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.

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."