catapult magazine

catapult magazine

Vol 8, Num 5 :: 2009.02.27 — 2009.03.13


Love breaks through

For the past three-and-a-half years, 24 hours a week, I have primarily paid my rent by working in an oncology clinic in Portland, Oregon, mastering such tasks as filling out disability forms, creating spreadsheets, scheduling meetings, answering phones calls.  I currently sit at a mute-colored desk with a fancy, flat-screen computer, a black phone to my left with constant blinking lights and three lines filled with sappy hold music – and of course there’s the surplus of post-it notes at my fingertips.  To be sure, this is an excellent place to work, so as to pay said rent – I work with incredible people and just last week I moved from my old closet-y workspace, the one with disappointing leg room and the occasional waft of grease from the basement cafeteria, to an office down the hall with a witty office mate, expansive leg room and an actual window (with a view of Mt. St. Helens on clear days, no less).  One need not read very far to see that my relationship with the place is more than a bit complex, but it is in such complex relationships that we often make the most interesting observations about life and self, I think.

For me, the most significant observation I’ve encountered in this role as cancer clinic admin support really happened in the very beginning. Post-graduation, and having intended to take a break from the intense academic world of peace and justice studies (unbeknownst to many, peace studies endeavors often require one to look more intimately at the darkness and details of violence than anything else), I somehow ended up working in a place with people who were looking intimately at their own mortality and talking about the body as a source of clamoring disease and imploding cells.  An ironic choice, I suppose.

The observation I was struck with then was such a basic concept, but one that I’d unfortunately lost sight of.  That is that individuals have the vast capability to choose to love one another.  And especially in the face of impending death, one can find love most profoundly expressed between humans.  One could I suppose be constantly amid cancer patients and see only that implosion of health and body, see only the darkness of disease, but what I somehow (how, I am still not sure) was able to see instead was the way in which patients’ loved ones – spouses, lovers, siblings, neighbors, parents, children – surrounded them so fiercely.  Sadly enough, this struck me daily and still does at times.  The act of watching people use their body not as a weapon, but as a tool to nurture and care seemed a bit of a foreign exchange. I witnessed this unruly devotion and animalistic way humans are able to respond to the prospect of loss, and while I had spent the previous years studying and trying to understand human-induced violation, this place seemed oddly filled with violence’s antithesis: profound examples of love.

In this insight’s evolution, I also see that the love exchanged in these raw moments of disease is actually a living, breathing narrative.  Rather than some sort of beautiful snapshot in time that may fill us with hope, it is a story that is drawn out by time itself, shifting and changing to something always new, and as a member of a care team in this place I am very much in that narrative and am thus very much an agent of that narrative, as is every other staff member and clinician.  This recognition of agency changes things a bit I think.  It pushes us into their disease and death and requires us to contemplate more intentionally how we add to a narrative full of shalom, a narrative that carries that snapshot through.

However, the challenges that exist within any institution evolve with time as well.  Last year, the clinic was bought by a much larger hospital system and thus has grown exponentially.  The sheer fact that the group’s momentum has taken it to a larger system presents us with newer and even more difficult reflections I think.  Again, it’s back to the basics: that concept of system itself.  In growth and (apparent) progress, our practices of creating narratives of love for the ill shift a bit to accommodate that growth.  Maintaining efficiency and organization in a system with an increasing volume of staff, patients and paperwork often, if not inevitably, means shifting to something more bureaucratic, formalized and stringent.

One such example occurred in the midst of our most recent staff meeting.  The guest presenter was a very professional woman with the title “service excellence specialist,” there to discuss the basics of kindness and service. We as employees were asked to sign a contract stating that we’d read the glossy brochure handed out to us, a brochure filled with pretty color photos of happy people in lab coats and bullet-pointed statements such as, “I will welcome customers with a warm smile and a friendly introduction,” and “I will ask customers, ‘How may I help you?’”  We were instructed on things such as the details of greeting people in hallways: make eye contact at 20 feet, greet with a hello and warm smile at ten feet.

Perhaps it is my own culture shock during these trainings and meetings that leaves me so stricken.  Of note, it’s not that I disagree with its practice. I think it communicates the best of intentions and is frankly (and sadly) quite necessary.  It is the systematic recognition that we are agents of the patient’s narrative, but somehow I’m still struck by the reality of being and working in a context in which training on compassion as concrete as the instructions on how to fill out that disability form are so necessary.

Then again, this is the essence of system I think.  It is within these large systems that every single member of that living organism becomes a chart number or an employee number, and identity as a number inevitably changes relationships.  Only those at the top of that organism are embodied by something more human than the number, and even then their place on the pedestal leaves them misunderstood and often resented. Suddenly our patience for the “customer” grows thin, and our definition of a “good patient” becomes more and more narrow.  The patients, facing monumental news about their own mortality, grow weary and angry of being that number on our computer, and physicians, struggling with the new role as insurance-navigator that challenges their original intention in medicine, are often reasonably frustrated. One can quickly see the cyclical nature of these frustrated relationships. And so we combat this cycle with videos on kindness, basic trainings on compassion, brochures on what it means to serve people, and signed contracts promising our commitment to it all.

In the world of peace work the definitions of violence, nonviolence and shalom can be incredibly complex and extend to the far reaches of these systems, begging the question of how to create it, function in it (if at all) and still maintain the genuine mission that was placed there to begin with (although I fear that the answer realistically lies in asking people to pretend that the system they operate in doesn’t even exist, but that’s another story).  

Unfortunately and perhaps to your deep disappointment, I don’t currently possess the specific prescription for this diagnosis. Talk to me in another three years and I’m sure I’ll have it all figured out.  In the meantime I will offer this: again and again I seem return to that original narrative, the breathing story of love and my agency in it and while I work daily within the system I often critique, this constant return seems to ground me and challenges me to stay.  And again and again, my training and other occupation as a peace worker and healer leave me with constant reflection and friction about that narrative’s practice.  It is the narrative of that shalom we speak so passionately about, the narrative we’re constantly called to enter into, recognizing our role and agency. 

So perhaps it’s simply fair at this acute point to ask people, both “employee” and “customer” alike, to continually shift our lenses back to the narrative, to the story of people’s lives, to the gritty moments in which they learn what terminal means to the heart and to the place where that exchange of love is expansive and includes us all.

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