God's Grace Revisited

Surgery Board at Tenwek Hospital, Kenya

Consequently, you are no longer foreigners and strangers, but fellow citizens with God’s people and also members of his household, built on the foundation of the apostles and prophets, with Christ Jesus himself as the chief cornerstone.  

Ephesians 2:19-20 (NIV)

“From an African perspective, to NOT make a spiritual connection with patients is 

essentially medical malpractice.”

    Suzanne R. Snyder, MD Medical Missionary to the Masai

It is often difficult to relate to patients but it is an essential part of caring for patients no matter where you practice.  Language, cultures and the limited knowledge of the patient’s history makes establishing a relationship a challenge.

What I have found is that the organization that you represent is an important ingredient in how that relationship is understood.   When you are identified with a medical organization with a clear statement of its mission, you have a basis for the beginning of a relationship that has the opportunity to transcend the barriers of culture and language. 

So beside the diplomas and credentials, it is important for patients to know that we are more than just competent!   We must  build a relationship in the belief that the outcome will be healing.  For Christians this is done for the glory of God and his Kingdom.  It is  in those relationships, a living mystery,  that we have the privilege to experience God’s Grace. 

Marvin

References

Jolles EP.  Clark AM.  Braam B.  Getting the message across: opportunities and obstacles in effective communication in hypertension care. [Review] Journal of Hypertension.  30(8):1500-10, 2012 Aug.

Abedini NC.  Gruppen LD.  Kolars JC.  Kumagai AK. Understanding the effects of short-term international service-learning trips on medical students. Academic Medicine.  87(6):820-8, 2012 Jun.

Hage, M. L. (2012). God’s Grace. Retrieved from http://healingagents.blogspot.com/2012/10/

Tenderness

Mother and Infant statue at St. Vincent Women’s Hospital, Indianapolis, Indiana

For I too was a son to my father,

    still tender, and cherished by my mother.

Proverbs 4:3 (NIV)

Seven years ago, 2006, I saw this statue in the waiting area at St. Vincent Women’s Hospital in Indianapolis, Indiana.  It spoke to me of the tender care provided by mothers to their infants.   This is an icon of tenderness!

More recently, I have heard the strong but tender voice of Jean Vanier who articulates a contemporary theology of medicine.  He is the founder of the L’Arche communities where tenderness is at the center of the care.  That tenderness leads to a wonderful spirit of gratitude and joy. You can find that same gratitude and joy from others like the minister, Nadia Bolz-Weber, and the scientist, Natalie Batalha.

What is common in these images, voices and messages is what occurs in the lives of healing agents.  The good news is there are new virtual spaces like “On Being” with Krista Tippett that allow us to hear the words and see the actions of tenderness.

Marvin

References:

Levin J.  "And let us make us a name": reflections on the future of the religion and health field.   Journal of Religion & Health.  48(2):125-45, 2009 Jun.

Hage, M. L. (2013). The Nature of Healing. Retrieved from http://healingagents.blogspot.com/2013/01/the-nature-of-healing.html

Hage, M. L. (2013). Residential Learning. Retrieved from http://healingagents.blogspot.com/2013/03/residential-learning.html

Hage, M. L. (2013). A Theology of Medicine. Retrieved from http://healingagents.blogspot.com/2013/07/a-theology-of-medicine.html

Rounds are Over!

Ready for Rounds

On September 1, 2013, I attended my last clinical morning rounds.  This activity and habit has been a part of my life for almost 50 years.  It has been a method of learning, teaching and caring for patients.  There are certainly other important methods, but this has been a key to sharing information.

This activity has changed remarkably.  In the past memorization was key.  We needed to remember the history, physical and laboratory findings of each patient that we saw.  We then had to be ready to answer questions regarding the pathology and management of the disease.  Today, the patient and disease information exist in the “peripheral brains” (clinical computers and databases) of the clinical team.  What hasn’t changed is getting the clinical history from the patient, family and other team members.  We still need to sit, listen and touch patients.

It is a strange feeling to close these chapters of clinical learning and teaching.  The rounds that would sometime seem endless have stopped.  The reality is that others need to be the “rounders” that learn, teach and care.

Marvin

References:

Gonzalo JD.  Masters PA.  Simons RJ.  Chuang CH.  Attending rounds and bedside case presentations: medical student and medicine resident experiences and attitudes.  Teaching & Learning in Medicine.  21(2):105-10, 2009 Apr-Jun.

Tariq M.  Motiwala A.  Ali SU.  Riaz M.  Awan S.  Akhter J.  The learners' perspective on internal medicine ward rounds: a cross-sectional study.

BMC Medical Education.  10:53, 2010.

Hage, M. L. (2012). Vocation & Retirement. Retrieved from http://healingagents.blogspot.com/2012/07/vocation-retirement.html

Resistance/Resilience

Photo in the Constantine Basilica, Trier, Germany, 2013

“The Church is only the Church when it exists for others”, Dietrich Bonhoeffer

André Heintz (left) at Le Mémorial de Caen, 2013

I just returned from a wonderful return trip to Europe.  One theme that recurred was the role of the resistance/resilience prior to and during World War II.  We saw and heard again the courage and the resilience of individuals.

There have and are continued “wars” waged on suffering in the world.  Like other conflicts there is a real concern about whether or not these are “just wars” with their associated costs.  Do we see these responses as individual or community efforts?  Do we need to rethink our priorities and the model of our activities?

“Resistance/Resilience” maybe that new model of our healing vocations. Resistance/Resilience can be a clearer way of understanding our healing activities than our usual “war” rhetoric.  We do possess some tools to “resist” the suffering around us, but healing frequently occurs in quiet and "covert" ways from that inner strength of both resistance and resilience. This is where the healing church is at its best as a source of resistance and as a place to learn resilience! It is where people live out the gift of salvation in a suffering world. 

Marvin

References

Fournier, G., & Heintz, A. (2006). If I Must Die.: From “Postmaster” to “Aquatint” (Des Souvenirs Et Des Hommes): From “Postmaster” to “Aquatint” (illustrated edition ed.). OREP.

Retrieved from http://www.bbc.co.uk/history/ww2peopleswar/stories/85/a2524385.shtml

Shirey MR.  How resilient are your team members?  Journal of Nursing Administration.  42(12):551-3, 2012 Dec.

Hu YY.  Arriaga AF.  Roth EM.  Peyre SE.  Corso KA.  Swanson RS.  Osteen RT.  Schmitt P.  Bader AM.  Zinner MJ. Greenberg CC. Protecting patients from an unsafe system: the etiology and recovery of intraoperative deviations in care. Annals of Surgery.  256(2):203-10, 2012 Aug.

Hage, M. L. (2012). “Standing Firm” and Pilgrimages. Retrieved from http://healingagents.blogspot.com/2012/03/standing-firm-and-pilgrimages.html

A Theology of Medicine

There was a celebration of the life and work of Dr. Albert Schweitzer this last week (July 6 & 7, 2013) in Gabon, West Africa.  His name and work are still recognized around the world and medical students continue to be inspired by experiences at sites named for him. 

His religious philosophy was summarized by the phrase, “Reverence for Life.”  His religious history is that of a Lutheran but his life was his theological argument!  So the question today is where do we see a theological and a life argument in the practice of medicine?

Mission medicine continues to respond in providing service to the poor.   Here is an example from Duke University...Duke Global Health.   But what about the larger questions and a “life argument”?  Here is another response from that same institution:

“The Christian tradition also is very clear that physicians are not in medicine alone but, like all Christians, are part of a larger body, the church, which has as its mission the reconciliation of the world to God. And so the question is how to help congregations to own that and to support physicians and to sustain medicine as a practice.”   Dr. Warren Kinghorn, Duke University

What is amazing is that we have not put a name on this body of knowledge that makes the argument about the relationship between theology and medicine. Maybe it is still captured in the phrase, “Reverence for Life”.

Marvin

References:

http://schweitzerlambarene100.com/en/centennial-symposium-celebration

http://www.ecu.edu/cs-admin/mktg/field_journal_africa_rowe_7_25.cfm 

http://www.faithandleadership.com/qa/warren-kinghorn-asking-broader-questions-medicine

Joy

“If you do away with the yoke of oppression, with the pointing finger and malicious talk,

and if you spend yourselves in behalf of the hungry and satisfy the needs of the oppressed, then your light will rise in the darkness, and your night will become like the noonday.”    

Isaiah 58:9b-11 (NIV)

The revelation of God is whole and pulls our lives together. The signposts of God are clear and point out the right road. The life-maps of God are right, showing the way to joy. The directions of God are plain and easy on the eyes. God’s reputation is twenty-four-carat gold, with a lifetime guarantee. The decisions of God are accurate down to the nth degree.   

Psalm 19:7-9  (The Message)

On June 20th (What Makes Us Happy?) and 21st, 2013 (Why Those Who Feel They Have Less Give More), Paul Solman on the PBS Newshour addressed the growing economic inequality in our society and the associated effects.  He reviews the findings of the Greater Good Science Center at the University of California, Berkley.   As you might guess, the questions and the answers are controversial!  

“The U.S. is kind of a notable case in the sense that in the last 35 years, as GDP has grown, we actually haven't seen our average happiness level go up.”  Christine Carter on What Makes Us Happy?

“There are a lot of new data that show if you're generous, and charitable and altruistic, you'll live longer; you'll feel more fulfilled;”  Dacher Keltner on Why Those Who Feel They Have Less Give More.

 I have come to come to two conclusions:

(1)  Even without experimental evidence, the ancient psalmist and the prophet Isaiah would agree that one of those “signposts” leading to a  joyful life is the virtue of charity.

(2) The scientific approach to hard questions of “purpose and place” may be good news to those who search for joy.   What a wonderful surprise when science is usually seen as antithetical to the search for meaning.

Marvin

References:

Photo by Elizabeth Hage

Hage, M. L. (2012). Burdens and Benefits. 

Retrieved from http://healingagents.blogspot.com/2012/01/burdens-and-benefits.html

Hage, M. L. (2013). The Poor. 

Retrieved from http://healingagents.blogspot.com/2013/03/the-poor.html

Healing Tools

Jesus now called the Twelve and gave them authority and power to deal with all the demons and cure diseases. He commissioned them to preach the news of God’s kingdom and heal the sick. He said, “Don’t load yourselves up with equipment. Keep it simple; you are the equipment.                           Luke 9:1-3 (The Message)

In her recent book, Dirt Work, Christine Byl describes the sacred (my word) work of a traildog where tools and vocation meet.  She works in complicated and mysterious places.  She and her husband worked at Glacier National Park and now in Alaska.  She reports on a life of physical labor.  It is an earthy tale!

For me, the connection with her story was the use of tools.   Specifically, tools, both simple and complex have been at the heart of my profession.  When I first received that black bag and within it the first stethoscope, I entered a world where healing tools would be a part of my life.   They required dedication to learn the secrets they would reveal.

The tool most taken for granted were my hands.   The best expression of the power of hands was the comment I heard about a retired surgeon who was said to have “kind hands”.  That ability to transmit care is the essence of a healing tool.  For his colleagues, the skill and efficiency of his hands were impressive even though the patient only felt his touch before and after the surgery.  

The many tools we use should not be the focus of our work.   What is sacred and mysterious is how the tools bring healing by those who learn to use them.

Marvin

References

Byl, C. (2013). Dirt Work: An Education in the Woods. Beacon Press. 

Blog 7/2/11 Minds, Bodies, Machines and Souls

Gawande, A. (2011). Personal best. The New Yorker