Green Lights Aplenty, Yet I Still Only Hope for Hope

 This morning a friend, who has played basketball at levels higher than I ever dreamed, likened my recent increase in ministry and employment opportunities to the momentum a team experiences when there has been even a brief series of successes on defense and/or offense. A few three-pointers, or a couple of steals in a row, or any number of other combinations can propel one side forward. What had been a close contest moves toward a seemingly inevitable victory. When one player is finding a great deal of that success, it has been said that they have a “green light” to take whatever shot they choose.

Eavesdropping on conversations in the publishing and motion picture production industries, I have also learned what it means to “green light” a project. Here are some of the green lights that have recently begun falling into place for me.

One of those green lights this week was the scheduling of my dissertation defense (also referred to by some as the presentation of my ministry project paper) for April 4. Because this really is a presentation, and not the kind of defense you can “lose,” I now know that I will, in fact, graduate from Multnomah Biblical Seminary in Portland, Oregon on Friday, May 12. Four years of work will have culminated in being a Doctor of Ministry. (I’d use the abbreviation, but some enjoy pronouncing it “demon.” So, well…no.)

Any discussion of green lights has to
eventually get to F. Scott Fitzgerald.
Right?

Another green light, in the sense of getting the go-ahead with other aspects of my ministry, is the invitation I have accepted to serve Multnomah Biblical Seminary as an adjunct professor this fall. I will be teaching one course, being on campus in Reno for just two Friday-Saturday face-to-face sessions with students, and covering the rest of those responsibilities from the internet-connection (which interestingly has failed yet again while I type this) here in my office at the house in Fall River Mills. That means I get to continue being pastor of The Glenburn Community Church, and be a seminary professor as well. Gravy!

Still another green light comes from being part of the faculty for Right On Mission Vocational Seminary. I accepted an invitation this week along with others from the faculty being funded (as in “all-expense-paid”) by Church United. We will be participating in a conference in Washington D.C. entitled “Watchmen on the Wall” late this May. This is a great opportunity to better understand some of the priorities and perspectives of those within our government and from within the Evangelical tradition’s church leadership.

The view from Jay's dock?

Finally, this last “green light” borders on irony, if not the sublimely ridiculous. As some of you may remember, there had been a number of hateful misrepresentations made about me to the faculty and staff of my three-time alma mater,[1] Simpson University, where I was serving at the time as an adjunct professor, preparing to teach “Old Testament: Kings and Prophets.” In short, the President, Provost, and Board Chairman had all suggested, recommended, and requested (though not respectively in that order) to the new dean of the seminary that I be relieved of my responsibilities. To shorten a long story, I did teach my class that following Spring. But I have not had a similar opportunity since. And yet, this past Thursday, I was blessed to guest-lecture in that dean’s Pastoral Care course on what I refer to as “pastoral thanatology”—encouraging and equipping our students to serve our dying and bereaved neighbor. Following that morning’s session, we discussed how we might go about getting similar training into the hands, hearts, and minds of others throughout the Central Pacific District of the Christian and Missionary Alliance (my ordaining denomination).

Neil Hilborn - conveniently attired.

So, I am seeing a lot of green lights.

And that brings two others into view. Some of us who paid more attention in high school’s American Literature class may only need to Google the second reference. Others who are more attuned to social media may only need to Google the first reference. Those of you who immediately recognize both—well, you are doubly blessed, indeed! I do hope, though, that all of you take the time to fully understand what these last two green lights mean to me.

It has been nearly forty years since I first read about Jay Gatsby’s green light, and all the hopes for future success and satisfaction that distant glimmer represented. Gatsby’s green light, of course, never fell fully within his grasp. I have fears about that green light, and the attractive illusion that somehow there is a point of arrival, after which I can say, “I am done.”

Don't blame the fixture.
It's just letting you know it's there.

It has been a much shorter time since I became acquainted with the work of Neil Hilborn. Because the signs at each door of my office’s building glow green, I think of his “exit sign” as another kind of green light. I have fears about that green light as well. It is, for me, no illusion at all that there could be a point of arrival, after which I could say, “I am done,” even though, lately, in the words of Mr. Hilborn, the show has “never been quite bad enough to make me want to leave.”

So, for all those who imagine that all we need is for a few things to go well, to go right, or to go not-quite-so-badly, and we’ll be feeling much better shortly, I’ll tell you this. For all the other green lights I have seen so recently, it is my fear of these two others, Gatsby’s and Hilborn’s, that dominates my thoughts, even now.

---

[1] To refresh your memory: I hold a bachelor’s from Simpson College, a master’s of ministry in pastoral counseling from The Simpson Graduate School of Ministry, and a master’s of divinity from A.W. Tozer Theological Seminary. In total, the four members of my immediate family have earned four bachelor’s, three master’s, and two teaching credentials, and all four of us have been employees of the college/university/seminary, some among us on multiple occasions. 

Life-and-Death Differences: How do I know whether I need Hospice, Palliative Care, Terminal Sedation, or Physician-Assisted Suicide?

Doesn't it seem like there should be
at least one more option than this?

Those of us who discuss dying on a regular basis sometimes forget that terms we use very specifically can have a much broader range of meaning for most other (i.e., “normal”) people. For example, grieving, mourning, and being bereaved are often used interchangeably as synonyms (i.e., words with essentially the same meaning). Is it helpful to identify the particular definition of each one? I believe it is, especially for those who are experiencing all three simultaneously, and trying to find a safe course to navigate through them. Technically, then, but briefly: Bereavement = the condition of having experienced a significant loss. Grief = the involuntary reaction we experience when we are bereaved. Mourning = the voluntary actions we take that help to process our grief.

Vocabulary for the Dying

If the terms describing the experience of loss and its aftermath are important to distinguish from one another, then it is even more important to do so when the terms apply to our own experience as an imminently dying patient. Most of us would like to know only what it means to have symptoms, receive a diagnosis, follow a course of curative treatments, and be restored to health. And yet, the reality is that most of us, either in our own life or the lives of those closest to us, will hear some form of that dreaded sentence from our doctors: “I’m sorry. There’s nothing more we can do to make you well.” What are we supposed to do when “there’s nothing more we can do?”

The important distinction, even when you are diagnosed with a terminal disease, is that while there is nothing else to be done that will cure you, there is far more that can be done to ensure that you continue to live the best possible life until that terminal disease (or some other cause) ends your life. The next step, especially for those whose terminal or chronic illness is likely to end their lives within six months or so, is usually a referral to “Hospice.”

Well, this is a third option, but it's not exactly
what hospice care is all about.

Hospice: What it is, and why.

The best definition of hospice says more about what it is not than what it is. “Hospice exists not to prolong your life, nor to hasten its end, but to help you live until you die.” When curative measures are no longer possible, or desirable (since some patients find the treatments more difficult, debilitating, or even deadly than the disease), hospice can provide patients with symptom-management and pain relief throughout the natural, physical process of dying. But just as importantly, and sometimes more so, hospice provides support for the mental, emotional, social, and spiritual needs of the patient, their family, friends, caregivers, and others. The focus on a patient’s personal preferences includes determining how best to provide service in either the patient’s home or in a medical facility. The support for the many peripheral needs can include discussions with insurance providers, referrals to funeral planners, and coordination with the appropriate faith communities for spiritual support as well.

Why am I so concerned that you understand what hospice is and does? First, you or someone you know will likely need hospice services someday. Second, there are other alternatives becoming more popular, primarily because people are unaware that hospice care is available to them. And third, I want you to understand what hospice is and does because I hear too often, “If we’d only known everything hospice could do, we would have called you in much earlier.” Sadly, I also have to hear people say, “I wish we’d known about hospice when our loved one was dying.”

At least when it's prescribed in California,
it still has to be suicide, not homicide (so far).

“Turn Out the Lights; the Party’s Over”

To fully understand what hospice is and does (and isn’t and doesn’t), there is another pair of terms that are often confused (Palliative/Terminal Sedation and Physician-Assisted Suicide), and a third (the Dual Effect) that needs to be clarified as well.

These distinctions are very important, especially for those exposed to recent references in popular Christian books. In Rob Moll’s The Art of Dying, he quotes from Dallas Willard’s The Divine Conspiracy (before repeating the phrase as his own perspective) to portray hospice as employing “the widespread use of heavy sedation.” No wonder, then, that some patients, friends, and family members imagine that once hospice service begins the patient’s conscious existence becomes a thing of the past. But in actual practice, even what is called the “dual effect” of a patient becoming unconscious (or dying) as a side-effect of sufficient doses of pain medication is rare. When it does occur, it results from attempts to relieve distressing symptoms and/or unbearable pain. Further, it is almost exclusively occurring at the very end of a terminal illness’s progression. And yet, even when diseases have done nearly all they can do to us, hospices routinely accommodate the preferences of patients who, willing to endure higher levels of pain than others might, want to stay as awake and alert as possible. This is sometimes a temporary preference that allows, for example, one last visit with distant relatives or friends, and sometimes a distinct desire to experience as much as possible of the life remaining to them.

But there are, occasionally, physical symptoms that are “intractable.” Sometimes the extraordinary panoply of medications and techniques available are unable to provide the level of symptom management and/or pain relief that the patient desires. Palliative/Terminal Sedation (usually referred to as either Palliative Sedation or Terminal Sedation) is necessary for those patients who can only be made comfortable by rendering them unconscious. This is “palliative” in that it is a means of relieving pain and/or other symptoms. It is “terminal” because, unless there are measures to provide nutrition and hydration (food and water) artificially, the patient does not regain consciousness. Death occurs within a matter of days once there is no further fluid intake.

Is Palliative/Terminal Sedation, then, a form of Physician-Assisted Suicide? Some would see any claim to a difference between them as merely splitting hairs. In practice, however, there is a vast difference between the prescription of pain relief that may result in diminished or lack of consciousness (as can be a side-effect of effective Palliative Care), the prescription of unconsciousness as the only means of relieving pain (Palliative/Terminal Sedation) and the proactive ending of one’s life in order to preemptively avoid whatever symptoms may or may not accompany the progression of a terminal disease (Physician-Assisted Suicide).

So, we have made some progress.
(In grammar, punctuation and spelling, too, it seems.)

One Last, Unfortunate Distinction

While all hospices provide palliative care (relieving pain and symptoms), not all palliative care should be confined to hospice. There are patients for whom symptom-management and pain-relief should be provided, even as they pursue curative care. This is not currently the case for most patients. There are hopes for change, and some signs of progress. But currently both public and private insurers are hesitant to cover palliative measures for non-terminal patients. Still, palliative specialization in the medical community continues to be developed in anticipation of one day overcoming the legislative and regulatory roadblocks to a more enlightened public policy.

This bears careful attention as the push toward suicide continues to grow (as with California’s recent passage of the End of Life Options Act). If our society continues to advocate for hastening the deaths of the terminally ill, we are morally obligated to allow all patients the option of pursuing a cure for their disease and the restoration of their health. Unfortunately, patients too often abandon that curative care due to the debilitating side-effects or devastatingly difficult life-adjustments necessitated by otherwise effective treatments. As the proponents of Physician-Assisted Suicide disregard hospice, offering instead a “get well or die” paradigm, every opportunity should be provided to those patients who would seek to get well, were they not asked to endure torturous treatments unmitigated by palliative care.

On Attending an Intentional Death: Some things to consider before you invite me to join your friends and family for your premature send-off

If all you can see is death,
then I would suggest you look more closely.

I was recently honored to consult on a blog post by my friend, Paul Louis Metzger, entitled “Lights Out: Shining a Light on Caring for the Dying in a Multi-Faith World.” (It can be found here.) He begins by asking, “What would you do if you were a chaplain or pastor or trusted friend given the honor of caring for someone of another faith tradition who is approaching death?” For some, there would be some complications, or obstacles that might prevent them from doing so. For me? Well, I have cared for many outside my faith community, including some whose beliefs differ greatly from my own. But recently, a similar question has been asked, and I now am the one facing the complications and obstacles.

The question is deceptively simple. Would you attend the patient’s death? The answer should not be all that complicated, either.

Can you make death out of life?
Certainly. But why would you?

After all, I have attended myriad deaths, from a variety of causes, in many different venues. As a hospice chaplain, most of the deaths have been serenely accommodated with a gathering of loved-ones clearly aware of the impending last breath. As a police chaplain and as a pastor, however, I have been present when life ended traumatically, amidst the valiant efforts of emergency medical professionals. In a hospital waiting room, I have notified next-of-kin of their loved-one’s death when it was our own law-enforcement officers who fired the fatal shots. I have left the bedside of the woman wounded by her suicidal son, just long enough to confirm that her husband, in the emergency suite next to hers, had not yet succumbed to his wounds. When he died a short time later, I was there to tell her so. I have participated as a first responder and in critical-incident stress debriefings with witnesses to horrific carnage literally on the front porch of police headquarters. There are more and more scenes that come to mind even as I write this, so before I lose track of my point, let me hope that I have clearly illustrated it. There are very few kinds of death that I have not already witnessed.

So, to my ears, the subtext of the deceptively simple question above is this: “Given that I have attended all these deaths under so many and widely-varied circumstances, why would there be any death from which I would choose to be absent? Especially if it is a patient or parishioner with whom I have an ongoing relationship?”

The complications and obstacles I face occur in the specific context of this simple question. My struggle arises primarily from the fact that I have attended some spectacularly overwhelming non-deaths. Those have included SWAT-calls, hostage rescues, and other interventions where the survival of those involved was far less than guaranteed. I have been present when lives were saved by extraordinary medical interventions. And I have been called to the scene when we simply needed someone to argue in favor of life with someone who was intent on ending their own. And that brings me to the reasons you do not want to invite me to your suicide, physician-assisted or otherwise.

I will try to stop you.

Sometimes what we see is not really life.
So, definitely not a time to choose death.

I was one of the founding members of the board of directors and executive committee of The Suicide Task Force of Larimer County. It later became The Suicide Resource Center. Now, since October, 2011 it has a new name. In order to differentiate themselves from other organizations that want to provide you with the resources by which you may commit suicide, the team is called the Alliance for Suicide Prevention. Due to excellent training, and whatever it is about God’s will that passes for “luck,” as both a police chaplain and as a pastor I have yet to lose the argument on behalf of life. Do not mistake me, though. I have friends and colleagues who have lost that argument, though. They were in attendance at a completed suicide and, had I continued in that field, it would only be a matter of time before I was, too. But in each case, we say and do all we know to prevent that suicide from being completed.

That is what I have done in the past; it is what I will continue to do in the future.

So, imagine for a moment that you are not the dear friend invited to attend, but the patient preparing to implement your legally-protected, physician-prescribed, self-administered, and invariably-lethal solution to an unacceptable life. Try to visualize yourself terminally ill, told that your life retains far too much quantity for the declining level of quality—and that the logical decision is to proactively and preemptively end your life? Do you have that picture of a life-not-worth-living firmly in your mind? Good. Now, consider whether you want me to be there.

Please understand, I would be very honored to receive your invitation to be present in that very special moment. But I would also hope to bring your breakfast in the morning, and to be present with you for many more days, weeks, or months.

Don't fear the reaper, but don't rush the hourglass.
What do you need with all that extra sand?

No matter how convincing the arguments in favor of death may be, I will argue in favor of life. No matter how others seek to terrorize you with wild fantasies of unmitigated agony, I can testify to you that it is only the rarest of patients who choose to experience higher levels of pain as a trade-off against greater awareness of the dying process (or simply being as mentally acute as possible for the visit of one more friend or family member). As a hospice chaplain I have seen the life-enhancement that is possible through palliative care (including psycho-socio-spiritual assistance far beyond what most would imagine could ever be made available in our cost-benefit-ration-driven healthcare system) even when the experience surpasses the worst physical deterioration that suicide advocates promise you. You have the option to accept care that neither prolongs your life nor hastens its end, but helps you to live until you die.

So, yes, please, do invite me to attend your going-away party. Just understand that I will still want to win the argument. I will plan to visit with you some more on the morning after. I will never stop encouraging you to give life one more try.

The Expensive Habits of the Pure in Heart

Jesus said, “Blessed are the pure in heart, for they shall see God.”

I am not pure in heart. That should be noted immediately. Not that I don’t have my moments of altruism. I occasionally do the right thing for the right reasons. But short afterward, my retrospect-o-scope looks for ways in which I may have missed the potential profit, improved influence, or at least reputation-building benefits that could have accompanied my efforts.

So, when I am looking at even those few moments that some would imagine me pure in heart, what do I see? I see me. I see what resources I had available. I see what needs those resources met. I see my frustration at being unable to accomplish even more for those in need. And I see…well, the gratitude I think I deserve, the pay-back that should replenish whatever the particular act of service “cost” me, or even just the spiritualized brownie-points of somehow imagining that God is glad to have me on His team.

Let me illustrate my point by haunting you with the same story He haunts me with.

A servant rises before dawn. He attends to the household chores before sun-up. The master wants breakfast. So the servant cooks. Then serves the food. Then clears away the remainder. Then does the dishes. And then, at first light, the heads out into the fields, knowing that the sun will set before the work there is done. But after finding the way back to the house in the dark, the servant finds the master waiting. No small talk. No offer of cool water at the end of a hard day. The master wants dinner. So the servant cooks. Then serves the food. Then clears away the remainder. Then does the dishes. And then the servant makes the fire, checks the doors, sweeps and mops and ensures that the house is pristine before the master awakens again tomorrow morning, and the same cycle of service begins again.

Jesus uses a very similar illustration in Luke 17:7-10. Here’s how that concludes in the New American Standard translation. “So you too, when you do all the things which are commanded you, say, ‘We are unworthy slaves; we have done only that which we ought to have done.’” (Luke 17:10)

At one point in my life, I thought that religion could be pursued as a hobby. And I still think that. I have plenty of (nominally—meaning they claim the title, whether or not they have any idea about what it means) Christian friends who do just that. One occasionally tells me, “Yep, you’ll see me in church Sunday. Time to get my batteries recharged.” Some hobbyists think they can buy God off with an hour or two here or there. Others find the self-help lectures from the pulpit to be profitable, more or less. Too many feel the need to brush up on their proof-texts. Otherwise they may not know what to say when discussions turn to morality…of other people.

But what has made me dissatisfied with my hobby is what lies at the core of Jesus’ illustration in Luke 17:7-10. As grating as I once found that passage, I now count myself grateful for those moments, sometimes hours at a times, though hardly any full days (yet) in which I find myself being the single-minded servant He describes.

I used to look at God as that master who is unrealistically robbing his servant of any free time, making his life a drudge of routine, frustrated by never-ending chores to be done. Then I began to spend time with caregivers. Not always is it possible. But I have seen the closest family, and especially spouses, who serve the needs of a Hospice patient, a chronically-ill patient, or the disabled. Some leave home only to eke out the basic economic support of continuing their employment so that the insurance paying for their loved-one’s care doesn’t lapse. All the while they do so, knowing that eventually there will come those days when they return from work to find that there is no end to the work to be done at home.

What is the difference between their attitude and that of others who see Jesus’ demands eating into “their spare time?” They serve because it is the most authentic expression of who they are in relation to the patient. And because they know that, one day, the time for such loving service will be ended. Those who have been relieved of that duty almost unanimously wish for just one more day of it.

The more I recognize the purposes God is seeking to fulfill in and through my life (glorifying His name, so that the body of Christ is strengthened and made whole, so that the Church may tear down the gates of hell holding so many captive in the communities we are called to serve), the more I think fondly of the privilege of serving Christ and others. And the more I do that, the more I am reminded of another of Jesus’ teachings: “We must work the works of Him who sent Me as long as it is day; night is coming when no one can work.” (John 9:4-5)

When you see God, does it purify your heart? I believe it does. And I seek to purify my heart so that I might see God all the more. Except when I don’t. That is, when I begrudge Him the infringements on my “free time.” By which I mean: Whenever I forget that I am privileged to serve the One I love, and those whom He and I love together, and that the time remaining for doing so grows shorter every moment that passes.

Do you serve the Master? Good. Sacrificially sometimes? Probably better but, for me, that still means I’m looking at “my time” being given up for Him. So, I invite you to join me—to strive to serve your Beloved. You’ll find that to be far more fulfilling. 

Defining Bereavement, Grief, and Mourning…and the Blessings Therein.

Actually, I'm rethinking my epitaph.
It might read instead: "This machine is
temporarily out of order."

Most North Americans, in my experience, use the words Bereavement, Grief, and Mourning interchangeably. But some of us regularly discuss the experience of loss, its effects, and the means of processing its intrusion and integration into our lives. For specialists in Hospice and other fields like death education and grief counseling, there are important distinctions among these terms. I think that you may find these distinctions helpful, too.

Bereavement = having experienced a significant loss. Whether the life of a cherished loved one, a position of employment, a marriage, a child’s affections, or any other loss, being “bereaved” simply means, “I had this; now it’s gone.”

Grief = our reaction to bereavement. When we significantly value anything (whether positively or negatively), losing it upsets our sense of balance, order, and/or identity. The various elements of these reactions have been traditionally labeled within five categories. “Denial” is that buffer that allows us to process the loss in “bite-sized pieces.” “Anger” may be merely irritability for some, yet overwhelming rage for others, independent of what some might see as the “severity” of the loss experienced. “Bargaining” is our attempt to establish some argument or action that will change the reality of having experienced the loss. “Depression” often results when our mental, emotional, and physical energies have been nearly exhausted by the intensity, the hard work, of these reactions. “Acceptance” is that fluctuating state in which, I would hope, we are able to integrate the valued existence, of whatever we’ve lost, alongside the loss, of whatever existence we previously valued.

Mourning = our proactive response to grief. Most of us process our grief organically, independently, and successfully. Even when we find our way intuitively, though, we generally discover particular techniques that are especially helpful to us, and we practice them repeatedly as we “effectively mourn” the “authentic grief” that results from a “significant loss.” Some of us have specialized in discovering and developing as many of these methods as we can, and are available to help you when you feel “stuck” at some point, or find that some of your reactions are troubling and/or persisting. (If you find that you would like a referral for a grief counselor in your area, please send me an email at deathpastor@frontier.com.)

In addition to discussing death, dying, bereavement, grief and mourning, of course, as “Death Pastor” I also get the opportunity to discuss scripture, theology, and spiritual care just as regularly. In my tradition, as a theologically-conservative Christian, there is an assumption that the answer to every question is supposed to be “Jesus.” (A popular joke offers a Sunday School teacher asking, “I’m a furry gray creature with a bushy tail who lives in a tree. What am I?” After repeating the question twice and getting no response, he directs it toward his most promising student. She replies, “I know the answer is supposed to be Jesus, but it sure sounds like a squirrel to me.”) But as much as we might imagine that Jesus provides direct, even simplistic answers to all of life’s problems, when we actually read what He says, we find that He distinctly complicates our lives.

For example, Jesus says, “Blessed are those who mourn, for they shall be comforted.” (Matthew 5:4) In my context, I hear that as “Some of us more openly express and process the grief we feel over having experienced a significant loss. When we do so, we invite the compassionate response of those around us to provide whatever comfort they may have to offer.” Again, in my culture, that differentiation makes perfect sense. Many of us choose not to openly express and process the grief we feel. We do not openly mourn. (In fact, too few of us actually mourn privately, either. We follow the usual prescriptions to “get over it and get on with life,” to “be strong for the kids,” or simply to “get a grip.”)

In the testimonies of Jesus’ life and followers, though, there are several words with similar ranges of meaning to our “bereavement, grief, and mourning.” Yet Jesus chooses a word that incorporates all three elements: the experience of loss, the effects of that experience, and the expression of those effects. If I may take liberties to translate one word with three, “Blessed are the bereaved, grieving, and mourning.” Culturally, in what I read of first-century Palestine, there was no need for such careful delineation as I have to practice today. If you lost something, and especially a loved one, then you reacted to that loss and expressed it openly. This “mourning” of which Jesus is speaking is often contrasted with joy, happiness, and blessing. It is seen openly, and recognized, and attracts comforters…or at least fellow-mourners, even professionals who would weep and wail alongside the family and friends—but that’s another discussion for another time.

Are we willing to name our reality?

Where Jesus upsets His culture and mine is in saying “Blessed are those who mourn.” He does not say, “Those who mourn will receive a blessing by being comforted.” We are blessed while we are bereaved, grieving, and mourning. It is not that we will be comforted at some point in the future, but that we shall be comforted in the midst of, and as a part of the reality of our bereavement, grieving, and mourning. That’s not what we may want to hear. It may be very different from what we seek to provide to others, compassionately desiring to comfort them. But the complications Jesus causes are many and varied. This is just one of nine blessings Jesus describes in what are called “The Beatitudes.” (Matthew 5:3-12)

In The Beatitudes, Jesus speaks to His disciples about a realm of existence, the kingdom of God, that seems entirely upside-down to them. The poor, the mourning, the gently, the pure, the peacemakers, the persecuted…these are the marginalized, oppressed and exploited, those who many see as sub-human. Hardly blessed, at least in our eyes. But Jesus says they are blessed. Not will be, not have been, but are blessed. How? Because they recognize the reality to which so many others have blinded themselves.

The world lives in the midst of an incalculable loss. Every day, every life experiences the longing for that which we were created to be and to enjoy. The environment, the economy, our relationships, and our own minds and bodies—these and so many other evidences remind us that something is not quite right. In fact, it is far from being merely satisfactory. Just as there are alternatives to each of the other categories Jesus addresses in The Beatitudes, those who mourn are blessed because they can name the reality they see. We are bereaved. We grieve. We mourn. And we are comforted in knowing that there is hope for the broken and damaged world, just as much as there is for us as broken and damaged persons. But only if we stop refusing to see things as they are. Before we can get angry, or begin to bargain, or deal with our depression, we must overcome our denial.

We are broken. And blessed. Not just because Jesus said so. But because Jesus is here to say so, to us.

Two Ways To Make Better Emergency Decisions – Part One: A Primer in Preparedness

If you had to leave the building right now,
where do you go?

“You should improve your impulse control.” Usually, that means restraining our impulsive purchases. Turn off the “one-click ordering,” don’t “stop by for your free test-drive,” and ignore everything offered you at the grocery store check-stand. Those are good steps to take, especially if you find that you’re headed toward an eventual storage locker rental.

But there are other impulses that are essential to our health and well-being. When backing out of a parking spot, or changing lanes in traffic, feel free to respond quickly to the sounds of beeping horns or shouting pedestrians. It’s appropriate to duck or turn in response to loud, sudden noises. Definitely dive for the toddler who’s managed to unbuckle the safety belt and stand up in the shopping cart. Don’t let those occasional spikes of adrenalin go to waste. React.

But not all our reactions are intuitively appropriate. That is, some impulses may not result in the best outcomes. The adrenalin rush fuels our need to fight, to flee, or to freeze. Sadly, though, it does not always lead us to choose correctly among those options. In an emergency, we often find ourselves needing to act without thinking through the potential consequences of our actions, and the results can be very different. For example, if the pedestrians shouting at you are warning of what you’re about to hit—the brakes are the better choice. If they’re warning of what’s about to hit you—you might want the accelerator.

The first of the “Two Ways To Make Better Emergency Decisions” is…

Prevent Emergency Decisions

Emergencies are an inescapable reality. There will be moments in which we need to act immediately in order to prevent damage or injury to others or ourselves. But even in those moments, we do not have to make emergency decisions, if we have already decided what we will do in case of a particular emergency.

Do yourself and your loved ones a favor:
complete and file your advance directives.

As a bank teller, I was trained and drilled in the actions to take in the event of a bank robbery. When a man leveled his pistol at me through the window one day, despite the adrenalin-fueled impulses I felt, I followed the protocol that we had practiced. The need to focus my mind on “doing this the way I was taught” helped prevent me from fighting, fleeing, or freezing. The correct response was to calmly follow-through on the requests made by the man holding the gun.

Later, though, as a police chaplain, I was reminded frequently of the potential risks of accompanying our officers into the field. One night on a hotel balcony, several occupants of a particularly rowdy room wanted to join the officer and me in the narrow, confined space outside their door. The officer repeated his request that only the one we were to contact should come out, until a young man inside the room called me by name. Inexplicably, the officer let him come out to visit with me. A moment after, when those inside the room decided that wrestling with an armed law enforcement officer seemed like a good idea, the young man of my acquaintance, now behind the officer, began to reach for the officer’s pistol. I remember thinking about my training, but I didn’t think about it until after I had taken the appropriate measures to restrain the subject.

I'm not sure "See Your Chiropractor"
belongs above "Notify Your Insurance
Company," but you get the idea.

Not every emergency involves firearms. But almost every emergency can be anticipated. The necessary decisions can be thought through, and preparations for various contingencies can often be made. In three very common situations, though, I find that there has been almost no forethought, much less preparation. Our fantasy is often that “we’ll never have to make that decision,” which we often phrase, “we’ll cross that bridge if we come to it.” Most of us will face a chasm or two like these in the course of our lives. Don’t wait until you’re there to realize that there is no bridge.

Childbirth Complications

We can spend most of an evening in some circles discussing, theoretically and hypothetically, “Do we believe that abortion should be an option if and when a mother’s life would be endangered by continuing to carry her as-yet-unborn child?” I’m sure there are plenty of interesting opinions we could share over dinner. But when the doctor says, “I can’t save them both. What do you want me to do?” the answer is time-critical. When our son was just about to become the subject of such a conversation, the doctor had already worked out the way he was going to phrase it. “I’m going to have to break him, or her, or both.” We were within thirty seconds of having to give him an answer. But since he was our third child, we’d had plenty of time and opportunity to discuss what we believed. We literally had the answer ready before (several years before) the doctor needed to ask the question.

Complications at the Other End-of-Life

There is almost no end to the research, education, and information available on the techniques and technologies that continue to complicate what has never been a simple subject: how hard do we want the medical community to work before they let us die? In polite company we might ask, “To which among the many life-prolonging therapies, procedures and medications would I feel comfortable submitting myself or a loved one? From which of them would I hope my loved ones protect me when I am no longer able to make my own wishes known?” This needs to be discussed in detail, and more frequently than you might think. New options are constantly becoming available. It would be good to hear about them from your doctor, at least sometime before he needs to turn to your assembled family and/or friends and ask, “What was her preference? Do we hook her up, or let her go?”

An excellent resource for putting together
your advance directives. 

Planning for Violent Crime

Would-be pacifist that I am, I frequently contemplate, and discuss as often as anyone will allow, “How do I feel about the terrible possibility that I might have to employ violence in response to violence toward myself? toward others? toward my loved ones?" The time to decide whether you’re willing to use force in response to force is before you ever face such circumstances. Simply put: hesitate in deciding and you might as well not decide. Even a momentary delay will usually prevent any subsequent action from being effective, no matter how extensive your planning and training may be. I mean to address here, however, only those momentary circumstances in which immediate action must be taken to protect yourself or others. In communities where law enforcement resources and responses are limited, these questions apply primarily toward criminal behaviors. For others, where law enforcement resources and responses are excessive, the same questions apply in our approach to law enforcement officers themselves. In both cases, however, advance preparation leads to more careful response, whether we choose to support, to obey, to resist, or even to confront those threatening violence.

In part two, I’ll discuss the second of the two ways to make better emergency decisions. Even more important that what we do ahead of a crisis is what we do amidst the crisis.

Hospice Chaplaincy – Equally Available and Avoided by Both Adherents and Atheists (and everyone in between).

Lizzy Miles, MA, MSW, LSW

Lizzy Miles is a Thanatology Rockstar. Deservedly so. Since serving as a Hospice social worker, among her other involvements, she has initiated the first North American gathering of a “Death Café” (The profile for the Columbus Death Café is here: http://deathcafe.com/profile/49/), and seen its influence spread to other events across the country.

She recently wrote on a subject near and dear (and frustrating) to my heart. The article, “When Patients Refuse the Hospice Chaplain” can be found here: http://www.pallimed.org/2014/10/when-patients-refuse-hospice-chaplain.html. In eleven-plus years of serving as Hospice chaplain (among my other involvements), I can attest to her observations and recommendations. I would add two things, though, one of which I hold in greatest certainty, the other of which I offer as a question, or at least an invitation for comment.

The first addition I would make (an “Amen,” if you’ll allow it), is to her observation that patients often decline the services of a chaplain because they have “an existing long-term relationship with their church, mosque, synagogue, or other group. They often believe their spiritual leader knows them and will be a supportive presence during their end-of-life journey.” She also notes, though, that social workers need to assess further throughout the course of care. “Sometimes patients expect they will receive more support than they do.”

There's one near you, and a locator function on their website.

I would say that patients routinely receive far less support than they had imagined. This is not only due to the natural discomforts, fears, and personal challenges to lead to avoidance by clergy and others, though that is a significant factor. Some patients find that their community of faith and its leaders are very willing to call, visit, and assist, but in ways that betray their lack of perspective and/or training in end-of-life care. In short, there can be a lack of involvement, or a lack of competence, or both. As a result, there are unmet needs for which the chaplain (or spiritual care coordinator) may be helpful, despite the patient’s or family’s earlier estimation. Therefore, I wholeheartedly endorse the recommendation to social workers and others working with Hospice and palliative care patients: “Check in occasionally with patients and families regarding their church support.”

Regarding my other, less certain suggestion for this excellent article, I agree with the admonition that we “don’t forget the atheist, agnostic or non-believer” who may “avoid religious or spiritual support.” But I also believe that the “spiritual” aspect may be poorly defined for most of us.

In my experience, we tend to identify spiritual and religious as related in their supernatural orientation, but differing in their level of organization (being socially or dogmatically prescribed, in the case of religion). My reason for inviting comment is my uncertainty regarding the terms I use, as well as my perception that we lack effective alternatives to “spirituality” as the appropriate descriptor.

Specifically, along with Lizzy Miles, I worry that we deny atheists, agnostics, and non-believers the support they would find helpful when facing their impending death. I would also point out, though, that many of those would consider themselves to be spiritual, or to possess spirituality. (Among several volumes exploring this issue, the most popular seems to be The Little Book of Atheist Spirituality, by Andre Comte-Sponville.) A chaplain, adequately prepared to provide care to those of diverse spiritual backgrounds, would be an appropriate source of support even for those who reject any notion of “spirituality” prior to a clarifying definition of that word.

That clarified definition that I would suggest may fit another word better. But as I wrote earlier, if that word exists, I don’t know what it is. So, my proposal is that we offer the services of the chaplain/spiritual care coordinator in a way that clearly expresses how each of us experiences “spirituality” as “the framework by which we derive meaning from life, and assign value to its various elements.” What life means, and what we value within it, seem to me to fit the common use of “spirituality.”

The Center of Hospice Care: The Patient.

Again, if there is a better word, let me know. If there are objections that some avoid any sense of meaning or value in life, I would love to collect some specific examples. But there seems to me to be a universal tendency among human persons to think that their existence has some relation to the society and world around them, and that certain elements of their life have more positive or negative value than others. Facing their impending death will likely require some re-examination, if not adjustment to that meaning and those values. Thus, it is my belief that in the midst of that experience, the support and encouragement of an adequately prepared chaplain/spiritual care coordinator is invaluable.

So, if your definition of spiritual differs, or if the definition I offer fits another word better, or if you have any other question or comment, I look forward to hearing from you.

Parents of Unvaccinated Children: “Parasites?” Really?!

This post is in response to a Facebook meme picturing Amanda Peet, with a quote attributed to her as, “Frankly, I feel that parents who don’t vaccinate their children are parasites.” A friend shared the image and noted, “Well…she’s a bit harsher than I would be. But still….” Here’s my take on the semantic implications of “parasite,” as well as some recommended alternatives to the term.

Mistletoe: Our Favorite Parasite.

I agree it's a little blunt.

But it does seem supported by one prevalent thread of the logic. It seems to go like this:

First, let's say that I believe the potential side-effects of vaccinations could pose a risk to my children.

Second, again imagining, I hypothetically believe that prior generations of vaccinated children and the majority today who vaccinate their children have so reduced the risk of certain diseases that, even unvaccinated, my child is unlikely to contract those diseases.

Therefore it follows that I can avoid one remotely potential risk to my children (vaccination) because the other potential risk (disease, disability, and/or death) has been made even MORE remote by the majority who have chosen (past and present) to vaccinate their children.

Given that thread of logic, "parasite" is entirely accurate. I would be leeching benefit from the resources accrued through the risks and responsibilities of others.

But there is at least one alternative thread of logic.

Clearly, this is far preferable...

1-If vaccinations are an unnatural intrusion into the natural order, and

2-if they do pose a risk of potential side-effects from proactively disrupting the regular decimation of the human population through epidemic disease, then

3-it stands to reason that a more natural course demands that we only react to disease once it has occurred, and then only to quarantine all who have potentially been exposed. This will allow us to see whether our children are genetically preferred or not (or, for those who object to the "survival of the fittest" implications, more divinely loved or not) on the basis of whether or not they survive the outbreaks of measles, whooping cough, polio, etc.

Of course, those who would choose this second option, to impose their own preferences in this risky experiment upon the lives of others' children, would not accurately be considered "parasites."

...to this. Isn't it?

Some have called them psychopaths, which denotes them as responding appropriately, but to a reality other than what the rest of us are perceiving. (Remember, it's always the "sane" majority who gets to define "crazy.")

To others, their inability and/or unwillingness to consider the needs of persons with whom they interact would label them sociopaths.

Either way, to be clear about our main point here: "parasite" would not apply.

Instead, by inevitably introducing disease into their surrounding networks of trusted relationships, they would more accurately be described as "pathogens."

I am in favor of inoculating ourselves against them.

Silence Is Rarely Golden, but the Alternative Is Often Mercurial

Loading mercury with a pitchfork
   your truck is almost full. The neighbors
   take a certain pride in you. They
        stand around watching.

-Richard Brautigan

Mercury is difficult to handle (especially with a pitchfork, as Richard Brautigan understood), and dangerous as well. The potential for damage to yourself or others recommends we avoid it if at all possible.

That’s how many of us feel about talking to the bereaved. And so we opt for silence. I hope to change that.

A good friend, socially-adept, mutually acquainted with a couple enduring incredible distress, explained again last week that he had not called or visited them. “I don’t know what I would say,” was his well-reasoned motivation. Others have felt the need to say something, anything, and with unfortunate results. Those facing great difficulties, especially bereavement (“having experienced a significant loss, usually through the death of a loved one”), hear some truly amazing things.

If our words might be damaging, then silence should be the safer choice…except that it’s deadly. The echo of the past often deafens those in grief and mourning, disabling them from hearing a balance of the valued relationship and the reality of its loss. It helps to speak aloud past memories, along with today’s grief. But if all their friends are more fearful of speaking than they are of silence, they sit alone, searching for signs of continuity in their lives.

For a moment, imagine yourself speaking to a friend who has experienced a significant loss—and as you realize that you don’t know what you might say, consider also that silence is among the least effective alternatives. “But I might say the wrong thing.” Yes. That’s very true. In fact, those who are sure they know “the right thing to say” are often oblivious to how wrong they are. So, I would like to offer you two tools I find helpful.

Since one of the most helpful activities of mourning is reminiscence, the first tool is to simply go and listen. Simple questions are most helpful in starting the process. I serve many bereaved individuals and families. Most of them I am meeting for the very first time in the midst of one of their least-social moments. I ask, “What should I know about your circumstances that would help me serve you best?” For closer friends, I have asked, “What have you found yourself thinking about?” or “What are you feeling today?” (Remember, “How are you feeling?” suggests they tell us, “Fine, thanks.”) It doesn’t take much to start the conversation.

Second, though, since even when we’re committed to asking simple questions and then simply listening, there are so many things that sound so right…until we actually say them. I have found it helpful to catalog “The Wrong Things to Say.” So, if it helps motivate you to go and listen, then I’ll gladly share that list with you, so that you at least have a map of as much of the mine-field of well-intentioned platitudes as I’ve discovered so far. (I just learned a new one last Friday. It’s a beaut! You’ll find it at the end of the list.)

‘Til then, I remain…

Your servant for Jesus’ sake (II Corinthians 4:5),

Wm. Darius Myers, Death Pastor