Worst Practices

Worst Practices

by Philip Siddons

Joseph still hasn’t shown up.

a-jpg“Of course” says the pageant director flippantly. “Gabriel? Where’s Gabriel?” she calls to the back of the church over her shoulder. “Gabriel” she musically calls again as if she’s calling her child for only the second time for dinner.

“Oh” Gabriel says from the back of the church as he stumbles hurriedly down the aisle.

“I was showing her how to keep her ribbon on” he explains with more earnestness than the task would normally command.

The director comically tilts her head sideways and says “Ya? . . . ya?” as if to mock him for his failure to be up with the other angels who are, at this point, rolling on the stage floor with the shepherds who are supposed to be asleep on the hillside but have somehow missed their morning dose of Ritalin

As speakers number 4 and 5 rapidly mumble through their lines, it’s clear that once again, nobody in the church will hear anyone say anything from the front. The fact is, they’ll be cute and it won’t matter. It’s the doing of the pageant that makes Christmas.

bJoseph is still not here and a couple of the angels are missing in action. How many had to show for the original nativity scene? Did God have to have a last minute rehearsal and sit them all down, barking out, “Now during this scene, you can’t talk to the person next to you. And don’t pick your nose. And if see any Gameboys® I’m going to take them away from you and you won’t get them back. So take that back to your parents or you’ll never see it again.”

The director rattles through the order of events once again, obviously confident that their photographic little minds will methodologically and nimbly string the coming sequences of pageant segments together with the precision of Microsoft’s latest video editing program.

The mid-teen Joseph slowly waltzes down the aisle. “Joseph is finally here” the director says with some relief. “We’re glad you made it” she says, softening even more. Perhaps her real life experience of the male absence or unreliability has taught her to work with what she’s got.

Suppose the original Joseph hadn’t shown up and Mary would have to go through the birth alone in the stable? Who would have wiped off the cow drool? Would she have screamed at the weird little drummer boy to go practice anywhere but in the stable – “like go play in the DMZ of the West Bank or something!” she could have blurted out.

OK, so no little drummer preadolescent or any a-rump-pa-pa-dums in the original production.

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They should really make this last-minute pageant rehearsal THE pageant. Most of the parents are here anyway and the director’s expectation that this production will be anything other than what it is now (only without her prompting everything and everyone across and off the stage at the right time) is the most spectacular act of faith in the history of Christendom. “Come see a faith that can move mountains” the bulletin board outside of the church should say. People ought to get out of their beds and come here to see the futility of this rehearsal.

cThe children are herded back to the Sunday School classrooms to change. We expect more of the same to happen only back out of sight. But we know that with the addition of costumes, the in-the-wings nervousness of their peers and a sanctuary packed with their family clan and a host of unknown adults grinning, the volume of their spoken lines will dive down to zero, the prompters’ shouted whispers will be even more embarrassing and the pauses before the hoped-for movements of groups of bathrobed or haloed children will seem painfully strained.

So when central characters didn’t enter stage right in the original production, what did the Almighty do? Whisper little prompts in their hearts? Did Joseph suddenly snap to attention out of a distracted moment and say “Oh yea” after hearing an inner prompt just before lurching over to stand by his wife who had creatively used the cow’s manger for a cradle?

How much stage whispering did the Cosmic Producer of this first nativity have to do to remind Joe and Mary that these overworked and rambunctious contracted sheepherders are supposed to be crashing their barn encampment in the middle of the night and just after the baby finally got to sleep?

“Mary, stop breast-feeding – there’s a bunch of guys coming in here!” Joe probably said.

And later on, not long after their boy would ace His bar mitzvah at the temple and be offered an internship as the youngest teaching assistant in the history of the temple’s education department – why did Joseph disappear?


Did all the pressures of being the parent of a icon drive him to drink?

Maybe Joe had a gambling problem and when the young Jesus started turning angry bully’s thrown rocks into birds before they hit their victim, Joe started making bets.

“I bet you my boy can out-argue a member of the Supreme Court” he’d wager and win several hundred shekels. Maybe Joe, one day, got a little cocky and bet the whole wad and lost to some pretty heavy hitters and ended up at the bottom of Lake Galilee wearing clay overshoes.

Whatever happened to Joe must have been a major embarrassment to the Apostolic Fathers for them not to even mention him after a certain point. Maybe Joe got Alzheimer’s and the gospel writers couldn’t figure out why Jesus, Who could raise the dead, couldn’t or wouldn’t bring clarity of mind to His mom’s husband.

But with all the botched lines, absences, miscues and frankly inappropriate behaviors, there was a first nativity scene with inattentive and clueless characters.

e“You work with what you’ve got” the Almighty must have mumbled to Self after every scene in the Messiah’s life.

Just before the pageant starts, the Reverend comes to the podium and announces to the congregants that “whoever has come in a blue Ford with a license plate that starts with NAZ has left their lights on.

This brings predictable and comfortable laughter among the assembly. With all of our life’s struggles and our obvious failure to be the next Dali Lama of our own faith expression, church is the one place where we can forget to turn off our car lights. Perhaps all of life is like one large Christmas pageant through which we stumble, forgetful of our parts or relevance to some unknown overriding theme.

The pastor flees the podium, just after expressing gratitude to all the children and the beleaguered director for what they are about to present.

As narrator number 1 begins to mumble through her hurried description of the scene where Joe is turned down by the inn keeper, (who has the Gameboy® in his bathrobe pocket), I think I hear something. It’s a voice but is it behind me? Perhaps a child speaking to their parent?

No, it’s internal. It’s within me. It’s like a quiet thought that suddenly comes to you like an almost forgotten matter that comes to you in a special and profound moment.

And the voice within me says, as if it’s my clue to the meaning of my life today and forever, “… and don’t pick your nose.”

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Aquarius, Please Bear With Us

How To Manage Hydration During Prostate Cancer Radiation Therapy

“Are you ready?” every one of us hears in the waiting room of the prostate radiation treatment center. “Do you feel the urge?” the nurses frequently ask, trying to sound sympathetic but within earshot of everyone in the waiting room. And when these guys are older and their hearing is failing, these beleaguered medical professionals have to repeat themselves even louder. Then it sounds like an exasperated parent dealing with their three year old who is in-between meltdowns with an eminent bladder accident.

“Are you ready?” even the receptionist asks the guy standing before her who is leaning against her sign-in counter, with his eyes nervously darting back and forth from her face to the therapy room door beyond.

That’s what we are all reduced to in the mandatory task of keeping our bladder filled with water in order to tighten it up with water in order to keep it from sagging down over the prostate during the radiation delivery.

We never saw that coming and there aren’t even Cliff’s Notes or “Hydration Preparation for Dummies.” Since grade school when we were frantically waiving our hand, trying to get our teacher’s attention for permission to pee, it has always been the same. Through the years, we’ve rarely got caught short, having to urinate but having no place to go. Whenever we felt the call, we just went to the nearest restroom. Like our ‘videos on demand,’ we are used to urination upon demand.

Now, having been told to drink one-and-a-half 25 ounce plastic containers of water one hour before your therapy, it seems like a setup for failure. Through the years, we have had no practice in ‘holding it.’ We’ve always just gone when we’ve had to go. That’s why every building structure in our society invests in ample restroom facilities. ‘When ya got da go, you’ve got da go.’

So suddenly, within one week’s time of being told that you’ve got a diagnosis of prostate cancer, you’ve got to learn how, for the first time in your life, to make yourself have a full bladder and not urinate through your pants and look like a complete idiot. Every guy going through radiation therapy for prostate cancer finds himself in this predicament. You’ve got to do this for the initial cat scan and MRI alignment of the radiation equipment. You’ve got to do this every day for each of the ensuing 45 days of treatment. Every day! Rain or shine, snow or hail.

So this is a new experience for us with no prior training. We essentially have one week from the diagnosis to the initial equipment setup to get this right.

On the day of diagnosis, we’re told, by a cheerful and well-experienced nurse practitioner, that “my guys drink one-and-a-half these containers one hour before treatment; . . . you want to feel the urge before you go into treatment.”

As you hear her refer to “my guys” it sounds endearing. It sounds somewhat comforting, like a nurturing hen gently but confidently gathering her chicks under her protective wings. And when you’re getting used to your new cancer diagnosis, perhaps even “intermediate” or “advanced” cancer diagnosis, you’ll take all the nurturing that’s available.

But that’s essentially it in terms of instruction. Having heard the level of fluid you’re supposed to down, you want to be like the rest of “her guys” so you put that in your daily check list. But you have no idea what it means “feel the urge” other than feeling the need to urinate.

The first time you try it, you discover there is a range of “feeling the urge” from ‘Oh my gosh, I better be near a bathroom’ to ‘Holy shit, how am I supposed to not wet myself in front of all these people?’

This is totally new ground. You wonder if they did this to prisoners of war to break them down. No matter accomplished you’ve been in your career; no matter how close you are and have been to your friends and loved ones, you are now forced to be in a miserable and potentially socially embarrassing circumstance seemingly beyond your control. Make your self have to pee but you can’t and you’ll have to wait!

One thing that lurks in the back of your mind is if you don’t have enough water suspending your bladder up away from your prostate, the radiation could burn your bladder if it didn’t have enough water and sagged down in the way of the radiation beams aimed at your prostate.

Actually, this fear is unfounded, I’m told by Christ, the radiation technician. “We can see how full your bladder is as we begin and we simply wouldn’t do it if you were not amply hydrated. We’d make you go out and drink some water in the waiting room so you’re always safe.” (Which happened to me at my 3rd treatment.) But more on that in a minute.

Having to drink more water before therapy begins apparently happens so frequently, that they’ve got a water cooler in every waiting area. We are the water bearers – this is the age of Aquarius – at least for next several weeks.

This, of course, is better this than a slow and miserable death, some years later, by prostate cancer that has metastasized to your vital organs – right when you were starting to enjoy your relationships, your life, dance at your kid’s weddings and attend your grandchildren’s graduations.

So what are the tricks to “mastering” your bladder control for the sake of your radiation therapy?

If you ever participated in a competitive sport, you’re in luck. You had to do a lot of things to make the team and thrive on the team. You had to:

  1. Get in shape and exercise
  2. Pay attention to your diet
  3. Practice, practice, practice
  4. Keep it constantly in your head that you can’t do it alone but are on a team that functions interdependently

Here are some straight-forward bits of advice that embody the above four tips.

Whatever shape you are in is what you’ve got. Remember, you have a matter of days from the time you’re diagnosed until you’ve got to get used to having enough water in your bladder to push it up out of the way of the instrumentation. But regardless of your physical condition, at least start walking. Get your muscles and body, in general, to the point of having oxygen and blood going through it to get as good a circulation as possible. You already know you should have been doing this for years but start now if you haven’t already. It makes a difference on a number of levels. Our bodies are complex chemical and nutritional exchanges, all of which helps every bodily, emotional and intellectual function that makes up who we are.

You already know what irritates your bladder – coffee and any drink that has caffeine. There’s caffeine in chocolate. Immediately eliminate all of them from your diet (at least until after you’re cancer-free). Get a grip and take aspirin if you get caffeine-withdrawal headaches but discipline yourself to do it. It makes a huge difference in helping you go through this therapy.

The practice part of it has to start immediately. Being told to drink 1.5 bottles of water one hour before therapy is almost no help unless you put yourself on a timed schedule and record how many oz. you drink; what time you drank it, what time you first realized you felt you have to urinate and at what time you could no longer hold it. That’s three points in time.

You almost have to do this once a day as an experiment because you can’t really do this two or three times in one day. You’ll be hydrated from your first try and any time you try it later that day will not be helpful in your calculations. It will probably take you 4 or 5 days to figure out how long it takes you to feel your bladder full, how many ounces it takes and how long you can hold it until you must relieve yourself.

This obviously takes a disciplined focus and commitment to learning how your body handles water. Each of us are different and it has to do with our level of exercise, when we drink the water, our weight and our level of anxiety.

For my particular body weighing in at around 170, it took me 7 days to find out that if I drank 28 ounces of water, in 40 minutes it would trickle down and my bladder would feel full and I could hold it for another 30 minutes.

The Breakthrough Fact About Hydration

Once time early in my therapy, I was waiting for my turn and I absolutely couldn’t hold it any longer and went into the restroom and let out what I thought was most all of my bladder. I fully expected they’d tell me to go back out to the waiting room and drink 3 cups of water and wait for about 15 minutes. But they didn’t.

They had me come in and get on the table and they could see how much water was in me with their imagery equipment. It was enough, even though I thought I had urinated out everything that was in my bladder.

“It’s because you were hydrated enough. And don’t forget, it takes a while for what you drink to make its way down to your bladder.”

“You were hydrated enough” was the pivotal phrase that turned everything around for me. This is because at the beginning, all I thought was involved was drinking a certain number of ounces of water so many minutes before the therapy. Instead, it’s about hydration. It’s about having getting your body hydrated, having enough fluid running throughout your system so that when you begin drinking your water at a certain time (before the therapy), you will not be starting from zero hydration.

That’s why they say that most of the time, guys come in there on Mondays, after a weekend of not drinking their usual daily fluid for therapy, they are less hydrated than the rest of week when they’ve been consciously drinking for their therapy sessions. Mondays see the most incidences of patients being sent back out to the waiting room to drink more water.

So how to you maintain hydration? In your experimentation, drink other fluids earlier in the day before you drink your water before therapy. You might ordinarily have a protein-blueberry shake at breakfast. You might have a glass of water or green tea with you your eggs or cereal. Whatever you drink at the start of the day, keep doing it and also practice drinking your pre-therapy container of water.

Ideally, by the time you go in for your first session where they calibrate the radiation machine, you should have a pretty decent sense that when they do it, you will be in the zone where your bladder has a lot of water in it but you’re not going crazy trying to hold it. You should be hydrated and that you could hold it another ten minutes or so.

And suppose you can’t? Suppose you have to urinate and you just do?

No problem. If you’ve been drinking fluids throughout the day, you’re already hydrated. IT ALL DOESN’T ONLY DEPEND ON THE WATER YOU DRANK IN THE LAST HOUR TO FILL YOUR BLADDER.

This was startling new information to me that I didn’t get when I was initially told to drink so many ounces of water so minutes before the therapy. After a while, I confidently urinated right before my therapy time and because I was hydrated enough, it was usually determined that I had enough water in my bladder for the treatments.

But I got to this point only with help from the radiation technology team. If you are not hydrated enough, they’ll send you out for a few drinks of water and a few minutes wait. But in the process of experimenting, perhaps by the 2nd or third treatment, you’ll learn exactly how much water (or liquid) before treatment you’ll need and the timing. Learning to fine-tune this process truly takes a team effort. It is a training task that you, primarily, have to do yourself but you have to have the radiation technicians helping you make those final adjustments.

That’s why I’ve used the sports analogy. Most all of it is on you to get in shape and discipline and do what you have to do in order to get hydrated and be in touch with your own bladder. But you need the team around you to make it happen.