Going to church to wake up

by Pamela Grenfell Smith

Four thousand miles from home, in a city where I didn’t speak the language, I’d staggered off the plane more than a week ago but I still couldn’t get myself in focus. Then we went to a concert. The first piece was Gregorian chant, a familiar passage from Wisdom. Hearing it, tears came to my eyes and extra air somehow returned to my lungs. In the music and text I rediscovered myself, my own inner voice, my capacity to act.

Liturgy – even this small dose of liturgy - can wake us up, take us from clock time to kairos-time, re-situate us as active listeners. Singing, responding, we’re put back together, restored again to our own capacity for what social scientists call agency - an idea that is studied in all the human sciences and generally means the capacity of people and groups to act independently towards their own goals.

Personal and shared agency comes and goes, and has to be discovered, re-discovered, nourished, and reflected on. After the birth of my first child, I had a lot of trouble pulling myself together. We had moved – three thousand miles – leaving behind a crowd of friends and a job I loved. Alone all day with a much-loved baby, I spent a lot of time staring at walls. I hesitate to say that I was depressed, but I was certainly befuddled. At some point our daughter got strep throat and had to be given antibiotics on a strict schedule; I remember looking out at some lawn or other and thinking, this is serious. I sure wish there was someone who could take responsibility for this. And then: HEY. THAT WOULD BE ME. Behold the re-discovery of agency.

Routine and befuddlement aren’t the only potential threats to my capacity to act independently towards goals I have chosen, my sense of agency. Also on my list: pain, fatigue, grief. Meditation helps me know, name, and muffle these inner neighbors – when I find enough agency to meditate.

Let me name another threat to agency, a massive one that we may all have in common: overwhelmedness at the complexity and pace of change in our understanding of the world. I hear overwhelmedness in the voices of those who look on the sorrows of the world’s peoples - the destruction of its ecosystems - the suffering of its creatures – and find themselves believing there is nothing they can do to help. I hear it also in the voices of those who are overwhelmed by social change and respond with anger and resentment.

These failures of agency, these twin passivities of hopelessness and rejection, are toxic to us all. Is there a way we can hold them up into the healing power of the Gospel? Agency is social-science talk, so let’s reword this in God-talk: we are co-creators with the Holy One of this holy world. Day by day, minute by minute, the future is transformed by our choices and by our failures to choose.

And so I return to the capacity of liturgy to call us back into ourselves. Sunday morning is a powerful tonic for my own sense of agency – so much so that I’ve come to think that one of the roles of the parish church’s liturgy is to re-articulate and re-energize the human capacity to choose and act. Corporate worship is always an urgent, transformational opportunity to restore the people of God. We gather, sing the songs, speak the words, tell the stories, raise the prayers, and become more fully able to choose and act in Christ.

Pamela Grenfell Smith is a storyteller and hymnodist in Bloomington, Indiana. Find her hymns, projects, and liturgies at babayaga.org or friend her on Facebook to hear about her knitting and her grandchildren.


by Kristin Fontaine

I've been thinking about addiction as a result of all the news swirling around Phillip Seymour Hoffman's death. Many columnists, bloggers, and twitter users have condemned him for losing control. However, one of the best things I read was the suggestion that we should celebrate the extra 20 years he gave himself by being clean for as long as he was. Maybe it wouldn't hurt to look at people who pull out of addiction and get clean as more similar to cancer patients whose disease has gone into remission. We would never say some of the things that have been said about Mr Hoffman to someone whose cancer reemerged after years of being in remission.

Given the powerful nature of addiction, and how unpredictable it is from person to person, celebrating the gains rather than demonizing him for his failings seems the kinder way of looking at the situation. I have friends who lost family to addiction, lived with an addict, seen the damage left behind for children of addicts, so I am not inexperienced in the devastation addiction can leave it its wake.

Looking at the extra time gained, gives credit where credit is due to the tremendous battle some addicts face in trying to survive their addiction. Moving more firmly to a disease model of addiction (and for that matter mental health issues in general) acknowledges the effort the person made to control something that we don't even fully understand medically yet. So the next time I am tempted to say 'what a waste' when I hear of someone who 'fell off the wagon' and died as the result of addiction, I want to refocus and treat them like anyone else who has been diagnosed with a severe, recurring illness, and take joy in the extra time that was granted by their effort to get help in the first place.

As a result of recent personal experience and of thinking and reading the many thoughtful posts that came out as a result of Mr Hoffman's death, I came up with my own metaphor for addiction.

I had an itchy patch of skin that didn't want to heal-- in part because I kept scratching it. In the moment, it felt very good to scratch the itch, but I kept damaging myself in the process. Very short term relief set the healing back each time.

Now my rational brain recognized this and I did my best not to scratch and damage the healing skin. My rational brain can remind me to use my medication and to trim my fingernails; however, if you've ever had a really bad itch, you know that the moment your mind is on something else, you look down and find that you are bleeding once more. All the rational brain thinking can't overcome the sneaky hind-brain when the rational brain is distracted, sleepy, or overwhelmed.

I don't know if I can convey the level of compulsion in words, but the experience has given me a visceral reason to celebrate every day an addicted person stays clean rather than blame them for losing a battle that they did not get to choose in the first place.

Kristin Fontaine blogs at Ceramic Episcopalian.

Forgiveness is not re-booting or cache clearing

by George Clifford

On a recent trip, I visited a public library where I had previously used a convenient, free Wi-Fi hotspot. Unlike my prior visits, I could not connect to the Internet even though my computer received a strong signal from the network. After I rebooted my computer and still had no success, I spoke with one of the librarians. She was very pleasant, informed me that several people had complained about difficulties connecting to the internet that day, asked if I had tried rebooting my computer, and then apologetically told me that library policy does not authorize the staff to reboot the network.

Both the librarian and I were aware that rebooting can correct many computer glitches, sometimes so effectively bringing closure to problems and rectifying the situation that no trace of the prior difficulties remains.

Driving from the library to another Wi-Fi hotspot prompted me to reflect on rebooting. Most people probably have a few moments when they wish that humans came equipped with a reset button with which to reboot life or a relationship, moments for which we want (or need) forgiveness and/or closure.

Humans, however, differ from computers. Rebooting a life, or even a relationship, is impossible. Our brains record data from every experience. Some of that data may degrade over time, some may become inaccessible to one's conscious mind, but no data set is ever likely to be entirely deleted (apart from permanent brain injury or a debilitating neurological disorder).

Popular theological and spiritual descriptions of forgiveness as wiping the slate clean therefore rely on an unhelpful metaphor. We can more powerfully conceptualize forgiveness by picturing it as removing the barrier that an injury or wrong places between two people, or even between God and a person.

For example, in the fifth chapter of John's gospel, Jesus tells a paralytic, Walk! The paralytic, and probably most of those present, shared the worldview that paralysis resulted from sin, that is, a wrong done to God or neighbor prevented the person from walking. Jesus' injunction to walk shattered that perceived barrier, communicated forgiveness, and brought healing. The gospel is also clear: the paralytic, after his healing, remembered his paralysis and, by inference, the circumstances that had led to his paralysis.

Decades of ministry have taught me to recognize the paralysis that sin causes. One of my first parishioners refused to enter the church, insisting that a nameless, unforgivable sin would cause the roof would collapse. In retrospect, I now recognize that parishioner lived in the shackles of paralysis caused by sin. Other cases of paralysis caused by sin were perhaps less dramatic but no less real: individuals trapped in dead-end, destructive relationships convinced that s/he deserved nothing better; individuals unwilling to succeed, believing that they merited only failure; etc.

Most of us have moments that we wish a rebooting would delete. Those moments need not paralyze us; the reality of forgiveness can shatter the barrier or barriers that prevent us from living abundantly. Jesus incarnated God's forgiveness; his words to the paralytic echo across the years, words we can hear him speak freshly and directly and freshly to us: Take up your pallet and walk; live fully, as God intended.

One of my pet liturgical peeves is people pausing between two inseparable phrases of the Lord's Prayer: forgive us our trespasses PAUSE as we forgive those who trespass against us. The PAUSE insidiously implies that experiencing God's forgiveness is detached from our forgiving others when actually the two are indivisible. Resenting others blinds and deafens us to God's grace; spiritually, and perhaps otherwise, negativity immobilizes us.

Yet forgiveness is not rebooting. Living with moments that we would prefer to delete and the associated remorse can help us to learn from our mistakes and to avoid, at least some of the time, hurtful repetition.

If rebooting – starting fresh with no lingering memories of the past – is impossible for humans, is closure also impossible?

The phenomenon of people explicitly talking about closure is relatively new. Couples ending their relationship want closure. Bereaved persons seek closure. Families missing a loved one (a member of the armed services missing in action (MIA), a person presumed to have died in a natural disaster but whose body remains undiscovered, etc.) yearn for closure. Traumatized persons pursue closure, wanting to move ahead with life free of their injurious past.

Aiming for a type of closure that connotes erasing all memory of a relationship, no matter how desirable, is to tilt quixotically at windmills. The physiological reasons that prevent human rebooting also thwart any closure that entails erasing memories. Furthermore, the plasticity of the human brain records and then subsequently contributes to the unique interaction of the physical and experiential that shapes an individual. Erasing every residual memory trace of a relationship, regardless of how painful or damaging the relationship, would alter a person in presently unimaginable ways.

Instead, genuinely constructive closure adds a new layer or sequence of experiences to an existing relationship, as an author might add a new chapter to a book or a composer might append additional measures to an existing opus. The new complements or completes rather than replaces the old. A couple may rejoice for what they shared, jointly acknowledge what has changed, and together release the other from the vows that once expressed their mutual claims upon the other. Symbolically, the bereaved says goodbye to the deceased, admits to feeling abandoned (or other negative feelings), and takes the first tentative steps to a new life. Families tell stories to remember the missing and honor the life shared; through caring expressions for others, done in the name of their beloved, they can give the gift of hope and enable the missing to live again. Traumatized persons may metaphorically burn their memories, expressing their decision to not allow a painful, injurious past to monopolize the present, discovering in the release living springs from which spiritual gifts flow.

Forgiveness and closure, unlike rebooting, are inflection points in the spiritual life. The option for Reconciliation of a Penitent in the Book of Common Prayer's Pastoral Offices and the new liturgy for the Dissolution of a Marriage are helpful rites for marking and more fully experiencing God's grace in inflection points. We would do well to create more such liturgies, for in inflection points God acts, barriers fall, and we experience life a little more abundantly.

George Clifford is an ethicist and Priest Associate at the Church of the Nativity, Raleigh, NC. He retired from the Navy after serving as a chaplain for twenty-four years, has written Charting a Theological Confluence: Theology and Interfaith Relations and Forging Swords into Plows: A Twenty-First Century Christian Perspective on War, and blogs at Ethical Musings.

The literally life giving power of stories

By Marshall Scott

It won’t surprise anyone that I peruse medical journals for entertainment. I don’t claim to understand everything I read; but I still find fun in it.

And sometimes I find something that particularly catches my interest. During one such session not long ago, I actually found two. One was this title for a research study: “Culturally Appropriate Storytelling to Improve Blood Pressure” (Annals of Internal Medicine, 2011; 154:77-84). The second was another study with a title apparently similar, but subtly different: “Effect of Preventive Messages Tailored to Family History on Health Behaviors: the Family Healthware Impact Trial” (Annals of Family Medicine, 2011; 9:3-11).

Now, in my business both storytelling and family history are important things. So, I was certainly interested as I read the articles. As I said, the titles seem alike. However, there are differences, and the differences are important.

In “Storytelling,” a team was looking for a way to provide both information and encouragement for changes in behavior for African Americans with hypertension. African Americans are more likely to have high blood pressure, less likely to get it under control, and more likely to have serious complications. The team thought of storytelling.

Now, at first blush storytelling might seem well outside the frame of reference of modern allopathic medicine. However, for more than a decade now some medical schools have offered courses in narrative medicine. There is some appreciation that we understand ourselves and our lives, not only in light of facts, but also in light of the stories within which those facts have meaning.

So, they began with a number of focus groups made up of African Americans living with high blood pressure. From participants in those focus groups they selected a number that told their stories well. They recorded them telling their stories, and put the stories on a DVD, along with additional information on hypertension. They then provided DVDs to African American patients with hypertension. Study patients (both those with controlled and uncontrolled hypertension) received study DVD’s. Patients in the control group (whose hypertension was also not controlled) received a DVD with basic health information. Investigators hoped that study patients whose hypertension wasn’t yet controlled would show improvement, and that patients who hypertension was controlled would sustain their existing control and behaviors.

And it worked. It didn’t make a big difference for the patients whose hypertension was already controlled. However, for those for whom hypertension wasn’t controlled, those who watched the DVD had a significant improvement (lower average numbers) in their systolic blood pressure (the first number in blood pressure) over the control group at three months. In fact, the patients were followed for nine months; and while the average pressures for all patients went up between three and nine months, there was still a significant difference for those who had watched the study DVD.

What made the difference? Well, the investigators suggest (and I agree) that personal stories about living with high blood pressure were more powerful than a straight lecture, and especially when the person telling the story looked and sounded like them. As a result, they were more likely to embrace and maintain the lifestyle changes that led to better control of blood pressure.

The second study seemed to suggest the same point and yet had different results. The article “Family History” reports on the Family Healthware Impact Trial. Family Healthware is a software program developed by the Center for Disease Control (CDC) as an interactive tool to allow patients to record information on family history for six common diseases and for related health behaviors. When the user has completed his or her entries, the software generates a health risk assessment for the various diseases based on family history. It also provides health messages and suggestions for healthy behaviors. The thought was that because these health messages were customized and based on the patient’s individual family history the patients would find them easier to adopt and maintain. They selected 2,364 subjects in the control group, and 1,422 in the control group, and followed them for a series of good health behaviors (smoking cessation, eating more fruits and vegetables, getting more exercise, taking aspirin daily, tracking their blood pressure, and getting cholesterol and glucose checked regularly). Study subjects received the report with risk assessments and health messages connected to their individual family histories. Control subjects received a set of standard health messages, not individually tailored.

Surprisingly, investigators did not see the results they had hoped for. Study patients did show increases in eating fruits and vegetables, and in getting exercise; but for the other health behaviors results were small to insignificant. For most of the behaviors, the fact that the recommendations were based specifically on patients’ family histories didn’t seem to make much difference.

As I read the article, I realized that there was a significant difference between the studies. In the first study communication with the patients was not only customized, but specifically reflective of their community, and, really, of their own lives. In the second the messages were customized the family history, but were not specifically reflective of the patients’ communities. They were the standard medical messages, and not personal stories. While the messages in “Family History” were arguably just as useful, the stories in “Storytelling” were more meaningful, in that they were more related in their expression to the lives and experiences of patients.

Now, this is one of those moments where we notice the differences in how we see the world. In modern medicine, “if it didn’t get documented, it didn’t get done;” and if it hasn’t been documented in a formal research study, it can’t be approved. For the rest of us, and especially for those of us in the church, the reaction is likely to be, “Well, duh!” Our most important information is rooted in story – specifically, in the story of what God has done for us. Moreover, as any person in the pew can tell you, it is shared more effectively in story than it is in simple discourse.

Fact is, this is at the center of our lives as Christians. We are committed to receiving and passing on the Gospel; and since we receive it in and through story, we are committed to passing on the story, and not just the principles and conclusions that we derive from the story. Even in passing on the principles and conclusions, it is in story that we find them meaningful. That makes it important that we find ways to pass on the story that are culturally relevant for those we pass on to. I have said over the years that central to the task of theology is translation of the truths of the faith into a language understood by those we seek to reach. That is simply another way of saying that as we pass on the faith, we do best to do so in ways that are, as the study says, “culturally relevant.”

We know, really, how this affects our evangelism. From the first efforts at translating the Scriptures in to a language understood by the people – arguably, we could go back to the Septuagint, and even farther – we have been making our efforts to share the story in ways that are culturally relevant. At times in our history we have not only identified new languages, but even created alphabets for the purpose (Cyril and Methodius come to mind). We wrestle with it within our congregations (how shall we teach our children?): in our communities (what will reach Gen X or Gen Y?): and across the Body of Christ (as one example, just what do we all think about the Chinese Three Self Christian Movement?).

At the same time, it also raises some anxiety: is there a point where cultural relevance begins to dilute, even pollute, the faith we seek to convey? How many times did European missionaries feel that they had not only to translate the language of the faith, but also to make faux Europeans of the evangelized? How well otherwise do the stories we receive translate? How well do our stories, the experiences in which we find the meaning of the faith confirmed, translate? I have noted that one of my favorite books is Martin Palmers’ The Jesus Sutras: Rediscovering the Lost Scrolls of Taoist Christianity. In that work he translates a number of documents, produced by Chinese Christians over a couple of centuries. By the later of those documents, the effort is clear to translate the stories not only into Chinese characters, but into Chinese terms. When the stone stele of the Religion of Light, produced in 781 CE, speaks of Jesus in much the same terms as a bodhisattva, is that a culturally relevant meaning, or is it a step too far?

By the same token, we know just how central this anxiety is in our current Anglican difficulties. Each side finds points at which the other side addresses and embraces the culture; and each side asks whether the other has gone too far. I have written before here at the Café of one cultural difference – whether one lives in an individualist or a “communalist” culture – that I think makes our communication difficult. Another is between those who feel that what God wants us to know is conveyed in the contents of Scripture; and those who feel that God also wants us to know what we learn through scientific study, and to wrestle with how both can be meaningful in our lives. This difference is critical because the details of what we learn through scientific study also shape the stories that we use to make meaning. In the case in point, we do have different understandings of what it means to be human when some of us want to quote only Scripture, and some of us also want to include information from medicine, anthropology, and psychology.

In that case, it can be tempting to try to turn again to specific tenets, to distill from the received stories concepts that transcend the limits of our languages and our stories. That, too, has been an ongoing process, from Augustine to Aquinas to Tillich. Yet even then we discover that cultural relevance lurks in the wings. Each academic theologian is working with a philosophical language that reflects its own time and shapes its future – in my examples, Neo Platonic to Aristotelian to Existentialist forms. As much as some might try to see them as more pure and more abstract, each theologian and the language the theologian seeks to use is shaped not only by concepts, but by cultures and the stories through which those cultures make and find meaning.

And with each generation we discover it anew, or at least we think we do. We discover that our efforts to abstract concepts and convey them by discourse – as in, for example, modern allopathic medicine –don’t help people live in the way that we might hope. In a very real sense they aren’t meaningful, because they don’t relate to our experiences and our perceptions. We return again to stories and storytelling. It is how we make meaning in our lives. It is how we connect our past with our place in the world now, and how we shape our hopes for the future. Critically for us, it is how we live in Christ. It is how “the faith once delivered to the saints” becomes our faith. It is how we discover that faith can live in our own lives. It is how we pass on the faith we have received to those who come after. It is how we know what Christ has done for us, and is doing in us; and how we know that he will be with us even to the end of the ages.

The Rev. Marshall Scott is a hospital chaplain in the Diocese of West Missouri. A past president of the Assembly of Episcopal Healthcare Chaplains, and an associate of the Order of the Holy Cross, he keeps the blog Episcopal Chaplain at the Bedside.

Dementia and the language of the soul

By Martin L. Smith

How many years do I have left with a clear mind?—a question I asked myself a few days ago after I had phoned to check how my godmother is doing in her nursing home in Toronto. Her Alzheimer’s has been progressing over 15 years. One of the most poignant losses is the total eclipse of her religious awareness. She had been a faithful Christian all her life, indeed, she was the only religious woman my father knew, which is why I ended up with a godmother who lived 3,000 miles away. Rising to the challenge, she nurtured my faith wonderfully well from a distance, with books, letters and prayers. And now the disease has taken away every conscious vestige of the faith that had sustained her. It could happen to me. It could happen to you. It may have already happened to someone you love. As life expectancy grows, more of us will live under its cloud than ever before.

I have been thinking how important it is not to lose the language of soul in our faith today. You hardly ever hear about our souls. The concept is commonly regarded as antiquated, tied up with an obsolete notion that our bodies are inhabited by a kind of entity that floats away to heaven when we die. But if that concept is misleading, it doesn’t mean that we should stop referring to soul. To talk of our souls is to point to an ineradicable core to our being. In the ‘innermost person’ our lives are ‘hidden with Christ in God’ (Col. 3:4) in a bond that no loss of brain function, however ravaging, can diminish. Far from being obsolete, deep faith in the soul is a vital assertion of our absolute human equality in God. When it comes to our souls, we are all equals and remain so. At the core level of soul, the man or woman who has succumbed to complete dementia is equal in dignity and worth and spiritual standing to the brother and sister whose brains (so far) are in brilliant form.

If we let the language of soul fall into disuse, a malign sense of inequality can creep in. Just because a woman or man has lost the ability to remember or recognize those she or he once knew, we might be tempted to think of them as blighted lives best put out of sight, out of mind. We may find ourselves tolerating horrible clichés about people ‘becoming vegetables.’ We may look down pityingly on those whose brain functioning is compromised as our inferiors. But the souls that God holds in life are not diminished, even though the brain is injured. In God their suffering, and the eclipse, partial or total, of awareness, diminishes them as persons not one iota. Rather they might be the special objects of God’s tender and compassionate regard. My godmother refuses the offer of Holy Communion as something incomprehensible to her, even irritating. But her soul’s union with Christ cemented by decades as a communicant is as real and solid as it ever was, isn’t it, though accessible to us only by the second sight of empathic faith?

Where the language of soul has not been lost, those with dementia are cherished within the community, not abandoned. For years I used regularly to celebrate the Eucharist in convents and the nursing homes they ran, and learned the ropes of including those with dementia in the act of worship. I remember a mother superior looking at me with a searching smile to see how I would react when a rumpled but feisty old nun would start to scream obscenities as I gave her communion, whether I could muster both humor and respect in this incongruity. And I remember one contemplative convent where one of the oldest sisters would frequently interject into the services an amazingly penetrating rendition of “Hickory, dickory, dock, the mouse ran up the clock.” I got the impression, from the equanimity with which this was woven into the service, that her sisters believed that God lovingly accepted her song as her way of worshipping, a language that God had no difficulty in decoding.

The thought that I myself may enter dementia eventually is not new to me. For some years I served as a volunteer subject in Alzheimer’s research in a Boston hospital, so I am aware that dementia is not something that just happens to someone else. Tests revealed a brain in fine form, but if dementia is my destiny I hope I will be surrounded by people who have faith in the reality of my soul, and acknowledge that within the confusion and fog is that intact and abundant inner man whose life—here’s that priceless verse again from Colossians—is “hidden with Christ in God.”

Martin L. Smith is a well-known spiritual writer and priest. He is the senior associate rector at St. Columba’s, D.C.

Keeping death before our eyes

By Leo Campos

In talking with a friend of mine who works for a divorce lawyer, she told me the story of a client who is dying of cancer. All of us have been directly affected by cancer, and most of us have been directly impacted by the death of someone close. We also know plenty of survivors and we rejoice with them. This is one of the reasons why every year I join the Susan G. Konnen Race for the Cure here in Richmond. I have been taking my son since he was 6 to run the 5k with me. He is quite knowledgeable about cancer by know, and a strong advocate of wearing pink.

There is something very bitter about terminal illnesses that comes from the degeneration, usually quick, of a loved one before our very eyes. It is as if they are running their lives in fast-forward while we are in normal speed. It is not as if any of us do not know we are going to die (excepting the chronic megalomaniac and teenagers). It is not death as such, I believe, that is shocking and bitter about this. Rather, it is the rush towards death which the disease causes, bringing with it accelerated suffering.

We are all dying slowly, at a natural pace, at an orderly rate. Cancer and other diseases break that unspoken contract, and go speeding down the road. We cannot keep up - emotionally, mentally, spiritually.

Monastic wisdom has always recommended that everyone keep in mind their mortality. Benedict in his Rule suggests that the religious keep "death in mind at all times". At first blush nothing seems to be less desirable. Why would I want to remember such a depressing thought? To our ears it seems like a morbid focus on the negatives.

Here it is important to find ways to take a step back and assess our own judgments. First, we live in an age which idolizes youth. Everything, nearly everything, is about staying young. Our whole culture has a form of thanatophobia (fear of death) which seems to have reached unprecedented levels. If you listen to the news (something I highly discourage) you will see that almost all the dire health warnings, the "obesity epidemic" or the tobacco pogroms that are going on, they all reference how eating fatty foods leads to...premature death. Smoking leads to...premature death. Lack of exercise...premature death. And then take the advertising for cosmetics and other drugs. They are "age-defying", "youthful looking skin", "feel young again!"

So when a voice from the past, a voice which lived in a world where death was imminent, and the expectancy of a long life was of about 40 to 50 years, that message seems so foreign as to be nearly alien.

But if we allow ourselves a little patience and the space to deal with issues of mortality, we will find much wisdom in the idea of keeping death before our eyes. All this means is that we need to make decisions based on reality. I have found that I tend to make decisions as if I was going to live forever. Is it a mistake to do this or that? -- it does not matter if I have infinite time to fix any mistakes.

But let us go a little deeper. Keeping death before our eyes is possibly the most effective way to counteract our implicit egotism (also known as "unconscious self-enhancement" - I love that phrase!). We all are egotists and we work hard at transforming our environments to both bolster our self-image and to protect it from any harm. Notice that I say "it". But no matter what barriers we put up, no matter what Neverlands we build, death always enters. And disease (always a threat) is the ultimate offense to our anxiety for immortality.

Back to my friend and her story about the client who was dying of cancer. You might wonder why she needed a divorce lawyer? Because her final wish was to get divorced. The lady was so weak they needed to go out to the car to depose her. She could die any day - so the paperwork needs to be rushed.

I am not sure if this is tragic or liberating (it certainly is uncommon). But death makes individuals of us all. At death's door we will stand in our own convictions and our own faith - nothing imported will do.

When you have all those external things that support you in life removed, what will you stand for?

Brother Leo Campos is the co-founder of the Community of Solitude, a non-canonical, ecumenical contemplative community. He worked as the "tech guy" for the Diocese of Virginia for 6 years before going to the dark side (for-profit world).

"I am having a hard time with this, Chaplain"

By Marshall Scott

I’ve been thinking about another of my frequent conversations at the bedside. It begins with, “How are you doing?” And while it might wander a bit, frequently it comes back to this: “I’m having a hard time with this, Chaplain; but they say that God won’t give you more than you can handle.” My initial response to this is, “Perhaps; but I often find myself wishing God didn’t have quite so much faith in me!”

“God won’t give you more than you can handle.” This is another of those axioms that most folks think is found somewhere in Scripture. It’s like “The Lord helps those who help themselves,” a saying so pervasive in our culture that it has its own aura of authority. Everyone says it, so it must have an authoritative source; and since the subject is God, the source must be Scripture.

Like to many other common sayings about God, though, this one doesn’t really paint God in that good a light. Perhaps we wrestle with the second half of the saying, “more than you can handle;” but I have a great deal more trouble with the first: “God won’t give you.” It continues that belief (and, honestly, one that can be based in Scripture) that God is directly and personally responsible for each event in our lives, both the blessings and the injuries.

Now, often we rail against this, we chaplains, as do others. “What does that say about God?” we ask. “Do we really want to believe in a God who ‘tests,’ who does harm?” We find it more attractive to think of Lamentations 3:33: “for he does not willingly afflict or grieve anyone;” even if it means that we have to ignore the verse just before, 3:32, which begins “Although he causes grief….”

I can see, though, why the image of the God who tests, the God who causes grief, continues to be attractive. In a time when people feel out of control – and few people feel more out of control than hospital patients – there is some comfort, some security in the thought that this is all managed. Even if I am not in control, God is; and so this time of trial and confusion has meaning.

Even more powerful, perhaps, is the sense that the suffering person has God’s attention. Even if God has afflicted me, it is at least a sign that I have God’s attention. It may not be undivided, but it’s certainly clear. I have sufficiently held God’s interest for God to decide to test me.

Still, many of us, and not just chaplains, would resist this image of God. We would look, for example, to the lessons for Lent III. We would look at God as Moses encountered him at Sinai. “Then the LORD said, "I have observed the misery of my people who are in Egypt; I have heard their cry on account of their taskmasters. Indeed, I know their sufferings, and I have come down to deliver them from the Egyptians, and to bring them up out of that land to a good and broad land, a land flowing with milk and honey….” He has seen suffering and has come to deliver. The suffering isn’t some kind of test, some affliction from God; but that doesn’t mean that God isn’t interested or concerned for his people.

Granted, the Gospel lesson for Lent III might not seem so helpful. Well, perhaps we might consider it a mixed bag. Certainly, Jesus calls for repentance; but neither the murdered Galileans nor the victims under the Siloam tower were identified as worse sinners, worse offenders.

And then there’s that parable of the unfruitful fig tree. The owner of the vineyard has expected results, results that haven’t come despite years of waiting. It is not the owner of the vineyard but the gardener who shows patience, even if that is limited.

But, I wonder if we read this right. It seems obvious to read this and think that the vineyard owner must represent God. But what, I wonder, if this isn’t so obvious? What if there’s another way to read this? What if Jesus is more subtle than we expect?

And Jesus is really central to this question. Which character is more like Jesus? Which character is more like God as God has revealed himself in Jesus? Which character seems better to reflect forgiving seventy times seven? Which character seems in all things to do good for those under his care? Which seems more like a high priest who intercedes for us unceasingly? Isn’t it the gardener?

How, then, shall we account for the tests, the challenges? Well, certainly there are challenges in life. Some we can even attribute to God, without making any suggestion of personal animus on God’s part. There are circumstances of the world as we know it, not least of them our free will, that present us with tests and challenges and setbacks. So we read in Paul the passage that I think lies behind our problematic maxim: “No testing has overtaken you that is not common to everyone. God is faithful, and he will not let you be tested beyond your strength, but with the testing he will also provide the way out so that you may be able to endure it.” Suddenly, the point is not that God won’t test us beyond what we can bear. The point is that when we are tested by all the things that flesh is heir to, God will be with us, and will provide us what we need to endure.

And, really, that is the focus of the passages from Lamentations: “Although he causes grief, he will have compassion according to the abundance of his steadfast love; for he does not willingly afflict or grieve anyone.” It isn’t really about God putting us to the test, for “he does not willingly afflict or grieve anyone.” Rather, in the face of pain and grief, even if it seems God has some hand in it, his compassion is with us and his love is steadfast.

“I’m having a hard time with this, Chaplain; but they say that God won’t give you more than you can handle.” Well, I can’t endorse the thought that God has brought this affliction; much less that God has calibrated it to the individual limitations of this patient. Still, I’m less interested in teaching patients the right theology than I am demonstrating it myself. So, my call isn’t to challenge or to correct. Rather, my call is to reflect by my care the steadfast love and compassion of God in Christ. I am called, I think, to be like the gardener, providing resources for health and wholeness so as to give the patient the best chance. Then I, and all of us caring for the patient, staff and volunteers and family alike, take our part in God’s providence. We can become for the patient the extra care, the extra strength, the extra love: we can become for the patient “the way out” that God intends, so that the patient can endure.

The Rev. Marshall Scott is a chaplain in the Saint Luke’s Health System, a ministry of the Diocese of West Missouri. A past president of the Assembly of Episcopal Healthcare Chaplains, and an associate of the Order of the Holy Cross, he keeps the blog Episcopal Chaplain at the Bedside.

Love came down at Christmas

by Kay Flores

A few weeks before Christmas, my friend Andrew asked what time our Christmas Day service was scheduled. I hated to say we didn’t have one scheduled – but it was true, we didn’t have one scheduled. Our small congregation had decided to focus our efforts on two special services: the Banging-of-the-pans-to-drive-away-the-dragons-of-darkness service (followed by Compline) held on December 21, and our Christmas Eve service, and there wasn’t much energy around another service on Christmas Day.

Andy then had a great idea: Let’s take Eucharist to our new rehabilitation hospital, where our friend Kay Rohde is hospitalized.

Kay, an Episcopal priest, and until recently the Wind and Wings youth coordinator in the Diocese of Wyoming, was told in late November that the numbness in her leg was caused by a tumor on her spinal cord. By early December she had the surgery to remove it. A few days later she was moved to Elkhorn Valley Rehabilitation Hospital in Casper, and has been hard at work ever since as her body relearns the physical skills she needs.

I was excited about Andy’s idea, and immediately took it to Kay. She consulted with the administration at Elkhorn Valley. They enthusiastically agreed to host a 10:00 a.m. service, as long as we made it an ecumenical service. As part of her occupational therapy, Kay made and delivered flyers to the other patients. We agreed on a service from the Iona Community, and my friend, Temple, and I prepared the bulletins. Our altar guild packed a to-go box containing a chalice, paten, and wine. A neighboring church shared gluten free wafers.

Kay Rodhe tells the rest of the story.

Folks began to gather in the cafeteria. The altar was a bed side table, set with chalice and paten. St. Stephen’s had prepared the worship leaflets, and the two young people from St. Stephen’s, Elizabeth and Catherine Kerr, handed them to the patients as they began to arrive. The room was full of the Spirit as the 20 patients and 9 members of St. Stephen’s sang O Come All Ye Faithful. We read the Christmas story from Luke and reflected a bit on the wonder of Love coming down at Christmas, and that no matter what is going on in the world, Love always will risk to be present - based on a poem by Madeline L'Engle. I looked out at the congregation, most in wheelchairs, some not able to speak out loud, but God was there - in their eyes, in their smiles, in the Spirit of Love that connected all of us. We blessed the bread and the wine and as communion was distributed, we sang more Christmas carols. We thanked God for the meal and for sending Love down to dwell among us and closed with a rousing verse and chorus of Angels we Have Heard on High. For those of us there, Christmas had come once more - and the feeling spread down the halls as they returned to their rooms to get ready for Christmas Dinner -(served to us by the hospital staff).

The thing about ministry is that when you minister to someone else, you are being ministered to, also. That was certainly true for me today. With the help of St. Stephen’s, we were able to give those here in the hospital a gift - to be able to worship on Christmas, to hear the Gospel, to sing the carols, and for those who wished it, to receive Communion. But I received gifts also. I had been feeling a bit down last night - about the time that midnight services would be starting. I badly wanted to be there, to hear the O Come let us Adore Him, to hear the music and smell the pine boughs and feel that incredible sense of awe at being a part of the Christmas story. Today, celebrating in a rehab hospital cafeteria, no candles, no booming organ, no pine boughs or choirs, just a small group from a little church in Casper who were willing to share their worship with people they didn't even know and a hospital full of people in pain, just recovering from traumatic surgeries, people who are trying to relearn how to walk, people who may never walk again - that same awe was there. Love came down at Christmas and wrapped arms around each one of us - and you could feel it! And for me another gift: One of my rehab goals was to be able to continue to function as a priest - and I am!

This is no time for a child to be born,
With the earth betrayed by war and hate
And a nova lighting the sky to war.
That time runs out and sun burns late.

That was no time for a child to be born,
in a land in the crushing grip of Rome:
Honour and truth were trampled by scorn-
Yet here did the Saviour make his home.

When is the time for love to be born?
The inn is full on the planet earth
And by greed and pride the sky is torn-
Yet Love still takes the risk of birth.

~~Madeleine L’Engle

Photos by Elizabeth Kerr, click to enlarge, more photos here

Kay Flores, St. Stephen's, Casper WY, is soon to be ordained transitional deacon in the church she serves. She is a mentor and trainer for EfM both face to face and online and is an unemployment judge for the State of Wyoming.

Health care: if you can't save everyone, who do you save?

By Marshall Scott

It will surprise no one that I pay attention to news about health care. And these days there is certainly enough news to pay attention to. There’s the ongoing work in Washington that we hope will result in universal access to health care for all in America (and I say “we” deliberately in that the General Convention has called for universal access for a generation and more). There have been two reports, one on breast cancer and one on uterine cancer, each suggesting that screenings commonly accepted for some time aren’t as helpful as we thought. Finally, all of these have led to discussions of what we might and might not be able to offer and include in health care for all.

The conversations on all these topics have been heated. That’s because, I think, the topics have been in one way or another about limitation, and sometimes explicitly about how limitation might apply to each of us personally. We’re not comfortable talking about limitations, really; but we get even more disturbed, and even frightened, when we realize we might have to face limitations ourselves.

For me, though, this has focused my attention on a very personal question: what is my life worth? Actually, for me the question has been less abstract and more comparative: why is my life worth more than someone else’s?

In a way, that’s a difficult question to face. That’s because the applications of such a question are very specific. They’re also very critical.

Let me give some examples. According to current statistics there are more than 100,000 persons who might benefit from donation of an organ. However, in all of 2008 less than 28,000 organs were transplanted. That’s not the number of donors; it’s the number of organs. The number of persons who die who become donors are perhaps 6,000. Now, if my heart or my liver begins to fail, I might indeed benefit from a transplant, but I would be only one of thousands. If I accept a donor organ, I can be sure another person will die. So, why is my life worth more than someone else’s?

We don’t have to choose an issue as blunt as organ transplant. Consider the announcement from the U. S. Preventive Services Task Force changing the recommendations regarding screening for breast cancer. One way of understanding the findings of the Task Force is to consider that 1,904 women between the ages of 39 and 49 would need to be invited for screening to have one breast cancer death prevented. Many women, and many physicians, have been very critical. They worry that, based on the recommendation, insurance companies will deny payment for screenings for women younger than 50, whether for those with circumstances that might indicate an exception or for those who simply want the screening. They point to women who have benefited from mammograms, and ask why 1903 unnecessary mammograms aren’t worth the saving of the 1904th – especially when we can’t really know which woman in the 1904 is the one who will actually benefit.

However, that sounds like a choice between spending resources for mammograms or not. That’s not really the situation. How we use resources (including but not limited to money) is important because they’re limited, and as I said above, resources used in one place aren’t available for another. So, where might we use these resources? According to the CDC in 2005 more than 40,000 women died of breast cancer. However, in the same year almost 330,000 women – eight times as many – died of heart disease. So, if we committed the same resources of those 1900 plus mammograms to heart disease screening instead? Would we save eight women instead of one? Why is the one woman’s life more important than the eight women’s?

We have known for some time that achieving universal access to health care is really a matter of political will. We can do it, but we can’t do everything. I remember from my youth that wonderful poster, “What if we had all the money we needed for schools and the military had to have a bake sale to buy a bomber?” So, perhaps one thing that gets us closer to universal access is cancellation of the F-22 fighter program.

The same thing is true within health care. Just how great our resources for care will be is largely a matter of political will (and no, I don’t think the market will be more effective in meeting our needs in the future than it has been in the past), but they will certainly not be infinite. We will be able to do much, but we won’t be able to do anything. We can give that a negative focus and speak of “rationing,” or we can give it a positive focus and speak of “comparative effectiveness;” but we won’t be able to do everything, and we will have to set priorities.

And as we participate in setting those priorities, I think this is a relevant if difficult question: “Why is my life more important than someone else’s?” I think it’s especially apt for Christians. We are the community of him who laid down his life for us. We remember in light of his sacrifice that he said, “There is no greater love than to lay down one’s life for one’s friends.” So, this question is particularly important for us.

Now, I don’t want to claim any particular nobility here. This question may be easy or hard to ask in the abstract, but I have no illusion that it has to be hard to ask in the particular. If the person at the center of the discussion were my wife or one of my children, I don’t know that I could maintain a sense of altruism.

Still, it seems to me the critical question. Whatever our hopes for health care reform, we know we won’t be able to do everything for every person, any more than we are able to now. Within those limitations we are required to set priorities, and in those priorities there will be some who won’t get what they want, or will only get it at great difficulty and expense. We can hold those decisions at arms length, and let politicians and policy makers take the heat and the blame. Or, we can consider what we would forego as individuals, and call on those politicians and policy makers to use wisely the resources we decline. As a people gathered around one who let go of his life that we might have ours, we have a special responsibility for this very question. Why is my life more important than anyone else’s? And, how will I act on the answer I discern?

The Rev. Marshall Scott is a chaplain in the Saint Luke’s Health System, a ministry of the Diocese of West Missouri. A past president of the Assembly of Episcopal Healthcare Chaplains, and an associate of the Order of the Holy Cross, he keeps the blog Episcopal Chaplain at the Bedside.

The Alchemy of Effort and Grace

In the confluence of personal narrative and reflective theology that often mark the experience of a CREDO conference, the Rev. Brian Taylor, rector at St. Michael and All Angels Church in Albuquerque, New Mexico, and CREDO conference faculty member, offers a look at how change moves into deep transformation. Join an online conversation on the just-released book All Shall Be Well: An Approach to Wellness (William S. Craddock, Jr., editor: Morehouse Publishing, 2009), and visit the CREDO Web site.

By Brian C. Taylor

I live in New Mexico, and my favorite time of year here is the beginning of fall. It’s not just the impossible blue skies, the cool, clear air, the explosive yellow cottonwoods, and the smell of roasting chili. It’s the palpable feeling of change. You wake up in the morning and there’s something electric in the air, something fresh and new, something that is just starting to become. The world is born again.

This is the same feeling that I sometimes get when returning from a good vacation or retreat. I return to my daily life with hope, with a sense of promise. I see that life is what I make of it, and that it just might be possible to slow down and be “perched a little more lightly on the globe,” as Peter Levi described monks in The Frontiers of Paradise: A Study of Monks and Monasteries (Weidenfeld & Nicolson, 1990).

Changes such as these are renewing. But if we’re paying attention, they also hint at a much more compelling possibility: genuine, deep transformation. But how does one move from change to real transformation? There are several models of change and transformation to consider.

One model of transformation relies almost entirely on divine intervention, and it assumes an instantaneous, and sometimes complete, change. This is often how conversion is described: “I was immersed in worldliness, running after women, drugs, and money, living the high life, not even knowing how miserable I was, when BAM! God stopped me cold with a heart attack. I realized that I had been living for nothing. My Christian friend came to see me in the hospital, and there I accepted Christ, and haven’t looked back since. I was lost and now am found.”

This is the transformation of Paul on the road to Damascus, knocked off his horse and temporarily blinded. It is the transformation of an alcoholic who one day walks away from a horribly destructive life, into the light of health and sanity. It happens to people because of a crisis, a powerful retreat, or just because we’re unconsciously ready for God to slap us upside the head.

Miraculous, transformative intervention either happens or it doesn’t. We can’t sit around waiting for an epiphany. And yet this doesn’t stop some from trying to manufacture one: straining to hear the life-changing voice of God in their heads, saturating themselves with emotional prayer by a crowd of prayer-warriors, or sweating it out in rigorous meditation until enlightenment is attained. When the breakthrough doesn’t come, we are disappointed in ourselves (we don’t have enough faith) or in God (who apparently doesn’t care, or even exist).

There is another kind of transformation, one planned and executed through our own efforts. It comes out of the business model. We see it today in programs to lose weight, get in shape, improve our effectiveness at work, build intimacy in our marriage, and yes, grow spiritually. We set overall goals, identify measurable objectives, and practice the seven steps promoted by the author or workshop leader.

A rule of life can function this way, as the practitioner gradually takes on a series of activities that he or she knows will bring positive results. My wife essentially did this on a recent vacation, re-plotting her normally distracted week into a format that would allow for quiet time every morning and painting in her studio for two uninterrupted days every week. Previous efforts such as this never worked for her, but this time the timing was right. The plan took hold, and she changed her life for the better.

But the planning/execution model doesn’t always work. A well-planned rule of life can become the life-killing law that Paul warned about, a method of measuring our spiritual inadequacy when we fail to keep it perfectly (or worse, a source of smugness when we do). Sometimes we are not ready for change; we instead to stew awhile longer in our unhappiness in order to learn a lesson at a deeper level. Sometimes we can’t see what is best for ourselves, and so any plan we might come up with is worthless. There are times when even if we do know the direction forward, we keep bumping into a familiar roadblock that prevents us from progressing.

There is a third way toward transformation, a mysterious interplay of human effort and divine grace.

When I was growing up in California’s Bay Area, every self-respecting teenager had to at least try to surf on occasion. What I remember most vividly about my occasional ventures into the surf is not an image of myself standing triumphantly upon the board, but rather, bobbing peacefully in the water, watching the horizon as swells came in groups, and wondering if this set was going to be The One.

I remember turning towards shore, paddling hard (the boards were long and heavy in those days), only to fall back when I couldn’t catch the momentum of the wave. I remember especially the glorious sensation when my vigorous strokes were magically met by the powerful surge beneath, lifting me up and forward. It was an amazing physical sensation, when, after having waited, discerned, tried, and failed, suddenly my strength and the ocean’s strength came together in a glorious alchemy.

So it is with spiritual transformation. We put in our time in prayer, we go to therapy, read books, talk to friends, offer ourselves in worship, and practice our rule of life. We paddle along by our own strength, trying to propel ourselves forward, hoping to catch a wave of freedom, compassion, simplicity, or intimacy with the divine.

But there is a significant place for the waiting on grace. We float in the deep waters, waiting, praying, watching the horizon. Eventually the waters beneath us surge. We receive insight, we hear as if for the first time a familiar passage of scripture, or a part of the old self just sloughs off like dead skin.

Transformation does not usually happen to us by magic or simply because we will it into being. It happens because we try, we fail, we surrender, we wait, we try again, we get help, we let go, we beat our heads against the wall, we wait some more…and all the while, we do our best to trust that the Spirit is actually working harder than we are, beneath the surface of consciousness. Occasionally we catch glimpses of this graceful work, until finally, when the timing is right, it comes out into the open, when all our efforts are matched by the more powerful surge of grace, and we are carried forward.

Fighting HIV/AIDS in Malawi

By Donald Schell

Malawi 2009

WHAT CAN WE DO? The truth is that, we the youths Are engaging in casual sex And to protect ourselves From HIV/AIDS, we need Realistic advice From our Parents/Church leaders

I imagine we’d be surprised to see this poster in a diocesan office. But my wife, Ellen, and I saw it visiting the Anglican Diocese of Southern Malawi in Africa to meet with the Diocesan Health Officer. Ellen is the International Programs Director for GAIA (Global AIDS Interfaith Alliance) and the Diocesan Health Officer (a full-time public health worker with substantial experience in Malawi’s ministry of health) wanted to discuss GAIA and diocesan program looking for common goals.

The poster and the diocesan health officer both witness to a powerful force that’s changing African Christianity (and Islam). Malawi Christians and Muslims know health issues (particularly AIDS, malaria, TB, and maternal mortality in child birth) are fundamental religious issues. U.N.AIDS says there are 550,000 AIDS orphans in Malawi. Others estimate it’s as high as a million out of a population of 13,000,000. In Malawi, as in much of sub-Saharan Africa, the group most at risk for HIV infection is married women who are faithful to their husbands. Every thirty seconds a child in Africa dies of Malaria. The problems are stark.

Still I wondered why we don’t have posters like the one we saw in our churches in the U.S. The average age for first sexual experience in the U.S. is 15, the same as in Malawi. Forty percent of births in the U.S. are to unmarried mothers. Our epidemiology in sexually transmitted diseases isn’t the same as Malawi’s, but the risks our children are taking are quite similar.

Another poster in the bishop’s office offered a drawing of a Christian clergyman in collar and a Muslim sheikh cheerfully going together for HIV testing. It challenged religious leaders to set the example for their congregations by getting tested themselves and then telling everyone in the congregation to get tested as well.

Trying to tell the truth about sex is changing the African church. Our rhetoric back home says something else because African Christians talking honestly about LGBT people in their congregations lags behind U.S. and European churches and society, but that honesty is coming to Africa too. One Anglican priest we talked with remarked that he’d read in the newspaper that there were “10,000 gay people in Malawi.” With a population of 13,000,000, we’d guess that Malawi has more gay people than that. But what we in the U.S. need to hear was where that priest took the news story. “What would Jesus do for those people?” Jesus would listen to them,” he said, “to understand their experience and then find a way to welcome and serve them.”

Another priest talked of friends who had bravely come out as gay in support of a 2002 national referendum to decriminalize homosexuality. The referendum failed, but that priest said, “I listened to those good people and learned that they’ve known they were attracted to people of the same sex from the time they were children. It’s something about how God made them.” That priest is doing doctoral studies in Malawi on the experience of gay people in Africa. “We have to listen as Africans and tell the story of African gay people. This question is not about people in foreign countries. It’s our own people, our family members, and our friends.”

The American secular and church press typifies African Christianity as a religion of fervor and doctrinal rigor (or rigidity). Of course the real picture is much more complicated.

In visits to Malawi as a volunteer driver, interviewer, photographer and sometime theological consult with GAIA I’ve heard countless stories of seemingly fundamentalist churches and church leaders reaching out in caring support of HIV positive people in their congregations and in their wider communities. American Christians have much to learn from this crisis our sisters and brothers in Africa face. Their earliest response to AIDS (as in the U.S.) was denial and stigmatization, but what we see and hear now again and again is that compassion is displacing judgment as simply and decisively as in Jesus’ parable of the Good Samaritan.

My wife’s work brings her to Malawi at least annually for extensive visits with GAIA’s community-based, grass roots, development oriented projects and programs. On this, my third visit accompanying her, we visited GAIA villages to talk with the network of caregivers for housebound people living with AIDS. We met an old man in his new, mud-brick, grass-roofed house, a house the caregivers built for him because his old house was in danger of falling down around him. He’d lost his wife and all his children. Many of the GAIA caregivers are AIDS widows themselves.

We drove long dirt roads across tea plantations to see GAIA’s mobile clinics in action. We met a woman who was HIV positive but because she had the drug treatment during birth, her son was born HIV-negative. She told us of her great sorrow that her husband still refuses to get tested. As in the U.S., one of the biggest social challenges facing Malawi is empowering women and creating a new society where women and men face one another as equals.

Ellen has seen Malawi churches and mosques come a long way since her first visit here in 2002. The AIDS epidemic was largely not talked about in preaching because sex wasn’t talked about in church. Deaths that have touched everyone in Malawi have changed things here. Change comes imperfectly and haltingly, but it keeps coming. Of course the church’s familiar dilemma is that the epidemic forces us to acknowledge that we’re all as fallible as ‘those sinners’ in the town markets or bars. With brave exceptions like the poster in the Anglican bishop’s office, churches mostly don’t want to talk about condoms. Most church leaders leave condom promotion and distribution to the government. But in so many ways, change keeps coming.

What will it take to change things in the U.S.?

Both of my previous visits, I participated in a U.S. National Institute of Health funded study on the response of religious institutions to the AIDS crisis in Malawi. University of California, San Francisco partnered with GAIA for this three year series of over three hundred in depth interviews with national religious leaders, local religious leaders and local lay participants in churches and mosques, and people living with AIDS (not necessarily connected with the congregations). My own interview assignments included two Anglican Church leaders (as different as two leaders could be on their approach to AIDS) and a Muslim Sheikh. Our pool included Roman Catholics, Anglicans, Baptists, Living Waters (a new Malawi denomination) and Muslims. We transcribed the hours and hours of interviews and back home in San Francisco the research team met monthly to discuss what we were hearing, analyze data, and prepare to report back to the religious leaders in Malawi and to share findings in U.S. and Malawian publications.

I’m repeating myself to say it, but I kept wondering as we read our Malawi data what American congregations are doing to do to make our church’s response to sexual choices honest, genuinely moral, and engaged with people’s real experience.

This trip we gathered the leaders we’d interviewed for two daylong conferences to report back what we were hearing and discuss with them what next action steps they saw their churches and mosques might take. From the research team our presenters included UCSF faculty member Susan Kools, GAIA President Bill Rankin (whom some Café readers will know as the former Dean and President of Episcopal Divinity School), UCSF faculty member Sally Rankin (principal investigator on the NIH study), UCSF faculty member Sharon Youmans, and me.

Susan’s expertise is adolescent behavior and development. She’d overseen a smaller study in Malawi interviewing youth and talking with religious leaders about the youth. Her interviews confirmed that the average age for first sexual experience is 15, just as in the U.S. She also reported that a significant minority (about a third) of girls in Malawi said their first sexual experience was not fully willing, in a range that began with pressured or coerced and extended to rape. Susan talked about the human dilemma that our bodies develop faster than our brains, that judgment and restraint functions in the human brain don’t complete their formation until we’re in our mid-20’s. The group’s first articulated response was, “Well then, we must be more determined to teach pre-martial abstinence.” When more realistic voices among the leaders were quiet, Susan protested that it wasn’t enough to give our children nothing but our ideal for their behavior. Why should they pay for adolescent mistakes with their lives? She spoke of ‘our children’ because we worked consistently to put our own U.S. dilemmas alongside those of the Malawians. The research team was learning alongside the Malawians. So we could ask about ‘our response’ and ‘our children.’ And I ask it again to Café readers – how are American churches addressing adolescent sexuality?

Bill Rankin, GAIA’s president, made the theological argument that victimization of women and children in the epidemic is a justice issue, and he described it alongside our American experience of two and a half centuries of facing up to the injustice written into our Constitution, with its denial of full human rights to slaves and women. Bill showed a PowerPoint slide of Rosa Parks. A Malawian Baptist woman told us later, “we learn of Mrs. Parks in school here.” Bill showed a slide of Martin Luther King speaking at the Lincoln Memorial and said, “This great leader was showing us a way to justice and he was assassinated.” He showed a slide of Nelson Mandela. There were murmurs of pleasure and approval, and then when the slide of Barack and Michelle Obama came up, the conference cheered, and Bill said, “we’ve still got a lot of work to do, but change is happening.”

With America’s slow path to justice and freedom as background, Bill argued that for Malawi, justice requires churches and mosques to acknowledge that women’s physiology makes them more vulnerable to HIV than men. They pay for their husband’s infidelities with their lives. As one Baptist past put it, “If you have an affair and then come home and refuse to use a condom, it’s like putting a gun to your wife’s head.” Women are infected and dying, children are orphaned and dying because women in Malawi are not honored and respected as fully as men’s equals

A happy surprise breaking another Western stereotype was the deep conversation between Christian and Muslim leaders that marked our two conferences. HIV/AIDS is making connections in the practical work of compassion and life-saving teaching, and that practice of compassion is (at least partly) blurring differences of doctrine and bringing common humanity in God into focus.

In two full days of conference, what I heard was the Holy Spirit’s painful, exhilarating work of change. AIDS, telling the truth about the epidemic itself, and the work of service and of letting go of judgment that it brings are changing churches and mosques in Malawi.

The African church is learning to talk about sex, to tell the truth about human experience, and in some important ways, it’s ahead of us in America. There’s still plenty of denial and hope for simple answers and idealized righteousness in the mix, but the epidemic doesn’t allow Malawians the luxury of wishfulness. I hope and pray that Africa continues to move toward a godly embrace of LGBT people, but I also pray that American Christians find a way to face the challenging questions of sex and sexual behavior.

The Rev. Donald Schell, founder of St. Gregory of Nyssa Church in San Francisco, is President of All Saints Company.

Does this car make me look fat?

By John B. Chilton

Contrary to what you might think, people who drive to restaurants are thinner those who walk. But that result is a classic example of an omitted variable. Those who walk are more likely to be poorer and live in neighborhoods that lack an affordable restaurant serving healthy food that is within walking distance. (The thinnest people are those who don't drive and do not have a fast food restaurant nearby.) The study appears in the September issue of the Journal of Urban Health: see this post at the LA Times blog, Booster Shots.

There are similar findings with respect to the availability of grocery stores in poorer neighborhoods -- the poor face lower access to healthy foods, and they pay higher prices. As Daniel Engber observes,

We know, for instance, that the lower your income, the more likely you are to inhabit an "obesogenic" environment. Food options in poor neighborhoods are severely limited: It's a lot easier to find quarter waters and pork rinds on the corner than fresh fruit and vegetables. Low-income workers may also have less time to cook their own meals, less money to join sports clubs, and less opportunity to exercise outdoors.

One thing that gets insufficient attention is that the clearest waste in the American health-care system, if you think of personal choices as part of that system, is primarily at the level of the personal health-care practices: poor eating habits, lack of exercise, smoking, teenage pregnancy, violence. As the economist Greg Mankiw has observed, "For men in their 20s, mortality rates are more than 50 percent higher in the United States than in Canada, but ... accidents and homicides account for most of that gap. Maybe these differences have lessons for traffic laws and gun control, but they teach us nothing about our system of health care." And homicides also teach us lessons about poverty.

We know why we have become less responsible about exercise than our ancestors: the development of labor-saving devices at work and in the home, the automobile, the TV. Less obvious, but also true, we eat less responsibly because the price of food has fallen -- all foods - but especially yummy fatty foods relative to healthy foods. On the plus side, as the result of education, taxes on cigarettes and social pressure, fewer Americans are smokers today than in the past, and we should expect to see this pay dividends in the future.

John Tierney in his Findings column recently presented evidence that the longevity gap between the U.S. and other developed countries reverses if you take account of one major difference: until the 1980s Americans were exceptionally heavy smokers. He quotes medical researchers Samuel H. Preston and Jessica Y. Ho : "The health care system could be performing exceptionally well in identifying and administering treatment for various diseases, but a country could still have poor measured health if personal health-care practices were unusually deleterious."

In a related finding, in a new paper the economist Robert Gordon writes, "A continuing tendency for life expectancy to increase faster among the rich than among the poor reflects the joint impact of education on both economic and health outcomes, some of which are driven by the behavioral choices of the less educated." This could include everything from bad eating habits to teenage pregnancy to gun violence.

Health education in schools is one suggested remedy. And there are various things government might do to create incentives for better individual choices like helmet laws and taxes on sodas, liquor and tobacco. But see this level-headed post on the Food Police -- if we knowingly make bad choices and we bear the consequences, the higher health care costs, what business is it of the government's to intervene; if Americans are especially irresponsible that will make the U.S. look like an outlier in terms of health care costs, but it's not the fault of the health care system per se.

Pooling individuals into insurance exchanges will create a perverse, if perhaps unavoidable incentive towards irresponsible behavior, a perverse incentive that also exists under employer-provided insurance. (It is disingenuous to point out the flaw with the insurance exchanges proposed in current bills working their way through Congress without acknowledging the same is true of employer-provided insurance.) Some of us are lucky enough to have health insurance through our employer. Ultimately the insurance premium the employer pays comes out of our salary. But because I'm pooled with others my premium does not reflect my personal health-care choices which play a substantial, though not exclusive, part in my pre-existing conditions. As a matter of public policy we may not want to penalize those whose pre-existing conditions are beyond their control, but what about those whose pre-existing conditions are?

In short, once you follow the logic full circle, none of us bears the full consequences of our poor personal health-care choices.

If you're like me there's no excuse for not making more responsible personal health-care choices. I'm just taking advantage of the system. I would suggest, however, that some personal health-care practices are not due to freedom of choice so much as they are due to a paucity of options. The poor don't choose to be poor [or do they, in a way?], and many of their options are bad ones. If you can only afford to live in a poor neighborhood what fault is it of yours that your only choices are fast food? Or that you are exposed to more violence? Yes, life expectancy is increasing more slowly among the poor because the poor are more likely to make bad choices due to lack of education, but where is the choice in education if your schools are failing?

Health insurance reform is worthy. But it won't solve a root cause of waste in our health-care system: poverty.

John B. Chilton holds a doctorate in economics from Brown University. He has taught at the University of Western Ontario, the University of South Carolina, and the American University of Sharjah (United Arab Emirates). He resides in Orkney Springs, Virginia, home of Shrine Mont, a Conference Center of the Episcopal Diocese of Virginia. Shrine Mont is the location of the Cathedral Shrine of the Transfiguration. He keeps several blogs.

The necessity of outrage

By Marshall Scott

I was one who had waited with great excitement to see the President speak on health care. I will admit to a certain personal stake in what he would say; I am, after all, a chaplain. I am also an Episcopalian, whose General Convention has affirmed again and again, and as recently as this past summer, the Episcopal Church’s support for universal access to safe and affordable health care.

I don’t think anyone will be surprised that I was largely pleased by what I heard. I was also interested in the political theater of the event. There was a carefully choreographed dance of expression and gesture. The supportive Democrats stood and applauded. In those few times when the President explicitly reached out to the Republicans they smiled, if a bit grimly; and they applauded, if half-heartedly. And between those few references they sat, mute, and unresponsive.

All, that is, except Congressman Joe Wilson. The President came to a part of the speech when he debunked false claims that had been made broadly about the various bills being pieced together. And as the President stated that there was no provision in the bills being pieced together for these benefits to extend to illegal immigrants, Congressman Wilson lost control and cried out, “You lie!” I was shocked at the disrespect, both for the moment and for the Office of the President. Those present were shocked and disapproving, in both parties. Perhaps the person who appeared least shocked was President Obama himself. As he has done so often he simply held his calm and returned to his point.

There was certainly outrage at the incident, and under pressure from House and Senate leadership in both parties Congressman Wilson apologized to the President. The outrage even lingered for a while. It was, of course, a perfect television moment, and it was replayed again and again to feed the needs of the 24-hour news cycle.

I was certainly outraged at the event. We have fallen far if anyone, but especially an elected Representative, should show such disrespect for the Office of the President, whoever currently occupies that office. But quickly I was outraged at something else: I was outraged at the opposition to making provision to provide care for illegal immigrants.

In fact we need to make provision for providing health care for illegal immigrants. The most important reason is simply one of public health; and as we face this fall not only our seasonal flu but also H1N1 flu, we should be acutely aware of it. Those populations that don’t get care provide reservoirs, opportunities for viruses and other diseases to flourish and adapt, and perhaps become more problematic. This is not, of course, because the victims are illegal, for citizens and legal residents will suffer in much greater numbers. It is because they are not identified and treated in a timely manner if at all. We have certainly seen this issue in AIDS and in the return of tuberculosis: populations that fear seeking treatment, whether out of shame or fear of legal consequences or simple lack of resources, create reservoirs of disease that put the rest of us at continued risk.

There is also the economic reason to make such provisions. In some numbers we will be providing care in any case. We will not send them away; indeed, we cannot. The laws that have made it illegal to “dump” patients, sending them from one ER to another based on ability to pay, make no distinction between patients who are insured or uninsured, legal or illegal. We make the case often enough that lack of primary care brings patients to ER doors only when the illness become in some way debilitating. Thus, they arrive at the place where care is most expensive, and at the time when their illnesses are more advanced, more problematic, and more expensive. And we cannot turn them away. Of course, we don’t want to turn them away. Certainly, Episcopal and other faith-based hospitals see their missions as providing care to all to the best of their ability, including those who can’t pay. But, there is also the law; and under the law we have to provide assessment, stabilization,
and care as appropriate and as we are able.

So, we will be paying for them. Those who simply wish they would go away seem sometimes to hope we could somehow not pay; as if our not providing health care would somehow encourage them to leave. So, they want no provision; and with no provision, it becomes another reason that providers have to “cost-shift.” We don’t end up paying through a program, so we end up paying through higher expenses elsewhere.

But for us as Christians, the most important reason to provide for illegal immigrants is moral. These are still our brothers and sisters in Christ. They are among “the least of these” in Jesus’ family, and Jesus himself has called us to provide care and support. They are neighbors; and if they are neighbors who make us uncomfortable, with whom some don’t wish to associate, well, neither was the Good Samaritan. We are called to care for them simply because they have need, and because it is the Christian thing to do.

We are also called because it is just. These neighbors are among us, most of them working and working hard, and they should no more be “muzzled” than the ox that treads the grain. Do they take jobs away from others? That’s debatable; but it doesn’t mean they shouldn’t be treated justly for the jobs they do. They participate in our economy, working and paying local taxes and often income taxes, including Medicare and Social Security – taxes from which they can never hope to benefit. At the same time, we benefit, those of us who expect to receive Social Security and Medicare benefits some day. They participate in this economy, and receiving benefits of this economy is just.

But what have faith-based arguments to do, some will ask, with a government program? Is there not separation between Church and State? Well, in fact in health care there isn’t much. Faith-based institutions receive the same Medicare and Medicaid reimbursements that other institutions do. They have the same requirements to meet as employers and providers. They are accountable for the National Patient Safety Goals and for infectious disease reporting in the same way.

And to turn the argument around, the diseases don’t distinguish between people of faith and those who aren’t. Some have suggested that the burden of providing care for illegal immigrants, or of providing universal access at all, should fall to those charitable organizations who include it in their mission. But, all our health is “public.” Illness, like the rain, “falls on the just and the unjust.” We have long said we all benefit when certain risks are shared as widely as possible. We have long structured our insurance that way, including especially our health insurance. And there is no wider base for the risk than all who share in the economy – all residents, all providers, all of us. There is also no wider distribution of responsibility, no wider sharing of sacrifice. Thus, in the face of illnesses that do not discriminate, it is unjust for us to discriminate. And as we would affirm here, justice is a Gospel value.

Congressman Wilson wanted to claim a place among those calling not only for an end of illegal immigration, but for isolation and estrangement of those who are already here. Apparently, obnoxious as it might seem, he has succeeded. His outburst has become the central issue of his reelection campaign, used by both his campaign and his opponent’s to raise funds. And yet, as powerfully as I disagree with his position, I will agree that he has raised an important issue. No, President Obama didn’t lie when he said that no legislation proposed so far allows the benefits of health care and health insurance to illegal immigrants. At the same time, we all understand the truth that they will need health care, and somehow we will provide it. Congressman Wilson is outraged that some how we might provide care to illegal immigrants. I think we should be outraged at Congressman Wilson and his compatriots, because I think we must.

The Rev. Marshall Scott is a chaplain in the Saint Luke’s Health System, a ministry of the Diocese of West Missouri. A past president of the Assembly of Episcopal Healthcare Chaplains, and an associate of the Order of the Holy Cross, he keeps the blog Episcopal Chaplain at the Bedside.

Health care reform as Christian imperative

By Bill Carroll

An Open Letter to My Congressman on Health Care Reform

I sent the following letter to my Congressman, the Hon. Charles Wilson, (Ohio, 6th District). I wrote similar letters to Ohio’s two Senators, George Voinovich and Sherrod Brown. In light of our Church’s clear teaching on universal access to health care, moving in the direction of a single payer, public system, I would urge all brothers and sisters to do likewise. In the letter, the colleague that I quote is the Rev. Ed Bacon of All Saints, Pasadena.

August 19, 2009

Dear Congressman Wilson:

I am writing to you as a constituent and the pastor of a church in your district. I am also writing you as a father and husband, and the son of aging parents. With these responsibilities in mind, I beg you to do all in your power to pass substantive health care reform. Please don’t listen to the hysterical voices that try to sidetrack us from this crucial debate. For every one of them, there are hundreds of Americans who struggle daily under the current system and want change.

Take our family, for example. Our eight-year-old son Daniel has significant developmental disabilities, and, like many Americans, we live in fear of losing our insurance. He is a walking “preexisting condition,” and the Down Syndrome that affects every system in his body renders him vulnerable to several costly and potentially life threatening illnesses.

We are lucky that the church I serve provides health insurance for our family. This is a huge financial burden for a small congregation. It costs us about $1700/month, a sizeable proportion of my monthly salary. I can only imagine how such expenses affect businesses, large and small, and hamper economic growth.

Even more importantly, however, health care affects real people. Some members of my congregation are not so fortunate as we are. I am writing this letter on their behalf, as well as that of underinsured and uninsured persons throughout Athens County. Many of these folks have turned to me for help when they could not pay for a doctor’s visit or fill a prescription. Others have needs too large for private charity to meet. The people we both serve need justice, not charity.

Our congregation and our diocese, the Diocese of Southern Ohio (82 congregations numbering nearly 30,000 people), have both endorsed universal access to care as the minimum morally acceptable standard. In fact, our church board voted unanimously to endorse these principles. Our denomination also supports universal access, with our eventual goal a publicly funded system. We are Republicans, Democrats, and Independents, from a wide variety of backgrounds, united by our faith, which teaches us to love our neighbor and serve the common good. I am convinced that a public option has to be part of meaningful reform, which really moves us in the direction of healthcare as a public good rather than a private privilege. As a colleague of mine recently observed, “Jesus told his followers to heal the sick. When we turn our back to the sick, we are turning our back to God.”

I wish you well as you return to Washington, and hope that you will be fighting for all of us. I understand that politics is the “art of the possible,” and that compromises will inevitably be made. I want you to know that more may be possible than we think, if we listen to our hopes rather than our fears. I am praying for you and your colleagues as you engage this important debate.

Yours sincerely,

The Rev. R. William Carroll

The Rev. Dr. R. William Carroll is rector of the Episcopal Church of the Good Shepherd in Athens, Ohio. He received his Ph.D. in Christian theology from the University of Chicago Divinity School. His sermons appear on his parish blog. He also blogs at Living the Gospel. He is a member of the Third Order of the Society of Saint Francis.

Not a pretty sight

By Donald Schell

Peter is twenty-eight now. This memory must be almost twenty years old. It was Christmas. I’m guessing we were home between the early Pageant Liturgy and the Midnight Choral Eucharist on Christmas Eve. Peter, just beginning to grow into his manhood, took an elegant nonchalant stance leaning against the mantle over the fireplace when a tea-light on the mantle ignited his t-shirt. He felt heat on his back glanced over his shoulder and did what any of us might do seeing fire - he ran. His mother, the nurse, did what she knew to do – though I don’t remember her telling us that she’d been trained as a tackle in nursing school. She ran after him to the dining room, threw her arms around him, and slammed him against the dining wall, smothering the flames. And when the nurse had dealt with the first stage of the emergency, his mom reappeared to comfort him and calm him enough to get the t-shirt off and survey the damage.

Between Peter’s shoulder blades, he had a blistered area about four inches across, second-degree burns. Some small areas were charred, third degree burns. My dad, the physician was there and Ellen and Dad cleansed the wound and Dad set out the twice-daily protocol for debriding the wound. For the next several days I was her assistant.

A serious burn destroys our body’s most powerful defense against infection, our skin, and to make matters worse, dead skin in a moist wound is particularly hospitable to airborne bacteria. Debriding is tough love. Twice daily with a sterilized pair of tweezers Ellen methodically pulled dead skin from the wound. Dead skin is attached to living skin. It hurt Peter. My job was to help him lie very still on his stomach while she worked. I say ‘help him’ because Peter proved a brave and cooperative patient. Step by step Ellen told him what she was doing, and when she was about to pull. He did his best to steel himself and not to jump or pull away from her. My pinning his shoulders down was his back-up. Because sometimes he had to flinch, and then, without my hands on his shoulders holding him still, he would inadvertently poke himself on the tweezers or break his mother’s grip on the scrap of skin she was pulling away. Sometimes too, Ellen asked me to help by pulling the healthy skin on either side of the wound taut to make a dead skin fragment yield an end she could grab.

My role was mostly silent. For the first couple of days I thought of what an unlikely nurse's assistant I was. Growing up with both father and grandfather physicians, I lost track of how many people had asked me if I wanted to be a doctor. Usually I just said, ‘no.’ Sometimes I might venture a boyish imagining of vocation as ‘a preacher.’ But either way, my unspoken response was a forceful ‘NO,’ imbued with the painful knowledge that not only didn’t I feel called to medicine, but that I couldn't do it. Visible wounds made me queasy. Injuries to my own body frightened me. I was convinced I was too squeamish to be a doctor.

When my firstborn was coming and dad heard that her mother and I were taking birthing classes and that I planned to be in the delivery room, he wondered whether my presence there was a good idea. ‘Birth can be a little startling,’ he said. ‘It’s messy. There’s blood.’ But I was determined, and was glad to be present, and am still very glad for that experience. It was also my first hint that I’d outgrown some of the old un-ease at how raw bodies can be.

Then in my Clinical Pastoral Education at St. Luke’s Hospital, New York, I saw some badly battered bodies, some living, some dead, and I did my job all right, helped families talk to staff, stood by the body, said prayers, touched when it was helpful and appropriate. For my C.P.E. summer I’d been assigned to be the student chaplain on the Intensive Care Unit, which included burn patients.

Eighteen years later, as Ellen and I began our twice-daily routine with Peter, I remembered St. Luke’s burn unit. The memory of a child on the burn unit, most of his body burned, no one knowing whether he’d live or die, helped me with context and focus as we worked on Peter. Where, I wondered, was God in such suffering? I wasn’t satisfied with any answer I could offer to that question, but ‘where is God,’ resonated in this work, the painful and more hopeful treatment of my son. My job was to watch closely to anticipate when Peter's taut muscles would jump or lurch. As the delegated minister of stillness, my task was to watch, to hold a steady gaze as Ellen’s tweezers patiently took us to lower layers of Peter’s burn.

In the second day of this gazing as I watched Ellen’s meticulous work, I saw in Peter’s wound what Symeon the New Theologian called, ‘the impossible beauty of the life in Christ,’ or, to put it in plainer language, the awesome beauty of Life.

So soon after the burn “the wound” that I’d begun to know well from steady scrutiny through twenty minutes of teamwork unexpectedly showed a wholly different face. Just hours before I’d seen only ugly disfigurement, an opening to infection, damage, and grave risk to his health. Now healing was visible. In that same place where old skin was dying, brand new skin was beginning to appear. It felt so much like seeing healing in the moment that I wondered whether we’d actually see new cells or fresh patches of healthy skin move into place as Ellen worked. Peter’s body’s own work healing itself from session to session presented greater changes day by day. I was astonished. Watching the wound was moving me to a kind of joy. I loved gazing at it.

Had I not loved my work as a priest, that gazing spoke deeply enough to prompt a vocational crisis. Why had I imaged I couldn’t bear doing what my dad loved so much? Being a physician, seeing healing happen – ever – was an amazing privilege. Did Dad have to get over his own queasiness? Gazing at the wound, I understood something of my father’s heart and of his joy in his work. My Dad was an often skeptical Christian, but he did insist Life and God did the real work of healing, which he said made his work simpler and humbler: doctors could remove obstacles, sometimes clean things up or put them back together, keep them clean and in their right place, and watch healing overcome disease while trying to prevent complications.

Those days of watching my son’s very ugly wound heal I experienced, saw, and felt beauty where I’d imagined nothing was possible but ugliness. I’m not saying I found the idea of healing beautiful, not even my own thoughts observing the process of healing, but rather seeing Life present as Peter’s body healed, I felt the radiance of the Life that is the Light of humankind.

Culturally, but also religiously, we have a hard time with beauty. Sometimes we explain that difficulty in economic terms. When we’re working for justice or any pragmatic alleviation of human suffering, we mistrust beauty, suspecting it’s a luxury or a distraction. By common cultural consent we reduce beauty to a purely subjective, personal, and even idiosyncratic matter of taste.

But theologians as diverse as Jonathan Edwards (who calls the Spirit “the beautifier, the one in whom the happiness of God overflows … the one who bestows radiance, shape clarity and enticing splendor.” (Paraphrased by David Bentley Hart in The Beauty of the Infinite, the Aesthetics of Christian Truth). Or Gregory of Nyssa (“Human nature’s perfection is nothing but this endless desire for beauty and more beauty, this hunger for God.” From Gregory’s Life of Moses, quoted in Hart) Or Hans Urs von Balthazar,
Or – liberation theologian Alejandro Garcia Rivera whose work, The Community of The Beautiful, Jesuit James Empereur draws on so heavily in La Vida Sacra, Contemporary Hispanic Sacramental Theology.

Ancient theologians, a famous Puritan in New England, a Roman Catholic teacher beloved by Vatican conservatives, a Jesuit, and new work in the tradition of liberation theology all tell us beauty drives it all.

Gregory of Nyssa describes the engine something like this:

God creates life, Life beholds Beauty, Beauty begets Love, Love of the Life of God.
(Paraphrase from Gregory’s On the Soul and the Resurrection by Scott King who set this text as a four-part canon in Music for Liturgy)

Just as ‘love is stronger than death,’ beauty, the real thing has power enough to include and transform the raw suffering of a healing wound.

Beauty makes our world radiant with the life of God.

Some recent discussions here at the Café focused on verifiable truth claims got me thinking about Peter’s burn and healing and prompted this piece. Watching my son’s wound heal doesn’t prove the existence of God. In fact those who play the game of proofs, sooner or later will admit that none of the proofs give us a loving, forgiving God; it’s simply not possible

Love proves nothing, and watching that wound heal wasn’t an experience of proof or testing but one of simpler knowing: in a community of love facing a hard task, I was seeing the love that sustains our every moment in Life doing its work. It wasn’t a pretty sight, but it was simply beautiful.

The Rev. Donald Schell, founder of St. Gregory of Nyssa Church in San Francisco, is President of All Saints Company.

The Christian response to a pandemic

By Daniel J. Webster

“Though I walk through the valley of the shadow of death, I shall fear no evil.” The words of the Psalm 23 are familiar to many. Those words are being recited or sung throughout Episcopal and other Christian churches last Sunday. The readings are about the Lord or Jesus as the good shepherd.

Yet many people will be afraid to go to church. Or they will refrain from taking communion or passing the peace with a handshake because of the fear that has gripped nations because of the spread of a virus.

The collect or opening prayer at Episcopal Sunday services asks God to “grant that when we hear his voice we may know him who calls us each by name, and follow where he leads.”

Where are we led in the face of such paralyzing fear, illness or even death? We have some examples.

In 1878 Memphis, Tennessee was hit by an epidemic of yellow fever. A group of more than 100 Anglican and Catholic nuns led by Sister Constance heard the voice of God calling and felt they needed to stay in the city and care for the sick and dying. Constance and her companions are commemorated on the Episcopal Church calendar on September 9. They are known as the Martyrs of Memphis. Only two of the sisters survived.

So many people died there or fled, Memphis lost its designation as a city. It took 14 years to regain the population and its city status.

Several centuries earlier some unnamed followers of Jesus living in the Roman Empire were singled out for their unselfish response to a plague that killed millions.

It was 160 C.E. Roman troops returning from the Near East brought with them an illness never seen before by Galen, the emperor’s physician. The disease spread from Greece to Rome to Gaul. Some medical historians believe 2,000 a day died in Rome. As many as a third of the population in some regions were killed. Total deaths in the 15 years that the plague rocked the empire have been put at 5 million.

Galen was among the many who fled to the countryside. But in his notes about the plague he had some interesting observations about one group of people. The followers of Jesus heard a call to heal or at least alleviate suffering. Many did not flee the cities but felt called to stay.

“[For] the people called Christians . . . contempt of death is obvious to us every day . . . They also include people who, in self-discipline . . . in matters of food and drink, and in their keen pursuit of justice, have attained a level not inferior to that of genuine philosophers,” as quoted in Elaine Pagels’ book Beyond Belief (Vintage, 2007).

Galen did live to write about it. Many of the unnamed followers of Jesus did not. There are those who even today will say Galen was smart to flee, to live another day. But there are those who see their baptism in Christ as dying with Christ and living into a new life. That life can also lead to the death of the body.

But if we hear the voice of the shepherd calling us, assuring us, that death cannot kill us just like it did not kill Jesus, then our answer will be to heal, alleviate suffering, calm the fears, comfort the anxious.

We are an Easter people. We live in the light of the resurrection. We are the Body of Christ witnessing to that resurrection every day. Nothing can kill that.

The Rev. Canon Daniel J. Webster is canon for congregational development in the Diocese of New York and Vicar of St. Francis of Assisi Church in Montgomery, New York.

Bound tight through blood

By Joy Caires

“the nails in his hands” (Jn 20:25)

They pushed fluids until they started to pour from her mouth, gave round after round of epinephran and took turns doing chest compressions for over two hours. They would get a pulse for a moment or two, just long enough to decide to keep going, before her heart would slow to a stop again. It was the longest I ever saw the medical team in the pediatric intensive care unit attempt resuscitation.

“This is my commandment, that you love one another as I have loved you.” (Jn 15:12)

She was eight years old. After she arrived I stood outside the door of her hospital room room as the clinical team worked. As team members shouted orders for items from the crash cart, I prayed; with each bump on the monitors, I prayed; as numbers fell and rose, I prayed. After what seemed an interminable time, but was really less than 40 minutes, the parents arrived. I met them at the door of the intensive care unit and their eyes opened wide as they took in my black shirt and white collar.

“Was it not necessary that the Messiah should suffer these things and then enter into his glory?” (Lk 24:26).

At that point I told them exactly what I knew—their daughter was still alive but barely, that the medical staff was fighting for her, that she had been intubated and that they continued to do chest compressions. I could not tell them that she would “make it”, and I couldn’t tell them that she wouldn’t. I huddled with the parents on the sleeper couch in the child’s hospital room as the team continued to struggle. I read the faces of the staff I knew so well and I knew that their heads had given up hope but their hearts and hands would continue to struggle to exact a miracle from the improbable.

“Put your finger here and see my hands. Reach out your hand and put it in my side.” (Jn 20:27)

They went beyond the point of possibility and shortly before they stopped, her head lolled to the side and I saw her eyes and I knew she was gone. Her parents kept praying and, after a momentary pause, I prayed as well—for a miracle I was certain would not come. But, just as the medical staffs hearts and hands fought on, my heart and mouth continued to pray for the improbable. For this child the difference between the declarative of a flat line and hope was the pounding of hands upon her chest.

“Why are you frightened, and why do doubts arise in your hearts? “ (Lk 24:38)

By 2pm it was all over. The air in the unit was thick with tension and unspent grief. Another little girl whose family had been preparing for her death for months had slipped away and another child had entered Hospice care—all while we had tried to pound life into a lifeless chest. The medical staff huddled in small groups—two of the children had clear diagnoses, but the third would be a coroner’s case. The parents spent time with the children’s bodies and eventually left. The mortician made his appearance—even he was shaken by the magnitude of the death that day. And, we all kept working—other patients and families needed to be attended to and we were all conscious of the need to keep moving.

“When it was evening on that day, the first day of the week, and the doors of the house where the disciples had met were locked for fear…” (Jn 20:19)

Then word came, the attending physician had ordered pizza for the staff on the unit. As we were able, we used our identification cards to let ourselves into the locked staff room. It was quiet in the room and the locked door made me feel safe, safe from pain, safe from inexplicable death, safe... I don’t remember any conversation beyond the running commentary about the sauce and toppings—to an outsider we would have seemed callous. But, the current of the unspoken ran through us. While the words would not be uttered, love was truly in that place. Our bond as a team had grown as tight as that of blood brothers—but the blood we shared was not our own. Our souls had been bound by the blood of an innocent.

“You did not choose me but I chose you. And I appointed you to go and bear fruit, fruit that will last” (Jn 15:16)

I wonder what choices had brought us there? I wonder, what fruit we bore that day? Perhaps it was the peace that came from having shared in the washing and dressing of the child’s body; of giving a family an image that was less that of the violent cross and more that of the quiet tomb; or, the knowledge that we had given a child her last and best chance at life. We all went home later that evening, it was hard to leave and we clung to each other—finding excuses to stay a bit later, work a bit longer. We, regardless of beliefs, had chosen to dwell in the valley of the shadow of death and we needed each other—we needed to bear the fruit of hope even as we ate the fruit of misery. Blood and pizza became our sacraments whilst death lurked.

“I lay down my life for the sheep.” (Jn 10:15)

The outward signs of devastation and recollection and the insistence of living in the face of death—we eat because we are alive, we gather because we need to see life in each other. Each week we, the Christian faithful, gather around a feast of the body and blood. Each week we are joined with those who gather in mourning--bound together by a shared participation in the bloody death of an innocent. We will live despite death, we will feast in the shadow of the cross and we will love throughout time.

“Blessed are those who have not seen and yet have come to believe.” (Jn 20:29)

I have seen too much. My hands have touched the wounded side and my ears have heard the final breath. I have not seen…but I still hope. I hope for the resurrection, I hope for the loving embrace of God and I hope, for each innocent, peace beyond that of my own understanding. The irony for us Easter people is that it was Christ who conquered death and eternal life is on the other side of a flat line.

The Reverend Joy Caires, a graduate of Episcopal Divinity School, is currently the Associate Rector at Church of Our Saviour in Akron, Ohio. Joy's first call, after ordination, was as the pediatric chaplain at Rainbow Babies and Children's Hospital in Cleveland, Ohio.

I am not my illness

By Ann Fontaine

I am not a measure of a central tendency, either mean or median, I am one single human being with mesothelioma, and I want the best assessment of my own chances—for I have personal decisions to make, and my business cannot be dictated by abstract averages. I need to place myself in the most probably region of the variation based upon particulars of my own case; I must not simply assume that my personal fate will correspond to some measure of central tendency.
Stephen Jay Gould, “The Median Isn’t the Message” Discover, June 1985

Many of our prayers in the Book of Common Prayer pray for “the sick.” The language of the prayer assumes that “the sick” are a category and not individual people who happen to have an illness. As Gould notes, his illness is particular to him and he is not a “mean” or “median” category.

In 1993, I was home for the year from seminary, as it was our son’s senior year in high school. I had planned to take that year off to be home for his last year before he left for college. In the spring of my middler year I had begun to feel out of shape and short of breath. I chalked it up to too much pizza and not enough exercise. I thought when I got home to Wyoming I would resume a healthier lifestyle and recover my energy. What happened when I got home is that I discovered I could not walk across a room without taking break. This seemed a bit more serious.

After many trips to many doctors and becoming somewhat of a laboratory experiment for them, it was decided that I had an autoimmune disease. My immune system had decided that it did not recognize my muscle tissue as part of me anymore. Part of the attack by my valiant protective immune response was to make the little muscles in lungs stop working due to the inflammation. (BOOP they call it). All during the process of discovery I would go from thinking, “oh this is terrible” (pneumonia, anemia, etc) to “oh, that would have been okay to have.”

The point at which I changed from interested person trying to discover what was going wrong to “sick person” was when I went into the hospital and they put a hospital gown on me. Once I donned the open backed skimpy gown, I began to self identify as “sick person.” I fell into a category with a variety of statistics piling up to affirm that identity. I continued in that hapless state of non-person as I returned home and continued treatments. Lying on my bed staring at the ceiling was my main activity. I could not really track even a cartoon on TV. Reading a book was too much. I could feel the prayers of my friends upholding me through this time. I had mystical experience of the sensation of showers of stars filling my body from their prayers. But I was still sick.

I returned to church several months later and they were offering the laying on of hands for healing. It was the standard BCP/BOS healing formulation. I asked them to pray for my healing. I did not get well from the disease but what I received was much more than I expected. I was healed of being a “sick person.” I regained my identity as an individual who had a specific disease. I was “me” again. Although I still had this illness, it was not my total self.

I think this is a part of what Gould is saying. We each have our own way of going through the events of our lives. We are not “the sick” or “the poor” or “the whatever.” We have our own set of people and circumstances that make whatever is happening to us different from every other person.

Now, when I pray and work for healing or relief for others, I try to remember this lesson. Yes, there are commonalities in our conditions, and some things are better approached as a category to help solve the presenting issue, but each person is “one single human being” who needs restoration to his or her sense of self to be fully healed.

The Rev. Ann Fontaine, Diocese of Wyoming, keeps what the tide brings in. She is the author of Streams of Mercy: a meditative commentary on the Bible.

A ministry at the bedside

By Marshall Scott

He stopped me because he saw my clerical collar: "You're the chaplain here, aren’t you?" I nodded and introduced myself. "Do you get to help a lot of people?" Once again I nodded; but I knew that wasn’t where this was going to end. "But, do you get to lead a lot of people to Christ?"

That, of course, was the question he'd had from the beginning. He wanted to know whether – hoped it was the case that – I was meeting my patients in their moment of crisis and anxiety, and helping them to understand that a personal relationship with Jesus Christ would meet their needs, assure their spiritual safety, and resolve their fear. He was certain of what God would want, would want me to do, for the sick and suffering – even though Jesus never asked it of those he healed.

This was one of those moments when I was most aware of Jesus’ instruction not to plan what I would say, but to allow the Holy Spirit to speak. This time I said, "Sometimes I get to talk about Christ; but I think it’s important that they see Christ in me first."

He walked away, his smile fixed and noncommittal. That wasn’t the answer he'd wanted. It wasn't something he could really argue with, but it wasn't what he wanted.

I have that conversation from time to time. There are those who are just certain that the bedside of the ailing and frightened patient is the place to introduce the saving love of Jesus. After all, what better time to secure one's place in the afterlife than the moment one stares it in the face?

That's not a new thought, and for more than one reason. I have certainly done my share of emergency baptisms (usually but not always of infants), providing comfort to families in crisis. And then there’s the legend that Constantine himself postponed his baptism till his deathbed, taking seriously the thought that baptism should lead to amendment of life, amendment that he might not have managed perfectly (or might not have wanted to manage in the first place).

Still, these conversations make me sad. In the first place, they imply something I don't want to affirm: that somehow God can't accept a person who's not baptized. I appreciate that there are some who do want to affirm just that; but, to use the Biblical language, I can't believe that somehow "God’s hand is shortened." I appreciate what God wants of us. I just can't believe God's ultimate love and saving grace are somehow dependent on our success.

In the second, evangelizing at the bedside runs counter to the ethics of my profession. I am Board Certified by the Association of Professional Chaplains (APC). The Common Code of Ethics for Chaplains, Pastoral Counselors, Pastoral Educators and Students, adopted by APC and a number of other pastoral care organizations, includes these injunctions:

"Spiritual Care Professionals understand clients to be any counselees, patients, family members, students or staff to whom they provide spiritual care. In relationships with clients, Spiritual Care Professionals uphold the following standards of professional ethics. Spiritual Care Professionals:

1.1 Speak and act in ways that honor the dignity and value of every individual.

1.2 Provide care that is intended to promote the best interest of the client and to foster strength, integrity and healing.

1.3 Demonstrate respect for the cultural and religious values of those they serve and refrain from imposing their own values and beliefs on those served.

1.4 Are mindful of the imbalance of power in the professional/client relationship and refrain from exploitation of that imbalance.

1.8 Refrain from any form of harassment, coercion, intimidation or otherwise abusive words or actions in relationships with clients."

In light of these commitments, I couldn’t as a professional evangelize at the bedside.

As an Episcopal priest, I look at these commitments and appreciate just how similar they are to portions of the Baptismal Covenant. I am committed, and frequently recommitted, to "seek and serve Christ in all persons, loving neighbor as self," and to "respect the dignity of every human being." When I put myself in the hospital bed (and I have been there), I would hardly feel loved or respected by someone seeking to impose a new spiritual tradition or technology, however strong their conviction that God would want it for me.

Now, I appreciate that the Baptismal Covenant also includes commitments to "continue in the apostles' teaching and fellowship," and to "proclaim by word and example the Good News of God in Christ." At the same time, in light of some sort of "last chance for salvation" attitude, proclamation by word can indeed become abusive and coercive. We have heard much lately about how coerced confessions fail, because the coerced prisoner will say what the torturer wants to hear, whether it's accurate or not. We have a much longer history of discovering that coerced conversions don't change hearts (sadly, forced baptisms go back at least to Carolingian times).

No, instead I find myself appreciating the opportunity to proclaim by example the accepting love of Christ that the apostles taught. To do my best to love the person before me, just as the person is, seems to me the best proclamation I can offer of what Christ wants for the person, and of what Christ wants of me as a Christian.

It would, of course, also be bad clinical practice. That is, for the patient in crisis, the most dependable resources for spiritual and emotional support are those the patient knows and trusts best. If I want to help the patient rally the spiritual and emotional strength that will support physical healing and comfort, I do best to help the patient appreciate or rediscover what he or she already knows.

But first and foremost, to do otherwise, to seek to impose some Christian content and coerce some Christian behavioral response, is to deny and preempt God. We trust, after all, that the Holy Spirit is constantly working in the world, calling all to God’s purposes, including those who don’t know it. We trust that God can work in frail creatures, frail people – indeed, it is central to our theology of sacraments. In that crisis, at that bedside, I am called to discern, and as best I can affirm, what God is already doing in and around and through this person, not to somehow take control myself. That would indeed be pride of place, expressed in abuse of power; and it would evil, which in the Baptismal Covenant I am called to resist.

As I said, my conversation did not satisfy my questioner. Nor would all this reflection have made any difference. As a wise mentor once told me, sometime you just can't get your point heard. And so we parted: he out of the hospital and I back into it. I hope he prayed for me as I prayed for him. And in the meantime, I continue to pray for the many that I cannot pray with, hoping that they experience in my work some poor reflection of the love of God that someday – perhaps someday soon – they will experience face to face, in ways beyond my imagining.

The Rev. Marshall Scott is a chaplain in the Saint Luke’s Health System, a ministry of the Diocese of West Missouri. A past president of the Assembly of Episcopal Healthcare Chaplains, and an associate of the Order of the Holy Cross, he keeps the blog Episcopal Chaplain at the Bedside.

Who Will Provide the Care?

By Marshall Scott

Last April I was invited to participate in a meeting of the Standing Commission on Health of the General Convention. Those invited represented quite a variety of health ministries and concerns within the Episcopal Church. I was invited as a member of the Assembly of Episcopal Healthcare Chaplains; but participants were from a wide variety of organizations associated with the Episcopal Church.

Early in the meeting the chair, Bishop Barry Howe, asked us to go around the table, speaking of the health care issues that we saw for our society. Again, around the table there were many concerns: universal access to care; the aging population; care for the poor and underserved in a variety of settings and cultures; the rising cost to the Church of providing insurance for clergy and lay employees; and many others. By the time they came to me, I had heard many I agreed with; so I raised one I hadn't heard, but that I see every day in my practice: the current and growing shortage of physicians and nurses to provide care.

I was reminded of that discussion when I saw the front page of my own Sunday paper. On December 28 the Kansas City Star has this on the front page (one column, but above the fold): “Doctors try to treat physician attrition.” While the story was written with a local focus, it addressed a national problem: "While the supply of physicians roughly meets demand now, by 2025 the nation could be short from 124,000 to 159,000 physicians, according to different scenarios."

The expected shortage of nurses is even more marked, and arguably more critical. According to the Web site of the American Association of Colleges of Nursing , "The shortage of registered nurses (RNs) in the U.S. could reach as high as 500,000 by 2025 according to a report released by Dr. Peter Buerhaus and colleagues in March 2008."

There are a number of factors affecting the shortage of physicians. Some are as inevitable and intractable as time: physicians, like all of us, are aging and considering retirement. Some are financial: physician reimbursement keeps getting squeezed, pressed by the weight of Medicare, and followed by insurance companies; and family practice physicians, who provide the most and the most cost-effective care, are paid worst of all. Some are matters of public policy: Medicare is the primary supporter of medical education, including M.D. and D.O. degrees, and has placed a cap on the number of medical school slots.

The shortage of nurses is somewhat different, as the field becomes squeezed between fewer graduates and higher attrition. Research has shown that the primary factors in nurse retention or attrition are about “work/life” – balancing the requirements of the job with personal and family requirements outside - although poor pay (relative to other ancillary health professionals), poor working conditions, and poor relations with physicians contribute significantly. More critically, AACN writes of a shortage of nursing faculty. Finally, the sheer number of education programs for nurses has fallen with the virtual vanishing of Diploma programs, programs associated with hospitals rather than academic institutions.

I wondered to what extent Episcopal institutions are educating physicians and nurses. To begin, I went to the web page of the Association of Episcopal Colleges. There are eleven members of the Association, each with a web site. I reviewed each site to see whether any offered degrees in Medicine or Nursing, or offered Pre-med majors. In fact none offered a major in Pre-med. That wasn't really a surprise, as that specific major is less common, and most students seeking to attend medical schools were already in other undergraduate majors. Nor did any have an associated medical school (as a graduate of Sewanee, I was aware that there had been one there, now long gone; and that may be true of other schools). So, while our colleges certainly prepare students for medical education, they are not offering those degrees themselves.

Three of the colleges did offer degrees in Nursing. Only one, however, is in the United States. Clarkson College in Omaha offers a Bachelor’s of Science in Nursing, as does Cuttington University in Liberia and Trinity University of Asia in the Philippines. Considering the number of nurses from the Philippines who have come to the United States to work, one might think of Trinity University as also serving the health care needs of the United States (but with even more significant needs in the developing world, that has ethical issues all its own). There was an Episcopal School of Nursing associated with Temple University in Philadelphia, but that program has closed. I would also note that St. Augustine College in Chicago offers a degree for Respiratory Therapists, another profession in short supply. Over all, then, Episcopal institutions have little explicit involvement in addressing the future health care needs we face.

In an essay last year I reviewed the Episcopal Church Annual to get some count of the number of Episcopal health care institutions. I identified seventeen Episcopal hospitals or hospital systems. As far as I can discover only one includes a school of nursing: the Saint Luke’s College, part of the Saint Luke’s Health System in Kansas City (full disclosure: that is the System within which I am a chaplain). This is not to say that Episcopal hospitals are not involved in educating nurses, medical students, and medical residents. Many do participate in clinical education programs in these and other health care professions. However, our health care institutions are no more extensively involved in educating physicians and nurses than are our academic institutions.

In one sense, this might not seem such a big story. After all, there are many other institutions providing education for physicians and nurses, and it would be far easier and more effective to expand opportunities in those existing programs than to try to establish new programs in our own institutions. At the same time, as an expression of our commitment "to seek and serve Christ in all persons," General Convention has repeatedly supported universal access to quality health care for all in our country. Three resolutions were passed in Convention in 1991 alone (A010, A094, and A099). Moreover, among the purposes of the Standing Commission on Health when was reestablished in Convention in 2003 were:

* Advocating, in cooperation with the Office of Government Relations, for a health care system in which all may be guaranteed decent and appropriate primary health care during their lives and as they approach death;
* Bringing together those within The Episcopal Church who develop, provide, and/or teach health care and health care policy to continue to develop a Christian approach to pressing issues that affect the health care system of this nation;
* Understanding and keeping abreast of the rapidly changing health care market and developments in biomedical research that affect health policy (from 2003-A124)

So, we have expressed our commitment to support universal access to health care, and to advocate for it in our society. However, I would agree with those who point out that "universal access" is meaningless if there aren’t enough professionals to provide the care.

So, how can we contribute to addressing this growing need? We can identify and honor our own members and institutions whose vocations are to provide medical and nursing care, and to educate those who will provide it in the future. We can encourage those who are pursuing professional training to appreciate it as not only a secular occupation but also a spiritual vocation of service. The Church’s Office of Government Relations is already raising health care issues; but we can encourage the Office to include professional education explicitly in their efforts. We can provide in the budget of the national Church resources for the Commission on Health so that the Commission can pursue its mission of leadership. We can advocate ourselves at all levels – individuals, congregations, dioceses, and the national Church – with our civil leadership to pursue universal access to health care for all in the United States, including having enough professionals, and providing them sufficient support, financial and otherwise. We can especially acknowledge that we who can are willing to pay for those professionals and those resources so that care can be provided for those who can’t.

For all the interest expressed in last year’s election rhetoric in expanding access to health care, the crashing economy has tended to sideline any other issues, including those like health care that are arguably related to industrial growth and economic recovery. We can take steps both within and without the Episcopal Church to keep one important issue from simply overwhelming another, and to keep alive the call to make access to health care universal – indeed, to see it as a civil and human right. We have a particular opportunity this year, as we will be gathering in General Convention, the one gathering in which we speak as a whole church. However, the first step to take is to recognize the problem. Once we've done that, raising our voices is much easier. And unless we do both – recognize the problem and raise our voices – we may discover that the care we need simply isn’t there.

The Rev. Marshall Scott is a chaplain in the Saint Luke’s Health System, a ministry of the Diocese of West Missouri. A past president of the Assembly of Episcopal Healthcare Chaplains, and an associate of the Order of the Holy Cross, he keeps the blog Episcopal Chaplain at the Bedside.

Making sacred connections

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.

Lift up your health

By Luiz Coelho

Celebrant: The Lord be with you.
People: And also with you.
Celebrant: Lift up your hearts.
People: We lift them up to the Lord.

How many times have you heard those sentences, either said or chanted? I bet many! This short dialogue, which is at the beginning of (most) eucharistic prayers, is also known by its Latin name: sursum corda (which means literally “lift up the hearts”).

But why this concern with hearts? Conventionally, they have always been linked with emotions: fear, love, anger, sadness, joy and so many other feelings that literally make the heart ache, beat faster, or enlarge. Recently, scientists have learned that those emotions actually are much more related to the nervous system than to the heart per se. However, to the common folk (including myself), the heart is still directly linked to feelings.

We cannot ignore, though, that the heart plays a big role in our own state of health. It is regarded as one of the most critical organs in human bodies. Its main function is to pump oxygenated blood throughout the whole body, with a special emphasis on the brain. It is so important to the preservation of life, that after a cardiac arrest, death can occur within a very short period of time. The heart, therefore, is central to human health, and one would logically conclude that lifting it up to the Lord should mean more than emotional and spiritual fitness; it should also include one’s physical fitness as well, as we are presenting our entire selves to God in the Eucharistic offering.

Given that fact, how do we promote the physical wellness of people in our churches? Certainly there has been an emphasis on campaigns which focus on certain epidemic diseases, as well as and relief and development campaigns during times of disaster. But, how much has the Church contributed to the preservation of health for the average pew-sitter? What is the Church doing to promote the best physical state, with a decent quality of life, so that they are able to fully contribute to the building of God's kingdom?

In our case, some has been done, but not enough. As time passes by, we get saddened to see an increased number of brothers and sisters with severe diseases – many of which could have been prevented. Such conditions are often the results of modern life and could affect any of us. As life passes by, and sursum cordae are recited, what have we done to lift up everybody's hearts and provide quality of life to all?

Surely you all have been heard that depression is the “21st Century's disease”. But between well-organized liturgies, with vested choirs and stiff acolytes, how much time has been dedicated to hearing the plea of lonely people who look for someone with whom to share their pain? Budget problems, and the pressure of a fast-paced life have led parishes into an extreme concern with management tactics, often reflected in commissions, reports, meetings, and other activities that resemble a corporation much more than a Church. Such time-consuming events often reduce time for pastoral care to a minimum. Confessions, counseling and simple informal conversations between clergy and parishioners are increasingly rare, and the possibilities of helping lives in need, sometimes even recommending the help of a professional, become impossible.

Our concern with what we eat has somehow changed over the course of the last decades, and signs of change can be seen in parishes. Many now offer gluten-free wafers. It is startling to see, though, that in many cases the parish lunch that follows it does not conform to the same consideration. It is not rare to find that the only eating option is still hyper-caloric, high-cholesterol, sugar-enhanced, non-vegetarian, heart-defeating food. For those who have eating disorders, or even for the ones who have strict diets, taking part in such events is a dreadful temptation, and often an opportunity for “breaking the diet” and getting back to dangerous eating habits.

And what about alcohol? Many of us can be eager to make fun of other Christians whose traditions totally forbid the consumption of alcoholic beverages. However, such a line of thought commonly holds hands with a tacit acceptance of some behaviors that can be – and are – very destructive. As we grow aware of the dangers alcoholism can bring to individuals, families and communities, I wonder how many times we have witnessed the excesses of alcohol consumption, even at church-related parties, and how silent we have been, not willing to accept that many of our brothers and sisters (including clergy) already have all sorts of “drinking problems”, which can dramatically explode in the future, leading to very sad results.

The same can be applied to smoking. While I do not think it is a mortal sin, as some Christians would say, it is for sure extremely dangerous for one's health. My father, who was a chain smoker for more than twenty years, still suffered the effects of it (and eventually died as a result of permanent damage in his lungs) years after having completely left cigarrettes behind. However, how many times have we been blind to the ones around us with similar problems, often regarding them as a natural consequence of life?

Do not get me wrong. I am not advocating any kind of abstinence theology, or the imposition of a strict diet, as some churches do. However, I think that in many situations, we – as a Church – have been silent while people – our own people – suffer from the awful physical and emotional results of diseases and addictions. We can always lend our parish halls to AA or NA meetings, but in many cases, that is not enough. It is necessary for the Church to be a real safe space for those who come to it with all sorts of conditions, and sometimes it is our duty to make sacrifices in order to accommodate them. Such “sacrifices” can cover a wide range of simple practices which can be implemented, in many cases, in a seamless way. Why not consider the possibility of having all parish meals fat and sugar free? Why not start offering gluten, lactose free and vegetarian options as well? Why not offering community based classes on healthy-cooking and nutrition? Why not cease having alcoholic beverages in Church parties whenever recovering alcoholics are present? Why not promoting seminars to youth and adults on the dangerous effects of addictions, and providing space for church people to have anonymous counseling, which in most cases cannot happen with the group that meets at the parish hall? Why not sponsoring walks, sports competitions and even gym activities in our churches? Those are only some examples, and I am sure that you know of much more.

Surely, in many religious communities around the country (and the world) some signs of change are already visible. However, health care is never too much, and much still needs to be done. As the Body of Christ, it is utterly necessary that we work towards keeping as healthy as possible our individual bodies, which will work more efficiently for the building of His Kingdom. This involves caring for ourselves, so that we are able to care for others, and lifting up our hearts, once for all, to a better living standard.

Luiz Coelho, a seminarian from the Diocese of Rio de Janero, spends part of the year in the BFA program at the Savannah College of Art and Design. His Web site includes his art and his blog, Wandering Christian, on which he examines "Christianity in the third millennium, from a progressive, Latin American and Anglican point of view."

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