The After-Care Hole

I just had to spend some time with the subject of the huge hole in the current healthcare system - that of a lack of decent after-care. After-care is that time following a hospital stay (classically) when a person is discharged with a bunch of new instrucitons for care (and usually a host of new medicines) and has to make sense of this new way of being in the world. In the rush to get folks out of the hospital, discharge instructions are typically left to an overworked nurse and are given the barest of review with the patient. It is hoped by all involved that the patient can understand and follow the instructions. It is assumed by all involved that medication reconciliation has occurred and all medication issues have been resolved. It is assumed that the patient will call if there are any problems. Many assumptions - we all know what happens when we assume. My mother who is in her early 70's received a new knee last week. She had this procedure done (her second) at a world famous medical center. She went in on an early Monday morning and was discharged by noon on that same Thursday. My mother has the typical issues of someone her age, hypertension, metabolic syndrome, overweight, and over the summer had carpal tunnel surgery. My mother has no memory problems, but was receiving narcotics for pain control. In the early afternoon on Friday of last week I received a phone call from my mother who was totally confused by the discharge instructions that she received. Attempting to sort through reams of uncoordinated paper, she couldn't remember what she was supposed to do with her medicines - nor could my father make sense of it. Luckily, she has a son who has a Doctoral degree in Pharmacy and who understands the holes in our current system of care. It took 45 minutes to straighten all this out, and my mom had neglected to take her warfarin (blood thinner) the night before. Where's the after-care? Warfarin is a difficult medicine to manage and the result of too much or too little can be life-threatening. What happens to the people who do not have a resource like a pharmacist son? What happens to people that go home to an empty house, or to a home where they are the primary caregiver? What happens if they aren't clear mentally, or have their mental capacity dulled by narcotics? We know very well what happens, these persons return quickly to the hospital. The so called "bounce back" costs each of us a lot of money each and every year. The almost total lack of a coordinated system of care, coupled with the financial imperatives to get people out of the hospital sooner (and sicker) before the capitated insurance payment is used up, has proven to be a recipe for cost overruns and personal disaster. Even when an after-care program is implemented, there are barriers to receiving care such as persons who don't know or trust who comes to the door, and won't let them in (a situation encountered in Memphis, TN, in the LeBonheur system). Creation of caring communities where everyone looks out for everyone else is the essence of all religion - and a moral mandate. Hospitals originally began out of this basic need to care for one another and to do it with more resources and trained individuals. Unfortunately, in creating institutions of care, we have lost the mandate to do what communities used to do - to care for each other always. This is what we're working on at Possibilities Journey, Inc (www.possjrny.org). The re-creation of caring communities that link faith and healthcare to leverage the best of both for the betterment of all. This week, look around your neighborhood for someone who needs your help. You'll be surprised by the level of need and the possibilities for improving lives. Peace for the journey, Dan

The Illusion of Control

Part of my role in the world right now is to lead support groups. I have overseen my church's Stephen Ministry program for 11 years, and have recently broadened this outreach to include a DivorceCare program. I began the second group last night and was struck again by the suffering engendered by a perceived loss of control. A major life event had occurrred for the people attending (divorce/separation) and they were rocked by the disorientation which accompanies this life transition. I listened to the pain of lost dreams and the fear of unknowing. One persons quipped that he was most bothered by the loss of control in his life. That really resonated with me at this juncture in my life. Much of our development from childhood into adults is about making choices, living with consequences, and pursuing a goal/dream. Along the way we develop a sense of self and a sense that we are in control of most everything that happens to us - with the exception of some degree of chance. I can plan my life, but a natrual disaster can come along, or a car accident, or a major medical issue (e.g., cancer), that are the "slings and arrows of outrageous fortune". In other words, "bad luck" can happen, but otherwise I'm in control of my future and as long as I live my life in accordance to the rules, I can do ok. Yet, when I'm beset by outrageous fortune, I lose all sense of myself and my understanding of the world and how it operates. I'm surrounded by friends and family who are well-meaning, but who run out platitudes and cliches seeking to help me, but all they do is drive me deeper into the abyss. The illusion of control is very harmful to our health, wellness and wholeness. All of the religious doctrines deal with this delusion in some way or another. We believe, in our adolescent and narcissistic way, that we are the masters of our universe. That all good things have come from us, and that we ourselves control what occurs. I'm able to accomplish my success due to hard work, intelligence, and good luck. We don't often acknowledge that being born in a developed country, of parents who are doing ok, in a nuclear family (as I grew up in), in a family with strong moral values and sense of right/wrong, is not in our control. In fact, it is an act of grace bestowed on us by a loving God who wants the best for us. So when the illusion is shattered, if we are unclear of who God is for us, we have no place to turn - we have lost control. Thus the suffering that occurs for these children of God who come to DivorceCare and other support groups. It is the same for our health and wellness when we are confronted ultimately with our fraility and finitude. There is another narrative that can restore our sense of self and our place in the universe, however. Those of you who are observant in a faith tradition know what I mean. This week marks the celebration of Rosh Hashanah. The foundational story being one of a child who squanders his wealth and wanders for so long that he loses the ability to speak his native language when he finally returns home. The blowing of the shofar mimics his cry of pain and frustration - but G-d knows his voice and let's him back into the kingdom. So it is with persons who have lost their illusion of control, they need to be heard and let back into the kingdom. This week, listen for those who need to hear that they are loved and known. Listen for those who are lost and out of control. Share the narrative of a loving and forgiving God. Return them to a place of health, wellness and wholeness. Peace for the journey, Dan

Stewardship of Pain

It is a particularly painful time in my life as I write this. Not pain of a physical or physiologic nature, but rather pain of a psychic or life choices nature. The Buddha stated that all life is suffering - one of the four Noble Truths. I have not found that to be true in my own life, but I have suffered some and am suffering now. Certainly, my time as an ICU practitioner brought me into daily contact with the realities of suffering for critically ill and injured persons and their families. I have witnessed countless thousands die, and countless others who through the "miracle" of technology left the ICU to exist neither living nor dying in residential facilities across the U.S. Sometimes in this life there are things out of one's control that cause suffering. All of that suffering which was out of my control has wounded me...but it has also blessed me. How is that?! My favorite preacher is Frederick Buechner whose best sermons have been collected in a work entitled, "Secrets in the Dark: A Life in Sermons". I highly recommend it as a wonderful look into a truly gifted man and his attempt at making sense out of life. One of his sermons called out to me today as I contemplated my current situation. It is entitled, "Adolescence and the Stewardship of Pain". A seemingly obtuse title linking becoming an adult, with being responsible for something, and pain - something we all try very hard to avoid. Reverend Buechner does a marvelous job of weaving his story with that of the parable of the five talents and the lifelong learning that we are called to. Life teaches us, if we not only have our eyes and ears open, but the courage to accept the lessons that are presented. One of those "teachable moments" is that it is difficult to be fully responsible for our pain and by being fully responsible, to live into it and through it and come out the other side transformed. It is easier to bury painful lessons, at least for a while. Those of us who have lived a bit understand that sooner or later those painful lessons emerge. Becoming a good steward of our pain, both personal and collective, is what a spiritual life seems to be all about. Being able to share with one another both good and bad, and to seek wisdom from those events, seems to be the point of all major religions. We are not created to be alone, nor are we created to suffer alone - we need right relationships to help us move through our adolescence. Like the parable of the five talents, we are good and faithful servants when we invest what we are given - even when that investment is fraught with peril and fear. Having the ability to invest my pain instead of holding on to it is a life lesson that is proving invaluable to me right now. What a blessing! This week, find someone to share your pain with - or someone who needs to share their pain. If you don't know how to do the latter, investigate programs like Stephen Ministry, spiritual guidance or pastoral counseling. Learn how to be in right relationship with another. Be a good and faithful steward of the whole of your life. In this way you will be blessed and a blessing. Peace for the journey, Dan

The Power of Perspective

It was a busy week last week. The week started off as a real struggle, but gained terrific momentum so that by yesterday, life was relatively easy and I felt back in synch with things. Community does that for me - real spiritual community where one knows that one is supported in more than just words. Sincere people who are lead by a world view that finds value in others and is empathic, truly allows hurting people the space to just be. I was amazed on Tuesday when I was going to a meeting at the local hospital that I ran into a friend in the Lobby. She does not live near to the hospital, but volunteers in the Pastoral Care department. I was coming to discuss some of the issues curently going on in my house, and how it was going to affect my ability to participate in my volunteer work. I was feeling down and was inwardly focused on my troubles. Then I see my friend, first time in a while, and her words to me were, "I was just praying that God would send me some help, and there you come." She started to cry and gave me a big hug. My perspective changed immediately and I sat down and listened to this person's pain and struggles. I gained some much needed perspective and was able to address my challenges from a new and larger viewpoint. The meeting that followed was a good one and I left it with an invitation to lunch on Thursday with a consortium of six churches that call themselves the "Interchurch Community Health Initiative". They work together to leverage each congregation's gifts and people to work on health and wellness issues. The friend that I saw in the Lobby was running it, and when she found out I was coming she wrote me an e-mail. Turns out that her speaker for the meeting had to cancel at the last minute, and she asked if I would be able to fill in. Her note stated simply, "I wonder why I cry." (A change in my perspective.) I attended a wonderful meeting of these pastors and their programs and talked about how we might work together. It sparked my thinking about how to put this kind of group together with other faith communities. Another change in perspective. Perspective. Insight. Attitude adjustment. Whatever the term you choose to apply to these life situations, it is clear to me that much of what is going wrong in the world is due to a lack of perspective - or a very introverted and self-directed one. In contrasdistinction to this world view, I walked into the small and unassuming church where the consortium meeting was being held. On the entry hall wall were hung two large posters (3' x 4'). On these posters were written the expectations of congregants and for congregational leaders. It was clear that when one joined that you wouldn't just come for an hour on Sunday morning and then leave to go on with your life. This was a church that had a clear view of what they were about. They had a "Family Life Center" across the street along with an "Aquatic Center". Additionally, they were instrumental in developing two blocks of low-income apartments that are 100% occupied. Phenomenal leadership, vision and perspective. It made me think of the lack of clarity that so much of organized religion has nowadays. My own church is in desperate need of this kind of perspective and I believe we would benefit from it - as would our greater community! This week, examine your perspective(s). How do you view the world and your place in it? What are you being called to do within your faith community to improve the lot of those less fortunate? How can you look to your faith traditions for guidance and perspective? I look forward to seeing what comes from your discernment. Peace for the journey, Dan

H.R. Woes

I've been working for myself since 1996 - two private consulting businesses and now a 501c3 public charity. I had a conversation with my Senior Pastor on Monday around the difficulty of managing other humans - he asked me if I'd ever managed anyone. It reminded me of why I left institutional employment and management level positions - I got worn out by dealing with human resources issues instead of doing my job as a pharmacist. At one point, I had management responsibilities for 90 FTE's and I found myself spending inordinate amounts of time serving as a glorified babysitter. There I was doctorally trained and I was having to counsel other professionals about why it was necessary to follow the rules, show up on time, behave themselves and get along with others. Amazing, frustrating, disturbing, sad! My pastor was in the same place - his staff is not working well together, don't have a high level of trust, and some are still laboring under a philosophy of work and approach to spirituality that was resident for 25 years. Additionally, he's dealing with some staff who are also long-term members of the church - well-meaning people, but possibly not a good fit for their jobs. They've been used to having their own way and to doing whatever they felt was right. My pastor's guidance is seen as opinion to be ignored, rather than edicts from the boss. He's frustrated and I could empathize. Human relations are the toughest things that any of us engage in everyday. What's the way out of these H.R. woes? Not sure I have an answer, but I do have an approach for faith communities. In the Christian tradition there is a section of the book of Matthew (5th Chapter) known as the Beatitudes or the Sermon on the Mount. Jesus talks about who is blessed by God, and one of those who are blessed are the peacemakers - for they are God's children. Max Lucado in his book, "The Applause of Heaven" notes that peacemakers are those "architects who build bridges with the wood of a Roman cross". Beautiful imagery and so necesary to the proper and healthy functioning of a community. When we seek to build bridges based on our best characteristics, instead of moats or fortresses based on personal need, we create space for the "other" to meet us. Much of what manager's deal with on a daily basis could be undone with a view to bridge building. So this week, seek to build a bridge with someone who is challenging. Tackle a situation that seems too big by enlisting support from others. Build a bridge of positive communication with your direct reports and see what happens to their demeanor. I wish you well. Peace for the journey, Dan

The Power of Blessing

My sermon this coming Sunday will be about blessing and the effect on us individually and communally. I've been working through the book, "Leading Causes of Life" by Gunderson and Pray, and have come to this leading cause. I think that blessings are, for the most part, overlooked nowadays. In the past, receiving a blessing from a father or father figure was an important part of the maturation process. Blessings, in some cases, determined what one would do in life - or what one would have to work with (think of Isaac's blessing of Jacob). We don't see blessings in the same way now - in fact, many people are not even aware of how blessed (how graced) they are. My wife has been traveling for business in Indonesia and India on two separate trips over the last 3 months. The disparity in standard of living, the crowded conditions, the lack of comfort and the feeling of insecurity were almost constant companions. Coming up hard against the social injustices of different cultures calls many ideas and ideals into question. Yet, she marvels at the humor and joy, at the ability to share, at the sheer delight in living that she has also experienced. Some blessings are hard, and some are difficult to understand, yet all are powerful and transformative. Blessings come in many shapes and sizes, and some take years to realize. The power of blessing lies in its ability to transform us and our life narrative. Difficult times, challenging people or situations, poor choices, unforeseen tragedy all carry with them the seed of blessing. Our ability to live into each situation, some times just day-to-day, yields a treasure trove of experience and wisdom. It is often difficult if not impossible to see blessing within challenging situations (I'm in one right now). It takes faith to know that all things come to an end and that we will ultimately come out the other side of the issue. A dear friend is still struggling with her experiences of 10 years ago. She is still wrestling with God on this and hasn't yet come to the place of asking for the blessing in the situation (think again of Jacob). However, she is closer to the dawn than she ever has been, and though she still struggles with the meaning for her, she doesn't doubt that there is a blessing hidden in the experience. So this week, take a look at your life and note your blessings. Also note the places that you struggle, and spend time discerning about how that experiencing is blessing your life and the lives of those around you. Peace for the journey, Dan

Lack of Empathy

I attended a meeting this morning with a group of health professionals and leaders of NGO's in my community. We get together monthly and discuss social justice issues and lack of healthcare access. Today our conversation took an interesting and unexpected turn. One of the group bemoaned the lack of interest by physicians who would volunteer time or who would provide free services. The chorus of similar stories was overwhelming! It seems that over the last 10 years or so, all of these groups that depend on gifts of time and service are seeing providers turn away. It got me musing on why we seem to be encountering a decrease in empathy - or as my colleagues put it, a lack of community engagement. We certainly are living in a time where we are overwhlemed. Busy-ness is the by-word right now, and we all seem to have too many irons in the fire. This distracts us from what is really important - taking care of each other and thus our communities. It's possible that the relative lack of attendance and participation in faith communities is playing a role as well. If the dominant narrative is that we should do whatever we can to get our "share of the pie" then it stands to reason that we would not help out another. Giving something away for free is not in our best interest, because it takes money out of our pockets and distracts us from getting ahead. Could this be the case? I have noted in my own children the tendancy to want to hold on to what's theirs and to compete with everyone (even siblings) to get their share. It is a dominant narrative - one that is hard to overcome even in people who attend a faith community almost weekly - and who are leaders. Certainly all the major religions have at their core a model of behavior that promotes simplicity, honesty, empathy and love. My own Christian tradition is full of loving neighbor as self and sharing freely what I have. My friend Dr. Christina Puchalski, who runs the George Washington Institute on Spirituality and Health (www.gwish.org), noticed the lack of spiritual focus in her students and has designed medical school courses to try and change that. My conversations with her have been around how to get those same physicians-in-training to become an active participant in a faith community. Without that (my opinion) the course in spirituality is just another class with no reinforcing narrative. Thus, the transformational piece of belief and faith never occurs, and we have another group of medical professionals who lack the desire and moral imperative to give freely. Lack of empathy is a major issue in our world. When we cannot walk a mile in another's shoes, we cannot fully appreciate them. If they are not appreciated as unique and valuable, then they become just another competitor, and we all lose the race. This week, as we celebrate the 10th anniversary of the terrorist attack, see if you can practice some empathy for those who performed the act and those who are left behind. Peace for the journey, Dan

Side Effects of Life

We're coming up on the tenth anniversary of September 11th. The news media, the made-for-TV-movie and documentary makers, the ever present images will be overwhelming for many. Messages will be all over the media from Facebook to Twitter to YouTube to other forms of internet communication will in many cases be unhelpful and often will increase the hurt that people are feeling. Side effects of great trauma are long lasting and can become resistant to treatment if left unaddressed. All people can be affected by these life events - even those too young to remember great traumas can be adversely affected by the responses of those around them. How can we deal with these side effects of lfe? I'm about to embark on a new support group for teens entitled "Life Hurts, God Heals" from SimplyYouth Ministry. This program deals with people who are especially vulnerable to life's hurts and who are ill equipped due to lack of life experience to deal appropriately with it. Add into this mix that very few of them are affiliated with a faith community or have any tether to a narrative that gives hope, and you have a group of people who find themselves at a loss to deal with difficult issues. Side effects in this population include cutting, excessive drinking, prescription and other drug abuse, promiscuous sex, addiction to pornography, or combinations of these. They are overwhelmed and at a loss to deal with life's hurts. Their parents, who also are largely unaffiliated with a faith community (Washington DC area only 30% report attending) have no narrative to give them hope or a firm foundation. Program like "Life Hurts, God Heals" can provide much needed perspective. We spend a lot of time dealing with side effects of medicines (much of my professional life) yet we don't adequately deal with the side effects of living. Our world hurts us, and if we continue to become more and more isolated, we will have few resources to bring to the process of healing. Self-help gurus and made-for-TV doctors and therapists are largely unhelpful because they do not know the situations or the people. While it is true that we can help ourselves, often we just succeed in deluding ourselves more - we need an outside pair of eyes and ears to clue us in. We also need true friends who will tell us when we've made mistakes (think of Nathan and King David) and help us get back to where we need to be - in right relationship with each other. Life does hurt, it's a side effect of living. How we deal with those hurts makes all the difference to us and to those around us. So this week, provide a listening ear and caring heart. Speak the truth to someone who needs to hear it, and offer unconditional love and forgiveness. Speak of a different story than the world provides. Speak of a love that is unconditional and never ending. In this way, healing can begin. Peace for the journey, Dan

One Day at a Time...

Life is busy - I know that I'm preaching to the choir, and that those three words are so commonplace as to be trite. However, it has come home again to me as my family trends back into another year of organized school. Busy-ness is all around us whether it is church activities, sports, jobs, friends, life events - there's always something that could be done (not to mention yard work). Every so often, I find myself overwhelmed by the pace and the number of issues at hand. It is easy during those times to fall prey to anxiety and helplessness. My work with contemplative spirituality however, has shown me a different and healthier path. Humans have a tendancy to look ahead and to plan. This in and of itself is a good trait, but often we fall into the trap of "what if?" in our future-view and we lose sight of the precious thing that is today. Often, and this is the case for me currently, life events can get so onerous that we lose sight of the fact that the only thing we have to work with is today. Many years ago, Kris Kristofferson and Marijohn Wilkins penned the song "One Day at a Time, Sweet Jesus". It entered my mind as I was reflecting on what to write today, and how to write it. For those unfamiliar with the chorus it goes like this, "One day at a time sweet Jesus, that's all I'm asking from you. Just give me the strength to do everyday what I have to do. Yesterday's gone sweet Jesus, and tomorrow may never be mine. Lord help me today, show me the way, one day at a time." Beautiful and healing sentiments for those times when we get a little too out of control and are being battered by the sea of life. For me, and for those who I come into contact with at challenging times in their lives, it is such a wonderful gift to stop the mindless doing and to just breathe. To slowly inhale and exhale, to count heartbeats, to simply "be". Slowing down to the point that you are truly present to the moment allows for the wonder of living to be apparent (at least to me). This allows for relaxation and healing, and for the opportunity to be whole - not fractured or scattered, as is the norm nowadays. It is my contention (in a long line of contemplatives) that this type of mindfulness and stillness could heal the world. For more on this try Thomas Merton, Theresa of Avila or John of the Cross, Richard Rohr, to name just a few. This week when life gets out of control, just stop and breathe for a few minutes. See what happens - I think you'll like what you find. Peace for the journey, Dan