Teaching Hospital Caste System

Lions and tigers and bears?

No…

Medical students, interns, and residents, oh my!

What in the glory is a Fellow (and should I allow her to treat my daughter) and where in the hell is the Attending, anyway?

(See Maternal Coat & I Was The Mamma to read more about why these questions became so important to my family in the care of The Oldest Girl.)

Medical students are persons still attending medical school who have yet to earn their Medical Degrees.  In their third year of a four-year program, medical students rotate through the different medical services of the hospital to learn the rudiments of case management and to become familiar with the different areas of medicine so that they can choose their specialization.  Much like a simulation model, medical students are on the floors to get an idea of patient care and to practice writing orders, but they are not directly responsible for patient care. After graduation from medical school, doctors earn their M.D.s, elect their area of specialization and enter a three-year residency program.  The first year of this program is called the intern year.  Interns are primarily responsible for patient care.  During the second and third year of residency, doctors are referred to as residents and follow patient care while being directly responsible for the supervision of interns.  After completion of their residency programs, most doctors begin to practice in their field, like pediatrics, gynecology, or family medicine.  Others decide to pursue advanced training in an area of specialization like pediatric cardiology. Referred to as fellows, these physicians enter a three-year educational program.  Fellows oversee patient care and resident training while developing their expertise in a medical specialty.  Attendings are the doctors at the top of the hospital medical caste system.  They are ultimately responsible for the care a patient receives and directly supervise the residents.  Attendings are not only teachers in this capacity, many also hold teaching posts in the medical school associated with their hospital.  Although the nuances of this medical training hierarchy makes for good television, it also increases the volume of people and amount of repetition and stress with which a family or patient must tolerate.  It took over two days for me to learn the answer to the question I had asked myself during The Oldest Girl’s test. How many cardiologists does it takes to read an echo?  It takes only one, maybe two if s/he calls for a collegial consult as was done in The Oldest Girl’s case.  Not only were all the other doctors who were in the room not cardiologists, they were there as much for their own training as my daughter’s care.

This answer demanded that I ask more questions.  The Oldest Girl had lain on her back crying for hours during the echocardiogram.  Her screams of protest echoed cannon-like in my head.  The number of people in the room did not necessarily increase her discomfort, but it did raise my own.  I felt like a carnival sideshow.  A phantom carney’s voice mocked me, “Step right up Ladies and Gentlemen.  See the world’s most incompetent mom’s inability to comfort her daughter in her hour of need.  Witness her desperate attempts to quiet her with her breasts.  Listen to her voice crack as she tries to sing consolation.  See her doctors’ frustration as they wrestle a tough diagnosis.  Watch the dramatic events unfold as they happen.  It’s all included in the price of tuition.”  Our privacy had not been invaded in the traditional sense.  Nosey neighbors had not peered through the slats of their venetian blinds to catch a moment of impropriety.  It was instead an intrusion of one system upon another, in this case the hospital machinery upon the already strained dynamic of my family.  Again a sense of double reality distorted my attention.  On one hand, The Oldest Girl’s doctors needed me calm and focused.  I was their best conduit of information about her condition, its onset and its progression.  I was the keeper of her history, the only one who could report the events they needed to hear.  On the other hand, the teaching hospital’s system and multiple layers of caregivers taxed my composure and distracted me.  I knew I had to organize a plan to secure as much of my strength and energy as could be safeguarded.  This made me keenly aware that I had to actively investigate my rights to secure my role as a member of The Oldest Girl’s team of caregivers.  I needed a plan to guarantee that only the best, most qualified doctors provided her care, regardless of the medical training hierarchy.  And I had a deadline.  The Oldest Girl was scheduled for a heart cath and possible surgery.  Oldest Girl was fighting for her life.

My fight was to honor hers through the creation of the best possible circumstance I could organize.  The similarity of how I observed the teaching hospital faculty treat family members reminded me of the public school system dynamic I was a participant of, and made me respectful of how carefully I needed to proceed.  I did not want The Oldest Girl to be labeled as the patient with “a problem mom.”  I needed to conduct myself in a professional manner to get what I wanted.  I noticed a direct relationship between the quality and amount of information that was shared with me and the staff’s perception of my wellness.  They talked to me differently based on how tired I looked, whether or not I had showered, how emotional I was and whether or not I was alone.  Given this variance, one of the first things I did was to request to read The Oldest Girl’s medical and floor charts to insure not only that I had access to all information related to her care, but also to check my retention and comprehension of it.  The right to review medical charts is one of the patient/parental rights in fine print, my experience suggested that it is not a popular request.  I was given access to The Oldest Girl’s chart, but with resistance, I had to push to assert my legal right, and even then could only view it with a hospital staff member present.  Reading the chart was an extremely validating experience for me.  Because I was so emotionally engaged in the situation, I had predicted that there were things that I had not heard or understood about The Oldest Girl’s condition.  I was relieved to find that this was not the case upon reading the chart, which helped me feel more focused, and in control.  It helped reinforce my understanding of The Oldest Girl’s medical needs, which were her primary care providers and what the plan for her treatment was.

The redundancy of the chart bolstered my unease with the medical training system practiced in the teaching hospital culture.  It seemed backwards logic to me that the interns with the least experience were directly in charge of daily patient care, while the attendings assumed more of a management role.  I wanted The Oldest Girl’s attending intimately involved with her treatment.  The next step of advocacy I took was to request that only those primary care providers interact with The Oldest Girl and our family.  The caveat, “that’s just one of the things you have to put up with at a teaching hospital,” is not wholly accurate.  Medical students, interns, and residents cannot participate in patient care without consent.  Parents can designate their child’s case a non-teaching one, even in a teaching hospital.  This step reduced the volume of people we needed to interact with on a daily basis and helped to lessen the sense that The Oldest Girl’s room was a high traffic area during rush hour.

I spoke at length with The Oldest Girl’s cardiologist about this as we reviewed the details of her upcoming heart catherization.  He explained that although it was not routine, the team had decided that The Oldest Girl should be intubated during the procedure because of the “unknown” status of her airway.  Intubation is the process of inserting a breathing tube down a patient’s throat so that breathing can be controlled by a ventilator.   The respiratory symptoms that had initially brought us to the hospital had become more severe.  At that time, we did not know if this was due to heart failure, an airway collapse, or both.  Because of this uncertainty, her cardiology team wanted to make certain that her airway was controlled in case of an emergency.  Her cardiology attending told us that if it was determined that The Oldest Girl needed surgery that she would remain intubated until after the surgical repair.  We asked who would be performing the heart cath, intubation and surgery and, were assured that only the best would be doing those jobs.

I did my best, it wasn’t much
I couldn’t feel, so I tried to touch
I’ve told the truth, I didn’t come to fool you
And even though
It all went wrong
I’ll stand before the Lord of Song
With nothing on my tongue but Hallelujah!

I Was The Mamma

I had a title and a job description.  I was The Mamma. (See Maternal Coat for backstory.)

This realization goaded my Midwestern work ethic just about the time another doctor entered the room to join the troupe already assembled.  I was offering The Oldest Girl the comfort of the breast again when the new M.D. positioned herself directly behind me, so that she could get a better view of the already crowded monitor.  Frustration tensed my neck as I finally began to wonder how many cardiologists it takes to read an echo.  The night before when doctors lined up with their stethoscopes three and four deep to listen to The Oldest Girl’s breathing, I was impressed by the volume of care she received.   A shift had occurred since then, however, and the same level of attention felt redundant, oppressive and even voyeuristic in this context.  The stress of feeling like a goalie in a soccer game was more pressure than my already challenged milk supply could withstand. My doppelganger turned to her and said, “Who are you?”

“Dr. Another One,” she confidently replied.

“Do you have to be here?” my doppelganger asked.

“She’s a member of our team,” the eldest, female consultant intervened authoritatively.

“Is she a vital member of the team?” my otherself surprised me by asking.

“I can leave,” Dr. Another One offered.

“Thank you,” my twin replied signaling her dismissal.

“But…” the elder discouraged as her pledge left the room.  Disapproval veiled her face as she muttered something else I couldn’t hear.  An awkward pause perpetuated the veneer of her objection before her attention returned to The Oldest Girl and the answers the echocardiogram screen would provide.

Those answers were not as concrete as anyone would have liked.  The cardiac team was able to determine that it was probable that The Oldest Girl had a heart defect called coarctation of the aorta.   She did not have palpable femoral pulses, and the pictures suggested an obstruction.  One of the cardiologists drew us a diagram as he explained the condition.  He used his pen to punctuate points as he made them to educate us about a coarch (“co-arc”); a narrowing of the aorta that restricts or limits the blood flow to the lower extremities.  He outlined the surgical repair that would be required if this diagnosis was confirmed.  He assured us that the surgery was one that boasted a high survival rate, but it was premature to assume that it would be necessary until an angiogram or heart catheter verified the diagnosis.  The prospect of a heart condition and likely surgery eviscerated the remnants of denial I held about the gravity of the situation.  He then asked us what questions we had.  We asked many.  Among them, I asked if we could control the number of people in the room during procedures.  Disapproval brushed his face as he asserted that one of the frustrations of being associated with a teaching hospital was putting up with those physicians who were in training.  He indirectly judged my dismissal of Dr. Another One as inappropriate.  He argued that inconveniences such as having many people in the room were a part of the package that was balanced by the exceptional facility and treatment options.  However cordial his language, his message was not subtle, he advised me not to tamper with the status quo.

His dictate to play nice really resonates with me.  My entire upbringing socialized me to be nice.  My earliest training reinforced the message my daughter’s cardiologist had just delivered.  These memories include lessons about manners, praise for cooperation and practice following the rules.  I grew up without outgrowing my eagerness to please my parents and teachers and friends.  Marry this conditioning with society’s reverence for doctors, and I felt it was incumbent of me to be good.  He had, after all, just reminded me to be a good girl.  I felt the pull to be obedient and quiet.  Liquid tractability intoxicates.  Unfortunately, it does not inform or guarantee quality care.  However traumatized I felt by my daughter’s illness, no matter how compelling the temptation to follow orders, I knew it did not feel appropriate to subject myself and my family to more stress than necessary, even if doing so did provide excellent opportunities for the professional development of others.  I had just been told my daughter was a candidate for heart surgery and simultaneously counseled to be a good sport.  I not only didn’t want to play; I knew that I could not simultaneously participate and do my most important job.  My already depleted resources could only be invested into being The Oldest Girl’s mom and advocate even if it didn’t feel comfortable, I wasn’t going to blindly follow guidelines that I did not believe to be in the best interest of her care or my family.

The slippery thing about hospital guidelines was to become educated about which were necessary regulations and which were rules of convenience.  Unfortunately, I knew as little about this as I did about heart disease at the time.  One benefit of my eager-to-please nature is that I learned how to be a good student.  Like an anthropologist, I had to study the foreign culture and mores of this hospital civilization in order to understand our experience and make informed decisions.  Like a native tour guide, my first source of information was our floor nurse.  Much like the teachers of a high school, nurses run the hospital and offer the best chance for a continuity of care.  The doctor administers as little of the day-to-day care to his patients as the typical principal provides daily instruction to students.  I discovered there were many familiar parallels between teaching and nursing, a realization that helped me acclimate to my new environment.  Our nurse explained the hierarchy of a teaching hospital.  One of the most ambiguous aspects of The Oldest Girl’s initial treatment was trying to determine who was who in the myriad of medical players that we encountered.  Much like a caste system, she explained the progression from medical students to attendings.

Lions and tigers and bears?

No…

Medical students, interns, and residents, oh my!

And The Mamma better know which is which and who does what!

I’ll stand before the Lord of Song
With nothing on my tongue but Hallelujah

Maternal Coat

I’ve taken a wee hiatus from the blog thing this week in order to get our family’s Back-to-School legs under us.  Much like motion sickness, we all cycled through our own versions of green under the gills and wobbly knees.

I also carved out some time to read some other blogs.   A Pandora’s Box of an experience, authenticity splatter paints site after site with open process and genuine welcome.  There’s a sacred chord common among them too.   The minor falls aren’t always that minor, but openly and honestly explain.  In many cases, I felt as if the blogger was talking directly to me, like we were sharing a bottle of Shiraz, and she really wanted me to understand.   The major lifts mold hope like clay on the wheel.   I read about what broke the hallelujahs of others, and was stirred by the movement of those fierce hearts.  They write to understand; they write to keep breathing; they write to help us all make sense of life’s density and experience.

Aunt Becky has such a site.  She wasn’t always Aunt Becky, but she will tell you about that when you visit her there.  When you go, carry my admiration and my prayers with you like fireflies  sparkle the night, with gentle whispers to lift her and to craft her Princess of the Bells a new tiara of light.

Reading about Aunt Becky’s journey brings The Oldest Girl to mind.  I now wear a new coat. The Oldest Girl’s illness changed my identity. The story went something like this:

I’m naked and I’m cold.  My infant daughter’s emergency heart surgery and subsequent hospital admission has stripped me of my maternal coat.  You know the one.  That warm, cozy fleece with all the comforts of flannel designed by Denial.  The one I curled up with at night to keep me safe so I could sleep secure in the belief that my family was protected.  The one I held open to catch my two-year-old son’s running giggle dives.  The arms cocooned my pink and wrinkled newborn daughter.  Its deep pockets held Kleenex, Goldfish, and Pokemon Band-Aids, all the medicine I thought I’d ever need to heal hurts.  The hood shielded me from the evening news like a solemn promise that mine would never be the statistical anomaly whose strange lump turned out to be cancer or who walked in the wrong McDonalds at the wrong time, and fell victim to unspeakable violence.  I miss that coat more than the cigarettes, caffeine, vodka, Pop-Tarts, profanity, bad men and other vices women give up to become mothers.  It’s cold out here.  My world feels bigger and more scary now.  I no longer enjoy the luxury of the Denial label.  The Oldest Girl is the one who almost died and, I will never be the same.  My daughter is the one in 12,000 born with a congenital heart defect.

The term heart defect has only two words.  The first, an adjective, conjures the undeniably positive connotations of love carved into the side of a proud oak, a child’s sloppily pasted Valentine’s Day card, Mother Theresa-like character and the center of debate.  It’s the noun that fires the phrase with sinister associations of betrayal, pyromania, Adolph Hitler and dysfunction.  The two words together describe a disease I never thought would be used to characterize my daughter’s cardiac condition.  I knew The Oldest Girl breathed differently than other babies. She snored, hummed and whistled from birth.  My family joked that she snored like an old man after a long poker game and too many cigars.  I teased too, as we had the pediatrician’s assurance that periodic breathing was normal in infants, and that some babies simply breathe more loudly than others.  We all slowly became accustomed to her respiratory percussion, and I repressed my SIDS fears like a movie trailer, a scary feature I would not pay money to keep me up nights.  On the Monday of her one-month well-baby visit, however, neither her pediatrician nor I liked the way she sounded.  Three days later, we were in the Emergency Room of the University teaching hospital.

The Husband and I walked our five-week-old daughter into the trauma center with unspoken confidence even though we were at parental DEFCON-4.  Though neither of us said so to the other, each of us held the same conviction.  This trip was merely a scary formality to confirm The Oldest Girl was completely fine.  We knew it was a good hospital.  The banner that touted, “Voted A Top-100 Hospital,” on their pedestrian walk-way proudly confirmed our conviction.  The Husband, a firm believer in the religion of modern technology, held my hand as I snuggled The Oldest Girl close to my chest.  The triage process was simply tedious, not painful.  The staff we interacted with seemed as interested in our insurance information as they did our daughter’s condition.  Nothing in their manner suggested The Oldest Girl’s condition was critical.  The physician who initially examined her seconded our pediatrician’s tentative diagnosis of tracheal malacia.  This doctor explained that the strider, or noisy breathing, The Oldest Girl experienced might be caused by an under developed trachea that was more soft or “floppy” than its cartilage should be.  We were assured that if this was the case, it was a grow-out, developmental condition. She ordered a chest x-ray and explained that The Oldest Girl would be placed on a monitor and admitted for the night for observation and further evaluation the next day.  We accompanied Oldest Girl to radiology with a sense of relief.  Experts and the best equipment possible were put in place to help us monitor her breathing.  If the worst happened, if she in fact stopped breathing, help would be immediate.  Even the doctor’s report that the x-ray showed that she had an enlarged heart, and that a pediatric cardiologist would consult on her case did not daunt our blithe expectation that we would be going home the next day.

The cardiologist who entered our room the next morning seemed to share this expectation.  As he wheeled in the machine to administer The Oldest Girl’s echocardiogram, he promised that we could rule out that she had any cardiac issues in ten minutes.  Forty anxious minutes later, during which I futilely sang to comfort my daughter in an attempt to quiet her screaming discomfort and outraged frustration, the cardiologist said he had to call in one of his colleagues to consult on The Oldest Girl’s case.  I’ve seen too many reruns of ER and Chicago Hope to miss the implications.  It was then that I began to split like an ameba during cell division.  I was in the middle of at least two experiences.  First and foremost, there was the numbing reality of Oldest Girl’s condition.  Secondly, there was the distracting interface of being immersed into a hospital culture with which I had little knowledge.

This sense of doubling only increased when the consult entered the room.  The next three hours were a blur of my attempts to console Oldest Girl while the pediatric cardiology team assessed her condition.  At no one time was there fewer than three doctors in the room. All the while, Oldest Girl screamed and screamed and screamed.  She was tired and anxious, in a strange environment, and did not want to lie on her back, her least favorite position, one more minute dammit to hell.   All the while, the doctors surrounded the monitor and spoke their code to each other, “I can’t see.”

“I can’t get it,”

“If she would just,”

“There it is,”

“Coarch?”

“Did you feel femoral pulses?”

“Her color isn’t good, she’s grayish.”

“Look.”

“See?”

“What if her duct just closed yesterday?”

Meanwhile, I serenaded Oldest Girl, I climbed into the crib and curled her into my side, I breast fed her, I held her in almost every conceivable position, including one that was almost upside down and I attempted to sooth her with my mama words and voice. We were told that her response to the test was not a good match with the team needs.  In order to get a good reading, Oldest Girl had to be calm and relatively still.  Frustration began to wear on everyone in the room, an occupancy that grew to an alarming six-doctor level at one count.

The sheer volume of white coats in the room heightened my anxiety as much as the test itself. The simultaneity of demands for my attention danced in kaleidoscope neon.  I was dizzy with their patterns:  The Oldest Girl’s needs, my own foreboding fear, and the mysterious medical vernacular that decoded her prognosis.  I was as saturated as a diaper in a kiddy wading pool, but these waters were deep and the undertow menaced.  It was a startling moment of maternal epiphany.  As inadequate as I felt, as viscerally engaged as I was in my experience of The Oldest Girl’s illness, I was the only mother in the room and Oldest Girl needed me.  This infused me with a sense of purpose.  I had a title and a job description.  I was The Mamma.

And even though
It all went wrong
I’ll stand before the Lord of Song
With nothing on my tongue but Hallelujah!



A Shout Out to Teachers

Back to School

Yesterday launched another school year.

Pause for Miss School Year 2010-2011 to make her way down the runway, folks.  Isn’t she lovely in her crown and sash!  Look at those tears of joy.

Tears are plenty too.  It’s back to school time all over the land.  In some houses, teachers weep to have to return to lunch duty.  Who could blame them really?  In others, children sob because they don’t want to leave home or get up early.  And, I am certain there are homes in which mothers cry out with joy to have their kids return to school, because they love them, dammit, but can they just breathe for a minute or get a pedicure for glory’s sake?

My four headed out to storm academic halls with new kicks, shiny backpacks, unbattered Sigg bottles, and mixed emotional features.

The Baby was thrilled to start kindergarten, but not certain that she wanted to stay the whole day.  Her attitude was as eager as the pleats of her skirt were pressed.

The Boy begrudged every aspect expect lunch.  Even his friends weren’t much of a draw this year.  He saw his friends plenty over the summer actually,  and you don’t have to take a Geometry quiz at a sleep over.

The Oldest Girl felt socially networked and gorgeous in her sassy, pirate shorts.  She’s being groomed for a leadership role in her classroom, and was happy to have us get out of her way so that she could get to her ambassadorial role, thank-you very much.

The Middle Girl was excited about getting her own desk this year.  Previously, she’s worked at team tables.  She’s been all about the desk quest since she visited her Mamma Grandma this summer.  She has aspirations to be a journalist or book writer and illustrates grand, epic tales.

As for me, I’m a cross between an anxious dash and a calendar page.  I think I was the bed-headed grump this morning who grouched, “I will not be your clock the entire year!  I am not Big Ben!  7:30 means 7:30!”  (Yes, yes, very Pinochio, I know. I want to be a mamma, a real, live mamma!) I always forget how much chase, chase, chase comes with the school pace, soccer teams, music lessons and tournaments.  I’m sure I’ll find my voice about it later, but right now, my phone is beeping to remind me of another family calendar event.  Again!

Until then, in their own words, original snippets from our kids’ first back-to-school assignments:

The Boy, 12, who was not only assigned reading, but also a Herculean, summer project:

“Would I Recommend This Book to Others?” 🙂 🙂 🙂 🙂 🙂

Absolutely. This book is a canon classic, and is on many schools’ reading lists. However, I always recommend reading a book before it’s required by a teacher as it is always more fun to choose your own book.  We all know students hate being assigned to read over the summer.  The only thing worse than that is to have a summer project on an assigned book.”

The Oldest Girl, 10:

“My hobby is writing songs, I really like to see what the combination of melodies and syllables can make. Also, whether I am singing high or low, l feel at peace when I am singing.”

The Middle Girl, 8:

“This season in my life is ornge enthuseasan and warmth and energe.”

The Baby, 5, assigned a gingerbread man to decorate.  She made him into a piñata and dictated this verse:

Gingerbread Piñata

Friends, teachers,
Lend me your ears!
A gingerbread
piñata is here

Run, run,
to the big room!
if you do,
you’ll get a lollipop soon

Mrs. [Teacher],
you’re a dear!
We’ll lift our hands,
and give you a cheer!

Jesus, Jesus,
We love you!
You do things
no one else can do

K, kids,
Of the [Name of my] School!
As a matter of fact,
I know you rule!

Now’s the time,
I have to flee!
You can’t catch me,
I’m the gingerbread man!

I’ll stand before the Lord of Song, with nothing on my tongue but Hallelujah!

Hallelujah, Hallelujah,

Hallelujah, Hallelujah!

Word Study

Through His recent, gentle command to rise, I am again reminded of one of the most insightful teachers I ever had the privilege with which to study.  She owns my respect as this woman excites in me an adrenaline pang of abject fear accompanied by the simultaneous desire to sit at her feet and bathe in her wisdom.   I never know for certain if she will smack me or hug me, and her lessons always stretched me to the tippy-toes of my fledgling understanding of content.  A most mighty and majestic oak, she evidences the conviction that a concept cannot be studied if one does not understand the terminology.  She is rattlesnake quick to distinguish between a scientist’s operational definition of terms (that tell the reader what a word or phrase means for the purpose of a study) and a word study.  She exalts that all connotations, denotations, derivations, and cultural contexts must be sifted before any idea can be fully understood.  Her insistence on this process often bring to mind Heinlein’s Valentine Michael Smith, the prophet who calls his brothers to wait in fullness in order to grok.  This woman teaches many;  she is one diva of groking in fullness, and I am also convinced she’s got a Batphone to the Throne.

By the way, I know she’d slap me if she knew I distilled her most empirical and rigorous Word Study process down to the science fiction term grok, but Baby, truth is what it is, and that teacher, water brother mine, groks, and bids me to do the same.

Recent process here prompts me again to apply her word study model to grok in fullness.

As such, one of my strategies when I attempt to get my head around a new pattern or idea is to study the antonyms of the concept.  I actually like to turn my journal upside down when I do this as a visual reminder to consider it from the opposite perspective.  I wish I could type upside down, but I don’t even have to ask The Husband to know that that would get the big technology veto.  He would also certainly argue that it would make it too hard for you to read, thus building a division between us when what I seek if communion.   If, however, you wanted to pretend I was typing upside down starting now, that would be great.

Term: broken

Definition: (abridged from http://www.merriam-webster.com/dictionary/broken)

1 shattered
2 damaged, altered, irregular, violated, disrupted
3 made weak, subdued, crushed, sorrowful, bankrupt, reduced
4 cut off, disconnected, imperfect
5 incomplete
6 disunited

Antonym: whole

1 intact
2 original, pristine, revered, continuous, regular
3 made strong, supported, lifted, joyful, rich, maximized
4 networked, connected, perfect
5 complete
6 united

These inversions pull the brakes on the runaway express of my busy brain.

Earth bound, I have one spiritual quest, to lift my voice in love to Him that made me.  With dirt on my feet and salt on my face, the best I can offer from here is a broken Hallelujah.

However, He meets me in my broken spaces right where I am, and stirs my soul with Victory.   He bathes my offering with Grace, and returns to me a

Holy Hallelujah

an intact song,
pristine love,
restored wholeness,
vintage freedom,
pristine mercy,
revered hope,
continuous strength,
unconditional support,
lifted confidence,
joyful healing,
rich communion,
maximized potential,
fellowship networked,
holy dove connection,
perfect peace,
complete unity

He offers my Hallelujah a new identity and restoration because He not only hears my imperfect Praise with delight, He celebrates me back with perfect Love.

And even though it all went wrong, I’ll stand before the Lord of Song with nothing on my tongue but Hallelujah!

Predictive Index

Job applications make my Top 10 List of Hallelujah Breakers today.

Get this; my sister emailed me today to share the heads-up that she had decided to put her name in the hat for some part-time work.

As part of the application process, she was asked to complete a “Predictive Index.”

On page one, she was instructed to check off the words from a supplied list that she feels describe the way others expect her to act.

On page two, she was asked to check off the words from a supplied list that identify her expectations of herself.

I’ve pasted the word list below:

So, clearly, I’m no therapist, but I assume there is a psychodynamic inventory embedded in this check list, and I am intrigued on many levels.

I confess the title of the task really bakes my cupcakes.  “Predictive Index?”  Just like Silence of the Lambs, baby, the gallant and elegant sociopath, Hannibal Lecter, said it best, “Oh, Agent Starling, do you think you can dissect me with this blunt little tool?”

Come on!  Clearly this Predictive Index is meant to measure personality indicators that some company paid a puffed-up consultant a ridiculous wad of cash to build.  “Yeah!  Build me a matrix!  Write me a tool so I can hire someone who lives the mission statement and honors the code.  Construct me a Skinner’s Box so that we can weed out the weary, helpless, broken-hearted, faithless, and confused.   Let those lost souls cry out to Jesus, ‘cause we only hire producers who promote value and honor the company name.”

Really now, has our social code degraded to the point that a potential job applicant would assert that others should expect him to act fearful, self-centered, selfish and dominant?  Can you imagine any non-dream state that would compel you to say, “Hi, my name is Jael, I am a passive, audacious, worrying, docile, obstinate, fussy escapist who promises to add value to your organization.”

Usually people smart enough to participate in 12 Step programs know the difference between a job application and a meeting.

Certainly, there must be words that flag potential psychopaths and narcissists for the employer.  I respect companies must roll the dice as they throw development capital into the recruitment and training of talent, but come on!  This kind of exercise could produce clinically measurable anxiety.

It’s like a Bounce House for the Id, Ego and Super Ego to collide!  Do I check what I think they want me to say, or check what I think is right, or check how my kids would describe me when I go postal over spilled chocolate milk on the couch?

What does this Predictive Index measure?  What the potential employer expects?  What one expects of potential colleagues?  What one expects of oneself?  And those are just the not crazy-kind of second-guessing questions.  What if it somehow measures if I am insecure or if English is my second language or if I have some kind of cheese fetish?  What in the hell does resolute really mean anyway, and is it exclusively a good or bad attribute?

I’d say more, but at this point, I am afraid someone is watching me.

The Holy Dove ain’t ever tried to dissect me with a blunt little tool.

In fact, my God promises to prosper and not to harm me.

I did my best, it wasn’t much (not passive)
I couldn’t feel, so I tried to touch (not audaciously)
I’ve told the truth, I didn’t come to fool you (trusting)

And even though it all went wrong, I’ll stand before the Lord of Song with nothing on my blessedly employed tongue but Hallelujah!

Handy Packs

The night we returned home from the beach our home felt like a palace.  As well as the six of us did in one double room for two nights and three days, we appreciated space to enjoy space.  I was interested to observe the children like lemmings migrate to their comfort zones.  The Boy checked his email, The Baby sprawled out onto the middle of the playroom floor and The Oldest and Middle Girl just wanted to shower.  Alone.

I expect it will take some time for me to shift through the family experience.  I remain amazed how quickly we morphed into a cohesive team that stormed the waves together.  I tear to remember how much The Boy, who usually has little to do with his sisters, played with the girls. Like a magical algebraic reduction, being away simplified who were his options, and that his sisters actually had game.

The Oldest Girl was so giddy and breathless the first time we hit the beach that I reached for a lunch sack and all but hyperventilated with her.  She experienced the encounter with a throttle so open you could hear her laughter roar like a plane as it takes off in flight.  Like a delighted porpoise, she rolled and frolicked in the waves, as enchanted to remain upright as she was to be thrown against the shore.  She laughed with such abandon we had to remind her to close her mouth as the waves crested because she gargled more sea water than adults use Listerine during flu season.

The Middle Girl and The Baby both journeyed to find their legs.  Initially timid, The Middle Girl spent the first twenty minutes in the water screaming, “Don’t let go!,” and the rest of the weekend testifying, “I got this!”  It took her less time to cycle from uncertain to confident than it takes our washing machine to shift from wash to rinse.  Really, I can’t add fabric softener that fast.

The Baby maintained a healthy respect for the ocean.  Mesmerized by its scope and the crash of the tide, she maintained touch contact with a parent at all times while in the water.  It was clear we were her lighthouses that guided her safely out through the waves and back home again.  I can only imagine how big it looked and what sense she made of its vastness.  I watched her face and tried to see the images as her eyes captured the moment, her sincere, “Wow!” a succinct prayer of wonder and wholly sufficient, thanksgiving Hallelujah.

The nautical blues of the choppy ocean provided a crows nest for The Husband and I to view our children.  So much of our usual rhythm directs the traffic of our schedules and obligations, that we can lose sight of our children amid their activities.  Too often the lens considers how they do something like the dishes, or homework, or a soccer game, that we lose focus on who they are.  These new and updated images of them, snapshots of adolescent postures, porpoise joy, confidence cycled, and touch contact clarified their sensibilities to us more than any family meeting or orchard hike.  We were Away together, and we came back Here more knitted in our family fabric.

All of that this, of course, records the esoteric hot fudge of decadent, relational sundaes, and not the nitty-gritty of funds or tips on how to make it feasible logistically.

We were crazy 11^th hour in our adventure.  The most obvious thing we learned is to plan ahead.  For a “beach” of any mention, and if you want a house or a condo, that might actually mean to plan a year ahead.

There are innumerable tips on how to travel cheaply and practical tips about what to pack on the Web.  These are my novice contributions for a quick (even unexpected) trip to the beach:

Handy Packs

• Pack a couple of rolls of paper towels.  Your family can’t live without them at home and they shouldn’t be expected to operate without them Away.  They will greatly aid the towel shortage in the hotel bathroom too.
• Line trunk or storage space of vehicle with an old sheet to collect sand.  Sand invades more pervasively than fleas, and you don’t want to bring it into your home.
• Cooler tip:  The cooler will fill up quickly no matter how big it is.  Pack extra beverages to be chilled as you use them during your stay, and give Igloo priority to food that must stay refrigerated.
• Boiled eggs are a perfect food. They offer a ready breakfast, quick protein with yogurt for a filling lunch, or an easy snack that satisfies.  Peel before you leave home.  Pack 2-3 per day for each person who eats them.  Oh, sliced over cream cheese on a whole wheat bagel, they make a great and healthy sandwich for the kids too.
• Pick a hotel that serves a free Continental breakfast. If they serve fruit (and many don’t to control costs), bring an extra piece back to the room to eat later with lunch or for a snack.
• Make a family compact that one meal a day will be from the cooler. We agreed that all lunch, snacks and drinks would come from the cooler during the day.  We packed things easy to prepare and able to be eaten quickly without utensils like Gogurt, PB&Js, bagels with cream cheese, boiled eggs, nuts, fruit, cheese sticks and, I confess, cheeseballs.
• Take the time to prepare sandwiches before you leave for the beach in the morning. There’s nothing more annoyingly magnetic than sand and the thing you least wish is to have it on your cheese stick or Oreo.
• Pack bags with your bags. You will need them. Pack gallon size freezer bags to portion beach snacks like cheeseballs, kitchen garbage bags for dirty laundry and sandy towels, and beach bags to ferry your towels and sunscreen to the waterside.
• Bring a good hair detangler. Salt water and sand do a number to the most manageable of tresses, and snarls make tired children as cranky as Medusa.
• No screens!   The tide will eat your cell phone, iPad and laptop as hungrily as it gobbles sandcastles.  If you must check in with the world, make a pledge to only do so only once a day, AFTER the kids are in bed.

I’ll stand before the Lord of Song
With nothing on my tongue but Hallelujah!