I'm writing this from Cape Cod. I've come up here to attend my niece's wedding and have been surrounded by family for the last 24 + hours. It triggered me to consider how relational we are as human beings. Genesis states taht man was lonely, so God created woman to keep him company. Over the thousands of years since, we have continued to be interdependent.
Now, in this new millenium, we have created virtual communities, but they haven't replaced the need to connect with each other. In fact, they've pointed out the difference both in quality and in perspective, that "actual" versus "virtual" communities offer. E-patient sites are proliferating, and some have suggested that they are the next wave of healthcare revolution. I'm not convinced, as there are too many loop holes in the system that allow for people to exist without accountability and truthfulness. It's not a huge leap to guess that a smart marketing person from a for-profit company could create an image on-line and promote a product or service, all the while seeming to be a person suffering from X, Y or Z disease.
Humans were created to be in real community - to be relational. It is a key piece of our health, wellness and wholeness; in fact, we can't be whole alone. While virtual space can allow for interaction in a less overwhelming way, it can't replace the knowledge and insight that a real friend can have. Face-to-face communication transmits nuances that can't be shared via electronic media (at least at this time). That nuance can bring a new depth of understanding to the listener, who can then bring that knowledge into the discussion. This allows for enhanced understanding and connection.
Don't get me wrong, I think that the virtual sharing of information and experience can broaden our mutual understanding of where we need to go next in our journey towards health, wellness and wholeness (HW2). It just can't replace the face-to-face and longitudinal interaction that real people have. Wholeness can't be created on-line, brokenness and alienation are the only things that are enhanced. Be careful and use the on-line health sites as tools to improve your understanding and advocacy - do not let them replace your human interactions. You HW2 is at risk.
Peace,
Dan
Friday, June 25, 2010
Monday, June 21, 2010
Informed Consent?
Today's post is a reflection on a NY Times article from yesterday (see: http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=1&re&src=me). It is a heart-rending account of how medical technology is often applied in the interest of "doing something" whether or not the individual or suurogate decision makers understand what they're signing on to.
This case deals with a post-stroke victim in his 70's who was less and less functional and who had already wondered to his adult daughter whether he was too much of a burden to his elderly wife. Interestingly, there was a primary physician in this mix who knew the husband and wife well, and who had prevented the pacemaker a year before it was placed.
Without consultation with the primary MD, a pacemaker was placed prior to surgery to "fix" a slow heartbeat. While a temporary pacemaker might have done the job, a "hard wired" one was placed instead. The wife, overwhelmed by responsibility, followed the cardiolgist's suggestions without consultation to the PMD.
What follows is all too familiar a story. Technology keeping a person alive far after they would have wished it. THis scenario is happening in thousands of intensive care units (ICU's) in this country alone, today. Well meaning physicians give decision makers the information and help lead them to the "right" decision. The problem is, that most people are not educated about risk/burden versus benefit of different options. After 20+ years in the ICU environment, I can tell you that even the most educated of decision maker is lost when trying to consider whether or not to use dialysis, mechanical ventilation, blood pressure supportive medications, enteral or parenteral nutrition, etc.
It is easy for me to posit, therefore, that there is no real informed decision making taking place. One of the things that Possibilities Journey, Inc., (www.possjrny.org) is doing is to engage people ahead of time in educational programming targeted at end-of-life and ICU decision making. Talking pointedly about the burdens of therapeutic choices both on the patient and on the support system. We have long ago come to the place where medical technology can keep organs functioning almost indefinitely. But at what cost both monetary and in suffering for the people who come to support the person in the bed? Also, at what cost to society in both dollars and shared suffering?
Be proactive, before you do anything, research the burdens of proposed therapies. Look at how long packemaker batteries last (10 years) and ask if you want that - if you'll feel the same way in another decade about living. Hard to contemplate, I know, but the decision made in extremis is often the one that is most burdensome to you and to those you love.
Peace,
Dan
This case deals with a post-stroke victim in his 70's who was less and less functional and who had already wondered to his adult daughter whether he was too much of a burden to his elderly wife. Interestingly, there was a primary physician in this mix who knew the husband and wife well, and who had prevented the pacemaker a year before it was placed.
Without consultation with the primary MD, a pacemaker was placed prior to surgery to "fix" a slow heartbeat. While a temporary pacemaker might have done the job, a "hard wired" one was placed instead. The wife, overwhelmed by responsibility, followed the cardiolgist's suggestions without consultation to the PMD.
What follows is all too familiar a story. Technology keeping a person alive far after they would have wished it. THis scenario is happening in thousands of intensive care units (ICU's) in this country alone, today. Well meaning physicians give decision makers the information and help lead them to the "right" decision. The problem is, that most people are not educated about risk/burden versus benefit of different options. After 20+ years in the ICU environment, I can tell you that even the most educated of decision maker is lost when trying to consider whether or not to use dialysis, mechanical ventilation, blood pressure supportive medications, enteral or parenteral nutrition, etc.
It is easy for me to posit, therefore, that there is no real informed decision making taking place. One of the things that Possibilities Journey, Inc., (www.possjrny.org) is doing is to engage people ahead of time in educational programming targeted at end-of-life and ICU decision making. Talking pointedly about the burdens of therapeutic choices both on the patient and on the support system. We have long ago come to the place where medical technology can keep organs functioning almost indefinitely. But at what cost both monetary and in suffering for the people who come to support the person in the bed? Also, at what cost to society in both dollars and shared suffering?
Be proactive, before you do anything, research the burdens of proposed therapies. Look at how long packemaker batteries last (10 years) and ask if you want that - if you'll feel the same way in another decade about living. Hard to contemplate, I know, but the decision made in extremis is often the one that is most burdensome to you and to those you love.
Peace,
Dan
Thursday, June 17, 2010
Shifting Into Gear
Sorry that I missed posting on Monday, I was traveling to the Virginia Annual Conference of the Methodist Church, and didn't have computer access. I did, however, spend a great deal of time with a new report from the Center for Advancing Health (www.cfah.org) on engagement in healthcare. This analysis of published studies presents a detailed picture of the attitudes of adults in the US with regard to whether they will engage fully in their healthcare.
The findings are sobering, but not surprising. CFAH defines engagement as "actions that individuals must take to obtain the greatest benefit from the health care services available to them." There are 42 defined behaviors that are grouped into ten broad categories (engagement behavior framework or EBF). The ten categories include things like "make good treatment decisions", "plan for end of life", and "participate in treatment". The overvew reveals that only 2 out of every 5 adults felt able to participate in their care (40%). That means that more than 180 million people feel inhibited in actively and completely participating in their health!! Another telling statistic is that even among behaviors with good participation, a significant number of persons (often as high as 50%) do not consistently participate.
So, how do we get ourselves and our communities to shift into gear and out of idle? Certainly, there needs to be barrier identification and removal - health insurance reform will do some of that initial payment barrier removal. Then you have up to 40 million people coming into the system without a history of access and integration that will need to learn how to engage in health decisions. Most people report that they would not access needed resources until they were diagnosed with a chronic illness.
As I read and discerned about this report, one thing struck me powerfully. The barriers to engagement are really of a spiritual nature. There is no faith or sense of community - everyone is existing as an isolated person, and has no connection to or reposonsibility for anyone else (outside of family groups). This individualization of life, leads to a lack of shared vision and energy, thus a lack of motivation to be proactive. If we could get a signifcant portion of the population engaged in their spiritual life, then their worldview might broaden, and they might be more interested in being healthy, well and whole. This is the focus of Possibilities Journey, Inc (www.possjrny.org). Engagement of spiritual and faith communities will allow for improvements in health by improving engagement in community.
Something to consider as we travel this path together. More on engagement on Monday.
Peace,
Dan
The findings are sobering, but not surprising. CFAH defines engagement as "actions that individuals must take to obtain the greatest benefit from the health care services available to them." There are 42 defined behaviors that are grouped into ten broad categories (engagement behavior framework or EBF). The ten categories include things like "make good treatment decisions", "plan for end of life", and "participate in treatment". The overvew reveals that only 2 out of every 5 adults felt able to participate in their care (40%). That means that more than 180 million people feel inhibited in actively and completely participating in their health!! Another telling statistic is that even among behaviors with good participation, a significant number of persons (often as high as 50%) do not consistently participate.
So, how do we get ourselves and our communities to shift into gear and out of idle? Certainly, there needs to be barrier identification and removal - health insurance reform will do some of that initial payment barrier removal. Then you have up to 40 million people coming into the system without a history of access and integration that will need to learn how to engage in health decisions. Most people report that they would not access needed resources until they were diagnosed with a chronic illness.
As I read and discerned about this report, one thing struck me powerfully. The barriers to engagement are really of a spiritual nature. There is no faith or sense of community - everyone is existing as an isolated person, and has no connection to or reposonsibility for anyone else (outside of family groups). This individualization of life, leads to a lack of shared vision and energy, thus a lack of motivation to be proactive. If we could get a signifcant portion of the population engaged in their spiritual life, then their worldview might broaden, and they might be more interested in being healthy, well and whole. This is the focus of Possibilities Journey, Inc (www.possjrny.org). Engagement of spiritual and faith communities will allow for improvements in health by improving engagement in community.
Something to consider as we travel this path together. More on engagement on Monday.
Peace,
Dan
Thursday, June 10, 2010
Self-centered love and Dis-ease
Today's post is a reflection of a sermon that I'm delivering this coming Sunday. The scripture text is from Matthew 5: 21-26 and 38-48. Following the "Sermon on the Mount" the Disciples receive further instruction on how to actualize the teachings. The text covers things like how angry words can kill, that revenge is never sweet nor effective in community building, and on loving those who appear to be un-lovable.
Jesus is teaching his Disciples how to build and live in community. The world that they lived in was Roman dominated and reflected a world in which idol worship, egotism, consumerism and militarism were all the rage. The text here reflects the countercultural nature of God in that things of the world need to be seen for what they are - misleading images of the truth.
Let's look at this teaching from another perspective, that of our health, wellness and wholeness (HW2). If we can learn how to become indifferent to annoyances and petty insults, if we can learn how to love through offenses and not retaliate, and if we can learn to create love instead of enemies, a great deal of our angst and anxiety will disappear. The indifference here is an Ignatian one, that of learning to ignore wordly things to allow for more space to love fully (agape love). This is in contradistinction to acedia type of indifference which is the inability to feel anything at all (think "whatever!").
Learning to love in a full and unencumbered manner through prayer and spiritual development allows for the world to take on its relative importance and for non-worldly things to come to the fore. My premise is that this transformation will lead to better and more loving interactions, less conflict, and a new perspective on how to live together in true community.
So give love a chance! Open yourself up to the healing power of perspective and decrease your dependance on wordly things.
Peace,
Dan
Jesus is teaching his Disciples how to build and live in community. The world that they lived in was Roman dominated and reflected a world in which idol worship, egotism, consumerism and militarism were all the rage. The text here reflects the countercultural nature of God in that things of the world need to be seen for what they are - misleading images of the truth.
Let's look at this teaching from another perspective, that of our health, wellness and wholeness (HW2). If we can learn how to become indifferent to annoyances and petty insults, if we can learn how to love through offenses and not retaliate, and if we can learn to create love instead of enemies, a great deal of our angst and anxiety will disappear. The indifference here is an Ignatian one, that of learning to ignore wordly things to allow for more space to love fully (agape love). This is in contradistinction to acedia type of indifference which is the inability to feel anything at all (think "whatever!").
Learning to love in a full and unencumbered manner through prayer and spiritual development allows for the world to take on its relative importance and for non-worldly things to come to the fore. My premise is that this transformation will lead to better and more loving interactions, less conflict, and a new perspective on how to live together in true community.
So give love a chance! Open yourself up to the healing power of perspective and decrease your dependance on wordly things.
Peace,
Dan
Monday, June 7, 2010
Transitions and Their Impact on HW2
Today's posting is a reflection from my own spiritual world view - Methodism. This time of year, about 25% of Methodist pastors and their family's will move to a new church. Each Annual Conference will be meeting over the next couple of weeks to enact these changes, and then the ministers and their congregations will part ways, seldom to interact again.
This got me thinking about our own life transitions and their impact on our health, wellness and wholeness (HW2). A while back I posted about the concept of resilience and its impact on our health. Resilience, that ability to "bounce back" from an insult or incident, is a key player in maintaining our health and our healthy behavior(s). There have been many studies done, and gauges of stress published, that show how difficult transitions can be on the human psyche.
How have you done with your life transitions? How has it imapacted your ability to function in your activities of daily life? Transitions might be loss of a job, moving to a new job, leaving home for school or the military, divorce, death of a close friend, etc. All of these transitions affect not only us, but all of our social network. Many times we can keep in touch with those we leave behind, but often the relationships suffer from distance and lack of shared experiences. Often in transition, we lose a key support for our lives.
How does life transition affect our HW2? There is a spiritual component in all of life's events, both positive and negative. Life transitions will affect our ability to be part of a spiritual or faith community. Re-connecting with a group of people who share a philosophy/theology is never easy. Though God never changes, human perceptions of God and worship of God change drammatically from place to place. This change can be very uncomfortable and destabilizing. Certainly we can keep up our personal devotional lives, but a lack of corporate interaction often leads to self absorption and a loss of connection. All of these things can lead to dis-ease and decresed HW2 - and extend the pain of transition.
A solution is to make connecting to a faith or spiritual community a priority. Just like connecting the phone and utilities, forwarding mail, setting up new computer access, etc., finding a new community to worship in will make the transition easier and support you while you grieve. Don't neglect this important aspect of your HW2 - transitions are hard enough, don't do them alone.
Until next time, peace!
Dan
This got me thinking about our own life transitions and their impact on our health, wellness and wholeness (HW2). A while back I posted about the concept of resilience and its impact on our health. Resilience, that ability to "bounce back" from an insult or incident, is a key player in maintaining our health and our healthy behavior(s). There have been many studies done, and gauges of stress published, that show how difficult transitions can be on the human psyche.
How have you done with your life transitions? How has it imapacted your ability to function in your activities of daily life? Transitions might be loss of a job, moving to a new job, leaving home for school or the military, divorce, death of a close friend, etc. All of these transitions affect not only us, but all of our social network. Many times we can keep in touch with those we leave behind, but often the relationships suffer from distance and lack of shared experiences. Often in transition, we lose a key support for our lives.
How does life transition affect our HW2? There is a spiritual component in all of life's events, both positive and negative. Life transitions will affect our ability to be part of a spiritual or faith community. Re-connecting with a group of people who share a philosophy/theology is never easy. Though God never changes, human perceptions of God and worship of God change drammatically from place to place. This change can be very uncomfortable and destabilizing. Certainly we can keep up our personal devotional lives, but a lack of corporate interaction often leads to self absorption and a loss of connection. All of these things can lead to dis-ease and decresed HW2 - and extend the pain of transition.
A solution is to make connecting to a faith or spiritual community a priority. Just like connecting the phone and utilities, forwarding mail, setting up new computer access, etc., finding a new community to worship in will make the transition easier and support you while you grieve. Don't neglect this important aspect of your HW2 - transitions are hard enough, don't do them alone.
Until next time, peace!
Dan
Thursday, June 3, 2010
Discernment and Our Health
Today's post centers on an age-old spiritual discipline, that of discernment. Discernment, at its essence, is listening to what God has to say about God's plan for each person. In our overly busy and noisy world, it is difficult (sometimes nearly impossible) to still our inner and outer selves to actually listen. Listening is important to understanding what our bodies are trying to tell us.
Health is not just an absence of definable disease or illness. Health comes from a balance between inner and outer selves - a working relationship, if you will, between who we are meant to be and who we are. Much of our dis-ease therefore, comes from a lack of coordination between the inner life and the outer life. Discernment, listening to the inner or "true" self, allows us to begin to heal those areas which have become broken by our tendancy to live for the world - to be actors playing a role. The Bible in the New Testament talks often about "hypocrites" the Greek word for actor. In order to become whole (less broken) we need to identify when we are acting, and when we are being true to ourselves.
Americans neglect the inner self. Partially because it is not spoken of in a way that the average person can grasp. My own upbringing in the Protestant tradition totally neglected any training in prayer. In fact, prayer was taught corporately and consisted of the Lord's Prayer and petitionary prayer (bringing to God a list of things that we'd like accomplished). None of this penetrated my inner self (soul). It wasn't until just a few years ago that I dsicovered the mystical writings and contemplative prayer (living in the present in the presence of God). This ability to open into unconditional and unfailing love has allowed me to go to the places that needed light and air and deal with them.
Prayerful discernment is healing, but it can be difficult to do alone. I found a program on Spiritual Deepening through the Shalem Institute in Bethesda, Maryland. This program allowed me to experience both group spiritual direction and individual direction. That has made all the difference! Having a spiritual guide to listen and to aid in discernment has been invaluable. Her love and non-judgemental acceptance of me has allowed for tremendous growth over the last 3+ years. Just think if this type of program was applied in large measure to all persons - it would be heaven on earth!
I encourage you to explore discernment as a mechanism to improve your health, wellness and wholeness, as well as your personal interactions. Spiritual Directors International (www.sdiworld.org) has a listing of spiritual directors in your area. Many of these relationships are free or at a low cost. Find one that feels right and try it out. If your relationship is like mine, the improvement in your health, wellness and wholeness will be remarkable.
Until next time, peace and grace!
Dan
Health is not just an absence of definable disease or illness. Health comes from a balance between inner and outer selves - a working relationship, if you will, between who we are meant to be and who we are. Much of our dis-ease therefore, comes from a lack of coordination between the inner life and the outer life. Discernment, listening to the inner or "true" self, allows us to begin to heal those areas which have become broken by our tendancy to live for the world - to be actors playing a role. The Bible in the New Testament talks often about "hypocrites" the Greek word for actor. In order to become whole (less broken) we need to identify when we are acting, and when we are being true to ourselves.
Americans neglect the inner self. Partially because it is not spoken of in a way that the average person can grasp. My own upbringing in the Protestant tradition totally neglected any training in prayer. In fact, prayer was taught corporately and consisted of the Lord's Prayer and petitionary prayer (bringing to God a list of things that we'd like accomplished). None of this penetrated my inner self (soul). It wasn't until just a few years ago that I dsicovered the mystical writings and contemplative prayer (living in the present in the presence of God). This ability to open into unconditional and unfailing love has allowed me to go to the places that needed light and air and deal with them.
Prayerful discernment is healing, but it can be difficult to do alone. I found a program on Spiritual Deepening through the Shalem Institute in Bethesda, Maryland. This program allowed me to experience both group spiritual direction and individual direction. That has made all the difference! Having a spiritual guide to listen and to aid in discernment has been invaluable. Her love and non-judgemental acceptance of me has allowed for tremendous growth over the last 3+ years. Just think if this type of program was applied in large measure to all persons - it would be heaven on earth!
I encourage you to explore discernment as a mechanism to improve your health, wellness and wholeness, as well as your personal interactions. Spiritual Directors International (www.sdiworld.org) has a listing of spiritual directors in your area. Many of these relationships are free or at a low cost. Find one that feels right and try it out. If your relationship is like mine, the improvement in your health, wellness and wholeness will be remarkable.
Until next time, peace and grace!
Dan
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