On the Tradition of Healthcare: Happy Holiday

Invocation for the Saint Luke's Health System Leadership Meeting, 11/30/2017. Our System is faith-based, rooted in the Episcopal Church. In radical hospitality, we are explicitly supportive of the traditions of all our patients, families, and staff.

 

Welcome to the Holiday Season! But, what is a holiday?

Our word "holiday" comes from older versions of English that spoke of "holy days." Not that the idea is particularly English: here are those days in any spiritual tradition that stand out, and that call for different behavior. Work stops. Sometimes even war stops. Families gather, communities gather, and do something different for the day. It may be to feast, or it may be to fast. It may call for quiet and private reflection, or it may call for public celebration and public service. It is a day that stands out, when believers stand out, from other days.

Welcome to the Holiday Season. Looking at November, December, and into January, and looking just at on line resources, there are special observations in ten different faith traditions, and several civic observations as well – and that’s without counting separately the distinctive practices within broader traditions. Some commemorate births. Some remember special revelations. Some are as much about cultural heritage as about religion per se, although those observing would not likely make that distinction. Certainly, this period is a season of holidays – of holy days – for many different communities.

 

There are those holy days that we might identify in this tradition of health care. There are those "first times." I remember the first patient seen in the Emergency Room at Saint Luke’s South, not long after midnight when we first lit the sign. We remember the first heart transplant, both that initial surgery half a world away, and the first one done at Saint Luke’s. We remember new resources and facilities, from the first hospital established 130 years ago to the completion of the new Anderson County Hospital. We remember special honors – state Quality awards, or the Baldrige: days of honor and prestige.

 

And then there are those more personal days. Every surgery is a holy day, a special day of observation for patient and family. Every discharge is a holy day, whether it is a day of feasting or fasting. Every birth is holy day, as is every death. It is our vocation, and also our privilege to participate in these holy days, directly or indirectly, and to work to make them days of honor and celebration; to make them memorable for hope and grace and compassion and mercy.

 

Welcome to the Holiday Season. May each of us in our own communities celebrate, knowing that our colleagues support us in celebration. And, may each of us in our health system celebrate those other "holy days," in support of those we serve, and those we serve with. Amen.

On the Tradition of Healthcare 6.29.2017

Invocation for the Saint Luke's Health System Leadership Meeting, 6/29/2017. Our System is faith-based, rooted in the Episcopal Church. In radical hospitality, we are explicitly supportive of the traditions of all our patients, families, and staff.

We as a group come from a number of different traditions. But, some of you have heard me suggest that there is a tradition we share, one that is a tradition of healthcare; and a recognition that healthcare in all its variations is holy work.

That tradition is old, older than we know. The Code of Hammurabi sets compensations and punishments for doctors and surgeons. Hippocrates learned his profession from his father and grandfather. Shimon ben Sirach was quoting his father when he wrote, 

Honor physicians for their services, for the Lord created them; for their gift of healing comes from the Most High, and they are rewarded by the king.

There is a tradition that is healthcare, healthcare as holy work, and we are all participating in it.

We, though, are not simply participating. We are leading. On the back of each badge in the room is our commitment to “the spiritual health of the communities we serve.” For us the communities we serve first, I think, are those we serve with. They are the physicians, yes; and also the nurses, therapists, technicians, engineers, housekeepers, volunteers - all those who share with us in creating and sustaining institutions of curing and healing, of caring and compassion and hope.

As we lead, there are various ways we might support the spiritual health of those we serve with; but I am sure this will be among them. We must reflect to them how each person contributes to the health and safety of every patient; and how each role expresses our commitments to service and compassion. We must recognize in them, and let them recognize in us, that we all participate in the tradition that is healthcare, and the knowledge that any service of healthcare - every service of healthcare - is holy work. Amen.

An Interesting Comment on Christian Moral Teaching

I was pointed to a new article from La Civilta Cattolica, a Jesuit publication based in the Vatican. Notably, the Wikipedia article about it states, "It is the only [publication] to be directly revised by the Secretariat of State of the Holy See and to receive its approval before being published." The article, published in English, is titled "Evangelical Fundamentalism and Catholic Integralism in the USA: A Surprising Ecumenism." (And thanks to IT at the Friends of Jake blog for pointing to it.)

The article raises very interesting questions about the political alignment between (political) Conservative Evangelicals and (political) Conservative Roman Catholics. While I would encourage my readers to read it in detail (and, it isn't either so long or so complicated as to make that difficult), I can point to the one theme I think important. The article points to the model of Pope Francis in trying to embrace the full breadth of Roman Catholic social teaching. That is, the Catholic Church is equally concerned about abortion, poverty, and stewardship of the earth. It has teachings on providing medical care to all, on serving the most needy, and on pursuing peace, as well as on human sexuality.

The point is not that the Catholic Church has changed any of the teachings that progressives might find difficult. It is, rather, also to embrace those teachings that progressives might agree with, and to challenge the pursuit of political power as a form of enforcing moral authority.

And on this last, it is especially pointed. Francis is leading in this, but he is not the model. As the last paragraph states,

This is why Francis is carrying forward a systematic counter-narration with respect to the narrative of fear. There is a need to fight against the manipulation of this season of anxiety and insecurity. Again, Francis is courageous here and gives no theological-political legitimacy to terrorists, avoiding any reduction of Islam to Islamic terrorism. Nor does he give it to those who postulate and want a “holy war” or to build barrier-fences crowned with barbed wire. The only crown that counts for the Christian is the one with thorns that Christ wore on high. (emphasis mine)

Interested in the Assembly of Episcopal Healthcare Chaplains (AEHC)? Benefits of Membership

Specifically for folks interested in the Assembly of Episcopal Healthcare Chaplains: several years ago I developed a list of benefits of membership. Two things occured to me. One was that I had never published that here. The other was that those thoughts needed to be reviewed. So, here for review (with some annotation) are the benefits of membership in AEHC.

-  Activities at the Annual meeting (commonly scheduled in conjunction with the Annual Meeting of the Association of Professional Chaplains [APC]):  the Episcopal Eucharist, participation in the Episcopal Breakfast, and the AEHC business meeting

-  The Episcopal Banquet at APC.  Ours is the function to attend, contributing to fellowship and networking with colleagues from across the country.  The President, President-elect, and Executive Director of APC are also invited to attend each year. Recently we have tried several different alternatives to a banquet to allow us to gather.

-  The AEHC web site (http://www.episcopalchaplain.org/; link in the right sidebar).  We share information with the membership, including membership information and web links.  We have recently completed an upgrade to the site.

-  The AEHC Facebook Page. AEHC maintains an open page in Facebook to share information and to raise the visibility of our work. It's another opportunity for members and supporters to hear about events and stories of interest.

-  Our listserv.  For those members who choose to join, it provides an opportunity for rapid communication and feedback from the Executive Committee, and from other Episcopalians in healthcare ministries. (We use the Mailchimp service, so you may need to review your Junk settings to allow our emails through.

-  Our Relationship with the Endorsing Officer for Healthcare Ministries, currently the Rev. Margaret Rose, Deputy for Ecumenical and Interfaith Collaboration, with the Office of Mission and Program of the Episcopal Church Center. Her Administrative Assistant, Terry Foster, has long processed our applications for endorsement. We benefit from their faithful ministries.

-  Our relationship with the Office of the Bishop Suffragan for Federal Chaplaincies, currently the newly elected Rt. Rev. Carl Wright.  The Bishop of Federal Chaplaincies has been another voice to advocate for healthcare ministries in the offices of the Episcopal Church and the House of Bishops.  The AEHC Executive Committee works to maintain clear communication and collaboration with the Bishop’s office.

-  Presence and visibility of healthcare chaplains at General Conventions of the Episcopal Church.  AEHC members have served as Deputies, as representatives of AEHC in the General Convention Exhibit Hall, and have assisted with the Office of the Bishop of Chaplaincies.  We’ve been present for most Conventions since 1994, raising the image of our work.  In Denver in 2000 that put us in a position to respond to resolution 2000-A079a, “Create an Association of Episcopal Health Care Groups and Individuals,” on advocacy in healthcare.  AEHC was noted by name in that resolution.  Two results of that resolution were the Formative Symposium for Healthcare (2001), and the conference “Waging Reconciliation: an Episcopal Response to Barriers to Health Care.” (2003). In Salt Lake City in 2015 current and former members of AEHC were able to touch base on the sidelines of Convention. 

-  Participation and representation in events of the Episcopal Church such as the Formative Symposium for Healthcare, “Waging Reconciliation: an Episcopal Response to Barriers to Health Care,” and the 2008 and 2012 meetings of the Standing Commission on Health.  AEHC officers have represented the organization in these meetings, allowing us to participate in shaping the church's positions on healthcare.

And now, to comment on some past benefits:

-  Chaplair, the AEHC newsletter, is published three to four times a year. (For the time being, Chaplair has been on hold. We continue to explore how best to communicate with our members and folks of interest, and at the moment Chaplair is part of that discussion, but hasn't been published recently.)

-  Representation at the JCAHO Forum of Liaison Organizations.  AEHC is a member organization of the Joint Commission’s Liaison Organization network. That gives us a voice when JCAHO is discussing new initiatives and regulations.  (While AEHC has been a member, The Joint COmmission has suspended its Forum of Liaison Organizations. Should they resume those gatherings, we will certainly be interested.)

AEHC has, I think, much to offer members, adapting as things change in chaplaincy and in the Episcopal Church. I hope you'll join me in membership.

It's All About Priorities

This started on my Facebook page. There I also tagged the Facebook pages of my Congressman and Senators. Feel free to share this yourself.

So, here's a thought. Instead of trying again to take healthcare away, or to address something as complex (and dicey) as the tax code, why not press forward on infrastructure.

• First, it has bipartisan support. 
• Second, it will create jobs, and jobs that can't be sent out of the country. 
• Third, those jobs will be in the private sector (remember, the Government contracts those jobs out; they don't buy bulldozers or hire workers itself). ...
• Fourth, there will be some significant multiplier effect, from the additional retail purchase of workers to the upgrading of heavy equipment to the investment in materials. 
• Fifth, it will help with health insurance because these new employees will either be able to get employer-supported insurance or they'll be able to buy on the exchanges with fewer subsidies. 
• Sixth, all that economic activity will increase tax receipts without increasing tax rates, for all levels of government.

So, why not pursue this instead of wasting time on the other issues?

Insight into Supporting Those Who Have Served in, and All Too Close To, Combat

I am just young enough that I did not have to worry about being drafted in the Viet Nam era. This not to say that I did not worry: I had already thought through how I might try to have some choice in my service if I was drafted (I had rejected the thought of somehow not serving). I registered as I was supposed to, but it didn't turn out to be an issue. As many will remember, in those waning days of Viet Nam the draft was determined by lottery; and just before my 18th birthday the lottery was suspended. That was not a call I received.

That was not to say, however, that I wasn't touched. I have older cousins, most of them women; and among their husbands were several who served. One of them was a career officer, who had more than one combat deployment. In our family that was appreciated and welcomed, if not always understood; but I was also aware of just how hostile the world outside the family could be for those returning veterans.

This comes to mind today as I have been reading the article "Only God Can Judge Me": Faith, Trauma, and Combat. The author is Nathan Solomon, a U. S. Navy Chaplain. I recommend it highly.

Central to Solomon's thesis are the categories of the Sent, the Senders, and the Liminal Ones. It should register immediately that the Sent are the service members who experience combat, whether directly or in support services. The Senders are, really, all of us: the nation, the society whose goals the service members seek to serve. The Liminal Ones are the chaplains who support the Sent. They are themselves Sent, and at the same time they bring something of the rest of us, the Senders, as well. 

For each of these groups, Solomon examines the experience in three categories: "What It Means," "What It Costs," and "Living With It." The explorations are honest, and through the paper the differences among the experiences of Sent, Senders, and Liminal Ones are well laid out. There is particular attention to how the churches (sic), both denominations and congregations, might want to examine ministries. 

While the article is written primarily for congregational clergy, I think there is value here for healthcare chaplains as well. Around us are those who have experienced combat trauma, among our patients and their families, and among our professional colleagues. While few of us could claim the same experiences, we do have some experience of serving with violent trauma, and that might make us - and call us to be - better listeners, better pastors, for those around us. 

On Keeping Healthcare Stable

Some of you may wonder why I haven't said too much about the threats to adequate healthcare for all Americans. Some of you may wonder why I have said "keep healthcare stable," instead of just defending the Affordable Care Act. I have done that because I actually work in healthcare, and want to be clear, including by when and where I'm logged in, that these are my opinions and not a reflection of or a reflection on my employer.

That said (and I can't imagine anyone will be surprised), I do have opinions. First and foremost, I think we have sold the Act incorrectly. The name of the act that is labeled Obamacare is "The Patient Protection and Affordable Care Act." We've spent so much time letting folks complain about what "affordable" might mean, and for whom, that we are now at risk for letting the "protection" get washed away. Pay close attention: it is the protections that are truly popular - no exclusions for pre-existing conditions; equity on preventive care for both men and women; equity for mental health with physical health; subsidies to allow the most vulnerable to afford insurance; insurability for folks whose employment and lack of income had left them out; coverage for children on a parent's policy until age 26; a set of minimum standards for what a policy should provide. It is also the protections that make this less "affordable;" and so it is the protections that are at risk. So, not just "Defend the ACA;" "Defend the Patient Protection Act."

So, I speak about "keep healthcare stable" because I can imagine improvements to the Patient Protection and Affordable Care Act; and even a replacement that might be better. At that point, I heard Paul Simon singing about "the myth of fingerprints:" I don't care much whose name is on the bill as long as the bill does the right things. Call it Romneycare instead. Call it the German Model, because this is basically how the Germans meet everyone's needs. Call it Trumpcare or Ryancare - I don't care, as long as it's a real replacement - you know, one that does at least what the old one did (EVERYTHING the old one did), and perhaps more, and perhaps more economically. One of our major auto insurance companies has this ad out, with a focus on their full replacement policy. The hook, proclaimed by the actor complaining about another company is, "Do they expect you to drive 3/4 of a car?" So, I am interested in stability more than the myth of fingerprints. I don't care whose name is one it; but 3/4 of a replacement for the Patient Protection and Affordable Care Act is not a true replacement.

I am also concerned about stability because healthcare is one of the largest employers, as a sector of the economy. These are good jobs, professional jobs, that can't be outsourced overseas. In my years in the business one of its hallmarks has been the many people who have started at the bottom and used employer-supported resources to have better jobs and better pay. One of the patient protections at risk if things aren't stable is an adequate workforce to care for them. Note that at this point I'm not talking about chaplains. We are so small a part of the industry already that we can't sway much. I'm talking about nurses, therapists, lab scientists, and pharmacists. To have them when we need them means we need to keep healthcare stable.

So, there I am: I'm willing to hear that there's a better way; but those who claim that need to actually offer something better. They need to offer it clearly, and they need to offer it before dismantling what is in place. For patient protection, affordability, and a stable economy - things that have actually been helped by the Patient Protection and Affordable Care Act - we need to keep healthcare stable.