By Andrew T. Gerns
[Easton Hospital is the only for-profit hospital in the Lehigh Valley of Pennsylvania, and is the hospital located nearest my parish church. It is a 369-bed hospital owned by Community Health Systems of Bentwood, Tennessee, and employs a pastoral care staff of one. There are part time paid per diem chaplains who together work a total of 20 or so hours a month and these are funded through the contributions of area congregations. As a member of the community board that supports chaplaincy at Easton, I was invited to speak to the Pastoral Care Week luncheon for chaplains and the volunteer clergy, lay pastoral visitors and office volunteers who make the pastoral care program at Easton Hospital work. Also present on October 29, 2008 were community clergy, hospital senior and middle management. Of course, the views expressed here are my own and not that of the hospital or the department.]
This may come as a surprise you but as of this morning I have 166 friends. At least according to Facebook. I mention this because we live in a world and in a culture that is aching for connection and will just about anything to find it.
Facebook allows me to have some connection, many fleeting and some fun and a few intense with people from all over the globe. Depending on how a person uses this social network, I can know their little peeves (One fellow said this morning that he wished that people knew about ‘Please’ and ‘Thank you.’ There is no doubt a story behind that one!) or their trials (A woman asks for prayers for her husband) and their whimsy (someone else just poked me and my niece in Vermont just threw a sheep at me). We all see connection and human beings are every bit as creative in finding ways to build connection (not all of them healthy) as they are in building protective walls and safe distances.
All of us embody the contradiction of “come closer” and “stay away.” Very few of us keep our balance. We can be like Ebenezer Scrooge who, before his conversion, was described by Dickens as a man whose very mannerism telegraphed to strangers and even dogs “keep your distance.” And literature ancient and modern describes the pitfalls of uncontrolled intimacy. We need and crave connection and yet we spend a lifetime learning how to navigate it.
It’s easy to see why. Connection brings up all kinds of things. The list begins with intimacy and relationships, and moves on to our sense of self, the dignity of life, our purpose in living, what meaning we make of and draw out of our lives. The list goes on and on and on. What Frederick Buechner once said about sex is true about our quest for connection and so the ministry of health care: it is like nitro-glycerin. It can either heal hearts or blow up bridges.
So we create distance. We talk about everything but the risk of connecting with the volumes of hurting people who come through these doors. Listen to our language. It is the language of distance and diminution. We find ourselves talking about “patient days,” and “staffing levels” and “FTEs” and “customer experience.” We worry about outcomes but don’t know if a person was meaningfully touched. We define our caring around not only the metrics of clinical norms but the hard realities of the economics of health care.
In what is perhaps the greatest distancing behavior of any culture anywhere, we have over a period of decades moved health care from a moral obligation borne by the community to a commodity to be packaged and marketed. And just so no one feels picked on, know that I am talking about the whole enchilada: both the tax-exempt and the for-profit world, from the local doc-in-a-box to modern medical mega-malls. I am talking about insurers and providers, both governmental and private. Talk of margin and profit, the volumes of regulations, HIPPA and JCAHO and all the policy books in the world are a cover for the fact that we are afraid of the connection we crave but cannot contain.
We have done far worse. We have sliced, diced and packaged our need for connection and compassion put it on the open market.
The movement from compassion to commodity has been a long time coming and I see no sign that this is going to change anytime soon.
This is why you pastoral caregivers are so very important. You serve as a tangible reminder of something deeper that is going on in this place no matter how short the stays, how managed the care, how contained the costs and how measured the outcomes. You show us the value of unconditional human connection. You show us that first and finally, the work of health care is to care for the person who is physically, emotionally and spiritually un-whole. You bring wholeness and hope to the stranger and the neighbor because finally, the least among us is us.
Harvard University President Drew Faust gave a morning meditation at that school’s Appleton Chapel last September during which she described the hymns she remembered from her youth including this one:
All things bright and beautiful,
All creatures great and small,
All things wise and wonderful,
The Lord God made them all.
Each little flower that opens,
Each little bird that sings,
He made their glowing colors,
He made their tiny wings.
Written in 1848, (Faust says) the words to this hymn are steeped in Victorian romanticism, extolling the glowing colors of each little flower, the tiny wings of each little bird. Its rather treacly sentimentality and continuing popularity in a far more cynical age moved Monty Python to parody:
All things dull and ugly
All creatures short and squat
All things rude and nasty
The Lord God made the lot.
Each nasty little hornet,
Each beastly little squid
Who made the spiky urchin?
Who made the sharks? He did!
Opening flowers, singing birds matter. Urchins, squid, hornets, and sharks matter too. All creatures, great, small, dull, and ugly matter.
And we all want to matter and we all fear that we don’t. On a very basic level all of us fear that we mean nothing to anyone; not to God, not to our parents, not to our spouses or partners, not to our neighbors and co-workers. This weekend, Christian churches will celebrate All Saints Day, a feast devoted to the fact that before God we all matter, we all have a purpose and none of us are forgotten.
But we need frequent reminding.
Once when I was a clinical chaplain, the hospital where I was decided to have a weekly support group for men who were in cardiac rehab. They were re-booting their lives after a near miss with cardiac death through exercise, diet, lifestyle changes and the nurse who ran the program thought having an hour session with the chaplain might be a good idea. All of us “specialists” had our one-hour shot at education and encouragement. It was fun. Once, I found myself in a group of diverse men who mostly didn’t know each other except that during my time with them we discovered that every single one of them was a combat veteran of some war. World War Two, Korea or Viet Nam. Army. Navy. Air Force. Wehrmacht. Yes, one of the group was even, in his youth, on the other side. Stephen Spielberg had just released Saving Private Ryan, so memories were effervescent and being uncorked all over the place. So I was privileged to hear their experiences and their memories while these men talked, often for the first time, about what it was like to be under fire, to be so close to death and sometimes the bringer of death.
Once the bottle was uncorked, I was struck by the sense of connection of these men who had a shared experience that could only live in story and deep memory.
One of my first pastoral encounters was as a twenty-year old studying abroad in England. As a religion major at Drew University, I had the chance to study theology in Oxford. There was a catch, I had to act as if I were studying for ministry. That meant mandatory chapel and it meant field work. Rather than send some college kids to a parish where they might break things, they sent us to place where we could do no real harm. You guessed it: they sent us to a hospital!
There I met a man from Uganda. I don’t remember his name, but I will never forget him because I was so very helpless. This was the era of Idi Amin and this man was a judge who had been kidnapped, beat up and maybe tortured. He escaped Uganda with his life but had lost complete touch with his family and friends…all now enemies of the state. What could a suburban American kid who never lacked for anything possibly say to such a man?
It was there that I first learned the promise of Ruth who as a widow said to her widowed mother in law “where you go I will go. And your God will be my God.”
I was in seminary when AIDS first hit Manhattan. I found myself sitting with people who were dying for no apparent reason. I was forced to learn very early that this was no time for empty, high-minded theology or critical moralisms. When partners were prevented from sitting with their dying loved ones or when people were abandoned out of fear, this was precisely the time to hang in there and seek connection. “Where you go, I will go. And your God will be my God.”
We who work in this place may find this stuff both fascinating and routine but for the average patient it is scary, it is unexpected, it is lonely. To the people who come here this is not a place of routine but a place of danger. Which means that it is full of meaning and story and hope and dread that often has no place to go except to a person called “chaplain” or “pastoral caregiver” or “pastoral volunteer” or “clergy” who can take the time to connect and to listen.
The New York Times recently had a front page story about chaplains who go around the city visiting dying people in their homes. It is a wonderful piece. Everyone here should buy one or log onto nytimes.com and read it. When I read it last night, it reminded me of a classic picture of Jesus found in many of our churches. It is of Jesus standing outside a door and knocking. In most of these renditions, there is no knob. Our fear of connection causes us to close the door. Our need for connection may cause us to open the door just a crack. And the person who is invited into that closed room is the face of God. The person who lets us in is sharing a tentative prayer of hope that maybe, just maybe they are not forgotten. Could it be, they pray, that I matter?
To the extent that we clergy, chaplains and pastoral caregivers are successful, to the extent that the ministry of chaplains is cultivated and allowed to grow, our work is a fundamental, often unconscious and sometimes irritating, reminder to every single person in every single job in this hospital that we are not just selling a commodity. No, we are not fighting for market share! We are not here to beef up the margin or return value to the stock-holders. There is no “product” here except compassion exercised with skill.
By hanging a sign out front that says “hospital” and opening the doors to all comers, we have dared to take on the sacred work of remembering the forgotten, caring for the weakest and healing those who are broken in body, mind and spirit. We are doing this on behalf of a community who trusts us to navigate places most people would rather not think about. We are doing the impossible: we bring the best skill and the best tools and the best education to crises faced by ordinary people. We do the impossible by bringing compassion, connection and reverence to human beings when they are the most vulnerable.
The only metric that tells us we are succeeding is the sense of connection we find when we bring our best to people when they are at their worst. That metric is often shrouded in holy mystery and resists neat expression in Excel files.
The connections you make are costly and much more real than a friend on Facebook. The connections you make are the difference between a good hospital and a great hospital.
Everyday you confront and hold hands with matters of life and death on behalf of us all. There is nothing more sacred. Thank you and may God go with you in all you do.
The Rev. Canon Andrew Gerns is the rector of Trinity Church, Easton, Pa., and chair of the Evangelism Commission of the Diocese of Bethlehem. He keeps the blog Andrew Plus.