Friday, December 23, 2016

Once Again, Amahl - Once Again

I posted this for Christmas eight years ago. As I look back at it, somehow the tenor of the times call it back to me, make it seem particularly apt. I offer it again. Once again this Christmas there will be Amahl; and once again I will cry.

This morning I am once again practicing my last Advent (or first Christmas) ritual: I am listening to “Amahl and the Night Visitors.” As “Jesus Christ Superstar” has long been my Holy Week ritual, I can’t be quite ready for Christmas until I’ve heard Amahl.

If you haven’t heard it before, I commend it to you. Gian Carlo Menotti composed it for the first broadcast of the Hallmark Hall of Fame on NBC. It was first broadcast on Christmas Eve, 1951, and every Christmas Eve after until 1966. It is a memory from my childhood, before we had joined the Episcopal Church and I had discovered Midnight Mass. Wikipedia has a good synopsis, with the history of the production, here. I have written some earlier reflections on the opera here.

As I listened this morning, I was particularly struck at how timely the setting is for this opera. Amahl’s mother is in her own survival mode. She can see no value beyond the economic, whether in her son’s poetry or in her guests’ possessions. It isn’t because she’s unfeeling. She loves her son powerfully, and wants, with what little she has – another “widow’s mite” – she wants to show hospitality. She is enough of a known person in her community that those around her will turn out in the middle of the night to extend their hospitality with hers.

At the same time, she is defeated, or so nearly so as not to matter. She is ashamed to consider begging, however exciting it might seem to her son; but she sees no other option for his survival, much less her own.

And so she is driven to theft. She considers differences in class: “I wonder if rich people know what to do with their gold,” thinking not of great luxury, but of the simple pleasures now beyond her reach, beyond her hope. She considers a greater good to be done: “Oh, what I could do for my child with that gold!” She considers even whatever incipient relationship, even obligation, she might have with her guests: “Why should it all go to a child they don’t even know?” Finally, she gives in, not for herself but for her child; not for it all, but for just what she might need: “If I take some they’ll never miss it.”

Perhaps; but she is caught in the act. And when caught, her humiliation, and that of her son, are complete. She is seized, and her only defender is her crippled son, too weak to do more than appeal plaintively to the kings themselves.

It is then that she discovers mercy: for the kings know she and her son are more important than the gold itself:

Oh, woman, you can keep the gold.
The Child we seek doesn’t need our gold.
On love, on love alone
He will build His kingdom.
His pierced hand will hold no scepter.
His haloed head will wear no crown.
His might will not be built on your toil.
Swifter than lightning
He will soon walk among us.
He will bring us new life
and receive our death,
and the keys to His city
belong to the poor.

And in that moment, there is a miracle – indeed, there are two. We will all celebrate with the second, when Amahl can walk, blessed with healing in the moment of his own greatest generosity. But, neither do we want to miss the first: for it is indeed miraculous when his mother’s eyes are opened, her imagination expanded, and her hope renewed. Indeed, her miracle is not so different from his; for as his body his healed, so is her spirit. She can see possibilities again, possibilities that take her beyond herself, even beyond her son: “For such a king I’ve waited all my life. And if I weren’t so poor, I would send a gift of my own to such a child.”

We are surrounded these days with the same desperation Amahl’s mother felt. We see it of course in any Christmas, and will until we see the Kingdom in fullness: those who, beat down by their circumstances, unable to imagine alternatives, will steal. Some will be simply and solely greedy; but many, like Amahl’s mother, will be unable to bear the shame of what they cannot do for another, for children or spouse or those otherwise family. But this year I fear there will be so many more. The economic devastation around us, wrought in no small part by our own inability to see value beyond the economic, our own poverty of spirit, leaves many, and more than usual, literally with “nothing to eat, not a stick of wood for the fire, not a drop of oil in the jug.”

Give thanks for those who can say, to whatever extent and in whatever way, “Oh, woman, you can keep the gold [because] the Child we seek doesn’t need our gold.” Give thanks and praise when you can and I can say that, for when we do we open up possibilities for miracles. Cry aloud, “On love, on love alone will he build his kingdom… and the keys to his city belong to the poor.”

And pray, pray now and always, for those miracles, whether as visible as a dancing child, or as profound as a healed and opened heart. Pray that as our hearts are opened, so might theirs be; so that all of our eyes might be opened to the miracles wrought in the name of the Child.

Blessings for Christmas, and for all in this season of Light, from the Episcopal Chaplain.

Monday, December 19, 2016

Opportunity for Fun for Wonks and Geeks Like Me

This morning I received a link to a page that ought to be exciting - if you think knowing about published research is exciting. Take a look at the Top 100 Articles of 2016 as compiled by Altmetric. Altmetric is new to me, too. They say of themselves, "Altmetric is a Digital Science company based in London, UK. Our mission is to track and analyse the online activity around scholarly research outputs."

At any rate, their list of the most reviewed articles is interesting. They include at least one unexpected author. And, at least some of the articles are available for anyone to read (and, yes, for some you'll need to get the journal in which it was published).

So, take a quick look to see at least which was number 1. Take a quick scan, and you'll discover a number that are not only of broad interest, but also accessible to a broad audience. (And thanks to Becker's Hospital Review for the link.)

Monday, December 05, 2016

Up at the Cafe: On Healthcare for All

I have a new piece up at Episcopal Cafe - my first in quite a while. The topic is to continue commenting on where the Episcopal Church is on health care. Specifically, General Convention has repeatedly called us to work for universal access to affordable, quality healthcare. (I've written about that before, including here and here.) 

Go over, take a look, and let me know what you think, whether there or here.

Thursday, September 01, 2016

A Political Thought for September 1

I have been mulling over again and again this concern I have heard often expressed, "I don't like the feeling of voting for the lesser of two evils." I can appreciate the sense of dissatisfaction in that. However, I have come to a different concern. If we accept that "All it takes for evil to triumph is for good [persons] to do nothing," (attributed, or more likely misattributed, to Edmund Burke; but thoughtful, whatever the source), then I think we are offered a different perspective. That is, we may feel some disappointment at the thought of voting for the lesser of two evils. However, we should feel a sense of duty to vote against the greater of two evils. That applies whether we identify the "evil" with a person or a platform; and whether the "evils" are two or more. (It applies whether you agree with me or disagree on where the "evil" is seen.) If we are called to act in this world for the love neighbor as self, we who are citizens have a positive moral duty, when we see "evil" to act against it. Vote!

Friday, August 26, 2016

And Yet Another Chaplain's Voice - This Time, A Familiar One

Faithful readers know that one of my simple pleasures is to share here when I discover a chaplain blogging. I have one to share, and I'm a bit embarrassed. This person is a dear friend and valued colleague. While her topics aren't only chaplaincy, she is a chaplain, and it shows up in her work. The chaplain is Joy Freeman, and her blog is Chaplainhood. Take the time to see what she has to share.

Thursday, June 30, 2016

Another Chaplain Voice in the Blogosphere

Any regular readers know that I'm always attentive to any new chaplain voices that pop up in the blogosphere. In this case, it's not that this person has just popped up. However, she's just come to my attention. She's actually been blogging longer than I have.

The name of the blog is Diary of a Contemplative. The Blogger is Amy Kumm-Hanson, an ELCA Chaplain. As I notes, she's been out here longer than I have (although not nearly so long as a chaplain). So, for those of us in the business - or just interested in the business - give her work a look.

Thursday, June 23, 2016

Further Considerations: More Reflections on "Testing the Efficacy of Chaplaincy Care"

So, I’m still in the process of thinking about Literature Review - Testing the Efficacy of Chaplaincy Care. This particular post isn’t really critique, but some thoughts.

One point to appreciate about the report is an entire section on “Limitation of Scope” (pp. 11 forward). The authors are discrete in describing what they are doing, and a clear sense of what they can and can’t do. For good reasons (again, it’s worth reading, so you can look at these yourselves) they note that they are looking at the North American environment for chaplains, and at acute care settings. They note specifically that “A review of the extensive literature on the influence of spirituality and religion on health is beyond the scope of this report.” (p. 12)

It seems to me that this highlights a theme in the report: to emphasize the research on chaplaincy specifically, and especially that done by and/or for chaplains.  It is an arguable approach. I can see the point, but it also misses a point. One of my concerns has been that we don’t read other professions’ research.

This is a comment I have made before, but I think it worth making again, and especially in considering this report on research that can guide and benefit chaplaincy. Research that speaks to spirituality, and so to the area of expertise of chaplains, appears in journals of a variety of professions. A review of the bibliography that the report includes demonstrates that to some extent. However, as the report focuses on chaplaincy specifically it doesn’t give a clear idea of the breadth of research to consider, whether in medical, nursing, psychology, or social work journals.

Now, I have noted that some of that research isn’t all that helpful (although I believe profoundly we need to be responding to it for that reason.) On the other hand, some of it is. We need to be reading it to see what our professional colleagues might be seeing, and to see what might be useful for us.

We need also to attend to the research on the correlation between religious behavior and health. The authors of this report allude to that work. They also note that there is criticism of that work. It often is hard to address the mechanism: that is, to identify the causative factor that brings the correlation about. While this is legitimate, I believe it overlooks the perspective of the individual patient that the motivation or association or affiliation that contributes to the result is religious. While not specifically about chaplaincy (and not always necessarily helpful for chaplaincy) it is research we need to be conversant about.  

I would also note that there is a good deal of research now to describe the current religious and spiritual landscape in the United States (and perhaps more broadly in North America). Most of this has been done for faith communities, most of them Christian, who want it to help focus evangelism. Evangelism is specifically not an interest of chaplains. However, the religious and spiritual landscape is very important for us. That includes both some sense of how people are affiliated, and also some sense of the spiritual lives of those who are not affiliated. One of my touchpoints with my own administrators is that with the growing number of folks who are indeed spiritual (expressed in familiar terms) but not religious (in the sense of being part of an institution) there is greater need for chaplains. We are those best prepared to support those with spiritual needs and no outside professionals to call on.

The authors are correct that chaplains need to be doing research to better describe and guide our work. We also need to be reading other professions’ research, whether it seems applicable initially or not. A report comparable to this that gave some review of where else we might be reading, and what we might want to recognize, appropriate, or challenge in the research of other groups would also be a valuable contribution.

Sunday, June 19, 2016

Credit Where Credit Is Due

The Healthcare Chaplaincy Network (HCCN) has disturbed the chaplaincy profession with the decision to establish the Spiritual Care Association (SCA). While I don't think it was necessary, my position is basically that of Gamaliel in the Acts of the Apostles. I plan not to say too much about it, and trust in God. If it brings benefits it will stand. If it doesn't, it will fail without help from anyone else.

With all the criticism, though, of HCCN for starting a new organization, I think there is some point in appreciating other things that they have contributed. They have provided support for a number of projects. They have been especially interested in research. HCCN leadership has felt that, to the extent possible, the profession should be evidence-based, and research is how we get the evidence.

With that in mind, I want to commend their document, Literature Review - Testing the Efficacy of Chaplaincy Care. It is well worth reviewing.

Not that I'm going to do that here - at least, not in full. The document is 88 pages, with a great deal of information to digest. So, I'm not going to do   single review of the entire piece. I am, however, going to look at some interesting parts of it.

I am going to recommend that we all read the first section of the paper, the Executive Summary. There is plenty of information there to consider. There is a summary review of chaplaincy in healthcare, and an argument that chaplaincy should be research-based.

Also helpful, and especially helpful to include in the Executive Summary is Gap Analysis, a list of areas for research that would benefit the profession. The list itself is both exciting and appalling: it is both excitingly thorough and depressingly long. We have a lot of work to think about doing.

I happen to agree that our profession can and should do research. However, my concern is that we're not doing research that could benefit us. As the Executive Summary states,

Since chaplaincy research has only begun to accumulate, there is a significant danger that research will not proceed in a focused and organized manner.   

We're not alone in that. In this recent story on NPR it was observed that in many fields that's an issue. There is excitement over the new and groundbreaking, but not much over confirming (or disproving) something already started.

For chaplains, at least, this has resulted in a host of small studies, essentially pilot studies that demonstrate (if they demonstrate anything) that a subject can be studied, and that perhaps there is value in studying it again. And if no one actually studies it again, the potential value is lost. So, the authors point out,

If study questions, methods and outcomes are carefully chosen they will build upon and integrate with other work in the field of spiritual care.  One way to support a focused research agenda is to fund research through one or more central consortia, which would set the research agenda, fund studies through a Request for Proposals process, and promote communication and capacity building among the research groups. The consortium would be advised by clinical and research leaders in chaplaincy who would set the basic parameters of the research, monitor its progress, and serve as mentors to new researchers.

This is certainly an issue that the professional organizations, and larger chaplaincy institutions (like HCCN) might take up, whether individually or as part of a proposed consortium: choosing topics for study, or replicating worthwhile pilot studies, on a large, even multicenter scale. We might even be able to leverage recent changes in healthcare in general to support that. For example, a number of centers using the same electronic medical record platform might add specific pieces to their documentation. That would allow consistency and ease of access to the data across a variety of institutions. Such a proposed consortium, or even a single body adept at coordination and grant writing, could help make these meaningful steps.

The paper, Literature Review - Testing the Efficacy of Chaplaincy Care, from HCCN is a significant contribution to the field, one that many may have missed. I think all of us should review at least the Executive Summary. Those of us with a more active interest in research should dig further (and, after all, for those of us whose continuing education requirements include some focus on research, there are several contact hours to be acquired here, covering the good work). While HCCN has become a center of controversy, we also do not want to ignore their important contributions, including this one.

Tuesday, May 31, 2016

A Quick Note: AEHC in Orlando This Year

All right, siblings, here is the news: we have the schedule for AEHC events at this year's APC Conference in Orlando. All events are scheduled for Friday, June 24th (the Feast of the Nativity of John the Baptist!):
  • Eucharist 7:00 am
  • Breakfast/meeting 8:00 am Palm Ballroom 1
  • Reception outside Pavilion 6:00-7:30 pm- appetizers and cash bar.
The registration fee for this year's events will be $100.00, to include both breakfast and the reception. So, get the word out!
As soon as a registration form is available, it should be posted at the AEHC Facebook page.

Friday, April 15, 2016

Whither Chaplaincy? Looking at the Spiritual Care Association

The newest event in the profession of healthcare chaplaincy has been the announcement by the Health Care Chaplaincy Network (HCCN) by a broad new initiative centered in the Spiritual Care Association (SCA). SCA will encompass a new professional organization, new standards for Board Certification (without rejecting existing standards for other professional organizations), and new opportunities (that may also mean new standards) for clinical pastoral education (CPE). There has been a good deal of conversation on this on the Facebook page of the Association of Professional Chaplains, and I’ve made my contribution. With that in mind, I thought I would also share my observations here.

Let me say, though, that to make sense of these observations, you need to look at the SCA website. Review the plans for Membership, for Certification and for CPE, and see for yourself what you think.

This conversation began when I asked on Facebook about the need for a new spiritual care organization and its multiple initiatives, I took the time to watch the video of Eric Hall introducing the Spiritual Care Association at HCCN's Caring for the Human Spirit conference. It addresses the questions I raised. Some things in it I find compelling and some things I don't; but it's well worth the 45 minutes to watch. To contribute to the discussion we've started below, or to respond to me now, go first and watch the video. We can then talk more about how we react.

First, I found some of the criticism of the existing organizations apt, and some inappropriate. I agree that things haven't moved as quickly as I might like - matters like settling on a limited number of spiritual assessment models, or developing the Standards of Practice. At the same time, It simply is easier for a business enterprise (non-profit, certainly, but structured as a business) to act, and develop a membership organization as justification, than it is for a membership organization, working almost entirely with volunteer "employees," to develop the structures to act like a business; much less to develop collaborative structures with other collegial membership organizations. HCCN has been quite successful over the years at pursuing philanthropic funds. I wish APC had been as successful. I wonder if there wasn't some loss due to the competition.

Beyond that, where to start? Let me start with thoughts about a different set of educational standards. What Hall describes in his address is a clinical education curriculum that is much more content-focused and content-driven than clinical pastoral education as we know it. That was, I think, somewhat more the case with the NACC CPE programs, because they had clear expectations of formation not just as chaplains but as Roman Catholic professionals. I grant that CPE curricula are not standardized; but in general they have been oriented toward formation of the individual vocations rather than a specific content. To move the focus from personal growth toward content transmission would be a significant change. (Enough for the first comment.)

There is a distinct movement within the entire SCA panorama to identify and focus on the spiritual as separate from the religious. Evidence for this is the lack of extensive theological education or ecclesiastical endorsement for certification. This concerns me for several reasons. First, it remains the case, at least in these United States, that most persons express their spirituality in language we would call religious, even if they are not members of institutions. Indeed, those who have done research on Nones or Unaffiliated (depending on your research) found that more than 70% of them had values that shaped their lives and decisions, that they commonly expressed in language we would call religious.

A second concern would be how we identify the spiritual separate from the religious. In our house we have a long history of saying, "The mystics all have the same experience, and then describe them differently due to the inadequacy of human language and culture." We might try a reductionist process to identify what is spiritual, derived from what is religious; and then how would we talk about it? The HCCN/SCA effort would want to focus on something like this at the core of a coherent body of knowledge; but I'm not sure the effort would yield meaningful results, or results that would translate to our patients, families, and staff.

Another concern related to the spiritual/religious divide is the loss of accountability to a faith community. We have long understood ecclesiastical endorsement as something of a "patient safety" matter: it is another avenue of accountability, another resource to address questionable practice. In the presentation, and also in the information on the HCCN/SCA web site, this is simply absent. It would be important to hear explicitly why this is not still helpful to our consumers.

That is not too far from my own experience. In my years as a chaplain in healthcare - virtually all of my career - I have certainly understood that I needed to understand and participate in the culture of healthcare. I am committed to research, both doing our own and reading and understanding the research of others. I am committed to communicating well what our value is. I am also convinced that the team, from doctor to nurse to administrator to HR to... well, to all of them, that the team does not want me to be more clinical at the loss of what the team understands as spiritual, which quite clearly includes the religious. The team wants us to be spiritual providers - clinically informed, yes; but definitely distinctive.

These are the thoughts I started with. There will be more.  The conversation will continue on Facebook. There should also be a feedback page coming to the SCA site, so the conversation can happen there. Dig in.

Tuesday, March 01, 2016

Faith Leaders and the Ebola Epidemic in Africa

If you're not on the list to receive headlines from the Anglican Communion News Service or the Episcopal News Service, you may have missed this (it was circulated by both services). Three bishops of Anglican dioceses in west Africa recently visited England where they spoke both to the Anglican Alliance and to General Synod about the church's response to and participation in the efforts against ebola in the recent epidemic. At the link above there is information about their meeting with Anglican Alliance, and also other information about responding to ebola.

One of the resources there that I found especially interesting was Keeping the Faith: The Role of Faith Leaders in the Ebola Response. This publication of Christian Aid is worth reviewing. It reports a study describing how religious leaders, both Christian and Muslim, were critical in gathering community support and convincing anxious communities to accept medical assistance. While the document is quite long, the Executive Summary, beginning on page 8, describes the findings well. Initially, some communities feared the government intervention as much as the disease. After disease had struck a village or a family, there was significant stigma. Initially, the medical workers were not interested in participation from faith leaders. However, once engaged, faith leaders were able to provide educators whose authority was accepted to help communities understand the disease and the necessary help. They were also able to provide support for disrupted families and communities, and to address directly the issues of stigma.

We were anxious in the United States about ebola, even though the risks to the population as a whole were small and manageable. This report speaks from the center of the outbreak, where risks were great and resources for control thin. It's helpful to see how faith leaders, with their established authority in their communities, were able to take the lead in providing care for prevention, treatment, and community need. I hope you'll take time to at least read the Executive Summary.

Friday, February 05, 2016

On Days and Numbering and Other Things

Regular readers know that I am an occasional contributor to the Episcopal Cafe, so it won't surprise anyone that I am a daily reader. This morning, I followed this post, Bishop Katherine Jefferts-Schori contributing to the series on Faith and Science in the 21st Century at Day1, the radio and on-line resource supported by mainline Protestant churches. I certainly commend Bishop Jefferts-Schori's video and her reflection on re-framing and repentance.

And then, looking further in that series, I discovered another contribution: the Rev. Dr. Tom Long reflecting on Psalm 90 and the call to Number Our Days. I was especially interested because the point of his sermon (on the link, and then scroll down past the interview portion. If you're registered with Day1 you can hear the audio of the sermon.) was to reflect on numbering our days in light of the capacities of contemporary medicine. He speaks to a difficulty that I have described by saying, "When will folks understand that Dr. House lied to them? We don't get every patient cured, much less in 60 minutes!" Tom Long points this out himself, if more gently, and reflects on numbering our days and wisdom.

Often enough I have spoken to this myself, frequently addressing (all right, complaining about) the tendency in the media to hype every small study with an apparently positive result, without presenting that result in its longer - and not necessarily so positive - context. Tom Long does it with a bit more grace and a bit more Scripture, and I commend this to you, too.

Wednesday, January 27, 2016

Extending God's Party: Sermon for Epiphany 3, year C

I had the pleasure of preaching again at St.Mary Magdalene Church in Belton, Missouri (or, yes, Loch Lloyd). You can link to the sermon here.

Just one explanatory note: I also preached there on Sunday the 17th, and, reflecting on Jesus at the wedding at Cana, spoke of God's party, the celebration and celebrating we do that demonstrates the presence of Christ in the world. So, if you're not sure what "party" I mention in the sermon, there it is. God calls us to celebrate by demonstrating God's presence in Christ; and to use all our gifts for the party; and to invite to the party those who most need to hear about the Year of the Lord's Favor.

Tuesday, January 19, 2016

We're Here to Help

I do still look up health news now and again, considering topics of interest. And, this evening I ran across this story from ABC News.

The headline captures the point well: “Many Doctors Choose End-of-Life Care Differently Than the General Population, Two Studies Show.” In fact the two studies appeared today in JAMA. the Journal of the American Medical Association. You can review them here and here. The points are that doctors are less likely than the general public to die in a hospital, or to use medical procedures and technology at the end of life. Both studies are based on the medical records of literally hundreds of thousands of people, and as we all know, those large numbers mean statistically meaningful results.

Perhaps this would be a surprise to someone, but not to those of us who work in healthcare. Indeed, the second study looked at folks who worked in healthcare who were not doctors; and their results were closer to the doctors than to the general public. The comment in the article is that the general public isn’t prepared to discuss what the limits might be to appropriate care. I think we need to respect the other side of that coin: those of us who work with it every day are more likely to discuss it, precisely because we have seen what those hospital stays and late life interventions do – and don’t -  accomplish.

I don’t want to press these results too far. While the differences are statistically significant, they aren’t absolute. In fact, a lot of those late life interventions in hospitals happen before the decision is reached that it is in fact the end of life. And, of course, there are certainly enough doctors who also have difficulty talking about decisions at the end of life – their own lives and those of their patients.

At the same time, perhaps the opportunity is for folks who don’t work in healthcare to ask those of us who do, whether doctors or not. It would be even better if they were to ask us especially when it isn’t a crisis. I have said often enough that these topics should be discussed over breakfast at home; and that the worst place to discuss the patient’s wishes is at a bedside in ICU at 2:00 in the morning.

So, perhaps the ABC News article can stimulate more of these conversations. It is a bit easier to have these conversations with one’s physician these days, but you don’t have to wait for that annual appointment. Perhaps it would be better to have the conversation with friends and family, especially (but not limited to) any who work in healthcare. We know the stakes. We want to help. And if it does get to 2:00 in the morning at a bedside in ICU, it’s likely to be those family and friends who get asked just what your values would be.