AEHC: A (Very Different) Meeting in Pittsburgh

I wanted to bring to everyone’s attention the Annual Meeting of the Assembly of Episcopal Healthcare Chaplains (AEHC), which is coming up next month. Events will be taking place March 9 and 10 in Pittsburgh, Pennsylvania. Let me share with you in part the letter from Margie Tuttle, President-elect of AEHC, and planner for this year’s Conference:

We hope you’re coming to Pittsburgh! The Assembly of Episcopal Healthcare Chaplains will gather for worship, fun, and fellowship during the annual Conference of the Association of Professional Chaplains.

AEHC Schedule

Sunday, March 9 7:00 a.m.

Celebration of Holy Eucharist
Breakfast sponsored by Bishop Packard’s Office
AEHC Annual Meeting

Monday, March 10 6:30 p.m.

Banquet – Dinner Cruise

Come aboard the Keystone Belle of the Gateway Clipper Fleet for a buffet dinner and narrated tour of three rivers. We’ll sail from the Convention Center Dock, a short walk from the hotel. The cost is $60.00 per person. A cash bar will be available. The Keystone Belle is handicapped accessible. Please don’t let the increase in cost for the banquet stop you. Assistance is available.

AEHC members will be receiving this letter and a registration form shortly, and it will also be in the coming issue of Chaplair, the AEHC newsletter. However, if you’re available and interested and would like information, email me either through this blog or from the AEHC web site, and I’ll be happy to provide you with a registration form.

Take some time to look at the AEHC web site. Yes, some of the information is dated (mea culpa, mea culpa, mea maxima culpa), but much is not (including the email link to me for more information). Take some time to learn more about who we are as an organization.

The AEHC Conference is taking place in conjunction with the Annual Conference of the Association of Professional Chaplains (APC). The APC Conference continues to offer the most opportunities for continuing education and networking; and since many of our members are limited in how many conferences they can attend, we think it offers them the best bang for limited bucks. You can learn about that meeting, including schedule and housing, at their web site.

I won’t be able to be in Pittsburgh myself this year – the first meeting I’ve missed in a decade and more. However, I hope you’ll consider it; and if you can, I hope you’ll join with Episcopal colleagues to celebrate our ministries in health care institutions.

Until the Kingdom Comes....

This has been a day for discussing mortality. Actually, it’s been a week for it – and it’s only Tuesday! But in two days I’ve had a week’s worth of such considerations.

I’m not really talking about death here: it hasn’t been that a number of patients have died. Rather, it’s been that a number of patients and family members have been thinking about dying, about that point where either medical science or human will or both reach the point where there is nothing more to do. Some are there, some can only see it in the foreseeable future; but for all it is a firm reality. There’s the patient who no longer seems to care, and the patient who’s announced that it’s time to have last conversations, to say goodbye and then “to sleep, perchance to dream.” There is the spouse who doesn’t want to let go, but who is realizing the beloved will never be quite the same, even if in some sense the body continues to function. There’s the patient newly diagnosed with the same disease that took the lives of all his siblings. All of them are seeing with particular clarity a truth they knew but, like most of us most of the time, shelved, somehow thinking there would always be “another day.”

That truth is that we die. Unless the Kingdom comes first, we can all expect to die. It has long been a soapbox issue for me to rail when I see a new medical study talking about “the mortality rate.” A new study comes out, proclaiming the great leap forward, the new chemical or the new technique that offer such progress. And such progress is often described this way: “with the new medicine the death rate (from x circumstance) was reduced by 15% (or 2% or 20% or whatever number is presented). Brothers and Sisters, the truth is this: the death rate is 100%. Until Christ changes things beyond all recognition, the death rate is 100%, and all of us will fall.

As a chaplain it’s often within in my purview – indeed, it’s sometimes my responsibility – to point out this truth. In general I have always wanted the bare fact to be stated by the physician, because often the bare fact requires illustration, illumination, with biology and chemistry and engineering that the physician is better able to provide, and better heard in providing. But once the bare fact is out there, the human reception, the emotional incorporation, falls under my professional sphere. Often enough it’s simply to hear and encourage the resulting grief. Sometimes it’s to ask the question that no one else can ask: “And what if your loved one is dying? What if this is the end?”

Understand that in general I’m not interested in stripping way denial. Denial as an initial reaction in grief is a buffer, a shock absorber (both literal and metaphorical). It can actually aid the grieving process, allowing the griever to absorb without being overcome. But sometimes there are decisions that must be made. Sometimes when medical science or human will or both reach their limit for the patient, those around the patient must be confronted with that which they’ve most feared, most avoided; for if they do not the patient suffers – suffers what some of them, and certainly some of us in the business, consider literally a fate worse than death.

As a priest it’s also part of my purview. Indeed, the Church instructs me to instruct you that someday you will die. There is this rubric in the Prayer Book:

The Minister of the Congregation is directed to instruct the people, from time to time, about the duty of Christian parents to make prudent provision for the well-being of their families, and of all persons to make wills, while they are in health, arranging for the disposal of their temporal goods, not neglecting, if they are able, to leave bequests for religious and charitable uses.

I cite it regularly, although I fear I may be one of the few priests who does. Many of my Sundays are spent supplying, filling in for colleagues who are traveling or ill. When we get to the announcements I announce my “second sermon.” When they laugh, I say, “You think I’m kidding.” I speak to the rubric, and then expand on it to discuss the importance of Health Care Treatment Directives and Durable Powers of Attorney for Health Care – to say, not only must we expect to die, but we can expect that we might well get sick, and make appropriate provision. (I will offer here, as I do in the congregations, a gold star to the person who knows just where in the 1979 Prayer Book to find this rubric. It is in a place that makes sense, but it’s not where I would have put it.)

So, as a priest and a chaplain it is part of my role, part of my practice, to bring home now and again that we are mortal. It is an important fact of life, for all that we do our best to ignore it or delay it or prevent it. It will confront each of us, and because of each of us those we love, sooner or later. Indeed, it is critical that we appreciate it (by which I do not mean to pursue it, suicidally or homicidally, or ascetically); for our faith is built on our mortality. We believe in Him who became mortal that we might become immortal – in him who died that we might live. We believe Christ took on all that is our human nature, including our mortality, so as to transform it. We participate in his resurrection because we participate in his death; but we participate in his death because he participated in ours. Until the Kingdom comes, we have no way to resurrection except through death.

And so until the Kingdom comes, we must discover and rediscover the truth: the death rate is 100%. And when some have difficulty with that, I will do my best to help them. I will do my best to be with them as they realize and recognize mortality. I’m a priest and a chaplain; it’s what I do.

New Shimmer! Is It Church Humor or Health Care Humor? Actually, It's Both!

(All right; apologies to the original cast of Saturday Night; but I couldn't resist.)

My friend over at Kirkepiscatoid has posted something delightful, something both of my constituencies should enjoy, titled, "If Clergy Paperwork were like Heath Care Paperwork." Take a few minutes and enjoy it.

My only comment is that Maria missed the requirement for a prescription before communion. When we first opened the hospital I serve, the Pharmacy had a liquor license. That's really not so unusual. They had need to buy ethanol in quantity, and the license made it easier I think. In any case, I asked the manager whether I could buy communion wine through the Pharmacy and get a better price. He said I could, but then I'd need a prescription for everyone who received communion. And he smiled as he said it; but it was only partly in jest. We would have really needed prescriptions for him to distribute it. Imagine the paperwork nightmare that would have been!

Anyway, read and have fun.

On Decisions and Stumbling Blocks

In my regular perusing this week, I ran across an interesting article. It’s published in the latest JAMA: the Journal of the American Medical Association (January 9/16, 2008) in the column, “A Piece of My Mind.” Written by Ann-Marie Rosland, MD, of Ann Arbor, Michigan, it’s titled, “Assuming the Worst.”

Dr. Rosland writes from personal and family experience. A beloved aunt would perhaps benefit from aggressive care, but a quick decision needed to be made. This aunt had a history of health challenges (and from the description of this aunt, “challenges” seems a more apt term than either “problems” or “issues”), and might well consider aggressive treatment. However, it was not initially offered. From Dr. Rosland’s experience and perspective, it wasn’t offered because of assumptions made by the responsible physician. The physician looked at the patient’s physical appearance, her immediate lab work, and general information from her history, and determined that the patient would not benefit. The physician did not, however, actually speak to the patient to learn about who she was, about her history, her perspective, and her hopes for the future. Because the physician didn’t really know the patient, and didn’t really try to know the patient, the patient was not initially offered all options for treatment.

Dr. Rosland speaks of “attitudinal barriers” to treatment:

Before this, I thought the challenges people with disabilities faced getting medical care were physical barriers: an examination table that doesn't lower, a mammography machine that the patient must stand up to use. But now Jean faced attitudinal barriers: clinicians' attitudes led them to assume that Jean couldn't handle chemotherapy, which they did not confirm before making treatment decisions. Jean had faced unfounded assumptions about her abilities before, but in the medical setting the assumptions seem more dangerous, in both their subtlety and their potential for harm.

Dr. Rosland notes that, “The idea that biased attitudes might contribute to health disparities is nothing new,” and connects this with our experience of assumptions based on race, ethnicity, or economics.

Unfortunately, the situation could be even trickier for people with disabilities. While there is no physiologic basis to assume that minorities will do worse with catheterization, knee replacement, or chemotherapy, it is reasonable to assume there might be medical contraindications to aggressive therapy in someone with physical disabilities. The problem comes when these assumptions are not tested with the individual patient.

Dr. Rosland concludes that, “The responsibility to overcome attitudinal barriers has to lie with those who make clinical decisions and the institutions they work in,” and she notes several initiatives that might provide models. She also “can't help but wonder if changing the circumstances in which we make medical decisions (time pressured, tired, without colleague input) would make us less likely to rely on implicit assumptions.” I can’t help but think she’s right.

Those of us who work in health care see these “attitudinal barriers” all too frequently, and always affecting the way, and the sort of care that is offered. We have our own in-house jokes and acronyms, the most famous and obnoxious of which might be “gomer,” an acronym for “Get Out of My Emergency Room!” Whether it’s an assumption that a patient will be difficult or noncompliant, or that the patient is drug-seeking, if we fail to test out that assumption patient by patient, we risk failing to provide care that would be meaningful and appropriate. If we’re honest, we know we have our biases. Where we fail is when we fail to wrestle with them, to test them, in assessing this patient, this situation, this decision.

When you have the chance, look up this article. It offers us another opportunity to return to the critical factor in medical decisions: the patient right in front of us; and offers it with both clinical and personal authority. For chaplains, trained to “exegete the living human document,” this is an always-timely reminder of where our attention needs to focus. For all of us who work in health care, or in any other field of service or ministry, it’s a call for self-examination: how do we raise “attitudinal barriers” to care, barriers every bit as real and as consequential as the physical barriers we sometimes find easier to see and confront.

One Priest on Baptism

It’s not so much that it’s been a slow week as I’ve been slow this week. Please God, this too shall pass…. Back to work:


As do many of us, I use a service to track how many people visit this blog, where they are, and what brought them there. That last is usually another web page. Often enough it’s a search page, and I often find the search questions quite interesting. Earlier this week there was one search string that seemed fortuitous. The search question was, in essense, “What do Episcopalians believe about baptism?” That was fortuitous because just that night I met with a group of parents to instruct them about baptism. Their children will be baptized this Sunday, the Feast of the Baptism of our Lord. In light of the question, and my own preparation, I thought I would share here what I shared with them

SO, what are we doing in Baptism? As I thought about it, I decided we were doing eight things.

1. Following the Lord’s command
Baptism is one of the two sacraments of the Church that everyone agrees was commanded by Jesus: “And Jesus came and said to them, ‘All authority in heaven and on earth has been given to me. Go therefore and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything that I have commanded you. And remember, I am with you always, to the end of the age.” (Matthew 28:18-20)

2. Participating in the Baptism of Jesus
Jesus was baptized by John in the Jordan. John’s baptism was a statement of repentance. To “repent” – metanoia in Greek – means literally “to turn around.” John was calling the people of God to literally turn toward God and to turn away from lives that distracted them from God. By participating in John’s baptism, Jesus endorsed John’s message. Of course, he then went on to transcend it.

3. Participating in the death and resurrection of Jesus
Paul speaks about our participation Christ’s death and resurrection: “Therefore I endure everything for the sake of the elect, so that they may also obtain the salvation that is in Christ Jesus, with eternal glory. The saying is sure: If we have died with him, we will also live with him.” (2 Timothy 2:10-11) The Church has long understood that being baptized, going through the water, is to symbolically die so as to be resurrected.

To catch some of this, we need to recognize where water fits into those “might acts of God.” Think about the stories we tell in the Easter Vigil. We recall the story of Noah, when God carried his family through the waters that killed all of life so as to virtually restart creation. We recall the story of Israel at the Red Sea, when they walked through the waters “that stood up like walls” – waters that would destroy the Egyptians. There are other stories – notably Joshua leading Israel through the Jordan into the land of promise, and Jonah being saved in the belly of the fish – in which God brings his chosen to life through waters that would otherwise mean death.

It can be a little easier if we understand how baptisms were done in the early Church. The earliest good information we have is from the late Third-early Fourth Centuries. It describes a powerful rite of passage held in a special baptistery, a separate structure adjacent to the church. The candidate, stripped naked and anointed for exorcism, was brought to the font by two attendants. The bishop stood on a dais above the candidate and asked, “Do you believe in God the Father?” The candidate would answer, “I believe!” and would immediately be immersed by the attendants. The bishop would ask again, “Do you believe in God the Son” The candidate would answer, “I believe,” and would once again be immersed. The bishop would ask finally, “Do you believe in God the Son?” The candidate would answer a third time, “I believe,” and a third time would be immersed, held in the strong hands of the attendants. When lifted from the water, the candidate would be anointed again for blessing, dressed in a new white robe, and escorted to the church to join the congregation.

Think about that experience of being submerged in that big font. You could get a very real sense that you could drown if this went wrong. So, the sense of risking death to rise to new life was quite palpable. We don’t put our children – or, for that matter, our adults – through that sort of experience these days; but we retain the understanding.

4. Cleansing from sin.
Now, sometimes we struggle with this. We baptize infants. What sin do we want to attribute to infants? Look at what the Catechism says:

Q. What is sin?
A. Sin is the seeking of our own will instead of the will of God, thus distorting our relationship with God, with other people, and with all creation.

When are we as human beings more committed to seeking our own will than as infants? In one sense we’re prepared to excuse it: babies are so helpless, we’re not surprised that they’re needy. At the same time, they demonstrate quite clearly a characteristic of being human that just doesn’t go away. Left to our own devices, we little less inclined to seek our own way as adults as we were as infants. And left to our own devices, we certainly do distort all of our relationships. We speak of that tendency, overcome at best only temporarily and at significant effort, as “original sin.”

We believe that we are cleansed both from past sins and from “original sin.” That is, God’s forgiveness is made free to us – free for what we’ve already done, and free to prevent our ultimate destruction by those things we will almost certainly do in the future. We’re not freed from the tendency, the character flaw. That would be to take from us our humanity. However, we are freed from that tendency, those distortions, from being God’s last word.


5. Receiving the Holy Spirit
We believe God shares with us his Holy Spirit. While that’s God’s action, and not something we can force, we trust that if we do this in the right way and with the right intent, God will come through. God shares with his Holy Spirit, which offers us the opportunity to be aware always of God’s presence, and empowers us to live lives that resist sin and evil. Our natural inclination is to distort. Our capacity to resist that inclination is God’s Spirit working in us to support and strengthen us.

6. Being born again into the Body of Christ
We know that birth is in itself passage through water. The first public sign of the coming birth is when the water breaks. In this case, it is the Church’s water, and the person newborn is newborn into the Body of Christ, which is the Church. In this birth the Spirit we receive is the Holy Spirit, which we also know is the Spirit of Christ. So, we become “members” in Christ’s Body, as Paul wrote in 1 Corinthians 12.

The other image we use in the Church to describe this new relationship is agricultural: we speak of the person being grafted into Christ. This catches the image that Jesus gave us in John: “I am the vine and you are the branches.” (John 15:5) Paul picks up this image in Romans when he speaks of Gentiles being taken into the community of God in place of unbelieving Israel: “For if you have been cut from what is by nature a wild olive tree and grafted, contrary to nature, into a cultivated olive tree, how much more will these natural branches be grafted back into their own olive tree.” (Romans 11:24) Although it isn’t quite as powerful an image as birth, we do still remember this image as well.

7. Joining the Church as institution.
Of course, the public expression of being newborn in Christ is to be added to the Church roles. Now, note that baptism is full membership in the Church. You’re never more a member of the Church that at Baptism. We require certain maturity to participate in some of the activities of the Church – notably, being 16 years old to vote in parish meetings and serve on vestries – and we offer Confirmation as an opportunity to claim the faith as a choice; but those don’t make a person “more” of a member. Every baptized person is a full member of the Episcopal Church.

8. Committing to the new life of faith.
Finally, we commit ourselves, or we commit to raise our children, to a life that shows forth our faith publicly. That’s why we recite the Baptismal Covenant in full for every Baptism, for every Confirmation, and each year at the Easter Vigil. It’s why the Baptismal Covenant as we understand it in the Episcopal Church doesn’t end with the recitation of the Creed, but includes some pretty specific claims of what the Christian faith and life looks like:

Celebrant Will you continue in the apostles’ teaching and fellowship, in the breaking of bread, and in the prayers?
People I will, with God’s help.

Celebrant Will you persevere in resisting evil, and, whenever you fall into sin, repent and return to the Lord?
People I will, with God’s help.

Celebrant Will you proclaim by word and example the Good News of God in Christ?
People I will, with God’s help.

Celebrant Will you seek and serve Christ in all persons, loving your neighbor as yourself?
People I will, with God’s help.

Celebrant Will you strive for justice and peace among all people, and respect the dignity of every human being?
People I will, with God’s help.

It’s not just a matter of what we believe. It’s also a matter of how we will live out that belief.

It’s also not just a matter of what we believe as individuals. First, parents and Godparents commit to see “that the child you present is brought up in the Christian faith and life” – this Christian faith and life. We commit do this actively, and not passively, by our “prayers and witness.” And we commit to support one another, and to support one another’s children, in this when we say “We will” “do all in [our] power to support these persons in their life in Christ.”


So, this is one priest's response. The class seemed to appreciate it; at least they stayed attentive and interested, and that's all one can ask.