Friday, December 31, 2010
Back in Memphis after a brush with global weirding. That's a more useful phrase than global warming, as the local affects of climate instability show up as extremes of cold, heat, drought and drenching. In our case, we just caught a glancing blow of a storm that rearranged many lives this past week. Just 10 inches of snow and temperature in the teens locked us in our cabin for three days longer than these city people planned.
And amid the weirdness, great beauty for our eyes are tuned to regard as beautiful the most mundane aspects of nature. Freezing and thawing of water, snow on the trees, fire on wood. What could be less notable? But I am drawn in wonder to the play of sunset's light in the ice.
We are so comfortable in natures womb that we are surprised to learn how wondrously balanced it all is, and what a narrow range of conditions permits our living. Just a wobble this way or that, and we find ourselves near edges we had no idea were there.
About a month ago I found myself with many hours of driving alone, so I downloaded Bill McKibben's, Eaarth which riveted me in extremes of sadness and hope. Sadness as he persuaded me that the planet I grew up loving no longer exists. We have literally changed the chemistry of the air with countless effects, some of which we can actually see in all their weirdness. The hope (less convincing) is found in the human ways of coming together with what we have and can do. Bill sees hope in localism and regionalism and, via our long term connectedness, globalism. He and some Vermont students created one of the most remarkable signs of viral hope that you should visit: 350.org.
The number is the whole story--the level of carbon in the air above which our Eaarth can stabilize somewhere near our current level of warming. Above that and the chemistry of the air guarantees that we will continue to warm -- and not in the long future of our grandchildren. But visibly, quickly, in a few dozen years. I love a lot of people who are vulnerable to that.
McKibben sees hope in how we connect to each other where we actually live. I saw that this week up in our micro-neighborhood of a couple dozen cabins scattered around the steep and winding gravel roads. Eddie Geller is about 6 foot two inches of practical human decency, who made it around on his ATV to check on every last stranded family. Getting baby formula for the Brazilians up the hill, getting another woman to her chemo appointment. And then he guided us all down the icy roads to safety when it was possible to move at all.
I was worried for the safety of my family amid the ice. I was glad Eddie was in my life to help. And I am worried for my larger family amid the growing warmth. But also filled with the wonder of how we are wired to find our way, first toward each other, and then to do what wisdom makes visible.
Go to 350.org and help out.
- Posted on the journey
Tuesday, December 28, 2010
I'm hoping this post does not circulate to certain foundations making major healthcare grants for consumer engagement such as one we recently applied for. So don't go forwarding this willy nilly; keep this among us humans. I think I'll even hide it beneath some nature pictures for safety.
Maybe its just being snowbound in a cabin, but I've had it with calling human beings "consumers" as if that is a promotion of some sort. The curious habit has even infected healthcare organizations who started describing the people in their care as....consumers. This is more common among those receiving stigmatized outpatient treatment, such as mental health services. The idea is that we should remember patients are active decision-makers and purchases of services, just as honorable in their own way as somebody choosing Target over Walmart.
Treating people with as much decency as Walmart seems like a low goal to aim at. Human beings in a relationship of caring and treatment are in a more complex dance of intimate exchange than Walmart understands.
Somewhere between 17-19% of economic activity in the United States currently involves health services, so there is a lot of consuming going on. But even when the activities do involve people paid to be present, the relationship is poorly understood as consumption. Larry Pray, who may be my very smartest friend, posted about his visit this week with his mother who is suffering from dementia and is in the daily care of people who are not his family. "It is the last day of my visit to the nursing home in Madison. The Memory Care unit to be exact. I am touched, once again, by the kindness of the staff who have learned how to lovingly live with confusion, how to turn caught thoughts to another topic, how to comfort, and how to laugh. Doctors are great, but here where folks actually live it is the staff-on-duty who speak of life." (http://www.larrypray.com/?p=2024)
It not just impolite or impolitic to describe such relationships as consumption; it makes everyone involved stupid and less able of playing their role. Those closest to the work of healing, the family, are reduced to functional bargains because they work for free. Physicians and nurses are similarly diminished, but paid. Hospital leaders are no more than marketers and distributors of services. Leaders of caring congregations are reduced to gullible partners, lending their skills to doing others' work without pay. I can assure you that the Le Bonheur staff in the picture care way, way beyond what money can explain.
Thinking of people only as consumers blinds us to the extent that the "health system" is constrained to only institutions and people who do things for money. All professionals, whether medical or those in "public health" are diminished to mere employees and providers of monetized exchanges.
No wonder we have trouble understanding the complex journey to and through our institutional space that is governed by many moments of discernment, trust, judgement, expectation, hope and fear. No wonder we are surprised when, for reasons of race or religion, people fail to act like we think rational consumers would do.
Health is not consumed or provided, it is the name of how we live together. We do not engage consumers, we listen to each other.
So why not call ourselves members? Why not citizens? Why not extended family, brothers and sisters?
Our electronic medical record at Methodist is the hard wiring that connects every member of the our treatment system with those in our care. It keeps track of every pill and procedure for every person involved, including many things nobody pays for, such as spiritual care. Our system is distinctive in that it also has a page allowing physicians to recommend actions to be offered up by a patients' congregation, as a natural part of the healing system. We have the capacity to help all involved in the caring process to be informed and guided by the others. Sort of like humans might do.
Even those of us most highly paid "providers" will experience our time of dependency. We hope that when we do, we will be engaged not as a consumer, but listened to even as a mother, father, sister, brother, friend.
- Posted on the journey
Sunday, December 26, 2010
The "A-Team" is usually not covering Christmas Eve, so unusual--and always interesting-- things happen. Once we were waited on by--I swear to God--Mary. The teen-age waitress was pregnant, unmarried and obviously ready to have the Prince of Peace right there in the corner booth at any moment. Last year, we ordered (eggs, eggs, eggs and, for me, a waffle). After a bit, the eggs and hash browns showed up. Waffle?
"Oh, I'll be right back."
The coffee was refilled twice as each time I commented how good a waffle would be.
The third time she noticed all by herself that I was waffle-less. I heard her exclaim (as she shuffled out of sight).... "waffle, waffle waffle."
You would not think one would need memory tricks to remember waffles in this restaurant, but some do.
And you wouldn't think you'd need to remember what Jesus was about, either, but most of find it heard to keep track. And not just amid the ridiculous clutter of brain dead buying and selling that marks the month.
I write in the aftermath of the Waffle House, but also anointed by 10 inches of astonishing snow that has frozen us in place and riveted my attention.
Robert Farrar Capon wrote "The Astonished Heart", the title inspired by Ecclesiasticus 43:17-18 (KJV): "As birds flying he scattereth the snow, and the falling down thereof is as the lighting of grasshoppers. The eye marvelleth at the beauty of the whitness thereof, and the heart is astonished at the raining of it." (p.118)
Capon continues: "The Lover who restores the world in Christ is not the God of the philosophers or even the theologians (unless they are very astonishing theologians indeed). And that God is certainly not the god of the inner-harmony-through self-help gurus.... He runs the world from beginning to end by the radically astonishing device of romancing it into being out of nothing..... And when every last particle of creation--including you, me, the lamppost, and the church--ends up dead, gone, and at absolute zero, its heart will still leap up at the voice of the Beloved." (p122)
"Waffle, waffle, waffle," she muttered.
"Life, life, life," I try to remember.
- Posted on the journey
Thursday, December 16, 2010
Tubigen, Germany has been home for really big ideas for centuries: Hegel, Nietzsche, Moltmann worked here. Up the hill from the University is the jewell-like "Tropiklinic" and German Institute for Medical Mission (www.difaem.de). We met here this week, convened by the World Council of Churches and DIFAEM as the "Strategy Group on Health and Healing." Conversations like this have happened here many times since the 1960's. And every now and then, something big emerges. I think I just saw it.
We were listening to Prof. Bernard Ugeux carefully describe his work in Eastern Congo rehabilitating young girls accused of witchcraft, thrown into the streets and shunned. It is a bitter story, even offered in his priest's hopeful voice and anthropologist's systematic detail.
Noticing the pattern, I asked psychiatrist Ehab El Kharrat whether he saw a similar framework to his work with alcohol and drug recovery in Cairo. (Ehab on the left, Bernard on the right. Dr. Vijay Aruldas in the middle). It reminded me of the journey with diabetes in Memphis.
And then the magic happened, which might have slid past if not captured on index cards by Dr. Gisela Schneider, the physician who leads DEFAEM. Within a few minutes Manoj Kurian roughed out the map on the computer, which then acquired the name "integrative programmatic framework for transformation."
Ehab, also a Presbyterian Elder, noticed a profound theological level to the pattern. And then somebody put the Holy Spirit -- "Spirit of Freedom" -- underneath. Witchcraft, drugs, diabetes--all conditions in which God moves to transform. Alleluia, indeed.
More chewing and coughing is needed. But can't you see what an astonishing advance it will be for Christian health organizations to have a distinctive framework in which to see their individual "best practices" so they add up to.....transformation? Right now we have a clutter of pretty good practices that help, sort of, to fix a lot of different medical problems that catch our attention. And we argue that faith-based organizations perform as well as anybody in delivering that clutter, which is less than inspiring.
Actually, miracles as Bernard and Ehab see, are not uncommon. We have not had a way to see the pattern of those miracles so that we can be accountable for creating a natural channel for God's healing work. And without a common framework, we have not really had a way to be attentive to the evidence of that healing.
It is well below freezing as the snow feathers down quietly the day after. But something shook this sacred ground and I can still feel it. A good idea is alive.
- Posted on the journey
Monday, December 13, 2010
The Horseshoe lake lunch was at the home of John and Anne Stokes with other major Memphis leaders who had been through the Life of Leaders experience a few months ago. Life of Leaders is an intense time of guided discernment for groups of 10-12 people put on by Methodist Healthcare and The Church Health Center. It includes pretty much everything medical that you'd experience at someplace like Mayo, but also a more comprehensive range of psychological, spiritual and social aspects. The point of the whole thing is to enhance the leaders capacity to lead a life of value and change-making. That has many aspects, so reflecting back on what happened since their intense time together, some shared medical journeys both profound and mundane while others found themselves drawn into a deep search for meaning.
Some of the group had attended an unveiling of a report from "the shalom project" which is an attempt to gather the energies of the evangelical christians in Memphis to fix the city (theshalomproject.org). Like Life of Leaders, the project is bold in its expansiveness, but social, not individual. But nothing at personal or social levels changes without transformational relationships. There is no escaping transformation in every aspect.
The highly privileged leaders at the lake ended up talking mostly about their relationship to the poor and how their lives would be measured by whether they advanced God's vision of justice. The Shalom Project looks hopes for broad shalom, but stressed the explicit need for old fashioned Calvinist repentance and salvation as the starting point. I helped write part of their report and I am about 400 years from Calvin.
Putting aside for a minute the specific components of needed change (personal or social), let me ask a question: How much do we have to think the same about Jesus, global warming, sex, vitamin D, Obama, hunting ducks, and eating cows in order to find the future together?
Does the future of the planet (or even little Memphis) depend on coming to agreement with each other? The question is unavoidable here in Tubigen, where we are convened by the World Council of Churches, which has 300+ denominations, not counting close working relationships with Adventists, Catholics and Pentecostals. This is a theological scene as edgy and explosive as the Star Wars bar, but for higher stakes--a real planet.
It is said that "it takes all kinds." Does it? How exactly does a leader live like that?
The clue may be that "in the beginning was the Word" which was not a creed, book, blueprint (or blog). It was more like an image, an idea, a hunch, in the mind of God of what might be possible. So it is with every beginning and every restarted effort that we will need to find our way from here. We move toward a word, an image. And that may well take all kinds, or at least a very great cloud of kinds. Ideas and experiences--including painful and failed detours that we talked about at Horseshoe Lake--can be parts of new images of what is possible.
The vision of shalom is assembled out of a box of parts like you might find in an old garage. I still have a jar of screws that my father collected decades before he passed away and passed them onto me nearly 20 years ago. I don't throw away those screws because you just don't know when you'll need just that one. And I am loathe to draw lines between useful and non-useful people. You just don't know when you'll need just that one. I would hope for something of that optimistic humility when leaders try to find the parts out of which to assemble the future. "Okay, we know the parts we need are in here somewhere......."
- Posted on the journey
Wednesday, December 8, 2010
For all the internet metaphors that fill our conversation these days, we remain squishy, not hard-wired. Transformation is hard because humans are, well, human. We are distracted by all the other connections and appetites that tug for our attention. Physicians and nurses and everyone involved in the health journey are already busy. The new ways add work long before they free up any time and trouble.
The good news is that humans are made for connection, but with eyeballs, voice, touch, tone and gesture. Wires and machines are dead as a box of rocks until somebody connects them and makes energy move through.
Humans, however, move toward each other naturally because we are alive. We connect. We handle complexity through relationships more than protocols. We seek to know somebody who knows somebody who knows somebody who cares. We use the odd and unpredictable links to find our way: the former wife's boyfriend's buddy who works for the hospital who knows the admission person. Friends and the kindness of strangers help us find our way through and across the dangerous cold currents as across rocks in a mountain stream.
Don't read me as excusing the toxic stew of policies and practices that explode like land mines in the journey. It is the job of the grown-ups in the structure to get the predictable stones out of the healing way. But we don't have to figure it out in maddening detail like we do with machines.
Part of management is bringing order out of disorder. But another part is holding the space for disorder so that new human connections can find their own order, smarter and more adaptive than our imposed structure.
If we permit connection, humans will figure it out, especially if we permit their friends to help out, too. That is what happens a thousand times a day with congregations and friendship networks anyway.
We are making it easier and more likely in Memphis by allowing our hospital to be more receptive to the connections through congregations. It is like dropping the string in the sugar water, signaling that it is okay for the crystal to form. The crystal wants to form.
Look like you want a human connection and the human networks will form. And people will move across them more efficiently than you could program. Squishware!
Tuesday, December 7, 2010
This is Adam, the first child of 162 who were moved from the old Le Bonheur hospital to the new palace of healing and care topped with a huge red heart you can see for miles. Almost every story about the new hospital cites its cost--360 million or so-- and that it included the largest fundraising campaign in Memphis history. But the financial story misses the point, as it usually does with pediatric healthcare. The point is the thoughtful overflowing attention to detailed planning, which rose to the level of reverence. I do not normally notice or write about that kind of reverence the raw and ragged creativity. I love emergence and flow and generativity.
But I must pause today in praise of plannfulness, detail, thoughtful anticipation of every possible thing that might go wrong so that Adam's ride across the street might be totally smooth. That playfulness extended for months, indeed, years. So the ride was so smooth that everyone involved could enjoy it with the celebratory delight it deserved. The air vibrated with delight and pride of a job well done--and prepared for.
It was a day to wonder about what else might be possible. What if we turned ourselves to even the more complex challenges of community disorder and chaos. From the top of Le Bonheur you can see many neighborhoods in which wicked problems twist and thrive, having their deadly way with children who will never ride like Adam. The more mundane catastrophes of poverty and social brokenness have far more fluid variables difficult to anticipate and plan for. But what if we could summon the gods of generativity to work with the gods of detail? What if??????
Surely it must be possible to imagine that after seeing the miracle beneath the big Le Bonheur heart.
- Posted on the journey
Wednesday, December 1, 2010
Fred commented once that evil doesn't have us outnumbered. But we have allowed it to out-organize us. There is a big difference, although the affect is exactly the same: we fail to break the pattern of disease, stigma, injustice and suffering. Everything in our faith and science says that the sufferings of AIDS is not inevitable and thus not acceptable. But we have not organized ourselves well enough and the band plays on.
Humans are not hard-wired and thus capable of rearranging our connections to let the energy and intelligence flow in new ways to do new things. That's what AIDS has demanded of us that we have only partly accomplished--so far. AIDS exploits our human weaknesses buried in our most intimate patterns of silence, domination, fear and ignorance. Religion has been mostly complicit in those deadly patterns. But none of this is locked in our DNA. And where the pattern breaks, it is because we have found our voice, new relationships, hope and knowledge. Sometimes our faith does the breaking.
There are now more than 91,000 names on the AIDS quilt and many hundreds of thousands that will never be known. We should feel appropriate shame. But lament only for a moment. For even while the grinding pace of scientific discovery is much slower than we ever imagined, we learn on. And the most important thing we learn is how we are together.
- Posted on the journey
Monday, November 29, 2010
That is a work of discovery, not recovery, for there is no "re" to go back to. There never has been a time when Memphis can be said to have been healthy. Cleaner and quieter, perhaps, at least for white people. But healthy?
Health lies in the undiscovered, not in memory.
This is why our center of excellence revolves around the "innovation studio" and why our research is driven by our curiosity about what might be possible, not what's wrong. What if we mash up this and that with the other to see if they might lead to something more like health?
We have eyes for strengths, assets and webs of trust where others just see pathology and gaps. And we are learning how to weave them in patterns that are tough enough for these tough streets. The fellow in the picture is painting this space. I assume he thinks it honors somebody for the past. But it is built for the next idea. You can see the room is curved in on itself, which gives mind to a womb safe for the gestation and generation of living ideas. We are only midwives of the future, maybe raising children of other parents, blending an extended family of odd, but hopeful members.
We can live here and even thrive, if we see the possible and work toward it.
Thursday, November 25, 2010
This morning Fred sent this kind of thanksgiving anthem to that circle of collegues. It came in while the bizzaro Macy's thing was filling the streets of New York with balloons, rental elves and such. Just as I was descending into cynicism Fred pulled me toward deep gratitude.
I give thanks for
and to all of you.
for all the years
we labored together
in Faith for the Health
of all God's People.
Let's all give thanks
for all the inspiration
and soulful deliberations
that has shaped our
Life gives thanks
for those who have chosen it
and pursue living
with academic rigor
and the passion
of an evangelist
to a dying world.
From one end of the world
to the other
God gives thanks to all of you
But are deeply woven
together in the Beloved Community
Shalom to you...
Monday, November 22, 2010
Last thursday the families of the patients of Methodist University Hospital made a small step in the right direction as we opened our Family Care Center. At the same moment we closed and abolished the old intensive care waiting room where thousand of people over the years spent uncomfortable traumatized hours as their loved ones were in treatment upstairs. They waited.
I'm not a trained hospital professional, but as a fairly experienced human being I appreciate the fact that nobody attending to a loved one in a time of hospitalization should just be waiting. They should either be cared for themselves -- because just getting momma to the hospital is enough to wear anybody out-- or they should have the chance to learn the things they will need to know when momma comes home. Who knows anything about a stroke and its grueling process of recovery until someone you love has one?
So the concept is simple: no more waiting and no more waiting room. Instead, a Family Care Center bathed in gentle northern light, equipped with hotel-quality furniture, abundant space, staffed 24 hours a day with people who, well, care. The families have access to a quieter and more dim space where they can get deeper sleep anytime in the cycle of the day. Every surface, fabric and square foot of carpet was chosen to speak of life, growth and peace.
We're not done, but we have made a huge lurch in the right direction. Soon the chapel for the families will be done and the volunteers will begin to flood the space like the gentle light. The education and resource center next door will be finished next month.
And the hours will still be grueling and filled with fear, anxiety and exhaustion. So when we paused to bless the space, we used a litany written by Larry Pray just for the occasion. I'll post the whole thing tomorrow, but this to start:
"Let us be honest. In such a place as this
there is a note of uncertainty,
and no small measure of fear.
And yet, beset as we are by circumstance
here we are surrounded by hope.
We know we will leave from here
not as we were,
but called to reshape and restart our lives.
We leave called to care, called to hope,
called to bless
and called again to find life."
We've all been waiting a long time for such honest not-waiting to begin.
Sunday, November 14, 2010
We lovers must see the rivers of crap that determine Haiti's breaking catastrophic cholera hell. And don't look away from the stagnant swamp of Memphis' gross disparities and broken systems. There is no magic, machine or pill that will get back to Eden's innocence. And so many interacting forces make hope harder. But this is the world God gave us to live in; the only one to love. So we can act in ways that are good for what we love. Or dream of innocence and be complicit as crap.
Love casts out fear, which is good news. Fear creates and sustains illusions that disable good choices, especially at social scale. This is most obvious of diseases that travel in body fluids that are hard to talk about, such as AIDS/sex and Cholera/crap. Disease loves stupid silence.
Fundamental determinants of hope emerge amid chaos, too. Nicholas Christakis is able to map the spread of such ephemeral virtues as happiness across social webs which are also relevant to mapping epidemics.( http://www.ted.com/talks/nicholas_christakis_the_hidden_influence_of_social_networks.html) This kind of network modeling is usually being engaged to map out negative phenomenon like obesity and depression. So it is of practical significance that goodness spreads through networks powered by meaning and trust. Disease hates smart trust. And we can build those networks on purpose!
For roughly 90% of the time since Jesus, the gaggle of believers that are his Body did not have anything that could really be called a hospital. But even in the first astonished days recorded in Acts, that Body expressed "diakonia"—ministries of practical care that were understood as evidence of God’s practical presence. Where hope rubs up against mortal reality social forms arise. That's how the hospital I work for came from; and where our new forms of community alignment with 280 congregations are now coming from.
Who knows if our slender webs of trust are enough and in time? Not for the 1,000 bodies already in bags in Haiti as I type. Innocence long gone. Crap.
But I do believe that God so loved the world that God send us out into it. God gives us hope, not innocence.
Never give up on who God loves.
Monday, November 8, 2010
“There is only one stream of water. What passes through the bodies of humans, passes through the bodies of animals, insects and plants. It flushes through our sanitation systems, flows through the rivers, seeps through wetlands, rises to the heavens to become clouds, and returns to nourish us and all living things. There is no life outside this cycle, and theology has to get real about it. Talking spirit without talking water is meaningless.” –Steve de Gruchy, Water and Spirit: Theology in the time of cholera.
Steve DeGruchy lived on the turbulent waves where theology was helping those in adjacent fields do hopeful labor amid fundamental vulnerability. Steve died earlier this year in, ironically, a wild river that he should not have been in. One of those emergent fields which Steve thought useful for life, was about Religious Health Assets which is how I became one small potato in his big bubbling stew of hopeful relationships. Last week, a group of us in the International Religious Health Assets Program (IRHAP) planted a tree on the Emory campus and gave papers in his honor at the American Academy of Religion.
Steve has been much in my mind as we get ready to open our “center of excellence in faith and health” in the heart of the hospital precisely because he constantly focused our attention outside of anything with walls toward the community—the social body.
Community is not just where we heal, but the thing that does the healing. This can only make sense when spoken with a theological accent, probably one with an African lilt. Shalom, like Bophelo, is a quality of a social body that is not “sort of like a body” or one only in the mind of a poet or prophet. It is, in the more crude language of our day, a network attribute. A network is not normally thought of as sacred but it can be. Shalom/Bophelo is the work of God, for Trinitarians, the work of the Spirit. We thrive because we are made into something capable of shalom or Bophelo.
Nobody even has an accurate count of how many religious hospitals have been born in the past two centuries. But it is important to note that every single one was formed out of a web of humans bound together in hopeful meaning capable of working amid chaos. Even a cursory glance at the tangled and tumbling stories of how the institutions of healing came to emerge alongside the wild Mississippi reveals a twisty bit of chaos. A hospital that was built to care for a very white Methodist pastor by a plantation owner in the heart of the Delta now provides the preponderance of indigent care for mostly African American men and women, upon whose ancestors' backs and suffering that early wealth was built. Closely aligned academic and research institutions share the same intertwined ironies that are almost too incendiary to fully map. Today we are wrestling real relationships and caregiving from this bitter landscape partly by means of relationships that dare to bear the name of a “covenant” designed to weave a “web of trust.” We hope to do this even amid ongoing unpredictability at the heart of liquid modernity. We live on the banks of a very turbulent river that never lets us forget that history emerges from unpredictability which produces good, bad and tangled things all along the journey.
It is almost too painful to read Steve’s writings about the complex symbolism of water in which both life and death tangled and tumbled together in ways that can only be spoken of in song, poem and lament. Do not try that at home alone for any one life is too bounded and random on which to rest any hope of transformation. Surely, this is the most obvious thing in all of human history.
The testimony is not all about bleak unpredictability, for chaos has an upside. Both theology and public health wonder whether chaos actually trends toward upside or downside. Human plans are often swept away, but sometimes improved in the process.
The findings of IRHAP on the effectiveness of faith forming entities on improving health outcomes remains somewhat mysterious precisely because the impact is inseparable from the ritual spiritual practices that form, sustain and reform and express faith. Worship, prayer, practices of accompaniment, hope and lament are not advanced by stripping them of their religious essence to be explained by the more barren language of functional outcomes. Health is a by product of an essentially mysterious process of faith. At least that is what those practicing in the context of the faith forming entities say. Steve listened to them, which is why his research and analysis has been so strikingly vivid and bold. May we be so, too.