Finding life here

We were happy this week to see that Memphis has dropped out of the top ten most violent cities in the United States, letting St. Louis receive the dissing we normally absorb. Some things are moving in the right direction. However, we remain at the wrong end of nearly every list ever made of problems: obesity, diabetes, violence, stroke, disparities, foreclosures, failure to graduate and pretty much any other way of measuring pathology. Nobody in Memphis is surprised to learn of anything bad. But this is our city and we choose to live here. We work with the strengths and assets to be found to craft the future along the lines of God's hopes, not our fears.

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.

Life thanks you

The Reverend Fred Smith has been my guide and pathfinder for many years in the shared work of faith and, well, all sorts of things including health.

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.

Fred's words:

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
common vocations
together.
 
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
who know
no boundaries
But are deeply woven
together in the Beloved Community 
 
Shalom to you...

Not-waiting, honestly

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.

Eden Long Gone (Thank God)

In the past couple weeks I've spent about 3,500 miles in my Prius bouncing back and forth to an odd assortment of events looking forward and backward. I listened to Bill McKibben's painfully clear new book Eaarth. The new spelling makes the point the old Earth simply doesn't exist anymore given the imminent affects of carbon levels unseen in 20 million years. And then I read Sue Thistletwaite's "Dreaming of Eden", which as a bit ironic in that I was speaking at Eden Seminary. Hers is an equally searing call to lay down innocence-- leave Eden--so we can make the real choices that must be made today. They both write as lovers, seeing their world whole, deeply threatened, but not lost.

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.

Wild Water

“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.

Gary

Thoughts and Prayers for the Week of March 24, 2008

by Butch Odom


Thought & Prayer for Monday, March 24, 2008

Welcome to the season of Easter, where we will remain until May. Easter is the most important time in the Christian year, but it is also the most mysterious. Since death has been overcome, since death has lost its sting, let’s consider embracing life and spend this week contemplating the Leading Causes of LifeTM, by Gary Gunderson with Larry Pray.

The lectionary passages for this week are numerous, and include: Jeremiah 31:1-6; Psalm 118:1-2, 14-24; Colossians 3:1-4; Acts 10:34-43; John 20:1-18 and Matthew 28:1-10.

From John 20:1-2 – Early on the first day of the week, while it was still dark, Mary Magdalene came to the tomb and saw that the stone had been removed from the tomb. So she ran and went to Simon Peter and the other disciple, the one whom Jesus’ loved, and said to them, “They have taken the Lord out of the tomb, and we do not know where they laid him.”

Leading Cause #1 - CONNECTION: As human beings we depend on our connectedness to family, friends and even coworkers. Imagine the sense of loss Jesus’ followers felt after the crucifixion. Now Mary finds the tomb empty, making her think initially that the final connection to Jesus, his grave, has been severed. Think of the significant connections in your life. Wouldn’t you agree that those connections are life-giving?

Prayer:
Creator God, you made us a people who thrive in healthy communities. Help us heal the disconnections in our lives so that we might live more fully. AMEN.


Thought & Prayer for Tuesday, March 25, 2008

From Acts 10:34-36 – Then Peter began to speak to them: “I truly understand that God shows no partiality, but in every nation anyone who fears him and does what is right is acceptable to him. You know the message he sent the people of Israel, preaching peace by Jesus Christ-he is Lord of all.”

Leading Cause #2 – COHERENCE: We strive for lives that have a sense of meaning and purpose. Imagine the coherence the disciples felt through their work with Jesus. Now imagine how that life-giving meaning was upset when Jesus was killed as a common criminal. Today, consider those people, those connections and those beliefs which bring the most meaning into your life.

Prayer:
Faithful God, for those people, those institutions, for all that brings rich, life-giving meaning into our lives, we thank you. AMEN.


Thought & Prayer for Wednesday, March 26, 2008

From Acts 10:36-38 – [Peter is still speaking.] “You know the message [God] sent the people of Israel, preaching peace by Jesus Christ-he is Lord of all. That message spread throughout Judea, beginning in Galilee after the baptism that John announced: how God anointed Jesus of Nazareth with the Holy Spirit and with power; how he went about doing good and healing all who were oppressed by the devil, for God was with him.”

Leading Cause #3 – AGENCY: “Just Do It” was the slogan of or the name of an organization that encouraged young people to do good…to act…to do something for the greater good that was within their power or skill set, even of something simple like planting a tree or picking up trash. Agency entails this ability to get things done. Can you begin to see how these Leading Causes of LifeTM tie together? The greater the sense of connection in our lives and the more coherence we feel, then the greater our ability to act effectively. Also, the more we act, the more meaning we could add to our lives and the more opportunities for connection we could have.

Prayer:
Gracious God, it is easy for us to think globally. Give us strength to ACT locally. AMEN.


Thought & Prayer for Thursday, March 27, 2008

From Psalm 118:1-2 – O give thanks to the LORD, for he is good; his steadfast love endures forever! Let Israel say, “His steadfast love endures forever.”

Leading Cause #4 – BLESSING: “How are you doing today?” I asked Janice. “Fine and blessed,” was her reply. We give blessings to each other and we receive blessings from others. But blessing also occurs through the ages as we connect with our parents and their parents on through the years and with our children and our children’s children. Through blessing, we are connected to forever.

Prayer:
Steadfast God of the beginning, middle and end of time, stand by us in our now. Help us be a blessing to those around us, and may we be blessed today. AMEN.


Thought & Prayer for Friday, March 28, 2008

From Psalm 118:24 – This is the day that the LORD has made; let us rejoice and be glad in it.

And from Matthew 28:5-8 – But the angel said to the women, “Do not be afraid; I know that you are looking for Jesus who was crucified. He is not here; for he has been raised, as he said. Come see the place where he lay. Then go quickly and tell his disciples, ‘He has been raised from the dead, and indeed he is going ahead of you to Galilee; there you will see him.’ This is my message for you.”

Leading Cause #5 – HOPE: The final of the Leading Causes of LifeTM is real, grounded hope. Such hope comes from the interaction of all the other causes discussed previously this week. How does one have hope in the midst of deep despair, for instance, if their life is not connection and coherence-filled? If one feels powerless to act and has no sense of blessing how can they experience hope? Today, take a moment to embrace that for which you hope most.

Prayer:
Steadfast God of hope, even in our despair, we know you are by our side. Help us be better instillers of hope in those around us. AMEN.

Clinical Improvement is Life, too

This week in a couple of our hospital leadership meetings we took a close and very encouraging look at some new work aimed at reducing the leading cause of death in our (and most everyones') facilities, sepsis. Although strokes and heart attacks are more familiar, sepsis kills more people. Sepsis, which is really blood poisoning, is one way the body shuts down naturally, so it can't be eliminated. But some sepsis is unnecessary and, if detected early can be beaten back. Indeed, in just one of our hospitals (Methodist North) we are now seeing 5 fewer sepsis deaths per month because of a carefully coordinated set of tools and practices. That's a lot of birthdays over a year.

When this was presented to managment, the story was all about the technology, which is not inappropriate because the early detection that is the key is driven by the dramatically new potentials our brand new fully eletronic medical record system have given us. When the vital signs are entered into the system (more and more this is done via monitoring devices that are directly wired into the system), the system screens for the pattern of early sepsis. Those symptoms may not be apparent to a nurse just standing next to the patient, but when that pattern is recognized by the system an email and text page is sent to the physician and response team so they can go intervene right away.

What I see is wires, but more precisely, wires allowing the leading causes of life to flourish. The whole response is highly social--its a team. And any time there are two or three in some relationship to each other, there will be life going on. In this case, the new level of connectedness, illuminates dramatic new levels of agency possible for the team. When you hear the team report on this powerful innovation, the voices vibrate with coherence -- this kind of life giving work is what they have organized their life around since they entered school. This is why they come to work and the source of their creative passion. It is the reason Dr. Joe Kettracide went into the odd and arcane stream of work known as medical information management. He's a physician who helped invent the technology of the electronic medical record and came to Methodist because he wanted to see one health system actually fulfill its promise. Those five birthdays a month ring every coherence bell in his body. But so it does for the nurses, the managers who figured out how to build the business case, the tech guy who plugged the computers together.

The word blessing pops up in this kind of conversation as something experienced not just by the patient, but by everyone involved. The successful innovation brings everyone into a living relationship in which they experience more life and deeper life.

The connection feeds the agency which resonates deeply with the coherence among the care team which creates a powerful sense of blessing. The result is a lot more life than we had going on. The new energy in the room was palpable. We were all more alive and capable of participating in more stuff like this. We found ourselves with more hope --riskable expectation-- that we had before. Methodist risked $100 million so far on these electronic tools, so that is not a small thing to think about.

Life was at work in this process, which can even flow across the wires, beepers, stainless steel and odd language of a hospital.