"I Read About This Case...."

Just how valuable is anecdotal evidence? In my world, “anecdotal evidence” refers to the individual interesting story. In a world that is shaped – or at least believes it is shaped – by research, anecdotal evidence is interesting, but not all that valuable. They are almost always interesting, but usually too exceptional to be useful.

Unless, that is, it’s brought up by an anxious family member. In that case, it is a moment to grasp at slim hope; and in that case, the story almost always begins something like, “I read about this one case….”

So, it caught my attention when this AP story showed up in my paper. While they are not the whole content of the story, it is built around two exceptional young women. They share the distinction of each having weighed less than ten ounces, and having lived to tell about it (so to speak). They have had remarkably few ongoing health problems. They are perhaps as exceptional a pair as we might find in any set of health statistics.

And the article does note that. Early on the reporter notes,

A medical report from the doctor who resuscitated the infants at a suburban Chicago hospital is both a success story and a cautionary tale. These two are the exceptions and their remarkable health years later should not raise false hope: Most babies this small do poorly and many do not survive even with advanced medical care.

It would be more true to say, “most do not survive with advanced medical care.” The article notes the research of a physician who tracks data on this, and says that, “about 7,500 U.S. babies are born each year weighing less than 1 pound, and that about 10 percent survive.” Which is to say, of course, that 90 percent die, even with all the medical technology that we can bring to bear.

The article notes that this is especially important in trying to determine at what point a fetus is viable. This is an important consideration in two hot questions in medical ethics. The first is when it is or is not appropriate to treat. That is, what is the point after which all the medical technology might benefit this new child, and before which it won’t – and so arguably isn’t worth putting this new child through. All the medical technology is scarce and expensive; and while there is resistance to the idea of rationing that care, it’s a reasonable question whether there are circumstances in which it would be wasteful.

The second hot question is abortion. In efforts to regulate abortion, and especially after the first trimester, many states have sought to identify some point of “viability,” some point in gestational development after which most fetuses (and in application any individual fetus) will probably survive, and so should have some measure of legal personhood – enough at least for the state to defend.

The difficult thing is that these cases don’t really help us know about viability. Yes, they have survived, and indeed have thrived; and, like other anecdotal evidence, they are too exceptional to be really useful.

That doesn’t mean, though, that these stories won’t come up. Such stories always come up. It is at that point when physicians and other health professionals need to step beyond simple statistics. It is at that point when they have to become more specific and discuss why this case – this person, this fetus, this patient – is more likely to be on the 90 percent and not in the 10 percent. That’s not an easy task. It almost always involves telling people something they don’t want to hear, something that emotionally they may not be able to hear.

At the same time, it’s what we have to do (and I say “we” advisedly; because helping hear what they’ve been told is also part of what a chaplain might be called to do). It’s all we can do. Our best information and our best medical guidance is all we can offer in response to this opening: “I read about this one case….”

The Good News Really Is Good News: Reflections for Advent 3, Year B

From the lessons for this Sunday, the 3rd of Advent:

“The spirit of the Lord GOD is upon me,

    because the LORD has anointed me;

he has sent me to bring good news to the oppressed,

    to bind up the brokenhearted,

to proclaim liberty to the captives,

    and release to the prisoners;

to proclaim the year of the LORD's favor….” (Isaiah 61:1-2a)

Wait a minute! Don’t we hear that somewhere else?  Of course!  We hear if from Jesus.

“When he came to Nazareth, where he had been brought up, he went to the synagogue on the sabbath day, as was his custom. He stood up to read, and the scroll of the prophet Isaiah was given to him. He unrolled the scroll and found the place where it was written:

‘The Spirit of the Lord is upon me,

   because he has anointed me

     to bring good news to the poor.

He has sent me to proclaim release to the captives

   and recovery of sight to the blind,

     to let the oppressed go free,

to proclaim the year of the Lord’s favor.’” (Luke 4:16-19)

So, this Sunday as we find ourselves in the story just before the public presentation of Jesus the adult (that is, just before the baptism and, in John, the encounter with the first disciples) and in the church calendar just before the celebration of Jesus the infant, we also find ourselves just at the beginning of Jesus’ public ministry, at least as recorded by Luke. In the context of Luke, we would say that this is Jesus’ opening description of his own ministry. Surely to those who heard Jesus in the synagogue at Nazareth this would bring to mind not just the memory of Isaiah’s prophecy, but also the context in which he prophesied. He prophesied to folks who had returned to Jerusalem, only to find that it wasn’t all that they had hoped. So in Jesus’ time Jerusalem was not all that the people might hope: occupied by Roman troops, ruled by cooperation – one might even say conspiracy – between a Roman governor, a puppet king, and the religious establishment, but certainly not by God.

In the midst of that confusion, that darkness, John comes baptizing and preaching. When representatives of the religious establishment come and ask, “Who are you,” all he says at first is who he is not: “Not Messiah, not Elijah, not even the prophet predicted by Moses.” Whoever he is, he finds more important who he is not. “I’m one calling you to prepare. Another is coming, greater than I, and I am not worthy to be his slave.”

These days as we look at a world that is not all that we might hope – wars and rumors of wars, economic injustice, and a world apparently ruled by those whose first question is, “What’s in it for me and mine” – we are called to be people of hope. We are called to proclaim as Jesus did that God’s intent is good news and health and freedom and restoration. We are called to proclaim the time when the Lord’s grace will rule all, when all things will be set just as God intends. It isn’t necessarily easy, and it won’t always be heard. That doesn’t matter. Jesus confirmed what Isaiah proclaimed: that God’s plan is for wholeness and restoration. In our generation, it’s our vocation to pass that on.

Another Chaplain's Voice

I'm always interested in another blog about health care chaplaincy. There just aren't that many. However, I've discovered another. Check out The World of Pastoral And Spiritual Care. The author is a rabbi and chaplain in New Jersey. The posts and citations are interesting. So, give it a read.

 

Remembering That Insurance Isn't Necessarily Enough

A friend picked up on this video on YouTube:



If you don't know Elizabeth Warren, it's time you did. She was President Obama's choice to establish the new Consumer Financial Protection Bureau, intended to monitor investment practices on behalf of the general public. She got the Bureau established; but when the President wanted to nominate her as its first head, Republicans in the Senate made it clear she could never be confirmed - a telling point, if one can be known by one's enemies. She is now running for the Senate herself.

Her point in this video: even those of us with insurance can be bankrupted by medical expenses. This isn't the result of any one factor. However, with all the various reasons for this, it remains a cautionary tale.  Take a few minutes to watch.

On God and Job Descriptions: Reflections on Proper 17A

Yeah, I know this it a bit behind. It's been an interesting autumn. But, more about that another time.

Most of us – certainly, all of us who are adults – have at one time or another been through the process of hearing a job description. It might come as part of a job interview. It might come as part of a peer review process, or perhaps an annual review. But one way or another, most of us have listened to a detailed job description.

Which is, really, what happened to Moses.

Now, Moses had been coping with a serious identity problem. Was he a Hebrew slave? Was he an Egyptian prince? All of this came to head when he killed that Egyptian overseer – something that would make sense for a Hebrew slave, but which only an Egyptian prince could get away with. That was the reaction the next day of the other Hebrews: “Who are you? You’re nothing but a murderer!” Then he fled to Midian. There he married a preacher’s daughter, and became a shepherd. Hebrew slave, Egyptian prince, murderer, shepherd – that has to be an identity crisis to end all identity crises!

So, there he was, out in the wilderness with the flock, when he sees the bush; and it’s burning – except it’s not. It’s flaming – yet nothing goes to coal or ash. “This,” he says, “I’ve got to see.” He turns aside, and when he gets close enough, God calls to him: “Moses, take off your shoes. You’re standing on holy ground.”

And then God gives Moses a job: “I’ve seen how my people suffer at the hands of the Egyptians. I’m going to bring them out; and I’m going to send you to do it.”

Now, this is pretty basic as a job description – but Moses wants none of it! He starts to crawfish, coming up with every reason he can think of that he’s not the right person. He doesn’t speak well, and he doesn’t make much of an impression. First and foremost, he says, “Who am I to go? More important, when they ask, who can I say sent me?”

And God answers: “I am who I am;” or, “I will be who I will be;’ or, perhaps, “Is-ness. And that will be my name forever.”

But for all of that, Moses wants nothing to do with it; and won’t, until God eliminates all his objections. But, this got me to thinking: Moses doesn’t sound all that much like someone we’d accept into the ordination process. After all, when bishops and Commissions on Ministry and seminaries think about who they might consider for ordination, they tend to think about someone who is confident and competent, and certainly not someone with a serious identity crisis. They look for someone who can function independently. When I was in the process, they were looking for “a self-starter.” Fifteen years later, the phrase was “a change agent.” Recently, I’ve heard that the goal is someone who is “entrepreneurial.” And there’s a point to all of this. Most clergy are in one-person positions, or perhaps part of a small staff. The capacity to act independently has its value.

But, Moses wasn’t very “entrepreneurial.” He wanted nothing to do with this job, at least not at first. And yet look what God did with him!

We get caught up in these images of what things are supposed to look like, and especially what leaders are supposed to look like. That was Peter’s problem. He had just proclaimed that Jesus was the Messiah and the Son of God; and Jesus had proclaimed that this confession would be the foundation for the new body. And then he went on to give the job description, to say what being Messiah would mean. It would mean journeying to Jerusalem, where it would mean arrest and torture and crucifixion and death, and then resurrection. But as we know that didn’t fit Peter’s image of the Messiah. Wasn’t the Messiah supposed to raise up Israel again, and, not incidentally, to through out those oppressive Romans and those awful Greek-speaking pagans? So, he took Jesus, pulled him out of earshot, and said, “Wait a minute! Don’t tell them that! God forbid that should happen!”

But Jesus answered so that everyone could hear: “Get behind me, Satan. You are deceived and deceiving. You’re seeing things the way everyone has always seen them; but God sees them differently. And if you can’t see things right you’re a hindrance to me and not a help.”

He went on, “If you want to follow, you need to take up your own cross and follow. If you try to hang on to the life you’ve had, you will lose it. If you will let go of that life for me, you’ll discover new life that you haven’t imagined.”

So, Jesus laid out a new understanding of what it meant to be Messiah, one that included torture and suffering and death; and he laid out a new job description for his disciples. Peter was convinced it was all wrong. He wanted nothing to do with this new job. But, look what God did with him!

The thing is that this is entirely consistent with how God does things. Time and time again God takes someone who isn’t at all entrepreneurial, who often enough is unprepared and uninterested, and in and through that someone carries out God’s purposes. God takes folks who are unexpected and uninspiring and sometimes just flat incompetent, and does wondrous things with them. Those folks we think of as great heroes of the faith didn’t start out heroic at all. That’s just how God does it.

Which ought, I think, to make us both hopeful and anxious. It ought to make us hopeful because these are folks like us – like me. I have to admit that one of my favorite canticles in the Prayer Book is one we largely hear in Lent. I feel quite connected to the Song of Penitence, with its verse, “I have sinned, O Lord, I have sinned,/ and I know my wickedness only too well.” I think if we’re honest, we are all aware of our shortcomings. We can be hopeful to think that God can do wonderful things in and through folks like us – and usually does!

And that’s what might make us anxious. If God can work through folks like us, then we need to consider that God is always calling folks like us – that God is always calling us. Sure, that call doesn’t often come in some great and mysterious event; but it certainly will come. And we are people who say we will respond. Every time we attend a baptism in the Episcopal Church, and at Easter and other times, we say again and again that “We will, with God’s help.” We trust that God in Christ is calling, and we have committed to answer when we hear. In the Baptismal Covenant we have heard, if you will, a job description; and we have committed to the job.

Blessedly, rarely are we called to lead God’s people out of slavery into freedom; but we are called. And few of us will see a burning bush; but we will hear God call. And when we hear we can trust that God can work in us, because God has always worked in folks like us. From a Hebrew mother, who put her child in a basket because she was required to throw him in the river, to a teenage girl, who said to God’s messenger “I will do what God asks;” from a frightened shepherd with an identity crisis to a confused fisherman who, until after the resurrection, can’t keep his foot out of his mouth; God has worked in folks like us to carry out God’s purposes. So when God calls, we need not worry that we’re not good or competent or entrepreneurial or heroic enough. God can do wondrous things through folks like us. God always has.