragement to think about GLBT issues at all. Other than occasional playground taunts directed at others, I remember very little discussion about people being gay or lesbian until late high school and then, there is only one conversation that I recall. Of course, that is very much in keeping with the time. HIV was just coming into the public conversation as I started college. And in our part of the world, it was HIV that forced straight people to actively confront their views of GLBT individuals. I remember being in my dorm room and hearing that Rock Hudson was HIV positive and recognizing that his disclosure was a turning point. A year or so later, a scandal rocked a church in my college town in which a married male pastor was found to have been having an affair with a young man in the church. That was the church you were supposed to go to when you were really serious about your faith. The pastor tearfully departed for “counseling” in Colorado with the goal of expunging his “demons” leaving many young people deeply disappointed and confused. I went to a different church and remember bringing up the situation in Sunday school. The teacher asked me the crucial question, “When did you decide that you were heterosexual?” I never went back to the Sunday school class. But I remembered the question, remembered I couldn’t answer it, and that paved the way for future learning.
Fast forward to my second year MSW field placement, at the NIH on the allergies and infectious diseases unit. On my first day my field instructor asked me, “How do you feel about working with people with AIDS?” Me: “I’m scared. We don’t know how it’s transmitted.” Field Instructor: “Mimi, we really do know. You can’t be scared if you’re going to do this work. ” Me: “Okay. I won’t be.” (You’re right. It was a little more involved than that but that’s the abridged version.)
Fast forward again, I’m working in inner city Baltimore in an adolescent health clinic where a girl explains her desire to continue a pregnancy that literally threatens her life by describing the taunts she receives about being lesbian and her belief that the pregnancy will prove she’s not. I did not know how to respond. Or, the young man in our clinic who was HIV positive. We assumed he was an IV drug user and that he was lying to us about his substance abuse. We never asked about his sexual orientation. So many people were in so much denial. But that same clinic had great people working in it, people that saw there were issues we were missing and brought in someone to talk with us about GLBT youth. This was a watershed moment for me. I finally got it and got that I could not sit by on the sidelines and “be neutral.” There is no neutral on people’s humanity. If I’m not affirming it, I’m diminishing it.
Next, I learned a high school friend was dying of AIDS. Like all of our high school gang, I had assumed he was gay from early in our college days forward. But I’d never talked to him to say, “You don’t have to pretend with me. Whoever you are is okay.” I watched as he brought young women to parties at my home when we both lived in Washington, D.C., while thinking, “I wish he knew he doesn’t have to do that.” But I didn’t say it – not until he was weeks away from death. Thankfully, I was given the opportunity to make that right.
So over time, I’ve become what some call a “straight ally.” When students ask me if they have to do readings about GLBT youth if they never plan to work with “them,” I smile and say yes while wondering, “Where exactly do you plan to work?” I’ve put my teaching evaluations at risk by allowing class discussions that become heated and supported doctoral students wanting to investigate questions related to the GLBT population. But perhaps most important is what this journey has done for my children. My sons, unlike so many in our society, do not have to grow up wondering whether their parents will accept them for whomever they turn out to be. And over time, I hope that they will spread this acceptance to their friends and if one of those friends is questioning he or she will know a family that will be supportive of them even if their own family is not.
There is a journey to take and it starts in different places for different people. It may start with me – telling my own story, supporting others in telling theirs, being compassionate as people struggle between their up-bringing and new information, yet standing strong in defense of the oppression of fellow citizens.

A Few Thoughts on a Great Book

Shortly after New Year’s I began reading one of “those” books, a book that sings and breaks your heart and now I am re-reading it, something I almost never do.  The book is Colum McCann’s “Let the Great World Spin.”  Although I have wanted to write and talk about it, I have yet to do so.  But today is Ash Wednesday and the book is about grief and redemption, grace and pain.  So here it goes…

The book is held together by the tightrope walk of Phillipe Petit, an event that has never held any particular fascination for me.  The idea of tightrope walking between the twin towers makes my heart race and my hands sweat.  It is not something I want to think about.   But McCann uses the event to weave many lives together, predict the future, and illuminate the truth of Ash Wednesday: we are dust and to dust we shall return.  In the meantime, we each walk our own tightropes in different ways and it is our compassion and that of others that allows grace to save us from a fall.

Corrigan is a monk who chooses to live in the burning Bronx of 1970’s New York.  His faith is quiet yet completely obvious to all with whom he comes in contact.  It almost seems as if his faith and the accompanying grace he bestows on others was given to him as a child and he could no more rid himself of it than he could his eye color, the shape of his brow, or any other in-born trait.  We meet him first and all the other characters and emotions that form the book spin out from his compassion and suffering.

Not long ago, the class I am currently teaching was spending time at the Ackland museum.  One of the objects that had been selected for us to look at was a photograph of someone jumping from one of the towers on 9/11.  At first, many of us did not know what we were looking at.  The jumper appears to be a bird or perhaps a skydiver.  And the angle of the picture is such that it takes several seconds before the viewer notices the smoke and fire in the far left of the picture.  The conversation that followed was poignant and difficult.  If our class was any indication, as a nation, we still do not have good ways to discuss this event or the grief and disappointment that stem from it.  Even within a class of nine we were on the brink of polarization very quickly.  As a teacher, I was tempted to jump in and “get us back on track.” However, I didn’t really know how to do that, so I took a deep breath and waited.  And, like the characters in McCann’s book, these students found a way to be generous, forgiving, and kind to one another.  Their ability to listen to one anothers perspective and experience allowed us to maintain the open, seeking dynamic that is very important to this class, in particular. It was a small moment of grace and it reminded me of the many moments of grace found in ordinary moments in McCann’s novel.

I’m still not sure I can talk about this book very well.  It is like a piece of music that makes your heart ache and soar at the same time.  If you read it, please tell me how it affects you.

Here’s a link to an interview with the author. http://www.nationalbook.org/nba2009_f_mccann_interv.html

No Child

Several nights ago I had a new, fun experience.  Playmakers, our local repertory company, called and asked if I would be part of a post-play panel discussion.  Loving live theater and feeling very excited, I instantly agreed even though there is truly no time for such things…  The play is called No Child. The author, Nilaja Sun, has been performing the show for five years to much critical acclaim.  In the show, she writes plays 17 characters all of whom are part of a fictional New York City public school in the Bronx.  The play brings the reality of teaching in an arts poor, inner city community to life in a way in which the audience is able to feel compassion for all of the characters.  There are no villains and no heroes – just people kids, adults, parents, administrators, teachers, students trying to do too much with too little, becoming discouraged, finding their voice, losing it again, and achieving moments of transcendence but not necessarily a lifetime of it.    It was not “Stand and Deliver,” where everyone aces the AP calculus test and the audience feels great.  The play was thought-provoking and left me thinking about what constitutes success in working in very difficult environments.

UNC is a “research one” university.  We want to find solutions to society’s “wicked problems” as our chancellor has referred to them.  To do so requires measurement rubrics, scales, pre and post-tests, randomized trials, etc., etc.  all of which are absolutely necessary to do good science.  But art, like this play, sometimes conveys what science cannot.  No Child is a “play within a play” about a teaching artist’s struggle to engage a class of inner city students in a six week effort to analyze and perform a play for their school.  We get to know and care about each of these exceedingly difficult teens as well as their regular classroom teachers and administrators along the way.  Through the small miracles that are a daily part of education, they do engage with the teaching artist and a play is produced – an outcome which seems unlikely at the start.  But what the play does not do is pretend that one positive experience will solve everything.  In the epilogue, the narrator provides a ‘what happened to whom’ kind of re-cap.  Only one or two of the characters has what we would call a “good” outcome.  One announces her too early pregnancy immediately following the play, another is killed a week later in a gang incident, and another is lost to the mean streets of his community.  Yet, they had all experienced a moment of transcendence, a moment in which they did something that they did not believe they could do, in which they learned something about themselves and connected their own lives to the wider human experience.   What is a moment like that worth?  Is it worth the cost of the grant that brought the teaching artist to the school?  Is it only worth it only if it lowers the drop-out rate or improves end of grade test scores?  Of course not.  Moments of transcendence make us more human, more compassionate, better citizens, better parents, better neighbors.  If we have enough of them, they may even affect those outcomes that science needs so much to demonstrate.  Toward the close of the play, the teen who tells her teacher of her pregnancy says something like, “Why are you crying?  Why does everybody cry when I tell them?  Don’t worry. I’m going to take my baby to see things and have adventures because you showed me I could.”   Is that enough to make the students’ play worth the blood, sweat, and tears, not to mention the resources, it took to produce it? To answer that question risks a reductionism that dehumanizes us.  But by putting science and art together, we may have a shot at those wicked problems that be-devil us.

A Post About Ghosts

The “ghostly book” is one of my seasonal favorites. An English professor here used to dress up in Victorian garb and read the story while members of the community drank cider at sat spell-bound listening. He has apparently retired. But listening to him perhaps prompted me to begin a similar tradition with my almost 11 year old son. We have read Dickens, A Christmas Carol, together for about the last four Christmas seasons. Skylar is an avid reader and finds pleasure in losing himself in a book, as long as we can keep him away from the infernal Ipad! So it is rare that I read aloud to him anymore and, in fact, I wondered what he would say when I made the offer of our annual tradition. But he gladly snuggled up and we began our journey into the world of Dickensian London, ghosts, and life lessons.
We heard from Jacob Marley last night… “It is required of every man that the spirit within him should walk abroad among his fellow-men, and travel far and wide; and if that spirit goes not forth in life, it is condemned to do so after death. It is doomed to wander through the world and witness what it cannot share, but might have shared on earth, and turned to happiness…My spirit never walked beyond our counting house.” And then, “I wear the chain I forged in life. I made it link by link, and yard by yard; I girded it on of my own free will, and of my own free will I wore it.” I can’t help but wonder every year as we read this story, is my spirit walking far and wide enough, what chain exactly am I forging, am I sharing in the human condition to the extent I am able and turning difficulty into happiness? There is truly so much to do and it feels overwhelming much of the time. Can one person really be of much use? The paper daily provides a litany of miseries that need attention. Just walking up the main street of our small college town finds plenty of opportunities for acts of compassion small and large. Every good cause asks for money this time of year – how to choose when one’s own resources feel limited in light of no raises for multiple years, and whatever other good excuses we make.
And what about the hospitality we extend to our family and friends? Skylar has been assigned the project of writing his autobiography over the course of the next few months. As part of his chapter on his immediate family, I asked him if he could identify some sort of adjective or theme that would define our family. I can’t do it but I can do it for other families. Two are welcoming families, always including people in various celebrations, cooking for both family insiders and outsiders, to the point that it is hard not to feel like a part of those families. And it always seems easy, effortless. I can’t say we are like that – although I admire that in them. Another is a close family – close to those in the nucleus of the family and close to the extended family. Most weekends seem to include activities with some member or multiple members of the extended family.  That family places a high value on spending time with all its members. Again, we love our extended family but we are not like that either. Another family may be athletic, another fun loving, another might seem sad, another mysterious, another high achieving, and another nurturing. Who are we? I truly have no idea. I’ll let you know what he comes up with…
Jacob Marley raises all of these questions for me because he demonstrates that we don’t know what we’re doing most of the time and we don’t know what we’re missing. We are caught up in looking down, unknowingly forging our chains. Taking a moment during a busy season to reflect seems like the least I can do to avoid Jacob Marley’s fate. I’ll close with his words in case you don’t have time to read them for yourself,
“Oh! Captive, bound, and double-ironed,” cried the phantom, “ not to know that ages of incessant labour by immortal creatures for this earth must pass into eternity before the good of which it is susceptible is all developed. Not to know that any Christian spirit working kindly in its little sphere, whatever it may be, will find its mortal life too short for its vast means of usefulness. Not to know that no space of regret can make amends for one life’s opportunity missed!”
So although there may be other opportunities I will miss, tonight Skylar and I will commune with the first spirit. Perhaps you’ll join us.

Last Class

Last week I was walking to my health care practice class and ran into my dean. We chatted for a few minutes and I told him I was about to do a class on grief which always felt not quite right. Spending three hours, one class day talking about a subject that permeates work in health care seems a little weird, redundant, perfunctory, etc. and I told my students as much at the beginning of class. But onward we went and with this group, nothing is perfunctory or redundant. They are thoughtful, reflective new social workers and so basically everything I am supposed to teach, teaches itself through their insights and discussion.
In the course of our three hour class, the conversation took an interesting turn which I’ve been reflecting upon ever since. One student talked about recent experiences in her intensive care field placement that had shaken her. The sudden death of teenager, the realization that a child with cancer will likely not survive until the fall and her awareness of how she was changed by these experiences – changed in ways that are hard to talk about and permanent. Many of us are lucky to reach adulthood not having to confront the profound spiritual and philosophical questions that arise in the face of severe crisis, loss, and grief. When we enter this line of work, as a doctor, a social worker, a nurse, or other health care professional, our illusions about safety and control are quickly shattered. At that point we must make a critical choice. In a follow-up journal, this student wrote that she sought counsel from another professional about how to live with what she was feeling. The person told her that over time and more exposure she would become “desensitized” to these experiences and it would not be so difficult. I cringed when I read this and a memory from my own early days in the field came flooding back.
My second year field placement brought me in contact with a five year old boy from overseas. He was desperately ill and in the U.S. seeking last ditch experimental treatments. I was 23 and remember the absolute shock of first meeting him. He had been in bed for year, not outside for year, and had to go through painful treatments every afternoon that left the halls of the unit echoing with his screams. He was also full of life and mischief and managed to give everyone on that unit a run for their money. His parents were interesting and kind. They let me into their experience for what reason I’ll never know. In the time that I knew him, things got better. His father and I snuck him outside in his hospital bed to see squirrels and stars after CT scans. The medical team got on board and he got to go outside most days, IV poles and all. But his condition was not curable and things got worse, then still worse, and he died. Everyone involved was devastated, relieved, conflicted, angry, and sad. I grieve him still.
Several months after his death, I was working in my first “real” job in an emergency room in a different hospital but one that had been involved in a consulting basis in this little boy’s treatment. His parents were there for some follow-up meetings with doctors and called me for coffee. We sat outside and talked about their son, my new job, etc. I rambled on about this and that and said something about my supervisor helping me learn about keeping professional distance, not letting the situations I was involved in overtake me, etc. etc. The father paused and looked at me with a penetrating, almost stern stare, and in accented English said, “Don’t learn that. Whatever you do don’t learn that.” At the time, I thought, “maybe he doesn’t understand exactly what I’m saying. Or maybe he doesn’t know what I’m dealing with every day in the ER.” But, of course, he knew exactly and that is precisely why I cringed when I read the advice given to this student. I want her to be able to do this work and be able to experience the joys and happiness that life offers. But if she is “desensitized” to the sorrow she sees in her work, she will be desensitized everywhere. She will suffer and so will her clients. It is a strange and difficult balance to find ways to fill up our own wells so that we can pour the water out again for others. And the struggle to allow ourselves to be changed but not desensitized is on-going not something that can be answered in a three hour class session, a semester, or a year. Indeed, it is a challenge for a lifetime.

A Morning with Chinese Students

This morning I had the good fortune to spend time with Chinese MSW students. A professor here invited me to talk with his class. I did a formal presentation but, as is often the case here, I had to go a bit off message because there are so many questions about differences between the U.S. and China.

The hardest question, of course, concerned child protection. In China at the moment child protection systems only serve children who are abandoned. There is no clear definition of maltreatment and no system to deal with it, even if there was. Students here apparently hear about situations in which Asians from many countries move to western countries and run afoul of child welfare authorities because of child-rearing choices that are considered maltreatment in the host country are ostensibly acceptable ways of discipline in the home countries. The students asked how social workers in the U.S. negotiate these divergent views. This is a question that I dread. I was first asked something similar when I was a new professor. An adult MSW student from another country, not an Asian country, stated, in the course of a class discussion that as a young child she had stolen something and had had her hand burned on the stove as punishment. She stated emphatically that this was not abuse but a common cultural practice and that she maintained a close relationship with the family member that burned her. As a new teacher, this was a moment of horror. In addition to terrible image of a child being deliberately burned, there was the implicit challenge in the statement from the student to which I needed to respond. Breathe, feel, think, speak. Another student in the class expressed deep sympathy for what had happened to her, giving me the space to think how to approach her statement. What might the consequences of a burn to the hand be – infection, nerve damage, loss of mobility? How would someone know whether they had burned too much or too little? How angry would a caregiver have to be to do that? Does true discipline come out of anger? If discipline is teaching, what was this practice teaching? Is that what every parent in that country did or were there some families that would have chosen some other method to teach their child not to steal? My husband, the lawyer, does not find all of this as complicated. You live in a particular country, you abide by its rules. But in the social work role, it is complicated. We spend a lot of time thinking and talking about cultural competence but what does that mean in the child welfare context? Is the same behavior maltreatment if you are American and a cultural difference if you’re not? And if I’m a social worker tasked with intervening, how do I demonstrate respect for cultural difference even as I say that particular behaviors cannot stand? There are no easy answers accept the simple ones: breathe and take time to listen; feel and find compassion, it really is so hard to be a parent; think, use your education; then speak honestly and say what needs to be said.