In Search of Epiphany

In these 12 days of Christmas, the Christians among us are tracking towards the Epiphany. Traditionally, Epiphany is the feast celebrating the occasion of the Three Kings who came to worship Jesus. More Orthodox traditions have Epiphany marking the baptism of Jesus, but is there a broader concept of epiphany that can help us as we try to find ways to be engaged spiritually in the world? Merriam-Webster's Online Dictionary has one definition of epiphany as: "(1): a usually sudden manifestation or perception of the essential nature or meaning of something (2): an intuitive grasp of reality through something (as an event) usually simple and striking (3): an illuminating discovery, realization, or disclosure." I think that this is helpful as we search for meaning and understanding of our world and our role(s) in it. Aren't we all searching for the essence of something - of life? Wouldn't it be nice to have a better grasp of how we can make a difference in the world - through a simple and striking event? In this season of light, aren't we all in one way or another searching for illumination for our paths? The quest for epiphany is as real and as meaningful today as it ever has been. By this time next year we will have chosen another President; many disasters will have befallen the world; many millions will be born and will die; new scientific discoveries will be made - some of them revolutionary. Will you be any different in your understanding of who you are and what your purpose is in this world - will I? How is it that you will search for meaning in this new year versus years past? There are many ways to open the inner life to explore how G-d is moving in your life. I recommend a spiritual director (www.sdiworld.org) or good cleric. Make one of your resolutions to open your mind to the possibility of epiphany in 2012. This is a choice that will make all the difference in the world and in you. Peace for the journey and have a blessed 2012! Dan

What am I Worth?

I hope all had a wonderful Christmas celebration yesterday (or for those who don't celebrate Christmas, a wonderful and relaxing day off)! We are entering the last week of 2011 and I wanted this post to reflect some of the struggles that I'm having with the big issues in health and wellness both personal and societal. One aspect of this crystallized yesterday as I was washing dishes and having a wonderful discussion about the cost of healthcare. The bottom line comes in when making payment decisions on a macro level, what is the life of a person worth? What am I worth in dollars and cents support from the government and other payors? I've done a lot of work over the last six months with investigational cancer drugs. Some of them are pretty far into the future and some are relatively close to market. All of the compounds show promise in controlled clinical trials, but we clinicians know that practice life is far from the controlled trial environment of drug development. This is one of the reasons why drugs perform less well in actual practice than they do in research trials. Once a compound is approved in the U.S. a prescriber can use it in any way they deem appropriate given their level of understanding of the compound (think Avastin or NovoSeven for example). The other problem is the euphemisms used as markers for success in cancer trials (e.g., disease free interval, progression-free survival, objective response rate, clinical benefit rate, time to treatment failure, invasive disease free survival, overall survival). Saddled by a lack of curative compounds, cancer drugs are evaluated on their ability to keep the disease below our crude level of detection. Many of the new compounds I've reviewed are not replacing anything, they are additive to what is already being used - so they are adding significant cost to the equation. The compounds in question cost many thousands of dollars each month (up to $10,000). If, as one compound I reviewed last week, an agent on average prolongs overall survival by 4 months - is that a "good" investment? It begs the question, what am I worth? Not just to my family and friends, but to society as a whole and to those who will share the burden of my treatment. Most drug manufacturers have patient assistance programs to offset some of the cost burdens of these therapies, but as a society we are coming up against a most difficult dilemma. No one wants to use the "r" word (rationing) but the reality of the cost burdens of these new targeted therapies is too big to ignore. The Center for Medicare and Medicaid Services (CMS) is already dealing with programs that are impossible to maintain financially (due to poor management over the last decades), but those costs to maintain are increasing at an unsustainable rate. John Q. Public is asked to fund these programs from payroll taxes, but no one ever envisioned a cost scenario like what we are currently living. What is my life worth? Huge societal dilemmas like this one can not be answered easily or gently or quickly. It takes great courage to open the debate and dialogue on how to even begin to approach somehting of this magnitude. One has to be able to suffer under the slings and arrows of rhetoric (think "death panels") and come out the other side with self intact. We need to be able to approach these large issues from a place of openess and honesty - love for each other. On one hand, each human life is precious beyond measure and should be nurtured in ways to help it meet its intended reason for being created. However, we can not afford to spend $10 million on 7 billion...there has to be some rationality and social justice. At the end of the year, I offer this musing to begin the dialogue with you on how we come to grips with huge truths. I don't have answers, and I struggle daily with these questions. Together, however, we can find a way to deal with that which confronts all of us. Peace for the journey, Dan

What Paradox Teaches

I've been reading more of Parker J. Palmer's "The Courage to Teach", and was moved by his thoughts on paradox and how it can help educate. Merriam-Webster's Online Dictionary has one definition of paradox as: "a statement that is seemingly contradictory or opposed to common sense and yet is perhaps true." There are many paradoxes in our everyday lives as well as oxymorons (Reality T.V. leaps to mind for the latter). To highlight the role of paradox in my life I offer the following examples: One of the things about being a trained scientist and a healthcare practitioner (and possibly soon an educator) is the need to read and evaluate new research. One of the aspects of this that has been a difficult truth is that there is much about the way that research is undertaken and reported that lead to falsehoods. One paradox in scientific research is that we study a small subset of the human population (800 to 1000 persons out of 300+ million in the U.S.) and extrapolate the findings to the rest. Another is that we scientifically examine complex human physiology and pathology using univariate (studying one aspect of something) modeling and then try to extrapolate the findings. It's not surprising therefore to see how we fail when drugs come into broader use (Xigris and Avastin only two more recent examples). Yet, once and awhile some truly remarkable discoveries are made that in the beginning seem incongruous - because they fly in the face of "what we know". The idea that the world is round, that the Earth revolves around the Sun, that the world is getting warmer, that a single child can and did change the world, that Christmas isn't our birthday. Religion is often seen as an inconvenient truth at best, and as a self-indulgent fantasy at worst. How can a G-d be everywhere and nowhere at the same time? How can G-d (in the Christian view) be three things in one? How can a good G-d allow evil to be in the world (theodicy); and the corollary, how can that same G-d give us free will - when G-d well knows we don't use it wisely? We can shrug these and other questions about faith off and ignore the questioner, but if we avoid these paradoxes then we miss the educational potential in each. In my own spiritual journey it has been uncomfortable to hold paradox lightly and to stay with it until it teaches me. Some of the "truths" I have discovered only after many years of discernment (use of koans and other spirital disciplines) others still evade me. Yet, the power of paradox to teach is that when one allows oneself to be in relationship with the tension of not knowing, then one finds an expansion of the mind and the soul. It becomes less important to find an answer than it is to live into the question. Certainly, my life as a healthcare practitioner demands that I come up with answers to health questions and to try to give the best and most evidence-based recommendations that I can. When I'm called to care for the spiritual aspects of the illness or dis-ease, however, I'm called to be in a place of paradox and to hold that up to the person who is searching. There are many paradoxes in this holiday season - the need/desire for Currier and Ives versus the reality of poor family systems, the brokenness of humanity versus the wholeness of spirituality, the need to become childlike to access heaven on Earth, loving neighbor as self. I ask you to hold your personal paradoxes lightly this season and spend time with them. They have much to teach you about you and the world in which you live. Peace for the journey, Dan

Asleep at the Wheel

I opened the news this morning on my computer to see the obituaries of two diametrically opposed men. On one hand there was the death of Kim Il Jung of North Korea, on the other, the death of Vaclav Havel of the Czech Republic. It is unfortunate that so much press will be given to the former versus the latter. The rhetoric of "ding-dong the witch is dead" over the North Korean leader and opinion pieces of how wonderful it will be for the world that he is gone will totally supplant the quiet news of the passing of a truly great man. Many of you might not recognize the name, Vaclav Havel. He was a poet and playright who came to fame as a dissident voice against Communism. In the "Velvet Revolution" he was a key player and served as first President of both Czeckoslovakia and the Czech Republic. Havel was insightful, humble, spiritual and morally sound. His ability to name the ills of his land in the post-Communistic rebuild were keys to how that nation built itself into a stable force in middle Europe. He wrote seemingly constantly, and there is a collection of his essays entitled, "Summer Meditations" from 1991 that are truly wonderful and spiritually meaningful. One quote struck me as I was musing over his life and his accomplishments. Here it is: "Time and time again I have been persuaded that a huge potential of goodwill is slumbering within our society. It’s just that it’s incoherent, suppressed, confused, crippled and perplexed — as though it does not know what to rely on, where to begin, where or how to find meaningful outlets. In such a state of affairs, politicians have a duty to awaken this slumbering potential, to offer it direction and ease its passage, to encourage it and give it room, or simply hope. They say a nation gets the politicians it deserves. [...] At the same time – paradoxically – the opposite is also true; society is a mirror of its politicians. It is largely up to the politicians which social forces they choose to liberate and which they choose to suppress, whether they rely on the good in each citizen or the bad." "Slumbering goodwill"...it echoes Martin Luther King Jr's. sadness at the reticence of good people to become engaged by the wrongs that they see. In this time, though these words are 20 years old (at least) don't they still ring true? Hasn't our goodwill become "incoherent, suppressed, confused, crippled and perplexed"? One just needs to look at the current debates on any political topic or social ill and see that there's no guidance, no compass, no cogent thought processes. In a democratic society, we get the leaders that we deserve and they are truly a reflection of who we are at the time. Can the current crop of politicians really "awaken this slumbering potential" or are we all just going to continue in our self-induced stupor towards ruin? The writings of Havel give us a view towards a revitalized and fully aroused state: "There is no simple set of instructions on how to proceed. A moral and intellectual state cannot be established through a constitution, or through law, or through directives, but only through complex, long-term, and never-ending work involving education and self-education. [...] It is not, in short, something we can simply declare or introduce. It is a way of going about things, and it demands the courage to breathe moral and spiritual motivation into everything, to seek the human dimension in all things. Science, technology, expertise, and so-called professionalism are not enough. Something more is necessary. For the sake of simplicity, it might be called spirit. Or feeling. Or conscience." Hmmmm, the "courage to breathe moral and spiritual motivation into everything". He suggests that secular education and re-educaiton are not enough, he suggests that we also need to engage equally in reconnecting our spiritual and moral selves so that we can make decisions based on graeter ideals than our own petty selves. Can a dedication to spiritual disciplines arouse our sleeping goodwill and set us on a better path? Well, I'm not sure, but it seems prudent to say that what we're currently doing is not working and look for another option. Spiritual disciplines such as prayer, fasting, journaling, spiritual direction, worship and spending time with sacred texts have opened the eyes and minds of countless people over the millenia, maybe it's not too late for us. Peace for the journey, Dan

Institutional Fear

I picked up a book that my wife had been given some years ago by Parker Palmer called, The Courage to Teach". In it he devotes a whole chapter to the fears that both teachers and students need to confront when they come together (A Culture of Fear). It got me thinking about fear within institutions, and then I continued along that path and thought about other human created institutions and idols and how fearsome they can be. Think for a minute about some that are at the forefront of the news right now...government, the economy, and health care. These are enormous institutions that are quite broken (at least in practice) and also quite fearsome. The fear comes because they have been made into idols that are worshipped instead of the broken human creations that they are. I've blogged before on the power of idol worship and the demonizing that happens when a good thing is elevated to an ultimate thing (i.e., becomes and idol). The creation of institutions which exist only to foster their own continuation, creates these idols that then become inviolate. Think about the vitriolic rhetoric that accompanies anyone who tries to say that there's something wrong with one of our idols...does the name Dr. Donald Berwick come to mind?! Here is a brilliant man who had the courage to stand up and say that CMS is terribly broken and needs to be radically altered to become something both functional and affordable (two things it currently is not by any stretch of the imagination). It cost him his job - though his reputation is still intact. Idols and institutions that become idols (and are thus seemingly above reproach) are fearsome. We choose not to challenge the status quo for fear of what will happen to us. We fear being sacrificed in public for our contention that something is wrong with 50 million people having inadequate health insurance, and 16% of the population being unemployed or underemployed. We fear the recriminations of being the ones who say that indeed the king is parading around buck naked. Our fear of things continuing in the same broken manner is balanced by the idol worshippers who fear the loss of their idol and wonder what will replace it. They continue their idolatry because their fear of change and the unknown paralyzes them. We have a way to overcome this paralyzing fear. It is called faith, and it is at its core the means and the grace that allows us all to move forward in the face of fear. It is a common quote that courage is not the absence of fear, rather it is the ability to do what needs to be done in spite of our fears. That kind of courage comes from a place outside of us. Our faith in a power that is greater than us, in a wisdom that dwarfs our own, in a way of living in right relationship with each other where all are of equal value, is what has toppled all the idols of history. During this holiday season then, where are you finding the faith to move forward to conquer your fear(s)? What institution(s) in your life have become idols that need to be named and changed? We at Possibilities Journey Inc (www.possjrny.org) believe that it is time for the idol of health care to meet the power of faith in order to be transformed into the life giving service that it was created to be. Thanks for being with us on this journey. If you are looking for end of the year donation opportunities, we would welcome your support. You can donate at our website and we thank you in advance. Peace for the journey, Dan

A House Divided

Interesting how ideas come for both sermons and for this blog. Inputs from disparate places such as e-mails from my mother, sermons from dear friends, readings and my own prayer life all come together (at least often enough) to give life to a concept. My spiritual journey (which greatly informs my worldy journey) is all about becoming unified in my beliefs, and allowing that unity to permeate my interactions with the world. This is more and more a unique way of being in the world. Our current world is very dissociated, individualized and polarized. Idols are created and they require blood sacrifice (e.g., working 80+ hour weeks and neglectiing the rest of our lives) and they are never satisfied. That's where we are in the world right now - serving self-created idols and never being satisfied. We live in houses that are divided - and as Abraham Lincoln noted, a house divided can not stand. How different it is when we view the world from a place of integrity. Integrity has synonyms of completeness, soundness and incorruptibility (Webster's on-line Dictionary). When we are complete or whole, then we are able to live into the chaos and vagaries of everyday life without being judgemental and reactionary. If I have integrity, then I am comfortable with who I am and how I see the world, and I am comfortable enough to meet others where they are. I may not agree with them, I may find them uninformed or misguided, but I can still love them enough to continue to be in relationship and community and try to help them find themselves. The integrity that comes from a right relationship with G-d allows me to be in right relationship with everyone else. That right relationship allows me to be less corruptible than I otherwise might be - the old saw is applicable, "If you don't stand for something, you'll fall for anything". Integrity allows us to discover how to have a unified life and house. When we are working towards completeness and wholeness, then we are first looking inward to see how an interaction is making us feel. We respond to an interaction inwardly before we react outwordly. We ask ourselves, "what teaching does this interaction offer me?" If it is unfounded and judgemental, then it offers us very little and we can shrug it off and go on. However, if it is offered in truth and in love as a constructive teaching, then we can take it on and learn from it. The learning becomes transformational and enhances our ability to be relational. This week, explore your own integrity. Where are the holes, the incompleteness, the judgemental areas in your life? How is it that you can get in touch with those areas and find ways to make them more integral? One way is with a spiritual director. There is a wonderful website listing spiritual directors across the world (www.sdiworld.org) and I encourage you to engage one as a gift to yourself and the world this holiday season. Peace for the journey, Dan

The Missing Link...

A new physician survey has just been completed that shows quite starkly the missing link in our current healthcare system. (see: http://www.rwjf.org/vulnerablepopulations/product.jsp?id=73646&cid=XEM_2809280). It seems that 80% of physicians surveyed understand that the social needs of patients is just as important as any medical therapy. After all, if the patient can't afford the medicine, has no place to store it (because they're homeless), does not have a stable life, then it will be next to impossible to be compliant and adherent with any prescribed therapy. This is the missing link in healthcare. It's one of the glaring holes in the ACA legislation. That is, it's one thing to cover everyone with health insurance, but if many of those 50 million are homeless or semi-homeless then they can not eat properly, get sufficient rest, etc. There will be no overall improvement in health, or if there is, it will be incremental not transformational. A long time ago, a researcher named Maslow developed a heirarchy for human behavior that noted unless foundational needs are addressed and taken care of, no development happens. Analogously, if basic needs for health (good quality food in sufficient quantity, adequate rest, safe place to live) are not addressed, then people will not be optimally healthy. The really good news is that the Robert Wood Johnson Foundation (RWJF) has invested money into a program called Health Leads that trains colege students to work in physician offices to provide basic social service needs. In this model, a physician can write a "prescription" for any social service that a patient needs, and the Health Leads person in the office will help to "fill" it. It works really well and has grown over the last few years from its humble beginnings in Boston to now up and down the East Coast. What a fabulous leveraging of a renewable resource (college students) to meet a real need in the system. More of this transformational thinking is necessary if we are to overcome a healthcare system that is often not about health, and more often doesn't seem to care. This week, look for those things that could be changed in your life. What change, large or small could you develop that would transform what happens in your world? Really beneficial to spend some time discerning about things like this. I'd love to know what you find. Peace for the journey, Dan

Heat vs. Light

You all know the saying "more heat than light" when referring to a debate that allows anger and venom to win out over informed dialogue. I find myself musing today (not for the first time) about the prevalence of angry diatribe versus informed and socially appropriate debate. At one point in the not too distant past, Debate Teams were seen as an important part of High School education. Nowadays, if a High School even has a Debate Team, it is relegated to the deepest, darkest part of the High School experience and there it languishes. The learning that comes from building and debating a topic is lost to the whims of personal opinion and technological savvy. If I can get my viewpoint out faster and broader than my "opponent" then I will win in the court of public opinion. Case-in-point, the current news "reporting" about child abuse in Penn State and Syracuse atheletic programs. Child abuse and pornography are hot button issues to be sure, and are serious issues that we as humns need to deal with appropriately to ensure healthy and safe enviroments for our children to grow. However, when we allow our "need for news and gossip" to outweigh our need to know facts, then we run the real danger (and current reality) of trying people before they've ever had their right to a trial of their peers. I don't know what has happened in either of the situations mentioned, even though there's been an outrageous (IMHO) amount of news coverage devoted to these issues. When news becomes focused on headline making rather than balanced investigative reporting (lots of work and longer time frame results) we all become victims of abuse - abuse of our intellect and humanity. Time and again in scripture we are cautioned against judgments. We are encouraged to forgive - not to forget nor to act like hurtful things never happened, but to forgive and to release the power that the perpetrator has over our view of the world and our ability to live our lives freely and fully. Forgiveness is an individual act that requires nothing of the other party. This is why forgiveness is so challenging...we want the perpetrator to be "brought to justice" and to "suffer as we have". Vengence appears to be sweet and healing on the surface, but the reality is something altogether different. Justice never takes away waht happened, nor does it allow for the transformative love of God to intervene and heal the situation. Certainly, people who hurt other people must be stopped, and that often requires judicial intervention, but healing is not part of our criminal justice system. News people and editors have forgotten that everyone deserves a fair shake - and our current delivery system for news is not focused on balance and fairness. Life is not like CSI nor NCIS, issues do not resolve themselves in 60 minutes into nice tidy packages of right overcoming wrong. We need to remember that life is messy and difficult and requires a lot of work to relate to each other in healthy and wholesome ways. The internet is not helping that process. Do yourself a favor and find your way to decent reporting that doesn't seek to vilify or promote guilty until proven innocent. The longer I live, the less judgemental I become, the more latitude I allow for the fact that I don't know everything - and I never will. I do know, however, that God is God and I am not - and I find myself thankful for that reality as it provides much light for my path. Peace for the journey, Dan

Surrendering Ourselves

Today we complete the muses on Mahatma Gandhi's Seven Deadly Social Sins with thoughts on "Worship Without Sacrifice". The Mahatma was not referring to ancient forms of animal or human sacrificial killing as a form of worship - rather he was suggesting that if we're just going through the motions, then we're not truly worshipping. I'm a leader within my United Methodist congregation and time and again am confronted with the 20-80 rule (20 percent of the people doing 80 percent of the work). The rest either show up or not, and the average pledge to keep the church open is less than $500/year (in a town where the average income tops $80K)! People do not come to church regularly either, in fact, the largest church in the Methodist denomination sees congregants attending worship an average of 1.7 times each month. Hmmm, do we have a problem with comittment?! Why is worship without sacrifice a deadly social sin? How does our lack of sacrifical worship lead us to sin in a social context against each other? Now remember, I'm defining sin in a broad theological sense as any action which disrupts our connection to God. Sin is not one of the 7 deadly (not contained anywhere in the Christian Bible by the way), it is that action or set of free will decisions that keep us from loving God above all else and neighbor as self. Sacrifice is defined in many ways, but the one that I think is closest to where we want to go is "destruction or surrender of something for the sake of something else". So if we are attending a faith community and/or worship service and not surrendering ourselves (our worldviews, our judgemental natures, our need to control, our brokenness, etc) for something else (i.e., God) then we can not be transformed. If we are not transformed, then we can not see the needs of the "other" and feel a call to do something about it. If we can not see the needs of others then we allow the world to perpetuate the social injustices (yes, Glenn Beck they exist) and status quo that leads to upwards of 50 million people living at or below the poverty line in the U.S. I have found that the more I commit myself to the exploration of my spirituality, the less judgemental I become - the more tolerant I am of difference, the kinder I am. This is true no matter what doctrine you practice. Immersing yourself in a spiritual discipline and practicing the same diligently and intentionally, will lead to a new vision and a new way of being. In the Christian tradition God says, "see I am making all things new." This new vision is what lead me to create Possibilities Journey, Inc (www.possjrny.org) which seeks to re-integrate all faith communities into the healthcare system. The reason we are convinced that we need to do this is because of the lack of attention to spiritual aspects of illness and recovery. Also to the lack of meaningful after-care and elder care in our current system. Surrendering my worldview has allowed me to see something much greater to work for than a paycheck. What is it that you need to surrender to combat some of the myriad social sins of our world? Peace for the journey, Dan